White House COVID-19 Task Force, Dr. Fauci Press Conference Transcript March 1

Jeff Zients: (03:41) Good morning. Thank you for joining us. We got very good news over the weekend. The Food and Drug Administration issued an emergency use authorization for a third safe and effective vaccine, the Johnson & Johnson vaccine which will help us defeat the pandemic. While we have much work ahead of us on so many fronts this is certainly a very [inaudible 00:04:04] a state of the pandemic update from Dr. Walensky, Dr. Fauci and Dr. Nunez-Smith will discuss the recently authorized J&J vaccine and I'll close with an update on our planning, logistics and distribution of the J&J vaccine and then we'll open it up to questions. With that, I'll turn it over to Dr. Walensky. Dr. Walensky. Dr. Walensky: (04:24) Thank you Jeff, I'm delighted to be back with you today. Let's get started with the current state of the pandemic. I remain deeply concerned about a potential shift in the trajectory of the pandemic. The latest CDC data continue to suggest that recent declines in cases have leveled off at a very high number. The most recent seven day average of cases, approximately 67,200, represents an increase of a little over 2% compared to the prior seven days. Similarly, the most recent seven day average of deaths has also increased, more than 2% from the previous seven days, to nearly 2,000 deaths per day. Dr. Walensky: (05:07) These data are evidence that our recent declines appear to be stalling, stalling at over 70,000 cases a day. With these new statistics, I am really worried about reports that more states are rolling back the exact public health measures we have recommended to protect people from COVID-19. I understand the temptation to do this. 70,000 cases a day seems good compared to where we were just a few months ago but we cannot be resigned to 70,000 cases a day, 2,000 daily deaths. Please hear me clearly, at this level of cases with variants spreading, we stand to completely lose the hard-earned ground we have gained. These variants are a very real threat to our people and our progress. Now is not the time to relax the critical safeguards that we know can stop the spread of COVID-19 in our communities, not when we are so close. Dr. Walensky: (06:06) We have the ability to stop a potential fourth surge of cases in this country. Please stay strong in your conviction. Continue wearing your well-fitted mask and taking the other public health prevention acts that we know work. Ultimately, vaccination is what will bring us out of this pandemic. To get there, we need to vaccinate many more people. Yesterday, CDC's advisory committee on immunization practices or ACIP endorsed the safety and efficacy of Janssen's COVID-19 vaccine. After the ACIP met, I was heartened to sign their recommendations for use of this vaccine in people 18 or older. This means we now have three safe and highly effective vaccines that prevent serious illness, hospitalization and death from COVID-19. Dr. Walensky: (06:57) Importantly, ACIP does not state a preference for a particular COVID-19 vaccine, rather, they recommend that individuals can get any of the ACIP recommended COVID-19 vaccines and they encourage individuals to receive the earliest vaccine available to them. The Janssen vaccine is a much needed addition to our toolbox and increases the number of vaccine doses available and makes it possible for more people to get vaccinated and protected from COVID-19. It also offers several unique benefits. It's a single dose vaccine that provides COVID-19 protection with just one shot. That can help fully vaccinate people who may have difficulty or who are not interested in returning for a second dose. For those administering the vaccine, this vaccine is also easier to store and transport since it does not need to be kept in a freezer. This will make it easier to provide the vaccine in more community settings and mobile sites as supplies scale up. Dr. Walensky: (07:59) Having multiple types of vaccine available, especially ones with different dosing regimens and different storing and handling offers more flexibility. For example, clinics in mass vaccination sites that do not have [inaudible 00:08:13] communities. I know that many Americans look forward to rolling up their sleeves with confidence as soon as a COVID-19 vaccine is available to them. We are working hard to get and distribute these vaccines to your communities. Dr. Walensky: (08:29) I also know that some people may not be there today and may still have questions about these vaccines including wanting more information about the process for developing and authorizing them. That's natural, and I know that some people have had experiences that may have diminished their confidence in the health system. That's also understandable. I want to emphasize several important facts about these vaccines. We have conducted the largest scale clinical trials of any vaccine and what made that possible so quickly was the high amount of disease in the community and the fact that so many people were interested in participating. Dr. Walensky: (09:07) All of the available data show that