( NY Governor's Press Office via AP, File / AP Photo )
Leana Wen, MD, emergency physician, professor at George Washington University, contributing columnist for The Washington Post, CNN medical analyst, and former Baltimore Health Commissioner and the author of the forthcoming book Lifelines: A Doctor's Journey in the Fight for Public Health (Metropolitan Books, 2021), shares her thoughts on how to re-frame vaccine passports so they are less divisive, and explains how she believes proof of vaccination can give people more freedom, not less. Plus, she discusses the latest on the race between the variants causing new case spikes and vaccine distribution.
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Brian: Brian Lehrer on WNYC. We'll talk again today about so-called vaccine passports because I think it's a really important clash of perceived rights right now, the right to go wherever you want without having to take a substance into your body or divulging a medical record versus the right to know if the people you're sharing the air with a public place like a theater, or a wedding hall, or a school building is a COVID risk to you and others.
We talked on yesterday's show about Texas Governor Greg Abbott banning state-mandated vaccine passports there. Florida's governor is even banning private businesses from requiring proof of vaccination status. Here's Florida Governor Ron DeSantis on Florida's WINK-TV last Friday.
Ron DeSantis: The idea that you should have to show that to be able to participate in normal activity like going to a football game or a movie theater, any of that, certainly, for government to force you, that's something that's not acceptable.
Brian: But so far, the Florida and Texas policies are in the minority. Rutgers, a state University in New Jersey, of course, will require proof of vaccination for students who want to return to campus in the fall. An increasing number of private colleges are also announcing the same requirement. Cornell, Brown, Northeastern, Notre Dame are among those listed by CNN.
Interestingly, they report that St. Edward's College in Texas and Nova Southeastern in Florida are the only two so far to say all faculty and staff will need to show vaccine proof as well as students. Interesting that they're in the two states where the governors are digging in against it, Florida and Texas. In the two states, I should say in New York, some music, theater, and sports venues are now requiring proof of a vaccine or recent negative COVID test in order to get inside. So you can go all over the map and find policies that are all over the map. Some people on the left and racial equity advocates have reservations too, not just the Ron DeSantis's of the world. So who's getting our rights right?
With me now is Dr. Leana Wen, former Baltimore Health Commissioner, current George Washington University professor, CNN medical contributor, and Washington Post columnist. She's also got a book coming out in July called Lifelines: A Doctor's Journey in the Fight for Public Health. Her Washington Post column this week is titled "Stop Calling the Vaccine Passports." Dr. Wen, always great to have you on. Welcome back to WNYC.
Dr. Wen: Thank you, Brian, great to join you.
Brian: Let's start by getting our terminology straight. Why do you want people to stop using the term vaccine passport?
Dr. Wen: For two reasons. First, the term itself is actually inaccurate. Second, it is inflammatory and divisive. It immediately conjures up this concept that somehow people are going to be restricted and having freedoms taken away in their own country. When we think about a passport, we generally think about something that is a national government-issued ID, without a passport it's hard to travel, there are certain benefits that are associated with a passport. Maybe you also think about a driver's license or something else that's a government-issued ID that you need in order to show proof that you can enter certain places or be eligible for certain benefits.
That is really not what we're talking about here with proof of vaccination. Actually, I think that it's much closer to a health screen. Right now when you want to enter a lot of buildings, maybe you want to go to the doctor's office or even to school, you have to answer a list of questions related to symptoms, so you fill out this symptom questionnaire. Sometimes to enter a building, you get your temperature checked, maybe in some settings, they even administer a rapid COVID-19 test. That's actually what proof of vaccination is. In essence, it replaces those other types of checks and is a more accurate way for businesses and other entities to determine if somebody is at much lower risk for carrying coronavirus.
I guess my stance here is that businesses should be able to innovate, to cater to customers who want peace of mind in something closer to a normal experience. You were mentioning businesses trying to do different things. There are colleges that are beginning to require proof of vaccination. Some gyms and restaurants may be wanting to do this in order to give their other customers who are vaccinated a safer environment. I just think that it's the height of hypocrisy for politicians who normally champion free markets to now say that they want to ban private entities, businesses from innovation on COVID safety protocols. I think that is the definition of government overreach.
Brian: You note in your column that Israel actually does have a version of something that could be called the COVID vaccine passport, known as the Green Pass, for people to enter gyms and theaters, and more. I have an Israeli friend who's a big fan of this, by the way, as part of getting society back to normal with confidence, but you're right, that almost no one is proposing this for the United States. So, give us further clarification of your understanding of the difference between what Israel is doing because it does pertain to private spaces to get into gyms and theaters and stuff and what the gyms and theaters and colleges may be doing on their own in the United States that has the same requirements.
