Rae Woods: From Advisory Board, we're bringing you in Radio Advisory. My name is Rachel Woods. You can call me Rae. In our last episode, we talked about the progress of the COVID-19 vaccines to date and the role that clinical leaders have in distribution. But we stopped at distributing the vaccine to clinical staff, which is, of course, going to be a little bit more difficult than folks might think. But now, I want to talk about distributing the vaccine to everyone else. To do that, I've brought back healthcare ecosystem leader, Brandi Greenberg. Hey Brandy, welcome back. Brandi Greenberg: Hey. Hi, Rae. Rae Woods: Let's get right into part two, because part one uncovered probably more questions about the vaccine than I had even thought of. When it comes to distributing beyond just clinical staff, is that going to be more difficult, less difficult than the sort of practice rounds that leaders will have had? Brandi Greenberg: It's definitely going to be more difficult. I think there's a lot they will learn from working through some of the kinks with clinical workers and nursing home residents. But there are two things that are making a lot of folks nervous. The first is that the decision about who comes next is pretty unclear. [crosstalk 00:01:31]. Rae Woods: Have you thought about that? Brandi Greenberg: Yeah, I don't think it's my position to judge, but there are pretty compelling reasons to think essential workers. So folks that are even in grocery stores, teachers, folks that are interacting with folks because it's their job and they don't have much choice. There's also folks, 65 and older, which now, it looks like we know enough to know that it's effective for them. There's also folks that have significant chronic diseases that we know to be in high risk populations. Each of those, I think, runs between 50 and 100 million people in the population. Some of folks, of course, being double counted, but choosing who comes first among that group that goes second is up for discussion Rae Woods: And even counting them. In our last episode, we talked about just the difficult task of keeping track of who and how many and where your healthcare workers are. Part of me is just like, "How do we even define an essential worker?" What's the bar for level of chronic condition that would put you in the fast track versus not? I just think that even the act of counting, again, is really hard. Brandi Greenberg: Yeah. And that's a great segue into the second thing that makes this so complex, is that everybody has to be counted twice. These first vaccines all are two dose as we've talked about. And so, our ability to track the patients, confirm that they are in that right priority group, properly enter which vaccine they got, when they got it, and be able to make sure that, whether it's three weeks for Pfizer, or four weeks from Moderna, that they are showing up somewhere to get the same vaccine, and having that information available to other people that need it, feels like a Herculean task. Rae Woods: And this is where I start to have heart palpitations, because when it comes to vaccine development and distribution, there are, frankly, some things that the healthcare industry does pretty well. We do a pretty good job at clinical innovation. We reach new scientific milestones, but when it comes to things like patient access, care continuity, care gap closures, these are not necessarily things that healthcare organizations did well in normal times, so how the heck are we going to be able to get it right in the middle of a pandemic? Brandi Greenberg: I love the subtle use of the term health care organizations here. This is a problem that extends way beyond provider organizations. Rae Woods: Yes. Brandi Greenberg: You have health plans that have been trying to figure out how to close care gaps. You have all kinds of technology vendors who have been trying to help improve care coordination, tele-health platforms, but in some ways, all of those parties have made questions around interoperability and access to data harder, not easier, so this is definitely one of those things where I think it will require, not just effort within an individual organization to do the best data tracking and care coordination, but it will require them to really reach out to other stakeholders in their ecosystem to figure out how to get this right. Rae Woods: I feel this is really new territory. To my knowledge, something like this has never been done before to this scale, with multiple vaccines on the market at the same time, with different storage temperatures, and different amounts being distributed, and different timelines, and different doses, and all of that. I mean, this has never been done. Brandi Greenberg: Not to my knowledge. It does remind me a little bit of some of the complexities that people talk about with cancer care and different regimens. But I think, at this scale, this is definitely probably why people refer to it as we have to think of the pandemic as a war. And this is [crosstalk 00:05:25] logistics as if we are at war. Rae Woods: Let's talk about one of the can of worms that you just mentioned, this challenge opens, which is data sharing and interoperability. What is being done right now to actually make that information sharing possible? Brandi Greenberg: My understanding is that there is stuff being done, again, at the federal