Single-Shot and First Doses First

&gt; This is evidence of what I call magical thinking–an undue focus on the clinical trial design as having incantatory power.<p>This isn&#x27;t complicated. Once we have clinical trial evidence, the protocols tested form the <i>standard of care</i>.<p>With no standards of care (i.e. no tested vaccine, here), then we can only guess about what might be better than nothing. It&#x27;s fair to make that decision on a balance of probabilities -- try something if it&#x27;s 51% likely to help (absent negative side-effects, anyway).<p>But once we have such a standard, the very deliberate conservatism of our medical science means we need compelling evidence before supplanting it. I think it&#x27;s very likely that a single dose of Pfizer&#x2F;Moderna is adequately protective in the medium term (weeks to months), but this was not fully tested. It&#x27;s not appropriate to start experimenting on the general population based on a hunch.<p>This community is IT-centric, so think of it like experimenting on a production system. Even if you are 80% sure that something&#x27;s likely to work out, the risk of failure is so catastrophically high that <i>you don&#x27;t do it</i> when any other option is open to you.

Alex Tabarrok has been arguing in Marginal Revolution for &quot;First Doses First&quot; since mid-December.<p>Back then, media commentators and the medical establishment objected &quot;But the clinical trials were for two doses&quot;.<p>Sadly, very few people acknowledged that prudence had a very real cost in additional infections, deaths, risk of mutations, slower economic recovery.<p>The consensus only shifted to &quot;First Doses First&quot; after the faster spreading UK and South African variants emerged, and the risk of inaction became more obvious.<p>If we step back from Covid-19, this kind of one-sided thinking is all too common in daily life.<p>We need more training (at school, university, in media debates) that the choice is never &quot;Do A or not&quot;.<p>It is &quot;do A instead of B (and compare the likely costs and benefits of both)&quot;. Or &quot;do the first bit of A, learn some more, and do A&#x27; or go back to B&quot;. Etc.<p>Real options improve expected outcomes!

Way back when, I wasn&#x27;t convinced about our (UK) vaccination stance; from the start of the rollout it has been first doses - with the gap for the second set at 12 weeks.<p>The British Medical Association said it was wrong, and there was international condemnation. Now the WHO have endorsed an 8 to 12 week gap. They&#x27;ve also recommended the AZ jab for all age groups over 18, despite French and German comments otherwise (I&#x27;m not anti either, I&#x27;m a remainer and respect both, but their politician&#x27;s uninformed comments denigrating the AZ jab were downright dangerous, and the EU is now sitting on unused doses of it).<p>I don&#x27;t know whether we&#x27;ve rather unexpectedly got something right in this sorry mess, or just had a very lucky break.<p><i>Edit: I&#x27;m in the first-doses camp, but not first-doses-first, as the UK is doing two doses in parallel but with an extended gap so a larger volume of first doses go out &#x27;quickly&#x27; but people aren&#x27;t just left with the one. Feels like a good compromise to me.</i><p>I also have to say, despite the fact that it is absolutely nothing to do with me, it does feel quite good that the Oxford jab is by far the cheapest and also being manufactured by third parties across the world at pretty much cost. They done well.

from an earlier post in the series:<p>Michael Osterholm, Regents Professor, McKnight Presidential Endowed Chair in Public Health, the director of the Center for Infectious Disease Research and Policy (CIDRAP) and state epidemiologist for the Minnesota Department of Health:<p><pre><code> …Imagine you are setting across the table from two people both of whom are 65 or older, both with underlying health conditions. You have two doses of vaccine, one in each hand. And you say to them I can give two doses to you or to you but then the other person gets nothing. Or I can give one dose to both of you. And this is what I know. At the very least, one dose is likely to prevent serious illness, hospitalization and death. Two doses will probably even prevent clinical disease with B.1.1.7. But the other one of you; if you get infected with this virus, which I think substantial numbers of Americans will, things are not looking good for you. What do you want me to do? If that is your Mom or Dad. Your Grandpa or Grandma. What would you do? This is where the rubber meets the road. I think if the data bears it out we can save so many lives in the upcoming weeks and we are missing that opportunity. I have already made my choice. I am postponing my second dose. I want my second dose. But I am confident that I can wait. And I can only hope that my second dose, which I have just deferred, will go to someone who it will save their life. It will make a totally different world for that family. You know some could argue that this could be the end of my career. But I could not sleep with myself at night if I didn’t do this. I just know in my heart of hearts that this is something we must do if we are going to save lives. </code></pre> <a href="https:&#x2F;&#x2F;marginalrevolution.com&#x2F;marginalrevolution&#x2F;2021&#x2F;02&#x2F;osterholm-on-first-doses-first.html" rel="nofollow">https:&#x2F;&#x2F;marginalrevolution.com&#x2F;marginalrevolution&#x2F;2021&#x2F;02&#x2F;os...</a>

