Via Teleconference

4:33 P.M. EST

MR. ZIENTS:  (In progress.)  Today, we’ll focus on booster shots.  And we’ll start with Drs. Walensky and Fauci, and then I’ll provide an operations update.

Dr. Walensky, over to you.

DR. WALENSKY:  Thank you, Jeff.  Good afternoon.  As always, I’d like to start by walking you through the data.  The current seven-day daily average of cases is about 92,800 per day.  This is an 18 percent increase from last week’s seven-day daily case average. 

The seven-day average of hospital admissions is about 5,600 per day, about a 6 percent increase from the prior seven-day average. 

And the seven-day average daily deaths are about 1,000 per day. 

I want to take a moment and talk about the critical steps forward we took last week in our country’s vaccine booster program.  I want to share with you what Friday’s regulatory action by FDA and updated recommendations from CDC means for millions of Americans.

Last Friday, following CDC’s Advisory Committee on Immunization Practices’ unanimous vote, I fully endorsed the committee’s expanded recommendations for booster shots to include all adults ages 18 years and older who received a Pfizer BioNTech or Moderna vaccine at least six months after their second dose. 

That means everyone over 18 years of age is eligible to get boosted.  So, if you’re 18 years and older, I encourage you to go get boosted. 

These updated recommendations and the data critically reviewed by the advisory committee emphasize an additional point: It is especially important for older populations who may be more vulnerable to severe disease and individuals with underlying medical conditions to get boosted now. 

I know that many individuals may have questions about these new booster recommendations, and I want to help answer them. 

First, let’s talk about why this recommendation was made now.  CDC is continuously monitoring the state of the pandemic, and our current surveillance shows a rise in cases over the past few weeks.  Heading into the winter months when respiratory viruses are more likely to spread and with plans for increased holiday season travel and gathering, boosting people’s overall protection against COVID-19 disease and death was important to do now. 

In making these recommendations, we took into consideration the current state of the pandemic, the data on vaccine effectiveness over time, and importantly the safety profile of booster shots of over 30 million Americans who have already received an additional vaccine dose. 

The safety data showed that serious adverse events after a booster dose are rare and, in general, people had fewer reactions after their third dose than after their second dose.  Reactions that did occur included the previously seen sore arms, headaches, and joint aches. 

This latest CDC action underscores that booster shots are an important public health tool to strengthen our defenses against the virus. 

While the actions of the FDA and CDC represent an important step forward in our vaccination program, we are not losing sight of the goal to vaccinate all who are eligible with their primary vaccine series.  Forty-seven million eligible American adults and more than twelve million teens are still not fully vaccinated and remain at highest risk of disease. 

Data updated and posted today on CDC’s COVID Data Tracker continue to show that unvaccinated people are six times more likely to test positive for COVID-19 than vaccinated individuals.  And most tragic are the vaccine-preventable deaths we are still seeing from this disease. 

Even in our updated data, unvaccinated people are at 14 times greater risk of dying from COVID-19 than people who are vaccinated. 

In this updated figure on COVID Data Tracker, the blue line shows rates of hospitalization among the unvaccinated and the green line among the vaccinated through September 25th.  The downtick in hospitalizations of the blue line is because of decreasing case rates towards the end of September, and the very slight uptick in the green line represents waning immunity, for which we are recommending boosters.

But still, overall, when looking at hospitalization rates, unvaccinated adults had nine times higher rate of hospitalizations than vaccinated adults. 

Infections among the unvaccinated continue to drive this pandemic, hospitalizations, and deaths — tragically, at a time when we have vaccines that can provide incredible protection. 

As we approach the Thanksgiving holiday, I want to take a moment to reflect on where we were a year ago.  I can remember waiting in great anticipation for the lifesaving vaccines we currently have at our fingertips.  Last year, many families did not gather and celebrations went without parents, grandparents, aunts, uncles and cousins. 

This year, I’m more optimistic.  I have heard from many families who are now able to reunite because of the protection from COVID-19 vaccines.  There is certainly much to be thankful for this year.  For me and my family, we will reflect on how deeply thankful we are that we can safely be together. 

If you or your family members are not yet vaccinated, please consider the benefits of vaccination.  Roll up your sleeves and get protected or boosted, especially if you will be around those who are at higher risk or children under the age of five who are not yet eligible for vaccination. 

