U.S. asking states to speed vaccine, not hold back 2nd dose
January 12, 2021 3:18 PM   Subscribe

U.S. asking states to speed vaccine, not hold back 2nd dose (AP): The Trump administration is asking states to speed delivery of COVID-19 vaccines to people 65 and older and to others at high risk by no longer holding back the second dose of the two-dose shots, officials said Tuesday. Trump administration reverses course and adopts part of Biden vaccine distribution plan (CNN): The Department of Health and Human Services is expected to announce sweeping changes Tuesday in vaccine rollout guidelines in an effort to boost the lagging number of vaccinations in the first month -- effectively adopting the approach proposed by President-elect Joe Biden's incoming administration. Biden's Plan To Release More Vaccine Is A Gamble. Is It Worth The Risk? (NPR): The Biden administration plans to send most of the currently reserved doses out right away, allowing more people to get first doses. For people who've gotten initial shots, the Biden team is making a bet that new doses could be manufactured in time to keep booster shots on schedule. How can countries stretch COVID vaccine supplies? Scientists are divided over dosing strategies (Nature): Researchers worry that efforts to free up limited vaccine doses are driven by desperation rather than data. Related: A Single Vaccine Dose Appears To Protect Against COVID-19. So Why Are We Giving Two? (WBUR)
posted by not_the_water (115 comments total) 26 users marked this as a favorite
 
Scotland is doing this already. And, in fact, have not committed to giving the second dose on schedule, saying it could be a 12 week gap. I am.... not convinced it is a good idea, to put it politely. In fact I am prepared for it to turn into a total shitshow in a few weeks.

There's not much data on the single dose, so who knows! Could be fine and save some lives! Could be a terrible, awful, fatal decision! Fun gamble
posted by stillnocturnal at 3:28 PM on January 12 [15 favorites]


First article linked says Moderna vaccine single dose is 80-90% effective. BMJ article on the subject says:

A paper published in the New England Journal of Medicine stated that the efficacy of the Pfizer-BioNTech vaccine was 52.4% between the first and second dose (spaced 21 days apart).5 However, in its “green book” Public Health England said that during the phase III trial most of the vaccine failures were in the days immediately after the first dose, indicating that the short term protection starts around day 10.6 Looking at the data from day 15 to 21, it calculated that the efficacy against symptomatic covid-19 was around 89% (95% confidence interval 52% to 97%). Meanwhile, Pfizer has said that it has no evidence that the protection lasts beyond the 21 days
posted by BrotherCaine at 3:44 PM on January 12 [6 favorites]


I should have included the following paragraph from the BMJ article as well:

In the case of the Oxford-AstraZeneca vaccine, PHE said, “High protection against hospitalisation was seen from 21 days after dose one until two weeks after the second dose, suggesting that a single dose will provide high short term protection against severe disease . . . An exploratory analysis of participants who had received one standard dose of the vaccine suggested that efficacy against symptomatic covid-19 was 73% (95% CI 48.79-85.76%).”
posted by BrotherCaine at 3:45 PM on January 12 [2 favorites]


Presumably this can be modeled by epidemiologists? Given X doses, what are the resulting spread numbers, if there is less efficacious protection of more immunized people, as compared with more efficacious protection of fewer people. How that difference plays out seems perhaps more salient than the raw efficiency of the vaccine itself.
posted by They sucked his brains out! at 3:56 PM on January 12 [3 favorites]


Are there any actual, full studies on a single dose though? Or is all this data just drawn from the gap between the first and second shot in the studies? Because whilst the first shot obviously does something, it really bothers me that these vaccines were approved on a specific, two-shot schedule which we are now ignoring. Not saying its a BAD idea, it may very well be a REALLY GOOD idea because having twice as many vulnerable people given SOME immunity is the better choice and saves more lives. But it all feels a little ad-hoc...
posted by stillnocturnal at 3:58 PM on January 12 [10 favorites]


Of course if there were actual single shot studies I didn't find because I am a stressed out mess these days then I take it all back.
posted by stillnocturnal at 4:00 PM on January 12 [2 favorites]


(I should also clarify that when I say I am concerned about a "shitshow" I am more concerned about the ability to make sure everybody does actually get a second dose in this new time frame, of the same vaccine. Seems a lot harder to manage when you're not holding the two doses for everyone, and its not like our admin side of things has been great so far)
posted by stillnocturnal at 4:07 PM on January 12 [4 favorites]


For anyone else who missed it, the New Yorker devoted nearly an entire issue to a 40-page piece about how America botched the virus response:

The Plague Year: The mistakes and the struggles behind America’s coronavirus tragedy.

Summary at the Verge: Go read this New Yorker report on the failed response to COVID-19 in the US: Dozens of choices made the pandemic a catastrophe
There are three moments this year that determined the scale of the COVID-19 catastrophe in the United States, argues New Yorker staff writer Lawrence Wright in a sweeping, searing look at the country’s year spent fighting (and failing) against COVID-19. The magazine is devoting an entire double issue to cataloging those missteps and the many other mistakes made by officials that set us on a path toward hundreds of thousands of deaths from the disease.
MeFi Thread.
posted by homunculus at 4:11 PM on January 12 [14 favorites]


Much of US data to catch newest coronavirus variants is several months old
As part of the hunt for new coronavirus variants, an international database shows the United States ranks 61st in how quickly virus samples are collected from patients, analyzed and then posted online.

Countries with far fewer resources, including Bangladesh, Sri Lanka and Suriname, process samples more quickly than the United States does.

"It's pathetic," said Dr. Peter Hotez, a virologist at Baylor College of Medicine.

The median number of days from the time a sample is collected from a patient's nose until the time its genetic sequence is posted on GISAID, an independent data sharing initiative, is 85 days, according an analysis of GISAID data by the Broad Institute of Harvard and the Massachusetts Institute of Technology.

"By the time you wait (85) days, a sequence can go from being a rare variant to being half of the circulating virus in a population," Hotez said.
posted by homunculus at 4:13 PM on January 12 [8 favorites]


Derek Lowe thinks that this is both risky and the right call.

The delayed-dose idea had been floated before, and I wasn’t exactly an early adopter, but the more contagious version of the virus has made me reconsider. . . . I’m in favor of doing it, but I’m not happy about ending up in that position. I don’t trust immunology to always work the way that I think it should work, but it seems that we have little choice. . . . Not dosing more people could exacerbate the problem of regions getting overwhelmed with the more contagious variant, with needless deaths due to the loss of hospital capacity. But if we spread out such vaccinations too much and manage to generate another variant that partially or even completely escapes the existing vaccine response, we will be in even worse shape. I do not know how to make this decision.
posted by nosewings at 4:15 PM on January 12 [21 favorites]


All of this depends on the rate of manufacturing and delivery. So far it looks like Pfizer claims 2B doses in 2021 and Moderna 1B doses (upper bound) in 2021, which means a total of 1.5B complete rounds. If the USA is assured that they will get 662M doses in 2021 and can get it on tap then we should start sticking arms randomly as fast as possible. If manufacturing is rate limiting then we risk spacing out shots too long or never delivering second shots by doing the "random arms" strategy.
posted by benzenedream at 4:16 PM on January 12 [10 favorites]


Are there any actual, full studies on a single dose though? Or is all this data just drawn from the gap between the first and second shot in the studies?