these vaccines are safe and are highly effective. Over 100,000 people participated in clinical trials to evaluate the safety and effectiveness of these vaccines and they have all met rigorous FDA scientific standards. Equally importantly, as of today nearly 50 million people in the United States have received at least one dose of a COVID-19 vaccine. We have put in place the most intensive vaccine safety monitoring systems in U.S. history and we are actively monitoring for any new safety signals. CDC's new V-safe smartphone-based health checker has not enrolled approximately four and a half million people to capture patient reported side effects in realtime. These results are all reassuring. Some people have no side effects after vaccination, many people have reported mild side effects - Dr. Walensky: (10:03) -effects after vaccination. Many people have reported mild side effects like pain, swelling at the injection site, and headache and chills or fever. These are common with all vaccines and should go away after a day or so. Serious, generally reversible reactions remain exceptionally rare. For those who have still have questions about the vaccines, I encourage you to visit the CDC COVID-19 website for more information. Our decisions today as a unified nation and as individuals, including whether and when to get vaccinated, will determine how quickly we can stop this pandemic and what life will look like in the coming months ahead. The most important thing you can do is to be ready to get the vaccine that is available to you. It will help protect us all from COVID-19. Thank you. I look forward to your questions, and with that, I'll turn things over to Dr. Fauci. Dr. Fauci. Dr. Anthony Fauci: (10:55) Thank you very much, Dr. Walensky. I'm going to just talk a little bit more now about the Yonson COVID- 19 vaccine. If I could have that first slide, let's move on to the second slide. We get questions. Just move on to the second slide. We get questions regarding the various percentage numbers that people see, and I know most of you are aware of them, but let me just clarify a few things. The 66% vaccine efficacy that we have is really against all of the countries involved. You must recall that this vaccine trial was done on three continents, the United States, South America, and South Africa, with varying degrees of infection dynamics, as well as varying strains, variants, or lineages. That is the 66%. The 72% is the vaccine efficacy against moderate to severe critical infection in the United States. Dr. Anthony Fauci: (11:58) I want to point out, again, a question we often get asked. In order to try, we always say, "What vaccine is better than the other vaccine?" In order to be able to determine that, you would have to compare them head-to-head. This was not done. We have three highly efficacious vaccines that are also, as Dr. Walensky says, has a very good safety profile. Dr. Anthony Fauci: (12:23) A very important number that I want to reemphasize is that this 85% efficacy against severe COVID-19 globally, including the United States, this is very important, because if you look at other countries such as South Africa, if you go to the next slide, where you have the B-1351, you can see that the efficacy against severe, critical disease was 82% there. That's really very important, because even though the vaccine itself, the spike protein that was used and expressed in that vaccine was the spike protein against wild-type virus, namely, the virus that is the D-614G, not against the B-1351. So even though the vaccine itself was not specifically directed against those variants, it did extremely well when it came to preventing severe, critical disease, and as we've heard many times now, there were no hospitalizations or deaths in any of those studies. Next slide. Dr. Anthony Fauci: (13:39) I want to just spend a minute now telling you the difference between the mRNA and the Ad26, because we often get asked that question. As we've said on previous briefings, the mRNA that's injected into the muscle codes for the spike protein in the proper configuration. The body sees that and makes an immune response against that, giving you the protection that has been shown with both of the mRNA vaccines. Next slide. Dr. Anthony Fauci: (14:16) In contrast, the Yonson COVID-19 vaccine approach is to take a common cold, harmless, non-replication-competent virus called adeno-26, in which the DNA of the SARS spike insert was given into the genome. That virus is then injected into an individual. The DNA then transcribes the RNA. The RNA then gives you the spike protein. The ultimate end game is that both of the vaccines ultimately result in a spike protein in the right conformation that gives the body the opportunity to feel that this is the actual virus that it's seeing when it's not. It's the protein. Next slide. So just to put everything into perspective, we've shown this slide before. We now have, again, the third vaccine that is highly efficacious, as shown here, which has been granted an EUA, as has been described by Dr. Walensky. Dr. Anthony Fauci: (15:29) Let me go to the last slide and just make a comment