Dr. Michael Osterholm Says Variants Will Cause More Havoc

Dr. Michael Osterholm - 20210315Oster holmXM

[Music]
Female : Welcome to Conversations on Health Care with Mark Masselli
and Margaret Flinter, a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery, global health, and the great minds who are shaping
the hea lthcare of the future.

This week, M ark and Margaret speak with Dr. Michael
Osterholm , renowned infectious disease expert, and Director
of the Center for Infectious Disease Research and Policy at the
University of Minnesota . Author of the 2017 book The
Dead liest Enemy : Our War with Killer Germs . Dr. Osterholm is
among the team advising President Biden's transition on
COVID - 19 strategies. He warns that we're in the eye of the
hurricane. The pandemic is far from over and more infectious
variants are driving th e next surge a pandemic .

Lori Robertson also checks in, Managing Editor of
FactCheck.org, looks at misstatements spoken about health
policy in the public domain, separating the fake from the facts.
We end with a bright idea that ’ s improving health and well
being in everyday lives.

If you have comments, pleas e email us at [email protected]
or find us on Facebook, Twitter, or wherever you listen to
podcast. You can also hear us by asking Alexa to play the
program. Now stay tuned for our interview with Dr. Michael
Osterholm here on Conversations on Health Care.

Mark Masselli: We're speaking today with Dr. Michael Osterholm , Director of
the Center for Infectious Disease Research and Policy at the
University of Minnesota , a renowned epidemiologist . Dr.
Osterholm recently served on President Biden's Transition
Committee on COVID - 19. Dr. Osterholm has also served as
interim CDC director and advisor to Homeland Security and
the National Institutes of Health.

Margaret Flinter: Dr. Osterholm is a Member of the National Academy of
Medicine. He's the author of more than 300 publications,
including the 2017 book, The Deadliest Enemy : Our War with
Killer Germs , in which he outlined the exact s cenario we are in
with COVID - 19. Dr. Ost erholm , we want to thank you and
welcome you back to Conversations on Health Care .

Dr. Michael Osterholm : Well, thank you for having me back.

Mark Masselli: That's great. I wanted to start off with asking you to give our
audience a sort of a big picture vi ew . W hat's , first of all ,
positive about what we're doing in our battle with the

Dr. Michael Osterholm - 20210315Oster holmXM

pandemic , a nd what keeps you up at night?

Dr. Michael Osterholm : Well, first of all, I think you have to start out by saying it's a
tale of two cities right now . One tale is t hat of the vaccines and
the rollout of the vaccines here in the United States. It has
been a remarkable accomplishment to date by the
administration in terms of helping the private sector
companies actually get vaccine, get it out to the state and local
ar eas, and trying to get into people's arms. To date, we've had
somewhere right around about 10 % to 12% of the population
vaccinated with two doses, or one if it's the Johnson &
Johnson vaccine, which is a great , great start. But it still leaves
a number of people left unprotected at this very moment,
including about 20 million Americans 65 years of age and
older. W e've got a lot of work to do. The problem is we just
don't have enough vaccine and they're putting it out as quickly
as they can.

The other tale i s one where we're very concerned that we're
now beginning to see the emergence in the United States of
this variant from originally identified in the United Kingdom,
BB17 or the UK variant. This particular one is a virus that fits
two of the three categori es we call a variant of concern, more
transmissible , causes more serious illness, or can evade the
immune protection of the vaccines or natural disease. Today it
is doing the first two.

In Europe, this has been a real challenge. Number of countries
in Euro pe are in various states of lockdown and including
major lockdown activities for the last two months in England.
We're now seeing in particularly the eastern countries of
Europe, and even continuing in Portugal, Spain and France
have real challenges. That virus is about 40 % to 60% more
transmissible than we've seen with the previous SARS - CoV - 2
virus as a cause COVID - 19. Clearly , we're accumulating more
data every day showing us a much more serious virus in terms
of illness, and the kind of illnesses it caus es.

Now that we see a very rapid development here in this
country of the B117 variant in our various states, and right
here in Minnesota, we have an outbreak going on right now
with widespread transmission in kids that is now spilling over
into adult. We w orry that the next 4 to 12 weeks could be a
real challenge with a surge that will surely far exceed what our
vaccine w ill be able to protect us with.