Dr. Wen: Yes. I think that there are going to be some people in the US who will favor a similar system to what Israel has, which is, as you were saying some form of really a nationally issued proof of vaccination. To be fair, there are real advantages of this, of having a single system instead of having 17, 20 different systems as we're probably going to end up having in the US of private entities trying to figure out proof of verification.
Having one national system, some might say is better. From a purely infection control standpoint, having a single source of verification that somebody is in fact vaccinated, having something like that be securely done, is again, from a purely infection control standpoint, probably the right way to go about things. However, in this country, in the US, anything that approaches this concept of a national ID will have many detractors, people from both sides of the political spectrum.
There will be people on the right who are very concerned about individual liberty and freedom and slippery slope arguments about what the government can be doing. I think there are some on other parts of the political spectrum who are also in some ways rightfully concerned about equity, that not everyone has access to the vaccines yet, there may be furthering of a digital divide, these are real concerns.
What private businesses are doing though is to say-- Let's imagine that there is a college as they are now that want to give their students something close to a pre-pandemic experience. In essence, if they are requiring vaccinations, then they probably confirm they'll be able to create a herd immunity environment on their campuses. It may well be that the students don't even need to be masking or physical distancing. They can have a pre-pandemic college experience with relatively low risk that many students may want. Cruise ships, for example, people in close settings may for a prolonged period of time, may also want something like that, and I could imagine a real benefit to it.
You can also think about other entities, including let's say gyms and restaurants, that would otherwise not be able to operate at 100% capacity. Many gyms, for example, have had to close down their indoor classes, high-intensity classes, cramped indoor spaces because it's not safe if there is a risk of coronavirus spread, but if everybody really has proof of vaccination, in theory, those classes could come back. I think that may be the difference here. One is something that's mandatory issued by the government. Another is voluntary by businesses that want to cater to customer demand.
Brian: Listeners, does anyone listening right now object to the idea of requiring proof of vaccination status or a very recent negative COVID test to enter public spaces? 646-435-7280. Does it matter to you if it's called a vaccine passport, or just a health screen or some other term, or whether the government mandates or whether the business itself or the college mandates it? 646-435-7280, 646-435-7280 for Dr. Leana Wen or you can tweet your comment or question @BrianLehrer.
You mentioned the cruise ships who want to do this so they can get back to business. Florida is no stranger to cruise ships. Is that your understanding? I realize you're a public health expert, you're not a Florida law expert, but is it your understanding that Florida is banning businesses even including cruise ships from requiring this help screen voluntarily as a private sector business?
Dr. Wen: That's my understanding. I understand that Florida is trying to do two things at the same time which are contradictory. On the one hand, they are suing the federal government for what they're considering to be arbitrary and capricious laws around not allowing cruises to come back. They want cruises to come back because that is, as you mentioned, a big part of their industry, but on the other hand, they're saying they're not allowing cruises to mandate vaccination. There's another way of thinking about it. They keep on saying, "Well, this is a private health matter." This is the same state that currently is allowing COVID testing.
They're saying "You can be COVID tested and have a negative COVID test to prove that you can enter a facility." Why can you not in lieu of that test have a COVID vaccine? That's why I think the passport concept is just one that is rubbing people the wrong way. If we instead think about it as an extension of a health screen. Really a vaccine is not that different from asking somebody for proof of a negative test. Actually, that's why I like what New York state has done, which is you can show proof of either. I think that in time we're going to see that, in the US at least, that we will allow people to have an opt-out of the vaccine through negative testing.
That's also something that could help families with children. I've got two young kids who are not going to be vaccinated this year not because of lack of desire on my part, but likely because we're not going to have a vaccine approved for children in 2021. If they're to enter public spaces, maybe parents can be vaccinated or children can also show proof of negative testing. That would be a way to level the playing field.
Brian: Also, to use children as an example. I'm you know as a parent of young children that you have to show proof of various other kinds of vaccinations to put your kid in a public place. I know that I had to show proof of health insurance in order to put my kid into college and show it every year. It's not like this is something new and unique.
Dr. Wen: That's right. I think that's why it's really important, again, to frame COVID vaccines in the terms of something that we already know. A vaccine passport is not something that we currently have. Yes, and over history, there have been forms of vaccine passports. People have said, "What about the yellow cards?" The WHO issued yellow card that you travel to different countries that require yellow fever vaccination or something else.
