Video and Transcript of Path Forward Ask Me Anything – Public Health

Dr. Tom Frieden:

Good afternoon. Good evening. Good morning, everybody. I'm delighted to be with you. I'm Dr. Tom Frieden Former Director of the CDC, Former Health Commissioner of New York City. Currently, President and CEO of Resolve to Save Lives. Ask Me Anything. I'll be answering your questions for the next half hour. I was born in New York City, raised here, went to medical school here, worked most of my career here. So I'm going to talk fast. Hang on tight. First question, please.

Question: What information can you provide to healthcare professionals who are hesitant to take the vaccine?

Dr. Frieden:

For healthcare professionals who are reluctant to take the vaccine, there are a few things you should know. First, this is not a rushed vaccine. More than ten years have gone into developing these vaccine technologies. They've been studied in trials in more than 100 thousand people, given to more than 100 million people without any serious adverse events. Nearly all doctors offered this vaccine take it as soon as they can get it. So you should too.

Question: Can someone who has been fully vaccinated against COVID-19 still pass COVID to other people?

Dr. Frieden:

It's very unlikely that someone who has been fully vaccinated, which means the full dose series, one for Johnson & Johnson, two for Moderna and Pfizer plus two weeks, will pass the virus to others. Not impossible. No vaccine is 100%, that's why you have to continue to mask up, but it's very, very unlikely. Next.

Question: How can we get county officials to create vaccine sites to address inequity in distribution? How else can we help lower-income and people of color to get vaccinated promptly?

Dr. Frieden:

Getting vaccination sites to address the population distribution with the vaccine distribution requires effort. If we just let first-come first-serve work, we're going to exacerbate inequalities. There are lots of best practices for how we can get more vaccines to people who need it most. I'll mention just three. One, open pop-up sites that only allow vaccination by people who live within certain zip codes and bring proof of that zip code residence. Two, open sites in high-risk communities for people from those communities and don't require appointments. So you don't have all these barriers for the digital divide. And three, work from doctor's offices, community sites, pharmacies in the neighborhoods most at risk with the highest rates so that you can get vaccination quickly and drive down cases. The more we vaccinated people at higher risk in high prevalence communities, the more good we do, the more lives we’ll save, and then the more we knock down transmission of the virus.

Question: How long do current vaccines maintain our immunity?

Dr. Frieden:

We don't know how long the current vaccines are going to maintain immunity. It's at least six months. It may be lifelong. It may be one year, two years, five years. For certain things, only time will tell. And the right honest answer from any expert is, "It depends." We need to see the data and learn. And as we learn, we'll share that information openly.

Question: When do you think we’ll have an approved vaccine for elementary and middle school children?

Dr. Frieden:

It's not likely that we'll have a vaccine for elementary and middle school kids any time before the end of this year or early 2022. There are some exceptions though, 12 to 16 year olds we may have vaccines sooner, 16 to 18 year olds we already have vaccines. We're walking down the age range making sure that vaccines are not only effective, but also safe in different age groups.

Question: When do you think it will be safe to attend large attendance events?

Dr. Frieden:

Big events are going to be challenging, particularly indoors. Out of doors, much safer. Indoors, you're really going to need to know that everyone or nearly everyone is vaccinated and that the virus is at a very low rate, because there's a risk the virus can overwhelm the immunity. Remember, no vaccine is 100%. So large indoor events? Well, with a mask, may be possible in the fall but we're going to have to be careful. That category of large indoor events is really probably the hardest along with restaurants and bars, where people are talking and shouting without masks on. So that's where the virus can spread most and quickest.

Question: We have an office team of 10 people of all ages and stages of health and work in a relatively small space. When is it safe for all 10 of us to return to work?

Dr. Frieden:

Ten people working in a small space. Well, if you're all vaccinated, then I would say it's probably okay. However, you'd want to increase ventilation. If it's really a small space, you'd want to consider wearing masks. And if any of the people have underlying conditions and there's a risk that they won't respond well to the vaccine, because for example, some people with cancer who are on certain treatments or have organ transplants may not respond as well. Those people may want to continue to stay home.

