My thoughts on 1-dose vs 2-dose approach.

TL; DR

Wrong questions give you wrong answers.

We assuredly should want 2 doses, the only issue is the timing of 2nd dose. And a brief delay is a risk worth taking.

But let's prioritize >65 year old 2nd doses at same time.

1/9

First, let's start with @VirusesImmunity brilliant thread:

We know enough to know that there is vast benefit from giving substantial immunity to as many as possible as quickly as possible. 2/9

https://t.co/QRHx198wkd
We also know that the timing of second dose was never set in stone. Pfizer chose to give second dose at 19-23 days; Moderna chose at 28-31 days. They tested at these levels and proved safety and efficacy. Safety is not at issue with delayed dosing. Efficacy probably is.

3/9
Most of medicine, as practiced, has not been subjected to rigorous clinical trials for various reasons. We weigh available evidence & act accordingly. We pivot when new evidence is available. We should want more RCTs, but they are often unethical or impossible to perform. 4/9
Ideally, Pfizer &/or Moderna would have already done a single dose arm. JNJ is testing both a single-dose & 2-dose regimen. We will have some data in a few weeks on the 1-dose regimen.

But we don't live in an ideal world. We live in the real world. 5/9

https://t.co/oEpNWM6k1p
"Reserving" the second dose undermines our ability to vaccinate the most vulnerable as quickly as possible. We know that many people won't even show up for their second dose (we want to avoid this, but we have seen this with other 2-dose regimens). 6/9 https://t.co/YdLdfhH45A
We don't have to be dogmatic. We can be evidence-based but also practical. We know that the elderly have a reduced immune response to a single dose compared with younger individuals. We can prioritize an earlier second dose for them (>65 year olds). 7/9 https://t.co/lX8bu7UPcX
Bear in mind JNJ vaccine may well get EUA in early February, doubling immediate vaccination capacity with single-dose regimen (hopefully!); AstraZeneca is also still a realistic option in near future.

We ABSOLUTELY should collect data (preferably RCT) on 1- versus 2-dose. 8/9
We seemingly gain a LOT from delaying (for some) the second shot by a short interval (perhaps just a few weeks ). The risk to "reserving" vast numbers of doses, while rampant spread occurs seems HIGHER than the alternative.

Let's put logic & science ahead of dogma. 9/end

More from For later read

Wow, Morgan McSweeney again, Rachel Riley, SFFN, Center for Countering Digital Hate, Imran Ahmed, JLM, BoD, Angela Eagle, Tracy-Ann Oberman, Lisa Nandy, Steve Reed, Jon Cruddas, Trevor Chinn, Martin Taylor, Lord Ian Austin and Mark Lewis. #LabourLeaks #StarmerOut 24 tweet🧵

Morgan McSweeney, Keir Starmer’s chief of staff, launched the organisation that now runs SFFN.
The CEO Imran Ahmed worked closely with a number of Labour figures involved in the campaign to remove Jeremy as leader.

Rachel Riley is listed as patron.
https://t.co/nGY5QrwBD0


SFFN claims that it has been “a project of the Center For Countering Digital Hate” since 4 May 2020. The relationship between the two organisations, however, appears to date back far longer. And crucially, CCDH is linked to a number of figures on the Labour right. #LabourLeaks

Center for Countering Digital Hate registered at Companies House on 19 Oct 2018, the organisation’s only director was Morgan McSweeney – Labour leader Keir Starmer’s chief of staff. McSweeney was also the campaign manager for Liz Kendall’s leadership bid. #LabourLeaks #StarmerOut

Sir Keir - along with his chief of staff, Morgan McSweeney - held his first meeting with the Jewish Labour Movement (JLM). Deliberately used the “anti-Semitism” crisis as a pretext to vilify and then expel a leading pro-Corbyn activist in Brighton and Hove
Every single public defender. Every single day.


Bail arguments, motions, oral arguments, hearings. Judges don’t know, follow, or care about the law. Prosecutors are willing to take advantage of it. And mandatory minimums, withheld evidence, & pretrial detention coerces people to plead before trial. When theres a jury. A shot.

But defenders still fight. And still win. Most times wins aren’t “Justice.” It’s power of repetition of argument in front of same judges. Introducing those in power to the people they oppress. Not just a RAP sheet or words on a page. Defenders make it harder to be brutal & cruel.

I worked as a public defender at an office as well resourced as any in the country. Social workers, team of investigators, a reentry team, support staff, specialist attorneys in immigration, housing, education, family. Relatively low caseloads (80-100). And yet still injustice.

Most think that balancing the scales of justice means more funding for defenders. Thats part of it. Enough a attorneys to actually be at bail hearings. Wrap around services to be able to help people trapped in the system end up better off in their communities. Lower caseloads.

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