What plans are put in place for distribution of the Coronavirus Vaccine once it becomes available. We will discuss this and more, a few housekeeping notes, at the hill events, the hashtag, special letters, thehillrx supply chain. We will take question throughout the program and i look forward to those. If you experience trouble live stream refreshing it will work i hope. My first guest is National Health expert and respond to the frontlines and implementation of the Affordable Care act, governor secretary Kathleen Sebelius is the ceo of sibelius resources which provide strategic advice to nonprofits that is my go to person when it comes to issues of knowing what a smart Healthcare System looks like. Let me just ask you, you oversaw many of the institutions we are looking at to save this country whether it is pushing the time curve on developing a vaccine and distributing it or how you approve various dimensions of this therapeutic, what would you say is going well, what would you say has been awful . Thanks for including me in this program. I dont think theres any question socalled operation warp speed, having the United States government on a number of vaccine candidates early on pushed that pipeline, has really accelerated the possibility of getting a vaccine for the new coronavirus faster than people could have anticipated. That is good news, that will be beneficial to the United States citizens and hopefully to the rest of the globe. Collaboration, cooperation looks very good and the early investment makes sense. Pharma companies are drilling down on massive Clinical Trials, looking at safety results and hopefully competing to get to the starting line first but we could have a number of effective, safe vaccines in record time. A very bad news, sticking with just the Vaccine Development is at every point along the way this white house, this president has undercut public science, undercut confidence in the Public Health messages and by doing that may have discouraged a lot of americans from volunteering to get the vaccine, ever be leaving that it is safe and effective. That is really not helpful. Communication strategies, clear, effective, scientifically based communication from the start is part of any Public Health crisis, any Public Health recovery, and tying the vaccine to his political election which donald trump is done for months and months suggesting there will be an october surprise, an effective vaccine before the campaign, something coming out makes people feel like it is being rushed, the we are not on track for safety and effectiveness. We are on track for some kind of political to make. Nothing could be more harmful to the confidence that we are going to need for a massive Vaccination Campaign in two dose Vaccination Campaign. That has good points and bad points. I would say the rest of this Coronavirus Response weve seen much of the same. Public science which has evolved over time, scientists have learned more and corrected themselves when they learn more undercut consistently by the white house who has a different agenda in mind, not Public Health and safety but getting the economy back running as quickly as possible regardless of death, regardless of the disease. We had a point counter point, the clearest indication of that is Johns Hopkins in the fall of 2019 gave grades to countries around the world for pandemic readiness and not knowing what we were going to face. The United States was regarded as the most prepared best prepared country in the world and yet we had unquestionably the worst response for any developed country in the world. You were featured, one of the stars in the new movie totally under control which profiles the response to the pandemic, managing everything from operation warp speed to other dimensions of this. The real heroes that pop out in the show, doctors that were securing ppe, some companies stepping up and part of the discussion today is around supply chain incoming drugs and therapeutics, whether americans can have confidence that there is an infrastructure out there that is dependable enough to have confidence and faith to the leadership and i wonder how you see that, you saw states competing over masks and downs. When a vaccine roles that will we have confidence it will be wellmanaged . We will only have confidence if we have a National Plan and it is clear the current president does not want a National Plan. He pushed every issue on 2 states and sometimes the private sector and awaited is not transparent, put burdens on states as a former governor, they cant possibly achieve. Ppe is a great example. Rather than the United States mobilizing efforts through the defense production act, to get ready to go, or using credible purchasing power, and global contacts to purchase ppe, fair and equitable manner, use the depends Department Logistics to make sure equal intense machinery, that we had everything from virtual inventory where there were extra beds, the federal government under donald trump washed his hands of it and set it is up to the states, states competed against one another, competed against their own health system. Off and i heard so many stories about states, or major health system, only to have the federal government confiscated at the border and put it into the stockpile and have the United States say the stockpile isnt for the states, it is for us, whoever us is. We had a totally misguided and inappropriate response. We need a National Plan in place right away. We will only get that with a new president who has made it very clear he will have a National Plan for Vaccine Distribution, for vaccine integration, vaccine communication. We need the National Plan to start right away. People have to have confidence in the safety and security. Beyond that we need transparency. Wheres the vaccine going, who gets it . How many people again, the effort has been pushed to the states. States are submitting plans. We need a National Strategy for how this is going to roll out and how we are going to have confidence when the fda says the safe candidate has not been pushed ahead or the guidelines for the fda have been the Gold Standard in the world have not been shortened by political pressures. The business leaders, scientists i talked to since the pandemic began, and get worried