(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)
0:05
Hello, everyone. Thank you for joining today’s webinar, Why Our Vaccine Deployment is Shy of Target, State Responses to Vaccine Supply, and How We’re Adapting.
0:15
I’m Sarah Dash, president and CEO of the Alliance for Health Policy. For those who are not familiar with the Alliance, we are a non partisan resource for the policy community dedicated to advancing knowledge and understanding of health policy issues.
0:28
Welcome.
0:30
The Alliance for Health Policy, gratefully acknowledges the support of Arnold Ventures for today’s webinar. And now, I’m pleased to introduce Kevin Love, Health Care Manager at Arnold Ventures for some very brief opening remarks before we get started.
0:43
Kevin, welcome.
0:44
Thanks, Sarah, and good afternoon. And thank you to everyone for joining us today. And thank you to Sara and the Alliance for Health Policy. We’re very happy to support the work of the Alliance and really looking forward to today’s important discussion.
0:56
I’ll keep my opening remarks fairly brief because I know we have a lot to cover today.
1:00
As Sarah said, my name is Kevin Love and I’m a manager with Arnold Ventures in our drug pricing portfolio.
1:06
Arnold Ventures is a philanthropy dedicated to tackling some of the most pressing problems in the United States today.
1:11
We invest in sustainable change based on research and evidence driven policy, education, and advocacy.
1:17
Arnold Interest focuses our work in the several portfolios, criminal justice reform, higher education, public finance, and, of course, health care.
1:25
Our objective in health care is to lower cost while maintaining and enhancing access to needed high quality care.
1:31
Across the health care system, we focused on opportunities to achieve more affordable care while securing better health outcomes.
1:37
These focus areas include reducing hospital and physician prices and costs, identifying and avoiding low value or unsafe care, improving the care for Americans with complex health conditions and needs. And of course, the portfolio I work on rationalizing prescription drug prices, and purchasing.
1:53
Our work in drug pricing through research work.
1:56
Grants to advocacy organizations, or technical assistance, focuses on ensuring drugs are affordable to patients, employers, and taxpayers, while also maintaining meaningful incentives for innovation.
2:06
While our work has historically examined issues such as anti competitive behaviors, market distortions by middlemen, or unjustified price increases, the current crisis has forced us all to think hard about ways to navigate America supply chain to deliver products like the … vaccines efficiently to the patients who need them.
2:22
With that in mind, we’re incredibly excited for today’s panel and discussion. I’ll turn the floor back over to Sarah to introduce the panelists.
2:31
Great. Thank you so much, Kevin.
2:33
Let me go through a few quick housekeeping notes. and I’ll introduce our panelists. As a reminder, everyone can join today’s conversation on Twitter, using the hashtag …, and follow us at all health policy as well, and as well as on Facebook and LinkedIn.
2:47
And all of the materials from today’s webinar will also be available on our website at all health policy dot org. Now, we also want you to all be active participants. So please, do get your questions ready. You can see the little speech bubble icon on, on your dashboard there, and you can use that to chat any questions to us, as well as any technical issues you might be experiencing. We’ll try to get to as many of your questions as possible throughout the broadcast.
3:12
Alright. And so, if we move to the next slide.
3:17
Will all of Yes, As I said, all of our resources will be available, and then save the date for february 11th one. We’ll be talking about the basics of budget reconciliation and the connection to health policy. And now, let me invite our fantastic panelists to turn on their videos, and I’m really pleased to introduce them.
3:36
So first, I’m pleased to be joined by Jim Blumenstock, Jim is the Senior Vice President of Pandemic Response and Recovery at the Association of State and Territorial Health Officials.
3:46
His portfolio includes emergency preparedness and response infectious and emerging diseases, immunization services, and environmental health. And Jim, welcome.
3:56
Thank you. Great to be here.
3:58
Yeah, thanks, And, next, I’m pleased to introduce Kate Johnson. Kate is the Program Director for Health at the National Governors Association Center for Best Practices. Kate has served as … lead on … vaccine deployment through Out the Pandemic and … Alliance webinar. So thrilled to have you here, Kay.
4:21
Great, I’m pleased to introduce Esther. … is Executive Director at Faster Cures, a center of the Milken Institute and she joins us for what is that?
4:30
We’re quickly getting into the double digits of Alliance Webinars on vaccines.
4:35
I think Esther has deep experience in the government, non-profit and for-profit sectors where she has led efforts to bring together diverse stakeholder groups to solve critical issues and achieve shared goals that improve the lives of patients. So, I start. Welcome.
4:51
Thank you.
4:53
Fantastic.
4:53
All right, so let’s, let’s start with, with Jim Blumenstock, who is going to give us the, the overview of what has happened in the last 8 to 10 weeks of vaccine deployment gen.
5:04
Off to you.
5:05
Great, Sarah. Thank you so much. And it’s great to be back with you again. If I can have the next slide, please.
5:10
So, you know, the selection of the of the topic for today is outstanding when we talk about the vaccine deployment, and why is it shy of target?
5:21
And what I wanted to do is be a little bit provocative, and maybe sort of push back a little on that hypothesis. And as I get into my conversation, I think you’ll understand why I’m taking this stance in our conversation this afternoon, but I would certainly welcome your feedback, or your, your thoughts on this particular point. So, if we go to the next slide, please.
5:41
So, let me start off by saying, you know, when Sarah said, to reflect on the last 8 to 10 weeks.
5:48
I think it’s critically important here where we really need to recognize that fact, that, you know, what we’ve accomplished is significant, That we administered over almost 34 million vaccinations, including about 6.5 million second doses over that period of time. Which really was part of an unprecedented effort, and a high complexity environment, and under very stressful conditions. You know, when we do, you all know the complexity of the two vaccines, their profile, significant logistical and storage requirements associated with it.
