William Foege  : Good morning or good afternoon. I'm Bill foggy I'm
Lisa Brown : Hold on, Bill, we're gonna give it a few minutes yet.
William Foege  : Okay, okay.
For folks to join.
William Foege  : Let me greet everyone who is here and thank you for being part of helping us to improve on these recommendations.
William Foege  : My name is Bill Fagin, I'm on the Americas faculty at Emory. I'm Co chair. The other co chair is darker Helene Gayle, who is the CEO of the Chicago community trust and we are going to call first on the President of the National Academy of Medicine, Dr. Victor trouble Victor
Victor Dzau	: Thank you very much, Bill and Helene I speak on behalf of the National Academy of Sciences, Engineering, medicine and welcome all of you to this important public listening session.
Victor Dzau	: The Comedian the equitable allocation vaccine for the novel coronavirus which causes that devastating coven 19 pandemic.
Victor Dzau	: So you all know that there's been intensive effort to accelerate and develop safe and effective vaccines against his novel coronavirus. The whole idea is to protect people from covered infection and is devastation.
Victor Dzau	: This intense effort covers research discovery development clinical trials manufacturing to maximize production capacity.
Victor Dzau	: But under even the best circumstance explosive set, we may have an effective vaccine. By the end of this year, early next year.
Victor Dzau	: But we all know that, despite these promising efforts, the initial doses will be limited and decent supplied very beginning, although there'll be enough, eventually for everyone.
Victor Dzau	: But given this is scarce vaccine or vaccines will need to be allocated and waste a thoughtful strategic and fair, so we can reduce morbidity, mortality.
Victor Dzau	: And or virus transmission to protect people's health. And this economic and social well being. So it's important, therefore, that we have a thought well thought out framework.
Victor Dzau	: That will help determine who get the vaccine. First, who's next. And who's third based on science, public health, social factors and equity.
Victor Dzau	: Because these important issues affect people's lives and well being. This framework must be signed space objective transparent trusted
Victor Dzau	: And independent of the government have any private interest. I believe this is why NIH and CDC came to us that should can read medicine and National Academies outside the government to assemble a top team of experts to provide this independent recommendation for a vaccine framework.
Victor Dzau	: Just a little bit about US National Academies was founded in 1863 by Abraham Lincoln and Congress to be an independent advice to a nation. We're not part of the government.
Victor Dzau	: We avoid any full financial or other conflicts of interest, especially with for profit companies. We've always worked in public interest.
Victor Dzau	: And over 150 years we've established a reputation of excellence evidence base objectivity and trustworthiness.
Victor Dzau	: So it is rooted in these principles that we agreed to take on this work and convene and outstanding committee of experts with the highest integrity.
Victor Dzau	: I want to take this opportunity to thank the Community co chairs no fee and then Gail and you will hear from both of them, and all the members of the committee who have dedicated their time expertise to spend the last eight weeks, night and day long hours to this important task.
Victor Dzau	: Now you have all read our preliminary discussion draft today sessions important because we want to hear from you, the public and get your feedback.
Victor Dzau	: during this session, members of public will have an opportunity to address the committee directly
Victor Dzau	: Us individuals or representation representatives organizations and provide input on the committee's discussion draft.
Victor Dzau	: Want to hear from you because your opinions matter. We're here to serve the public by giving a best recommendation.
Victor Dzau	: But these recommendations have the practical acceptable trusted and implementable. This is why we look forward to hear your comments during today's session input from public on this draft framework, especially from communities disproportionately affected by
Victor Dzau	: Is essential to reduce a final report that's objective balance and inclusive. So with that introduction. I want to thank all of you for being here on time. The Comedian staff will do great job 100 back to Dr AG, who is opening this meeting. Thank you.
William Foege  : Thank you Victor for that important background. And I would add my thanks to CDC and NIH for recognizing
William Foege  : That it would be valuable to the public to have a non government organization make these recommendations.
William Foege  : And this is a draft. I want to say that over and over. This is a draft and that's why we're meeting today because we want the final product to be even better than this.
William Foege  : And have to add that it's a fast draft. I mean, I really fast draft. Why so fast, because the health officials at state, county, city tribal level need time to prepare the program before the vaccine becomes available. So we had to do this in the fastest possible way.
William Foege  : Less than half of this final report is now in your hands. So you can see, it's going to be a big report by the time it actually comes out.
William Foege  : The
William Foege  : uncertainties that we had our overwhelming. I'm not going to go through all of them, but we don't know when the vaccine will be available.
William Foege  : We have no idea how good it will be at different age groups. What will this do for 80 year olds, what will it do for three year olds.
William Foege  : We don't know enough about the epidemiology. We've only been studying this disease for six months and you think of all of the other
William Foege  : Infectious diseases where we have a vaccine that were studied for years before the vaccine became available. So there's still much to know the uncertainties were great. So we did the best we could. With all of these uncertainties.
William Foege  : On previous committees that I've been on that are similar to this. We've always started with the science.
William Foege  : And then we've asked the question of how do we look at the ethics of this this committee did it backwards.
William Foege  : And I want to emphasize that we started with the ethics and we started with equity before we went to the science.
William Foege  : And you can ask, why would we do that. And the reason is this pandemic laid bare the problems of equity in this society. The fault lines.
William Foege  : It showed us what systemic racism can do to people, the vulnerabilities and we came to the conclusion that while many people
William Foege  : Would immediately take the approach minorities should be first in line. We took the approach this virus doesn't understand skin color at all, but it's understands vulnerabilities.
William Foege  : And so we looked at the vulnerabilities and there are many co-morbidities but some of the biggest ones turn out to be heart failure, kidney failure, a
William Foege  : Body Mass Index of over 40 some of the social vulnerabilities, have to do with crowding with people who have to go to work, they don't have an option.
William Foege  : With multi generational occupancy. And so we looked at those things and we put those it first in line rather than saying skin color is the way we'll make this decision.
William Foege  : We tried to talk through every situation. And I tell you that some of these. We don't have enough information.
William Foege  : For instance, we want our children to get back to school. Everyone understands how important that is. That means we have to give a priority to teachers and staff and schools, but what about the children.
William Foege  : We know from schools opening that there is spread of this virus in school and the children take it home to people that we don't know whether they're vulnerable or not.
William Foege  : None of the phase three vaccine studies in this country actually include children under the age of 18
William Foege  : So it's very difficult for us to make a recommendation, we will have to rely on AC IP to decide what to do with children under 18 which leads me to does this committee actually overlap with a Civ
William Foege  : AC IP is a government committee advising CDC and CDC and NIH said, we also want to look from non government people. And so we are hoping the recommendations we give will actually help inform a Civ but inform the rest of government, I must tell you that this was an incredible committee.
William Foege  : Score people who have never worked together before and even now, we've never been in the same room together. And yet, in a month.
William Foege  : It's beyond imagination. We were able to come to an agreement on most of these issues. So it's been a great committee, but I also have to thank the academy for putting together such an unbelievable staff.
William Foege  : People like Lisa brown and and Ben Khan have literally worked at night and weekends in order to put down the thoughts of this committee.
William Foege  : Get replies from other people on the committee to take us to where we are today and where we are today. Dr. Helene Gayle is going to tell us what were the highlights of the report.
William Foege  : Particularly for those of you who could not get through it 24 hours because there's a lot of material there so I turn this over now to Dr. Helene Gayle Eileen.
Helene Gayle   : Thank you Victor and Bill and I will just add a few very, very brief comments because our we've got a lot to cram into five hours and you know really
Helene Gayle   : The key part of this is to hear from the public and to hear comments. But, you know, just to add my own sense of, you know, the incredibly important tasks that we were asked to
Helene Gayle   : Commit to and you know I have had the honor and privilege of being part of national academy studies in the past and other important public service.
Helene Gayle   : Opportunities, but I think in some ways, this is one of the most important endeavors that I've been a part of in my public
Helene Gayle   : Health career and career, you know, this is an unprecedented situation we have a public health challenge that has had
Helene Gayle   : Deep economic and political ramifications at a time where we're dealing with all of the uncertainties that Bill mentioned in his comments.
Helene Gayle   : And so I think this task, which is an incredibly important one was one that this committee took on very, very seriously and as people have talked about work.
Helene Gayle   : tirelessly to pull together the different backgrounds that are represented in this committee.
Helene Gayle   : To really put together what what hopefully is a very thoughtful report, but it's why, you know, in some ways, this public hearing
Helene Gayle   : In this chance to hear and listen to comments from the public, perhaps as important as ever. You know, we want to make sure that in
Helene Gayle   : Taking together all of the incredible issues that we deliberated around that we haven't missed perspectives that that we're hearing from parts of the public.
Helene Gayle   : That may present different perspective than we might have had within our own group, and so it's incredibly important for you to
Helene Gayle   : Present and provide to us a perspective that you bring from the different walks of life and avenues that you that you represent you know we do want to make sure that you are providing comments on the parts of the draft that we have provided and as
Helene Gayle   : People have mentioned, you know, this is half of the report, and we have other parts of the report on implementation on vaccine hesitancy on on
Helene Gayle   : Communication and and community engagement as well as global aspects. And so those parts are coming, but we really want is to get your best thinking about the draft report that we have provided. So, you know, again, I just want to thank our committee.
Helene Gayle   : The staff of the national academies and to all of you who have taken your time to provide your wisdom, your insights and your perspectives. So, this report can really serve the purpose that we hope it will have a being able to provide a independent unbiased ethical and science based
Helene Gayle   : Frameworks on equitable allocation of covert vaccine. So with that, I think I will start with a brief overview of the report and everybody said this is you know this is a lot we haven't provided
Helene Gayle   : A long time for this, but we wanted to make sure that we had the opportunity for all of us to be starting from the same starting point, as we listened to your comments, so I know somebody is advancing slides.
Helene Gayle   : And as was mentioned, as was mentioned, our two sponsors for this study, the Centers for Disease Control and the National Institutes of Health.
Helene Gayle   : And I think it really reflects the kind of collaboration that is so important at a time like this to have the two agencies come together to request that this study be done.
Helene Gayle   : The next slide shows the committee members. And while we don't have time to go around.
Helene Gayle   : And introduce you to all of them. We have 18 outstanding committee members that represent epidemiology.
Helene Gayle   : And modeling demography public health practices of practitioners at the territorial state, local and national levels. Emphasis vaccine researchers
Helene Gayle   : Law economics and and a diversity of racial and ethnic diversity that we think represents the populations most impacted the charge to the committee.
Helene Gayle   : It was twofold. First of all, to develop an overarching framework for back vaccine allocation to assist policymakers in the domestic and global communities in planning for equitable allocation of a coven 19 vaccine.
Helene Gayle   : The expectation is that this framework would inform decisions by health authorities, including the ACI P is Bill mentioned and that they as they create an implement national and local guidelines for the Cyrus Colby to vaccine allocation.
Helene Gayle   : So that was our overarching charge that charge has multiple dimensions. And I won't go into these in great detail. But first of all,
Helene Gayle   : And most importantly, what would be the criteria that should be used in setting priorities for allocation equitable allocation of the vaccine, how should those criteria be applied.
Helene Gayle   : To determine who should get those first and then subsequently
Helene Gayle   : What were the priority list for recipients. How will this framework be applied in various scenarios.
Helene Gayle   : Given the different characteristics and different availability of doses and and other scenarios that we'll talk about more
Helene Gayle   : If multiple candidates are available. How do we ensure equity. How can countries assure equity and allocation of covert 19 vaccine.
Helene Gayle   : For the United States. Specifically, how can communities of color, be assured access to vaccination.
Helene Gayle   : How do we communicate to the American public and what steps should be taken to mitigate vaccine hesitancy, especially among high priority populations. So that was our overall charge and the different components.
Helene Gayle   : As I mentioned, what we will not be covering today and what was not in the draft report our sections on program implementation.
Helene Gayle   : Vaccine hesitancy risk communication and global considerations and the overview of the discussion draft that we will be discussing are the lessons learned from other allocations. Next slide.
Helene Gayle   : Lessons Learned from other allocation efforts, the framework for the equitable allocation of Cobra 19 vaccine and then applying the framework for for allocation under various scenarios.
Helene Gayle   : Next slide. Now, in doing this we first of all started with some of the lessons learned from other efforts that we thought were relevant to our charge in our task.
Helene Gayle   : 2009 H1 and one influenza. The Ebola epidemic in West Africa, looking at allocation of scarce medical resources during Cobra 19 particularly treatment and other
Helene Gayle   : medical resources and then other vaccine allocation frameworks that were in progress. So those were we took into consideration as we thought about what were some of the lessons that could be learned.
Helene Gayle   : And applied to our task. Again, I don't. I won't go into this in a lot of detail. It is in the report.
Helene Gayle   : But I think, suffice it to say, we looked at issues of ensuring maximum benefit promoting common good saving the greatest number of lives possible
Helene Gayle   : Using the available evidence to make sure that we're benefiting communities and addressing uncertainty, looking at how
Helene Gayle   : frameworks for allocating scarce resources, providing clear and transparent criteria and then ensuring that this ALEC, the allocation policies were flexible and responsive to concerns of populations.
Helene Gayle   : And the changing epidemiologic situation and vaccine supply, all of which are things as as bill do in his comments are in flux and will change over the course of time.
Helene Gayle   : Next slide.
Helene Gayle   : And this is our overall framework that we
Helene Gayle   : Develop for the equitable Alex allocation of the coven vaccine and as As Bill mentioned, we started with foundational principles and these foundational principles that are both ethical, as well as other principles are kind of
Helene Gayle   : Throughout the process of what we're thinking about in terms of the allocation framework. So we wanted to have these foundations all of what we did grounded in these foundational principles and really very much
Helene Gayle   : influencing how we thought about our overarching goal, our allocation criteria and our allocation phases.
Helene Gayle   : Next slide.
Helene Gayle   : And so these were the foundational principles that we developed and again taking from established ethical frameworks.
Helene Gayle   : that already exist and using the ones that we thought were most relevant to the situation and most relevant to our charge and they are maximum, maximum ization of benefits.
Helene Gayle   : The obligation to protect and promote the public's health and its social economic well being in the short and the long run.
Helene Gayle   : Equal regard, we thought it was important that we look at requiring that everybody be considered and treated as having equal dignity worth and value.
Helene Gayle   : Is as was already mentioned the mitigation of health inequities is was an important one for us a moral imperative for an equitable vaccine allocation system.
Helene Gayle   : Particularly given the inequities that were highlighted throughout this pandemic fairness, the obligation to develop allocation criteria based
Helene Gayle   : Only on relevant non discriminatory characteristics and to plot to apply these criteria in partially to make sure that we are fair and in procedures in allocation evidence based
Helene Gayle   : Who receives the vaccine should be based on the best available evidence and transparency, the obligation to communicate with the public openly clearly accurately and straightforwardly about the vaccine allocation framework and criteria.
Helene Gayle   : So those were the overarching foundational principles that led to developing our primary goal on the next slide.
Helene Gayle   : Which is to maximize societal benefit by reducing morbidity and mortality caused by the transmission of the novel coronavirus and in doing this, we took into consideration the importance of the morbidity and mortality that
Helene Gayle   : We have seen as a result of the transmission. But recognizing the importance of also a focus on the transmission of the virus itself.
Helene Gayle   : We developed the following risk based allocation criteria, the first being the risk of acquiring infection. The second the risk of severe morbidity and mortality.
Helene Gayle   : The risk of negative societal impact and the risk of transmission transmitting disease to others. We also included in our allocation framework, the consideration of mitigating facts.
Helene Gayle   : As well, because we know that there are ways in which people can mitigate both morbidity and mortality as well as the transmission disease and we wanted to take that into consideration as well.
Helene Gayle   : So that led to our allocation phases.
Helene Gayle   : Phase 123 and four based on the risk category. As mentioned before, as well as our principles.
Helene Gayle   : And the Phase one is divided into
Helene Gayle   : A jumpstart phase and a Phase one be in that first phase, we considered all of the
Helene Gayle   : Groups that we listed as being high priority, but we also realize that at the very beginning of the of the distribution of the vaccine, we may have a very scarce supply
Helene Gayle   : Of vaccine available. And so we wanted a group that we thought would be the best group to kind of jumpstart
Helene Gayle   : The, the distribution of vaccine and so that group includes high risk workers and healthcare facilities and first responders with the understanding that not only are they highly
Helene Gayle   : At risk for transmission, but that they also are so important for taking care of others who
Helene Gayle   : acquire the coven 19 and so we put them in our first phase. The next part of phase one, or people of all ages with the highest risk of co-morbidities and then older people living in congregate and overcrowded settings.
Helene Gayle   : The phase two was critical, health, we're at critical workers and using DHS category for workers who are in industries that are important for the functioning of society.
Helene Gayle   : teachers and school staff people of all ages with comorbidity and underlying conditions that put them at moderately higher risk all at older adults that are not included in phase one people in homeless shelters and similar environments and people in prisons jails detention centers.
Helene Gayle   : Phase three includes young adults, children and workers in industry that were that are considered essential to the function, but not in phase two.
Helene Gayle   : And then phase four. As we said, we hope that as the vaccine becomes available and the number of
Helene Gayle   : Vaccine courses are available that anyone in the United States that did not receive the vaccine in previous phases would be included in that in the fourth phase.
Helene Gayle   : Important for us across all of the phases is our equity consider it cross cutting consideration.
Helene Gayle   : So within each of these groups each population group vaccine access we prioritize by geographic areas identified through CDC social vulnerability index.
Helene Gayle   : With the idea again of looking at what are some of the underlying causes that put populations that greatest risk particularly communities of color and locals social economic status populations.
Helene Gayle   : Ensuring equity.
Helene Gayle   : Within the population groups, as I mentioned, we looked at the social vulnerability
Helene Gayle   : Index CDC social vulnerability index and will prioritize within the four phases, based on that social vulnerability index.
Helene Gayle   : Finally, we applied the framework in various scenarios and in this box. It looks at some of the uncertainty factors that would affect backseat allocation.
Helene Gayle   : And what we tried to do at a high level, was to look at our framework and how it might adapt in various vaccines scenarios and so we'll
Helene Gayle   : Be happy to take comments on this as well. But what we tried to do was to look at given number and timing of doses number of available vaccine.
Helene Gayle   : backseat efficacy and safety differences vaccine uptake epidemiologic conditions vaccine distribution and administration and political and regulatory environment and how they might impact.
Helene Gayle   : Our vaccine allocation framework. So, that is that is described in the third chapter that you have available. So I think with that, I hope that this was a good opportunity to
Helene Gayle   : In brief here where we landed landed in terms of our allocation framework and now would like to turn it over to public comment with our confirmed speakers, so I will turn it over.
Helene Gayle   : First before turning it over. Let me just go over our rules of conduct. Many of you have been in some of these public meetings before. So you're very aware of this.
Helene Gayle   : We're asking that commenters maintain the same rules of public decorum, that they would in a traditional public meeting, please. Maintain the order and don't display behavior that has disrupted.
Helene Gayle   : The National Academy reserve the right to mute or disconnect virtual participants, if they are disruptive.
Helene Gayle   : commenters may not present comments or questions to the committee unless recognized by the chair or the staff and I think the staff will be calling on most of our presenters.
Helene Gayle   : And with that I think we will open it up for public comment.
Benjamin Kahn : Thank you. Julian. Yeah. So we're going to get started and first on our list, we have Randall Morgan from the W Montague top nama Health Institute. If I'm begins now.
Randall Morgan  : Good afternoon and thank you for the opportunity to provide comments today I am Randall see Morgan jr MD and I'm the executive director of the W Montague cop and I'm a Health Institute.
Randall Morgan  : And the 95th president of the National Medical Association, I will speak today on behalf of the W Montague copying it may Health Institute and the enemy.
Randall Morgan  : My comments will be about the ethical considerations of vaccine allocation and about an informed strategy to assure that the social determinants of health.
Randall Morgan  : That negatively affect black and brown people during the coverage pandemic will be mitigated by focused community planning strategies that begin now well before vaccine availability.
Randall Morgan  : The copy Institute was founded in 2004 by the National Medical Association to be a research based organization with a mission to eliminate health disparities and to achieve health equity through research inquiry and advocacy.
Randall Morgan  : From the years 2010 to 2013 the cob Institute was funded by the Office of Minority Health to study and recommend strategies to increase the level of immunizations of African American and Hispanic seniors for seasonal influenza in order to avoid epidemics.
Randall Morgan  : Much was learned about involving the primary medical providers in the community to increase immunization rates.
Randall Morgan  : Among their patients by personal intervention and influence among skeptical and reluctant senior patients.
Randall Morgan  : This model was successful as the national rates for immunization increase each year of the intervention, the influence of the trusted provider nurse or community worker was essential. Then, and even more essential now as we prepare for carbon vaccine.
Randall Morgan  : I will focus my comments today on the key statements of the discussion draft found on page 37 on that topic mitigation of health inequities.
Randall Morgan  : The obligation to mitigate health inequities and their effects has become particularly salient in this pandemic.
Randall Morgan  : Covered 19 infections and death so strongly associated with race ethnicity occupation and socio economic status.
Randall Morgan  : A significantly higher burden is experienced by black, Hispanic lead next American Indian, Alaska Native populations.
Randall Morgan  : It is the opinion of the cob Institute and his partner. The National Medical Association.
Randall Morgan  : That any strategy to decrease the mortality rates do the Quran a virus virus must account for the greater percentage of black and brown deaths per capita.
Randall Morgan  : This over representation is problematic at all of the national hotspots demonstrated by proven cases.
Randall Morgan  : The causes of multifactorial. However, the lack of availability or acceptance of the vaccine will simply compound this situation.
Randall Morgan  : Transparency must address reality when looking at the course of the disease and of the virulence of the virus.
Randall Morgan  : We identify from further discussion and consideration challenges related to many of the patients that we serve first. There are ethical challenges.
Randall Morgan  : Versus suspicion of vaccines and the black community historically. Second, the lack of trusted providers and information sources during the process.
Randall Morgan  : Second, there are vaccine preparation and dissemination challenges, the lack of preparation and participation by black and brown people in the current clinical trials for all of the vaccines.
Randall Morgan  : The reality that the recommendations for maximum vaccine effectiveness means the two doses of the vaccine will likely be required.
Randall Morgan  : The lack of true education programs to include vaccine and vaccination and literally literacy for those community residents who have major trust issues.
Randall Morgan  : And finally, a different view of equity and fairness that emphasizes prevention of unnecessary deaths and high risk populations. Thank you for the invitation today and we look forward to contributing to the solutions to these challenges.
Helene Gayle   : Thank you very much, Dr. Morgan and thank you all so as the first speaker setting.
Helene Gayle   : Being a role model for five minutes really mean five minutes. So thank you very much for that, and I trust that everyone else will follow that model.
Benjamin Kahn : Thank you very much.
Benjamin Kahn : Next up we have the was the best affiliate from the association of black cardiologists
Elizabeth Ofili : It action index SPD Gail and doctors out in the community and thank you for this opportunity. My name is Elizabeth Ofili
Elizabeth Ofili : I am a cardiologist, professor of medicine at Morehouse School of Medicine and I practice cardiology with Morehouse healthcare. I am here today representing the association of black cardiologists where I serve as a chair of the board.
Elizabeth Ofili : I'm particularly interested in appreciate the committee's focus and transparency on sharing obviously some of the methodologies to ensure equity.
Elizabeth Ofili : As a professional medical society with an established community voice, such as the ABC with more than 2000 members and two thirds of who are community health advocates, we have a unique role of bridging, not just the point of care service that our members provide
Elizabeth Ofili : axing hesitance
Elizabeth Ofili : I stated in the report lines 834 to 836 ultimately the mitigation of health inequities includes development and deployment of distribution systems that ensure that people who are allocated a vaccine actually receive it.
Elizabeth Ofili : I E by taking you to where they are can afford it, even if they are hard to reach
Elizabeth Ofili : In this regard, the association of black cardiologists members and physicians like that who serve these communities are significant acid.
Elizabeth Ofili : But we asked the recommendations clearly acknowledge the fact that the cost of a vaccine goes beyond the vaccine itself includes practice infrastructure to administer the vaccine.
Elizabeth Ofili : And in order to overcome some of the vaccine hesitancy there is a significant amount of time and effort required and that needs to be included as part of the distribution process mitigation of health inequities is documented in life that 10 third
Elizabeth Ofili : Really mentioned the fact that there are aspects of race, ethnicity, that's included in the prioritization, but it falls short of actually stating race, ethnicity,
Elizabeth Ofili : The ABC strongly recommends that mitigating health inequities should specifically prioritize ethnic minorities who are most severely impacted by
Elizabeth Ofili : The BBC and others have documented that African Americans have poor outcomes of care, regardless of socio economic status and so the vulnerability indices may not capture this type of inequity.
Elizabeth Ofili : We know that. Another challenge is to your under representation of African Americans and current vaccine trials.
Elizabeth Ofili : We certainly welcome the opportunity to provide real world data collection and formal vigilance for a collaborative and carefully valued at vaccine and therapeutics registry, we will be putting in this written comments and we thank you for the opportunity to join this discussion.
Helene Gayle   : Thank you very much for your comments and Dr Seeley and also you know I think some of the comments that you made really bring will be brought to bear in some of the chapters that we have not released
Helene Gayle   : Yet on hesitancy implementation, etc. So thank you. That will help those deliberations as well.
Benjamin Kahn : As your next up we have LM Provost from the Alaska Native Tribal Health consortium epicenter.
Ellen Provost : Thank you for providing me the opportunity to speak today. My name is Dr. Ellen provost, I am a physician, board certified in preventive medicine.
Ellen Provost : And general public health I serve as the director for the Alaska Native Tribal Health consortiums Alaska Native epidemiology center one of 12 tribal epi centers serving Indian country.
Ellen Provost : The tribal health consortium serves at the core of the Alaska tribal health system. The system is a hub and spoke network for the delivery of clinical and public health services for the 229 federally recognized tribes in Alaska.
Ellen Provost : With over 180,000 members I speak before you today to share that Alaska Native people must be identified as a population.
Ellen Provost : at high risk of severe illness and death from SARS Colby to when considering the allocation and distribution of covert 19 vaccine.
Ellen Provost : Alaska Native people are explicitly named as a high risk group for the influenza vaccine and this designation should be the case for the coven 19 vaccine as well.
Ellen Provost : The great death. This is how the pandemic flu of 1918 is remembered by Alaska Native people half the deaths that year were due to influenza and 80% of those were among Alaska Native people
Ellen Provost : villages were decimated. It is this collective memory that is alive and well today, making people fearful that this could happen again.
Ellen Provost : Although great strides have been made in improving Alaska Native health
Ellen Provost : Some of these risk factors that existed back then still exist. Risk factors such as geographic isolation and the socio economic and health disparities.
Ellen Provost : That we are all well aware of about half of our population live off the road system presenting significant challenges for access to needed health services.
Ellen Provost : Poverty is three times higher for Alaska Native people and unemployment, two times higher.
Ellen Provost : And deaths from influenza and pneumonia have consistently been three times higher for Alaska Native people in more recent times.
Ellen Provost : An estimated 40% of Alaska Native people will currently meet the CDC criteria for having underlying medical conditions that put them at risk for severe illness from covert 19
Ellen Provost : Clearly, Alaska Native people are at high risk and early widespread distribution of a safe and effective vaccine would greatly mitigate the risk of another great death.
Ellen Provost : What did we learn from the H1 and one pandemic. We learned that indigenous population suffered disproportionately
Ellen Provost : They experienced higher rates of hospitalizations ICU admissions and a four fold increase of influenza related deaths.
Ellen Provost : In the 2016 study by Hennessy at all. The authors distinguished between a risk factor based strategy and designating a population as high risk.
Ellen Provost : Following 2009 American Indians and Alaska Natives were prioritized to receive vaccine, on the basis of racial status.
Ellen Provost : That we learned and should continue to maintain the high risk designation for American Indian, Alaska Native people in lieu of a risk factor based strategy.
