--:-- Sean Rameswaram: Support for Today Explained comes from the FIFA World Cup, of all things. The FIFA World Cup 26 is coming to North America next summer. It is the ultimate celebration of sports and culture. You can get closer to the beautiful game with a hospitality package, closer to the action, the best seats, the best suites, closer to match day and that world-class food and that world-class entertainment, closer to the experience of a lifetime. Book a hospitality package at fifaworldcup.com slash hospitality. And listen to The Guardian for free at theguardian.com.
--:-- Sean Rameswaram: On Monday, I will name a group of leading scientists and experts as transition advisors to help take the Biden-Harris COVID plan and convert it into an action blueprint that will start on January the 20th, 2021. That plan will be built on bedrock science. It will be constructed out of compassion, empathy, and concern. I will spare no effort, none, or any commitment to turn around this pandemic.
--:-- Sean Rameswaram: President-elect Joe Biden gave his victory speech Saturday night, stressing he would hit the ground running on COVID-19. His timing couldn't be better. The United States hit 10 million confirmed cases today. We're seeing 100,000 new cases a day. Hospitalizations are up. Deaths are up. and the outgoing guy shows little to no interest in doing very much about any of it.
--:-- Sean Rameswaram: In fact, it was reported that Mike Pence, who's supposed to be in charge of the White House's coronavirus task force, is heading to Florida tomorrow for a vacation. Yeah. The former vice president, Joe Biden, once again spoke to the American people today, echoing what he said on Saturday. The bottom line, I will spare no effort to turn this pandemic around once we're sworn in on January 20th.
--:-- Sean Rameswaram: Dylan Scott, you cover health care for Vox. Biden announced this task force officially today. How is it different from the one we got other than, you know, the guy in charge of the one we have is taking vacation right as things have gone from worse to worst?
--:-- Dylan Scott: So Biden has appointed a lot of prominent public health experts. You know, it's people who have been advising his campaign for a while, people like Vivek Murthy. And we know that you've got to bring together all of the resources in the public and private sector. You've got to communicate with one voice, lead with science and get resources to people on the front line. Those are tried and true principles of pandemic response.
--:-- Dylan Scott: He was the former U.S. Surgeon General under President Obama. David Kessler, who's a former FDA commissioner. There are people like Zeke Emanuel and Julia Morita, who's a former Chicago health commissioner. So it's a pretty broad coalition of folks who have various levels of expertise that will be important for responding to the COVID-19 pandemic.
--:-- Dylan Scott: In terms of how it differs from the White House task force, the most obvious example is, you know, Scott Atlas has kind of become the most important White House advisor on COVID-19. Those who are not at risk to die or have a serious hospital requiring illness, we should be fine with letting them get infected, generating immunity on their own. And the more immunity in the community, the better we can eradicate the threat of the virus, including the threat to people who are vulnerable. That's what herd immunity is.
--:-- Dylan Scott: And the kind of people that Biden has appointed, I think, envision a much more sort of proactive intervention on the part of the federal government. Well, let's go through what this Biden task force can do instead of just giving up and banking on herd immunity and who knows, hundreds of thousands, if not millions of deaths that that would entail.
--:-- Dylan Scott: What more can be done on testing? So I think there's a couple of things. One, making rapid testing widely available. more widely available, much more widely available. But it also means changing some of the criteria and the guidelines for who gets tested.
--:-- Dylan Scott: You know, the Trump administration has, through much of the pandemic, had a pretty restrictive criteria for who should actually get tested. We know that really you need to be doing as much testing as possible. You need to be testing out in the general population, not just people who are showing symptoms, because that's the only way you're going to catch some of these infections early, encourage people to isolate, and thereby help reduce some of the spread.
--:-- Dylan Scott: And then Biden has talked about creating a pandemic testing board that would be responsible for making sure that we have the right testing resources in the right places across the country, depending on where COVID-19 is ramping up versus some places where it might be ebbing, and they don't need as many testing resources.
--:-- Dylan Scott: Something that a pandemic testing board could do is say, like, all right, we need to send more supplies to California or to Kansas or wherever is experiencing a spike in COVID-19 cases because that's where the emergency is right now. And right now, we don't really have that kind of national coordination of testing. It's much more of a free-for-all, states having to figure out on their own how to get their hands on the supplies they need.
--:-- Dylan Scott: So again, I think Biden envisions a much more proactive role for the federal government in managing testing resources and trying to make sure that everywhere where more testing is needed, they're able to get results in a timely fashion so that we can really start to clamp down on new infections.
