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Brigid Bergin: It's the Brian Lehrer Show on WNYC. I'm Brigid Bergin from the WNYC and Gothamist newsroom, filling in for Brian Lehrer who's got the day off. Coming up on the show today, New York City's Chief Democracy Officer Laura Wood will talk about what to expect in the primary elections next month, including rank-choice voting, plus an update on the mayoral race from WNYC's Gwynne Hogan.

In the second hour, we'll talk about how so many people missed cancer screening appointments during the pandemic this past year, and we'll take your calls on the perfect work from home versus in-office ratio. We know you have thoughts on that. To start, yesterday the FDA approved the use of the Pfizer vaccine for 12 to 15-year-olds, and the CDC is expected to issue guidelines for its use.

It's already available to anyone 16 and over today. The Moderna and J&J vaccines are available to those aged 18 and over. Once the CDC acts, minors will need a parent or guardians’ permission to get vaccinated. For adults, glass half full. Over half of the currently eligible New Yorkers have received at least one shot. Glass half empty, almost half of eligible New Yorkers have yet to receive their first vaccine dose.

All New York City and state-run sites are available for walk-in appointments. Both New York and New Jersey have come up with incentives to get some of the remaining folks vaccinated, from baseball tickets to free beer. For anyone about to decide for their younger teenagers or for adults who haven't made it to a vaccination site, here's a chance to ask a virologist.

Do you have questions about the science behind the three vaccines and how they work? We're joined now by Brianne Barker, an immunologist and virologist who is an associate professor of biology at Drew University in Madison, New Jersey, and co-host of the podcast This Week in Virology. Welcome to WNYC Professor Barker.

Professor Brianne Barker: Thanks. It's great to be here. I'm excited to talk with you all about vaccines.

Brigid: We're excited to hear it. Listeners, you can tweet @BrianLehrer or call 646-435-7280, with your specific questions about Pfizer or other COVID vaccines. Now, Professor Barker, since it's the Pfizer vaccine that looks like it will be available soon for younger teens, let's start there. Can you give us a little lesson and how it works? What does it mean that it's an mRNA vaccine?

Professor Barker: Sure. With vaccine science, we've done a lot of great work to understand which parts of the virus are key targets for your immune response. We have learned that a particular piece of the SARS-CoV-2 virus called the spike protein is the main portion that your immune system responds to. Instead of giving you a vaccine that includes all of the parts of the virus, we have made some mRNA that just codes for the spike protein. We inject that into someone's arm so a few cells will make the spike protein and allow your immune system to respond just to that one target.

Brigid: Wow. When they tested it on people ages 12 through 15, were they using the same dosage as they use for adults?

Professor Barker: Yes, they did everything the same as they did in the trial for adults. It's exactly the same vaccine.

Brigid: Were the responses the same for some of the younger teens as for adults?

Professor Barker: When you look at the efficacy responses, which are calculated based on the number of people who were infected following vaccination, the effect was actually slightly better. They had 100% efficacy in the younger teens as opposed to the 95% efficacy in adults. The only difference is that they saw slightly more fevers in the younger teens, although that is not terribly surprising.

Brigid: Were there any other side effects anything that differed in terms of how these younger folks reacted to the vaccine?

Professor Barker: No. Otherwise, the vaccine had really the same safety profile and seemed to have similar efficacy.

Brigid: As an immunologist, can you explain what's happening with these side effects, what's triggering them, and why the body reacts this way?

Professor Barker: Sure. Many of the side effects you feel after getting a vaccine are things like fever or some aches or things like that. Those are all effects that happen because of one part of your immune system's response. Those are all actually things your immune system is doing to you to make some changes in your body to stop viral replication. That means that you're making an immune response.

Brigid: I've heard people actually try to say that it's a good thing when you're having side effects because it's your body doing what it's supposed to do. Is that a positive spin to put on potential as some of these lesser side effects perhaps?

Professor Barker: Absolutely. I often will tell people that I'm happy to hear their immune systems are working as they should be.

