1 00:00:03,640 --> 00:00:08,640 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day two hundred 2 00:00:08,680 --> 00:00:14,360 Speaker 1: and seventeen since coronavirus was declared a global pandemic. Today's 3 00:00:14,400 --> 00:00:19,040 Speaker 1: main story in the US, it's up to individual states 4 00:00:19,200 --> 00:00:24,239 Speaker 1: to develop plans for distributing a vaccine once one is available. 5 00:00:24,840 --> 00:00:29,520 Speaker 1: But now they face intense time pressure to develop their strategies, 6 00:00:30,280 --> 00:00:34,760 Speaker 1: and they're flying blind without necessary information about the type 7 00:00:35,159 --> 00:00:39,800 Speaker 1: and timing of the vaccines they'll be offering. But first, 8 00:00:40,680 --> 00:00:54,360 Speaker 1: here's what happened in Virus News Today. Food and Drug 9 00:00:54,400 --> 00:00:58,760 Speaker 1: Administration Commissioner Stephen Hahn said that the recent pauses in 10 00:00:58,880 --> 00:01:03,040 Speaker 1: several clinical trial else are a necessary step to making 11 00:01:03,080 --> 00:01:08,000 Speaker 1: sure any COVID nineteen vaccine or therapy will be safe. 12 00:01:09,000 --> 00:01:12,800 Speaker 1: In an interview with Bloomberg Today, Hans said that recent 13 00:01:12,920 --> 00:01:17,120 Speaker 1: stops to clinical studies of vaccines and antibody treatments by 14 00:01:17,319 --> 00:01:21,640 Speaker 1: Johnson and Johnson, Eli Lily and Astra Zeneca are normal. 15 00:01:22,560 --> 00:01:25,720 Speaker 1: The system, he said, is designed this way to identify 16 00:01:26,040 --> 00:01:29,959 Speaker 1: safety issues and protect participants, but also to find the 17 00:01:30,120 --> 00:01:34,840 Speaker 1: right treatments and vaccines. In the end, a surge in 18 00:01:34,880 --> 00:01:39,479 Speaker 1: coronavirus infections in the US is threatening the very survival 19 00:01:39,520 --> 00:01:44,240 Speaker 1: of hospitals just when the country needs the most. Hundreds 20 00:01:44,240 --> 00:01:48,840 Speaker 1: of facilities were already on shaky financial ground before the virus, 21 00:01:49,480 --> 00:01:52,800 Speaker 1: and the impact of caring for COVID patients has put 22 00:01:53,000 --> 00:01:59,240 Speaker 1: hundreds more in jeopardy. The pandemic sidelined profitable elective procedures 23 00:01:59,440 --> 00:02:05,080 Speaker 1: and pushed up costs to keep patients and staff safe. Meanwhile, 24 00:02:05,440 --> 00:02:09,240 Speaker 1: hospitals are losing the privately insured patients they depend on 25 00:02:09,760 --> 00:02:14,320 Speaker 1: as millions of Americans lose their jobs and their employer 26 00:02:14,440 --> 00:02:20,560 Speaker 1: sponsored coverage. The American Hospital Association estimates the pandemic will 27 00:02:20,600 --> 00:02:24,720 Speaker 1: cost US hospitals more than three hundred and twenty three 28 00:02:24,760 --> 00:02:29,040 Speaker 1: billion dollars by the end of the year. The industry 29 00:02:29,040 --> 00:02:32,720 Speaker 1: group is asking Congress for an additional one hundred billion 30 00:02:32,800 --> 00:02:37,720 Speaker 1: dollars and full forgiveness of loans made under Medicare's Accelerated 31 00:02:37,840 --> 00:02:44,919 Speaker 1: Payment Program, among other requests for relief. Finally, i Ran 32 00:02:44,960 --> 00:02:49,240 Speaker 1: announced a travel ban to and from five major cities, 33 00:02:49,600 --> 00:02:53,680 Speaker 1: including the capital Tehran, over an extended holiday weekend, as 34 00:02:53,720 --> 00:02:58,360 Speaker 1: part of measures to curb COVID spread. The restriction comes 35 00:02:58,400 --> 00:03:02,040 Speaker 1: into effect tomorrow, amid a record spike in the country's 36 00:03:02,120 --> 00:03:13,840 Speaker 1: coronavirus fatalities and rising new cases. And now for today's 37 00:03:13,960 --> 00:03:18,240 Speaker 1: main story, States are racing the clock to meet a 38 00:03:18,320 --> 00:03:22,480 Speaker 1: Friday deadline. That's when the federal government says they must 39 00:03:22,600 --> 00:03:26,600 Speaker 1: submit