Working Paper: NBER ID: w29180
Authors: Witold Wicek; Amrita Ahuja; Esha Chaudhuri; Michael Kremer; Alexandre Simoes Gomes; Christopher Snyder; Alex Tabarrok; Brandon Joel Tan
Abstract: Due to the enormous economic, health, and social costs of the COVID-19 pandemic, there are high expected social returns to investing in parallel in multiple approaches to accelerating vaccination. We argue there are high expected social returns to investigating the scope for lowering the dosage of some COVID-19 vaccines. While existing evidence is not dispositive, available clinical data on the immunogenicity of lower doses combined with evidence of a high correlation between neutralizing antibody response and vaccine efficacy suggests that half- or even quarter-doses of some vaccines could generate high levels of protection, particularly against severe disease and death, while potentially expanding supply by 450 million to 1.55 billion doses per month, based on supply projections for 2021. An epidemiological 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 further testing 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 that testing may not occur without public investment. Governments could support either experimental or observational evaluations of fractional dosing, for either primary or booster shots. Discussions with researchers and government officials in multiple countries where vaccines are scarce suggest strong interest in these approaches.
Keywords: COVID-19; Vaccination; Fractional Doses; Public Health; Epidemiology
JEL Codes: F62; F68; I1; I15; I18; I31; I38
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Lower doses of some COVID-19 vaccines (I19) | high levels of protection against severe disease and death (I12) |
| Vaccinating more people faster (I14) | substantially reduce total infections and deaths (I14) |
| Investing in generating evidence on the efficacy of fractional doses (C90) | high expected return (G17) |
| Switching to fractional doses (Y60) | reduce deaths significantly (I12) |
| Public funding (H59) | advancement of vaccine research (I23) |
| Without public investment (H54) | necessary research may not occur (D80) |