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Top Risks of Deferring Second Dose of COVID-19 Vaccine, According to Anthony Fauci

In the United States, more than 40% of adults have received at least one dose of vaccine, but cases have increased for four weeks in a row (REUTERS)
In the United States, more than 40% of adults have received at least one dose of vaccine, but cases have increased for four weeks in a row (REUTERS)

Given the shortage of inoculants, the health authorities of the United Kingdom and Canada decided to postpone the application of the second dose of the vaccine against COVID-19 to reach more population at higher risk complications with the first dose.

In the In the United States, more than 40% of adults have received at least one dose of vaccine, but cases have increased for four weeks in a row. “We know that These increases are due, in part, to more highly transmissible variants, which we are monitoring very closely, ”he said. Rochelle Walensky, director of the Centers for Disease Control and Prevention (CDC), during a briefing Monday at the White House.

His warning underscored the concern of Anthony Fauci, the United States government’s leading infectious disease expert, that Americans must receive both doses of Pfizer and Moderna vaccines on time, even though extending these deadlines has allowed the UK to accelerate ahead of the US in the vaccination race.

For the specialist, delaying a second dose of the vaccine could put people in a “soft zone” of risk for contracting a more infectious variant of the coronavirus. To the doctor Fauci you are concerned that people who have not had the “full impact” of two doses of vaccines will be dangerously vulnerable to infection with variants that weaken the effects of antibodies.

A scientific study by researchers in Canada has now warned that delaying the second dose may carry risks of a further increase in COVID-19 outbreaks in the future (REUTERS)
A scientific study by researchers in Canada has now warned that delaying the second dose may carry risks of a further increase in COVID-19 outbreaks in the future (REUTERS)

In it UK, the second dose of vaccines manufactured by Pfizer O AstraZeneca it can be delayed up to 12 weeks. The strategy was controversial when it was first introduced there, but it has helped the UK to ensure that almost half of its population has some level of protection with one or more doses of vaccine.

At that moment, Fauci he rejected and even criticized the UK for employing the unproven strategy (although he later backed off on his harsh words). But on Monday he said there was no “right or wrong” strategy when it comes to delaying doses. “There are different approaches and different opinions,” he acknowledged.

“We have been concerned, and still are concerned, that when looking at the level of protection after a dose, it can be said to be 80%, but it’s something like a slight 80%, because the level of, for example, neutralizing antibodies against the coronavirus, when you leave it in a single dose, the question is, how long does it last? ”, the expert questioned.

So far, the South African variant and the Brazilian variant each account for less than 0.05% of COVID-19 cases in the US (AFP)
So far, the South African variant and the Brazilian variant each account for less than 0.05% of COVID-19 cases in the US (AFP)

Research published last month showed that the risk of contracting COVID-19 after a first dose of the Pfizer or Moderna vaccines was reduced by approximately 80% within two weeks of that first injection. But a second dose was given to those people a week or two later, depending on whether they received the vaccine. Pfizer, which has a dosing regimen with a three week interval, or that of Modern, which should be administered four weeks later.

It is not clear how protected people will be with a dose after that second week. And with the variants in circulation, every element of protection counts. Two doses of either vaccine continue to protect against the avoidance variants of the vaccine from Brazil and South Africa. But the antibodies generated by these vaccines are two to six times less effective at binding to the spike protein that allows the coronavirus to enter human cells.

So, in Dr. Fauci’s opinion, It may not be worth the risk of leaving more people on just one first dose for a longer time. Neither variant is common in the US, so the chances of Americans finding them are slim.

Until now, the South African variant and Brazilian variant represent each one less than 0.05% of COVID-19 cases in the US, according to the tracking of Outbreak.info. Still, they are substantially more infectious than the ‘wild-type’ virus, and experts fear that they will only become more prevalent.

Given the shortage of inoculants, the health authorities of the United Kingdom and Canada decided to postpone the application of the second dose of the COVID-19 vaccine to reach more population at higher risk of complications with the first dose (REUTERS)
Given the shortage of inoculants, the health authorities of the United Kingdom and Canada decided to postpone the application of the second dose of the COVID-19 vaccine to reach more population at higher risk of complications with the first dose (REUTERS)

Recently, a scientific study by researchers in Canada now warned that delaying the second dose may carry risks of further increase in COVID-19 outbreaks in the future. The study was published in the journal Science and was conducted by researchers from the universities of Princeton, Harvard and Columbia and the National Institutes of Health of the United States, the Universities of Montreal and Mc Gill of Canada, the University of Oxford and the Wellcome Trust of the United Kingdom, and the University from Sydney from Australia.

Although the work was mainly focused on the Pfizer / BioNTech, Moderna and Oxford / AstraZeneca vaccines, the researchers clarified that the results “are generalizable on all platforms.” “Several countries, including the UK and Canada, have stated that they will delay second doses of COVID-19 vaccines in response to shortages in supplies, but also in an attempt to rapidly increase the number of people immunized,” explained Chad Saad-Roy, who works in the departments of Ecology and Evolutionary Biology (BSE) and Quantitative and Computational Biology at the Lewis-Sigler Institute at Princeton and was the lead author of the study.

“The original clinical trials of the vaccines, plus the subsequent epidemiology, are quite optimistic about the efficacy of the first dose. Nevertheless, we still don’t know how long-term protection and duration of immunity from a single dose will persist (or the full two-dose course or natural infection, really), ”he added Saad-Roy.

The study found that one dose may not be enough. He identified that single-dose strategies can, as expected, reduce the number of cases in the short term by more rapidly immunizing larger numbers of individuals. Nevertheless, if people’s immune responses after a dose are less robust, subsequent outbreaks could be larger.

Another important outcome associated with imperfect immune responses is the potential for viral immune escape (REUTERS)
Another important outcome associated with imperfect immune responses is the potential for viral immune escape (REUTERS)

Another important result associated with imperfect immune responses it is the potential for viral immune escape, the researchers warned. To begin to address this complex question, the authors adapted an earlier model for viral immune escape, developed by co-authors. Bryan Grenfell, Oliver G. Pybus y Edward C. Holmes, along with other colleagues who were not involved in the current work.

“At least one variant has already emerged that can be adapted to partially escape immunity.”noted Dr. Holmes. “The simple theory underlines that the evolution and transmission of variants by infected hosts with intermediate levels of immunity may be important. Therefore, the power and duration of immunity, and in particular their effect on retransmission, are key parameters to be determined ”, he added. Grenfell.

An intuitive finding that the document highlights is that very low rates of vaccine administration may be associated with higher numbers of cases and possibly to a higher adaptation potential of the virus. “This strongly underlines the importance of equitable vaccine distribution globally, as immune escape in one location will spread rapidly “, Explain Jessica Metcalf, co-author of the work, who researches at the Princeton School of Public and International Affairs.

In the study published in Science, the scientists wrote: “Where vaccine distribution is delayed and vaccination rates are low, our results underscore the consequent negative epidemiological and evolutionary consequences that may arise. In particular, since ethese consequences (for example, the evolution of new variants) could arise as global problems, this underlines the urgent need for global equity in the distribution and administration of the vaccine ”.

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