CDC Director Rochelle Walensky Talks Boosters, Masks and Health Equity

Dr. Rochelle Walens ky

[ Music ]

Female : Welcome to Conversations o n Health C are with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation, health policy, care delivery and the great minds
who are shaping the health care of the future. This week m ark and
Margaret speak Dr. Rochelle Walensky D irector of the Centers for
Disease Control and Prevention. She talks about vaccine progress,
confusion around new mask guidelines for vaccinated Americans , h ow
the CDC is reorganizing to bett er respond to future pandemics and
addressing health inequities across the country.

F act C heck.org ’s Managing Editor L ori Robertson joins us looking at
misstatements spoken about health policy in the public domain
separating the fake from the facts. W e end with a bright idea that's
improving health and well being in everyday lives. If you have
comments, please email us at [email protected] o r find us on
Facebook, Twitter, or wh erever you listen to podcasts. Y ou can al so
hear us by asking Alexa to play the program. Now stay tuned for our
interview with CDC Director Dr. Rochelle Walensky h ere on
C onversations on H ealth C are.

Mark Masselli: We’re s peaking today with Dr. Rochelle Walensky , Director of the
Center for Diseas e Control and Prevention. She was C hief of the
D ivision of Infectious Disease at Massachusetts General Hospital and
P rofessor of M edicine at Harvard Medical School.

Margaret Flinter: Dr. W alensky is a past chair of the Office of AIDS R esearch Advisory
Coun cil at the National Institutes of Health. Previously, she served as
an adviser to both the World Health Organization and the J oint United
Nations P rogram on HIV / AIDS. Dr. Walensky , we welcome you to
C onversations on H ealth C are today.

Dr. Walensky: Thank y ou so much. Thanks for having me.

Mark Masselli: Yeah, it was great. W hen I when I think about wearing masks, I think
about safety. W hen I come out of my house, I put my mask on . I f I go
into a public setting, I'm wearing my mask . I can I guess understand
why there's a little consternation in the country when all of a sudden my cheese got moved in terms of what I think mask wearing was all about for so many people . I’m wonder if you could just share with our
listeners just a high overview of what the new CD C policy is. T hen talk
a little maybe about the science behind it. You got a lot of feedback ,
I'm wondering if you've heard anything that was constructive, where you thought a point well made.

Dr. Walensky: Thank you for that. Y es, things changed on Thursd ay a nd I will -- let's
just acknowledge where we are 16 months later into this pandemic. All of those things that we have been telling you to do, we're now

Dr. Rochelle Walens ky

telling you it's okay not to do , and change is hard especially since
we've been so locked down for s uch a long period of time. M aybe
what I will say is that the new guidance that we've put out is for fully
vaccinated people. T he guidance reads that if you are fully vaccinated,
it is safe to take off your mask in essentially all settings. Certainly ,
there are some carve outs not during travel , not during in healthcare
settings, not in correctional facilities. But for the most part in all
general public settings i t's safe for an individual who's fully vaccinated
to take off their mask. We also want to be su re that everyone knows
that if you're immunocompromised for any reason, you should
consult your doctor before taking off your mask.

How d o we get here? T here were several big things that were really
moving us , one is our case r ates are really quite a bit d own , they’re
down out just over the last two weeks by 30%. The rates we haven't
seen really since last spring , over a year ago . Two is vaccine is
available for everyone now . 90% of Americans live within five miles of
a shot , a nd there is enough vaccines su ch that if you want it you
should be able to have access to it. T hose are two things that are
going on outside the science.

What's happening within the science was several studies , just even
o ver the last two to three weeks, an d they were -- they kind of b ucket
into three different areas. One is what I call the real world
effectiveness studies, the studies that said that the vaccine is working
in the real world just like it did in the clinical trials . T he effectiveness is
somewhere between 90 to 95 t o 97%. T w o is that the vaccines are
actually working against the variants that we have here in the United
States , a nd th ere was just recent data about that. T hen three is data
that was not examined in the clinical trials , a nd the question was if
you're vaccinat ed c an you asymptomatically get infection and
potentially give it to somebody else ? An emerging data has really
demonstrated that that doesn't happen either. At the coalescence of
all of this new science and the intersection of cases coming down and
vaccines being available , w e really thought now is the time to release
that guy s .

