Dr. Ashish Jha is arguing that the United States should seriously consider postponing the second doses of the COVID-19 vaccine and instead choose to give more people the initial injection first, as the vaccine’s launch in the country falters and with a more contagious strain of the virus expected to spread.
The dean of the Brown University School of Public Health, with Dr. Robert Wachter, head of the department of medicine at the University of California at San Francisco, outlined the case to update the vaccine distribution in the Washington Post.
“As Mike Tyson said, ‘everyone has a plan to get punched in the mouth,'” the two doctors wrote in an opinion article on Sunday. “When it comes to COVID-19, we are getting punched in the mouth repeatedly. It is time to change the plan; that is, we must give people a single vaccination now and postpone the second injection until more doses of the vaccine are available. “
The United Kingdom already opted delaying second doses of the Pfizer and Oxford University / AstraZeneca vaccines as a means of providing a broader group of people more quickly with the initial protections that the first injection offers.
Jha and Wachter argued that with fewer vaccines approved than expected in early 2021, bottlenecks in the distribution of vaccines, hundreds of thousands of people being infected and thousands dying daily in the United States, and now a new variant of the virus spreading, the action must be taken immediately.
“We need to vaccinate as many people as quickly as possible to save as many lives as possible,” they wrote.
According to doctors, clinical trials of the Pfizer and Moderna vaccines indicate that the first injection provided benefits about 10 days after administration, and by the time the second injection was given about a month later, the initial dose was already about 80 to 90 percent effective against COVID-19. But the second dose adds effectiveness and potentially makes the vaccine’s immunity “more durable,” they said.
In the ‘Today’ program Monday, Jha said the clinical trial data indicates that postponing the second dose may still be “quite effective”.
“Given the crisis we are in, I think it is at least worth exploring,” he said.
I talked with @SavannahGuthrie in @TODAYshow
A more contagious virus is a big problem: exponential growth means many more infections, hospitalizations, deaths
Proposed 1/2 dose of Moderna or 2nd delayed dose
Not ideal. But neither are 100,000 deaths expected in the next 4-6 weeks https://t.co/5qJiIVswUD
– Ashish K. Jha, MD, MPH (@ashishkjha) January 4, 2021
Jha and Wachter emphasized in their article that they are not arguing that people should not receive both injections, but acknowledged that there is a risk in the proposal.
“We don’t know if and when immunity from the first shot starts to decrease,” they wrote. “But Moderna’s data, for example, is reassuring. It shows a robust immune response four weeks after the first injection, and most experts believe that immunity is somehow unlikely to collapse in week eight or even week 12 after a single injection. Another concern is that, with a delay, some people may forget to take the second chance. It will take effort to track people down and remind them to receive it. “
But the reality, doctors said, is that between 50,000 and 100,000 Americans will die of COVID-19 in January alone. The pandemic has already claimed lives of more than 350,000 people in the United States, with experts predicting that there will be an increase in the number of cases and deaths after the festive events that took place around Christmas and New Year.
On Twitter, Jha emphasized that, with the current plan, most 75-year-olds will not receive their first dose of the vaccine for “much more weeks”, while the majority of 64-year-olds will not see the vaccine for months.
Until then, the new variant of the virus may become dominant, he said.
And while so far it doesn’t seem to be more deadly on an individual level, being potentially more infectious means it will cause more cases, which in turn means more hospitalizations and deaths, Jha and Wachter wrote.
“Anyone we can protect now is someone who is less likely to become infected tomorrow and die in 4 weeks,” wrote Jha on Twitter. “The main point is that I realize that we are pushing for something that presents risks. But we must not ignore the risk of not doing this at all. “
Obviously, if you want to keep trying (reasonable position), stick to the default range
But soon, we will be faced with the question – we give the second chance to some people or the first chance to more people
Is there evidence from clinical trials that 1 dose is useful?
yea
2 / n
– Ashish K. Jha, MD, MPH (@ashishkjha) January 3, 2021
But while we may not be sure, that doesn’t mean that we have no idea
This is one of the most experienced immunologists in our nation, @VirusesImmunity presenting your evaluation of the 2nd delayed vs. immediatehttps: //t.co/BN7k4Xxx5C
4/9
– Ashish K. Jha, MD, MPH (@ashishkjha) January 3, 2021
We are in the process of having another 50,000 to 100,000 Americans dying of COVID in January
And that number again in February
Most 75 year olds will not receive their first dose for more weeks
And most 64 year olds won’t do it for months
And the new variant will become dominant at that time
6/9
– Ashish K. Jha, MD, MPH (@ashishkjha) January 3, 2021
And for us, the answer is, distribute the first doses immediately
Place 2nd doses on weapons as soon as they are available at the end of winter
It is now reasonable to make some exceptions, such as nursing home residents, where you want to maximize protection
But if you hear Operation Warp Speed
8/10
– Ashish K. Jha, MD, MPH (@ashishkjha) January 3, 2021
Anyone we can protect now is someone less likely to get infected tomorrow and die in 4 weeks.
The main point is that I realize that we are pushing for something that is at risk
But we must not ignore the risk of not doing this at all
Here is the article again
Finhttps: //t.co/UWAj9cY08N
– Ashish K. Jha, MD, MPH (@ashishkjha) January 3, 2021
Receive email alerts from Boston.com:
Subscribe and receive breaking news and updates on coronavirus, from our newsroom to your inbox