Brian Lehrer: Brian Lehrer on WNYC. We've talked a few times on the show about the argument for and against stretching out doses of the two-shot Pfizer and Moderna vaccines delaying people's second doses so more people can get there first more quickly. Delaying doses was not studied in the clinical trials. That's why people are hesitant, but this week two major medical journals supported the idea or at least research seem to support the idea.

Researchers and Israel's largest hospitals. They've vaccinated a lot of Israel already kept track of 7,000 hospital staff after the first Pfizer vaccine and a CNN report said, by the second to fourth week after the first shot, rates of symptomatic infection were down by 85%. In Canada, researchers in another study found 90% protection after a single shot of that same Pfizer vaccine. Which is it? Can we delay the second shots or skip them entirely, especially if you've already had COVID?

In the meantime, Johnson & Johnson single-shot vaccine is heading to the FDA seeking approval. It's one shot and much easier to store compared to the Moderna and especially Pfizer vaccines. It'll be a good candidate, they say, for rural or economically underserved areas, but it's also less effective in some ways. If the vaccine is approved, can law makers roll it out without inadvertently creating resentment and unequal protection.

Joining me now is Katherine Wu, staff writer for The Atlantic where she covers science and she has a major new article about this called Delay A Shot, Skip One Vaccine Dosing Messaging Is A Nightmare. Katherine, thanks so much for joining us. Welcome to WNYC.

Katherine Wu: Hi, it's good to be here. Thank you for having me.

Brian Lehrer: You want to take us a little further into that research from Canada or Israel, what's significant there?

Katherine Wu: This seems to be the latest data in what has been a trickle in the past couple months with people looking into whether these vaccines, which were authorized as two-shot regimens can actually be good enough after just one shot. This data does seem in line with what was preliminarily observed in the trials and a little bit of the post-trial analysis that some people have been doing. I think it's really important to point out that we are still in the short term with these vaccines.

When you're looking at who is getting infected, when you're looking at who is coming down with noticeable symptoms and who's getting hospitalized and dying, the numbers are looking pretty good for that single shot in the short term, but we want these vaccines to protect us for a long time. We don't know how long that protection is going to last. These numbers could look pretty different a few months from now. I think it's worth saying that the second shot is not only to boost how effective the vaccine is, but how long that protection lasts.

Brian Lehrer: You're right. There might even be good reason to give the immune system more time to settle down after it's been jolted by that first jab before it must deal with a refresher. Are you saying since I didn't study longer periods than three weeks or four weeks between the first dose and the second dose, that it's possible that it actually gives us more immunity to wait rather than we can say?

Katherine Wu: It's possible and I think that's a really tricky question to answer. There would be some precedent for that. We have a lot of vaccines that have been fully licensed and approved, including a lot that we give to kids that are given out in multi-dose regimens months apart. We as adults get boosters for vaccines years after we get the first shot.

Anyway, the idea is you do want to wait long enough between the first and second shot to really give your immune system time to sit with the information and internalize it. What's going on is your cells are in a sense committing the information in the vaccine to memory. If you give the second shot too soon, it's still processing the first shot and the second shot might not actually do that much.

It's certainly possible that waiting longer could give the immune system more time retain that information and really deal with it well, the second time around. I don't think there's any reason to believe that the intervals that were determined in the trials are bad.

I think some people have been pointing to data from another trial run by AstraZeneca. Their vaccine is different. It is somewhat similar to the J&J vaccine that might get authorized later this month. They did see that, when they extended the dosing interval to longer than four weeks, which is what the vaccine was originally designed for, it did seem like there might be a little bit more protection against disease if people were getting the doses like 12 weeks apart. It's really, really hard to extrapolate that to what's going on with the Moderna and Pfizer. Different vaccines, different countries, different trials. It really is apples and oranges at some point.

