As we await the FDA’s final decision on booster shots, Andy talks with the person tasked with making the final determination: Acting FDA Commissioner Dr. Janet Woodcock. Only on In the Bubble will you get a chance to hear how she’s approaching this decision, how close we are to vaccines for kids under 12, and more from the person in charge at the Food and Drug Administration.
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Check out these resources from today’s episode:
- Read more about the FDA advisory panel’s decision to recommend boosters for people over 65 and others at high risk: https://www.nytimes.com/2021/09/17/us/fda-pfizer-booster-covid.html
- Check out the latest FDA info about COVID-19: https://www.fda.gov/emergency-preparedness-and-response/counterterrorism-and-emerging-threats/coronavirus-disease-2019-covid-19
- Here is The Lancet article written by two departing FDA regulators who oppose boosters: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02046-8/fulltext
- Find a COVID-19 vaccine site near you: https://www.vaccines.gov/
- Order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response: https://us.macmillan.com/books/9781250770165
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Andy Slavitt, Janet Woodcock
Andy Slavitt 00:19
Welcome to IN THE BUBBLE. I’m your host, Andy Slavitt. And we have a fascinating show today. On Friday, the FDA Advisory Committee met to discuss whether or not to approve boosters. And that decision now sits in the hands of one person, that one person is Janet Woodcock, the Acting Commissioner of the Food and Drug Administration. She does not do a lot of press, but she came on IN THE BUBBLE, today. She’s on today’s show. So we are newsmakers, and you’re going to really find this, I think to be interesting, there’s only so much she can say, she doesn’t reveal her decision on the show. So don’t listen for that. But I do want you to hear a couple things, I want you to hear how she thinks about making this decision. And I want you to hear about how she thinks about other decisions that they’ve got to make including the data that’s just going to be coming out today. And tomorrow around kids, we’re gonna see data, which suggests how kids 5 and 11 are doing on the vaccines and the dose of the vaccine. And the word that we have is that it’s going to be quite positive.
I tried to push her a little bit as to when the decision would get made based on the submissions. So you’ll hear a little bit of that. And that’ll be very interesting. So let me just preview this with a summary of where we are now on this decision around boosters. The FDA advisory panel met on Friday. And that meeting was actually more conclusive than I think people who followed it step by step found it. What they decided was to recommend that people over 65, get boosters. Now, again, Janet Woodcock has to decide whether she’s going to prove that, but I’m highly confident that she will, and I think you will be, too, for listening to her. And then there are other categories, people who are high risk that they approved, and they, through some acknowledgement towards people who had high levels of exposure, who were under 65, that they might, in fact, be approved.
Andy Slavitt 02:31
Now, what they rejected wholesale, was providing a booster to everybody 18. and older, they rejected that, like 84%, to 16%. And because that was the first most they took; I think it threw people into a little bit of chaos. So to talk about two things, one is what that process feels like. And secondly, what happens next. So there’s a lot of people that would say, you know, wow, that’s an ugly process. And it was ugly, in the sense that we heard from a lot of people who really didn’t have a lot of data and didn’t really know what they were talking about. Or if they didn’t know what they were talking about. Their arguments were kind of academic. And so it was frustrating for some people to listen to this, who thought there was a right answer, and that they weren’t hearing it. And while that may be true, I think this process of descent is a really healthy one. And we had an article written by two people within the FDA, who were opposed to boosters.
And while Janet and I don’t talk explicitly about that, you’ll hear us talk about this idea of dissent and what’s important about it. And boy, I tell you, I feel a whole lot better knowing that if there are scientists who disagree with the mainstream thinking that they can write about it, that they can say it, that we don’t get pinned into groupthink, and that we have a democracy where people like that don’t get punished for saying such a thing. It makes it harder. It gives people who are antivax, you know, things to find, and that they don’t like and to distort, to blow out of proportion. It makes the public less certain. All of that is true in the short term. But in the longer term. You know, I think we really want to have a country where things can’t get swept under the rug. And we do. And so we were I think we’re both gonna get to the right answer, but also have the messiness of the fact that we’re making decisions under uncertainty.
