This is just over one hour. Hello and welcome i am editor at the hill, thank you for joining us for covid19 and a responsible rx supply chain, or Virtual Event looking at the resiliency of the Prescription Drug supply chain during a Global Pandemic. Id like to thank our sponsors the Healthcare Distribution Alliance for their support of todays program, the coronavirus pandemic has upended our lives and forced a new normal upon us, what accommodations can be made for lifestyle choices but little flexible lead to health care, patients with chronic disease and those most at risk from the coronavirus access to regular medication is in the choice and matter of life and death in a pandemic the Healthcare System and patients have changed their behaviors, as a consequence in concerns of drug availability and shortages, what are stakeholders doing to ensure the disruptions do not occur in collaboration between the public and the private sectors, what plans are being put in place for the distribution of this corona vaccine once it becomes available, we will discuss all of this and much more with the smartest minds in health policy, before we get underway he is entered a few housekeeping notes at the hill event and the comes special letters, the hill rx supply chain. Sibelius resources which provides strategic advice to companies, investors and nonprofits and is my go to person when it comes to issues of knowing what a smart Healthcare System looks like. So, great to see you. Let me ask you, to get to the point, you oversaw many of the institutions that we are now looking at today to help save this country whether its pushing the time curb, developing a vaccine, whether its on how you approve the various dimensions. What would you say is going well and what would you say has just been awful . Its good to see you. Thank you for including me in this program. I dont think that there is any question the socalled operation warp speed on a number of possible vaccine candidates early on pushed that pipeline and has accelerated the possibility of getting a vaccine for a brandnew coronavirus faster than people could have been dissipated and that will be beneficial to the United States and hopefully to the rest of the globe. That collaboration looks very good and the early investment makes sense. So the Pharma Companies are drilling down on the massive Clinical Trials and looking at the safety results and how competing to get to this starting line first so we could have a number of effective and safe vaccines in record time. The bad news is that at every point along the way this white house has undercut the public science, undercut confidence in the Public Health messages and by doing that may discourage a lot of americans from ever volunteering to get the vaccine and ever believing that it is safe and effective so that is really not helpful. Communication, strategies, clear effective scientific based communication from the start is part of any crisis and any recovery and tying the vaccine to his political election which hes done for months and months suggesting there will be an october surprise, an effective vaccine before the campaign, something coming out it makes people feel like its being rushed. That we are not on track for safety and effectiveness but on track for some kind of a political gimmick and nothing should be more harmful to the confidence we are going to need for a massive Vaccination Campaign and a two dose Vaccination Campaign so that has good points and bad points. In direct response we have seen much of the same. Public science which has evolved over time and scientists have learned more and corrected themselves 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 deaths. We have had a counterpoint in the United States and the clearest indication of that is Johns Hopkins in the fall of 2019 gave grades to countries around the world for the pandemic readiness not knowing what we were going to face. The United States was regarded as the best prepared country in the world and yet we have had the worst response for any developed country in the world. You were one of the stars in the new movie called totally under control that profiled the response managing everything from operation warp speed. Some heroes that pop out, some governors were securing ppe and part of the discussion was around the supply chain and whether americans can have confidence that there is an infrastructure dependable enough they can have confidence in regardless of the leadership and i wonder how you see that because you saw the states competing with one another before over masks and downs. I wonder when he vaccine rolls out well we have the confidence that it will be wellmanaged . We already have the confidence if we have a National Plan and i think that its clear the president doesnt want a National Plan. Hes pushed every issue on to the states and sometimes the private sector in a way that isnt transparent to anyone and puts burdens on states as a former governor as they cannot possibly achieve so ppe is a great example. Rather than the United States mobilizing efforts through the defense production act to make more stuff in america, to get it ready to go or to use the incredible purchasing power and previous global context to purchase ppe and then distribute it in a fair and equitable manner and use the logistics to make sure equipment and machinery is at the right place and right time and we had everything from a virtual inventory to where there were personnel. The federal government washed its hands of it and said its up to the state so states competed against one another and against their own health system. Ive heard so many stories about states ordering 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 its not for the stockpile its for us whoever us is so we have had a totally misguided and appropriate response and we need a National Plan in place. We will only get that i would say with a new president whos made it very clear that he