Abstract
Recent evidence indicates that a single dose of mRNA-based vaccines produce similar immune responses in people with evidence of past infection compared with two doses in immunologically naive individuals. For COVID-19 vaccines with two dose regimens, point-of-care antibody testing for prior infection when administering the first dose could enable expanded vaccine access in a cost-effective manner. Generally, antibody tests with sensitivity and specificity well below that typically accepted for product licensure would still enable expanded vaccine coverage, though to be cost-beneficial total test cost (i.e. procurement and administration) needs to be less than roughly a third of total vaccine dose cost. For highly sensitive (90%) and specific (99%) tests, coverage could be expanded by more than 33%. Tests with the appropriate performance characteristics are plausible, though likely need setting specific tailoring.
Highlights
Many countries have experienced high SARS-CoV-2 infection attack rates and currently have limited vaccine supplies
Recent evidence indicates that a single dose of the mRNA-based vaccines produce immune responses in people with evidence of past infection that are at least comparable to the response elicited by two doses in immunologically naive individuals[2,3,4,5,6]
If effects observed in these studies are validated, the use of a point-of-care antibody test when administering the first dose could allow for more efficient use of available vaccine doses
Summary
Many countries have experienced high SARS-CoV-2 infection attack rates and currently have limited vaccine supplies. If effects observed in these studies are validated, the use of a point-of-care antibody test when administering the first dose could allow for more efficient use of available vaccine doses. This benefit depends on test performance, cost, and the seroprevalence in the population being vaccinated. To be a better option than buying more doses, administering a test should cost less than a single vaccine dose, but how much less will depend on test specificity (to avoid giving too few doses) and sensitivity (to benefit from reallocating doses), as well as seroprevalence. Data to evaluate vaccine effectiveness for a single dose conditional on antibody testing could be collected in countries pursuing a delayed second dose scheme, like the United Kingdom
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