COVID Update: We are now nearing 5 billion cumulative global vaccinations. This is welcome news & our most important priority.

1/3 of the globe has now had 1 dose, 25% with 2. We can do this.

But if we don’t do it fast & with global equity we will have failed. 1/
This is both straightforward & exceedingly complex.

What’s straightforward is we must vaccinate the majority of the globe before an immune escape variant. That would mean needing to start all over.

Let’s avoid that. 2/
With 8 billion people & a 2 dose regime (will come back to that!), we would need 16 billion doses to vaccinate everybody. To vaccinate 70% of the globe (which experts use as a benchmark & accounts for kids) would mean 11.2 billion doses (or 6.2 billion more than today). 3/
Right now we’re vaccinating 36 million people/day, close to 80% of them in Asia.

The fact that we can produce & administer 36 million/day is great (that’s a billion/month— remember that figure!).

The fact that only 2% have gone to Africa (17.5% of the population) is shameful.4/
One billion doses/month tells us that we have the capacity at that pace to hit our 70% target by the end of February 2022.

@JeremyFarrar tells me that we must aim to hit this target by the end of April 2022 (1st dose March) to have the best chance against variants. 5/
But keeping up the pace means vaccinating Africans with blinding efficiency & high priority.

In 40 African nations, fewer than 10% of the population has yet to receive their first dose. 6/
Let’s start with efficiency. 1.5 million Africans are getting vaxxed every day. Low, but 3.5x July 1. If it grows at this pace, this is encouraging.

The # of vaccines is a limitation, but so are supplies, cold storage & rural distribution. We must improve logistics every day.7/
The improvement since July 1 is gratifying. 10 African countries have increased daily vaccinations by more than 500%.

Gambia, Rwanda & Malawi are up 2500%+
Morocco is averaging more than 350,000 doses per day, Egypt 170,000. 8/
There are more roadblocks to knock down in Africa & other low and middle income countries. But the issue isn’t money. We have it. The IMF is providing funding. The US has donated 500 million doses.

The issue is one of leadership and prioritization. 9/
Let’s start with prioritization.

One obvious complexity emerges. What if it’s a 3 dose regiment instead of 2. What about wealthy nations (who have consumed 75%+ of the doses) all do a third dose. 10/
The US has allotted doses for 3rd boosters in the US. And to be clear, the science is increasingly painting the following picture—

mRNA is either a 3 dose vaccine or a 2 dose 6 months apart. (Not sure which). So this is a correct scientific decision for any government. 11/
The US had sent 100 million doses to states that can’t be sent back & sent overseas.

But the issue isn’t 100 million or 200 million. It’s this— If every wealthy country that did 2 doses added another, it’s 3.75 billion doses. 12/
So if all the wealthy nations use their 3rd shots now, even with blinding efficiency, February becomes May— a month past the target the world needs to hit.

The moral failure & scientific failure of missing this better goal is unacceptable. 13/
Certainly it’s hard for world leaders not to vaccinate their people. They are elected by their constituents w/ a duty above all else to protect them. And their taxes are paying for the vaccines.

But no country can do this without pledging to meet the global goal by April. 14/
There’s a word for succeeding at home & failing globally.

Failing. 15/
So what has to happen. Here’s the plan:

1- At the UN conference in September the wealthy nations must pledge to meet this March 1 dose, April 2 dose goal.
2- That means the coordination, cold storage, and production needs to get better in Africa & everywhere.
3- We need to plan for appropriately spaced or 3rd doses globally. Once the infrastructure is in place this will be easier next time.
4- We need to fund, target, approve new vaccines with other features: nasal delivery, upper respiratory targets, multitalent for variants. 16/
5- We need to stop competing with China & Russia on vaccine distribution and collaborate with China & Russia on vaccine distribution.
6- We should begin working on hesitancy campaigns & conversations all over the globe.
7- We need oral anti-vitals. 17/
8- We need a global pediatric vaccine approval & distribution program. This is something the world has done before.
9- We need our enhanced global surveillance capabilities to publicly monitor new variants & continue to evaluate vaccine effectiveness. 18/
10- We need political G20 leaders—particularly the US— to empower global coordination, ideally through the ACT Accelerator.
11- While countries are being vaccinated, we need to coordinate the supply of oxygen & medicines to countries in need. 19/
We can do this— vaccinate the globe quickly and more fairly than we’ve done it so far. We’ve done harder things when we mean to.

