MS. SELLERS: Good morning, and welcome to Washington Post Live. I’m Frances Stead Sellers, a senior writer here at The Washington Post. Today we’re going to be talking about the troubling rise in cases from the delta variant and also vaccination challenges with Dr. Rachel Levine. She’s the assistant secretary for health at the Department of Health and Human Services. And, Dr. Levine, a very warm welcome to Washington Post Live.

MS. LEVINE: Well, thank you very much. It's a pleasure to be here.

DR. SELLERS: It's wonderful to have you at a time when we need to understand so much more. There was a change in guidance this week from the CDC resulting from new science about the delta virus, including new mask advice even for people who are vaccinated in certain settings. What is the science behind that change?

MS. LEVINE: Well, so we know and we have been discussing for the last number of months that the delta variant is different. The delta variant has been shown to be more transmissible. It is at least twice as contagious than previous forms of COVID-19 that we have seen. And approximately two months ago the delta variant was 1 or 2 percent of the percentage of COVID-19 cases that we were seeing in the United States. Now it is more than 80 percent of the cases that we are seeing. So because of this more contagious variant, CDC has changed its guidance in terms of masking. And it is recommending that if you live in an area which has moderate to high spread, immunity spread of COVID-19, is that when you're in public, you wear a mask.

MS. SELLERS: So that's the broad picture. But scientists this week were really wanting to see the data. So were the public. I believe we may be seeing more of the data later on today. Why the delay? Why change the guidance without giving scientists a really good sense of what lay behind it?

DR. LEVINE: So the CDC will be releasing more data today in its weekly MMWR, or Morbidity and Mortality Weekly Report. So data should be coming this afternoon.

MS. SELLERS: So mask mandates are also returning in some parts of the country. Do we need to be masking up? Would you recommend masking up, and are mask mandates the way to go?

MS. SELLERS: Well, so mask mandates would not be done federally. There are some local or state health departments that might choose--might choose to do that. But we do recommend that if you are in areas that have moderate to high community spread of COVID-19, that you wear a mask when you're in public. Now if you're in other areas of the country, other communities that don't have that, it will be more of a personal choice whether you wanted to take that extra level of safety and to wear a mask.

MS. SELLERS: So we understand that historically, of course, state and local governments--and you of course have worked for a long time in Pennsylvania and have experienced this on a state level--have taken the lead in these issues and can see the need to have differing mandates or recommendations in different parts of the country. But should there be greater federal oversight at this point on these issues that are causing so much frustration with people perceiving a change back and forth about masks and other things?

DR. LEVINE: Well, you know, the change in terms of our recommendations is because there has been a change in what we are seeing in the country. So we have to adapt our recommendations according to the data on the ground and what we are seeing, and we are seeing the spread of this more transmittable delta variant.

Now, you know, as you said, I was previously the state health official in Pennsylvania. And so what we really need is very close collaboration and coordination between federal public health officials, state public health officials, and local public health. And that collaboration is how we'll be most successful.

MS. SELLERS: Thank you. I have a viewer question that relates to this that I'd like to ask you. I'm going to read it to you now, and I think the question will come up on the screen. It's from Mary Jo Marks from Ohio. And Mary Jo asks, do you advise masks in crowded outdoor events such as concerts and airshows?

DR. LEVINE: Well, the COVID-19 virus and even the delta variant is less likely to be transmitted outdoors. It is much more likely to be transmitted indoors. If you were in a very, very tightly packed outdoor setting, it would be reasonable to wear a mask, and it's really personal choice about the level of protection that you would like to take.

MS. SELLERS: So I'd like to ask you about a policy President Biden announced that was federal employees should either be vaccinated or undergo weekly testing. Is weekly testing sufficient to slow this virus, particularly now that we have the delta variant?

