When the Pfizer and Moderna vaccines were first approved, it was clear that they were highly effective at preventing covid and that they would be in short supply for months. The clinical trial data also suggested that, at least in the short-run, one dose of the vaccines would provide almost as much protection against covid as the two-dose protocol that was tested and approved by the FDA.
This led a number of economists and public health professionals to argue that we could gain an edge in the fight against covid – and likely save tens of thousands of lives – by prioritizing first doses and delaying second doses (“first doses first”). We could also stretch existing supplies by giving people half-doses, and by giving one dose to people who have recovered from covid and have some degree of natural immunity to reinfection, or simply by delaying their vaccination until more vulnerable people have been protected.
Most of the debate over vaccine stretching policies has been technocratic. Proponents argue that first-doses-first and other vaccine stretching policies will save lives, and opponents point to various risks. In my view the technocratic case for first-doses-first and other vaccine stretching policies is strong, but the politics are difficult. Unfortunately, proponents of these policies have failed to think creatively about how to overcome political obstacles to vaccine stretching. So let’s think about the political challenges and ask how the Biden administration might have been persuaded to try using first-doses-first, half-doses, and similar policies
The politics of first doses first are challenging