Transcript: Health Equity: Lessons from the Pandemic

DR. GHALY: Hey, Dan. Thanks for having me this morning.

MR. DIAMOND: Dr. Ghaly, I’d like to begin with President Biden’s recent comments saying that the pandemic is over. To be fair, he said that while we have a problem with covid, the pandemic is quote, “over.” With more than 400 deaths per day still linked to covid, do you believe that the pandemic is over?

DR. GHALY: Well, I’ve certainly over the last two and a half years been humbled by any predictions of where we are. We know that covid is a swirly virus that mutates for a living and certainly, even though the current situation is better than it had been in recent months, certainly over the past couple years, we remain prepared in California, and I hope across the nation, for what could come next. So, in many ways us–we in the public health community are preparing for, you know, changes that come, as we’ve seen other times, you know, the past couple years fall and winter surges. So, it’s certainly something that continues to be on our mind.

MR. DIAMOND: From a public health perspective, though, does the president’s statement help you and your team? Does it help you convince more Californians to get vaccinated when the president says that the pandemic is, quote “over”?

DR. GHALY: Well, you know, at other times with other infectious diseases, whether you think we’re in the middle of an increased surge, whether it’s flu or other things, we always are working hard to make sure that Californians here in California are protecting themselves. So, getting boosted, still a top priority, especially given that we now have boosters that protect against the current circulating variants. So, you know, certainly having statements that may persuade people one way or the other to get protected, you know, can help, can harm the efforts. But our sort of key message is, we have valuable tools that are going to protect us, and we’re encouraging Californians to still go out and get boosted today.

MR. DIAMOND: If you’re watching this program, remember, you can always contribute and ask questions by tweeting @PostLive. That’s @PostLive. Dr. Ghaly, I’d like to go back to what you just said about having the tools available to fight the pandemic. We’ve reported in The Post, others have looked at the fallout from President Biden’s statement that the pandemic is over, the continued resistance on Capitol Hill led by Republicans for more funding for covid response. The White House has wanted more than $20 billion to keep funding its response for more vaccines, tools, and so on. How important is that funding to what you’re doing in California?

It’s absolutely critical. I mean, we’ve already made enormous investments in so many areas of covid response. And as we continue to beat the drum of the importance of staying prepared, staying protected, we in California in February put out what we believe is the first state’s sort of pandemic recovery preparedness response, called the SMARTER Plan. It is an acronym that has all of the components of what California is working on doing–promoting shots, staying ready with masks, being aware of what’s happening with the covid numbers from a surveillance perspective, staying ready with being able to deliver a couple hundred thousand vaccines in a day, half a million–half a million tests in a day–these elements that we think keep California squarely prepared for what could happen. And so those dollars, both from the federal level and being able to have the state support to allow our local counties to do the work that they need to continue doing is vital. So certainly, as we move through an uncertain fall and uncertain winter, we want to make sure Californians are aware of our SMARTER Plan, that this is where the state is oriented, working with our counties to keep California State. And those dollars that you’re referring to, Dan, critical to keep that work going.

MR. DIAMOND: California and other states have made significant investments over the past couple of years in setting up covid testing centers, vaccination centers. My understanding, Doctor, is that many of those efforts have been forced to wind down because of the freeze of federal funds. How do you ensure long-lasting investments in improving access that go beyond the pandemic? Is that the SMARTER Plan? Is there more that needs to be done? What are the lessons from California?

DR. GHALY: Yeah, well, first off, I think the–one of the first lessons is we in California like to think we were more prepared than many, but we still had a long way to go. And you’re right, Dan, part of the work today is how do we stay ready, and that is our SMARTER Plan. So making sure that even though there may not be as much federal support, that we still have the ability to have 200,000 doses of a vaccine, a booster provided every day in California, having that sort of infrastructure remain set up either through specialized tests or vaccine sites, testing sites, sites in the case of testing are really having built that infrastructure into the core of our healthcare delivery system, our public health system. That has been the approach. So, our hope has been that the investments in today’s need around covid have allowed us to make–strengthen the foundation to do same sorts of activities. Whether it’s covid in a case of another surge, flu, m-pox, it doesn’t really matter, having the infrastructure built because of the covid investments has been a key strategy for California.

