Fauci: U.S. must stick with two-shot strategy for Pfizer-BioNTech, Moderna vaccines - The Washington Post

The government’s top infectious-disease expert on Monday reiterated that the United States will stick to a plan to inoculate tens of millions of Americans with two doses of coronavirus vaccine, as calls mount to protect more people by letting them get one shot now.

“There’s risks on either side,” Anthony S. Fauci told The Washington Post, warning that shifting to a single-dose strategy for the Pfizer-BioNTech and Moderna vaccines could leave people less protected, enable variants to spread and possibly boost skepticism among Americans already hesitant to get the shots.

“We’re telling people [two shots] is what you should do … and then we say, ‘Oops, we changed our mind’?” Fauci said. “I think that would be a messaging challenge, to say the least.”

Fauci said he spoke on Monday with health officials in the United Kingdom, who have opted to delay second doses to maximize giving more people shots more quickly. He said that although he understands the strategy, it wouldn’t make sense in America. “We both agreed that both of our approaches were quite reasonable,” Fauci said.

Some public health experts and other Americans have urged policymakers to reconsider whether millions of doses intended as second shots in Pfizer’s and Moderna’s two-dose regimen could be distributed as first doses instead — to offer at least some protection to a greater number of people. The issue gained steam after regulators this weekend authorized a single-dose shot from Johnson & Johnson, and an advisory committee to the Centers for Disease Control and Prevention on Monday wrestled with the question.

Two Democratic senators on Monday also called for the Biden administration to inoculate Americans with a single dose to ensure more people get some protection before a possible spring surge of cases. “Based on conversations with health officials, we believe this approach is worthy of serious consideration,” Sens. Chris Van Hollen (D-Md.) and Martin Heinrich (D-N.M.) wrote to Jeff Zients, the White House coronavirus coordinator, in a letter shared with The Post. About 80 percent of adults have yet to get a single dose, according to CDC data.

Fauci said the science doesn’t support delaying a second dose for those vaccines, citing research that a two-shot regimen creates enough protection to help fend off variants of the coronavirus that are more transmissible, whereas a single shot could leave Americans at risk from variants such as the one first detected in South Africa. He also said there is insufficient evidence of the benefit of a single Pfizer or Moderna dose — or data showing how long the immunity conferred by one shot would last. “You don’t know how durable that protection is,” he said.

Fauci argued that Pfizer and Moderna’s commitment to provide 220 million total doses by the end of March, in addition to Johnson & Johnson’s pledge to deliver 20 million shots this month, renders moot any debate about whether to redirect vaccine supply.

“Very quickly the gap between supply and demand is going to be diminished and then overcome in this country,” he said. “The rationale for a single dose — and use all your doses for the single dose — is when you have a very severe gap between supply and demand.”

Meanwhile, Fauci said he spoke on Monday with Chris Whitty, the British government’s chief medical adviser, to discuss the U.K.’s strategy to prioritize first doses and delay second doses. The dialogue was part of a standing weekly call between the two nations’ experts. In an inversion of the debate in the United States, British doctors have complained that the U.K. was wrong to delay second doses.

“We had a really good conversation this morning,” Fauci said, noting that officials on both sides of the Atlantic acknowledged that delaying second doses posed challenges. “We agreed that there is a risk of making things worse by doing that — balanced against the risk of not getting as many people vaccinated as quickly as you can.”

“There’s no right answer to that, and when there’s no right answer … we want to go with what is scientifically, absolutely correct,” Fauci added. “We know that when you give people two doses, not only are they protected to a higher degree, but they have such a redundancy of antibody that you can protect them against even the worst variants.”

Fauci acknowledged that the United States repeatedly has shifted strategy during the pandemic — including his own reversal on whether Americans should wear face coverings — but said that the stakes are higher when it comes to communicating about vaccines.

“People are very skeptical on vaccines, particularly when the government is involved,” he said.

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