Today, Explained - What if developing a vaccine was the easy part?

Episode Date: December 1, 2020

Covid-19 vaccines are coming out faster than many thought possible. But distributing the vaccines could be an even tougher challenge. Transcript at vox.com/todayexplained. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Visit connectsontario.ca. The U.S. averaged over 160,000 COVID cases per day during the last two weeks. And that number may rise quickly due to Thanksgiving travel. But we just might be starting to see light at the end of the tunnel. In the last few weeks, we've seen three companies, Pfizer, AstraZeneca, and Moderna, release encouraging news about their vaccines. And today, Moderna released the final results of their phase three trial, which showed a vaccine that is 94% effective. This is unprecedented. This is the only time this has happened at this speed. Dr. Rebecca Weintraub, she heads up the Global Health Delivery Project at Harvard. That we have now three likely candidates, three vaccines that will

likely make it through phase three trials. But developing a vaccine is just the first step. What might be even harder is actually getting the vaccine into people's arms. Right now, public health leaders need to prepare transparent, evidence-based strategies for three different services. Number one, how will they allocate vaccines? Number two, to actually distribute the vaccines. And then to verify. We have to actually, to ensure we understand you're not only eligible, but you've received the full course of your vaccines. Okay, let's start with allocation.

Are there certain groups that are going to get this vaccine before others? Back in August, the National Academies sat down. We knew from day one we won't have enough vaccine for everyone from the start. We will eventually, hopefully get there. So that demands some thinking that's based on science, that's based on bioethics and other logistical considerations that who comes first. And they established 13 subpopulations that are the most vulnerable to COVID-19. They laid out an order by phases, Phase 1, 2, 3, and 4. First, of course, high-risk

workers in health care, first responders, high-risk individuals with underlying conditions, also older adults. Phase 2. That includes K-12 teachers and school staff, as well as critical workers in high risk settings like the food supply system and public transit. Also people in homeless shelters or group homes and all older adults who don't fit into that phase one category. Phase three. That's about 40 to 45% of the population. That's young adults, children, and workers in industries

like colleges and universities, hotels, banks, exercise facilities. Finally, phase four covers everybody else, guys. And now the states are interpreting that and will likely see very different implementations across the United States and territories. Okay, how about the second issue you mentioned, distribution? Once the FDA approves a vaccine,

how does it actually get to people? First, actually think about this. When there's an emergency use authorization, which is quite unusual, these vaccines have already been manufactured. So they will ship 24 hours after the EUA is established. So that means state and local officials need to get ready now for how do they think about the allocation and distribution of COVID-19 vaccines. And if you remember back to September, the CDC director at

the time told Congress. Somewhere between five and.5 and $6 billion is what I think it's going to take to distribute this vaccine. And you don't have that money right now. No, sir. And you need it to distribute the vaccine. I think it's as urgent as getting these manufacturing facilities up. Unfortunately, there's been less than 10% of that funding that's been allocated as of November. So right now, the states are scrambling. The actual distribution of the vaccine will go from the feds,

shipped directly to the states and territories. Then there's a second parallel process directly to federal entities, like the Veterans Association or military bases. And then third, there'll likely be a direct distribution to the three large pharmacy chains, CVS, Walgreens, and Walmart. And once these companies figure out allocation and distribution,

that still leaves the third issue, verification. So it has not been clear if you'll have to show identification at the point of vaccination. Will the vaccinator ask you to identify who you are as an individual or bring any type of formal identification? And why I bring this up is if we have to remember that all these vaccines, at least this first generation vaccines, are two-dose vaccines that need to be administered within a certain time frame. So we need to be able to remind you to come to the second dose. And that's going to also require digital infrastructure to ensure we're identifying you and reminding you to come back for the second dose of the vaccine.

And I mention that because each of these vaccine candidates has had a different protocol, not only about dose, but about the actual vaccine administration, the time between the two doses. So if you are the immunization provider, you're going to have to ensure the person's getting the second dose, for example, within 21 days or 28 days. And that in and of itself will require information infrastructure. We're talking mainly about the FDA and Americans, but I imagine to vaccinate a population effectively, you know, diseases don't just stop at borders. What are the problems that could go wrong in allocation from a global perspective? Unfortunately, what we're seeing today is a form of nationalism.

Excess demand and competition for supply is already creating vaccine nationalism and risk of price gouging. The nations had said, I will serve my nation first. I will procure the supply that I need to cover my general population. And that has weakened actually global cooperation to think about global allocation. This is the kind of market failure that only global solidarity, public sector investment and engagement can solve.

What happens if countries don't work together on this? There's no way at this point, considering our global economy, our global supply chains, to say I will protect alongside my political borders. The virus is apolitical and doesn't know state or national borders. So we'll have reservoirs of disease

and then we'll have future outbreaks and the continuation of the pandemic. It is unclear today the reintroduction of the virus from borders slash transport slash the biology of the virus. And that's actually why the particulars of the vaccine are important. So these first vaccines that we're looking at today are effective to protect you as an individual from COVID-19 disease. We don't know yet if it actually will decrease transmission of the virus. So you may be protected as an individual, but you need to wear a mask to protect others. And so it'll take

us quite some time to really understand the duration of immunity and its ability to decrease transmission. Have we seen examples in the past where countries have worked together to use vaccination in a responsible way to eradicate disease? Yes. And, you know, Noam, thank you for bringing that up because it's actually a tremendous concern where if we see those outbreaks, it will actually affect confidence in the vaccine. People will say, gosh, why are we seeing a future outbreak? I thought we were vaccinated. And that in and of itself is quite complicated to explain to the general public. So you're right. So we actually have seen this with the global polio eradication initiative. They actually generated that type of political will,

and they had heads of state sit down with each other to think about how do they procure and allocate the vaccine to where it's needed most. That took us decades to get there from the discovery and development of the polio vaccines. And that happened with smallpox too, right? That's correct. So this is also kind of a story that's been decades in the making.

