I believe in following the science, but I also believe we must always discuss, and when data and circumstances dictate, have the fortitude to change recommendations. And based on what I’ve seen, I think we need to delay the second dose of #COVID19 vax.

The bird in hand we have offers the possibility of 1.5-2x number of available vaccine doses right now. The “two in the bush” is a hedge against the possibility that people won’t come back for a delayed second dose, or won’t achieve/ maintain high enough levels of immunity. 2/?
Studies are increasingly showing one dose of mRNA vax is highly effective, and provides protection for much longer than 1st thought. I just don’t think the fear that people won’t come back, or that immunity will wane in 3 months, outweighs people infected/ dying right now... 3/?
I also think that we were promised increased use of DPA and other policies to massively increase vax production. If that promise is kept, we should see rapidly increasing number of doses, and 2nd dose issues should be moot point in near future. But people infected/ dying now. 4/?
There is very real and tangible scientific benefit to increasing available doses now. There is a potential (and as yet unproven) benefit to not changing current stance on 2nd dose. And we are in race- a sprint vs marathon at this point- against variants. 5/?
Science can move slowly, & govt can move even slower. I’m open to having my mind changed but right now I haven’t heard much more than “because science” & “because we said so” regarding not changing vax recs- but again the science and landscape have changed, so we deserve more.6/?
If I were in the room, I’d be asking for more of an explanation for why with taxpayer funded vax doses, so many still can’t get them due to a policy that seems less and less scientifically sound. I’m not in the room, so I’m asking on Twitter. And maybe Congress should ask. 7/?
And finally, I’m not saying it’s wrong to maintain current position/ policy. I’m saying based on the info/ explanations/ science available to the public, MANY scientists and public health experts feel the benefits of delaying 2nd dose could > risk. So let’s talk about it. Fin

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More from @JeromeAdamsMD

19 Feb
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn @CVSHealth @Morehouse Thanks for that- minorities were disproportionately dying long before #COVID19 & will continue to afterwards- but we have an opportunity to change trajectories for the better. We must first understand not everyone has the same opportunities for health- equality isn't equity. 1/ Image
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn @CVSHealth @Morehouse We talk about "social determinants of health." Thinks like transportation, and housing, and a good paying job. All of these things are just as important (studies actually show them to be more important in many cases) as access to doctors or medicines. 2/?
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn @CVSHealth @Morehouse What does it mean to tell someone exposed to #covid19 to quarantine for instance, if we don't take the time to ask them about or address that they take the bus, or live in crowded multigenerational housing? 3/?
Read 6 tweets
19 Feb
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn Public health experts always knew this was going to be the hardest vaccine distribution in history. And we need to understand that while federal planning and funding/ support are critical, most of the work happens at the state and local level. 1/?
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn I used to run a State Health Department. You absolutely cannot bypass the state or you will have chaos. But you also have to recognize that not all states have the local partnerships in place to reach the most vulnerable communities. 2/?
@margbrennan @FaceTheNation @CDCgov @KFF @ASTHO @AmerMedicalAssn One of the things we need to do is learn from places like West Virginia. They are blowing away much larger, better funded, & healthier states. So sometimes it IS about leadership, and we need to share best practices and put some friendly pressure on poor performers w the data. 3/
Read 4 tweets
19 Feb
@margbrennan @FaceTheNation @CDCgov Great question. Life expectancy decreased 2.7 years for the non-Hispanic black population (74.7 to 72.0). It decreased by 1.9 years for the Hispanic population (81.8 to 79.9) and by 0.8 year for the non-Hispanic white population. 1/?
@margbrennan @FaceTheNation @CDCgov The first thing we need to do is collect, analyze, & share the data. @CDCgov is now doing this (I've been calling for it for a while so I'm glad to see it). @KFF and others are also putting demographic data out there. Once we have the data, we can identify gaps and targets. 2/
@margbrennan @FaceTheNation @CDCgov @KFF You can check out cdc demographic data at their website. But so far only about 50% of states report.

Read 4 tweets
16 Feb
I’ve been calling for ⁦@CDCgov⁩ to publish demographic data on vaccinations (eg race, gender, and age breakdowns on who is- and who isn’t getting vaccinated), and I’m happy to see it’s finally on their website. VERY revealing- Check it out. 👇🏽

covid.cdc.gov/covid-data-tra… Image
Blacks make up 12% of US population, but less than 6% of vaccinations. Hispanic Americans are 18% of US population, but les than 9% of vaccinations.

Whites seem to be over represented in vaccinations, but so are asian Americans and native Americans. Image
Some fascinating vax data on age and gender- there is a large over representation among women who’ve gotten vaccinated, and among 50-64 year olds who’ve gotten the shot. Does this represent a healthcare worker bubble? Better access? Less hesitancy/ more willingness? 🤔 ImageImage
Read 4 tweets
15 Feb
Lots of debate about what this means. Here’s my take:
- Fewer sick and dying is good, no matter why
- It shows we CAN control the virus
- Like an MMA fight our opponent is stunned- if we keep at we can win- If we let up, we could get knocked out... npr.org/2021/02/15/968…
Is it herd immunity? Well it’s complicated. Herd immunity is a threshold that depends on the setting. On a National level, it could take > 250 million vax + infected (ie 80%). For individual encounters, all it takes it’s one person with immunity to slow/ stop spread...
So with the possibility of 100 million plus infected and recovered in US (some estimate 3-4 x as many who’ve tested positive have actually been infected and have antibodies) and almost 40 million vaccinated, some degree and type of herd immunity is likely helping ⬇️ spread.
Read 5 tweets
11 Feb
I respectfully disagree w @DrTomFrieden here- or at least contend his hypothesis (and that of MANY other experts is incomplete). If you flooded the market right now with vaccine, data suggest they’d continue preferentially going to affluent whites, and you’d increase disparities.
The math is in fact unforgiving. Overall supply is the most important rate-limiting step- IF YOU ARE WHITE. If you’re a minority (and therefore on average at higher risk), there are other significant “rate limiting” factors, like hesitancy and location.
I greatly respect Dr. Frieden’s work, but this is the blind spot (and unintentional but real perpetuation of bias) I continue to see in public health. We often talk of equity, but when we have a chance to drive the conversation, we often prioritize averages > inequities.
Read 4 tweets

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