about drug therapeutics etc. The other side of it is companies, they were not eventually shortages and supplies, what is the right way forward. And have a list the slot can on, passing on strengthening americas Strategic National stockpile looking at that. And what the private sector is doing, what are the parts of the skeletal structure we need to amp up, and the ecosystem and what is wobbly right now instead of shorn up. It is going to be hugely important to do a really in depth after action report, we found we didnt have sufficient manufacturing for vaccines. We tripled the Production Capacity. That is good news, putting back in place the responses, red flag folks, National Security and the white house going to be critical. We need to figure out the protective supplies and gowns, what makes sense that would have Production Capacity to deal with an issue where everybody in the world with equipment and supplies at the same time, renewed confidence and publicprivate partnership, pharma has stepped up but what we know about stockpiles and vaccines is unless the government has a side of money and it is worth your time to invest, if there isnt a willing bias it doesnt happen. We are facing a possibility, microbial resistance, antibiotics, we need a line of antibiotics in this country, that is an example, a pool of money that happened after 9 11 and massive resources for making sure america was safe and secure, some of the supplies that will be developed i never used, and you have them in place, something happening, we need to fund proactively and not reactively. On a scale of 1 to 10, 10 being worst, one being best, how bad was the administrations response on covid19 . It is bad. The death we are seeing in the United States are unparalleled for a developed country with the resources that we have. The burden on the black and Brown Community and native American Communities is immoral, that we didnt move more quickly and tell people the truth and take the steps to secure the most vulnerable population. We are at a 9. Maybe we can recover territory with Vaccine Distribution but there is no reason, we had 1000 peoples a day dying, in the middle of the country, the virus is raging here and it is raging in communities that have no capacity to deal with it because there arent icu beds and there is and personnel. Secretary Kathleen Sebelius, it is very sobering every time i talk to you. Thank you for joining us and helping us to launch our program. Thanks are heavily. Our next test believe stockpiling medical supplies made in the us is an issue of real National Security. Congresswoman alyssa slot can, just a week from all this other stuff you have going on, i know this is a priority for you in a priority for the country. To be pointblank, what is broken the needs to be fixed . A lot of my experience, it came down to things like medical supplies, pharmaceuticals, supply chains that keep us safe were so outsourced to places like china, we couldnt get a hold of them. My experience in the pentagon and National Security, it will my mind that we have a preference for making things in america, military quitman, body armor, meals ready to eat, we didnt have the same by american requirements on other medical supplies and pharmaceuticals. The stockpile, we opened that sucker up and a lot of it was expired in michigan. We got moldy stuff a lot less than we were expecting. We need to make sure there is a better way to stockpile equipment when we need it but in general it has combined by National Security background with major american manufacturing. In michigan we have been saying outsourced too far, you will get caught with your pants down and we did. Haggling with the chinese middleman in the middle of the night for a 78 sent mask, something has gone wrong. That has been at work since april. Where is your legislation now, with Kathleen Sebelius stretching the stockpile, i talked to other Industry Leaders in pharmaceutical production, talking about if you can identify the top 100 most needed therapies and figure this out that it is doable where does it stand now . It is a series of 7 bills city, bipartisan, 10 democrats, 10 republicans built by, bipartisan, this issue should be bipartisan. They passed the house in september but we are in negotiations to have them in the next covid19 package, they have been struggling to negotiate. Those bills are in there and once you get past the election we hope to get something that. Im frustrated we havent before the election. It is something that we should be moving on now and the biggest part of it is 500 Million Pilot Program for publicprivate partnerships on extra lines, extra pharmaceutical lines, in being partners on additional surge capacity. That is the part i am most excited about. Have you talked to Industry Leaders . How do they feel in terms of partnership with government as what they know will be a big list, vaccines and therapeutics, have to be deployed in every corner of the country. Are you finding them to be robust partners or do you have concerns . Companies at the ready for when the vaccine is identified, they are ready to ramp up reduction in my district, we have been talking to them and others, everyone talks about manufacturing more in the United States but you have to talk to the industry to talk about what incentivizes people. You cant decide from washington that you know what will bring industry back. We had such a globalized spy chain, such an ecosystem. A ton of things come from all parts of the globe. What i want to do is hear from our business leaders. I was a great group called Business Executives for National Security. They have done after action on our supply chain. I was one of the members of the commission that looked at it. You talk to leaders in industry to figure out how to incentivize additional production in the United States. One of the things i wanted to talk to you about is your cia background, background as an analyst. I talked earlier this week to rick bright, the florida official who said he was pushed out of the job, left government and came in and said something, called totally under control but i didnt realize. Back to a playbook developed in the obama period, they did a simulation, you did simulations of the cia, exercises in october of 2019 that anticipated