You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Rebecca Weintraub, director of vaccine delivery at Ariadne Labs. This call was recorded at 11:00 a.m. Eastern Time on Thursday, December 9th.
MODERATOR: Dr. Weintraub, do you have any opening remarks for us?
REBECCA WEINTRAUB: Sure. Pleased to start us off and thank you for inviting me. And hello, everyone. Thanks for joining, eager to have a dialog today. I thought I would just start with kind of a few major bullets first, just front and center that we need a combination of risk mitigation strategies at this stage of the pandemic. Vaccines have never been a silver bullet in the midst of a pandemic, and it’s the combination of reducing your risk with masking, ventilation, access to testing and vaccination when possible. The second message I think we want to ensure everyone reinforces is that we still have 75 million Americans that remain unvaccinated and 43 percent of the counties in the United States have less than 50 percent of those eligible vaccinated at this time. In addition, 94 million Americans are eligible for a booster and have not received one as of today. I’ll spend just a few moments maybe talking through kind of the data that came out yesterday, the preliminary lab results that Pfizer introduced and a few comments about why I’m worried about kids in the midst of the pandemic. So if we think about the fact that we know that the Omicron variant harbors 30 mutations on its spike protein, which is the primary target of most of the COVID-19 vaccines that we have on the market, what we’ve learned yesterday with this preliminary data and other scientists have reminded us is that it’s likely Omicron is dodging some of the antibodies that the vaccines produce and the variants that may come. But the good news is that the Omicron variant isn’t stealth enough to elude all of the antibodies that we produce regarding those who are vaccinated. So, yes, we still need to await the data. Although, you know, many of us are reviewing what the scientists are putting out, and it looks like there’s a decent vaccine induced protection, especially against severe disease. So while we’re hopeful there’s more that we need to wait for in the weeks to come to full fruition.
The other piece I just want to reinforce is that this was a press release from Pfizer yesterday, pointing to the possibility and the positive news that the booster helps coax and cushion the Omicron blow for some time. But remember, once again, this is a press release from Pfizer itself. So we’re still waiting for these to be published in scientific journals to go through the peer review process and to remind ourselves that this is the beginning of a long and complicated conversation about this variant and future variants and vaccine efficacy. But, you know, I think in many ways acknowledging that this is too early to come to some consensus. We know it’s likely this variant will chip away at some aspect of vaccine effectiveness. We also know that our immune systems are complex. So in the real world, it will look different than in the studies. And right now, we have to say and remind the unvaccinated that Omicron is unfortunately increasing their risk. And so the risk landscape for the unvaccinated is now more worrisome with both the Delta and Omicron variants in circulation. And that’s not because actually the vaccines themselves have changed, or that our immunity and the mechanisms our immunity has actually changed, but it’s because we’ve allowed the virus to circulate among the unvaccinated.
The second kind of challenge to remind us is where we are with respect to the pediatric vaccine rollout in the United States. So if you remember, we had an initial very short period of high demand where the rate of COVID-19 vaccination for children aged five to eleven has now slowed considerably. So demand peaked around two weeks after the authorization. And as of December 5th, unfortunately only has sixteen point seven percent of five to eleven year old’s have received the first dose of the COVID-19 vaccine. So that’s about 4.8 million of the 28 million children in this age group, and only 4.3 percent have been fully vaccinated. What’s worrisome is that this variation is significant across the country, so we have rates of even less than that at four percent, for example, in a state like West Virginia. And we’re in the double digits, for example, in states like Vermont. And I mention that because we are concerned about this holiday time period, the notion that we know families will congregate and the message will need to continuously be that the risk landscape has changed and that it is the combination of utilizing testing, improving your ventilation, masking, especially when you’ll be with folks that are unvaccinated and vaccinated. And obviously those who have not been fully vaccinated, encouraging them to receive the booster or begin their series. So I will stop there, but just want to share those early comments. Eager to have a dialog with you all.