MR. DIAMOND: You’ve mentioned several times, Doctor, the booster shots, and federal officials recently authorized new reformulated booster shots that better target omicron and its sub variants. What are you seeing in terms of demand in California for these booster shots? How are you making sure that your residents are not only aware of the shots but actually going out and getting them?

DR. GHALY: Well, you know, for so much of the vaccine campaign in particular, it’s been about using our connections to community. We’ve talked a lot in our conversation on equity in this pandemic, about the building up of community-based organizations, trusted messengers, working with those anchor faith-based institutions certainly across the state, and ensuring that we in California continue to support and fund those entities in addition to federally qualified health centers and community clinics, so that the message isn’t just coming from officials at a state or a county level but really from those who meet communities where they are every single day, those providers in the community, health workers from a tour of trusted members of churches and other faith-based institutions. So that work continues in California in deep and real ways, so that we have the best chance of getting as many Californians who can benefit from boosters in the case of boosters and other doses if needed in the future, actually have the access to the information and access to people who they trust and believe it.

MR. DIAMOND: There has been a fair amount of vaccine hesitancy over the past few years. I’m curious what the folks on the frontlines–these people in churches, in the communities–what they’re encountering at this point with booster uptake and how you’re arming them with, say, messages that will convince holdouts. Nationally, about two-thirds of Americans have yet to get a single booster shot. Now there are new booster shots, and the uptake in my understanding has lagged behind. So, what are you giving the folks on the frontlines who aren’t health experts but are encountering community questions about why the booster shot is necessary?

DR. GHALY: Well, I think a number of things. First, clear, simple data and information about the impact that these boosters can make, what we in California update on a regular basis, what the different impact, whether it’s becoming infected, becoming hospitalized or God forbid, dying from covid, what the difference is between somebody who’s been immunized vaccinated versus those who haven’t. So, updating that information, making sure that we use the benefit of now many, many months, millions of people around the globe being vaccinated safely and sharing that information. But there is no doubt we still have a huge mountain to climb when it comes to building trust around these messages, creating reasons to give up your current hesitancy. And we know that for so many communities, they come by that very honestly–right?–decades, centuries of structural forces that don’t always create a safe trusting place. And you don’t overcome that in a matter of weeks or months. It takes a long time. So, we are certainly doing what we can, but also are humble in the face of what we know is a real sense of lack of trust of the information that many of us in the public health science community wholeheartedly believe.

MR. DIAMOND: Maybe one more booster question, which is, are these boosters arriving too late? They target omicron and it’s some variants which raged last winter and some months ago. They’re not targeted necessarily to the variants we might see this winter. So, Doctor, the timing of the boosters, is it optimal or suboptimal?

DR. GHALY: Well, I think in this world of developing science so quickly, developing these tools so quickly, having the assurances that they’re safe and effective, I think we have institutions, they become available when they’re available. And in many ways, Dan, your question may be best answered in a few months when we see if the threat of the certain variants that we are protected against by these boosters really rear their head and create the kind of surge that some people fear could happen. So, I say that they’re valuable tools, that they protect against what we know has been the recent threat, and that for that reason it is–given their safety and their effectiveness–wise to go ahead and get your booster. Again, I think over the next few months, we’ll have a chance to really see if that’s right.

MR. DIAMOND: A reminder that if you’re watching and have a question for Dr. Ghaly, you can go on Twitter and tag @PostLive.

Doctor, I’d like to pivot to inequality. California–a state with the biggest economy, and it’s one of, if not the most progressive states in our union–and yet, it is also one of the most unequal. Can you talk a bit about the relationship between economics and public health and if California’s economic inequality played a role in the state’s covid outcomes?

DR. GHALY: Well, I mean, certainly California, the economic inequality that we see in certain parts of our state create living conditions that were not optimal for protecting yourself against the virus–crowded living conditions. I remember early on in the pandemic concern about issues around crowded living. And California is home to it’s either seven or eight of the most densely crowded household ZIP codes in the nation. What that means is that you have people living in single room dwellings, many people sharing small dwellings, and that that is not optimal for the spread of an aerosolized airborne illness like covid is. So early on, we knew these conditions, were going to really change the impact of the pandemic, and that’s directly connected to economic inequalities and economic status. You look early on at who was infected, and we talked in the first year of the pandemic, especially about, quote, “essential workers,” people who couldn’t stay home during the pandemic, had to go to work, worked in some very high-risk settings–whether those were nursing homes or healthcare facilities or factories to keep our economy going. And that has, of course, direct impact or connection to one’s economic status.

