Today, Explained - Are boosters good science — or just good politics?

Episode Date: September 29, 2021

Former CDC Director Nancy Messonnier and former White House Covid-19 adviser Andy Slavitt join Sean at Code Conference in Los Angeles to explain the back and forth on vaccine booster shots. Today’s show was produced and hosted by Sean Rameswaram, with help from Dylan Scott and Haleema Shah, edited by Matt Collette, engineered by Efim Shapiro and fact-checked by Laura Bullard. Transcript at vox.com/todayexplained. Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. It's Today Explained. I'm Halima Shah sitting in Sean Ramos' firm's chair in Washington, D.C., because Sean is in California, and you're about to hear the conversation he had with two people who've been tasked with managing the government's response to COVID-19.

Sean's conversation was recorded yesterday in Los Angeles at this year's Code Conference, where the biggest names in business talk about tech, and in this year's case, the pandemic. The conversation has been lightly edited for clarity and time. Hello, everyone. Remember when this thing was still called the novel coronavirus? Way back then, in late February 2020, a federal official said, ultimately we expect we will see community spread in the United States. It's not a question of if this will happen, but when this will happen,

and how many people in this country will have severe illnesses. This official said she had told her family that morning, we need to be preparing for significant disruption of our lives. She said businesses might want to consider remote work options. She warned that American public schools might have to close. She said parents should look at child care options. Again, late February 2020, right? It was the first time such a stark warning had been issued by the federal government. The stock market didn't like it. The president at the time didn't like it. Senator John Kennedy of Louisiana said dire warnings like these were, quote, bullshit.

But they weren't. A year and a half later, we're still stumbling through this thing, even with vaccines. So today at Code, we're going to talk about the ongoing fight against COVID-19 and what we can do better as a country the next time around, the next pandemic. Joining me to talk through it all is that fortune teller from the federal government back in february 2020 her name is nancy messonnier she was the director of the national center for immunization and respiratory disease at the cdc at the time now she's the executive director for pandemic prevention and health systems at the school foundation also

andy slavitt he was the guy the the Obama administration brought in to save healthcare.gov from becoming a cautionary tale, and he served as a senior advisor to the Biden White House on COVID response. Please welcome Dr. Nancy Messonnier and Andy Slavitt. Pick a chair. Thanks for joining us, guys. So let me start by asking you,

we're sitting on stage at a conference which feels like progress, but in January of this year, with the vaccine starting to roll out in earnest, where do you honestly think we'd be in September, in the fall of 2021? What year is it? 2021. You know, there's always this, you got to hope for the best and expect the worst kind of feeling. I've worked on vaccines for 25 years and frankly, in the midst of working on that vaccine knowing how good the data was on the vaccine I thought the public would rush to get it that um that the data on safety

and effectiveness and the recommendations from all the scientific experts would have people queuing up by this point I thought we'd have widespread high vaccination coverage and we'd be back to live in our normal lives look in January where we sat this is hard to remember this you know only about 40% of Americans said they'd be vaccinated we had little to no vaccine inventory in the country nobody could get an appointment alpha was roaring through which was before Delta and about 5,000 people a day were dying at peak. And so I think we both saw tremendous progress, and then I think we hit the wall that Nancy described, where 40% became 70%, but it turned out that that last 30% made a really big difference and for all

the people that in this country there for whatever reason don't believe in science are suspicious of authority etc etc you know you can win most things 70 30 turns out you can't win a pandemic 70 30 and back in January did you think we'd be through it you know I don't think anybody anticipated Delta. And if they if they're saying that, then it's just par for the course with the pandemic, which is that everybody predicted everything after the fact. But not a lot of people at the time, I think, saw this coming. Yeah, certainly.

