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IDEpiPhD's profile
Dr Nicole E Basta
Dr Nicole E Basta
Dr Nicole E Basta
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@IDEpiPhD

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Dr Nicole E BastaVerified account

@IDEpiPhD

Infectious Disease Epidemiologist | Associate Professor of Epidemiology | Canada Research Chair in Infectious Disease Prevention | PI @BastaLab & @TrackVaccines

Joined July 2014

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    Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

    As you consider the #COVID19 #vaccine debates about 1 vs 2 doses, timing of 2nd dose & dosing w/ 2 diff vaccines, keep in mind there is no "right" answer & there are gaps in the evidence such that we may not know which is the "right" answer for a long time. Why not? A 🧵… 1/

    5:13 PM - 1 Jan 2021
    • 174 Retweets
    • 569 Likes
    • PM.TIGER FORCE BUREWALA BASHARAT ALI PK Nili Kaplan-Myrth MD PhD Bryan Tegomoh, MD, MPH denis lau McLovin Juan Rizzo 💚 R T Cin 💚🧡 Rodrigo Quiroga
    17 replies 174 retweets 569 likes
      1. New conversation
      2. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        Well, while individually-randomized clinical trials give great evidence to understand vaccine efficacy, they cannot tell us which is the most effective COVID19 #vaccination strategy. This should not be a surprise-none of the COVID19 trials evaluated any vaccination strategies.2/

        3 replies 12 retweets 79 likes
        Show this thread
      3. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        As a result, the phase 3 trial data from #pfizer #moderna #oxford #COVID19 #vaccines alone cannot single-handedly identify how we should vaccinate populations. Optimal vaccination strategies depend on population-level factors such as context-specific disease epi & logistics. 3/

        2 replies 7 retweets 79 likes
        Show this thread
      4. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        We (population-based public health researchers. i.e. epidemiologists) specialize in designing phase 4 studies that go beyond phase 3 trials by assess the effectiveness of multiple vaccination strategies in populations using cohorts and other methods. 4/

        3 replies 10 retweets 90 likes
        Show this thread
      5. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        We ask questions like what is the most effective way to optimize the benefits of vaccination in this population at this time given what is known about vaccine efficacy (incl efficacy against multiple outcomes, differences in efficacy by age, efficacy waning over time)? 5/

        1 reply 6 retweets 67 likes
        Show this thread
      6. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        We gather evidence to determine the impact of targeting different age groups or targeting based on transmission etc. These phase 4 studies are crucial because they complement evidence from phase 3 trials and answer the next important question-how should we use this vaccine? 6/

        1 reply 6 retweets 70 likes
        Show this thread
      7. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        My group & many others focus on this population-level public health research. How can we maximize the effectiveness & thus the benefits of vaccines via optimal vaccination strategies? Why do we do this research when clinical trials tell us if a vaccine is safe & effective? 7/

        2 replies 7 retweets 65 likes
        Show this thread
      8. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        Because individually-randomized clinical trials incl the #COVID19 vaccine trials assess the average individual-level benefit of vaccination. Such a trial might tell us that 2 doses given 21 days apart maximizes the immune response & duration of immunity among individuals. 8/

        2 replies 7 retweets 63 likes
        Show this thread
      9. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        These clinical trial results are critical, which is why FDA & other regulators use trials to assess whether a vaccine is safe & effective enough to be given to individuals. They ensure that the evidence demonstrates that the vaccine protects (and does not harm) individuals. 9/

        1 reply 5 retweets 53 likes
        Show this thread
      10. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        What does this tell us about how to protect populations? Surprisingly little! There are dozens of decisions that need to be made about HOW a vaccine that is safe and effective on an individual-level SHOULD be used to control a disease at the population-level. 10/

        1 reply 7 retweets 74 likes
        Show this thread
      11. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        In normal times, we (epidemiologists & population-based researchers) would launch studies to ask these questions & inform evidence-based vaccination strategies. These studies take time & if we’ve learned anything during the pandemic it is that time is of the essence. 11/

        1 reply 6 retweets 68 likes
        Show this thread
      12. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        No doubt these studies WILL be done, but decisions will need to be made before results are available. So, how should we approach these debates? 12/

        1 reply 5 retweets 63 likes
        Show this thread
      13. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        First, be clear about what the evidence says about maximizing individual-level efficacy AND acknowledge that that evidence alone is insufficient to assess pop-level effectiveness for any strategy, especially if the proposed one deviates from the doses/timing/age in the trial. 13/

        2 replies 7 retweets 73 likes
        Show this thread
      14. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        Second, acknowledge the decisions that need to be made-urgently-and identify which of those decisions are: 1) supported directly by evidence 2) extrapolated from related evidence, and 3) made in the absence of evidence based on assumptions. 14/

        9 replies 8 retweets 114 likes
        Show this thread
      15. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        These distinctions are CRITICALLY important because the scope of evidence available & the assumptions we make WILL change over time as we gather more knowledge, so we must be explicit about how these decisions are being made now & which elements might change in the future. 15/

        1 reply 6 retweets 62 likes
        Show this thread
      16. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        Third, communicate these decisions transparently & clearly. It is a major disservice to all to suggest scientific evidence exists to support a decision that was made based purely on lack of resources or on logistical feasibility. Of course there are trade-offs. 16/

        1 reply 7 retweets 98 likes
        Show this thread
      17. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        Communicate how those trade-offs are prioritized from the start or risk losing credibility and trust - we cannot afford losing trust and faith in the process at this stage. 17/

        2 replies 6 retweets 80 likes
        Show this thread
      18. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        And, finally, accelerate the implementation of phase 4 studies of #COVID19 #vaccines so we can revise guidelines & recommendations as soon as possible. All decisions not fully based on evidence are a gamble. If we don’t collect these data, we will never know... 18/

        1 reply 8 retweets 69 likes
        Show this thread
      19. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        Which gambles paid off and which should be revised immediately. We can’t afford gambling for longer than necessary. Too many lives/livelihoods are at stake. Too many have been lost already. 19/

        1 reply 5 retweets 58 likes
        Show this thread
      20. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        If you follow me, you’ll see this is why I often say that the same resources-billions $$$-that have been devoted to vaccine development need to be devoted to vaccination research. There remains so much we don’t know about how to use vaccines effectively at population-level. 20/

        1 reply 12 retweets 96 likes
        Show this thread
      21. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        Thanks for reading this far. Hope this clarifies some of the very real challenges w/ making decisions about optimal population-level vaccination strategies when we only have evidence about individual-level vaccine efficacy. 21/

        3 replies 7 retweets 78 likes
        Show this thread
      22. Dr Nicole E Basta‏Verified account @IDEpiPhD 1 Jan 2021

        And I hope you’ll keep this in mind & ask questions if others claim certainty about decisions for which there is no comprehensive evidence at present. Let’s gather the evidence needed now as we move ahead so we don't risk wasting the best chance we have to end the #pandemic. /end

        10 replies 7 retweets 104 likes
        Show this thread
      23. End of conversation

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