Vaccines Live Q&A

hello and welcome everyone to the vaccine covid 19 teachout hosted 0:08 by the university of michigan. today we are going to have 0:13 an informal discussion about covid19 about vaccination progress and we're 0:19 going to be talking with some experts here at the university of michigan 0:24 so how it's going to work is you can write your questions in the chat function of zoom if you're 0:31 on facebook you can write your questions there if you're on another platform we'll be trying to keep an eye out for the 0:37 questions that you may have you can also use the q a function in zoom so please 0:43 start putting in your questions if you find a question from somebody else that you think is interesting or very 0:49 similar to yours instead of rewriting the question you can upvote it so 0:55 we look forward to to hearing your questions and we'll be trying to answer as many of them as possible 1:02 so let me start by introducing our panelists we have dr emily martin and dr arnold 1:10 monto here dr martin is an associate professor of epidemiology at the university of 1:16 michigan we also have dr arnold monto who is a professor of epidemiology also at 1:24 the university of michigan and they are experts in infectious disease epidemiology 1:29 in particular in viral respiratory disease and they have many studies looking also 1:34 at influence of vaccine effectiveness and within the past year they've been heavily involved in studying the the new coronavirus and 1:42 working with state health departments and with international organizations as well 1:48 we also have a few people who will be responding to some of the questions in 1:54 the chats dr ryan milosh is also on faculty at the university of michigan 2:01 and he studies influence of vaccine effectiveness we have dr nina masters who recently successfully defended her 2:09 phd and her research has been on vaccination coverage 2:15 and predictors of the of outbreak potential and then we also have peter deyoung who 2:21 is a phd student who studies the transmission of viral diseases in child 2:26 care settings so you'll be seeing all these names pop up in the chat and responding to you i should also 2:33 mention i'm abram wagner i'm a research assistant professor in the department of epidemiology and i'll be i'll be your 2:40 host and moderator and basically i'll be taking your questions from the chats and posing them to dr martin and dr 2:48 um so i think that the first major question that i i 2:55 saw a lot of people ask about um we we asked some people to submit questions ahead of time too 3:01 but maybe you can sort of update us with what's going on 3:07 with chronovirus now so so take us through uh what the current situation of coronavirus is and um 3:14 you know what it looks like in the near future yeah i can start with that so uh we are definitely seeing around 3:20 the country and then here in the state of michigan that chronovirus rates do appear to be decreasing we're seeing 3:26 decreases in hospitalizations and some of the metrics that we monitor are improving um this you know 3:33 there's a lot of debate amongst geologists about uh used probably due to a couple of 3:38 different factors that we're seeing that are that's driving this um you know we do want to recognize the 3:44 fact that there are people starting to become vaccinated so that's going to help hospitalization rates 3:49 um there's probably an adjustment happening after the travel um you know travel patterns over the 3:56 holidays has settled in people have settled into the regular routine so you know we're probably seeing people 4:01 stay put a little bit more than we were in november in december and in early january um and uh and some of this could just be 4:09 you know things the respiratory viruses naturally wax and wing throughout a season so maybe we're 4:14 seeing a little bit of a contribution of that too but we're definitely seeing a clear sign but things are getting a little bit 4:20 better now rates are definitely still high um risk is still higher than we'd like it to be 4:26 but on the right track for improvement yeah i wonder dr manto if you could also 4:32 just update us with uh vaccination development so where are we right now 4:38 what vaccines have already received approval or emergency use authorization and what 4:43 looks to be likely on the near horizon well we have in the united states given 4:50 emergency use authorization to two mrna vaccine 4:57 the same platforms developed independently by two different companies 5:03 the pfizer vaccine and the moderna vaccine 5:08 and those are the two vaccines that are being rolled out in the united states the one that has had more of an 5:15 international impact is the pfizer vaccine which has been used extensively in a number of 5:22 countries including in in israel where as a small country they've been a able to act uh 5:30 vaccinate a significant portion of individuals next to come up for emergency use in the 5:37 united states is the johnson and johnson vaccine in fact we are going to have a review 5:45 of that vaccine on friday at the fda's 5:52 vaccine and related biological advisory committee i'm going to be chairing that meeting as 5:58 i have the other meetings approving the vaccines for emergency use 6:04 when that happens we have this two-stage affair in the united states when that happens after that happens uh 6:12 the advisory committee on immunization practices which is housed at the cdc will 6:19 give us recommendations on how that vaccine once approved should be used 6:25 so that's another vaccine that's coming online here in the united states other vaccines have been improved 6:31 internationally the astrazeneca vaccine in particular and there are some 6:36 other vaccines which have not been uh subject to the same regulatory