--:-- Dylan Scott: You mentioned that Zeke Emanuel will be on Biden's coronavirus task force. He, of course, advised the Obama administration on health policy as well. We had him on the show months ago to talk about the coronavirus and he stressed the importance of contact tracing.
--:-- Dylan Scott: Contact tracing depends upon being able to identify COVID people and then look at their contacts rapidly That where technology really needs to come in and then get those people tested That is the nature of the game.
--:-- Dylan Scott: And of course, the Trump administration has not. Is this something that the incoming Biden administration will finally ramp up?
--:-- Dylan Scott: Yeah, I think this will be another point of emphasis for the Biden administration. That's certainly how countries like Germany and South Korea have managed to keep their outbreaks under relative control is a very aggressive testing and tracing program.
--:-- Dylan Scott: As you say, the Trump administration has really not taken any kind of interest in contact tracing. They haven't, you know, they haven't focused on just providing the money to hire more contact tracing workers. They haven't taken much of an interest in the digital smartphone applications that could help with contact tracing. This is another thing that's largely been delegated to the states.
--:-- Dylan Scott: And it's an area where I think the Biden administration would like to see the federal government take more of a leadership role. Now, this will be an interesting one because Biden has proposed creating this new U.S. public health corps that would basically hire 100,000 people to be spread across the country and oversee these kind of contact tracing efforts.
--:-- Dylan Scott: That is probably the kind of thing that would require Congress to get involved and approve the funding to hire those people. And that's one where we'll have to wait and see what the mood is and the political environment is in January when Biden takes office.
--:-- Dylan Scott: Are Republicans in charge of the Senate or do Democrats have a majority? If Republicans are in charge, is Mitch McConnell willing to approve this kind of funding for the testing and tracing efforts?
--:-- Dylan Scott: I think that remains to be seen. I think there are certainly some things that the Biden administration could do administratively to try to encourage states to do more contact tracing, to try to provide them with better guidance about how to do it.
--:-- Dylan Scott: But in terms of a big investment into contact tracing, that could be an area where we need more action from Congress. And obviously, there's just a lot of uncertainty right now about what Congress will be willing to do under the Biden administration.
--:-- Sean Rameswaram: The president-elect has talked a lot about listening to science. We'll follow the science. who will follow the science, let me say that again, and will adjust to new data when it comes in.
--:-- Dylan Scott: I mean, we can assume that that means that he won't have an antagonistic relationship with people like Dr. Fauci. We can assume that we might see the CDC playing a bigger role here than it has under President Trump.
--:-- Sean Rameswaram: What does that actually mean for the nation's ability to fight this virus?
--:-- Dylan Scott: When I talked to the folks on the Biden COVID planning team, earlier this fall, they really emphasized over and over again that they see one of their most important roles as just providing steady, trustworthy leadership on COVID-19.
--:-- Dylan Scott: Because, you know, the polling shows us that most Americans don't trust what they hear from President Trump or from the White House when it comes to the coronavirus. And I think that distrust helps to explain a lot of the problems that we've had.
--:-- Sean Rameswaram: And, you know, one of the things that we've seen under the Trump administration is that it's been political figures who have often been the face of the federal government, the people who are communicating important information to the public about COVID-19.
--:-- Sean Rameswaram: And I think that is part of the reason that we've seen a lot of distrust in the public because they can't tell how much of this is science and how much of this is politics.
--:-- Dylan Scott: So I think the Biden folks think that just by putting Anthony Fauci out in front or whomever the new CDC director might be. Just putting them out in front, making them the face of the government response rather than Mike Pence or Trump himself could do a lot.
--:-- Sean Rameswaram: Doesn't matter your party, your point of view. We could save tens of thousands of lives if everyone would just wear a mask for the next few months. Not Democrat or Republican lives, American lives.
--:-- Dylan Scott: You know, maybe we'd save the life of a person who stocks a shelf at your local grocery store. Maybe it saves the life of a member of your place of worship. Maybe it saves the lives of one of your children's teachers. Maybe it saves your life.
--:-- Sean Rameswaram: So please, I implore you, wear a mask. Obviously, there's no guarantees. We are a very polarized country. There's certainly people who are going to be mistrustful of what a Biden White House says about COVID-19, just like there were people who didn't trust the Trump White House.
--:-- Sean Rameswaram: But I think the polling shows pretty clearly that Americans do want to get on board with a lot of these public health interventions. They do trust Joe Biden more than they trust Donald Trump when it comes to COVID-19.
