Omicron vs. Vaccines, the booster shots rollout and more

Dr. Tedros Adhanom The Omicron variant has now been reported in 57 countries, and we expect that number to continue growing. Certain features of Omicron, including its global spread and large number of mutations, suggest it could have a major impact on the course of the pandemic.

Jordan We now know a little more about the newest COVID variant. For one thing, we’re beginning to discover just how much it evades vaccines. And while there is a significant reason for concern, for those of us who have had two shots, there is of course, something that can be done about that

Dr. Kieran Moore Beginning in January, Ontario will further expand eligibility for booster doses based on age and risk, with an interval of six to eight months from the second dose.

Jordan As COVID cases rise again, I’m sick of saying that, across Canada, and we begin to worry about holiday plans and seeing family and keeping children and grandparents safe. It’s fair to ask for every Canadian 18 plus, where’s my booster? How fast can these third shots be rolled out? And what will the uptake on them be? After all, many people who might’ve been a little reluctant to get their shots in the first place, were told that two doses would fully protect them. Will they come back for a third?

And what about kids who are just now getting their first shot or can’t even get that yet? Do we know how they’ll fair against Omicron? Finally, is this booster, or the third dose, or whatever you want to call it, really the end? Or should we just admit that we’ll be getting annual COVID shots the same way we do with flu shots? And if that’s the case, can public health officials just tell us that?

I’m Jordan Heath-Rawlings, this is The Big Story. Sabina Vohra-Miller is a clinical pharmacologist who has spent the entirety of this pandemic explaining the illness and the vaccines to everyone from the prime minister of Canada, to us here on The Big Story. Hi Sabina.

Sabina Hi. Thanks for having me again.

Jordan You are most welcome. I’m really pleased to speak to you again. I can’t say I’m pleased we’re talking about more doses of vaccines, but here we are.

Sabina Yeah, exactly. I was really hoping by now we’d have COVID behind us, but I guess the saga goes on.

Jordan Well before we talk about booster shots in general, let’s talk Omicron variant specifically, because I guess now we’re starting to get some data. What do we know about vaccines versus the new variant?

Sabina Okay. So first of all, what I want people to know is that it’s not nearly as bad as we initially thought. So first everyone breathe.

Jordan That’s a good thing to start with.

Sabina Exactly. I just want to put that up in front because I think a lot of people are, you know, terrified, mixed with despair, tons of sensationalist headlines over the last few weeks. So this is good news. Yesterday, a study was released that showed a significant decline in neutralization in those who were vaccinated with two doses, but a very small decrease in those who were vaccinated with two doses and infected.

When I saw that data, I know a lot of people were very concerned, but to me it actually implied that a third dose or a booster, those would actually bump up those who had two vaccines to similar levels of neutralization as the vaccinated plus infected. So today I was so pleased when I woke up and I saw Pfizer released their promising results. They basically looked at this in their lab and they found that three doses offered great protection. In fact, similar to other variants. There is a 25 to 40 fold decrease in neutralization with just two doses. But the part that I love is that T cells, T-cells are actually responsible to prevent severe illness, T-cells were not significantly affected.

So even those who have only had two doses of the vaccine still have protection against severe illness from Omicron, which I think is absolutely fantastic. Neutralizing antibodies are basically what neutralizes the virus right away. This is more for symptomatic illness. And so I think it’s great that we’re looking at doing third doses. I think to me, what this suggests is that with any of these vaccines, it’s going to end up being a three dose primary series for everyone.

Jordan In a few moments we’re going to get into those third doses, when they’re coming, for who, if they should be speeded up, et cetera, but just to probe a little bit on what you mentioned, for regular people like myself and I think probably the majority of people listening right now who have had their first two doses, and it’s great to hear that there is still some resistance against severe disease, does that mean we should kind of be expecting at least until we have dose number three, that we’re definitely at a higher risk of catching COVID, but somewhere near the same level of risk in terms of like actually going to the hospital, ending up in the ICU?

Sabina Yeah. So I think for the most part, we’re going to still see strong efficacy against severe illness with two doses. At this point, Delta is still our dominant variant. And what we’re seeing right now is that even with our two doses, we are seeing that it is pretty protective even against actually just getting COVID infections. If you look at some of the Ontario data, we see that majority of the cases are essentially in the unvaccinated. So your two doses is still protecting you. But I do think that this is a great opportunity for us to be proactive and get a kickstart on third doses before we actually see what is happening in other European countries happen over here. I don’t think any of us want to see further lockdowns further school, shutting downs, et cetera. So we need to be proactive.

