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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, everyone. We begin today with WNYC health and science editor, Nsikan Akpan, who has done such great reporting himself and led others in our newsroom who have reported on health and science in the pandemic. We'll touch on a few developments in the news with Nsikan. One is the new finding from the National Institutes of Health that if you got the Johnson and Johnson vaccine, you're better off getting a different type of booster, the Pfizer or Moderna. If you got Pfizer or Moderna, looks like they're saying stick with what you got originally for your third dose. We'll get into that.

Another piece of vaccine news that we haven't touched on yet on this show is the amazing history-changing news that after 100 years of trying, there is now a vaccine for malaria. Now, we hardly have any malaria in this country, so maybe you don't even think about it, but for some other countries, mostly in Africa, this is expected to add up to hundreds of thousands of lives saved a year. Mostly children, in fact, who are most susceptible to malaria's worst effects. Then there's the COVID treatment news we also haven't discussed yet.

The pill from Merck that they're saying could cut COVID deaths in half for certain vulnerable people. You know when we talk about science these days, it's so often the politics of science, or William Shatner going into space. Science itself if it's used for good is so incredible to talk about in its own right. With me now is WNYC health and science editor, Nsikan Akpan. We'll also touch on his investigation into the New York City public schools not being transparent about how much COVID there is in the classroom. Hey, Nsikan, thanks for coming on the show today.

Nsikan Akpan: Hey, thanks for having me as always.

Brian Lehrer: Let's start with this booster shot study from the NIH. People who got the Johnson and Johnson originally are best off with a Pfizer or a Moderna booster.

Nsikan Akpan: Yes, exactly. This was a study that was sponsored by the National Institutes of Health. It involved exactly 458 volunteers split across nine different groups, so about 50 people for each group. What's very interesting about it is that the booster vaccines did seem to increase the body's ability to neutralize virus. We're talking mainly through antibodies.

It increased that by 4.2 to 76 fold. Mixing and matching the vaccines increased that protection by 6.2 to 76 fold. Yes, you're right, hitting somebody with J&J first and then Moderna second improved things by 76 fold. That was the biggest increase in neutralization that they saw. The second biggest bump happened after following J&J with Pfizer and that improved things about 35 fold.

Brian Lehrer: Do they know why that's the case? Why switching from one for the original dose to the others for the booster increases the effectiveness?

Nsikan Akpan: I don't think it's totally clear at the moment, but if we were going to speculate, as everyone probably knows by now, the Pfizer and Moderna vaccines are based off of genetic material called messenger RNA or mRNA. It's a cousin of DNA. We've known for a few decades that mRNA is pretty good at stimulating the immune system. The J&J vaccine is based off of different biotechnology, and while it provides solid protection, it has always been a little bit wimpier than the Pfizer and Moderna vaccines.

If you remember back to last year or early this year, the clinical trials showed that two shots of Pfizer and Moderna lowered the chances of moderate and severe COVID by about 95%. Johnson and Johnson, it lowered things by 72% and 86% against moderate and severe disease. Part of that could also be because Johnson and Johnson is one shot, and that's actually why the FDA, one of its advisory panels is reviewing an application for a booster today. J&J is really adding that booster, so that way you can it can boost its protection up to that 95% level that we're seeing with the mRNA vaccines.

Brian Lehrer: Did they test the reverse, a J&J booster in original Pfizer or Moderna recipients to see if that difference helped boost immunity, that variety of protection?

Nsikan Akpan: They did, but J&J didn't offer much in terms of a boost relative to the reverse situation where Pfizer or Moderna were given to Johnson and Johnson were recipients.

Brian Lehrer: Yes. From what I read, this study has not yet been peer-reviewed, but still, the National Institutes of Health is publicizing it. Can you bestow a little health and science editor education on us and remind us what peer review is and say whether you think it matters in this case?

Nsikan Akpan: Yes, exactly. This study is in preprint form and the number one thing everyone should remember about preprints is that they aren't final and that the results might change. It's funny, for example, this study is looking at three different time points. One day after a person receives a booster, 15 days after a person receives a booster, and 29 days after a person receives a booster.

At the moment they haven't finished all of the 29-day observations. If you look in the chart in the preprint, it literally says, "In process," in the chart. I think we should wait and see the final results, and also we should keep in mind that this study is fairly small, 50 people per group. How is that going to compare and translate to the entire nation, right? The millions of people who might want to get these booster shots.

Brian Lehrer: This, I guess, brings us to a way into the malaria vaccine story. If the COVID vaccine was developed through operation warp speed, the malaria vaccine has been like operation turtle and sloth. Why did this, which is so central to global public health, even if people aren't aware of it much in this country, take a century while they were able to create a COVID vaccine in months?

