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next, a discussion on the development of a coronavirus vaccine with the head of the national center for immunization and respiratory diseases. this is from the aspen institute. is currently leading cdcs effort on the covid-19 vaccine. 2019, she directed -- [crosstalk] to activate a center-based response to an unknown respiratory disease in china that later transitioned into a full agency response to the covert 19 pandemic -- covid-19 pandemic. dr. nancy messonnier is leading the effort to support the covid-19 vaccine program in the areas of into mentation, safety, and access for hard-to-reach populations with the goal of ensuring a safe and effective covid-19 vaccine is available

for every american who wants one so i want to welcome dr. messonnier to this discussion and i'm very excited to speak to you. how are you? happyssonnier: i'm very to be here. thank you. it is nice to see you. >> i can see and hear you so hopefully others can as well. before we get into the vaccine, i want to ask you a related question about the ongoing surge. many expected this awesome and winter to be -- autumn and winter to bad. -- to be bad. we broke the single day record for deaths and that the next day -- and then, the next day, we broke again. i have seen large crowds going tomatoes and people are out in the streets, protesting the closure of bars. there is clearly a covid-19 fatigue going on so how does the cdc and the rest of the american

health enterprise go about convincing the public to take the pandemic seriously? dr. messonnier: that is a great question. it's that people will not take the pandemic seriously. i think it is that people are tired. socially don't -- distancing. homeschooling.s i canceled our christmas vacation. i expect the american public, like i, are tired. the thing that folks need to understand is that now is the time to really buckle down and follow the rules and if we can all do that for a month, a couple months, we can really get ourselves past this thing. it is their commitment to -- keep each other safe and the way to do that is to follow the rules and wear our mask -- a

mask. >> i asked that question the approvalknow, of the pfizer vaccine was momentous, historic, use any adjective you want. there are many more vaccines that seem to be on the way. it is an un-debatable win for science, the progress of the vaccine this year, but right now the public has not seen much of the data behind these candidates so how do you go about addressing concerns that the vaccines have been rushed out? and based on what you have seen so far, what makes you so confident about the process? dr. messonnier: yeah, i think it's a really important distinction for the viewers to understand and sometimes, i think that the term "operation warp speed" was not thought through because people seemed to interpret that as going fast and sacrificing science.

that somehow, by going fast, we have cut through the size and scope of the studies being done, and it's really not that at all. these vaccines have moved so quickly, remarkably quickly, because they did not come out of nowhere. they are actually built on a firm foundation of science. scientists have been working on this novel technology for years, looking for that first vaccine. so when it came time to think about a covid vaccine, scientists went back to the vaccine platforms they had been working on and said, ok. can i adapt this quickly to covid and for a vaccine -- form a vaccine quickly? that's the first thing. this did not come out of nowhere. it came on a firm, scientific foundation. the second thing is that what makes it faster is when everybody wants to know and it's

a couple things. a few studies in general have places where there is a lot of work and then there is a pause for additional evaluation or they stopped because they cannot find a supply of reagent or do some sort of shortfall. operation warp speed has taken every piece of that equation from the beginning until now and done everything to lower any obstacle so there is no time and space between things moving forward. if there was a shortfall of supply, operation warp speed helped to improve it. they have helped to make clinical trials go as fast as possible. they are not sacrificing size and scope. the reason i have confidence in these vaccines is because i have confidence in the process. i am somebody who understands the process. these clinical trials are the same size and scope as any trial

that goes on in vaccines in the united states. the vaccine trial has been overseen by an independent group of experts that's called data safety monitoring board. they are the first ones that see the clinical trial data. and then it is passed off to fda. reviewentists don't just in detail the data they are given, they actually reanalyze the data themselves to make sure they agree with every bit of it. it goes to the fda's advisory committee which is meeting this thursday. they review the data and they do it in plein air. it's publicized so the public can actually see. and then it comes to cdc. our scientists reviewed the data and then our advisory committee reviews the data in public so everybody sees it. it'smay seem excessive but a series of checks and balances designed on purpose to make sure nothing falls through the cracks