Margaret Flinter: Well, Dr. Osterholm , thanks so much for starting with som e
great news that people have b een really eager to hear about
how we're doing as a country with the vaccine rollout and

Dr. Michael Osterholm - 20210315Oster holmXM

then of course, following it up with the reality . I t kind of
juxtaposes with a number of states really lightening up , right,
light e ning up mask requirements, lightenin g up on the
restrictions , and gathering just as we move into the nice warm
weather, at least on the East Coast, we hope , where people
are starting to plan more social activities, all of which seems
like a recipe for a surge in the United States.

I'm wonder ing what you're thinking is likely to happen over
these next 90 days or so with the reemergence of spikes.
We've just gotten some good news over these last several
weeks. But this sounds extremely worrisome , and I think the
public on some level, we've all wanted to go with the good
news for a bit about the rollout of the vaccine being
successful. But this sounds like a cause for real concern about
people continuing with the masks and the restrictions. What's
the balance there do you think with the public?

D r. Michael Osterholm : Well, let me just add some perspective first . Again , if you want
to find out what is likely to happen here in the United States,
just look at Europe. Today, Germany just put in place a new
major lockdown just because of the challenges there , and I can
go through country by country . W here this B117 variant has
taken off , the case numbers have surged substantially.

Remember, in the United States, even with everyone who has
been previously infected, and with even the amount of vaccine
we' ve rolled out, we still have roughly 50 % to 55% of the
population unprotected. F or all the pain, suffering deaths and
cases we've had in the past year, we still have at least an equal
amount, if not more of people who are still vulnerable to this
virus , s o we have to take it very seriously.

The second thing is, is you hit it right on the head with regar d
to we're done with the virus. As a society, we're done . We
want to move on . I understand that . T he pain, the suffering,
the economic disruption, what i t’ s done to our lives has been
dramatic. But unfortunately, this virus is like gravity, you might
not like it, but you can't ignore it. One of the challenges we
have right now is everybody is opening up because of how the
numbers have dropped , and this has bee n a great , great
outcome since January we've seen this big drop in cases. But
we're still at 60,000 plus cases a day and any surge that would
take off would take off on top of that.

Remember, last summer, when we had a house on fire , a
period in the summer months, we were at 70,000 cases a day ,
and now here we are almost at same level. T he real worry we
have is as in loosening up, this is like the perfect storm, we are

Dr. Michael Osterholm - 20210315Oster holmXM

all but inviting this virus to take over and do what it can do. I
think that -- I worry t hat we're going to see over the course of
the next weeks, even despite vaccine and by the way, the
vaccine is effective against the strain. I t's not somehow that
we have to worry about the vaccine not protecting with this
particular variant. But I also wor ry that people are going to get
within days to weeks of getting their dose of vaccine, but
unfortunately die beforehand, because they didn't just take
that last few weeks of care to keep themselves from getting
infected.

Mark Masselli: You know when I pull the thread in your statement, this
particular variant , and we've had one year since the inception
of CoV - 2 , and we have these two variants that have come up
that seem to be somewhat highly transmissible maybe
Virulent and B117, B1351. Educate us a little more , most of the
world won't be vaccinated, I assume this is a place where
more variants will arise. What are our worries? These are
what's in front of us right now , w e took a year . We've got a
number of years before we can get the world vaccinated.
What should we know about th ese mutations that go on with
CoV - 2 and what we might see in the future?

Dr. Michael Osterholm : Well, it just as you mentioned, the v ariant 1351 is actually a
variant that was first identified in South Africa. This one looks
to be re ally falling in largely that third bucket of variants of
concern I mentioned , the ability to evade immune protection
from either a vaccine or from natural infection , and it's not
100% evasion, meaning that there still is some protection,
particularly again st reducing severe disease, hospitalizations
and deaths.

But there's also another variant P1 , which originated in Brazil,
which we're seeing right now wreak havoc in Brazil . It was one
that has not only minimize d substantially the protection from
previous vaccination or previous infection, but also appears to
have both increased transmissibility and causing serious
illness. P1 is something we're very concerned about, should it
become c irculating around the world. Right now we see P1 in
the United States, bu t in a very limited way. Clearly , B117 is
the variant that is spreading rapidly right now in some areas
over 50% of the [inaudible 00:09:53] for that .

