Coronavirus (COVID-19): Press Conference with Rebecca Weintraub, Mansi Kansal, and John Brownstein, 06/10/21

You’re listening to a press conference from the Harvard School of Public Health with Rebecca Weintraub, director of vaccine delivery at Ariadne Labs, Mansi Kansal, product manager at Google Health, and John Brownstein, chief innovation officer at Boston Children’s Hospital. This call was recorded at 12:00 p.m. Eastern Time on Thursday, June 10th.


MODERATOR: Dr. Weintraub, do you have any opening remarks?

REBECCA WEINTRAUB: Sure. I’m pleased to start us off. I’m thrilled to be here with my collaborators on the call, who are going to correct me in route. But just to start us off with the problem statement, which I think we all know well, and especially the reporters on the call today, is that our state and local leaders, all the jurisdictions that are distributing the vaccine, continue to confront uncertainty about how to help those that are unvaccinated overcome barriers, including geographic distance. And across the nation, it is clear that there are vaccine deserts, the areas where people have limited access to COVID-19 and they’re persisting today. So while we know from, that there are fifty thousand plus vaccination sites, we also know there’s over 20 percent of people in the United States who do not live within five miles of locations where the vaccines are made available. So we’re in this precarious state, while supply clearly outweighs demand, we know the variants are circulating. After cresting at over two million folks on April 13th, the number of people receiving the first dose of the vaccine each day has plummeted. And Biden’s goal to vaccinate 70 percent of Americans by July 4th will mean iterating on local strategies to ensure we reach all communities. The unvaccinated face greater risks with the variants in circulation. So we’re looking forward to having a discussion today about the vaccine equity planner developed by Ariadne Labs, Boston Children’s Hospital with Google is a free public tool designed to help public health planners and providers identify areas where access to COVID-19 vaccines is limited and aid in identifying promising sites to open up these areas. The tool is powered by vaccines that the data of active COVID-19 vaccination sites, combined with geospatial data and travel times provided by Google. The tool also overlays millions of data points on the map of the country to identify areas of limited vaccine access. Leaders can model where to put new sites taking into account travel time, social vulnerability, the number of unvaccinated people in an area, and changes in vaccine confidence. Across the vaccine deserts in the United States, there are about four thousand two hundred health related sites that could potentially offer vaccines such as primary care, health centers, federally qualified health centers and pharmacies. Our tool can answer the following questions; where is access to the vaccine limited? How do we improve access for vulnerable communities? How do barriers change when individuals do not have access to cars? How do barriers to vaccination differ across counties? And are there potential sites to open within these low access areas? The leaders that we’re interfacing with face a question, not only where are the unvaccinated, but how do they lower the fence today, improve confidence in the vaccine and protect us all from the variants and circulation? Advancing vaccine equity is a key strategy to limit viral transmission and mitigate the consequences of this global pandemic. I will pass the baton to Dr. Brownstein, who’s been my colleague in arms throughout this development of the vaccine allocation.

JOHN BROWNSTEIN: Thanks, Rebecca. And I think you’ve basically covered everything. We’ve been running a tool called for many years, actually. Google started it nine years ago with the H1N1 pandemic. And we’ve been working with CDC to build tools to support consumers accessing the vaccine with that product transition to, it’s been the main resource for the country to figure out where to get COVID vaccines in the population. The challenge with that tool is that it is not necessarily a level playing field for all of the population. There are incredible deserts that create situations in which certain populations are favored for access and certain populations are unfavored. So ones would be medically vulnerable populations, disadvantage populations, minority populations, rural populations. And this is through the data that we’ve been pulling together as part of the effort. It also represents an opportunity for us to really fully understand where gaps in the existing network are. And with and the vaccine equity planner, essentially this is a tool to help optimize the network and fill in the important gaps that exist. And especially as we head towards this July 4th milestone of trying to get 70 percent of adults with at least one shot, the only way we’re going to get there is with a ground game of essentially deploying vaccine in populations that are in low access. And we recognize the fact that while vaccine hesitancy is an issue and there’s many people in the wait and see category, the combination of vaccine hesitancy and access can’t be ignored. And if you can improve access through optimization of the network, you can get people from the wait and see category into the immunized category. So this is really the attempt of what we’re trying to do here with this tool and to support our public health colleagues that are have been challenged in terms of resources to essentially work to essentially improve how they’re delivering vaccines to the community. I don’t know if Mansi wanted to add anything from the Google front.

