demands that our health system acknowledge these inequities and work to integrate new policies to level the playing field in all communities. the ama takes his work very seriously. last fall the ama explicitly recognized racism as a public health threat and pledge to mitigate by supporting antiracism policies, research and prevention. fourth, we must improve public health domestically and global globally. we do that by protecting the patient physician relationship from outside influence at all costs and this means influence from government overreach and strict political ideologies that can erode trust and stifle open and free conversations between patient and doctor. we do it by prioritizing physician health and well-being and working to remove administrative burden to slow our ability to respond to a health emergency and we do it by revitalizing our gutted public health infrastructure and decades of this investment of neglect have left us unable to effectively handle a widespread health crisis like covid-19. in the last 13 years we lost 40000 jobs to state and local and public health agencies with the local health department workforce shrinking about a quarter. of course, we are seeing the impact of this disinvestment play out today and the slow vaccine rollout we are witnessing. marginalized minority communities and people living in rural areas have also suffered the consequences of this disenfranchisement for too long. we need to rethink our system and who is trying to serve and invest in infrastructure that actually supports are culturally ethnically and geographically diverse people. and finally, we cannot act as our country exists in isolation. we must recognize the global community of health providers and healthcare institutions and lead these efforts as we are called to do. mobile alliances and healthcare are critical in helping prevent future threats before they sweep our planet. we applaud the incoming administration's commitment to rejoin the world health organization and are eager to help shape policy for the betterment of mankind. all of us want this to be over how we respond to the urgency of this moment and the lessons we take from the last year will go a long way toward correcting the long-standing problems of our health system in preventing new tragedies from occurring. these next few months are critical and we must allow science to lead the way and this means heeding the advice of scientists and experts by continuing to wear masks outside the home and to wash our hands and to physically distance as much as possible. it is been inspiring to see physicians and healthcare workers around the country post photos on social media after receiving their vaccinations. i share photos of my initial shots a couple of weeks ago and i hope this continues to remind people that we are all in this together. when it comes time for everyone to get the vaccine it is critical that we have the facts straight and that we communicate them clearly. the vaccines made available by the fda were authorized by using all the necessary checks and balances and the scientific rigor that we require of any vaccine, just like the ones brought an end to widespread transmission of polio, smallpox and the measles. scientists and researchers who authorize vaccine are not driven by political agendas. they are driven by vigorous standards, safety and efficacy and by the importance of their work. they know that science can save lives and end of suffering. we know this is a challenging time for many americans and that there is misinformation circulated widely around the internet but there are many credible facts based resources provided by the cdc, fda and others about the vaccine process and what it would appear. at the end of the date when it is your turn to get the vaccine you are only remaining question should be left arm, or right? we really won't get to the final month of this pandemic by wishing it were over. the stakes are far too high in any of us has an important role to play and elected policymakers, public officials, physicians, journalists and the public at large and we have to remain strong and steadfast and we have to adhere to the advice of experts and scientists who will continue to light our way. thank you, mike. >> thank you, doctor bailey. once again were pleased to accept questions from our journalists jeanine in today. to submit a question e-mail headliners at press .org. let's go to some of the questions that offense committed by journalist members of the national press club. our first question and it addresses what you've just been talking about is that the national strategy the ama is urging the biden administration to take different then what president-elect biden is proposing? if so, how. >> well, i'm not sure i could completely answer that question at this point in time. my understanding is the biden administration is going to release it formal plan under on this week. we are a little bit concerned about the announcement that hhs will not hold back vaccine doses to make sure that everyone who is gotten there first dose that will have a second dose and reserve and we really don't have adequate data to tell us if one does is sufficient. we don't think it is and how long you can wait for your second dose without losing the benefits of the first dose. we really need the federal government to help local providers where they are good in some communities are doing a pretty good job of rolling out the vaccine now in some communities are not. there are rural areas and in fact i talk to patients this morning, even though i'm president of the ama and i'm still seeing patients on regular basis and there was one pharmacy in her entire county that was administrated vaccines and she did not know when she would be able to get hers. it's important we make sure the vaccine is available to everyone when they needed and and there are many concerns about new equitable distribution. >> you laid out a substantive set of recommendations for the incoming biden administration and we are into this year now and is there a feeling that one year in now we need to