Thank you. 

And I’ll now turn things over to Dr. Fauci. 

DR. FAUCI:  Thank you very much, Dr. Walensky. 

If I could have the first slide. 

As Jeff and Dr. Walensky have mentioned, the subject matter of this briefing are booster shots.  But before I start talking about boosters, let me reiterate something that Dr. Walensky just said. 

First and foremost, if you’ve not yet been vaccinated, get vaccinated.  We know now from overwhelming data that vaccines prevent infections, hospitalizations, and save lives.  So, now we asked the question: Do we need boosters?

Next slide. 

As shown on this slide, it is very clear now from a number of studies, including this from a U.S. veterans study published in Science just a couple of weeks ago, if you look at the left-hand part of the slide, and go from March to September, and take a look at waning immunity against infection: With Johnson & Johnson, with Moderna, and with Pfizer BioNtech, as you go from month to month, the immunity clearly wanes.  The effectiveness overall against infection declines from 87.9 percent to 48.1 percent, as well as the vaccine against — the vaccine efficacy against death in people less than 65 and greater than 65. 

So, we know we need boosters, but do they work? 

Next slide. 

I’m going to go through a few studies from different places. 

This is an Israeli study that has looked at individuals who — after their second dose compare to their third dose.  And 12 days or more after the third booster dose of a BioNTech, they had a diminution in the risk of infection of 11.3-fold difference and a rate of severe illness was lowered by a factor of almost 20.

Next slide.

This slide makes it a little bit more graphic.  These three boxes here show what the effect is on hospitalization; severe, in the middle; and death, on the right.  This is referred to as a Kaplan-Meier curve.  And it’s very easy to see what the data are.  The red line is showing the cumulative incidence after two doses, and the greenish line shows what that cumulative incidence is after three doses.  There is no doubt what the efficacy and real-world effectiveness of boosters are here. 

Next slide. 

It is on- — not only related to Israel — because a study from the UK in people 50 years of age and older, when they compared a third shot to those who received the second shot, they looked at two types of vaccines.  One was AstraZeneca, which is not relevant to the discussion now.  But when you compared the protection of two doses of Pfizer-BioNTech to three, you went from 63 percent up to 94 percent. 

But it isn’t only the UK and Israel. 

Next slide. 

Another study — now from Brazil, South Africa, and United States with cumulative data of 10,000 participants.  And, again, in the two-month interim analysis, the efficacy against symptomatic disease in those who received the third dose versus the second dose was 95.6 percent. 

Next slide. 

Now, if you look at this again — I want to show it because the results in that same study are really dramatic.  If you look at this again, the red boxes are what happens after placebo — after booster vaccination.  If you look at the blue, it’s what happened after you get the third-dose booster shot — unequivocal effect of the booster. 

Next slide.

This slide, now, is something that is really important.  And I’d like everyone to pay attention to it, because you asked the question.  If you look at the peak antibody response, which is generally a reflection of protection, and you look at it after the second dose and then compare it 28 days after the third dose, and look at the difference: In younger people, it goes from 55 to 872.  In the elderly, it goes from 32 to 706. 

Next slide.

Now, if you look at things like what about the effect of Delta — as shown here in the blue box: Again, one-month peak after the second dose — 241 — it goes way up after the third dose to 1,321.  And those differences are seen both in the younger group and in the older group.  So, clearly not only do boosters work, they work even better than the peak dose, the peak response after the second dose. 

So, the last slide.

You have to come to this conclusion from the data I showed you: Protection from infection, disease, and death wanes significantly more than six months after the primary series.  Data from Israel, the UK, Brazil, and now the United States show boosters significantly enhanced protection.  And so, protect yourself, your family, and your community by getting boosted if you are already vaccinated.

And as Dr. Walensky said — and I’ll underscore it — please enjoy the holidays. 

Back to you, Jeff.

MR. ZIENTS:  Thanks, Doctors.  As Drs. Walensky and Fauci just said, boosters provide the highest level of protection against COVID.  And everyone eligible should go get their booster shot as soon as possible.

Over 135 million individuals are now eligible for a booster shot, with tens of millions more becoming eligible over the coming months.  This is a major step forward in our vaccination program that will help accelerate our work to put the pandemic behind us.

For months, we’ve been working with governors, pharmacies, community health centers, and other partners to plan for this moment.

