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The COVID Pod with Dr. Ashish Jha: Vaccinating the Nation, Two Doses at a Time

The COVID Pod is back in 2021 with more insight from Dean of the School of Public Health at Brown University Ashish Jha. On this episode, The COVID Pod team takes a look at vaccine administration — what has been done so far and where it is going to go in the next few months. Dr. Jha shares his experience with vaccination, addresses vaccine hesitancy and postulates what the timeline for rollout will look like for college students and the public in both Rhode Island and the country.



Subscribe to the podcast on Spotify, Apple Podcasts or listen via the RSS feed and email us to contribute a question for the next episode: herald@browndailyherald.com 

Cate Ryan  

Hello and welcome back to The COVID Pod with Dr. Ashish Jha. Today is January 29, 2021, and this is our first episode of our second season. We will be continuing our biweekly conversations with Dean of the School of Public Health at Brown University Ashish Jha, who is a world-renowned expert in public health and has really provided us with so much useful information over the past few months or almost a year of COVID-19. We are really excited to be back. I am Cate Ryan, and I’m joined by two of my colleagues at the Brown Daily Herald, Rahma Ibrahim and Emilija Sagaityte. 

Emilija Sagaityte

Hello everyone, great to have you all back and listening to The COVID Pod. My name is Emilija Sagaityte and I’m a Senior Editor here at The Brown Daily Herald.

Rahma Ibrahim

Yeah, great to have you guys all back, my name is Rahma Ibrahim, I am now a section editor for Science and Research. 

Cate Ryan

On today’s episode we’re diving into vaccine rollout and what the next few months could look like. Feel free to email us at herald@browndailyherald.com. Thanks for listening.

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Cate Ryan  

A lot has happened since we last spoke in November. We are in a new year, there's a new president, vaccine administration is underway and I guess we wanted to start with something that happened this week, which is that you got your first shot of the Moderna vaccine. So could you just tell us a little bit about that process?

Ashish Jha  

Sure. Yes. So yeah, so vaccine rollout is starting to happen, started happening in December, and has not gone super well, which we can talk more about, but one of the first groups of people prioritized were frontline healthcare workers. And you know, as you all know, I recently switched jobs about five months ago, right, and I came over. And so I also switched clinical location. And so I was just, I was waiting to get vaccinated until I was ready to start basically going back on the wards and seeing patients again. And so all my credential stuff went through, and I was ready. And so I need to get vaccinated if I'm going to go back and start seeing patients, and so I got set up. And what's interesting is the morning of, I was texting with a friend and she said, “So which vaccine are you getting?” And I said, “I have no idea.” Like I literally had no idea. And it was another way of saying it didn't matter. Like it made no difference to me. And I showed up, and it was super simple, straightforward, and I got my first shot, felt fine, like my arm was sore for about 24 hours, but that happens after the flu shot, too, and the Moderna vaccine is known to cause more symptoms after the second dose. And I've had some friends who've … who felt pretty exhausted for a day after their second dose, so I'm ready for that. But it was great like, obviously I think all of us eventually want to get vaccinated and most people do and people should, and for me, it was very important that I not cut in line, but as a frontline health worker, I needed to get vaccinated — it was good for me and everybody else as well. And it's been totally fine, and now it's almost been a week, and I've got my second shot scheduled about three and a half weeks from now. I'll let you know how it goes.

Cate Ryan  

Thank you. Yeah, and sort of going off that topic: We also have heard lots of stories in the news about vaccine hesitancy still being an issue, even among the people who were in these first few phases getting offered the first doses of the vaccine, and what do you usually say to people who express any doubt about that vaccine or this process in general?

Ashish Jha  

Yeah, I think my feeling is: I'm, I'm sympathetic to people being hesitant. Look, the vaccines were developed fast. And I know that a lot of people are worried about whether they are really safe and how much we really know about them. I am obviously very comfortable because I feel like I've looked at the data, and the data is really compelling that these vaccines are super safe. And it is a bit of a problem that there's so many people in the healthcare industry who are hesitant because we need them vaccinated for themselves, but we also need them vaccinated for the people they're going to be taking care of. And so my approach on this is, we should be engaging with them, talking to them, understanding their hesitancy and trying to address it respectfully. I also think some of those people who are hesitant will become less so over time as they watch their co-workers get vaccinated and do fine. 