Brian Lehrer: Listeners who has a question for Katherine Wu covering COVID-19 for The Atlantic, her latest article Delay A Shot, Skip One Vaccine Dosing Messaging Is A Nightmare. 646-435-7280, 646-435-7280 or tweet a question @Brian Lehrer. Katherine, by the way, has a PhD in microbiology and immunobiology from a college called Harvard. Well, she's definitely a good healthcare journalist. 646-435-7280.

In your article, you write an overarching concept. Immunity is not binary, it's a spectrum. Can you explain that?

Katherine Wu: Yes, absolutely. I think some of the trouble comes back to really how we talk about immunity. A lot of people want to know, am I immune to this virus? What seems to be in that question is, "Well, am I immune or am I not immune?" Is it an either or thing. What's really true is immunity is this big spectrum. We are always talking about how to improve our immunity, how to build up immunity. It's this iterative process, where the body is just continually learning to protect itself from different viruses like the one we're dealing with now.

In the context of vaccines, I think people should really be thinking about it, less like a light switch, and more as a dimmer switch, which is a really beautiful metaphor that my colleague, Sarah Zang came up with and put in one of her recent pieces. A vaccine is not going to be some magic bullet that suddenly creates this impermeable barrier around you that no viruses can pass through. The idea is teaching your immune system to really defend itself. It's like putting armor on a person. They might not be totally bulletproof but they're way more protected than they were before.

Brian Lehrer: Why wouldn't that encourage a skeptic to say, "Well, all right, I'm really not going to get this vaccine because I don't even know that it 100% protects me. I can't even go out and fully resume my life with confidence that I'm not going to get this potentially deadly disease."

Katherine Wu: I do hear that concern a lot. I think it's worth thinking about this, not only at the individual level but also the population level. Let's start with, the single person, improving your chances of surviving this disease when you get it, that's still a big deal. There are very few things in life that guarantee 100%. Insurance doesn't work that way. Eating healthy doesn't work that way. So many things in science and life are just incredibly squishy. The idea is, again, about reducing risk. That really matters on an individual level.

Again, we're not talking about either or, we're talking about improving everyone's individual chances. You take that to a population level, and no, the vaccines are not perfect. They're not going to protect each individual person, and they're not expected to 100% protect every single person that they're administered to in exactly the same way. The more people who are vaccinated, the fewer people are going to get really sick and die from COVID-19. It seems likely that the more people we vaccinate, the fewer people are going to be able to transmit the virus to other people.

We're just really in this long period of diluting risk over and over and over throughout the entire population. That is how this pandemic is going to end. It's not going to be that someday everyone flips a switch and we're all protected. It's going to be this slow trudge toward until the risk is low enough that we can start to resume the behaviors that we all miss.

Brian Lehrer: Maria in Brooklyn, you're on WNYC with Katherine Wu from The Atlantic. Hi Maria.

Maria: Hi, Do you hear me?

Brian Lehrer: Hear you fine. [crosstalk] Yes, you're good.

Maria: [unintelligible 00:10:05] I've seen various articles like in The Guardian, and I think recently WSJ about efficacy of, particularly the Pfizer one, and maybe the Moderna one, against variants. I heard that the Pfizer one maybe two-thirds less effective possibly against variants. I think the one in South Africa, I'm not sure. There's a big question and I keep seeing conflicting information.

I know people who are actually doubting whether they should receive the vaccine as soon as possible or wait, because maybe some tweaks will be made, or I saw something about combining vaccines. Just need some clarification on the topic and that's it.

Brian Lehrer: Just to put a few more details on that. I just looked this up on Business Insider, and their version says, "Pfizer's COVID-19 vaccine produces a weakened immune response against the variant found in South Africa. A study suggests. The vaccine produced two-thirds less neutralizing antibodies against a lab-made virus designed to mimic the variant. The study's author said that the vaccine will probably still be protective in real life," per Reuters.

Now people are even more confused. The lab experiment that was created to mimic the South Africa variant finds the Pfizer vaccine makes two-thirds less antibodies, but then they turn around and say, it'll probably still be protective in real life. Do you understand it?

