Out covid19 vaccines across the country. They will also discuss the opportunities for the Biden Harris Administration to deliver a rapid coordinated response to covid19, that includes strategic use of vaccines to protect more people. The speakers will bring a sciencebased perspective on these and other topics. Please note participants are welcome to use images, video, and quotes readily from the webcast and the content is for immediate relief. Release. I would like to briefly introduce our two speakers. Dr. Chris beyrer is the director for human health and public rights in the department of epidemiology, International Health and Health Behavior and society at the Johns HopkinsBloomberg School of Public Health and also the founding director of the center for Public Health and human rights. During the pandemic, dr. Beyrer has been engaged in research and focusing on lessening prisons to prevent the spread of covid19, transmission of covid19 and efficacy of mask wearing, as well as the development of covid19 vaccines. He also serves as a Senior Scientific liaison for the covid19 prevention network. Our second speaker will be dr. Monica schochspana at the Johns Hopkins center for security. She also Senior Scientist of the department of Environmental Health and engineering at the Bloomberg School. During the pandemic, she has worked to translate Scholarly Research into actionable recommendations for policymakers and practitioners including as cochair of the working group on readying populations for covid19 vaccine. We will have time for questions following the panelist remarks. The procedure will be as follows. We will take some questions that have been submitted in advance of the briefing and some questions for the zoom check. If you have a question for the briefing, you can enter it in a zoom chat addressed to all panelists. Please enter your name, media outlet, and question. We hope to cover as much as possible. And note that participants will be muted during the briefing and it will be recorded. Dr. Beyrer, please go ahead. Dr. Beyrer thank you very much. Good to be with everyone. I would like to make brief remarks as we begin. First of all, to say we are in an extraordinary moment now of Scientific Achievement because we have two vaccines, both messenger rna vaccines that have been approved for emergency use authorization by the fda and which are now rolling out in a vaccine immunization effort. Both of these vaccines have shown high, in fact very similar efficacy, 94 and 95 with the pfizer and moderna products. Both require a two vaccine dose regimen. The Clinical Trial data for these vaccines show for pfizer, the optimum was 21 days between the doses, and for moderna, 28 days. They are on a two dose strategy. We also have at least three more vaccines in the Clinical Trial pipeline that has been established by what was called operation warp speed and what is now being called by the Biden Harris Administration, the operation. That is the astrazeneca vaccine which is a different technology, a live vector vaccine using an adenovirus, also referred to as the oxford vaccine, which has been approved for emergency use in the u. K. And is being rolled out over there, and the Johnson Johnson vaccine also a live viral vector vaccine for which we are expecting an application to the fda for emergency use authorization any day now. The fifth trial, started just after the new year with a novavax product, which is a protein subunit vaccine, that has been and rolled remarkably well, 1000 american volunteers a day. We already have 13,000 people immunized with the first dose. I would also add that the we will be back in one moment. Go ahead. Dr. Beyrer thank you. That the Johnson Johnson vaccine is a single dose vaccine, so we are encouraged by the utility of that product. These trials have been rigorous and the outcome so far has been highly encouraging, but the rollout of these very efficacious products has been halting and slow and challenging, and it has been too slow to have these vaccines, at least until now, to have an impact on protecting the American People from the covid pandemic. As we all know, we are still seeing very high rates of community transmission. We are rolling out this vaccine effort in the high transmission context and also with a high burden for our health care system. All that means that we really need to continue is the other non the other nonvaccine interventions. That includes mask wearing and we are now being recommended perhaps to do double masking. The Biden Administration has imposed a mandate for mask wearing on federal properly property, but also social distancing and handwashing. It means we are still in an extraordinarily dangerous time for Public Health. The Biden Harris Administration has come into office basically stepping into the vaccine rollout efforts that were already underway, that was really based on the state approach to this. So we really have a 50 state and territory plan, and it is an extraordinarily challenging thing to begin to move to a more national plan. Lastly, i would say, we have really an unparalleled Biomedical Research infrastructure in this country and that has been spectacular in terms of delivering two highly efficacious and safe vaccines in 10 months. But we have had a 20 year disinvestment in the Public Health infrastructure, so it is perhaps not surprising, but a hugely challenging and unfortunate reality that our Public Health systems and implant mentation implementation is nowhere near the level of our biomedical infrastructure to develop these vaccines and that is something we will have to work on as a country and very quickly, while we are rolling out these vaccines. I will stop there. Ellen thank you, dr. Beyrer. Now we will hear from dr. Schochspana. Please go ahead. Dr. Schochspana thank you. And thank you to everyone joining us today. A few remarks i want to call out focus on the chronic inequality and recent institutional failures that have produced two trends for the pandemic in the United States. Those are the high rates of covid19 infection and mortality in black, indigenous, and latino populations, and at the same time, disproportionate levels of vaccine hesitancy, particularly among black communities. The question arises, how might authorities work to strengthen covid19 Vaccine Confidence within communities of color . Im going to point out three actions. The first is to diagnose properly the causes of the hesitancy and treat them effectively. There are many reasons for vaccine hesitancy. I want to pull out two p the first is the hesitancy around very specific vaccines as people of color and many others in the United States see states roll out the vaccines are the second is skepticism recommending the vaccines. That skepticism is grounded in abuses bypassed health authorities, sometimes in government names, biased health systems, symptoms of suffering among people of color, and also modernday Public Health programming that deals ineffectively with social determinants of health. We need to focus in particular on that second set of hesitancy, the second kind. The second action here is recalibrating our ideas about the tempo of work needed to improve covid19 vaccine uptake among communities of color. Few of us doubt that a real race is on, even though the finish line may have to be redrawn due to bottlenecks and vaccine supply and administration. For communities of color, the campaign has to engage in two very differently paste work streams. The first is the urgent task of reducing disease transmission and burden, but the second work stream is not to be rushed and ongoing job of demonstrating trustworthiness and earning a reputation for reliability and honesty, while trust is an intangible product of Community Engagement work. That Community Engagement work still requires very tangible provisions, and the loadbearing Community Engagement structures and Public Health have historically not been prioritized for investment given finite resources. The third action is investing of course, as chris has pointed out, sufficient Human Resources to perform both work streams. That means Human Resources on the Public Health side and Human Resources on the community side. We need to strengthen the organizational capacity of the Health Department to partner with their Community Allies in a genuine fashion. We also need to strengthen the communitybased workforce comprised of community organizations, Community Health workers, and other champions who are best poised to promote covid19 vaccination among people whose roots they share. If we want to align the demand for and the benefits of covid19 vaccines for communities of color, we as a country have to provide lasting opportunities for our communities of color to exercise collective agency over their own health and wellbeing. Back to you. Ellen thank you, dr. Schochspana. Now we will take questions, and if you have a question, enter it in the zoom chat with your name, media outlet and question. We will start with questions from griff whitty at the Washington Post for dr. Beyrer. What are the factors that account for the wide disparities among states and how quickly they have been able to administer Vaccine Supplies . The second followup, have there been Lessons Learned about best practices as well as tactics to avoid . Dr. Beyrer very important questions. Unfortunately, what we see is a very heterogeneous picture. Essentially, the Previous Trump Administration passed it to the states to come up with their plans. They also, through the cdc, made recommendations about prioritizing the use of these vaccines. For example, virtually all of the prioritization efforts said that we should start with Frontline Health care workers who are providing covid19 care. But a number of states chose not to do that and instead decided to immunize the elderly, but without a plan to do that and had a rather chaotic beginning of the rollout. That is a huge challenge for the Biden Harris Administration, harmonizing and trying to work with the states, and of course they are under resourced to do this. Resources for the state and counties and local level were meant to be in the second Covid Recovery act, of course President Biden has asked for that. We will see. The second question about best practices, i think there are states doing significantly better. For the most part, where that has happened is because the governors were paying attention to scientific expertise to the Public Health experts listening to epidemiologists and working closely with their local health authorities. Of course, it is a heterogeneous patchwork because Public Health has been so underfunded in so many states for decades now. Ellen thank you so much. Here are some questions from at least reuter at midcity news for dr. Schochspana. What can be done to make sure people in underserved communities have access . You touched on that in your presentation, but any concrete things that you can share. Dr. Schochspana right. Again, along the themes of strengthening the organizational capacity of local, territorial, state, and Tribal Health agencies. I just want to call out concrete examples of those assets in which we have to invest and hopefully, we will see more pandemic relief dollars channeled to these kinds of things. We need time on an executive schedule and Health Department to engage in Strategic Planning around the need for institutions and communities of color. We need dedicated Equity Advisors who can steer it implementation of the covid19 Vaccination Campaign among these communities. We need all tiling will staff who can navigate communities skillfully. We need budgets to convene regular meetings with stakeholders from hardhit communities. We need to compensate those participants. We also need to strengthen communitybased organizations that have root in hardhit immunities of color, concretely by providing direct ending in the form of rants, but also grants, but also providing them skills like grant writing that will allow them of the pandemic and into the future. The point is Community Engagement is hard, timeconsuming work that requires an adequate number of personnel and a robus, operating budget robust operating budget, and we need to get dollars in these line items. Ellen thank you so much. The followup from midcity on a different topic. As we start to vaccinate larger groups of people, how can we ensure there are not long lines or difficulties in getting an appointment . Dr. Schochspana again, it is important to put the user, the end user of a vaccination system , at the planning table so that they can provide their own problemsolving capabilities to suggest ways that can improve delivery. So in this case, a