Will Everyone Need A Second Booster Soon? : Consider This from NPR Many Americans haven't gotten an initial COVID-19 booster. A second one is authorized for some. Others are waiting to see if they can get one soon. Will everyone need them eventually? An FDA advisory committee met Wednesday to discuss what's next in America's booster strategy.

Dr. Anthony Fauci tells NPR the path forward is paved with uncertainties — about whether more variants will arise, how long booster protection lasts, and what kind of funding will be available for research. Fauci spoke to NPR's Rob Stein, who explains what's likely for booster guidance later this fall.

Whatever the future of the pandemic holds, public health officials are hoping to get early glimpses of it by monitoring waste water treatment plants. John Daley reports.

In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.

Email us at considerthis@npr.org.

Another Booster? Omicron Shot? What's Next For COVID Vaccines

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There's a lot going on this week.


PETER MARKS: I want to welcome everyone and thank everyone for joining the meeting today.

KELLY: On Wednesday, an FDA advisory committee met to talk about the future of COVID boosters. You're hearing Peter Marks, the agency's top vaccine scientist who pointed out many Americans haven't gotten an initial booster dose even as a second one is authorized for some, and many more are waiting to see if they can get one soon.


MARKS: And so what we'll be doing is having a variety of presentations relevant to the broad discussion of boosters.

KELLY: A broad discussion of big questions.

ANTHONY FAUCI: What about as we get into the fall and the winter? The entire population, will they or will they not require a fourth boost?

KELLY: Or Dr. Anthony Fauci told NPR this week, boosters could be given once a year like the flu shot.

FAUCI: That is certainly possible.

KELLY: Or there could be a threshold after a number of boosters where immunity stays strong enough, long enough.

FAUCI: That you will not need that regular a boost. I have to emphasize, we don't know the answer to that right now.

KELLY: Then there's the possibility of another variant emerging.

FAUCI: There are a lot of moving parts here. We have to take it, you know, point by point, month by month, you know, segment of the year by segment of the year to determine what the proper approach would be to keep this under control and to protect our citizens.

KELLY: CONSIDER THIS - there are way more questions than answers about the future of the pandemic and what role vaccines will play in that future. But we do have some answers based on what we know in the present. From NPR, I'm Mary Louise Kelly. It's Wednesday, April 6.


KELLY: It's CONSIDER THIS FROM NPR. In the U.S., the future of vaccines isn't the only unknown. There's also how the government will pay for those vaccines.


UNIDENTIFIED PERSON #1: Mr. Rubio. Mr. Rubio - no.

KELLY: On Tuesday afternoon, a $10 billion COVID funding package was blocked by Senate Republicans...


UNIDENTIFIED PERSON #1: Miss Murkowski - no.

KELLY: ...Who say they will not vote to authorize the money unless they get something they want.


UNIDENTIFIED PERSON #1: Mr. Cotton. Mr. Cotton - no.

KELLY: What they want is a continuation of a Trump-era policy that permitted immigration officials to expel asylum-seekers and migrants for public health reasons.


UNIDENTIFIED PERSON #1: Miss Collins - no.

KELLY: In the U.S., with many places under no COVID restrictions at all and key COVID metrics continuing to fall, the Biden administration wants to lift those immigration restrictions in May.



KELLY: Republicans do not.


CHRIS MURPHY: On this vote, the yeas are 47, the nays are 52. Three-fifths of the senators duly chosen and sworn not having voted in the affirmative, the motion is not agreed to.


KELLY: That means Congress will likely leave for Easter without an agreement to fund the purchase of more vaccines, tests and research into new treatments and new variants.

FAUCI: And we are really in quite difficult need to continue not only the production and the distribution of countermeasures but also the research.

KELLY: Dr. Anthony Fauci told NPR more funding is needed to invest in things like the development of a pan-coronavirus vaccine, something that would protect against the virus that causes COVID-19 and others that may emerge in the future.