retool and put new engines on an airplane that is already in the air? there are challenges along the way here so how do you see this playing out? >> oh, i think the plane in the air just needs more fuel. i believe that healthcare workers are doing all they can to take care of critically ill covid-19 patients in hospitals. we need to make sure we put more fuel in the system by making sure that those healthcare providers have the ppp they need even though the numbers are much better than they were at the beginning of the pandemic. there are still shortages of ppp that is still being conserved very carefully and physicians that are not in hospital-based settings are having a hard time competing with large help subsystems for the same units of ppp and can't compete with them on price or quantity. we do think that we need to fuel the system to keep the vaccine production going. we need -- we think that there will be plenty of vaccine but when that vaccine will be available is going to be very important to local health authorities so that they can then plan their administration plan. we need to continue to you'll the ongoing vaccine trials and there are two that may come up for fda review in february we hope. there are even more down the line. i think we will need all the tools in our toolbox to escape this. i don't think we need to retool the planes but we need to make sure it's got enough gas to get to the finish line. >> we don't need new engines but just need more fuel to fire up. i will go back to something you mentioned earlier and a question that has come in, president-elect biden plans to accelerate vaccination distribution when he takes office and release all available doses of the two dose pfizer and mentor not vaccines instead of holding back with millions of doses to guarantee that people receive their second shots. to be clear, he is not recommended the two dose vaccines be split in half in order to double the supply but rather expedite the shipments of first doses to more americans and use his powers a president to provide the required second doses in a timely manner. so, owing to this just clarify for this whether the ama supports this strategy for distribution and if you could elaborate a little bit on the potential advantages and the challenges of doing it this way. >> in general the ama supports getting as many vaccines and as many arms as possible and observes the priority categories that were laid out by the national academy of medicine as well as the advisory committee on immunization practices. i do have a bit of concern for individuals that have already received their first dose, especially individuals that have received the pfizer vaccine and it is not recommended anywhere that you mix brands and that you get pfizer for your first one and moderna for your second one. that is not recommended at all. the pfizer vaccine has such rigid storage requirements that i want to make sure that there is plenty of pfizer vaccine for those initial, mostly front line healthcare workers who got the pfizer vaccine because it was the first want to come out in december but i would want them to be able to get their second doses on time and not have to wait. we do or hope that there will be plenty of supply but again this is something where local and state health departments really need communication with the fda and federal authorities about how much vaccine are you going to get when in which brand will it be and are we sure that all of our people who got their first dose are going to be able to get their second dose in the right timeframe. >> it sounds like what you're saying is that not only do we need the national strategy that you are calling for but a longer-term strategy for this in so far as you mentioned the loss of local officials and state and local health departments over an extended time of decades and it will take some time even if we ramp up as quickly as possible i think to remedy that challenge out there now so it sounds like it will require a really effective and substantive, strategic plan for years to co come. >> yes, i think that is right, mike. i think even just over the course of 2021 my crystal ball tells me that eventually, right now we got an incredible demand for vaccine in patients that are in very high priority categori categories, those with underlying health conditions, frontline healthcare workers and those in long tim care facilities and essential workers et cetera. when we get through most of those and i'm not sure at what point in time that will be our strategy is going to need to change from all hands on deck as many shots in short a period of time as possible to strategy that is focused more on physicians offices that is focused more on those that have doubts about vaccines and folks that have or that are concerned about vaccines and they don't mind sitting back and waiting at all but let everybody else go first but once those vaccines and once it comes to their turn we need to have a completely different message to the public and this is when i think we need to prepare for in advance and with the ama has been working with the ad council and other organizations around the country to craft messages for the public to combat vaccine hesitancy and so it will be or that plane will not have landed and it may need to go to a different airports than it originally had planned. >> have you been working with the transition team for the incoming administration? are your plans already known to them or have you been developing them and announcing them now? >> we have been working with -- we worked with both teams prior to the election and have been working with the biden transition team since november and we communicate with them on a regular basis and make our concerns known and have that we are happy and interested in helping them in any way that we can to help make sure our physicians have the information they need to provide vaccine and take the best care of their patients. and then get that message out to the public. >> speaking of getting the messages out to the public and we will talk along the way here about