This toolkit tackles one of the most pressing topics in the world: how you will get your COVID-19 vaccine and when. Get answers about the science from Dr. David Agus, and the logistics from CVS Health’s Tom Moriarty. Andy asks them your questions about when you can get it, which one you’ll get, and more. Plus, a fun little bit of vaccine history from David.

 

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

 

Follow David Agus @DavidAgus on Twitter and on Instagram @davidbagus.

 

In the Bubble is supported in part by listeners like you. Become a member, get exclusive bonus content, ask Andy questions, and get discounted merch at https://lemonadamedia.com/inthebubble/

 

Support the show by checking out our sponsors!

• Livinguard masks have the potential to deactivate COVID-19 based on the testing they have conducted from leading universities such as the University of Arizona and the Free University in Berlin, Germany. Go to shop.livinguard.com and use the code BUBBLE10 for 10% off.

 

Check out these resources from today’s episode: 

• Learn more about how the CDC is making COVID-19 vaccine recommendations: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html
• Find out (approximately) where you stand in the line for the COVID-19 vaccine with this tool from The New York Times: https://www.nytimes.com/interactive/2020/12/03/opinion/covid-19-vaccine-timeline.html?referringSource=articleShare
• Read more about CVS’s plan to distribute the COVID-19 vaccine to nursing homes: https://www.nytimes.com/2020/12/02/business/covid-treatment-CVS-nursing-homes.html
• Pre-order Andy’s book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response, here: https://us.macmillan.com/books/9781250770165

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-the-bubble shortly after the air date.

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia. For additional resources, information, and a transcript of the episode, visit lemonadamedia.com.

Transcription

SPEAKERS

Reagan, Andy Slavitt, Tom Moriarty, Dr. David Agus

Andy Slavitt  00:06

Welcome IN THE BUBBLE. This is Andy Slavitt. The most exciting episode so far because we are one week from vaccines rolling out across the country, can you imagine? Less than 11 months ago, we hadn’t even sequenced this thing. We just learned about this thing. The vaccine was done in March. And then we just basically been making sure it works. And looks like it works. So your question, how do I get it? What do I need to know who gets it when? Where does it come in? How’s get distributed? You ask many other questions. And that’s why we have a toolkit episode for you. We have two people, Tom Moriarty, who is from CBS. He is the Chief Policy and External Affairs Officer, and the general counsel. Super good guy, I think you’ll really appreciate the work when I heard the work that CVS has been doing, and he’s speaking on behalf of CVS, but also the many other pharmacies and other distributors around the country. And in the bubble, favorite David Agus, and he’s one of my favorites, too. He is a doctor at USC is one of the leading cancer doctors in the world. He’s founded several personalized medicine companies, he has been intimately involved in the data that’s been going on with these clinical trials on vaccines, he was on our vaccine episode before, you may want to go back and you can listen to it. He, by the way, predicted pretty close to where we’d be when we would be there on that show. But let’s get these guys on Tom Moriarty and David Agus. Let’s get you your vaccines.

So we have time, Moriarty, from CVS. And David Agus. Back to our show, Dr. Agus, you guys can introduce yourselves a little more in a moment. Although I took care of that in the intro. I’m so pleased to be able to have this episode. It’s an amazing sign of progress that we received the genetic sequence to this pathogen, January 11th I believe it was, and we are now possibly within a week or so from putting actual vaccines into people’s arms and soon millions of people. And so you know, we’re gonna use this toolkit episode, really to answer your questions about how it’s gonna work. And we’ve got great experts on it. I’m really pleased that David and Tom are both on so. Hi, Guys, and Welcome. Thanks for coming back, David.

Dr. David Agus  02:40

I am glad to be here. always glad to work with you. Although you look a little strange, but the glasses I have to say.

Andy Slavitt 

the glasses on the forehead?

Dr. David Agus  02:47

Yeah.

Andy Slavitt

Yeah, that’s I think a sign that I need a new prescription. Maybe I’ll head over to CVS. How are you doing, Tom?

Tom Moriarty 

Very well. Thanks for having us, Andy. Appreciate it.

Andy Slavitt 

Great. People just started to very high level. Dr. Agus. I’m gonna call you David just because unless you object to call you then you

Dr. David Agus

You are welcome to I like it a lot better than Dr. Agus.

Andy Slavitt 

Okay. Just give us a big picture. Here we are. We’re entering December. Where are we in terms of vaccines and the vaccine roll out and give us a sense of the process. And what’s ahead.

Dr. David Agus

You know, man, it’s been vaccine Monday, really the last three, Monday’s we’ve had three different vaccines announced data, that I think all of them exceeded expectations. You know, the remarkable thing to me is that vaccines started in the march timeframe, you know, the vaccines didn’t get any better. It’s not like writing code for a software program where you can make it better every week, or you can iterate on a product. The vaccines were their final version in March. And now we are the end of November. And we finally have enough data that they work. So they clearly blocked you from getting the virus. The key question that was just answered on Monday was are you infectious when you’re asymptomatic from the virus? And the answer is no. And that was an enormous step for which means the duration of the pandemic will be shorter than we thought. And science is going to win here because it’s three vaccines, and they were all manufactured at risk. So it’s three major supplies a vaccine becoming available in December, not just for the US, but for the globe.

Andy Slavitt 

So we saw that point you just made about the vaccines preventing you from being infectious with the Oxford AstraZeneca vaccine. Do you conclude that because of that the other vaccines are also likely to not be infectious or is it just clear for the one?

