WEBVTT - U.S. Vaccine Distribution Strategy is a Mess

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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 seventeen since coronavirus was declared a global pandemic. Today's

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<v Speaker 1>main story in the US, it's up to individual states

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<v Speaker 1>to develop plans for distributing a vaccine once one is available.

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<v Speaker 1>But now they face intense time pressure to develop their strategies,

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<v Speaker 1>and they're flying blind without necessary information about the type

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<v Speaker 1>and timing of the vaccines they'll be offering. But first,

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<v Speaker 1>here's what happened in Virus News Today. Food and Drug

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<v Speaker 1>Administration Commissioner Stephen Hahn said that the recent pauses in

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<v Speaker 1>several clinical trial else are a necessary step to making

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<v Speaker 1>sure any COVID nineteen vaccine or therapy will be safe.

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<v Speaker 1>In an interview with Bloomberg Today, Hans said that recent

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<v Speaker 1>stops to clinical studies of vaccines and antibody treatments by

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<v Speaker 1>Johnson and Johnson, Eli Lily and Astra Zeneca are normal.

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<v Speaker 1>The system, he said, is designed this way to identify

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<v Speaker 1>safety issues and protect participants, but also to find the

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<v Speaker 1>right treatments and vaccines. In the end, a surge in

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<v Speaker 1>coronavirus infections in the US is threatening the very survival

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<v Speaker 1>of hospitals just when the country needs the most. Hundreds

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<v Speaker 1>of facilities were already on shaky financial ground before the virus,

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<v Speaker 1>and the impact of caring for COVID patients has put

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<v Speaker 1>hundreds more in jeopardy. The pandemic sidelined profitable elective procedures

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<v Speaker 1>and pushed up costs to keep patients and staff safe. Meanwhile,

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<v Speaker 1>hospitals are losing the privately insured patients they depend on

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<v Speaker 1>as millions of Americans lose their jobs and their employer

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<v Speaker 1>sponsored coverage. The American Hospital Association estimates the pandemic will

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<v Speaker 1>cost US hospitals more than three hundred and twenty three

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<v Speaker 1>billion dollars by the end of the year. The industry

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<v Speaker 1>group is asking Congress for an additional one hundred billion

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<v Speaker 1>dollars and full forgiveness of loans made under Medicare's Accelerated

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<v Speaker 1>Payment Program, among other requests for relief. Finally, i Ran

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<v Speaker 1>announced a travel ban to and from five major cities,

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<v Speaker 1>including the capital Tehran, over an extended holiday weekend, as

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<v Speaker 1>part of measures to curb COVID spread. The restriction comes

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<v Speaker 1>into effect tomorrow, amid a record spike in the country's

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<v Speaker 1>coronavirus fatalities and rising new cases. And now for today's

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<v Speaker 1>main story, States are racing the clock to meet a

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<v Speaker 1>Friday deadline. That's when the federal government says they must

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<v Speaker 1>submit their plans to distribute a vaccine once an effective

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<v Speaker 1>one is ready. But Angelica Levita reports that they're putting

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<v Speaker 1>together the strategies effectively blindfolded. State health officials have no

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<v Speaker 1>clue which vaccine they will be distributing, nor when or

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<v Speaker 1>even if a vaccine will be forthcoming. I talked to

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<v Speaker 1>Angelica today about the problems with this state by state

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<v Speaker 1>strategy in terms of getting the US ready for a

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<v Speaker 1>COVID nineteen vaccine. What's the significance of this Friday oct

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<v Speaker 1>The states are required to submit their plans to the

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<v Speaker 1>CDC detailing how they plan to distribute and administer COVID

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<v Speaker 1>nineteen vaccines. And so these plans are outlines because obviously,

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<v Speaker 1>right now it's hard to give exact specifics on how

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<v Speaker 1>you'll distribute a vaccine that you don't know what the

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<v Speaker 1>storage requirements will be, when it will be here, how

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<v Speaker 1>much of it you'll have. So the CDC gave states

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<v Speaker 1>a playbook to use to help prepare these plans. And

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<v Speaker 1>so the states will use those use that playbook to

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<v Speaker 1>compile their rough plans and share those with the CDC.

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<v Speaker 1>Now this this might sound a bit obvious, but how

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<v Speaker 1>exactly can states plan for a vaccine that doesn't exist yet?

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<v Speaker 1>That's not at all obvious. This is a big question

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<v Speaker 1>that states and other experts that I've spoken to talk about.

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<v Speaker 1>And states have done this before. They help vaccinate people

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<v Speaker 1>every single year for flu shots. They've been involved with

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<v Speaker 1>the H one N one pandemic, so this is not

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<v Speaker 1>new to them, so they know how to run mass vaccination. However,

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<v Speaker 1>this one, of course, is different because the scale will

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<v Speaker 1>be much larger, and like you said, we don't know

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<v Speaker 1>which vaccines, if any, will be approved when and what

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<v Speaker 1>the requirements will be. So they're using their previous experiences

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<v Speaker 1>and taking the mass vaccination plans that they already have,

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<v Speaker 1>refreshing them and planning really scenarios. So and some of

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<v Speaker 1>the plans um they'll talk about if this happens, we

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<v Speaker 1>will do this, and here is what we're thinking. Now

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<v Speaker 1>this is to be determined. So these are really blueprints,

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<v Speaker 1>we can call them. They have a lot of details

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<v Speaker 1>based on their previous experience and what we know of

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<v Speaker 1>the vaccine candidates look like, but there are still tvds

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<v Speaker 1>that they need to figure out. And you mentioned this

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<v Speaker 1>CDC playbook. Are there any hard and fast requirements that

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<v Speaker 1>is in this playbook that all the states have to

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<v Speaker 1>adhere to. So the states are using the information that

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<v Speaker 1>is provided in the playbook to form their proposals here

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<v Speaker 1>their plans, and so there are some things that they

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<v Speaker 1>will have to do. So, for example, there are reporting

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<v Speaker 1>requirements that say, you know, they dictate how often they

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<v Speaker 1>need to be communicating with the CDC to make sure

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<v Speaker 1>that all of the states are sharing their information about

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<v Speaker 1>how many people are getting vaccinated, who's getting vaccinated with what,

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<v Speaker 1>how many supplies they have. So those are some of

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<v Speaker 1>the requirements that all of the states are really required

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<v Speaker 1>to do. However, the other things are more of guidelines

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<v Speaker 1>about um and that's where things can get tricky. So,

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<v Speaker 1>based on what we know now, there will be different

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<v Speaker 1>priority groups, so essential workers, healthcare workers, and the CDC

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<v Speaker 1>recommends that the states figure out how many of these

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<v Speaker 1>populations are in their states, but that can obviously vary

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<v Speaker 1>based on what types of healthcare workers you're talking about.

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<v Speaker 1>How do you define essential workers? You know, essential worker

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<v Speaker 1>might be different in New York City versus Arkansas. As

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<v Speaker 1>one person told me, so these are some of the

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<v Speaker 1>variations that they are working through. So it sounds like

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<v Speaker 1>there might be fifty potential different plans in terms of

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<v Speaker 1>distribution and priorities. That sounds like it might create serious issues.

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<v Speaker 1>I was just wondering, maybe if you could unpack a

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<v Speaker 1>little bit, what might be some problems that arise in

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<v Speaker 1>terms of how one state's plan might differ from another

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<v Speaker 1>state's plan. Right, And that's a really good question. And

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<v Speaker 1>one person I talked to had mentioned that the issue

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<v Speaker 1>here that states are facing right now is that it's

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<v Speaker 1>really a top down approach where the federal government is saying,

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<v Speaker 1>here the requirements we need from you, when really it

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<v Speaker 1>should be a bottom up approach, if that makes sense.

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<v Speaker 1>So this is obviously a local effort um, and so

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<v Speaker 1>there should be some variation here because priorities in one

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<v Speaker 1>state might be different than another state. So that's natural. However,

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<v Speaker 1>the CDC and Operation Warp Speed are asking for all

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<v Speaker 1>these answers to these questions that might really vary state

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<v Speaker 1>by state. Naturally there will be some differences here. Um.

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<v Speaker 1>But then one of the big questions about the differences

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<v Speaker 1>and the plans are with data, because all of these

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<v Speaker 1>states already have their own data reporting systems to track vaccines,

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<v Speaker 1>and the CDC is offering its own version for them

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<v Speaker 1>to use and hope in hopes of creating more of

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<v Speaker 1>a federal database, But some states don't want to use that.

