The United States has an ambitious plan to get to population level immunity, but it doesn't have the vaccines to accomplish it (no less the buy in of Americans)
@WSJgraphic by @ErikBrynildsen @joshulick @TaylorUmlauf
@toddlindeman /1

Before the vaccine problems with Sanofi-GSK (wrong dose) and Astra Zeneca/Oxford (? dose) the US was already short in covering its population
https://www.nature.com/articles/d41586-020-03370-6 /2

Here the US ranks #32 as compared with other countries
https://www.bloomberg.com/news/articles/2020-12-09/which-countries-have-reserved-the-most-covid-19-vaccines-u-s-is-32nd-on-list @bloomberg @ArmstrongDrew @tsrandall /3

About ~40% of the US pre-order supply was dependent on Sanofi/GSK and Astra Zeneca/Oxford
https://www.ft.com/content/ac5e5ef8-bccb-482b-9f8d-0dab5cac6f9a
Sanofi issues https://www.statnews.com/2020/12/11/sanofi-suffers-major-setback-in-development-of-a-covid-19-vaccine/ by @HelenBranswell @statnews /4

But, owing to the virus left unbridled, ~20%, more than 60 million Americans have now had a covid infection
https://www.economist.com/graphic-detail/2020/12/10/almost-one-in-five-americans-may-have-been-infected-with-covid-19?utm_campaign=editorial-social&utm_medium=social-organic&utm_source=twitter&%3Ffsrc%3Dscn%2F=tw%2Fdc
https://covid19-projections.com/path-to-herd-immunity/
by @youyanggu /5

The vast majority of those infected would be expected to have a durable (>8-9 months) immune response
https://www.biorxiv.org/content/10.1101/2020.11.15.383323v1.full.pdf @profshanecrotty and colleagues
https://www.nytimes.com/2020/11/17/health/coronavirus-immunity.html @apoorva_nyc /6

Eventually we'll have enough vaccines. But those with prior infections could be deferred. The problem is of the 60+ million people, confirmed infections were in 16 M. The rest were not tested or asymptomatic. What if we could accurately and rapidly determine serology status? /7

Modeling work by @bubar_kate @DanLarremore @CUBoulder @BioFrontiers and colleagues supports a much accelerated timeline if we prioritized vaccines for people who were seronegative (and other demographics)
https://www.medrxiv.org/content/10.1101/2020.09.08.20190629v2 /8

The problem with determining serostatus is the time from infection and false positives from current tests. If we had a rapid, accurate neutralizing antibody test or surrogate metric to support durable immune response, we could do this well /9

Another point that ironically helps us is that the proportion of the 60+ million infected (and >1 million/5 days now) is that 30-50% (w/ @youyanggu) will likely not opt to get the vaccine /10

Given vaccine supply issues, we need a smart strategy to accelerate our trajectory to herd immunity. An unmet need is a test that could provide guidance, which could also be used to verify a salutary immune response to the vaccines. /11