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Description

Andy clears up a lot of the confusion surrounding boosters on this must-listen Toolkit with Dr. David Agus and Tom Moriarty of CVS Health. From who can get one to why we need them and where they’ll be available, this Toolkit is chock-full of all the latest information on COVID-19 booster shots.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow David @DavidAgus and CVS Health @CVSHealth on Twitter..

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Check out these resources from today’s episode: 

• Check out CVS Health’s COVID-19 resource center: https://cvshealth.com/covid-19
• Here’s more on what to expect next from the FDA on boosters: https://www.nytimes.com/2021/09/20/science/covid-booster-FDA.html
• Johnson & Johnson says a second shot of their vaccine boosts protection against symptomatic and severe COVID-19: https://apnews.com/article/johnson-and-johnson-covid-booster-4f86b7f00d354c289af17503eeb50824
• Read The New York Times story about Andy and Facebook: https://www.nytimes.com/2021/08/10/technology/facebook-vaccine-misinformation.html
• 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

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble.

Transcript

SPEAKERS

Andy Slavitt, Tom Moriarty, David Agus

Dr. Scott Gottlieb  00:00

I think the logistical lesson on the rollout of the boosters is that they need to have in place the infrastructure to actually distribute those vaccines in hard-to-reach communities in hard-to-reach settings. I think what the Biden ministration has done here is by backing into an approximate date, and I know they were beaten up a little bit for putting out a date. But by putting out an approximate date, they’re now able to start that planning process in advance and so that the boosters are made available by FDA, if FDA does authorize it, and the Advisory Committee, the CDC ultimately judges it to be appropriate for a certain population, they’re going to be ready to start making it available in the nursing homes right away, so there’s not going to be a delay.

Andy Slavitt

Welcome to IN THE BUBBLE. I’m your host, Andy Slavitt. Thank you for joining a toolkit episode today. The voice you just heard with Scott Gottlieb. Scott, the former head of the FDA and in the Trump administration been on the show before, he’s got a new book out. And he’s talking about boosters. And what he’s talking about is what we’re going to talk about on the show today, because we have a toolkit episode on how and when and where and how and why to get your booster. There’s many, many questions. It’s clear as mud right now. But we have two guests who are going to be amazing at helping us figure it out when we get to them very quickly. But I want to take care of two quick pieces of business. The first is a very exciting one. You may know that we run ads on this show, did you know that we do run ads on the show, the reason we run ads on the show is obviously to help pay to produce the show and pay the wonderful people like Kryssy Pease our executive producer who’s on the show, but it’s also the money that gets left over. You may know if you listen to the show that we donate 100% of it, or I donate 100% of the money that comes to me to COVID relief causes that you choose.

Andy Slavitt 

So because you listen to the show, we get to make these very cool donations and we’re donating $8,591.65 to the International Rescue Committee, that’s my first piece of business. What do they do? I’m glad you asked. They provide free vaccines and translations as well as testing services to refugee communities, refugee communities, it’s reminder, there’s a lot of displaced people who aren’t living in the safest of conditions who are new to this country who can both get and spread COVID and we need to take care of them. And I want to thank Masked Squirrel Girl, Masked Squirrel Girl, where are you? That’s her name on Twitter. She turned us on to this idea to donate to the International Rescue Committee. And I’m so glad we’ve done it. It’s an important part of the show. Speaking of the show, speaking of the show, my second piece of business actually relates to the show we’ve done now 150 shows we’ve done 150 shows, a lot of shows we started in April of 2020 with Mark Cuban, you want to go binge go just been from Mark Cuban forward 150 shows. That’s a great weekend idea.

Andy Slavitt  03:16

Seriously, don’t do that. Don’t do that. If you’re thinking about it, don’t do that. But we started the show, we called it IN THE BUBBLE. It obviously is themed around the pandemic. And the idea behind the show is basically been to try to hopefully bring you some facts from experts in a not totally heavy-handed way, in a way that’s gettable. And of course, I’ve always used as models, the late Fred Rogers and the late Winston Churchill and the tone that they bring, and have brought to basically helping people through difficult times, inspiring them through difficult times. And I think we have hopefully brought a good array of guests and hopefully we do our jobs. Obviously, I’m leaving out the most salient element of the show. I’m sure the reason you all listen. Just my jokes. I know that’s a lot of the reason why you come for the stuff that’s serious, but the jokes just they kill. And it’s just an important other important part of the show. But the question today, it’s not about the guests. It’s not about the jokes about the show itself when I came back from the White House, I committed to doing about 20 episodes, 10 weeks’ worth of episodes, I’ve now done that.

Andy Slavitt  04:30

The question is, what do I do here? And I need you to send me a tweet in response to one of the IN THE BUBBLE pod tweets about this episode. It tells me what I should do. And option A of course is just hang it up, Slavitt. You’ve kind of had enough. You’ve done your 10 weeks you’ve done your job, and we’re tired of listening. Number two, of course is you know, continue. Stick to your knitting. And you know, as soon as the pandemic thing kind of runs its course, we don’t need to hear anymore. But I do say that if I do keep the show up, I am going to want to start to talk about other things, other things that are important to me. And the question is why? And that’s a question that I invite you to opine on, are there other things we should be talking about that kind of fall in the category of, they’re super complex, they are kind of scary. But if we break it down and think about it, we can kind of get through it. And you kind of go, I really want to hear some, like 50-year-old guy talk about this topic. If that’s the case, you know, then I want to know that and maybe we’ll continue to talk about those kinds of things in the show, I do plan over the next period of time to start introducing a couple of interesting new topics, to pepper in here and there.

Andy Slavitt 

And I want to know what you think one of them is going to be about climate, and what’s going on with the climate, and hearing from some experts in ways that make it gettable and understandable. I could also talk more, and plan to talk more as I have from time to time about healthcare and healthcare policy and politics, and so on. But again, interested in your input, and of course, nothing says we have to continue the show, if people don’t want to keep hearing what we do the guests we bring, etc. Okay, enough of that talk about the show. Time to get to this toolkit. It’s great toolkit. David Agus, is a physician, he’s a scientist, he leads the Ellison center in California. He has been on the show before, he does CBS this Morning frequently, he’s really the doctor explaining things to you very well. And he’s on with Tom Moriarty, who’s a senior executive at CBS. And they’re going to answer questions that you asked Dr. Lisa, out in the field, that you sent an email she sent in voicemails about this somewhat confusing topic, how, what, when, where and why you might get a booster. As the details get ironed out.