Mark Masselli: Great.

Margaret Flinter: Well, I thought there are some very good news in that , a nd I
appreciate that we get to sit in the studio fully vaccinated and not
wearing a ma sk, which we did not do for the entire year of the
pandemic. But yeah I want to focus maybe a little bit on the kids. I'll
start by saying in January and February I had never met so many
people over the age of 100 in my life as we did at our mass vaccine
c linics, when we first rolled it out a nd they were an incredibly
appreciative group of people to get the vaccine . W e marched down
the timeline, the 80 plus peo ple down to the 50s and beyond, and

Dr. Rochelle Walens ky

n ow we arrive at our young people. W e know that children accou nt
for about 22% of new COVID cases in the United States. While many
have mild illness, we certainly know there are also some very severe
cases.

We're wondering what your messages to the parents of which the
surveys show maybe only about 30% of parents pla n to vaccinate
their 12 and up children right now. We’re hearing from our frontline
teams that sometimes those kids are bringing in their parents saying
g et me vaccinated , I never want to be in quarantine again. But what's
your message to parent and educat ors about the risk to children of
COVID, the benefit of the vaccine and what they can expect in the
coming months in terms of kids being able to go back to what we
hope is a normal life ?

Dr. Walensky: F irst, I think let's celebrate yet another moment last week, which is
that we have the authorization and recommendation to give the
Pfizer vaccine to 12 to 15 year olds . T his is the first vaccine that's
available to kids lower than age of 16 , a nd now all the way down to
12.

Our data have shown that, you know p eople haven't necessarily
wanted to be first, but they a re really willing and confidence increases
over time. I think that we'll see that again here. I can tell you, I have a
16 year old who was vaccinated as soon as it was available to him. I
was encourag ing that , and I think you're exactly right, I have received
so many pictures from text of these high school stadiums filled with
like really excited kids to get back a n d vaccinated. As you know when
we've had more and more people who were vaccinated who ar e
older, our cases are now concentrating in our younger populations.

We do know that our teens tend to act from a transmission
standpoint, like our 20 year olds or older adults so that we know that
they can actually transmit . W hat we really want us to allo w them to
get back to their lives , when we think about what the toll has been for
them with schools with real milestones that have lost -- many have
lost graduations . I have one myself who've lost a graduation. I think
they are really enthusiastic about get ting vaccinated .

O ur clinical trial that they did in these te en s demonstrated it was
100% effective and no different safety signals. W e had -- certainly
they may have the sore arm that we all got, and they may have a little
bit of aches and feel fever ish o r headaches the day or so after. But for
the most part, the symptoms are exactly the same as the adults. M y
message is let's give our kids their lives back and get them vaccinated.

Mark Masselli: M y youngest graduated from high school this last weekend, an d it
was a wonderful event. You know I want to go back and pull the
thread on your comment earlier about the clinical trials and try to

Dr. Rochelle Walens ky

figure out those trials told us , I forget when , in November that the
vaccines were safe and effective for us to start ta king. Tell us a little
more about those clinical trials because they're still going on , a nd they
have some important information they were going to be able to tell us
somewhere along the line .

I think they're at least saying now publicly, the vaccine i s go od for six
months, it may be good for much longer. But science really likes to go
back and look at those clinical trials. What are we learning from
them? I don't ever sense not that people are hiding it, but a sense of
transparency, but they will be a harb inger for what might happen in
terms of things like a booster, or whether or not there is a an annual -
- as many people have to get for influenza , an annual shot . W hen will
we hear word about what's happening there ?

Dr. Walensky: T he clinical trials provid ed us information with two months of safety
data which allowed us to have the authorization . W hat we're really
now looking at is six months of data, which will allow us to have
approval that Pfizer has just put forward , and so we don't expect any
signals t here at all. We're certainly going to f ollow, we’ll see what
they say . B ut I don't imagine that they would have put forward with
the approval if there wasn't just good news to share.

