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Brian Lehrer: Brian Lehrer on WNYC. Amid the global shortage of COVID vaccines, the medical community in Europe and the United States is debating whether to use all COVID-19 vaccine doses on hand now to vaccinate more people or continue to hold back those now designated for second shots. In the UK, a new study conducted by Oxford researchers found that the AstraZeneca COVID vaccine was 76% effective at preventing symptomatic infection for three months after a single dose, according to CNBC.

The AstraZeneca vaccine has not been cleared for emergency use authorization in the United States, though the same research is being conducted with the Pfizer vaccine, which of course they are using here, that research also in the UK. Plus, there's data from Israel, whose quick rollout has made it the largest real-world study, some are calling it, of the Pfizer vaccine, according to Reuters, but some officials, including Dr. Anthony Fauci, are not convinced it's the right move for the United States. Joining me now to break down each side of that argument and some other COVID vaccine distribution strategies is Jonathan Cohn, Senior National Correspondent at HuffPost.

His forthcoming book is called The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage and will be out on February 23rd. Jonathan, welcome back to WNYC. Thank you for coming on.

Jonathan Cohn: Thank you for having me on the show.

Brian Lehrer: As you pointed out in your latest article, both the Moderna and Pfizer shots require a two-dose regimen that is approximately 95% effective against preventing serious illness. You write, however, "But buried in the research that the vaccine makers submitted to the FDA was another intriguing finding, evidence of some protection from just one shot." What does the science about how effective one shot of either vaccine show?

Jonathan Cohn: Well, it is pretty clear at this point that one vaccine does produce an immune response and that within 7 to 10 to 12 days of getting that first shot, people develop some protection against COVID. We see that in the Pfizer data. Again, Pfizer study, they gave people a shot, and in the Pfizer shot, you get one, you get an initial dose, you get the second dose three weeks later, with Moderna, it's four weeks later.

Even before those second doses were administered, you could see the incidence of disease fell, and Moderna, which in particular, had done some very close following and testing, you could see that there was lower rates of-- The immune response was kicking up, there were lower rates of infection. There's clearly some evidence that these shots work after one dose.

At the same time Pfizer and Moderna, they didn't decide to do two doses willy nilly, there's a lot of literature that suggests that for this kind of vaccine, you're going to need a booster, you're going to need a second shot. They looked at their data, they looked at their experiments, Pfizer for each shot, thought three weeks was probably the optimal amount. Moderna decided four weeks for theirs. They're similar shots, but they came to different conclusions. That is what they tested completely, and they actually set out to test in those figures you saw, 95% efficacy, that is after two shots.

Just to emphasize that is in the world of vaccines 95% efficacy, that's a home run. That is just better than anybody had hoped for and what your goal is, and that's now we have solid 100% clinical data on this. The question, the debate is now all right, well, we know that we get almost full protection, 100% efficacy or close to it with two shots. We know that you get some protection from one shot, but we have a lot of questions about that, and the data is a lot softer.

At that point, the question becomes, well, do you switch? Should we be focusing on just getting as many people first shots, and maybe delay the second shot, or should we stick to the three four week regimen that was tested and shown to be so effective?

Brian Lehrer: Listeners, if you have a question for Jonathan Cohn, health reporter from HuffPost, about this debate, maybe you're personally experiencing it at least theoretically, wondering if your second dose is going to be there, wow that you've gotten your first dose, if they flip this around, and this is an active debate. In New York, for example, Mayor de Blasio wants to start using those stored up second doses for first doses and hope that the second doses, more second doses arrive on time. Governor Cuomo does not want to do that. They're making different public health calculations on that. For the moment, Cuomo prevails but this is very much in play as a policy debate in New York City.

Whether you are personally affected by being uncertain if you're going to get your second dose or personally affected by saying, "Come on already, we need more first doses. I can't get an appointment, no matter how many times I log on to," whatever website you're logging on to, if you have a question, or a stake in it, or a story, 646-435-7280. Questions about the science, definitely welcome and encouraged 646-435-7280.

About the science, Jonathan, we have a political dilemma, wrapped in a moral dilemma, wrapped in a mathematical dilemma, it seems to me. When Cuomo and de Blasio are on different sides of that question, they're trying to serve constituents, on the one hand, the political question, there's certainly the moral question of who do you put at risk? The people who can't get vaccine number one as quickly, or the people who might be not as well protected by getting their second dose in a timely fashion, but we don't really know.

