Today, Explained - Booster shots

Episode Date: August 24, 2021

Vox’s Umair Irfan explains why you might need one. The Atlantic’s Sarah Zhang says the coronavirus is here forever, but ultimately, it might not be so bad. This episode was produced by Will Reid, edited by Matt Collette, engineered by Efim Shapiro, fact-checked by Laura Bullard, and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained. Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. Umair Irfan, ScienceVox. We got FDA approvals. We got President Biden boosters. We got a lot to talk about with the COVID-19 vaccines. Let's start with approvals. The FDA fully approved the Pfizer vaccine on Monday. What does it mean? It's the fastest any vaccine has ever achieved full approval in history.

Ever. And they did this basically in just under two years. I guess the big question then is, were they cutting corners, taking shortcuts? That's the big question. And the regulators insist that they have not. That the main reason that they were able to do this so quickly is the urgency of dealing with the COVID-19 pandemic. And in fact, the FDA has been criticized for taking so long to actually get to full approval at this point. But they say that in order to actually hit this benchmark,

they need to have six months of follow-up data for the people that are in the clinical trials. For the emergency use authorization that they got back in December, they only needed two months worth of follow-up data. So they needed about three times as long. And also they need to look at things like the manufacturing lines, like the assembly plans for these vaccines. They need to investigate also some of these super rare side effects as well. And then they also need to look at this in a broader public health context and see if there is a vaccine that's better suited to one group of people than another, and then come up with recommendations basically to minimize risks and maximize effectiveness. All the same, how do they crunch this, what, usually 10-year process into two-ish years?

Well, one of the big things that they did was, first of all, they overlapped a lot of the clinical trial phases. So they were concurrently running phase one and phase two trials. Usually those are done sequentially and they're spaced out months apart. And there's a lot of lag time in between these different phases as well, just doing paperwork and bureaucracy. But the regulators and the companies, they devoted a lot of human power to actually doing a lot of the data analytics and whatnot, more than you would typically see with any other kind of drug. And finally, with the phase three trials, they recruited a lot of people very quickly. We're talking 30,000 to 40,000 people in each one of these clinical trials.

And so when you have a large group of people in those clinical trials, you can get results faster. What has it changed, this FDA approval, this formal approval, not emergency approval, but real deal, record-breaking approval? In practical terms, for most people, they're not going to see a lot of changes in terms of how the vaccines are being distributed. But on the regulatory side, there are some things that might actually happen. So one is mandates. For instance, there are already companies that are starting to require their employees to get vaccinated. Disney joins a growing list of employers who are mandating vaccines in order to return to work. Tech giants like Facebook, Twitter, Google, they're taking a stance on vaccines. And beyond that, though, there might be some companies that are a little bit on the fence

or worried about having some sort of legal cover. And now that they have a fully approved, FDA approved vaccine, they can be, you know, more aggressive about trying to get their employees vaccinated. Companies can now very comfortably move to mandate the vaccine. Similarly, like public institutions like, you know, the military and, you know, other kinds of like local governments, they may be more inclined to now start enforcing these mandates. A new mandate for all active duty U.S. service members to get vaccinated. They've been waiting on full approval of the vaccine at the FDA to do that. That full approval has been granted. The DOD is now moving

ahead. And we'll also see a bunch of these mandates going into schools and universities, as we already have almost immediately after this was passed, right? Right. You're going to probably see universities starting to mandate this, probably for their students. Mandatory vaccinations for all New York City school teachers and employees was Mayor de Blasio's announcement today. That'll likely continue propagating outward. Another big change from this is that with full authorization, doctors can use this off-label. What that means is that doctors can, using their own discretion, prescribe vaccines to people that they think may need it beyond the scope of what's authorized here. So, for instance, right now with the full approval for the Pfizer know, under the age of 16 and may have you being immunocompromised, maybe getting treated for cancer or some other high risk factor, they can at their own discretion choose to prescribe it to them if they're in high risk scenarios. And right now we still don't have full emergency authorization for children, but doctors could make that decision on behalf of individual children. And also for some of the older adults that they think are at high risk, they can also decide individually to prescribe a booster ahead of

