Transcripts For CSPAN2 The Hill Discussion On COVID-19 Response Supply Chains 20240712

Thank you for joining me for covid19 and a responsible rx supply chain, a look at the prescription chain during a global pandemic. Id like to thank our sponsor the Health Distribution alliance for support of todays program. The pandemic has upended our lives and forced a new normal upon us. While accommodations can be made for our lifestyle choices theres little likability when it comes to our healthcare. When patients for chronic diseases have access to regular medication it isnt a choice and in some cases its amatter of life and death. Both the Healthcare System and patients have changed their behaviors. As a consequence concerns and fears have arisen surrounding drug availability and shortages. What are stakeholders doing to ensure disruptions do not occur and theres collaboration between the public and private sectors and what plans are being put in place for distribution of this corona vaccine once it becomesavailable . We discuss all of this with some of thesmartest minds in Health Policy but before we get underway , you can tweet us at the hill advance, thats altogether. In the hashtag, but hell rx supply chain. Hell rx supply chain, where well be taking a question through the program and i look forward to. If youexperience trouble with the live stream , refreshing it will work i hope. My first guess is Health Expert on the front lines in the implementation of the Affordable Care act. Governor, secretary kathleen civilian served as health and Human Services secretary under president obama and is the ceo of severely are resources which provides resources to investors and nonprofits and shes my go to person when it comes to issues of knowing what a smart Healthcare System looks like so kathleen, great to see you. Lets get to thepoint. You oversaw many of the institutions that we are now looking at today to help save this country whether its pushing the time curve or developing a vaccine and distributing it, whether its on how you approved various dimensions of this in therapeutic. What would you say is going well , what would you say as a fan all its good to see you stephen. I dont think theres any question that the socalled operation warp speed, having the United States government that on the number of possible vaccine candidates for leon push pipeline has really accelerated the possibility of getting a vaccine for a brandnew coronavirus faster than people could have anticipated and thats, that will be beneficial to the United States citizens and hopefully to the rest of theglobe. I say that collaboration, cooperation looks very good and the early investments makes sense so far not Companies Really are drilling down on massive Clinical Trials and looking at safety results and hopefully competing to get to the starting line 1st so that we can have a number of effective, safe vaccines in record time. The various bad news again, speaking with just the Vaccine Development is that at every point along the way this white house, this president has undercut public science, undercut confidence in the Public Health messages and by doing that, may really have discouraged a lot of americans from ever volunteering to getthe vaccine , ever believing that it is safe and effective. So that is really nothelpful. Communications , strategies, clear effective scientifically based communication on the start is part of any Public Health crisis about any Public Health recovery and tying the vaccine to his political election which President Trump has done for months and months, suggesting that there will be an october surprise, there will be an effective vaccine before the campaign, there will be something coming out makes people feel like its being rushed and we are not on track for safety and effectiveness, we are on tracks from some kind of political gimmick andnothing could be more harmful. To the confidence that were going to need for a massive Vaccination Campaign and so that has some good pointsand bad points. I would say in the rest of this coronavirus response, weve seen much of the same. Public science which has evolved over time and scientists have learned more and collected themselves when they learn more. Undercut consistently by the white house, who has a very different agenda in mind, not Public Health and safety but getting the economy back running as quickly as possible, regardless of the depths, regardless of the disease. So weve had a Point Counterpoint in the United States and i think the clearest indication of that is Johns Hopkins in the fall of 2019 gave grades to countries around the world or pandemic readiness, not knowing what we were going to face. The United States was regarded as the most prepared , best prepared country in the world and yet we have had i think quite simply the worstresponse for any developed country in the world. You were featured recently, you were one of the stars in a new movie called totally under control which profiled the response thus far in responding to the pandemic, managing everything from operation warp speed to other dimensions of this and myquestion is the real heroes that pop out in the show , some governors that are , were issuing ppe, companies stepping up and part of the discussion today is around apply chain and the coming drugs and therapeutics and whether americans can have confidence that there is an infrastructure out there thats dependable enough that they can have confidence and faith in, regardless of the leadership and i wonder how you can see that because you sauce saw state competing with each other over masks and gowns and im wondering when a vaccine rolls out,will we be able to have the confidence it will be wellmanaged . We would only have the confidence if we have a National Plan and i think its clear that the current president does not want a National Plan. He has pushed every issue onto states and sometimes into the private sector in a way that is not transparent to anyone and puts burdens i would say onstates as a former governor that they cant possibly achieve. So ppe is a great example. Rather than the United States mobilizing efforts through the defense production act to make more stock in america, to get it ready to go, or to use their incredible purchasing power and previous global contexts to purchase ppe and then distribute it on a fair and equitable manner, use the Defense Department logistics to make sure that equipment and machinery was at the right place at the right time , that we had everything from a virtual inventory to where there were extra beds to where there were personnel, the federal government under donald trump washed his hands of it and said its up to the states. So states competed against one another, states competed against their own health system. Often ive heard told many stories about states or a Major Health System organized supplies only to have the federal government confiscate it at the border and put it into the stockpile and then have the United States say the stockpile isnt for the states, its for us, whoever us is so weve had a totally misguided and inappropriate response. We need a National Plan in place right away. We will only get that i would say with the new president who has made it very clear that he will have a National Plan. And for Vaccine Distribution, for vaccine integration, for vaccine can indication we need that National Plan to start right away. People have to have confidence in the safety and security but beyond that we need some transparency. Where is the vaccinegoing . How will it be available . Who gets it first . That whole effort has been pushed to the states. States are submitting plans but we need a National Strategy for how this is going to roll out and how we can have confidence in when the fda says we have a safe candidate that that has not been pushed ahead, shoved add or that the guidelines for the fda which have always been the Gold Standard in the world have not then shortened or rushed due to political pressure. I cant even think of the number of Business Leaders, pharmaceutical Industry Leaders, scientists i talk to since this pandemic began and one of the interesting things is while you saw a lot of society frees up and get worried about drug therapeutics etc. , the other side of it is a lot of the companies beyond political control bent over backwards to make sure there were eventually no shortages of supplies so asking whats the right way forward, in a few minutes im going to have to representative melissa slatkin on. She passed legislation on strengthening americas stockpile and as somebody who had heard you what the private sector is doing, what the government needs to do but what are some of the parts of the skeletal structure you think we need to ante up rather than the national thathow you look at the ecosystem and what you think is wobbly right now that needs to be shored up . I think its going to be hugely important steve to do a really indepth after action report. We did that after h1n1 and found we didnt have sufficient manufacturing capacity for vaccines so new contracts were left and you know i think triple the Production Capacity. Thats good news. I think putting back in place the responses, red flags of the National Security within the white house are going to be critical, but i think we need to figure out what of the protective equipment supplies and gowns and gloves should we actually make your in the United States. What makes sense. How we have