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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Is it necessary to get a booster shot? For some people, probably yes, but experts disagree on for whom. Is it moral to get a booster shot or is it even the right strategy for ending the pandemic when most of the world hasn't gotten one shot? Experts disagree. Is it moral not to get vaccinated at all when other people's lives depend on it? There's not much disagreement on that.

With us now on President Biden's new booster recommendations to answer your questions on the phones and to discuss other COVID news as the Delta variant surges and the Lambda variant looms is Dr. Georges Benjamin, he's president of the American Public Health Association. Dr. Benjamin, we really appreciate you coming on with us. Welcome to WNYC.

Dr. Georges Benjamin: Hey, Brian, how are you doing? I just want to make one correction. I'm the executive director.

Brian Lehrer: Executive director. Sorry about that. I always get those two positions mixed up.

Dr. Georges Benjamin: It's okay.

Brian Lehrer: Let's start with some basics. The president is recommending booster shots for all Americans vaccinated with the Pfizer or Moderna. We'll get to the Johnson & Johnson, but for now, the Pfizer or Moderna eight months after their second shot. Can you describe the science that's based on?

Dr. Georges Benjamin: Absolutely. Let me just make sure that people understand. This was a heads-up announcement and what I mean by that, it tells everyone that they're proceeding down the line to get boosters. As you know, we've been talking for really not just weeks, but a few months about whether or not we are getting a booster. That's been the talk show question of the moment and they've answered it.

They've said, "Yes. There's a group of people that definitely need to get the booster because we know that because of the status of their immune system, they did not get enough a response so we need to get a third shot," and that they're anticipating that the rest of us will need one. The evidence that they're using for that is that they've been tracking people since they've begun vaccinating people.

They've noticed a steady decline in the blood test that they've been following coupled with real-world experience in places like Israel, which is highly vaccinated, where they've had significant breakout even amongst people who are vaccinated and some outbreaks and they want to get ahead of that process. They're alerting us that boosters are in our future for that very reason.

Brian Lehrer: What about people vaccinated with the Johnson & Johnson, which is not mentioned in this recommendation?

Dr. Georges Benjamin: It's only mentioned because Johnson & Johnson has not finalized some of the data that they need to fully make the assessment, but of course, they have the opportunity to look at some of the data as it's coming in and they're seeing similar trends, so that's why they did not make that announcement yet.

Brian Lehrer: Listeners, we can take your COVID vaccine booster questions and other things for Dr. Georges Benjamin, Executive Director of the American Public Health Association, 646-435-7280. 646-435-7280, or tweet @BrianLehrer. I'm going to take a caller right away, Dr. Benjamin, because Jane in Chelsea wants to ask one that we've been getting a lot. We're going to put this right on representing a lot of listeners who were probably wondering the same thing. Jane, you're on WNYC. Hi, there.

Jane: Hello. It's good to talk to you. I'm a regular listener and a fan. I'm 85 years old, healthy, but I did not have any reaction to my Moderna shots, which were completed in February. There's two questions. One is the Pfizer is available in my area. If I wanted to get a booster shot even though I had the Moderna, can I take the Pfizer? Since I did not have any reaction to the shots, should I worry about my immunity?

Dr. Georges Benjamin: Thanks about that. I think that what's important to know is that-- let's just talk about your basic physiology. It sounds like you've done quite well and hopefully, you're as healthy as you sound, but as all of us age, our immune system becomes less efficient. It's good to see that not only did you get fully vaccinated but that you tolerated that physically fairly well.

I would anticipate you'd have a similar experience, and by the way, I had a little more illness when I got my vaccination. I got a little bit of a fever, I felt a little down for about 24 hours, and then I was back to my great self the next day. That, as you know, has been the experience of a few people that have gotten vaccinated. It was not a big deal, and I'm glad to see that you did okay.

Now, we don't know for sure whether or not they're going to allow us to mix and match vaccines. When I said that what the federal government did was give us a heads up, and what I meant by that is that there are two processes that they still need to go through. Number one, the FDA has to review that idea, that recommendation and decide, first, whether or not they agree with it, and number two, whether or not we can mix and match.

I think we'll get both of those answers when the advisory committee to the FDA tells us what to do, and by the way, that'll be soon. Remembering that they're not going to recommend anything before September 20th, and they've got time to do that. The second one, of course, is the advisory committee of immunization practices with CDC, which will then officially tell us what the dose is, again, whether or not you can mix and match.

