Thank you for joining me for covid19 and a responsible rx supply chain, a look at the prescription chain during a global pandemic. Id like to thank our sponsor the Health Distribution alliance for support of todays program. The pandemic has upended our lives and forced a new normal upon us. While accommodations can be made for our lifestyle choices theres little likability when it comes to our healthcare. When patients for chronic diseases have access to regular medication it isnt a choice and in some cases its amatter of life and death. Both the Healthcare System and patients have changed their behaviors. As a consequence concerns and fears have arisen surrounding drug availability and shortages. What are stakeholders doing to ensure disruptions do not occur and theres collaboration between the public and private sectors and what plans are being put in place for distribution of this corona vaccine once it becomesavailable . We discuss all of this with some of thesmartest minds in Health Policy but before we get underway , you can tweet us at the hill advance, thats altogether. In the hashtag, but hell rx supply chain. Hell rx supply chain, where well be taking a question through the program and i look forward to. If youexperience trouble with the live stream , refreshing it will work i hope. My first guess is Health Expert on the front lines in the implementation of the Affordable Care act. Governor, secretary kathleen civilian served as health and Human Services secretary under president obama and is the ceo of severely are resources which provides resources to investors and nonprofits and shes my go to person when it comes to issues of knowing what a smart Healthcare System looks like so kathleen, great to see you. Lets get to thepoint. You oversaw many of the institutions that we are now looking at today to help save this country whether its pushing the time curve or developing a vaccine and distributing it, whether its on how you approved various dimensions of this in therapeutic. What would you say is going well , what would you say as a fan all its good to see you stephen. I dont think theres any question that the socalled operation warp speed, having the United States government that on the number of possible vaccine candidates for leon push pipeline has really accelerated the possibility of getting a vaccine for a brandnew coronavirus faster than people could have anticipated and thats, that will be beneficial to the United States citizens and hopefully to the rest of theglobe. I say that collaboration, cooperation looks very good and the early investments makes sense so far not Companies Really are drilling down on massive Clinical Trials and looking at safety results and hopefully competing to get to the starting line 1st so that we can have a number of effective, safe vaccines in record time. The various bad news again, speaking with just the Vaccine Development is that 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 really have discouraged a lot of americans from ever volunteering to getthe vaccine , ever believing that it is safe and effective. So that is really nothelpful. Communications , strategies, clear effective scientifically based communication on the start is part of any Public Health crisis about any Public Health recovery and tying the vaccine to his political election which President Trump has done for months and months, suggesting that there will be an october surprise, there will be an effective vaccine before the campaign, there will be something coming out makes people feel like its being rushed and we are not on track for safety and effectiveness, we are on tracks from some kind of political gimmick andnothing could be more harmful. To the confidence that were going to need for a massive Vaccination Campaign and so that has some good pointsand bad points. I would say in the rest of this coronavirus response, weve seen much of the same. Public science which has evolved over time and scientists have learned more and collected themselves when they learn more. Undercut consistently by the white house, who has a very different agenda in mind, not Public Health and safety but getting the economy back running as quickly as possible, regardless of the depths, regardless of the disease. So weve had a Point Counterpoint in the United States and i think the clearest indication of that is Johns Hopkins in the fall of 2019 gave grades to countries around the world or pandemic readiness, 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 have had i think quite simply the worstresponse for any developed country in the world. You were featured recently, you were one of the stars in a new movie called totally under control which profiled the response thus far in responding to the pandemic, managing everything from operation warp speed to other dimensions of this and myquestion is the real heroes that pop out in the show , some governors that are , were issuing ppe, companies stepping up and part of the discussion today is around apply chain and the coming drugs and therapeutics and whether americans can have confidence that there is an infrastructure out there thats dependable enough that they can have confidence and faith in, regardless of the leadership and i wonder how you can see that because you sauce saw state competing with each other over masks and gowns and im wondering when a vaccine rolls out,will we be able to have the confidence it