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Brian Lehrer: Brian Lehrer on WNYC. With us now, New York Times reporter focusing on science and global health, Apoorva Mandavilli. Her widely read article that was published yesterday is called "Reaching 'Herd Immunity' Is Unlikely in the US, Experts Now Believe." We'll also touch with her on the announcement yesterday that the Pfizer vaccine is likely to be approved next week under the current emergency use authorization rules. That's in effect for adults for 12 to 15-year-olds, so 12 to 15-year-olds, that's a nation eligibility apparently, on the near horizon. Apoorva, we always appreciate when you come on with us. Welcome back to WNYC.

Apoorva Mandavilli: Nice to be you back, Brian.

Brian Lehrer: Remind people how you define herd immunity for the sake of this article and what real herd immunity would do. Then we'll get into the numbers and what they mean for our risk. What's herd immunity, and what would real herd immunity accomplish?

Apoorva Mandavilli: The term 'herd immunity' actually just refers to the level of immunity in the population to a virus, or bacterium, or whatever the pathogen is. What we are really talking about when we say herd immunity is this number called the herd immunity threshold, which is some percent of the population that we have to get to where the virus starts to run out of hosts to infect, and so its progress just becomes very slow, and we see very few cases. That's the herd immunity threshold that we've been trying to get to.

Brian Lehrer: You report that officials used to think 60% or 70% vaccinated or recovered from the virus with antibodies would provide herd immunity. Now they think 80%. Why is that?

Apoorva Mandavilli: A couple of different things happened. One is that, in December, we started to hear about this more contagious variant B117 that was circulating in the UK, and that's now in the United States as well. It's more than half of the coronavirus cases in most states. That variant is more contagious than the original form of the virus, and herd immunity threshold is calculated from contagiousness.

A more contagious variant means you need a bigger percent of the population to have immunity. The second thing that's happened, which I know you've been talking about on the show, is the hesitancy that we're seeing in the US population. Something like 30% of the population does not want to get vaccinated, at least at this moment. Hopefully, that number will grow smaller as time goes on. I think it's highly unlikely that we will be able to convince all of those adults to get vaccinated.

Brian Lehrer: Your article mentions that Dr. Fauci says there is no one hard number that defines herd immunity, and that his office has basically stopped using the term as opposed to the idea of a sliding scale, the more people who are vaccinated, the more infections will go down. Yes, that's certainly a true statement that the more people are vaccinated,

the more infections will go down. From a public health messaging standpoint, do you think he's hoping that that language might accomplish more to fight vaccine hesitancy rather than pushing for a national goal of 80%, or anything like that?

Apoorva Mandavilli: I really think that the definition and the way that they're framing it has changed, not because they think that will go over better, but just because, I think, there's a consensus among a lot of scientists now that herd immunity is just not achievable. We're not going to get to that percent, that 80%, or whatever it might be, anytime soon, but that may not be what matters in the end. What we really care about is to ease the pressure on the healthcare system, to reduce the number of hospitalizations and deaths.

What Dr. Fauci and all the experts that I talked with for this article were saying is that we can forget about the herd immunity threshold, we've been fixated on that for about a year, but let's move away from that and really just talk about what's important, which is vaccinating as many of the high-risk people as we can so that the only people who are still getting infected are young and healthy people who may not get as sick. We would bring overall the number of hospitalizations and deaths down to some manageable level.

Brian Lehrer: You cite experts saying, "Rather than disappear, the virus will become a manageable threat that will circulate in the country for years to come." That's why I think it connects to our last segment on reopening and with what kinds of rules do we reopen, but trying to reopen as fully as possible everywhere now, but again, with what kinds of rules and guidelines, because the scientists now believe the virus will not disappear, but rather become a manageable threat. What do they mean by 'manageable?'

Apoorva Mandavilli: By manageable, they mean that the vast majority of people who get infected will not get really seriously ill. We might see a few hundred people in the hospital rather than 40,000, or we might see a few thousand people in the hospital, or we might see a few hundred deaths rather than thousands and thousands of that, since what they're saying is basically, "We will still see outbreaks, but they won't be these overwhelming, massive outbreaks that require us to shut huge parts of society down."

