CareTalk Podcast – The Vaccine is Here! Where is it?

The Pfizer and Moderna vaccines are officially approved by the FDA. But the vaccination program isn’t going as planned. In this episode, hosts John Driscoll (CEO, CareCentrix) and David Williams (President, Health Business Group), cover everything that is going wrong with vaccinations in the USA.

John Driscoll (00:00):
Hey David, the vaccine has arrived, hasn’t it?

David Williams (00:03):
No. It’s in the freezers, John, and then the Feds are keeping half and then the states are keeping half and
very little is getting into the upper arm.

John Driscoll (00:08):
What?

David Williams (00:20):
Welcome to CareTalk, your vacation home for incisive debate about health care business and policy. I’m
David Williams, president of Health Business Group.

John Driscoll (00:28):
And I’m John Driscoll, the CEO of CareCentrix.

David Williams (00:30):
So John, merry Christmas. The Pfizer and Moderna vaccines are both approved, they’re just sealed up
and wrapped in a nice gift wrap. How’s everything going?

John Driscoll (00:39):
Good news. Good news, David. Good news. But it only is good news, if it gets distributed wisely. How do
you think that’s going? How’s the distribution of the vaccines going?

David Williams (00:51):
Well John, we sort of fooled ourselves before with this sort of a red herring, which was the cold chain
problem. All the freezers that we needed. We talked about that before the deep freeze. And it turns out
that’s actually not the real problem that seems to be getting around in the freezers. But a lot of the
doses are just sitting in the freezers, John. They need to free the doses from the freezers.

John Driscoll (01:10):
Free the doses, I like that. I must admit I was a skeptic that we would be able to exploit the technology
we have to get a vaccine that was so effective. Now we’ve got two, exploiting this mRNA technology. It’s
just remarkable. And the results from the clinical trials are really outstanding. And now that we’ve got
this technology available, it’s sort of amazing that we’re bungling the distribution. I mean, just last week,
General Perna took personal responsibility for the explanation of the distribution. I think there’s some
structural flaws with the plan. I mean, it’s great to see those boxes going out the door, but we are at
peak vulnerability as a society with the post Thanksgiving, post holiday surges. We’ve had some of the
most devastating deadly days in sort of COVID time of our experience and David, what can we do about
that?

David Williams (02:18):
This transcript was exported on Dec 30, 2020 – view latest version here. So, John, let me try to underline this point because it’s actually a major one. I think it’s possible that … We always knew there was going to be supply constraints. We wouldn’t have enough, but I think we may only be using about 25% of the doses that we actually have, John.

John Driscoll (02:33):
I don’t believe that. I was upset at 50%, but let’s wait, how do you get to 20? So that would say that of
the vaccines we have, only one in four is being put into people’s arms.

David Williams (02:44):
So John, here’s what seems to be happening. So the federal government is getting the vaccine and then
they’re distributing it. Now they’re not distributing all of it. They’re only distributing 45% of what they
get. The reason is they’re taking 50% of it and keeping that because they want to use that for the second dose. And then they have another five percent for the safety stock, which, they have now. They’re sending out the 50% or 45% and then some of the states, this is happening in Massachusetts. They’re only releasing a certain portion of it because they want to have enough for the second dose. So what’s happening, this is like D-Day, this is written up in the Washington Post. Imagine you say, “Well, we know we’re going to need more bullets, so let’s hold them back now. No, what you want to do is use them all now. And then there’s more that are coming and you wait and you use those for the second dose.”

John Driscoll (03:31):
Actually D-Day is the wrong example, David. It’s more like if you were being attacked at Pearl Harbor and
the ships were sinking, do you say, “Well, you know what? Let’s hold back on some of that ammunition
because we’ve got people dying next to us. But you know what? Maybe the Japanese attackers have
more.” No, it’s ridiculous. I think what’s extraordinary to me is this incredible bet the federal
government made on Operation Warp Speed. The Trump administration has done a remarkable job at
catalyzing with the private sector, a revolutionary advancement and a vaccine that can directly help us.
David, there’s no question we’ve only measured fully the clinical results of two doses. But I recall that
the effect of just one dose on the Moderna side had potentially up to 80% efficacy. It’s not into that high
’90s efficacy. And we bet on industry and government wants to produce for us and they have, and it
seems like by holding back that second wave of doses, we’re betting against our own ability to solve the
problem. That baffles me.

