COVID News Roundup: Boosters and Rising Global Cases

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Brian Lehrer: Brian Lehrer on WNYC now for some of the latest on COVID-19, including vaccine booster shots and the state of the pandemic in general, as cases are rising again in Europe and the United States. New York City just approved booster shots for anyone who wants one, because of this, trying to get ahead of the federal CDC and FDA, which is controversial in Washington. The FDA is expected to authorize at least Pfizer vaccine boosters for all adults 18 and up as early as tomorrow, fulfilling a request Pfizer made only a week ago.

On Friday, the CDC will convene its panel of vaccine experts for what will likely be a straightforward meeting, fast-tracking, expanded eligibility of a third shot. Widened access from federal regulators comes as not only New York City, but a few states made similar announcements, loosening eligibility requirements. Colorado, New Mexico, California, also ahead of the federal curve, some using executive action by governors to provide vaccine boosters as at least available to all adults, just as Mayor de Blasio did by executive action here in New York.

If you're over 18 in New York City, not the rest of New York state for now, or New Jersey or Connecticut, and it's been six months since your second Pfizer or Moderna dose, or just two months after Johnson and Johnson, you're eligible to get a booster at a city-run vaccine site. If you want to go to an ordinary pharmacy, they are behold into federal guidelines so you can't do that there yet.

As I said before, if you live outside the five boroughs, you are not yet cleared to get that extra shot of any COVID vaccine. If you are concerned about getting a booster, sitting down to Thanksgiving dinner, or booking that holiday flight, maybe though I think they say they don't take full effect for two weeks and Thanksgiving is next Thursday.

With me now on all of this is Dr. Syra Madad, Infectious Disease Epidemiologist, and she's Senior Director of the System-wide Special Pathogens Program at New York City Health and Hospitals. It's great to have you back on, Dr. Madad. Welcome back to WNYC.

Syra Madad: Thank you for having being here back on, Brian. Great to be here.

Brian Lehrer: Listeners, we can take your COVID calls for Dr. Madad on booster shots or anything else, 212-433-WNYC, 212-433-9692, or tweet a question @BrianLehrer. Do you support the City making this decision ahead of FDA and CDC approval?

Syra Madad: I do support it. I think if we look at the data, if we look at what is playing out, I think that it is a right move and we're following suit just with some of the other cities and states, as you've mentioned that have expanded eligibility for booster shots like Arkansas, West Virginia and the like. At the same time, I think the message also needs to be very clear that boosting our way out of this pandemic is not the way to go.

Certainly, booster shots are needed. There's a time and place for it and the data supports it. If we truly want to end this pandemic, we really need to continue to focus on those that are unvaccinated. Again, data is supporting that. If you're looking at what is driving the surge of infections and causing hospitalizations and death, it is the unvaccinated.

Brian Lehrer: What's the state of booster data? Is expanding boosters across the US to all adults putting the cart before the horse?

Syra Madad: Not necessarily. I think that if we're looking at the data and it really depends on what is our end goal here. I think first for boosters, what they're doing is they're helping restore full protection against infection, so experiencing mild, moderate, symptomatic illness with COVID-19. It's also helping to prevent further onward transmission.

In the context of the pandemic, any way we can prevent and breaking the change of transmission, that's good, but the vaccines currently, the primary series are still holding up very well in terms of protecting against severe outcomes like hospitalization and death. We're still, obviously, in the middle of a pandemic. We're on the cusp of seeing this fifth surge or the tail end of the fourth surge, however you want to frame it. People are going to get to together in holidays. It's just adding that additional layer of protection at the moment. I think it's certainly a right decision in that regard.

Brian Lehrer: One other thing about the data. According to a study by researchers at the New York State Department of Health, reduced vaccine effectiveness was really just prevalent with people over 65, which, I guess, supports boosters for that target population, but not necessarily for the general public. Was that research ignored or the authorities decided that it was misleading for some reason?

Syra Madad: Not necessarily. I think that given the information that we have, and I think first from a public health want, you're working with the data that you have, and you're trying to make the best decision and making sure that this decision is something that you know is going to impact, not just now, but in the long term and in the future.

I think that based on the information they have knowing that, obviously, those that would benefit the most are those that are highest risks that are elderly, and that's why in the US initially as the booster discussion started, our public health authorities expanded it to that particular age group and now, obviously, we know this week that may expand to anybody over the age of 18 and Pfizer is going to present some more data to CDC on what they've collected here in the US that shows waning immunity basically five to six months after vaccination. I think there's much more data that we're going to probably see this week.

