White House COVID-19 Task Force, Dr. Fauci Press Conference Transcript April 9

Jeff Zients: (13:38) Thank you for joining us for today's briefing today. We'll get a state of the pandemic update from Dr. Walensky. Dr. Fauci will highlight the latest science and Dr. Murphy will provide an update on our outreach and education efforts. First, I want to provide a brief update on our accelerating vaccination program. As of today, overall, more than 112 million Americans have received at least one dose, and more than 66 million adult Americans are now fully vaccinated. That's more than one quarter of all adult Americans that are now fully vaccinated. That's up from less than 1% when we came into office 11 weeks ago. This is significant progress. And as you can see in our weekly vaccination progress report, we're accelerating our number of daily shots in arms. Our current seven day average is now 3 million vaccinations per day, up from 2.9 million last week, 3 million vaccinations per day, and this includes the lower volume days around the Easter holiday. Jeff Zients: (14:51) And as the President announced on Tuesday, all adult Americans will be eligible for vaccination no later than April 19th. That's in 10 days and ahead of the original May 1 timeline. Our vaccination program is working, it's accelerating, and we're on track to meet the President's goal of administering 200 million shots in his first 100 days. This is only possible because of our whole of government response and the aggressive steps we have taken to get more vaccine supply, more vaccinators in the field, and more places for Americans to get vaccinated. However, we know there's more work to do. That's why we're accelerating our efforts to get more safe and trusted places for Americans to get vaccinated and meet the President's goal that by April 19th, 90% of Americans have a vaccine site within five miles of where they live. Jeff Zients: (15:57) First, on the federal retail pharmacy program. As we expand to more pharmacies, millions of Americans are able to get their shot at their local pharmacy, the same way they get their flu shot. Today, there are around 30,000 pharmacies participating in the program. That's an increase of over 70% in less than two weeks. And we are on track to meet the President's goal of nearly 40,000 local pharmacies by April 19th. Jeff Zients: (16:28) Second, on federally run mass vaccination sites, our mass vaccination sites located in some of the most underserved neighborhoods in the nation are run and staffed by FEMA and DOD personnel, in close partnership with state and local officials. And these sites have a combined capacity to administer 110,000 shots per day. On March 29th, the President challenged us to open at least a dozen new sites by April 19th. We've brought nine online in the last 10 days. And today, we're announcing two new sites in Tulsa, Oklahoma, and Baton Rouge, Louisiana. Jeff Zients: (17:11) Third, we are making progress on meeting people where they are. More than 500 community health centers are already receiving vaccine directly from the federal government. These community health centers serve nearly 30 million Americans. Two thirds of community health center patients live at or below the poverty line, and 60% are racial and ethnic minorities. As we announced earlier this week, we're expanding our community health center vaccine program so that all of the nearly 1,400 community health centers can sign up to receive and administer vaccines. Overall across the country, there are now more than 66,000 sites where Americans can go to get a shot. And by April 19th, we will meet the President's goal of ensuring 90% of Americans have a vaccination site within five miles of where they live. Jeff Zients: (18:08) On vaccine supply, this week, a total of more than 28 million doses went out to states, tribes, and territories, and through the federal channels, more than enough supply to maintain and increase our current seven day average of 3 million shots per day. In fact, over the past three weeks, we've allocated almost 90 million doses of Pfizer, Moderna, and Johnson & Johnson vaccine to states, tribes, and through the federal channels. And we're working with states, tribes, and territories and our other partners to make sure they are administering shots as efficiently and equitably as possible. Both Pfizer and Moderna are on track to meet their commitment of each delivering a total of 200 million doses by the end of May. And on Johnson & Johnson, the company is working closely with the FDA to resolve any manufacturing issues at the immersion facility in Baltimore, and to secure FDA authorization. Johnson & Johnson is installing a new senior leadership team to oversee all aspects of production and manufacturing at the facility, and Johnson & Johnson will have full responsibility for the operation and will leverage the expertise of Merck as well. Johnson & Johnson