COVID19 Vaccine Town Hall: 1/27/2021
Transmitted LIVE on January 27th on the Health Channel’s FB page, AllHealthGo, COVID Vaccines: Ask the Experts, was a one-hour national Town Hall offering the public around the country an opportunity to ask and get answers to their questions about COVID-19 and the vaccines. Along with Dr. Anthony S. Fauci, below is the list of the top national medical experts who participated and some of the important questions they answered from viewers.
Co-hosted by Michael Zinner, MD, CEO and Executive Medical Director, Miami Cancer Institute, and Health Channel host Olga Villaverde, the panel of health and medical experts included:
• Dr. Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID)
• Dr. Atul Gawande, Author, Harvard Medical School; Harvard School of Public Health Researcher and member of the Biden Presidential COVID-19 Task Force
• Dr. Henri Ford, Dean and Chief Academic Officer, University of Miami Leonard M. Miller School of Medicine
• Dr. Geeta Nayyar, Assistant Clinical Prof of Medicine of Florida International University
Question: President Biden has promised a hundred million vaccinations in a hundred days and now he’s raised it to 150 million. Is that really going to happen?
Answered by Dr. Fauci: President Biden is sticking with the hundred million being the floor and not a ceiling. The most important thing is to get as many people vaccinated as quickly as we possibly can. The goal that was set, is quite an ambitious goal, even though early on, like right now, we have seen the last couple of days of getting a million per day. Things could get more difficult as we try to vaccinate out into the community because logistically it is easier when you’re in a hospital setting or going into a nursing home to vaccinate. But when you have to go particularly into communities where you have Brown and Black people who don’t have access to healthcare, as much as others might or who live in areas that are not as accessible. So, the bottom line is, it’s an ambitious goal. It’s quite a reasonable goal though. And I believe that we will meet that goal.
Question: Many people in underserved communities have fears about the vaccines. Were people of color included in the clinical testing. Can you please address these fears?
Answered by Dr. Henri Ford: It is a real challenge in the Black community and what we have tried to do as a health system, it is to make sure that we are in contact with community leaders, community centers, barbershops, hairdressers, to try to educate everyone on the importance of getting vaccinated. Because at the end of the day, when we look at the effect of the virus, we know it affects a greater proportion, a disproportionate number of Blacks and Brown people in particular; not only do they have higher rate of infection, but also the mortality has been significantly higher in that community. So, if anybody should be vaccinated, it’s exactly Black and Brown people. That’s why we have made it a targeted effort to try to address this. We try to reach out to members of the community to convince them that this is a very, very important initiative and I don’t hesitate to let them know that I certainly I’ve been vaccinated. And then if you’re worried about complications from the vaccine, you only have complications in survivors. So, if you die from COVID-19, then you’re not going to be around to know whether or not there was any complication associated with the vaccine. So, I think this is the kind of persuasive argument. We are trying to drive home to the community with some degree of success, but we recognize that it is indeed an uphill battle because of the historical challenge that we must deal with, skepticism and enrollment in clinical trials, especially based on the Tuskegee experiment that we all know so well.
Question: Are we going to be able to achieve the kind of herd immunity we want to achieve?
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.
Question: Will the COVID vaccine be like a once a year shot cuddled, like the flu, which we do every year, or will it be like the measles where we only receive one shot once in our lifetime?
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.
Question: Who should not get a vaccine as we address this issue of allergies and allergic reactions in the past?
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.
Question: Those with compromised immune systems who are either under treatment or, or just before, just after treatment, should they get the vaccine?
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.
Question: Will the vaccines work against the new virus strains?
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.
Question: Will the vaccine affect male fertility?
Question: Do kids have to wait until more people have been vaccinated to go back to school?
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.
Question: With the new strain of COVID-19 is one mask sufficient or should you wear two masks?
Question: If everyone is vaccinated, is it ok to have an unmasked dinner party?
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.
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.
Question: How long should you wait before getting a pneumonia vaccine?
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.