Should the Vaccinated Worry About Waning Immunity?

CHRISTIANE AMANPOUR: Despite pleas from the World Health Organization, the U.K. and other rich countries are moving forward with COVID booster shots. The United States is just the latest to join the list, after some bold action from the CDC director. Dr. Rochelle Walensky endorsed the recommendation by outside advisers to offer boosters to people over 65 and with underlying conditions, but, in a rare step, she broke with the panel and decided to also include front-line workers. And with infections rising amongst children, another big decision awaits Walensky. Pfizer says that, within days, it’ll ask authorities to approve its vaccines for kids ages 5 to 11. And here is Dr. Walensky speaking to Walter Isaacson about the chances for a COVID-free future and how she hopes to convince 70 million American holdouts to finally get vaccinated.

(BEGIN VIDEOTAPE)

WALTER ISAACSON: Thank you, Christiane. And, Dr. Rochelle Walensky, welcome to the show.

DR. ROCHELLE WALENSKY, CDC DIRECTOR: Good morning. Thanks for having me, Walter.

ISAACSON: Why did you expand the eligibility for people getting booster shots on Pfizer from what the FDA expert panel had recommended?

WALENSKY: Yes, this is a really important question. So, first of all, this past week, we recommended boosters for people who have received the Pfizer dose and are more than six months out. This is for people over the age of 65, people who have high-risk underlying conditions, and for people who are at high risk of disease by virtue of where they live or work. So, these are people with diabetes, asthma, obesity, underlying heart or lung disease, people who are high-risk workers like health care personnel and teachers and front-line workers, as well as people who might live in homeless shelters or prisons. So that was the group that we were talking about, the highest risk group. The scientific process unfolds here by a scientific advisory panel at the FDA, the authorization at the FDA, an advisory panel at the CDC, and then my recommendations. And after listening intently to the scientific deliberation of all of these panels, I fully endorsed the recommendations to have boosters for those over the age of 65, as well as those at high-risk conditions. And where was the scientific close call, I made the recommendation in line with the FDA and many people at the CDC to also include people who are in high risk by virtue of where they live or work. These were our health care workers, as well as our front-line workers and teachers.

ISAACSON: So that means, if I’m a 45-year-old person slightly overweight and I teach at a high school, I should get the booster?

WALENSKY: All of these are going to be individual recommendations. But, really, what we are saying is for those who were at highest risk by virtue of the fact that they were vaccinated first, by virtue of their underlying conditions, again, diabetes, underlying heart disease, lung disease, kidney disease, those are the people we’re really targeting with really just our first step in booster rollout. And there will be more scientific evidence and more steps to come.

ISAACSON: So, many of the people have gotten the Moderna shot, you haven’t recommended it for them yet. They’re just going to pharmacies around here and say, hey, give me another one. Does that makes sense?

WALENSKY: So what I want to emphasize here for all of the people who’ve gotten their initial doses of vaccine, that this is really a slow wane, and you remain very well protected for people who have gotten any one of these vaccines. What I do want to say, though, is for those who got Moderna and J&J, we will look at this with similar urgency. We are waiting the submission of the packages from Moderna and J&J. And as soon as they come in, we will be looking at the FDA’s recommendation — authorization, and CDC will work urgently.

(CROSSTALK)

ISAACSON: Well, you say with real urgency. You mean by tomorrow, the next day, next week?

WALENSKY: We are awaiting those packages. I think we’re on the order of weeks.

ISAACSON: Weeks. So somebody who’s gotten just as slightly different vaccine has got to wait weeks?

WALENSKY: Well, what I would say, again, is, the protection is — really remains quite good, really high levels of protection in terms of averting hospitalizations, averting severe disease. We — all of these actions now artists stay ahead of the virus. So…

ISAACSON: Well, you say it remains quite good. Give me the exact numbers. If I had the vaccine two months ago, if I completed it, how much less immunity do I have if it was seven months ago, in February, when I did it?

WALENSKY: The studies vary by which study was done, when it was done?

(CROSSTALK)

ISAACSON: Yes, but wait. You run the CDC. Shouldn’t we know how much lower our protection is after seven months than two months?

WALENSKY: Absolutely. So, we have started to see some waning in those who are over the age of 65 and 75. But what we still know even today is that, if you are unvaccinated, you are 10 times more likely to die and 11 times more likely to be in the hospital compared to if you’re vaccinated.

ISAACSON: Well, we’re talking about people are vaccinated. When you say it starts to wane, do you have half the immunity, one-third of it, or 90 percent of it?

WALENSKY: Oh, absolutely not. So, what we’re talking about is differences between 95, 90 percent protection to 85, 80 percent protection. We’re not seeing — in terms of hospitalizations. We’re seeing waning a little bit more with regard to infections. So places — people who might have had protection of 90 to 95 percent before, maybe it’s 70, 75 percent, 80 percent, depending on the study.

