1/10: My latest thinking after speaking with several important people on our current vaccine dilemma.

2/10: Right now, we just don't have sufficient vaccine supply to go around, and we need to clarify our goals. Later on as vaccine becomes available we can open it up to everyone but for now I think it helps to establish some national priorities.

3/10: Among the priorities:
1. Maximize reductions in hospitalizations and deaths, OR
2. Maximize reductions in community transmission, OR
3. Open the economy

4/10: While each reinforces the others, we still need to make some hard choices on what's most important to our nation. Also this needs to take into context, the horrible reality that the new variants are bearing down on us

5/10: Some like Mike Osterholm give us 6-14 weeks before the variants take over. In the meantime, news reports say that J&J and Novovax vaccines won't be here in the hundred million dose range until the summer, while mRNA in summer/fall.

6/10: Therefore, from my point of view, how do we best manage this from now until May.

7/10: Some are calling for single dose mRNA to spread it around. But my concern is that a single dose mRNA vaccine won't provide adequate or consistent virus neutralizing antibodies to protect against the new variants, whereas 2 doses look like some protection?

8/10: But this is squishy, some data would help. Alternatively, I understand we're sitting on tens of millions of doses of AZOx vaccine in the US? This was just authorized by the EMA for the EU. Even if it's not great for older populations, it could be released for 20-40 yos?

9/10: This might free up more mRNA vaccine for older populations and also help with transmission reduction. Another possibility, create more particle or recombinant protein vaccines through DPA?

10/10: These are really tough decisions. I think the Biden Admin had a good plan in place for the nation to vaccinate by the fall, but now with the new variants looming we need to find a way to accelerate our national vaccination program.