level, the state level, health system level, as well as tech companies trying to step in to figure out how can they be the glue or the connective tissue. But essentially, you are seeing a combination of policies and databases that are being set up in different ways fundamentally so that we can track and make sure that my grandmother, who lives in New York and gets her first vaccine, can still get her second dose when she goes for her Snowbird trip to Miami. Rae Woods: That's right. And that's a great example of just how complicated this might actually be. But on that note, do we actually know what getting a vaccine will look like? You mentioned the logistics of this, we need to get in kind of a wartime mindset, but I'm not picturing military trucks, kind of zombie apocalypse, movie style lines to get the vaccine. Am I just going to be going to my regular PCP? Do I get into a drive-through line like we've done through testing? What is it going to look like? Brandi Greenberg: It's going to look different in different parts of the country. And I think there are some places where, yes, it will be as simple as going to your PCP, especially larger practices that have access to the right kind of storage and the right scale of a population to know that they can use all of the vials that come to them. But I think it's quite possible that you may need to go to a CVS or a Walmart or a Walgreens, or you may need to go to the local health system wherever the vaccine is within that community. And it's really on your doctor to be able to make sure that you get to the place where you need to go. Rae Woods: And I should say that not everybody has a PCP. I mean, should our kind of lay listeners be worried that they should be trying to find a primary care physician as quickly as possible? Should they be calling to find out if folks are going to be able to get the vaccine or is there going to be an alternative option? Brandi Greenberg: I'm pretty confident that since so much is being done to ensure that a lot of local drug stores, which have footprints over so much of the United States, are going to be equipped to administer the vaccine. I think that they're pretty interested in making you aware of where they are and where you can get it. Rae Woods: Is it correct to assume that every kind of hospital physician office is going to even be able to carry the vaccine? Brandi Greenberg: Absolutely not. I think this is especially true in smaller towns and in rural communities where, as we have discussed, as Zeke Emanuel has mentioned, the ability to store these vaccines at the right temperatures, is questionable. So I do think that a lot of PCPs will not be able to afford, or will not have access to. That kind of storage technology. Rae Woods: So, what if you are one of those organizations that maybe knows today, "I haven't bought negative 70 degree..." Or whatever it is, "Refrigerators. We're not going to be keeping this vaccine." What should you do if you're a leader at one of those organizations? Brandi Greenberg: I think this is another area where clinical leaders, down to individual physicians, can really start doing their homework now and begin to understand who has purchased or has the necessary refrigerators? Who has signed up to be a administration site? Where are those closest drug stores that may be available? And to really understand within the community that they serve, what are all the options? Rae Woods: Brandi, this is kind of an incredible statement that you're making. I can think of exactly zero healthcare leaders who, in normal times, would be willing to send their patients anywhere else, let alone a disruptive competitor like the Walmart's or the CVSs of the world. But you're saying that that might be exactly what has to happen. Brandi Greenberg: Yeah. And I'm going to hold really firm on that. And I've gotten quite a bit of stares when I make that point for exactly the reason you mentioned. This is about thinking outside of yourself, this is about thinking outside of your own practices best interests, or your own health systems best interests, from a competitive landscape. This is about public health and about our communities and about reaching out to folks that we may have thought of as outside of our health system network, and potentially even competitors, to make sure that our population gets vaccinated. Rae Woods: I think that's right. And it's also important to remind our audience that the fear here is that you might lose that patient entirely if you send them to a CVS. I might push back and say, "If you don't do that proactive connection, here's where you can seamlessly easily get the coronavirus vaccine." You've probably lost that patient anyways. I actually think there is a plug for positive patient experience that can be made just by anticipating the wholistic needs of your patient, even if it means going somewhere else. Brandi Greenberg: And I think it is really born out in how consumers, in a lot of cases, have really stepped up to take greater control of their own care during the pandemic. And they're asking different questions, they're looking to different platforms. So I think they are thinking more holistically about what they want from their PCP. And they want a PCP that is going to help them get the vaccine that they need and not worry about what it might be in their own economic [inaudible 