This entire conversation with senator lee is Available Online at cspan. We will have to leave the last few minutes for live coverage. The Bipartisan Policy Center discussing with medical professionals how to build trust in Covid Vaccines. An organization that focuses on the appropriate use of medication to improve costs and outcomes. Todays event occurs against the backdrop of covid and significant optimism now that we have a vaccine, a remarkable achievement. 160 7 million doses of covid19 vaccine have been administered. This has resulted in nearly one in five americans being fully vaccinated and over 55 of seniors being fully vaccinated. Todays event also occurs against the backdrop of caution. We have a ways to go with respect to vaccination campaigns. Variants are circulating and we are seeing americans exhibit less cautious behavior. Echo additional challenge that may grow as supply outpaces demand is Vaccine Confidence in racial minorities, white rural americans, and young americans. A poll found that 25 of the American Public will probably or definitely not give vaccinated. Those polls had those polled had concerns about side effects, tend to be republican and are usually younger. We will talk about how to increase Vaccine Confidence using a multifaceted approach to address side effects, distrust of the medical community, and a feeling by many that they do not need the vaccine. We will hear from experts from a variety of fields. We will also hear from the ceo of an institute announcing the launch of a new National Task force. This will be followed by a discussion moderated by susan with a terrific panel of experts. Please utilize the chat function to ask question for questions for todays event and we will try to get as many as possible. I would like to introduce the former Senate Majority leader, dr. Bill frisk, who will provide some opening remarks. Dr. Frisk thank you and thinking to the staff of the Bipartisan Policy Center and our partners at gtmrx. We are together to discuss a timely topic. Covid has taken too many lives, halted our economy, disrupted our social connections and overwhelmed our health care system. Masks and social distancing continue to be fundamental to our toolkit to reduce our risk of being exposed to the virus and of spreading it to others, but now we have the Game Changing tool that will accelerate our efforts to end the pandemic, vaccines. The three fda authorized vaccines are safe and effective. Vaccines are the miraculous final piece in the puzzle to help us to return to work, to return to play, and to engage in everything in between. Vaccines will save lives. We have been encouraging uptake and vaccinations as they become more available to americans at no cost, but we are only at the beginning of the road. We have a moral imperative to work as hard as we possibly can, and as quickly as we can, to return immunity. To get there, we must continue to build confidence in covid19 vaccines. Here is how we do it. First, increase trust. Vaccine hesitancy is nothing new, nothing new. As a physician, i witnessed some type of hesitancy with vaccines with my patients for 40 years. What is new is that Many Americans have concerns specifically about the covid19 vaccines. They are concerns typically center on the Vaccine Development and on the approval processes. Throughout the pandemic, public trust in the Scientific Community has unfortunately decreased. Compounding this, some americans express skepticism because covid19 vaccines received fda approval faster than many other vaccines in the past thanks to emergency use authorizations. Authorizations. Moreover, Many Americans feel the approval process has been politically motivated rather than driven by science. In fact, recent polls just from march found that the largest single divide among americans in their support for vaccination now falls along political lines. The truth is this virus does not discriminate based on political affiliation. Building trust and confidence in vaccines has got to transcend politics. We can increase trust by leading with the facts, and the facts are that the three fda approved vaccines met the agencys rigorous scientific standards for safety, for quality, and for effectiveness. Those are the facts. We must remember the political tones of these conversations in order to improve trust, in order to increase the uptake of vaccines, and in order to reduce preventable deaths. All americans who can get the vaccine should regardless of political affiliation, regardless of political affiliation get those vaccines. Number two, we must leverage public and private partnerships. These partnering connections are integral to successfully Building Confidence in covid19 vaccines. The covid19 pandemic is a Public Health threat that is too great for anyone company, anyone institution, any one Government Department to solve alone, so like all other Covid Response efforts, Building Trust in vaccines requires this inclusive, this all hands on deck approach. We have to make a decision to give vaccinated as easy as possible for americans. We have to meet people where they are, employers and businesses and faithbased organizations play a hugely important part in getting people vaccinated. They are the ones those institutions, faithbased organizations, those employers, those businesses, are deeply embedded across communities in communities across america. Partnerships help us use all the resources to get the gettable. These organizations can take active measures to encourage employees and Community Members to give vaccinated. One example, faithbased organizations could partner with state Health Officials to serve as vaccination sites, or provide transportation to those vaccination sites. Employers might offer employees paid time off for the time involved in going to get the vaccine. Vaccination, you see, is not just a win for Public Health, but we know that businesses will benefit too. Ultimately, vaccination plays a large role in getting us to herd immunity and fully reopening the economy. Finally, we must incorporate the medical neighborhood in our strategy to build a vaccine to build Vaccine Confidence. We think of hospitals, Health Care Professionals come all the others who provide Health Care Services professionals, all the others who provide Health Care Services in communities, all critical to Building Trust in vaccines. As a doctor, i know firsthand the amount of trust americans put in the medical neighborhood, the neighborhood around them, the ecosystem around them each and every day, to care for themselves, their children, their loved ones. There is no more important time than now to tap into that trust and to build confidence in covid19 vaccines as well as vaccines of the future. You know, we have a great panel of experts today that will go into much greater detail about the role of these medical neighborhoods in building Vaccine Confidence and i am excited for the conversation. Thank you all for joining us today. Thank you, senator frist. I would like to introduce the founder of the institute for Health Care Improvement, dr. Don berwick, to make some additional remarks. Don i am a pediatrician by training, president emeritus and senior fellow at the institute for Health Care Improvement in boston, and former administrator of the centers for medicaid and Medicare Services in the obama administration. My field of work for a long time, decades, has been improving the quality of health care around the world and now, even more, improving the quality of health. In this regard, the covid pandemic certainly is a call to arms for reasserting our commitment to learning and improvement at the core of our work in health care. The concept of building Vaccine Confidence through work with medical neighborhoods is also core to the theories of improvement overall. There really are two ways to think about making things better, to oversimplify. One is, unfortunately, too much the tradition and the habit, and that is through commands, control, incentives, exhortation, trying to force or push people to people into new ways of being, to change processes through simply insisting on change. That is convenient. It is simple. And it is wrong. All improvement happens through learning. And learning is a shared enterprise not involving control, not involving command, not even involving incentive. It involves curiosity and empowerment and the idea that, as we say, all teach, all