Rae Woods: From Advisory Board, we are bringing you a Radio Advisory. My name is Rachel Woods. You can call me Rae. Rae Woods: Today we're bringing you the first of a two-part series on the state of coronavirus vaccines. We'll talk about what's happened to date, what questions are left unanswered, and what leaders in healthcare need to be doing to prepare for the vaccine. Things are changing incredibly quickly. We're recording this as of December 8th and things are most certainly going to change, but when they do, we'll be here to update you on Radio Advisory. Rae Woods: For this episode, I brought back healthcare ecosystem expert, Brandi Greenberg. Hey Brandi. Brandi Greenberg: Hi Rae. Rae Woods: Before we start talking about the details of the vaccine, I'm curious if your conversations just in your personal life are as focused on the vaccine as mine are? Brandi Greenberg: Absolutely. I describe it as I remember in 2010, I couldn't go to a cocktail party with somebody asking me about the ACA and now I feel like it's the same thing all over again. I get asked all kinds of questions about when will I get mine and are you taking it, and it makes for pretty good family conversation. Rae Woods: And hopefully after this, now you can just say, "Listen to my podcast episode. That's where I give you all the answers." Brandi Greenberg: Absolutely. Rae Woods: Well, let's go ahead and dive in. It's been a while since we've actually talked about the coronavirus vaccine on Radio Advisory, so I want to do a quick update. Which vaccines are actually furthest along today? Brandi Greenberg: There are two vaccines, both of which use a similar technology called mRNA, messenger RNA, and they are made by Pfizer and Moderna, and both of those have advanced far enough along in their process that they have applied for emergency use authorization with the FDA. And Pfizer has actually already been approved for emergency use in the UK. Rae Woods: And you mentioned that they use the same technology, but are there differences about these two vaccines we should be aware of? Brandi Greenberg: The biggest differences at this point have to do with the logistics of the shipping and storage. One has to do with administration. The Pfizer vaccine is dosed three weeks apart. The Moderna vaccine is dosed four weeks apart. The second is about storage. Pfizer as is well covered in the press, has to be kept at a really, really cold, negative 70, I believe below zero. Moderna is only at about negative nine I believe, Rae Woods: When we last talked to Zeke Emanuel, we were wondering whether any of the vaccines in progress we're going to be effective. And I think his quote was, "There's so many shots on goal, we're at least going to get one." What have the results been to date of the vaccines that have reached this point? Brandi Greenberg: Just last week, the FDA shared information that they're going to be using in their evaluation of Pfizer's vaccine. It showed not only that the first dose gave you strong efficacy within 10 days of it, over 50%, but that the efficacy of the vaccine was equal across racial differences, age differences, and weight differences. Rae Woods: And there is potentially even more good news to come because these aren't the only vaccines that have reached these kinds of late stages. What's happening with some of the other vaccines that are on the market? Brandi Greenberg: The great news here is again, we have over 10 more vaccines that are in phase three trials, so being tested among a broad set of individuals, a diverse set of individuals across the globe. The one that has gotten the most press to date is from AstraZeneca. They have preliminary results suggesting effectiveness somewhere, I know it's a broad range, in the 60 to 90% category. So they're doing a little bit more testing and theirs uses a viral vector technology and does not require the same level of cold storage. Rae Woods: Huge benefit. Brandi Greenberg: Huge benefit. Johnson and Johnson Novavax and several other candidates are also in late stage trials, considering things like single dose, a pill vaccine, and other forms of vaccination. So I think we have potentially to use your quote of Zeke Emanuel, many more shots on goal. Rae Woods: And this is all really good news, but none of the vaccines are actually distributable yet, at least at the time of this recording. There's at least one more step in the development part of the process. Is that right? Brandi Greenberg: There is one more step. I would say Pfizer is so close and by the time this podcast goes live, we may have already vaccinated the first individuals. But Pfizer took the bold step of actually already transporting several thousand doses from its plant in Belgium to a facility in Chicago. They have already moved several canisters of the vaccine to different distribution points in the United States, so that if and when the EUA comes through, they can begin vaccinations 24 to 48 hours afterwards. Rae Woods: I do want to make the comment that it isn't all good news. I kind of want to have this moment of hope, but we don't actually know everything yet. When it comes to just the science behind the vaccines, what are some of the open questions that we just haven't been able to figure out yet? Brandi Greenberg: Two biggest open questions are, how long do the vaccines last? And can you transmit the virus even if you are protected by the vaccine? And that is part of the reason that both Pfizer and