CareTalk Podcast – The COVID-19 Vaccine is Here. Now What?

Pfizer and BioNtech have filed for Emergency Use Authorization (EUA) for their COVID-19 vaccine. In this episode of CareTalk, John Driscoll (CareCentrix) and David Williams (Health Business Group) discuss how the vaccine will be distributed, how effective the vaccines are projected to be and the question that’s on everyone’s mind: “when can I get it?!”

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#pfizer #biontech #vaccine #healthcare

Transcription 

John (00:00):

David, winter is coming. What about the vaccines?

David (00:03):

Oh, John, the vaccine’s coming, too. I got my short sleeve shirt on so that I can get that first shot.

John (00:08):

Ooh, you’re not first in line.

David (00:10):

Oh.  Welcome to CareTalk, your inaugural home for incisive debate about healthcare business and policy. I’m David Williams, president of Health Business Group.

John (00:29):

And I’m John Driscoll, the CEO of CareCentrix. David, what do we got?

David (00:32):

John, I’m so excited to talk about the new COVID-19 vaccine, but partly because we have some new acronyms to introduce.

John (00:38):

Oh, wait a second. I mean, you think that vaccine is ready for prime time?

David (00:43):

John, there are a lot of them. They’re just chilling in the fridge for you, although I guess it’ll be ruined there. Yeah. There’s Pfizer and BioNTech, or is it BioNTech or BioNTech, just put in an EUA for their COVID-19 vaccine and it’s supposed to be at least 95% effective, John. As I recall, that’s an A grade.

John (01:02):

Well, I got to say the grades for the effectiveness, which is measured by how effectively those vaccinated avoid getting the coronavirus, the early results are super impressive, not just for Pfizer and BioNTech, but you’ve got a series of really good news. Moderna, that’s that’s like the latent [inaudible 00:01:34] biotech. You’ve got AZ and Oxford today talking about it. I mean, you’ve got a relative plethora of options. And I don’t know, I’m just generally happily surprised at how consistently the positive results suggest that we’re going to beat this thing. And they’re very different and we’ve got to obviously get through the EUAs, the safety protocols, figure out everything else about it. But David, even you have to admit, this is a big Trump administration win and a great moment for science and biotech.

David (02:14):

Well, I’ll agree with part of it, John. I’m going to throw out your vote on the first one about Trump being the winner here. [crosstalk 00:02:23] Pfizer didn’t really get any aid from the Trump administration, but-

John (02:29):

No, that’s not true. That’s not true. They got a guarantee.

David (02:30):

Oh, big deal. They knew they could sell it anyway.

John (02:32):

Multi-billion dollar guarantee. I’ll make a vaccine for you if you give me [crosstalk 00:02:38]. Come on.

David (02:38):

John, roll up your sleeve. I want to see your puny bicep before I give you a shot. Okay. So listen, it is good news, John, and it’s exciting on a couple of fronts. This 95% is very good. Whatever your technical explanation is of that, I’m sure it’s a good number.

Now, one of the concerns was that, are you going to trust the vaccine because it was rushed and rushed before the election, et cetera. Now, it came just after the election, so it’s clear that Trump wasn’t interfering. And then the other thing is that-

John (03:06):

You’re obsessed with this election.

David (03:08):

You brought it up. John, I have to ensure you’re enjoying the last election of my lifetime, so yeah.

John (03:16):

Your friends, the anti-vaxxers, have effectively demonized what is an incredibly safe and effective regime. I mean, every baby gets, I think it’s somewhere between 10 and 15 vaccines, and they’re unbelievably safe and they’ve transformed healthcare, not just in the US and in the world, and all of these trumped up claims that vaccines don’t work are just garbage. But I do think that much more than the election has undermined the public’s confidence. But I’m hopeful, David, that we can turn it back.

David (03:51):

Well, John. Same here. What I was going to say about the 95% effectiveness rate is that it also means that, okay, so the people who get it, it’s going to be more effective, but also because the rate is so high, it will make more people say, “Yes, I’m going to get this vaccine,” rather than waiting for a new one to come. I think it’s actually going to be a big booster shot, and it’s going to be quite a success. I’m going to party, John. That’s why I’m going to go party on Thanksgiving, Christmas, et cetera. To hell with my mask.

John (04:20):

No, no, no, no, no, no. We all worship in the church of Fauci and he has been very, very, very clear that this is not a time to let down your guard. In fact, this is a really grim time in a lot of parts of the country as the vaccine’s spiking, so [crosstalk 00:04:37]-

David (04:37):

Well, the vaccine isn’t, John, unfortunately.