Andy Slavitt 04:29
And while We’d love for everybody to agree with one another, it’s just not gonna always be the case. And we don’t always know. So what happens next, after today’s podcast, we’re going to bring you a podcast on Wednesday. That’s a toolkit to help interpret what we do know about boosters and what people can and should be doing. So if you’re confused right now, it’s appropriate. It’s not always clear we are in a period where it’s not clear whether or not you’re going to be getting a booster or not. I will tell you that in all likelihood, people who have Pfizer will be able to get boosts, people who have had Johnson and Johnson, and Moderna, probably with a note from their physician saying that they’re at higher enough risk, we’ll be able to get a Pfizer booster and then a few weeks from now, we should be able to see both Moderna and Johnson and Johnson. So I’m baking in what I think the answer is. I think they’re probably going to issue a ruling that may be different than what comes from FDA. It may not be 65 years old; it may be 40 years old; it may be 45 years old, and maybe 50 years old. We’re just going to have to see, we’ll bring you more on that on Wednesday’s episode. But in the meantime, I think is important baseline we’re thrilled to bring to you, Janet Woodcock from the FDA. And so you can hear how the FDA is thinking about the important decisions that they’re facing. Right now. Here’s Janet.
Andy Slavitt 06:05
It’s so good to talk to you, former colleague, head of the FDA, Janet Woodcock, welcome to IN THE BUBBLE. So you all have a fair amount on your plate these days. And I thought it would be great to level set people on how the FDA actually works and the things that the FDA actually considers because you face as we did know, a fair amount of public pressure, I want this now or a fair amount of Monday morning quarterbacking they were so fast and improving this, they were too slow and approving that. But you have a job to do. And public pressure aside, what are the things you look at when you consider a decision, such as you know, approving a vaccine, approving a test approving booster shots? What are the major considerations? And how does FDA approach these kinds of questions?
Yeah, well, I think one of the things people don’t appreciate is that we set standards in advance, we work with the companies during development. And we often put out guidance like we did for the vaccines of the things we’d like to see, the kind of trials number and size of patient safety database, and other activities. And CDRH will do performance standards for various diagnostic tests, for example, and the same thing happens for therapeutic development. So when an application comes in, for either EUA or a marketing approval, FDA will look at a lot of things. So we look at all the manufacturing. And usually we’ve been working with the firm’s all along on making sure they can make a reliable reproducible product without making errors. And you know, mass producing something like a vaccine, for example, at a very high volume is not a trivial exercise to get it right every time.
Janet Woodcock 08:02
So we do a lot of review of manufacturing, then we look at all the data, all the clinical data we get, unlike anywhere else in the world, we get all the line listings, which is each patient’s data in tables, right? What happened to each individual patient, we don’t get their names, usually, but we get all their data. And we repeat a lot of the analyses and do additional analysis on our own to make sure what the company has sent us really reflects what happened in those trials. And then we go out and we audit, we audit the manufacturing facilities, and we audit the clinical trials to make sure that they were all actually conducted the way they’re supposed to be. And that is what a lot of what goes into the FDA evaluation. So it’s not a matter of too fast or too slow. It’s really how thorough can we be? And does the product meet the standards that have been established?
Got it. And the standards that you’re most focused on from an outcome standpoint, putting aside the research, etc, are they, how well does it work? And how safe is it is Are those the two big questions safety and efficacy that you try to evaluate?
That’s right. But underneath those is if you can’t make a reproducible product, you don’t know whether the next dose is going to have the same characteristics as the last dose. So a foundation is that the product has to be reproducible has to be you need to be able to make it reliably without errors. And then, does it work, and how is that been shown? Right? How big is the effect and then put that against any potential harms and safety issues.
So just to take a decision that you’ve already made, and I think it’d be good for the public to hear about this is, is you made the decision to give a VLA Which is the final approval to the Pfizer vaccine. Now that vaccine has gone into probably a billion or more arms across the world, you have probably more data on just real-world evidence and how that’s worked, what’s whether it’s safe, whether it’s effective, and yet there were people putting pressure on the FDA to say, you have to approve this, you have to approve this. Can you just assure the public or let the public know how much do you take that hue and cry into consideration? Were you able to completely block that out? And then, based on everything you saw was in the thorough work? What can you say about the safety and efficacy of the vaccine that was approved?
