U.K. Vaccination Puts U.S. to Shame
American authorities rejected advice to delay the second dose. Britain shows that approach’s wisdom.
By Marty Makary
The U.S. will soon achieve herd immunity against the novel coronavirus, but the U.K. will get there sooner.
That’s because medical leaders across the pond put the priority on first-dose vaccination, delaying booster shots so that more people could get the initial shot.
Fifty-nine percent of British adults are now vaccinated with one dose, vs. only 38% in the U.S.
Far more Americans are fully vaccinated—21% have received either a booster or the single-dose Johnson & Johnson shot.
In the U.K., where the only options are two-dose vaccines, only 8% of adults are fully immunized.
In both countries, the number of daily deaths peaked in January—3,352 on Jan. 12 in the U.S. and 1,248 on Jan. 23 in the U.K.
Since then, the U.S. count has declined 72%—which sounds impressive until you put it up against Britain’s 96%.
U.K. deaths now average 47 a day.
The U.S. figure, 938, is 20 times as high in a country less than five times as populous.
Many public-health experts thought the U.S. should take the “one dose is better than none” approach, including Ashish Jha of Brown University, Robert Wachter of the University of California and Christopher Gill of Boston University.
Even Michael Osterholm of the University of Minnesota, a member of President Biden’s Covid task force known for speaking his mind, suggested delaying second doses.
“We could get more of our over-65 age group vaccinated,” he told the Star Tribune.
“I think the data will support that actually is a very effective way to go.”
But Anthony Fauci publicly disagreed. On one occasion, Dr. Fauci warned of “the danger” that could come from focusing on the first dose.
And at a Feb. 19 White House briefing Dr. Fauci played down a single-dose study from Israel.
White House senior adviser Andy Slavitt chimed in, telling reporters, “We’re not going to be persuaded by one study that happens to grab headlines.”
The Israeli study demonstrated that the first Pfizer dose was 85% effective at two to four weeks.
But it isn’t the only study. Moderna’s phase 3 trial included 2,000 people who received only a single injection of either a placebo or the vaccine.
In that group, the efficacy of the single vaccine dose was 80% to 90%.
A Feb. 17 New England Journal of Medicine letter notes that first doses of Pfizer and Moderna had an extraordinary 92% effectiveness at three to four weeks.
The authors concluded: “A scarce supply of vaccine could be maximized by deferring second doses until all priority group members are offered at least one dose.”
I agree.
Why use half the nation’s vaccine supply to boost immunity by 3% to 15% in the short-term when we could give lifelines to more vulnerable Americans during a vaccine shortage?
But this week, in response to a new Centers for Disease Control and Prevention study showing a first-dose efficacy of 80% at two to four weeks, Dr. Fauci said that it isn’t known whether the protection drops “off a cliff after two weeks or three weeks.”
That doesn’t happen with other vaccines.
Why dismiss data and real-world U.K. experience with an untested hypothesis?
Regulators also shot down the idea of delaying the second dose.
In January the Food and Drug Administration issued a statement rebuking those “suggesting changes to the FDA-authorized dosing or schedules,” claiming they are “not rooted solidly in the available evidence.”
The FDA warned that delaying the second shot could make people “assume that they are fully protected when they are not, and accordingly, alter their behavior to take unnecessary risks.”
The scientific rigidity and paternalism of health officials sidelined a smart policy that would have resulted in more Americans being vaccinated faster, including in minority communities.
A January Annals of Internal Medicine study estimated that delaying the second dose could have averted up to 29% of Covid-19 cases over an eight-week period.
The U.K. not only reduced Covid-19 deaths more quickly but beat out a contagious new variant as the U.S. lags behind.
Some may argue that the U.K.’s rapidly declining death and hospitalization numbers are really due to their lockdowns, but Germany has had near-identical lockdowns and cases there have doubled over the past four weeks.
That’s because only 11% of the total German population is vaccinated (vs. 45% in the U.K.).
The second dose is important. It creates more-durable immunity and better protection against variants.
Spacing the doses further apart may also help.
With other two-dose vaccines, a longer spacing interval usually results in a stronger immune response.
That was true for the only Covid-19 vaccine formally studied with two different dosing intervals.
The study of the Oxford/ AstraZeneca found that a “higher vaccine efficacy is obtained with a longer interval” of 12 weeks instead of six.
On March 1, Senate Democrats Chris Van Hollen of Maryland and Martin Heinrich of New Mexico sent a letter to the White House urging the administration to consider the “one dose is better than none” approach.
It isn’t too late.
Refusing to think outside conventional wisdom may be the norm in politics, but it isn’t how science is supposed to work.
Dr. Makary is a professor at the Johns Hopkins School of Medicine, Bloomberg School of Public Health and Carey Business School. He is chief medical adviser to Sesame Care and author of “The Price We Pay.”
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