the role of journalists in covering the pandemic and get some thoughts from you on that. let's talk about public health guidance to the public. we do see here and read a lot of stories about people who make calls and they wait online for a long time and they end up in a hangup situation, whether inadvertently or and they are having difficulties with good guidance at this point. how big an issue is that because your goal here is to effectively help people understand the value of the vaccine and without the guidance in advance of that, that seems like the mountains just got taller. >> i think -- i think it is going to be important at some point in time to separate the guidance from the logistics. physicians are, you know, i devote every part of my appointments now with my patients to questions about covid and questions about vaccine because i want to make sure that every patient has the opportunity and i will say as long as you have a doctor here and no questions about this particular thing and they virtually always do. many of the country questions are when and where can i get my vaccine and i have to say stay tuned. and so but, sometimes just preparing someone to be mentally ready to get the vaccine is the first step and then we can move them farther down. along those lines i just heard earlier about a special initiative in san antonio, texas which was a vaccine event for individuals that didn't have broadband access or smart phones or not able to sign up for appointments online. it was strictly a call in and i think even a drop in kind of basis and i hear that they didn't distribute all of their vaccine. i hear that it didn't go as well as they were hoping it would and again you got patients in rural areas who are allowed to get a vaccine but there aren't enough distributors in her area. this is one area where i think the federal government needs to listen to the unique needs of what one county needs and not what another county will need. >> talk a little bit about dealing with covid fatigue among people after and in a lot of cases more than ten months of isolation and people working from home had people losing their jobs and now we have two approved vaccines and how do you keep people from saying as long as i know i will get a vaccine then i no longer need to wear a mask and i no longer need to follow the applied rules because i'm going to be okay? >> not only do we need to continue to wear masks until they get the vaccine but we need to keep wearing masks, washing hands and social distancing after we get our vaccines. we still don't know at what point in time you are not able to transmit virus to other people and they are unable to catch it from you. getting your second dose of the vaccine is not the or that is not the plane landing or the end of the story but it's just one step in the journey and we need to be very or speak for the unified voice and all our public health authorities, we need journalism's help with this aching sure that people understand that they still need to keep doing the public health measures that we hope that they have been doing all along. covid fatigue is real and we are all tired of it and want to go back to the way things were although i am sure i'm not sure we will ever what the new normal will look like but it has workee yet. i think a long with covid fatigue i think we have some covid numbness and i think that many of us have become desensitized to the horrifying numbers that you yourself stated in your introduction about the numbers of cases and the numbers of deaths. i made a speech to the ama in early november and at that point in time we were shocked that we had gotten to 1000 deaths a day and that was only two months ago and now we are seen up to 4000 deaths a day. someone dies of covid in the united states every 25 seconds or so. it is easy to become numb to these numbers because we don't want to see them and we don't want to think about it but virtually everybody now knows someone who had covid or who has died of covid and so it is reaching much more of us on a personal level. the increase amount of depression we are seen decreased deaths from opioids and overdoses because of the isolation and of course the economic situation that many families are in, it's just a really, really tough time right now but we've all got to stick together to make sure we get to a good end to this journey. >> you mentioned in your talk the issues that are health professionals are facing along the way as well. how are your doctors doing in all of this after a year of such intense work? >> they are exhausted. it is interesting in that the frontline health work docs that are in the emergency room that runs cardiac specialists and work in the icu they are been running on fumes for a long time and they definitely need more jet fuel but then on the other side there are doctors who are having to close their practices because they don't have enough patience to see because of local shutdowns combined with fears of patients. this is still in the public. a survey released by physicians foundation last year suggested that is much as nine or 10% of the private practices would close or would be gone. this is because of the pandemic and the economic stimulus packages have helped but physicians in many cases are small businesses just like the other small businesses that have been hurt and so badly in this pandemic but there is burnout and many are aware of the position in new york who committed suicide last year and we don't have good numbers on what has happened with the suicide rate amongst physicians and other healthcare workers but i'm sure it is not going down. >> something quite remarkable has occurred over the course of this year that has been underplayed is the fact that pfizer, moderna, the two companies that have come up with approved vaccines and the other companies that are working on this have really worked at warp speed to come up with vaccines. this is the stuff that nobel prizes are made of and we are obviously all relieved to have these vaccines. talk for a few minutes about this quite remarkable scientific feet. >> it