Katherine Wu: Yes, and I think there is a lot of tricky stuff going on here. Maria, thank you for asking this question because it is a really important one. I guess, let's talk about the variants first. We know that this virus is evolving, that's to be expected. Some of the variants that have been identified recently are concerning because it does seem like, and again, I'll be very specific here, in the lab, it does seem like some of the antibodies that have worked really well to fight off or destroy the first version of the virus are not quite as effective. That does have implications for vaccine, that does have implications for our own body's natural ability to fight off a natural infection.

I think it's not yet clear exactly, we can't yet fully quantify the impact this is going to have on the vaccines like Pfizer and Moderna. Those vaccines were tested in trials that pretty much were done before these variants really took off. The lab data that these articles are talking about, that is just lab data. It is putting cells in a dish, it is using a virus that kind of, sort of looks like the Coronavirus, but is not exactly the Coronavirus. I think it's really important to point out that while a lot of people talk about antibodies, antibodies are not the only thing in our bodies that are able to fight off these viruses.

We have these amazing cells called T cells that are much harder to study, but they are actually really, really flexible, and are able to recognize a lot of similarities between variants. It's really hard for a virus to accumulate a couple of mutations and suddenly become fully unrecognizable to the immune system. This is something that I'm going to be saying over and over again. But again, immunity is this spectrum. While the variants might look less familiar to the immune system, they're really dialing back how familiar they are. They're not just becoming completely invisible.

I'm actually pretty confident that the vaccines are going to protect pretty well against the variants. In some cases, they may not protect as well as they do against the original Coronavirus. There's already encouraging data on this.

Some of the vaccine trials that started later and did include some data that probably included variant infections like J&J, which is expected to get authorized later this month. It doesn't really seem like there is still decent protection against the variants. I still think people should get vaccinated. Our bodies have this amazing ability to recognize the similarity between variants and that means we are on a much better footing if we get the vaccines than if we don't.

Brian Lehrer: We'll continue in a minute with Katherine Wu from The Atlantic. We'll take more of your calls. Katherine, I'm going to pass along a question I got from a couple in their 90s this week who've gotten both vaccine doses and they ask, "Can we go back to playing bridge now?" We'll continue in a minute. Brian Lehrer on WNYC.

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Brian Lehrer: Brian Lehrer on WNYC with Katherine Wu and I should say Dr. Katherine Wu from The Atlantic with a PhD in microbiology and immunobiology. Her latest Atlantic article: Delay a Shot? Skip One? Vaccine-Dosing Messaging Is a Nightmare. Anthony, in Astoria, you're on WNYC. Hi, Anthony, Thanks for calling in.

Anthony: How you doing?

Brian: Good.

Anthony: Yes, hi, can you hear me well? Okay I just want to say, I work in a hospital and I already had gotten my first shot, but I'm very leery about taking my second shot because during the worst part of the pandemic in March, I actually was putting bodies into the trailers, during the time where it was increased. All I did at that time was take vitamin D and some other vitamins to help me plus wear my PPE, I was able to manage it.

I tell you I was paranoid, but I was still able to function doing my duty. Now that I got my first vaccination, I'm a little leery about the second one. I really think that the second one should really be given towards the end of the year so that you get secondary protection for any new cycle of COVID.

Brian: Interesting, Anthony, thank you. First, is there any science, Katherine, if you've covered this that taking any vitamins or other supplements provides any protection against getting COVID? I know some people say that, but I haven't seen any actual scientific studies that appear to back it up, correct me if I'm wrong.

Katherine Wu: There have been scientific studies and in my opinion, they really run the gamut in terms of quality just because of the study, doesn't mean it's a good study, that said vitamins are important, but I don't think there's any evidence to say that taking a specific supplement is going to be as protective from the virus as just maintaining distance from people masking and just ensuring your health is good generally.

