WEBVTT - Who Should Get the First Doses?

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

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<v Speaker 1>and seventy since coronavirus was declared a global pandemic. Today's

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<v Speaker 1>main story new vaccines are well on their way to

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<v Speaker 1>being distributed broadly in countries around the world. But how

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<v Speaker 1>we get the shots to billions of people and when?

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

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

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<v Speaker 1>public health authorities have approved the Fiser and bio n

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<v Speaker 1>Tech coronavirus vaccine. The approval paves the way for Justin

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<v Speaker 1>Trudeau to begin a government campaign to vaccinate Canadians again

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<v Speaker 1>COVID nineteen, which has killed more than twelve thousand, eight

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<v Speaker 1>hundred people in the country. So far, Canada has secured

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<v Speaker 1>more doses of the vaccine per person than any other

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<v Speaker 1>country in the world. The Prime Minister said last month

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<v Speaker 1>that a majority of the population of Canada should be

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<v Speaker 1>able to get their shots by September one. Some more

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<v Speaker 1>news emerged about how well the Fiser and bio en

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<v Speaker 1>Tech vaccine works. According to the US Food and Drug Administration,

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<v Speaker 1>it prevents symptomatic cases of the virus, but it's not

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<v Speaker 1>clear if the shot keeps the disease from being transmitted.

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<v Speaker 1>The FDA published their findings in a report issued Tuesday.

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<v Speaker 1>The risk that immunized people could still transmit the virus

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<v Speaker 1>carries important implications for continued mask wearing and social distancing,

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<v Speaker 1>even among those who have been vaccinated. Finally, new tests

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<v Speaker 1>show the coronavirus was circulating in Italy as early as

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<v Speaker 1>the end of November. That's according to a report published

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<v Speaker 1>by the Centers for Disease Control and Prevention, and it

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<v Speaker 1>lends weight to other studies showing the disease appeared in

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<v Speaker 1>Europe earlier than originally thought. The new findings shift the

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<v Speaker 1>timeline for the beginning of the outbreak in Italy from

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<v Speaker 1>late February, when the first cases on the continent were identified,

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<v Speaker 1>until late autumn. And now for today's main story. The

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<v Speaker 1>UK began administering the first COVID nineteen vaccine this week

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<v Speaker 1>and the US may do the same within days. But

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<v Speaker 1>the emergence of these vaccines brings tough choices around who

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<v Speaker 1>gets it first and how it will be distributed. Bloomberg

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<v Speaker 1>Senior editor Jason Gale spoke with an ethics expert about

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<v Speaker 1>the thinking behind some of these decisions and how the

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<v Speaker 1>current vaccines could affect how we develop future ones. Professor

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<v Speaker 1>Arthur Kaplan says, there's a list of people who should

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<v Speaker 1>get the vaccine first, and healthcare workers are at the

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<v Speaker 1>top in the emergency side. I think it's pretty clear

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<v Speaker 1>that you're trying to in the US in particular, preserve

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<v Speaker 1>the health care system from not being tipped over. So

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<v Speaker 1>healthcare workers are going first, not considered the greatest need,

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<v Speaker 1>for the greatest risk, but you've got to try and

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<v Speaker 1>maintain the system. It will be frontline healthcare workers there,

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<v Speaker 1>and I think that everybody agrees on that. What is

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<v Speaker 1>the head of the Division of Medical Ethics at New

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<v Speaker 1>York University Grossman's School of Medicine, and he's been looking

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<v Speaker 1>at questions related to vaccine nation for the last six years.

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<v Speaker 1>I says the second group on that list should be

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<v Speaker 1>nursing home residents. They got beat up very badly by

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<v Speaker 1>the virus and they still are, you know, out of

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<v Speaker 1>two dred or so deaths here, I think a hundred

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<v Speaker 1>thousand or nursing homes. Says After that, there are differing

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<v Speaker 1>views about who should be next then as more supply

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<v Speaker 1>begins to appear, who probably then go to older over

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<v Speaker 1>sixty people with chronic conditions and quote unquote essential workers.

