“When a mass vaccination campaign is rolled out, adverse events are observed more acutely and more accurately than during the slow trickle that goes with any other kind of vaccine or drug distribution. The infrequent becomes more frequent because the number of people vaccinated in a very short time is so large — a one-in-a-million problem becomes one per day rather than one every two to six months,” writes the 91̽��’s  in a recent , jointly produced by Johns Hopkins University and the UW.

The key to catching adverse effects is an effective surveillance system, which worked in the blood-clotting case and must continue to be supported with time, energy and resources.

“The advantage we have at this point is that we know how to diagnose and treat it, so there’s at least a potential to lessen the impact of the disease,” Corey wrote in . “A thorough review of the risk benefit of the vaccines was performed by both the CDC and the FDA and both of these organizations advised that people should be alerted about the possibility of (blood clotting) and to seek medical evaluation if they experience prolonged abdominal pain, worsening headache, or shortness of breath in the days following vaccination.”

This should improve public confidence that these vaccines, including the Johnson & Johnson vaccine which was put back into circulation, are still being monitored for effectiveness and safety. And, Corey points out, while adverse effects will be investigated and vaccines evaluated in light of them, the risk-to-benefit ratio of the vaccines needs to be kept in perspective. After all, the odds of being hit by a car are about one in 4,292 and dying as a result are about one in 47,273.

“Clinical trials have given us a wealth of information about the efficacy and safety profile of vaccines for COVID-19. But the work of gathering evidence and weighing results in the context of an ongoing pandemic isn’t done,” said Corey.

To read this and other articles by Corey and other experts, visit the  blog series created by Johns Hopkins and the 91̽��as an outcome of the joint symposium — Preserving the Scientific Integrity of Getting to COVID-19 Vaccines: From Clinical Trials to Public Allocation — the two universities hosted in October.

Dr. Larry Corey is the leader of the  (CoVPN ) Operations Center, which was formed by the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health to respond to the global pandemic and the Chair of the ACTIV COVID 19 Vaccine Clinical Trials Working Group. He is a Professor of Medicine and Virology at 91̽�� and a Professor in the Vaccine and Infectious Disease Division and past President and Director of Fred Hutchinson Cancer Research Center.

With COVID-19 cases again in many parts of the country — including Washington state where were pushed back to Phase 2 effective Friday — there’s a growing between continuing to give both doses of Moderna or Pfizer-BioNTech vaccines close together, or giving them months apart in order to get first shots in more shoulders faster.

The argument for giving more people the first dose before circling back months later to give the second, which provides the strongest protection against COVID-19, centers on the numbers: It’s better, the argument goes, for more people to be partially protected in order to curb infections by the coronavirus than to have fewer people fully vaccinated. Advocates of this hope partial vaccinations would not only curb infections but also save lives, since a single dose significant protection against illness.

Under the current strategy, the second dose of either two-dose vaccines comes within a few weeks of the first shot. The dose-sparing strategy, considered either because a community has too few doses or climbing infections, schedules the second dose for months later.

However, the dose-sparing strategy could create even greater trouble than we’re currently facing, argues the 91̽��’s  in a recent  jointly produced by Johns Hopkins University and the UW.

“I say that because the viruses we’re going to encounter today and what we will encounter in the next several months are not the same viruses that we tested the vaccines on and upon which the single-dose [strategy] data are based; they are going to be more formidable adversaries,” writes Corey, a professor of medicine and virology at the 91̽��School of Medicine.

These future versions of the viruses are “escape variants” that have evolved in the environment of weak immune responses — the body in this case has produced a strong enough immune response to tamp down the infection but not strong enough to keep mutated viruses from spreading.

“How do we overcome escape variants? We do so by using the full strength of the tools we have available to us. We provide immunity that is capable of eliminating the virus quickly and we don’t expose the virus to lots of people with low levels of immunity,” Corey writes.

Corey adds that the coronavirus variants currently spreading require a stronger immune response to beat, and current versions of the two-dose vaccines were designed to battle the original versions of the virus. So, using one dose to create partial immunity to a variant that requires a stronger immune response to beat could create an environment for new, tougher variants to evolve and spread. However, giving the second dose creates a much stronger immune response and can stop escape variants.