Andy Slavitt  07:02

It’s a perfect follow up to our episode on Monday with Janet Woodcock, the Commissioner of the FDA. And if you haven’t listened to that one already, you can go back and listen to that one as well. One note I want to make before is that, you know, this episode will sound like it jumps right in, because it’s going to talk about some of the topical meetings that have just been taking place around the FDA, and then it’s gonna go back and talk and get your questions answered in much more detail about why boosters are needed, how they might become available, who should get them, etc. Here goes.

Andy Slavitt 

Let’s take a look at what the FDA Advisory Committee actually said. And then let’s take a look at what it actually means or might mean. David, can you give us a summary of what the recommendations coming out of the advisory committee meeting? And what does it mean to be an advisory committee, do they get to decide or what process happens between this the FDA, the CDC, at the time it gets to Tom and the people in the stores?

David Agus  08:10

The FDA committee reports to the FDA. So the FDA makes their own decision and they look at the advisory committee’s recommendations, they can accept them or not accept them or they can change them. And on Friday, the FDA advisory committee made […] and it was very poorly done, because initially, they were going in with one vote. And the one vote question was, is it appropriate based on all of the data to approve a booster shot for anyone over the age of 16 years old, who’s six months out from completion of their COVID-19 shots? And the answer to that was no. The majority of the advisory committee said that doesn’t make sense. Then they went back and kind of an unprecedented move add on another question. And so the next question was, is it appropriate to improve a booster shot for people 65 years of age and people high risk for complications from COVD-19? And unanimously they voted yes. And then they went back not at her other question, but a cool poll and said would you want the committee support adding to this people who are frontline health care workers, anybody who’s occupationally exposed to COVID-19?

David Agus 

So that includes teachers, waiters, people work in offices, anybody who basically doesn’t work for home. And unanimously, the committee said, yes. So what we can take from this is that the committee in general thought the back that booster shot a third shot was safe of Pfizer, what they thought was that it was appropriate to give it after six months in almost all people except those people who are low risk for exposure to COVID-19. That being said, this is an advisory committee who in this piecemeal way made this where there was a headline, basically every 20 minutes the FDA advisory committee says no, wait, they said yes to some wait, yeah, they say yes to more. So it was remarkably poorly communicated to the American people unfortunately.

Andy Slavitt  10:00

So did they ultimately reach what you think is the right decision?

David Agus 

Well, I think they ultimately reached a consensus of confusion in America. But the right decision, I really believe is that we are losing about 6% of immunity per month. And what we know is that every month you were out from that COVID-19, your risk of a breakthrough infection goes up. And by the time you’re at six months, that risk is real. And we have to protect people. And so frontline healthcare workers, if I’m in an emergency room, I don’t want to go home and bring it to my children or potentially my wife, so I should be able to get a booster. If I am a teacher, I don’t want to potentially bring it home to my spouse, and I should be able to get a booster. And that to me makes some sense how they communicate it was very poorly and was all over the place. And we’ll see if the FDA can clean this up and their final recommendations. And then it goes to the ACIP and the CDC, for what to do in America. And what are the formal recommendations that we’re making for vaccine policy. And so we’re still left in kind of a gray zone, we don’t know where we are. And that’s really a shame.

Andy Slavitt 

So it sounds like there’s a couple more steps to play out before this gets finalized for the public. So we don’t, let’s posit that we don’t yet at this point in time, know the final answer for the public. But let’s try to summarize and to make it easier for to come to time. But some of the things that if this is upheld what we do know, start with the simple, if you’re over 65, if you’ve taken Pfizer, presuming that things continue to go forward as they will, that seems like the easy case that, that we I think we’d all agree, those are people that will be able to get boosted as soon as this is done.

David Agus 

I think it’s also going to go for health care professionals and frontline workers and people who are exposed in their occupation. And it makes sense, they are taking a risk, and they deserve not to be able to risk themselves and potentially their family members. So I think with all of those, it clearly makes sense to give a booster shot.

Andy Slavitt 

So the next category is there’s a loophole. If you’re not 65, as you say, David, but you’re at risk because of your health. And depending on how the CDC interprets it, depending on your occupation, you may also be able to get a booster. So Tom, what practical issues does that create for people administering vaccines, whether it’s CVS or anybody else?

Tom Moriarty  12:18

Well, I mean, the primary issue is going to be the question of who has to verify whether or not they qualify. So the way we have heard things will be set up. And again, we need to wait for the final guidance is that will essentially be a self-verification, if you represent that you meet the criteria, then we will be allowed to give you the booster shot. We need to see what the final, you know, guidance is on that because we’re going to be bound by that final guidance. But if they stick with the self-verification or you represent that you qualify, then we will in fact give the booster at our pharmacies.

Andy Slavitt 

Got it. Let me take on the next complicating issue. I had conversations with people need administration over the last couple of days about what would happen to the people who have taken Moderna or Johnson and Johnson, with the hope being that if the FDA is silent about it, if the FDA doesn’t put a restriction in its label, or in any other way to comment on it, that the CDC would be free to either also be silent on it. Or say that it could be up to the discretion of a doctor to write a prescription for someone to take a Pfizer vaccine, even if they’ve already taken Moderna or Johnson and Johnson, is that how you think things are shaping up?

David Agus 

I will tell you that the quest for certainty is very dangerous. And what we’re talking about here is a quest for certainty for every nuance, depending on which vaccine what we know now is that a third shot of the Pfizer is safe and effective. And you know, there’s a risk associated with waiting if we’re going to wait to the final data, Moderna and J&J come out. For many months, you’re going to have a significant portion of the patient in that population United States at risk and feeling like they have made the wrong decision with their vaccine and they’re not being protected. So I do think the FDA and the ACIP, CDC need to stand up and make cogent recommendations. And the recommendations I would make at this time is that every person should be eligible for a vaccine if they meet the criteria, independent as long as it’s six months from completion of the vaccination, as long as depend independent of what was the vaccine that was given to them. Again, the quest for certainty is dangerous.

Andy Slavitt  14:33

Tom, have you heard anything thus far that would cause you to think that a doctor couldn’t bring a prescription for somebody who is coming in for a Pfizer shot even if they’ve had a different shot beforehand? What guides you have on that today?

Tom Moriarty  

Well, we don’t know anything different after Friday that we knew you know before and that is Pfizer is fully approved now. So the off-label use within a physician’s discretion based off of the what the medical literature is indicating, should still be there for the Pfizer booster. So to David’s point, it shouldn’t be flexibility unless CDC or ACIP provides different guidance. And I do think, Andy, the listeners need to know that what happened, you know, on Friday is really to me almost a timing question. Because, you had the FDA staff not taking a position here. And primarily because they didn’t have a chance to look at the underlying data. I do think when they look at and have that chance to look at the underlying data, you may see a different result, several weeks from now or whenever that happens, and we saw this past Friday. So it’s not that they’re not going to be recommending they could recommend at this time. And I think that’s an important point for the listeners.

