Kind: captions
Language: en
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back in december 2020
we did an episode when the pfizer
biontech moderna and oxford astrazeneca
vaccines
were on the horizon it was an exciting
time we have to be vigilant but i do
think a safe and effective vaccine
is the silver bullet i mean we don't see
polio we don't see
smallpox this is what vaccines do this
vaccine will be doing its job
if a year from now we don't have this
virus in our lives
and i absolutely look forward to
thanksgiving 2021.
um uh it better be a big feast
and it will be if we do this right yet
here we are
at the beginning of august 2021 and
these
are the headlines america's coveted
recovery has hit a dangerous roadblock
the united states topping 100 000 new
coronavirus cases
just friday a stunning fourth wave
hospital admissions surging to more than
6 000 a day the highest number of
patients since february
dr anthony fauci warned this latest
surge driven by the delta variant
will get worse
remember when we were just dreaming
about getting vaccines for coba 19
well they're here and surprise the
pandemic still is as well
we've got the emergence of new variants
of the virus and infections continue to
spread across most
of the world in the meantime people have
questions
can the vaccines handle the new variants
and wait do we need booster shots
and there are still a lot of folks who
wonder are the vaccines
safe today we'll get you answers and
talk about just what it'll take to get
to the other side
of this pandemic this is nova now where
we give you the shot of science
behind the headlines i'm alok patel
i'm speaking with monica gandhi md an
infectious diseases doctor and professor
of medicine at the university of
california in san francisco
i want to get into all the positive news
about vaccines and then a little bit of
a reality check
and so you know we've seen vaccines roll
out and
a lot of the optimism in the beginning
was based on
clinical trial data and now we're
getting more real world data
so i'm wondering if you can clear up a
little difference for everyone out there
of efficacy
versus effectiveness and what we know
about the vaccines today
the word efficacy is the outcome in a
clinical trial
and that already blew us away in terms
of
what the johnson johnson the moderna the
pfizer the sputnik the
covaxin i mean actually all of the
vaccines
looked really good in terms of that
outcome of efficacy
did it prevent disease symptomatic
disease in the clinical trials
and then we saw all this real world
effectiveness data effectiveness meaning
how does it look in the real world and
these are looking really good in the
real world and
actually if you stick to one outcome and
one outcome alone
that of preventing severe disease the
real world effectiveness
of these vaccines is quite astounding
it's why 99.7
of the people in the hospital right now
in the united states
are unvaccinated eligible adults uh not
those who are vaccinated
our headlines are flooded right now with
things about the variance
rightfully because delta variants kind
of wild but for the
unvaccinated people out there what is it
about the delta variant that makes it so
contagious yeah it's true this delta
variant is different
it is more transmissible there was this
question for a while oh is it just more
fit and it's knocking off the other
viruses no
no no there are higher viral loads in
the nose of people who get infected with
delta variant
and then really their mechanism of
action is they think it replicates
faster it's basically shortened
the period of incubation so you get
higher viral loads in your nose
so if any unvaccinated eligible adult is
walking around
they are susceptible to any variant that
is more transmissible that has a higher
viral load
and again i want to distinguish adults
because children are not able to be
vaccinated less than 12
but we are not seeing increased
hospitalizations among children due to
the delta variant
but the big news lately has been about
breakthrough infections
people who are fully vaccinated but
still test positive for covid
and may even develop symptoms now we
expected
some vaccinated people would be infected
but breakthrough infections still appear
to be relatively rare
with current data showing infections in
less than one percent
of vaccinated people but out of the
millions who are vaccinated
that comes out to be large numbers that
make worrying headlines
i just wanted to ask you to
differentiate what we see and what we
know about breakthrough cases
versus all the other positive cases from
cover 19 that are presumably from the
delta variant
yes i want to divide it into three
categories of breakthrough
let's start with asymptomatic
breakthroughs if
you are vaccinated you don't have any
symptoms someone happens to swab your
nose
and your viral load is low viral load
is determined from a pcr test that's a
vaccine success
you just proven that you saw the virus
and you won but then there are some
breakthroughs where vaccinated people
do get sick symptomatic breakthrough is
real
meaning there are people who get
symptoms that are mild
with a breakthrough infection with more
with a delta variant
so it gets into your nose it takes you a
while for your b cells to kick in
so b cells are the ones that produce
those antibodies it's going to come out
and kill it but it may take
a bit and that bit of time unfortunately
will result
in something like a cold-like symptoms
or even you can feel like you have the
flu at its worst
um and that there are those symptomatic
breakthroughs but they're not putting
people in the hospital in any way shape
or form
and then the third type of breakthrough
is a severe breakthrough infection
those are rare to give you a sense of
how rare
here's a quick breakdown as of july 26
the cdc reported more than 163 million
people in the u.s
had been fully vaccinated against cova
19.
