0:00

You're listening to the pandemic podcast.

0:02

We equip you to live the most real life possible

0:04

in the face today's crisis. My name

0:06

is Matt Boettger and I'm joined with my one good

0:08

friend, Stephen Kissler, an epidemiologist

0:11

at the Harvard school of public health. How are you doing buddy?

0:13

I'm doing all right. How are

0:14

you? It's good. You know,

0:16

it's, you know, doing this two week thing, it feels like

0:19

it feels a little bit longer, you know? So, it's

0:21

good to see you again. It's great to see ya. And

0:24

suddenly we got some stuff to chat about. It's, it's

0:26

kind of nice, you know, to do every two weeks.

0:28

I know some of our listeners probably would like to every week, It

0:31

gets a little more time to breathe and

0:33

kind of see what's going on in the

0:35

whole COVID spectrum, because now

0:37

somethings, sometimes things change

0:39

really quickly and it's in a week, but

0:41

other times it takes a couple of weeks to kind of really see

0:44

what's the w what's really, really making headlines and

0:46

what really needs to be talked about. I think

0:49

these two weeks have helped to frame a couple of things that I

0:51

want to share. With you

0:53

to see what's going on, but first, just

0:56

to hear what in your neck of the woods, you know,

0:58

now that you were saying a couple of things,

1:00

what you've been doing and the past two weeks,

1:02

what you've been working on over there at at home.

1:05

Well, yeah, so we've been doing some you know, a lot more modeling,

1:08

so, you know, different organizations

1:10

are really interested in just sort of how to keep their

1:12

clientele safe. As we're going into the

1:14

winter, as we're starting to think about, you know, Yeah,

1:16

just what sorts of testing do we need? It's,

1:19

it's really interesting because I think

1:21

that a lot of these questions have become a lot more nuanced.

1:23

Both as the technologies have advanced as

1:25

our understanding of the virus has advanced. And

1:27

I think a lot of the questions have shifted from is this safer?

1:29

Is it not? Or Do we need to test or do we need to not,

1:32

and now it's more like, so

1:34

we have this many people who are vaccinated and this

1:36

many who aren't, but they were vaccinated this many days ago.

1:38

And these are the vaccines that they were vaccinated with. And some

1:40

people we know, and some people we don't and there the different types

1:42

of tests that we have available, and we can

1:44

do it this frequently with this type of test. But it,

1:48

it, it keeps me. Well

1:50

employed for one and that's good.

1:52

And on my toes so it's been sort

1:54

of fielding a lot of those kinds of questions on different

1:57

levels. So it's been good,

1:59

challenging man, busy, the

2:00

same good, the same epidemiologists.

2:03

And so I'm pretty excited to be less

2:05

famous, but

2:06

I I'm sure. I know. Well, you know,

2:08

you mentioned winter and so let's start with this.

2:11

It's a bit on my mind. Maybe only like may

2:14

seven days really, because I think my wife

2:16

brought it, brought it up to me. I'm like, oh yeah. Like she

2:18

was like, what do you expect to winter to be, you know, you know, she's asking

2:21

me as if I'm a qualified person, but she just says, I have,

2:23

I have the gateway to asking these questions

2:25

to you and mark. So, you know, so

2:27

I'm gonna throw my scenario and then I want

2:30

the actual informed person you to actually

2:32

talk about. What you might

2:34

expect about the upcoming months.

2:36

I know we've done all these caveats

2:38

of you are not a magician. You can't

2:41

see the future. And when it comes to viruses

2:43

is way unknown. But given

2:45

what we know, so this is what I'm thinking, Stephen I'm. Okay. All right.

2:48

A couple of things have been happy in my mind. I follow

2:50

the news about every couple of days or maybe

2:52

about every day, at least for five or 10 minutes and clips

2:54

some articles, and I've seen a pattern. I

2:56

haven't seen a lot of

2:58

information on headlines about other

3:00

variants. Whereas say a month, six weeks

3:03

ago, eight weeks ago, there was

3:05

a number of headlines

3:07

talking about other variants other

3:09

than. So I'm thinking,

3:11

huh? I wonder what that is. We've talked about how Delta

3:14

is just way more intense it's, you know, at least

3:16

two times more contagious.

3:18

And so it seems to be a strong

3:21

force among variants. So, so

3:23

I'm thinking, you know, is there going to be another variance

3:25

like, or, or as Delta going to

3:27

keep things abate? I have no clue, but it seems

3:29

to be right now holding strong, which

3:32

for me is a great news. I mean, for a number

3:34

of reasons, Yes, because there's not new

3:36

new variants, but because Delta is incredibly

3:38

more contagious, but not necessarily

3:41

that proportionate in how worse

3:43

it is. Right. It's so I would

3:45

rather have a super, highly contagious one, roughly

3:47

the same kind of worseness whatever,

3:49

you know what I mean? And so keeping

3:51

those maybe more traumatic

3:54

mutations at bay, right? So

3:56

the. We're also seeing now

3:59

in the U S that cases are starting

4:01

to level out to decline overall. Right

4:03

now we're seeing hot pockets here and there. Someone

4:05

at, oh my gosh, is this winter going to be like,

4:08

just like, as really slow burn anticlimactic

4:11

in a good way. Right. As long as there's

4:13

no variance. So what are you thinking about what

4:15

this winter might look like in light of what we've seen so

4:17

far in the past two or three weeks?

