Transcripts For CSPAN2 Washington Journal Dr. William Moss 20240712

Professor at Johns Hopkins Bloomberg School of Public Health. Doctor moss thank you for joining us today. Thank you for having me. Host a little bit about your work on the Vaccine Access center. Talk about your international aspect. Guest International Vaccine axes center we celebrated our tenth anniversary just last year and our main focus has been to ouincrease access to lifesaving vaccines throughout the world. Traditionally we have been focused on childhood vaccines particularly making sure that those acts as in africa and asia and that the vaccines are reaching the most Vulnerable Children but weve also been very involved in thinking about covid19 vaccine and particularly how such a vaccine might be distributed, how we will ensureow its safety and efficacy and how we will get equitable distribution of a vaccine around the world. Host with that in mind how does that apply to the current efforts going on with coronavirus . Guest there are a number of initiatives both at National Levels and particularly here in the United States and that the global level led by the Global Health organization and trying to think about how we are going to distribute the safe and effective vaccine to those people who most need it and particularly given that we are not going to have sufficient number of vaccines doses initially to cover all people interested in getting the vaccine so we are working on thinking through ways in which a chvaccine should be allocated. We are thinking about how to buildt trust in communities and this will be a very important issue for our covid19 vaccine because many of the most vulnerable populations have some mistrust and something about vaccines in general and others about this particular vaccine. Host you wrote in a recent piece in the atlantic that the topic of coronavirus the success of vaccine hinges on community trusted backed scientists which requiren transparent evaluatios of honest commute occasional potential harms. Your stand on that. Guest you know, as everyone knows and your listeners will know that this, these efforts to develop and evaluate and approve a vaccine for sars, coronavirus two or covid19 has been accelerated and we want to accelerate that process. We are in the midst of a terrible, tragic pandemic. We need ways to shorten that traditional timeline in order to have a safe, effective vaccine approved and available for those who need it. Part of this, part of having a vaccine work and other people have said this, just having a vaccine is not good enough. People have to be willing to take that vaccine so we need to build the trust in the process. There are ways to accelerate the Vaccine Development and we are seeing that in full force but that doesnt mean that safety and our knowledge of vaccine efficacy needs to be compromised in any way. I think this is a important point to get to listeners that there are ways to move a vaccine forward more quickly than is traditionally been done in the midst of a pandemic and yet maintaining the integrity of the science and maintaining the ethical standards that are required and we can talk more about these but some of them are combining some of the early phases of vaccines testing, particularly phases one and phase two that we have two find those more and i think particularly what we are seeing with the covid19 vaccine is the large investment, largely funds in the United States government to build a manufacturing capacity while the trials are going on and that can greatly expedite access to a vaccine. Host 2,027,488,000st1 mac 2eastern, 202 7488001 fountan and pacifics so the trust doctor when you see then astrazeneca saying theyre putting a pause on some of their testing for concerns house of the public take that . Guest thats a very good question. What we need to reassure the public is that this is how to process should work. Astrazeneca is testing a vaccine that we developed at the Oxford University. It is what we call and add no virus vaccine and we can talk about the different types of covid19 vaccines and c they are conducting large phase three trials in a number of countries, some combined phase two, phase three trials that are ongoing and what they identified was an adverse event. What we call an adverse event. That is exactly what these trials are meant tot detect. We heard through the news that one individual who received their vaccine developed a condition called transverse myelitis in this is an inflammation of the spinal cord that can be triggered by autoimmune diseases, immune system disorders and possibly by prior infections and even vaccines although we dont really understand in detail how this disease comes about but it is some type of immune reaction of the body against a part of the spinal cord. This was detected and they rightfully paused the trial and what they are going to try to do is see if there is any reasonable evidence to even suggest that this adverse event might have been related to the vaccine but i want to point out that very difficult, very difficult to determine whether a vaccine causes this type of rare serious adverse events but i would state the first thing the public should know about this is this is the process as it should work. Adverse event is identified in the study is paused and they look very carefully at the evidence and all these trials have what are called independent data safety and monitoring board which is a independent scientists who are invested in the