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The World & COVID-19

Vaccines Live Q&A

Vaccination is one of the most successful public health interventions our world has ever seen. Since we started vaccinating more than 200 years ago, we have seen the elimination or control of diseases such as smallpox, polio, diphtheria, measles, and pertussis. Despite these successes, we are starting to see increased concern and hesitancy about vaccines. We created the Vaccines and COVID-19 Teach-Out to discuss these important topics and to provide updates on the current state of COVID-19 vaccines and encourage you to join the Teach-Out, happening now through Feb. 28. To expand the conversation and better connect you with experts, we’ve invited several contributors from Teach-Out to respond to your questions about the COVID-19 vaccines, vaccine hesitancy, communication, development and distribution processes, and more in a free live, event next week.

Excerpt From


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