Dr. David Agus  04:43

So what Oxford did was every week they swabbed everybody in their study. And so that way they know were they infectious or not. Could you find virus by PCR or not? And that’s how they got their answer. The other studies did not do that. That was not something that was done in studies in the United States, but Since they all target the spike protein, and they all are getting similar antibody and T-cell responses, we can assume just like we assume when we got the Pfizer data, they’re all going to show benefit. And we were right, I think we can assume the same here is that they are blocking people from being effective. It’d be nice to prove it. But I think we have that assumption now, remember how vaccines work is they present that spike protein to your immune system, and then your immune system makes a response against that spike protein, which is required for the virus to get inside the cell by human cells by binding to the h2 receptor.

That immune response carries over if you’re exposed to the live virus and doesn’t allow the virus to get in. So you would assume pretty much that they would work. And in fact, they did. And they showed safety. Almost every vaccine in the history of humankind has shown its side effects in the first few weeks and the first few weeks with these vaccines. There were no serious side effects that were lasting in any single individual secondary to the vaccine.

Andy Slavitt  06:00

Is there anything about the vaccines that are different that you want to point out in either in terms of dosage? Or I think some people know that there’s some vaccines that are on something called an mRNA platform, and some that aren’t? Is there anything that’s useful for people to understand about the differences in these vaccines?

Dr. David Agus

Yeah, I mean, they are different in many respects, RNA vaccines are the instructions for your body to make that spike protein. And they’re new, they’re going to be exciting when they’re validated in that all of a sudden, we can quickly turn around and make it to any pathogen. So that part is really encouraging. But we don’t have with RNA vaccines, his long-term data, because they haven’t been around for long term. And these will be the first ones that will be available for mass use in the country. The Oxford vaccine is making on a version of Adenovirus has his backbone, the same one that was used for the MERS vaccine. So there is a multi-year history with that vaccine. And so we do have long term safety data. All three I think are encouraging. It was the right decision for our government to do at risk manufacturing. And we’re going to benefit now, because these vaccines will be here months earlier, had been had we not done this at-risk manufacturing.

Andy Slavitt

Great. So before I go talk to Tom about the last mile, where CVS is going to be helping us get these vaccines into our bodies. Can you give a general overview about the philosophy and the approach to vaccine distribution? How do we go from a whole bunch of vaccines sitting in factories or warehouses or wherever they sit? Maybe your basement or somewhere? How do they go from there? What’s the general philosophy of getting them out to the rest of us?

Dr. David Agus

So the first step we did we validated the vaccines are safe, and they work. The second step is manufacturing. And we still are not fully there on the manufacturing side, which is why we’ll talk a little later, I’m sure but how many doses are available. It’s not enough yet for the whole country. Then the next is putting them into a bottle and shipping them which is not as simple as it sounds, what size vial you use do you do one dose, do you do 10 doses, do you do 100 doses in one vial, and then distribute it the RNA vaccines have to be distributed at a very cold temperature minus 94 degrees fahrenheit for the Pfizer vaccine and Pfizer is going to go its own distribution, not through Operation Warp speed, using a hell of a distribution partner called Federal Express. And so this is unprecedented for a number of reasons. One, it’s a two part shot these first three vaccines, day one and day 21 for Pfizer, and AstraZeneca, day one and day 28 for the Moderna vaccine. Second is not like you know, a polio, we could stand in line and wait to get it.

08:39

Here we don’t want people standing in line because you could spread the virus. So it really is a unique challenge where you want people to come on time you want to do large volume, the Pfizer vaccine, for example, is being shipped in thousand approximately thousand dose containers. So you have to do the whole thousand doses in a day basically, or the vaccine can go bad. And so you need to have a large volume place to do that. Most hospitals in the country are filling up now. So what it means is a couple months ago, we plan to distribute a lot of them at hospitals where they’re filled up, when their parking lots are full, they can handle several thousand extra cars and people a day. So we have to transition and the CVS is of the world are our saviors. And we are really relying on them to come through no pressure on you at all times. But we’re relying on them as a society for them to come through. And I think they will. I mean, I don’t think that’s going to be the weak note. I think the weakest node right now is getting from where they’re being manufactured. And getting to the CVS is to be able to do it. And then the scheduling part also really hasn’t been tried and tested for this many people.

Andy Slavitt

So Tom, maybe you could start with how CVS and others got involved in the project, what work you all have been doing to prepare and a little bit of an overview of how you see it going.

Tom Moriarty

Sure, so Our environment really started when the onset of the pandemic. So, Andy, it started first with COVID-19 testing and really launching that on a on a broad scale across the country and working with the administration to governors and state and local officials across the country, to bring testing into communities because I was going to be your first really critical thing to get right. But also, you know, what David said, I think is really important. The Public Private Partnership here across the board, whether it’s on the vaccine development, the manufacturing, and now in the distribution administration, the focus has been placed on this over the last six plus months has been real, this has not been the last two weeks kind of conversation. We have been kneeing deep in the planning and the production and the rollout of this with the Operation Warp Speed Team, with HHS, with the governor’s and their public health departments.

Tom Moriarty  10:55

And so as you look at the reach that CVS has, and frankly, pharmacy has, across the country, we have some 10,000 locations, many folks are within less than three miles of a CVS, we also have the ability to take these into underserved communities with technology and capabilities that we’ve put together to deliver vaccines, both flu and others into these underserved areas. So I give credit to our public health officials for recognizing the important role that pharmacy can play and needs to play here, we’ll have some 100,000 health care professionals available to administer vaccines once they’re available across the country. So that’s the kind of scale that we can bring. And then the other thing that’s really important on this, because you’ve highlighted the second dose and the booster dose, it has to happen here, the scheduling systems and the follow up tracking systems to get folks back in for that booster dose is going to be hugely important.

