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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, everyone. I'll start today with part of an email I got from a listener this morning. It says, "I have been refreshing pages constantly looking for a first vaccine for my husband. There are really no appointments, zero and if I do see one opening by the time I refill out the form for him for the 20th time, it's no longer available. The reason some people get them before other people is because they are better at looking online or something like that.

All the appointments are gone, no appointments, they open up vaccinations to more and more people, which is fine, but they should tell people it's a full-time job looking to get vaccinated. It's very poor planning." That's one listener's experience. Here's a shocking New York story from Gothamist that backs that up. The headline is Mount Sinai Cancels COVID Vaccine Appointments, sending at-risk New Yorkers back to square one.

It starts, patients with upcoming vaccine appointments at Mount Sinai Health systems got some scheduled months in advance are being notified this week that they should look elsewhere. Cancellations affect thousands of people seeking the life-saving immunizations according to an insider at the hospital. Who's that insider? It says that's according to a letter Dr. Vicki LoPachin, Chief Medical Officer at Mount Sinai sent to faculty and staff on Sunday. She said Mount Sinai is honoring second dose appointments for employees and patients by putting new bookings on hold for the time being.

Here comes the reason, LoPachin cited the rapid expansion of eligibility groups as the cause, saying that the city and state "Revise their vaccine allocation Plan" this Week in light of people with certain health conditions becoming eligible. She went on to imply that the supply is strategically being shifted from hospitals to city and state-run vaccine sites. As a result, she writes, we like other health systems across the region and the state will be getting no new supply of first-dose vaccines this week.

That's one thing that's happening. Another new york development is that the city has released the long-sought-after vaccination rates by zip code and it shows things like that on one end of the Rockaway Peninsula where the population is largely white, the vaccination rate is 27%. At the other end, where the people are mostly black, it's 4%. For people who have gotten fully vaccinated, the Centers for Disease Control have an interesting and hopeful new guideline. If you are vaccinated, and then exposed to someone with COVID-19, you don't necessarily have to quarantine.

Now that implies that the vaccine might make you less able to transmit the virus, which has been a question, the vaccine might protect you from getting really sick, we know that pretty well by now but does it prevent you from actually getting and spreading the virus? We'll see with our guest if we can get any more clarity on that. With those stories as prelude, with us now is our guest, Dr. Dhruv Khullar, a practicing physician, and professor at the Weill Cornell Medical College.

His research focuses on topics including health disparities and medical innovation. He's also a New Yorker magazine staff writer whose latest article is called, Why are so many health care workers resisting the Coronavirus vaccine. The one before that is called, 6Biden's Pandemic Plan Just Might Work. Dr. Khullar, so glad you could join us today. Welcome to WNYC.

Dr. Dhruv Khullar: It's great to be with you. Thank you for having me.

Brian: I'll bite it on your latest headline, why are so many health care workers of all people resisting the Coronavirus vaccine?

Dr. Dhruv: It's a great question, Brian. One of the things that surprised me and I think surprised a lot of people early on, on the one hand, you have so many people, as your caller's email suggested who are really trying to get the vaccine and unable to get it. On the other hand, we started hearing reports that even some health care workers were expressing vaccine hesitancy that they weren't jumping at the opportunity to get vaccinated. I wanted to try to understand why this was the case, so I spoke to a number of doctors and nurses, as well as nursing aides, people who worked in nursing homes and I think it really came down to a few different issues.

One was that some people felt that the vaccine had just been developed too quickly and so we had been told for a long time that vaccines can take months or years, I'm sorry, years or decades to be developed and this one- these vaccines came out in less than a year. Some people were concerned about the side effects of vaccines, but I think the driving force in a lot of examples, particularly for people who worked in nursing homes, was a lack of trust, a lack of trust in the motive of the people that were asking them to get vaccinated, having felt that the health system hadn't treated them as well as they thought they deserve to be treated over the years so they simply didn't trust that the vaccine was effective.

