Narrator: Coming up on Mayo Clinic Q&A:
Dr. Gregory Poland: 21% of Americans have gotten at least
one dose and 11.5% are now fully immunized.
Narrator: Even as the vaccination numbers continue to
climb, there are still people who are riding the fence or even
leery about getting the COVID vaccine.
Dr. Gregory Poland: The vast majority of people who are
hesitant, are not rejecting, they're unsure. They have
information needs. Talking to people who are vaccine hesitant
or vaccine rejecting is not a one and done conversation. It is
a trust building exercise over time.
DeeDee Stiepan: Welcome, everyone to Mayo Clinic Q&A. I'm
DeeDee Stiepan sitting in for Dr. Halena Gazelka. We're
recording this podcast on Monday, March 15, 2021. COVID-19
vaccinations around the US are picking up speed, and President
Biden set an aspirational goal that all adults in the country
be eligible to get the vaccine by May 1. Here with us again
today to discuss the latest COVID sews is Dr. Greg Poland, a
virologist and infectious disease expert at Mayo Clinic.
Hi, Dr. Poland. Thanks so much for being here.
Dr. Gregory Poland: Hi DeeDee, good to work with you again,
it's been a little bit.
DeeDee Stiepan: It has, and you know what, we're making
progress, aren't we?
Dr. Gregory Poland: Boy, isn't that true? I mean, you look at
it, over the weekend, over 4 million doses were given in the
US. I looked at the numbers this morning, just to be sure 21% of
Americans have gotten at least one dose and 11.5% percent are
now fully immunized. So, I don't see any reason we wouldn't
reach, or hopefully even exceed that goal. The big trick now
will be to get people to accept the vaccine when one is
available to them. That is our way out of this pandemic.
DeeDee Stiepan: Absolutely. Well, it is incredible progress.
You know, since we last spoke on this podcast, the CDC released
recommendations on activities for fully vaccinated people. Can
you clarify for our listeners, what are these recommendations?
Dr. Gregory Poland: Now, this is really important. These were I
guess exactly a week ago now that they released them and they
gave them an appropriate name or title. They call them interim
recommendations. And they use the term guidance, not
guidelines. So, they are guidance and they are interim.
And what they are saying is, when you weigh risk and benefit,
because there is an economic and a mental health cost to being
distanced from one another, they're saying that if you're
fully vaccinated, you can meet with other fully vaccinated
people in your home without wearing masks, you can be
indoors. You can also meet with an unvaccinated, say member of
your family, who is unvaccinated if they are not at severe risk
of complicated disease. So, the intent behind this is to allow
that grandmother to get her arms around that grandkid. Or, in my
case, to get my arms around my adult son and welcome him back.
He's been in Europe as a coach. So, it's really a marvelous
thing to se. This is part of that rheostat, that dimmer
switch, where we're starting to turn, carefully measuring what
we do toward normal, and being vaccinated is what has allowed
these recommendations.
DeeDee Stiepan: Very good. Studies, as we know, they're
looking at whether the vaccines are not only effective in
preventing illness but also effective in preventing
asymptomatic transmission. So, what have we learned so far?
Dr. Gregory Poland: You know, this has been one of the harder
answers to get a hold of because of the nature of asymptomatic
infection. But, we now have data from multiple sources, from
Israel from Pfizer studies. Most recently from a very large
study done and published from the Mayo Clinic in Rochester,
Minnesota, showing that the risk is decreased by 80 plus percent
in people who have gotten one to two doses of the vaccine. So,
this is really good news. That's the toughest thing to prevent is
a symptomatic. It's easier to prevent severe disease, that
might be seen backwards in some people's minds, but that's the
case with vaccines. So, this is really, really good news, and I
think reinforces the concept of beginning carefully to allow
vaccinated people to gather face to face and loosen some of those
restrictions that we've had.
DeeDee Stiepan: Absolutely. You know, we continue to hear from
our listeners, and there's a lot of concern from those who are
immunocompromised, so should people with autoimmune diseases
be vaccinated for COVID-19?
Dr. Gregory Poland: Yeah. So, you mentioned two things,
immunocompromised and people with autoimmune diseases. Both
of those categories should be vaccinated. Those are not contra
indications. Those are indications to get the vaccine.
Now in those two categories, depending on how severely
somebody is immunocompromised, we don't yet know how effective
is it 80%, 70% effective? We don't know. For the auto immune
group of people, I think the concern there has been more will
it worsen or exacerbate my underlying disease? We don't
have a huge amount of information on that. But the
information we do have is that the demonstrated benefit far
outweighs the theoretical risks. In other words, we have not
seen, and when we're looking at the US we're talking about close
to 79 million people who have been immunized, and we have not
seen exacerbations of underlying autoimmune disease.
DeeDee Stiepan: For the immunocompromised, should they
be tested for antibodies to make sure that their vaccine was
effective?
Dr. Gregory Poland: Yeah, you know, that's a very good thought
and idea. Right now, there is no standard recommendation to do
that. I do think that might be a case by case basis between
provider and patient, depending on their unique risks that they
face or, you know, whatever their life situation might be.
