Update with top officials at the International Vaccine access center. This is 30 minutes. Welcome and thank you for joining us today. My name is ellen wilson and i will be the moderator for this expert briefing for the media hosted by the Johns HopkinsBloomberg School of Public Health. This briefing will address vaccines for covid19. The world has made unprecedented strides in developing covid19 vaccine candidates quickly. Many with higher efficacy than anticipated. Bringing these vaccines from Clinical Trials to the general public would require many considerations. Todays briefing would tackle these questions, including how do scientists develop vaccines against covid19 in less than a year, and how do we know they are safe . Will there be enough for everybody in the u. S. . What about people in low and middle Income Countries . Be demandingerly vaccines. Others will not be. How do you determine who will get it first and how do you convince those who are hesitant about such a new vaccine to be unionized immunized . Once we have a vaccine, what will our lives look like . Will we need to continue mask wearing, handwashing, and physical distancing . Bring arts will sciencebased and engaging perspective on these and other questions. Andng closer to having safe effective vaccines is a giant step toward putting this pandemic in the rearview mirror. Please note participants are welcome to use images, video, directly from the webcast, and that the content is for immediate release. I would like to briefly introduce our speakers. Professor inoss is the department of epidemiology, international health, and molecular microbiology and immunology at the Johns HopkinsBloomberg School of Public Health. Ofis also executive director the International Vaccine access center. Mossg the pandemic, dr. Has been engaged in research to understand the impact of the pandemic on Childhood Vaccination programs and in communicating with the general public about the covid19 vaccine. Dr. Rupali limaye is in the apartment of health, epidemiology, and health, behavior, and society at the Johns HopkinsBloomberg School of Public Health. She is also director of behavioral and implementation science at the International Vaccine access center. Beeng covid19, she has leading the Communications Work global grant to develop demand generation strategies to maximize covid19 Vaccine Acceptance. Questionsve time for following our panelist remarks. The procedure will be as follows. We will take questions submitted in advance of the briefing and some from the zoom shack. The zoom chat. If you have a question you can enter it addressed to all panelists. Enter your name, media outlet, and question. We hope to cover as many as possible. Participants will be muted during this briefing and it will be recorded. Dr. Moss, go ahead. You very muchk and welcome to all of you. We are setting record numbers of cases, hospitalizations, and deaths and we are seeing our Health Care Systems overwhelmed. We are also about to face a winter where we may see increases in the numbers of cases, hospitalizations, and deaths. We are at a critical juncture in this pandemic. We do have good news about the vaccines. There has been astonishing progress made in the development of covid19 vaccines. Inis hard to believe december 2020 about a year after this pandemic was first recognized, we are talking about the potential availability of vaccines that may protect up to 95 of vaccine recipients being made available in the coming weeks. This is truly a remarkable achievement. As all of you know, the vaccines that we are likely to see in use in the United States are the Pfizer Vaccine and the modernity vaccine. Rna of these use messenger technology, a novel vaccine platform, and we do not yet have a license vaccine based on this technology, but this technology has allowed for this very Rapid Development and testing of these vaccines. How are these vaccines develop so quickly . They are built off a decade of research on mrna technology as well as other vaccine platforms. We have been able to combine some of the trial phases. Phase i and phase ii, or phase ii and phase three, that has expedited the process. During a pandemic because there are so many infections and cases , in the phase three trials, we are quickly able to tell whether these vaccines actually protect against disease or not. The pandemic situation, as tragic as it is, has allowed for the Rapid Testing of these vaccines. Lastly there has been concurrent manufacturing along with the phase three trial that makes it possible for when the phase three trial results are analyzed and hopefully we get emergency youth authorization, we are ready to roll. What is the process Going Forward . We anticipate there will be a Public Meeting on december 10 of fda,visory group to the the products advisory group, and that they are going to really assess the data that the fda has been reviewing since pfizer submitted their application for the emergency use authorization. About a week later we expect something similar from the modernity vaccine. Vaccine. A a Public Meeting where the data made will be made transparent. There still remain many questions to be answered. We do not know the duration of immunity conferred by these vaccines. Its going to be very important to continue followup in the phase three trials and in individuals who get the vaccine after the rollout. We need to know how these vaccines work in particular highrisk groups. Older adults, those with underlying conditions, but also pregnant women and children. We need to know the impact of these vaccines on transmission. That is not one of the primary outcomes of the phase three trial. We also need to know whether there are longterm side