Brian Lehrer: Brian Lehrer on WNYC. Late yesterday, the CDC okayed Moderna and J&J boosters for people in certain categories. The agency also said fully-vaccinated people can get a booster shot from a different brand than the one you received initially. Some big vaccine news to end the work week, for sure, and it comes as the White House anticipates the approval of COVID vaccines for children ages 5 to 11 as well. In fact, Pfizer this morning of their vaccines 90% effective in preventing symptomatic COVID in children 5 to 11.

We'll talk about these developments now and answer your questions about when to change vaccine brands and what about your kids and other questions you may have for Céline Gounder, infectious disease specialists, an epidemiologist at NYU and Bellevue Hospital, host of the podcasts Epidemic and American Diagnosis, and she was a member of the Biden-Harris transition COVID-19 advisory board. Dr. Gounder, thanks for coming on. Welcome back to WNYC.

Dr. Céline Gounder: It's great to be here.

Brian Lehrer: Listeners, our lines are open for those questions I just laid out, 646-435-7280, 646-435-7280. Now that the CDC has effectively given Moderna and J&J boosters the green light, can anyone eligible just go out and get one or at least make an appointment?

Dr. Céline Gounder: Yes, if you're in one of those eligible groups. If you are over 65, if you are in a long-term care facility, if you have an immunocompromising condition, those are the people who absolutely should get a additional dose of the vaccine. In addition, that would also include people who are between the ages of 50 and 64 who have underlying chronic medical conditions.

Then people who may-- so it's just up to you, it's dependent on your own risk tolerance and whether you want that extra dose, people who may get an additional dose of vaccine are people who have chronic medical conditions who are a bit younger in the 18 to 49 age group and people who work or live in higher-risk settings. That might include healthcare workers, policemen, firemen, people who work in education, people who work in jails or prisons, and there's a whole long list of those groups. If you fall into one of those categories, yes, you can now make an appointment and get that extra dose.

Brian Lehrer: Let's take a call right away from Sabrina in Manhattan. Sabrina, you're on WNYC with Dr. Gounder. Hi.

Sabrina: Hi. It is my understanding that the approval for Moderna, which is what I took, you get half a dose, but that the serum is not packaged, at the moment, in half-dose vial. That means that the person who's giving the injection has to extract half a dose from the full dose vial and give it to one patient and then the next patient comes in and they go back to that same vial for the second half. I read and I think it was in [unintelligible 00:03:37], I'm really not sure, but I read that raises concerns about contamination and I would say also it raises concern to me about how do they know they've got half a dose when they are extracting it, et cetera?

Brian Lehrer: Sabrina, thank you. Let's see if we can clarify both of those things. There's a used needle question or at least a vial that was already used by one needle question, and there's a how close can they really come to exactly half a dose compared to the original Moderna shot? Dr. Gounder.

Dr. Céline Gounder: The vials are actually not packaged as full dose, they're packaged as 15 doses per vial, one-five doses per vial. Regardless of whether you're being given a half dose or a full dose, that vial has multiple doses for administration. If you look at those syringes that doctors and nurses use to give you that vaccination, there are actually milliliter markings that allow them to measure precisely how much they're drawing up into that syringe.

We also do not reuse needles and syringes. After every patient, those get disposed into what we call a sharps container so that we don't accidentally harm ourselves with a needle stick injury or somebody else doesn't get harmed with a needle stick injury. You'll also notice if you watch healthcare providers drawing up the vaccine, they will swab the top of the vaccine vial with an alcohol wipe between every drawing up of the vaccine. There are procedures in place to, one, make sure you get the right dose and to do so in a sterile fashion.

Brian Lehrer: All right, good to know. I'll bet a lot of people didn't know about that 15 doses per vial, so they've already got a lot of experience with taking many doses out of one container and doing that safely. Lee in Manhattan, you're on WNYC. Hi, Lee.

