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Experts Weigh In on Booster Shots for the Immunocompromised

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Published on August 19, 2021

What Do We Know About COVID-19 Booster Shots?

Watch as Patient Power co-founders Andrew Schorr and Esther Schorr meet with Chancellor Professor Emeritus Jim Griffith, PhD, CLS (NCA), and Chancellor Professor Emerita Susan Leclair, PhD, CLS (NCA) from the University of Massachusetts Dartmouth to discuss booster shots for immunocompromised individuals. Dr. Griffith reveals that “the immune response is complex” and “we ought to try to advantage it as much as we can.

For more information, read: CDC Recommends Third COVID-19 Vaccine Dose for Immunocompromised Patients

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Transcript | Experts Weigh In on Booster Shots for the Immunocompromised

Andrew Schorr: Hello and welcome to Patient Power. We are in San Diego. I'm Andrew Schorr.

Esther Schorr: And I'm Esther Schorr.

Andrew Schorr: And of course I've been living with the immunocompromised condition, CLL affecting my B cells. And I'm very focused on COVID. We both are, of course. And so, for our friends who are dealing with conditions, where you worry about either the medicine compromising your immune system or your condition itself, we want to talk with two experts. And that's another couple Jim Griffith, who is a microbiologist married to Susan Leclair, a laboratory science cell expert who joins us from Dartmouth, Massachusetts. Thanks for joining us.

Dr. Leclair: Anytime.

Dr. Griffith: Happy to be here.

Andrew Schorr: Thank you, Jim. So, we have questions about boosters, right Esther?

Esther Schorr: We do. We have gotten lots of questions about boosters. So maybe the way to frame it is, are they needed? Is a booster shot needed? If so, how soon? And will it help patients who didn't get a response if they were immunized already?

What Do We Know About Booster Shots for COVID-19? Are They Needed?

Andrew Schorr: Jim?

Dr. Griffith: Okay, well, let me say first off that anyone who got the Pfizer or Moderna vaccination already got a booster, the second shot was a booster. A booster is any vaccine component that you give that enhances your immune system after the first vaccination dose. So those people already got a booster. What we're talking about in the scientific world at this point, and in the general public is "should we give an additional booster?" i.e. third shot for those Moderna and Pfizer people, or let it go the way it is. And the answer is we don't know yet. And I'm talking about just people in general. Pfizer has indicated very publicly that they are ready to give or to produce a booster, a third shot. I think they're going to manipulate it a little bit from the first two that we had, the general vaccinations that went around, but they're prepared to do it.

And they think it's a good idea. The FDA at this point has said, "Well, we don't know that yet." And so, we're waiting to see. If you count back to when the vaccines were first widely available, not initially, but widely available, we're starting to approach the six-month timeframe, but most people have only had these vaccinations for two months or three months or something like that. So, we just don't have enough data to know in the general population, whether this is warranted or not. And what everybody is looking for, is the fall off in antibody level. The antibodies, assuming they are protective, which it would have assume so far that they are, the Delta variant as decreased. The effectiveness may be down to 66%, but it's still in the nineties for a serious disease. So even with this Delta variant, the initial vaccination is holding.

So now we get to anyone for any reason who is immunosuppressed or immuno-depressed, and there are lots of reasons for that. You constitute a particular reason, but there are lots of them. So, the question is when an infectious disease or public health scenario, like this comes up and gets rolling, what do we do? Until we have a chemotherapeutic, some pill that you take that directly knocks out the virus, which we're not there yet. We have pre-formed antibodies like Regeneron, but essentially, we're not there yet. We might get there someday, but we're not there now. So that only leaves vaccination. When you do vaccination, you are hoping for one of the other, or the best thing would be a combination of three things. Neutralizing antibodies, activating CD4 and CD8 T cells, the T cell side of this, and immune modulatory cytokines like interferon gamma. So, the response to a vaccine challenge is complex. There's a lot of stuff going on. And the literature so far suggests that people who are immunosuppressed or immunocompromised and they don't make a lot of antibodies, that would include you, you may still have the other stuff going on. It's hard to measure.

The T cell side, there are tests and I'm sure Susan could talk about them. There are tests, but it's not the easiest thing to do. And we're not entirely sure what the answers mean when we do them. So, there's this other part, the T cells are basically the street cop saying to your immune system, "Hey, wake up." And then the interferon gamma on another immunomodulatory cytokines, we can measure those, but not well, not easily. So, my advice would be to anyone, I don't care who you are, don't care where you are, unless there is a medical reason why a vaccination is dangerous for you. And that's not the case for you. You should get the vaccine. When we come to the point where the conclusion is, the antibody level is fading and therefore the FDA and the CDC recommend that everyone who got the initial vaccination, whatever it was, whether it was a two shot-er a one shot-er, if the recommendation comes that there should be a booster, then you should get a booster too because the immune response is complex and we ought to try to advantage it as much as we can.

Esther Schorr: So, Jim, just to clarify, at the beginning of the conversation, you mentioned Pfizer and Moderna which were two shots each. An initial shot, and what you now called the initial booster, but there are lots of people who got the J&J, which was one shot. So technically they haven't had an initial booster.

