WEBVTT - The Struggle to Distribute the Vaccine 0:00:00.960 --> 0:00:05.680 Welcome to Prognosis. I'm Laura Carlson. It's day two hundred 0:00:05.720 --> 0:00:09.720 and sixty five since coronavirus was declared a global pandemic. 0:00:10.720 --> 0:00:15.040 Today's main story A vaccine is likely to start shipping 0:00:15.080 --> 0:00:18.320 around the US before the end of the year, but 0:00:18.520 --> 0:00:21.840 states are getting mixed messages from the federal government about 0:00:21.880 --> 0:00:25.159 how much of it they'll get, and that makes it 0:00:25.239 --> 0:00:28.560 hard to set up programs to give people the shots. 0:00:29.640 --> 0:00:38.640 But first, here's what happened in virus news today. Nations 0:00:38.720 --> 0:00:42.760 across Europe are pushing ahead with fast track vaccine programs. 0:00:43.440 --> 0:00:46.280 The UK has approved of vaccine and is hoping to 0:00:46.320 --> 0:00:51.440 inoculate millions of Britons before year end. Spain aims to 0:00:51.520 --> 0:00:55.640 vaccinate up to twenty billion people by June, and Sweden 0:00:55.720 --> 0:00:59.560 expects to get enough doses next quarter to immunize a 0:00:59.680 --> 0:01:06.120 fifth of its population. The US posted another day of 0:01:06.240 --> 0:01:12.360 record COVID nineteen infections and deaths. That comes as overburdened 0:01:12.400 --> 0:01:15.960 hospitals around the nation brace for a surge in cases 0:01:16.319 --> 0:01:22.759 after Thanksgiving. Coronavirus hospitalizations in New York topped four thousand 0:01:23.200 --> 0:01:27.840 for the first time since late May. New York City 0:01:27.880 --> 0:01:31.640 plans to partner with private companies to create an institute 0:01:31.640 --> 0:01:36.920 devoted to predicting and responding to future pandemics, according to 0:01:36.959 --> 0:01:43.440 the city's mayor, Build A Blasio. Finally, California, the first 0:01:43.440 --> 0:01:46.039 state to tell residents to stay home to fight the 0:01:46.040 --> 0:01:51.040 coronavirus pandemic, may be about to do it again. Governor 0:01:51.080 --> 0:01:54.520 Gavin Newsom warned Thursday that the state would impose a 0:01:54.600 --> 0:01:58.559 new shelter at Home order if hospitals start running short 0:01:58.640 --> 0:02:02.320 of intensive care capac city that could happen in some 0:02:02.400 --> 0:02:06.520 areas as soon as this week. The order would be 0:02:06.520 --> 0:02:12.040 imposed in specific regions rather than statewide. If imposed, the 0:02:12.160 --> 0:02:21.400 order would last three weeks. And now for today's main story. 0:02:22.639 --> 0:02:25.920 Weeks before states expect to receive their first shipments of 0:02:25.960 --> 0:02:30.320 COVID nineteen vaccines, they're getting conflicting messages from the federal 0:02:30.360 --> 0:02:36.000 government about exactly how many doses may arrive. Some governors 0:02:36.000 --> 0:02:39.360 have made splashy announcements about how much of FISER and 0:02:39.480 --> 0:02:42.520 bio en Tex vaccines they expect to get if the 0:02:42.639 --> 0:02:47.880 US Food and Drug Administration authorizes them this month. Other 0:02:48.000 --> 0:02:53.440 states can't provide a solid answer, but all of them 0:02:53.639 --> 0:02:58.360 must submit orders and distribution plans. Friday, I spoke with 0:02:58.440 --> 0:03:03.480 reporter Angelical loveto about how the shifting expectations are creating 0:03:03.639 --> 0:03:10.959 all sorts of problems. Over the past few weeks, there's 0:03:11.160 --> 0:03:14.280 been a lot of anticipation about the rollout of COVID 0:03:14.360 --> 0:03:19.799 nineteen vaccines, with first doses available potentially very soon, but 0:03:20.160 --> 0:03:24.400 the gargantuan task