DR. LEVINE: Well, as you said, yesterday President Biden issued a directive in terms of federal government employees. And so federal government employees will be asked to attest to their vaccination status. And if someone does not attest that they've been vaccinated or they have not been vaccinated, then they will be required to mask, no matter where they're located. And the recommendation is to test once or twice per week and to socially distance and generally not be allowed to travel for their work. So we're taking these measures to protect the federal workforce.

MS. SELLERS: Another puzzling aspect of this new variant is the drop--sudden drop in cases in both India and Britain. How do you explain that, and do you expect to see strange behavior from this virus that may not be directly related to human behavior and how we're responding?

DR. LEVINE: Well, so we'll have to get more data about what's exactly happening in those--in those other countries. So, you know, we're going to again continue to collect data from throughout the United States, and we do get reports from data from other countries and particularly from Great Britain. And as that data is analyzed, we'll use it to inform our decision.

MS. SELLERS: So you're--obviously we've talked about you working in Pennsylvania, but you're also a pediatrician by training. And I think some of the questions coming up now are about vaccinations for children. When do you expect to see vaccines become available for the under 12s?

DR. LEVINE: Well, thank you. I want to emphasize first about the importance of our vaccination effort. Our vaccinations against COVID-19 are safe, they are effective, and they're more important than ever for--to protect us from the spread of the delta variant. So, you know, the Pfizer vaccine is authorized right now for use in adolescence 12 through 17, of course in addition to adults 18 and older. There are studies being--going on right now in younger children, five through 12, and then there's clinical trials being done as young as six months to five years of age. Pfizer is ahead of that, of the curve in terms of they're working to complete those studies. The Moderna vaccine is sort of right on its heels. And so we hope to have the completed critical trials by the end of the year. But, you know, we'll be looking at the science. And it's hard to put a date on when scientific studies will be completed. But we're hoping to have data by the end of the year for those younger children.

MS. SELLERS: So that's very encouraging although it seems a long time away as well. Are you hearing of any evidence of negative side effects for these younger groups?

DR. LEVINE: No, no. Again, those clinical trials are proceeding as we speak. But we would not expect to see a different safety profile than what we saw in teens, for example, 12 through 17. But we will await the results of the clinical trial.

MS. SELLERS: So until we get this younger group vaccinated--and we all interact with younger children--will we be able to reach herd immunity? And is that goal of reaching herd immunity even relevant now that we're talking about this highly transmittable virus?

DR. LEVINE: Well, so herd immunity is when there's enough people in the community or the population that have immunity to the virus so that it doesn't spread. That immunity could be from our safe and effective vaccines. It could be from people who've had the virus and developed their own immunity. Of course, the level of protection that you need depends upon how contagious the virus--and so the amount of the population that would need to be immune would be higher given the higher transmissibility of the delta variant. It's more contagious, so you need a higher population to achieve herd immunity. So we don't know what that number is, and so we'll be observing the data.

The key point, however, is that--is that it really depends upon our safe and effective vaccines. And so we need people to take that step and to roll up their sleeves and to get vaccinated and to complete the series of the vaccination. Of course, the Pfizer and Moderna vaccine do require two doses. People need to do that to protect themselves but also to protect their children. As we've been discussing, we do not have a vaccine for children under 12. So to protect their children, their families, and their communities, we need people to step up, roll up their sleeves, and get their vaccination.

MS. SELLERS: So, again, I'd love for you to talk as a pediatrician, and you know about parents' worries about their own children. How do you address those concerns for parents who are looking to sending their kids back to school this coming fall?

DR. LEVINE: Sure. So we really do want children to be back in the classroom this fall. We feel it is very important in terms of their education but also the physical and mental health of children to be back in school. The key to getting children successfully and safely back to school is our vaccination program. So the more teens that are vaccinated that are 12 through 17. The more that their parents are vaccinated, the more their community is vaccinated, the safer it will be for those children as they enter school. But we do want children in K-12 classes, as well as their teachers and staff, to wear masks given the transmissibility of this delta variant.