will have a National Plan. And for Vaccine Distribution and integration and communication we need that plan to start right away. People have to have confidence in the safety and security and beyond that we need some transparency. Where is the vaccine going, how will you b it be available, whos it first. That whole effort has been pushed. States are submitting plans but we need a National Strategy for how this is going to roll out and how we can have confidence. When the fda says we have a safe candidate that hasnt been pushed ahead, shoved ahead or the guidelines that have always been the Gold Standard in the world have not been shortened or rushed due to political pressures. I cannot even think of the number of Business Leaders and scientists ive talked to since the pandemic began. One of the interesting things while you solve the society worry about drugs, therapeutics et cetera, the other side is a lot of the companies beyond political control bent over backwards to make sure there were no shortages and supplies and asked whats the right way forward. In a few minutes i will have the representative on who passed legislation on strengthening americas Strategic National stockpile and again as somebody that has her view of what the private sector is doing and federal government needs to do, what are some of the parts of the skeletal structure we need to amp up rather than the National Plan but how do you look at the ecosystem and what do you think needs to be sure not . Its going to be important to do an after action report. We found we didnt have sufficient manufacturing capacity in the u. S. So we now have i think tripled the Production Capacity. Thats good news. I think putting back in place the red flag folks at the National Security and within the white house are going to be critical but we need to figure out what are the protective equipment supplies and gowns and gloves what makes sense and how we have Production Capacity to deal with when everybody in the world is trying to find equipment and supplies at the same time. I think we are going to need a renewed confidence in Public Private partnerships. Pharma has stepped up but what we know about the stockpiles particularly for therapeutics and vaccines is unless the government has a pot of money and says its worth your time to invest in the science and manufacture these drugs and bring them to development, if there isnt a willing buyer it doesnt happen. We are facing a possibility of Antimicrobial Resistance to antibiotics. We dont have a big pipeline of antibiotics in the country so that is an example where with a government pool of money that happened after 9 11 and we had resources for making sure america was safe and secure which means some of the supplies that will be developed are never used or put into action but you have them in place if something happens. We need to be willing to fund proactively and not reactively. On a scale of one to ten, ten being the worst and one being best, how bad was the administrations response so far to covid . I think its bad. The deaths we are seeing in the United States are unparalleled for a developed country with the resources that we have. A burden to the communities it is immoral we didnt move much more quickly and tell people the truth and really take the steps to secure the most vulnerable population. I think we are at about nine. Maybe we can recover some territory with Vaccine Development and distribution but theres no reason in the world we should have had this many deaths and now we have all these people dying of the virus. Its raging here and in communities that have almost no capacity to deal with it because there are no beds or equipment. There isnt the personnel. Im grateful every time we get a chance to talk but its also very sobering every time i talk with you so thank you for joining us today and helping us to launch our program. Thanks for having me. Our next guest believes stockpiling medical supplies made in the u. S. Is an issue of National Security. A democrat from michigan running for election right now joins me. I cant tell you how grateful just a week out from all this other stuff you have going on but i know that this is a priority for you and for the country. Point blank what is broken that needs to be fixed . A lot of my experience the worst of it in march and april came down to the fact things like medical supplies, pharmaceuticals, just major supply chains that help keep us safe were so outsourced. We couldnt get a hold of then when we needed them and our experience in the pentagon and the National Security world it kind of blew my mind while we have a preference for making things our military equipment, body armor we didnt have the same requirement 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 a lot less than we were expecting so we have to make sure that theres a better way to stockpile equipment when we needed and then in general i think it combines kind of the National Security background with major american manufacturing. Here in michigan we have been saying if you outsource too far you will get caught with your pants down at some point and i feel like we did. If im haggling with a chinese man in the middle of the night for the 70s and mask something has gone wrong. Thats been the focus of the work since basically april. Where is your legislation now i mentioned strengthening the Strategic National stockpile. I talked with some other Industry Leaders in the pharmaceutical production. Theyve been talking about who can identify the top 100 most needed therapies and medicines that are out there and figure this out. Where does this stand now . Its a series of seven bills completely bipartisan, ten democrats, ten republicans built purposely bipartisan because these issues should be bipartisan. They passed the house in september and now we are in the negotiations to have them in the next package. This thing that theyve been struggling to negotiate. The bills are in there and my hope