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<v Speaker 1>They say, we have our own. It's hard enough to

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<v Speaker 1>get providers to enroll in that. We're just getting them

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<v Speaker 1>comfortable with reporting UM into this new system. We're not

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<v Speaker 1>adding another system. So we're already seeing some of this

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<v Speaker 1>tension between the state and federal effort, and then of

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<v Speaker 1>course that creates differences among all of the different states

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<v Speaker 1>and how exactly they'll do this. There does seem to

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<v Speaker 1>be a natural tension there that states might report a

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<v Speaker 1>higher population of you know, frontline healthcare workers than another

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<v Speaker 1>state and receive than more vaccine than another state. Are

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<v Speaker 1>are we looking at that kind of potential situation where

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<v Speaker 1>states might have to justify receiving more amounts of the

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<v Speaker 1>vaccine before another state. So the state officials I spoke

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<v Speaker 1>to said that they are not yet sure how the allocation,

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<v Speaker 1>meaning how many doses they will receive, will be determined

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<v Speaker 1>in the past, where H one N one, for example,

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<v Speaker 1>it was equal. Every state got the same amount, at

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<v Speaker 1>least at first, and there's questions of whether it will

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<v Speaker 1>be different this time, especially because they are required to

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<v Speaker 1>estimate the sizes of those different populations that you mentioned,

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<v Speaker 1>the essential workers healthcare workers, so there is an open

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<v Speaker 1>question of how much they'll receive. And that's why I

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<v Speaker 1>think now the CDC is asking, hey, can you please

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<v Speaker 1>estimate these different populations and can you give us Can

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<v Speaker 1>you give us an idea of how many of these

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<v Speaker 1>people are in your state and how that information will

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<v Speaker 1>be used. We're not really sure yet, at least from

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<v Speaker 1>what I've heard. Just looking at one other potential logistical hurdle,

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<v Speaker 1>it seems that most of the vaccines in development currently

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<v Speaker 1>are two shot vaccines, requiring two doses. Essentially, that would

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<v Speaker 1>seem to add additional logistical hurdles in terms of getting

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<v Speaker 1>both shots. There is a lot of discussion about that

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<v Speaker 1>hurdle because I think the idea is that at the beginning,

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<v Speaker 1>it might be easier if you have if you're vaccinating

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<v Speaker 1>healthcare workers. Let's say I'm a hospital, I call in

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<v Speaker 1>all of my emergency room staff let's say hypothetical, and

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<v Speaker 1>I know who they are, they work for me, I

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<v Speaker 1>can track them tell them to come back. So I

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<v Speaker 1>think at the beginning it might be a little bit easier.

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<v Speaker 1>But there are real questions of what happens once you

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<v Speaker 1>start broadening the scope of this um and so people

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<v Speaker 1>are thinking a lot about that. How do you make

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<v Speaker 1>sure that you prompt people to come back and you

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<v Speaker 1>track which vaccine they received, Because that's another important factor

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<v Speaker 1>here is we don't know how these vaccines will work

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<v Speaker 1>when they're used together. We know, of course, the manufacturers

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<v Speaker 1>are studying how their vaccine performs when you get multiple doses,

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<v Speaker 1>but they're not studying how getting their dose for the

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<v Speaker 1>first shot and then another vaccine for your second dose,

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<v Speaker 1>how that will perform. So that's another big issue here

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<v Speaker 1>that people are talking a lot about. And finally, so

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<v Speaker 1>this Friday is only a few days away, the states

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<v Speaker 1>will submit their plans. What happens next. So the people

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<v Speaker 1>I spoke to from the different states say that they

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<v Speaker 1>assume this is a big assumption that these plans will

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<v Speaker 1>really be drafts, because the idea was that these states

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<v Speaker 1>were supposed to submit their plans early in the event

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<v Speaker 1>that we had a vaccine available in early November, which,

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<v Speaker 1>based on the new guidelines from the f d A,

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<v Speaker 1>is all but certain that will not happen. So now

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<v Speaker 1>I think people are breathing a little bit easier, thinking

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<v Speaker 1>they have more time to refine these plans as they

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<v Speaker 1>answer the outstanding questions. So the idea, at least among

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<v Speaker 1>the States is that they will have time to take

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<v Speaker 1>a breath, review the plans and see how they need

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<v Speaker 1>to refine them. From here. That was Angelica Levito, and

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<v Speaker 1>that's it for our show today. For coverage of the

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<v Speaker 1>outbreak from one and twenty bureaus around the world, visit

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

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

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

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

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<v Speaker 1>produced by top foreheads Jordan Gospore, Magnus Hendrickson and me

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

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

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

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<v Speaker 1>Thanks for listening, L