Andy Slavitt 

Well, taking David’s point that anything that confuses the public is not good. I will just remind people that, you know, I was reminded on Friday, that thank God, we live in a democracy. Thank God, we live in a country where people are free to dissent, where people of differing views can express them, where there is scientific doubt, as David indicated, that doubt can get expressed. And people can hear it transparently. One of the comments at the beginning of the meeting from the FDA was we understand, there’s going to be differences of opinion, and we want to hear them all. And so while, I appreciate David viewpoint that it would have been nice if there was a nice clean communication, and everybody would have agreed and there have been no confusion.

Andy Slavitt  16:39

At the same time when the world doesn’t work that way. We want to know about it. We want to understand that we live in a country where that’s not going to get swept under the rug. And you know, to be frank, we lived under with an administration before this one where dissent was not as welcome. We still got it, thank God, we still got the strength and the people willing to speak up and speak their mind. But I don’t mind when career staffers at the FDA have the right to publish their disagreement publicly. And while I recognize that in the short term, it causes confusion, it may even so more distrust over the long term, if we’re going to reestablish trust. In science, we’re going to reestablish trust and expertise, cutting those people off from telling the truth is probably not the answer.

David Agus 

I disagree with you respectfully, I mean, this was a case where they did not have the data.

Andy Slavitt 

You already disagreed with me. I just disagreed with you; already made your point I disagree with you.

David Agus 

I know but they can’t not having full data. And going forward and get telling you, hey, we’re going to go forward with this, you know, is there any reason not to and that the thing is, they didn’t have it reviewed first. And they have every welcome to do that. But they didn’t need to add somebody that had above them. But it said, hey, there’s some data you don’t know about. So let’s hold off on this. I do think we need leadership here, it’s not a free for all, everyone doesn’t have a right to write an opinion, especially if they’re at the FDA. And when not everybody knows everything. You got to be really careful.

Andy Slavitt  18:12

And that is the counter point. And as I said, there’s a lot of validity to that counterpoint, and the steering and managing this correctly. But I think you know, one of the things we know, over the course of this pandemic, is there a bit a lot of things we thought we knew with certainty that we ended up not knowing with certainty. And I think people have varying motivations. It’s not clean, it’s not pretty people don’t have equivalent levels of knowledge. And God knows we don’t want them to mirror social media where you know, everybody’s brother-in-law has an opinion. And I think there was too much of that, at this hearing. I mean, we had people showing up telling anecdotes about how there’s a 4000-increase percent increase in heart attacks since the vaccine came out. And you know, your question whether or not there’s an actual place for that, on the other hand, those people are sort of exposed themselves as fools. And as that I think the election in California showed I mean, a lot of people thought it was gonna be a nail biter.

Andy Slavitt 

Both sides wanted this to be a referendum on pandemic management. And yes, it’s California, but by two to one, by two to one, people said, get this garbage out of here. And so, you know, at the end of the day, we are, we have these advisory processes that have more visibility than they normally would. I mean, normally, this is the kind of arguing and stuff that takes place that people don’t pay attention to it. And then we get to the clean recommendation. This is something people are paying attention to. So it has the ability to do damage. But you know, there’s not a meeting, we go to David, Tom, anyway, where there’s not a stupid person there or it’s not a person that hasn’t read the materials. It’s still making comments. That happens all the time. It’s just now at the public domain.

David Agus 

And the other thing that we just were seen by this back and forth with Andy and I is that there’s a reason Andy can survive in politics at least for a time. And there’s a reason I can’t.

Andy Slavitt  20:31

Okay, let’s move into listener questions. To start off, we’ll go to a question that Dr. Lisa got for us.

Speaker 4 

Why do we mean need booster shot? I guess that will be my main.

Andy Slavitt 

David, do we need booster shots? And why?

David Agus 

The answer unfortunately or fortunately, hey look, it is going to be yes. And so the vaccines are remarkable vaccines. They’re protecting predominantly against serious illness. Although every week we go we’re seeing more and more people were vaccinated with serious illness and hospitalized. Again, it’s dramatically lower than the unvaccinated. But what happened is after the vaccine, your body loses about 6% immunity per month with the RNA vaccines. And with this new virus, and Delta really is a new virus, what we’re seeing is you need a high level of immunity to protect on it. And so Israel we are very fortunate is a country that has a healthcare system, where their records because everybody’s in one system, we can look at those records. And on July 30th, Israel started to give booster shots to people 60 years and older.

David Agus 

And we have the data and the data have shown in the New England Journal of Medicine paper last week, that it dramatically reduced people after exposed to COVID, who tested positive it dramatically these drugs, fully vaccinated people got a third shot, dramatically reduced hospitalization and reduced the death rate of those people. So that kind of triple winner here is what we’re looking for. And what a booster does is give you a 4-to-10-fold increase in immunity to help you block infection or reinfection or breakthrough infection with the Delta variant or any other future variants. So yes, after a period of anywhere from 5 to 8 months after that second shot or after full vaccination with the J&J, people are going to need a booster shot to keep immunity at a high level sorry for the long answer. But I think it’s important that we just put it all into perspective.

Andy Slavitt  22:27

No, that’s great. It’s very helpful. But can you tell us a little bit more about how it works, I think lay people like myself are getting informed about these three different types of immune responses, the antibody levels, and then the two cellular types that we hear about memory B cells and T cells. And you know, you can laugh at me because you know how little actually know about this stuff, David.

David Agus 

No, I’m just smiling because it’s so cool. That’s something I’ve been passionate about my whole life being in T cells, the world is talking about now. So it makes it actually warms my heart to hear people talk about this topic, because I think it’s awesome to educate them.

Andy Slavitt 

Yes, our kid’s softball teams soon are going to be called the T-cells. It’s really cool. But so what we’ve been led to understand if you’ve helped explain to folks is that as your immunity wanes from your antibodies, you still get a response from the cellular responses, but sometimes they take a bit longer. And that’s why people sometimes face symptoms at first. But as you see hospitalizations go up. Is that evidence that the first two shots also that the immunity in the memory B-cells and T-cells also wanes? And why do we think that a third shot will make a difference? It will make a permanent difference? Or will it just make a several month difference?

