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Health Matters - The Aspen Medical Podcast: So why do we need booster shots?

on 27 October 2021, we spoke to Aspen Medical's Group Medical Director, Dr Andrew Jeremijenko, about his research in Qatar into the waning efficacy of COVID-19 vaccines and why boosters are important. 

Transcript 

Eamonn Quinn 

Welcome to Health Matters, the Aspen Medical podcast. I'm your host, my name is Eamonn Quinn and I work in the Aspen medical Marketing and Communications Department. I'm joined by my colleague, the Group Medical Director of Aspen Medical, Dr Andrew Jeremijenko. Andrew, good afternoon.

Dr Andrew Jeremijenko

Good afternoon.

Eamonn Quinn 

Let's hope people are listening to this podcast in the afternoon because it will sound a little bit silly if they're listening to it on the way home at eight o'clock in the evening. Anyway, Dr Jeremijenko, I first met him a couple of weeks ago when he joined Aspen Medical and I was deeply impressed by the fact that he's the only person I've ever known who has had something published. It happens to be a rather important piece of work; it was about the waning efficacy of a particular vaccine in fighting COVID-19. We're talking about a particular mRNA vaccine and if Andrew wants to mention it, that's fine but we will get to that. The important thing is, it was about booster shots. It was about the fact that if we didn't do something, then quite simply, there would be more trouble ahead for Australia and the globe. Andrew's work appeared in the New England Journal of Medicine along with several co-authors and is based on his time in Qatar before joining Aspen Medical. So that's the context. Andrew, I'm just going to hand this over here because it is very, very topical. Today is the 27th of October and the TGA has approved booster shots for Pfizer in Australia. Andrew, what is the waning efficacy all about and tell us why we need those booster shots.

Dr Andrew Jeremijenko 

Okay, you're right and thank you. We were studying this in Qatar and we have a great database over there; millions of people were vaccinated. We were able to see that over six months, the vaccine efficacy, so how many infections were stopped by the vaccine, really started to fall off, particularly at seven months. Now, the good news is that you don't get severe disease when you're vaccinated, but you could get milder symptoms, particularly around about six months and you could spread it as well. So, we saw in other countries like Israel, when they opened up a big wave, even though they'd had 80% of the people vaccinated by Pfizer or mRNA vaccines and that was because of that waning immunity. So with Australia already planning to open up, we really want to make sure our immunity is good. So, we stopped that surge that we saw in England after Freedom Day and in Israel when they opened. It's about trying to control this virus and stop it from getting to those sick people who will actually die from it.

Eamonn Quinn 

It's interesting because I do recall that a lot of the poster people for vaccines were from Israel. We always go back and think this is years old. This was only months ago, right? So, Israel got well ahead of the game, so to speak, and they vaccinated so many of their people. Though it wasn't that long ago that, as you rightly point out, we began to see on the news or whatever that another wave was beginning. People went, 'oh no, this will never end' because the Israelis have got so many people vaccinated, this thing doesn't seem to ever want to stop but that was the reason, right? It was just that waning efficacy that was happening in the background. This might sound obvious but to the layperson like me, this has only been going on for 18 months. However, this virus has actually been around millions of years and we've only seen it for 18 months. So, we're really flying this plane as we're going along. Right? We're making the plane as we're flying it too, to an extent.

Dr Andrew Jeremijenko 

It is true. I think what we saw in Israel, even though they had that second wave, and there were lots of reports about it, they didn't actually have many deaths. It was a lot lower because Pfizer was still protecting you from severe disease. It actually did cause quite a significant number of cases and when they vaccinated again, they stopped it. So vaccines really do work and that's the great news. Probably we don't need another booster shot after the six months shot. That's probably going to last us for years. You might have to get an in the flu vaccines. You have to change the vaccine a little bit every year to match the flu seasons. Now potentially with COVID-19, we think with two shots, say the Pfizer vaccine that's two shots three weeks apart, and then one shot six months. Then you're going to be good against the virus.

