Topic: Experts will discuss and take questions on COVID-19 vaccine distribution. What can we do to increase the pace of vaccination? How do we address vaccine hesitancy? How long does it take immunity to build after getting vaccinated? How long will immunity last? How does geographic location factor into it? Will the rollout be consistent with timeframes for getting a second dose of the vaccine?
Journalists and editors are invited to attend this live virtual event and ask questions either on camera or we can relay your questions to the panelists. Register to attend and receive the on-demand recording after the session is concluded.
Who:
- Dr. Georges C. Benjamin, MD - Executive Director, APHA
- Dr. Bob Hopkins, M.D - UAMS professor and division director of General Internal Medicine and chair of the National Vaccine Advisory Committee of the U.S. Department of Health & Human Services.
- Dr. Tony Reed, MD, MBA - Executive Vice President and Chief Medical Officer, Temple University Health System and Chief Medical Officer of Temple University Hospital.
- Dr. Lana Dbeibo, MD - Director IU Vaccine Initiatives, Assistant Professor of Clinical Medicine, Medical Director - Infection Prevention, Division of Infectious Diseases, Department of Medicine at Indiana University School of Medicine.
- Dr. Benjamin Linas, MD, Associate Professor of Epidemiology, Boston University School of Medicine and a physician at Boston Medical Center.
When: Wednesday, January 13, 2PM-3PM EDT
Where: Newswise Live Zoom Room
Registration for media, as well as colleagues from participating Newswise member institutions
This live event will also be recorded and transcribed for use by media and communicators after it is concluded. All registered participants will receive a copy of the transcript, so even if you can't make this event, we recommend you register.
Thom: Welcome to this Newswise Live event- today we have five panellists to discuss topics related to the Covid vaccine distribution and of course the current state of things with the pandemic, the record high number of cases and deaths in recent weeks. I would like to introduce our first panellist – Georges Benjamin, he is a Doctor and Executive director at the American Public Health Association. Dr. Benjamin, thank you very much for joining us. I want to ask you what do you think is driving this continued high number of new cases and deaths and is there any hope that public health measures can do anything to bring those numbers down or do we have to wait for the vaccine to get implemented to get out of this pandemic?
Dr. Benjamin: Clearly what we’re seeing now is a series of waves that started Thanksgiving, then got built upon from Christmas and obviously the fact that we’re in winter, we always see the increase in these kinds of infectious diseases during winter. I also am very much concerned that of course we will then see another wave based on the number of people that were in Washington DC running around without masks and then of course going back to their communities, but of course that remains to be seen. I think that at the end of the day, wearing masks, washing your hands and keeping your distance is still the name of the game right now. We’re now adding to that the vaccinations, but we’re going to have to speed that up in a dramatic way for us to be really effective in controlling this outbreak, but it’s a big problem, and people need to understand that those basic public health measures of mask wearing, washing hands and keeping your distance work, and anything that we do that exacerbates that, is going to continue this outbreak.
Thom: Thank you Dr. Benjamin – I want to introduce next Dr. Benjamin Linas – Dr. Linas you’ve done a lot of statistical analysis of these public health measures – Dr. Linas is an Associate Professor of Epidemiology at Boston University School of Medicine and he's a physician at Boston Medical Centre – so Dr. Linas as you’ve studied this, looking at the need for things like business closures or limits on events to get people to stop transmitting the disease versus holding out for implementation of the vaccine, what’s going to be the most effective way forward and how can we convince the public to get onboard with that.
Dr. Linas: Sure thanks for having me today, I want to reiterate what Dr. Benjamin said that really wearing masks and distancing and all the non-pharmacologic interventions that we’ve had in place since back in March remain absolutely critical and I can actually show some data that really opened my eyes to this fact – these are data – I’ll share my screen – so these are data that comes from a simulation model, I think people throughout the epidemic have started to look at simulation data and understand the transmission model, so this is simulated data looking at the Covid epidemic in the United States from January 2021 moving forward and what you can see here – two counter facts or hypothetical situations – the orange curve represents what the epidemic might have looked like if we had no masking requirements, no distancing and just pretended like this wasn’t happening and these shades of green represent what the epidemic looks like if we continue what we’re doing today – in terms of masking and distancing and then you can see there is two different shades of each colour – so there's that dark red represents no restrictions at all in masking and then that orange colour is what the epidemic would look like if we still had no restrictions and just put in the vaccine, roughly 300,000 doses per day – which is roughly what we’re doing it this time and then the two greens represent if we do our masking and distancing – and then the teal colour at the very bottom is if we do masking and distancing and vaccine at 300,000 doses per day and what really strikes out to me about this curve is that the difference between the red-orange family, which is no masks and no distancing and the green – teal family which is current restrictions – is much greater than the distance between that orange and the yellow, and the dark green and light green – so what we can see is at this time it’s the non-pharmacologic interventions, masks – distancing – all the things that we’ve been doing that really have been holding up the house and are going to continue to do so, that where we can't rely on vaccine yet to be our protection and I think its striking when you look at curves like this –
Thom: Yeah thank you very much Dr. Linas – that’s compelling and amounts to over the course of weeks and months – tens and tens of thousands of new deaths – that’s quite remarkable the difference between continuing to implement those measures, thank you for sharing that. I want to introduce our next guest who can tell us a little bit about how particular hospital systems in a major city are implementing things here – we have Dr. Tony Reed from Temple University Health System, welcome Dr. Reed – he is MD and MBA – he is executive vice president and chief medical officer at Temple University Health System and Chief Medical Officer of Temple University Hospital – so Dr. Reed how is your health system addressing the current state of things with the pandemic, and also as vaccines are getting distributed, a lot of concern about inequities and how that’s being done or how that might roll out, what are you doing to address those issues?
