Dr. Céline Gounder: “Herd Immunity Is Off The Table”

CHRISTIANE AMANPOUR: And turning now to the Omicron coronavirus variant that has the world on edge, at least 70 countries and territories have now imposed travel restrictions on several African countries after South Africa alerted the world to the variant. Epidemiologists and infectious disease specialist, Dr. Celine Gounder, was part of the Biden-Harris Transition COVID-19 Advisory Board. And she’s joining Walter Isaacson to tell us more about how the U.S. should be responding.

(BEGIN VIDEO TAPE)

WALTER ISAACSON: Thank you, Christiane. And, Dr. Celine Gounder. Welcome to the show.

DR. CELINE GOUNDER, INFECTIOUS DISEASE SPECIALIST AND EPIDEMIOLOGIST, NYU AND BELLEVUE: It’s a pleasure to be here.

ISAACSON: So, the big news today is that the CDC recommends that all adults should, they say should, get their booster shot. At first, a few weeks ago, you were a little bit cautious saying maybe you weren’t going to get that booster. Have you changed your mind, and if so, why?

DR. GOUNDER: Walter, the reasoning has changed significantly. The debate that we were having, scientists were having about boosters before was really about waning immunity. Were we seeing waning protection against infection and we were seeing waning protection against more severe disease? That calculus has shifted now. This is really a debate now or a decision about whether Omicron is immune evading and can you overcome some degree of immunization by giving an extra dose of vaccine? We know from another variant, the Beta variant, which was an earlier immune evading variant that you can, in fact, overcome that immune invasion with another dose of vaccine.

ISAACSON: So, in other words, if this mutation of the Omicron has caused it to be able to evade some of our immune structures just by building up more immunity with the booster shot, we might be able to overcome it?

DR. GOUNDER: That’s right. That’s right. So, by giving an extra dose, you might be able to overcome that relative evasion of the immune system and it also buys us time, time in which Pfizer, Moderna, other vaccine manufacturers can formulate second generation vaccines that are specific to Omicron. So, you know, if that booster buys us six months, that would be quite significant because we think it will take about three months or so for Pfizer and Moderna to update those vaccines and to get that into manufacturing.

ISAACSON: Now, tell me what mutations have occurred to make this new variant more dangerous?

DR. GOUNDER: Well, looking at Omicron variant, there are over 30 mutations of concern. It’s really the best hits of all the scary mutations we’ve seen in all the different variants. So, it’s hard to predict exactly how it’s going to behave just from its genetic sequence. But what we’re seeing, at least, in terms of individual mutations is concerning.

ISAACSON: Well, some of the mutations not to the spike protein but to the rest of the virus makes it seem like it could be sort of a stronger variant of the virus. Is that true?

DR. GOUNDER: Certainly possible. The three main characteristics of viruses that we worry about like this is, is one, is it more transmissible? Is it more infectious? Does it spread more easily from one person to another? And that we certainly saw with the Delta variant. The second question is, can it evade our immune responses, particularly, the immune responses we get from vaccination? We saw that, as I mentioned, with the Beta variant, and we are worried that we might see that with Omicron. And then, the third characteristic we really pay attention to is what’s called virulence. So, in an individual who’s infected with the variant, will they have worse disease than with other earlier forms of the variant? And we just don’t know really the answer to any of those three questions right now.

ISAACSON: Now, the mRNA vaccines we have, it uses a particular type of coding, you know, it’s a messenger RNA that goes after certain parts of the spike protein to replicate it so that our system develops immunity to that. Can we tell by looking at the sequence of this new variant how the mRNA vaccine might work?

DR. GOUNDER: You know, it is really difficult to predict by looking at a sequence. I do think we will have answers to whether our vaccines provide protective immunity and to what degree against Omicron really within about two weeks. Scientists are hard at work in the lab and that is a question that could be answered through laboratory testing. And so, I think, at least, that first of those three key questions, we’ll have an answer to pretty soon here.

ISAACSON: Now, the mRNA vaccine can be reprogrammed pretty easily. So, if indeed it’s not quite aimed at given immunity to this variant, you could just sort of put in a new sequence. If they do that, if BioNTech or Pfizer or Moderna are able to reprogram these vaccines, will they have to go through clinical trials again or can we get them quickly as possible?

