It's trade-offs all the way down
From The New York Times:
Can We Do Twice as Many Vaccinations as We Thought?
By Zeynep Tufekci and Michael Mina
Data suggests significant protection even without a second shot. If studies prove that’s true, it could be a game changer.
Another thought: there are going to be many, many more vaccines available, and some of those will be easier to make, cheaper to make, easier to store, and cheaper to ramp-up. https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html
Phizer and Moderna are going to come to the rescue of a select few. Let them do so at the best level available. The proof of concept they have shown will likely lead to a cascade of positive results, of varying CI%. We will need them all, and even if the general roll-out is late, choice will come into play when people are reluctant to take a vaccine that 1) can give a strong allergic reaction 2) was derived from stem-cell lines 3) was made from GMO's 4) is from a company they don't like 5) you get the idea. Whatever it takes, we need to effectively vaccinate as many people as possible.
Personally, I think the avoidance numbers will be much lower than the polls are predicting, because of a feature of human nature: When people see other sub-groups getting in line ahead of them, their jealousy will incline them to want to join the herd.
To accept a smaller dose of the vaccine, wouldn’t it also be important to know more about what that does to transmission rates? It seems to me people who get a vaccine will surely (?) ease up on their precautions, so it might be even more risky to ease up on the strength of the vaccine without knowing this.
Zeynep, in the unlikely case you aren't already doing this, can you please try to get this into the mainstream press? What I'm seeing so far in the media -- particularly here in Germany -- is dominated so heavily by "do it right or bust"-type thinking and a fascination for ethical conundra over practical solutions, I'm worried that we won't get the vaccine until Fall. It takes a certain kind of person to believe that rolling out the vaccine needs to wait until panels of ethicists have finished deciding who gets it first (the elderly or medical workers?), but somehow this kind of person tends to be particularly strongly represented in newsrooms and (to a lesser extent) in the German government. Someone needs to state the obvious: something is better than nothing, and now is better than later.
I was worried myself about missing my booster shot (due to job-related travel) -- I feared it could somehow help the virus adapt, in a "what doesn't kill me makes me stronger" way, like stopping antibiotics courses supposedly does to bacteria. Some google searches later, not only doesn't this seem to be a thing, but apparently even the oft-repeated claim about antibiotics isn't actually true ( https://www.who.int/news-room/q-a-detail/antimicrobial-resistance-does-stopping-a-course-of-antibiotics-early-lead-to-antibiotic-resistance , https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2536180 ). It seems that, as far as medical topics are concerned, scary what-ifs spread much faster than facts.
I think that Pfizer and others don't want the responsibility of choosing between 1 and 2 doses and dealing with lower effectiveness; so is this something that policymakers want to make a decision upon? Part of the no testing strategy is to avoid having the data condemn you; why would they change that now?
A somewhat differing view: In the latest iteration (#134) of his podcast ( https://www.mdr.de/nachrichten/podcast/kekule-corona/kekule-corona-zweite-impfung-viruserkrankungen-vegane-ernaehrung-audio-100.html ), the German virologist Alexander Kekulé has commented on the one-dose plan. The TL;DR is that he is somewhat worried but is not dismissing it as a bad idea. He believes the possibility of "escape mutation" via half-immunity is real, and the use of existing studies for one-dose effectivity is somewhat hampered by low statistical power. (At least this is how I understand him; there is no transcript yet that I could link to.) Note that he is talking not just about the mRNA vaccines but also about the Oxford/AZ one (which he doesn't fully trust yet). His own upshot is to give the elderly the original two-dose program and everyone else the "first dose now, second dose when it's ready" treatment. (He argues that it's particularly the elderly and immunocompromised that are likely to contribute to escape mutations.)
Kekulé's podcast has been a great source of information and informed opinion throughout the last year, so I am inclined to take him far more seriously on this than anything written by a philosopher or politician. As they say on reddit, Δ (but not to the opposite).
Do we know if the Moderna vaccine has the same properties in terms of effectiveness after 1 dose?
Zeynep asks what's better, one dose of vaccine for 200 million people with 60-80% efficacy or two doses of vaccine for 100 million people with 95% efficacy? If 70% of unvaccinated people will ultimately get COVID-19, the standard two-dose regimen would lead to 5 million vaccinated people and 70 million unvaccinated people becoming infected and the suggested one-dose regimen would lead to 40-80 million people becoming infected. The other factors she mentions, including public trust, must be used to decide how best to use scarce vaccine.
This is certainly a very good line of thought to have now, and to try to obtain more data now as well. One aspect that is missing in your discussion, though, or which I didn't see :), is that lowering the infection rate has not to be the ultimate goal, but most important is to save as many lives as possible. So I think for the most vulnerable, who should be highest priority, we should always play safe and provide them with two shots, and probably also for the people directly surrounding them. Then, and only then, it makes sense to turn the attention towards the infection rate. Since this will probably only happen some month from now (at least this is what I understand will be happening here in Europe) there should be enough time to collect more data as you suggest.
Okay, I read the paper. >18,000 people took the second shot of vaccine, and >18,000 took the second shot of saline, so that is a relatively robust N showing that the first shot was 52% effective.
Conversely, only 304 of the vaccine recipient group failed to get the second shot of vaccine, while 316 people failed to get the second shot of saline. I think this is the group that got the 82%.
I like to find out when I am wrong, and what the right answer is, so if anyone wants to straighten me out, don't worry about my feelings!
Maybe the N that was too small was the N for the "one shot only" treatment. I would be more inclined to have confidence in the CI number derived from the highest # of recipients. But seeing that the "in between shots" subset only scored 52%, maybe that's closer to where one shot only actually will get you. I don't like doubting data (not smart!), but those two figures are not really compatible.
Hold the phone, what's that second result line about? Result CI from between first shot and second shot is only 52%, with a wicked-big range of 29-64. I can't think of a good reason that this would vary so widely from the one treatment only study. In fact, they should be pretty close, with the after first-shot, before second shot being more likely to be HIGHER CI% than one shot only, because less elapsed time to get SARS CoV-2 before booster. Is this just because data are not robust? 21,000 is a pretty good number, but what was the N for just the "in between shots" treatment?
Please don't make me read the whole study :(
On this topic, I'm planning on listening to what the epidemiologists suggest. At the moment, it doesn't seem like there is sufficient peer reviewed opinion to suggest that the single dose route is appropriate.