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How To Get 1.8 Million San Diegans Vaccinated

 February 8, 2021 at 10:04 AM PST

Speaker 1: 00:00 Examining the vaccine rollout in San Diego from supply to hesitancy, Speaker 2: 00:06 The ones that have impacted the highest are the one set up well, hesitant to seek the backseat. Speaker 1: 00:12 I'm Maureen Kavanaugh. This is KPBS midday edition. Today. Midday edition brings you a special broadcast called the road to 1.8 vaccinated. San Diego wins. How can this vaccine rollout become clearer to the public? How can various agencies coordinate better? And when will we get all the vaccines? Speaker 2: 00:41 You know, I feel like a firefighter with a hose ready to go to put out this terrible fire that's killing people and the hydrant just isn't cooperating. We just, we need more doses. Speaker 1: 00:50 Join us for today's special panel discussion. That's ahead on midday edition. Speaker 1: 01:00 The goal is to vaccinate 1.8 million people in San Diego County by July 1st. That's about 70% of the region's population over age 16. Currently about 2% of our County is fully vaccinated. So what does the County need to do to reach that goal today? We bring you a recent KPBS panel discussion on the subject called the road to 1.8 vaccinated. San Diego wins moderator KPBS health reporter Taran mento was joined by guests, Dr. Rodney hood, a local physician who has served the Southeast San Diego community for decades. He's a member of the state's vaccine safety advisory group, and one of the chairs of the county's vaccine clinical advisory group. He's also the president and founder of the multicultural health foundation. Also joining the panel was Patty Mason, the CEO of UC San Diego health, which is partnering with the County on community vaccinations, particularly the mass vaccination site at Petco park. Their third panelist was Dr. Christian Ramers. He is the chief of population health at the family health centers of San Diego. Dr. Ramers is also on the counties clinical vaccine advisory panel. Here's a reporter Taran mento. Speaker 3: 02:19 I want to first begin with hearing from each of you, what you think your role is to get the County to this goal. So let's begin with you, Patty, what do you feel you are responsible for to get us to 1.8 million? I think we view it as our role at UC San Diego health to work with our other health systems, with our partners, with our community, with the County to get our community vaccinated as quickly as possible. Uh, we established the first super, uh, station, uh, down at Petco park in collaboration with the city of San Diego and the County of San Diego and the San Diego Padres. Uh, and today we hit a thousand vaccinations given. So we're on the road. Um, we have a long way to go, but we were on the road. Thank you, Dr. Ramers same question to you. What do you see as your role to reach this goal? Speaker 4: 03:10 Dr. Hood and I are on the County clinical vaccine advisory committee, and really that committee was formed to advise the health officer Dr. Wooten, and to advise the County on what we think should be the rollout and the implementation. And we've had meetings really every week, a very passionate discussions about what we think is right, how we can maintain equity in the implementation and then getting really into the weeds of how this looks. This is a really incredibly complicated operation, and I'm happy to say that we've made, I think 17 or 18 formal motions and formal recommendations to the County. And Dr. Wooten has really looked through all of them and really take an action on the majority of things that we have presented. So that's, uh, that's kind of my personal role there. I speak Spanish, you know, as a bilingual doctor, I've, I've really done my best to try to speak to the Latino community about the risks and benefits of the vaccine, uh, trying to do community forums and, um, educate our own providers at family health centers, as well as, you know, any Spanish language news outlets. And I will say that as an organization and family health centers is a federally qualified health center. We exist in a lot of the neighborhoods that have been hit hardest by COVID. And so we are very much looking forward to, and very much ramping up as more vaccine becomes available, being a community vaccination site. And we're already doing quite a bit of education to get people ready to get the vaccine. Speaker 3: 04:24 Thank you. And Dr. Hood, same question to you. What do you think your responsibility is to get us to 1.8 million? Speaker 5: 04:29 I really feel that I'm a part of the team here in San Diego and, uh, for the last 40 years I have spent time really is what I want to call the equity of warrior. So, uh, as a physician, I have done a lot of community engagement and really advocating for a new specialty in medicine called, uh, uh, physician community organizing because I think there needs to be a link between community in the clinician. And so as a Christian talked about, I have been working not only with the County, uh, with the state and nationally. So I hope reign a equity lens. When we talk about vaccine distribution, um, if we're going to reach 1.8 million is a lot of vaccine hesitancy individuals out there and they fall into the realm of the people of color and underserved communities. And I think it's important to have a message that will decrease that hesitancy. I also recently joined sane Seadrill health, uh, have, uh, gotten involved. I was happy to learn that, uh, San Ysidro health very engaged in this vaccine outreach. Uh, I think up to date in less than a month, they've now vaccinated close to 5,000, uh, individuals and, uh, about, uh, 300 a day. And I think their plan is to continue not only for the same deceitful patients, but beyond. Speaker 3: 05:54 Thank you. So again, I've broken this down into three areas. The first is communication. That's the messaging and access necessary to get 1.8 million people to turn out for a vaccine. And, and just to draw a loose comparison