Certainly some of the people who participated in the trial received
place bo, perhaps have opted to get the vaccine in the interim. W e
may have lost some of our power in that situation in terms of long
term two year follow - up , but we are looking at the two year follow up
and those trials will go on and look at follow - up up to t w o years.
T hey're continuing to do their work. I think that there isn't really news
to share with regard to them, which is why you haven't heard a whole
lot.

Y our point is , well , taken with regard to boosters, though , s o among
the things that we're looking at, not just in the trial, but really in the
real world studies as well is what happens to our immunity , doesn't
wane over time ? I want to be very clear to people, when we talk
about boosters, that doesn't mean you're not protected now, t he
question -- and because that has caused some confusion . T he
question is not do we need a third today ? Y ou are -- if you get your
two doses, you're protected now . W hat we want to see is if in a year
from now you will continue to be protected. W e're looking at those
data n ot just in the trial, but in clinical studies as well.

Where we're worried most about that to start is among the
population that got vaccinated first, of course, and that's our long
term care facilities where people might not have had a robust
immune respo nse to start . W e really want to make sure that they're
going to maintain protection.

Dr. Rochelle Walens ky

Margaret Flinter: Well, Dr. Walensky we appreciated your recent statement , a nd it
really echoes out t o so many great leaders around the country that
racism is a threat to public health in this country, and it has been for a
very long time. But we've zeroed in on it this year with the
unmistakable reality in front of us of what we saw. The Biden
administration, the American recovery plan has many provisions that
are focused on addressing inequity in health care . W e've really been
intrigued by this rebuilding of the public health workforce and
infrastructure , and in some new ways i n this country of -- I noted the
public health Ameri Corps, AmeriCorps being a program we've
champ ioned for many years, community health workers, also public
health specialists from your perch, leading CDC . H ow are you going to
use these resources in this kind of new and revitalized workforce to
address racism as a public health issue in this country, and to really
help us move much closer to health equity ?

Dr. Walensky: Well, we had big news on masking last week, we had extraordinary
news on investments about on our future , a nd that's really what I'm
super excited about how are we going to take our $7 billion and
strengthen the public health system that we have , a system that has
lost over 50,000 jobs just in the last decade. W hat I think is really
important as we do so is not just investing in new people , B ut in
training people in a diversity of discip lines from genomic
epidemiology to contact tracing and all across the spectrum.

One of the things that's critically important to me as we do this is to
make sure our workforce looks like the people they serve, and really
ensure that we have the diversity i n that workforce, be it urban or
rural, African - American or Hispanic , a nd to make sure at all areas of
the workforce we're training people that look like the people that
they serve, because those are actually how we make those contacts
those trusted messen gers. I feel very strongly as an infectious disease
doc , as a person who trained during in taking care of patients with HIV
and AIDS. We knew and have known all along that there have been
extraordinary disparities in health . W e're taking this moment in
COV ID where we've seen it yet again, and to call it now totally
inexcusable, and to take these new investments moving forward and
to make sure that we invest a n d make sure that people understand
this is about where they work and how they traveled to work and
where they play and where they pray. T o make sure we have
investments in those areas to ensure health everywhere.

Mark Masselli: We’ re speaking today with Dr. Rochelle Walensky , Director of the
Center for Dis ease Control and Prevention. I want to connect t he dots
between our conversation about boosters and the public health
system , a nd thinking a little bit about the hubs that we all created.
Here in Connecticut, our health center was asked by the governor to
set up for large mass vaccination sites . T his up coming week w e’ ll have

Dr. Rochelle Walens ky

delivered our 500,000 dose of the vaccine , a nd those hubs were really
important for everyone in our in our state. But we've also developed
lots of spokes that are out in the community. They're at the immigrant
center. They're at the food pantry . T hey're really in the
neighborhoods .

B ut I'm worried a little bit about the states now seem to be saying
maybe the mass vax, the h ub s their work is completed , certainly we're
seeing we're on this side of the bell curve. Our own numbers show
th at if something goes wrong our lesson learned on this whole thing is
we didn't have a distribution system in place. I think the Biden
A dministration got the pharmacies started to recruit pediatricians has
done all that. But I'm thinking hope for the best a nd fear for the
worst , h ow will we be prepared for that large distribution, God forbid
we need it to stand those up again, if we're taking them d own. What's
your sense as you think about the infrastructure over the 50 states
a n d the territories of how we c an make sure that this never happens
again that we're caught short?

