The U.S. Approves a Vaccine

[0] From a New York Times, I'm Michael Bobarrow.

[1] This is a daily.

[2] Today.

[3] The United States has granted emergency authorization to Pfizer's vaccine for the coronavirus, a turning point in the pandemic.

[4] I spoke to my colleague, science reporter Donald G. McNeil Jr. on what happens next?

[5] It's Monday, December 14th.

[6] Donald, I just want to start by...

[7] getting your reaction to this news, the fact that we now have an approved vaccine for the coronavirus in the United States?

[8] I think it's great.

[9] I mean, this is what we've been waiting for.

[10] This is the way out.

[11] We're not getting out through masks and social distancing and all the other steps that, you know, countries like China took, so we're going to have to get out through pharmaceutical means.

[12] And fortunately, this is step.

[13] Step one.

[14] We're going to need several vaccines, but several vaccines are on the way.

[15] Right.

[16] This was our, in some ways, first and last best hope, and it has happened a heck of a lot faster than I think many of us, including when I first began speaking to you back in February and March, you thought was going to happen.

[17] Yeah.

[18] The record was four years.

[19] I thought maybe we could cut that in half, but we're doing much better than that.

[20] I mean, we've got a vaccine out in less than a year.

[21] It's amazing.

[22] And it shouldn't take.

[23] too long for other vaccines to come out because the epidemic is raging so fast right now that the phase three trials of other vaccines ought to go quite quickly.

[24] Well, I want to talk about the fact that the pandemic is still raging in such an out -of -control way and kind of where that is going to leave us during this kind of weird interlude between approval of the vaccine and the vaccine actually reaching lots of people.

[25] And I wonder, just how dark you think this is all going to be during this kind of inter -period?

[26] I think we are in the valley of the shadow of death.

[27] It is really dark.

[28] We know the sun is going to come up over a mountain at the other side of the valley, but it can't rise fast enough.

[29] Right.

[30] You have invoked this very dark biblical reference, but how deep and dark will this, Valley of the shadow of death be, do you think?

[31] Okay.

[32] We are now seeing more than a million new cases a week, new confirmed cases.

[33] So presumably there's more that we aren't testing.

[34] We have more than 100 ,000 people hospitalized and it's growing.

[35] We have about 3 ,000 dead a day.

[36] which is almost an impossible figure to absorb.

[37] Yeah, well, that's about how many people died in 9 -11.

[38] Exactly.

[39] That's about how many people die to Pearl Harbor.

[40] That's more than people die of cancer or heart disease each day, what were normally the two biggest killers in America.

[41] And if nothing changes, we're on track for 500 ,000 dead by the end of winter.

[42] Wow.

[43] Unless we have a giant change.

[44] of heart as a country.

[45] So are we in the really awful place that we are in right now, partly because of the Thanksgiving holiday, partly because, as we saw in many televised images, people did travel.

[46] Is that part of what's going on here?

[47] Yes.

[48] TSA figures show that about 40 % as many people came through their airport checkpoints this year as last year, you know, on Thanksgiving week.

[49] So 40 % of a normal, very high travel week is a lot of people.

[50] Yeah.

[51] So, and, you know, many of those people gathered together in houses and there was clearly a lot of transmission and we're now a little bit more than two weeks beyond Thanksgiving.

[52] And normally, if you get infected, you know, usually one week till you show symptoms, two weeks till you show hospitalization.

[53] And then usually it's three to six weeks before death.

[54] So we expect the deaths to keep going up.

[55] And if nothing changes, you know, we might go through this.

[56] again at Christmas time, and Christmas isn't very far away.

[57] A surge upon a surge is what Fauci calls it, and he's right.

[58] Well, that's extremely depressing.

[59] Yep.

[60] I'm curious how you would, Donald, describe this period that we are in when it comes to the government's approach to the virus, because it feels like both in a national level and at a local level in many places, there's not really any effort to keep people from behaving the way that they are beyond rhetorical guidance, right?