6:22
These distressful, conditions and environment of combating the acute clinical effects of the pandemic, the time of year with the holidays, the multitasking of the healthcare industry for caring for individuals, as well as becoming vaccinators or becoming vaccinated. So, in that it could not have been a worst period of time to initiate such a critically important and unprecedented effort, OK. But all that said, in this 7 to 8 week period, we still have basically put close to 34 million shots in arms of American citizens, and I think that is outstanding.
6:59
Next slide, please.
7:01
So, so the point to begin with here is, Where are we really shy of this target? And how do we know?
7:08
I wanted to touch upon about 6 or 7 elements here. And this is sort of my effort, also, to sort of level set up everyone’s understanding from my point of view, and hopefully set it up nicely for case presentation. Or the first point is, did we really have a target? It wasn’t well defined.
7:26
And, you know, we have all heard Operation Warf speeds goal of having 300 million vaccines. By January 2021, we’ve heard then Secretary Azar talk several times refining his forecasts and projections of how many tens of millions of vaccines would be available by Thanksgiving, early December, Christmas, and the holidays. But, again, they were just that forecasts.
7:53
And projections, In many people’s assessments, they really weren’t targets. The other point to make is, did we sufficiently mobilize with a target in sight.
8:04
With those numbers, did we really design a plan and an approach that was right sized an aggressive enough to address those surrogates for targets, if you will, goals, objectives, or **** Forecasts.
8:19
And, a couple of points here is with, with planning, you know, some of the challenges that the public health community really experienced was delayed in our planning in earnest for this campaign.
8:32
While the states were working in refreshing and revising their generic pandemic plans, specific planning elements in details really didn’t emerge from operation warp speed, the White House, and HHS, to probably early, to mid August. So, that was surely when this, with a clock started, so to speak, as far as serious, detailed, planning, and then carried through the fall and early, early, winter. So very compressed, very aggressive. In hindsight wise, it would have been much more beneficial if it started earlier, as far as engaging state and local folks in the planning and readiness efforts.
9:10
The other point is our resourcing.
9:13
We all know the investment made to operation warp speed for the research and development of the facts vaccines, and the production of the vaccines.
9:23
That level of commitment and investment was not provided to the public health and healthcare components that were responsible for the distribution and administration, last tactical mile, as we call, as we call it.
9:36
Another point to raise is, did we really, do we appropriately manage the expectations of policymakers, decision makers, and members of the general public in sort of this national narrative of what our goals and objectives were? And, and, and really manage those expectations and help the general public understand what could have been sort of those outlying events that could slow up our pace or escalated. and also the degree of difficulty of getting vaccines through, emergency use, authorization, and eventually, and status, to be used.
10:13
Know, I’m posing this as a question, but I will also make it as a statement. Did we over promise and under deliver based on everything I’ve just shared? And I think the answer is, yes. And, you know, this was a hard lessons learned 11 years ago, during H 1 N 1, And unfortunately, I believe the collective, we repeated that, that unfortunate set of circumstances. And the last point here is that we have a metric to really gage this. And this is really right now where sort of the public narrative is taking place, assessing performance, and voicing some dissatisfaction, disappointment, and even stronger emotions about where we are over this 8 to 10 weeks. But the fact of the matter is, you know, is speed and volume, a good, or a sole metric.
10:58
To determine progress is success, is a metric which we don’t yet have, but focused on the issue of prioritizing risk, and the addressing the issues of equity, and equally good, or better metric for evaluation to use for progress and success, or both. And that is really the tension that we’re now experiencing, as you’ll, as you’ll see in a few moments. So next slide, please.
11:26
Shelby, if we get like, vacuum, so in my few moments left, swipe left, I really wanted to talk about, is the data tracker at CDC, Because this is critically important, and I apologize this maybe a little more detail that you want to hear, but it’s essential because it really is the backstory of the national conversation that’s taking place right now of being critical of the public health system, federal leadership and state and local partners, and where they are in the administration.
11:54
A vaccine, as you can see here, you know, as of yesterday, almost 56 million doses were delivered to the jurisdictions around the country. And about 34 million of those have been successfully administered, which is a 61% administration rate. So, you know, is the glass half full, glass half empty on this particular issue?
12:16
And there’s been a lot of criticism about the delta between those two numbers, whether they should be much closer together, or even be identical that there should be no doses sitting around. And as soon as they come in, they should go out and be administered to eligible individuals.
12:32
Well, the fact of the matter is, there are multiple contributing factors that must be recognized, that explains this supply chain dynamic, and I’ve listed them there, for you to really understand or help you understand, know, the complexity complexity of this challenge. The first one is the learning curve. As we will all have heard, this is, you know, this is brand. This is a brand new vaccine, we have used modified legacy systems and new systems to help administer it. But the fact of the matter is, that, you know, we were lacking initially and establish cadence. A level of confidence of consistency and predictability of how much vaccine would actually become down the line, so that really made for a little bit of a difficult, and rocky start going forward. As we were sort of in that shake down and ramp up mode. And other areas of wastage, you know, the vaccine that just for whatever reason can no longer be used, is not quite factored into that formula. Fortunately, that is not a significant number of at all. Estimates are that is much less than 1%.
13:39
We do know that there’s a reporting time, there’s a lag time between reporting.
13:43
The data that’s, that shows amounts of materials distributed is real time. You know, just like if you’ve got a FedEx package today, at two o’clock in the afternoon, Your system at 204, I would say the packages delivered, that’s different doses administered because the data’s going to be entered. It’s gotta go through, the process is going to be uploaded to CDC, and that takes anywhere from, you know, a three day performance window, if you will. That’s been identified.
14:11
Also concerned about underreporting.