4:20

No, I'm, I'm glad you bring all of this up because

4:22

I think that You know, last year,

4:24

last year, around this time, or even a little bit

4:26

earlier when we were talking about the winter, you know, I was,

4:29

I was pretty certain that we were going to have a

4:31

major winter search which

4:33

we did end up having. And

4:35

you know, that was based off of experience

4:37

with previous respiratory pandemics and some of the modeling

4:40

that we had done at the number of susceptible people

4:42

who were still in the population. We of course didn't

4:45

have vaccines at that point. And

4:47

so, yeah, I, you know, the,

4:49

the, the playing field has

4:51

changed. And I

4:53

am a lot less, I'm a lot less certain about

4:56

what this winter is going to look like as a result.

4:58

So one of the things

5:00

and there was a, there

5:02

was a paper on this by by some colleagues.

5:04

So I really highly respect last year. But

5:06

it also matches up with just sort of my own epidemiological

5:09

intuition, which is that the.

5:13

Sort of this, this seasonal variation

5:16

and transmission that we see where we see these real spikes

5:18

in the winter and troughs in the summer. Is,

5:21

it depends a lot on really just sort of the baseline

5:23

infectiousness of the virus itself. W which

5:25

is basically the, you know, if you have this virus

5:27

that sort of just on the knife surge of, of transmissibility,

5:30

where the reproduction number, once

5:33

you factor in behavior and immunity, and

5:35

all of these things is right around. Then

5:38

these subtle changes in

5:40

the weather and how frequently people spend time

5:42

indoors and so on is really enough

5:44

to sort of shift the virus on one side

5:46

or the other of that threshold. And that's what gives us this

5:49

seasonal change in transmission,

5:52

but for something that's a lot

5:54

more infectious, you know, we have this Delta. Variant

5:56

where you know, we think the reproduction number is

5:58

like on the order of six to eight

6:01

in a, you know, in a you know, in a population

6:03

with no immunity and where everybody's mixing at a normal

6:05

rate, but that's, you know, that's, that's quite a bit more infectious

6:08

than, than we think flu is. And

6:10

the result of that can sometimes be

6:12

that these seasonal variation

6:15

in transit. Sort of gets damped out. It's

6:17

sort of overwhelmed by just the inherent

6:19

contagiousness of the virus. And, and

6:21

I think that's, that's part of why we saw so much spread

6:24

this summer because the seasonal damping

6:26

effect that we normally see in the summer just wasn't

6:29

strong enough to. Really

6:31

do much to suppress transmission

6:33

of this, of this highly infectious variant.

6:36

And so then I think, you know, the question becomes, you know,

6:38

what do we expect to see this winter? And

6:40

it could very well be that with high vaccination

6:42

rates with lots of spread over

6:44

the course of this. That

6:47

we might actually not see as much of a winter surge

6:49

as we might've expected with

6:52

previous variants. I think that's possible

6:54

now. I, I do still expect to see

6:56

a bit of a surge, especially in places that

6:58

have colder weather, where people are going to

7:00

spend a lot more time indoors. I do think

7:02

that keeping control of the virus this winter, especially,

7:05

you know, up here in the Northeast is going to be a lot harder

7:07

this winter. And I do expect to see spikes in cases

7:09

up here. But I am hopeful that

7:11

it's not going to be. As

7:14

disruptive as last winter's search

7:16

was in large part due to vaccination

7:18

and due to exposure and all of these different factors

7:20

playing into it. So I don't think that

7:22

we'll able to be able to totally avoid

7:24

this kind of wintertime surge, but but

7:27

I, I know it's strange for me, but

7:29

I'm a little bit hopeful. You know, it the,

7:32

that it might It might be a lot less disruptive

7:34

than it could have been otherwise. So

7:38

great. You know? Yeah. Again, I mean,

7:40

not that I want to be thankful for

7:42

the amount of transmission in

7:44

the summer and cases, that

7:47

seems to be potentially to our advantage that

7:49

Delta raised locally head around,

7:51

you know, April, may, June kind

7:54

of, you know, again, allowing it to be not quite

7:56

as intense, right. I,

7:59

even though hospitals were overwhelmed still,

8:01

if I'm not trying to make light of some really particular

8:04

hard states. Yes,

8:06

but I could have only imagined if that

8:08

was December or January. Now

8:10

I get it. Florida's a little bit different if you were saying

8:13

how you know, they're kind of more in the inside during

8:15

the summer months because it's so just

8:17

crazy hot and humid and

8:19

maybe in the winter they're more outside. So that could, it

8:22

could cause it, so, before we continue on, I forgot

8:24

to mention this because we always say a couple

8:27

intro things that love reviews.