Moderna even have committed to still studying the impact ... they're still in test essentially to look at the long-term use. So the trials aren't done. I will say good news is that it looks like Pfizer has done testing to kids as young as 15, and that they have begun testing in even younger populations, or they're about to. One being questioned that has come up is whether or not this is safe for pregnant women, and I have not seen any information yet on that. Rae Woods: So we've checked the box on effective vaccine and safe for majority of the population and to your point across ages, across ethnic racial backgrounds, et cetera, but once you get the vaccine, we actually don't know how long you'll be protected, and we don't know if you can continue to pass the virus. Those are pretty important unanswered questions that time will only tell when we have answers to. Brandi Greenberg: Yeah. One of the pieces of advice I have been giving friends and family in terms of thinking what the new normal could look like next year is that I am assuming that even after folks get vaccinated, they will still be wearing masks for some time to come. Rae Woods: Up to this point, we've been focusing mostly on scientific research. There isn't a ton that the typical leader in healthcare could do to support the path to the vaccine, but I have a feeling you are going to tell me that that is about to change, if it hasn't changed already. Brandi Greenberg: Absolutely. And I think this is at the level of the health system, as well as the level of state and local governments have already gone into action. And that is because as recently as two weeks ago, states were already asked to submit their initial numbers for what they thought they would need in the first group of vaccinations for healthcare workers and folks that are in nursing homes and long-term care facilities. In addition, several large health systems have already shared about how they are beginning to think about allocation of those vaccines. Rae Woods: I'm glad that folks are starting to think about this because in my pessimistic moments, I am not sure that folks totally understand the immense challenge that is actually getting this vaccine into the arms of everyday Americans. I actually like to tell people that making a safe and effective vaccine is actually the easier step than all of the other ones in line. Brandi Greenberg: I am also looking at it with my typical glass half full mentality of saying that the same level of innovation and ingenuity that was required to develop a safe and effective vaccine will be required of all Americans in order to make sure that we get the vaccine to as many people as possible. Rae Woods: I appreciate your optimism. I'll maybe be the glass half empty until proven otherwise. Rae Woods: When it comes to actually distributing the vaccine, what role do clinical leaders actually have? Brandi Greenberg: I think it's a great question, Rae. I think the clinical leaders have a greater role to play than they probably realized even six to eight weeks ago. And what's exciting is we have seen many of them step into that role in a really big way. When we're talking about it, this isn't just the CEOs and the chief medical officers. This is very much about getting the CNOs and increasingly the chief pharmacy officers involved as well. And that's really because the first thing that they have to get right is figuring out how to distribute the vaccine to their extensive healthcare staff. Rae Woods: And I think this is one of those areas that to your point is maybe harder than folks initially realized. I'm even thinking about the challenge of getting an accurate count of all of your staff, all of the locations that they work, et cetera. Brandi Greenberg: Yeah. Even something like you said, head count, especially when you may have clinicians who have privileges at more than one facility and even more than one system, and so getting that count right. The second thing is for health systems that have facilities across multiple States. It is also recognizing that the States may make different decisions about how they allocate. There isn't one centralized allocation policy. The CDC has just made guidelines. Rae Woods: So every leader needs to start planning right now to just understand who and how many and where they should be distributing the vaccine for their own people. And on that note, I think it's easy to lose sight of the fact that despite the very positive news that millions of doses are being released in this initial wave, that's actually barely going to put a dent into the American population. Are you at all concerned that there won't actually be enough to cover the physicians and nurses on the frontline of the pandemic? Brandi Greenberg: I am. I think we'll get there, but as much as I want to be that glass half full person, the logistics are complicated enough that I think it will take longer than we want it to. And that's for a couple of reasons. The first is that health systems really have to think hard about how they allocate it across their staff. Some are choosing to focus on those that are most patient-centric, so those in the ICU, those that are most exposed. Others are choosing to focus on those that are actually at highest risk that may be older or have higher health conditions. But the thing that is really making it complicated is the fact that as much as these vaccines are effective, a lot of them do have side effects for one to two