On Friday, Nov. 13, Dr. Ashish Jha joins The Herald’s COVID Pod team to discuss the aftermath of the 2020 Election and President-Elect Joe Biden’s announcement of a COVID-19 Task Force. Dr. Jha also walks us through news from Pfizer that the company may have a highly effective vaccine in the development, based on early results, and what the roll out of that vaccine could look like.
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This transcript has been edited for clarity and length.
It’s Friday, November 13 and this is the COVID Pod with Ashish Jha. I’m Colleen Cronin, Editor-in-Chief of the Brown Daily Herald, and I’m here with three of my colleagues from the Science & Research desk who will be introducing themselves to you.
Hi, I’m Cate Ryan and I’m a senior Science & Research editor at The Herald.
Hello my name is Emilija Sagaityte and I’m a Science & Research section editor here at The Herald.
And I’m Rahma Ibrahim, a Science & Research senior staff writer.
On today's episode, Dr. Jha will talk about President-Elect Joe Biden's new COVID-19 Task Force and what they will and won't be able to accomplish before Joe Biden is inaugurated in January. And he also will talk about Pfizer's potentially 90% effective vaccine that they sent a press release out about this week. What does 90% effective mean? When could we see the results of further trials with that vaccine? And what would it look like if it eventually gets rolled out in the coming year. Stay tuned. Listen in. Email us if you have any questions and enjoy the episode.
The last time we spoke with you in the runup to the election, we obviously didn’t know who had been elected, and we’ve since found out that Joe Biden will be the next President of the United States. And this week President-Elect Biden announced a COVID-19 task force made up of scientists and doctors and public health experts. We were curious what you think about the makeup of this committee and if there were any surprises?
Yeah, a couple of things. So first of all, I will, I have to say, I was very pleased by the election, and, and not for sort of kind of traditional partisan reasons. But really, because the current administration, especially in the last three, four months, has taken an approach to the pandemic that I think is borderline unconscionable — just really has decided to let the infection spread. And, and the Biden team really has been very, very clear. And Mr. Biden himself has been very clear throughout the entire campaign that he plans to take a very different approach. And I believe we need a different approach. So his views on the pandemic really, were much, much closer to mine.
In terms of the task force, the pandemic task force that he named on Monday, this past week — you know, I tweeted, this is the A team. It's actually funny, because I put A dash team, and a bunch of people were like, the A minus team? I’m like no, no, no, the A team. It’s the A plus team if I need to clarify.
But let's talk about why it's so, it's such a good team. It is a really broad mix of individuals. It is people who are physicians, who are health policy experts, people who are infectious disease experts, people who are experts on issues around health equity. When you think about all of the different ways in which the pandemic has affected our society, there are people on, on the taskforce who've been deeply enmeshed in each of those areas. So it's a great group.
There's some challenges, like the biggest one is President-Elect Biden is not President Biden. He's President-Elect. And he has … no more power today than he did two months ago. Or last week. And so then there are some fundamental questions like, what can the task force actually accomplish? And, and I believe there are two main things they can accomplish, three things maybe.
One is well we can start getting both from the taskforce and from Mr. Biden himself, and Senator Harris, is much more clear and consistent information. So one of the major problems in this pandemic has been the constant misinformation that has not just come from various sources, but also has been echoed by the White House. And I think having a national figure speaking plainly to the American people about what the status of the pandemic is, what the likelihood is of things over the next three, six, 12 months, I think will be immensely helpful. Because I really think it has been deeply unhelpful for our current president, to be saying, really, since February, that the pandemic is about to go away, that the virus is going to disappear.
Guess what, the virus is not going to disappear. It's not gonna disappear next month, it's not gonna disappear in three months, it's not gonna disappear — it may not ever disappear. Now, you know, we'll be able to manage it very effectively. But there are very, very few viruses that we have been able to eradicate from the face of the planet. So, it's not at all clear to me that that's ever going to be possible. But the bottom line is, we just need to level with the American people. And then we need to help them understand how their lives are going to change over the next three, six, 12 months if we can do what we can do. So I think that communication’s going to be really important, the team can help do that.
The second thing the team can do is lay out the plans for what Mr. Biden will do on January 20 when he assumes office, right? You don't want to start thinking about it at that moment; you want to start thinking about it now. And they can do that.
