White House COVID-19 Task Force, Dr. Fauci Press Conference Transcript February 19

Andy Slavitt: (00:00) ... weather this week. Now, I want to give an update on how severe weather across the country has impacted vaccine deliveries in the administration and how we intend to catch up. As of now, we have a backlog of about 6 million doses due to the weather. All 50 states have been impacted. The 6 million doses represents about three days of delayed shipping, and many states have been able to cover some of this delay with existing inventory. So let me first walk you through the situation, and then tell you how we as an entire nation will have to pull together to get back on track. There are three places along the distribution chain that have been impacted by the weather. First, FedEx, UPS and McKesson, our logistics and distribution teams, have all faced challenges as workers have been snowed in and unable to get to work to package and ship the vaccines, kits, and the required diluent. Andy Slavitt: (01:03) Second, road closures have held up delivery of vaccines at different points in the distribution process, between manufacturing sites to distribution and to shipping hubs. Third, more than 2000 vaccine sites are located in areas with power outages, so they're currently unable to receive doses. General Perna's guidance to the team was to ensure safety of personnel, preservation of the vaccines and supplies, and constant communication with the states. Because of 72-hour cold chain constraints, we don't want to ship doses to those locations, and have them sitting at a site where they might expire. So the vaccines are sitting safe and sound in our factories and hubs ready to be shipped out as soon as the weather allows. Now, as weather conditions improve, we're already working to clear this backlog. 1.4 million doses are already in transit today, and we anticipate that all the backlog doses will be delivered within the next week, with most being delivered within the next several days. Andy Slavitt: (02:20) And we expect we will be able to manage both this backlog and the new production coming online next week. With everybody's hard work and collective effort, we will be able to catch up, but we understand this will mean asking more of people. UPS and FedEx both will support Saturday deliveries tomorrow. We are working with the jurisdictions to see which ones are able to take Saturday deliveries. The packaging plant for Moderna vaccines is just now coming online. Roads are being cleared for the workforce to leave their homes. They're working today through Sunday to package the backlogged orders, and we'll put the vaccines and ancillary supplies on aircraft on Sunday night for Monday through Wednesday delivery. As we get back on track, we're asking states, sites, and vaccinators to help us catch up and to get Americans vaccinated. We know many Americans are awaiting their second dose, and many more, their first dose. Andy Slavitt: (03:35) We're asking vaccine administration sites to extend their hours even further, and offer additional appointments and to try to reschedule the vaccinations over the coming days and weeks as significantly more supply arrives. States and vaccination sites are going to want to be prepared for the additional volume. Whatever reduction we see in our seven-day average this week in vaccinations from the weather, if we all work together, from the factory all the way to the vaccinators, we will make up for it in the coming week. Andy Slavitt: (04:15) I want to personally thank the men and women who have continued to keep our operations up and running throughout this storm, and they've been working 24x7 with the states and with local vaccination sites, and my thoughts remained with all of those impacted. I'll be happy to answer any questions about this topic, but before we turn it over to Dr. Walensky and Dr. Fauci, I do want to briefly touch on our work to stand up more federally-run sites. Even as we manage the weather on the one hand, we are pushing ahead with plans to get more vaccines to more places, to get more Americans vaccinated. Today, I'm pleased to announce we will be opening five additional vaccination centers, one in Pennsylvania, and four in Florida. In Florida, we will stand up four major new community vaccination centers in partnerships with the state in Orlando, Miami, Jacksonville, and Tampa. Andy Slavitt: (05:19) These sites will have the capacity to vaccinate a total of 12,000 individuals per day in total. In Pennsylvania, we're announcing a major new community vaccination center at the Pennsylvania Convention Center in Philadelphia. This site will have the capacity to deliver 6,000 doses per day. Selection of all of these sites is based on a CDC FEMA framework that has been developed to target vaccinations to those who are most vulnerable. The goal is to launch vaccination sites that use processes and are in locations that promote equity, and deploy the CDC's Social Vulnerability Index. The federal government will be deploying teams immediately to work hand in hand with state and local jurisdictions to get these sites set up, and we expect them all to be up and running in the