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

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

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<v Speaker 1>also another group on that list that would need the vaccine,

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<v Speaker 1>people who have already been infected with the virus, because

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<v Speaker 1>reinfection is possible. Everything that I hear tells me that

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<v Speaker 1>you're gonna have to vaccinate people who've had COVID because

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<v Speaker 1>you don't know how strongly anybody responses or how long

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<v Speaker 1>it was. So I think I think they're gonna have

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<v Speaker 1>to go too, unless you had COVID last week and

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<v Speaker 1>you know, maybe you know that your antibodies are high

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<v Speaker 1>and maybe that. But I mean, that's a tiny handful

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<v Speaker 1>of people. But getting people to even take the vaccine

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<v Speaker 1>maybe a challenge. If flu is anything to go by.

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<v Speaker 1>New data says that only half of US residents received

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<v Speaker 1>a flu shot this season, and more than a third

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<v Speaker 1>of adults don't plan to get one. Poles indicate a

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<v Speaker 1>lack of support for COVID vaccines as well. Says that

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<v Speaker 1>may reflect concern that safety might have taken a back

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<v Speaker 1>seat to speed in developing them. There's certainly some people

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<v Speaker 1>out there who are just anti vacs, as there are

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<v Speaker 1>in Australia, Britain and other parts of Europe, but I

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<v Speaker 1>don't think that's a big number. I think what's going

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<v Speaker 1>to happen is as soon as the healthcare workers get

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<v Speaker 1>vaccinated and they do well and they don't get sick,

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<v Speaker 1>and then we see protection for nursing home residents. I

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

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<v Speaker 1>move from I'm not sure I want to get this,

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

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<v Speaker 1>some nations Australia, Taiwan, New Zealand kinda have worked their

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<v Speaker 1>way out of this thing my behavior change, lockdowns and

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<v Speaker 1>strict isolation in quarantine. The US has not. It's lost

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<v Speaker 1>control of it. It has to rely on vaccines. But

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<v Speaker 1>I do think I do think ultimately they're going to

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<v Speaker 1>help the states work their way out of it. Steell

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<v Speaker 1>says mandatory vaccination is not likely, with maybe some exceptions

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

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<v Speaker 1>experimental vaccine mandatory. So emergency use the first phase of

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<v Speaker 1>availability They're not going to mandate it. You're gonna get

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<v Speaker 1>an offer. You're gonna get to choose. Once the vaccine

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

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<v Speaker 1>I think health care institutions, nursing homes will say you're

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<v Speaker 1>not gonna work here unless you get vaccinated. I think

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<v Speaker 1>you'll see airlines and trains and cruise ships saying you're

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<v Speaker 1>not coming on board unless you show proof of vaccination.

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<v Speaker 1>I suspect most Americans are nervous that the government's going

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<v Speaker 1>to tell him I have to get a vaccine. But

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<v Speaker 1>I think you're gonna see mandates coming out of the

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<v Speaker 1>private sector more than the government. Arts says the rollout

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<v Speaker 1>of the vaccine will present another ethical issue. It will

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<v Speaker 1>make it harder to test the safety and efficacy of

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<v Speaker 1>other COVID vaccines, stealing development the way large randomized controlled studies,

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<v Speaker 1>so called phase three clinical trials are stretched. It means

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<v Speaker 1>that a portion of people get an experimental COVID vaccine,

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<v Speaker 1>while a portion get a place EBO or at least

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<v Speaker 1>a vaccine that's not protective against the coronavirus. Art says

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<v Speaker 1>he suspects people, especially healthcare workers and others that high

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<v Speaker 1>risk of infection won't want to take their chances. They

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<v Speaker 1>want to get a proven COVID vaccine, and that will

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<v Speaker 1>make it harder to recruit participants for these trials. There

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<v Speaker 1>are many vaccines in the pipeline that haven't reached phase

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<v Speaker 1>three trials, so maybe cheaper, so maybe easier to store

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<v Speaker 1>some maybe one shot. They may have different advantages. If

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<v Speaker 1>you have a couple of vaccines that are either out

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<v Speaker 1>there with emergency use approval or get licensed, who's going

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

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<v Speaker 1>vaccines that are effective and they have no side effects.

