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Monica Gandhi MD, MPH Profile picture
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17 Aug, 7 tweets, 3 min read
Not only am I not convinced we have the science yet to recommend booster shoots for everyone but I am very worried about #globalvaxequity and how the Biden Administration could donate some of our >>300 million doses to help vaccinate teh world salon.com/2021/08/17/bid…
Please take a look at how many surplus doses we have and what dire straits low-income countries are in to get their populations vaccinated. Getting the world vax'd would decrease worldwide transmission and the emergence of future variants
covidcollaborative.us/global-vaccine…
The T cells generated by the vaccines are holding up amazingly well, with 99% of the hospitalizations being among unvaccinated adults in the US. T cells protect us from severe disease which is summarized well in this article from UCSF @GladstoneInst
gladstone.org/news/chasing-c…
Antibodies waning from vaccination natural process of the immune system and, when our antibodies wane, memory B cells (generated by the vax) serve as the blueprint to make more. Memory B cells produce antibodies adapted or evolved towards the variants
medrxiv.org/content/10.110…
See how the antibodies produced by memory B cells evolve after vaccination so you know you will get antibodies adapted towards the variants
biorxiv.org/content/10.110…
Problem in giving a 3rd dose of the vaccine that contains the mRNA or DNA (from J&J) that codes for the ancestral virus' spike protein is that the antibodies you produce against that spike protein won’t be adapted towards the variants. Majority of breakthroughs mild
The recent FDA/CDC decision to give a 3rd shot to the immunocompromised is indicated. However, instead of giving 3rd shots to the immunocompetent, the US should donate its excess of 300 million shots globally to end the worldwide pandemic faster.

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More from @MonicaGandhi9

Monica Gandhi MD, MPH Profile picture
17 Sep
BOOSTERS: Dr. Jonathan Sterne's slide from VRBPAC on how 2-dose vaccines provide persistent protection from severe disease in studies where delta variant is circulating. For me, the debate on boosters can be divided into 2 lines of research: immunologic & epidemiologic Image
IMMUNOLOGIC: From an immunology standpoint, no evidence that a 3rd shot needed. Antibodies waning is a normal part of the immune system; you have the blueprint (memory B cells) to make more with T cells helping. Saying "HepB, HPV are 3 shot series" belies
leaps.org/how-long-do-co…
fact that we have NEVER done this amount of research on a vaccine or the immune response before. We have robust studies showing strong memory B cells formed in response to the vaccine in lymph nodes after 2 shots.
EPIDEMIOLOGIC: However, we didn't tamp down transmission enough
Read 7 tweets
Monica Gandhi MD, MPH Profile picture
15 Sep
This is likely study (just got released) pushing booster conversation in US for >60 (of note, booster discussion most relevant to places with high circulating virus due to low vax rates, not urgent in EU now). Data from Israel -not an RCT-
nejm.org/doi/full/10.10…
but decision made in Israel to boost those >60 whose 2nd shot >5 months ago on June 30. This is data from July 30-August 31, 2021, from Israeli Ministry of Health database comparing those who had 3rd shot >=12 days before to those who had not. No matching on co-morbidities etc.
>= 12 days after booster, rate of confirmed infection lower (factor 11.3) in booster group than in nonbooster group as was rate of severe illness (factor of 19.5) . Better protection later on. Likely to push US to boost >60 while cases will circulating with our low vax rate
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
15 Sep
Don't have time to analyze this now but publicly-available documents that the FDA will review for their decision on boosters on Friday are now available here if you want to take a look
fda.gov/media/152176/d…
FDA seems unconvinced so far but we need to go through it bit-by-bit and make a clean decision by Friday so will analyze the studies for you later today
endpts.com/as-booster-sho…
However, this India study showing declining antibodies after vaccination is not really showing anything but how the immune system works. Antibodies wane to avoid your blood becoming the consistency of a milkshake but memory cells make more
reuters.com/world/india/in…
Read 5 tweets
Monica Gandhi MD, MPH Profile picture
14 Sep
Discussing balance, nuance, risk factors for COVID (before vax or even after vax, including heart disease, obesity, etc.) is important. Episode with @DrTomRifai & @DrDavidKatz about balance, collateral damage of pandemic (ok to say that word) and 1918 pandemic
For instance, even fetal stress in 1918 due to health, lower attainment of adulthood income, and occupational fulfillment led to shorter lifespans. Similar to discussions of long-acting impacts of our prolonged school closures in US last year (balance)
read.dukeupress.edu/demography/art…
Cohorts born during 1918 pandemic and in its aftermath exposed to stress, which leads to inflammation which has long-term health effects (on cancer, cardiovascular disease, etc.)
ajph.aphapublications.org/doi/10.2105/AJ…
Read 6 tweets
Monica Gandhi MD, MPH Profile picture
13 Sep
A lot on boosters & immunity (the higher the better; obviously in a surge, immunity goes higher but vaccination rates up too) this week with a summary on @MdMashup
mashupmd.com/weekly-expert-…
Nice paper this morning from Lancet on "Considerations on boosting COVID-19 vaccine immune responses". "The vaccines that are currently available are safe, effective, and save lives. The limited supply of these vaccines will save the most lives if made ..
thelancet.com/pb-assets/Lanc…
available to those who are at appreciable risk of serious disease and have not yet received any vaccine. Even if some gain can ultimately be obtained from boosting, it will not outweigh the benefits of providing initial protection to the unvaccinated" [ and tamping down variants]
Read 4 tweets
Monica Gandhi MD, MPH Profile picture
11 Sep
NOVAVAX vaccine: Want to do a thread on this more traditional vaccine as it involves a protein (spike protein) + an adjuvant instead of genetic material for you to code for spike protein. Remember, we have >9 vaccine candidates worldwide
6 of the vaccines involve the spike protein (5 have you produce the spike protein from genetic code; 1 - Novavax- is the spike protein + adjuvant) and 3 are inactivated whole virions. Spike protein attaches virus to cell
Here are the 6 that involve the spike protein including Novavax so let's explain the latter next and data to date
Read 10 tweets

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