The second hour of the future of health care summit. Id like to thank our sponsor for their support of todays great program. We spent the first out on lessons we learn from the coronavirus pandemic. Will expand to look at policymaking breakthroughs and innovation in the face of seen and unseen challenges. Before we get underway a few housekeeping notes. You can tweet as at hashtag the Health Health and taking questions. Ive got a bunch that already come in. Speakers beware. If your experience, with a live stream lees refresh the page. It should be a quick fix. Thats what they say. Lets get started. Im please enter it is my first guest dies Health Official in the land alex faison sect of health and human services. Secretary azar has a a breadthf expense of both public and private sectors. His key areas of focus include healthcare reform, research and innovation come all of which have assumed added significance in the coronavirus era. Well, thanks for joining us today. We had a fantastic form and it wouldnt be what it would be without you. Thanks for being here. My pleasure. Let me start off and just ask you, weve had a lot of discussion of various dimension of the coronavirus challenges from the front line, whats going on in canaries, debate about schools. What im interested in right now are vaccines because theres a lot of confusion about vaccines seem to divide of getting to that point. Is there anything to tell us about where were at on that Front Operation warp speed and your oversight and encouragement of a vaccine thats going to save us . Absolutely. Thanks for asking about warp speed and what were doing on vaccines. What were doing with warp speed and the president commissioned us to say i heard the Pharma Company timelines and theyre also drawn up. I used to be at a pharmaceutical company. I know these timelines. I know why they are drawn up and he said can we with the full might of the u. S. Government and all of the Financial Resources that we can bring to bear, can we compress those timelines while still delivering safety and efficacy on vaccines . We said yes, we can. We are following basically tracks. The first is you compress the Development Timelines by reducing 80 unnecessary delay or inefficiency in that system. The second is you actually invest at scale up front commercial manufacturing rather than waiting until you have faced two, three, or even file fda approval. You build scale and you manufacture product now at risk with the kind of investment. Thats what enables us to fairly dramatically reduce the estimated timelines. What if we done . We currently have four Major Investments that weve made in vaccine candidates, so we have the Moderna Vaccine which came out of dr. Fauci collaboration with the thats in where the oxford vaccine which is an adenovirus vaccine candidate. Jj jansen which is also an adenovirus plaque from canada and that which is this weekend and out 1. 6 point potential potential investment in advanced development and advanced manufacturing of a nova backs protein vaccine. We now have major bets and all three of the major potential platforms for vaccine. With each of them we wont drive towards manufacturing to tens of millions of doses by this fall and hundreds of million into the beginning of next year, and phase two, three clinical Clinical Trials will be beginning just later this month probably. Do you think its important to communicate to the public more what you just said, that theres some risk in this, that you could invest so much because thats what we need to do today but one of these vaccine candidates or other women in ia talked about might be blocked . We have and will continue to do so. We are placing multiple investments across a portfolio, and we are not done. Because we know its science, its a pharmaceutical development. Not everything will necessarily hit and thats why we are placing disinvestment and again its that. When the same country back into the apollo project can radically change the speed of development of vaccine given the urgency, look, we spent 3 trillion so far just in Government Spending connected to coronavirus, not even consider the economic impact. I like to see the return on investment for a vaccine is almost infinite in terms of the investment that you would make. I want to move in a moment to the broader healthcare ecosystem which is also what were talking about today. The various dimensions, not everything is code. There are other pieces of the puzzle that i would love to get your insights into but i do it ask about the manufacturing side and International Research base because this isnt just an american problem. This is a global problem. Some of the firms are talked about have Global Manufacturing deals. How does america position itself both so that it gets vaccines developed and produced here but it doesnt excuse my language the of the finger to the rest of the world . How do you manage the International Dimensions of science and production and global need today . Let me give you an example just like the astra seneca platform. They took the oxford vaccine and astra seneca has Done Development rights in most of the world that they contacted with oxford, what weve done is contract the research and Development Work in the United States so Clinical Trials, but also for manufacturing here in the United States. That doesnt preclude their doing manufacturing elsewhere in the world. In fact, i think they talked about several billion doses to be manufactured in india and elsewhere for the rest of the worker we dont stint in a way of that. We encourage you that. With our candidates we are investing, investing in u. S. Manufacturing and u. S. Feel