Transcripts For CSPAN2 National Press Club Discussion On COVID-19 Vaccine Development 20240712

University of maryland global campus and executive producer of the report, moderated by journalist marvin cal. We thank you for joining us for our virtual news maker events with francis collins, director of National Institutes of health and were pleased to accept questions from our audience, especially our journalists tuning in today. Ill ask as many as time permits. To submit a question, email headliners press. Org. National institute of healths, or nih part of the health and Human Services is our nations medical research agency. Its the largest public funder of Biomedical Research in the world and investing more than 32 billion a year to enhance life and reduce illness and disability. Nih comprises 27 different components each with its own specific research agenda, often focusing on particular diseases or body systems. All, but three of these components received their funding directly from congress. The office of the director is the Central Office responsible for setting policy for nih, and for planning, managing and coordinating the programs and activities of all of the nih components. In 2009, dr. Francis collins was appointed by former president barack obama to serve as the 16th director of nih and he was selected by President Trump to continue in that position in the current administration. Dr. Collins is a physician geneticist known for his landmark discovery of diseased genes. He was head of Genome Institute nih, 19932008 where he led the International Human genome project. He was awarded the president ial medal of freedom by president obama in 2005. Dr. Collins in the perilous year of the coronavirus pandemic, were honored to welcome you to the National Press club and to say that our virtual podium is yours. Well, thank you very much and its a privilege to be able to be your virtual news maker here today in this special year of 2020 where everythings a little different than what we thought it was going to be just a year ago. Im speaking to you from my home office in chevy chase. Those are my books behind me there and this is where ive been for most of the last eight months, trying to run the largest supporter of Biomedical Research in the world and the National Institutes of health a budget of 42 billion a year generously provided to us by the congress on behalf of the taxpayers at a time when medical research was actually making remarkable advances across the board in many areas. The basic science, the Clinical Trials and everything in between, however, were talking about diabetes or Heart Disease or cancer or Rare Diseases or common diseases or Infectious Diseases. Nih is in the middle of that and when you hear about a breakthrough in any of those areas, its likely that it was spun from nih that supported it. With puts them through this very rigorous process. We still are able to fund about one out of five of those applications so that the cream of the crop, the best there is and we provide them with resources and they go out and make discoveries that are transforming our understanding of how life works and how disease happens, and that is why this is such a remarkable moment. What understanding things like how the brain works and what the needs about alzheimers disease we are figure out how you can read the instructions of individual cells, developing gene editing approaches like just won the nobel prize a couple of weeks ago and applying them to cure diseases like sickle cell. Theres a lot going on. But this year, being 2020, being the worst pandemic in more than a century, our focus has turned very intensively to the effort to try to figure out how we can get the best side brought to bear to develop diagnostic therapeutics and vaccines against this virus, this coronavirus, this guide which ocean a model of, circular little devil on surface five proteins which enable this virus to get inside your cells and a conducive because you because you inhaled it and those proteins latch onto a cell in your respiratory tree, find a way into that cell and turn that into a factory to make lots and lots of copies of itself. And on that cycle goes. And yes, this is a virus we really did know anything about until january and here we are in october with a remarkable batch of scientific advances that it happened that it what you briefly tell you about and am looking forward to hang the questions from the group that has submitted them into dense and some that will submit them right now, so please do. First let me say were at a very serious moment in this covid19 pandemic in the United States. People may have some a gotten complacent after we had this terrible experience in march, april and may, particularly in new york, of a great deal of a number of people who fill l and many of whom are in icu and many of them died, and efforts were made to try to do Everything Possible to camp that down and it looked like things are Getting Better but then we had the big outbreak in the southeast, florida, louisiana, alabama, mississippi, georgia, arizona, california and texas. That led to a great number of increased cases, hospitalizations and deaths. That started to get better again because people took appropriate measures of Public Health protections for themselves. But now were in the third bump. I dont want to call it the third wave. In a certain way we are still in the first ways because we never really drove the infections down to the baseline but now we are in a very serious place. Yesterday there were 75,064 new cases of covid19. Thats the secondhighest recorded in the United States since the start. I would be willing to bet well have sadly a new record highs in that in the course of the next few days because the curve is going straight up. This time its in the middle of the country. The midwest and stretching over to the rocky mountains, and particularly in places like wisconsin and the dakotas and montana and iowa and missouri, all of those places. Its not just in the citys which is what people are getting used to. Its in rural areas. This is a very infectious virus and its diabolically infectious in that about 40 of the people who get infected with this dont have symptoms. They dont know the habit and yet theyre spreading it by being out in the public area and lest theyre doing Something Like wearing a mask to prevent that. We havent really seen i buy wrist quite like that before and thats why this is been so difficult to try to manage and thats why it is so critical for all of us, recognizing that is how this virus to take responsibility to not be that unwitting super spreader that happens to the virus and doesnt know it and then is getting