Question: Do you think proof of vaccination will be required to travel or attend sporting events, movie theaters, etc. in the near future?

Dr. Frieden:

This is a hot topic. Will there be a proof of vaccine requirement, a vaccine certificate for travel or sporting events or movie theaters in the near future? There is already in some countries. I think first off it's going to happen globally. You're going to have to have a certificate of vaccination to enter certain countries. That's just the reality. It's also going to be required for cruise ships. All passengers and staff of cruise ships are going to have to be vaccinated. I think very few other businesses are going to require this, but it's not impossible. It's within their legal right. It's not a recommendation from the government, but I can imagine a restaurant or other facilities saying, "Hey, our comparative advantage is that all of our staff or clients are vaccinated so you have a lot less to worry about here." That's the market, that's not big government changing things.

Question: We have expatriate employees in Asia who would feel more comfortable getting one of the COVID-19 vaccines approved by the U.S. FDA. Is there any way for them to get these shots?

Dr. Frieden:

It's a tricky issue about expatriates. I was asked yesterday on another one of these, what about someone coming back to the US to get vaccinated? Would that risk be greater than the risk of waiting to get it where they're going? So I would say it depends very much where you are, what vaccines you have available, what your risk level is. It's really an individualized question. Again, important to keep this answer in mind for many questions, the right answer is, "It depends."

Question: How much confidence do you have in the vaccines developed in other countries?

Dr. Frieden:

There are some vaccines that are very promising that were developed in other countries. The US doesn't have a monopoly on great vaccine technology. We have had companies that have produced really four stellar vaccines, the J&J vaccine, the Moderna and Pfizer vaccines and the Novavax vaccine. All four of those are the first to provide public data and they're terrific. We haven't seen as much data about some of the other vaccines. For AstraZeneca, I think one of the problems is that the data wasn't as well standardized as it was for the US vaccines. So we really don't know if it works as well or even better, but we just don't have as good of data, but we hope we will see that pretty soon. And for the Russian vaccine, the Sputnik vaccine, there is one published study on that vaccine that's quite impressive. It uses very sophisticated technologies. As we see more published data, we'll be able to have more confidence in different vaccines.

Question: When will we reach a point at which countries recognize vaccinations regardless of whether they’re authorized for use in that country?

Dr. Frieden:

That's a great question. I think, really, it comes down to what does the science show? What is any individual vaccine proven to accomplish? Does it result in complete and long lasting immunity? Right now, there are a handful of vaccines that show that. There are others that are being used for which there really isn't scientific data widely available. We would expect to see any vaccine that's been approved by what's called an SRA, Stringent Regulatory Authority, if that's approved I would hope all countries would recognize it. There are a handful of SRAs around the world, including the European Union, the US and others.

Question: How and why do mutations of the virus occur?

Dr. Frieden:

How and why do mutations of the virus occur? Great question. First off, take it from the standpoint of the virus. The virus is a sloppy replicator. It makes mistakes. When it makes mistakes some of those replications, some of those mistakes are carried on to the next generation of viruses. But there's another answer that has more to do with the population dynamics. Wherever there is uncontrolled spread, there is greater risk of emergence and spread of mutations or variants. So anywhere there's uncontrolled spread, it's a risk to all of us. It matters. It's not just about ethics that we want to make control and vaccines widely available. It's also about epidemiology and disease control. This is one of those conditions, one of those circumstances where it's in all of our best interests for all of us to be safer and healthier.

Question: Will each COVID-19 variant require a different vaccine?