Brigid: Now, another thing we've seen out there is this question about, can the vaccine change your genetic code? Can you weigh in on that?

Professor Barker: Sure. These vaccines are mRNA-based vaccines. Your genetic code is made of DNA and that DNA lives in the nucleus of your cells. The mRNA cannot join with the DNA or impact the DNA in any way. It doesn't go into the nucleus. It actually stays in the cytoplasm of your cells. That mRNA is going to go into a small number of cells, which are the cells in the area of the arm where you're injected. It's not going to go into all of the cells of your body, and even in that small number of cells, it is going to stay in the cytoplasm and doesn't have the ability to influence your DNA.

Brigid: Very clearly, it does not affect your genetic code.

Professor Barker: No. Not at all.

Brigid: Now, children seem to be at a lower risk for severe COVID-19, but there can be serious consequences for kids in this age bracket. Can you talk about what those are?

Professor Barker: Sure. It seems as though there are a number of consequences. The most common is one called multi-system inflammatory disease. Is similar to a disease people have seen before called Kawasaki disease, where kids have too much inflammation and will start to have a number of different symptoms. We also know that some people who have asymptomatic infections can end up with something called long COVID, where they have some issues longer term, and it's not clear what proportion of kids have that right now. That also could be a potential risk.

Brigid: Let's go to the phones. We're getting lots of calls for you. I'm sure some really good questions from our callers. Megan in Brooklyn, welcome to WNYC. What's your question for Professor Barker?

Megan: It's a practical question. I've been vaccinated, the whole family has. We want to have guests over, they don't have the vaccination, they don't believe in it. I still want to have them over. Is that at all safe?

Professor Barker: I think that that's a little bit of a question of personal choice in terms of what your personal risk level is and what types of things your guests are doing that may put them at higher or lower risk. You as someone who is vaccinated are certainly protected from most severe disease, from SARS-CoV-2 and so you are not likely to get sick yourself. In theory, you could potentially get infected and you could spread the virus to others or even to your guests.

In my personal life situation, I will think about having a conversation with someone about what they are not comfortable with. You certainly are at a much lower risk. If you look at the CDC site, they have some recommendations, which I believe recommend that that is intermediate risk type of situation.

Brigid: Megan, thank you for your question. I think it's probably something a lot of listeners are trying to weigh. It sounds like there isn't a single answer Professor Barker, that you have to evaluate what your risk tolerance is in that scenario. Let's talk to Mike in the Bronx. Mike, welcome to WNYC.

Mike: Thank you. Good morning. As I think about whether to vaccinate my teenager, I worry more about long-term side effects and how we can be reassured that something might not develop 10 or 20 years from now. I've been vaccinated, but I'm in my 60s. If something happens to me 20 years from now, I'm liable to not be around anyway. When you have a youngster and you're wondering whether or not something could happen over the long term, is there any reassurance to give about that? Or is it just the fact with all vaccines that we simply cannot know.

Professor Barker: I can give you some evidence-based on some other situations that we know about different vaccines. One thing that we know is that more than 99% of all vaccine side effects, at least present to a physician, so show up for the first time within six weeks after vaccination. We've certainly at this point, vaccinated many millions of people who are much further than those six weeks post-vaccination, and so we have some pretty good idea of the side effects that we potentially will see. There aren't any great examples of side effects that happen in the long term with any different vaccines that we can think of, so it's hard to imagine how that would happen.

The mRNA vaccines have been used in human vaccine trials for some other viruses since 2013, and have been used in cancer vaccine trials in people since 2008. At this point, we have not seen any long-term effects. As I think about the science, mRNA is a molecule that tends to stick around the body only for a very short time. It's not a very stable molecule over the long term. I have a hard time imagining ways that it could lead to long-term effects. When I think about some of the longer-term effects that we are seeing with patients with long COVID, to me, the benefit really seems to outweigh any potential risk given that I have a hard time imagining much in terms of potential risk.

Brigid: Mike, thank you so much for your call. I think, again, another important question that I'm sure is on the minds of many of our listeners. Professor Barker, we started the conversation by talking about the Pfizer vaccine, but are Moderna and J&J also testing their vaccines on children?