learn. In the covid pandemic, we were learning a ton very fast. In Clinical Care around the world, knowledge is speeding from place to place at a pace i have never seen before. The sense of humility and crisis curiosity dealing with this tragedy is leading to curiosity about how to do better but it is also leading to crises. It is leading to a crisis of confidence and experts. In experts. In the early part of the pandemic, we actually enforced parts of these fears and hesitancy, particularly in communities that have been left out or behind. People tend to do what makes sense to them. Trust in science, expertise, the allegations are professionals, if that wanes, we are in trouble. How do you recover trust . Thats the problem the conference and the Bipartisan Center and colleagues are trying to address. It is done through cooperation. There is no other way. The idea that we can somehow browbeat or even convince people to do things they do not believe to be in their interest is bankrupt. It is crucial to address fears honestly and with enormous respect, to engage in dialogue, and constant listening so that we can walk in the shoes of people that we are in dialogue with. Trust is everything. In the pandemic, with respect to vaccine concerns, that is trust in science, trust in expertise, in accumulated experience, and trust in the helpers trying to reach out to reverse the effects of this pandemic. I think that happens best in communities, neighborhoods. The terminology that is entering health care more and more, and i think favorably so, is placebased approaches to addressing the problems. We will have to think that way in the covid pandemic too. Localities, neighborhoods, collectives of people that care about where they live, care about each other, getting together to understand what the problems are. That is the only way. There is no topdown solution. I think in this journey toward dialogue and curiosity and authentic conversation and careful listening, toward trust, primary care has an essential role. We need trust in messengers, people who when they speak in communities because of their relationship to the communities, has two start out with a has to start out with a bankroll of trust, and that is all people involved in points of First Contact in the health Care Community. They are potentially the very kinds of trusted voices that are needed to help people become comfortable with what needs to be done in order to stop this pandemic. Some will never agree. Some will never find the source of the trust they needed, and thats ok. We just need enough people in dialogue to change the overall characteristics of the community as a whole. I think the effort underway here to build trust at the medical neighborhood level is exactly right. And do you know what . This is about more than vaccines, then covid. More than vaccines, more than covid. It is about improving trust as a whole. The source of health, wellbeing, our social determinants, and those lie in the hands of the communities we deal with. Just as with Vaccine Hesitancy, we need to talk more on understanding the nature of concerns and the sources of trust in those communities. Be it Food Security or transportation or housing security or criminal Justice Reform or environmental improvement or equity itself, we are going to need to do that in exactly the same way, in localities, places, communities, with a sense of real respect as we enter the dialogues. I thank you for the chance to share these thoughts. I am so delighted about the effort now underway. I will tell you, it is exactly where that effort needs to be. Thank you. Thank you, don, for those remarks and particularly your focus on the role of empathy. Now, we are very lucky to hear from the cdc, which is playing a leading role across the nation when it comes to building Vaccine Confidence. Please welcome the director of the Cdcs National Center on birth defects and develop metal disabilities and the former deputy incident manner of the cdcs Covid Response. They also served as ceo of the American Academy of pediatrics. Thank you very much for having me and thank you to everyone who is on the call at the Bipartisan Policy Center and the Gtmrx Institute for hosting this very important call. As you heard, i have had a lot of roles in health and health care, but one of the most important things and don just spoke about it is nutrition. As a pediatrician, have spent countless hours talking to families, parents, about what to do to their child and listening to what their concerns were or not and how we could answer them. We have been discussions been having discussions as pediatricians about the importance of vaccinations for many years. It always needs to be a conversation, that we join in together, humble, listening, and learning. Im excited to talk about this important topic. We know that strong confidence in the vaccine in the community leads to more people getting vaccinated, which leads to fewer illnesses, hospitalizations, and deaths. We appreciate that the Initiative Focuses on community, trusted relationships, and as i say, there is no thing more important than health. I will share about the available vaccines, our current distribution and administration, vaccine safety, and an overview of the cdcs Vaccine Confidence framework, which may be of help to address Vaccine Hesitancy, an overview of partnerships and programs working on expanding access to vaccine, identifying barriers, increasing uptake, and ultimately listening to all of you today to learn what we can do better at the cdc in partnership with all of you. As has been said, vaccines are a critical tool to bring the pandemic to an end. As we know, multiple vaccines have been developed and have gone through Clinical Trials. We have talked about the three available, the pfizerbiontech, two doses, 16 and above, my turn moderna, two doses, 18 and above, and the johnson johnson, windows, 18 and above. I think, as you heard, as of april 4, over 207 million vaccine doses have been distributed in the u. S. With over 165 million being administered. That includes over 99 Million People with at least one vaccine and 50 million leave vaccinated. We continue to work with states to understand roadblocks and overcome challenges in distribution and administration to ensure we are getting vaccines into arms as quickly and as safely as possible. We had the cdc know that Vaccine Confidence is built on the foundation of vaccine safety. Covid19 vaccines are safe and effective. They were evaluated in tens of thousands of participants in Clinical Trials and met the fdas rigorous standards for safety, effectiveness, and manufacturing quality, leading it to support emergency use authorization. Any adverse effects that may not have been seen in Clinical Trials. If we see an unexpected adverse event to experts quickly study it to assess whether it is a true safety concern. Experts this monitoring is critical to ensure that the benefits continue to outweigh the risks for people who receive vaccines. Here at the cdc and fda, we have a number of tools to do this. We have a new smartphone based checker for people who received vaccines. We have more than a million users enrolled. Over 80,000 individuals have self identified as pregnant. We also have the vaccine adverse reaction reporting system. This system has been in place for many years and collects reports from Health Care Professionals, vaccine manufacturers, and the public on adverse events that happened after vaccination. They also collect reports of adverse events that are unexpected, happen more often than expected, or have unusual patterns. These are followed up with scientific study. We have not had any significant safety signals in matters related to the covid19 vaccine. Lets talk about covid about Vaccine Confidence. Most people in the u. S. Are planning to get vaccinated. As you heard, the numbers continue to go up as we do more poles, but we know many people may want more information about the vaccine, including about the process for authorizing them and their safety and effectiveness. People have previous experiences that affect their confidence in the health care system. Strong confidence in the community leads to more people getting vaccinated, which leads to fewer covid illnesses, hospitalizations, and deaths. Many factors influence vaccine decisionmaking cultural, social, political, and vaccine specific factors. I think today we are talking about