On March 26, 2021, the COVID Pod team welcomes Dr. Ashish Jha again to discuss expanded vaccine eligibility coming soon to Rhode Island, how to address ongoing vaccine hesitancy and what the summer and next few years will look like after more people are vaccinated. Dr. Jha also provides his perspective on the confusion surrounding the AstraZeneca vaccine. The team also breaks down the sweet incentive Krispy Kreme has in place for vaccinated Americans and the pros of promoting vaccination for COVID-19.
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Cate Ryan
Hello and welcome back to another episode of the COVID Pod with Dr. Ashish Jha. Today is Friday, March 26, 2021. My name is Cate Ryan, and I’m joined by Emilija and Rahma.
Emilija Sagaityte
Hello my name is Emilija Sagaityte, and I'm a senior editor at The Herald.
Rahma Ibrahim
And I’m Rahma Ibrahim — a Science and Research section editor at The Brown Daily Herald.
Cate Ryan
We are happy to be speaking with Dr. Jha again, and with the recent announcement here in Rhode Island that all adults will be eligible for the vaccine by April 19, today’s conversation is centered around ongoing vaccination efforts. On that note, we also talk about how to make sense of complex science and communications controversies surrounding the AstraZeneca vaccine. Dr. Jha also gives us his perspective on the Krispy Kreme Donut effect. Stay tuned to find out more, and thanks for listening.
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Emilija Sagaityte
One of the things we wanted to start off talking about was more of a positive note, I guess, in regards to vaccination. As I'm sure most people here have heard by now, we have Rhode Island eligibility for the vaccines, at least for adults, opening up on April 19. And so it seems that we're pretty quickly moving along with our timeline of having this ability to vaccinate all adult Americans by May 1. But can you talk a little bit (about) in practice what this will look like? So what that date actually means in terms of when people will then actually be able to get that vaccine?
Ashish Jha
Yep, absolutely. No, I think it's fantastic. And I think in places like Rhode Island, it's a sign that things are going well, that people are getting vaccinated. I worry a little bit, and I say that about Rhode Island, because again, our numbers have really come up a lot in terms of proportion of people who've gotten at least one dose. There are some states like Georgia, Texas, Utah that went to eligibility for everyone right away. And for them, I actually worry that it may be a sign of a lot of hesitancy among older people and high-risk people that they're having a hard time filling their slots. So we've got a lot of work to do on vaccine confidence which we can come back to. But here in Rhode Island, I think April 19 is a great sign. It does not mean that everyone's going to get their first shot on April 19. And, you know, I expect that the first few weeks are going to be like with everybody then coming in, it's gonna, it's gonna take a little while for people to get the appointment. So you may not get your first shot until May 1, you may not get your first shot until like, first or second week of May. But I'd be very surprised if people can't get a shot until like late May or June. I just think that's unlikely. And so I think everybody will get their first shot by — who wants one obviously — by first week of May, second week of May at the latest. And then that means people will be fully vaccinated by mid-June or certainly by the end of June, which I think is fabulous and completely in line with what I've been expecting. And that's why I've been so optimistic about what I think is gonna be a great summer.
Emilija Sagaityte
Yeah, I think a lot of people are really looking forward to that, at least, like having that option open. But you bring up an interesting point that I kind of want to follow up on. So in terms of, I guess, the vaccine supply, because it sounds like we do have a good amount of vaccines then if we're able to open this up, but you mentioned vaccine confidence could be playing a role. So what is the imminent April 19 data actually telling us about that vaccine supply? Both then I guess, in Rhode Island, but then also how would that compare to other states in the country and also the rest of the world? And should we be doing, like, anything else then to promote global vaccination?
Ashish Jha
So it's a great question. And I guess, you know, there's been a debate for months now, among several of us about when does the supply outstrip demand. Like, right now, we're still in a demand greater than supply, right. There are a lot more people that want a vaccine than can get one today, across America, and even in pretty much in every state, that's true. But, you know, the debate has been, when does that flip? And I've always said that I thought it was sometime in mid-to-later part of April is when that would flip. And I think we're kind of on track for that right now. And, you know, we may see in mid-April, when the eligibility opens up to everybody that for a week or two, it's hard to get an appointment, but sometime around, certainly by May 1, you will have a point where, like, supply will not be the problem. And we're building up a lot of distribution capacity in Rhode Island, so distribution won't be a problem. It won't be like we’ll have vaccines, but nobody to give the vaccines out (to). And so then if vaccine confidence becomes the major issue, if demand becomes a major issue, you don't solve demand problems overnight. Like that requires a lot of work. And there are two separate sets of issues in my mind around demand that I want to mention.
