Answered by Dr. Anthony S. Fauci: Well, herd immunity by definition means you get enough of a proportion of a population vaccinated and/or having gotten infected, and in most infections, most, that usually leads to immunity. For example, with measles it would be lifelong immunity. For measles for instance, which a 98% effective vaccine and a highly, highly transmissible virus, you need a high percentage of the population to get herd immunity and herd immunity really means it’s kind of a metaphor. When you have the overwhelming majority of the people who are protected, the vulnerable among us, who either can’t get vaccinated or for one reason or other don’t respond, are protected from infection because the virus does not have the leeway to go easily among them, because most of the people are protected. It’s almost like when you see a picture of a herd of willdabeest. They’re all together, right? And you have a couple of lions trying to look for the weak baby or the old person there. The herd protects the vulnerable. So, with regards to infections like SARS COVID, we don’t know exactly, what the number is. For measles, it is somewhere around 90%, because we know from the experience in some of the sections in New York City, when some of the Orthodox Jewish population did not get vaccinated, it went down to around 80% of the people vaccinated, and they had a lot of breakthrough infections. We estimate that the requirement for herd to immunity for SARS COVID-2, it’s somewhere between 70 and 85%, which I believe gets to your question. And what was just said by the other panelists, that if you have a substantial proportion of the population who don’t want to get vaccinated because of hesitancy, you won’t reach optimal herd immunity.

So, you won’t have the kind of strong protection of infection. You want minority populations, particularly African-Americans to get vaccinated, one for their own protection, since they’re vulnerable for a number of reasons, including their underlying medical conditions, which they have in a greater percentage than the general population, but also because you want them to contribute to the broad level of protection in the community, which we refer to as herd immunity. A very good reason why we should get as many people vaccinated as we possibly can.

Answered by Dr. Nayyar: Right now, it is too early to tell. We’re in firefighting mode. It is all about putting the fire out and focusing on the lives to save right now, today, as we put out the fire. We are going to focus on whatever we must do to make sure the house never catches on fire again. So, the reality is it’s just too early to tell.

Dr. Fauci addressing same question.

Our experience with this is measured in less than a year because we only began vaccinating people on a phase three trial. The first one started on July 27th. So, we are not even anywhere near a year into the experience. So, the bottom line is we do not know and only time will tell.

Answered by Dr. Gawande: The only two that we’re instructing the people coming into our vaccination centers are those who have an allergic reaction to a specific component in the COVID vaccine, polyethylene glycol. Those people who have a history of reactions to just that, we recommend not having the vaccine. The second is if you have had a severe allergic reaction, anaphylactic attack, to the first shot, you should not get your second shot. As a kid, I received the smallpox vaccine. My parents are from India. They wanted to return to India after they finished their medical training here. I had a severe allergic reaction to the smallpox vaccine. I could not get the booster shot; therefore, I could not leave the country, which is part of the reason why I stayed here. I didn’t get to leave until smallpox was eradicated in 1979. So, this is not uncommon, but smallpox vaccination was highly effective and safe. And same with the coronavirus vaccine.

Answered by Dr. Nayyar: One category we forget to sometimes mention is the acutely ill. So often in the hospital when someone is acutely ill with COVID. If you’re actively sick, this is not the time to get the vaccine you want to recover, get better, and then absolutely get the vaccine.

Answered by Dr. Fauci: There’s some misperception that if you are a person who has an immunosuppressed disease or you’re immunosuppressed for any number of reasons, you’re healthy, you’re well, but for some reason or other, you have a compromised immune system. The only reason you wouldn’t get vaccinated is if we were dealing with a live attenuated vaccine. This is not a live attenuated vaccine. Now, if you don’t have a suppressed immune system, it is conceivable and maybe likely that you would not have as robust a response to the vaccine, but it isn’t a safety consideration. We get asked often, “I have an immune deficiency, should I not get vaccinated?” I think that’s a good reason that you should get vaccinated because you’re going to be vulnerable to a serious outcome from COVID-19.