Dr. Reed: Yeah and I will reiterate what was said by both of our first two speakers- wearing masks, social distance, wash your hands – first and foremost that is something that I think we all need to continue to put out as a mantra – with regards to picking up where Dr. Linas left off – vaccination measures are going to be what makes the difference here and so we began with what’s known as Phase I A – or Healthcare workers and as an urban intercity underserved hospital and academic medical centre with five different colleges of health science, from medical to dental to pharmacy and so we have a large population of healthcare providers here, so that’s where we began, in our healthcare provider groups, starting inside of our Covid units, and we didn’t do this by job description – this wasn’t – physicians line up and then nurses line up – we did it by work unit and so everybody who was working on the Covid units from our transporters to our environmental services housekeeping people, our IT support who have to come on to the unit, pharmacy, our nurse practitioners and then our physicians, so we did it as one global cohesive unit systematically throughout, starting in our Covid units – then going to our emergency department, then going to our units that may have the risk of having Covid patients like labour and delivery and then keep working out in concentric rings into our offices where patients are being seen and to others. And so with our process we also incorporated education on the vaccine. We have the Temple University centre for urban Bioethics here, they are known for their research in the urban underserved community – they got on board early in this process, began to give us some ideas of what the right language is to use, how to have conversations about vaccine hesitancy – who the right credible messengers are – we did focus groups within our own employees – particularly those who live here in the communities and the focus groups out in the community we serve. All of that is informing the process of how we reach out to our employees – we start with an email invite. We make an open introduction and a welcome to come get vaccinated move – and then we go through systematically by department to sit down and have the conversations. Did you see the invite? Have you been able to make time? Are there concerns you have about the vaccine? Are there concerns you have about the process in general, so on and so forth -and we keep working our way through department by department systematically, without regards for – like I said job description, ethnicity, race – we are working our way through every one and all this to get as close to 100% as we can. We’re going to use the same methods when we get to the community.
Thom: Thank you Dr. Reed – I want to introduce next Dr. Lana Dbeibo – from Indiana University, she is the director of IU vaccine initiatives and Assistant Professor of Clinical Medicine and also the Medical Director of Infection Prevention in the division of Infectious Diseases Department of Medicine there at Indiana University School of Medicine – Dr. Dbeibo, tell us a little bit about how Indiana is handling all this – going off of what Dr. Reed described and tell us also if you can, what some of the rationale is for the way the prioritisation of the distribution is done- what do you feel like the public are to understand about that, and how we can kind of look ahead to getting through that initial goal of taking care of the healthcare workers first and then what happens next?
Dr. Lana: Sure, so Indiana University currently is planning the second wave of the vaccine distribution and collaboration with local health departments as well as the state health department for Indiana, so we are currently getting ready to start vaccinating our constituents as they move through their priority list in collaboration again with the local health departments. We have places where we are going to open our own clinics to help speed up the process of distribution and getting vaccines in arms, and there are locations where we are going to join resources with the local department to be able to achieve vaccination of our constituents and our communities more effectively. We are also doing very similar to what Dr. Reed mentioned in terms of vaccine hesitancy – sending out surveys for our constituents to try to understand the reasons behind the hesitancy and we are partnering with our school of public health as well to start focus groups so that it can inform our educational campaigns and address people’s concerns about vaccines. In terms of prioritisation, obviously it is mainly driven by the supply and the distribution and vaccination infrastructure. So the reason why the priorities were set the way they were, is because the initial goal for a vaccine is to try to prevent people from dying and I think the priority went out to health workers first because we wanted to have an infrastructure that’s fully supported to be able to take care of our patients. Without them we cannot move forward with this pandemic. And then the next priority list comes to people who are at most risk for death, from Covid 19 or being hospitalised. So what we need right now is to create a barrier to prevent those that are at most risk for death and disease, so that we can keep people healthy but also limit the strain that we have currently in our healthcare systems. Our health systems are full of patients and we really need to get to a level where this is all more manageable and as we move forward with the phases, I think this is going to be taken into account for the next priority list.
Thom: Yeah thank you Dr. Dbeibo, I understand that we should expect some announcements soon about moving on to the next phases. I want to turn next to Dr. Robert Hopkins, he is at the University of Arkansas for Medical Sciences where he is a professor as well as the division director of general internal medicine and he’s the chair of the National Vaccine Advisory committee of the US department of health and Human Services, HHS – Dr. Hopkins from your perspective there in Arkansas, tell us how things are going with implementing the vaccine, but also I’d like to know what your sense is on what’s driving these new cases and these high levels as we saw the potential models from Dr. Linas and we talked about what some of the other panellists – holiday travel, resistance to mask wearing- what’s happening and what do you think we need to do about it.
Dr. Hopkins: Thank you for the invitation to participate in this group, I think there are multiple factors playing in to why we’re seeing so much disease. I think the holiday travel, I was struck by – one of my sons who is a college student, as we saw the pictures of all the people in the airports around Thanksgiving and then around Christmas – how can these people do this? Don’t they listen? Don’t they see what’s going on around us? We see a lot of people putting their hand in the sand and doing what I call the ostrich manoeuvre rather than doing what we’ve emphasised by a number of the experts ahead of time and what we continue to exercise – wearing masks, social distancing, avoiding crowds and washing our hands – I think that’s much of the problem. We probably also have fairly widespread disease with some of the more contagious variants. I think that the number of isolated genomic evaluations that have shown that it’s out there, I think we all expect that there's more out there than we’ve detected. And then I think that people get tired and that fatigue shows and lapses in use of personal protective equipment and that is another player in things. The other thing that I think is important that we recognise in addition to some of the other activities that people have talked about for getting people engaged is one on one engagement with those that are hesitant to get vaccinated by trusted local voices, can be absolutely critical. I and a number of the members of my team have spent a number of hours of this last month meeting for 20-30 minutes with small groups of our employees, with people in our community that are concerned about the vaccine, about the speed of development and walking through some of their concerns has been tremendously effective in getting people vaccinated, so that personal touch makes a big difference.
Thom: Very interesting, thank you Dr. Hopkins. I want to make sure that the media on today's call know that we would love to hear your questions, so chat your question to me, we’ll invite you to ask the question yourself or I can ask it on your behalf. As Dr. Hopkins summed up the issues with the continued high level of cases, I want to comb back to Dr. Benjamin – a lot of this is state by state policy kind of coming home to roost where some states have been very lax about restrictions and others have done a better job- what’s your assessment of this state-by-state approach and where has been effective, where has it not and what kind of guidance and coordination would you like to see from the national level and the federal government.
