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This fall, Schwartz and Paltiel, along with Rochelle Walensky, who now heads the Centers for Disease Control and Prevention, took a closer look at which would save more lives: a highly effective two-dose vaccine, like those from Moderna and Pfizer, or one that’s less efficient but easier to hug people, like J & J’s. Effectiveness versus efficiency. They devised a simple model that projected the number of deaths and potential hospitalizations in the spring, based on the dire state of the pandemic, and compared how well various theoretical plans would prevent them. For the most effective two-dose vaccine, they started with 75% effectiveness. “We thought it was the best we could hope for,” says Schwartz. (When Pfizer and Moderna’s results came in, the team had to quickly revive their numbers.)
Even with the two-dose vaccine increased to 95% effectiveness, their model suggested that effectiveness remained key. A single-shot vaccine that is 55% effective could prevent as many deaths, they found, provided that many people can get vaccinated quickly. Hence the team’s enthusiasm for adding the J&J results, says Schwartz. It takes half the doses – which means half the shipments, registrations, staff time, headaches – to protect the same number of people. And, unlike his team’s simulation, the United States is getting both types of vaccines, not just one or the other, which means more deaths can be prevented.
Always – and here we will stop evading the question – having all these options means that states will have to decide. or doses of each shot. There are no guidelines yet on where the vaccines will be sent, and Schwartz believes many states will choose to keep it that way: the federal government will send a batch of the vaccine, and they will go to any supplier. – whether it is a pharmacy or a doctor. office or mass clinic – needs it. In other words, the distribution will be on a first come, first served basis and fairly random. But other states may see an opportunity to prioritize certain vaccines for certain people. They might try to reserve mRNA vaccines for those most at risk of serious illness, given the slight increase in protection. Or they might choose to push the J&J vaccine into certain areas – for example, rural communities with less medical infrastructure – because of its logistical ease.
Still, Ann Lewandowski, program manager at the Rural Wisconsin Health Cooperative, says that doesn’t match the challenges of the vaccine distribution effort so far. The logistical challenges peculiar to mRNA vaccines, such as freezing space, have been far less of an issue than ensuring adequate and predictable supply – enough for their patients, but not so much in one batch that they are overwhelmed. (J&J could help, among other things, by sending smaller, more flexible orders suitable for small clinics, explains Lewandowski. The company did not respond to a request for information about the expected minimum order size.) Anyway. , she agrees with Fauci: The greatest need is to deliver more shots.
In some situations, she could see a single shot vaccine being particularly helpful. These may be cases in which the second doses are particularly difficult to organize: for example, in a pop-up clinic that serves people who are not housed. Lewandowski has a relative with no permanent address or doctor, and she knows how difficult it can be to bring people back in these situations for a second dose. “I’m a realist,” she says. “My personal experience is with someone who is difficult to find.” But when she pitched the idea to a Facebook group where health workers were discussing J&J results, it was rejected. Another health official argued that giving vulnerable people a less effective vaccine amounted to “giving up” on finding them for second doses, relegating them to a substandard product.
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