Working Paper: CEPR ID: DP16599
Authors: Witold Wicek; Amrita Ahuja; Esha Chaudhuri; Michael Kremer; Alexandre Simoes Gomes Junior; Christopher Snyder; Alex Tabarrok; Brandon Tan
Abstract: Due to the enormous economic, health, and social costs of the COVID-19 pandemic, there are highexpected social returns to investing in parallel in multiple approaches to accelerating vaccination. Weargue there are high expected social returns to investigating the scope for lowering the dosage of someCOVID-19 vaccines. While existing evidence is not dispositive, available clinical data on theimmunogenicity of lower doses combined with evidence of a high correlation between neutralizingantibody response and vaccine efficacy suggests that half- or even quarter-doses of some vaccines couldgenerate high levels of protection, particularly against severe disease and death, while potentiallyexpanding supply by 450 million to 1.55 billion doses per month, based on supply projections for 2021. Anepidemiological model suggests that even if fractional doses are less effective than standard doses,vaccinating more people faster could substantially reduce total infections and deaths. The costs of furthertesting alternative doses are much lower than the expected public health and economic benefits.However, commercial incentives to generate evidence on fractional dosing are weak, suggesting thattesting may not occur without public investment. Governments could support either experimental orobservational evaluations of fractional dosing, for either primary or booster shots. Discussions withresearchers and government officials in multiple countries where vaccines are scarce suggest stronginterest in these approaches.
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Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| fractional dosing of COVID-19 vaccines (C46) | high levels of protection against severe disease and death (I12) |
| neutralizing antibody response (C45) | vaccine efficacy (I12) |
| fractional dosing (Y60) | reduction in total infections and deaths (I14) |
| fractional dosing (Y60) | increase in vaccine supply (I19) |
| public investment in research (H54) | testing of fractional dosing (C90) |
| fractional dosing (Y60) | risk of increased immune escape (Y50) |