From the last link:

Moderna actually collected data from people who only received one dose of its vaccine, Gill says. Some 2,000 participants in Moderna’s phase three clinical trial received just a single injection of either a placebo or the vaccine. In that population, the efficacy of the single vaccine dose was roughly 80 to 90%.
posted by justkevin at 4:17 PM on January 12 [5 favorites]


If we could segment the (R)eproduction value by various subgroups and give the high R subgroup two doses and everyone else a single dose I'd think that'd be the best outcome. I'm not sure that we have those kinds of stats or that there's a clear point of division though. I mean, my suspicion is that people who are in the room for ventilator/respiratory procedures need two shots, but between dental hygenists, delivery workers, cashiers, etc... I don't know what the best choices are. Especially since some states are effectively gaming the stats by their own poor response.
posted by BrotherCaine at 4:29 PM on January 12


I think everyone is also underestimating how bad vaccination compliance rates will be once you get out of the healthcare provider population.
posted by benzenedream at 4:34 PM on January 12 [34 favorites]


Texas has a population of 29 million. To date the state has received slightly more than 150k doses. I'm on the 1B list and have signed up with a local regional clinic but I fear it will be a long wait...
posted by jim in austin at 4:41 PM on January 12 [1 favorite]


Will this make the virus more resistant to the vaccine? Is that even a thing? If after a single dose of the vaccine people still get sick in high numbers, then doesn't that just mean that the selective pressure on virus wasn't enough to eliminate it, and the viruses which survive are better suited to avoid the attack of the primed immune system?
posted by ecco at 4:44 PM on January 12 [4 favorites]


I'm curious what the plan would be for people unable to get the second dose in time. Would they get 2 more doses later? Just the second dose, but late?

As someone who can wait it out, I would rather wait until I can be assured of getting the best possible protection (which seems like 2 doses on the proper schedule) and would not want to get a rushed first dose if it means I would never achieve the same level of protection possible by doing it the 2-dose-properly-spaced way.

Would there be harm in getting 3 doses? (Like, if you got one early and then had to wait 6 months but then could get the standard 2 dose regime).
posted by thefoxgod at 4:48 PM on January 12 [4 favorites]


But if we spread out such vaccinations too much and manage to generate another variant that partially or even completely escapes the existing vaccine response, we will be in even worse shape. - Derek Lowe.

More on variant generation:

Why new coronavirus variants 'suddenly arose' in the U.K. and South Africa (National Geographic, Dec. 2020) Some researchers suspect chronic cases allow the virus to replicate over long periods of time and that certain new therapies [ex.: convalescent plasma] may encourage it to mutate.

Persistent SARS-CoV-2 infection and viral evolution tracked in an immunocompromised patient (COVID-19 Genomics UK (COG-UK) Consortium, Dec. 18, 2020)

Japan has found a new Covid variant. Here’s how it compares to virus strains in the UK, South Africa (CNBC, Jan. 10, 2021) Japan’s National Institute of Infectious Diseases on Sunday said it had detected a new variant of the coronavirus in four travelers arriving from Brazil. The newly discovered mutant strain of Covid-19 was found to share some of the mutations in common with those of concern for increased infectivity, the institute said, referring to highly infectious variants recently discovered in the U.K. and South Africa.

Are We Creating Immune Resistant Variants Of SARS-CoV-2? (Forbes, Jan. 11, 2021)
--
Optimism:
What’s Ahead for SARS-CoV-2 Research in 2021 (The Scientist, Jan. 8, 2021)

FasterCures, a center of the Milken Institute, is currently tracking the development of treatments and vaccines for COVID-19 (coronavirus). This tracker contains an aggregation of publicly-available information from validated sources. Tracking: 319 total treatments, 240 total vaccines. Spreadsheet.

posted by Iris Gambol at 5:13 PM on January 12 [9 favorites]


Vaccines try to target multiple epitopes. Viruses can accumulate point mutations, but they are very deleterious. Getting two or more would be very rare, such that this could weaken the defensive effects of a vaccine.
posted by They sucked his brains out! at 5:19 PM on January 12 [2 favorites]


I'm not a doctor, but I strongly suspect this means that few people are ever going to get a second dose under the current trainwreck circumstances.

And as we've just found out, congresspeople who got vaccinated a few weeks ago are now coming down with it anyway. I'm really not sure this is a good idea. I'm fairly sure it's not at all.

But hey, we make the worst possible choices here, why not this too.
posted by jenfullmoon at 5:20 PM on January 12 [3 favorites]


If one shot is partially effective, the reduction in overall spread could save lots of lives. I also feel like, unless we are totally crazy, vaccine production will continue to ramp up until we have excess, at which point perhaps people could be revaccinanted if necessary. For sure this could be a big mistake, but I feel like leaving half the vaccine in a freezer when it could be helping is more likely to be a mistake. But I am not an expert.
posted by snofoam at 5:36 PM on January 12 [3 favorites]


If I were eligible for a shot and I was in a location where the second shot is delayed indefinitely (I am in such a location but not currently eligible), I'd be strongly considering waiting until they are back to guaranteeing two shots. I'm all for the vaccine, but not this weird half-dose of it for political purposes.
posted by jeather at 5:41 PM on January 12 [6 favorites]


I have already gotten my first shot (healthcare worker). It was a roller coaster to get the first one and now it feels like it's going to have been for nothing and I'll be right back to square one.

My husband got his second shot yesterday. I am really concerned about vaccine compliance once more people see the side effects. The last 36 hours were rough. He slept through a lot of it but he had a fever, chills and a terrible headache. He feels better but is still getting dizzy if he moves around too fast.
posted by MaritaCov at 5:48 PM on January 12 [20 favorites]


Soooo.... we need to cut transmission, because the more transmission, the more likely we have mutations, either by statistics of host contact, or by statistics of finding a natural reservoir for this........so that means: more single shots for a wider population. Also, to stop us crashing out healthcare systems now!

but paradoxically, ALSO if we don't do a good job of eliminating viruses completely in people; i.e. with a strong immune response, that also leads to mutation....which means more double shots for fewer people.....


The lowe article is the one to read. We are in a bind; in an ideal world we would only choose based on clinical evidence - 2 shots for everyone!, but covid is essentially endemic now and we are racing a clock to different kinds of disaster. There is NO PERFECT answer here.


--

In other "good" (as in "2020") news, I expect existing and upcoming mutations to provide some escape from the as currently configured vaccine's immune response ; we currently only make one spike protein - a variant of the one discovered in march 2020 - and our bodies generate antibodies to it. There are multiple strains out there already with mutated spikes, some with multiple mutations (not just "point" mutations) ! Some of these mutants of bind to vaccine-derived antibodies in a neutralizing fashion, others..... less so. Lord help us if we have ADE to contend with too.

The only question is: what consequence does the reduced/modified neutralizing binding have?

If this has on-the-ground consequences, when this becomes widely known....not good. Not good at all.

posted by lalochezia at 5:50 PM on January 12 [2 favorites]



My husband got his second shot yesterday. I am really concerned about vaccine compliance once more people see the side effects. The last 36 hours were rough. He slept through a lot of it but he had a fever, chills and a terrible headache. He feels better but is still getting dizzy if he moves around too fast.


MariaCov which vaccine did you & your hubby get?
posted by lalochezia at 5:53 PM on January 12


I got the Moderna and am currently scheduled for shot two on 1/25. Husband got Pfizer. Luckily, he scheduled his during his week off. They had a ton of staff calling in. Other than sore arms, neither of us had side effects from our respective first shots.
posted by MaritaCov at 5:59 PM on January 12 [4 favorites]


According to Vox, all 3 members of Congress who tested positive for COVID this week already recieved their first dose of vaccine.
posted by cheshyre at 6:25 PM on January 12 [7 favorites]


Fwiw, I also got Pfizer dose 2 today and got hit with brain fog about 3 hr post shot, which lasted most of the afternoon, now feel normal/ok. The fatigue is well-documented from the trial (as is the fact that dose 2 side effects are in general stronger than dose 1), so I expected it and scheduled dose 2 on a day I didnt have much planned. But I agree that most people are going to be expecting something like the flu vaccine and are going to be surprised.