--:-- Sean Rameswaram: And so I think the Biden administration in waiting is just hoping that having a new face and one who so clearly foregrounds science will make a difference and just kind of help to get Americans all on the same page about what it's going to take to get through this pandemic.
--:-- Sean Rameswaram: Is it going to be too late, Dylan? I mean, is this thing just going to be wildly out of control and even potentially on the path to Scott Atlas's dream of herd immunity by the time Joe Biden takes office along with this task force he's building in mid to late January?
--:-- Dylan Scott: It's hard to predict too much in terms of like how many cases we're going to see, how many deaths we're going to see by January. Obviously, we got some very good news on the vaccine today. And that is going to be probably the top issue for the Biden administration by the time they take over is figuring out vaccine distribution.
--:-- Sean Rameswaram: But yeah, we're in for a difficult couple of months. There's some optimism that even just the prospect of Joe Biden coming into office could help Americans get on board with more social distancing and with wearing masks to try to get us through to the period when a vaccine is ready to be distributed.
--:-- Sean Rameswaram: But yeah, there's little evidence that Donald Trump is going to chart a new course on COVID-19. And there is only so much the Biden transition team can do.
--:-- Sean Rameswaram: So I don't have a lot of hope for the rest of November, December or the beginning of January. But we'll see how much Biden, just by being the president-elect, is able to start influencing people's attitudes. And maybe that will help to stem some of the pain that we're likely to experience over the next few months.
--:-- Sean Rameswaram: Dylan, thank you. Thank you.
--:-- Sean Rameswaram: After the break the very good news about the vaccine today
--:-- Sean Rameswaram: Support for Today Explained comes from Built Rewards These days, it seems like everybody has a rewards program. You swipe your card and you get one cent on the hundred dollars. But with your rent, frequently, you just pay month after month. You never get anything from it other than that roof over your head. Not anymore, says Built Rewards.
--:-- Sean Rameswaram: Built Rewards says it lets you earn points on your rent. By paying rent through Built, they say you can earn flexible points that can be redeemed toward hundreds of hotels and airlines, perhaps a future rent payment, your next Lyft ride, and so much more.
--:-- Sean Rameswaram: Your home isn't just where you sleep, it's your community. And Built wants you to go out and do things in the community. You can eat at your favorite local restaurants, then earn more points. You can get VIP treatment at certain fitness studios. You can enjoy exclusive experiences just for Built members. every month.
--:-- Sean Rameswaram: When you're ready to travel, they say Built Points can be converted to miles or hotel points all around the world. You can earn points on rent and around your neighborhood wherever you call home by joining built.com slash explained. That's J-O-I-N-B-I-L-T dot com slash explained.
--:-- Sean Rameswaram: Avoiding your unfinished home projects because you're not sure where to start? Thumbtack knows homes, so you don't have to. Don't know the difference between matte paint finish in satin, or what that clunking sound from your dryer is? With Thumbtack, you don't have to be a home pro. You just have to hire one.
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--:-- Sean Rameswaram: Umair Irfan, you report on science for Vox. As our colleague Dylan just mentioned, there was big vaccine news, and you've been covering the vaccine news for Vox as well. What is the big vaccine news of the day?
--:-- Umair Irfan: The pharmaceutical giant Pfizer and one of its collaborators, a company called BioNTech based in Germany, they announced today that their clinical trials for their COVID-19 vaccine candidate showed that their vaccine was 90% or more effective at preventing the infection. 90 percent. Yeah, that's a pretty high number and it's pretty good news.
--:-- Sean Rameswaram: Is this like break out the champagne across the world like we saw on Saturday? Is this kind of different kind of news?
--:-- Umair Irfan: Well, there are a number of different caveats with this news as well. One big one is that this is only drawn from a very small sample size. This was only based on 94 reported infections in a sample pool of more than 40,000 people.
--:-- Umair Irfan: The other big caveat here is that they announced these results in a press release. They didn't publish their data. They didn't have any peer-reviewed findings. So we only have the company's word to go on.
--:-- Sean Rameswaram: Help us contextualize what the testing of this vaccine suggests for its efficacy.
--:-- Umair Irfan: So the way a trial works is you have to get a large number of people in phase three. and you sort them into two categories. One group gets the vaccine, one group gets a placebo. And then you just kind of let them out into the world. You know, we can't deliberately infect people with the virus. So we just kind of have to wait and see how many people get infected.
--:-- Umair Irfan: And once they clear a certain benchmark, we can look and see which group they fell into. So if you looked at the 94 people that were infected, the majority of them were probably in the placebo group, meaning the people who got the vaccine, very few of them got sick. but most of the people who did get sick did not get the vaccine at all.
