The Bridge with Peter Mansbridge - WHAT VACCINE DO YOU TAKE FOR A SECOND SHOT?

Episode Date: June 7, 2021

Clip and save this one.  If you have a choice for your second dose, which vaccine should you pick?  This is a key question many people are grappling with right now.  Including me.  Dr Isaac Bogoch gives you everything you need to consider.   Also today, the latest updates on work from home, supersonic commercial travel and it's never too old to graduate high school!

And hello there, Peter Mansbridge here. You're just moments away from the latest episode of The Bridge. Today, the big question, if you're about to get your second shot, which shot should you take? We'll tell you. You still trying to find ways to get into the world of crypto? Well, look no further. Bitbuy is Canada's number one platform for buying and selling Bitcoin and other cryptocurrencies. Bitbuy has launched a brand new app and website with a new look, lower fees, and new coins. Bitbuy is your one-stop shop to get involved and super easy to use for beginners. Visit bitbuy.ca or download the Bitbuy app. Enter referral code PODCAST20 to get $20 free when you make your first deposit. Yes, hello there, Peter Mansbridge here. Welcome to another

new week. We're starting to get deep into the heart of June already. Man, the summer is fast approaching, and this weekend sure felt like it. Man, what a gorgeous weekend here in southern Ontario. Blue skies for just about all 48 hours, very warm temperatures around the 30 degree mark. So it was a weekend to be outside, and I spent almost all of it outside and enjoyed every second of it. But some big decisions to make and that's what we're going to try and help you with

today. In fact, this may well be the most important podcast, broadcast, show, call it whatever you want that we've done since we started a year and a half ago because today i mean let's face it most of the country has had one shot i've had one shot waiting to get my second shot now here's thing. When we got our first shots, remember the advice was whatever you can get, take it. And that was probably pretty good advice if you're on a one-shot strategy. It's a little different this time around because there are choices. Not everywhere, not at every pharmacy, not at every clinic, but in many of them, there are choices.

You could either go with AstraZeneca, or you could go with one of the mRNA vaccines, Pfizer or Moderna. And then there's always the J&J, the one-shot vaccine. But most people are going to have to make that choice between AstraZeneca and the two mRNAs. So what do you do? If you started with AstraZeneca, should you then stay with AstraZeneca?

Or should you move on to one of the mRNAs? If you started with Pfizer or Moderna, should you go to AstraZeneca? So here we have choices, right? And fundamentally, at the end of the day, it's your choice. Nobody's going to tell you what you have to do. But when you have choices and you don't have your own mind made up firmly,

you seek advice and you look for expert advice. And that's what we got today. We've got one of our experts. You know, every Monday we have one of our people on, either from Halifax and Lisa Barrett, Edmonton, Lenora Saxinger, Hamilton, St. Chagla, or Toronto, Isaac Boguch. These are all infectious disease specialists. They're all really sharp. They've all faced the challenges that this this COVID-19 has created for the country. They've all faced it head on,

either in various committee meetings or with patients in hospitals, in their offices, you name it. They've all seen the worst of this and they've all seen the best of this. If there can be something called the best of it. And I think the best of it is the dedication of those who are working at it.

Anyway, today we have Isaac Bogoch with us. And I'll tell you there's a section of this interview, about four or five minutes, where he breaks it right down. He goes through every possibility. So listen closely. If you've got a pen and paper at hand, and this is a decision that you've got to make, quite possibly, you might want to jot some of these thoughts down.

Play it back again, just to be sure. But it's really good. Now we start off on some kind of general areas, but then we get into it on second doses. And I know a lot of people are confronted with this issue right now, and they're trying to make decisions. This may well be your guide. No pressure, no time limits.