DR. GOUNDER: So, the approval process is a bit different for an updated vaccine. It’s more similar to the approval the FDA gives for updated flu vaccines every year. And so, really, they’re looking at laboratory testing, not those big clinical trials for that approval. It’s a far more expedited process.

ISAACSON: Explain some of the recent state data to me. Let’s start with New Mexico, a place highly vaccinated and yet, it’s having one of the worst spikes and it’s very warm there, people still outside and people generally wearing masks inside. Why does that happen when everybody is doing everything right and getting vaccinated

DR. GOUNDER: Well, if you look at the hospitals in New Mexico, they’re not just taking New Mexicans. In fact, there’s a lot of overflow from Colorado, which we know has also been experiencing a huge spike recently, a lot of overflow from Texas, which — and I have colleagues in New Mexico right now. It’s been creating a lot of challenges for them because they have found themselves in a situation where their ICUs are full of out of state patients and they then are trying to call, you know, literally up to 40 local area hospitals for a local New Mexican. So, you know, I think we have to remember that this is not confined within our state borders, that what’s happening in the state next door can very much impact your hospitals as well.

ISAACSON: But you look at states like Minnesota, Vermont, New Mexico, having spikes, having a lot of cases, but also having high vaccination rates. That seems counterintuitive.

DR. GOUNDER: Yes, Minnesota is a really concerning sign as is Michigan. They have high vaccination rates, but it is not evenly distributed. So, if you look at the twin cities, they have very high vaccination rates. But if you go out to the rural areas in Minnesota, the vaccination rates drop tremendously. And even if we say, you know, a state has high vaccination rates, that’s high within the U.S., if you actually compare those numbers to other countries in the world, very few of our states measure up. So, if you’re only hitting 60, 70 percent vaccination rates, that’s still not nearly enough. You still have far too many people susceptible to infection and who could still land in the hospital.

ISAACSON: Should we have more easy to get tests that you can just buy at the drugstore and do self-testing? Would that help

DR. GOUNDER: Yes. I think it would. I think, right now, the rapid tests range in price from $7 to $25 a piece. That is still far too expensive. If you think about, you know, a family of four that might have wanted to test on Thanksgiving Day at $25 apiece, that’s $100 just for that. And so, this is really not affordable for most people. We really need to make this freely available, for free as have other countries. The U.K., for example, you could have them shipped to your home for free. Singapore proactively mails rapid test kits to their citizens for free. You know, and then there’s the behavior change of getting people used to the idea of testing and how do you use the results to inform your behavior. But I think the biggest obstacle hurdle here is you’ve got to make it free.

ISAACSON: Why isn’t it free? Why — who makes that decision that it’s not going to be something covered that would be free?

DR. GOUNDER: Well, you’ve got a combination of issues. I think one, the demand for these rapid tests has not been consistent. So, it’s difficult for the producers, the manufacturers of these test to scale up and to provide at scale cheap rapid testing when they are not sure exactly what the volume of demand is going to be from month to month. And then secondly, it needs to be subsidized by the federal government to make it free from there.

ISAACSON: Do bans on travel make sense now or is the genie out of the bottle?

DR. GOUNDER: I do think, Walter, that the genie is out of the bottle. Travel restrictions can work but they need to be implemented far more quickly. Are American travel restrictions didn’t go in effect until Monday, so you still had several days where people could travel back and forth. Those travel restrictions need to be implemented on citizens, not just foreigners. And that’s much more akin to what countries Australia and New Zealand did. That also left many of their citizens stranded overseas for months. And I don’t think we have the political will to be that strict. But if you have Americans who are still traveling back and forth to these countries, the virus can hitch a ride on them just as it can on somebody from South Africa.

ISAACSON: 16 percent of Americans will say they’re not going to get vaccinated. What does that mean? Does that mean we’ll never be able to stop this or can we get herd immunity?

DR. GOUNDER: I think herd immunity is off the table. I think, with respect to that remaining 16 percent that says that they will never get vaccinated, I think this is a long-term project for all of us, public health leaders, community leaders, to really address what is an ideological issue, a trust issue, and that’s going to take a long time to bridge that gap.

ISAACSON: We can’t even vaccinate ourselves more than, say, 80 percent in the United States. Are we ever going to be able to get the rest of the world to be vaccinated enough that we’re not going to see these variants? People are talking a lot about we should focusing on making sure we have vaccines in Africa to stop these variants. Is that really reasonable?