David Agus 

All great questions. And so what we know is that these vaccines are amazing at the immune response in the lower respiratory tract, which is the lungs. And because there’s so good there even people who are exposed, very few of them are getting lung symptoms, which is why hospitalization is so low. They’re not as good as the upper respiratory tract of the nose, which is why breakthrough infections predominantly are like colds, just nasal infections. But what happens is, you know, over time that antibody level, which kind of your first guard is these, what we call neutralizing antibodies, they bind to this spike protein, and they block it from binding to our entry portal which is called the H2 receptor. And over time they get they go down. So if you’ve been exposed to COVID-19, you go out with your cousin who’s unvaccinated and he or she gives you the virus. What can happen is if you don’t have a high level of antibodies, the virus can go in and get started to cause some symptomatology.

David Agus  24:40

And many people those memory responses can come in, tickets but so there’s minimal to no symptomatology. But sometimes those aren’t as profound and we don’t know if it’s maybe you just didn’t respond as well to the first two shots and you need that third shot to get to a really high level or overtime the immunity went down. We’ve seen both of them happening. And you know, what we know with Coronavirus, where the common cold because it’s been studied before is that those memory responses and the antibodies, they do fall with time. And it’s been followed in what we call challenge studies about a decade ago, where they actually gave cold virus to people after they had a similar cold virus. And they were able to show that their immune response waned over time. And that’s what we’re betting on now.

David Agus 

So, you know, there’s a notion in science and I think, you know, there was an op ed, or a piece, I’m sorry, a review study, written in Lancet by some FDA officials and World Health Organization officials. And what they wrote was, well, it’s too soon to know definitively that the booster shots are needed, because it’s still helping block it is serious infection, which is true. It’s too soon, because we haven’t done the formal long-term studies with the boosters. And that’s true also. But in time of war. Sometimes when you look for completeness, you’re going to miss the picture. And right now we need to add, because there’s no downside to that third shot, it’s about 60% lower side effects than that second shot. So it’s remarkably well tolerated, and it does increase immunity. So in a striving for perfection, sometimes you can miss the whole game. And we don’t want to do that here.

Andy Slavitt  26:09

Got it. Well, I want to come back and ask about some of the studies and data but I want to bring Tom into the conversation, first, and Tom, is real people approach this question from the other end, he’s going to go as we saw two local places, places they trust, places like CVS and other places in a community for answers. To get vaccinated. Maybe you could start by just take taking a bit of a step back and give us a little bit of your experience in CVS overseeing the program first to vaccinate people inside nursing homes, then in your own stores, what you’ve learned and how efficient that’s become. And then we could talk about how that will play out with the boosters.

Tom Moriarty 

Sure, Andy, so, you know, since the onset of the pandemic, we really have been at the frontlines of this, as you mentioned, vaccinated within long term care facilities and assisted living, and then in the initial rollout of the first dose and then second dose, we’ve administered well over 30 million vaccinations, COVID vaccinations to date, we’ve done more than 29 million COVID-19 tests today. And we’ve been leveraging our footprint across communities across the country. So for example, we’re administering vaccines today in over 9600 of our pharmacies, we have the ability through our scheduling system, it’s a very simple scheduling system, folks be able to schedule an appointment and come in, then we added to really meet the need the ability to simply walk in and do walk in visits and get your vaccinations that way.

David Agus 

How many flu shots to give a year just for example, to compare?

Tom Moriarty 

So we generally on average, give between 16 to 20 million a year. So that’ll give you a sense of scale and how we have scaled up to meet, you know, the COVID need. And we do have the capacity to administer some 40 million a month, if the need is there. So we can scale up to do that Dr. Agus, yeah.

David Agus  28:01

Great. So impressive. It’s a lot of needles, by the way.

Tom Moriarty 

Well, it takes it takes a huge workforce. And, you know, Andy, kudos to you and the White House team and in extending authority for first pharmacy technicians to be able to administer vaccines, leveraging that additional workforce has made a huge difference. And you know, that will make a big difference as we roll out boosters as well.

David Agus 

How much I mean, compare, like the first week you did it to know how much better is it?

Tom Moriarty

It’s, you know, it’s interesting. It actually, once we moved away from the large-scale clinic settings, which we were doing in our stores, where we’d have two or three administrator, folks administering, that was a very seamless type system. As we moved off of that, and it’s become more sporadic and ad hoc, we now have it in what we call our workflow, where we have the pharmacists doing it directly. Depending on the need and demand for the boosters, we may revert back to some mixture of a clinic setting as well as just in the walkthrough. Walk in settings. So a lot has been learned and meeting that consumer need. And making it as convenient as possible is really important. And it answers the first part of your question, information. And accurate information is crucial here. So we’ve spent an awful lot of time investing in different educational tools, communication tools, reaching out to underserved communities, and the needy communities who really don’t have as much access as they should. And we’ve seen a really great outcome. They’re having probably the highest level of minority and underserved vaccination percentages of anyone in the country.

Andy Slavitt 

So people on the podcast have heard me talk. We had an episode with leadership at Facebook, and you’ve heard me be very critical of push and pull. And there was of course, a New York Times story about the giant fight I got into with Facebook about misinformation. But I do want to tell the other side of the story, which is that there were a large number of companies and individuals that companies that every time we called for the White House did dramatic work to help the public, oftentimes, without asking any questions, just saying, yes, we’ll figure it out, and Tom, when you were, when I was in the White House, you and I would sometimes communicate several times a week, the requests were ever changing, hey, we need the website to do X, hey, we need to make sure that we understand how many people of color are getting vaccinated. And then the big one, hey, can we get to walk ins and guaranteed appointment times and so forth. And, you know, I think it’d be good for the public to know, because people are sometimes distrustful of government corporations, what goes on behind the scenes, that that was a stellar kind of experience. And there’s no way that the government could have done this without you guys, there’s no way you could have done this without the government. And I found working hand in hand on those things to be very rewarding.

Tom Moriarty  30:47

I was great public-private partnership, Andy, it really was and, and you let it, so great work.

Andy Slavitt 

So before we go back to David, just want to help understand that now, as the process begins. For boosters, there’s still some unanswered questions from the FDA such as, you know, when are they gonna be rolled out for what ages etc? How will it work with for people within your stores and on their websites? If they run it, if they say, you know, for example, one thing they could say is, people over 65, along with the immunocompromised will be eligible for a third shot. Help us with some of the logistics to people need. Will people need to bring their own, their own vaccine card in order to get the third shot, will they need to show proof of age? Will they be have to make appointments? Will they be able to just walk in? How do you see it rolling?

