Biden & Single shot/Delayed Second Shot - Printable Version

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Biden & Single shot/Delayed Second Shot - M_T - 01-09-2021

News reports indicate the President-Elect will have Operation Warp Speed ship all doses out as soon as they are manufactured, counting on second doses to come from future manufacturing.  

This won't help the current situation where the hangup is that the states didn't get their act together of getting doses in arms.  For instance, no  one in California arranged for anything but token vaccination of LTCF residents (in the very first group per CDC recommendation) until Dec. 28, months after they knew it was coming and 2 weeks of it sitting in the refrigerators.

I can see it happening two ways.  One is that if you get a first dose, you are first in line for your second dose at 3 or 4 weeks, if there are doses available, or as soon afterwards as possible.  Two is that everyone gets a first dose, and then second doses are distributed, as I understand the UK is doing. Unless the manufacturers (that we know are going full sped) somehow can go at 110% of capacity, this will mean delays of 6-12 months.    I understand the second option is contrary to what the CDC has recommended.

The first option gets a first dose for the 250M eligible (16+) people about June.  With current purchases of current vaccines, only 150M of those have a second dose by the end of July.  The remaining 100M are not covered yet.

The second option pushes first doses ahead by 3-4 weeks from the prior schedule.  The last of the 200M courses are manufactured and arrive by the end of July.  The 200 millionth second dose will be given in August either way.  200M get two doses by August either way, 50M get no doses.

If Biden is going to follow the scientists, he will take the second option.  At this time we don't know that.

RE: Biden & Single shot/Delayed Second Shot - dabigv13 - 01-09-2021

Not sure I agree that following the scientists favors the second option. Many scientists worry that the UK approach will increase the odds of generating vaccine resistant variants by putting out lots of people with low levels of antibodies which would favor escape mutations. 

I think the first approach is the best. Remember, mRNA vaccines are a completely new type of vaccine, and both were designed to be given in two shots. The adenovirus vaccines may be another story but the science on them is murky. They are a slightly mature technology as well.

To wit, I am aware of two physicians who caught covid after getting one dose of the vaccine (one was Pfizer, not sure on the other). One about a week later, another two weeks. 95% efficacy was after two doses, and then in a controlled trial.

RE: Biden & Single shot/Delayed Second Shot - M_T - 01-09-2021

EDIT: Whoops!  When I wrote this, I confused by 1st & 2nd options.  Both dabigv and snorlax had it as I wrote it above.

dabigv, I'm not sure you understood what I referred to as the "second option".  The first option is the UK system.

Currently, the US stockpiles the 2nd dose for each of the 1st doses they ship.  When time comes, they will pull that dose out of the freezer and ship it out.  That way, no matter what happens in manufacturing, there is always a 2nd dose ready to be there when the time is right.

The alternative that I described as 2nd option is where all doses are shipped as they come out of the manufacturer's warehouse.  When it comes time for someone to get a 2nd dose, it is one freshly manufactured.  But if manufacturing hiccups, the 2nd dose may be delayed.

As it turns out, I see that Santa Clara County has turned some unused first doses into second doses since that sat unused.

RE: Biden & Single shot/Delayed Second Shot - Snorlax94 - 01-09-2021

I agree that the holdup is with the counties, which have been sitting on the vaccine that they have, but I suspect the delay is in their attitude, not in their capacity, so the hope is this change will help unclog the counties that have been slow. So I am in favor of the Accelerated Biden plan, though of course there are risks.

I assume the way they will do this is by, as new vaccine is produced, to prioritize the new inventory FIRST to make sure people get their second shot. BUT you still accelerate rollout by not having vaccine sitting around for 3 weeks.. Let’s say vaccine production looks like this (numbers are millions of people, assuming people are vaccinated as soon as vaccine is earmarked, which we know isn’t happening, but bear with me)

Week 1   2.    3.   4.   5.    6.   7.   8
Dos.  10  12   14  16  18   20   22  24
current plan # ppl 1 shot
         5   11   18  26  35   45   56  68
Current plan # ppl receive 2 shots
         0    0     0    5   11   18  26  35

IE in week 1, you produce 10M doses, but only vaccinate 5M people and hold the other 5M doses for the second shot. In week two, you produce 12M doses, but give only 6M more people a dose, and reserve the other 6M doses you produced for 3 weeks.

