Vaccines and Variants with Dr. Leana Wen

Leana Wen, emergency health physician and former health commissioner for the city of Baltimore, Maryland, discusses how state and local governments can prepare for and respond to COVID-19 variants and future public health emergencies.

FASKIANOS: Thank you. Good afternoon, everybody. Welcome to the Council on Foreign Relations State and Local Officials Webinar. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR.

We’re delighted to have participants from 49 U.S. states and territories with us. Today’s discussion is on the record. As you know, CFR is an independent nonpartisan membership organization, think tank, and publisher focusing on U.S. foreign policy. We’re also the publisher of Foreign Affairs magazine. And through our State and Local Officials initiative we serve as a resource on international issues affecting the priorities and agendas of state and local governments by providing analysis on a wide range of policy topics.

So I’m pleased to have with us today Leana Wen. We previously shared her bio with you so I’ll just give you a few highlights, and to say that we will need to end a little bit early because we are perfectly placed. President Biden is announcing his pandemic vaccine plan at 5:00, but an embargoed copy has been released. So we’ll be able to hear some insights from Dr. Wen on that. Dr. Wen is an emergency physician and visiting professor health policy and management at the George Washington University Milken Institute School of Public Health. And she is the author of Lifelines: A Doctor’s Journey in the Fight for Public Health that was just released in July. Previously she served as health commissioner for the City of Baltimore, where she led the nation’s oldest continuously operating health department. Dr. Wen is a member of the Council on Foreign Relations and has received numerous recognitions, including one of Time Magazine’s 100 Most Influential People.

Dr. Wen, thanks so much for being with us today. It would be great—I’m just going to throw it open to you—over to you to talk about the current state of the COVID-19 pandemic, and where we are now, and any insight you can share on what we will hear from President Biden shortly?

WEN: Wonderful. Thank you very much, Irina. I’m glad to join you and also glad to join our state and local officials. I mean, what a time it’s been for all of you, for all of us. And I just, first of all, want to say thank you, because you are really on the frontlines. And I think you’ve all seen too how unfortunately COVID has become so polarized, so politicized. And you are the ones who are delivering messages that people don’t necessarily want to hear. And I think you’re on the frontlines in more ways than one. I mean, you’re also on the frontlines of getting and dealing with misinformation, disinformation, but also in harassment and in messages directed at you in ways that are totally inappropriate. But you still do the work and serve your communities, and I just want to thank you for them.

Now, I don’t think that we’re in a very good place at all in the U.S. I mean, we reached a point back in June/July where we were seeing consistent declines in the numbers of infections. We were down to just over 11,000 daily infections. But now we’re seeing these surges, to the point that we’re having about 150,000 new infections every day. And I was just looking at where we are now compared to last—to Labor Day. We are now at 300 percent the level of COVID-19 infections compared to last Labor Day. We are at more than—at two-and-a-half times the level of hospitalization compared to last—compared to a year ago. And we’re at nearly twice the level of death compared to last year as well.

And so in total, that is not a good picture of where we are, especially because we have vaccines. I mean, my colleague at CNN, Dr. Sanjay Gupta, was just saying that if you had shown us these statistics a year ago we might have said, oh, well, in that case we didn’t develop a vaccine, because it would seem hard to believe that we have vaccines that are safe and very effective, but we would still be at this point. And why are we at this point? Because only 54 percent of Americans are fully vaccinated.

Now, we could have avoided this point if it were not for the Delta variant, but also if it were not for the fact that so many people remain unvaccinated. And so Irina mentioned the announcement that President Biden is going to be giving. I have an embargoed copy of the plan that was embargoed until 3:30 Eastern, which was, you know, half an hour ago. So I can now talk to you about the plan. But it’s a six-prong strategy that really would not surprise any of us who have already—who have been following this. I mean, it talks about testing, masking, and keeping school safe. It goes into a lot of detail about vaccinations. And I think that the Biden administration is using many of their levers in order to increase vaccinations. Not as many as I would like, and I’m happy to talk about that too, but there is a lot that they are doing.

So for example, they are announcing that all federal employees and also contractors with the federal government now need to be vaccinated. There’s now not a testing opt-out option. Another big—another big item that’s going to come is they are directed—the federal government is directing—or, the White House is directing OSHA to develop a rule that requires vaccinations for—or testing—or weekly testing for all companies that have one hundred or more employees. That’s a big deal.

