Once a week, the Chicago Sun-Times asks random people “How hard have you found it to get a Covid-19 vaccination?” and devotes a page to the responses.
Virtually every answer is a variation of “I’ve tried to sign up on all the websites every day at all times of day and night and appointments are never available.”
The situation is worse for people who aren’t computer-savvy or don’t own a computer since virtually all appointments are to be made online.
Why is this happening?
Just 62% of the US Covid-19 vaccine supply has been administered as shots in arms. The other 38% of our vaccine inventory is sitting in reserve. Illinois is 41st on the “doses received versus doses administered” list.
The answer to this disparity lies in emerging vaccine data. An op-ed in MedPage Today put it succinctly:
One reason for the slow rollout: states and some hospitals are holding back vaccines for scheduled second doses. But to save more American lives and beat back the threat of new variants, we should use the entire current vaccine supply to offer a first dose to all seniors and high-risk people before we administer second doses.
Data are mounting to show that one dose can be highly effective in the short term. In the Pfizer vaccine trial results, there was 91% protection in the first 7 days after the second dose, a period in which the second dose has not yet kicked in. The 91% efficacy observed at 4 weeks is entirely attributable to the first dose.
Considering the annual flu shot gives you 50% protection, this percentage with a single Covid shot is very good indeed.
The most serious endpoint of infection with SARS-CoV-2 is, of course, death. The vaccine reduces the severity of any illness you might get after your injection. And while people who receive just one shot sometimes get a mild case, there has never been a reported death from Covid-19 among those who only got a single dose.
In other words, we should be using our entire vaccine supply to vaccinate all seniors and other high-risk people before we consider administering second doses. To be clear, people who receive an initial Pfizer or Moderna vaccine dose should ultimately get their second dose, but we should not be second-dosing while our supply is severely constrained and 3,000 of us are dying every day.
Holding back vaccine supply to give some people their second dose leaves a multitude of seniors as sitting ducks because they can’t get shot #1 in the first place.
The gap between jabs
The three-week time period between first and second doses is also being greeted with some skepticism. There’s a known phenomenon with vaccines: a longer gap between doses can actually improve the immune response.
For example, with the HPV vaccine, when the two injections are given one year apart the immune response is best. If you sign up for a shingles shot, you’ll be told to return for your second jab anywhere from two to six months later.
The AstraZeneca/Oxford vaccine clinical trials showed that the immune response was three times greater when the second dose was given two to three months after the first instead of the usual three to four weeks. Delaying the second Moderna shot by three months gave people 80% protection after the first shot and 95% after the second.
Now the ethical question becomes: would you rather offer 50 people 95% protection with two shots three weeks apart, leaving the next 50 unvaccinated and unprotected OR would you choose to give all 100 people 80 to 90% protection.
Faced with data like this, the UK recently issued a guideline recommending that people wait three months before getting their second shot. This frees up vaccine supplies so those who are vulnerable get at least one jab.
How did US vaccine rationing come about?
First, we didn’t buy enough vaccine. Remember last year when former president Trump took a pass when Pfizer offered to sell us more? The administration attempted to reverse its decision when they realized the error.
The UK results on single-dose efficacy came from a vast clinical trial called RECOVERY, which was also testing Covid-19 treatments like hydroxychloroquine and the antibiotic azithromycin. It was because of the RECOVERY data that US hospitals began administering the steroid dexamethasone to patients seriously ill with Covid.
US scientists, however, were reluctant to participate in vaccine studies coming out of Europe and FDA scientists were dismissive of RECOVERY data even as they made the decision to hold back millions of doses so that some people could get their two-dose injections. They denied that warehousing second-dose vaccines was actually rationing healthcare.
But here we are. We’re rationing like crazy.
UK results on single-dose efficacy
However, with the compelling UK data, at least some doctors are changing their minds. A few days ago, epidemiologist Michael Osterholm, PhD, advisor to the Biden administration’s pandemic transition team, said he sees the potential for a “hurricane” surge of infection in the next six to 14 weeks due to the more transmissible Covid variants seen in other countries as well as the US, saying “We still want to get two doses in everyone but right now, in advance of this surge, we need to get as many one-doses in as many people over 65 as we possibly can.”
This is precisely the opposite of what new CDC Director Rochelle P. Walensky, MD, has said. She upholds the two-shot policy, recommending waiting as long as six weeks between injections only in “rare circumstances.”
Right now, we need a policy shift to something like “Just get one shot for now. Get your second when supplies increase.” And, as recent data confirms, if you’ve already had SARS-CoV-2, one shot is entirely sufficient.
Shifting policy will not be easy, especially when we’re seeing a massive vaccine grab by people with money. The Miami Herald reported last week that Fisher Island, Florida, one of the wealthiest zip codes in the nation, has a 51% vaccination rate, while nearby Opa-locka, where 40% of residents live in poverty with its attendant vulnerability to chronic illness, has a 2% vaccination rate. There is no justification for denying Opa-locka residents a first dose while the Fisher Island residents are getting their second.
How the one-dose/two-dose issue will unfold in the coming days, weeks, and months is uncertain. We’re confident that vaccine supplies will loosen up slowly but surely. So go online and sign up wherever you can. Ask vulnerable people you know if they need help getting signed up.
Eventually, whatever group you’re in will be eligible and you’ll get the call. Go for it.
David Edelberg, MD