The uncomfortable truth is that public health authorities and leadership must make rapid decisions that will have profound consequences with limited information.
Biden Announced He Will Release All Available Vaccine Doses—What Does That Mean for Access?
On Friday, the Biden transition team announced they are releasing all the available vaccine doses.
Both FDA-approved vaccines require a second dose 21 days (Pfizer-Biontech) or 28 days (Moderna) after the first in order to achieve the greater than 94% efficacy in COVID-19 protection. A third vaccine (AstraZeneca-Oxford) approved in the UK and India, also requires two doses, initially 28 days apart, with greater than 90% efficacy.
Eight governors recently wrote a letter to the current administration requesting the release of all available vaccine doses to states. Until now, the federal government had been maintaining a stock of half of the available vaccine doses in order to ensure adequate supply for second doses.
Releasing all the doses at once means there is a risk that the people who get the first dose may not get the second dose at the scheduled time. The Biden team has asserted confidence that supplies would be adequate, or that they could invoke the Defense Production Act to increase vaccine production if needed.
Several scientists in both the US and UK have already proposed that second doses be delayed to 12 weeks rather than 3-4 weeks in order to increase the first dose. Getting only one dose does provide partial immunity (52.4% efficacy for Pfizer-BioNTech, but this may increase to over 85% after 10 days or more) but not the full >94% provided by the second dose. It is also unknown if the protection provided by the first dose will be long-lasting without the second dose—the study only monitored for 21 days.
Delaying second doses is a wager that, in the setting of such severe shortages and limited data, getting more people partially immunized quickly will have better outcomes compared to getting fewer people immunized fully.
For the Pfizer-BioNTech and Moderna vaccines, there is no evidence for or against this strategy. The only data is from the clinical trials themselves, which only assessed one schedule (two doses within a month). However, in the UK, studies of the Oxford-AstraZeneca vaccines included a subset that had longer gaps (8-12 weeks), which indicated greater immune response. However, this was a smaller group so it is difficult to tell how robust this result is. It is not clear if the same will be true for the Pfizer-BioNTech or Moderna vaccines.
This story originally appeared on: Vogue - Author:Dharushana Muthulingam