But we also know that there’s a deep cross between race and ethnicity. And as we process data and information, not just here in California, but across the nation, we see a real impact on life expectancy, whether it’s Latinos in California losing over five years of life expectancy between 2019 and 2021. Similarly, Blacks in California, three and a half years, and Asians a full three years of life expectancy. So that isn’t just an economic issue, we believe also is connected to those racial ethnic disparities that we’re knowledgeable of but have a lot of work to do to really ameliorate [unclear].

MR. DIAMOND: Doctor, the federal government has declared a public health emergency for covid that allows for more flexibility in their response, more funding. But there could be significant fallout for the U.S. health system in your state when the public health emergency ends. The Urban Institute, for instance, has estimated that as many as 15 million people might end up losing Medicaid coverage at the end of the public health emergency. How do you ensure that there isn’t more churn, more consequences for the most vulnerable people when the public health emergency ends?

DR. GHALY: Well, Dan, this is a real concern. And I think at this point, we in California–and I’m really proud of our teams within the agency. I have the privilege of running a number of departments, including our health exchange, Covered California, involved in exactly–answering exactly this question. What are we doing to equip our population? We have over 14 million Californians currently in our Medicaid program called Medi-Cal. We aren’t exactly certain but believe 2 to 3 million are vulnerable to lose that Medicaid coverage at the end of the public health emergency. And so we have put in lots of plans, made investments in our county infrastructure to be able to support Californians with ensuring that they learn of their eligibility for Medicaid after the public health emergency ends, and understanding that if they are no longer eligible, that there is an opportunity in our health exchange to remain covered. So, lots of good legislation in the last two years addressing this issue, investments of real dollars in the infrastructure, and then creating plans to avoid exactly that churn that you’re mentioning, Dan, to ensure that people don’t lose the coverage that we know was vital during covid and is going to be very, very critical for us to be working on health equity and closing disparities.

MR. DIAMOND: Maybe a final question or two. You mentioned monkey pox. You called it an m-pox earlier. That virus spread more quickly than many experts were expecting. There are now more than 20,000 Americans infected. Do you think, Doctor, that the response to monkey pox, which has been criticized for being slow and lumbering, especially on the federal level, shows that the lessons from the covid pandemic haven’t been fully implemented?

DR. GHALY: Well, I mean, there’s always room for improvement. And I would say some of the lessons that we experienced, frankly, there–when you’re actively implementing those changes, it’s hard just to say that they’re learned lessons. But honestly, some of the learnings from the evolving covid response playbook helped California with our m-pox strategies as well. But yes, of course there is challenges on vaccination, on mismatch between supply and demand, being clear about who the most vulnerable groups are, and how to ensure that the messages are clear in those communities first and foremost. So again, I would say that the m-pox response in California integrated a lot of what we learned from covid but still not fast enough, still not focused enough and we always will look for chances to improve as we move forward.

MR. DIAMOND: Last question, Doctor. How worried are you about a bad covid surge this winter? Scale of one to ten, fifteen seconds.

DR. GHALY: I’m gonna go with a solid five because I think we don’t quite know yet. That’s why California’s SMARTER plan is out there, sort of supported across our state to make sure that we’re ready for whatever this virus throws our way.

MR. DIAMOND: Okay. Well, Dr. Ghaly, thanks so much for that. Thank you for the very interesting visual behind you. I don’t know who painted those paintings or drawings, but it is a colorful background. Thank you so much for joining us at Washington Post Live.

DR. GHALY: Yeah, my four kids will be happy to know you noticed them, but they’re the artists. Thanks a lot for having me, Dan.

MR. DIAMOND: If we had more time, I would have asked a few questions about those drawings.

Please stay with us for the next segment of this conversation. We’ll be joined by Dr. Kizzy Corbett, one of the researchers behind the coronavirus vaccines.

