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All Podcasts Vaccinate the World, End the Pandemic (with Nicole Lurie)

Vaccinate the World, End the Pandemic (with Nicole Lurie)

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Dr. Bob calls up Nicole Lurie from the Coalition for Epidemic Preparedness Innovations to talk about the state of COVID-19 vaccinations around the globe. They cover COVAX, vaccine nationalism, how vaccine hesitancy is playing out in different countries, and the biggest barriers to vaccinating the world. Plus, the lessons she’s taking away from COVID for the next global health crisis.

 

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Transcript

SPEAKERS

Dr. Bob Wachter & Nicki Lurie

Dr. Bob Wachter  00:09

Welcome to IN THE BUBBLE. I’m Dr. Bob Wachter. Well, it’s become almost a cliche that we are not safe until everyone is safe. And that means that there’s not only a moral and ethical dilemma to vaccinate the world, but very practical reasons as well, not only will new viruses inevitably enter our world if rates of infection are high elsewhere, but we’ve seen that rampant uncontrolled spread of the virus. We’ve learned this painfully, is a tremendous incubator of variants that sometimes take on a variety of superpowers. We’ve spoken a lot on the show about the domestic scene but at least the last several months since I’ve been on less so about the international scene.

Dr. Bob Wachter

As in the US, it’s a mixed bag with some successes cases coming down in many countries, but they’re going up in others. Our greatest concern now is what’s happening in India, where cases are literally exploding. India is the site of the greatest concentration of vaccine manufacturing in the world. So, as India turns its attention to its own problems quite appropriately. This will also influence the world’s vaccine supply. So it’s just yet another demonstration of how extraordinarily interconnected we all are, and how we are not safe until everyone is safe. And it’s wonderful that many people the United States are vaccinated, but many people in other countries are not.

Dr. Bob Wachter 

Well, how are we doing in our effort to vaccinate the world? What’s different about the global and US vaccination efforts? We’re really fortunate to have, I think, the best person in the world to talk to us about that. She’s an old friend who has been a leader in pandemic preparedness in the United States, and now is focused largely on the global scene. So she has seen both what the domestic scene looks like and the global scene and it’s been incredibly useful to efforts to vaccinate the world and her insights are really spot on. So, our guest is Nickie Lurie. Nikki is a physician. She was the former Assistant Secretary for Preparedness and Response in the US Department of Health and Human Services under the Obama administration. So when you heard things about the Trump administration coming in and tearing up the pandemic preparedness plan, that plan was one that Nicki and her colleagues had developed.

Dr. Bob Wachter  02:33

Now she’s a senior advisor at the Coalition for Epidemic Preparedness Innovations known as CEPI, one of the organizations that’s leading the global vaccine equity effort known as COVAX. So she sits right in the middle of a whole bunch of organizations that are focused on trying to promote global vaccination. And that’s everything from the logistics and the financing and the supplies to addressing issues of vaccine hesitancy, which is obviously not just a domestic problem. It’s a global problem as well. So I appreciate Nikki coming on and let us ring up Nicki Lurie.

Dr. Bob Wachter

Hello, Nikki.

Nicki Lurie

Hey, how are you?

Dr. Bob Wachter 

I’m good. Great to see you. Yeah, it’s been too long.

Nicki Lurie

Good to see you too. I know it has been forever.

Dr. Bob Wachter 

Yeah. Okay, why don’t we get started? Thanks a lot for doing it. Why don’t we start tell us what Kovacs is.

Nicki Lurie 

So COVAX is a collaboration between CEPI, the Coalition for Epidemic Preparedness, Innovations, Gavi, The Vaccine Alliance, WHO, and UNICEF. And it was formed to solve the problem of having a single system that got us from vaccine research and development, through manufacturing and the purchase of vaccines to the delivery of vaccines to people’s arms around the world. It is not a legal entity, but it is a collaboration in which each organization plays its part.

Dr. Bob Wachter  04:05

And particularly focused on the developing world?

Nicki Lurie 

Particularly focused on the developing world. Although it’s fair to say that COVAX exists for the whole world. And there are a number of upper middle- and high-income countries that have joined COVAX almost as an insurance policy to ensure that if the vaccines that they had contracted for didn’t work out that they would also have a mechanism for accessing vaccines through the global system.