[61] There are a few states, California, Pennsylvania, New York just made some announcements that are trying to tell people that they can't eat indoors or they can't go to the gym.

[62] But by and large, that is rare.

[63] So what do you make of how the government is approaching this right now?

[64] Well, there's no guidance out of the national government in Washington.

[65] I mean, Donald Trump has just sort of lost interest in the problem, it sounds like.

[66] And then you've got the 50 different states.

[67] And states that had resisted imposing mask mandates, the governors have sort of finally come around, realizing that their hospitals are filling up and said, put on a mask.

[68] I think it was the governor of Iowa, the governor of New Hampshire, there's another one in North Dakota.

[69] And the hospitals in the mostly unmasked states are the hospitals that are filling up.

[70] Something like 200 hospitals across this country are already at capacity.

[71] one -third of the hospitals in this country are at 90 % capacity.

[72] And there are also states where you have people out in rural areas with, you know, sometimes hundreds of miles between hospitals and many of the hospitals full up.

[73] So the truth is that what we've got across the country is even though the idea of achieving herd immunity by letting the virus wash through is made fun of by all public health experts, we are de facto sort of following that policy because in a lot of.

[74] a lot of places, the measures, the masks and the social distancing and the shutting down of restaurants and stuff that would hold off gaining herd immunity that way are not being imposed.

[75] So the virus is blasting through us and old people are hiding from it, but young people are not.

[76] The problem is we're seeing the flaws in that strategy, which everybody, every responsible public health officials said were there.

[77] You can't hide all the vulnerable.

[78] And some people die, they have no underlying conditions, no reason to think that they would have a bad outcome from this disease.

[79] And yet they're, you know, people dying.

[80] So it's fair to say at this point that the United States has kind of unofficially decided to let the virus more or less wash through the population.

[81] I don't think anybody's decided it.

[82] But individually, one by one by one, every state is not doing anything to stop it.

[83] So you've got the fact on the ground that the virus is washing through the population and filling the hospitals and killing people.

[84] I'm just curious how much that surprises you that we have arrived at this point as someone who has covered so many different approaches to pandemic in the past.

[85] I knew from the beginning it would be difficult to get Americans to go along with the kind of lockdowns that were imposed in China, obviously.

[86] I thought that once the virus began hurting and killing people around the president and around the governors of seeing their own voters or their own family members die, they would embrace social distance skin masks and things.

[87] And that didn't happen.

[88] I mean, the president got it himself.

[89] And then he got, you know, the monoclonal antibodies that saved him.

[90] And that his wife got it.

[91] His child got it.

[92] Several of his children have had it.

[93] It's, you know, I cannot believe that the lesson doesn't get through.

[94] So, Donald, as we continue to exist in this valley of the shadow of the death phase and we wait for mass inoculations, I want to just quickly touch on the treatment options that are available to people who do get sick.

[95] And you have introduced us to monoclonal antibody treatments.

[96] and you have told us how effective they are, and we have seen that because of those around the president who have received them and done well by them.

[97] So should we expect that that treatment may end up serving as the key stopgap while we wait for the vaccine to make its way through the population?

[98] No. And the reason is that there's not enough of it.

[99] The two companies, Regeneron and Eli Lilly, that we're making the antibodies were, I think, on track to make about 100 ,000 doses each by the end of December.

[100] We're now, we've got 200 ,000 people getting infected every day.

[101] So it's impossible.

[102] And our colleague, Charles Tolberg, did a great story the other day saying that people who were connected to the president were getting these antibodies and VIPs were using their connections to try to get them for themselves or for their relatives.

[103] That's not the way you're supposed to distribute medicine in the country.

[104] Right.

[105] So the bottom line is that we should not expect any treatment, whether it's monoclonal antibodies or something else, to serve as a meaningful treatment to get us through these dark days before the vaccine is widely available.

[106] Not as long as we keep crowding into our hospitals as fast as we are.

[107] I mean, not unless we do something to stop the increasing cases.

[108] We still have what we had before.

[109] We still have oxygen, thank God.

[110] We still have ventilators.

