Local experts skeptical of plan to cut vaccine doses

Published 5:34 pm Tuesday, January 12, 2021

Local health experts who participated in the Isle of Wight County NAACP’s virtual COVID-19 panel discussion Jan. 4 expressed reservations about a U.S. Food and Drug Administration proposal to cut doses of the Moderna COVID-19 vaccine in half to speed up its distribution.

“We know it induces identical immune response to the hundred microgram dose and therefore, we are in discussion with Moderna and with the FDA,” Dr. Moncef Slaoui, chief advisor to the Operation Warp Speed federal vaccine program, told CBS News anchor Margaret Brennan on “Face of the Nation” Jan. 3.

Moderna’s vaccine, which is presently the only one available in the Western Tidewater Health District, has demonstrated 94% efficacy in preventing COVID-19 in clinical trials, according to the U.S. Centers for Disease Control and Prevention. But that’s based on a person receiving two full-dose injections 28 days apart.

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“The data is very clear that it’s based on full doses,” said Dr. Keith Newby, a Norfolk cardiologist who recently received his first dose of the vaccine.

As for Slaoui’s claim that a half dose would produce an identical immune response, “You would have to go through a whole new study,” Newby said. “I don’t see how that could be the case and you would know that you’re developing the immune response necessary without it going through the proper tests to know that. … I have a lot of reservations about that personally. I have a lot of angst about that one without seeing strong data that it was studied and shown to be effective, as effective as the full dose.”

Western Tidewater Health District Emergency Manager Will Drewery agreed, stating, “All the research we have seen says the first dose is only about 62% effective. … Really the big challenge from the planning side of the house, which is what I generally do, is making sure people come back to get that second dose so that they get the full efficacy.”

Moderna’s vaccine, and the Pfizer-BioNTech one also approved for use in the United States, are both messenger RNA vaccines. Both require two doses.

“People talk to me … they say they fear the fact that this came out so fast,” Newby said. “I’ve tried to convey to people when you look at how the vaccine works.”

As Newby explains, messenger RNA vaccines work like a foreman on a construction job, but instead of directing the building of a house, it’s instructing the body’s cells to produce the spike seen in microscope photos of SARS-CoV-2 — the official name for the virus that causes COVID-19. It doesn’t inject the virus itself, just the instructions for making the spike protein.

“Say somebody’s getting ready for a boxing match and they say, ‘OK, I need to prepare for this fight, so I need to get me a sparring partner that fights like my opponent. … That’s kind of what this spike protein is doing,” Newby explained. “It’s getting your body ready so if it sees it again it knows it needs to fend it off and fight it. Once that code is delivered, the vaccine part is gone so all you have left is that spike that’s created, and then your immune system creating antibodies to fight or to block that spike from being formed, so it can’t get into your cells.”

Creating that spike protein and the subsequent immune response takes time.

“So I tell everybody if you see somebody that says they got the vaccine and then three days later they got infected … three days is not enough,” Newby said. “That’s why you’ve got to take two injections. The first injection starts the process. After about maybe seven to 10 days, you’re starting to create your antibodies. You’re starting to get the immune response, but the second injection is what actually creates that 94% efficacy. … That’s why they’re advocating that despite getting the vaccine, you still have to wear your mask, still have to do your social distancing.”

Newby assured those listening to the panel discussion that the vaccines, based on current data, carry a side effect risk of less than 1%, meaning one or fewer people out of every 100 may develop an adverse reaction.

According to Dr. Lauren James, interim director of the Western Tidewater Health District, Virginia’s supply of COVID-19 vaccines is currently only available to health care workers and residents of long-term care facilities — a group the U.S. Centers for Disease Control categorizes as 1a. The Western Tidewater Health District began distributing vaccines the last week of December 2020. Per the CDC’s guidelines for phased allocation of the vaccines, the next eligible group — 1b — will include people age 75 and older and “frontline essential workers,” but “that group has yet to be defined by the CDC so we’re still waiting for that.”

Asked if either vaccine will be effective against the faster-spreading SARS-CoV-2 variant first reported in the United Kingdom, which had spread to at least four states — New York, Colorado, California and Florida — as of Jan. 4, Newby said “I don’t think we fully know yet,” but “based on what they’re saying, what I’ve heard and what I’ve read, both parties from Pfizer and Moderna are saying that they feel it should be effective against the variant as well.”

According to James, there hasn’t been a lot of testing for the variant in the Western Tidewater Health District, which she explained requires a genotype test to identify different strands of the virus.

“I’m not familiar with any facilities outside of hospital systems that are offering that, and as far as I know it’s not being done widespread in the Hampton Roads region,” she said.

According to Drewery, the Western Tidewater Health District is currently in the midst of a surge of post-Christmas COVID-19 cases, and expects a similar surge this month from the New Year’s holiday.

“I don’t think we’ll see the full extent of where we really are as a community until we get past the second full week of January, maybe even into the third week of January,” he said.

James added that roughly 40% of people are asymptomatic.

“They don’t have any symptoms, so they are unknowingly spreading COVID. Social distance, even when you’re outside. If you can’t be six feet apart, be sure to wear a mask.”

James added that across the region, Black and Latino people who contract COVID-19 are statistically more likely to be hospitalized and to have longer hospital stays.

“What that says is that there something going on, you know, in that community … I know specifically in the other district I’m in, Portsmouth, that African Americans in that community do have higher rates of obesity and chronic health diseases,” James said.

“There have been a couple young folks that I’ve seen that have been hospitalized with COVID that do quite well with it but have had, like, one in particular had bad kidney disease, but he was really physically fit, and he really remained relatively asymptomatic the whole time he was in the hospital,” Newby said. “It’s almost like you’re rolling the dice … you don’t know what your outcome’s going to be compared to someone else.”

“There’s still a lot of people who have not been vaccinated, he added. “We’ve still got a lot of work to do so treat everybody as if they have it, and that’s the safest thing.”