Brian: The other part of Anthony's question is about the timing of the second dose if the vaccine once you get two doses might only give you temporary protection. I think that's another thing that's unknown. Is it three months? Is it six months? Is it much longer than that? If he's going to be working in a hospital or in a healthcare setting where he has a lot of potential exposure, he's saying why not wait till next winter when perhaps there would be another seasonal spike?

Katherine: Yes, that's a good question as well and I think there's a couple of things to consider here. One is we do know that the second shot of Moderna and Pfizer vaccines, I'm not sure which one you got, but my answer is pretty much the same for both. It does seem to really boost not only the quality of protection but also the durability of that protection.

We really don't know how long protection after that first shot lasts. Maybe you're great at sending off the virus for a few weeks, maybe a few months, and then your body starts to forget a little bit. Part of the reason we use that second shot is to remind the body, "Hey, this is important. Take this seriously, remember this long-term and make sure you are ready when the actual virus comes around."

I don't think there's data yet to say what would happen if you waited a year between shots and I think even the CDC has noted if it's impossible to schedule your second shot within the three or four weeks that are recommended at least like, please, please, please try to do it within six weeks. There's really not good data beyond that and that's the thing that I would worry about. Under an ideal circumstance, if you waited too long for that second shot, your body might in fact have forgotten the first shot and it would be like wasting that first shot.

I don't think it would actively harm you, but it would not protect you in the way that we would want it to, I think. That said, your question is an important one. We also don't know exactly how long to few dose protection lasts, though all signs are really pointing to it should be pretty good if we're talking like many, many, many months, years, possibly even decades if we're basing this on what we know about immune responses to viruses that attack the airway.

That said the virus is changing and that's different from our immune systems failing. Maybe the virus is a little bit less recognizable, but our immune systems are still going. That can be solved to maybe a year from now. Some of us will need a booster shot and maybe that booster shot will look a lot like the shots that we're getting now, or there'll be tinkered a little bit to accommodate these variants that are coming up, but in the meantime, I don't think there's anything that should stop anyone from getting their full protection now.

It's not the kind of thing where everyone gets only two shots in their lifetime and they're done. I think the science will keep adjusting and public health officials are going to do what they need to do to make sure that people are protected for as long-term as they can be.

Brian: Regina in Eastchester. You're on WNYC. Hi, Regina.

Regina: Hi, good morning. I was wondering if anybody had studied whether or not if you have side effects or you don't have side effects if there's any relationship between that and how effective the vaccine turns out to be?

Katherine: Another great question. I think I will say the first thing is there is some indication that with the natural infection with the actual virus and this applies to a lot of viruses generally it's possible that slightly more severe infections are more memorable to the body, it's a bell-shaped curve, something, that's super mild.

The body thinks, "Oh, maybe this wasn't so bad and we don't have to devote as much memory space to it," if you will. Really, really severe infections are not great either because they can overwhelm the body and make it harder for the immune cells to memorize the pathogen. You do want to hit that sweet spot where the body gets sick enough that it says, "Okay, we need to take this seriously, but not overwhelm it."

Those sorts of patterns have not really been seen with vaccines. I think it's partly because the side effects we see with vaccines are not really the same things as the symptoms that we get when we stick with actual viruses. That's a really important distinction, it's the idea that if you feel not great after getting your vaccine, that's absolutely not the same thing as getting COVID, even though there might be some overlap in what people experience. The vaccines are always going to be better in the long run and they're going to be more temporary.

We just know more about what those side effects mean. I think it's also worth pointing out that looking at the trial data from Moderna and Pfizer, you were seeing 95% efficacy. That's incredible and absolutely not everyone in those trials had side effects. I think that alone shows that you don't have to have side effects to be protected.