And I think if we would have vaccinated more people ahead of Delta like we did with Alpha, we would probably be in much different shape as it is. No, I think we're in worse shape than I anticipated we'd be and I think probably most people. The latest convoluted chapter of this saga has been booster shots. So I'm just going to run through a timeline here, a rough timeline, and correct me if I get anything wrong. Biden says in August that he wants the vaccinated general public to get boosters starting on September 20th. Immediately, you're hearing these rumblings that health officials think the administration is jumping the gun. The head of the WHO says you're giving life jackets to people who already have them while others are drowning.

A couple scientists at the FDA say they don't believe there's evidence the general public needs boosters. They announce their resignations. The FDA's party line says those scientists don't represent the views of the agency. Then last week, there's a ton of action. FDA eventually says, just give these Pfizer boosters to people 65 and up and those who are at severe risk of illness, including potentially essential workers. Then last week, the CDC's advisory committee says yes to 65 plus and sure, people with severe risk, but they exclude essential workers. Then in what I'm told is a highly unusual move, the director of the CDC, Dr. Rochelle Walensky, goes against her own advisory committee and kind of brings this back to where the president wanted it to be.

People over 65, people at risk, and then essentially anyone who wants to make the argument they need it. Right? Bit of a roller coaster. That was impressive. Thank you. Thank you. Thank you. Did the Biden administration jump the gun?

Did they come out too early with this announcement about September 20th? It's a messy system, but it's actually the system I want. I want a system where we can see the dissent, where we can see people of differing opinions, where we have, let's face it, very uncertain information about a decision like this, which as you said, has moral complexity, it has scientific complexity, we have limited amount of information. And sure, would it be great to see everybody uniformly come out and say, this is what we should do? Sure, but in a democracy like this,

where we can have people dissenting, we can have people writing opinion pieces, we can have people protesting, and that's OK. You can do that. And that's not a bad thing. We're used to disagreement being violent. But scientific disagreement, in the right way, is OK, even if it's a little bit confusing but to parse think things a little bit just a couple

of pieces you said one is on the global side if we absolutely needed these vaccines across the globe I think we would all agree that a first vaccine in someone's arm is more important than a third vaccine in someone's arm but the truth is we're producing a billion vaccines a month now. Most of the world is well ahead of the U.S. The biggest problem we have globally now is the last mile problem in Africa, which is about 6% vaccinated. But we're producing more than enough vaccines. What we have to do is get them from airports into people's arms. The couple hundred million to 150 million that would go into boosters in the U.S. make a difference so we don't have a zero-sum game anymore

and look for people in the US I think it's particularly clear that if you're over 65 or your repressed immune system or you're at risk that a booster will be helpful to you and it's less clear as you get younger and as you get healthier and so you know I think the argument reflected the difficulty of that judgment. Yeah, maybe just to parse the two issues. Around the booster dose, I think the public is used to hearing scientists talk about settled science and a lot of the disagreement that is scientific occurs behind the scenes.

And what you're seeing now is that disagreement about where the science is play out in real time and us making decisions before all the science is settled and I think that may be the new era going forward on this specific issue CDC's advisory committee has the has to look at the data and interpret the data, but then use the data to make a recommendation. And there is inherently in that step of analyzing the data and making a recommendation of subjectivity to it. They have to take the data and parse it through their own values

and judgments and experience. If it was purely a technical argument, frankly, you wouldn't need people. You could run it through a computer algorithm and have a result. And so the reason there is an advisory committee with experts is to try to balance out the difference between where the science says and where you have to make a judgment. I think in the story that you told, the one piece that you're missing, which I think is really important, is that the ACIP, the CDC's advisory committee, wasn't unanimous. It was actually a 9-6 vote. And what that means is nine people voted for the recommendation, but six people voted for language that basically is very similar to what Dr. Walensky eventually recommended. And that

split you're seeing, I think, showcases the fact that the science wasn't settled and that there was a lot of judgment inherent about it. Yeah, and just to finish that point, have you ever been on an advisory committee before? Absolutely not. If anybody's been on an advisory committee before, you don't get paid to make decisions.

