New guidelines, old hesitancy and the future of covid vaccines

CLIP You’re listening to a frequency podcast network production in association with City News.

Jordan I would say that I hate to be the bearer of bad news, but that has basically been the job for the last while. So it gives me no pleasure to tell you that C O V I D is still with us, still evolving and can still mess up our health, our healthcare system, and perhaps our hope of a nice, easy back to school season. Covid is obviously still here that we’re likely to see a resurgence of cases as we move through the summer and into the fall. There is good news though, and that is that by now we are well prepared. We have all the weapons we need, we just have to make sure that people use them. Recently, Canada’s vaccine advisory committee updated its guidelines on Covid vaccination for this fall and beyond marking what could become an annual move to hopefully protect those most vulnerable to the virus. So according to the new guidelines, who gets what shot and when, how do scientists subtly alter these vaccines so quickly to combat new variants? Will this really become a yearly ritual, like a flu shot? And if so, how many people will bother to do it when it doesn’t feel as urgent as it did a couple of years ago? I’m Jordan Heath Rawlings. This is The Big Story. Sabina Vohra-Miller has a master’s in clinical pharmacology. She has been for just about the duration of this pandemic, our favourite vaccine expert. Welcome back, Sabina.

Sabina Vohra-Miller Hi. Thanks for having me again.

Jordan Of course. It’s been a while since we talked, which I guess is a good thing because it means that there’s a little less urgency to what’s going on. But as we speak, over the past couple of weeks, there have been some doctors and epidemiologists warning that we could be in for a bit of a rough fall with Covid. Why is that happening?

Sabina Vohra-Miller : Yeah, I mean, I think we’ve had a bit of a lull in the last few months with respect to Covid, likely because omicron sort of hit people very quickly, which means we’re riding that, you know, sweet hybrid immunity wave for a bit. And also because of summer, people are, for the most part gathering outdoors a lot more. And I think once fall hits our leftover immunity is going to wane and people are going to hang indoors a lot more. And so we will see another sharp increase in cases particularly, you know, because we’re, we’re getting into a period where our immunity is going down, our collective immunity is going down, and so we have to avoid another winter of a tripledemic like we had last year. I mean, I don’t know if you remember, but it created a lot of havoc, you know, for hospitals and, and as you know, we’re already, you know, stretched on a good day with respect to our ERs. We’re having situations where ERs are fully shutting down because of lack of funding and staffing. Mm-Hmm. you know, so it’s only gonna be worse. Plus parents and children missing school being very ill, even for employers, we saw downstream labour impacts in many industries, right. From this tripledemic. So we really don’t wanna be in that position again. And then we also have the ability to see what’s happening in Australia, sort of to give us a bit of that heads up of things to come. And unfortunately, they had a really intense winter with Sky high influenza, along with Sky High covid, plus other respiratory viruses. And so we, you know, we have a bit of that insight into what is, what is going to come and we need to make sure that we’re prepared for it this time.

Jordan: Give me a sense quickly, if you can, for people that didn’t, didn’t quite realise how serious it was, we’re lucky enough to avoid it. Don’t have loved ones maybe in the vulnerable categories. What was that tripledemic? How does it happen?

