Biden COVID Task Force Member Michael Osterholm on Vaccine Perils and Promise

Dr. Michael Osterholm

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Marianne O’Hare : Welcome to Conversations on Health Care with Mark Masselli
and Margaret Flinter, a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery, and the great minds who are shaping the hea lthca re
of the future.

This week Mark and Margaret speak with Dr. Michael
Osterholm, one of the world's most renowne d infectious
disease specialist, and a member of President Elect Biden's
COVID - 19 Task Force. Dr. Osterholm is the Director of the
Center for In fectious Disease Research and Policy at the
University of Minnesota, whose 2017 book the Deadliest
Enemy w arns of exactly the pandemic we're having now. He
warns that if the outbreak continues on its current pace we
could see between 50 0,000 and 800,000 de ad Americans by
s pring .

Lori Robertson also checks in, the Managing Editor of
F act C heck.org looks at misstatements spoken about health
policy in the public domain, separating the fake from the facts .
We end with a bright idea that's improving health and w ell
being in everyday lives.

If you have comments, please e - mail us at [email protected]
or find us on Facebook , Twitter , wherever you listen to
podcast. You can also hear us by asking Alexa to play the
program . N ow stay tuned for our interview with Michael
Osterholm here on Conversations on Health Care.

[ Music ]

Mark Masselli: We are speaking today with Dr. Michael Osterholm, Director
of the Center for Infectious Disease Research and Policy at the
University of Min nesota . A renowned epidemiologist he was
recently named to President Elect Biden's COVID - 19 Task
Force. He's the author of more than 300 publications on
infectious disease, and pandemic and bioterror preparedness,
including the 2017 book, The Deadliest Ene my , Our War with
Killer Germs .

Margaret Flinter: Dr. Osterholm has served as the interim CDC Director . He was
Science on Board for health and security at the US State
Department , and he is a member of the National Academy of
Medicine and the Council of For eign Relations. Dr. Osterholm ,
we welcome you back to Conversations on Health Care today.

Dr. Michael Osterholm

Dr. Michael Osterholm: Thank you. It's great to be back with you.

Mark Masselli: Yeah, I think it's great. You were with us in June and you
warned us at that time of the very dire situation come fall if a
national strategy wasn't launched , and sadly your predictions
are now coming to pass. America is really now a house on fire,
as you say, cases are really mounting , hitting 200,000 cases
per day, hospitals are full , an d yet so many Americans really
are not heeding the warnings. I'm wondering if you could help
our listeners understand the current assessment. I think
you've said, we're now living in the most dangerous pu blic
health moments since 1918.

Dr. Michael Osterhol m: First of all, thank you for that summary, because it's a painful
reminder of actually where we've been , but in fact where
we're going. One of the things that I don't think most people
have factored in or thought about with regard to this
pandemic is the time. What I mean by that is, if you look back
at previous global pandemics of a respiratory transmitted
virus, in this case, almost exclusive [Inaudible 00:02:59]
influenza. Including 1918, the average time that a community
is impacted by this is usually about 6 to 10 weeks – as from
start to finish of the virus arriving, doing all its deadly work ,
and then b asically exiting the community.

We're now going into our 10th and almost 11th month of this
pandemic , and no one really understood what it would be like
if day after day after day after day you had that hurricane
hitting your shore. But that's in a sense what we're doing right
now with this infectious disease situation and so some of the
human response that we're seeing, this pandemic fatigue
shouldn' t be unexpected. And yet, we never really anticipated
in this way, because of the fact that we had not had this kind
of an experience before. Now, if you add in that pandemic
fatigue, people who really believe that this pandemic is real,
but they've just g rown tired of trying to isolate themselves or
be distant from those in their world, they want to be in public
places. And then you add in another category that I've call ed
the group of pandemic anger.

These are individuals who don't believe that this pand emic is
real, that in fact is politically motivated to discredit one or
more government entities. In this case, they're not about to
take any public health recommendations with any kind of
meaningful activity that has a very, very important
combination wit h pandemic fatigue to make for a large
segment of our society, who are really not doing what it's
going to take for us to get to that next spring when the

Dr. Michael Osterholm

associated vaccines can truly deliver us from what's
happening. So this is a real cha llenge.