vaccine, arent part of the Research Team and they look very carefully at the evidence. They will make a determination as to if and when the trials should we start. Host since you talked about the International Nature of the Vaccine Development and who gets the vaccine it is interesting that the majority of cases in the United States says that automatically suggests that those in the u. S. Will be the first ones to get the vaccine. Guest rswell, it will depend first of all in parts where the vaccine developed and which country has put the investment, Financial Investment and there is no doubt that we are going to have a limited supply of a vaccine or one or more vaccines early on and they will have to be decisions made on prioritizing who gets it. Because of the large investments made by the u. S. Government it is highly likely that citizens of the United States could be one of the first to get eight covid19 vaccine. We already know the vaccine being administered, perhaps prematurely and we can talk about this in russia and they have granted limited approval for vaccines to be used and this received a lot of criticism justifiably because they had not sufficiently completed the large phase two trial and they demonstrate efficacy. I think it is the largescale rollout may happen first in the United States because of the large investment of the u. S. Government into Vaccine Development and the commitment of several pharmaceutical companies and vaccine manufacturers to provide vaccines to the United States but we will face a very challenging set of decisions about who in the United States gets prioritized for a vaccine early and there are a number of groups thinking through that process. Host doctor william moss our guest to talk about Vaccine Development with john hopkins. Our first call from you comes from washington dc, doctor. You are on with doctor william moss. Good morning, go ahead. Caller thank you. Y when you called in [inaudible] i have a general comment to make that trust and building trust. I think that the key is to get politics out of medicine. I think it plays two for large a role. I have a rare cancer [inaudible] would like to thank President Trump w for getting a drug approved that prolonged my life and it was not a cure but it has kept me alive and it was [inaudible] and this drug was available in europe for decades and we didnt bring it to this country and i think it had to do with money and that doesnt make sense to me but anyway the fda would not approve this drug and it had been discovered in the netherlands at the university of erasmus i think and so Much Research has been done, so much scientific documentation in the fdad could have rubberstamped te Clinical Trials and all the research and approved this drug. Host we appreciate it. Doctor, go ahead. Guest yes, thank you. The caller makes an interesting point. First of all the role of the food and Drug Administration and the fda to ensure that drugs and vaccines that are approved in the United States are safe and effective and that is their main goal. The public needs to have trust in that process and i agree with the caller that if politics is even perceived to be involved in that process that results or can result in serious mistrust in the public and i think unfortunately there have been a number of instances in the past few months within this pandemic where decisions by the fda have been questioned related to the emergency use authorization of hydroxychloroquine and some of the statements around convalescent plasma. That kind of mistrust of the decisionmaking process t and te approval process at the fda has serious implications potentially for the approval process for thl vaccine. We have been assured that process will be free of politics and we have seen nine vaccine manufacturers pledge that that process will uphold scientific integrity so having politics even the perception of politics, interfering with the approval process, undermines trust in the vaccines. I will also point out and i think its important for listeners to be aware that we need to be much more rigorous in the approval process for vaccines then we are for drugs for diseases. This is because one vaccine are given to Healthy People, rather than people with disease so that riskbenefit ratio is different for vaccine they are given two huge numbers of people rather than compared to drugs for individuals with diseasespe. Covid19 vaccine could potentially be given to hundreds of millions, if not billions of people in the world and lastly if there is mistrust of a cove in 19 vaccine there is a potential for spillover effect where that leads to mistrust of other vaccines and could undermine our whole immunization system that has been so highly successful in preventing many lifethreatening diseases in the United States or globally. Host barbara in massachusetts. Good morning, you are next up. Caller i have an idea for confidence building which is this. We have seen once a video of emergency docs and nurses and respiratory therapists and hospitals treating the people and it makes complete rational sense that those people should be the first frontline people to get the vaccinesto but what s also important is they are the most highly educated in medical and scientific fields so if those emergency room doctors have a professional association through which they can communicate the fact that they have reviewed the data and they trust it and furthermore they are taking it. Even if there is some way to have a simple website