Professor Barker: They are. I know that the Moderna vaccine is expected to announce results in their tests with the same age group very soon. Johnson & Johnson is a little bit further behind. We'll be looking at their data later in the summer.

Brigid: When we talk about children, how young are we talking about? I think we heard that in one of our earlier callers, it's still hard for families when not everyone has the same level of protection to make some of these decisions about who to see and where to go. How young could we anticipate seeing people potentially being eligible for vaccines?

Professor Barker: That is a fantastic question. I know a lot of people who are having that same dilemma. Right now, Pfizer is doing tests in order to test its vaccine on younger children as well. They are currently testing the two-year-old to 11-year-old age group. They have said that they expect to be able to apply for authorization for approval in that age group by September. There are also trials with Moderna that are covering ages six months to 12 years, that they expect to be completed within the second half of this year.

Brigid: I saw that you were also quoted in an article explaining this percentage that 95% effectiveness of the Pfizer vaccine didn't mean that five out of 100 vaccinated people would necessarily come down with COVID-19. What does it mean?

Professor Barker: When you are calculating vaccine efficacy, you look at the number of people who were in the vaccine group and the number of people who are in the placebo group. You try to then look at the number who got COVID in both of those groups. The way that these trials were set up was actually looking for symptomatic disease. In the Pfizer vaccine trial, for example, there were about 21,000 people who got the vaccine, about 21,000 people who got the placebo. Out of the placebo group, there were 172 cases of COVID out of that 21,000. While in the vaccine group, there were nine cases out of the 21,000.

Brigid: Wow.

Professor Barker: You can do some math with the percentages, comparing those two percentages. That's how you get to that 95% efficacy rate. That's way less than 5% when thinking about nine out of 21,000.

Brigid: I'm not going to do the math on air for everyone's sake, but I could appreciate the magnitude of your figures and definitely I think it should give people some comfort in terms of the efficacy. I think a similar question we have a lot of people trying to figure out as we're moving into this new phase is how much masking is necessary once you're fully vaccinated? Where do you still wear a mask?

Professor Barker: I still wear a mask when I am in public places because I want to make sure that everyone around me is feeling comfortable. I will admit that the mask seems to help my pollen allergies a little bit. [chuckles] I tend to wear my mask more often, even though I'm fully vaccinated. However, as someone is fully vaccinated, they certainly have that reduced risk of disease, and they are less likely to be transmitting. I think that just as Dr. Fauci and the CDC have said, we can start to relax some of those mask guidelines if we're not worried about our pollen allergies.

Brigid: Pollen allergies and colds. I did not miss not having a cold this past year.

Professor Barker: You do seem to have some benefits in addition to protecting you from COVID-19. They really do and if you look at the United States, and really the world's data for influenza over the past year, we are at record lows for influenza cases. The masks clearly helped with more than just COVID-19.

Brigid: You're listening to The Brian Lehrer Show on WNYC. I'm Brigid Bergin from the WNYC and Gothamist newsroom, and we're taking your calls for a virologist and immunologist Brianne Barker of Drew University. You can tweet your questions @BrianLehrer or call us at 646-435-7280. Let's go to Ula in Mercer County, New Jersey. Ula, welcome to WNYC.

Ula: Thank you. Thank you for taking my call. I am a breastfeeding mother and I really want to get the vaccine, but I'm worried because there hasn't been any, or what I can find, any published research on the effects of a baby who is receiving it through the breast milk. The other thing is my whole family recovered from COVID. I feel like we have a little bit of immunity. I just wanted to get your recommendation or how I can get comfortable with the idea of getting it. My husband's already fully vaccinated. I really want to do it. I'm just worried about what the effects can be on my child.

Professor Barker: Sure. Those are both really great questions. I have not seen any data on transmitting the vaccine through breast milk. I wouldn't expect that to happen. There is some data that shows that a vaccinated mom actually can transfer some antibodies via breastfeeding to her infant. That data came out within the past week or two. It looks like, in fact, if you were vaccinated, you could give a little bit of partial protection to your baby. There doesn't seem to be any risk shown in those studies, but there does seem to be some potential benefit of transferring the immune response, particularly the antibody response through breastfeeding.