Now, we know that the vaccine is effective, we have a lot of work to do to convince both health care workers, but also the general public that it is safe, it is something that is life-saving, and that is important to get, but those are some of the reasons that I think people initially had some level of skepticism, I think that will improve over time, but we have a lot of work to do in that area as well.

Brian: Dr. Khullar, some of the stories you tell in your article are of health care workers who simply don't trust their employers, like cases of being lied to in the past about whether they would have to be around COVID patients. In certain assignments, they were told no and it turned out to be yes. How much of a factor do you think that is?

Dr. Dhruv: That's absolutely right. That's a big issue around trust and I think there's the issue that you highlighted that people weren't always told that they would be caring for COVID patients. There's the issue that people haven't always had the PPE, the mask, the goggles, the gowns that they needed, they haven't received hazard pay, they haven't been paid well in the past. All these things contribute to an environment in which some staff can feel that their best interests aren't at heart that certain entities, whether it's hospitals or nursing homes may value profits over the interests of patients or of staff.

I should note here that, we talk about health care workers as a large homogenous group, but that's not at all the case obviously, there are doctors, nurses, there are people that help transport patients, there the cleaning staff in hospitals and so what we see is that healthcare workers have different levels of vaccine hesitancy depending on their role, and depending on the setting in which they are working.

Nursing homes seem to have somewhat higher levels of vaccine hesitancy as compared to hospitals, people who work in relatively lower-paying jobs in the healthcare system, people who are transporting patients, people who are working in food services, or cleaning rooms or nursing assistants, they also have higher levels of vaccine hesitancy. Then, obviously, we see disparities by race. There are a number of historical reasons for that but also, current reasons that people feel like they have been marginalized or their interests haven't been valued by the system, all those things are contributing to levels of vaccine hesitancy.

I will note that I think this will improve over time, I think one thing that we heard a lot early on is that people simply wanted to see how their colleagues did after they got vaccinated, people want to understand when the general public is starting to get vaccinated, how do they do in terms of side effects, in terms of the protection that they receive after they're vaccinated. As those things become clearer and clearer to people, I think more and more people will decide to get the vaccine ultimately.

Brian: Now, listeners, in our next segment, we will give you specific advice for navigating the vaccine appointment process in New York City, that's with our next guest in our next segment, don't call about that right now. For this segment, we invite your calls for Dr. Khullar from Cornell Weill and the New Yorker magazine, on the science and the guidance for what you can do or cannot do after being vaccinated, the policies of how the Biden administration or your local government are adding new eligibility groups compared to how much vaccine and how much people in the already eligible groups are getting vaccinated, and things like that for Dr. Dhruv Khullar from Cornell Weill and the New Yorker.

646-435-7280, 646-435-7280. Again, if you're calling to talk about how to get access to vaccine appointments in New York City, please clear the lines, we will take those calls in our next segment. Doctor, do you have a take on vaccine rollouts. I don't know if every place is as frustrating as New York City seems to be in that Gothamist Mount Sinai story, and the letter from the listener the email. Are localities adding too many eligibility groups all worthy, of course, but still may be too many all at once into the teeth of too few available doses?

Dr. Khullar: I’d say it's a complex issue, I think early on the CDC in most states had very narrow eligibility criteria and that makes sense for a lot of reasons. You wanted people who are at the highest risk to get the vaccines first. What ended up happening, though, in many cases, is that some of those vaccines were going to waste because certain hospitals or clinics weren't able to find enough people in the short amount of time during which these vaccines after you open them needed to be used.

That's obviously a very frustrating situation where you have extra vaccines and you're not able to give it because of strict eligibility criteria. What's happened since is that we've probably opened up, who is eligible for vaccinations. Some of that has been good, we've seen the daily number of vaccines really rise over the past few weeks. A month ago we were doing something like fewer than a million vaccines across the whole country a day. Now that number is often twice as high. There's many days in which we have two or 2.3 million vaccines that are given out each day.