about 1.6 million San Diego Diegans voted in the 2020 general election. It was a smaller timeframe, but there were lots of ads to get out to vote, and people could actually vote from home for our vaccination goal. We do have five months, but getting 1.8 million people out of their homes to sometimes wait in lines is going to be a big lift, especially because at least right now they have to do it twice because there are only two dose vaccines. But we do know recently just today, um, the one dose vaccine from Johnson and Johnson, they did apply for their emergency use authorization authorization. So that should be coming soon. This first question is directed at Dr. Hood. You just hit on an equity. It's a key focus for you. A key focus for health officials to get to 70%. Everyone from all backgrounds has to do their part. They must be included. So what kind of messaging is needed from the County and vaccine providers to make sure information is reaching everyone? Speaker 5: 06:57 First of all, let me state, I think we're very fortunate here in California, that we've had good leadership, both at the state and the County level in that when I talked to my colleagues across the country, uh, what I'm learning is that, uh, we're quite fortunate here in the San Diego, uh, the community docs and clinics and, uh, partners have a good relationship with the County of San Diego in this linked to the input that we're given. Uh, but if we are truly to achieve 1.8 in an equitable way, we need to have a specific strategy for the individuals in the populations that are impacted the highest. And sometimes the ones that are impacted the highest of the ones that up will hesitant to receive the vaccine. So we need to have direct, specific outreach and messages to those communities. I'm happy to say that the County has already funded local community-based organizations, specifically aimed at that next communities, Asian communities, African-American communities, immigrant communities. And I think that that needs to continue. I hope it's that we want to use COVID as a launch because we always talk about health inequities associated with COVID, but health inequities existed long before then. And I hope we use the model that we're developing for COVID to continue beyond. COVID Speaker 3: 08:27 Just mentioned that the County is doing a good job with its messaging, um, and, and trying to reach everyone. And Dr. Ramers, I'm going to come to you with this one. We do have a little bit of preliminary data on who has been getting vaccinated. And half of those who received vaccines were white, 14% were Hispanic or Latino, 12% Asian and 2% black, well, 20% did identify as other race now, um, Dr. Wilma, when I was just speaking with her, she's our county's public health officer. She did say that because we are in the stage of vaccinating, primarily healthcare workers. This is perhaps a reflection of the poor, uh, diversity that we have in the healthcare sector. Is, is this where you thought we would be at this stage or do we, is there more that needs to be done to turn people out from different backgrounds Speaker 4: 09:12 That's coming out right now is really addressing what happened in phase one, a essentially, and that is mostly healthcare workers. And so, you know, it's, it's a little difficult to critique the equity of that group because it's, it is what it is. And maybe you, you want to say there needs to be more people of color within healthcare. That's a different issue. Uh, the numbers are, are definitely skewed towards what doctors and nurses and healthcare workers and people in phase one a look like. So what we've done is within the advisory committee, there are several sub committees, one of which is an equity sub committee. And one of the motions that we put forward is that this data needs to be shared in a transparent way to keep the County accountable, to watch these numbers as we move into the general population. So I don't like where they are now, but they should, uh, they should get better as they move forward, particularly into phase one B I'll make one other comment, which is that, you know, we've had eyes on this, uh, Dr. Speaker 4: 10:05 Hood and myself on the committee, really holding the County accountable. And there's a lot of other places in the country that don't have this equity focus. So I think we're already in a good spot and we have very, like I said, passionate discussions and really, you know, making, pushing this, it takes extra effort to do things equitably. If you just let the chips fall, where they may, the populations that need these interventions, the least tend to go first. It's actually in the medical literature, something called the reverse equity hypothesis. So it does take extra effort to do things equitably in those of us that are on the ground on the front lines have seen the disproportionate impact of this infection on people of color, on neighborhoods, um, in terms of case rates and hospitalizations and deaths. So we know it takes extra work and I'm happy to see the County responding to some of our recommendations by locating some of the vaccination sites in the South Bay, for example, um, the Superstation in Chula Vista, for example. Um, so those are really concrete actions rather than just saying, we're going to do this with an equity lens. We say, okay, that's really nice to say that, but what are your actions going to do? Speaker 3: 11:06 Um, I'm going to transition to our second subtopic here, which is scheduling. So Patty we've heard stories of older seniors needing help with scheduling because a lot of it is done online. So how is UCS D identifying and contacting eligible patients, especially those who aren't as tech savvy, or may not have great internet access. Um, you know, the County has established their two on one system. Um, we have a callback system that allows us to contact people, and then we just walk them through the system of getting registered, um, a day doesn't go by when we're, we are on the phone, helping folks work through the