Narrator: Coming up on Mayo Clinic Q&A, we're talking
boosters, who's eligible, and will a booster really provide
more protection against COVID-19.
Dr. Gregory Poland: All of the boosters would dramatically
boost your antibody response. And people are kind of focused
on that because that's what we report. We report that because
that's what we can measure. But it's only one part of the story.
I would make the decision about a booster based on how did you
respond to whatever you got originally? And are there any
unique risk factors that you have?
Narrator: The Food and Drug Administration has updated its
authorizations to allow medical providers to boost eligible
people with a vaccine other than the one that they initially
received. This is also known as mix and match. But given the
choice, is one better than another?
Dr. Gregory Poland: There's no magic in it at all. There's not
one that you can say, wow, that's the one to get. All of
them do spectacularly well in protecting against severe
disease, hospitalization, death, even moderate disease.
Dr. Halena Gazelka: Welcome, everyone. Mayo Clinic Q&A. I'm
Dr. Halena Gazelka. We're recording this podcast on
Tuesday, October the 26th, 2021. I'm here welcoming back Dr. Greg
Poland, who's here to give us our latest updates on COVID and
vaccines. Welcome back, Greg.
Dr. Gregory Poland: Thank you, Halena.
Dr. Halena Gazelka: I'm thrown a little bit because we're doing
this on Tuesday. And typically, you and I record together on
Mondays.
Dr. Gregory Poland: Yes, a little different, but you know,
here we sit in chilly Rochester.
Dr. Halena Gazelka: That's right. That's right. It is
turning to fall. That is for sure.
Dr. Gregory Poland: No question.
Dr. Halena Gazelka: Well, Greg, give us the latest on infection
rates and vaccination rates in the U.S. and around the world
too.
Dr. Gregory Poland: Yeah, well, you know, there's good news and
bad news, kind of mixed news, if you will, in that regard. Cases
are falling. No question about that.
Dr. Halena Gazelka: That's good news.
Dr. Gregory Poland: Yeah, whereas we were bumping up
against 200,000 cases a day. O average over the last week,
Dr. Halena Gazelka: Two of the things that you said really
we've been at about 73,000 cases a day. So, it's not like nothin
, but dramatically decrease . We're down to about 170
Americans dying each day from COVID. Still way too much.
bout 58 percent of the U. . population is fully vaccinate
. But, we have about 90 per ent of U.S. counties that still
ave high or substantial transmi sion. So, we have a ways to
o. But and I really want t stress this Halena, we have
n opportunity. Cases have fa len down. We've seen this ha
pen three times before, four imes really. And then what happe
s is we begin to pretend the pan emic is over. We begin to
loosen all of the restrictions and we have another surge. T
ere is a lot of concern a out this possibility of a s
rge with Thanksgiving, winter, C ristmas, and what to call
it, COVID fatigue. So, if e're bigger than those things, a
d we say no, you've got to wea a mask indoors, you'v
got to be vaccinated, if it's ppropriate for you to get a boo
ter. Those are things that may get us through the winter i
struck me, Greg. One was 58% of Americans, that doesn't sound
addition to a topic I'm sure w 're going to talk about, which i
kids and immunization, if w get them immunized. I think
that high to me.
Dr. Gregory Poland: I know.
Dr. Halena Gazelka: It sounds lower than I would have liked
we have an opportunity that we ve had few of during this pa
for you to have said.
demic. The question is, wil we embrace that opportunity
Or will we once again pretend t e pandem
Dr. Gregory Poland: Yes, of course.
Dr. Halena Gazelka: And the other thing is that you said
people act like the pandemic is over. Well, if you have flown on
an airplane recently, it is crowded in the airports.
Dr. Gregory Poland: Yeah.
Dr. Halena Gazelka: And you would think that the pandemic
was over by how many people are traveling and how tightly packed
those airplanes are.
Dr. Gregory Poland: Yeah, you're absolutely right. And kind of
the more discouraging thing, at least on an airplane, you're
mandated to wear a mask right, but trying to get people to wear
masks in other indoor venues, and again, with the holidays
coming which for the most part are going to be indoors, this is
a potential looming, yet again, another surge.
Dr. Halena Gazelka: So Greg, last week, one of the big pieces
of news was about these mix and match boosters being recommended
by the CDC. What does that mean and what are the implications?