MANSI KANSAL: Thanks, John. So, yes, at Google, we are very excited to be part of this initiative. Through the pandemic, Google has been working to support consumers and public health with information that can help decision making. And we see a huge potential for us to be able to help mitigate access issues and still be very excited about providing the data said that computer travel times to vaccination sites and to power the vaccine equity tool.

MODERATOR: All right. Thank you, everyone. First question, go ahead.

Q: Hi. I just wanted to ask you guys about a similar issue globally. As you know, the US just announced it will buy millions of Pfizer doses for lower income countries. But as we know, that’s just the first step. So I’m wondering what you guys think about what does COVAX need to do or the US need to do, what can countries do to make sure those shots get there, or is that really up to the countries themselves?

REBECCA WEINTRAUB: That is great. I’ll start and pass it to John in a moment, if that’s helpful. So first, I think there’s tremendous lessons from what we just learned in the United States, as all countries will initially face vaccine scarcity and they’ll be facing a portfolio vaccine, so not only the mRNA vaccines, but the Johnson and Johnson vaccines will likely be donated. And so how do you plan and prepare for allocation of different vaccines to subpopulations, considering the diversity within each country? So I think there’s actually many lessons we learned from thinking about planning for the allocation of the COVID-19 vaccines at the country level and how to help Ministers of Health, for example, plan and prepare for vaccine scarcity when demand is high and supply is low. And then the phase that we’re in right now where supply is stable in the US, but you’re trying to improve demand and confidence. The second piece of your question, I paused for a moment, but I think there’s also an important piece here that we hope COVAX will be leading to secure vaccine supply for the health care. So there’s 50 million health care workers across the globe and, you know, our health workforce is unfortunately at the front lines and are vulnerable to COVID-19, and so there’s many folks working on how to get the vaccine to protect the workforce so the workers can then stabilize access and care for the general population. And I actually hope that the tools that we’ve created for the United States will be models and prototype for many other countries and eager to work with this collective team that are on the call today for other countries. John, I’ll pass it to you.

JOHN BROWNSTEIN: I mean, I think you really covered it. I mean, there are, of course, plenty of lessons to be learned, both through sort of the successful parts of the rollout, but then also some of the challenges. We clearly have recognized as part of the rollout that while we were able to get a deal with a huge amount of demand initially, that wasn’t necessarily rolled out in the most equitable way. And this is why with vaccine planner, we are attempting to make sure that we are considering vaccine deserts and access and how that links to social vulnerability. So what we’re trying to do, of course, is bring this to a we’re actually having conversations with other ministers of health to think about how they can bring in a tool that considers equity from the beginning is clearly a part of the role. I did consider these issues, but there are incredible gaps as well. And we know that, unfortunately, populations that need the greatest access are probably also the ones that suffer the greatest consequences of this fire. So I think your question is absolutely right. It’s great to secure that huge number of doses that will make a significant dent in our ability to control the pandemic. But if those doses aren’t delivered in equitable ways, and then we will not necessarily be successful in bringing this pandemic to a close in any rapid sense. So that’s a really great question.

MODERATOR: Do you have a follow up?

Q: Thank you. Yeah, just quickly, we know that there’s at least hundreds of thousands of Johnson and Johnson doses that may expire that are here? Do you think those should be donated abroad or used in these vaccine deserts you guys are talking about? What should be done with those?

REBECCA WEINTRAUB: That’s a great question, I mean, I’ll just add that one of the things that we’re optimistic about is that we’ll likely learn soon that the vaccines are shelf stable. So these expiration dates that were initially set in the midst of an emergency use authorization created a very short window for their usage. But as we gain more data, I think we’re going to see a change in that policy. And so what is interesting is that different companies have taken a different policy regarding labeling of the packaging. So some of the companies have decided to label the package with the expiration date, printed others, and put a QR code that you call to learn about the expiration date. And we’re actually hoping that small tweak in a product packaging enables us to, in a sense, change the shelf life as these policies change.

JOHN BROWNSTEIN: Yeah, I think clearly it would be great to extend the shelf life of the J&J vaccine. I do think it’s a good question because we have been monitoring confidence around each of the different vaccines. We have a partnership with Survey Monkey where we’re looking at willingness to take each of the vaccine among those that are unvaccinated. And unfortunately, what happened when J&J was paused was a real drop, a massive drop in confidence around that vaccine. And unfortunately, it has not fully recovered. So we do have the struggle of a lot of supply of a vaccine that is an effective and really valuable vaccine, especially as you think about hard to reach populations where there’s potential loss of being able to get their second dose. So there is a struggle now where we have a supply, we have an effective vaccine, but potentially not a huge amount of confidence in this particular shot. And so we need to do a lot more work to figure out how to educate people that this is incredibly safe vaccine and worthwhile for those who are yet to be vaccinated.