Janet Woodcock 10:40
Well, don’t forget, they were extremely large trials done for the vaccine, 10s of 1000s of people. So we had all that evidence, then, as you said, we had real world evidence. And we have all kinds of monitoring systems that were set up for the vaccines between FDA and CDC. Now, we did discover for the Pfizer vaccine, some safety signals, including the younger people, particularly men some and youth, some myocarditis signal, okay. And we took that into account and put that in the label. But we had a huge amount of data to go over. And it was really that, that took the time, because we had to look at all that clinical data and make sure we understood the effectiveness and understood the safety risks to the extent, you know, that they were understood, and we could put them in the label, so people knew about them.
So you ended up with a high amount of confidence. I don’t put words in your mouth. But there are people who are you out there actively trying to undermine what the FDA actually said, and saying that the FDA process was rushed or things of that nature. And that so I’m not trying to lead the witness here. But I also want to make give you an opportunity to be clear. Was this a large amount of data, both real world and clinical trial to safety signals? How did you scope them in terms of, were they very infrequent? Were they frequenting enough to be concerning?
Janet Woodcock 12:14
Well, effectiveness of this vaccine was extremely high in preventing a condition that can have very severe consequences, including death. And the safety signals are always balanced against the benefit to the population. And we do that balance very carefully. And so we’re very confident that we dotted all the i’s crossed all the t’s, we went through all those clinical data, we use our usual standards for a VLA approval for vaccine and the vaccine met those standards. And afterward, we’ll continue our post marketing, surveillance and incorporate any new information that we gain.
So now, to come to kind of what’s in front of the country today. We obviously have kids who are under 12, who are unable to get vaccinated. And you know, a lot of parents listen to the show. And I think their top question, of course, is, you know, they feel nervous, because they see 1000s of kids being hospitalized every week, with COVID. Fortunately, most of them, the vast, vast, vast majority of them don’t die, and they get out of the hospital. But it’s still a tragedy. Pfizer’s announced that they have filed for approval from the FDA in the coming weeks. What can you tell us about the process and the indicators and what takes the time it’s taking and when people can expect to hear from the FDA?
Janet Woodcock 14:11
Sure, well, first thing people need to understand is that kids are not little adults. We thought that long ago and it was wrong. All right, that you can just cut the dose a little bit and for smaller people, and you know, really not do studies. And in the last few decades, we’ve realized we really need to study kids and of course, for vaccines, kids have always been studied. So kids need a smaller dose, that means they need a different formulation or you know, the way the product is made, so it’s less concentrated so that you can easily provide those lower doses. And that’s true for many vaccines. And then, you know, we need to look at make sure that we’re using the correct dose for the different age groups and then we need to look at the safety very carefully. So whenever the data from the clinical trial is filed, we’ll go through that in the same way. Okay, we’re gonna have to look at the manufacturing if there are lower concentrations and make sure they’re reliable so that you’re getting the same product every time. And then we’ll look at the clinical data and make sure that children responded to the vaccine the way we would expect, and that the safety profile is acceptable. In other words, the benefits of the vaccine to children exceed the potential harms
How close are we to being, to having an answer? Well, you
know, we’re going to have to obtain, the company has publicly said they’re going to file but we have to get that it isn’t done until it’s done, right? Until we have received an application. We can’t talk about that. But the company can talk about when they have, you know, filed an application, and then we have to go through it with the same care, we would go through any pediatric vaccine and make sure those benefits way exceed any potential harms. But then we’ll do that as quickly as we can. I’ve heard also from many, many parents about their concerns. Some have immunocompromised people at home or children are immunocompromised, they’re worried about the other children, you know, acquiring the virus and then spreading it around the family. They’re worried about their own children getting sick, we understand this. But on the other hand, we must reassure many people, you know, and ourselves that this vaccine for children has met all the standards before we approve it.
Andy Slavitt 16:45
Sure. Now, if I’m not mistaken, the FDA recently asked Pfizer for more data to contribute even more data. If I’m right about that. What was the thinking about what that would help you learn?
Well, you know, I think the issue is making sure the safety database is large enough, all right? For children, obviously, children, the risk of harm is lower than it is for adults, what we saw in the younger age groups that are currently getting the vaccine, we are seeing some rare instances of myocarditis, mostly, which is not serious. But we want to make sure that the safety of the vaccine in the younger children is fully understood.