MS. SELLERS: So this was a change of course because at one point CDC was saying they should not have to wear masks, and now that has changed, too. Do you think that's going to be a consistent message now going ahead, knowing what you do about the delta variant?

DR. LEVINE: Well, we'll always have to change our messaging and our guidance depending up on what we see on the ground. But I anticipate with this delta variant that that message will be consistent for the foreseeable.

MS. SELLERS: So Washington Post published numbers showing a triple, I think, in the number of cases in the last month, a tripling of the number of infections. What does that suggest to you about what the fall will look like for us?

DR. LEVINE: Well, I think what the fall will look like will depend upon the success of our vaccination program. And we are seeing an increase in the number of people who are rolling up their sleeves and getting vaccinated. But as we've been talking about, this delta variant is extremely dangerous. It is significantly more contagious, more transmissible than the previous forms of the virus. And there is evidence that it can lead to quicker onset of disease and more severe disease. So I think that that the prospects of the fall could be very challenging. However, if we are able to continue to ramp up our vaccination program, that's the most important way to protect people in the fall.

MS. SELLERS: So another unsettling piece of news recently came from the CDC director who thought that the virus could only be a few mutations away from a variant that could potentially escape vaccines. How--you know, speaking as a scientist, I've asked you as a pediatrician, how does that inform your thinking going ahead, and how should it inform messaging to people who are still hesitant about taking vaccines?

DR. LEVINE: Well, whenever the virus has significant immunity spread and transmission and there's lots of cases, then you can see the development of variants. It has to do with how the virus evolves. And so the way to actually decrease the amount of variants that we would see would be to increase our vaccination program in the United States and to increase the vaccination programs across the world. I think that it should inform people about the importance of getting vaccinated now. We have a tremendous safety record with these vaccines. Almost 350 million doses of vaccines have been given in the United States and countless millions more across the country. They have a remarkable safety profile. And we know that they are effective against the delta variant in terms of people getting very sick, in terms of being hospitalized, et cetera. And so now is the time for people to get vaccinated, and that's the best way to protect against the development of these variants.

MS. SELLERS: So are vaccines really the only way we're going to stop this thing from spreading?

DR. LEVINE: Well, you know, there are three tools in our public health toolbox. Since the beginning of the pandemic--and I have been saying this in Pennsylvania and now nationally--the first is containment. Containment means significant rates of testing and then notification of those that are positive and contact tracing, finding out who their contacts are, and then having isolation and quarantine. So that's a way to contain the virus.

The second tool in our public health toolbox is mitigation. Mitigation includes, for example, the masking recommendations that we just came out with--previous recommendations that limited the size of indoor and outdoor gatherings, et cetera. Mitigation is very challenging for people, but it can be very effective.

And the third are medicines. One is--the most important--is our safe and effective vaccination. But the other I'd like to emphasize are actually medicines such as monoclonal antibodies for the virus itself. We have safe and effective monoclonal antibodies that can be given to people who have the virus. It needs to be given early in the course, especially for those who might be more susceptible to getting very, very ill from the virus. Seniors, those with--who are immunosuppressed, those who have other medical conditions--for example, hypertension, heart disease, diabetes, et cetera. So those are the three tools: containment, mitigation, and medical countermeasures, so to speak. And so those are the tools that we have to battle COVID-19.

MS. SELLERS: I'm glad you raised the medical community. I have a question not only about the use of medicine but the role of physicians in getting people vaccinated, which I think is growing. Is there more the medical community with its authority should be doing to move us ahead and to counteract this enormous spread?

DR. LEVINE: Well, there are several different ways that we partner with the medical community, and we have regular communications with the medical community, as well as our state, local, and other public health officials throughout the country. One is that, you know, our medical community are on the frontlines. I mean, they are--they are nurses and doctors and other medical providers that are seeing patients in doctor's offices and clinics and doing testing, as well as seeing patients that are very ill and in the hospital. So they're medical heroes.