registration process and get folks scheduled. Um, but we've got ways to go there. I think we've got some new proposals coming for how we can better equip our seniors and others who are, who are not as tech savvy to get scheduled. I'm going to jump to our last topic in this section, which is hesitation. And I know it's important to all of you, but I know Dr. Hood, this is particularly important to you and you as well. Dr. Ramers Dr. Hood, there've been polls that show a large number of Americans. Aren't sure if they'll get the vaccine, how should providers and public messaging be addressing that Speaker 5: 12:13 These vaccine hesitancies didn't occur overnight. They existed before COVID and they have actually been exacerbated because of COVID because of the prior administrations, poor communication, lack of trust in the messaging, and it even made it worse. So that needs to be focused outreach to African Americans, Latin X, Asians, even them the message that you can trust this vaccine. This is why, and I put it into three categories. There are those who are vaccine, except Doris. They just need access and know where to go and how to go need a strategy for that. There are those who are vaccine hesitant, what they need is a little knowledge education, and, uh, you can decrease that. And then you have the vaccine objectors that for a whole lot of reasons, no matter what you say may not get the vaccine, and we need to be very respectful of them and talk about mitigation techniques that include masks, et cetera, and then measure our success from now as to is that decreasing over time. Speaker 3: 13:24 The next section is on coordination. This is focused on the logistics of space staff and stuff. And I'd like to start with Patty Patty and the County launched the first vaccination super site. Um, and staff are there getting through 5,000 to 6,000, and I believe you set it up within a matter of days. Can you walk through the process to pull that off? Sure. It was a, it was really an amazing couple of days. We sat and, and, uh, met with our County partners and talked about how we were going to get more vaccine in arms. And we said, this was on a Wednesday. And we said, okay, what, what is it gonna take to get 5,000 vaccines and an arm in arms by next Monday? So it was five days later. And, um, we said, let's do it from there. We picked up the phone, I talked to, uh, the Padres leadership. Speaker 3: 14:13 They were all in. We can have their parking lot, um, their support team, their beds coordinators, um, the County brought their vaccine and their support. The city came in with support. And, uh, so we, we kind of had all the right pieces that all came together at the right time to, to, to roll it out. It's complicated. You need, uh, internet, you need, uh, a doc of the day because people do have reactions to the vaccine. So you need a physician who can respond to, uh, emergencies. Uh, you need to figure out the triage and the gating and the registration and the it, and the observation and how the cars are going to flow. So lots of great minds came together to build out the site. And as I said, it wasn't a perfect day one. We continue to make improvements as, as it went on it's. Speaker 3: 15:03 Um, and even today, you know, we know that there are traffic problems and, uh, the roads roads are getting clogged certain times of the day, but it has, um, been pretty effective. We've actually this last weekend delivered, uh, 6,000 doses on Saturday and 6,000 on Sunday. So, um, it's, it's been pretty effective. We're going to need these sites because we have multiple super sites. We're going to need them for months. Are they sustainable? We have everything that we're going to continue to need here. So no problem. Don't need to worry about it. Oh, you always need to worry about things, you know, and I think, again, what's been smart about the strategy in San Diego, in our road to 1.8 million is, um, we do have multiple super sites. So the is that Vista site has been established with, with sharp, the sharp system and the East Bay side has been established. Speaker 3: 15:47 The North, uh, site has been established. We're going to be opening up a new site on our San Diego, uh, Loyola campus on Monday, uh, which will serve as another. Uh Supersite so all of this network is coming together. So if, for instance, like when the winds came, it completely decimated Petco park, uh, tailgate parking lot for two days, we were out of commission for two days, but we've got all these other super sites around the region that can pick up the Slack. So I think we've built a really nice network, uh, where we can cross cover each other, Speaker 1: 16:21 Coming up more discussion on coordinating vaccine distribution as our special broadcast continues. You're listening to KPBS mid-day edition. This is KPBS midday edition. I'm Maureen Kavanaugh, our special broadcast of the KPBS online panel discussion the road to 1.8 vaccinated. San Diego ans continues. Our guests are Dr. Rodney hood and Dr. Christian Ramers both on the county's vaccine clinical advisory group and Patty Mason, the CEO of UC San Diego health KPBS health reporter Taran mento continues the discussion on vaccine coordination, Speaker 3: 17:05 Dr. Ramers family health centers is in the process of planning your own vaccination clinics. I was there this morning. What challenges around logistics are you seeing right now? Well, I think the most important one is just, we don't have enough vaccine. You know, I feel like a firefighter with a hose ready to go to put out this terrible fire. That's killing people and the hydrant just isn't cooperating. We just, we need more doses. Um, but we're getting there. I think that there was a question in the chat about the supply. There's a slow and steady supply that's coming. And now that we've really made it through almost all of our healthcare workers in phase one day, we're going to be moving towards the general public. And we want to do it in, in a way that's convenient for people in their neighborhoods. So one of the