Brian Lehrer: Let me play two clips of Dr. Fauci on this from the New York Times Podcast, The Daily, which almost sound a little contradictory to my ear. In this one, he supports expanded booster eligibility and not just eligibility, but he seems to say some public health people do that they're going to be necessary in order to stave off the next big wave. Listen.

Dr. Fauci: The boosting is going to be an absolutely essential component of our response, not a bonus, not a luxury, but an absolute essential part of the program.

Brian Lehrer: At the same time, he seems to indicate that that conclusion that he came to isn't based yet on really hard data. Listen.

Dr. Fauci: I'm making my own personal projection as an immunologist and an infectious disease person, we don't have the proof yet. The proof of the pudding will be after you get people vaccinated and boosted.

Brian Lehrer: To people who may doubt what the messaging is there, or be confused what the messaging is there, he's saying the proof of the pudding will come after people are boosted, but he's convinced that it's an absolutely essential, not a bonus part of the anti-COVID program. Can you explain it?

Syra Madad: Yes. I think there's three things. First, the messaging around booster shots has been abysmal unfortunately, it's been very confusing, and certainly, I think this is the muddiest phase of the pandemic as we talk about boosters and waning immunity and the like. I sympathize with the general public. It is confusing.

Second, I think that as we look at what is happening around the world, and we have countries like Israel who actually are producing some really great data, and as you know, they were the ones who first recognized vaccine waning 46 months after their primary series in July, and they started to offer booster shots. If we just focus on Israel, you're seeing that after they had this mass booster campaign, they were able to restore full protection in their population by that third shot, and they saw decrease of infection rates, decreased hospitalization rates, and decreased deaths associated with the third shot.

We have the data in terms of what we're seeing in other countries and the impact that these booster shots are having, and it's positive. The third thing that I'll mention is that here in the US, we've already had about 30 million people that, or about 15% of those that are fully vaccinated that have gotten that third shot. We have data, we have really good data and that's what's going to be presented today to CDC as they make their decision.

The last thing that I'll mention is that I do think personally that the COVID-19 vaccines are going to be part of a three-part regimen, and it's going to be first, second, and third shot. We're calling it a booster shot, but in reality, I think it's going to be part of the entire package of what's going to constitute full protection. They're seeing some of the other countries around the world changing their fully vaccinated definition to that third dose. I think it's going to be here in US soon.

Brian Lehrer: We have a lot of calls coming in. I'm going to take some phone calls for you as soon as we come back from a break. The first one is going to be asking, now that all the brands are available to anyone, which booster should I get? Stay with us. Brian Lehrer on WNYC.

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Brian Lehrer: Brian Lehrer on WNYC, as we talk about booster availability and other COVID news with Dr. Syra Madad, Infectious Disease Epidemiologist and Senior Director of the System-wide Special Pathogen's Program at New York City Health and Hospitals Corporation. Susan in Manhattan, you're on WNYC with Dr. Madad. Hi, Susan? Dr. Madad, I'm sorry.

Susan: You basically paraphrased my question very well. I had Pfizer as my original shots and I'm ready for my booster, but I don't know whether I should go with Pfizer or I'm better off going with Moderna or another one.

Brian Lehrer: How should people choose, Dr. Madad?

Syra Madad: As we look at mix and match studies and what they're showing in terms of those that are generating, essentially, the most neutralizing antibodies. Those that get three shots of Moderna, that's essentially the best. If you've gotten Pfizer, the second is getting a booster shot with Moderna, which is the second-best, and then if you've gotten Moderna, you can also get the Pfizer.

I think that the end here is that the mRNA-based vaccines are producing much better neutralizing antibodies in that regard. Whether you got the Pfizer or the Moderna as your primary series, you can either stick to that brand or you can go with another one and you'll have a good and robust response. Now, if you've got the J&J, I would advise getting an mRNA-based COVID-19 vaccine, because that in terms of neutralizing antibodies, you're getting more bang for your buck in that sense.

Brian Lehrer: Is there any data yet on whether the Pfizer booster or the generally available Moderna booster is providing more protection? Because the Pfizer is a full dose of what was originally offered in shots one and two, the Moderna is a half dose.

Syra Madad: Right now I think data is still coming in. The public health partners are going to be meeting this week. For example, CDC is going to be looking at authorizing the booster for Pfizer. Moderna is going to provide additional information, hopefully in the coming weeks.

