FDA panel backs another shot for some Johnson & Johnson COVID-19 vaccine recipients

An FDA advisory panel on Friday recommended a second booster dose for Johnson & Johnson's single-shot vaccine. Dr. Celine Gounder, an infectious disease specialist and epidemiologist at New York University's Grossman School of Medicine, and Dr. Ashish Jha, the dean of Brown University's School of Public Health, join William Brangham to discuss.

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  • Judy Woodruff:

    The FDA panel that recommended a second shot of the Johnson & Johnson vaccine today has been busy the past two days considering whether more Americans should get a booster dose and when.

    William Brangham helps us break down what people need to know.

  • William Brangham:

    That's right.

    In addition to their J&J recommendation, this panel also looked at whether mixing doses from different manufacturers can improve protection against the virus. Their recommendations still have to be approved by the FDA and the CDC.

    We explore this with two people.

    Dr. Celine Gounder is an infectious disease specialist and epidemiologist at New York University's Grossman School of Medicine, and she cares for patients at Bellevue Hospital Center. And Dr. Ashish Jha, he is the dean of Brown University's School of Public Health.

    Good evening to you both. Thank you both very much for being here.

    Dr. Gounder, to you first.

    So, this advisory panel recommends this booster, the second dose of the Johnson & Johnson vaccine, for all adults 18 and over.

    We should say also, by the way, that Johnson & Johnson is a funder of the "NewsHour."

    But the company did get kind of roughed up today during the testimony. There was questions about their data. One panelists seem to suggest that this should have been a two-dose vaccine all along.

    All of that said, do you think the evidence for this booster is merited?

    Dr. Celine Gounder, Infectious Disease and Public Health Specialist,: Look, I do think it was noble to try to have a single-dose vaccine, I think, from the perspective of operations logistics, getting people vaccinated, from an equity perspective, that it meant only one appointment, time off work, child care associated with that.

    And I think many of us had hoped that this would truly stand up the test of time. But what we have seen over time is that the Johnson & Johnson vaccine does not perform as well as the Pfizer and Moderna vaccine with respect to the more critical outcomes, in particular, severe disease, hospitalization and death, not just with respect to breakthrough infection.

    And what we are seeing is that, with an additional dose of vaccine, you really do boost the immunity with the Johnson & Johnson vaccine.

  • William Brangham:

    Dr. Jha, could you help remind us why we're actually having this conversation about boosters? Is it because the vaccines are slipping somewhat in their efficacy? Is it because the Delta variant is so potent?

    I mean, why are we having this conversation?

    Dr. Ashish Jha, Dean, Brown University School of Public Health: Yes, William, it's a really critical question.

    The reason we are having this is really twofold. One is, we are seeing some waning of the effectiveness of vaccines, typically about six months after the second dose for the mRNA vaccines and two months after the J&J vaccine.

    But the other is the Delta variant. I mean, the Delta variant is so contagious, and it infects people with such high viral loads, that you need a very high level of protection to keep yourself safe.

    And what we're finding is, six months after the vaccine, the — it's just no longer as good as it needs to be, particularly for high-risk people, where a breakthrough infection can end up being a real problem. That's what we're seeing. That's what we saw in Israel. That's we're seeing in European countries. And that's what we're starting to see here in the United States.

  • William Brangham:

    Dr. Gounder, as I mentioned at the beginning, there was this — also a discussion today about whether or not people can mix and match vaccines.

    And there wasn't a vote taken on that. But it seems that there was support for that idea. Again, explain why someone might want to do that. If I took A, why do I want to have a shot of B next time around?

  • Dr. Celine Gounder:

    Well, think of it like maybe a mug shot of a criminal. If you have two different photographs, one from the front, one from the side, you have a better chance of recognizing that person out in public than if you only had one snapshot.

    And, similarly, these vaccines give your immune system different ways of looking at the virus. And so your immune system has a better shot at recognizing it down the line.

  • William Brangham:

    I love this idea of the virus having a mug shot and we see two sides of its face to help better figure out how to get it.

    Dr. Jha, a broader question about the pandemic. I mean, we are seeing a couple of weeks of pretty good news. Cases, hospitalizations and deaths all seem to be on a downward trajectory. I mean, we are still losing, we should say, somewhere around 1, 800 people a day, which is, of course, tragic, and we have become somewhat inured to these numbers.

    But do you have a good sense as to why those trends seem to be going down right now?

  • Dr. Ashish Jha:

    Yes, it's a great question, William.