There is a form of that, but that's not a concept that a lot of Americans may be comfortable with or may not know personally, but a lot of people know about schools and the requirement for vaccines in schools. I think if we frame it with that terminology, it would be easier for people to understand, not as something new and additional that we're doing, but actually an extension of something that we already do.
Brian: Do you know, by the way, just to go up the ladder on this Florida case, especially if that's going to set a precedent for other conservative ran states, do you know if private colleges are exempt from the ban on requiring vaccination to come back to campus? Because there is that college in Broward that's reportedly going to require proof of vaccination among faculty and staff not just students one of the only ones in the country to do that. Again, I know you're not a Florida legal expert, but if you know are they in their own exempt category because a college is not a business and a college if it's a private college is not the state?
Dr. Wen: No, I actually believe the opposite. My understanding is that the college that had previously announced that they will require vaccines, once Governor DeSantis in Florida said that he will not allow private entities to do this, that college had to walk back their requirement. Especially because these colleges probably are dependent on the state for some kind of funding or subsidies in some way. There really is a real stick that can be used for the colleges, maybe even at a different way than private businesses.
Brian: Let's take a phone call Elizabeth in Manhattan. You're on WNYC. Hi, Elizabeth. Elizabeth, are you there? Is it Elizabeth in Manhattan? No, let's try John, in Flatbush you're on WNYC. Hi, John.
John: Hi, thanks for taking my call. I recently got vaccinated a couple of days ago. It was a great experience. There were safety officers in a high school gymnasium. They really seemed to be taking a lot of safety precautions, but I think--
Brian: Safety officer's meaning spacing people out and that kind of thing?
John: I think so. They had the label safety officers and there wasn't anything that necessitated officiating, but they were there and it was still hundreds of people for about an hour in a high school gymnasium. I just was wondering if there was any studies or documentation into the possibility of people getting the virus while waiting to be vaccinated?
Brian: Getting COVID while getting your COVID shot. You know Dr. Wen I have to be honest, every single person I know who's gotten their COVID vaccine has had the same question. For me, I had to wait 40 minutes inside a pharmacy. It was the longest I've been in a store in a year and other people going into crowded high schools in gyms and armories and everything for the period of time that it takes, is anybody getting COVID from their COVID vaccine experiences?
Dr. Wen: It's a great question. It's definitely one that I get a lot as well from patients who are anxious, especially people who are at high risk for severe outcomes from coronavirus. To my knowledge, there has not been documentation of cases that were of Individuals who contracted COVID through getting, or through being in line for getting the vaccine. I will say that people who are in those settings are generally very aware of space and very aware of masking. These are individuals who clearly believe that COVID is real. They want to protect themselves by getting the vaccine. I would imagine that they are very good about keeping their mask on at all times others are too.
There is good physical distancing that is attempted. Ventilation attempted to the best of people's ability. I would just advise people also to try to do as much as you can. If you know that there's going to be paperwork to be filled out, try to do that in advance. If you are particularly worried about safety, ask in advance about the setting that you're going to be in. Gymnasiums, I'm less worried about because typically they are higher ceilings, good spacing, et cetera. Again, this is relatively lower risk just because individuals are trying to take so many precautions. I would just say, in the long run, yes, this has some risk, but you are going to be very well protected from COVID as a result of taking this pretty low-risk step.
Brian: More with Doctor Leana in a minute, including more of your calls and why she thinks we're in a fourth COVID surge nationally now, and how it's different from the first three. Stay with us.
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Brian Lehrer On WNYC as we continue with Dr. Leana Wen, former Baltimore health commissioner, current George Washington University Professor, CNN, medical contributor, and Washington Post columnist. She's also got a book coming out in July called Lifelines: A Doctor's Journey in the Fight for Public Health. Consider this your book interview invitation, Dr. Wen and her Washington Post column this week is titled "Stop Calling the Vaccine Passports." Mike in Stanford you're on WNYC. Hi, Mike.
Mike: Hey. I had basically a question and a comment. The question firstly is it seems the way they're setting these things up, they give your name and your date of birth, and some of them want your address. Wouldn't people be much more likely to get these if they simply showed your face and said, "You've been vaccinated"? Because as I said to the call screener, do you really want somebody who's a bouncer at a nightclub to have all that information?
Secondly, I would like you to address the fact that really most of my co-workers who are working remote they're in Florida, they're going to happy hour, they're not wearing masks, they're going about their normal life and they're not dead. Why is it that you keep beating up on Florida when people there are going about their life and they have a lower death rate and everyone at CNN, including you dodges the question? I'd love to hear the answer to those two.
Brian: Mike, thank you very much. Dr. Wen.
