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WPCNR COUNTY-CLARION LEDGER. From the Westchester County Department of Communications. August 24, 2022:

Westchester County is leading all counties in New York in using a new American Rescue Plan program to keep our most vulnerable families and individuals from homelessness.

Westchester has helped nearly 200 individuals and families find leases for permanent homes through the federal Emergency Housing Voucher program. That’s more than any other county in the state, including all of New York City. Since the program got underway last November, 195 Westchester households have moved in to permanent housing or are scheduled to move in by September 1.

County Executive George Latimer said: ” When the COVID pandemic hit, we had grave concerns about its impact on people being able to stay in their homes, especially those who are most vulnerable. By staying ahead of the curve and using all available resources to keep people from homelessness, we’re not only preventing human tragedy for those individuals and families, but we’re reducing the social and economic costs of homelessness for everyone in Westchester.”

Westchester’s success is a result of diligent advanced planning by the County’s Department of Social Services and the County’s partner in the program, Westhab. And the County’s proactive response to processing applications has put Westchester in a position to help even more people than anticipated as additional federal application slots become available.

There are currently 76 additional referrals completed on the waitlist just in case more applications become available.

Department of Social Services Commissioner Leonard G. Townes said: “When we got word that this program was being discussed in Congress, we didn’t wait. Even before it was passed we had selected a partner, began developing criteria for those who might qualify, and worked to identify people who could be helped by the program as well as landlords who would be interested in leases. When final approvals came, we were able to hit the ground running. This is a program that focuses on people most at risk of homelessness and in need of safe, stable homes like domestic violence survivors. For them, time is of the essence, and so it was for us as well.”

Latimer said: “In the end, government programs are only as good as our ability to execute on them. I want to thank Commissioner Townes and the staff at DSS and Westhab for their example of proactive leadership in leveraging federal funds to help County residents most in need of help.”

The Emergency Housing Voucher (EHV) program is available through the American Rescue Plan Act (ARPA).

It focuses on individuals and families who are homeless, at-risk of homelessness, fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, stalking, or human trafficking, or were recently homeless or have a high risk of housing instability.

Participants live in housing of their choice while paying approximately 30 percent of their monthly income on rent. The remaining rent is paid directly to landlords through the voucher program, which protects landlords by ensuring payment of that portion of the rent.

WPCNR YOUR LOCAL EPIDEMIOLOGIST. By Dr. Katelyn Jetelina, Reprinted with permission. August 24, 2022:

Fall COVID-19 boosters will be available soon.

This is a notable shift in the pandemic response, as we’ve been using the same vaccine formula throughout the pandemic—one created in early 2020 to fight against the original Wuhan variant.

The FDA and CDC (and their external scientific advisory committees) met in June and decided that not only do we need a fall booster, but we should try and match it to Omicron as best we can.

Fall is around the corner and, with it, many questions. Here is my attempt to offer some answers until we have more clarity next week.

What are the new boosters?

The fall booster will be a bivalent vaccine, which means its formula covers two variants: the original Wuhan virus and Omicron (BA.5). As of yesterday, Pfizer and Moderna submitted their emergency use applications to the FDA.

• Pfizer: This will be a 30 microgram vaccine, which is the same dosage as the original series. Pfizer is first seeking approval for those aged 12 and older. But they did confirm they are working on a booster for ages 6 months to 11 years. CDC confirmed this in their fall planning guide, saying that we should expect a booster for younger kiddos following the adults.
• Moderna: This booster will be a 50 microgram vaccine, which is the same dosage as the original booster and half the dosage of the original Moderna series. They are seeking approval for ages 18 years and older.

Why do we need an updated booster?

Omicron changed the game in terms of evading immunity, which caused protection against infection to wane quickly.

Vaccine protection against severe disease wanes, but ever so slightly.

Mix this with the fact that coronaviruses thrive in winter, and that Omicron continues to mutate, and there is a strong possibility of a winter resurgence.