Dr. Walensky: Yeah , s o that's a great question. I have a few responses to that. One is
we never had a vaccine distribution plan for adults, we have a vaccine
distribution plan for children , but we never had one for adults. In fact,
our flu vaccination rates, which are somewhere around 40 to 60%
e very season, probably demonstrate that right, we should be far
higher than that. N ow, we very well may be, we have one for children
that works pret ty well , s o maybe now is the time to capitalize on this
moment and say we're going to need a vaccination plan for adults.

One of the things I feel really strongly about, and one of the silver
linings of this is we've made those inroads, we've created those hubs
we've created those spokes, we've created this network of trusted
people , a nd I really feel like we need to not just keep it for boosters,
but to keep it for hypertension control, and to keep it for where 11
million childhood vaccinations behind. W e need to keep it to make
sure we get those children caught up on their measles vaccinations
and to do all of the other stuff that we should be doing in the
community. Why are we not doing diabetes training in the community
at the food pantry that just deliv ered your company vaccine?

W e've made some of these networks, we've created a system of
people who are willing and wanting to engage , willing and wanting to
help , reaching people where they are . W e've done that now , let's
solidify it and make sure that we actually can engage in that for all
other areas of health.

Margaret Flinter: Well, I'm really glad you addressed all that other stuff, because that's
exactly where I wanted to go next. H ere you have this amazing
organization, the CDC, and if we can take ou r eye not off of COVID,
but maybe at least broaden our gaze f or a moment . O pioid crisis

Dr. Rochelle Walens ky

didn't go away w hile this was going on, people continue to die all over
the United States from opioid addiction and overdose. Certainly, the
issues that we see with obe sity, the climbing rates of diabetes,
continued , concerns with HIV / AIDS, we don't need to make the whole
long list. But as you come into this position, I know you've been there
for a little while now . W hat's your picture for CDC ’ s role and its vision
even beyond the COVID pandemic, which will end at some point to
really address these enormous public health issues of consequence in
the country, what's the game plan or the vision for CDC going
forward?

Dr. Walensky: The big goal, right ? M aybe I'll break it do wn to several , and one is the
public health infrastructure of the country , a nd that's $7.4 billion
we've talked about before . B ut I do think we need to invest in
workforce , we need to invest in laboratory structure, and we need to
invest in data mo dernizat ion across this country. That doesn't
necessarily feel like we're disease specific , b ut I do think that if we
have a more established public health workforce, if we can report labs
and really understand where issues are happening, if they can
integrate, an d we really can see them at the local level, we will be
better off and better serving our communities to know where we
need to target intervention. B ig public health infrastructure that
needs to happen with data mo dernization.

Two is his health equity, we' ve also talked about that. But layered on
top of the public health infrastructure, we really take an intentional
view of all the work that we're doing within equity lens. I have
challenged my own organization to do this , I said, p lease do not
document the problem anymore , y ou can document it, but now is the
time to test in terventions to see if they work. S ome will and some
won't a nd we can't be afraid to fail. Let's fail fast and learn what we
have and move on to another intervention that might work , becaus e I
just -- I don't want year after year for us to just say we hav ing more of
a problem. W e do need to do a lot of work in health equity.

T hen, new ways, numerous issues I could list many more. Certainly we
have to do something about mental health and opio ids in this
country. It was bad before the pandemic , it got worse during the
pandemic , and we have young people old people dying of mental
health disease and of opi oid overdose and then of opioid, collateral
damage of opioids infections and whatnot. O pioid s a n d mental
health, maternal mortality, one of the highest rates of maternal
mortality around the world affects African Americans and Asia Pacific
communities almost two fold more than anywhere else.

There are many, many -- and the AIDS/ HIV epidemic which had such
momentum and then kind of lost the momentum over the last year ,
so lots of different areas there. I do hope that the public health

Dr. Rochelle Walens ky

infrastructure, the investment in equity will raise so many of these, I
worry a lot about community violence, domes tic violence, gun injury
prevention, s o lots of different areas that we're hoping -- that we're
hoping to focus on when we can take a little bit of our eye off of the
pandemic a nd even while we have our eye on the pandemic.

