While these are valid concerns, they are not universally shared in the medical community. In a Washington Post essay, Jha and Bob Wachter, the chair of the department of medicine at UC San Francisco, argued that the combination of a vaccine shortage, the rise of variants, and the death toll justifies a bold strategy like First Doses First. Unlike others, they concluded that the Pfizer and Moderna clinical-trial data on first shots were “reassuring,” with 80 to 90 percent effectiveness for at least one month. The single dose protects against disease, they argued, even if we aren’t sure how long strong protection lasts.
“The best argument against First Doses First and other strategies to stretch the supply, like administering half-doses of the vaccine, is that they go off script from what the clinical trials suggest,” Jha told me. “But one way to solve the data shortage is to get more data.” He suggested enrolling willing participants in randomized blind studies on the efficacy of first doses and half-doses. “Running these trials need not be incredibly hard, and I think enough people would be willing to get a shot in exchange for helping us understand how the vaccine works,” he said. “I know I would.”
A legal analogy may also help frame the debate. In disputes about the Constitution, strict constructionists, or originalists, base their decisions on the literal text, whereas liberals treat the Constitution as a living thing with underlying principles that can be applied to an ever-changing society. Reasonable people can demand that we interpret the clinical-trial data with studious literalness. But Jha is not a vaccine originalist. In this crisis, he is seeking to apply what we know about immunology to a dynamic emergency. “I don’t think being a loose constructionist of immunology means breaking away from science,” he said. “This is science. Science is a process, not dogma.”
3. Eligibility: ‘Simplicity, simplicity, simplicity’
Americans who are eager to get vaccinated face glitchy websites and alphanumeric gobbledygook. Across the country, thousands of vaccines are winding up in the garbage, in part because of confusion over who can get a vaccine and when. In some states, eligibility requirements read like advanced military cryptography. The state of Washington is currently in Phase 1B-Tier 1, which is not to be confused with Phase 1A-Tier 2, which, you may have guessed, followed Phase 1A-Tier 1.
“I really don’t like these 1B, 1C guidelines,” Hotez said. “They’re too fussy, too confusing, and too difficult to operationalize.” He said the national policy should be that everybody who wants a vaccine can get one—or they will be placed in a queue to receive a shot when the supply allows. On Twitter, former FDA Commissioner Scott Gottlieb argued for adopting a reservation system that keeps everybody connected to the process. “If you’re young and it’s not yet your turn, the web site doesn’t say ‘check back later,’ it sends you [a] ticket that guarantees you a slot in a future week or month,” he wrote.