Update with top officials at the International Vaccine access center. This is 30 minutes. Welcome and thank you for joining us today. My name is ellen wilson and i will be the moderator for this expert briefing for the media hosted by the Johns HopkinsBloomberg School of Public Health. This briefing will address vaccines for covid19. The world has made unprecedented strides in developing covid19 vaccine candidates quickly. Many with higher efficacy than anticipated. Bringing these vaccines from Clinical Trials to the general public would require many considerations. Todays briefing would tackle these questions, including how do scientists develop vaccines against covid19 in less than a year, and how do we know they are safe . Will there be enough for everybody in the u. S. . What about people in low and middle Income Countries . Be demandingerly vaccines. Others will not be. How do you determine who will get it first and how do you convince those who are hesitant about such a new vaccine to be unionized immunized . Once we have a vaccine, what will our lives look like . Will we need to continue mask wearing, handwashing, and physical distancing . Bring arts will sciencebased and engaging perspective on these and other questions. Andng closer to having safe effective vaccines is a giant step toward putting this pandemic in the rearview mirror. Please note participants are welcome to use images, video, directly from the webcast, and that the content is for immediate release. I would like to briefly introduce our speakers. Professor inoss is the department of epidemiology, international health, and molecular microbiology and immunology at the Johns HopkinsBloomberg School of Public Health. Ofis also executive director the International Vaccine access center. Mossg the pandemic, dr. Has been engaged in research to understand the impact of the pandemic on Childhood Vaccination programs and in communicating with the general public about the covid19 vaccine. Dr. Rupali limaye is in the apartment of health, epidemiology, and health, behavior, and society at the Johns HopkinsBloomberg School of Public Health. She is also director of behavioral and implementation science at the International Vaccine access center. Beeng covid19, she has leading the Communications Work global grant to develop demand generation strategies to maximize covid19 Vaccine Acceptance. Questionsve time for following our panelist remarks. The procedure will be as follows. We will take questions submitted in advance of the briefing and some from the zoom shack. The zoom chat. If you have a question you can enter it addressed to all panelists. Enter your name, media outlet, and question. We hope to cover as many as possible. Participants will be muted during this briefing and it will be recorded. Dr. Moss, go ahead. You very muchk and welcome to all of you. We are setting record numbers of cases, hospitalizations, and deaths and we are seeing our Health Care Systems overwhelmed. We are also about to face a winter where we may see increases in the numbers of cases, hospitalizations, and deaths. We are at a critical juncture in this pandemic. We do have good news about the vaccines. There has been astonishing progress made in the development of covid19 vaccines. Inis hard to believe december 2020 about a year after this pandemic was first recognized, we are talking about the potential availability of vaccines that may protect up to 95 of vaccine recipients being made available in the coming weeks. This is truly a remarkable achievement. As all of you know, the vaccines that we are likely to see in use in the United States are the Pfizer Vaccine and the modernity vaccine. Rna of these use messenger technology, a novel vaccine platform, and we do not yet have a license vaccine based on this technology, but this technology has allowed for this very Rapid Development and testing of these vaccines. How are these vaccines develop so quickly . They are built off a decade of research on mrna technology as well as other vaccine platforms. We have been able to combine some of the trial phases. Phase i and phase ii, or phase ii and phase three, that has expedited the process. During a pandemic because there are so many infections and cases , in the phase three trials, we are quickly able to tell whether these vaccines actually protect against disease or not. The pandemic situation, as tragic as it is, has allowed for the Rapid Testing of these vaccines. Lastly there has been concurrent manufacturing along with the phase three trial that makes it possible for when the phase three trial results are analyzed and hopefully we get emergency youth authorization, we are ready to roll. What is the process Going Forward . We anticipate there will be a Public Meeting on december 10 of fda,visory group to the the products advisory group, and that they are going to really assess the data that the fda has been reviewing since pfizer submitted their application for the emergency use authorization. About a week later we expect something similar from the modernity vaccine. Vaccine. A a Public Meeting where the data made will be made transparent. There still remain many questions to be answered. We do not know the duration of immunity conferred by these vaccines. Its going to be very important to continue followup in the phase three trials and in individuals who get the vaccine