- Dr. Ashish Jhadean of the Brown University School of Public Health.
On his first full day in office, President Joe Biden unveiled a 198-page national plan to tackle the coronavirus pandemic as the U.S. death toll tops 410,000. He signed 10 executive orders to create a new national COVID-19 testing board, to help schools reopen, to mandate international travelers to quarantine upon arrival, and to require masks on many forms of interstate transportation. Biden also invoked the Defense Production Act to increase COVID-19 testing and the production of vaccine supplies, saying a wartime effort is needed to combat the virus. “It just feels like the federal government is back, the federal government is going to play a constructive and helpful role in this pandemic and the pandemic response. And that’s critical,” says Dr. Ashish Jha, dean of the Brown University School of Public Health. “It’s science-driven stuff that I wish we had had a year ago.” Dr. Jha also discusses his proposal to delay giving out second shots of coronavirus vaccines until there is more supply, as well as how new variants of the coronavirus impact the efficacy of existing vaccines.
AMY GOODMAN: On his first full day in office, President Biden unveiled a 198-page national plan to tackle the coronavirus pandemic and ramp up vaccines, as the U.S. death toll tops 410,000. This comes after President Trump left Biden with no plan for a national vaccine rollout. Biden signed 10 executive orders to create a new national COVID-19 testing board, to help schools reopen, to mandate international travelers to quarantine upon arrival, and to require masks on many forms of interstate transportation. Another order creates a COVID-19 Health Equity Task Force. Biden also invoked the Defense Production Act to increase COVID-19 testing and the production of vaccine supplies.
PRESIDENT JOE BIDEN: Today I’m signing an executive action to use the Defense Production Act and all other available authorities to direct all federal agencies and private industry to accelerate the making of everything that’s needed to protect, test, vaccinate and take care of our people.
AMY GOODMAN: President Biden said a wartime effort is needed to combat the virus.
PRESIDENT JOE BIDEN: Our national plan launches a full-scale wartime effort to address the supply shortages by ramping up production and protective equipment, syringes, needles, you name it. And when I say “wartime,” people kind of look at me like “Wartime?” Well, as I said last night, 400,000 Americans have died. That’s more than have died in all of World War II. …
We will make sure that science and public — scientists and public health experts will speak directly to you. That’s why you’re going to be hearing a lot more from Dr. Fauci again — not from the president, but from the real, genuine experts and scientists. We’re going to make sure they work free from political interference and they make decisions strictly based on science and healthcare alone, science and health alone, not what the political consequences are. …
The honest truth is, we’re still in a dark winter of this pandemic. It’s going to get worse before it gets better. It’s going to take many months to get where we need to be.
AMY GOODMAN: On Thursday, the nation’s top infectious disease doctor, Anthony Fauci, spoke to reporters at the White House and was asked about the difference between working under President Trump and President Biden.
DR. ANTHONY FAUCI: I don’t want to be going back, you know, over history, but it was very clear that there were things that were said, be it regarding things like hydroxychloroquine and other things like that, that really was uncomfortable because they were not based on scientific fact. I can tell you I take no pleasure at all in being in a situation of contradicting the president, so it was really something that you didn’t feel that you could actually say something and there wouldn’t be any repercussions about it. The idea that you can get up here and talk about what you know — what the evidence, what the science is — and know that’s it, let the science speak, it is somewhat of a liberating feeling.
AMY GOODMAN: To talk more about the Biden administration’s COVID plan, we’re joined by Dr. Ashish Jha, dean of the Brown University School of Public Health, previously the director of Harvard University’s Global Health Institute.
Dr. Jha, welcome back to Democracy Now! It’s great to have you with us. Can you respond to this series of executive orders that President Biden has just unveiled and signed in his first days in office? What is most significant?
DR. ASHISH JHA: Yes. So, first of all, thank you for having me on.
You know, if you look at the whole package of activities, it just feels like the federal government is back, the federal government is going play a constructive and helpful role in this pandemic and the pandemic response. And that’s critical, because the strategy under the Trump team was let every state figure it out on their own, and the federal government was largely absent.
There’s a series of things here that I think are really important. One of them, that has gotten very little attention, is the executive order just to start collecting data in a more systematic way. You know, data is the lifeblood of any pandemic response. And we have been hampered by lack of good federal data. We’re going to start doing that. But, obviously, there’s so much more than that — rejoining WHO, getting our Defense Production Act powers for testing and vaccinations. So, I’m pretty pleased with the whole package. It’s straightforward. It’s basic public health. I don’t mean to denigrate it by calling it basic public health, but it’s sort of science-driven stuff that I wish we had had a year ago.