I don't exactly know why the trials were designed as 2 dose, when multi-dose series are a known barrier to adherence (even aside from the rollout issues). But post-hoc analyses of single dose regimens should be taken with a grain of salt, unless you can verify that randomization was maintained. As soon as you lose randomization, you're in the realm of speculation.
posted by basalganglia at 6:32 PM on January 12 [9 favorites]


According to Vox, all 3 members of Congress who tested positive for COVID this week already recieved their first dose of vaccine.

From the article 2/3 received it just a couple days prior to their probable exposure, and the third less than two weeks? So I’m not sure how much this really says about the effectiveness of a single dose versus the caveats everybody should be very aware of regarding the ramp up period for immunity.
posted by atoxyl at 6:34 PM on January 12 [23 favorites]


If I recall correctly, your body won't generate a full immune response until a few weeks after the second shot.
posted by eagles123 at 6:40 PM on January 12 [6 favorites]




This has become an issue in Canada. Because Quebec decided to vaccinate as many people as possible and stretch the second dose to months later, Pfizer has threatened (they won't confirm or deny this) to withdraw our supply.

Pfizer could withdraw vaccine supply from Quebec if two-dose schedule not followed: Legault

Also, Maimonides residents threaten legal action to get 2nd dose of COVID-19 vaccine
posted by quoththeraven at 7:04 PM on January 12 [4 favorites]


This is only hearsay, but a healthcare worker friend told me that compliance in his hospital is around 50%. Among healthcare workers. If true, stunning.
posted by Dashy at 7:19 PM on January 12 [13 favorites]


I think there are two different plans here:

US version: Give all the doses we have right now, and trust that the supply chain / just-in-time production will deliver the boosters to us as needed.

UK version: Just give single doses to everyone and don't schedule a booster shot.

The problem with the 2nd version is that it's like abandoning a course of antibiotics before you're finished. The problem with the 1st version is ... have you tried to order a sofa recently? Supply chain is borked.
posted by Harvey Kilobit at 7:24 PM on January 12 [24 favorites]


Both plans are going to equate to the same thing: one shot only.

I assume the vaccine creators had enough one-doses 'not fully working to make them be 2 shots, but yeah, 2 shots is HORRIBLE for compliance and even worse NOW.
posted by jenfullmoon at 7:58 PM on January 12 [2 favorites]


Figures this would start happening on the very day my employer tells me I qualify as what NYC is calling Phase 1b. Don't seem to be any more appointments to be had through the NYC.gov site anymore.

I suppose this has all become a delaying tactic until the only-one-shot-needed versions of the vaccine reach our shoreS?
posted by The Pluto Gangsta at 8:08 PM on January 12 [1 favorite]


I'm having a tough time finding fault in the first approach that Harvey Kilobit mentioned above.

We've tried holding back doses, and it's led to way more doses than necessary being kept back in warehouses, which is almost unquestionably the worst possible outcome.

Yes, this represents a failure to come up with a coherent distribution plan. As much as that sucks, it does mean that we have way more supply than we should, which helps nobody. At the point where we are now, it seems like it makes an awful lot of sense to pull out the stops, and hope that production keeps up, lest the perfect become the enemy of the good.
posted by schmod at 8:15 PM on January 12 [15 favorites]


Essential/frontline workers are really being screwed all around, huh?

- generally increased risk of catching and transmitting COVID
- clinic and pharmacy workers having to distribute vaccines they can't take to a population that is largely blowing it off
- retail/customer service types having to serve anti-mask dipshits even as they break state law and flout their own health and safety
- retroactive hazard pay magically disappearing from stimulus chatter despite being present in the original HEROES Act
- enhanced unemployment benefits that often outstrip their regular wages/salaries by a significant amount

And now states being pressured to scrap them as an early-adopter group to focus on politically-influential over-65s.

Make sure to thank your frontline workers! Just don't, you know, give them any sort of tangible benefit for the risk they take every day.
posted by Rhaomi at 8:30 PM on January 12 [19 favorites]


Texas has a population of 29 million. To date the state has received slightly more than 150k doses.
This doesn't seem to be accurate. According to the Houston Chronicle, Texas has 1.9 million doses distributed, and over 764k people who have received their first shots.

The CDC data is slightly more recent. It says over 900k people in Texas (3% of the population) have received their first shot, including 68k yesterday alone.
posted by mbrubeck at 8:52 PM on January 12 [4 favorites]




For the question to will a single dose put us at risk for the virus mutating into something the vaccine won't work against? My new internet crush thinks probably not but also MAYBE?

(The other video from this series on mRNA vaccines with the same guest speaker is also nerdily riveting.)
posted by [insert clever name here] at 9:27 PM on January 12 [5 favorites]


UK version: Just give single doses to everyone and don't schedule a booster shot.

For info the UK is scheduling boosters. We are scheduling them at 12 weeks out, and I agree that manufacturing and distribution problems could render the UK plan de facto one shot, but we haven’t got there yet.

As some possibly reassuring anecdata, my 92 year old father had the Pfizer jab with minimal to no discomfort. I know some people have a rough time, but not all.
posted by dudleian at 12:00 AM on January 13 [9 favorites]


In this context the experience we had with polio is quite concerning. Difference pathogens...

Parts of Nigeria boycotted the polio vaccine in 2003. This had devastating consequences - not only did local cases rise dramatically, it then spread to 8 other neighbouring countries which were previously declared polio free.

In most parts of the world, 3 to 4 doses of the vaccine are enough to confer protection to an infant. However, in Nigeria, with the large viral exposure of multiple wild strains, infants need to receive 8 or more doses to receive effective immunity. Infants which do not receive sufficient dosing fall victim to infection, replicating vaccine resistant strains even further. Nigeria eventually accounted for 80% of the global polio disease burden.

It's entirely possible that if certain countries don't get their infections under control, and where vaccinations are given at insufficient strength, they could endanger the rest of the world. The only way polio was eradicated was with WHO coordination, where they could ensure that even the poorest countries were fully vaccinated. They eventually managed to overcome the boycott by getting Indonesia to test and manufacture the vaccine, alleviating their belief that the vaccine was a Western conspiracy to impair the fertility of Nigerian girls. Nigeria - and indeed all of Africa - was declared free of wild polio as of last year.

---

As an update from Australia - we're continuing to explore more effective ways of controlling the virus without implementing movement restrictions. There was a small outbreak two weeks ago in Victoria introduced by international flight crew who broke curfew and headed into town in Sydney, which led to about 28 local transmissions here, ending a nearly 90 day streak of 0 local transmissions. Initially there were fears that restrictions would need to be introduced.

Every positive Covid case has its genome sequenced within hours, allowing contact tracers to directly map the line of infection. This reveals any "missing links" which they might otherwise miss. Also, not only are close contacts of positive cases made to isolate (eg patrons in the same restaurant in the same time period, restaurant have to keep records) - but close contacts of close contacts are also made to isolate, just as an extra layer of safety. People in isolation and unable to work are eligible for a government stipend.

We're back to 7 days with 0 local transmission. There's generally 10-15 infections detected per week in the state amongst the 1100 international arrivals which enter the state per week. and fingers crossed no more cases escape international arrival quarantine, Australia as a whole has limited arrivals to around 4000-5000 per week and they have to undergo a 2 week quarantine.
posted by xdvesper at 2:20 AM on January 13 [20 favorites]


It's a hard decision and I'm glad I don't have to make it.

It's worth noting that 3-4 weeks is the shortest possible prime-boost interval for immunological reasons. So it is not the case that the pharma companies very carefully optimised for that interval which is now being changed, rather they picked the shortest possible so the trials would be done faster.

It is of course true that the best data generated by the trials is the data supporting the primary outcomes which is generally number of symptomatic infections starting a week or so after the booster dose and Pfizer etc. are right to say that they can't guarantee how well it will work in other dosing regimes.