Sabina Vohra-Miller : Yeah, you know, I think there’s a multitude of things that kind of went into it. First of all, you know, there are some theories that suggest that because we were not really exposed to many of these viruses during covid because our public health measures worked really well. There was what people call the immunity gap. And I, you know, I don’t like that term, but I really think it’s just an exposure gap. We were just not exposed. Masks worked really well, for instance. And so because of that, we had a lot of people who just hadn’t been exposed to a lot of these respiratory viruses for, you know, a matter of two or so years. And then when they’re exposed and exposed at the same time, you had vast numbers of people who were getting hit with multiple viruses at the same time. I mean, I’ve heard of many cases of, of children who had both influenza and R S V at the same time, or, you know, R S V and adenovirus at the same time. And, and it, it was really difficult because we don’t have the hospital capacity at this point, even if it is, you know, for the most part, something that requires a short hospital stay. We just didn’t have that capacity. And so we had instances of even children who died, you know, from R S V in, in Canada, when really no one should be dying from R S V in Canada. And I, and I think people just don’t don’t understand necessarily that things like R SSS V can affect very healthy, you know, otherwise completely fine healthy children just because they, you know, children are at a higher risk for some of those downstream impacts from these respiratory viruses. And, and I think a lot of people were caught off guard by that. And we also don’t talk a lot about viruses. I feel before Covid. I mean, I think I’m the, I was the only person who obsessively looked at what’s happening in Australia. I look at all the surveillance reports for influenza and other respiratory viruses, but I think most people just didn’t have that in their repository of things to do. And I think we’re becoming more and more hyper aware of this now, which I think is good. Especially now that we have tools in our arsenal. You know, of course we have covid vaccines, but we have influenza vaccines and you know, if all things go well, we probably also have an R S V vaccine in our right, in our arsenal very soon. Which means there are things we can do to prevent this from happening. And that’s great. That’s good news

Jordan: In terms of vaccines. That’s the reason we obviously wanted to talk to you today. Recently the advisory council on vaccines in Canada updated its guidelines. Now let’s just start with what did they say? What’s happening now?

Sabina Vohra-Miller : So to keep it very simple, NASA basically recommended a booster, an updated booster for everyone in the authorised age group, but especially those who are at higher risks. That includes those who are older adults, you know, living in long-term care or other congregate settings, underlying medical conditions pregnancy. And so for these, this group, they strongly recommended it. And for everyone else in the authorised age group, they also recommended a booster.

Jordan: What do you mean by authorised age?

Sabina Vohra-Miller : That is the confusing part. So authorised just means who Health Canada approves this new vaccine for and that we don’t know yet. We’re waiting to see what Health Canada says as of right now. Both Moderna as well as Pfizer have submitted an application for their updated booster. It’s the updated booster is a monovalent, so it’s just one strain pertaining to the X BBB 1.5. Both of them have actually applied for all age groups over six months. Now, it really depends on who Health Canada decides to approve this for. If they still require human data, which they did last year, it will likely be 18 plus to start and then 12 plus after. But if they, you know, decide that they don’t need human data, which they don’t, for instance, for influenza vaccines every year, if that’s the case, I, I’m not sure if they’ll do six months plus or maybe five years above. So that’s the part that we still need to wait to see who Health Canada, you know, approves it for. But NACI essentially is recommending this new updated booster for everyone who Health Canada approves it for.

Jordan: How does the process of updating a vaccine work, like what do they actually do?

Sabina Vohra-Miller : Yeah, so this is actually the best part about mRNA vaccines. When we first came out with them, the thing I was most excited about back when we first had this vaccine was the fact that we could update it really quickly. And that is literally what is working in our favour right now. So with other more traditional vaccines, you know, you need to culture isolate. You have many steps, you have to grow into large quantities, but with mRNA vaccines, you don’t need to do any of this. It’s basically just a plug and play. You know, you drop in the new sequence and you’re done. Hmm. You’re able to be nimble with having updated versions of this. And I just wanted to quickly, you know, talk about what I mean by the updated. So I did mention that it’s a monovalent X B B 1.5 and last year there was a lot of confusion on which variant will be included for the vaccine, right? The WHO Canada. And in fact, most of the world had agreed on, you know, a vaccine that was going to be based on the BA one slash two variant, but then the FDA, you know, steamrolled everyone and said, Nope, I want, you know, they wanted for BA four slash five and so we had half of the vaccines being targeted towards BA one two and then the other half towards BA four or five and people just didn’t know what to get. Hmm. This year, thankfully everyone is getting the same variant vaccine, it’s going to be just X P B. So last year we had half and half 50% of the original vaccine, 50% of the new variant. This year it’s going to be all of the new variant. And this is because of three reasons. First of all, there’s no benefits to include the original variant. I mean, it’s not been in circulation for, you know, over two years now. We don’t see it at all. The X B B variants are the ones that we see circulating. You know, although we are beginning to see some drift, there’s still no real variant of concern at this time. And all mutations are descendants of this X B B 1.5. Right? So, you know, while it may not be the most exact perfect match, it’s a very, very, very good match this year. You know, of course, as long as we don’t see any new variants emerge in the next few months, months. And then higher dosage of just this X B B variant would be really good because it’ll help our body create more targeted antibodies. So we’re not recalling the older antibodies. We’re going to focus on getting some of these more newer targeted antibodies. So the newer variant. So for all those reasons, you know, the way we’re progressing this year for our booster is much more cohesive. And you know, I actually think we’ll be much better than last year’s response.