Ultimately, there's a mathematical question. I imagine public health people somewhere, are really crunching these numbers and trying to figure out how many more people get sick, how many more people die if we choose path number one or path number two. Can you begin to answer that question or discuss how people are grappling with the math of it?

Jonathan Cohn: They are grappling with the math of it and it's not an easy question to answer, in part because it's a math problem with quite a few unknown variables. That's what makes this so hard. In talking to scientists about this and when I was interviewing people about this, the cautionary note, the skepticism I heard from people like Anthony Fauci about this, and this is what he has said also repeatedly when asked about this, is that, yes, we know that first shot gives you some protection, that's clear. Nobody disputes that at this point. What we don't know is how long that protection lasts. That raises a couple of concerns.

First of all, if it diminishes quickly, well, you could have a situation where you've given the shot to a bunch of people, and now within a few weeks, a few months, they've lost their protection, and they don't know it. You can just imagine, you've now given all these shots, and suddenly, all these people are running around who you thought you've protected, and they're not protected. There is concern that if you have a bunch of people running around with partial immunity, and a lot of them still getting sick, well, that's more opportunities for the virus to mutate. We end up with a greater and we see more and more of these variants, which we are already starting to see. That is a very scary proposition.

Now, the flip side of that is, there are people who will tell you, yes, the variants are very scary and that is all the more reason to move as quickly as possible to vaccinate as many people as possible, because in the long run, actually, if we do first doses, even if the protection is partial, even if it diminishes, well, that is going to slow the spread more. It'll slow the spread of the disease more quickly than sticking to the three week, four-week two-shot regimen. If we slow the spread more quickly, we will reduce the number of variants. It gets very complicated.

To some extent, it's a bit of a value judgment. How you weigh risk, how much you think is truly unknown? I will say this and again, I'm speaking not as someone, I don't have an infectious disease degree, I'm not a doctor, this is me talking to the experts. I will say this that there is definitely seems to be more interest in this now among scientists than there was four, six weeks ago, when the idea first started really getting serious attention. I feel like I'm hearing more scientists saying, "Yes, maybe this is something worth thinking about."

That said I would say the majority opinion among the experts I've spoken to and certainly among people like Fauci, the most high-profile most trusted physicians out there, the dominant although not unanimous opinion is that we should stick with the three-four-week timing. We should stick with two doses, at least for now until we get more information because it is the surest way to protect the most people early.

Brian Lehrer: What you notice as a health journalist is the same thing that I've been noticing on the show. For weeks, when I've asked public health guests if they should go to use those second doses for first doses model, everybody was, "Oh no, no, no, no. Oh, no, you don't do that. That wasn't tested in the trial, so you just do not do that," but now I'm starting to see and we haven't had someone on the show doing this yet, but I'm starting to see on TV more scientists and public health types being a little bit more open to the idea.

I want to play a clip of Dr. Fauci from a White House Press briefing on Monday where he does come down on the side, but I think you can hear him being a little ambivalent. Listen.

Anthony Fauci: The way viruses respond to pressure, you could actually be inadvertently selecting for more mutants by a suboptimal response. For that reason, we have continued to go by the fact that we feel the optimum approach would be to continue with getting as many people on their first dose as possible but also making sure that people on time get their second dose.

Brian Lehrer: As earnest as that was, Jonathan, it was in a way, about the least clear that I've ever heard Anthony Fauci. Because he talked about, I'll just requote his words, "The optimum approach would be to continue with getting as many people on their first dose as possible," but then he says, "But also making sure that people on time get their second dose." He's more laying out the dilemma than answering the question.

Jonathan Cohn: It's funny you played that. I remember I was part of that press conference and I remember thinking, "Huh, that was interesting." It was less definitive than he sometimes sounds and a little more opaque. I think I can't see into the brain of Anthony Fauci obviously, and I think there's a reason he's the most trusted figure in America on this because he's earned that.

We do have data from elsewhere in the world that does suggest that the early first dose does provide a fair amount of protection in a lot of cases. It's not a crazy idea at this point. In fact, there was another part of that press conference that same one where he was speaking on Monday where he said, where Fauci mentioned that it would be nice to study this more if we could, to run some trials here in the United States, testing delays, testing a single dose. We haven't done that yet.

