Interview, Fireside Chat
A Conversation with US Department of Health and Human Services Secretary Alex Azar
- U.S. case counts are projected to continue rising with a 14 percent seven-day rolling average increase, concentrated in the midwest, upper midwest, plains, and upper plains areas, with hospitalizations expected to rise directly in response.
- A surge in cases is anticipated during fall and winter months in northern climates due to reduced natural social distancing from indoor movement, with continued community spread predicted if current mitigation steps are not re-committed to by the public.
- Managing the holiday season is expected to rely on adherence to state and local guidance regarding household gatherings, while a national directive or mandate is not predicted to be effective due to the necessity of public buy-in.
- The national strategy aims to delay and flatten the curve to maintain health system capacity, reduce cases, hospitalizations, and mortality, and bridge the gap until vaccines and monoclonal antibodies achieve national herd immunity.
- Mortality rates for individuals age 17 and above are projected to remain below 10 percent, a significant improvement from the 30 percent rate observed in April.
- Pfizer data readouts might be available as soon as late October, with a hope for an emergency use authorization filing by the end of November, approximately 10 months after the virus entered the United States.
- Operation Warp Speed is producing millions of vaccines, projecting sufficient supply by the end of December for the most vulnerable populations, enough by the end of January to cover all seniors, healthcare workers, and first responders, and full availability for any U.S. resident by the end of March to early April.
- Vaccine approval authority is expected to rest with FDA career leadership and Dr. Hahn, with independent determinations regarding AstraZeneca safety and protocol modifications anticipated despite clinical trial holds on AstraZeneca and J&J Janssen.
- The flu vaccination campaign is proceeding at full speed with an additional 20 million doses planned, and stockpiling needles for Operation Warp Speed is not expected to negatively impact the flu shot market or supply chain.
- Distribution plans from all 64 jurisdictions are under review, with a rollout via CVS and Walgreens expected to provide swift distribution for nursing home seniors, and states are not expected to require additional funding for the vaccine rollout.
- Monoclonal antibody therapies are projected to be most effective when administered early to jumpstart the immune system before excessive viral replication, with supply expected to reach well over a million courses for Regeneron and Eli Lilly products by the end of the year.
- A surplus of remdesivir is currently held after securing 90 percent of the world's supply through the end of September, though ongoing real-world evidence is needed to confirm the extent of its benefit beyond initial trial data suggesting a one-third reduction in hospital stays.
- Testing innovation continues with over half of U.S. testing already at the point-of-care, and future self-administered and self-evaluated testing is hoped for pending FDA validation and human factor studies.
- Public health measures are viewed as tools to enable a return to school, church, healthcare screenings, and civic life, with communication expected to involve multiple government perspectives including mental health considerations rather than relying solely on the CDC.
- Health officials including Dr. Fauci, Dr. Redfield, and Dr. Hahn are expected to frequently appear on media and tour the country to address regional outbreaks, while vaccine production and distribution timelines are viewed as critical milestones for restoring normalcy.