--:-- Sean Rameswaram: Support for Today Explained comes from Saks Fifth Avenue. Fall is here. Might be time to find some nice new pieces you can wear again and again. With Saks Fifth Avenue, it can be a breeze to shop for your personal style, like maybe a relaxed Prada blazer or Gucci loafers that are great for both work and the weekend.
--:-- Sean Rameswaram: This is very Sean. This is very Sean-coated. Gucci loafers. Saks says Saks makes shopping feel totally customized to you, whether that's from an in-store stylist or a visit to Saks.com, where they can show you just what you want to see. They say they'll even let you know when arrivals from your favorite designers are in or when something you've been eyeing is back in stock.
--:-- Sean Rameswaram: You can find inspiration for your personal style every day at Saks Fifth Avenue.
--:-- Sean Rameswaram: Not all journalism is the same. Take The Guardian. Our coverage has something unique. Fierce independence. Nobody owns us or tells us what we can and can't say. So we're free to report the whole picture. We connect what's happening in Washington to the rest of the globe. Expose corruption wherever we find it. and give first perspective on everything from wellness and soccer to culture, the climate and more.
--:-- Sean Rameswaram: Read, watch and listen to The Guardian for free at theguardian.com.
--:-- Sean Rameswaram: President Biden has found a higher gear in the fight against COVID-19. This is a pandemic of the unvaccinated. And it's caused by the fact that despite America having unprecedented and successful vaccination program, despite the fact that for almost five months, free vaccines have been available in 80,000 different locations, we still have nearly 80 million Americans who have failed to get the shot.
--:-- Sean Rameswaram: So long, chill dad saying it'd be really cool if you did that one thing. Hello, mandate. My job as president is to protect all Americans. So tonight, I'm announcing that the Department of Labor is developing an emergency rule to require all employers with 100 or more employees that together employ over 80 million workers to ensure their workforces are fully vaccinated.
--:-- Sean Rameswaram: We wanted to dig into Biden's new plan, but also talk about whether the administration has been failing the country on vaccines and boosters. So he reached out to Dr. Richard Besser. He's the former acting director of the CDC and the current CEO of the Robert Wood Johnson Foundation, which means he's close enough to this world to have insights, but far enough to be critical.
--:-- Dr. Richard Besser: Well, you know, Sean, I think what changed was a recognition that what we've been doing so far, while it's had a dramatic impact in terms of saving lives, it's not enough. And what we saw was the dramatic rise in the number of cases, the rise in hospitalizations and deaths, largely due to a new strain, the Delta variant, which is causing problems around the globe.
--:-- Dr. Richard Besser: I remember back in June when we were seeing less than 10,000 cases a day across the country. Now we're up to about 150,000 cases a day. This is not about freedom or personal choice. It's about protecting yourself and those around you, the people you work with, the people you care about, the people you love.
--:-- Dr. Richard Besser: And so you can't continue to do the same thing and expect a different outcome. And so this plan by the administration, the six-point plan, is really an attempt to shake things up and get this pandemic under control.
--:-- Sean Rameswaram: Let's talk about what explicitly he's saying here regarding the vaccine. Yeah, so there's six points here. One is vaccinating the unvaccinated. Another is further protecting people who are vaccinated, so boosters. The third is keeping schools safely open. So what do we need to do to ensure that our kids are safe?
--:-- Sean Rameswaram: The fourth is on increasing testing and requiring masking. The fifth point is about economics. And so protecting our economic recovery and those businesses that have been hit really hard. And then the last is improving care for those with COVID as we're seeing hospitals getting slammed.
--:-- Sean Rameswaram: My message to unvaccinated Americans is this. What more is there to wait for? What more do you need to see? We've made vaccinations free, safe, and convenient. The vaccine has FDA approval. Over 200 million Americans have gotten at least one shot.
--:-- Sean Rameswaram: We've been patient, but our patience is wearing thin, and the refusal has cost all of us. When it comes to the issue of mandates, that's really under the category of vaccinating the unvaccinated. And here, the president is now going to be requiring all employers with at least 100 employees to ensure that their workers are either vaccinated or tested weekly.
--:-- Sean Rameswaram: And this is a bold move. It's a change. He's going to be calling on OSHA, the Occupational Safety and Health Administration, to issue emergency rules that will help ensure that the workplace is safe for people who are coming in.
--:-- Sean Rameswaram: And to make that workplace safe, it's going to require that either the workforce is vaccinated or that workers are tested weekly. In addition to that, there are mandates for federal workers. So all federal workers and contractors will be required to be fully vaccinated.
