Re­lease sec­ond doses to speed vac­ci­na­tions

Sup­ply will rapidly ex­pand to meet needs

- Tin­g­long Dai and Prashant Ya­dav

As of Mon­day about 9 mil­lion Amer­i­cans, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion, have re­ceived the first dose of a COVID-19 vac­cine, which is far be­low the goal of vac­ci­nat­ing 20 mil­lion peo­ple by the end of 2020.

The slow vac­cine roll­out is oc­cur­ring at the same time the United States is en­dur­ing record lev­els of in­fec­tions and deaths.

To ac­cel­er­ate vac­ci­na­tions, some have pro­posed to de­lay the tim­ing of the sec­ond dose. Crit­ics of this ap­proach ar­gue that it lacks clin­i­cal ev­i­dence and may weaken the pub­lic’s con­fi­dence in vac­cine ef­fec­tive­ness.

In the ab­sence of ad­di­tional clin­i­cal trial data to sup­port chang­ing the tim­ing of doses, the Food and Drug Ad­min­is­tra­tion strongly rec­om­mends fol­low­ing the au­tho­rized dos­ing sched­ule for the cur­rent COVID-19 vac­cines.

A re­lated is­sue is that Op­er­a­tion Warp Speed and hos­pi­tals have held back vac­cine doses to en­sure those who have re­ceived the first shot will have guar­an­teed ac­cess to the sec­ond. Op­er­a­tion Warp Speed is hold­ing back more than half of the vac­cine in­ven­tory for sec­ond doses.

At the same time, hos­pi­tals also are hold­ing back sec­ond doses. The prac­tice is well-mean­ing but traps up to 85% of our life-sav­ing vac­cine doses in ware­houses and hospi­tal freez­ers.

As sup­ply chain ex­perts who have fol­lowed closely the COVID-19 vac­cine roll­out, we be­lieve that at this early stage, Op­er­a­tion Warp Speed and health care providers should not hold back the sec­ond doses.

Our rec­om­men­da­tion is based on our analysis of how vac­cine sup­ply will change in the com­ing months, the way vac­cines are ad­min­is­tered in prac­tice, and how the sup­ply of and de­mand for vac­cines evolve over time.

Sup­ply dis­rup­tions are un­likely

First, hold­ing back a sig­nif­i­cant pro­por­tion of doses makes sense only when the sup­ply is ex­pected to de­crease be­cause of man­u­fac­tur­ing and sup­ply chain dis­rup­tions.

While sup­ply dis­rup­tions are a real pos­si­bil­ity, the like­li­hood of such a sce­nario is rel­a­tively low. Both Pfizer and Moderna are ramp­ing up their vac­cine pro­duc­tion, and we ex­pect to see an uptick in the com­ing months, which means there is lit­tle rea­son to hold as much as half of vac­cine doses to pro­tect against pro­duc­tion glitches.

Sec­ond, most peo­ple who re­ceive a first dose are im­me­di­ately sched­uled for their sec­ond vac­cine ap­point­ment. So even if fu­ture sup­ply is lower than an­tic­i­pated, the sys­tem can be de­signed to pri­or­i­tize those who have re­ceived their first doses over those who have not.

No need to hold back doses now

In essence, even if vac­cine sup­ply re­mains flat, most health care providers will still be able to sat­isfy the need for sec­ond doses. By not hold­ing back doses, more peo­ple can re­ceive their first doses ear­lier, which max­i­mizes the power of COVID-19 vac­cines to end the pan­demic.

Third, the de­ci­sion to hold back sec­ond doses de­pends on the stage of COVID-19 vac­ci­na­tion. We are at the be­gin­ning of the vac­ci­na­tion process, and both sup­ply and de­mand will rapidly ex­pand in the com­ing months.

It makes lit­tle sense to hold back doses at this point. Hold­ing back a sig­nif­i­cant pro­por­tion of doses makes sense only when sup­ply is ex­pected to be flat and the de­mand is ex­pected to grow, a sit­u­a­tion we may en­counter in the late spring when the gen­eral pop­u­la­tion has ac­cess to COVID-19 vac­cines.

The on­go­ing de­bates about whether we should give ev­ery­one only a sin­gle dose or de­lay the sec­ond dose are based on false trade­offs. A more ur­gent prob­lem is to re­ex­am­ine the sig­nif­i­cant pro­por­tion of COVID-19 vac­cines that have been held back.

We are glad to see that the prob­lem is on Pres­i­dent-elect Joe Bi­den’s radar and his team plans to re­verse the holdup strat­egy. On Tues­day, the Trump ad­min­is­tra­tion also sig­naled that it will now en­cour­age states not to keep sec­ond doses in re­serve.

In the un­likely event that fu­ture sup­ply be­comes more con­strained due to sup­ply dis­rup­tions, we can at that point de­cide whether to pri­or­i­tize those who need a sec­ond dose or use the lim­ited sup­plies for vac­ci­nat­ing more peo­ple with the first dose.

But for now, we do not need to, nor should we, make that de­ci­sion. Too much is at stake. Tin­g­long Dai is an as­so­ci­ate pro­fes­sor of oper­a­tions man­age­ment and busi­ness an­a­lyt­ics at the Johns Hop­kins Uni­ver­sity Carey Busi­ness School. Prashant Ya­dav is a se­nior fel­low at the Cen­ter for Global De­vel­op­ment and a lec­turer on Global Health and So­cial Medicine at Har­vard Med­i­cal School.

 ?? GETTY IMAGES ?? Pfizer and Moderna are ramp­ing up vac­cine pro­duc­tion.
GETTY IMAGES Pfizer and Moderna are ramp­ing up vac­cine pro­duc­tion.

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