But I think a point that you raise is a very critical point. In fact,
I covered it just last week in an a rticle I published in foreign
affairs on vaccine nationalism, and this idea that yes the world
can't make enough vaccine for everybody overnight. But we
have to readjust the prioritization that we've placed on getting

Dr. Michael Osterholm - 20210315Oster holmXM

vaccine to low and middle income count ries. Originally COVAX ,
that organization under the auspices of the WHO , with a
number of other philanthropic organizations CEPI , the GAVI
group, all part of this, were aiming at getting 20% of the low
and middle income countries vaccinated in the next yea r,
meaning getting that much vaccine out.

Well, it turns out that these variants, the ones that are now a
real challenge to us in terms of what they can do to vaccine,
for example, are likely to come spinning out of uncontrolled
transmission in low and mid dle income countries . We don't
have a couple of years to wait to get people vaccinated in
those countries so that we don't see our own vaccines in the
high income countries challenged by these variants that would
spin out from natural infection. T his is a huge issue , and
there's no easy solution because we just don't have global
capacity to make a vaccine for everyone right now , and even if
we did, would everyone take a vaccine ?

But the bottom line is, is that we've gone from just
humanitarian aid altruism in the low and middle income
countries to a strategic investment. We don't want to see the
vaccines threatened by these variants . I f we're going to do
that, then we've got to really take care of low and middle
income countries.

Margaret Flinter: Well, Dr. Osterholm , I really appreciate the urgency with which
you speak about that. Again , looking at some of the positives
we've now had the Pfizer and the Moderna out for a couple of
months, maybe three months now, in pretty wide use the
safety data is wonderful to see . I believe, to this day, we still
have not seen a death from vaccine, correct me if I'm wrong
on that . We've seen very good efficacy in terms of fearing to
give real protection against serious illness and death . W e've
seen great increase in capacit y to get the vaccines out, while
we're still working on making sure that we target all
populations and address equity right here in the United States.
Yet , still, we have the issue of vaccine hesitancy.

I'm curious what you're seeing in a big picture view . H as the
safety profile of the vaccines and the reports caught up with
people who have ha d issues with vaccine hesitancy? Are you
seeing that kind of go down at the same time that the
availability of vaccines , again, at least here in the United States
is g oing up if we conquered that challenge?

Dr. Michael Osterholm : Well, again, let me just say the vaccine situation in the United
States, and in much of the high income countries of the world
is good news, these are highly effective vaccines that are

Dr. Michael Osterholm - 20210315Oster holmXM

working well, just as you pointed out, the safety profiles are
remarkable. The challenge we have right now is getting
enough vaccine quick enough to enough locations , and again,
it's all comes back to just global production. E ven here in the
United States, we may have enough vaccine for every adult by
sometime in May to June . T he challenge will be even then
getting in people's arms. As you pointed out, vacc ine hesitancy
has been real.

Now , we have some information suggesting that maybe been
reduced a bit that more people are now willing to consider
taking it. At the same time , when we look at the BIPOC
community, we look at certain -- people of certain political
persuasions that are much , much more reluctant to even
consider the vaccine for a variety of different r easons. We
even see in healthcare settings up to a third of healthcare
workers wanting more safety data before they'll be
vaccinated , and so w e have a lot more work to do .

As I’ve shared with you before, when you name this O peration
Warp Speed in part was run by the military , you also had a
situation where some people believe it was a political thumb
on the scale to get it approved, which wasn't the case, but
some people believe that. T hen on top of that, you have these
new messenger RNA vaccines injecting genetic material into
you which then plays into all the fears and concerns about
what that will do to my own health , is this someone wanting
to put a chip inside of me , all disinformation, not true at all ,
but nonetheless, it's there.

We have to do a much , much better job of trying to educate
the public , share with them what we know , what we don't
know about these vaccines . The fact that mRNA vaccines have
been researched for many, many years , t his is not just a first
time use of such . The fact that the imm une response is very
good and we're not seeing challenges such as to pregnancy or
that this will cause someone to become fertile or infertile,
which has been a challenge on the internet.