this kind of pandemic, looked at the government responses, partnership with industry and underscored the weaknesses and decisions we saw. Is there any awareness that playbook, not the playbook but that simulation occurred highlighting these gaps among your colleagues in congress and the need to fill them . I was astonished to hear that the Trump Administration already had this experience in hand. I dont know how widespread that knowledge is that anyone with a National Security background knows there are people in each administration who look at these for a living. They have a whole Homeland Security counsel at the white house, i know people who are working over there and people focused on this. It is the difference between having folks in the system and having it rise to the level of Senior Leaders who will do something about it and the most important thing in dealing with federal responses, do you have the will and intend to lead from the white house or lead from washington, and it was this paralysis that came from not wanting to accept the gravity of the problem, not wanting to accept the federal government was the best place to respond in a lot of these scenarios. Those things meant we got too late of a start. This kind of thing would have stretched any administration of any party, the fact they backed away from that leadership role meant they didnt even seek out the expertise that mightve already been in their administration. What are the other critical supplies you think the nation needs and the partnership with the private sector look like from your perspective . We need to look at what are the supply chains with the National Security value. As someone who is from michigan where obviously we are never far from thinking about vehicles in Vehicle Production there are certain batteries, certain capacity around Energy Storage that we dont want to do without. There is certainly a lot of technology around superconductors that were at risk of having to depend on other countries. What we needed, i wrote this into the Defense Department budget through my role in the Armed Services can be, cannot look at identification of the specific supply chains with National Security important sans then we can look at incentivizing more production here at home but we have to agree on that list, have a common understanding and be able to review it every few years but certainly Energy Storage is a big one that we would be low to live without. I really appreciate your insights and what you are doing to think through this ecosystem, how to be smarter than we have been. Im grateful for your time. I know how busy you are, thank you for joining us for todays program. My next guest has been a pharmacist for 30 years and the only pharmacist in congress. He thinks coronavirus is the wakeup call America Needs to bring back the pharmaceutical supply chain to the United States. Welcome, congressman buddy carter, youre up for reelection in a few days. Thank you for taking time to talk to us about this. You think this ought to be a wakeup call. What needles do we need to move to make sure america has the supply chain, something it can trust to deal with this pandemic. I always said theres a difference in knowing something and realizing something. We have known we are too dependent on other countries for our pharmaceutical needs but then this pandemic, we realized it. Having realized it means we have to do something about it. The things we are proposing and i have legislation on manufacturing, pharmaceutical ingredients, drugs in the us. And they are located out of our country back into our country. 90 of what is made in china, comes from Foreign Countries. Thats not a good situation for us to be in. We realized in the 1970s we were dependent, we need to have energy independence. We are too dependent on foreign companies, pharmaceutical needs, we need pharmaceutical independence. What im trying to do is attract those companies to come back to america to incentivize of them and repatriate back to america. The opportunity zones, the tax credits, the manufacturing facilities, tax incentives, not the least of which is trying to browbeat them into appeal to their patriotism that we need to come back, fairly important. Pharmaceutical dependents and cte on these Foreign Countries, for our ppe, personal protective equipment. With ppe as well. One of the interesting things as i delve into this, the pharmaceutical side, the sense of anxiety in crisis, when you get into it i cant find anywhere they werent delivered. The supply chain largely worked through this time and i wonder if my bearings are off. I know youre working on what our National Stockpile should be and how to look at the key medicines and therapies. When we looked at the actual experience, did things hold together or not . We had threats. If they didnt come to fruition we had threats from china, we are glad to send this medication, we will do what we have to first and if anything is left over, theres the kind of situation we need to be in, thats not in the best interests of the healthcare of our citizens. The situation we should avoid, we do need to get manufacturing, we have been able to get everything we need at what price . You heard of price gouging happening from Foreign Countries and that is why we need to address it. I talked to leaders in industry, pharmaceutical and therapeutic manufacturers and they are interested in partnering with government on things like looking at the strategic stockpile but they sit in terms, on this capacity that has moved abroad it required a whole economy system. You need longterm purchasing, regulatory changes, opportunity zones. Is there a place in our government that is thinking holistic we about that environment . If it is done piecemeal it wont work. Weve got to make it worth their while. One thing we have trouble with, there have to be other incentives to make sure we cover that part of it. It is important that it is holistic. We cant piecemeal this to make it work and we understand that. That is why this legislation again addresses all of those things and there are pharmaceutical manufacturers located in the United States already and a lot of them have been asking what about me . There will be incentives to attract them so that is important so that is something we have considered. If i could talk a second about the stockpile. You mentioned that a couple times. Legislation that is important to address our stockpile. We have a strategic federal stockpile but weve been too dependent on that. I have Bipartisan Legislation i am cosponsoring with a democrat, a state strategic stockpile, dollar for dollar grant, what we found out in this pandemic, in the National Stockpile in place, this is the Pilot Program that will offer grants to encourage states to have their own stockpile. That will help us be better prepared for the next time. A bill i am cosponsoring is the essential medicine stockpile. 