You know, come on, doctor, give us your answer in 30 seconds or less. This is, you take your time. This is a big decision for many of us. So walk me through the options. And that's what Dr. Bogoch does so well here. It's really, really good. So enough, Peter, let's get on with the interview. Dr. Isaac Bogoch, University of Toronto. Here we go. So I was fascinated with one of your tweets this weekend, and it dealt with a kind of dilemma that I think some people are faced here right now as we move rapidly through first doses and now crunching into second doses,

that there's no real guidance for people as to you know what's acceptable and what kind of life should they be leading if they've had two doses so what do you say to that right like it's we're in a very interesting time right now where we're in this interim period where some people have no doses a lot of people have had a single dose and a growing number of people seem to be a very, very rapidly growing number of people are going to have two doses. And we need some guidance either at the provincial level or at the federal level on what is acceptable behavior following one dose and following two doses, because we're just going to be in this situation more and more and more. We should probably have some standardization on what is acceptable behavior.

The United States, in my humble opinion, I think did a really good job on this. It was pretty clear that these vaccines worked. They basically had some very practical guidelines, like small groups of fully vaccinated people could get together in someone's home for dinner, unmasked and without physical distancing. Why? Well, that's what vaccines do. That's the whole point. They're really effective and they help get us back to normalcy. Of course, they're not 100% perfect, but they're really, really good. And that's

reasonable behavior to consider. The other thing they had, for example, very practical was grandparents could hug their grandchildren provided that their grandchildren were asymptomatic and low risk. But again, you know, talking about what are the wants and needs of the community? What is a science-based and evidence-based approach? And they sort of met where those Venn diagrams overlapped. And I thought that was very, very reasonable. So we don't really have that here. We have public health guidance.

We have reopening plans, but I think what we're really missing is individual level guidance and sadly like if you don't provide people with practical science-driven guidance people will just make it up on their own and i think that's what's what's happening so i think it'd be very helpful to have some some measures in place what do you think the hesitancy is in doing that or did they have they just not thought of that while they're thinking of all these other things that they have to do as well i honestly don't know i truly don't know i mean it's fair to say everyone's got a lot on their plate but it's also fair to say that this is kind of one of the more important important bits of policy and recommendations you have because quite frankly

you got 38 and a half million people who are going to be in the situation or who currently they're in the situation right Everyone knows someone who's been vaccinated. We have a growing list of people who have a second dose of a vaccine. Like we're just, we just need to know. And, you know, I think some people are just quietly looking at what the United States did and just doing that on their own. Other people are perhaps throwing caution in the wind.

Other people probably don't know. And of course, many people are taking a very, very cautious approach. It's just, you know, just waiting to hear until there is guidance. So I'm not sure. I mean, obviously it's not up to me, but if it was, I would just copy and paste what the U.S. CDC put out. I thought that was very reasonable guidance in terms of, you know, small gatherings unmasked with no physical distancing if everyone's been fully vaccinated. That's what vaccines do. That's what we can expect. We know that they work very, very well. Of course, it always has to be said, though, in this era, nothing is zero percent. Nothing is 100 percent risk-free. You're never going to completely minimize the risk but like it's also fair to say that the vaccines are extremely uh extremely effective and that you know i think most people

would be very would be fine going with small gatherings with other people who are also fully vaccinated let's uh let's break down the vaccine uh especially as it relates to second doses here. I got an interesting letter last week in my sort of mailbag for this podcast, and it was starting to feel like, you know, going to the buffet table at the weekend restaurant. You know, there's all these choices. You know, is it meat? Is it chicken? Is it pork?

Is it whatever? And it's kind of like that now on vaccines you know do you want the astrazeneca do you want the pfizer do you want the moderna because in some places you actually have that choice when you go for your second dose you can make a decision yourself as to which one you should take so what's the guidance there, let's break this up into two parts. One is, what if you got a first dose of AstraZeneca? And the second part is, what if you got a first dose of an mRNA vaccine? Actually, let's start with the easy one, the mRNA vaccine. You know, NACI basically said, if you've got a first, let's just make it up. Let's say you could

someone get a first dose of Moderna. Well, they said you should probably get a second dose of Moderna. That's ideal. If you got a first dose of Pfizer, you should probably get a second dose of Pfizer. But quite frankly, they're interchangeable. And if for whatever reason, the clinic isn't giving what you got initially, it's totally okay.

But that's an mRNA. Yeah, exactly. Either one of those two. They're interchangeable. Try to get the same one, but if you can't, Either one of those two. They're interchangeable. Try to get the same one, but if you can't, it's no biggie. They're interchangeable. So that's what they said. I've got to be very clear. That's what they said, and here's my editorial.