after the rollout. We need to know how these vaccines work in particular highrisk groups. Older adults, those with underlying conditions, but also pregnant women and children. We need to know the impact of these vaccines on transmission. That is not one of the primary outcomes of the phase three trial. We also need to know whether there are longterm side effects. We are only going to know about shortterm side effects, but we need to know whether there are potential rare longterm side effects. It may be that other vaccines in the pipeline turn out to be better than these frontrunners. These frontrunners are not the optimal vaccines. We would ideally have a vaccine that does not require the stringent requirements the messenger rna vaccines require. Wey b would have up would have a vaccine that guarantees longterm immunity after a single dose rather than two as required by the messenger rna. We want to make sure we have the optimal vaccine for populations. We are going to face numerous challenges and we can talk more about these. The allocation process, who is first in line. We heard from the Advisory Committee on immunization practices this week. Prioritizing the 21 million healthcare workers and 3 inlion residents and staff longterm care facilities in the United States. We need a phased approach because we will have insufficient numbers of doses to reach all those who should or want to get the vaccine. There are going to be distribution challenges and this is going to be up to the states, to determine the final allocation process and to figure out the logistics on how to distribute these. We are going to have challenges with acceptance. We need to track these vaccine doses so we know who got which vaccine and when. We heard today about vaccination curves being administered to all vaccine recipients. Lastly, very importantly, we need to continue our safety monitoring as we go forward. My last point is that these vaccines are not going to be the Silver Bullet that brings us back to prepandemic. We are going to need to continue to wear masks in public, socially distance, wash hands frequently and avoid gatherings. I think we will see over the course of 2021 a phased return to our normal prepandemic life. Thank you. Ellen you, dr. Moss. Limayewill hear from dr. That weye it is great have potential product but the important thing is to remember that vaccines do not save lives. Vaccinations save lives. We have to figure out how to get people to accept these vaccines. There are five key things we must do. We need to understand peoples attitudes toward the vaccine and how this might vary by specific segments of the population. We are finding that nonwhite people may be less likely than whites to accept the vaccine. We need to understand who people trust for Vaccine Information and identify barriers for acceptance. Vaccine intentions vary wildly. A study reported on a Global Survey of more than 13,000 people in 19 countries to determine potential acceptance rates and factors. About 72 of participants ororted they would be very somewhat likely to take a Covid Vaccine once it is available. Differences in acceptance rates reached almost around 90 in china to 55 in russia. Respondents that reported higher levels of mistrust in information from government sources were more likely to accept a vaccine. Are able to we better understand attitudes toward the vaccine, we need to deliver messaging to address issues. Leading toctors hesitancy in segments of the population need to be identified so the most appropriate intervention can be applied. Different interventions should differ by subgroup, context, setting, vaccine product, and time. Use tothe messaging we nudge people toward Vaccine Acceptance must be salient, impactful, and tailored to meet the needs of different audience segments. It must come from a credible, trustworthy source. Berth, we need to transparent with information about vaccine side effects. Clinical trial participants from the Pfizer Vaccine trial indicated the vaccine can cause people to feel unwell for a few days. We need to be able to communicate this is normal and remind people the vaccine has undergone rigorous safety testing. Should communicate expectations about who and when people look at the vaccine. As dr. Moss mentioned, not everybody will be able to receive the vaccine once it is available. Living ine have been this pandemic for more than a few months now. A lot of people are feeling a certainty uncertainty, fear, and anxiety. To encourage appropriate behavioral action it is critical we have clear and consistent communication. Thee are resources such as cdc crisis and emergency Risk Communication to serve as guidance that can assist Public Health authorities, government officials, and other stakeholders in communicating with the public, utilizing Risk Communication principles. While we are confident about the efficacy of the current product, a vaccine will not mean people can stop taking precautions. Thank you. You. thank if you have a question, please enter it in the zoom chat with your name, media outlet, question, and to whom you would like to address your question. The first question comes from hannah at the Financial Times for dr. Moss. How long will it take us to understand whether a vaccine can stop covid19 transmission . Is a verythis important question because if the vaccine can stop