There is this consequence of having opened up vaccines to more than 100 million Americans now. It is hard for certain people who may be higher-risk to get vaccines, even as lower-risk people are starting to get them so that's certainly an area of frustration. What we have heard from the Biden administration is that in the coming months, they have secured more than enough vaccines to vaccinate every American adult in the country. The estimate is that sometime by this summer that supply will be where it needs to be, but right now we are in a situation where not everyone who wants the vaccine is able to get it so really there is still this supply-demand mismatch.

Brian: I saw a report from a smaller city in Colorado yesterday where they haven't even added 65 year-olds yet, it's only 70 and up, plus a few selected job categories. Until they get to something like a two-thirds vaccination rate in those oldest residents. Is that a better way to do it? Is it applicable in bigger as well as smaller places?

Dr. Khullar: Again, it's a real challenge I think weighing and balancing the need to vaccinate the highest-risk people with getting these vaccines out as quickly as possible. We know that there are concerns around new surges in terms of the new coronavirus variants and strains that we're seeing in order to tamp down the level of spread and the risk of those variants becoming even more contagious and dominant in the United States. It's important to roll out the vaccine to as many people as possible.

We know that strict eligibility criteria can be challenging in terms of getting the vaccine out quickly. On the other hand, people who are older, we know that It's the greatest risk factor for severe disease, hospitalization, and death from coronavirus infections. It's imperative that we really continue to focus on those groups. One thing that I think has been very effective is that we now have the vast majority of nursing home residents in the United States have been vaccinated.

That was a challenge early on, but we've gotten to a place where most nursing home residents, the very highest risk group are vaccinated, which is a real show of progress. Again, it's a real balancing act between rolling the vaccine out as quickly as possible and making sure that the highest risk people get it first.

Brian: Before we go to some phone callers, let's go on to the new CDC guidelines for people who have been fully vaccinated. The CDC is still urging vaccinated people to keep taking most of the usual precautions, as I understand it, like wearing masks and social distancing, but a few days ago said vaccinated folks should not have to quarantine if they're exposed to someone who's COVID positive. I'm really confused how those different pieces of advice fit together, you do have to keep masking and social distancing but if you're exposed, you don't have to quarantine. How much can you explain it?

Dr. Khullar: The CDC has laid out a few criteria for people who are fully vaccinated, not to quarantine after a coronavirus exposure. They say you have to be at least two weeks after your second dose of the coronavirus vaccine. That is the time at which we expect that your immune system has matured and has delivered some level of protection or full protection, nearly full protection against infection so you have to be at two weeks out.

The other thing that they said is that you have to be less than three months out so between two weeks and three months and the reason for that second piece is that it's not yet clear how long immunity lasts after you've been vaccinated so you have to be somewhere in that timeframe. The third part of this is that you can't have experienced any symptoms, so if you start to feel symptoms, cough, fatigue, runny nose. Those would all be suggestions that you may be having symptomatic COVID-19, and therefore should enter a quarantine.

Assuming that you meet all these criteria. The rationale here seems to be that fully vaccinated people can feel a lot safer that they are protected against severe disease. While there is a theoretical risk that they can still contract the virus and potentially spread the virus that is not high enough in their estimation at this point to offset the social and economic problems that occur from quarantine.

The idea here is that you still need to take precautions when you go out in public. You're assuming that if you are asymptomatic, the risk of spreading it to others is less than if you become symptomatic, so it's kind of trying to walk a tight balance here. The idea is you have been vaccinated. The risk of you then contracting and transmitting the virus, especially if you're asymptomatic is relatively low.

Brian: I think we have a follow-up question from Barry in the Bronx. Barry, you’re on WNYC. Thank you for calling in. Barry, are you there? Barry's not there. I'll ask the follow-up question. What's the best science to date on whether the vaccine reduces your ability to transmit the virus to others?