On the other hand it is also true that immunology would say that from a basic science point of view, going to 12 weeks as the UK has done is almost certainly ok (but of course in immunology there are no guarantees).

The public health, immunology, virology, and epidemiology experts on the JCVI as well as the chief medical officers are all strongly in favour of this and of the view that this will save many, many more lives than sticking to the original dosing schedule. Part of the driver is the more infectious variant, the previous tiered restriction system had a level of control in tier 3 that just about seemed to work to control infection while keeping schools open. This variant is infectious enough that those measures will slow but not stop growth.
posted by atrazine at 2:22 AM on January 13 [20 favorites]


This is all very interesting and I've learned a lot about the problems with vaccine dosing, which provides a better explanation for the UK's decisions than I'd otherwise understood.

I too am glad I don't have to make the decisions on this. It seems for sure certain that one way will turn out to be better than others but also not possible to know which one in advance. Undoubtedly whoever picks the wrong approach will be vilified.

I'm concentrating my personal efforts on encouraging individuals that I know to take up the vaccine when offered. We don't yet have enough for everyone so the worst outcome is vaccine sitting unused and expiring. I'll just have to trust and hope that our vaccine strategy turns out to be good enough.
posted by plonkee at 2:48 AM on January 13


Also worth noting that for the AZ/Oxford vaccine which does have longer data, the best evidence is that the sweet spot is between 8-12 weeks anyway, quite apart from making difficult decisions about trade-offs between individual efficacy and population.
posted by atrazine at 4:22 AM on January 13 [1 favorite]


People seem to be thinking that the covid-19 vaccine is supposed to provide covid-19 invulnerability. It is not the case. The 95% effectiveness is for people with the double doses under normal circumstances and those normal circumstances included the pandemic related directives and mitigations that were in play at the time of the trials - so not even "normal life". They most definitely did not test it on people who spend 3+ hours in a small room with several hundred people some of whom are infected. The capital terror attack victims were practically drinking covid-19 from a hose. Stopping an infection in that scenario would be like trying to stop a presidentially ordered mob of several thousand deranged lunatics along with several hundred terrorist militia members from overwhelming one hundred+ capital police and sacking the capitol building.

The vaccine provides societal level protection by lowering the probability infection AND concurrently lowering the probability of exposure. Some vaccinated people will still get covid-19. At our current rates of over 250,000 per day a 95% effective vaccine would still have 12,500 cases even if everyone was vaccinated that day (ignoring that it takes time to ramp up the immune response). Maybe a lot more cases if vaccinated people opt for recklessness. This is why you still need to do as much mitigation as you can even after you are vaccinated until most of the population is vaccinated (which America absolutely won't do because in aggregate the US is a spectacularly selfish stupid toddler nation).
posted by srboisvert at 5:38 AM on January 13 [29 favorites]


US version: Give all the doses we have right now, and trust that the supply chain / just-in-time production will deliver the boosters to us as needed.

This, as well as fairly soon switching from carefully-focused groups (eg healthcare workers, nursing home residents) to just plain getting as many people vaccinated as possible, makes sense to me. Delaying the time between the shots makes me nervous but I get that there is science behind that; doing the mix and match approach (shots 1 and 2 from different manufacturers) does not make sense to me.

It seems like we are currently in a situation where a key bottleneck is at the state/local level for giving injections (due to a total absence of federal support/planning/resources), and even though the supply lines are still far too anemic to vaccinate everyone, the local implementation of shots can't keep up with those limited supply lines as-is. This will change soon, and right now feels like an inflection point between the initial approach and what will work through the spring.
posted by Dip Flash at 5:54 AM on January 13 [1 favorite]


those normal circumstances included the pandemic related directives and mitigations that were in play at the time of the trials - so not even "normal life"

But the effectiveness is compared to the control group who were exposed to the same environment with the same mitigations in place. The comparison is not with some non-pandemic times trial group living normal lives in a world where SARS-CoV-2 exists.

I agree with your point that mitigations like masks will still be needed.
posted by bdc34 at 6:10 AM on January 13 [3 favorites]


I've heard that with a mRNA vaccines it would be a very short time line to develop a new vaccine to target a mutation of the virus. I think I saw this in the UCSF Medical Grand Rounds videos.
posted by bdc34 at 6:12 AM on January 13 [1 favorite]


I've just qualified for my state's 1b list. The only symptom so far seems to be compulsive repetitive checking of the secondary email account that is associated with the sign-up.
posted by Dashy at 6:43 AM on January 13 [5 favorites]


This, as well as fairly soon switching from carefully-focused groups (eg healthcare workers, nursing home residents) to just plain getting as many people vaccinated as possible, makes sense to me.

Consider this though, from Prof Wei Shen Lim, chairman of the Joint Committee on Vaccination and Immunisation (JCVI) which advises the UK government on vaccine priority:

"In terms of protecting people within a constrained vaccine supply, the estimates are that we have to vaccinate only about 250 people aged over 80 to save one life.

For care home residents, we only need to vaccinate somewhere between 25 to 45 care home residents to save one life.

If you were trying to vaccinate, for example, train operators, then you would have to vaccinate many thousand train operators to save a life.

It doesn’t mean that that’s not important, but it’s weighing up the values there. That’s a policy decision as to what value one wants to weigh up."


Getting total numbers up might make us feel good but from a mortality POV, vaccinating 10,000 care home (nursing home) residents is equivalent to 100,000 in the 80+ age group not living in group settings. It is the equivalent of millions of younger people.

doing the mix and match approach (shots 1 and 2 from different manufacturers) does not make sense to me.

I don't think anyone is advocating this. There is a study being run by AZ and Gamaleya (the manufacturer of the Russian Sputnik vaccine) on heterologous prime boost (a strategy using different vaccines for prime and booster). Sputnik already does this, using one viral vector for the prime, and another one for the booster. Sputnik uses two human adenoviruses, Ad5 and Ad26 and the Oxford/AZ vaccine uses a chimp adenoviruses. I think they are intending to test all possible prime boost combos against each other, that's six options if you only use one boost, more if you use two boosts. Viral vectored vaccines have the problem that an immune response develops to the vector as well as the payload which can lead to your booster being mopped up before it can get into cells, the clever thing about mRNA vaccines is the encapsulation which has been developed to deliver the payload without being immunogenic so theoretically this is less useful for them.

The UK vaccine green book allows use of a different vaccine for the boost if there is no record of the first vaccine type or if it cannot be obtained and there is a substantial risk of the person not being able to return for a later appointment. I don't think anyone would do this as a first choice outside of a trial.

I've heard that with a mRNA vaccines it would be a very short time line to develop a new vaccine to target a mutation of the virus. I think I saw this in the UCSF Medical Grand Rounds videos.

Very fast, yes. Even the vector vaccines like ChadOx and Sputnik can be adapted within weeks. I would be surprised if this had not already been done by the way. I imagine a very fast trial could be conducted on a modified vaccine considering we will soon have tens of millions of data points on safety for the current vaccines.
posted by atrazine at 6:44 AM on January 13 [12 favorites]


That's a good point about exposure and testing conditions, srboisvert.
posted by Dashy at 6:45 AM on January 13


If Biden does nothing but speed up vaccine distribution his presidency will be considered a success.
posted by tommasz at 7:04 AM on January 13 [13 favorites]


>>This, as well as fairly soon switching from carefully-focused groups (eg healthcare workers, nursing home residents) to just plain getting as many people vaccinated as possible, makes sense to me.

>Consider this though, from Prof Wei Shen Lim, chairman of the Joint Committee on Vaccination and Immunisation (JCVI) which advises the UK government on vaccine priority: ...

