Coronavirus (COVID-19): Press Conference with Howard Koh, 09/16/20

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Howard Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School and faculty co-chair of the Harvard Advanced Leadership Initiative. This call was recorded at 11:30 a.m. Eastern Time on Wednesday, September 16th.


HOWARD KOH: Welcome, everybody. It’s good to see you. For those of you who don’t know me, I’m a physician who was trained in multiple fields, cared for patients for some 30 years, but had the privilege of serving as the state health commissioner here in Massachusetts and then also as the assistant secretary for health in the Obama administration, through H1N1. So I’ve been tracking this pandemic and the pandemic response so closely from the very beginning and really appreciate talking to many of you about how we’re doing and where we need to go in the future. You all know that we’re into month eight and counting for this pandemic response in the United States. It’s still a very challenging time. The fall is very dynamic and very complex because we have so many schools and colleges reopening. We have the seasonal flu. Vaccination efforts are already on board and ramping up. We could have a potential second wave of COVID this fall and then we’re all anxiously awaiting an FDA approved COVID vaccine in the near future. So these are all issues that are consuming our attention right now. Right now, I feel it’s very important to keep the public’s trust and confidence in public health and any vaccine approval and delivery process as high as possible. And there have been many challenges to achieving that goal that we can discuss. I think it’s really important to send the message of getting the flu vaccine now, making that campaign effective, and showed that public health is working well to protect people and have that be the foundation for a future COVID vaccination campaign that’s upcoming. And then, as Nicole mentioned, I’ve had the privilege of being part of the public health system now for several decades, and we need strong public health now more than ever. One of the reasons why this pandemic has been so devastating is because it came on top of a system that’s been under-resourced and overlooked for far too long. So starting with the contact tracing efforts, we need to build it back up. And I’m hoping that as we move through this pandemic response and beyond, we really reinvest in public health and public health infrastructure so we can never have something like this happen again. So with that, I can just stop. Happy to take any questions from any of you.


MODERATOR: Great. Thank you, Dr. Koh. It looks like our first question.


Q: Hi. Thanks for taking questions. I’m wondering, we’ve seen some colleges take sort of two week pauses as they’ve tried to bring outbreaks on campus under control. So sometimes that means like putting classes online that had previously been some mix of online and in-person, you know, they’ll close their dining halls for takeout only. I’m wondering if these two week pauses really work. And if they do, how is it that they work? And what are some best practices for those kinds of pauses?


HOWARD KOH: Those are great questions, and we all know that there’s no playbook for how to do this right. One of the challenges of colleges reopening is that, first of all, the colleges are trying to get back on board in different parts of the country where background, community trends, mission rates vary greatly. So to try to do that in places like the Northeast might be a little bit easier since cases and deaths and positivity rates have been going down for a while as opposed to other parts of the country. We also know how complicated this is because so many colleges have students from not only from nearby areas, but from around the country and sometimes from around the world. So there’s so much dynamic movement going on. I think the two-week pause is appropriate to give us time to constantly reassess where we are, campus by campus. And it should be a lot of attention to issues like distancing not just on campus, but off campus, not just in class, but out of class while we’re seeing where there have been outbreaks, particularly related to social events off campus. So those have to be monitored carefully. And then another issue that has no consensus really has been any testing protocols and strategies from campus to campus. There are no national guidelines and still very, very little research on this. So some campuses have taken the strategy to be very aggressive in the testing. There was one very important study from JAMA that came out about six weeks ago suggesting that students may have to be tested up to every other day in order to control the virus at these universities and colleges. So we just have to communicate what’s going on as a country, put together the best efforts possible, evaluate, share those data, and then try to generate best practices sooner rather than later.


Q: How is it exactly that a two-week pause is doing that helps bring outbreaks under control?