Dr. Khullar: That is still an open question, I think, theoretically, most scientists would say that the risk that you would contract and transmit the virus is lower, much, much lower after you've been vaccinated as compared to before you've been vaccinated. We've seen some suggestions in terms of declining case rates in areas where you've had higher vaccination, Israel is a good example of this. That would suggest that, indeed, not only are you protected from getting a severe disease, but you also have a lower ability to transmit the virus.

There's still a lot of uncertainty around this question and so until we know the answer to that, the most important things that we need to do still exists in terms of masking and social distancing, avoiding large indoor gatherings. I hope that we have an answer to this question in the coming weeks and months, but right now we just don't have enough science around it.

Brian: Claire in Sleepy Hollow, you're on WNYC with Dr. Dhruv Khullar from Cornell Weill and The New Yorker. Hi.

Claire: Morning Brian, thank you so much for taking my call. My husband and I both had coronavirus after a fire in our house on Christmas day, we think that's where we might have gotten it.

Brian: Oh, God.

Claire: Both of us are in recovering. Thank goodness they were relatively mild cases. By relatively, I really mean relatively. My question is the reaction that people in my circle seem to be having after the second shot, sounds like an immunological reaction. My understanding is that this is not a live virus in the vaccine, and after that my science falls apart, but I know it's an RNA vaccination. Can you explain how it causes that immunological reaction in people if it's not live virus?

Brian: Right, meaning some people feel sick for a day or a couple of days after getting usually the second dose. That's an immunological response, Dr. Khlullar, can you further explain that to Claire.

Dr. Khullar: Sure. First of all, Claire, I'm sorry to hear about the fire and the coronavirus infection that you and your husband had, but I'm glad that you're feeling okay now. You're absolutely right so it's not a live virus that the vaccine is using. It's this new technology called mRNA platform technology. The idea is that it takes the genetic code, it takes some of the genetic material of the virus, the same kind of printout that you could think of and delivers it to your cells, and it gets your cells to make a specific type of protein.

That protein is very similar to the type of protein that the virus itself a real virus would introduce, but it's not the real virus's protein. It's a protein that the mRNA technology has asked your cells to make. That protein is what inspires the immune response in your body. Your body starts reacting as if you have the live virus, but it is not the live virus, it's protein, but the symptoms that one feels from that type of immune response are very similar. That's the reason that even though the virus is not in your body, it can feel like your immune system is reacting in the same way.

Brian: Claire, I hope that--

Claire: Just a quick--

Brian: Go ahead, do you have a follow-up? You can go.

Claire: Yes just a quick follow-up question. Thank you so much, Brian. Is that why they are thinking it might also protect against the other mutations of this virus, and then I'll go off the air. Thank you both so much.

Brian: Claire, actually, I want to ask you because I'm sure our listeners are curious. First of all, they're sympathetic, I'm sure like we all are, what a double whammy to have a fire and then coronavirus, a triple whammy on Christmas Day, no less, you said. What was the relationship between the fire and the virus? Was it that you had to then go be around people you wouldn't otherwise been around?

Claire: It was a power surge, an electrical fire. There was an explosion and very dramatic, but luckily not terrible. We were very lucky in that regard, but fireman and the electricians who came out and Kohn, Edd, and everybody who came to our rescue on Christmas Day, when they go to somebody's house, they don't knock on the door and say, "Oh, excuse me, do you have coronavirus before I come in and put the fire out?" We don't know exactly where we got it. These people saved us.

Brian: You were exposed to other people.

Claire: Exactly. We feel like we might've been exposed at that point. We don't really know, we just know that a week later we were both quite sick.

Brian: I hope everything works out. Thank you for your call. Dr. Khullar, do you have that answer to her second question?

