J. Stephen Morrison: Welcome to today’s CSIS session, COVID-19 “Variants Rattle the World.” I’m J. Stephen Morrison, senior vice president and director of the CSIS Global Health Policy Center.
This session is sponsored by the CSIS Commission on Strengthening America’s Health Security, which was founded 2018. That work is carrying forward through the end of 2022. We’re delighted that one of our commissioners, Peggy Hamburg, the former FDA commissioner during the Obama administration, will be presiding today.
I want to offer special thanks to my colleague Amith Mandavilli for his careful efforts to put all of the pieces together very rapidly for today and to Anna McCaffrey, my colleague, who also contributed substantially, and a special thanks to all who are assembled here today to speak, Rochelle Walensky, Maria Van Kerkhove, Loyce Pace, Oliver Morgan, John Brooks. They’ll be introduced momentarily by Peggy Hamburg.
Today’s event grew out of a CSIS commentary that my colleague Anna McCaffrey and I published January 22nd, New Variants Rattle the World. We scrambled to put this session together rapidly for a few reasons. We’re at a major moment, a turning point. The variants are threatening to change the pandemic, including the feasibility and development of vaccines and therapies. And there’s a lot of fast-moving questions around what this all means.
(Inaudible, technical difficulties) – what it’ll take to achieve herd immunity, how high the bar will have to be. And they’re adding new urgency in how – in controlling the spread, in accelerating vaccination programs, in creating genomic sequencing capacity, and R&D of adaptive vaccines and therapies. And in integrating efforts globally, we’ll hear about all of these topics today.
We’re also at a major moment when President Biden is renewing the U.S. relationship with the World Health Organization, something that all of us have advocated and we’re delighted to see happening. We want to use today in part to celebrate that and show what it means. The U.S.-WHO relationship and the many collaborations remain vitally important across many fronts, and we’ll hear about that today. We’ll hear about the evolving collaborations.
This is the first of a series of high-level sessions where we will attempt to bring to the table the perspectives of both the Biden administration and senior levels at WHO on very important and urgent matters, along with other experts.
So, we’re delighted that from WHO we have Maria Van Kerkhove, an American citizen. And we have Oliver Morgan, who served at CDC for 10 years.
Over to you, Peggy. Thank you so much for presiding with us, and thank you for all your contributions to the CSIS Commission.
Margaret “Peggy” Hamburg, M.D.: Well, thank you very much. I couldn’t be happier to be with all of you, although I wish that it wasn’t about a topic that is as worrisome and as urgent. But as Steve just said, you know, I think that the emergence of these variants really requires us to rethink and renew our commitment to how we invest in public health, the importance of science driving our actions, the importance of international collaboration and the importance of coming together across these different components to focus in and talk about problems that need meaningful solutions.
And so we hope that today’s discussion will really be a contribution to deepening understanding of these challenges before us and what needs to be done. And for many of us, it’s also our first introduction to our new CDC director, Rochelle Walensky. And so we’re really so pleased that, with everything else on her plate, day 11, I think, into her tenure, that she has chosen to be with us. But she only has 30 minutes, so I’m not going to say anything further on framing the issue but will just quickly introduce our panelists and then get into the substance.
You know, as I said, we have Rochelle Walensky, the Biden administration’s new CDC director, with us. She’s the 19th director of the Centers for Disease Control and Prevention, and the 9th administrator of the Agency for Toxic Substances and Disease Registry as well. She is well-known in the infectious disease community and the public health community nationally and internationally, predominantly from her work on HIV/AIDS, but also the leadership and wisdom that she has provided throughout the COVID crisis. After she leaves, then her colleague John Brooks will be available to stay with us and help be a voice for CDC programs and policies in our ongoing discussion.
We also, as has been noted, have Maria Van Kerkhove, the COVID-19 technical lead of the WHO Health Emergencies Program. And she’s joining us from Geneva, along with her colleague Oliver Morgan. And she has really devoted her life and career to global public health. She’s worked in several different roles with WHO over the years, and also has worked at the Imperial College. She is a U.S. citizen. I don’t know that you’re spending enough time here working in the U.S. or with U.S. institutions, but we’ll welcome you back at any time. But she is just a distinguished and accomplished epidemiologist and public health specialist who I know will help us shed some light on the issues of the day.
And then finally, Loyce Pace, who’s the executive director of the Global Health Council. And she has also been a longstanding leader in global public health and has devoted her career to working not just on programs and policies, but also on the ground in 10 countries or more, leading health programs and mobilizing advocates. Before joining the Global Health Council as president and executive director she had important leadership positions in global policy and strategic partnerships at Livestrong Foundation and at the American Cancer Society. And so she brings a breadth and depth of perspectives and experience to these issues.