We hope that an updated booster this fall will provide three things:

1. Higher protection. The booster will no doubt increase neutralizing antibodies, which is our first line of defense. Neutralizing antibodies naturally wane over time, but they will temporarily help prevent infection and transmission in the first “X” months of vaccination.
2. Longer protection. We don’t know “X,” but an updated booster may protect against infection longer than we are currently seeing. Moderna already tested a bivalent vaccine with a Beta formula. (We thought we would need this booster, but then Omicron came on scene.) This data showed neutralizing antibodies waned more slowly than the original vaccine formula and lasted at least 6 months. This is because a booster helps our second line of defense, too: B cells. B cells are antibody factories that, just like factories, can modify their product on the line. These factories will eventually make a product that targets the circulating virus.(Moderna)It’s important to note, though, that if we want immunity against infection beyond 6 months, we need new vaccine altogether, like a nasal vaccine.
3. Broader protection. The third hope is that a booster increases the diversity of our protection. In other words, we hope the updated booster allows our antibodies to “see” more virus parts and “attach” more strongly compared to the antibodies we have right now. We can realistically only broaden or diversify our response by updating the vaccines (or getting infected).

Will the vaccine be effective?

Yes. How much more effective than the current booster is unknown.

We have a lot of human and non-human data showing that an updated vaccine that closely matches circulating variants (like Alpha, Beta, and BA.1) are at least as good as the old vaccines (this is called non-inferiority). But an updated vaccine has strong potential to be better.

No one knows how muchbetter, though, because we don’t have human data. The U.S. originally planned for a BA.1 bivalent booster, so we have a lot of data for this. But Omicron keeps changing remarkably fast. So, the FDA choose to use a BA.5 formula this fall to better “match” the circulating virus. (Notice, this is different approach than what the WHO recommended and what Europe is rolling out—a BA.1 booster.) Because BA.5 is new, we haven’t had time to analyze it in humans; we have to rely on mice data. This is the typical approach for the annual flu vaccine. It’s not perfect, but does work as a good proxy.

So, there is the key tradeoff:

• Have an updated booster that matches the circulating variant the best we can, but rely on animal studies OR
• Require human data for updated vaccines, but always severely lag whatever variant is circulating.

Pfizer and Moderna are starting the human trials this month. We will, of course, follow the real-world data, too. But demanding an effective vaccine and clinical data is simply a fantasy against this rapidly changing virus. There is absolutely no reason why safety would be any different than with vaccines based on previous variants, either.

What’s next?

The FDA will review the applications submitted from Pfizer and Moderna. ACIP (the external scientific committee for the CDC) will meet next Thursday and Friday (September 1 and 2). This meeting will answer a lot of questions, but some answers I’m anxiously waiting to hear include:

• Should older adults wait until October-ish in case the booster does wane more quickly than we think? This may especially make sense if someone was recently infected. There’s clearly a risk/benefit balance here, especially for vulnerable adults.
• What animal data do we have? We’ve already seen preliminary mice data from Pfizer. (Spoiler: The BA.5 booster worked great.) I’m very curious to see more, especially from Moderna.
• How many people will actually get a booster? Vaccine recommendations do not equal vaccination. ACIP always presents fantastic survey data reflecting public perception. This data will help forecast how this winter may (or may not) look.
• What is the plan for unvaccinated people? I have heard rumblings that they will not be able to get an updated booster without getting the original primary series.

After the ACIP meeting, the CDC director will sign off. This means, if all goes well, vaccines should be available the first week of September.

An important note

This will be the last vaccine that is freely to the American public. We could barely find enough money to purchase fall boosters for everyone. Congress has stopped funding the coronavirus response and has invested very little into pandemic preparedness. This will be a tragedy on many fronts.

Bottom line

Fall boosters are coming very soon. We will have a whole lot more clarity next week after the ACIP meeting. I will be in attendance and will report back with Cliff notes.