What to expect from Omicron-specific boosters

By Anne Blythe

David Wohl, an infectious disease specialist at UNC Health, went to a CVS pharmacy last week and rolled up his sleeve for one of the new Omicron-specific vaccines.

North Carolina now has the updated Moderna and Pfizer-BioNTech COVID-19 vaccines that specifically attack the Omicron BA.4 and BA.5 subvariants.

The U.S. Food and Drug Administration amended the emergency use authorizations for the Moderna and Pfizer-BioNTech COVID-19 vaccines on Aug. 31 to include bivalent vaccines created by the companies to attack the Omicron subvariants, as well as the original coronavirus strain.

Wohl has a knack for breaking down medical and scientific information that can sometimes be complicated into language that’s much easier to understand. He has done that throughout the pandemic.

So North Carolina Health News checked in with him to find out more about the updated vaccines and where we stand now in the battle against COVID-19. Here’s some of what we learned.

This interview has been edited for length and clarity.

NC Health News: What’s your routine at this point in the pandemic?

David Wohl: I wear a mask indoors when I’m around others, and I wear an N95. Since Omicron started, I just do it. This is a much more catchy virus, and so I’m optimizing my protection.

I wear an N95 when I’m in public spaces, indoors, and private spaces indoors outside of my bubble. Home, of course, my wife, my kids, I don’t wear a mask. We’re pretty careful. My 80-year-old mom who comes over to visit, we test her on the porch before she comes into the house, and we test ourselves because we don’t want to give it to her, unknowingly. So we all test and then we can have dinner together when she comes over every few weeks.

I’m about to go to Africa on Sunday. I will wear an N95 on the plane all the way there. I will wear it when I arrive and once I get to our UNC research house, the five other folks who live there will test and we’ll all test together and we’ll create a bubble. So I don’t go to Home Depot without my N95, I don’t go to Whole Foods without my N95, I’m not in a car with people. I don’t eat indoors at restaurants right now. 

(Wohl was scheduled to fly to West Africa several days after our interview to spend time with researchers at UNC Project Liberia, which studies Ebola virus survivors and the viral hemorrhagic Lassa fever.)

David Wohl, an infectious disease specialist at UNC Health and UNC-CH School of Medicine. Photo contributed by UNC Health

NCHN: Will we see a surge of cases as the weather gets colder and people make plans to travel for the winter holidays?

Wohl: I feel that, and hope that, we’ll have a more muted rise than we had previous winters and I think that’s a consequence of hundreds of thousands of people catching BA.5 every week in the United States and thus being protected and people getting vaccinated. I think there’s going to be a pretty good uptick of the new vaccine. When I went to CVS, they told me they were booked out. So I think that we’re going to have a lot of immunity as long as BA.5 sticks around.

NCHN: What was your experience with the updated vaccine?

Wohl: I’m so excited. I have had reactions to every vaccine so far, and so I was really concerned because I’m in the hospital taking care of people and I really wanted to get vaccinated before I travel and I wanted to get it as soon as possible. 

I was really worried yesterday that I was going to feel crappy. I took Tylenol the night before, right before I went to sleep. I woke up in the morning, took Tylenol, and I felt slightly, maybe tired, but then I was good and I’ve not had any problems since, just my arm is a little sore, but nothing else. And I worked out yesterday. I’m at work today, fully functional. So of all the shots, this has been the best, and I think people should take Tylenol after they get their shot and the day after. There’s no data that I know of that shows that that interferes with anything.

NCHN: Should we expect to get a COVID vaccine every six months now?

Wohl: I think it’s going to be every year and let me tell you why. I had to stop going on Twitter. There’s good things and bad things. Some of it is really useful. Some of it really tells you stuff, like, ‘Oh, I didn’t know about that article.’ 

But the problem is people are so critical. 

I understand why people are saying that’s a white flag, we’ve given up. But when you think about it, you know if we take it every year, it’s not like we’re protecting 100 percent of the population. That’s not the goal. We reduce the risk, and it’s practical. 

It’s very hard to get people to take a vaccine every six months. We don’t know that that’s the greatest idea in general, but if it’s annual, like your flu shot, then a significant portion of the population will now be better protected in sort of a rolling fashion. I see this as sort of a risk reduction and a pragmatic way of doing it. And you know, we should develop mRNA flu vaccines and give them both together. That just seems to make a lot of sense.

NCHN: At a Sept. 6 briefing with reporters, Ashish Jha, the White House COVID-19 Response Coordinator, Rochelle Walensky, director of the Centers for Disease Control and Prevention, Anthony Fauci, chief medical advisor to the president, and Xavier Becerra, secretary of Health and Human Services, said they expected that it would be routine in the years to come that people get a COVID-19 vaccine once a year, similar to the flu shot. Some public health advocates worry that the Biden administration’s messaging ignores the many curve balls that COVID-19 has thrown us throughout the pandemic. Is this just surrendering?

Wohl: So I don’t think this is defeatist at all, and I think there’s a very pragmatic approach that could be instituted just like we’ve done for flu. 

Flu vaccine is not a hundred percent effective. It reduces significant amounts of death, even when it’s 40 percent effective, tens of thousands of people’s lives are saved. They just don’t know it. You and I, maybe our lives were saved because someone took their flu vaccine that was only 40 percent effective.

NCHN: We’ve seen people who have been vaccinated and gotten boosters get COVID. Some people have described the vaccines as “leaky,” meaning they haven’t been as effective as initially touted to prevent COVID infection. How do you convince people to keep taking a shot? 

Wohl: I believe the vaccines do protect you from infection, they just don’t protect you as well as we’d have liked. I also believe that, let’s say, that the virus never mutated, the virus was the same from Wuhan and never changed. I don’t know that we understand yet whether or not the vaccine would have protected us from infection from the original. 

We don’t know how fully because new variants popped up within months of the vaccine being rolled out. We had Alpha, then we had Delta very soon thereafter. So I think these experts have to think of the alternative scenario where no new variant came out. Would the vaccines that were 95 percent effective continue to be around that level of effectiveness had the virus not changed?  And maybe it would have waned somewhat, but probably what we’re seeing is mostly a waning of effectiveness, a leakiness, because of new variants that are popping up. 

So what if BA.5 sticks around? Let’s say it sticks around for a few months. Let’s say through the winter, and you have BA.5 immunity. Who’s to say it’s leaky?

When we talk about leakiness, I think we have to be careful. Are we talking about the variant that’s circulating now? Or the variant that’s coming down the pike?

NCHN: Pharmaceutical companies in India and China have received approval from those countries for intranasal vaccines. CanSino Biologics, a Chinese company, developed a nasal spray. Bharat Biotech International, which is headquartered in India, developed a nasal drop vaccine. Should the U.S. start looking into nasal vaccines?



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