elements that that Dr. Hood was mentioning about hesitancy really has, has do with deep mistrust. Speaker 4: 17:51 And if you have been in a neighborhood for 30 to 40 years, providing healthcare to the community, you, you have a real high degree of credibility and trust. And so we've actually been doing In-Reach now that we can vaccinate those above age 65, that are our patients in reach, where we send a text message, the same way we do to our patients who are coming in for a clinic visit. We've had a very high acceptance rate. And in our first 2000 people vaccinated that were non-staff or non-healthcare workers, 83% were people of color. So we, we feel like we are in a good position to work through some of these mistrust issues. And in fact, there was a survey commission by the County, looking at San Diego attitudes towards vaccination, and clearly, uh, one of the most trusted sources of information is a patient's own physician. Speaker 4: 18:35 It's that private conversation. And, um, if you'll excuse me to go back to hesitancy one more time, we had some healthcare workers in our system that actually did refuse and decline. And I gave my personal cell phone number to every single one of them and said, I will have the conversation with you if you want. And I got hundreds of calls over several weeks and hesitancy means a different thing to each person. It's not just one thing, except in the really extreme cases where people think vaccines have microchips and I'm in that kind of thing. But everyone just wants to have a conversation and wants to get their questions answered. And most people with a good conversation with their trusted healthcare provider will get to the point that they feel safe. And these vaccines are just incredibly safe. And the benefits that you feel once you've been fully vaccinated are profound. We're having people crying when they're getting vaccinated, because they're so happy to do it. Um, so those are kind of the issues that we're seeing. It's going to be challenging. There's still a lot of, um, uh, resistance and reticence, I would say out there, but I feel like we can work through it. Speaker 3: 19:31 You know, Dr. Hood, the other struggle we've heard from County officials and other people, um, you know, better vaccinators is that there just aren't enough staff and enough vaccinators. The governor has, has made a lot more people eligible dentists, you know, were, are now eligible. And that got a lot of attention. Um, and the County says it has heard from hundreds of volunteers. So like, how do we, why do we keep hearing that staffing is a problem? It seems like we have enough people to go around. Speaker 5: 19:56 Um, I think right now the main problem is a vaccine shortage. What San Diego has done very well is built out capacity. So they have capacity to do more vaccination with the current staffing in the amount of vaccinations there, however, as we move forward and especially as we expect new vaccine to come on and we get to the general population, that may be more and more of a problem. But I think, uh, preparing for these two vaccines that have been proved the Pfizer arena, there are a lot of storage issues and how you administer, et cetera. Um, the allergic issues that we've seen with them. So there's a lot of our precautions that are taken the, this new vaccine because of this new that aren't taken with, uh, other vaccine. So you really want to be in a setting where if there is an allergic reaction, which overall is very rare, uh, somebody can administer it to you. So it's not as simple as the flu vaccine. So it's more staffing and more caution to go along. Uh, the hope is, is that with the new vaccine, that doesn't have the same storage issues and can be given once, uh, it would become easier. Speaker 3: 21:09 Just another point about this stuff, if that's okay. You know, you know, we're trying to, we're trying to staff up to do the vaccination at a period of time where we've gone through the worst surge of the pandemic since it's began. Right? So all of our clinical staff are working in the hospital. They're taking care of really sick patients. Um, we're diverting their attention a bit to the stations and to places where vaccinations are given, but that's where the creativity is come in. Yes, we have our nurses who are down giving vaccinations. Um, but we're also looking at our pharmacy students and our medical students and training up our EMS and others who can be vaccinators. Um, the community outpouring for volunteerism has been amazing. So people really want to come help do this work, our physicians, who, um, those staff, our facilities, um, are finding it to be some of the most rewarding work they've done in years. Speaker 3: 22:01 This ability to give vaccines and watch the reaction of people who are just overjoyed with, uh, you know, relief, but the stuff that's kind of the tension with the staffing. And I will say in the chat, actually, some person just said that they received their vaccine and they cried while receiving it. And so did the, um, registered nurse at Pittsburgh. It's true. So I'm going to go right ahead to our last section, which is vaccination and supply. It's what we've been talking about. Supply continues to be what officials and providers say is the barrier. Um, but now we have a new federal administration, new partners announced at the state level. Um, so penny, can you briefly explain how allocations work now and what you're hearing regarding the changes in leadership, how that would potentially improve supply challenges? Well, I think the, um, how, how, how it is been working today is that, um, at least for UC San Diego, because we're part of a multi County, um, system, the university of California, we do receive out, um, allocations through the state for our healthcare workers and our patients. Speaker 3: 23:01 But it's very, very small. The state also provides vaccines to the County who disperses it. And for instance, for Petco park, we get our vaccination allocation from the County. The challenge is, and