that I think people do not seem to appreciate that it has to do with what goes into making these vaccines successful. I have as the title of the slide The Role of the NIH and the US Government in the Development and Testing of J&J. I think what people don't appreciate is that there have been decades investment in basic preclinical and clinical research to actually develop the adenovirus-26 vector, a lot of work done by Dr. Dan Barouch and his colleagues up at Harvard. Dr. Anthony Fauci: (16:07) The development of the stabilized pre-fusion spike protein was done by scientists at the NIAID Vaccine Research Center. The utilization by J&J of the extensive domestic and international clinical trials network, that was established actually for HIV and influenza. Also, the NIAID-funded core lab at the HVTN at the Fred Hutchinson Cancer Research Center performed all the immunological testing. The data and safety monitoring board was established by NIAID, and there was extensive support from [inaudible 00:16:46] of HHS to conduct the trial and to pre-purchase hundreds of millions of dollars worth of vaccines by [inaudible 00:16:57]. So it's a complicated process. So even though it looks like it was quick and it was done in a very relatively short period of time, there was a lot of effort, including fundamental basic preclinical and clinical research that went into that. I'll stop there and hand it over to Dr. Nunez-Smith. Dr. Marcella Nunez-Smith: (17:15) Well, thanks so much, Dr. Fauci. This is all very, very good news. All three vaccines are safe and highly effective at preventing what we care about most, and that's very serious illness and death. So all of the authorized vaccines will be distributed across states and jurisdictions and across all of our federal vaccination channels. That doesn't mean that every vaccination site will have every vaccine, but it means that all vaccines will reach all communities. So all three authorized vaccines, available in the suburbs, all three available in the cities, all three available on the coast and in the heartland. Dr. Marcella Nunez-Smith: (17:55) So I just want to briefly talk about some of the clinical benefits of the J&J vaccine from a healthcare provider's perspective. So having these different types of vaccines available for use, ones that have different storage requirements, different handling requirements, different dosing recommendations, that will bring more options and more flexibility to healthcare providers. Could absolutely allow for expanded availability of vaccine in some temporary clinics, some pop-up mobile sites, and those locations that do not have cold storage capacity. The overall increased vaccine supply creates greater opportunity for people to get vaccinated. Dr. Marcella Nunez-Smith: (18:35) We also recognize some individuals may have a preference for a single-dose vaccine, so those who do not want to return for a second dose or who would have difficulty returning for a second dose. We understand that. Still, as a physician, I strongly urge everyone in America to get the first vaccine that is available to you when it is your turn. If people want to opt for one vaccine over another, they may have to wait. Time is of the essence. Getting vaccinated saves lives. No doubt communities across the country have been devastated by this pandemic. The vaccines and vaccinations are a critical tool in bringing this unprecedented pandemic to an end, and now we have three. Dr. Marcella Nunez-Smith: (19:19) So for that, in addition to the scientists, I want to thank all of the clinical trial participants for their contributions to scientific discovery. For this vaccination campaign to be successful, vaccines will have to reach everyone, and so kudos to those states and jurisdictions who are already working closely with trusted leaders in the hardest hit communities to ensure fair and equitable access to vaccinations. This is best practice. So, again, all three vaccines have been proven safe, highly effective at preventing severe disease, hospitalization, and death from COVID-19 after full immunity. If I could leave people with one message, it is this: Get vaccinated, but the first- Dr. Marcella Nunez-Smith: (20:03) Message it is this. Get vaccinated. Get the first vaccine available to you. Protect yourself, your family, and your community from COVID-19. And with that, I'll turn it over to you, Jeff. Jeff Zients: (20:13) Thank you, Dr. Nunez-Smith. I'll provide an update on our planning, logistics, and distribution of the recently authorized Johnson and Johnson vaccine before we open it up for questions. For the last several weeks, we've been working with governors, state and local health officials, and pharmacies and community health centers to ensure we were ready to roll out the J&J vaccine immediately after FDA approval and CDC recommendations. Starting yesterday, we began executing on our plans by distributing 3.9 million doses of Johnson and Johnson to states, tribes, and territories, and also to pharmacies and community health centers. Johnson and Johnson doses will be delivered as early as tomorrow. Jeff Zients: (21:04) We're allocating