90 of all the drugs used, instead of waiting until we have a shortage of the drug, a generic drug and then stockpiling it, we create the essential medicines we know we will need and this is a Pilot Program, whereas we create this National Stockpile of essential medicines and realize the ideas that are being currently utilized, making sure that we have an inventory of these essential medicines, and have them on hand for our citizens. By using that perpetual inventory we can guard against a lot of that being wasted. When i was in the joint saint legislature we went through millions of dollars worth of tamiflu to make sure and the right decision back then but to make sure we had we didnt have to use it. The new policy we can get from the new procedures from the private sector we can avoid that. I want to squeeze more in. Your role as a pharmacist, in some ways the canary in the call mine, they know the inflow and outflow, what should we know about what role they can play ramping up their role in terms of alerts and what the flow and need is of various Key Pharmaceuticals . Great question. Pharmacists are 90 of all americans, they are not utilizing pharmacists in particular. Doctor adams, secretary is our, hhs, had to be utilized. We can learn about it, in the covid19 pandemic be able to test for this and administering the vaccine from a pharmacy now. This will help us to get it out there as quickly as possible. We are taking questions from the audience what is the appetite of industry providers and potential administration for the challenges assuring more pharmaceutical selection. Are we willing to pay for it . The question is are we willing to pay for it . Weve got to be prepared for this. I think we all agree that this is necessary. To attract these Companies Back to america, weve got to be competitive, a private company but they went offshore in the first place, financial incidents whether it be lower manufacturing costs or whatever it is, we have to bite the bullet you signed up for a vaccine trial and we will come up with a safe and effective vaccine, i wish you well, and it is an important time. I had my first dose and three weeks, dont know if this is the real thing. The staff doesnt know. A number on the file got the key, and a daily diary of symptoms, it is important as a member of the healthcare profession, a safe and effective vaccine so confident for the process. If your Blood Pressure and temperature went up you can blame in your journal Steve Clemons of the hill. Thank you for joining us, you have a lot on your plate just around the corner, thanks for joining us. The United States just reported on most new covid19 cases in one week since the pandemic began. It is skyrocketing in the kohler months. Under donald trump, the American Enterprise institute, lawmakers and governors on responses, you are up at 6 am and clicking on cnbc, you can get really smart, and cnbc and squawk box. Would any of these be better, perhaps unfair is i look at this and see a lot of keystone cops stuff, who is strong and capable about our response, if someone like me is missing. What we are following with respect to the vaccine, one of the companies that has that, and fda and someone follows the news or suits in that role. It is very transparent and a lot of integrity. And these products before an Advisory Committee, they outlined subjective criteria and multiple guidance and it makes sense and not too aggressive, the middle path recognizing this is a crisis, rigorous data, and in this past week they brought the criteria to an Advisory Committee, and looks back at this, with a number of things. The when i come back to is the diagnostic and the situationally blind in january and february and didnt have diagnostics deployed and i have written about this many times. And look at the things we could have done differently that might have had an effect on the contours of the epidemic that ensued. It is not just getting the cdc test out was a lot of people. 2 but getting the Clinical Labs in the game, bio reference labs and academic labs back in january, recognizing it would take a month or so to ramp up their capacity, you had to get them started early on that. When you look at the drug and therapeutics, is the supply chain working, does it need to be moved, we are also talking about festival at of new vaccines and new therapies, i talked to a number of ceos including pfizer and others, new stuff coming online and whether the system can handle and appointment of vaccines but also what we saw in terms of drugs and therapies. Did you have any concerns about that, the system largely work . They talk about the speed of these products, we develop them quickly but didnt shortcut the development process. The reason the we were able to pivot is we had these established platforms we were able to use to start deriving drug constructs based on the gene sequence alone. We have mrna platforms that were reasonably far along, pfizer using that to develop a flu vaccine, moderna used it for a vaccine against sars and other purposes, the technology was far along, they were able to insert it and start deriving drug constructs, we had those platforms available. Including ebola and sars. We were able to quickly take those platforms and get drugs around it. It is quite extensive. We didnt take any shortcuts there, a 40,000 patient trial, doing a 60,000 trial, these will be the largest vaccine Clinical Trials, some of them will be almost the largest trials ever undertaken, the Rotavirus Vaccine was over 60,000 patients but most vaccine trials are not this large and a randomized portion isnt this large. These are Big Development