is, stunning, mike. the fact that one year ago yesterday scientists at moderna first got the mrna sequence of the covid-19 spike protein, three to 65 days ago and now millions of vaccines are being given. one of the reasons that we were able to do this so quickly is that, believe it or not, we were almost in a plug-and-play situation one year ago. research was being done on coronavirus vaccines for the past ten years because of sars and mayors. there were facts and knowledges that were very familiar with the coronavirus and also the technologies for mrna vaccines being developed. there have been mrna vaccines before but they just never have been in widespread usage. there was one for evil law and there were other that i can't think of off the top of my head. so when the mrna sequence was available january 11 of 2020 scientists were able to take that sequence, nucleic acids, and literally plug it in and make the vaccine from there and the benefit of operation at warp speed is that they were able to eliminate the financial uncertainty from the situation because typically with vaccine development you do a little bit of work and then the company will analyze the results and say is this worth the investment to go forward and after a while they will say yes and then they do more work and those phases can take a long period of time. we also got lucky in that we already had large clinical trial networks set up because of research that was being done with hiv. and so, there were, so those clinical trial centers were able to be converted to coronavirus vaccine trial centers in an amazingly short period of time. to me that is as stunning as any other part of this vaccine development process is the fact that starting in the late summer we were able to recruit a total of 77 -- 77000 patients to participate in these trials and that so many of them completed it. it really is a stunning scientific achievement but we all worked in this, the federal government played a huge role private companies played a huge role and that is fortunately for wants everything worked just the way it should. >> you mentioned earlier that there was no place for politics and during a pandemic of the sort yet, we have not been able to separate the politics from the pandemic over the last year and that's a high hurdle. do you have thoughts about how we might be able to go about this? you mentioned earlier that basically everyone has been touched by this in one form or the other so it's harder and harder to have an improper belief that this does not exist or that it was some sort of a hoax but what are your thoughts on dealing with dad to separate out the politics from the drive to be the pandemic. >> i think the key is in sticking to the science and listening to our public health authorities and all having or all singing the same song in all delivering the same message and seen our leaders at all levels, not just in the white house but leaders in our local communities and our schools and churches and college campuses all wearing masks and seeing them and observing them social distancing and realizing that this is not about anything but the desire to get back out of this pandemic and get our country back on the right track again. i think you know, masks shouldn't be political and going back to school shouldn't be political and whether or not you take a certain medication or not should not be political and we need to stick to the science and listen to our public health authorities. i think that will be the quickest way out. >> i am wondering if the ama has issued any recommendations regarding distribution of the vaccine to students and teachers in our nation's schools and our universities? >> the ama supports the recommendations that were made by the advisory committee on immunization practices. it does have teachers and any teachers are going to fall in so-called higher categories, priority categories because they may have chronic conditions or maybe older. one thing i think that it is important for us to remember is that pfizer vaccine was approved only down to age 16 and the moderna vaccine was approved to only 18 so there are trials that are being conducted in the pediatric population but right now for the most part children less than college age are not candidates for the vaccine at this time. we don't have a plan for them but any college campuses have had some great success by these aggressive testing quarantine and now being able to roll out shots for individuals more than 18 years of age have really done a great job getting covid off their campuses. >> thank you. you've spoken a couple of times now about journalists in the course of our conversation and our audience today comprises largely of journalists and some of whom have been on the frontlines covering the story for the past year. if i may ask you, what is your assessment of the press coverage of the pandemic? a second part is, are there additional elements you would like to see brought to light? >> well, we cannot, as far as we have come in this process without the media and without wonderful journalism. the fact that terms like oh gosh, social distancing that was not a household word one year ago and now we hear people talking about incubation times and we hear the people don't have a science background at all discussing the benefits of one vaccine versus the other and i think good journalism has been responsible for the dissemination of incredible amount of information to the public that we need desperately. medicine and the media need to work together very closely to make sure that good, sound science -based munication is made available. i'm very, very grateful for the wonderful work that has been done. one request that i have personally is background photos and videos of needles. there are a lot of folks out there that are afraid of needles. believe it or not there will be people that don't get the vaccine because they are afraid of needles. of course, they know that when they go in to get that shot it will be a shot but the imaging of needle after needle after needle can actually fuel vaccine hesitancy