of those 163 million 0.004 percent
are patients that have been hospitalized
with breakthrough infection
and less than 0.001 percent
of breakthrough infection cases have
resulted in death or just about
eight in a million so it doesn't mean
this isn't working
because what did we promise with the
vaccines
we promise to turn it in to one of those
circulating coronaviruses
that we don't care about actually
because we get colds
which are those endemic chronoviruses
but the promise of the vaccines were
never
that you wouldn't get anything happening
in july there was a major cluster of
breakthrough cases
in provincetown massachusetts which
helped convince the u.s centers for
disease control and prevention
that vaccinated people could still
spread the virus
leading the cdc to update its mass
guidance
it now recommends masking up indoors
again in areas with high rates of cover
whether you have the vaccine or not it's
also a good idea
when you're around children under 12 who
aren't vaccinated or anyone who's high
risk
such as the immunocompromised that's
partially because
right now they don't want vaccinated
people in a store with a high viral load
to be around an unvaccinated person and
they certainly don't want someone who
has a mild breakthrough infection to
pass it on
but the delta variant it is a different
beast and as bad as a delta variant is
we know that as long as the virus is
still in circulation it'll continue to
evolve
meaning more variants may be headed our
way
the vaccine's main job is to give the
body a way to remember
how to fight that virus in the future so
if the virus
mutates will the body be able to use
that memory to fight it
is there any scientific proof that we
could see a variant that is
able to withstand our vaccines okay so i
have
two very optimistic ways to explain why
i do not think
that we're gonna get a variant that's
going to evade our vaccines
the two arms of the immune system they
are called b
cells and t cells so b cells are the
ones that produce antibodies
and your antibodies over time
to anything a vaccine or a natural
infection are going to go down in your
bloodstream over time if they didn't
your bloodstream would be so thick you
couldn't move
so all those proteins are going to go
down but it's the memory b cells
those cells can actually keep a template
and adapt the antibodies they produce
to changes in the virus that should
thwart future lookalike variants
those are the blueprint that will
produce new antibodies if you need them
in the future
we know these vaccines produce memory b
cells there is another study from oregon
health sciences university
that showed that if you see a variant in
the future
that blueprint of those memory b cells
are just going to come out and produce
an antibody that is adaptive towards
that variant
they see the zeta variant in the future
they are going to produce
antibodies that are directed against
that variant but they don't store
antibodies in their
surfaces they come out and produce the
antibodies to exactly what they see
the second reason is t cell immunity
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t cells are one type of cell that make
part of your immune system
they find and destroy infected cells in
your body to prevent infections from
spreading
for covid the vaccines train the immune
system
including t cells to target a protein
specific to
this virus the spike protein this
byprotein is made up of 1273 amino acids
little building blocks so mutations of a
dozen or so are not likely to make our
vaccine ineffective
the spite protein will still look like a
wanted criminal to our t
cells i think about a spike protein that
is so long and say the delta variant or
the
epsilon variant or any variant has 12 to
13 mutations across the spike
protein t cells like think of them as
soldiers that march up
and line up across the spike protein if
you have 13 mutations 14 mutations
20 mutations you still have t cells that
are going to attack
that virus if they see the virus in the
future so i am very hopeful
we just got to get through what's going
on now the question of how immunity from
vaccines
fades over time is still an open area of
research
while some of the vaccine companies and
manufacturers have been pushing for
boosters for this reason
there's no clear data on that yet but
understanding how vaccines empower the
immune system
gives gandhi reason to believe healthy
people will do fine for quite a while
without them
for the majority of people are
immuno-competent
i see zero need for boosters because
going back to those memory b
cells those memory t cells if your
antibodies wane
which is natural is that a glitch of the
immune system it's like a natural
adaptive thing that you may have fewer
antibodies in your
nose because you know that's waning but
your memory b cells will happily produce
them for you when you need them
so while she thinks this means most
people don't need a booster yet
there are data to show that certain
people do
there was a very nice paper from israel
that looked at who are getting
severe breakthrough infections and
that's the population
where you'd want to think about a
booster and that was
