The original idea behind the global vaccine solidarity mechanism, called COVAX, led by WHO, CEPI, & Gavi, was that health workers & high risk people in ALL nations (high-, middle-, & low-income) would get vaccinated first. Rich nations, including the US, rejected this idea. 1/n

Rich nations like the US bypassed the global solidarity mechanism. They screamed "me first, me only." The equitable approach, the moral approach, the approach that would have saved most lives would have been to vaccinate 20% of people (health workers + high risk) first. 2/n

Rich nations like the US rejected the equitable/moral approach that would have saved most lives. They hoarded doses. They desperately wanted vaccine herd immunity now. They wanted it WAY more than they wanted health workers/high risk people in poor nations protected. 3/n

So after American health workers & high risk people were protected, the US didn't pause. Didn't listen to the pleas of health workers in less wealthy nations. Didn't listen to Dr Tedros's calls to think about other nations. The US wanted vaccine herd immunity now. 4/n

So the US kept going. Didn't share doses. Wouldn't initially share IP. Hoarded doses AND blocked less wealthy nations from making their own doses. Some of the folks who pushed hardest for this approach suddenly seemed to have realized that the US has been hoarding. 5/n

What gave them this sudden realization? It's the FDA authorization of vaccines in 12-15 year olds (which I am thrilled about). Folks who pushed so hard to get the US to reach vaccine herd immunity are suddenly saying "it's wrong to vaxx American kids, send doses to India" 6/n

I'm sorry if I sound a little angry. There are folks who oppose vaccinating 12-15 year olds in the US claiming a moral high ground ("we must give the doses to India instead") who have been the loudest proponents of the US gunning for vaccine herd immunity asap. 7/n

The US absolutely should IMHO have supported a global push to vaccinate ALL health workers & high risk people first. I wrote about this last year. 8/n https://covid19healthdiaries.com/diary?did=397 

I wrote: "Let’s say that the initial supply of vaccine is two billion doses in total, enough to vaccinate one billion people (assuming a two-dose regimen), or around 13% of the global population....." 9/n

"......an equitable approach would be to ensure that these doses go to high-risk people in all nations first. Then as the supply ramps up, doses would be allocated to lower risk groups."

This is what we should have done. We didn't. 10/n

If you were a cheerleader for ignoring this approach & for pushing the US to get to herd immunity now, forgive me if I find your pleas to "send doses to India ahead of vaccinating American teens" a bit too little, much too late. It's, um, not convincing to me. 11/n

Finally my disclosures
-I was in a voluntary work group (unpaid) that advised Gavi on the design of COVAX
-I've had grant funding from Gavi & WHO
-Our 5-year old kid is on the wait list for the Duke vaccine trial
-I support pediatric COVID-19 vaccine trials & my main reason..12/n

..is that very early in the pandemic, I had multiple meetings with global child health experts, vaccine experts, pediatricians, & immunologists (working in global health), & I was very persuaded by their scientific arguments for vaccinating children. Their arguments were....13/n

..partly about reaching vaccine herd immunity but also, crucially, about delivery platforms. One of the greatest public health achievements in recent history has been the establishment of astounding vaccine delivery platforms for kids worldwide 14/n

These platforms are in place in low- & middle-income nations, and even in many of the most resource-poor nations on earth. I was persuaded by my colleagues that getting to high population coverage in low- & middle-income nations will probably requite this platform to be used 15/n

ugh, require not 'requite'....anyway, this turned into a long-ish thread. I'm grateful to all the scientists who took time last year sharing studies and data with me (including amazing colleagues at @TheDHVI) that shaped my thinking on pediatric COVID-19 vaccination. 16/n

I think there are very strong reasons for conducting trials in children & for vaccinating kids if the vaccines become licensed. I definitely understand the argument that we should be vaccinating high risk people & health workers FIRST (I've said that since last year!), but...17/n

...I am finding the timing of this argument in some quarters a little, um, late in the game. END.