--:-- Sean Rameswaram: And people in the healthcare system. Anyone in the healthcare system who works at an institution that receives dollars from Medicare or Medicaid will be required to be vaccinated. And that's a really important one because when you think about risk of severe infection and death, it's not spread equally.
--:-- Sean Rameswaram: People who are elderly, people with certain medical conditions are at the greatest risk. And one of the things that's just blown me away during this is the number of healthcare workers, the number of nursing home workers home aides who have not gotten vaccinated.
--:-- Sean Rameswaram: And this is saying you know you need to This is something where you are putting other people at risk You need to get vaccinated
--:-- Dr. Richard Besser: Yeah, so, you know, I'm a general pediatrician. And so a lot of my life as a pediatrician is around vaccination. And, you know, we take it for granted. You wanna send your kids to school, they need to be vaccinated. It's a law and it's legal.
--:-- Dr. Richard Besser: I think that's going to be the case here in the workplace. It is legal to mandate vaccination. Smallpox vaccination was required in the United States. It's the reason that that disease was eliminated from the face of the earth.
--:-- Dr. Richard Besser: You never would have done it if it was a voluntary vaccine program. But the way the administration is doing mandates is going to raise legal challenges. So using OSHA, that ensures that the workplace is safe, that you're not exposed to toxic chemicals or other things in the workplace.
--:-- Dr. Richard Besser: Using OSHA to say that vaccines are a requirement, that probably will be challenged in the courts. Requiring that healthcare workers are vaccinated, that will be challenged. We've seen that with flu, where hospital systems have required flu vaccination, but the various statutes and approaches and ways the administration goes at this will clearly be challenged.
--:-- Dr. Richard Besser: I think, though, that just by putting this out there and saying there's going to be requirements. There are a lot of people who are on the fence. They're like, well, do I really want to do this? I don't like needles. I'm not sure I want to do it. If it's a choice between getting vaccinated or potentially losing their job, people are going to get vaccinated.
--:-- Sean Rameswaram: The president clearly did not want to mandate this. I think the question here, one, that's not the role of the federal government. That is the role that institutions, private sector entities and others may take. That certainly is appropriate.
--:-- Sean Rameswaram: He wanted to sort of put the onus on Americans, encourage them to get vaccinated and and end the pandemic that way. That was sort of what he laid out in that speech where he gave us that Fourth of July target. You know, we're going to declare independence from the pandemic on Independence Day.
--:-- Sean Rameswaram: If we do our part, if we do this together, by July the 4th, there's a good chance you, your families and friends will be able to get together in your backyard or in your neighborhood and have a cookout and a barbecue and celebrate Independence Day.
--:-- Sean Rameswaram: Is this new plan and acknowledgement that that prior approach just failed? Yeah. And even earlier than that, the administration, the president was saying that there would not be federal mandates. And I think that you have to continually let people know that you are dealing with a situation of incredible uncertainty and that as you learn and as situation changes, the guidance guidance that you provide will change.
--:-- Sean Rameswaram: You need to set that up as an upfront expectation and reinforce it every time. If you don't do that, then whenever there's a change, whether it's a change to say, now we're recommending masks, now we're requiring masks, now you don't need to wear masks, it's going to come off like you don't know what you're talking about rather than the fact that you're responding to a new situation and new science.
--:-- Sean Rameswaram: The president's decision to now mandate is a reflection on where we are as a nation and the fact that in many states, the states that have been hit hardest with this new surge, they have the lowest vaccination rates in the country.
--:-- Sean Rameswaram: I will say that he was channeling the frustration that millions of people across this country are feeling who are vaccinated, that many governors and elected officials have also shared their frustration over.
--:-- Sean Rameswaram: Now, if I'm not mistaken, there is this vaccine mandate, which is controversial, which is sure to get challenged in the courts. But there's also this option to not get the vaccine, but be tested weekly. Is that right? There is for the employer group. There's not for the federal worker group.
--:-- Sean Rameswaram: And the logistics, the details on this haven't been spelled out. What type of testing, how frequently the testing will need to be done, who's paying for the testing, how that's being reported. Even with mandates, we don't have some of the systems in place in our country that would make it easier for these to be used.
--:-- Sean Rameswaram: We don't have a national vaccine registry. We don't have a vaccine passport, something that you could show that certifies that you're fully vaccinated. Each state is figuring this out on their own, and it would definitely be helpful if there were a national tool.
--:-- Sean Rameswaram: If, you know, a majority of the unvaccinated employees of organizations with 100 plus people decide, well, I'm not going to get the vaccine, but I'll do this testing thing, I guess, because I have to for my job. Will this plan, will this push have failed? I don't think that's going to be the case.
