Dr. Ashish Jha, Part Two: When Will the Pandemic End?

Transcript

ERIC: From the Museum of Science in Boston, this is Pulsar, a podcast where we go to the experts for answers to the most frequent questions we get from our visitors. I'm your host, Eric, and this is part two of our Fall 2021 exploration into the two most popular questions asked at the museum about the pandemic, to go along with the launch of our newest exhibit, Project Vaccine: Our Best Defense. Last week, we wanted to find out how it started, and we asked our virtual exhibit COVID Conversations with Dr. Jha. Today, we're going to ask: when will the pandemic end? Joining me live, virtually, is Dr. Ashish Jha, the Dean of the School of Public Health at Brown University. Dr. Jha, it's fantastic to talk to you today. Thank you for coming on Pulsar.

ASHISH: Hey, thanks for having me here.

ERIC: So when will the pandemic end?

ASHISH: Well, the pandemic is going to end when we stop having it sort of dominate our lives the way it does right now. Now, pandemics kind of fade away, they don't really end. The virus is going to still be with us. But it will no longer be much more than a nuisance. And obviously, it's hard to predict exactly when. I suspect for most of us in the United States 2022, sometime next year, things really will begin to fade into the background. But it's always hard to paint, you know, kind of the exact point when a pandemic has come to an end.

ERIC: Right, so there's no definite date, there's no definite even definition of what the end is.

ASHISH: Correct. I mean, in some ways, if you think about the 1918 flu pandemic that's so famous, that virus is still around. It just doesn't do much harm anymore. It'll be the same thing with this virus, it'll still be around. And you know, there's an old saying by a historian which I love, which is, he said: pandemics end with a whimper, not with a bang. And that is the way to think about it. At some point, we'll wake up one morning and go, wow, haven't thought about the pandemic in weeks. And that's the day it'll be over.

ERIC: So the vaccine has really made an impact, but we're still waiting on approval for children under 12. What's the latest on the timeline of when the clinical trials will finish and the vaccine will be made available?

ASHISH: Yeah, I'm hopeful that we're going to get vaccines for kids under 12, for 5 to 11 year olds, at least, very, very soon. The best guess, and is really is a guess because you can't rush the science, you got to wait until the clinical trials come in. The best guess is probably end of September, early October, we'll have the data submitted to the FDA. It'll take them a few weeks to go through all the data and make recommendations. And I'm hoping by the end of October, maybe early November, we're gonna start being able to put shots into kids arms, and getting kids protected as well.

ERIC: So that data you mentioned is being released very soon. Is there anything in particular parents should be looking for in that data when they're making decision about vaccinating their kids?

ASHISH: Yeah, so the two things I always look for in any data and for vaccines, and again, I'm gonna be looking for here, you know, I have a nine year old who's not vaccinated, so I'm going to pay very close attention. I'm going to look for data on safety. Of course, first and foremost, I want to make sure these vaccines are safe in kids, they have been really safe in 12 to 17 year olds, so I expect them to be safe. But we'll look at that. And then I want to see data on effectiveness. I want to see data that it's generating the kind of immunity for 5 to 11 year olds that we saw for older kids and for adults.

ERIC: So a lot of people have been asking us why there was a separate set of clinical trials. Why couldn't we include kids all the way down to six months in the clinical trials that we did earlier in 2020 and 2021?

ASHISH: Yeah, it's a great question. Why didn't we just study everybody right away? Studying vaccines and kids is different, and it's harder. And we also just tend to be much more careful. Because of course, as you might imagine, kids can't give consent in the same way, they're more vulnerable, their physiology is a little different. So we have a long tradition of studying vaccines in adults first, making sure that it's safe in adults. And that gives us more assurance to go and test it in kids. Also, of course, the virus is not as dangerous for kids as it is for adults. And so that's another thing. I mean, the truth is that if this virus were somehow just as dangerous for kids, I could have imagined that we would have gone ahead and done the clinical trials for kids right away. But it's a classic thing. You start with adults, then you go with adolescents who are kind of like kids, but also like adults, we got those done. And now we're going to go to 5 to 11 year olds, probably have to make some dosing changes. And then the little ones under five, you know, the six month old, the two year old, we're gonna need to think about different dosing, different approach. And it's complicated and we want to be really, really careful.

ERIC: Yeah, you uses that word complicated, which I was going to say exactly as the point where you have so much going on the different dosing, the different effects for the kids, there's just so much to think about.

ASHISH: Yeah, and you know, for little ones, and again, they're all important, of course, but particularly for the little ones, I think that we just want to be that extra careful. And so knowing if it's safe in six and eight year olds is going to give us more confidence, testing it in three and four year olds.

ERIC: So with the delta variant we've seen the vaccines are still holding up, still preventing most hospitalizations. But can you talk about how there's been breakthrough infections among the vaccinated population? And how we can fight this stage of the pandemic? What's the best strategy for right now?