effects. We are only going to know about shortterm side effects, but we need to know whether there are potential rare longterm side effects. It may be that other vaccines in the pipeline turn out to be better than these frontrunners. These frontrunners are not the optimal vaccines. We would ideally have a vaccine that does not require the stringent requirements the messenger rna vaccines require. Wey b would have up would have a vaccine that guarantees longterm immunity after a single dose rather than two as required by the messenger rna. We want to make sure we have the optimal vaccine for populations. We are going to face numerous challenges and we can talk more about these. The allocation process, who is first in line. We heard from the Advisory Committee on immunization practices this week. Prioritizing the 21 million healthcare workers and 3 inlion residents and staff longterm care facilities in the United States. We need a phased approach because we will have insufficient numbers of doses to reach all those who should or want to get the vaccine. There are going to be distribution challenges and this is going to be up to the states, to determine the final allocation process and to figure out the logistics on how to distribute these. We are going to have challenges with acceptance. We need to track these vaccine doses so we know who got which vaccine and when. We heard today about vaccination curves being administered to all vaccine recipients. Lastly, very importantly, we need to continue our safety monitoring as we go forward. My last point is that these vaccines are not going to be the Silver Bullet that brings us back to prepandemic. We are going to need to continue to wear masks in public, socially distance, wash hands frequently and avoid gatherings. I think we will see over the course of 2021 a phased return to our normal prepandemic life. Thank you. Ellen you, dr. Moss. Limayewill hear from dr. That weye it is great have potential product but the important thing is to remember that vaccines do not save lives. Vaccinations save lives. We have to figure out how to get people to accept these vaccines. There are five key things we must do. We need to understand peoples attitudes toward the vaccine and how this might vary by specific segments of the population. We are finding that nonwhite people may be less likely than whites to accept the vaccine. We need to understand who people trust for Vaccine Information and identify barriers for acceptance. Vaccine intentions vary wildly. A study reported on a Global Survey of more than 13,000 people in 19 countries to determine potential acceptance rates and factors. About 72 of participants ororted they would be very somewhat likely to take a Covid Vaccine once it is available. Differences in acceptance rates reached almost around 90 in china to 55 in russia. Respondents that reported higher levels of mistrust in information from government sources were more likely to accept a vaccine. Are able to we better understand attitudes toward the vaccine, we need to deliver messaging to address issues. Leading toctors hesitancy in segments of the population need to be identified so the most appropriate intervention can be applied. Different interventions should differ by subgroup, context, setting, vaccine product, and time. Use tothe messaging we nudge people toward Vaccine Acceptance must be salient, impactful, and tailored to meet the needs of different audience segments. It must come from a credible, trustworthy source. Berth, we need to transparent with information about vaccine side effects. Clinical trial participants from the Pfizer Vaccine trial indicated the vaccine can cause people to feel unwell for a few days. We need to be able to communicate this is normal and remind people the vaccine has undergone rigorous safety testing. Should communicate expectations about who and when people look at the vaccine. As dr. Moss mentioned, not everybody will be able to receive the vaccine once it is available. Living ine have been this pandemic for more than a few months now. A lot of people are feeling a certainty uncertainty, fear, and anxiety. To encourage appropriate behavioral action it is critical we have clear and consistent communication. Thee are resources such as cdc crisis and emergency Risk Communication to serve as guidance that can assist Public Health authorities, government officials, and other stakeholders in communicating with the public, utilizing Risk Communication principles. While we are confident about the efficacy of the current product, a vaccine will not mean people can stop taking precautions. Thank you. You. thank if you have a question, please enter it in the zoom chat with your name, media outlet, question, and to whom you would like to address your question. The first question comes from hannah at the Financial Times for dr. Moss. How long will it take us to understand whether a vaccine can stop covid19 transmission . Is a verythis important question because if the vaccine can stop transmission it is going to have a greater impact on the pandemic. The phase three trials do not have that as one of their primary outcomes. Their primary outcomes are looking at disease. There are going to be a number of ways in which we learn that. It is going to take several months. Is through the existing trials. We know in the astrazeneca trial they looked at asymptomatic infection. That is not a direct measure of transmission, but if people are not developing asymptomatic infection, it is unlikely they will be transmitting, or their probability of transmission will be low. I think we will get some information, but we are going to need to set up additional studies to look at this. What we pandemic, in are going