that has the names of the nurse or person who administered the vaccine to doctor and then theyre both going public same i have administered it and i took it. That would be a tremendous confidence boosting. If my gp takes it and he tells me i took it because i validated the data and i consider it personally save that would go a huge weight and buildingui confidence for me. Last thing i want to say, on the estrogenic at trialhe did the person who got the negative meningitis thing himself or herself have the meningitis vaccine . That would be fascinating to know. Host thank you so much. Guest barbara, she makes a good point about she is addressing the issue of how dow we build trust among the general public and in specific communities. She is raising the point that one of the most trusted voices and this may be emergency room doctors and people who are on the frontline fighting and working to save patients with covid19. There have been and there are ongoing efforts to try to think through what that prioritization process or allocation process would be. One came out of the center for Health Security which is my own institution at john Hopkins Bloomberg of health and the National Academy j of medicine also has a High Level Committee of thinking through these issues and as barbara raised frontline healthcare workers in addition to people who are most vulnerable from severe disease or dying from disease, essential workers in the economy those are the type of people who will be prioritized for a vaccine andr i completely agree with barbara that if those people can come out and say that they have reviewed the data and they have felt that this vaccine is likely to be both safe and effective and they tested the vaccine, that could be a powerful voice in the community. We also need to go beyond that and have other community leade leaders, celebrities, people who have influence come out when the data is available and the experts agree that they have a safe and effective vaccine and to help build the trust within the communities. I want to highlight the fact that we need to build trust in communities of color. Justifiablyities have had mistrust of the government and of science, scientific experiments because of some of the history but these are the communities that had been really most effected by the pandemic and working through Community Leaders whether these are religious leaders or other Leaders Within the community that can help build trust. This is really important. I want to clarifyy one point tht the adverse event as reported in the astrazeneca trial that is something called transverse myelitis, it is not meningitis and it is not due to the bacterial causes of meningitis for which we have vaccines. Host follow up to that, this is from a viewer on twitter that when a trial is paused the study and adverse event does they tweaked the vaccine based on the event or does the entire process stop . Guest good question. The process stops in order for the data safety and monitoring board, this group of independent investigators as well as the investigators engaged in the Vaccine Development and testing can do their best to try to understand, whether that adverse event is likely related to the vaccine. As i said, from one single instance it is impossible to directly say that the vaccine was the cause so it is a judgment call of a probability and it is important that this deliberation and view of the evidence goes forward as rigorously as possible. I think it is unlikely after a single adverse event like this that there would be any modifications made to the vaccine and certainly one would have to have a better understanding of first whether this adverse event was thought to be causally related to the vaccine and what the actual pathology might be. My own speculation is that there are not makingti changes to the vaccine but doing their best to try to understand whether it is possible that this adverse event was related to the vaccine. Just to give you an example what they might be looking at, look at the timing for example. When did this occur after vaccination . If this occurred, lets say one, two days after the vaccine, its probably less likely that due to the vaccine. That is too early to develop or for the body to develop this autoimmune phenomenon. To that is one example that the investigators will look at in the timing. Host North Carolina lori, hello. Caller hello. Host you are on, go ahead. Caller i would like to say i appreciate doctor moss acknowledging the vaccine history here in america and that you know it is not been a good one. I would also like to ask about people with preexisting conditions taking this vaccine. There were numerous gulf war veterans who took experimental vaccines who have had Adverse Reactions and how this new vaccine would interact with vaccines that w already have ben administered to them and i would also like to have doctor moss address Robert F Kennedy juniors lawsuit against the government over vaccines and there are 32 years of not doing any kind of studies on some of these vaccines. I would like to get his comments on those. N thank you. Guest yes, first let me say that vaccines have been and continue to be one of our, if not the most important Public Health intervention. Vaccines have saved hundreds of millions of lives around the world and there have been adverse events, numerous adverse events following some vaccines and some vaccines have been withdrawn because of that but the vast majority of vaccines have been well