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Biden Administration Recommends COVID Booster Shot after Eight Months; Defense Secretary and Joint Chiefs Chairman at White House Briefing Biden on Afghanistan. Aired 11:30a-12p ET

Aired August 18, 2021 - 11:30   ET



DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (voice over): And what it shows is that a model of vaccine efficacy in this case based on the Moderna phase three trial, showed that four weeks after the second dose, that what you have is a serum neutralization titer of 1 to 100, which goes up from the vertical red line, that gives you an efficacy of 91 percent. But if you look at the dark black line going from left to right, as you go further up, you get a higher degree of efficacy. So, the higher the neutralization titer, the higher degree of efficacy of the vaccine in this model.

Next slide. Third issue, higher levels of antibody may be required to protect against delta. And I'm showing you data now both from Moderna on the left and a paper in the New England Journal has very similar data from Pfizer. So, if you look at the left panel, what you're measuring is neutralization titer after two doses of the immunization. And the open circles are the same people as in the pink circles. And you're looking at the fact that the immunization -- the neutralization titer required to neutralize the standard prototype D614G, which was the original variant, is clearly the titer is much lower, as you see it all goes down in pink when you're dealing with delta.

Next slide. The next concept, and that gets to the booster, the booster mRNA immunization increases antibody titers by at least tenfold. These are data from Moderna, but Pfizer has announced very similar data. The bottom line is, if you look first at the left panel, the first column is looking at the antibody titers just before the third dose and then 15 days after the third dose is shown right next to it that says D15. As you can see, a remarkable increase in titers against the 614G, the B1351, the P1 and then the Pfizer data, which you would expect would be very, very similar to the Moderna. It was also against the delta variant. So, you get a dramatic increase in antibody titers when you do third immunization dose.

Last slide. And so in summary, the current immunological data that indicate that antibody levels decline over time, higher levels of antibody are associated with a higher level of efficacy, higher levels of antibody may be required to protect against delta and, as I showed you on this former slide, a booster mRNA immunization increases antibody titers by multiple fold. All of these support the use of a third booster mRNA immunization to increase the overall level of protection. We'll go back to you now, Jeff.


I want to be clear, the president's whole-of-government vaccination effort is ready to get every American who needs one a booster shot. Pending FDA and ACIP approvals, boosters will be available starting the week of September 20th.

The plan is for the rule to be simple, get your booster shot eight months after you got your first -- second shot. I apologize. So if you got your second shot on February 1st, you can get a booster starting on October 1st. If you got your second shot on March 12th, you can get your booster starting on November 12th and so on.

Thanks to the aggressive actions we have taken to establish our vaccination program. It will be just as easy and convenient to get a booster shot as it is to get a first shot today. We have enough vaccine supply for every American, and you'll be able to get a booster at roughly 80,000 places across the counted, including over 40,000 local pharmacies. In fact, 90 percent of Americans have a vaccine site within five miles of where they live. And importantly, boosters will be free regardless of immigration or health insurance status.


No I.D. or insurance required. So, the bottom line is that we are prepared for boosters and we will hit the ground running.

In the weeks ahead, we'll continue working closely with states, health care providers, pharmacies and national and community-based organizations to ensure Americans know they should get a booster shot eight months after their second shot. And we will be laser-focused on getting boosters to long-term care facilities to make sure residents and staff get their shots and are safe and protected.

Importantly, as we continue to vaccinate Americans, we will maintain our focus abroad as we know this virus knows no borders. We have already shipped more than 115 million vaccine doses to 80 different countries, more vaccine doses donated than all the other countries in the world combined. And just this week, we started shipping the half a billion Pfizer doses that the U.S. pledged to purchase and donate to 100 low and lower-middle income countries in need.

And in the coming weeks and months, we will do even more to lead the global vaccination efforts, accelerating our work to build vaccine manufacturing and production capacity both here in the U.S. and in other countries. Our wartime effort will continue doing everything we can to get even more people vaccinated both here at home and around the world. We can and must do both at the same time because that's what it's going to take to end this pandemic, and we will not stop until we get the job done.

With that, let's open it up for questions. UNIDENTIFIED MALE: Thanks, Jeff. And as a reminder, please keep your question to one question. There are many today. First, let's go to Lev Facher at Stat News.

