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walensky talks about the covid-19 vaccine booster shot and the decision to approve pfizer's vaccine boosters for certain americans. she spoke at an event hosted by the atlantic. katherine: so providing helpful guidelines to the public during a pandemic is not easy. i am joined today by the director of the katherine: i am joined by rochelle walensky, the director of the cdc and we will talk about covid guidance and guidan. dr. walensky, thank you so much for being here.

dr. walensky: thank you for having me, i am delighted to be here. katherine: you've clearly inherited an incredibly difficult job dr. walensky: i inherited an agency of people who have been working tirelessly for the last 18 months to protect public health. to me if you're not a little bit afraid if your next job perhaps the job isn't big enough so i took it out when i was here, i was a little afraid of the strap has been a daunting task in the middle of a pandemic. it's been hard, i inherited an agency both people's working tirelessly for the last 18 months to protect public health. it's all during their work remotely so getting to know the people doing that work has been hard diving in and recognizing so much of the public and public health and they hands of these -- this agency. i've taken on the task with that work in hand and a feeling of great gift of inheriting incredible people working every day and night, literally to make sure the public is safe. katherine: definitely. i'd love to talk about your decision-making process

which had to be incredibly fast-paced and not always clear cut in every single direction. you and your team have repeatedly ben tasked with collecting and analyzing endless flows of data is often imperfect and collected in real time and and making high-stakes decisions for the public good. how are you balancing timeliness of these recommendations with sticking to scientific rigor? you know, during a pandemic, all is enough enough to make a big sweeping recommendation especially when data might conflict experts disagree with each other? dr. walensky: yeah. that's important in one of the things i think we've done even since i've been here is to understand and anticipate what questions people will be asking and what's the data we need to collect now to inform those decisions? sometimes the data aren't as we would want them. or they come to us and we say, oh, no, is that really what's happening? and maybe i'll sort of the take

the description what happened in july when we saw breakthrough infections from massachusetts, a county in massachusetts. these breakthrough infections. so back in march when we said -- i should say may when we said vaccinated people could take off their mask. we had the alpha variant. breakthrough infection, you couldn't transmit to other people. so fast forward in july, we had the delta variant. we anticipated the vaccine would be working just as well. and in fact, they have been working well to prevent infection. but what we first found in the massachusetts outbreak was that the viral load was just as high as people in breakthrough infections. we saw the data as the outbreaks investigation was actually happening. we saw it on a weekend and said, that would be different and that would be policy changing if in fact that is happening. we didn't necessarily want to make a decision on a single

outbreak so we reached out to our colleagues doing outbreak investigations and there was a similar investigation that found a similar thing. we reached out to international colleagues and they were starting to see something similar. all within a weekend. so we needed to move. we needed a change of policy because these were corroborated in several different places literally in real time and we knew we needed to publish the data almost immediately so people could make the -- could see the data upon which we made the decisions. katherine: i think we are in a somewhat similar situation with a little bit of meteness with the recent guidance on boosters. given what's come out of the white house, the f.d.a., what came out last friday.

people are feeling a little confused and maybe whiplash and recently your own recommendation to greenlight high-risk workers for boosters was not what the acip advised you to do. tell me a little bit how much of that was based on what data was available at the time also knowing the public had been told to expect something very specific who would be eligible and recommended boosters, how did you balance those two things? dr. walensky: right. so back in august, we have now set up a way to review our vaccine effectiveness data in real time every two weeks or so from all of our cohorts and that's really been helpful and informing where we wanted to go. in august we started to see data that demonstrated some waning infections. so we knew we needed a plan and publicly plan because the data was going to be published. we had been talking to our international colleagues as well. that's where the planning had begun. we had been planning for the last month or so to make sure

when the data were available for boosters that we would be ready to go. so fast forward, we had more data, you know, this week and the package went to the f.d.a. the pfizer biontech went to the f.d.a. our booster announcement was people who got pfizer. the scientific process works. there's a vaccine advisory board to the f.d.a. that met with scientific deliberation. the f.d.a. authorized it. my vaccine advisory board, the advisory council on immunization practices met, and they gave me advice. then, i made some recommendations. and for the most part, there was a lot of consensus. so after listening to all of the science, i fully endorsed vaccine boosters for people greater than 65, for people who live in long-term care facilities and for people who are at high risk of severe illness. so people with underlying medical conditions. and where there was a scientific

close call, i listened to the science and i ultimately ended up going with and fully in line with what the f.d.a. advisory panel said and what many in our c.d.c. advisory panel said as well which was to endorse boosters for people who are in high-risk settings because of where they work or live. so these were health care workers and occupational -- our grocery workers, our frontline workers. katherine: to clarify that point a little bit, you know, the language in these recommendations was very specific. tlrl certain -- there are certain people who should get boosters and that's the older 65 crowd, older groups with co-morbidities and there are people who may get boosters. what's the delineation of what's being recommended to get a booster and being allowed to? what's the qualitative difference between that and just kind of greenlighting boosters for everyone? dr. walensky: you know, it's really the strength of the scientific evidence.