the schedule, ahead of what the FDA and CDC might want. Okay, so big changes here. We're going to see lots of mandates. You're going to see doctors able to recommend these to people who might not otherwise get them. Anything else? Well, as far as Pfizer and BioNTech are concerned, one big thing for them is they can now start marketing this drug. Huh. You would think these things don't need sell this. But in the United States, we still have holdouts. You know, we still have parts of the country where fewer than half of all adults are vaccinated and the unvaccinated continue to dominate the majority of new hospitalizations and deaths. And of course, you know, they have a financial interest in trying to get as many people vaccinated as possible. So we may soon see commercials for what Pfizer and BioNTech are calling Comirnaty, which is the brand name they came up with. Comirnaty?

Comirnaty. What? That's the Pfizer vaccine? It's like, I don't know, somebody trying to say community with like a really bad Southern accent. But yeah, like imagine the team that marketed Viagra turning their muscle and attention to a vaccine. Are you suffering from shortness of breath, lack of taste, and crippling fear of a deadly virus rapidly spreading throughout the country? Have you lost touch with friends and acquaintances, haven't seen your grandma in over a year,

or are you suffering from maskne? Try Comirnaty, a new vaccine from Pfizer and BioNTech. I'm helping cut community transmission. I'm no longer wracked with virus anxiety. My immune system says, take that, COVID. Thanks, Comirnaty. It's much worse than the Moderna vaccine brand name, which they're calling Spikevax. Spikevax?

Spikevax! Leave your apartment with Spike Vax. Screw wearing a mask with Spike Vax. Went to Lollapalooza on Spike Vax. Everyone's hooking up on Spike Vax. Spike Vax! Okay, that covers the Pfizer vaccine approval. Historic moment.

Just happened this week. What about the boosters that were announced last week, Umair? What's going on there? Well, the Biden administration said that they will start the process for evaluating boosters, and they expect that the first batch will start rolling out in mid or late September, around September 20th. You know, this will boost your immune response. It will increase your protection from COVID-19. And it's the best way to protect ourselves from new variants that could arise. And this has been bandied back and forth for a while now. Initially, we didn't need boosters.

Then it was immunocompromised people need boosters. And now everyone needs boosters. What's the deal? Right. It was kind of strange. Back in early July, Pfizer and BioNTech said that they were going to apply for a license for boosters. And then the FDA and the CDC put out a joint statement basically criticizing that decision. And they pretty explicitly said Americans who have been fully vaccinated do not need a booster shot at this time. They were pretty categorical about that. And now, you know, with the progress of the Delta variant and also some of the things that we've learned about the decline in immune protection, particularly for high risk people, they're a little bit more concerned about this. And now they think that actually there is some merit to the idea

of giving a booster shot. And what exactly is the booster shot? Is it a different composition cocktail than a lot of us had injected into ourselves earlier this year? Yeah, pretty much. This is going to be basically an identical dose to the first two that we received. And functionally for the companies, it's not going to make much of a difference. It's just more of the same thing. And so when you say two shots, you mean Pfizer and Moderna, the two mRNA vaccines. What about the Johnson & Johnson, for example? Right. That's the one-dose adenovirus vector vaccine that was approved earlier this year.

Since it came out a little bit later than the other two, it's going to take a little bit more time for regulators to look at the first batch of people that got the vaccine and see if there has been a significant decline in whether a booster is warranted there. But people are talking about it too. So just so I have this straight here, if you got Pfizer shot one and then got Pfizer shot two, was there any difference between those shots? No, they were identical. The exact same thing. Yeah. And this third shot, this booster shot will also be the exact same thing. That's the plan. Yes. So Pfizer one, Pfizer two, potentially Pfizer three, all the same shot. Moderna one, Moderna 2, Moderna 3, all the same shot from Moderna. Correct. Couldn't you just go to like CVS right now with how easy we've tried to make it in this