Dr. Gregory Poland: Yeah. So, just to be a little careful
about this, what mix and match means is that regardless of what
you got for your primary series, you could get any of the other
three vaccines available for use in the U.S. as your booster if
you're eligible for a booster. Now, these results are coming
from an NIH study, a relatively small study showing both safety
and a boost in antibody levels. As we've talked about in this
show, that's only one part of the story. It did not measure,
and we don't know about T cells, just antibody levels. So, the
point is, they're following what happened in Israel, that with
time, they saw an increasing number of breakthrough cases,
embarked on a booster program, dramatically suppressed and
decreased those breakthrough cases. The key there is what
kind of cases are we talking about? Are they severe, death,
hospitalization, or asymptomatic and mild cases? And there's not
as much science as I would like to see around this whole idea of
boosters and third doses in the case of mRNA vaccines. But
nonetheless, that recommendation was made.
Dr. Halena Gazelka: And so, who is eligible for a booster at
this time, Greg?
Dr. Gregory Poland: So, anybody who is 65 and older, anybody 18
and older living in a long term-care setting, or with
underlying medical problems that put them at risk for severe
disease, or like you and I that live or work in a setting where
we are exposed more often and run higher risks of disease. So,
medical professionals, if you live in a group home setting, a
prison, you know, anything like that where you're congregated in
large numbers. One other thing Halena about the boosters that
bear saying is that these are for people 18 and older who meet
the criteria for a booster. The J&J booster can be given any
time two months or longer after the first dose. For the two
mRNA vaccines, Pfizer and Moderna, those are generally
given six or more months after the primary series. The other
thing is that for all of these, the dose for the booster is the
same, with the exception of Moderna, which will be half the
dose that you received as your primary doses.
Dr. Halena Gazelka: Greg, so we have our savvy listeners asking
you questions about the boosters now. And they want to know, how
do people know which booster to get. For instance, a listener
asked, will one of the boosters give me a higher antibody level
than the others? Why are Pfizer and J&J the same dose, but
Moderna's booster is half dose?
Dr. Gregory Poland: Yeah, those are good questions. So, all of
the boosters would dramatically boost your antibody response.
And people are kind of focused on that because that's what we
report. We report that because that's what we can measure. But
it's only one part of the story. And you know, the nature of
Americans is that more is always better. We don't know that.
Presumably, that's true. But we don't know that there's an
advantage to having your antibody increase 35-fold versus
70-fold. Who says that that's better, particularly in view of
B and T cell activity? So, I wouldn't get too hung up on
that. Rather, I would make the decision about a booster based
on how did you respond to whatever you got originally? And
are there any unique risk factors that you have, for
example, because of the very, very rare chance of this TTS,
this blood clotting disorder in younger women, I would prefer
not to use the J&J booster. If you had some other side-effect
or reaction to one of the other vaccines, you might say, well,
I'm going to use a different vaccine. So, honestly there's no
magic in it at all. There's not one that you can say, wow,
that's the one to get. All of them do spectacularly well in
protecting against severe disease, hospitalization, death,
even moderate disease. So, you're then talking about, well,
does one better prevent asymptomatic or mild disease
than the other? We don't have that much science to know that.
So, there's nothing we can say really about that that would be
solid scientifically.
Dr. Halena Gazelka: You alluded earlier to the fact you were
going to talk about kids and vaccines. So, could you give us
an update, Greg, on where are we? A decision is forthcoming
soon, I think?
Dr. Gregory Poland: Well, in fact Halena, today is an
exciting day because the FDA advisory committee is going to
meet and talk about this very issue. My prediction, they have
not yet met. I don't think they start till nine o'clock or so.
My prediction is that they will approve it for Pfizer. And the
reason for that is that they have presented data showing
spectacularly good immune responses, not surprisingly, in
these young kids to a dose that's one-third the adult dose.
So, instead of 30 micrograms, they'll get 10 micrograms.
Dr. Halena Gazelka: They'll get two shots, Greg?
Dr. Gregory Poland: Yes. I saw no particular safety concerns at
all. So, my understanding, and my own guess is that they will
likely approve that today, it will then go to CDC for
approval, and I would not be surprised to see kids starting
to get immunized in the latter part of the first week of
November. So, this is exciting news. These kids are at risk. As
you know, they can spread disease, and they represent a
large block of the U.S. population that, of course, is
unvaccinated. And it's an opportunity, I was just thinking
it sounds like a pun, I didn't mean it that way, for a shot at
a more normal kid's life. You know? So, I'm excited about
that.
Dr. Halena Gazelka: And what ages will this be, Greg?
Dr. Gregory Poland: This will be five to 11-year-olds. Now
studies are being done that will go down to age six months with
lower and lower doses. Because again, you know, those are
healthy kids, their immune systems are our Ferraris
compared to our Chevrolet or, you know, our slower immune
systems.
