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Who should get an updated COVID-19 booster? Doctor explains

Children’s Hospital of Philadelphia's Director Dr. Paul Offit joins Yahoo Finance Live to discuss COVID-19 boosters and who should be getting one this winter, the benefits of a booster shot, the biggest concerns surrounding the latest COVID-19 variants, and the outlook for COVID-19.

Video Transcript

ANJALEE KHEMLANI: Welcome back to Yahoo Finance Live. I'm Anjalee Khemlani. A new coronavirus booster is on its way, but with only 1/3 of individuals opting to get this shot, the question being asked is, who should be getting these new bivalent boosters?

Joining us now to discuss is Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia. Dr. Offit, thank you so much for joining us and taking time to discuss this important topic. I know that there have been questions about these bivalent boosters and the lack of clinical data. So let's jump in on that point. Who is the most eligible, and who should be really getting these boosters now?

PAUL OFFIT: Right, so when Omicron came into the United States, it was an imbued invasive strain. So even if you'd been vaccinated or naturally infected, you could still get a mild infection, and for some, a severe infection. So the CDC did studies trying to answer the question, do you benefit from a third dose? And then later, do you benefit from a fourth dose? And what they found out was that you did, that there were groups of people who clearly benefited in terms of staying out of the hospital, staying out of the intensive care unit, and staying alive.

But it wasn't everybody. The people that really benefited were, one, people who are older, meaning those over 75. Two is people who had serious health problems, like chronic lung disease or chronic heart disease, or out of control type 1 diabetes, where even a mild illness could land them in the hospital. And then thirdly, the people who were immune compromised. So I think focusing on those three groups for this bivalent booster dose probably makes the most sense.

ANJALEE KHEMLANI: So we've already seen that there's been low uptake of boosters. And we know that right now, those who are 12 and older are eligible for Pfizer, 18 and older for Moderna. We've got other age groups coming into the mix pretty shortly. So is it advisable for them to get those boosters if they don't meet the criteria of chronic-- a chronic patient or having any other underlying issues?

PAUL OFFIT: Right, so think of your otherwise healthy, say less than 65 years of age and don't have any health problems. What a booster buys you is a few more months of protection against mild illness. So low risk, low reward.

ANJALEE KHEMLANI: So is it a situation where maybe someone who is considering it for their child, it's up to them if they want it, or is it because of other mitigation measures going away, maybe the vaccine is the best option right now?

PAUL OFFIT: Well, in some ways, it's a matter of your style. In other words, some parents may argue, well, if there's any benefit, then I'll accept what I think is a low risk. And others may argue, well, if there's any risk, I don't want to risk that if the benefit is so low. So I think-- I just don't think it's going to make much of an impact in otherwise healthy young people.

We really should focus on those three groups who are most likely to benefit because the goal of the vaccine is to protect against serious illness. It's the only reasonable goal. It's the only attainable goal. We're not going to be able to stop mild illness. We're not going to be able to stop transmission. And to try and do that with frequent boosters for otherwise people who are not likely to end up in the hospital, I think doesn't make a lot of sense.

ANJALEE KHEMLANI: What about in context of the newer variants coming along? Should we be getting boosters as a result of preparing against those?

PAUL OFFIT: Right, that's a great question. I mean, right now, the strains that are circulating are BA.4, BA.5, so these subvariants of Omicron. They're clearly highly contagious. They clearly evade immunity in terms of protection against mild disease, but they don't evade immunity for protection against severe disease. I mean, if you're otherwise healthy and have had, frankly, say, three doses, you're likely protected against-- highly likely protected against severe disease. So then the only question is for how long.

And I think ultimately, the epidemiologists at the CDC and immunologists in academic centers are going to have to answer that question. For how long are we protected, say, after three doses if you're otherwise healthy? Because I think a booster dose makes sense for some as we approach the winter, but not everybody. And I think how long immunity lasts is going to be critical because this virus is going to be with us for years, if not decades.

ANJALEE KHEMLANI: And so you're not saying no one should get these doses. It's just that certain groups are better off getting them than others. But then what about the clinical data part where you don't yet know sort of that efficacy level against not just the current variant, but also looking forward, is that a concern?

PAUL OFFIT: Right, so when data were presented to our committee, the FDA vaccine advisory committee on June 28, the companies did the studies the right way. They looked at people who'd gotten three doses of the current vaccine, the monovalent vaccine, with then a fourth dose of the monovalent vaccine or a fourth dose of this bivalent vaccine, except then it was BA.1, the original Omicron.

What they found was that there was an increase in neutralizing antibodies against the BA.1 strain. We assumed that that would also translate to BA.4, BA.4, but the increase wasn't very big. I mean, it was 1 and 1/2 to 1.75-fold greater, which is not likely to be a clinically significant difference. So I'd really like to see data showing that the bivalent vaccine is clearly and significantly better than the current monovalent vaccine because the monovalent vaccine does protect against serious illness, which is the goal.

ANJALEE KHEMLANI: You've stirred up some controversy over having this opinion and sharing this insight. What do you think the future outlook is for COVID vaccines? Are we looking at annual shots, or are we still dealing with a situation where it's still pretty unpredictable?

PAUL OFFIT: I think we have to be very good at monitoring on a worldwide level whether there is a variant that arises that is resistant to protection against serious illness. So even if you've been vaccinated or naturally infected or both, it doesn't matter. You would still be at risk for severe disease. And when that happens, then we're starting all over again.

That variant hasn't arisen yet because even though these BA.4, BA.5 variants are resistant to protection against mild disease, for most, they aren't resistant to protection against severe disease. So we're still good in that sense. That original vaccine, which was made against the so-called Wuhan 1 strain, which was the strain that raised its head in China, has still worked well to protect against severe disease for all subsequent variants-- Alpha, Delta, Omicron, the BA.4, BA.5. So that's good.

And the reason that that's true is that protection against severe disease is mediated by something called T-cells. And the regions recognized by T-cells have remained fairly conserved across all those different strains. So that's good. If the virus drifts so far that you're not protected against severe disease, then we're talking about something else. But for right now, the current vaccines work well to protect you against severe illness.

ANJALEE KHEMLANI: Certainly a discussion and some people still wrestling with this idea. Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, thank you again for joining us today.