Ellen Provost : What do we currently know about covert 19 hatcher at all in the August 19 mmm WR stated that the cumulative incidence among American Indian, Alaska Native persons was three and a half times greater than non Hispanic whites.
Ellen Provost : In addition, preliminary results from a yet unpublished study coordinated by CST and tribal epicenters soda mortality rate that is 2.6 times higher than non Hispanic whites.
Ellen Provost : This suggests that the Alaska Native American Indian population has been disproportionately affected by the SARS co ve to pandemic.
Ellen Provost : If we are to avoid another great death if we are to avoid compounding and equities and increasing disparities.
Ellen Provost : If we are to protect our Alaska Native people and our health systems throughout the state of Alaska and reduce the current and future potential impact of this pandemic.
Ellen Provost : This committee will acknowledge Alaska Native people are at significant risk of hospitalization and death.
Ellen Provost : From stars Kofi to and explicitly places population in the highest priority group for covert 19 vaccine allocation and distribution, thank you again to the committee for this opportunity to provide input and I hope there will be future opportunities in this process as well. Thank you.
Helene Gayle   : Thank you very much. Very appreciate your comments very much. Thank you.
Benjamin Kahn : Great. Next up we have a winner Rios from the National Hispanic Medical Association.
Elena Rios  : A. Thank you. I'm Dr. Linda Rios with the Presidency of the National Hispanic Medical Association. Thank you for the opportunity. I think that
Elena Rios  : We, the National Hispanic Medical Association was created to provide input and to serve as a resource.
Elena Rios  : On policies and programs that impact the Hispanic and other underserved communities. And I have to say, first of all, you know, we agree with the, the, the report the so far the the criteria for allocation. The goal and the the phases.
Elena Rios  : I think what I like to say really is about the fact that Hispanics are very heterogeneous in this country.
Elena Rios  : Even though one out of four Americans will be of Hispanic origin. There's quite a big difference. I'm Mexican American from the southwest from Los Angeles area and
Elena Rios  : You know, we didn't have Latin Americans until the revolutions in the 1980's. And I think that the and on the on the eastern seaboard. You've got the Puerto Rican and the Cuban
Elena Rios  : In the Dominican communities. And I think that there's there's also a huge difference in family structure in terms of mixed families. So the eastern coast, our citizens terms of Puerto Ricans Cubans and on the West Coast, you've got many, many Mexican
Elena Rios  : Immigrants my grandparents were
Elena Rios  : Did get documented were brought over in the presale programs and the programs in the 1920s and 30s. I think that that's something that is not
Elena Rios  : Talked about in the report, the fact that the allocation criteria is about individuals and not families. I think families need are very big in terms of the educational efforts in the trust efforts and in
Elena Rios  : I think what needs to happen is to have stories about our families stories about the survivors of covert stories about how to take that the vaccine works.
Elena Rios  : And many of that many of this attitude I think comes from our, our health care in our communities and traditional health has been passed on from our grandmothers to our mothers. My mother was a nurse. I think I, I got that healing spirit night and I do believe that we have a lot more
Elena Rios  : Educational information than is noted
Elena Rios  : Because we do have health literacy problems and low income problems and low education problems. However, there's a very basic fundamental interest in having our children be healthy.
Elena Rios  : And being able to go to work and able in being able to get ahead and go to school and for the Hispanic population. I think that there's something that is missing in terms of that understanding and I know that
Elena Rios  : Dr. Gail, you mentioned the that the rest of the report will deal with Communications, and Education, but I just think that when we talk about criteria that there is something missing here and
Elena Rios  : We have developed
Elena Rios  : Programs with the Office of Minority Health along with enemy and a IP and others about influenza seasonal influenza working with our providers nama represents 50,000 Hispanic physicians right now that are licensed in this country we have 17 chapters and we have
Elena Rios  : Categories of membership that include young physicians residents and medical students and I think they all are very unique.
Elena Rios  : Because we're only 5% of the population of physicians in the country. And I think that the providers through our organizations that are nonprofit.
Elena Rios  : We're not necessarily connected to one medical school or, you know, there is no real on the mainland Hispanic medical schools. There are Hispanic Serving medical schools, but I think our providers have a lot of expertise and a lot of experience needs to be
Elena Rios  : Brought to the to the forefront and with the National Academy here. And I think the only other thing I'd say is that we're very concerned about trust issues. And I know that it is important to have trusted voices. We have many, many physicians and providers community health workers.
Elena Rios  : Caregivers, and our homes that need to be part of the of the allocation system and also cost issues.
Elena Rios  : Many of the Latino community like the other ethnic, racial groups are part of the essential workers can't work at home and are working in nursing homes working in hospitals working in the retail industry supermarkets food industry farm workers and many, many
Elena Rios  : Many high risk populations within, within our within our group.
Elena Rios  : So, thank you.
Elena Rios  : Very. I hate to do this.
Helene Gayle   : Thank you. Thank you very much. Sorry, we're really yeah yeah like that great points. As always, thank you very much. And I think we'll move on now to our next speaker, Kim Roberts, Ben. You're supposed to introduce. Go ahead.
Benjamin Kahn : Oh good john roberts take it away from the Alaska Native Tribal Health consortium. Yeah.
Jim Roberts : Thank you for having me today. So my name is Jim. Roberts I work as a senior executive liaison in the Intergovernmental Affairs Department for the Alaska Native Tribal Health consortium.
Jim Roberts : And THC is a statewide Tribal Health Organization that serves over 229 tribes and provide services to more than 199,000
Jim Roberts : Alaska Natives we operate a tertiary care hospital in Anchorage and we also provide a wide range of statewide public health community health, environmental health and other programs and services throughout the state of Alaska.
Jim Roberts : My colleague, Dr. Davis just discussed some of the epidemiology issues related to to the framework. So I'm going to focus my comments on allocation issues that are discussed throughout the throughout the framework.
Jim Roberts : So my first recommendation has to do with, you know, Alaska Native and health disparities and the mitigation of health inequities and and how this must inform allocation of covert 19 vaccine and I think
Jim Roberts : What's important to underscore about this is that Ellen discuss some of the effects of
Jim Roberts : Health disparities and the Spanish flu pandemic and Alaska, which was extremely severe mortality rates were four times higher than then were reported for larger cities in the United States.
Jim Roberts : The virus exactly the worldwide death toll of about 50 million, but more people died on a per capita basis in Alaska than anywhere. Well in Alaska than anywhere on Earth, with the exception of Samoa.
Jim Roberts : Among Alaskans the vast majority of deaths were among Alaska Native people
Jim Roberts : The Spanish pandemic devastated our state rural Alaska, whole villages were depopulated and broken and have never recovered. To this day,
Jim Roberts : Without a vaccine plan that acknowledges that the unique needs of Alaska and our tribal communities. We feel fear a similar result from covert 19
Jim Roberts : Such a strategy is preventable and we must not forget the lesson of rural Alaska vulnerability to the to the influence influenza pandemic.
Jim Roberts : We support the frameworks foundational premise principle and recommendation related to mitigation of health inequities and the statement.
Jim Roberts : I found particularly found compelling was that health inequities are a moral imperative on an equitable vaccine allocation system.
Jim Roberts : The framework goes on to discuss the importance of respecting tribal sovereignty and tribal governments. We thank you for the inclusion of these statements and placing a high priority on mitigating the impact of health inequities.
Jim Roberts : We agree with the underlying principle about mitigation of health inequities in the framework it justifies specific vaccine distribution and recommendations to address vulnerable populations and communities.
Jim Roberts : Affected by these disparities. This includes tribal communities.
Jim Roberts : But it's important that the framework also explain the allocation decisions related to tribes isn't fulfillment of the unique legal and trust relationship.
Jim Roberts : That the United States has with tribal governments. This is supported in the Commerce Clause in the Constitution, the Constitution and numerous case law.
Jim Roberts : So we think that's an important element to also include and underscore throughout the framework, certainly as this policy document will inform other other uses, we feel that it's very important to include that element in the discussion.
Jim Roberts : Thirdly, tribal governments and tribal heart health organization should be discussed as a central partners in the frameworks code allocation of covert 19 vaccine.
Jim Roberts : So we acknowledge and thank the committee for the inclusion of references to the tribal governments trust responsibility and that it should allocate vaccine to tribal urban and Indian health and the Indian Health Service facilities.
Jim Roberts : directly through the existing IHS system.
Jim Roberts : However, we further recommend that the report expand the discussion about the distribution process to allocate vaccine directly to tribes and tribal health organizations as well as urban Indian health organizations and not just through the Indian Health Service.
Jim Roberts : We make this recommendation in acknowledgement that 50% of the IHS programs are contracted or contracted under directly by tribal organizations and tribes under the Indian self determination act.
Jim Roberts : Well, I just as a partner in the distribution process, it is much more effective and timely and efficient to directly work with tribes and tribal health organizations that contract and compact. These programs from IHS
Jim Roberts : A good example of why we make this recommendation is some of the experiences that we're we're dealing with right now related to testing supplies we are having extreme difficulty.
Jim Roberts : Filling orders for testing supplies that are channeled through the, through the federal government and through the state's allocation methodology.
Jim Roberts : We also had similar experiences related to h1 vaccine distribution.
Jim Roberts : Where we were challenged with that process as well. And the process would have been much more efficient had that flow through the tribal health system. And with those tribal programs that contract and compact programs directly from from the federal government.
Jim Roberts : Item for relates to vaccine distribution administration that's discussed on page 94 this section of the framework discusses how the federal government will issue guidelines for allocation distribution and administration of the vaccine.
Jim Roberts : At the framework discuss as an example of how a statement.
Benjamin Kahn : I am. I'm sorry to cut you off. But your five minutes have
Jim Roberts : Hoping so but but basically we recommend that the framework include and discuss requirements for tribal consultation and the frameworks allocation criteria for vaccine distribution we think these will also kind of complement the existing recommendations that are already included
Helene Gayle   : So I thank you very much.
Helene Gayle   : Yeah, thank you very much for your comments and please. We look forward to. If you want to submit any further in in written comments and then we have our last presenter for this panel.
Benjamin Kahn : Yes. Next up we have Winston, along with the National Council of Asian Pacific Islander physicians
Winston Wong : I wish to thank the committee for not only inviting myself on behalf of the National Council of Asian Pacific on your physicians to offer some recommendations but also
Winston Wong : The terrific job that you've been doing in terms of this very Herculean task.
Winston Wong : Again, my name is Winston long I'm a practicing family physician and also the chairperson of the National Council of Asian Pacific Islander physicians, also known as in cap it
Winston Wong : I'm also honored to cheer that roundtable and health equity at the National Academy of Medicine, but my comments today are really on behalf of capitalism as we are known
Winston Wong : We're an organization of organizations in terms of our composition. We've been in existence for 10 years and we represent physicians that are organizing IPAs.
Winston Wong : academic centers community health centers and large healthcare delivery systems, but we're all you all united around addressing health inequity in the API Native Hawaiian community.
Winston Wong : The API Native Hawaiian community has been hit hard by the coven
Winston Wong : Pandemic in multiple ways. The committee sites to disproportionate burden of disease on various minority communities, including black Native American and Latinx communities.
Winston Wong : But failed to mention the equally alarming and distressing rates of infection and death in API native wind communities.
Winston Wong : The Pacific Islander community in particular has experienced mortality rates up to five times to proportion to the, to the general population.
Winston Wong : Marshall least two keys are seeing rates of covert 19 as high or higher than any other racial ethnic group in states such as Arkansas and Oklahoma where they
Winston Wong : fulfill a significant part of the agricultural industry Native Hawaiian stuff for from Kobe at 19 mortality at a rate three times higher than the proportion of the population in the State of Hawaii.
Winston Wong : Half of the deaths in the county of San Francisco where among agents and Pacific Islanders, and the patterns of Pacific guy into mortality are also true in the state of California.
Winston Wong : This report addresses the mitigation of health inequities. But it's a disappointing a mission to not explicitly cite the API H and H disparities in the pandemic report goes on to site specific aspects of health inequities.
Winston Wong : Namely social disadvantage added risk of social exposure, because of the nature of essential work and living in dense settings.
Winston Wong : All of these factors are a feature of API Native Hawaiian communities. While much of our community says often being
Winston Wong : being depicted as occupying high tech industries, we are in fact disproportionate represented
Winston Wong : In service sector jobs in hotels in the hospitality industry in family business and most tellingly we occupy many important roles in low paying healthcare occupations such as nursing aides in long term care facilities.
Winston Wong : Being Captain wishes to emphasize that vaccine allocation needs to incorporate three strategies that we think are really essential and relevant to
Winston Wong : Its implementation immediately we need to number one aside for utilizing social vulnerability in this indexes.
Winston Wong : We need to identify populations most at risk taking an account the realities of multifamily households that rely on a few breadwinners
Winston Wong : That heightened risk and infection. These indicators are only know
Winston Wong : By community grounded organizations that serve our communities and by physicians who are embedded in the community, providing care to ethnic on clubs and linguistically isolated communities.
Winston Wong : Number two, there's a political vulnerability that needs to be acknowledged.
Winston Wong : Both references to the China virus and policies that have been promoted to change the definition of public charge that impacts immigrants stoke fear and avoidance of screening for Copa
Winston Wong : And in all probability vaccination, we have to acknowledge these are really political threats to how patients and communities for see how they access themselves to vaccinations.
Winston Wong : Number three, it is not enough for public health departments to identify tears if race and faces a vaccine ALLOCATION. IF cultural and linguistic barriers are not address
Winston Wong : IE, we have to look at cultural competence, two thirds of Asian Asian American Pacific Islanders are forum board and one third 7 million or have limited English proficiency.
Winston Wong : So cultural competence strategies must be incorporated into the allocation of vaccines.
Winston Wong : The API communities, a vital part of American society their increased risk for infection and death are being reviewed in this pandemic.
Winston Wong : Please consider their unique circumstances and the risk of marginalization and the allocation of vaccines that needs to be acknowledged and incorporated into the recommendations. Thank you.
Helene Gayle   : Thank you very much and very helpful comments. I think we are now going to, and thanks the entire panel that focused on issues, specifically related to
Helene Gayle   : communities of color and communities that are disproportionately impacted. We will now transition to our second panel on state and local government and and healthcare, so I will turn it over to Ben to get us started.
Benjamin Kahn : Thank you. Next we have Aaron payments from the Sioux Sainte Marie tribe of Triple A Indians.
(AV) Moises Ramirez: And he's not independent Muslims. I don't think he's here. That's okay.
Benjamin Kahn : I'm going to give up. So we'll come back to Aaron payment Aaron payment if you come up. If you are on, you will have one more chance at the end of this panel to provide remarks. So in that case, we will move on to Oscar Allen from the National Association of County and City Health officials.
Lean
Oscar Alleyne : Out, it's fine.
Okay.
Oscar Alleyne : The two ways. Alan is the way. Okay.
Oscar Alleyne : So thank you again, my name is Dr. Oscar Alan I'm representing nature. The National Association of County and City Health officials.
Oscar Alleyne : Which is comprised of the nearly 3000 health departments across the US serving as a leader and catalyst and voice of local health departments.
Oscar Alleyne : Specifically when you think about the role of health departments with respect to you and ization. We know that most of the come come for programs.
Oscar Alleyne : That reside and services in LA HTTPS remain with respect to immunizations for about 8% provided both childhood and adult immunization, and that is consistent, regardless of the size urbanization orality
Oscar Alleyne : We know that the health departments have been chief health strategists or community, how strategist in that regard and working very closely with key.
Oscar Alleyne : community stakeholders, whether it's healthcare schools daycares nursing homes faith based institutions and other colleagues, this will
Oscar Alleyne : Be represented here today are common activities with respect to host and amortization clinics conducted education and outreach and provided them and get immunization across the lifespan.
Oscar Alleyne : As well as being knee deep in the conducting of communication campaigns. So when we think about the impact of coven on LSD and I don't get to the draft in two seconds. The nearly 90% of our
Oscar Alleyne : Members that we we did an assessment on and with respect to the impact of LSD immunisation programmes have
Oscar Alleyne : Talked about how frequently immunization activities have been altered and that's been provision of clinical services, education outreach.
Oscar Alleyne : Routine of the UFC school audits and you name it. There's been a tremendous impact. And not only that, but also with respect to the overall loss in our workforce capacity infrastructure over this.
Oscar Alleyne : Over this period point of time.
Oscar Alleyne : And as was mentioned, we support the incorporation adoption of principles of social justice in everyday public health practice to eliminate the root causes of health inequities that have been essentially rampant in our total communities across the country.
Oscar Alleyne : We've actually seen that One Health Department of established Community mitigation groups to work in collaboration with local organizations to participate in what is called accountable communities of health.
Oscar Alleyne : Going in depth with respective black indigenous and other people are colors to ensure that these communications, both from flu and flu vaccines and others and messages are instantly and linguistically culturally
Oscar Alleyne : Tailored and responsive.
Oscar Alleyne : So as it pertains to the draft and we appreciate the opportunity to provide comments we will focus on a few things the outline of the vaccine allocation phases and the rationalized prioritization.
Oscar Alleyne : And examination of that framework in this application under various scenarios we respected a phase approach, we feel that
Oscar Alleyne : The face approach does make sense. And it's guided by what we've learned in each one. And what I will tell you that I am one of those who still experience my PTSD is a local epidemiologist deal of H1 and one
Oscar Alleyne : But that shared approach did illustrate for us an opportunity to hopefully make better assumptions around the populations ability to social systems and other mid game factors.
Oscar Alleyne : Given the current reality of Community mitigation with schools and businesses reopening
Oscar Alleyne : We asked to reconsider the assumption that a group may be able social distance and really look specifically at how to clarify and define those high risk comorbidities versus the moderate risk types have shown as a footnote on the table.
Oscar Alleyne : The effective allocation of the vaccine will be critical to contain in this pandemic.
Oscar Alleyne : So it is important to ensure that prioritization guidance. Be flexible to accommodate the changing characteristics and epidemiology.
Oscar Alleyne : As local public health will be on the ground implementing these recommendations of this committee, it is important to ensure that there's continued support for local public health.
Oscar Alleyne : As they operationalize plans to identify contact and mobilize targeted vaccine efforts vaccine allocation and the various scenarios, the number and then time in the vaccine.
Oscar Alleyne : Has been discussed, we know that there's limited doses that may be available as early as November.
Oscar Alleyne : Therefore, there's the need for expedited plants that is critical for State and Local territorial and tribal authorities to be able to implement an allocation plan that is equitable
Oscar Alleyne : Vaccine advocacy and vaccine safety must be transparent and communicated with administrators in the public to ensure that any shift and allocation is clearly defined and communicated
Oscar Alleyne : For example, our colleagues in Denver said one important point that they didn't see that there should be requirement in this document.
Oscar Alleyne : To have all administrators of this vaccine put their information into an is and hopefully it's the is that has been implemented at that level.
Oscar Alleyne : Of focus of building out that structure will be important for the various types of vaccines in between management and that should also be included in this document.
Oscar Alleyne : With respect to vaccine uptake consideration and training. These are all important tasks and we want to make sure that there's proper training for those healthcare providers to truly impact and be a critical component in increasing faxing confidence.
Oscar Alleyne : With respect to committee mitigation models during the rollout of covert we recognize that that needs to maintain because it's important to consider.
Oscar Alleyne : What the current reality is with respect to social justice and utilization of mask and hand hygiene.
Oscar Alleyne : And the need to continue to communicate this doing an important vaccine rollout. So there must be strong consideration of public health messaging.
Oscar Alleyne : Which is needed as a dual approach and it has not yet. It's not just about making banners or bulletin boards, we have to truly embrace what it's going to be important to affect to affect communication.
Benjamin Kahn : Some ground.
Benjamin Kahn : Zero.
Oscar Alleyne : I was closer or I tried. I did my New York minute okay
Helene Gayle   : Thank you. Thank you very much and you know we hate to have to cut off some of this very rich discussion, but in the interest is fairness for all of our speakers.
Helene Gayle   : And if there's something that has already been covered, feel free to just say ditto and move on so that we can cover as much ground as we possibly can. So thank you very much.
Benjamin Kahn : Next up we have David Gerstner from the Dayton metropolitan medical response system.
David Gerstner : Thank you.
David Gerstner : My name is David Gerstner I'm with Dayton fire department in Dayton, Ohio where I'm the regional Mrs coordinator for a 10 County area in West Central Ohio. I'm speaking on behalf of Dayton, em, Mrs. And we appreciate the opportunity to speak with this group today.
David Gerstner : Like other Mrs cities, we've been involved with pandemic planning for two decades now big name, Mrs had a leading role free MS response during the H1 and one pandemic in 2009 and 2010
David Gerstner : Public Safety, which includes firefighting emergency medical services or MS LAW ENFORCEMENT, PUBLIC SAFETY dispatch.
David Gerstner : And emergency management agencies or EMAS along with public health are crucial components of US infrastructure.
David Gerstner : MS is a component of the health care, as well as the emergency services sectors.
David Gerstner : During 2009 and 2010 MS played significant roles in vaccination campaigns, including assistance with vaccination public or open points of dispensing pods.
David Gerstner : Vaccination of homebound and homeless population and vaccination closed pods planning is already underway to provide similar assistance with both influenza and covert 19 vaccination campaigns this year.
David Gerstner : As late as summer 2009 CDC and the Department of Homeland Security were planning collaboratively and included public health and public safety personnel in tier one vaccination allocations.
David Gerstner : When the AC IP priority groups were replaced were released they included healthcare and emergency medical services personnel.
David Gerstner : But not other public health and public safety personnel that resulted in the paradoxical situation where we had certain public health and public safety personnel assisting with vaccination efforts.
David Gerstner : But who were not permitted to receive the vaccine. There were law enforcement officers, including in my region.
David Gerstner : Who lost their lives from H1 and one, including some who were turned away from vaccination clinics numerous law enforcement MS and fire personnel have already died this year from
David Gerstner : We applaud the committee's efforts and are very grateful that healthcare and public health personnel are included in the phase one, a priority.
David Gerstner : Critical Infrastructure issues must be considered when determining vaccination allocation and prioritization.
David Gerstner : Including dispatch and em a personnel will have minimal impact on the numbers and although those personnel may have vulnerabilities that are less than frontline providers, the emergency services sector cannot function without them.
David Gerstner : We ask and recommend that this categorization continue into the final draft and they didn't include all public health firefighting MS LAW ENFORCEMENT, PUBLIC SAFETY dispatch and emergency management personnel. Thank you again for the opportunity to speak to this group and we will submit
David Gerstner : Comments in writing as well, but thank you.
Helene Gayle   : Thank you very much, Mr Gerstner
Benjamin Kahn : Okay, next up we have Sarah. My dad from the New York City Health and Hospitals.
Helene Gayle   : I see the name but
(AV) Moises Ramirez: Yeah.
(AV) Moises Ramirez: I'm trying to recognize her name. Her name is pronounced I guess as Syrah mother.
Saad Omer : And so maybe that's the reason why
Helene Gayle   : There she is. Yeah. Okay, you're muted. I think Syrah
Benjamin Kahn : I'm
Helene Gayle   : Sorry, you feel I'm showing up.
Helene Gayle   : Oh, she's connected
Helene Gayle   : We could perhaps go on to the next speaker. And then, oh, you are you there.
Syra Madad : Is this better.
Syra Madad : Yeah. Okay. All right. I called in on my phone. So I guess there was an issue there. But let me go ahead and get started. So thank you for the opportunity to speak today.
Syra Madad : So I'd like to first thank the National Academies of Science, Engineering and medicine to, you know, for organizing this forum and for the committee for providing the nation of framework where equitable
Syra Madad : Allocation of cover 19 vaccine. I went over the framework and the proposed framework is based on sound ethical values.
Syra Madad : And while the acceptable principles and importantly it's based on science transparency and societal functioning and it's evidence based core elements that should be driving all public health decisions.
Syra Madad : And I agree with the overall allocation criteria proposed in the framework, just to provide us to brief suggestions based on
Syra Madad : What I've read within the framework first on the disability community, while the priority in the framework doesn't exclude the disabled, there should be more context for this particular community which affects approximately 61 million or nearly
Syra Madad : One in four Americans in the United States.
Syra Madad : Secondly, as we know, risk is not uniform, even among frontline healthcare workers. I appreciate vaccine access should not be defined by professional title, but rather by the individuals actual risk of exposure to covert 19
Syra Madad : Having conducted numerous vaccine focus groups among healthcare workers specifically specifically for seasonal influenza.
Syra Madad : A common finding within these focus groups that I tend to find is just the overall hesitancy due to multiple
Syra Madad : Factors among healthcare workers. And so a consideration for this framework, as we move forward is one the ongoing education around
Syra Madad : Vaccines and the allocation to full transparency on the data and three a clear distribution process. So those are some of my high level remarks. Thank you for having an open session.
Helene Gayle   : Thank you very much.
Benjamin Kahn : Thank you. Next we have Marcus placebo from the association of stating Territorial Health Officials
Marcus Plescia : Great, thanks. Can you hear me OK.
Marcus Plescia : Ok I'm Marcus plush on the Chief Medical Officer for the Association of State and Territory health officials.
Marcus Plescia : Thank you for the opportunity to provide some comments on the discussion drafted preliminary framework for equitable allocation of coven 19 vaccine.
Marcus Plescia : The Association of State and Territory health officials is the national organization represents leadership and State and Territorial public health agencies.
Marcus Plescia : And I think most of you know state and territory public health agencies will ultimately be playing a central role in the vaccine capacity allocation process at the state level.
Marcus Plescia : ASCO is submitting detailed written comments for your review and in the interim, I'd like to highlight the following areas.
Marcus Plescia : First of all, on behalf of our members. We'd like to thank the National Academies committee members and staff, they were preparing this framework.
Marcus Plescia : Framework is an exceptional resource and guide for our state and local public health efforts. It's well grounded in scientific evidence space and it draws on the expertise recognized and trusted national experts.
Marcus Plescia : It builds on knowledge of previous max vaccination efforts and as well grounded and ethical models.
Marcus Plescia : It's adaptable to a number of different future scenarios, and most importantly, it takes a close look at what are increasingly concerning inequities in the burden of code 19 across our society.
Marcus Plescia : As to appreciate the attention to address health inequities through equitable allocation throughout this report.
Marcus Plescia : And we'll have some additional suggestions about this issue in our written comments and provide you with some further considerations.
Marcus Plescia : We'd also like to offer three specific recommendations on potential refinements to the document.
Marcus Plescia : First of all, we believe the document should reinforce the role of the American Council on Immunization Practices asap as the primary decision making body.
Marcus Plescia : The committee framework provides excellent considerations, but its role in authority could be confusing and So Astro encourages the committee to further describe with greater transparency, have the existing asap body will provide the final prioritization guidance.
Marcus Plescia : Secondly, we like document, we'd like to suggest that the document should reinforce the need for state based flexibility to set priorities.
Marcus Plescia : While the important for the framework to be applied uniformly across the country. It's also critical for each state to have the flexibility.
Marcus Plescia : To tailor vaccination prioritization meet local needs as you know allocation will depend on various key factors such as public confidence, a better understanding of risk factors and safety net and safety and efficacy issues of the vaccine and certain populations.
Marcus Plescia : So we recommend that allocation decisions continued to be customized and adapted at the state level. And we also recommended that state public health departs be closely involved in any specific strategies or allocations designed to address health disparities.
Marcus Plescia : Finally, we'd like to emphasize that both the document and committee, place an emphasis on a unified approach and messaging around vaccine distribution and allocation.
Marcus Plescia : It will be very important for all government and civic entities engaged in this effort to communicate and engage with the public in a unified consistent and transparent matter.
Marcus Plescia : discord among leaders at any level will erode public trust we suggest the document provide further clarification of the roles and actions of leaders at different levels of society.
Marcus Plescia : And they're reinforced that any changes in policy or guidance should be clearly explained and based on consensus among public health leaders who oversee and are responsible for effective implementation.
Marcus Plescia : Again, will provide additional comments in our written application or written submission. We appreciate the opportunity to make these comments. And again, thank you for your work.
