Will Booster Shots Make a Difference?

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S1: Earlier today, our medical experts announced the plan for Booster shots to every fully vaccinated American adult American.

S2: On Wednesday afternoon, President Biden announced what his administration had been telegraphing for several days.

S1: The plan is for every year, every adult to get a booster shot eight months after you got your second shot.

S2: In addition to vaccine mandates for some nursing home employees and an aggressive pushback on mass bans in schools. The administration wants adults who got the Pfizer or Moderna vaccine to be eligible for a third shot starting as early as September 20th

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S1: will make you safer and for longer and will help us end the pandemic faster.

S2: And hearing that made me wonder. Will it?

S3: I don’t know, honestly,

S2: that Saad Omer, the director of the Yale Institute for Global Health,

S3: so there are two things, two variables there. There is what do we mean by end of the pandemic? This is a long standing pandemic. And infectious disease experts at this point don’t have high expectations of elimination or eradication.

S2: Instead, they expect the virus to be something we control aggressively but live with. And then there’s the other variable. How much is protection from the vaccines waning?

S3: It’s pretty clear data that there is something happening and either it’s winning or it’s the effect of Delta. And I think it’s a bit of both

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S2: for some people. Saad says Booster makes sense. The immunocompromised, maybe the elderly.

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S3: But I was sort of a bit surprised about the recent discussion of a blanket Saad Booster.

S2: So why is the administration promoting them today on the show? Do we all need third shots? I’m Lizzie O’Leary and you’re listening to what next? TBD, a show about technology, power and how the future will be determined. Stick with us. The first thing I Saad Omer to do is walk me through the data. It’s important to note that we’re talking about the Fizer and Moderna vaccines in this episode. The Biden administration says they’ll be talking about the Johnson and Johnson vaccine in the coming weeks. On Wednesday, the president’s top Koven advisers cited a few early studies to make the case for boosters from New York, from nursing homes from the Mayo Clinic. Plus, there were some data from Israel.

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S3: I see two things. First, I see a few canaries in the coal mine. I do see that there is especially from based on the US data, there is a diminishing of effectiveness against mild to moderate disease.

S2: Here’s Rochelle Walensky, the director of the Centers for Disease Control and Prevention, on Wednesday talking about a Mayo Clinic analysis of more than eighty thousand vaccinated and unvaccinated people like we saw in the New York data.

S4: Vaccine effectiveness against infection declined over time. In this case, from seventy six percent to forty two percent for those who received the Viser vaccine and from eighty six percent to seventy six percent for those who received the medicine, a vaccine.

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S3: I also see that things seem to be holding up against severe disease, including hospitalization more or less. Which seems great. It seems great, which is good. The other thing I see is whenever things are that nuanced, I want to see the whole process unfold.

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S2: He means the Advisory Committee on Immunization Practices. It’s a group of 15 outside advisors, doctors, nurses, public health specialists who make recommendations to the CDC on vaccines, on covid, yes, but on other things too. And the committee has a standard deliberative process that anyone, you or me, can log on and watch.

S3: The encouraging thing and something that got lost in a lot of coverage was that the actual wording of things that came out yesterday was that they are doing this for planning purposes to start with September 20th, pending authorization from FDA and pending the Advisory Committee on Immunization Practices Review. So as a scientist, I’d wait for the ACP review because things are that nuanced.

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S2: The administration recommended that this start next month. But when I look at places with big surges in both cases and hospitalizations, Texas, for example, over 90 percent of the cases in Texas are in the unvaccinated. Why do Booster shots if if that is not the group of people who are, you know, the most threatened right now?

S3: So this is the reason why we want to see more nuanced discussions. And that’s part of it. Like sort of the it’s the unvaccinated that are contributing the highest burden. It is unclear what how much gain in actual effectiveness there will be with the third dose. Remember, increased antibody responses after the third dose is very much expected, even if it doesn’t have an additional benefit, because they are these required responses that if you vaccinate someone again, so there’s a sort of a burst of antibody because they remember

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S2: their immune system kicks back into overdrive.