it to other Vulnerable People. This does become a moment where all americans have to recognize that each of us individually has a responsibility if we want to turn this around. Im glad to talk to you about vaccines but we dont have them yet and is going to be a tough season here as people are more indoors with cold weather and we know thats the time or viruses like a start to spread and we consider the ark, all the more recent trip to take action in a very serious way. That means wearing a mask as we go outside. That means staying succeed apart. That means not congregating inside where you might have the greatest chance of spreading this especially if you took off a mask. Please dont do that. Also it means getting a flu shot because we dont need to have a double problem this fall of covid and flew at the same time. Thats my exhibition but when we talk about the size because thats i spent 100 hours we could buy time. Thats about what is right now because of the intensity. Where working a diagnostic tests. Nih has whole program there. Weise have developed we have developed way to new ways to get a test to find whether somebody is infected with this virus and those are many of them what you call point of care test where they can be done and a particular location where you want the answer right away. For instance, a nursing home where you want the staff to be tested before they start their shift to ensure that not brought this into that. So theres a lot happening in the testament and one of my hopedfor urgently needed efforts was to wider and wider asymptomatic test with point appear that gives you quick answer. We could get people isolate before the infected others. Let me talk about treatment. You no doubt is seen in cases the president , the treatments were offered in the case of drug called rim does appear as a drug worked with the Company Gilead designed and carried out a very vigorous and early trial so that by may we knew that drug would provide benefits for people are quite sick with covid19. Just this week fda has granted full approval of remdesivir. Its an antivirus. Basically they get into the virus and kind of clogs up its gear so cant replicate itself and thats what you want to happen. We know steroids, dexamethasone, can also be helpful for people of serious lung disease. The president also received that. That. We had shown in several trials that reduces likelihood of people in the up on the ventilator or even died. Those everybody agrees, are beneficial at this a lot of things that are kind of on the way and one that is got a lot of attention is the solidity of monochrome antibodies. With echo those . We know people have had covid19 and survived, they survive because their immune system made antibodies against the virus. So i would learn from them and turned their antibody into a product that could be given to people who havent made their own yet . Might be getting that would be very powerful strategy and its wood for a few of the things, ebola. Theres a couple of companies, that are far along with developing these antibodies derived from covid19 survivors, turned into very purified pharmaceutical products and put into trials and it does look encouraging but not yet definite and not yet fda approved. Those kind of interventions for people who are fairly recently infected will provide some benefits. It may not be so good after while because you wait today she probably starts to make your own antibodies so you need somebody elses at that point, its adequate internet this will be particularly useful early on or maybe even for prevention, get somebody an antibody before they see the virus. We are thinking about that in place like a nursing home. Therapeutics are coming along. We have this Public Private Partnership Involving 20 pharmaceutical companies, nih, fda, cdc, bunch of other agencies working on that together in a way thats never happened before in partnership that normally take about two years to put together because i have done some of those in my 11 years as nih director fixes will put together in two weeks because of the urgency required. Lets talk about vaccines because thats what every once to talk about and i totally get that. We really want to put covid19 in the rearview mirror. You have to come up with the behavior our population develops immunity they be as many as 80 of us developing immunity would be enough for this virus will not to be able to continue replicate. It would fade away at that point because we are a long way from that right now. Even in places like new york that a lot of infections may be 20 have not got immunity because of having recovered from illness. Thats not nearly enough. The way were going to get to the 80 is going to be a vaccine. We knew that. Vaccines have been such an incredible gift to humanity ever since gender and smallpox was figured out. We have developed ways to do this in the course of the last few years that are much faster and potentially much safer than previous methods. On january 10 when the chinese released the sequence, the letters of the code of this sarscov2 virus that causes covid19, within 48 hours a vaccine was being designed at the Vaccine Research center at nih and then working with a Company Called moderna within 65 days, that we need to phase one trials come first patient volunteers were getting injected. That is light years ahead of any vaccine effort that have been mounted before at that scale. Phase one looked real good. People look at the injection basically had a a sore arm butt much else and when you tested them they develop antibody levels that were very similar to what we would seem simply to us at the real disease and gotten better. That meant it was time to start scaling that up, and that trial and another one from pfizer started on july 27 enrolling participants. We at nih working with other companies have set up a way that those trials can be done in what you call a harmonized master protocol so that theyre all very similar in their design. They are very rigorous, very largescale come all of them involve at least 30,000 participants. They have an agreedupon standard which fda has put forward about what would be considered safety and what would be considered efficacy if nobodys going to get the vaccine approved until it happened. The moderna trial, the one in a most about because they have been a partner with nah since the beginning, announced yesterday that completed their involvement of 30,000 participants. And working with then we also made sure that this is a Diverse Group of participants, 37 of those people are people of color. We want to see that because the disease hit people of color particularly hard so you want to know does a vaccine