White House COVID-19 Task Force, Dr. Fauci Press Conference Transcript March 10

Andy Slavitt: (00:21) Thank you for joining us. Before I turn to Dr. Walensky and Dr. Fauci, I want to give a quick update. Yesterday, Jeff Zients, our COVID coordinator, announced yet another supply increase. Pfizer and Moderna vaccine supply will now increase to more than 20 million doses going out to states, tribes, territories, and pharmacies. That's double the number going out every week before we came into office. This presents an opportunity for everyone to increase their vaccinations, even as that supply and supply of Johnson & Johnson vaccine ramp up even further. The country must quickly work through this additional supply. Andy Slavitt: (01:14) Today, President Biden will direct Jeff and the Health and Human Services team to procure an additional 100 million doses of the Johnson & Johnson vaccine. This order allows for the president to plan for the future and the latter part of the year. This is war time, and as facts still emerge, it gives us maximum flexibility for our upcoming needs. Andy Slavitt: (01:41) So to review some of our progress from the vaccination program over the first 49 days, we've increased vaccine supply. The president has ordered enough vaccine doses for every adult in the US. We've more than doubled the number of vaccines going to states. We've improved the efficiency of the vaccination process. When we arrived, less than half of vaccines, distributed to States were administered. Today, that number is approximately 75%. We worked with the vaccine manufacturers to speed up their delivery to May 31st. And as you'll hear about later today, we led a historic partnership between two rival drug companies to scale manufacturing and speed delivery. Andy Slavitt: (02:29) We've searched the number of vaccinators. The president has deployed 3,500 federal personnel, in addition to providing federal funding for members of the National Guard to serve as vaccinators, with many more to come. We've signed an order to allow our nation's doctors and nurses to give shots. We've mobilized more than 2000 military men and women to support community vaccination sites. Andy Slavitt: (02:55) We've also dramatically increased the number of places to get vaccinated. We provided federal support for over 500 community vaccination centers. We've launched a program to directly send vaccines to more than 9,000 local pharmacies. We've opened or are ramping up 20 high volume federally run sites that we'll be able to deliver 70,000 shots a week, in some of America's most disadvantaged neighborhoods. 16 sites are operational now. Those sites have already delivered more than 500,000 shots. Andy Slavitt: (03:32) We're ramping up a program that directly sends vaccines to more than 1300 community health centers to [inaudible 00:03:39] communities. We're launching mobile sites to help vaccinate the hardest to reach communities. And this is leading to results for the American people, most importantly. Andy Slavitt: (03:51) More than 91 million Americans ever received a shot; at least one dose. 61 million Americans fully vaccinated, 32 million Americans. America leads the world in total vaccinations. On January 20th, there was a seven day average of 890,000 shots per day. And today we're averaging above 2 million shots per day. On Saturday, we set an all-time single day record, nearly 3 million Americans vaccinated, at a pace seen nowhere else in the world. Andy Slavitt: (04:29) In terms of protecting the most vulnerable, our core duty as a nation. When we came into office, 8% of people over 65 were vaccinated. Today, 60% are vaccinated. And according to the CDC's new guidance, vaccinated parents can now visit and hug their grandchildren, and in most circumstances, without wearing a mask. This is an accomplishment every American going through the difficult process of waiting for the vaccine can take pride in. And as more people get vaccinated, more people will become eligible. Yesterday, Alaska became the first state to make vaccines available to all people over the age of 16. Andy Slavitt: (05:16) There are many steps left in the path, but we were making progress. With that, I will turn it over to Dr. Walensky. Dr. Rochelle P. Walensky: (05:27) Thank you, Andy. It's a pleasure to be back with you today. Let's take a look at the current state of the pandemic. CDC's most recent data indicate that the recent plateau of cases may be again, starting to trend downward, with a seven day average now of 56,000 cases per day. We also continue to see decreases in new hospital admissions for the most recent week. An average of 4,900 patients with COVID-19 were admitted per day in the most recent week. Dr. Rochelle P. Walensky: (05:54) And while we have seen deaths hovering around 2,000 deaths per day in recent weeks, the latest seven day average is now down to 1600 deaths per day. Earlier this week, we saw the number of deaths per day drop below 1000 for the first time, since November. All of this is really good news. Dr. Rochelle P. Walensky: (06:15) And while these trends are starting to head in the right direction, the number of cases, hospitalizations and deaths still remain