--:-- Sean Rameswaram: That seems to indicate that the vaccine is very effective. But again, this is a preliminary benchmark. The company has said so itself. The trial, they say that they're not going to run it to completion until they confirm and detect about 164 cases.
--:-- Sean Rameswaram: But the early results here are a good sign for the technology. The Pfizer vaccine here is using an mRNA-based vaccine. This is in contrast to more conventional vaccines. The old school vaccines used the whole virus that was either weakened or killed off or a fragment of the virus.
--:-- Sean Rameswaram: In this case, they're using genetic information that's used to make parts of the virus. And this is a completely new technique. This has not been tried before on large scales in humans. And the fact that they were able to get good results is an important validation of this technology.
--:-- Sean Rameswaram: And it means that this is something that we could be using from here on out. And other vaccine manufacturers are also using similar genetic-based vaccines, companies like Moderna. And so that's also a good sign for them as well.
--:-- Sean Rameswaram: But again, this is a very limited sample size. We're not talking about a huge positive result. But the fact that they were able to see a positive result this early does indicate that they're on the right track.
--:-- Sean Rameswaram: What comes next for Pfizer and this vaccine?
--:-- Umair Irfan: Well, they say that they are going to continue the trial. The 94 infections in the placebo group is not enough to end the trial. But they do think that within a week or two, they may have enough not to get full authorization, but maybe to get emergency authorization from the Food and Drug Administration.
--:-- Sean Rameswaram: And so this would make the vaccine available to people in very high risk exposure roles, people like doctors and other frontline health workers. They may have the option of being able to get this vaccine.
--:-- Sean Rameswaram: But very likely, it means that before the general public gets it, it will still be a few weeks, if not a few more months before they can actually get enough usable data to get the full approval.
--:-- Sean Rameswaram: We're still in the early stages here, Amir, but can we just talk for a second about the scale involved here in potentially vaccinating the world?
--:-- Umair Irfan: Right. This is going to be one of the biggest challenges here. You know, we're talking about a global pandemic, which means we need to have something that works on that scale. Even our existing vaccines, you know, we're not talking about typically vaccinating a billion people with measles vaccines every year. we're trying to target a small number of people, namely, you know, children, you know, babies who were just born or people who are at highest risk.
--:-- Sean Rameswaram: With COVID-19, you know, just about everyone's at risk. And so we want to be able to blanket this across as many people as possible. That's something that, you know, pharmaceutical industries have not really dealt with at that scale. And they're kind of learning by doing
--:-- Sean Rameswaram: One of the things that they done already is starting to build the manufacturing capacity even though they haven received approval for any of these vaccines So there are already factories and facilities being built up Companies are already investing in the supply chain and the distribution, knowing full well that some of their candidates will not pan out.
--:-- Sean Rameswaram: And there's been a lot of cooperation, a lot of governments that are funding these at risk. Some private nonprofits and some philanthropists are also investing in vaccines, expecting that most of them won't pan out. but they're trying to get ahead of this as much as possible because they know the scale of this is going to be unlike anything we've ever seen before.
--:-- Sean Rameswaram: Okay, and so if that totally unprecedented thing can be accomplished, could this vaccine be, you know, the one, the one that could bring back some more of that normalcy people are looking for or should we put that dream on the shelf and not look at it for a while?
--:-- Umair Irfan: Well, there are some moving parts here that we have to think about. Now, 90% efficacy, which they're reporting, that means that 9 out of 10 people who get the vaccine will have some form of protection. We don't know what that protection actually is. It could be that the vaccine completely prevents infection altogether. And that would be great. It would mean that basically if the virus jumps into somebody who has the vaccine, it'll come to a halt.
--:-- Sean Rameswaram: But it could also be that the vaccine protects only against severe illness. So this may keep you out of the hospital, but it might not prevent you from getting the sniffles or feeling mildly under the weather.
--:-- Sean Rameswaram: We know, though, that people with mild symptoms can still spread the disease. And so it may be the case that this vaccine, while it may offer most people some form of protection, it may not be enough to bring the disease to a halt.
--:-- Sean Rameswaram: Now, the other element of getting back to normal, you know, is this idea of herd immunity. We need to have enough people in the population immunized and resistant to the virus such that it can't jump easily from person to person.
--:-- Sean Rameswaram: And with a highly efficacious vaccine, as this looks like it is, that means you don't need to vaccinate as many people to reach that benchmark. But you still need to be vaccinating millions of people. And right now, you know, in the clinical trials, we're only testing tens of thousands of people.