massively immunocompromised patients so
organ transplant recipients
there was also some elderly patients who
had multiple
comorbidities like multiple medical
conditions
and then also a group that's emerging as
the morbidly obese
and those three populations are the ones
that i think the cdc is already
considering and will likely recommend
boosters for
okay so there are variants out there
like delta that are huge threats
and the vaccines can help us handle that
threat so you might be wondering
we've had vaccines now for eight months
why are covered cases still rising
well it comes down to this having the
capacity to do something
doesn't necessarily mean you'll do it
after the break
how nations around the world respond to
outbreaks of disease
like covid and unfortunately this past
year and a half has offered a
very good example of a lot of things not
to do
welcome back so it's been almost two
years since covid first emerged
why haven't we beaten it yet here's
where we need
an epidemiologist jennifer nuzzo doctor
of public health is at the johns hopkins
bloomberg school of public health
and is a senior scholar at the center
for health security
she also directs the outbreak
observatory
its mission is to build our
understanding of what works against
biological threats we know about so
we're ready for whatever hits us next
they've studied hepatitis a in the u.s
ebola and the democratic republic of the
congo
and measles outbreaks in both countries
they've seen how hospitals have been
overwhelmed by previous flu seasons
raising concerns about whether we'd be
prepared to face something worse
so in december of 2019 i was actually
on holiday with my family just before
new year's and i got a note from my team
and somebody suggested you know there's
this
strange outbreak that's happening in
china some people think it could be sars
you know maybe we should cover that on
january 2nd 2020
the observatory wrote their first blog
post on this novel respiratory virus
which was soon all anyone was talking
about on the news
china has identified the cause of the
mysterious pneumonia outbreak in ohan
city
and it's from the same family that
caused the deadly sars epidemic
17 years ago it's a new type of
coronavirus
you are never going to forget that
holiday with your family are you
no the last taste of freedom then there
was the inkling of what was to come
jennifer nuzzo co-led the development of
the global health security index
which measures how equipped countries
are to handle bio threats
they scored 195 nations considering
numbers of hospitals and laboratories
doctors and nurses and the strength of
viral surveillance systems
they also weigh political socioeconomic
and environmental risk factors
just a few months before covett went
global their report
showed that of those 195 nations no
country was ready
for a serious pandemic some countries
like the united states the united
kingdom had
more capacities than others but no
country was fully prepared no country
had everything
were there any countries that did
surprise you in terms of either how
poorly they responded the pandemic or
how well they did
the united states one factor in
particular has
undermined u.s efforts to deal with
cobit from the very beginning
and it continues today public confidence
in government
which has turned out to be
a really critical arguably cross-cutting
factor
in our ability to use many of the
resources that we have
our abilities to convince people to go
and get tested
if they found that they have cobid 19
our ability to convince people to take
protective actions like wearing masks
and avoiding crowded indoor spaces
you know our abilities to vaccinate
people now
lack of trust in government and people
who are delivering the messages you know
really kind of takes a stab at all of
those things
a lot of us in october we saw people
dying we saw cities getting shut down
and we sincerely thought the minute a
vaccine is approved
americans will run out and go get the
vaccine are you
or were you surprised at the level of
vaccine hesitancy in this country
no not surprised i expected there to be
hesitancy
as a pediatrician i've dealt with
parents who've declined vaccines for a
variety of reasons
including concern over side effects so
yeah this hesitancy is nothing new
but side effects don't have to be scary
they mean your immune system is working
actually these vaccines the mrna
vaccines and the adenovirus dna vaccines
which is the johnson johnson do elicit a
very robust immune response
this is monica gandhi again they elicit
both antibodies and then importantly
very strong t cell responses
remember those t cells that fight
infections and help remember
past infections and so having symptoms
after a vaccine like feeling
pain at the injection site fever even
malaise not feeling great muscle aches
you are going to have those side effects
that is your body forming a robust and
effective immune response
but most of the hesitancy around cova 19
vaccines
has been driven by more than fears of
aches and pains
back to jennifer nuzzo we got a little
bit of foreshadowing when we were
studying the measles outbreaks because