uh reviews at least in the 6:45 western world we have chinese vaccines we have the sputnik vaccine 6:50 and some of those vaccines appear to be effective so there's a variety of vaccines 6:56 available and it's all a question of where you are in the world 7:02 so um dr mano could you talk to us a bit about why these vaccines were able to be 7:07 developed so quickly i think some people have just some concerns about how you know we barely knew the coronavirus 7:12 a year ago and now we have vaccines which are available so how were these vaccines able to be developed so quickly 7:19 well up to now coronaviruses have been sort of a specialty area for some people 7:26 except if you were in asia and some cities in toronto when sars hit 7:33 because that was a coronavirus and that via that outbreak produced 7:42 interest in vaccine development and then we had a uh distant cousin the mirrors 7:48 virus which occurred mainly in uh the african in the asia uh 7:55 in the arabian area mainly associated with camel vectors but with an outbreak in korea 8:03 the reason i bring this up is these are closely related viruses and they spurred vaccine development 8:10 on top of that with the vaccine being in development not really being uh 8:17 evaluated extensively then we had realization that vaccines were going to be necessary 8:24 and a great push both financially and politically in the united states for 8:31 vaccine development which basically pushed things into 8:36 into the fast track so people companies that would have waited for positive 8:42 results were doing studies in parallel rather than in sequence 8:47 but the process has been the same as ordinarily except 8:54 people have done things which would have been risky in terms of financial uh outcome 9:00 because they didn't they didn't wait to see if there were positive results and then when it came to the approval 9:07 process we went through this in the usual way at the fda except for 9:14 we didn't want to wait six months or more uh for for final data 9:22 the approvals were done after two months of data now we're accumulating even more 9:29 data so nothing is uh out of out of the ordinary in terms of the process what's happened 9:37 is that it's just been sped up what would have taken a lot longer 9:42 has been done very quickly dr martin could you talk a bit about 9:48 these chronovirus variants that we've been hearing about i think some people have concerns about 9:54 how well will the current vaccines work against these variants then also is there potential 9:59 for new variants to pop up in the future and how will vaccines work against those ones 10:05 absolutely so one thing i want to start out by being clear about is that you know 10:10 viruses vary viruses generate these changes as they transmit 10:15 and the more that they transmit and move from person to person they they create these changes and that's a normal 10:21 um that's a normal effect of viruses it's something we're used to seeing where we get concerned is when those 10:27 changes start to impact the way the virus works and the way the virus interacts with the body 10:32 so um those are those variants that we see on lists that you know the cdc now has a list of variants of concern 10:38 the who has a list of variants that we watch um so the the data is pretty clear 10:45 that those uh the the variants that we're watching do spread about fifty percent faster 10:51 what is uh and there's still a lot of investigation going on to see whether 10:57 or not the disease that these variants cause is any different is it more severe is it less severe 11:02 now one kind of area as you mentioned that's of high concern is you know when we really worry about a 11:08 variant is when um the vaccine does not protect against the variance what that means is that the 11:14 antibodies that your your body produces once you've been vaccinated can they still recognize this 11:20 new strain so far the data looks good um this isn't like we hear you know we're used to this 11:26 happening with the flu vaccine that some years there's not a good match between the flu vaccine and the strain that's 11:31 circulating so far we have still a pretty good match between the vaccine 11:36 and the variance close enough that your antibodies from the vaccine will still provide a pretty high level of protection 11:42 against the variant it may not be quite as high as um the earlier strains 11:48 but it's still high enough to really slow down the epidemic protect against severe disease 11:53 all those things that were were you know primarily concerned with 11:58 some um some of the audience members have this question about you know will how long will kova 19 12:06 be with us do we know at this point in time if we're going to be able to 12:12 uh control this disease to sort of an eliminatable level do you think this will turn into something kind of seasonal similar to 12:18 what influenza is like i'm interested to hear what arnold thinks i i you know i think that it's 12:24 probably going to turn into something similar to influenza it'll get less severe because that we know for sure that the vaccine pulls 12:30 back the severity um but it's something that we will probably be dealing with waves 12:35 and outbreaks but at a milder level as we go into the future well emily and 12:41 i have come to agree totally about this we started out having different views 12:48 early because i remember i got very much involved in sars control and we kept saying it was 12:56 going to be with us forever it would start to be like flu and then it totally disappeared 13:03 which we still don't understand but this virus is very different in the way 13:09 it spreads even before some of the new variants have come along it is everywhere in the world and i 13:17 think i agree totally with emily