Helene Gayle   : Thank you. And thank you for the work of ASCO
Helene Gayle   : Next,
Benjamin Kahn : Next we have Christian rumors from the family health centers of San Diego.
Christian Ramers : Thank you so much. Can you hear me okay
Christian Ramers : Great. I just want to say it's an honor and a privilege to be speaking to you, I did my training at the University of Washington in the William figure building and Department of global health. So
Christian Ramers : I am a infectious disease physician in San Diego. I work at a large federally qualified health center and I'm really just going to share some of my own thoughts.
Christian Ramers : Regarding our experience in the pandemic, thus far on the front lines.
Christian Ramers : I want to share with you just what it's look like in San Diego. We've had dramatic racial and ethnic disparities that are just mind blowing.
Christian Ramers : In San Diego, we have a population of it's about 34% Latino
Christian Ramers : Or Latin. Next, and yet 62% of our cases are in the Latin next community that's a doubling in terms of a disparity amongst cases and similar disparities exist in death rates.
Christian Ramers : We also have a dramatic geographic disparity where there's a clear gradient from affluent communities down to poor communities where the Kobe case rates are much, much higher by zip code and our local media has been reporting on this.
Christian Ramers : Thirdly, I think it's important that the outbreak in San Diego has shown the importance of local trusted partners such as community health clinics and FQ HC. So I'll give you just a couple of examples.
Christian Ramers : We have a large homeless population in San Diego, and although the county would love to be the outreach and the ones doing education. It's really the local partners.
Christian Ramers : That have been doing the testing the coding in collaboration with the county, I should say, to help keep keep us from having your congregate living outbreak.
Christian Ramers : And I think the local partners have actually the best eyes on the on the local situation on the ground, for example, as a county our
Christian Ramers : Test positivity rate is hovered around three to 5% for Cobra testing. And yet, in my own clinics where we've conducted almost 30,000 tests are positivity rate is 10 to 15%
Christian Ramers : So if you were to just take even what you think is a granular look at the county level and say, well, this is a high risk County. This is a low risk County. You're missing the full picture.
Christian Ramers : So having local partners and local data to be able to drive where we put this vaccine. First, I think is incredibly important.
Christian Ramers : I'm just going to summarize a couple of comments from my colleagues that I solicited
Christian Ramers : I think this has already been said, but we really need to use data to drive our response and to allocate the vaccine appropriately.
Christian Ramers : I've reviewed the plans from the 2009 pandemic really targeting pregnant women.
Christian Ramers : older individuals those with contact with infants under age six. This is a very different virus. And so we need to use our data to show us where the highest risk communities are
Christian Ramers : Such as those with diabetes, cardiovascular disease, obesity, metabolic syndrome and we have to acknowledge the racial differences.
Christian Ramers : In terms of how this virus is affecting people, as I mentioned, we have to take into account local data.
Christian Ramers : We have to acknowledge the racial and socio economic disparities that this pandemic has revealed
Christian Ramers : And I think we need to take a close look at what we consider to be an essential worker before asking undocumented people to pick our food.
Christian Ramers : To make our economy work. They need to be considered an essential worker, just like I am as a frontline physician.
Christian Ramers : So essential worker, it needs to include teachers, it needs to include jail workers needs to include people that are that are serving our food cleaning our, our houses cleaning our offices and that type of thing.
Christian Ramers : And I think it's very important that the definition of an essential worker has a place high on the tearing of who gets the vaccine first
Christian Ramers : I also think we need to have special attention to high risk individuals Heinrich settings such as congregate living settings homeless shelters nursing facilities and jails and prisons as well.
Christian Ramers : As we've seen in San Quentin in my own state, we can have incredible explosions of disease if we don't have protected populations in these dangerous congregate living settings.
Christian Ramers : I would say that we do not need to be creating new systems or distribution is the worst possible idea in the middle of a pandemic to try to create something new.
Christian Ramers : We have trusted partners, like I said, and community health centers, we have vaccine delivery systems at the Community Health level. We've been delivering vaccines for years to our communities, please use this, those of us who know what we're doing, since we've been doing it already.
Christian Ramers : Finally, a couple of comments. I just want to say being 10 miles from the border in Mexico. We've seen
Christian Ramers : Incredible influence and I've seen it for years with infectious diseases, whether it be HIV or tuberculosis infectious diseases do not respect international borders.
Christian Ramers : And it is foolhardy for us to think we can wall off the rest of the world and just vaccinate ourselves. We are not safe until all of us are safe and we see this all the time.
Christian Ramers : Infectious Diseases cross back and forth US citizens thousands of them live in Tijuana and come into San Diego to work.
Christian Ramers : So if we're not paying attention to our international partners in the availability of vaccines for our international partners, it will come back to bite us
Christian Ramers : And finally I for full disclosure, I my side is trying to recruit vaccine participants from communities of color and it has really not been easy.
Christian Ramers : Because of historical mistrust and historical abuses that I think we have to be transparent about
Christian Ramers : And what I do these community forums in English or in Spanish is striking when people say, how can you possibly expect me to be a guinea pig.
Christian Ramers : When time and time again we volunteered. Our, our community members and not seen the benefits of the research. So I think Medicaid, Medicare private insurance companies and then even programs for the uninsured need to acknowledge
Benjamin Kahn : I'm sorry to cut you off that your
Benjamin Kahn : Time is on there.
Christian Ramers : Should be first in line. Thank you very much.
Helene Gayle   : Hey, thank you so much. Thank you for your perspective on the ground.
Benjamin Kahn : Next up we have mayor Shaw from Harris County Public Health
Benjamin Kahn : Are you
Umair Shah : Available. Yeah. Hey,
Umair Shah : Sorry.
Umair Shah : Can you guys see me.
Umair Shah : And hear. Okay. I apologize. I was having trouble with my video here.
Umair Shah : I've been just let me know when you're ready.
Helene Gayle   : Okay.
Umair Shah : Great. Thank you for having me. My, my name is Dr. Marisa, I'm the executive director for Harris County Public Health
Umair Shah : And the local health authority for Harris County, Texas, and I want to thank you for the opportunity to present our perspective. Today I'm a past president of nature and I'm also past president of Tito
Umair Shah : Which represents about 45 local health departments across Texas.
Umair Shah : Harris County is the third largest county, the US with 4.7 million people spread over a geographic area larger than the State of Rhode Island. Not only are we large but we're home to one of the most diverse communities in the nation.
Umair Shah : Along with our fellow public health departments in Texas, our department has been on the front line fighting this pandemic since the beginning.
Umair Shah : Of this year we issued our first health alert January 9 activated January 23 and since that time have worked tirelessly against all sorts of obstacles.
Umair Shah : Which are not in the past but continue to be in the, in the present, we continue also to believe that testing remains a foundation cover 19
Umair Shah : Response epidemiology contact tracing are key public health tools go hand in hand with robust outreach and community engagement.
Umair Shah : We also see Kevin 19 vaccination is the hope for a long term solution.
Umair Shah : To the continued prevented public health efforts and will eventually provide the way out, quote unquote, for cover 19 for our nation.
Umair Shah : With this in mind, is especially disappointing to see the US reject the who efforts in global coordination for a coven 19 vaccine.
Umair Shah : Let me start with a few assumptions. It is expected that any future cover 19 vaccine.
Umair Shah : Will be unlimited supply especially initially and is crucial that we have clear and concise national strategy to allocate distribute and administer vaccines regardless. As with other
Umair Shah : pandemics local health departments will play a key role in the on the ground partner operating and coordinating local mass
Umair Shah : Vaccination sites and points of distribution with state and federal support, as highlighted in your draft report lessons learned during the
Umair Shah : H1 and one pandemic are critical to cover 19 planning for future vaccines and medical countermeasures in 2019 our Department released a grant groundbreaking report called Harris cares
Umair Shah : Which looked at a comprehensive community health assessment.
Umair Shah : In Harris County and highlighted significant health inequities in this report, it was made clear that communities of color have faced and continue to face disproportionate.
Umair Shah : Barriers to the opportunity for health, life expectancy in our community alone ranges 24 years, the largest gap in Texas.
Umair Shah : These pre existing in equities only worse since since they started Kevin 19 first with our Asian American communities and subsequently with our African American. And now, most recently.
Umair Shah : concerning our Hispanic and Latino communities to model our Cornerstone values of innovation engagement and equity during our coven 19
Umair Shah : Response at pH formed a racial and ethnic approaches to coven 19 and health task force the REACH Task Force has been
Umair Shah : Has been responsible for examining equity approaches across the nation and applying those locally in our coven response, especially for disproportionately impacted communities.
Umair Shah : Placement of covert 19 testing resources we have utilized the CDC social vulnerability index alongside weekly
Umair Shah : Zip code level analysis emerging hotspots testing deserts and emerging coven 19 disparity trends, just this past week in the face of potential hurricane Laura coming our way.
Umair Shah : We Ford in equity based coven 19 testing strategy to our Harris County elected officials.
Umair Shah : Overall we commend the National Academies proposed phased in approach for utilizing the equity and social vulnerability as a cross cutting consideration and vaccine allocation, especially its emphasis on utilizing science ethics and health.
Umair Shah : in decision making. It is our strong belief that in order to implement the framework effectively coordination by public health.
Umair Shah : Of health care and community partners will be crucial. The vaccine allocations should also consider removing barriers that prevent others from getting vaccines, such as health insurance.
Umair Shah : Or how access to health care. This upcoming flu vaccine season offers an opportunity for strengthen relationships in preparation for coven 19 vaccine.
Umair Shah : Enhance relationships among safety net providers vaccine programs and partnerships developed to expand code and 19 testing should be leveraged as well.
Umair Shah : The current framework indicates that that you have drafted in case a future reports will focus on implementation considerations and these must taken to account anti vaccination.
Umair Shah : concerns us, especially in a state like Texas where concerns for misinformation further driving decrease in uptake of vaccine remain a significant issue. There are five areas that I want to just
Helene Gayle   : Continue going to have to do those very quickly without any
Helene Gayle   : Explanation just pick through them because your time is up.
Umair Shah : You got a goal. So vaccine vaccine utilization one tracking of the covet 19 vaccine distribution in analyzing success for prioritize population, the
Umair Shah : Efficacy of that vaccine. Strategy number two national guidance and support for state efforts such as the immunization registry search capacity.
Umair Shah : With opt in to opt out, and also technology supports number three National Vaccine education must be coordinated this flu season, ensure that locals can better combat conscientious objections.
Umair Shah : To vaccines number for emphasis should be placed on equity based strategy for engagement and allocation for those
Umair Shah : Communities disproportionately impacted by coven 19 with linguistically and culturally appropriate messaging and outreach.
Umair Shah : Number five, strengthening the support for local public health agencies that often are responsible for the last mile of vaccine delivery, given that many of these agencies.
Umair Shah : Are going to be very busy with other efforts in the midst of vaccine allocation. In summary, mass vaccination should have a transparent.
Umair Shah : National Strategy with input from state local jurisdictions prioritizing the higher risk of those that have higher risk for Cobra 19 complications only close by saying
Umair Shah : We need to ensure that local voice of public health, the boots on the ground who represent our communities across this great nation of ours are included in decision making and planning before those plans are enacted and finalize thank you for the opportunity to present today.
Helene Gayle   : Thank you. Thank you. And thank you for getting 20 minutes worth of information into seven
Umair Shah : Send it in writing to
Helene Gayle   : Thank you very much and thank all those great panel for representing state and local government and healthcare perspective, we will now take a 10 minute break and meet you back at precisely
Helene Gayle   : 130 do. Yep. All right. Thank you.
Rebecca Chevat : Did one of your colleagues log on, as you are. I
Michelle Hood: Don't believe so. I came on and off when we went to break. So maybe that's it. Okay.
Rebecca Chevat : I'll just demote that other Michelle hood
Rebecca Chevat : Okay, but I'm glad you're on. Okay.
Benjamin Kahn : I was just gonna say, I think I'm one of your colleagues me apprentice or do you, is it possible that someone else logged in, I saw there was a separate email link to your name when I when I included you
Michelle Hood: Oh, I don't
William Foege  : So Ben, are we ready to get started.
Benjamin Kahn : Think we should
William Foege  : Okay, welcome back. And I must say that the earlier panels were very interesting
William Foege  : I can assure you that the recommendations you have made are going to be considered. They may not all be met to your satisfaction, but they will be considered we're going extra panel and health and medical professional organizations, Ben.
Benjamin Kahn : Yes. First up, we have Claire hand him from the association of immunization managers.
Claire Hannan : Hi, can you hear me.
William Foege  : Yes.
Claire Hannan : Okay, good. Good afternoon. My name is Claire hand and I'm the executive director of the association of immunization managers, our members are the individuals in State and Territorial public health agencies that strive daily to ensure the time
William Foege  : Where we've lost your sound.
Benjamin Kahn : And here we did for the, for the first couple seconds.
Benjamin Kahn : Yeah, why don't we try and move into the next speaker, and you can try to look into the audio and come back.
William Foege  : Okay.
William Foege  : Great.
Benjamin Kahn : Okay, so next we have Michelle for the American Hospital Association.
Michelle Hood: Can you hear me okay
Michelle Hood: Thank you. Thank you very much. So first of all, I'd like to thank all those who participated in the in the body of work that was released yesterday afternoon I
Michelle Hood: Think it's very well organized very thoughtful very comprehensive and, in general, certainly.
Michelle Hood: Providing us a good starting point directionally for this important work that the country is about to undertake. So start with a big thank you.
Michelle Hood: I am from the American Hospital Association, the association advocates on behalf of its over 5000 hospital and health system members.
Michelle Hood: And we appreciate the opportunity to speak today and also the ability to submit written comments which we will do in addition to my brief comments today.
Michelle Hood: In general, we're supportive of the phased approach to distribution and administration and especially the inclusion of healthcare workers in early phases of the vaccine program.
Michelle Hood: We hope that the plan, as outlined will be modified as the science of the various vaccines.
Michelle Hood: evolves and we learn more about the specificity of those vaccines to population segments that would best be served accordingly.
Michelle Hood: As that occurs. We also anticipate that a sophisticated communication plan will be essential to keeping stakeholders informed to the changing guidelines.
Michelle Hood: And plans and those stakeholders, of course, including the public vulnerable populations public health officials and the provider communities.
Michelle Hood: One of the difficulties. I think we've all experienced in the pandemic today is the constant change and that there's
Michelle Hood: You know, there's no fault in the change we are learning as we go. But hopefully we will have established a better communication channel to keep people informed and on the same page as as these
Michelle Hood: learnings to inform us about the actions to be taken and I'll say more about that in just a moment.
Michelle Hood: To items that either were not included in the material or perhaps could be expanded upon it as we work on refinements is are as follows. Number one,
Michelle Hood: Mental health is a significant risk and we didn't see that it was necessarily included as a co morbidity that might put individuals at a higher priority.
Michelle Hood: We're aware of the impact of isolation missed social socialization for children and older persons.
Michelle Hood: And all of the living with coven that has impacted people who were previously living with mental health disorders and challenges. And so the long term effect of this on those vulnerable populations we hope can be considered as we've prioritized vaccine distribution.
Michelle Hood: Second, the science is not yet definitive enough to suggest that an antibiotic antibody level due to exposure to cope it or or having a code and active code in
Michelle Hood: Case actually equals immunity at the same level that of vaccine would provide. So unless research is completely between now and the time that the vaccines begin to be administered
Michelle Hood: It should not be a criteria that those who have developed antibodies from prior exposure, particularly high risk individually individual should not be excluded from groups when a when be into
Michelle Hood: At some point, however, science may tell us more. And that could impact.
Michelle Hood: We jiggering the prioritization and in fact moving individuals that have had the coven
Michelle Hood: Exposure into a lower risk category and therefore extending the limited supply of vaccines to a greater population.
Michelle Hood: The correlation between testing and vaccination is a difficult one as well.
Michelle Hood: The fact that
Michelle Hood: We will begin together that data will be important as we
Michelle Hood: Re establish priorities and communication about the vaccination protocol.
Michelle Hood: And last point, the public really needs to hear all of this information from one leading voice.
Michelle Hood: That is speaking on these issues and making everyone making sure everyone is getting the same organized information from a source of truth.
Michelle Hood: As previous speakers have said, the, the lack of clarity and sometimes misinformation and conflicting information that has flowed is made a lot of
Michelle Hood: Hard work even more difficult. There are several comments in the document that suggests that if state's decide to do something different or private companies are employers require vaccines that they will be allowed to create their own protocols and principles.
Benjamin Kahn : Michelle. I'm sorry to cut you off at your five minutes.
Michelle Hood: Okay, thank you.
William Foege  : Thank you. Thanks so much and thanks for mentioning the mental health aspects of the system very useful.
Benjamin Kahn : Right, next up we have Anthony Sue from the American College of Emergency Physicians
Anthony Hsu : Thank you all for the opportunity to speak on behalf of more than 35,000 Emergency Physicians. I'm Anthony. Sue MD.
Anthony Hsu : This year's Chair of the public health and injury prevention committee and I'm here to comment on how Emergency Physicians can help assist on today's topic.
Anthony Hsu : The American College of emergency physician believes EDS are uniquely positioned with public agencies for the work of mass immunization to ensure all people can be
Anthony Hsu : Reached including those facing homelessness and the under insured for whom emergency departments may be their most likely source of care.
Anthony Hsu : With adequate financial support emergency departments who have already faced the brunt of the pandemic can further help to provide vaccinations behind the highest risk individuals.
Anthony Hsu : Process structures for tracking effectiveness as well as the safety and adverse event outcome should be made accessible by all emergency departments.
Anthony Hsu : Background, we have a robust 20 473 65 system for the distribution of preventative health care already the emergency department vaccinate for tetanus, diphtheria and pertussis rabies, and more.
Anthony Hsu : asap has provided thoughtful leadership supporting the frontline clinicians nurses and support personnel rapidly and continually since the start of the cobra 19 pandemic in the US.
Anthony Hsu : EDS with the covered project already partnering with the CDC on studying vaccine effectiveness among Ed staff.
Anthony Hsu : The various VA ERS has already been in existence since the national childhood vaccine injury act 1986 and is administered by the FDA and the CDC.
Anthony Hsu : Here's some quotes from thought leaders within a set quote the real tragedy will be those who are may be unduly concerned into not taking it then die from the disease or spread it to others who die.
Anthony Hsu : This is a situation where vaccine development as usual is counterproductive. Dr. Taylor June 16
Anthony Hsu : Another quote and acep Council resolution was passed in 1998 advocating for using the ED for vaccinations. The Ed has been recommended as a potential site for influenza and pneumococcal vaccines by the CDC and the ACP Dr. Martin, June, July 1
Anthony Hsu : The following our concerns regarding vexing distribution that can occur in the emergency department, but also apply outside
Anthony Hsu : Number one at the bedside utilization of shared decision making tools regarding measurable risks and benefits tests and therapeutics.
Anthony Hsu : Promotes adherence by ensuring individual agency, how can we best standardize this process what continually updating and easily accessible knowledge base at the bedside.
Anthony Hsu : To rapidly address vaccination disparities. Number two, managing expectations of uneven vaccine availability can help reduce anxiety strife and concerns of unfairness.
Anthony Hsu : rural and urban stakeholder representation advice and consent will be necessary. Number three.
Anthony Hsu : Understandably, the FDA manages vaccine trials and while the CDC manages the information science with pandemic which federal agency within the Department of Health and Human Services best equipped
Anthony Hsu : To manage the efficient and equitable distribution of vaccines less each vaccine company negotiate with each health system and lead to much less equitable market based scenarios, as has been seen in certain instances with testing.
Anthony Hsu : Number four, when a system considers having more primary care providers, more than primary
Anthony Hsu : Care providers administer destination, such as EDS pharmacies or urgent cares
Anthony Hsu : There are state registries of explanation, but not a federal one. What are the benefits and potential adverse implications of temporarily instituting a federal agent registry for vaccination against the stars, Coby virus. Number five.
Anthony Hsu : Consider the possibility of malfeasance fear and ignorance. If a person only needs one vaccine will people get more than necessary. That's reducing supply
Anthony Hsu : Number six, will they be security related issues regarding distribution throughout the country.
Anthony Hsu : Number seven. The quality of the code 19 information landscape has varied overtime and by source hello vaccine misinformation intention or not be managed by State and Governments as we
Anthony Hsu : As well as new and old media. Number eight. Last one. How can we leverage the distribution of vaccines for Health and Science moving forward.
Anthony Hsu : Could private public partnerships regarding health and science education utilized technologies such as kiosks for the less connected
Anthony Hsu : That can be continually updated standardized and distributed to address health and education disparities.
Anthony Hsu : Overall I think you again for the opportunity to speak on behalf of Emergency Physicians regarding the very timely discussion of vaccine distribution and we look forward to working with the National Academies on providing advice and the means to help address the code 19 pendant
Helene Gayle   : You're on mute, though.
William Foege  : I was saying this is the
William Foege  : Precision and speed that we would expect for an emergency department.
William Foege  : So thank you very much.
Benjamin Kahn : Great. Next we have Scott nor from the American Pharmacists Association.
Scott Knoer : Good afternoon. I'm Dr. Scott, can our CEO of the American Pharmacists Association.
Scott Knoer : We represent pharmacists in all practice settings, including community hospitals long term care physicians offices clinics.
Scott Knoer : hospice and government facilities. Thank you for providing a draft framework for the equitable allocation of covert 19 vaccines.
Scott Knoer : We appreciate the committee's recommendation of an evidence based phase allocation and prioritization approach to vaccine distribution.
Scott Knoer : We strongly urge the committee to reconsider the placement of pharmacists in tier two in the allocation scheme.
Scott Knoer : Pharmacists belong in tier one pharmacies and pharmacists in all practice settings are essential frontline healthcare providers.
Scott Knoer : And had been providing coven 19 and related patient care. Since the coronavirus first appeared here. We're proud of the critical impact that our members have made to help our nation respond to the pandemic.
Scott Knoer : pharmacists have been on the frontlines working with other members of the healthcare team and communities, ensuring medication access and availability to support continuous adherence
Scott Knoer : Expanding the availability of code 19 tests and administering vaccines protect children, adolescents and adults from vaccine preventable diseases, including the flu.
Scott Knoer : Providing evidence based information to other healthcare providers and patients on medications delivered in person and tele health services.
Scott Knoer : To patients with chronic conditions and compounding drugs to mitigate and prevent shortages.
Scott Knoer : These essential public health protection efforts provided by pharmacists are critical to ensuring the high risk patients.
Scott Knoer : Health care providers and those who support critical infrastructure remain healthy to keep the country open and productive.
Scott Knoer : Pharmacists provide direct patient care daily and will serve as key in users for persons and high risk of transmission
Scott Knoer : Pharmacists are the most accessible healthcare providers with close to 90% of the US population living within five miles of a pharmacy.
Scott Knoer : Including many underserved areas and patients don't need an appointment to see their pharmacists, whether inner city rural or elsewhere.
Scott Knoer : More than 360,000 pharmacists had been trained to administer vaccines were ready and able to meet the healthcare needs of our communities.
Scott Knoer : Any successful vaccination plan for the equitable allocation of coven 19 vaccines must involve all licensed pharmacist and pharmacies.
Scott Knoer : To defeat this virus. A pivotal CDC pandemic influenza vaccine study showed that national vaccine administration capacity increase to 25 million doses per week.
Scott Knoer : And the time to achieve 80% vaccination coverage nationally was reduced by seven weeks when pharmacists are included in the response.
Scott Knoer : We have three recommendations for the committee to include in the finalized framework. First, to ensure that pharmacists are able to continue to provide critical care to patients.
Scott Knoer : The framework must recognize pharmacists in all practice settings and chair, what
Scott Knoer : The framework identifies clinicians and other workers and healthcare settings, who meet the phase one, a risk criteria.
Scott Knoer : Pharmacist meet three of the four criteria, including risk of acquiring infection risk of nation negative societal impact and risk of transmitting infection to others. Therefore pharmacist volunteer one
Scott Knoer : Not Tier two second a PHA strongly or just the committee's report include a primary recommendation that all licensed pharmacies are given a priority designation in federal and state vaccine allocation distribution and immunization plans.
Scott Knoer : This should include prioritization of ancillary supplies and access to pee pee in the delivery of care to patients and protection of our immunizing workforce.
Scott Knoer : Third, the committee should recommend the federal and state vaccine distribution and elimination immunization plans include a fully funded component for pharmacists and others.
Scott Knoer : To conduct community based education and outreach campaigns to eliminate stigma.
Scott Knoer : Address vaccine hesitancy and improve prevention and health outcomes for high priority and vulnerable patient populations.
Scott Knoer : Pharmacists are trusted healthcare providers and that patient trust is key in educating and current patients to get vaccinated
Scott Knoer : Thank you again for your efforts, we strongly recommend that the committee engage the pharmacy community in any ongoing and process evaluations related to vaccine allocation and distribution.
Scott Knoer : The American Farm Association looks forward to continuing to work alongside all of America's heroic healthcare workers to defeat coven 19
Scott Knoer : Pharmacist or healthcare providers in your neighborhood in on healthcare teams where the front lines and are an essential part of the effort to vaccinate communities and prevent the spread of colon 19 across the country.
Scott Knoer : Will be submitting more detailed comments. For the record, on behalf of the broader pharmacy community. Thank you.
William Foege  : Thank you for this clear expression of a very important perspective, then
Benjamin Kahn : Next we have Kathleen oh Laughlin from the American Dental Association.
Kathleen O’Laughlin : Hi and thank you so much for allowing us to provide some comments, I speak on behalf of the American Dental Association. I'm the executive director and CEO.
Kathleen O’Laughlin : And I speak on behalf of our hundred and 63,000 members and thank the committee for this opportunity to provide very important comment.
Kathleen O’Laughlin : Along with many of the speakers today Ada seeks to ensure the most vulnerable at risk groups, including Native Americans, Latino, a black communities. The institutionalized medically and mentally compromised and at risk of elderly are allowed early access to the vaccine.
Kathleen O’Laughlin : A healthy essential healthcare workforce is vitally important serving all of these communities of interest.
Kathleen O’Laughlin : And the ADA so that the committee recognize dentist as critically important members of the essential healthcare workforce.
Kathleen O’Laughlin : In the early days of sorrows coven to pandemic dentists were among the first healthcare providers to restrict practice and this was done to
Kathleen O’Laughlin : Reduce possible transmission rates to conserve personal protective equipment for our medical colleagues.
Kathleen O’Laughlin : And to continue to provide basic emergency care to reduce the burden on already over on hospital emergency departments.
Kathleen O’Laughlin : And currently over 95% of dental practices are safely and effectively providing comprehensive care to their communities 58% of the population have a dental visit each year over 170 million individuals.
Kathleen O’Laughlin : So routine care is essential health care and dentists and their teams are essential health care workers.
Kathleen O’Laughlin : Dentists evaluate and diagnose oral diseases that are directly linked to overall health. For example,
Kathleen O’Laughlin : A routine dental exam include screening for oral cancer prevention is extremely important in early detection, as you know, can lead to early treatment.
Kathleen O’Laughlin : And this is especially important in the case of HPV related cancers, which have caused a dramatic increase in oral cancer.
Kathleen O’Laughlin : In the absence of traditional risk factors such as age and smoking and alcohol abuse delaying treatment for months or even weeks can make the difference between life and death.
Kathleen O’Laughlin : So oral health has always been associated with overall health.
Kathleen O’Laughlin : And evidence now shows that gum disease is related to the incidence or severity of diabetes, cardiovascular disease, rheumatoid arthritis, anxiety, depression, dementia, and other systemic diseases.
Kathleen O’Laughlin : Furthermore, CDC recently reported that screening for systemic conditions could result in up to 100 million dollars of healthcare expenditure savings annually.
Kathleen O’Laughlin : And finally, dental pain is the number one cause of missing work and school at effects military readiness and impacts the overall well being of the population.