AMY GOODMAN: So, let’s talk about what’s happening right now in this country. You have what? More than 900,000 vaccines being administered every day, which sounds like a lot but in fact is not. Here in New York, people are waiting in the freezing cold, hour after hour, to get a vaccine. They’ll sign up for an appointment. They’ll get an appointment for a past date, or they’ll get an appointment, and then that appointment is canceled — clearly, running out of vaccines, not only in New York, but around the country. Can you explain what the use of the Defense Production Act, what so many were calling on Trump to invoke, month after month — what it actually could mean? Could companies and factories that have been closed down — this also involves employment for people, going back to FDR, a kind of entire public program — of actually making these vaccines, or parts of the vaccines, either the chemicals or the actual — not only the ingredients, but what’s needed in making the needles and the vaccines?
DR. ASHISH JHA: Yeah, absolutely. So, first of all, the reason we’re having those long lines and canceled appointments is because of the approach that the Trump administration took through Operation Warp Speed. Operation Warp Speed did have its successes, but also, in the last month, they did a terrible job of communicating to states how many vaccines people were going to get. So, states would be told, “OK, you’re going to get 100,000 vaccines in five days,” and then, two days before the delivery, that would be canceled or be changed. It made planning for this stuff incredibly difficult.
What the Defense Production Act can definitely do is help with all of the things that go into getting a vaccine into somebody’s arm. So, it’s not just about the vaccine ingredient itself. It is about the vials. It is about the syringes. The way that these vials are filled, we can often get an extra dose out of them if we have the right vial and the right syringe for this. Just really simple, basic stuff that the Trump administration paid very little attention to, that Mr. Biden’s team, President Biden’s team, has been very clear that they’re going to maximize every single thing.
I think the question of “Can we use the DPA to somehow make a lot more vaccines?” turns out to be a far trickier question, something I’ve delved pretty deeply into. The problem there is that these are complicated vaccines to make, and you can’t just have somebody else step in and make these mRNA vaccines without a lot of technical expertise and very specialized equipment, much of which comes from countries outside the United States. A lot of it comes from Germany, for instance. So, there are going to be challenges to ramping up a lot more production. I do think the Biden team is definitely going to try to do that. We will see what’s possible. But there are going to be some technical limitations that will make it hard for us to, let’s just say, start producing tens of millions of these vaccines every day. I think that’s not going to be possible just because of technical challenges.
AMY GOODMAN: I mean, it raises very interesting questions when it’s not only the United States, but a massive shortage in the world of vaccines. I think — what did the — was it the World Health Organization? — said, of the 46 countries that are now vaccinating their populations, at whatever speed, only one of them is a low-income country. So, these vaccines have to get out all over.
I was just going back years in Health Affairs, the magazine, to an article that talked about a little-known law codified as 28 U.S.C. Section 1498, that could allow the federal government to substantially lower prices for high-cost drugs, allowing the government the right to use patented inventions without permission while paying the patent holder “reasonable and entire compensation,” assessing — the article assesses the potential for the federal government to invoke it to make important, new, high-cost therapies widely available to patients. Now, this is well before the pandemic.
And you’re saying, well, it’s difficult, but you already have — is it the factory in Belgium, that they had to stop because they had big problems with the manufacturer of the vaccine? I mean, there are factories all over the country that have been shut down. Pushing harder on this, is it that, well, they have to be just made very carefully, or because of the capitalist system that we work in, that there is this sort of sacrosanct “We will not challenge the purview of these corporations,” when there is such a lack of necessary vaccine right now that so many hundreds of thousands of people are dying?
DR. ASHISH JHA: Yeah, so, there are several points here, Amy, that are worth taking apart. I mean, one certainly is that we have got to have a global strategy. I mean, this is one of the many atrocious sort of policies of the Trump administration, was we were the only major country, I guess along with Russia, that wasn’t part of COVAX. COVAX is the global effort to get vaccinations out to people around the world. We absolutely need to rejoin COVAX, and the Biden administration has made clear that they will.
Second is that there is a whole host of vaccines that are going to be possible. There’s the AstraZeneca. There’s Johnson & Johnson, should be coming. We should see some data from them, I think, in the next few days. So we’re going to really need a global strategy.
On the issue of patents, the issue, in my mind, is, I don’t think that the Biden administration is going to let Americans die because of a desire not to infringe patents. I think the challenge there — and if you think about it from a Moderna or Pfizer point of view, if there were other companies that could make their product, they’d be happy to license it. There are mechanisms for doing this. I think they’d feel a lot of pressure from the U.S. government to do so.
I really do believe there are capacity issues on this that are not unsolvable, but I think there’s been no effort to try to solve them from the previous team. And what I expect Dr. Kessler, who’s going to be running Operation Warp Speed, and others in the Biden administration, is to look into those questions to say, “How do we put the power of the federal government towards ramping up production of these specific vaccines?”
And the one last thing I will say about these vaccines is, because they are technically complicated, you have to be very, very careful about making sure the quality is good. And that’s not my way of saying only Moderna or Pfizer can do it. I think lots of companies can. But we’ve got to be careful that we don’t end up messing up the really high quality of these vaccines, that are so important to keeping people confident that the vaccines are going to be safe and effective. So,I think all of this is going to be looked at, but there are a set of challenges here that go beyond patent laws.