So we’ve developed you know, an app on your phone, that will allow you to schedule your first appointment. And while you’re scheduling that first appointment, you’re going to schedule your second appointment for that booster. And we are going to give you the card to remind you, we’re going to send you text messages we’re going to call you, we’re going to do everything within our power to get you in for that booster dose. Because getting both doses is going to be critical for patients and citizens across the country.

Andy Slavitt  12:19

So how will you notify me? Or how will I know whether or not it’s time for me to get a vaccine? And as David said, there’s not enough for everybody, everybody can come at once anyway. So you know, here I sit, maybe I’m two miles from a CVS,

Dr. David Agus 

what David did and said that the supply.

Andy Slavitt

David wanted there to be more. But the supply said, but as David pointed out to us, we’re not going to be able to get it at once. Even if we could, Dave makes a great point about the fact that we need to not all jam ourselves into a CVS store or other place. And if you might, maybe you could also say, besides CVS, were the kinds of places that people are going to be able to go to get a vaccine, and then maybe help us understand how people will be notified that it’s time for them to go get one.

Tom Moriarty 

Right. So the prioritization of who’s going to get the vaccine and when is going to be set by the CDC and ACIP

Andy Slavitt

Could you tell what ACIP is?

Tom Moriarty

It is the committee essentially on Immunization protocols and practices, David will know the full, it’s within the CDC, it’s a committee that makes the decisions on who can be vaccinated and when.

Andy Slavitt

good enough, perfect.

Tom Moriarty 

And so they have a very important meeting December 10 to 12th. That is currently scheduled that will likely come out with the full prioritization as to who gets vaccinated and when. What we do know is that the first two phases of this is going to focus on healthcare workers, and other essential workers that are defined within that first wave. And then wave one B, if you will, will be folks in long term care facilities, skilled nursing facilities, and assisted living facility so our most vulnerable seniors, and that rollout will start immediately after the first approval within 24 to 48 hours. We’re working with the states as to how they want to prioritize and where folks can go after that first wave and it’s more of supply and becomes available, then you’re going to work your way down the prioritization list that CDC has established.

Andy Slavitt 

Got it. So let’s say I’m a nurse. I live in Baltimore, Maryland, and Maryland, gets its doses. Will the governor of Maryland and the State Health Commissioner sent out a notice will I contact you would CVS contact me? Any idea how people will be alerted?

Tom Moriarty

Yeah, so again, breaking it into the two primary populations for the first wave in long term care and assisted living, HHS contract with CVS and Walgreens to take care of those populations. So the long-term care facilities assisted living facilities They have signed up with CDC as to who they want to administer for them whether Walgreens or CVS. So we will be given those names and we’ll start coordinating when we’re given the go ahead to get those scheduled with those facilities, in terms of the health care workers through the states, they will be advised as to who will be administering and where and when, and where to contact and how to schedule those. We will be doing it for a number of states. And we’re still working through whether it be across all 50 states for those health care workers.

Andy Slavitt 

Got it. And do they come to a CVS store? Or do you go somewhere at a different site, what’s typical?

Tom Moriarty 

So for the non long-term care and assisted living, because we will go there to administer on site, you will be coming into a CVS Pharmacy for these. And we will as more supply becomes available, we’ll be doing something very akin to the flu clinics that we do, which are larger scale vaccination clinics, that we have an awful lot of experience doing over the last number of years.

Dr. David Agus  16:00

You know, the issue is going to be it’s not, you know, while the ACIP American Committee on Immunization Practices recommends this, the states can do what they want and make their own hierarchy. And that’s, you know, in a sense, the scary part is they’re allowing states to make it. I saw last night that Hawaii State recommendation, it’s over 230 pages, the Hawaii plan on who gets it when, first of all, you know, you could read two or three pages and you’re sound asleep. It’s a little scary to me multi hundred-page recommendations per individual state, and then coordinating with the CVS and others of the world. It’s not a simple step.

Andy Slavitt

So the places where this could bog down. And look, we should acknowledge, I think that this is being done with as you both have said incredible speed, incredible coordination. And people want this done without delay. But little snags will happen. They may happen in one state and that another because this is a lot a lot of stuff to do. But it sounds like vaccines have to get from the manufacturer over to the storage. It sounds like Federal Express in the instance of Pfizer and is McKesson doing the distribution, Tom? To the pharmacies.

Tom Moriarty

McKesson is doing the non-Pfizer product.

Andy Slavitt  17:20

Okay. So for those who don’t know, McKesson is a very big distributor of pharmaceutical products. And this is sort of what they do. And of course, the US Army is involved in logistics. But as David said, it sounds like a GOV and a state health department also is going to have to play a role in making these decisions. And so we’re gonna, we’re gonna have to observe how that works.

Tom Moriarty 

To David’s point. So at the press conference this morning with Secretary Azar, and Operation Warp Speed, they announced the states have been given their initial allocation number in terms of the first wave. So the states now by a certain date will have to advise what populations are going to be getting those and then pick the partners they want to actually administer for them on that first allocation, and long-term care assisted living may be in that phase one a, some states may want that they may want the allocation simply to be for health care workers and other essential workers. So that’s where the kind of the state-by-state approach can get pretty complicated.

Andy Slavitt  18:23

And now, for something we like to call advertising.

Andy Slavitt

The first question we came in was, I think one of my favorite questions that was so simple. When can I get it in time, you’ve already done a good job of explaining that it sort of depends on who you are. And David, you’ve added sort of, also depends what state you’re in, because the states may do things differently. But I believe that the warp speed folks have estimated that by the end of January, that there’d be 50 million people, which I assume, because I’m very good at math is 100 million doses. See how I did that, David?