will be wellmanaged . We would only have the confidence if we have a National Plan and i think its clear that the current president does not want a National Plan. He has pushed every issue onto states and sometimes into the private sector in a way that is not transparent to anyone and puts burdens i would say onstates as a former governor that they cant possibly achieve. So ppe is a great example. Rather than the United States mobilizing efforts through the defense production act to make more stock in america, to get it ready to go, or to use their incredible purchasing power and previous global contexts to purchase ppe and then distribute it on a fair and equitable manner, use the Defense Department logistics to make sure that equipment and machinery was at the right place at the right time , that we had everything from a virtual inventory to where there were extra beds to where there were personnel, the federal government under donald trump washed his hands of it and said its up to the states. So states competed against one another, states competed against their own health system. Often ive heard told many stories about states or a Major Health System organized supplies only to have the federal government confiscate it at the border and put it into the stockpile and then have the United States say the stockpile isnt for the states, its for us, whoever us is so weve had a totally misguided and inappropriate response. We need a National Plan in place right away. We will only get that i would say with the new president who has made it very clear that he will have a National Plan. And for Vaccine Distribution, for vaccine integration, for vaccine can indication we need that National Plan to start right away. People have to have confidence in the safety and security but beyond that we need some transparency. Where is the vaccinegoing . How will it be available . Who gets it first . That whole effort has been pushed to the states. States are submitting plans but we need a National Strategy for how this is going to roll out and how we can have confidence in when the fda says we have a safe candidate that that has not been pushed ahead, shoved add or that the guidelines for the fda which have always been the Gold Standard in the world have not then shortened or rushed due to political pressure. I cant even think of the number of Business Leaders, pharmaceutical Industry Leaders, scientists i talk to since this pandemic began and one of the interesting things is while you saw a lot of society frees up and get worried about drug therapeutics etc. , the other side of it is a lot of the companies beyond political control bent over backwards to make sure there were eventually no shortages of supplies so asking whats the right way forward, in a few minutes im going to have to representative melissa slatkin on. She passed legislation on strengthening americas stockpile and as somebody who had heard you what the private sector is doing, what the government needs to do but what are some of the parts of the skeletal structure you think we need to ante up rather than the national thathow you look at the ecosystem and what you think is wobbly right now that needs to be shored up . I think its going to be hugely important steve to do a really indepth after action report. We did that after h1n1 and found we didnt have sufficient manufacturing capacity for vaccines so new contracts were left and you know i think triple the Production Capacity. Thats good news. I think putting back in place the responses, red flags of the National Security within the white house are going to be critical, but i think we need to figure out what of the protective equipment supplies and gowns and gloves should we actually make your in the United States. What makes sense. How we have Production Capacity here to deal with a global issue and everybody in the world is trying to find equipment and supplies at the same time. I think going to need renewed confidence in publicprivate partnership. Pharma has really stepped up but what we know about stockpiles and particularly stockpiles for therapeutics and vaccines is unless the government has a pot of money and says to pharma, its worth your time to invest in the science. The manufacture these and bring them to development, if there isnt a willing buyer, it doesnt happen. Were facing a possibility of Antimicrobial Resistance to antibiotics. We dont have a bigpipeline of antibiotics in this country. Thats an example where with a government pool of money that happens after 9 11 and we have massive resources for making sure that america was safe and secure which means some of the supplies that will be developed are never used hopefully, are never put into action but you have been in place if something happens. We need to be willing to fund proactively in and not reactively. Real quickly, on ascale of 1 to 10 , how, with one being best how bad was the administrations response to covid. I think its bad. I think the deaths 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 much more quickly and tell people the truth and really take the steps to secure the most vulnerable populations so i think were at about anine. Maybe we can recover some territory with Vaccine Development and distribution, but there is no reason in the world that we should have had this many deaths and now we still have almost 1000 people a day dying and the virus, if im in the middle of the country