Is Early Vaccination a Good Idea?

On August 2, bio-statistician Steven Salzberg argued that We Should Consider Starting Covid-19 Vaccinations Now. But, under immense pushback, including an article by another bio-statistician Natalie Dean writing in the NYTimes, he changed his mind and reversed course. I was frustrated by both sides of the debate since neither “biostatistician” presented any numbers to justify their arguments! So let’s do this better.

Suppose you take a vaccine now as opposed to (optimistically) on Dec. 1, 2020. From May 1 to August 5 we averaged 1001 deaths a day. There are 117 days between now and Dec 1 so at that rate there will be ~117,000 additional deaths by Dec. 1. Let’s call it 100,000. There are 324 million people living in the United States so the probability of dying from COVID in the next 117 days is 1/3240 or .03%.

Now what are the risks of dying from a vaccine? We don’t know these risks but suppose the vaccine is given to 100 million people in the United States then in order for there to be an equal number of deaths the probability of death from the vaccine would have to be 1/1000. That’s unlikely but not impossible!

Furthermore, phase three trials are the acid test for efficacy. Results from many phase II trials look good but we will learn more in a larger, more varied population actually at risk for the disease. We will also will learn which vaccines are better, e.g. Novavax’s protein based vaccine looks much better than others in early trials and that will become clearer with larger trials.

Overall, the numbers here do not make a strong case for vaccinating early. I’ve long argued that the FDA is much too risk averse in approving new drugs but vaccines are meant to be given to large numbers of healthy people which makes risk aversion more reasonable.

Note, however, that these numbers are for a randomly chosen member of the population but the people choosing to vaccinate early will not be randomly chosen. If you are an African-American or Latino, for example, your risks are higher. Your risks are higher still if you are an older, male, African-American or Latino physician, nurse, taxi driver or nursing home resident. In these cases, my judgment is that the benefits swing towards early vaccination. The benefits would be larger still if we assume that a vaccine won’t be available until 2021.

I’ve focused on deaths. Clearly, there are also other health risks but they fall on both sides of the equation.

A mass vaccination campaign in advance of phase three clinical trials would be unwarranted. Vaccinating large numbers of healthy people has real risks. Nevertheless, in my view it would not be unreasonable for someone at high-risk of COVID to choose to be vaccinated before waiting for longer clinical trials and such early vaccination, as Tyler noted, would also provide valuable information for everyone else.

Addendum: The Open Source RADVAC vaccine is one option for those with the requisite medical expertise.


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