MS. KOCH. Hi, I’m Kathleen Koch. When it comes to health equity, one area where we’re seeing increasing disparity is in adult vaccinations. Rates were already low before the pandemic, but they have dropped by double digits since 2019, with the greatest decreases among Black and Hispanic populations. Here to talk about how to reverse that trend are Judy Stewart, senior vice president at head of U.S. vaccines at GSK, where she leads a time of 800 people. Judy is responsible for U.S. commercialization efforts for a portfolio of 17 brands with a collective goal of increasing immunization rates and vaccinating more than 300 million Americans over the next five years. She’s also a member of the Vaccines Investment Board that globally decides R&D priorities and investment.

And also with us is Dr. Kelly Moore. She is president and CEO of Immunize.org. It’s a leading nonprofit organization focused on immunization education for healthcare professionals as well as advocacy for immunization policies that remove barriers to vaccination for all. Now Dr. Moore is an immunization and policy advisor to the World Health Organization. She was also a part of the CDC’s frontline response to 9/11 and the anthrax attacks and served on its Advisory Committee on Immunization Practices. So, thank you both for joining us today.

DR. MOORE: Good to be here.

MS. KOCH: Dr. Moore, what lessons has the public health community learned from covid-19 that can help address that gap that I described when it comes to routine immunization rates?

DR. MOORE: Well, first of all, we’ve learned what is possible when you’re adequately funded, and certainly we hope that we can translate some of the lessons we’ve learned with our resources from covid-19 to our routine vaccination programs. Timely data and the investment it took to create timely information for public health has been invaluable to us and really a critical part of our success in reaching vulnerable populations, especially those who were falling behind because we could see quickly which groups were falling behind. Then we had resources to go and meet with leaders from those communities, trusted partners with those communities to understand their needs and the barriers they were facing so that we could then go about addressing them together with the community.

In addition, we also addressed out of pocket expense. There was no charge for covid-19 vaccines for anyone. And we addressed we convenient access. Remote populations got vaccines at a time and place that were convenient for them. And all of those efforts really made a big difference in covid vaccination coverage. They took resources and investments, but we hope we can use those to address our routine vaccine gaps now.

MS. KOCH: Judy, what about GSK? What lessons has your company learned during the pandemic, and what has it done to help boost immunization rates?

MS. STEWART: Yeah, so I think that one of the things we’ve learned during covid is that adult vaccinations where we saw health disparities even before the pandemic just got larger and larger throughout the pandemic. And so one of the things that we are focusing on is trying to change the seasonality of adult vaccines. There are many CDC-recommended vaccines that are not around the flu season and there’s capacity constraints, quite frankly, when we’re trying to deal with a flu vaccination at the same time we’re also doing covid boosters. And so we’re trying very hard to educate adults that, you know, preventative care can happen at any point during the year. So, for things like a hepatitis vaccine or a Tdap booster or a shingles vaccine, you can really be doing that outside of the flu season so that you’re preventing, you know, diseases but not during the flu season so that we can help with the capacity constraints.

And then I think the other thing that we’re really focused on and trying to dial up the education around is just how important data transparency is. We’ve created a tool called Vaccine Track, and what we hope to do with that is to provide insights around where the biggest gaps in care are. It’s a state-level tool. It provides information on a quarterly basis for adult vaccination rates, and it cuts it by state, by age, by gender, and by race so that you can really start to see at a very local level where the discrepancies in care are so that we can hopefully improve them as we go.

MS. KOCH: Vaccine Track sounds really fascinating. So how exactly does that close the gap? So, it’s just having this more up to date information and broader information?

MS. STEWART: Yeah, so some of it’s just having access–easy access. It’s available to anyone in the health ecosystem, so it’s going to be updated quarterly. We partnered with IQVIA to provide the information. So, I think the first step is providing the tool for everyone and providing updates on a frequent basis so it’ll be quarterly. I think the real richness, though, of the tool comes when you start to take those insights and take that data and then start to build efforts to improve those health disparities. So as an example, we’ve partnered with the U.S. Hispanic Chamber of Commerce, and we’re working to really look at the Hispanic Population within the U.S. because we see large discrepancies in adult vaccination rates in that group, and we’re also targeting at a local community level in Spanish education materials and really trying to come to deliver those messages in channels where they are often visiting–so things like Univision, Telemundo–really trying to get in-language education so that we can try to improve those rates.