The UK said something to the effect of for healthy kids, the risk of myocarditis could be higher than the risk of a severe illness from COVID. And therefore, you know, they’re not in all cases of I don’t have the wording exactly right, but that they’re not in all cases recommending this for kids. What do you think of that?
Well, I think it has been confusing for the public that there are different approaches in different countries around the world. This is because there’s scientific uncertainty, we’re going to look at the data that we receive and make a decision based on the data that has been generated in the kids, the safety data, and we will thoroughly explain what the basis for whatever decision we make. So we’ll make that public.
Andy Slavitt 18:21
So Pfizer does a good job and gives you a complete data set working as fast as you think is reasonable to work. Is that a several week process? Is that a several month process?
You know, I really can’t comment on it, because it’s going to depend on what they find, right? If their safety concern, so we’re going to investigate them thoroughly. So it really does depend. And it’s not wise to give. I think people should just know, we understand the urgency, we’ll reevaluate this thoroughly. But you know, as fast as we can consistent with a thorough evaluation that meets our standards.
Yeah. Yeah. And look, I appreciate what you said, I’ve said on this show before, that, like those last few weeks, or whatever it takes, may feel excruciating. But in the scheme of things, we would much rather the FDA took whatever time it thought it needed to answer whatever last question it felt was reasonable and important to ask. That’s far more valuable than those incremental weeks even though people feel impatient.
We need to get this right. Okay. This is very important. And, you know, the safety of children is very important. We know there is a threat with a virus. We know about the pediatric hospitalizations and so forth. But you know, we have to get this right. So we’ll work on it.
Got it. So speaking of reviewing data, I want to ask you a couple of questions about how the decision for boosters is made. Obviously, a lot of the data that exists the real-world data on whether boosters are required comes from other countries like Israel or Germany. Does the FDA review that data? Do they take that into account? Or is it only us data that the FDA looks at for a decision like that?
Janet Woodcock 20:10
For many, many decades, FDA has had policies on ex-US data. And of course, we do accept ex-US data in routinely, many, many trials, including vaccine trials are done multi nationally. Alright. And that makes sense. We do want to make sure that we have data that represents the US population, and it’s all its diversity. So sometimes trials are strictly done in say, Eastern Europe, and they may not reflect our diverse population in the United States. However, yes, we do accept data from other countries and the experiences of other countries may be extremely valuable. And in fact, many trials nowadays are multinational trials. And we take all those data into account.
We try to understand, was Israeli data part of the consideration? Or was only US data part of the consideration?
Certainly the Israeli scientists presented their data at the Advisory Committee. And of course, that’s important input into determining the impact of a third dose.
Got it. This feels a lot like decision making under uncertainty, which is welcome to your life. Right? So maybe we’ve talked about some of the most important factors, you’re primarily concerned with preventing hospitalizations, concerned with preventing infections, preventing even symptoms. You know, when you look at a decision, like the booster decisions, how do you think about what the most important factors are?
Well, I mean, there are multiple factors to consider. One is trying to halt the rise of the epidemic in the United States, right? And transmission of the virus. So if people are acquiring a virus and spreading it, you want to stop that as much as possible. And of course, freezing mitigation measures like masking and so forth. But vaccination is important. Another factor, though, is to make sure the benefits outweigh the harm for any given individual, right? That’s the decision they make to roll up their arm. And that’s something we put in the labels information about various potential harms from a vaccine and what the overall benefit to the individual as well as the population benefit from vaccination. So I think these things all go into the mix. And there is uncertainty, FDA is used to making decisions under some uncertainty because we never have all the full information that everyone would like to have, you know, I’d like to have it all laid out for you and nice tables, but that doesn’t always occur because of how science proceeds.
Andy Slavitt 23:10
Right. So we had Tony on the show, Tony Fauci. And he said that he believed, based on what he saw one person’s opinion that with higher amounts of antibodies from boosts, it would make COVID less transmissible that the […] went down. I think he said it Israel from like, 1.3 to 1.1 or something. I don’t know if those numbers exactly right. But there was some decline. Is that been an important factor in deciding not just whether to approve boosters, but whom boosters should be approved for?