Dr. Benjamin: I think the fundamental problem of course is that we’ve not had a really strong federal presence in terms of guidance. The guidance has been all over the place in many cases, we’ve also not had a consistent national message, for just about anything and that causes a whole range of challenges. So having consistency and a strong national message – but certainly one that allows for some customisation locally, every community in America is different – this is not a one size fits all response, but having said that, if you're in the Washington DC metropolitan area as an example, the fact that two of our jurisdictions allow dentists to get their vaccine and one doesn’t, the fact that we have differences in opening and closing, even though the leaders have gotten together somewhat on that – I think it creates real problems in an environment in which you have a broad media environment where you have different people giving different messages, where you have overlap in the media, and when people hear different messages they don’t know who to believe. So I think to the extent that the federal government can provide better – more targeted guidance, even such things as making sure people that understand the prioritisation in a better way and recognising the fact that the most important thing for us is not these grey areas between these priority categories as an example, but the fact that as we look at this, we really need to have a better understanding that the most important thing is not to have vaccine wastage, and if Aunty Sue gets the vaccine – the worlds not going to come to an end. That we still need to make sure that we focus on those high-risk priorities, but that vaccine wastage is a greater sin.
Thom: Thank you Dr. Benjamin, I wanted to turn to Dr. Reed who wanted to add something to that and then I have another question for Dr. Reed –
Dr. Reed: What’s really important in that is the degree of coordination that’s happening and in some cases the lack of degree of coordination that’s happening between the federal state and city levels – I'm in Philadelphia, we’re one of the direct distributions, one of the seven cities that were chosen outside of the states – and so what happens to us, the CDC I believe, maybe it was the administration itself, put out a memo, a statement yesterday or day before – they’re going to suddenly jump in to phase 1B three weeks ahead of what was originally planned out – that causes chaos and turmoil. Our phone lines have been going crazy in the last 24 hours.
The problem I'm faced with is the CDC gives guidelines, the rules come from the city of Philadelphia and the city has not created the exact prioritisation rules for Phase 1B yet and so what my patients are now all expecting that this is what’s going to happen – my answer back from a practice perspective is – we’re not ready for that yet and I'm still waiting guidance. We also have a scenario where the secretary of health for the common wealth puts out an order that conflicts with what the rules that are wrote for here in Philadelphia, and so then that causes turmoil among the healthcare care providers, and so we get those kind of things that happen – yet at the same time giving the due credit where it belongs, the roll out from what was happening at the manufacturers, so lets say Pfizer and Moderna and the federal allocation, and then giving the distribution to us timely, albeit in small amounts, to then us being able to set up a schedule and coordinate and use 80-90% of the allocation that arrives at our door within the week – before the next allocation comes in, that worked seamlessly. So I've been able to keep my inhouse stock of vaccine down because I've been able to have that predictability of the coordination between them. So there are some days when they're doing a phenomenal job of this, there are some days when they're really causing me a whole lot of extra work and headache. So I think we need to really tighten that up as we go into the new administration and with the proposals of “let’s release it all and hope for the best with vaccine dose number two,” – that’s going to get a lot of push back first -from my pharmacists- because they're going to look at me and say, “that’s crazy, you're not going to give out all of our stock, because what about number two?” And second, from my physicians who are hearing it from both the pharmacist and from the patients, “what do you mean you won't have a dose two ready for me when I need it?” And so, that plan, while it's probably better than let’s it hold it all back in some secret storage area somewhere – probably still needs some refinement as they move into the next administration.
Thom: So you’ve laid out very well what some of these complicated decision points are with regards to the supplies currently, meanwhile we have a question about this from Mark Opera- he's a freelancer from Cleveland, contact tracing – how important is that and what do you expect from the new incoming Biden administration who is expected to have a robust federal contact tracing effort as part of their plan, how important is that?
Dr. Reed: In terms of fighting Covid itself – critical. If I can identify people who may have been exposed before they even turn positive, and separate them out from others before they expose others, that helps curb the disease. That helps flatten the curve so to speak. From a vaccination process it's good to know it’s not going to interrupt what I do from vaccines, but it is critical to the overall fight. And so more contact tracers is huge – we ramped up an education program in our college of public health to be able to put more on the streets here of Philadelphia. I know other universities have done the same, we’ve been able to leverage that and our fight here in the city.
Thom: Dr. Hopkins there in Arkansas, what are your thoughts about the importance of contact tracing and I’ll add one other element to this, are the same kinds of behaviours and attitudes that lead to resistance about mask wearing and the vaccine, are they also causing people to not be voluntarily forthcoming with contact tracing?
Dr. Hopkins: I think there are challenges on both of those sides, I think we clearly need more contact tracing to help blunt the degree of disease we have in our communities. As Dr. Reed pointed out – if we can detect these people before they become symptomatic, if we can detect these people and isolate them before they spread to the second or third or fourth order contact and spread the disease, we may help reduce some of the strain that’s currently present on our healthcare systems at present. We had huge press announcements in our town three days ago that our hospital had opened up additional ICU beds- they're full. We have way too much disease in our community and I'm sure the same thing is present in Indiana, in Philadelphia, in Boston and everywhere else. We have had some reports around the nation of people not collaborating with the contact tracers, I've heard that a little bit here in Arkansas, but not a whole lot. We need to continue to reinforce that all of these are endeavours to try to protect your neighbour, your family members, your community and we also have to reinforce that pandemics do not respect borders, that’s a part of why this collaborative and one voice, one message, one plan – is so critical, and when we get a different message from a governor that we get from a mayor or we may get from the federal government, that just causes chaos and all of us need to be speaking with the same voice, working with the same set of plans and that’s been missing since January of 2020.
Thom: I want to get Dr. Dbeibo to weigh in on this as an infectious disease expert – what do you think the vaccine schedule needs to look like for people in certain jobs that are high contact with the public – a question from Jeff Gelski at Sosland Publishing – what should that look like for people working in the food and beverage industry – will priority be given to people like restaurant waiters who work with the public and what about people like meat packing workers who work in close proximity to each other? What’s your recommendation for how that process needs to go?