--:-- Sean Rameswaram: You know, there are 80 million people, the administration reports that are in the group that are eligible to be vaccinated and haven't done so. Some of these are younger people between 12 and 18. But in that workforce group, I think we're going to see some movement. I think we're going to see people rolling up their sleeves and getting vaccinated.
--:-- Sean Rameswaram: And if we don't, if we see a lot of people opting for testing, the testing programs can be effective if they're done very well. They can help ensure that you're not allowing ongoing transmission to occur.
--:-- Sean Rameswaram: I guess like in a perfect world, everyone just got the vaccine and we wouldn't be seeing hospitals being overwhelmed again. And we wouldn't see these rising death tolls again. But that's just not the world we live in. And we don't live in the world that just because the president said, you know, we're taking this a lot more seriously now, people are going to take it a lot more seriously.
--:-- Sean Rameswaram: Do you think on some level, we should just be preparing to be dealing with this for a long time to come? I think we do have to prepare to deal with this for a long time to come. And a number of reasons for that. One is that there are no vaccines for anyone under the age of 12. So children remain vulnerable
--:-- Sean Rameswaram: And we have never been more polarized more divided as a nation in dealing with a public health crisis And that politicization of the response, which began in the earliest days of the response, has been one of the biggest challenges that we all face in getting this under control.
--:-- Sean Rameswaram: If your decision to get vaccinated is so closely aligned with your political beliefs, rather than your trust in science and public health science, we are in big trouble. And that's where we are as a nation.
--:-- Sean Rameswaram: Biden and boosters with Dr. Besser after the break.
--:-- 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.
--:-- Sean Rameswaram: That's J-O-I-N-B-I-L-T dot com slash Explained. Thank you.
--:-- Sean Rameswaram: Dr. Besser, we spent the first half of the show talking about how to get vaccines into the arms of people who haven't yet been vaccinated, but there's also a move by the Biden administration to get more shots into the arms of people who are already vaccinated. What's the latest on booster shots?
--:-- Dr. Richard Besser: This is a really controversial area, and it's been a bit confused by two groups being lumped together. Last month, there was a move to approve a third dose of vaccine for individuals who have immune disorders who did not get a good response to the first two doses. That was approved and those recommendations are out there.
--:-- Dr. Richard Besser: So there's a group of people who have certain medical conditions where they didn't get a good response from two doses. They should be getting a third dose. That's in my mind, not really a booster. That's just saying that, well, for certain people, it's a three-dose series rather than a two-dose series.
--:-- Dr. Richard Besser: What's being discussed right now is a booster shot, a third dose for people who got their first two doses or who got the one dose of the J&J vaccine. And it's a recognition that over time for many vaccines, you can see a drop-off in levels of protection.
--:-- Dr. Richard Besser: The reason this is controversial is that a decision like this, from my perspective, should come out of an independent review of the data and the science by two committees. One is an advisory committee to the FDA. That's the committee that first approved these vaccines under emergency use and is now looking at vaccines and proving them for full use.
--:-- Dr. Richard Besser: And a committee that advises the CDC that makes recommendations in terms of who should get various vaccines. Those groups haven't done their work. And the administration basically announced that starting September 20th, booster shots would be available.
--:-- Dr. Richard Besser: We purchased enough vaccine and vaccine supplies so that when your eight-month mark comes up, you'll be ready to get your vaccination free, that booster shot free, and we have it available. It will make you safer and for longer.
--:-- Dr. Richard Besser: They've had to walk that back. In their announcement, they did say that this would be all pending the committee work, But they pretty much prejudge the outcome of those committee hearings.
--:-- Dr. Richard Besser: I watch those hearings. These are some of the nation's biggest experts in vaccines. And there's a lot of things for them to consider in terms of booster shots. Should they be approved for everyone? Are they safe? Do they increase the risk of side effects?
--:-- Dr. Richard Besser: A lot of things to wade through. And if I'm going to be recommending vaccines to my patients, I want to make sure that they were able to do this work independently.
--:-- Sean Rameswaram: Well, let me break down some of what you just said. I mean, let's just start with the Biden administration. Do you think the Biden administration jumped the gun on this rollout of booster shots on September 20th?
--:-- Dr. Richard Besser: I do. I do. I think that what they should have said is that we are asking the FDA and CDC to look at this question to determine when and whether and for whom booster shots are indicated rather Rather than to say, we've determined that these are indicated and we'll be starting on September 20th, assuming that they're approved by the FDA and CDC.
--:-- Dr. Richard Besser: That ties the hands of those institutions and puts some political pressure that really shouldn't be there as part of that deliberation.
