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Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day two hundred

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Speaker 1: and eighty two since coronavirus was declared a global pandemic.

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Speaker 1: Today's main story. The US has begun a massive vaccination

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Speaker 1: campaign to fight the coronavirus. It's not the first time

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Speaker 1: the country has rolled out this kind of public health initiative.

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Speaker 1: Today we look at what lessons we can learn from

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Speaker 1: the past. But first, here's what happened in virus news today. Europe,

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Speaker 1: as well as areas reaching from Canada to Hong Kong,

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Speaker 1: suspended travel to the UK as a full lockdown came

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Speaker 1: into force in London and Southeast England to contain a

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Speaker 1: mutation of the coronavirus. The Europeans Center for Disease Prevention

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Speaker 1: and Control said preliminary analysis in the UK indicates that

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Speaker 1: the coronavirus variant is significantly more transmissible, with an estimated

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Speaker 1: increased transmissibility of up to seventy The new faster spreading

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Speaker 1: mutation of the virus has also been detected in Australia,

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Speaker 1: Denmark and Gibraltar. The European regulator has said it is

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Speaker 1: very likely the FISER and bio en Tech vaccine will

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Speaker 1: offer protection against the new strain of COVID nineteen. The

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Speaker 1: vaccine just won the backing of a key European review panel,

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Speaker 1: clearing the way for inoculations in the region to start

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Speaker 1: before the end of Marco Cavalery, chair of the European

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Speaker 1: Medicines Agency Pandemic Task Force, said that while more evidence

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Speaker 1: is needed, the antibody response seen from the shot suggests

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Speaker 1: the new strain shouldn't compromise the vaccines effectiveness. Meanwhile, in

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Speaker 1: South Africa, private hospital operators have warned that they are

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Speaker 1: facing severe capacity constraints due to a resurgence in coronavirus cases.

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Speaker 1: The COVID nineteen pandemic first peaked in South Africa in

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Speaker 1: late July, before infections tailed off in the fall. The

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Speaker 1: country is in the midst of a second wave of

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Speaker 1: the disease that began shortly before the holiday season, when

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Speaker 1: millions of people traditionally travel. Finally, congressional leaders in the

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Speaker 1: US reached a deal on a roughly nine hundred billion

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Speaker 1: dollar spending package to bolster the US economy amid the

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Speaker 1: continued coronavirus pandemic. This gives lawmakers a short timetable to

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Speaker 1: review and pass the second largest economic rescue measure in

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Speaker 1: the nation's history. Senate Majority Leader Mitch McConnell, Howse Speaker

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Speaker 1: Nancy Pelosi, and Senate Democrat Leader Chuck Schumer announced the

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Speaker 1: accord on Sunday. The legislative text is still being written,

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Speaker 1: but the House is expected to vote on it Monday,

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Speaker 1: followed by the Senate. And now for today's main story,

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Speaker 1: the US has begun a massive vaccination campaign to fight

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Speaker 1: the coronavirus, but the effort will have plenty of challenges,

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Speaker 1: including convincing people to get immunized. Of course, it's not

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Speaker 1: the first time the country has rolled out this kind

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Speaker 1: of public health initiative. Bloomberg's John Lawerman spoke with infectious

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Speaker 1: disease specialist William Shaffner of Vanderbilt University to learn more.

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Speaker 1: You've observed, lived through, and participated in some ambitious vaccine campaigns.

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Speaker 1: Is it fair to say that the small pox imnization

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Speaker 1: effort was the biggest and most successful on record? I

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Speaker 1: would think that that's the case that in polio, smallpox

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Speaker 1: of force was eradicated the global campaign against polio. We

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Speaker 1: now have polio confined really to Afghanistan and Pakistan. They're

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Speaker 1: the last holdouts for the wild poliovirus. Both of those

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Speaker 1: have been extraordinarily comprehensive, and both of them lasted years

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Speaker 1: around the world, but both very very successful public health

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Speaker 1: interventions against two very dreaded diseases. Well, let's talk about

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Speaker 1: smallpox first, because smallpox was effectively eradicated. Is that the

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Speaker 1: only disease that we've been able to eradicate? And if so,

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Speaker 1: why was that possible? It's the only human disease we've

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Speaker 1: been able to eradicate. Yes, it was possible for or

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Speaker 1: a number of reasons. One, the smallpox virus actually spread

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Speaker 1: relatively slowly. It has this reputation of spreading rapidly, but

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Speaker 1: it actually spreads rather slowly. You need rather close contact

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Speaker 1: for transmission to occur. You knew where every case of

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Speaker 1: smallpox was because we didn't have any asymptomatic or subclinical infection.