14:14
Many of the providers, some of the providers are having a challenge of resourcing on whether or not it’s more important to put vaccine in arms, have individuals as quickly and efficiently as possible or sort of the back end process of entering data to keep an administrative record of all of the materials.
14:34
The other issue is that some of the data systems and, you know, tronic health records may not be interoperable with states immunization information systems. So, that’s a difficulty where data is just not being captured or reported.
14:46
Vaccine inventory spread, there are about 80,000 providers that are currently enrolled with materials being provided strategically in those locations.
14:56
I think the lesson learned here is that the inventory may have been spread a little bit too far and that, you know, and there is materials there waiting, but the volume and throughput may not necessarily be what was visually envisioned.
15:12
In other areas, of states have been very conservative inventory management, not having the assurance of second dose is coming down the line when they needed to states for holding that and reserve. And, of course, the issue, that there are some sites that are just lower throughput and states now need to rebalance inventory, movie inventory out of sites that are not seeing the amount of clientele that they anticipate and bringing them into higher volume sites.
15:37
They could readily apply that, that vaccine, and the overall uptake. And possibly over allocation of vaccine into the long term care program that the federal government was overseeing. Again, over time, those were observed, And adjustments are being made where states can back off of back away that information, that that material and bringing it into the general inventory, that could be …, burst, some of these higher volume vaccination centers going forward. So, my closing thought on this slide is, again, while speed and volume are important, targeting high, high risk individuals, first, and the commitment to vaccine access and equity are paramount.
16:15
Which takes time and effort to be truly impactful. And that really, the, the, the metric of speed and raw volume really isn’t a good indicator when you recollect recognize the complexity of the of this of the of the project or the assignment.
16:29
And also the critical importance of addressing the highest risk individuals throughout the country first and foremost With with it as vaccine supply increases, you will get a little bit easier and broader to administer the vaccine across the country. Next slide, please.
16:48
So, again, the way forward, you know, to really be on target, you know, I could honestly say, I believe we’re turning the corner, gaining momentum and picking up the pace, You know, through this continuous assessment and adjustment, to improve the efficiencies of moving inventory around, ongoing management of supply and demand tensions, so that we do a better matching so that there, there is inventory there.
17:09
When individuals are being scheduled, we need to bring to scale the campaign by expanding and sustaining infrastructure capacity and capabilities. Congress and the Administration has funded this initiative, and, finally, in December, so that will write a considerable resources as a down payment for this campaign and the weeks to come working with the new administration to sustain the effort.
17:32
The ongoing commitment and necessity to address vaccine hesitancy and build trust in the system and confidence in the vaccine itself.
17:40
And the last point is to really maintain a flexible posture for those curveballs, such as what will we do with varying strains that may need booster doses That we would actually have to repeat this cycle, possibly, a second in subsequent times, as as the as the virus may mutate or change. Next slide.
18:00
So in closing, you know, from my association, you know, I would encourage everybody who wants to sort of see the state health perspective on our website. We have an outstanding amount of resources that we’ve created on behalf and for our members, and also feature a lot of the work that’s being done in the states and territories across the country.
18:18
And with that, I want to thank you very much for this opportunity. And I look forward to our conversation in a few minutes. Thank you.
18:25
Thanks so much, Jem. And that was quite a tour de force. Thank you for outlining all of those different factors for us. I look forward to the conversation. So, let me now ask Kate to join us.
18:38
Kate, from, there, you go, Kit Johnson, from National Governors Association, K, and for their specific data and communications, and other needs that, need that states need in order to meet some of the metrics that the gym outline.
18:52
So, um, can you build on, James, just recap, tell, speak to the foundational infrastructure that states need to really equitably distribute vaccines and talk about any, any longer term efforts on the part of the state’s? Thanks, Kate.
19:08
Absolutely.
19:09
Thanks so much. And that was a really great overview from Jim And so I’ll just, I’ll do exactly that, kinda take a little bit of a step back and provide some additional context for those foundational elements.
19:21
So, if we move to the next slide, this is just kind of an overview of what I’ll be walking through at a high level, because we could, of course, spend probably hours on each of these topics. But we’ll focus on allocation. So, you know, how are states determining who gets the vaccine first, in particular, while there is limited supply and distribution and administration, of course, So how the vaccines are making it to providers. And ultimately being administered to individuals’ data infrastructure.
19:55
Jim talked a lot about some of the complexities there, but really understanding, you know, this is essential to making everything work, and, importantly, allowing us to understand how things are going. Communications and engagement, and particularly engaging with local and community partners, and then, of course, equity, being foundational to all of this. And really, you know, needing to be centered in all of these activities. So, I’ll touch on that along the way, but, if we move to the next slide.
20:25
Let us start with allocation. And so, on the right-hand side, you can see the federal recommendations that were released back in December. And since that time, there’s been additional federal encouragement to expand eligibility specifically to populations, 65 years and older, as well as those, with high risk conditions. And I’ll talk a little bit about, you, know, where states are on this, and what we’re seeing across the states.
20:55
But before I do, I just want to highlight that, you know, the way that states structure their allocation approach, and, importantly, how quickly they move through allocation is really dependent on supply. And there are undoubtedly a number of other factors that may impact, you know, how fast or slow states are able to move through this process.
21:16
But until we really reach a point where demand no longer exceed supply, supply itself is really critical in, in kind of the shape and progress of state allocations.
21:29
And so, governors and state leaders have been really focused on developing equitable approaches to allocation that recognize, you know, those most vulnerable to severe illness or death, as well as those that are at high risk of exposure, an essential job functions. And so the federal recommendations have certainly, you know, served as guidance for state decisions.
21:52
But there are a number of factors that play that have really necessitated some additional steps at the state level to provide clarity on, you know, who exactly falls and what group and how those groups may need to be further prioritized. And those factors include, again, you know, what the level of supply is. And the fact that, as you can see, you know, the populations outlined by ACIP are quite vast. So there’s, you know, particularly if you look at high risk conditions, if that, over 100 million people that may fall into that bucket.
