"Everything Has Changed": You're Going to Need a Booster

[MUSIC PLAYING] Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. Have you heard the news about the vaccine from Johnson & Johnson? How effective is it really? And if it's less effective than the current vaccines, how do you make the choice whether or not to get it? So to provide insights, I've asked Dr. Eric Topol. You all know him from previous episodes. Dr. Topol, thanks for joining me.

Oh, great to be with you, John.

I have to ask you, Eric. I've seen a range of headlines today. One says it's 72% effective. One says it's 60% effective. One says it's 80% effective. And they're all parsing the data, whether we're talking about moderate to severe disease, whether we're talking about hospitalizations. Returning to you to help us understand how effective is it? What do listeners need to know ?

Well it's a really good question, John, because they didn't do a good job, the company here, in making it clear about the data. We do know there was a drop off between the US and South Africa. So it was in the 70s, 72, and down to 57 in South Africa. So we do know there was that.

We also have been seeing all these things about suppression of severe infection. 85%, 100%, well there's no data. They don't give us any data. So right now we can say, with the one shot, which is good. Which is out of the deep freeze, which is good. There's a vaccine that works.

What we really don't know how it stands up against the mRNA vaccines that were very clear 95% efficacy. Right? And it was communicated clearly. This is modeled. So it's tricky, it's hard for us, and I hope in the days ahead it's going to get much more clarification because it's so confusing. The bottom line is 66% by the criteria that we usually use. But that accounts for South Africa where there's resistance now to the new variant.

But you've been educating us about the variants. First, the UK and South Africa. And I've got to be honest, when I'm hearing there's a decorum of efficacy in South Africa where there is a variant. How concerning do we need to be?

We have to be concerned because there has this immune escape property.

Explain that to people.

Yeah. So this variant is known as South African. It's B1351 is the real name. It-- In the test tube experiments, it didn't bind to the antibodies as it should, as well. But we had hope that when we get a vaccine, we make such large quantities of antibodies we will override that. As it turns out, uh-uh, doesn't. It drops down from-- so Novavax also reported with South Africa 4,400 people yesterday. And just like with the Johnson and Johnson, it was a big drop off. For Novavax it went from almost 90% to 49% in South Africa. Here it went from 72 to 57. These are big drops.

So we do know that that variant, which is in the US, it was found in South Carolina yesterday, two community transmission cases, it means there's more here. Now there's one good thing about this variant. Not much. It may not be the hyper-spread or super-spreader as the one from the UK. So maybe we're not as going to be in such a bad position to cope with it. But it's going to provide a vaccine resistance to some extent. The vaccine still works. It just doesn't work as well. So we're going to have to do some tweaking of the vaccines coming up.

Well here's what people are thinking. There's a shortage of supply. And we do know that they still have to apply for EUA. But let's be realistic, the likelihood that it'll be authorized is very high. They may have a few million next month. 30 million roughly by April. We're trying to figure out, is it 300 million at the end of March? Those are all best case scenarios in terms of manufacturing. And problems happen. So people are out there thinking if I can get a vaccine that's 70% effective or 60% effective, you know, somewhere in that range, versus 94-95% and it's only one shot, do I take that? Or am I putting myself at risk later on?

Well first of all, take a vaccine, any vaccine. That's better than getting COVID, right? For sure. But secondly, do you want to get the one that's very high efficacy or the one, at this point, it's still kind of murky? Maybe it's actually pretty close. But the data are so all over the place as we reviewed. So if there really is a gradient in efficacy, then that's going to make it tricky. It's going to-- You're going to say I want the 95% one, I don't want the 66% one or the 70% one. Yeah.

You predict people will have a choice? Or will they just have to get what's in their county? Because remember it's the government buying it and that's going to be distributed to the states and the county. Do you predict people will even have a choice?