really work in those communities and also as a generous number of individuals have chronic illnesses. We need to know that and we have a lot of people are over 65. We need we need to know that, too. This trial is now reached the point where they will start looking to see how people actually been protected by the vaccine and getting sick . How do you know that . You have to do this the way we learned over the decades is the only way to be sure. This is a randomized controlled trial. That means if you signed up for this trial and went through all of the process and did the consent you would get an injection. You would not know whether that was the active vaccine of whether that was a placebo. It was a 5050 chance. Then we follow those 30,000 people, 15,000 of them got the vaccine, 15,000 didnt appear reluctant see and theyre all in areas with the virus is spreading, particularly in the southeast in the middle of the country, and see who gets sick. The question is, are the people who got the actual act active vaccine getting a whole lot less cases of covid19 which would tell you it worked. Also other doing okay . Are there any safety issues a popup . Thats what were going to be doing. This is now one of the four vaccines that i started its phase three trial. Two of them have been on a temporary hold because of the concerned about a single patient that had an outcome that was concerning but may have nothing to do with the vaccine. This may people not surprising that somebody would develop a medical problem. It would be surprising with his many people if he if you didne some of that so were waiting to see whether they get started back up again. But two of them are moving along without that and are in a place now where i think its reasonably likely by late november that it will be possible to say it looks like one of these working then it will be up to the fda, look at that data and they had a big meeting about this yesterday, to decide whether they met the standard and should be issued and emergency use authorization. If that happens then it would be safe to start administering that vaccine to those who want it who are at high risk. You dont want to start giving vaccine to just anybody because we have limited number of doses for a while. Operation warp speed which was generated and put in place back in may to try to think about all these things has already paid for the manufacturing of hundreds of millions of doses of these various vaccines in order to have them ready if the vaccine turns out to be successful. That would be probably 100 million by january, more after that. We dont know the weather vaccine to going to work and theres a fair chance that one or more of these will fail for some reason and we just have to throw those notions out but if youre trying to end a terrible pandemic, you dont want to find yourself along about december january saying hooray, we have a vaccine that works. Oh, its going take another six months before with doses to give to the people who need it. We would not let that happen so this is an unprecedented way. Thats all happening with nih working with our partners, with industry come with operation warp speed. I saw the front page of the Washington Post today writing a very positive story about whats happening with covenant. We dont see a lot of that. It was positive because of the sites because we which the Vaccine Development has gone has been unprecedented. One of the commentators said its flawless. You dont expect to see that. Something could still go wrong. We could find some out infections vaccines to work but at the moment this is breathtaking at the pace that is been achieved and the promise that he carries along with it. Were pretty excited about that even as a new resolve a lot of work to do. So that was my opening sort of view of where we are with the disease, therapeutics, the vaccine without we would like to what questions people have. Lets have at it. Thank you very much and we do have a number of questions for you, dr. Collins. Lets start with, what is currently within the realm of possibility in terms of approving a vaccine . What do you think in terms of steel before the end of this year . Let me walk you through the steps that have to be followed to get there because i think thats really important. Theres been a lot of concern about whether this warp speed means that corners are being cut and safety is being not treated with as much seriousness as it deserves and theres politics involved. Let let me walk you through whas to happen for such an approval to happen. Ive already told you about the way in which the trials have to be designed, they have to be very large and have to be randomized and control. This is the only what you really know whether something works. Thats what were doing. If one of these vaccines comes to the point in the next month or so where it looks as though theres a significant number of people who got the vaccine who are protected against illness, that is, more cases in the Placebo Group than the Vaccine Group and it looks as if over at least two months since half the people got the injection that the safety issues are fine. We want to be sure theres not some sort of slightly delayed safety measure. If that happens there is a data safety monitoring board which is a group of individuals who dont work for companies. They are basically scientists and statistical experts. They are the only people who get to see that unblinded data and they would then raise their hand and say i think theres something here. And they would tell the company okay, we think that we would like to work with this the stad decide whether you agree that its time to go to the fda. The company would look at it. All the company ceos have said i dont want to submit to the fda something that you dont believe is real good, so they might say lets wait a little longer but we will see. If they decided if they hit the mark they go to the fda. Looks at it, it will take a couple of weeks and decide whether they think never into the details, they will hold a Public Meeting of the same group that met yesterday, the group vaccines related biological products advisory committee, thats a mouthful. But this is a group also distinguished experts who dont have any particular consequence. Youre just deciding what is right thing to do. Everybody will get to see is the data component or not. And only then the fda would consider issuing and emergency use authorization which says that were in the middle of the pandemic. The data looks really convincing. Were going to allow this to start to be distributed, but we still want to see more in terms of longterm followup to ensure theres no other consequence downstream