studied and have been shown to be safe and effective. I am a big vaccine proponent and i dont want to give listeners the indication that vaccines are not an important part of our toolkit in fighting diseases. That said,d, the purpose of the Clinical Trials, the phase i, phase ii and phase three Clinical Trials that enroll an increasing number of individuals art is designed to detect adverse events and to make sure that the vaccine is both safe and efficacious against the disease of interest. That is the process that we are going through. In terms of comorbidities i dont think that there is a likelihood that any prior vaccine will have any impact on a covid19 vaccine. The caller does raise an important point about this, a new covid 19 vaccine being effective in people with comorbidities and what the particular interest are people with those cold morbidities that placed them at higher risk of severe disease or mortality from covid19. We know for example that individuals with asthma or individuals with diabetes are at higher risk of severe disease. The elderly are at higher risk of severe disease and we want to make sure thate. A new covid19 vaccine is effective in these populations and the populations that are most vulnerable to severe disease. Whatwh has happened with aging s the immune system changes in weekends and so vaccines have made effective and Healthy People may not be effective in the elderly or older adults and maybe elderly older adults need more doses and maybe they need something that we call and adjuvant that closes the immune response but i want to make an important point that we need to understand how that vaccine works in individuals with comorbidities and in the elderly, the most vulnerable populations and we need to ensure those people are participating in these phase ii trial so we can have a better understanding before the vaccines become approved. Host doctor, earlier on you talked about russia and china. Could you clarify their role in the process . Guest yeah, both china and russia are working and have worked on covid19 vaccines and there are a number of vaccines in development and china of different types of Chinese Companies working on messenger rna and dna vaccines and my understanding is that the Chinese Government has approved the use of these vaccines and limited populations. For example, military populations. In russiaxa too much fanfare of Vladimir Putin announced the approval of the vaccine after some very early small phase, phase ii studies and those were recently, the results of those trials were recently published in a premier medical journal and what it shows is they use an adenovirus vaccine and it was interesting they used it with two different types of adenovirus effective vaccines, one called adenovirus 26 and the other called adenovirus 25. These are two different human and no viruses and i will just say aside the astrazeneca vaccine developed by Oxford University is a chimpanzee and no virus vaccine but these early publications from the phase one phase two trial so that vaccine is safe in the short term and we can get back and induced an immune response that potentially was protected but we dont know for sure whether a vaccine will be protected until the large phase three trials. If those letters free phase trials on 30000, 40000 people where we can really tell where we look to see whether a vaccine protects individuals against covid19 disease. Host doctor, you may have seen this but theres a story in usa today when it comes to research that there is a monky shortage when it comes currently going on and could you tell us what that means as far as the testing process. Guest yeah, so most if not all vaccinesos or all undergo before they enter into humans undergo preclinical testing and this is preclinical means the t vaccines being tested outside of humans and some Early Research on vaccines can involve just cells growing in a laboratory or test tube in a laboratory and what happens is the next phase that looks promising and the vaccines move into animal studies. They often begin with small rodent studies that studies in mice but monkeys provide what are called nonhuman primate studies and provide a better glimpse as to what may happen in humans than from mouse studies. Just because the immune system and the immune response to the vaccine is much more similar in a monkey than to a human then a mouse immune system is. Imso, a shortage of monkeys migt impact that preclinical testing stage that we know we have currently have more than 130 potential covid vaccines in development that at least nine and later stage trials in humans so there is a very large tight line already of potential vaccines and i have no doubt that we will have multiple vaccines against covid19 eventually. Ga host oklahoma, matt, go ahead. Caller thanks for taking my call. As far as to speak about the trust and vaccines idea i think what gives a good example here is the explanation, you go off into the weeds of multi trials and stuff like that and im going to give you two questions i think spell out some of the apprehension people have. Have there ever been any more vaccines save for any of the krona viruses and any other rhinovirus is because those people are under the impression you cannot cure the common cold and the common cold can, if i am correct, be called by other corona viruses and other things like rhinovirus we dont have vaccines for that. My second question is when you are elderly and populations arent passed away how many people