ASHISH: Yeah, so the delta variant is a tough one, it really is the worst version of this virus that we have seen. And my hope is the worst version we'll ever see, we don't want to see anything worse than this. The big problem of the delta variant is that it generates very, very high levels of virus very quickly. And so when somebody who's infected with delta shows up and breathes on you, or coughs on you, they give you a large viral load, and that can overwhelm your antibodies. And that's why, and particularly if you've been vaccinated for a long period of time, the data from Israel says that there's a little waning of antibodies, and then the delta can kind of overwhelm it and cause a short term infection, a breakthrough infection. The good news is that those vaccines do more than give you antibodies, they also give you memory B cells and T cells, other parts of the immune system that then kick into high gear and say, wait a second, we don't want to deal with this invader, and take care of the virus. And that's why most people who are fully vaccinated don't end up getting particularly sick. They have a few days of symptoms, fever, cough, sore throat, but then they turn around and they almost never end up hospitalized. It's not never because nothing's 100% but rarely end up needing to get hospitalized or dying, that is still holding up. And the truth is that these vaccines remain remarkably good. Again, we are seeing some breakthrough infections, we're not seeing a lot of long term complications from those breakthrough infections. And it gives me confidence that these vaccines are really every bit as good as we had hoped they would be.

ERIC: So we're hearing a lot about booster shots, too. Another dose of the vaccine for those who received it already. Can you talk about the pros and cons of getting booster shots in the arms of Americans this fall and winter?

ASHISH: Yeah, yeah, absolutely. And so boosters, you know, are pretty common with vaccines. I mean, there are a lot of vaccines where we give that third shot. Hepatitis B vaccine is a three dose vaccine. And what you're doing usually when you do that booster is you're giving your immune system one more look at the virus, or in this case, giving it a look at the spike protein of the virus. And it's really helpful for immunologic training. So the data so far suggests that a booster, I'd say about six months, and we can talk about timing, about six months after the second shot, gives you very high levels of antibodies, and then really does probably rev up your T cells and B cells as well. And so that then when you encounter the virus, your immune system is raring to go and takes care of it. Far fewer breakthrough infections and far fewer hospitalizations. Not that there were that many with after two shots anyway. The big question is, who needs it? And when after the second shot should you get it? In my mind, the science on this is becoming clearer for some groups and less clear for others. So no doubt about it, everybody agrees if you're immunocompromised, you need to get that third shot. If you're a frail elder, if you are somebody with significant chronic diseases, someone who would not tolerate a breakthrough infection very well, probably worth getting a third shot. And I think we're going to have policies that are really going to push on making sure that high risk people are getting that third shot. The question is, what about the healthy 25 year old who's got no other health problems, no other issues? There, I think the data is not all that clear. And I also think it's a bit more of a dealer's choice, like in the sense that there's probably no downside, clinically. Now we've kind of got the vaccines out to the whole world. So it's not totally clear that a healthy 25 year old should be going out there and getting a booster shot. Probably not going to harm them in any way, maybe give them a little bit more immune immunity, but they've already got so much protection that they're, you know, in really good shape. And that's much less to me clear. High risk people: clearer.

ERIC: Yeah so coming back to the end of the pandemic, to really make it end worldwide and not just here in the United States, we need to get vaccines around the world, we need to get those numbers up all across the globe.

ASHISH: Absolutely, absolutely. I mean, if you think about it, every variant, we've had delta, alpha, beta, they've all come from other countries. And they've all come in the context of large outbreaks. There are large outbreaks happening right now and around the world. We do not need many more variants, we will probably get some more. And what we want if we want to end the variants and the pandemic and all the suffering and death across the world, is we gotta get the world vaccinated. Now world vaccination, global vaccinations, is moving reasonably quickly, it needs to go faster. And we've got to do a better job in the United States donating more of our vaccines and helping production of vaccines.

ERIC: So to wrap up, what's giving you hope right now?

ASHISH: I feel very hopeful. And I'll tell you why I feel very hopeful. You know, last year in 2020, we basically were saying, hey, hunker down, keep people safe, wait for the cavalry to arrive. And the cavalry was vaccines. And we said let's hope we get good vaccines and let's hope we can use them to really turn to spend this pandemic around. The bad news on some level is there's no cavalry coming. We've got the cavalry, it's here, but it's also actually really the good news and what gives me hope, which is today we have all the tools we need to end this pandemic, and vaccines are obviously a huge part of it. We've talked about it. But in my mind, there are four things that really control this virus that we need to pay attention to. And we want to be doing some of the others as well. Vaccines, we've talked about widespread availability of cheap testing. Testing is a great way of catching people early in their infections and separating them so they don't spread. Indoor masking. We will not need to be wearing masks forever. But in the short run, especially when there's a surge, wearing masks indoors makes a lot of sense. And then cleaning the air indoors. You know, one of the interesting things is almost all of these infections happen indoors when infected people spread it to others and you don't have good ventilation. We've got a real challenge on our hands. We've got to improve the filtration and ventilation of indoor spaces. We've got to clean the air. We do that, we get widespread testing, people wear masks in indoor spaces, people get vaccinated, the pandemic is over.

ERIC: Alright, Dr. Jha, it's been really great to talk with you. Thank you for all your hard work over the last 18 months and we look forward to hearing more from you.

ASHISH: My pleasure. Thank you for having me back to the Museum of Science.

ERIC: You can follow Dr. Jha on social media for the latest updates on the fight against the pandemic. And be sure to visit the Museum of Science to check out our newest exhibit, Project Vaccine: Our Best Defense.. Until next time, keep asking questions.

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