June 16, 2021

Dr. Monica Gandhi on the Origins of COVID-19, Vaccine Equity, the Debate over Masks & More

14 min read

This is a rush transcript. Copy may not be in its final form.AMY GOODMAN: This is Democracy Now!, democracynow.org, The Quarantine Report. I’m Amy Goodman, with Nermeen Shaikh.
President Biden has ordered U.S. intelligence agencies to investigate the origins of the COVID-19 pandemic and report back to him within 90 days. Biden said the U.S. intelligence community has coalesced around two likely scenarios: that the virus emerged from human contact with an infected animal or that it started spreading after an accidental leak from a Chinese lab. The first COVID cases were reported in Wuhan, China, which is also the home of the Wuhan Institute of Virology. The Wall Street Journal recently reported three employees of the institute fell ill with COVID-like symptoms in the autumn of 2019 and were hospitalized in November of that year, before the first recorded case of COVID-19. On Wednesday, White House Deputy Press Secretary Karine Jean-Pierre said the administration would press China for more information.

KARINE JEAN-PIERRE: We will continue to press China to participate in a full, transparent, evidence-based, international investigation with the needed access to get to the bottom of a virus that’s taken more than 3 million lives across the globe, and, critically, to share information and lessons that will help us all prevent future pandemics.

AMY GOODMAN: China has criticized the Biden administration’s call for a new probe, saying the lab leak hypothesis is a, quote, “conspiracy created by U.S. intelligence agencies.” In March, the World Health Organization said its investigation into the origins of the COVID-19 pandemic found it was extremely unlikely that the novel coronavirus emerged from a laboratory. But many scientists are calling on the WHO to further investigate the possibility.
To talk about this and a number of other issues around the pandemic, we’re joined by Dr. Monica Gandhi, infectious disease physician and professor of medicine at UCSF — University of California, San Francisco — San Francisco General Hospital.
Dr. Gandhi, welcome back to Democracy Now! First off, if you could address this issue, why it is significant to know about the origins of COVID-19, whether it was, you know, the virus going from animal to human or whether it was an accidental leak from this virology lab?
DR. MONICA GANDHI: You know, I actually think it could still be both, right? So, if we think about SARS-CoV-2, which causes COVID-19, this is now the third coronavirus in recent history that has caused severe acute respiratory syndromes in humans. The first one was 2002, early 2003; that was called SARS. The second one was MERS in 2011. And this is the third and far worst, which is now in — we knew about it as of December 31st, 2019. All three of these viruses likely originated in bats, went through some sort of animal host and came to humans. It could still be that with SARS-CoV-2.
What I think is at stake is the question of: Was this virus known about, being studied in this laboratory at the Wuhan Institute of Virology prior to the world knowing about it, and then, unfortunately, during the study of it, had this lab accident where there were some people in the laboratory infected? It’s not an either/or. And, in fact, I think it is quite difficult to design a virus. I mean, this has been constantly thought about with HIV and other viruses. It’s difficult for humans to create what nature creates. So, I’m still — Jane Goodall actually has a very nice explanation of this, about it’s really our treatment of animals that fundamentally has led to most of these infections coming into human populations.
The issue at stake is, if this was known about before, it should have been told to the rest of the world prior, because things like vaccine development could have been accelerated. People would have known to start with the isolation procedures. So, there could have been things that had happened faster. But I personally do not think that you can create these type of viruses in a lab. Only nature can do this.
NERMEEN SHAIKH: Dr. Gandhi, I’d like to ask about another issue, which is the CDC lifting restrictions here in the U.S. with respect to the pandemic. Could you explain what some of those — these new guidelines from the CDC are and what some of the opposition to those, this lifting of restrictions, is? Many have suggested that lifting restrictions without requiring proof of vaccination is a mistake.
DR. MONICA GANDHI: Yes. So, as you indicated, it was May 13th. It was kind of a — well, it was a very surprising day, I’ll say that. And this was a surprising day for actually many of us, including me, who had been talking about metrics of when you want to ease restrictions based on our vaccination rates. So, to put it cleanly, it was May 13th. The White House task force and the CDC messaged a point in a quite surprising announcement that those who are vaccinated don’t need to wear masks, and those who are unvaccinated should stay wearing masks.