You're not accountable if the decision goes right or wrong. So advisory committees are meant to advise. You're not accountable if the decision goes right or wrong. So advisory committees are meant to advise. You're meant to get good, smart people to give their opinions. But at the end of the day, Dr. Walensky is the one that has to live with the decision that got made. And so she did a smart thing in saying,

I'm going to consider all of your opinions, which were mixed, and what I heard from the FDA, and I'm going to make the call. And she's the one that's got to live with it. She made the right decision. But going against, quote-unquote, an advisory committee, I think is something that is... It's not something we should be frowned upon. It's something that we should look at,

and as long as people explain their decisions, we should feel very good about. That seems well and good, but I guess I still want to know, could the Biden administration have handled it better? Could they have not come out and said, we're hoping to do this thing by September 20th and then have to take that back?

Could they have been a little clearer in the rollout of boosters? Well, look, I mean, having been one of the people in charge of communication at the Biden administration when I was there, I can tell you that every single thing you say needs to be thought through. You need to understand how people are going to interpret it, and you need to understand that that is absolutely going to happen. So when President Biden

said, you know, I want to get this out the week of the 20th, and then he came back and said, subject, of course, to FDA approval, I'm sure he would have in his mind, he would have liked to emphasize that more the first time he said it and said, look this is the FDA's decision. Or maybe not thrown out the date of September 20th. Well, I think what he was doing with the date of September 20th was he was basically,

he had to get the government's engines in motion. He had to get the pharmaceutical chains to be ready to administer shots. So he had to do that. And he had to get the country ready. He had to get boosters in place. There's no way to do that in Washington without that being known. But yes, if he would have emphasized subject to the FDA, would it have been slightly better? Probably. I think that's a fair criticism. I guess I would also say that there is a level of scrutiny of science that is

just exponentially more than again I've ever experienced before in other public health emergencies and I think sometimes our scientists or even our public health leaders don't understand how much the public and the media are scrutinizing every sentence and how people are franking talking heads all over the country are picking out words and perhaps taking them out of context of what it was meant. I think it's a new era that we're living in. And I don't know that our scientists have completely caught up with it. I mean, these resignations don't feel reassuring at the FDA. I feel like it can give the impression

that people are afraid that, you know, science may be following politics instead of politics following science. I have to ask you, Nancy, you recently resigned from the CDC after years in the organization. Was that because of politics? Yeah, I think, you know, I spent 25 years at the CDC, and I'm really proud of the time I spent there, proud of what I accomplished, and frankly, proud to work with a team of incredibly talented and committed scientists. 18 months throwing yourself in a pandemic is a long time.

And it's not surprising, I think, that I and many of my colleagues at CDC and FDA and, frankly, at health departments and at hospitals throughout the country are exhausted. And like everybody else, I think you think about where you are in your life and what you want to do next. I had the opportunity to work for Skoll Foundation. It's a tremendous foundation, and it's really a complement to what I've done at CDC. SCO really focuses on championing the doers, the folks that are at the ground level, at the end of the equation, who are really doing the work,

understanding globally that they're the ones that we actually need to champion in order to change the world. And I'm proud to work for that organization, just as I'm proud of my time at CDC. Are we hearing enough from scientists in this pandemic? Or are we hearing too much from politicians? You know, it's interesting.

This sort of pundit class that Nancy's talking about is sort of emerges in a way that at times can be healthy and at times can be quite unhealthy. You know, I think, you know, as we know and from not just healthcare but from everything, you know, there's this trap of you've got to continue to be edgy and interesting in order to get invited back and there's not enough people that can make their bones by showing how reasonable they can be and by showing how thoughtful and cogent they can be.

And that doesn't get rewarded enough. So look, I think thankfully we live in a society where anybody can speak their minds. You know, these two colleagues at FDA disagreed with an opinion, felt strongly about it, published. They're allowed to publish. Nobody said, hey, don't publish that. Now, it turns out they didn't have all the data

that their bosses had. And even then, you know, you could make the argument that a boss should have said, hey, wait a minute, look at the complete set of data before you publish. But no one suppressed it. It's out there. It's out there. And I think that's good.