the J&J vaccine the exact same way we allocate Pfizer and Moderna's vaccine, proportional to a state, tribe, or territory's population. For example, if a state represents 2% of the U.S. population, it receives approximately 2% of the Pfizer allocation, 2% of the Moderna allocation, and will now receive 2% of the J& J allocation that is made to states, tribes, and territories. We have directed states to manage distribution of all three vaccines in a fair and equitable way, and we will continue to monitor that closely. As part of that work, the CDC is tracking distribution of vaccines across a range of equity metrics, including zip codes and Social Vulnerability Index data. We have three very effective vaccines, and all communities should have equitable and even access to each vaccine. Jeff Zients: (22:11) As to the expected supply of Johnson and Johnson vaccine, this week, we'll distribute 3.9 million doses. That is the entirety of Johnson and Johnson's current inventory. We're getting these doses out the door right away to ensure vaccines get into arms as quickly as possible. J&J has communicated that the supply will be limited for the next couple of weeks following this initial distribution of nearly 4 million doses. The company then expects to deliver approximately 16 million additional doses by the end of March. However, as we have discussed with governors and their teams and with federal partners, we know that J&J distribution and delivery will be uneven across these early weeks in March, and the company expects the delivery to be predominantly in the back half of the month. Jeff Zients: (23:10) Overall, in the J&J vaccine, we've done the planning, we have the distribution channels in place, and we're getting doses out the door as quickly as possible to get shots in arms. We're focused on execution, and that includes the important work of ensuring that we continue to increase overall vaccine supply, increase the number of vaccinators, and increase the number of places Americans can get vaccinated. Jeff Zients: (23:41) Next, I want to provide an update on the pace of doses being administered. As you can see on our weekly vaccination report, the current seven-day average is 1.7 million shots per day. Given that the first couple of days in this seven-day period included the storm impacts, 1.7 million actually understates the current pace. Over the weekend, we experienced new record levels of daily vaccinations. That said, we have much more to do on all fronts in our war on this pandemic. There is a path out of this pandemic, but how quickly we exit this crisis depends on all of us, and that's why I encourage everyone to take the advice of doctors Walensky, Fauci, and Nunez-Smith. Follow the public health guidance, get vaccinated when it's your turn, and continue to wear masks and social distance to protect yourself and your fellow Americans. We will continue doing everything we can as a federal government to defeat this virus, but it'll take all of us stepping up to do our part. Jeff Zients: (24:53) With that, let's open it up to questions. Speaker 2: (24:58) Great. And a reminder to please keep your questions to one question only. First up, we'll go to Elizabeth Weise at USA Today. Elizabeth Weise: (25:05) Hi. Thank you so much for taking my question. You didn't say how many doses are being shipped this week. I think usually you've had that. My question, however, is so appointment systems seem to be the rate limiting factor for getting people vaccinated in a lot of the country. And in some cases, this is frustrating people who aren't coming back because they couldn't get through. As states move into phase 1B and 1C and we get tens of millions of more Americans who are eligible, how is the system going to cope, and what are you doing to strengthen it? Jeff Zients: (25:40) The number of doses is 3.9 million, so that was the entire J&J inventory, and all of those doses are being shipped this week. I think scheduling an appointment is too difficult and remains too difficult in too many places. In some states or in some locales, things have gotten better. The pharmacy systems are often better at scheduling and appointments, but overall, too many Americans are suffering frustration, taking up way too much time to schedule an appointment. Jeff Zients: (26:13) And we have addressed some of those root causes as we've increased the vaccine supply, as we put more vaccinators in the field, as we've increased the number of places. But now, we really need to make sure the systems can handle not only the current demand, but the projected demand for people being vaccinated, so we're working with states to improve their health sites so that they can handle this capacity. We're also looking at lower tech solutions that the federal government might be able to provide, whether those are call centers or people to help navigate the system. I think overall, scheduling remains for far too many people too frustrating, and we need to make it better. Jeff Zients: (26:58) Next question. Speaker 2: (27:00) Next, we'll go to William Joy with WFAA Dallas. William Joy: (27:06) Thank you for taking my question. This