Well, I think we don’t know that yet for a fact. Okay. So basically, the FDA decision is do the benefits, overall benefits outweigh the potential harms for any given vaccination. And that’s how perceived but obviously, individuals benefit from not having a transmissible virus circulating around, but I don’t think we know enough about the impact of boosting on transmissibility, we do not understand totally any what are called serologic correlates of immunity, you know, how can you take an antibody titer, which you can in some diseases and say, oh, they’re not going to get infected, right? And they’re not going to spread the infection. This disease, we don’t have all that information yet. So we have to do the best we can. Dr. Fauci has vast experience. And so his opinion, I think, is worth a lot of weight. But scientifically, we don’t have those nailed down.
Andy Slavitt 24:49
Sure. I think he would acknowledge that, that his insights are clearly subject to FDA rigorous analysis. So that’s, I appreciate you pointing that out. Is there sufficient data by age cohorts to be able to understand where benefits may be higher or lower? For example, you know, we understand that older people, there seem to be greater amount of a waning of the vaccines due to their immune systems, presumably, is there sufficient data to be able to have made that analysis?
Well, it’s hard when you break things down, because you get fewer and fewer people in each cohort, I think, actually, Andy, the waning is probably the same, but the older people start a lot […] and so they reach a lower level earlier because they started lower. Right? That is my understanding of the current data on at. So then the question is, we don’t know about cellular immunity, you know, is there T-cell protection. And I think some of that will emerge now, as we get more and more experienced stay with third doses and more and more experience with distance from a primary series of vaccination for the different vaccines. So there are a lot of things we don’t know. But we do know is that the antibodies do wane over time, and they seem to follow a predictable course. And we do know that once they get to a certain level, then people start getting breakthrough infections. And we do know that the older or more vulnerable, of course, to the more severe disease, right? And so the older you are, the more comorbidities you have, the more likely you are to end up in the hospital.
Andy Slavitt 26:42
Got it. And I presume that the FDA will continue to watch even after the decision that’s been made and continue to see real world data and make whatever adjustments you feel appropriate down the road?
Oh, absolutely. Yes, between the FDA and CDC, we have a large amount of surveillance ongoing. And for all the vaccines that was under EUA approved vaccine, we will continue to do that we do that for all vaccines. And this one is particularly important. So new systems have been set up to try to do this as well as using theirs a vaccine adverse event reporting system, CDC has some certain cohorts they’re following, and so to others, so there’s a huge amount of effort going forth on monitoring, both for safety, and then the overall outcome of vaccination.
Andy Slavitt 28:04
Well, as we finish up, I just have a couple more questions, one more, and then I want to give you an opportunity to send a message out that hopefully, your colleagues will appreciate. But you mentioned theirs. And you know, I think we all should worry when things that are so intricate to understand become used and abused by the general public. There’s a community of people who are spreading information about the vaccines, pulling data that they claim is from theirs to make statements like this is how many people are dying. And this is how many people are facing these kinds of issues. And they’re really spreading horror stories in social media. I’m wondering if you could help people as the authority […]. Just to explain to people how that information should and should not be used?
Yeah, well, this information is being misused, because, you know, because people don’t understand as you said, it’s a system where we’ve asked everyone to report any adverse event happening, you know, after vaccination. And so all the providers have agreed to report and that’s a very unusual situation, right? And, as one academic pointed out, I like this analogy, you know, if you vaccinated half the country with sailing, right, and didn’t vaccinate the other half, maybe cut it in half geographically, right? There would be a fair number of people who died in the next two weeks in the vaccinated group, but the same number of people would die on the other side of the country in the unvaccinated group, right? Because we have a death rate in the country. And actually, we tried to vaccinate the people who are most risk, the most fragile people got vaccinated first.
And so some of them are going to have strokes, heart attacks, you know, sepsis, other kind of problems, because they’re all fragile people in nursing homes and you know, the elderly, so people just simply didn’t understand this and they thought all these reports of deaths were actually all due to the vaccine. And, you know, we analyze all these and look at them carefully, and we have access, way beyond the public records for, you know, we can get the autopsy reports and other medical records and so forth as a public health authority. And so we investigate these deaths and so forth. And we don’t see this. And it’s been very carefully followed up. So I think it’s a misunderstanding that has grown into kind of a belief set. And certainly a lot of those folks have contacted me, it’s very unfortunate, because it spurs vaccine hesitancy that it’s really incorrect.
