US debates whether UK approach is better on COVID-19 vaccinations

A new approach to COVID-19 vaccination just adopted in the United Kingdom is gaining traction in America, but is dividing public health experts. 

In an effort to push out as many doses of the vaccine as possible, British officials will no longer hold back the second of two doses.

Instead, they will prioritize giving people the first dose and delay the second shot for as long as three months.

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“Everyone will still receive their second dose and this will be within 12 weeks of their first. The second dose completes the course and is important for longer-term protection,” the U.K. government said in a statement. 

“With two vaccines now approved, we will be able to vaccinate a greater number of people who are at highest risk, protecting them from the disease and reducing mortality and hospitalization.”

Each of the two vaccines currently authorized for use in the U.S. require two doses, given either three or four weeks apart. 

Under the current distribution plan, the administration's Operation Warp Speed only delivers half the number of needed doses to states every week. The other half remain in a warehouse, held back to ensure there is enough supply for a second dose.

With the U.S. vaccination campaign crawling out of the gate and more than 3,000 people dying of COVID-19 every day, proponents of the British policy don't understand why the administration isn't using every single vaccine it has. 

“Why not vaccinate as many people with a single dose as you possibly can, with the intention that you should backfill that second dose later?” said Christopher Gill, a professor of global health at the Boston University School of Public Health.

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“I just feel like stateside, we are suffering from a lack of creativity here in thinking about the most efficient way of protecting the population, rather than the most efficient way of protecting the individual. To me that's the fundamental flaw in this,” Gill said.

Anthony FauciAnthony FauciFauci says FDA data shows J&J vaccine should have been two shots Sunday shows - Buttigieg warns supply chain issues could stretch to next year Arkansas governor backs employer vaccine mandates MORE, the country's top infectious diseases doctor, said Thursday the idea of pushing out the first dose to everyone is “under consideration.”

“I still think, if done properly, you can do a single dose, reserve doses for the second dose, and still get the job done, but there's a lot of discussion about whether or not you want to spread out the initial vaccination, by getting more people vaccinated on the first round,” Fauci said on NBC's "Today Show."

Logistical problems have plagued the Trump administration’s distribution efforts, with much of the crucial “last mile” of work falling to underfunded local health departments.

Federal health officials promised 20 million vaccines would be administered by the end of the year, but on the final day of 2020, the Centers for Disease Control and Prevention said only about 2.8 million people have been vaccinated. Fewer than 13 million doses have been delivered. 

Those figures are likely an undercount because of data lags, but the final numbers are still a fraction of the administration’s targets. 

Former Food and Drug Administration Commissioner Scott Gottlieb, who sits on the board of Pfizer, has been a proponent of vaccinating as many people as possible even before the U.K. changed its policy.

“I feel very strongly that we should get as many shots in arms as possible, right away,” Gottlieb told USA Today in early December. “The reality is that one dose is partially protective. I don't think we should be holding on to supply now, anticipating that something goes wrong.”

Gottlieb elaborated in a Twitter post that he is not advocating for delaying or forgoing the second dose. What he wants is for the government to push out more supply now, rather than holding back 50 percent of what's available. 

But there’s a supply risk. By not initially holding back the second doses, more doses will need to be manufactured by the companies, and then distributed by the time the second doses are needed. 

In addition, clinical trials did not study what happens if doses are spread out beyond the three- or four-week window, or how much immunity is provided with a single dose.

While partial protection from the vaccine appears to begin as early as 12 days after the first dose, “two doses of the vaccine are required to provide the maximum protection against the disease, a vaccine efficacy of 95 percent,” Pfizer said in a statement. “There is no data to demonstrate that protection after the first dose is sustained after 21 days.”

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Moncef Slaoui, chief science adviser for Operation Warp Speed, said he does not support a policy with no evidence behind it.

“It's very important, I think, to use a vaccine based on how you have studied it. For me, the biggest concern if we were to extend the time period between the first and second dose is what happens to persistence of protection,” Slaoui told reporters Wednesday.

“You know, I would really advise not to do something that we have no characterization of,” Slaoui added.

Natalie Dean, an assistant professor of biostatistics at the University of Florida, said she thinks delaying a second dose will undermine public confidence, because people who already received their first shot are reportedly having their second dose appointments canceled or rescheduled.

“They're making choices here that are deviating from the standard. It does reflect that it's an emergency, but we don't have the full evidence in front of us, we don't have these discussions or deliberations. And I think they would be better served with a more transparent process,” Dean said. 

Fauci said he understands why people support spreading out the second dose.

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“We know from the clinical trial that the optimal time is to give it on one day, and then, for Moderna 28 days later, and for Pfizer 21 days later. If you want to stick with the data, that's the way you should do it,” Fauci said.

“But you can make an argument, and some people are, about stretching out the doses by giving a single dose across the board and hoping you’re going to get the second dose in time to give to individuals,” Fauci said.