--:-- Sean Rameswaram: Some countries have started boosters. The one that's getting the most news is Israel, where they are providing boosters for their population. Authorities say that among the over 60s protection against infection provided from 10 days after a third dose was four times higher than after two doses
--:-- Dr. Richard Besser: The question is whether the level of protection against what we care about most and that hospitalization and death whether that level of protection goes down or whether it's just breakthrough of mild infection. And we still don't know?
--:-- Sean Rameswaram: Well, you know, that's what has to be looked at. CDC put out several studies last week that suggests that over time, there is a decline in protection among some groups, but not all.
--:-- Dr. Richard Besser: But that is the information that these committees need to look at and wrestle with to determine who should get vaccinated and who should not.
--:-- Dr. Richard Besser: The other challenge, you know, there's some logistical challenges in that there are three vaccines that are approved for use in the United States, two under emergency use authorization and one with full approval. And the Pfizer is the full approval and it's Johnson and Johnson and the Moderna with the emergency approval.
--:-- Dr. Richard Besser: That's right. FDA has already indicated that they don't have enough data to say anything except about the Pfizer vaccine. And so there could be some big confusion if there's boosters that are allowed for one vaccine and not another.
--:-- Dr. Richard Besser: There's questions about, well, if you received one vaccine as your primary, could you get a different shot as your booster? There's a lot for these expert committees to wrestle with. And until that's done, I think it was very premature to suggest that people could start getting boosters on the 20th of September.
--:-- Dr. Richard Besser: And that purely sets aside the moral question here, where you have the head of the WHO saying, A month ago, I called for a global moratorium on booster doses. Stop refilling your already full cup while the rest of the world is dying of thirst.
--:-- Dr. Richard Besser: So today, I'm calling for an extension of the moratorium until at least the end of the year to enable every country to vaccinate at least 40 percent of its population. The Biden administration is going to be leading a global summit next week to try and address some of the challenges in vaccine and medical supplies and medical care globally.
--:-- Dr. Richard Besser: But it strikes me as that effort should really precede a decision domestically about using boosters. The Delta variant that has really turned things upside down here did not arise in the United States. That was first found in another country. And it's likely that variants could spring up anywhere.
--:-- Dr. Richard Besser: So we do have a national interest as well as a global interest in controlling this pandemic everywhere. Now, know there's some world leaders who say America shouldn't get a third shot until other countries got their first shot. I disagree. We can take care of America and help the world at the same time.
--:-- Sean Rameswaram: Dr. Bester, the last time we spoke on this show about the pandemic was during the former president's tenure when, you know, we were all guaranteed to feel confused about this pandemic. That was a confusing president we had back then. President Biden is certainly a less confusing pandemic president.
--:-- Sean Rameswaram: But this booster shot thing, this new approach, it's not the clearest strategy. Can I ask you, back in January of 2021, when Biden took office with vaccines about to go out to the masses, where did you think we'd be by September?
--:-- Dr. Richard Besser: You know, I think when I was asked that question at that time and as vaccines were rolling out, I was envisioning a fall that's very different. I was envisioning a fall where kids could go back to school in a way that they could be kids and wouldn't have to worry about these sorts of things in the same way.
--:-- Dr. Richard Besser: That hasn't happened for a number of reasons. I'm thrilled that we have a big focus on keeping kids in school learning because that's critically important and last year was devastating for children. So I'm thrilled that the efforts are really focused on keeping children in school.
--:-- Dr. Richard Besser: But I hope that we would have come together more as a nation, that we would have seen that viruses don't care about political party, they don't care about race or ethnicity, they don't care about what country you're from, and that we would come together and tackle this in a more unified way.
--:-- Dr. Richard Besser: It's a bit Pollyanna-ish, but in every public health response that I've been involved in, One of the success factors was whether we could keep this as a bipartisan or nonpartisan effort. What's become more and more clear to me is that once this becomes politicized, once there's a loss of trust, it's really hard to get back to that ideal state that you want to see.
--:-- Sean Rameswaram: Dr. Richard Besser is the CEO and president of the Robert Wood Johnson Foundation. I'm Sean Rameswaram. This is Today Explained.
--:-- Sean Rameswaram: Our episode today was produced by Hadi Mawajdeh with help from Miles Bryan, edited by Matt Collette, engineered by Efim Shapiro, fact-checked by Laura Bullard, and hosted by Sean Rameswaram.
--:-- Sean Rameswaram: The reason I don't like it is because in the old days, they'd go, hey, that old man died. Now, they'd go, hey, he lost his battle. That's no way to end your life, you know. What a loser that guy was.
--:-- Sean Rameswaram: Last thing he did was lose. And I'm pretty sure, I'm not a doctor, but I'm pretty sure, if the cancer dies, I mean, if you die, the cancer also dies at exactly the same time. So that, to me, is not a loss, that's a draw.