we're going to be with this virus and it's going to be with us 13:24 for a long time we are figuring out ways to control it and i think that this is going to be 13:31 manageable we will may not never go back to exactly way the way we lived before we may start 13:38 wearing masks when we're sick not all the time uh aft after we've 13:44 achieved some degree of control but i think we're going to be managing this like we 13:49 currently manage flu where a a proportion of individuals do 13:54 get severely ill we use vaccine to control 14:00 that and uh we move on so some of the viewers were having some 14:06 questions about mrna vaccines uh because as you previously mentioned the pfizer and moderna vaccines are 14:12 based on this mrna technology so dr monto could you talk a bit about 14:19 how does an mrna vaccine work and then how do we know that it is safe 14:25 given that you know we haven't had mrna vaccines for as long as we've had some other vaccine technologies 14:33 right well ordinarily we give the protein 14:40 usually the protein antigen that we want the body to respond to to make 14:46 antibodies to the virus we develop that outside the body now 14:51 typically for viruses in cell culture the mrna vaccine works differently 14:59 it takes the genetic instruction or producing that part of the virus the 15:06 protein and it's given into the body into the muscle and the antigen that we want 15:15 to have a response to is produced in the body so then 15:21 the antigen is present and the body responds not only with antibody but also with 15:29 cell mediated immunity a different kind of response which broadens protection uh we think 15:37 uh based on all sorts of experience this is a very safe approach 15:42 the mrna is destroyed very rapidly that's why 15:47 we have to be careful with freezing and the rest to preserve the vaccines so the mrna 15:53 is gone and uh thus far we've been very happy with the safety profile 16:01 we're always concerned at the start of a vaccine rollout because only a small not only is haven't 16:08 we watched it for very long but relatively small numbers of individuals have been involved 16:14 in this situation we've had many more individuals involved in the clinical trials 16:20 but now we've rolled it out into millions of individuals and aside from the anaphylaxis which 16:26 occurs at a very low level with all vaccines we really haven't seen any safety 16:32 signals that are more than uh rare uh there are a couple that are 16:38 being worked out but again they're uh one or five or something like that in a minute so dr 16:46 monto could you oh wait did you hear something okay dr could you talk a bit about uh what are 16:52 the typical side effects that um come up with the like the pfizer and modern vaccine so 16:58 you know the vaccines can be rolled out to more and more individuals so um what kind of side effects should people expect if they were to get vaccinated 17:07 well after the first dose there is typically just a sore arm most people do not have any other side 17:14 effects uh after the second dose with both and that's what gives you a feeling of uh 17:21 of comfort and saying that these are related to the vaccin just the the product and at the 17:27 particular company's product uh there tends to be uh in about 20 30 percent of people 17:36 uh a little bit of achiness uh sometimes very low grade fever just for a day or 17:42 two after vaccination it's nothing that can't be managed and it's fairly similar to what if any 17:50 of you have received the herpes zoster the shingles vaccine 17:55 what is seen in the second dose of those who've had both typically say this one isn't as bad as 18:01 the one they've had with the shingles vaccine which is again a more traditional vaccine than 18:07 this uh emily do you have any comments yeah well i think what i what i want to 18:13 put a plug in for is the v-safe program and um which i'm super interested by 18:19 so um one of the things that is being done with this vaccine rollout that's never been done you just haven't had the 18:25 technology to do before is that um after you vaccinated you get a text 18:30 link um to sign up for this program and with that the cdc is running and you get 18:36 daily uh daily things to your phone to fill out what your reactions is and so really monitoring the side effects to 18:43 this vaccine in real time across the entire u.s population which is something we've never had the 18:49 technology or ability to do before and so cdc's got amazing levels of just on the ground 18:54 symptom by symptom what are people experiencing as they're seeing the vaccine and so we're moderating this in such a 19:00 really robust and kind of thorough way compared to what we've done in the past that i think it gives a lot of confidence that if anything comes up 19:07 it'll be found pretty quickly and with all of the you know the tens of millions of vaccines that have rolled 19:13 out to date um you know the the side effects have been pretty pretty minimal uh overall 19:21 so uh dr martin i was wondering if you could talk a bit more about vaccine effectiveness so 19:27 a couple of questions have been kind of popping up so one is if somebody is vaccinated 19:35 can they still pass on the virus can they still be sort of a source of viral transmission 19:41 to other folks yeah this is an issue where we get into 19:47 what we know and what we're still learning so the way the trials were designed we know that the vaccine stops 19:53 people from needing to go to the hospital it prevents deaths it prevents kind of 19:58 moderate to severe disease what the trials are what the trials were measuring to see whether or not the 20:04 vaccine prevents you from getting very mildly or sick or even just carrying the virus with no symptoms 20:11 that you could still