Thread by @MoNscience

Just going to say the quiet part out loud again...

Vaccine campaigns were already unrolling unequally, so Johnson & Johnson’s candidate and its lower efficacy raise some tricky ethical questions for the coming months of the rollout. gothamist.com/news/it-fair-g…

Ok now, before you smash that reply button...

Some people may see this story as a criticism of the J&J vaccine, but it's really about disparities in our health care system... gothamist.com/news/it-fair-g…

...On Wednesday, the FDA reported the one-dose candidate from Johnson & Johnson is 72 percent effective at preventing moderate to severe cases of COVID-19 in regions w/o the variants.

For the mRNA vaccines, this protection was upwards of 90 percent in clinical trials...

...the mRNA vaccines also generate more antibodies, a larger percentage of recipients with immunity defenses called T-cells, and higher efficacy among older adults and people with pre-existing conditions than Johnson & Johnson.

Happy to send receipts for anyone who needs 'em...

These differences raise ethical questions around the next stages of the vaccine rollout.

If certain demographics have fallen behind, then policymakers must now wrestle with who should get the more effective mRNA vaccines. gothamist.com/news/it-fair-g…

Mathematically, the best way to control the pandemic would be to inoculate people as fast as possible with any vax above 60% efficacy.

“Our models have shown that vaccinating more people faster is better than waiting for a vaccine with a higher efficacy." - @bruce_y_lee

But we know the J&J vaccine is more likely to be used in under-resourced settings because of its storage advantages.

A weaker regimen, whether it's with J&J or one-dose of mRNAs, will prevent less illness than a stronger one—something to consider given chronic COVID.

Deliver too many weaker vaccines in one area, and its recovery will be slower than those with access to the best vaccines.

If certain areas already mistrust the rollout, and then they learn that they're receiving doses that are less effective... gothamist.com/news/it-fair-g…

In other words, access to these up-and-comers and the mRNA vaccines needs to be equitable and messaging needs to be spot on.

Here are some things we learned from recent @KFF surveys:
gothamist.com/news/it-fair-g…

Or another way to look at uneven vaccine access, courtesy of Jewel Mullen associate dean for health equity at the University of Texas at Austin Dell Medical School. gothamist.com/news/it-fair-g…

And yet another way...

“If you give priority over a certain age, you’re actually prioritizing white lives, and ignoring the historical and current structural inequities that shorten Black lives." - @uche_blackstock

And this issue extends beyond New York. Twenty-two high-income nations, including the U.S., possess more than half of the confirmed supply of COVID-19 vaccines. Most are of the stronger mRNA variety. gothamist.com/news/it-fair-g…

Or to echo @krishna_u: "We wasted too much of the first year figuring out what needed to happen...We can’t get it wrong going forward.”

Ok now, you can smash that reply button (but don't yell at @LoisParshley!) gothamist.com/news/it-fair-g…