When I was studying in Qatar, there were people who lived eight to a room, and they were coughed on and everything like that and we vaccinate a lot of those people. They still got coughed on, they still basically were getting exposed COVID-19 but they didn't get sick. It just boosted their immunity. I mean, basically coughing on a person who's vaccinated, you get a mild illness but actually boost your immunity. It's almost like a booster shot but it's much better to get a booster shot and not spread it to your mom or your grandmother, who potentially might die from this disease.

Eamonn Quinn 

Qatar is where the next World Cup is going to take place. There are a huge amount of people working on building stadiums and so on. So, they had a vested interest in trying to get vaccinated as soon as possible. They've just to give it some context. Your research is based on one of the world's most vaccinated countries, we're not talking about 50%. Here, we're talking about...

Andrew Jeremijenko 

Well over 80%. The interesting thing about Qatar and why it didn't get the surge that Israel got, is basically because many of those poorer, the workers, they got infected in the first wave. In the second wave, there were a lot of people in the city that got infected. So, they probably had about 70% of their population infected through the first and second wave. Then when the vaccines came, we protected all the elderly and health workers, and so we had a really low death rate. The normal death rate in the world is about 2% and our death rate in Qatar was 0.2%. That’s a 10th of the normal death rate. Australia's also got a very low death rate of population, compared to the rest of the world. The US has about 100 times more death per capita than Australia does. I think amongst all the bad news and arguments about vaccinations and quarantine, that sometimes people don't understand how well Australia has done. Australia and Qatar both did amazing jobs.

Now back to the Qatar Story. Sorry, I diverged. Qatar had 70% of people that are infected and then they had 80% of people vaccinated, and more than 80% now. They've got really strong immunity. We haven't seen a third wave come back because they've got both natural immunity and the vaccination immunity. Now they've also given booster shots as well. I think that Qatar is safe for the World Cup, they've done a great job in making their country as safe as possible for it. Australia's doing the same thing. If Australia can get vaccinated and open up and use these boosters, we will have one of the lowest death rates in the world. We will be one of the most successful countries in the world when it comes to controlling COVID-19. You really have to give it out to the public health physicians. They deserve medals, they've really helped control it. I know it was a pain with all those lockdowns but to have such a low death rate, 100 times less than the US and 90 times less than the UK, that's an amazing achievement. Then for everybody to roll up their sleeves and go and get vaccinated is even better. Now all we're doing is just saying, let's be double sure, get a booster and we'll be right. We will be having the Australian Open and the Grand Prix and all our great sporting events and concerts and everything again because we will have immunity, herd immunity.

Eamonn Quinn 

That is exciting. I clearly wasn't born and bred in Melbourne or anywhere like that, I'm Irish, and I've a very personal relationship with COVID. I often would say to colleagues and people in the media that you have got to give Australia and Australians and our system, the kudos it deserves. There are very few Australians who'd know somebody who's either had COVID or certainly who's passed away from COVID. I would always open up with that kind of stipend to people. Then they say “no, I don't”, and I said “well you do now” because my mother passed away in Ireland of COVID related complications. She was 90 and she had a list of comorbidities that looked like a shopping list for Coles it was that long. It was COVID that eventually got her and that's in a modern European capital city, where she had been double vaxed. Still, the virus got into the major public hospital and unfortunately took her away, along with many, many, many others. The lesson there isn't about me, it's about what we've done in Australia because we still, despite the loss of life which is dreadful, we've got to give ourselves a clap on the back for what we've done and as you rightly pointed out, the boosters, that's the finishing line really. Is that how public physicians are seeing it? Andrew, are Boosters the cherry on the top of the cake, are they the finishing line?