REPORTER: High, folks. Thanks, as always, for doing the briefing. This is a Mike Ryan quote from a WHO briefing earlier today about booster shots. If we think about this in terms of an analogy, we're planning to hand out extra lifejackets to people who already have lifejackets. And I'm curious. I know you have emphasized all of you that this is a false choice, vaccinating Americans versus vaccinating the rest of the world, but could you explain how there isn't finite vaccine capacity and how booster shots for Americans does not at this moment come at the expense of first vaccine or second vaccine doses for folks elsewhere in the world?

ZIENTS: So, let me go first and Dr. Murthy, if you want to add anything. Look, to end this pandemic, we have to protect the American people and we have to continue to do more and more to vaccinate the world. Both are critical. And we're already proving that we can protect our own people here at home as we help others.

Just to give you some data here, in the months of June and July, the U.S. administered 50 million shots here in the United States and we shipped more than 100 million to other countries. As I said, the 115 million doses that we've already donated is more than all the other countries combined.

And during the coming months, when we talk about booster shots, we expect to give about 100 million boosters in the United States and at the same time we will be donating more than 200 million, twice that number, additional doses to other countries on our way to donating more than 600 million vaccines.

So, we are continuing to serve, as the president has said, as an arsenal of vaccines for the world, and you'll see us do more and more. This builds on our support of the trips waiver, our commitment to COVAX, where we're the largest contributor, of the quad partnership which we helped to establish, which is on track to produce at least a billion doses of COVID vaccine in India, for the Asia region by the end of 2022, and our work to support vaccine manufacturing in Africa by providing financing to a South African business to bolster manufacturing capacity to produce more than 500 million doses.


And we're just going to keep going and going and going.

So this is a situation where we're going to do both. We're going to both protect the American people and we're going to do more and more to help vaccinate the world. Dr. Murthy?

DR. VIVEK MURTHY, U.S. SURGEON GENERAL: Well, thanks, Jeff. And, Lev, good to hear your question. I appreciate it. Look, I do not accept the idea that we have to choose between America and the world. We clearly see our responsibility to both and that we've got to do everything we can to protect people here at home while recognizing that tamping down the pandemic across the world and getting people vaccinated is going to be key to preventing the rise of future variants. We know that. We see that clearly. And we believe we have to work on both fronts, as we have been.

But, Lev, when we see data that is giving us essentially indications that protection is starting to diminish in terms of mild and moderate disease when we recognize that if this trajectory continues, that people who are well protected today may see more vulnerability in the future, we have to act. The science tells us that. Our clinical judgment tells us that, and that was a collective decision of the top public health and medical experts in this administration.

So, again, we will do everything possible to protect people in our country. That's why we're announcing this booster plan, but we will also continue to accelerate our efforts to vaccinate the rest of the world. We take that responsibility very seriously.

ZIENTS: Next question, please.

UNIDENTIFIED MALE: Cheyenne Haslett, ABC News.

REPORTER: Hi. Thanks for taking my question. How realistic is that September 20th launch date given that we haven't seen the official EUA request from Pfizer or Moderna yet?

ZIENTS: That is the date we're working toward. And as we've said, that is obviously pending both the FDA's approval and the ACIP's recommendation. So that is the date that we're prepared for, beginning the week of September 20th.

Next question.


JEREMY DIAMOND, CNN WHITE HOUSE CORRESPONDENT (voice over): Hey there. Thanks for taking my question. First of all, why did you guys decide not to limit this to older and more at-risk Americans and simply say that all vaccinated people will need a booster shot after eight months? And, secondly, you say in the statement that the protection against severe disease, hospitalizations and deaths could diminish. How certain are you about that? And are you saying over time that you do not believe these vaccines will continue to be highly effective at preventing hospitalization and deaths? Thanks.

ZIENTS: Let's start with you, Dr. Murthy.

MURTHY: Thanks, Jeremy, for that question. Look, first, I would say, when we look at the data, we see a reduction in protection against mild to moderate disease across age groups. And that was an important part of why we made this recommendation for all adults. We want to protect all adults in our country from the worst effects of COVID-19.

But our plan does prioritize the most vulnerable. If you look at how we began vaccinating people, Jeremy, at the beginning of the vaccination effort, we prioritized health care workers, long-term care facility residents and the elderly. And those are exactly the same populations that we will be starting with. So we do prioritize the most vulnerable. We think that's going to be essential in our goal to ultimately protect the country and save the most lives.

ZIENTS: Next question.

KATE BOLDUAN, CNN AT THIS HOUR: All right. We've been listening to this important announcement from the White House Coronavirus Response Team about boosters, and they're now recommended after your second months -- eight months after your second shot. A lot to get through, there's a lot of information that was just offered up.