of supplying vaccines to all fifty states 0:03:24.560 --> 0:03:27.600 raises a lot of questions about how this is going 0:03:27.639 --> 0:03:32.040 to be achieved. What do we know about how states 0:03:32.080 --> 0:03:35.280 are liaising with the federal government in the US about 0:03:35.480 --> 0:03:39.440 how many doses they will need or the timeline for 0:03:39.480 --> 0:03:44.360 getting those doses. So we have heard from federal officials 0:03:44.840 --> 0:03:47.360 that at the very beginning, there will be six point 0:03:47.400 --> 0:03:53.200 four million of the fiser vaccine doses available, and those 0:03:53.400 --> 0:03:56.640 doses need to be spread out across all of the states, 0:03:56.880 --> 0:04:00.800 as well as a few cities and then oratories, as 0:04:00.840 --> 0:04:04.840 well as five federal agencies. So all of those doses 0:04:04.960 --> 0:04:07.360 need to get spread out, and from what we have 0:04:07.440 --> 0:04:11.280 heard is that the federal government is giving estimates to 0:04:11.640 --> 0:04:15.200 all of those jurisdictions. However, we've heard that some of 0:04:15.200 --> 0:04:19.120 those numbers have been changing, and that's very frustrating, as 0:04:19.160 --> 0:04:22.600 you can imagine if you're trying to plan exactly what 0:04:22.640 --> 0:04:25.560 you're getting and how you will build those out. As 0:04:25.600 --> 0:04:29.800 of today, all of those jurisdictions should have received their 0:04:29.839 --> 0:04:33.320 final numbers because they need to place their initial orders 0:04:33.600 --> 0:04:37.719 today as in Friday. That way, the federal government knows 0:04:37.760 --> 0:04:42.159 exactly who wants what day one, so as soon as 0:04:42.200 --> 0:04:48.800 the FDA authorizes a vaccine, those shipments will start going out. Now, 0:04:48.839 --> 0:04:51.480 there are a lot of numbers and a lot of 0:04:51.600 --> 0:04:55.800 math involved in these calculations, obviously, and in terms of 0:04:55.839 --> 0:05:01.280 the individual states, how are they supp hosts to really 0:05:01.320 --> 0:05:04.640 calculate how many doses of the vaccine they will need. 0:05:06.040 --> 0:05:09.200 So that's a very good question, and unfortunately we have 0:05:09.279 --> 0:05:12.119 had a hard time figuring that out. We have asked 0:05:12.160 --> 0:05:17.039 Operation warp Speed exactly how those doses will be allocated, 0:05:17.360 --> 0:05:19.640 and it should be a simple math problem. There's six 0:05:19.680 --> 0:05:24.480 point four million doses available initially, and those are supposed 0:05:24.520 --> 0:05:29.840 to be allocated by the adult population in each jurisdiction, 0:05:30.279 --> 0:05:32.760 so the number of people you have over the age 0:05:32.760 --> 0:05:37.200 of eighteen. However, we've asked for the master list of 0:05:37.520 --> 0:05:41.040 the allocations across the states and the five federal agencies, 0:05:41.360 --> 0:05:43.559 and we were not able to get such a list. 0:05:44.040 --> 0:05:47.520 So it's a little difficult to figure out exactly how 0:05:48.080 --> 0:05:53.320 those how those doses are being distributed. We've gotten numbers 0:05:53.360 --> 0:05:56.159 from different states saying that these are the numbers we've 0:05:56.160 --> 0:05:59.040 received from the federal government. However, we have not been 0:05:59.080 --> 0:06:02.719 able to get of a comprehensive list, and so it 0:06:02.800 --> 0:06:06.840 sounds like there there isn't a unilateral confirmation that if 0:06:06.839 --> 0:06:10.640 a state says it needs so many doses, that may 0:06:10.720 --> 0:06:15.080 not be the amount of doses they get right. And so, 0:06:15.200 --> 0:06:17.840 for example, we reached