confidence unfinished capacity so were not dependent on any movement of products across borders from outside the United States. But in no way would we do anything to preclude the velvet for the rest of the world. We. We coordinate closely with the g7, with the European Union and andrew witty who is leading the accelerator project that its a very tight international collaboration. We are all working towards a common goal. And because of current tensions, are you just a sick, only put a fence around china now and leaving china out of this bible . China is not a participant in the excellent project even so they were not cleverly with them in any direct way on vaccine or therapeutic manufacturing so they are doing, theyre doing their own think that were working very much in collaboration with the rest of the world so as i just mentione mentioned. One of the other dimensions within looking at is the kind of broad state healthcare in america and are a lot of different moving pieces to that. Sometimes people look for silver bullets. Theres been this Administration Trump administration has wanted to replace obamacare with something. How have you been managing that . Is there an altar that you been working on as you look at we provide healthcare insurance and alternative to obamacare . You said Something Interesting with your question. You refer to silver bullets in healthcare, and i think what weve learned as part of the experience with the promises that failed with obamacare is the American People with healthcare, a that would like utopian visions. Most people when it comes to their healthcare are actually relatively happy with what they have. They dont want that taken away and it would like to see continued incremental improvements with their experience, with the choice, with the cost and outcomes have an healthcare. But they dont want their settled expectation or delivery, the relationships with the hospitals or doctors, they dont want those taken away or disrupted. Thats how we have tried to approach healthcare is how can we deliver more choice, option for people in the individual market, more options and medicare for people . How can we deliver lower cost through transparency, to reducing Prescription Drug prices come through in the Surprise Medical Bills . How we deliver Better Health tackling some of the real discrete and impact of Health Challenges like any the hiv aids epidemic, solving the rural healthcare Crisis Consulting the maternal or tell the price come into the open epidemic, dressing and tackling social determines of health, fixing how to take your people with endstage renal disease of preventing it in the first place . We look at healthcare, help for 330 million americans instead of only thinking about the important issues, but the more limited issues of the 10 million in the individual market and we will be a ready and willing partner for congress if there comes a time when theres an impetus to address the Affordable Care act with congress to get. One of the big zinger items, you get to hold the i largely agree with with you that people most people want to keep what they got. They do worry about those that are not covered and how does this all work. They worry about losing coverage of preexisting conditions. The administration has come in my view, you can look at what you like but there it been different moment where you could read different things. Is the administration, is your tenure committed to maintaining coverage of existing conditions . Absolutely. The president has made this as an ironclad commitment from him directly and it assured by his of administration, i can assure you can which is first off its in statute already in hipaas that pretty conditions the present conditions are comfortably at at people with preexisting conditions will have access to affordable healthcare enhancing options. That commitment is there. Obamacare, while it has insurance for individuals with preexisting conditions, its not always an affordable solution for them. We got to stop talking about this as it we are living in the land of milk and honey with obamacare. When you are a couple that makes 70,000 a year and you are living in nebraska and having to spend 38,000 a year on premiums and 12,000 12,000 in deductid jeff preexisting conditions, thats not actual affordable healthcare financing for you. We do believe there are ways to approach this working with congress. We do believe that our proven mechanisms. One of the fatal conceit of obamacare was you were going to make the Healthy People in the individual market pay more, excessive more to find affordable interest of the less Healthy People in the same individual market. We believe in the protection and Affordable Access to Health Insurance the people who have preexisting conditions but we think about as a societal obligation to help them. We work with congress if the time ever comes to find solutions that help those people get real insurance, real affordable insurance, allow them to the coverage they need while letting Healthy People those who dont have preexisting conditions have insurance that meets their needs at the cost that they need also. I dont know what its been like for you during the time of covid. You look like youre in your office, in dash i ministered to my life is moved on to zoom and skype and the digital platforms we are all wheezed to talk about it but now were doing it. Healthcare is there, telehealth, we have the seal of teledock tk joining us in the pyramid arrested, i think theres a lot of nervousness out there among some people been getting help through new media come new mediums and getting covered right now under the things you play that