18 ms·

We should administer Covid-19 vaccines as fast as possible, not reserve doses

170 points by elsewhen 6y ago

d33lio 6y ago
But we're supposed to prolong the temporary overreach of government power! /s
- dtoznayxvf 6y ago
  They never do let a good crisis go to waste do they? Tell you what all those talking heads arguing about who get's to be first can have my dose.
JoeAltmaier 6y ago
All things being equal, perhaps. But first doses are medical professionals and other critical workers. Guaranteeing they will be here for the long haul is another worthy goal. I'm not sure 'spray and pray' is a well-thought-out approach. Its perhaps another internet pundit who can take one number and divide by another number and become an instant expert.
- BurningFrog 6y ago
  The proposal is not to start vaccinating random people off the street. It is to vaccinate twice as many high priority people.
- dougmwne 6y ago
  This is not what the article is about at all. It is saying we should not reserve the second dose in the freezer for that patient and should instead immediately distribute it to at-risk populations. Then we should trust the supply chain will come through for the second dose and that a 1-2 week delay in case it did not would not overly harm immunity. It is perhaps a very sensible suggestion that would depend on the supply chain quality. I think we should all make efforts to tone down our rhetoric and not tilt at windmills.
  - JoeAltmaier 6y ago
    Sure it is. Again, if there should be some issue with the supply chain, then the first dose could be 'wasted'. For hospital personnel etc that would be a bad scenario. We're not talking millions/billions of doses. We're talking about what are really very small numbers. It may be worth taking some very small hit in herd immunity, for an assured continuity of care.
    - vonmoltke 6y ago
      > Again, if there should be some issue with the supply chain, then the first dose could be 'wasted'. It's not "wasted". As noted in the article, the first dose alone is ~50% effective; the second dose is required to boost that to ~93%. So, it's a tradeoff between vaccinating n people at 93% effectiveness versus 2n people at 50% effectiveness.
    - random5634 6y ago
      Is there an actual serious claim that the first dose would be wasted? This claim is being made despite CLEAR CDC guidance on how to handle delayed vaccination doses? I'm serious - where is the citation for the claim you are making that the first dose is wasted if the second dose is not perfectly on schedule. The reason this claim is likely a lie is that millions / billions of vaccines are given out. Every school child in America is getting vaccines. With very narrow exceptions, if you are off the exact timing (ie, you get a 12 month vaccine a bit later, you get the second shot 14 days later) which by the way happens ALL THE TIME because doctors and parents are busy etc - there is no evidence that the first shot is wasted or that you need to restart vaccination. So please provide a citation for the "first shot wasted" claim.
      - bluGill 6y ago
        Provide citation yourself for this case. Nobody can, there is no data to cite. The only data that we have is that getting both doses on schedule works. Everything else is speculation.
- paulgb 6y ago
  The issue is not who gets the vaccine, but whether to hold the second doses in reserve or distribute them as first doses and use later-arriving doses as second doses. The former has the obvious advantage of vaccinating more people quickly, but runs the risk that if the second doses don’t arrive on time the effects of the first dose will wear off. Edit: I originally used the phrase “back to square one” but I agree with replies that it’s the wrong phrase.
  - sanxiyn 6y ago
    Why is one "back to square one"? Pfizer vaccine schedule is the second dose at 21 days after the first dose, but as I understand, in theory, the second dose after a month, or even two months, should work equally well (except obviously reduced protection in between).
  - JoeAltmaier 6y ago
    Sure it is about who gets it. Saved for 2nd doses for critical workers, or distributed to those further down the list now.
  - newen 6y ago
    The first dose is already 50% effective, so you are not back to square one. The second dose also doesn't necessarily need to arrive precisely on time.
cryptica 6y ago
Agreed, we need to incapacitate... Um, I mean inoculate the peasants as swiftly as possible so that they don't start to become suspicious... Um, I mean paranoid. Damn it, where is Bill Gates when you need him? He knows how to reassure the peasants. Anyway, I think we should start with young fit adults first, then do old people and children last...
- jtsiskin 6y ago
  Is this a serious belief you have?
  - cryptica 6y ago
    Mostly satire to summarize the current mood of distrust and paranoia. I think that the people at the top have been getting more crooked and reckless so the trend is definitely getting there but I don't think we're there yet but I'm not 100% sure. It wouldn't be totally uncharacteristic of those in power in any case, just look at WW1 and WW2 (70+ years ago so perhaps we're overdue for a culling).
ars 6y ago
Summary: The title makes it seem like they are talking about medical professionals vs general public. But actually they are talking about reserving second doses for those who got the first dose, and the article says it's better to actually administer those doses, even if it means a delay on the second dose for people.
- paulgb 6y ago
  I hope that if people don’t bother to read the article they at least see your comment. Most of the comments here so far are debating the merits of what they assume from the title rather than the text of the article.
  - ogre_codes 6y ago
    When a pay-walled story is posted, the number of people who read the story drops significantly.
- y-c-o-m-b 6y ago
  Thanks for this quick summary. I've got a pay-wall error and can't read the article.
chiefalchemist 6y ago
Somewhat off topic but in theory, would it be possible to have jab #1 be Moderna's and jab #2 be Pfizer? Would it be ethical to test this? Is there anything inherent in either's approach that would make this dangerous?
- BurningFrog 6y ago
  As just another software guy who's near that dangerous "knows enough to be overconfident" spot: That would probably not work the same way. The point of a booster shot is to make the immune system "think" it's been infected by the same intruder twice, so it steps up permanent defences to a more serious level. Both the Moderna and Pfizer vaccine produces replicas of the virus "spike protein", but with (presumably) different mRNA formulas. So if their different versions are similar enough that the immune system sees them as "this shit again!", which would work as a booster shot, or as an unrelated infection, is impossible to say. At least for me, who is (again) unqualified to talk about this stuff. That said, two vaccines would at minimum be better than one.
  - davrosthedalek 6y ago
    Well, they are at least similar enough to the real thing that the body would say "this shit again!" for the real virus. My guess is that they have different start/stop sequences (that shouldn't matter for the protein the mRNA is encoding) and different stabilizers to help the mRNA survive.