Tom Moriarty  

Yeah, so you know, as we look at boosters, it will be available at pharmacy, it’s going to be rolled out through the federal pharmacy program that we and some 20 plus other pharmacies are a part of, and you are given the, you know, your vaccine card when you received your first dose and second dose, and you were told to really hold on to it. So if you can bring that in, or have it available when you’re scheduling your booster, that will make it the easiest. But if you don’t have that, or you misplaced it, or for some reason you didn’t get it, when you received your first shots, there’s a number of different ways that we can access that information. If you were vaccinated CBS, we have a closed loop system. So regardless of what pharmacy, you were vaccinated at, we have that information that detail, we can access that for you as well. Or you can go to your state, or even to the CDC systems, which will have where you received your vaccine and what vaccine you received and when, that information available as well. So there are a number of different ways to obtain that. And then when you come in, we’re actually going to be relying on you to verify that information, self-verified, not necessarily presenting a card or otherwise, but just simply representing what you received. And that’s the guidance we’ve received from CDC.

Andy Slavitt  32:45

So if I came in and said, This is my age, but I don’t happen to have an ID. I’ve lost my card. But I got vaccinated six months ago, eight months ago. whatever the standard is, DO you basically have to just essentially communicate that to the pharmacist. And will you require them to show anything?

Tom Moriarty 

they won’t necessarily be required to show anything. But again, the different systems that we will paying whether if you had insurance, it will show up in your insurance, your insurance information, if you did it at CVS will show up in your CVS system. Sure. So a lot of that will become almost self-evident as we enter your name and the other information that you provide as part of the booster program.

Andy Slavitt 

Got it. So when you have the information that becomes easier. And then if someone says, let’s say that the guidance comes out from the FDA, it says it’s six months or eight months, and I’m gonna ask David in a second what he thinks the tea leaves read. But let’s say it’s eight months, and you’ve come in, it’s only been seven months, will people be turned away?

Tom Moriarty 

Unfortunately, the rules are currently we’re obligated to follow both the CDC and ACIP guidelines as part of the Federal Pharmacy Program. So if you don’t meet the requirements that they set out, we’re not gonna be able to minister that vaccination at that time. What we will do though, in our scheduling system is we will ask you those questions. And if it indicates that you’re not eligible, we’ll tell you before you come in, that you’re not eligible yet. And here’s where you are eligible or when you’ll be eligible.

Andy Slavitt  34:12

And if they’ve been vaccinated at Walgreens, which by the way, is a small pharmacy company. I don’t know if you’ve heard of it. If they’ve been vaccinated there. And they come to CVS, will they be able to have the record access, if they don’t have a card?

Tom Moriarty 

We won’t be able to access Walgreens directly. But if it’s it should be in the state system, it should be in the CD system, and it more than likely will be an insurance system as well. So yes, we should be able to verify through that as well. And if we can’t, we will rely on your memory and your self-verification as to what you’ve received and when?

Andy Slavitt 

So let’s talk now about the different vaccines because here’s where it will make it confusing for people. And where we have some of the most questions. Right now, the only data that’s being submitted to the FDA is from Pfizer. So it’s reasonably straightforward If the FDA comes out and says, you know, the Pfizer booster is approved, but they are good, they’re further behind on Moderna. And they may be a month behind from what I understand. And then Johnson and Johnson is still yet another unknown. So let’s maybe we’ll try to walk through each particular case. If you’ve had the Pfizer vaccine, presumably, you can get a Pfizer booster. But I suppose you could also say, I want to mix and match and get a Moderna booster, theoretically, and if you’re a Moderna person, generally speaking, you’re being told to wait even maybe you’re an at-risk person. You’re 85 years old, you took Moderna, would you have the option? And would it be advisable to get a Pfizer booster instead of waiting for Moderna booster? And then for Johnson and Johnson, should those folks get boosters, to help us through this spaghetti mess.

David Agus 

It really is a spaghetti mess. I mean, the bottom line is the boosters were worked any which way. So what we know, from pilot data, again, these are pilot data, but pilot data is that if you switch shots, so you got to Pfizer, you get a Moderna booster, more side effects, probably a little bit better immunity, but more side effects. And what we’re worried about is that you have significant side effects, it’s going to increase vaccine hesitancy, it’s going to make people wary of vaccines in general. So that’s why we’re really pushing people stick to the same shot if you can, is what I’m doing is you know if you got Pfizer to try to stick with Pfizer, well, if you got Moderna, and the Moderna booster is not available, right now, Moderna tried several doses of its booster and trying to figure out what is the beneficial dose for that booster has not been done yet. You certainly can get a Pfizer booster if you meet all the requirements, if you’re immune suppressed. So you got Moderna, I want you to get a Pfizer booster now, you’re eligible for it and makes total sense.

Andy Slavitt  36:52

Tom, if someone comes into your store, who’s had two Moderna shots and asked for a Pfizer booster? Can they get one?

Tom Moriarty 

Well, this is where the FDA and ACIP is going to have to weigh in very clearly Andy so that mix and match protocol is going to have to be specified in the guidance that they give. And just you know, one, just one point on Moderna, which listeners may not fully appreciate, they’re behind because as David outlined, they have been trading different doses. And what they’ve submitted is actually a less dose or smaller dose than the currently approved first and second shot. And as a result, that’s a new application. And they need to develop all the safety and efficacy information around that. So that’s a big reason why they’re behind. But the FDA and ACIP have to address this and guidelines in terms of our ability to administer on a mix and match basis.

Andy Slavitt 

Okay. So even though we could have Dr. Agus on the one hand saying, yes, if you’ve had Moderna and you’re at risk, you should get Pfizer. We need ACIP to come back and say that that’s allowable, otherwise, you and other people administering vaccines won’t be able to do that.

Tom Moriarty 

Or as simple as saying, or as directed by your physician to the direction and discretion of the physician. If they do that, that gives us the ability to do the mix and match on a physician recommendation.

Andy Slavitt  38:12

Okay. So that’s going to be up to you and your physician. And you shouldn’t be afraid to talk to your physician, if the guidance comes out in a way that says, you really feel like you would like a booster. But you know, CVS at others are in a rock and hard place they have to follow guidance. That’s when one key step you can take is go to see your doctor.

Andy Slavitt 

So let’s go down to Johnson and Johnson. And the question that we get most frequently and we have gotten most frequently is for people who take a Johnson and Johnson and want to know do they need a boost? Should they get a boost? And what should that boost be from and this is I will tell you people who’ve had Johnson and Johnson feel very frustrated, they feel ignored. In all of the messaging, they were told get whatever vaccine you can get most quickly. And they got Johnson and Johnson and now they feel like they’re not getting any communication.