programs. We did not shortcut this at all. Where we moved with this and it is reflected, these products are commercially optimized. You have two used to develop a vaccine, and requires two doses or would you optimize it into a single dose, optimize and get a single dose vaccine. Would you develop a vaccine requires these positions, you try to manufacture in ways it is stored at room temperature. We didnt optimize that, they are extensive, that needs to be understood. We didnt take any shortcuts and the fda didnt take any shortcuts and this is driven by the regulators in terms of the data they are requesting. As far as the supply chain the challenges are with respect to the supply available. In some cases supply constraints because it takes time to ramp up and other cases because we didnt take all the steps we could have taken at the outset to provide their supply with the drugs where i long lamented we didnt push harder to expand supply. Companies a lot of work, extraordinary work but there is more we couldnt have done with the federal government to provide more supply to those drugs and use them as a bridge to a vaccine. As far as distribution concerns, there will be complexity with how drugs are being distributed because of policy choices we make in terms of how we are doing that but as far as logistics are concerned, the distributors have done a good job in this crisis and it shows how good the logistics are when it comes to medical products and when the supplies were there they were able to distribute them. It wasnt because things werent showing up but because there wasnt enough material. Distributors have to have their act together but there needs to be a plan. Kathleen sebelius was on the show and says shes waiting for a plan. I know you talked to governor larry hogan from maryland and other governors as well. In the new film totally under control every hogan welcoming a package of ppe from south korea, trying to prevent it being hijacked by federal authorities, a kind of law of the jungle feeling in that moment so you ask your self as we get closer and closer to multiple potential vaccines how do you preempt the same story from occurring again . The Vaccine Distribution system based on my understanding of it will exert a lot of control over how the vaccine is distributed. Based on our location tied to what the initial authorizations are for, the states get a proportionate allocation based on how many people they have in their state that meet the criteria. Vaccines authorized to 65, i am not saying that is what it is going to be other than what is disclosed by the National Academy of sciences cheering and medicine. That is 55, 60 million people. If you only have 30 million doses every state gets a portion of the 30 million based on how many over 65. That system has been designed but the system goes further in that they will have tight tracking of where all the doses are going and who they are being administered to inside the state so that allows the federal government to reach in to reallocate vaccine at any point and allows you to make sure it is going to properly indicate populations, the given discretion for the states to make a final choice on who will get it but the price on that level of control and oversight is you have to distribute it through a more narrow chain. You have to have close monitoring what the sites are. They need to be registered and undergo special training and so that limits the number of sites you can distribute, hopefully there will be enough in underserved communities and accessible to people who have difficulty coming into cvs or Vaccine Distribution point, that is where you start to be concerned that people getting access to it, creating friction in the system they are the ones who will be most disadvantaged. How do you offset . If you are a governor, maybe go around, that cost money. Is their federal money for that . Those are places i would be focusing attention where incremental friction will create some opticals which he could be getting a covid19 vaccine is like going to vote where you go to a special location and a special window to get your vaccines so for most people that could be okay but you worry about people with obstacles. As far as the antibodies are concerned you will be supply limited but the way the system is designed based on my understanding is they plan to distribute those through hospital Emergency Rooms and the challenge is initially indicated population is older individuals a lot of people already are reluctant to get infusion of antibodies. We know that from the commercial side of the drug market. People receive swallowing a pill as something less consequential than getting an infusion of the drug and that is why a lot of primary care drugs are formulated in ways people inherently look at an infusion as more invasive and potentially more risky so you have that bias in terms of how consumers receive it. And to deliver them quickly they are most effective when they are delivered. You have to convince in over individual, has Coronavirus Diagnosis to go to an emergency room and sit for an infusion with a 2hour followup. There will be other wait times and you are in a location where coronavirus is already epidemic or they wouldnt have caught it in the first place in the emergency room is busy and someone has to drive them there so someone has to take me to the emergency room and expose themselves to coronavirus. That is a challenging Distribution System as designed and conceived based on my understanding. In the wall street journal, we advocated Home Infusion of an alternative or offering that as an alternative. That will be another challenge, and create friction, getting into the doctor, and find ways to mitigate that. And face a obstacles getting access to care, they come from communities with good access to healthcare and good Resources Available to them. I appreciate the perspective but you talk to everybody on every side of the island we know what is possible, you tweeted out recently, time for National Mask mandate. Do you see any way leading republicans and democrats, this might be the right time. Not sure how you would enforce a national mandate. There are republicans that are on board with trying to promote mask wearing and there are ways to provide carrots rather