transmit to other people those studies are still ongoing and so that information is going to be coming 20:16 out we expect over the next couple of months that being said i think a vaccine with a 20:23 95 effectiveness against preventing hospitalizations and deaths i mean it's 20:28 it's a pretty good signal that it probably does reduce transmission but the degree to which it does that 20:34 we're not sure yet and so while this is rolling out um we that's why we're still seeing a 20:39 lot of recommendations to wear masks in public be careful around vulnerable individuals 20:45 all those good kind of low-cost mitigation strategies that we've had until the rollout is really taken off until we 20:51 understand more about transmission another sort of a follow-up question to 20:57 that uh one of the viewers asked so why 21:02 are we seeing that these vaccines have different levels of efficacy for instance you know are there some um mrna vaccines 21:10 which might be have different levels of of efficacy and then you know a follow-up to that would maybe be 21:15 do we know anything of why an mrna might be more or less effective compared to some of the other vaccine 21:20 technologies which are being used yeah you know so actually the mrna the 21:25 two mna products are actually surprisingly similar they're within the range they're basically within the range of 21:31 uncertainty with each other um and so those trials were actually and i think it's really confidence boosting boosting how similar 21:39 the answers from those two trials were um with each other now as we talk about 21:44 um other vaccine products we start talking about the estrogenic vaccine and the the j and j vaccines 21:51 other vaccines that are now being evaluated those are vaccines that are built in different ways 21:56 they're gonna present the antigen to the human body in slightly different way so don't be surprised if different 22:03 numbers start coming out of different products this is something that we've seen before you know flu vaccine there's all these 22:08 different versions of flu vaccine they all have different levels of effectiveness and i think that's something that we're 22:14 kind of used to contending with in the public health space um so a question for dr monto 22:22 so you mentioned that under this emergency use authorization the vaccine was reviewed after two months of data 22:28 collection instead of the typical six so what do we know about uh sort of that 22:34 discrepancy should we be expecting that there could be more long-term side effects that we would see 22:40 after two months and i guess the broader question is um you know how long do you need to 22:46 study a vaccine to figure out what kind of long-term side effects there might be 22:52 well the two months was chosen because most of our side effects if there are 22:59 going to be any occur within about six weeks of vaccination 23:05 so they wanted to allow a median time of two months because the outbreak 23:12 is raging and we don't want to sit and wait if the vaccine is as safe as 23:19 we believe it is uh and that's why that time was picked 23:26 uh there is always with anything that we put in our body either a vaccine or a 23:32 drug or anything like that the possibility for a very low frequency 23:38 long-term side effect we don't expect to see any uh just remember the two mrna vaccines 23:47 and those are the two only that have been approved so far in the united states have now been 23:53 used uh they started getting rolled out for in december and they've been used 23:58 globally and if there were a signal after let's say four months we would 24:05 have it by now so we're now four plus months uh and even longer than that given the fact 24:13 that um that that some of some of these vaccines were actually 24:18 used even before in small numbers of individuals in phase one 24:23 and phase two studies so we're uh pretty far out there in terms of 24:30 period of observation and these seem to be very safe vaccine 24:36 the other thing to keep in mind is that the guidance for approval 24:41 said that we would be approving a vaccine if it was more than 50 percent 24:48 effective uh why that what seemingly low bar 24:53 well a lot of our influenza vaccines in some years are 50 to 60 percent effective and they 25:00 didn't want to set the bar too high and to our great and happy surprise 25:06 we got with the mrna vaccines two vaccines that are in excess of 90 percent effective now we're going 25:14 to be looking at another vaccine uh the johnson and johnson vaccine 25:22 which is given in one dose and the public uh publicly uh 25:29 available data suggests that the effectiveness is going to be less and one of the things that we're going 25:35 to be wondering about is well is this because it's a different product 25:40 or is this because it's only given once and these are answers which uh we're 25:46 going to be concerned about and uh the other thing about getting high 25:51 effectiveness is that even if you have reduced effectiveness against the variance 25:57 coming down from more than 90 percent effective is uh going to give you a fair amount of 26:04 of efficacy even against the variants if they are reduced in the way they were 26:11 the vaccines work dr martin um i was wondering if you 26:16 could comment on the duration of protection from these vaccines uh so about how long 26:23 do we think these vaccines will work in protecting an individual against um cover 19 disease 26:31 i think it's too early to say you know you got to remember that people haven't had 26:36 these vaccines for very long and so i think we're still watching to see what the trajectory of their 26:41 response is after they've been vaccinated we're still also learning a lot about what the protection is after 26:48 infection you