COVID-19 boosters are here : Short Wave The United States is on the verge of dramatically expanding the availability of COVID-19 vaccine boosters to shore up people's immune systems. As NPR health correspondent Rob Stein reports, the Food and Drug Administration is poised to authorize the boosters of the Moderna and Johnson & Johnson vaccines. Still, many experts argue boosters aren't needed because the vaccines are working well and it would be unethical to give people in the U.S. extra shots when most of the world is still waiting for their first.

COVID-19 boosters are here

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MADDIE SOFIA, BYLINE: You're listening to SHORT WAVE...

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SOFIA: ...From NPR.

EMILY KWONG, HOST:

Hey there, SHORT WAVErs. Emily Kwong here with science correspondent Rob Stein from our dream team of NPR health reporters helping us navigate the COVID pandemic together. And we're right now at a critical moment. Booster shots are a big topic right now for the government.

ROB STEIN, BYLINE: Yeah, Emily. You know, the nation is on the verge of dramatically expanding the availability of COVID-19 vaccine boosters to shore up the immune systems of tens of billions of people.

KWONG: Yeah. It's a big undertaking and a pretty dramatic pivot because after months of saying the U.S. didn't need boosters, White House officials this summer said...

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VIVEK MURTHY: Having reviewed the most current data...

KWONG: ...We do.

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MURTHY: ...It is now our clinical judgment that the time to lay out a plan for COVID-19 boosters is now.

KWONG: They announced back in August that starting September 20, booster shots would be offered to all adults who've been vaccinated for at least eight months.

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MURTHY: We are concerned that this pattern of decline we are seeing will continue in the months ahead, which could lead to reduced protection against severe disease, hospitalization and death. That is why...

KWONG: And that set off a pretty intense debate, right?

STEIN: Yeah, it was a debate about science, but it was also a debate about ethics. You know, many experts argued that boosters weren't needed because the vaccines are still working incredibly well and that it would be unethical to give people in this country extra shots when most of the world is desperate for their first.

KWONG: Yeah, that is a whole conversation. And, of course, some also fear that boosters will distract from the top priority, which is vaccinating tens of millions of unvaccinated people in this country to prevent yet another deadly surge.

STEIN: Yeah, absolutely. But, you know, then it took some time for Pfizer, Moderna and Johnson & Johnson to actually formally request authorization for boosters for their vaccines and submit the evidence to make the case for that extra shot. That spurred an intense review of the scientific evidence. And the FDA advisers finally issued their recommendations, albeit with many experts complaining the process was rushed and the evidence is still pretty thin.

KWONG: Today on the show, after months of zigzags, the campaign to roll out boosters is upon us. You're listening to SHORT WAVE, the daily science podcast from NPR.

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KWONG: So, Rob, the FDA is expected to make some important announcements on boosters this week. Who are you expecting to hear from?

STEIN: Any day now, the FDA is expected to authorize the Moderna and the Johnson & Johnson boosters, following recommendations by the agency's advisory committee last week. This will mean many of the 69 million people who got the Moderna shots and all 15 million who got the J&J are about to become officially eligible for boosters. That's on top of the millions who've been eligible for the Pfizer boosters for several weeks now.

KWONG: Booster-eligible - it is coming. OK.

STEIN: Yeah.

KWONG: Who exactly is eligible for these boosters? And when will they be able to get them?

STEIN: So the Moderna boosters are being recommended for the same folks who are getting the Pfizer boosters. That's anyone age 65 and older and younger adults who are at high risk because they have other health problems or maybe risky jobs or living situations who got their second shots at least eight months ago. The J&J boosters would be for anyone age 18 or older who got their shot at least two months ago.

KWONG: OK.

STEIN: Then on Thursday, CDC advisers will find exactly who is eligible and under what circumstances people should get the boosters.

KWONG: It's a lot of information...

STEIN: Yeah.

KWONG: ...To take in.

STEIN: I know.

KWONG: And, of course, one key question here is whether people should get the same vaccine as their booster or a different one, right?

STEIN: That's right. And that's because new research suggests people who got a Pfizer or Moderna benefit about equally from getting either of those as a booster.

KWONG: OK.

STEIN: But those who got the J&J look like they might do much better if they get one of the other vaccines this time instead. Here's what Dr. Anthony Fauci said Sunday at Fox News about this.

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ANTHONY FAUCI: I believe there's going to be a degree of flexibility of what a person who got the J&J originally can do, either with J&J or with the mix-and-match from other products.

STEIN: For example, young women who are concerned about rare blood clots associated with the J&J shot might be especially interested in getting one of the other vaccines this time. On the other hand, young men worried about a rare heart inflammation linked to the mRNA vaccines might want to go with another J&J. And Dr. Fauci also says federal health officials are keeping an eye on the situation to see if they should eventually expand the pool of people eligible for Pfizer or Moderna boosters to younger adults if more evidence accumulates that their protection is fading, too.

KWONG: So a lot of people hearing this, they may be confused about which booster they should get and when. What are you hearing?

STEIN: Yeah, yeah. Well, you know, the first thing I should say, if people can wait a little bit, like to the end of the week or maybe next week, a lot of this should be official, and there should be more specific guidance. But others, you know, like Dr. Carlos del Rio at Emory University, are telling me that most people who got the J&J vaccine really should go for Pfizer or Moderna this time because it looks like that would really rev up their immune systems better.