confidentially something called bla that the company would get and then they would have full approval. Although steps have to be taken and youre asking so where are we now. Again the first two vaccines a cup start at the end of july will probably get to the point where the their dsm these in may be november will look and say i think theres enough here to say to the Company Better have a look or they might not because we dont know. Remember, vaccines are not usually 100 effective. Even the very best vaccine, 96 been effective and we know Something Like the flu varies from year to year but a lot of times for the flu vaccine is not better than 60 or less. Fda will not approve of vaccine that has less than 50 effectiveness. We have no way of knowing until we see the data how these are going to do. What if you like the measles . What if you like the flu . Until you have, we dont know. Im saying im cautiously optimistic that i been up to 120 the would be least one vaccine that is reached the stage of emergency use authorization but i dont know that for sure and it might not happen and it might take longer and in my be one of the other vaccines has yet to get started, there are two more in the pipeline that will start the next several months, well turn it to be better. Its a good thing we have this menu of diverse scientific approaches. If youre betting dont think one vaccine i would be a lot more worried. The Associated Press working in partnership with Kaiser Health news has undertaken a a substantive loot Public Health departments across the country and reports they currently lack the staff, the funding, the tools to distribute, administer, track the doses to some 330 million people. How big a challenge is this going to be once we have vaccine, and how do you see that resolve . Thats a great question and its a good thing were thinking about that now and not waiting until the end of the year. All of the states were required to thin there how they would do this distribution part thinking at about what kind of logistics would need to be addressed. The distribution across the various localities has been pretty well mapped out already between the companies that would be making the doses, and they know what their capacities going to be, and then the distributors, particularly places like lets be clear this is been done before. This is not the first rodeo. The cdc oversees this for influenza vaccine every year and about 80,000 doses im sorry, 80 million doses go out in a typical year. The framework for achieving this is something that weve already had in place. We will have to build on in a special way. I do think the questioner is right to point out that this is going to be a stretch. We have unfortunately underfunded, i do support Health Departments in this country. They had been allowed to flip into a phase of really very difficult financial stress. Because it just hasnt seen to some people like priority and here we are and what, is it a priority. So that we need be a lot of attention to how good it backs up any of efforts will look like. They will be really stressed. Were looking at the very intensively now. Thats the whole process in the middle. You talk a few minutes ago about our being and perhaps the third bump of the first wave. To what do you attribute the current rise in covid19 cases across the country . And i will just suggest some possibilities. Is it the cooler temperatures . Is it in person schooling . Is a pandemic fatigue . Is a combination of all those, and more . Its probably a a combinatin of all of those, and more. I think the ones where you can really see what happened are often a sort of indoor gathering. Sometimes people who were just tired of the pandemic and wanted to party. Sometimes something as wonderful as a Family Reunion or a wedding, or choir practice. And without stringent attention to keeping physical distance and mask wearing and not congregating indoors is so easr this to happen and then you have super spreader if it. We saw estimates suggest part of the reason why you are seeing so much covid19 in the dakotas dates back to that Harley Davidson sturges gathering. Im Harley Davidson motorcycle rider so i dont want to dump on bikers but this was not a good thing. 1000 people gathering in sturges without mask, congregating in congregating in bars and having really no concern about this, clearly there were infected people there anybody got and the bikes and went back to where they came from and spread this around. We just cant afford to do that. Pretty clear there are holidays and memorial day, july 4, labor day are often followed two or three weeks later by a spike in cases. As i said at the beginning there is no hightech solution to this right now. We are looking at one with vaccine with a lowtech solution which rests on the shoulders of every american, he is you could be the one that is spreading this. Dont do it. Where that mask, avoid that close proximity to others. Watch your 60. The three ws come where mask, watch her distance, wash your hands. Keep that in mind. That applies not just to Vulnerable People at young people may think they are in mortal but they be the ones spreading this to the neighbors, grandparents and result in terrible outcomes. Unless we all think of it that way this will would just keep happening. Im afraid its why were in the pic we are now. We have not in this country figured out how collectively to turn this into a circumstance where we can just drop the cases down. Given everything that you just shared with us how do you react and respond to the question of science i politicians, abundance and a substantial percentage of the population . What impact is that happening as a result . It is troubling at a time where i think in many ways our best hope to get past this depends upon the full power of the scientific methods, reliable methods of treatment and prevention. And yet there is a lot of suspicion of whether science is something you can trust. It reflects i think the fact that we have right now in this country a great deal of suspicion about everything and great sense of division between sort of tribal attitudes and sciences probably come across as sort of these elitists who think were smarter than everybody else and maybe we dont do a very good job sometimes of communicating what we do and why you should trust it. On top of that you have the cancer of social media conspiracies which come at you 24 hours a day and many people basically have that as their main feed of information. Some of those conspiracies are absolutely outrageous and yet they seem to acquire followers who become quite convinced that thats the source of truth, and its hard to turn away from that because that