next two weeks. So that's a brief status from the white house COVID response team here. We'll have more announcements to come next week. Now with that, I will turn it over to Dr. Walensky to overview a state of the pandemic and public health. Dr. Walensky. Dr. Walensky: (06:39) Thank you so much. I'm delighted to be back with you today. I have new information to share from CDC regarding ongoing safety monitoring of the COVID-19 vaccines, but before I go into those findings, I want to provide a brief overview of the latest data on the pandemic. We continue to see a five-week decline in COVID cases, with cases decreasing 69% in the seven-day average since hitting a peak on January 11th. The current seven-day average of approximately 77,000 cases is the lowest reported since the end of October, but still higher than the height of last summer's peak. Like new COVID-19 cases, the number of new hospital admissions continues to drop. The seven-day average of new admissions on February 16th, approximately 7,200, represents a 56% decline since the January 9th peak. As I reported on Wednesday, the number of deaths continues to fluctuate. The latest data indicate that deaths have declined modestly in the past week, to an average of approximately 2,700 per day. Dr. Walensky: (07:44) These numbers are a stark reminder of the thousands of lives lost to this pandemic. Another reminder of the devastating impact that the pandemic has had on our country was brought into clear view yesterday in a report released by the CDC on the provisional life expectancy in the first half of 2020. The report found that life expectancy was at its lowest level in 15 years, dropping by a full year compared to the life expectancy in 2019. This represents a substantial decline in life expectancy in our nation. Importantly, like the populations most heavily affected by this pandemic, the declines in life expectancy were again most pronounced in certain racial and ethnic minority groups. The largest declines in life expectancy occurred in non-Hispanic Black persons, dropping 2.7 years, levels not seen since 2001. And Hispanic persons had lost the second largest life expectancy, dropping 1.9 years. These findings, though not surprising, are sobering and representative of the continued need to take this pandemic and actions to stop the spread of COVID- 19 seriously. Dr. Walensky: (09:01) Now, more than ever with continued spread of variants that stand up to threaten the progress we are making. We must recommit to doing our part to protect one another. Wear a well-fitting mask, social distance, avoid travel and crowds, practice good hand hygiene, and get vaccinated when the vaccine is available to you. I also want to spend a moment talking about vaccine safety. To date, more than 41 million people in the United States have received at least one dose of the COVID-19 vaccine, but we continue to hear that people might be reluctant to roll up their sleeves because they are worried about adverse effects. I will reiterate, the CDC is committed to monitoring vaccine safety and frequently reporting on what we know. Today, CDC is releasing a study in the morbidity and mortality weekly report that describes findings from our COVID-19 vaccine safety monitoring in the United States from December 14th through January 13th, 2021. Dr. Walensky: (10:02) December 14th through January 13th, 2021. During the first month of vaccinations, approximately 1.6 million people enrolled in V- safe, CDCs new phone-based COVID-19 vaccine safety monitoring system. Among those enrolled, 71% reported pain where the shot was given, 34% reported fatigue and 30% reported a headache. These are common with most vaccines and they typically resolve within a day or two of vaccination. It's important to know that about half the people don't feel very well after getting their second dose. This should not deter you from getting your second dose, but you need to have a light day of activity after getting vaccinated. There were also rare reports of severe allergic reactions like anaphylaxis, a serious, but treatable reaction. In fact, there were 4.5 cases of anaphylaxis per 1 million doses given during this time, a rate similar to what we've seen in other commonly-used vaccines. In the first month of experience, a total of 113 deaths were reported, of which approximately 65% were among long-term care facility residents. Dr. Walensky: (11:15) A thorough review of the available data indicated that these deaths were not related to the COVID-19 vaccine, and the death rate in this population, though truly sad and unfortunate was consistent with the expected background death rate in this demographic. I want to emphasize that we've implemented the most comprehensive vaccine safety monitoring system program in our history, and the data released from the CDC today are reflective of this effort. We will continue to closely monitor these events and report back as further data emerge. I want to be sure that you know the fact, and not the myths about vaccine safety. The fact is they are safe, and they will save lives. That is why we are committed to working with state and local public health partners, as well as