Yeah, it makes total sense. They're completely interchangeable. They work in a very same way. The more we look into these two mRNA vaccines, Pfizer and Moderna, the more similar they are based on how they work, side effect profile, the efficacy, the effectiveness. They're basically nearly identical products. Of course, they're not identical, but they're functionally identical products and same as the clinical response.

I think that's very very reasonable and also we've got pfizer and moderna pouring into the country so i don't really think it's going to be a huge issue i think most people will be able to get a second dose of whatever they got the first dose of so that's that's one i don't think that's a very contentious topic whatsoever you know the second part is okay what if you received the first dose of AstraZeneca? What do you do next? Now, in some places, you're going to get the choice. In other places, for example, in Manitoba, you don't get the choice. If you receive the first dose of AstraZeneca, you're getting a second dose of an mRNA vaccine.

So that's the case in Manitoba. Maybe a few other places, I'm not sure. I have to check. But in many places, you will have a choice. So for people that have a choice, you know, quite frankly, we hear a lot of, well, what do I do? And before we go there, I think it's also fair to say that there are some people who say, no way, I want a second dose of AstraZeneca for whatever reason. And the answer is, great, if you get that,

you've got a good vaccine series and you're going to be okay. Other people are saying no chance. I don't want to take another dose of AstraZeneca. I'm going for the mRNA vaccine. And the answer there is great. You've got a good vaccine series and you're going to be okay. The key point is the right edge is you still need two doses. As long as you're getting a second dose, you're doing something right. And I think everything we go every, every time, everything beyond that is, you know, nuanced and detailed, but, but the key message here is you got to get a second dose and whether

or not it's a second dose of AstraZeneca or an mRNA vaccine, Pfizer, Moderna, you're doing the right thing. Now let's just take a second and look at the pros and cons of each approach. Let's say you've got a first dose of AstraZeneca, the pros and cons of getting a second dose of AstraZeneca. Pros, well, there's only tens and tens and tens of millions of people in the world that have gotten the same vaccine series, and they're doing very, very well. It provides very robust protection against COVID-19, including the variants of concern, and probably has 60 plus percent effectiveness against the more recent circulating variant, the B one six one seven,

also known as Delta, also known as the variant initially discovered in India. You know, we've got to have five names to confuse everybody as much as possible, but it's, it does, you know, about 60 ish,

maybe 60 plus percent effectiveness. And that's going to change with time as we have more data, but well-trodden path. I think, I think that's, that's fairly to change with time as we have more data. But well-trodden path, I think that's fairly reasonable. The cons, well, we all know and heard about the blood clots, right? And the risk of a blood clot after dose one is probably around 1 in 55 to 60,000. Risk of blood clot after dose two, significantly less likely, but of course not 0%. It's probably, UK standing one in

600,000. I don't know where it's going to level off, but maybe it's going to be somewhere between one in 300,000, one in 600,000. Okay. It's still not 0%, but it's very, very unlikely. So, you know, those are things that people are considering. Let's talk about people who got a first dose of AstraZeneca and now want to get a second dose of an mRNA vaccine. So pros. Well, there's some data out of Germany and some data out of Spain demonstrating that people do mount a pretty significant and robust immune response. So that's helpful. We also know that the mRNA vaccines provide probably better protection. There's probably better effectiveness against the circulating variant,

the B1.617 or Delta variant. That's probably the real deal, and there's data demonstrating that from England. Cons are that, you know, maybe there isn't enough highway miles doing this with mixing and matching with these particular vaccines. Having said that, I think it's fair to say that we this with mixing and matching with these particular vaccines. Having said that, I think it's fair to say that we've been mixing and matching vaccines long

before COVID-19 was ever known to humankind, but it's still a fair point. There is less highway miles and less experience doing that. They are doing it in Canada and in France and Germany and a few other places as well. The other con is people may have more significant side effects following that second dose. Like there's some data out of the UK demonstrating,