the vaccinaters and how the Community Based can make a difference. Our vaccinate with confidence strategy is built on three pillars build trust, and power Health Care Personnel empower Health Care Personnel, and engage the individuals. To build trust, we always try to share and will continue to share clear messages about the Covid Vaccines and build trust in the vaccine, the vaccinator, and the vaccination system. These are some of the tactics the cdc believes reinforce trust. Talk transparently about the process of authorizing, approving, making recommendations, monitoring the safety of, and administering the Covid Vaccine, including how it is handled, providing regular updates on the benefits, safety, side effects and effectiveness, and clearly comedic eight, what is not yet known, proactively address the spread of misinformation via social media platforms and trusted messengers. Empowering Health Care Personnel in their decision to get vaccinated and to recommend vaccination to patients. These are some tactics the cdc believes will empower Health Care Personnel. Engaging Health Systems and personnel often in early to ensure a clear understanding of Vaccine Development, approval process, new technology, and benefits of vaccination, ensuring those Healthcare Systems and practices are equipped to create a culture that builds confidence in covid19 vaccination, and strengthening the capacity of Health Care Professionals have to have a vaccine conversation. Provide tailored information to patients and use motivational intervening techniques when needed. I know motivational interviewing techniques can have a Significant Impact on that conversation with patients. Engaging each community and individual in a sustainable, equitable way to build trust and increase collaboration. These are the tactics that we will need to engage individuals. Empower vaccine recipients to share their personal stories. Working with Health Departments and National Partners to engage communities around Vaccine Confidence, including adaptation of vaccine provider sites to meet community needs. Collaborating with trusted messengers such as faith and Community Leaders to share culturally relevant messages and material to diverse communities. This is where we are focused Building Trust to help people make decisions with those who trust them. Vaccine confidence for the cdc is not in advertising, marketing campaign. It is a cohesive framework to help providers, immunization partners, and Community Partners and leaders in their promotion of the vaccines. Confidence in the vaccine within communities leads to more people getting vaccinated, which leads to fewer hospitalizations, illnesses and deaths. We have resources to assist and share information about vaccination. We have an informational guide to build confidence in covid19 vaccines with strategies for immunization coordinators to build Vaccine Confidence within their Health System or clinic. We have a number of the tools including communications and confidence checklists, covid19 confidence conversation starter, Vaccine Confidence strategy, and Building Confidence in vaccines among patients, tips for Health Care Providers. These includes toolkits, slides, information that helps providers, print offs they can give to their patients. More information can be found on the cdc covid19 vaccine with confidence website. I want to very quickly go over a few highlights of some work we have been able to do with our local and state partners. We have an agreement with multiple districts to support vaccinations. 10 of the funding received by these districts must be allocated for high risks and underserved operation including in order to engage minority communities and build trust and improve vaccine uptake we are working with diversity champions to meet these communities where they are. We have developed a comprehensive flow gram of 20 National Organizations to support federal and local communitybased organizations to improve covid19 and Vaccination Coverage among racial and athletic groups. We have a Retail Pharmacy program with 21 pharmacy chains and independent Pharmacy Networks to administer vaccines in communities across the united states. Almost 90 of people in our country live within five miles of a community pharmacy. Pharmacies have a unique reach and ability to fight access to covid19 vaccines and provide this presents one component of the vaccine on march 29, the Biden Administration announced a plan to more than double the number of pharmacies offering covid19 vaccines, and that by april 19 90 of adults in the u. S. Would be eligible for vaccination, and 90 will have a vaccination within five miles of where they live. What we are talking about is so important, we need to bring the vaccine to communities, but we need to have communities and individuals want to be able to get the vaccination. We have programs with Health Centers working with federally qualified Health Centers, local vaccination unit are being supported, over 500 mobile sites and partnerships with jurisdictions around the country are committed to providing available resources to support our state and tribal partners in our effort to provide a vaccine to everyone. In addition i am now working through multiple different hhs agencies to promote features for people who are homebound and people who have disabilities to also have access in a culturally up to vaccinations within their community. When we talk about community, there are communities within communities, within communities. That understanding works best at the local level. It makes sense we would have to make sure we consider all of those communities within communities and we think about the groups that may be left out and how we make sure we always reach out to them. I look forward to any questions and i will turn it back over to you. Thank you for those remarks. We do have a couple questions if you dont mind. The first question comes from a viewer on youtube, can you please comment on recommendations for a patient who is experiencing severe or serious side effects from a covid19 vaccine. For that individual receive a different vaccine . Dr. Remley i am assuming that individual is talking about their first vaccine. The first thing i would do is talk to my Health Care Provider and make sure i understand whether those side effects or symptoms were related to the vaccine or may have been related to something else. That provider can call and talk to an expert about vaccine efficacy and walkthrough whether that was related to the vaccine or not and what their recommendations would be for the second vaccine. I think its very important, as we know people have different types of allergies and we can also have symptoms of another health problem. We never want to take questions about vaccine safety lightly, we want to make sure they talk to a Health Care Provider. Another question from youtube. The speed of approval causes many to be hesitant, believing the vaccine has not all the typical protocols. How do we collectively address this issue . Dr. Remley this is an important issue. Walking through people this is not new technology. This is technology that has existed, yes the process itself was sped up, not by cutting any corners, but by focusing research, scientists, clinicians, everyone together on this important issue. Im old enough to remember the first flu shot, and this was, i think this generations flu shot, we can do all we can to make sure this vaccine was created not just fast, but as safely and effective as possible. I am confident there were no corners cut and also importantly the days the vaccine is approved we dont stop monitoring and following closely. Every day we are working with the Pharmaceutical Company and continuing to monitor for safety. Im very happy to say that i come from a family of Health Care Providers, so everybody in my family has been vaccinated and we have had all three. Some have had pfizer, some have had moderna, some have had j j. I cant wait for my grandson when the vaccine is available for children for them to get the vaccine. On a personal professional level im confident in vaccine safety. One final question from the audience. If you can just summarize this scientific advice or consensus for women of childbearing age or in women with respect to the safety of the covid19 vaccine. Working with the American College of obstetrics and gynecologist the cdc has recommended that pregnant women be offered the opportunity to be vaccinated, and that they do that in conjunction with having a conversation with their provider, their position about whether the vaccine is right for them. We are gathering more information. 