Dr. Frieden:

Right now, it looks like most of the variants we've seen are well-handled by most of the vaccines, but there are some differences and some of the vaccines seem less effective against some of the variants. We're still going to have to learn about that because more information will become available as more people are infected with those variants. But the dominant variant in the United States now, B.1.1.7, first identified in the United Kingdom is controlled by the vaccines we're using in this country. This is the biggest wild card, the biggest unknown going forward. Will our vaccines control the variants, or will we need to continuously tweak the virus formula that control the variants and only time will tell.

Question: Will COVID-19 be a permanent part of our lives like the flu?

Dr. Frieden:

I do think COVID-19 is here to stay for a long period of time. We don't know exactly how that's going to happen. Will it be seasonal like flu? We haven't gone through enough seasons to know. Will it be worse in some years than others? Or will it be like a measles or a condition where when everyone is vaccinated, we just have small clusters here and there. We just don't know. We hope that we'll be able to control it better than flu. When we have not just the US, but the world vaccinated we'll be able to crush the curve and then mop up the cases in clusters where they occur. That doesn't mean we can eradicate it, but it does mean we can control it. That's what we hope will happen.

Question: Do you think we’ll ever reach herd immunity in the U.S.? If so, when? And is that when we’ll be able to get back to “normal”?

Dr. Frieden:

So, herd immunity I'm afraid is a concept that's been not very well understood. Herd immunity isn't like a light switch turning on and off. Herd immunity is not like stampede of buffalo moving into town. Herd immunity really reflects a level at which there is less free spread of the virus within a community. And already we're seeing some of that, kind of a break on the spread of the virus. But the second part of that question, "When will we get to the new normal in the US?" I think by the summer we're going to be getting a good deal toward the new normal, and by the fall we'll be at the new normal, unless a dangerous variant emerges. And what that would allow us to do is, back in-person for learning, back in-person for work, most of the activities that we've done before we're able to do again.

But we will see some changes we will have to test and trace. We'll have to vaccinate. We'll maybe want to wear masks increasingly, after all masks crushed the curve of influenza and have saved tens of thousands of lives. They're widely used in East Asia and so that's something that may become part of our reality. Not like now, not all the time for everyone, but in certain circumstances. So I think we will get to a new normal by the fall in the US. However, until this disease is controlled globally, we will not be safe here. In part, because of the risk of dangerous, even more dangerous variants emerging.

Question: How can we overcome vaccine hesitancy in communities of color as well as partisan-based hesitancy?

Dr. Frieden:

There is so much hesitancy. And very soon, you're going to see the flip from too little vaccine to too few people willing to get vaccinated. Right now, there are about 50 million people over the age of 50 who haven't been vaccinated in the US. A certain proportion of them, maybe a quarter of them, really want to get vaccinated. They'll get vaccinated in the next month or so. But another 30, 40 million people have a lot of doubts, a lot of questions. And what we need to do with every community, Black, Latinx, White, urban, rural, North, South, whatever political affiliation, the formula is the same. First and foremost, listen. What are people concerned about? What are they hearing? What are their questions? Second, acknowledge. Understand that, yes, those are valid questions. Third, answer. Not in a rhetorical way, not in an excessive way, but factually. Give the facts, tell people what we know when we know it, how we know it, what we don't know and how we're going to find it out. And also tell stories. Stories about people suffering from long-COVID, stories of people who may have passed or died from COVID. Stories of people whose lives were saved and who can now go back to work and school and their former lives because of the freedom that a vaccine brings.

Question: What advice do you have for small businesses, like bars, that are struggling to stay afloat because of capacity restrictions but want to do their part to help prevent the spread of the virus?