W e have a lot of work to do, but we're , I think at this point ,
moving forward . A gain, I just come back to the fact we got to
get as many people vaccinated in the high income countries.
But we cannot forget for a moment about low and middle
income country individuals.

Mark Masselli: We're speaking today with Dr. Michael Oste rholm , Director of
the Center for Infectious Disease Research and Policy at the
University of Minnesota. Dr. Osterholm recently served on the
team advising President Biden and COVID - 19.

Dr. Michael Osterholm - 20210315Oster holmXM

I want to continue the conversation about equity issues and
your vacci ne nationalism. As more and more people get
vaccinated, desire to open up businesses and return to normal
grows . I think we're bound to encounter many ideas about
how to open things up safely, including giving special
preferences perhaps to people who've b een vaccinated, and
these ideas are bound to be well meaning but they will,
perhaps , have detrimental consequences.

The idea of putting rules into place to minimize risk is not new
in the not so distant past neighborhoods that were deemed to
have higher fi nancial risk were redlined. In many were
communities of color . S hould we be worried that we might be
running into similar issues if we are redlining people who've
not been vaccinated, and really in a good attempt to try to
open the economy, past neighborho ods, perhaps with
countries as well?

Dr. Michael Osterholm : Well, first of all, it's very important that we don't discriminate
against people for any reasons relates to COVID - 19. But it's
also fair to look at risk , and we tell people now to avoid certain
e nvironmental areas with regard to risk , where i s the virus
more likely to be present ? It’s not as if we don't deal with risk .
I think the point we're trying to raise right now is just what is it
going to take to protect you .

If you are vaccinated, frankly, you're in a totally different
planet with regard to protection, versus almost any other
thing except total distancing from someone who then might
infect you. It’s not inappropriate to say, if you've been
vaccinated these are the things you can do now, and feel much
more secure in what you're doing and the safety of the vaccine
is there to protect you .

For example, as the CDC said if you’re a grandparents, you
want to go visit your grandchildren who you've not seen for a
year , and they're -- although they'r e not vaccinated, and if
they're not at high risk for getting infected, then go do it , go
see them, hug your grandkids. I think the point we're trying to
raise here is , is that what kind of incentives can we provide to
people who say, why did I get vaccina ted if I have to continue
to lead my life the way I have for the last year, when in fact,
the data do support that you're protected ? I agree with you
100% , w e don't want to redline any area or any individual. But
at the same time, if you know that certain individuals are going
to be at higher risk and you're trying to avoid that risk , then I
think that is fair to at least describe what that risk might be.

I f you have a large number of people who are not vaccinated,

Dr. Michael Osterholm - 20210315Oster holmXM

were going into bars, restaurants, no mas k s, you know what,
that's an environment, even if you're vaccinated, remember,
they're not 100% effec tive, you want to likely avoid. T he key
thing I think is going to be finding that it might -- I’ll call it a
sweet spot where people can feel good about bei ng
vaccinated, they can feel good about it being identified as
they're now protected , and at the same time, not trying to
discriminate against someone else , but I don't want to be put
at risk because of what someone else does.

Margaret Flinter: Dr. Osterho lm , I think I'm still stuck back in my mind thinking
about the global challenges , and you talked about it really
being a problem of worldwide production. But we've , Mark
and I have had the opportunity to be very engaged in setting
up mass vaccine clinics a nd targeted population, vaccine
clinics , and even on the end of delivering the vaccine , it's
pretty complicated resource intensive process as currently
exists, right , multiple dose files and drawing them up and
keeping the chain of refrigeration and so for th.

Do we have any hope on the horizon for innovations? We've
heard about things such as perhaps being able to use a patch
that has a kind of pinpric k administration of the vaccine, baby
being freed up with only single dose vaccines as we go
forward . Are y ou hopeful of any innovation in those areas that
will really make it much more possible to get that global
distribution of vaccine? What are you seeing on the delivery
end that will help the global community?