their plans to distribute a vaccine once an effective 40 00:03:26,639 --> 00:03:31,200 Speaker 1: one is ready. But Angelica Levita reports that they're putting 41 00:03:31,240 --> 00:03:37,160 Speaker 1: together the strategies effectively blindfolded. State health officials have no 42 00:03:37,280 --> 00:03:41,400 Speaker 1: clue which vaccine they will be distributing, nor when or 43 00:03:41,440 --> 00:03:46,000 Speaker 1: even if a vaccine will be forthcoming. I talked to 44 00:03:46,040 --> 00:03:50,040 Speaker 1: Angelica today about the problems with this state by state 45 00:03:50,320 --> 00:03:58,280 Speaker 1: strategy in terms of getting the US ready for a 46 00:03:58,320 --> 00:04:04,000 Speaker 1: COVID nineteen vaccine. What's the significance of this Friday oct 47 00:04:04,760 --> 00:04:07,520 Speaker 1: The states are required to submit their plans to the 48 00:04:07,560 --> 00:04:11,920 Speaker 1: CDC detailing how they plan to distribute and administer COVID 49 00:04:12,000 --> 00:04:17,760 Speaker 1: nineteen vaccines. And so these plans are outlines because obviously, 50 00:04:17,880 --> 00:04:21,719 Speaker 1: right now it's hard to give exact specifics on how 51 00:04:21,760 --> 00:04:24,839 Speaker 1: you'll distribute a vaccine that you don't know what the 52 00:04:24,880 --> 00:04:27,640 Speaker 1: storage requirements will be, when it will be here, how 53 00:04:27,720 --> 00:04:31,440 Speaker 1: much of it you'll have. So the CDC gave states 54 00:04:32,080 --> 00:04:35,840 Speaker 1: a playbook to use to help prepare these plans. And 55 00:04:35,880 --> 00:04:39,160 Speaker 1: so the states will use those use that playbook to 56 00:04:39,279 --> 00:04:43,600 Speaker 1: compile their rough plans and share those with the CDC. 57 00:04:45,080 --> 00:04:48,760 Speaker 1: Now this this might sound a bit obvious, but how 58 00:04:49,520 --> 00:04:53,320 Speaker 1: exactly can states plan for a vaccine that doesn't exist yet? 59 00:04:54,640 --> 00:04:57,839 Speaker 1: That's not at all obvious. This is a big question 60 00:04:57,920 --> 00:05:02,240 Speaker 1: that states and other experts that I've spoken to talk about. 61 00:05:02,320 --> 00:05:06,880 Speaker 1: And states have done this before. They help vaccinate people 62 00:05:06,960 --> 00:05:10,560 Speaker 1: every single year for flu shots. They've been involved with 63 00:05:10,680 --> 00:05:13,640 Speaker 1: the H one N one pandemic, so this is not 64 00:05:13,880 --> 00:05:18,880 Speaker 1: new to them, so they know how to run mass vaccination. However, 65 00:05:19,480 --> 00:05:22,160 Speaker 1: this one, of course, is different because the scale will 66 00:05:22,200 --> 00:05:25,080 Speaker 1: be much larger, and like you said, we don't know 67 00:05:25,440 --> 00:05:30,040 Speaker 1: which vaccines, if any, will be approved when and what 68 00:05:30,160 --> 00:05:34,360 Speaker 1: the requirements will be. So they're using their previous experiences 69 00:05:34,440 --> 00:05:37,560 Speaker 1: and taking the mass vaccination plans that they already have, 70 00:05:38,320 --> 00:05:42,760 Speaker 1: refreshing them and planning really scenarios. So and some of 71 00:05:42,800 --> 00:05:46,760 Speaker 1: the plans um they'll talk about if this happens, we 72 00:05:46,800 --> 00:05:49,839 Speaker 1: will do this, and here is what we're thinking. Now 73 00:05:50,000 --> 00:05:54,240 Speaker 1: this is to be determined. So these are really blueprints, 74 00:05:54,320 --> 00:05:57,080 Speaker 1: we can call them. They have a lot of details 75 00:05:57,160 --> 00:06:00,200 Speaker 1: based on their previous experience and what we know of 76 00:06:00,200 --> 00:06:04,760 Speaker 1: the vaccine candidates look like, but there are still tvds 77 00:06:04,760 --> 00:06:08,919 Speaker 1: that they need to figure out. And you mentioned this 78 00:06:09,200 --> 00:06:14,280 Speaker 1: CDC playbook. Are there any hard and fast requirements that 79 00:06:14,839 --> 00:06:17,479 Speaker 1: is in this playbook that all the states have to 80 00:06:17,520 --> 00:06:21,760 Speaker 1: adhere to. So the states are using the information that 81 00:06:21,880 --> 00:06:25,200 Speaker 1: is provided in the playbook to form their proposals here 82 00:06:25,400 --> 00:06:29,240 Speaker 1: their plans, and so there are some things that they 83 00:06:29,279 --> 00:06:31,800 Speaker 1: will have to do. So, for example, there are reporting 84 00:06:31,800 --> 00:06:35,480 Speaker 1: requirements that say, you know, they dictate how often they 85 00:06:35,520 --> 00:06:38,599 Speaker 1: need to be communicating with the CDC to make sure 86 00:06:38,760 --> 00:06:42,200 Speaker 1: that all of the states are sharing their information about 87 00:06:42,520 --> 00:06:45,880 Speaker 1: how many people are getting vaccinated, who's getting vaccinated with what, 88 00:06:46,120 --> 00:06:49,120 Speaker 1: how many supplies they have. So those are some of 89 00:06:49,160 --> 00:06:53,200 Speaker 1: the requirements that all of the states are really required 90 00:06:53,240 --> 00:06:57,480 Speaker 1: to do. However, the other things are more of guidelines 91 00:06:57,640 --> 00:07:00,640 Speaker 1: about um and that's where things can get tricky. So, 92 00:07:01,000 --> 00:07:03,440 Speaker 1: based on what we know now, there will be different 93 00:07:03,480 --> 00:07:07,640 Speaker 1: priority groups, so essential workers, healthcare workers, and the CDC 94 00:07:07,920 --> 00:07:11,000 Speaker 1: recommends that the states figure out how many of these 95 00:07:11,000 --> 00:07:15,080 Speaker 1: populations are in their states, but that can obviously vary 96 00:07:15,240 --> 00:07:18,720 Speaker 1: based on what types of healthcare workers you're talking about. 97 00:07:18,760 --> 00:07:22,480 Speaker 1: How do you define essential workers? You know, essential worker 98 00:07:22,560 --> 00:07:26,040 Speaker 1: might be different in New York City versus Arkansas. As 99 00:07:26,520 --> 00:07:28,640 Speaker 1: one person told me, so these are some of the 100 00:07:29,280 --> 00:07:33,720 Speaker 1: variations that they are working through. So it sounds like 101 00:07:33,760 --> 00:07:39,040 Speaker 1: there might be fifty potential different plans in terms of 102 00:07:39,200 --> 00:07:45,640 Speaker 1: distribution and priorities. That sounds like it might create serious issues. 103 00:07:45,680 --> 00:07:48,280 Speaker 1: I was just wondering, maybe if you could unpack a 104 00:07:48,320 --> 00:07:52,520 Speaker 1: little bit, what might be some problems that arise in 105 00:07:52,640 --> 00:07:56,040 Speaker 1: terms of how one state's plan might differ from another 106 00:07:56,120 --> 00:08:00,240 Speaker 1: state's plan. Right, And that's a really good question. And 107 00:08:00,440 --> 00:08:03,480 Speaker 1: one person I talked to had mentioned that the issue 108 00:08:03,520 --> 00:08:05,960 Speaker 1: here that states are facing right now is that it's 109 00:08:06,040 --> 00:08:09,840 Speaker 1: really a top down approach where the federal government is saying, 110 00:08:10,560 --> 00:08:13,360 Speaker 1: here the requirements we need from you, when really it 111 00:08:13,400 --> 00:08:16,480 Speaker 1: should be a bottom up approach, if that makes sense. 112 00:08:16,520 --> 00:08:19,480 Speaker 1: So this is obviously a local effort um, and so 113 00:08:19,560 --> 00:08:24,160 Speaker 1: there should be some variation here because priorities in one 114 00:08:24,160 --> 00:08:27,880 Speaker 1: state might be different than another state. So that's natural. However, 115 00:08:28,120 --> 00:08:32,199 Speaker 1: the CDC and Operation Warp Speed are asking for all 116 00:08:32,240 --> 00:08:36,520 Speaker 1: these answers to these questions that might really vary state 117 00:08:36,559 --> 00:08:41,199 Speaker 1: by state. Naturally there will be some differences here. Um. 118 00:08:41,240 --> 00:08:44,120 Speaker 1: But then one of the big questions about the differences 119 00:08:44,160 --> 00:08:47,319 Speaker 1: and the plans are with data, because all of these 120 00:08:47,360 --> 00:08:52,320 Speaker 1: states already have their own data reporting systems to track vaccines, 121 00:08:52,920 --> 00:08:56,319 Speaker 1: and the CDC is offering its own version for them 122 00:08:56,360 --> 00:08:59,280 Speaker 1: to use and hope in hopes of creating more of 123 00:08:59,280 --> 00:09:02,920 Speaker 1: a federal database, But some states don't want to use that. 124 00:09:03,000 --> 00:09:05,480 Speaker 1: They say, we have our own. It's hard enough to 125 00:09:05,520 --> 00:09:08,880 Speaker 1: get providers to enroll in that. We're just getting them 126 00:09:08,920 --> 00:09:12,600 Speaker 1: comfortable with reporting UM into this new system. We're not 127 00:09:12,679 --> 00:09:15,720 Speaker 1: adding another system. So we're already seeing some of this 128 00:09:15,840 --> 00:09:19,920 Speaker 1: tension between the state and federal effort, and then of 129 00:09:19,960 --> 00:09:23,320 Speaker 1: course that creates differences among all of the different states 130 00:09:23,360 --> 00:09:26,520 Speaker 1: and how exactly they'll do this. There does seem to 131 00:09:26,559 --> 00:09:31,440 Speaker 1: be a natural tension there that states might report a 132 00:09:31,520 --> 00:09:35,520 Speaker 1: higher population of you know, frontline healthcare workers than another 133 00:09:35,640 --> 00:09:41,120 Speaker 1: state and receive than more vaccine than another state. Are 134 00:09:41,160 --> 00:09:43,839 Speaker 1: are we looking at that kind of potential situation where 135 00:09:43,880 --> 00:09:48,800 Speaker 1: states might have to justify receiving more amounts of the 136 00:09:48,880 --> 00:09:53,240 Speaker 1: vaccine before another state. So the state officials I spoke 137 00:09:53,280 --> 00:09:56,400 Speaker 1: to said that they are not yet sure how the allocation, 138 00:09:56,840 --> 00:09:59,760 Speaker 1: meaning how many doses they will receive, will be determined 139 00:10:00,240 --> 00:10:02,520 Speaker 1: in the past, where H one N one, for example, 140 00:10:02,720 --> 00:10:06,200 Speaker 1: it was equal. Every state got the same amount, at 141 00:10:06,280 --> 00:10:09,760 Speaker 1: least at first, and there's questions of whether it will 142 00:10:09,800 --> 00:10:13,040 Speaker 1: be different this time, especially because they are required to 143 00:10:13,800 --> 00:10:17,000 Speaker 1: estimate the sizes of those different populations that you mentioned, 144 00:10:17,080 --> 00:10:21,319 Speaker 1: the essential workers healthcare workers, so there is an open 145 00:10:21,400 --> 00:10:24,840 Speaker 1: question of how much they'll receive. And that's why I 146 00:10:24,880 --> 00:10:28,320 Speaker 1: think now the CDC is asking, hey, can you please 147 00:10:28,480 --> 00:10:32,679 Speaker 1: estimate these different populations and can you give us Can 148 00:10:32,720 --> 00:10:34,600 Speaker 1: you give us an idea of how many of these 149 00:10:34,640 --> 00:10:37,559 Speaker 1: people are in your state and how that information will 150 00:10:37,600 --> 00:10:40,040 Speaker 1: be used. We're not really sure yet, at least from 151 00:10:40,040 --> 00:10:45,600 Speaker 1: what I've heard. Just looking at one other potential logistical hurdle, 152 00:10:46,360 --> 00:10:49,600 Speaker 1: it seems that most of the vaccines in development currently 153 00:10:49,640 --> 00:10:54,560 Speaker 1: are two shot vaccines, requiring two doses. Essentially, that would 154 00:10:54,559 --> 00:10:59,920 Speaker 1: seem to add additional logistical hurdles in terms of getting 155 00:11:00,160 --> 00:11:03,880 Speaker 1: both shots. There is a lot of discussion about that 156 00:11:04,080 --> 00:11:07,480 Speaker 1: hurdle because I think the idea is that at the beginning, 157 00:11:07,520 --> 00:11:10,439 Speaker 1: it might be easier if you have if you're vaccinating 158 00:11:10,800 --> 00:11:14,560 Speaker 1: healthcare workers. Let's say I'm a hospital, I call in 159 00:11:14,840 --> 00:11:19,439 Speaker 1: all of my emergency room staff let's say hypothetical, and 160 00:11:19,640 --> 00:11:21,680 Speaker 1: I know who they are, they work for me, I 161 00:11:21,720 --> 00:11:23,680 Speaker 1: can track them tell them to come back. So I 162 00:11:23,720 --> 00:11:26,679 Speaker 1: think at the beginning it might be a little bit easier. 