The Daily - Do We Need a Third Covid Shot?

Episode Date: July 19, 2021

The rise of the Delta variant has prompted a thorny question: Do we need a booster dose of the vaccine for Covid-19? Vaccine makers think so, but regulators are yet to be convinced.Principles are also at stake: Should richer countries be talking about administering extra doses when so many people around the world are yet to receive even a single shot?Guest: Rebecca Robbins, a business reporter covering Covid-19 vaccines for The New York Times. Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: Although studies of a third dose are underway, experts agree that the vaccines are still working well. Here’s what to know about the potential booster dose.U.S. officials said that the decision to go ahead with a booster shot would depend partly on how many infections cause serious disease or hospitalization in vaccinated people.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From New York Times, I'm Michael Bavaro. This is The Daily. Today, the companies that make COVID-19 vaccines stand to earn enormous profits from booster shots. So how exactly will we know when or whether we actually need them? I spoke with my colleague, Rebecca Robbins. It's Monday, July 19th. Rebecca, I want to talk about why it is that we're all suddenly talking about booster shots for the COVID-19 vaccine.

And I suspect that it's in part because of the Delta variant. Is that right? That's definitely part of it. I think we're always going to be having a conversation right around now about whether booster shots would be needed, in large part just because enough time has passed since many people got their first shots. For some people, that's been a few months, but for others, it's been six, seven months at this point. And so I think there was always going to be a question about how long that protection will last. That said, I think Delta has accelerated these conversations and given them new urgency. The Delta variant is now the most dominant strain in the United States. New infections, hospitalizations, even deaths are increasing when many predicted they would be at all time lows.

You know, Delta has contributed to cases rising across the United States. We know from the evidence that Delta is more contagious. And it's, I think, contributing to a sense of uncertainty and insecurity about how far we've gone in camping down the pandemic. The fast-spreading Delta variant is raising new concerns and increasing that push to vaccinate. Might some of us need a booster for this Delta variant? We got plenty of questions about the Delta variant and vaccines. So how good are the vaccines now and how long do we expect that to last? Well, these are great questions on everyone's minds, not just parents.

And that has really risen in the minds of people that have been vaccinated so far. really risen in the minds of people that have been vaccinated so far. So the good news is that there's not reason right now to suspect that immunity is waning. The evidence that we've seen so far strongly, strongly suggests that the vaccines remain effective against the virus and its variants, including Delta. The other piece of good news is that even if you do have a case of COVID after getting fully vaccinated, the chances are vanishingly low that you'll be hospitalized or die. That's all really encouraging right now.

But the question is how long this protection will last. And that's why we're having this debate about whether, and if so, when we might ultimately need a booster. Right. And when we talk about a booster, what exactly are we talking about? And how is it different than the original vaccine? So a booster shot is a second, third dose of the vaccine that you received that is meant to strengthen the immune response. It's called a booster because it boosts the immune response. And you've probably received plenty of boosters

before. For instance, you probably get a tetanus shot every 10 years. Or with the vaccines that are given in childhood, you've probably gotten boosters after a few months, sometimes up to a year. And so when we're talking about boosters for COVID, there are two different forms that that might take. One is just the original vaccine, another shot of the same substance that you've already gotten two doses of. But then there's a different version,

which is an altered version of the vaccine that's designed specifically to target one or more virus variants of concern. Got it. For example, like Delta. Exactly. So with that example, the vaccine would be specifically altered to target the Delta variant. And theoretically, if it turns out that the vaccines become less effective over time, that could raise the protection back up to the levels we saw before. So previously, the vaccines were above 90% effective. And if it turns out that over time they drop to a threshold of 70% effectiveness at a population level, a booster could help raise that effectiveness level back up

to, say, 80 or 90%. So I guess the question on everyone's mind is, do we need a booster shot? So how should we be thinking about that? What does that discussion look like right now? So we don't know the answer yet as to whether and if so when booster shots might be needed. Some researchers believe we might never need a booster, that the data indicate that the protection we got from vaccines could last for years and years. But there's been an interesting divergence between the signaling from the federal government

and from Pfizer. So this started on July 8th. Developing story tonight, Pfizer is asking the FDA for emergency approval for a third dose of its COVID vaccine. Pfizer put out a statement saying that it was planning to seek authorization to give a third dose of its original vaccine. Pfizer says a booster within a year could bump up immunity and better protect against the highly contagious Delta variant. The company says its internal data shows antibody levels jump five to tenfold after that booster. boost the immune response, which is not surprising, but a good sign. And that there also might be a need for a third dose based on data that it was seeing about how antibody levels were evolving

among people who had received doses months prior. And what Pfizer's looking for there is signs that those antibody levels are waning. Which might be a sign that it's time for a booster. That's one sign. However, some scientists are skeptical of that approach as a way of deciding whether booster shots are necessary because antibody levels are just one part of the immune response. So just because antibody levels are waning doesn't necessarily mean you're not protected. There are other ways that the immune system may protect you when you're confronted by the virus, even if your antibody levels have fallen. So given that skepticism, what is the government's response to this argument from Pfizer that it might be time for a third shot, a booster shot of its COVID-19 vaccine and to its application for a booster shot to be approved? So the same day that Pfizer put out that announcement, the federal government put out a very unusual statement. Within hours, the CDC and FDA releasing a joint statement undercutting that announcement, saying Americans who have been fully vaccinated do not need a booster shot at this time.

