Vaccine hesitancy in alive and well in the US. And it is going to cost lives. The level of vaccination we have in the US is simply not sufficient against the delta variant.

Friends: tell unvaccinated friends to get vaccinated.

Leaders: lead. Talk to your constituents. Beg them
30 million people who got one dose of vaccine need second dose. One dose is not enough.

Another 60-100 million people need to be fully vaccinated.

Get vaccinated even if you had COVID before.

Im trying not to be alarmist even though I'm extremely worried.
The delta variant is a triple threat. It is here.

1) More transmissible: In India, If often if one family member had it, everyone got it.

2) Vaccine evasive: In UK study a single dose of Pfizer or AZ had only 33% protection against symptomatic COVID.

3) Likely more virulent
More on the delta variant in this thread.
And a lot of important details and analysis in this thread. @DrEricDing
In many countries people are dying without access to vaccines. We have vaccines in abundance. If we miss the boat it will be very sad.
Hear Dr. Fauci speak to @nehakhanna_07 @IndiaAheadNews on low protection with single dose of vaccine against delta variant.
On the J&J vaccine.

There is no scientific or biological reason on earth why this vaccine won't also benefit from a second dose. The company, FDA, and CDC must act and provide guidance to the public who have had only one dose of this vaccine soon.

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More from @VincentRK

8 Jun
Incidental COVID positive test after full vaccination without COVID symptoms is not COVID.

Better still I have been calling for Reinfection COVID and Post vaccination COVID to have their own names, because the natural history and prognosis will be different.
COVID is the name of a disease: SARS CoV-2 infection in people without prior immunity to SARS CoV-2 infection. It carried a certain hospitalization / mortality rate.

SARS CoV-2 infection in people who previously had COVID or were fully vaccinated are different diseases.
You have to define the natural history of each separately because both for the individual patient and for public policy the implications are different.

It doesn't mean Post Vaccination COVID cant be serious: it means the prognosis from such diagnosis will be different from COVID
Read 4 tweets
7 Jun
The reason Biogen's Alzheimer's drug is priced at $56,000 per year and not $112,000 is because they are being kind.

Nothing in the law or process that prevents them from setting whatever price they want. The system is not broken. There is no system.
Hope people at recent @icer_review meeting remember the comment I made at the myeloma meeting: Pharma is wary about lawmakers going after them for price increases. So the name of the game is going to be front loading. Get all you can get early.

@SarahKarlin @RESachs @DusetzinaS
Please for heaven's sake pass a law enabling Medicare to directly negotiate prescription drug prices. 90% of the public wants it.
Read 5 tweets
7 Jun
The FDA basically has the stance that as long as efficacy and safety are shown, the magnitude of the clinical benefit, no matter how tiny, doesn't matter. The cost however huge doesn't matter. It's not in their purview.

We need to reform the system.…
In all other developed countries, regulatory approval is only the first of two steps.

I believe with existing law, CMS and insurance companies can play hardball and exercise the second step: Value. It would be better still if we had an automatic second step to assess value.
We are going to spend money we don't have. We are going to spend money that can go for other life saving treatments. No country has infinite resources.
Read 4 tweets
7 Jun
Important study on relative efficacy of COVISHIELD versus COVAXIN in India. @singhak_endo

Quite a difference in seropositivity after one dose. Difference narrows after 2 doses.

Get whichever vaccine you are offered first. Make sure you get both doses.…
Note that they didn't use neutralizing antibody test. But the results reported should still have a high degree of correlation.

Second, there is more to immunity than antibody titers. However, we do have data that neutralizing antibody levels do correlate with clinical efficacy.
What does this mean: After 1 dose, COVAXIN may not be as effective as COVISHIELD. Thankfully, 2nd dose of COVAXIN is given 4-6 weeks after first. Make sure to get the 2nd dose. After 2 doses, you have an excellent chance of the body being able to fight & destroy the COVID virus.
Read 5 tweets
6 Jun
Based on what we know so far about the COVID delta variant, and what's happening in the UK, 40% of population fully vaccinated is NOT sufficient protection.

See below. The rise in cases in the UK is more apparent in log scale. It's worrying. #GetVaccinated
#GetFullyVaccinated ImageImage
In the US, 30 million need to make sure they get their second dose.

Another 60-100 million need to be fully vaccinated.
Here is why I'm worried about the B1.617 family, including the delta variant (B.1.617.2).

It is a triple threat: More transmissible, reduced vaccine efficacy, and likely more virulent.
It's better to be safe.
Read 4 tweets
5 Jun
Dr. Fauci has a H index of 227.

Which means he has 227 papers that have been cited 227 times or more. There are few people in the history of medicine who have a higher H index. It speaks to how much he has contributed to medicine.

Be respectful. Image
Let me add that 99.9% of academics on Twitter don't have a H index >150. Let alone 200+
@EricTopol is the only one I know in the 200+ range.

The higher the H index, the harder it is to increase it by even one point.
Read 4 tweets

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