Public health expert answers questions about COVID variants, boosters, back-to-school

DEARBORN - The federal government is preparing to deliver "booster" shots of COVID-19 vaccines to Americans by mid-September, recommending that immunocompromised people take a booster even sooner.

Health officials have acknowledged that protection from vaccines wane, or diminish over time, though they still remain highly effective at preventing serious illness, hospitalization and death from the novel coronavirus.

The need for boosters has become a relevant topic in the public health conversation, with the reality of highly contagious variants of the coronavirus producing surges across the country and causing "breakthrough cases" among those already vaccinated.

In Michigan, like in many other states, the Delta variant continues to surge through unvaccinated populations. This week, the state's health department revealed that 99 percent of the COVID-19 test samples available for sequencing are the Delta variant. Vaccine hesitancy continues to be a concern.

Adding to the fear and uncertainty is a looming return to school, with vaccines still not approved for the very young, while districts are left on their own to make decisions on mask mandates.

The Arab American News reached out to a public health expert, and Dearborn native, to get more insight into these developments. Ali Abazeed is a public health advisor with the U.S. Department of Health and Human Services, based in Washington D.C. A three-time graduate of the University of Michigan, he holds bachelor's of science, master's of public health and master's of public policy degrees.

- There has been some confusion regarding the COVID-19 vaccines and continued infections among the vaccinated. For those still on the fence, why is a vaccine still our best weapon against this pandemic, even with "breakthrough infections" among vaccinated folks appearing daily?

The vaccines work. Endless news cycles and reports of "breakthrough infections" often leave the mistaken impression that the vaccines are not working. This is not correct and the vaccines remain powerfully protective against severe illness, hospitalization and death, which is what they were designed to do.

A "breakthrough infection" simply means that a vaccinated person has tested positive for the virus, not that they will necessarily become ill or transmit the infection to someone else.

Breakthroughs were always expected and since the vaccines remain remarkably effective at the crucial task of protecting vaccinated people from severe illness and death, they remain our best weapon against the virus. Despite the endless coverage of breakthrough cases, unvaccinated people still make up most cases, hospitalizations and deaths.

Q- Tell us a bit more about the waning of vaccine effectiveness and the need for booster shots

There has been talk recently about waning vaccine effectiveness and the need for boosters. Here is what we know so far: A growing number of studies suggest that though the vaccines remain highly protective against severe illness, hospitalization and death, the Pfizer-BioNTech and Moderna vaccines' ability to prevent mild or moderate illness is less robust today than the original research showed last winter when the original strain of the virus was circulating. This is likely due to a combination of waning vaccine immunity, reduced use of protective measures such as mask-wearing and the rise of the highly contagious Delta variant.

The concern here is that that this pattern of decline will continue in the months ahead and could lead to reduced protection against severe disease, hospitalization and death, which is a trajectory not without debate among immunology experts who believe that protection against serious disease might last a few years. Nonetheless, this concern is why we are seeing this week the recommendation to boost Americans' immunity by administering a third dose of the vaccine known as a "booster", a move that was both predicted and predictable based on results in other countries.

So, even though we are protected now, rather than wait until we potentially see an increase in disease and hospi- talizations, this is an effort to get ahead of the curve and get boosters to people as a preventative measure, which is sound public health policy in my view. Public health is about anticipating the worst possible outcomes and it is my view that we should be skating to where the puck is going regarding waning vaccine effectiveness.

At this time, the most important thing we can do is get unvaccinated people vaccinated as quickly as we can. It is not too late. Please get vaccinated.

Q- There has been chatter in social media about vaccine safety. Specifically, some are worried that an emergency authorization does not offer the same guarantee of safety as a full FDA authorization. Some are choosing to wait till vaccines get full approval to get a shot. Could you tell us your thoughts on this idea?

The three vaccines currently approved for use in the U.S. are operating on an emergency use authorization (EUA). Applying for a full approval takes much longer. While an EUA gets vaccines out to the public more quickly, it does not skip any steps that full approval requires. This is because full approval typically requires the FDA to review hundreds of thousands of pages of documents - roughly 10 times the data required to authorize a vaccine on an emergency basis.

To put it simply, full approval looks at more data from a longer period than the EUA does. Instead of two months of follow-up data from trials, full FDA approval looks at a minimum of six months of data. However, full approval has the same safety and effectiveness standards. The process of the EUA did not and does not compromise at all safety considerations, nor did it compromise any scientific integrity. When a product is fully approved by the FDA, those patients who have been on the fence can be assured that its recommendation is grounded in even larger amounts of scientific data.

My hope is that this final approval could help mute misinformation about the safety of vaccines and clarify any legal issues about mandates.

Q- Finally, what should the community know about staying safe and protecting vulnerable populations, like children ineligible for a shot as they soon begin a new school year?

We can define the stage of the pandemic we are now in largely by its impact on two groups of people: The vaccinated and the unvaccinated. Children under 12 fall into the latter category as they are not yet eligible for a COVID-19 vaccine.

With the caveat that the pace of information is changing rapidly, the fear of COVID-19 in kids is getting a bit ahead of the data. A recent report by the American Academy of Pediatrics shows that 0.9 percent of COVID-19 cases in children have resulted in hospitalization and 0.01 percent have resulted in death. To put that data into perspective, more than 350 children (out of 74 million) across the U.S. have died from COVID-19 since the beginning of the pandemic.

Pediatric hospitalizations are rising in regions of the country where vaccine uptake is low. There is risk everywhere and it is often context specific. The fact remains that most infected children will experience mild symptoms, but there are ways to mitigate even that small risk:

* Since many of our children cannot get the vaccine, the best and most effective way to protect them is by vaccinating everyone around them above the age of 12;

* Outdoors is always better than indoors when spending time around the unvaccinated;

* Mask indoors when around the unvaccinated.

Remember that risk is cumulative, and some risks are more worthwhile. In-person schooling is a worthwhile risk because of the immense psychological, educational and developmental benefits afforded to children. An indoor birthday party for children is probably not a worthwhile risk. We will likely have a vaccine for children under 12 sometime this winter, but until then adults need to step up and continue to protect the most vulnerable among us by getting vaccinated and masking up indoors.