I'm hoping for immunology/virology people to tell us the potential trade-offs here. We know one side: due to shortages, hundreds of millions of people will not get vaccinated anytime soon. What does the calculation on the other side look like?
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At a minimum minimum, there should be an immediate single-dose trial launched, like yesterday. We sadly have a raging epidemic and will get results quickly but I think not giving this real thought now—and an explanation to the public—would be a grave mistake, given the stakes.
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zeynep tufekci Retweeted Stefan Baral
Yeah, but given the stakes, "we don't know for sure so we won't vaccinate hundreds of millions" is not an acceptable answer. Shortage is a terrible trade-off, too. Why didn't they/we immediately launch a single dose trial after prelim data? They knew.https://twitter.com/sdbaral/status/1337053741015502850 …
zeynep tufekci added,
Stefan BaralVerified account @sdbaralReplying to @zeynepDose de-escalation/non-inferiority trials tend to be very difficult to get pharma to agree to. But indeed, it is an open question of the non-inferiority of 6 weeks after one dose vs 2 weeks after the 2nd dose. Imagine Pfizer/moderna fights back on behalf of their shareholders.14 replies 24 retweets 219 likesShow this thread -
Look, folks, like all things pandemic, this is a trade-off. The immunology people should weigh in and explain to us about one side of the trade-off. The other side is a societal/ethical decision because we're bouncing potentially less efficacious against *not at all vaccinated*.
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This is immediately consequential. US plans to HOLD BACK for many millions now vaccination to preserve for second dose later.
@ScottGottliebMD—Pfizer board member—disagrees: "We should get as many shots in our arms as possible right now." https://www.usatoday.com/story/news/health/2020/12/07/covid-vaccine-pfizer-board-member-disagrees-us-distribution-plan/3860363001/ …pic.twitter.com/6CGpcLlsSb
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zeynep tufekci Retweeted Michael Mina
Let me ask this. We know older people need the booster more (from published data). But why we wouldn't launch a single-dose effort (randomized/blinded within) for <65 which can answer the questions about durability while immunizing millions more?https://twitter.com/michaelmina_lab/status/1337078184597217281 …
zeynep tufekci added,
Michael MinaVerified account @michaelmina_labAgree! One dose = 2x people vaccinated The math is plain & simple Approach is broken. We do not do what makes sense: w/ rapid tests or making single dose vacc a priority when they work (both obvious benefits). We fail to do what's smart We choose perfect over most effective. https://twitter.com/zeynep/status/1337047714341785605 …Show this thread9 replies 21 retweets 194 likesShow this thread -
I wrote up the case for launching immediate trials to test a single-dose regime. Calling for volunteers among < 65 health-care workers for single dose and later booster seems like the minimal prudent response to this chart. We could know fairly quickly.https://zeynep.substack.com/p/vaccines-and-decision-making-with …
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Replying to @zeynep
Worth noting that no mRNA vaccine has ever been widely deployed for humans before. There was not a strong a priori reason to think that these vaccines would be even close to this efficacious. It was not clear that they would be protective at all.
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Consequently, when designing the trials, it would have arguably been foolish to waste statistical power on inoculation regimes likely to show borderline protective effect, given what was known at the time.
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Replying to @Merz
Absolutely. Plus people were saying even a two year timeline was too optimistic. Do hoorah! On the other hand, they had this initial data months ago? If they had started then, we would already know by the time the second dose will come up. I wish we were more nimble in testing.
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I understand having the trial go for clearing the bar. I don’t understand why we are not a lot more aggressive with having more trials as quickly as possible given how much this is costing, both human and other costs.
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