know there are some studies that are seeing that infection can protect possibly even 26:54 out to six months or more and we are seeing encouraging signs in the data that a vaccine can protect 27:01 provide a stronger protection than infection can provide so we would expect the vaccine to be as good 27:07 um it's you know right now it's just sort of a prediction game to see whether the production is still 27:12 going to be good a year or more for now or if we're going to have to treat this like we treat the influenza vaccine and provide 27:19 boosts throughout time time to people and i think we're still watching that data 27:24 i was wondering if we could switch a bit to talking about the rollout of the vaccine so there has been 27:31 some concern in minority groups particularly black americans about the covenanting disease 27:39 throughout the cove 19 vaccine certainly there's a history of you know experimentation like the 27:45 tuskegee experiment there is sort of people's lived experiences with medical 27:50 racism so what's being done to overcome some of the concerns that 27:57 these groups have about the vaccines and and what would you tell somebody who was concerned 28:03 um particularly when we're thinking about the racial dimensions of um sort of the burden of disease so far 28:10 with clove19 but also who should be getting the vaccine in the near future 28:15 yeah i think that what this speaks to is the importance of making sure that vaccine is delivered by the right 28:22 people the right way for a community um that you know we know that people have trusted sources of 28:29 information and the more that we can get good information to trusted trusted leaders community 28:35 leaders the more that will help make sure that good information is getting out there and that people are able to get their 28:41 questions answered um and able to get their fears addressed by people that they trust i think that's 28:46 important and um you know to that end i think what i what i get um what i really like is the more effort 28:54 uh all the effort that i'm seeing being put into community kind of small community vaccination 29:00 clinics working with organizations churches small providers 29:06 rather than mass vaccination strategies they get people the opportunity to receive a vaccine in a trusted space 29:11 from a trusted somebody that they already have a history of working with so i think the more that we can invest in those 29:17 programs the more that we can um bring these to communities that have historical 29:23 um distrust and concern about the system for very legitimate reasons 29:28 uh you know and i think that um a lot of you know simply kind of talking 29:35 and vetting and and having uh people have the opportunity to ask their questions and get information that is 29:41 really going to be important as as we roll vaccines out that it's not just a one-size-fit-all solution for 29:48 opening up a big drive-through clinic that we are expecting thousands of people to come through those solutions are needed too but we're also going to 29:53 need these community engagement yeah i guess one thing i want to mention 29:59 for people who uh might not be aware but the modern vaccine one of the the developers of that one of the top 30:04 developers was dr kuzmakia corbett who is a black woman i also know that a lot of the 30:12 pharmaceutical companies tried to partner with historically back colleges and universities to sort of 30:17 make sure that there were you know a large proportion of uh black individuals who were in the 30:24 um who are in the study population so that you know we can be sure that this vaccine um 30:30 is acceptable and it works in in a diverse group of of people you know there was a requirement before 30:39 approval that uh minority groups be included 30:44 and with some of the recent vaccines the new ones that the johnson johnson vaccine a lot of 30:50 testing has been done in south africa and brazil which basically have 30:55 communities large communities of color so the testing is fine the problem one of the 31:00 problems we have right now is with the shortage in supply people who are linked into the system 31:07 are getting more are more likely to be able to get vaccine we have a high demand 31:13 and that's really going to have to be looked into as we try to roll this out to communities of color 31:22 another question for dr monto so there are there any populations of 31:28 people who are not recommended to get a vaccine 31:33 for example should pregnant women be getting a covenant 19 vaccine 31:40 well that the problem uh of vaccinating pregnant women comes up whenever we have 31:46 a new vaccine because for all sorts of medical legal reasons uh the companies are 31:54 not happy about moving into that population soon uh if we look at the history of 32:01 influenza vaccines pregnant women were not vaccinated to 32:06 any extent even though it was an inactivated vaccine and there didn't seem to be any reason 32:12 to think that the vaccine was bad and we knew that if somebody what we began to learn is 32:19 how bad flu was when it infected pregnant women and that's why now from a whoo 32:27 standpoint their highest priority for a vaccine group to receive influenza vaccination is pregnant women 32:35 with the current covet vaccines there is not nearly as strong a signal of danger for 32:43 a pregnant woman who gets coveted it certainly is not good for her and and and for her baby to 32:51 get uh covet and now the recommendations are if you are in a risk 32:57 group you should just get vaccinated as you would if you 33:04 uh if you were not pregnant so the recommendations are not all that strong 33:11 they're permissive and uh if i if there was if if 33:18 in terms of a pregnant women woman who is in health care i would