This fall, Schwartz and Paltiel, along with Rochelle Walensky, who is now head of the Centers for Disease Control and Prevention, took a closer look at the issue of saving more lives: a two- a very effective dose, such as those from Moderna And Pfizer, or one that is less effective but easier to get into people’s arms, like J&J. Effectiveness versus effectiveness. They designed a simple model that predicted the number of possible deaths and hospitalizations in the spring, based on the true state of the pandemic, and compared how well they were treated. various theoretical illustrations stop them. For the most effective two-dose vaccines, they started with a 75 percent effectiveness. “We thought that was the best we could hope for,” Schwartz says. (When the results of Pfizer and Moderna arrived, the team had to quickly reverse their numbers.)
Even with the two-dose vaccine hit up to 95 percent efficacy, their model suggested that efficacy remained significant. A 55 percent effective single-shot vaccine could have prevented the same number of deaths, they found, while many people would quickly get that sight. So is the team’s excitement about adding J&J results, Schwartz says. It requires half as many doses – which means half the loads, the signs, the staff time, a headache – to protect the same number of people. And, unlike his team’s imitation, the U.S. is getting both types of vaccine, not just one or the other, meaning more deaths can be avoided.
Still – and here we stop to avoid the question – by getting all these options states have to decide where doses of each go. There is no guidance yet on where vaccines will be sent, and Schwartz believes that many states will choose to keep it that way: the feds will send out a batch of vaccines, and they will go to whatever provider – regardless of the supplier. that is a pharmacy or doctor. office or general clinic – needed. In other words, the incoming, first-served and relatively random distribution. But other states may see an opportunity to prioritize certain vaccines for some people. They could try to retain the mRNA vaccines for those most at risk of serious illness, with the slight increase in immunity. Or they could choose to promote the J&J vaccine to some areas – say, rural communities with less medical infrastructure – because of its ease of use.
But Ann Lewandowski, program manager at the Wisconsin Rural Health Association, says that does not address the challenges of a vaccine rollout effort so far. The supply challenges specific to the mRNA vaccines, such as freezer replacement, have been far less than ensuring an appropriate and predictable supply – enough for their patients, but less so. in a batch that they get over. (One way J&J could help put out smaller, more flexible orders is appropriate for small clinics, Lewandowski says. The company did not respond to research about the minimum order size expected.) In any case, she agrees with Fauci: The greatest need is delivering more shots.
There are some situations where she would find a single-vaccine vaccine particularly useful. This may be the case for situations where second doses are particularly difficult to schedule: for example, at a pop-up clinic serving homeless people. Lewandowski has a relationship without a permanent address or doctor, and she knows how difficult it is to be able to get people in these situations back for a second dose. “I’m an expert,” she says. “I have a personal experience with someone who is hard to find.” But when she posted the idea in a Facebook group where health workers discussed J&J’s results, she got pushed back. Another health official argued that giving less effective vaccines to vulnerable people was like “giving” when they were rediscovered for a second dose, bringing them back to lower yield.