Booster shots for those 75+ is a 'no-brainer': Doctor

Dr. Howard Forman, Yale Radiology and Public Health Professor joins Yahoo Finance’s Anjalee Khemlani and the Yahoo Finance Live panel with the latest COVD-19 vaccine update.

Video transcript

AKIKO FUJITA: Well, the death toll from COVID-19 has officially surpassed that of the Spanish flu, with 675,000 Americans now dead. We did get some promising news today though, specifically from Johnson & Johnson their COVID-19 booster shot. Their results pointing to some strong results for those who got the second dose. Let's bring in Dr. Howard Forman, Yale radiology and public health professor. We've also got Yahoo Finance's Anjalee Khemlani joining in on the conversation.

Doctor, it's always good to have you on. What do you make of the results out of J&J today and how should we be thinking about it in the context of where we are in the pandemic right now?

HOWARD FORMAN: Yeah, look, first of all, the J&J results exceed expectations. They continue to point out that the J&J vaccine is highly effective, even-- as a one dose vaccine. They presented us with two scenarios of giving two doses of J&J. One, as just a typical two dose vaccine separated by eight weeks. And then they also present the idea of using the second dose as being a more traditional booster at six months.

They have outcomes, data efficacy data for the two month cycle, which shows it to be highly, highly effective, on par with the existing mRNA vaccines. And they have good antibody data for six months, which even exceeds what you get when you give the second dose at two months. And so there's a few things that we learned from J&J. One, it's highly effective. Two, they report that there's no evidence in a large real world effectiveness study, of it waning immunity, which people have been very concerned about with Pfizer and Moderna. There's no evidence that it's actually waning.

They find that the second dose really helps and that the later the second dose is, presumably more antibodies, which is something really important for us. And they're pointing out that protection against severe disease is effectively 100%. These are remarkable outcomes. Even the original vaccine is a single shot exceeded the earlier expectations we all had about what a vaccine could do. It only looked more modest when you compared it to mRNA vaccines, which had been presented a little bit earlier.

ANJALEE KHEMLANI: Dr. Forman, I'm so glad you brought that up because I want to talk about the difference between the two and the idea that this debate about antibody titers and whether or not it's that or memory cell immunity, that's the key factor that we should be paying attention to here. So what do you think about that and does that signal that maybe we don't need a booster?

HOWARD FORMAN: So for J&J, one of the things to think about is not so much about traditional booster, but rather have we reached an optimal level of immunity for any given vaccine and how do we discount our account for waning immunity? In the case of J&J, it seems like you have very strong, steady immunity, but it's a little lower than we at least learned about with the Moderna and Pfizer vaccines. Now remember, J&J tested when alpha variant was already out there and the beginnings of delta variant were out there. So we've never been sure that we're comparing apples with apples in this particular case.

I do think there's a compelling case to be made for boosters in certain populations right now. It's not clear there's a compelling case for boosters for other populations. But getting this type of information on J&J allows us to start to make similar decisions for all the vaccines, rather than picking and choosing just Pfizer or just Moderna.

AKIKO FUJITA: Doctor, I wonder where you stand on this debate about whether, in fact, boosters are necessary. I mean, you've heard the discussion here about whether, in fact, we should be pushing for this third shot at a time when there is low supply in other countries. How do you think we should be thinking about this and how effective ultimately, do you think these boosters can be at a time when we've seen so many breakthrough infections?

HOWARD FORMAN: Right. So we are seeing a lot of breakthrough infections, but we still know that all the existing vaccines are protecting against transmission. It's just that people have gone back to resuming normal lives and so our mitigation is no longer about social distancing, de-densification, and work from home or mitigation factors, primarily about vaccines. And those are complementing one another. But the highest impact is now the vaccine, whereas the highest impact a year ago was working from home and other factors like that. People are going to Broadway shows again. People are going to movies again bars, and so on.

So the vaccines are important in breaking the chain of transmission. What we now face coming into the fall and winter months is what we think will be the usual seasonal effect of increased transmission. And then the question is, is the vaccine enough to halt that transmission or are we going to see escalating breakouts in the Northeast and other areas, even with high vaccination rates? And that's why people are speaking about getting a booster shot.

But let me put that aside for a moment and just say that among the super elderly and the immune compromised, there's a strong case to be made for a booster shot, not because of waning immunity, but because their initial immunity was not at the level that we all would have liked to see. And since that is the most vulnerable population to hospitalization and death, one can make a very strong case for boosting that population.

The FDA in their initial advisory, which will be followed up by the ACIP meeting at the CDC later this week, is presumably limiting that to 65 and older. I was public about the fact that I thought 75 and older was a no brainer. 65 and older probably is also the right choice. I can't make a good case for us using a limited global supply of vaccines on people below 65 right now. But come back to me in six or eight weeks when we start to see what the outbreak looks like in the United States, as we head into the real crux of fall, which begins tomorrow, and I may change my mind about that.

ANJALEE KHEMLANI: Certainly seems to be the direction that a lot of people are thinking. Dr. Forman, I also want to get your thoughts on the pediatric trial and the fact that J&J hasn't yet begun it. Do we see that as an issue, considering a limited supply, but also the really important need right now in that trial group?

HOWARD FORMAN: It's really disappointing. We've had decades now of seeing whether the pharmaceutical companies will test their drugs in pediatric populations early enough. And there was legislation about this, in fact, about 20 or 25 years ago, in order to incentivize the pharmaceutical companies to test other drugs in pediatric populations.

J&J has made a big bet on the fact that there is huge demand for their vaccine and they're going after the adult population first. There's obviously a greater risk proposition for any company to expand use to the pediatric population and they're obviously letting other players move into that space first, which I'm disappointed in because their vaccine does seem to be very safe and it does seem to be very effective, and it would be nice to have yet one more addition to that population. At least the 12 to 18-year-old group, if not younger.

AKIKO FUJITA: Dr. Howard Forman, Yale radiology and public health professor, always good to have you on. And our thanks to Anjalee Khemlani as well, for joining in on the conversation.