I know this is what everyone's been talking about is, um, how quickly are people getting a vaccine into arms. And again, I think we've been in a pretty good position in San Diego, not just at UC San Diego, but throughout the region, uh, in terms of getting vaccine and arms and situating San Diego region to show that we have the capacity and the ability to move quickly, to get vaccine arms and therefore deserve more vaccine to then go ahead and continue to, to distributed into arms. So I think, you know, we, we've strategically tried to position our region as that has a lot of capabilities and a lot of commitment. And, uh, therefore we should, we should get more vaccine because we've demonstrated we can, we're not letting that sit in the freezers. Speaker 3: 23:55 It's not sitting weeks on end, but, um, within a very short period of time, we're getting it, getting it into arms. And the final subtopic I want to get into is prioritization. Everyone wants to know when it's their turn. Um, and we know that the, you know, right now we're in healthcare workers, long-term care facilities and people 65 and older, but the next group is going to be based on people in certain industries. So, uh, Dr. Ramers, can you give us, um, a quick rundown of who those individuals are going to be in, maybe why people might be hearing that those individuals are being vaccinated in other regions and not yet in San Diego, Speaker 4: 24:30 This goes back to, you know, the national Academy of sciences had a really nicely run, um, open public forum to decide how we make these phases. And it was really two goals. Let's fascinate people who are at risk of dying, and it's vaccinate people who are at risk of catching COVID because of their occupation or their work, and are more likely to spread it. And based on those two main principles, adding in equity and ethics, they had a nice form and develop these phases. And then unfortunately they were changed by the CDC a little bit. And then they were unfortunately changed by CDPH a little bit. And then things kept being tweaked really every couple of weeks, we'd say, well, no, it's 75, not 65. So it is maddening to me as a vaccinator and I'm sure it's maddening to the public, but I think we're getting to the point where we now have a nice plan being laid forward, and we are all working on communication of that plan. Speaker 4: 25:18 There is an app or a website called my that is now going to be kind of the go-to place to find out if it's your turn. And all you got to do is entering your age, uh, and whether you have underlying medical conditions and what your occupation is. Uh, so to your question, as we're moving into phase one V we've now made it through the greater than age 65, which are clearly the highest risk of dying. 75% of the deaths of COVID have happened in the 65 years old and older. And thank goodness that we've made good progress on that, but there's now studies showing that really well. Where is all the transmission happening? The transmission is happening amongst essential workers who, uh, you know, because of their job because of what they have to do. They don't have a choice. They need a paycheck. Speaker 4: 25:59 They have to come out and work in public and have contact with people. So that's where you get into these next sectors. And I'll just read it off the County website, transportation industry, we're talking bus drivers, um, systems and logistics, industrial commercial, residential, uh, childcare services and food and agriculture. So that really is a nice broad smattering of essential workers. And there's one more group, which is congregate settings without break potential. So it's a very important question because it's going to be relatively difficult to track who these people are. Um, and then, uh, and what we really don't want to do is be the documentation police and turning people away after waiting in line for a couple of hours to get a vaccine, last comment I'll make. And then I'm interested in my co-panelists thoughts is that the state order to be more expedient about everything and just to remove all these barriers made yet another change and said, well, we might just go down to do an age-based vaccination only. Speaker 4: 26:54 Now our committee deliberated on this and had some very important discussions. Basically, if we just did age, that would jump over the entirety of phase one B that was very carefully thought out to be essential workers, most likely to transmit the infection. And it would allow people to be Frank who have very easy ability to protect themselves. Who've been telecommuting, um, who have, uh, high resources to just sort of jump in front of all those other essential workers. And we, as a County recommended, we as a committee, I should say, recommended to the health officer that we not do that scheme. And we stick with the way the, the phases were originally, um, laid out, uh, by CDC and other people. It's going to mean that we have to work a little extra hard to very clearly communicate when it's, people's turn and then have an easy way to verify that people qualify, Speaker 3: 27:41 Because I'm going to toss it over to Patty because being a big provider, um, UCSE how would you go about actually identifying people by their jobs? Like, how is this going to work well with respect to, I'm going to talk about the two finite populations that we're looking at, not so much in the Superstation, but in the, um, in our universe. Um, so for our patients, you know, we, we are using our electronic medical record. Um, we've got a risk-based algorithm that we use to, um, identify our patients and risk stratify them. Um, we use, uh, another index that healthy place index, which allows us to also take into account social justice, social equity measures, as we, um, rank our patients, bring them in for vaccination. You know, the campus workers followed pretty much the tiers that, um, Christian just outlined, I'm going to give you one other idea though, that I think is important. Speaker 3: 28:37 It's not actually, it there's, there