Dr. David Agus

Very impressive

Andy Slavitt 

I can walk you through it. So that there’d be 50 million by the end of January was an estimate. Does that seem close to real or close to right to both of you?

Dr. David Agus

if we do this correctly, and that that did not take into account AstraZeneca. And when that was made. And so that number can be up by 10s of millions of people, assuming AstraZeneca gets an EUA from the FDA, then I think we are under estimating and we could actually be in the 80 million range at the end of January.

Andy Slavitt

Wow. So between the middle of December and the end of January, how many people do you estimate Tom will be in a CVS? Recognizing that as you said, if you’re in a long-term care facility, you’re not technically in the CVS, but how many vaccines? And how does it look? How did the logistics of all those people work?

Tom Moriarty

Yeah, so it’s a great question. And we’ve done an awful lot of work around this. So we estimate that we’ll have capacity to administer anywhere between 20 to 25 million vaccines, vaccinations a month. So that’s a capacity. And as David is indicated a lot of this supply, supply reliant in terms of how we scale up and how quickly we do it. But there will be capacity in the system to administer a large number of these vaccinations very early on if supply is there. So, again, if you assume this supply rollout that’s been talked about, and an additional manufacturer to coming in April or March or April, you can see certainly by the middle of the year, the bulk of the population having been vaccinated.

Andy Slavitt  20:39

Wow. Okay, here’s an email from Louis and Kane. She says is it safe to assume that the public will not be making a choice between vaccines, i.e., we’ll get whatever vaccine is sent to our geography.

Dr. David Agus

But this is like, you know, when I tell my kids, you get what you get it, you don’t get upset. I think it’s going to be your own decision. You could say, I want to take an RNA vaccine, or I want to get the AstraZeneca vaccine, I think every city is going to have vaccines and it may be easier to get one than another, you may be able to get one on a quicker timeframe than another. But certainly nobody is going to say you were only able to get vaccine x or y or z, you know, you do have autonomy here and you can make your own decision in this regard. That being said, I think it is going to be pretty chaotic. And it will be a rush. I mean, I saw in Colorado yesterday an In and Out Burger opened and there was a 13-hour line at an In and Out Burger. I can only imagine what’s going to happen with vaccines come.

Andy Slavitt

Those fries are good, though. So question is from Michael, once we get vaccinated and get the subsequent second shot, assuming that it’s either Pfizer or Moderna, although that’s true with AstraZeneca as well. Will we be safe to be outside without masks and around people? Or will we need a certain amount of the US to be vaccinated? First very intelligent question, David, what do you think?

Dr. David Agus  22:06

I think it’s no question is that we have to wear masks until we get toward herd immunity. And I think that’s clear. I think when you immunize 100 people, I think a good portion of them will not get the virus and not be contagious if they’re exposed, but not all of them. And right now, we estimate about 7% of the United States population will not respond to a vaccine, they have autoimmune issues to cancer treatment and others. And we have to protect them, the way we protect them is getting toward herd immunity. So if you look at vaccinations plus who has previously been exposed, and probably has some immunity, we’re going to need to vaccinate in the mid 70% range of the country will get us to in the mid 80% range of herd immunity when we do that. And I think it’s the only way possible. And then we can relax some of the things on mass and go to what Asian countries do is you wear a mask when you’re sick. So you don’t spread the virus for others, we have to start caring about others in our country.

Andy Slavitt

Yeah, that’s a long order. But you’re absolutely right about that. Tom, do you want to add anything or otherwise I’ll play a voicemail.

Tom Moriarty

Just to the point of you know, the vaccine choice, because I think that was something we were very focused on and concerned about, until we knew the efficacy levels that have been reported, because you were worried that one might be 95 effective, and the other one only being 70. That would really lead to it. The fact that they have relatively similar advocacy, and they’re both a two shot, that whole issue of choice, I think becomes less of a consumer issue than it may have been in a situation where you had different makeups of the products.

Andy Slavitt

And there’s the same thing true with I don’t want to say safety, I want to say with the sort of side effect profile and that, you know, I think we just heard it was either Fauci or the CDC say that, that there might be the feeling people might get a slight flu. If they take one of these products, is that universal for all products? Or what did you expect there to be differences?

Dr. David Agus

Yeah, I mean, every vaccine, you have the potential of getting a sore arm, getting fatigue, getting chills, etc, all of which are reversible in 24 to 48 hours, it’s your immune response. In a sense, when you get that you cheer, because your body is making a very potent immune response that is going to protect you from the virus. And the big question is, do you want that inflammation in your arm? Or do you want it in your lungs and your heart? any day of the week? I think every citizen in this country will say I want it in my arm where it’s not going to cause any long-term ramifications. It is as simple as that.

Andy Slavitt  24:33

That’s a great way to think about it. And so you wouldn’t, you wouldn’t recommend people shopping for vaccines, because of the likelihood of that response.

Dr. David Agus

There’s no data that one is different than another in terms of side effects, you know, short term side effects, immune response, what we do know which is kind of shocking is that the older you are the less side affects you get from these vaccines.

Andy Slavitt

Whoa.

Dr. David Agus

And it probably has to do with some coronavirus, prior exposure, you’ve been exposed to other things, but you have less of a fever, chills, fatigue, etc. You’re so young, you’re gonna have issues but the rest of us because we’re older, we’re not.

Andy Slavitt 

I’m so lucky I actually just had a birthday. That is awesome for me. That’s great news.

Dr. David Agus 

Happy birthday.

Andy Slavitt 

Thank you. If I hadn’t had the birthday, I’d be a little more worried. But now I’m 54. Okay. All right, I would play a voicemail.