Kathleen O’Laughlin : So as essential healthcare workers dentist and their teams also can play a role in expanding the nation's medical search capacity for example.
Kathleen O’Laughlin : Some states such as North Carolina and Pennsylvania have already authorized dentist to screen patients per SARS, Coby to
Kathleen O’Laughlin : Several states such as Illinois Minnesota and Oregon also allowed us to provide life saving vaccinations.
Kathleen O’Laughlin : It is also worth noting that every year, more than 31 million people visited a dentist and do not see a physician.
Kathleen O’Laughlin : This makes every dental encounter and opportunity to test or vaccinate those individuals for SARS, Coby to in states that currently allow it.
Kathleen O’Laughlin : According to a consumer survey from August of 2020 15% of the public is reluctant to return for routine dental appointments until a medical breakthrough like a vaccine is available.
Kathleen O’Laughlin : Early Access to a safe and effective SARS, Coby to vaccine will reassured that 15% of the American population that it is safe to resume routine dental appointments
Kathleen O’Laughlin : Here, Health and Human Services agrees with the Federal Emergency Management Agency that dentistry is an essential health care service.
Kathleen O’Laughlin : And dentist in their teams including the dental students and residents within the clinical operations of 66 us dental schools and community health centers are essential health care workers.
Kathleen O’Laughlin : So we appreciate your thoughtful consideration of how to allocate the early supplying of the vaccine equitably and with the greatest positive impact on all of our communities. Thank you so much.
Benjamin Kahn : you're muted again.
William Foege  : This is being recorded.
William Foege  : And so we will be going through this, but feel free also to send in a written notes on what you've just said, then
Benjamin Kahn : Great. Thank you. Before we move on to the next panel. I wanted to circle back to a clear hand in from the association of immunization managers.
Right.
Claire Hannan : Thanks very much. Can you hear me.
Claire Hannan : Okay, great. Thanks for circling back. Good afternoon. My name is Claire hand and I'm the executive director of the association of immunization managers.
Claire Hannan : Our members are the individuals in State and Territorial and a few large local public health agencies.
Claire Hannan : That work in immunization and strive to ensure the time the vaccination of every child teen and adult. We appreciate the opportunity to provide comments.
Claire Hannan : And really think the committee for your commitment to quickly develop an overarching framework to assist in planning for the equitable allocation of covert vaccine immunization program managers.
Claire Hannan : My video didn't realize it was not an immunization program managers are on the front lines of vaccines distribution planning and they need this evidence based guidance to ensure success. I want to make three observation I
Claire Hannan : Want to share three observations. I had upon reading the draft report and just to state up front that these are observations. I have not had an opportunity to discuss with my membership or that with them, due to the short timeframe, but we will submit written comments.
Claire Hannan : First, the acknowledgement of the coldest disease impact, I commend the committee for thoroughly exploring all the aspects of the framework and the principles on which the framework is founded.
Claire Hannan : This approach acknowledges the significantly higher burden of code 19 infections and diseases amongst blacks, Hispanics American Indians and Alaska Native
Claire Hannan : The report also acknowledges the fundamental health inequities in covert and other health conditions are rooted in structural inequalities racism and residential segregation
Claire Hannan : I think this acknowledgement is critical, it's really critical it to establishing trust in these communities trust in the public health and the providers that are going to be given giving vaccine.
Claire Hannan : Trust in the vaccine itself. I'm concerned that the principle of medicating health inequities when discuss alongside the principle of equal regard and fairness.
Claire Hannan : May cause confusion and blur this strong acknowledgement of the higher disease impact on certain populations.
Claire Hannan : The committee notes, a key lesson from your bowl outbreak in West Africa, the lack of effective Community engagement was among the barriers that delayed a rapid and effective response.
Claire Hannan : State and local immunization program managers need to engage in these communities where the virus is impacting the most
Claire Hannan : These communities. Know the viruses infecting Blacks, Latinos, Native Americans Alaska Native higher than lights and the hospitalizations and death rates are higher because they're experiencing it.
Claire Hannan : State and local public health officials talking in these communities engaging with leaders, church groups employers. They need to have clear information.
Claire Hannan : And they need to be able to establish trust and they need to be able to explain the recommendations to explain the priority groups.
Claire Hannan : They've got with knowledge with these communities already know that they've been hit harder by the disease.
Claire Hannan : And that's where I'm concerned about Operation realizing the guidance and the logic of the committee.
Claire Hannan : It's difficult to acknowledge health inequities and a strong association of coca disease infection with race and ethnicity, but then communicate that with respect to the vaccine all individuals are regarded equally.
Claire Hannan : Second, I wanted to touch on the specificity versus the flexibility for state.
Claire Hannan : The committee notes at the H1 and one vaccine program allows state and local jurisdictions flexibility to develop their own distribution plans.
Claire Hannan : And this is critically important workers that are essential to the function and economy of communities may vary from state to state and strategies may vary as well. It drives through clinics might be great in sunny Florida but not feasible in Chile, North Dakota.
Claire Hannan : But this has to be balanced against the need for consistency, as the report notes the decisions made by states in 2009
Claire Hannan : Around allocation of vaccine was in priority groups and when to broaden vaccination efforts beyond priority groups lead to compete communication and challenges and confusion.
Claire Hannan : Now, I think the vaccine supply is likely to be more limited in the early phase then the populations recommended to receive the vaccine.
Claire Hannan : without additional guidance on who to prioritize within those larger groupings in one day and one be because against the variance across states, leading to confusion and communication challenges.
Claire Hannan : Now, our hope is that we learned from the lessons of 2009 and apply final recommendations with more consistency, while still allowing state flexibility.
Claire Hannan : Third, I wanted to touch on translating the priority into outreach.
Claire Hannan : Well, it seems entirely appropriate to prioritize people of all ages with co morbid underlying conditions that put them at significantly higher risk in phase one be as the Committee recommends. My concern is the challenge around operational realizing this is very good for five minutes.
Claire Hannan : Okay, it would be very difficult to operationalize this just because of the large numbers in the vaccine group one vaccine is scarce.
Claire Hannan : So I would encourage looking at operational ization challenges when when finalizing you report.
Claire Hannan : To face great, let's do it for the opportunity to comment, and I also just wanted to say the guidance that will be coming out from you on risk communication and steps Medicaid vaccine hesitancy will be very much needed. Thank you. Thank you.
William Foege  : Okay, thank you very much. And we're going to go to
William Foege  : A new panel and looking at some of the particular problems of the order population been
Benjamin Kahn : Great. First we have Luis Aronson from the University of California, San Francisco.
Louise Aronson : I thank you all for listening to so many voices I actually feel like this is a model for the America. I'd like to be living it. So this is terrific. Thank you.
Louise Aronson : So I'm here to talk about old age. But I think if I have one point, it's this that you're listening to a lot of groups and we're sort of grouped by sub category. And I actually think these aren't separate interest group issues, but
Louise Aronson : It's really the same sort of biases can see some constraints of our systems applied to different populations. So to my eyes there to unifying themes going on here and I'll just say also that I'm
Louise Aronson : I'm painting with a very broad brush here because I have colleagues speaking after me and we'll get into more specifics
Louise Aronson : But so the two big unifying themes I think across the subpopulations are intersection ality which is really the synergistic impact of multiple disadvantages.
Louise Aronson : In human lives and in terms of old age 80% of deaths have been an older people and just having scanned the people I can see here
Louise Aronson : Let's be clear that the risk of coven depth starts going up at age 50
Louise Aronson : And then it goes up significantly. At age 60 and then it doubles again at 70 and then it is at its highest over age 80 and as my colleague, Joe Lynn Lynn likes to say if we're not old now. We're all people in training.
Louise Aronson : And the other thing that is often missed in these discussions is that you can actually be black and brown and old at the same time. And that turns out to be not good for you in this country.
Louise Aronson : So there's another issue here. In addition to intersection ality which is complexity, which sort of began as like the systems based cousin of intersection ality. It's like the multiple connections between components, but we actually now use this in reference to human lives a lot now.
Louise Aronson : Particularly older lives, but it turns out if you look closely, and I say this as a as a clinician than Dr that the majority of human lives.
Louise Aronson : Are this complexity. Right. It's basically anything other than the sort of human that we studied when modern medicine began, which was an able bodied white, heterosexual at least middle class mail between the ages of 20 and 50
Louise Aronson : And there's no I don't want to mean any disrespect to people in that category. But that is the minority, right. The others are knocked. If you look at the Health and Human Services List of vulnerable populations. It is the vast majority of people in this country.
Louise Aronson : So what I really hope for this panel and and and your recommendations is that we don't continue these mistakes.
Louise Aronson : So we know that scientific research, including vaccine research works best when you could control a lot of factors. The problem is when you control factors.
Louise Aronson : You end up with a really narrow maybe so called ideal human that isn't most of us. So I think the research has to start out in that complexity and intersection ality because those are the lives in which the results will be applied.
Louise Aronson : We learned this the hard way at the start of research, you really have to be in that ideal category and what they would say about women was that, well, we can't include them in the study because they've got these weird hormones.
Louise Aronson : And we can't include people of color because their lifestyles are different.
Louise Aronson : than ours. Again, quote unquote, we can include old people and young people. And then what happened when they applied the results of the study, some of which yielded tremendous advances.
Louise Aronson : Was that they found that women and people of color had much poor outcomes and at first they blamed them for their demographic attributes and
Louise Aronson : But, but then in 1989 the NIH said you must include women and people of color in studies.
Louise Aronson : Now that hasn't gone as well as one might hope 30 years later, but at least they had a mandate in the 1990s, they discovered the children were different from adults. So in 1998 they mandated the inclusion of children.
Louise Aronson : When did they manage the inclusion of elders defined broadly as people over age 65 and in clinical research 2019
Louise Aronson : Last year right so bottom of the barrel 80% death rate from Copa really important in terms of vaccines. We see this play out all the time. The CDC issues of vaccine schedule yearly, as I'm sure you all know.
Louise Aronson : They acknowledge subcategories of children and adults but not have elders so vaccines are usually targeted based on your social behavior and your biology. So there are 17 set schedules for children.
Louise Aronson : There were five for adults. This year they reduced it to four there was a single vaccine schedule for people over age 65 as if any one of us doesn't know that biology and behaviors are very different.
Louise Aronson : Between a 65 year old and an 85 year old and 105 year old. No, no less. Different than between a two year old and a 12 year old or a 22 year old and a 52 year old boys ageism plain and simple.
Louise Aronson : Now for code. In particular, we have seen intersection ality and two main ways
Louise Aronson : There was a study in the Journal American geriatrics society, and there have been multiple other showing that if you control for everything else you control for other diseases.
Louise Aronson : You control for insurance type you control for wealth, all sorts of other things. If you're skilled nursing facility has a higher proportion of black residence, then the risk of covert in that facility as it needs to fold right so you can be both these things and that's not
Louise Aronson : Good. Now there is a second
Louise Aronson : Important way in which this is interacting with old age, which is the people who work in congregate care facilities for the elderly are very often female the brown or black something in many states also immigrants now.
Louise Aronson : On your foot. Okay.
Louise Aronson : Okay. Um, I'll just, can I have one quote from the flu. So this is from my local newspaper though people age 65 and older, the most vulnerable to flew to which they're much less vulnerable than coven
Louise Aronson : Reporting their desk is problematic. So we don't do it anymore because it would require too much time and money and their cases are often complicated by multiple health problems. That's not a reason not to provide care that's a reason to provide care. Thank you very much for this time.
William Foege  : Thank you for reminding complexity and 84 I felt like you were talking right to me.
William Foege  : Ben.
Benjamin Kahn : Next up we have Timothy Pharaoh from the American geriatrics society.
Timothy Farrell : Good afternoon. My name is Dr. Timothy feral, I'm a geriatrician Associate Professor of Medicine.
Timothy Farrell : At the University of Utah school medicine and a physician investigator at the Veteran Affairs Salt Lake City geriatrics research, education and clinical center or Grech,
Timothy Farrell : I'm honored to provide this testimony on behalf of the American geriatrics society or a GS right I served as vice chair of the ethics committee.
Timothy Farrell : Our committee developed the recent AGM position statement entitled resource allocation strategies and age related considerations and the coven 19 area and beyond.
Timothy Farrell : NGS appreciate the emphasis that the committee has placed on the healthcare workforce and older adults in this draft framework.
Timothy Farrell : As Members work to improve health independence and quality of life and to ensure that older adults have access to high quality health care that is free of ageism
Timothy Farrell : The ACS believes that vaccination strategy should focus on achieving the greatest possible reductions and disease related death and morbidity.
Timothy Farrell : We therefore strongly recommend that our National Vaccine allocation strategy should do the following.
Timothy Farrell : First prioritize the health workforce broadly defined to cover workers across care settings, including in long term care assisted living and other congregate living facilities.
Timothy Farrell : And home and community based settings. Second, prioritize access for high risk populations, including older adults those living in congregate settings. People with chronic health care conditions and communities of color.
Timothy Farrell : Third, avoid using age as a criterion, given the diversity of the older adult population. We believe that is not the role the ag is this committee or government
Timothy Farrell : To assign different values to individual life based on age, income potential or other factors.
Timothy Farrell : We respectfully recommend that the committee should, instead, consider the effect of vaccine distribution on public health mortality and decreasing demands on the health care system in general.
Timothy Farrell : I'll address each of these three points in turn the GS strongly recommends that the committee include an expansive definition of the healthcare workforce that is comprehensive
Timothy Farrell : As to type of worker and setting of care are United States healthcare workforce provides care and not just an acute care hospitals.
Timothy Farrell : But also in nursing homes assisted living and other congregate living facilities and at home and in the community.
Timothy Farrell : We must ensure that direct care workers, such as certified nursing assistants dietary aids and others who work in facilities were covered 19 patients are cared for our prioritized
Timothy Farrell : This is in addition to the priority that will be given to health professionals such as doctors, nurses, pharmacists and social workers.
Timothy Farrell : preventing infection and healthcare workers is an important public health intervention to decrease the exposure of all of us. The most critically are vulnerable populations to coronavirus infection.
Timothy Farrell : We appreciate that older adults people with chronic conditions and others at high risk of dying from coven 19 are prioritized in the draft framework.
Timothy Farrell : However, he is would like to speak on behalf of all older adults given are concerned that portions of the underlying analysis that inform these recommendations lean on stereotypes that potentially devalue older adults.
Timothy Farrell : We refer specifically to the idea that age, in and of itself as a potential criterion for making allocation decisions.
Timothy Farrell : Our current reality is that due to advances in our understanding of diseases and how to treat them. People are living healthy lives even when they have heart disease or other chronic conditions.
Timothy Farrell : Resting. These recommendations on analysis that does not reflect the complexity of how he he runs the risk of older people will be discriminated against because of their age, when this framework is implemented.
Timothy Farrell : I like to highlight four principles from the reason he has position statement, there are particularly relevant to the issue. I just raised
Timothy Farrell : First aid should never be used to exclude someone categorically from a standard of care, nor should he cut off be used and allocations.
Timothy Farrell : Second, to avoid similar biases factors such as life you're saved and long term life expectancy should not be used since they disadvantage older adults and are often unreliable.
Timothy Farrell : Third when assessing comorbidities decision makers should carefully consider the impact of age, race, ethnicity, and social determinants of health.
Timothy Farrell : Fourth resource allocation strategies must be transparent applied uniformly and regularly and rigorously reviewed.
Timothy Farrell : We strongly encourage the committee to expand its analysis related to age and fairness by incorporating these principles and adjust health system resources are allocated equitably using criteria that treats similarly situated people the same
Timothy Farrell : Age. Yes, appreciate the work of this committee and your focus and commitment to developing a fair and equitable strategy that is transparent and free of age or other discrimination.
Timothy Farrell : Thank you very much again for the opportunity to provide this testimony. And I would add that when it comes to how well we all age.
Timothy Farrell : It behooves us all to remember that is often the ninth inning of life that is the most important I'll say also the GS will be providing written comments, similar to those described here. Thanks so much.
William Foege  : Thank you for very good
William Foege  : Statement and
Benjamin Kahn : Next up we have random Flynn for leading edge.
Brendan Flinn : Oh, I'm. My name is running fine and I am the director of Medicaid and community based services for reading age for whom I am speaking today.
Brendan Flinn : Leading edge of a national association representing more than 5000 not for profit services providers.
Brendan Flinn : I remembered include nursing homes continuing care retirement communities assisted living facilities affordable housing communities home health and Hospice Agency page organizations adult day services and more. So I am speaking today on behalf of the full breadth of our membership.
Brendan Flinn : To start, we can aid appreciate the high priority, the discussion draft assigned to older adults and the workers who care for them.
Brendan Flinn : Ensuring that these groups have the cat pee pee and ultimately vaccinations are imperative to ensure they are imperative to ending the coven 19 pandemic.
Brendan Flinn : To that end, we support the inclusion of high risk workers and healthcare facilities and phase one. A for the vaccine allocation.
Brendan Flinn : As noted in the report, each worker provide a central cat and are often themselves exposed to coven 19 sometimes without the p, p, they need
Brendan Flinn : Close to 100 workers and nursing home alone and many others across that into died from the data and this group query need priority access to any destination.
Brendan Flinn : The committee us multiple healthcare settings, including nursing homes hospital assisted living and home based care for your home how
Brendan Flinn : We support and creating these settings and believe staff at all levels clinical and non clinical should be included.
Brendan Flinn : Further, we earned the committee to include community based care workers as well. So I could workers and adult day services or and paste organizations.
Brendan Flinn : community based services provide critical support to older adults, including those with multiple chronic conditions and at high risk for colon it
Brendan Flinn : vaccinating workers and community based health and long term care settings would also help prevent disparities.
Brendan Flinn : A 2019 record from the CDC, for example, founded about 15% of adult day services participants are black and 23% of Hispanic figures, much higher than the 65 plus population in general.
Brendan Flinn : Moving on to older adults themselves. We think the committee for including older adults in the congregate settings and living in Tonga get started in the top tier
Brendan Flinn : Nursing home and assisted living residents have experienced the brunt of the Panda and along with others and congregate settings should be among the first to receive a potential vaccination, we do or the committee to consider one a level priority, if possible for this population.
Brendan Flinn : Potentially for folks in this group and hotspot areas or those with the CO boarded condition at highest risk for Carbonite
Brendan Flinn : We also see confirmation from the committee that This category includes 1.1 million older adults within an affordable housing and federally assisted
Brendan Flinn : Communities. Well, quote, affordable housing is not mentioned in the report older adults living the high risk ricotta 19 and facing any of the conditions described
Brendan Flinn : In in the required and and have more kind of conditions in their heart and their unassisted peers.
Brendan Flinn : Further affordable housing communities are often more diverse with respect to race and ethnicity compared to other time you get started.
Brendan Flinn : We ask the committee to confirm the older adult and affordable housing communities are part of tier one day and we see similar confirmation as relates to older adults and independent within communities.
Brendan Flinn : We also just want to quickly express support for their committee recommendations on Medicare and Medicaid coverage for any potential destination, as well as the development of a guideline by a CIT if needed. Thank you. And we will also be submitting written questions.
Brendan Flinn : Or comments.
William Foege  : Thank you very much. And I'm impressed with how people are really keeping to their time with it's been
Benjamin Kahn : Actually having to call Lynch.
Benjamin Kahn : For voice.
Nicole Lynch : Hello, my name is Nicole and shine the public policy coordinator for a nonprofit voice in St. Louis, Missouri.
Nicole Lynch : We are the provider of the long term care ombudsman program and we provide Advocacy Services to nearly 27,000 long term care residents in greater St. Louis and northeast, Missouri.
Nicole Lynch : Voice is one of only one, one out of 500 ombudsman programs across the country.
Nicole Lynch : And we are concerned, expressing concerns to the committee because ombudsman have been left out of group one, a as they are not considered long term care facility staff because they are considered to be non biased and work for outside organizations.
Nicole Lynch : These ombudsman work very closely with residents and the program is federally mandated by Congress and the amendments to the Older Americans Act.
Nicole Lynch : Every long term care facility and every county across the United States has an ombudsman to serve that facility.
Nicole Lynch : A small number of these are employed and funded through the Local Area Agencies on Aging, but most of the program is sustained by volunteers themselves.
Nicole Lynch : And the what I'm buds Minh does they go in and they advocate for nursing home residents, they can detect signs of abuse and neglect ensure residence.
Nicole Lynch : rights are being upheld and they're critical and reducing hospitalizations for early identification of preventable health concerns such as pressure sores dehydration and UTI.
Nicole Lynch : It's a role that's incredibly critical to nursing home residents right now as they've been on lockdown for over six months.
Nicole Lynch : And long term care staff that are working there is stretched thin as staffing is limited. This is especially prevalent and Medicaid facilities with primarily African American residents.
Nicole Lynch : The Ombudsman are at high risk for contracting coven 19, as the report states 80% of all Kobe deaths have occurred and people over age 65 and
Nicole Lynch : nursing home staff and residents have been at the direct center of this on the volunteers themselves are frequently older adults as it is a high time commitment I know in Missouri.
Nicole Lynch : Each Ombudsman will spend three to 10 hours a week, providing Advocacy Services one on one with residents in the nursing home.
Nicole Lynch : And additionally, they have to go through in Missouri 50 hours of initial training and 20 hours of continuing education, training,
Nicole Lynch : Leaving this role primarily up to retired older adults as they're the ones with this time commitment.
Nicole Lynch : We already have a very small volunteer pool as our ombudsman are afraid to go back into the nursing homes.
Nicole Lynch : And advocacy services have been very limited to these residents who are very vulnerable right now. So we just ask the committee to consider this and
Nicole Lynch : Providing them and putting them into group one day, as they are very high risk of working with nursing home residents and high risk themselves. Thank you.
William Foege  : Thank you. That's very important information. So thanks for presenting it and
Benjamin Kahn : Next we have Mark Parkinson from the American healthcare Association National Center for assisted living
Mark Parkinson : Well, thank you very much. My name is Mark Parkinson, I am the CEO of the American healthcare Association and National Center for assisted living
Mark Parkinson : We represent 10,500 skilled nursing facilities across the country as well as 4000 additional assisted living facilities across the country.
Mark Parkinson : We really appreciate the opportunity to provide input today. I had a chance to read the draft report this morning and I was extremely impressed. I mean, it is really great to see such thoughtful work product.
Mark Parkinson : super impressed with the work that you've done and glad to try to give you some input to help shape it in
Mark Parkinson : In in any way that we can, I think, you know, it's very clear that the impact on older people in, in particularly older people live in congregate settings has just been absolutely devastating.
Mark Parkinson : We have very good data on skilled nursing facilities, because they are required to report every week. And so we now know that almost 200,000 people living in skilled nursing facilities have contracted code.
Mark Parkinson : That's an astonishing number when you stop and think that there are only about 1.5 million people in these facilities at any given time 200,000 have contracted co but
Mark Parkinson : Even worse, of course, is that we know that the mortality rate for people that are is over 80 years old is really high and the average person that lives in one of our facilities is 83
Mark Parkinson : Mortality rate is somewhere around 20% perhaps even a little bit higher than that.
Mark Parkinson : We now have know that definitively through the reporting that we have almost 50,000 deaths in skilled nursing facilities. We don't have good data on assisted living buildings and independent living buildings, because there's no
Mark Parkinson : Required reporting requirement, but it's very clear that there have been 10s of thousands of deaths in those settings as well. And so for that reason it's
Mark Parkinson : Obvious. And I don't think debatable that any sort of prioritization of a vaccine really needs to try to figure out how to address this population.
Mark Parkinson : I think that the framework that was put together in the draft is brilliant. The idea of maximizing the benefits of what might be a limited supply of vaccines makes complete sense.
Mark Parkinson : And any sort of analysis of how you maximize the benefits would certainly include older people in congregate settings as well as the people that take care of them. And that's, that's been a tragedy as well. We've lost almost 1000
Mark Parkinson : Caregivers to co but and so they certainly need protection as well. We only have a couple of substantive comments. The first would be to completely endorsed the comments and Brendan plan that he just gave from leading age.
Mark Parkinson : Which is that it's not just skilled nursing facilities where these people live. It's also independent living facilities assisted living facilities.
Mark Parkinson : And a number of other settings that older people are living together and we may need to make sure that we protect them all.
Mark Parkinson : And secondly, you may need to do some analysis based upon the effectiveness of the vaccine.
Mark Parkinson : If the vaccine is approved, but not completely effective maybe only effective at a 50 or 60 or 70% level, we may need to give some serious consideration to what do we do about
Mark Parkinson : Healthcare workers and their immediate family, so they go home and live with.
Mark Parkinson : What do we do about caregivers that come into facilities that might not otherwise be in a protected age group. So for example, we have a lot of family caregivers that are women.
Mark Parkinson : 5060 years old and are taking care of their parents. Some men but tends to be women and we might again if Maxine. It's not effective, they might not fall into a top tier
Mark Parkinson : Category, but we may need to give some consideration there. So if I will just let me conclude by saying that your work product, product is truly impressive. We will be submitting some additional written comments and really appreciate the opportunity to be
William Foege  : Thank you very much. And you're describing an absolute disaster that our hope, of course, is that vaccine is going to come much faster. Once it starts there won't be alone delay, then
Benjamin Kahn : Next we have David from the American seniors housing association.
David Schless : Thank you and good afternoon, everyone. My name is David less. I'm the president of the American seniors housing association.
David Schless : An organization with 550 members, our members are involved in the full spectrum of senior housing, ranging from independent living
David Schless : To assisted living memory care as well as continuing care retirement communities, our industry houses and cares for approximately 2 million older adults and we have a workforce of approximately 1 million
David Schless : In the settings, want to thank you for the opportunity to share our views today.
David Schless : Upon review of the preliminary report, we are pleased to see healthcare workers and high risk seniors are recommended population groups for inclusion in the Phase, Phase one of this for phased
David Schless : Approach to the vaccine allocation. I do want to echo some of the comments that have been made by Mark Parkinson, as well as Dr. Feral and Brendan Flynn.
David Schless : Again, it would really point out that while the term, long term care is an appropriate term we really think there needs to be more specificity in the report.
David Schless : So that independent living and assisted living and memory care really don't get overlooked and again without belaboring this point, the fact of the matter is that the Skilled Nursing. Nursing Home sector has received many
David Schless : Things from the federal government that the rest of this spectrum has not received independent living assisted living has been
David Schless : Overlooked throughout this process from the government, with respect to pee pee rapid testing kits, etc. So I think that's a really important point to make.
David Schless : I will just reiterate again the prevalence of certain chronic conditions.
David Schless : Among the seniors housing population makes our residents a higher risk than other other older adults living at home for Kovac 19 infection death and other poor outcomes.
David Schless : According to the CDC people with chronic kidney disease, chronic lung disease, diabetes, serious heart conditions are at a higher risk for severe illness from coven 19
David Schless : These conditions are prevalent among assisted living residents with 68% having at least one of these conditions, compared to private housing.
David Schless : Residents of independent living in assisted living are older and have higher rates of cognitive and functional impairment
David Schless : Our residents are well over the age of 80 on, on, on average, and often exhibit one or more of these chronic conditions. So given these and other health risk factors senior living residents are definitely at increased risk of serious illness and death of infected with
David Schless : I also want to just point out again that the lead to quarantine and isolate residents to keep them safe from infection.
David Schless : can often lead to loneliness, which is of course linked to other health risks, including dementia. So our communities have
David Schless : Really limited and restricted visitation with families and friends.
David Schless : Too. And so again, the risk of infection from outside parties is a real concern and obviously you've been reading about the challenges associated with visitation.
David Schless : I want to talk a little bit about the workforce in these settings again in senior living independent living assisted living memory care continuing care retirement communities.
David Schless : We have a range of individuals coming in their caregivers nurses housekeepers dining staff others, they're interacting with the residents on a daily basis.
David Schless : They put themselves at danger of either contracting the disease themselves or carrying the virus asymptomatic Lee.
David Schless : So again, I would really just, you know, reinforce that comment that both the residents, as well as the caregivers in these buildings and other folks that work on a daily basis 365 days a year, need to be included in this prioritization.