has been confusion. You actually can find the answer for where you are, um, and kind of where you are in the tiers, but people don't always like that answer. And, uh, I have to say that I've seen some of the most outrageous behavior that I've seen in my career of people who don't like the answer and want to try to ask it a different way. And I make this point because I think it's reflective of this incredible anxiety people have about this virus and what am I mean to them and their families. And there's just such a high degree of anxiety that there's going to keep pushing until they can get the answer they want. The answers are not going to change. So wherever you are, those answers, aren't going to change. If they're changed, if they change, we'll make a big deal about it and we'll make sure people know Speaker 6: 29:27 Still ahead. The conclusion of our special, the road to 1.8 vaccinated, San Diego, you're listening to KPBS midday edition. Speaker 1: 29:43 This is KPBS midday edition. I'm Maureen Kavanaugh, our special broadcast of the KPBS online panel discussion the road to 1.8 vaccinated. San Diego continues. Our guests are Dr. Rodney hood and Dr. Christian, Ramers both on the county's vaccine clinical advisory group and Patty Mason, the CEO of UC San Diego health KPBS health reporter, Taran mento continues the discussion with audience questions. Speaker 4: 30:13 Do you want to San Diego is really one region. What are we doing to help solve the pandemic South of the border, which will continue to affect us North of the border. I'm going to wrap it and hope you don't mind. I'm going to kind of tweak that a little bit and kind of have, um, is our vaccine roll at our, our goal to vaccinate affected by what Mexico is doing on their side. And I know you're familiar a little bit, so I'm going to throw that one over to you. You know, this is a complicated issue. Um, I host a Spanish language, uh, sort of discussion forum twice a week for clinicians all throughout Latin America. And it's been very interesting to see the vaccination rollout from the Latin American perspective. Um, first of all, because, you know, just a couple of months ago, we were not even part of the who, and we were not part of the Kovacs facility, which is the global response by who to vaccinate lower and middle income countries who can't pay top dollar for Pfizer and maternal type vaccines. Speaker 4: 31:04 Uh, just now I'm happy to say that in Mexico, they're rolling out Pfizer vaccine and they actually have access to a Russian vaccine called Sputnik, which many were very skeptical of a while ago, but just yesterday, the phase three results were published in the landset and it looks good. It looks safe and effective 91.6% efficacy and relatively few safety events. So it is happening. But, uh, I think most of the Latin American countries that I am in contact with are just now in the early phase one, a a so to speak where only healthcare workers are starting to get vaccinated, but you're absolutely right. Infectious diseases do not respect borders. You know, that from tuberculosis or HIV or viral hepatitis, just because of the international regulations, we can't be vaccinating people from a different country that are sort of subject to different forces and different systems. Speaker 4: 31:52 Um, but it's a good, it's a good point. And, um, we are, you know, none of us are going to be safe until all of us are safe. I think I heard Tedros, the UN director say that, you know, what about international travel? It's just going to start all over again. If we don't have very high vaccination rates, not just in rich countries, but in poor countries as well. And I do know that speaking with Dr. Wilma Lewin, um, those who may live on the Mexico side of the border and do cross because they are essential workers. So individuals coming over and working alongside of San Diego is on this side of the border and would be able to get access vaccinations, according to the eligibility schedule. One of the questions that we got is there enough confidence in supply that there will be plenty to have second dose available when that time comes for all of the individuals that were vaccinating with the dose Patty, Speaker 3: 32:40 Maybe because you could work in the lab. I think we believe that we'll have second doses available. You know, we've been instructed and we've made that decision to go ahead and give us as much of the vaccine into arms as we can, um, every week and, uh, expect to be replenished. And so far that's been the case. Speaker 4: 32:56 And I just trying to, yeah, I totally agree with that so far. I don't really, I, I have seen the problem with not getting the second dose and I think we just have to hope that the, uh, the supply continues just to tie it back to what Dr. Raymond said about the local issue. One of the data that I saw in the concern that we're real concerned about reaching her immunity here, but in somebody other poor countries that haven't even started vaccine names, they've been agreed more and more variant, and we're already dealing with a very cheer that are existing. And so even if we reach herd immunity here and other countries do not, you're going to develop various that may be resistant to the vaccine that we're relying on. So I think we need to look beyond that. Talking about getting back to, Speaker 3: 33:50 We did actually get a question about the vaccine and against the new variants from Rahini, um, mandate and, um, will the current strain will the current vaccines protect against new variants? And I guess how threatened is this goal of vaccinating people against this virus? When we keep hearing about these variants and Dr. Ramos', I'll direct that one to you? Speaker 4: 34:12 Well, for me, why infectious diseases are so fascinating, it's an arms race really between the amazing scientific developments that we've made in these vaccines and then evolution, which happens before our eyes, that's what's happening here. And we have good confidence that the Maduro and Pfizer vaccines that