Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day two hundred
Speaker 1: and seventeen since coronavirus was declared a global pandemic. Today's
Speaker 1: main story in the US, it's up to individual states
Speaker 1: to develop plans for distributing a vaccine once one is available.
Speaker 1: But now they face intense time pressure to develop their strategies,
Speaker 1: and they're flying blind without necessary information about the type
Speaker 1: and timing of the vaccines they'll be offering. But first,
Speaker 1: here's what happened in Virus News Today. Food and Drug
Speaker 1: Administration Commissioner Stephen Hahn said that the recent pauses in
Speaker 1: several clinical trial else are a necessary step to making
Speaker 1: sure any COVID nineteen vaccine or therapy will be safe.
Speaker 1: In an interview with Bloomberg Today, Hans said that recent
Speaker 1: stops to clinical studies of vaccines and antibody treatments by
Speaker 1: Johnson and Johnson, Eli Lily and Astra Zeneca are normal.
Speaker 1: The system, he said, is designed this way to identify
Speaker 1: safety issues and protect participants, but also to find the
Speaker 1: right treatments and vaccines. In the end, a surge in
Speaker 1: coronavirus infections in the US is threatening the very survival
Speaker 1: of hospitals just when the country needs the most. Hundreds
Speaker 1: of facilities were already on shaky financial ground before the virus,
Speaker 1: and the impact of caring for COVID patients has put
Speaker 1: hundreds more in jeopardy. The pandemic sidelined profitable elective procedures
Speaker 1: and pushed up costs to keep patients and staff safe. Meanwhile,
Speaker 1: hospitals are losing the privately insured patients they depend on
Speaker 1: as millions of Americans lose their jobs and their employer
Speaker 1: sponsored coverage. The American Hospital Association estimates the pandemic will
Speaker 1: cost US hospitals more than three hundred and twenty three
Speaker 1: billion dollars by the end of the year. The industry
Speaker 1: group is asking Congress for an additional one hundred billion
Speaker 1: dollars and full forgiveness of loans made under Medicare's Accelerated
Speaker 1: Payment Program, among other requests for relief. Finally, i Ran
Speaker 1: announced a travel ban to and from five major cities,
Speaker 1: including the capital Tehran, over an extended holiday weekend, as
Speaker 1: part of measures to curb COVID spread. The restriction comes
Speaker 1: into effect tomorrow, amid a record spike in the country's
Speaker 1: coronavirus fatalities and rising new cases. And now for today's
Speaker 1: main story, States are racing the clock to meet a
Speaker 1: Friday deadline. That's when the federal government says they must
Speaker 1: submit their plans to distribute a vaccine once an effective
Speaker 1: one is ready. But Angelica Levita reports that they're putting
Speaker 1: together the strategies effectively blindfolded. State health officials have no
Speaker 1: clue which vaccine they will be distributing, nor when or
Speaker 1: even if a vaccine will be forthcoming. I talked to
Speaker 1: Angelica today about the problems with this state by state
Speaker 1: strategy in terms of getting the US ready for a
Speaker 1: COVID nineteen vaccine. What's the significance of this Friday oct
Speaker 1: The states are required to submit their plans to the
Speaker 1: CDC detailing how they plan to distribute and administer COVID
Speaker 1: nineteen vaccines. And so these plans are outlines because obviously,
Speaker 1: right now it's hard to give exact specifics on how
Speaker 1: you'll distribute a vaccine that you don't know what the
Speaker 1: storage requirements will be, when it will be here, how
Speaker 1: much of it you'll have. So the CDC gave states
Speaker 1: a playbook to use to help prepare these plans. And
Speaker 1: so the states will use those use that playbook to
Speaker 1: compile their rough plans and share those with the CDC.
Speaker 1: Now this this might sound a bit obvious, but how
Speaker 1: exactly can states plan for a vaccine that doesn't exist yet?
Speaker 1: That's not at all obvious. This is a big question
Speaker 1: that states and other experts that I've spoken to talk about.
