Should we or should we not have a COVID-19 booster? That's the dilemma. Public health experts have divided opinions on who should get it. Currently, only those who opted for the Pfizer vaccine are eligible for the third dose. 

To know the opinions of two great health professionals, Ethnic Media Services organized a session with the media to know the different points of view, and also the coincidences where better information can be provided to the public.. 

For Dr. Ben Neuman, virologist and head of the University of Texas Global Health Research Complex, humanity must focus on exterminating the SARS-CoV-2 virus, which causes COVID-19.

This, he said, because this disease, "will probably always kill a percentage of the people who are infected," because, looking at the figures worldwide, the case fatality rate, which is the number of people who die versus the number of confirmed infected people, always seems to settle at about 2.2 percent, with differences by age, "but one in 50 people who are infected with covid-19 are more likely to die. 

He added that, currently, there is no data to suggest that the virus will change to suit humanity, because "a percentage of people who are vaccinated and get COVID will also be hospitalized or die from COVID. And this will continue indefinitely.

The expert said that based on data from the Sept. 17 FDA meeting, it suggests that the term "fully vaccinated" is being used incorrectly. 

"No one is fully vaccinated. And, in fact, at this stage we don't really know what it would be like to be fully vaccinated. What we have is evidence of their waning immunity - from vaccines - and their varying degrees - of protection." 

In that regard, he noted that as time passes after vaccination, the amount of protection decreases to about 50 percent after five months, but the amount of protection against death remains constant at about 90 percent. 

"This is the dichotomy that is trapping people. The coronavirus is fundamentally a moving target, it's evolving, and it's changing. And if you look at the trajectory of change, the virus has gotten faster and better at reproducing very consistently throughout the outbreak, and based on the available data we don't have any evidence that this will be otherwise in the future," he said. 

And, he said, of all the variants of the disease that exist, 99 percent of infections in people are currently due to the Delta variant, which has more than 40 subtypes that are being monitored. 

"Delta is essentially synonymous with COVID-19 in the real world." However, the efficacy of Delta vaccines is about the same as with any other variant.

Neuman explained that while there is a relatively small difference between the elderly and those under 65 in terms of vaccine effectiveness, the benefit of a booster has also been found to be very large.

"Regardless of age group, with a booster, people end up with 5 to 10 times more antibodies than they had at the peak after the second vaccination, and they end up with up to 55 times more antibodies than they had just before the booster," he said.

"So the benefits seem to be universal. The consequences seem to be relatively similar across all age groups. And on that basis, it's hard for me, as a virologist, to understand the FDA's decision to recommend boosters only for a certain age group and not for everyone." 

"If vaccination is universal, universal boosters are going to be beneficial."

And is that, he recalled that vaccines such as hepatitis A or MMR are needed three or more doses to move towards a lasting immunity, while polio is virtually eradicated and smallpox completely eliminated due to widespread vaccination.

"So with additional doses of vaccine, we're essentially trying to move from what is considered reasonable protection to a position of certainty... And I think the benefit there is very, very great psychologically. And not just in terms of hope, but in the possibility of a better life, without COVID-19," he stressed.

The expert pointed out that the booster dose is exactly the same as those administered in the first and second shots.

However, in order for COVID-19 to be eradicated, it must not only be possible to vaccinate in the country, but globally, otherwise we will not be able to move towards the right path.

"You have to fight this like you attack fire: put it out completely in one place and then extend the ring of protection until it covers everyone... If we don't stop this everywhere, it will eventually come back in some form." 

For her part, Dr. Monica Gandhi, a professor at the UC San Francisco School of Medicine, explained that unlike other viruses that have been eradicated in the world, COVID-19 or measles are infections that have animal hosts, and you can even catch them before you are sick. "So it doesn't have a short period of infection and we don't know if it's immune for life.

In that sense and unlike Dr. Neuman, Gandhi stressed that, unlike smallpox, "what will probably happen with COVID is that it will go the way of measles, so it will always be with us".

Thus, he said, this type of virus will become endemic, meaning it is a disease that always occurs in one population within one geographic area.

He recalled that in the United States alone there are three vaccines that help prevent deaths from the disease, and there are others around the world that can help mitigate the pandemic, which help produce T cells (antibodies).

What are T cells?

"T cells are really there to protect you from serious diseases." These are a kind of immune cell, whose main purpose is to identify and kill invading pathogens or infected cells. They do this by using proteins on their surface, which in turn can attach to proteins on the surface of these imposters.

Each T cell is highly specific. There are billions of possible variations of these surface proteins, and each one can recognize a different target and fight the virus like SARS-CoV-2 in a lasting way.

"It's pretty amazing what a two-dose vaccine does in terms of memory B and T cell storage."

"There is evidence from the SARS pandemic of 2000 to 2003 that people who survived still have very strong T-cell immunity, just as with measles vaccines. And vaccines also generate B cells that together with T cells create important antibodies," he added.

He explained that unvaccinated people are 20 times more likely to be hospitalized for the Delta variant than those who are vaccinated. So those who require a booster of the COVID-19 vaccine are those patients with compromised immune systems. "They always need three or more vaccines than a typical three-dose vaccination in a row."

Also, those over the age of 65 and those who are frequently exposed to the disease, such as health care workers.