Production Capacity here to deal with a global issue and everybody in the world is trying to find equipment and supplies at the same time. I think going to need renewed confidence in publicprivate partnership. Pharma has really stepped up but what we know about stockpiles and particularly stockpiles for therapeutics and vaccines is unless the government has a pot of money and says to pharma, its worth your time to invest in the science. The manufacture these and bring them to development, if there isnt a willing buyer, it doesnt happen. Were facing a possibility of Antimicrobial Resistance to antibiotics. We dont have a bigpipeline of antibiotics in this country. Thats an example where with a government pool of money that happens after 9 11 and we have massive resources for making sure that america was safe and secure which means some of the supplies that will be developed are never used hopefully, are never put into action but you have been in place if something happens. We need to be willing to fund proactively in and not reactively. Real quickly, on ascale of 1 to 10 , how, with one being best how bad was the administrations response to covid. I think its bad. I think the deaths we are seeing in the United States are unparalleled for a developed country with the resources that we have. The burden on the black and Brown Community and native American Communities is immoral. That we didnt move much more quickly and tell people the truth and really take the steps to secure the most vulnerable populations so i think were at about anine. Maybe we can recover some territory with Vaccine Development and distribution, but there is no reason in the world that we should have had this many deaths and now we still have almost 1000 people a day dying and the virus, if im in the middle of the country in a rural face, the virus is raging here and its raging in communities that have almost no capacity to deal with it because there isnt the equipment and there isnt the personnel. Secretary kathleen sebelius, im grateful every time we talk but itssobering every time we talk. Thank you for joining us and helping us launch our program. Thank you for having me. Our next guest believes stockpiling medical supplies is an issue of real National Security. Congresswoman elissa slotkin, a democrat from michigan is running for election and joins me right now. I cant tell you how grateful we are for all the stuff you have going on but i know this is a priority for you and its a priority for the country so lets be pointblank, whatsbroken that needs to be fixed . A lot of my experience in sort of the worst of it in march and april really came down to the fact that it seems like medical supplies, pharmaceuticals, just major supply chains that help keep us safe were just so outsourced to places like china we couldnt get a hold of them when we needed them and my experience in the pentagon and the National Security world, it kind of blew my mind that while we still have a preference for making things in america on our military equipment, our body armor, our meals ready to eat, we didnt have the same by american requirements on other things like medical supplies and pharmaceuticals. Obviously the stockpile, we opened that up and a lot of it was expired. Here in michigan we got moldy stuff, a lot less than what we were expecting so we have to make sure theres a better way to stockpile equipment. When we need it. And then in general i think it really combines my National Security background with sort of major american manufacturing. And here in michigan weve been saying for 30 years and if you outsource too far, youre going to get caught with your pants down at some point and i feel like we did. If im haggling with a chinese middleman in the middle of the night for a . 78 mask, something has gone wrong so thats been the focus of our work since basically april. Where does your legislation now, i just mentioned with secretary sebelius, strengthening americas stockpile, i talked to other leaders in pharmaceutical production and they been talking about people who can identify that 100 top most needed therapies and medicines that are out there. And figure this out, that its doable. Where does this stand now . Its a series of seven bills, completely bipartisan. 10 democrats, 10 republicans, built purposely bipartisan. They all passed the house in september and now were in negotiation to have them in the next covid package, this thing that mnuchin and pelosi have been struggling to negotiate. My hope is once we get past the election were able to get something done. Ive been frustrated we havent before the election. And its something that frankly we should be moving on now and the biggest part of it is this 500 Million Pilot Program for publicprivate partnerships. On extra lines, particularly extra pharmaceutical lines for the very thing you were mentioning. When we need to serve and go the American Government has an interest in being partners on additional surge capacity. So thats the part im most excited about. Have you talked to Industry Leaders . How do they feel in terms of their partnership with government and in terms of what they know is going to be a big lift, a big load of new vaccines and therapeutics thats going to have to be deployed to every corner of the country. Are you finding them to the robust partners . Is it a good track or doyou have concerns . We have one of these companies that now being sort of at the ready for when their vaccine is identified. Theyre readyto go and ramp up in production in my district. But weve been talking to them and others about everyone talks about manufacturing more in the United States , but you have to make sure youre talking to the industry to figure out what truly incentivizes people. You cant just decide from washington that you know whats going to bring manufacturing back. We had such a globalized supply chain. We had such an ecosystem that theres a ton of things that come from all parts of the globe and its more thanjust saying come on back. What i want to do is hear from our Business Leaders and i was in this great group called Business Executives for National Security. If done and after action on our supply chain and i was one of the members of that commission that looked at it. Youve got to talk to the leaders and industry to figure out how you properly incentivized production in the United States. It cant be made up from washington. One of the things i wanted to talk about is your cia background, yourbackground as an analyst. I happen to talk this week to rick bright who was the bar to official who said that he was pushed out of that job, he recently came in and he said something and its on alex gibneys new show on the crisis called totally under control that i didnt realize and a lot of people look back to a playbook that was developed during the obama period that was on the shelf gate data simulation. You did simulations in the cia and you did exercises in october 2019 that anticipated this kind of pandemic that looked at all the government responses, that looked at partnership with industry and actuallyunderscored the very weaknesses and decisions that we saw. Is there any awareness that that playbook, not a playbook but that the simulation occurred highlighting many of these gaps . Among your colleagues in congress and the need to fill them . I was astonished to hear that the Trump Administration already had this experience in hand. I dont know how widespread that knowledge is i certainly and anyone with a National Security background form many administrations knows there are people in each administration who look at these kinds of scenarios for a living. I have a whole Homeland Security council at the white house and i know people working over there and i know that there arepeople who were focused on this. Its the difference between having folks in the system who look at the problems and having it rise to the level of Senior Leaders where theyre going to do something about it. The most important thing in dealingwith federal response is intent. You have the will and intent to leave from the white house or leave from washington . I think it was this paralysis that came from sort of not wanting to accept the gravity of the problem, not wanting to accept that the federal government was the best place to respond in a lot of these scenarios. In those two things meant that we just got way too late to start. And while this kind of thing would have stretched any administration of anyparty , the fact that they backed away from that leadership role meant they didnt even see out the expertise that might have already been in their administration. What are the other medical supplies that you think the nation needs and what would some of the partnership with the private sector looklike from your perspective . I think we need to do a soup to nuts look at what are the supply chains with the National Security value. As someone who is from michigan where obviously or never far from thinking about vehicles and vehicle production, theres certain batteries, certain capacity around Energy Storage that we depend on a lot ofother countries four. That we dont want to do without. There certainly is a lot of technology around uber conductors that were at risk of having to depend on other countries. What we actually think we need and i wrote this into the Defense Department budget is through my role in the Armed Services committee is a soup to nuts look at identification of the very specific supply