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<v Speaker 1>So while it's great that we have vaccines that appe

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<v Speaker 1>is safe and effective, the bad news is that it's

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<v Speaker 1>going to undercut future trials. We're gonna have to decide

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<v Speaker 1>as a world how much evidence is What kind of

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<v Speaker 1>evidence are we going to accept to license these things,

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

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<v Speaker 1>randomized trials of this sort that historically have been used

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<v Speaker 1>to establish the efficacy and safety of vaccines. One option

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<v Speaker 1>is that experimental vaccines are compared head to head with

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<v Speaker 1>proven ones, but artzies another possibility I think, and it's

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<v Speaker 1>controversial for me to say this, but I think that's

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<v Speaker 1>going to open the door to trying some challenge studies

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<v Speaker 1>deliberately in affecting small numbers of people to get hard,

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<v Speaker 1>reliable data quickly when big trials become unlikely or impossible

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<v Speaker 1>to do, especially if we get better and better therapeutic drugs,

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<v Speaker 1>so we could prevent death, rescue someone who's got severely

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

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<v Speaker 1>But I've tried to argue for a long time now

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<v Speaker 1>that challenge studies are in our future, and I think

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<v Speaker 1>this collapse of the big studies is going to make

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<v Speaker 1>them more in our future. There's also the matter of

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<v Speaker 1>whether people will be able to choose which vaccinet they gain.

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<v Speaker 1>The other thing I think we've not paid enough attention

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

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<v Speaker 1>that's nice, but in the short run, the issues and

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<v Speaker 1>who's going first. The issue is our place is going

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<v Speaker 1>to be able to administer this during vaccine fizes. Vaccine

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<v Speaker 1>needs to be stored at ultra phreezing temperatures from where

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<v Speaker 1>it's manufactured through to the clinics and senters potentially hundreds

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<v Speaker 1>of miles away administering it, and that requires more careful

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<v Speaker 1>maintenance of a rigorous cold chain than a similar vaccine

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<v Speaker 1>ape by Maderna, which is stable at regular phrase of

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<v Speaker 1>temperature psers is cold chain, very very cool temperatures. I

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<v Speaker 1>don't know if I trust being able to keep everything

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<v Speaker 1>at the cold chain temperatures all the way through. It's

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<v Speaker 1>hard even if you do. It comes in packages. I

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<v Speaker 1>think of a thousand says that in order to avoid wastage,

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<v Speaker 1>the immunization process needs to be done incredibly efficiently and

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<v Speaker 1>at a large scale. At least for the fines vaccine.

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<v Speaker 1>There may be more flexibility with Maderna. Shop open up

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<v Speaker 1>the package and you've got to give him out within

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<v Speaker 1>five or six hours. It takes a lot of people

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<v Speaker 1>to vaccinate that many people that fast. Those people have

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<v Speaker 1>to be in one place to get it. Oh. I mean,

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<v Speaker 1>it's logistically gonna be harder than I think people think.

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<v Speaker 1>So while we're all worried about is Grandma going to

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<v Speaker 1>get it before the healthcare worker, before the essential worker,

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<v Speaker 1>I have a feeling there's some short term logistics issues

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

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<v Speaker 1>do I get to pick which vaccine I want. I

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<v Speaker 1>doubt it. That was Jason Gail, and that's it for

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<v Speaker 1>our show today. For coverage of the outbreak from one

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<v Speaker 1>hundred and twenty bureaus around the world, visit bloomberg dot

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<v Speaker 1>com slash coronavirus and if you like the show, please

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<v Speaker 1>leave us a review and a rating on Apple Podcasts

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<v Speaker 1>or Spotify. It's the best way to help more listeners

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<v Speaker 1>find our global reporting. The Prognosis Daily edition is produced

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<v Speaker 1>by to for Foreheads, Jordan Gaspore, Magnus Henrickson and me

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<v Speaker 1>Laura Carlson. Today's main story was reported by Jason Gail.

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<v Speaker 1>Original music by Leo Sidrin. Our editors are Rick Shine

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<v Speaker 1>and Francesco Levi. Francesco Levi is Bloomberg's head of podcasts.

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<v Speaker 1>Thanks for listening, l