And really, in the end, it was political will to say we need to eradicate and end smallpox, which means we need to map smallpox globally and allocate, distribute, and verify those doses when to those outbreaks as needed. I know we've been successful in the past here with, you know, large scale efforts at vaccination, but given all these hurdles standing in the way, how confident are you? I mean,

are you confident this vaccine is going to get where it needs to go? Yes, I am much more confident today than I was 30 days ago. And I think there's going to be an evidence-based approach. I think the Biden-Harris COVID-19 committee is focused on how best do we participate in global allocation of the vaccine.

And we'll see many different tactics and strategies ahead as of the new year. More with Rebecca in a minute. I'm Noam Hassenfeld filling in for Sean Ramos for him. It's Today Explained. Support for Today Explained comes from Ramp. Ramp is the corporate card and spend management software designed to help you save time and put money back in your pocket. Ramp says they give finance teams unprecedented control and insight into company spend. With Ramp, you're able to issue cards to every employee with limits and restrictions

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If you have any questions or concerns about your gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. Rebecca, at the end of the day, how many people actually need to get a vaccine? We don't need all Americans or the entire global population to get vaccinated. So the models show we need 70% of the population must be immune to terminate transmission. So as population immunity climbs, vaccinated individuals may receive some degree of protection as the vaccine is rolled out. And I imagine not everyone is going to just sign up for new vaccines immediately here. Do we know how many Americans are planning to opt out?

That is a great question. There's kind of constant polling now, both of the workforce and of subpopulations. Dr. Mack at Morehouse College of Medicine is leading this effort for the NIH to understand that for several populations that are facing considerable vulnerabilities. So right now, 40% of Americans would not take the COVID-19 vaccine if it was offered today in their local pharmacy. Okay, so it seems like getting to that 70% threshold isn't exactly going to be easy. How do you reassure some of those people that, you know, don't want the vaccine at first? So first, I think we need to acknowledge we're actually in the midst of a pandemic trying

to distribute a new product. And as a healthcare provider, I hear about people's risks and their worry, their lack of confidence of a new product entering the market and their safety concerns about vaccines. So we really need to think about what is your motivation to protect yourself and others today? The second piece which I think is important is we have to acknowledge the effect of public trust because of the politicization of the approval process. We're way ahead on vaccines. You wouldn't have a vaccine if it weren't for me

for another four years because FDA would have never been able to do what they did, what I forced them to do. So we understand when patients are saying, I am not sure about this vaccine. Our job as a healthcare workforce is actually to communicate that, to share with you the data about efficacy and safety.

And do you think the government is going to be able to earn that trust back? I am optimistic we're going to have a tremendous moment when, for example, there's a photograph of Anthony Fauci getting the vaccine. I would have no hesitation to take it, nor would I have any hesitation to recommend it to my family. And generationally, for those who've seen him be a public servant for decades through multiple pandemics, I think that'll help instill a sense of this is a safe vaccine for me to take. And

maybe my parents, my grandparents should actually get the vaccine first. So number one, establish trust with the workforce itself. Number two, your local provider likely will get the vaccine before you. And that will be quite compelling. You're a local nurse, respiratory therapist, physician, and you'll be able to ask your health healthcare provider, did you get the vaccine? And would you suggest I get this for myself or my family members? What about conspiracy theories? I mean, when people are talking about 5G technology causing COVID, how do you combat that? I think what is important right now is actually what information do we share and show the public and display?

And I think there is a role that when we're seeing information that is fabricated to market, to tag it, especially if it's being disseminated via social media platforms, and to counter that with very straightforward, evidence-based information that the public can understand. Misinformation originates in your local community and then spreads via private messaging. So the World Health Organization created a page of Mythbusters, where they actually feature fact-based answers to the most common misconceptions about COVID-19. And we're encouraging people to actually go to their site and use that to counter the conspiracy theories in your inbox. And if it's not about conspiracy theories, you know, if it's just about being scared of a new vaccine, you know, if you have a friend or a sibling or an aunt or an uncle, I mean,

what do you say to a person like that who is just kind of generally scared of this whole situation? This is a similar message to what Anthony Fauci and others have shared about masking and physical distancing, that in order to protect ourselves and our loved ones, this is the public health playbook. This is a standard practice. These are required data sets that many third parties have reviewed for phase one, phase two, phase three trials. It's happened faster than ever before, but the quality of the data required, the review process is exactly the same as other products, both treatments and vaccines. When we think back to the polio vaccination campaigns.

Once the public health service authorizes its release, the polio vaccine can begin to protect American youngsters. Pediatricians reminded parents, we want to prevent polio disease in your child, and the pediatrician was a trusted advisor to that parent. Make use of increasing supplies of vaccine. Help your child grow up strong and straight, free from crippling polio. I am hopeful we'll be able to reestablish a sense of trust between an individual and their health care provider,

an individual and their pharmacist, an individual and their nurse. And because that's a longitudinal relationship, they will listen to that local influencer and be willing to get the vaccine to protect themselves and others. And are you confident? Are you going to get the vaccine once it's approved? Absolutely. I am pro-science. I believe in the quality of the data that we're going to see once these phase three trials go out. And I recommend the vaccine for my parents and in-laws as well. Dr. Rebecca Weintraub. She's a professor at Harvard Medical School. Her team created an online tool for states and counties

to figure out how to distribute vaccines equitably. You can check it out and enter in scenarios yourself by going to covid19vaccineallocation.org.