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People who are immunocompromised didn’t gain enough immunity from their first COVID-19 vaccine shots and need a booster for full protection, explains Dr. Fauci. Fauci spoke with William Brangham about breakthrough infections, the delta variant’s threat to children and how the virus is changing.
As we reported, the Food and Drug Administration is expected to approve a booster shot for some vaccinated Americans with compromised immune systems.
It comes as the Delta variant surges, with more states seeing new highs in infections and hospitalizations.
I spoke with Dr. Anthony Fauci moments ago. He's the director of the National Institute of Allergy and Infectious Diseases and the chief medical adviser to President Biden.
Dr. Fauci, great to see you, as always.
I mentioned the FDA is likely to approve these booster shots for immunocompromised people. Why is that? And how many people are we talking about?
Dr. Anthony Fauci:
Well, we're talking about a relatively small percentage of the adult population, less than 3 percent. It's somewhere around 2.73 percent.
The reason for it is really, from a health standpoint, a very good reason, because people who are immune-compromised, those who fall under the congratulate that were delineated by the FDA, such as people with organ transplants on immunosuppressive therapy, people in cancer chemotherapy, immune-suppressive therapy for a number of diseases, naturally occurring immune-compromised, those individuals as a group never got a really good and adequate response to begin with.
So we're not talking about the durability of a good response that tends to wane. We're talking about people who are in harm's way because they're at considerable risk because they are immunocompromised, in whom the vaccine regimen never really got them to the level you wanted to.
That's the reason for that additional boost, to try at least, in a proportion of them, to get them up into a safe, protective level.
I want to talk to you a bit about breakthrough infections, because it seems like everyone now knows someone who has had one or knows of someone who has had one.
You said in your briefing today that, even with those breakthrough infections, it is it vanishingly rare that those people end up in hospital or end up dying.
But people are still nervous about this. Can you just — how worried should we be about breakthrough cases?
You know, I think the first thing we should do is that clarify the word breakthrough, because that really has quite a negative connotation.
No vaccine is 100 percent effective. Even vaccines that are really quite effective, like the mRNA vaccines, which are 94 percent to 95 percent effective. But if you look at what that number means, it means effective against clinically apparent disease. So people who get infected despite the fact that they're vaccinated generally fall in the category, with some exceptions, of course, of either being minimally symptomatic or not having any symptoms at all.
They are categorized as a breakthrough infection. The real critical issue of what you want the vaccines to do is to protect you against severe disease that might lead to hospitalization and in some cases death.
So, the fact that you get breakthrough infections, in some respects, if it protects you from getting serious disease, the vaccine is doing exactly what you want it to do. So, that's not saying we can do better. Of course, you would like to see no infections. But that's almost an impossible demand on a vaccine.
Bottom line is that the vaccines are doing what we expect them and want them to do, even in the context of a Delta variant.
For people who are seeing news reports about children being hospitalized, help us put that into perspective.
Is that simply a function of, that is the population, the largest population in America that is still unvaccinated, or is that a function of the Delta variant? Both? How should we see that?
I think it's both. And there are things about the Delta variant that are concerning.
So, when you had a high degree of capability of transmission, you had a certain number of people who would get infected, a certain percentage of children would get infected. And you remember back then, a long time ago, seemingly, they would say, oh, children generally don't get infected as much and they don't transmit as much.
We were dealing with a different virus then. Now you have a virus that does a big and better job of infecting anybody much more efficiently than the previous virus, including children. So, relatively speaking, you are seeing more children getting infected.
And just on numbers alone, when more children will get infected, a proportion of them, a small proportion, albeit, are going to wind up with serious disease, getting hospitalized. And that's one of the reason why, maybe the overwhelming reason, why you're seeing children in this particular context of Delta being in the hospital.
One other point, because you want to make sure that people understand everything and we're transparent. When you look at the severity of disease with Delta, and you put children aside and look mostly at adults, there are some studies that indicate that the chance of hospitalization with Delta, at least in adults, is greater than it was with Alpha.
So there may be a difference in severity. We don't have that nailed down yet. The thing that's nailed down is that, clearly, it's better in transmitting. So, you can make an assumption that it could be that the disease might be even more serious in kids, even though we haven't definitely proven that.
Lastly, Dr. Fauci, I think many Americans, especially those who had been vaccinated, felt like we were starting to turn the tide on this pandemic.
And now they see these reports, these flaming red maps of outbreaks in almost every state around the country, particularly in areas with low vaccination rates, and there's a sense of despair and a sense of anger from those people.
What would you say to them?
Well, certainly, the frustration is understandable.
But I think, if you look at what we are dealing with and what is changing, the virus is changing. It is not a stable virus. It's a virus that over a period of time has evolved into something that's much more transmissible. We have to deal with that.
We can't imagine that it's not happening. And, yes, it causes frustration. It might even cause anger. But there is a solution to this. And the solution is vaccination. If we had the overwhelming proportion of the population vaccinated — and I particularly refer to the 93 million people in this country who are eligible for vaccination who are not getting vaccinated — we would not have the tone of the conversation that you and I are having right now.
Dr. Anthony Fauci, always good to see you.
Thank you very much.
Thank you for having me. I appreciate it.
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