Brigid: That's so interesting.

Professor Barker: Yes, no, it's fantastic. It's really fascinating. I apologize that I forgot your second question.

Brigid: I think we don't have Ula to ask her second question, but I think the bulk of it you answered in terms of would she be able to pass on immunity while she was breastfeeding. Let's go to Eaton in West Orange, New Jersey.

Eaton: Hi, thank you so much for taking my call. My daughter, she's 14 she actually had coronavirus. Fortunately, it was a mild case in October, and no one else in the family caught it mysteriously, fortunately. I was wondering how if at all, having had coronavirus changes the calculation or the vaccination calculation, if you will?

Professor Barker: Thank you for that question. That question reminded me that in fact, that was the same second question of the previous caller. I'm happy to be able to make sure that I address it. There is some data looking at people who have previously been vaccinated, or hopefully, excuse me previously been infected and looking at the vaccine responses. They seem to make a good response to the vaccine after one dose. That's very encouraging.

There also was some data published that showed that people who were making immune responses after infection with SARS-CoV-2 would make a slightly different immune response in terms of this part of their lymph node called a germinal center, that might make us think that those antibody responses may not last as long or may not be of quite the most ideal quality. I would say that it's entirely possible that you will have an immune response after infection, but perhaps it will not last as long as that immune response that you would get from vaccination and the general recommendation at this point is that those people who were infected should still go ahead and get vaccinated.

Brigid: Eaton, thank you so much for calling WNYC. We're going to go to a caller with some additional expertise about what's happening here in New York City, Council Member Mark Levine, who chairs the city council's Health Committee. Good morning, councilmember, how are you?

Max Levine: I'm doing very well, Brigid, nice to speak with you.

Brigid: You are joining us to talk a little bit about how people can access vaccinations for their children, correct?

Max: That's right. A lot of parents have been frantically searching online last night and this morning to get an appointment for their kids, but that's not possible yet. That's going to take a formal approval from the CDC as you've mentioned, but the good news is the city is going to pivot very quickly to actually start administering the vaccine for younger people. Assuming we get the CDC approval tomorrow, I think by Thursday morning, hopefully, at least at the city and state-run sites in New York City, young people will be able to get their shots.

The appointment system should also be up I would hope by the latest Thursday morning. There's potentially going to be a rush when we have eligibility expansion. That always happens for the first few days so I would certainly advise anyone who can to get an appointment, but now all the city and state-run sites are accepting walk-ins. That will be a possibility as well for families who prefer that.

Brigid: As you were saying, the process for actually obtaining an appointment once the vaccine has been approved is essentially going to follow this same process that has been in place for adults seeking vaccinations, correct?

Max: Yes, of course, you have to go to a site with Pfizer. The city's vaccine finder website makes it very clear what kind of vaccine they're using so that's not a problem. Also, I want to remind folks that the state rule is that anyone under 18 needs consent of a parent or guardian to get the vaccine. Ideally, that would be done in person. Ideally, the adult would go in person to offer consent.

The state has actually set out rules so that if that's not possible, if a young person comes unaccompanied, they can try and reach a parent or guardian by phone. Actually, some providers I think will accept written consent as well. There is some flexibility, but if possible parents really should try and make time to go with their kid when they get their vaccines.

Brigid: Council member for parents who are looking for information and maybe they themselves have not gotten vaccinated yet so they're not familiar with the city's vaccination finder, what's the best place to go to for the latest information about where to find appointments?

Max Levine: Well, yes, first of all, Brigid, the pediatricians of the city are a great place to start for information. The health department has been working proactively to brief pediatricians on some of the information that Dr. Barker was discussing and they can talk about individual patient histories as well, but increasingly, pediatricians are able to administer the vaccine, not enough that needs to be more of that. This is something we have to push, but it really is a great idea today as we're waiting for the final approval for parents to give a call to their pediatrician, to their kid's pediatrician, talk through this vaccine, see if they're administering it at that office. If not, other suggestions on where to get the vaccine.