Lee: Hi, good morning. I'm actually a physician. I'm anesthesiologist, primarily cardiac anesthesiologist. I lived through COVID times and I could not get my Pfizer injection fast enough. It was actually on the second day it was available. I'm due for a booster and I'm trying to get some guidance and clarity. I believe that Moderna is probably a marginally better vaccine therapy than Pfizer. I think they're both better than certainly nothing, for God's sake, but would it be appropriate for me to seek out a Moderna booster after having my Pfizer initial series of injections?

Brian Lehrer: He is officially allowed to do that. Those of you who haven't heard it yet or didn't hear the intro to the segment, that's one of the biggest things that the CDC officially approved yesterday. You can, at your own discretion, switch brands of vaccine for your booster. Dr. Gounder, what do you advise in the case of somebody who originally got the Pfizer?

Dr. Céline Gounder: The NIH conducted mix and match studies, where they looked at all possible combinations of-- You have three different vaccines that we use in the United States, the Pfizer, Moderna, and J&J, all possible combinations of which you got first, which you get as a booster. That's nine separate combinations, but in that study, they looked at full-dose Moderna, not half-dose Moderna. What's been approved as a booster is half-dose Moderna.

While in that study, we did see Moderna seemed to be a little bit better as a booster than Pfizer. That may be and likely is almost entirely because Moderna was given a full dose rather than half dose. Given you would be getting a half dose of boost of Moderna as a booster, it's probably essentially a toss-up between Moderna and Pfizer. I personally got Pfizer as my initial regimen and will likely be getting in Pfizer as my booster.

I'll just take whatever I get when the time comes. I'm personally not in a huge rush to do so even though I'm a healthcare provider. I am in my mid-40s, I'm not a high-risk age group and don't have any underlying medical conditions. I know from the studies that my immunity in my group, age group, risk group remains quite robust, even this far out from vaccination, so I'm personally not in a rush to get anything.

Brian Lehrer: Isn't the Moderna, even at half dose for the booster, still a bigger dose than the Pfizer, I think 50 micrograms compared to 30 micrograms?

Dr. Céline Gounder: It's a little hard to compare head to head because that micrograms measurement is measuring the lipids, which is this chemical that we use to deliver the vaccine, it's not measuring the mRNA itself. It's a little bit hard to make that head-to-head comparison.

Brian Lehrer: Is there any point in switching brands? The J&J is different and we'll get to that, but if you've had a Pfizer or a Moderna, either way, is there any argument for switching brands just because they're different, because you might get some kind of a fuller spectrum of protection just from whatever differences there may be between these two mRNA vaccines?

Dr. Céline Gounder: Honestly, the differences between those two are very minor. Where you really may get a benefit is when you're switching technologies, which you do get with Johnson and Johnson being a completely different technology. Pfizer and Moderna are both mRNA vaccines, so the same technology.

Brian Lehrer: What about J&J?

Dr. Céline Gounder: J&J we've known for some time was likely going to be a two-dose vaccine. I think it was noble to really try to develop a one-dose vaccine. It's a lot easier for logistic in terms of getting people vaccinated. It's much more equitable, because for a lot of people, getting time off work, or childcare, or transportation, or making that appointment, those are all barriers to getting vaccinated.

What we've learned over time is that you really do benefit from two doses. It's not that the J&J vaccine is inferior, after all, we give two doses and now three of Pfizer and Moderna, it's that now we understand that you probably do need more than one dose. For people who got J&J, they really have the option. They can get any of the three. This is a situation where I might advise switching technologies, that you may get some benefit from switching to Pfizer or Moderna.

Brian Lehrer: Do you think age and gender in this regard? We had another guest who was saying there's a slightly elevated risk of blood clots with the J&J for younger women, but there's a slightly elevated risk of myocarditis, heart inflammation, with the mRNA vaccines for younger men?

Dr. Céline Gounder: That's right. It's important to remember that these are still very, very low risks. It's like winning-the-lottery kind of risk, but if you are somebody who really, really wants to avoid even that one-in-a-million kind of risk, if you're a younger man, you might opt for the Johnson & Johnson as your booster, if you're a younger woman, you might opt for either Pfizer or Moderna as you're a booster.

