Mary Louise Kelly of MediaFrolic speaks to Dr. Celine Gounder, an infectious disease specialist and epidemiologist at New York University, on mixing and matching COVID booster vaccines with an original vaccine.
AILSA CHANG, HOST:
Eleven months ago, in December 2020, the US had just launched its mass vaccination campaign. Looking ahead to this winter, we are in a completely different place. Almost 70% of Americans 12 and older are fully vaccinated. And this time it’s about booster shots. The FDA has now expanded the approval for Pfizer and Moderna boosters, stating that anyone 18 or older would like to receive them. A panel of experts advising the CDC made similar recommendations today. And tonight, CDC director Rochelle Walensky signed booster for everyone. But it does raise a question. When faced with a choice, which booster should you get? And is it worth mixing and combining? We will answer these questions from the infectious disease expert Dr. Celine Gounder from New York University. My co-host Mary Louise Kelly interviewed her earlier today.
MARY LOUISE KELLY, HOST:
There are some nuances in the CDC recommendations today. They say that people aged 50 and over should be given the booster, while people aged 18 to 50 can get the booster. What are your thoughts on that? Is it optional for anyone under the age of 50?
CELINE GOUNDER: Well, to be clear, even among the 50-year-olds there are those who can. So if you don’t have any risk factors it is recommended that you get a booster anyway. And for those over 50 who have pre-existing conditions, it should receive a booster vaccination. And at the end of today’s meeting there was some debate. Should we just do it for everyone over 50 years old? – because the vast majority of them are likely to have an underlying medical condition, whether or not it was diagnosed or undiagnosed.
KELLY: Well – and that leaves me confused and the whole …
KELLY: The whole point of this new guide was to try to get some of the confusion and nuance out of it. Is this new guide too nuanced? Should you have just done it? Appearance; Everyone only gets one booster. What’s the harm?
GOUNDER: Well I think the big plus is when you’re 18 and older – so if you’re an adult in this country – you want a refresher, you can get a refresher. I think there are some nuances in terms of who should, who may. Some of this will continue to be ironed out as we get more data. But if you’re 18 or older and want a refresher, you can get a booster provided Dr. Walensky, the director of the CDC, signs today’s vote.
KELLY: As for the question I just raised, what’s the harm in getting one, there’s an ethical question here. I remember the director general of the World Health Organization tweeted a few months ago that it was unreasonable for some countries to offer boosters, including the US, while so many others in the world had no vaccine at all. Is a refresher for someone in this country at the expense of an unvaccinated person abroad?
GOUNDER: Well, for logistical reasons, it’s very difficult for us to ship all of the vaccine doses that we have here in the United States overseas. So I don’t think the person who chooses to refresh should feel guilty. I think there are bigger, systemic problems that need to be addressed because on a global level it is a zero-sum game. You have a shortage of vaccines. There are not enough vaccines for many countries in the world. But that’s really up to government officials, not the average person trying to decide whether or not to get a booster.
KELLY: On the mix and match questions, if I got a vaccine to start with, then I got Moderna. Should I get a Moderna booster syringe? Can I get a Pfizer? Is it important?
GOUNDER: So that’s already regulated, which means that as a booster, you can get anything you want. By and large, based on what we see from the data, people are pretty stuck – when they have Moderna they get a Moderna booster. If you have Pfizer, you get a Pfizer – you get a Pfizer booster. The only thing we see mix and match a bit is with people who got Johnson & Johnson to start with who are now …
(NOISE FROM DOG BELLS)
FOUNDER: Sorry. My dog is in the background.
KELLY: I see your dog has an opinion on this.
GOUNDER: You want a booster too. You know, I think by and large we’re seeing some mixes and adjustments in people who got J&J where they got Moderna or Pfizer as a booster.
KELLY: Yeah. I mean, so we can get – we can mix and match. Shall we mix and match? I’ve seen some data that suggests getting one vaccine first and then switching to another might help boost your immune system.
GOUNDER: Yeah, I mean, that’s a theoretical possibility. What we see is more likely to be related to the dose. In the mix-and-match study, the recipients with the Moderna-Boost received higher doses, but in the real world they actually get half a dose for the booster, so to speak. So I really don’t think you’re going to see any significant differences between the three different brands. I would say go with what is easiest for you when you get a booster.
KELLY: Are we starting to see significant differences in the effectiveness of the three vaccines that have been offered to Americans – Pfizer, Moderna, Johnson & Johnson? We were told they all work. You should all get vaccinated. But there is some data coming out that shows that maybe one protects a little more than the other.
FOUNDER: Yes. So it is now clear that the Johnson & Johnson vaccine should be viewed as a two-dose vaccine, much like Moderna and Pfizer were before. So that’s pretty clear. In terms of Moderna compared to Pfizer, Moderna seems to be a bit more effective and durable. And again, this may be related to the fact that the Moderna vaccine of this mRNA vaccine only gives you a higher dose than the Pfizer vaccine.
KELLY: And when you say that some of the data pointing to Moderna could be both more effective and more durable, just to emphasize that that means – both that it might offer a little more protection and that that protection will last longer .
GOUNDER: That’s right. Correctly. And I would still say, you know, these are very small differences. You know, I got the Pfizer vaccine myself, one of the first to be eligible for first aid. I got my first dose of vaccine last December, and all we had then was Pfizer. And I really don’t feel any less – significantly less protected than someone who has received Moderna at some point.
KELLY: Last question – any Thanksgiving tips on risk-reward balancing when it comes to holiday gatherings?
GOUNDER: (Laughter) Well, I think ideally everyone would be vaccinated. And the other things we recommend – so think of them like winter shifts. You know, you wear your sweater and your jacket and your mittens and your hat. You know, combine other things in a similar way. So, you know, when you’re in a place that allows, do as much outdoors as possible, or open doors and windows. Buy a HEPA air filter unit if you can and place it in the dining room or other places where people sit together. And then finally quick tests. They’re still too expensive for most people, but if you can afford them, try them out on Thanksgiving Day. When you are negative you can enjoy.
KELLY: This is Dr. Celine Gounder, NYU epidemiologist who also practices at Bellevue Hospital in New York City. Thanks very much.
GOUNDER: It’s my pleasure.
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