for people to get that covered but theres a worry thats going to fall back. How much of this new world we entered into of Health Consultations and Health Online if you will is going to remain and remain paid for under our system at we move past at some point, god willing, the covid era . This pandemic has led to a lot of innovation in health care to the president s leadership, the National Emergency authorities that weve been able to use to wait some of the embedded requirements that of ossified healthcare system, kept it as a 1960s stop a delivered. We have been able to break through that with the regulation and telehealth is one of the things we wanted to do for so long but congress has been unable to change the Social Security act to make medicare and medicaid amenable to telehealth. Now thats a male. Ive been traveling all over the world and that thats available. I think wed have a revolution if anyone tried to go backwards on this. This is now an embedded part of our healthcare system. It has changed the nature of delivery. Its brought us back uptodate in the system. We will do everything we can by regulation to keep the gains that weve had that put the patient and the doctor relationship in the center and work with congress to get statutory changes as needed to make sure that we keep whatever is required by statute. Final question. Dr. Fauci this morning was blowing the whistle as loudly as he could in saying, worried about was happening in certain states in the country. A lot of folks need to take this more seriously. How worried are you that america is not getting this right and that theyre going the wrong direction on covid . What we are experiencing in the southeast and southwest and, frankly, seeing emerge in some other areas of the country is aa very Serious Public Health situation, very serious and weve called that out. But it often is phrased as a question about reopening. We dont believe its about the fact of reopening in terms of a legal or regulatory structure. Its rather how are we behaving within that context . Are we practicing appropriate social distancing . Are we wearing facial masks, facial coverings, spatial in circumstances where we cant social distance . Are we practicing good personal hygiene . Went to the individual responsibility in the construct of reopening work, school and Healthcare Systems again. If we dont, we will see results like this. That doesnt say thats every aspect of what we are experiencing but that is definitely the feedback were getting on the ground from these impacted areas and thats why weve been talking about acting with good individual responsibility. Mr. Secretary, great to see you even if virtually so thanks very much for joining us today. Good luck with the challenges that are ahead. Thank you, steve. Good good to be with all of you. Our live Coverage Today on cspan2 includes a hearing on developing safe coronavirus vaccine. At 3 30 p. M. Eastern eastern susan rice from Obama AdministrationNational Security adviser and just ambassador to the u. N. Will talk with Washington Post columnist jonathan capehart. They will discuss u. S. China relations and to potential to be a running mate for joe biden. You can watch all of these online at cspan. Org or listen live on the free cspan radio app. Watch our live daily unfiltered coverage of congress, the white house. Our countries are linked by trade and travel. On issues that matter to you. Our ongoing efforts focus on a mission to save lives, meet the needs of our states, our healthcare workers. Along with briefings on the coronavirus pandemic. Supreme Court Oral Arguments and decision. Thanks coming out to say hello, everybody. The latest Trump Campaign 2020s. Your comments welcome. Be a part of the conversation every everyday with our live callin Program Washington journal. If you missed in our live coverage, watch anytime ondemand at cspan. Org or listen on the go with the free cspan radio app. Booktv on cspan2 has top nonfiction books and authors every weekend. Coming up this weekend sunday at 9 p. M. Eastern on after words wired Magazine Editor at large steven levy discusses his book facebook, the inside story turkeys interviewed by author and Financial TimesGlobal Business columnist. Watch booktv on cspan2 this weekend. Dr. Black seconds emergency medicine physician in new york. You may read some of her postings at yahoo news, shes a medical contributor and the founder and ceo of an Organization Called advancing Health Equity. Doctor blackstock, welcome to washington journal. Thank you for having me. Tell us what is your group advancing Health Equity, what is at about . I form the organization a and half ago in response to Racial Health inequities that ive seen in my clinical practice, practicing over ten years in the Emergency Department. We have some very concerning statistics, blackman have the shortest life expectancy. Black women have highs Maternal Mortality rates and a really wanted to work with healthcare and related organizations around these Racial Health inequities. How do you propose to going about doing that . In a practical way what is your organization doing . I partner with these organizations and i do talk, training, consulting. Trainings are about racism in healthcare, unconscious bias in healthcare just to make clinicians and organizations more aware how although we are, we try to be wonderful physicians and clinicians to people come sometimes our biases actually influence the way we care for people and we have data shows that there and also worked with organizations to ensure they are meeting their Health Equity goals, cherry all patients are having the Optimal Health outcome, as much as