S3: Exactly. And so what the implications are that it actually has an effectiveness that, again, doesn’t 100 percent solve that question. So, yes, that’s part of it. But also, look, you know, those of us who talk about global vaccine equity, you know, what is the best use of the next available dose? It’s not just that we are all warm and fuzzy people who want to save the world at the expense of anything here in the US. Part of the fact is that the history will judge us poorly if we are too selfish. But part of it is hard nosed. Calculus on our part is what is the best public health strategy to get this Booster under control? And there is evidence there was a really nice paper in science. We did our work in November, back in November that looked at saying that having after a certain level of vaccination coverage, it may be best to donate a huge chunk of those doses outside the US to get this outbreak under control. We can’t build Fortress America when it comes to infectious diseases. We know that for decades. And the fact that new variants emerge in places where this is rampant, we need to keep in mind what is the best use of the next available dose.

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S2: So let’s get to that that criticism a little bit. If you look at, say, the numbers in Indonesia where, you know, children are dying, the rate of spread seems quite high. The way Joe has said wealthy countries should stop Booster incentive system, poorer ones. How is this moral?

S3: Well, that’s that’s a question we need to ask, and I do think that countries do have a bigger responsibility, not just to us towards their own population, but that responsibility is not absolute. And where you draw the line is that if there is a reasonably clear benefit to a high risk population, let’s say nobody had any issues with the immunocompromised individuals because you knew that within the US there was a clear benefit. So that’s what I’m saying, that there is a higher burden. It’s not an impossible burden, but a higher burden. You don’t do a third those from just in case perspective.

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S1: No, there’s some world leaders who say America shouldn’t get a third shot until other countries got their first shot. I disagree. We can take care of America and help the world the same time. In June and July, America administered 50 million shots here in the United States and we donated a hundred million shots to other countries.

S2: Biden pledged that the U.S. would donate another 200 million vaccine doses to other countries over the fall and winter. But that number is roughly a third of the vaccine stockpile that the U.S. is currently sitting on.

S3: A couple of things. I do think that we should have worked and as have been sort of appropriating Martin Luther King’s words with a fierce urgency of now. Yeah, I think we should have had switched very quickly to the operation was a global version of it and with the same urgency as, you know, when you talk to folks who have been involved with these things that say, of course, there is an effort. No, but not with the same urgency if your own grandmother’s life was on the line. The other thing is a lot of them are scheduled to be delivered through next year and people need those vaccines right now.

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S2: When we come back, how should most of us respond to this week’s announcement? You’re listening to what next, TBD. I’m Lizzie O’Leary and I’m talking with Saad Omer, the director of the Yale Institute for Global Health. I want to be very careful not to give fuel to any of actors, but I wonder if you worry at all that some people will look at this recommendation and say, oh, well, if the shots don’t work as well as they thought, why do it at all?

S3: You know, but that’s a real possibility. That’s something that we should be thinking about in terms of messaging. We should follow the science. If if if the evidence suggests there’s a clear benefit, especially in terms of severe disease, by all means, do that and then worry about communications. But now we are in the gray zone and I think we need to be super careful about this.

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S2: Also, why do this now? The, you know, committee has not met. As you’ve said, there was currently no authorization for this. Last week we did a show on the FDA and this feels awfully close to politicians getting ahead of the FDA.

S3: Well, so I can’t read their minds, but I can tell you the regular order of things is that a request comes from the political appointees and it’s reasonable for the EPA to consider that.

S2: What the administration seems to be saying is we’ve learned that if we wait with this virus, it is too late that they’re coming from sort of a better safe than sorry point of view. Do you think that’s valid?

S3: Well, I think I think we should explicitly look at the trade offs and the trade off, is that what are the implications on our long term security in terms of what is the best use of the next doors? And full disclosure, I serve on the W8 shows covid-19 Vaccine Working Group. And having been part of that process, I can tell you it does tend to clarify a lot of these questions.

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S2: I want to ask you about some interesting criticism I saw from Dr. Katie Stevenson at Harvard, and she essentially said we cannot boost our way out of a covert search either in the U.S. or abroad, that that we need to get vaccines to the unvaccinated. But but she went on to say that the U.S. needs better ventilation, more masking paid time off. I wonder if you think as an epidemiologist that focusing on vaccination might limit the portfolio of public health measures that that we have as a country, as a society to to fight the epidemic or whether vaccines really are the best hope?