partners in the private sector, to support getting people vaccinated as quickly and as safely as possible. Dr. Walensky: (12:16) To help advance our collective efforts to scale up vaccines in communities, on Monday, CDC is convening a 3-day, virtual national forum on COVID-19 vaccine. The forum will bring together a broad range of governmental and non-governmental partners to share information and best practices on how to build trust and confidence in COVID-19 vaccines, how to use data to optimize vaccine implementation and how to provide practical real-world experience on how to increase vaccination capacity in communities, especially for those at increased risk of COVID-19, and for those who may face barriers to vaccination. I'm excited about this forum and the rich dialogue it will stimulate, and I invite those who are involved in vaccine efforts to register and intend this important meeting. Thank you. As always, I look forward to your questions, but before that, I'll turn it over to Dr. Fauci. Dr. Fauci. Dr. Fauci: (13:10) Thank you very much, Dr. Walensky. What I'd like to do is to just take a couple of minutes, very briefly reviewing the status of the vaccines and vaccine trials that we have, but then too,` as I've done in the past, pick out a question that I believe is being asked more frequently, to try and preemptively address it, and perhaps generate some discussion. With regard to the trials that we have, as you know, the US government had been involved in the development of, and/or facilitation of the testing of three separate platforms represented by six different companies. You're all aware of the data of the Moderna and the Pfizer BioNTech, which have their EUA now, having shown a 94 to 95% efficacy. Right now, as we speak, the data from the onset study, which as you know, showed a 72% efficacy in the United States, but was also done in South Africa and Latin America, and showed a diminished efficacy against the variant, but very good against severe disease. That is being reviewed at the FDA for the US data. Dr. Fauci: (14:22) On February the 26th, the FDA will consult with their Independent Advisory Committee, their VRBPAC, and we should be hearing from them soon. With regard to the AstraZeneca and the Novavax, those trials are both fully enrolled. These are event- driven decisions, so when they reach a certain amount of events, they will then look at the data and make decisions as to whether or not to go ahead with a request for an EUA. So, having said that, let me just now very briefly address a question that is a very relevant question, that we are now more commonly being asked. If you look at the existing trials, those have already gotten a new UAE and those that we anticipate and hope will get an UAE, when will we be able to say we can vaccinate children, children in the high school range and children in the elementary school range. You know from Pfizer, that they started off with the trial of 44,000 individuals down to 16-year olds and then progressed it down to 12-year olds. Dr. Fauci: (15:33) So, what they're going to be doing in April, starting in April, they are going to be studying twelve-year-olds down to five to six-year old. That will take likely one year to get the information on that, likely not until the first quarter. However, we anticipate data on high school-age individuals, namely individuals 12 years old to 17 years old by the beginning of the fall. Maybe not exactly coinciding with the first day of school, but sometime in the fall, we will have that. Moderna, as you know, started off with already 18-year old, they are now currently enrolling 12 to 17 year olds. So, let me take a moment to explain the process of how you get relevant information regarding these younger individuals. This is a representative trial, which very likely will reflect other trials. It's a 3000- person trial. Dr. Fauci: (16:36) So, right off, you're not dealing with the 30,000 and 44,000- person trial that gave the efficacy signal in the original Moderna and Pfizer study. What the trial is, is the trial is what's called a non-inferiority by immunogenicity, which is a lot of big words to really mean what they're asking, is it safe in the children, and does it induce an immune response that's comparable or not inferior to the immune response that we know is associated with efficacy in the other trials? That's the way that trial will go. Then we're starting by the end of March, they will do what's called an age deescalation study. We are already enrolling on the 12 to 17. They will go to the six to 12, then two to six, then six months to two years. Again, we will likely get information for high-schoolers at some time in the fall, but it is, I would say more than unlikely we will not have data on elementary school children until at least the first quarter of 2022. Dr. Fauci: (17:58) Similar types of approaches are being taken by the other candidates, the other companies, namely J&J, Novavax and AZ. So, the bottom line of all of this is as follows. It is highly likely that sometime in the fall, we will have data that will give us the capability of saying the safety and comparable efficacy in children, 12 to 17, 