Osterholm recommends delaying second COVID-19 dose to get more vaccinated

Minnesota epidemiologist Michael Osterholm said Wednesday that he will ask federal health officials to re-examine COVID-19 vaccine data with an eye toward delaying the second dose so more people can quickly receive first shots.

Osterholm, speaking before a Minnesota House health committee, said immunity protection improves with many other vaccines when doses are spaced out by months.

"We could get more of our over-65 age group vaccinated," said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "I think the data will support that actually is a very effective way to go."

Federal officials approved the Pfizer vaccine with three weeks between shots, while the Moderna vaccine was set at four weeks. Osterholm said he thought the dosage schedule was chosen as a way to speed up the approval process under Operation Warp Speed.

A change would address the vaccine shortage and lessen the impacts of new, more infectious coronavirus variants.

"We have a real possibility of seeing a major surge of cases this fall and into the winter," Osterholm said. "I am convinced that it will be much more severe than anything we've seen to date."

Minnesota health officials said Wednesday that they have documented a second case of the more infectious variant strain linked to Brazil. The new case was found in a housemate of the first resident to test positive for the Brazil variant. Both traveled to that country.

The Minnesotans are the only identified Brazil variant cases in the U.S., according to federal officials.

So far, 458,651 people in Minnesota have received at least the first dose of COVID-19 vaccine, and 122,597 of them have completed the series. The state estimates that 2.2% of the population has been vaccinated.

The Minnesota Department of Health (MDH) plans no changes to vaccine dosing for now.

"The official guidance from the CDC and FDA hasn't changed on this topic, but we'll continue to look at any and every way we might be more effective and efficient in bringing this pandemic to an end," the agency said in a statement.

U vaccine researcher Marc Jenkins said he would want to see modeling data showing that giving more first doses sooner would save more lives than giving two doses on schedule over a longer period of time. Estimates suggest the first dose of the Moderna or Pfizer COVID-19 vaccines would be 50 to 80% effective, compared with the research showing 95% effectiveness with both doses on schedule.

"Does that 50 to 80 percent efficacy actually save more lives than waiting to give two doses and get 95 percent efficacy in a lot smaller group of people?" he asked. "It's a tough call."

Jenkins said he hasn't seen research on how quickly the effectiveness of the first dose wanes, or whether efficacy worsens or even improves with a later booster dose.

"It's hard for me to walk away from the solid knowledge of what the two-shot regimen did," he said. "But, you know, if you told me, 'Gosh … it's going to take us a year to get two shots into most people,' I'd be thinking hard about that first strategy."

Osterholm joined other experts calling for reconsideration of dosing. Dr. Stanley Plotkin of the University of Pennsylvania and Dr. Neal Halsey of Johns Hopkins University co-authored a letter outlining the benefits of delaying the second shot — a position they advocated before new variants emerged.

Halsey found in Pfizer and Moderna trial data that one dose offered good protection for at least one to three months.

MDH laid out a $167.8 million plan Wednesday for 2021 state vaccination efforts.

Among the proposals are a $1 million overhaul of the state's COVID-19 vaccine registration system, which has more than 200,000 names of those hoping to be randomly chosen for shots.

In addition to entering identifying information online, registrants would indicate if they fall within one of the priority groups, such as 65 and older, first responder or worker in essential industries such as schools or grocery stores.

Once the state's vaccine rollout moves onto a new priority group, the system will send a notification to eligible individuals.

"You can then find out where you fall in the prioritization so that people know where they are in the lineup," said Margaret Kelly, deputy commissioner at MDH.

With consent, the system can also send names of newly eligible individuals to nearby vaccination sites that will then offer to schedule an appointment, Kelly said.

"That is what we are trying to get to with the immunization registry," she said. The online registry will be open to all Minnesotans who want the shot, even if they don't fall in one of the priority groups.

It is unclear how long it will take before the system becomes operational, and a legislative panel must approve the spending plans before MDH can tap into a federal grant that will help pay for the new registration system.

The Federal Emergency Management Agency announced it will provide $15 million to the state to set up and operate 10 vaccination centers. This week, state officials decided to reduce the number of community vaccination sites from 10 to two. It said the sites were meant to test the concept of community vaccinations and that more sites could be in the works.

State health officials on Wednesday reported 24 more COVID-19 deaths and 669 newly diagnosed infections with the novel coronavirus that causes the disease. Residents of long-term care facilities have suffered 63% of COVID-19 deaths in Minnesota because of their age and underlying health conditions. That includes 14 of the deaths reported Wednesday. The state also reported a COVID-19 death in a jail, one involving a group home resident and eight involving people who lived in private residences.

The number of COVID-19 patients admitted to inpatient beds in Minnesota hospitals dropped to 379, below the peak of 1,864 on Nov. 29 during a second wave of viral spread.

The United Kingdom has decided to delay second COVID-19 doses to 12 weeks after the first shot, a move that has been met with criticism.

The FDA would probably need to approve any changes to the dosing schedule.

Osterholm said scientists and disease experts are still learning more about COVID-19.

"These coronaviruses are a real challenge in that we still don't understand a lot," he said. "I am very concerned about where we are today."

Staff writer Christopher Snowbeck contributed to this report.