When To Consider Another COVID-19 Booster
EMILY KWONG, HOST:
You're listening to SHORT WAVE...
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Hey, SHORT WAVErs - Emily Kwong here with a reminder that although some aspects of indoor life perhaps have resumed for you, like eating out and traveling and being out and about, it can kind of seem like the pandemic is over, right? But it's not. This virus is still infecting people, which is why my girl, Allison Aubrey, is here to catch you up on where we are with ongoing vaccination and boosters in the U.S.
ALLISON AUBREY, BYLINE: Hey there, Emily. That's right. This week, advisors to the Food and Drug Administration will meet to discuss the future of COVID boosters. In late March, the U.S. government approved a second booster for people 50 and over.
KWONG: But considering that half of Americans haven't even received their first booster, Allison, how do policymakers convince people to get more shots that may be beneficial?
AUBREY: You know, I think it might be tough. But for those who think they might want to get one, we've got tips on how to decide timing and whether to hold out for a variant-specific booster. Also, the FDA is expecting more data to roll in from vaccine trials in kids under age 6 - but will this data be convincing enough to win authorization and sway parents?
KWONG: Today on the show, Allison talks us through the U.S. vaccination campaign and why it's so important for ending the pandemic once and for all. You're listening to SHORT WAVE, the daily science podcast from NPR.
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KWONG: Allison, let's take a quick trip down memory lane. Remind me about the state of vaccination efforts in April 2021 - one year ago.
AUBREY: Well, a year ago, vaccines were just starting to become more widely available. A Kaiser Family Foundation poll showed a lot of people back in March and April of last year were just getting their first dose of the two-dose regimen, and the FDA had yet to authorize a vaccine in the 12 to 15 age group.
KWONG: Yeah, I remember all of this. We've come a long way, you know? As of this week, 65% of the population is fully vaccinated. That's, like, two-thirds of people in the U.S. Why is the conversation, though, right now, about boosters important, and why is getting even more people vaccinated continuing to be important?
AUBREY: Well, we are living with a virus that just isn't going to go away. In the last year, when many people assumed that the worst was over, we were hit by both delta, then omicron - so the virus is unpredictable.
KWONG: Yeah, I hear that - so we got to get the distribution of boosters right. What exactly can we expect from the FDA advisors when they meet this week?
AUBREY: Well, there are a lot of unanswered questions about where we go from here with vaccines. The agency has already given the green light for a second booster for people 50 and up, as we just said. But when should people get that booster? And should people hold out for a variant-specific booster - the type being tested now? Will those be any better? Will everyone be encouraged to get a COVID shot every year - maybe every fall? Many scientists say we're headed in that direction. I spoke to Josh Sharfstein. He's a former FDA official and a public health professor at Johns Hopkins. He says there's just a lot to consider.
JOSH SHARFSTEIN: I really think it's going to be increasingly important for there to be more information from the experts at the FDA about how they're thinking of these key questions, and I think this advisory committee meeting is the right step.
AUBREY: He says the goal is to gain the trust of people and show everyone that there is a long-term strategy.
KWONG: Yeah. And in the meantime, people 50 and older can opt to get a second booster right now if they want. My older relative just texted me their plan to get it. So, Allison, what is the best way for people to think through this decision about booster or not and when?
AUBREY: Well, two key factors to consider are age and overall health. A person in their 50s who is healthy is at lower risk of serious illness from COVID than someone the same age who has underlying conditions. Bottom line - the risk of hospitalization and death increases incrementally with age. There's no bright, shiny, silver line where, you know, north of that line you're at risk and, you know, south of that line you're not at risk. It's just sort of incrementally increasing over time. I spoke to Dr. Robert Wachter of the University of California at San Francisco, who told me, when he thought about his own decision about getting another booster, the answer was clear.
ROBERT WACHTER: You know, I'm 64, pretty healthy, but the evidence is clear that, six months out from my first booster, the effectiveness of that booster has waned considerably, and now there's quite good evidence that another booster will decrease the probability I'll get infected and also decrease the probability that I'll die.
AUBREY: So he says that's a lot of potential benefit. Bottom line here - the older the person, the stronger the case for another booster now.
KWONG: Yeah, but millions of people in the U.S. have had recent COVID infections - during the winter omicron surge, for instance. Among those folks 50 and up, do they need to get a booster right now?