Now, what they cited in their press conference actually was very important, which was the true science behind this, which is, what we’ve really been seeing since the clinical trials is how incredibly effective these vaccines are. And to explain efficacy versus effectiveness, “efficacy” is the word that we use in clinical trials. We had all the clinical trials come out right in December. We had New England Journal papers on these vaccines that we have in this country, so-called Pfizer, Moderna, Johnson & Johnson, and then also FDA reports. And they were very efficacious in clinical trials — 95% with the Moderna and the Pfizer.
But what ended up happening is all these real-world studies came out. How do they look like in the real world, where things are messier? People aren’t always wearing masks. People are doing a variety of behaviors. There is still ongoing circulating virus. And some of the studies they cited, for example, was a very large March 29th CDC MMWR study that looked at vaccine effectiveness in first-line responders, healthcare workers across the nation, and vaccine effectiveness was 90%. Then they cited a JAMA study from Israel on May 6th that showed that effectiveness is 97%, and, importantly, cited a New England Journal study from Qatar. And the reason this was important is the Qatar campaign, as they were rolling out vaccine, the variants were emerging in Qatar, and by the time they got to March in this campaign, there were about — almost all of the virus was the B.1.351, so-called South Africa variant, B.1.1.7, so-called U.K. variant, and still 97.4% effective in that study. Those were the three studies they cited. There are actually many more, that shows that the real-world effectiveness, even in older patients, is very high — 95% prevention of hospitalizations, in a CDC older patient study, across the United States, over 65 years old.
They then cited a series of studies, including some of which I mentioned but many more, that vaccines block transmission. It prevents us, if we’re vaccinated, from even having infection in our nose that could lead to, even when you feel well, asymptomatic transmission. That has been actually an Achilles heel of COVID-19, that we could spread it when we feel well. These vaccines block your even having asymptomatic nasal carriage, so that you can’t pass it on to others. And again, a series of studies showing blockage of asymptomatic infection and transmission by 86% to 98%. And then, finally, cited the breakthrough data in the United States, even with circulating virus, very, very low rates of people actually getting sick, thankfully, with COVID-19 after vaccination. Really, it’s hard to estimate — to tell you, but it’s really multiple zeros before a 9%, so .0009%, getting severe illness after you’ve had the vaccine.
So, if you put all those studies together, what they said was sound. What they said was sound. Vaccinated people don’t have to wear masks. Unvaccinated people, depending on the community transmission in your area, should continue to wear masks.
Where this led to confusion — and I agree with the confusion, and I was not — I would never have done it this way, and I actually messaged that very publicly before this — is that it leads to this question of equity. It leads to this question of how do you figure out who’s vaccinated and unvaccinated. And what I was — I and many others were advocating for was: get a date in the United States — it probably would have been somewhere mid-June, maybe even July 4th, President Biden’s day of getting 70% first vaccination — check that your case rates are low, and then lift masking for everybody. It would have eliminated a lot of this confusion. But I really want to stress that the science is sound, and I don’t think transmission rates are going to go up because of unmasking of unvaccinated people who are deliberately unmasking but yet not vaccinating.
AMY GOODMAN: So, I wanted to play for you the head of the nation’s largest nurses’ union, the National Nurses United, criticizing the CDC rollback on COVID protection guidance. This is NNU President Jean Ross.

JEAN ROSS: We at NNU believe that the change in guidelines the CDC gave on wearing masks is unwarranted, and it’s very, very premature. For one thing, we don’t know yet how many mutants are out there, and we don’t know how the vaccines are reacting with those mutations. We also know that the CDC did recognize, finally, that the virus is airborne. It is aerosolized, and it floats through the air. But they didn’t fully recognize it, or we would have guidelines on ventilation and other respiratory precautions, which we don’t have. So, National Nurses United continues to believe that vaccines are only one portion of a good comprehensive plan to make sure this epidemic, this pandemic, does not get any worse.