country to get these shots and just walk in and not tell them you've been vaccinated and get a booster shot? People have been doing exactly that. Oh, yeah. And health officials are trying to warn people not to. Yeah. There's this whole situation of people just wildcatting these vaccines. Wildcats? You know, just running around and trying to get whichever one they can and, you know, making their own risk assessments and trying to figure out, you know, if I'm at risk and I think that I need a booster, where can I get one? One man who got the Johnson & Johnson vaccine told you it's like you're in a hurricane and someone gave you a garbage bag to put over your head. It's not the same as the Gore-Tex bodysuit that Pfizer and Moderna people are wearing in the same storm. Now, the CDC says a booster shot is not necessary right now, and it's not clear.

And why are they warning against it? Well, again, because, you know, this hasn't really been studied. You know, there's a difference between making a categorical judgment when we're talking about hundreds of thousands, if not millions of people versus individuals. And certainly health officials, public health officials are concerned about the large groups of people. Huh. I feel like this also gets into an ethical question. Although it seems like there are more vaccines than we need in this country, there are still a ton of people who haven't gotten it in this country for more complicated reasons, but also all around the world. I believe the head of the WHO came out and said something like,

giving people booster shots in the United States at this point is like giving people who are already wearing a life jacket an additional life jacket while essentially people around them are drowning. Is there a real ethical problem with giving everyone in the U.S. who already has the first two shots a third? Yes, and there are health officials and health researchers in this country making that same point, too. I do think the administration is moving a bit too fast. We vaccinate to save lives. The purpose here is not to prevent mild cough, cold, flu symptoms, or even something that

leaves you laid up in bed. The point here is to prevent severe disease, hospitalizations, and death. One thing to remember is this virus got here from overseas. You know, it crossed borders. It went across airplanes. You know, they didn't respect any of the boundaries that we've tried to draw between countries and between people. And as long as the virus is circulating somewhere, it poses a threat to all of us. Right now, there are countries where their vaccination rates are

in the single digit percentage points, like health workers are not even vaccinated. And, you know, what we saw with the Delta variant, the more spread we have of this virus, the more likely it is to mutate in a dangerous way. So a lot of health officials have argued that, you know, it would behoove the United States for our own self-interest, not just out of charity, to try to ensure that health workers, frontline workers at least are being vaccinated around the world. You know, there was actually an international program to do this called COVAX, where the idea was that everybody would chip in, donate money and resources, and the first batch of vaccines would go around the world equally to health workers on the front lines. And that kind of fell apart because a lot of the wealthier countries decided to keep the vaccines for themselves and vaccinate their own populations. And the ones that were actually supposed to go to the other countries, you know, the many of the poorer and developing countries that are still dealing with an acute crisis with very low vaccination rates. You know, they've been scrounging for resources and they really haven't been getting the shots that they need.

All the same, this is going to happen. Ethical quandaries aside, the booster shots will be rolling out officially in the United States come September. That's the plan. You know, it will probably roll out in the same way that the vaccines initially rolled out because again, they want an eight month gap between your second dose and your first booster.

Okay. So the first people to get the boosters are going to be the people who first got the vaccine. So the first people to get the boosters are going to be the people who first got the vaccine. So it's going to be health workers and very high-risk adults, older adults, people who are being treated for cancer or people who are otherwise immunocompromised. Those will likely be the first folks to get boosters. And the large wave of people we saw getting vaccinated back you know, back in April and May, you know, they're not going to be eligible until probably early next year.

Though, as we established, you could probably just sneak into CVS like a wildcat and go get one. I mean, you could and you shouldn't. You could, but you shouldn't for a lot of good reasons. Sure. Sure. Listen, I haven't done it. For a lot of good reasons. Sure, sure. Listen, I haven't done it. Don't do it, Sean. Omer Irfan, thank you. My pleasure.