transmission it is going to have a greater impact on the pandemic. The phase three trials do not have that as one of their primary outcomes. Their primary outcomes are looking at disease. There are going to be a number of ways in which we learn that. It is going to take several months. Is through the existing trials. We know in the astrazeneca trial they looked at asymptomatic infection. That is not a direct measure of transmission, but if people are not developing asymptomatic infection, it is unlikely they will be transmitting, or their probability of transmission will be low. I think we will get some information, but we are going to need to set up additional studies to look at this. What we pandemic, in are going to see, there is going to be so much transmission in the United States that i expect we will be able to see this. People have been talking about setting up studies in College Dormitories to look directly at transmission. Part of the answer is going to come from the current trials, partly from new studies. We will probably have a good handle on that question by mid2021, if not a couple months sooner. From the next question is Alan Greenblatt governing. Can you comment on the challenge involved in distribution . What role do you see government playing . Do you feel they are prepared . Dr. Limaye it is a great question. With the introduction of new types of vaccines, mrna vaccines , they require a different storage, cold chain storage. This will require states to coordinate and think about how vaccines will be transported, not only from where they are being distributed, but to the state. Once they make it to the states, to the facilities. It is going to be clear states are going to have to take the role with regards to distribution. The cdc can provide guidance and feedback on this but it really is up to the states to determine how this will work. There is a need to have a coordinated response. This is a new vaccine so we will have weighed a bit of learning very quickly as we start to roll this out. Hopefully that we can use to improve the process as vaccines continue to get rolled out. Ellen here is another question for you from julie washington from the cleveland plain dealer. Are there any plans for the national for the government to roll out a National Media vaccine to overcome hesitancy . Dr. Limaye there is a recent oped by a great colleague just two days ago that talks about the importance of this. Regardless of what happens, communication is critical. Transparent communication is critical. To my knowledge i am not quite sure if there is a planned National Media communication campaign, but i think it is absolutely paramount if we can do Something Like that that would be really useful with regards to increasing acceptance of the vaccine. Ellen how can media prepare the public for side effects without making the vaccine seem dangerous . Dr. Limaye i am glad the media is interested in this. Media is an important partner for us. The key is to be critical to be credible, to be transparent. We do not want to scare people but we do not want to lie to people. How do we make sure we are providing the facts but we are also providing individuals with the ability to prepare for a vaccine so they are ready . To me, having Media Journalists talk to different scientists so they can clearly communicate this in a way that is not scary would be ideal. Question fore next dr. Moss. Why is the astrazeneca vaccine less effective than messenger rna vaccines from pfizer, biontech, and moderna . Dr. Moss it is a very different kind of vaccine. Ultimately they all do the same thing. Both the mrna and the viral vector to vaccines introduce the genes, the spike protein, that is produced by ourselves, our immune system to respond to it. My first answer would be the efficacy data on the vaccine, the astrazeneca vaccine is a little quirky. They reported 90 vaccine efficacy with that half dose, full dose schedule. That is pretty close to what the mrna vaccines produced in terms of vaccine efficacy. With awer efficacy, 62 , full dose full dose schedule. That remains a mystery as to why that is. We learned subsequently the half dose, full dose may have been in younger individuals. The first thing i will say if there is a lot more to learn about the vaccine efficacy of the astrazeneca. Lower, theat it is honest answer is we do not know. Courseot know what the of immunity are. Hopefully we will learn that, if there is a level of neutralizing antibody that confers protection, one could hypothesize the astrazeneca , it reaches that threshold in lower proportion because of less spike protein produced by the cells. The honest answer is we do not know. Ellen another followup. Johnson johnson has been testing a single dose regimen, but announced they will begin testing with a booster shot. Is that a concerning development . Earlier as i mentioned , the ideal vaccine for covid19 a single dose to confer longterm protection. That ais possible vaccine of lower efficacy but with a single dose might do better in the population level then the two doses of a higher efficacy vaccine if we have trouble getting two doses into p. Whyo not know the reasons Johnson Johnson switched and decided to test a two dose schedule. I suspect they were seeing some signal that perhaps the duration of immunity or level of immunity after the singledose was not what