198: Children’s COVID-19 Vaccine Outlook

ROBERT JOHNSON:

This is Public Health Review Morning Edition for Monday, June 13th, 2022. I'm Robert Johnson.

Now, today's news from the Association of State and Territorial Health Officials.

It's a busy time for the federal committees that review vaccines, both the FDA and the CDC have panels that will discuss the COVID-19 vaccine for children under five in meetings starting tomorrow.

Dr. Paul Offit is an expert on vaccines and a member of the FDA's review panel. He talks about vaccines and what to expect the rest of this year in today's morning conversation.

COVID-19 vaccines are in the news every day like they've been for a year and a half, if not longer. Let's start with your take on the vaccine for children under age five. How important is it to have that formula finally on the market?

PAUL OFFIT:

I think it is important. Although it is true that that you're much less likely to be severely infected and much less likely to die if you're a young child, the fact of the matter is you can be severely infected and you can die as a young child.

And you know, this virus is going to be with us for decades. And every year, three and a half to four million children are born in this country who are susceptible to this virus. And so, not only will they be susceptible when they're little, they'll be susceptible when they grow up. So, I think it is important to have a pediatric vaccine.

JOHNSON:

Switching over to the Novavax vaccine—that's been in the news a lot lately—the company reported its own trial results. They were strong, at least according to what we read.

How do you see those results, and what could this vaccine mean in the fight against the virus?

OFFIT:

Right, so, it's nice to have another strategy to attack this fire. So, whereas, say the MRNA vaccines—or Pfizer and Moderna—return or provide you with the gene that then codes for the SARS-CoV-2 spike protein. Your body makes that spike protein.

Here, what happens is the technology is you actually give the person that spike protein adjunctived with a chemical that enhances the immune response—so, a chemical that's have been used in vaccines for at least five years. It's a tried and true strategy. It's the same strategy we use to make the hepatitis B vaccine, which has been around for 30 years, human papillomavirus vaccine, one of the influenza vaccines. So I think that is comforting to some people, to know that this is a long-lived technology.

I think it's the greatest strength of this vaccine actually will be as a booster dose to those who've already received the MRNA vaccines. I think we need to generate those data. But the so-called heterologous boost—meaning you boost with a vaccine strategy different than the one that you did initially—could offer a better boost response.

My sense is this in the end will—although it was now approved, at least recommended for approval, I should say, as a two-dose vaccine—it may, in the end, end up being a three-dose vaccine, but we'll see.

JOHNSON:

We talk a lot in public health about vaccine hesitancy about messaging, finding the right messengers. What do think we should be thinking along those lines, going into the rest of this year and beyond?

OFFIT:

I think we need to make it very clear what it means to be fully vaccinated, because I think Americans are not clear on this and I don't blame them. I think it's been confusing.

The CDC definition of fully vaccinated is to having received two doses. Then, you're considered to be up-to-date based on—whether you have various comorbidities or if you're a certain age—whether you've gotten a third dose or a fourth dose. And I think that's been very confusing to people.

I think what we need to define is what is a primary series for this vaccine? And then, then do you need booster doses moving forward? And what's the goal of the vaccine? Most importantly, what is the goal of this vaccine?

I think the only reasonable goal for this vaccine is protection against serious illness. This is a short incubation period, respiratory mucosal infection. Even if 100% of the world were vaccinated, the virus would still circulate to some extent and cause mild disease. And at some level, we're going to have to get used to that.

Right now, we're coming up this zero tolerance notion of anybody who's asymptomatic or mildly symptomatic infection—test, test, test, mask, mask, mask. But again, you're going to have mild infection with this virus for decades moving forward. And at some level, we're going to have to accept that.

JOHNSON:

So, we're trying to educate people constantly with all of these changes. I don't think there's been a virus lately that's had so much attention and so much scrutiny. People know things about the vaccine approval process that they never even thought of before 2020.

Does public health need to change the way it engages people on this as well?

OFFIT:

I think we can do better. I definitely think we can have a more clear message. So, for example, I'm on ACIP, the vaccine advisory committee. When we met in December of 2020 to approve or not approve the Pfizer and Moderna vaccines, those vaccines at the time were 95% effective against all symptomatic illness, including mild illness.

There is no way that was going to hold up. The reason that the protective efficacy was so good against mild illness is that those were trials that were done over a three-month period. Most all of those participants had just gotten their second dose, so therefore they had high levels of neutralizing antibodies, which are always going to fade over six months or so, which is what happened.

So then, you know, six months later, mid-July you have an outbreak in Provincetown, Massachusetts, which is investigated by the CDC—who does a great job of investigating that. They find that thousands of men get together in Provincetown, they celebrate the July 4th holiday, 79% are vaccinated. Nonetheless, 346 get COVID even though they were vaccinated. Four were hospitalized—that's a hospitalization rate of 1.2%.

That is a win. That's what you want. You've shown that you are highly protective against severe illness. The others—the other 342 men—had mild or asymptomatic infection, which were unfortunately called breakthrough infections—wrong word. A breakthrough implies failure. That's not a failure.

If you've gotten a mild or asymptomatic infection because of, after having been vaccinated, that's good. That's what you want. You've been kept out of the hospital or out of the intensive care unit or out of the morgue. That's as good as you're going to do with this vaccine over the long run. And I don't think we made that clear.

And right now I think we're sort of treading a very fuzzy line between whether we're trying to protect against serious illness or whether we're trying to protect against all symptomatic illness. And the only way that would be accomplished, frankly, would be by boosting twice a year, which I think is not a viable public health strategy. And so, I think we need to be clear about what the goals are.

JOHNSON:

ASTHO has posted another update to its COVID-19 vaccine comparison chart. There's a link to the latest edition in the show notes.

Dr. Thomas Dobbs is leaving his position as Mississippi's state health officer later this summer. Recently, he appeared on The Other Side podcast, a political issues podcast in Mississippi.

Talking about preparations for a pandemic event, Dobbs says response plans were in place before COVID-19 appeared; but, they were more focused on an influenza-type outbreak.

THOMAS DOBBS:

We had a plan, but it was woefully inadequate for so many reasons. This was a pandemic that lasted through multiple waves, right? I mean, and it's still going on. It changed. It's been a very elusive enemy.

And then, not only are we fighting the pathogen but we're also fighting sort of a division in the public health response, right? It's been a really daunting situation because the science has improved, but our sort of collective response has sort of splintered as we sort of get deeper into the pandemic.

JOHNSON:

During his time in office, Dobbs pushed back on people who intentionally used social media to mislead audiences about the virus and vaccines.

DOBBS:

It's not okay for folks to make up a reality that folks want to have. There is one truth and we should always be approaching to it—one reality.

But the politicians are going to have to make hard calls and that's totally legitimate. And I think as we look forward, the whole concept of, you know, respond to these sorts of things really needs to be that yes, the scientists and the public health professionals need to help identify what reality is and what the consequences are going to be. But then, the elected leaders are going to have to make the tough call—what's the balance between public safety, collective mortality reduction, and also, you know, the economy and that sort of stuff.

JOHNSON:

You can listen to Dr. Dobbs' interview on The Other Side podcast using the link in the show notes.

Finally this morning, another reminder that ASTHO's Juneteenth webinar on the impact of racism on health equity is coming up Thursday afternoon. The panel includes a visit from Ms. Opal Lee, the grandmother of the Juneteenth holiday.

The event is online. It starts at 1:30 p.m. Eastern time on June 16th. Sign up using the link in the show notes.

That'll do it for today's newscast. We are back tomorrow morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great day.