Sept. 28, 2020 — Only 17% of doctors say they will get a COVID-19 vaccine if it is authorized before all clinical trials have been completed, according to results of a Medscape poll.
The poll asked doctors and nurses how likely they were to order or use treatments or vaccines if the FDA grants emergency use authorization before phase III trials are completed.
The poll was first posted on Medscape.com on Sept. 2. Of those responding, 17% of doctors said they would order or use the vaccine; 63% said no; and 20% said they were unsure. Younger doctors were more likely to say they would not get a vaccine under such circumstances (68% of those younger than 55 years said no, vs. 61% of those ages 55 years and older.)
The Washington Post reported last week that the FDA is expected to roll out a tough 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 unsure. Answers did not vary substantially by age.
The poll was taken after Medscape Editor-in-Chief Eric Topol, MD, wrote to FDA Commissioner Stephen Hahn on Aug. 31, detailing why he thinks recent emergency use authorizations (EUAs) of interventions to treat COVID-19 have not been based on evidence.
Topol cited three EUAs specifically: one for hydroxychloroquine on March 30 (revoked in June for lack of evidence), one for convalescent plasma on Aug. 23, and an expanded EUA for remdesivir to treat any patient hospitalized for COVID-19, not just those with severe disease.
The letter, which was also posted online, drew more than 500 comments.
Another poll question concerned the use of plasma collected from survivors of COVID-19 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 using convalescent plasma to treat patients who have COVID-19.
The poll asked doctors and nurses if they would or have ordered convalescent plasma for hospitalized COVID-19 patients.
Nine percent of doctors and 2% of nurses said they had ordered it; 28% of doctors and 40% of nurses said they would. On the other hand, 44% of doctors and 29% of nurses said they would not. The rest were unsure.
One ear, nose, and throat doctor who responded to the poll wrote, “As to whether or not I would consider prescribing convalescent plasma for a seriously ill COVID patient, yes I would. And if I ever found myself falling off a cliff, I would try to grab onto any twig projecting from the cliff.”
But the responder said the biggest problem with the EUA for plasma was the “false claims about efficacy.”
“The data are not convincing of its efficacy for COVID-19, and convalescent plasma had no significant effect in Ebola. The best situation for using plasma would be in a clinical trial.”
Doctors and nurses were also asked whether they would order, or have ordered, remdesivir, given the available clinical trial evidence that supported the EUA. Doctors were more likely to say they had or would order it (42%) than were nurses, at 37%.
But in both groups, there was much uncertainty about the drug. Only slightly more doctors (44%) said no than said yes, and 14% were unsure. Among nurses, 39% said no and 24% were unsure.
Among doctors, answers on remdesivir differed by work setting. Whereas 37% of hospital doctors said they would or had ordered remdesivir, 52% of those who were office-based answered that way.
Overall, most doctors and nurses (about 60%) reported they had not treated patients hospitalized with COVID-19.
Commenters had different views on the evidence behind EUAs. Some stood by their support for hydroxychloroquine, even though the EUA for it was revoked on June 15.
A reader who agreed with Topol’s criticism of the EUAs wrote, “People in significant leadership roles must be held accountable for their actions. If you serve in an office and are receiving intolerable political pressure from superiors to take actions that are inconsistent with your training and personal integrity, then you have but a few options.
“Convince your superiors of their misguided directives or resign. History is not going to be kind to those who have supported these unscientific and completely inappropriate positions.”
A registered nurse wrote that issuing the EUA can discourage completing clinical trials.
“The saddest thing isn’t so much that EUAs are allowed in emergencies (if truly believed potential benefit outweighs potential risk), but when it is allowed to get in the way of well-planned and designed research that can actually determine its true usefulness,” she wrote.