chains with National Security importance. Once we identify that list can look at incentivizing more production here at home. We got to agree upon that list. We have to have a common understanding and be able to review it every few years certainly Energy Storage is a big one that we would be loath to live without. Representative elissa slotkin, i appreciate your insight and what youre doing to think through this ecosystem and how to be smarter and perhaps we have been so ungrateful for your time. I know how busy you are so thank you for joining us for todays program. Thank you so much. My next guest has beena pharmacist for 30 years and is the only pharmacist in congress. He thinks covid19 is the wakeup call America Needs to bring back the supply chain to the United States. Welcome earl buddy carter, for election in a few days again but thank you for taking time totalk to us about this. I just said it, you thinkthis book to be a wakeup call. What needles do we need to move to make surethat america as the supply chain , something that can trust to deal with this pendant . First of all, thank youfor having me. Ive always said theres a difference in knowing something and realizing something. I think weve known for a while that we were too dependent on other countries for our needs but then during this pandemic we realize and having realized it, means that we have to do something about it. And one of the things that we are proposing and that i have legislation called the nation, its active pharmaceutical ingredients, drugs in the us. But what were trying to do is to attract some of these countries, some of these pharmaceutical manufacturers that are located out of our country back into our country. We know that 90 percent of all the output in the world is made in china, 90 percent of our antimonies come from Foreign Countries. Thats not a goodsituation for us to be in. Mind you in the late 70s when we realized we were dependent on the middle east for our energy needs and we realized we needed to have Energy Independence andwe achieved that. The same can be said now. We realize were too dependent on Foreign Countries for our pharmaceutical needs and we need to do something about it, we need to have pharmaceutical independence. Thats why what im trying to do is attract those companies to come back to america, to try to incentivize them and to repatriate them back to america. Through the use of opportunity zones, youre a member they were created in the jobs act and that will actually be a tax credit if they will locate their manufacturing facilities in these areas. We can use other incentives as well, tax incentives. Not the least of which is trying to appeal to their patriotism, that we need you to come back to america. Thats very important. Pharmaceutical independence, not only pharmaceutical but also with pde, we are too dependent on these Foreign Countries for our pde, for our personal protective equipment. We need to make sure were doing manufacturing here in america with that as well. One of the interesting things as ive delved into this and im glad you made a distinction between ppe and the pharmaceutical side but he clearly saw the law of the jungle but if you look and you peel back i think there was a sense of anxiety and crisis about pharmaceuticals, about the benefits but when we got into it i cant find anywhere where they were delivered, at the supply chain largely worked through this time and i just wonder if my bearings are off somewhat because i know that youre working on what our National Stockpile should be and how we should look atwhat the key medicines and therapies ought to be but when we look at the Actual Experience , did things hold together or not . Certainly we had threats and fortunately they didnt come to fruition but we had threats from china who said we are glad to send you this, were going to use what we have to use first and if theres anything left over, then we will send it to you. Thats not the kind of situation we need to be in and thats not in the best interest of the healthcare of our citizens nor is it in the best interests of our national defense. Thats just a situation we should avoid and we can avoid. We do need to get pharmaceutical manufacturing and the same thing ppe. Weve been able to basically get everything that we need but at what price . The price has gone up in or mislead. Youve heard of price gouging that has been happening from Foreign Countries and thats again why we needto address it. I talked to leaders in industry. The pharmaceutical and therapeutics manufacturers and i think theyre interested in kind of partnering with government on things like looking at the strategic stockpile, like doing this but they said in terms of on shoring some of this capacity thats moved abroad, it would require the kind of whole economy system. If got to have longterm purchasing, regulatory changes, you mentioned opportunity zones and my question is is there a place in our government thats thinking holistic week about that environment . Because they said if its done piecemeal it wont work. Youre absolutely right. Weve got to make it worth their while. One thing we have struggled competing with his labor costs and there are going to have to be other incentives in there to make sure that we cover that part of it. And thats why its important that it is holistic as you point out. We understand that and thats why this legislation again addresses all those Different Things and also there are some important manufacturers that are located in the unitedstates already. And a lot of them have been asking the question what about me, and i going to get into this as well . There will be incentives there to attract them to remain here in america thats important and certainly something we have considered. In fact, i talked just a second about the stockpile, you mentioned that a coupleof times. I also have two pieces of legislation that i think are important to address our stockpile. We know weve got a federal stockpile, a strategic federal strategic stockpile but we recognize that weve been too dependent on that so ive got legislation in and its Bipartisan Legislation by the way that im cosponsoring along with Lisa Rochester blunt from delaware, a democrat to address estate 50 stockpile. And what this is is a matching grant, its a dollar for dollar grant to encourage states to have their own stockpile. We found out during this pandemic was we were all too dependent on the National Stockpile and that states didnt have what they should have had in place. This is a Pilot Program as i say that will offer grants to encourage states to havetheir own stockpiles. Thats very important and that will help us even be better prepared. Another bill i want to tell you about and again im cosponsoring with representative rochester is the essential medicine stockpile and what this does is 90 percent of all the drugs that are used are generic drugs and instead of waiting until we have a shortage of the drug, of a generic drug and then stockpiling it, we actually create the Central Medicines that we know were going to need and again, this is a Pilot Program whereas we create this National Stockpile of essential medicines and we utilize the ideas that are being currently utilized in the private sector of perpetual inventories and making sure that we have an inventory of these essential medicines that if there is a shortage at any given time we will be able to have them in for our citizens and thats very important and again, by using that perpetual inventory can guard against a lot of it going out of date and being wasted. I can remember when i was in the Georgia State legislature and the state senate and we went through and we bought millions of dollars worth of tamiflu, it ended up going out of date and we didnt have to use it which was a good thing but we ended up just, theres a new policy that we can get from and the new procedures that we can get from the private sector using perpetual inventory, we can avoid that. I know weve got aquestion from the audience but i wanted to squeeze one more in. I know your role as a pharmacist and i may have this wrong to my mind pharmacists are like in some ways the canary in the coal mine. They know what inflow and outflow is. Are there things we should know about the pharmacists and what role they can play or ending up their role in terms of alerts and what the flow and need is out there . Of various Key Pharmaceuticals . Thats a great question because pharmacists are the most accessible Healthcare Professionals in america. 