Status quo bias and vaccine supplies
Here is a simple thought experiment on the use of scarce vaccine supplies.
Suppose that we had tested the Pfizer/Moderna vaccines with one dose per person and discovered that they were 85% effective at preventing covid-19. However, due to an administrative error, we gave some people two doses, and when we analyzed the data it turned out that a two-dose regimen was 95% effective at preventing covid-19.
Only 200 million doses of vaccine will be available over the next six months.
Under these circumstances, the idea that we should switch from our initial vaccination plan of one dose per person to two doses would be regarded as insane. It is clearly better to give 200 million people 85% protection than it is to give 100 million people 95% protection.
Yet today, many people believe that we should vaccinate half as many people using two doses per person, simply because this was our initial plan. This certainly seems like an irrational framing effect, or a status quo bias of some kind, or hidebound, bureaucratic thinking, and it seems likely to lead to thousands of unnecessary deaths and prolong our social and economic misery by months.
Come on people! Let’s think outside the box.
But did we find it was 86%effective at one dose? Not a very rigorous approach, supposing vs reality. What is the reality? And there are other vaccines that are over 80% effective. Really thinking outside the box would be using those vaccines as well.
Perhaps you should forward your CV to the FDA to serve on their vaccine panel. I’m sure your suggestions have never occurred to all the virologist, immunologist and epidemiologists who currently serve and have worked for years, sometimes decades, in the field. Since the SARS-CoV-2 virus and the mRNA vaccines are all novel and unknown to these so-called experts, your wealth of experience with the virus, the pandemic and mRNA vaccines would be welcome!
Many epidemiologists etc. are also expressing interest in the one-dose approach:
although conjecture is more fun, a more scientific approach would you be to give everyone in California two doses but everyone in New York one dose then tally up the results. Do you see how it works? the economist seldom runs a controled study but usually posits conjecture.
HAPPY BOXER DAY
Is it currently the case that if, say, 1000 vaccine doses were received by a hospital they would only vaccinate 500 people and save the remaining 500 for their second shot? Or is it more like they vaccinate 1000 people ASAP while expecting delivery of more doses within the month to enable the second dose? If the second scenario is true, and it is also expected that production and distribution rates of the vaccines is increasing all the time, does it make a significant difference whether they stick with the two shots rather than one?
Not all people are created equal in the eyes of a pandemic. Some are more vulnerable and some are more needed in healthcare. Some can stay safe at home. By the time those that need the increased protection are all vaccinated they we may have better data and more suitable environmental conditions for mass vaccination clinics. The present limiting factor is places and people to administer vaccines.
Mathiness is not next to godliness. Practical risk management is applicable to situations where risk is high and there can be no do-overs. For now the goal is survival, which is perfection of a kind.
…and definitely not surviving is not good.
It is simply a better idea to begin vaccination with two doses until the most critical groups are vaccinated. We can always switch from two doses to one dose in the future if data supports that approach, particularly after the highest risk groups have obtained the maximum protection. If we started with one dose and later found that we needed two for the high risk groups and the booster needed to be administered just 3 or 4 weeks later, then we would have screwed the pooch. For the next two or three winter months the logistics of vaccination will be such a limiting factor that we are not likely to run out of vaccine even at the two dose rate.
We can deal with running out of ICU beds with a quicker response than running out of ventilators, but we are already shopping offshore to import nurses and physicians. My guess is that wherever that they are now then they already have their hands full. That places US hospitals in a bidding war for healthcare professionals. There is probably no regression analysis that fits that kind of regressive behavior, so all that I expect to hear here of that is crickets….
At least one single dose vaccine is in the works, so in a few months this won’t need to be a choice, especially if you are willing to take a 70 or 80 % effectiveness.
I am 71 years old. No one that has ever known me would accuse me of status quo bias. OTOH, anyone that has ever known me would accuse me of moron bias.
Both the AstraZenica and J&J Janssen vaccines are single dose. Both are adenovirus-based, so mechanistically different from the Pfizer and Moderna mRNA vaccines.
If I am understanding the math correctly, we don’t really know how much additional protection the second dose provides. The protocol was not designed to answer the question. It may be smaller than an added 10 percent.
Even so, I think I swing back to the idea that 2 doses is the right way to go (at least until all healthcare workers and high risk folks are protected). I expect behavior to change towards even less social distancing such that hospitals continue to be pushed to capacity until the crisis is practically over. Since the impact (I envision) depends on the patients behavior, the scale tips to protecting nurses.
Bless you my son, for you are saved :<)
What does 85% effective mean? That the person has produced 85% of the ideal antibody protection, or that 85% of people produce antibodies and 15% don’t? Is the point of a second dose to strengthen everyone’s reaction or to give those that need a bigger dose a chance to get there?