Back with me is CNN's Sanjay Gupta as well as Dr. Peter Hotez, who is Professor and Dean of Tropical Medicine at Baylor Medical College in Texas, and Dr. Aileen Marty, Professor of Infectious Diseases at Florida International University.

Sanjay, just your reaction and your take on what we just heard.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, they're making the case that there's some evidence that there's waning effectiveness of these vaccines against mild and moderate symptoms. So not severe symptoms, certainly not severe enough to get you in the hospital, there's still a lot of protection against that and preventing people from dying.

What they seem to be saying, and it's an interesting sort of discussion here, because they're saying, hey, look, we're trying to get ahead of this. Because we've seeing evidence, and this is U.S. data that they're presenting from nursing homes, from hospital systems, from a large number of people in the general population, they say, since we're seeing this decreased effectiveness against mild or moderate disease, we're worried that that will start to translate into decreased effectiveness against hospitalizations and death.


I haven't seen that really yet, but that's a concern.

It's an interesting point, Kate. I mean, it's going to be a subject, I think, of significant discussion. Because for so long, the message has been, until we see decreased effectiveness against hospitalization and death, and that's clear, we probably won't be recommending booster shots. Other people have said, look, booster shots were always going to be part of the plan. The messaging has been confusing, Kate, I can tell you.

BOLDUAN: And you wonder if it's -- as we see how long it takes for people to go out and get a shot. Maybe they're trying to see -- they can see -- I don't know. They can see the danger ahead. They're trying to kind of meet it there with these booster shots and rolling it out.

I thought it was interesting exactly what you pointed to when they said they wanted to stay ahead of it. We have a graphic of what they showed that probably best sums up the decrease in the vaccine effectiveness that is leading them to this conclusion, right? Prior to delta, you see 92 percent effectiveness against infection, and now they're looking at 64 percent effectiveness against infection. Can you put this into English, what this means that they're seeing? What do you see with this, Sanjay?

GUPTA: Sure. Yes. I mean, so, it's a really important point, decreased effectiveness against infection. And I don't know if you noticed, when you listened to Dr. Walensky, she really stressed that against infection. Because when we say infection, we know there are people who may have infection and have mild or even no symptoms, and there are people who have infection and have significant symptoms. They didn't really stratify that out. So just in general, we know that graph basically shows that the likelihood someone could test positive and have no symptoms all the way to test positive and be in the hospital could be reflective of that number.

It would be nice to know how much of it is in each population, how much decrease was there really in terms of protecting against severe disease. What we know is from the other studies, besides this one, is that it seems pretty protective still against hospitalizations and deaths. So the majority of decrease in efficacy has been against mild or moderate disease. That's what that really means.

I will say that the delta variant seems to have accelerated some of that decrease in protection. That's another point they made.

BOLDUAN: Dr. Marty, what stuck out to you? What sticks out to you from this briefing?

DR. AILEEN MARTY, DISTINGUISHED UNIVERSITY PROFESSOR, INFECTIOUS DISEASE, FLORIDA INTERNATIONAL UNIVERSITY: Thank you so much. First of all, I have boots on the ground, and I can tell you exactly what's happening. Right now in Miami-Dade County, 20 percent of the people in hospital are people who are fully vaccinated. So I need to make it very clear -- and, of course, that does reflect that we have a high percentage of individuals who are high-risk for a variety of reasons, especially a lot of elderly people that live in our community, a lot of the transplant patients, et cetera, which are the vaccinated group that's most likely to be in hospital. We have to be very clear.

Also, being a lab director for a high complexity lab, which is another hat I wear, I can tell you that I have seen the C.T. values on fully vaccinated individuals with mild and moderate disease and they are sky high. So this decision and the presentation made by Dr. Fauci, Dr. Walensky and Dr. Murthy were outstanding and incredibly valuable. But we very much need to be giving these third doses to those individuals who absolutely didn't get an initial first rise, that's the group that was talked about last week, and we need to give boosters to those of us whose immunity is waning.

BOLDUAN: Dr. Hotez, I want to get your take on this. Because I believe what Dr. Fauci said is that the increased antibody levels after the third dose are by at least tenfold. Talk to me about what that actually means.