We've got to do that one thing, and after that, what comes after the booster shots? It's Today Explained. Support for Today Explained comes from Aura. Aura believes that sharing pictures is a great way to keep up with family, and Aura says it's never been easier thanks to their digital picture frames. They were named the number one digital photo frame by Wirecutter. Aura frames make it easy to share unlimited photos and videos directly from your phone to the frame. When you give an Aura frame as a gift, you can personalize it, you can preload it with a thoughtful message,

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BetMGM operates pursuant to an operating agreement with iGaming Ontario. Sarah Zhang, you're a staff writer for The Atlantic. You recently wrote an article titled, The Coronavirus is Here Forever. This is How We Live With It. Did that title of your article bum people out or were they ready for it, you think? You know, I think when I was writing this article, I thought I was being the bearer of bad news and it's going to be a huge bummer. But I actually have had a lot of people come up to me or message me and say, hey, I actually found your article kind of encouraging and it made me feel better.

I think because, you know, like, yes, like we're not going back to 2019 where there was zero COVID. Right. But, you know, this current like terrible pandemic phase, it's also not going to last forever. I, too, was one of the people who actually found it encouraging. We'll see how people feel by the end of this conversation. What exactly was the thesis of your article? Yeah, well, I think it's been pretty clear for a while now that this virus is not going to be eradicated or eliminated. So it's not going to be like smallpox. It's not going to be like polio or measles.

We're going to be living with this virus for a really long time. So this virus is going to be what people call endemic, which means it's going to keep circulating. It might be another seasonal virus. So it might look something like the flu or the cold. It's probably going to be something that we hear about every year, but it's not necessarily something that's going to be like big news the way it is right now. So for the people who that might be news to, that this isn't going away, it's sticking around forever, Let's dig into why exactly and what that might look like. So you say it could be the cold or the flu. What's the difference there? Let's start with the cold. How might this end up looking like the cold? Yes, I think the most optimistic scenario

is that this ends up something like the cold. And we actually have maybe some precedent for this. So coronaviruses are actually a whole family of viruses, and there are four really common coronaviruses. They have names like OC43, HKU1. You've never heard of them because they are not very severe. What they do is they cause common colds, and we've actually probably all had these viruses before. We probably first had them as children where the disease was pretty mild, and we've actually probably had it more than once because we see that the immunity to infection from these coronaviruses actually wanes pretty quickly. We, you know, have some immunity to it. And the second time you have it, it's not going to be as severe. It's going to be mild.

It might even be symptomatic. So we don't really have to worry that much about it. And a slightly worse scenario is this becomes something like the annual flu? Yeah, it's basically we have a second flu, though, you know, not quite the same thing as the flu. Flu, we sort of just live with it, right? But it does kill something like tens of thousands of Americans every year. And I don't want to say like we agree that like we're okay with the risk of flu because it's not like we sat down at a table and all agreed to this. But we kind of lived as if we were okay with the risk

of flu, right? And most American adults don't get flu shots, even though it's, you know, it's free and it's right there. So I think we sort of like, as a society, had agreed to live with a certain amount of risk to flu, even though it does kill a lot of people every year. And in really bad flu seasons, hospitals do get pretty stressed. So you can imagine, like, you know, if you have a bad flu season, plus, you know, a coronavirus that looks like the flu, that's still going to be pretty bad in hospitals in the winter. If this ends up being just like the annual flu, does that mean all those people who are constantly saying coronavirus is just the flu would have been kind of right? They would have been right if they changed their tense, if they said the coronavirus will

eventually be like the flu, not is. So, right, the reason that we're having a pandemic right now is that we have a new virus that is meeting a lot of naive immune systems that have never seen this virus before. And that's why we're seeing so many deaths and so many people who need to be hospitalized. You know, but with flu, we've all had the flu at some point in our lives, right? Or we had a flu shot. We all have some immunity to the flu. So when we get the flu, it's not going to be as bad as encountering it completely blank slate for the first time. What's happening with the coronavirus is that we are doing that. But in the future, when it's endemic, when we've all had some immunity to the virus because we've been vaccinated, or maybe because you've been

