America’s COVID-19 vaccination is going much slower than expected – in fact so slow that leading scientists are starting to debate whether authorities should take the drastic step of stretching available supplies to twice as many people by postponing the second of two doses. or to cut each dose in half.
Their fear is that America’s distribution of vaccines is too slow to keep up with – let alone stop – a raging pandemic increasingly driven by new, more transmissible variants.
So far, only 4.6 million Americans have been vaccinated, according to the Centers for Disease Control and Prevention, which is far less than the target that federal officials would give at least 20 million people their first shot before the end of December, and not nearly the 100 million. doses in 2020 initially promised by the Trump administration.
If the vaccinations were to continue at the current rate, it would take nearly ten years, according to an NBC News analysis, to vaccinate enough Americans to get the pandemic under control.
With more than 2,500 Americans giving in to COVID-19 daily – and no end in sight – the US cannot afford to wait until 2022, let alone 2031. And since cases of coronavirus after weeks of vacation still (again) signs are of a boom. meetings, experts inside and outside the government are starting to consider the idea of splitting doses differently, getting more shots into more arms as fast as our cumbersome infrastructure allows.
This is a complex, controversial issue and there can be significant disadvantages. But in theory, the logic of reconsidering the authorized dosage regimen has a certain appeal.
The approach that has received the most attention is to delay the administration of second doses until the stock catches up. In their clinical trials, Pfizer and Moderna tested two doses of 100 micrograms spaced three weeks (Pfizer) or four weeks (Moderna) apart. Both found that the regimen is safe and that it is about 95 percent effective in preventing disease.
Although both companies also reported that by the time participants show up for their second shot, their first shot already offers them a high level of immunity. In the case of Moderna, the first (or ‘primer’) shot is was apparently 92.1 percent effective in preventing COVID-19 after two weeks, long before volunteers received a ‘booster’ injection their day. Pfizer’s results indicate similar protection – higher than 80 percent – after 10 to 12 days.
Neither the Pfizer nor the Moderna trial are designed to study the efficacy of a single dose. It is therefore unclear how long this immune protection will last, or at what level. But in real life, booster shots is often applied months or years after the initial primer; an interval of three or four weeks was not fixed in stone.
So should America continue to act as it is? The federal government said Monday it has delivered more than 15.4 million doses of Pfizer and Moderna vaccines to states. But that’s only half the federal stock; At the moment, Washington is holding the other half in reserve to ensure there are enough shots to go around within 21 to 28 days.
The question then becomes whether it makes more sense to use a stock of about 30 million shots to provide 95 percent protection in 15 million Americans over the next month – or to use the same stock to provide something like 85 percent protection at twice so many people in half the time.
The United Kingdom, Denmark and several Canadian provinces have already decided to postpone the second doses (up to 12 weeks in the United Kingdom and six weeks in Denmark). Belgium, Germany and Ireland are planning a similar upheaval.
Meanwhile, more and more top American scientists are saying that what may be preferable in a perfect world – such as following the initial vaccination schedule – may be counterproductive in the depths of the spiral pandemic, especially as a new variant of the virus that is 50 percent more transferable already distributed.
“Given the increasing transmission variants, we need an adapted strategy,” said Yiko immunologist Akiko Iwasaki. tweeted Friday. “Unfortunately, the vaccine is going out much slower than we expected. This means that even the defenseless have to wait months to get their 2-shot vaccines. ”
Iwasaki further noted that “a mutant virus with 50% ⬆ in transmission kills many more people than a mutant with 50% ⬆ of lethality”; viruses spread exponentially, and a small percentage of a very large number can easily be much larger than a large percentage of a small number.
While ‘I am still a proponent of 2-dose vaccine’, Iwasaki concluded, the situation in the US is so dire that ‘we can postpone the 2nd dose until more vaccines are available’, adding can be good. ”
Robert M. Wachter, chair of the Department of Medicine at the University of California, San Francisco, and Ashish K. Jha, dean of the Brown University School of Public Health, agree Sunday in the Washington Post.
“Until recently, we supported the strict vaccine regimen, which required two doses within a month,” they explained. But ‘between 50,000 and 100,000 Americans will die of covid-19 just this month. Giving 100 million people – especially high-risk people – a single shot of 80 to 90 percent effectively will save far more lives than giving 50 million people two shots that are 95 percent effective. This is what we need to do. ”
Meanwhile, President-elect Joe Biden’s team thinks it’s worth investigating. “The data from Pfizer – the amount of protection you received at a single dose – was quite impressive,” said Dr. Zeke Emanuel, a member of Biden’s COVID-19 advisory board, told Yahoo News. “It must be considered: how to expand this absolutely scarce resource.”
Other experts remain skeptical. Some say it would be irresponsible to postpone a second dose until studies explicitly prove that the protection against the first dose lasts longer than 28 days. Some worry that it will be unethical to tell those who have already accepted their first shot – with the promise of a second to follow three to four weeks – that they will have to wait. Some fear that postponing a second dose that boosts immunity can give the virus more chance to multiply and mutate people. And some believe that changing rates based on untested extrapolations of limited data will further undermine the public’s fragile confidence in these already controversial vaccines.
For the record, dr. Anthony Fauci, America’s leading expert on infectious diseases, no proponent of following in the footsteps of the United Kingdom and changing the dosing schedule. “I will not advocate for that,” said Dr. Fauci told CNN on Friday. “We’re going to keep doing what we do.”
But postponing the second shot may not be the only way to expand America’s vaccine supply. Authorities are also considering volume vaccine in each dose, effectively doubling the amount of available doses. On Sunday, Moncef Slaoui, the head of America’s vaccination effort against Warp Speed, said CBS that participants in Moderna’s clinical trials between the ages of 18 and 55 who received two half doses of 50 micrograms each produced an “identical immune response” to those who received two full doses of 100 micrograms.
“Injecting half the volume into adults younger than 55 could be a more responsible approach that would be based on facts and data to immunize more people,” Slaoui said. The US Food and Drug Administration and Moderna are now in talks about implementing and ‘accelerating’ this regime on a wider scale, he added.
It remains to be seen what will become of the discussions. It also needs to be seen whether the distribution of vaccines will accelerate in the new year – an essential part of getting more people vaccinated, but the doses are large or scheduled.
The federal stock setting aside second doses is only about 30 percent of the first doses delivered to the states was actually injected into living, breathing Americans. That means more than 10 million unused doses are just sitting there waiting to be used – according to experts, the result of the Trump administration’s decision to transfer responsibility for vaccine distribution to individual state health departments through the pandemic, with little in the way of federal coordination or support. The new COVID-19 relief bill includes an additional $ 7 billion for state vaccination efforts, which should help, and the incoming Biden administration has promised to take a more practical approach.
But so far, America has vaccinated only 1.38 percent of its population. Israel, on the other hand, has vaccinated more than 14 percent. As U.S. deployments continue to falter as cases, hospitalizations, and deaths continue to increase – and frightening variants become prevalent – impatient Americans may demand that leaders start thinking outside the box.
“We seem to be getting a LOT to (for some) delay the second shot at short intervals (maybe just a few weeks),” said Yale Howard Forman health policy expert. tweeted on Saturday. ‘The risk of’ reserving ‘a large amount of doses while the distribution is occurring is higher than the alternative. Let’s put logic and science above dogma. ”
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