--:-- Sean Rameswaram: So this is something that's orders of magnitude more complicated, more logistically intense than what we've been doing to date. So this requires a huge scale up in production, in administration.
--:-- Sean Rameswaram: And another thing to remember about this vaccine is that this is a two-dose vaccine, and the two doses have to be spaced about three weeks apart. So however many doses we manufacture, you have to basically cut that in half in order to get viable doses. and then you need a tracking apparatus to keep people in check and also to make sure that they get the right dose of the vaccine at the right time.
--:-- Sean Rameswaram: Now with Pfizer's vaccine in particular, there's one additional caveat. This vaccine can be highly unstable at room temperature and so they have to keep it extremely cold, something close to minus 80 degrees Celsius, which is about minus 112 degrees Fahrenheit.
--:-- Sean Rameswaram: And there are very few freezers or facilities that can actually provide that level of cold. It's certainly not your refrigerator's freezer that can do that or even a lot of pharmaceutical freezers. These are things that have to be custom designed and special ordered on a large scale in order to distribute this vaccine to everyone that needs it.
--:-- Sean Rameswaram: Now, Pfizer, the company, says that they've been investing a lot in building the infrastructure to transport this. They've developed this box that they say can passively keep this cool for shipping and handling and allow it to get to all the locations where it's needed.
--:-- Sean Rameswaram: But this stands to be one of the big weak links in the vaccination campaign, the cold chain, making sure that vaccines stay cold and stay viable in that process. That's going to be a huge challenge.
--:-- Sean Rameswaram: The World Health Organization has reported that somewhere up to half of all vaccines in the world to date get spoiled in transit. So this is a really big problem that we need to resolve if we're going to make sure that this is an effective vaccination campaign.
--:-- Sean Rameswaram: Okay, so this is just orders of magnitude tougher than anything that's ever been done before in the history of humanity.
--:-- Sean Rameswaram: What has Joe Biden said about how he plans on managing the vaccine portion of the equation here?
--:-- Umair Irfan: Well, President-elect Joe Biden talked about making this more of a centralized approach. Rather than giving this to the states and local cities to administer, it seems like he wants to have the White House doing more of the management of the production, the distribution of a vaccine like this.
--:-- Sean Rameswaram: That makes sense in some areas, and there are some tradeoffs as well. This is already a fairly centralized approach right now because the government is doing so much funding. But now we're going to need a lot more coordination because, well, one, this is a complicated vaccine to distribute and administer.
--:-- Sean Rameswaram: But also we're very likely going to have more than one vaccine, which means that we need to make sure the best vaccine goes to the right people. And that, again, will require high-level coordination. And I think the Biden administration has shown that it is thinking about these things.
--:-- Sean Rameswaram: And we'll have to see exactly how they plan to tackle these challenges. And of course, as I discussed with Dylan earlier in the show, this entire coronavirus has been politicized to the point where the whole country seems to have little agreement on one set of facts here.
--:-- Sean Rameswaram: How will Joe Biden get the whole country on board with one, two, a number of vaccines? It's hard to say at this point. I mean, this is going to be one of the biggest challenges.
--:-- Sean Rameswaram: Vaccine hesitancy and vaccine acceptance are going to be big hurdles to making sure everybody gets vaccinated. And if you don't get enough people vaccinated, then we won't be able to control the pandemic.
--:-- Sean Rameswaram: Certainly, messaging campaigns are going to be a big part of it, but also building trust with public institutions. Groups like the Food and Drug Administration, for instance, they lost a lot of credibility over the past year because they authorized drugs which seemed like weren't that effective based on political pressure.
--:-- Sean Rameswaram: You may recall hydroxychloroquine, which was given an emergency use authorization after President Trump promoted it aggressively, or similarly things like convalescent plasma that also got an approval, even though the data for that were weak.
--:-- Sean Rameswaram: So these institutions need to be rebuilding trust. They need to be a lot more transparent about what kind of information they're using as their benchmarks. And they also need to be communicating with people, with messengers that they actually will listen to.
--:-- Sean Rameswaram: So they need to have like a good PR campaign for this vaccine to make sure that everybody who needs to get the vaccine will get it.
--:-- Sean Rameswaram: Well, Umair, I imagine we'll be in touch. Thanks so much for your reporting.
--:-- Umair Irfan: No problem. Thanks for having me.
--:-- Sean Rameswaram: Umair Irfan, along with Dylan Scott, he's been covering this pandemic over at Vox.com. I'm Sean Rameswaram. It's Today Explained.