Brian Lehrer: Would you make any particular recommendations by age or gender? For example, I think there were some findings, and I'm going to rely on you to say what they were, having to do with blood clots that occurred more in women. From one of the brands, also some temporary heart inflammation that occurred in younger men from one of the brands. Do you sort this by brand or is this just mRNA general?

Syra Madad: First, with the J&J or the Johnson and Johnson COVID-19 vaccines, that's where you're seeing a rare side effect of blood clots more so in women and so that's where I think having that option of going with an mRNA vaccine based vaccine is great. I think if I was personally in that position where I got my initial dose with Johnson and Johnson, I would go with an mRNA-based COVID-19 vaccine for two reasons. First, you're getting a better protection in terms of antibody response, and second, you don't have that even potential, rare side effect of that rare blood clot.

The second in terms of myocarditis and pericarditis that you've referred to is based on the mRNA-based COVID-19 vaccines, and it is another rare side effect that's generally seen after a second dose in young men. I think based on certain studies, it's less common with Pfizer than with Moderna. If you actually look at the risk of getting infected with COVID-19 and experiencing this heart inflammation, it's much, much more common with actual infection.

Brian Lehrer: Maria in the Flatiron district, you're on WNYC. Hi, Maria.

Maria: Hi, good morning. I have a question for Dr. Madad. I'm triple Pfizered, but after my second Pfizer, we had the Delta breakthrough, and so then I got my booster a couple of weeks ago. Since then I've had two negative PCR tests. My situation is I'm invited to go up to New England for Thanksgiving, and there are young children there and people that are only single-vaxed and little ones that are un-vaxed at all.

I'm going to be in a packed train, is there any data on anyone of having the capacity to transmit to someone that's non-vaccinated, even though I'm completely protected and I have a negative PCR? Can I carry the virus from being in a very crowded environment?

Syra Madad: First, congratulations on being fully vaccinated and getting your booster shots. I think first as we talk about breakthrough infections, they're going to be more common as we have more virus circling in the community. If we're going to get together with anyone, whether it's a small gathering or a large gathering, the rule of thumb is to get tested, I would say, at least three days before the event and then the day of the event.

You've mentioned that you have a negative PCR test, which is great. It's showing you're not actively infected. If you want to just be extra sure and have that extra layer of protection, I would say, get a rapid antigen test before your gathering, and if that's negative, that shows that you are actively not infected.

I think if you are feeling sick, again, another thing in terms of rule of thumb is not to get together. I think it's one of those things where based on your risk profile as well shows that you're also meeting, you're doing everything that you can to reduce that risk, you're fully vaccinated, you got the booster shot and you're going to get tested before the gathering. I think that the risk is going to be very, very minimal.

Brian Lehrer: What defines fully boosted? Is it two weeks after your booster like it was with the original series?

Syra Madad: That's correct. It takes about two weeks for our body to generate a robust immune response or so, and so after your primary series and you've got a booster shot, we are still considering fully vaccinated with the two doses. For example, the mRNA vaccine or the one dose of the J&J, but that booster shot is giving you that added layer of protection.

I think personally, I wouldn't be so worried that I would wait, for example, two weeks before getting together. After getting my booster shot I think given that you aren't even fully vaccinated, that booster shot is going to give you that extra layer of protection, and then just coupling that with testing would be great.

Brian Lehrer: We have a few more minutes with Dr. Madad. This is WNYC FMHDN-AM New York, WNJT-FM 88.1Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are New York and New Jersey public radio. Elliott in Manhattanville, you're on WNYC with Dr. Madad. Hi, Elliott?

Elliott: Good morning, Brian? Good morning, Dr. Madad? The previous caller asked my question about the transmissibility. If I can pivot if that's okay? I have just forgotten what I was going to say.

Brian Lehrer: I thought you had a different question. Anyway, let me ask what I thought your question was since you can't remember what your other question was. When will the pandemic end? Are we going to need boosters every six months for a while? We're seeing what I think they're calling a fifth wave in Europe right now, much more serious among the unvaccinated than the vaccinated over there in terms of the effects on the seriousness of the effects on people.

Each time we think we're starting to phase out of this thing, there seems to be another wave. When will this end, and do you anticipate many more rounds of boosters being recommended every six months?

Syra Madad: That's a great question, and I think one that we need to make sure that we're responding with good data, and unfortunately, given the pandemic, the science is evolving. I think right now the data supports giving that third dose or that booster shot. Whether we are going to warrant another booster shot next year or the year after or every six months, I think that's still something up in the air. I think based on some of the research I am seeing is that, this technically I think eventually will be a three-part series if you will, and we, hopefully, will have long-term protection after that third dose.