you know, it's more likely that people will get the fever, the, you know, muscle aches and pains, the fatigue, the headache with mixing and matching. You know, and in that data, none of it was severe enough to land people in hospital, but it was more notable and it was more severe, for example, than people that did not mix and match vaccines. So those are the pros and cons of each approach. But the end result is two doses is the right answer. And, you know, you hear some narrative saying, well, why are we even giving people the option? Like, why doesn't

everyone just get a second dose of an mRNA vaccine? And I think it's important to note that there's a lot of people out there. I see them and I talk to them because they're my patients who truly don't want to mix and match. It's AstraZeneca as a second dose or nothing. And I think it's important that we facilitate that. In the same breath, there's other people are saying, I'm not taking AstraZeneca dose number two. No way. And again, I think so. I really think it's very helpful that we can enable people to make an informed decision and that both decisions have pros and cons. And that, like anything else in medicine, there's not a one size fits all answer.

There rarely is. There's nuance and details at the level of the individual that are extremely important like there's some people who are terrified about adverse effects following vaccination and they don't want to have those side effects so maybe astrazeneca is the better choice for them there's other people who are saying you know i want the most effective regimen possible and i don't care about side effects uh you know i don't care about mixing and matching. Maybe Pfizer or Moderna is the best second choice for them. So like anything else, you've got to tailor to the individual. You can never make blanket statements.

You can use the data to have meaningful conversations with people and help enable them to make an informed decision. And there's a lot of right paths here. Well, you certainly gave us a lot of detail there in breaking it down. And I appreciate that, and i'm sure our listeners do too because this is a choice that many people are confronted with right now and you've got all the possible pathways in your answer i mean it's a long way from back in the the old days of like two weeks ago when the answer was whatever you're offered take it right

now there's a lot of different things to consider. Let me ask you this, though, because I've thought of this lately. There's a lot of talk about when we get by this first and second dose situation and we move into either the fall or into next spring, there are going to be boosters. What are the boosters likely to be? I doubt whether boosters are going to be all these choices again. There's probably going to be one kind of booster, right? Yeah.

I mean, for Canadians, it's probably just going to be Pfizer. We have tons of Pfizer, and Canada has actually purchased 30-something million doses of Pfizer for 2022 and 30-something million doses of Pfizer for 2023. So I think it's fair to say that everyone's getting two doses in the 2021 calendar year, probably by the end of August, that the right things are going. And then it's fair to say that we'll all likely get a booster. Okay. Beyond that, I have no idea,

but it's probably fair to say that we're all going to get a booster and the booster will be a booster that accommodates for the emerging variants of concern now and also that it's likely also that it's likely to be likely to be a booster that is an mrna yeah yeah i mean that's what we have like that's those are the contracts that canada's that canada's made so so if you're making the choice now because you're you know a little gun shy on him on an mrna you're gonna get what you're gonna get one anyway i think that's a great point that is such a good point whatever you decide now you're gonna get a booster and it's very likely to be an mrna and of that it's very likely to be pfizer you know what else might

happen and again this is pure speculation, pure speculation, but what might happen is you get, you know, your two doses now of whatever it is you get, but we may keyword may, depending on how things go, I think we should be open-minded that some populations that don't mount the same degree of an immune response, like people on the older end of the spectrum or people with underlying medical conditions that really preclude them from mounting a significant immune response. I wonder if there will be boosters with the same vaccine,

like the same Pfizer that we have now, you know, later in the 2021 calendar year. Right. And maybe people just need that additional immune kick, especially with these variants, the Delta variant. Now that's pure speculation. Like I truly don't know, but there's some emerging data looking at the immune response, especially to this Delta variant. And, you know, it may not be as robust in the older populations and in those with underlying medical conditions.

