Doctors Wary of Rushed COVID Vaccine
September 28, 2020 – According to the results of a Medscape survey, only 17% of doctors say they will receive a COVID-19 vaccine if it is cleared before all clinical trials are completed.
The survey asked doctors and nurses how likely they were to order or use treatments or vaccines if the FDA grants emergency use clearance before the phase III trials are completed.
The survey was first published on Medscape.com on September 2. Of those who responded, 17% of doctors said they would order or use the vaccine; 63% said no; and 20% said they were not sure. Young doctors were more likely to say they would not get a vaccine under such circumstances (68% of those under 55 said no, compared to 61% of those 55 and over).
The Washington Post reported last week that the FDA is expected to roll out a strict new standard for emergency authorization of a COVID-19 vaccine.
Nurses were less likely than doctors to say yes (11%); 69% said no; and 20% said they were not sure. Responses did not vary significantly by age.
The poll was conducted after Medscape Editor-in-Chief Eric Topol, MD wrote to FDA Commissioner Stephen Hahn on August 31, explaining why he believes recent Emergency Use Authorizations (EUA) for Interventions to treat COVID-19 have not been evidence-based.
Topol cited three EUAs specifically: one for hydroxychloroquine on March 30 (canceled in June for lack of evidence), one for convalescent plasma on August 23, and an expanded EUA for remdesivir to treat any patient hospitalized for COVID-19 , not just those with serious illness.
The letter, also posted online, drew more than 500 comments.
Another survey question concerned the use of plasma collected from COVID-19 survivors as a treatment for the disease.
The National Institutes of Health’s COVID-19 Treatment Guidelines Committee said this month that current data is insufficient to recommend the use of convalescent plasma to treat patients with COVID-19.
The survey asked doctors and nurses if they would or would have ordered convalescent plasma for COVID-19 hospital patients.
Nine percent of doctors and 2% of nurses said they ordered it; 28% of doctors and 40% of nurses said they would. In contrast, 44% of doctors and 29% of nurses said they would not. The others weren’t sure.
An ear, nose and throat doctor who responded to the survey wrote: “As to whether or not I would consider prescribing convalescent plasma for a critically ill COVID patient, yes I would. And if I ever found myself falling off a cliff, I would try to hang on to any twig sticking out of the cliff. “
But the respondent said the biggest problem with the EUA for plasma was the “false claims about efficacy.”
“The data is not convincing of its effectiveness for COVID-19, and convalescent plasma had no significant effect in Ebola. The best situation to use plasma would be in a clinical trial.”
Doctors and nurses were also asked if they would order or have ordered remdesivir, given the clinical trial evidence available to support the EUA. Doctors were more likely to say they had or would order it (42%) than nurses, at 37%.
But in both groups, there was a lot of uncertainty about the drug. Only slightly more physicians (44%) said no than yes, and 14% were not sure. Of the nurses, 39% said no and 24% were not sure.
Among physicians, responses to remdesivir differed depending on the workplace. While 37% of hospital doctors said they went or had ordered remdesivir, 52% of those in the office responded that way.
Overall, most doctors and nurses (around 60%) said they had not treated hospital patients with COVID-19.
Commentators had different views on the evidence behind the US. Some backed their support for hydroxychloroquine, even though the EUA for it was revoked on June 15.
One reader who agreed with Topol’s criticism of the EUA wrote: “People in important managerial positions should be held accountable for their actions. If you work in an office and are under pressure. intolerable political pressure from your superiors to take action that is inconsistent with your training and personal integrity, then you have only a few options.
“Convince your superiors of their misguided directives or resign. History will not be kind to those who have supported these unscientific and completely inappropriate positions.”
A registered nurse wrote that issuing the EUA may discourage clinical trials.
“The saddest thing is not so much that EUAs are allowed in an emergency (if you really think the potential benefits outweigh the potential risks), but when they are allowed to hinder well-planned research. and designed that may in fact determine its true usefulness, “she wrote.
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