18 years old. Again, the final decisions we always leave to the FDA. I'm trying to give you a roadmap of what likely will happen, but then also with the studies that I just mentioned, to getting the information, to make the decision in elementary school children, almost certainly will not be firmed down until the first quarter of 2022. I will stop there and hand it back to Andy. Andy Slavitt: (18:59) Thank you, Dr. Fauci. Okay, we can take some questions. Speaker 1: (19:05) All right. First up, we will have Jonathan [inaudible 00:19:08]. Jonathan: (19:08) Thanks for taking the question. I have a question about the federal mass vaccination sites, and how you're deciding where to do them and setting them up. How much of this is states coming to you and saying, "Okay, we need help with this place or that place. Can you come in and set up a FEMA site?" How much is this you going to the states and saying, "Hey, it looks like you need some help here, or we see that the progress, you're not hitting enough of the underserved communities, so we think we want to do a site here." In general, has there been an overall 50-state assessment of how the states are doing at distribution and where they need help? Have you done something like that, some kind of comprehensive look? Andy Slavitt: (19:52) Yeah. Thanks Jonathan. I may ask Dr. Walensky to comment in a second in how the CDC thinks about the social vulnerability index in places where- Andy Slavitt: (20:03) The social vulnerability index in places where we'd like to target. What I would reflect for you, Jonathan, is we have a very healthy, ongoing dialogue with multiple participants in a state every week. And there is a good give and take. We are obviously looking for two things as we select these sites. The first is how can we get more people vaccinated more quickly and the second is how can we get more people vaccinated more equitably. Those are really the two most important criteria. And so having these conversations, these dialogues go back and forth as an illustration, we may have a governor says, "We're very interested in this," and then when we work with the CDC and with FEMA, we may say, if we do something in this state, "This is the location that we think works best, that makes sense," and then we'll have a back and forth. So it's very collaborative. It's very positive. Dr. Willinsky, anything you want to add more specifically? Dr. Walensky: (21:10) I don't have a whole lot to add to that except to say that really it is a collaborative. We are doing outreach and we are actually receiving more, trying to incorporate what state's specific needs are. We do look specifically at the social vulnerability index of where the sites might go, also the population size so we can understand exactly what the needs are in those specific sites. So it's a deep collaboration and it looks both at social vulnerability index, the outreach that's needed, whether there's the size as well as what mobile units might be needed as well. Andy Slavitt: (21:45) Yeah. Yeah. Jonathan, federal state partnership to us is the key and is the approach. We view ourselves hopefully as good partners to the states. And if they bring us challenges, our goal is to help them solve them, not to reward or punish as I think it has been a prior philosophy. Let's go to the next question. Speaker 2: (22:08) Next, we'll go to Cheyenne Haslett at ABC News. Cheyenne Haslett: (22:13) Hi, thanks for doing this. On school openings my question is, about 75% of schools that are currently located in the red zones, which the CDC guidelines recommend be hybrid or virtual. So I'm wondering how in April, just about two months from now, the President intends to make good on that promise of full-time in person schooling. Andy Slavitt: (22:39) Thanks for that question. I think that question actually allows us to clarify a few things that I'm going to turn to Dr. Willinsky to do that. Dr. Walensky: (22:45) Yeah. Thank you for that question. The first thing I just want to convey is there are opportunities for in-person learning at all stages of all states of community spread. As we've seen community spread coming down and as we've seen our numbers improving right now, what I would invite the schools to do, we have actually seen many more communities leave the red zone and move into the orange zone, which actually has more opportunities for in school opening and for in-person learning. So our numbers are coming down. I would actually invite schools to lean in and to look at what is needed so that in the roadmap to try and get more and more children back to school. Andy Slavitt: (23:25) And I want to just clarify something you said because it's so important, Dr. Willinsky. Is it possible if you are in the red zone even if things are improving, is it possible to open schools under the CDC's guidance? Dr. Walensky: (23:42) Absolutely. So in the area that remain red and there are about two thirds of districts now, although the numbers continue to climb and the numbers that remain red, we say with universal masking and physical distancing and de-densification of classrooms, there are opportunities for in-person learning as well as for middle