And the encouraging news is that the progress is real & hard fought & has taken massive cooperation. Now we need to do even better. /end
If you want to hear everything you need to know about winning the global war, here it is.…

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More from @ASlavitt

15 Sep
COVID Update: There is an amazing array of efforts, some not very visible, to tackle COVID.

If you want to know how COVID plays out, the variables are here. But there’s the fatal flaw: us. 1/
I can try to classify many of the efforts to address COVID as now (high impact progress we are working on now), med term (things underway but not immediate), and long term (potential big game changers). 2/
The now items are critical to saving lives today & reducing the odds of future variants.

Number one on that list is to vaccinate the majority of the globe by the first quarter. 3/
Read 25 tweets
14 Sep
COVID Update: With requirements rolling across the country, I called a company that implemented vaccine requirements last month.

Here is the experience & lessons for the rest of us. 1/
Background first. The company is based in the Midwest with 6000 people.

The workforce has salaried, factory workers and service center workers.

Their starting point was 70% of the staff vaccinated.

The CEO announced that by 10/1 everyone needed to be vaccinated. 2/
The first reaction was a 10% reduction in their employee satisfaction surveys— the first reduction in the history of the company.

Some people were quite upset. So the CEO began to try to understand people’s reasons for being unvaccinated & their objections. 3/
Read 24 tweets
12 Sep
This chart is interesting.
What it says is that Delta is spreading within households (that’s what Secondary Attack Rate means) at the same level as peak flu season.
Note the increase over last September.

It implies at least 3 things we should try to understand better. 1/
First, kids are getting COVID at school and infecting family members.

Policies preventing schools from protecting kids are failing the entire family including seriously at risk adults. 2/
Second, household infections are going to grow over the Fall and early Winter without more layered interventions. 3/
Read 4 tweets
12 Sep
COVID Update: Watching the reactions & meltdowns to the proposal that Americans are required to get vaccinated (or tested) to be around others.

There is so little actually controversial here but the sideshow is first rate. 1/
Real people by large majorities support vaccine requirements. We’ve had them for decades, even centuries with little controversy.

No governor has threatened to light himself on fire & blow himself up (until now). 2/
Like traffic lights, as inconvenient as they sometimes are, people are pretty ok with rules if they do things like keep kids safe, reduce deaths, and allow businesses to be open safely. 3/
Read 20 tweets
9 Sep
COVID Update: After recent FDA approval, society is moving towards, requiring vaccines at a rapid pace.

And that’s about to get another jolt. 1/
Over 5.5 billion vaccines have been administered around the world. Think about this from a safety standpoint. Rare things happen when they occur a few times per MILLION. So we’ve seen it all.

At this point the safety record would have to be called impeccable. 2/
Over 5.5 billion shots, given to people of all ages & health, you would expect everything to occur. Yet there are only very modest & rare adverse events.

Even anti-vax strategies seem to acknowledge this reality. 3/
Read 20 tweets
7 Sep
COVID Update: How big a problem will future variants be?

I got an update from several top scientists. 1/
Quick review. Viruses continually mutate but can only mutate when they replicate. And so far we’re giving SARS-CoV-2 plenty of opportunities to replicate. 2/
Most mutations aren’t worth noting. They don’t increase hospitalizations. They don’t increase infectiousness. And they don’t cause problems for prior immunity. 3/
Read 26 tweets

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