HOWARD KOH: Well, you get to identify and isolate the people who are infected. I know a lot of colleges and universities have made dedicated efforts to have spaces and rooms available for students who are infected so they could be isolated. And then you need to institute, immediately, good contact tracing efforts so that if you were exposed, they can be quarantined on campus. We are all concerned, by the way, that people who are infected or exposed, if they leave campus too early, they can just go back home to their communities and make the infection spread more. So campuses that have been really proactive in thinking about facilities for isolation and quarantine and then ramping up on contact tracing and testing, I think are being much more aggressive about trying to control this.


Q: I’m sorry for another question, but what you’re saying are all things that a campus could do without doing the two-week pause, they could contact, trace and isolate students without doing a pause. What is it that pausing the whole campus does that’s helpful?


HOWARD KOH: Well, it clearly lowers the density of students interacting with one another. And also, if I can say, sends a message to the whole community that everyone’s got to continue to take this seriously and double down on the public health practices. You know so well that so many universities, like ours at Harvard, are pretty much online. And so to be as cautious as possible and make sure the whole community is included every step of the way in supporting the goals and then opening up in phases in evaluating each point in time. Those are the steps that fall universities need to follow right now.


Q: Great. Thanks very much.


MODERATOR: Next question.


Q: Hi. Thanks so much for doing this. The CDC put out a playbook for vaccine distribution today, but it seems to leave a lot of the logistical challenges to the states. So I want to ask your assessment of how states will be able to handle distribution. Not necessarily who should get it? But just like the nuts and bolts of moving a vaccine to different places and getting it into people’s arms. It was the little things that tripped up states during testing, you know, gloves and Q tips, et cetera. And I’m wondering if you think that’s going to happen again, only this time he’ll be sharp kits and band-aids.


HOWARD KOH: OK. Well, that’s a great question. I haven’t seen that plan; I was just made aware of it before we went on this call. But I can say that when you stop and think about it, the country goes through this extraordinary public health exercise every fall through the seasonal flu vaccination efforts where tens of millions of people are vaccinated. Then you have federal, state and local officials working together to get hundreds of millions of doses distributed and then administered all through the umbrella of a broad scale communication campaign. So as a state health official, I did this many times and then also as assistant secretary, I was very involved in that seasonal flu vaccination effort. So public health knows how to do this. And it does require. Very strong communication coordination at the federal, state and local level. So I assume that this playbook is now building on those efforts with respect to COVID. As I mentioned in my opening comments, I think it’s going to be very critical to coordinate the messaging and the efforts around seasonal flu in any COVID vaccination effort that’s upcoming to make sure all these coordination efforts are going forward in a positive fashion, but also sending the message to the public that there is a system working on their behalf to protect them against threats. So I’m looking forward to hearing about those communication and coordination efforts. One feature of the potential COVID vaccine that many of us have heard about is that some of the candidates may require not only two doses, not just one, but also special storage in freezers that go as low as minus 80 degrees centigrade. So I assume that’s part of the coordination efforts that’s addressed in this playbook.


Q: If I can just follow up on that for saying, because you mentioned that it’s building off a flu vaccine. But in this country on a good year, 40 percent of adults get the flu vaccine. So we’re not exactly great at that. We obviously need a much higher mark with this. And like you said, this is different because there’s much higher thresholds for data requirements. There are freezers that may need to be in place. And all of this is sort of being done in a compressed timeframe without even knowing what kind of vaccine states will receive yet because it hasn’t obviously been approved. So doesn’t that make it a lot more challenging than your standard flu season?


HOWARD KOH: Absolutely. And your points are excellent. You’re right. Last year that the flu vaccination rates overall were about 45 percent. And there’s been increased vaccine hesitancy over the years, which troubles all of us in public health. So I, for one, feels it’s very important to make this ongoing flu vaccination campaign a major success. It’ll be tremendous if we as a country could show that we can get the seasonal flu vaccination rates way over 45 percent, demonstrate confidence in the whole effort, and give us momentum going into a COVID vaccination effort that’s going to follow hopefully shortly afterwards.


Q: Thank you, I may come back for a second round, but thank you.


HOWARD KOH: Thank you.


MODERATOR: Next question.