CARLOS DEL RIO: If I had gotten the J&J vaccine, I would probably want to be boosted with one of the mRNA vaccines, either Pfizer or Moderna. I feel that that's probably a good strategy.

STEIN: But he says anyone who got the Pfizer or Moderna should just go get another one of those because it doesn't really matter very much which one.

KWONG: OK. How are these three vaccines holding up? They've been out in the world for a little less than a year. And the booster conversation is happening in part because there's evidence that the efficacy of some of these vaccines is fading, right?

STEIN: Yeah. You know, the first thing I should probably say is they are still working really well on keeping most people from getting really sick or ending up in the hospital. But they are holding up in different ways, and some of it depends on the age group. You know, people age 65 and older are the ones that seem like that's fading the most, so they're at - near the head of the line to get boosters. And evidence seems to be mounting that Pfizer's protection seems to be waning, especially among those older folks. Moderna looks like it's holding up better than the Pfizer, but it looks like it also may be fading, especially in the face of the delta variant. And the J&J could actually be holding up the best. The thing is it's never provided as strong protection as the others. And with the super contagious delta variant now the dominant strain, health experts say it's more important than ever to pump up the protection for everyone who got the J&J shot.

KWONG: I can see that. But, you know, I also got to say COVID cases are on a downward trajectory in the U.S. At least that's been the trend the past few weeks. So where do experts land with this?

STEIN: Yes, that's a very good point. You know, there are still skeptics about how strong the evidence really is that boosters are really needed since the vaccines are still doing a really good job of, you know, keeping most people out of the hospital and keeping them alive...

KWONG: Yeah.

STEIN: ...Which is their main job, and especially, again, when most of the world still isn't vaccinated at all. But more and more breakthrough infections are happening. And remember, more than 80,000 people are still catching the virus every day. More than 1,200 are still dying every day. And we're heading into the colder weather and all the holidays, which makes people worry about yet another surge. Yeah.

So the experts I've been talking to you say, look; it's just really important to shore up the immunity of as many people as possible. Here's Dr. Nahid Bhadelia at Boston University.

NAHID BHADELIA: The boosters will help decrease some of the more severe breakthrough infections at a time where we are in that tenuous period with the holidays, with the colder weather, with still a percentage of the population in many states that are undervaccinated or unvaccinated. I think that it's going to definitely provide more resilience.

STEIN: And here's Dr. Ashish Jha. He's the dean of the Brown University School of Public Health. He agrees.

ASHISH JHA: We do know that vaccinated people can have breakthroughs, and they can spread, even if they spread less than unvaccinated. And so getting them boosted is going to help. It's going to make a difference in keeping infection numbers low this fall and winter.

KWONG: Yeah, and speaking of fall and winter, I mean, next up is vaccines for young kids, those 5 to 11. A lot of those kids are going back to school, and a lot of parents are on pins and needles waiting for this vaccine news for them. When will they get that?

STEIN: Yeah, so the FDA advisers will take this up next week, and the CDC will weigh in the first week of November. So kids ages 5 to 11 could finally start getting vaccinated with the Pfizer vaccine right after that. And, you know, while many parents are eager to vaccinate their kids, a new national survey just came out that finds parents' concerns about vaccinating their kids has actually increased as the reality is getting closer.

KWONG: Yup. All right. Well, Rob, I want to step back and say we're hearing a lot about boosters and the nuances of immunity. And there are so many moving parts between science and regulation at a time like this. But a year ago, you know, if we were sitting down chatting like this, there was no vaccine authorized.

STEIN: Yeah, yeah.

KWONG: And the FDA was telling pharmaceutical companies that any vaccine that was even 50% effective would've been acceptable. So as far as tools to keep people from getting sick or dying, I mean, there's been a lot of progress in just 12 months.

STEIN: Absolutely. You know, I don't think it's a stretch to say these vaccines are nothing short of a medical miracle. I mean, it's amazing, if you think about it, that scientists were able to produce these three incredibly effective vaccines so quickly.

KWONG: Yeah. And maybe I just think too much about the multiverse, but, like, imagine where we'd be right now if they hadn't.

STEIN: Oh, my God. It would be a totally different universe. And there's no doubt about it that the bigger priority still remains getting the one-third of the U.S. population who could be vaccinated to get their shots. That's the only way life is ever going to really get back to something more like normal. Also, you know, people have to keep wearing their masks and thinking carefully about, you know, indoor gatherings over the holidays, especially when they're around unvaccinated people.

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KWONG: Rob, thank you so much for coming on SHORT WAVE to tell us where we are in this pandemic. It's hard to keep track of it day to day, but your reporting really makes it clear. Really glad to have you on the show.

STEIN: Oh, well, thanks, Emily. It's always fun to be here.

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KWONG: This episode was produced by Rebecca Ramirez and edited by the amazing Jane Greenhalgh and the incomparable Gisele Grayson. Margaret Cirino checked the facts. Welcome to SHORT WAVE, Margaret. We're so glad to have you. The audio engineer for this episode was Marcia Caldwell. I'm Emily Kwong. Thank you so much for listening to SHORT WAVE, the daily science podcast from NPR.

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