Dr. Khullar: Yes. The idea is that when the spike protein is introduced, your body makes many different types of antibodies. It's not as if it makes just one antibody in response to the vaccine. It makes many types of antibodies. Each may be slightly different than the others. It is able to neutralize slightly different versions of the virus, whether it has a mutation on this part of the virus or that part of the virus. That's the idea behind having what we call polyclonal. Polyclonal mean many type antibody response.

There is some evidence, particularly with the South Africa strain that certain vaccines may not be as effective against it. It may have developed some type of mutation that actually renders it somewhat more resistant to particular types of vaccines, but for the most part, the vaccine seemed to be effective against the viruses and the variants that we know of to date

Brian: Nelly in Brooklyn, you're on WNYC with Dr. Khullar. Hi, Nelly?

Nelly: Hi, how are you? Thanks for taking my call.

Brian: Sure.

Nelly: I have a follow-up question actually to Claire's. My mom's in her 70s and she had COVID and then got the first vaccine and she is waiting for the second and she tested positive for antibodies. I'm just curious, there hasn't been a lot of talk about the difference in immunity between the vaccine and actually having the illness and the antibiotics and the illness. She's walking around like she's superwoman. She's masked and she's doing socially distance, but she's definitely alleviating some of the barriers and opening her germ circle a bit.

I'm just curious if you could talk a little bit about the difference between that immunity and whether or not you should live your life differently depending on whether or not you have immunity from the vaccine or immunity from the illness.

Dr. Khullar: Yes, that's a great question. We don't know enough about the differences at this time between naturally acquired immunity and vaccine-generated immunity. We do have a recommendation from the CDC that people who have had the infection should also still get vaccinated. The idea being we don't know how long naturally acquired immunity lasts, and we don't know how robust that response is, as compared to the vaccine-generated response.

I think the short answer is both people who have had naturally acquired immunity or vaccine, generated immunity probably have a greater level of protection for themselves, but when they're still out in public need to be doing the things that you said your mom is doing, which is continuing to wear masks, continuing to exercise social distance until enough of us have the vaccine have protection, such that it's safe for people to be out together in larger groups,

Brian: Nelly, thanks. I was speaking to a healthcare worker who's over 60 and has been fully vaccinated, and the impression I got is that the old story of who's protecting who in somebody's family has flipped. The person used to avoid his grandchildren, so he didn't get the virus with his risk of serious illness from being over 60. Now he's concerned about seeing his grandchildren for fear of exposing them because he could be safe from getting sick, but still be a carrier. With the elderly being the most vaccinated group for the moment, has society switched places generationally on who's protecting who?

Dr. Khullar: That's exactly right. It's an interesting thing that has happened by virtue of people who are in the older age group, initially being the most vulnerable, and now potentially being the most protected. I think the hope is that over time, more and more younger people are getting vaccinated. My other hope is that the science bears out, that it's unlikely that people who are vaccinated are able to transmit the virus, but until that time, the scenario that you laid out is certainly true and that people who have been vaccinated are themselves safe, but we can't say one way or another just yet whether or not they can transmit it to others.

Brian: Sheila, in Brooklyn, you're on WNYC. Hi, Sheila.

Sheila: Hi. Sorry, I have [inaudible 00:27:33] Thanks for taking my question. I'm concerned about the fact that I have several-- I'm very immunocompromised. Even before coronavirus, I was at a high risk of getting sick so I was like more aware of covering my nose and mouth whenever someone was around coughing and stuff like that, washing my hands, et cetera.

I'm just worried that with the more deadly South African variant and the British variant and possibly others that like once I get the vaccine, that my workplace will think, "Well, you're perfectly safe so now you can be full-time in person," and I'll still be at high risk of getting like one of the variants. Of course, I'm going to try to get the vaccine, but I'm just worried about employers feeling they have full reign to get people back at work, but the vaccine isn't really protecting the most vulnerable from the more dangerous, the more easy to transmit variants.

Brian: Dr. Khullar, we have a workplace question and a medical question.