to see, there is going to be so much transmission in the United States that i expect we will be able to see this. People have been talking about setting up studies in College Dormitories to look directly at transmission. Part of the answer is going to come from the current trials, partly from new studies. We will probably have a good handle on that question by mid2021, if not a couple months sooner. From the next question is Alan Greenblatt governing. Can you comment on the challenge involved in distribution . What role do you see government playing . Do you feel they are prepared . Dr. Limaye it is a great question. With the introduction of new types of vaccines, mrna vaccines , they require a different storage, cold chain storage. This will require states to coordinate and think about how vaccines will be transported, not only from where they are being distributed, but to the state. Once they make it to the states, to the facilities. It is going to be clear states are going to have to take the role with regards to distribution. The cdc can provide guidance and feedback on this but it really is up to the states to determine how this will work. There is a need to have a coordinated response. This is a new vaccine so we will have weighed a bit of learning very quickly as we start to roll this out. Hopefully that we can use to improve the process as vaccines continue to get rolled out. Ellen here is another question for you from julie washington from the cleveland plain dealer. Are there any plans for the national for the government to roll out a National Media vaccine to overcome hesitancy . Dr. Limaye there is a recent oped by a great colleague just two days ago that talks about the importance of this. Regardless of what happens, communication is critical. Transparent communication is critical. To my knowledge i am not quite sure if there is a planned National Media communication campaign, but i think it is absolutely paramount if we can do Something Like that that would be really useful with regards to increasing acceptance of the vaccine. Ellen how can media prepare the public for side effects without making the vaccine seem dangerous . Dr. Limaye i am glad the media is interested in this. Media is an important partner for us. The key is to be critical to be credible, to be transparent. We do not want to scare people but we do not want to lie to people. How do we make sure we are providing the facts but we are also providing individuals with the ability to prepare for a vaccine so they are ready . To me, having Media Journalists talk to different scientists so they can clearly communicate this in a way that is not scary would be ideal. Question fore next dr. Moss. Why is the astrazeneca vaccine less effective than messenger rna vaccines from pfizer, biontech, and moderna . Dr. Moss it is a very different kind of vaccine. Ultimately they all do the same thing. Both the mrna and the viral vector to vaccines introduce the genes, the spike protein, that is produced by ourselves, our immune system to respond to it. My first answer would be the efficacy data on the vaccine, the astrazeneca vaccine is a little quirky. They reported 90 vaccine efficacy with that half dose, full dose schedule. That is pretty close to what the mrna vaccines produced in terms of vaccine efficacy. With awer efficacy, 62 , full dose full dose schedule. That remains a mystery as to why that is. We learned subsequently the half dose, full dose may have been in younger individuals. The first thing i will say if there is a lot more to learn about the vaccine efficacy of the astrazeneca. Lower, theat it is honest answer is we do not know. Courseot know what the of immunity are. Hopefully we will learn that, if there is a level of neutralizing antibody that confers protection, one could hypothesize the astrazeneca , it reaches that threshold in lower proportion because of less spike protein produced by the cells. The honest answer is we do not know. Ellen another followup. Johnson johnson has been testing a single dose regimen, but announced they will begin testing with a booster shot. Is that a concerning development . Earlier as i mentioned , the ideal vaccine for covid19 a single dose to confer longterm protection. That ais possible vaccine of lower efficacy but with a single dose might do better in the population level then the two doses of a higher efficacy vaccine if we have trouble getting two doses into p. Whyo not know the reasons Johnson Johnson switched and decided to test a two dose schedule. I suspect they were seeing some signal that perhaps the duration of immunity or level of immunity after the singledose was not what they wanted. I would say in that sense, perhaps if that is the rationale behind based on evidence of durational immunity after a single dose, but we are still hopeful one of the vaccines in the pipeline, and there are many more types in the pipeline that will be able to have a single dose that requires refrigeration. Have a choiceople what vaccine they take, or will they have to settle for what is available where they can get it . Dr. Moss this is going to depend on the timing and where we are in the rollout. Early on people will probably not have a choice. Vaccines,ve two similar vaccines but not identical, and people likely will not have a choice. But as vaccine manufacturing builds up and the distribution the storage,et up, the delivery of vaccines, likely even more vaccines, i anticipate toward the end of 2021, maybe people will be able to choose the type of vaccine. And we may learn certain types of vaccines are better in some populations. Maybe one vaccine is better in people with or in different underlying conditions. I think we are going to see more choice, but