UCSF's Department of Medicine Grand Rounds on November 4, 2021 included (from left to right): Bob Wachter, Paul Offit, and George Rutherford. Illustration by Molly Oleson; photos from screenshots of live event.

With the United States hitting the “grim milestone” of 750,000 deaths, UCSF Grand Rounds moderator Dr. Bob Wachter brought on two experts to discuss vaccines, the current state of the pandemic and the “darkish clouds on the horizon.” Despite improvements in the United States, and the Food and Drug Administration’s approval of Pfizer vaccines for children 5 to 11 years old, we may not be out of the pandemic woods yet, Wachter said. 

Dr. Paul Offit, professor of vaccinology at University of Pennsylvania, arrived armed with studies to discuss obstacles to herd immunity and to dispel vaccine myths. Following Offit, Dr. George Rutherford, UCSF professor of epidemiology, returned with a familiar presentation to discuss the pandemic at the local and national level. 


Offit began with a familiar refrain, stating that you are far less likely to be infected, hospitalized, or to die from Covid-19 if you are vaccinated. Protection against hospitalization is mediated by memory B cells, he said. These cells circulate in the bloodstream, and when they recognize specific invaders they have previously encountered, they trigger a strong immune response. 

These cells are “generally long lived,” Offit said, noting that “it certainly looks like protection induced by vaccination induces high frequencies of memory B cells” which is what allows protection against severe disease over such a long period of time. 

Because about 419 million vaccine doses have been administered in the United States (with 67 percent of the population having received at least one dose) and at least 100 million people naturally infected, Offit estimates that at least 80 percent of the U.S. population is protected against covid. 

“Is that enough?” he asked. Probably not. Given the delta variant’s high rate of infection,he believes we still need to vaccinate at least another 40 million people. 

The three obstacles to herd immunity are variance, claims to personal freedoms and misinformation, he said. 

“Frankly, it’s hard to imagine a virus that’s going to be more contagious than that, but we’ll see,” Offit said. 

He then went down a long laundry list of the various pieces of misinformation cycling through social media and the general public, and cited evidence against this misinformation. 

He began with the myth that the vaccine is unnecessary for children, noting that the instance of disease in young children has gone from about three percent when the virus first came to the country to more than 25 percent today, with 150,000 to 250,000 cases in children in the last month or so. 

In April, 2021, the U.S. Centers for Disease Control and Prevention published a study that looked at 200 adolescents admitted to the hospital with covid. It found that nearly one-third of them required intensive care unit admission, and five percent required mechanical ventilation.

Another myth that is “completely unfounded,” he said, is that the vaccine decreases fertility. In Phase 3 clinical trials of mRNA vaccines, instances of pregnancy were split across groups who received the vaccine or a placebo. If vaccines decreased fertility, there would have been more instances of pregnancy in the placebo group, he said. 

Other myths Offit dispelled include the idea that covid vaccines alter DNA, that the vaccine should not be taken when pregnant, and that the coronavirus spike protein is a toxin. 

He also unpacked Tucker Carlson’s claim that 3,362 people died after getting the vaccine, according to the Vaccine Adverse Event Reporting System. While this number is what VAERS reported, VAERS submissions are not vetted, and just because someone died within days of being vaccinated does not actually mean that the vaccine was the cause of death.

“You can report that your child got a vaccine and turned into the Incredible Hulk and that will end up in the system,” Offit said. 

He also debunked the “misinformation potpourri” created by the conspiracy theory movie Plandemic, which launched many falsehoods such as the idea that Bill Gates created the virus to make money off of the vaccines (“Presumably $60 billion is not enough for him,” Offit said) or that wearing a mask activates the virus. 

“We’re drawn to conspiracy because conspiracy creates order out of chaos,” he said. Because we don’t have a clear understanding where it started or exactly how it spread, it’s much more comforting to blame Bill Gates or a Wuhan lab, Offit noted. 

The final obstacle to herd immunity that Offit discussed was the claim to bodily autonomy, such as the decision to not get vaccinated during a pandemic — which affects those who you come into contact with and which is “not your right,” he said. 

Offit caught off guard by the anti-covid vaccine movement and the political turn it took. He discussed an old half-joke about how to stop anti-vax movements. 

“People used to say ‘because vaccines are a victim of their own success, maybe what we need is just a good plague.’ Well, we’ve got one,” Offit said. But though “vaccines are clearly our ticket out,” he said, “these anti-vaccine activists are incredibly successful at getting their information out there.” 

Offit is in the camp that children 5 to 11 should get vaccinated. Regarding boosters, like many other Grand Rounds visitors he said that if the goal is protection against serious illness, two doses of mRNA vaccine should do. “We’re not going to boost our way out of this pandemic,” he said, but boosters can protect against asymptomatic or milder disease, and are important in older generations. 

Regional Updates

Grand Rounds favorite Rutherford returned in “not a particularly great news session,” he said. Cases are going up in California, with a 26 percent increase in cases over the last 14 days and a six percent increase in hospitalizations. The United States case rate is plateauing with 70,000 new cases per day. 61 percent of California’s population is fully vaccinated, and 58 percent are nationally, which Rutherford said we should be “paying really close attention to as we enter the colder months.”

Despite this, Rutherford is “not at all convinced we’re not going to have another surge this winter.” 

“I don’t know that we’re able to just laugh this one off and say this has now become sort of part of the new normal.” November will be the month to watch for a surge, he said. However, as a state and region, he believes “we should be out of this by spring.”

See our previous Grand Rounds coverage here.

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FREELANCER. Madison Alvarado was raised in the Bay Area and moved to San Francisco after attending undergrad at Duke University. She fell in love with reporting in high school, and after a brief hiatus is eager to continue learning and growing as a storyteller. She has been covering UCSF's Grand Rounds since the summer of 2020.

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1 Comment

  1. Thank you for covering UCSF Grand Rounds. This is a great resource for current Covid information. How often does Grand Rounds occur?

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