is once we get past the election we are able to get something done. Im frustrated we havent been able to before. And its something frankly we should be moving on now. The biggest part is this 500 Million Pilot Program on extra pharmaceutical lines. When we need to surge and go the American Government has an interest in being partners on the additional capacity so thats the part that im most excited about. Have you talked to the Industry Leaders and how do they feel in terms of their partnership and what they know is going to be a load of vaccines and therapeutics thats going to have to be deployed in every point in the country. Are you finding them to be robust partners or do you have concerns . We have one of these companies that smell sort of being at the ready for when their vaccine is identified they are ready to go and ramp up production in my district. But we have been talking with them and others. Everyone talks about the manufacturing more in the United States, but you have to make sure you are talking to the industry to find out what truly incentivizes people. You cant just decide from washington that you know its going to bring manufacturing back. We have such a globalized supply chain and ecosystem from all parts of the globe. I want to hear from our Business Leaders and i was in this great group called Business Executives for National Security. Theyve done an 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 them to figure out how to properly incentivize the United States. It can to be made up from washington. One of the things i want to talk about is your cia background. Your background as an analyst. I have been to talk earlier this week to the official who said he was pushed out of that job. I didnt realize, and a lot of people look back at the playbook developed on the shelf, they did a simulation. You did the simulations and the cia and exercises in october of 2019 that anticipated this kind of pandemic. It actually underscored the weaknesses and decisions is there any awareness that that simulation occurred highlighting many of these gaps among your colleagues and the need to fill them because i was astonished to hear the Trump Administration tn already had this experience in hand. They look at these scenarios and have a Homeland Security council at the white house. I know people that are working there and people that were focused on this. The difference between having folks in the system and then having it rise to the level of Senior Leaders where they are going to do something about it. I think it was this paralysis that came from and not wanting to accept the federal government was the best place to respond to these scenarios. This would have stretched any administration of any party. The fact they backed away from that leadership role meant they didnt seek out the expertise that might have been in the administration. What are the other critical supplies you think the nation needs and what would some of the partnerships in the sector look like from your perspective . Theres a certain capacity around Energy Storage that we depend on a lot of other countries for that we dont want to do without. A lot of technology around superconductors that were at risk having to depend on other countries. What we need, and i wrote this into the Defense Department budget through my role in the Armed Services committee is the identification of the very specific supply chains with National Security importance. Once we identify that list we can look at incentivizing more productions at home but weve got to agree upon that list and have a common understanding and be able to review it every few years. Certainly though Energy Storage is a big one that we would be loath to live without. I appreciate your insight and what you are doing to think through this ecosystem and how to be smarter than perhaps we have been. Im grateful for your time. Thanks for joining us for todays program. Thank you so much. The next guest has been a pharmacist for 30 years and thinks the coronavirus is the wakeup call America America neo bring back the pharmaceutical supply chain to the United States. Welcome congressman up for election in just a few days. Thank you for taking time to talk to us about this. I just said it. You think this ought to be a wakeup call. What do we need to do to make sure that america has the supply chain, something it can trust to deal with this pandemic . First, thank you for having me. Ive always said theres a difference between knowing something and realizing something. Weve known for a while that we are too dependent on our needs but during this pandemic, we have realized it and having realized it means we have to do something about it. One of the things we are proposing the pharmaceutical ingredients and drugs in the u. S. What we are trying to do is attract some of these pharmaceutical manufacturers that are located out of the country back into the country. 90 of all of the ibuprofen in the world is made in china. 90 of antibiotics come from foreign countries. That isnt a good situation to be in. We realized we were dependent on the middle east for our energy needs and realized we needed to have Energy Independence and achieved that. The same thing can be said now. We realize we are too dependent for our pharmaceutical needs and we need to do something about it. Thats why with this legislation what im trying to do is attract those companies to come back to america and try to incentivize them and repatriate them back to america. It will be a tax credit the companies can get if they will locate their manufacturing facilities in these areas. We use other incentives as well, tax incentives, not the least of which to appeal to their patriotism that we need to come back to america. Thats important not only pharmaceutical independence but also ppe. We are too dependent on these countries for our personal protective equipment and need to make sure we are doing manufacturing here as well. One of the interesting