David Agus 

I agree with you communication has been off and again, I fault right now. You know, the CDC and the ACIP need to give guidelines for every citizen in the country, not just when studies are completed announce the guideline changes and that’s an issue that we have to deal with. But Johnson and Johnson is an excellent vaccine, don’t get me wrong, the immune response or immunity you got afterwards was slightly less than that seen with Pfizer and Moderna but also the rate of decline on a monthly basis of the immunity is less with J&J than it is with Pfizer, Moderna. So when we looked at breakthrough infections, and we take into account when people were vaccinated, you know, because it’s an unfair bias people with elderly and at higher risk were vaccinated early, and those were almost all Pfizer because that was the first vaccine approved.

David Agus  40:17

When you correct for that, there’s no increase in breakthroughs with J&J or Moderna, or Pfizer. All three are excellent vaccines, all three, you know, provides protection excellently against serious infection. And so there’s really you weren’t given the short end of the stick. If you got J&J, there was some data out of mayo clinic and a very poorly done study, showing that there was potentially more immunity with Moderna than Pfizer. And that is not true. That is not accurate. There’s some data out in that study that maybe there was a slightly more breakthroughs with Pfizer and Moderna. And the reason for that, again, is that people who were vaccinated early, were elderly, with Pfizer. So if you take that all into account, they’re all excellent vaccines and nobody got the short end of the stick to date.

Andy Slavitt 

Okay, so that take us to the booster point. You said it wanes, less, but it started lower. There’s still some waning, it sounds like and I know that this show doesn’t give out medical advice, and people should talk to their own doctors. But if it was your own, if it was your mother, or someone with an elderly parent, and they’ve had a Johnson and Johnson vaccine, would you recommend that they strongly consider getting a Pfizer booster.

David Agus 

Based on my extrapolation of the data from Israel, and my extrapolation of what we know about immunity with the J&J vaccine. Approximately six months after the original shot? I would make them a consideration for booster, no question about it. I mean, the goal is prevention. And you’re making all these arguments about? Well, we don’t know yet. Well, the downside is minimal to none. The upside is we can protect people from getting sick. And right now about 14% to 16% of the hospitalizations, the United States are in the vaccinated and I don’t want any one of them to happen. So I want to protect my mother, I want to protect my neighbor, I want to protect everybody as much as we can.

Andy Slavitt  42:05

Let me play a voicemail to you, that came in from one of our listeners.

Speaker 5 

I wanted to know if it’s recommended to mix and match the vaccine, for example, having two Pfizer’s in the beginning and then the Moderna. Is it better for the booster shot to be mixed and matched? Or do we just stay in the same family of Pfizer, Pfizer, Pfizer, Moderna, Moderna, Moderna, what are your thoughts? And what’s the data showing? If any, thank you.

David Agus 

I would stay in the same family. Again, I think it’s gonna be better tolerated. And I think we have very good data on the follow up shot with each of those if you can. If it’s not available for the vaccine you got whether because just in your geography, it’s not or the ACIP or the FDA, have not yet said you could give us a booster with the brand you got originally, it’s fine to mix and match, slightly more side effects, but you will make a potent immune response and you’ll be protected. So the bottom line is if you can get the same one do, if you can’t, not a major worry. And get it it’s more important that you are protected.

Andy Slavitt 

So Tom, as people are getting ready to go in to get shots, if they qualify. People have a variety of different memories from different stages of getting vaccinated the first time around, there was a period of time when we just didn’t have enough supply. And during that period of time, people had to wait. Sometimes they had to get onto websites and try to refresh. And then one day that cleared up because the demand dropped and the supply was higher. And there were enough distribution sites. Do you anticipate what situation you anticipate we’ll be in? As boosters begin rolling out? Do we anticipate people will have a difficult time finding an appointment and getting a vaccine slot? Do you think that’s just going to be if that happens? Do you think that’s just going to be the case at first, or something that we’ll be dealing with longer term?

Tom Moriarty

Well, they really shouldn’t have a problem, Andy and I think you know, as David has outlined, you’re likely to see a little bit of a staggered tiered rollout to this in terms of health care workers, folks over 65 long term care and then continued rollout based off of when you received your vaccination the first time. So that’s going to create a natural sort of tearing of folks coming in. But the supply situation has changed dramatically. I mean, you know, kudos to Pfizer and Moderna in terms of their production capacities and the distribution capacity, so we don’t anticipate any shortcomings there. And the way we’ve now been operating under the federal pharmacy program, our ability to order to have visibility to those orders, and then also for CDC to have visibility to our supply, even at a store level has really created a lot of efficiencies in the distribution system. And I think we’re in a much, much better place now than we were when we first started combating this pandemic.

Andy Slavitt  44:53

And Patty Rose wants to know, will the boosters be free?

Tom Moriarty 

They will be I mean under, you know, the cares act. The […] act, there is no charge for this. So you will be covered by insurance. And if you are uninsured, there’s a federal program by which these should be covered for you, at the pharmacy or  wherever you’re going to obtain that that vaccination.

Andy Slavitt 

Here’s another question Dr. Lisa got for us. This one’s from Susan.

Speaker 6 

I want to know if they think it’s going to be an annual thing like the flu shot? Or if it’s going to be just as you know, one time and you’re done?

David Agus

The answer is yes. We just don’t know, right? Over a million years of evolution, the human genome change 1%, this virus can change 1% in a day. So if you ask me today and say, listen, this is the last variant we have, Delta is it, I would bet you that we’re three and done would be my gut. And my guess, although we do not know how long these boosters will last, we haven’t tested it yet. But the virus is changing. And we’re seeing that, there are new variants that are popping up and there will continue to be new variants. And so at some point, I’m sure there will be a variant, I try to be a pessimist or negative or evoke fear. But there’ll be a variant that does evade somehow the immunity that’s provided by the vaccines. And so we may need to get a specific booster for those variants at some point, like we get a flu shot because we see Influenza is changing every year.

Andy Slavitt  46:23

Got it. Do you have any worries whatsoever that we’ll see a variant at some point that the vaccine can’t be manufactured, to solve to create an immune response?

David Agus 

That’s a very interesting question. And you know, what we know now is that the virus can change and there are certain what we call mutations or changes in the virus that can happen and they’ve been actually characterized that can evade the vaccine. And that’s what worries us, will they change so that they’re not vaccine herbal at all, I don’t think that’s a possibility right now, at least our modeling of the spike protein really shows that no matter how it changes, we should be able to make an immune response to it. But what worries us if it evades the vaccine, you know, it does take maybe a little take, you know, Pfizer and Dr. Bourla, 90 to 120 days to make it but then you have to do the studies and the safety and the producing. And so we are talking a relatively long time between we have enough to vaccinate the country, and the change. So we are worried about that.