Dr. Dbeibo: I think these are great questions because we have seen outbreaks in certain situations that you have mentioned – obviously meat packing plants etc, so obviously we can't overstate enough the need for vaccinating people as fast as possible because of the risk that they are enduring – enduring their work and again this is essential work so they have to be present and they can't work remotely from home. From an infectious disease perspective we talked about the prioritisation going first to people who are currently dying – I mean the rate of death in the country is really, really high – so I think that focusing on deaths in particular at the beginning those who are at highest risk – comorbidity and mortality and are moving on to what we call essential workers was part of the CDC recommendations to begin with and I think – I'm sure everybody is taking that into consideration as we go into the next planning phases.
Thom: Dr. Linas I wonder if you could tell us a little bit about the comparisons you’ve made to the influenza season with the Covid infections rate and what insights that gives us about how to do the social distancing measures and masking properly while we get this vaccine going, what’s there to be learnt from looking at that?
Dr. Linas: What’s happening now is that generally we’re at the beginning of influenza season when the curves picked up and at least in Massachusetts right now there is effectively no influenza which was really striking to me, because I have to be honest – I have assumed until recently that the reason we’re having such a hard time getting the Covid epidemic under control is that we’re not fully adherent to our masking and distancing and hand washing and that we need to double down on those things and I think that’s still true, but at the same time, whatever we’re doing now at least in Massachusetts is working to effectively extinguish influenza, which means – I want to say congratulations to the people of Commonwealth of Massachusetts – we’re doing a good job, we’ve pretty much eliminated the flu this season but then that raises the question – Covid is still going out of control and what is it about this virus and we know the reproductive number of the virus is quite high – its higher than influenza, but why? Is it the virus? Is it about where it's transmitting? Is it about the way we’re behaving, it's some combination of all of those things, but it's not as simple a story as we’re just not doing a good enough job, and I think it also raises the stakes of the vaccination situation? We’re engaging in a truly historical logistical operation, I’ll just show one more slide from our simulation model that’s comparing different rates of vaccination across the population to see what that might do – so these are hypotheticals again, but now we’re looking at these green lines again represent our current state of masking and distancing whatever that might be – state by state and we have new deaths on this vertical axis and time on the horizontal axis and you can see starting from the far right with no vaccine, it’s a little bit hard to tell but we don’t end this epidemic even by September without vaccine and as we go up to 300,000 doses a day if we’re able to get and sustain that, we project that we might be able to get to something approximately the end of the epidemic by the end of the summer, but as you can see here, the pace of vaccination really matters a lot as to what we can expect over the late winter and the spring and where we are now is somewhere maybe on this 300,000 dose curve – perhaps a little bit less. We’re not, I would argue – on target yet, certainly not – I’m a parent to three so I've done a lot of work on Covid in school, so in my world there's this time horizon of July- August – what’s going to happen for the 2021-2022 school year? That’s my perspective, but I think a lot of people share it. We’re not I would say – currently on target to get there. that’s not meant to be a statement, I think there's a lot of potential for improvement, but this is a major logistical operation and there are major issues around hesitancy because this graph here just assumes that if we’re doing 300,000 doses per day, there is 300,000 people out there who are willing to accept the vaccine, to the extent that’s not true this curve starts to fall off, because we just can’t vaccinate enough people to make a difference. So, I think the flu story is interesting from epidemiologists’ perspective. To me it tell us something about Covid and really raises the question about what is different about this virus and about the way we interact with the virus and it really shows us that the vaccine is going to be critical but again, we can't just lay back and wait for the vaccine, we have to stay active in the meantime.
Thom: Dr. Benjamin, I’d love to hear your thoughts about this comparison and what insights there are to that and I want to throw into it also to get your response for this question from Leslie Mertz, one of our reporters who is with IEEE Pulse magazine - it seems like we’re figuring out vaccine distribution now, even though it was clear it was coming. Why weren’t we ready to implement this months ago?
Dr. Benjamin: So let me just lead on to the influenza – just know that the rest of the world has had the same experience with the extinction of influenza with the combination of vaccine for flu and mask wearing and it tells you as Benjamin said that mask wearing is extraordinarily important and it just turns out it’s a whole lot effective for influenza than we previously thought and you combine that with an effective vaccine program, then you can make a disease go away, and the truth of the matter is that we should have started building the vaccine program, the public health piece of this last April – we should have started the planning last April, we should have been drilling and thinking about the logistics, even thought there was a lot of pieces that we didn’t know, such as the ultra-cold storage piece, but we should have started then. And we saw that, we saw this – going back to a lack of a real federal plan, while we were worried so much bout hospitals and we were trying to flatten the curve, we were not building our contact tracing and testing infrastructure and by infrastructure I mean not just getting the test right, but hiring people and training them and doing the kinds of things necessary to build a strong public health prevention response. And so, then we’ve repeated that failure on the vaccination program and again the federal government could have – we have a whole commission core in the public health service that we could activate, we have the ability to build community health centers, and a lot of the safety net programs into this response and we know how to do that because we’ve done that before for flu, for H1N1 – but we didn’t do it, we’ve started too late and we didn’t engage as many people as we needed to.
Thom: I have another question from one of the media in our audience – JL – HHS leaders are suggesting that states move beyond healthcare workers to a broader population, I believe there were some announcements made about this yesterday, about preparing to move to the next tiers – do you agree? And with this urging for states to move beyond vaccinating in just hospitals and pharmacies, they're also recommending community health centers and mass vaccination sites, what are good examples of those working – I want to take this to Dr. Reed and to Dr. Hopkins – Dr. Reed what’s your plan there in Philadelphia for community vaccination sites?
