Thread by @TomBollyky

Interim results on Pfizer vaccine are promising

But getting safe doses to those who would benefit most depends on reversing a trend that has defined this pandemic:

to quote Isaac Asimov, “science gathers knowledge faster than society gathers wisdom” 1/
theatlantic.com/ideas/archive/…

US #COVID19 hospitalizations & deaths are surging, and projections are ~200,000 more Americans will lose their lives to the virus before March

A safe vaccine could help shift that trajectory but only if we learn from past US failures distributing vaccines to adults 2/

According to recent analysis, 75% Americans would need to receive a vaccine that prevents at least 80% of infections for that vaccine to end #COVID19 pandemic on its own

(h/t @PeterHotez) 3/
ajpmonline.org/article/S0749-…

75% is going to be a tall order in US

In last decade, US has *never* managed to vaccinate more than half of adults for seasonal influenza in any single year

Seasonal flu vaccination rates among Blacks, Latinos, and high-risk adults aged 18 to 49 are generally even lower 4/

During last pandemic for which we had a vaccine—the 2009 H1N1 pandemic—only 22.7% of American adults were vaccinated

That's with Medicaid covering the cost and CDC + same contractor as we are using now managing distribution 5/

cdc.gov/flu/fluvaxview…

More people might feel urgency to be vaccinated in deadlier #COVID19 pandemic, but perhaps not

Public could be reluctant to be vaccinated with technology— mRNA—that FDA has never before approved

Masks are harmless, and yet 40% of Americans refuse to wear them on daily basis 6/

In this situation, USG priorities should be

1. Prepare state and localities to boost vaccine coverage among high-risk & high-priority populations

2. Convince rest of nation that highly effective vaccine provides future hope, not an immediate promise of life returning to normal

So when does this mean you will get the Pfizer vaccine if it's expanded use is authorized in early December?

Let's do some vaccine math 8/

Pfizer says it will to produce 50 million doses by the end of 2020 and 1.3 billion doses by the end of 2021

US will get half of the initial doses in 2020: 25 million

But vaccine requires 2 doses so: ~12.5 M Americans can be vaccinated in 2020 9/
nytimes.com/2020/11/12/bus…

It's possible that expanded use of Moderna vaccine is also authorized later in December.

It is similar to Pfizer vaccine so if one works well, other might too

If so, that will mean a bit more early doses 10/

https://twitter.com/florian_krammer/status/1325890147850866688?s=20

The US will have plenty of access to these early vaccines.

The rest of world is another matter

If US exercises its purchase option, a few rich nations will have reserved ~85% of Pfizer vaccine doses thru 2021

That leaves everyone else w/enough for only 100 million people 11/

CDC is expected to recommend that frontline healthcare workers get that vaccinated first

The current estimate is that is ~20M people

That will consume most or all of the 2020 supply
12/
cdc.gov/vaccines/acip/…

CDC won't decide prioritization of vaccine allocation for everyone until FDA authorizes expanded public use of safe vaccine

But the next wave is likely to include these categories 13/
cdc.gov/vaccines/acip/…

Whichever priorities are used, we shouldn't leave too much flexibility to states & localities on implementation

In H1N1, states & local vax distribution favored politically powerful which meant big racial disparities & low coverage for health workers 14/
washingtonpost.com/outlook/2020/1…

State+local officials desperately need federal $$ for vaccine dist. plans to work

But CDC has provided just $200M for that purpose

Once in office, President-elect Biden will seek $25B for this but might be too late to repair damage from botched rollout
cdc.gov/coronavirus/20…

Here is the take away:

Science has given the United States an opportunity: a potential vaccine that works unexpectedly well.

Americans can seize that opportunity—but only by working fast and gathering wisdom from our past mistakes

16/16
theatlantic.com/ideas/archive/…