MS. KOCH: Dr. Moore, what new is the public health community trying right now to reach these vulnerable populations?

DR. MOORE: Kathleen, we’re leveraging data like the Vaccine Track that Judy described which is new to us but is really valuable with its sort of up-to-date information. We’re also using information from CDC and other sources to identify and better characterize exactly who the vulnerable populations are when it comes to specific vaccines and where they are. And then we’re leveraging those data to track and measure how well our interventions are working so what you measure gets better, and using the data in that way will help us work with those communities to address their needs in ways that are effective.

We’re also in public health working to remove barriers to access. I think we’ve really embraced the role of the pharmacist vaccinator as a person who can be conveniently accessed by anyone, even those without routine access to primary care.

And I’m delighted that in 2023 we’re going to see barriers to out of pocket costs go away for people who are on Medicaid and Medicare. Their out-of-pocket expenses to get routine adult vaccines are going to be eliminated under new laws that will go into effect next year, and that will give us more opportunities to address the needs of vulnerable communities as well.

MS. KOCH: We only have about a minute left. So, Judy and Dr. Moore, what one thing can public health advocates and, say, those participating in this event today do to improve vaccination rates?

MS. STEWART: I mean, I think from my perspective it’s going to take everyone involved to really be educated, understand what vaccines you should be getting as an adult, for your family and your loved ones, remind them that they need to get vaccinated. It’s the easiest way to prevent disease, especially as we age and our immune systems start to decline. So I think it’s about talking about it more.

MS. KOCH: And, Dr. Moore?

DR. MOORE: I’d just add if you’re a healthcare professional watching this, you have enormous influence over the people you see. The number one reason people decide to get vaccinated is because their healthcare provider told them they should. So your strong recommendation will save lives.

MS. KOCH: Well, thank you both. If our audience has any additional questions, especially about this cool new tool, Vaccine Track, they can check that out at vaccinetrack.com. So, Judy, Dr. Moore, thank you so much for joining us today.

MS. KOCH: All right. And back now to The Washington Post.

MR. DIAMOND: Welcome back. And for those of you just joining us, I’m Dan Diamond, a national health reporter here at The Washington Post. Our second guest is Dr. Kizzy Corbett. She’s assistant professor of immunology and infectious disease at Harvard’s T.H. Chan School of Public Health, where I’m actually going up next week, so I should know how to pronounce it. Dr. Corbett and her team at the National Institutes of Health developed the mRNA vaccine for covid-19 along with Moderna. Dr. Corbett, welcome to Washington Post Live.

DR. CORBETT: Thank you so much for having me again.

MR. DIAMOND: And if you are watching and have questions for Dr. Corbett, please tweet @PostLive. Dr. Corbett, I’d like to start our conversation off the same way I did with Dr. Ghaly, California’s health director. President Biden said recently that the pandemic is quote “over.” Do you agree?

DR. CORBETT: I’ve been very hesitant to actually say whether I agree or disagree with President Biden’s statement, because I do think that a lot of the context of his thinking was likely left out. When he made that statement, one of the things that he contextualized it with was saying that, as you can see, many people aren’t wearing masks anymore, which certainly is not a measure of whether or not the pandemic is over at all. Whether or not the pandemic is over is measured by whether or not the disease is preventable, treatable, and also importantly, predictable. And we have not gotten to the point yet, where the so-called seasonality, or endemicity, of the virus that causes covid-19 is predictable enough for us not to call it a pandemic.

So, I would largely disagree. But I do think that President Biden had the best of intentions in helping us to understand that we are moving in the right direction. There are certain public health measures that we were very strict with in the beginning of the pandemic that we’ve certainly let up with at this point. But we are not out of the pandemic just yet.

MR. DIAMOND: Is there a marker that you’re looking for, Doctor, in terms of total infections, number of deaths? At this point, we’re around 55,000-60,000 confirmed infections per day. The likely number is much higher because many people aren’t reporting their at-home tests. We’re at maybe 400 deaths per day linked to covid. Do you have a threshold in your mind for when this pandemic would be over?

DR. CORBETT: I don’t have a threshold with regards to numbers. I will say that we call the seasonal influenza an endemic virus and it causes about 50,000 deaths on high end in a really bad season. And so if we could get to that point, we might think about this being an endemic virus.