Dr. Wen: Well, I'll address both of them. The first regarding the privacy issues I think is very real. This, again, is why some people say that a national system is better because if you have private companies, maybe if there is no national standard for privacy and security, then you're potentially giving your private information to a lot of different companies, what are they doing with this? I would say that if there are these private companies that are starting out and you're experimenting with different types of passports, it would be good to know where that information is going. Is it going to be sold to somebody else?
In New York, there seems to be good assurances for the Excelsior Pass, that your private information is not going to some other source. If you are going to be trying out other startups other apps, it might be good to figure out that your personal information like your address is not going to be sold to someone. As to your question about why is it that some people are going about their normal lives and are not getting ill. Well, here's the thing. We know that with COVID-19, it is a really tricky disease.
There are a lot of people who get very lucky. They get COVID-19. They are asymptomatic or are very mildly symptomatic to the point that they may not even know that they're ill. They may never get tested, but we know what happens after that which is that they end up transmitting it to others. They are third generations and more of spread from individuals who are asymptomatic.
Brian: I think his question was different from that. This brings us to your other observation this week that we’re in a fourth COVID surge nationally right now and it's different from the first three. From the data that I'm seeing the surge is where I am in New York and New Jersey and in parts of the Midwest, it is not in Texas and Florida which are reopening more fast.
Dr. Wen: I think that it is a matter of time. There are a lot of experts who believe, including me, who believe that we are in the middle of a fourth surge of sorts right now. It will look different from previous surges because we have vaccinated so many of the most vulnerable. 80% of the deaths previously were in people over 65. Over 75% of this group have gotten at least one dose of the vaccine. That's why we're seeing the numbers beginning to tick up in terms of overall infection rates, but we're not yet seeing the hospitalizations and death thankfully, trend up because some of the most vulnerable, many of the most vulnerable are already vaccinated.
What we saw previously in previous surges is that there was a surge in the Northeast and then the upper Midwest. Then, we saw the Sun Belt get affected. It may be a matter of time before Texas and Florida are hard hit as well. It may also be and I really hope this is the case and I think this is why making the case to Mike is a bit challenging in this case because public health works when we prevent something from happening. It may be that we get really lucky in the case of Texas and Florida. Maybe it's that by the time the surge would have otherwise gone to them, we have vaccinated enough people there that we have prevented a massive surge.
I really hope that that's the case and I think if that's the case, we should be celebrating why vaccinations are so effective. My main concern though, Brian, is that things get relatively better in the spring and summer so much so that the people who are holding out from getting vaccines don't see the purpose of getting vaccines anymore. They say as Mike was saying, "I haven't gotten sick. I'm going about my daily lives. Of course, everybody else is getting vaccinated, so I don't need to be vaccinated." I'm afraid that as a result, we never reach herd immunity. At least we don't reach herd immunity in 2021 and we could be hit with a devastating wave if more variants end up coming because of that.
Brian: How much can you say speaking of the variants if the new variants are causing the spikes in new cases? The UK variant is now the most common in the US too. Or is it premature re-openings including in New York and New Jersey?
Dr. Wen: I think it's probably a combination of things, but the variants for certain play some quite significant role. The variants that came from the UK, the B.1.1.7 variant is the dominant strain here in the US. It's in all 50 states. It clearly is driving this spike, the quite dramatic spike that we're seeing, for example, in Michigan. This variant is a lot more contagious than the wild-type strains, it's also more lethal. If something is more contagious, it doesn't just increase linearly. It increases exponentially and so it's crowding out the other strains and certainly plays some role.
I think the reason why I and others are so concerned about this is if something is more contagious, it means that the activities that we might have gotten away with before are now going to be higher risk. That's why things like sports that maybe we're not that big of an issue before now have become a major driver of COVID spread.
Brian: This is WNYC FM HD and AM New York, WNJT FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89 Netcong, and WNJO 90.3 Tom's River. We are New York and New Jersey public radio. A few more minutes with Dr. Leana Wen. Lexi in Newark, a Rutgers student. You're on WNYC. Hi, Lexi. Thanks for calling in.
Lexi: Hi. Thank you for taking my call. I’m actually calling because I wanted to say that I agree with having Rutgers mandate the vaccines for individuals that come to campus as long as students have the opportunity to get vaccines and then for other populations to be able to get vaccines because I know it's very difficult for individuals to get them and get appointments. I think it makes it a little tricky for others that want to get out and go different places and yet they can't get an appointment. That's just one of my concerns.
Brian: Thank you. Equity has to be central to any of these conversations as you well know Dr. Wen.
