Challenges involved in rolling out covid19 vaccines across the country. They will also discuss the opportunities for the Biden Harris Administration to deliver a rapid coordinated response to covid19, that includes strategic use of vaccines to protect more people. The speakers will bring a sciencebased perspective on these and other topics. Please note participants are welcome to use images, video, and quotes readily from the webcast and the content is for immediate relief. Release. I would like to briefly introduce our two speakers. Dr. Chris beyrer is the director for human health and public rights in the department of epidemiology, International Health and Health Behavior and society at the Johns HopkinsBloomberg School of Public Health and also the founding director of the center for Public Health and human rights. During the pandemic, dr. Beyrer has been engaged in research and focusing on lessening prisons to prevent the spread of covid19, transmission of covid19 and efficacy of mask wearing, as well as the development of covid19 vaccines. He also serves as a Senior Scientific liaison for the covid19 prevention network. Our second speaker will be dr. Monica schochspana at the Johns Hopkins center for security. She also Senior Scientist of the department of Environmental Health and engineering at the Bloomberg School. During the pandemic, she has worked to translate Scholarly Research into actionable recommendations for policymakers and practitioners including as cochair of the working group on readying populations for covid19 vaccine. We will have time for questions following the panelist remarks. The procedure will be as follows. We will take some questions that have been submitted in advance of the briefing and some questions for the zoom check. If you have a question for the briefing, you can enter it in a zoom chat addressed to all panelists. Please enter your name, media outlet, and question. We hope to cover as much as possible. And note that participants will be muted during the briefing and it will be recorded. Dr. Beyrer, please go ahead. Dr. Beyrer thank you very much. Good to be with everyone. I would like to make brief remarks as we begin. First of all, to say we are in an extraordinary moment now of Scientific Achievement because we have two vaccines, both messenger rna vaccines that have been approved for emergency use authorization by the fda and which are now rolling out in a vaccine immunization effort. Both of these vaccines have shown high, in fact very similar efficacy, 94 and 95 with the pfizer and moderna products. Both require a two vaccine dose regimen. The Clinical Trial data for these vaccines show for pfizer, the optimum was 21 days between the doses, and for moderna, 28 days. They are on a two dose strategy. We also have at least three more vaccines in the Clinical Trial pipeline that has been established by what was called operation warp speed and what is now being called by the Biden Harris Administration, the operation. That is the astrazeneca vaccine which is a different technology, a live vector vaccine using an adenovirus, also referred to as the oxford vaccine, which has been approved for emergency use in the u. K. And is being rolled out over there, and the Johnson Johnson vaccine also a live viral vector vaccine for which we are expecting an application to the fda for emergency use authorization any day now. The fifth trial, started just after the new year with a novavax product, which is a protein subunit vaccine, that has been and rolled remarkably well, 1000 american volunteers a day. We already have 13,000 people immunized with the first dose. I would also add that the we will be back in one moment. Go ahead. Dr. Beyrer thank you. That the Johnson Johnson vaccine is a single dose vaccine, so we are encouraged by the utility of that product. These trials have been rigorous and the outcome so far has been highly encouraging, but the rollout of these very efficacious products has been halting and slow and challenging, and it has been too slow to have these vaccines, at least until now, to have an impact on protecting the American People from the covid pandemic. As we all know, we are still seeing very high rates of community transmission. We are rolling out this vaccine effort in the high transmission context and also with a high burden for our health care system. All that means that we really need to continue is the other non the other nonvaccine interventions. That includes mask wearing and we are now being recommended perhaps to do double masking. The Biden Administration has imposed a mandate for mask wearing on federal properly property, but also social distancing and handwashing. It means we are still in an extraordinarily dangerous time for Public Health. The Biden Harris Administration has come into office basically stepping into the vaccine rollout efforts that were already underway, that was really based on the state approach to this. So we really have a 50 state and territory plan, and it is an extraordinarily challenging thing to begin to move to a more national plan. Lastly, i would say, we have really an unparalleled Biomedical Research infrastructure in this country and that has been spectacular in terms of delivering two highly efficacious and safe vaccines in 10 months. But we have had a 20 year disinvestment in the Public Health infrastructure, so it is perhaps not