too high and our somber reminders that we must remain vigilant as we work to scale up our vaccination efforts across this country. We must continue to use proven prevention measures to slow the spread of COVID-19. They are getting us closer to the end of this pandemic. Dr. Rochelle P. Walensky: (06:40) As I discussed on Monday, CDC released initial guidance on activities fully vaccinated people can resume safely while limiting risks to themselves and others. To help this important information out to the medical community and to the public, today, the Journal of the American Medical Association published a scientific commentary from CDC. In the commentary, we again summarized the new recommendations from CDC. That fully vaccinated people can visit with other fully vaccinated people in small gatherings without wearing masks or physical distancing. That fully vaccinated people can also visit with unvaccinated people from one other household without wearing masks or distancing, as long as no member of the unvaccinated household is at high risk of severe illness from COVID-19. And that fully vaccinated people do not need to quarantine or get tested following contact with someone who has COVID-19, as long as the fully vaccinated person is asymptomatic. Dr. Rochelle P. Walensky: (07:41) We also reiterate that in other scenarios, including public settings and travel, people who have been fully vaccinated should continue to wear masks and practice safe public health precautions, just like people who have not yet been vaccinated. In addition, the commentary includes information about the scientific basis for CDC's new recommendations that. Dr. Rochelle P. Walensky: (08:03) ... A scientific basis for CDC's new recommendations that balance the risk of fully-vaccinated individuals with the risk of infection and spread among the still 90% of the American public not yet protected by a COVID-19 vaccine. The commentary also describes the outstanding scientific questions we are working to answer to inform future guidance and get people back to their everyday activities. Dr. Rochelle P. Walensky: (08:27) Key among them are questions about the risk of vaccinated people transmitting the virus to others if they have a vaccine breakthrough and become infected. How long protection from vaccine lasts and how well the vaccine works against the circulating virus variance. While we are starting to see emerging evidence that the vaccines remain effective against circulating variants and that the risk of breakthrough infections in vaccinated persons and spreading the virus to others is low, we must be resolute in our efforts to fully answer these critical questions. Dr. Rochelle P. Walensky: (09:01) When answered they will inform the future guidance that will enable us to safely resume activities, while also protecting others who remain vulnerable to this disease. We are working across the government and with many scientific partners to answer these questions as quickly as we can, and I'm committed to updating our guidance as new scientific information becomes available, and importantly, as more people get vaccinated. Dr. Rochelle P. Walensky: (09:28) I want to close by reiterating that our actions this week represent a first step, not our final destination. We are at a critical point in this pandemic and on the cusp of having enough vaccine to protect every adult in the United States. We ask for your patience in practicing proven prevention measures for just a little while longer. We ask for your participation by rolling up your sleeve when it is your turn to be vaccinated, and we ask for your leadership in helping others do both of the same. With the above actions we are so very close we can turn the tide on this pandemic. Thank you. I look forward to your questions and I'll now turn things over to Dr. Fauci. Dr. Fauci: (10:13) Thank you very much, Dr. Walensky. What I'd like to do over the next couple of minutes is talk a bit about what we refer to as special populations, so if I could have the first slide. Many of you are very familiar with this slide. It is a slide of the phased vaccine distribution that is been put out by the CDC. If you look at these from the Phase 1A, B, C, and 2, what is not specifically mentioned here are pregnant women and pediatric individuals, namely people from age six months to 16 to 18. Also in the third panel on Phase 1C we refer to as high-risk conditions. I'm going to get a little bit more granular on that with you. If I can have the next slide, please. Dr. Fauci: (11:08) First of all, let's take a look at what we mean by special populations. First of all are pregnant individuals. There are about 3.7 million births in the United States in 2019. Then there are adolescents and children, a very important topic when we think in terms of schools and the protection of children, there are about 73 million individuals between the ages of birth and 18 years. And then importantly, there are immunocompromised individuals, those who have immunosuppressive medical conditions, either primary imminent deficiencies or acquired immune deficiencies, such as HIV, or individuals who are receiving immunosuppressive treatment or chemotherapy. That could