than sticks to try to prod governors to implement those mandates. If you make it more culturally acceptable that would be a big start. The bully pulpit is very powerful. If it was used to encourage governors to do this that would go a long way instead of what we have right now which in some cases is the opposite wear masks are being discouraged in some respects. Remember the masks are to prevent a sum to medical present somatic people from being able to transmit the virus. They can also you protection as an individual but the quality of mathematica the Higher Quality of mask the more protection it will afford you. Doctor scott gottlieb, my favorite voicing Early Morning sun cnbc and resident scholar at aei, thanks for sharing your thoughts with us today. My next guest have a deep understanding of the healthcare ecosystem and its infrastructure. Im delighted to have them on to discuss not only the resiliency of the pharmaceutical supply chain but also their recommendations for seamless rollout of the Coronavirus Vaccine when it becomes available. Doctor rios of the Hispanic National medical association, and doctor Joshua Sharfstein of the practice and Health Policy and management at the John Hopkins School of Public Health and heather zenk of america source corporation. Let me start with you. One of the reasons we are doing this program today is americans are anxious, they are anxious about what is going on in the country, the stress out there, anxious by what they have seen with regard to some of the management of ppe in the past and there is concern about how a virus vaccine is going to rollout in various therapeutics. My question, take up the corporate hat, should americans being just about some parts of this or should they have confidence that the system is going to work . Should have confidence the system is going to work. We have Lifelong Medical staff, lifelong resources that have done this kind of work over and over again. What is unprecedented which is a term we use really in these times, the truthfulness example. It is unprecedented we are looking for vaccine for the United States competition population in a short time. With that unprecedented effort comes a strong supply chain that wants to support it. You have Healthcare Professionals and we all want to get back to more of a normal life cycle. I want to see my family. Many of us would enjoy spending the holidays together which may not happen this Holiday Season but lets look forward to next Holiday Season. What you need to rely on is having a sophisticated robust supply chain that can do this in the United States and what some of the uncertainty is coming around is we are hearing ultra cool temperatures, frozen temperatures, not something we typically deal within the supply chain in a daily basis. Outside the norms but not daily and looking at vaccine for the entire United States we need a robust plan, people that will raise their hands to want to do this, a willing Healthcare Supply Chain to do this. A matter of becoming collaborative together, communicate among each other and execute on a plan we can all agree upon in order to get the vaccine to patients, not just to approval but to patients, what we need to focus on. Joshua sharfstein, one of the realities we are seeing is incredible time pressure put on science, the industry, the innovators trying to discover a vaccine and manufacture and distribute it. At the same time a lot of politicking, this is the time of an election and there are concerns about trusting the is science able to give the leeway it needs to produce what it should do or are we taking shortcuts . You have 5 on pressure on the fda and others but i will ask a similar question. Should we all be able to trust what is developing . Trust comes from expertise, people who know what they are doing are making good decisions. It comes from data, transparency, it doesnt come from political interference, that undermines trust. We are poised to have a safe and effective vaccine, depends what the studies show. We are poised to have a good review process with the independent Advisory Committee weighing in on the data and a lot of transparency and we are poised with the agency to be explaining itself to the public about getting a vaccine and the Advisory Committee, the pieces are moving into place but those pieces could get knocked aside and very dangerous when the president accuses people in the agency of not moving fast enough for political reasons. It is really doing a lot of damage, making people see the agencies as primarily political when they are moving it the speed of time. I would ask all of you in the earliest stages of the virus, when every day i was doing a show every day on where the tests were, why didnt we have a National Testing plan, you get down to it and look retroactively and a lot of dysfunction between things like the fda and the cdc and we saw this virus infection rate and mortality rates hit parts of the nation in uneven ways. The hispanic population, the black population took on a huge burden, frontline workers, i would come to you and say what needs to be put in place so that we have a fair, just, even, followed response on covid19 that along with the supply chain and everything, you have been working on this so what matters most for you and your community . Two things. You have to have the data. Data collection by race and ethnicity is really important and in our Healthcare System it is hit or miss. It has never been mandatory and for Infectious Disease of this magnitude that his army and burdening all americans but especially hotspots like africanamericans, hispanic, native americans, poor communities, Rural Communities it is important to have that data identifier. The second thing, important for people to realize, that live in the United States even if they are not documented need to be vaccinated. We need Health Access big time in our community use, latinos in this country have not applied for Government Programs. They mistrust Government Program so there needs to be messengers, physicians, nurses, frontline workers in our Healthcare System, nursing homes, communitybased organizations, we all need to work with Public Health agencies and we need leadership that looks like us in the Public Health agencies and in our Healthcare