AMY GOODMAN: Dr. Ashish Jha, you’ve written an article, “It’s time to consider delaying the second dose of coronavirus vaccine.” It’s an op-ed that was in The Washington Post. So, on what science are you basing this? We all know that both Moderna and Pfizer — won’t be true with Johnson & Johnson, the one shot — it requires two shots. Why do you think you can get away with one shot? Usually people have a reaction to the second shot, which is, what, about a month later, which suggests that bolster shot is the one — the booster shot is the one that basically kicks up the reaction and the immunity.
DR. ASHISH JHA: Yeah. So, as the title says, it’s time to consider delaying the second shot, not forgoing the second shot. Everybody needs two shots. There is no doubt about that in my mind.
If you look at the data from the clinical trials, both for Moderna and Pfizer, it’s also very clear that one shot provides about 80 to 90% protection, at least until the second shot is given. And the question in front of us is: In a normal situation, would we even think about delaying a second shot? No, we would just give everybody their second shot on time. But the question that I and my colleague, Bob Wachter, who co-wrote this with me — what we did is we spoke to a large number of immunologists, vaccinologists, and asked the question: If we delay the second shot by a few weeks — let’s say instead of giving it at week four, we gave it at week six or week eight — what are the chances that the protection from the first shot would somehow wane dramatically after four weeks? Because, again, you do have that 80 to 90% protection after the first shot. Everybody agreed that that is extremely unlikely, that you could delay it by at least a few weeks.
And so, our idea was — we have a set of vaccines sitting on shelves. Let’s get them out into people’s arms. Let’s assume, because we’ve done the checking, that the production of the vaccines will continue to go well. And then, as the new vaccines come off the production line, get everybody their second shot. And let’s do this particularly for high-risk individuals, older people, people with chronic diseases. I would rather have all of those folks have their first shot. And most of them will get their second shot on time. And if a few end up getting a little bit delayed, in my mind, that is not a particularly risky thing based on the data and science.
But what we know, Amy, is that if we don’t do that, and if we don’t vaccinate more people, given the variant, the U.K. variant, that is circulating in the U.S., that I think has all of us extremely concerned, we are looking at another 100,000 Americans dead in the next four to six weeks, and we’re looking at things even getting worse after that. That’s the alternative. And so, in that context, this felt like it was both science-based and it would not put people at risk to delay things by a few weeks — definitely not forgo it, definitely not delay it by many months.
AMY GOODMAN: I’m trying to cram in so many questions, and I know you have to go in a minute, Dr. Jha. So, on Thursday, President Biden signed the executive order to form a COVID-19 Health Equity Task Force.
PRESIDENT JOE BIDEN: Today, I’m formalizing the Health Equity Task Force that we announced in the transition, led by the brilliant Dr. Marcella Nunez-Smith, who ensures that — is going to ensure that equality is at the core of every decision we make. That includes addressing vaccine hesitancy and building trust in communities, as well as fighting disinformation campaigns, that are already underway.
AMY GOODMAN: I don’t think people understood, Dr. Jha, that information on who was getting sick, who was dying the most, was actually not being kept for months. Is that right?
DR. ASHISH JHA: That’s absolutely right. So, when I started off earlier saying that one of the executive orders I’m most pleased about is just collecting better data, it took us months to figure out that this pandemic was disproportionately impacting communities of color, people of color. One could say you could have predicted it, given our known structural inequities in our society, but we didn’t know, and we didn’t see it until the data became clear much later.
I think what we’re going to see from the equity task force is far better systematic data collection, making sure that our policies on vaccinations and testing don’t leave behind people who are disproportionately being impacted. I’m very pleased to see this. And we’ll see where the equity task force goes. But there’s important work to do here to make sure that as we climb out of this pandemic —
AMY GOODMAN: And very quickly, because we’re almost a minute over.
DR. ASHISH JHA: — that we bring everybody along. Sorry, yeah.
AMY GOODMAN: Very quickly, are the variants going to lead to nonimmunity with these vaccines?
DR. ASHISH JHA: I think that’s pretty unlikely. I think, certainly, the U.K. variant looks like the vaccine is going to be effective. There is some questioning about that with the South Africa variant. But I remain very optimistic that the vaccines will be effective against the variants we have. But we’ve got to get people vaccinated, because we don’t want to keep pushing our luck and having more variants pop up. The best way to stop more variants is to get the pandemic under control.
AMY GOODMAN: Dr. Ashish Jha, thanks so much for being with us, dean of the Brown University School of Public Health, previously director of the Harvard University Global Health Institute.
This is Democracy Now! Speaking about health equity, when we come back, we’re going to North Dakota, to the Standing Rock Sioux Reservation, to talk about the decision the leaders made there to vaccinate the elders, who are the keepers of the language, so not only the elders don’t die, but that the languages don’t die with them. Stay with us.
AMY GOODMAN: That’s nurse Lori Marie Key of Livonia, Michigan, singing “Amazing Grace” Tuesday night during the COVID national memorial at the reflecting pool. She sings in her hospital, and so the president, Biden, asked her to come and sing for the country.