That’s 80 million Americans who would be affected. In this case they are giving an opt out. They are saying: Either require vaccinations or weekly testing, but I think that is going to be a big deal. We know that many businesses have already voluntarily taken the step of requiring vaccines, but also a lot of businesses have not. And so I think this gives businesses cover that want to do this. And now they can point to OSHA and say, hey, this OSHA rule is coming. That’s why we’re doing this. I think that will be really important.

But, I mean, I wish the federal government would go even further—for example, requiring vaccinations for travel, for interstate travel, for planes and trains. And in the meantime, I wish that we would do more to abide by actually what the CDC recommendations are, which, as you know, are requiring indoor masking in places with substantial or high transmission, which is most of the country. That is not the case. I mean, my—you know, I think there is this cognitive dissonance sometimes that we have.

We—and I’m sure you all experience this too—we talk to some people who are pretty blasé about COVID, who might be vaccinated or even are unvaccinated but don’t really think that COVID poses much of a threat. And on the other hand, we have people who are really afraid of COVID, are not resuming many aspects of pre-pandemic normal, cannot wait to get booster doses, et cetera. And I think we’re living in this very strange, bifurcated world at the moment. But in any case, I think that there’s a lot of work.

To summarize, we are not at the place that any of thought or wished that we would be at this point. But I think there is a lot that we can do to get us to a much better place.

FASKIANOS: Thank you very much. We’ll go right now to questions. You can raise your hands and unmute yourself and tell us who you are and—to give us context of the state from which you—where you’re sitting. Or else, you can write your question in the Q&A box. And if you write your question, it would be great if you could include your affiliation and I will read it.

So the first raised hand—sorry as I am juggling. How long have I been doing this? Is Liz Johnson. Mayor Liz Johnson, if you could unmute yourself. OK.

I’m going to go next to Councilman Wilkerson. And we will come back to the mayor. Go ahead.

Q: Hi. How are you?

FASKIANOS: Fine, thank you. And where are you tuning in from?

Q: I am from Killeen, Texas—in the wonderful state of Texas.

I would like to ask Dr. Wen—first of all, thank you for having this forum. I would like to ask you to get a little more into depth about the concerns that we should have about school systems, because a lot of our municipalities are working with our school districts, and the concern that some may have or some not have with the opening of the school districts at this time of year.

WEN: Yeah. It’s a really good question. And I know this is one that we’re all wrestling with in different ways. You know, recently I was on a Post—on a Washington Post podcast with Hannah Nathanson, who is the educator reporter for the Post. And she made a comment that really stuck with me. It was something about how at this moment—I mean, based on her reporting all over the country—the range of what we’re seeing in terms of this piecemeal approach to reopening schools is as wide as one can possibly imagine.

I mean, you’ve got some places that are going above and beyond the CDC recommendations when it comes to the layers of protection—which, you know, is good, right? I think the CDC approach of talking about layers of protection, that we need as many of these layers in possible, kind of like in the winter when you’re cold. You know, you want as many layers as you can. And if you’re replacing—if you’re removing one layer you replace with another. So if we can no longer do distancing, we’re replacing it with having as many adults being vaccinated as possible and doing regular testing, indoor masking, et cetera. You’ve got that one extreme.

Then you’ve got many schools reopening as if it’s 2019, without any restrictions at all and without any kind of indoor masking, unclear even what their protocols for quarantining and isolation are. I mean, I’m very concerned. I mean, I think essentially, we have subjected our children to a natural experiment that they did not sign up for, where children in different parts of the country are exposed to dramatically different environments. The schools that are relatively responsible but are not implementing all these measures, I think they’re going to see a lot of cases. And hopefully they’ll be quarantining students accordingly. Although, of course, the consequence is that children are going to be missing out on school.

I guess from a public health standpoint, I and many other experts are really worried. I mean, we’re really worried about the consequences. We’re really worried about why we’re even doing this in the first place. You know, when we know what it takes for schools to reopen safely, why aren’t we doing everything that we can? I’m the parent of two young kids. I have a four-year-old also who just started preschool. I’m here in Maryland, and I feel so fortunate that I live in a jurisdiction where we do—we are following all the—all the guidelines. But I would really worry about—if we were living in a different area. I worry about all these parents who are being subject to very different types of environments.

So I’m not sure that I’m quite answering your question.