So let me turn now – we’re going to first hear from Rochelle. And we’ll have a little bit of an exchange after her presentation. Then after she leaves, we’ll have brief presentations from our other two major panelists, and then time for questions and answers and more discussion before our hour ends. So, with all of that introduction, let me turn to you, Rochelle, first, with a big welcome. And the podium, so to speak, is yours.
Rochelle Walensky, M.D.: (Laughs.) The two-dimensional podium. Thank you so very much. I’m really just quite honored to be with you today. Thank you for that lovely introduction and the invitation to be here. COVID-19 has brought to the forefront how interconnected we are as a global community, and the importance of our international, scientific, collaborative relationships. Thanks to you, Steve, and to the Center for Strategic and International Studies for convening us here today and for this really important dialogue.
The emergence of variants is, of course, concerning and underscores really the essential need for real-time surveillance and increased vigilance in the implementation of public health mitigation measures. So today’s meeting focus is both timely and critical. We know that viruses mutate, and variants that emerge as dominant often do so to some advantage to the virus itself. The higher amount of virus in the community, the more opportunity there is for viral replication and for variants to develop. In the United States, 467 cases of the B117 variant lineage, that originated from the U.K., have been confirmed in 32 states, as of yesterday. In addition, one case of the P1 variant originally detected in Brazil has been identified in the United States, in Minnesota. And three cases of the B1351 variant, first detected in South Africa, have been confirmed in the United States – two in separate cities in South Carolina and one case in Maryland that was reported this weekend.
The available data on these variants suggests that they are more transmissible and may lead to more cases, taxing our already overwhelmed health-care system. And pressing questions remain about the impact of these variants that will – they will have on vaccine effectiveness, severity of disease, and mortality.
CDC has been acting on multiple fronts to increase the surveillance in the United States for variants of SARS-CoV-2. Since November, state health departments and other public health agencies have been regularly sending samples to CDC for sequencing and further analysis. This system is called NS3, or the National SARS-CoV-2 Strain Surveillance, and it is now being scaled to process 750 samples per week and will be increasing to 15(00) samples per week in the coming weeks, geographically distributed across all states. We have also contracted with large national commercial reference labs to look for variants, and expect that these labs will be able to analyze about 3,000 samples per week now and 6,000 samples per week by the middle of February.
As a result of these efforts our throughput of samples has increased tenfold in recent weeks, going from 251 sequences in the week of January 10 th to 2,238 sequences during the week of January 24th , and this may well be among the reasons that we’re finding more variants now. Additionally, CDC has contracts with seven universities that are working with public health agencies to identify variants. We’ve released $15 million to several health departments in the United States to accelerate the integration of next-generation sequencing and bioinformatics into the United States public health system. And we’re leading a coalition of 200 cross-sector organizations to set standards and share information about SARS-CoV-2 sequence-based surveillance.
In addition to these efforts, the CDC is conducting research to assess growth and replication properties of these variants in vitro to establish their fitness and conduct antibody neutralization testing of variant strains to identify potential vaccine escape phenotypes and to help prioritize new mutations of concern. CDC is also engaged with NIH’s Accelerating COVID-19 Therapeutic Interventions and Vaccines, or ACTIV, public-private partnership that aims to facilitate the rapid development of the most promising treatments and vaccines. These efforts are fast-moving and variants continue to spread throughout the globe – throughout the globe. Hopefully, our efforts are moving faster than the variants.
This reality underscores our international – the need for our international collaboration and our regular information sharing. And that is why the CDC is so heartened – I am personally heartened by the recent efforts of the administration to renew our long history of partnership with the World Health Organization. WHO has been a critical partner and connector of public health, in particular in responding to public health emergencies like that which we are in today.
As you know well, the COVID-19 pandemic is the public health challenge of our lifetime. And the rapid emergence of readily transmissible variants across the globe underscores the critical need for strong scientific partnerships internationally. The CDC is committed to that partnership. I am personally committed to that partnership.
Thank you. I look forward to the discussion.
Dr. Hamburg: Terrific. Well, thank you very much. You certainly are joining CDC at one of the more extraordinary moments in time and with so many urgent challenges before you, you know, to begin to understand how to set priorities. But this one has been delivered in your lap. But it is a very, very fundamental public health challenge.
And it’s a reminder, I think, about, you know, the critical importance of public health and surveillance, and applying all of the best tools of science and technology to surveillance. And as you were describing the efforts that are gearing up to do genomic surveillance, you know, I of course was reflecting on the fact that it’s ironic that the U.S., which has led in the area of genomics, you know, for now, you know, several decades, that we should have lagged so far behind in terms of applying that knowledge and capacity to the unfolding COVID pandemic. But what’s also striking to me is that as we build this urgent capacity now to respond to the situation that we’re in, are we doing it in a way that is creating an integrated surveillance system both nationally – at the, you know, local, state, and federal level – and internationally, but a system that can remain in place, also? Because this kind of surveillance needs to be applied to many other challenges, both routine and of course we all recognize that this may hopefully be the worst pandemic of our lifetimes, but these kinds of infectious disease threats will continue to occur.
