4 ms·

> 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 certain

by 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.

trhway 6y ago
you described precisely the reason why anyone wielding deciding power on the matter and acting rationally wouldn't allow the second doses be administered until [almost] everybody (in the country or on the whole planet) gets the first one. To prevent such a situation the subjects of that power have to stockpile.
toast0 6y ago
The last year has been supply chain disruption after supply chain disruption. If the vial manufacturer has a covid outbreak at their facility and has to stop manufacturing for two weeks, your scheduled shipments aren't going to be on time. As supply goes up, and we get past the priority recpients to the general public, it probably makes sense to reduce the stockpile requirement; some general public aren't going to come back for their second dose anyway, and more risk is appropriate for general public than high risk groups.
- est31 6y ago
  > The last year has been supply chain disruption after supply chain disruption. Indeed, but even if 20% of people don't get their second shot on time and the impact of that is equal to them not being vaccinated at all (we don't know but likely the impact is smaller), even then the impact would be lower than stockpiling vaccines which increases the number of symptomatic infections by 34 to 42 percent. > If the vial manufacturer has a covid outbreak at their facility and has to stop manufacturing for two weeks, your scheduled shipments aren't going to be on time. That's precisely where the government can step in and ensure that antibiotics therapies are available to workers in those facilities as well as daily tests. Then it doesn't have to shut down. > As supply goes up, and we get past the priority recpients to the general public, it probably makes sense to reduce the stockpile requirement At that point it's less relevant which strategy you choose.
  - toast0 6y ago
    > Indeed, but even if 20% of people don't get their second shot on time I think my worst case expectation is much worse than yours. With a two week production shut down, I expect my corner of the world would not get new shipments for more than two weeks; higher priority places would be getting their previous orders filled before us, and we'd only get more once the backlog was filled. Also, I fully expect any production will take at least a week to be made public, so too late for an eager dosing regimine to start holding back. Keep in mind, we're in winter, and winter storms often cause logistical problems. The one dose efficacy data is too low confidence to make good decisions with. I'm open to the argument that it's better to use two doses to give two people one dose than to give one person two doses, but it would have been nice if that was trialed. There's also a related question of if you have a dose, if it's better to give that to a properly timed first dose recipient, or to give it to someone who hasn't received a dose yet. Again, there's not quality data; I would lean towards following the trial parameters. > That's precisely where the government can step in and ensure that antibiotics therapies are available to workers in those facilities as well as daily tests. Where has this suddenly competent government been for the past year? Yes, we expect a new executive in the US in a month, but the handoff takes time in normal conditions, and we have reason to believe this one will be more abrupt than many. How do antibiotics help for covid? How do daily tests help avert a shutdown when you can spread the disease while testing negative? One person could infect most of a shift of workers, given the right circumstances; more than one shift if they do handoff work to the next shift. Supply chain workers for the vaccine aren't in the priority lists for the vaccine either. Anyway, covid isn't the only communicable disease possibility.
    - est31 6y ago
      > higher priority places would be getting their previous orders filled before us Hmm yeah that's a problem with the vaccine manufacturer. Ideally in such a scenario, the second doses get served first, after which the higher priority first doses get served. > How do antibiotics help for covid? Urgh my fault sorry, I meant antibodies not antibiotics. I tried to use them as example for something that has limited availability but allows to shorten disease durations. > How do daily tests help avert a shutdown when you can spread the disease while testing negative? Of course a shutdown is most effective and if done on a population scale it's bad for the pandemic. But daily tests do help to curb the spread.
- vkou 6y ago
  I would bloody well hope that people manufacturing COVID vaccines are the quintessential essential workers, who should be the first in line for getting COVID vaccines. On the other hand, given how poorly essential workers are actually treated by our society, I doubt that's how things actually work. (See - senior hospital administrators getting vaccines ahead of front-line medical staff...)
  - bluGill 6y ago
    And their supply chain, but now we are at everybody anyway.