But the third thing, which I think would be probably the most — I don‘t want to say the most important, but just as important — is they can start sending out market signals now. So I'll give you an example. There's almost every major company that makes testing or could make testing, will make diagnostic tests. I have spoken to almost every one of them there and their leadership. We have so much more capacity to ramp up testing in America than what we're actually doing.
Right now we're doing a million and a half, maybe two million tests if you include all the tests that are being done per day. We should be at 10 or even 20 million tests a day, that would make a profound impact on the pandemic. So the question is, why aren't we? And it's basically because the federal government has been absent. And when I talk to companies, and they say, yeah, we could probably do another, you know, 20 percent more. And then I say, what if I told you that, that there was no limits on money, like you would, you could get lots of resources, you could get help from the federal government, what could you do? And they’re like, in that context, and if I'm guaranteed resources, I could probably double my capacity.
But of course, I'm like a random, private citizen, I don't have the ability to say, go ahead and do it, and I promise we'll pay 100 million dollars, right? Like I, I couldn't write a 100 million dollar check. But the Biden team could make that promise today that “if you do it by after January, we will be in power, and we will make sure that you get paid.” Right. And that would send the kind of signal to the market where people would then start really ramping up production.
So that's the challenge. That's something that they can do, that market signal that we’re coming, and you can really start doing things differently. I think it'd be incredibly helpful in getting things going, even before they have any formal power.
I think you sort of just touched on it talking about increasing testing, but in the first 100 days of a Biden administration, are there a couple of things that you think could happen that could make the difference? And maybe help us out in this coming winter?
I do. … In order to get that accomplished in the first 100 days, they got to get going now, right. But what I think they can absolutely do is, and what I'm going to want to see, and I think they ... is again, as I said, we're at, we want to see ubiquitous testing, we want to get to a point where there's just testing happening all over the place. And the value of it, just so everybody's clear, is when you can test people on an ongoing basis, you pick up a ton of the asymptomatic folks. I mean, why are we testing on campus at Brown? We're testing on campus because we want to pick up asymptomatic people. Now why do we want to pick up asymptomatic people? Because asymptomatic people spread, and we want to catch them before they spread the virus to lots of other folks. That's how you prevent outbreaks. And there's very good modeling data and other types of data that if we do lots of asymptomatic testing, we can actually bring the pandemic under control. So I want to see ubiquitous testing.
And if we're at one and a half to two million tests a day right now, I think by the end of the first hundred days of the Biden administration, I will be disappointed if we're not at five to 10 million tests a day. And I suspect we can be for two reasons. One is I think it has been fully within the power of the federal government to enable it. Mr. Trump and his team have just chosen not to. But second, is they've been saying that's what they want, and they're committed to doing it. And so they claim to be committed to doing it, they have the power to do it, and it'd be immensely helpful. I think it's gonna happen. And I would be disappointed if it didn't.
Do you think we'll see a national mask mandate?
I think they're gonna try. Again, I’m obviously not a legal scholar, and there are people who wonder whether such a thing is possible. So I think they're going to try, and I think that's a good thing.
But I'll tell you, I think there's something even more important than that on mask wearing, which is there are a lot of places that have mask mandates where people don't follow it, because of a combination of misinformation, a sense that somehow masks are political. And, you know, I'm not advising President Elect Biden, but if I were, one of the things I would suggest to him is that he consider in this interim period going and visiting red states, states that did not feel free, and talking to people about the importance of wearing masks.
And it's one thing for him to do it from Delaware. And of course, there's safety issues in the pandemic is going to be raging. And again, his team's gonna have to figure out whether he can do this and what, but I think that would send a very powerful signal of him saying he wants to govern as an American president. And second, that he, I believe he would have a chance to really win some hearts and minds by going to people's home states, and saying, this is really important. And this is not important for politics, this is important for people's lives and health. So I would love to see that. I think we might, we probably will see some sort of an effort to do a massive national mask mandate. But fundamentally, this is about the hearts and minds more than it is laws — the laws are important.
