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Scripps Research Director Weighs In On Vaccines, Boosters And The Fourth Wave

In this March 2021 photo provided by Pfizer, vials of the Pfizer-BioNTech COVID-19 vaccine are prepared for packaging at the company’s facility in Puurs, Belgium.
Associated Press
In this March 2021 photo provided by Pfizer, vials of the Pfizer-BioNTech COVID-19 vaccine are prepared for packaging at the company’s facility in Puurs, Belgium.
As public health leaders continue to emphasize the important of vaccination in fighting the nation's ongoing COVID surge, many Americans are left with questions about the future efficacy of available vaccines.

Johnson & Johnson on Wednesday announced findings that booster doses of their one-shot coronavirus vaccine would provide a significant boost in immunity to recipients. This comes only days after FDA approval was granted for the Pfizer-BioNTech vaccine and only a week after leading health officials announced plans to deliver booster shots of the Pfizer and Moderna vaccines to all Americans. As the nation continues to grapple with its fourth wave of the virus, many are left with questions about the vaccines, the status of their approval and their long-term efficacy.

Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, joined Midday Edition on Wednesday to answer those questions.

Q: FDA approval was granted for the Pfizer vaccine just days ago. You've been critical of how long it's taken for this approval process to play out. What's your reaction to this news?

A: I'm certainly gratified that it did get approved and it will help considerably. The only issue was the approval, had it come in late May or June, which was certainly possible, it would have done so much more to prevent the toll of the delta waves that we are now experiencing. So it will lead to, and it already has, a lot more mandates by companies and schools and universities, municipalities, health systems, everywhere across the board, but had that occurred many weeks ago, it would have been even more helpful.

Plus, we know that many people were holding out for getting the vaccination to make sure that it was past this so-called emergency authorization and had been given the full FDA go-ahead. So there will be many individuals ... who will now go on to get vaccinated, which is great.

Q: Can you explain in layman's terms how efficacy for a vaccine can wane over time and why boosters would be necessary?

A: Before delta, there was little evidence of this waning issue, but what happened with this delta strain is that it's so much more formidable. It's not just more contagious, but it's challenged the vaccines. It's the antibody waning problem with delta specifically over time that starts at around five or six months, but still protection that's quite strong against hospitalization or various severe illness because of the originally induced cellular response against the virus.

Q: We have a sense of how the vaccines administered in this country wane over time, but what about the vaccines elsewhere? What is data showing around the globe?

A: Well, it's interesting. This problem of the waning immunity has first shown up in Israel because they were the earliest country to get to high-level vaccination, but we are seeing it not just with the Pfizer and Moderna, also with AstraZeneca, and I suspect because of delta we will see it across the board. But the studies of large numbers of people past six months are just starting to come in in recent weeks. And the delta wave, of course, just started here in July, so we're just getting our hands on the data.

Unfortunately, in the United States, we don't have national data, so we have to rely on San Diego County, LA County, and other county and city reports, which is really unfortunate because we could do so much better if we had national data to be tracking.

Q: Does the waning immunity provided by our current vaccines against the delta variant impact FDA approval for booster shots specifically?

A. Pfizer just filed for their booster shot today. Moderna will be following up, I'm sure, within days on that as well. The booster shots look like they're going to be important. One thing we have to acknowledge is we need vaccines around the world, and by shunting them internally, that may reduce what we can do to help containment of this virus throughout the world.

Q: Do we know how long booster shots would provide additional immunity for?

A: Originally, we knew from SARS CoV-1, the original SARS virus in 2003, that people had an immune response that was intact even 17 years later, and the hope was that the vaccine was going to do that. But as it turned out it might have, but delta changed the whole landscape. The question now is with this high level of neutralizing antibodies that happened just days after the booster - instead of weeks, it's just a couple of days. Will that then help with respect to a durable response that would last for years? Or are we going to be looking at boosters every six months? I sure hope not. Hoping for a durable response, but we'll only know when we go six and 12 and 18 months out from where we are right now once we start a booster program.

Q: Will these boosters be tweaked for the more transmissible variants?

A: Well, the Delta variant certainly deserves a specific booster, and it's a work in progress, but it's not ready yet. It hasn't gone through the obligated trials that would be required by FDA. So it's months away from being ready. More forward-thinking is the pan-coronavirus vaccine, which would take out all variants. This can be done, and if we really push on this and give it number one priority, which hasn't happened yet in this country, we can develop this. I'm confident that and there's many steps along the way, very promising that we'll get there, but we should go after that quickly because there likely will be other variants - new Greek letters to deal with that could be potentially even worse than delta. And it's better to have a vaccine ready to take on the entire family of this so-called sarbecovirus of coronavirus so that we don't have to deal with this anymore.

Q: There have been mixed messages from public health experts on where we are in the state's fourth coronavirus wave. What are your thoughts on where we are in that wave? And can we start expecting cases to reduce, or have we not seen the worst of it?

A: Well, we've had an abysmal performance here in the United States. We're over 100,000 hospitalizations now, that's more than 75% of the peak of the monster third wave when there was no vaccine. And in contrast, in the UK, they've suppressed hospitalizations by more than 75% in the country. So the reason for that, largely is that we had such poor vaccination rates, especially in the people of advanced age, but across the board, we're at 51% percent, and other countries are 20% points higher than us of the total population. Now, we've done a little bit better in California, of course, and in San Diego specifically, our problem is that we had so much resistance to vaccines, a lot of anti-vax movement, anti-science movement, and other countries like Canada, which is exemplary, which has had a relatively small effect of delta, whereas we've had a very marked problem of hospitalizations increasing deaths recently, 1,000 deaths per day. I never would have envisioned this would be possible in the post-vaccine era. But here we are, and we would have had a better outcome had the FDA approval come early. But that's only a small part of it. Our real problem is things like Fox News and Newsmax, and all the anti-vax work that goes on to undermine the success of these remarkable vaccines.