[111] We still have steroids.

[112] And we have monoclonals, but they're just aren't enough for everybody.

[113] So we're sort of stuck waiting for the vaccine.

[114] There's no choice.

[115] We'll be right back.

[116] So now let's turn to this new and much brighter world that we are about to start entering.

[117] The world.

[118] of inoculations throughout the United States, starting with Pfizer's vaccine and eventually with vaccines from rival companies like Moderna, AstraZeneca, Johnson, Johnson.

[119] I want to just start, now that we are living in a world where a vaccine has been approved, with a few very practical questions.

[120] Once you get vaccinated, how able will anyone be to start resuming life in what might be a normal way, unmasked, unencumbered.

[121] Well, first of all, you have to get the two doses for the vaccines that are two doses, and those are either three or four weeks apart.

[122] I mean, you do get some protection from the first dose, we believe, but you really have to wait for this, take the second dose, and then you have to wait at least a couple of weeks your antibodies to build up, and then you are considered to have gotten basically the full protection.

[123] So you're looking at something like a month or so.

[124] you're looking more like six weeks from the first shot you get the shot you're going to get another shot close to a month later and then you have to wait another couple of weeks for the effects of that booster to kick in and then you're about as protected as you're going to be now the important question is even if you're protected against severe disease and if you're protected against infection is it possible that you can get a mild infection that can then reside in the cells in your nose so that you can actually spread the virus.

[125] And the answer is we don't have that data yet.

[126] So that is one area where public health leaders are being conservative and saying, let's assume you might still possibly, you know, be able to get a second infection or transmitted to somebody else.

[127] So the benefit of asking people to keep abiding by these rules, it may be psychological rather than medical, but it's likely to happen.

[128] Donald, who at least at the beginning will not be eligible for this new vaccine?

[129] It's not who won't be eligible.

[130] It's that the FDA punted on this a little bit back towards doctors.

[131] The vaccine is authorized for people over 16.

[132] There are people who are in risk groups for which there is not enough data for the FDA to make a really specific decision.

[133] for example, pregnant women, for example, people who might be immunocompromised because of HIV or cancer treatment.

[134] But in those cases, they said essentially consult with your doctors.

[135] Because what they recognize is, even though the safety data doesn't exist for these specific groups, they know the virus is dangerous for these specific groups.

[136] So they'd like everyone to talk to their doctor about whether or not the vaccine is safer for them than the risk of the virus is.

[137] That's a fair number of Americans, especially those under 16.

[138] Children are now being enrolled in some of the clinical trials, and you wouldn't normally enroll people who are immunocompromised in trials because it's potentially dangerous.

[139] So we haven't tested it.

[140] We'll learn that over time.

[141] Yeah.

[142] Okay.

[143] What about people who have had the virus and recovered from it?

[144] Do you expect that they will be taking the vaccine, should they?

[145] I talked to a doctor friend of mine who had a bad bad of the virus, and he expects to take the vaccine.

[146] He's doing it because we don't know how long immunity from the virus lasts.

[147] And also he wants to set a good example for his patients, since he's a gerontologist and he has a lot of elderly patients and he wants them very much wants them to vaccinate.

[148] And one of the first things that happens for a doctor is that the patient says, well, Doc, would you take it?

[149] And if he can say, I already did, then that's pretty persuasive.

[150] And what good or bad have we learned from the first few days of vaccinations in the United Kingdom?

[151] It's going pretty well.

[152] It's encouraging.

[153] It's going into very elderly people.

[154] And most of them, as far as we know, are doing fine.

[155] There were a couple of anaphylactic reactions that's a intense.

[156] hence allergic reaction, sometimes in which your throat begins to close up.

[157] But those were in people who had a history of anaphylactic reactions.

[158] And we don't know if they were actually caused by the vaccine or maybe latex in the stopper on the vaccine or something like that.

[159] And it should not surprise people.

[160] You know, if they feel bad, what you're doing is putting an antigen into the body that provokes the body into producing an immune reaction as it does when you actually get sick.