So we'll see. I mean, I just, I don't know the answer to that, but I think in late, late, late 2021 or sometime in 2022, we'll get a booster that does accommodate for those circulating variants of concern. Like it won't be the same vaccine that we're getting now. It'll be the same brand, like a Pfizer brand, but it will be a slightly different mRNA in there that really is more up to date with the circulating variants of concern. I don't mean to rewind too far, but I think it's also important that,

what we were talking about two minutes ago, the sort of choosing between AstraZeneca and Pfizer. People who are in this situation that haven't made up their mind, sit down with a healthcare provider talk it out with somebody because I think that's you know there's some people that have made up their mind and that's great they know what to do others might be confused and this is something that would really be helpful to look at you know your unique medical

condition where you come from your you know your unique situation and really you can tailor this decision to to you as an individual. I think that's an important point that doesn't come out enough. You know, my admiration for you and your fellow doctors in the infectious disease world grew even more this weekend because somebody flipped me on this issue. As you said, there was a new German study just a couple of days ago on um astrazeneca plus pfizer and the impact it would seem to be having on the new delta variant um they flipped me the study it's about eight pages long eight or nine pages long very small print i couldn't understand

a word of it not a word i tried like it is. I mean, I don't know how you stay awake reading that stuff, but obviously it's important that you do and that you're able to translate it as the way you did today for us. All right. We'll leave it at that for this week. I really appreciate your time as always, Dr. Boguch. Thank you so much. My pleasure. Have a great day. And as I said, you know, that's a clip and save. You want to save that one. That, you know, that really gives you a lot to think about in

terms of the decision that you very well may have to make in the next little while about which vaccine. Now you can just go with whatever your, you know, your doctor or your pharmacist or whomever may suggest. But knowing you, knowing you, my listeners, you probably want to think through this one yourself. And there's some good advice in terms of things to consider from Dr. Isaac Bogoch. And he's clearly one of the best. University of Toronto and one of our consultants that we talk to every week, and we're lucky enough to have access to, so we do appreciate that.

We're going to shift topics as we move on to the second segment of The Bridge for this day. When we come back, this is where we're going to update you on three things that we've been watching, or at least two of them anyway, that we've been watching quite carefully over the whole course of this. One is the work from home, the latest on that. And supersonic jets. You know, I love jets. You know, I love the Winnipeg jets. Although that love is not doing much good right now, is it?

And also that it's never too old to graduate from high school we'll tell you those stories when we come back and hello once again peter vbridge here. This is The Bridge. For Monday of a new week. And we've got a couple of, I guess, you can call them updates if you want. I wanted to make sure that you had not missed last week, because we have talked quite a bit over months now, this whole work from home issue and what will happen

when there's some sense of normalcy again. And, you know, different companies are making their minds up. They're making their decisions on how they want to handle this. And one very influential company, certainly in the tech field, is Apple, of course. And they made their feelings known last week when Tim Cook, and you know who Tim Cook is, he's the top guy at Apple, he sent out a memo to his staff. Basically explaining to them that, you know, we're going to ask you to return to the office three days a week,

starting in early September, so in a couple of months. I'll quote from the memo. It's an email, actually. For all that we've been able to achieve while many of us have been separated, the truth is that there has been something essential missing from this past year, each other. Video conference calling has narrowed the distance between us, to be sure, but there are things it simply cannot replicate. You hear that a lot, right? Cook said that most employees will be asked to come into the office

on Mondays, Tuesdays, and Thursdays, with the option of working remotely on Wednesdays and Fridays. Teams that need to work in person will return four to five days a week. Employees also have the chance to work remotely for up to two weeks a year to be closer to family and loved ones. This is not holidays. This is like working from home up to two weeks a year. Find a change of scenery, manage unexpected travel,

or a different reason all your own. Managers need to approve remote work requests. So that's the Apple plan. Now, it's not universal in terms of other tech companies. In fact, Google is quite the opposite. Last month, Google announced that 20% of its workforce would be able to work from home permanently. Mark Zuckerberg has said that remote work is the future

and told Facebook employees they can all work from home forever so long as they get their manager's approval. So there you go. More to consider on that issue, the work from home issue. A couple of times I've mentioned over the last few months that there's a lot more talk about supersonic air travel. Remember, we used to have it with the Concorde, right? And then the Concorde ran into problems.

First of all, cost. And second of all, had a terrible accident out of Paris. And that, I think, was the last commercial flight. Everybody was killed. But there's been a lot of talk in the last year about bringing back supersonic travel that people want to get from A to B faster, especially transatlantic, trans-Pacific flights.