8:29

We've got two that came in this week. I'll

8:32

read this. This is from will

8:34

6, 1 9 6 happened on Thursday. Love

8:36

the podcast. Great way to stay up to date on

8:39

the, on the latest pandemic info. I'm an RT

8:41

in this podcast is a great way to keep up with

8:43

the newest variants treatment in vaccine.

8:46

Thank you. Will the 61 96

8:49

and then September 12th, squids 1, 1

8:51

12. I love these. Helpful

8:53

and quick knowledge, love this podcast to get instant

8:56

info on the pandemic as we learn more together,

8:58

super helpful and straight to the point. Thank

9:00

you. All of you for leaving reviews helps

9:03

us and inspire. Keeps us going. So

9:05

I want to do that. If you wanna support us in any way as

9:07

little as $5 a month, patrion.com/pandemic

9:10

podcasts, or just a one-time

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gift PayPal, then Mo all

9:15

in the show notes. Okay. I got the other

9:17

way we can continue to move forward as

9:20

I get back to my screen, it went away. Okay.

9:22

So the next thing I want to talk about is let's just

9:24

go straight to the vaccines. Cause there's a lot of information

9:27

when talking about I want to get to the boosts.

9:29

For sure. And let's talk about, you said there's

9:31

some news that dropped to this morning that I wasn't aware

9:34

of speaking of vaccine with. We want to share that.

9:36

Yeah.

9:36

So it seems like, what Pfizer

9:39

has just announced this morning is that they

9:41

now have safety and efficacy data for,

9:43

I believe it's five to 11 year olds.

9:46

So this is sort of the next age group down from

9:48

who the vaccine is currently approved for. I

9:50

believe it's a smaller. Then what's normally

9:53

given to adults, which is pretty standard for pediatric

9:55

vaccines. And

9:57

yeah. I haven't seen the data yet. I don't think that they've

9:59

actually released those data yet, but they

10:02

say that it looks good. So I'm looking forward to reviewing

10:04

it. And and I imagine, you

10:06

know, if, if it does bear out, then, then we, we

10:08

could start to see some regulatory changes relatively

10:11

quickly. I wouldn't be surprised if we start to see

10:13

vaccine approvals for those

10:15

age groups. And the coming month or so,

10:17

so

10:18

great. That's awesome. And then let's

10:20

just continue on the heels of this. You said there was a piece

10:22

of information as well. New news that may drop later

10:24

on today or tomorrow

10:26

it's related to kind of the vaccines, it's all about

10:29

safety and, and, and reduce

10:31

the level of mortality. But you said there's kind of a

10:33

interesting statistic that might be making

10:36

headlines soon.

10:37

Yeah. So, I was speaking with some

10:39

journalists over the weekend and sort of talking about.

10:42

What's going to be coming up. And there's,

10:45

there's a really significant threshold. Unfortunately

10:47

that we're about to cross. And

10:49

that is that the the number of deaths in the United

10:51

States is about to pass 675,000.

10:54

The number of recorded deaths from COVID-19.

10:57

And that's significant because that is

11:00

the same as the best estimate of the number of deaths

11:02

that we suffered in the U S during the 1918

11:05

flu pandemic. So that's, you

11:07

know, even just from a cultural

11:09

and social significance point of view, you know, that's,

11:11

that's, that's a big deal. Now of

11:13

course, in in my conversations this weekend, I

11:15

was talking about a lot of these things too. There are,

11:17

there are a ton of reasons why.

11:21

We need to interpret these numbers in context first

11:24

and foremost, of course, is that the United States is

11:26

over three times as big as it was in

11:28

1918. So on a per capita basis

11:31

the COVID-19 pandemic still

11:33

has not been as deadly as

11:35

the 1918 flu pandemic. And

11:38

you know, furthermore, as we've talked about in a number

11:40

of episodes since the question of mortality

11:42

data is, can be a really sticky

11:44

one in the sense that you know,

11:46

what, which, which deaths

11:49

do you actually attribute to COVID? So

11:51

there, there may be some undercounting,

11:53

you know, or there may be some over counting in some contexts,

11:55

but there's almost definitely a lot of undercounting

11:58

as well, because we've seen these huge spikes

12:00

in excess mortality. But

12:02

really surpassed the official counselor COVID

12:04

19, but also, you know, that was

12:06

probably in play even more so

12:08

during the 1918 flu pandemic, because there

12:10

really weren't these national

12:13

robust crosschecked

12:15

data streams for mortality data. Then

12:17

either a lot of our estimates come from

12:19

sort of these rough estimates that we're extrapolating

12:22

from certain populations. And

12:24

certainly. Minority

12:27

populations at the time were not counted in

12:29

any sort of rigorous way in the mortality

12:31

counts either. And we're doing better at

12:33

that now, but still not perfect.