163 00:11:26,720 --> 00:11:29,760 Speaker 1: But there are real questions of what happens once you 164 00:11:29,840 --> 00:11:33,240 Speaker 1: start broadening the scope of this um and so people 165 00:11:33,280 --> 00:11:36,160 Speaker 1: are thinking a lot about that. How do you make 166 00:11:36,200 --> 00:11:39,560 Speaker 1: sure that you prompt people to come back and you 167 00:11:39,679 --> 00:11:43,280 Speaker 1: track which vaccine they received, Because that's another important factor 168 00:11:43,320 --> 00:11:46,080 Speaker 1: here is we don't know how these vaccines will work 169 00:11:46,160 --> 00:11:50,200 Speaker 1: when they're used together. We know, of course, the manufacturers 170 00:11:50,200 --> 00:11:54,960 Speaker 1: are studying how their vaccine performs when you get multiple doses, 171 00:11:55,240 --> 00:11:58,600 Speaker 1: but they're not studying how getting their dose for the 172 00:11:58,640 --> 00:12:02,360 Speaker 1: first shot and then another vaccine for your second dose, 173 00:12:02,640 --> 00:12:05,520 Speaker 1: how that will perform. So that's another big issue here 174 00:12:05,559 --> 00:12:10,000 Speaker 1: that people are talking a lot about. And finally, so 175 00:12:10,160 --> 00:12:12,839 Speaker 1: this Friday is only a few days away, the states 176 00:12:12,840 --> 00:12:18,240 Speaker 1: will submit their plans. What happens next. So the people 177 00:12:18,360 --> 00:12:22,119 Speaker 1: I spoke to from the different states say that they 178 00:12:22,160 --> 00:12:25,880 Speaker 1: assume this is a big assumption that these plans will 179 00:12:25,960 --> 00:12:30,760 Speaker 1: really be drafts, because the idea was that these states 180 00:12:30,800 --> 00:12:34,520 Speaker 1: were supposed to submit their plans early in the event 181 00:12:34,760 --> 00:12:38,880 Speaker 1: that we had a vaccine available in early November, which, 182 00:12:39,080 --> 00:12:41,240 Speaker 1: based on the new guidelines from the f d A, 183 00:12:41,520 --> 00:12:45,120 Speaker 1: is all but certain that will not happen. So now 184 00:12:45,160 --> 00:12:47,640 Speaker 1: I think people are breathing a little bit easier, thinking 185 00:12:47,679 --> 00:12:51,040 Speaker 1: they have more time to refine these plans as they 186 00:12:51,040 --> 00:12:55,080 Speaker 1: answer the outstanding questions. So the idea, at least among 187 00:12:55,120 --> 00:12:57,400 Speaker 1: the States is that they will have time to take 188 00:12:57,400 --> 00:13:00,600 Speaker 1: a breath, review the plans and see how they need 189 00:13:00,679 --> 00:13:10,600 Speaker 1: to refine them. From here. That was Angelica Levito, and 190 00:13:10,679 --> 00:13:13,160 Speaker 1: that's it for our show today. For coverage of the 191 00:13:13,160 --> 00:13:16,600 Speaker 1: outbreak from one and twenty bureaus around the world, visit 192 00:13:16,679 --> 00:13:21,559 Speaker 1: bloomberg dot com slash coronavirus and if you like the show, 193 00:13:21,920 --> 00:13:24,440 Speaker 1: please leave us a review and a rating on Apple 194 00:13:24,520 --> 00:13:28,000 Speaker 1: Podcasts or Spotify. It's the best way to help more 195 00:13:28,040 --> 00:13:32,920 Speaker 1: listeners find our global reporting. The Prognosis Daily edition is 196 00:13:32,960 --> 00:13:37,760 Speaker 1: produced by top foreheads Jordan Gospore, Magnus Hendrickson and me 197 00:13:38,400 --> 00:13:42,800 Speaker 1: Laura Carlson. Today's main story was reported by Angelica Levito. 198 00:13:43,559 --> 00:13:47,880 Speaker 1: Original music by Leo Sedrin. Our editors are Rick Shine 199 00:13:47,880 --> 00:13:52,960 Speaker 1: and Francesca Levi. Francesco Levi is Bloomberg's head of podcasts. 200 00:13:53,559 --> 00:14:17,160 Speaker 1: Thanks for listening, L