00:11:09]. Rae Woods: We're talking so far about educating patients on where to get a coronavirus vaccine, but it also has to be said that not every consumer, or patient, or citizen, actually wants to get a vaccine at all. What can be done to boost some public support on getting vaccinated? Brandi Greenberg: Every single leader across the healthcare ecosystem needs to be thinking about what role they can play in convincing people who might be on the fences, to get the vaccine. Otherwise, all the work we've done to develop a safe and effective vaccine, to build the right cold chain storage infrastructure, to find the staff necessary to administer it, will just be wasted, and we'll be that much further away from the herd immunity that we need to get back to our new normal. Brandi Greenberg: The good news here, Rae, is that most patients still trust their doctor. Those that have a PCP will look to that PCP for guidance. So, if I'm a clinical leader right now, I am arming every single clinician, nurse, physician, social worker with the talking points that they need to be able to have the kinds of conversation and sensitivities to get those patients to opt toward yes. Rae Woods: Even if that particular clinician isn't going to be the one administering the vaccine. Brandi Greenberg: Absolutely. This is about sending the signal that you are about what is in the best interest of the patient and their overall health and making sure they get the care they need. Rae Woods: I think this is one of those challenges that might seem simple in the abstract, but getting ahead of the massive amounts of misinformation on the internet and on social media, it is absolutely keeping me up at night. I don't know about you. Brandi Greenberg: Yeah. Rae. And what's interesting, and I think we had talked about this a little bit before, is that the concept of medical misinformation is not a COVID-19 problem. My team has been tracking this, particularly with vaccinations, for quite some time. But in this case, I'm not sure medical misinformation is the right term. Rae Woods: Why is that? Brandi Greenberg: I think there are really two things going on here. On the one hand, you have misinformation or what some folks call disinformation, and this is the stuff that is circulating so prolifically around social media, where we all get into our information silos, and you have everything out there from the extreme forms of, "This is a hoax." To, I've even heard the story that there are nano particles in the vaccine so that Bill Gates can control us all. Rae Woods: Oh my god! Brandi Greenberg: So there are really extreme stories out there. And there's one approach to how you talk to someone who has a fundamentally different beliefs about what is real and what is true. But I think that that is really different than the very legitimate kind of distrust of the medical system that you find within certain populations. Things like the black community, who really go back to that Tuskegee Syphilis Study and have every reason to distrust and kind of say, "Yeah, I'm going to be a Guinea pig." Rae Woods: So this is a really, really powerful statement. And I think it's powerful for a couple of reasons. One is, like you said, just showing the difference between worthy distrust and the anti-vaxxers of the world. The other important thing is that I think we sort of know, or at least have an example playbook, for how to deal with typical medical misinformation. It's what we've talked about, coming back to arming your clinical leaders, all of the public health campaigns that are going to happen, celebrities getting the vaccine, et cetera. I don't know how we address the kind of legitimate distrust that you're talking about in some more specific communities. Do you have any advice? Brandi Greenberg: So there's two stories that come to mind that I actually want to dig in further because the first one was so exciting to me. There was a recent story on the news about an approach that the Denver Public Health system is taking. And what they've done is taken the long view by going out into some underserved populations, largely with black and Latino folks, and set up flu shot clinics. And again, we're talking about regular flu. Rae Woods: Not COVID, yeah. Brandi Greenberg: Not COVID, just flu shot clinics. And they were out in parking lots and they found that evening and weekends, when people weren't working, were the best time. And they set up little tents and they had educational resources. But the real goal was to have the folks that were giving the flu vaccine, start a conversation, and build trust, and give them the reliance that when those same people show up in the same parking lots, or the same community health clinics, or the same boys and girls clubs, to give the coronavirus vaccine, there will be a history of trust that they have built up over months. And I was really impressed by that strategy. Rae Woods: Yeah. I like that story because, first of all, it's a practice round for the city to just deal with the logistical aspect, but it's also a moment to capture more information and more data. You will learn who has distressed, what questions are being asked about the vaccine so that you can then go back and arm clinical leaders with that information. Brandi Greenberg: Yeah, absolutely. I felt the news story I saw just scratched the surface of what I think could