becomes part of the way you look at the world. Its kind of a perfect storm of our culture being in a bit of a spasm of difficulty and divisiveness, source of information that are unregulated and can very much then spread false information almost more rapidly than the true information. Scientists that are perhaps seen this from what real people are experiencing, we have a lot of work to do. When i look at the attitudes that are out there now about this vaccine about who would be interested in taking it, its really, really troubling. Ive been talking so optimistically about how were likely to have a vaccine by the end of the year but if only 50 of americans are interested in taking were never going to get to that point of unity across the population where this covid19 goes away. It could be here for years. You mentioned tribal attitudes. Are we in the time when science is being questioned more than other times . Youve been in this business a long time. Does it just feel this way because this is at the top story on the news every minute of every day . I dont want to make the mistake of saying this came out of nowhere. It has been a problem in other areas, so look at the whole debate about Climate Change where it does seem americans have gotten polarized about that. The Scientific Committee would be absolutely with very few exceptions outlined to the perspective that Climate Change is very real, that is a result of human activity. We need to take action now, and yet the general public for the most part hasnt really quite seen it that way although some have we been in this issue for a while where this type of scientific, even when its strongly supported by evidence doesnt necessarily receive a warm public embrace. Thats particularly true if you put a map across the divisions, the tribal courses in our country that Climate Change is done and most of the discussed but whether you to work the mask is also. You have a very warm and easy to understand methodology of explaining these things related to what we were talking about. Perhaps it is one of the great challenges that scientists are facing today in translating their research and findings to the larger population. Getting this down to understandable levels for i dont want to use the term average but for more people so that they get and perhaps simpler terms what we are dealing with here. And i recognize that all scientists are good at that. I am fortunate to be surrounded by some are world class in that regard and a to mention tony fauci in particular context because here is somebody who is probably the most highly respected Infectious Disease expert in the world, and i could have conversation with tony when we get deep into immunity and he can run circles around with what he knows and with the specifics of the scientific information. He can also in any setting ive ever seen him take these complicated concepts entered into compelling evidencebased conclusions about what kind of Public Health measures we should be undertaking without the spin attached to that, just telling it like it is. We need more tony fauci. We dont have enough of them. A lot of scientists kind of really had enough experience in how to do that and they sort of came to slip back into using terminology that is offputting because people dont quite understand which four syllable words they just use and what it was supposed to be. We have done a great job in terms of educating our scientist about how to communique what they do. They are excited. They like to do this. They want to tell this story. We are now working harder with her graduate students and postdoctoral trainees to get People Better prepared to be able to do an elevator speech about what youre working on. We are working on it but its not widely successful so far. At one time journalist Walter Cronkite was considered the most trusted man in america, and as you mention you have an employee, dr. Fauci, who today is considered by many to be the voice of knowledge and reason. How you go about defending dr. Fauci against criticism he is receiving for effectively doing his job . Well, i dont have a problem defending him. Its pretty easy. I just say this is a dedicated Public Servant with intensely broad and deep knowledge about the problem we are facing, somebody who is completely devoid of political connections who has served six president since 1984. You can you can trust him because he has that track record, he has that knowledge. And if you dont like what he had to say, okay, then look at the facts and try to figure out what we should do about that. It is hard, somewhat distressing to see how somehow demonize tony is for tony to do now is a fulltime Security Force around him because some of the threat he and his family have received. I guess i didnt expect to see that in the midst of this crisis but here we are. Its a reflection of just how intense the feelings have become. One of the challenges for journalists in the 24 7 news environment is the pressure to bypass the traditional process which is gather, sort, report. And instead rush information out and does not come through the sorting process. With this rush to find a viable vaccine for covid19, are we seeing a similar gather, report, and then report process playing out with the research . In other words, is the public seeing, hearing and reading about the processes, the sausage making so to speak on this that would normally play out behind the curtain . Is that more confusing . Is that exciting . What are your thoughts on that . On the Positive Side i would say its great for the public to have window into how this all works. Youre right, this has never had the kind of attention and scrutiny in the public eye that this particular sort of set of steps in developing a vaccine has now led to stories all over the place. I bet until a few weeks ago most reporters and most members of the public had no idea what a defcon b is. Now its like on the front page that we have might be meeting soon to look at the interim data. This meeting yesterday of the vrbpac and make it i think was covered on cspan. This is like one of those government committees that most people would find it want to spend hardly want to spend five minutes and get it was six hours. But the good part is we ought to be transparent. This is good. People want to know exactly what we know and what we dont know. See with the process is. I love that but it is challenging im sure for the press to figure out how to fullback industries. To say ive been very impressed for the most part with the way in which the press has tackled the situation and i end up talking reporters a lot and a monster like it as they are really delving into details and do not just buying