Calling In

Hi. Specifically, I’m wondering if the volume of vaccines that are to come, we’ll be absorbable into the current supply chain for vaccines, we already receive vaccines that are frozen, maybe not deemed frozen. We also receive vaccines that are fridge. And I’m curious if that volume of current vaccines that is to come, however, hundreds, millions of those are to come if they will be able to get absorbed into the delivery supply chain of the current vaccine supply chain.

Tom Moriarty  26:13

So maybe I’ll start David on that one. The answer, Andy is yes to those questions. And let me let me walk you through all the work that’s been done around here. And it’s not just work over the last six months, it’s frankly work that’s been done over the last 15 plus years, you know, and the role that pharmacy can play in providing vaccines. So five of the six vaccines that are that are going to come ultimately to market. They all work with existing freezer refrigeration capabilities that exist today at retail pharmacy. So at all of our 10,000 locations, we have the freezer and refrigeration capability to deal with these vaccines. The Pfizer vaccine is the only one that’s different because of the Deep Freeze requirement in the transportation element of it. Pfizer is invested in new technology that are shippers that allow them to be in dry ice and stay stable in that dry ice for an extended period of time, when they’re at the location. They also have data that for five days, they can be within the existing refrigeration and freezer systems outside of that deep freeze that we have at retail pharmacy.

So as you look at the scheduling supply, that will happen here, these vaccines will be released based off a scheduled demand. And they will go into these pharmacies and an allocation that attaches to what will be used within the window that these vaccines can be used once they’re basically opened. And so this is well thought out. It’s the infrastructure is there. And again, that scheduling capabilities, what’s going to be really, really important to manage the flow of these vaccines.

Andy Slavitt

You give me the warm fuzzies, Tom.

Tom Moriarty

It’s Listen, it’s an it’s building off of existing capabilities and existing technology. The real difference here is that second dose that booster dose, and that’s where the ability to remind people and bring them back in within that window for the booster. That’s what’s going to be critical here to make sure that we’re successful going forward.

Andy Slavitt  28:12

How tight is that window? David? Really? Is it like got to be precise, or is there? Is there a little play?

Dr. David Agus

No. I mean, we tried it one way. I mean, there certainly were some halts in that trial. So there were people who were at 22, 24, 25 days when it goes on a weekend they were delayed. It’s not that tight. I mean, what we know is that you want a couple week window. And that’s what we call a prime in the immune system. If you do it too soon, you don’t get the benefit. But you can wait an extra couple of weeks. And we saw that with the shingles vaccine, right? It was, you know, Day Zero and month three, so three-month window, plus minus weeks and either end didn’t matter, and we had very efficient ability to do in the country. You know, what’s going to be unique about these vaccines is the coolest thing in the rolling you will love this Andy Slavitt, is that throughout history when we approve a drug at the FDA or a vaccine that day, we stopped collecting data. Going forward with these vaccines. There are mechanisms in place now that anybody can start to report how they feel and what’s going on. So we will collect data after approval, which you would say we should have been doing since the FDA was established and we have never really done. But the notion of using real world evidence is crazy powerful, and I’m glad we’re finally doing it.

Andy Slavitt

That’s great. That is great. I do love that. I’m going to play another voicemail.

Reagan 

Hi, Andy. This is Reagan in Charleston, South Carolina. My question is about vaccines for the broader population, including children. So I know there’s a timeline for adults to get vaccinated and hoping that over the next six months the majority of adults should be able to receive that. How will teenagers and younger kids get vaccinated and will they need to be vaccinated if enough adults have been vaccinated in order to go back to school, just trying to figure out how to get to some point and herd immunity. Thanks.

Andy Slavitt  30:08

Very smart question from Reagan. David, you want to go first?

Dr. David Agus

Yeah, it’s a great. I mean, it’s a great question. Listen, my son, who you last saw when he was literally like months old, and is now a junior in college was told he can only come back in the fall if he has a flu shot. And I think what you’re going to start to see is universities, you’re going to say, Hey, listen, you cannot come back. Unless you have a COVID vaccine Live Nation. You know, the biggest concert provider in the United States said, you can only go to a concert if you have proof of vaccine in the future. And I think that is crazy powerful. And I applaud them for doing that. But I think what this question is also alluding to is that the clinical trials really did not focus on young individuals, young kids. And so you know, they didn’t have not vaccinated six-year old’s, five-year old’s, four-year old’s, that data is being started. Now, the notion in the United States with regard to experimentation, and it makes sense is do it on adults first, we can tolerate side effects more. And if it’s totally safe, and adults, we then go to young children. And so that’s happening now. So young children will be the end of the chain in terms of vaccinations, but it will be critically important for herd immunity, that they are vaccinated.

Andy Slavitt

Teenagers, are they in the adult category, or they are the children category?

Dr. David Agus 

You know, it’s kind of like their different age cutoff, whether it be 12, or 16, depending on how you look at it. But certainly anybody under the age of 12 will be in the later categories. So get your fake IDs kids and get in line at CVS with fake IDs,

Andy Slavitt 

I see that happening in the CVS guys are very typically sent pretty well.

Dr. David Agus 

So instead of alcohol, to get a vaccine.

Andy Slavitt

Don’t go anywhere, we’ve got to go earn some money to donate to charity.

Andy Slavitt  32:00

I know that health care workers This is from Gil Williams, and other health care workers will take priority for first round vaccines. What’s the likelihood that educators, i.e. teachers will be high up on the list of priorities? I feel like the push to get kids back in school should correlate to giving a priority to teachers and educators. After health care workers. I’m wondering if Jill’s a teacher? Does anybody know? I mean, this is a state decision. It sounds like

Dr. David Agus

Certainly, when the ACIP and others come out of the recommendations, teachers are very high up and listen, they should be they are risking their life, their health to help other family members through their job, which is educating children who could be vectors of the virus. Just like when I see patients, I am taking a risk. So people who take risk and also see multiple evils they have the ability to spread also, they should be early in the vaccine distribution and by all inclinations, I would hope that every governor views it as such and puts them high on the list.