It was interesting. He followed that up by saying, "As a practical matter, really undertaking that study would be very difficult and would be hard to do in a timely fashion. By the time we would be done with it, by the time we'd have enough data, it really wouldn't matter anymore because by that point, we'll have enough vaccine and it won't really be an issue." I think that actually gets to the second part of this which is there's two big facts out there that are driving this debate and why we're having this debate.

The first is again the variants. There's a lot of fear out there about these variants that the virus is mutating, we're seeing strains that don't respond as well to the vaccines. Although it still looks like the vaccines work against them just not quite as well. There's that factor. Then there's just the factor that it's taking a while to vaccinate the public. We don't have enough vaccines yet to reach everybody, and the distribution chain itself still has a lot of kinks in it. There's an anxiety about that because this is taking so long.

Now, in reality, it's easy to forget, we've just been doing this for two months and we are now vaccinating 1.5 million people a day, and it is quite possible that the pace will pick up. I certainly hope it will pick up. The Biden Administration is certainly doing everything it can, along with state and local authorities to increase the pace.

Obviously, if we do increase the pace, if we are able to increase the supply and shots are getting into arms much more quickly, then suddenly this issue seems less important because we're fine giving everybody two doses. It's not a bottleneck, but that all depends on getting that pace up and that's a separate challenge. That's not a scientific challenge, that's a logistical challenge.

Brian Lehrer: I know we've got you for about another seven minutes. Let me get some callers in here. Marcia in Queens, you're on WNYC with Jonathan Cohn, health reporter for HuffPost. Hi.

Marcia: Hi, I heard what you said. You answered part of my question maybe vaguely, about how long this would take for this first shot that I've had to last, but I have another concern now thinking and hearing what you're saying. You have brought up to me that I signed a contract. I signed a contract that I would get two doses. Had I known that I might get one dose, maybe I would not have signed that contract at all. Maybe I would have just waited until our officials know what they're doing. Can you tell me about that? What about the contract that we signed that we would be getting a second dose? Or is it negated because of an emergency?

Brian Lehrer: It's a very fair question. Jonathan, I don't know that you have the answer but she puts it very, very well.

Jonathan Cohn: Well, I don't know that I know the answer, but I would say that for the moment at least, the best science we have, we go by what we know for sure in medicine. The thing we know for sure, the thing that was tested, that was proven, was that two shots of Moderna or two shots of Pfizer get you to 95% efficacy. That is what the FDA approved and that is what we were doing.

I would say the analogy here is that it's new science, obviously, and we're learning more about it. Is it possible at some point to decide that one shot is enough? Well, maybe, but in the same way that it's possible that tomorrow some scientist in California or Michigan will pop up with, "Hey, I figured out a cure." At that point, "Oh, hey, we have some new knowledge." Well, I think that's probably the best way to think about going from two doses to one dose and that for the moment we know two doses work.

The FDA has said, "We're going to go with two doses because we know that works." Now there may be something out there that works as well, and if we discovered that, great, then we can do that. As far as we know right now, that doesn't work. We don't have evidence that it works. We don't have what we count as evidence that meets the bar for scientific evidence, and therefore we're sticking with two doses.

To me, I think it's the best I can tell you as an answer, and again, I'm trying to put my mind and pretend I'm sitting at the FDA, would be that, "Look our job at the FDA is to give you a guarantee of what we know works, and this is what we know works." If something new comes along that's better, that's different, we'll let you know that works too. Right now we don't feel comfortable saying that, so we're going to stick with what works.

Brian Lehrer: I can imagine some people who got their first doses are staying home, staying safe. They don't have a lot of exposure and they might be thinking, "Well, if I knew I wouldn't get the second dose on time in a way that the science knows that it will be effective, I could have just waited for a couple of weeks or a couple of months." People who've already gotten their shots, their first shots, wouldn't have that option if they suddenly switch up in the middle. Faisal in Manhattan, you're on WNYC. Hello, Faisal.

Faisal: Hi, how you doing, Brian? How you doing, Jonathan? Thank you for taking my call. I think we know in New York City we see that there's a problem with distribution, but it seems to me that we should be focusing on production. The problem is these pharmaceutical companies are holding out the patents for these when really they can be releasing this information so that we can get the production out there and get the vaccine to the distribution lines. Why aren't we talking about how these pharmaceutical companies are holding onto these patents for these vaccines and withholding our economy with all the people of the country? I'll take the answer off the air. Thank you all so much.