Dr. Frieden:

Very tough issue, especially with bars. Bars may be the hardest point here. Because, what happens is, when people are drinking and eating and speaking loudly they're much more likely to spread COVID. So if you're a small business owner, it's in your self-interest to get the disease controlled in your community and that can be done by three key measures. Vaccinate as quickly as possible, mask up any time you can indoors, and third, limit indoor contact with others not in your household. Now for businesses, there are certain mitigations you can use. Out of doors, massively safer than indoors. Masking up all of the staff, increasing ventilation, providing more takeout to the extent that that's legal. There are adjustments, but it is a big problem. And that's why some of the federal programs under the last year, and this year are supporting businesses that otherwise really won't be able to stay afloat. A safer world is coming a safer time is coming. By summer things will be very different. By fall we'll be back to, or to, a new normal. But these next couple of months are very challenging. Cases are increasing, there's not enough vaccine yet and there are still too many hospitalizations, too many deaths, too much uncontrolled spread, too much risk of dangerous variants emerging.

Question: When will we have enough vaccines for everyone?

Dr. Frieden:

We're going to have enough vaccine for everyone in about a month. It's really close, even though one of the companies had some problems with vaccine production, we're seeing big increases in the amount of vaccine available. So this issue of scarcity is almost over. Another three, four, six weeks, somewhere in that range, there will be enough. There may still be spot shortages, but soon we're going to go from not having enough vaccines to not having enough willing arms to have vaccines injected into. And that's where we really need to double down on listening to communities, working with doctors’ offices, working with community sites, figuring out innovative ways to get people vaccinated, making it convenient for people so it's not hard for them.

Question: Now that supplies have increased, why isn’t the government making vaccines available to employers so they can administer them in the workplace?

Dr. Frieden:

Vaccines administered in the workplace is something we are likely to see quite soon, maybe not till mid- May or June. But we want to see multiple platforms for vaccination. Not just the community vaccination sites, not just the pharmacies, but also at doctors’ offices, workplaces, pop-ups in churches. I'd like to see the single dose vaccine, the J&J vaccine available outside of shopping malls in communities where there's a lot of disease in particular, so that we can quickly crush the curve. The more of us who get vaccinated, the more all of us are safer.

Question: If you already have had COVID-19 and still have the antibodies why do you still need the shot?

Dr. Frieden:

If you've had COVID-19, you have some protection against getting infected again, but it's probably not quite as good as protection by the virus. The best estimate is that prior infection protects to about 80% efficacy. The vaccines are 90 or higher percent efficacy. So even if you've had the vaccine, even if you have antibodies... I'm sorry. Even if you had the virus and even if you have antibodies, you should get vaccinated. Now, you may want, when it's available, to get the J&J vaccine, because it's only a single dose and there is data that people who've been ill before can have a very robust reaction from the vaccine. Think of it this way. The mRNA vaccines are two doses. If you're infected and you get the J&J vaccine, you've essentially gotten the two dose immunization. But you can get the mRNA vaccines also.

Question: We ask all employees (who can distance at work) to document daily temperature and symptom checks. Can we allow those who are vaccinated to stop doing those?

Dr. Frieden:

Yes. I think you can stop doing temperature and symptom checks on those who are vaccinated. I think actually temperature checks do almost nothing. I don't think I've heard of any place that's found someone with a fever from a temperature check with probably millions and millions of measurements. It's, it's performative, to be blunt, it doesn't really make a difference. It makes people feel better. But no harm, but probably not of much good. Much more important. If you're thinking about keeping a place safe to monitor mask use. A best practice that I've seen in a few places is they have people randomly checking, not by name, but just looking around and then providing on a daily basis what percent mask use was there in that facility? There's a free software that allows this to be done. It can also be done very simply, but basically I know of one facility where, when they started doing that, it was only 60 or 70%. Quickly it got up to 100% and it stayed at 100%. So, the mask wearing is really important. Remember the main freedom that a mask inhibits is the freedom of this killer virus to circulate and take other people's lives.

Question: When we return to work, will it be safe to use public transit especially during “rush hour”?