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Speaker 1: Smallpox was a dramatic, serious, easily recognizable disease, so you

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Speaker 1: could find it. And then we had a brilliant strategy

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Speaker 1: of vaccinating. We first tried to just vaccinate everybody, and

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Speaker 1: you know that went halfway there, But the real strategy

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Speaker 1: was to find out where the cases of smallpox were

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Speaker 1: and then to vaccinate everybody around them so the smallpox

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Speaker 1: virus couldn't spread any further and that snuffed out the

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Speaker 1: transmission and of smallpox. So what about with polio. We've

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Speaker 1: had an excellent polio vaccine for years, I guess almost

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Speaker 1: as long as we've had a small pox vaccine, perhaps

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Speaker 1: even longer. We don't even use smallpox vaccine really anymore

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Speaker 1: because we don't need it. But polio, there's still some

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Speaker 1: pockets of polio, right, what's the obstacle there, Well, there's

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Speaker 1: several obstacles to polio. Polio is a much more subtle

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Speaker 1: infection because it's an intestinal virus. And for every hundred

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Speaker 1: people who are infected who have this virus in their intestines,

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Speaker 1: usually without symptoms, without symptoms, John there's one case of

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Speaker 1: paralytic polio, so it's much harder to trace. But however,

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Speaker 1: the vaccine was so easy to administer. Remember you could

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Speaker 1: give it on a sugar cube to a child and

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Speaker 1: it would go down into the intestinal tract and then

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Speaker 1: do it's work, So we could vaccinate. In this case,

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Speaker 1: we had a different strategy to just vaccinate very comprehensively

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Speaker 1: and they're The trick is to be accepted in the

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Speaker 1: population to vaccinate each and every child, and that becomes

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Speaker 1: the great challenge in areas where there is civil unrest, turbulence,

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Speaker 1: and indeed UH guns are blazing, so the last challenges

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Speaker 1: are very severe. So this situation that you mentioned with

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Speaker 1: many many asymptomatic people along with some who actually become symptomatic,

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Speaker 1: that sounds kind of familiar. So what kind of lessons

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Speaker 1: do you think we can learn from polio that could

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Speaker 1: be applied to, you know, coronavirus to covid vaccines. Yes,

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Speaker 1: it is familiar, isn't it, because we have many people

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Speaker 1: who are without symptoms who can transmit the COVID virus

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Speaker 1: the same. The most important lesson I think has to

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Speaker 1: do with actually the business you're in communication, communication, communication.

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Speaker 1: You have to provide a goal, you have to enlist

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Speaker 1: the population to achieve that goal, and then you have

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Speaker 1: to tell them very explicitly, very honestly, and very repeatedly,

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Speaker 1: how we're going to get from here to the goal.

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Speaker 1: What about the vaccine, who will get it, when will

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Speaker 1: it be available, how many side effects will it have?

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Speaker 1: And then you have to put down all the rumors

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Speaker 1: that come up, all those falsehoods uh related to the

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Speaker 1: vaccine that people out there managed to conjure up all

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Speaker 1: the time. I chuckle, But it's very serious business because

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Speaker 1: it can have a very dampening influence on the acceptance

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Speaker 1: of the vaccine. Over the years, you've seen various campaigns,

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Speaker 1: for example, just the annual effort to try to get

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Speaker 1: people to take flu vaccine. I know you're a huge

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Speaker 1: supporter of flu vaccine, right. What can we do to

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Speaker 1: actually make the messaging better and overcome these obstacles that

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Speaker 1: we've seen in the past. Well, if we're speaking about COVID,

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Speaker 1: and this is a public health statement, not a political statement,

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Speaker 1: but there's been so much mixed messaging about COVID and

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Speaker 1: we have not had, at least to date, a single

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Speaker 1: national campaign. We haven't had a single national coherent response.

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Speaker 1: It's been left to the states, and now we have

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Speaker 1: a crazy quilt, if you will, of different approaches in

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Speaker 1: different states. Is it any wonder that people are confused?

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Speaker 1: What I would like to see as regards the COVID

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Speaker 1: vaccine is the public health people and the clinici and

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Speaker 1: such as myself out in front, with our political friends

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Speaker 1: behind us. Supporting us, but let us do the messaging,

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Speaker 1: take the politics out of it as much as possible,

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Speaker 1: and let us do our job in a coherent, straightforward

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Speaker 1: fashion with their support, making sure that we are all

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Speaker 1: part of a national effort to dampen the spread of COVID.

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Speaker 1: And we can do that with a combination of masking,

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Speaker 1: social distancing, avoiding large groups, and now adding the vaccine.

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Speaker 1: We'll have to do all of those together for a

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Speaker 1: period of yet many months, but next year in the

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Speaker 1: holiday season could be back to normal or close to

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Speaker 1: it if we could do all those things together. The

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Speaker 1: vaccine alan won't be enough, not for a long time.