Dr. Khullar: Sheila, thank you for your question. A few things to think about, one is that as far as we know right now, the vaccines, thankfully, are effective against the variants, and so the hope is that that continues to bear out, but we don't know that for sure until many more months have passed and we've seen how the vaccines hold up against some of these new variants.

A lot of employers, I think you're correct in saying that they will hope that people are able to come back into the workplace. So far, many have not mandated it, even nursing homes and hospitals, it's not mandated that you get the vaccine, but as more and more people get vaccinated, I think you're correct and that there will be a push to get people back into the workplace, at least for some employers.

Many employers do offer health exceptions both in terms of if people for health reasons can't get the vaccine or even after they're vaccinated if they have certain medical conditions or if they're immunocompromised in a certain way. My hope is that you would be able to gain some type of exception through a conversation with your employer. Usually, those are handled on a case-by-case basis.

Brian: About the variance, Dr. Leana Wen, in her Washington post-column today says the guidance is so confusing from the government that she's had vaccinated patients who've discarded their masks and gone bar hopping, and she could see how others would ask, "What's the point of getting vaccinated at all if you can't really open your life back up?" I guess by implication, one of the reasons for that concern and not fully opening your life back up is that we don't know yet the science of how much the vaccine protects against the new variants. What's your behavioral advice in light of that. When do you think we'll really know?

Dr. Khullar: I think one thing that we need to help people have during this period-- We're a year into the pandemic and people are understandably frustrated need some level of hope. I think we need to be clear about the benefits and the unknowns around the vaccines and the benefits are profound. People who are vaccinated have much, much lower levels of risk for severe disease, for hospitalization, for death.

They can be much more confident that they're safe, even at this time as far as we know from the variants. We need to get as many people vaccinated as possible in order to prevent the emergence of new variants. We know that variants are more likely to emerge in countries and in places where there's a rampant spread of the virus. Those public health measures are still important for tamping down the ability of new variants to emerge and people who are vaccinated, if two or three or four people are vaccinated, they can feel more comfortable gathering in a way that they weren't before.

That's not to say that they should completely throw caution to the wind, or when they're around unvaccinated people, they should still not take all the public health measures that are needed, but as more and more people get vaccinated, have that level of protection. We need to give people hope and hope that's based in science that life will get better and we will reach a place where we will be much, much closer to normal than we are today.

Brian: Before you go, your article in the New Yorker Biden's Pandemic Plan Just Might Work. That's his plan to speed up delivery of vaccines, right?

Dr. Khullar: It is. A lot of it has to do with speeding up the number of vaccines that are being delivered, but there are other parts of the plan as well in terms of mobilizing federal resources to make sure that we have enough masks, that we have enough other protective equipment, working with governors to introduce things like masks mandates and other public health measures, but really putting the muscle of the federal government behind erecting new vaccination centers, giving states the support that they need to get as many shots in as many arms as possible and really start to turn the corner on this pandemic.

Brian: How long or what do you see as the just might work part and the hardest parts of that to make succeed?

Dr. Khullar: I think there's still a long way to go in terms of getting hundreds of millions of doses into Americans' arms, all along the way, in addition to getting people vaccinated as you mentioned, it's hard to get people to continue to adhere to public health guidance whether its mass or distance or changing their lives and pretty fundamental ways, as they see these vaccines getting rolled out.

I think that by the end of summer life will be much, much closer to normal. I hope that when we start the new school year, we're essentially back to a place where everyone is back in school and teachers feel safe and students feel safe. I think later this year, we're going to get to a place where we see something close to normal, but there's a lot of work to be done between today and that moment,

Brian: Dr. Dhruv Khullar, a practicing physician, and professor at the Weill Cornell Medical College and a New Yorker staff writer, his latest articles are Biden's Pandemic Plan Just Might Work and Why Are So Many Health-Care Workers Resisting the COVID Vaccine? Dr. Khullar, thank you so much.

Dr. Khullar: Thank you so much for having me.

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