Q: Well, yes, that was helpful. As far as statistically speaking, I know that there’s a consensus out there, or there’s some who may think that children are less susceptible to this, of course. And I think that the science has kind of played that out. But to what—to what level should we really be concerned with sending our kids back into a school environment? And also, you know, what kind of innovative ways can we do—because I’m the parent of two school-age—well, actually, one’s in college and one’s in high school. How do we get the message out to the kids from a municipality standpoint? And maybe you can speak to something as far as what President Biden’s going to announce today. How can we make the importance of being safe in this type of environment for those type of kids, for kids that are entering into the school system?

WEN: Yeah. I mean, you make a—you make some really good points. And I think one thing that we need to make very clear is that children are affected by COVID. There has been this untrue, and I think very unhelpful and dangerous, narrative that somehow children are not affected by COVID. And it’s because of a comparison that never really should have taken place, as in what we have been saying from the beginning—which actually is true, but it’s not helpful in this context—is to say then, well, the majority of people who have died and have gotten hospitalized are older people. It is definitely true, and also true that children make up a small proportion of the total number of individuals who have become severely ill. Also it is true that children tend to become much less severely ill than adults from COVID.

But that is true for so many other illnesses as well. Children are resilient. Children are not supposed to die. I think that is the key that’s missing here. I mean, when we’re looking at what’s happening around the country, we know, of course, that kids twelve and old are eligible to be vaccinated, but under twelve they are not. When we have something like the Delta variant that’s so contagious, what’s gone on is that those who are left to be infected because of this very contagious variant are children. And children are now being—are now being affected in large numbers. In fact, the American Academy of Pediatrics just released the number saying that more than one in four of the new infections are now occurring among children.

We are now having more than two hundred kids being hospitalized every single day around the country. Tens of thousands of kids have been hospitalized during the pandemic. The hospitalization rate for children is 2 percent. So 2 percent of kids getting COVID are now getting hospitalized. And hundreds of kids have died. Thousands potentially could have long term consequences from COVID. I wrote an op-ed back in June about what if we had looked at this differently and instead of comparing kids’ outcomes to adults, what if instead we said: There’s a new illness out there, and that illness only affects children. And by the way, hundreds of children, including previously healthy ones have died, tens of thousands have been hospitalized. How might we react to that kind of news?

I mean, that is what’s happening. COVID is now one of the top ten killers of children. I mean, that cannot be acceptable to any of us as parents or as members of society. It’s our job as adults to protect our children. And I guess the final thing that I would say here is when asked about this issue, in particular in relation to schools, isn’t it our job as adults to protect our children? And if that’s the case, then what are we willing to do to do that? I mean, I guess I find it hard to see. Again, I have a four-year-old. I don’t think it’s very difficult—my four-year-old thinks that wearing a mask is just fine. That’s really all he knows, frankly. And, you know, wearing a mask and not going to school when you’re sick and doing regular testing, that doesn’t seem like a big price to pay in order to safeguard our children.

Q: No, Dr. Wen. Thank you very much for that education, because that’s the first and most powerful thing I’ve heard about the advocacy for masking up and getting vaccinated for children entering into the school system, because a lot of us don’t know this is a top ten killer of children at this time. So that’s very powerful, necessary information. We can pass it onto the citizens to make sure that we’re doing the right thing. Thank you very much.

FASKIANOS: Thank you. I’m going to go next to William Murray, who wrote a question and also has raised his hand.

Q: OK. Well, thank you so much for participating.

This is really a great thing. There’s so many questions that local officials have. We’re confronted daily with rising rates here in our own village, the village of New Paltz in the Hudson Valley and upstate New York. One question I had that I wrote about is—or, questioned, is that with the high transmissibility of the Delta variant, there doesn’t seem to have been any modification to recommendations to prevent spread. All that we’re reading is the same sort of information based upon, you know, variant A, if you will. But given how much more potent this one is, one would think there would be changes in ventilation recommendations, distancing recommendations, that sort of thing, given how quickly it can spread. Any thoughts on that? I haven’t seen anything from the CDC upping—you know, maybe we should be eight feet apart, or maybe we should all be wearing three-layer masks, or maybe, you know, ventilation systems aren’t going to be able to handle this particular variant.

WEN: Yeah, it’s a really good point that you’re making. And you’re right that we are dealing with something different here. I mean, not totally different, in that we’re still talking about a respiratory virus. It’s still spread through the same route. But the Delta variant is a lot more contagious. And when something is more contagious, it means that the activities that we once thought were pretty safe are now going to be higher risk. And so also we know, based on a study done by the Chinese CDC, that an individual carrying the Delta variant carries one thousand times the amount of virus compared to somebody with the previous variants, which I think is also—just tells us something about the transmissibility of this variant compared to before. And I think another reason why our schools, as they are reopening, we really need to take every precaution.