Brian Lehrer: Thank you very much. Well, certainly, we can talk about whatever the obstacles are to ramping up production of the Pfizer and Moderna vaccines more quickly. I don't know if patents are a factor in that question. Jonathan, you're a political reporter covering health, do you happen to know?

Jonathan Cohn: Yes. That's actually a very interesting question and it's a possibility that's been raised. Why don't we license out production of these vaccines to other companies? I do think there are some issues that will come into play at some point about that. Certainly, it would not be the first time the pharmaceutical companies were very protective of their proprietary knowledge and didn't want to share it.

Having said that, having talked to people who understand the vaccine production process, what I have been told, what I have heard so far is that really there's no easy way to ramp up production. Pfizer and Moderna are churning these out as fast as they can, it's in their interest to get these vaccines produced as fast as they can. It is a hard thing to produce. These are brand-- Both Pfizer and Moderna are brand new kind of vaccine that requires very specialized equipment. It requires special material, you can't just give the formula over to some other vaccine maker and say, "Hey, go ahead and start churning this out," it takes time to retool the factories. You have to get the raw materials.

I don't believe right now there's an easy way to just quickly dial up the production. There are ways to dial it up in the future, over the next months from now, a year from now. I know this is something that the Biden administration is actually paying attention to. For the short term, for the medium term, for getting us back to normalcy, I don't think that-- There are no easy ways to dramatically improve production. I don't think, again, based on when I'm being told that patents are an obstacle to producing more vaccine.

Brian Lehrer: Biden can't just use the Defense Production Act and order facilities, whatever they are, to take more of the Pfizer and Moderna vaccine raw materials and produce more shots?

Jonathan Cohn: They are actually trying to use Defense Production Act to increase the production of raw materials for it, and that does look like that may help down the line. I don't know if it's going to lead to a dramatic increase in production. I think that's-- It sounds to me, like it's more of a failsafe measure to make sure there aren't shortages of key materials. One of them being, what we hear a lot about are the lipids, which are how you actually deliver the vaccine into the body.

In terms of setting up factories, that design, if you talk about the Defense Production Act, I think most people think, "Oh, you go and you come into your factory and you say now you're going to- you factory that was producing X, you're now going to produce Y because we need Y." Well, these vaccines, it's not that easy to-- It's specialized equipment, it's specially trained personnel.

I was talking to someone the other day, who was explaining that there's one part of the process, I think this is for the Pfizer vaccine. I'm not 100% solid on this, but they were telling me about a particular piece of equipment that's like it's very specialized, it's made by one machine maker that's in Germany. There are no other companies that make it and you can't just snap your fingers and say, "All right, we're going to have new factories start doing this."

I do think there's a role for the DPA in the raw materials, in the syringes, and I think we're seeing the Biden administration put that to use now. Actually there was some of that use under the Trump administration. We are going to see that, I think it can help guarantee that the supply line stays, it continues to flow so that we don't see hang-ups at Moderna or Pfizer, they don't have to delay production. Again, at least what I've been told so far, there is not a great ability to dramatically increase production.

The flip side of that is, they are actually producing vaccines quite quickly. If Johnson and Johnson gets approval, that will soon come online. I am hopeful, at least the people I talked to sound reasonably optimistic that we will have supplies soon, that it's being produced, we will get a substantially larger injection of vaccines in the next few months. At that point, the issue won't be supply anymore.

We'll have enough vaccine. It'll be a question of can we get them into the arms of Americans fast enough? Can we get Americans, many of whom are hesitant to take the vaccine, to take the vaccine and can we do it in a way that's equitable so we don't get the situation where all this sort of-- Like we're seeing now in some cities already, where the more affluent zip codes, people are getting vaccinated. In the low income parts of communities, they aren't getting vaccinated. Of course, it's in those low-income communities where you have essential workers, crowded housing conditions, and so these are the people who really are the most vulnerable to it. Those are the questions to come.

I do feel reasonably good about the supply, with the caveat that anything can happen. Vaccine production is a complicated process.

Brian Lehrer: Thanks for such a substantive answer on that one and throughout the conversation. Jonathan Cohn, Senior National Correspondent at HuffPost, and look for his book out later this month, The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage. Jonathan, thank you so much.

Jonathan Cohn: Thank you for having me on the show.

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