Andy Slavitt 

Great. Same question came in from Phil Myers about college and university professors. How do you feel about that one.

Dr. David Agus

Well, since I am a college and university professor, I can’t be an advocate for myself and all but. Yeah, I mean, there’s an anybody who is, you know, out there on the front lines, that is seeing large numbers of people a day and part of their job involves helping others or doing something for others where they take risk, they should be vaccinated first. They don’t have the ability of not taking that risk if they want to help others. So we have to enable society function like that. So frontline workers, whether you’re working at cash register to grocery store, whether you’re driving a taxicab in an airport, or a university professor, you are taking a risk to help others. And you should be vaccinated early in the process is what I believe.

Tom Moriarty

We’ve kind of test driven this prioritization, through testing, recall in the early stages, the pandemic, the prioritization of health care workers being tested, and then others. And so, you know, presenting IDs at the testing site became, you know, really important because you weren’t going to qualify, if you didn’t have the right identification, you’re going to see something relatively similar as you do the vaccines, with the populations being prioritized. And as David indicated, this is all supply driven, the more supply there is, the less of an issue, there will be around price prioritization. So you’re probably looking at six, two to six weeks to two months, where the prioritization becomes really important. And then as more supply becomes available, you know, it moves to more of the general population.

Andy Slavitt  34:31

That makes sense. So one way or another, we’re just talking about, you know, March versus May. We’re not talking about 2021 versus 2025. So hang tight, if you’re not a teacher, let the teachers get vaccinated. Don’t elbow them out. Someone wants to know, Allison Miller, I’m curious how they will determine high risk individuals, beyond the elderly, those in communal living facilities and those with immune specific conditions such as those inactive cancer treatments, etc. Additionally, how are authorities going to assess confirm someone’s high risk status? So there’s really two questions in here. One is this question about whether the ACIP and or the governors, how will they make those determinations of high risk? But there’s a second question, which I think is interesting and applies to a lot of this, which is, how do you confirm someone’s status? You know, someone comes in and says, You know, I am high risk here is why (inaudible) We don’t trust each other very much in this country, do we?

Tom Moriarty 

It’s a great question. And I mean, I don’t have the answers right now, because we don’t have the prioritization of who’s to come in and when linked with the availability of supply and how significant that prioritization is going to be. But clearly, in the first several categories, there will be some form of identification needed to show in order to get the vaccine to meet the prioritization requirement.

Dr. David Agus

I mean, obviously, the data will speak for itself. So we know medical conditions and their risk for complication or hospitalization from COVID-19. It’s very transparent there, there have been a number of studies published and you could look at that data. It’s on the CDC website. So that should be the hierarchy of need in that regard. Well put it a counterweight is that, you know, listen, the goal is to stop the spread of this pandemic, so much of the spread now is 20-, and 30-year old’s who are covid fatigue, why not just vaccinate them first and tell people who are they know, they’re high risk, stay indoors until we vaccinate them? Because then we stopped spreading the virus, we’re not going to do that. But I’m just putting that out there is that it’s not a simple hierarchy and how to do things here. You know, we’re doing it, you know, if you’re an African American, you’re higher risk if your diabetes if you’re overweight, if we can kind of go through the list here. But when you look at the data, close to 65% of our countries, 65% of our country of adults are considered high risk by these criteria, mainly because we are a very large country.

Andy Slavitt  36:53

Yes. I think I know what you mean by that. David, this is the most important question that’s being asked. It’s from someone named Jen Polander, it says will @aslavitt get priority, so we don’t lose our COVID info.

Dr. David Agus

Well, there’s a lot of talk about what to do with at @aslavitt part of the world says, Listen, let him talk about it more and more, because he’ll be educating and pushing if we don’t vaccinate him. And part of his said, We need him because he’s doing a good job. So we should vaccinate him early. You know, depending on which day different aspects are winning, and I think it’s going to come down to the end, and it may actually go for a recount. It is really tight at the present time.

Andy Slavitt 

Okay, Tom, I assume you have an opinion.

Tom Moriarty

I’ll defer to David as a medical expert.

Andy Slavitt 

Okay. Question from Joy. I wonder about how people who are typically highly exposed, for example, restaurant workers, but who now are out of work. Interesting question. So they’re not connected to an employer will be prioritized. I feel like they might fall into a gap is not essential. Yet, they do need to get to work as soon as possible. Really interesting cases here.

Dr. David Agus  38:07

I think you’re going to find lots of these nuances. And you know, unfortunately, we cannot be nuanced in how we do this. The hope is, we didn’t think we would have three vaccines to start with. So I think supply is going to be better. You know, the biggest problem is when you do a manufacturing lot of a vaccine, you never know what’s really going to come out. So we don’t know the exact supply next week, three weeks, five weeks, because manufacturing right now has been pretty variable. In fact, the first rounds of the AstraZeneca clinical trials, they actually dosed the patients incorrectly because they calculated how much vaccine was actually in the vaccine, how much you know, a spike protrudes in the vaccine? It’s harder to do you think? So the hope is these nuances don’t matter, right? I’d rather over vaccinate, if somebody tells me they’re high risk. I would just personally vaccinate them rather than spending the time the energy and arguing. I would just vaccinate rather over vaccinate and under vaccinated in this regard. And, you know, push as hard as we can to get toward herd immunity. I don’t want to go over in the nuances and say you’re a day early go home. It doesn’t make sense to me. I don’t know how you feel, Tom?

