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Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day two hundred

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Speaker 1: and seventy since coronavirus was declared a global pandemic. Today's

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Speaker 1: main story new vaccines are well on their way to

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Speaker 1: being distributed broadly in countries around the world. But how

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Speaker 1: we get the shots to billions of people and when?

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Speaker 1: Isn't just a logistical problem, it's an ethics question too.

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Speaker 1: But first, here's what happened in virus news today. Canada's

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Speaker 1: public health authorities have approved the Fiser and bio n

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Speaker 1: Tech coronavirus vaccine. The approval paves the way for Justin

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Speaker 1: Trudeau to begin a government campaign to vaccinate Canadians again

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Speaker 1: COVID nineteen, which has killed more than twelve thousand, eight

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Speaker 1: hundred people in the country. So far, Canada has secured

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Speaker 1: more doses of the vaccine per person than any other

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Speaker 1: country in the world. The Prime Minister said last month

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Speaker 1: that a majority of the population of Canada should be

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Speaker 1: able to get their shots by September one. Some more

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Speaker 1: news emerged about how well the Fiser and bio en

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Speaker 1: Tech vaccine works. According to the US Food and Drug Administration,

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Speaker 1: it prevents symptomatic cases of the virus, but it's not

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Speaker 1: clear if the shot keeps the disease from being transmitted.

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Speaker 1: The FDA published their findings in a report issued Tuesday.

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Speaker 1: The risk that immunized people could still transmit the virus

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Speaker 1: carries important implications for continued mask wearing and social distancing,

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Speaker 1: even among those who have been vaccinated. Finally, new tests

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Speaker 1: show the coronavirus was circulating in Italy as early as

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Speaker 1: the end of November. That's according to a report published

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Speaker 1: by the Centers for Disease Control and Prevention, and it

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Speaker 1: lends weight to other studies showing the disease appeared in

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Speaker 1: Europe earlier than originally thought. The new findings shift the

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Speaker 1: timeline for the beginning of the outbreak in Italy from

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Speaker 1: late February, when the first cases on the continent were identified,

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Speaker 1: until late autumn. And now for today's main story. The

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Speaker 1: UK began administering the first COVID nineteen vaccine this week

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Speaker 1: and the US may do the same within days. But

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Speaker 1: the emergence of these vaccines brings tough choices around who

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Speaker 1: gets it first and how it will be distributed. Bloomberg

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Speaker 1: Senior editor Jason Gale spoke with an ethics expert about

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Speaker 1: the thinking behind some of these decisions and how the

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Speaker 1: current vaccines could affect how we develop future ones. Professor

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Speaker 1: Arthur Kaplan says, there's a list of people who should

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Speaker 1: get the vaccine first, and healthcare workers are at the

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Speaker 1: top in the emergency side. I think it's pretty clear

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Speaker 1: that you're trying to in the US in particular, preserve

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Speaker 1: the health care system from not being tipped over. So

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Speaker 1: healthcare workers are going first, not considered the greatest need,

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Speaker 1: for the greatest risk, but you've got to try and

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Speaker 1: maintain the system. It will be frontline healthcare workers there,

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Speaker 1: and I think that everybody agrees on that. What is

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Speaker 1: the head of the Division of Medical Ethics at New

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Speaker 1: York University Grossman's School of Medicine, and he's been looking

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Speaker 1: at questions related to vaccine nation for the last six years.

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Speaker 1: I says the second group on that list should be

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Speaker 1: nursing home residents. They got beat up very badly by

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Speaker 1: the virus and they still are, you know, out of

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Speaker 1: two dred or so deaths here, I think a hundred

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Speaker 1: thousand or nursing homes. Says After that, there are differing

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Speaker 1: views about who should be next then as more supply

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Speaker 1: begins to appear, who probably then go to older over

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Speaker 1: sixty people with chronic conditions and quote unquote essential workers.