AMY GOODMAN: So, that’s the National Nurses United President Jean Ross. Dr. Monica Gandhi, if you can respond? And also, I mean, how, practically, if you’re walking down the street or if you’re walking into a store — I mean, you’re talking about a worker at a store saying, “Are you vaccinated?” to figure out whether they should be wearing a mask. How this actually gets enforced? But start by responding to Jean Ross.
DR. MONICA GANDHI: Yes. So, I sympathize with the position, though there are actually biological inaccuracies in the statement that we just heard. So, number one, we actually do know how these vaccines work against the variants. In fact, that’s a really key point that many of us have been making since February, and now we’re into May. But when I cited the Qatar campaign that I just told you, that really was real-world data, beyond a lot of work that we’ve all been talking about, that T cells, which is another arm of your immune system, were never thought that they wouldn’t work against the variants. We now have great data, just from this week, that B cells, which are your other arm of your immune system, can actually evolve and produce antibodies to variants. So, the real-world story on how these vaccines work against variants is very, very heartening. And absolutely the vaccines work against the variants.
The second is it’s true that there’s confusion around aerosol versus droplet. It’s important to say that many of us in the ID community want to get away from this discussion of the size of the particle and talk about the mitigation strategies that are most effective for a certain virus. It is true that masking, distancing and ventilation have different roles to play depending on the type of infectious agent. And it’s not as clear-cut as something as an aerosol, and thus you need an N95 mask, and something is droplet, and distance matters. It is actually a sort of nonpharmaceutical interventional triangle, and all three matter.
And then, the other thing that I need to say about what the statement said is that, actually, vaccines are not one more tool in the toolkit. If they were just a tool, India would be doing much better than they are now. The five tools for SARS-CoV-2, prior to vaccines, are masking, distancing, ventilation, contact tracing and testing. It’s all we had before vaccines. Vaccines are the solution. When you have immunity to a virus, it is the only thing that ends that viral pandemic. Very unfortunately, with the 1918 influenza pandemic, the only way to end that viral pandemic was 50 million deaths. It was terrible, because there was no vaccine. It was natural immunity, and people — finally, natural immunity ended the pandemic. That is not at all how we want to go. We were lucky and very grateful to get highly effective vaccines for this virus. And this is what is ending the pandemic in countries that are wealthy enough to have the vaccine, including the U.K., including the U.S. And it will end the pandemic, if we can work on global vaccine equity for everywhere else. Those are tools. This is the solution.
And so, that’s how I respond to these three statements. And then I also want to just comment on one thing. Actually, the CDC says that in healthcare settings we all must universally mask, and we continue to mask, whether unvaccinated or not, in healthcare settings.
NERMEEN SHAIKH: Dr. Gandhi, you mentioned now the question of global vaccine equity. You’ve recently co-authored a piece in The Washington Post [sic titled “American Kids Can Wait.” Can you explain the argument you put forward and why you think it’s essential and possible to give tens of millions of doses to countries that are suffering massively devastating effects of the virus — in India, especially, as you mentioned — and, in particular, giving this vaccine to healthcare workers around the world, tens of millions of whom have not received the vaccine at all, not even one dose?
DR. MONICA GANDHI: Correct. So, that piece was actually in The Atlantic. But what that piece was about — and maybe it’s a theoretical argument, because we’re likely not to delay any vaccination for American — children who are in a wealthy nation prior to poor nations. But the argument is this, is that children are much, much lower risk for severe symptomatic COVID-19 than adults. Healthcare workers in hard-hit countries, even when they’ve had one dose of a vaccine because of limited vaccine supply, there is so many cases that they’re still getting sick prior to their second dose. It is imperative to understand that we will never get to the end of this pandemic until what I just said: The solution of the pandemic is immunity. And the only way to get to immunity is to vaccinate the world. We are seeing Thailand, we are seeing Taiwan, we have certainly seen in Nepal and India, that no matter what, even if you apply beautifully those five tools — masks, distancing, ventilation, contact tracing and testing — the fundamental way to get through the pandemic, as we watch cases, hospitalizations and deaths plummet in the United States, who have been lucky enough to have the vaccine, is the application of vaccine. And we cannot wait ’til 2023 to end the pandemic, when we have the tool at our disposal.
