May 17, 2021 -- The United States will send at least 20 million doses of U.S.-approved COVID-19 vaccines abroad by the end of June, President Joe Biden announced Monday.

“Over the past 118 days, our vaccination program has led the world, and today, we’re taking an additional step to help the world,” he said at a news conference. “We know America will never be fully safe until the pandemic that’s raging globally is under control.”

His administration will send 20 million doses of the Moderna, Pfizer, and Johnson & Johnson vaccines, in addition to the 60 million doses of the AstraZeneca vaccine already set for shipment to other countries.

“No ocean’s wide enough, no wall’s high enough to keep us safe,” Biden said. “Rampant disease and death in other countries can destabilize those countries and pose a risk to us as well.”

He said this move will help prevent new variants from springing up around the world and making their way across U.S. borders.

Global Impact of the COVID-19 Crisis in IndiaWebMD's Chief Medical Officer, John Whyte, MD, speaks with Amesh Adalja, MD, senior scholar, Johns Hopkins Center for Health Security, about a variety of topics including the global impact of the crisis in India, vaccines, summer, immunity passports, workplace policies, and political leadership.930

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JOHN WHYTE: Hi, everyone.

I'm Dr. John Whyte, Chief

Medical Officer at WebMD,

and you're watching Coronavirus

in Context.

A lot has been happening

over the past few weeks,

so to help break down the latest

data,

provide insights

on the recent guidelines,

I've asked Dr. Amesh Adalja.

He's a senior scholar at Johns

Hopkins Center for Health

Security.

Dr. Adalja, thanks for joining

me.



AMESH ADALJA: Thanks for having

me.



JOHN WHYTE: Let's start off

with, how concerned do we need

to be about what's happening

in India?



AMESH ADALJA: What's happening

in India, I do think,

is something that everybody

should be concerned about.

Because when you're talking

about an infectious disease

outbreak, one with a highly

contagious virus,

if the outbreak is not

controlled

in all corners of the globe,

the rest of the globe

will remain at risk, the world

will remain disrupted,

and we will really not have

control of this pandemic.



It's even more important

that this is happening in India,

because India is a place where

they export vaccines, where they

are part of major global efforts

to vaccinate the developing

world.

So the fact that India now has

to turn its attention

to its domestic problem

is going to, also, cause

a supply constraint

for the developing world which

was relying on Indian

made vaccines,

such as the AstraZeneca vaccine,

to vaccinate their population.

So this is going to be something

that will delay the control

of the pandemic

and have a ripple effect outside

of India

to the rest of the world.



JOHN WHYTE: On

a practical basis, in the United

States, is it an issue

that if the virus isn't

controlled

there's going to be

additional mutations, more

variants that, perhaps, can

evade the current vaccines?

Is that a major issue going

on here that then could require

more boosters?



AMESH ADALJA: Any time the virus

is spreading

in an unchecked fashion,

you're going to have

the generation of new variants.

Most of those variants

are going to really not have

much consequence,

and some of those variants

are going to be concerning

because maybe they're more

contagious, such as the variant

that is spreading right

now in India.

It's very hard, however,

for a variant to completely

evade a vaccine.

Although people talk

about vaccine escape variants,

it still appears

that our vaccines,

from the variants that we've

seen, have the ability to stop

what matters,

serious disease,

hospitalization, and death.



So while it's very important

to think about immunizations,

I also don't want to go too far

on the other side and kind

of envision a super virus that's

able to evade our vaccines

completely.

But the point is, we don't want

more contagious variants,

we don't want to deal

with variants.

We don't even want to be

in conversation about boosters.

So the quicker we can get spread

contained, the quicker we

can get the population of India

vaccinated, the less will even

have to think

about these hypothetical

possibilities.



JOHN WHYTE: And you've been

talking about herd immunity,

what it means.

Some people are saying it's 80%,

other people say it's 70%.

How do we factor

into those people who have

gotten COVID, which is probably

an underestimate.

Does anyone really know what

the right percentage

of vaccinated

needs to be to get this virus

under control?



AMESH ADALJA: Not exactly.

So herd immunity

is a mathematical formula,

and you can come up

with the number of 70%, 80%,

but there's a lot of assumptions

in that number.

One is that the population is

homogeneous, meaning

that everybody is at equal risk

for getting infected

and spreading it, and that's not

true.

We've seen in other types

of mathematical studies

where a herd immunity threshold

can be lower if the people who

actually spread the virus

in the community

are the ones who have immunity

through a combination

of vaccination

or prior infection.



And if you look at countries

like Israel,

they had a precipitous decline

in cases when they got to about

40% of their population

fully vaccinated.