in a rural face, the virus is raging here and its raging in communities that have almost no capacity to deal with it because there isnt the equipment and there isnt the personnel. Secretary kathleen sebelius, im grateful every time we talk but itssobering every time we talk. Thank you for joining us and helping us launch our program. Thank you for having me. Our next guest believes stockpiling medical supplies is an issue of real National Security. Congresswoman elissa slotkin, a democrat from michigan is running for election and joins me right now. I cant tell you how grateful we are for all the stuff you have going on but i know this is a priority for you and its a priority for the country so lets be pointblank, whatsbroken that needs to be fixed . A lot of my experience in sort of the worst of it in march and april really came down to the fact that it seems like medical supplies, pharmaceuticals, just major supply chains that help keep us safe were just so outsourced to places like china we couldnt get a hold of them when we needed them and my experience in the pentagon and the National Security world, it kind of blew my mind that while we still have a preference for making things in america on our military equipment, our body armor, our meals ready to eat, we didnt have the same by american requirements on other things like medical supplies and pharmaceuticals. Obviously the stockpile, we opened that up and a lot of it was expired. Here in michigan we got moldy stuff, a lot less than what we were expecting so we have to make sure theres a better way to stockpile equipment. When we need it. And then in general i think it really combines my National Security background with sort of major american manufacturing. And here in michigan weve been saying for 30 years and if you outsource too far, youre going to get caught with your pants down at some point and i feel like we did. If im haggling with a chinese middleman in the middle of the night for a . 78 mask, something has gone wrong so thats been the focus of our work since basically april. Where does your legislation now, i just mentioned with secretary sebelius, strengthening americas stockpile, i talked to other leaders in pharmaceutical production and they been talking about people who can identify that 100 top most needed therapies and medicines that are out there. And figure this out, that its doable. Where does this stand now . Its a series of seven bills, completely bipartisan. 10 democrats, 10 republicans, built purposely bipartisan. They all passed the house in september and now were in negotiation to have them in the next covid package, this thing that mnuchin and pelosi have been struggling to negotiate. My hope is once we get past the election were able to get something done. Ive been frustrated we havent before the election. And its something that frankly we should be moving on now and the biggest part of it is this 500 Million Pilot Program for publicprivate partnerships. On extra lines, particularly extra pharmaceutical lines for the very thing you were mentioning. When we need to serve and go the American Government has an interest in being partners on additional surge capacity. So thats the part im most excited about. Have you talked to Industry Leaders . How do they feel in terms of their partnership with government and in terms of what they know is going to be a big lift, a big load of new vaccines and therapeutics thats going to have to be deployed to every corner of the country. Are you finding them to the robust partners . Is it a good track or doyou have concerns . We have one of these companies that now being sort of at the ready for when their vaccine is identified. Theyre readyto go and ramp up in production in my district. But weve been talking to them and others about everyone talks about manufacturing more in the United States , but you have to make sure youre talking to the industry to figure out what truly incentivizes people. You cant just decide from washington that you know whats going to bring manufacturing back. We had such a globalized supply chain. We had such an ecosystem that theres a ton of things that come from all parts of the globe and its more thanjust saying come on back. What i want to do is hear from our Business Leaders and i was in this great group called Business Executives for National Security. If done and after action on our supply chain and i was one of the members of that commission that looked at it. Youve got to talk to the leaders and industry to figure out how you properly incentivized production in the United States. It cant be made up from washington. One of the things i wanted to talk about is your cia background, yourbackground as an analyst. I happen to talk this week to rick bright who was the bar to official who said that he was pushed out of that job, he recently came in and he said something and its on alex gibneys new show on the crisis called totally under control that i didnt realize and a lot of people look back to a playbook that was developed during the obama period that was on the shelf gate data simulation. You did simulations in the cia and you did exercises in october 2019 that anticipated this kind of pandemic that looked at all the government responses, that looked at partnership with industry and actuallyunderscored the very weaknesses and decisions that we saw. Is there any awareness that that playbook, not a playbook but that the sim