ISAACSON: Well, explain that to us in numbers that we can all understand. Last week, how many people in America got breakthrough infections that had — they have been vaccinated, but they got infections?

WALENSKY: That’s actually not the best epidemiologic way to examine how our vaccines are working, because many of those breakthrough infections are not being reported. They’re not being followed. And, in fact, many people are not even being tested. So the way that we…

ISAACSON: Well, wait. Wait. Isn’t that what the CDC is supposed to do, is to tell us how many people are getting infected with this disease?

WALENSKY: Well, so how we follow this is through numerous cohort studies, where we have exactly the number of people who are — who’ve been vaccinated. And we actually test them weekly in some of our cohort studies, so we can find both the symptomatic infections, as well as the asymptomatic infections.

ISAACSON: So, still, I’m kind of curious, about how many people last week did get breakthrough infections?

WALENSKY: So, we have last week about 15,000 people that have been reported of breakthrough infections that have been hospitalized. About 75 percent of those are over the age of 65. And that is why we — hospitalized with breakthroughs. And that is why we have made this recommendation now to get your booster shot if you’re over the age of 65.

ISAACSON: So, of those 15,000 that were hospitalized, how many of them have had the vaccine in the past two months vs. didn’t have it for the past seven months?

WALENSKY: The data that we’re seeing now looks like there is some waning that is related to the time since the last — you had your vaccine. And then there’s some decreased protection because of Delta itself. And we’re working now to look at the science to tease apart, how much of this is related to the Delta virus, and how much is this related to the waning of vaccine effectiveness over time?

ISAACSON: No, that’s a very good question. What’s the data show?

WALENSKY: Well, so both are at play. And those data are just emerging right now. We have seen some evidence that suggests that it is not just because vaccines are waning, that there may have been less vaccine protection because of the Delta virus. To be honest, what — as we are scientifically — that will scientifically unfold, we are also saying, regardless, if you have less protection, now is the time to boost.

ISAACSON: And when we roll out these booster shots — and maybe you do it for Moderna pretty quickly and Johnson & Johnson and — do you worry that we’re taking vaccines away from the rest of the world?

WALENSKY: I think that we have to do three things at the same time. We need to vaccinate 70 million Americans who are unvaccinated. We need to boost those who have been vaccinated here in the United States and around the world who — in order to optimize the protect — their protection. And we need to vaccinate the rest of the world. I’m really proud that President Biden announced another 500 million vaccines for the rest of the world. We have now donated 1.1 billion vaccines for the rest of the world and encouraging other countries to really step up as we have. And for every vaccine we have administered here in the United States, we have donated three to the rest of the world.

ISAACSON: When do you think we’re going to get an antiviral treatment, rather than a vaccine, a pill, in particular, an easy one we can take, not like monoclonal antibodies, where you have to have them infused into you?

WALENSKY: Yes, this is a really critical question and an area of active scientific research. I think everybody recognizes, if we get to some steady state, when we get to some steady state with this coronavirus pandemic, we will, like we have with flu, want to have not just vaccines, but treatments available, easy treatments available. And I know that there’s active scientific investigation on those. And I am looking forward to seeing those studies and those drugs come to fruition.

ISAACSON: You said a while back that people who are vaccinated and get breakthrough infections, they’re just as likely to transmit the virus to somebody else as people who haven’t been vaccinated. Does the data show that is still the case?

WALENSKY: Yes, so that’s a really important question. First, I want to emphasize, if you’re vaccinated, you’re much less likely to get disease in the first place. But for those people who do get a rare breakthrough infection, we have seen that, likely because of the Delta variant, you are just as transmissible, almost as transmissible, as those who are unvaccinated. And that was the reason, back in July, we put the masks back on vaccinated people. And, yes, the science still holds in that area.

ISAACSON: And if you have gotten a breakthrough infection, but you have no symptoms, do you still have to be wearing a mask?

WALENSKY: Indeed. In fact, the science still demonstrates that, if you’re asymptomatic breakthrough, you likely still have enough virus in your nasopharynx and in your airways to potentially transmit to others.

ISAACSON: What proportion of new COVID cases are caused by infections from vaccinated people?

WALENSKY: We think the vast majority of infections are — remain among the unvaccinated. There are still 70 million people in this country who are yet to be vaccinated. And what we have seen is, the rates of community transmission are far higher in the areas that have lower vaccination rates. We have also seen in communities that have high vaccination rates that you actually protect your children, your unvaccinated children. Communities with high vaccination rates were four times less likely to have high rates of disease among children compared to communities of low vaccination rates. So we have seen this impact of community — high rates of community vaccination leading to lower rates of disease, even among people who are unvaccinated, like our children.

ISAACSON: And what proportion of these new COVID cases that are coming up now come from schoolkids or somehow they’re transmitting it?