MODERATOR: I have a quick question there, so you said that with a pause, the J&J vaccine, a lot of people lost confidence in it. Who were those people? Are they the people who are going to be receiving the shot or are they the health care leaders that we’re distributing them or the like, the politicians who lost confidence?

JOHN BROWNSTEIN: Oh, so we survey through survey monkey. We survey a representative sample of the US population. And we essentially found that across all demographics we saw there is a drop in confidence that was specifically among women, and someone can correct me on the exact age range because I can’t remember. But specifically, women to drop was even more significant. But it was actually across the board, across all demographics that we surveyed, that we saw this drop in sort of intent to get the J&J vaccine.

MODERATOR: I have a question about the tool, when you put the tool together, you were kind of going through the results of what came up on the tool. Were there spots that were a surprise to you about that they were a desert or that they were not a desert for vaccines? Were there any geographical locations that really stood out to you?

REBECCA WEINTRAUB: Well, I’ll mention what I found striking was that there were so many primary care providers that could alleviate the desert. So we think about the initial messaging regarding this vaccine was that it required specialized storage that requires specialized dilution, the complexity of administration, of an mRNA vaccine really in many primary care providers were not involved in the early rollout. And now we know this can be stored in the fridge for one month to three months, instructions to dilution. So it is much more accessible for a single provider at the family medicine doc who’s sitting in one of these vaccine deserts to begin thinking about its deployment and not be worried about wastage. So it’s exciting for us, to be honest, every time one of those red dots lit up in the desert, this is whom we should be doing outreach to. And we just got that feedback from the head of vaccine distribution in Tennessee. She was about to Google and look for providers in areas that she thought and estimated were vaccine deserts and she immediately used the tool yesterday and began calling those providers that lit up on the tool.

MODERATOR: Great. Anybody else want to contribute to that or otherwise, we have a question. We’ll just go to the question.

Q: Hi, thanks for taking my call. I did want to sort of follow up on that. In the areas where there is a lower uptick, we’ve been sort of reporting that it’s some southern states or, you know, and kind of matching areas of voting patterns with uptick. Is it a matter of refusing hesitancy or is it a matter of a state infrastructure not being adequate to handle that initial need when states were so involved in vaccine distribution?

JOHN BROWNSTEIN: I can take a stab and then others can jump in. Yeah, it’s a really good question and I think the answer to your question is it’s not clear cut. It’s multifactorial. I think that there’s this intersection of issues around access and confidence. And they the combination is what sort of leads to lack of sort of immunization. So if you’re in a vaccine desert, you have to drive 30 minutes to get a vaccine. You’re on the fence about it. That’s a situation which you’re not likely to get immunized if you happen to have a vaccine clinic within a couple of minutes of you. And it’s easy and it makes sense and doesn’t require a huge amount of time off work that becomes much more palatable. And so I do think we’ve been working on this issue since we started the vaccine finder project for COVID, we’ve been trying to analyze these vaccine deserts and have been pointing out these issues of access and how they line up with certain types of demographics. And you’re right, there’s an intersection between because we work with data from Facebook around vaccine confidence. And clearly there’s strong overlap. Deserts also happen to be places; some at least happen to be places where there’s low confidence in the vaccine. But that’s not always the case. There are plenty places where there’s a lot of people that are in the will get vaccinated category. But structurally, they’re just not in a position to get the vaccine. So the more that we can increase that sort of convenience, the more likely will sort of push people into the get vaccinated.

REBECCA WEINTRAUB: And just to add to John’s point, I mean, one of the things that’s been clear for large employers is the incentive of paid time off. So we’ve communicated as providers currently vaccinate folks. People are very concerned about the side effects after that second dose and if they’ll have to take time off. And so what we know is it’s about 20 percent of employed unvaccinated adults would be more likely to get the vaccine if their employer gave them that time off to recover from their side effects and that in and of itself may be an incentive. And then the second, which we know is a significant number of Americans are actually waiting for a full FDA approval of the vaccine before getting it. The difficulty is the risk of being unvaccinated today is significant. And how do we communicate both to those who are waiting for the full FDA approval.