Answered by Dr. Fauci: No, I would say yes. I think that’s the vulnerable population that you do want to protect. That is the point. And there is this feeling that because I have a condition that I should not get vaccinated now. Again, it’s always, I would say likely that when you have a certain degree of immunosuppression, for whatever reason, you’re not going to get the most robust response to the vaccine, but some response is better than no response. And that’s the reason why you want to protect the vulnerable.

Answered by Dr. Nayyar: I’m going to answer this both as a, as a doc, as well as a mom and women of childbearing age, I will not tell you how old I am, but I, but I will tell you, this is, this is a terrible, terrifying time, right? If you’re thinking about getting pregnant or you are actually pregnant, and the best thing you can do is exactly like Laura said is you want to get this vaccine because you want to have a happy, healthy body.

And the best way to do that is to arm yourself and shield your immune system. So whether it is the COVID-19 vaccine, whether it is the flu vaccine, you want to focus on having a happy, healthy body. If you are trying to get pregnant. And if you are pregnant again, this is a shared decision you’re going to make with your doctor. There is no data at this time, we continue to learn as we go. But the reality is, if you are pregnant, you are more at risk of getting an infection, any virus or bacteria COVID included, and you’re more likely to end up on a breathing machine. And if you lose oxygen, so does your baby. So these are important decisions you have to make for you, for your child. And you really want to have that conversation with your doc. And you want to keep in mind what your risk is, right? Are you a nurse on the front lines? Are you a teacher or are you in the basement watching Netflix for nine months straight? So, you’re going to assess that risk with your doc, but I am telling everyone as if they were my sister, you’ve got to get the COVID vaccine. You’ve got to do it.

Answered by Dr. Fauci: One of the things that people should be aware of is that although pregnant women were not allowed in the trial (So that was an exclusion criteria), since the EUA was given, there have been now about 10,000 pregnant women have gotten vaccinated and getting back to what Geeta just said, many of them were healthcare providers who were saying I’m pregnant. I really want to protect myself from getting COVID because I don’t want it to be a deleterious effect on my baby. We will get data that will be followed. The FDA is accumulating that data. So even though they weren’t in the clinical trial, we’re starting to accumulate a lot of data thus far, no red flags about that.

Answered by Dr. Fauci: It’s a complicated issue. We know that RNA vaccines mutate very readily. That’s what they do. Part of their existence is to mutate. The more they replicate in the community, the greater chance they have to mutate most of the time. The mutations don’t result in any functional change in a virus. But every once in a while, they do. That’s the situation that we’re facing now. And I’ll explain in a moment what impact it would have on the vaccine. The UK variant, which is now in more than 25 States in the United States, when you take a look at the antibodies that are induced by the vaccine that we are using, it does not appear to be a significant diminution in the effect of their neutralization in the test, too.

Having said that there’s a big caveat here. And the caveat is, will that be reflected clinically if you get exposed following the vaccine? The answer to the question I believe is going to be forthcoming in the next few weeks because we have the Johnson, or J and J, as well as Novavax, which are doing their experiments in a way that might give us the answer. They are testing it in the United States and in South Africa and with Johnson in South Africa and Brazil. When that data comes out, we’ll find out whether the neutralizing data correlates with the clinical data. Bottom line is we take these mutations very seriously. Currently, it looks like it will protect. Certainly, the UK is much less worrisome than the South African mutations. That’s where we are right now. But in real time, we must be prepared to upgrade the vaccines if it becomes necessary and by upgrade, I mean, make them with the insert to code for the viral protein that is associated with whatever mutation you’re worried about.

Answered by Dr. Ford: Absolutely not. We know that COVID-19 infection certainly is associated with impaired sperm function from studies that were done right at the university of Miami Miller School of Medicine. So we know the virus can actually affect the testes and impede sperm production, but the vaccine itself has no effect on male infertility, all on sperm function.