they wanted. I would say in that sense, perhaps if that is the rationale behind based on evidence of durational immunity after a single dose, but we are still hopeful one of the vaccines in the pipeline, and there are many more types in the pipeline that will be able to have a single dose that requires refrigeration. Have a choiceople what vaccine they take, or will they have to settle for what is available where they can get it . Dr. Moss this is going to depend on the timing and where we are in the rollout. Early on people will probably not have a choice. Vaccines,ve two similar vaccines but not identical, and people likely will not have a choice. But as vaccine manufacturing builds up and the distribution the storage,et up, the delivery of vaccines, likely even more vaccines, i anticipate toward the end of 2021, maybe people will be able to choose the type of vaccine. And we may learn certain types of vaccines are better in some populations. Maybe one vaccine is better in people with or in different underlying conditions. I think we are going to see more choice, but it is going to take us a while to get there. Ellen another one for you, dr. Moss. None of the vaccines have been tested in children younger than 12. Do you expect children will get access along with adults or will there need to be testing first . Is anyone doing that and what are the plans . Reallys this is a important question about when vaccines will be available for children. The first answer is yes, vaccines need to be tested in children before they can be ruled out. Typical process for vaccine development. They are first tested in adults, then adolescents. We work our way down to younger children. This is very typical of the process. , pfizer hasou know been administering the vaccine to children as young as 12 years of age. Moderna plans to do this soon. Able toy they will be have much smaller sample sizes than these phase three trials in the adults. We will begin to learn more and more as vaccines are tested in children. Im hopeful that by the school certainly21 we will have a vaccine we can administer to children over 12. I think we have a good shot of having a vaccine for younger children as well. Ellen thank you so much. Will with both vaccine skepticism and suspicion of political leaders running high, what is the single best thing president elect biden can do to convince people to get the Coronavirus Vaccine . Dr. Limaye i think unfortunately the process and the response has been a bit politicized. The best thing he can do is, one, get the vaccine once it is available, but also reach across the aisle, if you will, and make sure individuals regardless of political affiliation are comfortable, showing the vaccine is safe. Ellen a followup from Bloomberg City lab. What will City Health Departments and city leaders play in dr. Moss dr. Limaye one thing we have learned is relying on Community Leaders has been crucial with regards to some of the Public Health precautions we have asked individuals to this point. I dont think this will be any different once a vaccine is available. I think local leaders and city members will play a key role in talking to their communities, their groups, thinking about the different types of Community Groups that congregate together, reaching out to them and being a trusted voice in their community will be critical. Ellen and from bloomberg for dr. Limaye, what about employers . Dr. Limaye employers should do all they can to make it structurally able for employers to get for employees to get a vaccine. Meaning they should let them take time off if need to to get a vaccine. At some point in the future, having an employee based Vaccine Distribution would be useful. Ellen here is a question for you, dr. Limaye, from upi. Give us a well documented disparity s given the well documented disparity in the u. S. And their effects on the pandemic, is there a concern people in low income communities may not have equal access to a vaccine . Dr. Limaye i think it is a great question, and it will have to be one thing we have learned from the pandemic. Equities rated in in inequities. When distribution does occur, there will need to be a concerted effort that we are reaching communities that may have less access to health care in general and subsequently vaccines. Ellen here is a question for you, dr. Moss, from jane miller at wbal tv. What is the status of the supply of cold storage needed for vaccines . Dr. Moss there has been enormous efforts at creating that capacity for cold storage, and the reason why this is so important, as i am sure you are aware, is particularly for the Pfizer Vaccine it requires ultracold storage. The maternal vaccine Moderna Vaccine can be kept at refrigerator temperatures. There are many angles to this and efforts that the federal and state levels, but pfizer themselves have created these cold boxes that can store about 1000 to 5000 vaccine vials that require dry ice. That is how a lot of the Pfizer Vaccine will be distributed. But we will need the freezers at the sites of distribution in the states. One of the things i will point out about the current allocation of process and framework following what the Advisory Committee has laid out, healthcare workers and residents of longterm care facilities, these are two populations that are fairly welldefined and in whom for most groups i think it will