And the n finally, I would just add on is we're now in the season
of fall and winter air, where indoor air is now what is much
more commonly inhaled and exhaled into , and this is where
we're seeing really increased transmission.

Margaret Flinter: Dr. Osterholm, Pr esi dent - elect Biden has said that addressing
the pandemic is priority number one for his administration . He
has created the COVID - 19 Task Force bringing together a very
distinguished group of experts and thought leaders, but the
work of the Task Forces tea ms is impacted somewhat by this
very vulnerable period where we're in where you may not
have all the vital information that you need b ecause this has
not been shared as it normally would during a transition
period. What are you expecting to see in the comi ng weeks
and months, and what's the information in the data that
you're waiting on that you think might be out there that you
don't have access to?

Dr. Michael Osterholm: Well, as we are so well aware things can change on a dime and
in fact in the last 24 hours we've had was called
ascertainment. And so now, we expect over the course of the
next several days to have really quite good access to not only
the information on vaccines in general, how vaccine programs
are planned in terms of rolling out the vacci nes, or what other
activities around testing and so forth are in place , and most
importantly, the ability to talk to the senior scientists, the
senior policymakers within the current administration. So I'm
hopeful that the challenges that we previously had with regard
to information will be eliminated.

Mark Masselli: You know, obviously, global pandemic, other nations all across
the globe are impacted. There's a huge spike going on in the
European continent . Some regions have really met the
challenge lockin g down restricting sectors of their economy.
And as you just mentioned, pandemic fatigue is a real issue
everywhere , but if we're going to save lives, you say, it's pretty
simple, p eople have to minimize their chances of swapping air.
How have those interv entions in Europe reduce the burden of
disease on their healthcare system? Why do you think we
need to think about a similar strategy here?

Dr. Michael Osterholm: Well, one of the challenges that we have, what is our goal , is it
merely to keep the hospital s from being overrun, which is
surely not an insignificant issue , are we trying to do what
they've done in Asian countries, where they've actually driven
this virus into such low levels, that they actually are able to get

Dr. Michael Osterholm

back to pretty much normal life in many situations, and see
major increases in economic activity. We've never really
defined that. So number one, that's the first thing .

The Europeans to o have not defined that but what they found
themselves and slightly ahead of us was this big increase i n
cases after they had quite successfully suppressed virus
activity for the better part of the April to August time period .
Then what happened is it took off, it took off in a major way ,
and each of the different countries have had a little bit
different a pproach to what they've done. Pretty much the
Eastern European countries are still in big trouble, the
Western European countries have at least flattened the curve ,
and for some of the countries have started to bring the
numbers of new cases down.

What ea ch government did was so different from what other
governments did. Some were done in a regional level, some at
a national level, some were really truly stay - at - home orders ,
others were just limiting a number of different social events.
And so it's really hard to make any kind of conclusionary
statements about what works and what doesn't. That's been
part of the frustration of the public, i s they are willing to
sacrifice. Last spring, when we asked people to basically
distance themselves to stay at home ord ers , many counties in
the United States didn't have a single case of COVID - 19. They
kept asking, why are we doing this? That was a fair and
legitimate question.

Even in places like the Twin Cities here, we would have Uncle
Joe's Hardware Store , a small li ttle neighborhood hardware
store shut down for weeks and weeks, while the Big Box
Hardware Store just six blocks down the road was allowed to
stay open. And so we didn't have a plan. And now we're stuck
with a population that's disillusioned about these ki nds of
activities. Finally , from a standpoint of economic impact, it's
very real and right now, we have so many small businesses,
particularly in the hospitality industry, that are just holding on
by a threa d . The owners are saying, w hy do I have to shut
d own without any kind of compensation ? The waitress who
works in that restaurant who no longer has a job, and she has
two young kids at home, and she's trying to keep a roof over
their head and food on the table. She too, is hurt.

We've not had any kind of associated financial support
program in this latter part of the year like we had earlier in the
year. So summarizing it, number one, we don't really know
wh at it is we're trying to do yet. We just haven't defined it. I

Dr. Michael Osterholm

think clearly limiting the absolute crisis we have in our hospital
system right now should be job one . Job two, if we can get the
number of cases down, trying to get us to a vaccine. At this
point , we don't have magic answers , and no one has the
perfect formula to say, do this or don't do th at. We ne ed more
efforts to define that.