80,000 women who received the vaccine at the time of pregnancy, we are developing a registry in the next coming weeks there will be Information Published again about the safety of the vaccine and pregnancy. I just saw an article about the fact that antibodies are created and protecting not only the mother from covid protection but protecting the infant around it is again she completed her vaccine in the last week. Its important to protect all of them. Thank you for joining us, very much appreciated. At this time i would like to introduce katie, the cofounder and executive director of the Gtmrx Institute that has had a long history of collaboration in the Health Care Environment area thank you for your leadership, and welcome. We appreciate our partnership with the Bipartisan Policy Center. We are excited to share with all of you the successful fashion line launching a new National Task force odin Vaccine Confidence in the medical neighborhood. Our goal is to identify key issues and offer guidance to build Vaccine Confidence in local communities. This work is supported by a grant from johnson johnson, and we will inform strategies to engage at the Community Level and work collaboratively and communicate effectively about vaccination during current and future pandemics like making care teams in the local community, working with schools, religious organizations, collaborating with local, state, and federal agencies, and communicating to ensure and engaged community response. We at the institute believe in implementing programs designed to build Vaccine Confidence. Today as part of our partnership with the Bipartisan Policy Center we kicked off our first listening session for the task force. I am delighted on behalf of the board of directors to introduce to you the code leads of our task force. Dr. Benjamin, executive director of the American Public health association, and dr. Abramowitz, ceo of the American Society for Health System. Susan from the Robert Margolis center for Health Policy at Duke University, a colead to facilitate our meeting, and i will serve as staff officer. Ive inched delighted to introduce members of that task force on behalf of the board of directors, thank you to all of you for kate perry, American Health insurance plans, the American Nurses association, the primary care collaborative, innovator and president of the Gtmrx Institute. From the American Academy of family physicians. The alliance of Community Health plans. Tough school of business. American college of clinical pharmacists. The American College of physicians. The National Partnership of women and families. Marcus, association of state and territorial Health Officials. The National Quality forum. Walgreens. The National Association of community Health Centers. The National Alliance of health care purchasers. Howard university. University of pennsylvania thank you for participating and serving. Today we are releasing a report commissioned by the institute, background and resources to build confidence in the medical. This provides a tool for the gtmrx National Task force, crafting new innovations helpful to overcoming barriers to building Vaccine Confidence in local communities today and in the future. It can be found on the Task Force Website landing page. Thank you to all of you. I look forward to hearing the Upcoming Panel and engaging the medical community to build confidence in covid19 vaccines specifically and all vaccines more broadly. Now we moved our panel discussion. It will be moderated by susan, a senior policy fellow at the Robert Margolis center for Health Policy at Duke University and has had a distinguished career in Health Policy. Thank you, for being with us. Thank you for that kind introduction and for all of our opening speakers for their framing of the remarks this morning. Let me briefly recap what we have already heard. 160 7 Million People in our country have now been vaccinated as of today with 61 million of those fully vaccinated. The nation reached a record 4 million vaccinations over the past weekend. Many people abandoning mitigation measures like Wearing Masks in social distancing. We are far from out of the woods when it comes to this pandemic. Most people from the u. S. Do want to be vaccinated, but about a quarter of people say they wont be vaccinated. With vaccines being the Game Changing tool of this pandemic we have to accelerate our efforts to get more people vaccinated. We have a moral imperative to get as many people as possible vaccinated to reach herd immunity and break the chain of transmission of the sars cov 2 virus. We heard that the pandemic has been a call to arms for our country in so many ways about the need to improve health care in america by tackling health where it begins, in communities. Vaccination is part of an overall approach to improve the health and wellbeing of communities as a whole. Its the right place to begin to feel the drive to maintain and increase confidence in vaccines. From the doctor at cdc we heard that as a pediatrician she knows the importance of having the conversations with people, with parents about the importance of vaccines. We heard about all the tools the cdc has created to enhance confidence. The vaccinate with confidence framework. The pregnancy registry she mentioned, along with many other tools and toolkits available through the cdc to build confidence. We also heard about the report that the medications institute has released showing us that Vaccine Hesitancy has been a longstanding feature of our country and many societies around the world, but there are also very wellknown ways of addressing it. We know that black populations have wellfounded historical grounds for distrusting much of the medical and scientific establishment. That distrust has increased generally. People do what makes sense to them. Now we face the important point of Building Trust, correcting misapprehension, illuminating myths and taking other steps to build confidence. That means that they are particularly engaging people in the trusted medical neighborhood, the primary care doctors, the pharmacist, the nurses and others who already have a lot of trust of the patients they serve and it is time to tap into that trust and build that confidence and take advantage of all the other entities that can come together, public and private partnerships, employers, businesses, faithbased organizations and others, to turn that trust very importantly to the goal of building herd immunity in our population. With that as a summary of what we have heard lets turn now to our distinguished panel and let me introduce now. I want to remind the audience that they are open for questions so please use the live chat feature on youtube or facebook or go to twitter and use the hashtag. Our panelists include the chief medical officer of cvs caremark and cvs has played a vitally Important Role in vaccine rollout, cvs also recently recently issued to white papers addressing the issues around Vaccine Hesitancy and confidence that i know she will be happy to address. We are delighted to have a physician, the founder and ceo of grapevine health, an organization that creates Health Promoting content for underserved and under resourced communities and builds trust through delivery of credible and Community Focused Health Information and content. We are happy to be joined by a physician also president of global immunization at the Sabin Vaccine Institute in washington dc. The institute seeks to make vaccines more accessible to enable innovation and expand immunization across the globe. Bruce also served as the Deputy Assistant secretary for health and the director of the National Vaccine Program Office previous to his current position. A physician who is also executive director of the Maryland Primary Care Program at the Maryland Department the American Department of health. His career has been dedicated to solving complex medical care delivery challenges and implementing programs to serve diverse populations in maryland and across the nation. We have asked all of you panelists today to give particular observations and counsel to the distinguished task force that katie cap stopped about headed by two doctors. As