Jordan: Is this about to become a yearly ritual, like the flu shot?

Sabina Vohra-Miller : I think we’re moving towards that. What I am really hopeful is that what we’re going to see is that every fall we have a targeted effort towards three different, you know, vaccines. We’ll have influenza, covid, R S V, and everyone gets all three at the same time. So it kind of takes away the whole, how many months are you out of vaccines? Which ones are you going to get this way? It’s just a no-brainer. You go in for your annual fall vaccines, you get all three at the same time and you’re done. Right? And you know, so I’m actually hopeful we get to that so that it kind of takes away this whole, am I eligible? Am I not, what do I do, kind of thing, which is adds more uncertainty and confusion.

Jordan: Speaking of uncertainty and confusion, I’ve talked to people who, and I include myself in this, have a hard time remembering exactly how many covid shots we’ve had by now. The last one was the BIVALENT booster that you already discussed last fall or winter. How was the uptake on that one and is a vaccine uptake holding up as we move into round four, round five, et cetera?

Sabina Vohra-Miller : Yeah, I mean, great question. So unfortunately, you know, PHAC does not actually collect data to show what the numbers in Canada look like in terms of the bivalent booster uptake. So if you look at what data that they do show us, it’s, it basically tells us that only 51% of the population has received a third dose, which means the first booster dose. Right? And so if you use that as our, you know, foundation, one would assume that the uptake for the bivalent was obviously much lower than 51%. Mm-Hmm. , you know, if I had to make a guesstimate, I would probably savour looking at around 30%. That’s

Jordan: Not great.

Sabina Vohra-Miller : It’s terrible.

Jordan: How does that compare with the flu shot every year?

Sabina Vohra-Miller : Yeah. And flu shot is slightly higher. So we are seeing flu shot, you know, it obviously varies year over year, but we see 60 to 70% uptake for flu influenza Okay. Vaccine. So I think we still have a ways to go, which is why I, I actually feel hopeful that if we’re going to work towards this once a year annual model, that we might actually see a higher uptake off the covid vaccines as well. Hmm. And I think, you know, people have forgotten that thousands of people are still dying from Covid in 2023. And not just that, but long covid is also going to be, you know, one of our biggest challenges in the coming months and years. It actually already is, and I’m not saying that vaccines prevent either a hundred percent, but it, they do significantly reduce the risk of both. And I think that is the one key thing that we need to remember. I do think we have to do a much better job of educating the public, explaining why it’s so important to get the booster. And I feel that once we move towards a more targeted, more efficacious version, that selling the vaccine will be so much easier. And by selling, I mean uptake of the vaccine, not necessarily a transactional right version of the word.

Jordan: These guidelines came out a couple of weeks ago, as you mentioned a few minutes ago. We’re still waiting for the approved ages for this and for the booster, I guess, to get through trials or testing or, or whatever it is they’re doing. Will this be ready in time for back to school early September? And if it’s not, is there any benefit to people who are concerned getting whatever shot is currently being offered and going with that?

Sabina Vohra-Miller : Yeah, great question. So both Pfizer and Moderna submitted end of June for this monovalent new booster version. And so if all goes well, if I had to guess, you know, based on looking at previous timelines, we’ll probably see approval by late September-ish. Okay. And I, I would assume distribution by perhaps mid to end October. And so that is my best guess at this time.

Jordan: Is that an ideal target for the, the timeline you’re discussing when you talk about a tripledemic and back to school and gathering indoors?