You know, what the CDC has done—and I think this is the right thing for them to do—was to reinstate or was to encourage local jurisdictions and states to reinstitute indoor mask mandates. And that’s something that I know some states and cities have done, but the majority have not. I wish that they would do this. I mean, we really understand about how transmissible the variant is, and having indoor—at least having indoor mask mandates is important. I would add—and I agree that the CDC has not said this—but I would add that a cloth mask is not sufficient. We should at least be wearing a three-ply surgical mask when we are in public places. And I would recommend if people are in higher risk areas and traveling, for example, with prolonged exposure, for long periods of time, close quarters with people, to be wearing an N-95 or KN-95 mask. We know that the quality of mask definitely matters and it’s also something that very much impacts the wearer as well.

Now, another element that I do think—I mean, I think you make an interesting point about should we be changing anything about distancing or anything else. I mean, I think at this point my major concern is that people have just really let down their guard. My family and I were at the beach over the holidays, over the Labor Day weekend. We were in an area of the country that actually has generally—last year we were there at the same place. They had mask mandates and everybody was wearing masks in grocery stores. This time maybe one in five, one in ten people were wearing masks inside a public grocery store with a lot of people. I’m more concerned that people are not following the rules that we already have.

FASKIANOS: Thank you. So in the interest of time I’m going to group some questions here. So Keith Hooker. Will the OSHA rule/guidance on vaccination apply to state and local governments as well or only to private businesses? And somebody else asked—let me find it—about would they also apply to colleges and universities? State Representative Lori Gramlich from Maine.

WEN: I do not know the answer to these questions. I mean, those are the questions that I have as well. I don’t know. My understanding is that the White House has directed OSHA to develop this rule. The rule has not even been developed yet. And so I don’t know. But I think that’s something that we should ask for clarification from the Biden administration.

FASKIANOS: Great. I’m going to go next to Susan Hairston, who has her hand raised.

Q: Thank you, Irina. And thank you, Dr. Wen, so very much. I have been dying to hear from you all. I’m a councilwoman in Summit, New Jersey. And we have an amazingly high vaccination rate in our town. And I am shocked by the number of increasing incidences. And so it really does beg to ask, is what we’ve been doing not making a difference? And it seems like it’s ammunition for the people who are opposed to it. And so I hear you loud and clear that we have to keep insisting on the norms about mask wearing and social distancing because there’s a competing interest.

Business is saying: Open up. Let me us get back to normal. Let us get back to making jobs, stopping unemployment. And all of these things are competing. And so what I wanted to ask you about, do you think there is the threat of a shutdown being necessary, since we have Delta, we have Lambda, I hear there’s another one. Would that be something that would be a short-term effect? We’ve seen it happen in other countries. I believe that’s Australia and China continues to do that.

And then the other thing that I’m finding alarming is it is our police and fire and some of the first responders who are some of the folks who are not getting vaccinated. And that’s been a challenge. And so I’m just wondering, is a shutdown something that might be on the horizon? I know it’s really an awful thought, but I just don’t understand. We feel like we should have learned so much more about this. Thank you. Appreciate what you’re doing too.

WEN: Well, thank you for the excellent questions and for the points that you’re making. So a few things: One is that I don’t think we should say that just because things are in the wrong direction that our efforts were for naught. We don’t know our own counterfactual, right? I mean, had we not increased our vaccination programs much earlier, had we not implemented mask mandates much earlier, had we not done all these things that you all have been doing, and doing education and outreach, imagine where things would be now, right? I mean, I think we can’t think about, well, things are terrible now and therefore there was no point to doing all these things. Actually, it should be, well, what more can we—what can we—what more can we do?

Well, we know that—I really believe that in this country—not necessarily in other countries, where the cultural contexts and political dynamics are different—but in this country I strongly believe that vaccines are our best and only way out. And that’s because the restrictions, the lockdowns that we’re seeing in other countries are never going to happen. I mean, New Zealand, Australia, they closed down the entire country for a couple handful of cases. That is never going to happen here. There is no political will to do that, even in places that might be amenable to doing these things. I mean, there is just no—the thing with our country, as I think you all know firsthand, is that the places that have the outbreaks—the largest numbers of outbreaks—are also the places that have resisted mask and vaccine mandates. So to think that these places would somehow go for lockdowns, that is just not politically tenable. It is not going to happen. And understanding that reality, we need to do what else we can.