David Williams (04:45):
Well, John. So first of all, with the two doses, even if you are planning to give two doses, and that’s the
current plan. You still shouldn’t hold back because they’re manufacturing more. And if there’s supply
chain problems, they can’t manufacture it, we’ve got even worse problems. So you should just go ahead
and do it, but you’re right John, with most vaccines that need two doses, like the measles vaccine. If you
just get one dose, you get something like 90% of the way there. Now, this is a new technology. It’s
possible that won’t hold in this case, but remember we’re in an emergency and the early data from the
clinical trials, actually both Moderna and Pfizer demonstrate that you’ve got 80 or 90% of the eventual
efficacy from one dose. And they’re talking about, well, maybe we should do a trial. Maybe we
shouldn’t, Pfizer’s not planning to. One reason is because it would cut the size of the market in half if it
worked, but you don’t need to do a clinical trial. You could use real world evidence from what’s
happening out there and see what occurs right now.

John Driscoll (05:40):
I just think we have to bet on ourselves. I mean, the other thing to think about, this is a substantially
seasonally effected disease. We are at peak time now, some estimates, I think IMHE one of the leading
planning groups thinks that the infection rate and death rate will peak in the January to February period,
tail off into the spring and summer. It may come back in the fall. But by then, we’ll be substantially
better prepared. But if this is the peak time of being attacked by the virus, why we wouldn’t bet on
ourselves to expand the production to the point where we have as many vaccines in people’s arms. I
recall these numbers. Dave, I think they’re right, 52,000 nursing home residents are getting COVID a
week, roughly one in five, 21% plus are likely to die.

John Driscoll (06:37):
So that would put us at roughly 40,000 deaths, if you look at the difference between actually bringing all
… Just vaccinating as many of those residents as we can versus waiting for the perfect plan, it just
doesn’t make sense. It feels like in America, we are trading the certain risk probability with the infection
rates we’re at right now of vulnerable population deaths at a higher rate versus the uncertain, but
potentially manageable risk that we won’t be able to bring manufacturing online. I think we need to bet
on ourselves. The way I understand it David, the Feds are only releasing the first dose when they’ve got
the second dose available. To your point about firing the ammunition we’ve got, I think we should be
shipping as many vaccines as we can to the states and getting them into the frontline workers and
nursing home and vulnerable people as quickly as possible and bet on ourselves. We’ve proven that we
can.

David Williams (07:41):
John, we like to talk about data and international comparisons on this show. There is a site maintained
by Oxford University called ourworldindata.org. And if you go there, you can see the number of
vaccinations that have been given out for COVID-19 in different countries and they have it rated per a
100 people. So in the United States, as of December 26, it’s 0.59 per 100. In other words, about half a
percent of people. In Israel, which is the leader, it’s 4.37 as of December 27th. So even accounting for
the other day, it’s something like, more than seven times the difference. Now, what are they doing
there? They’re actually treating it as a civil defense emergency. They have their equivalent of the Red
Cross. They have military that are helping and they’re doing 24/7, if they need to. All of the nursing
homes are going to be vaccinated by next week, all done and they’re ready to go. And they’re ready if
they have allergic reactions with the EpiPen. And they’re just on it. And this is using the same vaccine
that we have here. So why can’t we do that?

John Driscoll (08:42):
I totally agree. I think, it’s bad decision-making at the center. We should be trying to … Think about it,
it’s the greatest number of vulnerable people are likely to get sick and die now. We should be using the
vaccines that we know can work. This is not about communicating the problem, 14 governors
complained about the federal government explaining how many doses it would have. And there will be
communication challenges, for sure. This is about being overly conservative when we are certainly at
risk. I just don’t think it makes sense, but let’s get into the communication David, in terms of who’s
getting and should get the vaccine. The Feds put out some somewhat complicated guidelines. What did
you think of those? And do you think that they’re going to add to the confidence of people that they’re
going to get the vaccine in time or just make it even more complicated?

David Williams (09:42):
Well John, as long as we’re trashing everything, let’s continue with this one. So I thought, everybody
wants to be in group one. Remember, when we used to go to the airport back in the olden days, and
they’d say, “Okay, you got something on your ticket.” And it says, “Boarding group one, so I’m going to
be the first one.” But then there’s Global Services, first-class, all your buddies, John. And then group one
is like the 10th group. So they have here, they’ve got group one, but it’s really group one A, group one B
and group one C. And by the time you-

John Driscoll (10:09):
It sounds like American Airlines.

David Williams (10:11):
Yeah, and by the time you get to group one C it’s over 200 million people out of a population of 328
million. And it’s probably even more of the eligible population because kids under 16 are not included.
So what’s happened John is, that even in this group one A, which is the frontline medical staff and longterm
care residents, there’s been problems. I’m going to tell you a problem I read about it was in the
New York Times and they were talking about New York Presbyterian, famous hospital. And what
happened was, some employees got access to the vaccine, even though they were in low risk categories.
And they just found out that, “Oh, we got some vaccine let’s go and pop it in.” Which, the CEO was sad
about.