22:28
Then there are also unique considerations that states have to weigh. For example, you know, categories of essential workers in Iowa may be different than, say, Delaware. So, there are other factors that, you know, they must address to their individual needs, and states have set up, A lot of states have setup formal committees or work groups to really work through these decisions. And those groups oftentimes are involving, you know, diverse representation, bringing and partners to really ensure that decisions are equitable and that they’re informed by those populations that they stand to impact.
23:08
So, that has been kind of the approach at the state level.
23:11
And in terms of what we’re seeing, in particular, around that piece, I mentioned where, you know, there’s been an encouragement to kind of expand eligibility. Right now, we’re seeing roughly 30 states or so that are currently vaccinating those, or have expanded eligibility to those 65 and older among the rest of the states, or some mix of 70 and older, 75 and older.
23:36
And there are a number of states that are doing kind of scaled approach, and, for instance, opening eligibility by five year increments over several weeks. So there’s a variety of approaches happening across the states, but that’s kind of the high level picture. Right now, there are roughly 17 States that have opened eligibility to adults with high risk conditions. And we haven’t, you actually have a tracker of each state’s approach to face allocation.
24:04
And I think one important thing we’ve seen in the last couple of weeks, is that a lot of states have taken steps to further identify, you know, who those folks with high risk conditions are. And, again, leaning on CDC guidance for that.
24:20
So, if we move to the next slide, I just wanted to talk through a few things on the distribution and administration side. On the left-hand side is just a snapshot of how things are working at a high level, as that’s probably familiar to a lot of folks from operational warp speed. And, it’s basically just showing that vaccine supply and ancillary kits are, you know, moving from manufacturers to distributors, and then on to providers.
24:47
And, I want to focus in on, kind of the right hand side, which is that there are a variety of different administration sites that are being employed. And Jim alluded to this as well, and these include, you know, hospitals, federally qualified health centers, local public health, clinics, pharmacies, etcetera.
25:09
And so, States are, you know, utilizing some variation of these sites in different ways, and, importantly, some states may have really robust local or county involvement, while other others may not. But, I want to focus on, you know, an important aspect here.
25:25
Strategies may adapt over time due to a variety of factors. But I think one in particular that’s really important is, you know, ensuring as mentioned previously, that this is really focusing on equity along the way. And really balancing that equity and speed dynamic.
25:42
And so, and thinking about equity and accessibility of these sites, there’s really no waiting is the location one that’s accessible and in a place that people will be able to get to or are familiar with.
25:56
So, not only is it, you know, close by, but is it maybe at a church or some other location that is rooted in the community? Transportation, of course, you know, if people can’t walk there, then do they have a car, or do they have access to public transport? And again, the provider type, is it someone they’re familiar and comfortable with?
26:21
And in terms of logistics, I think, you know, I lists ultra cold storage at the top there because that’s really been kind of the big one in terms of complexity, complexity, of managing logistics. But you see a couple of others there that I’ve listed. This is not necessarily exhaustive, and I won’t go into detail on it, I’m happy to follow up in the discussion. But, you know, states are doing everything from enrolling an onboarding providers, ensuring that there’s enough supplies if they’re not included in the ancillary kits, working through measures around coded and, and potentially whether Destructions, particularly in the winter that, for instance, could derail a drive-thru.
27:07
On in the logistics space. And just want to flag that, a lot of states are utilizing the National Guard in a variety of capacities to help support this work.
27:16
So, that’s another kind of trend we’re seeing across the states, as this rolls out on the next slide.
27:26
And won’t go into too much detail here, but, just wanted to walk through a little bit on the data and infrastructure elements of this.
27:35
I think Jim provided a really great overview of, kind of, you know, the issues around supply and management, and the, the graphic on the right-hand side. I think, you know, maybe a bit hard to see, but I think that’s OK. Because it sort of does its job at a glance, and really depicting the array of systems and flow of data that are involved in making this all work. And, this doesn’t even include, you know, certain elements, like systems for reimbursement and other ancillary data.
28:06
So, important to note here, you know, states are relying on existing systems, but they’re also navigating new systems. System enhancements, adapting to new processes for reporting, so, there’s a lot going on in there. There are certainly challenges that exist.
28:25
And, just a couple to highlight that I think are really relevant in terms of, you know, understanding completeness and timeliness of data. There are a number of states that may face some legal hurdles in particular state laws that may limit the ability to collect report or share race and ethnicity or other demographic data.
28:46
So, that, you know, may stand as a big barrier in terms of completeness of information and of course, ensuring full understanding of equity dynamics. Other, other issues to highlight, on the technical and operations side, you may have some providers that have limited broadband access and so that impedes their ability to enter data in a timely manner.
29:11
You know, there may be system issues, in terms of volume overload, add ons that haven’t been adequate, adequately tested yet, etcetera. So, a lot to work through and on the data front, and I think this will be a really important focus area in the weeks and months ahead.
29:29
And then lastly, on the next slide, communications and engagement, I think this is last but certainly not least, and it’s a really important focus area in the States, and I tend to think of it in two buckets. So, there are communication and engagement efforts around, you know, the policy and process of all of this, so, really, the who, what, where, when, how, of getting the vaccines and so much of this is rooted in setting the right Expectations.
30:03
Being transparent, you know, this is, of course, really fast moving.
30:07
Complex endeavor, and there’s a lot to clarify for folks, So, this is an area of, of clear focus for states right now.
30:15
And just to give one example, there’s a state that has set up a dedicated e-mail address for kind of case management of these issues and, like that, numerous staff members, you know, dedicated to that effort.
30:28
But this is a really kind of challenging space, and one that’s critical to get right. The other bucket is really around addressing misinformation and promoting vaccine competence.