- ufo 6y ago
  There only way to know for sure would be to run a controlled trial. Vaccines can work (or not work) in surprising ways.
- wyldfire 6y ago
  The danger is that it's untested and might not provide any more benefit than just the first injection.
- sanxiyn 6y ago
  In theory, yes, that should work. In practice, immunology is very complex and the only way to be sure is to test.
inglor_cz 6y ago
Israelis give shots to medical workers and oldest citizens first. This should drive down the death rate pretty fast. If this approach works, Covid-related deaths in Israel should visibly drop by the end of January.
- raverbashing 6y ago
  All countries are doing these groups first, of course Israel is probably the country doing it the fastest so I agree, we should see the results faster. And I agree with the topic, better 2 people somewhat immune "now" than half with the full vaccine immunity.
  - adriancr 6y ago
    > And I agree with the topic, better 2 people somewhat immune "now" than half with the full vaccine immunity. the 90%+ effectiveness is only with 2 does, who knows how long and if it works with only one dose... it's likely not half and/or not for very long...
    - jacob019 6y ago
      Immunity is not binary. Introducing the spike protien to our immune systems now will prime us for a stronger fight later, even if we are not fully immune.
    - zbjornson 6y ago
      Moderna's phase 3 includes preliminary data on a single dose, and it appears 80-90% effective at/after two weeks. See table 15 on page 28: https://www.fda.gov/media/144434/download https://www.fda.gov/media/144434/download https://www.wbur.org/commonhealth/2020/12/18/coronavirus-vaccine-single-dose-debate https://www.wbur.org/commonhealth/2020/12/18/coronavirus-vac...
      - mercurywells 6y ago
        From the same report: > The small, non-random sample and short median follow-up time limits the interpretation of these results. There appears to be some protection against COVID-19 disease following one dose; however, these data do not provide sufficient information about longer term protection beyond 28 days after a single dose. Obviously it'd be great if we can just dose everyone we can once then do a 2nd dose later, but we just don't know enough about how well that would work out long term.
Lewton 6y ago
This seems very Canada specific, is any other country doing it like this? I'm fairly sure neither the US nor most european countries are doing this (I mean, Canada seems to be the only place that are reserving the second doses) Edit: This article is clearly being upvoted based on title alone
- the_svd_doctor 6y ago
  I’ve seen multiple experts in the media mentioning this idea in Belgium. Not sure if it is really considered by the government though.
- kevin_nisbet 6y ago
  The initial vaccination statistics I saw over the weekend suggested that the US/UK have both far outpaced the Canadian vaccination rate (adjusted for population). I don't want to cite specific numbers as I don't remember what they were, but it was a pretty large gap among countries that had approved the vaccines.
- Mauricebranagh 6y ago
  Tony Blair suggested it
  - tonyedgecombe 6y ago
    That famous epidemiologist.
- Exmoor 6y ago
  I had read that the USA is/was initially ensuring there were two doses onsite for each person vaccinated, until they felt the supply chain had proven to be consistent. I'm having trouble sourcing that though.
  - formercoder 6y ago
    I saw that too and it makes sense. Begin with the most conservative approach and transition to just in time as confidence builds.
bluenose69 6y ago
It seems reasonable for different provinces to take different approaches, since their disease patterns vary significantly. Ontario and Québec have endured many weeks of increasing numbers of diagnosed infections per day, whilst the other provinces have seen decreases. The absolute incidences also vary between provinces, letting some test-and-trace cases more easily than others.
- Lewton 6y ago
  > Ontario and Québec have endured many weeks of increasing numbers of diagnosed infections per day Which would indicate that they -shouldn't- be reserving doses...
- dghughes 6y ago
  >..whilst the other provinces have seen decreases. Nova Scotia had a big jump mostly Halifax since it's the most populated part of the province.
- bryanlarsen 6y ago
  That's interesting phrasing. Ontario & Québec have increasing numbers but they still have lower per capita case rates than western provinces.
  - ced 6y ago
    Not really true anymore, according to https://mackuba.eu/corona/#compare.daily?pop=1&c=ca-on,ca-qc,ca-ab,ca-nb,ca-bc,ca-mb,ca-sk&trend=7 https://mackuba.eu/corona/#compare.daily?pop=1&c=ca-on,ca-qc...
    - cmrdporcupine 6y ago
      Alberta's numbers over the holiday are nonsense. Hinshaw even said so herself.
- hawkesnest 6y ago
  I would think we have the models to try many different strategies to determine the "best" distribution methodology. Depending upon what the definition of "best" is, of course.
sradman 6y ago
Ontario changes COVID-19 vaccination plans after slowing rollout [1]: > Ontario has changed its COVID-19 vaccination plan to give a first dose to as many people as possible and no longer hold second doses in reserve General Rick Hillier (retired) to Provide an Update at Queen's Park [2] today at 11am EST which is currently shown in the upcoming "Live" tab of CPAC [3]. [1] https://www.theglobeandmail.com/canada/article-ontario-changes-covid-19-vaccination-plans-after-slowing-rollout/ https://www.theglobeandmail.com/canada/article-ontario-chang... [2] https://news.ontario.ca/en/advisory/59836/general-rick-hillier-retired-to-provide-an-update-at-queens-park https://news.ontario.ca/en/advisory/59836/general-rick-hilli... [3] https://www.cpac.ca/en/ https://www.cpac.ca/en/
- sradman 6y ago
  The update by Rick Hillier is complete [1]. For Ontario residents, the key new information: - clinic holiday shutdown was a mistake; daily operation will now be the norm - first Moderna shipment arrives within 24 hrs, will be distributed outside clinics - the vaccination rate is currently limited by supply - 80K Pfizer / 50K Moderna per week in January - Phase 1 (vulnerable and health care workers): Jan-Mar (~1M) - Phase 2 (expanded distribution): Apr-Jul (~8M vaccinated total) - sentiment: over 80% of population willing to vaccinate as soon as possible - Hillier requested that Health Canada consider a 1-dose Moderna regiment [1] https://youtu.be/dy0ctRiU2IM?t=1008 https://youtu.be/dy0ctRiU2IM?t=1008
jancsika 6y ago
I wish there were a "flag" button but for the ensuing low-effort, low information discussion you know will come for a story clearly outside the expertise of anyone who posts here. flags as such If I come back and read any comment here that leaves me with more knowledge than when I arrived, I promise in the future to reward HN by donating 4 horror stories about uncles working union jobs.
- ketamine__ 6y ago
  There is. Go the direct link for a comment.
ojbyrne 6y ago
Seems like there could be a middle ground, administer more or less of the second dose based on the amount stockpiled and the probability of future deliveries.