John (04:40):

Well, [crosstalk 00:04:43]. We’ve got good news. By the way, the good news isn’t just on the vaccine front. I think this Regeneron E-way … Again, we’re using a lot of acronyms and you love that [crosstalk 00:04:54]-

David (04:54):

I love it, John.

John (04:56):

Consultants love that. It just confuses people.

David (04:58):

John, Regeneron, they’re actually … Stop the presses. They’re not calling it Regeneron anymore. It’s called Trumperon.

John (05:05):

No, no, no. Regeneron has been one of the pioneer biotech companies focusing on monoclonal antibodies, which are really very targeted biologic drugs, one of which was the specialty cocktail that Trump got access to that created what looked like a miracle cure. But all of the evidence suggests right now that for those folks who’ve got coronavirus, and before they get to the hospital, before they get really sick, that this can potentially stop the virus in the track. There’s good news on the vaccine front, but I don’t think it’s immediate. There’s good news on the therapeutics front. And actually, we’ve cut mortality of caring for coronaviruses in half, but we’re also in probably the largest and the worst surge in the country, so don’t let down your guard. Keep that mask on, David.

David (05:53):

All right, John, I certainly will. I hope you’ll do the same. It’s a lot easier on the eyes. Now, here’s the thing, John. I actually saw somebody with a mask that was a guy delivering groceries the other day, and he had a smiley face on his mask. And my wife asked, “Whose face is that?” And it was a picture of himself that was there. It was a little freaky, but it was-

John (06:12):

What were you guys drinking?

David (06:14):

We were drinking that cocktail, the Regeneron cocktail. Now, John, we get to throw another acronym out there that I saw. I was looking about who’s going to be getting the vaccine first, second, et cetera. And there’s a group called NASM, which is actually the National Academy of Sciences, and they added engineering and medicine to make it a nice thing. And they have a nice list that shows who’s going to get that vaccine, John. Where do you stand in that line?

John (06:38):

Well, I’m at the backend. I’m a healthy person with no chronic conditions. Unlike you, there’s no risk of me going to prison. I’m not a teacher. I think what’s really interesting-

David (06:51):

You’re a teacher, John.

John (06:52):

… is we’ve quickly … I’m trying to teach you something.

David (06:54):

You’re a lecturer.

John (06:57):

We’ve reached a point where we actually I think are pretty thoughtfully prioritizing first responders, people who are on the frontlines of keeping our country safe from a healthcare perspective, safe from a security perspective and educating our kids, those frontline workers who are involved in food service, and most importantly, our vulnerable seniors and folks of color. This has been a very targeted disease that’s taken a very terrible toll on nursing homes and on general population in communities of color and in places where there’s a lot of poverty. And I think that the country’s kind of organized to do the right thing here. I’m actually super enthused. It’s the first place where I really do believe we’ve got a plan in anticipation of the pain of this horrible coronavirus.

David (07:50):

Well, John, they say about the first a group of people to get this vaccine is going to be about 5% of the population, which as you say, is the frontline health workers. Also, supposedly people that are cleaners and first responders. And then there’s a group that had the underlying conditions and those who are older in nursing homes, which is hopeful that we’re going to see some improvements there because that’s a community that’s been just clobbered.

And then as you said, actually they are putting some priority of people that are in prison. Now, that will help out on some of the people from the administration who might get it a little bit sooner than they would otherwise. But then this phase four is just everyone else, five to 15% of the group. We’ll see about that. Now, John, they’re going to have-

John (08:36):

Well, I thought … Didn’t you think it was interesting that your friends, the bankers, were involved in phase three? I’m just saying.

David (08:42):

Yeah, the bankers and higher education, so those investment bankers working for Harvard University are going to be toward the end of the [inaudible 00:08:51]. I want to know who’s the last person who’s going to get it.

John (08:53):

It’s probably you and me.

David (08:56):

Yeah.

John (08:56):

But I think that one of the most important things to think about, David, and the biggest challenges from a public health perspective, we talked about the [inaudible 00:09:05] anti-vaxxers earlier. You’ve also got the painful result of a nasty public health narrative. There have been some studies that show that for some populations of color, only 20% really trust that the vaccine will be safe and effective for them. And if you think about probably the biggest public health challenge is to make sure that we get the vaccine to vulnerable people who are in poor communities, particularly those who are of color, and that we find a way to gap that narrative and give people confidence that the vaccine can really work. I mean, that is going to be one of the biggest public health challenges of our generation because I do think there’s a lot of skepticism in poor communities about a healthcare system that doesn’t work in a lot of other ways. Why should they trust it now?

David (09:57):

I agree, John, and access is always an issue, even if the vaccine doesn’t cost anything. And that’s really going to be something that we put a priority on and I’m more confident of the new administration, rather than the old one, to be able to prioritize that.