Biden plan, use all vaccine as it comes in, but prioritize
Second shots first, Assuming same production schedule as above
     # people each week (cumul) who have received one shot
         10  22  36 42  48  54   60  72

    Biden plan, # ppl who’ve refeived 2 shots (cumul)
          0   0    0  10   22    36  42  48

IE in week 1, you produce 10M doses and give 10M shots. In week 2 you produce 12M doses and give 12M shots. In week 3 you produce 14M doses and give 14M shots. In week 4 you produce 16M shots, and you earmark 10M for the people who got their first shot 3 weeks ago, so only 6M more new people get first shots. In week 5 you produce 18M shots, and you earmark the first 12M doses for people who got their first shot 3 weeks ago, and give the remaining 6M doses as first shots.

Everybody still gets their second shot 3 weeks after getting their first shot, but you get a burst now, which will be especially helpful for the elderly.

I am not advocating the UK plan, which seems reckless, but with the Biden plan, by not having ready vaccine just sitting around with a reserved sticker on it, we get more people vaccinated faster.

And actually, more people will receive their SECOND SHOT SOONER also!

The downside of the Biden plan is what if there is a disruption in production and you don’t produce enough one week to give a second dose to the people who got their first dose 3 weeks ago.

That is a risk, but given the number of people dying each week, and given the assurances from mfgrs, I think it’s worth taking.

Or MT, to put it in your parlance, my understanding is that the Biden plan is your approach #1
I agree it has less of an impact than the UK Plan (everyone gets first doses first and figure the second dose out later), but I think approach #1 (prioritizing 2nd doses without squatting on second doses) gives you an initial burst NOW, which I think is what we really need because the initial launch has been very slow, we’re in the middle of the worst wave ever, and we have not yet vaccinated the elderly, and the Biden approach will probably save tens of thousands of lives by getting the elderly vaccinated a month or two earlier.

RE: Biden & Single shot/Delayed Second Shot - M_T - 01-09-2021

Yep, you & dabigv got it right. I had swapped option 1 & 2 in my mind since I wrote the first post.

RE: Biden & Single shot/Delayed Second Shot - dabigv13 - 01-10-2021

Snorlax, I think that in an ideal world, it works out like you described. However on a local level, where you need to schedule patients for an appointment for their second dose, as well as deal with people canceling or showing up late etc, on a product that has to be used within hours, makes it tricky.

I think if we can be very certain that manufacturing will steadily ramp up with no hiccups, then it's a nice plan. But my sense is the hospitals find out pretty late how much vaccine is coming and when. Having some slack built-in is important.

RE: Biden & Single shot/Delayed Second Shot - M_T - 01-10-2021

Snorlax, I think your calculations of "weekly" numbers don't match the supply (obviously not in quantity nor in schedule).
You've shown something like a Ponzi scheme where there is always more coming in
... until there isn't.

As I understand it, the expected original 200M doses are expected around the end of February. Then and additional 100M Pfizer are due by June 30; 70M Moderna by June 30; 30M Moderna by July 31. (I could have Pfizer & Moderna swapped regarding the 70/30 split.)

So, the purchased production of vaccine doses is roughly (my estimation of schedule, not anything announced after February. The goal of 100M by end of February was announced early and may have slipped.).
December: 40M (actually less)
January: 60M
February: 100M
March: 0
April: 50M
May: 60M
June: 60M
July: 30M

If more doses are purchased from Pfizer or Moderna, I expect they'll not be available until July.

If no change is made to distribution, there would be 20M first & second doses delivered, an additional 30M first doses delivered by the end of January with 30M 2nd doses stored for those people. There'd be another set of 50M people in February that would get first doses (and 2nd doses in March).