Jordan Let’s talk about language before we talk about booster or third dose roll-outs. I’ve seen a lot of people call it a booster. I’ve seen some people now switch to calling it a third dose. Why does that matter? And have we been framing it wrong?

Sabina Yeah, I think for the most part it’s semantics. A primary series is typically the number of doses of vaccines that are required to have a full , robust, long acting immunity. This is what everyone would receive from the get-go. And in fact, typically most vaccines need at these two to three doses to achieve this. For the COVID-19 vaccines, those who are immunocompromised need a three dose series, which is why in this population, the third dose is done with less than a six month gap.

It is possible that ultimately these COVID-19 vaccines will end up becoming a three dose series for everyone. We don’t know at this point, but it is my feeling that it will. But until then we will call the third dose for everyone who is not immunocompromised as a booster dose. And the booster dose is basically given when there is waning or reduce in immunity. Typically this is done at least several months, to years after finishing your primary series. Like for instance, we do it with the Tdap vaccine. We have a booster given every five to 10 years after completing the series. So, I mean, at this point it’s mostly semantics. I think in the next few months, we’ll have a better idea, but at the end of the day, We’re still recommending that everyone gets a third dose.

I think that’s what NACIs recommendations are as well. And I think that the booster versus third dose is mostly for us scientific people to debate over, it does not really impact the general public.

Jordan So let’s talk about the programs themselves then. Maybe first, I know, a lot of your work is specific to Ontario. But maybe just broadly, what is the status of the booster programs in Canada and how do we compare with, you know, our peer countries that we’ve been comparing ourself against this whole pandemic?

Sabina Yeah. You know, I think that there is a huge issue with global vaccine equity. And I think Canada is trying to be very responsible on that front, trying to take a very measured approach.

And so, you know, I think NACI is slightly behind in terms of their recommendations than what we’ve seen in other countries that are being a lot more, I guess, proactive with trying to reach people on their third doses before they get to a point where they’re having very steep rises in cases. But on the flip side, I also do think that this is going to be a much harder sell to get people to go and get their third doses.

I think you’re definitely seeing people who are itching to get their third doses, but at the same time, you’re seeing a much lower uptake in other countries and the US is struggling as well. So I think the fact that we paced ourselves a little actually helps us because it really show us that waited until we had the evidence to really recommend a third dose. And I think that would just build the confidence in people that indeed a third dose is recommended. But, you know, I think that overall we are going to struggle with getting people their third doses.

Jordan Why do you think that is? And not to go back to the language thing again, but somebody pointed this out to me the other day, there’s a lot of people who got their shots, maybe didn’t want to get them, but we’re told, you know, this is what we have to do to get back to normal. Like do your part chip and roll up your sleeve. A lot of people did that. And they were told that two doses made them quote, unquote, fully vaccinated.

And now they feel like they’re being asked to go back and do more and they didn’t sign up for this and they don’t know how many more shots they’re going to have to get and can that drive hesitancy? They feel like they’ve been, I don’t want to say duped because I know it was all done well-meaning but you know, it definitely creates some apprehension I think.

Sabina Absolutely does. I’ve spoken to a lot of people who have said the exact same thing. They were all people who were excited to get their first and second doses. And now they’re at a point where they’re like frustrated because there doesn’t seem to be an end to the entire pandemic. Every time we think our lives can move on, we’re back to, I don’t want to say square one, but you know, not exactly where we were hoping we would be.

To a lot of people it does seem like there’s a lot of bait and switch that’s going on, even though that’s not the case, it’s just that science is evolving. We’re in this situation where we’re having new variants. And in fact, I have to say, you know, I think all things considered , the fact that Omicron, our vaccines are still effective for the most part against this new variant is fantastic.

But if you don’t work on vaccine equity. then what’s going to happen is we’re going to have newer variants where we may not be as lucky in fact. And so really I think that for us, having to convince people to get their third doses is going to be critical. And I think that having a new variant is going to help with that as well.

I think before the new variant, it was a much harder sell. I think now it’s going to be more of a capacity issue, especially in Ontario to try and ramp up these boast booster doses. I know capacity is going to be a massive rate limiting factor for us, given that we’re doing children’s vaccinations, we’ve stopped a lot of the mass vaccine clinics. A lot of this, you know, has not really kept up with the demand. And so we’re going to need to see this ramp up quickly.

