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1. 2021-01-10 11:32 Andrew Rambaut open
   That is the main point - close to herd immunity is the worst for selecting for escape. Why vaccination needs to befast and comprehensive. Its also why I am going more in favour of delaying second dose if you can get universal coverage quickly but the worse would be slow and delayed.
2. 2021-01-10 11:39 Robert F. Garry open
   How about splitting up the doses? Like they have done for smallpox...
3. 2021-01-10 11:41 Robert F. Garry open
   "Slow and delayed" is definitely the Trump approach.
4. 2021-01-10 12:07 Robert F. Garry open
   This might be worth considering and based on the above there is not a minor chance of this making it worse. Nevertheless - Looking back at least at the Pfizer vaccine they got very similar immunological/neut results with 10,20 and 30 ug doses - yet they went with the 30 ug dose in the phase 2/3. Don't know why. The pfizer vaccine isdiluted to about 2 ml per vial. 0.3ml dose. 5-6 doses per vial. I bet based on the Phase I you could double thevolume of the diluent and inject 0.2 mls instead of 0.3 mls and get similar immunity. That's 15-18 doses per vialinstead of 5-6.
5. 2021-01-10 12:12 Robert F. Garry
   Yes - risky!
6. 2021-01-10 12:28 Edward C. Holmes open
   @Robert Garry He sent me that to comment on.
7. 2021-01-10 12:30 Edward C. Holmes open
   @Andrew Rambaut Tasted fine in the stir fry.
8. 2021-01-10 12:44 Edward C. Holmes open
   "That is the main point - close to herd immunity is the worst for selecting for escape. Why vaccination needs to befast and comprehensive. Its also why I am going more in favour of delaying second dose if you can get universal coverage quickly but the worse would be slow and delayed." I can't agree because we don't know how good protection is going to be for 12 weeks. May be fine, but may also be that one dose maximises selection pressures. BUT it's also clear that it's Sophie's Choice in UK...in fact, they have no choice but to delay the 2nd dose. Very hardto balance theoretical evolution against hard deaths. It's also absolutely clear that plus of supply issues no country isgoing to be able to employ the perfect vaccination schedule. The virus is going to evolve and we'll just have to live with it.
9. 2021-01-10 12:47 Andrew Rambaut open
   I agree we don't know but if we drive the emergence of escapes then all of the people we have vaccinated will thenbe vulnerable gain whether they have the 2nd dose or not

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