has to do with equity for either Dr. Nunez-Smith or for Jeff. At least here in Dallas-Fort Worth, the gap between vaccinations in affluent zip codes versus underserved zip codes is actually getting worse. How, specifically, are you grading yourself when it comes to equity, and what's that grade right now? Jeff Zients: (27:27) Dr. Nunez-Smith? Dr. Marcella Nunez-Smith: (27:29) Yeah. Thanks for the question. We're absolutely a hundred percent committed to equitable vaccine access. And the statistics that you share are very concerning to us. We know that we still have a challenge in terms of data. The data quality are not exactly where we'd like them to be as far as race, ethnicity, but even the data that we have do suggest this pattern. We are already in the federal programs prioritizing equity. We have been committed to this from the very beginning of the launch of those programs using metrics such as the CDC's Social Vulnerability Index to help guide where resources should go. Ultimately, we do believe that people should be vaccinated at the rates, and different groups should be vaccinated at the rates in their population. And that's our target and our goal. We're already working closely with states to provide technical assistance where needed. We will continue to do so. Jeff Zients: (28:25) I think Dr. Nunez-Smith has captured it well. I will add that the president has been crystal clear that as important as speed and efficiency in vaccinations, equity and fairness are as important, and we need to make sure that we execute on a strategy that ensures equity and fairness. Speaker 2: (28:48) Great. Next question, we'll go to Laurie Garrett. Laurie Garrett: (28:58) Sorry. Had a moment of unmuting. Thank you very much. Yes, I have a question regarding the variants, and this would go to both doctors Fauci and Walensky. We have this new New York variant that jumped from 0.2% of identified viruses in early November to now about 28% in New York, and it seems to have arisen in an HIV-AIDS patient, indicating the possibility that we could see variants arising in highly immunosuppressed individuals. And they're warning that it may be colonizing nasal cells with very high, like tenfold affinity for ACE2 receptors, and that's a site pretty privileged in terms of IgG neutralizing antibodies. I wonder, my question is, how worried should we be about this particular variant, and is it possible that vaccinated and COVID-surviving individuals who have neutralizing antibodies in their blood systems could still harbor and colonize and transmit from their noses to other individuals? Thank you. Jeff Zients: (30:02) Let's start with Dr. Fauci, and then we'll go to Dr. Walensky. Laurie Garrett: (30:03) ... to other individuals. Thank you. Jeff Zients: (30:03) Let's start with Dr. Fauci, then we'll go to Dr. Walensky. Dr. Fauci. Dr. Anthony Fauci: (30:05) Well, we certainly are taking the New York variant, the 526, very seriously, Laurie. As you know, it started off and what is likely in the Washington Heights section, and then has gone through multiple burrows and is now gaining. Work done by David Ho has shown that we have to really keep an eye on it for its ability to evade both monoclonal antibody, and to a certain extent, the vaccine induced antibody. So it's something we take very, very seriously. Dr. Anthony Fauci: (30:39) The idea about the accessibility of antibody to the nasal pharynx, I mean, that's obviously a good point. It's theoretical, but it can be a real issue. So I'm sure that's going to be something that is going to be looked at and studied, about the degree of not only the viral load, but also the persistence of the viral load in the nasal pharynx. So, good points, all unknown right now. But something that we're going to be looking at very carefully, Jeff Zients: (31:10) Dr. Walensky, anything to add there? Dr. Walensky: (31:14) I would just say, we know that early studies actually showed that these variants could emerge in a single host, in a single immunocompromised host as well. And it's our reason to decrease circulating virus everywhere, but in the community, as well as in individuals. Dr. Anthony Fauci: (31:32) But I think is important because we often get asked the question, that's a reasonable question, should people who are immunocompromised get vaccinated? And the answer is, absolutely yes. Absolutely, yes. Because that's not only important for them for their own health, but that could be the breeding ground of the emergence of a variance for the simple reason that if you don't clear the virus rapidly, you're going to have immunological selection within a given individual. And as Laurie said correctly, that was probably how all this started with 526. Jeff Zients: (32:14) Next question we'll go to Jeremy Diamond at CNN. Jeremy Diamond: (32:19) Hey, thanks for taking the question. Sorry, let me just mute this TV here. Apologies. I'm hoping you could address some of the concerns that the more easily deployable nature of the Johnson and Johnson vaccine will make it the go-to vaccine for marginalized and harder to reach communities. I know you guys have said that that's something that