Margaret Flinter: Well, Dr. Osterholm , those of us on the frontlines of
healthcare and public health are in a moment where we are
simultaneously bracing for a very tough winter. We're kind of
riding now the result s of all the efforts that have gone into
standing up massive testing infrastructure, but we're also
simultaneously anticipating the arrival of vaccines a day that
we have long look ed forward to , and we're hoping all of that
effort in standing up testing has taught us a lot about how to
do what may be the greatest challenge in health care of our
generation in terms of getting the vaccine out to people when
it becomes available . Maybe share with our listeners, your
thoughts on the vaccines . They all look to be effective but we
know so many logistics to work out. What are you excited
about and what are you concerned about as they begin to
come into communities , and their real viability for mass
distribution ?

Dr. Michael Osterholm: We have to acknowledge that the scientists in our
government, the policymakers in our government, that have
put together Operation Warp Speed , an operation whose
name I would have obviously picked a different name for, but
nonetheless have to acknowledge it has been remarkable. It is
in a sense Public Health Manhattan Project moment. At the
same time though, a vaccine is nothing, it was just a vaccine . It
has to be a vaccination to be successful.

Our initial data supports that they will be effective, at least in
the first months after va ccination , and that this could have a
tremendous impact on this pandemic. Some challenges that
we have yet . Number one is we have m ore vaccines coming
down the pik e. We have to understand how we're going to
study those . Some of those may be much f riendlier in terms of
their use, their storage capacity, and how we disseminate
them. So me of them cause less reactions than some of the
current vaccines might going to be hard to do randomized
placebo controlled trials, when you have two vaccines licensed
alrea dy at the 95% protection level.

Number two is, how do you evaluate them over time ?
Remember that the data we have right now is for the first two
months after the second dose was received. But that should

Dr. Michael Osterholm

not be a deterrent to getting the vaccine. It just mea ns you
have to study it and maybe we're going to have to be giving
boosters down the road. Operation Warp Speed brought us
vaccines, but will they bring us vaccinations? I think this is
where we have fallen down and we need to really get up and
catch up ve ry quickly. That is how do we help the public
understand wha t these vaccines are all about?

We have many people today that are highly skeptical of the
safety of these vaccines, thinking that based on the name of
what's happened and how this came through s o quickly, that
there are huge safety issues. And that's not just true for the
general public. I've heard this over and over again from
medical care for providers, who they themselves say, well,
maybe I'll wait a little while. Well, right now, you know, we
have almost 2000 people a day dying from this disease. We
can't wait for 5 , 6 , 7 years to get better data . We are going to
have to make some tough but really informed choices over the
course of the next few weeks to decide, are these vaccines,
what we nee d to do, and I'm confident they are the ones that
we want . I can't wait to get in line to get mine when it's my
turn.

But in the meantime, we need an extensive effort of outreach,
to first of all to our medical care community so that they have
the facts t hat they are not misguiding their patients by
providing incomplete or not accurate information. Second of
all, we have to reach out and involve the communities most
impacted by this which are namely the black, indigenous and
communities of color. We have t o involve them and help them
be the leaders in their own communities to get this vaccine
out. I have been involved with some recent studies looking at
the knowledge attitudes and perceptions of members of these
communities , and i n one area saw data showing that up to
75% of young black men from age 21 to 44 years of age were
not planning on taking the vaccine, they don't want it , they
believe it's not safe.

So I think that that ultimately the success that we're going to
have or not have will come down not just to having the
vaccine but equally important is how do we convince people
to take it and then how do we deliver it . We do have
challenges right now, at least the Pfizer vaccine that needs to
be kept at - 94 degrees Fahrenheit. The Moderna vaccine has
l ess onerous requirements for refrigeration storage. But these
are going to be challenges. But this again is such a huge public
health challenge in of itself that we will have to rise to the
occasion and we need to get as much of this vaccine in

Dr. Michael Osterholm

people's ar ms as we possibly can.