the pathway from Natural Causes at any given time in the last couple of years test positive for any virus just any virus . If youre looking for dna sequence at this point what stops from another sequence popping out and discovering it in a large population. Take your answers off the air. Guest thank you. Two interesting questions. So, with regard to the second question around detecting viruses, the caller raises the point that in our nose and in our nasal cavities we can have viruses such as corona viruses or rhinovirus is that because the disease or that cause illness, may be cold but that this nucleic acid whether rna viruses can persist for some time and that is true that the nucleic acid can persist sometime in the body after the acute infection but is still not entirely clear whether these are just fragments of nucleic acid in the virus or actual complete viral particles. They could very well just be fragments of ribonucleic acid that cant cause disease and that can be transmitted and i dont think that is a big problem in estimating the number of covid19 deaths. I think that is the invocation of the callers question that if on what we might call a postmortem study after death if we look for potential pathogens we can find evidence of viral nucleic acids and it is not always clear. I think the caller is correct. It is not always clear whether that what is causative in the death or not. I think we do haveca good evidee about the access numbers of death and the deaths due to covid19. My guess is we are probably underestimating those deaths for a number of reasons. With regard to the first question about other vaccines against corona viruses the listeners will remember that the sars coronavirus one wasnt, was an epidemic in 2003 that affected a number of countries throughout the world and there was work to develop a vaccine against sars coronavirus one and the epidemic went away because we test that vaccine and another coronavirus is a middle eastern respiratory virus that has resulted in some sporadic cases largely in the middle east, largely due to contact with camels and it is not a pathogen that is directly transmitted from human to human and there were vaccines developed against that as well but it wasnt just asnot, it wasnt able, we were t able to do the large phase ii Clinical Trials because there werent enough cases but some of the laboratories that worked on the sars coronavirus one vaccine and a mers vaccine had a jump start in directing and in developing a vaccine against sars coronavirus two. Rhino viruses are many different types of rhinovirus and can infect humans but that is one of the challenges of developing a vaccine against rhino viruses that there is multiple different types and it makes that Vaccine Development that much harder. Host florida, barbara. Caller i am so glad youre and put my number in many mornings but this is the first time you ever answered. I appreciate the washington journal in meeting all these wonderful people and being able to speak. I am 92 and i would be willing to set myself up to take the virus and the injections but my children would not want me to do that but i am glad we have these wonderful scientists, doctors and everybody working on this virus. Host barbara, now that you are on with one of those people would you like to ask a question . Caller the question is how long do you think it will be before we get to the virus or the injection for the average person . Host thank you, barbara. Guest thank you, barbara. God bless you. The question about when we may get a vaccine and particularly for the general public is a really important one and it is one asked over and over again and maybe i can try to give out listeners a sense of why there is some uncertainty about that. I will just give barbara my guess is i think for the general public we are probably waiting or might have to wait to may 2221 before the real manufacturing is scaled off and we have enough doses but may be earlier than that. Here is what determines the timeline at least from the phase three Clinical Trials so first we want to ensure that the vaccine is efficacious and that it is protected against disease and the way these phase ii trials work is people are randomized so chance is used to determine who gets a vaccine, andgets a placebo vaccine this is the best way we have called randomized Clinical Trial of determining whether or not a vaccine or drug is effective and so what happens is volunteers in these studies are randomized so chances are used to determine who gets vaccine and who doesnt and then they are followed over time to see who gets the disease. If the vaccine is effective what will happen is that there will be fewer cases of covid19 in the group that got the vaccine then in the group that didnt get the vaccine. It takes time to accumulate these cases in the vaccine arm. We use the term arm compared to the placebo arm and in a pandemic where a lot of people are getting infected that will happen much earlier, much faster than perhaps other vaccines where we are not in a pandemic and we have to wait much longer before enough cases to accumulate in the two arms. What one thing that determines that timeline is just how fast people are getting infected who are participating in these trials. The vaccine manufacturers and investigators running these trials try to set these trials up in places where there is a large number of infections but sometimes other factors may play in. Maybe there isso changes in behavior, more mask wearing, more social distancing which is a good thing but from a Public Health point of view and we want that to happen but it can slow down the number of cases in each arm and just take longer to get definitive results from a phase ii trial. P the other thing is we talked about we want to be sure about the safety of the vaccine. What we can determine early on in a phase three trial as people get the vaccine are shortterm side effects. Usually this is the people that get pain or soreness at the site of injection and if they develop a fever and did they develop muscle aches or joint aches and those are the kinds of things that we can see early on in a phase ii trial. Its only much laterwhwh, perhat the end of the phase two trial or even after a vaccine is approved that we really have the ability to detect ain rare advee events. Rare adverse advents are just impossible or very difficult to detect and even large phase three trials so it is very important that countries that introduce covid19 vaccine have a Surveillance System set up so they can detect any potential rare adverse effects. Host gainesville, new york. Good morning. Caller morning. I wanted to say that i lost my trust in vaccines and therapeutics largely because of money. People have called it politics but back in the 80s it was very different. O a friend of mine had aids and his friends of his were dying from pneumonia and waiting for this trials and there are already things we are working for which was discouraged and it concerns me and also there are medicines. Ural im in my mid 60s and take a flu shot and healthier healthier than all the people in my age to get the flu shot because i go to the hard work of having a very Healthy Lifestyle and keeping things in my household at the first sign of any problems i wash my hands in my face and my nostrils when i come home from being outside during flu season and during corona and im concerned about mask wearing with the germs of the master my own terms becoming a very high level where they are going to make me sick and the people that have to wear them for eight hours a day back in the 80s i note the cdc was saying that i couldnt be with my friends any food left over that his own germs would multiplyy and could certainly with the poor immune system could kill him in that case. I dont intend to take the shot and i would like to know if you have any comments on that or anything that convinced me otherwise. Guest yes. Thank you. I know there arent many people in the United States who feel similarlyy. First i will say that there is no doubt that a Healthy Lifestyle, good nutrition, exercise, frequent washing of hands very important Public Health measures and people who practice Healthy Lifestyles are at lower risk of severe disease and death from covid19. However, i am a Public Health practitioner and researcher i firmly believe in the value of vaccines. Vaccines are not perfect. A i think part of the problem in the United States is thatit some people may want the perfect vaccine and the vaccine that protects everyone in the vaccine that has no side effects and unfortunately we live and an imperfect world and we have imperfect vaccine but the benefit of vaccines far outweighs the risk from a Public Health point of view. There are diseases in the United States that use to kill many, many children, smallpox, measl measles, polio and we dont have those problems anymore in the United States because of vaccines. We do not have to worry about our children dying of measles because of vaccines. I also understand the collars concern about a new covid19 vaccine and we are in unprecedented times with this and for a number of reasons we talked about earlier the vaccine pipeline has been accelerated but i want to emphasize i dont think that has compromised our assessments of safety and efficacy. Weve got some of these vaccines that are moving forward in our novel vaccine platforms. Vaccine platforms, rna vaccine for which we dont have a license vaccine and the adenovirus vector vaccine was the first license in july of this year for ebola. These are new vaccines and i can understand that people have or are have concerns and i think rightly so. We want to make sure that the science is processed and we want to make sure that the communication around these vaccines is transparent, open and telling the truth and that if there are concerns about adverse events that come out of these phase ii trials Like Astrazeneca that those are communicated to the public and the public knows. I think people will have a choice about this vaccine. I dont foresee that there will be any kind of government mandates about this vaccine and there could be some employers that required that their employees get vaccines and they dont particularly healthcare workers were dealing with patients and there could be some that butnt around people will have a choice and its up to the Public Health community to communicate very clearly and transparently about the benefits of the vaccine and the safety of the vaccine. Host new jersey, good morning. Caller good morning. Im 76 years old and healthy man but about 14 years ago i was tiled all the times my regular doctor sent me to a world cancer to test mehe went and found i had epsteinbarr virus and said i was loaded with it and said by the way, your immune from hivaids. I never get the flu and i do get colds and headaches and i still suffer from epsteinbarr virus but i am wondering could i be immune from the coronavirus and if i am i was never tested but