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From YouTube: Community Vaccine Advisory Committee Meeting #5
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A
Thank
you,
okay,
it's
two
o'clock,
so
I
think
we're
ready
to
begin
dr
burke
harris
and
dr
pond.
Would
you
like
to
welcome
everyone
and
then
we'll
go
through
the
meeting
process.
B
Absolutely
thank
you
so
much
bobby.
I
want
to
welcome
everyone
once
again
to
the
community
vaccine
advisory
meeting,
and
I
want
to
thank
everyone,
as
we
are
just
a
day
and
a
half
before
the
christmas
holiday.
We
know
it's
an
incredibly
busy
time
for
everyone,
but
for
those
who
celebrate,
especially
especially
busy
with
preparations-
and
we
have
been
incredibly
blessed
to
have
such
wonderful
engagement
and
participation.
B
We've
had
a
incredibly
robust
engagement
as
part
of
this
meeting.
We've
gotten
a
huge
amount
of
public
comment
and
we're
very
grateful
for
you
all
to
give
your
time
your
expertise,
your
your
perspective
and
your
knowledge
to
share
with
us
as
we
go
through
this
process.
I
I
want
to
kick
it
over
to
to
bobby
for
some
brief
words
of
meeting
process,
and
then
we
will
dive
into
the
meat
and
potatoes.
B
A
Well,
thank
you.
Dr
burke.
Harrison
welcome
everybody
and
my
feelings
are
exactly
the
same
as
dr
burke
harris
in
terms
of
all
of
your
engagement
and
your
communications,
during
and
in
between
the
meetings,
just
a
reminder
for
everyone
who
may
be
watching
us
on
the
live
stream
as
well
as
participating
in
meeting
today.
A
We're
trying
to
do
our
best
to
pretend
that
we're
all
in
the
same
room
together
talking
to
each
other
and
wishing
each
other
happy
holidays,
so
be
great.
If
the
members
of
the
committee
could
keep
their
cameras
on
and
keep
your
phones
on,
mute
until
you're,
ready
to
speak,
we'd
like
to
use
the
hand
raise
icon,
which
is
in
the
participant
bar
down
at
the
bottom,
if
you
click
on
it,
you'll
see
in
the
right
hand,
corner
a
hand
raised
icon
and
jackie
garman
will
show
you
how
to
do
it.
A
If
you
don't
know
how
cause
she
just
learned,
how
and
we'll
use
that
to
call
on
people
during
the
discussions
we
have
two
asl
interpreters
today,
katie
sales
and
vicki
kennedy
who've
been
with
us
for
our
last
several
meetings
and
they'll
be
interpreting
for
us
and
we
also
have
closed
captioning
for
those
members
who
prefer
that
the
public
is
in
several
different
modes
of
participating
in
the
meeting.
There's
a
public,
listen
in
call-in
number,
both
in
english
and
in
spanish.
A
A
Public
comments
can
be
sent
to
the
covid19
vaccine
outreach
at
cdph.ca.gov
and,
as
everyone
knows
by
now,
I
hope
public
comments
are
posted
on
the
website
two
days
before
the
meeting.
They
are
not
summarized
they're
included
fully,
and
then
I
will
summarize
them
a
little
bit
later
in
the
meeting
for
the
members.
A
Please
continue
to
do
that,
since
it's
very
hard
for
80
members
of
this
committee
to
all
weigh
in
verbally
on
each
topic.
With
that
I'll
go
back
to
dr
burke
harris
and
dr
pond.
B
Thank
you
so
much
and
as
we
start
at
this
meeting,
I
I
want
to
again
thank
everyone
for
making
time,
especially
during
the
holiday
season,
to
be
part
of
this
important
conversation
about
vaccine
distribution
here
in
california,
and
I
want
to
remind
folks
that
we
have
been
grounding
this
meeting
as
we
as
we've
talked
about
in
every
meeting
in
the
principles
that
guide
this
effort
of
safety,
equity
and
transparency,
and
to
that
effort
it's
it's
all
of
you
have
been
who
have
been
part
of
this
process,
know
that
you
all
have
raised
many
many
many
many
questions
really
really
excellent
questions
that
we
have
taken
back
and
we
have
had.
