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Stefan Baral Profile picture
@sdbaral
Sep 15, 2020 • 6 tweets • 3 min read • Read on X
Are we testing #COVID19 vaccines for kids?

I often see an assumption that the COVID vaccines being trialed will be available for kids at the same time as adults assuming efficacy. And that's a big (HUGE) assumption.

Let's take a look at the Oxford, Moderna, and Pfizer trials
Oxford Clinical Trials Link:
clinicaltrials.gov/ct2/show/NCT04…

Two things:
1) Efficacy doesn't appear to be primary outcome for kids as they are only getting one dose
2) Where are the 13-17 yo kids

If I am missing something, happy to be corrected ImageImage
The two mRNA candidates:
Moderna Clinical Trials Link:
clinicaltrials.gov/ct2/show/NCT04…

Pfizer Clinical Trials Link:
clinicaltrials.gov/ct2/show/NCT04…

These trials are easier as are both 18+ so no inclusion of kids. The others including the NA-831 adjuvant for OPV also focused on adults.
Pre-COVID, if we only had data on adults, we would do step-down studies to test for safety in adolescents, kids, etc. Now, exclusion of 13-17 yo in Oxford might be a mistake in clinical trials registration, but mRNA studies seem to be adults only.
ncbi.nlm.nih.gov/pmc/articles/P…
It may be that ACIP (cdc.gov/vaccines/acip/…) approves for kids anyways but I think that this would be uncommon without more data on safety in kids.

All to say, assuming these vaccines work, I don't think we will have efficacy and safety data for kids for quite some time.
If regulatory bodies do approve for kids, I think 50% of parents will sign up right away, 25% will want to talk about it for an hour, and 25% will refuse.

And would be more challenging conversation than for previous vaccines given 1) unproven technologies 2) limited data in kids

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More from @sdbaral

Stefan Baral Profile picture
Jul 20, 2022
For everyone coming to #AIDS2022, the Canadian gov't has reintroduced mandatory random arrivals testing.

The process will likely be convoluted for people staying in hotels as kits will need to be shipped to you or maybe can get one at airport and then returned somehow.

(sorry)
Most people attending #AIDS2022 will be flying into YUL/Montreal Airport.

I contacted Biron (the federal testing contractor in Quebec) and there are 3 options for testing.

1) At airport
2) Locations in Montreal where nurse will take swab
3) Shipping self-collection swab.

2/x
The Biron representative said that testing at YUL should continue for the next two weeks which would include folks arriving for the conference.

So if chosen, could just do test there and will get results in 24h.

If no longer there or wait too long (or tired), options 2/3.

3/x
Read 9 tweets
Stefan Baral Profile picture
May 11, 2022
A public health program implemented without a detailed plan is no more likely to succeed than a house built without a detailed blueprint.
Epidemiological data is one of many inputs into public health recommendations.

Others include:
1) knowledge, attitudes, and practices of affected communities
2) human rights
3) legal contexts
4) human behavior and desires

A pragmatic PH recommendation integrates more than data.
Never get ahead of the community or population you aim to serve with your program or message.

It is natural to assume that you are "helping" but critical to have a feedback mechanism in place to continually confirm and adapt as needed.

If no one comes, it's on you and not them.
Read 4 tweets
Stefan Baral Profile picture
Feb 15, 2022
Paper 19:

Led @Mat__MG, @mishrash, we studied structural risks for #COVID19 in 16 cities across Canada.

Critical for resource-driven interventions to address unmet needs as hypothesized "trickledown benefits" from protecting some folks was insufficient.

cmaj.ca/content/194/6/…
Paper 20:

Led by Barlo MS Center, we studied the prevalence & severity of #COVID19 in 7000 people with multiple sclerosis (PwMS).

No clear increase in burden of #COVID19 in PwMS, but trend of increased severity with certain disease modifying therapies.

msard-journal.com/article/S2211-…
Paper 21:

Led @mugecevik, we built on ideas by @mishrash about importance of networks when considering #COVID19 transmission dynamics and intervention impact.

tldr: we need to do more for people who need more--and need to ask them what it is they need.

science.org/doi/10.1126/sc…
Read 7 tweets
Stefan Baral Profile picture
Nov 11, 2021
I'm going to start a living thread summarizing all of the #COVID19 papers that I have been part of--both data-driven and commentaries/editorials.

Ultimately, anything I say here is based on what I've seen play out in studies around the world.

20 months in...we know a lot.

1/x
Paper 1:

In working with our colleagues at @amfar, we described the disproportionate effects of #COVID19 on disproportionately Black counties across the US.

Drivers of disparities were related to living & working conditions at the ecological level.

2/x
pubmed.ncbi.nlm.nih.gov/32419766/
Paper 2:

We published a commentary in @CMAJ suggesting that early data showed #COVID19 in Canada was marked by heterogeneity in risks of infection, spread and severity across people, places and time.

And responding necessitated adaptive responses.

3/x
cmaj.ca/content/192/25…
Read 12 tweets
Stefan Baral Profile picture
Oct 4, 2021
Just a FYI that one can be very pro-vaccination and appreciate that immunity from infection is real.

Thoughts:
1) No sane folks seek to be infected
2) Immune system is more than a few antibodies
3) Downplaying infection-derived immunity is an unnecessary battle that burns trust.
Read 7 tweets
Stefan Baral Profile picture
Apr 5, 2021
Let's pretend every business implements a #vaccinepassport.

Stay with me and let's think through some logistics.

1/x
(I'm not gonna edit as need to do kiddo bedtime stuff...but just to say, anyone who thinks this is easy has not really thought about that much at all)
Entering business

Does business scan your passport at the front door? If so, do they place an employee by the front door? If not, is the door locked and then unlocked via QR code? If so, does it only allow one person in at a time? If not, do they have a person watching?

2/x
If it is a restaurant, maybe the host does it before seating you? And if self-seating, then maybe waiter does it at the table? So they just eye ball it or do they need to scan something? Do they scan each person or just one person? Do they also check matching photo ID?

3/x
Read 5 tweets

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