Mark Masselli: W ell, let me just get one last question and we're doing so well, the
Biden administration, your leadership on thinking about the country,
but America is one of the most consequential nations in the world.
W e look around , we see in our TV how the pandemic is sweeping over
I ndia, causing so much tragedy and hardship. It was good to see that
the President had announced that , I think , it was 60 million additional
doses were going but it's a large planet with lots of needs. What's our
role? We had Dr. Van K erkhove, from WHO on l ast week, and she was
really talking about building this partnership, this global partnership .
W hat's the role that CDC is going to play and the advocacy and it's so
difficult sometimes, because certainly our country is interested in
making sure all of our citizens are vaccinated. But we play such an
important role globally. How do you envision the CDC in terms of its
global responsibility?

Dr. Walensky: T his is critically important, I think, from both a humanitarian
perspective, but also because I think it 's been said, no one is safe until
everyone is safe , r ight? I think if you look at what has plagued our
country over the last 10 years, between H 1 N1, Zika, Ebola and COVID -
19, none of them started here. W e really do have a critical key role to
play. R eally in COVID - 19 as well, our vaccines will only work if we
don't have circulating virus in other places that create variants
[ Inaudible 00:22:06 ]. M uch of CDC ’ s work is really been in
partnership .

W e have collaborations in 60 countries. W hile there was Ebola
happening in Guinea and DRC, we had people on the ground there
because we have a long standing relationships there. When India was
calling and saying we were following and seeing that they were having
challenges. We have a 20 year old country office in Ind ia, and we were
able to provide technical support and oxygen to get there and PP E
and how do you roll out vaccines and vaccine safety data collection,
and all that sort of support , so that's much of what CDC role has been
is the technical support on the gr ound . T he deployment of people into
Brazil, we have two teams in Brazil, to be able to provide that on the
ground support with lessons that we have learned here in the United
States.

Margaret Flinter: Great. We 've been speaking today with Dr. Rochelle Wale nsky ,
D irector of the Centers for Disease Control and Prevention. You can
learn more about this agency's vitally important work by going to
cdc.gov and follow her on Twitter @ CDC D irector . Dr. W alensky t hank

Dr. Rochelle Walens ky

you so much for your career long contribution to health to infectious
disease, for lending your sensitivity to the needs of vulnerable
populations, for leading the CDC and for joining us today on
C onversations on H ealth C are.

Dr. Walensky: Thank you so much, and thank you for all the work you all do.

[MU SIC]

Mark Masselli: At C onversations on Health Care we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy . Lori R obertson is an award winning journalist and managing
editor of F act C heck .org a nonpartisa n, nonprofit consumer advocate
for voters that aim to reduce the level of deception in US politics. L ori ,
what have you got for us this week?

Lori Robertson: L et's take a look at the COVID - 19 variants and vaccination. So far
COVID - 19 vaccines have been ef fective against variants of the
Coronavirus. Scientists are monitoring the situation carefully with
updated or new vaccines of possibility in the future if need be. The
fact that variants of the original SARS - CoV - 2 virus have emerged is not
surprising. Vir uses mutate randomly as they replicate and make errors
as the genome is copied again and again.

A variant is a distinct virus, typically with several mutations. Most
mutations don't change the viruses ’ biology or how the body's
immune system responds. But sometimes mutations can result in an
advantage for the virus and its ability to replicate or transmit for
instance, or in how effectively immunity from a previous infection or a
vaccine is able to fight the virus. The good news is that so far the
authorize d vaccines in the US have been largely effective against the
variants that have most concerned scientists.

The Centers for Disease Control and Prevention is using three
classifications for variants. There are five variants of concern , t hat's
the CDCs middl e level four variants for which there is evidence of
increased transmissibility, more severe disease, or reduced
effectiveness of treatment or vaccines. There are no variants in the
CDC ’s top classification level of variant of high consequence . W hile
the a uthorized COVID - 19 vaccines in the United States were designed
to protect against the original SARS - CoV - 2 virus, that's not the virus
the vaccines ultimately have confronted , s till they worked extremely
well as shown in the clinical trials. R eal world stud ies have shown they
continue to work well against those variants of concern.

