Thread by @MDaware

this is an excellent point

some of my COVID vaccine thoughts (thread)

https://twitter.com/Theresa_Chapple/status/1333742249641914368

bottom line:
vaccine, good.

I will get vaccinated as soon as I can, which, as an ER doc, will be "soon"

the data we have is very good & very reassuring. I suspect the pfizer data will be published soon, but the fact that they prioritized the EUA, knowing the FDA would release it as part of the process, seems reasonable

all the potential signs of political pressure to "rush" a vaccine have been gone for months. they paused when the DSMB said they should (which is fine!)

(my analogy for that is like a 3 hr drive; I'd rather not stop to go to the bathroom, but if I need to, it's expected and fine)

further, the safety data we have for pfizer & AZ are all reassuring

I'm a bit concerned about 2 things:
1) supply
2) uptake
2b) equity

1) supply
it will take time to get vaccines made & distributed. this sucks

2) there will be hesitancy. it sucks. this is long entrenched and goes back centuries but more recently people like Wakefield and Orient and McCarthy are terrible and I cannot believe we give them the time of day

some hesitancy will come from the sense that these vaccines were "rushed" but as @Theresa_Chapple 's OP said, these weren't rushed in the conventional sense; in historic times we put historic effort to try to solve a historic problem

I'm a little sanguine that these two problems will solve each other to some degree; a trickling supply will mean demand will outpace supply, so many people who are hesitant now may be reassured by all the health care workers who get vaccinated early,

and presumably, all the safety experience we have months from now when supply is more generous will hopefully reassure people

I'm a little more concerned that people will (mistakenly) rely on others' for herd immunity, or (falsely) reassured that 1 dose may be enough

re 2b) equity
I don't want to discount this but 2 things are easier than 3 and it's broadly part of the same uptake issue

this divides into 2 subissues: hesitancy from historic skepticism toward the health care / overall establishment (which is, tragically, well-deserved)

and 2, systemic bias in health care access, etc etc etc

trump's partnering with big pharmacies is broadly good BUT reinforces structural inequities such as disparities in health care access, pharmacy deserts etc

I'm cautiously optimistic that this is EXACTLY WHY @DrNunezSmith is co-leading Biden's COVID task force, particularly in light of the disparate impact on vulnerable communities/people of color

I don't have a lot of specific expertise here so I won't riff too much but this seems like a time where we have the opportunity and responsibility to work toward fixing those inequities

some other thoughts:
these are the first mRNA vaccines which is part of why we got to trial so quickly. IIRC theyve been tried & tested before and been safe but not effective for some other bugs which is promising, and again, safety data now is good

and hand waving physiology, our body is really good at digesting and not misusing mRNA, so it's promising

also the AZ vaccine is a "traditional" adenovirus one that also has very promising preliminary data, so while I'm not concerned about mRNA vaccines per se, I'm happy there will likely be options for those who are

another concern: we will not magically get back to normal quickly. it will take MONTHS to get enough vaccines, build immunity, distribute (2!) doses for most, and even if they're all 95% effective, not everyone will be immune, not everyone will be vaccinated

just as I wear my seatbelt in my car even though it has crumple zones and airbags etc etc etc I anticipate I will be wearing a mask and social distancing and not going to restaurants for months to come

will likely add to this later as I remember what else I forgot