out to a bunch of different 0:06:17.880 --> 0:06:20.680 states in Michigan said that they couldn't give us a 0:06:20.680 --> 0:06:24.040 concrete number because in the past several days alone they 0:06:24.080 --> 0:06:26.920 had heard everything from a couple hundred thousand doses to 0:06:27.080 --> 0:06:30.320 under ninety thousand, and so, as you can imagine, that's 0:06:30.360 --> 0:06:34.480 pretty frustrating if you're a state. However, it's almost certain 0:06:34.520 --> 0:06:38.120 that no state will receive enough vaccine doses right at 0:06:38.120 --> 0:06:41.600 the beginning to vaccinate even the priority group that they 0:06:41.600 --> 0:06:44.680 are supposed to start with, which is healthcare workers and 0:06:44.880 --> 0:06:48.040 long term care residents. And we've already seen an example 0:06:48.160 --> 0:06:51.720 of at least one state lobbying for more than it's 0:06:51.720 --> 0:06:55.480 supposed to get. So we have Wisconsin yesterday, the Democratic 0:06:55.520 --> 0:06:59.800 governor Tony Evers saying that you know, Republican lawmakers have 0:07:00.040 --> 0:07:03.520 under the response and created a disaster. Therefore, he wants 0:07:03.640 --> 0:07:06.760 enough doses to vaccinate all four hundred and fifty thousand 0:07:07.279 --> 0:07:10.760 of the state's healthcare workers. Right now, he's only supposed 0:07:10.800 --> 0:07:14.440 to get about sixty doses, so you can see sort 0:07:14.480 --> 0:07:17.560 of the imbalance between what people are expecting and what 0:07:17.600 --> 0:07:20.480 they'll need to cover everyone. However, I should also be 0:07:20.520 --> 0:07:24.080 clear that Operation warp Speed keeps saying that that is 0:07:24.120 --> 0:07:28.680 the initial allocation and that they will start increasing supply 0:07:29.000 --> 0:07:33.400 every week and distributing more supplies every week so that um, 0:07:33.400 --> 0:07:37.560 those quickly become available. You've mentioned, of course, that there 0:07:37.560 --> 0:07:42.120 are some different distribution plans, and these vary from state 0:07:42.200 --> 0:07:45.119 to state. That although there is a focus on getting 0:07:45.160 --> 0:07:49.080 the vaccine first to those specific communities like frontline workers, 0:07:49.480 --> 0:07:52.760 what are some of the other different distribution plans we've 0:07:52.880 --> 0:07:55.360 seen among the various states in terms of who will 0:07:55.400 --> 0:08:00.440 receive this vaccine first. Right, So, earlier this week, the 0:08:00.640 --> 0:08:06.840 CDCs Vaccine Advisory Committee met and finalized its inner recommendations 0:08:06.880 --> 0:08:10.680 so they will meet again whenever a vaccine is authorized, 0:08:10.760 --> 0:08:14.160 that healthcare workers and long term care residents should be 0:08:14.200 --> 0:08:18.520 the first to get vaccinated. However, that sounds easy, it's not, 0:08:19.000 --> 0:08:22.640 because if you're only getting enough vaccine doses to cover 0:08:22.720 --> 0:08:25.120 a fraction to those people, you have to make some 0:08:25.200 --> 0:08:28.240 hard choices about who you'll start with and where you'll 0:08:28.280 --> 0:08:31.560 send those doses. So we have heard that some states 0:08:31.640 --> 0:08:35.800 are viewing this differently, because some of them say, let's 0:08:35.800 --> 0:08:38.720 start with the healthcare workers, because they're the ones who 0:08:38.800 --> 0:08:42.120 are at the greatest risk of being exposed and possibly 0:08:42.160 --> 0:08:45.800 catching the virus. But other states are saying, let's start 0:08:45.800 --> 0:08:48.760 with the long term care residents because they're the ones 0:08:48.800 --> 0:08:51.199 who are getting infected the most, and if we can 0:08:51.880 --> 0:08:55.480 um tame those infections, then we can help the healthcare workers. 