B
We
brought
to
this
meeting
the
folks
within
public
health
within
the
governor's
office,
who
are
leading
those
planning
efforts,
and
we
convened
a
conversation
specifically
to
hear
from
you
some
of
your
most
thoughtful
recommendations,
ideas
and
suggestions
on
how
we
can
do
that
in
the
most
meaningful
way.
B
I
also
want
to
recognize
that
there
are
some
questions
that
it
takes
us
a
little
moment
to
respond
to,
and
I
think
just
like
many
of
you,
I
really
want
to
highlight
the
extent
to
which
all
of
my
colleagues
across
health
and
human
services,
the
governor's
office,
all
of
government,
but
especially
our
incredibly
hard-working
california,
department
of
public
health.
I
folks
are
literally
working
around
the
clock
to
be
doing.
B
You
know
to
be
supporting
testing
and
contact
tracing
and
getting
all
of
our
our
capacity
supporting
our
hospitals
with
additional
staff
and
personnel
setting
up
surge
capacity.
Doing
all
of
these
things,
and
so
sometimes
there
will
be
a
comment
that
you
raise
and
not
sometimes
I
I
want
to
be
very
straightforward.
B
There
are
some
comments
and
questions
that
are
raised
that
it
we
when
we
respond
to
you,
we
want
to
make
sure
that,
though,
that
the
response
that
we
are
giving
you
as
things
are
moving
very
quickly,
as
everyone
is
responding
to
a
pandemic,
that
the
response
that
we
are
giving
you
is
the
most
accurate,
up-to-date
response
in
terms
in
a
rapidly
moving
landscape,
and
so
I
want
to
acknowledge.
There
are
a
number
of
times
where
folks
have
have
put
questions
in
that.
B
Don't
have
an
immediate
response
and
we're
really
really
grateful
for
the
excellent
way
that
folks
have
been
using
the
chat
function
to
put
all
of
those
questions
in
there
and
then
we
as
a
group
we
dive
into
it,
and
we
say
okay
who's
going
to
do.
You
know
who
we're
going
to
some
of
these
questions.
They're
they're,
really.
You
know
simple
and
straightforward
some.
B
We
want
to
make
sure
that
the
answer
we
have
is
still
accurate
right
or
whether
circumstances
have
changed,
and
we
want
to
bring
you
to
bring
you
the
most
up-to-date
and
accurate
information,
and
so
today,
in
response
to
those
questions
we
are
going
to,
we
have
crafted
the
agenda
for
today
to
again
be
in
response
to
the
questions
that
we
have
heard
from
you
and
that
you
all
have
raised
so
first
we'll
be
hearing
an
update
for
from
dr
pan.
B
We'll
get
the
latest
on
surge,
but
we're
also
going
to
dr
pond
is
also
going
to
share
information
about
our
partnership
between
our
long-term
care,
our
long-term
care
partnership
to
get
residents
of
long-term
care,
centers
access
to
the
vaccine
right,
and
so
dr
pond
will
share
a
bit
about
that
partnership
and
and
then
we're
going
to
hear
a
public
comment
from
from
bobby
and
and
then
we're
going
to
dive
into
phase
1b.
We
know
that
there
have
been
a
lot
of
oh
when
are
these
folks
coming
in?
B
When
are
those
folks
coming
in?
So
we
want
to
bring
you
those
responses.
We
want
to
be
very
directly
direct
about
that.
The
drafting
guidelines
work
group
has
had
the
opportunity
to
convene
they
have
received
all
of
the
input
and
the
the
information
that
you
all
have
shared
and
considered
that
as
they
have
been
drafting
their
guidelines,
and
so
we
have
that
to
share
back
with
you
today
and
then
we'll
be
looking
to
hear
any
additional
input
suggestions,
thoughts,
considerations
that
you
have
from
that
and
then.
B
Finally,
in
response
to
many
of
the
questions,
we've
had
many
questions
about
logistics
right.
So
how
is
it
going
to
get
from
here
to
there
who
is
going
to
allocate
at
this
specific
time
are
folks
going
to
be
asked
to
verify
eligibility?