AUBREY: Well, a recent infection can certainly help boost your immunity and protect people who have been infected, at least in the short term. So Dr. Wachter says his take is that it may make sense for people in this situation to hold off.
WACHTER: So if you've had three shots and you had an omicron infection sometime between December and now, I would say stick - I think you're probably in a similar immunologic state as if you got your second booster. So that group - I think it's reasonable to wait.
AUBREY: Now, no one knows what's ahead. We've talked about how unpredictable the virus is. Right now, the BA.2 variant, which has been problematic in the U.K. and Europe, has led to a bit of an uptick here in the U.S. in about a dozen states over the last week or so, including New York, Massachusetts. But the big picture - nationwide, cases, hospitalizations and deaths all continue to decline.
KWONG: Yeah, which is great to see, but we can't know what the next several months will bring. A new variant could emerge.
AUBREY: That's right. The virus likes to throw curveballs, but the consensus among the infectious disease experts I talked to is that a big surge right now is pretty unlikely, simply because, as a nation, we've built up so much immunity through vaccines and this winter omicron wave.
KWONG: Well, that's pretty good to hear - that a surge is unlikely right now.
AUBREY: But there is a concern for next fall, when outbreaks or a surge could be more likely as people move indoors. Think about what's happened the last two years. So, again, this has some people wondering about the timing of a booster, since protection from a booster can be short-lived. I talked to Dr. Yvonne Maldonado - she's a pediatrician and researcher at Stanford University - about this timing conundrum.
YVONNE MALDONADO: And the question is - do I get a booster soon, and, you know, by September, will I need another booster for the fall, or should I wait as long as possible and get a booster that might help me through a potential fall surge? I do think that a second booster at some point could be useful for most people. I'm just not sure everyone needs one right this minute.
KWONG: And once the FDA decides the timing of all of this, will there be sufficient doses available to meet demand?
AUBREY: Well, the president's COVID advisor, Jeff Zients, has said within the last couple of weeks that there are enough available doses for now...
AUBREY: ...That the government has already purchased. But he has warned that Congress needs to pass more COVID aid because, if they don't, it's going to be harder to purchase more doses. He also said if a vaccine is approved for young children - 5 and younger - there will be enough kid-sized doses to vaccinate this age group to start out with. Eventually, pediatricians say, booster shots may also be recommended for children. Right now, elementary-school-aged kids - 5 to 11 - are authorized for two shots. So, look, there's going to be an ongoing need for more doses.
KWONG: Speaking of children, when might there be a decision from the FDA on whether to authorize the vaccine for the youngest of kids? This is babies through kids who are 5 years old.
AUBREY: There's a lot expected to happen over the next several weeks or so. Moderna is expected to give the FDA data from its trial in kids under age 6 to evaluate. The company has indicated that the vaccine was about 38% effective at preventing infection in kids ages 2 to 6...
AUBREY: ...And about 44% effective in younger kids - 6 months through 2 years old. Now, this might not sound very great, but...
KWONG: Yeah, no.
AUBREY: ...At this point, preventing infection is not as important as preventing severe disease, and the company has said no severe cases of COVID were seen in the children.
AUBREY: Now, there's some debate about whether the data is good enough to win authorization, so Dr. Maldonado says all eyes are on the FDA.
MALDONADO: We don't have a perfect set of vaccines yet. Given the options that we have, I think FDA is going to say, let's not make the perfect the enemy of the good. Do we have a safe vaccine? Absolutely.
AUBREY: And given vaccines have been shown to be very effective in preventing serious illness in older kids, there is momentum to get something approved for the younger ones. The FDA will also likely review data from Pfizer, which extended its trial to test a third dose in young children. The company has said it will have its third-dose protection data this month.
KWONG: OK. Waiting on a lot of data - and all eyes certainly are on the FDA. Thank you for being one of those pairs of eyes, Allison Aubrey.
AUBREY: Thank you. Great to be here.
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KWONG: This story was edited by Carrie Feibel and Gisele Grayson, who is also our senior supervising editor. Berly McCoy was our producer, and Gisele Grayson and Katherine Sypher checked the facts. Andrea Kissack is the head of the science desk, Edith Chapin is the executive editor and vice president of news, and Nancy Barnes is our senior vice president of news. I'm Emily Kwong.
AUBREY: I'm Allison Aubrey.
KWONG: And thank you for listening to SHORT WAVE, the daily science podcast from NPR.
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