Brian Lehrer: Let's talk to Lawrence in Bayside. Lawrence, you're on WNYC with Dr. Céline Gounder, Hi?

Lawrence: Hi. Hi, Dr. Gounder. Up until recently, the people who were getting Moderna boosters were getting a 100-milliliter dose because they were immune-compromised or had some other qualification.

Brian Lehrer: The full-booster dose, not half the full?

Lawrence: The full-booster dose, not the half-booster dose. I'm assuming that Moderna is simply trying to stretch their supply, but we actually don't have any data as to whether the 50-milliliter dose is as effective as the 100-milliliter dose, we're is making assumptions. Is that correct?

Dr. Céline Gounder: We don't have the same level of the clinical trial type of data. I wouldn't say it's just about stretching supply, I think you see more side effects if you give the full dose of Moderna as a third-dose booster. Some of what people get are swollen lymph nodes. When you have a sore throat, for example, you might have some swollen glands in your neck. Sometimes with certain infections, you might have swollen glands in your armpit or your groin. We certainly did see an increased risk of that with patients who got full-dose Moderna. I think this is, honestly, being really being driven by trying to reduce side effects with a third dose, and so giving a half dose of Moderna as the booster in that setting.

Brian Lehrer: Hopefully, that clears that up, Lawrence, thank you very much for your call. Talk about the kids, what's approved, what's coming for 5 to 11-year-olds?

Dr. Céline Gounder: We got some great news from Pfizer today about the effectiveness of their vaccine in 5 to 11-year-olds, over 90% effective in preventing symptomatic infections. This data's going to be submitted to the FDA for emergency use authorization. We anticipate you're going to see the vaccine approved for kids by both the FDA and the CDC by the first week of November. I think parents by around November 4th or 5th will be able to get their kids vaccinated.

Brian Lehrer: Do you have kids that age group? Would you get them vaccinated?

Dr. Céline Gounder: I myself do not have kids. My sisters both have children. One is six, one is two, and I can tell you the six-year-old is already getting ready mentally for that shot. She got her flu shot recently, and mom told her, "You're going to be getting another shot pretty soon here."

Brian Lehrer: The Pfizer results that they announced today, they said the vaccine is 90% effective at preventing symptomatic COVID in children ages 5 to 11. Can you remind us what 90% effective means? Is it that 90% of people actually exposed to COVID won't get sick with symptoms or something else?

Dr. Céline Gounder: I think this is a really important point, Brian. I think people misunderstand what we're talking about when we talk about vaccine effectiveness. It's a relative or proportional risk reduction from what your risk would be in your community without vaccination. To illustrate this with numbers, let's say the risk in your community is 100,000. You reduce that by 90%, you get down to 10,000, but if the risk in your community is 100 and you reduce that by 90%, you to 10. In both scenarios, your vaccine is 90% effective, but your risk after vaccination is quite different. This is one thing people need to understand, is your risk is a reflection of your vaccination status, but also how much virus is circulating in the community.

Brian Lehrer: Vaccine mandates for children currently 12 and up who are eligible are spreading to more and more places and is more and more in the public conversation. We have, in New York City, for example, Mayor De Blasio saying he would not require it for children. The likely next mayor, Eric Adams saying he would require it for children. De Blasio's position is basically that he doesn't want to do anything that dissuades kids from going to school or that would block kids from entering school based on a choice that their parents make for them. I wonder, for you as a policy person in addition to a medical person, if you have an opinion on vaccine mandates for kids to enter schools.

Dr. Céline Gounder: I think it's going to be a while yet before we really see something that coming into play. If you'll remember, we didn't see vaccine mandates really come on line in a major way until after the Pfizer vaccine was given full approval by the FDA for use in adults. I don't think many jurisdictions are going to want to go there until there's an approval of the vaccines and kids, not just the emergency use authorization.