, and is part of our commitment to the american public that we are committed to ensuring these vaccines are safe. and then as you just mentioned, the pfizer vaccine aremoderna vaccine undergoing fda review in the coming weeks. we received this question ahead of our event from lynn morrison. vaccinexplain how the does not change our human dna. i chuckled at this question and i got a question in the same vein this weekend. somebody asked me, ok, are there plant and animal extracts involved in this vaccine? do i want to take that? i was wondering if you could briefly answer that question about it changing our human dna and explain some of the fundamentals behind the mrna vaccine. dr. messonnier: i'm happy to do

this at a high level. there is something about these vaccines being new, new technology, that people find disconcerting, but mrna vaccine is still a vaccine. you get it like you get your flu vaccine. the mrna vaccine gets into your muscle. what it does basically is it gives c instructions to our cell. -- gives instructions to our cells. androduces a spike protein it teaches our body to produce an immune response to protect against the spike protein. down the road, you get exposed to the covid virus, your body says i recognize that and i know how to produce an immune response and stop that

virus in its tracks. you cannot get covid from an mrna vaccine. you cannot get flu from the influenza vaccine. it's just a way to keep the body prepared if it gets exposed to the virus. >> perfect. know,ng those lines, you we had another question that's kind of in the vein of some of the stories we heard about reinfections. we published a story in national geographic that while reinfections are rare, we are starting to see more and more of them and it's unclear if you will have a softer response the second time or harder response the second time. we got a question from jonathan fox who is essentially asking that question about that. are there any possible adverse effects from taking a covid-19 vaccine if you already caught

the disease and had a mild case but a strong immune response? dr. messonnier: yeah, good question. there is a theoretical response at a practical response. , the scientists who know this disease have worried about this and thought about this and don't believe there is a serious harm. practically, in a clinical .rial, they excluded people there were some people in the clinical trial had had covid in the past and had antibody levels and that certainly is something that the scientists who are going to be reviewing this data are going to be looking for. equally importantly i think is the question of, well, what does this mean down the road? how do i know how well the vaccine will last and if it will protect me forever? we don't know that. not surprising, there are always things we do not know at the

moment a vaccine is authorized and licensed. in a clinical trial as big as it is, is different from rolling out the vaccine to the entire public. that is why it is so important we study the vaccine so we are going to be carefully studying this vaccine to see how well it once in the public implemented but also to be looking at those important questions. know, does it protect you more against severe disease than mild disease, both from getting ill and transmitting? and doesn't protect you long-term or does the niimnity wear off in time? those are the kind of questions that are incredibly important and that is why we have put up a whole series of investigations that we will be launching as soon as the vaccine launches. >> a follow-up question from our chat. what about those with autoimmune disease or reactive immune

systems? should they take this vaccine at this point or do they need to wait a little while for more data to roll in? >> what we have so far is the clinical trial data. who got the vaccine. it does not allow us to evaluate every permutation of each individuals decision so what i would tell anybody is if you have questions or concerns, you need to talk to your own health care provider. your health care provider will be best to help you make decisions about what the best thing is for your own health. >> thank you. to stay on this vein of how the question --a apologies, judith. she said i am a 76-year-old. when the vaccine is available and i take the required two shots, will i be able to be with my children who have not yet had the vaccine?

am i am into the virus? i suspect you have more access to the data than most people, so do we know the type of protection we are seeing with these frontrunners? do they stop the spread or do they knock out symptoms? dr. messonnier: i wish i could tell you that the day after you get your second shot, you are good. without that mask, hug your it'sy, but the truth is, probably still too soon to be that. we will know whether the vaccines protect against illness, but we will not fully know on day one whether the protect against transmitting the virus. most people think that there will be some level of protection against transmission and some level of heard immunity -- heard immunity will come from the vaccine but after we have so been -- we have been so careful for so many months, the day after you get the vaccine is not the time to risk it so we will recommend for now that everybody

keeps going with masking and social distancing until we have a little more time to study it and then as soon as possible, we will lighten up those guidelines. now is not the time to do it. it is just too soon. >> i think i have heard this question from friends walking around the street. if the vaccine cannot stop transmission but it can't stop symptoms, what is the value in taking it? a lot of people are at -- what is the value in taking it? dr. messonnier: the value in taking it is there is an enormous number of covid cases every day in the united states spirits today, yesterday, tomorrow. if the vaccine can protect you , dramaticallyll decrease the number of cases, hospitalizations, deaths quickly. most people believe -- i believe that there will be some level of protection against transmission. we just don't know whether it is