expects a relatively low level of weekly dose delivery until the company secures FDA authorization. With FDA authorization, the company also expects a cadence of up to 8 million weekly doses in total, across state and federal channels later in April. Importantly, Johnson & Johnson has also reiterated its commitment to provide at or near 100 million vaccine doses by the end of May. Jeff Zients: (20:02) ... vaccine doses by the end of May. Jeff Zients: (20:05) Now, even as we accelerate our vaccination program, we are seeing areas of the country where cases are increasing. From the beginning of the administration, we've been closely tracking the data on the state of the disease in each state and territory. The CDC tracks data and outbreaks at the state and county level. Jeff Zients: (20:29) Since taking office, we've made this data public, and weekly state-by-state reports were made available for the first time. Our philosophy has been, see something, say something. So when we see metrics trending in the wrong direction, we talk regularly with state officials to offer our assistance, including deploying CDC teams to provide their expertise and resources. Jeff Zients: (20:57) With recent increases in cases in some states, we're intensifying those efforts even further. We will be offering the states with significant increases in cases a set of additional tools to help them to stem the spread, including first, working with states to make sure they are using all of the doses they have received. Today millions of doses have been distributed, but have not yet been administered as shots in arms. Jeff Zients: (21:27) Second, we're offering to surge federal personnel, including CDC response teams, FEMA, DOD, and other federal personnel to support vaccination efforts and get more shots in arms. Jeff Zients: (21:44) Third, providing additional testing capacity, including increasing the availability of diagnostic testing, as well as screening in schools and other settings. Jeff Zients: (21:55) And fourth, offering more therapeutics and treatments. All of this is on top of the more than three fold increase in vaccines that have gone to all states and jurisdictions since the President came into office. Jeff Zients: (22:12) For a medium-sized state, this translates to hundreds of thousands of additional vaccines each and every week. And as is our practice, it's been our practice since the beginning, we make vaccines available to states as soon as they are available. In closing, to be clear, we're working to put this pandemic behind us as fast as we can. But as the president said earlier in the week, everyone needs to do their part. That's why he has called on every governor, mayor and local leader to maintain or reinstate mass mandates. All of us need to keep up our guard and finish this job. So please, please wear a mask, socially distance and get vaccinated when it's your turn. Jeff Zients: (23:07) And with that, let me turn it over to Dr. Walensky. Dr. Walensky. Dr. Rochelle Walensky: (23:11) Thank you, Jeff. And good morning, everyone. I'm glad to be back with you today. Dr. Rochelle Walensky: (23:14) We'll start again with an overview of the data. Yesterday, CDC reported 74,860 new cases of COVID-19, and CDC's most recent data show that the seven-day average of new cases is a little more than 64,000 per day, up about 2% from the prior seven-day period. Hospital admissions continued to also increase. The most recent seven-day average, about 5,300 admissions per day, is up about 7% from the previous seven-day period. And deaths have continued to decrease more than 20% with a seven-day average now of 711. Dr. Rochelle Walensky: (23:53) Vaccinations continue to increase with the most recent seven-day average of nearly 3 million vaccinations delivered daily, up 4.5% from the prior seven-day period. Our vaccination efforts this week have continued to accelerate, moving us closer and closer to President Biden's goal of 200 million vaccinations in his first 100 days. Yesterday, we reached over 158 million. Dr. Rochelle Walensky: (24:21) Earlier this week, I acknowledged the complexity of our current state in this pandemic. On the one hand, we have so much reason for optimism and hope, and more Americans are being vaccinated and protected from COVID-19. On the other hand, cases and emergency room visits are up, and as I've highlighted through the week, we are seeing these increases in younger adults, most of whom have not yet been vaccinated. Dr. Rochelle Walensky: (24:49) On this graph are the national data showing the percent of emergency room visits for each age group that are for patients with confirmed COVID-19. As you can see, those 18 to 25 in orange, 26 to 54 in light blue, and 55 to 64 in green, have increasing numbers of emergency department visits. Importantly, those aged 65 to 74 in yellow, and those 74 and older in dark blue, have decreasing numbers of emergency department