    What we're seeing is dramatic falloffs in infections in the South. My sense is, part of that is driven by the fact that the Deep South tends to be very, very hot over the summer. And so people spend a lot of time indoors. As the weather cools, people can start spending a bit more time outdoors. That's helping.

    There's also — we have seen this come up over and over again with a Delta variant, without a very clear explanation, that it tends to do these very steep rises, last about two months, and then it turns back down. We did see that in the U.K. We saw that in India.

    So there's an element of this that's not fully understood. But I am not so convinced yet that the country is completely out of the woods. It is getting colder here in the North, in the Midwest and Great Plains states, where vaccination numbers are still low.

    I remain worried that there are parts of our country that are still quite vulnerable to more cases, infections and deaths. So, we have to be careful as we go into the fall and winter.

  • William Brangham:

    Certainly.

    And, Dr. Gounder, the similar question to you. I don't want to portray this as light at the end of the tunnel or, as Ashish is saying, that we are anywhere near the end of this.

    Do you think, though, that this — that this trend will continue, and yet we then might have a rough fall or winter? Or do you think this might be a change for the better more permanently?

  • Dr. Celine Gounder:

    Well, I do think we need to be cautious, particularly in parts of the country where people will be spending more time indoors, so, the Northeast, for example.

    In addition, we do see a bump in the transmission of respiratory viruses, whether that SARS-CoV-2 or influenza or just regular cough and cold viruses, in the winter months, and especially around holidays, like Thanksgiving, Christmas, New Year's, when people are traveling more.

    And so I do think we will see maybe not an extreme surge, like we have seen over the course of the summer. But I do think we will see an increase in cases later this fall.

  • William Brangham:

    And, Dr. Jha, this — about this cyclical nature that you were describing.

    I think it's very frustrating for people who like to think we're near the end of this. Can we be done with all these mitigation measures? Are we done? Are we not done? What do you mean I got to go back to wearing masks again? Dr. Jennifer Nuzzo today described this as us lurching between crisis and complacency.

    It seems that that poses a real challenge for public health officials on how to communicate that we're not necessarily sure how this roller coaster is going to go.

  • Dr. Ashish Jha:

    Yes, there's a complexity here, because, while we don't know exactly how it's going to go, it is not like we have no information, we have no idea.

    I think we are at this point pretty confident that this fall and winter will be clearly better than last one, because there is so much population immunity. It is hard to predict exactly the bumps up and down. But the bumps are getting smaller. I believe the worst of the pandemic is behind us at this point. That doesn't mean we're out of the woods. We have some tough days.

    And the key point is, pandemics are always — they're always changing. And they always pose new challenges. And we just have to be flexible as we get through the next three to six months. That might be periods of time where we're masking indoors, other periods of time when we can relax some of those restrictions.

    I think we're heading in the right direction. But we have to be willing to be flexible as we go through the months ahead.

  • William Brangham:

    And, Dr. Gounder, in this conversation on potentially the waning of this pandemic, there's a lot of discussion as to whether this virus will become endemic.

    Can you explain the terminology there? What does that mean? And do you think we're headed in that direction?

  • Dr. Celine Gounder:

    I do think we're heading towards endemicity, where the virus is endemic.

    What that means is that you have an ongoing, steady level of transmission of the virus in the community. You're not having these big surges like we have been having over the course of the last almost two years now. But you do have ongoing, stable transmission.

    And so that does mean that it is important that everybody get vaccinated. If you have not been exposed to this, there's a decent chance over the next couple years, you certainly would be, and you would still be at risk for the disease and other severe consequences of getting infected.

  • William Brangham:

    And, Dr. Jha, last question to you.

    This — we're seeing these panels and these recommendations for boosters coming out. And we believe these approvals will continue to come. Is it your sense that we will need boosters going forward, that we may all get a second or third booster now, but then down the road, six months, a year or two years, that we might be doing this, re-upping these over and over again?

  • Dr. Ashish Jha:

    Yes, that is my sense, William.

    I think, given the contagiousness of Delta and given that my sense is, it's going to be the variant that's going to be with us for a while, what we're going to see is periods of time where you have waning immunity. And people are going to need to get revaccinated or get boosted up again.

    My best guess is, it's probably going to be annual for a while, the way we get flu shots for — and that is something we can handle. Our system can handle that. But I think the idea that somehow this would be the last shot we'd ever get in our lives, probably not. We should be ready for, at least for the next few years, maybe an annual booster for this — for this virus.

  • William Brangham:

    All right, Dr. Ashish Jha and Dr. Celine Gounder, always good to see you both. Thank you very much.

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