Dr ulster holmes, served earlier as president on president bidens covet task force. So dr ostrom, thank you for being back with us. Uh were taking a lot of talk about boosters right now to try to combat this delta variant uh. Will they be helpful and should they be given to more than just the people whose immune systems are severely compromised? Well, i think first of all, we want to uh basically understand what were talking about with this new group of individuals that are being addressed. These are people, as you pointed out, are immune, compromised or have immune suppression from either a previous illness or taking certain drugs. Many of us would not call these booster shots. These would be more the continuation of the primary series, meaning, if you think about children, there are some vaccines, which we give three or four different doses before we consider them fully vaccinated. These are people that never fully achieved protection to begin with and thats what were seeing here. So these really this third dose is not a booster, in a sense, its more of just continuing the primary series to get these people to some level of protection. Booster, shots as such are when people are fully vaccinated, they have a good response, but then over time that wanes meaning that the antibody or the immune protection. We have drops and thats going to be a big challenge that one were looking at carefully because that really starts to set in potentially six to eight months after youve completed your series and theres some initial data coming out.

Now that says that at least for some of the vaccines, it may be necessary to maintain your protection to actually have a booster shot, but thats something were still working on and trying to understand. Well, doctor im so glad you took us there, because one of the questions i want to ask was about the fading of the effectiveness of these vaccines, because i saw a report just today coming out of your neck of the woods up in mayo clinic that perhaps Were losing something like six percent of the effectiveness of the pfizer or maybe the modern vaccine every two months now, as i understand thats, not been peer reviewed, but but does it look like thats where were headed well, let me just set the context for this is Because i think its really an important point that the discussions were having right now is what i call corrected science, its a situation where were learning more about how the vaccines work over time, as we have had more time now, since we first were vaccinated, we want To be really clear to the public, these are not questions about safety, and so therefore, nothing were talking about right now should deter anyone from getting a vaccine its not about safety. Its about. Are we going to need additional doses of the vaccine and again this is the number one two three and four thing you can do to protect yourself, so it is possible that what were seeing right now is with some of the vaccines and the data still are A bit unclear are all vaccines, acting the same or performing the same and expect just expect that over the course of the next two to three months were going to get more information.

That means were going to go back and reconsider the best way to deliver these vaccines. You know we could have easily done these kinds of studies over the course of a year or two and not have licensed the product or make it available, but how absolutely uh terrible that would have been in terms of the lives saved by having these vaccines out. Here so we expect to see in a sense mid course, corrections you might say, and how we deliver the vaccine in terms of the amount when its delivered, but these should be expected and not seen as any reason why not to get the vaccine now. Doctor also help me, as a public health, real expert. How do we balance, on the one hand, giving booster shots – and i take your point about the about the clarification that the people who are immunocompromised thats not for them, but for the rest of us whove been fully vaccinated to get a booster shot. On the one hand, and getting the vaccine to people who have never been vaccinated, not just the united states but around the world, because, as i understand it, this this virus will keep going and keep morphing until we really get it under control. And it can be a danger to us back here in the united states right and thank you. That is really an important point and, as you know, uh last week the who actually issued a statement urging countries to call a moratorium on booster shots until at least september 10th, with the hope that we could accelerate getting vaccine to low and middle income countries.

You know we are basically experiencing the riches of vaccine in high income countries, while if you look at the 6.4 million or 6.4 billion people in low and middle income countries, less than two percent of the population has had any access to vaccine now. Why is that important? Well, surely, from a humanitarian standpoint, its obvious, but even more specifically, if you look at the strategic protection of our vaccines, you know we hear us all talking about the concern about variant development here in the united states when people get infected from not being vaccinated. But when you want to ask yourself, where is the real risk of these new variants that could potentially get around the protection of our current vaccines, its the low and middle income countries? We have got to stop transmission there among the 6.4 billion people who have no protection. So you raise a very, very important point, and this is an ethical issue and its also, frankly, a strategic planning issue, so weve we, i think, need to balance. Do we want to keep giving booster doses to people in terms of protection in high income countries at the risk of seeing these people in low income countries getting infected and more variants coming at us? In the end? That may be the biggest challenge we have to keeping the vaccines working uh coming back coming back to the united states. If we could dr ulsterholm uh, you said theres nothing thats developed here that should discourage anyone from getting vaccinated.

At the same time, weve got a rather stubborn part of the population. If i can put it that way, that seems to be resisting that. What can we do to improve that situation? I understand, for example, hhs maybe has just announced you got to be vaccinated. Should we have employers, including government, across the board, just requiring vaccinations? Well, i strongly support vaccine mandates and that because not because i want to basically impose my will on your body, but this is about protecting the community. You know we dont, let you drive drunk just because you want to and its your choice uh. We do that because we dont want you to hit someone else and kill them, and so i think that this theres some similarities here in that were asking to protect the community. The more people vaccinated theyll grow much much less chance that anyone else will get infected out there, and so this is an important consideration. I think also when we look at these vaccines and this concern about people wanting to get vaccinated or not get vaccinated. They have to understand theyre going to know a covert related outcome. Eventually, you cant run the game clock out here. This virus is cell infection. Itll ultimately find you so, even though you havent been infected in the first 18 months of the pandemic, its going to happen and how many times in just the last couple of weeks have we had camera shots of people in intensive care units on ventilators.

You know that basically didnt want to get the vaccine and now their family regrets that they didnt or people who are even not on ventilators, who can talk and say please get vaccinated. I i wouldnt and now i know what im going through. So i think we just have to keep hitting home that message. You cant run out the clock its going to find you do you want to do it in a hospital bed where you may die, or do you want to get the vaccine where your chances of dying are dramatically dramatically lower than not being vaccinated? And finally doctor i mean i hear you loud and clear: the answer is vaccination get vaccinated but theres also the mask mandate question particularly to protect some of those who cannot be vaccinated, for example, children or even to protect some who havent been vaccinated. Give us the science on the masks. I know you think we should be wearing n95s, but what about fabric masks? Do they give you some protection yeah? Well, you know i very much support masking as part of the way that we in a sense protect ourselves beyond vaccination, but again you have to have an effective mask and thats. What has been missed in a lot of the discussion is the fact that, if you basically put whatever youre going to use to protect yourself on and youre in a room with somebody smoking a cigarette, if you can smell that, then which smoke from a cigarette is An aerosol the way we know that the viruses are now transmitted, then you know that that is not protecting you adequately to keep you from getting infected and research shows that if you wear a face cloth covering, you may get an additional five to ten minutes protection In a room where someone is there than if you had nothing on at all, if you wear a surgical mask, you may get 10 15 minutes of protection.

If you wear an n95 mask and you fit tight to your face, you get in some cases up to 25 hours of protection, and so i think that the challenge we have is is is dealing with this mask or non mask issue, which is terribly unfortunate. Its about mask yes, but use the best protection you can and for kids thats a challenge because we dont have routinely available n95s available for kids. However, we do have a similar type of product largely made in china called a kn95 which does have fit locations and for kids to be in fact protected. So i just urge people to use that. Well, that is terribly helpful and very specific.

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