[161] And so you feel the fever.

[162] It makes you feel crummy.

[163] But it's technically it's the immune reaction that's causing the fever, not the cold virus.

[164] You're telling us we should be celebrating on some level.

[165] Our body's reaction to this.

[166] Yes.

[167] If you're getting a reaction, good.

[168] You're getting what they call in vaccinology a take.

[169] That is the vaccine is having an effect.

[170] And you're reacting to it and basically breeding the soldiers that will fight the disease if that disease ever comes to you.

[171] Okay.

[172] Okay.

[173] So with all this knowledge, let's talk about how things are likely to unfold in the United States in the coming weeks as we start inoculating.

[174] We know from previous conversations with our colleagues that frontline medical workers, nursing home residents, they will be in the front of a line.

[175] Then we enter this kind of nebulous territory of essential workers.

[176] Who, as best you can tell, determines who is essential.

[177] And will that, vary from place to place in state to state?

[178] Yeah, I think it will vary from state to state.

[179] I mean, there is an advisory committee to the CDC, which will make up a recommended list of sort of the order in which this ought to go to people.

[180] But then those are just recommendations, and there are going to be a lot of people screaming and clutching at the governor's coattails trying to say, me, me, me first, and the governors are going to have to make some tough decisions.

[181] You're saying this could very well be subject to lobbying from all sorts of people.

[182] Well, look at what happened to monoclonal antibodies.

[183] They're in very short supply, and so VIPs are going after them.

[184] I could see this turning into chaos for a while, you know, in the beginning stage, because there's going to be a lot more demand than there is supply.

[185] Okay, so this is a trickier question.

[186] What does the government do with people in these various categories who don't want the vaccine?

[187] And how widespread do you think that phenomenon will be at this point?

[188] Okay.

[189] This is a really complex question.

[190] A few months ago, polls suggested that 51 % of Americans would not take a vaccine.

[191] But I was never that pessimistic because I thought those polls were being affected by fear that the vaccine was being rushed in order to help Donald Trump get reelected.

[192] And that once we got past that, assuming the vaccine was safe, that there would be more faith in the vaccine.

[193] And that is what happened.

[194] That's what not only did the results not come out until after the election, but then they were astonishingly better than anybody expected.

[195] I mean, 95 % effective.

[196] That, I think, gave people more confidence.

[197] And you could actually see that in the polls.

[198] The number of people saying they wouldn't take a vaccine started dropping, you know, to more like 40%.

[199] Now it's heading for 30%.

[200] And what gives people confidence in vaccines is seeing people they know and trust, advocate them, and then take them, and suffer no will effects.

[201] So as you look around, people you know have had the vaccine and nothing has gone wrong and they also haven't gotten sick.

[202] And you look at what your life could be if you took the vaccine.

[203] That is to say, eventually you'd be able to fly on airplanes and go back to work and take your kids back to school and all the rest.

[204] You'd have pretty strong motivations to take the vaccine.

[205] Right.

[206] Your fears would be allayed.

[207] Right.

[208] This all points to significant participation in vaccinations.

[209] Right.

[210] But there's also, I mean, if you think masks were polarizing in the last few months, vaccines, I fear, are going to be far more polarizing because masks are really simple technology to understand.

[211] You know, a piece of cloth goes over your face and you can't blow your germs to somebody else.

[212] But vaccines have all this, the questions of, you know, MRI, DNA, DNA, adenovies.

[213] virus.

[214] What's that?

[215] A chimpanzee had no virus.

[216] Are you kidding me?

[217] You want me to inject myself with something that came out of a chimpanzee?

[218] I mean, the rumors that spring up around vaccines are enormous and they're being fed by everything from Q &on to Russian trolls.

[219] And there's a chunk of the United States that has said that they're not going to take a vaccine under any circumstances.

[220] The problem is if you have enough people refusing the vaccine, your epidemic never ends.

[221] it slows down quite a bit, but you have this low level of continuously circulating virus.

