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Steve E. Bishop, M.D.

By: Steve E. Bishop, M.D. on August 24th, 2022

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COVID-19 Update 8/24: New COVID-19 Boosters & Monkeypox

COVID-19

In our monthly COVID-19 update, Dr. Bishop discusses the impending arrival of new COVID-19 booster shots, and he also talks a little bit about monkeypox. Watch the video below or read on for our full recap. 

Updated COVID-19 Boosters Coming Soon

Pfizer and Moderna are going to submit information to the FDA to get approval for boosters for the new Omicron variants that are circulating. It's going to be an interesting process to see how this evolves over the next few weeks.

The expectation is that FDA will likely approve both of these booster shots. The Pfizer one will be for those 12 and up, and the Moderna one will be for those 18 and up.

Now what's interesting about these approvals is that these new booster vaccines — and they are only boosters, so just to be clear, these are not primary series vaccines. If you have not been vaccinated for COVID at all, you can't use these new shots as your primary COVID vaccine series. You still need to go back and do those original two shots, either from Pfizer, Moderna, or now you do have the option of using Novavax instead.

These are specifically boosters to be used in people who've already gotten the initial primary series, and these new bivalent vaccines — bivalent meaning it's addressing two strains of COVID for the Omicron sub-variants — are only for those getting boosters.

And they are for people that haven't had a booster recently and haven't had COVID recently. We don't have specifics from the FDA yet because the official recommendation hasn't come out, but we're expecting it soon.

My guess is they're going to say if you've had a booster in the last 90 or so days or you've had COVID in the last 90 or so days, don't get the booster yet. Wait until that 90-day mark has passed.

Data on Updated Booster

What's interesting about these booster shots is that there have been no clinical trials on humans for these vaccine boosters as of yet. It's causing a little bit of controversy.

Because of that, the FDA is using data derived strictly from studies in mice with these booster shots. I think that does give a lot of us a little bit of pause in terms of recommending them broadly for all ages and all types of people.

I do have to say, again, we've been using these vaccines for about two years now, and in general, these mRNA vaccines have been proven to be generally safe and well-tolerated.

I suspect that for folks who are in the highest risk COVID categories — meaning people that have immune system problems, people being treated with drugs that suppress your immune system, or the very elderly, say 75 and up — I think considering this booster in the fall is still going to make some sense.

If you don't fall in those categories or even if you do fall in those categories and want to ask more questions, then the thing to do, as always, is to get highly personalized advice on this from your doctor to figure out if the risk and benefit balance of using these new vaccines boosters makes sense.

And again, I think that the fact there is no human data yet does give many of us a little bit of pause with using them with everybody 12 and up or everybody 18 and up.

But for those certain high-risk people, I think it still may make quite a lot of sense. I posted two articles here, one about the boosters in general, and then one about the controversy of using just the mice data in general.

And this may be something that we see more commonly going forward as we use more and more of these mRNA vaccines. They can be developed so rapidly and clinical trials in humans do take some time, so we may see this more as time goes on.

They are going to do clinical trials on these booster shots starting in the next month or so, so it's not as if they're not planning to do any trials at all. They just didn't want to delay the rollout of these boosters prior to the upcoming respiratory virus season this fall and winter. They wanted to get them out there, especially for the highest-risk people.

And I do think that makes some sense to make it available for people who it may make a lot of sense to go ahead and do that, even if there's some potential issue with the vaccine. The risk of them getting COVID is so high and so severe that it's worth taking a little bit of risk there. So I think that's fine.

The bottom line is here, again, as with everything with COVID, we're in uncharted territory. We're still learning new things. Talk to your doctor. Get specific advice from them on this issue because it is so nuanced and so individualized at this point that you really do need the input of your primary care doctor to make these decisions.

Because the bottom line is it's just complicated, and it really can't be answered outside of a one-on-one clinical discussion. So, that's my plug basically for finding a good primary care doctor.

And that's really what you need to do for your health in general, find a good primary care doctor. And if you find one, hang onto them, and have them available to answer questions like these. Because, again, it does get very nuanced and complex.

Monkeypox Update

Monkeypox is out there in the news. I know we haven't officially talked about that on this particular platform before. It's still going on. It's now been reported in all 50 states.

The main thing to keep in mind at this point is that it is spread by direct skin contact and significant contact. You're not going to pick this up casually by brushing up against somebody in the store or the mall or whatever.

It does take a significant amount of close personal contact to contract this. And even if you do contract it, the vast majority of people are having a fairly mild illness with it. Some people are getting a little sicker. But in general, fairly mild illness.

There are vaccines that are available for monkeypox that we think will work well. One of them is the older smallpox vaccine and one of them is another vaccine that's specifically for monkeypox. There is limited data in humans on these vaccines in terms of whether they work truly for monkeypox.