One is we've confused lack of access and lack of information for hesitancy when we're talking about the African American community. Like there's a lot of talk about hesitancy in the Black community in America. There's actually not a lot of hesitancy. There's lack of access, there's lack of good information. And so that has one set of solutions. But there is real hesitancy among people who are particularly more conservative, more white rural voters. And that requires a whole different set of strategies. It's not just about access. It's really about building up confidence and recruiting trusted voices to build up that confidence. And that work has got to get going, like, yesterday, because we're going to want a large majority of Americans to get vaccinated, especially since we're not able to vaccinate a lot of kids for many more months yet. And so if there's a large chunk of adults who are not vaccinated, and no kids are vaccinated, it's a much bigger problem. And so we need to do a lot of work on that.
Rahma Ibrahim
And I think just talking about vaccine hesitancy, and I know we’ve discussed this before, what do you say to people to encourage them to get vaccinated?
Ashish Jha
I first want to just understand what's holding them back. Because it's rarely one thing, or I should say, it's rarely the same thing for everybody. For some people, it may be, “Oh, I hear that like, after you get your shot, you have to be out for two days, and I can't afford to take two days off of work.” That's a different kind of hesitancy problem than, “I don't really believe in Big Pharma and therefore I'm not taking the vaccine” or some people who are just genuinely like, you know, “These vaccines were developed really fast, and it gives me pause, and I have questions.” And all of those are totally different. They all need addressing, and they're all important. And so for people who, for instance, say, you know, “These vaccines have been developed very fast, and I really have concerns about how quickly,” I say, “I get it and let's talk about that.” And of course, I think for them, talking about how these vaccines have been tested more thoroughly than almost every vaccine or drug that's out in the marketplace. These vaccines have gone through randomized trials with hundreds of thousands of people across all these different vaccines that are out there. It's rare that you see a drug or vaccine tested that well. So there's a lot of reasons to be confident, but you have to just understand what's holding people back and really try to address that.
Rahma Ibrahim
And another incentive it seems like is maybe getting a Krispy Kreme donut.
Ashish Jha
Let's talk about Krispy Kreme. I thought that was fabulous. So you presumably saw my tweet about this. I did not run it by my any of my public health colleagues who work on obesity and — but look, so for those of you who are not following this on Twitter, Krispy Kreme put out a statement saying anyone who shows their vaccination card gets a free crisp glazed Krispy Kreme donut every day, for the rest of the calendar year.
Now, as a physician, and a public health person, I can't recommend that people eat a glazed donut every day. But I do believe two things. First, I think things like this are great because they sort of shine a light on companies saying, “Hey, we think this is a good thing and want to encourage you to do it.” And second, there may be some people out there who, for whom this sweetens the deal a little bit, this tips them over. And, you know, there are a bunch of public health people who got very upset, and they said, “Oh, this could worsen cardiovascular disease,” and my response is, people, like we’re in a pandemic, let's get through the pandemic.
There's a lot of things that have gone wrong in this pandemic, there are a lot of ways that people have had to manage getting through it: Alcohol consumption has gone up, people have gained weight, people have stopped exercising, mental health issues. If a small number of people eat a few extra donuts, sure, it's not perfect. But it's really not going to show up in the top 100 public health challenges of the pandemic: the Krispy Kreme donut effect. So I just feel like, you know, we've got to have perspective. And my only sad thing about all of this is there are no Krispy Kreme donut places in Rhode Island or in Massachusetts. It's not within driving distance. I'm just not going to drive three hours for a free donut. So that's the only downside here, and what I'm hoping for, to be perfectly honest, is a matching or maybe even a better incentive from Dunkin Donuts. So we'll see what happens.
Rahma Ibrahim
Yeah, hopefully a lot of incentives for people to get the vaccines.
Ashish Jha
Absolutely.
Rahma Ibrahim
So I guess going back to opening up eligibility for vaccination, how do you think life may be different for people who get the vaccine versus those who don't, this summer? Or maybe if we have enough people getting the vaccine and reach herd immunity, how may things look different in general in the summer and in the near future?
Ashish Jha
Yeah, life really does change after you've gotten vaccinated in terms of what you can do safely. And obviously, some people have been doing things that are not super safe, even without the vaccine, but then a lot of them have gotten sick, and they’ve gotten other people sick.