you're monitoring and you want states to distribute these shots equitably. But beyond monitoring, what more can the administration do to not only avoid this perception that you have different vaccines for different classes of Americans, but also to make sure that you're getting the most bang for your buck from an epidemiological perspective, given the limited supply? Jeff Zients: (32:58) Dr. Nunez-Smith? Dr. Marcella Nunez-Smith: (33:01) Absolutely. Thank you for the question. So, we shouldn't lose sight of the very good news that we have. We have three authorize vaccines. That's tremendous. We do expect that they be distributed evenly for all communities to benefit. There are clinical benefits to J and J that we talked about briefly, in terms of the cold storage capacity, the single dose, that might make it very useful for healthcare providers in their toolkit as they're thinking about things like some pop-ups. But overall, we do think that the distribution again, should be even across communities. Dr. Marcella Nunez-Smith: (33:42) So importantly, providing that guidance upfront, we are modeling that within the federal programs. And then, as we said, we will be tracking biometrics, such as zip code and social vulnerability to see where vaccines are going. And should certain vaccines go consistently to certain communities, we will be able to intervene. And we're here to provide support and technical assistance to pivot and intervene and correct, if and when needed. Jeff Zients: (34:18) Last question, we'll go to Zeke Miller at the Associated Press. Zeke Miller: (34:23) Thank you all for joining the call. To questions. First, just to follow up on what Dr. Nunez-Smith just said. What would that intervention look like? Would that be reduction in a state's allocation? And then more broadly for Drs. Walensky and Dr. Fauci, What is the current timetable in terms of federal guidance on what people who had been vaccinated can and shouldn't do in this moment? Is it safe for them to go out to dinner right now? Can they start to travel? And are you worried that the delay in getting that sort of guidance is having a downward pressure on demand? Jeff Zients: (34:56) So Zeke, I'll go first here and then over to the doctors. If we were to see that vaccines were going to certain communities, we will take action, as Dr. Nunez-Smith said, to ensure supply is distributed evenly. And first actions would include, obviously the communication of our standards and our insistence that people adhere to the standards. And then we would begin by providing technical assistance to the state or other providers. Second question over to you, Dr. Fauci. Dr. Anthony Fauci: (35:29) Yes. So this is something that the team, the medical team talks about all the time. Ultimately, the CDC will be coming out, within a reasonable period of time I'll let Rochelle give you that timeframe in a moment. But, I have been asked and I've said publicly that as we get more and more people vaccinated, the logical question that was just asked by Zeke is an important question. And that is what happens if you get doubly vaccinated people with the Pfizer and Moderna, for example, members of family, people coming in. Like I use the example of a daughter coming in from out of town who is doubly vaccinated, and a husband and wife doubly vaccinated, and maybe a next door neighbor, who you know are doubly vaccinated. Small gatherings in the home of people, I think you can clearly feel that the risk, the relative risk, is so low that you would not have to wear a mask, that you could have a good social gathering within the home. Dr. Anthony Fauci: (36:31) Beyond that is going to be based on a combination of data, a combination of modeling, and a combination of good clinical common sense. And the CDC is working on that right now. And we'll all be together with a good message, hopefully soon. So Rochelle why don't you take it from there? Dr. Walensky: (36:50) Yeah, I don't have much to add except to say, we're actively working on this guidance. We're looking forward to releasing it soon. At the same time, and I would agree with all the Dr. Fauci has said. At the same time, I want to really keep our eye on the fact that our cases are increasing right now. Slightly, but they are. And so, the goal is not to sort of open up travel, open up things because we're scaling up vaccination. The goal in those first 100 days has always been to sort of make sure that we are in a place to be out of this pandemic. At 70,000 cases per day we're not in that place right now. So while we may have guidance at the individual level, as Dr. Fauci has suggested, I think we all need to keep our eye on the fact that we're not out of the woods here yet. Dr. Anthony Fauci: (37:40) Yeah, the environment of, as I just mentioned, the setting in a home of a small group of people having dinner together, all of whom have vaccinated, is very different when you step out the door and go into a society that has 70,000 new infections per day. So amen to what Dr. Walensky just said. Jeff Zients: (38:02) I want to thank everybody for joining today. We'll be back together on Wednesday. Thank you.