Andy Slavitt 30:46
And we bet we may want to think about how we think about labeling these things. So they can’t be quite as easily abused. Of course, people will always abuse and lie. But to me, it’s like, when there’s a crime, you could go by the crime statistics, how many people were convicted? You could go by, you know, was the evidence proved? To me there is like a neighborhood watch tip line, where, hey, I observed a guy walking around my neighborhood. And therefore we’re counting that, let me give you one final question and let you run. I’m so appreciative for your time, the men and women of the FDA have been through a lot. I have such respect for the career civil servants, you may be chiefly among them who have dedicated their lives to the public good and to science, and number of FDA folks out there, listen to the show. I don’t know why, but they do. So I’m just wondering if there’s a message that you want to share with your colleagues, and to tell the public just how remarkable these folks are?
Well, I would say I, you all stepped up, they stepped up when this crisis happened, and they work days and nights. And I know, it’s been going on a long time. And I know they’re really tired, but they are continuing to do the job because they’re dedicated to public health. And, you know, we couldn’t ask for a more dedicated, talented, and, you know, robust set of people to be doing the all this work that had to be done, because it’s all on top of the ordinary work that the FDA does to protect the public. So it has been an extraordinary effort. And it is continuing in unremitting fashion. And my hat is off to everyone at the FDA. And I will do everything I can to keep supporting everyone so that we can do the job we need to do for the public.
Andy Slavitt 32:39
Amen. So well said, just because I think it’s important, your philosophy and our philosophy, if people have scientific disagreements, whether they work inside the FDA or outside the FDA, having the kind of environment where they can say that publicly, because there are as you say, there’s so much uncertainty, it’s so impossible to know the right answer. I personally welcome knowing that if there’s voices of dissent, or questions, that people could raise those things and put them out in the public domain. Is that […], your philosophy as well?
Absolutely. I mean, the basis of science is vigorous dispute and resolving that with facts, right? And there’s always going to be scientific disagreement when there is uncertainty at when I heard of cedar, I had a whole program called equal voice. And when everybody could anybody could raise their hand at any time and say, you know, what they felt needed to be said, and it would be taken into account. And so yes, even public disagreement, which is viewed as scandalous by fans, sometimes it’s vigorous, it’s expected, you know, not everybody’s going to agree on what to do, or even when the facts and that’s where science comes in, to clarify the facts and get us to some kind of point scientific understanding.
It’s such a good point, I think the country’s forgotten how to professionally disagree. And the disagreement is not about lack of respect for another party. And we could learn to disagree again, in respectful, responsible ways. Well, Janet, I want to thank you so much for coming on the show, of course, but also just your dedication, I think you’ve got one of the toughest jobs, most people I know would run and hide under their bed, including me, if I had to do what you do every day. And it you do it with such intelligence, courage and wisdom. So we’re all grateful. Thanks, Janet. Let me tell you what’s coming up on the next episodes because I think we’re really going to help understand what’s going on as you listen to some of our next guests. On Wednesday. We have a toolkit on boosters. Now, I’m going to warn you that we may or may not have all the answers by Wednesday. In fact, we probably won’t. So we may need to do this again. But a lot of your questions are going to get answered by two different people, Tom Moriarty, who is an Executive Vice President at CVS.
Andy Slavitt 35:15
Tom will talk to us about the process of getting boosters. And David Agus who has been on the show well before and as a brilliant clinician and a brilliant communicator. We’ll be talking about the decision-making process, what it means what the clinical evidence suggests, and how we should all be thinking about getting boosted, the next week to great episodes. Sanjay Gupta from CNN will be on and we’re going to talk, just a great conversation. Sanjay and I are become good friends. And we’re going to have a great conversation about a lot of things if it in the pandemic. I don’t think you’re gonna want to miss that. And then Wednesday, Katherine Wu. Katherine was from the Atlantic, you may remember Eddie young, recommended we have her on and I always listened to Ed Yong, when he tells me to do something. So they’re add, we’re gonna have Katherine on actually, we made like Katherine even more than we like you Ed. So you may be sorry, you recommended Katherine to us because she is amazing. And she is on top of a lot of the details around COVID including the vaccines waning immunity. What could happen next? So I’m super excited for that. Hang in there, everybody. Talk to you on Wednesday.
Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen and please stay safe, share some joy and we will get through this together.