Already, the strong start to our boosters’ program has gotten enhanced protections to 36 million Americans, including nearly half of all eligible seniors, the most vulnerable population.

And we are prepared to get boosters to all adults as they are eligible — six months after the second shot for Pfizer and Moderna or two months after J&J.

We’ve secured enough supply of all three vaccines for booster shots for every adult, as well as for the half-million first and second shots we continue to get into arms each day.

Boosters are free and readily available at 80,000 locations across the country, including more than 40,000 local pharmacies.

And as we have done throughout our vaccination program, we have equity at the center of our work, ensuring boosters are available in the hardest-hit communities and by deploying mobile clinics to bring boosters to meet people where they are.

So, we are ready for more boosters and our pace will accelerate. 

In fact, just across Friday, Saturday, and Sunday, we got 3 million booster shots into arms — a million booster shots per day.

And as our doctors said, the message to everyone who is eligible is clear: Don’t delay.  Get your booster shot so you can have enhanced protection from COVID as we head into the winter.

In addition to getting Americans their boosters, vaccination requirements are driving more and more people to get their first shot. 

As part of the President’s plan to protect individuals and accelerate our path out of the pandemic, he announced in September that all federal employees would be required to be vaccinated. 

Ahead of tonight’s deadline, the federal government has achieved 95 percent compliance and 90 percent of the 3.5 million federal workers are already vaccinated.  So we are successfully implementing vaccination requirements for the largest workforce in the United States, with federal employees in every part of the nation and around the world. 

For example, we have 98 percent compliance at the IRS, with nearly 25 percent of IRS employees getting vaccinated after the President announced the requirement.

At the FBI, 99 percent compliance. 

And we’re well set up for the holiday travel season, with nearly 98 percent compliance at U.S. Customs and Border Protection, 93 percent at TSA, and 99 percent at the FAA.

To be clear, the goal of vaccination requirements is to protect workers, not to punish them.  So tonight’s deadline is not an endpoint or a cliff.  We continue to see more and more federal employees getting their shots. 

And for the small percentage of employees who have not yet complied, agencies are beginning the education and counseling process. 

Looking at the federal workforce vaccination data makes one thing obvious: Vaccination requirements work.  They encourage more people to get vaccinated.  Vaccination requirements are good for workers and the economy.  They protect our communities and country, and they will accelerate our path out of the pandemic. 

Stepping back, there’s no question that we are headed into a very different Thanksgiving compared to last year, when millions of families were unable to celebrate the holiday together.

Seventy-one percent of adults are now fully vaccinated, up from less than one percent when the President took office.  Thirty-six million Americans have already gotten the enhanced protection of a booster.  And 95 percent of Americans, including kids as young as five, are now eligible for the protection of a vaccine. 

This is significant progress, and it’s thanks to the American people rolling up their sleeves; heroic efforts by healthcare workers, public health officials, and others across the country to get people vaccinated and answer questions; and the President’s whole-of-government effort to get shots in arms and protect people from the virus.

Let me close by underscoring that continued progress requires everyone doing their part.  So if you’re unvaccinated or eligible for a booster, please go get your shot.  It’s safe and effective.  It’s free and easy.  And it will help all of us stay safe this winter.

With that, let’s open it up for questions.


MODERATOR:  Thanks, Jeff.  We have time for a few questions.  Please, keep your questions to one question. 

First, let’s go to Meg Tirrell at CNBC.

Q    Well, thanks so much.  I’m wondering: As we’re heading into Thanksgiving, a lot of people are looking at rapid tests as a potential extra layer of protection.  Do you recommend them as an extra layer, you know, in addition to vaccination and other measures?  And also, maybe Jeff, how are you looking at the availability of them right now?  And is it sort of stacking up with what you expect?

MR. ZIENTS:  Dr. Walensky.

DR. WALENSKY:  Yeah, let me just start with that.  Great question, Meg.  First of all, we are really enthusiastic for people to be able to gather again for this holiday season, and we would just encourage that people do so safely.  So, of course, that means to get vaccinated if you’re not yet vaccinated and, ideally, to practice safe prevention measures before heading into gathering numerous households together.

But just as you note, one extra layer of protection that you might take is to take a rapid test before you gather together. 

Jeff, back to you.

MR. ZIENTS:  Good.  So, Meg, we have more than enough testing capacity in this country to support current and potentially –- and potential testing needs, including testing ahead of the holidays. 