Answered by Dr. Ford: The study that was reported by the CDC really begins to shed some light on this issue. Without question, there is the capacity to open schools safely. It all depends on whether there’s adherence to all the principles that Dr. Fauci has been preaching for so long such as proper physical distancing, smaller classrooms, and making sure everyone is wearing a mask. And what they were able to demonstrate is that there is a very low percentage infection rate in that setting. So, you can reopen schools safely if you have the means, if you have the resources to implement, all the public health principles that have been championed. The data is still not quite there yet, but we know that Pfizer has been able to enroll over 2,259 kids in terms of vaccines between the age of 12 and 15 years and soon we’ll be able to begin to understand how safe it is going to be to vaccinate that population and begin to hopefully expand the number of vaccinations to an even younger population, to the extent that we can enroll other younger children. But right now, we don’t have the data yet done. What has happened is over 2000 kids were enrolled in the vaccine by Pfizer, but a lot of data is on the horizon that will help us open schools safely. In the meantime, though, we know that if we were to adhere to the strict public health principles that have been championed, we may be able to do that.

Answered by Dr. Gawande: Schools have not been major sources of outbreaks. The exception to that has been in communities where there’s a lot of virus in circulation. There are a couple of things that the Biden Administration has indicated that they are backing. In fact, in my state and several others, we’re committed to adding not only that the kids wear masks, but we want to vaccinate the teachers and get that to happen as soon and as quickly as possible. But then also we are offering testing for the staff and the students to our capability. I hope that Congress backs the funding to make that possible because I think it will make it feasible for most American kids to return to in-person schools. If we add in the funding to make that feasible specifically.

Answered by Dr. Fauci: Well, the CDC does not recommend that you must wear two masks. What they say very clearly is that everyone should be wearing a mask uniformly. The President himself has said he wants everyone to be wearing a mask for at least a hundred days and very likely beyond that. There are some people who make a reasonable deduction. They say, well, if a mask is a protective covering, that may be two layers would be better. That could be true, but the CDC still recommends a mask that everyone should wear. People should not get caught up with two versus three, just wear a mask.

Answered by Dr. Nayyar: The answer is universally NO. You’ve got to stay in your bubble, which means everyone who is in your family, in your household. Even if you all have been vaccinated and remember, you can still pass the infection on to others. What we all must get our head around is that we have to wear a mask for this year. We are going to have to commit to wearing a mask for 2021, whether you have been vaccinated or not. We’ve got to remember with, or without a vaccine, the mask stays on and you are still susceptible to infection and to spreading this virus if you are not wearing a mask.

So unfortunately, the answer is no.

Answered by Dr. Gawande: I’m going to add in that we recognize this is really hard. There are a couple of pieces of information that we still don’t have. First of all, all we know about the effectiveness of the vaccine is it reduces the likelihood that you will have severe illness resulting in hospitalization or death. You could be carrying asymptomatic infection and be still capable of spreading it. Furthermore, there is a subset of people, at least 5% who will get infected regardless. And that is part of the reason and presumably an even larger number that can transmit. So, the reason why we are continuing to ask that you wear the masks, even after you’ve been vaccinated, is partly for protection for that subset who still can get sick.

Answered by Dr. Ford: We won’t have enough data to start vaccinating the children. The Pfizer first clinical trial went to 16; Moderna at 18. So, we cannot really start vaccinating people who would be younger than 16, but we know, as I mentioned earlier, that Pfizer just completed the enrollment of children between the ages of 12 to 15. So hopefully within a matter of a several weeks, we will know about the efficacy and safety of the vaccine in that population.

The projection is that by late spring, early summer (hopefully no later than June) we would be ready to start testing smaller children. So hopefully children between the ages of two and all the way up to 15 and so forth so that we can determine not only the efficacy, but the safety of the vaccine in that population. And that’s the time when we know if we can truly vaccinate children in insignificant numbers, but until then, there isn’t much we can do about that. And that’s just a matter of safety.

Answered by Dr. Gawande: In the trials, there was a two-week wait recommended period recommended after you get a flu shot before you get the coronavirus vaccine. We’re not recommending that you get these simultaneously.

Commented by Dr. Zinner: So, a two-week wait period that once you got your vaccine, then you can either get the flu shot, or you can get your shingles shot afterwards.