DR. GOUNDER: Yes. I certainly think we can slow the emergence of variants tremendously by vaccinating the rest of the world. Too much of the world emains unvaccinated, and that includes people right here at home in the United States. In addition to vaccination, another key group we need to be paying attention to are people who are highly immunocompromised. What we have seen is these variants are more likely to emerge from people who are highly immunocompromised who tend, when they get infected, to have longer infections, where in a sense, it’s a training ground for the virus. It keeps mutating and mutating and testing different mutations out in those highly immunocompromised people. So, that’s a group where not only we should vaccinate but unfortunately, vaccines don’t always take in people whose immune systems are weaker, we need to have other back-ups which would include perhaps using monoclonal antibodies preemptively. So, even before they’re exposed, giving them, perhaps an infusion of monoclonal antibodies every three to four months so that they’re already blanketed with this layer of protection. Another thing we could be doing for that particular group is when they are exposed, have a known exposure, preemptively starting them on treatment with the antiviral drugs like Paxlovid and Molnupiravir to prevent them from ending up with an infection or to nip that infection in the bud. I think that’s a group we really do have to pay some very special attention to.

ISAACSON: You were on President Biden’s task force, and one of the things you all stressed was the racial inequities that had to be addressed and something you talked about on your podcast. Tell me about that. What can we do now to address the inequalities that come out of the COVID situation?

DR. GOUNDER: This is one reason I think we have to be very careful when we talk about living with COVID that we do so through a public health lens, so to speak. Which means that you’re thinking not just about, you know, what does it mean for you but that you’re looking at what it means for an entire population. In particular, thinking about vulnerable populations and equity. And so, what that might mean for you, you know, I’ve been vaccinated, I’ve had my booster. I don’t work face-to-face with people. I can work from home, in my office. Yes, sure. You know, for you, it might not be much of a threat, but I think we need to be thinking more broadly when we talk about living with COVID, it needs to be, how do we all live safely with COVID, not just you, the individual.

ISAACSON: One of the devastating things about this pandemic has been closing schools. People having a year, sometimes a year and a half, where they aren’t in school and we’re seeing enormous effects because of that. If Omicron spreads, do you think we should close schools again or should we do everything we can to avoid closing schools?

DR. GOUNDER: I think we can do everything we can to avoid closing schools. And I think we learned from our experience with prior variants that you can keep schools open as long as you layer certain protective measures. So, that includes, of course, masking, improving ventilation and air filtration, buying HEPA air filtration units for classrooms, testing on a regular basis to make sure that the kids who are attending school are not carrying the virus. There are billions of dollars in the American Rescue Plan, the Cares Act and other — the infrastructure bill and so on for improving K through 12 school infrastructure, including ventilation and air filtration. For whatever reason, the school districts have not prioritized spending those funds in that way, and that’s truly a missed opportunity to buffer ourselves against whether it’s Omicron or other variants.

ISAACSON: You’ve had a lot of experience earlier on battling Ebola and you were an aid worker for that. Tell me what parallels you see between that and the current virus.

DR. GOUNDER: Well, one very important parallel is how both epidemics, pandemics have been politicized, and that was really chilling for me back in December of 2019, January of 2020. For me, it was deja vu. If you think back on the Ebola epidemic, that hit during our 2014 midterm elections. That was highly politicized. The question of travel restrictions at that time. How to treat returning aid workers at that time. And then, on the ground in West Africa, they were in the middle of their own presidential elections. And so, you saw the response to Ebola, something as simple as hand washing, which you could compare to, you know, mask wearing. Both basic hygienic measures were highly politicized in that context.

ISAACSON: Why has it become so politicized here?

DR. GOUNDER: Well, I think part of the problem is the pandemic did emerge at a time when, one, this country is extremely polarized, and during an election where it was really feared by the former president that this would have set his chances at reelection. You already are hearing politicians saying that Omicron has been invented to win the 2022 midterm elections. And I think unfortunately, where you have something scary that threatens both the health of the people, the economy, the political stage, I think you do see conspiracy theories emerge in that setting.

ISAACSON: Dr. Celine Gounder, thank you so much for joining us.

DR. GOUNDER: My pleasure, Walter.