95 percent of all americans live within five miles of a pharmacist and ive felt for a long time were not utilizing pharmacists in particular but there are a number of Healthcare Professionals at the top of their license and ive discussed this with doctor adams, with the department of Public Health, with secretary lazar, hhs and they all agree we need to be utilizing these assists not only in situations that you described where we see a shortage of different drugs and we can learn about it but also as were going through this pandemic, being able to test for this, being able to administer the vaccine. Most people are getting their vaccines from a pharmacy now, from a pharmacist and we need to be able to administer the vaccine. Thats going to help us to get out to people as quickly as possible and as safely as possible. Thank you for that weve been taking questions from the audience and we have one now from buddy. Im kevin donnelly, ceo in chicago. Whats the appetite of industry providers and the current and potential administration for the added costs and challenges of off shoring more of our pharmaceutical supply chain . Great question is will we be willing to pay for it. That is a great question and i dont think the question is are we willing to pay for it, we have to pay for it. Weve got to be prepared for this. I think that we all agree that this is necessary and that in order to attract these Companies Back to america, weve got to be competitive. These are private companies and the primary reason they went offshore in the first place was financial incentives, whether it be lower manufacturing costs or labor costs or whatever it is. We in america are going to have to bite the bullet and step up and do what we have to do. I think we recognize that now. I follow you on twitter so i know you are right now ive signed up for a vaccine trial and youve said youre going to sign up, you believe were going to come up with a safe and effective vaccine and i want to wish you wellin that. I hope it goeswell because i like folks that stand up at an important time, hows it going so far . So far its going verywell and i had my first dose in about three weeks, ill get my second dose. I dont know whether its placebo or the real thing. Its a doubleblind study. Only the number of the files will know whether its a placebo or the vaccine but i keep a diary, a daily diary of symptoms and how im feeling that day, what my temperature is. I believe that its important as a member of the healthcare profession, a member of congress for me to put my money where my mouth is. Thats why im very confident were going to have a safe and effective vaccine, so confident im willing to go through the process myself. If your blood pressureand temperature went up right now you can blame Steve Clemons of the hill but buddycarter, thank you for joining us. I know youve got a lot on your plate with the election just around the corner so thank you for joining us. Thank you. The us just reported the most covid19 cases in one week since the pandemic began and rates are skyrocketing skyrocketing as we enter the colder months. Scott gottlieb and resident fellow at the American Enterprise institute, doctor gottlieb has been advising governors on the response the crisis and if youre like me and your up at 6 am and clicking on csn dc you can get smart on all things covid. This is going to be unfair to you and perhaps your colleagues but i listened to you on csn dc and im saying would any of this be better . My question and perhaps it would be unfair is what has been strong and good and capable about our response to foreign covid that you think someone is missing . I think the process that seifert has been following with respect to the vaccines , i have a perspective on that both from my position at fda and someone who follows the news as well as someone whos just in that role. I think the process that seifert has beenfollowing, peter mark has been very vigorous. Its been transparent and it has a lot of and integrity to it. I think that has gone well. The fact that theyre bringing these programs before an Advisory Committee and multiple guidance documents, the criteria makes sense. Theyre not too conservative, not too aggressive. They struck sort of the right middle path theyre recognizing this is a crisis that they need to make sure they have rigorous data on which they are basing these decisions. The fact that they had that Advisory Committee where they brought that criteria to public discussion. Some of the discussion, the bigger challenges when history looks back at our going to be really to a number of things but one that i come back to his diagnostics and the fact that we were situationally blind back in january and february and didnt have diagnostics deployed and ive written about this many times , i wrote about it at the time as well and i think you look back at sort of where were the things we could have done differently that might have had an effect on the contours of the epidemic , that would be one of them and the key was not just getting the cdc cast out , which a lot of people like you. But getting the Clinical Labs in the game, getting lab core and bio reference labs and large academic labs in the game early back in january, recognizing it would take a month or so to ramp up their capacity. Had to get them started early on that. When you look at the drug and therapeutics, one of the interesting questions were looking at today is are the supply chains working, doesnt need to be moved but were talking about the very fast abundance of new vaccines and new therapies , i talked to any number of ceos including from pfizer and others but theres this question of new stuff coming online, whether the system can handle it and the deployment of vaccines but also what we saw in terms of drugs and therapies already. Did you have any concerns about that, did the system largely work . I think people talk about the speed at which we develop these products and its true we develop them quickly but we actually didnt shortcut the development process. The reason we were able to get into getting products into the clinic very quickly is because we have these established platforms we were able to use to start deriving constructs and vaccine constructs based on the gene sequence alone did we happen to have the nra platforms that were reasonably are along 30 we were with pfizer using the platform to develop a flu vaccine and madonna have used it to develop a vaccine against sars and was using it for other purposes so the technology was far along. Once you have a gene sequence in the coronavirus youre able to insert it and start deriving drugconstructs, same with antibioticbased drugs. We have developed antibodies against other viruses including evil and sars. And so we were able to quickly take those platforms and get drugs into development. The programs are actually quite expensive. We didnt take any shortcuts there. The fact that pfizeris doing a 44,000 patient trial, k and j doing a 64,000 patient trial , these will be the largest vaccine Clinical Trials ever undertaken simultaneously against a single target. Some of them will be almost the largest trials ever undertaken. The Rotavirus Vaccine was over 60,000 patients but most trials are not this large and the randomized portions on this large so these are very Big Development programs. We did not shortcut this at all where we did move with speed is getting the products into development and in many respects thats reflected by the fact that these products are commercially optimized. If you had two years to develop a vaccine for three years to develop avaccine would you develop a vaccine that required two doses or would you try to optimize into a single dose . You try to optimize it andget a singledose vaccine. If you have time would you develop a vaccine that required special storage in cold conditions . You would try to manufacture it in ways it can be stored at Room Temperature so we didnt optimize it from that standpoint but in terms of the Development Programs thereexpensive and i think that needs to be understood. We can take any shortcuts and the fda didnt take any shortcuts this was driven by the regulators and in terms of the data that theyre requesting an frs supply chains i think the challenges are with respect to the supply going to be available and in some cases where supply constraints just because it takes time to ramp up supply and in other cases were going to be supply constrained because we didnt take all the steps we could have taken at the outset to provide for more supplies and thats true with the antibioticbased drugs where ive lamented that we didnt push harder to expand apply. The company did a lot of work , some extra ordinary workbut theres more we could have done. Electively as a federal government to try to provide more supply on those drugs and use them as a bridge to a vaccine and as far as the distribution, i think theres going to be complexity with how these drugs are getting distributed because of the policy choices that were making in terms of how were doing that but as far as the logistics are concerned , i think the logistics and the distributors have done a good job in this crisis and it shows you how good a just expire in this country when it comes to medical products and when the supplies were there, they were able to distribute them. The reason why there were shortages wasnt because things were showing up on time or becausethere wasnt enough material. On hearing what youre saying is the distributors have their act together but there needs to be a plan kathleen civilians was on our program a short while ago and shes waiting for a National Plan. I know that you talk to governor larry hogan, one of my favorite governors in maryland and other governors as well and alex given his new film called totally under control, larry hogan welcoming a package of ppe from south korea and trying to prevent it from being hijacked by federal authorities that might have taken it so it was a kind of law of the jungle feeling in thatmoment. You ask yourself as were getting closer and closer to multiple potential vaccines, how do you preempt thatsame story from occurring again . I think that the Vaccine Distribution system that they had created based on my understanding of it is going to observe a lot of control over how the vaccine is distributed and first of all the supply that the states are going to get on an