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A second COVID-19 vaccine is on its way. What’s next?

The U.S. has approved a second COVID-19 vaccine, made by Moderna, to begin rollout on Sunday. With America regularly recording more than 3,000 COVID-19 deaths per day, the much-needed additional doses will provide a boost to efforts to vaccinate healthcare workers, but may take months to reach the general population. Propublica health reporter Caroline Chen joins Hari Sreenivasan to discuss what to expect from the rollout.

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  • Hari Sreenivasan:

    For more on how and when the COVID-19 vaccines are being distributed, ProPublica reporter Caroline Chen joins us from New York City.

    Caroline, we've all heard that vaccines are being distributed, but we've also heard that there are hiccups in how that distribution is happening. And it's been, well, decades since we've ever had to try to roll something out like this. Hiccups are expected, but where are the big logjams?

  • Caroline Chen:

    Yeah, so we're hearing different stories from different states. And, as you're right, there are going to be hiccups. It's inevitable because this is a massive undertaking. So I think that there are various, I would say, different buckets of issues here. There– there's some states that are reporting that they're getting fewer doses than they originally expected. Some of this is a software issue where they're just seeing a different number. Those numbers have changed over time. I think that has now been sorted out, according to federal officials.

    And then there are sort of local issues and I just wrote a story about this yesterday, just to give you an example. We're at Stanford, there was an issue where residents were not prioritized, so residents in the hospital are the lowest ranking doctors, they're often frontline, and in the first 5,000 doses that were given out there were only seven residents and some higher ranking doctors who actually are not in the wards ended up being part of this distribution. And this came out of an algorithm that Stanford used to determine who were the first few. And there were some issues with that algorithm where part of it was age. And you can understand why age, you know, the older you are, you're considered higher risk.

    But then part of that also included location. So where you are on the ward, and that might make sense theoretically, but residents often are moving around the hospital. And so they didn't have a location attached to them and that actually penalized them in this algorithm. And somehow nobody looked at that when the list came out and said, 'hey, where are the residents here?' And so that sort of thing, you can understand why when you have a limited number of doses that there are all these questions like what are the factors you want to really bring to the top? And so that caused a lot of chaos. Yesterday, the residents started protesting and Stanford has since apologized and said we'll kind of relook at our system for how we prioritized and try to put the residents at the front of the line.

  • Hari Sreenivasan:

    And when you look at this across the country right now, what is the general pecking order if there is one who is supposed to be getting it first? And who are we expecting to get it in the next few weeks?

  • Caroline Chen:

    Yeah, so at the high level, there's not a whole lot of disagreement. At the high level, it's high-risk health care workers first and then long term care facility residents next. And then that's really going to be the next month or so. And then after that, starting in January, as we get more production both from Pfizer and now Moderna, who was just authorized yesterday, then we will move in to sort of the next much bigger bucket of both older than 65 and essential workers. That's all determined by the states, but it's in the details that get difficult. So a hospital gets their batch. How do they determine within their own hospital who exactly is at the front of the line? And that's where you get all this angst.

  • Hari Sreenivasan:

    Decreasing the transmission and infection rates in long-term care facilities should bring down our overall death rates that we're seeing continue to rise.

  • Caroline Chen:

    Yeah, and it's just been this horrible tragedy. And we've talked about this before, Hari, the number of deaths that have kept coming from long term care facilities that even though it's such a small percentage of the American population that something like 40 percent of the COVID deaths have come from the long term care facilities. So this is such a huge priority to get that population taken care of, to reduce transmission there, to reduce deaths there because they're just so high risk and we just have not been able to stop transmission there. So this is a huge rollout happening through CVS and Walgreens to all the long term care facilities. And that is just starting now. And we really have to be watching how that, that happens.

    And not only is it, you know, CVS and Walgreens bringing all these vaccines to the residents, but also they have to make sure that they get consent from all the residents to make sure that they understand what they're getting. And if there's a resident who's unable to give consent that they have to go find their family member or their health care proxy and get consent from their health proxy. So this is a process where we've talked about this, too, that getting a vaccine through the trials to approval or authorization is just the first step. Now, really, is the hard part: getting through the logistics to get it to people.