they work to draft legislation to harness the capability of medical neighborhoods across the country to build Vaccine Confidence and get us to the goals we have described. Let me turn first to you. Drawing on your experience at cvs caremark on those white papers i mentioned about hesitancy, what do you think are the key points that the task ors to keep in mind as it drafts its recommendations to build Vaccine Confidence . Thank you you for the opportunity. What i want to do for my introductory comments is talk about cvs healths capability and are vaccine efforts and what we learned and how we are using that information to build confidence in covid vaccinations. Briefly about cvs we have three Business Units at caremark and cvs pharmacies. Across our nationwide program we have nearly 10,000 Retail Locations. Cvs health like other pharmacy chains is in close proximity to the rest of america with 85 of americans within 10 miles of a cvs pharmacy, we have 50,000 trusted immunizes, pharmacists and pharmacy technicians who are trained and we will talk about clinical particles and training as part of Building Confidence in the vaccination process. We have significant expertise and experience in providing a number of Vaccination Services through the covid pandemic we provided thousands of flu vaccines. We have surpassed 10 million covid vaccinations that we provided for the country. Using these assets to provide 20 to 25 million covid vaccinations for the country on a monthly basis. Cvs health has been participating in National Efforts through to fedco program stash federal programs, the longterm Pharmacy Program where we are now completing that program where we partnered with 45,000 Skilled Nursing facilities and longterm care facilities and provided nearly 5 million vaccinations and through the federal Pharmacy Partnership where pharmacists and pharmacies that are in the community are providing communitybased access. Well talk more about that program briefly. Lets get to the topic of Building Confidence and what are the drivers of confidence and we conducted a number of white papers with some interesting insights on what drives confidence. There are three strategies, making sure it is easy to get the vaccine locally with an explicit locus on equity, making sure we had trustee can ash clinicians and protocols and making sure we amplify the messages around safety and efficacy using multiple communication modalities. Lets talk about our research and we have conducted a number of National Surveys where we have surveyed across the country thousands of individuals, marrying the demographics of america about their intent and reasoning about getting a covid19 vaccine. Early on we saw a very large middle. We have bookends about 45 that they would either get the vaccine or were not interested in the vaccine. 55 in the middle were just either waiting to see what would happen or would make a decision later on. What we have seen also is that varied by race and ethnicity with greater hasnt and see among black americans and hispanic americans than other americans. As the pandemic has progressed and Vaccination Efforts have progressed we have seen the hesitancy has decreased in the most recent months. And we ask what will help you with making a decision, clinicians matter. Hearing the messages around vaccines from trusted clinicians are critically important, and when we ask those who are willing to get the vaccine we say a return to normalcy is important, they want to get back to a normal life. The second piece that has arisen recently is an interesting one, it was a network effect. Knowing that somebody else has received a vaccine that has led people to say i know people who will gotten the vaccine so i can get a vaccine as well. Those who are hesitant around safety and efficacy want to hear from clinicians about the safety and efficacy and they want to hear from their community trusted clinicians. As we think about in the next minute or so, we are committed to making sure through the cvs pharmacy retail chains and federal Pharmacy Partnerships to make sure the vaccine is available locally. We have turned on stores based on the Vulnerability Index and our local understanding of communities. We partner with communitybased organizations that know the community to amplify messages about availability and how to do the scheduling and that has led to nearly 34 of individuals coming to our stores are underrepresented minorities getting the vaccine where we see that nationally hovering around 20 . Efforts of being confident about store location and amplifying messages with trusted partners has been important. As Vaccine Availability expands we will continue to provide vaccinations outside of our Retail Locations with offsite transportation support with partnerships with organizations. Our knowledgeable about the questions patients would have when they come in, would have a greater upfront to answer questions about the process as they go through the process our digital scheduling is also connected to educational efforts to ensure that people have the question answered before they even go through the process of getting the vaccine. Amplifying having trusted clinicians, making this accessible in communities and amplifying the messages around safety and efficacy are critically important in building Vaccine Confidence in the neighborhood. Thank you, so much. That is a remarkable success. 34 underrepresented minorities being vaccinated through cvs pharmacys versus the National Average of 19 . That takes me, lisa fitzpatrick, to you. Having heard that Success Story and recognizing your own extremely important work and finding the messages that resonate with blacks in particular and those in vulnerable communities, what are the most important takeaways for the task force in terms of thinking about reaching people who seem to be moving out of that movable middle that she referenced but may still be having concerns about the safety and efficacy of the vaccine. What messages do you think are most important . Lisa good morning, thank you for including me on this panel. This is a vital conversation. Id like to tell you a bit about what we have been doing. I want to focus my remarks on the message, because i think thats what it will take. If we focus on who is giving the nation and what they are saying misses how we can continue to meet our goals. I call it the Vaccine Acceptance continue will him. There are people in the black community who absolutely will not make the take the vaccine. My experience has been we have heard trust many times already this morning, i find people are looking during the pandemic bastion on you hurt a bit about it in my introduction. We have been out in the community and we have offered a combination of text messaging and emails so people can contact us to ask us questions. We also hold virtual sessions with doctors. We have a tribe of doctors who have been on rotation answering the Community Questions during the ask a doctor questions. We are also out on the street, we collaborate with social service providers, i havent heard much about that group today. Its a Critical Group with a goal of improving Vaccine Access because they are already in the community providing social services and they have also built trust in the communities. Its important to work in partnership with them. We have been doing that to be on the ground with them when they are providing services so we hear from people and understand what their concerns are. We talked a lot already today about what the concerns are, concerns are if the vaccine is safe and why we have the vaccine so quickly. Initially one of the concerns was around being used in the communities words as a guinea pig. Once we talk about the number of people who have actually been vaccinated or have i talked about my experience in the research trial. We still hear a lot of concerns about safety and the side effects and why the vaccine has been produced so quickly. I welcome the intervention in these two categories because when we talk to people virtually or in the immunities we hear missed information and misunderstanding. The reason the messengers are important is because people want to hear from a trusted source and that should not come as a surprise. The community is no different. When we talk about the black community we often hear that we should collaborate with churches, or we should collaborate with activists. We are