So on that note, I know you just mentioned not advising the Biden team. But when we spoke last week about the possible outcomes of the election in our Q&A session, you mentioned something about speaking with the Biden team. So can you perhaps elaborate on the capacity to which you are able to do that and if you are going to be in touch with them during the transition?
Yeah, absolutely. So my strategy throughout this entire pandemic has been, I'll talk to anybody who's interested in listening, and I'll share my views with anybody who wants to hear them. And so since March, I have spoken to people on the White House Task Force many, many, many times. I’ve spoken to other people in the White House who were not part of the task force. I have spoken to Republican and Democratic governors, Republican and Democratic members of Congress. And my strategy is the same thing, which is I just tell people what I think we ought to be doing.
And my, you know, my general take is, my advice is free. And if it's useful, please come back for more. And if it's not useful, don't. And I've also spoken to the Biden campaign team multiple times, during the campaign, and nothing is going to change. I know a lot of the folks on the transition team. I know a lot of people in the, on the task force — several of them are my friends. I expect to remain in contact and tell people what I think.
There are two strategies I use, I generally do it in a very informal way. That way, I can just tell people what I actually think and I don't have to guise it in the context of what do I think is going to play well, or not. Well, and, and second, I tell them in private what I would generally say in public. And I don't really change my message.
Obviously, in private, there's some specific issues that might come up, they might say, well, I'm really struggling with this issue or that issue that they can't say publicly. And obviously, I keep that in confidence. But I try to be very transparent, open about this. And again, I don't really struggle with trying to think about changing my message, I just feel like I, there are certain things we ought to be doing. And, and I will say that. And so yeah, we'll see what happens. But, but my goal is to try to continue to be helpful both to the White House over the next two months, because they control the levers of government, and to the Biden team to the extent that they need or want it.
So speaking of thinking about what to do next, and the next steps to take, as well as what can we do to address this virus, as you said, if we can't eradicate it right away, we did get some exciting news earlier this week about the Pfizer vaccine being over 90 percent effective. So we were thinking, if you've had the chance to look into the study behind that a bit more, could you elaborate on the significance of those findings? And what do we really know about the vaccine at this stage right now? And what is its potential moving forward?
Yeah, great question. The Pfizer vaccine, there is no study behind it yet. They just haven't released any data beyond what was in the press release. And I tend to be very, very cautious about analyzing studies based on press releases. And I'm gonna throw a little bit of that caution to the wind right now and say, I think this was a really big deal.
Okay, so why do I think it's a really big deal? Because I don't think Pfizer is manipulating the data for a press release, I just think the cost of doing it would be way too high. This is way too high profile. So I generally believe the headline numbers that the effectiveness data is going to show 90 plus percent effectiveness. Second is it's not like we have no data on the Pfizer vaccine; we do have some data from the first and second phase trials. But the reason why I think this is a really big deal is this is the first time we have seen data that shows a vaccine is actually effective. Until now we've shown that it generates an immune response. That's great. But we don't care about an immune response, per se, we care about it if it protects people. That's the goal. And there is plenty of history of vaccines that generate immune responses, but don't actually protect people from infections. And the fact that this one does seem to do that is great.
Second is 90 percent effectiveness is not what I was expecting. So I've been saying for months, that I think it can be 50 to 60 percent. And if it's 70 that'd be great. And I can't even really hope for 80. And so 90 makes a massive difference. Because it really ... once vaccines are widely distributed, it will really change the dynamics of the virus. Again, it won't eradicate it; it won't make it go away the way smallpox has been eradicated. We don't think about smallpox mostly, most people shouldn't because it's been eradicated, but we, but I don't think that's going to happen with this. But a 90 percent effective vaccine really makes a big difference.
The couple other things that to me, it's really useful to understand is 90 percent effectiveness of this vaccine makes me much more optimistic about other vaccines. So the Moderna vaccine is very similar in lots of ways to the Pfizer vaccine. And I wouldn't be surprised if the Moderna vaccine also comes in at 80 or 90 percent. And that'd be amazing.
The last point is, you know, that almost all of the vaccines have been targeting the spike protein of the virus. And there's been a fear in the back of my mind, I think a lot of people's minds, that we put all our eggs in one basket. And what if we misunderstand something fundamental, and the spike protein being not, like targeting, ends up not being useful. And that would have been a catastrophe, because it would have meant that almost every vaccine was destined to fail. And this has flipped it. And now it feels to me like almost every vaccine is destined to succeed. Again, I don't want to get too far ahead. I'm literally going off of a press release only. So I realized that I'm being a little less cautious than I generally am. But I see this as really good news.
