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Zoë McLaren, PhD Profile picture
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29 Jul, 11 tweets, 3 min read
I got an mRNA booster shot in late June about 12 weeks after getting J&J. With the uncertainty around J&J’s protection against Delta, which is unlikely to be resolved soon, I felt more comfortable with the booster than without it. Let me explain. 1/9
There is a good chance an mRNA booster isn’t needed at all. One shot of J&J provides high levels of protection against serious illness, even with Delta. Most J&J recipients are surrounded by mRNA vaccine coverage which provides indirect protection. 2/9
What evidence do we have?
1. Mix-and-match studies found that AstraZeneca then mRNA performed about as well as 2 shots of mRNA. AZ and J&J are not perfectly interchangeable, but analogous enough that this study is relevant. 3/9
nature.com/articles/d4158…
2. There is a J&J + Moderna trial underway at the NIH, which means it’s reasonable to expect it’s safe and will provide more protection. The CDC is unlikely to release new recs for J&J recipients until those results are in.

3. Several small studies found mixed results. 4/9
We know that mRNA vaccines are extremely safe and there is plenty of supply in the US right now. It seems fair for people who only had one shot to have access to a second, especially if since the J&J shot may be somewhat less protective than two. 5/9
Sticking with just the J&J for now is also a reasonable option. It’s highly protective and many people aren’t comfortable getting a booster without CDC guidance. The booster gave me peace of mind because my work and travel schedule this summer put me at greater risk of Delta. 6/9
So I spoke to my doctor openly about my situation and got a prescription for an mRNA booster. In many cases doctors do have the option to prescribe medical interventions that aren’t specifically recommended by the CDC. It’s analogous to “off-label use”. 7/9
I have no regrets about getting the J&J vaccine! It’s a very versatile choice. You can get one and be done or decide down the road to get a booster. It would make for a powerful first-doses-first strategy where booster timing is determined based on real-time data. 8/9
The bottom line is that there is likely little risk to getting an mRNA booster after J&J and potentially a lot of risk in not getting one, both for the recipient and for those around them. Second shots after J&J are one more bulwark against Delta. And we are going to need it. 9/9
This is a great thread by @michaelzlin with more evidence. Note that my argument for mRNA boosters after J&J is based on "the full landscape of uncertainty" not just preventing the worst-case scenario, which can potentially lead to over-caution.
Caveat: I am a health policy expert, not an MD. But Dr. @VinGuptaMD also recommends the mRNA booster after J&J.

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More from @ZoeMcLaren

Zoë McLaren, PhD Profile picture
13 May
Ohio is running a lottery to give 5 people $1 million each if they've been vaccinated. It sounds like a crazy idea but I think it's brilliant. Let me explain. 1/9
1. It creates buzz and gets everyone talking about the vaccine. That opens the doors for conversations that will help encourage vaccine hesitant people to get vaccinated. 2/9
2. Lotteries with bigger jackpots draw more people in. A million dollars might seem like a lot of money but it has the potential to massively boost vaccination rates. 3/9
Read 9 tweets
Zoë McLaren, PhD Profile picture
18 Apr
Unvaccinated people can fairly safely spend time with fully vaccinated friends unmasked & indoors. It’s a relatively safe way to make the pandemic more bearable for all of us while keeping cases down. My piece in the @nytimes @nytopinion explains. 1/8
nytimes.com/2021/04/16/opi…
Data from the @CDCgov shows vaccines not only protect against severe illness, but also greatly reduce the risk of mild and asymptomatic cases, so they help prevent overall transmission too. Vaccinated people can get infected, but it is rare. 2/8
cdc.gov/mmwr/volumes/7…
Spending time with a fully vaccinated person unmasked & indoors is far safer than the same contact with another unvaccinated person. This strategy is in line with @CDCgov guidelines that made the unmasked reunions of vaccinated grandparents with their grandchildren possible. 3/8
Read 8 tweets
Zoë McLaren, PhD Profile picture
21 Mar
If you're at extremely low risk for a severe case of COVID19 why does getting vaccinated make sense? The simple answer is that you still reap massive personal benefits from getting vaccinated because it helps end the pandemic. Let me explain 1/8
Vaccines provide two types of protection: (1) direct protection to the recipient and (2) indirect protection to others by slowing transmission. The transmission-slowing component is a lot bigger than you think and probably greatly outweighs the direct component. 2/8
Every vaccination is like a speed bump that slows transmission down. More speed bumps mean fewer cases, which makes it easier to bring the pandemic to an end and return to normal activities like going to bars and concerts. 3/8
Read 9 tweets
Zoë McLaren, PhD Profile picture
25 Jan
Here's a helpful analogy: We are in a battle against the virus. Each vaccine dose can be used to give armor to the most vulnerable OR to lay a stone in the wall to keep the virus out. 1/4
If doses are limited, it makes sense to start by *only* giving armor to the vulnerable since it offers them a lot of protection from illness and death.

We could try to build the wall first, but the vulnerable wouldn't be protected from the virus until the wall was finished. 2/4
So, while doses & infrastructure are too limited to vaccinate enough less-vulnerable people to control the virus, we must focus on getting the most-vulnerable vaccinated. It's the most effective way to protect them.

Only then should we turn to vaccinating the less vulnerable.3/4
Read 4 tweets
Zoë McLaren, PhD Profile picture
25 Jan
Could throwing some COVID19 vaccine doses in the trash actually help save lives? Buckle up. This thread might break your brain. 1/9
Some argue that it's a net positive for non-prioritized people (e.g. young people) to get leftover COVID19 vaccine doses that would otherwise end up in the trash. Let me try to convince you that this is far less helpful than you think and actually likely costs lives. 2/9
According to the CDC, someone aged 65-74 is 90 times more likely to die from COVID19 than someone 18-29.👇 So vaccinating people 65-74 is *about 90 times more effective* at preventing death than vaccinating someone 18-29. 3/9
Read 9 tweets
Zoë McLaren, PhD Profile picture
23 Jan
I respect @lindy2350's work, but this article draws the misguided conclusion that "declining a Covid-19 shot because you think it should go to someone else won’t help anyone." Let me explain. 1/9
nytimes.com/2021/01/21/opi…
The pandemic has been long and hard on everyone. And I don't want to add to anyone's burden. But the idea that letting other more vulnerable people ahead of you in the queue "won't help anyone" is patently false. It may not fix the system, but it could save someone's life. 2/9
If you are at relatively low-risk *within your priority group* then you have many reasons to believe that your vaccination appointment would go to someone with higher risk. A 65 year old who works from home is at far lower risk than a 65 year old who works in retail. 3/9 Image
Read 9 tweets

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