MODERATOR: Thank you, Dr. Weintraub. Real quick question, this is just a little bit of context for Pfizer with their press releases in the past, have you seen them kind of bear out in accuracy compared to what the later findings indicate? How big a grain of salt should we take those press releases, I guess, is what I’m asking.
REBECCA WEINTRAUB: That’s a great question, I have not done that comparison myself, but please look into that and circle back.
MODERATOR: OK, that’s just for me. So no need to do it for me. But if somebody else actually would like to know, let me know and I’ll pass that off to Dr. Weintraub. All right. First question.
Q: Thank you, Nicole, and thank you, Dr. Weintraub. I wanted to ask you about the potential public health risks of the at home testing, the rapid testing, in that if we get positive results, it’s unlikely that state and local health authorities will ever know if they have those results. And obviously that has implications for contact tracing. And then also, the government is pushing for more use of these at home tests and given that they are less sensitive than the PCR on balance, is this wise?
REBECCA WEINTRAUB: Well, first, that is a great question, I’m going to defer, we have some experts within the Harvard School of Public Health who can answer that more fully. I’ll share from the public health side, first, we know that and looking at kind of the community level data as well as state level data, many families are eager to incorporate a test alongside how they’re planning ventilation, masking, and receiving a booster. So I think the communication has been quite clear, this is an additional tool in our arsenal to mitigate your risk. And you’re actually right, it is a different mechanism power distributing a test, for example, to a family than it is in other countries. So if you think about how this is being done in Germany, for example, you can receive it on their street. They’re free at many public access points and to utilize the tests as a public health means to understand risk and surveillance that’s been well proven in other settings. The question will kind of become: will we make this as available at no cost so that families in those that are concerned are getting the test and then those we’re putting into maybe their school systems as well as their public health authorities? The second is that there’s been a significant amount of community messaging about a second test, so testing twice and improving the sensitivity and specificity of the test. I’ll have Nicole kind of follow up with others within our school who are experts in this realm.
MODERATOR: All right, next question.
Q: Hi, thank you. Thanks for you, Nicole. Thank you, Dr. Weintraub. My question is about the AstraZeneca monoclonal that was authorized yesterday. And one question I wondered is whether there might be some interest or utility in using it as a quasi-vaccine as well, meaning it’s being intended for people who are immunocompromised and can’t take the vaccine. But if it has these preventive and protective properties, is it possible that people who might be hesitant they heard about the word vaccine and they don’t want take that it, might there be some utility in making this monoclonal antibody available to them as a kind of vaccine?
REBECCA WEINTRAUB: Excellent question, I’m going to actually ask Nicole to refer you to experts in in our realm of, you know, that would be a very much an off label use at this stage. Second, I’ll just kind of counter that with this is a moment where we want to improve the confidence of the general public in the safety and efficacy of these vaccines. These vaccines have been now distributed and injected into billions of people, and we have a very robust safety data set. So I would first kind of counter that to say, I think our job right now is to help people understand. These are safe and effective vaccines, they protect you and your loved ones, and we appreciate that there are therapeutics that have been approved on the market to help those who may have had breakthrough infections or have not been vaccinated. We’ll leave it there. Thank you for your question.
Q: Thank you.
MODERATOR: Great. Next question.
Q: Hi, thank you guys for doing this, I really appreciate it. With my question, some anti-vaccine activists have been claiming that the COVID-19 vaccine very broadly is the deadliest vaccine ever made. How did the COVID vaccines measure up to other vaccines in history in terms of safety? And can we even compare? I supposed one, many, many decades ago?
REBECCA WEINTRAUB: Thank you for that question. Almost March of 2020, I spoke about the need to have billions of doses of a vaccine considering the swift nature of a respiratory virus leading to a global pandemic and first want to just take a step back once again that this has been an incredible scientific accomplishment to have multiple vaccines in the market approved being manufactured, billions of doses now distributed. There’s much more work to do, and vaccine inequity is a massive, complex problem that we can solve. And we also have the data that billions of individuals have received first, second and third dose. So yes, I think we can say this is a safe and effective vaccine. It prevents death. It prevents severe disease. It decreases transmission. We also know that those that are vaccinated from a small but interesting cohort, NBA players and staff that those that have been vaccinated clear the infection if they are infected, even when vaccines are they received a breakthrough infection, they clear the virus faster. So yes, at this stage, we are confident we have a robust database to say that these vaccines are safe and effective. As safe and effective as other routine vaccines.