Andy Slavitt 

So you know, we’ve had done a lot of planning at the federal level, we just wait some announcements, then we’re talking about 100 days to vaccine, and then 100 days of production to distribution. Regulatory process included, that’s one of the things I worked on at the White House. And if we could hit those marks, then what you really screwed is if you’re in the country of origin of the new variant, because there you’ll be like India was with Delta. But if you’re in a different country, the time it takes for it to travel and take hold and go up the curve is such that we’re not gonna be without a vaccine for 200 full days, it may be 30 days, it may be 50 days, if we can continue to improve the process so we can reduce it. That’d be good, too. But doing all that on a global basis, manufacturing another 10 billion vaccines, and being able to do it quickly. That’s a skill we don’t have. We’re trying to get it right the first time. But having to repeat that, as you say, David, would be quite a challenge.

David Agus  48:23

And listen, I mean, right now we are the lowest of the G7 countries in terms of vaccination rates. So even Japan has passed us and they were a very slow starter. So if we do it, and you built this amazing machine, we do, we still have to get vaccine adoption, we have to get it into people’s arms, which is, you know, no matter how good CVS is, and they are amazing, you know, there’s still a cohort of people that are enabling virus spread by not being vaccinated. And that’s what worries me every night.

Andy Slavitt 

How much time should be given between getting a booster shot and the flu shot?

David Agus 

What we know is that you can give them concurrently at the same time, little bit more side effects, you know, so, to me, optimally, I’m not a believer in side effects. So I would rather you take a couple of days, and do three, four days in between them if you can, if for whatever logistical reason, it’s too difficult. It’s okay to get them together.

Tom Moriarty 

And David, we were actually building our scheduling system to give folks that option to either do it at the same time or come in at a separate time to do flu and COVID. It’s trying to make it as easy as possible for folks.

David Agus 

That’s great.

Andy Slavitt 

Well, […] actually asked this question time, are we going to be able to get boosters via walk in right away? Or will appointments be required?

Tom Moriarty 

Yes. So you’re always going to be better with an appointment, because you’ll be guaranteed a time slot. We’ll be able to know which vaccine you receive the first time and ensure supply that vaccine at the location where you’re scheduled to be, we will be able to do walk ins, but you’ll be subject to wait times and other things based on whatever else may be happening at that time. So we’re going to very much encouraged scheduling. Once the boosters are approved by FDA, we have a set guidelines. We’ll have a fairly robust communication and marketing program for folks to help them understand all about the boosters and then how they can obtain them at CVS.

Andy Slavitt  50:19

David, question, my wife and I just recently recovered from COVID, both vaccinated with Pfizer in April, we’re fairly healthy as well, no preexisting conditions. My question is now that we’re recovering from natural infection, would we still need to get a third booster?

David Agus 

It’s an excellent question. And so what we do know is that if you’ve been double vax, which you have been, and you’ve been exposed to the virus, you have some pretty profound immunity, pretty strong stuff there. My gut. And again, it’s not based on data, because we’ve never done the study, my gut is you do not need a booster. But we have not done that study, we assume that the natural immunity together with the double vax really will give you protection, and it certainly looks like it in some laboratory essays. But we’ve never done that study, unless your doctor tells you otherwise, I probably wouldn’t get a booster.

Andy Slavitt 

Is that matter if what you had was Delta or the earlier variant? Does your interchange?

David Agus 

Yes, if you did not have Delta, I do want you to get the booster. So if it wasn’t in the last couple months, I do think you need to get that booster shot. Good question.

Andy Slavitt 

Great, that’s helpful, very helpful. Maybe just close with and maybe bring it back up to 50,000 feet for people. And you know, Tom, if you were to start with you, and then we’ll close with David, if you were gonna give general guidelines and advice to the average confused person, maybe it’s a member of your family, or someone out there knowing that everybody’s in slightly different situations, as they think about getting booster shots. What assurances Can you give them? What advice can you give them?

Tom Moriarty 

Yeah, I think overall, Andy, we’re unfortunately probably entering the third phase here of the pandemic, and it’s going to be the most confusing phase for consumers for patients across the board. Because of the staggering of a Pfizer booster approval versus Moderna. My core recommendation is go to trusted sources of information, talk to your doctor, go to cvs.com, go to cdc.gov and read the information there. Do not go to the general media sites, go to the trusted sources for information for the questions that you have. Because it will be confusing and having the right information, it’s going to be the best power for you to make the right choices.

Andy Slavitt  52:30

Well, one of those trusted sources it turns out, according to at least a lot of polls, are pharmacists themselves. I want to play something here at time you’ll find it interesting. We actually found this Twitter thread from Natalie Jackson in Washington DC.

Speaker 7 

I went to CVS this Morning to get a prescription and a flu shot. While I was waiting I saw firsthand the work pharmacists are doing to get anxious people across the COVID vaccination line. These people are heroes, y’all. It takes whole villages. While I was waiting, the woman over 65, Black, so definitely in demos we need vaccinated was clearly very anxious and the pharmacist was talking her through the paperwork. The pharmacist is also a Black woman. So I’d imagine that representation matter too. And then she said yes. When it came to the final yes, the woman prayed out loud to Jesus. Let whatever needs to happen, happen. And said yes. But then there was a bit of a wait, the pharmacist was really slammed. Pharma told me later she had a tech out today.

Speaker 7 

Another woman waiting for her second shot kept the first woman calm a couple of times, I told the pharmacist to handle theirs before even worrying about me to try to help move things along since we all saw how precarious this was. In the end, the woman got her shot. The pharmacist told me that she had mentioned that the President Biden convinced her but obviously there was still a lot of anxiety and it took work from the pharmacist to get her over the line. I hope this woman has no side effects. Anyway, just a story to keep in mind when you think about how to convince people and how to help them. This was clearly a combination of an influential president she respects, religion, a pharmacist who looks like her and cared a lot to convince her and even bystander help. To close, please remember, not everyone who isn’t vaccinated is a selfish jerk. Some are just scared with good reason in some cases, and we need to help them how we can.

Andy Slavitt  54:36

Interesting, so Tom, as you know many people don’t have their own doctors or maybe they don’t know where to get trusted information. So someone does come into CVS pharmacy, and they have a lot of questions before they get a booster or any other shot and they want to talk to a pharmacist. Will that pharmacist be prepared to give them advice?

Tom Moriarty 

Their pharmacist will be as well as others in the pharmacies, we have a program called Health Ambassadors where we’re training our non-pharmacists personnel to actually be able to answer questions and provide general information. And then obviously, if they’re more detailed questions or more detailed information needed, then the pharmacists will be available to answer those questions. We want to be a resource, whether it’s physically in the pharmacy, or through our virtual sites at CVS.com or otherwise, and we will be a trusted source for information for consumers.