Getting total numbers up might make us feel good but from a mortality POV, vaccinating 10,000 care home (nursing home) residents is equivalent to 100,000 in the 80+ age group not living in group settings. It is the equivalent of millions of younger people.


I think I wrote unclearly. I agree -- there is a moral imperative to offer vaccines first to healthcare workers (who have been taking huge risks and working in impossible conditions) and to the most vulnerable of the elderly. That has to be first. But as that effort is completed (which is happening way too slowly in most places), I just don't think that it will work and be effective to keep maintaining precise tiers and work through them in order.

>>doing the mix and match approach (shots 1 and 2 from different manufacturers) does not make sense to me.

>I don't think anyone is advocating this.


I don't know about actually advocating for it, but as this headline says, that door has been opened in the UK: article
posted by Dip Flash at 7:26 AM on January 13 [2 favorites]


the clever thing about mRNA vaccines is the encapsulation which has been developed to deliver the payload without being immunogenic so theoretically this is less useful for them.

. The immunogenicity and thus inactivation of viral vectors in vector-based immunization is a huge problem, and one we will have to live with. I hope we have a store of vectors that we're saving - or researching now - for future diseases that only respond to vector-based treatments/vaccinations & I really hope the longterm safety profile of mRNA/lipid nanoparticle formulation is good......
posted by lalochezia at 8:19 AM on January 13 [1 favorite]


I hope we have a store of vectors that we're saving - or researching now - for future diseases

I was trained in a lab that invented some of these vectors for gene therapy and developed others.
The answer is: no we do not, not on scales like this, where entire populations gain immunity against them.
posted by rubatan at 8:30 AM on January 13 [8 favorites]


You can go trawling for dozens of other Adenoviruses or other piggyback vectors among other mammals; since they are getting injected the only requirement is that they must be able to enter the right cells and express the therapeutic payload. Several labs have done this while looking for viruses that can jump into new and therapeutically useful tissues, e.g. muscle for DMD or neurons for Alzheimer's.

The problem is that since viruses are very information-compact, the capsid proteins usually serve not just entry purposes, but have many other molecular functions that could sabotage their use as a vaccine vector, e.g. capsid proteins which work well in a macaque but immediately kill human cells before they express the vaccine protein. You also have to verify that the multiple piggyback vectors have no antigenic overlap such that neutralizing antibodies to one do not wipe out the second booster shot. This is not as simple as doing a sequence alignment and needs to be done in a wet lab, ideally with actual antibodies from the target organism (human), which means you need to do small safety trials for every single piggyback vector to verify their immunogenic "pairing compatibility".

I think it remains to be seen what the long-term resistance to LNPs will be; it's been tested for booster shots but it's still unclear if there will be some sort of neutralizing response if you tried to take dozens of shots using LNP vectors. There are enough immune responses to non-mammalian lipids I would expect something may arise given enough shots. Since this pandemic has cost upwards of 6 trillion dollars I think we should be able to fund development of dozens of backup vectors.
posted by benzenedream at 9:47 AM on January 13 [5 favorites]


> there is a moral imperative to offer vaccines first to healthcare workers (who have been taking huge risks and working in impossible conditions)

I disagree with this. Healthcare workers should be offered the vaccine because they have more exposure to the virus, and because of the loss to the community if they're out sick. But vaccines shouldn't be treated like rewards.
posted by The corpse in the library at 11:17 AM on January 13 [17 favorites]


Agreed. Doses should be given out to

1. Reduce mortality
2. Reduce spread

and that's about it. Morality should not enter into it. Is it immoral to immunize prisoners before amazon drivers? Maybe, but you definitely reduce spread more by immunizing prisoners.
posted by benzenedream at 12:13 PM on January 13 [3 favorites]


Here's a link to the JCVI's published minutes, reports, etc.

I was trying to find the clip of the Downing Street press briefing where either the Chief Medical Officer or one of the other government experts answered a question from a journalist on this. Can't find it quickly, but he put it across as a clear, brutally logical piece of maths.

Two weeks after the initial shot around 70-90% of people have protection (from current data/understanding), and after the booster shot protection is 95%. If you can administer 10,000 doses in a certain time period (due to supply, manpower, whatever), prioritising the booster will give you 4,750 people protected, prioritising the first dose will give you 7,000 to 9,000 people protected (45-90% more).

That's a huge increase, especially with the high risk groups who are first to be vaccinated.
posted by MattWPBS at 12:14 PM on January 13 [1 favorite]


As tyler cowen pointed out, while you are supply constrained it's as simple as 0.8*2 > 0.95. I was in a waiting room and overheard the fox talking heads trashing the anti-science first-dose-first approach. Eager to see how quickly the turn will be to "brilliant trump strategy not bowing to eggheads".
posted by a robot made out of meat at 1:41 PM on January 13 [3 favorites]


Ohio researchers say they’ve identified two new Covid strains likely originating in the U.S. (CNBC)

Ohio researchers said Wednesday that they’ve discovered two new variants of the coronavirus, one of which has become the dominant strain in Columbus, Ohio.

The new strain prevalent in the city appears to spread more easily, the researchers said.

“This new Columbus strain has the same genetic backbone as earlier cases we’ve studied, but these three mutations represent a significant evolution,” Dr. Dan Jones, vice chair of the division of molecular pathology at Ohio State and lead author of the study, said in a statement. “We know this shift didn’t come from the U.K. or South African branches of the virus.”
posted by rambling wanderlust at 3:06 PM on January 13 [2 favorites]


Super conflicted about all of this... trying to extrapolate data on a vaccine that was already approved on an emergency basis makes me very nervous. As someone who treats patients on chemo protocols (who often has to deviate from protocols because of symptoms and lab values) - we design protocols and use them because that's what the approvals are based on, and that's how we know that they work.

But, I could be convinced with enough data that doses could be spaced out further apart.

My clinic has been approved as an administration center but hasn't gotten a distribution in any of the last 5 weeks. While we want to offer to our patients and community, it is a huge headache to figure out how to safely administer. Have to have onsite a physician, pharmacist, nurses, MAs, and plenty of people to perform data entry into the two separate databases. Also have to figure out an efficient BRAND NEW way to allow patients to schedule appointments for both doses. Also have to figure out how to build a moral waitlist so that if someone doesn't make their appointment, that dose still goes into someone's arm. I'm one of the deciders in my office, and this has been a constant logistical nightmare for weeks now.

Was lucky enough to get my second dose on Saturday morning. I see COVID patients in the hospital when asked (not a hospitalist or a critical care physician so my role is limited). Patients come into the office and we find out days later that they tested positive - even my chemo patients who don't leave the house (but have been seeing grandchildren who go to school, etc.). Explaining to people that having the vaccine is not going to obviate the need to wear masks, socially distance, and generally stay home is occupying at least 5 minutes of each clinic visit since vaccines became available.
posted by honeybee413 at 3:11 PM on January 13 [9 favorites]


According to Vox, all 3 members of Congress who tested positive for COVID this week already recieved their first dose of vaccine.

In one case, it was 8 days before exposure, in the other two cases it was two days before exposure. The vaccine hadn't had time to become effective and the fact that they are now ill is no evidence against the efficacy of one dose after two-three weeks.
posted by Pater Aletheias at 3:47 PM on January 13 [15 favorites]


If you’ve already had COVID, then get vaccinated, would the likelihood of bad side effects be less?
posted by I_Love_Bananas at 4:55 PM on January 13


I'm already seeing news reports of people who are having difficulty getting timely second doses in the crush of people applying for first doses. The main thing that seems to be happening just-in-time is any kind of planning or organisation. I think we're going to be inadvertently studying the efficacy of a single dose in a lot of people whether or not one is held back on the shelf.
posted by joeyh at 5:16 PM on January 13 [3 favorites]


Can I just weigh in here with my completely uninformed opinion and total lack of expertise in epidemiology regarding a virus that's a little over a year old, and a completely new vaccine model?
posted by GhostintheMachine at 5:48 PM on January 13 [12 favorites]


“1. Reduce mortality
2. Reduce spread

and that's about it. Morality should not enter into it.”