Mark Masselli: We're speaking today with Dr. Michael Osterholm , Director of
the Center for Infectious Disease Research and Policy at the
University of Minnesota. He was recently named to the
President - elect Biden's COVID - 19 Task Forc e . I was thinking
a bout efficacy and effectiveness – efficacy around the clinical
trial and effectiveness. And then just thinking about what you
were saying earlier about, if we had more data, we might have
been able to have a better strategy for how to in form that
Mom & Pop Store versus the Big Box , who's collecting all this
and is trying to model it up. So we can actually, as a public
health service provider, our frontline or local governments or
state governments better data about how all this is
transmi tting the sort of ping pong effect , be interesting to
know what's th e body of work that's going on?

Dr. Michael Osterholm: Yeah , when we look at efficacy that is under the ideal
conditions of a clinical trial, meaning that people are pre
selected for parti cipation. One part of the group gets a
placebo, one gets the actual vaccine, no one knows which one
it is , and through following carefully over time we're able to
determine who has what we consider an outcome or in other
words, an infection caused by the v irus – in this case, the
COVID - 19 virus that we're trying to prevent from be ing
transmitted to that person. Effectiveness date, on the other
hand, is a bit more of a challenge. That is one where we're
looking at, what is it doing in everyday life? What is happening
when I go into the clinic to get my shot? How well do I follow
up after , before I get my second shot? Effectiveness is really in
the end, what we're looking for is how well doe s it work in
everyday practice?

Mark Masselli: And then sort of the mo deling on the pandemic itself , what do
you believe will it look like --- ?

Dr. Michael Osterholm: At this point, I can't say that there is any one person collecting
all this information. I have said over and over again, when this
is over with, we need to ass ume that this was a public health
emergency of a 747 crashing, and there were 747 black boxes
on board. We need to take every one of them and examine
them carefully , so we learn from this . We learned about what
are the implications for messaging .

What do we know about the stockpiles of very important
protective equipment that we needed to provide medical
care ? How do we plan on messaging to the public and what
we're messaging about the issue of testing and how important
that is to determine where the pande mic is going, and yet not

Dr. Michael Osterholm

having it ? What do we need for medical capacity in terms of
not only the physical structures, the buildings, the beds, and
so forth, but the train ed personnel ? You can't make new
train ed personnel in the middle of a pandemic . Ther e are just
a number of critical issues that have come to play here for the
future that we're going to have to understand and just as
strategically, as we plan for a potential war or for some kind of
invasion, we have to look at infectious diseases i n the s ame
way, and we haven't.

One of the things we have to do is understand that the
investment in public health today is strategic and tactical and
has both not only human outcomes of life and death but also
human outcomes of financial ruin. Both of those, I think,
should motivate us to do a very different k ind of planning for
the future.

Margaret Flinter: But Dr. Osterholm , you've mentioned healthcare personnel a
moment ago, and I remember back in the early days in New
York City in particular, the lines of pe ople cheering and
clapping and applauding healthcare workers, which was
beautiful and a great outpouring of support. But the tragic
reality is that thousands of frontline health care workers have
died in the line of duty caring for people with COVID. I
unde rstand that you've actually launched an initiative to raise
m oney for these frontline health care heroes and their families
who've lost their lives. Tell us more about your ve ry important
work in this area.

Dr. Michael Osterholm: Well, you know, through the course of the past 10 months, I've
seen it front and center time and time again, the pain and
suffering that healthcare workers , who are trying to do
everything they can to save people like you and me, have had
to go through. They themselves have been sev erely challenged
with the kind of work conditions , the safety issues, but also in
their own communities becoming exposed to the virus and
what happens. We’ve now had over 1400 healthcare workers
in this country who have died from COVID - 19 and so I saw this
group being largely unaddressed. While there are surely
physicians who have been among these fallen warriors that
may have the financial means to leave their families well off ,
there are many in the health care work setting who do not
hav e that ability.