But for me, the way that I think about endemicity is really about whether or not the virus is predictable. Quite frankly, we could wake up tomorrow with a press release talking about a new variant that no one would have been able to predict, that really the only thing that could detect it was scientists around the world who are still working 24 hours a day trying to detect variants in sewer water and et cetera. And so we haven’t gotten to the point where we have an algorithm to predict what this virus is going to do, which causes us to be in a state where we don’t really know what’s going to happen next. And it’s important to know that in order for us to call this thing no longer a pandemic.

MR. DIAMOND: Just curious–and maybe this is a selfish question, because I’ll be in Boston next week–but what are you doing to protect yourself at this point? Are you still masking in groups? Are you eating indoors at restaurants?

DR. CORBETT: I am. So I do eat indoors in restaurants. I mask in groups. I mask inside of my building at the Chan School of Public Health. I still also–I test very frequently. We no longer test or have optional testing at work, but I do have PCR testing at home that I use and can use whenever is necessary. I think that that is part of the public health response that we didn’t necessarily get right. Noting that you can mask all you want and you can take all the precautions that you want, but the truth of the matter is everyone needs to know at each stage or each point whether or not they are infectious. And so that is the most important, I think, bit to moving along in the pandemic comfortably.

And you know, one of the other important things right now is boosters. And I have not had–I’m having my booster on next Thursday, which is the day after I have a huge grant due. I couldn’t lose a day, shall I have any, you know, symptoms that would prevent me from working for a day. But on next Thursday, I will be getting my booster.

MR. DIAMOND: So you circled that on the calendar as the day to both look forward to but plan around, it sounds like.

DR. CORBETT: Yes, I wanted to make sure that my side effects did not prevent me from getting my lab any money.

MR. DIAMOND: It’s important to know where the vaccine fits in in our day. I would like to talk about the current vaccination campaign. But first, for folks who might not know your story and role, maybe we can go back in time for a moment. Can you briefly explain the role that NIH played in developing the vaccines along with Moderna?

DR. CORBETT: Sure. The NIH along with other collaborators–so we collaborated with Andrew Ward’s Laboratory at Scripps, Jason McLellan’s Laboratory, which was then at Dartmouth, but is now at the University of Texas, Austin, to understand how to make vaccines for coronavirus is in general, really focusing on the MERS coronavirus, which was at the point of which I got to the NIH in 2014, the one that was most prevalent, and also the one that was most scary. And so, we worked on MERS vaccines for I’d say seven–six or seven years prior to the pandemic, understanding how we can make these vaccines better, understanding how we might be able to deliver those vaccines very quickly, in a reliable way. That’s how the collaboration with Moderna, which is a messenger RNA technology company, came about. And so, when the pandemic started, together with all of our collaborators, inclusive of Moderna, we understood really what the assignment was. We understood how we can make a vaccine, how we can make one that was safe and also reliable and quick.

MR. DIAMOND: There has been a fair amount of scrutiny around the speed of the Moderna vaccine, the Pfizer vaccine, which were rolled out in 2020, much faster than even experts like Dr. Fauci had predicted early in that year. Now you don’t call it vaccine hesitancy. You call it vaccine inquisitiveness, but there’s been vaccine inquisitiveness around that speed, and some folks have said they don’t feel comfortable with the pace of the vaccines. How would you address that?

DR. CORBETT: I think where we are now, two-and-a-half years into this pandemic, and about a year and a half since the vaccines have been approved, at least from an emergency use perspective, is that we have a plethora of data to support the vaccines being safe, and also being effective, particularly against very severe disease.

And so, I understand where people were coming from in the–in the beginning of the pandemic as they watched vaccines development really, for the first time in many people’s lives, happening on a day-to-day basis. You know, I or Dr. Fauci or someone was on the news talking about the latest revelation in the vaccine development process, and it was overload of information. And it also seemed to come out of left field or nowhere, so to speak. And so, I completely understood that inquisitiveness at that point.

But where we are now, it’s very clear that while the vaccine was developed in record speed–it’s very clear that we’ve proved ourselves over and over, whether it be from the first turn of the vaccine or with the initial booster or even today continuously with these boosters that this vaccine is safe and also very worthy to be taken.