visits, likely demonstrating the important impact of vaccination in protecting against disease requiring hospitalization. While those are national statistics, we should recognize that these trends are magnified in some regions of the country, like in the upper Midwest. CDC is working closely with public health officials in this region to understand what is driving these cases and how we can intervene. For example, in Michigan and Minnesota, there are also increasing number of cases linked to COVID to B117 variants in various settings. And in both of these states, there is concern about transmission in youth sports, both club sports, as well as sports affiliated in schools. Dr. Rochelle Walensky: (26:08) What is happening in Michigan and Minnesota is similar to what we are seeing across the country, increasing reports of cases associated with youth sports. I want to be clear, as cases increase in the community, we expect the cases identified in schools will also increase. This is not necessarily indicative of school-based transmission. If fully implemented, the CDC's operational guidance for schools and community level prevention measures can reduce or prevent transmission in schools. And we have not yet seen evidence of significant transmission of COVID-19 within schools when schools have fully implemented CDC's mitigation guidance. Dr. Rochelle Walensky: (26:53) In addition to educator vaccination, which we spoke about on Wednesday, testing remains an important tool in our overall efforts to stop the spread of COVID-19, including in our schools. This week, CDC is awarding $10 billion through the American rescue plan to support COVID-19 testing in schools across the country. Being able to rapidly identify new cases among students will help us slow the spread of COVID-19 while we simultaneously work to expand equitable access to vaccines. With this funding for testing, every state will have access to millions of dollars to set up screening programs to add an additional layer of protection for schools, teachers, and students. This funding can be used to test teachers, staff, and students with any symptoms of COVID-19, those who may have been exposed to the virus and to establish sustained screening programs across school systems. Dr. Rochelle Walensky: (27:54) We recognize that establishing a testing program is a new venture for many schools. That's why CDC is committed to continue our work alongside state and local health departments by providing technical assistance and support to assist schools and states in standing up and implementing these programs. As these are rolled out, we strongly encourage parents, staff, and students to participate to keep our children and our staff safe in school. These initiatives alongside with strict adherence to public health prevention precautions and getting a COVID-19 vaccine will help us turn the corner on this pandemic. Dr. Rochelle Walensky: (28:37) With that, I'll turn things over to Dr. Fauci. Dr. Anthony Fauci: (28:41) Thank you very much, Dr. Walensky. What I'd like to do over the next few minutes is to answer a commonly asked question, namely, how could it be possible that you went from discovering a virus in January of 2020 to approximately 11 months later to actually have a vaccine that goes into the arms of individuals in December of that same year, when we know generally vaccines take multiple years to develop? And this has often led to some degree of hesitancy on the part of people wanting to get vaccinated. So I'd like to answer that question. Dr. Anthony Fauci: (29:21) Yesterday, Science magazine published an editorial that I wrote, which tried to give an explanation of the story behind the vaccines. And the bottom line was that the speed and efficiency with which these highly efficacious vaccines were developed and their potential for saving millions of lives are due to an extraordinary multidisciplinary effort involving basic preclinical and clinical science that has been on the way out of the spotlight for decades before the unfolding of the COVID-19 pandemic. Next slide. Dr. Anthony Fauci: (29:57) One can look at vaccine development in two major buckets, platforms and immunogen design. Next slide. Dr. Anthony Fauci: (30:05) With regard to a platform, what do we mean by that? Next slide. Dr. Anthony Fauci: (30:10) A platform is the type of vaccine that you use. There's genetic immunization, such as DNA and RNA, and hence the mRNA vaccines, viral vectors, such as the adeno with J&J, recombinant protein, such as Novavax, and a number of others shown on the right hand part of the slide. Next slide. Dr. Anthony Fauci: (30:34) With regard to the mRNA vaccine, this work started a decade and a half ago when Katalin Kariko and Drew Weissman were working on RNA and was able to modify the molecule to remove a key inflammatory component, which would have made use of this as a vaccine impossible. This rather transforming