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Speaker 1: That's a big group, that's probably eighty million plus. But

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Speaker 1: I think we'll have enough vaccine to do that. There's

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Speaker 1: also another group on that list that would need the vaccine,

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Speaker 1: people who have already been infected with the virus, because

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Speaker 1: reinfection is possible. Everything that I hear tells me that

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Speaker 1: you're gonna have to vaccinate people who've had COVID because

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Speaker 1: you don't know how strongly anybody responses or how long

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Speaker 1: it was. So I think I think they're gonna have

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Speaker 1: to go too, unless you had COVID last week and

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Speaker 1: you know, maybe you know that your antibodies are high

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Speaker 1: and maybe that. But I mean, that's a tiny handful

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Speaker 1: of people. But getting people to even take the vaccine

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Speaker 1: maybe a challenge. If flu is anything to go by.

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Speaker 1: New data says that only half of US residents received

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Speaker 1: a flu shot this season, and more than a third

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Speaker 1: of adults don't plan to get one. Poles indicate a

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Speaker 1: lack of support for COVID vaccines as well. Says that

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Speaker 1: may reflect concern that safety might have taken a back

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Speaker 1: seat to speed in developing them. There's certainly some people

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Speaker 1: out there who are just anti vacs, as there are

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Speaker 1: in Australia, Britain and other parts of Europe, but I

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Speaker 1: don't think that's a big number. I think what's going

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Speaker 1: to happen is as soon as the healthcare workers get

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Speaker 1: vaccinated and they do well and they don't get sick,

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Speaker 1: and then we see protection for nursing home residents. I

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Speaker 1: think we're going to see a big shift. It's gonna

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Speaker 1: move from I'm not sure I want to get this,

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Speaker 1: and how come I can't get it right away. Look,

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Speaker 1: some nations Australia, Taiwan, New Zealand kinda have worked their

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Speaker 1: way out of this thing my behavior change, lockdowns and

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Speaker 1: strict isolation in quarantine. The US has not. It's lost

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Speaker 1: control of it. It has to rely on vaccines. But

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Speaker 1: I do think I do think ultimately they're going to

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Speaker 1: help the states work their way out of it. Steell

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Speaker 1: says mandatory vaccination is not likely, with maybe some exceptions

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Speaker 1: like the military. Well, look, no one's gonna make an

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Speaker 1: experimental vaccine mandatory. So emergency use the first phase of

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Speaker 1: availability They're not going to mandate it. You're gonna get

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Speaker 1: an offer. You're gonna get to choose. Once the vaccine

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Speaker 1: gets licensed, I think you'll see mandates all over the place.

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Speaker 1: I think health care institutions, nursing homes will say you're

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Speaker 1: not gonna work here unless you get vaccinated. I think

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Speaker 1: you'll see airlines and trains and cruise ships saying you're

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Speaker 1: not coming on board unless you show proof of vaccination.

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Speaker 1: I suspect most Americans are nervous that the government's going

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Speaker 1: to tell him I have to get a vaccine. But

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Speaker 1: I think you're gonna see mandates coming out of the

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Speaker 1: private sector more than the government. Arts says the rollout

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Speaker 1: of the vaccine will present another ethical issue. It will

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Speaker 1: make it harder to test the safety and efficacy of

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Speaker 1: other COVID vaccines, stealing development the way large randomized controlled studies,

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Speaker 1: so called phase three clinical trials are stretched. It means

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Speaker 1: that a portion of people get an experimental COVID vaccine,

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Speaker 1: while a portion get a place EBO or at least

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Speaker 1: a vaccine that's not protective against the coronavirus. Art says

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Speaker 1: he suspects people, especially healthcare workers and others that high

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Speaker 1: risk of infection won't want to take their chances. They

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Speaker 1: want to get a proven COVID vaccine, and that will

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Speaker 1: make it harder to recruit participants for these trials. There

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Speaker 1: are many vaccines in the pipeline that haven't reached phase

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Speaker 1: three trials, so maybe cheaper, so maybe easier to store

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Speaker 1: some maybe one shot. They may have different advantages. If

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Speaker 1: you have a couple of vaccines that are either out

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Speaker 1: there with emergency use approval or get licensed, who's going

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Speaker 1: to be in those trials? Nobody. You're gonna take the

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Speaker 1: vaccines that are effective and they have no side effects.

