New York Times
Some people want to delay the second shot to speed up vaccination.
The outlook for the fourth wave of coronavirus, with a surge in new cases in the Upper Midwest, has rekindled the debate among vaccine experts about how long to wait between the first and second doses. .. Extending that period will rapidly increase the number of people who partially protect single shots, but some experts fear that it could also create dangerous new variants. In the United States, the interval between two doses of vaccine is 3-4 weeks, consistent with what has been tested in clinical trials. But in the UK, health officials are delaying dosing for up to 12 weeks in order to reach more people faster. Also, in Canada, where vaccination is very low, a government advisory board recommended on Wednesday to delay the second vaccination even longer, up to four months. Some health professionals believe the United States should follow suit. Dr. Ezekiel J. Emmanuel, co-director of the Institute for Healthcare Transformation at the University of Pennsylvania, suggested that in the coming weeks, all US vaccines should be given to those who receive the first dose. Sign up for The New York Times The Morning Newsletter. “Especially in places like Minnesota like Michigan, it should be enough to calm the fourth surge,” he said in an interview. Emmanuel and his colleagues published their proposal in an editorial on Thursday at USA Today. However, opponents, including the Biden administration’s health adviser, argue that delaying the dose is a bad idea. They warn that it will leave the country vulnerable to varieties — in the bodies of those who are already in circulation and who are partially vaccinated who cannot quickly repel the infection. New things that have the potential to evolve. “Leaving a second dose at a later date is a very dangerous proposal,” said Dr. Luciana Borio, a former Deputy Chief Scientist at the Food and Drug Administration. Dr. Anthony Fauci, the country’s top infectious disease expert, agreed. “Let’s go with the optimal degree of protection we know,” he said. The seed of controversy was planted in December, when clinical trials gave scientists the first good view of how well the vaccine worked. For example, in a clinical trial of the Pfizer-BioNTech vaccine, volunteers enjoyed strong protection from COVID-19 two weeks after the second vaccination. However, only 10 days after the first dose, researchers found that volunteers became ill less often than those who received placebo. In the same month, the United Kingdom experienced a surge in cases caused by a new highly infectious variant called B.1.1.7. After approving two vaccines, Pfizer-BioNTech and AstraZeneca, the UK government has decided to fight this variant by delaying the second dose of both formulations by 12 weeks. That policy allowed Britain to take the first dose of an impressive number of weapons. As of Thursday, 48% of the UK population has received at least one dose. In contrast, the United States gives at least one dose to only 33% of Americans. In January, some researchers encouraged the United States to follow the British example. “For now, prior to this surge, I think we need to give as many single doses as possible to as many people over the age of 65 as possible to reduce the number of serious illnesses and deaths that will occur over the next few weeks.” And Michael T. Osterholm of the University of Minnesota spoke of NBC’s “Meet the Press” on January 31st. However, the government kept its path, arguing that it was unwise to confront the unknown in the midst of a pandemic. Clinical trials showed early protection from the first dose, but no one knew how well that partial protection would last. Dr. Celine R. Gowner, an infectious disease specialist at the Bellevue Hospital Center and a member of President Joe Biden’s Coronavirus Advisory Committee, said: board. “I don’t think you can logicalize your method from now on.” But for the past few weeks, proponents of delaying dosing can provide strong protection that the first dosing lasts for weeks. I was able to point out an increase in evidence suggesting. The Centers for Disease Control and Prevention reported that the risk of coronavirus infection was reduced by 80% two weeks after a single dose of either the Moderna or Pfizer-BioNTech vaccine. British researchers also found that protection from the first dose lasted for at least 12 weeks. Emmanuel argued that the UK’s campaign to give more people the first dose affected a 95% reduction in cases since its peak in January. “It’s pretty cool,” Emmanuel said. He points to such data as further evidence that the United States should expand vaccination. He and his colleagues estimate that by April 5, an additional 47 million people had received at least one dose if the country used a 12-week schedule from the start of the deployment. The University of Chicago said she thought the United States had lost many life-saving and valuable opportunities with such a strategy. “We missed the window, and people died,” she said. But even now, Emmanuel said it was worth the delay. The United States receives about 3 million vaccines a day, but nearly half are already given to those who have already been vaccinated once. He argued that the country’s entire supply should go to the first person instead. If that happens, his team will calculate that it will take a couple of weeks for the United States to catch up with Britain. Additional protection not only saves the lives of vaccinated people, but also helps reduce the transmission of the virus to those who have not yet been protected. Still, some scientists say it’s too early to admit that the vaccination schedule has been delayed due to the decline in the number of cases in the UK. “They did some other things like shutting down,” Fauci said. “I think the real test is whether we can see a rebound in the case now that the UK is reopening,” Gonder said. Critics say it is wise to take basic precautions, such as wearing a mask, seriously instead of trying out a vaccination schedule. “It’s important that we don’t just reopen to the big national party,” Borio said. She and others are also concerned about recent studies showing that single doses of Moderna or Pfizer-BioNTech do not work well for certain variants, such as B.1.351, first discovered in South Africa. I’m holding you. “Depending on one dose of Moderna or Pfizer to stop variants like B.1.351 is like using a BB gun to stop a charging rhino,” said Weill Cornell Medicine virologist. John P. Moore said. Moore also said he was worried that delaying administration could help promote the spread of new mutants that could increase resistance to the vaccine. Because the coronavirus replicates in the body of vaccinated people, it may acquire mutations that allow it to evade the antibodies produced by the vaccine. However, Cobey, who is studying the evolution of the virus, said he was not worried about delays in administration to breed more variants. “I spend money on having the opposite effect,” she said. Last week, she and her colleagues published a commentary on Nature Reviews Immunology to prevent delays in administration. Vaccination of more people, even with moderately weak protection, can lead to a greater brake on the spread of the virus in the community than if few people have stronger protection. They said there was. And that decline does not just mean that more lives have been saved. Subspecies are also less likely to emerge and spread. “There are few infected people who can develop mutations,” she said. Dr. Adam S. Rolling, a virologist at the University of Michigan who was not involved in the commentary, said he felt that Coby and her colleagues had filed a convincing proceeding. “The discussion of the work really resonates with me,” he said. While the United States is unlikely to change course, its northern neighbors are adopting delay strategies to address the fast-growing pandemic and vaccine shortages. Dr. Catherine Hankins, a public health expert at McGill University in Montreal and a member of the COVID-19 Immune Task Force in Canada, approved the decision based on new evidence for a single dose. She said she thought other countries facing even more serious shortages should consider it. “I advocate, at the world level, each country scrutinize Canada’s strategy and take it seriously,” said Haskins. This article was originally published in The New York Times. © 2021 The New York Times Company