Dr. Reed: Yeah and I’ll start with the first one of – do you agree? – yes, I think we’ve been doing healthcare providers for a month, I realize we’re not all the way through healthcare providers but at the same time we’re capable of multitasking. And that’s what we’re getting to in the concept of – we should have been planning vaccinations back in March – April – May, while also doing contact tracing, while also fighting the active disease, while also doing all that other stuff, and so this is a multi-faceted thing and it’s a series of moving targets and its trying to get through as rapidly as possible. Our basic premise – there are concepts called close pod and open pod when it comes to vaccination and so think of what was set up after 9/11 in the federal response and how we started doing coordination and those – they created a process that we can do widespread mass vaccination. In that case they were thinking of radiologic disasters and iodine and biologic disasters and anthrax and stuff like that- its never been used. And so, the closed pod is where we began, those are the health systems, the core groups in each community and for us there are five in Philadelphia that have a pre-built plan how we would push through the maximum number of people in the shortest amount of time, and that’s what we did for our healthcare workers. We went closed pod, it worked- even with my allocation that I'm getting, I could probably do 600-800 a day through our set ups and designs. Not enough to do the city, but enough to do my healthcare workers.
In the city we have a combination of things, there is the open pod process that involves things like our stadium complex, our convention center right in the center of the city, Liacouras which was used as a field hospital during our first peak, that’s our own basketball arena- and others. For our purposes here in North Philadelphia, that will get a fraction of our population – but we have a populous who aren’t necessarily going to go to those large centers, don’t have the means, the transportation, the ability to go to those centers and so we know we’re going to have to go door to door. I have a usual process of mobile vans that we go out and we set up in the corner of 5th and Gerard – we have a community network of churches, schools, other centers in all of Philadelphia, but here in North Philadelphia that have asked if we’re interested in partnering – so what we’ll do is take it out on the road and one day a week we’ll set up shop at one of the community churches, deliver the vaccine there, run people through, using our closed pod model, out in an offsite location. The city has also contracted with Right Aid – so all of the Right Aid’s have doses and have set up the larger centers as well. So, we’re going in a mass effort like this. At the moment we’re just waiting on the release of the allocation to be able to push farther forward and this is where I think the announcement of moving to 1B makes a lot of sense – I think they needed to make the announcement 3 weeks ago and say we would be moving to 1B on the 5th or on the 20th – so that we had time, we had readiness – as it was, we were told to be ready from mid-February, so I have spent much of my last two days getting ready for a go live in the next week – and again it causes that unnecessary chaos and turmoil, but at the same time – we’re going to be ready. This is what we do in healthcare, we adapt and overcome, and so we’re looking forward to when the city releases it, we’re looking forward to when they say we can go forward and I think the push from the federal administration is going to help drive that forward.
Thom: Dr. Hopkins what are your thoughts about moving on to the 1B and further and the setting up of community centers for vaccine distribution, how are you guys doing that there in Arkansas, and also the reporter who asked this was curious about what kind of system or process for people to sign up to come to these places, what are the logistics involved?
Dr. Hopkins: Well first I definitely agree with Dr. Reed- it is time that we need to think beyond just our healthcare systems, we are collaborating, we’ve got a very strong group that meets once a week – have since early in the year, early in 2020 – focusing on coronavirus vaccine planning for the state of Arkansas. We have membership from private hospitals, pharmacy groups, interested public members, public health, community health centers, all of us talking on a weekly basis about what we’re going to do to get as much vaccine into as many arms as possible across the state of Arkansas. Our challenge is a little different than Dr. Reed’s – we’re not just focusing on the city, we’re focusing on one of the largest states in the country, we’ve got to think about vaccinating a small population – 3.5 million people across – bigger than the state of New York, so we’re going to have to be thinking about a lot of community-based efforts. Just before getting on this call I was in a leadership meeting talking about how do we make that next step, how much are we going to be able to administer through on campus vaccination clinics, where do we need to send our mobile vans out to vaccinate – do we target schools first, do we target employers first – so we’re looking at all of those things from the standpoint of our university, but also in collaboration with our public health colleagues and with other institutions, because we want to get as much vaccine as possible into as many arms, once we actually get that vaccine allocation. That’s the challenging piece – the only ask that I wish we’d had the chance to give, before that announcement was made two days ago was – here is when you're going to get the vaccine, and today we’re making the announcement to expand. That would have helped us to proactively message to our populations – hey, we’re expanding to patient 65 and older, we will have vaccine in hand on Tuesday of next week and we will start giving the vaccinations into arms on Thursday, rather than we’re building our plane as we’re flying it- once we get vaccine in here is where we’re going to be, here is how you sign up. We have a lot of pharmacies, a lot of institutions that are already signing up a list of patients on a waitlist, they're starting to call people in and we want to be able to broaden that out so that we don’t forget our underrepresented minorities and we don’t forget our populations that don’t use electronic messaging. We got to use the old-fashioned technology of going down the street, the street crier – we have to use the old-fashioned thing – the telephone that you actually dial, then you call people and say – Mr. Smith, you're in a high-risk group, how can I get a vaccine into your arm to protect you and your family? All of those new and old technologies have to be interfaced if we’re going to do this successfully.
Thom: I have another question here from Nina Pullano at Courthouse News – she asks – are there any states that are partnering with each other to share vaccine distribution resources or come up with any shared policies across stateliness, I wanted to ask maybe Dr. Dbeibo – is there any instance of that that you're aware of around Indiana or your region, or anyone else want to chime in on that question from Nina?
Dr. Dbeibo: I have not heard no, that there is any collaboration between states.
Dr. Hopkins: I think that the way the system was set up was, distribution’s determined by specific localities, the designated cities and states, that’s again a place where more federal leadership and integration would have been more helpful for us. Cause again – we can't forget pandemics, viruses – do not respect borders, and so what’s happening in Arkansas is happening in Tennessee –
Thom: Dr. Linas you had something to add to that?
Dr. Linas: I just wanted to react that I agree completely and I think it's quite striking that we’re effectively one year into this epidemic and yet again it's an example of how you cant respond to a global pandemic which is absolutely a national priority with piecemeal state by state responses, or city by city responses and to some extent I know it’s in the culture and the history of our country that we rely on our state responses and often celebrate the 50 laboratories of democracy in the USA – but that approach doesn’t work for a pandemic and we’re finding over and over again that the rights based individualistic approach to what’s inherently a communal problem – doesn’t work. That has no response to this crisis and I think this is just another example of it – we have to come together and do this on a national scale.
