When the preliminary analyses of their Phase 3 trials came out , vaccine developers pleased their audience of scientists with the following data graphic:
The above was lifted out of the FDA briefing document for the Pfizer / Biontech vaccine.
Some commentators have honed in on the blue line for the vaccinated arm of the Pfizer trial.
Since the vertical axis shows cumulative number of cases, it is noted that the vaccine reached peak efficacy after 14 days following the first dose. The second dose was administered around Day 21. At this point, the vaccine curve appeared almost flat. Thus, these commentators argued, we should make a big bet on the first dose.
The chart is indeed very beautiful. It's rare to see such a huge gap between the test group and the control group. Notice that I just described the gap between test and control. That's what a statistician is looking at in that chart - not the blue line, but the gap between the red and blue lines.
Imagine: if the curve for the placebo group looked the same as that for the vaccinated group, then the chart would lose all its luster. Screams of victory would be replaced by tears of sadness.
Here I bring back both lines, and you should focus on the gaps between the lines:
Does the action stop around day 14? The answer is a resounding No! In fact, the red line keeps rising so over time, the vaccine's efficacy improves (since VE is a ratio between the two groups).
The following shows the vaccine efficacy curve:
Right before the second dose, VE is just below 50%. VE keeps rising and reaches 70% by day 50, which is about a month after the second dose.
If the FDA briefing document has shown the VE curve, instead of the cumulative-cases curve, few would argue that you don't need the second dose!
What went wrong here? How come the beautiful chart may turn out to be lethal? (See this post on my book blog for reasons why I think foregoing or delaying the second dose will exacerbate the pandemic.)
It's a bit of bait and switch. The original chart plots cumulative case counts, separately for each treatment group. Cumulative case counts are inputs to computing vaccine efficacy. It is true that as the blue line for the vaccine flattens, VE would likely rise. But the case count for the vaccine group is an imperfect proxy for VE. As I showed above, the VE continues to gain strength long after the vaccine case count has levelled.
The important lesson for data visualization designers is: plot the metric that matters to decision-makers; avoid imperfect proxies.
P.S. [1/19/2021: For those who wants to get behind the math of all this, the following several posts on my book blog will help.
One-dose Pfizer is not happening, and here's why
The case for one-dose vaccines is lacking key details
One-dose vaccine strategy elevates PR over science
[1/21/2021: The Guardian chimes in with "Single Covid vaccine dose in Israel 'less effective than we thought'" (link). "In remarks reported by Army Radio, Nachman Ash said a single dose appeared “less effective than we had thought”, and also lower than Pfizer had suggested." To their credit, Pfizer has never publicly recommended a one-dose treatment.]
[1/21/2021: For people in marketing or business, I wrote up a new post that expresses the one-dose vs two-dose problem in terms of optimizing an email drip campaign. It boils down to: do you accept that argument that you should get rid of your latter touches because the first email did all the work? Or do you want to run an experiment with just one email before you decide? You can read this on the book blog here.]