Tom Moriarty

No, I think it is. It’s a very interesting question. What I will tell you is, you know, in the agreements that we have signed with the federal government to administer these vaccines, we are obligated to follow absolutely the prioritization that’s set out by ACIP. So if you come in and you don’t meet that criteria, we cannot vaccinate you. So these prioritizations and the follow through is gonna be really, really important for folks to understand. And then to the question you raised earlier, Andy, you know, when are you going to know the information systems to push out that now group, whatever is available and should be coming in getting that through PSA announcements and other things. It’s going to be really important for both the state and local as well as the federal government to have a robust campaign around.

Andy Slavitt  40:01

Got it. Okay, so another question came in from Lisa. She says I heard a while ago that vaccine manufacturers were worried about raw materials for the glass files. vaccine vials are supposed to be made with a special sand. And there could be a shortage is that you. I have to say that we are the most intelligent listeners on the planet. Go Lisa, go, Lisa.

Dr. David Agus 

Yes, that is very true. Believe it or not, the vaccine vials were a limiting resource. It was a big decision to enable the manufacturing companies, the vaccine manufacturers to actually use multi dose vials. The thing about a multi dose vial is you, we don’t have enough data to know they could be stored. So you have to use the whole vial. But multi dose vials enables you to put 1050 vaccines in one vial, and then draw them up as needed. So I think we’ve been addressing that, it really goes to one of the critical questions to me and one of the failings that we’ve had in this whole pandemic response is we’ve let it be a free market. So there are 195 plus vaccines in development now, each one of them to contracts for vials for syringes for manufacturing, and 190 of them were not going to need or they’re not of the highest quality. And so you know, if we got intervention early, we could have had more in the supply chain, and manage it rather than let it be a free market. And the same is true in clinical trials. We had several thousand clinical trials very few completed because they all competed for patients. Instead of like in the United Kingdom, when they had their, you know, trials, they did one trial in the country at a time and actually got things done, which is how we got dexamethasone and some of the other treatments we have

Andy Slavitt 

Oh, now you’re just being unpatriotic.

Dr. David Agus 

No, now I’m saying free market doesn’t work in a time of a pandemic. Listen, at risk manufacturing was brilliant. We did an amazing job there and kudos to them for pushing early and choosing the right ones mean three working in a row. That isn’t by chance that was some smart people choosing the right vaccines.

Andy Slavitt

Yeah, Marks at the FDA did a great job. But no, it’s funny, one of the things I’d say in my book is we were either going to be first at something or last. We hate being second. So we’re just like, we’re gonna be the best at it. Or we’re just going to be horrible, because that’s just how we are. Okay? Chris Collin wants to know he’s got a wife. She’s have advanced maternal age, and her pregnant. Congratulations, Chris, and to your wife. He wants to know whether or not it’s going to be safe to vaccinate a pregnant mother or a new mother and baby. I think we talked about baby already. So he believes that he read that the vaccines have not been tested on pregnant women.

Dr. David Agus

Very true. We’re not going to vaccinate pregnant women in the beginning, it certainly makes sense, which is part of the reason we need herd immunity. Anywhere where you could affect a fetus, even though it’s hypothetical, it’s just not worth taking that risk. So we all every single citizen of this country has to step up to protect them. And so this is a new notion. It’s not just caring about yourself, it’s caring about others, we’re all going to step up and get vaccinated. So pregnant women don’t have to take a risk. So babies don’t have to take a risk. People getting cancer treatment, autoimmune treatment don’t have to take risk. We have to be one community, which is, you know, I think critically important, and maybe the positive that comes out of this horrible pandemic is, we think of other people.

Andy Slavitt 

I just got the warm fuzzy skin.

Dr. David Agus 

You do it too often, it’s gonna hurt your reputation.

Andy Slavitt 

Oh, no, I’m softy. How old is too old? My mom is 92 and has a pacemaker. She’s susceptible to pneumonia when she gets a cold, but she lives independently and is in pretty good shape for her age. What do you think, David?

Dr. David Agus 

You know, I don’t think any old is too old. Hopefully your mother’s got another decade plus, you know, to enjoy life and spend time with their family. You know, what we learned in this study with the Astra vaccine and the Pfizer the data are pretty clear is that elderly respond remarkably well. After one shot. They’re significantly below 20-30-year-old, but by two shot, they catch up in equal them and do really, really well and again, with a lower side effect profile. So your mother needs to be at one of Tom’s stores on you know, when her time is called to get her vaccine.

Andy Slavitt

That’s right. That’s right. 92 is the new 62. Okay. Jim Dolan, I want to know if the four or so states that have been selected as first run for distribution for the Pfizer vaccine. Will all the residents of those states be able to receive the vaccine or will it still be limited to certain populations?

Tom Moriarty

Yeah, I think there’s a misunderstanding of what that first run means. It is essentially a dry run of the ordering system tracking system and supply system. And so it’s not real vaccine going. It is empty bottles moving around as part of it, but it’s really just a dry run test run of the systems across the board.

Dr. David Agus

And kudos for them for doing a dry run. I think it’s awesome.

Tom Moriarty 

Yeah, exactly.

Andy Slavitt 

Okay. I’m not sure who which ones are the three of us this one was intended for. Will you personally be vouching for the safety and efficacy of the vaccines? Who do you trust? I am one who is mistrustful of the current administration, and need to know the process of approval, and the oversight of the whole distribution machine for safety. This is a trust but verify in person.

Tom Moriarty

Yeah, I mean, I’ll start I mean, what I can tell you tell you all and tell the listeners is the six or so months that we have been deeply engaged in all this. The folks involved in this are apolitical. They’re dedicated professionals, their career serving, you know, officials. And if you look at the work the Operation Warp Speed has done. These are career military folks who are experts in logistics and distribution. I will be, I’ll in line for the vaccine. Absolutely.