possible. Our guest from associate professor of emergency medicine at the nyu medical school. The organization you just mention you for a year and half goes well before the covid19 pandemic. In terms of inequities the pandemic must be really revealing much more that to you . Absolutely. Obviously these are concerns i had as you alluded to before the pandemic i think there are number of people come epidemiologist and researchers and other folks working in the Health Equity space that we are very concerned about health thh and equity it before the pandemic. What this pandemic has done is really exposed and amplified the numbers. Thinking about what weve seen so far we are for months in and weve seen indigenous communities being absolutely disproportionally impacted. Not only in infection rates but who are hospitalized and who died from coronavirus. That exposure and that amplification of those inequities, the problems it is caused in particular among minority communities in some way be a good thing in terms of evolving solutions down the road in terms of legislation, healthcare legislation in particular . What i will say, i dont find to is a good thing. I think its bringing attention to the issue of Health Inequities and i think i, for example, i testify in front the u. S. House of representatives subcommittee on the coronavirus. We had a briefing in early june on the raise this pretty and there were interest in developing legislation to address the inequities that we are seeing. I was happy to testify to talk about the importance of having federal legislation around these disparities because as we know we are going to be in this pandemic for much longer than we expected. What i expect for these committees that have already been devastated come to be devastated even further if we dont have legislation passed to mitigate the impact of the buyers. Our guest dr. Blackstock talking about the effect of covid19, the pandemic on minority communities. We welcome your calls, comments. Dr. Blackstock, given his idea of what your day today work life is like. So i do a combination of, i still work clinically. I have been seeing patients in urgent care since january and its interests because i thought if i transitioned out of the Emergency Department urgent care would be quite simple. Typically we see simpleminded complaints but the pandemic happened as i started saying patients that are essentially where the walking wounded of the pandemic. I have many patients that were even sick enough for me to have to send them to the Emergency Department. What i noticed over those first few weeks at newark city as the pandemic it was my Patient Population which was specifically very racially and Economic Diversity quickly shifted over a matter of weeks to mostly black and latinx haitian spirit. Many of them had been working continuously. They are not have the luxury of working from home. Many were essential workers and Service Workers so they were in effect expose and put at risk to being infected with the virus. Many of them also took Public Transportation and lived in overcrowded housing which we also know are risk factors to being infected. I really had the opportunity, for hundreds of coronavirus patients up until this point back. Unfortunately here in new york state our numbers are doing much better so we are seeing much less patients who are infected what i will say that that experience was quite scary. In terms of minority communities, you address some of the underlying issues. In terms of, is it more because those communities are more susceptible, you mentioned the transportation issues in new york, susceptible to an impact from covid19, or because they are lacking in the adequate resources, access to primary health care, for example . Those are all factors. The reason why we are see disproportionate rates, its multifactorial. Even before this pandemic and this is all we have communities that have high rates of uninsurance, who do not have access to quality care. We also know there are certain social determinants of health. So housing, employment, education all have a direct influence to health of individuals and communities. Even before the pandemic started, these communities carried the highest burden of chronic disease, diabetes, high blood pressure, obesity and asthma which we came to find that were risk factors for doing very poorly when youre infected with coronavirus. And add onto that the other factors such as overcrowding in housing, transportation, and its almost like the perfect storm to make these communities even sicker. Looking hopefully a year or more down the road when the pandemic subsides, what do you hope your organization, the dancing Health Equity, can take forward works what kind of ideas are you trying to take forward for minority communities . In the short term we are pressing for and i provide recommendations to the subcommittee on the coronavirus in house but the recommendations are targeted testing and Contact Tracing infrastructures in black and latinx and indigenous communities. Also managing outreach is going to be very, very critical as we go on in the pandemic the education of a what are the symptoms of coronavirus . How is it transmitted . We know the messenger is incredibly important in terms of relaying these messages to communities. Then in the longterm we need to think about impacting in the committees in the space i mentioned in terms of employment, right, in terms of having sick leave, having personal protective equipment on the job, having access to Home Ownership and we know homeownership is very important to developing wealth and welfare is key and addressing some of the issues we are