I n Qatar, researchers used national databases on vaccinations, testing
and clinical characteristics to estimate the Pfizer vaccine effectiveness
against any infection of the B117 variant at 89.5%. That's the variant

Dr. Rochelle Walens ky

that first emerged in the United Kingdom and is the most common
variant in the US a ccording to the CDC. E ffectiveness against any
infection of the B1351 variant, first identified in South Africa was 75%.
But effectivene ss against severe critical or fatal disease from any
variant was an estimated 97.4%.

The Johnson & Johnson vaccines clinical trial data also gives an
indication of its effectiveness against variants of concern since it
included study sites in South Africa and Brazil where such variants
were identified . While the vaccine ’ s efficacy in preventing moderate
to severe disease was lower in those countries than in the United
States , i n the trial the effectiveness against severe or critical COVID - 19
was more than 8 0% in all three locations. T hat's my fat check for this
week. I'm L ori Robertson, Managing Editor of F act C heck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenber g Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, email us at C HCR adio .com we'll have F act C heck.org ’s
Lori Robertso n , check it out for you here on C onversations on H ealth
C are.

[MUSIC]

Margaret Flinter: E ach week C onversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Louisville,
Kentucky has consistently been on a top 20 List of US cities you don't
want to live in if you have a lung disorder . S urroun ded by the nation's
leading rubber manufacturing entities and nestled in the Ohio River
Valley , t his is a city that has grappled with pollution. Several years
ago, the city's newly hired chief of innovation made a decision to
tackle the issue.

Ted Smith: I wondered if there was something we might be able to do new and
different. Maybe the risk i s concentrated in certain place, a nd if we
knew where the risk was concentrated, if that were true, maybe there
would be something we could do about it.

Margaret Fli nter: T hrough his work in public health research , Ted Smith had learned of
a tech enabled smart inhaler that when synced to a person's phone,
acted like a GPS for whenever that person needed to use their rescue
inhalers .

Ted Smith: It’s e ssentially to put a GPS transponder on top of your inhaled
medication so that when you took a puff of your medication, it would
take a snapshot of what time it was and where you were. T hat kind of
real time monitoring of asthma events, especially those rescue inhaler
attack s, is really high value signal, and you're capturing it in real time.

Margaret Flinter: Smith dubbed the program A ir Louisville and tracked 1100

Dr. Rochelle Walens ky

participants over the course of a year. He said they were able to chart
environmental triggers in any given are a where an asthma attack
occurred, and chart real time data on the conditions and the location,
giving them some great public health epidemiology data.

Ted Smith: We ended up with a very high spatial resolution map of the burden of
asthma in Louisville, Ke ntucky, and then that led us to explore where
those little micro areas are that are problematic and what we might
be able to do about it.

Margaret Flinter: More importantly, the smart inhalers gave users a feedback loop of
information which allowed them to better manage their exposure to
known asthma triggers.

Ted Smith: One part of the use of the technology is the surveillance , but another
part of the technology is the feedback loop to the user who learns
how poorly controlled or not their asthma is , or ho w adherent they
are with the medication they're supposed to be taking daily. T here is
an immediate effect , people end up getting better control of their
respiratory disease

Margaret Flinter: R eliance on emergency inhalers dropped 78% among participants ,
an d the city was now armed with data that could help them devise
pollution mitigation strategies .

Ted Smith: W ith the harder problem that I think the rest of the country has,
which is our ambient air quality standards are still not low enough ,
and people are exposed to levels of pollution that we are going to
have to work hard to figure out how to remove .

Margaret Flinter: A tech enabled smart inhaler that gathers meaningful data that
informs public health officials how they might reduce the burden of
asthma health cost while teaching asthma sufferers to better control
their disease and stay healthier. Now, that's a bright idea.

[ Music ]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret F linter.

Mark Masselli: Peace and Health .

[Music]

Female : Conversations on Health Care is recorded at WESU at Wesleyan
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Dr. Rochelle Walens ky
Health Center .