The following is a transcript of an interview with Dr. Scott Gottlieb that aired on Sunday, August 1, 2021, on “Face the Nation.”
JOHN DICKERSON: We go now to former FDA commissioner Dr. Scott Gottlieb, who is also on the board of Pfizer, and he joins us from Westport, Connecticut. Good morning. All right, let’s start, Dr. Gottlieb, with what Dr. Alroy-Preis was saying about this very specific issue of breakthrough cases. So once people are vaccinated, there are some breakthrough, as everybody expected, that they would get infected. But what Dr. Alroy-Preis was saying was that of those breakthrough cases, only 10%, infect one other person, and the percentage is even lower for those who infect more than one. So it seems like the case of breakthrough cases is a small set. And then there’s an even smaller set who might pass on the infection to others. Is that the way you see it?
DOCTOR SCOTT GOTTLIEB: That’s right. We know that there is more people with this Delta variant who’ve been vaccinated who are probably spreading the infection, but it’s still a very small percentage of people who are becoming infected after vaccination and who then are going on to spread the infection to others. Remember, the original premise behind these vaccines were that they would substantially reduce the risk of death and severe disease and hospitalization. And that was the data that came out of the initial clinical trials. That premise is still fully intact. We still see that these vaccines are doing a very good job preventing symptomatic disease, preventing hospitalization and death. The second premise around these vaccines is that they would reduce the incidence of infection, any infection, including asymptomatic infection, and they can also reduce the risk of transmission. And therefore, they would be an important public health tool at effectively ending the epidemic, the pandemic, because they would prevent people from transmitting the virus. That premise is still intact. But what we see with the Delta variant is it’s diminished. There is more evidence that people are likely to spread the Delta variant even after vaccination than they were likely to spread the other variants. But it’s still a very small percentage of people. But we need to recognize, especially for vaccinated people who might be in contact with young children, with elderly individuals who are at risk, that there is a risk that they could develop a mild or asymptomatic infection and go on to spread it to others.
JOHN DICKERSON: So Dr. Fauci said that they found in this Provincetown study that the amount of virus in the nasopharynx was the same as somebody who had not been vaccinated. So help me understand, that seems like if you have- if there’s a breakthrough case, then you’ve got the ability to spread if it’s in the nasopharynx. But then what Dr. Alroy-Preis was saying- was that it seemed like a much smaller group of people in the breakthrough category that could pass it on. So help me understand maybe the disconnect between those two.
DR. GOTTLIEB: Right, the CDC is inferring from this study that there’s a risk of transmission in vaccinated individuals and effectively what they saw was what Dr. Fauci said. High levels of the virus in the nasopharynx of individuals who were vaccinated and became subsequently infected on par with the level of virus that you would see in someone who wasn’t vaccinated. But we know two things. First of all, nasopharyngeal swabs, the virus titers that you see in those nasopharyngeal swabs, while it’s suggestive of someone’s ability to spread the virus, it doesn’t prove that they’re able to spread the virus. So it’s not a perfect correlate with your ability to transmit the virus and how contagious you are. You really want to measure virus levels in the lower airways because that’s where aerosols are created. And we know that you spread this virus through aerosols. We also have other evidence that came out this week that people who are vaccinated, even if their viral titers are very high initially for the first 24 hours after they become infected, even if they- even if they’re asymptomatic and infected, we know their viral titers fall much more quickly than those who are unvaccinated. So maybe after a day or two days or three days, they’re much less likely to spread the virus than someone who remains unvaccinated. So initially, someone who’s vaccinated may- may have the same level to spread the virus, may be on par with someone who’s unvaccinated, but their ability to spread the virus probably diminishes more quickly. And therefore, out in the community, if you were measuring their ability to transmit the virus, you would probably see on the whole, they’re less likely to be contagious.
JOHN DICKERSON: So one of the challenges that we’ve talked about before is that we weren’t testing every single breakthrough case. CDC was waiting until people got to the hospital. They had some inklings of breakthrough cases that weren’t at the hospital, but they weren’t testing. Should we do more testing to get to the bottom of this and this question?
DR. GOTTLIEB: The CDC has cohorts. They have tens of thousands of people that they’re following and cohorts who were vaccinated at different points in time and they’re looking at that data. They peek at that data every two weeks to try to look at whether or not they’re seeing a rising incidence of breakthrough cases in the vaccinated individuals. And- and the data that came out to The Washington Post in some slides that were leaked to The Washington Post, do suggest that the CDC has some evidence of declining efficacy in the vaccinated population, particularly older individuals who were vaccinated back in December and January. And that’s causing a rethinking of this whole question around boosters. I do think we should be following this. CDC is following it in some smaller cohorts. Other countries are following it in much much larger data sets, including the United Kingdom and Israel. And Israel really was the first to detect this rising incidence of breakthrough cases. And remember, two things are happening at once here. On the one hand, we have a much more contagious variant, the Delta variant that’s probably breaking through the vaccines a little bit more than the older variants. On the other hand, we have a population that is further out from when they were initially vaccinated. So if there’s any declining efficacy of the vaccine, it’s colliding up against a variant that’s more contagious.
JOHN DICKERSON: So does this speed up the need for boosters, these new findings that are- that are showing the breakthrough cases. Should that speed up their thinking about boosters here?
DR. GOTTLIEB: Well, look, I certainly think so for the elderly and the vulnerable population. And one of the- one of the pieces of data that was in that CDC data is that they looked at an outbreak in nursing homes and they found that the vaccines in that setting, in this outbreak were 61% effective at preventing infection. They were still 85% effective at preventing severe disease. So the initial premise is still intact that they’re preventing people from getting very sick. But if you see some decline in their ability to protect particularly older individuals, vulnerable individuals from any infection at all, that’s suggestive that eventually you’re going to see the- the infection break through in more cases in those individuals and start causing symptomatic illness.
JOHN DICKERSON: All right. Dr. Scott Gottlieb, as always, we really appreciate it. Thanks so much for being with us. That’s it for today. Until next week for FACE THE NATION, I’m JOHN DICKERSON.