30:40
And this is, of course, essential to getting, you know, ensuring that all communities and all populations, and particularly those most vulnerable, are getting access to the vaccine, and that you have that uptake.
30:53
And so, you can just see on the slide a number of the strategies States are employing in both of these areas, and I won’t go through each of them, but happy to talk into discussion, and I’ll just end on the fact that, again, here, equity is really critical. And so, this, on the communications and engagement front, means that you’re, you know, addressing things like different languages, and ensuring cultural competency, and your communications using different modalities.
31:24
You know, ones that may be more or less, familiar to certain individuals, informing your approaches by engaging with the community, and tailoring those approaches as needed.
31:38
And then, you know, recognizing that it’s not just all about communication and hesitancy and all of that, but making sure that the access is there as well. So, really, you know, as you’re communicating and reaching out to folks, if they’re not able to get to the vaccine and have that access, then you’re not going to solve the issue.
32:00
So, I will end there, and then turn it back to you, Sarah.
32:05
Great. Thank you so much, Kate, for that overview, and we can We can certainly do a full webinar and on any one of your slides. So, really appreciate you laying that out and look forward to the discussion. So, I’m really pleased to now invite Esther profile to join, hi, Esther.
32:23
So, you know, all of this would be so easy if there, if it weren’t for, you know, these new strains that are being discovered.
32:31
I am not to be facetious. This is already hard enough.
32:35
And now we’re discovering new strains. At the same time, we have some new vaccines coming down the pipeline.
32:40
So, what can you tell us about the state of the science and the state of the supply chain, now, as it stands from the, the closer to the discovery side?
32:51
Yeah. Well, thank you so much, Sarah.
32:53
And those were excellent presentations from Kate and Jim, if we’d gone, too, to the slide deck, I do think it’s important for us to level set in terms of, where are we in the development of vaccines, and what are we seeing emerging from these variants across the world?
33:08
If you go to the next slide, many of you know that at faster Cures Milken Institute we’ve been tracking the development of vaccines and therapeutics really since the beginning of this pandemic. Certainly, when it was spreading much more rapidly in March, important to note that they are still therapeutic development center way against the virus, which could help intrusive hospitalized patients. However, focus right now is on the vaccine development, 242 vaccines in development around the world, if you go to the next line.
33:41
So, what we’re seeing right now is that we have of the 242 vaccines in development around the world, and really, it is a global effort. 55 of them are in clinical testing, and 10 of them are in use in different parts of the world on the right-hand side of the slide. You see where these 10 are in use. Of course, we spent a lot of our time here talking about ludhiana, Pfizer, astra zeneca, vaccines, but they’re also vaccines, developed it in use from Russia, and China, as well, and those are listed here.
34:17
If you go on to the next slide, I think it’s important for us to understand that this is happening in a global context, that we, of course, need to tackle the distribution issues here in the United States. But also, we’re trying to really mitigate this virus all around the world. To new 108 million doses have been administered across 67 countries in the world, you know, about 8.5 billion doses under contract by 117 countries.
34:48
The US is secure contracts for about a billion doses.
34:52
But what I’m concerned about, and I think increasingly others, experts around the world, are concerned about is to ensure that we have equitable vaccine distribution globally.
35:03
As we see, whether in the US or in Europe or richer countries, are securing many more doses than we see in poorer countries around the world.
35:16
They have been, of course, organizations like the Kovacs facility that are working on a global distribution.
35:22
But we do have to keep in mind that we can end this pandemic when it’s really a global solution. Not just and national solution. That. Being said, we’ve heard already about you know, 35, 33 million vaccines have been administered here in the US, which is about 1.3 or a little over a million doses a day on average. We do need a ramp that up significantly in order to get to that herd immunity that we hear doctor Fauci and others talk about quite often.
35:53
And there are efforts underway to get upwards of that 1.3 to maybe 1.5 in the short term. And then likely what we need is closer to two million doses the day to get to that herd immunity, you know, by by end of the summer early fall, if we go to the next sign.
36:13
So, again, one of the big discussion points right now are these variants that are emerging all over the world, and they’re emerging really due to genetic sequencing and surveillance efforts that are happening. I do have to note that the US is not doing a terrific job in terms of genetic sequencing. Less than 1% of all positive kovac cases in the US are sequenced.
36:40
We do need to get higher that the UK has been very active in, genetic sequencing of positive cases, countries, like Denmark, for example, sequence, every positive case that being said, due to the sequencing of the virus, we’re seeing variance, and, in some cases, concerning variance, three in particular, that have been identified. The UK variant, the B, 1, 1, 7, The South African variant, the Brazilian variant, We are seeing increased cases of these variants in the US, particularly the UK.
37:14
Variant, the concern is because there’s higher level of transmissibility of these variants.
37:21
We saw a hockey stick approach in terms of, you know, the wide sort of exponential growth of cases in the UK, just these past several months, and there’s anticipation that will likely see the UK variant dominating US cases by the spring, So we do need to be very careful and mindful of what these variants that are emerging look like and how we can mitigate them with existing vaccines. This map below just shows you where these variants are already popping up.
37:51
Over 32 states reporting the UK very limited number of South African, and Brazilian. but that needs to be watched over time, particularly as we sequence more and more cases.
38:02
If we go on to the next slide, OK. so what do we know about these variants So far, I did mention they’re more transmissible. There is early data that the UK variant is, is more more deadly!
38:18
That is still early data, but there is some suggestions that the mortality rate could potentially increase with the UK variant. We also know that, you know, the antibodies that are been approved for the vaccines we currently have do recognize these mutations and can be effective against them though moderately.
38:39
So in some cases, the data is emerging pre print. Studies are coming out almost daily. So we’re learning a lot more about the potential. A lot of the early data we have is from lab studies, rather than in human clinical testing.