we were starting to hear from
public health officials about basically
disinformation campaigns that they
had noticed that were incredibly
sophisticated
you know health department told us about
how someone had spoofed their email
to make lies look like they were coming
from the health department
really an orchestrated attempt to try to
actively discourage people from getting
vaccinated
but even with this precedent the extent
of disinformation surrounding covid
shocked jennifer nuzzo very early in the
vaccine rollout
and we heard about a tremendous amount
of resistance
among health care workers to get
vaccinated
now it wasn't the doctors and the nurses
who were seeing patients but it was
other people in the health system
who should have seen the impact kovid
was having
on their hospital and their community
but in many cases they
were resistant to getting vaccinated in
part out of a belief that the virus was
a hoax
and so that to me that is quite stunning
to have that level of
just false belief in places in
populations that you think above all
should know
really i mean struck me as a far
bigger problem than we've ever dealt
with before
family and friends play an important
role in convincing those around them to
get vaccinated jennifer nuzzo says it's
going to take a concerted effort
from all of us not just the medical
community
to get enough people out there to get
the shot i have become increasingly
convinced
that we need bigger solutions and
the spreading online of
the amount of disinformation that's out
there
is killing us literally killing us she
cites research from the center for
countering digital hate on what they're
calling
the disinformation dozen almost
two-thirds
of the online lies about vaccines are
spread by just
12 highly influential personalities
these are people who have made
businesses out of spreading lies
36 million dollar industry for these
12 individuals who you know in some
cases employ
bloggers and people in multiple
countries to try to spread the
disinformation
u.s surgeon general vivek murthy has
issued an advisory on how misinformation
is hampering our efforts against kovid
new york city health commissioner
dave a chokshi has written an open
letter to twitter and facebook ceos
to root out those responsible for
planting untruths
on their platforms and because the
forces of disinformation are so
insidious especially on social media
jennifer nuzzo encourages us to feel
compassion for those who are taken in by
these campaigns
start from a place of empathy one thing
i have
commonly found among the people that i
talk to who have these beliefs
is they first of all talk about not
knowing who to trust
and not knowing where to go for their
information and when i ask them
can you talk to your doctor it is very
common that they say they don't have one
for people who have not benefited from
the medical establishment for much of
their life
who have probably had trouble accessing
it and have not
been able to come to see it as a
resource
to them to suddenly now have this new
tool
that's here to save them you know i
think we have to understand
the forces that have created
susceptibility to this misinformation
and to try to at least hear people out
in
why they feel a certain way and why
they're scared
jennifer nuzzo is taking every route
possible to get the correct information
out into the world
even serving as an advisor on the movie
borat
subsequent movie film in the film the
covet shutdown forces borat to stay in
the home
of two conspiracy theorists where is
everybody
i do not see anybody on the street it's
everybody's at home they're telling them
to stay inside so they don't spread this
virus
there's a violence yes they want
everybody to quarantine
i do not have nowhere else to go could i
stay in your home she then appeared in
the follow-up documentary series
debunking borat addressing the myths
from the film
working on that project in particular
was um really a privilege
in debunking borat um i got to talk to
two gentlemen
who you know probably have beliefs that
align with q anon
believers you know i think when you hear
about these things on the news
we have a tendency to kind of like other
people and think that they're not like
you
but these are two gentlemen who are just
trying to figure out their way in the
world
just like the rest of us you know
they're trying to take care of their
families and take care of themselves in
the same way and just unfortunately
they've
along the way accumulated beliefs that i
think are hurting them more than they're
helping them
i think we have to constantly be in in
feedback mode
where we take in what people's
complaints are
so that we can understand if we need to
do something differently but it seems
like
it literally is just a matter of vaccine
distribution
to contain this pandemic that's that's
what it's going to take am i correct in
in just saying that that boldly like
this is just a matter of getting
vaccines out there
the return to normal is only going to be
achieved through immunity
and there are two ways to do that you
can get vaccinated and be protected
against severe illness
or you can get the virus and play