David Schless : We can't serve our vulnerable seniors unless our staff are free from covert 19
David Schless : In conclusion, we hope that you will expressly include senior living residents and workforce and all references to long term care.
David Schless : Or Kongregate care settings in the final report to be included in the phase one allocation and we fear that without this
David Schless : Clarification we can be potentially overlooked, as has been the case with dissemination of rapid testing and supplies of p, p, we will be providing a written statement. And again, applaud your work and appreciate the opportunity to speak this afternoon.
William Foege  : Many thanks, we just, we just keep learning and appreciate that Ben.
Benjamin Kahn : We have Chad words from the American Society of consultant pharmacists.
Chad Worz : Thanks, Ben. My name is Chad words, I'm a pharmacist and chief executive.
Chad Worz : For the American Society of consultant pharmacists and I want to thank the National Academies of Science sciences, engineering and medicine for the opportunity to comment.
Chad Worz : On behalf of the long term care pharmacists and pharmacies that service. The 15,439 skilled nursing facilities.
Chad Worz : And the over 38,000 assisted living facilities as well as older other older adult medically complex patient populations.
Chad Worz : The American Society of consultant pharmacist is the only professional society devoted to optimal medication management improved health outcomes for all older persons in the United States and abroad.
Chad Worz : asap Senior Care pharmacist and pharmacy members managed improve the quality of life for geriatric patients and other individuals.
Chad Worz : Residing in a variety of environments, including nursing facilities sub acute care assisted living facilities psychiatric hospitals hospice programs and home and community based care.
Chad Worz : First, I'd like to applaud the work of the committee and assembling a comprehensive approach to the coven 19 emergency
Chad Worz : The specific details regarding the fairness equity evidence based and transparent process of identifying the most appropriate tears regarding vaccine allocation is impressive.
Chad Worz : We support wholeheartedly, the inclusion of the skilled nursing facility and assisted living facility residents and healthcare workers in the initial phases of any application.
Chad Worz : As widely recognized and accepted this population in this industry is the hardest hit by cope with 19
Chad Worz : In congruence with these facts and the conclusions of the Committee, I want to underscore the role of the long term care pharmacies and pharmacists and successful Deployment Administration and reporting of any vaccine.
Chad Worz : Long Term Care pharmacies and pharmacist have been and continue to be on the front lines of this pandemic.
Chad Worz : And existing relationships with all of the 15,400 skilled nursing facilities and over 38,000 assisted living facilities.
Chad Worz : As therapeutic approves as therapeutics approved for us can be acquired delivered it administrator using the existing effectively and efficient supply chain that is currently in place.
Chad Worz : Leveraging the close relationships that long term care pharmacy and pharmacist have with skilled nursing homes and assisted living facilities.
Chad Worz : Plans can be established to quickly and effectively get vaccinations administered within days of any emergency youth use authorization
Chad Worz : To the more than 1.3 million nursing home residents and over 800,000 individuals living in residential care facilities.
Chad Worz : As well as the over 2 million essential full time nursing home employees and healthcare professionals, including pharmacist that work in these settings.
Chad Worz : We support the conclusions of this committee and emphasize that all long term care pharmacies be included in the distribution process in phases, one A in one be as existing effective and efficient resources to deploying the vaccine to all areas of the country.
Chad Worz : This is accomplished by allocating vaccine to the major wholesaler and distributors for rapid delivery directly to the long term care pharmacies.
Chad Worz : That directly service, the skilled nursing facilities and assisted living buildings in every corner of the United States.
Chad Worz : We also have the size that in want to ensure that pharmacist can support the other qualified clinicians and the administration and reporting of any vaccine.
Chad Worz : This is accomplished by establishing pharmacist is bonafide providers of vaccines services through Medicare Part B and Medicaid programs.
Chad Worz : Thank you for being proactive to the needs of our vulnerable older adult populations that reside in skilled nursing facilities and assisted living facilities, as well as other at risk people in the community based programs and we will also be submitting written comments. Thank you.
William Foege  : Many things and we will do one more panel before we take another break and we recognize from earlier comments that these panels don't necessarily follow, but we have to put them in some sort of categories. So now we're going to look at the occupational risks and Ben, who's our first
Benjamin Kahn : Daddy, Daddy Berkowitz from the National Employment Law Project
Debbie Berkowitz : Hi. Sorry about that.
Debbie Berkowitz : And
Debbie Berkowitz : Thank you for this opportunity to speak at the public listening session of the National Academy of Sciences committee on equitable allocation.
Debbie Berkowitz : Of the vaccine for the novel coronavirus I'm Debbie Berkowitz some the worker safety and health program director at the National Employment Law Project in Washington, DC.
Debbie Berkowitz : The National Employment Law Project is a nonprofit, nonpartisan policy and education organization that seeks to improve working conditions such as workplace safety for low wage workers.
Debbie Berkowitz : Our work is focused on the many low wage industries that are disproportionately black and brown workers, as well as other workers of color, including immigrant workers and indigenous workers.
Debbie Berkowitz : I've spent 40 years in the field of workplace safety and health and I was a senior policy advisor and Chief of Staff at federal ownership for six years before coming to the National Employment Law Project
Debbie Berkowitz : I support the preliminary equitable policy framework that you have laid out in the draft document.
Debbie Berkowitz : I did want to inform the Committee of the importance of prioritizing the vaccine for workers in the meat and poultry and agriculture industries.
Debbie Berkowitz : The critical infrastructure industries listed in the second tier of your framework of your draft framework.
Debbie Berkowitz : You may already know from news reports that coca has spread like wildfire through the nation's meat and poultry plants.
Debbie Berkowitz : We know that at least 41,000 workers in the industry have been infected and hundreds have died.
Debbie Berkowitz : And we know this is an under estimate, since many plants are not doing testing in many states are not releasing data by industry.
Debbie Berkowitz : Nor does this total include the family members of workers who got sick and died from exposure to their relatives who worked in these plans.
Debbie Berkowitz : It was not inevitable that would race through and continue to race through these plans, it is because the industry did not implement the basic CDC recommendations soon enough.
Debbie Berkowitz : And sadly, in many plants. The basic CDC recommendations, such as for keeping individual six feet apart are still not being followed.
Debbie Berkowitz : That it is still spreading and the plants approaching planning California WAS JUST SHUT DOWN THIS WEEK EVER THE PUBLIC learned that eight workers had died in the plant and over 300 tested positive
Debbie Berkowitz : Unlike other industries such as automotive that have huge assembly lines, who developed a safe and science based strategy for we opening
Debbie Berkowitz : And work with their unions and work with their workers that included masks social distancing our production lines and in breakout rooms and other measures the media industry was not prepared for this pandemic.
Debbie Berkowitz : Or was it willing to rearrange its plans to keep workers and their community safe.
Debbie Berkowitz : The meeting industries failure protect workers was aided and abetted by this administration's failure to issue any requirements for employers to implement to protect workers OSHA, the agency that is totally failed decided not to protect workers.
Debbie Berkowitz : It's a stunning, stunning decision when the spread of this disease could have been mitigated. If the industry had been required to implement the basic CDC guidance of mass
Debbie Berkowitz : social distancing improve ventilation and stepped up sanitation and handwashing
Debbie Berkowitz : That's the diseases spread through the plants and into their communities, their plants were 1000 of 2800 workers got sick and they're still getting sick and many have died.
Debbie Berkowitz : The meat industry is disproportionately workers of color black, brown and refugee workers these communities, as you heard earlier also face a disproportional impact.
Debbie Berkowitz : Of the serious illness and death related to covert 19 stemming from structural racism over generations related to access to health care.
Debbie Berkowitz : That's in conclusion, it is very important that these critical infrastructure workers who've been sacrificing their health and their allies while we all get to be socially distant be prioritized for the vaccine.
Debbie Berkowitz : But this should not relieve the meat industry norm relieve the federal government from their responsibility to protect workers and mitigate the spread of the seven deadly disease. I just want to thank you for your time.
William Foege  : Thank you very much. It's another example, a tragic example of people that don't actually have power to work at home or to not work. And so they're putting this situation before. So thanks for reminding us of that then
Benjamin Kahn : Next we have Gary Ludwig from the International Association of fire chiefs.
Gary Ludwig: Good afternoon. My name is chief Gary Ludwig. I'm honored to serve as the immediate past president of the International Association of fire chiefs.
Gary Ludwig: The IFC represents the leadership of 1.2 million firefighters and EMS personnel in the United States.
Gary Ludwig: I want to thank you for this opportunity speak today about the importance of prioritizing firefighters and EMS personnel.
Gary Ludwig: With respect to the coven 19 vaccination program the IFC strongly supports the National Academies recommendation to include all firefighters and EMS personnel.
Gary Ludwig: In phase one at the eventual coven 19 vaccine vaccination, or I'm sorry vaccine distribution program and we thank you for that recommendation.
Gary Ludwig: Firefighters and paramedics are healthcare workers and are part of the healthcare delivery system in this calls or the vast majority of what we go on every day.
Gary Ludwig: We are the warriors at the tip of the spear. When you see all the outstanding work being done in the hospitals for Kovac 19 patients by doctors, nurses, and others.
Gary Ludwig: Please do not forget how those patients got there, the vast majority were transported there by ambulance.
Gary Ludwig: The fire service is the largest provider of emergency medical services, the United States transporting some 30 million patient is last year.
Gary Ludwig: Unfortunately, as of today, we have documented 79 firefighters and EMS personnel with die from directly contracting coronavirus a result of being infected on duty.
Gary Ludwig: Additionally over 10,000 firefighters have been infected minute these patient interactions do not occur in a sterile environment, but are in the patient's home or on the street.
Gary Ludwig: This increases the likelihood of infection and exposure exposure.
Gary Ludwig: Ms personnel provide hands on patient care and routinely treat both low acuity medical emergencies, as well as provide advanced life support services such as innovation and resuscitation.
Gary Ludwig: Even non MS train firefighters are normally trained in CPR and close physical contact with members of the public.
Gary Ludwig: When providing CPR rescuing them from car accidents or interacting on fire scenes the IFC urges the National Academies.
Gary Ludwig: National Academies to maintain the placement ball firefighters and EMS personnel in priority group one day for receiving the coven 19 vaccine.
Gary Ludwig: As we face increases the number of covert 19 patients and the continued hurricane and wildland fires, we've been seeing, we must protect our first responders.
Gary Ludwig: The National Academy should urge the federal government requires states to adhere to federal prioritization schedules.
Gary Ludwig: Firefighters and EMS personnel routinely cross state lines as part of the mutual aid responses.
Gary Ludwig: This is especially true for responses to major disasters such as the ongoing wildland fires in California and the recent response to the hurricane Laura than in Louisiana.
Gary Ludwig: Prioritizing first responders in one state and not another will lead to confusion and uncertainty regarding the risk faced by firefighters and EMS personnel.
Gary Ludwig: Lastly, the National Academy should consider the role that firefighters and EMS personnel can play in administering the code 19 vaccine to the public.
Gary Ludwig: fire stations and fire, EMS personnel are already being used as strategically located sites for Cobra 19 testing in many communities.
Gary Ludwig: Fire Departments are also providing code 19 testing for some nursing home residents and staff members.
Gary Ludwig: These medically trained and equipped personnel could assist in vaccine administration and in some fire stations or even drive through capable
Gary Ludwig: The IFC applauds the National Academies for their difficult work in developing the strategy in closing the IFC is ready and willing to assist the national academies in any way possible. Thank you again for this opportunity.
William Foege  : Thank you very much. As a former firefighter myself. This was one of the easier decisions, then
Benjamin Kahn : Next up we have Scott tomorrow from the National Education Association, and the Ohio Education Association,
Scott DiMauro : Good afternoon. My name is Scott tomorrow. My high school social studies teacher from Columbus, Ohio and president of the Ohio Education Association,
Scott DiMauro : I'm speaking today on behalf of the National Education Association, the nation's largest professional employer organization committing to advancing the cause of public education.
Scott DiMauro : Any as 3 million members work with students at every level of education from preschool to university graduate programs NEA has affiliate organizations in every state and in more than 14,000 communities across the United States.
Scott DiMauro : The NEA appreciates the work of this committee to develop this framework for vaccine allocation to assist policymakers and planning for equitable allocation of vaccines against SARS Toby to
Scott DiMauro : Get a welcomes this opportunity to present several comments today and will submit expanded written comments by Friday.
Scott DiMauro : I would like to begin by noting that the NEA believes that vaccines are essential medical tools and preventing and infectious diseases.
Scott DiMauro : Vaccines must be pervasive to be effective, we believe that vaccination guidelines from the American Academy of Pediatrics.
Scott DiMauro : And Centers for Disease Control and Prevention should be followed by educators parents and guardians and students state legislators should establish clear guidelines for waivers that minimize the number of unvaccinated individuals to those necessary due to documented medical conditions.
Scott DiMauro : With respect to the discussion drafted the preliminary framework or equitable allocation of a coven 19 vaccine.
Scott DiMauro : We strongly support the broadest description of school staff, which includes more classroom teachers para educators and other education support professionals specialized instructional support personnel librarians administrators and higher education faculty and staff.
Scott DiMauro : All staff who returned to work and education, work sites including schools and campuses are at higher risk of covert 19 infection and must be protected from the virus with non pharmaceutical interventions before the vaccine has failed.
Scott DiMauro : We agree wholeheartedly that it is important to include teachers and other school staff relatively early to facilitate the reopening of schools and protect the most high risk adults.
Scott DiMauro : We respectfully encourage you to broaden this crucial target by explicitly including faculty and all other employees of institutions of higher education.
Scott DiMauro : Indeed, is the discussion draft notes. Many professors and other university employees are older or have underlying health conditions.
Scott DiMauro : We further urge you do it to include all education employees and Phase one be in recognition of the crucial role these institutions play and the underlying vulnerabilities of many of the employees who work in them.
Scott DiMauro : We strongly agree with the draft report statement, the draft report statement that exposures in school settings is very difficult to control, especially when providing care or education to young children.
Scott DiMauro : We also support the draft conclusion that school staff who are at higher risk because of age crowded conditions inside facilities and other factors should be vaccinated in phase one be as noted above, we urge that all education employees be vaccinated in this face.
Scott DiMauro : We strongly support the continuation of these non pharmaceutical interventions after vaccination of staff and students until there is clear scientific evidence that schools are no longer a source of virus transmission
Scott DiMauro : Nothing is more important than ensuring that we return to safe and equitable in person instruction and the work, represented by the discussion draft is an important step in that direction.
Scott DiMauro : It is crucial for any vaccination plan to incorporate the voices of frontline workers, including educators and we thank you for giving us the opportunity to speak with you today. Thank you very much.
William Foege  : Thank you. And you remind me that vaccines will not be a substitute for other public health measures and we have to
William Foege  : Keep saying that
William Foege  : You also remind me why this is a living document because we keep learning new things about what happens in schools. So thank you.
Benjamin Kahn : Next up we have Alexis killed from farmer for justice.
Alexis Guild : Good afternoon and thank you for the opportunity to participate in this listening session. My name is Alexis Guild and I'm the Director of Health Policy and programs are from Lucca justice.
Alexis Guild : farmworker justice is a national advocacy organization that aims to empower farm workers and their families to improve their living and working conditions.
Alexis Guild : immigrations that is health occupational safety and access to justice. We work with farmworker community based organizations migrant health centers.
Alexis Guild : Labor unions legal services providers and local, state, and national organizations from Accra justice has a long history of working with farm workers to improve their health and access to health care.
Alexis Guild : Farm workers are critical to our nation's economy and food supply as essential workers there at the front lines of the Copa 19 pandemic.
Alexis Guild : They're risking their own health and safety to continue to work to support their families and to ensure the continuity in the nation supply of fruits and vegetables.
Alexis Guild : They're working and living conditions make them especially vulnerable to coven 19 in the field orchards dairy firms to produce packing houses.
Alexis Guild : From workers, most often work close to each other. They often have limited access to hand washing stations in the fields and many farmworkers share transportation to and from the fields.
Alexis Guild : Due to their low wages, they tend to live in crowded shared housing either provided by their employer or in their communities.
Alexis Guild : It is difficult for foreign workers to protect themselves against coven in part because many employers have not put in place protections that would reduce transmission
Alexis Guild : The failure of the federal government and most states to enact mandatory safety standards to adjust the pandemic.
Alexis Guild : Means that many agricultural employers do not take recommended actions issued by CDC and other public health experts. As a result, many farm workers are tested positive for
Alexis Guild : Across the country, and a number of farm workers have died from workers face numerous barriers to healthcare access and these barriers have been magnified by the Copa 19 pandemic.
Alexis Guild : The majority of farm workers like health insurance and access to regular medical care.
Alexis Guild : Due to the geographic isolation and lack the public transportation many farm workers face difficulty sick medical appointments generally
Alexis Guild : farmworkers do not have access to paid sick leave and are unable to take time off work to seek medical care.
Alexis Guild : working long hours, six or seven days per week is common fear and misinformation are rampant.
Alexis Guild : farmworkers are not necessarily receiving accurate information about Kobe and many are unaware of their access to paid sick leave. I did the families first coronavirus response act.
Alexis Guild : Due to stigma or fear of employer retaliation workers may be elected to get tested for coven or report if they have symptoms or been in close contact with someone who is coordinating positive
Alexis Guild : We appreciate and support the National Academies designation of critical risk workers, such as foreign workers as a priority for covert vaccine allocation.
Alexis Guild : Farm Workers substantially higher risk of COPD exposure due to working and living conditions that are often beyond their control.
Alexis Guild : But prioritizing farmworkers for vaccine allocation is only the first step to ensure access to a coven vaccine.
Alexis Guild : A comprehensive and innovative backstage strategy must be developed that it just as a social determinants of health and response to the unique needs of farmworker communities.
Alexis Guild : We encourage collaboration with community based organizations and the development and implementation of a vaccine strategy for farm workers.
Alexis Guild : Their expertise is crucial to ensure widespread allocation and adoption of a vaccine by phone with her communities community based organizations are trusted sources of information.
Alexis Guild : And have reaches into the community that the health care system such as hospitals and health departments may not have
Alexis Guild : Especially for farm workers who live in the more rural areas and therefore more isolated from Community resources.
Alexis Guild : Employers should be encouraged to provide farm workers with accurate information to engage with their employees and farmworker organizations to reduce exposure and respond to cope in 19
Alexis Guild : And to help ensure equitable access to vaccines. It's also important.
Alexis Guild : That the CDC provide vaccine information and formats that are widely accessible for all literacy levels and languages that are spoken by farmworker communities. This does not only includes Spanish
Alexis Guild : But also indigenous languages from central and southern Mexico and Guatemala from recruit justice is happy to be helpful to show the effectiveness of vaccination programs and agricultural communities and workplaces.
Alexis Guild : Keeping from workers healthy should be a national priority farmworkers should have comprehensive and equitable access to a coven 19 vaccine and achieving that goal will take special efforts due to the challenges faced by farm workers, their families and their communities. Thank you.
William Foege  : Thank you for your advocacy group that is often marginalized. I appreciate that and
Benjamin Kahn : Next we have pure maths for the food industry association.
Peter Matz : Thank you. Good afternoon. My name is Peter maths and I'm here representing FM I the food industry association, where I lead our food and health policy efforts.
Peter Matz : First and foremost, I want to thank the committee and also the National Academies project staff for all of the hard work that's being put into developing a framework for coven
Peter Matz : Vaccine allocation this in distribution from watching your virtual deliberations today two things became abundantly clear very quickly.
Peter Matz : First, the challenge of rapid vaccine development testing and approval is matched by the challenge of expedited distribution allocation and prioritization of populations and individuals and second
Peter Matz : The federal government clearly found the right group to take on this unprecedented challenge or perhaps it was the National Academies. But regardless, please no FM I appreciate all of your time and hard work.
Peter Matz : By way of background is the national food industry trade association FEMA works with and on behalf of the entire industry.
Peter Matz : From retailers who sell the consumers to producers who supply the food as well as the variety of related critical services including supermarket pharmacies, which is also a big part of what we do.
Peter Matz : To advance a safer and more efficient consumer supply chain for both food and pharmaceuticals in total FM nine member companies operate roughly 33,000 grocery stores and 12,000 pharmacies.
Peter Matz : Ultimately touching the lives of more than 100 million US households per week and representing an industry with nearly 6 million employees.
Peter Matz : Having said that, FM, I appreciate the opportunity to share insight from our members and offer feedback for your consideration is this process continues.
Peter Matz : First, as you know, the federal government designated the food and agriculture sector as part of the nation's critical infrastructure to keep the food supply chain running and Americans nourished during the ongoing health crisis.
Peter Matz : Your draft police preliminary framework which is extremely thoughtful and impressive.
Peter Matz : lays out a for phase plan for vaccine prioritization where food and agriculture central workers are prioritized in phase two, after front.
Peter Matz : After frontline healthcare personnel first responders and certain high risk individuals.
Peter Matz : Thank you very much for recognizing the importance of prioritizing food and agriculture industry essential workers in order to protect
Peter Matz : The food supply prioritizing vaccinations for these workers will help keep supply chains operating
Peter Matz : While those designated to receive the vaccine later continue to observe safety and distancing measures in their communities. However,
Peter Matz : Pharmacist and pharmacy staff are also grouped into phase two, which we see as concern.
Peter Matz : Given the success to date of pharmacists administering vaccines serving as knowledgeable and accessible immunization providers within their communities and collaborating with public health and other providers.
Peter Matz : We feel a successful vaccination plan should actively involve pharmacists.
Peter Matz : Many studies show the importance of pharmacies and pharmacists in the deployment of vaccines and treatments and even see the CDC researchers found that
Peter Matz : 80% of the nation can be vaccinated seven weeks sooner. When pharmacies are included in the vaccination deployment model.
Peter Matz : It's important to remember that 90% of Americans live within five miles of a pharmacy.
Peter Matz : So again, we think it's critically important to empower pharmacists to be part of the coven vaccine solution. And therefore, we believe, pharmacists should be given priority one prayer.
Peter Matz : Phase one priority. Excuse me. Additionally, given how well positioned pharmacists are are to expand coven vaccinations, the federal government should issue guidance authorizing pharmacists.
Peter Matz : To order and administer Cobra vaccines, the people of all ages, just as it authorized pharmacists to order and administer Cobra tests.
Peter Matz : Although pharmacies are authorized to provide adult vaccines and all 50 states for flu and pneumonia and shingles, to name a few.
Peter Matz : There are some limiting state restrictions that still exist which could prevent pharmacists from immediately providing a covert vaccine to all patients.
Peter Matz : So again, with 90% of the US population living within five miles of a pharmacy and pharmacies already reaching underserved and vulnerable communities, sometimes as the only
Peter Matz : Local provider of care pharmacy based vaccinations means reaching more citizens in neighborhoods nationwide, including communities disproportionately impacted by the virus. So this pharmacist after authorization is extremely important.
Peter Matz : I apologize if you can hear the baby in the background, I promise. It's not a hostage.
Peter Matz : I'll be quick to finish. It's also really important that your final framework takes into account associated equipment needs and supply services.
Peter Matz : We really appreciate the amount of attention cold chain storage has gotten as my members agree that could be a significant challenge.
Peter Matz : However, especially following with likely to be a bad flu season our members are also concerned about the potential
Peter Matz : For shortages of ancillary materials needed to provide any immunizations, including hypodermic needles syringes disinfected disinfecting wipes glass vials stoppers and pee pee, especially gloves.
Peter Matz : With that, again, FM I thanks the ad hoc committee in the National Academies for the opportunity to provide input on this critically critically important initiative.
Peter Matz : And if you have questions about these comments over like additional information from FEMA members, we're always happy to be a resource. Thank you. Thank you. Thank you. And now to get to the hostage.
Peter Matz : Sorry about that.
William Foege  : Thank you and
William Foege  : Thanks for bringing up the need for other equipment and supplies, because if these first vaccines really require minus 70 degrees centigrade. That's going to put a burden on the delivery system and for your first comments. Never underestimate the power of people addicted to food.
William Foege  : Then
Benjamin Kahn : Next we have Rebecca Rhino from the American Federation of Labor, and Congress of Industrial Organizations.
Rebecca Reindel : Hi, good afternoon, everyone, and thank you for organizing this forum for releasing the draft framework and for having a special panel on occupational risk.
Rebecca Reindel : I'm this Rebecca Randell I'm the safety and health director at the AFL CIO
Rebecca Reindel : We represent 55 national and international unions labor unions who represent 12 and a half million workers and pretty much every major industry across the country. I work on many workplace safety and health issues and hazards.
Rebecca Reindel : But this one is clearly unique of, you know, one the workplace exposures are so high and to that this part of the virus between workplaces and communities are so interconnected.
Rebecca Reindel : We already know. And we've seen evidence that reducing the spread in the workplace is a major contributor to reducing
Rebecca Reindel : Community spread of the virus. And we know that in locations where communities part of the virus has high workers are a greater, greater risk of catching the virus in our workplace. We urge caution.
Rebecca Reindel : Against using theoretical public health models and limit ourselves only two exposures scenario models of the past and past viruses that do not take into account current data that we have.
Rebecca Reindel : Current coven data 19 data point two major workplace exposures and outbreaks and we're happy to follow up with the committee and provide some more data sources to the committee if that's helpful. I have five main points about the framework for now.
Rebecca Reindel : One is we urge the community to focus on exposure scenarios, not just on job classification set put people at the most immediate and greatest risk.
Rebecca Reindel : The pandemic this pandemic is ravaged the country for six months and so many major outbreaks are being in workplaces that have key exposure factors in common, working with these are working with confirmed suspected
Rebecca Reindel : People with confirmed or suspected
Rebecca Reindel : Working close to those who are unknown unknown status working close together working indoors and with poor ventilation working in these scenarios for a long durations.
Rebecca Reindel : Lack of effective workplace protections, which are widespread right now, including engineering controls administrative controls pee pee real respiratory protection, lack of real workplace standards.
Rebecca Reindel : Movement them to focus on actual high risk workers and scenarios, essentially, which could be dependent on their job tasks.
Rebecca Reindel : We urge second we are as a committee to look and work with states and localities who have been specifically collecting workplace exposure and honest data and use these and major outbreaks.
Rebecca Reindel : That have been in the news and and through other investigations as a model for high risk industries and health disparity issues.
Rebecca Reindel : That exist with workplace exposures three, we urge the committee to recognize the complexity of the power dynamic in the workplace between employers and employees and existing workplace policies and agreements, these are complex settings when it comes to addressing health protections
Rebecca Reindel : And labor knows that, because we've been doing it for a long time.
Rebecca Reindel : And in addition, in addition to the ethical challenges described and mentioned already here today, based on the lessons from the past or key additional challenges to consider.
Rebecca Reindel : Not just in the distrust of the vaccine. But there's a need to consider the additional attention this time that has been brought to the rush
Rebecca Reindel : And the pushing of various vaccines and development before they have gone through required testing and approval and tying this with the need for ensuring safety or efficacy specificity of the vaccines before they're allocated.
Rebecca Reindel : And that high risk workers, do you want to be prioritized, but they also do not want to be test subjects for
Rebecca Reindel : Given all the above there needs to be dedicated input and involvement in the decision making recommendations requirements from workers and their representatives.
Rebecca Reindel : Using this time now to connect and engage with the unions and these other groups at the national and local levels.
Rebecca Reindel : At the national level, even where workers aren't represented unions do know these industries.
Rebecca Reindel : If you know in different localities, and in states where the distribution will occur there will be different priorities for different states and working through those worker groups estates are critical. And lastly, number five.
Rebecca Reindel : Allocation must be done in coordination with vigilant real time monitoring about breaks and heightened Russ.
Rebecca Reindel : With clear coordination and organization with access to medical follow up, especially for some of the more vulnerable working populations that are rightly targeted in the framework.
Rebecca Reindel : We heard the need for unified messaging, but there needs to be targeted messaging as well.