Dr. Frieden:

What about rush hour? What about crowded subways? Well, interestingly, public transit has pretty good ventilation better than you'd think. That's been studied now with this. But this is one of the reasons why it's really important that we reduce spread in communities. Getting vaccinated is really important. Clamping down on transmission, stopping cases from becoming clusters and clusters from becoming outbreaks is also important. Because ultimately, if you have a strong force of infection, it may overwhelm the vaccine induced immunity that people have. So I think what you're going to see is vaccination, masking in crowded public places, sensible thing to do, increased ventilation in those places and increased control so that we can have confidence that if cases are beginning to spread, if dangerous variants are emerging, we'll know about it and stop them. That's in all of our best interests, that's going to help our economy recover faster and it will also save lives.

Question: What are some of the long-term changes to our public health system that you expect to see after the pandemic?

Dr. Frieden:

Well, I'm hopeful. I think our public health system can get much stronger after this, but only if we really changed the way we fund public health. We need to enact something that we're proposing with a bi-partisan coalition called the Health Defense Operations Budget Designation. And what that says is, let's take politics out of public health defense. Let's make sure that we have a long-term investment in our public health system so that we have systems that will quickly find, stop, and prevent health threats. Not just in the United States, but around the world. That's going to take a multi-year investment, but the risks are huge and the benefits are even greater. If we can drive down the risk of a future pandemic, and we know that risk is there, we can save trillions of dollars and millions of lives. We have to make sure that we don't forget, this is the teachable moment that we have never had in our lifetimes. We can't mess it up this time. We have to make sure that we have a stronger public health system and one that's much better connected, Federal, State, City, and local, not four different playbooks but one playbook. And national and international understanding that health can and must be a bridge to peace, that when we're working together all of us are safer and healthier. Health is not a zero sum game. The healthier people are anywhere, the healthier all of us are everywhere. It's been said that an injustice anywhere is a threat to justice everywhere. And it's also true that ill health anywhere is a threat to health everywhere.

Question: Can COVID-19 be eradicated like polio and other diseases?

Dr. Frieden:

Unfortunately, COVID cannot be eradicated. For eradication to occur, there needs to not be an animal reservoir of the disease, and there are multiple animal reservoirs of this disease. So only smallpox in the human diseases and rinderpest of the animal diseases have ever been eradicated. Dr. Bill Foege, who led the global eradication of smallpox, just this week wrote a piece summarizing some of the key lessons from smallpox eradication. And they're really important. We need better data, we need more collaboration globally, we need effective organizations, and we need to make sure that we don't forget these important lessons of the deaths and the economic dislocation from COVID. And much of this we can avoid if we work together, we can't eradicate COVID, but we can greatly reduce the risk that COVID and other killer diseases will cause anything like the disruption that this pandemic has caused.

Question: What can we do to ensure local businesses are better connected to local health policymakers?

Dr. Frieden:

Great question. How can local businesses be better connected to local health policy makers? Well, you can get to know your local health department. There are many foundations that connect the public and private sectors, ranging from the CDC Foundation at the national level to groups like the Fund for Public Health in New York City, in New York City, to foundations and various different groups. There are lots of great potentials for collaboration. Give you one example, one of the things that we need to do in the coming months is to relaunch what used to be called contact-tracing as what it should be, which is COVID support services. And if there are clusters, and if people need food or housing or social support, then local businesses can provide that. We should make isolation and quarantine so appealing that people are fighting to get into them, not fighting to get out of them.

There are many, many roles that local businesses can play. And one of the single most important ones is to advocate for public health. Public health is about the most good for the most people. And interestingly, nobody ever held a rally on the steps of City Hall demanding the general good. So business really has common cause with public health. Businesses want and thrive in a stable business environment without unexpected shocks. Businesses want and thrive in an environment where people have lower costs of health and healthcare because they're healthier and more resilient. Businesses want and thrive in an environment in which the risk of unpredictable outbreaks is lower and the potential for rapidly finding, stopping, and preventing them is higher. There's so much we can do in this country.

