Consider This from NPR - U.S. Secures More Vaccine Doses As Distribution Continues For Essential Workers

Episode Date: December 23, 2020

Americans got some good news on Wednesday morning when the White House announced that it had secured another 100 million doses of the Pfizer-BioNTech's COVID-19 vaccine.Secretary of Health and Human Services Alex Azar released a statement afterward saying the U.S. will now have enough supply "to vaccinate every American who wants it by June 2021." Even with these announcements questions remain on how exactly everyone will get vaccinated. States are having varying levels of success with the vaccine rollout process. Dr. Jose Romero, Arkansas health secretary and chair of the Centers for Disease Control and Prevention immunization advisory committee, discusses the success Arkansas has had with vaccine distribution and the lessons learned in the process.In Seattle, NPR's Will Stone has been following vaccine distribution, including to health care workers who have been caring for COVID-19 patients for nearly a year. One of the questions that remains as more people get vaccinated is should volunteers who got a placebo during the vaccine trials now be offered the real thing? NPR's Ari Shapiro speaks with Dr. Steven Goodman of Stanford School of Medicine who is advising the Food and Drug Administration about this.In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Let's start with some good news, shall we? The White House announcing a deal to secure millions more doses of that Pfizer vaccine. Millions more doses. This morning, the Trump administration agreed to buy an additional 100 million doses of the COVID-19 vaccine, doubling the government's supply from the pharmaceutical company Pfizer. Soon after, Secretary of Health and Human Services Alex Azar released a statement. He said the U.S. will now have enough supply to vaccinate every American who wants it by June 2021. Now, there are questions here, because as things stand now, even with this latest deal and even counting the Moderna vaccine, so far the U.S. government has only contracted enough to

immunize 200 million people. Then there's the fact that this past week, many states did not get the vaccine supply they expected. At the end of the day, the number of doses available to us to allocate ended up being lower. U.S. Army General Gus Perna, chief operating officer of Operation Warp Speed, that was him offering an apology last week. He oversees the vaccine distribution effort. More than a dozen states said their Pfizer allocations were cut, some by as much as 40 percent of what they were expecting. And I want to take personal responsibility for the miscommunication. Consider this. It's been more than a week since the U.S. administered

its very first coronavirus vaccine. Now comes the hard work of making sure vaccines reach every corner of the country. From NPR, I'm Mary Louise Kelly. It's Wednesday, December 23rd. I'm Guy Raz, and on NPR's How I Built This, how Tim Ferriss, as an entrepreneur, author, investor, and podcaster, turned himself into a multi-million dollar brand. Subscribe or listen now. It's Consider This from NPR. Before we go on, let's keep something in mind. We are talking about the rollout of a vaccine for a disease that none of us had heard of a year ago. The timeline is extraordinary. So naturally, there were going to be a few bumps in the road.

We had a little hiccup in that when it was being delivered to one of our pharmacies, there wasn't somebody there to receive it when FedEx, I think it was, went to deliver it. That is Dr. Jose Romero. He's the Secretary of Health for Arkansas. He also chairs the committee that advises the Centers for Disease Control and Prevention on who gets vaccines first. But the vaccine was not left at the doorstep, so no harm done. But we learned from that, we need to let people know when the vaccine is coming, and we're putting measures in place to not let that happen again. Overall though, Romero says the rollout in his state

is going surprisingly well. To date, we have administered 12,762 doses. We have distribution now to 18 of our major hospitals, including the health department now is 19. That was for the Pfizer vaccine. We now have vaccine being delivered to our nursing homes, and that's the Moderna vaccine. So far, Romero says Arkansas has not seen the shortages other states are dealing with, and they've had enough ultra-cold storage to ensure the vaccines are kept at the right temperature. Our initial rollout of the vaccine was to centers that had the capability of ultra-cold storage. And the distribution of the vaccine to the pharmacies, which we are using to reach our smaller rural hospitals, also have that capacity.

So, knock on wood, at this point, we have not had a problem with that. Now it's a question of scaling up. So far, as you heard, Arkansas has administered more than 12,000 shots. They're going to need to do that many times over to get everyone in the state vaccinated. This is just the beginning. So we need to see if we can keep this up, this pace, if all these hospitals and the personnel are going to accept it. When we have more information in a week or beginning of next week of what the uptake is, that will give me a better idea of how well this vaccine is being accepted. When are you getting the vaccine? I am not in the

first year. I will take that vaccine when the time comes. If I need to take this in order to boost confidence, I will certainly roll my sleeve up. I will be the first to accept this vaccine if it's important for me to do so for public confidence, but I will not jump somebody else's place in line. Dr. Jose Romero. Arkansas is, of course, just one state out of 50, and it has not been as smooth everywhere. But still, this vaccine has been a game changer for the people caring for patients since the early days of the pandemic. Reporter Will Stone has been following the vaccine rollout in Seattle, where their first week was a mix of successes and stumbles. So much had to happen to get this shot into the left arm

of nurse Rebecca Engberg. One, two, three. Awesome. All right, you are all set. Do you take this? Yep, I'll take that one. But for all it took, the vaccine clinic at Seattle Children's Hospital feels pretty normal. After her shot, Engberg waits to make sure there are no unexpected side effects. I physically feel fine. I'm emotionally pretty excited about it. Engberg has cared for COVID patients in the ICU. It's been a long year already. It's scary working long year already.