not monolithic and it takes a multifaceted approach, the church especially. Its a powerful influencer in the black community. A lot of the people we are interacting with in this movable middle are actually not being influenced by the church. We have to think about some other influencers and who they are. We also have to talk about how people get their information. They get their information through wordofmouth a lot of the time. Thats the reason our company is called grapevine health. We recognize a lot of Health Information is being transmitted on the great fine. We are not there to correct misinformation. The pandemic has provided a perfect opportunity for us to learn and listen and understand where the misinformation is coming from. With respect to messengers in addition to the churches, and influential we also need to include Health Care Providers. I will tell you a quick story. In one of these ask the doctor sessions a lady said a person said their doctor told them not to get the vaccine. That told me we also need to implement training and access to resources and information for some providers. The Provider Community is not monolithic. Its not a foregone conclusion that all providers will understand the research and have been trained in academic settings very the public sees us as science messengers. Sometimes some of us need more help help and support. I would like the community to think about how to provide resources for primary care providers ensuring people understand what we are saying. We have been asking people virtually and in person if they understand words like antibody, community, efficacy, and they dont understand what we are saying. Its essential we find better ways to communicate this information using metaphors, or examples, relatable examples that help people understand what we are saying and frame the messaging. The other playful interaction i have with the community is i ask them if they know the difference between cdc, fda, and emma and nih. I havent found anyone yet who can tell me the difference, most people think dr. Anthony fauci is the head of the cdc. I am offering this as an example for why we need to think about how we are communicating Health Information. We take it for granted, we are close to the information. I would love to see some attention in the report focused on how we communicate. Its possible to be scientifically credible and also speak in plain language so people understand what we are saying. Otherwise we are leaving them behind. The final thing i will say before turning this back to you, susan, is i think it is critical for us to deploy vaccines into communities. It is so important because we talk a lot about equity and ensuring people have access. Even if we provide doctors and i think these interventions are incredible and we can reach many more people with these innervations. We have a last mile problem. To get those people who are still in the movable middle but taking a little more time, energy, and intervention to move for Vaccine Acceptance, we have to take the education and vaccines to them. If we think about strategies for that, all of these ideas we are hearing today collectively will get us to where we need to go. Thank you, very much, for having me here. Thank you, so much, lisa. Bruce, to pick up on some points that lisa made, she talked about her organization, grapevine and the fact that it was named after the grapevine, the notion of how people communicate. In your role at the National Vaccine center you do this grapevine well and the grapevine has a lot of participants on it saying different things, and as lisa says, sometimes that information is wrong and needs to be corrected. What do you think are the most important steps that need to be taken to get the right messages out through the right messengers and move the people who need to be moved towards a position of Vaccine Confidence . This has been such a rich discussion. I know the task force is taking great notes on all the things they can go forward on. As i think about that, maybe this is an opportunity to think about what we are doing now and this focus is local, this focus on place. This focus on the medical neighborhood is critically important. We shouldnt just do it for covid. We should take advantage of it and build it out so we have this not only for other vaccines or for children or adults, but for other things. This is where it is going to matter. At the heart of this its where people can get trusted information that will improve their health. We are doing a very narrow way around the Covid Vaccine but lets not use this opportunity to think about this chance to build out this part of the system which we all recognize is critical. Local matters most. The trusted voices matter most and people will turn to those trusted voices. What lisa describes as the grapevine is right. I think of it in a technical term as the information supply chain and everybody in the chain needs to know what is happening and they need to know the answers and how the system work. In some ways the issues are the same globally as they are within the united states. The big difference is supply. When it comes down to the Community Level, all countries have to think about equity and advancing the health of their communities and it gets down to the Community Level and where people are going to get trusted information to make the right decision for themselves. We should take the time in the same way that lisa talked about not using hesitancy we should be careful about the use of that word. A lot of things get swept into that and we need to make clear whether issues of access versus issues of peoples reluctance to actually step up to the vaccination clinic when supplies are available, otherwise they can get it. We need to make sure those are handled. Part of the access is not only the vaccine and the opportunity for vaccination, but the information. People may not have places to go to get trusted sources of information. We need to take a hard look at that and that something the task force to drill into. How to be sure that people have have the right information. Sometimes they may have it wrong, and sometimes it may have been contaminated by devious efforts and disinformation to try to fuel some of this. We need to make sure the end of this where people are going to seek information and get it from trusted sources, or can point to where those need to be. The senator set this up as meeting people where they are, not just a geographical statement, but a philosophical statement. They talked about moving vaccine to some centers of geography that are most effective, thats a place to get vaccines where they are. Talking about going further into communities to make sure transportation is not an issue and vaccines can be available. Meeting people where they are is about what they think about this and what they think about the whole process and the system and vaccines in general and the ability to address those questions. In my role at hhs as we started early on together, what i looked at from this perspective of a National Vaccine Program Office was the overall system, everything from the surveillance at the cdc and trying to figure out what the problems are to the whole research and Development Enterprise and how vaccines are approved and how they are recommended and used in measuring the overall impact. Thats another overlay of confidence. Its a complex system, but i think to understand that all of the elements of the system and how they work and the degree of transparency. That is central to trust and that transparency is important. I will give one example and i know we will have a chance to talk some more, the fda process. I was a former member of the vaccine and biological products Advisory Committee. The Advisory Committee process in the u. S. Is unique in its transparency. It has to have conversations in a public forum. Taking looking at the data and asking tough questions, that goes into making decisions. There are similar places along the chain, but transparency all the way through into how the vaccines work, how they are monitored for safety, vaccines continue to be evaluated when they are in use. All of that is critically important. I think the task force has plenty to do and i would encourage them to think through not only how they are going to continue to work on this problem but how it will translate into a better sense of medical neighborhoods