One Dose or Two?
One Dose or Two?
There are two theories out there about how to vaccinate. One says, look, we have data only on the protocols that were adopted in the trials. The Pfizer and Moderna vaccines were administered in two doses, three to four weeks apart. We know that works. Don’t mess with it. Stick to the protocol and make sure everyone getting these vaccines gets both doses in the proper time frame.
The other says, our goal should be to get basic protection for as many people as possible as quickly as possible, especially since ominous variants are spreading. We are in a race, and when time matters as much as it does now you cut a few corners. Since it looks like vaccine effectiveness is pretty strong two weeks after the first dose, make sure we get that dose out there and then go back, when there’s time and enough supply, to top it up later.
As often with dichotomous choices, the best course is neither.
We are after two related but different goals. One is to minimize death and suffering, the other to reduce transmission as rapidly as possible. Based on what we know, it is likely that a second dose of the two-dose vaccines (and maybe a third when variant-aware boosters become available) will increase protection, especially for those vulnerable to severe Covid. On the other hand, getting first doses out the door at maximum speed will hasten the end of the pandemic while shrinking the reservoir from which mutant strains can emerge. Two goals, not one.
Logically, with two goals and two choices, we would expect a mixed solution to be best. (1) Identify the subset of the population who would most benefit from a second dose. These will be the most susceptible to severe or long-haul symptoms, including the elderly, those with compromised immune systems, prior lung damage and other risk factors. They should get two doses in line with the current protocol. (2) For the rest of the population, prioritize the first dose.
There is room for adjustment. The size of the priority protection group can be increased or decreased as we learn more about the incremental effect of a second dose and the role of different risk factors. Perhaps some people who wouldn’t qualify for this group on the basis of their own health conditions might be folded in because their occupation or social circumstances either puts them at greater personal risk of severe symptoms or magnifies the consequence of otherwise modest declines in transmission potential that may result from getting both doses.
There is a lot of space for judgment, but the principle of a two-track strategy to pursue two different goals is the starting point.
“… Identify the subset of the population who would most benefit from a second dose. ..”
[Once that you include front line health care workers and first responders and food processing plant workers and anyone else that works exposed to lots of other people out of necessity, then you will be saying what I was saying from the beginning. That these were among those first in line to get shots in most jurisdictions should have been a tell.]
The approval of J&J makes the question irrelevant. In a few weeks or sooner a single dose shot will be available. Plus it is far easier to distribute. Until they can show that J&J is significantly less effective than a single dose of the two dose vaccines, just go with approved dosing whether it is one or two doses.
How about ‘No Dose’
30 percent of the country, including 41 percent of Republicans, doesn’t want the vaccine
NY Times – March 11
… a new survey indicates that a sizable minority of Americans — particularly Republicans — are not yet willing to take it.
Twenty-two percent of respondents to an NPR/PBS NewsHour/Marist College poll released Thursday said they had already been vaccinated, and an additional 45 percent said they would get the vaccine when it became available to them.
But 30 percent said that they would not. Among Republicans, that number leapt to 41 percent.
The poll revealed a stark racial disparity in terms of access to the vaccine. Roughly a quarter of both white and Black Americans said they had already been vaccinated — but among Latinos, that number dropped to 11 percent.
The results also flew in the face of a commonly circulated narrative suggesting that Black people are less willing to be vaccinated than others. In fact, while 25 percent of Black people said they did not want the vaccine, that number was 28 percent among white people, driven largely by Republicans’ ambivalence. Among Latinos, it reached 37 percent.
Fifty-two percent of Latinos and 48 percent of Black people said they hadn’t yet gotten the vaccine but would take it when it became available to them. Just 43 percent of white people said that.
All told, the share of Americans saying they wouldn’t get the vaccine stood at 30 percent, down from a high of 44 percent in a Marist poll in September. …
The Massachusetts vaccine rollout has been terrible
according to Rachel Maddow. However…
Who has been vaccinated in Massachusetts
via @BostonGlobe – March 11
Daily COVID-19 vaccination totals in Massachusetts
1st dose received
Cumulative: 1,533,849
Percentage of population: 22.3%
Fully vaccinated
Cumulative: 819,559
Percentage of population: 11.9%
(This seems pretty decent. Rachel Maddow resides in
western MA, where the population is relatively sparse,
& it is quite possible the vaccine rollout there is lacking.)
Note that the adult MA population of MA is
5.5M (estimated, 2019), and roughly 30%
of us have received our first vaccine dose.
As for distribution, some counties are more
equal than others. All have received at least
23% (by population), some have received 50%,
others have received 70%.
A stockpile of vaccine sits idle in the US, and Europe asked to tap into it
NY Times – March 12
The AstraZeneca coronavirus vaccine has been authorized for use in more than 70 countries, but the United States is not yet one of them. And as American officials wait for results from the company’s U.S. trial and then emergency clearance, tens of millions of doses sit idly in American manufacturing facilities — even as other countries beg for access.
The doses’ fate is the subject of an intense debate among White House and federal health officials, with some arguing that the administration should let them go abroad where they are desperately needed, while others are not ready to relinquish them.
AstraZeneca, a British-Swedish company, is involved in those conversations. …
I think somebody is trying to make it difficult for Astra-Zeneca. The reports of blood clots related to Astra-Zeneca seem to be statistically unlikely to be genuine. Why were they reported at all? Why was the initial testing so insufficient? I smell a rat.
reason:
I think you are right. These clinical trials were not done to the fullest extent so people can say pretty much anything and get away with it.