It is unclear that the primary barrier to vaccine access is the availability of doses. Distributing vaccines is an enormous logistical challenge even in the best case of centralized health systems and coordination. In the US, this is made even more challenging in a large country with a heterogeneous and fractured health system. Even so, the distribution has been accelerating. There is also the other concern about uptake—even as vaccine doses get sent out, people must accept them. Even among eligible healthcare workers, a large percentage have opted not to receive the vaccines, at least not right away. This may improve with time and more and more people receive the vaccine.
The European Medicines Agency has suggested that for the Pfizer-BioNTech vaccines, the second dose should not be longer than 42 days. In contrast to UK and European officials, the US FDA has strongly discouraged changing the dosing schedule, noting that such changes without data is premature. As of this writing, now 22.1 million doses have been distributed, and 6.7 million doses have actually been given to people.
There is some evidence that those with prior infection with “natural” immunity have sustained protection for at least 12 weeks or more, so it is reasonable to hypothesize the same might be true for a single vaccine dose. For other infectious diseases, such as with many childhood vaccinations we have seen a little bit of flexibility with “catch up” immunization scheduling, but the CDC discourages excessive delay.
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