With the launch of the coronavirus vaccine alarmingly delayed in the United States and a more contagious strain of the disease now spreading in at least three states, epidemiologists are concerned with a new strategy abroad: postpone the second dose of the vaccine to get at least more people partially immunized faster.
Earlier this week, British authorities announced that they would prioritize partially vaccinating more people rather than giving the second injection three or four weeks later – which led to a Intense debate among American health experts desperate for faster vaccinations amid a national surge.
But a maddening patchwork of vaccine plans – not to mention the scientific uncertainty about a second delayed dose – means that such a change is unlikely to happen in the United States, epidemiologists say.
“I am totally in favor of vaccinating as many people as possible for the benefit of the community,” said Dr. Peter Chin-Hong, an infectious disease specialist at the University of California at San Francisco, where the medical chair recently said he supported a single dose plan. But given how fragmented and confusing the launch has already been, he said, “that would never be possible in the US”
The Pfizer and Moderna vaccines are given in two doses, about three and four weeks apart, respectively. Although vaccines are more than 90% effective with two doses, it is unclear exactly how delaying the second dose beyond that recommended by manufacturers would affect the general population.
British authorities made the switch in order to do “as much as possible for as many people as possible in the shortest possible time,” the UK’s medical directors wrote in a letter on Thursday, citing data showing “the vast majority of initial protection against clinical disease is after the first dose of the vaccine. ”
Dr. Bob Wachter, chairman of the UCSF Department of Medicine, said in a series of tweets On Thursday, the slow release and the new viral variant “require us to speed up the process of protecting a large part of the population at least partially” with a single shot – mainly because Americans tire of the pandemic precautions.
“It seems increasingly evident that a strategy of getting as many people (particularly high risk) into their first injection as quickly as possible will save many more lives than following the two-shot plan,” he wrote. Wachter was not available on Saturday.
At the national level, however, the idea still needs to gain a lot of momentum. The director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, said earlier this week that the strategy was “under consideration”, but clarified on Friday that the United States will not follow Britain’s example.
Since states are largely responsible for their own vaccine launches after the federal government distributes doses, they could theoretically make the change on their own. The California Department of Public Health said in a statement on Saturday that it is “continuing to carefully review” clinical trial results to weigh against the potential benefit of vaccinating more people.
But Dr. Kirsten Bibbins-Domingo, another UCSF epidemiologist, said California would be wise to stick to its current plan.
“Although theoretically a single-dose strategy with a long lag can get more people with immunity, we run the risk of creating many more logistical obstacles to change gears halfway without the benefit,” said Bibbins-Domingo. “It is difficult to imagine that this is the right strategy.”
About 4.2 million people had received their first dose of the Pfizer or Moderna vaccine by Saturday, according to the Centers for Disease Control and Prevention – well below the 20 million that the United States intended earlier this year.
Fixing these delays took on new urgency after a more contagious strain of COVID-19 was discovered in three states, including California. Although there is no evidence that the strain is more deadly, scientists believe it is responsible for the recent spikes in England – meaning that the United States faces the threat of even more infections with the current winter wave.
In California, the seven-day average of cases has more than doubled since the beginning of December, exceeding 39,000 new infections daily. Meanwhile, the hospital’s intensive care capacity remains at 0% in Southern California and the San Joaquin Valley, and has dropped to just 5.1% in the bay area. Overall, the state recorded 53,341 new cases on Friday and 386 new deaths, most of which occurred in southern California, where health experts were seeing signs of a post-holiday increase.
With the risk of infection looking higher than ever, many anxious residents have recalibrated their expectations of when – if they did – they could be vaccinated in the coming months.
Patricia Fuschetti, 78, an Oakland resident, exchanged information with friends from Boston and the Bay Area about her eligibility, to no avail.
“Nobody knows, because there is no rhyme or reason for what is going on,” said the retired nurse, who would like to see President-elect Joe Biden’s administration come up with a nationalized response to the vaccine. “There is no centralized plan.”
The decision of one dose versus two doses, she said, seems more like something that local and state governments could screw up without clear federal government guidelines.
“Think of the New Deal,” said Fuschetti. “Think about what works in the story and what should happen quickly.“
Stuart Rojstaczer, 64, a writer who lives in Palo Alto, has been in contact with Israeli relatives his age who have already received their first doses. He hoped the vaccine would allow him to see his daughter on the East Coast this spring – and even attend a wedding in May in Israel – but it all seems unreal now.
“We are clearly doing something wrong,” he said of the launch. “It will be a little longer before I see the people I love.”
CNN and the Los Angeles Times contributed.