12:35

And you know, so, so there they're

12:37

all of these issues, but but nevertheless,

12:40

I think that it's, it's a significant threshold to

12:42

cross. And I think that we're probably going to be hearing

12:44

a lot more about that.

12:46

Yeah. Now, if you're new to our show, how

12:48

do you know which episode this was? We've talked about a couple

12:50

of times mark and Stephen, when they were both on

12:52

that, it was new to me. Early on there was all

12:55

of this kind of misinformation

12:57

about like conspiracy is

12:59

about over counting deaths.

13:01

As COVID. Now I'm not saying there's

13:04

not abuse. I w I'm

13:06

sure there could be a, you know, I'm sure

13:08

there's some abuse in some level on

13:10

COVID deaths, but in general, It

13:13

just really positing the difficulty

13:15

in, you know, the nature of our show. It's okay. It's, it's

13:17

complicated. The complexity of

13:20

actually determining the cause of death.

13:22

And this is not just strictly a COVID

13:24

issue. You bring mark back on here

13:26

and he'll definitely tell you about how it's just not straight or

13:28

it's not like a little like know algorithm you just put

13:30

in and it just tells you, there's just,

13:32

you know, there's narrative and there's

13:34

context. And, and so

13:36

it's a complicated reality that, that, that

13:39

this makes things harder. Not

13:41

conspiracy, just part of humanity.

13:43

So the complexity of humanity,

13:45

now let's get into this vaccine

13:48

and I'm trying to find a way to how I could maybe weave

13:50

this into one discussion because

13:53

we have vaccine to discuss

13:55

in general, right? Just Medina it's,

13:58

you know, you know, just hitting the topics like its efficacy

14:01

being stronger than Pfizer. We can

14:03

talk about that, but maybe the

14:05

context, and then we talked about immunity. And

14:08

how that works

14:10

and the waning immunity in light of when you might

14:12

need a booster and these kinds of things.

14:14

So let's maybe let's make the anchor

14:16

point, this Israel study. So

14:19

that might be a revolving way

14:21

for us to see it everything. So if you're

14:23

not familiar, there was a study

14:25

done in Israel. Credible

14:28

about really suggesting that there is a significant

14:30

Wayne and ethicacy in particularly

14:32

the Pfizer. What kind of thing that dominated Israel?

14:35

I mean, that's the one they used the

14:37

Pfizer vaccine you

14:39

know, down to maybe even like 40 to 50%

14:42

effective when it comes to I think

14:44

hospitalization or the I forgot

14:46

what that was, but something you can correct me on

14:48

all these stats. I'm just general. But

14:50

pretty significantly low 40, 50, 60%

14:53

on, on, on those kinds of things. So.

14:57

This has been circulating, suggesting that,

14:59

oh, we should really advance a cause

15:01

of a booster, right? Because if that's that

15:03

dramatic now, you know, Biden

15:05

and the administration advance for a booster for everyone,

15:08

FDA just came out, you know, kind

15:10

of countering and say, no, that's more nuanced.

15:13

Let's do that for 65 or older. Those

15:15

who are at severe risk. And I heard, they just released

15:17

a third tier that's basically health workers

15:20

that are like that, that are in constant contact. Those

15:23

kinds of three, three groups. So

15:25

we're seeing this kind of fight of what should

15:27

we do? Should we get a booster? Is

15:29

Pfizer really not effective? Now

15:31

we've got to pull in immunity and

15:34

waning and these kinds of factors in

15:36

this great article I've put in the show notes, please,

15:38

please, please read it as body

15:40

Atlantic waning immunity is not a crisis

15:42

right now. And to put it in there about

15:45

how fi you know, Pfizer also had.

15:48

Really suggesting that there's waning immunity, there's

15:50

antibody reduction significantly

15:52

within the Pfizer vaccine, maybe after six

15:54

months, eight months, these kinds of things. And

15:58

maybe you can help us sort all this out

16:01

when it comes to, again, like

16:03

last week, antibodies are

16:05

not the sole reason that

16:07

w the sole measurement of

16:10

whether we have strong immunity. And,

16:12

and really kind of helped us go through the T-cells B

16:14

cells antibodies in what

16:17

you think in the end, let

16:19

them all this craziness. What

16:21

is your suggestion when it comes to. Efficacy

16:24

and

16:24

boosters. Yeah. Yeah.

16:26

So let's let's try to break this down.

16:28

You know, and this is something that that's you know,

16:30

as, as this introduction or the

16:32

eldest is complex and it's something that, you know,

16:34

even we, epidemiologists are trying

16:36

to wrap our heads around in there's a lot of

16:39

disagreement or at

16:41

least, you know, very vigorous discussion

16:43

about, you know, sort of what, what the right path forward

16:46

is because it does play into, you know, there are these. Biological

16:49

physiological, epidemiological considerations,

16:51

but also social considerations considerations

16:54

to justice considerations to equity safety,

16:57

all of these things are really factoring

16:59

into this and that this is a pretty sticky situation.