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Speaker 1: So while it's great that we have vaccines that appe

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Speaker 1: is safe and effective, the bad news is that it's

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Speaker 1: going to undercut future trials. We're gonna have to decide

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Speaker 1: as a world how much evidence is What kind of

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Speaker 1: evidence are we going to accept to license these things,

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Speaker 1: because I don't think it's gonna come from large scale,

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Speaker 1: randomized trials of this sort that historically have been used

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Speaker 1: to establish the efficacy and safety of vaccines. One option

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Speaker 1: is that experimental vaccines are compared head to head with

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Speaker 1: proven ones, but artzies another possibility I think, and it's

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Speaker 1: controversial for me to say this, but I think that's

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Speaker 1: going to open the door to trying some challenge studies

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Speaker 1: deliberately in affecting small numbers of people to get hard,

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Speaker 1: reliable data quickly when big trials become unlikely or impossible

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Speaker 1: to do, especially if we get better and better therapeutic drugs,

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Speaker 1: so we could prevent death, rescue someone who's got severely

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Speaker 1: ill when they're starting to appear. They're not there yet completely.

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Speaker 1: But I've tried to argue for a long time now

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Speaker 1: that challenge studies are in our future, and I think

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Speaker 1: this collapse of the big studies is going to make

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Speaker 1: them more in our future. There's also the matter of

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Speaker 1: whether people will be able to choose which vaccinet they gain.

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Speaker 1: The other thing I think we've not paid enough attention

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Speaker 1: to do is everybody wants to know who's going first. Well,

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Speaker 1: that's nice, but in the short run, the issues and

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Speaker 1: who's going first. The issue is our place is going

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Speaker 1: to be able to administer this during vaccine fizes. Vaccine

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Speaker 1: needs to be stored at ultra phreezing temperatures from where

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Speaker 1: it's manufactured through to the clinics and senters potentially hundreds

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Speaker 1: of miles away administering it, and that requires more careful

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Speaker 1: maintenance of a rigorous cold chain than a similar vaccine

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Speaker 1: ape by Maderna, which is stable at regular phrase of

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Speaker 1: temperature psers is cold chain, very very cool temperatures. I

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Speaker 1: don't know if I trust being able to keep everything

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Speaker 1: at the cold chain temperatures all the way through. It's

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Speaker 1: hard even if you do. It comes in packages. I

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Speaker 1: think of a thousand says that in order to avoid wastage,

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Speaker 1: the immunization process needs to be done incredibly efficiently and

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Speaker 1: at a large scale. At least for the fines vaccine.

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Speaker 1: There may be more flexibility with Maderna. Shop open up

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Speaker 1: the package and you've got to give him out within

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Speaker 1: five or six hours. It takes a lot of people

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Speaker 1: to vaccinate that many people that fast. Those people have

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Speaker 1: to be in one place to get it. Oh. I mean,

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Speaker 1: it's logistically gonna be harder than I think people think.

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Speaker 1: So while we're all worried about is Grandma going to

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Speaker 1: get it before the healthcare worker, before the essential worker,

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Speaker 1: I have a feeling there's some short term logistics issues

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Speaker 1: that you're gonna have to be sorted out. For example,

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Speaker 1: do I get to pick which vaccine I want. I

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Speaker 1: doubt it. That was Jason Gail, and that's it for

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Speaker 1: our show today. For coverage of the outbreak from one

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Speaker 1: hundred and twenty bureaus around the world, visit bloomberg dot

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Speaker 1: com slash coronavirus and if you like the show, please

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Speaker 1: leave us a review and a rating on Apple Podcasts

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Speaker 1: or Spotify. It's the best way to help more listeners

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Speaker 1: find our global reporting. The Prognosis Daily edition is produced

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Speaker 1: by to for Foreheads, Jordan Gaspore, Magnus Henrickson and me

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Speaker 1: Laura Carlson. Today's main story was reported by Jason Gail.

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Speaker 1: Original music by Leo Sidrin. Our editors are Rick Shine

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Speaker 1: and Francesco Levi. Francesco Levi is Bloomberg's head of podcasts.

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Speaker 1: Thanks for listening, l