Speaker 1: And states have done this before. They help vaccinate people
Speaker 1: every single year for flu shots. They've been involved with
Speaker 1: the H one N one pandemic, so this is not
Speaker 1: new to them, so they know how to run mass vaccination. However,
Speaker 1: this one, of course, is different because the scale will
Speaker 1: be much larger, and like you said, we don't know
Speaker 1: which vaccines, if any, will be approved when and what
Speaker 1: the requirements will be. So they're using their previous experiences
Speaker 1: and taking the mass vaccination plans that they already have,
Speaker 1: refreshing them and planning really scenarios. So and some of
Speaker 1: the plans um they'll talk about if this happens, we
Speaker 1: will do this, and here is what we're thinking. Now
Speaker 1: this is to be determined. So these are really blueprints,
Speaker 1: we can call them. They have a lot of details
Speaker 1: based on their previous experience and what we know of
Speaker 1: the vaccine candidates look like, but there are still tvds
Speaker 1: that they need to figure out. And you mentioned this
Speaker 1: CDC playbook. Are there any hard and fast requirements that
Speaker 1: is in this playbook that all the states have to
Speaker 1: adhere to. So the states are using the information that
Speaker 1: is provided in the playbook to form their proposals here
Speaker 1: their plans, and so there are some things that they
Speaker 1: will have to do. So, for example, there are reporting
Speaker 1: requirements that say, you know, they dictate how often they
Speaker 1: need to be communicating with the CDC to make sure
Speaker 1: that all of the states are sharing their information about
Speaker 1: how many people are getting vaccinated, who's getting vaccinated with what,
Speaker 1: how many supplies they have. So those are some of
Speaker 1: the requirements that all of the states are really required
Speaker 1: to do. However, the other things are more of guidelines
Speaker 1: about um and that's where things can get tricky. So,
Speaker 1: based on what we know now, there will be different
Speaker 1: priority groups, so essential workers, healthcare workers, and the CDC
Speaker 1: recommends that the states figure out how many of these
Speaker 1: populations are in their states, but that can obviously vary
Speaker 1: based on what types of healthcare workers you're talking about.
Speaker 1: How do you define essential workers? You know, essential worker
Speaker 1: might be different in New York City versus Arkansas. As
Speaker 1: one person told me, so these are some of the
Speaker 1: variations that they are working through. So it sounds like
Speaker 1: there might be fifty potential different plans in terms of
Speaker 1: distribution and priorities. That sounds like it might create serious issues.
Speaker 1: I was just wondering, maybe if you could unpack a
Speaker 1: little bit, what might be some problems that arise in
Speaker 1: terms of how one state's plan might differ from another
Speaker 1: state's plan. Right, And that's a really good question. And
Speaker 1: one person I talked to had mentioned that the issue
Speaker 1: here that states are facing right now is that it's
Speaker 1: really a top down approach where the federal government is saying,
Speaker 1: here the requirements we need from you, when really it
Speaker 1: should be a bottom up approach, if that makes sense.
Speaker 1: So this is obviously a local effort um, and so
Speaker 1: there should be some variation here because priorities in one
Speaker 1: state might be different than another state. So that's natural. However,
Speaker 1: the CDC and Operation Warp Speed are asking for all
Speaker 1: these answers to these questions that might really vary state
Speaker 1: by state. Naturally there will be some differences here. Um.
Speaker 1: But then one of the big questions about the differences
Speaker 1: and the plans are with data, because all of these
Speaker 1: states already have their own data reporting systems to track vaccines,
Speaker 1: and the CDC is offering its own version for them
Speaker 1: to use and hope in hopes of creating more of
Speaker 1: a federal database, But some states don't want to use that.