17:02

So right. So we have the vaccines, we,

17:04

you know, some of the story that's starting to emerge

17:06

is all right. So it seems like the efficacy

17:09

of the modern vaccine seems to be holding up a little

17:11

bit more strongly than. Both

17:13

of them seem to be holding up more strongly than

17:15

the AstraZeneca and the Johnson and Johnson. And

17:18

so now there are a lot of questions as to what do we do

17:20

in this context. So as you

17:22

mentioned, this study from Israel is

17:26

one of the best that we have to date

17:28

on, you know, clear. Numbers

17:31

regarding the sustained

17:33

efficacy of these vaccines in

17:36

a real setting, which is really, really what we're

17:38

after. You know, we can measure antibodies,

17:41

we can measure sort of, you know, levels of immunity

17:43

in the blood. But all of those things are really

17:45

just proxies for what we care about,

17:48

which is, am I protected

17:50

from infection? Am I protected from symptoms?

17:52

Am I protected from hospitalization? And am

17:54

I protected from dying? Given

17:56

vaccinations. And

17:59

the study from Israel really did see

18:01

a pretty clear evidence of waning immunity. The

18:04

biggest declines in immunity you know, looking at

18:06

these different tiers it was of course in symptomatic

18:09

disease of any sort of showing any sort of symptoms.

18:11

And I think that's where we saw the sharpest declines. Efficacy

18:14

against hospitalization and deaths remained

18:16

high, but was definitely lower. I think,

18:18

I don't know if it quite reached down to that 40%,

18:21

but I, I think it was still, you know,

18:23

probably on the 60 to 80 level, which is,

18:25

which is lower, you know, definitely lower than

18:27

we were seeing with early on in,

18:30

in as these vaccines were first being rolled out.

18:32

And so that's, you know, that's the first thing that

18:34

sort of perks up your ears and it

18:36

makes you want to learn more. So

18:39

what's going on here? Well, you know,

18:41

first of all, we waning

18:43

immunity whether to natural infection

18:46

or to a vaccine is totally

18:48

natural, happens all the time. Really?

18:51

The outlier is

18:53

things that we get permanently immunized

18:55

to. So things like measles and

18:58

to some extent like varicella, which causes

19:00

chickenpox, you know, Viruses

19:02

in particular that basically

19:04

you get exposed to them and by, cause you know, they give us lifelong

19:07

immunity. Yeah, that's

19:09

pretty rare. You know, you can think about all sorts

19:11

of other infections, whether it be RSV

19:13

or flu or tetanus

19:15

you know, not naturally, hopefully you're not being naturally

19:17

infected with tetanus, but, but we have to get boosters

19:20

every 10 years, right. To keep up our immunity, to tetanus

19:22

for the same reason that our immunity wanes it

19:24

declines over time. And it seems like

19:26

for the coronavirus vaccine and for natural

19:28

infection, that seems to be the case here as

19:31

well. As

19:33

you mentioned this Atlantic article really you know,

19:35

describes this in a good way. You know, w

19:37

we can ask the question, like, why does

19:39

our immunity weigh in? And part of that is because

19:41

if we, if we kept these really high levels of

19:43

immunity to everything all at once, there's

19:45

just not enough space in the body for

19:48

all of those cells to keep circulating. And

19:50

so, so it has to decline. And so

19:52

really what our body has is this memory that allows

19:54

us to Mount a good response quickly. But

19:58

that response gets better and better. The more we get exposed

20:00

to a virus. And so, so the question that we're

20:02

trying to answer now is how many exposures do you

20:04

need and how does that depend

20:07

on the vaccine that you've gotten and

20:09

really critically on how old you are, so

20:11

that it brings in an extra layer of complexity into this study

20:13

from Israel, which is that the

20:15

they really focused on

20:18

vaccinating the oldest members of their society

20:20

first and sort of worked down the age group.

20:23

The people we have the most information about right now

20:25

on waning immunity as for

20:27

the most elderly. Now in this study, they did

20:30

break down by age group and they actually did show that

20:32

in younger age groups, it seems like the immunity

20:34

is better sustained than an older age

20:36

groups. That's also a very

20:38

well known phenomenon across

20:41

epidemiology, which is that frequently. You

20:43

know, we, we have just like, we have a physical age,

20:45

we also have an immunological age. And

20:48

that correlates with our ability to.

20:50

Mount a good and effective and sustained

20:53

response to things that we've been exposed to. So

20:55

oftentimes when people are older, They

20:58

need a higher dose flu vaccine, for

21:00

example, or they need boosters more frequently

21:03

against the pneumococcal bacteria.

21:05

And so this is, this is also very consistent.

21:08

And I think that what we're beginning to learn now

21:10

is, you know, not only do we need boosters,

21:13

but also who needs boosters and why

21:15

and how frequently. And so all

21:17

of that is sort of what the study from Israel is starting

21:19

to inform. That

21:21

then brings us to some of the FDA decisions

21:23

that that we heard over this past week. So

21:26

for a while the white house has been

21:28

saying, you know, we want to approve

21:30

boosters across the population,

21:32

basically, as soon as the FDA gives us the green

21:35

light and seems to really have been pushing for that.