roulette one of the biggest challenges
is the fact that people who don't have
symptoms potentially
can spread it and that just makes
control
without vaccines much much harder to do
and in particular
you know these new variants are
potentially shortening the incubation
period
the period of time for which you you're
exposed to potentially you can transmit
it
that makes it even harder to intervene
using
contact tracing and isolation and
quarantine to try to stop transmission
so
really important that we vaccinate
which brings us back to the question of
boosters
and how that discussion's impacting
parts of the world where people want the
vaccines
but can't get them because that's part
of the reason why i think countries are
holding on to vaccines that they're not
using as opposed to sharing it
with the countries in the world right
now who have not even had the
opportunity
to give even their most vulnerable
people a first shot
it felt very premature to talk about
booster shots
in this theoretical sense the united
states rather than talking about global
vaccine equity
that should be the priority right now
correct from a public health perspective
yes
we need to make sure that it's not just
us who has vaccines but the rest of the
world because
it's not going to serve us well if the
virus
rages in other parts of the world
unchecked
unfortunately when we're talking about
vaccine equity and the ability to roll
out vaccines and vaccine uptake
all correlations lead to income so you
know about 75 percent of
the vaccines that have been administered
in the world to date
have been administered by about 10
high-income countries
that is the single biggest predictor of
not only who has access to vaccines but
also
who is starting to
require vaccination for travel and
require vaccine passports so inequities
are going to compound
and they are compounding along uh income
lines
so while in the spring and early summer
life felt like it was starting to return
to normal
in some parts of the u.s in many parts
of the world
the variants were destroying lives and
upending some country's success at
controlling the virus
particularly with the delta variant
being as transmissible as it is
a number of countries that had been
previously great
at responding to cobid are now having
extraordinarily
heartbreaking surges in cases and
ultimately
you know deaths delta is just outrunning
those efforts and just
making it near impossible so when i see
places like australia
which for the last year was not even
wearing masks
quarantining anybody who was coming into
the country
really being aggressive with their
contact tracing efforts and testing
despite all of that now having you know
multiple cities under lockdown
and no signs of of the spread of the
virus abating despite those efforts
you know really i think underscores the
urgent need to vaccinate people
as quickly as possible particularly the
people who are most at risk
of dying and to protect the health care
workers who have the extraordinary
levels of exposure
we're not going to move on from this
pandemic until we make sure that
countries have vaccines to be able to
protect their populations
here's monica gandhi again we have had
these vaccines authorized in this
country since actually december 14th
2020.
any death worldwide from covet 19
is essentially preventable and to me the
fact that it's eight months later and
counting
and we haven't gotten all the health
care workers
vaccinated worldwide uh vulnerable
people who are older
it is so tragic it is such a moral and
and ethical feeling
i hate the delta variant i hate the
delta variant too i hate it so much
the delta variant is like just wrecking
all this progress and for those of us
who
who were from india originally i have to
say it was a very tragic time as you
know
my family was greatly affected as many
of ours were affected in india by it and
it was awful to hear
them comment on our vaccine hesitancy
so monica gandhi's and jennifer nuzzo's
most important recommendation for
everyone
when it comes to the vaccines this
incredible weapon we now have to fight
coven 19.
they are safe they are effective about
3.8 billion people have received the
mrna vaccines worldwide now
please take it just please get
vaccinated folks
let's end this
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nova now is a production of gbh and prx
it's produced by
terence bernardo ari daniel jocelyn
gonzalez
isabel hibbard sandra lopez monsalve and
rosslyn tordesillas
julia court and chris schmidt are the
co-executive producers of nova
suki bennett is senior digital editor
christina monan is associate researcher
robin kasmer is science editor kunal
patel is research intern and devin
robbins is managing producer of podcasts
at gbh
our theme music is injected with rhythm
thanks to dj kidd koala
we'll be back in two weeks and if you
haven't been vaccinated yet
and you live in the u.s you can visit
vaccines.gov to access the vaccine
finder a handy search tool where you
plug in your zip code
and find stocked vaccination sites local
to you
anywhere from clinics to pharmacies to
churches to supermarkets are all doing
their part
to help us end this thing
gbh