Brian Lehrer: You report that the US has already brought the hospitalization and death rates way down compared to the start of the pandemic. I think everybody knows that. How much is that because older people have had a high rate of choosing to get vaccinated compared to younger people? It's the older people who tend to get hospitalized or to die at the most frequent rates.

Apoorva Mandavilli: That's a really big part of it. We've really brought those numbers down because fewer of the high-risk people are still vulnerable. We have to keep going along those lines because there are still some elderly and some high-risk people who haven't yet been vaccinated. Part of that is that we haven't done a really great job yet of reaching out to communities of color and making sure that we get to all the people who can't bring themselves over to a vaccination site in order to get the vaccines. We have to get to all of those people. The more of them we vaccinate and protect, the smaller those numbers will get over time.

I do want to say that there is probably also an element of seasonality that we may be seeing some of the decline, just because this is what we see, the virus goes up, the virus comes down, the numbers go up, we all are a little bit more careful, the numbers come down. Some of that could also just be this up and down we've been seeing, and we can't just rest on our laurels and assume that the numbers are never going to come back up again.

Brian Lehrer: Listeners, we can take some COVID science questions for Apoorva Mandavilli, New York Times reporter focusing on science and global health, and how the angle of her newest article about how the US will likely never reached herd immunity with respect to COVID dovetails with how we manage it, how we reopen and get on with our lives, but as safely as possible. 646-435-7280. 646-435-7284, for Apoorva Mandavilli from The Times, or you can tweet a question @BrianLehrer.

I wonder how much of the lower hospitalization and death rates are because of better treatment options. For example, and I'm curious if you've seen this, I saw a TV commercial a few times the last few days for monoclonal antibodies, and it really shocked me the first time I saw it, right there between the car commercials and the beer commercials was one showing senior citizens looking frail and scared as they are informed that they just tested positive for COVID.

Like any other prescription drug commercial, it says something like, "Ask your doctor if monoclonal antibodies are right for you." Does that mean that the treatment that President Trump famously had, that wasn't widely available to the general public at that time, now is?

Apoorva Mandavilli: The thing about monoclonal antibodies is, it's been actually interesting, because the companies have been trying to get the treatments out to more people. It's a little bit complicated to give that treatment, because people have to be on IV. It's not just an oral pill or even an injection, although they're trying to make it into an injection, you have to be hooked up to an IV.

It's just a little too complicated for a lot of hospitals to really manage with a lot of patients, and so people who really want it and need it, haven't been able to have access to it. I think this advertising campaign is part of their goal to try and raise awareness so that patients start asking their doctors for the treatment and that the uptake of this treatment goes up a little bit.

You are right, that part of the reason the numbers are going down is because we just have a better handle on what to do when somebody shows up to a hospital, now. It's not like last year when doctors were just sort of flying blind and trying anything they could think of, hydroxychloroquine, or whatever the case may be. Now, there's a lot more information on which treatments work and at what stage of disease they need to be given in order for the treatments to work. We've made a lot of progress along those lines.

Brian Lehrer: I want to ask you a question left over from our previous segment that maybe you know the answer to. We were talking about New York City restaurants being able to open at full capacity with the new rules that Governor Cuomo announced yesterday, full capacity in restaurants, if they either have a vaccine, proof of status, or negative COVID test status requirement, or they have these barriers, I guess, plexiglass or whatever they are, barriers between tables. You don't have to have 6 foot distance between tables in a restaurant if you have these barriers. A caller said, "You know, then we should be able to smoke in restaurants again, because smoke travels a lot like COVID aerosols or maybe COVID droplets do." Do you, as a science reporter, know if that's true?