They probably won't prevent it 100% of the time, but those vaccines are available and they're being made available to the communities and the groups of folks who are at the highest risk of contracting monkeypox at this time.

That is something that is being managed by the local health departments in different areas.

Childhood Vaccines for Monkeypox?

"If we had smallpox and polio vaccines as children, are we covered for monkeypox and polio?"

These are awesome questions. The real answer is that we are not sure. Probably yes for polio. The monkeypox, again, probably yes, but we don't know.

It's been many years since we gave the last smallpox vaccine in the United States. It hasn't been given for almost 50 years. So, people in my generation, for example, never got vaccinated for smallpox. Those in our parents and my parents and above got vaccinated. You probably do have some protection from monkeypox. How much? We don't know, because we don't know how much of the smallpox immunity remains this far out.

I suspect that we will find out information about that in the coming months as people start doing data trials and analyses trying to figure out if the antibodies are persistent and the T cell responses are persistent against smallpox in particular.

But my guess is you probably do have some protection from that and from polio as well.

Again, it's close personal skin-to-skin contact, and at this point, the majority of the cases of monkeypox right now are in what's called the MSM community, so men who have sex with men.

That's not to say that community will be the only community where that happens. It's going to show up in other communities as well. It's going to be like a lot of our other illnesses.

Sometimes they show up in one population and then they spread to others over time. I say that to remind everybody not to stigmatize people, not to view people negatively about monkeypox or anything, any other illness like that, that just because it shows up in a community, doesn't mean anything in particular because it likely will spread beyond that community in a short time.

Just because someone has monkeypox, it doesn't mean X, Y, or Z thing about them. And just because someone's in a particular community, doesn't mean that they're necessarily at high risk for monkeypox or have monkeypox, okay?

That's not addressed to anyone in particular. It's just something I feel like is good to get out there and say as a general disclaimer about these sorts of things.

But to answer your question, you probably have some immunity and some protection. We just don't know yet.

Monkeypox Concern

"How dangerous is monkeypox in general?"

In the U.S. and the Western world where we have pretty good medical systems, the risk to people is low. There hasn't been, as far as I know, maybe one fatality, and that was in someone who also had other immune system disorders.

But for the vast majority of healthy people, it is an uncomfortable, but certainly not fatal illness, by and large.

I would classify it as a little worse than chickenpox for most people, but not as bad or as dangerous as smallpox. The truth is, we don't really know what the full spectrum of disease is because it's still a relatively new illness.

Until recently, we haven't had very many humans contract it outside of small outbreaks in Africa. We don't know what the spectrum of illness is. It's probably a pretty broad spectrum of illness, meaning just like COVID, where you have asymptomatic people that have almost no symptoms or none, and then very sick people who get very ill with it and it's all down to the personal factor in terms of their immune system, their overall health, that sort of thing.

In general, for the average person, probably not a huge risk. And even if you do contract it, probably not a huge threat to them in general.

Diseases from Animals

"Why are many diseases and viruses crossing over from animal to human?"

Good question. It's happening all the time. It's happening all the time. Always has been. Anywhere that humans live in close contact with animals or with the wild, there's always been some cross-contamination between what's called zoonotic infections, meaning they start in animals and cross over to humans.

These animal or zoonotic infections are always crossing back and forth with humans. It just happens to be in particular areas where there are lots of people living next to lots of animals.

Pigs are common. Birds, too. You worry about like swine flu, avian flu, that sort of thing because we're around lots of pigs and animals and that sort of thing.

Monkeypox is a little less common, right? Most people aren't around monkeys too much. But these viruses are always crossing back and forth and it's just a matter of time and a matter of chance before one of them sticks, crosses to the human population, and then maybe mutates a little bit and then can become transmissible between people.

There are actually whole sections of the CDC and the World Health Organization that this is all they do. They monitor these zoonotic infections to make sure that they're not crossing over. And then if they do, they start tracking them, because it is just a matter of time for all these things.

At the end of the day, when we talk about genetically and otherwise, we're not all that different from the other species on the planet. We share over 90% of our genes with a mouse, for example.

But the bottom line is these things do cross back and forth pretty frequently. And so, it's just a matter of time.

And we all travel a lot. We travel quickly. So 50-60 years ago, if somebody got monkeypox, they basically had no option to travel from Sub-Saharan Africa to Canada in any meaningful amount of time because they would've already gotten the illness and then recovered from it before they got on a plane and spread it to a few hundred other people.

Zoonotic infections happen all the time and travel and just the sheer volume of humans all over the planet interacting with animals, it's just an expected outcome in a way.