Andy Slavitt 

Great. How about you, David?

Dr. David Agus 

I think you’re going to see, both Pfizer and AstraZeneca, probably approved in the United Kingdom, and potentially the EU before the US. So again, that takes some you know, it just can’t be political in the US if it’s approved elsewhere first. And no question. I am familiar, very familiar with both the Pfizer data and the AstraZeneca Oxford University data. And I think they’re fantastic. And I would get either one of them, you know, today. The Moderna data I’m not as familiar with. So I can’t say at the present time, but I assume is going to be as good as the others.

Andy Slavitt  46:15

Got it. And in case you were asking me, I am not an authority. But good news is I have a lot of friends like David. And they all are saying the same thing that David is saying. And I assure you that if I hear differently, and David hears differently, he will make sure to say so because there’s no point in not having this completely transparent for everybody. Because it’s so important. And I just want to throw a commercial in. This is not just a great discovery of science; this is the greatest invention of mankind. These are things that I could never understand how we could take for granted. If we were alive in the 60s, we would have seen millions of kids dying from the measles in the early 60s, before a measles vaccine. So we live in a different age when we can do something like this. And it’s incredibly powerful.

Dr. David Agus

We live in a radically different age. You know, in the early 1800s, a good percentage of the world was dying of smallpox. And this guy, Edward Jenner noted that women would milk cow and get pox in their arm, and not die. And they could take care of people with smallpox, he goes the King of England, he goes, I want to stick a needle and draw pus out of their arm and inject other people in the king kicks him out. Well, the next day, the king say you inject your son, and I’ll know you really believe in he did. And number two through 11, who got that vaccine, the first vaccine ever were the royal family. So to get normative behavior change, you need leadership, the king stepping up, and going after Jenner’s son and taking a vaccine was a remarkable step of leadership. I hope that our leaders step up here.

And I hope they show the way to show people from every discipline. So I’m talking about leaders in a church, in a family in a state at the federal government, all different kinds of leaders, I really am calling for all of them to step up. And to get that change. So we can all be vaccinated and help each other we all have to be a part of this. Whether you’re the CEO of a company, show your employees, you’re doing this, we all have to step up.

Andy Slavitt  48:11

Be a role model. That’s great. Last question. may or may not have been from Zack, will the shot hurt?

Dr. David Agus 

Damn straight, it’ll hurt. You know, there’s an amazing thing in immunology called the danger response, the more it hurts, the more potent your immune response. And so it’s a needle, unfortunately, we have to pierce the skin and put it into the muscle. And then there’s an immune response there. So you may have a sore arm for a day. But after a day or two, there are no more side effects, right? You may get a little fever and chill. And that’s your immune response. I cheer when that happens. I don’t like cheering because you’re suffering. But I’m cheering because you’re having a great immune response. And we need that to protect you.

Andy Slavitt

So it’ll hurt. But let’s all get through it. It won’t hurt that much.

Dr. David Agus

You know, I made the mistake. It was a horrible mistake. One year my kids hated shots, their doctors, kids, they hate shots. So in the middle of the night, I went into the room and gave them a flu shot while they were sound asleep. It was literally the stupidest thing I’ve ever done. And they didn’t talk to me for weeks afterwards.

Andy Slavitt 

In closing, first of all, thank you both so much for really explaining this to the public. I think this will be immensely helpful to people. It was immensely helpful to me. Thank you also, Tom for your role in warp speed. And in making sure that we are thinking this through all the way from start to finish, doing dry runs, investing staff time. You know, your people don’t always think of it this way. But CVS workers and frontline workers, they are putting themselves in danger.

Dr. David Agus

So, I can’t treat any patient without a CVS, they wouldn’t have any drugs.

Andy Slavitt

So thank you to all your workforce for all that you’ve done and all you’ll continue to do. And David, you’re just a gem. You’re just an immense resource. You’ll always have been.

Dr. David Agus 

One question I forgot to ask before. Tom, are your employees going to wear PPE when they do this?

Tom Moriarty  50:03

They are. Yeah, absolutely. And that’s so to the state issue, we’re not going to be given an allocation directly to vaccinate our vaccinators. And so they have to be identified as priority within the state allocations to be vaccinated, hopefully before they go out and do the vaccinations, or as part of the process of doing it. So wearing the PPE and others until they’re fully vaccinated will be critical to get them comfortable, but also folks who are getting vaccinated to have them comfortable as well.

Andy Slavitt

Well, thanks so much, guys. Thanks for the time. Thanks for all this.

Tom Moriarty 

David, good to see you.

Dr. David Agus 

You too. Take care.

Andy Slavitt 

You got it. Have a great holiday.

Andy Slavitt

Thank you again, for listening in. Let me tell you about the next shows quickly. Laurie Garrett in Wednesday, you will find her fantastic. She is a Spitfire, very opinionated about what’s been going on with the pandemic. Then we have two incredibly useful podcast, very interesting. We have a toolkit on building your bubble. How do you build your bubble, who’s in your bubble, how do you get your bubble built? All that stuff? Of course, you should get that from us. We should be the authority on that. And then Wednesday, Heidi Larson from the Vaccine Confidence Project. We just talked today about how you get your vaccines. I think we’re going to talk about why people should want them and feel good about them with Heidi Larson. Great couple shows coming up. Have a great rest of the week. Thanks for tuning in.

CREDITS

Thanks for listening IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is Emeritus co-host and onsite producer improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives that executive produced the show. And our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @aslavitt on Twitter or at @andyslavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen, but still tell him at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome