Why are some COVID test results false positives, and how common are they?

Posted on June 21, 2021 by particularkev

Adrian Esterman, University of South AustraliaTwo COVID-19 cases previously linked to Melbourne’s current outbreak have now been reclassified as false positives.

They’re no longer included in Victoria’s official case counts, while a number of exposure sites linked to these cases have been removed.

The main and “gold standard” test for detecting SARS-CoV-2, the virus that causes COVID-19, is the reverse transcriptase polymerase chain reaction (RT-PCR) test.

The RT-PCR test is highly specific. That is, if someone truly doesn’t have the infection, there is a high probability the test will come out negative. The test is also highly sensitive. So, if someone truly is infected with the virus, there is a high probability the test will come back positive.

But even though the test is highly specific, that still leaves a small chance someone who does not have the infection returns a positive test result. This is what’s meant by a “false positive”.

First off, how does the RT-PCR test work?

Although in the age of COVID most people have heard of the PCR test, how it works is understandably a bit of a mystery.

In short, after a swab has been taken from the nose and throat, chemicals are used to extract the RNA (ribunocleic acid, a type of genetic material) from the sample. This comprises a person’s usual RNA and RNA from the SARS-CoV-2 virus, if present.

This RNA is then converted to deoxyribonucleic acid (DNA) — this is what the “reverse transcriptase” bit means. To detect the virus, the tiny segments of the DNA are amplified. With the help of some special fluorescent dye, a sample is identified to be positive or negative based on the brightness of the fluorescence after 35 or more cycles of amplification.

What causes false positive results?

The main reasons for false positive results are laboratory error and off-target reaction (that is, the test cross-reacting with something that’s not SARS-CoV-2).

Laboratory errors include clerical error, testing the wrong sample, cross-contamination from someone else’s positive sample, or problems with the reagents used (such as chemicals, enzymes and dyes). Someone who has had COVID-19 and recovered might also show a false positive result.

A health-care worker performs a COVID swab test on a patient. — There are a few reasons an RT-PCR test can result in a false positive.
Shutterstock

How common are false positive results?

To understand how often false positives occur, we look at the false positive rate: the proportion of people tested who do not have the infection but return a positive test.

The authors of a recent preprint (a paper which hasn’t yet been peer-reviewed, or independently verified by other researchers) undertook a review of the evidence on false positive rates for the RT-PCR test used to detect SARS-CoV-2.

They combined the results of multiple studies (some looked at PCR testing for SARS-CoV-2 specifically, and some looked at PCR testing for other RNA viruses). They found false positive rates of 0-16.7%, with 50% of the studies at 0.8-4.0%.

The false positive rates in the systematic review were mainly based on quality assurance testing in laboratories. It’s likely that in real world situations, accuracy is poorer than in the laboratory studies.

A systematic review looking at false negative rates in RT-PCR testing for SARS-CoV-2 found false negative rates were 1.8-58%. However, they point out that many of the studies were poor quality, and these finding are based on low quality evidence.

No test is perfect

Let’s say for example, the real-world false positive rate is 4% for SARS-CoV-2 RT-PCR testing.

For every 100,000 people who test negative and truly don’t have the infection, we would expect to have 4,000 false positives. The problem is that for most of these we never know about them. The person who tested positive is asked to quarantine, and everyone assumes they had asymptomatic disease.

This is also confounded by the fact the false positive rate is dependent upon the underlying prevalence of the disease. With very low prevalence as we see in Australia, the number of false positives can end up being much higher than the actual true number of positives, something known as the false positive paradox.

Because of the nature of Victoria’s current outbreak, authorities are likely being extra vigilant with test results, potentially making it more likely for false positives to be picked up. The Victorian government said:

Following analysis by an expert review panel, and retesting through the Victorian Infectious Diseases Reference Laboratory, two cases linked to this outbreak have been declared false positives.

This doesn’t make clear whether the two people were retested, or just the samples were retested.

Either way, it is unlucky to have two false positives. But given the large numbers of people being tested every day in Victoria at present, and the fact we know false positives will occur, it is not unexpected.

An illustration of SARS-CoV-2. — The RT-PCR test for SARS-CoV-2 is highly accurate, but not perfect.
Shutterstock

The broader implications

For an individual who received a false positive test result, they would be forced to go into quarantine when there was no need. Being told you have a potentially lethal disease is very stressful, especially for elderly people or those at risk because of other health conditions. They would also likely be worried about infecting other members of their family, and could lose work while in quarantine.

Particularly given authorities initially pointed to these two cases as examples of transmission of the virus through “fleeting” contact, no doubt many people have wondered whether without these cases, Victoria might not be in lockdown. This is just conjecture and we can’t really know one way or the other.

False negative results are clearly very concerning, as we don’t want infectious people wandering around the community. But false positives can also be problematic.

Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Liberals’ victory in Tasmanian election is more status quo than ringing endorsement

Posted on May 3, 2021 by particularkev

Michael Lester, University of TasmaniaThe Tasmanian Liberal government has been returned for a record third term, vindicating premier Peter Gutwein’s decision to go to an election a year early.

However, rather than the big swings to the incumbent governments seen in recent elections in Queensland and Western Australia due to their management of the pandemic, the result in Tasmania maintained the status quo.

While benefiting from Gutwein’s high personal popularity due to his management of the pandemic, the Liberal vote fell slightly from 50.3% at the 2018 election to 48.8% at the close of counting late on Saturday night. However, Labor’s vote fell 4.5% to just 28%.

The Liberals are poised to win 13 seats in the 25-seat House of Assembly, Labor nine, the Greens two and one independent.

Under Tasmania’s Hare Clark proportional electoral system, five members are returned from five seats. These are Bass in the state’s north, Braddon in the north-west, Clark and Franklin in the greater Hobart area and southern region, and Lyons, which sprawls across the state’s centre and east coast.

To win a seat, each candidate needs to win 16.6% of the formal vote but, based on the percentage of vote for each party group, it is clear the Liberals will win three seats in each of Bass, Braddon and Lyons, two seats in Franklin and most likely two seats in Clark.

Labor’s nine seats include two in Bass, Braddon, Franklin and Lyons but only one in the party’s former stronghold of Clark. The main reason for this is the loss of votes to two high-profile independents – Glenorchy City Council mayor Kristie Johnston and the former Liberal speaker Sue Hickey – one of whom is predicted to win a seat on preferences.

The Greens vote is up 2% to 12.3% statewide, securing the two seats they held in the previous parliament in Clark and Franklin, but not enough to win further seats.

Labor leader Rebecca White conceded defeat on Saturday night, congratulating Gutwein on winning the election and for his high personal vote after securing almost half the available votes in his electorate of Bass. This is among the highest individual votes in the modern era.

Gutwein claimed victory but stopped short of declaring he had secured a majority, saying only it appeared “increasingly likely”.

The election outcome means a return to the one-seat majority his government held just prior to the election. He also made history by securing the Liberals a record third term in office in Tasmania.

While the balance of seats remains much the same, there will be a turnover of members with some new faces replacing former MPs.

In the government line-up, Hickey, who was ousted from the Liberal Party a few days before the election was called, looks likely to be replaced by former Labor MP turned independent Madeleine Ogilvie, who switched to the Liberals just days after Gutwein announced the election.

In Braddon, first-term MP Felix Ellis lifted his vote by 6.1% while scandal-prone former MP Adam Brooks has edged ahead of housing minister Roger Jaensch and may replace him in the Liberal team.

On the opposition benches, Kingborough Council mayor Dean Winter, who was the subject of a fierce factional battle to prevent him standing for Labor, will replace Labor frontbencher Alison Standen in Franklin.

In Bass, former Launceston mayor Janie Finlay is poised to replace Jennifer Houston in Labor’s line-up.

Tasmania also saw elections in two of the Legislative Council seats of Derwent in the state’s south and Windemere in the north. Labor MLC Craig Farrell defeated his Liberal rival, Derwent Valley mayor Ben Shaw. In Windemere, where the sitting independent retired, Liberal candidate and television presenter Nick Duigan is leading Labor’s Geoff Lyons and independent Will Smith. That seat will be decided by preferences.

It will be 10 days before the final distribution of preferences can commence in the House of Assembly election due to the need to wait until all postal votes are counted. But only in Clark is there potential for this process to affect the election result.

Either way, it is either a Liberal majority or a Liberal minority government.

Michael Lester, PhD candidate, University of Tasmania

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Biden’s job gets easier after Senate wins in Georgia – but don’t expect a progressive revolution

Posted on January 8, 2021 by particularkev

Jared Mondschein, University of Sydney

History took place in the United States today.

Two Democrats were announced the winners of the run-off elections for Georgia’s two Senate seats, allowing the Democrats to take back control of the chamber from the Republicans.

Jon Ossoff and Raphael Warnock were the first Democrats to win a Georgia Senate race in a quarter of a century. It also marked the first time since Herbert Hoover’s loss in 1932 that a president lost a re-election campaign and both chambers of Congress in a single term.

(From left) Ossoff, Warnock and Biden at a pre-election rally in Georgia.
Carolyn Kaster/AP

Also today, a number of Republicans in Congress launched their last-ditch effort to contest the outcome of a presidential election — just the third such formal objection in US history.

And thousands more people died from COVID-19, as the US continues to notch some of its highest single day death tolls since the pandemic began.

But today will be most remembered for something else entirely: the first attack on the US Capitol since the War of 1812 against the British.

Many warned that President Donald Trump’s violent and divisive rhetoric was inevitably going to lead to violence, though few would have predicted the Capitol itself would be overrun.

Today’s violence will remain a shocking moment for generations of Americans. Trump’s own former defence secretary, James Mattis, invoked the language of Franklin Delano Roosevelt to say that the political leaders who enabled the violence will “will live in infamy”.

Hundreds of Trump supporters stormed the Capitol during the certification of the election results.
zz/STRF/STAR MAX/IPx/AP

No massive mandate for the Democrats

As Democrats prepare to take control of the presidency and both chambers of Congress, their attention must be focused on how to address the divisiveness and extreme partisanship that has become rooted in the US, allowing such a dramatic assault on democracy to take place.

Hoover’s landslide election loss to Roosevelt in 1932 similarly gave the Democrats control of the White House and Congress. The Democrats used this opportunity to launch the New Deal — a series of government programs and initiatives intended to lift the US out of the Great Depression. It was unprecedented in its size and ambition.

Many of these programs — ranging from Social Security (a government safety net for elderly Americans) to government regulatory agencies like the Securities and Exchange Commission and the Federal Deposit Insurance Corporation — were later expanded upon and continue through to today.

Unlike Roosevelt and his fellow Democrats in 1932, however, Joe Biden and his Democratic colleagues did not win landslide elections in 2020.

In fact, while Biden’s 306 Electoral College votes matched the total won by Trump in 2016, his pathway to victory was smaller.

Trump’s 2016 victory came from a combined 77,000 votes in the swing states of Michigan, Pennsylvania and Wisconsin. Biden’s 2020 win came as a result of a combined 45,000 votes in Arizona, Georgia and Wisconsin.

In other words, if merely 45,000 votes in those three states went for Trump, there would have been a tie in the Electoral College, likely resulting in a Trump win.

Similarly, the Democratic Senate candidates in Georgia did not win in landslides, either. And with the Senate now evenly divided by the parties, Vice President-elect Kamala Harris will spend a lot of time breaking 50-50 ties of her former colleagues in the chamber.

And beyond the White House and Senate, the Democrats actually lost, on balance, a total of 10 seats to the Republicans in the House of Representatives, thereby slimming their majority to only four seats.

Democrats celebrated their two wins in Georgia. — Democrats celebrated their two wins in Georgia, their first in a US Senate race in the state since the 1990s.
Carolyn Kaster/AP

How Biden will navigate the new Congress

But there are still clear advantages for the Democrats taking control of the Senate.

With Republicans no longer controlling when, or even if, votes occur in the Senate, everything from Supreme Court justices and Cabinet appointments to major pieces of legislation will no longer be contingent on Republican Mitch McConnell, the outgoing Senate majority leader.

In such a narrowly divided chamber, though, the onus will be on the Biden administration not to lose a single Democrat.

In many ways, the most powerful position in the Senate switches from McConnell to Joe Manchin of West Virginia and Kyrsten Sinema of Arizona, the two most conservative Democratic senators. They will likely prove to be the limits as to just how progressive a Biden agenda will be.

Conservative Democrat Joe Manchin could become a crucial swing vote in the Senate.
Michael Reynolds/EPA

The Biden administration will need to get approval from a “large tent” of Democrats, including Manchin and Sinema, as well as progressives like Elizabeth Warren and the independent Bernie Sanders.

Ultimately, this slim hold on power will remain a hallmark of at least the first two years of the Biden administration.

That doesn’t, however, mean it will necessarily be divisive. In coming to the White House with more Washington experience than probably any other president in US history, Biden will need to prove that decades of experience as a “Washington insider” actually helps.

What will change for Biden — and what we can expect

Even before the Georgia races were called in the Democrats’ favour,
Merrick Garland was tipped to be Biden’s choice for attorney general. Following four years of Trump’s blatant attempts to politicise the Department of Justice, no attorney general selection has been as consequential in decades.

This is particularly pertinent because Biden has vowed to restore the Justice Department’s independence, which would prove crucial if it faces public pressure to investigate the actions of the prior administration.

Garland’s choice as attorney general is expected to restore independence to the Justice Department.
Shawn Thew/EPA

Garland is not only President Barack Obama’s former Supreme Court nominee, whom McConnell famously refused to allow a vote on. He’s also a circuit judge of the US Court of Appeals for the District of Columbia, one of the most consequential courts in the country.

It was the fact Biden can now replace Garland’s seat on this powerful bench with another Democrat — thanks to Democratic control of the Senate – that gave him the opportunity to make the selection.

Derisively labelled by some a political “weather vane”, Biden is not known to be a particularly ideological politician. Unlike most other presidents, he was not elected with a well-known ideological or political slogans focused on the future (for example, “Build the wall”, “Yes, we can” or “It’s the economy, stupid”).

Instead, Biden’s most well-known 2020 slogan, “Restoring the soul of America”, seemed to herald a return to prior years.

While many Americans may be pining for more normalcy, Biden has already seemed to acknowledge that doing so would not address the root causes of the sort of mayhem that occurred on Capitol Hill.

The most pressing priorities, as defined by the Biden administration, are COVID-19, economic recovery, racial equity and climate change.

Taking control of the Senate, as well as the unprecedented unrest in Washington, will both widen the scope and redouble the urgency of the Biden team’s plans for addressing these issues.

But we shouldn’t expect a progressive revolution: the president-elect’s moderate tendencies are unwavering and unlikely to leave him simply because of Democrats eked out wins in Georgia. With that said, when the political spectrum has become stretched beyond conventional recognition, such moderation can often appear to be radical.

Jared Mondschein, Senior Advisor, US Studies Centre, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

‘Delighting in causing complete chaos’: what’s behind Trump supporters’ brazen storming of the Capitol

Posted on January 8, 2021 by particularkev

David Smith, University of Sydney

After weeks of President Donald Trump’s baseless claims about voter fraud and other improprieties costing him the presidential election, Washington erupted in chaos today as his supporters stormed the Capitol during a joint session of Congress to certify the results.

While shocking to watch, in hindsight, today’s riots feel almost inevitable.

Trump has spent weeks insisting the election was stolen, with very little push-back from the Republican Party. There have been some notable people who have challenged him, but even while this riot was going on, there were more than 100 Republican lawmakers trying to block certification of the election. This has been a highly opportunistic process on the part of Republican legislators.

For Trump, this is the whole game; at this point, it seems there is nothing else he cares about. He is desperately trying to hang on to power.

Amid all of this, it was inevitable at least some Americans would take the word of their current president very seriously. Having fired them up in this way, it becomes much harder to control mob behaviour. His belated tweet telling protesters to go home and go in peace (now removed by Twitter) was far too little, too late.

Looking at some of these images coming in from Washington, there is almost an element of “cosplay” (“costume play”). A lot of the rioters were dressed up in bizarre paraphernalia. On some level, I think they know they can’t actually seize power. There’s almost this carnival element to it of these people delighting in causing complete chaos.

Whether it’s Trump or his rioting supporters, if they can’t get their own way, if they can’t win, they’ll just create as much chaos as possible and revel in the absurdity of it.

Another thing that’s very obvious is these protesters didn’t fear the police. They were able to push their way past the police, they were able to force entry into the Capitol building and they’re then making jokes with reporters. They believed the police would not retaliate against them fatally — although four people died, including one woman who was shot by police.

The contrast with the Black Lives Matter protests is striking. A Black Lives Matter protest would never have been allowed to get that close to the Capitol. These are people acting with all kinds of impunity.

Undermining election results at all costs

In storming the Capitol and trying to stop a legitimate process of certifying the election, the rioters are following the lead of Trump and many congressional Republicans. It’s been trend for a while for Republicans that if they lose an election, they do as much as possible to nullify the results.

This is not necessarily trying to overturn the result. But if you look at recent elections in North Carolina and Wisconsin where Democratic governors won, that was followed by Republicans in the legislatures stripping as much power as possible from the governorship.

This idea that an election is only legitimate if we win has been put into practice by Republican legislators across the country for quite a while now.

With Trump’s loss to Joe Biden in November, there have been very few Republicans who have actually acknowledged this was the will of the people.

Part of that is because Trump’s victory four years ago was so unexpected, a lot of Republicans believe this was a new era in American politics. Part of that was the ability of Trump to win without actually winning the popular vote. Now that Biden has won, there’s a real unwillingness to acknowledge elections can still be lost legitimately by Republicans.

Delegitimising the election certification process was one of the goals of the protesters.
John Minchillo/AP

A failure of leadership from senior Republicans

From the beginning, Kevin McCarthy, the number one Republican in the House of Representatives, was absolutely behind these ridiculous stolen election claims. He’s never backed away from them.

Mitch McConnell, the Senate majority leader, let these things go on for weeks before he made the most minimal statement that the Electoral College has spoken. It is no surprise that McConnell was then completely unable to control Republicans in the Senate who wanted to contest the certification of the election results.

Republicans have learned the lesson that the way to get the most attention, the way to further your career, is to take the most pro-Trump stance possible. So, it was no surprise so many lawmakers would back this effort to block certification of the election. They’re raising money off this, they’re creating YouTube videos to show their supporters.

It’s become Trump’s party. A lot of people see the path to political advancement backing Trump at every point.

There were a lot of Republican legislators who hoped Trump would eventually give up. In the days after the election, some were saying we should let Trump play out his legal options, he will do the right thing eventually and he’ll step aside for the good of the nation.

Trump told a rally before the Capitol breach today, ‘we will never concede’.
Jacquelyn Martin/AP

But he was never, ever, ever going to step aside or concede. What he does is he just keeps people on board with him. Anyone who waits for Trump to do the right thing inevitably ends up supporting him when he does the wrong thing.

This is a lesson Republicans should have learned, but they’re scared of his supporters. None of them have supporters who would potentially risk their lives to storm the Capitol building.

The best check on power? The people

There have been surprises in both the strengths and weaknesses of America’s institutions over the last few years. For example, federalism has turned out to be quite an effective check on presidential power when it’s been exercised by someone like Trump, which is perhaps not something Democrats would have necessarily believed before.

On the other hand, we’ve seen this massive erosion of norms, especially in Congress. This has been going on for quite a while and McConnell has been one of the major eroders of norms for a long time. Congress was never really an effective check on Trump.

Ultimately, after the election, it was local and state officials like Georgia Secretary of State Brad Raffensperger and Aaron Van Langevelde, a member of Michigan’s board of state canvassers, who said enough is enough when members of Congress weren’t doing it.

And despite the fact Trump has packed the federal courts and Supreme Court with conservative judges, none of his legal challenges went anywhere.

But in the end, the lesson is the most effective check is the election. It is the voice of the people. For every norm that Trump broke, for every anti-democratic thing he did, there was a bigger backlash.

We saw an election with one of the biggest turnouts in history. We had four years of pretty consistent protests in the streets. And in the end, this is the most important check on the presidency that there is.

David Smith, Associate Professor in American Politics and Foreign Policy, US Studies Centre, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Oxford/AstraZeneca vaccine is the first to publish peer-reviewed efficacy results. Here’s what they tell us — and what they don’t

Posted on December 12, 2020 by particularkev

Kirsty Wilson, RMIT University and Magdalena Plebanski, RMIT University

The Oxford/AstraZeneca vaccine this week became the first major COVID vaccine candidate to have efficacy results from phase 3 trials published in a peer-reviewed journal.

The vaccine, AZD1222, is a viral vector vaccine. Researchers took an adenovirus from chimpanzees and modified it with the aim of training the immune system to mount a strong response against SARS-CoV-2 (the virus that causes COVID-19).

The Lancet paper confirms interim analysis AstraZeneca released last month showing the vaccine is safe and has an overall efficacy of 70% in protecting against symptomatic COVID-19.

Let’s take a look at these latest results — and why they’re important.

Safety first

The published article consolidated safety data across four human trials with 23,848 volunteers from Brazil, South Africa and the United Kingdom.

Only three people experienced serious adverse events (which were possibly related to the vaccine, but we don’t know for sure) over more than three months of follow-up. Each of these cases is recovering or has recovered.

While safety monitoring will be ongoing, this analysis gives us confidence the Oxford/AstraZeneca vaccine is safe.

Efficacy

The authors also analysed efficacy data for two of the above trials with a total of 11,636 participants. The follow-up period of the remaining two trials hasn’t yet been long enough to get a good sense of the vaccine’s efficacy — but this data will be coming.

Among the participants, there were 131 cases of symptomatic COVID-19. This included 30/5,807 (0.5%) in the vaccine group, and 101/5,829 (1.7%) in the control group. Based on the formulae researchers use to calculate how well vaccines work in clinical trials, this equates to an efficacy of 70%.

Of ten COVID-related hospital admissions, none were among the AZD1222 vaccine recipients — they were all people who received the placebo.

Although these numbers are small and will need confirmation with further data, this indicates the vaccine has strong potential to prevent severe COVID-19 disease.

An older man wearing a mask has his sleeve rolled up in preparation for a vaccination. — The study looked at the vaccine’s safety and efficacy at preventing symptomatic COVID-19.
Shutterstock

The dosing debacle

While 70% is the overall efficacy figure, we learnt in AstraZeneca’s interim analysis that there were actually two separate dosing regimens. Variation in dose measurement methods — widely reported to have been an error — meant some participants received half of the expected dose for their first of the two shots.

The latest analysis confirmed that for people who received the low dose initially, followed by the standard dose, the vaccine displayed 90% efficacy, compared to 62.1% in participants who received the full dose at both time points.

While this error appears to have had a positive outcome, it’s concerning that we don’t really understand why the regimen with the half dose worked better.

The full, higher first dose may have induced more antibodies that recognise the vaccine’s chimpanzee adenovirus components than the half first dose did, and it’s possible these “anti-vaccine vehicle” antibodies could have interfered with the efficacy of the booster dose. This is a recognised concern when using adenoviruses as vaccine components.

Alternatively, the Lancet authors speculate the low dose may have induced a different type of immune response that we are yet to know about. If this were the case, it could raise questions for other vaccine developers too about the way the immune system behaves.

A unique candidate

It’s exciting the Oxford/AstraZeneca vaccine could potentially work comparably well to the other front-runners from Pfizer/BioNTech and Moderna, because this vaccine is one of the most practical vaccines to produce, store and distribute.

It only needs to be stored at 2-8°C — so in a normal fridge — compared to the mRNA-based vaccines, which need to be stored around -70°C.

It’s also the cheapest so far, at about US$4 a dose (roughly A$5), making it highly attractive for global deployment. Oxford/AstraZeneca has an agreement with the COVAX facility which will enable equitable access for countries who may not be able to afford the more expensive mRNA vaccines from Pfizer and Moderna.

A health worker dressed in full PPE holds a syringe and a vial. — The Oxford/AstraZeneca vaccine would be easier than some of the other candidates to store and distribute.
Shutterstock

Australia has signed a deal to receive 3.8 million doses of the Oxford/AstraZeneca vaccine should it be approved for use. Meanwhile, biotechnology company CSL has been upscaling its manufacturing capacity for this vaccine, which will enable it to produce a further 30 million doses in Australia next year.

If a lower initial dose is recommended, this would also mean the available supply could be distributed to more people.

Some questions remain

One factor we still need to consider is the efficacy in older people (70 and above), as this age group is most susceptible to severe disease.

The current published efficacy results are mostly based on 18 to 55-year-olds. Although these trials do have older participants, they were recruited later, so collection of efficacy data for this group is ongoing.

A recent paper which looked at immune responses to the vaccine showed similar levels of antibodies across age groups (18-55, 56-69, and >70), which is encouraging. So it will be interesting to see efficacy results in older people as they become available.

Publication in a peer-reviewed journal means the data has been evaluated by expert independent reviewers whose job is to find any holes or problems. With this, the Oxford/AstraZeneca data now becomes more credible to the scientific community.

The data will likely encourage developers to move rapidly to request regulatory approvals for this vaccine, while awaiting further analysis on efficacy — and, importantly, how dosage affects this vaccine’s efficacy.

Kirsty Wilson, Postdoctoral Research Fellow, RMIT University and Magdalena Plebanski, Professor of Immunology, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How to read results from COVID vaccine trials like a pro

Posted on November 19, 2020 by particularkev

Adrian Esterman, University of South Australia

It’s been a busy week or so for news about COVID vaccines. First we heard preliminary clinical trial results from the Pfizer vaccine, then the Russian Sputnik V vaccine. This week, we heard about the Moderna vaccine. All these results were shared with the media, ahead of being peer reviewed and published in a journal.

As we expect preliminary results from more vaccine trials to be released in the coming weeks and months, it’s important to understand what’s behind these announcements, what news reports don’t tell us, and what researchers don’t yet know.

This can help us identify good news when we see it, be more critical of news reports, or delay our judgement until we have more information.

1. Does the news report tell me what type of trial it is?

At this stage of the pandemic, trial results making the headlines are generally the interim results of late-stage clinical trials, known as phase 3. This is when a vaccine is given to thousands of people and tested for how well it works and whether it’s safe (more on these issues later).

In these trials, volunteers are randomised into two study arms, the vaccine arm (people who get the actual vaccine), and the placebo arm (people who get the placebo, usually an inert substance, such as a saline injection). However, some vaccine trials use vaccines against other diseases as the placebo.

So, ideally, media reports should mention how the vaccine results compare with the placebo or the comparator vaccine.

Before the vaccine gets to this stage it will have successfully completed smaller trials (phase 1 and 2). Often, clinical trial phases are combined. So you could have results from a trial that combines phases 1 and 2, or phases 2 and 3.

2. Does the media report mention safety?

As vaccines are mainly tested on healthy volunteers, it is extremely important to demonstrate the vaccine is safe.

Side effects (also called adverse events) are reported to an independent committee — usually with two or more experts in immunology and medicine as well as a biostatistician. It’s one of the jobs of this data monitoring committee to receive and examine reports of adverse events, and to look at interim results to determine whether the trial should continue.

Sometimes, if safety concerns are raised, a trial is temporarily halted while the committee investigates. This is what happened with the University of Oxford/AstraZeneca vaccine trial, which has since recommenced.

So any media report should mention how many people are affected by side effects, the type of side effects (common/rare, serious/minor), whether they were in people in the vaccine or placebo arm of the trial, and whether the data monitoring committee is investigating. Not all these details are available to the public.

3. Does the media report mention how well the vaccine works?

Trial outcomes are measured at one or more interim time points, and at the end of the trial. This is another factor the data monitoring committee oversees.

For instance, the committee has rules about vaccine efficacy it applies part-way through the trial to work out whether the trial proceeds. So a rule might be something like “For the trial to continue, vaccine efficacy must be at least 60% after 25% of subjects have completed the trial”.

The types of results making the headlines currently come from this type of interim analysis. In other words, the committee will have assessed the results so far and will have given the trial a green light to proceed.

No phase 3 clinical trial has yet reported the full analysis from tens of thousands of study participants, but this will happen over the next few weeks.

Green traffic light against backdrop of cloudy sky — An independent committee analyses interim results to give the trial a green light to proceed.
Shutterstock

Vaccine efficacy

Vaccine efficacy describes how well the vaccine offers protection against the target disease. The formulae and calculations can get quite complicated, so I will only give a simple example here.

One measure is based on the “attack rate”, which is the proportion of the people in the trial diagnosed with COVID-19. We measure the attack rate in the vaccine arm and the placebo arm separately, then divide one by the other to give the “attack rate ratio”. We then subtract the attack rate ratio from 1 to get one measure of vaccine efficacy.

For example, if 5% of the vaccine arm are diagnosed with COVID-19, while 40% of the placebo are diagnosed, then the attack rate ratio is (5%/40%) or 0.125 or 12.5%. That gives a vaccine efficacy of 87.5% (100% – 12.5%).

Immune response

Some vaccine trials report how well the immune system responds (immunogenicity). For example, the University of Oxford/AstraZeneca trial has reported the antibody response as well as several other measures of immunogenicity.

Some trials only report on immunogenicity. This allows the trial to be smaller, shorter, and less expensive than vaccine efficacy trials, as they use immunogenicity as a surrogate for vaccine efficacy.

Although efficacy is the preferred endpoint for vaccine trials, some regulating authorities accept evidence of immunogenicity to authorise a vaccine.

Vaccine effectiveness

Vaccine effectiveness describes how well the vaccine offers protection against the target disease in the real world, rather than in a controlled clinical trial. Vaccine trials usually include healthy volunteers, but often don’t tell us how well the vaccine works in children, elderly people, or those with compromised immune systems.

Reported vaccine efficacies of 90-95%, as we’ve heard recently, may sound impressive. However, under real-world conditions, the vaccines are likely to offer much less protection in some population groups.

4. What else do I need to know?

Current trials are reporting whether or not a vaccine prevents COVID-19 (in other words, symptoms), not whether it prevents the infection itself.

However, a recent media report about the Pfizer vaccine says it is likely to prevent 50% of infections, as well as 90% of symptomatic COVID-19.

If the vaccine has 90% efficacy, then 10% of vaccinated people could still get the symptomatic disease. We would hope these people would have a much milder illness, but we don’t know if this is the case.

We also don’t know how long immunity lasts or if there are any long-term side effects.

All we can do now is wait with patience for the full phase 3 trial results to come in over the next few weeks.

Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Oxford immunologist on coronavirus vaccine: our early results look highly promising

Posted on July 21, 2020 by particularkev

Rebecca Ashfield, University of Oxford

A vaccine against COVID-19 is urgently needed if we’re to stop the virus spreading and prevent potentially millions of further deaths. We’re now one step closer to that goal.

Today, we published early results from our clinical trial of the vaccine ChAdOx1 nCoV-19 (also known as AZD1222), designed by the University of Oxford and developed in partnership with AstraZeneca. The preliminary data shows that it is safe and induced a strong antibody response in all vaccinated volunteers, suggesting that an effective vaccine could be within reach.

This trial was the first time that the vaccine had been given to humans: 543 healthy adults aged 18-55 were vaccinated with a single dose of ChAdOx1 nCoV-19. A further 534 people were given a control vaccine that gives similar minor reactions, including injection site redness and mild pain. Volunteers are having their immune response (both antibodies and T cell levels) monitored for at least 12 months, and will also be observed to see whether or not they develop COVID-19.

The preliminary data from the trial clearly demonstrates that the vaccine induces an antibody response within 28 days. This response is in a similar range to that in individuals who have recovered from COVID-19, providing encouragement that the vaccine will be able to protect the majority of people against infection.

Ten volunteers were also given a second “booster” dose of the vaccine. This increased the antibody response to even higher levels, and 100% of blood samples from this group showed neutralising activity against COVID-19 infection in a laboratory setting.

The vaccine also induced T cells that specifically recognise SARS-CoV-2, the virus that causes COVID-19. It’s encouraging to see both antibody and T cell responses, as together this is the right kind of immune response that could lead to protection against the virus. Importantly, the vaccine demonstrates an acceptable safety profile, with no vaccine-induced severe adverse events – that is, no major side-effects.

We were confident testing the vaccine in humans after encouraging trials with mice and rhesus macaque monkeys. These had shown that the vaccine was safe and induced a robust immune response. Significantly, the vaccinated monkeys were protected from severe disease after they were challenged with a much higher dose of SARS-CoV-2 than humans would encounter through natural exposure.

How does this vaccine work?

Vaccines work by training the immune system to recognise and fight off infectious agents (pathogens), such as bacteria and viruses. Vaccines do this by presenting the immune system with a readily identifiable part of a pathogen, which the immune system remembers so that it can quickly respond should it encounter that same pathogen in the future.

Most vaccines in development for SARS-CoV-2 – including this one – focus on presenting the spike protein that decorates the surface of the virus. It’s this protein that allows the virus into human cells by binding to a molecule on their surface called ACE2.

Illustration of the SARS-CoV-2, showing the spike proteins on its surface — The coronavirus SARS-CoV-2, with its spike proteins shown in red.
US Centers for Disease Control and Prevention/Wikimedia Commons

There is a broad range of approaches to vaccine design; ChAdOx1 nCoV-19 is what’s known as a viral vector vaccine. To make this vaccine, particles of a different, harmless virus (called ChAdOx1) are loaded with the portion of SARS-CoV-2 DNA that instructs cells how to build the spike protein.

When these ChAdOx1 particles infect human cells, the coronavirus DNA is then “expressed”, building the spike protein for the immune system to respond to. Importantly for vaccine safety, the viral vector can’t replicate and cause an ongoing infection.

The ChAdOx1 viral vector has been used to make eight vaccines already in clinical trials for other human diseases, including Mers (Middle Eastern respiratory syndrome), a coronavirus that is related to SARS-CoV-2.

What happens now?

Crucially, we need to demonstrate that the vaccine is effective – that it results in significantly lower (ideally zero) cases of COVID-19 in the ChAdOx1 nCoV-19 vaccinated group versus the control group. Falling infection rates in the UK are an excellent outcome for the health of the nation, but may compromise the ability to show this.

If there are no cases of COVID-19 in the group receiving the control vaccine, comparing that group to the vaccinated group would be meaningless. Deliberately infecting people with the virus may be possible in future (after careful consideration of the ethical implications), but is not currently allowed.

For this reason, a second trial has been launched in approximately 10,000 UK individuals, focusing on health workers, and further trials are being conducted in Brazil and South Africa, where infection rates are much higher. The expanded UK trial will include children and older adults to estimate vaccine efficacy in these age groups. Immune responses in people over 70 are often lower than those in younger adults.

It’s essential to follow the vaccine-induced immune response over a period of at least one year, to estimate whether booster injections will be required, and if so how often. My personal prediction – based on decreases in antibody levels in individuals infected with other types of coronavirus, rather than data from the current vaccine trial – is that we’re likely to need yearly boosters, similar to annual flu jabs.

Finally, if the vaccine proves effective, rapid manufacture of potentially billions of doses would be required to supply the world. To facilitate this, AstraZeneca has already initiated a large-scale vaccine manufacturing programme, aiming to have hundreds of millions of doses with delivery starting by the end of 2020. Agreements are in place to provide the vaccine to low-income and middle-income countries and also to the UK, Europe and the US.

Rebecca Ashfield, Senior Project Manager, Jenner Institute, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Got a COVID-19 test in Victoria and still haven’t got your results? Here’s what may be happening — and what to do

Posted on July 18, 2020 by particularkev

Hassan Vally, La Trobe University

Stories are emerging of Victorians who have followed advice and sought a COVID-19 test, only to find they’re still waiting to hear results more than five days later.

The scale of testing underway in Victoria — and Australia’s testing rates are among the highest in the world — means it’s likely this will happen from time to time. It’s unclear if this is happening to many people or to just a handful.

Nevertheless, it’s evidently happening to some people and we can piece together some information about what may be contributing to this problem, and what you can do if it happens to you.

What to do if it happens to you in Victoria

Firstly, if you are showing symptoms and still waiting on results of a test, it’s important you do not go out. Of course, that will grow increasingly difficult the longer you wait for a test result but self-isolating while awaiting test results is a crucial part of the pandemic management strategy.

Victorian health minister Jenny Mikakos said on Twitter results are usually available within 1-3 days or “sometimes longer” and referred people to a health department fact sheet.

The factsheet says:

Victorian and interstate labs are working around the clock to process all the tests, but with so many coming in every day, sometimes it takes a little longer to confirm the results.

It lists phone numbers to try if you haven’t got your result within the expected time frame.

Information from a Victorian health department factsheet.
DHHS

The factsheet doesn’t say what to do if you did the test using a home testing kit but the Victorian Department of Health and Human Services later tweeted to say:

Of course, if all else fails it might be simplest just to go and get another test.

Why might this be happening?

Again, we must acknowledge the enormous scale of the testing program underway in Victoria.

On Wednesday alone, 28,607 tests were undertaken in Victoria, and the total number of tests undertaken since January 1 is now at 1,225,999, Victorian Premier Daniel Andrews said in his Thursday press briefing.

Widespread testing is one of the best things we can do to control the spread of coronavirus, and these numbers are very impressive.

Many of these tests will be processed at laboratories in other states, as it is not possible for Victorian labs to test so many samples on their own.

A health department factsheet dated June 25, 2020 said:

Laboratories in Victoria, with surge staff capacity, can process 18,000 tests a day, noting that turn-around times are adversely affected when there is sustained testing above 14,000 tests per day.

New South Wales, South Australia, Queensland and Tasmania have agreed to provide surge lab capacity of over 4,000 tests a day. Private laboratories can also provide surge capacity of around 13,500 tests a day through their interstate operations. This will allow for at least 25,000 Victorian tests to be processed a day. There are currently sufficient test kits to meet this level of demand.

In addition, private pathology providers can draw on interstate supply chains. Safeguards, including repeat testing, will manage the risk of false positive tests.

So if you’ve got a test but haven’t heard back, it’s possible the delay is caused by test samples needing to be taken to interstate labs (which adds time) and the huge scale of testing underway.

It’s also possible there may have been some other problem with the test, so make sure you double check at the testing centre.

Who should get tested and why testing is important?

The Victorian health department says on its website:

Testing is currently available for people with the following symptoms, however mild: fever, chills or sweats, cough, sore throat, shortness of breath, runny nose, and loss of sense of smell or taste. The test takes around a minute and involves a swab from the back of your throat and nose.

The less invasive saliva test may also be available for some people in certain places and circumstances, the department has said.

Despite any difficulties you may be experiencing in getting tested or in getting your results, it’s vital to understand how critical getting tested is to protecting the community from this coronavirus. By being tested you are helping limit the spread of COVID-19. You are potentially helping save lives.

Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Final 2019 election results: education divide explains the Coalition’s upset victory

Posted on June 20, 2019 by particularkev

The most important reason for the Coalition’s victory was that Morrison was both liked and trusted by lower-educated voters, while Labor leader Bill Shorten was not.
Mick Tsikas/AAP

Adrian Beaumont, University of Melbourne

At the May 18 election, the size of the lower house was expanded from 150 to 151 seats. The Coalition parties won 77 seats (up one since the 2016 election), Labor 68 (down one) and the crossbench six (up one). The Coalition government holds a three-seat majority.

Owing to redistributions and the loss of Wentworth to independent Kerryn Phelps at an October 2018 byelection, the Coalition notionally had 73 seats before the election, a one-seat advantage over Labor. Using this measure, the Coalition gained a net four seats in the election.

The Coalition gained the Queensland seats of Herbert and Longman, the Tasmanian seats of Braddon and Bass, and the New South Wales seat of Lindsay. Labor’s only offsetting gain was the NSW seat of Gilmore. Corangamite and Dunkley are not counted as Labor gains as they were redistributed into notional Labor seats.

Four of the six pre-election crossbenchers easily held their seats – Adam Bandt (Melbourne), Andrew Wilkie (Clark), Rebekha Sharkie (Mayo) and Bob Katter (Kennedy). The Liberals narrowly regained Wentworth from Phelps, but independent Zali Steggall thrashed Tony Abbott 57%-43% in Warringah. In Indi, independent Helen Haines succeeded retiring independent Cathy McGowan, defeating the Liberals by 51.4%-48.6%.

The Coalition easily defeated independent challengers in Cowper and Farrer.

While Bandt was re-elected, the Greens went backwards in their other inner-Melbourne target seats of Wills and Cooper. Only in Kooyong did the Greens manage to beat Labor into second.

The final primary votes were 41.4% Coalition (down 0.6%), 33.3% Labor (down 1.4%), 10.4% Greens (up 0.2%), 3.4% United Australia Party (UAP) and 3.1% One Nation (up 1.8%).

The final two-party vote was 51.5% for the Coalition to 48.5% for Labor, a 1.2% swing in the Coalition’s favour from the 2016 election. It is the first pro-government swing since the 2004 election.

It was expected the Coalition would do better once the 15 “non-classic” seats were included; these are seats where the final two candidates were not Coalition and Labor. However, 11 of these seats swung to Labor, including a 9.0% swing in Warringah and a 7.9% swing in Wentworth. Eight non-classics were inner-city electorates that tended to swing to Labor.

The table below shows the number of seats in each state and territory, the Coalition’s number of seats, the Coalition’s percentage of seats, the gains for the Coalition compared to the redistribution, the Coalition’s two-party vote, the swing to the Coalition in two-party terms, and the number of Labor seats.

Final seats won and votes cast in the House for each state and nationally.

Four of the six states recorded swings to the Coalition in the range from 0.9% to 1.6%. Victoria was the only state that swung to Labor, by 1.3%. Queensland had a 4.3% swing to the Coalition, far larger than any other state. Labor did well to win a majority of NSW seats despite losing the two-party vote convincingly.

Official turnout in the election was 91.9%, up 0.9% from 2016. Analyst Ben Raue says 96.8% of eligible voters were enrolled, the highest ever. That means effective turnout was 89.0% of the population, up 2.6%.

Education divide explains Coalition’s win

Not only did Steggall thump Abbott in Warringah, the electorate’s 9.0% swing to Labor on a two-party basis was the largest swing to Labor in the country. Abbott’s two-party vote percentage of 52.1% was by far the lowest for a conservative candidate against Labor since Warringah’s creation in 1922; the next lowest was 59.5% in 2007.

While Abbott did badly, other divisive Coalition MPs performed well. Barnaby Joyce won 54.8% of the primary vote in New England and gained a 1.2% two-party swing against Labor. Peter Dutton had a 3.0% two-party swing to him in Dickson, and George Christensen had a massive 11.2% two-party swing to him in Dawson, the second-largest for the Coalition nationally.

According to the 2016 census, 42% of those aged 16 and over in Warringah had at least a bachelor’s degree, compared with 22% in Australia overall. Just 13.5% had at least a bachelor’s degree in New England, 19% in Dickson and 12% in Dawson.

In Victoria, which swung to Labor, 24.3% of the population had at least a bachelor’s degree in 2016, the highest of any state in the nation.

The Grattan Institute has charted swings to Labor and the Coalition, taking into account wealth and tertiary education. Only polling booths in the top-income quintile swung to Labor; the other four income quintiles swung to the Coalition.

Areas with low levels of tertiary education swung strongly to the Coalition in NSW and Queensland, but less so in Victoria. There were solid swings to Labor in areas with high levels of tertiary education.

Some of the swings are explained by contrary swings in 2016, when the Coalition under Malcolm Turnbull performed relatively worse in lower-educated areas and better in higher-educated areas. However, Queensland’s 58.4% two-party vote for the Coalition was 1.4% better than at the 2013 election, even though the national result is 2.0% worse. The large swings to the Coalition in regional Queensland are probably partly due to the Adani coal mine issue.

Morrison’s appeal to lower-educated voters

Since becoming prime minister, Scott Morrison’s Newspoll ratings have been roughly neutral, with about as many people saying they are satisfied with him as those dissatisfied. After Morrison became leader, I suggested on my personal website that the Coalition would struggle with educated voters, and this occurred in the election. However, Morrison’s appeal to those with a lower level of education more than compensated.

In my opinion, the most important reason for the Coalition’s upset victory was that Morrison was both liked and trusted by lower-educated voters, while they neither liked nor trusted Labor leader Bill Shorten.

Earlier this month, The Guardian published a long report on the social media “death tax” scare campaign. While this and other Coalition scare campaigns may have had an impact on the result, they did so by playing into lower-educated voters’ distrust of Shorten. Had these voters trusted Shorten, such scare campaigns would have had less influence.

Labor also ran scare campaign ads attacking Morrison for deals with Clive Palmer and Pauline Hanson. But I believe these ads failed to resonate because lower-educated voters liked Morrison better.

I think Morrison won support from the lower-educated because they are sceptical of “inner-city elites”. The Coalition leader emphasised his non-elite attributes during the campaign, such as by playing sport and going to church. Turnbull was perceived as a member of the elite, which could explain swings to Labor in lower-educated areas in 2016.

Parallels can be drawn to the 2017 election in the UK. Labour performed far better than expected in the election, reducing the Conservatives to a minority government when they were expected to win easily. Labour had adopted a pro-Brexit position, which may have sent a message to lower-educated voters that they could support the party.

This offers an option for Australian Labor to try to win back support from lower-educated voters: adopt a hardline immigration policy. Votes that Labor would lose to the Greens by doing this would likely be returned as preferences.

See also my similar article on how Donald Trump won the US 2016 presidential election.

The problem with the polls

The table below shows all national polls released in the final week compared to the election result. A poll estimate within 1% of the actual result is in bold.

Federal polls compared with election results, 2019.
Author provided

The polls did well on the One Nation and UAP votes, and were a little low on the Greens. The major source of error was that Labor’s vote was overstated and the Coalition’s was understated. Only Ipsos had Labor’s vote right, but it overstated the Greens vote by about three points – a common occurrence for Ipsos.

No poll since July 2018 had given the Coalition a primary vote of at least 40%. In the election, the Coalition parties received 41.4% of the vote.