They'll validate that and that'll get signed out by the director of the CDC and then we'll all start going to get vaccinated. The people that'll be first in line, we believe will be healthcare workers and people in long-term care facilities, and I anticipate they're also going to do the elderly. I'm not sure what that number means, and at what age they'll start, but it's eight months is the magic figure. If you've been vaccinated eight months [inaudible 00:06:26] , you will be in line to get your vaccine.

Brian Lehrer: Of course, immunocompromised people too at the top of the list. Is there reason to believe that there would be an immunity advantage to getting a different brand shot than you had before for a broader spectrum of immunity.

Dr. Georges Benjamin: No, I don't think so, and the data that I've seen doesn't give us any sense. There were some mixing matching that occurred inadvertently early on and in Britain, they did do some mixing and matching. My understanding of that data is that there really isn't a selective advantage to mix and match over the other. Although, let me take that back.

There were a couple of studies that suggest that there may be, but it didn't seem that that panned out when everybody looked at the data, but there are people really looking at that that'll be able to give us a better answer on that.

Brian Lehrer: The caller's concern about not having a reaction to her Moderna shots was that a reaction is said to indicate that your immune system is responding to the shot. If you do feel sick, a lot of people took that to mean that's a good thing, and have been worried like the caller is that if you didn't get sick a little bit from your vaccine, then it didn't do that much for your immunity. What does the science show on that?

Dr. Georges Benjamin: Now, I don't think there a correlation as to how ill you might have gotten in terms of side effects on the vaccine to efficacy.

Brian Lehrer: Are these third dose shots being reformulated to be more specific to the Delta variant, or are they more of the same of what people got originally?

Dr. Georges Benjamin: My understanding is that these are going to be more of the same, but again, that will be one of the things they will tell us when the FDA makes their ruling, but my understanding is they're going to be-- it's basically a third shot. Let me give you one other piece of information I think would be helpful. We know that that phenomenon occurs.

All of us got a measles, mumps, and rubella shots, and our mumps shot was quite frankly, about 78% effective, the first one we got, and the second shot went up to 88%. We know that there are vaccines like the tetanus shot you get your full series, three to four, and you're good to go almost a 100%, but it is not unusual for there to be a phenomenon that you get a stepped-up improvement in your coverage, in your protection from vaccines.

If you go back and look at-- remember the early studies that they talked about for both Pfizer and Moderna, and even some of the early stuff that J&J did was that you actually got increased coverage the more shots you got.

Brian Lehrer: Pamela in Bronxville. You're on WNYC with Dr. Georges Benjamin. Hi, Pamela.

Pamela: Hi. Good morning. Thank you. My husband has cancer. He just finished chemo. He's starting immunotherapy. He got the booster on Sunday and I'm his only caregiver, and I was wondering if I'm eligible to get it before September 20th. I had my second shot on February 14th.

Brian Lehrer: Doctor, people who are immunocompromised in various specific ways are eligible already for boosters?

Dr. Georges Benjamin: Technically they're not supposed to get it till September 20th, but I know there are some people that are- -that, for a variety of reasons, are jump-starting that for people who are immunocompromised. I think you, as a caregiver, you're fine. You will be eligible technically after eight months. the eight months figure it's not a magic number. It's not a clear point in time. As you can imagine, there are people whose immune response levels have been very high beyond eight months, and there are some people that have been a little shorter than that.

I don't know why they picked exactly the eight month period, but usually that's because that's the mean of the response.

Brian Lehrer: I believe that in New York state, they have already authorized the third doses for immunocompromised people. I think Pamela's concern was not so much for herself as for her immunocompromised husband. That she might be a carrier and so he would be at greater risk. That's I think why she's asking if she should get a third shot.

Dr. Georges Benjamin: I understood that. The question is whether or not she's at increased risk and there's no way to know for sure. I think if she's concerned, she certainly ought to talk her husband's doctor and see if there was a way to address that because of her concern.

Brian Lehrer: Are we looking at a scenario, Dr. Benjamin, where every eight months for a number of years we'll probably be recommended to get additional vaccination doses?

Dr. Georges Benjamin: I don't think we know. There's still two possible futures. One is that you get a third dose and like some of the childhood vaccines, you just needed three and you're done. There's another possible future where we need to do it probably on an annual basis. I can't imagine it being eight months. Again, they picked that period because that was the point in which they wanted to start re-vaccinating people as they looked at the data.