DR. PETER HOTEZ, PROFESSOR AND DEAN OF TROPICAL MEDICINE, BAYLOR COLLEGE OF MEDICINE: Well, you know, I think they actually missed some good opportunities to communicate this more effectively and to actually show the American people that they're more on top of this. When these vaccines were rolled out back in December and January, and I'm sure Dr. Marty and Sanjay -- Dr. Gupta remember this, it was done at a three- to four-week interval. And the reason that was done, the first dose and then the second dose three to four weeks after, whether if it's Pfizer or Moderna, the reason for that was we were in crisis. We were having 3,000 hospitalizations a day. We had to fully vaccinate vulnerable people as fast as possible. And we did that and that was extremely successful.

At that time, we knew that was a crummy vaccine schedule for giving long lasting protective immunity. And the minute that commitment was made, and, again, it was done to save lives and it was the right decision, but that already set into motion the fact that we were going to need a booster, whether it was a year from now or six months from then or a year-and-a-half from then.


And that's how I think it should be framed, that this was predicted and predictable. And it was just a matter of watching when we were going to start seeing a big bump in breakthrough cases and breakthrough hospitalizations that we pulled the trigger on giving the booster.

And we've seen data come out of the Mayo Clinic, New York State, it was mentioned, and we've been watching this out of Israel now for a few weeks where they have shown the protection against infection has gone down from 95 percent down to 40 to 50 percent. They made the statement they haven't seen the breakthrough hospitalizations. Although I tend to concur with Dr. Marty anecdotally, we're hearing about quite a number of breakthrough hospitalizations.

So I think the whole point was this could have been framed as something that we knew we were anticipating. We were getting ready for it. Now the data is showing up. Now is the time to do it.

BOLDUAN: Sanjay, kind of where we had kind of cut off before the briefing started, I'm wondering your take now if you think they effectively kind of conveyed and explained this enough in order to not contribute to further skepticism amongst those who are still resisting to get the first shot.

GUPTA: Yes, I think that's a -- it's concern that they raised when I talked to some of these officials on background. That was something that they were concerned about, as Dr. Hotez makes this case that this was always sort of part of the plan. But as he said, I don't think that was communicated. I don't think people thought that was always part of the plan. Even recently, we heard people saying there's no plan for boosters, there's no imminent booster needs, all of this just within the last few days we've heard that. This obviously is different. So, it's not been communicated well, I think.

Now, sort of going forward, the idea of what this means, you know, in terms of how people are going to get their shots, who should get their shots, I think they are going to have to be very clear on that. And also the FDA and the CDC still need to weigh in on this. The FDA needs to authorize this, safety data, efficacy data, all of that that they look for typically.

BOLDUAN: Yes, absolutely. Thank you, Sanjay. Thank you so much, Dr. Hotez, Dr. Marty. I really, really appreciate it.

We also have breaking news just in to CNN right now. Defense Secretary Lloyd Austin and as well as the chairman of the Joint Chiefs of Staff, General Mark Milley, they're at the White House right now. They are briefing President Biden on the situation in Afghanistan that has been unfolding and deteriorating for days now. It comes just hours before those military leaders are set to brief reporters for the first time since the Taliban seized control of the country this weekend.

CNN's John Harwood, he is live at the White House. He has details on this. What are you learning here, John?

JOHN HARWOOD, CNN WHITE HOUSE CORRESPONDENT: Kate, those military leaders, of course, are going to brief reporters and President Biden is going to do an interview with ABC's George Stephanopoulos this afternoon that we'll see tomorrow morning. He hasn't communicated directly with the American public much beyond that speech that he gave on Monday. And so this is really a critical moment for the president.

As bad as these images look so far from Afghanistan, the worst has not happened yet. But the decisions that he makes right now with the advice of those military leaders is going to determine whether that remains the case. The military has said they're ramping up the evacuations of U.S. citizens and allies.

It appears, so far, from what we heard from Jake Sullivan, the White House national security adviser, yesterday, that we are doing so at the sufferance of Taliban leaders who are allowing safe passage. Whether that's because of their own need for positive international public relations or because of some leverage the United States financial or otherwise still has over the Taliban, we don't really know.

But how they can sustain that operation is going to be critical to how the American people view the ultimate outcome of this withdrawal from Afghanistan and how they view President Biden's ability to respond to adversity handle a crisis. Hard to overstate the significance of these moments these next couple of days for President Biden.

BOLDUAN: John, thank you very much. And ahead of the briefing from the defense secretary as well as the chairman of the Joint Chiefs this afternoon, I have learned from a source familiar with this speech planning that General Milley does plan at least to take questions after his remarks today. And there are plenty of questions that he will be facing about the situation on the ground there.