Brian: I heard a theory that the older you are the milder the side effects. From the second dose, vaccine is likely to be because people's immune systems tend to be weaker, tend to not produce as much of a response, which is what makes you feel sick after the vaccine shot as you get older. Personally, I know a number of people in their 50s who really got socked for a couple of days afterwards. I know at least three people in their 90s for a home that was [unintelligible 00:08:24] after they got the shot. Is there science around that?

Katherine: Around age and side effects specifically?

Brian: Correct.

Katherine: Yes, that is absolutely a well-known phenomenon. This plays out a little bit in natural infection in some cases as well though certainly not always. The older you get the more tired your immune system gets a the quieter it gets. There's a lot of things going, but the body just gets less trigger happy. There's less inflammation generally with these kinds of shots for older people and so that is totally natural, but the trials did pick apart data by age group and they did show incredible protection for people who were over the ages of 55 or over the ages of 65.

Again, there was no correlation between how severe people's side effects were and how protective they seem to be. I think that's really encouraging. If you're older, you're probably going to be less likely to have side effects from both shots. That's not a reason to worry that's expected and enjoy the Percocet.

Brian: Does that mean the older you get the worse your immune system is in general at fighting off things you're exposed to?

Katherine: Yes, in some cases. There's this idea of immune aging, immune senescence. There are certain diseases, certain infections that older people are more susceptible to. We have in fact seen that with COVID-19, it's complicated, but I would be really careful not to equate susceptibility to disease with what's going on with the side effects in these vaccines, totally different ball game. I think the upshot here is don't worry about a lack of side effects. There are many, many explanations for that. I think they're, in general, rare cases in which our immunity is totally failing.

Brian: We are New York and New Jersey public radio with a few minutes left with Katherine Wu from The Atlantic: Delay a Shot? Skip One? Vaccine-Dosing Messaging Is a Nightmare. Listeners, just a quick program note, the mayor will be on at 11:30 today to accommodate his schedule. Hold your mayor calls until then.

I know it's usually right now, but Mayor de Blasio coming up at 11:30 and we have another segment after Katherine Wu between now and then so we can't tie up the lines, keeping you on hold from now until then. Please, hold your mayor calls until 11:30. Thanks a lot. Sarah, in Richfield, Connecticut, you're on WNYC with Katherine Wu from The Atlantic. Hi, Sarah.

Sarah: Hi, thank you for taking my call. I told your screener, my question was regarding the Johnson & Johnson vaccine. I understand that it is very effective against preventing deaths and maybe even severe disease, but with COVID, one of the issues is that like in moderate disease, I've read that people can still get heart damage, lung damage. Some people have had mild cases and developed diabetes afterwards, the loss of taste and smell, those are all devastating things to have happened.

I understand that preventing deaths is obviously a good thing, but for people who say that you should take the Johnson & Johnson vaccine and that 60% effective against all these other devastating things, whereas there's a 95% effective vaccine. That's what makes me hesitant about the Johnson & Johnson vaccine. I know it hasn't been approved yet, but it looks likely, I'm in a high-risk group, but my state hasn't gotten to me yet. I'm concerned that they're going to roll out Johnson & Johnson vaccine say, "This is what you get," and it's not as protective.

Katherine: Yes, and I hear that concern. First I'll slightly unpack that 66% number. I do caution against over comparing between vaccines. Again, the trials were different Johnson & Johnson vaccine is also just a totally different recipe compared to Moderna and Pfizer's. The trials also started later after these variants started coming around and that threw another variable into all of this.

That 66% number comes from aggregating data from all around the world, including in places where some of these variants that come up and those variants are less recognizable to the immune system. That doesn't guarantee that they're going to make people sicker, but I think it does make things a little murkier and makes it harder to interpret. In the US the number was much higher. It was in the 70s and we can keep that number high by making sure that the variants don't spread like wildfire here.

It's also worth pointing out that this number came from a single shot regimen. Moderna and Pfizer are two-shot vaccines. Johnson & Johnson will likely be first authorized as a one-shot vaccine though they are testing a two-shot regimen and I fully expect that to offer even more protection. If that ends up being the case, maybe they will change it up the dosing interval for that to shop Johnson & Johnson regimen is exactly to be eight weeks.