I think that it's also really important for the medical community to be talking about the safety and the effectiveness of the vaccines and to be giving vaccinations. And we are working with more and more members of the medical community to be giving vaccinations in doctor's offices, clinics, hospital clinics, pharmacies. Our pharmacist partners have been giving, you know, millions and millions of doses of the vaccination.

The other point I'd like to emphasize, that other people on the front line who deserve our respect and support are our public health officials. They are on the frontline, too. Local public health officials, state public health officials, the epidemiologist, the public health workers that are working tirelessly at all levels to protect our health, and they deserve our thanks, our respect as well.

MS. SELLERS: So the Biden administration put from the word go enormous emphasis on getting people vaccinated, and it was clear early on that there would be--there would be early adapters and then a slowing of this--adopters, sorry--and then a slowing of the uptake. Could you talk about any of the innovative measures the Biden administration is looking at or has adopted to reach the people who are sometimes hesitant and I think actually now hostile to the vaccine?

DR. LEVINE: Well, you know, I think it is important to recognize that we have made significant progress over the last six or more months under President Biden's leadership. There have been administered, totally, almost 350 million vaccinations; 160 million Americans are fully vaccinated, including 80 percent of seniors and approximately 69 percent of adults. But this delta variant is different and it requires, you know, us to be innovative.

So one thing that we're doing is we are--the president has actually recommended and is calling on state and local governments to use funding that they have received, including funding from the American Rescue Plan, to offer $100 to anyone who gets fully vaccinated, so a financial incentive. Other states have had lotteries, et cetera. I think that those are very innovative. They're not sufficient, but I think that they're innovative approaches. We are working across the nation to make sure that there are tens of thousands of vaccination sites throughout the United States. About 90 percent of people have a vaccination site within 5 miles of where they live. We're looking for people to get vaccinated at pharmacies, to get vaccinated again at clinics, at doctor's offices, at hospitals. And we're actually asking schools now to work with their local and state health department to have school clinics, pop-up vaccination clinics, school pop-up vaccination clinics, at least one but maybe many school pop-up vaccination clinics. And so we want local and state health officials, as well as pharmacy program partners to work with school districts to host these clinics. So we're looking in different ways to try to make it more accessible for people to get their safe and effective vaccine.

MS. SELLERS: You mentioned how public health officials are on the front line perhaps as never before. There has been a legislative backlash across the country in many states against the perceived overreach of governors and public health officials. How do you address that? Again, you saw this at the state level. You're now working at a federal level. And are we making ourselves more vulnerable with the potential surge this fall and even to a next pandemic, whatever that may be in the future, by rolling back on some of this legislation, [unclear]?

DR. LEVINE: Well, I think it has been very challenging really throughout the course of the COVID-19 pandemic that often this has been politicized. And I think the politicization of this public health crisis has made our public health response more challenging. This is not a political issue. This is not an issue of freedom of expression or freedom of speech. This is a public health issue. And so we all have a collective responsibility to ourselves, to our families, to our communities and to our nation to work with medical and public health officials throughout the country to stem the spread of this dangerous virus and now this even more dangerous COVID-19 delta variant. And so any type of political actions which limit the ability of public health to do its job I think are counterproductive.

MS. SELLERS: So coercion and incentives all can have a backlash, and the Republican governor of South Carolina recently said that pressuring people seemed like bad policy. Does he have a point?

DR. LEVINE: Well, we want to--we want to offer whatever incentives we can. And the most important thing is to provide accurate information about COVID-19, about the delta variant, about its significant risks to our communities, the risks to our children, especially as they--as they enter school. And we hope that by providing that accurate information, that is actually the best way to convince people to get our safe and effective vaccines. And we have to counter disinformation--disinformation in social media, for example. And our wonderful surgeon general has had a campaign over the last few weeks emphasizing how important it is for us to counter that misinformation and for us to transmit accurate information that can lead to the best decisions.