S3: Well, as someone who has spent the last 20 years of his life primarily working on vaccine research, I do other research as well. I can tell you that she’s right, that we need a whole I may phrase it differently, but we may need the full tool box of tools to counter this pandemic in the short run. In the long run, you may be able to sort of say that once you have achieved sustainable control of the outbreak, where it’s not a life altering pathogen for for the society, then you can sort of mostly rely on vaccines. But it’s entirely correct that if you’re opening up schools, you need more toolbox in your tools. But even if you’re opening up universities where, you know, at Yale, our latest data suggest that we are ninety five percent immunization coverage in students. And this is an underestimate because some students are still uploading their documentation and some of our international students are catching up. But even in those situations, it’s part of a multipronged strategy. So masking and other efforts are still being undertaken even in high vaccination coverage situations.

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S2: You know, you have been. I’ve listened to you steer me toward nuance, steer me back to the science, and it’s making me think you have this cartoon that is pinned to the top of your Twitter profile. And it’s a bunch of people lined up by a sign that says answers. And there’s like a big group of people veering toward simple but wrong and only a tiny group going toward complex. Right. And I just feel like we have spent. A year and a half trying to have simple solutions, why don’t you think political leaders are willing to say things that are complex?

S3: Well, look, they have incentives for simplicity. When you’re a political leader, you have incentives for simplicity. You have incentives for action even if you are wanting to do the right thing. But it is the job of people like us. It’s the job of people who do this stuff for a living to make sure that these conversations are nuanced. And I’m fully aware that one of my couple of my earlier answers where we are longer than you would what’s ideal for a partner when it was needed.

S2: So how should we as a public sit with this week’s announcement? Because, yes, the science is nuanced, but as people who are tired or worried about their kids or worried about their parents. How do we receive it?

S3: That’s a really good question and it’s a tough question to answer because there is understandable confusion. I would say some of it is with the understanding that it’s an evolving outbreak. The second thing is to understand the sincerity, but also fallibility of public health leaders that these are not perfect people, but they are sincere people. Cut them some slack even if you disagree with them. And I do that all the time, that even if I disagree with a specific policy partner, that’s true. The other thing I would say one way of cutting through the noise is look for folks who have been doing this stuff respiratory disease, virology, immunology and epidemiology. Before the pandemic hit. I can tell you, I have drawn so many times from previous experiences that have stopped me from making sort of rash errors in judgment. I haven’t been perfect and there is disagreement between experienced people. So the reason why everyone respects Tony Foushee, Dr. Fauci, it seems now his first name is Doctor, but is not because he’s always right and he would be the first person to admit that. But he comes from a place of experience. The second thing is look for the cumulative wisdom of experts like the ASCAP. And so these are some imperfect but useful ways of sifting through the noise.

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S2: Saad says that for now, if you’re vaccinated, don’t panic. There’s no need to try to finagle a third shot. Let the advisory panels do their thing, and the next few weeks should bring more data and with it more clarity. So if you watch this announcement this week, wait,

S3: I would say even the announcement said, wait, they plan to roll it out on September 20th. I would say, wait, don’t freelance at this time unless you are immunocompromised. Then by all means, go and get it, even if you’re on the fence about it. If you think maybe your immunocompromised, maybe you not go out and talk to your physician, but for a general recommendations even that yesterday’s announcement said that they plan to roll out around September 20th.

S2: Saad Omer. Thank you very much for your time.

S3: My pleasure.

S2: Saad Omer is the director of the Yale Institute for Global Health, and that is our show for today. This episode was produced by the Edes, were edited by Tony Bosch and Allison Benedict. Elise Montgomery is the executive producer for Slate podcasts and TBD is part of the larger What Next family is also part of Future Tense, a partnership of Slate, Arizona State University and New America. And I want to take a moment and recommend that you go back and listen to Thursday’s episode. What next? Hear the stories of Afghans who worked with the United States and have stuck trying to get out to. Mary Harris will be back next week. I’m Lizzie O’Leary. Thanks for listening.