Dr. Bob Wachter 

So just in kind of pure nuts and bolts if you’re the United States, and you are focusing on getting as much vaccine to your people first and we can talk about the ethics and all of that, but we’ll get to that later. Is COVAX competing with wealthier countries for vaccines, or does everybody agree? I’ll take 2/3 of it and we’ll put 1/3 given to COVAX, how does that work?

Nicki Lurie 

Well, it’s a great question. So what happened when COVAX was formed is everyone decided that COVAX would be the buyer of vaccines for low- and middle-income countries and for other countries that didn’t necessarily want to have to go on their own to contract for vaccines. What then happened is that a number of high-income countries came along or groups of high-income countries like the European Union and said, gosh, we’re not so sure we want to wait for COVAX. So we’re gonna cut deals on our own. And COVAX found itself competing in some sense with those high-income countries that worked out bilateral deals for themselves. But the idea of COVAX was to be the buyer and the distributor of vaccines globally.

Dr. Bob Wachter 

So now were 4 or 5 months into vaccine distribution, what have we learned about how this whole process of global vaccination works over the last five months that we didn’t really know, five months ago?

Nicki Lurie  06:04

Well, I’ll back up even further and say what we have learned in all of our pandemic planning around the world is that there were many parts of this that nobody planned for, particularly, who was responsible for buying raw materials, who was responsible for manufacturing vaccine, who was responsible for telling manufacturers if you make it, we’ll buy it. And then who’s responsible for ultimately buying it, let alone distributing it. So, now 4 months into this COVAX adventure, I think we’ve learned a number of things. First, the really great part is that COVAX has now distributed vaccines to over 100 countries around the world.

Nicki Lurie 

Be it they are small amounts of vaccines, but they have come up with an equitable allocation and distribution system, particularly for low- and middle-income countries who want vaccines. And so the priority first was to distribute vaccines for healthcare workers, that’s vaccines have now reached over 100 countries around the world. So that’s really terrific. And the system for doing that is working. At the other end of that we’ve experienced substantial shortages in the amounts of vaccine that COVAX expected to have able to distribute at this point. And that’s largely because a number of countries are holding on to vaccine, they have more than they need.

Nicki Lurie 

And some countries like India, which is having a huge surge right now in COVID has said we’re not letting any vaccines out of the country at this point, which is exactly what the US did, except that we were counting on lots of vaccines from India. So then in between there, what we’ve learned is, you know, not enough raw materials in the world to make all the vaccines that the world needs for COVID and the rest of routine vaccination and other products. So we’re trying to solve that problem. And still not enough money, for Gavi to be able to cut the deals to buy vaccines.

Dr. Bob Wachter  08:07

Yeah, people now have been talking about vaccine nationalism. I assume that’s an old concept and an old term, it seems sort of inevitable that a country is going to focus first on vaccinating its own people before it focuses on the rest of the world. Is there anything different about the way vaccine nationalism is playing out now as opposed to in the past?

Nicki Lurie 

Well, so I think this whole concept about vaccine nationalism probably started during the H1N1 pandemic, when then the US had all the contracts for manufacturing, and so had access to all of the vaccine. And there was a huge amount of anger in the rest of the world that the US vaccinated its people first and wouldn’t let vaccine out. This time, the rest of the world got smarter and a number of high-income countries said, we’re not going to be in that situation again. We’re going to contract for vaccine so that we have it for our people. And in fact, if you think about it, it is the responsibility of every sovereign leader to take care of its citizens. And so that’s not such a crazy idea. I think what’s been disturbing here is two things.

Nicki Lurie 

One is, not beginning to share some of the vaccine that a country has, so that it can simultaneously work on vaccinating its own population, and then populations around the world. And then the idea that right now, there’s a lot of sense of hoarding vaccine. So the many countries now have ordered far more vaccine than they need. And many of them haven’t yet made it clear what they’re going to do with that xx vaccine and how it’s going to get distributed around the world. So it’s not a new phenomenon, but the scale of multiple high-income countries buying it is new, and it should have been something that we all anticipated.