The Department of Ed in the public schools is also preparing an information campaign both for the young people themselves and for families on the benefits and safety of the vaccine and where to get your shot. Now, I would love to see vaccine administration in schools, in public schools. That's not imminent. I hope it will be but in the meantime, it's another great source of information but-

Brigid Great.

Max: -an answer to your original question. The city's vaccine finder, just google NYC vaccine finder. You can put in your zip code. It tells you what vaccine is being offered Pfizer, Moderna, et cetera. That's a great place to start.

Brigid: Wonderful. Councilmember, thanks so much for joining us, for popping in this segment with some information about the city's rollout. I'm sure we'll be talking to you again soon. Professor Barker, I want to turn to a question that we got from Twitter. Louis says, "You mentioned the effects of the vaccine and how the immune response is normal. I'm fully vaccinated but had no side effects or sickness. In fact, I feel great except for a sore arm, which almost made me more cautious than I was before." Can you speak to people who don't necessarily have a reaction to the vaccine? Is everything okay? Is it working the way it should?

Professor Barker: Of course, that seems to be a very common question right now. It turns out that while we talk about your immune response globally, there are in reality a lot of different parts of your immune response. The part that is involved in the side effects tends to be a somewhat different part than the part that we are trying to target with vaccines. So just because you don't have those classic, safe fever-type side effects, doesn't mean that you are not making a great antibody and T-cell response. It isn't a cause for alarm. I myself did not have much in the way of side effects following getting my vaccine.

Brigid: I didn't either, and I felt very lucky for that. Let's take another caller. Let's go to Ann Nassau County. Ann, welcome to WNYC.

Ann: Hi, thank you. I have the opposite of a vaccine-hesitant person in my house. I've got a 19-year-old who's interested in microbiology and biochemistry. He got the J&J vaccine very early, as soon as he could. He's now lobbying to get either the Moderna or the Pfizer because he thinks that he will get additional protection from them. Aside from the public health considerations of people hogging vaccines or vaccinations, I'm wondering about the science. Is it true? Because he keeps bugging me about this? I just want to give him an answer. Is it true that he could get additional protection if he got a second round of vaccination?

Professor Barker: The science would indicate that, in fact, he would have an increased response after getting an additional dose of the vaccine. The portion of the spike protein that is included in both the Johnson & Johnson and in the Pfizer and Moderna vaccines are the same and so you would get an additional boost to your immune response if you were to get some additional vaccines.

Brigid: That's interesting.

Ann: If he went from the J&J to the mRNA, there would be a different response and presumably additional protection?

Professor Barker: It would be an amplification of the first response. So it will be the same type of response just larger in magnitude.

Brigid: Professor Barker, has there been any advice or guidance for certain populations to do that? If you received a J&J to start, but it's determined that you have certain health risks that might make you more vulnerable, that you should then go and get a second dose of another vaccine?

Professor Barker: There have not been specific pieces of guidance on that, largely because the clinical trials have not yet been done to indicate what is going on with mixing vaccines. I think that there may be some physicians who have some anecdotal evidence of things working out well, but because the trials have not yet been done, there is no official guidance on that.

Brigid: Okay. While you were saying that it might increase someone's immune response, it's not necessarily something that people are recommending that people go out and do at this point because-

Professor Barker: No.

Brigid: -if you receive a J&J shot you have been vaccinated.

Professor Barker: Exactly. The Johnson & Johnson shot was designed as a one-shot vaccine and if you have received your one dose of Johnson & Johnson, you are fully vaccinated, and you should have an immune response that will protect you, again, their efficacy data was fantastic and you would be protected in that case.

Brigid: Okay. Let's take another caller. Connor in Chelsea. Connor, welcome to WNYC.

Connor: Hi, thank you. I just had a quick question.

Brigid: What's your question?