in some people. that is just a tiny pet peeve of mine and you asked so i answered. but i think as time goes on the continuing message of in local communities where you get the vaccine and how you sign up for it and what your priority group is and these are messages that will have to be given over and over and over again and then as time goes on that message will have to evolve into more of a message to fight vaccine hesitancy for one reason or the other. good news is by then there will be so many millions of people that have taken the vaccine and we will have a tremendous amount of safety and side effect data that we didn't have in such large numbers before the end of the year. hopefully that will help make the journalists job a little easier. >> i heard a wonderful story the other day, as a sidebar, but talking about the needles and people getting comfortable with taking the medicine that a boy came home in the early 1960s and his father and his uncle were the composers of the music for the film mary poppins and the father asked what the son did at school today and said i received my polio vaccine. the doctor or the father asked whether the shot hurt and he said i didn't receive a shot, i took a sugar cube and the father thought about that in the next day quentin and wrote the song a spoonful of sugar helps the medicine go down. >> isn't that amazing? >> that was a campaign onto its self and maybe we should use something like that today. i want to ask you the crystal ball question did if you want to take a shot at this. what is a realistic timetable in terms of getting enough people vaccinated that americans could return to some semblance of normal life like family gatherings, working in their offices, using public transportation and going to the movies and feeling safe and restaurants? >> a lot of it will depend on vaccine uptake and self-discipline in our society needs to continue doing the social distancing unmasking measures that it will need to do until -- one question is well, when can we stop doing that and the answer to that question is when the prevalence of the disease in your particular community has gotten low enough and the number of positive covid tests have gotten low enough that it is felt that you can function in your community fine without masks and social distancing. i think we are looking at probably at the end of this year and i am hopeful that by fall things will be a little bit -- it will not be completely back to normal but i think that things will have opened up and loosened up quite a bit as, you know, the then diagrams have supposed of those that have gotten the vaccine get larger and larger and larger. >> you mentioned earlier that when you talk with your patients you asked them to take advantage of the fact that you are with the doctor and ask a question so we have some of those kinds of questions coming in from some of our members. >> okay. >> here's the first one, i'm a 76 -year-old that has an allergic reaction to b's plus i think i'm pronouncing it right correctly, the lambton and i cannot take the flu vaccine. should i get this vaccine? >> yes. you might want to see an allergist first. the allergic reactions that have been associated with the vaccines now we think has something to do with the very unique lipid fatty envelope around those snippets of messenger rna. even though i said we have used this technology in some magazines there's never been commercially available on a wide scale. we are not seen any relationship between insect allergy and reactions to the vaccine but most medication allergies seem to not have anything to do with the vaccine but one ingredient that we think might be responsible is polyethylene glycol that is an ingredient that can be found in lots of medications but it is one of the most important ingredients in the prep for colonoscopy and there is also some constipation remedies that have medications like this in them. and so we hopefully will be able to develop a test to see who is susceptible to allergic reactions for the vaccine but at this point in time all we are recommending for individuals that have histories of allergies to medications, food or even vaccines make sure the people that are giving you your covid vaccine knows that and if you have an adrenaline autoinjector, epinephrine, bring it with you and make sure the facility where you are getting the vaccine is equipped to handle an anaphylactic reaction it should occur. >> thank you. we have questions on broader issues as well, some of which you touched on already and can you elaborate on what kinds of investments are needed to help reduce healthcare in equities and marginalized communities and people living in rural areas in the short term to reduce their risk of contracting covid-19 as well as in the long-term? >> oh boy. do we have another hour? i would love to talk about that at length. the different types of investment will be very different. i think that in terms of -- many marginalized and minority communities are also urban communities and i heard at one point in time someone say if we are just repeating the vaccines to pharmacies then everybody should be within 5 miles of one of these pharmacies. well, not really. if you live in far west texas that is certainly not the case and if you live or if you don't have good public transportation or don't have your own transportation, even 5 miles is prohibited. i think what we need to do right now is help stand up vaccine administration clinics and nontraditional areas and i think in many cases we will need to bring the vaccine to the people rather than bringing the people to the vaccine. and so that means more smaller areas and i think that eventually getting more private practice physicians and primary care physicians to be able to administer the vaccine from their offices will be helpful but in the short term investments and pop up, if you will, vaccine administration sites i think will be one of the quickest ways to add some jet fuel to this plane. >> we have a two-part question. it touches on some of what you just mentioned. in november the ama declared racism