recommend that individual get 33:24 vaccinated because she is in a risk group where and and the risk of getting covet in that 33:30 situation is far uh greater than the risk of a vaccine emily any 33:36 comments yeah well i think this is one of the reasons why the american college of obstetricians and gynecologists 33:42 support vaccination of pregnant women with covid19 vaccine is because of the risk to the mother um that 33:49 are in the risk of the pregnant person of becoming infected um the you know the data shows that it can 33:55 really have devastating effects for the the pregnant person um if infected during pregnancy what we 34:01 also know about um what about pregnancy and vaccines from years of research on other vaccines is 34:08 that the the antibodies that the pregnant person makes after vaccination can then get um 34:14 provided to the infant uh during pregnancy so that the infant is born with a little bit of an immune boost 34:21 um just the same way that you know if if um you know any sort of other antibodies 34:27 that the pregnant person's body has can be delivered to the baby it works exactly the same way and may provide 34:33 actually a little bit of extra protection to the infant after they're born um so it's another reason why 34:38 there's a lot of focus on vaccination and pregnancy uh dr martin i was wondering if you 34:45 could respond to this question how can the mrna technology that we're using for these vaccines how can it adapt to 34:51 new virus mutations in the future i love this question so this is one of 34:58 the reasons why the mrna technology is so exciting because i'm used to the flu world where you have to think of 35:04 it entirely you know you need to you need the vaccine to include virus strain so you have to grow it and then you have to put 35:11 it in eggs and it takes us all this time with an rna you could just swap out the component that you need um for 35:18 the new the new strain if it needs to be updated it's kind of like so here's an example i've been using with people 35:24 um it's like you have a lego house and you want to change the color of the roof with a flu vaccine you have to start 35:31 from the beginning and you have to build a whole new house for an mrna vaccine you take off the roof and you put a new roof on 35:37 and it's that easy just swapping out one piece without having to rebuild the whole vaccine and so i think that that 35:43 makes us much more nimble and responsive to these variants if for whatever reason we find out that 35:49 the effectiveness is not as good to the variant dr manto i was wondering if you could 35:54 talk a bit about previous chronovirus vaccines for 36:00 instance for sars and mers do we have any information about long-term outcomes of those 36:06 and then also i believe that mrna vaccines at least have been and been developed for phase one 36:12 clinical trials for for things like rabies and other uh viruses do we have any 36:17 information sort of on the medium term and after a few years what is the um efficacy or what is the 36:23 safety of those vaccines the development of vaccines is typically 36:32 influenced as much by the commercial world as anything else 36:39 and there have been studies for about 15 years on mrna vaccines 36:48 looking at those kinds of vaccines for flu and for other other diseases 36:55 they really haven't been deployed because of the presence of other effective 37:03 vaccines and for other considerations as a an example of that kind of a 37:09 situation there has really been no need to start using any sars 37:18 or mers vaccines because sars went away and mers is limited only to 37:26 certain geographic areas so we really didn't learn anything much in terms of the technology 37:33 we are just lucky that the technology was there the other thing about 37:39 uh how the that that makes the mrna vaccine so effective is that 37:46 protection to this infection seems to be mediated 37:51 we're not absolutely sure yet we can't call it a correlate of protection 37:56 by antibodies to the spike protein so you put in an mrna 38:03 the codes for the spike protein and this gives you very high levels 38:08 of protection so the fact that that technology giving one 38:16 antibody to antibody to one part of the virus uh gives you such 38:22 high protection is one of the few really lucky things we've had 38:27 with this uh virus and with uh covet control 38:35 so a question i'll first direct it at dr monto but both of you can answer 38:40 do you think we will need a yearly uh cover 19 vaccine shot 38:47 well we've been looking at coronavirus infections that occur 38:54 on a year-to-year basis we have a group of four coronaviruses 39:02 that cause in most people just common colds occasionally they infer they they will 39:09 put somebody in the hospital but that's pretty rare we know that those viruses do reinfect 39:16 infection is gives you only relative protection so the chances are even with a good 39:24 vaccine even if we didn't have uh variants developing we 39:30 might need booster shots and i have a feeling that we are going to 39:37 need a reboosting of antibodies to this virus and it all depends on what happens in 39:43 the population as well because it all depends on how much transmission is occurring 39:49 and how much immunity we have in the population and none of this is predictable i started saying at the 39:57 outset of this pandemic anybody who makes a prediction and says it with 40:02 great confidence don't listen to them because it's all very novel and we've all been wrong in our 40:09 predictions but i suspect we are going to need boosters 40:14 we are going to have to swap in new new variants uh one of the other things 40:20 we didn't think was that the we're going to see a whole lot of variation in these coronaviruses they're 