I mean, I am encouraged by that because if we are going to win back, the mission of this country now needs to be we need to win back the 30% of people who just don't believe in science whatsoever. And they believe scientists are arrogant. They believe scientists never admit they're wrong. They believe that expertise has got them in trouble. And so, you know, there's no way through that except an honest path. Tell the public the truth. Have public debate when it's uncertain, when there are no clear answers.

It's going to be messy. We have to accept that messiness. If we try to package it up and make it neat, it never works out. It never works out. Trying to oversell something to the public and overly package it doesn't work in this day and age. So that means there's going to be a degree of messiness. That messiness requires leadership, and I think it's the job of political leaders to say, you know, here's a lot of noise, but here's the direction we're heading. I'm going to listen to scientists, but then we've got to head this direction

because these are our objectives. I think that's right. I think that it's a mistake to think that you can completely insulate science from politics, especially of public health. Public health inherently requires the buy-in of politicians to make public policy. I think we have to accept that and accept that the science is one part of the equation,

but it's not the only part of the equation. Public health needs to understand that politicians are thinking around a broader array of issues. But I also think you touched on something else important, which is, you know, epidemiology, which is the science behind public health, in some ways seems pretty simple. And if you look now, it's not just these pundits or scientists that are analyzing the data. The data is very publicly available. And frankly, some of the most interesting analysis is coming outside of the traditional scientific routes. I think we as a country and as scientists have to embrace that. But we also really need to figure out how to teach the public to exist in a world where information is so easily available and how to find their way through it. One way is certainly to try to curate that data so that the most

reliable data comes to the top. But you can find any opinion that you want online. And if you are a disbeliever, you can find other people that believe the same way that you do. I don't think you can turn off that spigot. I think that's the era that we're in now. And the question is, inherently at our roots, how are we going to move forward as a country? How are we going to teach people to be better consumers of scientific data? And it's not just about health data or even about masks and vaccine.

It's more broadly about all the data that's available. I want to ask you more about what we should do next time. But first, I want to ask one more question about boosters. Since you are a scientist, do you think we ultimately ended up in the right place on boosters? I think we ended up in a reasonable place given where the data is. But I am worried about the global picture. You know, you said something earlier, Andy,

about nobody could have predicted Delta. While I specifically perhaps agree with you, I would say that what scientists know is that viruses evolve. And we knew that this virus was going to evolve. And we knew that there was the potential for some of those escape mutants to be more virulent, more transmissible, and frankly, in a more frightening way, more resistant to the vaccines that we have available.

The longer that we let the rest of the globe exist without enough vaccine and the infrastructure to implement vaccination, the higher the risk is that there's going to be another strain of the virus that evolves that escapes the vaccine. And that will then put us right back in the dangerous situation that we've been at. So I think boosters are part of the problem, but you really do need to think about the global picture. And the global picture is vaccines for everyone. That's the number one issue right now. After the break, Sean asks Andy Slovut and Nancy Messonnier how we can do better in the next pandemic. Support for today explained comes from Ramp.

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Let's talk about the next pandemic a little bit. 700,000 dead, we're approaching that number quickly. Being that this is the country we live in, what could have been done better? What could have been done or what should be done next time? Both, I suppose, to avoid that number. Let me give you some reasons for optimism for next time. The countries that performed well relative to almost every measure, the economy stayed reasonably steady, they had the fewest deaths per capita, their healthcare systems were less constrained, they were able to continue to provide healthcare services, had a couple of things in common.