- tdy721 6y ago
  Testing is already strained? And missing doses is all waste. Too risky imho?
  - Siira 6y ago
    I have heard a single dose is still pretty effective.
sunstone 6y ago
In practice it's likely that we'll do both. That is, all the doses will be used, and none reserved, as they arrive according to a priority schedule (ICU staff, care home staff, care home residents first, etc). Then when it's time for the second dose, the high priority targets will get their second dose immediately as new doses arrive while lower priority targets may have their second dose delayed as a first dose is given to those even further down the priority list. The result being that those at highest risk get the double dose ASAP while the twenty year olds get their first dose at the expense of the forty year olds having to wait a little longer for their second dose. This is because even a first dose while not fully protective is protective against serious covid-19 outcomes which is a big deal in itself. According to this scheme twenty year olds will be getting their second dose sometime in their thirties. :)
mannykannot 6y ago
Even if it were the case that the vaccination is only effective once the second dose is given in time, holding back half the supply is far too drastic: if the supply chain failed to the point where these doses would all be used for this purpose, we would have a much bigger problem on our hands.
jpdus 6y ago
I don't get why nobody seriously considers a one-dose regimen for the fastest possible vaccine rollout. All available data for both, Biontech/Pfizer and Moderna's vaccines suggests that one dose is enough for >90% efficacy which would be sufficient to reach herd immunity. There was a very good opinion article in the NY Times [1] about that, but not much more. The problem here is that a one-dose regimen was not studied in the trials. While it is good medical practice do not deviate from trial designs (see the Oxford/AZ vaccine), the data is very clear here. The vaccines are effective 14 days after the first dose and before the second dose. Sure, there are risks (maybe the efficacy drops later on or it is more difficult to reach the full efficacy if the booster shot is delayed) but these risks seem to be negligible compared to the hundreds of thousands additional unnecessary deaths due to limited vaccine supply and delayed vaccination with a two-shot regimen. We know from other vaccines that the timing of the booster shot normally is not that important and it is very probably that a booster shot after a few months would be exactly as good as a booster shot after 4 weeks. In my opinion, nobody seriously contemplates the one-dose regimen because somebody has to take responsibility to deviate from the proven and tested protocol - politicians have nothing to win here but much to loose in case anything goes wrong. And big pharma has no interest in financing and starting one-dose trials asap b/c it would hurt their own bottom line and there is no financial incentive at all, quite the opposite (+they have the same responsibility problem). This is a deadlock which will cost many, many lifes. [1] https://www.nytimes.com/2020/12/18/opinion/coronavirus-vaccine-doses.html https://www.nytimes.com/2020/12/18/opinion/coronavirus-vacci...
- tehjoker 6y ago
  That's not what the Pfizer paper showed. There was a confidence interval from between 20-70% iirc for the first shot. Maybe if we're lucky it's on the higher end, but I would stick to proven science if we're going to combat this thing effectively.
  - deleted 6y ago
    [deleted]
  - mlyle 6y ago
    Wargame the scenarios. You wouldn't want to give one dose on purpose, but reserving a whole bunch of doses to prevent some people from getting only 1 in a worst case scenario is silly. That 20-70% efficacy number includes the entire period between dose 1 and 2. It looks way better 10 days after dose 1, btw-- MLE around 80%. e.g. single dose -- 50% efficacy (to be pessimistic); double dose -- 95% efficacy. 10M doses "in flight" monthly. 100 deaths/million/month. Ignore all effects on transmission (to be more pessimistic). Scenario 1 (no logistics disruption, half held back): 5M dosed with 1 dose at day 0, 5M dosed with 2 doses at 1 month and 5M dosed with 1 dose at 1 month. 250 saved in first month, 725 saved in second month. Scenario 2 (no logistics disruption, 25% held back): 7.5M dosed with 1 dose at day 0, 7.5M dosed with 2 doses at 1 month and 2.5M dosed with 1 dose at 1 month. 375 saved in first month, 837 saved in second month. Scenario 3: (100% production disruption, half held back): 5M dosed with 1 dose at day 0; 5M dosed with 2 doses at 1 month. 250 saved in first month, 475 saved in second month. Scenario 4: (100% production disruption, 25% held back): 7.5M dosed with 1 dose at day 0; 2.5M dosed with 2 doses at 1 month; (5M late for dose 2); 375 saved in first month, 612 saved in second month. With a 25% reserve, you only get into the unexpected-only-1-dose regimen with a supply disruption of more than 50%... and even then it's still probably better than a 50% reserve.
myth_drannon 6y ago
Canada is the slowest among G7. vaccines administered per 100 people: • Canada at 0.14 • United States at 0.59 • United Kingdom at 1.18 • Bahrain at 3.23 • Israel at 4.37
- alex_duf 6y ago
  where did you find these figures? I've been trying to find some reliable source to keep an eye on it and I haven't been very successful so far
  - _Microft 6y ago
    Check this out: https://ourworldindata.org/covid-vaccinations https://ourworldindata.org/covid-vaccinations The sources they use to compile the data are listed here: https://github.com/owid/covid-19-data/blob/master/public/data/vaccinations/locations.csv https://github.com/owid/covid-19-data/blob/master/public/dat...
    - jpster 6y ago
      Wish I could find estimates showing “At current / projected vaccination rates it will take X years to vaccinate 90% of the population”, per country. I heard on TWiV (This Week in Virology podcast) for the US it was ~6.6 years and I believe it was based on < 90% of pop.
      - rsynnott 6y ago
        _Current_ rates are likely not worth worrying about, not this early on. Rates should be expected to increase fairly dramatically in the next weeks.
        jpster 6y ago
        I hope so. But, frankly, most national and local responses to this outbreak have been subpar. I do not take it for granted that we (the US) can pull off this major logistical challenge smoothly or on an aggressive timeline.
beervirus 6y ago
> We're sorry but we are unable to validate your access to this article. Please adjust your browser settings or turn off any extensions that may be causing this issue. Hard pass.
rkagerer 6y ago
So what happens if the second dose arrives very (eg. many months) late? Can you start again and give 3? And is there any chance all the partial immunities will catalyze resistant mutations?
- generationP 6y ago
