I also think it's possible one dose protection could drop off dramatically after just a few weeks, maybe a couple of months. So I agree we need trials. Doing it without trials could be disastrous.
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Replying to @stgoldst @K_G_Andersen and
I agree. I also worry that 2 dose efficacy could drop off dramatically in efficacy. We've only evaluated 2 doses within a couple of months - when plasmablasts were abundant, pumping out tremendous numebrs of antibodies. But all of those plasmablasts die off within a couple months
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Replying to @michaelmina_lab @stgoldst and
Post-plasmablast concerns are interesting, and are not being widely discussed [from what I can see]. Perhaps other experts don't want to cast doubt on duration of vaccine immunity [yet]. But plasmablast could be another reason to increase the time between 1st and 2nd shot?
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Replying to @JonL8675309 @JonLoflin and
Coming back to some of
@zeynep’s points: I fully agree that the global community is not good at doing rapid applied research to inform recommendations, ref masks, schools, rapid tests. And we need to approach this question with a sense of urgency. 1/1 reply 1 retweet 1 like -
Replying to @rvenkayya @JonLoflin and
Many groups are thinking about ways to maximize vaccine supply, including global organizations, regulators, vaccine developers, etc. Given the potential benefit, an accelerated research program into a one-dose and longer two-dose schedule to stretch supply would make sense. 2/
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Replying to @rvenkayya @JonLoflin and
That said, there are good reasons to believe a one-dose schedule may not be as efficacious as a two-dose schedule, including against severe disease in high-risk populations, due to magnitude, duration and quality of the immune response. 3/
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Replying to @rvenkayya @JonLoflin and
No one here is saying one dose is as good as two, but some may interpret early efficacy to mean one dose is sufficient, for all vaccines, before we have any data. We need to be clear about what we do and don’t know and prepare people for revised guidance as we learn more. 4/
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Replying to @rvenkayya @JonLoflin and
I'd say the way to figure out the "some may" risk is to communicate clearly, not avoid the trade-off discussion. One twist for this is the age risk is well-defined and exponential so we can make sure to communicate that. (In fact, more boosters for 65+? Anyone looking at that?)
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Replying to @zeynep @rvenkayya and
I get durability risk without booster(s?) but severe disease is not equally distributed, and dampening the outbreak rapidly is worth a lot (both the disease risk and the downsides to the world of this situation). If we don't put this on agenda now, it won't even be considered.
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What Michael and I are urging is to have the mindset, now, to start whatever we can to put this on a sound(er) footing—something we should have started earlier. Start recruiting Monday for a volunteer placebo arm for the second dose among lower-risk HCW to be vaccinated, for ex.
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Replying to @zeynep @JonLoflin and
That's a new efficacy study, which can certainly be done but not overnight. We'll have more data to inform this discussion soon. The immunogenicity data will allow us to compare kinetics of response and potential correlates of protection in single- vs two-dose recipients.
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Replying to @rvenkayya @JonLoflin and
Yeah it should be a discussion and rapid action before two-dose ossifies simply due to inertia rather than data against. We got a vaccine in basically nine months (amazing!!) but the lack of urgency in conducting more and many trials on everything is very frustrating.
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