really, the strength of that evidence that we really should be recommending this, should absolutely be recommending this. for the people we said may for, those that live and work in high-risk conditions were weighing the risk and benefits. understand what your own personal risk is and make a decision based on that personal risk. consult with your physician. consult with your pharmacist. consult with your public health officials. so that you can identify whether you're in a place that a booster is right for you. katherine: yeah. i think a couple follow-up questions to that. there was a lot of data sort of breaking down vaccine effectiveness against the sort of tiers of protection. you know, we have more severe, hospitalization and death, all symptomatic. any infection whatsoever. it's been clear from the beginning the public health priority is to certainly focus on the absolute worst outcomes knowing that's where vaccines will hold out the longest. what are you thinking at this point in terms of what boosters

are going to do for the populations in agreement for? are you most worried about infections, some symptoms? where can we see the biggest bang for our buck? dr. walensky: i think this is exactly where the scientific deliberation was during the f.d.a. and c.d.c. vaccine advisory meetings. you know, our clinical trials were evaluating symptomatic so it didn't create, you have to prevent or hospitalization. you just had to prevent symptomatic. so really the question was, do we have strength of evidence now for a third shot that we should just be preventing symptomatic or we should really keep the bar -- you have to prevent the severe hospitalizations and death? we don't -- you know, some people feel strongly one way or another. what i will say in our flu vaccination, we vaccinate people to prevent symptomatic. we have more experience with flu

vaccine. we have longer horizons we have been given flu vaccines year over year. there are people who very much believe, and i am among them, we should be preventing symptomatic because of the fact there are long-term consequences or because it keeps people out of the workplace, because even moderate can actually be pretty severe and debilitating. there is a lot of echo points in that question at this moment. katherine: sure. it's interesting you gave the example of flu vaccine. it's a great vaccine. i got mine about a week and a half ago and i am very glad for it. it is certainly not perfect. it seems to be not as good as the covid-19 vaccines we have. why boost now if our vaccines seem to be holding up quite well against that, especially against very severe, hospitalization and death? dr. walensky: yeah. it's a really important question. i think some of the reasons that we need to be boosting now is

because we are starting to see some people over the age of 65 and some cohorts over the age of 70 and other cohorts are having waning associated with the vaccine or associated with the delta variant and are landing in the hospital. and so that is the reason we feel like those especially vulnerable cohorts marriage a boost at this moment. if we can prevent those hospitalizations. we have seen deaths people vaccinated. the mean age is 80. if we can get more protection to those people, there are many people who believe this was always going to be a three-dose vaccine or a multidose vaccine and really many vaccines we have, you know, our hepatitis c vaccine is a prime boost of six months. there are many vaccines that follow this schedule. but you're right. and i think one of the important places that you're right is flu vaccines in any given year are about 60% protected.

we have wanted, yearned for a golden bullet covid vaccine. we have to manage our expectation what a vaccination can do during a pandemic time. even the vaccinated have to take the proper prevention measures. katherine: so my understanding is at this point, under your official recommendation, which you gave out on friday, you are now included in a group that may get boosters based on individual benefit and risk. are you planning to? how would that situation changed if you had stuck to the original vaccination from accip? dr. walensky: am i planning on getting a booster? i am planning on getting a booster. i am not high risk myself based on where i am working right now. much of the government is remote. i am -- when i think what my occupational risk is, if i were seeing patients still in the hospital i would absolutely get a booster. and so i intend to.

i want to make sure that people who are in high-risk categories than myself -- i am not prodding them out but i intend to. katherine: got it. i think sort of following that logic, you sort of gained out for me your own risk-benefit analysis now. this is what you and many others are asking to do at this point. i do want to point out, a lot of the guidance so far has focused on very individualistic rhetoric. boosters protect you, masks protect you. your health is in your hands. i think you even said in the course of this conversation, people are being asked to weigh individual risk, individual benefits. how do we square that with the risk that is entirely xhunl, knowing -- communal knowing much of the world is entirely unvaccinated? are we weighing the risks, individual versus communal? dr. walensky: that's an important concept. many of our vaccine guidances have focused on the individual. many of our -- you know, from an

