Wisdom experts debate delaying the second dose of the COVID-19 vaccine

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A proposal to delay the administration of the second dose of COVID-19 vaccines – proposed as a strategy to increase the number of people receiving the same level of protection from one vaccine with the Pfizer / BioNTech or Moderna vaccines – is proposed. ‘encourages strong debate among clinicians and public health officials.

Proponents argue that it is worthwhile to provide some protection to a larger number of Americans, especially as the number of cases and hospitals continues to rise and more contagious change emerges.

Opponents raise concerns about moving away from the two-dose schedule evaluated in clinical trials, including a lack of data on long-term protection from a single dose. They also suggest that a longer interval between doses may increase resistance to the SARS-CoV-2 virus.

It is time to consider delaying the second dose, Robert M. Wachter, MD, at the University of California San Francisco and Ashish Jha, MD, MPH, at Brown University in Providence, Rhode Island, wrote in a piece comment in The Washington Post January 3rd.

Both experts say supply restrictions, circulating bottles, and hundreds of thousands of new infections each day boosted their stance on administering COVID-19 vaccines according to the two-dose clinical trial rule. In addition, they cite a study in the New England Journal of Medicine that suggests an 80% to 90% efficacy for the prevention of SARS-CoV-2 infection after a single dose of the Moderna vaccine.

Not everyone agrees that a single dose is a good idea. “Clinical trials with specific records for vaccine doses – that’s the whole basis of the scientific evidence,” said Maria Elena Bottazzi, PhD, associate dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, Texas. Medscape Medical News.

After one dose “the immune system learns, but it’s not very suitable. That’s why you need a second dose,” Bottazzi said. “I appreciate the urgency and the confusion… but the data support [that] clinical efficacy requires two doses. “

Another strategy proposed to expand the current supply of COVID-19 vaccines to more Americans involves splitting the current dose of the Moderna vaccine in half. It is reported that officials in the United States and the United Kingdom are considering this approach. In the U.S., any dosing change must be approved by the FDA.

Agreeing to disagree

Wachter shared a link to his comment piece on Twitter, saying “We both came to this idea because of the slow release & the new variant. But it’s a difficult call and reasonable people will disagree. “


As expected, the tweet received a number of strong comments.

“There are no right answers but there is a lack of data, plenty of fodder and a need for healthy, intellectual debate. That would not happen if there was an adequate supply of vaccines,” Eric Topol, MD, director of the Scripps Institute of Translational Science and Medscape editor-in-chief, tweeted on January 3rd.


“If the problem was with the supply of the vaccine, one could argue to focus on the first dose. But the problem is in the circulation of the vaccine & giving real doses,” tweeted John Grohol , PsyD.


“Right now we don’t have a supply case, we have a distribution issue,” said Angela Shen, ScD, MPH, a research scientist in the Vaccine Education Center at Philadelphia Children’s Hospital. Medscape Medical News. Emergency use approval for Johnson & Johnson vaccines and other COVID-19 vaccines in development could further improve the sources available, she said.

“The clinical trials examined two doses,” Shen said. “We have no data that single-dose protection is permanent.”

Is the equation of change variable new?

Wachter and Jha, in their editorial, quoted from former boxing champion Mike Tyson, “Everyone has a plan to get their mouths pounded.” , the high number of cases and deaths in the United States, and other problems they are about to advocate for the delayed dosing strategy.

“Appreciate the concern about the new variant – I think it’s worth noting that we are puncturing ourselves with the slow release of the vaccine, and this is the first problem. to solve, “Jake Quinton, MD, an internist at UCLA Health in Los Angeles, noted on twitter.


Vaccination and public standing were raised

“I agree with the problem but not with the proposed solution, which is non-data-based work,” the Jan Grimm Lab at the Sloan Kettering Cancer Memory Center in New York City responded to Wachter and Jha on Twitter. “However, there are data showing that 1 bullet alone did not receive an adequate T-cell or antibody response. This could lead to mutations that are resistant to the vaccines. Dangerous!”


Other doctors took to Twitter to say that changing the recommendations at this stage could damage public confidence in the COVID-19 vaccine. For example, Deirdre Habermehl, MD, wrote, “We have spent months telling the public that the best way is to follow the science and now without data think course correction based on measurement okay? Public confidence is low enough and logistics are real at this stage. “


Shen and Bottazzi have not disclosed any material financial relationships.

Damian McNamara is an employee a Miami-based journalist. It covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter: @MedReporter.

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