38:54
So there’s much more that we need to do to better understand the effectiveness of existing vaccines against the variants. The mitigation strategies that we have in place. So masks and social distancing are still absolutely important in light of these variants. Of course, hearing, you know, obtaining higher quality masks are going to be important.
39:17
Being careful about usual, daily activities that we’ve, we do, go into the grocery store, just We need to be just a little bit more careful in terms of exposures at those point of of interactions as we had early on in the pandemic, but need to be even more vigilant now.
39:35
And in light of these pandemics, what we don’t know, how widespread they are. Again, we need to increase our surveillance and genetic sequencing and ramp that up significantly with positive cases in the US. How the disease my my may differ, in terms of increased morbidity, or mortality, and the effect of existing therapies, tests, and vaccines against these variants.
40:00
If you go on to the next slide.
40:03
So, that being said, you know, what do we know? Today? I listed here the vaccines that we’re watching very closely modern of Pfizer authorized here in in the US. The early data does suggest that they are effective against the UK variant, those slightly less effective against the South African variant.
40:22
I did not get too much information about the Brazilian very because we don’t have that much information about the Brazilian variant. But that, again, is an area that we need to watch very closely for the astra zeneca University of Oxford vaccine which Phase Street clinical trials are still underway here in the US.
40:42
It has been authorized in the UK, and it seems to, to maintain its effectiveness against that variant. It’s been used in the UK where we see the UK variant, but more data.
40:54
We’re waiting more data specifically to answer that question, as well as against the South African invariant, novak’s their early data. Again, they’re still in phase three clinical trials and did share early data.
41:06
In terms of the efficacy of their vaccine, it shows early on that it is effective against the UK variant, though, again, slightly lesser with the South African variant.
41:16
The Johnson and Johnson vaccine, which is the one dose vaccine, efficacy varies in different parts of the world, where the clinical trials were conducted. one dose vaccine, which really can be, you know, quite helpful in, in the race to try to get as many people vaccinated as possible. Does show. Yet, again, that, though, the overall effectiveness does go down a bit with the South african variant is still protective, I think. The bottom line for all of these vaccines, for people to note is that what we really care about are severe disease hospitalizations and deaths. And, across the board, all of these vaccines are effective for, for that severe disease, hospitalizations, and deaths. So, again, more data is still needs to come in and come in, and we will shed more light. But that, I think, is the most important thing that we should highlight here, for folks, figure the next slide.
42:17
So, what do we need to do in terms of and in light of these variants, um, better, faster genomic sequencing?
42:24
Ongoing surveillance of all positive covered tests would be very helpful for us to have a clearer picture in some ways. We’re flying blind, We don’t know what we don’t know.
42:34
And having more data is helpful for all the information, that we need to be able to address this in the appropriate way, rapid deployment of vaccines, that Kate and Jim so well described, particularly to those most at risk groups. And then the other priority groups.
42:53
So right now, we’re just in a race to get as many people vaccinated as possible.
42:59
Before we start to see, again, what we saw in the UK, which is the exponential growth of that variant dominating the cases there, and we need to be even more vigilant and consistent in our ongoing mitigation efforts.
43:14
And continuing those public health practices that we’ve heard, It’s still not the time for coming together and enlarge groups. All of that still needs to, to occur. I do think as we see more vaccines come into play, particularly with J&J Vaccine, going through their process for emergency use. Authorization which will happen over the next several weeks. and know of X that will give us more tools in our toolbox of opportunity to vaccinate more people. But right now, it really is about the speed of getting people vaccinated as quickly as possible to mitigate the effects of these variants that are likely to become even more widespread as we go into into the spring. So I’ll pause there for now and allow time for questions.
44:07
Great. Thank you so much STRS while while the others are joining us for the Q and A and we have a lot of great questions coming in from the audience. And I want to focus in a little bit more on the genetic sequencing. You know, you mentioned that fewer than 1% of all positive tests in the US are being sequenced. To just go into a little bit more specifics there.
44:26
Who should be sequencing them? You know, does this add a new burden to the reporting requirements. What do we want to do with that?
44:34
That information, can you just go into a little bit more depth on what are the practical next steps that need to happen there?
44:41
Yes, so, there is surveillance law, you know, labs that use these surveillance techniques all over the country. CDC, of course, has been quite heavily involved in identifying which labs are using for genetic sequencing is essentially deploy the next generation sequencing technology where they exist. And so, what we need is just that ramped up in more labs across the country. If you recall early on in the pandemic, we’re testing was it was a challenge. It was really about, how do we make sure that each of these labs have all the various things that they need in order to be able to conduct that, whether it’s … and so forth. Right now, it’s really about bringing more labs online to help out with that effort. I think CDC is ramping that up. They’d recognize the need for us across the country to do more of that sequencing.
45:35
But we’re still, of course, seeing that we have a whole, know, a high number of positive cases, right, Are still coming in for test. So the volume and the scale of it is still very high.
45:47
And then going through the PCR tests that are needing an adding on genetic sequencing of each positive test cases. Just a, you know, a volume ratio. But there is work underway to make sure we have the technical capabilities across the country to do that, but absolutely is quite necessary to understand exactly what happened in California. For example, we saw those cases go high. Why was that, was that entry to any kind of mutation, or was that just the natural effect of, of, of people spreading, you know, through community spread?
46:19
Yeah, and, Jim, I saw you nodding or did you are the saint Totara health officials responding in any way to this? Your thoughts on that?
46:29
You will, certainly, I mean, many, all state health departments have, you know, public health laboratory services that assist in this type of surveillance.
46:38
And so, certainly, rely as a lot of the reference labs, and research in academic labs.
46:42
So they’re working very closely with CDC, to, to expand the capacity to, as there’s point that, you know, of the necessity, to do a much better job in the genetic sequencing, to really get a full and accurate picture of the changing environment out there.