things and im glad youve made a distinction, we clearly saw the law of the jungle but if you look back i think there was a sense of anxiety about the pharmaceuticals and i cant find anywhere where they were not delivered. The supply chain largely worked through this time and i wonder if my bearings are off somewhat. I know you are working on with the National Stockpile should be and what the key medicines and therapies ought to be but when we look at the actual experience, did things hold together or not . We had threats that didnt come to fruition but we had threats that said we are glad to send this medication and we will use what we have to use first and if theres anything left over we will send it to you. That isnt the kind of situation you need to be in and it isnt in the best interest of our citizens nor of our national defense. Thats just a situation we should and can avoid. We need to get pharmaceutical manufacturers and the same thing with ppe weve been able to get everything we basically need, but at what price. The price has gone up enormously. Weve heard price gouging and that is again why we need to invest. Ive talked to industries in the leader the pharmaceutical therapeutics manufacturers and they are interested in partnering with the government on things like looking at the strategic stockpile. But in terms of only shoring and re on shoring some of the capacity that moves abroad, it requires the kind of whole economy system. Youve got to have longterm purchasing, regulatory changes. You mentioned opportunity zones. Is there a place in the government thinking holistically about that environment because they said if it is done piecemeal, it wont work. Your right weve got to make it worth their while. We understand one thing we have trouble competing with. There have to the other incentives to make sure that we cover that part of it and thats why its important that it is holistic as you pointed out. Thats why this legislation that ive introduced again at a addresses all those different things. There are some located in the United States here already and a lot of them have been asking the question what about me. Well i get incentives as well. Thats certainly something we have considered. If i can talk for just a second about the stockpile because youve mentioned that a couple of times. We all know weve got a federal stockpile, a strategic stockpile, but we recognize we have been too dependent on that. To address the state strategic stockpile. This is a matching brand to encourage states to have their own stockpile. We were too dependent on the National Stockpile and states didnt have what they should have in place. This would offer grants to encourage them to have their own stockpile. But would help us to be better prepared for the next time. I am cosponsoring with the essential medicines stockpile and what this does instead of waiting until we have a shortage of a generic drug and then stockpiling it, we actually create the Central Medicine that we know we are going to need. And again, this is a Pilot Program whereas we create this National Stockpile and we have utilized the ideas being utilized making sure we have an inventory of these essential medicines, so if there is a shortage at any given time, we would be able to have them maintained by our citizens. That is important and we can guard against a lot of that going out of date and being wasted. I remember when i was in the legislature in the senate and we had millions of dollars worth of tamiflu. It was the right decision back then and there are new policies we can get from the private sector and we can avoid that. I know your role as a pharmacist. I might have this wrong, but in some ways they are like the canary in the coal mine. Are there things we should know about the pharmacists and what role they could play and bring up their role in terms of alerts and with the flow and need is out there in the various Key Pharmaceuticals . That is a great question. Pharmacists, 95 within 5 miles of a pharmacist we are not utilizing pharmacists in particular but a number of Healthcare Professionals for their license, and i have discussed this with the department of Public Health, the secretary, hhs, the administrator and they all agree we need to be utilizing these pharmacists, not only in the situation that you described where we see a shortage and we can learn about it, but also as we are going through this pandemic being able to test for this and administer the vaccine. Most people are getting their vaccines from a pharmacy now, from a pharmacist. We need to be able to administer the vaccine and to get it out to people as quickly as possible and as safely as possible. Thank you for that. We have been taking questions from the audience and we have one now from buddy. What is the appetite of the industry providers and the current and potential administration for the costs and challenges of ensuring more of the supply chain . Great question is are we willing to pay for it. We have to pay for it. Weve got to be prepared for this. The primary reason they went offshore in the first place was with financial incentives. Whether it be lower manufacturing costs or labor costs, whatever it is. You signed up for a vaccine trial and you will come up with a safe and effective vaccine and i want to wish you well and like folks that stand about this important time, how is it going so far . So far it is going very well. In about three weeks i will get my second dose. I dont know if its a placebo or the real thing. The staff doesnt know, the doctor doesnt know. Its a doubleblind study. Only the number on the vile we will know if it is a placebo or vaccine. But i keep 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 and congress to put my money where my mouth is. Thats why im very confident that we are going to have a safe and effective vaccine. Im going to go through the process myself. If your Blood Pressure and temperature went up right now, Steve Clemons at