the first answer that comes to them from the first person to speak to. They are quizzing, asking difficult questions if they dont quite see it that way. Thats a pretty good thing and if you look at the Mainstream Press they are doing a fine job of telling this story at a level of detail the public has never before. Question, a question from ron lloyd. There seems to be a small group of covid19 patients that continues to experience symptoms long term. Some of them have symptoms that mimic other illnesses. Yukon it on whether you look into this and what can be done to help both patients and groups . Appreciate the question and us that actually several hours in the last 24 hours working with some of my Institute Director colleagues on a plan to investigate this more intensively. Because theres something going on here thats quite troubling, that people who had covid19, maybe even people at fairly mild versions of the illness, are not Getting Better, not all of them, when you think it would. You get the influence of bug, a week later youre going to be pretty much over it. With covid19 there is a subset of people, i will call the long haulers, who seem not to actually recover for weeks at a time. They are still fatigued, still short of breath. You can do various analyses of their bodies function. You start uncovering things that are troubling to see. For instance, a study just published a couple weeks ago that ohio state athletes. These are people in tiptop shape, women and men, who all had covid19. They look at them a few weeks later by a very sophisticated cardiac mri study. Fully half of them did not have normal cardiac function, and about one out of seven had frank myocarditis, that is an inflammatory problem of the heart muscle. That was not expected. If you look at people older who have been even sicker, the frequency of such cardiac abnormalities is even higher. Are those all going to get better works we dont know yet but it is alarming to see this kind of consequence week after the acute illness. There are people of this brain fog which is also very troubling which may linger also for weeks after we dont know what thats about. Because of some inflammatory response that lingers . Is it that theyve had some sort of faster if it . He can as we virus can make blood clots happen even in small vessels. We dont know. This is going to be a very critical thing and we put a lot of effort into understanding, we need a lot more data to figure how, this, the consequences comn how long does a lincoln and we identify people who are at highest risk of these longterm consequences and intervene at the earliest moment . I dont have a good answer for those questions. This will be one of the longterm questions that we will be wrestling with for a while. Thank you question from andrew scholl. Would you please talk about the characteristics that differentiate the first generation vaccine candidates, especially what makes the candidates more suitable for distribution to specific populations . There are several different technologies that are being studied for Vaccine Development among the ones that operation warp speed has chosen for the larger scale are three different ways. One is and the one that got out the first is a new approach where you basically no actual rna sequence of the virus and you synthesize that same rna. Its an rna code for one of these spike proteins. When you put that rna in muscle, you can inject it in the muscle, muscle says im going to make a protein out of this and makes the spike protein, the immune system goes i know what that is, im going to make an antibody. There you go. This is very rapid because you dont have a lot of work to do to prepare the vaccine messenger rna wrapped up in an envelope and thats why those were the first ones to get into phase three trial. But no mrna vaccine likenesses of been approved by fda. This is a new technology and went to think about that. The next step, the vaccines that are being put forward by Johnson Johnson and by astrazeneca are based on using an adenovirus as a carrier for the gene for that same bike. This is unopposed successful used for ebola thought to be safe and effective and so we will see how those go. And then two more are based upon an even simpler idea. Just purify that microbe gene and forgot make lots of it and use it as the thing that is the vaccine can injected into the muscle and let the immune system take it on. Those coming from novavax and from are little bit slower getting to us because those are harder to do and there are a few other ways people have done this such as having a kill virus or inactivated virus. The chinese are doing that. We are not doing those at the moment. Some concern about safety and that sort of thing. All these at different pros and cons. Again as he sipped a good thing is where not putting all of our eggs in any particular viral basket. Were trying to diversify the approaches and increase likelihood of one or more of these is going to work. And you had have a followup question, and i will ask it. Im not sure whether you covered this in your first answer. Would you please talk about the inclusion of in current trials and for nextgeneration vaccines . Great question. I did not cover it. Adjuvants is basically a molecule that activate the immune system to react to something even more strongly than it would. We have used adjuvants with lots of vaccines in to know to get overly vigorous response. Yes in fact, the last two vaccine platforms, vaccines and mentioned coming from novavax, those of the protein subunits. The both of all adjuvants. We have question here from member bob weiner wants to mention that spouse pat was that nih for 11 years, and they both have admired your work and they are thrilled to have you with us. Question is, covid driving Research Support down for other critical illnesses and or slowing work them like cancer which also kills hundreds of thousands in the u. S. Annually. Thats a very important question and theres no doubt about the fact that this pandemic has had consequences for research in other areas. Take cancer for for instance. A lot of the research on cancer would require working and let had to be slow down because researchers to keep themselves safe were basically having to work from home and most of us dont have lab bench at home. In my own Research Laboratory at nih, the ten people who work for me on diabetes and on aging pretty much had to go home for about three months. The gradually did come back in shifts, wearing masks. Everything that and all that type of bench work got slow den. In terms of things that involve Clinical Trials or the need to enroll somebody in a trial in the clinic because people were