surprising, but a hugely challenging and unfortunate reality that our Public Health systems and implant mentation implementation is nowhere near the level of our biomedical infrastructure to develop these vaccines and that is something we will have to work on as a country and very quickly, while we are rolling out these vaccines. I will stop there. Ellen thank you, dr. Beyrer. Now we will hear from dr. Schochspana. Please go ahead. Dr. Schochspana thank you. And thank you to everyone joining us today. A few remarks i want to call out focus on the chronic inequality and recent institutional failures that have produced two trends for the pandemic in the United States. Those are the high rates of covid19 infection and mortality in black, indigenous, and latino populations, and at the same time, disproportionate levels of vaccine hesitancy, particularly among black communities. The question arises, how might authorities work to strengthen covid19 Vaccine Confidence within communities of color . Im going to point out three actions. The first is to diagnose properly the causes of the hesitancy and treat them effectively. There are many reasons for vaccine hesitancy. I want to pull out two p the first is the hesitancy around very specific vaccines as people of color and many others in the United States see states roll out the vaccines are the second is skepticism recommending the vaccines. That skepticism is grounded in abuses bypassed health authorities, sometimes in government names, biased health systems, symptoms of suffering among people of color, and also modernday Public Health programming that deals ineffectively with social determinants of health. We need to focus in particular on that second set of hesitancy, the second kind. The second action here is recalibrating our ideas about the tempo of work needed to improve covid19 vaccine uptake among communities of color. Few of us doubt that a real race is on, even though the finish line may have to be redrawn due to bottlenecks and vaccine supply and administration. For communities of color, the campaign has to engage in two very differently paste work streams. The first is the urgent task of reducing disease transmission and burden, but the second work stream is not to be rushed and ongoing job of demonstrating trustworthiness and earning a reputation for reliability and honesty, while trust is an intangible product of Community Engagement work. That Community Engagement work still requires very tangible provisions, and the loadbearing Community Engagement structures and Public Health have historically not been prioritized for investment given finite resources. The third action is investing of course, as chris has pointed out, sufficient Human Resources to perform both work streams. That means Human Resources on the Public Health side and Human Resources on the community side. We need to strengthen the organizational capacity of the Health Department to partner with their Community Allies in a genuine fashion. We also need to strengthen the communitybased workforce comprised of community organizations, Community Health workers, and other champions who are best poised to promote covid19 vaccination among people whose roots they share. If we want to align the demand for and the benefits of covid19 vaccines for communities of color, we as a country have to provide lasting opportunities for our communities of color to exercise collective agency over their own health and wellbeing. Back to you. Ellen thank you, dr. Schochspana. Now we will take questions, and if you have a question, enter it in the zoom chat with your name, media outlet and question. We will start with questions from griff whitty at the Washington Post for dr. Beyrer. What are the factors that account for the wide disparities among states and how quickly they have been able to administer Vaccine Supplies . The second followup, have there been Lessons Learned about best practices as well as tactics to avoid . Dr. Beyrer very important questions. Unfortunately, what we see is a very heterogeneous picture. Essentially, the Previous Trump Administration passed it to the states to come up with their plans. They also, through the cdc, made recommendations about prioritizing the use of these vaccines. For example, virtually all of the prioritization efforts said that we should start with Frontline Health care workers who are providing covid19 care. But a number of states chose not to do that and instead decided to immunize the elderly, but without a plan to do that and had a rather chaotic beginning of the rollout. That is a huge challenge for the Biden Harris Administration, harmonizing and trying to work with the states, and of course they are under resourced to do this. Resources for the state and counties and local level were meant to be in the second Covid Recovery act, of course President Biden has asked for that. We will see. The second question about best practices, i think there are states doing significantly better. For the most part, where that has happened is because the governors were paying attention to scientific expertise to the Public Health experts listening to epidemiologists and working closely with their local health authorities. Of course, it is a heterogeneous patchwork because Public Health has been so underfunded in so many states for decades now. Ellen thank you so much. Here are some questions from at