if i am good my butt help a person infected with coronavirus and good my butt help him cure his coronavirus and that is my question. By the way, Rolling Stones [inaudible] guest so the caller raises a number of questions. First of all i will say epsteinbarr virus is a very common viral infection but it can cause some severe infections virus and that can cause mononucleosis or one of the main causes of mono and many listeners may be familiar with that but its also associated with the number of different cancers including adi cancer in africa called burkitts lymphoma and other cancers and it was the first virus that was known to cause cancer. We now knoww of others with the human papilloma virus. I am not sure about the callers statement about resisting for immunity but i will say coronavirus are very different types of viruses. I would not expect any crossreactivity with other types of viruses but the caller makes an important point about one is whether infection with other corona viruses and we alluded to this earlier that coronavirus there are a number that cause the common cold type illness in people and i think it is still unclear whether there is any kind of cross protection across the different coronavirus and this is an important area of research and whetheran someones blood can help someone else with coronavirus that is the whole issue of convalescent plasma. It is an old idea going back to the late 19th century about whether you can take blood, really the plasma from individuals who are recovered from an infection and that plasma has antibodies to that virus or pathogen and in this case cars sars coronavirus to and whether administering those antibodies as someone who recovers from covid19 to someone else can help them is a really important Ongoing Research question and there is although it is controversial right now but there is some evidence that this may be valuable in some patients, particularly when it is given early. Host from eagle, idaho, jo joel. Hello. Caller hello. Question, are they still using the monkey and my second question is does the, youve talked about the efficacy but does the efficacy very whether it is stage two or stage three . My third question is does the efficacy very with say a common ailments like asthma . Ill take my question off the air. Guest those are interesting and great questions. The first one the use of rhesus macaque as animals to study vaccines the answer is yes. It is one of the most commonly useded monkey and medical, biomedical research. The second question is around the. Host efficacy. Guest yes, measuring efficacy. The caller use the word phase but all refers to phase two and three. Efficacy, efficacy is only assessed inin phase three trial. What is assessed in phase i and phase ii trials are what are called immuno new just to does the vaccine induce a measurable immune response and so but it doesnt tell whether that immune response is protected so efficacy really only comes out of that phase three trial. Host when it comes then, were talking about the International Efforts is there a combination that works on various stages of trials . Guest yes, first of all maybe i will answer that question that there isi an efft called kovacs and a large global effort to coordinate the Development Distribution and allocation of covid19 vaccines. It is a Coalition Led by three large and very important organizations, they are charged with developing new vaccines by gabby the Vaccine Alliance which is a really important Global Institution that gets vaccines to those particularly children to focus on childhood vaccines in low Income Countries and the world Health Organization that develops the policies around who should bee prioritized. There is this global effort to coordinate a responses. For individual vaccines like lets say the astrazeneca vaccine that we have been talking about they will conduct their phase three trials c in multiple countries, brazil for example. And the United States. At the individual vaccine manufacturing level there is global coordination but what i really want to emphasize is this kovacs initiative that is a coordinated global effort. Host and the matter ofol politics the president of the United States is speaking out against the world health anorganization and is that ultimately affect the work done on developing a vaccine . Guest yes, i must say im troubled by that. Ive worked with the world Health Organization and many of my friends are there and these are the most dedicated, committed people to Public Health i know of. To hear them disparaged like that really pains me. You know, i think the United States not being a part of this global effort, i see as a real tragedy actually. They will move forward in other countries will step up but this really should be an effort in which the United States is fully engaged. Host doctor william moss, executive director of the international Vaccine Access center, also professor at Johns Hopkins Bloomberg School of Public Health talking to us for the last hour on the topic of vaccine and covid19. Doctor maas thank you for your time and expertise today. Guest thank you, peter. Memorial in shanksville pennsylvania live coverage of the 19th anniversary of the terrorist attacks on cspan, cspan2 and cspan three. Online at cspan. Org or the free cspan radio app. Providing federal Financial Aid for states and territories dealing with economic pressures and budgetary shortfalls caused by the coronavirus pandemic. The House Financial Services committeerd