Q: Morning. Following up on that, I’ve heard from some states who plan on independently reviewing the clinical trial data before distributing any COVID vaccine, so I was hoping you could give me a sense of how different that is from H1N1 when there was broad trust in CDC and ACIP. And what does that say about how much public trust has fallen in FDA and CDC during this pandemic?


HOWARD KOH: Well, there’s no doubt that trust and confidence in the federal agencies has been shaken recently, and that’s been very difficult to see. And so we need to reverse that as a nation immediately. We need to keep the trust and confidence levels at the highest possible standard. Otherwise, when a COVID vaccine, is approved, people will be reluctant to take it. And then this pandemic will go on indefinitely. And that is an outcome that no one can accept. So as you’re alluding to, really, the approval process right now to be followed are rigorously and transparently with full accountability. So that includes, as you mentioned, expert advisory groups like the ACIP, Advisory Committee for Immunization Practices, and CDC. There is another one for FDA that’s meeting October 22nd, I believe. When I was assistant secretary, I oversaw yet another one, called in back the National Vaccine Advisory Committee. So there are multiple ones. Given the concerns about trust and confidence right now for our current vaccine, I think having all those groups weigh in and review the data and share in the scientific outcomes will be critically important. And so that when the FDA approval comes forward, everybody will accept this scientifically valid. Now, you mentioned particular states. There are state organizations. I was part of one called this Association for State and Territorial Health officials asked them. And so it could be that that group would be eager to look at some of these outcomes, too. And they should be welcome to do that because we need the trust and confidence to be as high as possible.


Q: Do you think we could see a scenario where one state decides the evidence is there and to vaccinate in another state doesn’t?


HOWARD KOH: Oh, boy, that is something we do not want to see. And, you know, this is where the overall theme that Nicole mentioned as we got on, is critically important. We need a one nation approach to this pandemic response. And a major challenge has been we have had 50 states going in 50 different directions, but each state using their own criteria to reopen and then to try to generate a response. We’ve even seen states competing against each other for tests and supplies and PPE. And that is not the way to get control of this virus and put this pandemic behind us. So I think whenever a vaccine approval occurs, that’s got to be accepted by the country across the country and then implementation be done. As a country, I’ve often said through this pandemic response, we need a united plan for the United States.


Q: And could you just touch on, do you think it’s possible that we could see political interference with these independent outside committees like ACIP, or is that sort of harder to do?


HOWARD KOH: Well, those are committees have been set up for exactly the reasons that you’re alluding to. To invite expert outside high level, rigorous scientific input. In fact, this is why when I was at HHS, I spent a lot of time interacting with the expert advisory groups because we knew that we had some of the best scientists in the world, in our country, and we wanted their input and wanted their advice. So that kind of theme is really important right now, especially as we as a nation make a decision about any cold indexed in going forward.


Q: Excellent. Thank you.


MODERATOR: Next question.


Q: Hi, thanks for taking a second question from me. I’m wondering about the two-week pause I talked about before. I’m wondering if that is a better option than sending all the students home, especially in light of your Dr. Anthony Fauci and Dr. Deborah Birx have said that, you know, it’s not a good idea to send college students home because they may see outbreaks wherever they come from?


HOWARD KOH: So these things get so complex as we will all witnessed. I mean, there’s so much movement to get students onto campus from their home communities in the first place. And so I think having a two week pause is a very reasonable strategy so that all the efforts were related to the status of COVID on any campus is reviewed and in a regular and open and timely fashion and to send people home sort of on a more needed basis. It could be extremely disruptive for everyone and then also risks spreading the viral transmission back in the home communities. As I mentioned, of course, I think that’s what these administrators and college leaders are trying to avoid. So I think the lack of other definitive data reassessing on a regular basis is a reasonable approach.


Q: All right, thanks very much.


MODERATOR: Next question.


Q: Dr. Koh, I wanted to know about why is no one hearing what happened to that one patient that sidelined the AstraZeneca vaccine? And do we have enough representation of different groups? I mean, are there people over 65 testing the vaccine?