complete protection or not. vaccinated, and we were all protected ourselves by our own vaccine, it would not matter if it was still transmitted. another high-level question along that line. nancy from johns hopkins wants you to describe what is the mechanism behind the possibility that a vaccine can prevent symptoms while allowing viral transmission? dr. messonnier: think about it this way. that yourfferent ways body protects you against serious symptoms, so if the virus is getting into your nose and throat, it starts there, and then it basically goes through the rest of your body. it is potentially protecting you from the more harmful parts of , the virus could

be in your nose and throat and it is still possible that you could transmit it. it's the difference between being -- having the virus somewhere and sort of being fully infected by the virus. i guess that is one way to think about it. there are other vaccines with the vaccinees where protects you from getting sick but you can still transmit it to someone else, so it's not just theoretical. there are other diseases where that is true. again, frankly, i think there's a lot of reasons to be hoped that this vaccine will also protect against transmission. we want to be sure before we tell people to take off masks. >> what are some examples of those diseases just so people know? dr. messonnier: i would use an example, the influenza b vaccine. they are licensed based on safety and effectiveness but it

is not until you implement it that you actually find out that vaccinating of one population protects others so for example, kids protects older adults from getting exposed to the bacteria. so the problem would be mostly we find out these things after we start implementing them. we don't know it for certain because of the way the clinical trials are set up. >> that's a great set up for a question we got from the chat. i might have got that wrong. apologies. we have three to four solid vaccine candidates within a year. most phase 3 safety trials last one year. and the whole clinical process usually lasts six years to 10 years. by accelerating this process, are we losing out on long-term safety data?

i think also along those lines, if we do find something once we start to give the vaccine to more people, is there any flexibility in changing the dosing regimen, adding a booster? can we do anything like that after the trials are complete or do we have to go back and start the trials over? dr. messonnier: i will start with the first part of that question before i get to your titian. addition. safety is one of the most important things you have to do around these vaccines. i talked about checks and balances that are in place before a vaccine is authorized and recommended. is fromks need to know the moment that the vaccine starts rolling out, we continue to monitor safety and that is true not just for covid vaccines but for every vaccine that is in the united states. we have never stopped evaluating the safety of those vaccines.

in the united states, we have one of the most if not the most robust safety system in the entire world. we take this responsibility really seriously. and because of covid and the development of these vaccines safety, wecern about have taken those systems which start out as being really robust and actually enhance them. we have looked across all the safety systems we generally use in the u.s., and we incorporated them into a single system that is much more seamless and looks for weaknesses in our systems and said, ok, if there are weaknesses, how can we strengthen those systems? the size of the clinical trial is bigger than other clinical trials. the question is correct. there is a longer lifetime between the time the clinical trial ends and the time the in that time period, we don't

generally see the occurrence of new side effects but we want to be sure and that is why the safety plan is so robust. but there is a caveat. it is important for you all to know about, in order to monitor safety in a period of time after the vaccines are rolled out, we need the help of you, the people getting the vaccine. if you are in that first group of people who get the vaccine, we are asking you to do is report to us through a program called be safe. any side effects you experience from the vaccine, report them in . it's a textbased system. effects, youide will get a call back from us. we will need everybody to understand the importance of this early phase. i don't want to wait for systems to let us know six months from now if there is a problem. i want to know in the first couple weeks. in order to do that, we are really going to need the help of those people who are getting the

vaccine first. have had a like we lot of papers published on covid-19 this year alone. just this discussion we have had so far i think could qualify as would you give to normal people who want to -- how do they make sense of the wide world as antibody profiles and t cell responses -- you know, where should they go for information once the vaccine is approved? dr. messonnier: yeah. another thing that happens because we are doing everything quickly, trying to get the vaccine out quickly, and i think that's really important, we have this important tool. we need to get it to the people quickly. typically, after a vaccine is recommended, there are weeks or even months before it hits the

providers shelf or before patients are faced with the question of whether they should get the vaccine and we need that time to educate people, educate health care providers, educate the public, try to make sure messages get out before you show that your doctor's office and have to make a decision. but in this case, we are moving much more rapidly. there is a good reason for that, but it does foreshorten the period of time we have a educate and that's why it's really important that we have information readily available. you can find it on our website. the information is going to be updated, frankly, every other day, until we get to a place where there is enough information for people to understand -- asking about mrna vaccines. if you go to the cdc website, you click on covid and you click on vaccines, you will find a couple pages that really describe the mrna vaccine. we need people to be proactive about educating themselves.