40:26 a lot more stable than flu uh what do you think about that emily 40:31 you know i think that um what we this the speed of variation that we're seeing right now 40:36 is actually pretty comparable to fluent partly because we're seeing so much of that we're seeing so many you know infections that that helps 40:43 drive variation i i do you know i do think maybe even for a little maybe just for a little while probably 40:50 need some sort of booster shot strategy but i am happy for to be proven wrong as 40:55 this going forward this goes forward but when i look at it it makes sense you know something to keep in mind though 41:01 that if we end up having to use that type of strategy it'll be a one dose you'll get one dose updates you don't 41:07 have to do that full two dose series again a year from now you'll just continue to to get one dose like we do 41:13 with the flu shot and are we gonna have reactorgenicity to what that one dose booster 41:18 yeah you know what i uh i vaccinated because of my role in doing uh testing and the second just 41:25 was like a piece of cake for me no assistance at all so like i'm ready for another one whenever whenever it's 41:30 needed okay so um i do want to mention that we are um 41:36 close to the end of the hour so i just have a few more questions um to to wrap up with uh the panelists but 41:43 um certainly continue putting your questions in the chat or the q a and we'll try to get to as many of those 41:49 as possible i want to switch to talking a bit about the rollout of the vaccine 41:55 and to some people who might be a bit more vaccine hesitant 42:01 so first off uh what do you think of the rollout of the vaccine so far um i think one person 42:08 asked what are the top three reasons why the vaccine rollout has been so slow but 42:14 i think that that assumes that you think the vaccine rollout has been slow so uh yeah so why um what do you think the 42:20 vaccine rollout so far and if it has been still what do you think are some of the reasons for that and i could start with um 42:26 dr martin yeah my um yeah i do think the vaccine rollout has 42:32 been slow my top three reasons are organization organization and organization 42:38 and you know i think yeah we we don't have um enough information 42:45 and our information systems aren't organized in a way to to really kind of activate quickly 42:52 for this job of distributing things in a kind of a top-down manner from federal 42:59 to state to local i think the more disorganization that happens i think with distribution 43:05 um at the federal level which kind of it's you know it compounds when you get to the state level compounds you get a 43:10 local level we have a lot to do to build up the public health infrastructure to handle this we have to remember that we're deploying 43:16 this in a public health infrastructure that's gotten very little investment over the last couple of decades 43:22 so it's a big task for a lot of kind of really archaic data systems and ways of transferring 43:27 information and what we're seeing is the impact of some of that the other thing is just supply 43:35 because when you ramp up when you're starting to produce a new product and it's in global demand 43:42 the supply is going to be limited and besides the we i agree about 43:47 organization organization but part of organization is proper communication and i don't think that was 43:54 handled very well in terms of issues like supply and as soon as we can get more uh 44:03 facilities that can produce a vaccine online there have been some interesting developments in terms of the 44:10 pharmaceutical companies that do have vaccine production ability uh 44:15 making arrangements with those that are who do have the vaccine to use their 44:22 facilities for production that's going to be a a major change if we could get greater 44:28 production of the vaccine i was wondering if you could both comment on why do you think 44:35 some in the population are so adverse to taking a covid19 vaccine 44:42 and we could start with uh dr monto well i think there are some people who just don't 44:48 believe that vaccines are a solution to sub to our infection 44:54 problems and we've uh done many many studies to 45:00 uh make them feel more comfortable about getting vaccinations and for some people i don't 45:06 know that we're ever going to convince them of something which is really a belief system rather than 45:14 something that can be demonstrated on the basis of facts now there are some who 45:21 are a little concerned because this is novel i think there we just have to show that the 45:29 data are present about safety and anything you do in life is a risk 45:35 benefit consideration whether you think about it or not whether you're going to go out 45:41 and do something uh in a in a situation if you're gonna get on a plane or 45:47 something like that uh some people some people are uh 45:52 risk-averse to fly and we just have to use the data that we have 45:58 to convince them and also with information groups to show that 46:04 there are many people who are really eager to get vaccinated and to 46:11 communicate from those people to those who are uh concerned to try to disseminate the 46:18 knowledge emily yeah i mean i think it's understandable um i think 46:24 some level of caution is understandable because i think everybody's worlds have been turned on their heads um you know over the last year but i 46:32 think that um and i also think that you know we're fighting a real 46:37 um a real challenge here with the amount of uh misleading information that's on the 46:43 internet and that is easily accessible i think it's a different problem now than previous vaccine rollouts that we've had 46:49 historically uh and so i you know it comes to making sure that we're getting