Dr. Benjamin: Yeah a great example from Washington DC metropolitan area – DC has an enormously effective health enterprise. 5-6 national teaching hospitals in town, but the staff often – mostly work in suburbs, they live in the suburbs and work in the city. So, the question is where are they getting vaccinated? Most of them are getting vaccinated at work and if you think about it, that means that their vaccination stockpile is coming from the district of Columbia and of course the district of Columbia has a much smaller population than either Maryland or Virginia – I know the health officers are talking to one another, but at some point both of these jurisdictions are going to have to help the city in terms of their stockpiles, because they just – most of the people getting vaccinated right now, probably live in the suburbs, and that may not be an issue initially for the small number of healthcare providers we have to vaccinate or even the long term care patients. Once we start dealing with large numbers of individuals, that’s going to be an issue – so that again just argues for a better regional and national plan as we go forward.
Thom: Dr. Reed I want to ask you to weigh in on this – you're just across the river from New Jersey, you're just a 25-minute drive to Delaware, how are things being coordinated within your whole metro area?
Dr. Reed: And I personally have ties in all three states plus Maryland – so yes – it’s interesting, when it first started we were told – vaccinate the people within your organization, through our occupational health sites and so from an employer’s perspective I'm fortunate that I'm only in Philadelphia county. Other systems in town that have hospitals and sites outside of the county, had two jurisdictions to deal with. Those that had places in New Jersey, Philadelphia and Delaware County had three – and so my counterparts were dealing with multiple jurisdictions from the start whereas I only had Philadelphia to worry about. What has happened that’s really helped push this forward, the state of New Jersey put out notice a couple of weeks ago and said – we don’t care where you work – if you're a healthcare worker sign up and come get vaccinated – so that was open to anyone who lives or works in New Jersey as a healthcare worker. And so, my employees who live over there now have the choice, do they come here at work or do they go to one of the sites over there. I just sought and received clarity this morning – because I have the country’s largest lung transplant program, that’s a lot of pulmonary disease, that’s a lot of COPD, that’s a lot of phase 1B first wave – and so my question, because they come from 7,8, 9 states is – can I vaccinate my pulmonary patients or can I only vaccinate people who live here in Philadelphia? Because that makes a difference to my pulmonologist, and the answer is – vaccinate anyone who you have the opportunity that meets the criteria that are set forth. And so, that’s Philadelphia partnering with Pennsylvania, partnering with New Jersey, partnering with Delaware, Maryland, New York and being willing to say – we want to vaccinate at every opportunity we have, what we need are the 60 or so jurisdictions to all say the same thing. That’s no small task and that’s what national coordination does.
Thom: I want to invite here Dan Keller, one of our reporters on the call with Keller broadcasting. Dan has a question about vaccine production –
Dan Keller: Yeah, there's a lot of talk about using as much vaccine and getting it into people as quickly as possible and not waiting – not holding back second doses – has anyone gotten a read from the manufacturers and the distributors and the people who are going to administer it, whether the systems are there in the future that how much they can produce, how much they can get out, essentially will there be vaccines soon if you use up all the present vaccine now. Is it best to get 60% protection in a lot of people or wait for a 100% protection or 95% protection in a whole lot more people?
The second question is – Dr. Linas, are your curves based on two doses or have you also modelled only one dose and the protection it provides.
And finally, if this virus escapes this vaccine, how quickly could we invent a new one – if we get the sequence in a week, you could get it manufactured – do we have to go through all the same testing we do now, we probably don’t do that with the seasonal flu do we?
Dr. Linas: No.
Thom: Short answer for that.
Dr. Linas: No, we don’t do that for the seasonal flu and it’s a great question. I’ll just answer that direct question, our model assumes – actually what I was showing you was a pretty rosy situation for the vaccine, because I wanted to make the point that the pace is so important, the vaccine in those simulations was 95% effective in preventing transmission and also mortality, so it really is a rosier picture than reality. The one thing I’ll say and I’ll let others chime in – it is important I think to distinguish two things that are going on globally. There are some places where people are considering abandoning the concept of a second dose and just making this a one dose vaccine course. I think that’s a mistake. That’s now how we tested this vaccine. There's immunological logic reasons to believe that the 60% immunity from one dose is not the same as the 95 – it is categorically different type of immunity and different antibodies than you get when you have a booster vaccine, that’s why we have booster vaccines. So, I think it’s important to stick with our system and to use this vaccine as approved, until we have data to show that we don’t need to do that. However, that’s a little bit different than saying that perhaps what we should do is liberalize the release of the vaccine such that we’re giving people first doses and not holding back second doses and acknowledging that the second doses will likely be based on production capacity, but perhaps could be delayed, but to be fair, there's nothing that say that the vaccine must be given at three weeks. That is how it was trialed and I am the person who just said we need to use the vaccine as it was approved, but there are – I want to be careful when you say – no other vaccines – but to my knowledge no other vaccines – or very few that have a vaccine course that I so tightly defined that if you don’t get the vaccine within a couple of days of the recommended booster day, the vaccine is considered irrelevant. Generally, most vaccine courses have months or even years long windows around that booster dose, so I think we can debate – I think there is more logic to the concept of releasing first doses now and letting the second doses back though, but I think it would be a mistake to abandon the two-dose vaccine schedule, because we just don’t know, we’ll be flying blind and really building the airplane as we go in the most basic sense of the phrase.
Thom: So Dan’s question about the vaccine supply chain and also the question about whether one dose would be effective, that was also a question that Benita at WNYC had, in the chat – who I was going to call on shortly. So that’s great to get your response to both of those – so Dr. Hopkins what did you have to say about that?