I don't think we'll need additional booster shots moving forward, but again that data is what's going to help answer that question. In terms of when we're going to end the acute phase of this pandemic, and as I talk about acute, it's because we're seeing a lot of morbidity and mortality. For example, we're seeing at least 80,000 new infections per day, over 1,000 people dying. That's still in the emergency phase of the pandemic.

I think as we transition into this virus where it's going to be constantly around us but won't cause so much death and mayhem as we're seeing, we have a little bit to get to that point, we're on our way to recovery. I think with vaccinations and coupling it with our other public health measures like masking indoors and the like is going to get us to that point, and really emphasizing getting those that are unvaccinated vaccinated is what's really going to help us to get to the point of ending the emergency phase of the pandemic.

I think it's going to be near but it's hard to tell exactly when that's going to be. The one thing that I will mention, because I think there's a little bit of confusion as we are seeing the rise of cases here in the United States, it's not uniform, you're seeing pockets in cities and counties and states that are seeing higher levels of infection. If you actually look county by county level, in the terms of pattern of vaccination in the US, you're seeing that 9% of counties have rates below 30% of their total population fully vaccinated and only 3% have rates above 70% of their total population fully vaccinated. This is based on a Rockefeller print that just came out.

You're seeing a lot of variabilities there, and so what I mean, bottom line, is there are still a lot of vulnerable individuals who are unvaccinated and we have a lot of pockets in our own communities that are unvaccinated and that's where you're going to start seeing higher rates of infection.

I want to make sure we're emphasizing the need for vaccination. That's what's really going to help end the pandemic and again, coupling it with some of our other preventative measures to get to that.

Brian Lehrer: A listener asked me yesterday and I'm going to pass it on to you because you know the answer and I don't, why there are different doses for different age children. Why, for example, an 11-year-old gets, I believe it's only a third of the dose that a 12-year-old would get? Why it isn't more graduated, X dose if you're a five years old, a little more if you're six, a little more if you're seven. Can you explain that to confused parents?

Syra Madad: Yes. That's another really great question, is something that we get all the time. I think first the way that at least the vaccines work are very different than when you take Tylenol, which is a medicine where you need a certain concentration in your blood to get to the effect that you're looking for from a medication like lowering a fever or whatnot. Vaccines here are a preventative measure and they're trying to generate an immune response, really different in terms of the biological mechanism than what we're trying to accomplish.

With the COVID-19 vaccines and generally all vaccines, you have, for example, these immuno-bridging studies where you're looking at what is the sweet spot. What I mean by the sweet spot is, what dose can you give to a child that's going to elicit a robust immune response, but also be tolerable for children with minimal side effects?

With these vaccines that we have for COVID, they went through these immuno-bridging studies where you were giving lower and lower doses until you get to a point where you know that this is the dose and is accomplishing what you want immunologically so a good immune response, but also something that children can tolerate. That's where we were able to get to that dosing for five to 11-year-olds. You're going to see even a smaller dosage for those that are six months and older.

Brian Lehrer: Just tell people again as we run out of time. If they are looking for a COVID booster, where should they look because the pharmacies don't have them yet because the pharmacies are governed by the federal guidelines and the federal guidelines aren't there yet? If people are in New York City, and of any age, because now anybody over 18 is eligible for a booster, where should they look to actually find one?

Syra Madad: I think there's two things that I'll mention there. First is our city department of health is doing an amazing job at helping share information of where to go for your vaccination. I would say, go to the city department of health's website to get information on where you can get a booster shot and even New York City Health and Hospitals, where I work, they also have really great information, whether you want to come into one of our facilities and get your booster shot, or if you want to do it in the comfort of your own home.

For those 12 and older, you can actually request getting a COVID-19 vaccine, whether it's your primary series or booster at home. You have that option. If all else fails and if you can't find information, call 3 1 1.

Brian Lehrer: To be clear, I said the pharmacies don't have them. Pharmacies do have them if you're 65 or older and you've been cleared at the federal level, or if you have any of the underlying conditions or other risk factors that qualify. Dr. Syra Madad, Infectious Disease Epidemiologist, and Senior Director of the System-wide Special Pathogens Program at New York City Health and Hospitals. Thank you so much for all the information today. I know the listeners really appreciate it.

Syra Madad: My pleasure. Thank you.

 

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