the hill that represented buddy carter. Thank you for joining. I know you have a lot on your plate right now with the election just around the corner. So thanks for joining us. The United States just reported the most new cases in one week since the pandemic began. Rates are skyrocketing as we enter the colder months. Now joined by doctor Scott Gottlieb at the American Enterprise institute. Advising lawmakers and governors. If you are like me and up at 6 a. M. Clicking on cnbc, you can get smart on all things go. This may be unfair to you and some of your colleagues. Would any of this be better and so my question perhaps unfairly i look at some of this and i see keystone cops stuff. What do you see that has been strong and good and capable about the response that you think someone like me is missing . I think the process that has been followed with respect to the vaccine, and as you know im on the board of pfizer, one that has a Vaccine Development, so i have a perspective on that both from my position at the fda and someone that follows the news as well as someone that sits in that role. I think the process that has been followed has been very rigorous and transparent and has a lot of integrity to it. The fact that it makes sense and they struck pattern making sure they have rigorous data on which they are basing the decisions. This past week they brought that to the committee and had a public discussion so i think that has gone very well. Some of the bigger challenges when history looks back at this will be a number of things. But the one i come back to his s the diagnostics and the fact we were situationally blind back in january and february and didnt have diagnostics deployed. Ive written about this many times that ive written about it at the time as well. I think when you look back at sort of what are the things we could have done differently that had an effect on the contours of the epidemic that would be one of them. The key was not just getting the tests out, but getting requests and in the game the early back in january recognizing that it would take them a month or so to ramp up the capacity to get them started on that. When you look at the drug and therapeutic claim, is the supply chain working, and we are also talking about the very Fast Development of new vaccines and new therapies. I talked to any number of ceos including pfizer and others but the question is new stuff coming online and the deployment of the vaccine but also what we saw in terms of drugs and therapies already. Did you have any concerns and did the system largely work . People talk about the speed at which we develop these products and its true we develop them quickly but we didnt short come. The reason we were able to pivot into getting products in very quickly is because we had these established platforms that we were able to use to start driving the sequence alone. The platforms were reasonable to develop the vaccine and modern i used it to develop against sars so the technology was far along and we are able to insert it and start driving the constructs the same as the antibody. We had the platforms available and in the case we were able to take the platforms and get them into the development. The fact that they are doing a 44,000 patient trial these will be the largest ever undertaken. I think it was over 60,000 patients but most vaccine trials or not this large and the randomized portion is in this large, so these are Big Development programs. We didnt short cut this at all. Where we did move in getting the product into development in many respects the products are not commercially optimized. If you had two years to develop a vaccine or three years to develop a vaccine would you develop a vaccine that has two doses or optimize it into a single dose. If you had a lot of time to develop a vaccine would you develop one that has special storage and conditions, no. You would try to manufacture with temperatures so we didnt optimize from that standpoint but in terms of the program they are expensive and i think that needs to be understood. We didnt take any shortcuts and the fda didnt take any shortcuts. This has been driven by the regulators in terms of the data they are requesting. The challenges are with respect to the supply thats going to be available we didnt take all the steps we could have taken at the outset to try to provide and that is true where ive long lamented we didnt push harder to expand. I think the company is did a lot of work but theres probably more that we could have done collectively to try to provide more supply to the drugs and use them as a bridge to be vaccine. As far as a distribution concern because of the policy choices and how we are doing that, but as far as the logistics, i think the logistics and the distributors have done a really good job in this crisis and it shows you how good the logistics are when it comes to medical products and when the supplies were there they were able to distribute them and it isnt because things were not showing up on time or there wasnt enough material. So they had their act together but there needs to be a plan. Kathleen sebelius was on the program and said shes waiting for a National Plan. I know you talked to governor larry hogan and others as well. But in the new film, totally under control, larry hogan is welcoming a package from south korea trying to prevent it from being hijacked from federal authorities so its a kind of law all of th of the jungle feen that moment so you ask your self as we are getting closer and closer to multiple potential vaccines how do you preempt that story from occurring again . Based on my understanding of it, its going to exert a lot of control over how the vaccines are distributed. Its tied to the initial authorizations of the states are going to get a sort of proportionate allocation based on how many people they have in their state state that meet the criteria so its authorized for everybody over the age of 65. Lets say hypothetically. I dont know otherwise what has been disclosed by science and medicine. Thats 55, 60 million people. If you only have 30 million roses, then every state has 30 million based on how many people over the age of 65. That is a system that has been designed but it goes further in that its going to have tried tracking of where the doses are going and who they are being administered to. So that is to reallocate and also allows to make sure that its going to probably indicate its populations although they are giving discretion to make the final choice. But the price you pay for that level of control is to distribute it in a more narrow chain so there will be close monitoring of the sites that need to be registered and undergo special training and so that limits the number you can distribute through. Hopefully there will be enough sites that are accessible to people that have difficulty coming into a cvs or Vaccine Distribution point. Thats where you start to be concerned if you are creating fiction in the system they are the ones that are going to be most disadvantaged. If you are a governor you try to create mobile bands that go around and that costs money. Is there federal money for that it isnt clear but those are the places that i would be focusing some attention where there is incremental fiction. It could be getting a vaccine for that initial trust is a lot like going to vote where you have to go to a special window to get your vaccine. For most people that could be okay but you worry about people that have obstacles. As far as the antibodies are concerned, there again you are going to be supplies limited but the way that its being designed right now on my understanding they plan to distribute those through hospital Emergency Rooms and initially indicated population is older individuals a lot of people are already reluctant. We know that from the commercial side people perceive it as less consequential than going and getting an infusion and thats why a lot of the primary drugs are formulated in ways people inherently look at an infusion is more invasive and potentially more risky so you have that sort of bias in the system and a situation where they need to be delivered before the symptoms come on they are most effective so you have to convince an older individual that isnt that sick yet but has a diagnosis to go to an emergency room and sit with a two hour followup and there will probably be other way to time and you are probably in a location theres already an epidemic or they wouldnt have caught it in the first place and therefore its going to be very busy. Someones got to drive them there and take them to the emergency room and potentially expose them to coronavirus. That is the challenging Distribution System as designed based on my understanding. We advocated using Home Infusion as an alternative but it doesnt seem to be the direction that they are going in. Theres places where they are getting into the doctor or the emergency room or getting access to a provider site is going to be extra friction and find ways to mitigate that you have to look at it from the Patient Perspective and recognize they face even more obstacles because they are older and come from communities they dont have good access to healthcare or good Resources Available to them. Im not sure how you would enforce the national mandate. There are republicans on board trying to promote mask wearing and i think that theres ways you can provide ways to try to fraud the governors to implement the mandates. Certainly its made it more culturally acceptable that would be a big start. The bully pulpit is powerful and i think that if it was used in a way to try to encourage governors to do that, that would go a very long way. Masks are being discouraged in some respects. They are to prevent people from being able to transmit the virus and they can offer protection to you as an individual but the more protection its going to afford you. Its great to see you and also resident scholar at aei. Thanks for sharing your thoughts with us. My next guest has a deep understanding of the ecosystem and its infrastructure and im delighted to have them on to discuss the resiliency of the supply chain and also their recommendations for the seamless rollout of the vaccine when it becomes available. President and ceo of the hispanic medical association. Doctor shorstein at the Johns HopkinsBloomberg School of Public Health. Thank you all for joining us. Let me start with you. One of the reasons we are doing this program today is they are anxious by what theyve seen with regards to some of the management in the past, and theres concerns about how a virus or vaccine is going to rollout in the various therapeutics. So heres my question to take off the corporate hat for a minute, should americans be anxious about some part of this or have confidence that the system is going to work . I think we should have confidence the system is going to work. We have Lifelong Medical staff and resources that have done the kind of work all over again. I think what is unprecedented which is another term they use frequently is the truthful example. In a short amount of time i think with that unprecedented effort comes a strong supply chain and you have Healthcare Professionals we all want to give back to more of a normal lifestyle. I want to see my family. I know many of us would enjoy spending holidays together. So lets look forward to the next holiday season. And what you need to rely upon is the robust supply chain that can do this in the United States and i think some of the uncertainty is now we are hearing ultra cold frozen temperatures and those are not things we normally deal with in the supply chain on a daily basis. Outside of the norm, but not daily. If we are looking at vaccinating the entire United States, we need a robust plan and people to raise their hand and i think if you have a willing Healthcare Supply Chain to do this it is just a matter of becoming collaborative together, communicate amongst each other and have a plan we can all agree upon to get the vaccine to the patients not just the approval, but to patients is what we need to focus on. One of the reality is w reale seeing is incredible time pressure put on science and the industry and innovators to discover the vaccine and then manufacture and distribute it. There are concerns about trusting giving the legal way that it needs to produce what it should do. What are your thoughts they will last a similar question should we all be able to trust what is developing . I think trust comes from expertise. Knowing people who know what they are doing or making the decisions that come from the data and transparency. It doesnt come from political interference that undermines trust. So, i think that we are poised to have a vaccine and a good review process and independent Advisory Committee with a lot of the transparency and we are poised for the agency to be explaining himself to the public about who should be getting the vaccine and the Advisory Committee to weigh in, so i think that the pieces are moving into place, but they could get knocked aside. And i think that its very dangerous when the president accuses people not moving fast enough for political reasons and in that case a doing a lot of damage making people see the agencies as primarily political when they are moving at the speed of science. When the early stages of the virus were coming out and i was doing a show every day on where the tests were. Why we didnt have a National Testing plan. You get down to sort of look retroactively and a lot of dysfunction between things like the cdc. We also saw this virus and the mortality rate for two parts of the nation in uneven ways and the hispanic population and black people asian took on a huge work for the front line workers. I would come here and say what needs to be put in place so that we have a fair, just, solid response along with supply chain, everything. I know you have been working on this. So, what matters most for you and your community . One is you have to have the Data Collection by race and ethnicity is important. And in our Healthcare System it is hit and miss. Its been optional. Its never been mandatory. For the infections disease harming and burdening all of america but especially hot spots like africanamericans, poor communities, Rural Communities its important to have that data identified. The second thing, its important for people to recognize the people that live in the United States, even if they are not documented, neede need to be vaccinated. And we need access big time in our communities. Latinos in this country have not applied for government programs. They miss trust government programs. So there need to be messengers, physicians, nurses, frontline workers, health care system, nursing homes, Community Based organization. We all need to work with Public Health agencies and leadership that looks like us in the Public Health agencies and Healthcare Systems to be able to have more trust and get the campaigns to the media that we are already doing. We have been doing this all year. I think its important to realize a lot of the organizations that are healthcare related have jumped on the bandwagon to help. Thank you for that and we will see how this rules out ive kind of watched this grade and i look at the companies that have different approaches and dna and others and there are different phases and trials. Operation warp speed. Youve got to look at that lineup and i dont know who is going to go over the line are the differences coming in but can you take us down the track for a minute to explain when we are going to be able to see a vaccine sort of in the marketplace for regular folks and how that is going to be tiered for those who most need it and how we will deal with multiple vaccines . I think that its important to see the series of stages for the next stage to even matter. Right now we are at the stage of getting data from the Clinical Trials that will tell us whether they are safe and effective when they are used in thousands and thousands and to see whether they are likely to get covid and people who got a placebo and they will look at the safety data to see that it doesnt cause any side effects. Only when we know that, can we get to the next stage starting to think about who should get vaccinated and not all of it is going to be available by the way so theres a couple of phases. In any collaborations with a bunch of different partners including in the private sector. And then behind that there will be a lot more manufacturers who will prove safe and effective and multiple vaccines being manufactured and i think in terms of the what about everybody else, that might be more of a question for the late spring or summer. But if the first phases have challenges, then Everything Else gets put back. But to even be in the position is a lot further ahead than ever before. I know you have to leave so thank you for joining us and i will jump over to heather for a moment. When we talk about what our experiences were in the past, we had 150 million or so vaccinations of the flu when the last year and adding another 150 million on top, how does that work and was the system able to carry that load . The system is. I think the commercial supply chain is built on efficiency and scale. That will also play into how the distribution of this works so to add more to the status of traditional vaccines and also the flu vaccine at this point is going to follow the stages. And to me, there are 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 the covid vaccine, that is the time to rely upon all the entities that can vaccinate in the supply chain such as pharmacists, such as physicians and independent channels. We have the ability and it does rely heavily on the publichealth supply chain in order to vaccinate. We are going to need to use all the supply chain in the commercial supply chain to make it happen. But from the