Dr. Walensky: I think you raise a fundamental point that I’ve been thinking about in our response from a public health standpoint. So, first, we have to get out of this pandemic. That’s got to be the first 10 things that I do as part of my job. However, if we get out of this pandemic and we don’t set the table for future generations in some several key areas that we missed coming into this pandemic, we will not have done anyone a service.
So we have to rebuild the public health infrastructure because it was frail to start. It was never able to take on small outbreaks, never mind really large pandemics. We need to rebuild that.
We need to rebuild the data systems so that when we have – when the data are starting to emerge, we can actually recognize the new trends. We could have seen this coming. I often will look back at our own state and see that there was influenza-like illness happening in February and March before we had tests, and yet influenza itself was coming down. Is this something that we should have detected if we had seen better case detection, better surveillance?
And then, of course, the surveillance system that you are talking about.
So the final piece of that, I will say, is the health equity piece. If we are focusing on that now, if we’re focusing on it in COVID and we’re discussing that through COVID, if we only let it go there, we will have done a complete disservice. We need to make sure that the focus on that here is going to be throughout.
So the big – the overall response is we have to make sure we – (laughs) – can get to enough surveillance right now, but that itself is not enough. We need to make sure that we’re building the infrastructure and the systems so that they are in place for not just COVID, but for all the infectious threats that come after it and that are here now.
Dr. Hamburg: Yes. Well, as we sort of learn more about these variants and where they are and how they’re moving and the impact, obviously, that they’re having on spread of disease, and also the ability of new therapeutics and importantly vaccines to protect against the SARS-Coronavirus-2, I just wanted to sort of dig a little bit deeper into where we are. You know, you were talking about how the U.K. strain clearly is causing enhanced transmission and spread. There has been some confusion, I think, in the coverage of this about whether it’s actually more lethal. And of course, more studies need to be done, but is it that the virus itself is more lethal or that it’s overwhelming the health-care system and so the quality of care and the ability to manage patients has declined? Is there more evidence on that? I noticed you did not say that it was more lethal, but I have heard others say that.
Dr. Walensky: So when we think about these variants, I think we worry about things in sort of four buckets. One is, is it more transmissible, as you suggest? Is it more lethal? Does it affect our treatments? And does it affect our vaccines?
So I – there are increasing data that suggest that it is somewhere between 50 and 70 percent more transmissible. That has a lot of implications for our – for what is needed for herd immunity and things like that. So I think the data are relatively strong and increasing that it’s more transmissible. And from what the virology experts will tell me, that’s probably the worst one, actually, because if you have more transmission then everything downstream from that actually increases as well.
However, we also have now four relatively small studies out of the U.K. that have suggested also that not only is it more lethal, but it may – more transmissible, but it may, in fact, be also more lethal. I do think we need more data in this area. The increased rates of mortality have been anywhere between 30 and 90 percent. But, again, small studies. And so I think we have more information that we’re going to need. And we’ll see more there.
In terms of vaccines, data are starting to emerge right now. The press release from J&J suggested that there was perhaps a small hit to vaccine efficacy in the B117 strain compared to the native strain, but that overall I think the vaccine efficacy data from J&J were really quite good, especially when you look at the rates of severe and deadly disease, hospitalizations, which were really pretty well averted by the vaccine, to the efficacy of 85 percent. So I think overall we still have a lot more that we need to learn. There are data in the lab, in vivo data that suggest that suggests that – from pseudoviruses, and it suggests that our current Pfizer and Moderna vaccines are actually working – have the potential of working pretty well against the B117 strain. And I think we have a lot more to learn.
Dr. Hamburg: Yeah. Well, I guess that in terms of the ability to evade the immune system there’s more to worry about when we look at the variants that have emerged in South Africa and Brazil. And it looks like there the vaccine efficacy may not be quite as strong. But still, you know, adequate to prevent serious disease and death, and certainly a considerable protection.
But maybe you can tell us a little bit about what the role of the CDC in partnership with the other public health agencies is, in terms of making sure that the right studies are getting done, both by the companies and in other settings, to really better understand what the impact of new variants may be on the vaccine efficacy, as well as maybe touch on what the thinking is – I mean, we’ve heard that there may be investments in developing new vaccines for potential boosts over time. And of course, the mRNA technology for vaccines in particular lends itself to being able to quickly, you know, develop, using that platform, a new vaccine. So maybe a little bit about the impact of these new variants on the research and development agenda.