FAUCI: But that will likely come in multiple stages, the first stage being developing a vaccine that would be equally as protective against any of the variants we know of and those that we don't even recognize.

KELLY: Of course, scientists haven't come up with a one-size-fits-all vaccine like that yet, which is why that FDA advisory committee met on Wednesday to talk about all the variables on the table for booster doses. As of when we are recording this on Wednesday, the committee seemed focused on understanding when and how a formal decision to make variant-specific vaccines would need to be made. FDA's Peter Marks said the specifics of changes to current vaccines would be the subject of a separate, future committee meeting. The bottom line - still a lot of unknowns. Ahead of the FDA meeting, I spoke about what we do know with NPR health correspondent Rob Stein.

ROB STEIN, BYLINE: Hey, Mary Louise.

KELLY: So I want to start just laying out where things stand, which is that last week, the FDA authorized a second booster, which would amount to a fourth shot for people age 50 and older and for some people with particular health problems. Is that the writing on the wall that eventually everyone is going to need to line up and get yet another shot?

STEIN: You know, Mary Louise, no one knows for sure. And many experts think we should be focusing on vaccinating the unvaccinated and boosting the unboosted instead of just giving more shots to vaccinated people. But others say there's a pretty good chance that's where we're going to be headed, probably by the fall, because, you know, the virus isn't going away. Whatever immunity people have from their shots or infections could very well continue to fade. And yet another surge could easily hit the country next winter. I talked about this with Dr. Peter Marks. He's the FDA's top vaccine scientist.

MARKS: That's when we'll probably have a fair amount of waning immunity in combination with likely further evolution of the virus, along with people going back inside.

STEIN: Where the virus spreads more easily. So Marks says that the country must start planning now for whether everyone needs a shot and, if so, what kind of shot exactly.

MARKS: We could basically wait until another wave comes along and then try to deal with it. But I think we know that doesn't work because we can't manufacture and deploy vaccines fast enough.

KELLY: Right. So, Rob, they're talking about this constant game of catch-up. And I guess that prompts the question of how you get out of that. How are they going to go about making a shot that will at least try to get us ahead of the game and provide real protection?

STEIN: Yeah, that's a very good question. And that's a really tricky part of this. No one knows what version of the virus will be dominant by the fall or winter. It could be omicron, especially the omicron subvariant called BA.2 that's taking over now and threatening another wave even sooner, or it could be an entirely new variant that we haven't seen before. So while one option may be that everyone just gets the same vaccine again, Marks thinks that's probably not the best option.

MARKS: There is a certain diminishing return by giving the same vaccine over and over. And second of all, we have had enough evolution of this virus that it would make sense to want to try to cover some of the genetic diversity that has been introduced into the mix.

STEIN: By instead giving people a new vaccine that specifically targets omicron, or maybe one of the other variants, or that combines at least two different strains into one vaccine, that could provide even broader protection against some other new variants that might emerge. Here's Dr. Marks again.

MARKS: By this fall, we may be onto a new variant. It could be sigma. It could be tau. There may be something new circulating that we'll have to deal with, and we're going to have to make a good guess at what (laughter) may be most effective.

STEIN: Just like we do with the flu vaccine every year.

KELLY: Oh, my God, Rob. The thought of sigma and tau and all the rest that...

STEIN: (Laughter) I know.

KELLY: ...May be in the pipeline. But to his point, there is precedent for this. We already adapt the flu vaccine every year. Is that in the pipeline for COVID?

STEIN: Yeah. Yeah. Those so far - you know, there's an omicron version of the vaccine that hasn't looked all that promising so far in early testing. But scientists are waiting for more data about that shot and about other new versions of the vaccine that combine strains, you know, like omicron and the original strain or omicron and beta or maybe delta and omicron this time around.

KELLY: That's NPR health correspondent Rob Stein. Thank you, Rob.

STEIN: You bet, Mary Louise.