across the country. Thank you so much. Now, to you. And capturing some of the themes we have heard from your fellow Panel Participants here. Moving people along with what lisa calls the Vaccine Acceptance continuum which is a lot of people have already moved and the ones who have been left in the month or so are going to be different than the people who have moved out of the movable middle. The role in particular of primary care clinicians as the trusted messengers, as those who already have the trust of their patients and others in the community. Lets talk from your perspective about recommendations to the task force around i mary care in particular. Not all doctors are as informed as they always should be. They can be susceptible to some mixed messages. Give us a sense of what needs to be done at this point to continue to reach out to the primary Care Community to make sure they are well informed and extremely wellequipped to convey these messages that will help people move along that continuum that lisa described. Thank you very much. Its a pleasure to be batting cleanup in this illustrious panel and addressing some of those issues. I really believe that the majority of primary care providers are well informed and look to and seek the information they need. There is a minority of individuals in any particular profession i dont think thats typical for primary care. I would like to approach this more from the perspective of what this pandemic has really done which is shined up bright light on the fundamental issues that we have in the country like Health Equity and health disparities. We know that with this pandemic that communities of color have been disproportionately impacted in terms of from covid19 in terms of increased number of cases and disproportionately increase hospitalizations and deaths. At the same time they have not had the same kind of access to testing or either the antibodies it shines a very bright light on things that we need to address and things that can be addressed in part through the medical neighborhood and primary care providers. Helping with Health Equity and those social determinant underpinnings for Health Equity that education Transportation Administration economics, the things that are barriers to people being able to get to the access they need or many of the things that would be helpful for them to reduce the disparities. The flipside of that has been the address this issue of acceptance which is a much more personal issue, it is impacted by all of those social determinants of health but it comes down to where people are in their stages of change and whether they are contemplative and that is something that needs to be dealt with. Its about reaching people where they are physically but also all those things are going into their lives. The understanding of an individual that has a very intimate kind of conversation. Thats one of the conversations primary care can lean in, because they have developed with their patients these longitudinal relation ships that go for years and they do understand all of that and how it intersects with peoples lives. It might not be available from data but more from a longitudinal relationship in an empathetic way. I think it comes down to primary care being in part of the medical neighborhood. Being an essential foundational part of the medical neighborhood to supplement whatever else happens in hospitals or the great work that the pharmacies and the broad reach they have. Probably at a more intimate level. We know from surveys when we survey people that people who are most trusted in terms of medical information clearly are the physicians and providers. We survey people and we know where people prefer to go for their vaccinations, particularly their primary care office. Its a comfortable place for they have got many instances for their vaccines. They know over the people there its easy access and they are widely distributed just like pharmacies. With extraordinary hours and access and those kinds of things. The pharmacies have already had the infrastructure to train staff where someone can go and they are confident this is someone who can get the vaccine. We have to build a new mass vaccination side. I think they addressed two thirds of the population who are very comfortable with wanting to get a vaccine and going to the quickest and easiest place. I dont have that issue of equity or those barriers, i have the confidence in the vaccine and all those barriers, sign me up. Thats good because you have this third of the population or a quarter that needs to have more intimate kinds of relationships with who is vaccinated and the reasons why they are vaccinating. Instead of being a push, we do large mass vaccination sites to push people and say we are going to develop a registration process and we will issue into the queue, primary care providers have these relationships and they can help people. Particularly those they know have not been vaccinated. In maryland we have this Maryland Primary Care Program. The executive director of that the department of health and the center for medicare and Medicaid Innovation and 562 primary care sites across the state. It has a broad reach and we are able to provide all of those primary care practices and other primary care practices across the state. All of their patients their status on whether they have been immunized or the vaccines that allows providers to be very selective and say i can reach out to those who have not been immunized, particularly with sensitivity to the hardest to reach the most vulnerable for a variety of regions. Sometimes that is racial or ethnic. It is remarkable that we have seen even in the early days that when we do that, when we allow the reviver of the providers to pull people and based on their knowledge the people in very easily and they are often very thankful and waiting for you to be able to give them their vaccine. The results from that art that they provide an equitable product. When you look at the data the people who are vaccinated in those thats the neighborhoods in which the practices exist. They do need this hurdle of not only being acceptable but trusted and being accessible and equitable at the same time. Its not thats the only way to be vaccinated, if the all the things we talk about are critical. It goes back to being part of the medical neighborhood and being able to reach people where they are, 320 million or people 320 million or so people in this country, and everyone will be reached in their own unique way. Thank you. We have questions from the audience. Im going to try to work my way through as quickly as possible and direct those questions to one of you at a time. I want to start with a question from lisa. You have a lot of work to do to communicate along the great fun, how do we make sure grape line grapevine, how do we make sure people like you have the resources to communicate those messages . You mentioned the importance of social Services Organizations as well as those more medical entities. How do we make sure they have the resources to address this issue . Thats an incredible question and i appreciate whoever asked. This is about intention and will. We have a lot of resources and a lot of resources are needed that are needed are financial. A lot of organizations we worked with provide food, housing, transportation, or Employee Skill Development support. These organizations often struggle to make ends meet. By intention dedicating resources for these organizations and reducing our barrier for them to access their resources and support. I think about the foundations and the funding organizations that i dont want to be politically incorrect, but i think there is a mismatch between the mission of a lot of these organizations and the folks who hope the pursestrings. In order to facilitate their involvement, their engagement, to reach the folks we are trying to reach we have to help the system in getting access to the financial resources. Thank you so much, lisa. Bruce, i want to go to you next. We have an unusual circumstance, a number of Health Care Work is and longterm care workers remain hesitant about the vaccine or have not moved enough along in the continuum of Vaccine Acceptance. This seems to be different than what we might have seen in the past. Is it that different and how do we address it . Its an important question. To me part of what this boils down to is that Health Care Workers