infected and you've been recovered, it will probably look a little bit more like the flu than it is right now. What would it take to get there to the point where this ends up just being the cold or the flu? We get there with this coronavirus when everyone has some immunity to this coronavirus, either because they've been infected and they've recovered or because they've been vaccinated, hopefully vaccinated, because the consequences of getting vaccinated are not as nearly as possibly deadly as getting the virus itself. So either the cold or the flu scenario seems like a potentially ideal scenario. Is that fair? There must be something that looks worse. Yeah, well, so I think there are still some

unknowns, right? This is a new virus. We don't know exactly how it's going to behave. We don't know exactly how it's going to keep changing. And the one thing we can say is it's almost certainly going to keep changing because viruses do that. The flu virus keeps changing every year as well. So it could also end up maybe somewhere a little bit worse than the flu, you know, depending on how quickly this virus changes and how quickly our vaccines are able to catch up. It's possible we may need boosters every year, and it's possible that we're kind of in this arms race against with the virus every year with our boosters. On the more optimistic side, we had pretty good vaccines,

but it's possible we may have better vaccines. One of the things about respiratory infections is that it's pretty hard to make a vaccine that completely protects you from infection because the virus kind of affects your nose first, but vaccines are better at inducing immunity in your lungs. So they don't protect against infection, but they do still protect your lungs and protect you from getting severely sick. Like the flu shot, for example, tends to be like 10 or maybe as high as 60% effective, which is not very good, right? Like 10% is pretty bad for a flu shot. But we might have better vaccines for what, for example, ones that get sprayed in the nose are better at preventing infection, and we might have better treatments in the future. So,

you know, where exactly this virus ends up is up in the air for a lot of different reasons. And do we have any sense which one of these three-ish scenarios we might get? The cold scenario, the flu scenario, the something much worse scenario? I mean, I wish I knew. I feel cautiously optimistic because we are, you know, we are seeing breakthrough infections in people who are vaccinated. But for the most part, they tend to be really mild, if not asymptomatic. So it certainly seems like if this is something like the flu, we get a booster every year, we can probably keep up with this virus. The other thing is that the virus is spreading so much right now. It's having so many, so many opportunities to infect people and to replicate. And every time it replicates, it's kind of like buying a lottery

ticket where it can chance upon a certain number of mutations. And some of these mutations might be the mutation jackpot that makes it really good at spreading. I think that in a world where everyone has some immunity, that adaptation is going to slow down a little bit. So we won't be trying to run quite as fast to keep up with the virus. So sort of like it always has, this sort of just depends on us. Yes, as it always has. which is also maybe not encouraging. Commitments happen for the past year. Is any of this affected by the fact that we just seem to be heading towards a place,

at least in the United States, where we have a ton of people who are like hyper vaccinated, two shots plus a booster plus who knows what comes down the road. And then this other segment of the population that just won't be infected at some point. It's really a matter of time. So yes, we're going to have like vaccinated, unvaccinated people, but eventually almost everyone will have some immunity because you've been vaccinated, preferably, or because you've had COVID. And this is a reason to feel somewhat optimistic about this pandemic endemic that will never, ever end? Well, in that scenario, right?

Like when everyone has some immunity, the pandemic has ended. That's when we're in the endemic scenario. The unfortunate thing is, is that a lot of people get sick rather than get vaccinated. You're going to have a lot more death on our way to getting to endemic coronavirus.

So again, we kind of get to choose the path we take to get there. It depends on us. Sarah Zhang, she's a staff writer at The Atlantic. Today's episode was produced by Will Reed. I'm Sean Romsvorm, and I got comernerty. Side effects of comernity may include meeting people, seeing your family. Oh my, people have legs.

Communing with nature, making out with strangers, having plans, canceling plans, in-flight entertainment, live music, FOMO, catching all the other viruses you missed out on. Fine, I guess I'll give you a hug. What do I do with my hands? Dining in restaurants without fearing for my life is kind of cool. I miss my dog.