Eric Topol, MD, Discusses the Latest COVID-19 Vaccine Booster Data

John Whyte, MD;  Eric J. Topol, MD

Disclosures

April 08, 2022

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JOHN WHYTE: Welcome, everyone. I’m Dr. John Whyte, the chief medical officer at WebMD, and you're watching Coronavirus in Context.

We're still in the middle of a pandemic. We're all tired of hearing about it, but there are some things you need to know, especially about the role of boosters. A second booster for some. A third booster for immunocompromised.

Joining me today to help us unpack it all is my good friend, Dr. Eric Topol. Eric, it's great to see you again.

ERIC TOPOL: Thanks, John. Always good to be with you.

WHYTE: Let's start off with this is a second booster. It's actually a third booster for those that are immunocompromised. Correct?

TOPOL: Right.

WHYTE: But for the general population, I want to talk about those people over the age of 50. Let's start with that. Is the recommendation to do a second booster, a fourth shot for those that have got mRNA vaccines, the right thing to do?

TOPOL: I would say unequivocally, yes, John. Based on the data from Israel. So there's three studies from Israel. One that just shows a good jump in the antibodies from this fourth dose, compared to the waning after 4 months of the prior booster.

The second study shows a four-fold protection from severe illness, which is only out to 12 days. So that's short-term. And then the third, which is the most important study, in people over age 60, that showed a 78% reduction of death for the fourth dose versus the third-dose wane.

So for people over age 60, the data are clear. The reason why the FDA came out with age 50 is there was from the same big health system in Israel – that showed the 60-plus data for survival – that same health system had published in The New England Journal for the first booster with a 90% reduction in mortality for age 50-plus.

So what the FDA is doing is anticipating where the data is going to go. Because below age 50, there was only benefit from protection from illness. Not so much from – the survival is really critical.

WHYTE: But in fairness, if we're saying we're looking at anticipating where data goes, that's not typically where regulators make decisions. The data is supposed to be there with a rigorous review. So I'm going to push you, Eric. Why didn't they send it to an advisory committee? Some people are saying they didn't send it to an advisory committee because they weren't sure how the advisory committee might vote.

If you remember, on the first booster, there was a lot of debate about who needed it.

TOPOL: Well, that's why our booster situation is such a deplorable mess in this country, John. We have 29% of Americans boosted with the first booster – 29%. We rank below 70 in the world for boosters. And it's because the FDA used advisory committee and the CDC, and they didn't accept the data from Israel.

And we didn't get till the end of November 29th before the CDC finally said that booster should be in all adults. And in those months, we had people die and in the hospital unnecessarily. So this time, the FDA got smart and they said, “We're not going to have an advisory committee. We're just going to go with the data.” And that's what they did.

WHYTE: Was it enough data? Was it enough data? People will say, “Well, we should wait more.” And other people would say, “Eric, you know what? You pointed out the low booster vaccination rate that we have.” Let's be honest, the government cannot do everything well. And some people would say very few things they can do well.

So here we're still trying to get a large percentage of people that are unvaccinated. It feels like we just forgot about those folks. We still need a lot of work on those people that haven't gotten the first booster. Now we're seeing a second booster. Is it too confusing and too challenging to do all of this?

What's your message to the American people? So they can sort through all of this. Because they're not looking at it day to day. And they're just like, “What do I do?”

TOPOL: Well, first, I want to say the data were clear for age 60, as I reviewed. We're talking about life and death. We're not talking about getting a cough here. For 50, the question was if you're going to make a recommendation, and you're going to have more data from Israel in the weeks ahead.

You know, I wrote about this extensively. You can certainly wait for more data. It's up to the individual. It's an option to get the fourth dose. It's not a strong recommendation at this point, but they're giving people an option. It's free. That's good. It's keeping up with the data, all right?

Now, the problem we've had is that we've had infighting. That is, the CDC and the FDA fighting the White House response team and the NIH. That's not what you want in a public health crisis. And as you started out, we're not at the end of this pandemic. We're facing a BA.2 wave.

We don't know how severe that's going to be, but it's going to find people who are vulnerable. And if you've never had a vaccination, or you've had one and it's now 4 or 6 months past, you're going to be vulnerable.

One other point before we go on is, I would appeal to the people who haven't been vaccinated. If they've had prior COVID and think they can just rely on natural immunity, that was OK through Delta, but it's no longer the case.

And I would make a big public appeal: Just get one shot. It's as good as three shots. One shot is as good as three shots if you had prior COVID.

WHYTE: You've been a big proponent of that we need to acknowledge the role of natural immunity, which a lot of regulators are failing to acknowledge. And that's causing confusion. But now when it comes to which one do you get, I always point out about your Twitter feed and how I follow you, and everyone should, @EricTopol.

I want to ask you about this issue of interchangeability. So if you got the Pfizer vaccine first, maybe you should get Moderna or vice-versa. We have some new data about what might be good advice. What do you suggest to people? Should they stick with what they originally got, or maybe switch to a different one and why?

TOPOL: Yeah, so the point is they're not as identical in their performance in terms of how they induce the immune response. They have some complementarity. So the paper was published just yesterday, which showed that the Moderna vaccine had different properties than the Pfizer.

Now, why is that important? Well, we want to get as much of a kick from those vaccines as possible. So this mix and match is a good thing. And so, you know, that's why I would recommend if you've had Moderna's, a Pfizer is a good idea if you have a choice. If you have a choice. And vice-versa.