[222] And there are people who could be victims of that virus with bad outcomes, like people who can't get vaccinated, like people with compromised immune systems, like people who are undergoing cancer treatment.

[223] I mean, hopefully by that time, we'll have vaccinated children, but there will be a number of people in society who can't be vaccinated because of allergies to something in the vaccine or something like that.

[224] That's always true.

[225] And if there's a constantly low level of circulating virus, those people who can't vaccinate might get hurt.

[226] Right.

[227] It's tempting to think, well, I'm getting vaccinated, so I'm protected.

[228] But what you're saying is there are people who can't take the vaccine, for example, somebody with a serious allergic reaction.

[229] And that person is put at risk by somebody who refuses to get vaccinated.

[230] Exactly.

[231] Exactly.

[232] And when you have that situation, sometimes the government has to step in and say, this won't stand because it's not just your personal choice.

[233] You are putting other people in danger.

[234] Well, let's talk more about that because we have established on the show that the government of the United States is extremely unlikely to mandate that Americans get the vaccine.

[235] But I wonder if there will be rules in various work.

[236] or businesses about what you can or can't do depending on your vaccination status?

[237] Well, it isn't the government of the United States that would mandate the vaccine because most of these laws are state laws.

[238] And in the big smallpox outbreak of 1900 to 1903, 11 states mandated smallpox vaccine.

[239] Huh.

[240] Massachusetts among them.

[241] And that's what led to the famous 1905 case of Jacobson, Massachusetts, where there was a Lutheran pastor who refused to take the smallpox vaccine, and he was fined.

[242] He was fined $5, but that went all the way to the Supreme Court.

[243] He said, this is my personal liberty.

[244] I don't want the vaccine.

[245] And the Supreme Court said, no, you can be punished for refusing the vaccine.

[246] People misunderstand the law.

[247] People think the law is about my personal right to choose.

[248] And conservatives tend to see this as a version of the second amendment that, you know, the Constitution gives me a right that, you know, the government can't take away my gun, so the government can't make me take a vaccine.

[249] And liberals tend to see it through the lens of Roe v. Wade of the notion that, you know, the Constitution provides me a right to privacy and the integrity of my body, and so the government can't go and violate my body.

[250] And those are both wrong analogies because Jacobson versus Massachusetts was based on what's called the police power of the state.

[251] That is the power of the state to prevent me from doing damage.

[252] So the state may not be able to take away my gun, but if I walk down the street shooting people with it, they can definitely take my gun away.

[253] It is the right of the government to stop people from doing harm to others, whether it is with bullets or pathogens.

[254] And that is definitely, definitely, within the traditional police powers of the state.

[255] On top of that, it's also, it has been established that it's legal for employers under the right circumstances to require vaccination.

[256] And it may get beyond employers.

[257] It may be, you know, airlines may refuse to fly people who haven't been vaccinated.

[258] Cruise ships would be crazy not to, you know, let people on who were unvaccinated.

[259] You know, these are going to cause serious union battles.

[260] But there are, you know, numerous hospitals in this country where all the doctors and all the nurses and all the janitorial staff and everybody else has to have a flu shot every year.

[261] And it's not just a flu shot.

[262] They have to have all that they have to have tuberculosis test every year.

[263] They have to show that they're up to date on their other vaccines that you don't need every year.

[264] They have to be basically vaccinated against any possible disease that they could transmit to the patients in the hospital.

[265] Some hospitals say, well, you have to wear a mask in flu season.

[266] And other hospitals say you're fired if you refuse.

[267] And the unions fight against this, but the unions often lose.

[268] So given the patchwork of rules that are likely to come from states and from employers, that raises the really important question of verification and enforcement, how we will know that somebody has gotten vaccinated and isn't just saying, yeah, yeah, I got my vaccination.

[269] And Don, we started talking about this with you way back at the beginning of the pandemic.

[270] What mechanism?

[271] might exist to tell the world that you have been vaccinated, and that was very theoretical at the time.

[272] I wonder how far along we have gotten in creating, now that a vaccine is about to reach many Americans, a reliable system for signaling that someone has actually been inoculated.