And I see this as there's been a light at the end of the tunnel, and the light just got a whole lot brighter. It's still months away. I mean, we're not ... to quote our president, we're not turning the corner. But it is really good news. And I think we should take it as that.
I was thinking about an article I read in the Atlantic this week about how vaccine development may — with these results in mind — sort of be completed during the Trump administration to some extent, but then the Biden administration is going to have to work more with the American people to actually enforce vaccines being administered. So, I guess, how do you think that poses a unique challenge to the Biden team? And how will public health measures sort of be affected by this transition and this timing with the vaccine?
Yeah, so while I think, and I've been obsessed with testing since March, and so I think testing stuff is going to be a huge priority for the team, and it is, it's the logistical challenges of getting hundreds of millions of Americans vaccinated over the next six plus months, is immense. So many of these vaccines, including the Pfizer vaccine, has to be stored essentially frozen, and shipped frozen, be thawed and given to people. There's just this massive logistical challenge to get the vaccines out into places where people can show up and get vaccinated. That's one huge issue.
Second is we need a very clear plan on priority: who's gonna get vaccinated first, who's gonna get vaccinated second, who is gonna get vaccinated third.
Third, and maybe the hardest of all three, is we need an information and educational campaign that builds trust in the vaccine. There is a lot of hesitancy. I don't believe that, I may have said before, I don't believe the term “operation warp speed” was helpful. It creates a sense that somehow we're cutting corners. The good news is we have not been cutting corners; the vaccine development has been done with incredible scientific integrity.
I think a lot of the credit of why we've gotten to where we are goes to the Trump administration. They have done a fabulous job on speeding up the development of this vaccine, putting resources into it. You know, I feel like I am happy to criticize the Trump administration when they screw up, and they have messed up a lot in this pandemic, but on the vaccine stuff, they've been terrific. And the Biden team is going to inherit a process that's been done well, hopefully, the capacity and lots and lots of doses of the vaccine of various vaccines, but then they're gonna have to figure out how to get it out, and how to get people to feel comfortable taking it. And that's an enormous challenge. It's all going to depend on that, because, you know, I have to say, this kind of almost trite line that I often use, which is vaccines don't save lives, vaccinations do. And there's actually quite a large gap between vaccines and vaccinations. And they have to do with trust, and they have to do with supply chains.
Do you worry at all that, although the news I think, at least to me, made me feel a lot more hopeful — looking forward to the next couple of months — do you worry at all that the news might have people sort of reverting back to some not super safe behaviors because they're so optimistic that this vaccine will come out?
So one of the things that that's been hard from a communications challenge has been trying to help people understand that the next two to three months will be the hardest months of the pandemic. And we are. The vaccine is not going to help in the next two, three months, not in any meaningful way. And whereas, get beyond two to three months, and things will start getting brighter, much, much faster. Right. And so that means that actually, you want to be particularly careful from a public health point-of-view for the next two, three months. Because it's sort of like, we're almost there, this is not the time to get sick, this is not the time to die. Not that it's ever the time to die, but like this is the time to protect people. Because we're so close.
Now imagine, we didn't have a vaccine, imagine the alternative world of the vaccine had failed spectacularly andmade us worried that all the vaccines were going to fail. Then we would be saying, my God, we're like a year away or long term, time away from like, really being able to, then we would have, it would be harder to justify all of the public health measures, because they do have a real cost. But right now, like, we should be doing everything we can to protect people, because we're so close to the finish line.
And the way I see this is in December, by the end of December, January, I believe we're going to have two to three vaccines authorized. In December, in January, we’re going to start getting health care workers vaccinated, high risk people in February, March. And in many of their kind of rest of folks by like, March, April, May. And so it's sort of like, hang on for a few more months, and life will get better, life will get meaningfully better. This is not the time to let go of these restrictions.