Andy Slavitt 

Okay, great. Well, thank you, Tom. I did so appreciate it and appreciate all of your work. Just a critical piece of the puzzle for Americans health, David, you know, you’ve been watching, and not just watching and observing, but watching it out very hands on way, the development of science and the vaccines and various other kind of promising things that are coming, if you could go back up to 30,000 feet, and give people just a general sense of the most important things you’re seeing that they should be both thinking about right now, whether it’s relative to boosters. And then beyond that, as they think about what to expect, and to plan for, based on what you’re seeing, what would you tell them?

David Agus  56:17

So I want to thank you for everything you did in the administration. I mean, it was heroic, and you left your family to help our country. And we all appreciate what you did. You know, obviously, we have this new variant Delta, which is causing major issues, the numbers are starting to level off. And I think over the next three, four weeks, because of the immunity of people who got infected with the virus, and the 50 plus percent that you vaccinated, we’re going to see a significant improvement in the numbers, but it’s in our interest as citizens of the United States that we vaccinate the globe. We have to vaccinate the rest of the world to stop spreading the variants and that’s going to be a major issue historically, or nonetheless, you know, a year we’ve been delivering vaccines to airports and that’s not enough we have to get them into people’s arms around the globe to stop spreading the virus. Well, we also know is that we don’t yet have a small molecule, we don’t have a pill that if your wife has COVID you take it and you won’t get sick, or your tested positive that your doctor gives you that pills, you don’t have to go to a hospital and get an infusion of an antibody etc.

David Agus 

We don’t have that pill yet there to in late-stage development that look encouraging and my fingers are crossed, I am praying that they come through and they work. We have antibodies now there’s a Glaxo antibody, that it’s a shot in the arm that can last for four months. And that’s certainly very encouraging, again, to give protection to people who are immune suppressed. And that’s some optimism here now.

Andy Slavitt 

Where would somebody get those, the Glaxo?

David Agus 

You know, right now you go to your doctor and your doctor and arrangement with a hospital can arrange for those antibodies to be released in the right settings. Right now, it’s not in the what we call the prep setting, it’s down that prevention, you have to test positive to get them, which I think has to change at some point. Right now immune suppressed patients is not approved for them, even though doctors are using it for them. And it is very hard to get it for that I am many doctors have a lot of patients just who made no immune response to the vaccine, we have not taken care of them as a country, we have to step up and do that. Populations with CLL, lymphoma, some autoimmune diseases or immune suppressive drugs transplant patients, we have to do better for them. And we haven’t yet they’re basically confined to their room because they’re afraid to go out and that we have to address. And it really hasn’t been on the radar screen to date, although the studies are coming due. But again, we know there’s no downside to these antibodies, we know they’ll work and perfect.

David Agus  58:40

And even though the studies aren’t done yet, we have to step up and without perfect studies, we have to start to enact things. And then I think you know, we’re going to need leadership here, what we see is to get normative behavior change, you need leadership, and leadership has been all over the place in healthcare, unfortunately. And it’s not just doing the right thing. It’s the messaging around that, it’s the explanation of it to different backgrounds, different cultures, different races, we have to speak differently. And I think we need to look at our messaging across the country, you’ve addressed that we have to deal with social media. Social media has been a major issue, unfortunately, in this pandemic in a negative way. You and I and many others have been attacked like you wouldn’t believe and it is scary. And it is very easy to dissuade one from doing the right thing because you’re afraid of the attacking on social media, we have to step up against that and make it a positive not a negative. But you know, I hope that we can get kids to wear masks for the next month or so not forever. But until the virus numbers come down because I am worried about kids, you know, optimistic that the vaccine at least the Pfizer, one will be here for kids 5 through 12. Hopefully in the next 6 to 8 weeks, which is going to be critical because we have to protect our kids. We’re seeing more and more of them hospitalized. They’re also conveyors of the virus to others and we have to stop the spread in them.

Andy Slavitt

Great, well, thank you, you know, I probably should say, reiterate what I said in the introduction, David, you’re probably among the first people, if not the first person that I reached out to and I have a scientific question. It was true before I was in the White House to in the show, you were on several times one of the most popular people to be on because of how well you explain things, then how much you know, but then also in the White House, to very complicated questions that I would have, which I wouldn’t even show what I was asking sometimes that you would explain to me, no, Slavitt, this is the question you really want to ask. And this is the answer. Incredible, incredible help and service and support the fact that people like you out there and that you’re still continuing to do this. You do it on TV, you do it all over the place. You’re treasure?

David Agus 

Well, thank you. It’s my privilege, I always love the getting the text from you because it would first be with you up because you were in a different time zone three hours earlier. That was always the beginning, you up yet?

Andy Slavitt

Exactly. Well, thank you both. Both a great deal, and I’ve got a reserved for you guys back. There. It is good to have you back if you’re willing.

David Agus  

Thank you guys. We’ll talk to you soon.

Andy Slavitt 

Well, that was hopefully useful and helpful to you. I’d like doing these toolkit episodes. If it sounds exhausting arguing with David Agus, it is, it’s a tough argue. I tell you do you ever, like have anybody that like, you just have to argue with them. Because they’re constantly arguing with you. And you gotta argue back and you’re leaving to share? What if you want to argue with them or why you’re arguing? And that’s David. I love him. He’s phenomenal. I think you guys hopefully do too. He’s got his own opinions. Who’s coming up on the show? Four great shows coming up, one, Sanjay Gupta, America’s doctor from CNN. Wonderful. Got a new book out. I think you’re gonna love this conversation. Katherine Wu from the Atlantic. She just put out a piece called the six rules that will define our second pandemic winter along with Ed Yong, the two of them co-authored it. Ed was on the show recently. If you haven’t listened to that, go back and listen. He really was one of the recommended Katherine to us. Celine Gounder, who’s an internist and infectious disease specialists and epidemiologists at NYU. She was one of the CO chairs of the transition team on COVID for the Biden administration. She also hosts two podcasts of her own called American Diagnosis and Epidemic. She’s fantastic. And then last but not least, Ashish Jha, the Ashish Jha you’ve probably seen on TV. Very smart. Very wise. Remember last year he invited me over to a barbecue at his house on the Fourth of July. Did you go? I didn’t, I should have, but I didn’t go. Anyway. I sheesh is the head of public health at Brown. And he’s wonderful. Four great shows coming up. But before we get to those shows, enjoy the rest of your week. Thank you for tuning in.

CREDITS

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.