MS. SELLERS: Let me quickly read to you a tweet from Texas Congressman Dan Crenshaw. He said, addressing the president, "How about you don't knock on my door?" He's talking about vaccination. "You're not my parents. You're the government." So how can you counter that sort of sense that the government is intervening in parts of people's lives that they feel are private?

DR. LEVINE: Well, so, you know, we're not actually knocking on doors. It was a--the statement was to describe that we want to engage people throughout the nation in terms of the accurate information about the safety and the effectiveness of the vaccine. So that's what we're going to try to do. We're going to talk with local, state, federal public health officials. We want--we want to work with community members, and that is the purpose of the Community Corps, the COVID-19 Community Corps, so that actually local respected community members can speak to their communities about the safety and the effectiveness of these vaccines and so that people make the right decision to get vaccinated--again for themselves but also for their children, their families, and their community.

MS. SELLERS: Dr. Levine, during this COVID epidemic we've seen a drop in life expectancy. We've seen rises in anxiety and depression and also in drug overdoses. How can you address those factors which are clearly to do with COVID but also go beyond them? Are we neglecting other problems as we focus on COVID?

DR. LEVINE: So it's critically important that--to know that actually local, state, and federal public health officials are--really our offices are dealing with the entire spectrum of public health officials that we've always dealt with. So in terms of mental health and substance use disorders, that's a very, very important point. CDC data indicates that in 2020 we had the highest rate ever of deaths from drug overdoses, approximately 93,000 deaths from drug overdose.

And so I think that that is related to the significant mental health issues that have been triggered by COVID-19 and the pandemic. So we are going to address that head-on at the Department of Health and Human Services with Secretary Becerra's leadership. He has reinitiated our Behavioral Health Coordinating Council. I'm very pleased to co-chair that with the assistant secretary for SAMHSA. And we have committees that they're looking at substance use and overdoses. We're going to be having committees look at how to expand treatment--for example, the integration of physical and mental health in health clinics and doctor's offices and hospitals. The importance of telemedicine now in terms of behavioral health and substance abuse treatment. So we're going to be looking at all of those different factors to be able to address the significant mental health issues that we're seeing now and we're likely to see in the future.

MS. SELLERS: And how about the rise in homicides that we're seeing across the country?

DR. LEVINE: Well, we are seeing a rise in homicides, and the president has spoken out about that in terms of firearms and firearm safety, and so I'll leave that to the president. But he has spoken about the importance of--and the significance of firearms from a public health perspective.

MS. SELLERS: Dr. Levine, before we finish, I'd like to ask you about your personal story. You are the first openly transgender person to hold such high office in this country. You've been in this job for four months. How's it been?

DR. LEVINE: Well, it is going very well, thank you. As you can see, I'm in my office in Washington. We certainly have been very busy. I'm focusing on, of course, COVID-19 and all of the issues that we've been discussing. I'm also focusing on the mental health and substance use issues that we've been talking about. As I mentioned, I'm co-chair of the Behavioral Health Coordinating Council, and that has all been a longstanding focus of my career.

Health equity in general is a cross-cutting issue that our office will be focusing on. I'm a member of the COVID-19 Health Equity Taskforce. We're actually meeting today, this afternoon. But health equity crosscuts everything that we're doing. And we're actually going to be forming a new office, and this new office is going to be focusing on climate change and health equity and environmental [unclear]. So for example, you know, the issues of heat, of the severe heat that we're seeing in the United States, but it of course impacts some communities more than others. So it is a significant health equity issue, and we will be forming a new office to focus on that.

MS. SELLERS: Assistant Secretary Levine, I am so pleased that you were able to join me today. Thank you so much.

DR. LEVINE: Thank you so much. It was a pleasure to be here.

MS. SELLERS: I think we all learned a lot, and I loved ending on that note about health equity. That’s all we have time for. If you want to hear about future programming, please go to WashingtonPostLive.com, where you’ll see an exciting lineup of upcoming programs. Thank you for joining us today. I’m Frances Stead Sellers.

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