Rebecca Reindel : And for now, we should be educating people about the importance of the vaccinations encouraging them to get vaccination if and when it says safe and effective.
Rebecca Reindel : Is available a vaccine is available and the vaccine structure to protect workers must be accompanied with a broader frame of strong workplace protections
Rebecca Reindel : We're happy to work with the committee going forward on sources of information connecting with worker representative representation and anything else that you need. Thank you so much for your time today.
William Foege  : Thank you. And thanks for your offer because unions can be very useful as being a trusted source for the workers on what they should be doing and
Benjamin Kahn : Next up we have Miley Trevino sauceda from Alianza and I feel now that the competition.
Miley Trevino-Sauceda  : Good afternoon. This is merely revenue. So say that. And I want to thank you for allowing me to present in front of the National Academies on
Miley Trevino-Sauceda  : The committee that I'm in front of for the public listening sessions on the equitable allocation of
Miley Trevino-Sauceda  : I represent the answer is another company in us and by representing the answer we have 15 organizations in 11 different states.
Miley Trevino-Sauceda  : Here in the United States. And that means that we're representing more than 700,000 farmers are women and their families.
Miley Trevino-Sauceda  : And my statement here is that during the first half of 2020 our communities faced on precedent and social and economic distress.
Miley Trevino-Sauceda  : Essential farm and food system workers historically underserved tribal and beginning farmer family farmers and ranchers in rural and immigrant communities of color are especially vulnerable to the gaps in support from the congressionally provided relief programs to date.
Miley Trevino-Sauceda  : That coronavirus pandemic has exposed the vulnerabilities of our rural and Eric cultural communities and systemic inequities leading to the
Miley Trevino-Sauceda  : Accessibility Resources for immigrants farmers and small scale farmers, it is imperative that these most vulnerable frontline communities are included in vaccine efforts as soon as the vaccine is made available.
Miley Trevino-Sauceda  : 10s of thousands of farm and food system workers had been exposed to cobra 19 including over 4500 reported positive covert cases nationwide among agricultural workers and their families.
Miley Trevino-Sauceda  : Over 16,000 reported Kobe cases in 239 meat and poultry processing facilities thousands of documented.
Miley Trevino-Sauceda  : Cases in or near farm labor communities, including over 1000 positive cases in the farm labor community on the mockingly Florida.
Miley Trevino-Sauceda  : Due to the lack of employer protection in the in the workplace low wage high rents and substandard and Clark crowded living conditions for farmers.
Miley Trevino-Sauceda  : And other workers in rural agricultural areas least equipped to respond to this deadly epidemic.
Miley Trevino-Sauceda  : Have been disproportionately affected by the virus. According to the National Center for farm worker health as of August 31 98% of rural counties and America have reported
Miley Trevino-Sauceda  : Positive code cases and 70% had reported one or more deaths, more than 650 5000 rural residents have tested positive for covert 19 and 15,000 or 47 deaths among
Miley Trevino-Sauceda  : Americans have been attributed to the to the disease. Many farm and food chain workers lack access to health care or fear accessing medical services concerns, particularly hot Payton among undocumented workers and
Miley Trevino-Sauceda  : who comprise about half of the country's crop farm worker labor force and are subject to immigration enforcement these gaps become all the more
Miley Trevino-Sauceda  : Pronounced along gender lines as immigrant women of color and pregnant people increasingly comprise to the spike of covert positive cases. Therefore, it is important.
Miley Trevino-Sauceda  : To have vaccines made publicly available in a way that will reach workers and their families. That means is it is critical that is
Miley Trevino-Sauceda  : That in making vaccine distribution plans the organizations representing these frontline workers be integrally involved in making the plants, I request my full statement be accepted to the record again on behalf
Miley Trevino-Sauceda  : Of a young sadness. Another Campinas I do want to say is my conclusion part that farmworkers even though we're called
Miley Trevino-Sauceda  : Essential workers. We have never been treated as essential workers, just to be on the record.
Miley Trevino-Sauceda  : We're not even part of the Fair Labor Standards Act, it's, it's very clear since 1938 we're in your 2020 and we're not we're not there yet. AND WE WILL BE BE BE VERY HAPPY TO BE A resource representing role and farmworker communities. Thank you very much.
William Foege  : Thank you very much in you.
William Foege  : Remind me of what I said at the beginning that this pandemic has really disclose the fault lines in our society. So thank you.
Miley Trevino-Sauceda  : Ben. Thank you.
Benjamin Kahn : And in this session we have Randi Weingarten from the American Federation of Teachers
Randi Weingarten : Thank you. Thank you, David. So my name is Randi Weingarten I'm honored to be here in my normal life. I am the president of the American Federation of Teachers
Randi Weingarten : Who would have loved to be at lots of school openings said this week, but because of the pandemic. We are not we represent 1.7 million people who work in Pre K
Randi Weingarten : Through 12 education, higher education, healthcare and public service and to we thank you for this opportunity to provide commentary on the draft preliminary framework.
Randi Weingarten : Since the end of January. Our Union has been supporting our members through their struggle to balance serving those who rely on our work.
Randi Weingarten : With the safety of ourselves and our families, our members have lived and learn so much in the past few months, as I'm sure all of you have
Randi Weingarten : So number one, let me say we applaud the committee for crafting a vaccine allocation framework built on principles that include transparency fairness evidence equal regard and mitigation of health equities. We know the initial production of vaccine is likely to be insufficient.
Randi Weingarten : In quantity to permit every person to be vaccinated. So it is really important what you've done.
Randi Weingarten : There's a lot of fear and confusion right now in the current political environment and people need a process that they can understand and trust.
Randi Weingarten : Allocation of vaccine must be conducted in a manner that is fair, transparent protects those most at risk and take
Randi Weingarten : Those principles of equity into account. So if I haven't said thank you enough. I am saying it again and again. Number two.
Randi Weingarten : If our educators and healthcare workers have learned anything this year. It's the importance of comprehensive mitigation strategies in our communities.
Randi Weingarten : We all want to reopen our economy and find a new normal. And I am encouraged by the multiple references in the framework to the need for a comprehensive strategy.
Randi Weingarten : Even after a vaccine and have an quote and effective vaccine is available, the committee sensibly acknowledged the need for preventative policies and equipment.
Randi Weingarten : The end. The importance of P P for expose workers too many people have been lost because of supply chain gaps.
Randi Weingarten : Inconsistent federal guidance, lack of planning and lack of enforcement by OSHA, the importance VAX of vaccination is one piece, but it's only one piece in overall strategy number three.
Randi Weingarten : The committee has clearly given a great deal of thought to the criteria for allocation our members and healthcare correction and education have seen that frequent and sometimes unmitigated exposure Copa
Randi Weingarten : Can be deadly. We have, by the way, 200,000 members in healthcare and over 50,000 members in corrections. I've had too many conversations with too many AMT families after a member has died after contract in the virus at work.
Randi Weingarten : In every strategy discussion and every news interview and in reviewing this framework I carry those devastating moments with me as you hear from my voice.
Randi Weingarten : It's clear that great time and attention was given by you to ensure a fair, equitable and evidence based outline for how this precious quantity limited resource might be doled out when the first dose is becoming available, I implore you to
Randi Weingarten : reconsider placement of educators and school staff in this phase two, since we are going and being the first real wave in
Randi Weingarten : In buildings and in person and inside of everyone in the nation.
Randi Weingarten : As noted in the draft schools are necessary for maintaining core societal functions. And while it is true that schools can three up theoretically open remotely and many are
Randi Weingarten : In person instruction much forcibly is happening in communities right now, you've noticed that we have tried to renegotiate and negotiate this in different places.
Randi Weingarten : But there are many, too many places like in Florida and Texas and Mississippi and Arizona where you see this kind of forcible in school. And where you see people getting sick.
Randi Weingarten : I just was off the phone with people in New York State where we are still fighting in over 200 districts to get a mask requirement.
Randi Weingarten : We have, for example, 25% of educators in high risk categories. We know that there is a higher number of kids who are being hospitalized from coven
Randi Weingarten : I can say go on and on and on, but schools are reality that could potentially be super spreaders and we really need to make sure we don't pit learning versus living and we
Randi Weingarten : Are asking you to reconsider putting us or putting education in phase two.
Randi Weingarten : Schools are reopening in some areas are reopening in a way that may not be safe. You see, today we are all across the country, demanding safe schools.
Randi Weingarten : We and the NEA and others will continue to do this over and over and over again. So please, I know that schools are in phase two.
Randi Weingarten : I am asking you to see if you can reconsider the allocation to Phase one and I again thank you thank you thank you for your time and for your focus on all of these issues. Thank you.
William Foege  : Thank you for your thank yous and
William Foege  : We're going to take another break there a couple of things. I'll say first that so many of you have emphasized listen to the grassroots and we're going to take that seriously.
William Foege  : Some of you have emphasized, there is a system in place, use it. And that makes a solid sense. And for those of you who are concerned, these will be recommendations.
William Foege  : But the real decisions are going to be made at CDC at the state level, the county level the Native American level, the city level.
William Foege  : They're the ones that are going to modify these depending on the local conditions. So you can be reassured.
William Foege  : That we're not making recommendations at the periphery that people have to follow. They have to follow the recommendations and then modify them for their own conditions. Okay, we are going to take a break and
William Foege  : This group has been so discipline. Let's return it at 434 and 40 seconds. Thank you.
Can you hear me.
Yes. Okay.
Helene Gayle   : Welcome back.
Helene Gayle   : And we will now move to our six panel and our panel will be talking providing public comment on special populations and we look forward to hearing from this panel.
Benjamin Kahn : First off, we have, how am Anderson for school house collection.
Alleanne Anderson : Good afternoon, everyone. My name is eliana Anderson and I'm very happy to be speaking on behalf of
Alleanne Anderson : Connection and national nonprofit organization with the mission of overcoming homelessness through education.
Alleanne Anderson : But I would like to bring attention to you all as subsets of homeless families and youth, particularly those who classify as for Miss under the McKinney Vento education definition of homelessness.
Alleanne Anderson : Or those who like a fixed regular and adequate nighttime residence. So this includes persons who are sharing housing with others due to a loss of housing or some economic hardship. This is our population which is historically grossly under counted when taking totality of
Alleanne Anderson : Persons experiencing homelessness, according to a federal report that was published by the National Center for homeless education.
Alleanne Anderson : While 7% of homeless youth experienced on Shelter homelessness 74% of students who are experiencing homelessness were found to be living in
Alleanne Anderson : congregate settings such as like temporarily staying with other persons these situations are often crowded.
Alleanne Anderson : Unstable and do not provide opportunity for persons to safely and effectively. So quarantine.
Alleanne Anderson : They're very precarious and volatiles, so this also leaves this population to be very mobile
Alleanne Anderson : The fact in a recent congressional briefing that was co hosted by schoolhouse connection we heard directly from a parent tool has been experiencing this exact situation.
Alleanne Anderson : during the pandemic, and I quote from her I'm staying in someone else's house. He's afraid of coven 19 which is difficult.
Alleanne Anderson : Me and my kids are sleeping on the floor and my kids are tired of sleeping on the floor and also I did get I had to quarantine for 14 days in somebody else's house that was very difficult.
Alleanne Anderson : They gave me until the end of July, and then I have to go and I respect that. Some people, they don't want to catch movie nights.
Alleanne Anderson : They are afraid because I still have my part time job and I work in a grocery store people at the grocery store and at my job but Amazon have been catching coven
Alleanne Anderson : So every day I worry about catching it and bringing me back home to the bringing it back to the home and I also don't want to bring it back home to my kids.
Alleanne Anderson : This particular quote not only highlight supplies and threaten health and well being, that his face by persons who
Alleanne Anderson : Do find themselves temporarily staying in the homes of others, but also the fact that
Alleanne Anderson : These persons often are the same people who have been working in jobs that have been deemed essential since the onset of the pandemic putting
Alleanne Anderson : Them and those are wrong. That might heightened risk of infection and transmission of covert 19 including this population amongst those who receive or the application of the coven 19 vaccine is necessary to reduce the numbers of those
Alleanne Anderson : infected by the virus you to the potential dangers that such congregates settings full is on blood being of those input inside and outside of the household, including at their jobs are the mechanics. So
Alleanne Anderson : The McKinney Vento education for homeless children and youth program and the Head Start program both professor teaching means by which these populations can be reached.
Alleanne Anderson : And receive services you can receive services through these programs wanting is distributed to meet the early learning
Alleanne Anderson : Health family support and nutritional needs of homeless children and youth who have not otherwise be able to receive benefit from such services. We think this person's where they are, is the best way to eventually stabilize them and also reduce
Alleanne Anderson : Community spread it through these programs numbers by phone numbers and information on homeless children and youth are tracked which make it easier for these persons to receive vaccines. Should they be
Alleanne Anderson : chosen as one of the populations will be prioritized for the allocation. I hope that you consider adding this population or including them in further discussions of equitable allocation of feet of a covert 19th vaccine and thank you very much for your time.
Helene Gayle   : Thank you. Thank you so much for bringing the stories of the constituents to us. I think it makes a difference to hear real life stories like that. So thank you so much.
Benjamin Kahn : Great have stopped was informed that Gabriella Barbosa from Children's Partnership is no longer able to attend. So we'll move on to Chandra Crawford from the National Alliance to end homelessness.
Chandra Crawford : Hey, thanks.
Chandra Crawford : Okay, so thank you members of the committee for allowing me to speak today on such an important topic. So my name is Shawn Crawford and I'm
Chandra Crawford : The director of individual homeless adults and ah so the National Alliance in homelessness.
Chandra Crawford : And we're nonpartisan nonprofit organization dedicated to preventing in ending homelessness. So first, let me just say a front, I'd really like to applaud the committee for prioritizing people experiencing homelessness.
Chandra Crawford : As part of the discussion draft. And so, as many of you are probably aware that people experiencing homelessness are uniquely at severe risk for contract and Kobe 19 given the prevalence of risk factors and homeless population. So first,
Chandra Crawford : Of course they have higher rates of chronic health needs, including respiratory disease with limited access to can then second,
Chandra Crawford : People experiencing homelessness often find it difficult to comply with public health recommendations, such as physical distancing isolation.
Chandra Crawford : And quarantine because of shelter conditions and other challenges and then let's be clear, you know, we don't even want to
Chandra Crawford : make the assumption that people experiencing homelessness are even able to receive the proper communication about the pandemic. That's a privilege, so
Chandra Crawford : People living outside on a cabinets. They also live in close quarters. Right. So it's just not the shelters. They share utensils and other personal items that can spread Kobe 19
Chandra Crawford : So of course communities across the nation. They've taken measures to provide spaces for people experiencing homelessness, to ensure
Chandra Crawford : social distancing. However, there's still much more work to be done and more resources are needed, given the complex vulnerabilities of this population. So according to the framework, the first phase of access to the vaccine.
Chandra Crawford : This later for people of all ages with comorbidity underlying conditions. So while people experiencing homelessness or explicitly mentioned during Phase two, it is also really important for them to be considered for phase one as well. So for instance,
Chandra Crawford : Cardiovascular disease is a major cause of death among people experiencing homelessness, a variety of a complex set of factors contributes to this disparities, including conditions like diabetes.
Chandra Crawford : So really what I want to say is that this population is well within the parameters defined for phase one and it's not that that isn't obvious. I'm just really bringing forth that distinctions
Chandra Crawford : Since homelessness was specifically mentioned in phase two. I just want to make sure that we're seeing the connection there two and Phase one is the same one.
Chandra Crawford : Some of the older adults who fall under phase one who live in congregate sending so it's more research is becoming available.
Chandra Crawford : About older adults experiencing homelessness. We're learning that this group actually tests to age faster.
Chandra Crawford : than everyone else. So they have been found to experience geriatric conditions, much earlier due to conditions associated with being on house. And so we know that over about 300,000 people over the age of 50 stayed in
Chandra Crawford : homeless shelters representing about 23% of the entire shelter.
Chandra Crawford : Population and even before the current health and economic crisis, the older adult homeless population was projected to trend upwards until 2013
Chandra Crawford : And so even in places like Los Angeles. The 65 plus population is expected to increase by 54% over the next five years. And so, given what's known
Chandra Crawford : About the older population experiencing homelessness, who are in congregate settings and not limited to nursing homes are people being doubled up
Chandra Crawford : The membership most certainly be considered
Chandra Crawford : For phase one and so it is know that I know that every older adult what we consider for face to regardless of whether they're experiencing homelessness, but there are distinct challenges that the place older adults experiencing homelessness.
Chandra Crawford : at greater risk. And lastly,
Chandra Crawford : What I really want to emphasize is that we know the coven pandemic is not affected our communities. The same way in. We touched upon this a lot during this meeting that long standing health and social inequities that put many
Chandra Crawford : racial ethnic minorities at increased risk for covert 19 but I just want you to know that in terms of homelessness. Most minority.
Chandra Crawford : Groups in the US represent a disproportionate share the homeless population. So the most striking this bear. They can be found among black people black people, they make up about 40% of the population.
Chandra Crawford : In terms of people experiencing homelessness, but only 13% of the general populations. And so since minority groups are disproportionate.
Chandra Crawford : We impacted by homelessness and all the other challenges that go along with it and I'm more vulnerable.
Chandra Crawford : To underlying health conditions homeless population is should receive particular consideration so that ratio of equities are not further
Chandra Crawford : Exacerbated. So, in closing, we understand that public health decisions can be difficult. During a crises, especially in light of limited resources assist
Chandra Crawford : However, we encourage you to continue to consider the most vulnerable in our communities and they show that they have access to the code 19 vaccine in an equitable way. Thank you.
Helene Gayle   : Great. Thanks so much. This property and thanks for highlighting some of the intersections between the populations that we have been discussing. So thank you very much for that.
Helene Gayle   : Then
Benjamin Kahn : Actually have Charles lead from the American College of Physicians
Charles Lee, MD: Good afternoon. I'm themselves Lee. I'm a physician and president of the American College of collection on the sessions and I represent them.
Charles Lee, MD: I would like to thank you for this opportunity to hear the voice of conventional physicians who have dedicated their lives to an underserved population. Those are again mates.
Charles Lee, MD: I have been in the field of correctional medicine for 20 years the 10 years I was a prison, Doc. And then the next 10 years of prison auditor. I had visit nearly 200 correctional facilities all over the United States.
Charles Lee, MD: Although I have collaborated with individuals on the American Association of Public Health physicians and the American College of occupation on an Environmental Medicine. I do not represent them or their views.
Charles Lee, MD: There are more than 2 million prisons and correctional facilities. This is both for collection of workers and inmates. They all any very precarious coronavirus situation.
Charles Lee, MD: They live and work in a setting with social distancing access to adequate numbers of masks and hand sanitizers on virtually impossible. They live and work in close quarters were out of necessity. There are times when they come to very close contact with one another.
Charles Lee, MD: And they go home 80 to 90% of inmates are at some time released collection of workers go home daily they'd all be a source of spirit of coronavirus in our community.
Charles Lee, MD: There are segments of our society that have been forgotten why never thought of.
Charles Lee, MD: They are extremely susceptible to come on a virus infection.
Charles Lee, MD: Historically in Miss healthcare has been neglected for years as a result of their socio economic status and living conditions.
Charles Lee, MD: In may sell a far greater incidence of chronic health conditions and comorbidities. And those of us in the free world.
Charles Lee, MD: We all acknowledge the susceptibility of elderly healthcare workers first responders those in nursing homes. Those greater than 65 with
Charles Lee, MD: co-morbidities but we don't always acknowledge that similar susceptibility of our conviction of workers and then mates by June over 42,000 prisoners have been infected with coronavirus that was a rate of five times greater in general population.
Charles Lee, MD: Of the prisoners infected 510 died, which is one and a half times that the general population.
Charles Lee, MD: That's full collection of workers has been shown in the report by the mushroom project of only 18 states, there were 24,000
Charles Lee, MD: Cases that are cone of virus in correctional workers convent 19 cases and US federal and state prisons have five and a half times higher and the depth ways we times higher than the general population, this is according to a study published in JAMA
Charles Lee, MD: Eight of the top 10 coronavirus hotspots in the country or in prisons.
Charles Lee, MD: I was extremely pleased to hear just yesterday that the National Academies of Science, Engineering and medicine considered prisoners as a middle phase two priority.
Charles Lee, MD: Like to suggest that they also consider correctional workers, such as officers medical care providers and others who work inside prisons and bear same risks.
Charles Lee, MD: And I also hope that these often for guidance segments of our society. The collection of workers and the inmates be similarly considered
Charles Lee, MD: As being an A HINT increased risk by the other involved agencies such as HHS CDC operation warp speed and I, ah,
Charles Lee, MD: The Food and Drug Administration and the advisory committee when Immunization Practices when they discuss who's at increased risk for coronavirus
Charles Lee, MD: And that correctional facility workers and inmates must be included, they must remain no more than a phase two and considered a Phase one for effective
Charles Lee, MD: Safe cost effective FDA approved vaccination consideration. Again, thank you for allowing me to speak on behalf of correctional healthcare providers correctional officers another collection of workers and the inmates. Thank you very much.
Helene Gayle   : Thank you very much, Dr. Lee for your incredibly thoughtful comments. Thank you.
Benjamin Kahn : X we have here in Mountain, the migrant clinicians network.
Karen Mountain : Good afternoon. I'm Karen mountain chief executive officer of the migrant clinicians network and I'm with Randi Weingarten when I say thank you. Thank you. Thank you.
Karen Mountain : For the opportunity to express our strong support for prioritizing immigrants and migrant workers and their families.
Karen Mountain : Through enhanced vaccination programs at community health centers and for using community health workers for outreach and education.
Karen Mountain : The migrant clinicians network is a nonprofit organization that creates practical solutions at the intersection of vulnerability migration and health.
Karen Mountain : Since 1984 MCS has addressed the social determinants of health among underserved immigrant communities with an emphasis on workers families and children.
Karen Mountain : Over the last 636 years our organization has grown to serve constituents globally, providing training and technical assistance to the clinical workforce and developing
Karen Mountain : culturally appropriate resources and programming MTN has extensive experience in program design and implementation and evaluation.
Karen Mountain : This experience extends to both childhood and adult vaccination programs in particular vaccine hesitancy for annual influenza and HPV.
Karen Mountain : The clinicians that we serve and support provide safety net primary care and widespread outreach to the most vulnerable through community health centers and other health promoting agencies.
Karen Mountain : Across the US and Puerto Rico, we have engaged with community based participatory educational outreach that serves predominantly black Latinx and African American populations.
Karen Mountain : Who sustained the greatest arm from covert 19, for example, MTN partners with event Tinea day salute programs in the 50 D geographically dispersed Mexican consulate.
Karen Mountain : In the United States to connect low wage high risk mobile working populations with health promotion and care services.
Karen Mountain : Code 19 has made long standing underlying health inequities into front page news as essential workers hit barrier after barrier to save to get safe and to get the care they need much of MC ends work in 2020 has been pivoting toward protecting these populations from
Karen Mountain : And reducing the health inequities that the virus has really amplified.
Karen Mountain : Other pathogens, besides SARS, Coby to can cause fevers breathing difficulty scoffs coughs a myriad of symptoms which can be difficult to diagnose
Karen Mountain : And these pathogens have significant impact on populations that are already experienced experiencing disparate
Karen Mountain : burdens of chronic diseases MCS recommends and enhanced coordinated vaccination program fluence for influenza and ammonia this fall proceeding, the development
Karen Mountain : Of an effective vaccine for SARS co V2. This can minimize risk against mortality from influencer and pneumococcal pneumonia.
Karen Mountain : Additionally, MTN is focused on creating and bolstering the networks that mobilize within these communities when a proven set safe and effective Coby
Karen Mountain : coven 19 vaccination becomes available. Our approach will build trust and develop networks of communication and partnerships, which are designed to reach the most vulnerable.
Karen Mountain : The rollout of an coven 19 vaccine comes with lots of concerns generally the most vulnerable populations who would best benefit from a functional vaccine are also the populations.
Karen Mountain : That have been grossly mistreated historically during vaccine trials and forced into medical procedures without their consent, we must recognize and address this tragic racist past
Karen Mountain : If we are adequately to prepare the way for vaccine acceptance, we must continue our concerted efforts on outreach, but that won't be enough.
Karen Mountain : Because we also have to address the lack of health literacy confront the spread of health information online.
Karen Mountain : And recognize how social factors influence health and begin to really address those. We must meaningfully re evaluate and rebuild the social and healthcare structures.
Karen Mountain : That negatively impact the health and well being of patients. And finally, and critically health equity must be a national priority. Thank you again for the fabulous work that you're doing.
Karen Mountain : And as we at MC and stand ready to be a part of whatever you would need from us. Thank you.
Helene Gayle   : Great, thank you so much for your very comprehensive
Helene Gayle   : Comments, you touched on a lot of points that are important to this me. So thank you.
Benjamin Kahn : Next up we have only offer on me or call me from the University of Michigan.
Oluwaferanmi Okanlami : Good afternoon. Thank you for this opportunity.
Oluwaferanmi Okanlami : Since many of my colleagues have already and will continue to advocate for the special needs and specific needs of certain marginalized and vulnerable groups.
Oluwaferanmi Okanlami : urging you to consider the order in which the vaccine reaches specific communities. I will spend my time talking about and speaking more conceptually in order to make a few points one
Oluwaferanmi Okanlami : Valid and proven methods to prove safety will be paramount in this process, while we all want a vaccine as soon as safely possible
Oluwaferanmi Okanlami : If there is a belief that an expedited process means that shortcuts were taken many communities will be wary of the vaccine which could adversely impact the rate at which these communities get vaccinated
Oluwaferanmi Okanlami : I don't imagine that I need to remind this group of the Tuskegee study carried out by the National Health Service, which was held the known diagnosis and treatment of syphilis and the African American men that were enrolled in the study.
Oluwaferanmi Okanlami : This is cited by some as contributing to the reasons why some African Americans are still wary of enrolling and richer studies or of seeking preventive care.
Oluwaferanmi Okanlami : Next, as you continue to discuss who should get it and in what order, I would like to caution you to consider the way we speak about an individual's risk and how that plays into their priority.
Oluwaferanmi Okanlami : Members of the disabled community already fear that healthcare resources have been rationed in favor of others with lives worth saving.
Oluwaferanmi Okanlami : In light of that last point I want to applaud what has already been an attempt to engage in a clear and effective communication strategy about what is going to be done and why
Oluwaferanmi Okanlami : However, in order for communication to be effective. It must be accessible to win inclusive of all
Oluwaferanmi Okanlami : While I was delighted to have this opportunity to speak today at no point in this process. Was there an attempt to determine whether I had any specific access needs, such as a real time transcription or an ASL interpreter or any other form of accommodation
Oluwaferanmi Okanlami : In summary, we should not forget about our most marginalized and vulnerable groups as we progress through this process.
Oluwaferanmi Okanlami : However, as we do so, we must make sure that they are not the first ones we line up in order to test a vaccine that was not put through the necessary safety protocols and must communicate in a manner that educates and not one that discriminates
Oluwaferanmi Okanlami : Finally, it was by intention that I chose to identify myself at the end because I do not believe that the words that I've shared today should be given any more, or any less attention because of who I am or what I do.
Oluwaferanmi Okanlami : But merely because I'm a citizen of the world and the decisions that are made about how we go about this process will impact me just like they impact others.
Oluwaferanmi Okanlami : With that said, however, I'm an assistant professor of family medicine, physical medicine and rehabilitation and urology at Michigan medicine.
Oluwaferanmi Okanlami : The interim director of services for students with disabilities and the director of adaptive sports and fitness within the Division of Student Life at the University of Michigan.
Oluwaferanmi Okanlami : I serve on the President's coven 19 campus health response committee and ran our coven hotline.
Oluwaferanmi Okanlami : I'm the disabilities issues representative within the group on diversity and inclusion at the Association of American Medical Colleges and I'm a member of the National Medical Association serving on the Council on medical legislation.