an easy about coming to hospitals and clinics, those trials also slowed down in terms of enrollment and thats true for cancer for lots of other things as well. So sadly that is been one of the consequences. Were trying to keep it effort going as best we can and bringing back very carefully as many as the staff as we can to be sure that we are doing this during the next few months because its not over yet, what is necessary to keep momentum going. But theres no question, one of the staff outcomes of this pandemic would be a slowdown in the search on some of the things that without were going to be going really fast. Thank you. We have two questions from isaac from propublica. First question is, what is the militarys role in distributing a vaccine . So the military has been an incredible support of operation warp speed. General perna who is overseeing a lot of the logistics and supply chain and manufacturing is quite an impressive expert in that space and ive got to know a number of the folks at dod that it didnt know before and they been wonderful. When it comes to the actual distribution, from what i understand no member of the military will touch any of the doses that are on their way to somebodys arm. Basically, the doses will be manufactured by the companies in the manufactured facilities. They will be shipped using shipping that is not military and the will end up in appropriate distribution places, much of it managed by mckesson, which is a company, owned pharmacies and doctors offices. The militaries been incredibly helpful in designing logistics and making sure we would not have shortages of things like needles and miles. It would not be involved in actual distribution. Second question, from isaac, how will the Pfizer Vaccine be able to reach rural and remote areas given its ultra cold storage requirements and large minimum shipment size a thousand doses . Very sophisticated an important question. This is an issue. The Pfizer Vaccine requires minus 90 degrees in order to keep it active. Thats not going to be trivial to achieve because lots of places will not have freezers sitting there waiting for something to be kept at that temperature. We had to figure out how to do it. There are ways people have planned how to distribute such freezers advisor ends up being the only print vaccine. Roaches had to make this work. On the other hand, if we end up with more than one vaccine that turns out to be safe and effective you can imagine this might be one of the ways the distribution plants are made soy for needing to go to a place that doesnt have that kind of cold chain capability, and you might pick a different vaccine. In that regard i think a lot of us are watching closely to see if the Johnson Johnson vaccine which is bent on pause for about a week starts up again because it has a real advantage. First of all its a single dose. All of the other vaccines we are talking about require two doses. They are trying to do something for people far away from the nearest medical care facility. Its really nice, and it also the jj vaccine will not require much in way of cold chain. It will be all right in a refrigerator who doesnt need this ridiculous cold temperature of minus 90 degrees. Thank you. Researchers and lentil of the world work tirelessly this year in the race to develop viable covid19 vaccine. Some of our greatest scientific discoveries have happened by accident while trying to develop something else. Are there any new discoveries that are being made in the quest to develop a covid19 vaccine better particularly exciting to you . Thats a good question. We are always looking for those moments of serendipity where something happens that you did not expect and you dont want to just walk away from it. You want to go what can i learn here . Im not sure in a vaccine and mean i i can immediately put tn example. I will say in the diagnostic we know which is in the heart of what im try to do what called brand x which stands for rapid acceleration of diagnostics we have been encouraging Small Businesses and academics who have had ideas about how to develop new ways to detect the presence of this virus in a nasal swab or saliva sample to bring those forwarded. We put them into whats called a shark tank, thats the term senators have applied to it, and basically those Small Businesses that are academic investigators were all kind of inventors get there i did find a panel of business people, engineers, technologies, supply chain experts. Only a small fraction of them actually get through without over the course just since the end of april we have now come up with 22 new technologies to do testing for the presence of the virus which is breathtaking. Those are now being scaled up and getting ready to deploy. Some of those have involved the discoveries i was not expecting to see. Well heard about its effort to use gene editing. That was the nobel prize a couple weeks ago. And that you can use cryptic cash for diagnosis. Its really good at searching out and finding a particular genome sequence and a copulated 60 60 and the switch what if trying to decide if this virus in some recent nasal swapper thats very innovative. I dont think he wouldve seen that kind of insight on these kinds of intentions happening without this sudden motivation. Thats made an important point to say it will be spinoffs we will in the future have better ways of making vaccines because of what we have learned with this one. We will have new platforms for doing diagnostics for other Infectious Disease because what weve been able to encourage for this one. This is not just a oneshot. This is going to have some spin. Maybe the next time will be a little better prepared. Question from member alyssa. There been reports of a possible link between what types and covid. People with type o blood may have a lower risk of infection and a reduced likelihood of severe outcomes. What can you tell us about this . That is a finding based upon a recently good size study done in europe. Basically what they did was they look to people who got very sick with covid19 and of the people who got it were not nearly that sick and a steady their dna and said is there Something Different . It turned out the old group people were less likely be really severally ill and people with blood type a were more likely. It was not a big factor but it was statistical significance. Im not quite sure whether the final answer is but the another place where you seem to be a segment of dna that predispose people to get more sick. When you went and looked at that particular piece of dna on crumbs and what do you know, this is one of the 4 of our genome that came from neanderthals. What do you know it just happens to