Apoorva Mandavilli: That's a very smart color because they're absolutely right. The plexiglass barriers do absolutely nothing. It's just hygiene theater, as we call it. It's just has the appearance of doing something, but the virus doesn't just stop at whatever height you are. It's going to rise in the air. It's going to be just like smoke. It's going to get past those plexiglass barriers. This is something we talked about a lot actually during the election debates. I spoke to experts then because we were noticing that that was basically the arrangement, is to have some plexiglass barriers. I thought that we had moved past that, but clearly not.

Brian Lehrer: Then why do medical professionals wear those plastic shields over their faces? Because they're not sealed, they just seem to prevent people from actually like spitting accidentally on the healthcare workers.

Apoorva Mandavilli: That's true, but the healthcare workers are also wearing other masks for their nose and mouth. This is just an extra layer. You're not going to see healthcare workers wearing only those face shields. The facials will protect their eyes and they add an extra layer of protection because the virus would have to come from underneath, right? It's a little bit of more of a protection, but you just having that and not having a mask would not work.

Brian Lehrer: About healthcare workers, NPR this morning had a story about stalling vaccination rates in rural areas. For example, a quarter of rural hospitals have less than half their staff vaccinated was one stat that I heard. Even in New York City, Apoorva, according to city data that I've seen, reported only half of EMS workers and firefighters have chosen to get vaccinated. As I understand that they've had full access through their jobs since the beginning of the vaccine rollout. Is it because their demographics just put them significantly in those hesitant groups, or do you have a sense of, why even people on the front lines of health care are approving hesitancy at those percentage rates?

Apoorva Mandavilli: I think it's not entirely surprising that people would have a little bit of skepticism about a vaccine that was developed fairly quickly. At the beginning of the pandemic, we heard that we probably wouldn't have vaccines for quite a while because it takes a long time to make them. That is usually true. We just got very, very lucky, that these RNA vaccines, that they were so fast to make, and they work so well, but some proportion of the population is probably looking and thinking, "They must've cut some steps. They must have taken some shortcuts. I just don't know, and I want to wait and see."

I would like to think, anyway, that that 50% that hasn't gotten vaccinated will go down to a lot less, maybe 20% as the people see that their colleagues have gotten the vaccine haven't grown horns or anything, still seem fine and it seems safe, also that it's really protecting their colleagues, that they're not getting infected.

I think that real-world information about both safety and effectiveness may go a long way towards convincing them. The other thing that I heard from an expert I spoke to for this herd immunity piece is that it's always very important for people to see someone they trust. If they don't trust Dr. Fauci, for example, it won't matter how many times he goes on TV and talks about this. It may be that they need to see a former firefighter or somebody they really respect who says, "Hey, look, I got this vaccine and I'm okay, and you should, too." It might really have to come down to that level of appeal and trust.

Brian Lehrer: Hospitals often require the annual flu shots for their staffers. Why won't they just require it for this?

Apoorva Mandavilli: This was a little bit tricky. I think I'm not entirely sure about the legality, but there are some questions about whether hospitals can require their healthcare workers to get vaccinated when the vaccine is not fully approved. As you know, the vaccines have what's called Emergency Use Authorization from the FDA, and it's a temporary approval, if you will. I know that the companies are planning to apply for full approval, and once they're fully approved, it opens up a lot more room for companies and schools and other places to require vaccines in a way that it's a little harder to do with just Emergency Use Authorization.

Brian Lehrer: Danielle, in Rutherford, you're on w NYC with New York Times global health and science correspondent, Apoorva Mandavilli. Hi, Danielle.

Danielle: Hi. Thank you for taking my call. I was trying to understand for countries that have been faster with their vaccine rollout and have started to open up, what they have been doing about people with young children. If you need to get to show your vaccine card or to show a proof of negative COVID test, to go into an establishment, how can you really do that with a baby or little kids, and people are traveling with their children? What are the examples we're seeing around the world, and what are the plans being rolled out for our own, like New York and New Jersey, roll-outs to do with people with children?

Brian Lehrer: It's a great question. There's so many, I don't have to tell you, Apoorva, I'm sure most of the listeners, so many parents grappling with what kinds of summer vacations they can take with their vaccinated selves, but their unvaccinated children.

