Boosters could create more enduring immunity for new Covid-19 variants: Doctor

Dr. Manish Garg, Emergency Medicine Physician & Co-Founder of World Academic Council of Emergency Medicine, discusses the latest research on Covid-19 booster shots and the new Delta Plus variant surging in the UK.

Video transcript

- Going to keep talking about all of these developments with Doctor Manish Garg. He is Emergency Medicine Physician and co-founder of the World Academic Council of Emergency Medicine. It's good to have you here and thank you for joining us.

MANISH GARG: Yeah, thank you Adam. Happy to be here.

- I wanted to ask you in regards to these booster shots, we all believe that more information is better, and yet it's the paradox of choice. The paradox of too much information. We report yesterday, FDA says go ahead, now we're reporting the discussions about the CDC. And I think a lot of millions of Americans, perhaps, probably get confused thinking, wait a second, the FDA just said do it, now the CDC has to give its stamp of approval, and this might actually undermine the efforts to get people to get the booster shot.

MANISH GARG: Yeah, yeah. Thanks Adam. I agree with what you're saying. And I just want to say before I begin that my thoughts are my own, and I have no conflicts of interest, especially with the vaccine companies. There is a lot of confusing messages, especially when you have a multiple step process. So if you have first the FDA to give approval and then to the CDC and its advisory panel to also give approval, I think that that can be confusing. But what's interesting, actually Adam, about this particular study that was done with the boosters, it's a great study. It really shows that we are doing very well in that vaccines protect against the worst outcomes, hospitalizations, intubations, and death. And it makes me feel better about how vaccines are doing with enduring symptomatic protection.

But if they actually look at the numbers in this study, a five of the people who were boosted out of 10,000 people got the symptomatic infection versus 109 people out of 10,000 that were not boosted who got the infection. So and when you look at those numbers, that's 1% of symptomatic infections, and for the people who weren't vaccinated-- or sorry who weren't boosted and 0.05% in the boosted group. So said another way, you're still getting great protection. 99% if you had the vaccine. 99.95% if you were boosted. So it's really just a little bit of a protection addition that this is doing, and this is better than the Israeli data. The colleagues I have at the World Economic Council, they presented data that boosters were waning. So this actually makes me feel a lot better about that, and it's reassuring.

- Doctor, what does this tell you just about who should qualify for a booster? I guess if it's such a small percentage here, just a fraction of what you were just saying, does it make sense that only people who are 65 and older, or only people who are at high risk, that those should be the ones that are getting booster shots right now?

MANISH GARG: Yeah, and I think that's the real question, right? Is that if it's only giving this maybe fractional percent benefit. I think what you really have to think about is, where are we in the landscape of the pandemic? If another variant comes that has the potential to be highly contagious and evade our vaccines and has some additional mutations, then it makes a lot of sense that this boosting is the right strategy.

When they originally did the boosting strategy, the United States wanted to get immunity up right away. So that's why they did the initial kind of two set pretty close. We know with vaccines there usually needs to be some period of time. And when you talk to a lot to the researchers, they say that the initial kind of prime, this one month later, and then another one some months later, 6 to 12 months after that is probably the best strategy. So I mean, I think that it's going to create more and more enduring immunity as we look at the numbers.

So I think it'll be good probably for future variants from where we are right now. So I think it's a good strategy that's present. The 65 and older, absolutely. I think that group should be boosted. The immune compromise should be boosted. And then I think for those others in this study, they didn't have adverse events. So it looks like it was pretty good and pretty-- it was offering a little bit of benefit.

- I wanted to switch gears because now we're monitoring what could be a variant of the Delta variant with the surging cases in the UK. What do we know? Do we know if it's dangerous? How dangerous? And is it here in the United States?

- So, we have heard of at least in terms of talking about this AY42 or the Delta Plus variant. I think I would just take a step back and just kind of remind everybody we've had five pandemic level variants with varying profiles. Like the first one that was in New York City that I took care of as an emergency medicine doctor with my colleagues in March and April 2020, that had a deadly course. Then when the alpha variant evaded testing, the beta and gamma variants evaded the non MRA vaccines. And then Delta has been the most contagious of them all. In fact, it's one of the most contagious pathogens known to the history of humankind.

And I say that understanding that the chicken pox and measles are more contagious profile, but the incubation period for Delta is actually much, much shorter. So with that all said, will this new variant that's out there, the AY42 or Delta Plus, will it combine bad profiles, will it become the dominant strain over regular Delta? I don't like that the cases in the UK are expanding. We need to watch it. Time will tell. This is just another reminder that the world needs to take the best prevention strategy. And that's really to vaccinate the rest of the world.

If you talk about some wish lists that a lot of us have in the public health, it would be that they vaccinate the unvaccinated, try to create a non injectable version of the vaccine, because that was critically successful in smallpox and polio. Because remember, injectable vaccines require a professional license across the world. We need an effective oral antiviral, so the Merck thing is very exciting. Pfizer and Gilead have some of their oral antivirals that are coming out amongst others. We need rapid testing that's inexpensive, and then finally I just say we need a heterogeneous approach that's layered, as opposed to this homogeneous like one shot cure all kind of approach.

- We appreciate your joining us live, and wish you the best Doctor Manish Garg. Emergency medicine physician and the co-founder of World Academic Council of Emergency Medicine. All the best.