MR. DIAMOND: Well, then let me flip that question around: If we are in a world where we’ve proven the safety of these vaccines and the updated boosters, could we be moving even faster? The reformulated boosters that are now available, the one that you’re going to get next week, they target omicron and its subvariants which increasingly look like yesterday’s challenges. We’re going to have new variants on the horizon. Could boosters be expedited faster than they have been?

DR. CORBETT: Sure, they could. But one of the things that I think that is missing from the equation, and from the general understanding of how these boosters come about, is the analysis of whether or not updating the boosters is even necessary. So that does take some time, right? A new virus has to–or sorry, a new variant has to come about. And then teams, whether it be at Moderna or Pfizer, or the National Institutes of Health or other academic institutions, have to analyze whether or not the current vaccine responses are up to snuff with protecting against that new variant, and to what extent as well.

So, the current vaccines are not completely useless, particularly if you’ve gotten three doses, against the currently circulating omicron variant. It’s just that the bivalent booster does give you a notch up in the level of protection. And so those types of data take some time to acquire and there are some bits of regulatory ask in order to change the sequence or formulation of this vaccine, and so it is important for us to make sure that it is worth it to go through those regulatory hurdles that–and that–or to just keep the vaccine the same and boost with those vaccines.

Because if you remember that in the beginning of when omicron started, I think around Thanksgiving of last year or the holidays of last year, we were right in the midst of the first booster. And it turns out that boosting with the original sequence or the original vaccine actually did good enough against omicron in that it still was able to–that booster was still able to keep people from getting severely ill against the omicron variant. And so, I think that, for all intents and purposes, the speed of which we evaluate these boosters is okay. And the only way that we are able to get–going to be able to get better is if we’re going to be able to predict how the virus is going to mutate in the future. And I heard that question, actually. You asked it in the previous session, and that was my one comment in that, you know, you asked what was the prediction about the winter–the winter wave on a 1 to 10. And really no one can say. And for me, from my perspective, that is essentially why we are still in a pandemic. Until we can say it’s going to be a 4 this winter, or a 10 even this winter, then we are still in a pandemic. And that is also what keeps the lag time with developing the boosters a little bit slower than some might want.

MR. DIAMOND: Well, I appreciate you answering a question that I may have asked you in a few minutes. Sticking with the boosters–sticking with the boosters just for now, you mentioned the booster campaign that began last year. At this point, Doctor, there are still many, many Americans who have yet to get the first booster, let alone the second one that you’re planning to get in the coming days. I believe nearly two-thirds of eligible Americans have yet to get a single booster. Why do you think that is? What are the concerns that you are hearing?

DR. CORBETT: I think that people really have pandemic exhaustion, quite frankly. I think that it is—if–even if you look at the numbers of the amount of people who go and get their flu shot every year, those numbers are–adults, really–those numbers are dismal. And so, we are facing this level of exhaustion that is very hard to come by even if it is not about vaccine inquisitiveness or hesitancy, so to speak. People really don’t necessarily think that the risk is high enough for them to continue to go get boosters, which is, at this point, seemingly has been, you know, as close to every six months, which is a lot for many people. And so, I think that we’re dealing with that.

I think that the level of intensity around convincing people or educating people around the vaccines that we had very early on, because of the intensity of the pandemic, was higher. And so, there was some level of, you know, making sure that people knew about the vaccine so that they could go make their educated decision whether or not they would get it. These boosters come on board, and many people don’t even necessarily know enough information to make an educated decision. I think that we haven’t necessarily–and I’m included, quite frankly. You can blame Harvard and my new job for that. But I think we haven’t necessarily educated and kept the conversation going with people in the most diligent manner in order to really help them to continue to be abreast of whether they want to be boosted or not.

MR. DIAMOND: So, you’re saying we can blame you, Dr. Corbett, for vaccine update delays? Is that what I’m hearing?

DR. CORBETT: I’m saying that–I’m saying that it is very hard to start a lab but then also to communicate with the general public day in and day out about the necessities of boosters or any other vaccines.