However, it was a joint statement from the CDC and the FDA, and they said that they had not yet made a decision and there was not yet enough data to know whether booster shots would be needed at all. The CDC saying Pfizer got out ahead of itself. CDC and FDA officials say they are taking a wait and see approach. That doesn't mean that we're not very, very actively following and gathering all of this information to see if and when we might need it. They emphasize that they would need much more time to collect data and examine multiple sources of information about the strength of immunity of the vaccines. And a key part of that is looking at the breakthrough infection rates of people who've been fully vaccinated.

In other words, they want to understand how many people who have been fully vaccinated are nevertheless contracting COVID. Exactly. Because if that number is increasing, that might be a strong sign that the vaccines are not working as well as they were originally. So basically the government is telling Pfizer, hold your horses, we don't think there's enough evidence that a booster is needed. That's right. And that is a really unusual thing for FDA and CDC to do. So normally the regulators would not put out sort of a signal one way or another about how they're thinking about data that they've yet to review. a signal one way or another about how they're thinking about data that they've yet to review. This, I think, was an unusual sign from the FDA and CDC. And we're in unusual times, and these vaccines have not followed the normal precedent of FDA medical product reviews. So that's not surprising. But I think it would be much more typical for FDA to stay silent and ultimately issue a decision or a signal once they are further along in the review process or once they've made the decision.

So how do you explain the government's very strong and unusual response? I think there's a key part of this here, which is the huge concern about the large swath of the American population that remains hesitant about getting vaccinated. I think the government scientists are very cognizant of the skepticism among many in the public about just taking one or two shots of a vaccine. about just taking one or two shots of a vaccine. And the idea that perhaps, you know, a drug company would be looking to make money off of a shot that we're getting once a year for who knows how long is not going to help with that hesitancy. I think it also might suggest that if the vaccines don't even work as well as they've been billed, then people might be hesitant to get a vaccine dose in the first place if they're not yet vaccinated. So I think the FDA and the CDC are very sensitive to those concerns, and they really wanted to signal that they would be acting independently and not just doing what a drug company was telling them.

So the government is intent on showing it's not going to take direction from vaccine makers and it wants to wait for evidence that vaccines actually need a boost. But isn't there a risk that that would mean waiting until it's too late when, if vaccinated people potentially start getting COVID? Yes, that is certainly a risk. And I think that

speaks to the kind of fine line that regulators are walking here because they don't want to make the call too early and spend huge amounts of money and capital persuading people to get shots that they might ultimately not need. But at the same time, if you wait too long, you're going to have more people infected and in potentially rarer cases, more people hospitalized or dying. So it's a tough decision about when to make a call one way or another. And I think that's why FDA and CDC put out that statement, trying to emphasize how independent and data-driven they would be in the process. They're looking towards those breakthrough infection rates in the population that has already been vaccinated,

but they're also looking to other sources of information, like laboratory studies, looking at the immune response and how it evolves over time. Got it. So for now, there's a very live and very fascinating debate playing out between drug makers like Pfizer who say it's time for a booster shot and regulators who say we need more evidence before we will be ready to make that determination. That's right. And as this scientific debate is playing out, there's a whole other dimension to this as well, and that's a moral one. there's a whole other dimension to this as well, and that's a moral one. Many public health experts are saying that it's immoral to be having a conversation about giving booster shots at a time when so many people around the world

have yet to receive even a single shot. We'll be right back. So Rebecca, explain this moral debate that you just touched on when it comes to boosters and who is engaged in this debate specifically? So this debate comes down to the fact that in many parts of the world, particularly the poorest parts of Africa and Asia, there are many countries that have yet to vaccinate even the elderly, even some of their healthcare workers. And there's a finite number of doses that are being produced around the world at any given moment. A number of vaccine manufacturers are looking into possible booster shots. Pfizer is not alone in this. Moderna, AstraZeneca, Johnson & Johnson, they're all at least studying an extra shot.