Nsikan Akpan: Yes. The malaria vaccine that was finally authorized by the World Health Organization, it's called the RTS,S vaccine. It was first created in 1986, so just a very long time ago. Actually, the same year I was born. Malaria causes hundreds of thousands of deaths every single year. We're talking about 200 million cases every single year. With COVID-19, we knew that, okay, this is striking the entire globe, and it's striking them right now, and so that's billions and billions of people. I think that will always be a pretty attractive incentive to drug companies to-

Brian Lehrer: Ramp it up.

Nsikan Akpan: -develop a drug to stop that pandemic. I think they want to fight the disease, and they have altruistic motivations, but I think the market forces push companies to all dive into getting a COVID 19 vaccine, maybe not in the same way that we've seen support for the malaria vaccine. If you look at how the malaria vaccine was funded with the Bill & Melinda Gates Foundation, through a lot of nonprofits in terms of actually doing the field clinical trials. Yes, that just is your answer for why it would take so long. It really just comes down to charity.

Brian Lehrer: If it's mostly poor countries that have a lot of malaria, do you know if there will be the appropriate widespread dissemination of this vaccine or who will pay for that?

Nsikan Akpan: That's the hope because without widespread dissemination, it'll be a bit hard for this vaccine to cut malaria rates. If you look at the efficacy, we're talking sort of in the 30 to 40% range. That can cut tens of thousands of deaths and probably hundreds of thousands of cases every single year, but without a widespread rollout that's well funded, that can get these shots. We're talking about four shots for this vaccine. If you think it's hard to roll out two shots, and now three shots of the COVID 19 vaccines, just imagine trying to roll out four shots. There is going to have to be a huge, I think, humanitarian lift to make sure that these vaccines get to everyone that needs them.

Brian Lehrer: Another scientific breakthrough in the news, Merck's COVID treatment pill. When they say it can cut COVID deaths and hospitalizations in half, this is the headline everybody's been hearing, cut them in half. Is it clear what that actually refers to, Nsikan? Cut it in half among who or in what circumstances?

Nsikan Akpan: Yes, so not really. I think akin to the NIH study that we mentioned at the top that's a preprint, we have even less information about this Merck drug right now. All we have right now is a press release. We don't know very much about the individual subjects. We know that there were 775 adults, but we don't know what were the demographics there. Are they Black, white, brown? We also know that the subjects were at a higher risk for severe disease, due to pre-existing conditions. We need a lot more information to be able to discern exactly how this is going to impact a large population. They did see a 50% reduction in hospitalizations, or they reported a 50% reduction in hospitalizations. I think we need to see the data before we can fully validate that takeaway. It could be big.

Brian Lehrer: Are there indications at this point, how this compares to the monoclonal antibody treatment that people can also get early on to help prevent serious effects, that's more complicated to administer than taking pills. It's IV. Is it clear yet, assuming availability of both, how doctors should use these options?

Nsikan Akpan: Yes, exactly. I think people are excited because it's a pill, you can just pop it in your mouth and hopefully, it will reduce your chances of hospitalization by 50%. With the monoclonal antibodies, yes, it takes a little more work. You have to go to an outpatient facility or you have to have a clinician visit you at home to administer that IV. It reduces the odds of hospitalization by 70 to 85%. It's a bit better than what we're seeing with this pill.

If you consider the vaccines which, in the case of the Pfizer and Moderna vaccines, they're still reducing hospitalization by 90%, 85%, even in the face of Delta, yes, it'll be interesting to see where exactly this Merck pill shakes out. We don't know much about, "Can you take the pill and get monoclonal antibodies right now?" just because we don't know much about what exactly Merck found with this pill.

Brian Lehrer: We have a few minutes left with WNYC health and science editor, Nsikan Akpan, as we talk about various, really interesting, and important science things in the news. Let me touch on the investigative report that you did on lack of transparency about COVID in New York City schools. Who's not telling us what?

Nsikan Akpan: We've been digging into COVID outbreaks in New York City schools. We had a few reports about ventilation and the ventilation preparations for New York City schools. Then we had one about an outbreak at a school in East New York. It wasn't an outbreak. Essentially, a couple of days before school started, the whole staff at this school got together, and then there was a COVID exposure, somebody tested positive after the fact. The school had to quarantine about a third of their staff the night before school started.

The thing is that they didn't tell parents. That story was really just about what the department of education tells parents, and what they don't tell parents in an emergency situation like that. We're going to have a follow-up in the coming days looking at ventilation in schools. I think what would be nice is that if the department of education would share basic information about COVID in schools directly on the web page that everybody goes to to check what's happening.