21:37

So the FDA came back with really interesting decision,

21:40

which was that? Well, actually, actually,

21:42

no, we're not, we're not going to recommend

21:44

boosters for. Because

21:47

the the data just doesn't really suggest

21:50

that for people under the age of 65

21:52

who are healthy and have no other comorbidities

21:54

and aren't exposed to high levels of the virus

21:56

that they're actually going to have

21:58

much of a benefit right now from

22:01

a booster relative to the protection that they already

22:03

have no getting a booster will actually

22:05

provide, you know, it will absolutely provide greater

22:07

protection for those age groups.

22:09

But we have to remember that those age groups are

22:11

on average. Closer to

22:14

their finishing their vaccine. So, so,

22:16

people like me are more freshly vaccinated,

22:19

you know, my I already have higher levels of antibodies

22:22

in my system than people who were vaccinated earlier

22:24

and I'm younger. I got walloped

22:27

with the second dose, you know, and so I

22:29

don't know if that actually correlates to the level of protection

22:31

that I have, but I can guarantee you something happened

22:34

and I, you know, there's and

22:36

so. So I think that this,

22:39

this decision is actually interesting and based off of the

22:41

data we have available makes it makes a lot of sense

22:43

because those older age groups are

22:45

more likely to be further away from their vaccine. And they're more

22:47

likely to suffer the severe effects from COVID-19

22:50

anyway, and they're more likely to have

22:52

less durable immunity in the first place.

22:54

And so vaccinating those age groups with a third dose

22:56

makes an awful lot of sense. And

22:58

I do think that we will probably approve

23:01

a third dose for everyone at some point,

23:03

but. Necessarily think

23:05

that the time is now. And I

23:07

think it still makes sense. You know, we, we

23:09

have a huge abundance of vaccines

23:11

in this country, but. The

23:13

other thing that we've talked about in the last episode, I

23:15

think, and that has been factoring into a lot of these

23:17

decisions is that, you know, how do we balance

23:20

giving third doses to our own country versus

23:23

trying to provide vaccines for the rest

23:25

of the world? And I think that's really critically important

23:27

too, because. Vaccination

23:29

rates in a generally more

23:31

wealthy countries are much, much, much higher

23:34

than in other countries

23:36

who aren't able to afford the doses

23:38

or who weren't as quick to the, you know, securing

23:41

the doses or whatever, where distribution

23:43

is more difficult. And so I think that there's,

23:45

you know, we have to put in a really big effort to make sure

23:48

that we're providing doses to those countries as well.

23:50

And that's even in our national interests,

23:52

you know, we, we really. Prevent

23:55

the spread of COVID across the world because that's,

23:57

what's going to keep new variants from emerging. And that's,

23:59

what's going to keep infection from

24:01

spilling back over into the United States. So

24:04

from a humanitarian perspective, from a nationalist

24:06

perspective, from all of these perspectives, that makes a lot of

24:08

sense to raise vaccination

24:10

rates around the world. And

24:12

so I think it's actually a very good choice to still

24:15

protect the people who we know to be most vulnerable, but

24:17

for right now, to really focus on distributing

24:19

vaccines around the world and to do those things

24:22

simultaneously to really throw our weight behind

24:24

both. And I think that's

24:26

a really interesting and seems to me

24:28

like a very good way

24:30

forward to that. Both

24:32

the scientific data, but then also sort

24:35

of the social responsibility and

24:37

this long view forward for where do we

24:39

want to be in this pandemic in the next six months? It

24:41

seems to really integrate all of those things in a good way.

24:43

So I was, I was pleasantly surprised.

24:46

Great. Yeah. Can you help make sense? You

24:48

know, you know, I was thinking about, okay, the Biden administration.

24:52

They advance boosters for

24:54

everyone, you know, to me, I

24:56

could, I could logically

24:58

think through why Biden would want to,

25:01

and this administration wants to advance the cause

25:03

of that. Right. There's I won't get into that. Right.

25:05

That's the gets into the politics. Sure. But what I

25:07

want. Fast adviser as

25:09

Fowchee kind of backing

25:11

Biden. Who's he's, he's the science

25:14

guy, right? So he seems

25:16

to be at odds with the FDA. And

25:18

he still seems to be like, kind of answering the

25:20

cause of he still wants this to happen.

25:23

Can you help make sense of this in light of it? You

25:26

know, it may be, it just reveals the fact that. The

25:28

data really is complicated,

25:30

you know? Cause I, you know, I see in that

25:32

Atlantic article, they read about how

25:34

we know one reason why not to advance

25:37

boosters for everyone is because

25:39

of a particular demographic age demographic.