be a powerful best practice we could all learn from. Rae Woods: Was there a second story that you wanted to highlight? Brandi Greenberg: There was, and this came from some medical misinformation research that my team did in working with medical leaders of pharma [inaudible 00:17:57] and device firms. And this was the notion of looking at certain ethnic communities that do have a history of distrustful regular vaccinations. And what they found were either physicians or nurse practitioners or social workers that have the same ethnic background. And they sent those folks, not to a medical setting, not to a, "Here's a hospital education session." But they sent them out to the mommy and me groups, they sent them out to story hour, and they sent them out to the places where the moms and the kids were to get to know them and to then have the conversation about why they chose vaccination. Rae Woods: I should also mention that it isn't just the general public or your kooky uncle who is hesitant to get the vaccine. I'm actually seeing a lot of data that shows that clinicians are saying that they won't be getting the vaccine. Why is that? Brandi Greenberg: So I'm not totally sure, but some of it is, my understanding, that the folks that have already been exposed, again, are just saying, "I don't need to go first. I've already had it. I have the antibodies." But I think that there is still a hesitancy because clinicians love data. And at this point, they still haven't seen enough data. For all the positive data that has come out, they still want more, it still feels rushed to them. And so I don't know if this is as much a case of, "Not ever." As, "I don't necessarily want to go first. I want to still see more data before I decide." Rae Woods: And you said last time that maybe if there was somebody who has been exposed, has the antibodies, they're opting to go, maybe not to the back of the line, but a little bit further back because, one, they get more information, but also, two, then you're opening up vaccine potential for a vulnerable population that doesn't have as much exposure and hasn't built up as much immunity. Brandi Greenberg: Absolutely. Rae Woods: Any other advice to the clinical leaders who need to get their docs, their social workers, their physical therapists to actually get on board with this? Brandi Greenberg: I really think it's going to come down to meeting them where they are and understanding, those that are ready, willing, and able to get the vaccine that align with whatever allocation system your health system has come up with, should go first and then should tell their stories. I think it's very important for folks to be transparent about the side effects. Brandi Greenberg: There is a lot of concerns that folks who don't know that it is normal to feel a headache, a little achy, have a mild fever for a day or two, may get nervous and not go back for their second dose. So the more that clinicians can share their stories of, "Hey, this is how I felt. And after that, I was fine. But I did it. Here's why I think you should." I think it's really going to go a long way to helping to educate the public. Rae Woods: I completely agree. I think if you are an executive, a member of the C-suite at a hospital, health system, physician group, you should be willing to take that vaccine first and then talk to your employees about what the process, the experience, and the side effects were like. Brandi Greenberg: Absolutely. Although I must say, the three presidents that have said that they will get the vaccine on national TV, I think, is going to be pretty significant. Rae Woods: Yeah. Brandi Greenberg: And I do think it's going to take, as silly as it sounds, LeBron James, Kim Kardashian- Rae Woods: Oh, yeah. Brandi Greenberg: ... on Instagram, that where you're going to start. Rae Woods: TikTok. Brandi Greenberg: Yep. Rae Woods: I mean, it's going to be... Social media may be part of the problem, but it's going to have to be part of the solution too. Brandi Greenberg: Well put. Rae Woods: Brandi, I want to thank you for spending so much time, two whole episodes, talking vaccines with me. As we close out the second episode in our series, I want to ask my final question. What is the one thing that leaders need to do right now to ensure that the vaccine gets in the arms of as many Americans as possible? Brandi Greenberg: They need to be thinking about transparency. And they need to be thinking about transparency in terms of tracking the data they need to make sure that everybody gets the right two doses, and they need to be thinking about transparency in terms of sharing stories of folks that did get vaccinated, about what it was like and why they think of as soon as well. Rae Woods: That is so right. Well, Brandi, thanks so much for coming back on Radio Advisory. As we learn more about vaccines, I am sure we will have you back. Brandi Greenberg: Would be my pleasure. Rae Woods: I know I sort of joked that I was a bit pessimistic and I do think that you could listen to this conversation and just hear all of the challenges of vaccine distribution. You might even be feeling a bit defeated. But I actually want you to feel empowered, because there is so much that every leader in healthcare can be doing right now to ensure that the coronavirus vaccines are successfully administered. And remember, we're here to help.