  Disclaimer: not an immunologist. > So what happens if the second dose arrives very (eg. many months) late? Can you start again and give 3? WHO guidance on incomplete vaccine courses (pre-COVID): https://www.who.int/immunization/policy/Immunization_routine_table3.pdf https://www.who.int/immunization/policy/Immunization_routine... In almost all cases, the suggestion is "resume without repeating the previous dose". The only exceptions are typhoid and cholera vaccinations. I don't know what these suggestions are based upon, but the source is as close to expert consensus as it can go (the WHO has gotten a lot of flak on COVID, but I have never heard anyone seriously doubt its guidance on standard vaccinations). > And is there any chance all the partial immunities will catalyze resistant mutations? Apparently this doesn't even happen much for antibiotics ( https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2536180 https://jamanetwork.com/journals/jamainternalmedicine/articl... ), so I wouldn't worry about it happening for vaccines. See https://www.pnas.org/content/115/51/12878 https://www.pnas.org/content/115/51/12878 for a comparison. If it were a major issue, it would just as well be an issue with fully delivered vaccination courses, as they don't offer 100% immunity either. The amount of mutations arising should still be proportional to the sick population (or, rather, to its total prevalence over time and population), and anything that reduces the latter should reduce the former. Any vaccine-immune mutation can just as easily come up before the vaccine, unless it hampers the virus so strongly that it is unviable until the evolutionary landscape has shifted. At that point, however, we're looking at a much simpler problem.
- est31 6y ago
  > So what happens if the second dose arrives very (eg. many months) late? Can you start again and give 3? Stockpiling of vaccines is a method to obtain certainty that you can vaccinate on schedule. There are better methods of ensuring certainty, e.g. by supporting manufacturers as well as possible to meet schedules, analyze weaknesses in supply chains, trying to counter them early, etc. The issue is the cost of maintaining the stockpile: > she and her colleagues projected that frontloading vaccine doses would avert between 34 and 42 per cent more symptomatic coronavirus infections, compared with a strategy of keeping half the shipments in reserve. What's the cost of delaying the second shot for some groups? It's certainly non-zero, but 34 to 42 percent less symptomatic infections is a lot of prevented infections (and death). The cost-benefit analysis gives a clear conclusion: don't stockpile.
dan_hawkins 6y ago
Copenhagen hospitals vaccinating more people than scheduled [0] > Hospitals in the Copenhagen area are ahead of their COVID-19 vaccination schedule, according to the Capital Region’s vaccine taskforce. > According to the taskforce, 20 percent more people than calculated have been vaccinated because each vial contains at extra 1-2 doses. > The reason for the extra doses is producer Pfizer/BioNTech adding a bit to account for potential spillage. > And so to attain the excess doses, health personnel must handle the vaccine with care. [0] https://cphpost.dk/?p=121536 https://cphpost.dk/?p=121536 Edit: formatting
corona-research 6y ago
Is this vaccine some kind of genocide on idiots?
Animats 6y ago
This is an early stage situation. Once the supply pipeline starts running smoothly, having some number of doses in reserve will still be needed, but not as many. Combat logistics for ammo has the same problem. The person in charge of vaccine distribution planning is an Army logistics general, who will see that.
- mlyle 6y ago
  It's a different problem here-- making sure the second dose is available at all costs. The problem here isn't a logistics problem, but a "which alternative is worse" problem. It sure looks like 1 dose is still >50% effective after day 10. The data is sparse: you wouldn't want to give people a single dose on purpose. But holding back more than half the doses in case there's a low probability event of a complete supply disruption seems overcautious. Hold back 25%.
exabrial 6y ago
As many have been saying, optimizing to minimize case count has been where the entire handling of the pandemic has gone wrong. Let's not repeat this mistake yet again. We need to optimize to minimize long term effects: death, disabilities, mental health, etc. These are things that actually matter.
- TheDong 6y ago
  What are you advocating for here? It seems to me like case count and most long-term effects are linked. If we reduce case count sufficiently that we can stop quarantining, that improves mental health, and case count should be pretty strongly correlated with death and long-term effects. In the case of rolling out vaccination, are you suggesting we do something differently? Is there any difference between optimizing for minimizing cases and minimizing those other things in a vaccine rollout? In my mind, to optimize for any of those things, you'd roll out vaccines asap.
offsky 6y ago
I know second hand that UCSD is giving all doses right now. Vials contain 20% more to account for spills, so they are using this extra to give extra vaccinations. The second dose for each patient will come from future vaccine shipments. Other providers in San Diego may be doing the same thing.
choeger 6y ago
Berlin today closed it's sole vaccination center. Allegedly because of a lack of interest by the target audience. So we now reserve all doses, not just the second one. Total organizational fubar.
- iridium_core 6y ago
  People have been forced to endure lockdown and masks, but they have a choice about vaccines. We should just vaccinate the elderly and anyone else who wants it and get back to 100% normal life - ditch the mask rules and social distancing.
- aquadrop 6y ago
  That's hard to believe in multi million city there was not enough people to fill on one center. Maybe there was something other preventing people from going there? Do you have source?
  - guenthert 6y ago
    I found it hard to believe as well, but found [1]. Not living there at this time, I lack a sense of current sentiment, but it's my understanding that so far only medical personal is being vaccinated. Allegedly there was a lack of interest of being vaccinated right now (it's Christmas season and many are on holiday there I think). That'll change in a few days. [1] https://www.tagesspiegel.de/berlin/zu-wenig-rueckmeldung-zu-wenige-dosen-impfzentrum-arena-schliesst-voruebergehend-tegel-oeffnet-erst-spaeter/26756944.html https://www.tagesspiegel.de/berlin/zu-wenig-rueckmeldung-zu-...
  - choeger 6y ago
    Multiple sources in German/Berlin Media. Take for instance this piece: https://m.tagesspiegel.de/berlin/zu-wenig-rueckmeldung-zu-wenige-dosen-impfzentrum-arena-schliesst-voruebergehend-tegel-oeffnet-erst-spaeter/26756944.html https://m.tagesspiegel.de/berlin/zu-wenig-rueckmeldung-zu-we... As far as I was able to connect the pieces the organization was a total disaster. Mobile teams going into nursing homes do not vaccinate the people working there. These people should have come to the center, but could not because the were working at that time. Other elderly people (not living in nursing homes) should have come to the center but did not receive the invitation in time. This kind of utter incompetence is, sadly, quite typical in Berlin.
deleted 6y ago
[deleted]
andred14 6y ago
These creepy vaccines are far more scary than any virus that causes flu symptoms