distribution point of view, that is our bread and butter and what we went off of every day and what we build off of every day. Would you like to think globally but act locally. So to understand how we protect our Health Care Workers in highest risk and to think it would be beneficial if you would join the coalition but also think about the global access. We are in a Global Pandemic not a us pandemic it is a Global Pandemic. Global economy does need to come together in a Global Health care system needs to come together because we have so Much Movement between countries and continent continents. Host i should mention as we jump over talk about how to get this equation right, want to give the us, just this past week committed the economic commitments for preparation that is 20 million is a lot to some but a drop in the bucket frankly compared to other countries so there are coalitions. Come back to the question doctor Robert Redfield from the cdc said we will have to embrace a person without resources, a person who is homeless without shelter, we will have to find a way to bring that person to be tested was support and treatment so i think what heather just said is so important parts of the world that are hard to reach so you are thinking about this how can we just not be. It . But actually be committed like our lives are on it to make sure we are inclusive as we reach out to the community that needs it . One of the important things the whole supply chain every step of the way can do is to think in terms of family and focus not just individual efforts to the whole family needs to get vaccinated and needs to understand that what they are doing is helping other families when they translate into neighborhoods california has the whole Health Equity line and hot spots all over the country there are neighborhoods and census tracts to be focused on with the essential workers as well of those who are the most vulnerable with chronic diseases already. They need to be protected first at the National Academy of engineering and science with their distribution plan. But i do think there is an Important Role for commitment through media. We have a lot of people get information not only from providers who dont go to the pharmacy to pick up medication we have ethnic media that are momandpop type and then of course the National Networks and the spanishlanguage and the asian languages have their own media stations like telemundo that Work Together with the ad council to create a major focus on the importance and we need to start now with flu vaccine season upon us we are involved with the flu Vaccine Distribution and messages with some of our partners with the cdc. Heather knows this Business Inside out and i have done a deep dive into it so you realize how complex the backbone, the circulatory system, the supply chain is incredibly impressive but was very ignorant of what is out there as we have a big way to go when we think of the media but in terms of what is out there we have been taking questions from the audience and we have a question from daniel. How do we ensure the integrity and security of the supply chain . How to reassure various adverse actors through security or theft or tampering or cybersecurity there are other securityrelated perspectives thank you. This is a big deal where talking drugs today but then to go on ebay there are ridiculous things how do we and hands and amp up security . So to get a vaccine trust your local Health Care Professional they trust their supply chain partners. As long as we continue to use the resources over time know your partner and trust your partner and validate your partner second to be logical i know the cdc trains have Vaccine Development with the National Security event. And over the course of time i know where our distribution locations are and then to pick pharmaceuticals every day and thats the same practice that i know from the pharmaceutical supply chain for one of the key things is know who you trust at this point also. How do you approach that . Because it is amply important for communities that already have a trust challenge who dont see folks like them do that messaging. So what is the perceived risk and one is a real risk but what are your thoughts . The perception is important everybody talks about anti bias training and the importance of having equity inclusion. But what really matters is the messenger and i have to applaud what heather said about trusting so people can see who they are talking to and the federal government meets our face and i think that was the whole part of the problem with this years misinformation is that the cdc is the public trust department. And the cdc needs to be out there with the State Government and the local government working together with the faithbased religion that is important to our community and Community Leaders and Community Organizations with messengers lined up with the importance of vaccine for covid19. It is such an infectious disease. People in our community understand it is a very important vaccine and with the infection rates for their own families. I realize this is a complex time i really appreciate your thoughts on how we do this right because there are choices out there and also unacknowledged strings that we have not been talking about but how this election turns out is something we have to get our heads around and then will interrupt from the National Hispanic federation i hope you will be back because this is story we continue to cover take you so much. That brings us to the end of our program, thank you to the Healthcare Distribution Alliance for those of you who missed the conversation we will have video up on the website. I am Steve Clemons. Be well. Mr. Rainwater sponsored by the indiana debate commission. Host good evening looking to the second of two gubernatorial debates organized but independent nonpartisan commission we are live in the studios in downtown indianapolis. We will be hearing from two candidates one