HOWARD KOH: Yeah. So you have all followed the status of this AstraZeneca trial and in the UK, the regulators there allowed the trial to restart just a number of days ago. Here in the U.S., the regulators are still weighing the decision. So we’re watching that very, very carefully. And you probably know that this phase three trial for the AstraZeneca vaccine, it’s also occurring in other places in the world of Brazil and South Africa, I believe. I’ll have to check that. So this is done by country, but then the countries have to communicate and coordinate with one another. You’re right. There have been some concerns raised about transparency, issues, about the status of that one subjects, the details about her clinical course, since coming down with that neurologic condition called transverse myelitis. We hear that she has been released from the hospital, but there’s not much more information that’s forthcoming. So, you know, there are issues of confidentiality that these companies try to uphold as they enroll subjects in these trials. But on the other hand, as we’ve just now said a number of times, the urgency for transparency and accountability is so high right now, and especially regulators in the U.S. and elsewhere have asked for much more information than what’s been released so far. So I anticipate that information will be forthcoming. What you all know that, last week was it? I think it is last. So much happened. Those CEOs of nine pharmaceutical companies pledged that their trials would be done in the most scientific and transparent way. So they’ve made that pledge. That includes the AstraZeneca CEO. So we need those words turned into action right now.


Q: But do we know about the groups that are in these trials? I mean, are there people over 65 and maybe over 80, are there pregnant women?


HOWARD KOH: So I don’t have access to the exact numbers, and, of course, those trials are ongoing. They’re supposed to be reaching thirty thousand people. That number has not been reached yet. So I anticipate those numbers continue to change as we speak. But the goal is to enroll high risk people, adults, older adults. And then also to increase the percentages of people of color. There’s been some attention to that very important thing. So you’re right, these trials are going to be most powerful when they are in rural people who are at high risk are older adults, people of color. And then we’ll get to see all those results when the trial is completed and all your enrollment is done and get our scientists here and around the world to look at those in a transparent and rigorous fashion.


Q: Thank you.


HOWARD KOH: Thank you.


MODERATOR: Next question.


Q: Hi, thanks for coming back for round two. You were a Massachusetts health secretary, so I want to ask about the supply chain issues again. If there are, whether it’s in the spring or even early winter of 2021, millions of doses available, what would your advice be to states in terms of ramping up supplies? I mean, do you envision states once again bidding against each other for sort of simple items like these sharps kits or things like.


HOWARD KOH: OK, so you’re talking about seasonal flu in particular?


Q: No, COVID vaccine. So when we have millions of COVID vaccine available in not winter/spring of 2021, CDC has said it will send syringes, but not things like sharps kits, not things like gloves. So, you know, states are going to need presumably millions of those, and every state is going to be doing it at once. I would think that could lead to some kind of, you know, bidding war or just supply shortage.


HOWARD KOH: So, again, when you really think about the seasonal flu vaccination effort and you step back and take a big look at it from a national view. I call it an annual minor public health miracle that we get to do this year in and year out involving hundreds of millions of doses and tens of millions of people. So it requires first, developing a new vaccine every year. That’s what the seasonal flu vaccination efforts involve. And then lots of coordination between state, federal and local officials early on, way before vaccinations ever begin to identify how much is needed across each state in addressing the need at a city and local level, too, so that when distribution occurs, it’s done seamlessly and then people get access to timely vaccination as needed over time. For example, we’ve seen been increasing the roles of pharmacists and pharmacies to do this, businesses, schools, faith-based organizations. So when you stop and think about it, it’s an unbelievable public health collaboration. And it’s something that I know that every public health official is very proud of for seasonal flu this year. I know the CDC has ordered much more in terms of vaccine doses to make this fall go as well as possible. And as I mentioned before, we got to make that really strong and show the American people at this critical time that it’s going to go very, very well and build confidence that a process is protecting people as we move into coalbed vaccine. So I’m hoping that all these efforts, in summary, are a foundation for a process that improves coordination at the federal, state and local level going forward.