Dr. Wen: Of course, and I absolutely agree that in this pandemic we have seen how COVID-19 has unveiled, unmasked underlying disparities and that these disparities are not going to go away on their own and it’s not the individual. We so often blame individuals and say, "Oh, well black Americans are not getting vaccinated because they're hesitant." Actually, we are blaming hesitancy when access is the issue in many cases. Yes, we need to do more education and outreach, but we also have to make getting the vaccine the easy and convenient choice by bringing vaccines directly to people, to neighborhoods, to churches, to schools, to workplaces, to wherever it is that people are.
We definitely need to focus a lot more on this. Though I will say then I also don't love the argument of, "Well, let's not have proof of vaccinations for anything. As long as everyone doesn't have equal access, we can't make this available for anyone." I don't really appreciate that argument either. I've heard this even from people who say, "Well, children are not able to get the vaccine and so is it fair to exclude them from certain things?" Well, there are adult-only restaurant nights, adult-only resorts. Just because my children and my family can't enjoy those things, doesn't mean that no one should enjoy these things and that we should punish businesses.
Again, I think we absolutely should aim for equity, but that should not prevent those who want a safe setting from having that relative safety now and also supporting our businesses, our theaters, our gyms, our restaurants that otherwise would not be able to come back at full capacity if people don't have proof of vaccination.
Brian: I see you also noted on Twitter that the CDC has now and finally declared racism to be a public health issue. For listeners who may not get the connection automatically, can you explain it from a public health professional’s perspective?
Dr. Wen: Sure. Let's even look at something that we have just been talking about around COVID and the risks. We see the outcomes, we see that African-Americans, Native-Americans, Latino-Americans, for example, are disproportionately affected by COVID, much higher rates of hospitalizations, twice the number of deaths, et cetera. Why is that the case? Well, it's not the virus that is doing the discriminating. It's not that the virus is somehow specifically targeting certain groups. It's our systems. In my city here in Baltimore, one in three African Americans live in a food desert compared to one and 12 whites.
Is it any surprise then that African-Americans have higher rates of diabetes, obesity, hypertension, heart disease, these illnesses that then predispose to severe outcomes from COVID? We also know that individuals with lower income who come from communities of color are more likely to be essential workers, more likely to live in crowded multi-generational housing who don't have the ability to physical distance. We know that racial disparities directly contribute to poor outcomes from COVID and other illnesses. That it's these systems that we have to recognize.
That's why I and many others have been talking about racism as a public health issue, as a public health crisis for years. Having the CDC come out and recognize this means that there will also be systemic solutions that we’re seeking. That we're recognizing that equity has to be a linchpin to all of our efforts. Improving health is not going to be enough unless we also specifically say we want to reduce health disparities.
Brian: For a final question in our final minute tying it back to our main topic in this conversation, proof of vaccine requirements. We know who's having more trouble getting appointments and for the many socio-economic reasons that contribute to systemic racism and to the caller from Rutgers, from Newark point, they will be disproportionately barred from theaters and ball games, and on-campus learning. How do we account for that as rapidly and aggressively as possible so we can provide those safe public spaces that you're advocating, but with the most possible equity considering the underlying systemic racism and the vaccine disparities that it causes?
Dr. Wen: It's a really important question. I think there are two elements. One is we have to get rid of the vaccine inequities and that means looking at the data, looking to see where it is that people are not getting vaccinated and specifically targeting those communities. In particular, the communities that actually want the vaccine. It's not a question of desire, it's that they literally cannot get access. What is it going to take? Mobile vans going door to door outreach, door to door with the vaccine, enlisting trusted community messengers, having drives, vaccine pop-up clinics in churches and senior centers.
Part of that is addressing vaccine equity. The other part is to say, "In lieu of vaccination, what else can we have?" As in, if you are not able to be vaccinated or don't want to be vaccinated for some reason or can't be is there something else that could replace that? For example, twice-weekly surveillance testing might be a way for us to say for those who are unable to be vaccinated, "Here's another path that also ensures that you're safe and that there is lower risk that you pose lower risk to others around you." I think both of those things can help to overcome whatever equity question there might be.
Brian: Dr. Leana Wen, former Baltimore health commissioner, current George Washington University Professor, CNN medical contributor, and Washington Post columnist. She's got a book coming out in July called Lifelines: A Doctor's Journey in the Fight for Public Health. We've been mostly discussing her Washington Post column from this week titled "Stop calling them 'vaccine passports." We always appreciate it, Dr. Wen. Thanks a lot.
Dr. Wen: Thank you.
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