So I do think herd immunity is

an important milestone to cross,

but I think we'll still see

benefits even before we get

to herd immunity, probably

around that 40% fully vaccinated

range.

And the other point is that herd

immunity isn't everything.

What we were trying to do

with the vaccine program

was not to induce herd immunity

rapidly,

but to remove the ability

of the virus to cause

serious disease,

hospitalization, and death.



And that's why we vaccinated

in the United States, not

the people who are spreading

the virus first,

but the people who were at most

risk

for requiring hospitalization.

And I think we've been

successful in that regard.

Just walk through a hospital

now in April or May of 2021

versus January of 2021,

and you can see what

these vaccines have done.

So I think

that the primary objective

of the vaccines

was to remove the ability

of this virus to threaten

hospital capacity,

and that's largely been achieved

in the United States.



JOHN WHYTE: So it's a success

of the vaccination program,

particularly in the elderly,

where 85% have received at least

one dose, nearly three

out of four

have received both doses

and been fully vaccinated.

I want to ask you what everyone

else wants to know, get

your best predictions.

How is the summer of 2021

going to be different?

Is it going to be more

like the summer 2020 last year

or is it going to be more

like pre-pandemic summer

of 2019?



AMESH ADALJA: The summer of 2021

is going to look more

like the summer of 2019

than it did the summer of 2020.

We have a substantial proportion

of the population vaccinated.

We do not have concerns

about hospital capacity.

Anybody, really, who wants

to have a vaccine that's

eligible is able to schedule

themselves to get a vaccine

and usually can get that vaccine

pretty readily.

So I think that you're going

to see more activities being

able to be partaking in.

We've got a lot

of epidemiological data

on outdoor spread

so those types of activities

are going to probably be very

close to normal, I would assume.



It's all going to also depend

upon which state you live in.

Certain states have

certain restrictions, other ones

do not.

But as I think we get

into the summer,

I think we're going to be

in a point

where a lot of pre-pandemic life

is going to come back.

They're still likely will be

some concerns in certain states

with mass gatherings

because not enough people have

been vaccinated.



And we will still hear

about cases, we will still hear

about people getting exposures

and getting quarantined,

but they're going to be

of a lower cadence.

They're not going to be

at the same level as they were

in the past summer or at any

time during this pandemic

because of the power

of the vaccines

and because of the knowledge we

have of the epidemiology of what

spreads infection and what

doesn't.

But the key to making the summer

as close to 2019 as possible

is to have as many people

as possible vaccinated.



JOHN WHYTE: Say we have 25%

of people that aren't

willing to get vaccinated.

Do you think we're going

to start to see immunity

passports?

And I don't love that term,

but do you think we'll start

seeing there will be

a requirement for travel to get

on a plane,

to get into a concert.

We're starting to see

the requirement to come back

to college.

If you want to come in person,

you're going to have

to be vaccinated and prove it.

Do you expect more of that

in the private sector?



AMESH ADALJA: I definitely do.

We're already seeing it,

for example, with sporting

venues having

vaccinated-only sections.

We're hearing about parties

for vaccinated-only people.

And I think this is

a natural thing

because the vaccine does improve

your life.

It does allow you to reclaim

your pre-pandemic activities

in a way that you couldn't prior

to the vaccine.

And remember, if you're

a vaccinated person,

the virus is going to treat you

differently.

So you should expect

other people to treat you

differently because you're

no longer a threat to them.



So I think this is something

that's going to happen.

It's going to be temporary

until more people are vaccinated

or we have more control

of this virus,

but it is something I expect

the private sector to do.

And I think it's a good thing

because I do think

that vaccinated people are

getting vaccinated for a reason.

They want to use that immunity,

and they want to be able to get

back to their lives.

So I do think if people are

holding out on getting

vaccinated,

they should get vaccinated,

but they shouldn't expect

the rest of the world to wait

for them.



JOHN WHYTE: When do you expect

businesses to more fully reopen?

And is there going to be

the physical distancing

within offices?

Are people still going

to be wearing masks?

Is everyone going to have

a temperature check still?

What's your sense of where that

may be by the fall?



AMESH ADALJA: By the fall,

I suspect most businesses will

be open.

There still will be flexibility

for telecommuting.

And some places may like

telecommuting because it might

be cheaper, it might be easier

for them to do that than having

people fly to Chicago

for a meeting on Friday

afternoon every week.

So there will be some changes,

but most businesses, I suspect,

will have the ability to open

fully by fall

because enough people will be

vaccinated,

enough of this public health

emergency

will be over by that time.