Dr. Bob Wachter 

seems that part of the dynamic here is we’re talking about sending vaccines to other countries, but it’s not only one vaccine, it’s multiple vaccines. They have different characteristics in terms of ease-of-use cost. And now we’re learning they probably have different side effect profiles, which I assume adds levels of complexity on top of complexity, as opposed to if we were only talking about 1 vaccine, or we were talking about 4 or 5 vaccines that were all essentially the same. So how has the particulars of the different vaccines, the AstraZeneca, the J&J versus the mRNA vaccines? How has that changed the nature of this problem?

Nicki Lurie  10:36

Right. Well, first, remember that the world invested in a lot of different kinds of vaccines in different platforms to hedge their bets. Nobody really anticipated that so far just to bet everything they invested in would work. So that part of it’s been a pleasant surprise. Yes, they have different profiles. So the mRNA vaccines have really substantial requirements for the cold chain, so they’re very difficult to transport. And they’ll be difficult to use outside of dense urban areas for low- and middle-income countries. The routes are really quite expensive. The AstraZeneca and J&J vaccines are a lot easier to use. The J&J vaccine is one dose, which particularly if you’re trying to reach remote rural populations, or other kinds of populations, is going to be a lot easier to administer.

Nicki Lurie

The other thing about both of those, as both of those companies had found to have a not-for-profit vaccine during the time period of the pandemic. And so from their perspective of price and procurements, they’re a lot less expensive to buy. Then the mRNA vaccines, and when we’re talking about government’s donating money to Gavi to buy vaccine, that becomes a really big deal. But now what you have is a situation where you have these safety signals about blood clots. For both of the adenoviral vectored vaccines, we yet don’t know exactly how significant those are going to turn out to be.

Nicki Lurie  12:11

But it is still very much the thinking that the benefits of administering these vaccines far outweigh the risks. But what you’ve got is rising vaccine skepticism on top of a baseline of significant vaccine skepticism and resistance in a number of parts of the world. So there are a lot of countries now that really are having difficulty vaccinating their populations, because of skepticism about this vaccine. And then, in addition, with the new variants arising, there are concerns that the different vaccines performed differently with some of the variants. And so for example, it doesn’t make sense now, probably to use the AstraZeneca vaccine in South Africa as an example. So yes, it’s very complex.

Dr. Bob Wachter 

You hear a narrative emerging in the United States or maybe around the world, that the US is going to keep the good stuff and send the stuff it doesn’t want to other countries. Is that a narrative that is going to get us in trouble? Is that a narrative that is being discussed in around the world?

Dr. Bob Wachter 

Well, I think it’s a narrative that, frankly, before we had any vaccine candidates that had been shown to work, that was a narrative that we were worried about, and we’re all planning for. And I think we have to be very, very careful about this narrative, largely because it’s in everybody’s interest to get the whole world vaccinated, so that we can both keep Coronavirus at bay and so that the economies around the world, including the US economy will recover. It’s not the case that when we vaccinate most of our population, and we don’t have a big problem here that we’re safe or that our economy will recover, we’re all really interdependent, particularly economically.

Nicki Lurie  14:18

But yes, there are concerns of quote dumping inferior vaccines on the rest of the world. And it’s very much a narrative that has to be managed. I think, I would prefer right now to frame this this right now, the US has quite expensive, pretty hard to use vaccines that make it very difficult to vaccinate most of the rest of the world with those vaccines, and it’s going to be a while to those vaccines become less expensive and easier to use. And in the meantime, we need to go ahead and vaccinate the world.

Dr. Bob Wachter

Yeah. So much of vaccine skepticism hasn’t seen the United States appears to follow along, to some extent, racial and ethnic lines, but increasingly around political lines, and it’s fueled by the Internet, and it’s fueled by our different media bubbles. What’s the nature of vaccine skepticism and hesitancy in low- and middle-income countries? Is it the same? Or is that a different dynamic?

Dr. Bob Wachter

Well, it depends on which country and I don’t think we can paint all of low- and middle-income countries with one brush, just like we can’t paint America with one brush. And as you pointed out, you know, counties that voted one way politically, often differ from those that voted another way politically. So just as in the US, there are some countries have different views of whether COVID is a serious problem. And different countries, often those with different vaccine experience, have different narratives about vaccine and vaccine hesitancy. And for those listeners who haven’t read it, there’s a lovely little book called Stuck by Heidi Larson, which outlines the issues with vaccine hesitancy or vaccine confidence around the world.

Nicki Lurie  16:03

It’s clearly not uniquely a US problem. The other thing that is at play here, though, just like in the us is that some countries, as we know, are also trying to use vaccine as diplomatic or economic tools in one way or another. And some of those countries have also been fairly aggressive at targeting countries to try to get them to lose confidence in one kind of vaccine or another. So the whole phenomenon of the internet and social media and misinformation as rampant. So you may have seen some of the video clips early on of the Russian campaign against the AZ vaccine, saying it was going to turn you into a chimpanzee, for example. But that sort of stuff’s going on all over the world. And in the US, as well, we know that there is specific social media targeting of different populations, including African-American and Latinx populations in particular.

Dr. Bob Wachter 

Yeah, wow, you talked about the cost being, obviously being a barrier, talk about intellectual property, and what are the protections that manufacturers asked for? And how does that the dynamic around intellectual property and influence the global effort, I imagine there’s some pressure to make vaccines available for free and to decrease the profit to pharma companies, and of course, the pharma companies would like to make a profit. So how does that all play out on the global stage?

Dr. Bob Wachter 

Well, you know, there is a pretty healthy narrative out there that if we waived intellectual property rights, and the patent protections didn’t hold that we would just suddenly have enough vaccine in the world because other companies and countries would be able to manufacture it. I think what’s not as appreciated is that manufacturing vaccines is really, really different than manufacturing drugs, it is a much harder, much more complicated process. And you still need willing partners to transfer the know-how. And if you don’t have willing partners to transfer the know how I think it’s going to be very, very difficult to go ahead and manufacture these vaccines.

Nicki Lurie  18:14

So yes, the manufacturers are very much against the waiver of intellectual property rights. What I would just offer is that so far, CEPI has been able to accomplish its objectives by promoting voluntary licensing and technology transfer of the vaccine candidates it supports to manufacturers, in developing countries. And even doing that, I’ll just say the process is hard. It takes a long time. And even with willing partners, it’s not simple and straightforward. So while I think the intellectual property issues and discussions play out and need to get resolved, my own self, I don’t believe that right now that they’re the biggest barrier to having more doses of vaccine around the world.

Dr. Bob Wachter

And the biggest barriers you mentioned, some of it is just raw materials and kind of the technical process of developing these vaccines, is that the biggest one right now?

Nicki Lurie 

Well, so some of it is the technic, the facilities and the technical processes to develop vaccines, and to test them and show they’re safe and effective. But that’s a really huge barrier. And now we’ve come up against all of this set of issues around the raw materials, that they’re just not enough of certain kinds of raw materials to make what people hoped would be 14 billion doses of vaccine this year, most of it COVID went on an average year, the world makes about 3 or 4 billion doses of vaccine. And here it turns out that for right now, the US having exercise the defense production act, is really holding on to and hoarding a lot of raw materials that is inhibiting the manufacture of vaccine other places in the world. So just this morning, you saw the CEO of the Serum Institute Of India tweeting out again that they can’t make vaccine because they don’t have the raw materials that they need, or will run out within the next couple of weeks, and they’re the largest vaccine producer in the world, right?

Dr. Bob Wachter  20:13

Yeah, yeah. So what is your crystal ball say about global vaccination in 2022-2023? What’s going to happen over time here?

Dr. Bob Wachter 

I think over time, we will have enough vaccine, the question I think is going to be what happens in that time with the evolution of variance, and whether the vaccines can keep up with the variants. And I think we’ll get to some different level of population immunity, and maybe through natural infection and a lot of people dying, and some of it will be through vaccine. I think the acute problem is really in 2021, and probably going into the early part of 2022. But what we’re seeing is ramp up and scale up of manufacturing. And remember that there are many, many more vaccine candidates on the horizon.

Nicki Lurie 

Some of them, COVAX is negotiating agreements with to supply vaccines for the world. And they have prioritized those candidates that have the ability to produce large numbers of doses quickly. Remember that, just as we’ve seen with the adenoviral vectored vaccines or vaccine development is a little bit risky and uncertain, and we don’t yet know how those vaccines will perform. But my crystal ball tells me that convincing a lot of the world to get vaccinated is going to be as much of a problem as actually getting the vaccines made.

Dr. Bob Wachter 

So in the US, we have our own way of thinking about risk benefit tradeoffs. And we’re in the middle of a big discussion about that now if it turns out that the J&J blood clot issue is a one in a million, how then do we decide whether that vaccine is ready for primetime? And who should get it and who shouldn’t get it? If it’s the only vaccine that you have available because of the logistics of cold storage or the price? How does that kind of risk benefit trade off play differently in let’s say, a very poor country where, you know, there’s no alternative, it’s either this or nothing.

Dr. Bob Wachter  22:35

Yeah. Well, again, I think different countries are different. And I think what we have to recognize is that each country is both regulators, and government leaders are going to make a decision for their country and different countries are coming to different conclusions. You know, some say, wow, the worst benefit tradeoff is a very worth it. And we’re going to go ahead, and others are going to say, well, gosh, if it’s not good enough for the US, it’s not good enough for us. And I think it’s going to play out in lots of different ways and shapes and sizes. I think the reality, if in fact, it turns out that the issue right now with the J&J vaccine or either one of them, frankly, is a one in a million or one in 500,000% issue. The reality is that most countries would not have been able to pick up that kind of a signal related to vaccine to start with.

Nicki Lurie

And we’re in a very different situation with those vaccines than we were when we dealt with something like Rotavirus 20 years ago, which needed to come off the market. So I think we’ll see, I think it’s also going to be the case that the more we understand what caused this and can explain it to people, and can highlight populations that are at the most risk with this vaccine so that they can either use a different vaccine or make a different decision about vaccination. We’ll be better off but the messaging is sure complicated.

Dr. Bob Wachter  24:07

Yeah. Taking out your crystal ball even more. Let’s say we’re in 2022-23′, and COVID is under control worldwide. And all of the vaccine regulators and COVAX and others have a huge conference and trying to figure out what did we learn from this? And what do we have to do differently to be sure we get it right for the next time. What do you think the key lessons are going to be? And how will the system have to get rejiggered to do better?

Dr. Bob Wachter 

I think for me, the key lessons are about global coordination early and about looking at the parts of the vaccine development process that have been delayed because it wasn’t clear whose responsibility things were and it wasn’t financed. So I think is as I said, once we got through some other early preclinical development and into the other vaccine development, it wasn’t really clear outside of the US who was responsibility for supporting vaccine development, developers took a pretty long time to decide it was a sound enough business decision for them to get into it without a lot of support from the US government or others.

Nicki Lurie 

So whose responsibility is it to jumpstart it? Whose responsibility is it to pay for it? Who pays for materials, who pays for manufacturing, who pays for purchasing who pays for distribution, and for me, the biggest message is you can’t pass the Tim cup in the middle of a pandemic and expect that you’re going to have a successful response. The world needs a financing system for all of this that can be activated in an emergency, so that you don’t have all these hiccups and bottlenecks. Even in the US, while we celebrate the fact that the mRNA vaccine got made so quickly. And yes, NIH downloaded the sequence, the day after it was posted and got to work. The US didn’t put many billions of dollars into this till mid to late March. I imagine if they had started doing this in early January, when it looked like we were going to have a pandemic, we can always take an off ramp, but you can’t make up for lost time.

Dr. Bob Wachter  26:19

And last fairly political question, and you can punt on it if you want. But you talk about the absence of leadership on the international front, how much of that was because of the Trump administration’s general stance to focus on the US exclusively and to kind of withdraw from international organizations? Would this have been very different with different leadership at the time?

Dr. Bob Wachter

I think unquestionably, even in terms of what’s happened in the US. So you know, from where I sit at CEPI, we made a decision that we would need to start vaccine development for this before the sequence was posted. And we reached out to developers and said, when this is posted, we would like for you to pivot what you’re doing working on MERS or working on a platform and try to make a vaccine against this, we didn’t have the scale of money that the US government did. Okay, if we figured we could always stop if this turned out to be nothing.

Nicki Lurie 

Had we done that in the US? I think it would have been a very different situation. And had the US not taken the position, at head with WHO and really encouraged and supported them in their normative role set, you know, norm setting role. We also I think, would have been in a really different place. It’s also the case that some other leaders around the world, so look at Brazil and the mess there and now have a leader who hasn’t taken seriously. And I think that those kinds of people got a lot of encouragement, unfortunately from the US and it really helped propagate and perpetuate this.

Dr. Bob Wachter 

Yeah. Your role in under the Obama administration, as I understand it, was to do pandemic preparedness in the United States. And then there is we hear that the plan was ready to go and then was kibosh by the Trump administration. First of all, was that your plan? And second of all, is that actually what happened?

Dr. Bob Wachter  28:12

Well, I think I would say it very much was our plan. And there were a whole series of plans of many kinds are ready to go. And I think that failure to acknowledge that something was going on for a long time inhibited huge many, many aspects of the US government response, and certainly it was our plan with vaccines. And I can tell you that historically, you know, whenever a new flu virus shows up, we start making a seed virus and do a risk assessment and go through stages of development and decide when it is that we need to stop. On one other occasion H7N9, we were worried enough that we actually made a lot or a batch of vaccine and froze it in case it were ever needed.

Nicki Lurie 

The case of Ebola, early on in the Ebola outbreak in 2014. You know, my team came to me and said, have you seen these data about health care workers who are dying? Do you think we need to be concerned? And we looked and we said, gosh, you know, let’s look around the world see if there are any Ebola vaccine candidates that we could pull out of a closet that have got a jumpstart on development and get them going. And that’s exactly what we did. And that’s what is now the Merck vaccine. So starting early because you can never make up for lost time, I think is the name of the game.

Dr. Bob Wachter 

Yeah. Having had such a critical role in the domestic preparedness world, now much of your focus is in the global world. What are the unique joys and what are the unique challenges of focusing on the global scene?

Dr. Bob Wachter 

It’s been a fantastic honor and privilege to do this and I will say, and also say that I feel much better equipped to do this having lived through doing this in the US government side. But I took a lot of what went on in the US government for granted. So, you know, you download a virus, somebody grows it up and ultimately shares it. You know, with research laboratories, the US government has facilities that pay to develop animal models and to do the preclinical testing and work. They fund the clinical development through BARDA, they fund the clinical trials, and then they fund them manufacturing at risk and they buy the vaccine, and they vaccinate the population. And the US government pays for all that and does that, it might be not quite as smooth as one would like, but it happens.

Nicki Lurie  30:37

In the rest of the world, the roles and responsibilities are not so clear. So whose responsibility is it to grow up virus and share it with others, you remember that China didn’t share virus, and we had to wait till it got to other countries. And when it got to Australia, Australia said, well grow up virus and share it with folks, right? Whose responsibility is it to develop animal models for the world, especially when there are a huge shortage of certain kinds of animals that you might need to test vaccine. And then as I said, it’s not clear whose responsibility is to do the rest of this. So working together with large international entities, like WHO and Gavi, and then working with countries in different regions of the world, and different regional organizations, all of whom have different kinds of assets and different kinds of challenges and different regulatory systems, different cultures, is a really interesting challenge.

Nicki Lurie 

And then trying to do this all virtually forget the fact you know; I think it’s easy to forget the fact that we all can’t just sit in a room for two days and work stuff out. We’ve had to do this, you know, over Zoom in with parts of the world that might not have great connectivity, and all of those sorts of things. So the challenges have been enormous. And the fact that we’ve accomplished as much as we had is, I think, in many ways, nothing short of miraculous, even though I think we all wish we’d accomplished a lot more.

Dr. Bob Wachter  32:07

Of course, my last question I guess is where do you stand on your on your scale of pessimistic to hopeful today? Do you think feel like, are you more optimistic about where things are going? Are you still quite worried?

Dr. Bob Wachter 

I’m still pretty worried about the emergence of variance, including in this country. And I’m very worried about the issues now about vaccine uptake around the world, I’m optimistic that we’re going to work through our challenges with nationalism, that we’ll work through our challenges with the supply chain, I think it’s all going to come a lot later than we want it to, and that there will be a lot of excess death and morbidity because of that. But I’m optimistic that we will get there. I think the US now has a huge opportunity as it rejoins the rest of the world to lead and to be really constructive here. And I think it will find ways to do that.

Dr. Bob Wachter 

Great. Thank you so much. That was incredibly instructive. We spent a lot of time on the show talking about the domestic scene, and less on the global scene. It’s really incredibly interesting and really important that we understand it.

Nicki Lurie 

It’s been quite an eye opener; I will tell you. It’s been really super interesting and great to take what I learned to do and be able to contribute to this effort.

Dr. Bob Wachter 

Yeah. Well, thank you. Thank you for doing that.

Nicki Lurie 

And thank you.

Dr. Bob Wachter 

Well, thank you to Nicki Lurie for a fascinating and somewhat sobering chat, while we can celebrate how well the US is distributing vaccine, and we’re doing pretty well, now with 220 million doses distributed about 3 million doses a day. And we’re closing in on almost half of the adults in the United States having received at least one dose, we just simply have to be concerned about the pace of vaccination elsewhere. And as I think Nicki made clear, the daunting obstacles we face some of them around money, some of them around vaccine hesitancy, but some of them at least I wouldn’t have thought of, you know, testing in animals, raw materials, things like that. It’s a really complex problem. And I’m glad Nickii is helping to do what she can to sort it out.

Dr. Bob Wachter  34:37

I’m also grateful that we have an administration that now appreciates the importance of international engagement in leadership and is making some wise decisions about what we can do to move the needle not only in the United States, but also around the world, because it is all absolutely interconnected. You may have heard Nicki mentioned Heide Larson’s book, Stuck, and as the issues of vaccine hesitancy grow in importance both domestically and internationally. I’ll just point our listeners to an episode that Andy did with Heidi Larson back in, I think December, Heidi is the author of the book Stuck. Heidi leads the vaccine confidence project based in the UK and probably the world’s leading expert on vaccine hesitancy and what can be done to combat it.

Dr. Bob Wachter 

So if you’re interested in that issue and want to learn more, it’s worth going back in your archives and taking a listen to Andy’s interview with Heidi Larson. Well, we have a number of other terrific and interesting episodes coming up. We’ll talk to John Halamka, who is leading the efforts in digital transformation at the Mayo Clinic previously had a similar role at Harvard Medical School, and Beth Israel Deaconess Hospital in Boston, we thought it would just be a good time to think about how COVID and the pandemic have changed digital in the United States and around the world, in many ways have accelerated the digital transformation of medicine and that will have some long-lasting impacts.

Dr. Bob Wachter  36:02

And I think you’ll hear from John that the pat answer which is of course it has markedly increased the, the uptake of telemedicine is a very, very partial answer to the question, what about COVID has been accelerated in terms of digital transformation of our healthcare system. We’ll also talk about health equity with a particular focus on vaccinations and what we’re seeing in vaccinations. In two different segments, one, focused on the Black community with Rhea Boyd, another focused on the Latinx community with Jon Jacobo and Diane Havlir. Rhea has focused on issues around the African American community throughout the pandemic. And I think she makes some really interesting points about not going right to vaccine hesitancy if we’re seeing lower rates of vaccinations in blacks, it may very well have to do with access and communication. And it’s a really important message.

Dr. Bob Wachter

And Jon and Diane are leaders here in San Francisco, in efforts to collaborate between my university UCSF and the community, particularly in the heavy Latinx district called the Mission District. And that collaboration has been spectacular and has influenced everything from prevention to testing strategies, and now is influencing the way we’re doing vaccination. Finally, we’ll have a show that we’re still lining up about the future of work as more and more workplaces. Go back to some version of normal, maybe not normal, but normaler, what has COVID done what is the pandemic done to change the future of work and the workplace and we’ll have some interesting guests to talk about that with us. So a lot of great episodes coming up. I hope you stay with us and I look forward to speaking to you soon until then please stay safe and if you have not yet please get vaccinated.

CREDITS

We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced our show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs executive produced the show. Our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @InTheBubblePod. Until next time, stay safe and stay sane. Thanks so much for listening

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