accomplishment of theirs led to the use of mRNA as a platform. Next slide. Dr. Anthony Fauci: (31:08) With regard to adenovirus, the Ad26 that's used by J&J, the NIH has been funding for decades, a highly skilled and accomplished investigator, Dan Barouch from Harvard Medical School who had been working on this for a considerable period of time and demonstrated how immunogenic this particular vector would be. Next slide. Dr. Anthony Fauci: (31:34) And then you get to immunogen design, really the most fascinating component of this story. And it goes to a different discipline. Next slide. Dr. Anthony Fauci: (31:44) And that is the crystallography and cryo-EM capability of investigators throughout the country who were working to get the right confirmation of the HIV envelope trimor. Nothing at all to do with coronavirus. They were using these technologies to get the most immunogenic confirmation of the molecule to develop an HIV vaccine. Next slide. Dr. Anthony Fauci: (32:14) This work was done with great intensity, also at the NIH Vaccine Research Center. And I've circled two investigators on this slide. The one on the lower left is Peter Kwong, who was predominantly an HIV investigator. And the one in the upper right is Barney Graham, who was much more interested in respiratory syncytial virus. Next slide. Dr. Anthony Fauci: (32:40) What Peter Kwong did is that he used this structure-based vaccine design to get the right confirmation of the HIV envelope in what's called a pre-fusion form, which would be the most immunogenic and could bind to broadly neutralizing antibodies. Next slide. When Barney Graham took his interest in respiratory syncytial virus and collaborated in the same lab with Peter Kwong and Jason McClellan, they had a major breakthrough in respiratory syncytial virus vaccinology by it developing mutations that stabilized the immunogen to make it be used successfully for an RSV vaccine. But the story goes on. Next slide. Dr. Anthony Fauci: (33:32) When MERS came about, they did the same thing in an attempt to develop a MERS coronavirus vaccine, namely taking the spike protein and stabilizing it by mutations into a pre-fusion form. And then the culmination of the story. Next slide. Dr. Anthony Fauci: (33:52) When we had SARS-CoV-2, with Barney Graham and Kizzmekia Corbett and others in the laboratory, were able to make a stable component of the pre-fusion spike protein. Why is that important? Because that's a highly immunogenic protein, which has been used in five of the six vaccines that we're currently involved with. Next slide. Dr. Anthony Fauci: (34:18) And so on this last slide, what you see on the left are the three platforms, the nucleic acid mRNA, the adenovirus and the recombinant protein. And with that, we already have three highly successful vaccines that have a high degree of efficacy and a good safety profile. Dr. Anthony Fauci: (34:43) So the bottom line is, this did not happen in 11 months. It was due to an extraordinary, multidisciplinary effort involving basic clinical and preclinical science that had been underway, out of the spotlight, for decades before the unfolding of the COVID-19 pandemic. Dr. Anthony Fauci: (35:06) And with that, I'll pass it over to Dr. Murthy. Dr. Vivek Murthy: (35:11) Well, thank you so much, Tony. And it's good to be with all of you this morning. Dr. Vivek Murthy: (35:15) Before I start, I just want to take this opportunity, even though it's a few days late, to wish Dr. Rochelle Walensky a happy birthday. Her birthday was on April 5th. And Rochelle, I will spare you my rendition of happy birthday. I don't think anyone would appreciate that, but happy birthday nonetheless from all of us. Dr. Vivek Murthy: (35:32) I wanted just to take a moment today to talk a little bit about where we are with vaccine competence and with our education campaign. You've heard a lot from us about the state of the COVID pandemic. We've talked about it in terms of cases and hospitalizations and vaccination numbers, but I want to start today just by sharing with you a little bit more about what we've learned about the toll of the COVID-19 pandemic. Dr. Vivek Murthy: (35:55) For many Americans, this pandemic has not only impacted our physical health and wellbeing, but also the mental health and wellbeing of our children. This week, we learned, for example, that an estimated 40,000 children in America lost a parent to COVID-19 according to a new model from researchers. This week, scientists found that one in eight people with COVID-19 were diagnosed with the new psychiatric or neurological condition in the following six months, and anxiety and depression were among the most common conditions. Dr. Vivek Murthy: (36:25) Millions of people are experiencing symptoms of anxiety and depression right now. And research from the CDC has showed that younger adults, racial and ethnic minorities, essential workers, and unpaid adult caregivers have