Dr. Walensky: Yeah, that’s – it’s a key point. I think there are numerous spaces that I think we need to think about. One is this active collaboration that we’re in collaboration with, with BARDA, DOD, NIH, as well as the CDC, so that when these variants emerge, when we actually have access to them, we can do – we can do science in the lab to look at whether neutralizing antibodies from either convalesced patients or from vaccinated patients is actually effective against this variants. And there’s a lot of cross-scientific collaboration and sharing there.
I think we need to really start thinking about how we’re going to do population-based vaccine efficacy studies in the context of variants. What will the cohorts look like? How will we know? And our team is working actively on that right now, to sort of set up cohorts that’s not just through passive surveillance of this person had gotten a vaccine and therefore – and how they’re infected, now we need to look. So I think there are a lot of studies underway in the – in the basic lab, but then also at the population level, to say: How are we going to collect the data on the vaccine failures? That’s not as easy as it otherwise might seem. We don’t want to be passive about it.
And then finally, we want to be ahead of this. We have the great gift that these mRNA vaccines can be tweaked. And so the fact that they can be means that we should be starting to do that now. There’s a lot of vaccine that’s been purchased already, but I’ve been told – (laughs) – in not my words – that we’re not – we didn’t buy the Chevy, we bought the Cadillac. And whatever is the best vaccine for whenever it is available, that’s the one that we’ll be getting. So it may be that we have a two vaccine and then a booster suggested. It may be that we have bivalent or trivalent vaccines. It’s not exactly clear where our steady state will be and what will be the vaccine to knock out whatever is left in the steady state. But we’re working to try to get ahead of any of those potential.
Dr. Hamburg: Great. Thank you. There is a question from the audience I just want to ask you quickly, and then I want to see if Maria and Loyce want to respond a little bit to what you’ve been saying before I know you have to leave. But the question from the audience is: What’s the best way to communicate information about variants in the public without undermining trust in vaccination efforts? And I guess along with that is the challenge of communicating at this critical time about the importance of the continued nonpharmaceutical interventions – the masks, the social distancing, avoiding, you know, large congregant settings, et cetera.
Dr. Walensky: You know, this – you’re talking about a really key point. You know, people are saying, well, what are we going to do about the variants? And the truth is it’s the same disease, right. We’re going to do the same thing for the variants that we’ve been doing all along. The problem is that not everybody’s doing it.
I just looked at some data out of our two South Carolina variants. You know, there were at least 15 contacts of people among – of both those variants, and masks were not worn at all. So it’s really – or at least to my knowledge. But limited mask wearing is my understanding in those contexts.
So it is probably the case that everything that we should be doing for the disease, we should also be doing for the variants. We are going to have a lot of communication challenges as we start seeing the data from these trials that are going to suggest that one vaccine against one variant may have less efficacy than another.
But I think we have to communicate often. We have to communicate in plain English. We need to be really transparent about what the data show. And quite honestly, the outcome here that we’re trying to avoid is death and hospitalization. And the vaccinations that we’re – the vaccines that we’re seeing work against those end points. And so we really – I think the messaging has to be consistent and clear. We also need to convey that we’re doing the science actively, and we have to be humble in what we’re going to learn.
Dr. Hamburg: Well, thank you. And we’re fortunate that you have real communication skill – (laughs) – though it’s a very hard job.
Maria, you want to just weigh in a little bit before we lose Rochelle?
Maria Van Kerkhove: Well, thanks very much, Peggy.
And Rochelle, you’ve made my job easy in outlining all of these major issues. I mean, I think what you’ve outlined is the different aspects of trying to understand these variants of concern in real time. We are seeing science happen in real time. We are seeing collaboration. We are seeing innovation. We are seeing data sharing.
I think it’s foreshadowing what we are going to have to do into this year. You know, the virus is under pressure. This is what viruses do. This is part of the evolution of these viruses. And we’re in a situation now where we’re having events within events. And I think that what we are seeing is that we want the world to understand that there’s a process in place, to evaluate each of these mutations, each of these variants, in terms of transmission, in terms of severity, in terms of potential impact on diagnostics, therapeutics and vaccines.
Right now, as you’ve pointed out, we’re in a situation where diagnostics and therapeutics and vaccines work. But we may be in a situation where that changes. We need to be on this where we have good eyes and ears around the world. And how you describe the situation in the U.S., we’re trying to do on a global scale so that we can have that level of surveillance and eyes and ears in every country. And that’s a pretty tall order right now in a challenging situation to start.
But the last point on communication, I couldn’t agree more – open, honest, regular, humble. You know, we won’t always get it right, but we have to tell the world that we are in this together and trying to understand this together. So just to reemphasize just some of those points, I think, is really, really critical. And we’re with you on this. You know, I think all scientists together are fighting the same virus. Variants are not. And we are in this no matter what. So our goal is to suppress transmission, save lives, and end this pandemic. And we will definitely do that together.