Connor: Yes, I was just wondering about the long-term efficacy of the vaccines. I know that over the course of the last year there had been a lot of conversation in the media about the fact that even if we were able to develop a vaccine very quickly, that the likelihood was that they might only confer immunity for like three months or six months and I feel like in the push to get everyone vaccinated, that aspect of it has all fallen away from the conversation. I was just wondering if your guest could shed any light on-- And if there's a likelihood that three years, six months from now, we're going to be told, "Oh, we need we need boosters"?

Professor Barker: That's a really great question. That is one question that we don't have a complete answer to and we are going to need to observe people over time in order to see how long their immune responses last. There has been some data that has come out from Moderna that indicated that immune responses in their trial participants were still quite good at six months following vaccine administration. When you look at some of the data on immune responses following vaccination, they look like good immune responses that we would see with other vaccines that we know last a particularly long time.

However, we won't know the answer to that question until we are able to observe immune responses over time. We do know that different vaccines that we give, give protection for different amounts of time. That's something that we'll have to investigate further.

Brigid: Thanks so much, Connor. From what I understand, Professor Barker, what we know about these vaccines is determined by how they were tested, right?

Professor Barker: Exactly.

Brigid: You explained some of that. Is that why the second dose of Moderna is recommended for four weeks after the first while it's three weeks for Pfizer, or J&J is just one and done? Did they even test two shots for J&J? What do we know about the testing so far?

Professor Barker: All of that is exactly right. Pfizer chose to do their second booster dose at three weeks after the first, Moderna chose four weeks. J&J did not choose to go with a second dose. A lot of that had to do with the idea that when vaccinating individuals, it can sometimes be hard to get people to come back to receive their second dose. They wanted to make a vaccine that could be effective after one dose. They didn't check the second dose, what would happen with a second dose, although I believe they have some trials doing that now.

The three weeks and four weeks were largely chosen because we knew that with a second dose of Moderna, or Pfizer, the immune response would be higher, and people would be more likely to be protected because that response was boosted. Those times were picked in order to make sure that we could get people to that higher boosted response as soon as we thought it was going to be immunologically possible. It was really about getting people protected as soon as we could, and getting those trials done so that we could protect the public as soon as we could.

Brigid: How concerned should people be if their second dose is delayed? We know that some of the scheduling issues have thrown off when people get that second shot and we know some people have not gone for that second shot altogether, are they really protected?

Professor Barker: The way that the trials were done didn't actually look to see what would happen if the second shot was delayed. We don't have any official data on that. The general idea, thinking about how immune responses work, makes us think that getting your second dose a little late will be perfectly fine. All the recommendations are that if you are getting your second dose a little bit late, that's okay go ahead and get it, and make sure that you are getting fully vaccinated. If you look at the data from the trial participants, there is a large increase in the antibody response between the first and the second dose.

It looks like the second dose really leads to a very high antibody response that is going to allow for much better protection, especially as we think about different versions of the virus. While someone with only one shot of Pfizer and Moderna may be somewhat protected against the virus they were vaccinated against, that protection may not last as long, nor is it as robust as you'd see with two shots.

Brigid: Professor Barker, you've participated in the virtual town halls given by the American Society for Virology to answer people's vaccine questions, those are ongoing with virologists from around the country and there's one tonight at 7:00 PM Eastern. Are you getting similar questions there as you've heard this morning?

Professor Barker: Yes. I think that the question I have heard most frequently was the question about whether lack of side effects means that your vaccine didn't work. I'm hearing a lot of very similar questions. There are a few stories out there that people have heard that don't have a lot of evidence behind them about different potential complications. We've also talked a little bit about what the data are regarding those complications, but really there's no data behind them. We've talked about that a little bit, but largely it's the same questions I'm hearing here.

Brigid: Well, I can tell we have listeners with many more questions. Hopefully, we'll be able to ask them of you again in the future. Today, we'll have to leave it there. Thank you to everyone who called in with your questions about vaccines and to my guest, Brianne Barker, an immunologist and virologist, who is an associate professor of biology at Drew University in Madison, New Jersey, and co-host of the podcast This Week In Virology.

Professor Barker: Thank you so much.

 

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