And then there are going to be really interesting policy questions that organizations are going to have to face — like, if you're running a hospital, do you allow doctors who have refused to be vaccinated practice in your hospital? And you could make the case that your first responsibility is to your patients, and your patients are less safe. You know, I cannot practice in the hospital if I don't get my flu shot. If I ever walked in and said, “Yeah, I'm skipping it this year,” they would say “Your privileges are suspended until you get vaccinated.” And I think that's reasonable. I can imagine people are gonna end up making the same choice. But right now I'd like to use more education engagement and understanding and less the stick of, you're gonna lose your job.

Emilija Sagaityte 

Thinking about the idea of policies as well, so another challenge that has been discussed in terms of the vaccine rollout is discrepancy in guidelines and procedures across state lines. So we were wondering: Where would you recommend that people look to to get the best information for their state? And also, just generally, if they're trying to learn more about the vaccine and its distribution?

Ashish Jha  

Yeah. So there are two sets of things. If you want good information about the vaccine, I do think, again, we've always looked to the C.D.C. for this kind of information. The C.D.C. has not been quite as reliable in the past year, but I'm actually very confident that that is already changing, and will change under Rochelle Walensky. So Rochelle is a colleague and friend who is now the head of the C.D.C. She's fabulous and has more integrity and expertise than almost anybody I know, or more than anybody I know. She's incredible. So for people, if you're trying to just get good information about the vaccine, like go to the C.D.C. website, and that's gonna have probably the best summary of the data. On what to do in an individual state, I mean, what's been interesting is that the previous administration, more or less just said to every state, you figure it out on your own, and there's gonna be no real effort to do anything in a uniform way. States are different, like it probably does make sense to do things a little different in Rhode Island than in Montana, but you do need some uniformity, some amount of guidance, some approach that does cross state lines. And that's been hard. So I'm hoping that through more federal coordination, we'll get a bit more of that as well.

Emilija Sagaityte

In terms of people who then have received the vaccine already, such as yourself, could you talk a little bit about what they should be mindful of then moving forwards, such as in regards to public health regulations and policies and such?

Ashish Jha  

Yeah. And I've only gotten one dose, so I am hardly protected. The data, by the way, just is that after about seven to 10 days after the first dose, you start having some protection. And as of this morning, I'm like day four or five. So right now I feel like I am the same as somebody who has not been vaccinated; my immune system hasn't had a chance to really kick in. But you really need two doses to have the full protection of both Moderna and Pfizer. 

But the question is, okay, so I will get my second dose in a few weeks — what happens? Can I take off my mask and start like, hanging out in bars? No, no for many reasons. One of them is it's 95 percent, not 100 percent, protective. So you say, “Well, that's still a lot and it's awesome.” Like, it's huge. I don't want to undersell these vaccines; these vaccines are miraculous how good they are. But 5 percent risk is not zero. And here's the key point: 5 percent of a big number is still a big number. So while the pandemic is really bad, and there are lots of infections out there, I don't think I'm gonna do anything different. 

But once the pandemic starts getting under better control, cases come down — and again, let's hope all that happens — then being vaccinated, I think does afford you a bit more flexibility. And so could I imagine, in a few months, being able to sit down with somebody else who's also been vaccinated? Yeah, that will feel much more comfortable. So I think that's kind of another critical thing. 

And then the last thing that we still don't know is how much the vaccines reduce transmission. Now, one of the things that's really important for people to understand is a lot of people — because we don't know exactly how much — some people end up saying, “Oh, we don't know that the vaccine reduces transmission at all.” That's not true. I think we have very good reasons to believe that vaccines reduce transmission. But we don't know if it's 60 percent or 80 percent. 

It turns out, I live at home with my kids and my spouse. And if I started acting irresponsibly, I could then come home and infect others. So there's all sorts of reasons why I still need to do all the public health stuff, both for myself and for my family. But once there is widespread vaccinations, behavior will absolutely change, we will be able to wear masks less often, I will be able to get together more often — all the stuff that we want to be able to do.

Emilija Sagaityte

So kind of considering, though, then that we have these still ongoing public health concerns that we should be wary of, one of the things we had all talked about last semester, before we went on break, was about how we have these testing measures in place and these preventative measures. So could you also speak a little bit to what those are like currently, both in our community and kind of more broadly, where we stand right now?