That we ought to reduce mortality is a moral claim.
posted by oddman at 6:28 PM on January 13 [2 favorites]


There is absolutely nothing that leads me to believe that anyone can be trusted to not screw this up royally.
posted by dances with hamsters at 6:29 PM on January 13 [2 favorites]


I’m sorry to be US focused again on MetaFilter but do you know what mass vaccination campaigns used to look like in the USA? How many months did it take to put a man on the moon? Do you know what war time production can be like? Extensive, fast and on schedule vaccine production and distribution is absolutely possible. We have been existing in such buffoonery and malicious intention since the beginning of the pandemic Americans have forgotten that this is an entirely possible thing to achieve. It’s not possible how we’re currently operating, but it’s entirely possible. I can’t imagine that the Biden administration hasn’t been planning and orchestrating every aspect of this for the moment they set foot in office.
posted by raccoon409 at 7:51 PM on January 13 [12 favorites]


It's entirely possible that we in the US can do much better, but the current situation is such that 40% or more of the population will not get vaccinated for completely batshit insane reasons.
posted by mollweide at 8:04 PM on January 13 [5 favorites]


At the risk of stating the obvious what would be going here, were there rigorous data collection, is a mass clinical trial. Given that there is going to be little if any ongoing monitoring or data collection it is just an experiment (probably worse than that because experiments have some sort of design and have their results checked and compared).

If they get away with it it sets an awful precedent for the future. I am old enough to remember Thalidomide and while this is not the same that showed the risks of using drugs in an untested way.
posted by epo at 3:23 AM on January 14 [1 favorite]



At the risk of stating the obvious what would be going here, were there rigorous data collection, is a mass clinical trial. Given that there is going to be little if any ongoing monitoring or data collection it is just an experiment (probably worse than that because experiments have some sort of design and have their results checked and compared).

If they get away with it it sets an awful precedent for the future. I am old enough to remember Thalidomide and while this is not the same that showed the risks of using drugs in an untested way.


WHAT YOU WRITE IS FALSE and leads directly to death. PLEASE STOP THIS KIND OF ILL-informed "but I was just speculating" BULLSHIT.

There were telescoped Phase I, II and III clinical trials on all vaccines approved in Europe and North America, costing billions of real dollars with tens of thousands of participants.

There are serious questions about the long-term safety of RNA vaccines. In comparison to the risk profile of catching COVID-19, they are NEGLIGIBLE. However, your question is not serious. Your question is just FUD; and dangerous noise.
posted by lalochezia at 6:08 AM on January 14 [37 favorites]




You're saying there have been clinical trials of single-dose vaccinations, which are the topic of this thread?
posted by Not A Thing at 6:50 AM on January 14


This thread has devolved to general discussion of vaccines.

But you are correct; there is limited data - but real data! - on single/delayed dose work; my thoughts on that decision, which is not addressed by epo's broad-brush comment are in the thread. There is no question this is an experiment!

But comments like "getting away with it" and "thalidomide' implies gross, DANGEROUS, antivax-flavored antiscience dogwhistle BS, and the reality is we have to make one of two bad choices. More people on single (or likely: delayed) dose or less people on double dose. Either way, people will die of covid that wouldn't need to if we had scaled manufacturing & distribution better. The question is: what does the least harm.
posted by lalochezia at 6:59 AM on January 14 [14 favorites]


California is totally broken for vaccination. Our government has failed us. All the way up from Trump down to our county supervisors.

The big public vaccination center for Northern California, the Cal Expo in Sacramento? They won't be vaccinating the public for at least two more weeks.

My little county was apparently blindsided by the news they should be vaccinating everyone over 65 now. Their website says
As of January 13th, we've received just over 3,000 vaccines that have been allocated from the Federal supply by the State. There are more than 28,000 residents in Nevada County who are 65+, 2x more than the State average.
So the county's pointing the finger at the state. But even if we got the 56,000 doses needed there's no visible plan to actually vaccinate people.
posted by Nelson at 8:56 AM on January 14 [2 favorites]


Biden just really needs to activate the national guard or whatever elements of the military are needed to vaccinate people in a huge bulk fashion. Counties were never prepared for this and have been underfunded for decades. We have a gigantic military apparatus in place that can handle this -- the only reason it wasn't used was because of Trump's inability to take responsibility for anything.
posted by benzenedream at 9:08 AM on January 14 [4 favorites]


UK Chief Medical Officer outlined the Government thinking back in December is that we're likely to be looking at annual booster shots (like flu).

100% with lalochezia. This isn't based on 'no data', it's based on the simple maths of saving as many lives as possible with what we know now. If there are adverse reactions to having a single shot, in the UK at least there will be feedback through monitoring. Even in normal times there's the Medicines and Healthcare products Regulatory Agency YellowCard scheme to report these and they have a dedicated site for COVID vaccine and medication side effects.

Look at the sub-site, and then look at the current advice for the vaccines on the government site. There are already changes to use based on the monitoring and feedback.
The COVID-19 vaccine developed by Pfizer/BioNTech was approved for use by MHRA on 2 December 2020.

The CHM has reviewed further data for the Pfizer/BioNTech vaccine as they have become available. On 30 December 2020, CHM recommended the following:

  • Allergies – anyone with a previous history of allergic reactions to the ingredients of the vaccine should not receive it, but those with any other allergies such as a food allergy can now have the vaccine:
    ingredients for the qualitative and quantitative composition of the Pfizer/BioNTech vaccine
    ingredients for the excipient composition of the Pfizer/BioNTech vaccine
  • Pregnancy – the vaccine should only be considered for use in pregnancy when the potential benefits outweigh any potential risks for the mother and baby. Women should discuss the benefits and risks of having the vaccine with their healthcare professional and reach a joint decision based on individual circumstances – see also the advice from Public Health England
  • Women who are breastfeeding can be given the vaccine (this advice is in line with pregnancy and breastfeeding advice for the Oxford University/AstraZeneca vaccine)
  • Dosage interval – the advice has been updated to say that the second dose of the Pfizer/BioNTech vaccine should be given at least 21 days after the first dose – see also the Letter from the UK Chief Medical Officers regarding the UK COVID-19 vaccination programmes

    Updates have been made to the Information for healthcare professionals and Information for UK recipients about the Pfizer/BioNTech vaccine to include these elements.
  • If you get the chance to get one shot, get it.
    posted by MattWPBS at 9:17 AM on January 14 [2 favorites]


    Ill thought out comment, apologies. The "get away with it" was targeted at politicians.
    posted by epo at 9:36 AM on January 14 [4 favorites]



    This is only hearsay, but a healthcare worker friend told me that compliance in his hospital is around 50%. Among healthcare workers. If true, stunning.
    --Dashy

    For what it is worth, I was reading a site where a number of healthcare workers post and several said that they refused the vaccine because they are young and less likely to get severe symptoms , and wanted to save the limited vaccines for the elderly and others more likely to get seriously ill from Covid. Certainly this doesn't represent all the vaccine avoiders, but it does explain some of them.
    posted by eye of newt at 10:01 AM on January 14 [1 favorite]


    For what it is worth, I was reading a site where a number of healthcare workers post and several said that they refused the vaccine because they are young and less likely to get severe symptoms , and wanted to save the limited vaccines for the elderly.

    This makes no sense. The asymptomatic are the spreaders. Having health care workers as spreaders is endangering many people's lives.
    posted by JackFlash at 12:10 PM on January 14 [13 favorites]


    This makes no sense. The asymptomatic are the spreaders. Having health care workers as spreaders is endangering many people's lives.