170 points by elsewhen 6y ago

d33lio 6y ago

But we're supposed to prolong the temporary overreach of government power! /s

dtoznayxvf 6y ago
They never do let a good crisis go to waste do they? Tell you what all those talking heads arguing about who get's to be first can have my dose.

JoeAltmaier 6y ago

All things being equal, perhaps. But first doses are medical professionals and other critical workers. Guaranteeing they will be here for the long haul is another worthy goal. I'm not sure 'spray and pray' is a well-thought-out approach. Its perhaps another internet pundit who can take one number and divide by another number and become an instant expert.

BurningFrog 6y ago
The proposal is not to start vaccinating random people off the street. It is to vaccinate twice as many high priority people.
dougmwne 6y ago
This is not what the article is about at all. It is saying we should not reserve the second dose in the freezer for that patient and should instead immediately distribute it to at-risk populations. Then we should trust the supply chain will come through for the second dose and that a 1-2 week delay in case it did not would not overly harm immunity. It is perhaps a very sensible suggestion that would depend on the supply chain quality. I think we should all make efforts to tone down our rhetoric and not tilt at windmills.
- JoeAltmaier 6y ago
  Sure it is. Again, if there should be some issue with the supply chain, then the first dose could be 'wasted'. For hospital personnel etc that would be a bad scenario. We're not talking millions/billions of doses. We're talking about what are really very small numbers. It may be worth taking some very small hit in herd immunity, for an assured continuity of care.
  - vonmoltke 6y ago
    > Again, if there should be some issue with the supply chain, then the first dose could be 'wasted'. It's not "wasted". As noted in the article, the first dose alone is ~50% effective; the second dose is required to boost that to ~93%. So, it's a tradeoff between vaccinating n people at 93% effectiveness versus 2n people at 50% effectiveness.
  - random5634 6y ago
    Is there an actual serious claim that the first dose would be wasted? This claim is being made despite CLEAR CDC guidance on how to handle delayed vaccination doses? I'm serious - where is the citation for the claim you are making that the first dose is wasted if the second dose is not perfectly on schedule. The reason this claim is likely a lie is that millions / billions of vaccines are given out. Every school child in America is getting vaccines. With very narrow exceptions, if you are off the exact timing (ie, you get a 12 month vaccine a bit later, you get the second shot 14 days later) which by the way happens ALL THE TIME because doctors and parents are busy etc - there is no evidence that the first shot is wasted or that you need to restart vaccination. So please provide a citation for the "first shot wasted" claim.
    - bluGill 6y ago
      Provide citation yourself for this case. Nobody can, there is no data to cite. The only data that we have is that getting both doses on schedule works. Everything else is speculation.
paulgb 6y ago
The issue is not who gets the vaccine, but whether to hold the second doses in reserve or distribute them as first doses and use later-arriving doses as second doses. The former has the obvious advantage of vaccinating more people quickly, but runs the risk that if the second doses don’t arrive on time the effects of the first dose will wear off. Edit: I originally used the phrase “back to square one” but I agree with replies that it’s the wrong phrase.
- sanxiyn 6y ago
  Why is one "back to square one"? Pfizer vaccine schedule is the second dose at 21 days after the first dose, but as I understand, in theory, the second dose after a month, or even two months, should work equally well (except obviously reduced protection in between).
- JoeAltmaier 6y ago
  Sure it is about who gets it. Saved for 2nd doses for critical workers, or distributed to those further down the list now.
- newen 6y ago
  The first dose is already 50% effective, so you are not back to square one. The second dose also doesn't necessarily need to arrive precisely on time.

cryptica 6y ago

Agreed, we need to incapacitate... Um, I mean inoculate the peasants as swiftly as possible so that they don't start to become suspicious... Um, I mean paranoid. Damn it, where is Bill Gates when you need him? He knows how to reassure the peasants. Anyway, I think we should start with young fit adults first, then do old people and children last...

jtsiskin 6y ago
Is this a serious belief you have?
- cryptica 6y ago
  Mostly satire to summarize the current mood of distrust and paranoia. I think that the people at the top have been getting more crooked and reckless so the trend is definitely getting there but I don't think we're there yet but I'm not 100% sure. It wouldn't be totally uncharacteristic of those in power in any case, just look at WW1 and WW2 (70+ years ago so perhaps we're overdue for a culling).

ars 6y ago

Summary: The title makes it seem like they are talking about medical professionals vs general public. But actually they are talking about reserving second doses for those who got the first dose, and the article says it's better to actually administer those doses, even if it means a delay on the second dose for people.

paulgb 6y ago
I hope that if people don’t bother to read the article they at least see your comment. Most of the comments here so far are debating the merits of what they assume from the title rather than the text of the article.
- ogre_codes 6y ago
  When a pay-walled story is posted, the number of people who read the story drops significantly.
y-c-o-m-b 6y ago
Thanks for this quick summary. I've got a pay-wall error and can't read the article.

chiefalchemist 6y ago

Somewhat off topic but in theory, would it be possible to have jab #1 be Moderna's and jab #2 be Pfizer? Would it be ethical to test this? Is there anything inherent in either's approach that would make this dangerous?

BurningFrog 6y ago
As just another software guy who's near that dangerous "knows enough to be overconfident" spot: That would probably not work the same way. The point of a booster shot is to make the immune system "think" it's been infected by the same intruder twice, so it steps up permanent defences to a more serious level. Both the Moderna and Pfizer vaccine produces replicas of the virus "spike protein", but with (presumably) different mRNA formulas. So if their different versions are similar enough that the immune system sees them as "this shit again!", which would work as a booster shot, or as an unrelated infection, is impossible to say. At least for me, who is (again) unqualified to talk about this stuff. That said, two vaccines would at minimum be better than one.
- davrosthedalek 6y ago
  Well, they are at least similar enough to the real thing that the body would say "this shit again!" for the real virus. My guess is that they have different start/stop sequences (that shouldn't matter for the protein the mRNA is encoding) and different stabilizers to help the mRNA survive.
ufo 6y ago
There only way to know for sure would be to run a controlled trial. Vaccines can work (or not work) in surprising ways.
wyldfire 6y ago
The danger is that it's untested and might not provide any more benefit than just the first injection.
sanxiyn 6y ago
In theory, yes, that should work. In practice, immunology is very complex and the only way to be sure is to test.

