We now have a one-dose vaccine that we are confident is reasonably effective on younger people while, as usual, being somewhat less confident that it is effective on older people. Moreover, not only does the J&J vaccine require only one dose, it has no fancy requirements for transporting it. Even more, reasoning by analogy with the similar Oxford/Astra Zenica vaccine, it may reduce transmission significantly. So what should we do with it?
Here’s a modest proposal and before you dismiss it as crazy, note that it is actually backed by some really interesting mathematical models of disease transmission and some really good empirical evidence on contacts between groups as well as data on how Covid-19 is transmitted by different age groups.
Use the J&J vaccine to vaccinate people more likely to engage in riskier behavior or less likely to get a second vaccine and start doing this immediately once the J&J vaccine is approved. More generally, reserve it for people under 50.
Here’s one way to implement this idea: every day pick a city with a reasonably large airport. Show up at the airport with a “swat” team and vaccinate everyone who passes through it with the J&J vaccine. Do it for the bus and train terminal in the same city on the same day if there is one. Extend the idea by showing up in front of bars and restaurants if they are open in that city and offer to vaccinate everyone in that bar or restaurant. Do this by mobilizing the national guard and the commissioned corps of the public health service – think of it as analogous to a military mission to “secure” a city1.
Picking the city at random helps a little to prevent people from gaming the system I suppose. But that isn’t really the point. We shouldn’t care if people game the system. There are actually two points to keep in mind. The first point is that since the J&J vaccine doesn’t require any fancy storage capabilities, it’s certainly practical. The needed logistics are well within the capabilities of the national guard and the public health service.
The second point is the key though – it’s because it is the best way to break the back of the pandemic by greatly reducing transmission rates. Why? Because some really good models of disease transmission predict that lowering the infection rates among people who are more likely to transmit the disease is the best way to break the back of a pandemic! If you think about it for a second, you probably don’t need any fancy mathematics: this clearly works by lowering transmission rates quickly. So, yes, I really am advocating giving the people likely to engage in risky – even stupid – behavior the J&J vaccine and not giving it to people who might be at higher risk. Save the Moderna and Pfizer vaccines for high-risk people of course but don’t give them the J&J vaccine even if it takes longer to vaccinate the high risk population as a result of this choice.
So why is this a really good idea from the point of view of turning the pandemic around in the quickest possible way? Well, it is certainly reasonable to conjecture these kinds of people are less likely to show up for the second dose of the Moderna or Pfizer vaccine, but that isn’t actually the reason to act quickly to vaccinate such people with the one-dose J&J vaccine. The real reason to vaccinate them goes back to mathematical models that were developed around 12 years ago. One of the best was done by Jan Medlock and Alison P. Galvani and was published in Science (Science 25 Sep 2009: Vol. 325, Issue 5948, pp. 1705-1708 DOI: 10.1126/science.1175570) but a far better treatment of their ideas may be found in Medlock’s powerpoint presentation here:http://people.oregonstate.edu/~medlockj/other/flu.pdf. (You do need some knowledge of differential equations though.) And, in case you are wondering if this mathematical treatment leads to a result that is way too theoretical and not backed by “real” evidence, Mossong et al (https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050074) showed: “ a consistent pattern of contact frequency by age, with a gradual rise in the number of contacts in children, a peak among 10- to 19-y-olds, followed by a fall to a lower plateau in adults until the age of 50 and a sharp decrease after that age. And, while I suppose one can argue that Mossong et al is too old to trust fully, a recent paper (https://science.sciencemag.org/content/sci/early/2021/02/01/science.abe8372.full.pdf) showed that 65% of Covid-19 infections came from people between the ages of 20-49 and concluded that “Targeting interventions – including transmission-blocking vaccines – to adults aged 20-49 is an important consideration in halting resurgent epidemics and preventing COVID-19-attributable deaths.”
So let’s start by using the, easily administered, one dose J&J vaccine on the people most likely to spread the disease and more generally people who are less than 50 while reserving the Moderna and Pfizer vaccine for people at higher risk! (If we ever run through those people, we can use the J&J vaccine for people who already have been infected by Covid of course: https://www.medrxiv.org/content/10.1101/2021.02.05.21251182v1.)
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