One of them doesn't describe us very well. One of them actually might in the future. The first is actually has nothing to do with your wealth. It has nothing to do with your geography, your closeness to China, whether you're an island nation, none of that. It has to do with the difference between the top decile and the bottom decile income level in your country. The more commonality, the more society understands one another, the more people were willing to take steps for the common good. That doesn't describe the U.S. We look a lot more like Brazil, we look a lot more like Russia, we look a lot more like India than we do like East Asia or Central Europe or Northern Europe. But the other feature turns out to be even more important,

and that is prior experience with pandemics. And look at Hong Kong, you look at Taiwan, you look at Vietnam, you look at countries that all of which are very proximate to Wuhan, very proximate to China. They have reflexive behaviors, putting on masks. Even without government intervention, there were no requirements in Hong Kong that people put on masks,

but people had experience with, obviously, with SARS. Even in the U.S., in San Francisco, is probably the place where there's the strongest muscle memory of a public health crisis from AIDS and HIV, and there is some remnants, and you can talk more about this if you want, of a public health crisis from AIDS and HIV. And there is some remnants, and you can talk more about this, of a public health system and people who remember managing a public health crisis. And you could see it in the way that people behaved and responded.

So the things that we have to do better next time on the technical side, better stockpiles, better tests, all those other things, those are technical things that we'll get better at. But the real question... That's a guarantee. Sure. We'll get better at it. We'll get better at it. We won't be perfect at it. But look, we tend to be better after we learn our lesson. But even if we've learned that lesson, the question will be how do we as a country, as a populace, respond?

What will our memory of this pandemic be? And there is some hope, not that we'll be 100%, because this is not a country that does that, but that we will have more quick response and people with more muscle memory. That's the hope. But to do that, we need to have dialogue.

We need to understand. We need to listen to doctors and nurses. We need to have dialogue we need to understand we need to listen to doctors and nurses we need to listen to public health people we need to listen to small businesses to close we need to have a real dialogue for people to really let those lessons cement yeah it's interesting um i i get where you're coming from you know my concern is that we have a short memory and that i've um in my at CDC, I will get to a positive part, I promise. But, you know, we have a short memory. We live through a crisis and then we, I think, intentionally in some ways put that crisis down and move on with our lives, try to focus on the positives. And the energy to fix the inherent problems that cause that crisis don't drive sort of long-term investment. Now, none of those crises, I'm talking about Ebola, SARS, MERS, H1N1, influenza, anthrax, have been of the magnitude of scope of this.

And so I'm hoping that we as a country will seize the moment and say, you know, we're committed to saying never again. And never again means investment to ensure that we have the infrastructure and the people in place for public well in the u.s globally the kind of global coordination that you need in order to ensure vaccine development and production everywhere across the globe to ensure that countries have common intelligence have common approaches i think that really fell apart too and you know i um the um the summit last week, the UN General Assembly Summit, I'm sorry, the UN General Assembly and President Biden's summit was meant to be a launching pad for a new global initiative that really brings in not just the U.S. and governments, but philanthropy and businesses for sort of a whole of society moment to say we need to seize the moment we need to use this energy not only to end the current pandemic but to ensure that we build back better that is build the kind of infrastructure and systems that will be more resilient for the next time not to bring this back to a dark place but let's talk about political polarization for a minute here especially as it relates to this pandemic i I mean, 700,000 dead. President Biden likes to come out and remind us

of this unimaginable amount of death, and it feels like half the country's hearing it and half the country doesn't care. Half the country still wants to fight about masks on planes and make, you know, flight attendants' lives a nightmare. Have we learned anything about how to combat political polarization in a public health crisis over the course of two administrations? Yeah, I can't tell you, begin to tell you how sad it makes me. And I have talked to a few friends who are not mask wearers and aren't

vaccinated. And, you know, I go back to those conversations where even knowing me and trusting me, I can't convince them that those are the right things to do. I think we have to really move forward in a way that respects our differences and understands that people inherently believe differently. To me, it's about scientific literacy. People trust those that they're closest to in their own communities, who they trusted before the crisis happened. And I think we really need to understand where this is coming from. It's coming from deep distrust of our institutions and our scientists and what it means if it's been that long to develop, you're not going to solve it quickly and you're certainly not going to do well trying to

solve it in the midst of the crisis. So I think what it points to is the need to really invest in the development of those long-term relationships of public health officials in those communities who can be trusted but are also really rooted in the scientists in the science and also health care providers in those communities that have access to the right information and really build long-term relationships with their communities and their patients and this is a tech conference so I'm contractually obliged to ask if tech can help. I mean, a lot of the disinformation is spreading on tech.