we are getting packets of information ready for health care providers. even with all the questions these days about science, in fact, if you ask anyone who they health care provider is at the top of that list, so it's really important for the cdc to educate health care providers so that patients can ask their health care provider for any questions that they have. another thing that i would say is that these are things that can protect the individual. if we really want to stop this pandemic, the way we do it is by getting lots of people vaccinated. people have to feel confident getting the vaccine. people who are listening to this, people who tuned in, you can get educated about the process for the vaccine. you can help educate your family and your community. in many ways, people trust those

in their communities that help inform them in addition to their health care provider so we can all be really important parts of that. not everybody will go to the cdc website and really try to understand all the available information. if you can take the time to understand the science, i hope that you will educate more people, and five more besides that, and at that time the vaccines become available, folks will feel good about rolling up their sleeves. confidence andd we have a question from a chat that i think it's related to that idea. the question is about side effects. what do we know about the side effects that we have seen from the front runner vaccine? do along those lines, how the side effects breakdown verses, you know, just the first dose versus what happens after

the second dose, what should people expect? dr. messonnier: the point of a vaccine is to stimulate your body's immune response. that's the whole reason you get vaccinated. it can also mean that there are some side effects from that vaccine. phaseecise data on the three clinical trials in the united states should remain public later this week. thepfizer vaccine at meeting which is scheduled for thursday, and the moderna vaccine is scheduled for 10 days later. based on what we have seen so far, including the data from the earlier studies and the data from the u.k., here is what people should expect. these vaccines will have side effects in some people. some people will have side effects. most of those side effects will be mild to moderate.

the kind of side effects we are aches,so far are muscle fatigue, and people are even reporting that they have fever that lasts for a few days. the data so far suggests that the number of people that have those side effects is more after the second dose that it is after the first. the same person had a follow-up question with regards to protection. so you take one dose, you have a certain level of protection. what have a good sense of those two stages of protection are like and if we do have people who, you know, don't follow-up, getting the second shot, what happens then? what is the value of getting the two doses based on what we know? dr. messonnier: we will start

and end at the same place. is a precious commodity, and getting the vaccine is a gift, and if you're lucky enough to get that first vaccine, you don't want to waste it by not getting the second shot. thethe second shot of exact same vaccine -- if you get ma pfizer vaccine -- moderna vaccine, get it again. these first rst o vaccines are o dose vaccines and you need both. -- about how much protection there is between those first two doses. period of time. if you get your first shot day one and your second shot day 21 or day 28, there may be some protection in those limited three or four weeks but we have

no idea if you got the first shot, whether you would have any protection three or four months later so it's really important to get the second shot and to get it on time as much as possible. there is some data i think for people who are a few days late. there is limited data. we really want people to focus on getting themselves a second shot on time. in order to facilitate that, the health department and health care systems, a lot of them are actually scheduling you when you go into get your first dose, will schedule you to get your second dose. that's a really great way to ensure that you are getting it at the right interval. bottom line, get the first dose, please get the second dose. >> how are we tracking those two doses? i saw a picture of a little note card where you are filling out the dates where you were supposed to follow up and my immediate thought was, is 20/20.

i'm surprised we are not using smartphones or automatic alerts -- it is 2020. i'm surprised we are not using smartphones or automatic alerts. how do we make sure people follow-up? what types of tactics and tools? dr. messonnier: all the things you mentioned. it is 2020. text messaging, smartphone apps, all the modern technology you can possibly imagine, jurisdictions are using -- i hope every single one of them works. they are a backup system. youothing else works, if lose your phone and you are not a technology person, i don't want there to be anybody who has any question of what vaccine they got and when they are due again. those cards are tried and true. so wed-and-true approach are giving out cards.