Oluwaferanmi Okanlami : Lastly, after suffering a spinal cord injury during my orthopedic surgery residency and Yale, I became paralyzed from the chest down and now fall into what I call the marketplace. Multiply marginalized status as being a disabled black man living in America.
Oluwaferanmi Okanlami : Once again, thank you for the opportunity to share these words and thank you for all the wonderful work that you were doing to ensure the equitable distribution of this vaccine.
Helene Gayle   : Thank you very much for that. Dr. Dr. Open law me and thanks so much for sharing your personal experiences as well. I think we all recognize how important it is that as you spoke as an individual, you were able to also frame it in
Helene Gayle   : Different ways to
Amy Pisani : Experience these issues that we're
Helene Gayle   : Talking about. So thank you very much.
Benjamin Kahn : Next up we have any Pisani from vaccinate your family.
Thank you. Can you hear me.
Benjamin Kahn : Yes.
Benjamin Kahn : Great.
Amy Pisani : So good afternoon. My name is Amy Johnny and I served as executive director of vaccinate your family.
Amy Pisani : I really thank you for the opportunity to comment today this National Academies committee has taken on a tremendously important and very delicate issue of allocating future vaccines equitably
Amy Pisani : And the initial framework is moving in the right direction, particularly as it builds from past experience and existing distribution systems.
Amy Pisani : Back to meet your family, which is formerly known as every child by two is dr figure nose.
Amy Pisani : Is a national nonprofit organization committed to protecting people of all ages from vaccine preventable diseases.
Amy Pisani : For nearly 30 years our organization has been at the forefront of effort to educate the public about the critical importance of timely vaccinations.
Amy Pisani : And to increase confidence in the safety and efficacy of vaccines, our organization has helped to shape policies that have a lasting improvements to the vaccine infrastructure of this nation.
Amy Pisani : And we will continue to work with our partners to support the systemic changes to improve the vaccination rates of children and adults who are the ones who are experienced in the greatest disparities and coverage right now.
Amy Pisani : So while protecting everyone against covert 19 with a vaccine will not be possible immediate future, we are all very hopeful that SARS, Coby to will soon be on a list of viruses, against which the world is protected to life saving vaccines.
Amy Pisani : vaccinate your family is immensely grateful for the thoughtful draft distribution framework created by this committee and we support the principle of equal regard for all individuals.
Amy Pisani : Our organization and me personally, as a Rotarian urge the nation to extend this to include the prioritization of high risk health workers throughout the globe.
Amy Pisani : As the world is now aware, Coby 19 has disproportionately impacted adults over the age of 65
Amy Pisani : People of all ages with underlying health conditions and the economically disadvantaged.
Amy Pisani : The same population to have had severe outcomes from Koba 19 including those who suffer from diabetes, heart disease,
Amy Pisani : And a variety of lung conditions are also at higher risk from other infectious diseases for which we have vaccines, including influenza and ammonia shingles and whooping cough.
Amy Pisani : And we agree with the committee's view that the fundamental inequities and Koba 19 and other health conditions are rooted in structural inequalities racism and residential segregation
Amy Pisani : Well there have been devastated comment consequences from this pandemic. It's our hope that the public's awareness of the dangers of certain underlying medical medical condition.
Amy Pisani : will drive the development of new partnerships between public health community organizations patient advocacy groups and specialized health associations, many of whom actually commented here today.
Amy Pisani : All in an effort to increase awareness of the critical importance of eliminating vaccination disparities.
Amy Pisani : We are policymakers review the background information in this report and take immediate steps to overcome the challenges faced by adults who did not have full coverage for vaccinations under their health plans Medicaid or Medicare
Amy Pisani : And we support the committee's draft recommendation to develop an emergency infrastructure program for adults, they found the remarkable successes of the vaccine for Children program.
Amy Pisani : Which was created in 1993 and has been credited with nearly eliminating racial vaccine disparities among children.
Amy Pisani : In order to increase public competence and the prioritization plan we wish to stress the importance of making the decisions of this committee readily accessible to the public.
Amy Pisani : We appreciate that the committee recognizes the need to ensure the framework is easily understood by all audiences and that the vaccine. It's not only distributed equitably
Amy Pisani : But also perceived as equitable by population to our socio economically, culturally and educationally diverse and you'll have a distinct historical experiences with the health system. Some which may not have been positive.
Amy Pisani : Therefore, we urge the national academies and government agencies to engage traditional and non traditional vaccine partners now.
Amy Pisani : To share your final recommendations with the media online and through organizations with direct access to the public.
Amy Pisani : People in the US must understand the process for developing your framework, as well as the framework itself in order to feel confident that the new vaccines will be distributed fairly and equitably
Amy Pisani : And unfortunately, some people who are will be prioritized for coven 19 vaccines. They may be hesitant about the vaccine safety and efficacy
Amy Pisani : And so efforts to communicate about this framework must therefore be complemented with an ongoing conversation about the amazing systems that we have in place to monitor vaccine safety and efficacy in the US.
Amy Pisani : The purpose and historical success of these safety systems should be broadly shared with the public regularly.
Amy Pisani : The consideration set forth in this report reflect the committee's best scientific and social justice expertise and we appreciate the careful deliberation of the critical factors that will ensure equitable distribution that will help mitigate the spread of
Amy Pisani : And as we await the committee's final report vaccinate your family's staff and board will focus our efforts on ensuring that every individual who seeks a future vaccine has equal access to immunizations.
Amy Pisani : Thank you very much for everything that you're doing.
Helene Gayle   : Thank you. Thanks for your comments and they will be very useful for our Gurus and what we have already
Helene Gayle   : Issued in the
Helene Gayle   : Report, but also for some of the chapters that are coming later, particularly around communication. So thank you very much.
Helene Gayle   : We will now move to our last panel and it will be our last public comment panel that is
Helene Gayle   : already registered. We do have additional. We do have additional time afterwards for people who have not registered. But let's start with this panel and turn it over to you then.
Benjamin Kahn : Hey, start this panel we have George Benjamin, the American Public Health Association.
Georges Benjamin: Hi everyone, um, let me thank you very much for for allowing me to speak.
Georges Benjamin: To Gail Peggy and members of the committee.
Georges Benjamin: This is, this is a this is a good piece of work. And let me just thank you very much for for what you've done so far. I strongly believe in the principles and sound.
Georges Benjamin: That the phase approach that you've taken is the right approach. I think there was some clarity needed for some of the people in in multiple step could be in multiple phases. And what I mean by that is, for example, if you have high comorbidities. And you're homeless.
Georges Benjamin: You know, folks, folks, we're going to look at each one of those categories and figure out which bucket. They need to be in. And I think you just need to we need to make that clear so that people understand
Georges Benjamin: Which bucket of in the in otherwise you'll have enormous confusion. Same thing is, for example, high co-morbidities if you're a teacher. Um, I think that's going to be another way to think about that there are certainly some critical infrastructure jobs.
Georges Benjamin: That have to be covered.
Georges Benjamin: You know, obviously if you're in the military, and you're on a submarine, you're probably going to need to be vaccinated
Georges Benjamin: If you're at a nuclear power plant, and then maybe a couple other critical infrastructures that you might want to consider moving up into that first phase, because without them.
Georges Benjamin: There becomes single points of failure as a nation tries to recover.
Georges Benjamin: I also recognize that your phase one and phase two actually may get blended in real time when you have to try to try to implement this thing in the real world. I
Georges Benjamin: I would like to see
Georges Benjamin: The term cultural competency us more in the draft, you certainly talk about equity throughout. But I think that would be something that would strengthen that
Georges Benjamin: And then a two final things. Number one, I'm very much concerned about our nation. I'm participating in vaccine nationalism.
Georges Benjamin: And this is not a political statement. This is something I believe very strongly that unless we join the global effort, then all of our efforts will be at not
Georges Benjamin: And secondly, I believe it's going to be very, very important that starting right away that we promote a unified national voice.
Georges Benjamin: On this vaccine, with no deviations our risk of having people be totally confused about the safety and efficacy of this vaccine.
Georges Benjamin: Particularly in light of the anti vaccine movement, particularly in light of a political season. I know you've tried very hard to avoid the politics in this to several the statements you made in the document.
Georges Benjamin: But I do believe that importance of a national unified voice on this is more important enough and with that out. Thank you. A PHA will be course sitting more detailed written comments through the process as well.
Helene Gayle   : Thank you. Thank you very much, Dr. Benjamin and thanks for those very practical comments and
Helene Gayle   : Of course, take them seriously into consideration.
Benjamin Kahn : Next we have Paul Conaway, and the American Association of kidney patients.
Paul Conway : Thank you very much for allowing me to do comment today.
Paul Conway : As a kidney patient myself I've managed kidney disease for 40 years, three years on dialysis. The past 23 years as a kidney transplant patient
Paul Conway : And I also have five heart sense so many of the things that are in the report.
Paul Conway : Resonate. Not just with me but also my role as chair of policy and global affairs for the American Association and kidney patients and as a board member of the kidney health initiative.
Paul Conway : A KP is the largest independent kidney patient organization in the United States right now in the United States you have 37 million Americans.
Paul Conway : That have kidney disease and of those half more than half a million are on dialysis 100,000 are waiting for kidney transplant and you have 10s of thousands who have
Paul Conway : kidney transplants, like myself, who are immunocompromised across that population. It's extremely diverse and unfortunately it's over represented in the minority communities among African American, Hispanic, Latino, Native American, Asian island Pacific
Paul Conway : They have a disproportionate negative impact with kidney disease. And within those populations. Also, when you look at kidney disease. You have many co factors including heart disease, hypertension,
Paul Conway : Anemia many of the other co factors that are listed. I was pleased to see in the hundred and 14 pages of the report, there are two references to kidney disease and they parallel exactly
Paul Conway : The priorities listed by the CDC for kidney patients being high risk.
Paul Conway : One of the things that I wanted to point out today are two very strong headwinds that I think that the academy needs to be aware of for the kidney population. One is historic and chiefly what that is, is there has been a
Paul Conway : Tendency to ignore and not include kidney patients in clinical trials, historically, our organization which has been in existence for 50 years has worked quite closely.
Paul Conway : With the pharmaceutical industry and with researchers to change that. And more importantly, the kidney Health Initiative, which is a partnership between the American Society nephrology and the FDA.
Paul Conway : Worked quite strongly since March and issued a actual policy statement in May, calling upon clinicians and researchers to include
Paul Conway : Chronic kidney disease and kidney failure patients in clinical trials for Kovac 19 vaccines. I'm pleased to see that my burner and also
Paul Conway : Pfizer have included kidney patients in their trials. Right now there are three phase three trials, two of those do include
Paul Conway : kidney patients kidney transplant patients are not included because of obvious concerns about immuno compromised.
Paul Conway : And vaccine but the kidney Health Initiative is engaged with them and working with those communities and the transplant professionals.
Paul Conway : And we will be doing that on an ongoing basis. The other headwind that I wanted to put on the table here that you need to be aware of is more modern
Paul Conway : In fact, just in the past six months in the past six months, the kidney population and particularly kidney dialysis patients.
Paul Conway : Have seen a tremendous number of news reports that indicate that kidney patients are not being included emergency protocols in hospitals and in many of the care delivery systems.
Paul Conway : In the event of a surge or overwhelming number. This is despite the fact that many kidney patients have advanced directives that say keep me alive.
Paul Conway : This became such an issue in the spring that three major stakeholders. The American Association kidney patients, the American side and abroad in the renal physicians
Paul Conway : Association went to HHS, and the HHS Office of Civil Rights and the office of civil rights issue very, very strong.
Paul Conway : On ambiguous guidance to all healthcare providers in the United States that kidney patients on the American under the Americans with Disabilities Act have the same protections in rights intact, regardless of the crisis.
Paul Conway : And the reason why I raised that is because the level of distrust that was raised by healthcare systems, not all of them, but some of them.
Paul Conway : And some health care providers is still echoing in the kidney community based on our survey data which is rather robust in March 83% of kidney patients indicated they feared
Paul Conway : Contracting it by our tracking surveys in June that number has gone above 95% so while patients are very aware of the fact that they're at risk.
Paul Conway : There's a high level of distrust also in terms of how they will actually be treated.
Paul Conway : In to echo some of the comments here, some of those are cultural and historic going right back to Tuskegee, but also a lot of kidney patients understand that for the processes they go through
Paul Conway : Many of those drugs and procedures that they do did not involve patients at the start.
Paul Conway : So within the stakeholder community, we're trying to address that keep confidence. Keep transparency in educate people that a vaccine is coming
Paul Conway : But when the guidance is issued, I strongly encourage active engagement with the medical professional societies, the kidney health initiative.
Paul Conway : Our organization and many other patient organizations to make certain that our capacities for communication are ready to go.
Paul Conway : But that you've done due diligence and making certain that it is 100% transparent the prioritization of patients because as a community.
Paul Conway : Historically, and especially among our minority populations within the kidney community they felt as though their voice was not included in many of the medical solutions that they essentially have no choice and taking or
Benjamin Kahn : Your time is up the ramp up
Paul Conway : Sure thing. So again, I thank you very much have served under four presidents in three governors, including as Chief of Staff of the US Department of Labor. This is a health and workforce issue and we appreciate the work that you do and you stand ready to assist. Thank you.
Helene Gayle   : Thank you very much and thanks for giving us some nuance to the issues with kidney patients that we might not have no. So thank you very much.
Benjamin Kahn : Next we have Nicole crews from California State University.
Nicole Cruz  : Thank you for providing me the opportunity to speak today. My name is Nicole Cruz and I am a nursing student at the California State University of East Bay currently in my community health practice course.
Nicole Cruz  : I am in favor of first vaccinating the populations that have been hit hardest by coven 19 and are increased risk for exposing others but it's more important to look upstream at the factors that put many people at greater risk.
Nicole Cruz  : For hospitalization and death from coven 19 in the first place.
Nicole Cruz  : Racial and ethnic minorities are more at risk of having underlying health conditions.
Nicole Cruz  : Lack of access to quality healthcare inadequate health insurance coverage crowded living conditions low income or low wage jobs.
Nicole Cruz  : Lack of educational opportunities and ability to quarantine or work remotely and being an essential worker. These factors can offer less opportunity for social distancing as well.
Nicole Cruz  : Race by itself is not a risk factor for code but lack of access to quality healthcare causes people to develop untreated medical conditions.
Nicole Cruz  : This derives from inadequate health insurance coverage because people can't afford the cost of uncovered care.
Nicole Cruz  : The CDC states that the risk for hospitalization is three times more likely for people who have hypertension compared to someone without this condition.
Nicole Cruz  : Their data has also shown that racial and ethnic minority groups with the reference conditions such as obesity asthma and type two diabetes are at an even higher risk for severe coven illness.
Nicole Cruz  : We know that compared to white person's American Indian, Alaska Native African American and Hispanic persons have higher cases and hospitalizations.
Nicole Cruz  : There's a greater risk of exposure, leading to greater risk of disease, which specifically affects people of color.
Nicole Cruz  : Likewise, Frontline healthcare workers are very important in stemming the pandemic and preventing death and severe
Nicole Cruz  : Illness from the beginning of the pandemic many frontline workers have worked in environments where they have been exposed to the virus, often without adequate pee pee.
Nicole Cruz  : I had to leave my clinical site for my second medical surgical rotation at a hospital in Berkeley, California and march due to coven 19
Nicole Cruz  : I remember hearing the nurses saying that they were going to raise their concerns regarding lack of pee pee and information to infection control.
Nicole Cruz  : The nurse. I was shadowing that day, how to rule out coven 19 patient to care for and she knew that she did not have the appropriate personal protective equipment, because she was only given a surgical mask and gown.
Nicole Cruz  : She told the other nurses that the hospital with more prepared and giving its nurses, pp. During the Ebola outbreak.
Nicole Cruz  : Without a doubt healthcare workers are critical to providing essential care, especially to older adults who are at greater risk of Koba 19 disease.
Nicole Cruz  : They are also able to provide multilingual guidance and education to racial and ethnic minority groups regarding the virus vaccinating these individuals.
Nicole Cruz  : Not only enables them to provide these services, but also reduces the risk that they will spread the infection as they work in hospitals, nursing homes.
Nicole Cruz  : assisted living facilities home care and group homes or return to their own homes.
Nicole Cruz  : As stated in the draft on page 54 line 1177 frontline healthcare workers were recommended to be in the first phase to receive the vaccine based on the risk factor.
Nicole Cruz  : On on priority access to vaccines should also be based on risk factors such as occupation. So says susceptibility to disease age and income.
Nicole Cruz  : Vaccines should be given for free and for all, especially in adequate quantities two areas of high social vulnerability and delivered at locations accessible to racial and ethnic minority populations living in those areas.
Nicole Cruz  : Thank you again to the committee for the opportunity to speak and for the draft.
Helene Gayle   : Through. Thank you. Thank you very much.
Benjamin Kahn : Next we have Hannah leg read off from the American Society of health system pharmacists.
Anna Legreid Dopp - ASHP: My name is like ER doc. I'm the Senior Director of clinical guidelines and quality improvement at the American Society of health system pharmacist or is he located in Bethesda, Maryland.
Anna Legreid Dopp - ASHP: Thank you. National Academies committee members and dedicated committees staff for the opportunity to react.
Anna Legreid Dopp - ASHP: To the recently released preliminary framework for equitable allocation of the Coleman 19 back to your efforts to ensure the final report, it was balanced objective inclusive dynamic and feasible is no easy task given all the uncertainty in the months ahead.
Anna Legreid Dopp - ASHP: Is HP is a collective voice a pharmacist who serve as patient care providers in hospitals call systems and we'll try clinics.
Anna Legreid Dopp - ASHP: And other healthcare settings spanning the full spectrum of medication years our organizations nearly 55,000 members, including pharmacists pharmacy technicians and student pharmacist.
Anna Legreid Dopp - ASHP: Is HP members are at the forefront of efforts to improve medication use and enhance patient safety and this includes the safe and effective use of vaccines.
Anna Legreid Dopp - ASHP: Are comments am to supplement and amplify earlier remarks given by Dr. Scott Nora with American Pharmacists Association and Dr. Chad, whereas with the American Society of consultant pharmacists.
Anna Legreid Dopp - ASHP: Are components are centered around acceptable allocation and strategic distributed distribution of the vaccine against us. I was privy to
Anna Legreid Dopp - ASHP: This is a highly anticipated and critical countermeasure to the code 19 global pandemic.
Anna Legreid Dopp - ASHP: In particular, we want to bring to your attention the role that pharmacists place on the front lines of providing patient care to poke and making patients.
Anna Legreid Dopp - ASHP: As a few Members provide direct patient care on major professional teams, such as infectious disease be used
Anna Legreid Dopp - ASHP: In hospitals, emergency departments and critical care units including caring for those patients that may require mechanical ventilation.
Anna Legreid Dopp - ASHP: Pharmacists also provide direct patient care ambulatory and community settings.
Anna Legreid Dopp - ASHP: Addressing the chronic care needs in the high risk patient populations that have been discussed earlier and providing testing for code 19 across all 50 states has authorized by the Department of Health and Human Services under the pressure
Anna Legreid Dopp - ASHP: All frontline healthcare workers, including pharmacist and pharmacy technicians need to be included in the first phase or vaccination efforts.
Anna Legreid Dopp - ASHP: We specifically request because the committee include pharmacist in tier one as a higher priority group, group high priority target group that meets important societal
Anna Legreid Dopp - ASHP: This is one of many crucial conversations around strategic planning for the coven 19 vaccine that needs to take place.
Anna Legreid Dopp - ASHP: As a committee continues to work on the remaining aspects of the record, you'd like to share for your consideration some principles that HP released recently related to cope in 19 vaccine development.
Anna Legreid Dopp - ASHP: Distribution allocation administration monitoring and surveillance our principles aim to bridge lessons learned from previous maps that vaccination efforts.
Anna Legreid Dopp - ASHP: Current experience with the code 19 pandemic and best practices and effective pandemic preparedness supply chain management and clinical process.
Anna Legreid Dopp - ASHP: In addition, they emphasized that pharmacist and pharmacy technicians have a deep understanding of how to optimize vaccine supply and use
Anna Legreid Dopp - ASHP: Many of our principles overlap with considerations that this comedian successes, so we will submit them are comments.
Anna Legreid Dopp - ASHP: They range from collaboration and coordination both domestically and internationally to ensure ethical and equitable global distribution of the vaccines to remain vigilant with continued research and comprehensive enough surveillance.
Anna Legreid Dopp - ASHP: This truly is the largest single vaccination of effort to global health community as experience.
Anna Legreid Dopp - ASHP: It is imperative that covert 19 vaccines are distributed in an ethical equitable and efficient manner to maximize maximize population protection from SARS, Coby to
Anna Legreid Dopp - ASHP: In addition, extraordinary efforts will be required to empower mobile of it and protect our immunizing workforce, including offices.
Anna Legreid Dopp - ASHP: In summary, thank you for your dedication to guys these critical vaccine application diligence to ensure they are equitable and prioritize for greatest public health impacts the professional pharmacy and as he stands ready to play and support.
Helene Gayle   : Group. Thank you. Thank you so much. And we look forward to getting your total written comments and principles to
Helene Gayle   : Be very helpful for us as well. So thank you.
Ann Kimball : One has to unmute to be heard. Thank you very much for the opportunity. I've been watching some parts of these comments and wow they are very rich but congratulations on a really strong piece of work.
Ann Kimball : I'll probably be seen, you know, kind of singing to the choir here, but I've been working largely
Ann Kimball : With my own community here and kids of County with my county health officers with my rotary club and others working on masking and other initiatives to prevent covert
Ann Kimball : I also have 40 years of experience working internationally on pandemics and epidemics, which is also been helpful.
Ann Kimball : In my local work. I'd like to just comment on three aspects of your report. One is transmission risk inclusion to his political context.
Ann Kimball : And three is global cooperation, all of which you've addressed in the report, and by the way, I really want to congratulate you on this report, it's a very comprehensive and clear document.
Ann Kimball : Transmission risk as a core value. I think would enhance your discussion of reducing morbidity and mortality.
Ann Kimball : I was a little confused.
Ann Kimball : Online 746 when you began to talk about the car, the two different options of looking at morbidity and mortality as maximum benefit versus transmission risk reduction.
Ann Kimball : And in my experience in working with local health departments as much metrics, as can be included about transmission risk rationale
Ann Kimball : It really helps them. They're desperate for sort of signposts of when do I do this, when do I do that and being able to explain it to their communities. So I would just
Ann Kimball : Suggest that as we understand more about transmission risk which we are definitely beginning to do from the literature, I think, including that aspect, a little more prominently in your argument at the front end of framing your arguments would probably be helpful.
Ann Kimball : I think your report says online.
Ann Kimball : That you would like to avoid political context in your remarks and I sure appreciate how much that would be a wonderful thing.
Ann Kimball : But I would like to emphasize that, as you all know, political leadership is absolutely critical, and how this rollout occurs.
Ann Kimball : And I think other speakers spoken to the need for solidarity of messaging and you're all aware of that. But I'd like to bring some perspective from my community work.
Ann Kimball : Because I don't think we all appreciate just how far misinformation campaigns have reached into populations, be the blue populations or read populations.
Ann Kimball : On vaccine hesitancy and mask refusal. It's been very, very impressive to me as a Rotarian working across rotary clubs on a number of projects.
Ann Kimball : That even the most educated people are listening to some of the messaging that's coming forward about how masks can be dangerous, etc.
Ann Kimball : So vaccine hesitancy which is treated in the report, to some extent, I think digging into some of the current work that's going on.
Ann Kimball : About vaccine rumors and how they travel and communities will be very helpful in assuring smooth vaccine rollout.
Ann Kimball : And in terms of political leadership, no matter who is at the top of the pyramid. When this rolls out we honestly need to see our leader and his family or her family.
Ann Kimball : You know having the vaccine publicly and demonstrating because we all know that people watch as much as they listen and providing those examples will be critically important from the top.
Ann Kimball : From the community level your report talks about financial barriers in exploring this with the CDC guidance that just came out and the state and local planning that's going on.
Ann Kimball : The planning suggests there could be a charge when people present at the pharmacy and the uninsured, although mentioned in your report.
Ann Kimball : I think after we spent $8 billion on getting a vaccine your average american expects it to be free.
Ann Kimball : Now that may not be realistic, but I will also submit that we could do a lot better with the uninsured since fully a third of Americans don't have access
Ann Kimball : To health care at this point in our country. It'll be critically important to remove all financial obstacles as well as creating solidarity of messaging and getting political leadership.
Ann Kimball : Finally, I wanted to address just briefly a topic close to my heart, and to all of your heart, which is global cooperation and I would definitely
Ann Kimball : Emphasize what George Benjamin told you, just a few minutes ago. And you all understand as we've heard that the Colfax facility for assuring equitable access across the world to this vaccine effort.
Ann Kimball : The United States has decided not to be at that table we really have vacated our leadership internationally. And I think we are going to feel
Ann Kimball : Some of the consequences of that, not only in a loss of leadership for the United States, but our own people will suffer from the lack of interchange of information and collaboration around the globe.
Ann Kimball : And I think it's critically important that as we look at your framework that that in the report could be called out, you do mention it on lines for 92 and 493 but now that we've learned this new information, you may well want to
Ann Kimball : To emphasize as we learned, you know, as we've learned through every single pandemic and
Benjamin Kahn : Partner up your time is over here.
Okay.
Helene Gayle   : Thank you very much, Dr. Kim for those comments.
Helene Gayle   : Make sure you realize that the global considerations as well as the implementation. We're not in the draft that will release those are in chapters to come. So they weren't as fully covered, but those issues we more fully covered in
Helene Gayle   : The rest of the report that has not yet been issued as a draft. So thank you.
Benjamin Kahn : Next we have around Schmidt from the University of Pennsylvania.
Harald Schmidt : Hello, my name is Harold Smith. I'm an assistant professor of medical ethics and health policy at the Portland School of Medicine.
Harald Schmidt : At the University of Pennsylvania, a research associate at the Center for Health and sentiments and behavioral economics.
Harald Schmidt : And a senior scholar at penicillin David institute of health economics.
Harald Schmidt : The focus of my research as a buyer emphasis is on resource allocation and personal responsibility for health and that's the perspective of I'm providing here.
Harald Schmidt : So I'd like to start by thanking you for the opportunity to share some thoughts and also by congratulating the committee.
Harald Schmidt : Chairs, the members and the staffers for the way in which social justice considerations have been incorporated in the current framework.
Harald Schmidt : You have a nice review of existing frameworks and it's clear that the purpose framework quite seamlessly builds on
Harald Schmidt : But importantly, it also lays the groundwork to counter it clear trend in dominant allocation frameworks that are mostly utilitarian
Harald Schmidt : And address social justice at best peripherally, if at all. So my view, there's considerable value and conceptualizing equity as a cross cutting consideration as a committee proposes.
Harald Schmidt : And and demonstrating both the need and the feasibility of using measures of deprivation to improve fairness and allocating vaccines.
Harald Schmidt : Some of the committee members and staff has no I made a similar argument in an essay published in the testing center reporting may
Harald Schmidt : In which I'd want a different but closely related measure of deprivation, the error deprivation index.
Harald Schmidt : To suggest that it should be used for prioritizing worse off groups among the general population on economic epidemiological unethical grams.
Harald Schmidt : Doing that is imperative for social justice. Now, and especially also in view of the longer term impacts and the damage and pain that would result if
Harald Schmidt : In particular worse of African American communities find themselves at the back of the line for a safe and effective vaccine.
Harald Schmidt : That will be an immense damage and pain. So while I could really not be more sympathetic towards the approach. I'm also aware of some unique challenges that come with it and I want to share three here.
Harald Schmidt : And these are to do with how exactly the prioritization works. What, if anything, we owe to prioritize groups to receive a vaccine that is inferior to later one
Harald Schmidt : And how we should think about a framework for allocation, not just within but across states. So first on how to prioritize by disadvantage.
Harald Schmidt : The committee rights within the population groups included in each of these four phases. The committee recommends that vaccine access should be prioritized for geographic areas identified as vulnerable through CDC social vulnerability index.
Harald Schmidt : But, so the question is, would prioritizing by the index mean giving all vaccines to the worst of the siloed saying each of the groups.
Harald Schmidt : In each phase and non to the others, or should we select a random subset, and each of the ourselves within a phase, but say give disproportionately more to survival of the worst off their styles.
Harald Schmidt : Right, so the index can provide a helpful measure of disadvantage, but it also requires an external normative yardstick for guiding actual allocation.
Harald Schmidt : So we need clarity on how the weights or ratios are constructed in my view of pragmatic and ethically meaningful standard will be to allocate within the subgroups of a phase.
Harald Schmidt : By the relative code related impact that the group experienced which can be operationalize with existing data.
Harald Schmidt : Second on the point of whether they might be special obligations towards those who are prioritized
Harald Schmidt : One of the ways in which the company is unique. Is that an allocation framework needs to work, not only for delivering one type of vaccine but in all likelihood for survival ones.
Harald Schmidt : And these may differ and effectiveness safety or cost. So if it turns out that the individual. The initially practice populations receive a vaccine that is inferior in some way.
Harald Schmidt : Do we just accept that as such, or is there something that we owe them.
Harald Schmidt : And it seems to me that clarity about any such arrangements would likely also be of relevance for addressing vaccine hesitancy that came up a couple of times.
Harald Schmidt : And take it takes on even more important in light of the public concerns and also concerns that were made today about perceptions of the vaccine being rushed for political or other reasons.
Harald Schmidt : And then third, on the issue of how to think about allocating other than directly to people for the framework that the committee has outlined to work that needs to be clarity about what numbers of doses each state receives at different points in time.
Harald Schmidt : Many of the same considerations apply here and personally would make a lot of sense to me to urge that the highest level allocations formula also take into consideration.
Harald Schmidt : The respective states levels of deprivation. So maybe addressing such questions will come under the implementation part that understand
Harald Schmidt : If separate. But in any case, simply to say that addressing this aspect will likely add clarity, avoid what many have rightly called a chaotic way of distributing ridden severe
Harald Schmidt : And seems to be within the remit of the committee, overall, so again, my congratulations on the work so far.
Harald Schmidt : And I hope that you'll agree that the final report will be more helpful if it clarifies the weight or prioritizing across groups.
Harald Schmidt : If the addresses issues to do with multiple vaccines and comments on the rationales that should guide our locations across the US.
Harald Schmidt : And one final thought in the few seconds remaining
Harald Schmidt : Which is that in an early common today Dr affiliate noted that she was concerned whether the vulnerability index sufficiently catch a cove its impact on black communities and given the central role of the index.
Harald Schmidt : That would seem useful to comment on the differential utility of different types of indices to thank you very much.
Helene Gayle   : Thank you very much for those very thoughtful questions.
Benjamin Kahn : Alright, last we have really short from body politic.
Lynlee Swartz : Hi, everyone. Thank you. My name is Lily Swartz I help run an online support group for coven 19 patients.
Lynlee Swartz : Through the organization party politics. So first of all, I want to thank you everyone for selecting me to join in the discussion. I think the value of public input cannot be understated when we're determining allocation of a coven 19 vaccine.
Lynlee Swartz : I'm coming here today to present the experience of a coven 19 long hauler and an effort to better inform the Committee, how and why vulnerable population should receive equitable access
Lynlee Swartz : I hope that everyone here is familiar with the term long holler that I just used and you have at least some others, some understanding of what it means.
Lynlee Swartz : There's been more articles documenting the experience. Recently, but many people still do not know about this group.
Lynlee Swartz : For 10s of thousands of people. It's been a lived experience for months.
Lynlee Swartz : The term long haul, or here defines the group of people who became sick with coven 19 who had symptoms that may not have been severe enough to warrant hospitalization.
Lynlee Swartz : But who also did not recover in two to four weeks. These people have been suffering with ongoing symptoms for weeks and months.
Lynlee Swartz : I myself became ill in mid April with chat nice chest tightness and heart palpitations, but my PCP was dismissive on the phone and at the time I could not receive access to a test.
Lynlee Swartz : My symptoms continue to expand and persist for weeks when I could finally get a call back the PCP continue to be dismissive.
Lynlee Swartz : Finally, I was able to get a PCR tests seven weeks after my initial symptoms started in an antibody test at nine weeks at the guidance of a new doctor
Lynlee Swartz : Both results came back negative. It's now been nearly five months and I'm still symptomatic. At this point I want to pause here and name a few of the symptoms that I've been battling for five months, as I think it's really important.
Lynlee Swartz : Heart palpitations chest tightness food intolerance alcohol intolerance headaches now show heartburn, sore throat, fever, altered sense of smell and taste shortness of breath.
Lynlee Swartz : Phantom smells, muscle aches heat and humidity and tolerance and oh, to all drops with activity.
Lynlee Swartz : The most severe and ongoing have been debilitating fatigue and brain fog, the fatigue, for me, was so debilitating.
Lynlee Swartz : That I was nearly bed bound for eight weeks. I still require naps and loads of rest. Each day just to function.
Lynlee Swartz : The brain fog gets worse as I get tired I battle with short term memory loss, lads and critical thinking and communication challenges.
Lynlee Swartz : With health care providers denying the access to services related to coven 19 recovery and dismissiveness of my persistent symptoms. I've been mostly on my own to recover.
Lynlee Swartz : Thankfully, after five months. I am nearly functional and nearly recovered.
Lynlee Swartz : The completeness of my recovery so far has no doubt occurred because of my privilege. I am a fortunate person.
Lynlee Swartz : I have stable income through a job which provides health insurance allows me to work from home and supported me during the peak of my illness.
Lynlee Swartz : I own my own home, so I didn't have to worry about keeping a roof over my head. I had supportive family, friends and the significant other, who not only helped me but they believed me
Lynlee Swartz : I was also fortunate enough to find the online support group that I referenced earlier, who let me know that I wasn't alone.
Lynlee Swartz : Today body politics coven support group has had over 16,000 request to join from around the world, many of whom are also walk callers
Lynlee Swartz : I talked about this, because as an as was outlined in the committee's discussion draft, who is in vulnerable population should not solely be reliant upon socio economic status.
Lynlee Swartz : The committee must evaluate what types of populations are most risk if they potentially become long haulers
Lynlee Swartz : I know that we don't know the answers yet about who becomes alarm color and why, but it's something to consider for this committee.
Lynlee Swartz : Individuals who don't have health insurance, who can't afford to miss more than two weeks of work, who can't access support resources because they don't have in home internet connection and others.
Lynlee Swartz : Are very valid reasons to consider. Many of these individuals who work in certain industries could be at risk of losing their job, housing and other basic human rights if they were to become a wall color.
Lynlee Swartz : I urge the committee to consider these individuals as part of their vulnerable population when considering phase one and phase two.
Lynlee Swartz : I have, then a few recommendations to the committee when partnering with state and local authorities in regards to this vulnerable population.
Lynlee Swartz : Make vaccines available in the same location as PCR tests and antibody test to lessen confusion.
Lynlee Swartz : Make the vaccines available and pharmacies many individuals in all types of geographic geographic locations have access to a pharmacy within a few miles of their home.
Lynlee Swartz : Access should be along public transit routes access should in no way be related to previous PCR antibody tests encouraged Partnerships With Local Neighborhood organizations so that information can be disseminated in a non internet manner. Thank you, everyone.
Helene Gayle   : Thank you very much. And thank you for sharing your personal experience. And I think, giving us more insight to what many people are actually experiencing.
Helene Gayle   : So with that, that, that closes. Our scheduled panels, but we would like to open it up for about 20 minutes or so for general public to provide comments.
Helene Gayle   : You see there the instructions. Use your raise your hand feature on the webinar or nine a star nine if you have a if you're using a regular phone that will let the staff know that you're interested in making a comment and you will be unmuted.
Helene Gayle   : Everyone has exactly three minutes or less to make their comments so we can get as many comments as possible. So, and, and, of course, remember the rules of conduct that we talked about previously in terms of using
Helene Gayle   : Public decorum effectively. So thank you very much and we will open up or any members of the general public who would like to make a brief comment.
Benjamin Kahn : The first time that I saw was Robert Spyglass
Helene Gayle   : Go ahead please feel
robert steinglass: Yes, sir. Thank you very much for a great presentation and and also a great job on explaining the what and the why, in the draft.
robert steinglass: Document, I feel that it focuses much less on so many operational issues related to how and it wasn't clear to me actually until this public listening session.
robert steinglass: That there are still plans to draft further guidance on operationalize using the framework, you know, regarding Community Engagement risk communications vaccine.
robert steinglass: Vaccine hesitancy which I sometimes referred to as vaccination hesitancy not quite the same thing and global issues.
robert steinglass: So in fact, when I did submit some of my public comments and I had to choose a label for them.
robert steinglass: I was frustrated because there was no choice. In fact, for labeling them as operationalize in the framework in practice. So I'm glad to know that they're still plan to
robert steinglass: Have those chapters, just as an example. Can you imagine in practice under conditions of vaccine scarcity and also
robert steinglass: Given the local power dynamics, the frontline healthcare worker is going to be under enormous pressure if in fact they are expected to decide.
robert steinglass: And on their own and verify whether the individual standing in front of them truly qualifies for vaccination based on any designated higher risk category. So how is that going to be addressed. Hopefully the chapter will deal with that.
robert steinglass: Also, just one last example there are so many, but just one last one. How will the allocation of scarce vaccines supplies.
robert steinglass: Be locally determined across different sites private practices public clinics pharmacies outreach to migrant communities, for example.
robert steinglass: While in fact retaining overall public trust that the system is rolling out fairly without favoritism without leakage a vaccine to lower risk and more powerful individual. So those are just two examples of what I mean by operationalize the framework. Thanks so much.
Thank you.
Benjamin Kahn : Thank you. The next person is to Allen and I'm just gonna ask them when you have a chance to speak on raise your hands, let me know who's next.
Theo Allen: So what I heard today. Well, everyone speaking was that the national science, engineering and medicine is really focused on prioritizing healthcare workers when we know that the people with comorbidities who live in congregate settings like nursing homes health co long term low
Theo Allen: As well as any other place where people just live in overcrowded housing makes a difference. In addition, healthcare workers and he goes, did not experience any
Theo Allen: Increased risk of transmission and to buy rates will actually 12.2% compared to nearly 20% for general population.
Theo Allen: Unless you're going to consider. Who's that severe whisk, which means prioritizing the people who have come abilities grow elderly particularly minorities, you can't actually effectively distribute a vaccine targeting the most vulnerable and saving the most lives.
Theo Allen: Finally, we need to focus on pee pee particularly respirators and mass, because until we can get everyone vaccinated, you still need medication. So thank you.
Thank you.
Benjamin Kahn : Alright, the next name our list is I'm sorry if I don't put your name right Shamir Smith.
Chimere Smith: Hello everybody. It's, it's, it's a pleasure to be with you. I'm honored to have this opportunity to talk to you.
Chimere Smith: I am scheduled tomorrow. As a matter of fact and ironically for a cataract surgery. I'm 38 years old. I'm a black woman. As you can see, and I'm a teacher in Baltimore City.
Chimere Smith: And this virus has robbed me of my vision and my left eye. I have not been able to see since April of this year.
Chimere Smith: Not only that, but I have developed trigeminal neuralgia, and a snippet of neuralgia. I am living in a city with one of the most prominent hospitals in the world.
Chimere Smith: And I have been told that because I tested negative for this virus that I do not qualify for any vaccination trials or opportunities I am what you call a long holler.
Chimere Smith: I would, I believe that black women and Latino women should be as, as many of you all have have have said in this conversation, which has been a dynamic conversation we cannot exclude
Chimere Smith: Those demographics of women because of negative testing, we need to be included in those conversations as it relates to vaccination.
Chimere Smith: Because we understand also that black women and Latino women who are pregnant are also at a higher risk.
Chimere Smith: We cannot afford to exclude those women out of the conversation and those people out of the conversation Baltimore City is a is becoming more of a hot spot for the virus once again.
Chimere Smith: And I believe that we need to make sure that we concentrate on the negatives. People who have tested negative that we presumed positive and not exclude those people as well. So we do need to give for the consideration for that. I'm honored to be able to have spoken with you. Thank you.
Helene Gayle   : Thank you very much.
Benjamin Kahn : Next we have Matthew Elena would
Hear me
Yeah.
Matthew Ellinwood: Can you hear me now.
Matthew Ellinwood: Yes, my name is Matthew Elena, would I am a comparative medical geneticist and I am the Chief Scientific Officer at the national MPs society.
Matthew Ellinwood: Our society represents a group of serious rare genetic disorders affecting mostly pediatric patients involving severe cardiovascular respiratory orthopedic
Matthew Ellinwood: And cognitive diseases, our patients are members of vulnerable communities in multiple ways. However, the knowledge of these disorders is quite variable, both at the federal, state, and even local health care.
Matthew Ellinwood: Provider level some designation of individuals with rare diseases as phase one B vaccine recipients could be extremely useful to aid in the
Matthew Ellinwood: Vaccination of this vulnerable community who are also guaranteed to be encountering the medical community and must potentially affect during
Matthew Ellinwood: Disease up to strategically vulnerable populations listing them explicitly and also appendix is that may contain specific disease syndrome listings could help advocates who may be approaching state or county medical providers.
Matthew Ellinwood: To assure that they are considered as vulnerable populations. Thank you for an extraordinarily well done draft and a very good conversation. I've appreciated greatly it's inclusive any. Thank you.
Helene Gayle   : Thank you so much.
Benjamin Kahn : Next we have Sharon and me.
Sharon Inouye: Yes. Hi. Thank you so much for the report and the session today. I'm a national academy member. I'm a geriatrician and a professor at Harvard Medical School. And I wanted to ask or
Sharon Inouye: Make sure that the report my stress about the importance of older adults and other vulnerable groups, including the disabled and diverse populations that we've been talking about in covert vaccine trials.
Sharon Inouye: Many of the ones that have been published so far and also from a review of clinical trials.gov
Sharon Inouye: The these populations will often be excluded from these trials, which is really concerning
Sharon Inouye: Because we won't know you know about the effectiveness and whether there needs to be dosage adjustments or double doses, as are needed with some vaccines.
Sharon Inouye: In these populations and we may also not know about side effects and I'm also concerned. In addition, because funders and
Sharon Inouye: Organizations, may utilize the lack of vaccine testing as a reason to avoid equitable distribution saying that it hasn't been tested yet in these populations and it might not be safe so I'm hoping that part of the report can mention and focus on this really important aspect as well.
Thank you.
Benjamin Kahn : Max, we have Leslie grant
Leslie Grant: Thank you. My name is Leslie grant. I'm a general dentist in the Baltimore area and a speech language pathologist.
Leslie Grant: I like to state that I'm speaking as an individual and not representing or on behalf of any organization. However, I like to acknowledge that I am a past president
Leslie Grant: Of the National Dental Association. I want to thank you for this extraordinary forum to express our concerns regarding equitable vaccine allocation once COPPA vaccine becomes available.
Leslie Grant: Each of the testimonies today have been compelling. I just like to add to the earlier comments of Dr Laughlin from the American Dental Association.
Leslie Grant: Dental practitioners offer a great safety net for providing vaccinations. We are amongst the most trusted of health care providers and are well known for our historical and continuing focus on prevention.
Leslie Grant: general dentists typically treat the entire family and often multiple generations within one family.
Leslie Grant: Because of the frequency of dental visits our relationships with our patients. So solidly established, we are experts. Experts in injection administration safety.
Leslie Grant: And offer care environments where treatment is delivered by providers who have long term familiarity and implementation of infection control protocols.
Leslie Grant: Aerosol safety and proper sequence for donning and removal a personal protective equipment.
Leslie Grant: We provide care to children who receive Medicaid benefits we provide care and correctional facilities school based health programs nursing homes and community health centers are reaches broad skilled and impactful.
Leslie Grant: Dentist will be your phenomenal partner and reaching an expanded demographic of patients requiring vaccinations. We are often excluded from this arena.
Leslie Grant: Unfortunately, and we hope to be included as an integral component of the equitable vaccine allocation and administration. Thank you again for this tremendous opportunity. Thank you for all of your hard work.
Helene Gayle   : Thank you much appreciated.
Benjamin Kahn : Next you have a net Greer
Annette Greer: Okay. Thank you. Can you hear me.
Annette Greer: Yes. Okay, great. I want to commend the body for the work they have done and the speakers today, but especially those who indicated
Annette Greer: Not just equity, but cultural competency, one of our earlier speakers this afternoon strived to say that we need a national as many others did a national plan, but with local input.
Annette Greer: Our group in North Carolina. I'm from East Carolina University is reaching out into our community to do very similar to what you have done here, and I think
Annette Greer: I'm modeling the outreach at a national level is just as important at the local lab level to use the data and to determine how the health care team.
Annette Greer: Will work collaboratively to be effective in that distribution plan, whatever it may be, as based on an ethical framework. I like the fact that we have talked about an ethical framework. And I think we need to talk more about that because there were
Annette Greer: Noted.
Annette Greer: Personally persons today who everybody wants to be in part one, level one or level one a and clearly, we cannot do that. I did here.
Annette Greer: Today, when people said you have to look at those individuals that fall into more than one risk area.
Annette Greer: I think that is a consideration when we have a person who is chronically disease, but is a teacher or chronically diseased and a pregnant mom those people fall in to a higher risk bank, if you will. The other thing that I would like to mention is our pharmacy partners.
Annette Greer: I was on a call last week with Madonna and Johnson and others. And it's important to note that there's multiple facts things that have been developed using multiple technologies.
Annette Greer: Some will be one does some will be to the dose and so those types of factors need to be included in the transparency.
Annette Greer: Of education so that people understand what they are getting, whether it's a one does, whether it's the two does because there are a lot of myths out there that we need to overcome and single message is going to be important.
Thank you very much.
Benjamin Kahn : Next we have Carla Thomas
Karla Thomas: Hello. Thank you. My name is called Thomas. I'm a data tracker and presented for the native wine and Pacific Islander coping 19 data policy lab of the UCLA Center for Health Policy Research, research, and I also represent the national Pacific Islander Colby 19 response team.
Karla Thomas: native plants and Pacific Islanders here. And after refer to as any APIs, have been severely overlooked and ignored in this conversation surrounding vulnerable populations and HP is or the indigenous people of Oceania.
Karla Thomas: Ethnicities such as someone Fiji and Marshall each tomorrow talking among many, many others and HP eyes makeup less than half percent of the total US population.
Karla Thomas: At a population of around 1.5 million people. But despite this NXP eyes across the nation have the highest rates of Cobra 19 cases.
Karla Thomas: Particularly in two thirds of states where any HP is aggregated data is available. Some of these states where any guys have the highest case rates, out of all racial and ethnic groups include Alaska Arkansas.
Karla Thomas: California, Colorado, Hawaii, Iowa, Illinois, Louisiana, Minnesota, Ohio, Oregon and Washington, which is alarming for population of this size to be affected.
Karla Thomas: This disproportionate impact is resolved the fact that one out of four and HP eyes are essential workers, there's a nearly 40% prevalence of co-morbidities among the population.
Karla Thomas: There are high rates. It's actually the highest rate of homelessness among any APIs, which was a report to Congress in 2018
Karla Thomas: And we have very poor living situations where many live in high density multigenerational housing, there are high rates of uninsured for those with health care.
Karla Thomas: And we urge the committee to consider Native Hawaiians and Pacific Islanders in this equitable allocation plan because our people overlap in many of the Tier one criteria groups, especially those with
Karla Thomas: comorbidities and having a large older population of about 20% were many are living in overcrowded multi generational housing settings.
Karla Thomas: Once again, I just urge this committee to consider an HP is in this process, because we are overlapping in many of these focus groups that we are looking to provide equitable allocation to for the Kobe vaccine. Thank you.
Helene Gayle   : Great, thank you. And we have run over time, but I think it would be good to hear a few more of the comments from the public. So from the general public. So we'll take the last few that are in line.
Benjamin Kahn : Next we have Barbara barrel.
Benjamin Kahn : Oh,
BArbara Merrill: Hello. Can you hear me my unmuted.
BArbara Merrill: Thank you so much, particularly for going over the overtime. My name is Barbara Merrill, I'm the chief executive officer.
BArbara Merrill: Of the American network of Community options and resources and we are the national trade association representing private providers of services for people
BArbara Merrill: with intellectual and developmental disabilities in an autism. We have over 1600 members across the country and represent 55 state level associations.
BArbara Merrill: Our members provide the entire spectrum of of lifespan services.
BArbara Merrill: For individuals with intellectual developmental disabilities and their families from residential services to employment services. Today's services.
BArbara Merrill: To respite to schools. I really commend the committee for this initial draft. I think it's really well done and we are very encouraged by it.
BArbara Merrill: And core along that is our acronym, along with the American Association for developmental
BArbara Merrill: Medicine and Dentistry and nasties the American Association for State directors of developmental disability services will be submitting comments jointly, but I just like to make a couple of really quick comments.
BArbara Merrill: Our, our services providers have been on the front lines of this pandemic, but really largely overlooked in the beginning, we had to fight incredibly hard to be recognized as even essential workers able to go to work.
BArbara Merrill: And access to pp. He has been incredibly difficult. You know, there are. It's really quite a large population of people who receive services predominantly Medicaid funded services. I'm going to just cite a couple statistics from white paper that was just
BArbara Merrill: Published by a DMD
BArbara Merrill: 591,000 people the intellectual disabilities live in settings of six and under so nowhere near as big as the typical assisted living facility or nursing facility yet.
BArbara Merrill: Yet providers and the individuals who receive these services have really disproportionally been at risk, you know, all the comments that were made by the panel addressing the needs of older American nursing facilities assisted assisted living facilities are relevant to our population.
BArbara Merrill: The A A DMD paper referenced some of the research that's been done and some of that has been referenced in the discussion draft. I was really pleased to see that, particularly the research done by Landis with the university or Syracuse University rather
BArbara Merrill: Let me just give you a couple quick statistics in Virginia.
Helene Gayle   : So sorry. Unfortunately, we really do have to limit these two, three minutes.
BArbara Merrill: Okay, let me
BArbara Merrill: Let me just, let me just wrap up.
BArbara Merrill: Like we're very encouraged that phase one in appears to include our frontline workers and that phase two includes individuals living in group homes but it needs to be far more explicit in part.
BArbara Merrill: So we look forward to somebody in the comments. And thank you for the time.
Helene Gayle   : Thank you. Thank you very much.
Benjamin Kahn : X we have David curry.
David Curry: Hello. Thank you very much. It's been a very rich discussion and compliments to
David Curry: The group for the great work. I'm representing
David Curry: A center for vaccine ethics and policy part of a small foundation and my academic appointments at NYU division medical ethics. I just like to make two quick observations about more ethically seemed matters.
David Curry: Echoing our colleague from Ken and others who have properly described. I think as a draft does the very complex supply
David Curry: Authorization licensing and recommendation environment we face over the next few years, given the number of vaccines, with varying safety and efficacy profiles and potentially differently charged political baggage.
David Curry: We took note of the limited very limited references to consent.
David Curry: Which seemed to be limited to line one
David Curry: In the section where you're going through the experience of frameworks and we are concerned that consent may emerge as a very charged issue that could not only simply affect allocation volumes and mechanics.
David Curry: But could affect trust in the allocation scheme itself. The other point which is similar is the treatment in lines.
David Curry: And beyond in the social, economic and legal context of mandates and the first area of treatment is a discussion of the historical use
David Curry: Of mandates for children in schools for appropriate vaccines for their ages and the second is the potential for mandates that might be employed by
David Curry: Employers as a condition of employment, but in both cases, it seems like the draft is discussing the possible dislocation to the allocation framework mechanics, rather than weather mandates, given the politically charged landscape. We will undoubtedly continue to move through
David Curry: Might make mandates a a very challenging area also impacting trust. It is possible that you may be intending to address these kinds of issues in chapters that are not provided in the draft. We hope so.
David Curry: But we are mindful of what we're waking to each day and the fundamental impacts that consent and ideas about mandates wherever they may come from.
David Curry: And how they may affect not just the allocations scheme from mechanical point of view, but from a more fundamental trust view in the whole scheme. Thank you very much.
Helene Gayle   : I think we have time for one last comment.
Benjamin Kahn : Right. Last we have Mary Jo and a teary
Mari Jo Panettieri: Eyed. Good afternoon. I'm I'm participating, just as a member of the public, although I have a
Mari Jo Panettieri: Public health nurse years ago and I. My comment is regarding people who are perhaps caregivers in their columns of family or even friends and I
Mari Jo Panettieri: Was hoping that they would be considered and maybe one of the, you know, early tears when they are caregivers of persons with significant underlying conditions are caregivers of elderly persons with
Mari Jo Panettieri: With conditions as an example. I myself care for two persons in their 80s. I live with them and
Mari Jo Panettieri: They both have underlying conditions, although I myself am much younger and don't have any of those risk factors, I noticed aligned for 44 that this
Mari Jo Panettieri: Concept that I'm speaking of was included in the Johns Hopkins framework where they said
Mari Jo Panettieri: Those the greatest risk of severe illness and death and their caregivers should be considered in one of
Mari Jo Panettieri: The early tears and my thinking on this is just, you know, the frequent close contact of caregivers with the vulnerable for Medicare
Mari Jo Panettieri: And also the fact that, you know, they, the caregivers are doing
Mari Jo Panettieri: Important societal function, taking care of people in their homes, even though the caregivers are not you know employed by a health care agency or home care agency, but they're they're doing similar function and in so doing, you know, or
Mari Jo Panettieri: Perhaps relieving some of the burden on the healthcare system.
Mari Jo Panettieri: You know, by taking on the role of a caregiver. So I wanted to just say that I thought that they should be included. Perhaps it you know the similar time is when the vulnerable people are eligible for vaccination that it would be them and their caregivers, right. Thank you very much.
Helene Gayle   : Great, thank you. And you know, I don't know about anybody else, but I could continue going on and listening to this very rich commentary
Helene Gayle   : But, you know, we want to respect everybody's time. So first of all, just thanks to everybody who showed up to provide your insights, your wisdom, your passion, your personal experiences.
Helene Gayle   : The data that you provided it all makes such a difference. And I think this really has been a very, very rich discussion. You know, I think it really demonstrated why it was worthwhile to do this.
Helene Gayle   : You know we have a lot of work to continue to do. You've given us a lot of great things to think about some
Helene Gayle   : Specific to the draft that we release some that may be more relevant to some of the chapters that we have yet to go and some that are frankly beyond the mandate of this particular report but nonetheless are very important comments to be reflected
Helene Gayle   : So, you know, there's no way that I'm going to try to summarize what were the key points and the important issues because there were so many
Helene Gayle   : I'd like to thank our committee for hanging in there and listening, you know, as I looked at this Brady Bunch of squares. You know, I saw all the nods and, you know, really.
Helene Gayle   : People really leaning into this and and listening very attentively to issues. So I think the committee has really taken this
Helene Gayle   : Seriously, and we will be going back together as a committee and deliberating about all of these issues again want to thank the incredible staff for all that they did to make this meeting possible, as well as, you know, continuing to
Helene Gayle   : move us along on on our journey as we continue to make sure that we keep this make this a report is is really a high quality.
Helene Gayle   : Of value to the nation. So I think I will just stop there and say again thanks to everybody for this incredibly rich afternoon. You've given us a lot to think about.
Helene Gayle   : But we really, really. Thank you. And this has been incredibly worthwhile. So thank you all and we'll see you soon. And oh, just for to remind people. Yes, thank you, that you can continue to provide written comments until
Helene Gayle   : 1159 eastern time on Friday, this Friday, September 4 many of you had many more comments than you were able to present orally and I know there are others who have comments that they were able to
Helene Gayle   : Express to us provide to us. So thank you. We look forward to your written reports and we really appreciate this day. So thank you very much.
