Q&A with state epidemiologist Ben Chan

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Dr. Benjamin Chan, New Hampshire’s state epidemiologist, along with Beth Daley, left, Chief of the Bureau of Infectious Disease Control at New Hampshire Department of Health and Human Services, and Governor Chris Sununu.

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It has almost been a year since COVID-19 upended nearly every aspect of everyday life. In those 12 months, so many epidemiological concepts — vaccines, virus variants and even spike proteins — have worked their way into our vernacular.

To help understand it all, the Monitor’s health reporter sat down with Dr. Benjamin Chan, New Hampshire’s state epidemiologist. The following transcript has been edited for clarity and brevity.

New cases of COVID-19, hospitalizations and deaths have all been on the decline in New Hampshire. What do you think we can attribute this decline to? Do you think cases will continue to decline?

There are some really good and promising trends but it’s important to know that the overall levels of community transmission still remain high not only New Hampshire but really across the country. We are in the process of coming through the second wave of the pandemic in New Hampshire. So there are promising trends but we still need the numbers to continue to decrease.

I think the cause is likely multi-factorial. there’s a there’s a variety of different reasons why the numbers are coming down. I think it has to do with partly what’s being seen at a national level. We know that similar trends seen at the national level are playing out here in Hampshire so what happens around us it’s going to affect the communities in Hampshire.

I think that many people have gotten a message on the need to wear masks went out in public and social distancing. Especially around the holidays, I know that people were likely paying more and more attention to try and limit the spread of COVID-19. Then there’s the vaccines which are bringing the number of infections down, bringing hospitalizations down, bringing the number of deaths down, and this is exactly what the purpose of the vaccine is. And as we roll out more and more vaccine, more people are gonna have protection.

Until we have very high levels of vaccination across our country and across our state, we continue to stress the need for continued mass use of social distancing, of waiting on large groups and social gatherings. You know, we’re going to get there eventually. A lot of the focus now is shifting to getting the vaccine out so that we’re in a better place by the summer for example.

Can you give us an idea of how we’re doing on vaccines? Are we still on track to open up the next phase in March?

Yeah. So, it’s always hard to predict how the vaccination prioritization is going to progress because a lot of it depends on vaccine supply and how many doses of vaccine we get which we only find out a week or two beforehand. We currently have two different vaccines COVID-19 vaccines that are coming to us the Pfizer BioNTech vaccine and the Moderna vaccines. Both of these are very similar vaccines.

There is a third vaccine on the horizon here that the FDA is meeting to discuss in the next few days called the Johnson & Johnson vaccine. There’s likely going to be increased vaccine supply in the future. And as we get more supply, we will vaccinate more people and hopefully work our way through the prioritization groups more quickly.

Right now as a state, I think we’re doing we’re doing relatively well. We’re certainly above the national averages in terms of having our residents of New Hampshire vaccinated. just glancing at some numbers here. I think right now, at least 15% of our population in New Hampshire has received at least one dose of the vaccine. Probably about 6.5% percent of our population has achieved two doses of the vaccine or fully vaccinated, and these numbers are only going to increase. So right now we continue to vaccinate people in phase 1B, which has prioritized vaccination for people who are at the highest risk for severe disease from COVID-19 highest risk for hospitalizations and deaths. And now we expect that over the next, you know, month or so we will probably be able to get through the majority of the Phase 1B population and hopefully by the end of March, beginning of April, we will be able to look at starting to vaccinate the next phase, Phase 2A. We might be able to get to Phase 2A sooner depending on the interest in vaccine and they may be a little bit later. I think that it still remains to be seen how this is going to progress.

The state recently reported the first known case of the U.K. variant. So what is that confirmed case mean for N.H. and how widespread do we think this variant is?

This is going to be one of the next challenges in this pandemic. There are three primary variants that are being monitored. The U.K. variant is one that has been found to be now widely circulating globally, in the United States, and we’ve identified it in Hampshire. It’s also been identified and I think more than 45 other states around the country. So most states in the U.S. have identified this variant.