Speaker 1: They say, we have our own. It's hard enough to
Speaker 1: get providers to enroll in that. We're just getting them
Speaker 1: comfortable with reporting UM into this new system. We're not
Speaker 1: adding another system. So we're already seeing some of this
Speaker 1: tension between the state and federal effort, and then of
Speaker 1: course that creates differences among all of the different states
Speaker 1: and how exactly they'll do this. There does seem to
Speaker 1: be a natural tension there that states might report a
Speaker 1: higher population of you know, frontline healthcare workers than another
Speaker 1: state and receive than more vaccine than another state. Are
Speaker 1: are we looking at that kind of potential situation where
Speaker 1: states might have to justify receiving more amounts of the
Speaker 1: vaccine before another state. So the state officials I spoke
Speaker 1: to said that they are not yet sure how the allocation,
Speaker 1: meaning how many doses they will receive, will be determined
Speaker 1: in the past, where H one N one, for example,
Speaker 1: it was equal. Every state got the same amount, at
Speaker 1: least at first, and there's questions of whether it will
Speaker 1: be different this time, especially because they are required to
Speaker 1: estimate the sizes of those different populations that you mentioned,
Speaker 1: the essential workers healthcare workers, so there is an open
Speaker 1: question of how much they'll receive. And that's why I
Speaker 1: think now the CDC is asking, hey, can you please
Speaker 1: estimate these different populations and can you give us Can
Speaker 1: you give us an idea of how many of these
Speaker 1: people are in your state and how that information will
Speaker 1: be used. We're not really sure yet, at least from
Speaker 1: what I've heard. Just looking at one other potential logistical hurdle,
Speaker 1: it seems that most of the vaccines in development currently
Speaker 1: are two shot vaccines, requiring two doses. Essentially, that would
Speaker 1: seem to add additional logistical hurdles in terms of getting
Speaker 1: both shots. There is a lot of discussion about that
Speaker 1: hurdle because I think the idea is that at the beginning,
Speaker 1: it might be easier if you have if you're vaccinating
Speaker 1: healthcare workers. Let's say I'm a hospital, I call in
Speaker 1: all of my emergency room staff let's say hypothetical, and
Speaker 1: I know who they are, they work for me, I
Speaker 1: can track them tell them to come back. So I
Speaker 1: think at the beginning it might be a little bit easier.
Speaker 1: But there are real questions of what happens once you
Speaker 1: start broadening the scope of this um and so people
Speaker 1: are thinking a lot about that. How do you make
Speaker 1: sure that you prompt people to come back and you
Speaker 1: track which vaccine they received, Because that's another important factor
Speaker 1: here is we don't know how these vaccines will work
Speaker 1: when they're used together. We know, of course, the manufacturers
Speaker 1: are studying how their vaccine performs when you get multiple doses,
Speaker 1: but they're not studying how getting their dose for the
Speaker 1: first shot and then another vaccine for your second dose,
Speaker 1: how that will perform. So that's another big issue here
Speaker 1: that people are talking a lot about. And finally, so
Speaker 1: this Friday is only a few days away, the states
Speaker 1: will submit their plans. What happens next. So the people
Speaker 1: I spoke to from the different states say that they
Speaker 1: assume this is a big assumption that these plans will
Speaker 1: really be drafts, because the idea was that these states
Speaker 1: were supposed to submit their plans early in the event
Speaker 1: that we had a vaccine available in early November, which,
Speaker 1: based on the new guidelines from the f d A,
Speaker 1: is all but certain that will not happen. So now
Speaker 1: I think people are breathing a little bit easier, thinking
Speaker 1: they have more time to refine these plans as they
Speaker 1: answer the outstanding questions. So the idea, at least among
Speaker 1: the States is that they will have time to take
Speaker 1: a breath, review the plans and see how they need
Speaker 1: to refine them. From here. That was Angelica Levito, and
Speaker 1: that's it for our show today. For coverage of the
Speaker 1: outbreak from one and twenty bureaus around the world, visit
Speaker 1: bloomberg dot com slash coronavirus and if you like the show,
Speaker 1: please leave us a review and a rating on Apple
Speaker 1: Podcasts or Spotify. It's the best way to help more
Speaker 1: listeners find our global reporting. The Prognosis Daily edition is
Speaker 1: produced by top foreheads Jordan Gospore, Magnus Hendrickson and me
Speaker 1: Laura Carlson. Today's main story was reported by Angelica Levito.
Speaker 1: Original music by Leo Sedrin. Our editors are Rick Shine
Speaker 1: and Francesca Levi. Francesco Levi is Bloomberg's head of podcasts.
Speaker 1: Thanks for listening, L