And that’s why I think the Biden administration focusing on vaccines is the right step, because that’s the only politically tenable thing that we are able to get through and to get done. And so to your question about new variants that may arise, I mean, Delta is the issue for us at the moment. And that’s because it is so highly transmissible. When something is so highly transmissible, it displaces all the other variants that there are. And so, yes, there are Mu, and Lambda, and these other things that are on the horizon. But if they’re not more transmissible than Delta—and we don’t know whether they are. So I’m not saying that it will never happen with another variant. But Delta has taken this foothold here because it’s so highly transmissible. Could there be new variants that develop that are more transmissible, more virulent, more deadly, and that somehow evade the protection of our immune systems and the vaccines? Possibly. But that has not happened yet.

FASKIANOS: Just to group a couple of questions in the chat, how much of—the data on how much of the surge is due to unvaccinated compared to breakthrough cases in the vaccinated population? Can you give us the stats, and how this is very different considering the new variants? And then there’s another question about do you know when the approval will come through—this is like we all wish we had the crystal ball—for children under twelve? Those of us who have children under twelve, right? Do you know what the timeline is now for that?

WEN: Yeah. I might need you to remind me what the previous question was because I got so distracted by this—the kids question, as it’s so top of mind with two little kids under the age of twelve. The most recent—the most recent projections we have are that Pfizer, which is going to have data first, that they will submit for emergency use authorization for the FDA for kids in the six to eleven-year-old group—or, maybe the five to eleven-year-old group, sometime in late September. Authorization could come as early as late October to early November, that group. For younger kids, probably not until 2022.

And I’m sorry, Irina, the first question?

FASKIANOS: So just the first is just what is the data of—

WEN: Oh, breakthroughs.

FASKIANOS: The breakthrough—the surge—how much of the surge is due to the unvaccinated and how much is due to the breakthrough cases?

WEN: Yeah. I mean, it’s hard to have these exact numbers because we don’t have the capacity to do a lot of contact tracing in this country. But based on the numbers that I have seen we know that the vast majority of those who are hospitalized and dying are those who are unvaccinated. Numbers ranging from 95 to 99 percent. So very high numbers of those who are severely ill are the unvaccinated. I’ve also seen numbers that greater than 90 percent of those who are infected are those who are unvaccinated, compared to those with breakthrough infections. We also have a more recent CDC study that looked in the post-Delta world, after Delta became dominant, that a person who is vaccinated is twenty-nine times less likely to be hospitalized compared to somebody who is unvaccinated. And also, that a vaccinated person is five times less likely to contract COVID to get a breakthrough infection than someone who is unvaccinated.

So I think there has been some confusion, probably because the messaging from the federal government has not always been great. And I’ve written about the CDC’s messaging issues also. But one of the—one of the things that came out is that I think there has been some misunderstanding about, well, who is more likely to spread COVID—somebody who is vaccinated or somebody who is unvaccinated? Even if it’s true that a vaccinated person and an unvaccinated person, once infected, could both carry the same amount of virus and be just as contagious—which we don’t even know that that’s true. But let’s—even if that’s true, a vaccinated person is five times less likely to get COVID in the first place compared to an unvaccinated person.

So if it were me, and I had the choice to sit in a conference room with ten vaccinated people or ten unvaccinated people, I would choose the ten vaccinated people every single time because they are five times less likely individually to have COVID compared to the unvaccinated people. So I think that’s important to note. And I know this is not exactly what the question is asking about breakthrough infections, but I think many people are also asking—and all of you as officials might be getting this question too—of, well, what is the purpose of getting the vaccine if you can get a breakthrough infection?

Well, here’s the answer: Nothing is 100 percent, right? (Laughs.) Nothing in life is 100 percent. We don’t stop wearing seatbelts because somebody who had a seatbelt was in a car accident that landed them in the hospital. I mean, that’s not—we don’t stop doing that. You don’t stop taking your insulin because you could still have an exacerbation of your diabetes. And in this case, there’s actually a direct link because if you—the more—so some people will often ask too, well, what is my risk of having a breakthrough infection. Your risk depends on how much virus is all around you.

So if you are vaccinated, we know that the vaccines protect you very well but not 100 percent. That means that the more virus is around you because of the unvaccinated, the more likely you are to get exposed to COVID and to get ill. And I think that is really important to take into account.

FASKIANOS: Thank you. I’m going to go next to Kevin de Leon, who’s raised his hand.

Q: Thank you so much, Irina. And thank you so much for facilitating today’s conversation. And, Doctor, thank you so much for the information.