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Speaker 1: We'll have to do all those things together. Can you

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Speaker 1: can you think of any times in the past US

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Speaker 1: when we've had that kind of messaging, very direct messaging

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Speaker 1: about vaccines. One of the one of the things that

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Speaker 1: I recall, and I'm sure you recall very vividly, was

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Speaker 1: back in two thousand four when the US was trying

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Speaker 1: to roll out smallpox vaccine and I think to a

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Speaker 1: degree anthrax vaccine for certain populations healthcare workers. And that

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Speaker 1: was very difficult, and I think there were some issues

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Speaker 1: with messaging there, right, and some issues also with with

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Speaker 1: side effects. Do you remember that as a particular episode. Oh, yes,

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Speaker 1: I remember both of those. And we had vaccines, both

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Speaker 1: of them, the smallpox vaccine and the anthrax vaccine that

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Speaker 1: had substantial side effects associated with them, and as a consequence,

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Speaker 1: acceptance was kind of dicey. And that also had political

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Speaker 1: overtones because there were concerns that particularly the smallpox vacs

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Speaker 1: a nation campaign was perhaps was perhaps more politically motivated

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Speaker 1: than scientifically motivated. So that complicated both of those campaigns.

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Speaker 1: I'm in mind of another one, John, Back in two

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Speaker 1: thousand and nine, we had the pandemic swine flu come

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Speaker 1: upon the scene. It affected principally children as opposed to adults,

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Speaker 1: and there I think we made one blunder, uh in

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Speaker 1: that we overpromised when the vaccine would be ready, and

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Speaker 1: for a number of technical reasons, it took longer to

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Speaker 1: make the vaccine and get it out and when it

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Speaker 1: was finally ready. Instead of the public health messages being oh,

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Speaker 1: we've got a vaccine here it is, here's who should

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Speaker 1: get it, and here's where you where you should go

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Speaker 1: to get it, the message was in the news media

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Speaker 1: the vaccines here and it's late. Look at that, huh,

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Speaker 1: and so we stepped on our own message. We've done

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Speaker 1: a little bit of that this time too, and it's

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Speaker 1: made me grumpy because I always prefer to under promise

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Speaker 1: and then over deliver. Then everyone's happy and enthusiastic. There's

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Speaker 1: been too much over promising here. Any other cases in

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Speaker 1: the past that sort of offer object lessons for how

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Speaker 1: to move forward in this case, well, I can think

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Speaker 1: of a couple of other vaccines that have been introduced

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Speaker 1: into routine practice that were so good that either pediatricians

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Speaker 1: or in my in another case, internists and family doctors

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Speaker 1: accepted the vaccines immediately, and we're very enthusiastic about them

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Speaker 1: and got the moms who brought in the children and

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Speaker 1: older persons to really accept the vaccine. One had to

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Speaker 1: do with a vaccine again, a bacteria called the new Macoccus.

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Speaker 1: We had a really great new macoco vaccine that eliminated

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Speaker 1: bloodstream infections and meningitis and children. It was so good

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Speaker 1: that the pediatricians all wanted to give it immediately and

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Speaker 1: there were shortages. The same thing happened with the newest

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Speaker 1: version of the shingles vaccine. It's also a spectacularly good vaccine,

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Speaker 1: and among people who knew about shingles, they all went

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Speaker 1: out and wanted to get it right away. And once

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Speaker 1: again the company was in the public health community were

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Speaker 1: surprised at the demand. Uh. And it took a while

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Speaker 1: to catch up, but we had two brilliant vaccines, and

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Speaker 1: the messages were clear. These are great vaccines. No wonder

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Speaker 1: then that people lined up wanting them. When you look

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Speaker 1: forward to this effort, are you excited about it? I mean,

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Speaker 1: this is this is going to be the most massive

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Speaker 1: I suppose you know, on a timescale, this really dwarfs

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Speaker 1: the smallpox, any other vaccination effort we've ever had. I

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Speaker 1: think that that's right, John. And if I'm not excited,

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Speaker 1: there's something wrong with me. Covid is a really nasty virus.

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Speaker 1: It does awful things. And here we have what we

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Speaker 1: think are going to be two vaccines, extraordinarily effective, really

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Speaker 1: quite safe. Yes they hurt, but no serious adverse reactions. UH.

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Speaker 1: And the opportunity to provide this prevention to our entire

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Speaker 1: population and reduce COVID to very, very very low levels,

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Speaker 1: that's an extraordinary opportunity. We don't get a chance to

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Speaker 1: do that in medicine very often that was John Lowerman,

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Speaker 1: and that's it for our show today. For coverage of

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Speaker 1: the outbreak from one hundred and twenty bureaus around the world,

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Speaker 1: visit bloomberg dot com slash Coronavirus and if you like

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Speaker 1: the show, please leave us a review and a rating

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Speaker 1: on Apple Podcasts or Spotify. It's the best way to

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Speaker 1: help more listeners find our global reporting. The Prognosis Daily

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Speaker 1: edition is produced by top foreheads Jordan Gaspoure, Magnus Henrickson

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Speaker 1: and me Laura Carlson. Today's main story was reported by

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Speaker 1: John Lowerman. Original music by Leo Citrin. Our editors are

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Speaker 1: Rick Shine and Francesco Levi. Francesco Levi is Bloomberg's head

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Speaker 1: of podcasts. Thanks for listening.