and urgent public health care crisis. what specific steps is the ama taking or recommending be taken to address the disparities in access to testing and vaccinations? you just talked about standup clinics in areas and are there other elements that are necessary? >> yes, the questioner is familiar with the statement that we made in november but our efforts and health equity go back much longer than that in several years ago the ama board of trustees created what we call the commission to end health disparities and one of the conclusions of that commission was to establish a permanent center for health equity within the ama and that center has just finished its first year in operation and it is helping the ama invest health equity in everything we do and education and inviting chronic disease and basically in terms of some of the specific recommendations we are making recommendations to for education medical students, residents first of all we know that people do better when they look like there physicians and we are working with medical schools and residencies training programs to increase minority enrollment in medical schools and residency training programs. we are helping to sponsor bias training and many of these institutions to help the individuals that are there and be able to get a good medical education and a healthy environment. we are also providing working on education for physicians offices to take a look at practices that they might be doing that might be unintentionally racist and helping them to develop antiracist practices and the scope of our work will be very, very great. much of it is just policy but we have, we know there are still a lot of work to be done and we are just scratching the surface. >> you mentioned earlier that the u.s. continues to break its own single day record for new coronavirus infections. at the current pace when would you expect that our numbers might begin to fall? do you think as some have suggested that these are going to get worse before they get better? >> what we are experiencing now is kind of i've heard it called the third wave but basically it's a surge on a surge on a surge. we've had surges in case numbers that have happened after every holiday and it happened when we first noticed it memorial day and then we started advising people to not to get together on the fourth of july and don't get together on labor day because invariably we see cases that spike after holidays and then a couple weeks later hospitalizations go up and within a couple of weeks after that the number of deaths go up. covid is a long, terrible process. we are now almost two weeks after new year's and so i am hoping that once we see the surges of cases that we are in now in the case numbers will hopefully start to go down by the end of january and we may see increases in hospitalizations however that is a lagging behind number of cases so the rest of january will continue to be very difficult and i'm hoping we can make progress and we don't have a lot of holidays coming up which i think will be very good and more and more people getting vaccinated will eventually help as well. >> what do americans need to know about this variant from in the uk and what would be helpful for them to know? >> the variant that was discovered in the uk which has been called the b117 variant just a lab moniker, we believe that it is a mutation that makes the virus latch on more firmly to the human cells and it makes it easier to catch easier and it does not make the disease worse and then in more not likely to be hospitalized or have a more severe course of your disease if you catch one of these new variants but it's just that say if you are in a group of 100 people and the current strain and you may in fact, you know, two or three people but with the new strain you might in fact twice as many or three times as many. the vaccine works for it so that's great news. it just highlights the importance of wearing your mask, washing your hand physically distancing and avoiding large indoor gatherings because that is where you catch covid and even a more communicable form of covid with these new variants. it is no match for adequate public health safety measures. >> we have a couple of minutes left. we recently spoke with the director of the national institute of health, doctor francis collins. said the principles of faith and science are complementary and the fate of a lot of people have been shaken over the past year so how do you approach this and what do you say to people? >> oh boy. i think that -- this pandemic has taught us many things but i think one thing that it has taught us is that we need to, not only take care of ourselves but take care of each other and we need to realize that the actions, individual actions, can have an impact on very, very large groups of people and so wearing a mask and washing your hands and social distancing is not an act of selfishness but an act of faith in an act of kindness. it's an act of hope and i will choose hope any day. it made us realize that we are really all sane and that even though there are races groups of our population who are more prone to severe disease through no fault of their own but the fact is that covid does not discriminate. covid will attack any of us and can attack any of us. ... >> they wish was, i wish the virus would go away. so let's hope this wish comes true. susan: out of the mouth of babes. michael: that will be our last for today. doctor susan bailey, president of the medical americans are association . thank you for joining us. and we are pleased to present you virtually with our national trust club coffee mug. we will send it to you along with our hope that you will join us again in person in the very near future. thank you and good luck. susan: thank you. michael: our thanks to the producer and headliners team, coleaders and laura . into our wonderful national press club team and the scenes here in the broadcast operation center. if they are members and our guest for your questions and for joining us. be well, stay

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