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One-Dose Two-Dose Vaccine Risk Communication: Another Impossible Thing to Believe Before Breakfast

From our esteemed colleague, Dr. Peter Sandman, one of the country’s foremost experts in the field of risk communications, comes this clear-eyed assessment of the way government officials are talking about the COVID-19 vaccine, not with clarity but with a multitude of confusing messages.

If you agree with Dr. Sandman’s observations, we hope you’ll consider forwarding this article to your doctors, your elected officials and their staffs.


Lewis Carroll’s White Queen told Alice she could believe “six impossible things before breakfast.” But asking the U.S. public to believe yet another impossible thing about COVID-19 is profoundly unwise. We have had too many pandemic mistrust debacles already. We don’t need another, this one about vaccine doses.

Yet many experts and officials have been sending impossible mixed messages about second doses. The same mixed messages are coming from Democrats and Republicans alike; I almost entitled this column “One Dose Two Dose Red Dose Blue Dose.”

Message One: In the face of soaring death rates and emerging variants that are thought to be even more transmissible, we must do everything we can to get as many people as possible vaccinated as quickly as possible, starting with the most vulnerable.

Message Two: Everyone should and will get their second dose on schedule, either three weeks (Pfizer) or four weeks (Moderna) after their first dose.

Believing both messages requires believing the impossible. Every vaccine dose that’s in U.S. government hands should go into somebody’s arm as quickly as possible. No debate there. The question is whose arm: somebody who desperately wants an appointment for her first dose, or somebody who already has an appointment for his second?

I’m not qualified to judge which arm should be prioritized. There are pros and cons either way. To oversimplify: Would we be better off a few months from now if all of us were “half” protected or if half of us were “fully” protected? Tough call. We don’t know how long one-dose immunity will last. We don’t know whether the existence of millions of partly immune vaccinees will nurture the emergence of a vaccine-resistant virus variant. On the other hand, we have solid reasons to worry that a terrifying fraction of completely unprotected Americans could succumb to the more transmissible variants we’re already facing.

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