allocation system as compared to what the authorizations are for, so states are going to get a sort of proportionate allocation based on how many people they have in their state that meets the criteria so there vaccines authorized for everyone over the age of 65, lets just say hypothetically, i really dont know other than whats been disclosed by the National Academy ofscience and engineering and medicine. Thats 85, 60 million people. If you only have 3 million doses in every state gets a proportion of that 30 million based on how many people they have over the age of 65, thats the system thats been designed the system goes further in that are going to have very tight tracking of where all the doses are going and who theyre being administered to. So that allows the federal government to reach in and reallocate vaccines at any point and it also allows them to make sure that its going to properly indicate a population although their giving discretion to the states to make the final choice on who would get but the price you pay for that level of control and oversight is that you have to distribute it through a more narrow chain. So theyre going to have close monitoring of what the sites are, the sites needto be registered. They need to undergo special training so that limits the number of sites that you can read through. Hopefully there will be enough sites to underserved communities and the enough sites that are accessible to people who have difficulty coming into a cvs or coming into a vaccine that your vision point thats adjacent to a hospital, maybe standing in line. Thats where you start to be concerned that people who already have obstaclesgetting access to it , if youre creating friction in the system theyre the ones who are going to be most disadvantaged so how do you offset if youre a governor, you try to create mobile vans that maybe go around. That costs money. Is there federal money for that much in mark its not clear so those are places i would be focusing some attention. Places where some incremental friction is going to create some obstacles. Could be that getting a vaccine at least for that initial trial is a lot like going to vote where you have to go to a special location at a special window. To get your vaccine and for most people that can be okay but you worry about people who have obstacles and as far as the antibodies are concerned , there again youre going to be supply limited. But the way the system is being designed right now based on my understanding is that they plan to distribute those drugs through the emergency room and the challenge there is that again , if he initially indicated population is older individuals, a lot of people already are reluctant to get in. We know that from the commercial side of the drug market. People perceive swallowing a pill as something that is less consequential than going and getting an infusion of a drunk and thats why primary care drugs are formulated in ways that theyre not infusions because people inherently look at an infusion is more invasive, potentially more risky so you have that sort of bias in the system if you will and now you have a situation where theres antibodies need to be delivered right after you get sick, either before symptoms come on or just as you become symptomatic and you have to deliver them quickly, there more effectively earlier there delivered so you have to convince an older individual whos not that sick yet but has coronavirus to go into an emergency room and sit for 45 minutes with a two hour followup and theres probably going to the other wait times and youre probably in a location where it already evident when they wouldnt have in the first place and therefore the emergency room is going to be busy so someone drive in their, take them to the emergency room and expose themselves potentially. At a challenging Distribution System as it was designed and based on my understanding, i wrote about this with the wall street journal. We advocated using only infusion as an alternative or offering it as an alternative. But it doesnt seem to be the direction its going andso this will be another challenge. Simply put , we want to look for challenges in places where you create friction or difficulties where patients already have obstacles getting into the doctor or the emergency room, getting access to a providers site is going to be extra friction for that individual and youve got to find ways to mitigate that. You have to look at it from the patients perspective and recognize youre dealing with patient and face more obstacles adding access because theyre older, because they come from communities where they dont have good access to healthcare organ resources available. I appreciate perspective and where basically out of time but im asking quickly because you talk to everybody and everybody side of the islandof this and you know whats possible. You tweeted out recently but it was time for a National Mass mandate, do you see any way that leading republicans and leading democrats might come together and say given the dark winter were looking at potentially that this might be the right time . Im not sure how you would enforce that National Mandate area i think there are republicans that are on board with trying to promote mastering and i think theres ways you could provide terrorists rather than just sticks to try to prod governors toimplement those mandates. Certainly its made it more culturally acceptable, that would be a big start. So the bully pulpit is very powerful. And i think it was used in a way to try to encourage governors to do this, that would go a very long way instead of what we have right now which is in some cases the opposite where masks are beingdiscouraged in some respects. Remember the masks are to prevent asymptomatic or presymptomatic people from being able to transmit the virus and they can also offer you protection as an individual but the quality of mask matters and the more quality the more protection it will afford you. Doctor scott gottlieb, former commissioner of the fda and my favorite voice in the early mornings on scs nbc. Thank you for sharing your thoughts with us today. And now its time for the sponsor perspective portion of our program. Before we get going clarification. While im conducting this interview, the questions should be considered editorial and with that i like to welcome my friend chip davis, ceo of the Health Care Distribution alliance. Right backdrop, i like that. I hope youre enjoying todays program and thank you for supporting it. But let me ask you the same question ive asked a number of people because there are different holes in this, theres distribution of drugs and cuties, we have new drug therapies that arepotentially coming online to address this. How is that Distribution Network doing in terms of managing those stress points. Thanks for providing this event today, obviously for all theperspective youre getting. Very timely discussion given early on in the midstof this pandemic. In terms of sort of assessing where we have been and i want to be clear when i say that im not talking about some sort after action review here because as youand other experts have noted on this call. Were right in the midst of it, look at the numbers as you said. But earlier this week the aza foundation issued a report on how the pharmaceutical supply chain responded within the first 90 days to some that i will tell you that the pharmaceutical supply chain was stretched. And it that but it did not break. And i think you a return earlier the fact that pharmacy shelves by and large remain filled during the early days of covid19, compare that by way of example to other some other supply chains either in the food stores or Paper Products ill being empty, times people were put on processes where they can only go to the food store on the first letter of their last name so by and large pharmaceutical supply chain has been revery resilient and i think thats a credit to everybody involved in from the frontline manufacturers, certainly the frontline providers and healthcare is there in physician provider and pharmacy communities but also had a lot to do with our members really are if you look at the Global Supply chain sort of the wheel. Where the spoke of the wheel. We connect 1300 manufacturers, our members at hca over 130,000 providers and i think if you look at our role in ensuring that resiliency comes down to three things. I would submit, the first being the level of partnership that we have both the front and manufacturing and frontlineproviders. Second political expertise that you heard about through some of the speakers today, that distributors possess really is the skeleton of the supply chain for pharmaceuticals. Theres so much data and so much expertise they apply on a regular basis to move millions of prescriptions every day or the Healthcare System and lastly i would say it is the experiences, the prior experiences. Our members have been there every step of the day during things like natural disasters, games, tornadoes and otherclimate related events. As covid hit early on there were hotspots and allow their members to respond to those areas of the country were seeing surges new york, new jersey and certain areas of the west coast and to actually be able to move products from areas that were experiencing a surge to those areas that were in an effort to ensure everybody had access. In anticipation of this program and my conversation i tried to delve into some of your members how this