Ashish Jha  

So let's talk about testing for a second. Because one of the big misunderstandings a lot of people have had is well, once people get vaccinated, can we stop doing all this testing? And in fact, the short answer is no. And I think first of all, this spring, like Brown, obviously, our testing regime is more or less what we had in the fall. And it's good, because it worked, right, like we had some really large outbreaks in Rhode Island, but very little on the Brown campus, despite the fact that a lot of students live out in the community — so a reminder that a good testing regime is incredibly valuable and useful at allowing people to function and get a lot of their lives back. 

The good news for the spring is, while we could do that at Brown, the rest of the community of Rhode Island couldn't really do that. We're starting to see a lot more testing available in Rhode Island, so now people can go get tested much more readily. And in fact, I've been encouraging people to get tested. And I think we'll see testing in public schools, we're gonna see testing elsewhere. So what we were privileged enough to be able to do, we will need to continue doing, but now other people will be able to do it too. 

And by the way — here's the part I don’t know if I’ve even told the Brown University leadership, so maybe they're going to find out first my views on this — ... but I don't think we can stop testing next year. I expect, by the way, that all the students will have the opportunity to be vaccinated by next fall, certainly that by summer, we should have enough vaccines available for everybody. But in even a fully vaccinated campus, I would still have some sort of a testing regime next fall. Because it's not clear to me that we'll be able to keep the infections at zero, given what's going on: the variants, everything else. So I don't think testing is going to go away next year. We may not need to do it twice a week, we could dial it back a little probably, don't need to do the same test. There'll be other tests available, the 15 minute rapid test, so you get a result in 15 minutes. Yeah, there's gonna be advantages of being able to do it a bit differently, but we'll still need to be testing. I probably should have told the Brown people that earlier, but they probably know. Anyways, that was just realizing that that's not a view I've expressed publicly, but I’ve been thinking about it for a while.

Rahma Ibrahim

On that note about vaccinating at Brown and your ideas for what that could look like — we were wondering if you could share some insight on what and when vaccination for college students as a whole may happen. When do you expect that to happen? What's the timeline you envision?

Ashish Jha  

Yeah, that’s a really good question. And just in the last 24 hours, we've seen two sets of data released, one from Novavax and one from Johnson and Johnson this morning. And, we've got to get more clarity from both companies on when vaccines will become available. So let's talk about my best guesses. And there are a lot of moving parts here, right? I think most adults, including college students, will want a vaccine. And college students are going to be kind of near the bottom of the line because they're like the healthiest and lowest risk. … So let’s work backwards. 

I think certainly by June, anybody who wants a vaccine should be able to get one; May probably; April, probably not. Like somewhere around April, May there'll be a switch. April will still be like trying to vaccinate people who are at risk and the low-risk people will still have a hard time getting it in April. But I can imagine by May it’ll come to a point where all the high risk people have been vaccinated, and we really open it up to everybody. It's possible it could slip into June, but I'd be surprised. So if I’m a betting person, I'd say most college students will probably get vaccinated in May — could be June, I wish, or in April, but probably not.

Rahma Ibrahim

Shifting away from vaccines for a bit and focusing on Rhode Island leadership and your recent naming as a member of incoming Governor McKee's COVID-19 advisory group — can you talk about the announcement and what your role could look like?

Ashish Jha  

Yeah, I spoke to incoming Governor McKee and he wants to make sure that he is really focused on using evidence-based approaches to get (COVID-19) under control in Rhode Island. And he asked if I'd be willing to be on his Advisory Committee, and the short answer was yes and absolutely. With Governor Raimondo, it was more that I was on an Advisory Committee for the Department of Health and … often just conversations with her and with her office. Look, my job is very simple, right? I want to be helpful. I want to give advice, and given that political leaders can ultimately decide how they use that advice, but I want to give them open, honest advice. And I told incoming Governor McKee that I want to be helpful to him every bit as much as I wanted to be with Governor Raimondo. 

I don't know the details yet of this Advisory Committee — I don't know if it's gonna meet, I don't know all the issues that it's gonna tackle. But I expect that if I am being helpful that they should feel comfortable reaching out and I'll continue engaging.