That would be a consideration, but certainly not a routine
recommendation.
DeeDee Stiepan: And what about people taking immunosuppressants
like prednisone?
Dr. Gregory Poland: So, that's a drug that depending on the dose
that they're taking, could decrease their immune response.
Now, you know, let's just take the mRNA vaccines, we're talking
about vaccines that have about 95% efficacy. I mean that's just
stunning. Plus, they're getting two doses, in essence, a booster
dose. We may find out, we have to give even additional booster
doses as time goes on. We don't know that yet. But that's being
tested. So, depending on the dose you're on, maybe your
immune response would be 91% instead of 95%. Or if you're on
very heavy immunosuppressive drugs, maybe it's 50 or 60%, we
don't have a way of knowing, because the studies that would
tell us that have just started, there's a large study of 5000
immunocompromised people called the Octave study that has just
started and will give us those answers. But, I think I would
say that to any of our listeners that are taking those drugs,
talk to your health care provider. Sometimes those drugs
can be held, the vaccine given, and the drug restarted. Other
times they can't, and sometimes the drugs that you're taking
really don't have an effect on the vaccine. Other times,
depending on the drug they might. So, we want to
personalize that recommendation, and that's best done between
patient and doctor.
DeeDee Stiepan: Yeah, that's great advice. So ,we now have
this goal of May 1, for all adults to be eligible for the
COVID-19 vaccine, which leads to the question, when do you expect
that younger children even toddlers might be eligible?
Dr. Gregory Poland: Yeah, really good question. Because again,
this is going to take all of us. You know, I'm kind of reminded
that I don't know if you ever saw in history class, World War
II, they'd have men and women rolling their sleeves up and say
we're all in this together. I think that's a great, that's
actually a great model for the for the national situation we're
in now, if we all roll our sleeves up and get these
vaccines, we're going to emerge out of this much faster and
safer. So, to the question of children and even toddlers, what
the drug manufacturers are doing, I think is the right
approach. They're taking it step by step. So right now, it's 16
or 18, depending on the vaccine, and above. The study they're
doing currently is down to age 12. I think we will soon have
those results in the late spring, early summer, and then
they'll just keep marching that down by age bracket, being super
careful of safety, to know at what age can we immunize safely
and get a protective immune response? I think sometime this
summer and sometime in the third to fourth quarter of 2021, we'll
have that information, and we'll be immunizing most all of the
country.
DeeDee Stiepan: Very good. Finally, I know you mentioned it
a little bit before, but as more people become eligible to be
vaccinated, vaccine hesitancy needs to be addressed. Tell us
about your recent editorial on the topic.
Dr. Gregory Poland: Yeah, I wrote that editorial with my
daughter who is a mental health professional and does a lot of
research in this area, and with a woman in the Mayo Center for
Innovation, and she's what's called a human centered
designer. And so, between the three of us we collaborated to
look at how do we think about vaccine hesitancy? And how do
we, as healthcare providers, deal with it in the best way
possible. And it starts with recognizing that the vast
majority of people who are hesitant, are not rejecting,
they're unsure. They have information needs, they have
empathy needs, in some cases. And so, in that editorial
published in Vaccine, we actually provide what we call an
empathy tool for healthcare providers to use as a starting
point for them to have discussions. And I think that's
one of the issues that we would propose, is that talking to
people who are vaccine hesitant or vaccine rejecting is not a
one and done conversation. It is a trust building exercise over
time, helping people to allay their fears while recognizing
the valid fear of the actual disease. So, you know, we're at
a point, as I mentioned earlier, where tens of millions of doses
of these vaccines have now been given. When we look worldwide,
it's hundreds of millions of doses have been given. And, we
have not been able to define any safety concern other than the
risk of anaphylaxis, which we discovered very quickly in this.
So, I think that should help allay a lot of concerns. And
then it's talking individually with patients, I have found that
to be a very, very useful strategy. It goes back to our
roots, right? You know, at the Mayo Clinic, we have a simple
motto that we talk about all the time, the needs of the patient
come first. And what this editorial is really doing is
flipping things around to say, Okay, if the needs of the
patient are informational, let's start there.
DeeDee Stiepan: Very good. Dr. Poland, anything else that you
wanted to add before we let you go today?
Dr. Gregory Poland: I'm just you know, we've been through a lot
of, you know, sad and negative information. We're emerging from
that. It's delightful to talk about progress. I think one of
the things we've seen is quite a dip in the number of deaths,
hospitalizations, and even cases. There are still in the
50 to 60,000 cases a day, so we can't relax. This is one of
those hiatus moments where if we all choose to do the right
thing, with the recommendations that have been made based on
science, we're going to get out of this quickly. If we make the
decision not to do that, we will do what we've done so far and
prolong it.
DeeDee Stiepan: Yeah, very well said Dr. Poland. Well, our
thanks to Mayo Clinic infectious disease and virology expert Dr.
Greg Poland. Thanks for again for chatting with us today.
Dr. Gregory Poland: Good to be with you.
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