You know, if you look at the data around the US and around the world, the US has become a negative outlier. We've become a laggard. Americans are living about four years shorter lives with many years more disability and much higher healthcare costs than people in just about every other high income country in the world. And working together, public health and businesses can reverse that. A lot of what we need to do isn't expensive, isn't complicated. It's some of the most simple things. Ending the tobacco epidemic can be done. Increasing opportunities for healthy physical activity, walking and cycling and active transport. Supporting public health, improving nutrition, improving the care of the leading killer diseases like high blood pressure. This can be done. It will save lives. It will save money. It will make us more productive as a society.

Question: If you are still having residuals from having the virus is it safe to take the shot?

Dr. Frieden:

If you still have some symptoms from having the virus, it is safe to take the shot. There are some people who will wait for three months because your immunity is pretty good for three months after you've been ill. But there's no reason to wait more than 10 days and the shot is going to give you better immunity, as far as we know, then getting infected will.

Question: Do you know anyone who’s scared to get the vaccine? What would you say to them?

Dr. Frieden:

I know lots of people who are scared to get the vaccine, and it depends why they're scared. So, I would say to someone who is scared of needles, I'd say, "Maybe you want to take the J&J vaccine because it's just one shot instead of two?" I'd say to someone who thinks there may be long-term consequences of the vaccine that maybe it's got some really dangerous thing in it that, "First off the risk that you'll have long-term consequences from the virus, from infection, are vastly higher than any risk there might be of a long-term adverse event from the vaccine itself." And understanding that, because it's got the RNA in the title doesn't mean it changes you. The way these vaccines work, it's actually quite brilliant. They teach your immune system to recognize and kill the virus and then they disappear. They are like a disappearing message. It's a great technology, remarkably effective, remarkably safe. I've gotten the vaccine. My family has gotten the vaccine and I recommend to everyone to get a vaccine the moment it's your turn.

Question: What can we do about those that feel this vaccine is being forced and is against their constitutional rights?

Dr. Frieden:

Well, right now nobody is forced to get a vaccination. I will say on the issue of rights, I think we have to be very clear. There's an old saying that, "You’re right to swing your fist ends at my nose." Now, you were right to go into a business without a mask on and talk and shout when the employees there may get sick and die from that, if the business has mandated mask wearing, I don't think you have that right. I don't think you have that right. In terms of forced vaccination, no one is forcing vaccination so far. If you want to go on a cruise, you're probably going to need to get vaccinated because everyone who goes on that cruise needs to get vaccinated. But that's your choice. Don't want to go on a cruise. Don't get vaccinated.

Now there are some exceptions and I'll say one as we're closing and that has to do with nursing homes, long-term care facilities. I think we have to have a real conversation about the staff of these facilities. The residents are getting vaccinated, but if we're seeing cases and deaths in the residents, there is a case to be made for requiring the staff of those facilities to be vaccinated. That's the only situation that I can think of where there may be an ethical justification for a vaccine mandate.

Dr. Frieden:

I think we're just about out of time. So I hope I've gotten to just about all of your questions or we'll take one more.

Question: If our small office bubble is vaccinated except one, can we eliminate masks and allow that one employee to choose to do as they wish with their mask?

Dr. Frieden:

Well, let's see. If one person isn't vaccinated, the problem is that a mask protects that person even more than their mask protects themselves. So it depends how many people, what the age group is, why someone's not getting vaccinated, what the policies are of that business. Not an easy question, I think better safe than sorry. We'd rather see people masked, at least until summer or fall when we can drive cases way down with vaccinations, so drive that risk down. Because ultimately, yes, that person could wear a very good mask an N95 mask, but it's really hard to do that all day long and better safe than sorry. We don't want to risk people's lives unnecessarily.

Dr. Frieden:

Thank you so much for joining me. I'm glad you asked me anything and I hope I've answered all of your questions. I've tried to answer them as plainly and truthfully as I can, remembering that often in public health the right answer is, "It depends." It depends on the data. We tell people what we know when we know it, how we know it, what we don't know, and what we're doing to find it out. Thanks so much. It's been a pleasure interacting with you all.