by est31 6y ago

trhway 6y ago

you described precisely the reason why anyone wielding deciding power on the matter and acting rationally wouldn't allow the second doses be administered until [almost] everybody (in the country or on the whole planet) gets the first one. To prevent such a situation the subjects of that power have to stockpile.

toast0 6y ago

The last year has been supply chain disruption after supply chain disruption. If the vial manufacturer has a covid outbreak at their facility and has to stop manufacturing for two weeks, your scheduled shipments aren't going to be on time. As supply goes up, and we get past the priority recpients to the general public, it probably makes sense to reduce the stockpile requirement; some general public aren't going to come back for their second dose anyway, and more risk is appropriate for general public than high risk groups.

est31 6y ago
> The last year has been supply chain disruption after supply chain disruption. Indeed, but even if 20% of people don't get their second shot on time and the impact of that is equal to them not being vaccinated at all (we don't know but likely the impact is smaller), even then the impact would be lower than stockpiling vaccines which increases the number of symptomatic infections by 34 to 42 percent. > If the vial manufacturer has a covid outbreak at their facility and has to stop manufacturing for two weeks, your scheduled shipments aren't going to be on time. That's precisely where the government can step in and ensure that antibiotics therapies are available to workers in those facilities as well as daily tests. Then it doesn't have to shut down. > As supply goes up, and we get past the priority recpients to the general public, it probably makes sense to reduce the stockpile requirement At that point it's less relevant which strategy you choose.
- toast0 6y ago
  > Indeed, but even if 20% of people don't get their second shot on time I think my worst case expectation is much worse than yours. With a two week production shut down, I expect my corner of the world would not get new shipments for more than two weeks; higher priority places would be getting their previous orders filled before us, and we'd only get more once the backlog was filled. Also, I fully expect any production will take at least a week to be made public, so too late for an eager dosing regimine to start holding back. Keep in mind, we're in winter, and winter storms often cause logistical problems. The one dose efficacy data is too low confidence to make good decisions with. I'm open to the argument that it's better to use two doses to give two people one dose than to give one person two doses, but it would have been nice if that was trialed. There's also a related question of if you have a dose, if it's better to give that to a properly timed first dose recipient, or to give it to someone who hasn't received a dose yet. Again, there's not quality data; I would lean towards following the trial parameters. > That's precisely where the government can step in and ensure that antibiotics therapies are available to workers in those facilities as well as daily tests. Where has this suddenly competent government been for the past year? Yes, we expect a new executive in the US in a month, but the handoff takes time in normal conditions, and we have reason to believe this one will be more abrupt than many. How do antibiotics help for covid? How do daily tests help avert a shutdown when you can spread the disease while testing negative? One person could infect most of a shift of workers, given the right circumstances; more than one shift if they do handoff work to the next shift. Supply chain workers for the vaccine aren't in the priority lists for the vaccine either. Anyway, covid isn't the only communicable disease possibility.
  - est31 6y ago
    > higher priority places would be getting their previous orders filled before us Hmm yeah that's a problem with the vaccine manufacturer. Ideally in such a scenario, the second doses get served first, after which the higher priority first doses get served. > How do antibiotics help for covid? Urgh my fault sorry, I meant antibodies not antibiotics. I tried to use them as example for something that has limited availability but allows to shorten disease durations. > How do daily tests help avert a shutdown when you can spread the disease while testing negative? Of course a shutdown is most effective and if done on a population scale it's bad for the pandemic. But daily tests do help to curb the spread.
vkou 6y ago
I would bloody well hope that people manufacturing COVID vaccines are the quintessential essential workers, who should be the first in line for getting COVID vaccines. On the other hand, given how poorly essential workers are actually treated by our society, I doubt that's how things actually work. (See - senior hospital administrators getting vaccines ahead of front-line medical staff...)
- bluGill 6y ago
  And their supply chain, but now we are at everybody anyway.