There may still be a lot more

policies regarding coming

to work sick,

I think that's going to go away.

It should have went way long

before this pandemic.

There will be much more

attunement to that.

Social distancing, I think,

will be in place until enough

of a office

is vaccinated or enough people

that interact in that office

are vaccinated.



JOHN WHYTE: What if 10%

of your employee workforce

refuse to get vaccinated,

and you don't have

a mandatory policy?

Do you still need to have

those physical distancing

requirements?



AMESH ADALJA: What I would

do is if it's only 10%

of your population,

your workforce population,

you may Institute differential

policies and say,

if you're not vaccinated,

then you need to wear a mask

when you're in any situation

where you can't social distance.

And that's something hospitals

used to do before with influenza

vaccine.

So some hospitals,

if an employee wasn't vaccinated

for influenza, they would have

to wear a mask

throughout the influenza season.



So I do think they might there

may be ways to come up

with differential policies

if it's a small proportion

of your workforce population

that's not vaccinated.

If it's a large proportion,

then I think it's very hard

to do that because you're going

to get a lot of mixing

of unvaccinated people,

and it's going to make it much

more challenging to do.

This is something that's

evolving now,

I advise businesses on this.

And a lot of this hinges

on how much of your population

gets vaccinated

and what their job function are

and what your office setup is

and can you social

distance those people.



Remember, COVID isn't going

to go to zero.

We're not going to get

to a point

where there's no cases.

What we're trying to do

is really remove the ability

of the virus to cause

serious disease.

And then I think it's going

to become a little bit different

based on each company's risk

tolerance of what type of risk

they tolerate,

what type of business

they're in all.

Of that's going to condition how

people think about COVID-19 when

it's no longer

the same deadly threat

that it has been

for over a year.



JOHN WHYTE: You've been involved

in this from the very beginning.

What are the lessons learned?



AMESH ADALJA: The lessons

learned are, no matter how

prepared you think you are

as a country,

if you don't have

the political leadership

to execute

the appropriate pandemic

response,

you will end up in a very, very

dark place,

and that's what happened here.

We were ranked the most prepared

country in the world

for a pandemic.

We had plans, we knew exactly

what to do.

All of these subject matter

experts were telling people what

to do, but yet January,

February, half of March

basically passed

without any action taken.

And when the actions were taken,

they were the wrong action.



So the lesson, to me,

is that pandemic preparedness

really needs to be fortified,

not just in funding

because, obviously,

our public health infrastructure

has gone decade after decade

with neglect.



JOHN WHYTE: Absolutely.



AMESH ADALJA: But it's also

political leadership needs

to understand the risk

of pandemics

and that there is a way

to do this correctly.

And I think that if you go back

and look at it,

most of the mistakes that were

made were political in nature.

And there were a lot of us

on television everywhere saying

this is the correct action

to take.

This is what's in these reports

that we've been writing

for decade after decade,

but that was really ignored.

And I think that's what we have

to fix,

is this has to become

a national security priority

to get this right

so that the United States can

perform more like Taiwan

than the way that it did.



JOHN WHYTE: But in fairness, one

could make the argument

that there was not

adequate surveillance in terms

of the pandemic,

that there were some signs

earlier in December.

That wasn't a political issue,

that was more

of an epidemiological and public

health issue.

We could say there were issues,

as you may recall,

with the testing

that the CDC first started

in terms of the tests

were not accurate

and could not be used.

So that was a misstep as well.

Those weren't

political in nature, Dr. Adalja,

were they?

They really scientific ones

in terms of the public health

infrastructure.



AMESH ADALJA: I completely

disagree.

Those were completely

political decisions.

The CDC and the US government

decided not to take the World

Health Organization test.

They wanted a homegrown American

made test.

The CDC also refused the South

Korean test that was available.

In the very beginning,

because there was

a public health emergency

declared, there was an emergency

use authorization apparatus,

which basically prohibited

private labs, university labs

from making their own tests.



So the private sector was

basically cut out of the ability

to test,

and we had to rely on a CDC test

that was flawed, that was only

available at public health labs,

and we had very strict testing

criteria from the CDC that was

all political in nature

because this was being viewed

as a China problem.

So you can only test people

if they came from China.

You could only test people

with lower respiratory symptoms,

not upper respiratory symptoms,

because this was being viewed

as something that was in China.

We were quarantining people

on Air Force bases when they

came back from China,

but the virus was already

spreading outside those gates.



JOHN WHYTE: Dr. Adalja.



AMESH ADALJA: Those were all

political decisions.