What we were arguing for in that article is that we have surplus doses in the United States — actually, all rich countries, if you really look at the global vaccine supply, have surplus doses of vaccine, even if they fully vaccinate their own population, including 12- to 15-year-olds in this country. We were arguing that 50 million doses could be freed up for other countries even by the 12- to 15-year-olds. But going back to surplus doses, even above and beyond that, we have surplus doses. The Duke Research Center estimates that by July, we’ll have 300 million surplus doses in this country of vaccine. We have pledged — the President Biden administration has pledged 20 million on May 17th, plus 60 million of the AstraZeneca supply that we’re not going to use. That’s not enough. We have more. And how can we think about even global security, if we want to talk about global security, while a pandemic is raging elsewhere and deaths are happening elsewhere, when the solution has been known and present since December? So, yes, there are many ways to think about global vaccine equity. There are many other ways, which we can talk about. But I can’t imagine that we can ever feel at ease in this country, while we’re talking about masking versus unmasking — what a paradox — when so many places are massively suffering without the vaccine.
AMY GOODMAN: What about this issue of the WTO waiver? Clearly, the mass pressure from around the world and people here in this country led to President Biden saying he would support a waiver for patent rights at the World Trade Organization. But you have to have consensus at the World Trade Organization, and countries like Germany have said they wouldn’t, which very much supports the billionaire pharmaceutical companies. Can you talk about the significance of this waiver and what it would mean if it were accomplished?
DR. MONICA GANDHI: Yes. I can’t stress enough how significant I think this waiver would be and that we need to do it. So, going back to 1995, the WTO put a provision in place — World Trade Organization — that in the setting of a medical emergency, that patents can be waived for life-giving, essentially, medications or vaccines. And that was in 1995. I’m an HIV doctor. I’ve been an HIV doctor my whole life. And 1996 was the time where the U.S. and Europe had access, were getting antiretroviral therapies that fundamentally changed the face of the HIV epidemic. People were literally rising from the dead. It was a time where people were so sick and could live well and long, normal, healthy lives with antiretroviral therapy. 1996, only the U.S. and Europe had access to these medications, while millions of people in sub-Saharan Africa were dying of AIDS. This was where the problem was most acute.
Year after year, there was a discussion of “Let’s waive temporarily the patents on these life-saving antiretroviral therapies.” And year after year, the answer was no, while we watched people die in other places in the world. Finally, in 2001 — by the way, Pfizer made $47 billion in 2001. That was the year that we couldn’t get fluconazole, which was a very simple antifungal medication that we needed for cryptococcal meningitis, something that was afflicting AIDS patients. But the patent — 
AMY GOODMAN: We have 15 seconds.
DR. MONICA GANDHI: OK. The point is, this couldn’t be any more important, and we need to waive patents. And, sorry, we do need to get international consensus. And I hope the U.S. can persuade, with an emergency meeting, the European Union and Germany to do this.
AMY GOODMAN: Dr. Monica Gandhi, we thank you again for being with us, infectious disease physician and professor of medicine at UCSF — University of California, San Francisco — San Francisco General Hospital.
And that does it for our show. Democracy Now! is produced with Renée Feltz, Mike Burke, Deena Guzder, María Taracena, Carla Wills, Tami Woronoff, Charina Nadura, Sam Alcoff, Tey-Marie Astudillo, John Hamilton, Robby Karran, Hany Massoud, Adriano Contreras. Special thanks to Julie Crosby. I’m Amy Goodman, with Nermeen Shaikh.