If all goes well, maybe if you get a Johnson & Johnson shot in April, you could still get the second shot on time in June and be really well protected, possibly as well protected as if you had gotten the Moderna or Pfizer vaccines. I don't think it's a reason to be concerned, but I do absolutely hear you. Any amount of COVID illness is to be taken seriously.

That said every time we are lowering our risk, that is way better than getting no vaccine at all. I think at this point, we really need to know that we should not be passing up opportunities to vaccinate. Every vaccine we get no matter what the number was attached to its trial is going to make a huge difference and that's always worth considering.

Brian: Sarah, I hope that's helpful. As we run out of time, Katherine to what you were saying earlier about the difference between individual immunity and population immunity, I know this couple in their 90s who are avid bridge players, they both had their second Moderna of vaccine doses now. They want to know, "Can we wear masks and go back to playing bridge, sitting across the table from our friends?"

Katherine: Yes, it's a good question. I think we're getting a lot of these questions. Now people want to know if they can hug their grandkids and travel and visit each other. A couple of things to say here since I don't know exactly what the situation was. First, it does take a couple of weeks for full production to kick in even after that second shot.

Remember, your body is learning the content of the vaccine and that does take a little bit of time. You want to wait a couple of weeks before you start considering yourself fully protected. Another thing is I'm very glad that they brought masks into this. No vaccination regimen is an excuse to discard our masks. Remember that we are continually trained to ratchet down risk and while vaccines do really ratchet down risk, they cannot drive it all the way down to zero though it's still important to take precautions when we can. Masking is a huge, huge, huge part of that.

As far as bridge goes, I think that is a tricky question and I would almost ask them questions back before competently answering, how old are your friends? Who are you playing bridge with? Are they vaccinated? How are they feeling about it? We want to consider everyone's outlook here, how safe everyone is feeling? Do you live somewhere where you might be able to play bridge outdoors that would certainly make things safer? Can you play in a really big table?

Honestly, the bigger the table that is the less opportunities the virus is going to have to move around? I think these decisions are so hard and I do want to tell people, you can start making these risk calculations after you get vaccinated telling everyone nothing can change after you're vaccinated. I don't think it's going to help anyone, but I think these sorts of calculations still have to be made. Thank you for asking the question and I hope bridge playing is in your near future at this point.

Brian: Quick follow-up on that, on one of the things that you mentioned there, hopefully, it's with other people who were vaccinated. What about this notion I've been hearing of parties only for the vaccinated, where people who are all vaccinated can get together in a space and act differently than a mixed group? Just the same answer that you just gave?

Katherine: I think the actual layer of complexity here is because we still have such a small fraction of people nationwide vaccinated. It's really, really hard to restrict your entire life to a vaccination-only bubble. That's what we're working towards. The more people we vaccinate, the bigger those bubbles will grow, and then the more freedoms people will have, but at this point, it's a pretty big gamble.

Again, coming back to this idea of risk reductions, everyone is going to have to start making calculations about, "What are the essential things that I am okay taking some risks to do?" Is it seeing parents or children that you've been separated from for a year?" I think that's very different from having a huge and probably unnecessary party with a bunch of other vaccinated people. We know that the vaccines are excellent. They're extraordinary.

They work in the vast majority of people, but there are going to be one or two people in every batch who don't fully respond well. There are going to be a few people who are vaccinated and may still get infected and can pass the virus on to others. What happens when you leave that party? Who are you going home to? Are there people in your home that are vulnerable? I think these are the sorts of questions to ask and at this point, I think parties for me personally are pretty low on my list of priorities in terms of risk-taking.

Brian: Katherine Wu, staff writer for The Atlantic, where she covers science. Thank you so much. We really appreciate all your time and answers.

Katherine: Thank you. It was great to be here.

 

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