Dr Andrew Jeremijenko 

If we hit 89% I always thought. Now there are problems. Obviously, Papua New Guinea has a wave at the moment and many poorer places in the world haven't been vaccinated. That's where the mutations can occur and that's when we might need another vaccine if something mutates to a great enough extent. I'm hoping that it's over, I told Qatar it was over once they hit that high vaccination rate because I knew they had that high natural infection rate and the high vaccination rate. They were good. I came home to Australia and I said, you're good now but you're right, Eamonn. The places like Ireland, England and Italy, we saw doctors dying and nurses dying. Australia has not had that issue. I think now immunosuppressed people, they're already approved for booster shots. I think we're going to have everybody over 18 approved for booster shots and health care workers really need to get in there and get their booster shots.

I don't know why but I was talking to someone recently about the resource industry in central Queensland. There's a lot of guys out there who may have had some misinformation and they've got low vaccination rates. The resource industry, say the coal mines in central Queensland, I just want to say this virus is really infectious. In Qatar, you had two choices, you either got vaccinated, or you got the Delta virus because that's just the way it was. We've seen lots of young people die from this disease. It unfortunately does get the young people as well as the old. Higher rates in the elderly but young people can still die, it just seems like some people are susceptible. The guys that we've seen on TV have been quite fit, go to the gym, all that sort of stuff and they would die just because they didn't get vaccinated. The other thing, some of those shock jocks are anti-vaxxers and there's actually a site now that has recorded how many of those people have actually died. They've been giving this message to not get vaccinated, and they've actually got COVID themselves and died. I read that it was at least six of those people have died. It's a dangerous sort of philosophy to be spreading and to believe in yourself. Guys, it does actually kill people.

Eamonn Quinn

Just doing the math on the back of an envelope, so to speak, if there are 20 million Australians over 18. If we vaccinate 90% of those, correct me if I'm wrong but that leaves roughly 2 million people who will be unvaccinated for whatever reason. Maybe they can't get vaccinated because we know there are people in that group as well. Are we saying potentially that once we open up, there is potential for this virus or variants to just rip through the entire unvaccinated population? That's a lot of people. That's 2 million people at risk.

Dr Andrew Jeremijenko

That's right and my personal belief is delta virus will find them. If you're unvaccinated, Delta virus is going to find you. The two million people and about 1% of those people will die. So, divide by 100, there's 20,000 people.

Eamonn Quinn

That's, that's absolutely right. Unfortunately, you're absolutely right.

Dr Andrew Jeremijenko 

That's a lot of deaths and a lot of preventable deaths. So, to me, it doesn't make sense that people don't get vaccinated. The statistics are so clear. I used to work in Qatar and some of the nurses didn't want to get vaccinated because of fertility issues. They said they want to have a baby and it doesn't affect it. You know, all those nurses came back with COVID-19. So it was a real shame. I tried to convince them to get vaccinate, and they said 'no, I want to fall pregnant', and they didn't fall pregnant, but they got COVID.

Eamonn Quinn 

So, there we have it. Andrew you've worked in one of the world's most vaccinated countries, you've been at the epicentre of this pandemic, you have seen how it works, you've seen this virus close up, you've seen it firsthand, you've seen how the vaccines work. It really is a simple message to people, it's know the facts, get the vax, that's what's going to save lives going forward after we open up.  I think some people are commentators but you're genuinely someone who has worked right in the epicentre of this. When you say it, people should really take notice of it, get your shots, get your shots and get your booster. That's that simple.

Dr Andrew Jeremijenko

One of the things I'm going to take away from Qatar is going the morgue and seeing all these young people because it was mainly young workers, dead and alone in the morgue. No family, just lying there. You know, it was a tragedy. It's a real tragedy. So, I want to prevent that. All you’ve got to do is get vaccinated. It really does work. Now you can get the booster too, be double sure.

Eamonn Quinn 

Doctor Andrew Jeremijenko, again, thank you so much for your time and sharing your stories, your insights and your expertise with us here on Aspen Medical's Health Matters. Thanks so much.