You know, I had my first indoor gathering with two other colleagues, for a couple hours this week, all three of us have been vaccinated for a while. But we got together at somebody's home for a drink. And it was, first of all, it was weird. Because, like, literally have not been inside anybody else's home for any period of time without a mask on. So what it reminded me of was that there's going to be a bit of a re-entry feature that, like, it's gonna take a little while for people to get back to be comfortable doing things that we used to do before the pandemic.
Second, the vaccine really does allow for a lot of things we value to become safe. And people need to understand that and if that's not a motivation for getting vaccinated, I don't know what is. And you don't just protect yourself, you protect people around you who may not be vaccinated. If a large portion of adults end up not being vaccinated, and we don't get anywhere near herd immunity, it's going to be a challenge because we're going to continue seeing outbreaks. Of course, the vaccines are not 100 percent. And so if there are large cases of numbers happening, that means even people who are vaccinated are at a little bit more of an increased risk, though I don't think a lot. You're going to see more and more companies, businesses, private organizations requiring vaccinations, and so people who are not vaccinated are gonna start missing out on things.
Rutgers University just announced yesterday that if a student wants to be back on campus in the fall, they’ve got to be vaccinated — first university that I know of that's made that. I personally believe that that's what universities should do. They should make it a requirement. I again, by the way, just to be clear, like I don't, that's a broader policy decision at Brown that is going to be made at the highest levels. And I don't, I know it's not my decision to make. But my recommendation, which has been very public, is that every university should do that. And so if more and more places are requiring it, life is going to become less — it's just gonna be harder for people who've chosen not to be vaccinated. And that goal is not to make their lives miserable. But it is to say there is a bit of a civic duty here, like if you get vaccinated, you protect yourself, you protect people around you, you protect the whole country, people should do it.
Rahma Ibrahim
Knowing that children aren’t eligible for the COVID-19 vaccines yet, how may that impact what’s considered a safe summer plan for an otherwise vaccinated family?
Ashish Jha
Yeah, it's a very good question. So what to do with things like family vacations or gatherings with vaccinated adults and unvaccinated kids. So, Professor Emily Oster wrote a piece in The Atlantic that got her a lot of grief from a lot of people. And I thought the grief was unwarranted. She was making an important set of points. She's, by the way, for people who don't follow Emily Oster, you should, she's just been terrific in this whole pandemic before the pandemic too, but certainly in the pandemic. And some of it got a little distracting because of the title of her piece, which she didn't write, the journal writes the title. But to make a long story short, the good news is if lots of adults get vaccinated, if most adults get vaccinated, and we get infection numbers really low, that obviously has a huge protective effect on kids, because there's not that much infection to have. The other piece of good news is kids don't get very sick, usually. And so their risk of having a bad outcome from getting infected is thankfully very low. You know, kids are not completely immune, and they can spread. And so what that has meant, in my mind, is, you know, my wife and I have been talking about family vacation this summer. And our thinking is, yeah, like, that'd be good. And the way we've thought about it, it's like, we're going to be more careful with our children. Like, we probably wouldn't go to a large indoor gathering, where there are hundreds of children. Just because we don't think that's a good idea. But vacation where we are outside mostly, that's probably reasonably safe. And then there's some gray areas where, like, would we do indoor dining as a family? And in an area with very, very low levels of prevalence, I would. In areas where there's more outbreaks happening, I probably wouldn't. And so there's a gray area there. But I think as adults, you obviously can. So I think there's going to be a little bit of an adjustment. But once adults are vaccinated, and especially areas where there's very low levels of community transmission, kids should not be a major reason for dramatic behavior change among adults.
Cate Ryan
I think that's really helpful for families that are planning the future. And I wanted to ask sort of a separate question about vaccination, which relates to the AstraZeneca vaccine, which I know you've been vocal in the past about how this could help global vaccination efforts. And honestly, for me, the news cycle on this vaccine has been a little hard to follow and confusing because AstraZeneca faced accusations of cherry-picking efficacy data, and also, adverse effects reports associated with the vaccine indicated that it could cause blood clots, but then I know, that has been sort of, I don't know, the media has been talking about that. But it's hard to sort of follow the science. So I was wondering if you could tell us a little bit: What do we actually know about this vaccine? What are the potential cons but also potential pros of the AstraZeneca vaccine? And yeah, what do we know so far?
