5 ms·

Some more info from the uni that performed the study[1]: > In relation to the cellular (or T cell) immune response, which plays an important role in supporting

Some more info from the uni that performed the study[1]: > In relation to the cellular (or T cell) immune response, which plays an important role in supporting and maintaining antibody production, the team found that within the three-week interval group, 60% had a confirmed cellular response at two to three weeks following the second vaccine - although this fell to only 15% eight to nine weeks later. > The proportion of participants showing a cellular response in the 12-week-interval group was only eight per cent at five to six weeks after the first vaccine, but this rose to 31% two to three weeks after the second vaccine. Research is required to further explore these variations in responses. You're correct that the evidence isn't dispositive yet, but it's an encouraging signal. Antibody response in the short-term is positive and in the medium-term cellular response possibly converges. More importantly, the implications for the first doses first strategy are positive. Those who know how to reason under uncertainty saw the UK's strategy as a calculated gamble based on a model that extended the point information provided by the vaccine efficacy RCT; critics were generally incoherent but their claim was that it was likely to cause large _negative_ effects on efficacy, worth paying the cost of vaccinating far fewer people. On top of the priors that led to the decision, we now have signal from the way the winter surge played out in the UK, and the increased antibody response alone provides further weak signal that the delay was worth it - and conversely, that the US's approach cost lives). The evidence still isn't dispositive, but crucially, there's no such strong basis for believing the alternative either: that extending doses _reduces_ efficacy and that vaccine availability should be limited in the name of adhering rigidly to the RCT-studied timeline. The status quo bias of medical culture killed a lot of people during this pandemic by continuing their habit of pretending that certainty exists where none does and refusing to engage in critical thinking about uncertainty. Refusing to explicitly extrapolate a model from few high-quality samples really just means "implicitly extrapolating a crappy model through bias and guesswork". This may be adaptive in the normal medical context, where the status quo is generally fine, but is an incredibly poor fit for a fast-moving pandemic that was killing thousands a day in the US alone. [1] https://www.birmingham.ac.uk/news/latest/2021/05/covid-pfizer-vaccination-interval-antibody-response.aspx https://www.birmingham.ac.uk/news/latest/2021/05/covid-pfize...

arcticfox 5y ago
I completely agree with everything you said. That said, the most effective defense I've seen for the seemingly incoherently cautious status quo approach is that the medical community doesn't operate on the span of one pandemic, but is rather in a perpetual struggle. So even if the short-term expected value of an excessively cautious approach is negative, resulting in more deaths and a longer pandemic, it might be outweighed by reducing the chance of damaging public faith in medicine long-term by an erroneous more aggressive move. I still don't agree, but that very long-term view is the only defense I see for the approach given what we knew at the time.
- wutbrodo 5y ago
  Thank you for bringing that up. That makes a lot of sense, and public health absolutely does need to consider mass psychology and their credibility. The theory that they're overindexing on protecting that credibility doesn't really comport with their behavior the rest of pandemic, however. Leaving aside all of the blood on the hands of mindless bureaucracy (like effectively banning testing for Covid in the early pandemic when it was most crucial), there has been decision after decision that prioritized status quo bias and RCT-worship even when the long game suggests it would damage their credibility (the fervent anti-mask recommendations in the early pandemic is a great example, as is the bizarre insistence on recommending precautions against fomites over aerosols until extremely late). More importantly, "public health is misleading you at the cost of your health/life because they're playing the long game" doesn't actually preserve much credibility. It certainly casts public health figures in a more positive light, but I'm not really thinking in terms of blaming individuals over institutions/cultures anyway. It doesn't really matter _why_ public health advice is wrong in obvious and significant ways. What matters is the ultimate conclusion: if you have basic scientific literacy and an IQ over 105, form your own broad understanding of the science. This isn't a call to jettison epistemic humility: you're not going to be able to understand things anywhere close to as well as an individual epidemiologist can. But the point is that listening to the science as filtered through public health advice _is even worse_, in the same way that getting nutrition advice from the USDA will.
  - 5y ago

arcticfox 5y ago

I completely agree with everything you said. That said, the most effective defense I've seen for the seemingly incoherently cautious status quo approach is that the medical community doesn't operate on the span of one pandemic, but is rather in a perpetual struggle. So even if the short-term expected value of an excessively cautious approach is negative, resulting in more deaths and a longer pandemic, it might be outweighed by reducing the chance of damaging public faith in medicine long-term by an erroneous more aggressive move. I still don't agree, but that very long-term view is the only defense I see for the approach given what we knew at the time.

wutbrodo 5y ago
Thank you for bringing that up. That makes a lot of sense, and public health absolutely does need to consider mass psychology and their credibility. The theory that they're overindexing on protecting that credibility doesn't really comport with their behavior the rest of pandemic, however. Leaving aside all of the blood on the hands of mindless bureaucracy (like effectively banning testing for Covid in the early pandemic when it was most crucial), there has been decision after decision that prioritized status quo bias and RCT-worship even when the long game suggests it would damage their credibility (the fervent anti-mask recommendations in the early pandemic is a great example, as is the bizarre insistence on recommending precautions against fomites over aerosols until extremely late). More importantly, "public health is misleading you at the cost of your health/life because they're playing the long game" doesn't actually preserve much credibility. It certainly casts public health figures in a more positive light, but I'm not really thinking in terms of blaming individuals over institutions/cultures anyway. It doesn't really matter _why_ public health advice is wrong in obvious and significant ways. What matters is the ultimate conclusion: if you have basic scientific literacy and an IQ over 105, form your own broad understanding of the science. This isn't a call to jettison epistemic humility: you're not going to be able to understand things anywhere close to as well as an individual epidemiologist can. But the point is that listening to the science as filtered through public health advice _is even worse_, in the same way that getting nutrition advice from the USDA will.
- 5y ago