good information 46:55 that can be accessed from people who have questions so they can go to people they trust and get 47:01 access to good information yeah i mean i will also say that if you look at surveys over the past 47:07 year there's been an increase in the people who actually want to get a vaccine and i think part of that is asking people last summer do they want 47:13 to get a vaccine it's all very hypothetical they don't really know what the vaccine is but at this point in time we have really 47:19 robust safety information about the vaccine and by the time that the vaccine is going to be available to 47:25 the the larger population i think we'll have even more population and i think there will be more of a social norm 47:31 about getting the vaccine so i hope that over time this reduction in vaccine hesitancy will 47:37 sort of decrease it's understandable why people would be concerned about this about a vaccine about anything that like 47:44 is getting done to their body but i think we at this point in time we just have a lot of safety information and i'm 47:51 glad that we were able to talk to you two about that we do have one quick question which i i think um 47:57 you could you could briefly uh answer what is a good correlate of protection for this disease 48:03 is it a certain level of antibodies um or is there something with you know like the viral load 48:10 that you need to consider um when thinking about is somebody would be protected in the future against um copenhagen i think arnold and i are 48:17 smirking because we don't know um but we're pretty close to no we're we're close 48:23 we're getting closer on this thing we've never figured this out for influenza um but you know the best the best way to 48:31 demonstrate uh effectiveness of a product is to watch hospitalizations and deaths and 48:37 disease go down is to watch an actual endpoint and that's what we're able to watch in real time now in terms of you know can 48:45 you do a test to say is your body protected or not protected you know we're still a little bit of ways away from having 48:51 having that having in it probably honestly the real answer is probably going to be less clear uh even even with um all of 48:59 the the great work that's being done in this area yeah the trickiest thing 49:04 the trickiest thing is going to be with the variance because uh we me we've learned from flu 49:11 that we can't very well predict we know what the changes are in the virus how well the vaccine is going to work 49:18 against that change and i think that's that that that's become clear between the uk variant 49:25 where the vaccine seems to be working better than the south african variant 49:30 so i have a question which i think would be a great final question could you explain herd immunity and how 49:37 these individual choices about vaccination can affect the whole community and maybe uh dr 49:44 martin you can start yeah so herd immunity is basically the point at which this goes away on its own 49:51 with us and not having to do stuff not having to wear a mask not having a social distance 49:56 you know and all of those things it's it's a it's a it's a scale right you think about it like a balance 50:01 the more vaccine gets into the population the less we have to do things like you know 50:07 social distancing masking all these other mitigation measures um and so you know it's it's it's to the 50:14 benefit of everybody to try to get as close as we can to that quote-unquote immunity or trying to get as much vaccine as we can the other you know the 50:21 other thing is it's important to remember when we think about herd immunity is it protects those that may not have been vaccinated 50:28 how how high can we get our vaccination rates so that we can protect those who can't get 50:33 vaccinated this is a big question right now because we're not vaccinating people that are under 16 years old 50:39 so the protection that our kids are getting is solely through the protection that we 50:45 provide them as adults around them by getting vaccinated kind of vaccinating around these populations that can't be 50:51 vaccinated themselves and arnold you probably you probably have stuff to add on top well 50:58 i i heard immunity used to be a thing that we 51:04 brought up in epidemiology classes very carefully and because it was a kind of a 51:11 theoretical concept and i think we are overusing the term 51:16 now because herd immunity really as you pointed out means that the disease is going to go 51:23 away in the population and what we're look after here is to have the disease 51:29 uh go down in frequency and then other things help to go have it go away it doesn't have to all 51:36 be immunity and what we need to do right now is just 51:41 to get enough immunity in the population to get the disease to behave in a way 51:47 that we can go and start behaving in our normal way and whether it's 51:52 whether whether it goes away completely which i doubt because of immunity or not is really irrelevant as long as 51:59 we can control it and don't have hospitals filling up with cases that can't be handled 52:07 well thank you for those responses and i would like to thank all the viewers for taking time out of 52:12 your day to to learn more about covid19 vaccines i would like to thank our panelists dr 52:20 monto and dr martin who have been you know very busy um doing the research but who have also 52:25 spent a lot of time doing these public outreach events and i think that's that's very important um and also a big shout out to our chat 52:33 moderators uh dr ryan moulash dr niana masters and peter deyoung who um 52:39 we're busy answering all of your questions uh so again thank you for attending this 52:45 session of the vaccines and covet 19 teach-up i hope you have a wonderful day