inglor_cz 6y ago

Israelis give shots to medical workers and oldest citizens first. This should drive down the death rate pretty fast. If this approach works, Covid-related deaths in Israel should visibly drop by the end of January.

raverbashing 6y ago
All countries are doing these groups first, of course Israel is probably the country doing it the fastest so I agree, we should see the results faster. And I agree with the topic, better 2 people somewhat immune "now" than half with the full vaccine immunity.
- adriancr 6y ago
  > And I agree with the topic, better 2 people somewhat immune "now" than half with the full vaccine immunity. the 90%+ effectiveness is only with 2 does, who knows how long and if it works with only one dose... it's likely not half and/or not for very long...
  - jacob019 6y ago
    Immunity is not binary. Introducing the spike protien to our immune systems now will prime us for a stronger fight later, even if we are not fully immune.
  - zbjornson 6y ago
    Moderna's phase 3 includes preliminary data on a single dose, and it appears 80-90% effective at/after two weeks. See table 15 on page 28: https://www.fda.gov/media/144434/download https://www.fda.gov/media/144434/download https://www.wbur.org/commonhealth/2020/12/18/coronavirus-vaccine-single-dose-debate https://www.wbur.org/commonhealth/2020/12/18/coronavirus-vac...
    - mercurywells 6y ago
      From the same report: > The small, non-random sample and short median follow-up time limits the interpretation of these results. There appears to be some protection against COVID-19 disease following one dose; however, these data do not provide sufficient information about longer term protection beyond 28 days after a single dose. Obviously it'd be great if we can just dose everyone we can once then do a 2nd dose later, but we just don't know enough about how well that would work out long term.

Lewton 6y ago

This seems very Canada specific, is any other country doing it like this? I'm fairly sure neither the US nor most european countries are doing this (I mean, Canada seems to be the only place that are reserving the second doses) Edit: This article is clearly being upvoted based on title alone

the_svd_doctor 6y ago
I’ve seen multiple experts in the media mentioning this idea in Belgium. Not sure if it is really considered by the government though.
kevin_nisbet 6y ago
The initial vaccination statistics I saw over the weekend suggested that the US/UK have both far outpaced the Canadian vaccination rate (adjusted for population). I don't want to cite specific numbers as I don't remember what they were, but it was a pretty large gap among countries that had approved the vaccines.
Mauricebranagh 6y ago
Tony Blair suggested it
- tonyedgecombe 6y ago
  That famous epidemiologist.
Exmoor 6y ago
I had read that the USA is/was initially ensuring there were two doses onsite for each person vaccinated, until they felt the supply chain had proven to be consistent. I'm having trouble sourcing that though.
- formercoder 6y ago
  I saw that too and it makes sense. Begin with the most conservative approach and transition to just in time as confidence builds.

bluenose69 6y ago

It seems reasonable for different provinces to take different approaches, since their disease patterns vary significantly. Ontario and Québec have endured many weeks of increasing numbers of diagnosed infections per day, whilst the other provinces have seen decreases. The absolute incidences also vary between provinces, letting some test-and-trace cases more easily than others.

Lewton 6y ago
> Ontario and Québec have endured many weeks of increasing numbers of diagnosed infections per day Which would indicate that they -shouldn't- be reserving doses...
dghughes 6y ago
>..whilst the other provinces have seen decreases. Nova Scotia had a big jump mostly Halifax since it's the most populated part of the province.
bryanlarsen 6y ago
That's interesting phrasing. Ontario & Québec have increasing numbers but they still have lower per capita case rates than western provinces.
- ced 6y ago
  Not really true anymore, according to https://mackuba.eu/corona/#compare.daily?pop=1&c=ca-on,ca-qc,ca-ab,ca-nb,ca-bc,ca-mb,ca-sk&trend=7 https://mackuba.eu/corona/#compare.daily?pop=1&c=ca-on,ca-qc...
  - cmrdporcupine 6y ago
    Alberta's numbers over the holiday are nonsense. Hinshaw even said so herself.
hawkesnest 6y ago
I would think we have the models to try many different strategies to determine the "best" distribution methodology. Depending upon what the definition of "best" is, of course.

sradman 6y ago

Ontario changes COVID-19 vaccination plans after slowing rollout [1]: > Ontario has changed its COVID-19 vaccination plan to give a first dose to as many people as possible and no longer hold second doses in reserve General Rick Hillier (retired) to Provide an Update at Queen's Park [2] today at 11am EST which is currently shown in the upcoming "Live" tab of CPAC [3]. [1] https://www.theglobeandmail.com/canada/article-ontario-changes-covid-19-vaccination-plans-after-slowing-rollout/ https://www.theglobeandmail.com/canada/article-ontario-chang... [2] https://news.ontario.ca/en/advisory/59836/general-rick-hillier-retired-to-provide-an-update-at-queens-park https://news.ontario.ca/en/advisory/59836/general-rick-hilli... [3] https://www.cpac.ca/en/ https://www.cpac.ca/en/

sradman 6y ago
The update by Rick Hillier is complete [1]. For Ontario residents, the key new information: - clinic holiday shutdown was a mistake; daily operation will now be the norm - first Moderna shipment arrives within 24 hrs, will be distributed outside clinics - the vaccination rate is currently limited by supply - 80K Pfizer / 50K Moderna per week in January - Phase 1 (vulnerable and health care workers): Jan-Mar (~1M) - Phase 2 (expanded distribution): Apr-Jul (~8M vaccinated total) - sentiment: over 80% of population willing to vaccinate as soon as possible - Hillier requested that Health Canada consider a 1-dose Moderna regiment [1] https://youtu.be/dy0ctRiU2IM?t=1008 https://youtu.be/dy0ctRiU2IM?t=1008

jancsika 6y ago

I wish there were a "flag" button but for the ensuing low-effort, low information discussion you know will come for a story clearly outside the expertise of anyone who posts here. flags as such If I come back and read any comment here that leaves me with more knowledge than when I arrived, I promise in the future to reward HN by donating 4 horror stories about uncles working union jobs.

ketamine__ 6y ago
There is. Go the direct link for a comment.

ojbyrne 6y ago

Seems like there could be a middle ground, administer more or less of the second dose based on the amount stockpiled and the probability of future deliveries.