and high school learning and assuming you're able to do de-densification that we suggest. Andy Slavitt: (24:08) Great. I think that's a really important clarification. Next question, please. Speaker 2: (24:14) Next, we'll go to Brenda Goodman at Web MD. Jonathan: (24:20) Hi, I have a question about dosing. There've been several studies published in the last couple of days, the dosing of the vaccines that is, that have suggested that just a single dose of the vaccine might be highly effective after about three, two or three weeks. And I wondered if that had shifted Dr. Fauci, if it had convinced you that just a single dose of the mRNA vaccines might end up being effective. Dr. Fauci: (24:49) Well, if you're referring to the mRNA vaccine, you're probably referring to a recent Israeli study that looked at the mRNA because the extension of the time and a single dose with AZ has also been discussed. But let me refer and just answer directly your question with the mRNA. We always look at data very carefully and very seriously and we evaluate it as it evolves. But if you look at the data from the particular study and then go back and look at why we wound up with a prime and a boost and for Moderna, as you know that's 28 days and for Pfizer, it's 21 days. And the reason is even though you can get a fair degree of "protection" after a single dose, it clearly is not durable. We know that. The durability is not as much as the durability that you would get with the boost. Dr. Fauci: (25:49) Secondly, if you look at the difference between the degree, the intensity of the response after a first dose and compare it to that of the second dose, the second dose is 10 times higher in the sense of level of neutralizing antibodies, which is one of the parameters of immunity. So again, although the numbers of a single dose do look interesting, the one thing we don't know is how durable it is. And since it's 10 times less than the optimal dose that you would get, you have to look at it from two standpoints. You remember we discussed on one of these press briefings before that the reason why you look clinically and see that despite the fact that there is a maybe five to six fold diminution in the impact of the antibodies that are induced by the mRNA candidates, it still is within the range of protection. Dr. Fauci: (26:56) The reason for that is that the response following the boost was so high that even though you diminished the efficacy down to about 50%, you still had rather good efficacy against severe disease. So it's an variant issue to protect against variant. The other issue that we need to take into consideration is if you do have a less than optimal, even though with numbers, they look reasonably good, but not as good as the optimal response. What could happen theoretically is that because of the immunological pressure that you see on the virus, you might actually theoretically be inducing more variants. So there were a few scientific reasons why we feel given the information we have right now, we will stick with the scientifically documented efficacy and optimal response of a prime followed by a boost with the mRNA. Andy Slavitt: (28:00) Dr. Fauci, just a couple additional clarification. You said something here which is important for, I think the public to understand. If we do see more of the variant present in this country, do you feel better with people having two doses of these mRNA vaccine or one? Dr. Fauci: (28:21) Oh, there's no doubt. Andy, thank you for the question. I alluded to it, but thank you for giving me the opportunity to repeat it. There's no doubt about that, that you have an optimal response when you're dealing with variants. You want enough of a height of a response that even if you diminish it, you don't diminish it so much to get out of the realm of protection, number one. Number two, if you do have a less than optimal response, you could theoretically and inadvertently be selecting immunologically for variants. Andy Slavitt: (28:58) Thank you. So just a couple of things to emphasize here. One is we want the public not to be confused. The recommendation from the FDA is two doses just as it always has been. Number two, and I think this is a sort of more macro point and I invite either Dr. Fauci or Dr. Willinsky to comment here. There are studies all the time. There are preprints all the time. There are real-world evidence that comes out all the time and it will continue to happen. The people at the FDA led by Peter Marks, people like Dr. Fauci, people like Dr. Willinksy love looking at this data, love looking at these studies, but it's also important to understand that one study, even though it may look attractive if it's in the public domain and may capture a headline, isn't always what it appears to be and it is only one study. So I think we've got the best people in the world looking at this. I feel very confident and they'll look aggressively at these studies, but I think it's important- Andy Slavitt: (30:03) ... and they'll look aggressively at these studies, but I think it's important that people understand that we're not going to be persuaded by one study that happens to grab headlines. We here at