Dr. Halena Gazelka: Alright, Greg. Another listener wonders
about booster shots for those younger than 65 who don't fall
into the current risk categories. They thought it
would be nice with the holidays coming and people being closer
together, that more individuals could get boosters who are six
months out from their original series and be protected. When
will all of us be eligible for boosters?
Dr. Gregory Poland: It's a good question. It's unclear. There's
no meeting at this point scheduled for that at any of the
advisory committees. I don't disagree with that sentiment.
Several countries, Israel being the first one, I think they're
down to 18, maybe or 30. I can't remember, for routine boosters.
So, why do it? Well, on the one hand, they're not really at risk
for severe disease, death, or hospitalization. That would be
very rare if they otherwise had a primary series. But you are
still having breakthrough cases. And when you have a breakthrough
case, you increase the opportunity of spreading that,
transmitting that disease to those who are unvaccinated or
have weaker immune systems. So, I actually think it's a good
idea. I think that's what we will come to learn is that full
immunization against Coronavirus, COVID-19, is to
priming doses and a booster dose.
Dr. Halena Gazelka: Right. Well, thank you, Greg. Any last
words for us today?
Dr. Gregory Poland: You know, I think a couple of things. One of
the phenomena that's being seen nationwide, it's true here in
Minnesota too, is that we are beginning to recognize quite a
discrepancy between those who live in the more rural areas and
those who live in the more urban areas. In fact, the risk of
death due to COVID in the rural areas is twice that, even within
the same state, twice that of the urban areas. And that has to
do with I think one, a generally older population living in the
rural area, and not necessarily understanding or rejecting the
need for these vaccines and for boosters. So, I know we have
many listeners from actually all over the world. Getting
vaccinated is your singularly best strategy, augment it by
wearing a mask. I know not everybody shares that belief.
But this is not about beliefs. This is what does the science
show? What did the data show? And in fact, let me make one
other observation. When you look at the highest immunization
rates and the lowest infection rates, it's among the most
highly educated, the more wealthy, the people who live in
more urban areas rather than rural areas. So, if you don't
fit one of those three categories, you have to stop and
think, what do they know that I don't know? Why are they all
getting vaccine and not getting sick, but we are? And maybe
that's one avenue into opening that door to rethink your
position if you're not wearing masks and haven't gotten a
vaccine or a booster. This is really important. We're going on
two years now of this pandemic. And yet we have all the tools we
need to end this pandemic, and we just have not been able to
bring ourselves as a nation to do it.
Dr. Halena Gazelka: Very good points, Greg. I had seen an
article in one of the major news networks yesterday about that
there are physicians who are unaware of treatment options for
early COVID. So, before hospitalization, and I'm
thinking specifically of monoclonal antibody therapy.
Dr. Gregory Poland: Yes.
Dr. Halena Gazelka: And I thought, well, how tragic that
would be if people were not able to receive appropriate care as
well.
Dr. Gregory Poland: You're exactly right Halena. I mean,
compared to a year and half ago, it is miraculous, the therapies
that we have developed in this amount of time, monoclonal
antibodies being primary among them along with antivirals. In
fact, the Merck oral anti-viral is being reviewed now in Europe,
and I think soon in the U.S. too, but definitely avail
yourself of those therapies where appropriate under the
guidance of your health care provider, and don't hesitate to
ask about them. Now, I know that there are some areas that have
very, very high rates of disease still, where it's sometimes hard
to find them, and they run out of them. Again, no need for
that, get a vaccine and not wait for, you know, an expensive,
more difficult therapy after infection and complications have
happened.
Dr. Halena Gazelka: Sage advice. Thank you, Greg.
Dr. Gregory Poland: Pleasure.
Dr. Halena Gazelka: Our thanks to Dr. Greg Poland, vaccine,
infectious disease, and virology expert from the Mayo Clinic for
being with us here again today to give us our COVID-19 updates.
I hope that you learned something. I know that I did.
And we wish each of you a wonderful day.
Narrator: Mayo Clinic Q&A is a production of the Mayo Clinic
News Network and is available wherever you get and subscribe
to your favorite podcasts. To see a list of all Mayo Clinic
podcasts, visit newsnetwork.mayoclinic.org. Then
click on podcasts. Thanks for listening and be well. We hope
you'll offer a review of this and other episodes when the
option is available. Comments and questions can also be sent
to mayoclinicnewsnetwork@mayo.edu.