They want to get there yesterday, not tomorrow. So there are a number of companies have been toying with this idea. And here's the first one that's out there with an airline actually ordering aircraft from it. An airline ordering. United Airlines announced Thursday that, this is just last week Thursday, that it has ordered 15 supersonic planes from a startup company called Boom Aviation.

A startup, okay? They haven't made a single plane yet. But United likes what they're doing, and they're ordering 15 of them, saying it hopes to zip travelers around the globe in half the time for the price of a current first-class ticket. This is in an NBC News report. I should have mentioned, by the way, that Apple story.

I got the information from The Verge, theverge.com. Anyway, NBC's reporting on United. So it's saying, you know, you'll be able to fly from Newark, New Jersey, to London in three and a half hours. San Francisco to Tokyo in six hours. For about $5,000 to $7,000 for a one-way ticket. That's first class. You know, that's roughly what first class costs now.

But don't rush out to book a fare just yet. These flights won't be operational before 2029. And if they're saying 2029 now, you know that means like 2035. But they're pretty convinced they can do this. Now, who is Boom? Well, Boom's run by a guy by the name of Blake Schall. He used to work at Amazon. He started this company, Boom, in the basement of his house with a spreadsheet and a dream.

Travel's a fundamental human good, he told NBC News. It's better to live life in person. Now, he doesn't even have a background in aerospace, but he has flown small planes for fun. I've flown them for fun, and I've flown them for training. But I'm not telling you I'm about to build a supersonic jetliner. However, neither is Shull by himself. He's hired some of the leading minds in the business,

people who work for SpaceX, people who work for Gulfstream, people who work on the engines at Rolls-Royce. So these are all, like, people who know on the engines at Rolls Royce so these are all like people who know their stuff so there are a lot of ideas coming along to try and make air travel interesting again you know for the millions of people who've checked out

in the last year because of lockdowns and corporate travel prohibitions. Demand has slashed from a high of 2 million passengers a day to under 100,000. So what's all this going to cost? $3 billion for 15 planes. That, just like the prediction on 2029, you know that number's going to go up.

$3 billion for 15 planes, it'll probably end up at $3 billion per plane. I mean, who knows how these things go, but you know, we all know from experience that these estimates tend to double, triple as time goes on. What would it be like to travel in one of these things? At 60,000 feet with big windows, it's going to be an amazing experience, said the airline's vice president for corporate development.

60,000 feet, that's up there. You know, most commercial airliners are traveling into 30,000 to, you know, sometimes the low 40,000 numbers. 60,000, that's going to be different. At 60,000 feet, says the VP, with big windows, it's going to be an amazing experience. If we take off in London just after sunset, you'll be able to watch the sun rise in the west as you get back to New York City. What? you'll be able to watch the sun rise in the west as you get back to New York City. Something doesn't sound right about that.

Anyway, maybe it's different in supersonic travel. Anyway, there you go. United Airlines and their plans for the future. So here we leave you with this, this little Goldie. Put a smile on your face. At age 93, Pat Moore proves that age, like the year on a diploma, is just a number. He was supposed to graduate high school in 1945, then again in 1946, but life had other plans. He told CBS News, Verna Browning failed me, Moore said, about not passing his English literature course in 1945. I hate to read. Instead of graduating, he returned to high school the following year, but was then drafted into the

U.S. Army Air Corps a few months before graduation. Uncle Sam was calling, so I had to go, he said. After nearly four years of service, he came home to fly crop duster planes i love that and start a family being a father and a pilot left little time for school moore finally received his diploma this year in a small ceremony what made him want to come back and get his diploma that little girl right there he said as of his great-great-granddaughter, who also graduated from high school this year. His great-grandchildren, or sorry, his great-granddaughter, Brissa, was one of 697 students who graduated from Alvin High School this year. It was the same school he was supposed to graduate from decades ago.

Well, congratulations, Pat Moore, the old crop duster pilot. Graduates. All right. That's your Monday edition of The Bridge. We'll be back tomorrow. Wednesday is Smoke, Mirrors, and the Truth. Friday, the weekend special on everything in between. Look forward to talking to you.

Thanks so much for listening. I'm Peter Mansbridge. We'll talk to you again in 24 hours. Thank you.