Cate Ryan

And we also underwent a major leadership transition last week with President Joe Biden being inaugurated. And we were wondering if you could reflect on what you're seeing so far with this new administration, in terms of policies, but also what you hope to see going forward.

Ashish Jha  

Yeah, what a change. And, let me actually frame the change in the following way. Because, you know, people can easily see what I'm about to say, and what I have been saying, as a somehow a deeply partisan comment — that Joe Biden is a Democrat, and maybe I'm more supportive of Democrats and Republicans. I don't see it that way at all. I see it as the rules of the road. In the U.S. federal government, it has always been that when a Republican is in office, they put in conservatives, but competent, experienced conservatives. And then when democrats are in office, they put in liberals — competent, experienced liberals — and then you can see policy changes. But the fundamental, underlying principle is these people have to be competent and experienced. And so then, in the past, under a Bush administration, or even an Obama administration, I would disagree on policy. But I never wondered whether these people were actually competent and could do their job or not. I just disagreed with their approach, because maybe there's a philosophical difference. 

The last couple years of the Trump team, it was, I mean, I'm going to be excessively harsh, but it was filled with people who were incompetent, who didn't understand disease outbreaks, didn't understand how this stuff works, didn't understand vaccinations, and just kept bungling everything, like literally could not give deep information about how many vaccine doses were available. Like doesn't feel to me like an unsolvable problem. 

So the biggest breath of fresh air is that the people that President Biden has put in are all deeply competent people, deeply experienced. They’re good at their job. Now we can have a debate on policy, and we can debate trade-offs, but they're like good at their job, and that is already making a difference. They're communicating. They're not downplaying. So President Trump and his team kept saying this pandemic is gonna go away. These guys are not saying it's gonna go away, they're gonna, they're saying it's gonna get worse before it gets better because they're actually being truthful. So it's a totally different world. And I'm having to adjust because I generally am in public, you know, saying like, don't listen to the people in the federal government, they're giving you junk information. And now, it has to be much more nuanced, like, Rochelle Walensky, who I think is brilliant, is saying X, I think I have a slight disagreement, but it's a very different level of conversation, right? So I'm much more hopeful — of course, it's nice to have people who know what they're doing running the government. I think things are going to get much, much better. I trust information coming out much more. But they've been in office for about nine days, and they need more time to sort out the mess and get things back in shape.

Cate Ryan  

Is there anything else hopeful that you would want to leave us with this week?

Ashish Jha  

Absolutely. So there are a couple of challenges, people are probably hearing about the variants and how bad things are. And the variants really are complicated. But what I — the point I want to make to people is much more hopeful, especially with a competent federal government. And, and one of the other points actually is a competent federal government who understands we have to engage with the world because this is a global pandemic. But we are going to get through this. By the end of this semester, by the end of the spring semester — I know we are in a three-semester system, so it's a little different timing-wise — but let's just say by the end of spring, forget that semesters, life will really begin to feel meaningfully better. And if we do the things that we need to do, well, we will never look back like these are the hardest days. And so for folks who are listening, what I would say is that this month, rest of you know, basically, January, February, March are the hardest months of this pandemic. And April will be better, I promise, and May will be way better, and June is going to start feeling like a new version of normal, June into July. So if people are feeling like, I can't keep going like this, I totally understand, gotta hang on a little bit longer, not that much. Vaccines are coming, we're gonna have more of them. And we've got, we've got real policies that are starting to make a difference, and I'm incredibly hopeful. But people have to hunker down for a couple of more months, because it's just, it's that time period right now, where this is it, and then we're gonna get through this. And then we're gonna be in better shape.

Cate Ryan  

Yeah, well, thank you for sharing your insight and optimism with us, as always, and we look forward to more conversations this semester, as those changes begin to happen over the next few months.

Ashish Jha  

Thank you so much for restarting this. I really enjoyed doing this in the fall. And I'm glad that we're going to continue to do it in 2021.

This transcript has been edited for length and clarity.

____________________

Produced by: Cate Ryan 

Reporting contributed by: Emilija Sagaityte and Rahma Ibrahim

Sound mixing by: Cate Ryan

Music composed by: Katherine Beggs ’22.5

Special thanks to Bilal Ismail Ahmed and Elise Ryan for cover design.



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