Okay, I'm going to let you start this. Can you combat disinformation with tech? Are we? Are we doing a good enough job? Yeah, Facebook could do better. They know they could do better. I think others of the social media companies, I think, recognize the challenge and I think work at it. I think, unfortunately, of the people who aren't vaccinated, I think the data is two-thirds of them believe one of five major falsehoods about

the vaccine. And most of them say they get their information from social media and Facebook and whatsapp are real problems and that's just the reality the end is it addressable by them yes I believe it is and that's a long conversation you can read the New York Times piece where that showed the fight I was having with Facebook from the White House, if you want. I also think, though, there's also a part of this that is not the media, but sort of

more people-focused. You know, when I was a kid, if we had to do a research paper, we went to the library. And now I'm dating myself. And my teacher told me that the encyclopedia was not an appropriate reference. I had to actually look at real reference texts

and that was sort of baked in that you actually had to figure out what the source data is. I think we need to do a better job of teaching people that Googling something or looking it up in social media is not research. Research is knowing the source of the data, knowing who you trust,

and being able to sort of sort through all the misinformation to find the kernel of truth. And I think, by the same token, scientists need to do a better job making reliable information available and accessible and reliable by people. Yeah, interpretable. We're at this conference right now where, you know,

there's an app, there's rapid testing, there's really clear communications, there's really clear rules. We're living currently in this little bubble in the optimal version of this pandemic, and a lot of people aren't and haven't been for over a year and a half now. Have we gotten any better at dealing with that or learned some lessons that can help us in the next pandemic? Look, I mean, we opened our first federal facility right here in East Los Angeles, and it was mobbed on the first day by people from Beverly Hills. Probably the first time they've been in East Los Angeles in a long, long time, I would venture to say. And when we looked at the peak of deaths here in January, the western

part, Santa Monica, Beverly Hills, was some of the safest parts of the country. And East LA was where all of the deaths were occurring. And I personally think that's the whole thing right there. That's the whole thing right there. That's the whole thing right there. Out of sight, out of mind. I can't say how many people have said to me, Andy, I don't know a single person that died of COVID. This was the last year, so maybe that's changed. And, you know, my response was always, you do know people dying of COVID.

And they're like, no, I don't. And I'm like, well, the person who grows your food, the person who drives the truck to bring the food to the warehouse, the people in the warehouse, the people in the grocery store, you may not know their names, but those are all the people that are dying in a different kind of society. You would know their names.

But there's this sort of dissonance, this cognitive dissonance, because we live in these bubbles. My podcast is called In a Bubble. That you have a very... You can kind of carve out the life you want, whether it's information bubble, whether it's life or whatever. And that's why I think we tolerate so many things you'd think we wouldn't tolerate. If you would have told us, any of us, at the beginning of this, that we wouldn't be shaking our heads and seeing 2,000 deaths a day, 3,000 deaths a day,

that we would get used to it, it would be very sad. Maybe some of us would say that's possible, maybe a lot of us would say it wouldn't, but it would be very, very sad what it says about us, that kind of life just goes on unless we know the person and that means we had a lot of work to do as a society to bring this stuff together or all the questions you're asking politics is just a reflection of culture it's not politics doesn't just happen by itself we got to go fix some of these underlying societal issues i think That was Sean Ramos-Furham talking to Andy Slavitt, who used to work in the Biden White House, and Nancy Messonnier, who is a director at the CDC. Thanks to Vox Media's Michelle Berg and Andy Tao for their help with the live show.

And thanks to Vox's Dylan Scott for help with the questions. I'm Halima Shah. It's Today Explained. you