[273] Well, we don't have it.

[274] And as far as I can tell, through interviews I've been doing, there aren't any firm plans to do it either in the Trump administration or in the incoming Biden administration.

[275] Right now, the CDC is handing out little cardboard.

[276] cards that say CDC, and they, and on them, you know, when you get vaccinated, they should scribble the name of the vaccine, the lot number of the vaccine, and the date you were vaccinated, and then I suppose theoretically it will be stamped with a rubber stamp.

[277] So not a very high -tech system.

[278] No, it's not a high -tech system at all.

[279] And there's no reason you couldn't do that.

[280] I mean, you could have a way of showing through your cell phone, through a, you know, a unique code, a QR code or something that you, you know, put it over a scanner.

[281] And it doesn't have to give your name or particulars or anything else.

[282] It just has to say, you know, put a green check saying, yes, this person has been vaccinated.

[283] But you're saying no such system is in place or even is planned at the moment in the U .S. As far as I can tell, nothing is even envisioned.

[284] This is something that's being discussed, but no decisions have been made.

[285] So I'm gathering from what you're saying, that we don't know how widespread acceptance will be of this vaccine, and we don't yet have a system for even verifying that someone has the vaccine, all of which is suggesting to me anyway, that this next phase is going to be pretty complicated and a little bit messy.

[286] Yeah, it could be pretty chaotic.

[287] Okay, now that you have described all these variables and all these kind of unknowns, I wonder if you subscribe to the timeline that has come out of the government, especially from the head of Operation Warp speed, that life might look normal in the United States by the summer of next year by June of 2021.

[288] Yeah.

[289] I mean, everybody fudges a little bit on saying, you know, what month or what quarter they think.

[290] Tony Fauci says by the end of 2021 or sometime before that, maybe fall, maybe earlier, it's very hard to know.

[291] There's so many moving parts.

[292] You know, you have, you know, how many vaccines get approved?

[293] are they made and distributed with no big hitches, that kind of thing, you know, and what level of acceptance is there?

[294] I mean, if there was 100 percent acceptance and all the vaccines that are now in the pipeline all came out, yeah, I would think we'd be able to get there by late spring, early summer.

[295] But whether or not that's going to happen is impossible to tell.

[296] It will definitely slow down.

[297] That's one of the things that you can count on, is that as more people get vaccinated, and particularly as you vaccinate people in nursing homes, because that's been the source of many of the deaths, you may actually see a slowdown in deaths.

[298] And that might happen earlier than the overall appearance of the beginning of the end.

[299] Well, Donald, I want to wish you a very happy holiday.

[300] And thank you for all your wisdom and your warnings over the past year.

[301] And I look forward to catching up in the new year when the vaccine is reaching as many people as possible.

[302] And let's hope for a happier new year in 2021.

[303] Indeed.

[304] I'll talk to you then.

[305] All right.

[306] Thanks.

[307] On Sunday morning, the first doses of Pfizer's vaccine were packed in dry ice and loaded onto trucks at the company's plant in Kalamazoo, Michigan.

[308] Workers there applauded as the first truck left the facility.

[309] Those doses will now be sent to hundreds of distribution centers in all 50 states.

[310] Inoculations are expected to begin today.

[311] We'll be right back.

[312] Here's what else you need to know day.

[313] The Times reports that after failing to challenge Joe Biden's victory in court, allies of President Trump are plotting a final stand on the floor of Congress in early January.

[314] The Constitution allows for members of the House of Congress.

[315] representatives to seek to disqualify a state's vote before Congress certifies the result of the election.

[316] That effort, which is based on groundless claims of voter fraud, is not expected to succeed, but could further erode confidence in Biden's victory.

[317] Today's episode was produced by Asa Chatharvedi and Rochelle Banja.

[318] It was edited by Paige Cowan and Wendy Doer.

[319] and engineered by Chris Wood.

[320] That's it for the Daily.

[321] I'm Michael Wobarrow.

[322] See you tomorrow.