T he janitors, the nurses ’ assistants, even the nurses, even
young physicians, who have great debt , and so I thought, hey I
have a platform , so I began collaborating with the St. Paul
Minnesota Foundation, one of the largest community

Dr. Michael Osterholm

Foundation s in the coun try. We reached out to others Brave at
Heart , Scholarship America, and collectively formed this group
to actually prov ide resources for fallen health care workers ’
families, as well as not only immediate financial support where
they need it but also to set up college scholarships for the
children of every one of these fallen healthcare workers, so
that they can go to college, whether it's nex t year, it's 18 years
from now.

This fund, the F rontline F amiliesFund - all one word - dot org –
FrontlineFamiliesFund.org , and we are hard to make sure that
these families are taken care of. We hope everyone will
consider donating, of course, it's tax deductible, and we
apprecia te any help we can get with us.

Mark Masselli: That is great. Just I think that's so classic of Am erican standing
up and doing the right thing , but it is unconscionable that our
federal government has not come up with the relief dollars
that are needed. Tens of millions of Americans are impacted,
pass those frontline workers average day - to - day essentia l
workers. You talked about it early black indigenous people of
color, but just in terms of the economic lifeblood that needs to
flow through our country so that people do not have further
despair. Tell us what your prescription is about what the
federal g overnment needs to do in terms of a stimulus plan
now and why the logger jam?

Dr. Michael Osterholm: Well, you know, need I say these are the reality of the politics
of 2020. But the bottom line message is, is that taking care of
these individuals so adver sely impacted by this pandemic is
not just being altruistic, it is smart f rom an economy
standpoint . As we watch what's happening right now, with
small businesses barely hanging on, if not going under,
economically the modeling shows clearly it is better t o invest
in them and keep them going and to provide the support that
doesn't cause them to go to bankruptcy.

The same thing is true with the workers, those people who
have been adversely impacted by this, and not just in the
private sector. When we look a t city and state governments
today, we're watching the potential layoff of many, many
thousands of firemen, police, etc b ecause of the inadequacies
of support in those government bodies . We need to get the
resources from Washington and see this as an inves tment not
a handout, to keep our economy going to make certain that as
we are able to come back after vaccines are introduced we've
not wiped out an entire segment of small and medium si zed
businesses in this country.

Dr. Michael Osterholm

I can just tell you working with the economist s at the Federal
Reserve Bank and elsewhere, they see the benefit of this. This
is a scary time it's a scary time for all of us. Why are we adding
on to that when we're asking people to do things to reduce
the likelihood of transmission and not he lping them along with
it?

If you look at all the other countries that have successfully
contained those virus , limited its transmission, the one
overriding factor you'll see time and time again, is there was
government support there to do that . We still h ave a number
of months to go before a vaccine will be a reality in many of
our communities so we have to deal with this now. So we're
hopeful that Congress and this administratio n can get together
very shortly and provide that kind of relief that I can tel l you,
every governor in this country would welcome very much. And
of cour se, all the citizens would too.

Margaret Flinter: We've been speaking today with Dr. Michael Osterholm , newl y
appointed member of President - e lect Joe Biden's COVID - 19
Task Force, and the Director of the Center for Infectious
Disease Research and Policy at the University of Minnesota.
You can learn more about his vitally important work by going
to www.cidrap.umn.edu or follow him on Twitter
@m tosterholm. Dr. Osterholm, we want to thank you so much
for your decades of scientific contributions , for helping us
understand what we are faced with and for rising to the
occasion to help our country battle COVID - 19 and of course for
joining us again tod ay on Conversations on Health Care .

Dr. Michael Osterholm: Thank you very, very much for having me. I appreciate it.

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Mark Masselli: At Conversations on Health Care we want our audience to be
truly in the know when it comes to the facts about health care
reform and policy. Lori Robertson is an award winning
journalist and Managing Editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in U.S. Politics. Lori, what
have you got for us thi s week?

Lori Robertson: Late in the Presidential Campaign, President Donald Trump
claimed that state COVID - 19 restrictions are a partisan ploy
with the Democratic governors purposely keeping their states
closed while Republican governors are opening them , b ut that
doesn't square with the facts. For instance, in Bullhead City,
Arizona, just across the border from Nevada, Trump wrongly
contra sted the reopening actions of both states. In that speech

Dr. Michael Osterholm

on October 28, the President said, “In Arizona you've opened
up but Nevada, get your governor to open up your state
please ” . So by Trump's telling Arizona, which is run by
Republican Governor Doug Ducey is opened up but Nevada
run by Democratic Governor Steve Sisolak is not. But the
reality is both states have very similar r estrictions.

