Aug 31, 2020

Axios Vitals

Good morning ... Man, I like to think I'm pretty good at Smart Brevity, but I've got nothing on this guy who condensed every musical into a mere 48 seconds.

  • Tonight on "Axios on HBO": What Eli Lilly CEO David Ricks thinks about pressure from President Trump to speed up coronavirus treatments and vaccines. Tune in at 11pm ET/PT on all HBO platforms.

Today's word count: 859, or a 3-minute read.

1 big thing: The next pandemic

Photo illustration: Aïda Amer/Axios. Getty Images photos: Bettmann/Contributor and Noam Galai

At some point, this will happen again. There will be another new virus and another pandemic.

  • And while every pandemic is different, there are some universal lessons the U.S. should learn for the next pandemic — some big, some small, some lessons from what went wrong this time, some lessons from what's gone right.

1. Move fast.

2. Diversify the preparation.

  • The global public health community had been preparing for a pandemic, but may have been too narrowly focused on an influenza pandemic, says Claire Standley, an expert on international public health systems at Georgetown University.

3. Have a backup plan for diagnostics.

4. Build up contact tracing.

5. Accept risk on vaccines.

  • Governments, drug companies and philanthropies are accepting an unprecedented financial risk in the race for a coronavirus vaccine, and it seems very likely to pay off.

6. Walk the public through the things you're asking of them.

7. International cooperation is key

  • Some institutions may need to be reformed, Standley said, and others — perhaps the UN — may need to take on a bigger role in some parts of future response efforts.
  • But in a global pandemic, information-sharing and cooperation is essential to understanding the threat, figuring out who's most at risk, and allocating the resources everyone needs to get through it.

8. We need a more equitable health care system.

  • We can't know now what will cause the next pandemic, but we know that the status quo of the U.S. health care system will put poor people and people of color at a disadvantage from the very beginning.

9. The economic response and the health response go together.

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2. The risk of moving too fast on a vaccine

FDA commissioner Stephen Hahn. Photo: Kevin Dietsch/AFP/Getty Images

Everybody wants a vaccine. You want a vaccine, I want a vaccine, we all want a vaccine. But there are risks in moving too quickly.

Driving the news: FDA commissioner Stephen Hahn told the Financial Times that he would at least be willing to consider granting an emergency use authorization (EUA) for a vaccine before it has completed Phase 3 trials.

  • Let's be clear about the constraints in this hypothetical: Hahn only said he wouldn't rule out an EUA, not that the FDA definitely would grant one. And an EUA is not full approval; it could be tailored to specific groups.

Yes, but: This is why the uproar over the agency's emergency approval for convalescent plasma, and the concern it was done for political reasons, matters.

  • If you think the general public understands the difference between approval and emergency authorization, you're mad. Any action on a vaccine will create the impression that there's a vaccine.
  • And if it's done too early, with too little evidence, it could undermine ongoing work on potential vaccines that might turn out to be more effective.

As the NIH's Anthony Fauci recently told Reuters:

  • "The one thing that you would not want to see with a vaccine is getting an EUA before you have a signal of efficacy ... One of the potential dangers if you prematurely let a vaccine out is that it would make it difficult, if not impossible, for the other vaccines to enroll people in their trial."

Related: Inside Trump's pressure campaign on federal scientists over a COVID-19 treatment (Washington Post)

3. Companies embrace coronavirus gag clauses


A host of large employers — from Amazon to Cheesecake Factory — are ordering employees who have had the coronavirus not to talk about it, or even to discuss the virus at all, Bloomberg reports.

  • Many of them are reportedly relying on laws that protect the confidentiality of employees' health information — but those laws do not in fact prohibit employers from notifying employees of a potential health risk, and certainly do not bar employees from voluntarily discussing their own experiences with their coworkers.
4. Pharmacies, not troops, will do the vaccinating

Illustration: Sarah Grillo/Axios

President Trump has said many times that the military will have at least some role in distributing a coronavirus vaccine.

  • For the public, though, this won't feel like a military exercise, with heavy trucks rolling into town and people lining up outside medical tents. It'll feel like going to CVS, Kaiser Family Foundation president Drew Altman writes in his latest Axios column.

Government agencies — maybe including the Pentagon, maybe not — will do the behind-the-scenes logistics of allocating the available doses of an eventual vaccine. But when the time comes for individual patients to get vaccinated, the process will seem far more mundane.

Details: The leading vaccine candidates all need to be stored at sub-zero temperatures until they're administered — something major pharmaceutical distributors and pharmacy chains are already equipped to do.

  • Most of the leading candidates require two shots. Keeping track of who's been vaccinated and who's due for their second dose is work that pharmacies, doctors and hospitals are used to doing.
  • So is navigating insurance coverage and payment.
  • The vaccines are also expected to have side effects such as fever and chills that mimic virus symptoms, so it'll be important for patients to get a consultation ahead of time and to be able to consult their providers if they need to.
5. Catch up quick
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Data: The COVID Tracking Project; Note: Does not include probable deaths from New York City; Map: Andrew Witherspoon/Axios