be either due to an underlying neoplasm or maybe even more frequently to individuals with one form or another of an autoimmune disease requiring suppression of a hyperactive immune system. It's estimated that about 3% of U.S. adults fall within that category. Dr. Fauci: (12:18) Next slide. So what are some of the questions that we ask of these special populations? The obvious ones are, what is the safety and immunogenicity profile of vaccines in these populations? And as I mentioned on a previous presentation it is unlikely that we will require a full ethicacy study involving tens of thousands of individual volunteers. What we almost certainly will do is determine safety and do immunogenicity to determine if special populations, be they pregnant women, be the pediatric cases, that these individuals make a comparable immune response to that which we know actually is associated with the high degree of protection that we're seeing in our vaccines. Dr. Fauci: (13:11) Next is, what is the duration of the immune response to vaccination in certain special populations? Take for example, individuals who have immunodepression either by a disease or iatrogenically by a drug. We may show that the level of immune response is good but that the durability of that might be different because of the compromise of the immune system in these individuals. And then we want to know what is the efficacy of vaccination on reducing disease and transmission in certain special populations. There may be a difference between them and individuals in what we refer to as the normal adult population. Dr. Fauci: (13:56) Next slide. So let's take a quick look at the pregnant individuals. The American College of Obstetrics and Gynecology, ACOG, recommends that vaccines of SARS-CoV-2 should not be withheld from pregnant individuals and that pregnant individuals may choose to receive the COVID-19 vaccine and they should have a conversation with their clinicians. As I mentioned on a previous briefing, although we were not specifically looking at pregnant women in the studies which led up to the EUA, since the EUA left several thousands of pregnant individuals have actually gotten vaccinated. And the CDC has established a V-safe pregnancy registry to follow the outcomes among vaccinated pregnant individuals. Dr. Fauci: (14:48) Specifically in one case, Pfizer/BioNTech has launched a randomized placebo-controlled study to do just what I said a moment ago, to evaluate safety and immunogenicity in pregnant individuals. Also, as I mentioned in a previous briefing when we discussed J & J, the J & J Ad no. 26 vector has considerable experience with Ebola in Africa in individuals who are pregnant and/or lactating. Dr. Fauci: (15:19) And on the final slide, excuse me, not yet final, the adolescents and children, the age range that is currently authorized for the SARS-COVID vaccination as you well know is 18 and older for Moderna, 16 for Pfizer, and 18 for J & J. There are vaccine safety and immunogenicity studies in adolescents and children that are either ongoing and/or planned. For example, Pfizer BioNTech's study in persons age 12 to 15 is fully enrolled as is the TeenCOVE study from Moderna in individuals 12 to 17. This led me to tell you last time that we would know... Dr. Fauci: (16:03) This led me to tell you last time that we would know, likely by the beginning of the fall, whether or not we can, and I believe we will be able to vaccinate children of high school age. Now, there are also trials in younger children, which will follow, referred to, for example, as Moderna KidCo study. And as I mentioned previously, J&J is also planning studies in pediatrics. Next slide. Dr. Fauci: (16:29) And then on this last slide, just a couple of other considerations, people with HIV, questions we get asked all the time. People with stable HIV infection are included in the trials, although the data are limited. The HHS guidelines for HIV recommend that people with HIV should receive SARS-CoV-2 vaccine, because the potential benefits certainly outweigh the potential risks. And remember, although people with HIV, persons living with HIV, are often considered to be immunocompromised, many of them in fact who have normal CD4 counts, who have their viral load suppressed by combination antiretroviral therapy have relatively intact immune response. So we would expect that they would do quite well. Dr. Fauci: (17:19) And then finally, studies on highly allergic individuals are planned and we will keep you up to date as we get data from these studies. I'll stop there. And now back to Andy. Andy Slavitt: (17:32) Thank you. Let's take some questions. Speaker 1: (17:38) Great. First question. We will go to Cheyenne Haslett at ABC. Cheyenne Haslett: (17:47) Hi, thanks for taking my question. Two questions for Dr. Fauci and and Dr. Walensky. First, the CDC has said antibodies after a COVID infection can fade after three months. Should vaccinated people be concerned that their immunity might fade in such a short period of time? And then the second question is how concerned people should be about breakthrough infections. Dr. Rochelle P. Walensky: (18:13) Thank you for that question. Dr. Fauci: (18:15) Go