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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. The FDA could act any day now on COVID booster shot authorization for certain people who got the Moderna and Johnson & Johnson vaccines after the recent approval for certain people who got the Pfizer. The question of kids under 12 is also still out there and apparently moving forward. My next guest says access to booster shots should be more up to the individual than the CDC and have some thoughts about mixing vaccine brands.

Back with us now, one of our most frequent and reliably informative guests on COVID through the whole pandemic, Dr. Leana Wen, emergency physician, professor of health policy and management at George Washington University, The Washington Post columnist and CNN medical analyst and former health commissioner of Baltimore, as well as author of the book published recently Lifelines: A Doctor's Journey in the Fight for Public Health. Dr. Wen, we appreciate all your time during the pandemic. Welcome back to WNYC.

Dr. Leana Wen: Great to come back and join you, Brian.

Brian Lehrer: Before we get to this booster shot news, I want to acknowledge again, the passing of General Colin Powell at age 84 and for you, Dr. Wen, there saying he died of complications from COVID and was fully vaccinated. Is it clear to you how that would happen before the anti-vaxxers get ahold of it and put it in a false light?

Dr. Leana Wen: Well, first my condolences to the loved ones of General Powell, and to the many people that he inspired over the years with his leadership and service. I think it's important for us to put a couple of things into perspective. The first is that no vaccine is 100%. In fact, nothing in modern medicine is 100%. We know based on the latest CDC data that the unvaccinated are six times more likely to get infected with COVID-19 than the vaccinated, and that the unvaccinated are 11 times more likely to die from COVID than the vaccinated. The vaccine protects you extremely well, although they're not 100%. You can think of the vaccine as a really good raincoat.

It will protect you well in a drizzle but one of the issues is if there's a lot of virus around us, that increases the chance that we could also get wet if you will. The raincoat doesn't protect you 100%. That's the reason why we need to get as many people vaccinated as possible. The other thing to note is that those who are dying from COVID-19, from breakthrough infections, tend to be individuals who are older with chronic medical issues.

It is now being reported that General Powell had multiple myeloma. I don't know what kind of treatment he may have been on, but this would put him into the category of someone who is immunocompromised and we know that those who are immunocompromised, they should absolutely get boosters but also these are also individuals who are more likely to become severely ill should they get COVID-19. All of this is tragic, of course, but this is not a reason to doubt the effectiveness of the

vaccines.

Brian Lehrer: There's a human psychology and human media psychology issue here. It seems to me, which is that even if you as a public health official or a public health expert can say of the people who might have died of COVID without being vaccinated, if they then get it, 90% plus of them are going to survive and be okay, but when one really famous person succumbs, despite being fully vaccinated, it changes the public psychology and maybe it helps if we say that out loud.

Dr. Leana Wen: I agree with you, and I think it is important to acknowledge this. This is one of the most difficult parts of public health, in fact, and you and I have talked about this before that there is by definition, no face of prevention. You can talk about all the individuals who got COVID and tragically died, but what about all those individuals who could have gotten COVID, but because they were vaccinated, they didn't get ill, or maybe they got very mildly ill and didn't pass it on to others and didn't get ill to the point of needing to be hospitalized. That's one of the difficulties of explaining the importance of public health and prevention.

Brian Lehrer: We do know that 90% plus of the people who are hospitalized with COVID these days are not vaccinated, which is almost the only stat you really need to know. Let's go on the booster shot news. Authorization for Moderna and J&J boosters could come any day now. You seem to be hoping that people who got the J&J originally can get a booster of another brand. Is that right?

Dr. Leana Wen: That's right. What the FDA advisor said in their meeting on Friday, and again, the FDA has not officially authorized this and the CDC meeting is still this week, but I expect this is what they will all end up saying is that essentially the J&J vaccine should have been a two-dose vaccine. That one dose of the J&J vaccine is not nearly as effective at baseline than Pfizer or Moderna two doses.

I expect that the CDC is going to agree with the FDA advisors this week and say that anyone over the age of 18 who got a one-dose J&J vaccine, if it's been at least two months, they should get a second dose of another vaccine. Now, I hope that they will all say that you don't just have to get a second dose of the J&J vaccine. Some people, it might be the best thing for them, but there will be others who may prefer to get an mRNA booster including me.