tdy721 6y ago
Testing is already strained? And missing doses is all waste. Too risky imho?
- Siira 6y ago
  I have heard a single dose is still pretty effective.

sunstone 6y ago

In practice it's likely that we'll do both. That is, all the doses will be used, and none reserved, as they arrive according to a priority schedule (ICU staff, care home staff, care home residents first, etc). Then when it's time for the second dose, the high priority targets will get their second dose immediately as new doses arrive while lower priority targets may have their second dose delayed as a first dose is given to those even further down the priority list. The result being that those at highest risk get the double dose ASAP while the twenty year olds get their first dose at the expense of the forty year olds having to wait a little longer for their second dose. This is because even a first dose while not fully protective is protective against serious covid-19 outcomes which is a big deal in itself. According to this scheme twenty year olds will be getting their second dose sometime in their thirties. :)

mannykannot 6y ago

Even if it were the case that the vaccination is only effective once the second dose is given in time, holding back half the supply is far too drastic: if the supply chain failed to the point where these doses would all be used for this purpose, we would have a much bigger problem on our hands.

jpdus 6y ago

I don't get why nobody seriously considers a one-dose regimen for the fastest possible vaccine rollout. All available data for both, Biontech/Pfizer and Moderna's vaccines suggests that one dose is enough for >90% efficacy which would be sufficient to reach herd immunity. There was a very good opinion article in the NY Times [1] about that, but not much more. The problem here is that a one-dose regimen was not studied in the trials. While it is good medical practice do not deviate from trial designs (see the Oxford/AZ vaccine), the data is very clear here. The vaccines are effective 14 days after the first dose and before the second dose. Sure, there are risks (maybe the efficacy drops later on or it is more difficult to reach the full efficacy if the booster shot is delayed) but these risks seem to be negligible compared to the hundreds of thousands additional unnecessary deaths due to limited vaccine supply and delayed vaccination with a two-shot regimen. We know from other vaccines that the timing of the booster shot normally is not that important and it is very probably that a booster shot after a few months would be exactly as good as a booster shot after 4 weeks. In my opinion, nobody seriously contemplates the one-dose regimen because somebody has to take responsibility to deviate from the proven and tested protocol - politicians have nothing to win here but much to loose in case anything goes wrong. And big pharma has no interest in financing and starting one-dose trials asap b/c it would hurt their own bottom line and there is no financial incentive at all, quite the opposite (+they have the same responsibility problem). This is a deadlock which will cost many, many lifes. [1] https://www.nytimes.com/2020/12/18/opinion/coronavirus-vaccine-doses.html https://www.nytimes.com/2020/12/18/opinion/coronavirus-vacci...

tehjoker 6y ago
That's not what the Pfizer paper showed. There was a confidence interval from between 20-70% iirc for the first shot. Maybe if we're lucky it's on the higher end, but I would stick to proven science if we're going to combat this thing effectively.
- deleted 6y ago
  [deleted]
- mlyle 6y ago
  Wargame the scenarios. You wouldn't want to give one dose on purpose, but reserving a whole bunch of doses to prevent some people from getting only 1 in a worst case scenario is silly. That 20-70% efficacy number includes the entire period between dose 1 and 2. It looks way better 10 days after dose 1, btw-- MLE around 80%. e.g. single dose -- 50% efficacy (to be pessimistic); double dose -- 95% efficacy. 10M doses "in flight" monthly. 100 deaths/million/month. Ignore all effects on transmission (to be more pessimistic). Scenario 1 (no logistics disruption, half held back): 5M dosed with 1 dose at day 0, 5M dosed with 2 doses at 1 month and 5M dosed with 1 dose at 1 month. 250 saved in first month, 725 saved in second month. Scenario 2 (no logistics disruption, 25% held back): 7.5M dosed with 1 dose at day 0, 7.5M dosed with 2 doses at 1 month and 2.5M dosed with 1 dose at 1 month. 375 saved in first month, 837 saved in second month. Scenario 3: (100% production disruption, half held back): 5M dosed with 1 dose at day 0; 5M dosed with 2 doses at 1 month. 250 saved in first month, 475 saved in second month. Scenario 4: (100% production disruption, 25% held back): 7.5M dosed with 1 dose at day 0; 2.5M dosed with 2 doses at 1 month; (5M late for dose 2); 375 saved in first month, 612 saved in second month. With a 25% reserve, you only get into the unexpected-only-1-dose regimen with a supply disruption of more than 50%... and even then it's still probably better than a 50% reserve.

myth_drannon 6y ago

Canada is the slowest among G7. vaccines administered per 100 people: • Canada at 0.14 • United States at 0.59 • United Kingdom at 1.18 • Bahrain at 3.23 • Israel at 4.37

alex_duf 6y ago
where did you find these figures? I've been trying to find some reliable source to keep an eye on it and I haven't been very successful so far
- _Microft 6y ago
  Check this out: https://ourworldindata.org/covid-vaccinations https://ourworldindata.org/covid-vaccinations The sources they use to compile the data are listed here: https://github.com/owid/covid-19-data/blob/master/public/data/vaccinations/locations.csv https://github.com/owid/covid-19-data/blob/master/public/dat...
  - jpster 6y ago
    Wish I could find estimates showing “At current / projected vaccination rates it will take X years to vaccinate 90% of the population”, per country. I heard on TWiV (This Week in Virology podcast) for the US it was ~6.6 years and I believe it was based on < 90% of pop.
    - rsynnott 6y ago
      _Current_ rates are likely not worth worrying about, not this early on. Rates should be expected to increase fairly dramatically in the next weeks.
      - jpster 6y ago
        I hope so. But, frankly, most national and local responses to this outbreak have been subpar. I do not take it for granted that we (the US) can pull off this major logistical challenge smoothly or on an aggressive timeline.

beervirus 6y ago

> We're sorry but we are unable to validate your access to this article. Please adjust your browser settings or turn off any extensions that may be causing this issue. Hard pass.

rkagerer 6y ago

So what happens if the second dose arrives very (eg. many months) late? Can you start again and give 3? And is there any chance all the partial immunities will catalyze resistant mutations?