be easier perhaps to set up and maintain that cold storage for those two groups particularly. It gets more challenging as we start moving out into the general population. Ellen great, thank you. Aarp for question from dr. Limaye. Should the federal Government Institute a psa campaign patterned after the communication on smoking that has proven effective, or the work medicare does during open enrollment to reach seniors . And what role should primary care doctors play . Dr. Limaye i think the more communication we can have about the options, the availability, the potential side effects is going to be critical. Whether that is a psa campaign, whether that is any Public Education campaign that is national, i think it will be very important. With regards to providers, they are a trusted source for health information. Most individuals listen to recommendations with regards to any type of vaccine. I think the type of communication that is coming from a provider will also be important for us to ensure we get compliance. From here is a question the jh you news website the hub. Some vaccines are safe for Immunocompromised People and others are not. Will any of these vaccine options, including the messenger rna vaccine platforms, be appropriate for Immunocompromised People . Dr. Moss is a bit this is a very important question, and there is no question we will have to look at the safety and efficacy, because that can be impaired. The vaccines that are typically not recommended routinely for severely immunocompromised individuals are what we call it attenuated viral vaccines, where we take the natural virus and make it weaker. This is an old way of making vaccines. For example, our measles vaccine. None of the front runners for covid19 or sars coronavirus 2 are that type of vaccine. They are engineered to be nonreplicating. I do not anticipate problems but thatty with mrna, will need to be studied Going Forward. Ellen we will take the last question for you, dr. Moss. This is from today. Com. How will the vaccine authorization process deal with pregnant women . Is it possible they could be included in earlier distribution phases given that pregnancy seems to be a risk factor far more severe than covid19 symptoms and outcomes . Dr. Moss there was some data released by the cdc that suggested more severe disease and adverse pregnancy outcomes in pregnant women who get covid19, and this is always a very sticky issue around vaccines. School ofe Bloomberg Health have spent a long time thinking about the ethics of this. Re is no real simpleish no real simple answer. Some of the women in the phase 3 trials have become pregnant, though they may not have known at the time. We have to learn more about the risk of covid19 and any potential risks of the covid19 vaccines in pregnant women. It really comes down to weighing the risk and benefits, and that is not always a simple thing, but we also do not want to summarily exclude pregnant women from either getting the vaccine, when it may be a benefit. It may be a tricky issue, not yet resolved. Ellen thank you to dr. Moss and dr. Limaye for your presentations. We will email you the links to the resources mentioned today and shared in the link. I also wanted to note that the Bloomberg American Health summit starts next wednesday, december 9, beginning at 9 30 a. M. Eastern time. There is a lineup of speakers including dean ellen mckenzie, anthony fauci, david cussler, whitmer,e, governor and kadi k. Links to register and send the full program. With that, i would like to say thank you to everyone for joining us today. With coronavirus cases increasing across the country, use our website, cspan. Org coronavirus to follow the trends, track the spread with interactive maps, and watch updates on demand any time at cspan. Org coronavirus. Journal. s washington every day, we take your calls live on the air on the news of the day, and we will discuss policy issues that impact you. Coming up this morning, we will talk about the planned house vote on the more act which would decriminalize marijuana with a political reporter. Stephanie murphy on the future of the Democratic Party and the priorities of the blue don correlation. The blue dawn coalition. And criminalizing marijuana at the federal level. Watch cspans washington journal live at 7 00 eastern this morning. Be sure to join the discussion with your phone calls, facebook comments, texts, and tweets. Coming up live on friday, the a. M. Returns at 9 00 on the marijuana decriminalization bill. At 2 45 p. M. , former president barack obama at a Virtual Campaign rally for georgias Democratic Senate candidates jon ossoff and rough ale warnock, both facing runoff elections. 8 30 a. M. , john boehner, joe crowley, and former transportation secretary Rodney Slater look at the key decisions in the transition from a Trump Administration to a biden administration. At 10 45 a. M. , house beaker pelosi holter Weekly Briefing with reporters. Next, remarks from brandon on the 2020 election and the coronavirus pandemic. He spoke about the future of cybersecurity, including infrastructure. Held by the aspen institute, this runs a half an hour. Brandon i am pleased to be leading our next session. Agenda and bios of our speakers are available at aspeninstitute. Org. I would like to thank them for making this summit possible and organizing the conversations and