In late October in both Arizona and Nevada bars, restaurants,
movie theaters and gyms were all open, but use was capped at
50% of capacity. Jennifer Tolbert, Director of State Health
Reform at the Kaiser Family Foundation, which has been
tracking policy actions taken in states in response to the
pandemic confirmed to us that the two states were in similar
phases of reopening. In fact, Arizona has slightly tighter
restrictions in some areas. For example, large gatherings are
limited to 50 people in Arizona, but it is 250 in Nevada . Nevada
is stricter than Arizona in one respect. Nevada has a statewide
facemask mandate requiring people to wear them in public
spaces when they come into close contact with others such as
on public transport ation or in a business. Arizona does not
have such a mandate and leaves it up to local governments to
impose them if they want .

That's my fact check for this week. I'm Lori Robertson,
Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is co mmitted to factual accuracy from the
country's major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you'd like checked e - mail
us at www.chcradio.com , we'll have FactCheck.org's Lori
Robertson check it out for you here on Conversations on
Health Care.

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Margaret Flinter: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and eve ryday lives.
While the world grapples with a global pandemic, public
health experts have been simultaneously battling and other
ongoing health threat. Mosquitoes are considered one of the
deadliest animals on earth, leading to hundreds of millions of
illne sses and some 2.7 million deaths per year globally.
Diseases such as malaria, dengue fever, and Zika are on the
rise.

Dr. Scott O’Neill: There is one mosquito called Aedes Aegypti that transmits a
range of different viruses to people. They include viruses like
yellow fever, dengue fever, chikungunya, Zika, and the

Dr. Michael Osterholm

consequences can be very dire from a loss of life through to
crippling social and economic cost.

Margaret Flinter: Dr. Scott O'Neill is the director of the World Mosquito
Program , which has develo ped an innovative appr oach to
eradicating the threat.

Dr. Scott O’Neill: I was particularly interested in this bacterium called
Wolbachia. This bacteria is present in up to 50% of insects
naturally, but not this one mosquito t hat transmits all these
viruse s. When we put the bacterium into the mosquito the
viruses couldn't grow any longer in the mosquito. So we're
seeding populations of mosquitoes with our own mosquitoes
that contain Wolbachia . We are able to spread the mosquitoes
across very large areas ver y quickly. Once the mosquitoes have
it they're protected from being able to transmit viruses. When
they're protected, th e humans are protected as well.

Margaret Flinter: Dr. O'Neill's team released the genetically modified
mosquitoes into a targeted area , and the results showed a
dramati c reduction in human infections.

Dr. Scott O’Neill: In Northern Australia we deployed the Wolbachia over quite
large areas, entire cities, and we've seen ess entially a
complete elimination, 96% reduction in dengue in those c ities.
We believe if we can scale this intervention across entire
cities, we can completely prevent the transmission of diseases
like dengue, chikungunya, and Zika.

Margaret Flinter: The World Mosquito Program is one of the six finalists in the
MacArthur F oundation's 100&Change competition, which
awards a $100 million grant to innovative public health
intervention s.

Dr. Scott O’Neill: We're hoping that over the next five years, we could bring this
technology to protect 75 to even 100 million people. We
woul d hope that within 10 years we could bring this
intervention to 500 million people .

Margaret Flinter: The World Mosquito Program is an effective targeted genetic
engineering approach to eradicating the threat of deadly
mosquito borne pathogens, leading to a dramatic reduction in
harm to public health. Now, that's a bright idea.

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Marianne O’Hare : You've been listening to Conversations on Health Care.

Mark Masselli: I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Dr. Michael Osterholm

Mark Masselli: Peace and Health.

Marianne O’Hare : Conversations on Health Care is recorded at WESU at
Wesleyan University, streaming live at www.chcradio.com ,
iTunes, or wherever you listen to podcasts. If you have
comments, please e - mail us at [email protected] , or find us
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is brought to you by the Community Health Center.

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