ahead. Dr. Rochelle P. Walensky: (18:17) Our current guidance says that three months is the data that we have so far. So we are waiting for data to merge about how durable your protection is beyond three months. And so this is exactly among the reasons why we want to be cautious as we take these first steps in our guidance, post vaccination. The durability and the protection in the context of variants are among the areas we're watching the evidence very carefully. Dr. Fauci: (18:42) Yeah. One of the things we want to emphasize that there is not a direct linear correlation between the level of antibody and the degree of protection as Dr. Walensky says. Also, measuring antibody does not necessarily get the entirety of the immune response. We know now and we're learning more and more that the T-cell responses, both CD4 and CD8 may also contribute significantly to the durability of protection. Andy Slavitt: (19:10) Dr. Fauci, do you want to comment on the role in the case of Moderna and Pfizer of a second shot in your view of durability? Dr. Fauci: (19:20) Yeah. I mean, obviously we've been talking for some time now about why we feel very strongly that we need to go with the science and showing that with Moderna 28 days later and with Pfizer 21 days later, you get the maximum protection of 94% to 95% efficacy. But importantly, if you look at the titers of the antibody following the first dose, they may be good enough to do a degree of protection, but we don't know what the durability is. Dr. Fauci: (19:50) Also, when you're dealing with variants you want a considerable cushion of antibody response if in fact when you look at the variants, it diminishes by several fold the efficacy of vaccine induced antibodies. And if it diminishes it by several fold, you want to still stay within the range of protection, as opposed to essentially falling off the grid as it were, if you get it so low. So that's the reason why we continue to maintain that recommendation. Andy Slavitt: (20:20) Thank you. Next question, please. Speaker 1: (20:24) Next we'll go to Kaitlan Collins at CNN. Kaitlan Collins: (20:25) Thank you. And thank you for doing this briefing. My question is for Dr. Walensky regarding the new CDC guidance on what vaccinated people can do. We know that the risk of infection during air travel is low when everyone is wearing a mask. So wouldn't it be lower for people who are fully vaccinated? And if so, why did you not change the travel guidance for vaccinated people? Dr. Rochelle P. Walensky: (20:53) Thank you for that crest question, Kaitlan. What we have seen is that we have surges after people start traveling. We saw it after July 4th, we saw it after Labor Day, we saw it after the Christmas holidays. Currently, 90% of people are still unprotected and not yet vaccinated. So we are really looking forward to updating this guidance as we have more protection across the communities and across the population. Andy Slavitt: (21:22) Next question, please. Speaker 1: (21:26) Next we'll go to April Ryan with TheGrio. April Ryan: (21:31) Thank you so much. I have a couple of questions, one dealing with the vaccination of pregnant women. Once the pregnant women are vaccinated, will the vaccination by any chance transfer into the unborn child and give them antibodies? Have you found that as well? And also on the issue of herd immunity, Dr. Fauci, I would like to get this you if possible. What is the anticipation in the midst of all of these vaccines flooding the zone of herd immunity? What's the timetable? And do you think that you will reach that timetable as you have certain communities that still are not participating in the majority way for this effort? Thank you. Dr. Fauci: (22:19) Thank you, April. Very quickly with regard to your first question that you would definitely expect, and we've seen this with many other vaccines, that when you vaccinate a mother during pregnancy, that there's transplacental transfer of antibody IgG from the mother to the baby, and also in breast milk if a mother decides that she wants to breastfeed. So that is a very good way where you can get protection of the mother during pregnancy and also get a transfer of protection to the infant, which will last for a few months following the birth of the infant. Dr. Fauci: (22:54) With regard to your question about herd immunity, as I mentioned, you can only make a calculation of what the percentage of the population that would have to be vaccinated plus those who have been infected and would assume to be protected for at least for a limited period of time. We don't know what that number is, but you can calculate based on, for example, extrapolations from diseases like measles and the vaccine protection of measles and the transmissibility of measles, which is very, very high. That herd immunity level for measles is around 90%. Once you get into the 80s, then you could start getting into trouble. We anticipate, and again, it's purely a speculation, that the herd immunity level will be about 70% to 85%. And that's the time that we believe, if you look at the planned rollout of the vaccines, that we would hopefully get to that point somewhere by the end of the summer and the early fall. You're