least reuter at midcity news for dr. Schochspana. What can be done to make sure people in underserved communities have access . You touched on that in your presentation, but any concrete things that you can share. Dr. Schochspana right. Again, along the themes of strengthening the organizational capacity of local, territorial, state, and Tribal Health agencies. I just want to call out concrete examples of those assets in which we have to invest and hopefully, we will see more pandemic relief dollars channeled to these kinds of things. We need time on an executive schedule and Health Department to engage in Strategic Planning around the need for institutions and communities of color. We need dedicated Equity Advisors who can steer it implementation of the covid19 Vaccination Campaign among these communities. We need all tiling will staff who can navigate communities skillfully. We need budgets to convene regular meetings with stakeholders from hardhit communities. We need to compensate those participants. We also need to strengthen communitybased organizations that have root in hardhit immunities of color, concretely by providing direct ending in the form of rants, but also grants, but also providing them skills like grant writing that will allow them of the pandemic and into the future. The point is Community Engagement is hard, timeconsuming work that requires an adequate number of personnel and a robus, operating budget robust operating budget, and we need to get dollars in these line items. Ellen thank you so much. The followup from midcity on a different topic. As we start to vaccinate larger groups of people, how can we ensure there are not long lines or difficulties in getting an appointment . Dr. Schochspana again, it is important to put the user, the end user of a vaccination system , at the planning table so that they can provide their own problemsolving capabilities to suggest ways that can improve delivery. So in this case, a jurisdiction should be convening specific organizations that represent different demographic groups, whether its local disability groups, local senior groups, local youth groups. The point here is that we need to populate the planning table from people who represent the demographics that are being served by the Vaccination Campaign. And chris may have some additional details. Dr. Beyrer i would make the point, i concur with monica, but it is also important to know that these are challenging products, particularly the pfizer product, because it has to be stored and shipped at ultralow temperatures, arctic winter as it has been described. The moderna product is slightly easier but still has to be kept frozen. We are in a situation where once you defrost, you have to immunize. If people for example dont come to their visits, we were perhaps too restrictive at the beginning and throwing away doses rather than immunizing people and that has got to change. Ultimately, we have to get as many people immunized as quickly as we can to get ahead of this virus, which is also of course mutating as it moves through human populations. That is an urgent priority. This will be easier if we have emergency use authorizations for the other vaccines in the pipeline because some of them are much simpler to use. One is a single dose vaccine and most of the others need freezing. Only the pfizer requires ultracold temperatures. Ellen thank you so much. Here is a question from Adriana Rodriguez at usa today. Is it true pain relievers like tylenol and ibuprofen used to manage Covid Vaccine side effects can prevent the vaccine from working to its True Potential . Dr. Schochspana dr. Beyrer there is no Clinical Trial evidence of that. It has been known in pediatric vaccines that you can sometimes lower vaccine efficacy with premedication. What is being recommended now, particularly for the first dose, but also the second, to try and manage those symptoms, but it should be pointed out that in the efficacy trials we have, and the moderna and pfizer trials, no one was prohibited from using antiinflammatory medicines like tylenol or ibuprofen, if they felt the vaccine side effects were severe enough it would require that management. Those efficacy trials had 94 and 95 efficacy. We dont have any empirical evidence, but we are encouraging people not to premedicaid before getting the vaccine. Ellen thank you. Another followup on a different topic. What are the pros and cons of a lottery system for Vaccine Allocation during phase two after priority groups in phase one a, b, and c have already been vaccinated . Dr. Beyrer we are in a period of scarcity where there is more demand than there is vaccine and there will be for many months. The best estimate is we probably wont have enough vaccines for every adult who wants one of this country until probably june, maybe july. Vaccine scarcity will continue and people are using lotteries because they are seen as more just and fair. There certainly is an argument for that. I would say in major con argument for what monica has been saying, often if you leave it up to a lottery, there are all kinds of people who still end up being excluded, people who dont have access to a computer, people who dont have access to a car, if you have to use a lottery but still have to drive to the vaccine site. And there are whole segments of the population with lower immunization rates, and we want to achieve a