  • Hari Sreenivasan:

    Now, we've heard of Pfizer and we've heard of Moderna with vaccines, one that requires very, very specific cold storage and transit, the other one that just requires normal refrigeration when it gets to a drugstore or wherever. But do we see anything else coming down the pipeline that would increase the availability of different types of vaccines?

  • Caroline Chen:

    Yes. So the next one that would be upcoming and this would not be immediately in January, but hopefully coming up sometime soon in 2021 would be Johnson & Johnson's vaccine. The big difference with Johnson & Johnson's vaccine is it's a one-shot vaccine. So that would make it a lot more convenient. And you don't have to take the extra step of having someone come back 21 days or 28 days later and having to keep that straight in people's minds and also for doctors and pharmacists to have to say, hey, what did you get 21 days ago or 28 days ago? We've got to make sure that you get the same one because you can't swap and mix and match with the Pfizer/Moderna, if you got Pfizer, you got to get Pfizer again for the second shot. And remember to come back 21 days later. Same thing from a 28 days later, you have to come back and get the second shot of Moderna and just keeping those things straight logistically.

    The federal government also has had to make sure that if they send a state however many hundreds of thousands of doses of Pfizer, you know, 21 days later, they had to resend the same number so that they can make sure people get their second shot. So Johnson & Johnson's vaccine, again, we have to make sure it gets through phase three trials, that it is effective, that it is safe, but it will provide the third option that hopefully is a little more convenient.

  • Hari Sreenivasan:

    Just for people's background, if they have a family member who gets a vaccine, that doesn't mean we can just walk around without masks around them.

  • Caroline Chen:

    Yeah. So this is a great question and one that we just don't have a 100 percent answer to yet. And people ask, why? Isn't a vaccine supposed to protect me and make me immune? So, what we know right now as of this moment from the trials is, does the vaccine prevent me from COVID sickness. And that's because that's what they measured in the trials so far. Of these trials, the Pfizer/Moderna trials are actually ongoing and they'll actually track the people in the trials as long as they can for two years because they want to know did they have any side effects long ongoing and they're still measuring and gathering data. So that's really important to know that we're going to continue to get information from these trials.

    So at this point in time, they're able to say what was its effect on COVID sickness. So that means symptomatic illness, that somebody felt that they had a fever, they had COVID symptoms, and then they went and got a test. So is it possible that you could have the vaccine and then pick up the coronavirus? It's hanging out in your nose. You don't have symptoms. You wouldn't be positive on a test and you know, you wouldn't get sick, but you could still pass it on to someone else. That's still something that hasn't been totally proven.

    Now, I have talked to a lot of scientists and they say it's so effective at preventing sickness, it's actually quite likely that it will also prevent transmission. But we just haven't 100% proved this yet in a trial. So I can't tell someone, I promise you, that you can no longer transmit the coronavirus. They are trying to gather data on this. And Moderna's trial actually has collected a little bit of data that looks positive. But this is not yet a signed and sealed answer at this point in time. I hope that they're going to continue to answer these questions as the trials keep going. And of course, we all want to know this.

    But again, until a lot of people have vaccines that we have as a country, more herd immunity until the scientists gather more data, I think we just can't afford at this point to be like, we're going to let our guard down and do whatever we want. So if you get a vaccine, you also don't know who else has gotten a vaccine. And we want to keep encouraging, modeling good behavior for our neighbors until this pandemic is over. So I think that's why everybody is encouraging, even if you've gotten a vaccine, you want to keep wearing a mask at this point. Again, science evolves. We learn more as we go. So this could be a case where as we learn more and we get more data, public health guidance might change.

  • Hari Sreenivasan:

    Caroline Chen of ProPublica, thanks so much.

  • Caroline Chen:

    Thank you for having me.

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