MODERATOR: And I’m putting a link to that, that paper, which I happen to know very well. Dr. Stephen Kissler and Dr. Yonatan Grad, both authors on that one. So I’m going to be putting a link to that paper.
Q: Thank you so much.
MODERATOR: And I also want to say a little plug out there. It also got to kids, which is pretty amazing for a vaccine to get to kids that quickly too. So I’m excited about that. Next question.
Q: Hello. Nice to talk to you again. I have a couple of questions. One is a lot of readers are asking us today about when the journal vaccine. They saw the data from Pfizer and want to know about their vaccine and just wondered, I guess, are they likely to be exactly the same? Very similar? What’s your take on that?
REBECCA WEINTRAUB: That’s a great question, and we’ll have to wait here. Many patients are asking this question, thank you for representing our patients who received me during our patients who receive a Moderna booster. So we’ll have to wait and there’ll be a bit of time. So we appreciate everyone’s patience in the interim.
Q: Yeah, that’s what I told the editors, too. But apparently, it’s trending. And then I’m working on a story about sort of the future of vaccines, what we can hope. So much has happened in the last two years. Looking forward, what do you expect to change or to be, you know, if we were having this conversation a year from now, how would vaccines be different or the vaccination strategy be different, do you think?
REBECCA WEINTRAUB: Wow, that’s a great question. And so I mean, first that to say, I think in the midst of each pandemic, we upgrade and create advantages to the public health infrastructure that weren’t there before. So after the HIV pandemic, if you remember, we actually began to understand safety and blood banking, something not directly related but correlated with trying to decrease risk for the general population after the Ebola outbreaks. One of the new bilateral institutions that got established was CEPI, so that there would be an additional funding mechanism for the discovery and to ensure that there’s a portfolio of vaccines ready for the next pandemic, and I think we’ll see something quite similar, that there’s just been such an incredible cooperation in the scientific community. Immunologists, epidemiologists, the sharing of data sets, obviously the genomic sequencing that we saw with the courageous and robust effort from our colleagues in South Africa to sequence the Omicron variant so quickly. So I think number one, we’re going to see a speed and a level of cooperation that we haven’t before. And obviously, as we’ve all learned and experience the RNA platform being one and an additional arsenal to our toolkit so that we can in essence reproduce this and then iterate on a vaccine if necessary. The second, I think, which is incredibly encouraging, is the work that’s being done to establish intermediaries regarding the raw materials needed to produce the vaccines. And third, to establish regional manufacturing capabilities so that they are well distributed across the globe. That allows and decreases the transportation requirements and adds technical capacity in areas of the world where there was limited or almost no manufacturing capacity for vaccinations.
Q: Great, that’s super helpful. And I guess changing the vaccine strategy?
REBECCA WEINTRAUB: I can share is what I think needs to happen in the US that has not. So, you know, one of the incredible effects of the decentralization of public health in the United States is that our 64 jurisdictions, so every public health authority has a different data infrastructure for the flow of the data regarding identification of those who’ve been vaccinated, verifying they’ve completed their series, for example. And that data eventually has ended up in the CDC immunization data lake. But the quality of that data and the stops and starts of that data and we have certain jurisdictions that had almost no digital interface at this time has really hampered our ability to monitor not only the speed but the equity of its distribution. And as a country, we distribute many other products across the nation in an efficient manner so that we can, in a sense, understand the flow of the project that and the information can help with its monitoring. And this is an issue that we have the software to do. We need to upgrade and invest in this. In the same time, I have to say we’re incredibly concerned because 40 percent of our public health authorities are missing leaders today. They’ve chosen to retire. Some have been fired or removed from their offices. I mean, to invest in this next generation of public health leaders to serve within state and city offices.