0:08:55.960 --> 0:08:58.679 So hopefully we'll get to a place where there are 0:08:58.800 --> 0:09:03.400 enough doses to vacate everybody simultaneously among those groups. But 0:09:03.480 --> 0:09:07.640 there could be some states where they're starting with one 0:09:07.679 --> 0:09:10.840 group or starting with the other um as we start 0:09:10.920 --> 0:09:14.560 this process. Now, these are just some of the logistical 0:09:14.640 --> 0:09:17.440 hurdles that each state is facing right now, But of 0:09:17.480 --> 0:09:22.719 course there are other maybe even broader questions about the 0:09:22.800 --> 0:09:27.559 materials needed for this vaccine as well as storing and 0:09:27.640 --> 0:09:30.640 transporting the vaccine. And I was wondering if you might 0:09:30.679 --> 0:09:34.520 go into some of those other logistical hoops that the 0:09:34.600 --> 0:09:37.960 states are facing now to to receive this vaccine and 0:09:38.000 --> 0:09:42.319 distribute it. So it's all but certain that Fiser's vaccine 0:09:42.400 --> 0:09:46.280 candidate will be the first one to receive FDA authorization, 0:09:46.440 --> 0:09:50.000 assuming of course, that the FDA does authorize it. And 0:09:50.360 --> 0:09:54.760 that vaccine is very difficult to distribute and to handle 0:09:55.160 --> 0:09:59.679 because you need to keep that vaccine candidate at negative 0:09:59.800 --> 0:10:02.960 NIE need four degrees fahrenheit. What that means is that 0:10:03.000 --> 0:10:06.480 you need these special freezers to store them. The large 0:10:06.600 --> 0:10:09.360 health systems typically have those, which is why at the 0:10:09.400 --> 0:10:15.199 beginning you will almost certainly see large health systems receiving doses. 0:10:15.400 --> 0:10:17.840 If you don't have those freezers, you need to keep 0:10:17.880 --> 0:10:21.679 them in this special container that Feiser has created and 0:10:21.720 --> 0:10:25.960 will ship out the doses in. And these containers are 0:10:26.160 --> 0:10:29.439 kept cold with dry ice. And if anybody out there 0:10:29.480 --> 0:10:33.120 is familiar dry ice, you know that it's difficult to manage. 0:10:33.200 --> 0:10:37.000 There are specifics. You can only open the container a 0:10:37.040 --> 0:10:39.560 few times a day. Or else you run the risk 0:10:39.760 --> 0:10:43.320 of the dry ice vaporizing. So they require a lot 0:10:43.400 --> 0:10:47.600 of different handling instructions and it's not just as easy 0:10:47.640 --> 0:10:49.720 as getting it there and leaving it on the shelf. 0:10:51.280 --> 0:10:54.400 Have there been any, say, trial runs in just seeing 0:10:54.559 --> 0:10:58.800 how these supply lines or distribution chains work when it 0:10:58.880 --> 0:11:03.240 does come to getting the vaccine out to the various states. Yes, 0:11:03.520 --> 0:11:07.840 so there have been test runs to practice shipping the 0:11:07.960 --> 0:11:11.800 vaccines as well as the ancillary supply kits. So these 0:11:11.880 --> 0:11:16.240 kits will include things like syringes, masks, things that you'll 0:11:16.240 --> 0:11:19.920 need to actually give the vaccines. So over the past 0:11:19.960 --> 0:11:22.960 few weeks, there have been test shipments and they haven't 0:11:23.000 --> 0:11:26.640 included any real vaccines or any real supplies, but rather 0:11:26.840 --> 0:11:30.800 empty containers. And we've heard from at least two states 0:11:30.840 --> 0:11:34.439 who said that they got their test shipments of the vaccines, 0:11:34.520 --> 0:11:37.680 but not of the ancillary supply kits. So North Dakota 0:11:38.080 --> 0:11:41.600 and Colorado both reporting that they didn't receive those shipments. 