the White House will of course listen to whatever the scientists have to say and adjust accordingly, but anything you'd want to add to that, Dr. Walensky or Fauci? Dr. Fauci: (30:21) Yeah. Andy, thank you for bringing that up, and with regard to the specific study, and again, I'm not criticizing this study because it's an interesting study, and we really do want to follow up on this. But again, this is a study that we were made aware of by press release, so it wasn't something that we had the opportunity to look at all the data yet. But it's very interesting that it says here at the end, "The results might differ from others," getting to the point that Andy made. "There are many studies. The results might different from others because the subjects were largely younger and healthier," said one of the authors. She also said, "The study couldn't confirm how long the protection from one shot would last, as most of the subjects received a second shot." So the points that I made in my explanation to the person who questioned is actually admitted to by one of the authors. Thank you. Andy Slavitt: (31:20) Thank you. Next question, please? Speaker 3: (31:23) All right. We have time for one more question. Last, we'll go to Yamiche Alcindor at PBS. Jonathan: (31:30) Hi. Thanks so much for taking my question. I have two questions. The first is a lack of pharmacies and hospitals, providers and transportation has emerged as a significant concern in the communities hardest hit by the virus. What's the plan and the timeline for getting more vaccination sites for areas with inadequate health infrastructure, and has the government found that that that's a problem, an increasing problem when looking at vaccine distribution? And the second question I have is on life expectancy. I'm wondering how lasting this change in life expectancy is. Do we expect it to bounce back, and what will it take, if at all, for it to go back up? Andy Slavitt: (32:09) Well, let me take the first question, and Dr. Walensky, you can maybe get the second question on life expectancy. There are a number of issues that you point out that are access barriers, including transportation, including the clinical infrastructure, and then including I think it's important to point out that even when there is a local availability of vaccines, people from outside of these communities, outside of the hard hit communities come in, make appointments and often take some of those doses, which we shouldn't be surprised about. It happens in a shortage, but we have to act on it because we are purposely setting up both sites that are located conveniently in these communities. There will be a series of announcements over the next call it a week to 10 days about some major things that we're doing about transportation, about appointment reservations, and ensuring that those appointments are kept. Certainly bringing mobile vans into the communities, bringing federally qualified health centers, which are ideally located into communities, and then assuring that we have all of the things that end up becoming barriers, which are the hours people are open, the ability to get there and back and some of the other things that are getting in the way. So I can tell you that we are working these in detail along with the states, along with local communities. They are ... I think it's safe to say that if you don't do these things, you naturally end up with the people who are getting hit hardest by the virus also getting the least access to the vaccine. There are some success stories. I think it's too early to report that we figured this out. I think it's a constant battle to be honest. Dr. Walensky, anything you want to either add to that, and of course the life expectancy question? Dr. Walensky: (34:18) Great. Maybe I'll just move to the life expectancy question. I agree with you entirely, Andy. The report from CDC really only reported the life expectancy loss from January to June, the first half of 2020. Quite unfortunately, I think we're going to see, again, a decrease in life expectancy once we start looking at the entire year, because we do know that the hardest hit demographic and highest mortality rates have been in the older populations. I think we're going to have a lot of work to do in this country over the years ahead to try and make up the losses that we've seen with this pandemic, And that is going to be including an investment in our public health infrastructure and improving the health of the entire nation, and especially in improving the health of the ethnic and racial minorities that took the hardest hit. Andy Slavitt: (35:08) Thank you, Dr. Walensky. I want to finish where we've started, which is to thank everybody who is going to be working over this weekend to catch up from the weather-related events, to thank our partners in states and local vaccinators for extending their hours and in increasing the access to folks to get their vaccines and to assure people that if their vaccine, because of the weather, their second shot has been delayed for a short period of time, it is not a problem. That will be accommodated completely. Thank you all, and I hope everybody has a nice weekend.