Jordan Are you hearing signs that it will? I know you talk to a lot of people involved in public health on the daily and I think for people like myself, who would, you know, be happy to get that third shot and hope that that gets us a step closer to normal, there’s a little bit of impatience. Like I know we have the vaccines, I’ve seen the numbers, we have millions of them. We aren’t sharing a ton of them. So like, are they going to ramp this up and do this?

Sabina Yeah, they have to, I’ve been really advocating for it now with the data from Omicron coming on. We have to, we don’t have a choice over here. We have to start ramping up all of these mass vaccine clinics, and make sure that we’re actually not in a point where we’re being reactive once again. I mean, you know, it takes us 10 times more effort to try and squash cases when you already have a very uncontrolled spread, but when we’re more proactive, we can actually do a lot more, without overwhelming our ICU capacity, without closing down schools, that absolutely cannot shut down again for children.

I think a lot of this is going to be super timely. And so I would definitely recommend that we put as much pressure as we can on our provincial government and federal government to try and get this out as soon as possible

Jordan In terms of vaccine equity around the world and the potential of future variants, I’ll indulge my inner cynic for a minute and say, we’re not doing great on that. I don’t think the wealthy countries are all of a sudden going to get everyone vaccinated, which means that we will have new variants as you mention. Will it eventually come to the point where we’re getting our COVID booster shot every fall before the winter season, just like we’re all urged to get our flu shot now. And you know, if we are going to get to that point, should we maybe be more upfront about it so people aren’t surprised the way they were with a booster?

Sabina Yeah, great question. I think for me, I’ve been really avoiding this because I don’t have a crystal ball. There’s no way for me to predict. And I feel that a lot of healthcare professionals have been playing the speculation game. And I think that has been causing a lot of people to feel like they’re stuck on this bait and switch rollercoaster.

So personally my opinion is that we should cross that bridge when we get there. The one thing that I’m really hopeful for is that if we end up being in a position where we need this as an annual dose, it would be so amazing to actually have a three in one where we could actually target, not just COVID, but influenza and RSV in the same vaccine.

Jordan Is that possible?

Sabina Yes, absolutely. So they’re working on a version that actually is a joint combined vaccine, and they’re also working on a standalone RSV vaccine using mRNA technology. I mean, this is groundbreaking to be honest, because we’ve been working on a vaccine unsuccessfully for RSV for decades now. And RSV is not a joke in those who are really young and our seniors. And so if we can actually get to a point where maybe even combining all three together actually works, it would be amazing. But again, I don’t want to speculate because I feel like a lot of speculation is what’s causing some hesitancy and this feeling of frustration from people. So I’m going to wait until we get there.

But until then, I think third doses are going to be important. Vaccine equity around the world, like you said, Canada has tons of doses. We’re going to get 55 million more doses next year. We don’t need all of those. We need to be distributing it. We have not yet met our commitment to Covax. And so I think we should be doing that. We should be urging every other country to do that. And we need to work on making sure that intellectual property is being waived as well for vaccines and other key therapeutics for this specific virus. All of this needs to be done.

Jordan Before we get onto a few more booster questions and especially ones for kids. I want to ask you something, because it just popped into my mind when you talked about that three in one vaccine. I’m just curious about what it’s like to be a pharmacologist in this day and age, because you know, you just casually dropped like, oh, we might get an RSV vaccine and it might be a three in one. I know earlier this year we talked about mRNA might open the door to an HIV vaccine. And so I know the pandemic sucks, but it does seem like this is a time of just like incredible explosions of progress in your industry. What’s that like?

Sabina It is amazing. I mean, I have to tell you that seeing some of the scientific discovery and the speed at which it’s occurred and the collaboration that has occurred in the last year and a half to two years has just been phenomenal. And we don’t see that very often, right? We usually work in silos, There is a lot more competition. And things move so much slower because of funding issues, et cetera. And so seeing all of this happening, for me as someone who really, really wants to make sure that we’re making our communities healthy and thriving, is so important.

And some of this that is coming out because of the pandemic is going to be good for us in the long run. I think that it’s just, unfortunately, it took a pandemic, a global pandemic where 5 million people have died, unfortunately, globally, to get there. But these are the small little silver linings that we can take away.

Jordan Much like all the amazing progress in the green energy field right before we climate change ourselves to death.

Sabina You said it.

Jordan For young kids now, this is what I was about to ask you about before I got distracted by the amazing progress in the industry. There’s young kids right now who are just getting their first shots , five to 11s, there’s younger kids, who won’t be eligible until next year to get theirs or later. How much do we know about kids versus the Omicron variant and whether or not vaccines protect them and whether or not this variant is more dangerous to them on its own without vaccines?