We’ve made significant investments across the last few months: $3 billion in rapid testing in order to quadruple the supply of at-home tests from September to December.  Just today, in fact, we had our fifth new at-home test authorized by the FDA since October.  So that brings a to- — the total now to 13 on the market authorized by the FDA. 

Increasingly, tests are being sold in single packs, making them more convenient and affordable.  So overall, we will have about a half billion tests per month by the end of this year. About half of those will be the increasingly popular and convenient at-home tests, so this is well timed for the holiday season.

Next question

MODERATOR:  Let’s go to Tom Howell at the Washington Times.

Q    Hey, thanks for the opportunity.  We’re seeing, in Europe, some lockdowns like in Austria, some partial lockdowns in Netherlands, and there’s protests.  Can you talk about the U.S.?  Are we headed in that direction whatsoever, or is the focus purely on pharmaceutical interventions moving forward?


MR. ZIENTS:  Yeah, so, no, we — we are not headed in that direction.  We have the tools to accelerate the path out of this pandemic: widely available vaccinations; booster shots; kids’ shots; therapeutics, including monoclonal antibodies to help those who contract the virus.

We can curb the spread of the virus without having to in any way shut down our economy.  So that — you know, we have 82 percent of people now with one shot, and more and more people getting vaccinated each week. 

Obviously, the decisions how to manage the virus are done at the local level, informed by community transmission, vaccination rate, and local capacity.  So, we need to use the tools we have and get more people vaccinated to keep people safe without going backwards in any way, shape, or form. 

This is under our control. 

Next question.

MODERATOR:  Let’s go to Tamara Keith at NPR.

Q    Thanks for taking my question.  I am wondering about vaccines for the 5- to 11-year-olds and whether you have any sense of trends yet at this point how it compares to other vaccine rollouts or the older adolescent vaccines. 

Also, there are a lot of cases right now.  So, how is 2021 Thanksgiving not like 2020 Thanksgiving? 

MR. ZIENTS:  Why don’t I take the first one.  I mean, the vaccination for the 5- to 11-year-olds, as you know, started a few weeks ago and is really accelerating.  We, last week, talked about already having about 10 percent of those eligible with their first shot — that number continues to increase. 

We started with about 20,000 sites for adolescents — sorry, for 5- to 11-year-olds to get vaccinated — places like pediatrician’s offices, children’s hospitals, in place- — in local pharmacies where parents and kids are comfortable, and trusted providers. 

We’re now up to 35,000 sites, so that continues to increase.  We have one site for every 900 or so people in that age group — 5 to 11; that compares to one site per several thousand adults.  So it’s really convenient.  We have plenty of supply, and more and more kids are getting vaccinated in that age group — 5 to 11 — each and every day. 

Dr. Walensky, Thanksgiving.

DR. WALENSKY:  Yeah, I would just say that, you know, so many of those cases that we have right now are preventable with vaccines.  And what we have seen is that vaccines, you know, are leading to — if you’re fully vaccinated, there’s nine-fold decreased risk of being hospitalized, for example, compared to if you’re unvaccinated.  And so, we’re different because now we have the tools. 

We would encourage people who gather to do so safely after they’ve been fully vaccinated, as we’ve been saying for months now.  And so, I do think that this is very different because we actually have the tools to prevent the vast majority of cases.

MR. ZIENTS:  Next question. 

MODERATOR:  Zeke Miller, AP.

Q    Thanks all for doing this.  A couple questions on the mandate front.  Jeff, I was hoping you might be able to help us parse the share of the federal workforce that is actually vaccinated versus those that, you know, have requested exemptions.  So, what is the actual vaccine uptake there?

And then, secondarily, what’s the vaccine uptake at the White House — now that you have that data? 

And then finally, over the weekend, Secretary of Transportation Pete Buttigieg suggested that the domestic vaccine mandate for domestic travel was off the table.  Is that the case?  Is it no longer under consideration, and why not?

MR. ZIENTS:  Okay, Zeke.  That’s quite a few.  Let me — let me see if I can go one by one. 

As I said, 95 percent of federal workers are in compliance and 90 percent are already vaccinated.  And this is continuing to build.  The deadline is this evening.  And even once the deadline passes, as we’ve talked about, it’s not a cliff.  It’s not an endpoint.  We’ll continue to work with people, answer their questions, provide counseling and education, and get more and more people vaccinated.

