Immunologists have also suggested half-dose/half-dose prime/booster trials. I know trials are expensive but there's a lot on the line—vaccinating the whole planet, much earlier. Just last April, we thought we'd need another 18 months for any vaccine, let alone ones this good.
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Also, to be clear: our own op-ed advocated for immediate single-dose trials and resources/funding for it. A lot has happened since then, and many countries are forging ahead, it seems, with at least spacing boosters. That part is not mine to comment except: PLEASE COLLECT DATA.
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There are very obvious reasons why some countries are doing what they are, and there are also obvious and important cautions people are expressing. The worst case scenario is not measuring which has now turned into a natural experiment. If we measure, we can respond either way.
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An op-ed from
@Bob_Wachter (chair of UCSF Dept of Medicine) and@ashishkjha (dean of SPH at Brown). https://twitter.com/Bob_Wachter/status/1345741327330263042 …pic.twitter.com/KCQPer2SsV
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Also see this thread by one of the country's leading virologists on why she thinks we should delay the boosters in order to increase early coverage. (Disclosure: the article she's linking to about the risks of increased transmissibility is mine)https://twitter.com/VirusesImmunity/status/1345086669607890945 …
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Do note that with exponential growth, more *is* very different. If a location had an R just below 1, and if the new variant tips it just over 1—with the same policies—the difference isn't minor. It's the difference between decline and uncontrolled spread.https://twitter.com/AdamJKucharski/status/1345714389329051663 …
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I wrote this article (on New Years Eve!) because I was seeing so much media & even public health officials inappropriately reassure the public that the "new variant isn't more deadly." Technically correct but profoundly misleading about the real threat. https://www.theatlantic.com/science/archive/2020/12/virus-mutation-catastrophe/617531/ …pic.twitter.com/93Py6foXvO
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Another article advocating for an immediate trial for what happens when/if the booster is delayed, by
@peterbachmd of Sloan-Kettering. He, too, suggests health-care workers as potential (could be others). "All breakthrough no follow-through" is costly. https://www.statnews.com/2021/01/04/stop-debating-first-shot-vs-set-aside-hospitals-should-compare-them/ …pic.twitter.com/XC2Mphm3gj
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WHO expert committee says delaying booster up to six weeks (given supply issues) rather than three is okay (based on existing data) and also says will update recommendations for delay as more data becomes available.https://twitter.com/BogochIsaac/status/1347545566679592960 …
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Details from the WHO expert committee: "Countries experiencing exceptional epidemiological circumstances may consider delaying for a short period the administration of the second dose as a pragmatic approach to maximizing the number of individuals benefiting from a first dose."pic.twitter.com/INAZ6Iy6j5
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Biden administration will indeed stop keeping second dose in reserve and front-load the vaccine distribution. (NB: I advocated for a *trial* asap on delayed booster & not keeping second dose in reserve. I also support having these trades-off discussions).https://www.cnn.com/2021/01/08/politics/biden-vaccine-strategy/index.html …
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So update. CDC says some delay is okay & "if the second dose is administered beyond these intervals, there is no need to restart the series." I will repeat my plea that such modifications need a randomization and data gathering component for more clarity.https://twitter.com/MikeNedelman/status/1352406577664450561 …
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The man who leads the UK RECOVERY trials which produced incredibly useful information—including drugs that greatly reduce mortality—suggests a randomized trial of delayed dosing. Amazing how “controversies” evolve.
(Yes, we obviously should, as per first tweet in this thread.)https://twitter.com/MartinLandray/status/1353272270270181379 …Show this thread -
Seems Michael Osterholm (of Biden Covid task force) calls for delaying the second dose a few months to increase coverage now. (Because I keep having to clarify: My co-authored piece called for *A TRIAL* exactly so such discussions could have better data). https://www.cidrap.umn.edu/covid-19/podcasts-webinars/episode-42 …pic.twitter.com/f1AkWZjIrv
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Updating this thread started on December 18, 2020 with me and
@michaelmina_lab proposing an immediate *trial* for delaying the booster and monitoring the results. We both caught much grief then but if we had started a trial then, we'd know for sure by now.https://twitter.com/Atul_Gawande/status/1377275975050924040 …Show this thread
End of conversation
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