not everyone working in the Healthcare Industry has the same level of education, same access to information, and are often reflecting views more from their community than the fact i think we need to acknowledge that and the data we are seeing, it tells us where these gaps are and just because somebody is an health care does not mean they are bought into the whole thing and have a clear understanding. For them like someone else, what is the issue, and how can we help them understand that. Its been laid out for those who are waiting to see. They have seen a lot in health care. You think that would be subpart of the argument as well. It boils down to having a candid conversation with a person about what their concerns might be and the belief that you can address those and have them make an informed decision. Thank thank you so much, bruce. This question came in from an audience member on youtube. The process of getting the vaccine still remains a barrier for many people even if they have gotten past have it in hesitancy towards acceptance. And you are talking about things that cvs and caremark are doing to make this easier. Especially working with lyft to address the transportation component. What else should the task force recommended on the score for increasing the acceptance of vaccine through the medical neighborhood in conjunction with the effort to build confidence. Theres a couple of issues. One is that supply has been constrained until recently. As supply continues to accelerate that will allow for more locations. We believe that pharmacies will be one of the many channels, but an important channel with expanding the number of pharmacies and primary care physician offices and hospitals and communitybased organizations that are able to provide vaccinations. Unless you open up that site its important to amplify the awareness of that site being available in that community, potentially even thinking about how to advance, notify communities, find stakeholders and that communities the office has availability. I would say that the other complexity that has been making it difficult for covid19 vaccination has been the eligibility and the eligibility has been difficult because it changes state by state and week by week, and month by month. I think we are getting to the other end of that. We have a commitment from a federal level to have this opened up in a few short weeks and in many states they have already opened it up. The diversity and who is eligible which we will see over time and making sure there is awareness and that sites are open is important. Not the only piece, but the main one i want to highlight. Thank you, so much. We will take what i think will be our final question. We know that we are only now undergoing trials on the use of Covid Vaccines and children. We need to anticipate parental concerns about vaccinations for children. Thinking about that future and the adults that are going to have to be communicated with about the safety of vaccines and efficacy of vaccines for children how should we think about getting ready to undertake that part of the process . Potentially as soon as later this year . That is a great question. The simple answer to that is start early and be as comprehensive as you can. This is going to be a redo of what we had to do in the beginning of the pandemic with being able to develop confidence and what we continue to have to do throughout the pandemic to develop Vaccine Confidence. It is an entire level of concern when you are talking about your child. I am very encouraged, although i am not a pediatrician. I know who dr. Berwick is, for instance. I have many colleagues and many who are pediatricians. They have been communicating about vaccine, safety and efficacy for many years. There is still going to be a hardcore group of vaccines vaccine naysayers and doubters who will deny the efficacy which seen over the years, the outcomes of those in outbreaks of measles and other Infectious Diseases scattered across the country. I think we will reduplicate our efforts and pediatricians and state together in the nation will lead in to give parents comfort. It will hat to it will have to be based on the same kind of scientific basis or transparency we have seen with every other aspect of this vaccine rollout. I want to thank all of you, doctors for a terrific discussion. We have heard so many additional perspectives starting with the notion that we have seen the movable middle and moved a lot of people from the movable middle to along the continuum that lisa described to Vaccine Acceptance. We have heard important observations about the major drivers and messages that help people get their and their desire to see us all return to normal. Their desire to be assured that vaccines are safe and effective. We have talked about the role of trusted messengers and making sure those messengers have the right messages and are well resourced to get those messages out. Importantly about building out the components of the medical neighborhood including bringing up social Services Providers and others who are able to get those messages out to people along these very important great thankd thanks to our opening speakers. Thank you also to the cdc and to our task force members. We hope this has been an important, informative session for all of you. We look forward to working with you as we formulate the important recommendations that will come out of this to continue to move the nation toward Vaccine Acceptance not just for Covid Vaccines but for many vaccines to come. We dont unfortunately this will probably not be our last pandemic. We better figure out a way to get messages across effectively to populations and i cannot think of a better set of people to help us do that than those who have been with us today. Thanks to those of you who have joined us through youtube or various modes. We wish you all a good day and successful experience as the nation begins to emerge from the pandemic. Thanks again. For live coverage our live coverage continues at 1 00 p. M. Eastern with combating extremism hosted by the atlantic council. At 2 00 p. M. Eastern, the senate filibuster. We will talk about how it got started and whether it will continue. This afternoon, President Biden gives an update on the state of covid19 vaccinations across the country. He is expected to announce that all adults will be able to get vaccinated earlier than planned. Live coverage at 3 45 eastern on cspan. Go to cspans cspan. Org coronavirus for the federal response to the coronavirus pandemic. It is easy to find the latest briefings and Biden Administrations response cannot use the gallery of maps to follow cases worldwide. Go to cspan. Org coronavirus. Congressman Alcee Hastings has died. He was diagnosed with stage iv pink granite cancer and had been in hospice care leading up to his death. He was a civil rights attorney and floridas first black federal judge. He was impeached due to allegations of bribery and perjury but elected to 15 terms in congress. Commerce and hastings was 84. Congress returns from holiday recess next week. The Senate Returns monday, april 12 at three 00 p. M. Eastern to continue work on the nomination of deputy transrotation secretary. The number two post under secretary Pete Buttigieg transportation secretary. The number two post undersecretary Pete Buttigieg. The house returns tuesday, april 13 from legislative business. They do this month, Speaker Pelosi expect the house to work on equal pay for women legislation as well as a suspension of the 2 acrosstheboard cuts to medicare payments until the end of the year. President bidens infrastructure and drops packet is not expected on the house floor until later this spring or early summer. Watch live coverage from the house on cspan, the senate on cspan two, and follow congressional coverage anytime were listen on the free cspan radio app. All week on this program at this time, we have been featuring political podcasters talking about podcasts and news of the day. Joining us from los angeles, california, the host and founder ceo of a network. Thanks for joining us. What was the purpose of starting your podcast . What were you hoping to achieve . Number one purpose in the long run was getting a progressive message out there. Especially when we started in 2002, we were originally a radio show and turned into a podcast and then video form. There was almost no progressive shows on air. There