When Biden comes into power, there will be about 35M first doses and 15M 2nd doses delivered to the states with 20M 2nd doses in reserve.
Unless he forces Pfizer & Moderna to screw over the other countries who have contracts for deliveries in March, he is stuck with the same result: 100M people with first doses by sometime in February with 2nd doses stretching into March. In order to meet the 3 or 4 week second dose timeline, he's going to have to stockpile up to 50M doses from February for use in March.
Maybe he moves some first doses up by 2 weeks by shipping out the 20M in late January.

But, as was said in the California vaccine committee, vaccines don't protect the people, vaccinations do. Shipping out the doses doesn't mean they will do anything but sit on the shelf in the states.

By the way, my calculation is that California phase 1B tier 2 will be partially covered before the March hole in the schedule of vaccine availability. Being the first of that group means something like a 2-month difference in when you get the vaccine versus those just behind you.

RE: Biden & Single shot/Delayed Second Shot - dabigv13 - 01-11-2021

Seems Florida is already dealing with this problem.

Quote:On Monday, Sarasota Department of Health officials say all appointments to get the second dose of the COVID-19 vaccine the week of Jan. 11 are canceled. They say the state told them the county would not be receiving any vaccine supply this week.

RE: Biden & Single shot/Delayed Second Shot - Snorlax94 - 01-12-2021

We can avoid a “Ponzi scheme” type hole if we simply stop giving first doses when expected shipments are ending.

For example, if we expect 100M doses of Pfizer through the end of March and we’re not sure when the Q2 doses start, we can cap the accelerated first doses at 50M. It still gets out many of those doses out more quickly.

Anyway, this is now policy and I guess it’s not even the Biden Accelerated plan anymore as the Trump administration has adopted this plan.

Trump administration reverses course and adopts part of Biden vaccine distribution plan
Washington (CNN)
The Department of Health and Human Services is expected to announce sweeping changes Tuesday in vaccine rollout guidelines in an effort to boost the lagging number of vaccinations in the first month -- effectively adopting the approach proposed by President-elect Joe Biden's incoming administration.

The Trump administration plans to release reserved second doses immediately, a senior administration official tells CNN. The official expects reserved doses to be distributed over the next two weeks.

RE: Biden & Single shot/Delayed Second Shot - Snorlax94 - 01-13-2021

Very cool. A Stanford paper published on Jan 4 advocated for the earlier release of reserved doses to be used as accelerated first doses “while enabling most to receive second doses on schedule.”

An Alternative Dose Distribution Of Tight COVID-19 Vaccine Supply

SHP's Joshua Salomon and colleagues offer an alternative approach to COVID-19 vaccine distribution — modeling a flexible strategy that would result in an additional 23% to 29% of COVID-19 cases averted compared with the current fixed strategy.

With concerns mounting about surging COVID-19 infections, the emergence of a more contagious variant, and sluggish distribution of new vaccines, SHP’s Joshua Salomon and colleagues have mapped out a way to gain more benefit from the first available doses of the Pfizer and Moderna COVID-19 vaccines.

Last month, the U.S. Food and Drug Administration issued an Emergency Use Authorization for the Moderna and Pfizer-BioNTech COVID-19 vaccines — a result dubbed “a miracle” by some health-care analysts as clinical trials for new vaccines typically take up to three years before they are approved for manufacture and distribution.

Although trial evidence for both vaccines indicate partial protection against COVID-19 illness after just one dose, both vaccines are authorized only in as two-dose series and have not yet been evaluated for single-dose use. So, in the United States, national distribution plans for the vaccine call for initially withholding 50% of the supply from states, only to be released three weeks later for use as second doses.

With the surge of COVID-19 cases nationwide, however, the researchers argue in their study published Jan. 4 in the Annals of Internal Medicine that this conservative approach delays giving the first doses to many who could gain substantial health benefits from earlier vaccination, such as the elderly, essential workers and those with pre-existing conditions and comorbidities.

“Current policies place a premium on eliminating any possible delays to delivering second doses,” Salomon and his colleagues write. “We find that under most plausible scenarios, a more balanced approach that withholds fewer doses during early distribution in order to vaccinate more people as soon as possible could substantially increase the benefits of vaccines, while enabling most to receive second doses on schedule.