Just a really quick comment and perhaps your thoughts. I mean, one of the concerns I have with regards to the CDC was the criteria when it came to who would be first in line when it came to the vaccination. And clearly in California we’ve lost over 66,000 individuals to COVID virus. Slightly under half of them are from L.A. County. And the vast majority of people of color, but in particular Latinos, Asian Americans, African Americans. So when the criteria was sixty-five-plus, for L.A. County, you know, to illuminate that statistical data point, that meant 86 percent of Latinos were not eligible to actually secure the vaccination.

And many of them are frontline workers, essential workers, living in very dense neighborhoods with multi-generations under one roof—grandma, grandpa, mom, dad, kids. A lot of them did not have Blue Cross/Blue Shield, Kaiser, HealthMed, access to HMOs, PPOs, what have you, et cetera. Yet, they’re the one community who were most eviscerated and the ones who were standing in line waiting to pick up a box of food just to feed their children. And the only thing that’s standing between them living out on the streets and keeping a roof over their head is an eviction moratorium, which in L.A. actually extends one year.

So for the future, with regards to the booster shot—a third, you know, vaccination—what are your thoughts with regards to targeting those communities that have been hit the hardest as opposed to the generic CDC 65-plus, at the time when the first wave of vaccinations were available? Thank you so much.

WEN: Yeah. It’s a great question. And I also just want to mention that I grew up in the L.A. area. I grew up mainly in the East L.A. area, and I went to Cal State L.A. for undergrad. And so very much appreciate the work that you do from a personal standpoint, and certainly know of the communities that you’re referring to as well.

So with booster shots—and, again, many questions around booster shots. What we know about the vaccines is that they continue to provide excellent protection against severe illness, but that it looks like their protection against milder breakthrough infections does appear to be waning over time, and especially with the predominance of the Delta variant. I’m actually not so concerned as I was in the first instance when we were first making vaccines available, because that was literally a life-or-death issue, as in in the process of waiting—especially some of these communities that you mentioned that are particularly vulnerable, that are frontline workers, that are communities of color, with low income, multigenerational housing, et cetera—that some of them could have died. If they had—if they had gotten vaccinated earlier, they might have survived.

And so I think that’s a—that was a really big injustice, right? And that’s a huge inequity and that’s a major issue. I’m much less concerned now with the booster shots, because the boosters still protect—or, even without the booster, you’re still well-protected against severe illness. That said, I think—I hope that equity continues to be a focus for the Biden team going forward. But I also think that—you know, again, I’m just less—because this is not the life-threatening issue as it was in the first instance, I see it as a less pressing concern as it was before.

FASKIANOS: Great. Thank you. There’s obviously a lot of misinformation. There are a few questions about this. Is it a crime for TV or radio personalities to knowingly misinform people on issues like COVID, or can they be held accountable? Is there anything the CDC or the federal government, can they mandate anything, you know, to deal with that? And just to talk a little bit about—there’s some misinformation about people who’ve gotten vaccinated who have died. So and that linkage that maybe they died because they got the shot. Can you talk a little bit about those numbers and put in perspective of, you know, other vaccines and the percentage?

WEN: Sure. I mean, I think one of the difficulties with the numbers is there are people who just die, unfortunately, right? I mean, there are people every day who are dying unrelated to anything with COVID. But I think sometimes those deaths have very unfortunately been linked to the vaccine when that is really not the case. That said, there had been a handful—really a very small handful of individuals who actually have died because of—specific to the Johnson & Johnson vaccine and the rare blood clotting issue associated with it. It’s really tragic, and we now know about this issue.

But everything in life is about risk/benefit analysis. And in this case, when you look at the fact that 1,500 Americans are dying today because of COVID-19, and the number of lives that the vaccine is able to save, that’s the calculation that have to make at the end of the day. And so I think we really need to talk about how this is—these—we have vaccines for a reason. We don’t want people to get an illness that otherwise is preventable. The—by and large, the side effects are very mild, they are temporary, they are—people fully recover from them. And the—what we need to fear is COVID and not the vaccine.

The other issue that—about misinformation I think is a really important one. I mean, the surgeon general, Dr. Vivek Murthy, has announced that misinformation is, in itself, a public health crisis. And I think that’s a very important point. But I think we also—you know, I’m not a lawyer, so I don’t know—I don’t know how to answer the question about accountability and information. But it is of course, as you all know, a challenging issue of free speech versus the necessity of providing—of providing accurate information. I think having—for me, I was born in China. My parents left China because of the crackdown on free speech. And so for me the idea of limiting people’s speech makes me very uncomfortable. But I also—(laughs)—you know, agree that there’s more that, in particular, social media platforms can be doing so that messages aren’t amplified.