Dr. Michael Osterholm : Well, I think that's a c ritical , critical question. Some months
ago, I did a podcast entitled “ The Last Mile , The Last Inch . ” The
last mile was before the distribution of vaccine started , and I
laid out all the challenges that eventually we encountered with
just trying to get vac cine into the right communities. Didn't
speak to whe ther they got -- they took the vaccine or not. That
was the last inch . I think everything you just said is right on the
mark . W e have to look at every possible barrier that might be
there in terms of gett ing people vaccinated , and what can we
do to deal with that barrier, whether it is the kind of product
that we use , the requirements we have for how it has to be
refrigerated, how many doses, what are those potential side
effects, I can just get on the la u ndry list, those are all real.

I think our first challenge is getting more what we have . We've
got to get that and get that done , and that's going to be a big
impact issue. The second thing is we have to look at the
potential for new innovative vaccines th at may be what we call
the second or third generation vaccines that allow us to deal

Dr. Michael Osterholm - 20210315Oster holmXM

with these variants much more effectively rather than trying
to reconfigure an mRNA vaccine to now we accommodate this
mutation versus that mutation, we can be chasing our tail as
these new mutations continue to occur. Their vaccines, for
example, may rely more heavily on T cell responses that could
be nonspecific, and actually protect against any one of several
different mutations that might occur in the virus.

The third p riority is just what you said is for ease of production
and distribution, how do we do that so that we can make the
vaccines for the world that they will use, and I think that is a
high priority . Just no te , we're not going to be done with this
virus for a long, long, long, long time to come. E very
investment we make right now, in short term, intermediate
and long term vaccine development issues is going to have
payback. I think that's what's really important right now. I
think your points are a good one. Wh at can we do to make
these even more friendly in terms of administration and
consumer acceptance?

Mark Masselli: I noticed today that Germany, France, Italy , suspended the
AstraZeneca vaccine for some time so they can take a look at
it. Margaret was talkin g earlier about the -- we know about the
efficacy, at least during the clinical trials. But those trials have
continued for three months pas t . Is there a lot of transparency
on what's happening there , o r is there someone keeping it sort
of separate AstraZe neca [inaudible 00:22:12] just sort of
generally, how the public keeps informed on these?

Dr. Michael Osterholm : Well, I think at this point, we all have a number of questions
about the AstraZeneca vaccine . S ince more information is not
in the domain of th e public, I think that we just have to wait
until it is available. We want every vaccine dose we can
possibly get to take this on globally , and so I would sure hope
the AstraZeneca vaccine will remain in the mix and the data
will ultimately show that it is safe and effective. But I think
until we see those data, we have to rely on the government
bodies that are looking at what data they have and what
decisions they're making.

Margaret Flinter: We've been speaking today with Dr. Michael Osterholm ,
Director o f the Center for Infectious Disease Research and
Policy , CIDRAP, at the University of Minnesota . You can learn
more about his vitally important work by going to
www.cidrap.umn.edu or follow him on twitter @ Mt.
Ost erholm .

Dr. Osterholm , we thank you again for your career long
commitment to global health, for being so willing to share

Dr. Michael Osterholm - 20210315Oster holmXM

your expertise and wisdom and guidance during this
pandemic , and for joining us again today on Conversations on
Health Care .

Dr. Micha el Osterholm : Thank you.

[Music]

Mark Masselli: At Conversations on Health Care , we want our audience to be
truly in the know when it comes to the facts about healthcare
reform and policy. Lori Robertson is an award winning
journalist and Managing Editor o f FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in US politics. Lori, what have
you got for us this week?

Lori Robertson: President Joe Biden has made some misleading claims while
boasting ab out his administration's progress and getting
Americans vaccinated against COVID - 19. In remarks he made
in February at a Pfizer manufacturing site , Biden claimed that
the Trump Administration had “ failed to order enough
vaccines. ” The Trump Administration had contracts in place for
plenty of vaccines for all Americans, provided other vaccines
gained authorization.

The President also claimed there was, “ No real plan to
vaccinate most of the country ” when he took office . There was
indeed a plan to acquire and distribute vaccines. The Biden
Administration has done more on increasing vaccination sites
and vaccinat ors.
st
As of December 31 , 2020, the Trump Administration had
contracted to buy at least 800 million COVID - 19 vaccine doses
st
with delivery by July 31 . Those doses included vaccines from
four companies who had not yet received FDA authorization.
There were at least 1 billion doses under contract as of
January 2021. The government could acquire additional doses
by exercising options to do so under the agre ements with
vaccine companies. The Trump Administration had clearly
ordered enough vaccine doses for the US population.