Sabina Yeah. So, so far it doesn’t seem like Omicron is causing more severe illness than Delta. I think that kids who are getting vaccinated right now are actually in a spot of having an advantage because they’re going to have high levels of neutralizing antibodies, which is fantastic. So I think that is going to be incredibly important for parents to get their children vaccinated as soon as possible. I also do think that, you know, especially with cases rising steeply in schools and elementary schools, especially in children who are under age 10, I think that being fully protected sooner is going to be absolutely critical as we head into the holiday season and as kids go back to school in January. So I definitely think that’s one of the things that we should be looking at more. Allowing flexibility for parents do schedule their second doses for their children even sooner than eight weeks would be actually something that would be very advantageous.

Jordan When you say fully, I noticed, again, we’re talking about two shots there. Will we eventually have three shots for kids as well?

Sabina Yeah. You know, I think that it’s going to be a three dose primary for everyone. But I don’t think that, children, at least for now who are five to 11, who are just gotten their first and will be getting their second doses soon, will need that third dose for another couple of months. And by then we would have more information in this age group. At this point, because of just being recently vaccinated, they will have adequate protection because they’re neutralizing antibodies and binding antibodies levels are sky high right now, which is fantastic.

And so by the time we’ll see some waning of their immunity, we’ll have more information on third doses and the under 18 population. But my feeling on this is that it’s going to be a three dose for everyone.

Jordan In terms of people like myself, selfishly asking a question here, who don’t qualify for their boosters yet, and who are nervous about the new variant. When most governments across the country don’t seem to be, rolling back any of the reopenings that have happened. What’s our best weapon to keep ourselves safe till the boosters arrive?

Sabina Yeah. So, you know, I always say, while there’s so much unknown about Omicron, there’s also a lot we do know, and we know that public health measures work. So mitigate your risk as much as you can. And this means reducing your contacts, avoiding being indoors, unmasked. I mean, I’m seeing pictures of people in sports games, unmasked. And frankly, that terrifies me. I think that we need to make better use of our rapid antigen tests. In fact, you know, we have so many rapid antigen tests that are simply sitting unused, going to expire soon. We need to be distributing those to our public. To try and use them to, again, mitigate risks.

We need to advocate to improve ventilation, especially in schools. This is going to be so, so critical. And I think that everyone really should reconsider what masks they’re using right now. I think that we’re at a point where we need to have masks that not just fit really well, but have high filtration as well. It’s going to be really important as we especially go into being indoors during the winter season.

Jordan Last question: for those who are listening and want their booster sooner and who are listening to this and maybe are a little concerned, who holds the power to unlock those shots, and who should they be talking to?

Sabina Yeah. We need to use our voice. We need people to advocate for this. And I know that a lot of people feel like, well, I’m just one person what am I going to do? But in fact, if you look at a million people, it takes 1 million single individual people to make that 1 million people.

So, I mean, I would call the provincial government, write letters to your MP, to your MPP, to your school board, if you have children. All of these things really make a difference. And I know that a lot of pushback that we’re getting in Ontario, especially is that our efficacy post six months, looks strong. And so I think a lot of people are saying, well, we don’t really necessarily need to be moving that quickly, but I think that we’ve put too much emphasis on our efficacy being higher because of our second dose timing. But what we’re not remembering is that in fact, we’ve also kept up with public health measures like masking and the second we’re dropping these, as we’re seeing with a lot of events right now where masking is being dropped.

I think we’re going to see an increase in cases. We just don’t want to get to a point where we have too many cases and our ICU’s are full and we’re back to the same position that we were in. So I think, you know, when you speak to a lot of these things with your government officials, make sure we talk about the importance of being proactive. That’s going to be critical and key for us to preventing, you know, other waves and overwhelming our healthcare system.

Jordan I really hope we don’t have deja vu and do this again. I hope the next time that we talk, we’re talking about an HIV or RSV vaccine. Sabina, thank you, as always.

Sabina I keep my fingers crossed for that, for those vaccines too.

Jordan As always, Sabina Vohra-Miller, bringing a little calmness and knowledge to a worrying conversation.

That was the big story for more from us head to thebigstorypodcast.ca. Find us on Twitter @TheBigStoryFPN. Talk to us anytime with an email to thebigstorypodcast@rci.rogers.com [click here!]. Listen to this podcast wherever you want, on our website, in a podcast player on your smart speaker. And when you do: rate and review and tell a friend.

Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.

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