<p dir="ltr">Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee evaluating COVID-19 vaccines. In this episode, Paul's second appearance on The Drive, he provides an update on all the SARS-CoV-2 vaccines currently deployed, explains why the concerns raised around the mRNA vaccines are not legitimate, and offers his view on the prospects and timeframe of reaching herd immunity. He also takes a deep dive into immunology, explaining the short-term and long-term immune response to both natural infection and vaccination and how these two can function together to provide durable immunity. Additionally, they discuss the theories on the origins of this virus, what impact the new COVID-19 variants might have, and the recent pausing of the J&J vaccine. Finally, they discuss how we can be better prepared for an inevitable future outbreak of a novel virus. This episode was originally recorded on April 14, 2021.</p> <p dir="ltr">We discuss:</p> <ul> <li dir="ltr"> <p dir="ltr">Overview and current status of the SARS-CoV-2 vaccine strategies [4:10];</p> </li> <li dir="ltr"> <p dir="ltr">Addressing concerns about mRNA vaccines [9:00];</p> </li> <li dir="ltr"> <p dir="ltr">How the failure to make an effective HIV vaccine aided the development of a COVID-19 vaccine [16:45];</p> </li> <li dir="ltr"> <p dir="ltr">Where SARS-CoV-2 falls on the spectrum of its ability to mutate and what that means for immunity and vaccination [21:30];</p> </li> <li dir="ltr"> <p dir="ltr">How the combination of short-term and long-term immune response to SARS-CoV-2 work together to provide durable immunity [28:00];</p> </li> <li dir="ltr"> <p dir="ltr">Importance of understanding relative vs. absolute risk reduction [38:15];</p> </li> <li dir="ltr"> <p dir="ltr">Implications of pausing the J&J vaccine due to reports of blood clotting in the brain [42:45];</p> </li> <li dir="ltr"> <p dir="ltr">What constitutes herd immunity and the concerns of rising vaccine hesitancy [47:45];</p> </li> <li dir="ltr"> <p dir="ltr">When we might reach herd immunity, future vaccines for children, and long-term outlook for maintaining population immunity [58:45];</p> </li> <li dir="ltr"> <p dir="ltr">Theories about the origins of SARS-CoV-2 [1:07:00];</p> </li> <li dir="ltr"> <p dir="ltr">Preparing for the possibility of a future pandemic and how we can learn from our mistakes [1:10:40]; and</p> </li> <li dir="ltr"> <p dir="ltr">More.</p> </li> </ul> <p>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> <br /> Show notes page for this episode: <a href="https://peterattiamd.com/pauloffit2">https://peterattiamd.com/pauloffit2</a> <br /> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> <br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> <br /> Connect with Peter on <a href="http://Facebook.com/PeterAttiaMD"><u>Faceboo</u></a><u>k</u> | <a href="http://Twitter.com/PeterAttiaMD"><u>Twitter</u></a> | <a href="http://Instagram.com/PeterAttiaMD"><u>Instagram</u></a>.</p> <p> </p>
Actionable Insights
1. Prepare for Next Pandemic with Global Collaboration
Establish an international collaboration for surveillance, sequencing, and resource sharing (PPE, ventilators, vaccines) to monitor and respond to future pandemics, ensuring all nations are prepared and supported.
2. Ensure Global Vaccine Equity
Economically and technologically advanced nations should prioritize providing billions of mRNA vaccine doses to all countries, even if it means restricting intellectual property, recognizing global interdependence in pandemic control.
3. Prioritize Second mRNA Vaccine Dose
Always get the second dose of mRNA vaccines to achieve more durable, complete, and effective immunity, especially against emerging variants, as a single dose provides less robust protection.
4. Understand mRNA Vaccine Safety & DNA
Reassure yourself and others that mRNA vaccines cannot alter your DNA because the mRNA lacks necessary signals and enzymes to enter the nucleus, convert to DNA, or insert into your genome.
5. Recognize Vaccine Side Effect Timelines
Understand that serious vaccine adverse events, if they occur, are almost always identified within two months of vaccination, based on historical vaccine data.
6. Interpret Vaccine Efficacy Beyond Relative Risk
When evaluating vaccine efficacy, focus on absolute risk reduction (ARR) rather than just relative risk reduction (RRR), as ARR provides a more accurate measure of individual benefit.
7. Weigh J&J Vaccine Risk vs. Benefit
Consider that even with rare clotting events, the J&J vaccine prevents significantly more deaths (e.g., ~2,000 deaths prevented per million doses vs. 1 clotting event), making the benefit-to-risk ratio highly favorable.
8. Understand Societal Vaccination Responsibility
Recognize that choosing not to get vaccinated for a contagious disease like COVID-19 potentially affects others by increasing transmission risk, which may justify societal decisions regarding privileges like travel or employment in vulnerable settings.
9. Vaccinate Children to Prevent MIS-C
Consider vaccinating children not only to reduce their role as vectors but also to protect them from severe outcomes like Multi-system Inflammatory Syndrome in Children (MIS-C), which can cause long-term organ damage.
10. Set Realistic Herd Immunity Expectations
Understand that for mucosal viruses like SARS-CoV-2, the goal is to significantly slow its spread, not eliminate it, likely requiring at least 80% population immunity from natural infection or vaccination.
11. Monitor Herd Immunity by Next Winter
Assess the success of herd immunity efforts by observing the severity of the next winter’s COVID-19 season; a significant surge would indicate insufficient population immunity.
12. Prepare for Lifelong COVID-19 Vaccination
Expect that ongoing vaccination efforts against SARS-CoV-2 will be necessary for years, potentially for a lifetime, to maintain population immunity as the virus is unlikely to disappear.
13. Understand Long-Term Vaccine Booster Needs
Anticipate that the frequency of COVID-19 vaccine boosters will become clearer in about two years, with current optimism suggesting protection for a few years rather than decades.
14. Address Vaccine Hesitancy Differently
Distinguish between vaccine skeptics, who can be convinced with data and logic, and vaccine cynics, who distrust institutions and may not be swayed by reason, requiring different communication approaches.
15. Improve Pandemic Testing Infrastructure
For future pandemics, ensure rapid deployment of diverse, quality-controlled testing by involving multiple groups beyond a single federal agency, learning from past failures in test availability and distribution.
16. Understand SARS-CoV-2 Incubation & Immunity
Recognize that SARS-CoV-2’s intermediate six-day incubation period means immunity aims to modify disease rather than achieve sterilizing immunity, making immunization or natural infection the primary choices for protection.
17. Appreciate Cellular Immune Memory
Understand that long-term protection against SARS-CoV-2 relies on immunological memory (memory B cells, T helper cells, cytotoxic T cells) which, when reactivated, can produce antibodies and kill infected cells, even as antibody titers fade.
18. Recognize mRNA Vaccine Potency Signs
Be aware that common lymph node enlargement (ipsilateral lymphadenopathy) after mRNA vaccination is a sign of a powerful immune response, similar to other potent immunogens like the smallpox vaccine.
Keep updated on how well current immunity (from natural infection or vaccination) protects against new SARS-CoV-2 variants, noting that while some variants like B117 are well-covered, others like South African and Brazilian strains require close monitoring for severe disease escape.