Interesting piece that to me reads as ACIP making a bunch of value judgments without being clear that they’re doing so.

I left more sympathetic with Dr. Walensky’s decision not to accept some ACIP recs that were based on contestable value judgments 1/4

nytimes.com/2021/10/25/hea…
Why not use vaccines to prevent milder cases? This is value judgment city ⬇️

I think we should protect people worldwide from severe disease first, but since that wasn’t ACIP’s reason, this insistence seems confusing. Don’t we vaccinate against varicella & flu, even if mild?

2/4
This reasoning is bad⬇️

Letting people in high risk groups *opt* to receive a booster need not mean that “everyone in those groups needs a booster today”

Booster access should not be based on speculation about how boosters affect people’s perceptions of 2 shot vaccination!

3/4
This misuses the concept of evidence. Weak evidence ≠ no evidence.

Strongest evidence: 2-shot vaccination

Weaker evidence: boosters

“Not evidence based”: sticking berries up your nose

Experts need to find ways to communicate about degrees of evidence, not do this ⬇️

4/4

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More from @GovindPersad

18 Aug
This "simple rule" = locking in the inequity of initial vaccine distribution.

Boosters should be based on risk of severe outcomes if infected after vaccination, not based on how many months ago you were vaccinated--especially given that they admit 8 months is guesswork.
Based on this approach, we are going to put dedicated Jan 2020 vaccine-hunters & a bunch of random hospital employees who were conveniently near our early distribution sites before higher-risk populations who had to overcome hesitancy, access barriers, & unfair eligibility rules
Boosters for non-immunocompromised, fully vaccinated people do not have anywhere near the same individual or population benefit as first or second doses, and the eligibility rules and public health recommendations for them should not be in any way the same
Read 5 tweets
17 Aug
I’ve been critical of booster moratoria as overbroad. There are people at documented high risk here who may benefit greatly from a 3rd dose.

But this throw-the-door-open approach willfully ignores tradeoffs & global scarcity, & rests on scant evidence. apnews.com/article/health…
And the idea we need to give Pfizer recipients 3x Pfizer confuses following the manufacturer with following the science.

If we’re going to do this, at least use fractional-dosing or mix&match boosters so we can use supply to save more lives. Not 150M mRNA vaccines for tiny gains
Instead I’d bet we throw out boatloads of J&J and “old” mRNA vaccines before Sept (just as we did when they could’ve helped abroad or people who actually need 3rd doses), using “too complicated” as an excuse, then vaccinate many 2x vaccinated low risk people with fresh supply.
Read 4 tweets
16 Aug
Below I discuss why we should avoid wasting vaccine doses & redirect them where they can be used—including abroad.

But another interviewee's comments exemplify a systematic pandemic ethics error: seeking to avoid blame & ignoring background risk

npr.org/sections/goats…

1/5
Dr. Plescia @ASTHO says "particularly if it's been distributed to local communities, pulling it all back is kind of asking for some error or problem.”

Are errors possible? Could something go wrong? Yes

But what’s worse—risk of error, or risk of delayed/no vaccine access?

2/5
Avoiding blame-generating “error” vs. saving lives may also explain FDA’s slow-walking of pediatric approvals over objections from @AmerAcadPeds. Harm from denied access is no less harmful—and likely far larger—than harm from error. Others discuss too thehastingscenter.org/the-f-d-a-and-…

3/5
Read 5 tweets
30 Jul
This is the most compelling slide in the set, and makes a very good case for universal masking right now, which I agree with.

However, I'd have liked to see CDC grapple with this: what's the overall reduction in R if vaccinated people mask, but unvaccinated people don't?

1/5
My other concern about some framing (in reporting/Twitter, not the slides) is that it may fuel the following misinterpretation: "a vaccinated/vaccinated person encounter is as likely to transmit Covid as an unvaccinated/unvaccinated one"

That isn't what the slides/data say!
2/5
Even if we assume breakthroughs are just as likely to produce an infectious dose as an unvaccinated person's infection (stronger than CDC's claim):

- vaccines make people much less likely to *be* infectious
- vaccines reduce susceptibility to an otherwise infectious dose

3/5
Read 5 tweets
30 Jul
This is valuable reporting but there's a lot in here that's confusing. Would the Post or the CDC consider just publishing the slide deck?

1/
washingtonpost.com/health/2021/07…
"there is a higher risk among older age groups for hospitalization and death relative to younger people, regardless of vaccination status"
- but surely what should matter is whether vaccination reduces absolute risk for one or both groups, not risk relative to one another?
2/
"there are 35,000 symptomatic infections per week among 162 million vaccinated Americans"
- not sure how to think about this. Seems a lot lower when you think of it as 3.5/wk out of every 162,000.
- what should we expect given a very effective vaccine but high exposure?
3/
Read 6 tweets
29 Jul
The plurality answer in my (unscientific!) poll was the CDC's rec: require masks for everyone everywhere, but allow any type

A less popular answer--don't require masks everywhere (esp. for vaccinated people), but sometimes require KN95+ masks--may better balance benefit/burden.
People often want one-size-fits-all guidance

But current guidance allows high risk (unvaxed hospital visitors w/1-layer cloth masks) & imposes burden w/o large benefit (masking in distanced/ventilated indoor spaces w/everyone vaccinated)

Also hard to square w/open indoor dining
I can see good rationales for universal masking in supermarkets while allowing indoor dining

- everyone needs groceries, dining out's optional
- reducing risk at stores is low-burden vs doing so in dining

But also seems we're placing more restrictions on the lower-risk activity
Read 5 tweets

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