0:11:42.000 --> 0:11:45.200 Um Colorado even said that their kit went to another 0:11:45.360 --> 0:11:48.840 state because of a label printing error. We reached out 0:11:48.880 --> 0:11:52.880 to McKesson, which is the company responsible for creating and 0:11:52.960 --> 0:11:55.640 sending the kits, and they said that this was part 0:11:55.679 --> 0:11:58.120 of the normal process and that this is why you 0:11:58.160 --> 0:12:01.560 test things. They've addressed the issues and they confirmed that 0:12:01.600 --> 0:12:05.319 they fixed them. And so of course we are just 0:12:05.600 --> 0:12:11.040 discussing the very early rollout of this vaccine, but this 0:12:11.120 --> 0:12:15.520 eventually will be ramped up to vaccinating the general population. 0:12:16.000 --> 0:12:19.360 Millions more people to receive these doses. What are some 0:12:19.440 --> 0:12:24.280 of the other possible logistical challenges we might see once that, 0:12:24.840 --> 0:12:29.280 once that distribution plan scales up, right, So the irony 0:12:29.360 --> 0:12:32.600 here is that we're spending so much time talking about 0:12:32.960 --> 0:12:36.520 whether people are ready for day one that it's easy 0:12:36.600 --> 0:12:38.720 to lose sight of the fact that day one could 0:12:38.720 --> 0:12:42.560 actually be the easiest day because at the beginning, you know, 0:12:42.600 --> 0:12:46.520 we're only talking about six point four million doses getting shipped, 0:12:46.559 --> 0:12:49.400 and in the grand scheme of things, that's really not 0:12:49.480 --> 0:12:52.440 that many. We could quickly come to the point where, 0:12:52.480 --> 0:12:56.120 you know, many more doses are being shipped, as well 0:12:56.160 --> 0:13:01.160 as vaccine doses from multiple companies, So this could quickly 0:13:01.240 --> 0:13:05.880 quickly increase in scale, and of course with scale comes complexity. 0:13:06.000 --> 0:13:08.720 Are you making sure that they're going to the right places, 0:13:08.800 --> 0:13:11.200 Are you making sure that the people giving them are 0:13:11.320 --> 0:13:14.480 tracking everything correctly. Are you making sure that people who 0:13:14.520 --> 0:13:16.800 got the first shot are coming back in for their 0:13:16.800 --> 0:13:21.680 booster shot. These are all things that will quickly increase 0:13:21.760 --> 0:13:25.240 in complexity and are really vital to making sure that 0:13:25.640 --> 0:13:29.840 actually go smoothly, because, like you mentioned earlier, this is 0:13:29.960 --> 0:13:33.480 a huge, huge effort and there are so many moving 0:13:33.520 --> 0:13:37.080 parts that will need to be accounted for throughout this 0:13:37.120 --> 0:13:44.560 whole process. That was Angelica Levido, and that's it for 0:13:44.600 --> 0:13:47.200 our show today. For coverage of the outbreak from one 0:13:47.960 --> 0:13:52.400 bureaus around the world, visit Bloomberg dot com slash Coronavirus 0:13:53.200 --> 0:13:55.320 and if you like the show, please leave us a 0:13:55.360 --> 0:13:59.160 review and a rating on Apple Podcasts or Spotify. It's 0:13:59.200 --> 0:14:02.640 the best way to help more listeners find our global reporting. 0:14:03.600 --> 0:14:06.920 The Prognosis Daily edition is produced by Top for foreheads 0:14:07.040 --> 0:14:12.320 Jordan Gaspure, Magnus Hendrickson, and Meat Laura Carlson. Today's main 0:14:12.360 --> 0:14:17.320 story was reported by Angelica Levito. Original music by Leo Sidrin. 0:14:17.840 --> 0:14:21.880 Our editors are Rick Shine and Francesca Levi. Francesco Levi 0:14:22.240 --> 0:14:25.400 is Bloomberg's head of Podcasts. Thanks for listening.