What’s concerning about some of these variants that we’re seeing emerge is that they appear to be more infectious or more easily spread person to person, meaning that to control these variants from spreading, we need higher vaccination rates. We need greater attention to social distancing and facemask use and avoiding settings where these variants can be spread more easily, like social gatherings and large groups. To be clear, we can control the spread of this, of this pandemic, even with the variants We know how to do that. In fact that the vaccines we currently have at our disposal — the Pfizer and the Moderna vaccines — have been shown to still be very effective against this U.K variant.

There are other variants that are out there which are less common but are being identified more and more across the United States. There’s a variant that originated out of South Africa. There’s another variant that originated out of Brazil. These, we believe, similarly are more infectious or more easily spread person to person. But what’s a little bit more concerning about these variants is that some of the vaccines we have, while still effective, may have a lower vaccine efficacy against some of these other variants like the South Africa and Brazil variants. So it gets confusing because we’re talking about different variants and the different data around, you know, the vaccine efficacy around these variants. But that’s why we talked about the Janssen Biotech vaccine, the new Johnson and Johnson vaccine. That’s probably why you’re hearing different numbers, right? You talked about the overall vaccine efficacy of this new Janssen vaccine as being 66% to 67% efficacious but in the US, it’s no closer to You know, 72% effective at preventing, you know, COVID-19 and the reason for those differences in numbers is because these vaccine trials are conducted around the around the globe. So there’s a certain percentage of the population that they study in the U.S. They also studied these vaccines in Brazil and in South Africa. So when you look at the vaccine participants study population combined. You get an overall vaccine efficacy of 66%, 67% of preventive COVID-19. When you look at it more geographically, there are differences that are starting to emerge and the effectiveness of these vaccines, particularly against some of the differences

That’s interesting. So in other words, you know, some of the more recent numbers that we’re seeing might be slightly lower because of these new variants and because they affect the efficacy, interesting. So I’m going to jump to some of the commented questions:

Will Granite Staters have the option to choose between the vaccines, especially once the Johnson and Johnson vaccine becomes available?

As of right now there, there is not an option to choose between the two vaccines that are currently available. The Pfizer and the Moderna vaccines are very, very similar, in terms of efficacy. And so we haven’t heard a lot of issues with people wanting one vaccine over the other.

This is going to come more into play when, when and if and when we have the Johnson & Johnson vaccine because there are differences. I think we’re still waiting to hear some of the messaging that’s going to come out from the FDA if and when they authorize it. We’re waiting to hear from the CDC as well about recommendations and guidance that they may have around how best to use and target this vaccine, which again, it’s going to be a limited supply up front. We need to have some discussions over the over the coming days as a state for how best to roll this vaccine out and potentially best target it, the people that would benefit the most from maybe a single dose.

This is something we’re currently discussing in terms of how best to roll out on any new vaccine we get in the future.

Do you have any advice for people who are still struggling to get their first or second dose appointments?

So probably that the best thing I can say is that this is a little bit of a complicated process and we understand that people have had issues and certainly apologize for the trouble that people experienced and we’re committed to try and make this less confusing of a process and more streamlined and easier on people.

If somebody has a question about their appointment or needs to book their appointment but isn’t sure how, we’ve been telling people to call 2-1-1 and to talk through their specific situation. Now I’m also aware of people that have tried calling 2-1-1 and haven’t necessarily gotten a satisfactory answer. We’re going to work on sort of improving the communication around this, but currently, the best guidance I can give is if there are questions or issues that people are experiencing or if they hadn’t gotten a sooner second dose appointment, work through the 2-1-1 phone system for trying to work out some of those issues.

Will Granite Staters be given a choice about taking the vaccine or will vaccination become mandatory?

There is no plan from the state level to mandate COVID-19 vaccines. There may be situations where employers might have the option in the future of mandating vaccines. Similarly to how some healthcare organizations like hospitals require influenza vaccines every year for their employees, there’s certainly the possibility that employers in the future could look at doing that. But from a state level, there’s no plan to mandate that people get the COVID-19 vaccine.