47:00
Thank you. Great. Well, we have, oh, my gosh. Not enough time for all the amazing questions. So I wanna, I wanna focus in on the equity question. You know, Kate, you talked about the data not always be sufficient on, on race and ethnicity.
47:14
We have a comment from the audience, from someone in the disability community, but I know that this has been more widespread.
47:21
Just, you know, pictures of long lines at distribution sites, frustrations of people not being able to get through, you know, the Internet appointment scheduling a kid is there is terrorist spots.
47:35
You know, like, what is there anything that can be done quickly, to make it possible for an easier for people to get their vaccine appointments, when they are eligible for it?
47:49
Yeah. I think states are taking a variety of Approaches. It’s, it’s, it varies across the states, in terms of their ability to have a centralized approach, and I think some are looking at how they might be able to kind of advance that quickly now. New Mexico is a good example.
48:05
Of a state that has a centralized registration system that has been working pretty well, and they have been able to get, there are providers on board in terms of directing folks to the centralized registration system.
48:20
I think that is really kinda, the key is, you know, if you have a more kind of disbursed approach, it’s that’s what’s really creating, you know, the confusion for folks and having to kind of go to different sites. So, I think states are looking at what they may be able to do quickly, But, you know, again, this involves standing up systems and complex logistics around this, as well as that kind of relationship building and engagement with providers and communities.
48:50
I’m charge. And you may have additional comments on this too, but it’s definitely been a really challenging area for the states, and I think they’re working through new strategies right now.
49:01
Yeah, and I’m curious your thoughts on, you know, how do you balance this need for for it?
49:06
More centralized, you know, standardized approach with you, know, that. But that some people may end up calling a one size fits all versus like the need to go into the barbershops and the churches and, you know, like how do you balance those things.
49:19
And again, how can we quickly as or as quickly as, you know, humanly half of all, this.
49:27
Well, a couple of thoughts on, number one, you know, it, with the supply and demand equilibrium more vaccine is becoming available. The states were notified just the other day that their weekly allocations are receiving a fairly significant increase that will be sustained over the next several weeks, and states have visibility on that.
49:48
So, that achieves a couple of things that we want to give more vaccine out there to be available. And it gives the states the planning edge to say, OK, so now we have this high level of assurance. This is how much will have over the next couple of weeks.
50:02
We can go out with confidence and schedule new clinics or expanded clinics with that level of confidence that they’ll have sufficient supply only for first dose in second dose. So, you know, as as the days take off, we are getting into sort of that improvement process as things stabilize, enhance, and expand going forward.
50:23
two decades point about the that equity.
50:26
You know, the States are looking at every possible modality delivery model that they could consider from the smaller community based Federally Qualified Health Centers or centers to the pharmacies that we heard about the other day with the White House releasing their new retail pharmacy program. To stay standing up. The mega clinics know where they could have high volume. Again, of, basically, inviting or registering all the right individuals who, in those priorities schemes that are eligible.
50:59
So, they are looking at every possible option to increase volume, speed, but also the equity, and also take into consideration individuals at highest risk, and also critically necessary to sustain society as part of our infrastructure.
51:15
But, until we sort of get to that point where it’s steady state, you know, balance of supply and demand, it will be this prioritization scheme and, sort of a week to week, no flexibility going forward.
51:31
Thank you. And there was a question from the audience about the Federal Vaccine Administration Management System. Is that something that’s in use? Is that a lost? Cause? They thought that there was not mine, like, What’s the role of that? And all of this?
51:46
Kate, do you want to take that first?
51:48
Or, would you like me to Oh, go ahead and I’ll jump in after?
51:52
Yeah. So, you know, as I understand it, Vamps, was, is a one of the new products that Kate showed in our graphic, you know, you know, that in there, that scheme was excellent.
52:03
The show, the collection, and the network of existing legacy systems, as well as new ones, …, is a new one that was designed for states that felt they wanted to possibly step away from their existing immunization information systems and use dams, So I don’t believe a majority of the state’s went to the vamps tool or system. They stuck with their IIS and built it out and modified it and expanded accordingly.
52:31
So, you know, I’m not quite sure that, you know, you know, where where the appraisal is, as far as the bams, as far as being useful for those states that have decided it decided to use it, but again, it’s, if P if states are dissatisfied with it, they still have their immunization systems that they can fall back on and using this process, they think, hey, does you, as your response here, there’s another question about type area system, you know, that another kind of legacies that scientists explain that a little bit. Our state’s doing behr, brand new vaccine registries in your follow up, that would be great.
53:05
Yeah.
53:06
So, in terms of van’s, I think we’ve heard sort of mixed reviews in terms of experience. And of course, there in addition to states, maybe providers or, you know, localities that are utilizing it as well, it really was an option for those that didn’t have the capacity in terms of scheduling and managing clinics, et cetera. So, mixed reviews, I think, there, there have been some challenges, but maybe more or less so, with particular folks and working through some of the kinks. Again, with any new system It’s, it’s really a question of how thoroughly you’ve been able to kind of test its functions. And, you know, this obviously rolled out pretty quickly. And, you know, I think I think to be told sort of how that shakes out, in terms of whether, you know, folks think they need to switch to a different system or go back to their IIS.
54:02
Tiberius is a system that integrates, you know, sort of related manufacturing, supply chain allocation data, and it’s a place that you can kind of look across.
54:16
And we have heard that there have been challenges with type areas and being able to get clear information from tiberias.
54:26
Not, again, not totally sure, folks have, of course, been trying to work through these challenges. I think there’s been some men and some success and kind of working out some of those kinks, but it’s definitely been a place where it’s been difficult for states to kind of get the data that they need quickly, in terms of understanding, you know, where product stands, where supply stands, et cetera.