experienced disproportionately worse mental health outcomes during this pandemic. These numbers are sobering, but they are not altogether surprising, because many of you know intuitively of these struggles. Maybe you or a loved one has been wrestling with mental health challenges. We may not talk about them as often, but we're experiencing them nonetheless. Dr. Vivek Murthy: (37:01) And the administration is taking mental health challenges related to the pandemic seriously. It is provided nearly $3 billion to states and territories to address mental illness and addiction crisis. And the American Rescue Plan included around $3.56 billion for the prevention and treatment of mental health and substance use disorders. Dr. Vivek Murthy: (37:21) The mental health consequences of COVID are yet another reminder why people getting vaccinated is so important. It's our quickest path to ending the pandemic. And for all the suffering that COVID-19 can bring, I've also personally seen firsthand the joy and relief that vaccines can bring. Just yesterday, in fact, a friend sent me a picture of her two children hugging their grandmother for the first time in 16 months. And she wrote three simple words in her text, hugs are back. And I, myself, find that I breathe easier each day seeing my father and my sister go to their medical office to care for patients, because I know that they are vaccinated. And when I received my own second dose, not too long ago, I felt a wave of hope that I hadn't experienced in months. Dr. Vivek Murthy: (38:05) These vaccinations were made to help us return to our lives and to the people that we love. And that's why the President has asked that by April 19, just 10 days from now, all adults be eligible for the vaccine. Dr. Vivek Murthy: (38:19) Now as more and more Americans gain access to the vaccine, I'm happy to share that vaccine confidence is rising across the country. In December, a survey that showed that 34% of respondents were ready to get a COVID vaccine "as soon as possible". That same survey in March, just three months later, found that 61% of people reported either already being vaccinated or wanting to receive a vaccine as soon as possible. This is an encouraging trend, but we still have more work to do. Millions of people still have questions about the vaccine, and misinformation and disinformation continues to spread. Dr. Vivek Murthy: (38:59) That is why we are working hard to give people the facts about COVID-19 through a variety of channels. The most important of which is trusted messengers. The research tells us clearly that people want to hear from people they know and trust when deciding about the vaccine. For example, a survey in January, showed that more than three in four adults in the United States have said they would likely turn to a doctor or a nurse or other healthcare provider when deciding whether to get the vaccine. In that same survey, more than half of people say they'd likely turn to family or friends about whether to get vaccinated. Dr. Vivek Murthy: (39:33) That's why last week, we launched the COVID-19 Community Corps, and we're working with partners across the country to help deliver science-based information to community members, friends, and family. And in just one week since our launch, we've gone from 275 partners to nearly 5,000. And these partners include faith-based organizations, civic organizations, industry groups, individuals, health professionals, sports leagues, and so much more. In the last week alone, I've heard stories about doctors and- Dr. Vivek Murthy: (40:03) ... more. In the last week alone, I've heard stories about doctors and nurses who are now going door to door to help people learn about the COVID-19 vaccines. I've heard about churches setting up vaccine education and administration sites, and they're building. I've met grandparents who are now talking to their kids and grandkids about the importance of getting vaccinated. Dr. Vivek Murthy: (40:21) To end this pandemic, this is what we have to do. We've got to step up and help protect one another. And that's why today I'm asking everyone to do two things. One, get vaccinated as soon as you can. And, two, help the people you care about get vaccinated as well. Ask your family and friends if they have a plan to get vaccinated. If they have questions, talk to them about the facts, encourage them to talk to their primary care provider. You can get resources, fact sheets and toolkits at WeCanDoThis.hhs.gov. Dr. Vivek Murthy: (40:55) We've made extraordinary progress on the vaccine campaign, and what we've already accomplished gives us faith that we can accomplish the tasks ahead. But it will take all of us stepping up to help the people we love to get vaccinated. Thank you very much. We'll look forward to your questions. Jeff Zients: (41:12) Thanks, doctors. Let's open it up for a few questions. Speaker 1: (41:17) Thanks, everybody, for