Ashish Jha
You know, so here's the bottom line, and then we'll talk more about all of that. It is a pretty good vaccine. It's a pretty good vaccine. And I've had family in India, get it. They've called me before and say, “Should we?” And I'm like, “Absolutely.” So like, that's me voting with my feet, right? I mean, it's not available in the U.S., so I couldn't get it. But definitely encouraging family in India to get it. I have friends in the U.K. who have been getting it, I think it's great.
AstraZeneca has managed the clinical trial communication and regulatory stuff about as badly as any company can. The trial itself has been fine. Like there's no problems with the clinical trial, the science behind the clinical trial has been good. They've had a few mess-ups actually, in the ways that they designed dosing. And the reason why the FDA did not give it authorization last fall, and said to them, “Design and execute a really high-quality trial,” was because there was a little bit of messiness. But they've done that with the U.S. data. And my guess is, and again, we'll see the full set of data soon, is that it's a well-designed trial.
But my god, these guys do not miss an opportunity to mess up on the communication. The way they've dealt with the FDA in the fall when there was a potential adverse event, the way they dealt with the release of the efficacy data this week. Sounds like they had problems dealing with their data safety monitoring board. I don't understand. We've not seen this kind of mess up from Johnson and Johnson, Moderna, Pfizer. Like, look, there's a set of rules for clinical trials, we have a set of safeguards to make sure clinical trials really are safe, and that they produce high quality results. It's hard. You got to follow the rules really tightly. Everybody else seems to figure out how to do it. And AstraZeneca seems to keep — it almost feels like they've got somebody who's never done this before. There is a problem, which is AstraZeneca has not built vaccines before. This is not their area of expertise, whereas J and J has, Pfizer has, but Moderna hasn’t, and Moderna did it well. So I don't understand what's going on in the company in terms of communication and regulatory stuff. And I'm worried that it spills over into people's confidence of the AstraZeneca vaccine. And I guess what I will say to people is, you know, get the vaccine if that's the one you're eligible for. But, you know, don't take your communications lessons from the AstraZeneca company.
Cate Ryan
Yeah, I think sort of going off of that, how do you think this represents a case study or example of how a company's communication or even the news, or the media's portrayal of certain events related to public health, and in this case vaccination, can impact people's perceptions or their actions and their health?
Ashish Jha
For people like me, who follow the data very closely, I can shrug my shoulders at the changes in the efficacy data and say, “I know what's going on, it's not a big deal.” But most people don't do that. And vaccines are a source of concern for some chunk of people, and they want to know that it's being done well. And I think things like what AstraZeneca has done with this, with other things in the development of the trials, really harms people's confidence in all vaccines. I've had now people come up — not come up, not physically, because that's largely not happening, but you know, by email, or phone or other methods — reach out to me and say, you know, “Is this a problem for all vaccines? Is there cherry-picking everywhere?” I'm like, “No, it's not a problem for all vaccines. No, there are not blood clot problems happening with other vaccines, nor do I think with AstraZeneca.” But I think it has these large spillovers that are really important to not mismanage, and under normal circumstances, you'd sort of blow it off and say, whatever. But we’re in a pandemic, where vaccine confidence is our ticket out of the pandemic. And then for a company to mess this up this badly is, you know, borderline criminal.
Cate Ryan
Yeah and I guess going back to the blood clots. What is your understanding of the correlation between the AstraZeneca vaccine and blood clots and what should people think about that?
Ashish Jha
It's pretty complicated. There have been some blood clots after the vaccine. But there are people who are high risk of developing blood clots who have gotten vaccinated and you'd expect a certain proportion by random chance alone. And then we also know COVID causes blood clots. So, you know if your question is, is there a definitive proof that these vaccines cause blood clots, there isn't. Is there some hint that they might? Maybe, but extremely rare. Do we need to sort that out? Absolutely. You know, in the U.K., they've given out, I don't know how many — 12, 13 million doses, maybe more. Not seen rampant number of blood clots. And then the alternative is to remember that this vaccine protects you from COVID. And your risk of blood clots and other complications are much higher if you get COVID. So it's not, you can't look at this stuff in a total vacuum. But my best guess of the data, and this is really just a guess, is there may be a tiny increased risk in certain populations. But it's exceedingly small. And we don't know that for sure. And we need to sort that out. But that risk pales in comparison to the benefit.