Q: I actually wanted to ask you about that, because that just struck me when I read that had that same data. Is that just yet another excuse? I mean, in other words, we’ve seen how vaccine hesitancy has kind of morphed from issues of granola people who don’t like weird things in their bodies to the libertarian point of view. And so I just wondered, like, is there a way to get at is that an actual concern? And then I also wanted to kind of on that line, what is different about this vaccine hesitancy and the deserts, and the uptick compared to what we typically have known about vaccine deniers or refusers? What’s different?

REBECCA WEINTRAUB: That is a great question, I’ll start, but give a partial answer, glad there’s other books in the call. So, I mean, first, just as a vaccinator, I would say that most folks are coming with a degree of uncertainty. This is in the midst of an unprecedented pandemic where people have not had access to their providers, or they’ve had to establish via telemedicine caregiving relationship with someone new or had difficulty accessing providers in person. So I noticed just the sense of stress that the folks come to the vaccination side with the sense of relief they gain when they begin the vaccination process. But I agree with many of the question’s folks are asking that they want to begin a conversation about what this means to get an injection of a dose of the vaccine under an EUA. These are all the new terminology to the American public. This is not like a routine vaccine that you receive yearly the flu vaccine or the childhood immunization schedule. So I think in many ways we need to continue doing is to ensure that providers can have those conversations. This is about your preventative health, reestablishing and maintaining your health and wellness in the midst of the pandemic. And the vaccine is one of those tools and a bridge back to a healthier, more resilient self. And the second is, I think it was quite clear, is that this became a very politicized moment. Operation WARP speed, the terminology that we use, the terminology of emergency use authorization. These are not terming I normally use as a provider with my patients. And so. This has become very public, the approval process, but I understand why Americans are asking these questions, and I think what has been clear from the survey data is having a discussion with a trusted provider helps alleviate the stress, engage folks in not only the vaccine, but in reestablishing care.

JOHN BROWNSTEIN: Yeah, I think it’s a really good question. I think the diagram around people who say are willing to the flu shot, but not the COVID vaccine and then those are willing to get the vaccine. The flu shot. There are groups in those categories. And I think, of course, there’s going to be the underlying sort of vaccine deniers that don’t want it for any in any circumstance. But I think what you’ll see is there are different groups, right? There are plenty of people who just don’t want to get the flu shot but have been convinced that the vaccine is our ticket to getting to the other end of this pandemic. And then there’s plenty of people that get the flu shot who feel like it’s been studied for years but are really concerned about the fast timeframe in which the vaccines got emergency authorization and really want to wait and see. So it’s absolutely not a perfect overlap. And I think there’s, of course, all the incentives to get on board with the vaccine, which do not exist with your annual flu shot, clearly have made a difference. We have seen that it’s made a difference because we look at sort of the analytics around that we run and we can see sort of the uptake that you get with all the range of incentives, whether it’s lotteries or the very or even mass mandates changing. So clearly that is driving people to get this vaccine where potentially they would never have gotten a flu shot. So it’s absolutely interesting to look at sort of the differences in populations, but most importantly, to understand that to sort of figure out who to target to get on board.

MANSI KANSAL: And if I may join into kind of talk about the hesitancy versus the desires that you asked about, and this is something Google has been thinking a lot about, in addition to this data, certain access to vaccines, we’re also going to release data soon on such trends in volume of searches around vaccines in general, intend to get vaccinated and safety and side effects to better understand the concerns of the communities. And yeah, we’d love to be followed up with you and share more information if you’re interested.

Q: Thank you.

MODERATOR: I see while we’re waiting for somebody, I had a couple more questions as well, so we’ve been hearing more and more about the Delta variant and how it could be easily more transmissible and also how severe outcomes than other variants. Keeping that very in mind, how important is it to eliminate these deserts at this point in the pandemic?

JOHN BROWNSTEIN: Yeah, happy to jump in there. Yeah. So exactly. I think this concern about the Delta variant and we’re seeing in the U.K. a slight rise in cases even among highly immunized population, mostly because it’s spreading among those who are unvaccinated, slightly younger populations. And in fact, what we’re seeing is increased severity of infection. So that combination of increased transmission, transmissibility and severity is concerning. And that we have, what, about six percent of isolates, a Delta variant at this point here in the US that is likely to continue, and that variant will find the pockets of unvaccinated individuals and those populations, we can’t look at the US as a homogeneous estimate of vaccine uptake. It is all about sort of pockets of transmission. And if you have large or even small populations across the US that are under vaccinated and we know that there are plenty of communities that are sub 30 percent having that first shot, the Delta variant will take hold. And as you know, we also found out that the single shot was not as effective as getting the full sort of two doses of Pfizer. And so that is very concerning for what we might see heading into to later in the summer and fall, as we might expect, even a small surge that will impact, again, what we think. The deserts, of course, line up with the most vulnerable populations who have limited access to health care disadvantage. So it’s not a great combination of having a variant that will impact sort of the most vulnerable of the country. So this is why, again, we’ve been pushing this idea of how do you fill in these gaps in these critical deserts around the country.