Well, I don't know because it's been chaotic as you're well aware, John. These early weeks since mid-December when it got started. We haven't gotten into groove yet for getting the shots in arms. The point, I guess, is that we have Novavax which was almost 90%. Which is pretty good against the strain that we've lived with for a year. So we have that.

They're going to have manufacturing issues, don't they? They're not going to be available.

Yeah. And, well--

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hopefully we got the whole world of pharma to help them. All these other companies that can make vaccines like Novartis, like Sanofi, like GSK, like Merck. If we all cooperate, here, we can get into high production faster. Also the J&J, when we get that final data, how it's just not there, maybe it's going to look better than the 66 or what was in the US.

Does it ever look better after a press release? [LAUGHING] Let's be professional.

I don't know. I mean, I only can react to what I've seen and it's all over the place.

But let's presume it's around 70% if we use it's a comparator to how the mRNA vaccines. Is it unethical to give it to populations in the United States? Say we're looking at rural community so we don't have to worry as much about these super cold temperatures. Or we're looking at under-served communities so then we can bring it to them. Is there anything wrong with that to say well, you know what, 70% is better than nothing but guess what it could still be exposing yourself to virus and you could have a false sense of security? Is there equity in that setting or is it to the point get whatever is out there? If you can get it now, take whatever.

Well, two things on that, John. You're raising a critical issue. But number one, everything changed yesterday. We're all going to need another shot so just get started. Get a vaccine. It almost doesn't matter because remember those 95%--

Why do you say everything has changed?

OK. Because, remember, the mRNA vaccines, Moderna and Pfizer, the 95%? If you tested them in South Africa they wouldn't be any 95% anymore.

No. No. They'll be--

Yeah. So--

Do we know where they are? They haven't really said what they were. They just said there's a decrease but still enough for protection.

Yeah. Well they haven't been tested. They didn't-- [? though ?] didn't do those trials, those companies, in South Africa when it became the 90% strain in South Africa. The problem here is we have now seen this hyper-evolution of new strains, trouble strains, and we're all going to need not just one or two shots but actually another booster that's directed towards the new strains, right? So you just get started.

And people don't wait. But people don't wait either. Some people are saying, "Well, if you're going to have to make a booster and fix it, I'll just wait and do it all then."

No, no, no because you're going to get a lot of protection from the shots that we have today. And that's a good place to be is get protection. Maybe it's not 100%. Maybe we're going to keep-- If we get better in our country, maybe we'll get suppression of the South African variant or the Brazil P1 variant. Wouldn't that be nice? Because we can probably live with B117. It isn't as vaccine-resistant even though it spreads badly. That one has-- Unless we gear up now with better masks and better mitigation, B117 is destiny is it's going to become dominant. It has a slight drop down in efficacy too, but the problem is whatever we've seen in the pandemic till now, it could be much worse. So that's why we have to gear up and I'm not worried about people getting vaccines now because I got my two doses. I am sure you as well. We're going to have to get extra help from vaccination as we go forward, whether it's later this year, next year, at some point.

If people are offered 70%, do they take it?

Oh, absolutely. I'd take 50. Better than zero, right? 50% better than--

You can't mix it later. You can't be like I'm going to do 70% Adenovirus and then do an mRNA virus later. We can't do that.

Or you can. What you--

Well, we don't know that. We don't go that route, OK.

I think the bigger worry than you're bringing up. The most likely you'll be able. The bigger worries using Adenovirus repetitively. That's tricky. But doing a protein and mRNA, you could do that. Like--

Well, we still have to double check the match. Dr. Topol.

We're going to get data on that.

I'm going to follow up with you on that. You've been very good in helping explain everything. I want everyone to follow Dr. Topol on Twitter and Instagram. He's terrific. He and I did an Instagram Live which was one of our most popular Instagram Lives answering your questions. And we'll check in with you very soon. Thank you, Dr. Topol.

Thank you, Dr. Whyte. Thanks John.

And if you have questions for us, send them my way at [email protected]. Thanks for watching.

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