More adding support for delayed 2nd dose strategy. @mtosterholm + @mlipsitch are supportive. Early calls to consider this (notably op-ed by @michaelmina_lab + @zeynep in mid-Dec) were too quickly dismissed by some, IMO.
It's a race against new variants.https://www.cidrap.umn.edu/news-perspective/2021/02/experts-tout-delaying-2nd-covid-vaccine-dose-us-deaths-mount …
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Replying to @j_g_allen @mtosterholm and
Dismissed, heh. Got a lot of "how dare you", too. If we had started then—randomizing among those who'd already had a single shot in trials and also after the EUA—we'd have a lot more data-driven clarity now on how best to proceed.
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Replying to @zeynep @j_g_allen and
I remain worried that this is happening either by overly-broad strategy (everyone is delayed equally, UK) or by fiat (not putting enough effort into tracking people for boosters) and may disproportionately impact the elderly—who probably have less leeway.
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Replying to @zeynep @j_g_allen and
(Also is three weeks too short for a robust response? It increasingly seems that non-standard interval was chosen mostly to speed up trials. Randomizing three weeks and, say, five or six weeks and comparing outcomes might be useful and seems pretty low risk?).
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Replying to @zeynep @j_g_allen and
Very low risk. The immune system isn’t going to drop off a cliff at 28 days. Nor at 45 or 60 days.
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Replying to @michaelmina_lab @zeynep and
So, immunologically speaking, I don't disagree. But if we are going to change the recommendation (1 dose, delayed 2nd, etc)-then we are going to have a lot of ppl who mistrust us even more. We've asked ppl to follow the science/evidence. We've asked ppl to trust us (scientists)..
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Replying to @jabarocas @michaelmina_lab and
While we think that the vaccine will be effective w/delayed dose, there's no hard evidence. We're swimming upstream against a river of mistrust already. For those of us on the ground, having the conversations, this is a hard sell. IMO.
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Replying to @jabarocas @michaelmina_lab and
On the first, Michael and I had asked for a trial of delaying the dose back in December partially because I am indeed very attuned to the question of trust. Even though delaying doses is not uncommon, even a request to collect data was treated as a no-go. So a few things on that.
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Insisting that the only scientific way was whatever the initial trial happened to be—which isn't a practice set in stone, is modified routinely for other vaccines, and given the emergency we face, def something to discuss—kind of became an own-goal, I think. So now it's harder. +
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Replying to @zeynep @jabarocas and
Meanwhile, both WHO and CDC have said six weeks is okay but we can't even do that, partly because of that unnecessarily rigid messaging. We could have had better data, we don't. UK could have had a more targeted approach, they don't.
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Replying to @zeynep @michaelmina_lab and
Exactly—unnecessarily rigid messaging but also a completely disjointed messaging.
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End of conversation
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