“While my musings are inferential, I feel we will actually do more harm than good by markedly increasing the population of people with partial protective immunity,” Corey writes.

To read this and other articles by Corey and other experts, visit the  blog series created by Johns Hopkins and the 91̽��as an outcome of the joint symposium — Preserving the Scientific Integrity of Getting to COVID-19 Vaccines: From Clinical Trials to Public Allocation — the two universities hosted in October.

Dr. Larry Corey is the leader of the (CoVPN ) Operations Center, which was formed by the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health to respond to the global pandemic and the Chair of the ACTIV COVID 19 Vaccine Clinical Trials Working Group. He is a Professor of Medicine and Virology at 91̽�� and a Professor in the Vaccine and Infectious Disease Division and past President and Director of Fred Hutchinson Cancer Research Center.

While development of vaccines now being distributed to combat COVID-19, the deadly disease caused by the novel coronavirus, are a “remarkable achievement” that demonstrate the power of science to save lives, mistrust and fear continue to cause nearly to say they would be unlikely to get vaccinated.

Some of that mistrust stems from before the pandemic, but unfortunate politicization of COVID-19 vaccine development is also to blame. When the current administration jumped in to claim credit for the rapid development of the vaccines, that act personalized the science behind its creation.

“By personalizing it, it became politicized. It created an odd discord, as if science – and what is in a vial – had something to do with whether you’re a Republican or Democrat,” writes Corey.

Also, the administration put an enormous amount of funding into the rapid development of vaccines, but then named the effort Operation Warp Speed. And, says Corey, speed in medical scientific development “is not something we associate with positive outcomes.”

So, given the historic mistrust of vaccinations, the politicization of COVID-19 vaccines and an unfortunate project name, vaccine hesitancy is understandable. And yet the pandemic rages on. How, then, to bridge the divide between jubilation at the production of incredibly successful vaccines and mistrust?

“It will take work by all of us – in the scientific community and in the broader public. It will take hard work to convey the importance of vaccination. It will take time to rebuild trust across the divide. And it will take a public open to healing discourse; a public who remains curious and eager to know more as we learn more. Because we will,” Corey writes.

To read this and other articles by Corey and other experts, visit the  blog series created by Johns Hopkins and the 91̽��as an outcome of the joint symposium —  — the two universities hosted in October.

Dr. Larry Corey is an internationally renowned expert in virology, immunology and vaccine development and a leader of the  (CoVPN), which was formed by the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health to respond to the global pandemic. He is a professor of medicine and virology at 91̽��School of Medicine and a professor in the Vaccine and Infectious Disease Division and past president and director of Fred Hutchinson Cancer Research Center.

Answering questions around how vaccines affect transmission of the virus is “of obvious importance” and research will be conducted once people begin getting vaccinated, Corey writes in a new jointly produced by Johns Hopkins University and the UW. But we all must still wear masks, physically distance, wash our hands frequently, and avoid large gatherings — even when most people have been vaccinated.

“If vaccinated individuals are capable of transmitting infection,” Corey writes, “then anybody who is not vaccinated fares no differently before than after the introduction of a COVID-19 vaccine. With vaccine hesitancy resulting in fewer people agreeing to be vaccinated, we do not yet know whether and when we will be able to markedly reduce the public health implications of COVID-19 and reduce its circulation in the workplace, in close communities and stop super-spreading events.”

In addition, Corey notes that mathematical models suggest that vaccines could create a situation in which many more people carry the virus without showing symptoms, become more cavalier about whether they can spread the virus and therefore unknowingly infect even more people.

“This realization helps explain why we must optimize coverage and overcome vaccine hesitancy, especially in persons who are at high risk,” Corey writes.

To read this and other articles by Corey and other experts, visit the blog series created by Johns Hopkins and the 91̽�� as an outcome of the joint symposium — — the two universities hosted in October.

Dr. Larry Corey is an internationally renowned expert in virology, immunology and vaccine development and a leader of the (CoVPN), which was formed by the National Institute of Allergy and Infectious Diseases at the U.S. National Institutes of Health to respond to the global pandemic. He is a professor of medicine and virology at 91̽��School of Medicine and a professor in the Vaccine and Infectious Disease Division and past president and director of Fred Hutchinson Cancer Research Center.