54:53
OK, the other thing I’d like to add about tiberius, The 1, 1 beautiful feature of that resource is that it provides something that never really existed before. And that was a common operating picture or platform that basically pulled together all of these operational and technical details that the states could use and other states, and they all use sort of the same resource or tool. So to Kate’s point is it’s new. It’s, we’re finding challenges with it.
55:24
There wasn’t that there hasn’t been really an opportunity to do it in depth training and exercising with it, but I, I, for one, would be optimistic.
55:33
That, the next generation of tiberius, whatever it looks like and what are whatever it is called, we’ll continue to play a critical role in public health responses like we are experiencing today.
55:45
Great, thank you. Let me turn to Esther. And we have time for maybe just 1 or 2 more questions. We have a couple more specific questions about the vaccines. one person asked about the astra zeneca vaccine in particular, noting that some European countries are recommending against using it and seniors. You know, can you comment on that if we had to restrict some new vaccines based on age as Howard states need to then adopt their vaccination strategy strategies or adapt? And then I sorry for two kind of, vaccine questions at you, but But, But I also wonder if you could, you know, we’ve, We’ve had a number of different briefings and webinars on kind of the vaccine pipeline. You mentioned the 242 currently in development the race to develop the vaccine. Now, we have a few kind of promising candidates.
56:31
How do you see that pipeline evolving? Are we going to kind of get to the 5 to 10 and then these like the others will fall away?
56:38
Or, you know, are we getting to the point where we don’t need that many to be, you know, and in progress? and maybe if you comment on that.
56:47
Yeah, Very good questions. You know, I think we’re continuing to learn a lot more about the astra zeneca vaccine.
56:55
As you know, they conducted their clinical trials in the UK in Brazil and in South Africa. The US said, Well, we want to conduct our own phase three clinical trial before we are ready to authorize it for use in the US.
57:09
For many reasons, one is to understand that efficacy in terms of generating the immune response for all of those different populations.
57:17
As you age, your immune response gets weaker and studying the effect of whether that vaccine is effective for that population. I think it’s quite critical. What we’re likely seeing in the response is that we’re not generating that appropriate level of immunity or for the elderly population.
57:34
and so, trying to be careful there and maybe allowing use of the Pfizer vaccine and others that have demonstrated immunity or individuals, you know, at that age level. So, there’s still a lot that we’re learning about the astra zeneca vaccine in terms of the pipeline. It is a significant pipeline. I don’t think we’ve ever seen anything like that for any previous epidemic or pandemic. I think right now, we are still in this race to get as many online as possible. We’re still seeing, actually, quite activity, high level of activity in enrollment into the ongoing clinical trials and studies, which demonstrates that people want access to any kind of vaccine trial, wherever that may be. We may get to a point where that levels off. We don’t know what the point is, because the demand is so significant. We’re talking about vaccinating seven billion people on the planet. And so we have a number that are, of course, over the finish line, Elise authorized. But we still have a ways to go. These vaccines work differently, as you know, with the different vectors, right? We have those that use proteins that are m-r.n.a.
58:38
refrigeration or being frozen, one dose, versus two doses. So I do think we’re still a little bit in this upward curve to see how many of them are successful. We did see, of course, some already fall away, right? GSK and Mark said, Let’s take a step back. Or, vaccines are not producing the level of, immunity. Let’s, let’s try, you know, for, for a different approach. So, we’re not quite there yet. I think the goal is just to continue to see as many as possible. There will be a point, of course, or we say we’ve reached capacity, but we’re not there yet.
59:08
Great. Thank you. So, in the one minute we have left, I just want to ask each of you I know there was a question about the supply versus the vaccine hesitancy, and we’ve seen the vaccine acceptance kind of go up.
59:22
People are eager to get more people are eager to get the vaccine at this point in time, can you just share kind of, are you more concerned about hesitancy, or you more concerned about just getting the supply to people? Or is it still a combination of both?
59:40
Well, you know, if that’s an easy quick. It’s all of the above. No, I mean, I think, I think there are parallel lines of effort that you are articulated that continued to be addressed.
59:51
You know, I’m confident that, that every day, we are seeing improvement, whether it be that by the data or some of the testimonials from the field, but there’s a long way to go.
1:00:03
And as more vaccine becomes available, as people’s trust and confidence continue to increase and our infrastructure and our delivery systems become more efficient and more reliable, you’ll see improvement every day, We’ve seen in the last week or two and I’m confident that it will continue in that that glide path.
1:00:24
I would just can occur with that. I think, you know, ultimately, you, you really need a multitude of approaches in order to meet diverse needs, and continuing to engage with communities and leverage community assets. And Be Nimble is going to be really important, going forward, But Concur with Jim, all of the above.
1:00:44
Definitely.
1:00:46
Yeah. I mean, I would just say really quickly that we are in a state right now where demand is outstripping supply. We will get to a point where we have supply. The question is, can we get as many people over the finish line in that middle category where they’re in a wait and see approach? And then, of course, the very high art category at the end, where they’re hesitant. So I think, right now, is pedal to the metal to meet the demand, but let us not keep from being focused on the education that will be need needed for that second. Third and last there.
1:01:18
Absolutely. Thank you.
1:01:19
And that meantime will be wearing our masks, washing our hands, and ***, trying to stay physically, Justin, and limiting our, our unnecessary activities outside as much as possible. So, I know my, my daughter likes to watch Emos wash your hands video, I highly recommend. Good for the toddler set. With that, thank you, Esther Profile, Jim Blumenstock and Kate Johnson for joining us for a really, really rich and enlightening discussion on the vaccine supply and the current, the current state of play. Thank you to our new ventures for partnering with us on this, and we definitely to be continued, we look forward to future discussions.
1:02:05
Thank you, again.