And I think this really helps people. It just gives an extra layer of immune protection. And I think that's what we should be striving for when it's possible.

WHYTE: There's also some new data about the effectiveness of J&J. And several months ago, we were all kind of pooh-poohing it in terms of its effectiveness and safety. What does the latest data show us? Were we wrong initially in terms of our assessment of it?

TOPOL: Yeah, I mean, to some extent, John, you're absolutely right. When we had longer data on the J&J, it certainly performed better than expected. But I think the problem were two things. One is the very low incidence of this feared clotting issue. With even clots in the brain.

I mean, this is very rare, but it did occur with both the J&J and AstraZeneca. That gave a lot of people the heebie-jeebies, right? And then the second thing is that when the company came out with one and done, that really wasn't such a good idea because if you get a second shot – and especially if you get an mRNA second shot – you get really good protection.

In fact, you may not even need a third shot if you got a J&J first and an mRNA second. The reason why this vaccine seems to do very well over time is it elicits a really good cellular response. You know, the memory cell response. And so, yeah, we should still be keen on the J&J vaccine. It shouldn't have gotten dissed like it did in this country.

WHYTE: Now, what about this 4-month time frame that we're talking about in terms of spacing? Initially, we talked about 6 months, then 4 months. Some people might be saying, “You know what? I feel pretty good right now. And if we accept the concept that there is waning immunity, maybe I'll wait till summer to get it because I want to go on a trip abroad.” Or, “Maybe I'll wait before an upcoming wedding.”

So it gets confusing when we're saying, well, it's an option now. What about now when do you do it at 4 months? Do you maybe wait? Help guide people as they think through. Because some people are going to be like, “OK, it's 4 months, I'm going to get it now.” And others may say, “You know what, I'm doing pretty good. You know, I'll wait until I go back to work to get it.” What's your advice there?

TOPOL: You're getting at some really key points. I mean, who really wants to get another shot? I mean, really. I mean, this is not like having some ice cream or something. This isn't what we want! You know, I think there's a lot of factors that have come into play.

Did you get sick with your prior shot? You might not want to go through that again, right? As you say, do you have travel or some type of event where you're going to be in a big gathering coming up? What is going on in your neck of the woods in terms of case rise?

Some places may be fully spared of a BA.2 wave, and others may get hit hard. These are some of the things that should go in people's individual minds. There's still protection between 4 and 6 months. It's just declining over time. But also, if you're young, if you're below age 50, it's not even really on the table right now.

WHYTE: What are we really treating? Have we communicated it poorly from the beginning? Are we trying to eradicate all infection? That's not typically what we do. Or are we simply trying to keep you from being hospitalized and dying, which the vaccines in general are?

And I thought back the other day to your point. Because we've been talking so much during this pandemic. On the first booster, and you said to me then, you said, "John, we should be reformulating the booster, right, we shouldn't be using the same formulation that really was developed 2 years ago."

Is that what should be happening with future boosters? A reformulation or a re-educating of folks of what we're trying to do? Because no one wants to be getting boosters every 6 months, every 4 months, till when?

TOPOL: That's why I fought hard for a pan-coronavirus vaccine.

WHYTE: Yes, we talked about that.

TOPOL: That's what we need. Because we don't want to keep getting booster shots. You want something that's good against all future variants.

WHYTE: Where are we on that?

TOPOL: Not, you know, we have some work being done. The problem, John, frankly is we have great candidates; that is, we know all these so-called epitopes and binding sites. We can make these broad neutralizing antibodies. But we don't have one of the vaccine manufacturers making the vaccines at this point.

We only have one punitive pan-coronavirus vaccine out there from Walter Reed Medical Center. And it isn't really that type of broad neutralizing antibody. It's so-called ferritin nanoparticle. I don't know if it's going to work. I hope it does. But that's what we need now. We don't want to flex around with all these boosters.

WHYTE: What about vaccination for kids 5 and under? Is it going to be a three-shot regimen? That's what Pfizer has talked about. Is it going to be a two-shot regimen that Moderna has talked about? When are we going to see it, and what's it going to look like in terms of the number of doses?

TOPOL: Yeah, well first just to point out, we haven't done well with children 5 and older. There's a very important New England Journal paper coming out today that shows remarkable protection of hospitalization in children between 5 and 11, no less the adolescents above that age.

So we have failed in protecting our children, right? And now, obviously, there's lots of kids, like my grandchildren, in that lower age group, and yeah – I mean, who wants three doses, right? And that was only because Pfizer picked to lower dose.

We'd like to have a two-dose program that's safe and does protect these young children. I hope we'll have – we won't have the data. We won't know for weeks from now. So yeah, let's hope we have something. It's 6 months to age 5. That's what we're talking about. And yeah, it'd be nice if it only required two shots and it really worked. We don't know that yet.

WHYTE: Well, Dr. Topol, I want to thank you again for your time. We're going to be continuing the conversation, I think, for many more months because as we both have pointed out, we're still in the middle of the pandemic. I know we're tired of it, but that doesn't make it go away.

So we still have to do what you're talking about. Protect ourselves, protect our loved ones, protect our communities. And boosters certainly play a role. So thanks for taking the time today. It's good to see you.

TOPOL: You bet, John. Thank you.

This interview originally appeared on WebMD on April 8, 2022

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