individual standpoint, are your risks -- are your benefits greater than your risks? we get a lot of vaccines for that. i do believe we also have to take into account the societal benefits. in addition to that health care worker not being sick in bed, perhaps getting long covid or being out of work for two weeks, if that person is out of work for two weeks, that could be an i.c.u. bed that can't be filled because they don't have workforce. and so i think there are real tangible societal benefits from so many people being out of work. i say that also for teachers. you know, there are school systems that are having to close schools because their teachers are out sick. if we can prevent those from happening, not only do you prevent individual illness for that teacher themselves, but also, you know, can potentially keep a school or classroom open. katherine: do you think the boosters are going to have a substantial impact on

transmission? dr. walensky: you know, i have frequently said we are not going to boost our way out of this pandemic. we need to get unvaccinated people vaccinated. we have -- till this day in hospitals, even with waning, even with delta, the people -- you're 10-fold more likely to be hospitalized if you are unvaccinated. 11-fold more likely to die if you are unvaccinated. so really, yes, we need to optimize the protection for people who are vaccinated already. but we really need to, in addition, spend time, energy, get the unvaccinated vaccinated, and i mean that here in the united states and i mean that around the world. katherine: yeah. i absolutely agree with that. i do wonder what the past couple weeks, really past couple months of conversations over boosters which are shots with people who have already gotten some vaccines, what message does that

send to the unvaccinated? there's a lot to be confused about for i think everyone. seeing top health experts disagreeing immensely over recommendations. what affect does that have on public trust, especially when we're still trying to get first doses to people who have not gotten any? dr. walensky: yeah. i think right now the people who remain unvaccinated, we have to roll up our sleeves. we have to get into the communities. we have to understand what it is. this is not -- the unvaccinated population is not uniform. there are people who have been waiting for more data. so let us present the data that we have. we have over six -- nearly six billion in the world vaccinated at this point. we have over 180 million people vaccinated here in this country. we have extraordinary experience with this vaccine now. so let's present the safety data. what are they -- the questions of people who are unvaccinated? what is it that they are worried about? and right now we have to do that from trusted messengers.

we have to inform people and give them the information that they need. we have to meet people where they are. this is not about blame and shame. this is about, help me understand what has made you reluctant, you personally reluctant, and let's get to a place where you feel less reluctant. even if that conversation doesn't result in your rolling up your sleeves today, it may be one step closer to you rolling up your sleeves tomorrow. and that's hard work. katherine: to follow up on that. another question to meeting people where they are. in recent days, especially, we heard a lot of complaints, confusion from people who got the moderna or j&j vaccines, who got good word from federal officials they are in high-risk groups and maybe in need of boosters but they have no path to get them. to my knowledge, j&j recipients have not been greenlit for

boosters. you talked earlier about making decisions based on limited data which sometimes has to be done. why aren't we making faster moves on this front sometimes it's better to advise and advance in front of all of the data? dr. walensky: the first immunocompromise, we created a pathway. bone marrow transplant patients, cancer patients, organ recipients, all of those people now do have a pathway to be boosted. but your point is well taken. and what i want to say is, this is a walk, don't run situation to go get your boost. the vaccine effectiveness is still working really quite well. and we are now doing the scientific diligence to make sure we can review the data so we can bring it to you before we get into trouble but really after due process. that is happening in real time. moderna is coming. j&j is coming. it will come to the f.d.a. and

they will treat it with urgency and come to the c.d.c. we will treat it with urgency. that will come in the next couple weeks. what i want to reiterate, we want to do the scientific due diligence. because if we rush it, it looks like we haven't done that scientific due diligence. and this is -- we are doing it to get ahead of the virus and that's exactly what we're doing. we have not forgotten about j&j and moderna. we will be with you. [laughter] katherine: great. and final question here. hopefully we can end on a positive note. i want to ask what you are optimistic about. hopefully an e.u. for kids under 12, get more people vaccinated. what does it spell for the upcoming winter? dr. walensky: certainly, this virus has been humbling. so i want to remember all of those twists and turns that i have had over the last literally

18 months and said i think this may be a really bright step out of it, i do think we have some really bright step. i can see a future where we have the majority of the public vaccinated, we're working to vaccinate other people around the world, that we are optimizing boosters here in the -- optimizing vaccine effectiveness here in the united states, where children are starting to get vaccinated and feeling really comfortable back in school. i absolutely can see those times. and what really gives me hope, there's been so many challenges with this and so much dissension around it, but the things that i find beautiful are where people have really come together in the spirit of helping one another. those stories are fewer and far between because i don't think they make the news as often. having worked on the front lines for a year before coming to c.d.c. and now working squarely in public health and seeing so many ways that the communities are coming together to help one

another i think is truly inspiring. katherine: thank you so much. dr. rochelle walensky, [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> you're on to look -- unfiltered view of government funded by these television companies and more including buckeye broadband. ♪ >> buckeye broadband supports c-span as a public service with these other providers, giving you a front row seat to democracy. ♪ ♪ >> you can be a part of the national conversation by purposes of eating in c-span's video competition.

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