thing works because you sometimes lose some of the magic when you talk about logistics and supply chains but its extraordinary when you look at the amount of material that your members move under conditions of controlled temperatures. Sometimes when we see vaccines come on, cold storage distribution which is complex. Expiration date prescriptions, etc. And that broad array so its not just kind of a mass bulky move, its a high level of precision so i guess my question is when Something Like this happens , does the economics work out . Do you have the resources you need . Are the partnerships what they need to be to keep that healthy and strong and you know,complex and robust . I respond to your question two ways in that if you look at what our members have done i would summarize over the past several months as being incredibly adaptable to the moving pieces and dealing with the pandemic and in ensuring a robust level of two medications in the context of a publicprivate partnership. That is consistent with what i alluded to in making sure that hotspots came on the radar. Many of our members were the first ones to identify based on the data they have and they gave a heads up to both the federal government who we as an association were in contact with every day multiple times a day as you might imagine, places like enoch, cdc, hhs and fda as well as the State Governments and one of the things that we wanted to make sure as we move forward was that we were actually sort of realizing and putting into regular practice a level of communication that i think led to the fact that as we begin to look towards Vaccine Distribution, what the federal government has identified utilizing the expertise, the distributors brings the table on a daily basis to ensure that as the vaccines come online at the Distribution Industry is going to be there to play a significant role in getting those vaccines to the patients who need it. When it comes to adapting and from the experience weve seen so far looking ahead, what are some of those things that your members are preparing to do when it comes to the potential vaccines we might have life and mark. As you might imagine there in regular medication with the companies, many of them you heard about today. Are in the Development Phase right now and making sure that they understand all the requirements as you just alluded to as well. Some of them obviously have traditional cochain or ultra cold chain requirements and so its important for distributors to be aware of that, not once the vaccines approved without the vaccines are in development. So staying in close contact on the front end with the manufacturing and development community. On the backend as well is making sure talking to the states, given the responsibility they have and as you know all the states are in the process of submitting their vaccine plans to federal government by november 1 so i think were seeing trendlines more both in terms of consistency that the states are saying in terms of ensuring their needs are met and also identifying some potential outlier issues that may need to be addressed but constant importance of making sure that theres a publicprivate communication on a regular basis. Weve actually put up a series of principles for Vaccine Distribution highlight the importance of the Public Private sector partnerships but also to your underlying question, ensuring that there is as much robust and strategic medication between the federal government and State Government as we come closer to vaccines being approved. Chip, we have a question from our audience and im going to sneak in one more which is one of the questions ive been asking people for the last six months is what can we do today that prepares us well for the next emergency . I know we got waves of coping coming but what are we doing now to build infrastructure so that were not caught so off guard next time. And i know that you talkto your members about this, about what we can do to better prepare for the next Public Health emergency, what would be some of the things on your list . Theres two things to that point that jump to mind is one, as we move forward with an eye back towards the march april timeframe, the coordination by the day and by the week got better within the federal government. Its going to be importantto take away from this and i think secretary sebelius mentioned this at the beginning, when we get to that point hopefully sometime sooner rather than later when we start doing after action analysis , i think for needed centralized aspects of command will be important as a key take away from this and i think weve gotten there but as everybody was coming to terms with so much uncertainty in the early part of this that that was an area with the benefit of hindsight i think that could be improved upon the other aspect is just recognizing that in order to do this, to maximize the value of ensuring access to the treatments therapeutics and vaccines is going to be the leverage the expertise that already exist within the Healthcare Supply Chain the Industry Leaders and our expertise that we have to or the is to be really really cautious about thinking about Distribution Channels that would require a significant amount of investment timeframe frankly we will not time for if we actually get to a place where were dealing withother natural disasters or pandemics in the future. Whether its in clinics or phars or manufacturing. Thank you very much. Host great question. Scott gottlieb got into this a little bit. How do you see this rolling out . Because your members are going to be doing this. Guest very true. Theres a couple of aspects right out of the gate that are important. First is, obviously, as the first vaccine and the first and second waves of the advantage a seen get approved, were going to be talking about millions of doses for hundreds of millions and ultimately billions across the planet. Its really important we make sure we have directs from the government. And, again, this goes back to the importance of that regular daily communication and the Public Private partnership of understanding what the expectations will be, the direction of both federal and State Governments as to where those doses are to be delivered and distributed understanding the sensitive populations, the elderly, those with preexisting conditions. Obviously, we want to make sure that Frontline Health care providers are taken care of, and we anticipate that there will be a significant amount of Public Health facilities utilized as vaccines come onboard to insure not just the effective distribution, but ultimately, as we like to say, the goal for us is to turn vaccines into vaccinations. And thats what our members are very much focused on. And i think engaging with the public institutions, whether at the federal level, the state and the local level, particularly as we see areas that will probably be focused on with a higher degree based upon the spread rate is something that well be very, very focused on as we continue to move forward working with both the manufacturers and the government. Host well, chip davis, it was an important set of discussions today. Im very grateful to hda and to you for supporting the program but also just the conversation, so so thank you so much. Good to be with you, steve, as always. Thank you. My next guest has a deep understanding of our Health Care Ecosystem and its infrastructure. Im delighted to have them on to discuss not only the resiliency of our pharmaceutical supply chain, but also their recommendations for a seamless rollout of the Coronavirus Vaccine when it becomes available. Dr. Alannah rios is president and ceo of the National Hispanic medical association. Dr. Joshua sharpstein is director of Health Policy and management at the Johns Hopkins Bloomberg School of Public Health, and heather is from amei source coalition. One of the reasons were doing this program today is americans are anxious. Theyre anxious about whats going on in the country, theyre anxious by what theyve seen with regard to some of the management of ppe in the past. And theres concern about how a virus, a vaccine is going to roll out and the various therapeutics for it. I guess my question is should americans be anxious about some parts of this, or should they have confidence that the system is going to work . I think americans should have confidence that this is going to work. We have Lifelong Medical staff, we have lifelong resources that have done this kind of work over and over again. I think what is unprecedented, which is another term we use very frequently during these times, it is unprecedented were looking to vaccinate the entire United States population in a short amount of time. I think with that unprecedented effort comes a strong supply chain that wants to support it. I think you have Health Care Professionals, we all want to get back to more of a normal lifestyle. I want to see my family, i know many of us would enjoy spending the holidays together which may not happen this holiday season, so lets look forward to next holiday season. And i think what you need to rely on is you have a sophisticated, robust supply chain that can do this in the United States. And i think what some of the uncertainty coming around is, is now were hearing ultracold temperatures, frozen temperatures, those arent something that we typically deal with in the supply chain on a daily basis. Outside the norm but not daily. And i think when were looking at