The reason is we know that there are two things. One is that women under the age of 50 with the J&J vaccine, there is an association with a very rare, but also very serious blood clotting disorder. This is not a deep venous thrombosis. This is not a simple blood clot. This is a severe clotting issue that's been found especially in younger women with a J&J vaccine. The mRNA vaccines do not have this particular complication, so women under the age of 50 should have the option of getting an mRNA booster.

In addition, there was also an NIH study. The preliminary results came out last week that found evidence for a mix-and-match approach of an mRNA booster following a J&J dose to actually be even more effective in boosting neutralizing antibodies. Now, we don't have real-life side-by-side comparisons, but I think people should be given

the option of which vaccine, which booster they should get.

Brian Lehrer: Based on what you just said, why would anyone who got the J&J originally get a J&J booster as opposed to one of the others?

Dr. Leana Wen: Yes. With the mRNA vaccines, especially in younger males, there is again a very rare but serious complication of myocarditis, inflammation of the heart muscle. If you are a younger man under the age of 30, let's say, I could imagine that that individual, it might be better for them to get a second dose of the J&J vaccine.

The other issue is that the J&J two doses is actually what was studied. In fact, I was in that clinical trial. I ended up getting two doses of the placebo but I was in that clinical trial to study the two doses of the J&J vaccine. The study is actually quite convincing that two doses of J&J are more than 90% protective against infection and nearly 100% protective against hospitalization and death. Those are the data that we have that are very convincing in a real-world setting. I can imagine anybody outside of the women under 50 category, opting for a second J&J dose.

Brian Lehrer: A question about the Moderna booster. It's about the size of the dose. I think people who've been getting it so far because they've been immunocompromised, correct me if I'm wrong, have been getting a whole third dose, but the authorization for widespread use for boosters would be for half of what was in the original shots for Moderna. Can you explain why that is or if you support that approach?

Dr. Leana Wen: Yes. Let's go back and talk about the different doses of the Pfizer versus the Moderna vaccine, to begin with. The Pfizer initial dose is 30 micrograms. The Moderna initial dose was 100 micrograms. Pfizer for those individuals who are getting a third Pfizer dose, they're still getting the exact same booster as they did of the initial vaccines. It's still the 30-microgram dose is exactly the same. Moderna because it was much higher, to begin with,

they began studying what happens if you do a third dose that's half the dose, which is 50 micrograms instead of 100 micrograms. They have, according to their data, found that the 50 micrograms work very well and may have fewer side effects because the higher your dose, the higher potentially the side effects might be as well. Also, if you use 50 micrograms, potentially that vaccine can go a longer way and can vaccinate more people including worldwide. This is the reason why the Moderna booster that the FDA advisors just authorized, although again, noted that the CDC is meeting this week about it, that's why that booster dose is 50 micrograms.

Brian Lehrer: As we're coming to the end of this segment, listeners, I want to express my appreciation for Dr. Wen and the level of detail that she has come to our conversations with such as you've been hearing in this segment on some of the subtleties regarding the risks and benefits of different ones of the vaccines and the dosing, as she just described there with respect to Moderna and Pfizer. I want to just express both my respect and my outrage, Dr. Wen, that I saw on the news for the

crazy politics of this country that we're living through right now, that a Texas man has been arrested in recent days for threatening to harm you.

I presume you don't know him and he was charged for threats against you just from seeing you in the media. I don't know if you want to comment on the case, I would understand if you don't. I want to say it out loud, that it outrages me and I wonder if there's anything that you want to say just on today's environment for being an advocate for public health.

Dr. Leana Wen: Yes, I'm not able to comment on the specific case and investigation but I do want to say that I am not alone in this regard by any means and that's so tragic of where we are, that public health experts and officials and scientists have been threatened. There has been also an overlay with misogynistic comments and anti-Asian racism and racism and other things in general for many of us as well.

Also, public health officials on the front lines working in local, county, city-state health departments, many of them have been harassed and even assaulted and forced out of their jobs and this really should not be accepted. All we're trying to do is to provide information to help people to live their lives and to save lives in this time of the pandemic. I really hope that we will all stand up against such acts of harassment and assault.

Brian Lehrer: Dr. Leana Wen, who is emergency physician, professor of health policy and management at George Washington University, Washington Post columnist and CNN medical analyst, former health commissioner of Baltimore, and author of the recently published book Lifelines: A Doctor's Journey in the Fight for Public Health. Thank you again and thank you as always, Dr. Leana.

Dr. Leana Wen: Thank you, Brian.

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