Systems to be able to have more trust and to get the campaigns through media and social media we are already doing. We have been doing this all year. It is important to realize a lot of the organizations that are healthcare related have jumped on the bandwagon to help them. Thank you for that and we will see how this rolls out. I am interested in what activities we will get. Dont know if you have been following. I watch this grid and look at various companies, big pharma companies, small pharma companies, different approaches, different phases and trials, darpa, not darpa, but operation warp speed. When you look at it, you look at that lineup i dont know who will get over the line or when the differences come in but take us down the track to explain when we are going to see a vaccine sort of in the marketplace for regular folks and how that is going to be tiered between those who most needed versus not and how do we deal with multiple vaccines . It is important to see this as a series of stages. You have to get past one stage for the next to matter. The stage of getting data from Clinical Trials will tell us if the vaccines are safe and effective when used in thousands of patients. And look to see if people who got the vaccine a much like the less likely to get covid19 than someone who got a placebo and safety data to make sure the vaccine doesnt cause any untoward side effects. Only when we know that can we get to the next stage, starting to think about who should get vaccinated. Not all the vaccines we like will be available right away so there will be a couple phases. The first phase of vaccination it will be people who are likely healthcare workers and people at very high risk for getting the coronavirus and states play an Important Role industry meeting the vaccine in cooperation with a bunch of partners including the private sector. And behind that we will see a lot more manufacturing. Hopefully more than one vaccine will prove safe and effective so we will have multiple vaccines being manufactured. In terms of could grandma be getting the vaccine that may be a question for january or february. Everyone else might be more of a question for late spring or summer. That is if everything goes well. Those first phases have challenges that everything gets pushed back. To even be in this position is a lot further ahead than ever before. I know you have to leave. I will jump to heather and ask when we will talk about what our experiences are, and and vaccinations of the flu, adding 150 million on top. How does that work. Does the system carry the load . The system is. The commercial supply chain is efficiency and scale. As long as we do that, it happens. To joshs point around the phases that would play into how distribution of this works. To add into the covid19 vaccine into status of traditional vaccines and flu vaccine at this point, going to follow the stages. To me there are kind of supply chains in the us today. Theres the Public Health supply chain and then theres the commercial supply chain. And i think particularly when we add in the covid vaccine, that is the time to rely upon all the entities that can vaccinate in the supply chain such as pharmacists, such as physicians and independent channels. We have the ability and it does rely heavily on the rely heavily on the Public Health supply chain in order to vaccinate we are goingo to need to use all of the supply chain, both public and commercial to make this happen but from a distribution point of view scale, efficiency and effectiveness, thats her bread thats what we build off of every day. I want to ask you, covax coalition, 184 countries now members of it. Every other nation to come in into. The United States is not a member and ive interviewed the minister of health in sweden who says im shes really worried about vaccine nationalism and if america which is such a big innovator come such a big part of the puzzle isnt part of that shes worried about a law of the jungle. Are we worse were sought by nog part of covax . What are the implications of that . Personally, collaboration is best way to go about this. Were in a Global Economy, a Global Supply chain. A lot of pharmaceuticals are starred in other countries come finished in the u. S. In fda approved sites. We do need to think globally but we need to act locally also. I think as looking internally to understand how to protect her healthcare workers, our highest risk and then well is out it would be beneficial if we would join that coalition but we would think about some global aspect, and a global pandemic. We are not in the sweden, swedish and didnt. When a global pandemic. The Global Economy does need to come together and the global Healthcare System needs to come together just because were so Much Movement between country so Much Movement between continents. Thank you for that. Jump over,ntion as aus ask how to get this equation right, i do it to give the u. S. Just this past week committed to give funding and support to set become the coalition for epidemic preparedness innovations, about 20 billion which is a lot but a drop in the bucket frankly compared to many countries beginning of the year so there are some coalitions United States is part of. To come back to this question when we see him while that of vaccines, i interviewed dr. Redfield of the cdc and he made the same point you did. He said were going to have to embrace a person without resources, person who may be homeless without shelter, contact, we have to find a way to bring that person into being tested, if infected, give them support and treatment. Otherwise the system comes apart. I think what heather just said about the global dimension is so important. There will be parts of the world that are hard to reach. So you are thinking about this how can we just not be. It . But actually be committed like our lives are on it to make sure we are inclusive as we reach out to the community that needs it . One of the important things the whole supply chain every step of the way can do is to think in terms of family and focus not just individual efforts to the whole family needs to get vaccinated and needs to understand that what they are doing is helping other families when they translate into neighborhoods california has the whole Health Equity line and