vaccinating the entire United States, we need a robust plan, we need people to raise their hand to want to do this, which i think you have a willing Health Care Supply chain to do this. Its just a matter of coming collaborative lu together, to communicate amongst each other and execute on a plan we can all agree upon in order to get the vaccine the patients. Not just to approval, but to patients, is what we need to focus on. Thank you. Dr. Sharpstein, i think one of the realities of what were seeing is were seeing incredible time pressure put on science, put on the industry, put on the innovators that are out there trying to both discover a vaccine, but then manufacture and distribute it. And at the same time, we see a lot of politicking. This is a time, you know, of an election. And there are concerns really about trusting the science, being able to get the leeway it needs to produce what it should do, or are we taking shortcuts. I know you have thoughts on this, on pressure on the fda and others. I guess ill ask you a similar question, is should we all be able to trust whats developing . I think trust comes from expertise, knowing the people who know what theyre doing are really making good decisions, it comes from data, it comes from transparency. It doesnt come from political interference. That undermines trust. So i think the, were poised to have a safe and effective vaccine really depends what the studies show. I think were poised to have a good process at the food and drug administration, with an independent Advisory Committee weighing in on the data and a lot of transparency, and were poised for the agency to be explaining to the public about who should be getting the vaccine, for the cdc to weigh in. So i think the pieces are moving into place, but those pieces could get knock aside. And i think its very dangerous when the president accuses people at the agency of not moving fast enough for political reasons. Hes doing a lot of damage. Hes making people see the agencies as primarily political when really theyre moving at the speed of science. You know, i would like to ask all of you, and im going to go to alannah, in the early stages we were all, every day i was doing a show every day on where the tests were, why didnt we have a National Testing plan, you know . And you get down to it, you look back retroactively, and a lot of dysfunction between things like the fda and the cdc. We also saw this virus, both in infection rates and mortality rates, hit parts of this nation in uneven ways. And the hispanic population, the black population, you know, took on a huge burden. Frontline workers. And again ill come to you i would come to you and say what needs to be put in place so that we have a fair, just, even, solid response on covid19 that, along with supply chain, everything. I mean, i know youve been working on this, so what matters most for you and your community . Well, two things. One is you have to have the data. Data collection by race and ethnicity is really important. And in our Health Care System, its hit or miss. Its been optional. Its never been mandatory. And for an Infectious Disease of this magnitude that is harming and burdening all of america but especially hot spots like africanamericans, hispanics, native americans, you know, poorer communities, or rural communities, its important to have that data identified. The second thing i think is its important for people to realize, people that live in the United States even if theyre not documented need to be vaccinated. And we need Health Access bigtime in our communities. Latinos in this country have not applied for government programs. They mistrust government programs. So this needs to be mention there needs to be messengers. Our nursing homes, our communitybased organizations, we all need to work with Public Health agencies, and we need leadership that looks like us in the Public Health agencies and in our Health Care System to be able to have more trust and to get the campaigns to our communities through the media and social media that were already doing. Weve been doing this all year. I think its important to realize that a lot of the organizations that are health carerelated have jumped on the bandwagon to help. You know, thank you for that. And well see how this rolls occupant because im really interested out because im really interested in what kind of vaccines were going to get. Josh, i kind of watch this grid and i look at some companies, they have different approaches, mrna and dna, others, different trials, darpa funds some of this not darpa, but operation warp speed with the manufacturing, when you look at it and and you look at that lineup, i dont know whos going to get over the line or what the difference is. But can you just take us down the track for a minute to explain when were going to be able to see a vaccine sort of in the marketplace for regular folks and how thats going to be tiered between those who most need it versus not and how were going to deal with multiple vaccines. So i think its important to see that, you know, a series of stages. And you have to get past one stage for the next stage to even matter. Right now were at the stage of getting data from the Clinical Trials that are going to tell us if the vaccines are safe and effective when used in thousands and thousands and thousands of patients. And theyre going to look at safety data to make sure that the vaccine doesnt cause any untoward side effects in that group that got the vaccine. Only when we know that can we get to the next stage which is starting to think about who should get vaccinated, and not all the vaccine wed like is going to be available right away. So therell be a couple phases. That first stage of advantage su nation, it will be people who are likely Health Care Workers and people at very high risk for getting the coronavirus, and states are going to play a really Important Role in distributing the vaccine in collaboration with a bunch of different partners including in the private sector. And then behind that, were going to see a lot more manufacturing. Now, hopefully, more than one vaccine will prove safe and effective so that well have multiple vaccines being manufactured. And i think in terms of the, you know, could grandma be getting the vaccine, that a may if be a question for january, february. What about everyone else, that may be more of a question for the late spring or summer. And thats if everything goes well. Its those first phases, if they have channels, then everything challenges, then everything gets put back. But to even be in this position is a lot further ahead than ever before. Josh sharpstein, i know you have to leave, im going to jump to heather. When we talk about what our experiences were in the past, you know, we had 150 million or so vaccinations of the flu in the last year and then adding another 150 million on top, how does that work . Is the system able to carry that load . The system is. I think the commercial supply chain is really built on efficiency and scale. So success will happen. I think to joshs point around the stages, that will also play into how the distribution works. So to add the Covid Vaccine into that of traditional vaccines and also flu vaccine at this point, its going to follow the stages. And to me, theres two kind of supply chains in the u. S. Today. Theres the Public Health supply chain and then theres the commercial supply chain. And i think particularly when we add in Covid Vaccine, thats the time to really rely upon all of the entities that can vaccinate in our supply chain such as pharmacists, such as physicians and independent channels. We have the ability, and at times we do tend to rely very heavily on the Public Health supply chain in order to advantage i nate. Were going vaccinate. Were going to need all the public supply chains, both the Public Health and the commercial supply chains, to make this happen. But from a distribution point of view, scale, efficientness, thats our bread and butter every day. Theres this coalition thats a global i think there are 184 countries that are now members of it. Theyre kicking money into it. The United States is not a member of that, and ive interviewed the minister of health in sweden who said, you know, im really shes really worried about vaccine nationalism. And if america, which is such a big innovator, such a big part of the puzzle, isnt part of that, shes worried about a kind of law of the jungle out there. Are we worse off by not being part of covax . What are the implications of that . Personally i think the, you know, collaboration is the best way to go about this. Were in a Global Economy, were in a Global Supply chain. A lot of pharmaceuticals are started in other countries, finished in the u. S. Here in fdaapproved sites. We do need to think globally, but we need to act locally also. So i think us looking internally to understand how do we protect our Health Care Workers, our highest risk then roll this out, i think it would be beneficial to join that coalition. But we would also think about the global access. Were in a global pandemic. Were not in a swedish pandemic, were in a global pandemic. The Global Economy does need to come together, and the global Health Care System needs to come together just because we have so Much Movement between countries and so Much Movement between continents. Well, thank you for that. Yeah, i should mention as i jump over to elena and ask her about how we get this equation right, i do