WALENSKY: With more and more adults being vaccinated, we are seeing now more disease, and, with the Delta variant, we’re seeing more disease in unvaccinated people, and many of those unvaccinated people are children. But what I can say is, study after study shows that this is not actually happening in schools where proper mitigation strategies are being used. What’s generally happening is, in the schools, the disease comes from the community into the school. And if there’s proper mitigation strategies in the school, the chain of transmission stops there, and that there’s not more outbreaks in the school. However, if proper mitigation strategies are not being used in the schools, then the transmission will continue from the schools.

ISAACSON: And would you then say that all schoolkids should be wearing a mask?

WALENSKY: I would say anybody who is in a school, a teacher, a staff, a visitor, or a child, should be wearing a mask right now.

ISAACSON: Pfizer is going to ask for authorization of vaccines for children 5 to 11 probably in a matter of days. Walk me through how that’s going to roll out. What’s the FDA going to do, the expert panel going to do? When do you weigh in? And what do you say to somebody who said, wait, wait, I got an 11-year-old, I want her or him vaccinated?

WALENSKY: Right. So, this process unfolds the way all of our scientific process and vaccines have unfolded. So the package will be delivered to the FDA. It will be treated with urgency, I know. There’s an FDA advisory panel that will meet. Then the FDA will authorize the vaccine. That passes swiftly to the CDC advisory panel. They will meet and look over the data, both on the effectiveness and the safety profiles. And then I will make the recommendations. And I’m certainly hoping, after the FDA receives the package, that it will be in the order of weeks.

ISAACSON: And what about pregnant women?

WALENSKY: This is such a critical point in this moment in time. In August alone, this past August, there were 21 deaths from COVID of pregnant women. Here’s what we know. We know that pregnant women are more likely to be in the ICU, two times more likely to require mechanical ventilation. We know that the fetal adverse outcomes if mom has COVID are higher. And so we really do need to get pregnant women vaccinated. We now have extraordinary safety data on pregnant women. We haven’t seen higher rates of adverse pregnancy outcomes from the vaccine itself. And so the biggest challenge now is that only about 30 percent of pregnant women are vaccinated. And, in fact, if you look at racial and ethnic minority groups, only about 15 percent of African-American pregnant women have been vaccinated. This is an extraordinarily important issue. We need to work to get more pregnant women vaccinated.

ISAACSON: Can you tell those women that, if they get vaccinated, and they are, say, in their six months of pregnancy, that the vaccine won’t go into their unborn child and be too high of a dose?

WALENSKY: What I can tell you is that we have seen no adverse events from these vaccines from the pregnant — when pregnant women are vaccinated, and, in fact, just the opposite. The vaccine, it looks like, is crossing into the baby and may very well even protect the baby.

ISAACSON: Tell me about the people called vaccine-hesitant? Will they ever get vaccinated?

WALENSKY: I think that this is a diverse group of people, and we have to treat them individually. We have to understand what it is that makes them hesitant. Is it that they didn’t have access or time off of work? Is it that they had misinformation, and we really need to give them all of the information that they need in order to get hesitant — in order to get vaccinated? And so, really, we need to take these folks one at a time. This is not uniform. The reason for hesitancy is not uniform. And it’s really, really important we have trusted messengers for these people, people they trust, so that there’s not shaming or blaming, but rather talk to me about why you haven’t yet been vaccinated. And let’s have a discussion, because it would be really important for you to protect yourself and your family.

ISAACSON: Early on, the United States was the best in the world in rolling out vaccines. Now it’s not near — it’s not at the top. Why aren’t we the best at getting people vaccinated?

WALENSKY: As you mentioned, we do still have 70 million Americans who are not yet vaccinated. And we have some hard work ahead of us. There’s been misinformation, disinformation that has been propagated out there. And we’re working now through many different strategies, vaccine confidence consults, working with community partners, working with faith- based partners, doing the hard work of reaching into communities and getting people the information that they need, so that they want to be vaccinated.

ISAACSON: How could we have prevented vaccinations and mask-wearing from becoming so politically polarized?

WALENSKY: I think we, as a country, have not unified against the enemy here. The enemy here is a virus. And what we really needed — need to do even today is to address not one another, not the challenges that we have with these policies, but to recognize that these policies are really the best thing for public health. They’re the best things for individual health, for family health, for community health, and for the health of our nation. And I think we’re unifying against our common foe, which is the virus itself.

ISAACSON: How does this movie end? Will we have to learn to live with COVID, like we live with the flu, or will we be able to defeat it?

WALENSKY: Yes.

(LAUGHTER)

WALENSKY: I think we will be able to defeat it, so that we can keep it at bay. But I do believe that we will be living with COVID for some time to come. But that doesn’t mean that we — it will change our daily lives. What it does mean is that we will have to understand that some people may get sick with COVID, and we will do our best, through vaccination, through prevention strategies, not necessarily through masking in the long term, to defeat the disease.

ISAACSON: Dr. Rochelle Walensky, thank you for all you’re doing in this fight. And thank you for being with us.

WALENSKY: Thanks so much for having me.