ArticleProceedings of the National Academy of Sciences of the United States of America2022
Testing fractional doses of COVID-19 vaccines.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis.JMIR public health and surveillance · 2024Pooled it
- Predictive models for health outcomes due to SARS-CoV-2, including the effect of vaccination: a systematic review.Systematic reviews · 2024Pooled it
- Fractional BNT162b2 boosters induce durable immune responses after non-mRNA priming in Mongolia: a randomised controlled trial.Frontiers in immunology · 2026Trial
- Immunogenicity, safety and reactogenicity of heterologous (third dose) booster vaccination with a full or fractional dose of two different COVID-19 vaccines: A phase 4, single-blind, randomized controlled trial in adults.Human vaccines & immunotherapeutics · 2023Trial
- Article
- Avoiding four fallacies in the fair allocation of influenza countermeasures.BMJ global health · 2025Article
- Antispike IgG antibody decay after immunisation with fractional versus full booster doses of COVID-19 vaccines: a 6-month longitudinal analysis of the FRACT-COV trial in Brazil.BMJ public health · 2025Article
- Coagulation and inflammatory response after intramuscular or intradermal mRNA-1273 SARS-CoV-2 vaccine: secondary analysis of a randomized trial.Research and practice in thrombosis and haemostasis · 2024Article
- Article
- Immunogenicity and reactogenicity of intradermal mRNA-1273 SARS-CoV-2 vaccination: a non-inferiority, randomized-controlled trial.NPJ vaccines · 2024Article
- Immunogenicity, safety, and reactogenicity of a half- versus full-dose BNT162b2 (Pfizer-BioNTech) booster following a two-dose ChAdOx1 nCoV-19, BBIBP-CorV, or Gam-COVID-Vac priming schedule in Mongolia: a randomised, controlled, non-inferiority trial.The Lancet regional health. Western Pacific · 2024Article
- Performance of SARS COV-2 IgG Anti-N as an Independent Marker of Exposure to SARS COV-2 in an Unvaccinated West African Population.The American journal of tropical medicine and hygiene · 2023Article
- How can COVID-19 vaccines benefit people? A study based on the theory of the commons.Human vaccines & immunotherapeutics · 2023Article
- Cost effectiveness of fractional doses of COVID-19 vaccine boosters in India.Med (New York, N.Y.) · 2023Article
- Adverse Events to Comirnaty Vaccine Are Linked to Sex, Age and BMI: Should We Consider Reducing the Dose for Females?Vaccines · 2023Article
- Fractional Dosing of Yellow Fever Live Attenuated 17D Vaccine: A Perspective.Infection and drug resistance · 2023Article
- Targeted randomization dose optimization trials enable fractional dosing of scarce drugs.PloS one · 2023Article
- Review
- Article
- A Randomized Clinical Trial of a Fractional Low Dose of BNT162b2 Booster in Adults Following AZD1222.Vaccines · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Due to the enormous economic, health, and social costs of the COVID-19 pandemic, there are high expected social returns to investing in parallel in multiple approaches to accelerating vaccination. We argue there are high expected social returns to investigating the scope for lowering the dosage of some COVID-19 vaccines. While existing evidence is not dispositive, available clinical data on the immunogenicity of lower doses combined with evidence of a high correlation between neutralizing antibody response and vaccine efficacy suggests that half or even quarter doses of some vaccines could generate high levels of protection, particularly against severe disease and death, while potentially expanding supply by 450 million to 1.55 billion doses per month, based on supply projections for 2021. An epidemiological model suggests that, even if fractional doses are less effective than standard doses, vaccinating more people faster could substantially reduce total infections and deaths. The costs of further testing alternative doses are much lower than the expected public health and economic benefits. However, commercial incentives to generate evidence on fractional dosing are weak, suggesting that testing may not occur without public investment. Governments could support either experimental or observational evaluations of fractional dosing, for either primary or booster shots. Discussions with researchers and government officials in multiple countries where vaccines are scarce suggests strong interest in these approaches.
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