However, the issue is that only the Pfizer, BioNTech and
Moderna vaccines had been authorized when Biden made his
th
remarks on February 19 . About a week later, the FDA
authorized the Johnson & Johnson vaccine.

In December, Pfizer and Moderna had agreed to provide 400
million doses by the end of July for the two dose vaccines. The
Biden Administration announced in February that the two
comp anies would provide yet another 200 million doses by the

Dr. Michael Osterholm - 20210315Oster holmXM

end of July fo r a total of 600 million doses.

As for Biden's claim that there was no real plan to vaccinate
most of the country , his administration has built upon
vaccination plans made by the previo us administration. Dr.
Anthony Fauci , Director of the National Institute of Allergy and
th
Infectious Diseases, told CNN on February 16 that there had
been a vaccine distribution plan, but a “ rather vague ” plan on
getting the vaccine doses into people's arm s.

The Biden Administration has taken steps to increase the
number of people who can administer the vaccines and where
the shots can be given. These steps have also come as vaccine
availability has increased. That’s my FactCheck for this week.
I’m Lori Rob ertson , Managing Editor of FactCheck .org.

Margaret Flinter: FactCheck .org is committed to factual accuracy from the
country’s major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fa ct that you’ d like check, email us
at www.chcradio.com , w e’ll have FactCheck .org’s Lori
Robertson check it out for you here on Conversations on
Health Care.

[Music]

Margaret Flinter: Each week Conversation highlight s a bright idea about how to
make wellness a part of our communities and everyday lives. If
music soothes the savage beast, the question they want to
answer at the Sync Project is how exactly?

There are lots of anecdotal studies supporting music ’ s ability
to trigger memory or boost endurance or focus. But virtually
nothing is known about how music truly impacts our
physiological and neurological state. This is the question that
intrigued scientist Ketki Karanma a Systems Biology PhD from
Harvard, who wonder ed how could music be scientifically
harnessed as a powerful precision medicine tool .

They formed the Sync Project with a cross - section of
neuroscientists, biologists , audio engineers , even some rock
stars like Peter Gabriel, and started by using artificia l
intelligence systems to analyze existing playlists that purport
to promote relaxation, induce sleep, enhance focus or athletic
performance.

Ke tki K a ranam: Once we have th ese set of songs that our machine learning
algorithms predict to be effective for a specific activity, we can
then run studies using these devices like your heart rate
monitors, your Smart W atches , a ctivity t rackers , and actually

Dr. Michael Osterholm - 20210315Oster holmXM

look at how effective indeed is that song for that purpose .

Margaret Flinter: K a ranam met her colleagues note that most of us self
medicate with music already , s o why not harness this
ubiquitous tool that's available to all of us and develop
strategies and systems that might replace pharmacological
interventions with musical ones. The Sync Project is seeking a
mil lion volunteers to offer their music suggestions as well as
any information they can share on why these songs seemed to
work for them .

Ke tki K a ranam: So we’re literally walking around with 14 million songs in our
pocket every single day. W e saw a great opp ortunity and really
being able to understand how music was affecting us to
measure how different types of music effect both our
psychological h ealth as well as our physiology.

Margaret Flinter: K a ranam and her team seen vast potential for reducing
reliance on drugs by crafting personalized music interventions
and the management of a variety of complex conditions such
as pain management, PTSD, even Parkinson's disease.

Ke tki K a ranam: In Parkinson's disease, patients have trouble coordinating
movements , s o by playing them the right kind of music, it can
be an external auditory support they have that's going to help
them walk more smoothly.

Margaret Flinter: The Sync Project , combining computer technology and
neuroscience , physiology , and musicology to harness the
healing powers inherent in music to help manage a variety of
human ills. Now that is 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 Flinter.

Mark Massel li: Peace and Health .

[Music]

Female : Conversations on Health Care is recorded at WESU at
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Dr. Michael Osterholm - 20210315Oster holmXM