So there's a fear that if the vaccine manufacturers start prioritizing shipments of booster shots to wealthy countries, that could mean that poor countries are going to get pushed even further back in line to receive even their first shots. Good morning, good afternoon, and good evening. This debate is playing out at the highest levels of public health. We're in the midst of a growing two-track pandemic where the haves and have-nots between countries are increasingly divergent. The director general of the WHO, that's the World Health Organization,

recently came out and said that... Instead of Moderna and Pfizer prioritizing the supply of vaccines as boosters to countries whose populations have relatively high coverage, we need them to go all out to channel supply to COVAX and low and middle income countries which have very low vaccine coverage. Vaccine manufacturers should be prioritizing supply to COVAX. That's the program aimed at vaccinating the world's poor. Since so many countries are in desperate need of their first doses. The priority now must be to vaccinate those who have received no doses and protection.

And do we think those companies are likely to prioritize boosters to wealthy countries over first shots to poorer countries? What do the economics of the vaccine tell us about that? Well, we don't know how this will play out, but we do know that it would be more profitable for companies to prioritize shipments to wealthy countries simply because of how they're pricing vaccine doses. Explain that. So Pfizer is charging different countries different prices for the vaccines depending on their ability to pay. The United States, for example, is paying $19.50 for each shot of the Pfizer vaccine. But poorer countries are being charged discounted prices, in some cases paying just for the cost of the vaccine.

So the African Union, for instance, was able to secure doses that African countries will be paying from in the range of $3 to $10 for. Wow, so far, far less than the almost $20 that the U.S. is paying per dose. That's right. And so the drug companies would stand to make more money if they prioritize shipments to wealthier countries. Whether they'll actually follow through on that at a time when there's immense pressure and concern

around vaccinating poor parts of the world is a different question. So they'll be balancing those two considerations, the desire to make money with the optical concerns and the ethical concerns of prioritizing wealthy countries at a time when people are dying in poorer parts of the world, especially as Delta becomes a more intensifying threat. How reasonable is it, Rebecca, to fear that booster shots are eventually going to become a kind of never-ending source of profit for pharmaceutical companies? will inevitably be tempted to focus on boosters and getting boosters to wealthy countries rather than getting doses to the people who so desperately need them in poorer countries. And isn't that potentially why a company like Pfizer might be getting ahead of the CDC and the FDA in the U.S. in pushing to get approval for a booster shot? I think this is definitely a reasonable fear,

especially in the short term and the medium term, that we might see boosters prioritized over shipments to poorer countries. That said, I don't think we'll see the general public getting booster shots unless there's a scientific consensus that they are needed. And so I think both of these things could end up being true at the same time, that there is an urgent public health need for booster shots. But at the same time, Pfizer and the other vaccine manufacturers could and would be making an enormous amount of money. You know, the Pfizer vaccine is positioned to become one of the best-selling pharmaceutical

products of all time. That could be just for a year's worth of revenue. But if we end up getting booster shots annually or at some regular interval, that would change the financial calculus and, again, make this one of the most profitable medicines or medical products of all time. So at this point, given that we don't know that we need a booster, potentially ever, and certainly not at this very moment, the argument that the WHO is making would seem to be very compelling, that giving a very profitable vaccine to those already immune is not fair. But let's just say, in theory, that someday the call is made that we do need

boosters. Would it then be fair to ask vaccinated people who are suddenly being told that they do need an extra dose to wait for everyone else in the world to get their first doses? Because couldn't that mean waiting a very, very long time? So when I talk to researchers at the WHO and elsewhere, they're very much focused on the now

and what information we have available at this moment. And their main focus is saving the most number of lives. And the way to save the most number of lives is to focus on the developing world. And that's because fully vaccinated Americans already have strong immunity. Even if it turns out that vaccine protection wanes over time, we're still talking solid partial immunity. That's not the case for people in poorer countries, huge numbers of people in poorer countries. They don't have any protection against the virus at all. And that's the priority if your goal is to prevent more deaths, more hospitalizations.

Rebecca, thank you very much. We appreciate it. Thank you for having me. We'll be right back. Here's what else you need to know today. The Times reports that Indonesia has become the newest epicenter of the pandemic, surpassing India and Brazil to become the country with the world's highest count of new infections. The surge there is part of a wave of outbreaks across Southeast Asia, where vaccination rates are low and countries had, until recently, kept the virus relatively well-contained. Vietnam, Malaysia, Myanmar, and Thailand are also facing their largest outbreaks yet.

And the death toll from historic flooding in Belgium and Germany has exceeded 180 people and is expected to keep growing as the waters recede and rescue operations intensify. German meteorologists called it the worst flooding in at least 500 years. On Sunday, German Chancellor Angela Merkel met with survivors, telling them, quote, that the German language has no words for the devastation. Today's episode was produced by Eric Krupke, Diana Nguyen, and Rob Zipko. It was edited by Lisa Chow and Paige Cowett, contains original music from Dan Powell, and was engineered by Chris Wood. That's it for The Daily. I'm Michael Barbaro.

See you tomorrow.