I worry a lot that people are overestimating how quickly vaccines are going to become widely available. FDA hasn't even reviewed this yet. They have not even authorized it. You know, Pfizer thinks that they're going to have 20 million doses for America over the next month or six weeks — that's 10 million people vaccinated because everybody needs to get two doses. Let me assure you that unless you're a frontline health care worker or a first responder, you're not getting that vaccine in that first batch. And so it's not right there. Right, we got to hold on.
I want to just ask about having to get two doses. Is that a fear at all? Is there a possibility that, you know, I guess a fear that people won't get the second dose is what I'm thinking? And then my other thought is that, could there be another vaccine that just is a single dose, or, you know, which, as Americans will probably would welcome, having only one shot?
Yeah, no, there are single-dose vaccines that are pretty far along in clinical trials. So I fully expect single-dose vaccines to be coming as well.
This is a two-dose, your protection is going to be much much lower after one dose. And so people will and, and I do worry about just a logistical challenge making sure people can come back after 28 days, right if you think about it. And I'm less worried about healthcare workers and first responders, but I am more worried once it gets to the broader population, and people are otherwise healthy. What I'm thinking is that if we are lucky enough to get a single-dose vaccine out, let's say by late winter, early spring, then maybe we really use a two-dose vaccine for high risk people and first responders and those folks, and then for the broader population might end up being that we go to a more single-dose just because it'll be easier to administer. But we're gonna have to see, and obviously, like, now, I'm getting three steps ahead of myself, because we've just not seen any data yet on the single-dose vaccine. And we've got to, we've got to wait, but I am optimistic we're gonna get to a single dose vaccine by spring.
I know that we don't have a lot of time left. And we haven't even touched on the 160,000 cases in the single day of just ... I think every time we talk, we talk about how big the numbers are, and then they seem to get bigger and bigger. So I don't know if you want to touch on that.
Yeah, so this is... Yeah, as I said, I think we're in the worst moment of the pandemic, there's more infections right now in America than at any point. And I, it's hard to see what the circuit breakers are like, it's hard to see what slows this down. And, you know, and governors and mayors are, I think, reacting way too late. The federal government has essentially thrown in the towel and has decided they're not going to do anything.
This is not where we should be in this pandemic. I think we need to see more leadership from governors around the country. And I will tell you right now we have about 1000 to 1200 Americans dying, we are going to 2000 deaths a day. (It’s) already baked into the system — we are going to get there. We are going to have more than 100,000 Americans die between now and Inauguration Day. And it's wholly unnecessary. Like we've got a hold on, those hundred thousand people, who if we could have gotten them through it, would have gotten vaccinated and could have lived a very long time.
So I just find this kind of, find this unbelievable that this is where we are. And ultimately, the thing that is going to get us through this is if people themselves are careful, I don't think we should be expecting leadership from our leaders. And so I think we all have to exercise our own leadership. And that means being careful. It means always wearing a mask when you're outside your home. And it means not getting together with people who you don't live with indoors for any extended period of time, just not doing it. Two months, two months, it's not, we’re not talking about forever, but two months, and I and everybody needs to do it. And then I think we can get, you know, we'll get through it. And then things will start getting better.
Thank you so much, Dr. Jha, always so lovely to talk to you, even though it's a tough subject. And we look forward to talking to you again very soon.
Thank you so much for having me. And it's always fun chatting about this. And let me just do one quick thing. I know that it can feel like this is a down time. And this all sort of feels a bit depressing. As I said, there is a light at the end of the tunnel, it's getting brighter and brighter. And I'm really excited about the future, it will get so much better. And we'll get much of our lives back. And let's just do what we need to do to protect people until we get there.
This podcast was produced by The Brown Daily Herald. You can find us on Spotify, Apple Podcasts and on our website: browndailyherald.com. The song was created and composed by Katherine Beggs, a Brown University undergraduate student. And check back with us next week where we’ll sit down with Dr. Jha for a bonus episode about how to stay safe over thanksgiving and the coming holidays. Thanks for listening.
Produced by: Cate Ryan and Colleen Cronin
Reporting contributed by: Emilija Sagaityte and Rahma Ibrahim
Sound engineering by: Cate Ryan
Music composed by: Katherine Beggs ’22
Special thanks to Elise Ryan and Bilal Ismail Ahmed for cover design and production assistance.