Sabina Vohra-Miller : Yeah, I would probably see a, a wave of covid occurring slightly earlier. We’re seeing, you know, a slight uptick right now. And so if that’s, if this continues, we might see an uptick on covid, you know, by September, October, typically with R S V R S V hits later in the fall and influenza usually, you know, peaks around after December typically. And so there is a timing difference with all of these viruses and we may miss the covid uptake, but the way it stands right now, the way we’re going to see fall guidelines come into play, again, the provinces have not announced anything, but if they follow NA’s recommendations, they’re going to ask for people to have six months before getting the new bivalent dose. And so if there are people who are choosing to get a vaccine now, like the bivalent now, it would mean that they’ll have to wait six months to get the new monovalent and so I mean that is obviously a personal decision that someone has to make with their physician depending on their exposure when their last dose was and how high risk they are. But for the general population at least the advice is to wait until the new updated version is, is in, you know, in the market. But again, you know, it really varies depending on personal circumstances. So speaking to your doctor is probably the best way to go.

Jordan: Sabina, as always, thank you for that information. I do wanna ask you one more thing just ’cause it’s something we’ve talked about in the past and, and I’m curious about it. You know, when we spoke, when the vaccines were first becoming available, we talked a lot about conspiracy theories around them getting in the way of uptake and people being really vaccine hesitant and how to overcome that. And a lot of the theories were like, well, you just wait in 12 months or 18 months, people are gonna start dropping dead or people are gonna go sterile and all this stuff. Obviously that hasn’t happened. What’s happened to the conspiracy theories surrounding this vaccine and what’s going on with relation to he tenancy now ,

Sabina Vohra-Miller : You know, I actually thought that by now we would be in a much better spot than we actually are. In fact, I feel things have worsened particularly with the social media climate that we’re in right now.

Jordan: Even though nothing bad has happened

Sabina Vohra-Miller : Yet. I know it’s just, I don’t know, I don’t know how to explain it . But we’re seeing this across the board on so many different science topics including climate change. I don’t have an answer. I wish I did. Yeah. Because I mean, it’s one of those things that I really do want to solve in my lifetime. And so I think the eco chamber is getting louder and bigger, and it might just be because of what we’re seeing in social media these days. I don’t know if it’s necessarily reflective of the general population, but I think that it’s not something we can ignore. I don’t think we can say it’s a small, you know, cult group for instance. And we can ignore it. I don’t think we can, I don’t think we have the luxury to ignore this. ’cause I think the problem’s only gonna get bigger. Mm. I’m writing an opinion piece about this right now, but I think we’re in a phase in science where we need to stop talking about misinformation, stop talking about social media, propagating this misinformation and actually do something about it. And we need to talk about how we can use social media to do something about it. You know, I’m all about discussing it, about having those academic, you know, conversations about it. But I think we’re in a point where we just need more science voices taking over, especially in social media. And we need to put in efforts, we need to put in funding. We need to put in a lot more into it so that we get to a point where we have equal race in science as we do from the other side.

Jordan: Thank you again for finding the time for us and looking forward to reading the op-ed and yeah good luck with with fixing social media.

Sabina Vohra-Miller : Thank you so much, Jordan, for having me. Really enjoyed this conversation.

Jordan: Sabina Sabina Vohra-Miller, Vaccine Experts Masters in Clinical Pharmacology. That was The Big Story. I hope you get your shot when it’s offered to you. I hope you tell people you love to get theirs. Like it’s so easy and I don’t want to do this episode every August you guys. So help me out, do the right thing. You can find more of our episodes, including a lot of episodes shockingly talking with Sabina about misinformation and vaccines at The Big Story podcast.ca. You can also give us feedback by tracking us down on Twitter at The Big Story fpn. You can always email us. That address is hello at The Big Story podcast.ca and you can call us and leave us a voicemail spout, a vaccine conspiracy if you like. I have an itchy delete finger. You can find this podcast absolutely anywhere you get ’em, and you can ask your smart speaker to play The Big Story podcast. Thanks for listening. I’m Jordan Heath Rawlings. We’ll talk tomorrow.