want to give, you know, the u. S. Just this past week committed to give funding and support to coalition for economic preparedness innovations. Its about 20 million which is a lot to some but a drop in the bucket, frankly, compared to many countries. So there are some coalitions the United States is apart of. But, or elena, to come back to this question when we see a rollout of vaccines, i interviewed dr. Robert redfield of the cdc, and he said were going to have to embrace with a person without resources, a person who may be homeless, without shelter, contact. Were going to have to find a way to bring that person into being tested. You know, if infected, give them support and treatment. And otherwise the system comes apart. So im always and i think what heather just said about the Global Dimensions is so important. There are going to be parts of the world that are hard to reach. How can we, i mean, youre thinking about this a lot more than many of us are. How can we not just be philanthropic, but actually be committed like our lives are on it to make sure that were inclusive as we reach out to the community that needs it . I think one of the most important things, the whole supply chain every step of the way can do is to think in terms of familyfocused efforts, not just individual efforts. So the whole family needs to get vaccinated. The whole family needs to understand that what theyre doing by getting vaccinated is helping other families. And then the families translate into neighborhoods. And if you, you know, california has a whole Health Equity lineup, c, the c has hot spots cdc has hot spots all over the country. There are neighborhoods and census tracks that can be focused on with the essential workers, the Health Workers as well as those who are most vulnerable with chronic diseases already. And those people need to be protected first. The National Academies of medicine and science, engineering and Sciences Says for their distribution plan. But i do think that theres an Important Role for commitment through media. We have a lot of, a lot of people get information not only from their providers, but for those who dont go to the doctor or dont go to the pharmacies to ping. Medications pick up medications, they get information through the media. And we have ethnic media that are mom and pop type newspapers, magazines and then, of course, the National Networks and the Spanish Language and other language, asian languages, for example, have their own media stations, telemundo, that really need to have the same message and Work Together with the ad council and create major focus on the importance of vaccine. And i think we need to start now with the flu vaccine season upon us and the importance of getting involved. Were involved with the flu Vaccine Distribution messages with some of our partners right. And the cdc. Well, i really appreciate it, you know, i think that heather knows this Business Inside and out, you know, knows whats out there. As ive done a deep dive into it, you realize how complex i dont know whether to call it the backbone, the circulatory system, the tendons of the, you know, supply chain is incredibly imfrom pressive. But i have to say, you know, even with the concerns, i was very ignorant of a lot of what is out there. So we have a big way to go when you think about the media and what we need to know, but others in terms of whats out there and who the right messenger should be. Weve been taking questions if our audience, and we have a question from daniel. Daniel . Hi. My names daniel, im a associate managing director of the division of [inaudible] based out of virginia. My question today is how do we insure the integrity and the security of the covid19 supply chain . Namely, how do we insure that various adverse actors dont slip into the end to end supply chain, be it from security theft, tampering, fraud, cybersecurity and various other securityrelated perspectives . Thank you. I want to get both your views, but let me start with heather because this is a big deal, right . Were talking drugs today, pharmaceuticals and therapeutics, when you try to get a mask, i used to try to go on ebay and see ridiculous things going on there. How do we amp up our supply chain . Trust your local Health Care Professionals that you always have. They then the trust their supply chain partners that theyve always used. As long as we continue to use the resources that weve used over the course of time, that is one know your partner, trust your partner, validate your partner. The second thing is to be logical. I know that the cdc and operation warp speed is treating the Vaccine Development and where its being stored and how it will be disseminated as a National Security event. They are taking it very seriously around the transmission of it. And i think its a wonderful we question and something that we dont always think about. We always over the course of time, we dont always publish where our distributions locations are and where we have pharmaceuticals just out of safety and security of our societies and our associates that are picking pharmaceuticals every day. I thats a practice that i know my colleagues also take very seriously. One of the key things is know your partners, know who you trust and only do business with those you trust. Elena, how would you approach that as well . Thank you, heather, and thank you, daniel, for the question, but how do you approach this . Its amply important for communities that already have a trust challenge who dont see folks like them in the messaging. So one is perceived risk, and the other is real risk. But your thoughts. Yeah, the perception very important. I think, you know, everybodys talking about antibias training and the importance of having equity and inclusion. But i think what really matters is the message messenger. And i have to applaud what heather said about trusting your own provider, making it local so that people can actually see who theyre talking to. Trusting the, you know, the federal government needs to have a face. And that was the whole, i think, part of the problem with the misuse of information or miss information, i guess, the cdc is the Public Health d. And the cdc needs to be out there. The Public Health agency for the State Governments, the local governments working together with the faithbased, you know, our religions are are important to our communities of color, and community leaders, community organizations. I think we do need to have a face and messengers lined up, a speakers bureau, if you will, of the importance of vaccines for covid19. Its such an Infectious Disease. And i think the people in our communities need to understand that its a very serious disease and how important the vaccine is to the decrease in the infection rates in our own families and communities. Right. Well, look, i realize that this is a complex time and, you know, a stressedout country, a lot of choices. I really appreciate your thoughts on how we do this right, because i i think there are, you know, choices out there. I also think that there are unacknowledged strengths out there in the supply chain, in the medical chain that we havent been talking enough about. But i think that, you know, no matter how this election turns out, its something were going to have to get our heads around, you know, rolling out vaccines and therapeutics the right way. I want the thank josh sharpsteven, heather zenc and elena rios. I hope youll be back because this is a story well continue to cover, so thank you so much. Thank you. That was supposed to be e haven that rios. That brings us to the end of our program. Thank you to all of you in the audience for joining us. For those of you who missed any of the conversations, we will have video up shortly on our web site. Im steve clemens, be well. Weve got more Live Programming coming up later this afternoon with a discussion on the progress of operation warp speed and how a Coronavirus Vaccine will be deployed once approved end approved. The Heritage Foundation hosts this event beginning at 3 p. M. Eastern here on cspan2. Online at cspan. Org or listen live with the free cspan radio app. Today the candidates running for indiana governor, incumbent republican governor eric holcomb, democrat wendy meyers and libertarian donald rainwater take part in a televised debate sponsored by the indiana debate commission. Live coverage begins at 7 p. M. Eastern on cspan2. Seven days left until election day on november 3rd when Voters Decide who will control congress and occupy the white house next year. Stay with cspan. Watch campaign 2020 coverage every day on cspan. Stream or on demand at cspan. Org or listen on the cspan radio app. Your place for an unfiltered view of politics. Youre watching cspan2, your unfilterrerred view of government. Created by americas Cable Television companies as a Public Service and brought to you today by your television provider. Axios hosted a Virtual Event with representative karen bass, Maria Teresa Kumar and former National Security adviserrer h. R. Mcmaster. In oneonone discussions, they talked about the 2020 election and voter turnout, election security, diversity in government and foreign policy. Welcome to the fourth event in our news shapers, americased road ahead series leading up to the november election. im axios white house and politics editor, and im coming to you from my home in washington d. C. Thanks to bank of america for making these conversations possible and welcome to our