absolutely correct. If a significant number of people do not get vaccinated, then that would delay where we would- Dr. Fauci: (24:03) Then that would delay where we would get to that end point, which is the reason that I underscore what Dr. Walensky said about the importance in every aspect of what we do of getting more people vaccinated. Just as many people as we possibly can. I want to also mention that we don't want to get too hung up on reaching this end game of herd immunity because every day that you put 2 million to 3 million vaccinations into people, make society be more and more protected. So you don't have to wait until you get full herd immunity to get a really profound effect on what you could do. Dr. Fauci: (24:42) For example, as Dr. Walensky said, she keeps her eye on that very carefully as they reevaluate the guidelines. So you can get 20, 30, 40, 50% of the people vaccinated, not yet quite meet the empiric number that we're talking about and still get a very favorable effect from vaccines. Dr. Rochelle P. Walensky: (25:05) Maybe I'll just add that the point is incredibly important that these are local rates as well. So if you have a population rate that that is 85% protected across the country, but a community that's only 50% protected, you can have outbreaks in that community. And so really we need this level of protection pervasive across all communities across the country. Andy Slavitt: (25:28) Thank you. Kevin, let's take another question. Kevin: (25:32) Right. Last question, we'll go to Shannon Pettypiece at NBC. Shannon: (25:37) Hi. First of all, I was wondering if you could give a bit of the timeline on these new J&J vaccine doses that you're talking about. Is that going to ... When would you get those? Is that going to speed how quickly we can get every American vaccinated? And secondly, I know you guys have talked before about when we're going to get to the point where we have more supply than demand for the vaccine. And I wondered if you are seeing any areas yet where we are approaching that. I know there's been reports from places like Louisiana and Alabama, some of the Carolinas, where there seems to be more supply than demand in the states than have been expanding their population who is eligible. So I'm wondering what you guys are seeing. And then of course, what you're doing to try to address that. Andy Slavitt: (26:26) Sure. And maybe for your second question, I'll also invite Dr. Walensky add a comment about how she's thinking about this at the CDC. And of course, Dr. Fauci, if you want to add as well, the Johnson and Johnson, a hundred million doses that we discussed this morning, was a recent order given by the president to a COVID coordinator, Jeff Zients. So, that is a directive. And so more details about that. It's too premature to provide you more details about what the content of that is going to be. Andy Slavitt: (27:04) With regard to your second question, maybe I'll just kick it off by saying that I completely agree with the premise of your question, which is that there's not a magic date where the entire country moves from needing more vaccinations to having too many vaccines for the population. In point of fact, this is a journey that are were working on together. And as you suggested, community by community around the country, they're going to reach that spot in different places. We are working through the CDC and directly with state and local officials to continue to make that assessment. But important for you to know that we are working on both sides of that equation, helping people get straight answers to their questions about vaccines, as well as increasing vaccine production, crew spent more of our time talking about here. Dr. Walensky, what would you add? Dr. Rochelle P. Walensky: (28:02) Yeah, I would add several things. We are working now with 9,000 pharmacies across the country. We know that 90% of the population lives within five miles of a pharmacy. We are now rolling out to 250 federal qualified health centers across the country. We're working with our state and local partners to provide toolkits and assistance to ensure that they can reach all of their populations. We're doing vaccine confidence consults. If people have challenges in terms of vaccine hesitancy, how can we address those challenges? There's a lot of work going on so that we can actually delay the period of time where people don't want the ... where we have that inflection point. We want to have a lot of vaccine out there and we want to have a lot of people who want it. Andy Slavitt: (28:49) Yes. And I would add that the track record of these vaccines is so good from a safety and efficacy standpoint that simply making sure people have access to correct information and not misleading information is the most important thing. And making sure that local trusted people have access to that information as we continue to make vaccines more broadly available. Dr. Fauci, is there anything you wanted to add on that? Dr. Rochelle P. Walensky: (29:14) No. No further comment, Andy. Thank you. Andy Slavitt: (29:16) Great. Okay. Well with that, I will wrap up. We will be back on Friday, and thank you all for your attendance.