And
what
is
that
verification
going
to
look
like?
B
So
in
response
to
those
questions,
we
have
invited
some
local
health
officers
who
are
really
on
the
front
lines
of
of
where
the
rubber
meets
the
road
for
delivering
these
vaccines
to
our
communities,
to
be
able
to
share
a
bit
about
what
that
looks.
B
Like
we've
heard
from
you
that,
in
our
different
counties
that
you
know,
a
large
county
may
have
a
a
different
approach
from
the
with
the
local
health
officer
than
a
smaller
county
or
a
more
rural
county,
and
so
we
have
invited
several
local
health
officers
represent
different
types
of
counties
to
share
information
with
you
today,
and
so
with.
All
of
that
I
want
to.
I
want
to
set
the
scene,
and
I
and
I
want
to
again
come
back
to
grounding
in
this
conversation
number
one
focused
on
that
safety,
equity
and
transparency.
B
The
you
know
the
whole
point
of
of
this.
This
introduction
and
sharing
this
these
thoughts
with
you
is
really
to
give
you
all
a
level
of
transparency
around
what
happens
to
all
those
questions
that
you
share
with
us.
Even
if
we're
not
even
if
you
don't
get
a
response
immediately
in
the
same
meeting,
but
that
we
are
working
very
hard
to
make
sure
that
we
have
responses
for
you
that
are
accurate
and
the
most
up-to-date.
B
C
Great,
thank
you
so
much
dr
barcaris
and
good
afternoon.
Everyone-
and
I
just
want
to
echo
a
few
things
just
again,
want
to
be
very
grateful
for
all
of
you
and
your
time
and
your
input
and
your
feedback.
I
think
it's
just
invaluable
and
really
appreciate
this
group.
I
think
I'll
start
with
just
some
big
picture
kind
of
highlights
on
where
we
are
in
this
pandemic.
I
know
last
time
I
emphasized
as
well.
You
know
we
are
certainly
in
the
midst
of
a
surge.
I
think
some
you
know.
C
Possibly
good
news
is
that
you
know
we've
had
very,
very
high
numbers
of
cases.
You
know
as
high
as
50
000..
We
had
some
differential
in
the
media
last
yesterday
on.
You
know
where
we
are,
but
I
think
the
test
positivity,
for
example,
has
has
been
as
high
as
over
13
and
today
was
maybe
our
seven
day.
Average
is
a
little
bit
lower
and
you
know
there's
some
signs
that
maybe
we
you
know
are
getting
at
least
a
leveling
rather
than
a
steep,
steep
rate
of
increase.
C
So
I
think
that
is
I'm
hoping
to
be
encouraged
as
far
as
a
holiday
moment.
C
I
think
in
the
midst
of
that,
though,
you
know
the
other
really
difficult
work
and
conversations
we
are
having
literally
over
this
week
with
many
of
your
colleagues
on
the
front
lines
are
you
know,
I
think
many
hospitals
and
places
are
in
kind
of
contingency
care
right
now
and
really
thinking
hard
about
crisis
care
standards,
and
how
do
we
avoid
crisis
care
standards
and
how
do
we
make
sure
that
different
hospitals
and
regions
are
helping
each
other
and
level
loads?
So
that's
a
lot
of
the
difficult
conversations
going.
C
Even
if
our
cases
do
start
getting
better
now,
we
know
that
the
increase
in
the
hospitalization
will
happen
over
the
next
coming
weeks.
So
we
are
keeping
a
close
eye
on
that
and,
as
dr
prakeros
mentioned,
really
working
on
resources
to
really
keep
people
in
contingency
and
not
get
into
crisis
care
to
the
best
of
our
abilities.
But
I
think-
and
so
so
the
hospital's
part
might
get
worse
before
it
gets
better.
C
C
Really
good
news
is
that,
as
you
all
have
heard,
but
just
to
recap,
because
our
scientific
safety
group
couldn't
come
to
present
again
today,
but
they,
as
you
all
heard,
probably
from
the
federal
government,
the
fda
and
the
verbac.
And
then
the
acip
have
all
approved
moderna
for
use
in
the
united
states.