David Williams (10:48):
The other thing that’s happening, I also heard this from a source in New York state is that they decided
… First of all, New York had this thing where they have five different categories that were different from
the CDC one, then they aligned it. And so this group one A, they said even within that, let’s prioritize the
inpatient providers, which sounds good because they’re dealing with the COVID patients, except when
you’re an inpatient, then that’s actually where you’ve got the PPE in place, personal protective
equipment. Whereas when you’re dealing with these patients on an outpatient basis, it’s more like the
Wild West, you’re kind of on your own. And so those providers are feeling that they are not being
valued. So we got, remember John a ton of stress also in the health care system, when people have
been out there saying this is a hoax and so on, they’ve actually just been bombarded with patients and
people are reaching their breaking point.

John Driscoll (11:33):
Well, I think again, that speaks to one dose is the way. I think we can bet on our manufacturing to ramp
up. People shouldn’t forget that there are probably a 100 other vaccines in production. The most
promising one currently that I think in line is AstraZeneca-Oxford vaccine that had a little bit of a side
step in its clinical protocols, but does not require a cold chain and is much more easily and more flexibly
manufactured. I actually think that the CDC was trying to give the states a lot of flexibility. Ultimately we
are a 50 state regime, regardless of whether we like it or not, and the states are going to handle it the
way the states are going to handle it. I hear there are even more challenges in the center of your
universe, The People’s Republic of Massachusetts. You talk a little bit about how they are not just doing
50, but less than 50, and then actually less than … It’s around 45% of the vaccines. I mean, can you
explain to me what’s going on in Massachusetts?

David Williams (12:36):
Well John, no. But I do hear that what happened is they had an app like at Mass General Hospital that
wasn’t working and as a result, people didn’t get their doses. What I was thinking John, it would be like
sort of like you’re hanging around at the end of the day. And it’s like, “Hey, anybody have a few extra
doses?” Like, when they mark down food at the supermarket, when it’s about to go bad. You could
probably just like, hang around and go and get a vaccine, even a healthy youngster such as yourself,
John. So that would be the upside of it.

David Williams (13:04):
So John, on a positive note here, let’s look ahead to the New Year. So we’ve got a couple of things that
are going to happen. One is the Biden administration is going to come in and maybe you have some
insight into how the transition is going as it relates to the COVID-19 planning. And then the other thing is
that as more doses are available, maybe it’s going to be in the hands of those that are better at logistics,
people like Walmart and CVS and so on. So do you see any kind of hope in that direction?

John Driscoll (13:30):
No, I actually think the pharmacies have been intimately involved. Walmart, Walgreens, CVS are very
engaged and they do have the infrastructure to really be an extension of the arms and legs of the public
health authority to actually make sure initially vulnerable workers, sorry vulnerable populations,
particularly in nursing homes have access to the vaccines. And I think they’re pretty well organized and
we’ve got a huge retail store infrastructure with lots of pharmacists that are probably under utilized
from a clinical perspective. Actually, that’s really good news, but we have to flood the supply when
we’re being attacked by the virus. That’s the biggest challenge.

John Driscoll (14:09):
And I think the vagueness and the uncertainty and the distribution is again, being hamstrung by the
bureaucrats who are letting the perfect be the enemy of the good. The perfect being, knowing
absolutely that you’ve got a second dose, knowing absolutely that you even got support for any
breakdowns in supply or anything that goes bad. As opposed to just betting on our own distribution and
infrastructure. Look, there’s going to be a lot of uncertainty here, the anti-vaxxers and all of that. I think
we need to be leaning into the technology that works and bet on ourselves, production. And I bet we
have the infrastructure to vaccinate the vast majority country, to break the back of this by the spring.
And certainly by the summer with enough people getting that critical and very effective vaccine.

John Driscoll (15:03):
And I think the Biden administration’s big advantage is they believe in government, in a government that
works. And they’re going to try to make it work and partner with the states, Republican or Democrat to
actually deliver on breaking the back of this crisis. Leveraging the vaccine and also the therapeutics that
aren’t being utilized as effectively. The problem with an administration that really doesn’t believe in
government is that when it then needs to use government, it’s already undermined the confidence in
those governing bodies to do their work and probably made it much harder to do. But I think in general,
we’re moving in the right direction. We just have to expand faster at what we’re doing right.

David Williams (15:45):
Well John, we may not have the Israel Defense Forces here, but we do have Walmart. And I think that
should be a real shot in the arm in 2021, especially as the Biden administration comes in.

John Driscoll (15:54):
I’m betting on Walmart.

David Williams (15:56):
So let’s wrap it up John, for this episode. And in fact, this year of CareTalk, which has been quite a year,
John. With millions of downloads and many adoring fans, that would be probably rushing us and pulling
our hair out, if it weren’t for the pandemic.

John Driscoll (16:11):
You don’t have hair.

David Williams (16:12):
In any case, that’s it. I’m David Williams, president of Health Business Group.

John Driscoll (16:16):
And I’m John Driscoll, the CEO of CareCentrix. Thanks for listening.