JOHN WHYTE: But in fairness,

on the lab tests,

when the FDA loosened

the requirement on lab tests

through the private sector,

we saw a flood

of inaccurate tests come

to the market that lacked

sensitivity, that lacked

specificity, that did not have

the precision that we needed

in detection.

So to be fair, when

the requirements were loosened

under the emergency use

authorization, which is, as you

know, in FDA, devices have

a different process.

There is a whole bunch

of inaccurate tests.



AMESH ADALJA: There were

some inaccurate tests,

but I think--



JOHN WHYTE: There were a lot

of inaccurate tests.



AMESH ADALJA: Not PCR

molecular-based tests.



JOHN WHYTE: No, no, no.



AMESH ADALJA: You're conflating

antibody tests with PCR based

testing.

And I think what the issue was

is if you-- then, it's not

either or.

It's not a false alternative.

You can have organizations

like the American College

of Pathologists rating tests.

But we do know that companies,

like Quest and LabCorp plus

university lab tests,

they were basically had

their hands cuffed.

They were unable to do

those tests until the fix was

made in the emergency use

authorization apparatus.



So we were stuck with one test

that couldn't work and wasn't

working.

So I don't think

that this system made any sense

to do this.

And it was actually foretold.

People warned them

that emergency use authorization

pathway and moving away

from laboratory

developed tests was going

to hamper us.

And I think this is something

that's one of the original sins

of the pandemic.

And the fact was we could have

used the WHO test.

We could have used South Korean

tests that had already proved

their mettle before that.

So even that part of it

was a problem.



JOHN WHYTE: Where did we

succeed?



AMESH ADALJA: The biggest

success story

is likely Operation Warp Speed

where there were

pre-market commitments to make

vaccines,

where there was a portfolio

approach looking

at different types of technology

not knowing which vaccine would

cross the finish line first.

I think that is clearly

a success where we were

able to really push forward

certain technologies that had

been and burgeoning before

but really hadn't been

able to cross the finish

line yet.

And I think that's really

something where the United

States stands apart

is that Operation Warp Speed was

able to deliver vaccines

in record

speed

with multiple different

technologies,

multiple candidates

all crossing the finish line.



JOHN WHYTE: Well, Dr. Adalja,

I want to thank you

for providing your insights

today

for an engaging intellectual

discussion about some

of the issues

around the pandemic

and really providing us

the insight

that we need to put all of this

into context, so thank you.



AMESH ADALJA: Thank you.

John Whyte, MD, MPH, Chief Medical Officer, WebMD.<br>Amesh Adalja, MD, Senior Scholar, Johns Hopkins Center for Health Security./delivery/aws/db/a4/dba4426f-e622-36f9-ad7c-ce97d77e3fe0/Adalja_050321_v4_,4500k,2500k,1000k,750k,400k,.mp405/13/2021 12:00:0018001200Adalja_050321_1800x1200_v2/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Adalja_050321_1800x1200_v2.jpg091e9c5e821942e9

“We need to help fight the disease around the world to help keep us safe here at home and do the right thing in helping other people,” Biden said. “It’s the right thing to do. It’s the smart thing to do. It’s the strong thing to do.”

The AstraZeneca doses are still awaiting FDA authorization before they can be shipped.

"This is the most doses donated by any country in the world by 5 times," Jen Psaki, the White House press secretary, said during a news briefing Monday. "This will put 80 million doses out into the world by the end of June."

The announcement comes just a week after the FDA approved the Pfizer COVID-19 vaccine for adolescents ages 12 to 15. The anticipation of federal approval spurred an ethical debate among medical professionals: Should those doses set for American teens go abroad instead?

According to Biden, it is not an either/or situation.

The “United states has secured enough supply for all eligible Americans, all Americans 12 years and older,” he said.

According to Biden, COVID cases are down in all 50 states. The CDC revised its guidelines last week, saying that vaccinated residents no longer need to wear masks indoors or outdoors in most settings. The ones who are at risk now are those who are unvaccinated, he said.

“Given that the vaccine is convenient and free, it would be a tragedy, a needless one, to see cases among the unvaccinated go up,” he said.

Biden also announced a tax cut for American families: Starting July 15, people with children 6 and younger will receive payments of $300 per month, and those with children over 6 can receive up to $250 per month.

“This tax cut sends a clear and powerful message to American families with children: Help is on the way,” he said.

As of now, 60% of Americans have received at least one vaccine shot. COVID-related deaths are down by more than 80%, and the administration aims to have 70% of the U.S. at least partially vaccinated by July 4.

“Every day, the light at the end of that tunnel grows brighter,” Biden said. “Progress is undeniable, but we’re not done yet.”