As I said in my post-election write-up, it is likely that polls oversampled educated voters.

Seat polls during the campaign were almost all from YouGov Galaxy, which conducts Newspoll. The Poll Bludger says these polls were, like the national polls, biased against the Coalition.

Analyst Peter Brent has calculated the two-party vote for all election-day and early votes. The gap between election day and early votes increased to 5.0% in 2019 from 4.6% in 2016. This does not imply that polls missed because of a dramatic late swing to the Coalition in the final days; it is much more likely the polls have been wrong for a long time.

Boris Johnson very likely to be Britain’s next PM, and left wins Danish election

I wrote for The Poll Bludger on June 14 that, after winning the support of 114 of the 313 Conservative MPs in the first round of voting, Boris Johnson is virtually assured of becoming the next British PM. Polls suggest he will boost the Conservative vote.

I also wrote on my personal website on June 6 about the left’s win in the Danish election. Also covered: a new Israeli election, the German Greens’ surge, and the left gaining a seat in the May 4 Tasmanian upper house periodical elections.

Adrian Beaumont, Honorary Associate, School of Mathematics and Statistics, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The DR Congo is bracing for election results and it’s likely to get bloody. Here’s what you need to know

Posted on January 10, 2019 by particularkev

Susan Hutchinson, Australian National University

When Congolese gynaecologist Dr Denis Mukwege received his Nobel Peace Prize a few months ago, he inferred responsibility for what happens in the Democratic Republic of Congo (DRC) to everyone who owns a smart phone. As well as diamonds and oil, the country is rich in the gold, coltan and cobalt vital to the production of the smart phone in your pocket.

But it is also rich in strife. The DRC is holding its breath while the electoral commission decides the results of elections held on December 30, 2018. The Congolese constitution limits presidents to two five-year terms. But current president, Joseph Kabila, has now been president for 18 years.

But that may be about to change. Martin Fayulu, the man supported by a former rebel commander who had been previously charged (but later acquitted) with allowing rape and crimes against humanity under his leadership, may have won the election away from the ruling party.

But though one of the most trusted institutions in the country, the Catholic church – which deployed tens of thousands of election observers – announced it knew of a clear winner, the results can only legally be declared by the electoral commission. And the commission announced further delays in the results over the weekend.

In the meantime, however, the New York Times has announced Fayulu’s win. Anticipating violence and unrest, the US has sent troops to neighbouring countries to protect US citizens and diplomatic facilities.

Meanwhile, the UN’s Security Council met to discuss the issue on Friday. Although the meeting was closed to the public, it is known the Council was unable to agree on steps forward. There is to be another meeting in an open session in New York on Tuesday.

So, what is actually going on in the DRC?

Who were the lead candidates?

President Joseph Kabila had handpicked the government’s candidate to run in the elections. Emmanuel Ramazani Shadary had been Interior Minister and enjoyed the full resources of the government for his campaign, including unlimited access to state-run media outlets.

Shadary is subject to an EU travel ban, asset freeze and sanctions. This is due to his role in obstructing Congo’s electoral process and carrying out a crackdown against protesters angry over the vote which had been delayed for years.

The government is good at repressing political opposition. During previous elections, SMS communication was cancelled. But this year the government also turned off the internet. Key independent radio and television programs have been closed and reporters ejected from the country.

In turn, opposition parties have struggled to form coalitions or campaigns to topple the government democratically. In a landmark sign of cooperation, seven opposition parties banded together to endorse a single candidate, Martin Fayulu, to run against the ruling party’s pick.

But that agreement barely lasted 24 hours before the parties with the largest membership withdrew their support to run their own leaders instead.

After the pact collapsed, former warlord, Jean-Pierre Bemba maintained his support for Fayulu. Bemba had returned to the DRC after being imprisoned at the Hague for charges he allowed his troops to use sexual violence in war crimes and crimes against humanity when he deployed them to the neighbouring Central African Republic. Bemba’s conviction was later overturned on technical grounds.

Despite this record, he was a popular choice to run against the current president but was deemed ineligible by the electoral commission due to witness tampering charges that had been upheld by the International Criminal Court. So, Fayulu prevailed.

Fayulu is a wealthy businessman, a former Manager at Exxon Mobil who has been politically active in opposition for many years. He was even injured when government forces fired on opposition protesters in the capital in 2006.

He has promised to create an environment conducive to business and investment in the DRC, and to revise mining and oil contracts. This won’t necessarily improve the lives of the average person as oil is seen as a driver of conflict and displacement in the parts of the country with such reserves.

What happens now?

Many state functions fail in the DRC. The country ranks 176 out of a possible 189 on the Human Development Index. In the latest Reuters Poll, it came in as the seventh worst country in the world to be a woman. An estimated 70% of Congolese have little or no access to health care. Serious diseases are rife, with a current Ebola outbreak in the country.

The electoral commission has made questionable decisions about the election logistics in the years and months leading up to the poll. Early in December one of their warehouses was burned to the ground, including the thousands of electronic voting machines stored there.

An electoral commission warehouse in the DRC.

In the lead up to the election, more than one million voters who live in largely opposition-held areas (and those facing the Ebola outbreak) were told they would not be allowed to vote for health and security reasons. But mock elections were staged in the area to show they were able to do so.

The United Nations Security Council published a report of “major security incidents including attacks against civilians, security forces and United Nations peacekeepers in many provinces,” as well as illegal importation of military materiel. Human Rights Watch have reported violence, widespread irregularities and voter suppression during the election.

Given Fayulu is not the government candidate, further violence is likely. The President has shown his reluctance to let go of power. He and his party have the capacity to either announce Shadary the winner of the election, regardless of the count; or to simply refuse to give up power.

Either way, it is looking more and more likely it will get bloody.

Susan Hutchinson, PhD Candidate, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Sharing my thoughts with the world from a Particular Baptist perspective

First off, how does the RT-PCR test work?

What causes false positive results?

How common are false positive results?

No test is perfect

The broader implications

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No massive mandate for the Democrats

How Biden will navigate the new Congress

What will change for Biden — and what we can expect

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Undermining election results at all costs

A failure of leadership from senior Republicans

The best check on power? The people

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Safety first

Efficacy

The dosing debacle

A unique candidate

Some questions remain

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1. Does the news report tell me what type of trial it is?

2. Does the media report mention safety?

3. Does the media report mention how well the vaccine works?

4. What else do I need to know?

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How does this vaccine work?

What happens now?

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What to do if it happens to you in Victoria

Why might this be happening?

Who should get tested and why testing is important?

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Education divide explains Coalition’s win

Morrison’s appeal to lower-educated voters

The problem with the polls

Boris Johnson very likely to be Britain’s next PM, and left wins Danish election

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Who were the lead candidates?

What happens now?

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