Do you think we’ll approach herd immunity by spring? What do you think will change and what will remain the same?

So as we get more people vaccinated, we will be able to loosen restrictions further. No, I think that we’ll likely we’re going to be wearing masks for many more months to come. But the goal is to be able to loosen additional restrictions pull back on the quarantine requirements, allowed visitations in long-term care facilities, you know, be able to conduct normal community societal operations a little more freely. But but it’s not going to happen all at once. It’s going to be a process.

There’s not an exact number that we’re aiming for herd immunity. I mean, there’s been different numbers put out there, you know, we’d like to see 70% of people vaccinated, 80% of people vaccinated. At the end of the day that the higher the number, the better.

Whether we’ll reach 70% or 80% of people vaccinated by spring, I think is a little bit unclear at this point. We’re going to be vaccinating probably through the spring into the summer, at that point, we expect to probably have more data coming out in the next couple months about vaccines being studied in kids and pediatric populations. So there will be maybe more of an effort to roll out vaccine as a pediatric vaccine.

I think there’s going to be this sort of an ongoing process of vaccinating and reassessing and as new data emerges and I think we’ll have to see where we are in the Spring and early summer.

So the last question I see here is more of a statement than a question, but I think it’s a good opportunity to talk about some of these things. They say I don’t feel safe taking a vaccine that was pushed through so quickly, unlike vaccines for pneumonia, flu and shingles.

Yeah, and I think that this gets to the issue of vaccine hesitancy, right. We know that there’s a sizable proportion of people in communities across the country that are concerned about the safety and the efficacy of the vaccine. I think we’re hearing more and more about how effective these vaccines are. But I think there’s still lingering concern about safety. And I think a lot of it comes down to the scrutiny that these vaccines have gotten on watching it, you know, play out at a federal level in terms of vaccine, you know, development and rollout.

What I can say is that there have been no corners cut in terms of the development and study of these vaccines. The vaccines have been studied in the same way that other vaccines we currently have licensed had been studied. So this person references the flu vaccine and the pneumonia vaccine in the shingles vaccine. These COVID-19 vaccines have gone through the same, you know, phase three clinical study trials as any other vaccine that were that we were rolling out.

What we don’t have is necessarily you know, the same experience. I mean, flu vaccines have been around for years and these are new vaccines that are rolling out. I think that that’s caused some people to be concerned. But I want to stress that they’ve gone through the same vaccine trials and vaccine studies as these other vaccines that we currently have licensed. And they’ve gone through a rigorous review process, right. So before any vaccine is given to somebody, the FDA has a science advisory committee that has reviewed the science and the data; that’s the Vaccine and Related Biological Products Advisory Committee, the VARBPAC, which is actually meeting (Feb. 26) to discuss this new Jansson Biotech vaccine. They review the trial data. They make a recommendation to the FDA. The FDA then authorizes its use before vaccine is sent out.

The CDC has a medical and science advisory committee the ACIP, or the Advisory Committee on Immunization Practices, which looks at data and weighs in about appropriate and medical use of these vaccines. And then we also look at the data and the guidance that are that are out there from the FDA from the CDC.

So by the time you know, we’re getting vaccine out to our clinics and putting needles into arm, so to speak, they’ve gone through rigorous phase three clinical trials on by the pharmaceutical companies and they’ve gone through scientific review by the FDA. They’ve gone through medical and public health review at the level of the U.S. Centers for Disease Control and Prevention. And they’ve gone through our review. In fact, we just had a webinar with healthcare providers and other public health partners around the state reviewing some of the data that we have available at our disposal and talking about exactly what we’re talking about on this on this Facebook Live session, you know, vaccine efficacy numbers, where, where there’s good data where there’s gaps in the data what’s currently being studied. I want people to feel safe getting the vaccine because the vaccines have gone through a pretty rigorous study and review process before they’re ever rolled out and before people are ever getting vaccinated. There are still things that are being studied about these vaccines. But that should not dissuade people from from getting them. We believe that these vaccines are very, very effective, as I already mentioned, but also very, very safe.

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org