it's a safety mechanism. i hope it works, but as a last resort, we will have a card and we know what vaccine you got. have talked about how the vaccines work. we talked about why people should take them. we talked about the doses. noel from the university of north carolina has an interesting question about multiple groups have four national communications plan for a covid-19 vaccine. is this something the cdc is working on and has the biden transition team contacted you to begin work on such a plan? if you have a: communication campaign, cdcs focus and my focus is on education. educating providers, educating health departments, educating a vast array of partners so that

they can turn around and educate their populations. they are turning out lots of materials in every way that you can possibly slice it, lots of stuff online. lots of social media. using them all the way down the chain. as i said, these are moving really quickly. that material will have to get pushed out really quickly. we are trying to make sure health care providers, health departments, have the information they need so that they can educate people before they get vaccinated. >> we are in a global competition i think for these vaccine supplies. what is cdc doing? what is hhs doing to ensure that we are the first country to get the batches as they start to roll out from these manufacturers? theirssonnier:

negotiations with the pharmaceutical companies about doses is being done by operation warp speed. really part, the cdc is doing the science so we are collaborating around the globe with other scientists in the same positions we are to make sure we can take advantage of their science, they can take advantage of ours. that is a scientific exchange that is the bedrock of the work i do, and really important as we rollout these vaccines, for example, for the countries that are rolling them out early, gathering data and sharing that data so we can all learn from it. >> say we have a vaccine 95% effective is and then we have another that is 70% effective. do you want to talk about -- sorry, i should say efficacy.

do you want to talk about how efficacy works and in this situation where, say, we have access to both, how we will go about deciding who will get which one? so messonnier: yeah, effectiveness in this setting is a little complicated. when we license the vaccines were the fda authorizes vaccines , they are going to have an estimated effectiveness of the vaccine based on clinical trials. think of effectiveness as a sort of the risk of getting covid if you are vaccinated compared to people who are not. the clinical trial randomize his people. some get the vaccine. some do not. you are comparing the risk of getting covid in those two groups. you get an estimate of the effectiveness, that is the 75% versus the 95%. around that, there is a confidence interval. in these early

dates, some of the confidence intervals can be really wide and is not clear if those estimates are significantly different or not. estimate, estimates in every center or piece of the population with all of the caveats for how vaccines may be different. that's why it will be so important to study the vaccines. back to your actual question. there is differential effectiveness. how do you make the recommendations? that is why i am grateful we have advisory committees. cdc's advisory committee on immunization practices are still in place for 50 years. this is a group of independent scientific experts and they are vetted to make sure they don't have a conflict of interest. they are experts in immunology, pediatrics, vaccine side effects , and they also have more members of the group, members of

the public. they are surrounded by stakeholders. the group around them is the group that actually is responsible for implementing the vaccine recommendations. their input is incredibly valuable so if we have an issue like that, go into our advisory committee and say profile these two different vaccines so please tell us how you recommend we do it. chatacey abrams in the guest my follow-up question. once the advisory committee makes a recommendation for a vaccine, how does it affect its availability under medicare, medicaid, you know, private insurance, different insurance plans that we have, how does it affect its availability to people, and how will they pay for it? dr. messonnier: cdc in some ways are different issues.

the i would say is that u.s. government has purchased vaccines. there is no cost to the vaccine. in addition, the vaccines are going to be free of charge for the administration. when you get a vaccine, there's two different costs. one is the cost of the actual vaccine and the other is an administration fee. in this setting, there will be no cost to people who get the vaccine, no co-pays. free of charge completely no matter what your insurance. would not matter if you don't have any. and want to pivot for a second before i jump into my last question. this might be a good bridge. i think it has been an important voice and loud advocate for home tests.

