- First priority = understanding vaccine supply
- States often not sure what vaccine supple is, when/how much they’ll be receiving
- Unsure how much vaccine is in the system
- Twin challenges of actual supply, and distribution channels; also varies by state and over time → must have a tailored response
- Why haven’t more rules been broken to facilitate vaccine distribution?
- Ex. vaccine sites pen 24/7– usually limited by funds, personnel
- Also often not enough people to administer vaccine → need to relax regulations around who can do this (retired RNs and docs, etc.)
- Why weren’t states and the federal govt more prepared for this!?
- Past administration sort of passed responsibility to states for delivery...
- Pandemic requires politic apparatus to work with along with science, not just the latter
- Many blue states may have overplanned for delivery (NY, CA) → too strictly adhering to complicated guidelines, not enough flexibility? Missing link = communication of the guidelines, that they can be changed to fit the circumstances
- What they can do before the relief bill is passed
- Setting up community vaccine centers, working with pharmacies
- Ultimately do need the funding resources (ex. to open schools, to cover paid sick leave so people that they can deal with side effects or stay home if sick)
- Importance of two-way communication between states and federal government → states can give feedback, guidelines can be optimized
- Better communication with the public— trying to balance speed and fairness, so we might not be perfectly sticking to groups (to not waste vaccine), but still prioritizing, explain plan and expectations
- Without this, left to individuals to use their best judgement... worry of unfairness
- Always more concern when supply is limited...
- How to increase vaccine supply?
- Some Moderna data that half-doses can also achieve immune response— warrants study but not adoption, bc not a lot of data on longevity of response, and would waste more supply if you had to revaccinate people
- Similar decision for delaying second dose
- Still have a large quantity of vaccine sitting in storage → first need to work on delivery
- Already working closely with companies to increase production, related components
- If J&J vaccine is approved, will be great bc only one dose, less extreme storage conditions → primary care providers can also distribute
- How much data, how much certainty do we need to make decisions, especially when trade-offs are so high?
- Cannot look for full certainty— leads to justification of inaction
- Science-informed approach: knowing that we very likely have large supply coming in the future, best option is to stick with optimal dosing
- How to deal with new variants?
- Need to be prepared that there many be new, more aggressive variants that arise, and may be immune to vaccine
- Highlights weakness of US in sequencing and tracking virus, need to do this more
- More investment in treatment of virus, besides just monoclonal ab
- Getting US vaccinated → opens door to developing countries, too
- Will run into problem of vaccine supply, treatment being limited by production capabilities of one company → worth it to build effective biomanufacturing infrastructure for the future?
- Still ~30% people skeptical about getting vaccine... why?
- Worried it was developed too quickly, know people who had side effects, historic bad relationships with medical industry
- How to address?
- Build trust by listening to concerns— listening is a form of action
- Enlist effective messengers to different communities
- Combat incorrect information (whether misinformation or disinformation— unintentional or not))
- Some hesitancy and underselling of vaccine efficacy— scientists don’t want to be accused of misleading
- We know that vaccine will decrease your likelihood of getting sick, and probably reduces your chance of transmitting symptomatic disease
- Still need to distance, wear masks, because we don’t know for sure how much your risk of transmitting is reduced
- National testing facilities ($50 billion of plan)
- Aimed in scaling up production of current tests, but also developing new and better tests— ex. at home, mobile testing
- Why do we need testing if we’re vaccinating everyone? Need to be able to track future outbreaks easily
- Current supply varies in different areas
- Need to invest more in surveillance testing (sequencing positive tests), esp in high risk settings (universities, factories, prisons)
- Need to be more ready for next pandemic
- Is current regulation of testing too conservative?
- Yes— need to distinguish between public health diagnostics (widespread screening, at home, may spot asymptomatic cases) and diagnostic testing (more rigorous); not many paths for the former to get approved
- Contact tracing— why has it been so hard, and why do we still need it?
- How we can contain positive cases (act on info from above)
- Don’t have nearly enough people trained to do this
- Necessary to mitigate future of spikes and outbreaks
- Need more regulation and guidance on masking— what counts as a good mask?
- Also need to invest in more supply of surgical masks (if we can do it, definitely worth it vs cloth masks)
- Govt could send out good quality masks to people— not cheap, but cheaper than cost of people getting sick
- Recommendations:
- Book for Surgeon General: Plagues and Politics — Mullan