It's scary working with these patients, and it's something different. So anything that gives you a little bit more protection makes you feel a little bit better. She didn't have any real hesitation about getting the vaccine. Evan Mew, a respiratory therapist at Seattle Children's, also just got his shot. I was a little concerned about how fast this went through. I have not really been one to trust this government this past year. But ultimately, Mew decided the benefits outweighed the risks. Dr. Daniel Zare with Seattle Children's says this very first phase with the Pfizer vaccine was hard to orchestrate. Probably the biggest challenge is planning when you don't have information and

details. Zare says they could be vaccinating two to three times as many people. We have the freezer space, we have the staff, we have the clinic space, and we have the will to do it. But the vaccine is not coming as fast as some states would like. Washington and others are getting about 40 percent fewer doses than they initially expected. Dr. Jeff Duchin with Public Health Seattle-King County says the federal government hasn't invested enough in the vaccine rollout, and delays and hiccups should be expected. So I'm not surprised. I'm disappointed it happened so quickly that we're already seeing challenges with respect to allocation. There's also pushback at some hospitals over who gets it first. Medical residents at Stanford protested after employees who aren't at the bedside got the shot before them.

Ashley Bauer says there was a glitch at her hospital in Washington state where nurses like her were initially passed over as administrative staff got shots. They don't even come to the COVID floors and they're taking the vaccine before like their actual frontline staff that's doing the work. And while the vaccine is a big comfort, Seattle nurse Corrine Ingram says it doesn't change the nature of her work on COVID. Listening to people say goodbye to their loved ones

via FaceTime, I've been doing that for a year and I still cry every time. But also like getting to see people who get out of the ICU. It's just a crazy world of extremes. And that won't change nearly soon enough, even as the country enters this new promising chapter of the pandemic. Will Stone reporting. Now that we have two COVID-19 vaccines working their way through the U.S., here's a question.

Should volunteers who got a placebo during the vaccine trials now be offered the real thing? Those trials were double-blind, meaning that neither the volunteers nor the administrators know who got a vaccine and who didn't. My colleague Ari Shapiro discussed this with Dr. Stephen Goodman of Stanford School of Medicine. He's advising the FDA about this. To start, will you just briefly explain why trials are blinded in the first place? What's the point? Well, the main point is that when we ascertain the outcomes, and in this case, the outcomes were both safety, how bad people felt and exactly what symptoms they had afterwards, as well as the infection, that they're not affected by knowing whether they got the vaccine or the placebo. That is the injection that felt like a vaccine, but wasn't. Now, what's the argument for not giving everybody the vaccine right now? What knowledge might we potentially lose if the folks who got the placebo suddenly get vaccinated? Well, it isn't so much lose, but we won't learn some very important things as well

or as fast as we could. And the things that we want to learn more about, and this is really critical, are how long does the protection last? We don't know the efficacy in all sorts of subgroups, various ethnicities, the old people who have other conditions. And the other issue is if people leave the study because they think it's all over, then our attempt to learn about long-term effects, both safety and efficacy, is greatly diminished. So it's really important that people stay in as long as possible and report their symptoms in as objective a way as possible. So there's value in keeping this study going, but how do you weigh that against the ethics of denying a workable, effective vaccine to people who volunteered to be human subjects to develop that life-saving vaccine? Well, that actually is not exactly the choice.

There is a design that allows them to get vaccinated within the trial, just as they would be outside, even before, and still remain blinded. So you're saying there is a loophole here where you don't have to unblind the vaccine and you can still give everybody who got the placebo a dose of the effective vaccine? Explain that. Yes, so the proposal is to do what we call a crossover,

which is that everyone who has the placebo or who got the placebo is vaccinated and they get their two shots. But to maintain the blind, the people who got the vaccine originally also get two shots. But this time they get the placebo. And even though we're comparing now a vaccinated to a later vaccinated group, there's still many things that we can learn from that comparison. And if we unblind, they become more difficult to learn. Now that you have lots of people all over the country getting this vaccine, could the study just shift to following what happens in the general US population rather than these volunteers who got the injection before it was widely available? Well, in fact, the FDA is planning to do exactly that. But the problem is that the information you get from those

sort of studies, and they're absolutely critical, is going to be much slower and much less valid or less precise than what we can get from the studies, which are studying individuals and being followed very closely. So yes, we will be following these on a population basis, but the quickest and the most valid way to get some of this information is to make the most of what happens in the trials and continue to observe them, even under blinded fashion, even vaccinated, for as long as we possibly can. Dr. Stephen Goodman, Associate Dean and Professor of Epidemiology and Medicine at the Stanford School of Medicine, speaking there with Ari Shapiro.

You're listening to Consider This from NPR. I'm Mary Louise Kelly.