Q: Thank you.


MODERATOR: Good. Next question.


Q: Thanks very much, Doctor. I wonder if you could comment on whether having a presidential election and a vaccine roll out at the same time is a great thing in terms of public trust. Joe Biden is giving a vaccine speech today about one o’clock and two o’clock. And Trump is preempting that at 1:00 p.m. with a vaccine, saying that he just announced. Is there a precedent for this? And what is this? What’s your take on how public trust does or doesn’t do and in the midst of this kind of stuff?


HOWARD KOH: Well, first, it’s good to hear your voice again. Thank you for your continued interest. You know, I was the state health commissioner under multiple Republican governors and then I was the assistant secretary under a Democratic president. So I always viewed vaccination as a public health effort, a scientific effort, and not a partisan effort. And we have to keep that standard high at this critical time and going forward. You know, vaccination and prevention are lifesaving efforts that apply to everybody that has it. It shouldn’t have anything to do with elections and then partisan negotiations or any of those themes. And as we’ve mentioned many times, we got to keep the trust and confidence high and everybody in public health that’s concerned about that trust and confidence being shaken for multiple reasons. And the last thing we need whenever a COVID vaccine is approved is having people refusing to take it because they don’t trust the process of approval. And we’re seeing some polls. You’re all probably aware of some concern from the American public about taking such a vaccine. If and when approval occurs, then we just cannot allow that to happen. Otherwise, this pandemic will just go on indefinitely and that will be a disaster. So this is a time where, once again, if we can show that everyone is working together as a nation, as a bipartisan, nonpartisan effort, as it always has and should be. That’s the way to get this pandemic behind us.


MODERATOR: Do you have a follow up?


Q: I also wonder if you have any concern about HHS and CDC, the various agencies stepping on their own feet with how they’re describing the rollout? Just today, HHS Deputy Chief of Staff Paul Mango said that everyone will be vaccinated by April and then like an hour or two later. Dr. Redfield at CDC just told the Senate that it’s going to be the end of the second quarter, third quarter before we can start to talk about that. We know that’s July and later. You know, I just worry with 2009, there was concerns about shortages and surpluses that disappointed people. How careful you have to be throwing around these roll out numbers if you’re in charge of this sort of thing, to not create that kind of expectation.


HOWARD KOH: Good questions. You know, well, everyone knows so well that one of the many challenges of this pandemic response in our country has been the mixed message. And we have too many examples of that. So you’ve just cited another one. Unfortunately, you know, it’s really important to have consistent messaging for the American public, whether it’s from HHS or federal government or the White House, because people need to see in this country that there is a unified system working on their behalf. And when the mixed messaging occurs and all it does is so confusion and then the distrust rises. And that’s just absolutely tragic and unacceptable. So those examples you cited are concerning? No, we if I can just say on the COVID vaccine in particular, there’s so many uncertainties about it, about how many vaccines candidates will be approved. One or several. When will that approval occur? How much? Vaccine will be available initially as it gets distributed. Who will get the vaccine first? The timeliness of distribution and the vaccination efforts going forward. So based on all that, I think any public projection of when that process can be completed has to be made very, very carefully. And it’s got to be consistent by the leaders in government right now.


Q: Thank you very much. That was all really very helpful. I really appreciate it, sir. It’s good talking to you.


MODERATOR: Great Dr. Koh, do you have any other final thoughts to share with us before we go?


HOWARD KOH: Thank you for your interest in public health. I close by saying that the privilege of teaching at this great public school, we have students from around the world and I just tell them that they have chosen an incredibly important, fascinating field but a challenge is that the field is invisible. Now, I say that I congratulate them for joining a fascinating and very important field, and the field is very visible. It’s never been more visible, and the importance of public health and prevention that has never been higher than a time like this. So, when we have press interactions like this, you can help us send out the message, the importance of public health, it’s just critically important to build on this going forward so we can all enjoy the incredible gift of health in all of our lives. Thank you so much.

This concludes the September 16th press conference.

View more press conferences