generationP 6y ago
Disclaimer: not an immunologist. > So what happens if the second dose arrives very (eg. many months) late? Can you start again and give 3? WHO guidance on incomplete vaccine courses (pre-COVID): https://www.who.int/immunization/policy/Immunization_routine_table3.pdf https://www.who.int/immunization/policy/Immunization_routine... In almost all cases, the suggestion is "resume without repeating the previous dose". The only exceptions are typhoid and cholera vaccinations. I don't know what these suggestions are based upon, but the source is as close to expert consensus as it can go (the WHO has gotten a lot of flak on COVID, but I have never heard anyone seriously doubt its guidance on standard vaccinations). > And is there any chance all the partial immunities will catalyze resistant mutations? Apparently this doesn't even happen much for antibiotics ( https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2536180 https://jamanetwork.com/journals/jamainternalmedicine/articl... ), so I wouldn't worry about it happening for vaccines. See https://www.pnas.org/content/115/51/12878 https://www.pnas.org/content/115/51/12878 for a comparison. If it were a major issue, it would just as well be an issue with fully delivered vaccination courses, as they don't offer 100% immunity either. The amount of mutations arising should still be proportional to the sick population (or, rather, to its total prevalence over time and population), and anything that reduces the latter should reduce the former. Any vaccine-immune mutation can just as easily come up before the vaccine, unless it hampers the virus so strongly that it is unviable until the evolutionary landscape has shifted. At that point, however, we're looking at a much simpler problem.
est31 6y ago
> So what happens if the second dose arrives very (eg. many months) late? Can you start again and give 3? Stockpiling of vaccines is a method to obtain certainty that you can vaccinate on schedule. There are better methods of ensuring certainty, e.g. by supporting manufacturers as well as possible to meet schedules, analyze weaknesses in supply chains, trying to counter them early, etc. The issue is the cost of maintaining the stockpile: > she and her colleagues projected that frontloading vaccine doses would avert between 34 and 42 per cent more symptomatic coronavirus infections, compared with a strategy of keeping half the shipments in reserve. What's the cost of delaying the second shot for some groups? It's certainly non-zero, but 34 to 42 percent less symptomatic infections is a lot of prevented infections (and death). The cost-benefit analysis gives a clear conclusion: don't stockpile.

dan_hawkins 6y ago

Copenhagen hospitals vaccinating more people than scheduled [0] > Hospitals in the Copenhagen area are ahead of their COVID-19 vaccination schedule, according to the Capital Region’s vaccine taskforce. > According to the taskforce, 20 percent more people than calculated have been vaccinated because each vial contains at extra 1-2 doses. > The reason for the extra doses is producer Pfizer/BioNTech adding a bit to account for potential spillage. > And so to attain the excess doses, health personnel must handle the vaccine with care. [0] https://cphpost.dk/?p=121536 https://cphpost.dk/?p=121536 Edit: formatting

corona-research 6y ago

Is this vaccine some kind of genocide on idiots?

Animats 6y ago

This is an early stage situation. Once the supply pipeline starts running smoothly, having some number of doses in reserve will still be needed, but not as many. Combat logistics for ammo has the same problem. The person in charge of vaccine distribution planning is an Army logistics general, who will see that.

mlyle 6y ago
It's a different problem here-- making sure the second dose is available at all costs. The problem here isn't a logistics problem, but a "which alternative is worse" problem. It sure looks like 1 dose is still >50% effective after day 10. The data is sparse: you wouldn't want to give people a single dose on purpose. But holding back more than half the doses in case there's a low probability event of a complete supply disruption seems overcautious. Hold back 25%.

exabrial 6y ago

As many have been saying, optimizing to minimize case count has been where the entire handling of the pandemic has gone wrong. Let's not repeat this mistake yet again. We need to optimize to minimize long term effects: death, disabilities, mental health, etc. These are things that actually matter.

TheDong 6y ago
What are you advocating for here? It seems to me like case count and most long-term effects are linked. If we reduce case count sufficiently that we can stop quarantining, that improves mental health, and case count should be pretty strongly correlated with death and long-term effects. In the case of rolling out vaccination, are you suggesting we do something differently? Is there any difference between optimizing for minimizing cases and minimizing those other things in a vaccine rollout? In my mind, to optimize for any of those things, you'd roll out vaccines asap.

offsky 6y ago

I know second hand that UCSD is giving all doses right now. Vials contain 20% more to account for spills, so they are using this extra to give extra vaccinations. The second dose for each patient will come from future vaccine shipments. Other providers in San Diego may be doing the same thing.

choeger 6y ago

Berlin today closed it's sole vaccination center. Allegedly because of a lack of interest by the target audience. So we now reserve all doses, not just the second one. Total organizational fubar.

iridium_core 6y ago
People have been forced to endure lockdown and masks, but they have a choice about vaccines. We should just vaccinate the elderly and anyone else who wants it and get back to 100% normal life - ditch the mask rules and social distancing.
aquadrop 6y ago
That's hard to believe in multi million city there was not enough people to fill on one center. Maybe there was something other preventing people from going there? Do you have source?
- guenthert 6y ago
  I found it hard to believe as well, but found [1]. Not living there at this time, I lack a sense of current sentiment, but it's my understanding that so far only medical personal is being vaccinated. Allegedly there was a lack of interest of being vaccinated right now (it's Christmas season and many are on holiday there I think). That'll change in a few days. [1] https://www.tagesspiegel.de/berlin/zu-wenig-rueckmeldung-zu-wenige-dosen-impfzentrum-arena-schliesst-voruebergehend-tegel-oeffnet-erst-spaeter/26756944.html https://www.tagesspiegel.de/berlin/zu-wenig-rueckmeldung-zu-...
- choeger 6y ago
  Multiple sources in German/Berlin Media. Take for instance this piece: https://m.tagesspiegel.de/berlin/zu-wenig-rueckmeldung-zu-wenige-dosen-impfzentrum-arena-schliesst-voruebergehend-tegel-oeffnet-erst-spaeter/26756944.html https://m.tagesspiegel.de/berlin/zu-wenig-rueckmeldung-zu-we... As far as I was able to connect the pieces the organization was a total disaster. Mobile teams going into nursing homes do not vaccinate the people working there. These people should have come to the center, but could not because the were working at that time. Other elderly people (not living in nursing homes) should have come to the center but did not receive the invitation in time. This kind of utter incompetence is, sadly, quite typical in Berlin.

deleted 6y ago

[deleted]

andred14 6y ago

These creepy vaccines are far more scary than any virus that causes flu symptoms