Dr. Griffith: Right.

Esther Schorr: Did they behave any differently?

Dr. Griffith: Well, again, we don't entirely know. It hasn't been long enough. The J&J vaccine hasn't — worldwide, we don't have great data on it, we do in the United States, but — I would say for them, they should also consider a booster whenever it's recommended. But at this point they're probably doing a little bit less well overall than the people who got the two-shot vaccinations, but not by an amount that matters. So, I would say the Moderna, Pfizer, and J&J vaccinated people, whatever level their immune system can respond at, they're all probably in the same realm.

Andrew Schorr: Okay. Susan, you've been listening as we have and you've been with your husband many years. Let's just see if I've got it right. And maybe you can make sure. So what Jim is saying is boosters can be a good thing as the research rolls out, as to timing and when, for anybody. We don't have enough data yet to know when they're needed or how much of a kick there'll be. But even for people like me or our friends who are immunocompromised, it's not a bad thing. And it's hard to measure beyond the antibody test with the other parts of the immune system, how well it's going to help. Is that right?

Can You Weigh In on How Vaccines Work Within the Immune System?

Dr. Leclair: That's excellent. Yes. That's exactly what happens. It's like if you have a glass with liquid in it and the only thing you're testing for is, is it sweet? Okay. It's sweet. Did you bother to test for whether or not it has salt in it? It could be Gatorade. That's got a lot of stuff in it, or it could be water in which you just put some sugar into it. We can't, or we have a really hard time testing for those other elements of the immune system. And even if I did, one of the things I can't test for is do they work? No? You could have five cars in front of your house and that all looks wonderful, but none of them work. They're not going to get you anywhere. Well, so you test for amounts and you test for function. We test very good for amounts. We're good at counting. We're not so good at function for antibodies or for the rest of the immune system.

Andrew Schorr: Okay. So just to recap then where we are now is, it's a moving target. It's a moving target with what the drug companies are saying who make the vaccines. It's a moving target with what's being tried in different countries, on different populations and waiting for recommendations here in the U.S. from the FDA and CDC and how it applies to people like me, people who take immunosuppressive medicines. Stay tuned.

Esther Schorr: So, if that's the case, then what's the recommendation? How should patients behave now? Especially the ones who are immune compromised and aren't sure whether they're protected or not?

Andrew Schorr: And no booster yet.

Esther Schorr: And no booster.

What Advice Do You Have for Immunocompromised Individuals During This Time?

Dr. Griffith: Let me add another point of light. Just something to consider and possibly something you could follow, a group that you probably have never heard of, CEPI, the Coalition for Epidemic Preparedness Innovations, C-E-P-I. They have just put in some millions into a pot with several Norwegian health organizations who also put some millions into it. And they are specifically, the study has just started, they are specifically trying to assess whether giving a booster to any marginal immune response person, that would include you. How does that compare to an immunocompetent patient? So, this study is directly trying to measure giving a booster to somebody who’s vaccinated, but they're immunosuppressed, to someone who's immunosuppressed versus someone who is immunocompetent. Exactly how does that work? They are also going to look at immunosuppressive meds. There is some research that I saw recently that suggested that interleukin-6 receptor blockers.

This is a study from the World Health Organization (WHO), tocilizumab (Actemra) and sarilumab (Kevzara). These are interleukin-6 receptor blockers. These things cause a lot of your super immune response that puts you in the ICU when you are a coronavirus patient. And so, they’re, they're also looking at that. You would administer these things with corticosteroids. There are also studies that are starting and some that are ongoing about biomarkers and giving direct antibodies. And so, there's a bunch of stuff like that. And I certainly would like your viewers to appreciate that people are aware that you are there. Various scientific organizations have started and put up money, and they're doing stuff to see exactly how this works, but the CEPI work is something that I will keep following it for you, but you might want to follow. That directly applies to you. And at some point, I don't think it'll take too long. I think it'll happen before we have the boosters, if we get to that point. We will have something of an answer from CEPI as to whether, directly, that it makes some sense or it doesn't.

Andrew Schorr: Okay.

Esther Schorr: So it sounds like in the meantime, patients in fortitude and to continue to be careful.

Andrew Schorr: Wear a mask.

Esther Schorr: Wear a mask if you're immune compromised, especially.

Dr. Griffith: Absolutely.

Andrew Schorr: Okay.

Esther Schorr: Thank you.

Andrew Schorr: Well-

Dr. Leclair: I know it's not in our culture. But we could take a lesson from the Japanese and from other Asian countries that wearing a mask is not a bad thing. And that particularly with the non-N95 masks, but the lighter ones. We're not asking for anything that's huge here. Put it on when you go into a grocery store or into a place where you're not sure who's going to be there.

Andrew Schorr: Well, thank you so much for being with us. Once again, Jim Griffith and Susan Leclair joining us from Massachusetts with probably a combination of like 80 years or so of expertise.

Dr. Griffith: Oh yeah.

Esther Schorr: A lot of -

Dr. Leclair: I started when I was very young.

Andrew Schorr: [crosstalk 00:14:50] We'll be back with you. Thank you for your devotion to patients, Esther. Thank you. And as we always say, knowledge can be the best medicine of all.

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