Dr. Hopkins: Couple of things – one is we’ve had consistently increasing predictions on how much vaccine both Moderna and Pfizer are going to be able to be able to provide. We know that there are a number of other vaccines that are likely to be licensed in the relatively short term. We clearly don’t want to combine one vaccine from one company with another, because again – no data, but I think getting the vaccine into as many arms as possible, expecting us to catch up with those second doses based on production I think is a good strategy and to answer the question raised by Dr. Linas – there are none, at which the timeline is so tight that a delay causes us to need to start over again, and so I think that is the strategy that we need to move forward on, is getting as much out as possible – trying to get all the second doses as close on time as possible- but we need as many people vaccinated as we can.
Thom: Any other panelists would like to weigh in on these couple of questions – go ahead Dr. Benjamin.
Dr. Benjamin: The vaccine supply is [inaudible 51:44] step – what we’ve done here is we’ve created a hoard mentality, not a herd mentality, a hoard mentality – where everybody is kind of holding on to that second dose because they want to make sure that its available, and that’s a natural human instinct and to the extent that we can get this out to market and get the shots in the arm and focus on the production side of this – we eliminate all the other variables, because when you start creating different models for getting shots in the arm and you don’t have a consistent reliable supply, it becomes more complicated, and for people who actually work in hospital emergency departments, one of the things I did when I was younger is I used to go into the ER’s and helped them figure out how to shorten waiting times and what you discover very quickly is that if you can fix all your other variables and only have to focus on one variable, you can move a que very quickly, so in this case if we can get everything else regularized, so that its in a regular predictable form, and focus like a laser on getting the supply out there, I think we’ll solve the problem – also by getting the defense production act up and running – it allows us to do two things – number one – get enough vaccine and get with the supplier, and number two – the question that one of the journalists asked about – what happens if we get vaccine escape – and we have to go to a new vaccine, we’re going to have the same supply problems. So, once we fix that, even though we don’t have to go back – I don’t believe, to any of the randomized control trials, once we have it approved – we can just simply do another vaccine, once we prove it is both effective and of course we already have the safety data.
Dr. Hopkins: Another important comment is – particularly with this platform of messenger RNA vaccines, it is very easy to make a small change to that messenger RNA and those vaccines if we get a shift. Very different with some of our other vaccine platforms that take much longer to build the molecule that you're going to use to vaccinate with. So, we are well ahead of where we would have been if we’d had a change in influenza or tetanus or many other things.
Thom: Dr. Dbeibo, I wanted to ask you about the new strains and the possibility of that evading the vaccine through mutation, as this has come up in the last couple of responses, does that concern you at all and do we know that that’s becoming both more infectious and more deadly or are we uncertain about one or the other of those.
Dr. Dbeibo: So, all viruses actually mutate all the time, so there are several mutations that have been detected throughout the beginning of this pandemic. As we let this disease persist in our communities, the risk for mutation is going to continue to be steady until we get everyone vaccinated and the reproductive rate for the transmissibility goes down. The concern I have is yes, this newer strain is thought to be more transmissible and even though it is not a cause of concern for causing more illness or death, I think when we talk about higher transmission of disease, that eventually leads to more cases and that eventually leads to more death. So, even if it is not causing death in an individual, over a community, over a population level, eventually the death rates will increase if you don’t get a hold of it. So, I'm definitely concerned and this is why not only do we need to continue the fastest approach to vaccination possible, without hoarding all those vaccines out there, also continuing with all the measures for social distancing, masking, because this risk is going to continue as long as there is virus circulating.
Thom: Dr. Reed I want to ask you, we have a question from Benita at WNYC – vaccinating pregnant women, do you have any experience with that at your hospital or what do you know about the current data on that?
Dr. Reed: It's good to pivot towards that because my comments of the last series of questions – we currently do not have a vaccine for children less than age 16 and so we’ve working through the adult population but there are individuals in our society who are not going to be protected even if we make it all the way through everybody we’re allowing to vaccinate at this point, and so there are also going to be kids in there and they're going to be harbourers and they're going to perpetuate and allow new strains to develop, and so when you get back to the pharmaceutical manufacturers and what they're doing, obviously their first task is to get enough vaccine for 16 and up, concurrent two work streams parallel on going, has to be the pediatric studies so that we can get this all the way down towards the new born population - which then takes me to your question about pregnancy – the American College of Obstetrics and Gynecologists and their sub group off maternal fetal medicine have weighed in on it and they appropriately say that it’s a personal decision that the expectant mother should have with their primary doc – in many cases we have vaccinated after that conversation, there have been 1 or 2 cases where they’ve opted to wait until after delivery. The reality is – you're asking me my personal take on it – it appears to be safe from all of that data, however I'm not an obstetrician, I’m not a pediatrician who deals in neonatology so I'm going to defer to the experts on that, to say – we ask the question, we give all of the information that we have available to us through the emergency use authorization, we give them the recommendations from the national societies and we let them make the decision.
Thom: Thank you – a question from Leslie Mertz at IEEE+ Magazine – she wants to know about rural areas. I think Dr. Hopkins would be great to have your take on that with Arkansas having a lot of rural areas – where these rural health departments are in charge and they're covering huge areas with sparce population, what are they doing to serve those communities, and how that’s being managed?
Dr. Hopkins: Well, I think this again requires a broad approach. We have a number of pharmacies, both mom and pop type as well as the pharmacy chains that have been very engaged with our vaccination plans in the state of Arkansas and I expect in other states that would have large rural areas. We are working with the community health centers, groups- to try to get vaccine out to those areas and we at my institution at UAMS have had a mobile testing program where we’ve gone off to small communities around the state and tested for Covid and we’re very actively talking about how we’re going to pivot that from testing to doing vaccination in those areas and trying to make sure that we not only go out and vaccinate in the communities but also make a plan for folks to get a second dose, because we don’t want to miss the opportunity for people to get optimal immunity, and it raises the additional question that I wanted to raise and bring in front of those group too – coming from some of Dr. Reeds comments earlier, if you have people that are vaccinated outside of their own jurisdiction, we also don’t have a way that our immunization registries communicate with each other in different jurisdictions – and so this pandemic should also give us pause to think about how we’re going to make sure we’ve got record keeping so that if I'm vaccinated in Arkansas and I move to Philadelphia, that that vaccine information is transmitted in a way that can be used going forward.
