1 vaccine shot or 2? New tactic debated
Amid slow U.S. rollout and a new viral strain, experts rethink strategy
With the coronavirus vaccine rollout alarmingly behind schedule across the United States and a more contagious strain of the disease spreading in at least three states, epidemiologists are abuzz over a new overseas strategy: Delaying the second dose of the vaccine to get more people at least partly immunized faster.
Last week, British officials announced they would prioritize partly vaccinating more people over administering second shots three or four weeks later, which prompted a heated debate among American health experts desperate for faster vaccinations amid a nationwide surge.
But a maddening patchwork of vaccine plans — not to mention scientific uncertainty over a delayed second dose — means that such a shift is unlikely to happen in the U.S., epidemiologists say.
“I’m all for getting as many people vaccinated as possible for community benefit,” said Dr. Peter Chin-hong, an infectious disease expert at UC San Francisco, where the chair of medicine recently said he supported a one- dose plan. But given how piecemeal and confusing the rollout has been already, he said, “it would never be possible in the U.S.”
The Pfizer-biontech and Moderna vaccines are both administered in two doses, three and four weeks apart, respectively. Although the vaccines are more than 90% effective with two doses, it’s unclear exactly how delaying the second dose beyond when manufacturers recommend would affect the population at large.
British officials made the trade- off in order to do “as much good for as many people in the shortest possible timeframe,” U.K. chief medical officers wrote in a letter Thursday, citing data showing “the great majority of the initial protection from clinical disease is af
ter the first dose of vaccine.”
Dr. Bob Wachter, chairman of the UCSF Department of Medicine, said in a series of tweets Thursday that the slow rollout and new viral variant “demand that we turbocharge the process of getting a large chunk of the population at least partly protected” with a single shot, particularly as Americans tire from pandemic precautions.
“It seems increasingly evident that a strategy of getting as many people (particularly high-risk) their first shot ASAP will save far more lives than sticking with the two shot plan,” he wrote.
Wachter was unavailable Saturday.
On the national level, however, the idea has yet to gain much traction. National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci said last week the strategy was “under consideration” but clarified Friday that the U.S. will not follow Britain’s lead.
Because states are largely responsible for their own vaccine rollouts after the federal government allocates the doses, they could theoretically make the shift on their own. The Califor
nia Department of Public Health said in a statement Saturday it was “continuing to carefully review” clinical trial results to weigh against the potential benefit of vaccinating more people.
But Dr. Kirsten BibbinsDomingo, another UCSF epidemiologist, said California would be wise to stick with its current plan.
“Even though theoretically a single- dose strategy with a long lag could get more people with immunity, we risk that it creates way more logistical hurdles to shift gears midstream without the benefit,” Bibbins-domingo said. “It’s hard to imagine that is the right strategy.”
About 4.2 million people have received the first dose of either the Pfizer or Moderna vaccine as of Saturday, according to the Centers for Disease Prevention and Control, far belowthe20 million that the U.S. had aimed for by the start of the year.
Fixing those delays has taken on fresh urgency after a more contagious strain of COVID-19 has been discovered in three states, including California. Although there is no evidence the strain is more deadly, scientists believe it’s re
sponsible for recent spikes in England, meaning that the U.S. faces the threat of even more infections atop the current winter surge.
In California, the sevenday case average has more than doubled since the start of December to past 39,000 new daily infections. Hospital intensive care capacity meanwhile remains at 0% in Southern California and the San Joaquin Valley and has dipped to just 5.1% in the Bay Area. Overall, the state reported 53,341 new cases Friday and 386 new deaths, the bulk of which were in Southern Califor
nia, where health experts were seeing signs of a postholiday surge.
With their risk of infection seeming higher than ever, many anxious residents have recalibrated their expectations for when — if at all — they may get vaccinated in the coming months.
Oakland resident Patricia Fuschetti, 78, has been trading information with friends from Boston and the Bay Area about their eligibility to no avail.
“Nobody knows, because there’s no rhyme or reason to what’s happening,” said the retired nurse, who would like to see President- elect Joe Biden’s administration come up with a nationalized vaccine response. “There’s no centralized plan.”
The one-dose versus twodose decision, she said, seems like yet another thing that local and state governments could bungle without clear directives from the federal government.
“Think of the New Deal,” Fuschetti said. “T hink about what works in history and what has to happen quickly.“
Stuart Rojstaczer, 64, a writer who lives in Palo Alto, has been in touch with Israeli relatives around his age who have already received their first doses. He had hoped the vaccine would allow him to see his daughter on the East Coast this spring — and even attend a May wedding in Israel — but all that seems unrealistic now.
“We’re doing something wrong, clearly,” he said of the rollout. “It’s going to be a little longer before I see people I love.”