Right now, they show classroom closures, partial classroom closures. That really doesn't tell you exactly how many cases are happening in individual schools. To do that, you have to go to a separate database that's run by the state. You can only look up one school at a time. We're hearing from parents, we're hearing from teachers, that they're really concerned. They really want to know exactly what's happening in their schools. They want to know what's happening in the next classroom. I just think that leaving this mental gap of uncertainty for everybody, probably causes more problems than it fixes and that it would just-

Brian Lehrer: Just [crosstalk]--

Nsikan Akpan: -be better if they just-- Sorry, say it again.

Brian Lehrer: Told everybody everything.

Nsikan Akpan: Exactly.

Brian Lehrer: Yes, if they had just told everybody everything. For context, isn't it fair to say that outbreaks in the New York City public schools have been minimal, so far?

Nsikan Akpan: I don't know if I would say that. I think we're well over 4,000 cases right now in schools. If you look at the case rates across the city, 13 to 17-year-olds are leading the way right now. We're seeing, also, pretty high rates among kids that are 5 to 12. I think minimal is also relative, right? If your school is having more outbreaks than other schools then you're going to want to know about it.

Brian Lehrer: Some NYU professors, I see, are measuring carbon dioxide levels in classrooms there, as a marker of conditions that could also allow COVID aerosols to remain in the air. Preliminary findings show more carbon dioxide than expected, according to the Washington Square News report on this. Some faculty there are concerned that their mandatory in-person policy is not sufficiently safe. Give us a little glimpse into the science of this. Do you know why measuring carbon dioxide would be a good stand-in for the potential presence of COVID?

Nsikan Akpan: Right. When we breathe in, and then we breathe out, we take in oxygen and then we let out carbon dioxide. Measuring carbon dioxide after a class ends, can give you an idea of how good the ventilation was during that class. You have a room full of people, and they're all breathing out, if you have really high carbon dioxide levels, that tells you that the room wasn't well ventilated. The other really good measure is airflow. It's a little trickier because you actually have to measure the air moving around the room.

It involves measuring pressure outside the room and outside the building. I think carbon dioxide levels are becoming a pretty standard way to check on the levels of ventilation in a room. I think I even saw a story in The New York Times that parents are giving their kids little carbon dioxide meters, and that they're sneaking them into their classrooms [chuckles] to check on the ventilation in their classrooms. Yes. That's the other thing-

Brian Lehrer: They used to sneak--

Nsikan Akpan: -too. The department of education doesn't report the exact airflow ventilation rates in each classroom. It just gives them a green checkmark and says that they're good to go.

Brian Lehrer: They used to sneak candy bars into school, now it's carbon dioxide meters.

[laughter]

Finally, last thing for today, Nsikan. I know you're interested in space. Did anything scientifically meaningful come out of William Shatner's trip to space, to where no 90-year-old has gone before, or was it mostly a publicity stunt for Jeff Bezos' space travel company?

Nsikan Akpan: Yes, I think it was the latter, but it was definitely a moment to set phasers to stunned, I might say. I was very moved to see William Shatner land yesterday. He was obviously overwhelmed. As funny as it might sound, Star Trek has had a pretty strong influence over scientific exploration with regards to space. Yes, I was almost brought to tears when I heard his clip this morning, but for sure, it is a bit of a publicity stunt.

I think Blue Origin is obviously a little bit behind SpaceX when it comes to the commercialization of space. People make the argument that space travel right now feels like an elite activity, only the rich will be able to do it. I think space travel, to some degree, has always been that way. It's always been a very, very small percentage of people are going to be able to do it. I think that's true of the early days of space travel when that was public. Now, I think we're starting to see a repeat of that with private space travel.

Brian Lehrer: Yes. I thought William Shatner was really moving too in the interview that I saw with him where he was comparing the lifelessness of space, once you're outside the Earth's atmosphere, with all the life that he saw, looking down on Earth and imagined taking place, all the people, all the organisms. That the earth is a ball of life compared to the nothingness of space. That really was a very moving perception. I guess if he wanted to, he could've also told the anti-vaxxers, that he could tell from up there that the Earth is round.

[laughter]

WNYC health and science editor, Nsikan Akpan. Always great to have you on the show. Always learn from your broad interest in health and science. It's not every news organization that has a PhD in immunobiology leading our coverage of the pandemic. Thank you for everything you bring to the station and to the show when you come on with us. Thanks a lot, Nsikan.

Nsikan Akpan: Yes. Thanks, as always, for having me.

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