Unless there is a really dramatic reduction in protection, it'll be once a year. That's a guess, but that's a reasonable well-informed guess.

Brian Lehrer: We'll continue in a minute with Dr. Georges Benjamin, Executive Director of the American Public Health Association. I saw he was quoted on Salon warning about another variant, the Lambda variant. We'll ask him about that. We'll talk about the moral or strategic underpinnings of giving extra doses at all to Americans when most of the world hasn't had one dose yet. We'll take more of your calls and tweets, stay with us.

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Brian Lehrer: Brian Lehrer on WYNC with Dr. Georges Benjamin, Executive Director of the American Public Health Association. What do you think about the moral or strategic underpinnings of giving extra doses to Americans when most of the world hasn't had one dose yet?

Dr. Georges Benjamin: I think it's an ethical issue and dilemma for us. You may want to reframe that a bit. There are some folks would say that, well-- first of all, let me just step back and say that for those people who are immunocompromised, it's not an extra dose. It's a third dose that makes them adequately protected. Then the question is, is that same rationale true for the rest of us?

Reminding ourselves that the reason for the booster shot, this third dose, is to reduce our carrier state and to reduce our ability to infect other people. Not to keep us from getting severe illness and death because the data shows that the two shot regimen, at least for Pfizer and Moderna, seemed to do that really, really, really well. The argument that people are making is, if we're protected from severe illness and death, why don't we spend the time getting the rest of the world vaccinated?

Of course, the Biden administration's argument is, "We are doing that. We are trying to get the rest of the world vaccinated but we've got this vaccine that we have, and we know that we're not fully protected and so in order for us to keep us from having a big outbreak in this country.

Because it seems that there is a growing number of breakthrough infections-- even though it's still relatively small right now, we think that the strategy ought to be to get ahead of this by getting people their third shot and continuing our efforts to try to vaccinate the world." I think they split the baby, as they said, in the middle and tried to do both. I think we ought to be careful about making false choices. As a nation, we ought to be able to do both.

Brian Lehrer: You don't think it's a zero-sum game that president Biden said, "No third shots for Americans until half the world gets one," and gives away the supply that would be for boosters here? That it wouldn't actually make a difference to protecting a lot of people in poor countries or ending the pandemic for good because there would be more global immunity?

Dr. Georges Benjamin: If we could move that fast, I'd agree with that. I don't think that we could get that to happen that fast. If the infrastructure in those nations just isn't there to vaccinate them-- We took all the vaccine we had right now, got on ships and planes and went to other places and got people vaccinated. I think that would be a wonderful thing to do, but it's going to be tough to do.

Let me give you an example, Haiti's inadequately vaccinated. That's going to be really tough to vaccinate folks in Haiti. Cuba, really tough. Would even go down to Cuba and help vaccinate the people in Cuba. Other people in our own region, really tough to get in there and get those folks all vaccinated. It's not just a matter of passing the vaccine off to folks and the infrastructure has to be there to do it, we're going to have to balance both.

We're going to have to both make sure that we're adequately controlling the disease in the United States because we still have the risks of variants developing here. We have to work as hard as we can to not only get the vaccine into those other countries, but assist them in building their capacity for them to be able to vaccinate their own populations as well. Think about how long it's taken us just to try get [inaudible 00:16:52] polio eradication. It took years.

Brian Lehrer: A listener asks, "Can you please ask Dr. Benjamin, if you can catch two variants at once or if Delta is so virulent that it will crowd out Lambda?"

Dr. Georges Benjamin: That's a good question. I don't know the answer for sure about two variants, but I believe you can. I saw something somewhere that said that was possible, but the truth of the matter is that right now, Delta has crowded out Lambda because it seems to be as infectious and seems to have a head start.

Now, having said that, like anything else, if you're at the window in which your protection for all the current variants begins to wane and a new more lethal variant has a selective advantage, then it's going to take off like Delta did.

Reminding us that we had a lot of the Alpha and the Wildtype variants that were circulating the United States and then Delta, because it was more infectious, and we had populations in our country totally unvaccinated, and not doing any of the other protective things that they need to do, like wearing a mask, for example. Delta was able to take a foothold and just exploded in terms of its infectivity.

Brian Lehrer: Is the current crop of vaccines protective against Lambda as far as anybody knows yet?

Dr. Georges Benjamin: As far as anybody knows yet, the evidence is that most likely. I say that with great caution because we have been so surprised at the ability of this virus to change, to evade things so I don't think we really know for sure. It's still being watched.