days. And they're worried; they don't want to take out an entire nursing shift. If they need one to two days off, they have to stagger it so that they aren't all being hit at the same time. Rae Woods: Especially in this moment where across the entire United States, we're dealing with a massive surge of coronavirus cases. It's so interesting to think about, you need to prioritize so that you have enough vaccine and also so that you can continue to have enough staff to actually function as a hospital or as a health system. Brandi Greenberg: Yeah, it is a delicate balancing act to say the least. Rae Woods: I have one kind of specific follow-up to that. I'm hearing from clinical leaders this idea that perhaps they could deprioritize the clinicians that have been exposed the most to the COVID-19 pandemic. The theory is they probably have antibodies that can protect them from the virus. I sort of worry about the PR effect of telling people who are literally staffing these COVID floors, COVID units that they're not getting the vaccine first. What is the right way to think about this? Brandi Greenberg: I don't know that there is a right way, but I think that it is fair to assume from the research that we know to date that folks that have had COVID and have the antibodies at least have some protection for a little bit of time, or enough time that they may be deprioritized. What is giving me hope, a common theme I'm choosing to be positive, is that we're hearing stories of actually clinicians volunteering to go to the back of the line when they know that they have had it. Rae Woods: We're talking about this moment where leaders might not have enough vaccine for their clinical staff, but I'm curious about the opposite scenario. A lot of these vaccines are being distributed in specific amounts. What happens if a smaller hospital is given too much of the vaccine? Brandi Greenberg: This is the problem that is starting to keep me up at night. Or as I think I may have said, this was the moment when I had my primal scream, when I realized- Rae Woods: When you went from glass half full to glass half empty maybe? Brandi Greenberg: Yes. I'm still trying to hold onto that glass half full. But when you realize the complexities that Pfizer's can get its shipping containers, I believe to 975 vials. Moderna's will come and the smallest unit I believe is 200 vials. And so you have a situation where if a smaller health system has 130 employees they're asking, "What do I do with these 70 other vials?" And the answer is probably pick up the phone and call a friend. I think this is a moment where small hospitals really need to come together and figure out how can they get their community across health systems. Maybe it's reaching out to a nursing home or something like that, so that the priority list is still focused, but making sure nothing goes to waste when the size of the canisters may not necessarily perfectly match the number of people you need to vaccinate. Rae Woods: That brings me to a very specific question I want to bring to you. I saw a report that the CDC wants to and thinks they can pull off vaccinating all 21 million healthcare workers within a three week period. Do you think that's possible? Brandi Greenberg: I think there's a little bit of magical thinking there. I think if you just start to do the math, we are estimated still to hopefully have enough to vaccinate 20 million people before end of year, but to do that in a three week period would mean literally that everybody is known available and can get vaccinated on day one. Which gets to a problem; if they all then get sick on day two and three or a portion do, and then all show up magically, if it's the Pfizer vaccine 21 days later to get their second dose, and Moderna's would be an extra week afterwards, which is already outside of the three week time horizon. So I think if you just start to play around with the math and the logistical complexity, it's a wonderful ambition. I think the more exciting thing is just to realize we are very likely to begin vaccinating healthcare workers and our most vulnerable elderly patients before year's end. Rae Woods: Brandi, I already know that we're going to have you back for the second part of our vaccine update, but for now I still want to leave our listeners with a little bit of an action item. When it comes to vaccine development and distribution to clinical staff, what's the one thing you want our listeners to focus on right now? Brandi Greenberg: I think the single most important thing they need to do is have a plan in place for how they are going to allocate the vaccine and prioritize among their clinical staff. And a sub-point is that they need to be able to communicate their methodology and their approach to allocation to all of their staff so that everybody feels they understand. Rae Woods: Thanks so much for coming back on Radio Advisory. We will talk again in a couple of days. Brandi Greenberg: Looking forward to it. Rae Woods: If you're interested in learning more about the state of vaccine development, you should listen to an episode we did with Zeke Emanuel earlier this summer. Even though that was a couple of months ago, you'll find that a lot of his predictions are coming true today. And of course, tune into Thursday's episode where I'm going to be back with Brandi to go deeper on the clinical leader's role in distribution, this time to everyone else. And in the meantime, remember, we're here to help.