25:41

Because when you look at the teenage people

25:44

who, who they're in very

25:46

rare circumstances can

25:48

suffer from what like myocarditus.

25:51

Here's pericarditis, which I didn't know about. I don't know

25:53

the difference. Maybe you can, if you know the difference, you can talk

25:55

about those two. I have no idea, but this to exist.

25:58

Yeah. We need mark desperately. So these,

26:00

these two things exist. So they're like, well, it

26:03

may not actually be worth the costs given

26:05

how little they're susceptible already

26:07

and they've already been vaccinated twice. So

26:10

there is these kinds of situations. So is that's

26:12

where FDS reserved, but then here's Fowchee is

26:14

still really advancing. Is

26:16

there, what's the science behind

26:19

staying in that direction. Yeah. So

26:21

I think in my mind, a lot of what's

26:23

going on here is really just a question of time.

26:25

So I think the, you know, the

26:28

again, I, I

26:30

imagine that probably within the next

26:32

six months to a year, that third doses

26:34

will probably be approved. Across

26:36

age groups, because at that point,

26:38

you know, we'll have had more time for those age

26:40

groups in their immunity to weigh in and we'll have more data

26:42

and information. We'll just have more information

26:45

available to make a really sound decision

26:47

about that. I know

26:49

that with Dr. Fowchee, a lot

26:51

of his sort of, Well, it

26:54

seems like the reason why he is throwing his weight

26:56

behind this idea of boosters for all

26:58

is because it really, the question there comes down

27:00

to you know, resources,

27:02

like what, what are the resources we have available? And

27:05

he's very convinced that this

27:07

both and approach of. Providing

27:10

third doses for people in the United States

27:12

and providing doses for people around

27:14

the world is feasible. That, that

27:16

we could enter into this false narrative

27:18

of scarcity. When in fact there is

27:20

none and that, you know, we can, we can argue

27:22

about, well, do we do one or the other,

27:25

you know, are we, you know, stealing

27:27

doses away from the rest of the world? If we vaccinate

27:29

people here And you know, who better to

27:31

know what these numbers are then him, you

27:33

know? And he, he seems to believe that like, well,

27:35

no, there's, there, there is actually no

27:37

narrative of scarcity here that and,

27:39

and we can do, we can easily do both at

27:41

the same time. We can throw our weight behind. And

27:44

I think that's a really compelling argument, you know? But

27:46

it also makes sense to me that

27:49

an organization like the FDA who

27:51

is ultimately, you know, they're the ones with

27:53

whom the buck stops with

27:55

these decisions. They're ultimately responsible

27:57

and it would make sense to me that they would want to

27:59

tread slowly. I

28:02

think it's true that for those who are

28:04

under 65 and don't have co-morbidities

28:06

and are not frequently exposed to COVID-19 and

28:08

already have, are fully vaccinated

28:10

against COVID-19 that

28:14

the risk of hospitalization

28:16

and death from COVID is now. Not

28:19

that much different from many other risks that we bear

28:21

in our day-to-day life. And that's really

28:23

what they're trying to evaluate is like, how

28:25

does this risk stack up in other risks

28:28

that we accept every day? Yeah.

28:30

And so that seems sound

28:32

to me. And again, I think that there will come a time

28:34

when it makes sense, you know, of course

28:37

the risks that we face in our day to day life compound.

28:39

So, you know, we might have. Risk

28:42

from flu and a risk from COVID on a risk from

28:44

tetanus and a risk from all these other things. And we don't want

28:46

those to add up too much. So it makes

28:48

sense to introduce a third

28:50

dose at some point to reduce that risk. But right now

28:54

I think that it's a totally sensible choice to

28:56

say, like we've got plenty of data to know

28:58

for sure that a third dose for people over the age of 65

29:00

makes a lot of sense. Absolutely. I

29:04

think we can wait a little bit on, on,

29:06

on approving it. It's sort of, you know,

29:08

just pushing the decision down the road a little bit. And

29:11

again, I really want to emphasize that there

29:13

is a lot of room

29:15

for reasonable disagreements, amongst people

29:18

who are very well-informed on this. This

29:20

is even putting me at odds with some of my own very well-respected

29:22

colleagues who have been really pushing for

29:25

either a third dose or who had

29:27

been pushing for it and not giving third doses to

29:29

anyone until everyone in the

29:31

world. So. So

29:34

I'm sort of threading this middle ground, which

29:36

it seems like the FDA has chosen to as well.

29:38

But I just also want to emphasize that

29:40

this is, you know, this is just one young epidemiologists

29:43

perspective and there's a lot of there's

29:45

a lot of room for discussion out there.

29:47

Yeah. This is an insensitive

29:49

probably kind of way to say things because

29:51

of when I was a child, when you mentioned Fowchee saying

29:54

maybe it's not necessarily either or, but both hand, it

29:56

kind of reminds me of like when I was a child, And

29:59

yeah, I definitely heard from my grandma when I was eating dinner

30:02

and I didn't finish my plate and she would always use

30:04

the flame. Well, they're starving people in Africa.