Brian Lehrer: About vaccine mandates in general, as they spread to more and more people and more and more jobs and other categories, one of the debates is whether that's needed rather than the choice of vaccination or regular testing. Does the science support the position the vaccination is so much more effective for protecting others than, say, testing every few days?

Dr. Céline Gounder: The issue is that with the Delta variant, you really need to be testing at least every other day if not every day because it is so infectious and the incubation period is shorter. If you actually want to identify people who are infectious and isolate them so they're not infecting others, you'd have to be testing much more frequently. I think a lot of places are recommending or are doing twice-a-week or once-a-week testing, that's not enough, and so that's the challenge there. Clearly, vaccination has a much bigger impact because we're not testing enough.

Brian Lehrer: Kylie in Northern Virginia, you're on WNYC with Dr. Céline Gounder. Hi, Kylie?

Kylie: Hi, Brian. Hi, Dr. Gounder. Thank you for taking my call. I support the vaccination program. I'm waiting for this all to be over as most of us. I had an adverse reaction to my Moderna vaccine. My question is just if Dr. Gounder can talk a little bit about the process for tracking adverse reactions, and then what has been your personal experience? I know I have my own story about how my adverse reaction was documented and it's not a good one.

I'm just curious to know what is the exact process for tracking adverse reactions and how have you seen it play out? Because this would be big-- I have a four-year-old and I'm not very comfortable with-- I'm comfortable with the data, but I'm just curious to know how are we really demonstrating how safe this is if we don't have a strong way to track adverse reactions?

Dr. Céline Gounder: The CDC has a system called the VAERS system, which stands for a Vaccine Adverse Event Reporting System. This is a system that doctors, nurses, other healthcare providers can use to submit information on an adverse reaction. In fact, I believe, even just you could submit yourself. That's V-A-E-R-S, you can find it online if you want to look for that reporting system.

Kylie: I'm familiar with it.

Dr. Céline Gounder: You're familiar? Yes. Then once those reports get sent in, then they get investigated. I think one challenge that we're seeing is, unfortunately, this has also become a tool of disinformation, where people are submitting fake reports to try to get disinformation out there. Then it's created this huge volume of reports for people to try to sort through at the CDC of figuring out, "Okay, which of these are real reports, which are fake reports?" Then that slows everything down, and unfortunately, harms people who might have a real side effect because it means it takes that much longer to investigate your report.

Kylie: Are they doing any follow-up? Because no one has gotten in touch with me about anything. [crosstalk]

Dr. Céline Gounder: This is what I'm trying to explain. If you have tons of people flooding the system with fake reports, it takes them that much longer to try to get to everybody and figure out which are the real reports, which are the fake reports. Just imagine it's just that much longer of a line that they have to sort through.

Brian Lehrer: Kylie, thank you for calling us. I know you have to go in a minute. We talked about whether people who got the J&J should consider getting an mRNA for a booster. What about the other way around, if you got the Pfizer or the Moderna, is there a reason to consider the J&J because it's different and might give you a different spectrum of protection?

Dr. Céline Gounder: This is something I've looked into even for myself because I got the Pfizer as my initial regimen. There's just not a lot of data on that. You would think that switching technologies might work in that direction as well, but where we have the most data on switching technologies is with starting with AstraZeneca, which is similar to the Johnson & Johnson vaccine. It's what's used in Europe and the UK and other countries, where they switched from AstraZeneca to using Pfizer or Moderna as second dose. That's where we have the best data. We also have some data on switching from J&J to Moderna and Pfizer. The other way around, we just don't have the data to advise people.

Brian Lehrer: Is that a reason not to do it because you don't know what the risks are?

Dr. Céline Gounder: I don't think it's really a question of risk, I think it's more a question of where is the maximum benefit, and we, honestly, don't have the data to answer that question.

Brian Lehrer: All right. Céline Gounder, infectious disease specialist, an epidemiologist at NYU and Bellevue Hospital, host of the podcasts Epidemic and American Diagnosis, and she was a member of the Biden-Harris transition COVID-19 advisory board. Dr. Gounder, thanks so much.

Dr. Céline Gounder: My pleasure.

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