    This is a difficult ethical question. I've seen several people suggest that, after healthcare workers and older people, 20--30-year-olds should be prioritized for vaccination, since they tend to drive the spread. And it might be true that prioritizing that age group would cut transmission enough that it would save the most lives in the long run. But it would be a bit of a hard sell.
    posted by nosewings at 12:42 PM on January 14 [2 favorites]


    If you get the chance to get one shot, get it.

    This seems clear for people at high risk, people who work in public, etc.

    Is it clear for people who are not at any risk right now? I mean, I guess part of the answer is that in a well run system those people would be last, so it wouldn't matter yet. As someone who leaves the house once or twice a month for a short grocery run at off hours, I certainly want the vaccine but would prefer to wait a little longer and end up with better protection than rush it and end up with less. My chance of spreading to anyone is incredibly low, given that I am basically never in public (and have not seen any friends/family since March, etc). In the long run, waiting sucks but less than ending up with 80% protection or whatever versus 95%, especially since the virus is not going to go away (ever).

    But as in my previous comment, maybe I'm still wrong about this? The real question is can the efficiency be upgraded later even if you miss that second shot. I guess the answer is probably "we don't know" since no one has studied either of these options:

    1) Get a second shot MUCH later than intended
    2) Get 2 more shots on normal timeline after already having gotten 1st shot very early (so a total of 3 shots)

    This is mostly out of curiousity, it's not like I would be allowed to get a shot now anyway.
    posted by thefoxgod at 12:42 PM on January 14 [2 favorites]


    This makes no sense. The asymptomatic are the spreaders. Having health care workers as spreaders is endangering many people's lives.

    They aren't as likely to have complications or die though, and they are the people who are most likely to be taking proper precautions at work to avoid infection.

    We're at a point in the UK where London hospitals are doing transfers of intensive care patients to the other end of the country. Getting the most vulnerable protected sooner is going to cut the pressure on the NHS sooner. I'm assuming a lot of health providers are going to be under the same pressures around the world.
    posted by MattWPBS at 12:52 PM on January 14 [1 favorite]


    Biden just really needs to activate the national guard or whatever elements of the military are needed to vaccinate people in a huge bulk fashion

    Biden has no effective jurisdiction over the National Guards. Those are activated by the Governors of each State, and in the case of California, this has happened already at least at the CalExpo site in SacTown.
    posted by sideshow at 1:54 PM on January 14


    One good reason for some health care workers to postpone the vaccine (for now) is that many of them have already had & recovered from COVID-19, so they're immune, at least for a while. With limited doses available, it's not unreasonable to want to protect the vulnerable people in their care rather than "top up" their own immunity. (Yes, I know the strength & duration of natural immunity from infection is still not settled scientifically.)
    posted by Harvey Kilobit at 2:01 PM on January 14 [2 favorites]


    Biden has no effective jurisdiction over the National Guards. Those are activated by the Governors of each State, and in the case of California, this has happened already at least at the CalExpo site in SacTown.

    Yes, I know this -- I should have said Biden can provide frameworks and vaccination plans that are easy for governors to activate the national guard for. Or he can use federal forces. The point is that he has a hell of a lot of resources at his disposal that Trump refused to touch. My guess is part of the reason the Trump never wanted to touch the military procurement apparatus that at least has some protections against graft and self-dealing.
    posted by benzenedream at 2:40 PM on January 14 [1 favorite]


    I don't see why this would not be a valid use for military nurses and doctors. Big 24hr sites to just move masses of people. Seems like the most vulnerable are on the verge of being handled, and there are existing stockpiles. Use them all up and encourage increased manufacturing. When done here, send them to any countries that would welcome a visit from 'merican vaccinators. How this can not go full emergency and be done in a couple months.
    posted by sammyo at 2:56 PM on January 14 [2 favorites]


    I think that the point with healthcare workers isn't that they're more likely to die, but that they need to be healthy so they can prevent other people from dying. There are severe staffing shortages in many hospitals. Staffing shortages, not equipment or bed shortages, are what's causing a lot of places to have to ration care. So it's important to vaccinate frontline healthcare workers even if they aren't particularly vulnerable to serious COVID.
    posted by ArbitraryAndCapricious at 3:37 PM on January 14 [3 favorites]


    Biden has no effective jurisdiction over the National Guards.

    The National Guard are military reserve units with joint control. They can be activated by state governors under Title 32 or by the president under Title 10.
    posted by JackFlash at 4:09 PM on January 14 [3 favorites]


    Vaccines to stimulus checks: Here's what's in Biden plan
    — A $20 billion national program would establish community vaccination centers across the U.S. and send mobile units to remote communities. Medicaid patients would have their costs covered by the federal government, and the administration says it will take steps to ensure all people in the U.S. can receive the vaccine for free, regardless of their immigration status.

    — An additional $50 billion would expand testing efforts and help schools and governments implement routine testing. Other efforts would focus on developing better treatments for COVID-19 and improving efforts to identify and track new strains of the virus.
    posted by Nelson at 4:48 PM on January 14 [2 favorites]


    I've seen several people suggest that, after healthcare workers and older people, 20--30-year-olds should be prioritized for vaccination, since they tend to drive the spread.

    The New York Times vaccine calculator puts 20-30's ahead of the likes of me in my 40's. 40-59 seems to be the dead last group to vaccinate, apparently.
    posted by jenfullmoon at 6:13 PM on January 14 [3 favorites]


    My mom is a nurse in WA and got her second dose of the Pfizer vaccine last week. She’s relieved but the side effects make her worry about compliance and antivaxers. Mostly bad headaches, which many of her coworkers also reported.
    posted by floam at 7:01 PM on January 14 [2 favorites]


    jenfullmoon, if you're looking at the NYT calculator from early December, it's not accurate; look at The COVID-19 “Vaccination Line”: An Update on State Prioritization Plans for your location.
    posted by Iris Gambol at 7:04 PM on January 14


    Sadly, that link didn't really clarify anything for me and it was pretty vague about anything that isn't in Tier 1. Am I missing something?
    posted by jenfullmoon at 9:21 PM on January 14 [2 favorites]


    Since the updated CDC guidelines and changes discussed in the FPP, some states have broken out eligibility further; more changes are expected based on an individual state's age demographics and distribution stats. That KFF.org site seems to be updated more often than the calculators (or county departments of health, for that matter). The groups of people authorized to administer the shot ought to expand, too, with gubernatorial executive emergency orders.

    But so much of this rollout is dependent on location, and I'd hoped something in the link indicating your state "differs from ACIP recommendations" in some significant way could cheer you a bit right now. Using that infernal calculator, I'm in that dead-last, 40-59 group too. Using the KFF tracker (expanded view), if I lived in, like, Montana, I'd squeak into phase 1c; a few friends in their 30s would be in phase 1c -- in Utah; & my 52-year-old brother would qualify for phase 1b in Washington State.
    posted by Iris Gambol at 10:29 PM on January 14 [1 favorite]



    I think that the point with healthcare workers isn't that they're more likely to die, but that they need to be healthy so they can prevent other people from dying.


    I think it is equally likely that close to 35-40% of healthcare workers are not terribly different than IT workers who are concerned about self-driving cars, even if as 'health care workers' they have no specific experience with epidemiology or severe viruses, just like the majority of IT workers don't work on self-driving cars. Like it or not, those taking the vaccine are still very much in the experimental stage of development and the mind can imagine negative outcomes and questionable support for those with negative experiences.
    posted by The_Vegetables at 11:34 PM on January 14


    Honestly if there was some kind of unknown severe side effect occurring in a significant amount of vaccine recipients that we'd only find about five years from now, I'd still take the vaccine. We're striving for vaccination at such a huge scale that I would be in good company. At least I was in the group of people who tried.

