COVID-19 boosters coming but who will get them and when?
The biology behind booster decisions
NEW YORK, Sept 8, (AP): COVID-19 booster shots may be coming for at least some Americans but already the Biden administration is being forced to scale back expectations — illustrating just how much important science still has to be worked out.
The initial plan was to offer Pfizer or Moderna boosters starting Sept. 20, contingent on authorization from US regulators. But now administration officials acknowledge Moderna boosters probably won’t be ready by then — the Food and Drug Administration needs more evidence to judge them. Adding to the complexity, Moderna wants its booster to be half the dose of the original shots.
As for Pfizer’s booster, who really needs another dose right away isn’t a simple decision either. What’s ultimately recommended for an 80-year-old vaccinated back in December may be different than for a 35-year-old immunized in the spring — who likely would get a stronger immunity boost by waiting longer for another shot.
FDA’s scientific advisers will publicly debate Pfizer’s evidence on Sept. 17, just three days before the administration’s target. If the FDA approves another dose, then advisers to the Centers for Disease Control and Prevention will recommend who should get one.
That’s tricky because while real-world data shows the vaccines used in the US remain strongly protective against severe disease and death, their ability to prevent milder infection is dropping. It’s not clear how much of that is due to immunity waning or the extra-contagious delta variant — or the fact that delta struck just as much of the country dropped masks and other precautions.
When to jump to boosters “becomes a judgment,” said Dr. Jesse Goodman of Georgetown University, a former FDA vaccine chief. “And is that urgent or do we have time for the data to come in?”
Already the CDC is considering recommending the first boosters just for nursing home residents and older adults who’d be at highest risk of severe disease if their immunity wanes -- and to front-line health workers who can’t come to work if they get even a mild infection.
Some other countries already have begun offering boosters amid an ethical debate about whether rich countries should get a third dose before most people in poor countries get their first round. Here’s what we know about the biology behind booster decisions:
What Do Booster Shots Do?
Vaccines train the immune system to fight the coronavirus, including by producing antibodies that block the virus from getting inside cells. People harbor huge levels right after the shots. But just like with vaccines against other diseases, antibodies gradually drop until reaching a low maintenance level.
A booster dose revs those levels back up again.
Pfizer and Moderna have filed FDA applications for booster doses but the government will decide on extra Johnson & Johnson doses later, once that company shares its booster data with the agency.
How much protection does that translate into?
No one yet knows “the magic line” — the antibody level known as the correlate of protection below which people are at risk for even mild infection, said immunologist Ali Ellebedy of Washington University at St. Louis.
But vaccines’ main purpose is to prevent severe disease. “It’s a very high bar to really go and say we can completely block infection,” Ellebedy noted.
Plus, people’s responses to their initial vaccination vary. Younger people, for example, tend to produce more antibodies to begin with than older adults. That means months later when antibody levels have naturally declined, some people may still have enough to fend off infection while others don’t.
That initial variation is behind the FDA’s recent decision that people with severely weakened immune systems from organ transplants, cancer or other conditions need a third dose of the Pfizer or Moderna vaccine to have a chance at protection. In those people, it’s not a booster but an extra amount they need up-front.
Won’t antibodies just wane again after a booster?
Eventually. “We don’t know the duration of protection following the boosters,” cautioned Dr. William Moss of Johns Hopkins University.
But antibodies are only one defense. If an infection sneaks past, white blood cells called T cells help prevent serious illness by killing virus-infected cells. Another type called memory B cells jump into action to make lots of new antibodies.
Those back-up systems help explain why protection against severe COVID-19 is holding strong so far for most people. One hint of trouble: CDC has preliminary data that effectiveness against hospitalization in people 75 and older dropped slightly in July -- to 80% -- compared to 94% or higher for other adults.
“It’s much easier to protect against severe disease because all you need is immunologic memory. And I would imagine for a younger person that would last for a while,” maybe years, said Dr. Paul Offit, a vaccine expert at the Children’s Hospital of Philadelphia. What’s the best time to get a booster?
For many other types of vaccines, waiting six months for a booster is the recommended timing. The Biden administration has been planning on eight months for COVID-19 boosters.
The timing matters because the immune system gradually builds layers of protection over months. Give a booster too soon, before the immune response matures, and people can miss out on the optimal benefit, said Dr. Cameron Wolfe, an infectious disease specialist at Duke University.
“Sometimes waiting a little bit extra time is in fact appropriate to gain the strongest response,” he said.
NEW YORK: Veteran anchor Jose Diaz-Balart is returning to the MSNBC lineup later this month as host of the 10 am news hour on weekdays, the network announced on Tuesday.
Diaz-Balart was an anchor on MSNBC from 2014-16. His return is part of NBC Universal News Group Chairman’s Cesar Conde’s effort to bring more diverse voices to the network.
Diaz-Balart, also an anchor for “Noticias Telemundo,” has anchored national newscasts in both English and Spanish in a journalism career that began in 1983.
Hallie Jackson, who has anchored the 10 am hour for five years, will shift to the 3 pm hour. Jackson and another MSNBC personality, Joshua Johnson, will both debut shows on the NBC News NOW streaming service this fall.
Ayman Mohyeldin will host prime-time MSNBC shows on Friday, Saturday and Sunday, the network said.
Diaz-Balart is the recipient of a national Emmy for his work with Telemundo Network. He received two Emmy awards while working at WTVJ-TV in Miami; an Associated Press Award and four Hispanic Excellence in Journalism Awards, all in the 1980s. He also received a Du Pont and Peabody as well as the Orchid award for best news anchor in the US in 2006. Media 100 has named him best anchor three times, and Hispanic Business Magazine named him one of the “100 most influential people in the US.” He was given the Silver Circle Award by the National Academy of Television Sciences in 2010. In 2012, Multichannel News and Broadcasting & Cable presented him with the Award for Outstanding Achievement in Hispanic Television at the 10th Annual Hispanic Television Summit, produced by Schramm Marketing Group. (Agencies)
❑ MIAMI BEACH, Fla: The South Florida house that gangster Al Capone owned for nearly two decades, and died in, is facing demolition plans.
The Miami Herald reported that the new owners of the ninebedroom, Miami Beach house plan to demolish it after buying it for $10.75 million this summer.
One of the owners, developer Todd Glaser, told the Herald the home, which is about 3 feet (1 meter) below sea level, has flood damage and standing water underneath it. The new owners plan to build a two-story modern spec home with 8 bedrooms, 8 bathrooms, a Jacuzzi, spa and sauna.
“The house is a piece of crap,” Glaser said. “It’s a disgrace to Miami Beach.”
The other owner is Glaser’s business partner, Nelson Gonzalez, an investor and senior vice president of Berkshire Hathaway HomeServices EWM.
The house has been placed on the September agenda for possible historic designation by the city of Miami Beach, but Glaser said that is not going to stop the new owners’ plans.
Capone bought the house for $40,000 in 1928 and returned to it often. The gangster nicknamed “Scarface” died at the home in 1947 from a heart attack. The home is believed to be where Capone and his associates plotted the notorious St. Valentine’s Day massacre in which seven members of an opposing gang were gunned down in a
Chicago parking garage in 1929.
The Miami Beach house isn’t the only one of Capone’s possessions changing hands. In California, his three granddaughters are planning an auction of some of his personal items, including diamond-encrusted jewelry with his initials, family photographs and his favorite handgun. (AP)