Brian Lehrer: I know you got to go in about five minutes. Is this Delta variant wave of the pandemic? In this wave, are we seeing the disparities in who's getting infected, who's getting hospitalized, and who's dying? The disparities by race and class like we did in the earlier phases?

Dr. Georges Benjamin: Yes, we still are. If you think about the fact that there's a lot of people of color from a demographic perspective in the South, in the communities that are really getting the bulk of this infection right now, we're still seeing those enormous disparities. Then coupled with the fact that this variant seems to be so infectious that young people are getting infected more, it's really very worrisome.

Brian Lehrer: We also have a third of the country or so that's refusing to get vaccinated. We keep hearing about disproportionately Black and brown Americans and also white Republican men. There would be strange bedfellows- -in politics. How do you see that intersection with respect to vaccination?

Dr. Georges Benjamin: Yes, we've got to work very hard to continue to both to deal with the misinformation and disinformation because I know we still hear a lot of, quite frankly, myths. We've got to convince at least both of those communities to not deal with the myths. This does not have microchips that Bill Gates put in it. If the government wants to track you, they've got your cell phone. They don't have to spend money on microchips. It's not going to give you the disease.

It's not going to affect "your nature." In other words, your sexual performance. It's not going to kill you. We still hear people say the vaccine is killing people. It is not. We're still hearing people that just basically say that the natural disease will protect you. We know that there is evidence and pretty good evidence that natural infection certainly provides the body some protection, but that the vaccine is probably better, which is why we're vaccinating people who've been infected with COVID.

We've got to be really clear about the myths and realize that the people that are spreading that misinformation might be spreading it innocently, but that a whole bunch of them are doing it on purpose. That's a disinformation that we're getting and they're not doing things that are in our own best interests.

Brian Lehrer: Question from Twitter. A listener asks, "Can you ask what is known about the possible vaccine dosages for five to 11-year-olds? Will the dose be the same for an almost 12-year-old versus a five-year-old? We're eager for our 11-and-a half year old to be vaccinated, but wondering how it will differ if he was vaccinated on his 12th birthday, which is coming in January?"

Dr. Georges Benjamin: Yes. Well, hopefully happy birthday for him when he's 12. The answer is that they're doing the dosing studies now to figure that out. Usually, children's doses are based on both age and or weight. At the end of the day, whatever recommendations they make will probably be based on that and we'll just have to wait and see.

Brian Lehrer: The five to 11 year old approval probably won't come until around that 12th birthday in January anyway so it might be moot in that one family's case.

Dr. Georges Benjamin: It might be sooner for someone between childhood age but you're right. The likelihood of us having all those studies done, because J&J wants to bring those ages down right now.

Brian Lehrer: One more thing before you go because I know how concerned you are about disparities and all of this. I'm curious if you support the vaccine mandate in New York City and some other places for going to restaurants for indoor dining and other elective indoor activities? Some say that will have another disparate impact because in lower income, largely Black and brown neighborhoods, there aren't the economic conditions for outdoor dining structures.

Many of the restaurants are small local places compared to better off neighborhoods. There are fewer options for the people who live there in the first place and even more so with these new rules. Do you have an opinion about that?

Dr. Georges Benjamin: Yes. I've not been a fan of vaccine passports for all those reasons where people can discriminate against you. The truth of the matter is if you're someone who has a medical reason why you can not be vaccinated, therefore you'll be excluded. I have believed very strongly that all healthcare workers must be vaccinated. I believe very strongly that if you're in a school, you need to be vaccinated.

I draw the line right now at being able to effectively have a mandate for going in a restaurant, going in a bar. Look, think about all the challenges we have right now when we card people for tobacco, which again, I'm supportive of, but it's for youth, and when we do that for alcohol. The ability to train people effectively to do that is going to be a challenge. We're going to have lots of disagreements. We're going to have huge arguments over that.

I hope that we can get to a point where, as a society, we do what's in our own best health. That means getting everybody vaccinated. I'm very supportive of the mass mandates as well because I think that until we get our hands around this outbreak and this reoccurrence we're having, we're going to all have to wear mass. Otherwise if we don't and don't get our hands around this outbreak, we're going to be shutting things down again.

Brian Lehrer: Dr. Georges Benjamin, Executive Director of the American Public Health Association. Thank you so much for your work and your time with us today.

Dr. Georges Benjamin: Absolutely.

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