For the pandemic to be contained, he said, all countries, especially low-income countries, must have access to vaccines safely and effectively, because so far only rich countries have the majority of the vaccine supply.

"The only way to prevent people from being exposed to the virus is to reduce transmission everywhere and keep everyone safe," because if that's not done, even Americans can't be safe as long as other people around the world are not vaccinated, agreed virologist Neuman.

You may be interested in: Merck Announces Oral Medication that Halves Hospitalization or Death from COVID-19

As of September 21, there were approximately 45,000 people eligible for vaccination who remained unvaccinated against the COVID-19 virus, which is 29,000 fewer than the 71,000 reported in August.

According to San Mateo County Supervisor Warren Slocum, although 93.6 percent of eligible people age 12 and older in the county have been vaccinated, both East Palo Alto and North Fair Oaks are slightly behind, at about 82 percent.

He said California has the lowest coronavirus transmission rate of any state, following a sharp decline in cases and hospitalizations over the summer, while in San Mateo County, hospitalizations and daily cases have begun to decline. 

"But this is still a pandemic of unvaccinated. My point is that those hospitalized in San Mateo County with COVID-19 are almost all unvaccinated. Our message remains simple: get vaccinated to protect yourself, your loved ones and the people you come in contact with in the community." 

On the other hand, she commented that as far as the latest information on the booster shots, the county is preparing for their implementation, however, the information has been confusing. 

The Federal Drug Administration (FDA) approved Pfizer's booster vaccine for older adults and adults at high risk of serious illness from the disease, but also recommended against using a booster for everyone over 16 years old. 

As such, the Centers for Disease Control and Prevention (CDC) will soon recommend exactly how the additional doses or booster should be used, and that decision will inform how vaccination will move forward in the state and in San Mateo. 

In the meantime, health care providers and local pharmacies are already providing the third dose of Pfizer's COVID-19 vaccine to residents who are considered immunosuppressed.

You may be interested in: Merck Announces Oral Medication that Halves Hospitalization or Death from COVID-19

Merck Pharmaceuticals and Ridgeback Biotherapeutics announced Friday that their investigational oral drug, Molanupiravir, reduced the risk of hospitalization or death in at-risk adult patients with mild to moderate COVID-19 by 50 percent. 

In response, Merck said it plans to apply to the Food and Drug Administration (FDA) for emergency use authorization "as soon as possible" to become the first oral antiviral for COVID-19.

In a comunicadoIn the interim analysis, only 7.3 percent of patients who received the antiviral were hospitalized or died, compared with 14.1 percent of those treated with placebo, the companies said.

They added that as of day 29, no deaths had been reported in patients who received molnupiravir, compared with eight who received placebo. 

Thus, on the recommendation of an independent Data Monitoring Committee and in consultation with the FDA, recruitment for the study was stopped early due to these positive results. Merck plans to submit an Emergency Use Authorization (EUA) application to the U.S. FDA.

"More tools and treatments are urgently needed to combat the COVID-19 pandemic, which has become a leading cause of death and continues to profoundly affect patients, families and societies, and strain health care systems around the world," said Robert M. Davis, chief executive officer and president of Merck.

With these compelling results, we are optimistic that Molnupiravir can become an important drug as part of the global effort to combat the pandemic," he added.

For her part, Ridgeback Biotherapeutics CEO Wendy Holman said, "Because the virus continues to circulate widely and because currently available therapeutic options are injections and/or require access to a healthcare facility, antiviral treatments that can be taken at home to keep people with COVID-19 out of the hospital are sorely needed.

Results of the planned interim analysis of the drug for COVID-19

The planned interim analysis evaluated data from 775 patients who were initially enrolled in the phase trial on or before August 5, 2021. At the time of the decision to halt enrollment based on the compelling interim efficacy results, the trial was approaching full enrollment of the Phase 3 sample size of 1,550 patients, with more than 90 percent of the planned sample size already enrolled.

Eligibility criteria required all patients to have mild to moderate laboratory-confirmed COVID-19 with symptom onset within 5 days of study randomization. 

In addition, Merck said, all patients were required to have at least one risk factor associated with a poor disease outcome at study entry. 

Thus, Molnupiravir reduced the risk of hospitalization and/or death in all key subgroups; efficacy was not affected by timing of symptom onset or underlying risk factor. 

In addition, according to participants with available viral sequencing data - approximately 40 percent of participants - Molnupiravir demonstrated consistent efficacy in the Gamma, Delta and Mu viral variants.

In anticipation of possible FDA acceptance of emergency use, and in anticipation of the results, Merck is already producing Molnupiravir. 

In that regard, Merck plans to produce 10 million treatments by the end of 2021, with more doses expected to be produced in 2022.

It has also committed to providing timely access to Molnupiravir globally, if licensed or approved, and plans to implement a tiered pricing approach based on World Bank country income criteria to reflect the relative capacity of countries to finance their health response to the pandemic.

The drugmaker also announced that it has entered into voluntary non-exclusive licensing agreements for Molnupiravir with established generic manufacturers with the intention of accelerating the availability of the antiviral in more than 100 low- and middle-income countries.

You may be interested in: San Mateo marks milestone: 93% of residents with at least one dose of COVID-19 vaccine