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Boston Infectious Disease Doctor Says Booster Shot Plan Brings Up Complicated Issues

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The rate of breakthrough coronavirus infections among vaccinated people in Massachusetts is on the rise.

Nearly 2,700 people who are fully vaccinated tested positive last week. Those account for 40% of new infections during that time period, according to the state's Department of Public Health.

Meanwhile, the Centers for Disease Control and Prevention has announced a plan to give COVID booster shots to the majority of fully vaccinated Americans eight months after their second dose of the Pfizer or Moderna vaccine.

Dr. Nahid Bhadelia is an infectious diseases physician at Boston Medical Center, and founding director of the Boston University Center for Emerging Infectious Diseases Policy and Research. She told Jack Lepiarz on WBUR's All Things Considered that the idea of giving booster shots to generally healthy people soon is complicated.

Below are highlights from their conversation, which have been lightly edited.

Interview Highlights

On the factors involved in providing booster shots:

"I think that you could be on both sides of the topic and see benefits ... The data that the administration is sort of basing their decisions on so far, it looks like for people who are immunocompromised, there is clear data that having a third dose is going to help increase their response. What the administration is saying is that ... the canaries in the coal mine are basically saying more waning of immunity will be seen, which means that even healthier people may see more severe infections.

"So is there a benefit to vaccinate healthy people with boosters a month down the road? Sure, because I think if you potentially reduce breakthrough infections, you could reduce, A, illness and the impact on the individual, but, B, you could reduce transmissions.

"But ... our problem is actually the unvaccinated — people who haven't even gotten one dose. And the other side of this ... which is the global equity part of it — there is a selfish component to that, which is that if we did more first doses right now, rather than focusing on third doses, it may actually ... have a bigger impact, because it will decrease the chances that any one of us come across somebody who is positive."

On whether, from a moral perspective, booster shots for the general population are the right call:

"Only 16% of the world is vaccinated, and the longer you see unchecked transmission ... the longer you get destruction in those communities from a health care perspective, as well as societal and economic perspective ... [and] the more chances there are that we'll see new variants. And the question is, will we be chasing our tail?

"... Rich nations are making the choice. We'd rather keep vaccinating our population, keep giving boosters to our population ... I get why the Biden Administration has taken this stance — because they want to give Americans the best protection possible. What I would like to see is an equal, reinvigorated commitment of the U.S., as well as the EU and other places — because 90% of doses are going to 10% of the  world — we need to have a commitment to vaccinate the rest of the world."

On whether people who got the single-dose Johnson & Johnson vaccine should be eligible for a booster of that vaccine or a shot of the Pfizer or Moderna vaccine:

"In my mind, there's going to be a clear need for people who have Johnson & Johnson to also get a booster if everybody else who's gotten two doses of [an mRNA vaccine] would need a booster. What we heard from the administration today is that there might be more data coming out in the next few weeks that helps them release more guidance around this. And again ... the highest risk of those are people who are immunocompromised and potentially those who are over 65."

On what she takes from learning that 40% of new infections in Massachusetts last week were among people who are fully vaccinated:

"I think there's two things. One, we do know that there is waning of immunity over time as antibodies are going down. But then again, with [the delta variant], it adds another bit that might help reduce effectiveness of vaccines. And that's why you're seeing this increased number of breakthrough infections.

"But the tough part is, you also have to take into account that [a] huge part of Massachusetts is vaccinated. And so you expect more people — you expect them to be overrepresented. The better comparison should be how many of the people who are vaccinated got an infection, compared to people who are unvaccinated who got an infection."

On the 51 new hospitalizations and 18 deaths last week among people in Massachusetts who had been fully vaccinated (according to DPH) — and a New York Times analysis of data from seven states that found breakthrough cases represent 18% to 28% of new positive test results in recent weeks:

"Again, the same thing applies here as the numbers we talked about previously. As more people are getting vaccinated, you're likely to see vaccinated being overrepresented — because there are more people. However, the idea that breakthrough infections, in general, are growing, it does tell me that we're not out of the woods yet — that ... we've got to layer our mitigation measures."

On how we should respond in terms of testing and masking:

"I think that from the masking perspective, the data that the vaccinated could potentially get breakthrough infections and those breakthrough infection numbers are increasing, but also that the vaccinated in some cases can transmit, to me, it shows that we need to put on that mask for a bit longer. And we need to take measures to not have large gatherings, indoor gatherings in particular ... that bring people whose vaccination status you don't know into the same space. That's one bit.

"And I think for testing, I've always been a proponent of testing at least everybody who has symptoms, whether they're vaccinated or not. And had we done that, I think we would have had a better sense of ... how big a surge this is ... But I also think that it would have given us a much earlier marker of saying, 'look, we are seeing more increased breakthrough cases.' "

This segment aired on August 18, 2021.

Related:

Headshot of Lynn Jolicoeur

Lynn Jolicoeur Producer/Reporter
Lynn Jolicoeur is the field producer for WBUR's All Things Considered. She also reports for the station's various local news broadcasts.

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Headshot of Jack Lepiarz

Jack Lepiarz Reporter and Anchor
Jack Lepiarz was a reporter and anchor at WBUR.

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