The full agency-by-agency report will come out this Wednesday. 

As to the Executive Office of the President — which I believe was your second question — we’ve already reached 99 percent of employees vaccinated — so, 99 percent vaccinated in the Executive Office of the President. 

The message today, I think, is quite obvious, and that’s that vaccination requirements work.  They’re implementable without disruptions.  And they boost — they boost dramatically vaccination rates. 

And we encourage organizations around the country to adopt similar measures to keep their workers safe.

Next question, Kevin.

MODERATOR:  We’ll go to Peter Sullivan at The Hill.

Q    Hi, thanks.  Some experts have been calling on the administration to use the Defense Production Act or a similar authority to force Moderna, in particular, to share its technology abroad to help boost global vaccine supply.  And Dr. Kessler, you know, last month sort of hinted that that was sort of under consideration.  Do you have an update on that?  I mean, are you considering using the DPA to take action against Moderna for technology transfer?  Thank you. 

MR. ZIENTS:  So, as you know — just taking a step back — we’ve done a lot to lead the world in global vaccination efforts, with 1.2 billion doses donated to the world, over 250 million already delivered to 110 countries. 

Moderna, a couple of weeks ago, was able to accelerate delivery — at a fair price — of doses to the African Union.  That’s something that we helped facilitate, including by giving the AU — African Union — our place in line.  We have plenty of doses of Moderna for boosters and primary series here in the U.S.  So we’re able to do that to facilitate Moderna getting more doses to the African Union. 

We’re continuing to work with Moderna on how they can do more and more for the world. 

As people might recall, last week, we put out a request for information about expanding manufacturing capacity by another billion doses in the U.S., both to fight this pandemic and future pandemics. 

So, we will continue to work with Moderna, Pfizer, J&J — the three U.S. manufacturers — to expand production and do all they can to help the world, because we don’t defeat this pandemic until we’ve defeated it both at home and across the globe.

Last question, Kevin.

MODERATOR:  Yeah, last question.  Let’s go to Sheryl Stolberg, New York.

Q    Hi, thank you for taking my questions.  I think I have one for Dr. Fauci and one for Dr. Walensky.  Dr. Fauci, I think that many Americans are wondering how long the booster doses will be required.  In other words, will we be looking out at a fourth shot or shots every six months or every year?  And I’m wondering what the research shows and what your expectation is for that. 

And then for Dr. Walensky, vaccination has become a wedge issue in some families gathering this holiday season with families — family members wondering, “Should, you know, Uncle John show up if he’s not vaccinated, should he get tested?  What should he do?”  So, what is your advice to those families where maybe one person doesn’t want to get vaccinated and they’re trying to figure out whether or not it’s safe to get together?

DR. FAUCI:  Well, Sheryl, for the first question — thank you for that — the honest answer is that we do not know at this point but we are collecting data that hopefully will inform us about that. 

Let me explain.  What we are hoping for — and as an immunologist and infectious disease person — that the interval between the dose of the second dose of an mRNA and the booster, six months or longer, will give the immune response to COVID-19 the chance to mature and to strengthen. 

It’s referred to immunologically as “affinity maturation,” which means the B cells that will be making the antibodies have the opportunity to gain greater strength and hopefully greater durability. 

So, I would hope, and I think there’s a reasonable chance, that the durability of protection following the third dose will be longer than the durability of protection that I just showed in one of my slides, where it waned after several months.  If that’s the case, then we may not need to get boosted every six months or so.  But if it does wane, which I hope it doesn’t, then we will address it. 

In any case, we will find out that data, we will make it public, and we will act accordingly.

DR. WALENSKY:  And maybe to address your second question, Sheryl: We certainly want families to gather and we certainly don’t want these issues to create wedges in families.  If anything, we’d like people to unite, to come together not only in their — protecting their own health but protecting the health of each other.

Practically, to your question — you know, much of this depends on the specific situation: whether there are vulnerable people in the household, how well an unvaccinated person might be practicing other prevention measures.  And then of course, as we noted before, the capacity to take a test to put an extra layer of prevention in the — in place before people gather.

MR. ZIENTS:  Well, thank you everybody.  I hope everybody has a safe and enjoyable Thanksgiving.

5:04 P.M. EST

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