Q: Great, super helpful, thank you.
MODERATOR: Does anyone else have any questions out there?
Q: I can ask another one. Can you talk a little bit about boosters as a public health measure, what we expect? I mean, we’ve seen that the vaccines don’t necessarily prevent all infection. Can it help if everybody gets boosted to stop infection? And what role do you see boosters playing as a public health measure?
REBECCA WEINTRAUB: That’s a wonderful question. Obviously, we’re waiting for some of the science to come through regarding the third dose. What is clear is that it helps establish the individual’s immunity and obviously population immunity because it enables the vaccinated individuals to clear the infection faster. As Nicole mentioned, the New England Journal research letter that Yonatan Grad and Stephen Kissler published. So you know, in many ways, this is not unsurprising historically. We do have boosters for other vaccinations. If you think about the shingles vaccine, many vaccines are a series of vaccines, so I would say we’ll be seeing this as part of your routine vaccination. And what we see in the market in developing in the market are a combination of vaccines, so it may be in the future you’ll receive your flu and a booster for COVID, for example, together. And I think that is when the integration of this where you’re thinking of this as part of your preventative health, this will be part of employee campaigns for back to work will help reestablish this as part of your general preventive health versus have to say that this particular vaccine has become so politicized. So our actual hope is that this becomes part of your schedule vaccination schedule, allowing patients and providers to have that conversation improve confidence. And we hope to uptake across the nation.
MODERATOR: Any other questions?
REBECCA WEINTRAUB: I’ll just mention one of the, I think a wonderful leadership moment that happened this week was in New York City, where they expanded the vaccine mandate across the city. So as you know, vaccinations are required at hospitals for nursing home workers and city employees, teachers, police and firefighters. And the mayor also announced a series of new requirements. One was an order that five to 11 year old children get vaccinated to participate in extracurricular activities such as sports or band or orchestra. And they’re kind of the initial. This will take effect on December 14th, and I mentioned that because we do have this short interval as the holidays are coming upon us will have a generally generational household together. And in order for that first dose to take effect before the holiday time period, we have about three hundred hours. And so I would recommend that we have all sites open 24 hours, seven days a week in the next three hours to get as many people boosted or received their first dose. And what is concerning, which I know many of you are reporting on and we’ve seen across the country, is that people are waiting for their appointment to get boosted. And I would recommend this is a time we need to be full court press all doors open and the vaccine be available at every site.
MODERATOR: There aren’t any good questions out there right now. I have a question for Dr. Weintraub. So everybody’s been talking about what should we do during our holiday gatherings? How should we prepare? My question is what do we do after the holiday gatherings? If you aren’t sure about people’s vaccine status or their COVID status of testing or if rapid testing is taking place? What are your recommendations for after the holidays for folks?
REBECCA WEINTRAUB: That is a that is a great question to call, and I know many school systems are trying to think through, you know, when and how to ask families where they’ve traveled to, for example, testing on return. And that would be ideal. And I think this question that’s come up many times in different conferences regarding the role of testing. Many schools will be asking families and children to test before they return to school and to bring verification of the doses that they have received. A school has returned. The second is if you’ll be in mixed company with those who are vaccinated are unvaccinated to be wearing a mask indoors while traveling, for example, to help decrease the risk to yourself and to others during the winter months. While we know ventilation is difficult to spend time outside as much as possible, so it’s a great time to go ice skating and have your hot chocolate outside. And in many ways we’re asking folks to practice and calculate their risks as individuals, as family members, and then be conscious that they’ll be returning to congregate settings, maybe schools or places of worship. And if they’re feeling unwell to refrain from congregating with large groups after the holiday time period.
MODERATOR: Thank you. Any other questions out there?
Q: I’ll go with one more one.
Q: A colleague is working on a story about kind of looking back at how people felt when the vaccines were first approved. Do you have any memories of that day of that moment when you when you got your shot or when you knew that they were going to be available?