Apoorva Mandavilli: Yes. It's extremely complicated issue. I wish that I could tell the caller that there's a very simple solution here, but I think every state is sort of figuring it out on its own. Every establishment is deciding on its own what the guidelines are. The good news is at least, we will have vaccines for kids 12 to 15, because, Brian, as you mentioned earlier, that authorization is coming really soon. We hope as early as later this week. Those kids at least will be protected. We all already know that kids 16 and over can get it.

It will really be a matter of 12 and under, and I think those vaccines are coming soon. Those trials are underway and we should have them hopefully in the fall sometime. Until then, it is going to have to be up to the family to figure out what their risk tolerance is and to make sure that they really check with the airline, or the country, or the bar, or wherever it is they want to go with their kids to, that they will be allowed in, because everybody's making their own choices along those lines.

Brian Lehrer: The Pfizer vaccine in particular, it's being reported, will now be approved for 12 to 15-year-olds probably next week. Do you happen to know why Pfizer and not Moderna?

Apoorva Mandavilli: That trial just went a lot faster? Pfizer has been a little bit ahead of Moderna, almost the whole way through, part of that could just be that their vaccines are spaced three weeks apart, rather than four. The trial may have just moved through a little faster, and certainly, these results came out three or four weeks ago, and Moderna's results are not even out yet. The results looked really, really good.

They showed that kids 12 to 15 produce almost better antibodies than people older than that. They didn't seem to show any bad side effects really, or at least comparable to what was seen in the 16-to-25 age group. It's looking really promising. I do think we'll see the Moderna results fairly soon, though, probably in the next few weeks.

Brian Lehrer: Is Johnson & Johnson testing on kids, too?

Apoorva Mandavilli: Johnson & Johnson, AstraZeneca, Novavax, everybody's in the kids' game, too, but they're all a little bit behind.

Brian Lehrer: I've seen push-back to the ethics of this rollout for 12-to-15-year-olds, like from Johns Hopkins, epidemiologist, Jennifer Nuzzo, who says something like, we would be using doses to vaccinate low-risk kids in this country while high-risk adults around the world still don't have access to the vaccine.

Apoorva Mandavilli: Yes. This is a very tricky issue. Jennifer Nuzzo has kids of her own, and I've talked to her a lot over this past year about kids in schools. Even for this particular quote that you just read out, I had reached out to her actually to ask about how she felt about the coming authorization. I was expecting her to say this is great, because that's what a lot of other people said. When she brought up that issue, it is really a big ethical question with no easy answers, because there are just millions and millions of adults in other countries, in Brazil and in India, especially right now, who could really benefit from this vaccine.

Is it ethical for us to try and vaccinate our kids who are much lower risk than those adults? I don't know. I have family in India. I have an uncle in the hospital right now. Just about every Indian person I know has family in hospitals, family who are really struggling with COVID. It is a little bit hard to figure out what the right answer is. People will say, "Oh, Pfizer is hard to store. Maybe that's not even an option for these countries. That may be the case. We do know that the US at least has a lot of extra doses of AstraZeneca sitting around, so those could actually at least be donated. These are very tricky questions to navigate.

Brian Lehrer: Who would make that allocation decision, would it have to be President Biden?

Apoorva Mandavilli: Yes, it's the White House. They are getting a lot of pressure. There have been appeals from Democratic senators. There was just a statement earlier that the majority of House Democrats are pushing for patent waivers, which means basically that the companies would allow other companies in India and South Africa, these other companies to make vaccines with their technology and make it at much cheaper prices, but also make many more of them.

There is a huge push to try and get the White House to have the companies wave their patents on these vaccines, but it's unclear whether the White House is really going to go through with that because whenever I've asked anyone who would know, like Dr. Fauci, the answer is always very diplomatic, "We understand the need, but we also have to vaccinate the people here in this country first."

Brian Lehrer: Apoorva Mandavilli, New York Times reporter focusing on science and global health, so informative. Thank you so much.

Apoorva Mandavilli: Thanks for having me.

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