Now, John, we talked about cold chain before, and the fact that these vaccines have to be, especially the Pfizer one, has to be kept super chilly, negative 70 degrees Celsius, and Moderna one has to be frozen, too. Have these issues been fixed or are we going to have all this unusable vaccine around because it’s going to get ruined?

John (10:30):

I think actually, there’s a lot of parts of the supply chain that have been thought through. I will say that again, in terms of the distribution, there’s much more of a plan here than you would have necessarily expected from the slapdash coronavirus task force press conferences where we talk about bleach and light and we don’t talk about masks and social distancing. But I do think that the Operation Warp Speed is actually pretty much uniformly a success right now based on these results, and behind that sits a four-star general from the Army who’s working on a very detailed logistics plan. They have actually a pretty elaborate plan for maintaining the stability, which means keeping it cold, of the vaccines, and planning to distribute it.

I worry about that [inaudible 00:11:23] issue that Anna talked about in one of our earlier podcasts of making sure that whether it’s a hospital or a military facility, if you think about that we’re in the grips of this horrible coronavirus, the hospitals and a lot of doctor’s offices and infusion centers are going to be either shut down because of infection or potentially hard to get people to get to. I think that’s the piece that I still worry about, but actually the physical distribution at scale and the plan is actually pretty pretty well-developed.

David (11:53):

John, should we worry then about the fact that the transition to the new administration has been delayed? I mean, maybe it’s better to delay it because then they’re not wasting time briefing the next folks and disrupting the great plans that apparently your folks have laid.

John (12:09):

The childish and slapdash incompetence of not being willing to even share the information while it is entirely almost a certainty that president-elect Biden will be our new president is just insane. As a country, we’ve always come together across parties, even in Bush V Gore when there was a court dispute about the votes in Florida when Governor Bush prevailed against Vice President Gore. Even at that time, the GSA and the federal government provisionally shared a great deal of information with the Gore team to make sure that we would have a running start. And the 9/11 commission very specifically said that even then the delays and the lack of being able to seat the national security establishment, because of the slight delays that happened there clearly made it easier for the 9/11 terrorists to slip through our security net. If you think about public health as being a different form of security threat, I do worry about it. I don’t think there’s any question that competent people will be in charge and they’ll fix it, but the longer the delay happens, I do think the more people will suffer.

David (13:30):

John, let’s talk about vaccine number three and what it may mean for the rest of the world. You mentioned we’ll will be able to fix the supply chain issues with Pfizer and the Moderna vaccines. The AstraZeneca vaccine-

John (13:42):

[crosstalk 00:13:42] Oxford.

David (13:43):

Oh, Oxford. Oh, you studied at Oxford. Am I right? What did you do at the weekend?

John (13:49):

I can’t talk like that, David. I went to Cambridge. I think what’s really interesting about the AstraZeneca and Oxford work is their vaccine actually doesn’t need the deep freeze. And although the initial results suggested that it was not as effective as the Moderna and the Pfizer vaccine, apparently they bungled one of the tests and it turns out that … Well, why don’t you tell the story, David?

David (14:18):

I’ll tell the story, John. What happened is they realized after they had gotten the trial underway that from some sites, they weren’t seeing as many side effects. And so they went back and checked and it turned out the first dose … They’d only given a half dose to some people, and they decided rather than throwing those people out of the study, just continue along and give them the full dose on the second administration, as they were supposed to, and it turned out that was the group that was the most effective. The immune system works in mysterious and wonderful ways. And in this case, that made a pretty big difference.

It also means, John, that if you only need that half dose and then the full dose, that actually will stretch the number of people that you can give it to because you’ll need less upfront and it doesn’t have to be refrigerated and it’s about $2 and 50 cents a dose compared to $20 for the other ones. If you think about vaccinating the whole world, this is going to make a huge difference even if it’s not used so much in the US.

John (15:11):

Also, too, three cheers for AstraZeneca and Oxford who have developed this and said they will distribute it at cost. And even though I’m very impressed with Pfizer and Moderna, let’s be clear that these vaccine announcements on Monday before the market opens are really driven to drive up the stock price. And I do think that Moderna and Pfizer have both said they plan to charge a market price as opposed to where AstraZeneca and its partner Oxford, and also J&J and Merck, there is a clear distinction, and we will remember them, between those vaccine manufacturers who see this as a public good and a time to care for the public and those who see it as a public good that they can make a lot more profits off of. I just think you’ve got to call that out. Even though it’s amazing science, perhaps now is not the time to go grabby around profitability.

David (16:10):

Well, John now is the time to call a close to this edition of CareTalk. I’m David Williams, president of Health Business Group.

John (16:18):

And I’m John Driscoll, the CEO of CareCentrix. Thanks for listening.