are currently in use actually do have very good activity against the [inaudible] barrier. And that's the one that is more contagious versus described in the UK. It doesn't look maybe slightly more virulent and causes a little bit more severe disease. There's some debate about that, but that is the one that our mathematical modelers say is most likely to take over in San Diego. And our vaccines should still work against that. Not the same story with the other variants, the five Oh one Y V2 or the five Oh one, why B3, which come from Brazil and South Africa, where the vaccine efficacy really does drop quite a bit, um, not to zero, but down to sort of the 50, 60% range. Speaker 4: 35:05 And I have to just a little tale of caution here. I have a colleague in Mexico city that, uh, in one of our sessions has said, we're seeing a lot of re infections and reinfection should be very, very, very rare. You know, that 95% of people after they get COVID develop a very nice immune response that should protect them. If they're seeing an uptake in reinventions, that makes me think, is that mean there's a different strain going on? And the genomic surveillance capability of Mexico, I think is very weak. It's not the UK where they're doing all those genomic surveillance, the CDC in our country. And thank goodness we have the Scripps Institute here that is capable of doing this stuff. That's the reason why San Diego describes so many of these variants, but we're flying blind in a lot of other countries. And it's very concerning to me that some escape variants might emerge that may not be protected from the vaccines Speaker 3: 35:53 And in the Q and A's, we're getting a lot of questions actually about the issue of scheduling and online, um, and lack of internet access, English, proficiency, um, or just not tech savvy. And I know Patty, I directed that at you earlier, but I know Dr. Hood, um, you know, I'd like to ask we all, we do have this statewide website, you know, it's my turn, Dr. Ramers, you brought it up. Is that reaching everybody? Is that the best statewide approach to take? Um, if that's going to be the one place we're sending everybody, Speaker 5: 36:22 First of all, let me step back. This is like the vaccines were authorized for emergency use these programs that the state and the County are putting together, the input together on emergency use. So many times we put them together, retrospectively look back. It's not always the best. My answer to you is I think we're going to need more than just that site, especially for the vulnerable population. I can tell you, uh, just in my own family, my own patients, they have a lot of problems using that site. And so unless they have somebody that could actually help them, that's where the outreach comes from. Many of the grants that the County gay cultural and, uh, Chicano Federation, et cetera, we've hired community health workers. What are the things you're doing is helping these individuals actually navigate these sites. So it's helping, but there aren't enough, uh, community health workers. We're going to need more. I think the other thing is this is where, uh, but yeah, the fourth year medical student comes in that we're, maybe we should consider whether a state County reserving certain number of places for folks live in certain zip codes, realizing that they're going to have more difficulty accessing, because what happens is they've got a hundred spots and in 30 minutes, those are gone and folks who are less tech savvy have difficulty accessing them. Speaker 3: 37:49 Um, we just got a question from our YouTube audience, um, from Renetta, Brenda, is there a chance we'll have to take the vaccine again in a year? Like the flu shot? Speaker 4: 37:58 Yes. There is a chance. And in fact that the companies that came out with the first vaccines are already working on new versions that would protect against some of these other strains. Um, it's not surprising, you know, that that's what happens with the flu every year, we put three different flu strains into the flu vaccine, trying to guess what's going to happen. So it may be that we need boosters in order to protect that. The nice thing about this MRMA vaccine platform, it is just an ingenious innovation, really, when you think about how, how, how fast it's actually happened and how effective these vaccines are, is that you can just put a different piece of M M RNA in the vaccine, that codes for a different looking spike protein from, for example, the South African variant. And we would have boosters, um, to, to be able to give. And so I know that Pfizer and Madrona and actually Novavax, which has not been approved yet, are all looking at a new versions and we may need those. Speaker 3: 38:44 Another question we got was from Suzanne Royal, and she wants to know, are there opportunities for the general public to volunteer in some capacity for vaccine distribution, potentially helping people schedule a vaccine appointments or something that does not require a medical license. And I see Dr. Hood and Patty nodding their heads, but Dr. Hood Speaker 5: 39:02 Really at the, uh, 25% as we move forward, there's a large number of folks, the need to vaccinate. And just as you said, there's going to be a lot of folks, even if we simplify it, that's going to need help. So I know at the multi-cultural health foundation, we're looking for volunteers. I know the County is looking for volunteers. So, uh, the answer is yes, especially as we move forward. Speaker 3: 39:25 Patty, do you have any opportunities for volunteers from the public? Yes. There, there are. And so if you go onto, if you go into, uh, you could even search U C S D vaccination, Supersite volunteering, something like that, put that in the search. I don't remember the exact link. Um, it'll pull up and you can see you go in and, and volunteer, uh, put your name into volunteer that the County also has a link on their website, um, that you can put your name in and volunteer as well. You'll get, you know, you'll get screened and go through a