MODERATOR: I have another question about we were talking earlier about global distribution. Is it possible to expand the tool from US to other countries as well? Is that a framework that’s underpinning all this a little more? Is it flexible to be expanded to other areas?

REBECCA WEINTRAUB: Absolutely. This is work on the phone and on Zoom constantly about. So we built the infrastructure for this. You’re absolutely right. It’s a concern of any country trying to deploy a scarce resource and what we think about it, the public health strategies need to face scarcity and then as supply is dynamic and changes, how you need to rethink through your allocation and distribution. And we’re very eager to continue working as a tripartite partnership to think about whom else we could serve with this example tool.

MODERATOR: Any other comments on that?

Q: I just had two quick follow up questions. You mentioned you had spotted a red dot and then you called someone. Who are you reaching out to? Like how does this thing get put into action?

REBECCA WEINTRAUB: Sure. Oh, absolutely. So collectively, we’ve all had relationships with state and local public leaders throughout the pandemic. So, for example, yesterday I started with a phone call at 8:00 in the morning with Tennessee. So Dr. Michelle Fiscus, who runs the vaccine deployment, we demo the tool with her. She immediately had her team stop what they were doing because they were going to do the tape of spreadsheet analysis to use the tool and replay the tool to organize the death again this morning, to undergo over the tool again, to kind of help prepare her team for deployment. And then we’ll be sending out a significant emailing to all of the jurisdictions this afternoon. The Commonwealth Fund has also sent it to all of the state policy and outreach organizations and will present this to the Association of Immunization Managers later this week. So we have had this experience before where we think about what is the homework that all the jurisdictions need to do and can our collective brain trust here between John’s team and vaccinefinder, Google health’s team, and what are the pieces that we can layer on to help that public health leader truly be the spokesperson and localize the strategies for the needs that they’re facing? John?

JOHN BROWNSTEIN: No, I think you got it, I think Amy, do you have a second question?

Q: Yeah. So you were you were specifically saying that there was one person who was saying, oh, I’m going to contact these doctors. Was that in Tennessee?

REBECCA WEINTRAUB: Yes, that is an example use case and leverage the tool yesterday to call certain physicians to replan her outreach of surrounding areas in Memphis as an example.

Q: Yeah, and you may have answered this, but I don’t know if I heard this. What do we know the data for Johnson and Johnson and the one shot with the Delta variant, given what we know about AstraZeneca?

JOHN BROWNSTEIN: It’s a good question. It’s definitely information I’m looking for. I don’t think we do. I haven’t seen any data or at least solid data to support it. Yeah, it’s definitely something we’re looking forward to hearing about it. So, no, I don’t know if Rebecca, you have you seen anything? I think it’s too early to know.

MODERATOR: Are there any other questions out there? We have not. Do you have any other final thoughts before we go? For our speakers?

REBECCA WEINTRAUB: I want to share that the actual data itself underlying this will be updated frequently. You’ll see there’s a date in the top right corner of the screen. So folks are thinking about taking a screenshot, for example, or using the visuals that should help and also folks are feedback for us or they’re trying to think, how can I visualize this for the public, please, to help.

JOHN BROWNSTEIN: Yeah, just the same thing that our team, if their specific visuals or data or case studies that you guys are looking at that can help reinforce even other stories that you guys are working on. Just let us know and we’re happy to report on the data front in any way.

MODERATOR: Great. Mansi, did you have anything you’d like to say?

MANSI KANSAL: Yeah, I just want to tell the caller that we you know, we think it is important to show data. One of the things that we did with this tool and with our data was to show data travel trends for almost like, you know, whether people are driving or walking or using public transit, because we know that there are many populations who need access to vaccines but don’t have access to a car and need to utilize public transportation. And so it was really important for us to also bring that aspect to this tool. So I just wanted to highlight that as well.

This concludes the June 10th press conference.

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