If your &quot;normal times&quot; scientific standards need to change for an emergency, then they were never appropriate to begin with.<p>But here, I do think the scientific standards are OK. What should be changed in an emergency is not scientific rigor, but the amount of resource that we are willing to spend on the problem with an expectation of waste.<p>With that mindset, throwing money at the problem to fund trials that address a wide range of questions (e.g., 1 vs 2 doses of Pfizer&#x2F;Moderna, 2 vs 4 vs 6 weeks for booster timing, etc) would have been the way to go.

Naive question: given that there is a sort of pareto distribution in covid vulnerability, and that the vaccine rollout prioritizes vaccinating the most vulnerable first, doesn&#x27;t it also make some sense to prioritize stronger vaccinations (2 doses of Pfizer or Moderna) for the early recipients of the vaccine?<p>Increasing the speed of the rollout with delayed second doses or skipping second doses sounds compelling for other reasons, but it does seem like a more complex calculus to me than many articles online want to admit.

Oh god that first comment rings so depressingly true. Is this just the nature of mankind forever or is there some way of setting up incentives such that this doesn&#x27;t play out exactly the same way every time?

As an aside, I feel like suggesting this on social media will likely get you banned or in the least, you would have your posts labeled with a warning, and have to endure attacks from others for “not trusting the experts”. First doses first, and I would argue first doses as fast as possible (not having various “equity” focused schemes slowing things down), are very logical stances to hold. In the least, they are reasonable to bring to a societal discussion. The fact that we can’t openly talk about such ideas with friends, coworkers, or broader society is sad.

&gt; My view is that it would be good if the J&amp;J vaccine was followed by a booster–perhaps of some other vaccine–but that it’s individually fine and in fact socially beneficial to get more people protected quickly by delaying the booster for at least 12 weeks to when vaccines are less scarce. I don’t currently see a reason for thinking differently about the Pfizer and Moderna vaccines.<p>Not an expert, not a researcher, but an economist...

Note that the link takes you to the comments. Scroll up for context.

I try to read all perspectives. I appreciate that a lot of people believe vaccination is the only way out of the pandemic, but I think it&#x27;s a mistake to put &#x27;all the eggs in one basket. I haven&#x27;t noticed much in the way of efforts to help people become healthier so they can have mild cases of COVID-19, COVID-21, COVID-23, etc.<p>Furthermore, why are the medical industry wasting vaccine supply on people who are already immune due to surviving their infection? If a person loses antibodies after 6 months from a natural infection, why would they be expected to have antibodies for longer from a vaccine?<p>I haven&#x27;t noticed many attempts to rationalize vaccinating people who&#x27;ve already had a case of the SARS-CoV-2. The CDC says &quot;Yes, you should be vaccinated regardless of whether you already had COVID-19. That’s because experts do not yet know how long you are protected from getting sick again after recovering from COVID-19.&quot; [0] But that&#x27;s just &quot;trust us we&#x27;re experts.&quot;<p>[0] <a href="https:&#x2F;&#x2F;www.cdc.gov&#x2F;coronavirus&#x2F;2019-ncov&#x2F;vaccines&#x2F;facts.html" rel="nofollow">https:&#x2F;&#x2F;www.cdc.gov&#x2F;coronavirus&#x2F;2019-ncov&#x2F;vaccines&#x2F;facts.htm...</a><p>This week I learned my hair stylist had a mild case in January. She diligently wears her mask, but was not protected from getting exposed to her symptomatic co-worker. She was symptomatic herself for 5 days, and recovered without getting too sick. (Her husband was not so lucky, but survived his hospitalization.) She said she&#x27;s waiting patiently until she too can get vaccinated.<p>My uncle got himself hospitalized in December 2020 or January 2021. He recovered, but just got vaccinated anyways, even though he certainly still had the antibodies. My brother said our uncle was attesting to his faith in in the vaccine - I think the technical term is &quot;virtue signaling&quot;. I think my uncle ought to know better than to use vaccines recreationally.<p>My brother and his wife both had SARS-CoV-2... He was rather sick for a week or two. She was asymptomatic, but tested positive for antibodies. They both got vaccinated, 7 months after their illness&#x2F;exposure. My brother was presumably coerced by his workplace, she was probably virtue signaling too.<p>SARS-CoV-1 burned out after two years. Why would this version be any different?<p>Is not vaccinating people who&#x27;ve already recovered from SARS-CoV-2 the smarter approach to achieving population immunity?