jurisdiction should be convening specific organizations that represent different demographic groups, whether its local disability groups, local senior groups, local youth groups. The point here is that we need to populate the planning table from people who represent the demographics that are being served by the Vaccination Campaign. And chris may have some additional details. Dr. Beyrer i would make the point, i concur with monica, but it is also important to know that these are challenging products, particularly the pfizer product, because it has to be stored and shipped at ultralow temperatures, arctic winter as it has been described. The moderna product is slightly easier but still has to be kept frozen. We are in a situation where once you defrost, you have to immunize. If people for example dont come to their visits, we were perhaps too restrictive at the beginning and throwing away doses rather than immunizing people and that has got to change. Ultimately, we have to get as many people immunized as quickly as we can to get ahead of this virus, which is also of course mutating as it moves through human populations. That is an urgent priority. This will be easier if we have emergency use authorizations for the other vaccines in the pipeline because some of them are much simpler to use. One is a single dose vaccine and most of the others need freezing. Only the pfizer requires ultracold temperatures. Ellen thank you so much. Here is a question from Adriana Rodriguez at usa today. Is it true pain relievers like tylenol and ibuprofen used to manage Covid Vaccine side effects can prevent the vaccine from working to its True Potential . Dr. Schochspana dr. Beyrer there is no Clinical Trial evidence of that. It has been known in pediatric vaccines that you can sometimes lower vaccine efficacy with premedication. What is being recommended now, particularly for the first dose, but also the second, to try and manage those symptoms, but it should be pointed out that in the efficacy trials we have, and the moderna and pfizer trials, no one was prohibited from using antiinflammatory medicines like tylenol or ibuprofen, if they felt the vaccine side effects were severe enough it would require that management. Those efficacy trials had 94 and 95 efficacy. We dont have any empirical evidence, but we are encouraging people not to premedicaid before getting the vaccine. Ellen thank you. Another followup on a different topic. What are the pros and cons of a lottery system for Vaccine Allocation during phase two after priority groups in phase one a, b, and c have already been vaccinated . Dr. Beyrer we are in a period of scarcity where there is more demand than there is vaccine and there will be for many months. The best estimate is we probably wont have enough vaccines for every adult who wants one of this country until probably june, maybe july. Vaccine scarcity will continue and people are using lotteries because they are seen as more just and fair. There certainly is an argument for that. I would say in major con argument for what monica has been saying, often if you leave it up to a lottery, there are all kinds of people who still end up being excluded, people who dont have access to a computer, people who dont have access to a car, if you have to use a lottery but still have to drive to the vaccine site. And there are whole segments of the population with lower immunization rates, and we want to achieve a Public Health goal of immunizing enough of the population to get ahead of the virus. Ellen thank you. Heres a question for you, dr. Schochspana, from arthur allen. How do you ensure this when half the country is hesitant and the other half is frustrated by the lack of vaccine . Dr. Schochspana the first thing to do is to recognize that communications have to meet the needs of very different audiences. Theres never going to be a message that will resonate with all sectors of the United States. And so whats going to be important is to do Rapid Research among different social groups to find out what are those messages that resonate with their own social values, worldviews, scientific understandings. So we need to have an empirically based communication strategy in the United States, and that is very responsive to all of the different subgroups that characterize our country. Ellen thank you so much. Heres a question for you, dr. Schochspana, from abc 15. How important is it for states to keep track of Demographic Data and other data to ensure equitable distribution of the vaccine . Dr. Schochspana data and heres why data equals equity and heres why. We need to know in a systematic and comprehensive way, what are the impacts that are experienced by different constituents in the United States, and in particular, racial and ethnic minorities where we see disproportionate impacts. We have a very uneven data collection, analysis, and sharing system in the United States to understand concretely what the impacts are. We need to fill the data system gaps. We also need to know what impacts vaccinations are having within different demographic groups. We also need to have the data by which we can assess the effectiveness of distribution of vaccines throughout all corners of a community. Why is data so important . It needs to drive decisionmaking. It also provides a material and solid basis for allocating scarce resources so that those in the greatest need of vaccines get it, and also that decisions are made in a very transparent way. The public wants to be able to trust that a precious, scarce, lifesaving vaccine is being allocated fairly, and to people who need it. Data helps make that Decision Making transparent. Ellen thank you so much. Heres a question for dr. Beyrer from Colby Satterfield at w usa. What needs to happen in order for vaccine rollout to be successful from here out . How do states secure more vaccines, and is that the key to a smooth rollout . Dr. Beyrer i think there are several important steps, and there are more vaccines in late stage Clinical Trials, and we have, as we did with pfizer and moderna, invested through operation warp speed in manufacture of those vaccines while the trials are underway. If they truth prove to be safe and effective, we will be able to have more doses quickly. Secondly, there are some steps in the manufacturing that have been encouraging. One of the major vaccine