Arguing about one dose versus two doses in light of the number of available vaccines misses the point. As I’ve mentioned before, the critical bottleneck in the vaccine campaign is not the number of vaccines sitting in freezers. We currently have more vaccines sitting in freezers than we have arms to jab. The bottleneck is in our ability to actually get the vaccines we currently have into people’s arms. So if we reframe the problem that way, then the argument for a single dose makes a lot more sense because a single dose allows us to get the most number of people vaccinated given constraints on the number of doctors, nurses and pharmacists available to administer those shots. Right now the relevant bottleneck isn’t the number of vaccines, it’s the number of people who can inject the vaccine.
My understanding is that the efficacy rate is just 1 – ((x/n1) / (y/n2)) where x is the number of people infected who came from the treatment group, y is the number of people who were infected from the placebo group, n1 is the number of participants in the treatment group and n2 is the number of people in the placebo group. Of course, that does not account for the confidence bands around those estimates.
Although you are technically entirely correct, then in the present context of shooting just readily available arms in healthcare and long term care, then the second dose constraint is a matter of better safe than sorry. Even if there is only a small difference in efficacy between two doses and one dose, that still poses unnecessarily large problems in those petri dish environments, not just for human mortality but also bug mortality. Dead bugs do not replicate, mutate, and develop resistance. Resistant bugs in healthcare or long term care would be a game changer.
I was happy to learn on Christmas day that my best friend’s wife, who switched from ICU to obstetrics over 20 years ago when she had her first child, had gotten her first shot last week.
Every mind comes packaged in its own box with class biases inherited as accorded by that box’s provenance.
BIG THANKS or as my best friend’s wife would say, “Muchas gracias.”
Lost in Trump’s racist attacks on the “China Virus” is the fact that China did do great harm to the world with their actions at the beginning. Would be nice to see exactly how much time China cost the world, but I doubt that will ever be truly known.
“Hong Kong (CNN)An independent Chinese journalist who reported from Wuhan at the height of the initial coronavirus outbreak has been jailed for four years by a Shanghai court, her lawyer said Monday.
Zhang Zhan, 37, was found guilty of “picking quarrels and provoking trouble,” according to one of her defense lawyers Zhang Keke, who attended her hearing. The offense is commonly used by the Chinese government to target dissidents and human rights activists.
A former lawyer, Zhang traveled some 400 miles from Shanghai to Wuhan in early February to report on the pandemic and subsequent attempts to contain it, just as the authorities began reining in state-run and private Chinese media.
For more than three months, she documented snippets of life under lockdown in Wuhan and the harsh reality faced by its residents, from overflowing hospitals to empty shops. She posted her observations, photos and videos on Wechat, Twitter and YouTube — the latter two of which are blocked in China.
Her postings came to an abrupt stop in mid-May, and she was later revealed to have been detained by police and brought back to Shanghai. According to Amnesty International, at one point during her detention Zhang went on hunger strike, during which time she was shackled and force fed, treatment the group said amounted to torture.
Her lawyer Zhang Keke, who visited Zhang earlier this month while she was in detention, described on social media that Zhang had a feeding tube attached to her nose and mouth. He said her hands were tied to prevent her from removing the device, and that she suffered from constant headache and pain in her stomach and throat.”
Trump did great harm to the world with his actions before the beginning.
U.S. Legal News
March 25, 20206:26 PM
Updated 9 months ago
Exclusive: U.S. slashed CDC staff inside China prior to coronavirus outbreak
By Marisa Taylor
WASHINGTON(Reuters) – The Trump administration cut staff by more than two-thirds at a key U.S. public health agency operating inside China, as part of a larger rollback of U.S.-funded health and science experts on the ground there leading up to the coronavirus outbreak, Reuters has learned.
Most of the reductions were made at the Beijing office of the U.S. Centers for Disease Control and Prevention (CDC) and occurred over the past two years, according to public CDC documents viewed by Reuters and interviews with four people familiar with the drawdown.
The Atlanta-based CDC, America’s preeminent disease fighting agency, provides public health assistance to nations around the world and works with them to help stop outbreaks of contagious diseases from spreading globally. It has worked in China for 30 years.
The CDC’s China headcount has shrunk to around 14 staffers, down from approximately 47 people since President Donald Trump took office in January 2017, the documents show. The four people, who spoke on condition of anonymity, said the losses included epidemiologists and other health professionals.
The material reviewed by Reuters shows a breakdown of how many American and local Chinese employees were assigned there. The documents are the CDC’s own descriptions of its headcount, which it posts online. Reuters was able to search past copies of the material to confirm the decline described by the four people…