joining. Just a reminder, we are running tight on time, so please keep your question to one question. First, we will go to Shefali Luthra at Kaiser Health News. Shefali Luthra: (41:29) Hi. Thanks for taking my question. I'm actually at the 19th, but I was hoping to learn a bit about how you all plan to reach the almost quarter of seniors who are not yet vaccinated, many of whom say, right, that no one has talked to them about whether it's safe, who are maybe home bound, and if there are specific local or state coordinated efforts in partnership with y'all to make sure that people are getting the message about vaccines. Jeff Zients: (41:57) Dr. Murthy? Dr. Vivek Murthy: (41:59) Sure. Thanks, Shefali, for that question. It's very important because we know that people above the age of 65 are at the highest risk of poor outcomes with COVID. We absolutely want to make sure they're vaccinated. It's also why we're very proud that over 75% of people over the age of 65 have received at least one dose of the vaccine. More than half of people over 65 have been fully vaccinated. We're glad about that, but we're not done yet. Dr. Vivek Murthy: (42:23) Part of our effort to get vaccinations to the remaining group of folks over 65 involves working with community organizations that can reach people who are older. We're doing that on a very local basis. We're working with sports leagues, with groups like AARP, the American Association of Retired People, and we're working with faith organizations. All of which can reach seniors in different ways. We've got to keep going. Because this effort is hyper-local, our partnerships with states and with local communities matter; and that's why we are going to continue to work with elected officials who know their communities really well to make sure we're getting that message out to as many people as possible. Jeff Zients: (43:06) The only thing I would- Dr. Rochelle Walensky: (43:06) [crosstalk 00:43:06]. Jeff Zients: (43:07) The only thing I'd add is that I think it's really important that we bring vaccinations to where people are. Mobile clinics are essential for doing so, community health centers. We're also providing money for seniors who need transportation and transportation options so that they can get vaccinated as soon as possible. Dr. Rochelle Walensky: (43:26) Shefali, just this week, CDC distributed funds to states to reach, in fact, exactly those at-risk, disabled, elderly who are in their homes, reaching people who are home-bound. Jeff Zients: (43:40) Next question. Speaker 1: (43:42) Let's go to Josh Wingrove at Bloomberg. Josh Wingrove: (43:48) Hi there. Thank you for taking the time. Josh Wingrove: (43:50) Jeff, can I ask a little bit more about the J&J situation? Just for clarity, you say that if Emergent is authorized, their production will rise to up to eight million per week by the end of the month, is that correct? The spike that we saw last week, I assume that was because of the authorization of the other plant? Josh Wingrove: (44:10) Also, if you could give us an update on AstraZeneca, they're working with the US government to try to find new drug substance production. Have they found it? Do you have any thoughts on whether you will continue to loan from that accumulating stockpile? Thank you. Jeff Zients: (44:24) First on J&J, J&J is working with the FDA to get the Baltimore facility authorized. During the period that they're working with the FDA and the Baltimore facility is not yet authorized, we expect a relatively low level of weekly doses distributed to states, tribes, territories, and our federal channels. What the company has told us is once they have authorization, that they will be able to have a weekly cadence of up to eight million doses per week by the end of the month. Jeff Zients: (44:58) And, Yes, HHS is working with AstraZeneca to find a new facility. Part of what has happened here is that J&J has taken over the management of the Baltimore facility. The Baltimore facility, at one point, produced both J&J vaccine and AstraZeneca. It will now only produce J&J vaccine, and HHS is working with the company to find another facility for AstraZeneca vaccine. I think I covered the bulk of your questions there. Jeff Zients: (45:36) Next question. Speaker 1: (45:37) Let's go to Shannon Pettypiece at NBC. Shannon Pettypiece: (45:44) Yeah, I just wanted to follow up on that J&J question just a little bit more actually. When do you think they will get to the eight million doses a week? You mean that will be by the end of the month? So in a week or two, they'll be getting to those eight weekly doses? When do you think there will be that FDA authorization? Just to make sure we're all clear on that based on Josh's question. Shannon Pettypiece: (46:12) Then just bigger picture. I know this has come up a number of times and you were just talking about things you're doing for the states, but could you explain why, again, you're