30:07

Right. And so somehow that's supposed to make

30:09

me eat my plate because you know, some of

30:11

that, there's a relationship between the two and it's and

30:13

it's really, it's not a relationship directly between whether I

30:15

eat my peas and whether the somebody who's fed,

30:17

you know, it's just kind of a way to, like, I think that's a similar

30:20

kind of reality with with, without you

30:22

saying, like it's not necessarily. By

30:24

taking a mercy in an article by this, by take, by receiving

30:26

the vaccine in the U

30:29

S doesn't deprive someone

30:31

in somebody it's, it's much more complicated scenario

30:34

that you have to work with in policy that

30:36

actually needs to be addressed to be able to provide

30:38

these. So, you know, one thing

30:40

I wanted to drop on. Unless

30:43

you have anything else that you want to share, that that peaks your

30:45

interest. We didn't talk about this, but

30:47

I figured this might be an interesting topic if you know anything

30:49

about this, because since right now,

30:51

I feel as if the variants are kind

30:54

of at bay right now, there's not like, at least,

30:56

at least in the mainstream. We're

30:59

not talking about, I'm sure all you scientists are studying

31:01

all these little variants on a small level and seeing

31:04

where they're going and how they're. But I

31:06

remember seeing this article about three months ago,

31:08

maybe two months ago about us,

31:10

isn't prepared to track COVID variants

31:12

as Delta mutation spreads. Right? So now

31:15

it's all over this. This was back in probably may.

31:17

Have you heard anything talked about your colleagues

31:19

about what the us has done

31:21

or been trying to cultivate to

31:24

be maybe like a front runner,

31:26

kind of like the UK on really

31:28

being able to see a variance in the context

31:31

of the us and, and it starts kind

31:33

of scoping them out before they get too large.

31:36

Yes, we're, we're making progress

31:39

on it. Slow and steady progress, but progress,

31:41

you know, that's I, in many ways, you know, especially

31:43

early in the pandemic, you know, frankly, the UK has

31:45

run circles around us in terms of their

31:47

genomic surveillance for this

31:49

epidemic and, you know, kudos to them

31:52

for that they've and a big part of that is just

31:54

you know, there were some very clear policy

31:57

and funding decisions where. They're

31:59

public health regulatory agencies decided

32:01

that that was actually an important thing to do. And here, you

32:03

know, some similar proposals were advanced

32:05

and ultimately decided, well, we don't actually

32:07

need those as much. And so now that led us to the situation

32:10

that we're in, where we're kind of trying

32:12

to catch up. Now a lot of the sequencing

32:14

and a lot of the genetic surveillance that is

32:16

being done is still being done. At universities

32:19

and in local public health agencies.

32:22

So like for example, the

32:24

New York city department of health and

32:26

different universities are sort of acting as

32:29

the sequencing hubs for their

32:31

regions currently in doing a lot of the sequencing

32:33

and analysis and epidemiology

32:35

to try to figure out what's circulating and where

32:38

and that That's fine,

32:40

but definitely having an integrated platform

32:42

and, you know, agreement about, you know, who's doing

32:44

what a little bit better distribution of labor

32:46

there makes a lot of sense.

32:49

And so that's something that we're moving towards.

32:51

So that is going to be one of the key.

32:54

Goals. I believe of this new

32:57

national center for outbreak analytics

32:59

that's being started and is actually going to

33:01

be led by mark Who's

33:03

one of my very close colleagues

33:06

and mentors here at the school

33:08

of public health at Harvard. And so I think that's

33:10

going to be one of their first and

33:12

central efforts is, is trying to figure

33:14

out how they're going to make a national

33:17

responsive platform for

33:19

Genetic outbreak analytics in the

33:21

United States. So, but that's,

33:23

you know, we still have some time it's going to take a while

33:25

to build that infrastructure, to build the

33:27

sort of organization that we need for that kind of thing. So

33:31

it may still be some time before we build

33:33

up that capacity, but it's, it's moving in

33:35

the right direction. It's something that. Just

33:38

about every epidemiologist is thinking about right now.

33:40

And so, yeah, so we're, we're, we're racing

33:43

to to get it to get that sort of thing put

33:45

together. It'll come, it'll take some time, but it'll, it'll

33:47

get there.

33:47

Yeah. And I didn't even know this existed, so I don't know if you

33:49

have any information you could put in the show notes or links

33:52

to this new research or whatever

33:54

with mark at the head of it. And just, if he wants to follow

33:56

up, see what's going on, see their first kind of seeds

33:59

of movement. I'll try to put in the show notes if

34:01

Stephen can share. Great. I

34:03

think that's it for, for today.

34:05

We're good. I hope. You

34:07

guys have a wonderful week. We'll see you

34:10

guys yet. Our Dar normal every

34:12

two weeks until things change, you

34:14

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34:27

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34:29

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34:31

a wonderful time. We'll see you guys in two weeks.

34:34

Take care and.