And I'm told that part of his message that he wants to convey is in part a message to the troops. He wants to speak to the force. He wants to say that despite the difficult images -- not just the images but the difficult reality on the ground that he is very proud of what the men and doing are doing, the American military, what they are doing and have done. He will be providing an operational update in these remarks. He's going to highlight, of course, and understandably, that the airfield is now up and running once again.


And he will essentially make the case that the way forward is to now keep at it. And he is prepared to say in his remarks that their intention is still to get everyone out of Afghanistan and out of harm's way by that August 31st deadline.

Joining me now is Susan Glasser. She's a CNN Global Affairs Analyst and Staff Writer for The New Yorker. Just your reaction to seeing the defense secretary and Mark Milley at the White House with President Biden ahead of what will be their remarks today as well as what I'm learning a little bit of a preview of what we will hear from General Milley today, Susan.

SUSAN GLASSER, CNN GLOBAL AFFAIRS ANALYST: Look, it's very important. We haven't heard from them. They're overseeing this operation. They're accountable both for the on the ground execution and the questions surrounding the lack of preparation for it, as well as the bigger debate that has once again been resurrected in recent days, the decision itself and the years worth of statements from the Pentagon to the American people about the mission in Afghanistan. And it was always like just a few months away from success. So, I'm sure those questions will come up as well.

But it strikes me, Kate, that there are, as you pointed out, a number of extremely important and unanswered questions so far. Right now, what you're hearing from Washington is a classic example in some ways of Washington truth being different than ground truth. In Washington, the idea is that the Americans have the situation under control at the airport. Then you're airing reports from Clarissa Ward and others on the ground in Kabul. It's very clear that those American citizens and others who might be eligible to flee the country are not finding it easy to get to the airport. We are on the sufferance, in some ways, of the Taliban in terms of their control of the city of Kabul while we were at the airport.

So, I think there's a lot of big operational (INAUDIBLE) finish this by the end of July -- sorry, the end of August, which remains President Biden's stated timetable. It's not clear at all.

BOLDUAN: And I have to say, I mean, the disconnect, I think, is very real. I appreciate the way you say it, Susan, because you always see these images, like what we have seen from L.A. Times Photographer Marcus Yam of just -- I mean, they're brutal. Men, women and children brutalized and beat by Taliban forces is what he witnessed as they were trying to make their way to Kabul's airport. He spoke to Anderson Cooper about seeing these people being assaulted on the streets by the Taliban.

I mean, I think we can safely say that there is nothing new or enlightened about this Taliban despite what they're trying to say now. I wonder kind of -- and I guess I'll say it, like why are we kidding ourselves? Is the Biden administration, do you think, being clear-eyed enough about this? GLASSER: Look, those who follow the region very closely for the last couple decades, you know, that I've spoken with are not at all convinced that this is some kind of kinder, gentler Taliban or that the Talibans were could be good. In fact, many people believe that part of the origins of this sort of disastrous exit from Afghanistan lie in the February 2020 deal that President Trump made with the Taliban. It was supposed to be conditions-based. But my view is that, again and again, the Taliban did not abide by conditions for the reduction of violence and the U.S. continued to leave, continued to drawdown anyways in a way that may have enabled this situation to unfold as it did. So, why are we trusting the Taliban is a key question.

Now, of course, right now, you have several thousand U.S. troops at the airport, but that's the only territory they control. So, this is a very delicate situation. And I would imagine that's part of the reason why in President Biden's speech the other day, you didn't see him more critical of the Taliban, in part because the security and safety of those U.S. troops depends on not breaking into outright conflict with the Taliban in order to evacuate as many civilians as possible, which seems to be the goal of this mission right now.

BOLDUAN: And, look, and we're running out of time, real quick though, I just wanted to get your take if you were surprised. I mean, the NATO secretary general told Berman this morning that he hadn't spoken to President Biden as this was unfolding, that Biden has only spoken to Boris Johnson. Does that surprise you?

GLASSER: Absolutely. I was really -- I have to say, I was really surprised when yesterday, Jake Sullivan, the national security adviser, was doing a briefing and he said that President Biden had not spoken to a single leader. Later in the day, it was announced that Biden then spoke with British Prime Minister Boris Johnson.

One thing that's notable is that the American allies, after months of Biden saying, America is back and we're going to be multilateral, they feel very bruised and that they weren't consulted really by the Biden administration on this pullout.

BOLDUAN: Yes. Susan, thank you for being here for this. We have a lot of breaking news we are covering right now.

I'm Kate Bolduan. Thank you for joining me at this hour. Inside Politics with John King starts now.