Like right now, I want to even scream from mountaintops seeing what the flu season is probably going to do that people should also be getting their flu shots. You know, but those–that kind of messaging takes time, and I have–now have a lab run that is also taking the bulk of time as well. And so, similarly to when I was, you know, working on the vaccine development early on in the pandemic, I felt the same kind of burden almost on myself and that I was just like, I should just step away and go on tour and just convince people to get the vaccine. And I wish I could do that here with the boosters as well. Particularly with elderly people, people above the age of 50, I think it is extremely important that they be boosted in anticipation for a wave.

And so, one of the things that comes up I–when I hear from people is, what if the virus changed, then would I have wasted my booster on omicron? And absolutely not. The type of response that is generated from these boosters, it will likely–because of the breadth of it will likely to some extent target any sort of SARS-CoV-2 variant that might come along, you know. And so, it is very important for you to get boosted in the now, without worrying about how that might be wasted in the future.

MR. DIAMOND: You mentioned that part of you wished you could just go on tour to encourage vaccine uptake. If you were in charge of the vaccination campaigns right now, are there other tactics that you’d like to see, particularly in reaching out to communities of color that have at times lagged behind in vaccine uptake?

DR. CORBETT: I think that we certainly do not use social media enough. I think that the times have changed and the way that we get information to people has certainly changed. I think I read something recently about, you know, the number of people who get their news from Instagram, as opposed to, you know, their daily nighttime CNN slot, for example. And so, we really have to change the way that we reach out to people. We also have to change the face of those that are reaching out. I think that I was a very–I was very meaningful in the early parts of the pandemic, because I looked like people who were most hesitant, many times, around getting the vaccine. And so that is important as well.

And also, I think that, you know, I think that–you know, I think that we have to start to bundle vaccine education together. And what we’re doing now is we kind of single out vaccine education on a very virus-to-virus or a pathogen-to-pathogen level. And so, you’ll talk to elderly people about their shingles vaccine, but you’ll skip that, oh, yeah, you should get your flu vaccine and then you should also get your covid-19 vaccine.

And all–for all intents and purposes–right?–obviously, all vaccine technology is different, and they’ve been developed in very different ways. But vaccines train your immune system to protect you against whatever pathogen it is. And so having a very broad view of vaccines, and giving people that very broad view continuously will help them to understand that, and also help them to start to build a little bit of trust in the system that regulates vaccines and approves vaccines, so that when a vaccine for pathogen X comes about, you know, in five years, no one is going about the questioning in the same way, but rather saying, look, I know that these steps were taken. And because for the last five years, I’ve been getting my updates on these vaccines, I can trust this, and I’m going to get vaccinated. We’re really going to have to move people into a more educated position. And you know, I’m not an expert on these kinds of things. But I do know that these are some of the tactics that worked for me and have been very helpful.

MR. DIAMOND: Last question. You’ve mentioned some of the challenges in convincing folks to get vaccines not just for covid but beyond. Are you surprised by the ongoing politicization around covid, or does that make sense to you, given how heated and exhausted the rhetoric has been?

DR. CORBETT: I’m not surprised at all. I think that the times that we are in, everything comes with some bit of political slant. And so, we generally have to just accept that to some extent, and hope that we can, as scientists and as public health practitioners and medical doctors and et cetera, vaccine advocates really take on a neutral database view to tone out the politics of it all.

But I’m not–I’m not surprised. And quite frankly, I’m pretty sure that it’s not going to go away. If anything, it’s going to continue to get bigger as we think about changes to science policy, changes–and changes in the way that vaccines are made and, you know, different technologies that are going to start to come on board in, you know, the next 5 or 10 years. We are just going to have to be very diligent about tackling it from a data-driven perspective.

MR. DIAMOND: Yes, the politics of public health have gotten ever more complicated. We are out of time, Dr. Corbett, so we’ll have to leave it there. Thank you so much for joining Washington Post Live.

DR. CORBETT: Thank you so much. And I hope you go get your booster before you come visit Chan.

MR. DIAMOND: I don’t think it’s going to be in the cards scheduling wise, but I’m looking forward to the T.H. Chan School of Public Health in my Harvard visit next week. Thanks again, Dr. Corbett.

And thanks to all of you for joining us today on Washington Post Live. If you’d like to see upcoming programs, you can go to WashingtonPostLive.com for details and to register. Again, I’m Dan Diamond, health reporter at The Post, and thank you so much for watching.