    If the number of people affected is high enough, it's going to look like the Black Death. Not sure the survivors would be "winning" in that situation.
    posted by meowzilla at 12:52 AM on January 15 [2 favorites]


    if there was some kind of unknown severe side effect occurring in a significant amount of vaccine recipients that we'd only find about five years from now

    This statement -- that vaccines of any sort cause long-lasting "severe side effects" -- is a dog-whistle for the scientific misinformation that leads to claims that MMR causes autism. It is, or should be, a non-starter in talking about the ethics of vaccination.

    Vaccines work by showing the immune system either a live attenuated pathogen (chickenpox/smallpox vaccine, oral polio vaccine), a dead shell of a pathogen (flu vaccine, inactivated polio shot), a snippet of a pathogen (whooping cough or HPV vaccine), or a toxin produced by the pathogen (tetanus toxoid vaccine). It's a practice run for your immune system to prep antibodies so that if/when you ever encounter the real thing, you're fired up and ready to go.

    Now, we also have mRNA vaccines (Moderna's and Pfizer's) and a vector-based vaccine (AstraZenaca's), which don't even have any bits of the pathogen in them, just the blueprint of the pathogen. mRNA is degraded within hours; adenovirus vectors in a couple days.

    "Cool," you might say, "but these are new technologies, and we just don't have enough experience with them." You might say that, but you'd be wrong. That paper is a review article on adenovirus vectors published in 2004, and in addition to citing work dating back to 1969, explicitly talks about SARS as a motivator for developing adenovirus-based vectors. mRNA vaccines are only slightly newer, with animal studies dating back to the 1990s and human trials, mostly against HIV, from the 2010s. (if you click the reference superscripts in that table you'll be taken to the citation). You can also reread lalochezia's well-sourced comments above for how these particular telescoped trials were conducted. It's a remarkable logistical achievement for 2020, but the scientific groundwork was laid down decades ago.

    Expecting long-term damage from a delivery method that disintegrates in less than a week is like expecting that water has memory. TBH, the only long-term side effect of any vaccine, whether that's against smallpox or diphtheria or flu or covid, is ... staying alive.

    Let's talk about the ethics of vaccine distribution without resorting to misinformation, even in a hypothetical. Thanks.
    posted by basalganglia at 5:06 AM on January 15 [30 favorites]


    Lena Sun, this morning:
    When HHS sec announced this wk that federal govt would begin releasing coronavirus vaccine doses reserved for 2nd shots, no such reserve existed, according to state/fed officials briefed on plans. Reserve was already exhausted.
    Because of course there was no reserve. head::desk

    I've always wondered where the masks/PPE that Kushner and the feds seized actually ended up.
    posted by Dashy at 8:09 AM on January 15 [6 favorites]


    This statement -- that vaccines of any sort cause long-lasting "severe side effects" -- is a dog-whistle for the scientific misinformation that leads to claims that MMR causes autism. It is, or should be, a non-starter in talking about the ethics of vaccination.

    I think it can be, but I also think that you have to assume good faith. Look at the list posted above applicable to the UK - there are people that are currently recommended not to take this particular vaccine. To deny these dangers is to deny reality.

    UK guidelines

    This link says it has not been tested yet on pregnant women
    posted by The_Vegetables at 8:46 AM on January 15


    Vaccine reserve was already exhausted when Trump administration vowed to release it, dashing hopes of expanded access, the article behind Dashy's comment above. The Trump administration has been playing a fucking shell game with our vaccine supply.

    30.6M doses of vaccine have been distributed to the states. I can't find any numbers on how many vaccines the United States has already acquired. Lots of news coverage that it purchased another 100M doses recently, but no indication how much has already arrived.
    posted by Nelson at 9:00 AM on January 15 [3 favorites]


    there are people that are currently recommended not to take this particular vaccine.

    This is true of every vaccine. The goal of mass vaccination is to achieve herd immunity, such that even people who cannot be vaccinated due to their personal situations, can still be protected against the illness itself.

    Pregnancy is a special category in many ways; few pregnant people were part of the trial so can't make any real safety determinations either way. We already know the hard way getting covid is bad for pregnancy. In the link you provided, as well as the CDC guidelines for the US, the recommendation is for pregnant people to discuss risks/benefits with their own doctors. Just like for 99% of other medical situations in pregnancy.
    posted by basalganglia at 10:02 AM on January 15 [9 favorites]


    This link says it has not been tested yet on pregnant women

    Pregnant women have long been excluded from clinical trials, so it's not suspicious that they weren't included in the vaccine trials. And there have always been groups of people for whom any particular drug is contraindicated, whether due to immunocompromise or some other reason.

    This video addresses the kinds of (unwarranted) concerns like "what if something bad happens in five years": Try Guys Debunk COVID Vaccine Conspiracies With Dr. Fauci
    posted by Lexica at 10:32 AM on January 15 [3 favorites]


    I'm not even a tiny bit shocked or fazed to hear there is no reserve. Literally, the worst possible choices that can be made have been made.
    posted by jenfullmoon at 11:26 AM on January 15 [3 favorites]


    Surely the second doses were only ever going to come from expected future deliveries?

    Literally having vaccine on hand and locking it away rather than give it to people would be even more scandalous.
    posted by grahamparks at 11:33 AM on January 15


    I've always wondered where the masks/PPE that Kushner and the feds seized actually ended up.

    I'll bet dollars to babkas that they're "somewhere else." Jared says they went to hospitals, but your hospital doesn't have enough? Yeah, other hospitals, "call the number on this card ('Sal's Imports and Exports') and we'll get you taken care of." Teachers? "Oh, they went to schools somewhere else, Betsy gave us a list." So on and so forth, meanwhile the PPE are tied to bricks at the bottom of the East River.
    posted by rhizome at 12:21 PM on January 15 [2 favorites]


    So, uh, what the fuck? Are there any further articles explaining what the hell happened with this 'reserve, what reserve' story?
    posted by bq at 1:26 PM on January 15 [4 favorites]


    Here's another link to the WaPo piece without a subscription paywall:

    Vaccine reserve was already exhausted when Trump administration vowed to release it: States were anticipating a windfall after federal officials said they would stop holding back second doses. But the approach had already changed, and no stockpile exists.

    So they were lying about the second vaccine while Trump was busy stirring up an insurrection with lies about the election. Even for Trump, this is hard to believe. FFS!
    posted by homunculus at 1:27 PM on January 15 [3 favorites]


    New coronavirus variants could cause more reinfections, require updated vaccines

    Note qualifier, but also note this is in Science magazine, reporting on some bleeding edge issues in new variant science. 😡
    posted by lalochezia at 7:35 PM on January 15 [3 favorites]


    Yeah it sure seems likely there will be new mutations requiring vaccine updates before we even finish vaccinating for the original strains! Good stuff, we're really doing great.
    posted by Justinian at 6:47 AM on January 16 [3 favorites]


    30.6M doses of vaccine have been distributed to the states. I can't find any numbers on how many vaccines the United States has already acquired. Lots of news coverage that it purchased another 100M doses recently, but no indication how much has already arrived.

    The news was that the U.S. was attempting to negotiate the purchase of another 100 million doses when they were available. They are not necessarily available nor does the U.S. get to jump the queue ahead of other countries that committed to their purchases earlier and that was a lot of countries.
    posted by srboisvert at 11:37 AM on January 16


    Right, the US is trying to buy more. But I've seen no data on what has already been delivered to the United States. Or even the schedule of what we've bought and when it was promised to be delivered.

    It feels like a remarkable data omission and I wonder if it's classified for security reasons? Or maybe I just missed it.
    posted by Nelson at 3:36 PM on January 16


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