be in that space. Im going to take a big leap here and say okay, who has neanderthal dna on the planet . Much everybody except africans because the neanderthal crossbreeding happen in the middle east and did not get back to africa. Everybody came out of africa and didnt go back. Maybe this explains why so far covid19, despite the great fear many of us had, have not been as devastating in africa as it has been in every other part of the world. Thats the big leap. Nobody should hold me to that. Theres a question from mike fulton. China just joined the World Health Organization Led Initiative to test and approve a covid vaccine. The u. S. As as a know has optet of that collaborative effort and is going it alone. Do you believe this was a proven strategy, and what are the potential consequences . This is the Organization Called callbacks which types recorded Vaccine Development. Covax. We will learn how to work with her International Call expect scientist addenda for decades. We will continue do it with our without this framework of covax and make sure that we are playing the best and that we can. I would just say for myself personally, with what we do with this Vaccine Development is just limited to helping americans, then we have failed. We have a responsibility to the whole world in places that dont have their own resources that have lots of desperate when you think about them as were going through the process of how to make enough doses Everybody Needs one can get it. Im happy to say the companies we are working with have that same view. We are going to be citizens of the whole Global Health arena, not just for the United States. This is a final question. This is a bit more philosophical for you. You said that the principles of faith and science are complementary and that as a young man exploring your own faith you eventually concluded that atheism was the least rational choice because it takes the position of asserting a universal negative which scientists in general are discouraged from doing. Do you think your faith has major better at your job . A lot of peoples faith has been shaken this year. What is help you keep yours . Thats a wonderful question. I was an atheist, graduate student and as a medical student encountering people who are facing din been otherwise reali hadnt given much thought to those serious issues about why are we all here and what happens after you die and why is a something set of nothing . All of those questions that generally get shoved aside when youre a young person who thinks he will do forever, and i became a believer in my late 20s. And that is very much a part of who i am. Its times like this my faith is more important to me than ever. I dont understand why terrible things are happening around us. I can can understand how it started, through transmission of the spiders from about two human and maybe thats a something that how we be more careful about mixing together our environments of animals and people. Im now that it is here i can feel this sense of calling to try to do everything i i can to help with that and people around you feel that come to. For me thats a calling that is not just based upon a secular view but also on a perspective of faith. When they get up in the morning at 5 a. M. The first thing i do is try to reconnect with that spiritual part of who i am before i get plunged into all of the daily challenges of what is coming at me. And maybe theres something about this terrible crisis that instantly can cause all of us to reflect a little bit about not just the material parts of life but also the spiritual part of who we are into it is that we want to be and what kind of calling do we have to help out those who are suffering, some kind of comfort. We are all called for that. What is set come from . To me that comes from faith, going back and reading the beatitude of matthew. Its an anchor for me that helps me. We wont allow that to be our final word today. Dr. Francis collins, thank you so much for joining us. It was a pleasure. Thanks for the chance to be on this program and for getting to as many of these questions as he could. They were great. We are pleased to present you with our National Press club coffee mug. We will get this to you along with our hope that you will join us again in person in the very near future. I look forward to that. Thank you. Good luck, at least be safe. We need you. Our thanks to producer Lindsay Underwood tour Headliners Team coleaders and to our wonderful National Press club team behind the scenes here in the broadcast operation center. We think our members and guests for your questions and for joining us. Be well, stay safe, and have a good day. More Live Programming later today with a discussion on what to expect on election day. Including how long it could take to get results from states and other possible accounting and reporting challenges. Its from the Bipartisan Policy Center live coverage at 2 p. M. Eastern here on on here on cs. On linux cspan. Org or listen on the free cspan radio app. With five days left until election day on november 3 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 ondemand at cspan. Org or listen on the cspan radio app, your placement and filtered view of politics. American history tv on cspan3 exploring the people and events that tell the american story every weekend are coming up this week and for election date november 3 we will look at president s and president ial elections. Saturday at 10 p. M. Eastern on reel america a look at four films or explain the american electoral system. Watch American History tv this weekend on cspan3. Former hhs secretary Kathleen Sebelius and former fda commissioner Scott Gottlieb were part of a discussion on the federal response to the coronavirus and its impact on the pharmaceutical supply chain. Other speakers included representatives of mrs. Lofgren and buddy carter. Hosted by the hill newspaper, this is just over one hour. Hello and welcome. Im Steve Clemons editor at large of a hill. Thank you for joining us for covid19 and a responsible rx supply chain. Our Virtual Event look at the resiliency of the Prescription Drug supply chain during a global pandemic. I would like to think response of the Healthcare Distribution Alliance for their support of todays program. Es and forced a new normal upon us, what accommodations can be made for lifestyle choices but little flexible lead to healt is not a choice. It is a matter of life and death. The pandemic put Healthcare System and patients of changed their behaviors. Concerns have arisen surrounding drug availability and shortages. What are stakeholders doing to shore disruptions do not occur in this collaboration between the bl