FASKIANOS: Right. Amy Cruver put in the chat: Can you share the studies that validate masking in the chat and discuss natural immunity compared to medical vaccines? I don’t know if you can share maybe some of those studies that we could send out to the group, or you could put in the chat, but we can also circulate it for people. I want to make sure we get you that information.

WEN: Yeah. And actually, I’m going to put in the chat now all of my recent op-eds. And you can flip through. I’ve written a lot on children recently. But my most recent op-ed is exactly on this issue—which is on the so-called natural immunity versus immunity from vaccination. And, you know, my point in the op-ed is to say, look, if you recover from COVID, just as if you recover from other illnesses, you do get some level of immunity. We don’t know whether it’s better than or not as good as getting vaccinated. But we do know that if you get vaccinated on top of having COVID-19, of having recovered from COVID-19, you have even better immunity.

My husband had COVID before the vaccines were widely made available. There was no question that I was going to recommend that he gets the vaccine. And in fact, we now know from a CDC study done in Kentucky that people who are fully vaccinated after recovery are—well, we’ll put it another way. People who are unvaccinated are twice as likely to get reinfected compared to people who got COVID and then got—and then the vaccine. The point that I was making in the op-ed is we should not wait for natural immunity. The price to pay is just too high.

By the way, same thing for other vaccine-preventable diseases. We don’t wait for children to get measles, because a substantial portion of them are going to get brain damage. We don’t wait for people to get polio because a substantial portion will have irreversible paralysis. We don’t wait for people to get COVID, because people have long-term consequences, and brain fog, and could end up in the hospital and die. And so that’s why we have vaccines.

FASKIANOS: OK. There’s a question—just to clarify something that you said. You said that COVID-19 is the top ten killer in children. Was that for all disease or all—just comparing to diseases or just death for children? So they wanted clarification.

WEN: I believe it is death for children. Again, it’s one of the op-eds that I wrote recently that I will find for you and post in the chat.

FASKIANOS: Great. All right. So I’m going to go next to Representative Lori Gramlich from Maine.

Q: HI. Thank you. And thank you so much, Dr. Wen, for this opportunity. This is really informative.

My question has to do with—Maine has done a really great job, in my opinion. And I’d love for you to partner with our CDC director, Dr. Nirav Shah. He’s been fantastic. But we have seen our seven-day average in Maine back in June be right around twenty COVID cases. And as of today, we’re up to 359 COVID cases, which is, you know, obviously an incredible increase. We have hospitals that are seeing increased COVID patients. And we’re really getting to a tipping point. And I’m sure Maine is not the only state where we will have little to no room for other patients with emergent issues. And I know that you can appreciate that as a physician. What kind of protocols do you, in your medical perspective, suggest that we try to implement in terms of folks that could prevent this from happening by getting the vaccine versus somebody that presents with a cardiac event who may not have a space in the hospital? This is really—this is really going to, I think, get much worse before it gets better. And I really appreciate your thought and perspective on that. Thank you so much for the work you do.

WEN: Well and thank you for your work and leadership. And Dr. Shah is a friend and colleague who is doing great work. And so you’ve certainly got a wonderful top health official there. He is also the president of the—of ASTHO, which is the state and territorial health officials, and has been doing a wonderful job there as well. So I like the idea of listening of to Dr. Shah’s advice on the ground and his—and his public health guidance there in Maine.

But, you know, I think that part of it is—I don’t have a good answer to your question. I mean, the easy answer, of course, is the—we need a combination of approaches. We need to increase vaccinations. We need to get regular testing—which we really need to do a lot more of, by the way. We haven’t talked today so much about testing. We talked about masking, but not so much about testing. Imagine if everyone were to be tested every week, or even twice a week? That would be—testing is not, in itself, a preventive measure, but if people are tested that regularly you’re going to pick up a lot—on a lot more cases that we otherwise might not have.

I think part of the issue, and one that we as a country have not really wrestled with, is what is our end goal here? What is the endpoint? What’s the endgame, right? What are we aiming for? We’re not going to get to what Australia, New Zealand, and some of the Asian countries have tried of zero COVID. That’s just not going to happen. But are we OK if we reduce COVID to the level of the flu? I mean, are we going to be OK with about forty thousand deaths every year? Maybe. Right now we’re at half a million deaths a year. So I think getting down to forty thousand would certainly be better. But is that what we’re OK with? Are we OK just getting to the point that our hospitals are not getting so overwhelmed that patients with heart attacks can’t get care? I mean, what is our end goal? And I don’t think that we, as a society, have actually defined that.

