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Here's who Dr. Fauci thinks will need a 4th COVID vaccine dose in the immediate future

Dr. Fauci and other doctors with Johns Hopkins and the Mayo Clinic said the COVID booster could potentially become seasonal, but more studies need to be done.

WASHINGTON — As a new variant makes its way across the United States, many are wondering if everyone will need a fourth COVID vaccine dose to protect themselves.

WUSA9  took those questions to President Biden's Chief Medical Advisor, Dr. Anthony Fauci, Infectious Disease Specialist with the Mayo Clinic, Dr. John O'Horo, and Executive Director of Johns Hopkins International Vaccine Access Center, Dr. William Moss. 

Question: Will everyone need to get a fourth COVID vaccine shot soon?

Dr. Fauci: "Moderna and Pfizer and others have applied to the FDA for an emergency use authorization for the use of a fourth booster dose. We won't know what the results of that examination of the data are off for a few weeks at least, so it would not be a good idea to try and predict or anticipate what they're going to say. If in fact, there is the determination, it likely will be for a particular subgroup of people. I don't think we're going to see a recommendation for everybody I'm talking about in the immediate future."

He added that there is "no doubt" that those who are immunocompromised should get a fourth dose at some point. 

Dr. William Moss: "In terms of thinking about the fourth dose, I think about it as who, what, and when. And so, you know, right now, I don't think we have evidence to support a fourth dose for everyone, particularly younger, healthy adults, you know, who are at low lower risk of severe disease...So I think where we may see FDA recommendations for a fourth dose are going to be in individuals who have underlying medical conditions that place them at higher risk, particularly those who are immunocompromised, where their vaccine responses are going to be poor." 

Moss added that the type of recommended vaccine dose could be different the next time. 

"Maybe we'd be better off with a protein-based vaccine, or maybe we'd be better off with a nasal spray vaccine," he said. "Now, these aren't available yet. So we're not going to see that in the near future. But down the line, we may be seeing this kind of mixing and matching, if you will--have different types of vaccines for those booster doses. And those may end up giving better protection."

The timeline of when a fourth dose could be available is still unknown. 

"Ideally what we would do is start giving booster doses...to those who are most vulnerable, the older adults and immunocompromised people, right, before we get a surge," Moss said. "The problem is we can't predict when we're going to get a surge...One could argue that maybe if we don't see evidence of a surge this summer, that maybe we'd be better off waiting until the fall. And people could get, you know, their influenza vaccine and a fourth booster dose at the same time. And then be prepared for kind of a winter season increase in SARS COVID."

Question:  Do experts anticipate the COVID shot being a seasonal type of vaccination moving forward like the flu virus?

Dr. John O’Horo: “Most individuals who have been following this agree that we're likely to need a seasonal dose of a COVID vaccine. And whether that's a booster of the original or is going to be a new tailored one based on some of the variants, we've seen other variants that emerge is not certain.”

RELATED: Here's what Dr. Fauci has to say about the new COVID-19 subvariant

Question: Some people have shared skepticism about the fact that the initial recommendation for a fourth dose is coming from the drug companies that produce the vaccines. Is there any reason to be skeptical?

Dr. Fauci: "These are studies that are being sponsored by the NIH. The data that's looked at is clearly scrutinized very carefully by the FDA, and by the CDC. So the idea that the company is involved in the studies, doesn't change the interpretation of the data. The company is not interpreting the data, the FDA and the CDC are interpreting the data. So if anybody has any skepticism, they should not worry. It will be determined and interpreted by people whose only interest is the health of the country, not in anything like selling vaccines or profit margins."

Question: For those who were sick with COVID, likely the omicron variant in December or January, should they still be worried about the BA2 subvariant?

Dr. Fauci: “There is a lot of cross-protection. So if you've been infected with BA1, the chances are you're quite protected against infection with BA2 or at least infection accompanied by severe disease.”

All three doctors emphasized that the main goal is just that -- preventing severe disease, hospitalizations, and death.

Dr. William Moss: “I think we got a little just, you know, fooled in the beginning, because these mRNA vaccines were so good in the short term in the clinical trials that led to their authorization in actually preventing infection that we kind of, you know, developed the expectation that that should be our goal… It's a different part of our immune system, our cellular immune system that really protects us against severe disease. And that's what we're seeing really hold up in terms of vaccine effectiveness.”

Question: Should we expect a summer surge?

Dr. Fauci: "I think the general public should not be surprised if, as the weeks go by, you start to see an uptick in infections. We're seeing that in the UK, or seeing that in European countries. And it may not happen this way all the time. But we generally see in this country, what happens in the UK, usually by a lag of about three or four weeks, that's been rather consistent with regard to the dynamics of the outbreak. So right now they're seeing an increase in cases, they're not seeing an increase in the usage of Intensive Care Unit beds. And they're not seeing an increase in all cause mortality, which tells us or at least strongly suggests that the increase in the uptick of infections is not associated and accompanied by an increase in severity of disease."

Question: In January, you (Dr. Fauci) were quoted saying of the five stages of a pandemic, we're still in the first. Have we moved past that point, and if so, where are we at in the process?

Dr. Fauci: "We've actually gone beyond the pandemic phase and beyond the deceleration stage. We're in somewhat of a control. But the important thing is that what level of control we still, you know, we're down below 1,000 deaths a day for around 27,000-30,000 cases a day. That's not the level that we'd like-- we'd like it a bit lower than that. So we certainly are much better off than we were six months or a year ago for sure."

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