manufacturers did not go ahead with their own vaccine, it proved not promising in early studies, but they made an agreement with moderna to use their manufacturing capacity to make more of the moderna product. That will help with increasing the number of available doses. That all matters, but then there is the distribution process. We are very encouraged by the decision of the Biden Harris Administration to do vaccine rollout through federally qualified Health Centers. These are Health Centers that are federally funded and serve underserved communities across the u. S. We have also seen for example where the tribal nations have handled their own vaccine distribution, they are doing much better at immunizing the native american populations than those tribes that agreed to have the states in which their sovereign nations reside manage the rollout. That is an important lesson going forward. Finally, i would say the state and local entities that are tasked with doing this really need the resources in developing vaccines and not commensurate investment in the rollout, and that has got to change quickly. Ellen great, thank you. Here is a question from claire riley at cnet. Medical staff across the u. S. Say they are running out of vaccine doses to administer while also hearing there are doses sitting in storage and going unused. Is there any truth to this and if so, what have been the Major Barriers to rolling out vaccines quickly and effectively . Dr. Beyrer there has been some truth to this and it has been a concern for money. I think it is being addressed in the last week or two beginning late in the trump administration, secretary azar said states would loosen restrictions and make sure they are using every dose they have. It honestly has been for many, particularly hospital and health systems, a concern about wanting to not make mistakes and absolutely follow the cdcs allocation guidelines. And that is of course very important. The equity issues are very important. But these are precious resources. Vaccines sitting in freezers do not save lives. In music station immunization programs save lives. We need to getthe vaccines into peoples arms. Ellen thank you so much. We are getting to the last questions. Dr. Schochspana, heres a question from lola with the Washington Post. You mentioned the need for additional dollars for equity efforts. How much funding have states received for this funding so far . Maybe you can answer this broadly, and how much is needed . Dr. Schochspana i can speak more to what is being requested with regards to the Biden Harris Administration, and i think if i recall correctly, we are looking at i think 500 billion to the states and locals. So the point here is that there is a recognition i think out of the Biden Administration that distribution is a challenge on par with research and development of a vaccine. Its not enough to have a clinically successful vaccine, if it is not socially acceptable and readily available. I think there is trying to be a leveling of the field across the money that can be invested in the Lab Component of the vaccine, the Health Department component of the vaccine and then the Community Component of the vaccine. But over to you for more details. Dr. Beyrer i think that is absolutely right. Remember that the cdc ultimately, the agency tasked with managing these distribution programs and the funding for them was going to be in the second recovery act, which was longdelayed. We are very encouraged that the new cdc director, dr. Rochelle wolinsky, has already made a very explicit point about being honest about these challenges, about taking them on, and she is an outstanding Public Health leader, so hopefully, there will be resources to do this commensurate with the need and they will be well used. Ellen great. Last question. This is for dr. Beyrer. Tina from science news has the cold requirement for the Pfizer Vaccine been a limiting factor in this rollout . Dr. Beyrer it has certainly been a challenging factor in the rollout. You may know that the idea was initially that there were five doses per vial. You have to defrost those and then use them quickly. It turned out there may be six, and generally speaking, there are six doses in each file, but to get the sixth out requires a different syringe. These are the kind of kinks you have to work out as you do this. Theres no question that it is very challenging to use this product, and when you think about it globally, and of course we dont just need to immunize the American People, we need to immunize our species. We need to protect planet earth or we will never get out of this pandemic. This is going to be enormously challenging to use as a product in most low and middle income countries. We are expecting astrazeneca, the oxford vaccine will be better in those, and the Johnson Johnson singledose which if safe and effective, can be a game changer. The pfizer product in much of africa and latin america and Southeast Asia will be too challenging. Ellen so just one followup and then we will close. Is there a good estimate of how much vaccine has been wasted and what is the reason for the waste . Dr. Beyrer i have not seen any National Aggregate data, a lot of this i been anecdotal. I there have been some challenges where it cannot be refrozen and then people who had appointments scheduled either could not come or did not come for whatever reason, so those doses have been wasted. We have not invested in as opposed to for example south africa which they have done much better at this than the u. K. S that something we should not be proud of. We need to invest in a National Tracking system so that well know how the vaccines are being used and we avoid this problem of waste. Theyre too precious to waste. Thank you for your presentations and insightful answers. We will email the lynx and shared in the chat. And with that id like to say thank you to everyone for joining us today. Visit cspans new online store at cspanshop. Org to check out the new cspan products. With congress in session, we are taking preorders for the congressional directory. Every cspan shop purchase helps. Shop today at cspanshop. Org. Shortly, the annual march for rally which will mostly be held online because of the ongoing pandemic. Like covered at the top of the hour. Facebook. Com cspan. We will get to your thoughts on th