Welcome to Pandemic Problems, an advice column from The Chronicle’s engagement reporters that aims to help Bay Area residents solve their pandemic-related conundrums — personal, practical or professional. Send your questions and issues to pandemicproblems@sfchronicle.com.
Today’s question is fielded by The Chronicle’s Kellie Hwang.
Dear Advice Team: I was disappointed to learn that the Moderna vaccine is only 85% effective in adults over 65 based on clinical trials. I am 72 with no comorbidities and had a definite response of typical short-term side effects after the second dose of Moderna. This gave me confidence that the shot was working.
But since most of my older friends and relatives were injected with the Pfizer vaccine, I am wondering whether I can switch to Pfizer for any subsequent booster shots a year from now, as has been predicted? I really want the maximum protection out there because I live alone and do not want to even be a carrier of COVID as nobody really is clear about the long-term effects of the disease for those who are asymptomatic or have mild symptoms.
Thank you for your attention to this question.
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Dear Reader: These are some interesting questions and concerns that you raise. Let’s break it down.
First, you mention that the Moderna vaccine was found to be less effective in individuals over 65 during the clinical trials, which is true. In an analysis from the New England Journal of Medicine, patients 18 to 65 showed an efficacy of 95.6%, while the rate was 86.4% for those older than 65. Pfizer, on the other hand, reported that efficacy was over 94% in individuals over 65 years.
However, experts say the effectiveness of the Moderna vaccine for your age group in the real world likely is even higher than in the trials.
I talked to Monica Gandhi, an infectious disease expert at UCSF, and she said that in the clinical trial for the Moderna vaccine, only four symptomatic COVID-19 infections occurred in people over 65 of about 3,580 in the trial.
“With a limited number of events in a subgroup, the percent efficacy in a trial can appear lower than in the entire population tested,” she said. “However, the real-world effectiveness of the vaccines, even among those who are older, is much higher than that percent.”
She said based on the CDC’s real-world tracking of “breakthrough” infections, or people who are fully vaccinated and still get sick from COVID-19, the percentage of those who become sick is very small: As of April 26, 95 million Americans have been fully vaccinated and just 9,245 of them contracted COVID-19. Gandhi said this shows the “high effectiveness of both mRNA vaccines.” (Both Pfizer and Moderna are mRNA vaccines, which use messenger RNA to teach our cells how to mount an immune response to the coronavirus.)
Robert Siegel, professor of virology and immunology at Stanford University, said the real-world data so far “indicates that these vaccines perform at least as well as in clinical trials in prevention of both infection and severe disease.”
So the bottom line is, people in your age group are very well protected from the coronavirus whether they received the Moderna or Pfizer vaccine.
Next, there is the question of how long vaccine protection lasts and if boosters will be needed down the line. Experts still don’t know the answer to this because the vaccine trials are ongoing and they are collecting data in real time. Based on studies of natural immunity, experts can deduce that protection will last at least six to eight months.
Moderna announced last month its vaccine is 90% effective at protecting against COVID-19 and 95% effective against severe disease at six months. Pfizer also said its vaccine is highly effective after six months.
Moderna announced Wednesday that early data from an ongoing clinical trial for a booster vaccine show it is effective against the variants that originated in Brazil and South Africa. Two studies published Wednesday show the Pfizer vaccine is very effective at preventing the worst outcomes from the variants that originated from the United Kingdom and South Africa.
Your last question is about mixing and matching possible booster doses. Gandhi said there should not be a problem mixing vaccine doses down the line.
“We as practicing physicians don’t look at the brand name of the vaccine when we give boosters in the real world,” she said. “Moreover, there is evidence that mixing and matching different vaccines may actually boost the immune response to COVID-19, and this strategy is being tested right now in the U.K.”
Right now, people in the U.S. should receive the same brands in a two-dose vaccine regimen.
But either because of shortages or to boost a person’s immune response, some countries are encouraging people to “mix and match” their doses — for example, one dose of an mRNA vaccine and another of a viral vector vaccine like AstraZeneca’s, which uses a modified version of a different virus (the vector) to deliver instructions to human cells. Some manufacturers are even purposely developing two different types of vaccines.
But for right now, it’s too early to be concerned about booster shots.
“It is not yet time for the public to start worrying about what booster to get,” Siegel said. “When the time comes, there is little reason to believe there will be a significant difference between Pfizer and Moderna.”
Pandemic Problems is written by Chronicle Advice Team members Annie Vainshtein and Kellie Hwang, combining thorough reporting and guidance from Bay Area experts to help get answers and find a way forward.
May 07, 2021 at 06:03PM
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