We have done a great job doing registries for kids, we’re going to use those registries for adults, but that information doesn’t pass from one jurisdiction to another, and that posed a real challenge for us in this pandemic and as we go forward.
Thom: Thanks Dr. Hopkins – Dr. Linas – this has come up a little bit throughout the panel but I want to give a chance to directly address this diversity and inclusion in Covid research as well as the delivery of the vaccine. We’ve talked about a lot of ways for engaging in the communities and making sure that the underrepresented get access and solve those inequities. How is that being seen at Boston Medical Centre, treating patients and doing research?
Dr. Linas: So, Boston Medical Center serves an urban population, its nearly entirely medical, its large majority is persons of color, even before Covid. Our experience going all the way back to the very, very beginning. I still remember the very first time I walked into the hospital during Covid and its still an emotional thing, it was just overwhelmingly striking how over represented out African American LatinX patients were even on day one – and at that moment we had – despite best efforts we do clinical research for HIV trials and hepatitis C trials and all kind of infectious diseases trials, we approached those pharmaceutical companies, but at the very beginning for whatever reason we were passed over, we had no clinical trials to offer at that point, nor do we have any approved medications and also our professional society, the infectious diseases society of America was saying that you shouldn’t be using any of these candidate therapies outside of the clinical trial, which to our ears sounded like we’re supposed to just sit here and wait for everyone to tell us what to do while our patients are dying. So that was completely unacceptable to us and we actually began to use medications with safety monitors in place at the beginning of the epidemic and it really caused us to reflect carefully about this – and then again over the summer with everything that was happening, disparities in the research, and beyond just research to understand disparity which is critically important – the fact that the research that we’re doing on Covid is systematically excluding many of the populations that are most affected by the disease and it caused all of us to think – how can you possibly be doing the best science if your science is excluding the most relevant or effected population, you can't be asking the right questions, you can’t be forming the right hypothesis and your research isn’t generalizable to the population that its supposed to benefit, and so we’ve really taken that to heart – outside of Covid, across all research at our institution to recognize that really in 2021 access to cutting edge therapies for Covid, but also for cancer or diabetes or you name it – really does involve access to the newest therapies and access to cutting edge research for those who would like to be there and so we’ve started down that path – it’s a long path that involves both raising resources – but also working with our community because there's a lot of distrust of research. I'm running clinical trials now on Covid in our hospital and generally when I approach potential participants – the conversation begins with – what is research? Why are we doing this? What does it mean to be on a placebo? We have to start on the lowest base to concept before we can even raise the concept of this clinical trial and its requiring honestly 3-4 hours per person to consent them into a clinical study which is a very long time, and it makes it really hard to enroll but we’re starting down that work because Covid’s just an accelerator of this dynamic – everything that’s happening in Covid is happening in diabetes. It's just that it takes 20 years to see the complications and no one gets to see the entire time course -whereas in Covid all of us can see the whole thing from soup to nuts and that’s what’s so compelling, but it's happening all the time – in much slower motion, so it makes it less difficult to respond to, so I hope that that’s a new phase around the country – we’re ding a lot of work in that direction and we really need to expand access to clinical trials and access to cutting edge clinical research - both to do the best science and to help the communities that we’re trying to benefit.
Thom: Thank you very much, last question here for Dr. Benjamin – Serena Marshall, one of our reporters in the chat asks – we’ve heard generally about how we’ve created the vaccine and logistics about distribution, but what are areas that we’re hearing from patients? What are the concerns of patients that maybe need to be discussed? So, I want to ask you Dr. Benjamin – how we need to be communicating with the public to educate them and what concerns do you think are out there that we need to address and honor as part of this process.
Dr. Benjamin: Yeah at the end of the day I think the general public has one very important question – because I think they believe it's effective, but the real question is – is it safe, and how can we have done this so fast? And yes – it is a manifestation of an amazing amount of science and technology and I think it’s important for us to tell people that we’re actually been working on a vaccine for SARS- which is a relative of this virus, since 2003 and so while the early studies were done many, many years ago and we’ve also been working on MRNA vaccines to deal with cancer for many years, and what you have now is you have the bringing together of work previously done on vaccines and work being done on cancer, and so what we really did this time is we did the science and the research just as we’ve always done, we didn’t change that really in any meaningful way in terms of time, the size of the population that we did research on. How we educated people – we didn’t do any of that. What we did do is we cut out all the bureaucracy, because normally what happens – because vaccines don’t really make a lot of money, is company’s they do step one and then they check it, and then they do step two and then they check it and then they do step three – and what we allow them to do by pouring a lot of money into this, was allowing them to do the bureaucratic stuff all in multiple lines at the same time and then focusing like a laser on the science. What we also haven’t done very well as you can see, is we haven’t done the public health planning that should have also gone along with that, but people need to know that this vaccine is as safe and effective as any vaccine that we have out there and it's going into million of arms, all around the world and we’re all seeing the same thing – fairly high protection with some symptoms – like fever, headaches, sore arm, but no real serious side effects so far for this vaccine.
Thom: Thank you Dr. Benjamin and thank you to all of our panelists for joining today. We’ll go ahead and wrap things up, I want to just remind the media on the call, we’re going to share a video recording and transcript of today’s panel – if you're registered on todays event we’ll make sure that you're on the list for that, you are already- if you just clicked an invite link and you didn’t register and you want to get that stuff, email us at [email protected] and we’ll make sure to send you that info when we have it available. With that I will go ahead and thank Dr. Hopkins, Dr. Dbeibo, Dr. Benjamin, Dr. Linas and Dr. Reed – thank you all very much for joining and giving us hope for an eventual end to this pandemic. We’ll be doing another session next week of our Newswise live expert panel focused on current events in Washington, with the pandemic combining with expected impeachment coming through the house today as well as the inauguration next week and the events of the riot at the capitol last week – that’s coming up next Tuesday and then we’re planning another panel to talk further about the vaccines later this month – so if you're interested in hearing more about upcoming Newswise live events – reporters, check back with our site, feel free to send us an email, we’ll make sure to keep you on the calendar for invites to those upcoming events. With that I will say thank you – stay safe, stay healthy and good luck.
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