he says we can get the pandemic under control if we can just get these tests out to people. what are your thoughts on these tests? is the cdc working on exploring these rapid tests for daily use, for at-home use? what should people expect going forward for these tests that are under development? because they have been sort of said that they would be important for us getting back to normal life. dr. messonnier: i know that there are a variety of experts who are advocating for more available tests and that some of these tests may be less sensitive and specific but they can be an important tool. folks at cdc are assessing them. my focus on the last six months has really been on getting these vaccines -- getting the country ready for the availability of these vaccines. i think everything else that is

going on and with the disease rates going up, these vaccines are array of light at the end of a long -- a ray of light at the end of a long tunnel. if people are confident and willing to get vaccinated, that's a game changer. on me, my focus is very much the vaccine. >> >> i want to ask a few questions about what 2020 has been like for you. i grew up in atlanta. kids there, especially the biology nerds, we talked about working at the cdc someday. during the ebola outbreak, i think the united states response was what i would've expected. to head toere able

africa and really apply the decades long history of public health that we developed here in this nation. what has this year been like for you given that -- given where we are right now? it's been a hard year for me. it's been hard to live through this. i struggled with the daily practices that made life complicated and difficult, the , having toancing learn to work differently. kids, we had-age to be thoughtful and careful about everything in our day-to-day life. then i think about millions of

people who have had covid, all the people who have had family who diednd friends from covid. frankly, my daily inconveniences seem like nothing compared to that. to me, one of the reasons that i have been so focused on these vaccines for the past few months is that i really felt like vaccines are the way we can get out of it. team ofhis incredible committed technical experts and scientists who have been working every day morning tonight to get ready for the moment we are at now. on the vaccines that can get us all back to normal. it really has been those people, as well as friends and family and my community that have cap me working hard every day. but i really feel like we can all be part of the solution if

we work together. of thet's the hope vaccine and the hope of getting us through this that's cap me moving forward all year. i follow you on twitter. care you to all the health workers, we appreciate all you do on national doctors day. i think health care workers in this country or about to go through a fairly dark period. how do we support them? how do people in the public support them. what are your thoughts on that? >> i think you are right, they health care workers are the heroes of this pandemic. themselves on the front every day and they're still going to work, putting themselves at risk.

that the cdc wants to put health care workers first in line for the vaccine. what can we do for them? if you have a friend who is a health care worker, or a neighbor, it will make all of if there weresier less hospitalizations in the country. knoway that we do that, i it's not exciting, but frankly, we know what works. we have proven what works. stay at home, where the mask. help our friends and colleagues and health-care workers until we can get all of us to the vaccine. we celebrate our health care workers by staying out of health care unless we need it.

timen: just to wrap up our thatan't help but notice you'vepast few weeks sorta been opening up to the public and other cdc officials have been opening up to the public. what should the public expect from the cdc going forward into next year? what are your hopes for next year? what is your timeline on the return to normal? i think people really want to know that there is some light at the end of the toddle. three things that you're looking forward to next year? i walk intoer: when the office of the cdc, there is a pledge on the wall in big letters to the american public.

public that we base all health decisions on the highest quality, scientific data that is derived openly and objectively and places benefit to society above the benefit to our own institution. our i hope is that sisi and staff will be able to communicate regularly and consistently across all levels bythe government and that doing that and being transparent about the vaccine process, we will be able to redeem the trust of the american people. transparency or the vaccine process will encourage people to get vaccinated. i think there is a light at the end of the tunnel, but people do need to understand that the tunnel is longer than they might expect. but vaccines won't be available to everyone until the spring or

even early summer. so we will need to be patient. i know that is hard for all of us, because all of us are anxiously awaiting an end to this. i've worked at cdc for 25 years and i've worked on a lot of vaccines. we are doing to -- going to do everything we can to make this rollout vaccines as smooth as possible. there are going to be bumps in the road, and i think people need to expect it. residents of long-term care facilities will get the vaccine early because they are among the most fragile. they are medically fragile. we ask her -- vaccinate a nursing home on monday and if someone dies on wednesday, it will be a terrible tragedy. will try topeople

not jump to conclusions, try not to buy into this misinformation, to really look for trusted sources of data in the industry in the next six months, and stick together. i really think we can get through this. nsikan: i think that's a lovely place to leave it. i personally want to thank you for your public service, not only this year, but for the last 25 years. i just

next remarks from debra holland, on diversity and inclusion in politics and government. this is close to one hour. >> greetings and welcome i'm editor at large of the hill thank you for joining us for the final session of our diversity and inclusion summit. we have been testing the proposition that without dier