Thread by @michaelmina_lab

Great article bc it feels a bit haphazard (by intention) and thus captures the confusion of the current status of vaccine rollouts across the world.

But I want to talk about a specific quote in the article...

1/x
sciencemag.org/news/2020/12/i…

Many scientists have been frustrated that UK extended time between vaccine doses to ~12 weeks - in effort to get as many people as possible at least a single dose.

This makes sense for optimizing public health. But for optimizing individual protection it is controversial.

2/x

One scientist in the article said:

“I wouldn't want to be sitting around for 12 weeks waiting for the second dose with the partially protective vaccine,”

Under normal optimal circumstances, this opinion might be the right opinion, but In midst of a pandemic, it is faulty..

3/x

Here, the scientist needs to consider the other side.

Sure, if youre the one w 1 dose already in your arm - yeah... you want the second dose

But what if you’re the person w 0 doses, while the other has 1 dose given and the 2nd is just sitting in the freezer for weeks.

4/x

We have to see this w a whole perspective. It’s just too easy to forget that optimizing individual responses may mean giving zero doses to half the ppl

This is another example where in a pandemic we must consider, first and foremost, population health over individual health

5/x

Optimizing public health over individual health however is not an explicit part of clinical medicine. It is engrained in clinic medicine to optimally treat the person in front of you.

This has been the focus of our entire (failing) response to this pandemic.

6/x

This is NOT to say that physicians should not optimally treat the person in front of them. They should!

It is why we need policy guidance that doesn’t put the physician in a position to decide whether to prioritize the person in front of them or the population at large.

7/x

And these are really really tough decisions - decisions that make sense for the whole but some times do not make the most sense for each individual.

Unfortunately sometimes public health has to be a bit more calculated in order to do what’s right for the most people.

8/x

During a severe pandemic crisis, public health decisions often must be based on imperfect information.

This is, plainly, incredibly uncomfortable and comes w risks.

But if we always wait for perfect information, we lose potential opportunities to save lives

9/x

So, UK is taking a step towards optimizing health of the most number of people.

Is it possible it could backfire? Yes.

But not vaccinating half of people while doses sit in freezers carries obvious known risks of infections and deaths of many people waiting for dose 1.

10/x

And there is no reason the effort cannot adapt. Similar to this current adaptation

If there is signal of people getting infections after dose 1 at a rate that suggests the benefits are not outweighing the costs, then the UK can adapt and immediately start giving 2nd doses

11/x

To conclude, my point is that whether it be rapid tests or vaccines, we should prioritize populations over individual

We’re learning each step & there’s no absolute right / wrong way - risks will be everywhere

IMO we should act w an eye on maximizing population health

12/12

Here’s a useful tweet in response by @SRileyIDD

https://twitter.com/srileyidd/status/1344560296552226816