process and get contacted, and then you'll be able to help, you know, as we open up our second Superstation on Monday, where we are going to need some more volunteers. So we're really looking for more support. We're fortunate because this site is going to be on our UC San Diego health campus or UC San Diego campus. Speaker 3: 40:11 So are our undergraduates at my understanding is 2,500 of our undergraduates have already volunteered to help out. So that's, it's a reflection on the kind of students that we have, that they are willing to do that. Um, I'm going to go to one question that a colleague of mine asked earlier, which is, um, there are a lot of concerns and this gets kind of back to the anti-vaccination, um, a lot of concerns that people have with hearing about these extreme reactions, um, adverse reactions and allergic reactions. And then there was a report about Northern, Northern California that an individual died shortly after they had been vaccinated, but there weren't drawing a complete connection to the vaccine. So Dr. Ramers can you address, um, kind of, first of all, how should family members guide people to the correct information when they are bringing this up? And what do we know about, um, the consequences and how severe they are about the vaccines? Speaker 4: 41:07 Yeah. This is a case where social media and the internet can really work against you and people go down rabbit holes and all kinds of really bad information that's out there. Um, I think you need to go to trusted sources and thankfully the CDC has really stepped up and had been very transparent about this. In fact, they just had a meeting on January 27th, where they reviewed the data from the safe and be safe. If you've gotten a vaccine is the app that goes on your phone and it reminds you every to put in how you're feeling and really, really nice data collection. And they've now had over 21 million vaccines that have been given in the United States. That is a huge number and way more than the clinical trials. And it is very, very reassuring is NFL lactic reactions are incredibly rare, like one in 400,000 kind of rare. Speaker 4: 41:51 Um, and you're, you're much more likely to die in a car accident. I think it's one in 105 or so is your likelihood of dying in a car accident. So just getting the information out there, these are very, very, very rare events and they tend to happen in people that have already had severe allergic reactions in their life. Now, when you get a vaccine, you're likely to have some symptoms from it. This is, I don't even like calling them side effects because they're expected effects. This is how vaccines work and people should not be afraid of these. It really generally lasts a day or less, and is mostly going to be a sore arm. 70 to 80% of people have a sore arm. And then maybe 20 to 30% will have something like fatigue or feeling achy. Uh, I got my second dose. I felt achy for about a day and still was able to work and see patients and then it was over. Speaker 4: 42:33 So, um, just expect that don't expect that it's going to be nothing, but I like to use the, you know, there's, we're in San Diego, there's a Marine Corps here. We send our Marines to war to fight against our enemies. And first they have to go through bootcamp. Okay. And they're going to be a little bit sore after boot camp. That's part of the deal. This is an incredible way to train your immune system to literally protect you from a deadly disease. It's okay to have a day or two of side effects. And if you're on the front lines and you've seen people suffering and dying, I had a really rough week because two people very close to me died of COVID. Um, then you weigh these things and come on a day or two of a headache weighing against the potential for having death of yourself or death of your parents or being the one. I can't imagine the pain of someone who's younger, who gives this virus to their parents and then watches them die. Um, so let's be really, you know, clear-eyed about what the risks really are here. They're incredibly small from the vaccine, um, and, and really high and kind of unknown and unpredictable from the virus itself, including things like long COVID, which we really don't know what to do about at all. Speaker 5: 43:34 Yeah. If I can just add to that, first of all, I think what Dr. Ramos said is right on, and I think this is a critical issue because I to get called and, uh, we are now prioritizing 75, 65 years and older, guess what? They have coronary artery disease, diabetes, hypertension, and cried. COVID, they've been dying of heart attack, strokes, and kitten. Therefore people are going to die or have severe adverse doesn't mean it's related to the vaccine. So I've gotten to a, several calls on that, where they said, I heard somebody died after getting the vaccine. This person was 18 years of age. So just because something happens, doesn't be related to the vaccine. If I could share one anecdote on this topic, we had a women come through several weeks ago, our, our Petco site, and she did have an anaphylactic reaction and we had our team there and, and they took her to Speaker 3: 44:32 The hospital. This happened in the morning. She came back later that night, tears in her eyes and just thanked our team for giving her the vaccine. So, yeah, I had a reaction and yes, people took care of me, but you know what? I have the vaccine now Speaker 1: 44:47 That was Patty Mason, CEO of UC San Diego health, Dr. Rodney hood, founder of the multicultural health foundation and Dr. Christian Ramers chief of population health at family health centers of San Diego. They were speaking with KPBS health reporter, Taran mento for a panel on the road to 1.8 million vaccinated, San Diego ones.

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The goal is to vaccinate 1.8 million people in San Diego County by July 1. That’s about 70% of the region’s population over age 16. Currently, about 2% of the county's population is fully vaccinated. So, what does the county need to do to reach that goal?