A vaccine or two What the debate tells us


If you spend some time with doctors, epidemiologists, and concerned citizens on Twitter, you’ll see the most recent debate: one or two vaccines against COVID. The logic is that, given the limited supply of vaccines, it is better for more people to receive a vaccine with reasonably good protection rather than immunize a smaller number ahead with better protection. So far, our success with the offside role has been poor, as the United States only dosed 1 percent of the population.

Bob Wachter and Ashish Jha reduced it in favor of a vaccine to The Washington Post this week. This article published today in the Annals of Internal Medicine it offers a model around a second delayed vaccine that could substantially increase the benefits, although it would allow most recipients to receive second doses at the scheduled time.

Here are some things we can learn from the debate:

1. Everyone is an expert on COVID policies

We have known for a long time that access to data and a publishing platform make anyone an expert. Zeynep Tufekci, who is not formally trained in epidemiology, was one of the first to do so ask the single dose question. What is interesting is that the debate over vaccine against two has nothing to do with experience or authority. (Okay, true confessions: I shot Nate Silver just before Christmas because I find him deeply upset). But really, around this debate I have seen people’s acceptance of theirs ideas and not theirs pedigree or place in The Guild. This is a subtle but significant change in the behavior of the IMHO social network.

2. We learn as we go

Since the beginning of this, we have been in a constant state of flux as to what we know and understand about COVID. I am a modified schedule bassist. But if our recent history is an indication, we should have an open mind about how we should adjust course.

3. The models are perfect. Local operations: not so much

The model described in Annals above is compelling. But when we examine the problems we have faced with local distribution here in the United States, I think it is a fantastic dream to think that we will pivot on a dime and reallocate the second pending doses. Beyond the logistical challenges we saw with the first wave (Kerfuffle of the Stanford Vaccine Algorithm), only the challenges of communication seem overwhelming. We can theorize everything we want. If operations cannot continue, we are brazen.

4. Believing that people will act logically is a magical thought

If you think people will predictably act in the face of prevailing threats and good science, talk to a pediatrician. For years we have faced the reality that smart, well-meaning people will not necessarily behave responsibly when it comes to vaccines. Look at the statistics emerging from isolated areas of California as a case in point. Therefore, we can argue about modeling altered schedules: if people don’t accept it, the discussion is a total waste of time.

I am not sure that our current challenges represent the supply of vaccines in relation to distribution / allocation issues. The question of the durability of the immune response with a single shot is not insignificant.

My pediatrician will go online with not modifying the vaccination schedule based on our best tests.

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