seeing in terms of Racial Health inequities. What were calling for is really for the federal, state and local governments to invest in black and other minority committees because we will see in the future this pandemic continues and progresses that we will see for the devastation if we dont make social change. The u. S. Passing 3 million cases yesterday, a graphic in the Washington Post come into coronavirus cases and deaths by the david this as a 8 00 class types of this as ghana. New new cases yesterday 62,751 total cases now over 3 million and the deaths yesterday about 897 and that death toll has risen about 130,000. Were you surprised at all by the spike we have seen in cases in states that have reopened . No, i wasnt surprised to be honest. We knew at the very beginning, although there were not stringent federal guidelines about reopening, that you needed to see a certain number of cases, or at least see a downward trend over a course of 14 days, and many of those states that reopened did not have that. Some states were even stable or trending upward as the reopened. So to be honest what were seeing now could been very easily predicted because when you dont have the virus contained come when you dont have it under control and you are not using the basic Public Health measures and you decide to reopen, you are reopening restaurants, clubs, bars, youll see what were seeing now in the south and western parts of the country. We have calls waiting and go first to jimmy in farmington missouri. Good morning. Caller good morning. Just wanted to say that right now as anything is going on as everybody minority committees, i think all communities are minorities due to the fact that sometimes people get confused about who to blame and the whole world is watching and if its very hard to run a state, it is very complicated to run the country. Im a longtime democratic, and i believe that the president we have right now is doing his best, and may God Bless America and may god bless the United States. Host any thoughts . I respectfully disagree with that. I think that what were seeing now in look at the case numbers, the desk weve had in this country compared to other countries, compared to europe, compared asia, compared to even caribbean countries, right . What were seeing is a lack, clear lack of an effective federal leadership. Also of a Clear Strategy for containing this virus. We know that our basic Public Health measures that mitigate the spread of this virus. The fact is, its as if we have 50 Different Countries and the United States. I bought is doing their own thing. I think we had a uniform strategy that we would have had more success. Host you talked about protective equipment a moment ago. This is from the Washington Post. Cases spike. Healthcare workers again short of protective equipment. Healthcare workers on the front lines of the coronavirus pandemic our accounting shortages of mass, gowns, facials and close. Afflicting occurrence of a struggle that haunted the first months of the crisis. Why has this continue to be such a problem . Guest that such a great question. We know in the beginning that we had a a shortage and a lot of t was due to supply chain issues but also due to the fact that the federal government did not take a lead on ensuring that we could procure large amounts of personal protective equipment. So again i had to go back to we need to have a uniform strategy, and the federal government needs to be involved in that. It also the issue is that we have this shortage and then we started having reopening. Reopening happen and we are seeing surges in the south and west, and so those hospitals dont have enough ppe. We are also seeing Outpatient Clinics and offices open as well, and those clinicians and step also need ppe. We have even a larger demand for personal protective equipment now that we had previously but we had no strategy or no National Strategy to obtain large amounts of ppe. Host lets hear from share in dallas, texas, next up. Caller yes. I wanted to know since the coronavirus [inaudible] host dr. Blackstock, were you able hear her comment . Guest no, i wasnt able to hear that question clearly trying it was kind of muddy on my in. We apologize about that. Well go to john in virginia. Go ahead. Caller thanks for taking my call. Doctor, thank you for a circuit and i appreciate you give us the best advice that you can give. I would like to all of it the gym new called earlier and say community. The black people in this country, they have been suffering for long time and they have a lot of existence that they have but thats not what i call the doctor, the problem is we have a president who is challenging our doctors or telling us what need to be done and how can we use this disease. That doesnt mean that wearing a mask is that you get medication. You are protecting yourself and protecting the others. I would know for sure about a surgery with my wife without having a mask because you are not going to do it. I just came back from new zealand and i can tell you one thing. I am surprised how people are following Doctors Orders and guidelines. Thank you very much. I was looking for that experience from new zealand, doing a tremendous job containing the virus and that could be an example for this country. The other thing you mention in terms of this Administration Needs to follow the advice of Public Health experts, they are experts for a reason and they know what intervention works, universal masking, washing hands, physical distancing all work and we saw that in new york city. We had some scary numbers, preventable deaths and we saw what happens when we shut it down and we saw numbers go down