KELLY: Well, whatever the future of the pandemic holds, public health officials are hoping to get early glimpses of it in the murky depths of wastewater treatment plants. The idea, embraced by the Biden administration, is to enlist those plants to test sewage for coronavirus and spot new outbreaks before they become big outbreaks. Colorado is one place that has signed on to the strategy. John Daley filed this report from Denver.

JOHN DALEY, BYLINE: It was two years ago, right at the start of the pandemic. An engineer named Pieter Van Ry woke up and read an article in Popular Mechanics. It explained that the new coronavirus could be detected in human feces.

PIETER VAN RY: At the end of that article, it said, if you have a wastewater facility and you're interested in participating in the study, please contact us.

DALEY: Actually, he did have such a facility. Van Ry directs South Platte Renew, a treatment plant serving 300,000 people southwest of Denver. Over the years, he's heard the wisecracks.

VAN RY: Yeah. Your number two is our No. 1. There's a lot of good ones out there.

DALEY: At the plant, Van Ry and his team showed me how it works. They opened a hatch down to a dark stream where the effluent flows in.

VAN RY: So this is essentially where it comes in - one from essentially Englewood, one from Littleton.

DALEY: Let's just say the odor was not like a dozen roses.

Oh, yeah. Smells like waste.

VAN RY: Yeah (laughter).


DALEY: Whew.

The team siphons off wastewater fluid once a week and sends samples to a lab. Van Ry says the samples showed exactly, wave by wave, what the virus was doing over the last two years.

VAN RY: Really, what it tells me is that it was spreading rapidly through the community.

DALEY: The technique caught on. Now the CDC wants to tie together all this wastewater testing to create a national surveillance system. Colorado now has more than three dozen sites. Most of the samples get sent to a state-run lab, where they test for viral RNA unique to the coronavirus. Epidemiologist Rachel Jervis says, with wastewater, you don't need to rely on people to take a COVID test and report the results.

RACHEL JERVIS: Whereas with COVID wastewater, we found that up to 50% of people will shed COVID virus in their stool regardless of whether or not they have symptoms.

DALEY: The state then sends the data to the CDC. But for now, coverage is uneven. According to its website, more than a dozen states aren't part of the network. Still, backers say, along with clinical testing, it can give an early warning sign.


DALEY: Lots of colleges have been early adopters of this tool.

CORINNE LENGSFELD: So this manhole is in one of our sidewalks.

DALEY: That's Corinne Lengsfeld, a mechanical engineer at the University of Denver. And what is that down there?

KEITH MILLER: That's sewage right now.

DALEY: This is Keith Miller. He's a biochemist at the school.

MILLER: Well, it's everything right now. So there's - it's a heavy load - right? - because they're taking showers right now, so there isn't a lot of solids.

DALEY: This testing helped monitor student health in the fall of 2020. Lengsfeld says back then, at one site, wastewater samples were off the charts.

LENGSFELD: It was a million virus units per one liter.

DALEY: So a lot.

LENGSFELD: It's a lot.

DALEY: So it's like holy (laughter)...

LENGSFELD: Holy Toledo (laughter).

DALEY: That information convinced school officials to have everyone in one dorm do rapid nasal testing, according to Miller.

MILLER: That's what wastewater testing is. It's the one that's going to give you the biggest picture first.

DALEY: When they followed up with that quick testing, they IDed 10 infected students and moved them to an isolation dorm. Lengsfeld says without that, perhaps a hundred more students might have caught it.

LENGSFELD: It works. I mean, it definitely is a case study, I think, of exactly how to control spread.

DALEY: The CDC hopes the wastewater monitoring could help flag future surges and identify hotspots.


KELLY: Reporter John Daley in Denver. That story came from NPR's partnership with Colorado Public Radio and Kaiser Health News. Earlier this episode, you heard Dr. Anthony Fauci speaking to NPR. Rob Stein did that interview. It's CONSIDER THIS FROM NPR. I'm Mary Louise Kelly.

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