hot spots all over the country there are neighborhoods and census tracts to be focused on with the essential workers as well of those who are the most vulnerable with chronic diseases already. They need to be protected first at the National Academy of engineering and science with their distribution plan. But i do think there is an Important Role for commitment through media. We have a lot of people get information not only from providers who dont go to the pharmacy to pick up medication we have ethnic media that are momandpop type and then of course the National Networks and the spanishlanguage and the asian languages have their own media stations like telemundo that Work Together with the ad council to create a major focus on the importance and we need to start now with flu vaccine season upon us we are involved with the flu Vaccine Distribution and messages with some of our partners with the cdc. Heather knows this Business Inside out and i have done a deep dive into it so you realize how complex the backbone, the circulatory system, the supply chain is incredibly impressive but was very ignorant of what is out there as we have a big way to go when we think of the media but in terms of what is out there we have been taking questions from the audience and we have a question from daniel. How do we ensure the integrity and security of the supply chain . How to reassure various adverse actors through security or theft or tampering or cybersecurity there are other securityrelated perspectives thank you. This is a big deal where talking drugs today but then to go on ebay there are ridiculous things how do we and hands and amp up security . So to get a vaccine trust your local Health Care Professional they trust their supply chain partners. As long as we continue to use the resources over time know your partner and trust your partner and validate your partner second to be logical i know the cdc trains have Vaccine Development with the National Security event. And over the course of time i know where our distribution locations are and then to pick pharmaceuticals every day and thats the same practice that i know from the pharmaceutical supply chain for one of the key things is know who you trust at this point also. How do you approach that . Because it is amply important for communities that already have a trust challenge who dont see folks like them do that messaging. So what is the perceived risk and one is a real risk but what are your thoughts . The perception is important everybody talks about anti bias training and the importance of having equity inclusion. But what really matters is the messenger and i have to applaud what heather said about trusting so people can see who they are talking to and the federal government meets our face and i think that was the whole part of the problem with this years misinformation is that the cdc is the public trust department. And the cdc needs to be out there with the State Government and the local government working together with the faithbased religion that is important to our community and Community Leaders and Community Organizations with messengers lined up with the importance of vaccine for covid19. It is such an Infectious Disease. People in our community understand it is a very important vaccine and with the infection rates for their own families. I realize this is a complex time i really appreciate your thoughts on how we do this right because there are choices out there and also unacknowledged strings that we have not been talking about but how this election turns out is something we have to get our heads around and then will interrupt from the National Hispanic federation i hope you will be back because this is story we continue to cover take you so much. That brings us to the end of our program, thank you to the Healthcare Distribution Alliance for those of you who missed the conversation we will have video up on the website. I am Steve Clemons. Be be well. Theres more like Program Later today with a discussion on what to expect on election day including how long it could take to get results from states and other possible accounting and reporting challenges. Its from the bipartisan policy center. Live coverage at 2 p. M. Eastern on cspan2, online cspan. Org or listen on the free cspan radio app. With five days left until election day on november 3 when Voters Decide who will control congress and occupy the white house next year. Stay with cspan. Watch campaign 2020 coverage every day on cspan, streamer ondemand at cspan. Org or listen on the cspan radio app, your placement and filtered view of politics. Thats what gives us the confidence to center and describe the universe like we were there. It all started with a big bang. Is there a song in there . I wouldnt give a reporter an interview unless they read why not the best first . They had to read the book before i would interview them. For 20 years booktv in depth hosted americas top nonfiction authors for an indepth conversation with cspan2 viewers. On sunday at noon eastern join us for our live 20th anniversary special, more book talk with authors, your phone calls, Facebook Comments text in tweets and look back to memorable indepth moments. The picture on the back of you, do you remember those days . No. Not conceivably . Whats in the book . An examination of life at yale. Watch in depth sunday live at noon eastern on booktv on cspan2. You are watching cspan2, your unfiltered view of government. Created by americas cabletelevision companies as a Public Service and brought you today by your television provider. Up next indianas candidates for governor, eric holcomb, woody myers and donald rainwater take part in a televised debate. The Indiana Debate Commission is the host. This is just under one hour. Moderator good evening and welcome to the second of to go been short debates organized the independent nonpartisan Indiana Debate Commission. Where i live in the students of an fyi in downtown indianapolis and soon will be hearing from three candidates on the ballot want to be your governor. I and her debate moderator for the evening. My name is nadia brown at an associate professor and University Faculty scholar a political site and african africanamerican studies at the university. Now to introduce the candidates. They are