REBECCA WEINTRAUB: Oh, yes, you’re making me teary eyed. Yes, I mean, I think I had the privilege to vaccinate some of the first members of our intensive care unit at Brigham and Hospital nurses and physicians and respiratory therapists who’ve been working night shift after night, just taking significant risk in their own exposure and their own experience of caring for so many of our longstanding patients who’d been in the intensive care unit. So number one, it was an absolute privilege as a provider to be able to offer that immunity to my colleagues as a vaccinator in December. You’re right, that was a year ago.
I think the other piece that is striking and many of us keep reflecting on is the story of an immigrant and a female scientist who worked so hard to bring to bear the science behind mRNA vaccine and where she receives support, where she faced skepticism and what it takes to break in and establish in discovery the significant obviously R&D investment that was made by the NIH and members and leadership within the NIH to make this happen. And now our responsibility to deliver this with speed and equity globally. And we very much hope this becomes kind of the mantra had that it is the idea that the global unvaccinated that we need to protect that will decrease the variants that will ensure your vaccine is effective, your family’s protected, the communities affected and the pandemic will disrupt fewer aspects and dimensions of our daily lives.
Q: Thanks, sorry to make you cry.
REBECCA WEINTRAUB: Yeah, now it’s a bit happy, I mean, you know, I had the privilege of being in conversation with a producer at Netflix where and we created this series called Coronavirus in February of 2020. And when I said that will need billions of doses of the vaccine, you know the producer stopped short. And I think it’s that mentality, we are member of a global community of billions of people who need to be vaccinated. We can produce this vaccine, we can produce billions of doses, we can distribute billions of doses, it is now kind of our responsibility to use all the technology we have and the wherewithal to ensure the unvaccinated are protected.
MODERATOR: Any other questions out there?
REBECCA WEINTRAUB: I’ll just share Nicole. We do update the vaccine equity planner every week, so vaccineplanner.org, we take all the active sites across the United States that have procured inventory. We then calculate a polygon regarding your time to travel to each active vaccination site and then display the vaccine deserts. We’ve modified it if it’s helpful for you to understand the pediatric vaccination desert. So of all the active sites across the United States, only 40 percent of them can vaccinate a child five to 11 years old. So families are facing time scarcity. We’re asking them to travel a longer distance to ensure that their child is being vaccinated, we’re seeing many pediatricians choose to provide the COVID-19 vaccination, but at limited time hours. And we believe this is a moment where convenience needs to be top of mind. This vaccine needs be made available on your way to work on your way, to drop off on your way to the supermarket seven days a week, and, if possible, nights and weekends. So please answer any questions of books, review the vaccineplanner.org and help you drill down to county, for example, at the county level of interest.
MODERATOR: And for personal experience, I know that there was a shortage of pediatric vaccines a couple of weeks ago, we had an appointment at Walgreens and basically they canceled all the Walgreens appointments because they didn’t have the vaccines for the kids. Do you know if there are any other distribution hiccups like that? Or does it seem like things like that have gotten kind of smoothed out?
REBECCA WEINTRAUB: Yes. No. Unfortunately, I’ve heard of families going to specific sites, and they’re not being a vaccinator that is trained and skill to vaccinate children, for example. We know that the retail pharmacy, Walgreens, CVS, Walmart has fewer sites where the vaccine for five- to 10-year-olds is available due to the constraint of actually not having sufficient vaccinators, as well as securing the retail space required for the level of observation. Fifteen minutes after the dose. So we are concerned that we have not built this out so that this is convenient for families to. Bring their elder to get a booster, the child, for example, to get their second dose. And we were excited and thrilled to see the president announce family clinics. We have written about that. John Brownstein and I have done a bit of an analysis which we published with ABC News. But we are not seeing that be standard practice across the country. There are wonderful examples folks are reporting on, but they are very few and scattered throughout the country.
MODERATOR: Thank you.
This concludes the December 9th press conference.