FASKIANOS: Great. Just going to—the concerns about how fast the vaccine was developed—how fast. The mRNA technology, and there’s been a lot of people worried because it was developed in less than a year. But can you talk about the underlying—what came before, so that it really ramped it up and we were in a good position for this vaccine?

WEN: Yeah. I’m glad you mention this because this is one of the common questions that we get, is somehow about the speed of development. Well, this vaccine has—this platform for developing this vaccine has been undergoing science—a scientific research for over a dozen years. And so saying that this is new is not exactly an appropriate way of framing it. It’s a new vaccine because it’s a new disease. But the—because that technology was already developed for so long, this was essentially a plug and play. And that’s what it’s going to be going forward, that if there are new variants that end up developing you plug into this mRNA technology and it’s able to be used in the future.

This vaccine, just like others, work in a similar way. Which is, the idea is that if you were to get exposed to a disease you would have immunity going forward. But instead of having you to go through that sickness, and disease, and potential death, instead you get exposed to a component that stimulates your immune system. That’s exactly what the mRNA does. Some people have questions about well somehow is this going to interfere with my DNA. Your DNA is in the nucleus of the cell. The mRNA never enters your nucleus. And so there is no chance that it’s going to be interfering with your DNA. And so I think those are important components to mention for those of you who have to—those of us who have to answer questions about the vaccine.

FASKIANOS: Right. There is a question about symptom reductions from different viral treatments. We’ve heard a lot in the news about ivermectin and other things. Can you just talk about ivermectin and other early treatments, versus the monoclonal infusions? What’s the difference, et cetera?

WEN: Yeah. Well, I think it’s really important to talk about what works and what doesn’t. We now know that if you have severe COVID that what works if you’re hospitalized are steroids, remdesivir and anti-viral medications, supportive treatment. And you could get ventilation, oxygen, et cetera, if you’re very severely ill. To prevent you from reaching that stage, once you have gotten a diagnosis of COVID, monoclonal antibodies made by Regeneron, Eli Lilly, et cetera—those are—we know that those help to prevent you from ending up in the hospital. So those are meant to be treatment that you get while you have mild illness early on in the course of your illness to prevent you from being hospitalized.

There have been other things that have been studied. Plasma, hydroxychloroquine, ivermectin, vitamin D, zinc. All these things have been studied as: Could they also keep you out of the hospital if you get mild illness? And so far, all the evidence points to no. Ivermectin is an antiparasitic that’s—we hear that it’s used in farm stock, I livestock, but it’s also used for parasites, for scabies. So it is a medication that’s used.

There have been ten randomized controlled trials—a really great systematic review that was done in Journal of Clinical Infectious Diseases last month—or, I think back in June, maybe—in June or July—that looked at these ten randomized control trials of ivermectin. And they found that even if they’re used in small dose, or large dose, or several days, or one time use, that it does not contribute to a reduction in hospitalization, or symptoms, or mortality. So ivermectin, hydroxychloroquine, all these things are not—have not actually been found to be helpful in preventing or treating COVID.

FASKIANOS: Great. And with that, I am sorry, but we are going to have to end early, because I know you have to react to this—President Biden’s announcement. So thank you all. There are so many questions, raised hands. I’m sorry we couldn’t get to you all. But, Dr. Wen, we really appreciate your spending these fifty minutes with us. It was really terrific. And for all the work that you have been doing. Again, I commend to you all Dr. Wen’s book, Lifelines. Also, in the Washington Post she has a new newsletter called “The Checkup with Dr. Wen.” So you should sign up for that. I have. And we will send out a link with—to this webinar so you can share it with your constituents, as well as some of the other resources she mentioned, studies. We’ll collect that up and send it to you all so you can look at it in detail.

So thank you all again for being with us, and thank you for all the work that you’re doing, as well as you, Dr. Wen. You can follow here on Twitter too, @drleanawen. So take care, everybody. And please follow the State and Local Officials initiative on Twitter, @CFR_Local. You can go to CFR.org, ForeignAffairs.com for more expertise and analysis. And you can let us know how we can continue to support the important work that you’re doing by emailing us at [email protected]. So thank you all again. Take care.

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