not going to shift any additional doses to these states like Michigan or New Jersey? Why not get even more doses to them now? Is it because you feel they have enough doses? They're just not getting them to the areas that they need them, or the people just aren't being receptive to taking them? Jeff Zients: (46:40) Yeah, so the first part of your question is when will J&J receive the FDA authorization, which is the important step for them to be able to then get into this weekly cadence that they speak of, of up to eight million doses per week. Those conversations, that process is between the FDA and the company. I don't know, or I won't speculate on how long that will take. But once they receive the authorization, the company believes that it will be able to achieve that eight million per week cadence. Jeff Zients: (47:16) In terms of the situation in states that are experiencing increases in states, sorry, in cases, this pandemic has hit every state and every county hard. Thousands of people, hundreds of thousands of people have died, and more dying each day. There are tens of millions of people across the country, in each and every state and county, who have not yet been vaccinated. The fair and equitable way to distribute the vaccine is based on the adult population by state, tribe, and territory. That's how it's been done, and we will continue to do so. Jeff Zients: (48:06) The virus is unpredictable. We don't know where the next increase in cases could occur. You know that we push out all vaccine as soon as it's available. We're not even halfway through our vaccination program, so now is not the time to change course on vaccine allocation. We're going to stick with the allocation system of allocating by state adult population. Jeff Zients: (48:39) That said, it is a challenging situation in many states, and we want to do all we can to help those states. That's why we're working with states to make sure that every dose that they do receive is administered as efficiently and equitably as possible. We'll also send more federal personnel to help with getting needles in arms and other aspects of fighting the pandemic. We're increasing testing, both diagnostic testing and screening testing, sending those resources to states who have increases in cases. As I talked about earlier, we'll also make more therapeutics and treatments available. This is all in the context of we've delivered 90 million doses across the last three weeks, and we'll continue to get doses out to states, tribes, and territories, and through our federal channels, as soon as they're made available. Jeff Zients: (49:41) Next question. Speaker 1: (49:43) Let's go to Kaitlan Collins at CNN. Kaitlan Collins: (49:47) Thank you very much. I have two questions today. One, with these breakthrough cases that we're seeing, where people are testing positive more than two weeks after being fully vaccinated, what is the administration's level of concern with this given the trials, which of course were smaller, showed that there were no deaths? Kaitlan Collins: (50:06) Then, Jeff, on J&J, you have said to expect uneven dose numbers from week to week, but I don't think anyone was prepared for an 80% drop in the J&J numbers. Why are they down 80% now? Why has J&J struggled so much more with production than any other authorized vaccine here in the US? Jeff Zients: (50:28) Let's go to Dr. Fauci on the first question of breakthrough cases. Dr. Anthony Fauci: (50:34) Yeah, Kaitlan, with the number of breakthrough cases, I think the important thing is to look at what the denominator of vaccinated people is, because it is very likely, and what we're hearing at least indirectly and we're certainly going to be confirming that, that that number of individuals who were breakthrough infections is not at all incompatible with a 90-plus percent vaccine efficacy. I don't think that there needs to be concerned about any shift or change in the efficacy of the vaccine. Dr. Anthony Fauci: (51:10) The other point that you were alluding to, I believe, was the fact that there were a few deaths within that group. The group there that the breakthrough were predominantly elderly individuals and it's not surprising when you look at the scope of the ability to mount an adequate immune response that could protect you. If anything, it is likely that elderly individuals, particularly if they are frail and have underlying conditions, might not have responded as well to the vaccine, which when someone is already elderly and may or may not have an underlying condition, that it is unfortunate, but not surprising that you might have a couple of deaths within that more than 200 people who broke through. Dr. Anthony Fauci: (51:55) There's nothing there yet that's a red flag. We obviously are going to keep an eye out on that very, very carefully, but I don't see anything that changes our concept of the vaccine and its efficacy. Jeff Zients: (52:11) Kaitlan, on J&J, we've talked about this a few times, they're obviously earlier in their manufacturing process. They're not in the weekly cadence, regular cadence that Moderna and Pfizer have both achieved. When you talk about the doses being down significantly week to week, I think it's important to remember that a week or two ago, Johnson & Johnson actually delivered 11 million doses all at once. That we got into the market immediately. This past week, it was closer to, I think it was just under two million doses, so that's the decrease that you talked about, and that's the fluctuation that we expect until they are able to get through the FDA process and open the additional plant. We do expect, week to week, lower levels until the plant is approved by the FDA, and those conversations are between J&J and the FDA. Jeff Zients: (53:08) I do think that the company is doing everything they can. As we've talked about, they now have complete responsibility for that whole facility. They have their best people at that plant. They're partnering with Merck, who has expertise. We're optimistic that once they have the FDA authorization that there'll be able to deliver, as they've told us, at that eight million per week cadence. Jeff Zients: (53:37) I do want to remind everyone that we've had 90 million doses delivered across the last three weeks and that we've more than tripled the production of doses and the delivery of doses under this principle. Once a dose is available, we deliver it right away across the 11 weeks or so that we've been in office. Dr. Vivek Murthy: (53:58) Jeff, may I add one thing, just to Kaitlan's question about the vaccine efficacy. Just to build on what Tony said, we still have high confidence that these vaccines are effective, but because they are not perfect is precisely why we are still urging people to be cautious. It's why we still have such an emphasis on getting the overall case numbers down, which we can only do by vaccinating and by making sure that people, until we have a critical mass vaccinated, are wearing masks, keeping distance, washing their hands, avoiding indoor gatherings. Just want to emphasize, we have great confidence in vaccines. We understood they weren't perfect, but that's precisely why we've got to be careful in our approach until we hit a critical threshold of vaccination in our country. Jeff Zients: (54:46) Why don't we have time for one more question. Speaker 1: (54:50) Last question, we'll go to Liz Wise at USA Today. Liz Wise: (54:54) Hey, thanks so much for taking my question. On a slightly different note, I realize herd immunity is a somewhat problematic term, but given the data we're seeing out of Israel and plummeting death and illness rates, where do you think the US will need to get in terms of vaccination to start to see that kind of payoff? Is anything like herd immunity possible here? Jeff Zients: (55:17) Dr. Fauci? Dr. Anthony Fauci: (55:19) Yes, I think you said it correctly that herd immunity is kind of an elusive terminology because we don't know what that percentage of protection is which will be a combination of people who are protected by vaccination, as well as those who were infected, who have recovered and now have protective immunity. Again, we can only surmise what that is. I've said in the past, and it's purely an estimate, that that would be somewhere between 70 and 85%. I think we need to get away from waiting for this mystical elusive number and just say to get as many people as we possibly can get vaccinated as quickly as possible. Dr. Anthony Fauci: (56:04) Israel has not had the overwhelming majority of their population vaccinated yet. However, they are seeing a very, very beneficial effect already. Whether or not they will have reached herd immunity, again, herd immunity is an elusive concept. The one thing we do know that Israel is a classic example, is that as you get people vaccinated, you're going to start seeing diminution in number of cases, which will be followed by diminution in hospitalizations, which will inevitably be followed by diminution in deaths. That's what we're striving for. The important thing we keep emphasizing is that every day that goes by when we get three to four million people vaccinated, we get closer and closer to that end point to where we want to be. Dr. Rochelle Walensky: (56:55) And it was in fact part of the reason that I showed that slide of emergency department visits to show in the areas where we have a majority of people vaccinated in these demographics that are greater than 65, we can already in this country see those effects with decrease in hospitalizations. Jeff Zients: (57:11) Well, thank you, everybody. I mean, the clear message here is get vaccinated when it's your turn. I really appreciate everybody joining today and look forward to Monday's briefing. Thank you. Dr. Rochelle Walensky: (57:22) Thank you. Dr. Rochelle Walensky: (57:22) (silence).