Cate Ryan
Yeah, I think that it's important to think about weighing these pros and cons and promoting vaccine administration. So thank you for that. The last question I had about vaccines was just as we begin to see more people getting vaccinated in Rhode Island and in the country and in the world, how do we start to think about what it will look like, in a few years, I guess, like, will the vaccine be something that we need to get again, next year, the year after that, like going forward forever? Or is it something that maybe we would just get now? And how is COVID going to continue to peak? And how will that affect vaccination going forward?
Ashish Jha
Yeah, fabulous questions. We don't have a whole lot of answers. But (what) I will say is the following, which is I don't expect that this will be a once-and-done vaccine. You know, we don't know how long immunity lasts from these vaccines, I expect them to last for a while. What's a while, at least a year, probably longer. But there's a lot of science to sort all that out. And how do you assess whether somebody’s immunity is starting to wane? I mean, obviously you can look at reinfections or infections after vaccination. But there's a lot to sort out. I think we'll know more in the months ahead. I don't think people are gonna need booster shots for waning immunity anytime within a year, but I can imagine a year or two years down the road. So let's imagine that it is annual. Okay, so once a year, you get a COVID booster shot. Will we need that for the rest of our lives? No, I doubt it. The virus is going to evolve, there will be selection pressures, and the virus will over time become less and less important. And we'll get better at our vaccine development and will develop ways of making longer-lasting vaccines, we’ll probably have vaccines that are multivalent, meaning kind of capturing different elements of the virus. And that'll give us better protection. And I could easily imagine that we get to a point within a couple of years where you're getting a vaccine, and you have to renew every five years. Something that makes it something you got to deal with, but not a major part of your life. A lot we don't know in terms of how the virus will evolve. But mostly, I'm really optimistic that this will not be something we have to deal with in a significant way. And if everybody needs a booster shot next year, at least in my mind, that's not a big deal. Right, just go in and get your booster shot.
Rahma Ibrahim
Yeah, as we usually do, we wanted to wrap up this episode by asking if you had any good news or general updates that people should be aware of at this point.
Ashish Jha
Yeah, so the one thing that has come up, I think it's since the last time we spoke, is there was a really big study out of Denmark, that looked at reinfections for people who had been previously infected trying to basically figure out how much protection does being infected give you. So for people who are listening who have been infected, and you're asking yourself, am I good to go once you've recovered? The answer is moderately good to go, you have about an 80 percent protection over about six to eight months. So not quite as good as our best vaccines. But much lower if you're over 65. And it's a reminder, at least in my mind, that while natural infection gives you, you know, a moderate level of immunity. Everything I know about this virus so far suggests that vaccines probably give you much better immunity than natural infection. And so even if you've been previously infected, you should get a vaccine, it'll substantially boost your immunity and protect you for much, much longer. Previous infection is not a good enough reason not to get vaccinated.
Cate Ryan
Thank you for sharing that. And I think just before we end, I also wanted to just note that next time we meet will be our last episode. So we are looking forward to having that conversation. But I think it's kind of a good sign I guess that we've gone through this academic year together and talked about all of these changes and developments with the COVID-19 science and the vaccination efforts. And I'm at least optimistic given all the conversations we have had this semester compared to last semester, all the things that we know now. And so we will reflect on that next time in early April when we meet again. But thank you, as always, for meeting with us and answering our questions.
Ashish Jha
Oh, my pleasure. And that's, it's fun. I'm looking forward to our next and final episode. And, you know, I think we can be forward-looking as well, I think it'll be good to reflect on the year that just passed. But we can be forward-looking about what I think is going to be a terrific year ahead. For people who are coming back to Brown in the fall, who are not graduating, and then for those of you who are graduating, a terrific year ahead in terms of moving on with your life and doing new and exciting things in a new world. I mean, you know, the thing I've said this before, and I'll probably end up saying it again, is pandemics open up opportunities to reimagine the world, they scramble the rules. And so we get to ask not, do we go back to normal, but like, what do we want our new normal to be? And it's an incredible opportunity. Again, I don't wish it on anybody, like I wish we had not had this pandemic. But since we've had it, let's use it as an opportunity to build back a new and much better world. And maybe we can spend a little time talking about what that might look like.
Take good care. And I'll connect with you guys in a couple weeks. Be well.
This transcript has been edited for length and clarity.
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Produced by: Cate Ryan
Reporting contributed by: Emilija Sagaityte and Rahma Ibrahim
Sound mixing by: Cate Ryan
Music composed by: Katherine Beggs ’22.5
Special thanks to Bilal Ismail Ahmed and Elise Ryan for cover design.
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