And
then
our
scientific
safety
group
met
for
long
hours,
including
on
saturday
evening
to
also
review
that
data,
and
they
have
also
reassured
and
made
a
recommendation
to
approve
use
of
modona
as
safe
and
efficacy
to
use
in
california.
C
Combined
for-
and
I
think
this
is
probably
an
underestimate,
as
far
as
what's
been
reported
back
and
and
there's
more
vaccinations
happening
over
120
000
vaccines
have
been
given
to
people
in
california
today.
So
that's
a
huge
wonderful.
C
You
know
again
light
at
the
end
of
our
tunnel
and
again
thank
all
of
you
for
the
ongoing
feedback
on
that
and
then
to
to
circle
back
to
as
well
the
questions
that
have
come
up
about
the
partnership,
the
pharmacy
partnership.
So
I
want
to
acknowledge
again
just
as
again
the
overall
federal
guidelines
and
us
in
california
that
certainly
skilled
nursing
facilities.
You
know,
residents
and
staff
are
one
of
our
highest
priorities,
and
this
has
been
an
incredible
opportunity
actually
to
have
a
partnership
where
pharmacies
can
help
do
that.
F
C
G
C
Not
doing
as
much
contact
recently
they're
trying
to
direct
to
the
outbreaks,
including
in
the
skill,
nursing
facilities
and
other
places,
to
totally
try
to
control
these
outbreaks
and
dealing
with
other
vaccinations
dealing
with
just
all
the
different
elements
of
this
response,
and
some
health
departments
have
more
resources
than
others,
but
to
have
this
partnership
has
been
a
really
helpful
opportunity,
so
many,
I
think,
are
really
welcoming
this
opportunity
to
have
another
way
and
other
partners
and
other
vaccinators
to
be
able
to
get
the
vaccines
as
quickly
as
possible
into
a
high
priority
population.
C
So
again,
some
health
departments
are
going
to
be
more
resourced
than
others,
but
that
is
sort
of
why
we've
made
the
decision
at
least
statewide
to
to
work
with
this
partnership.
We
will
be
monitoring
all
of
this
very
closely
with
what's
happening
in
skilled
nursing
facilities.
I
know
there's
questions
as
well
about
what
happens
with
assisted
living
facilities
and
the
residential
care
for
the
elderly.
Those
would
be
what
they
call
part
b
of
the
partnership
and
we
will
know
any.
C
You
know
we
are
closely
sort
of
considering
that
as
well
and
if
and
when,
to
sign
up
for
that
part
b
part.
But
we
want
to
we've
been
again
making
all
of
these
decisions,
trying
to
balance
all
the
resources
that
are
there
and
trying
to
do.
C
What
we
think
will
make
the
most
sense
to
vaccinate
the
most
people
as
quickly
as
possible,
including
prioritizing
high-risk
populations
like
skilled
nursing
facilities
so
and
again,
we'll
be
watching
closely
and
monitoring,
and,
I
think,
on
all
levels
because
again,
different
regions,
different
health
departments
have
different
resources,
trying
to
see
what
we
can
do
at
the
state
level
to
help
augment
various
areas
and
again
using
the
priorities
that
u
of
law,
had
input
on
in
our
drafting
guidelines.
For.
H
C
Again
as
a
key
priority
and
key
way
to
prioritize
our
resources
so
wanted
to
be
able
to
sort
of
provide
that
perspective
for
you
on
why
we've
made
that
decision.
J
A
Great
thank
you.
So
all
of
you
received
the
public
comments
that
have
been
submitted
since
december
15
through
december
21st.
I'd
just
like
to
remind
all
the
members
of
the
committee
and
the
public
that
two
nights.
Before
the
day
of
our
meeting,
we
stopped
the
public
comment
at
5
pm
from
being
accumulated
into
the
submission.
A
So
we've
received
a
total
of
171
pages
of
comments,
including
several
hyperlinks,
that
included
many
many
pages
of
commentary.
None
of
the
public
comment
is
summarized
it's
actually
verbatim
posted
and
sent
out
to
the
members
of
the
committee
so
that
they
can
reflect
on
the
very
thoughtful
comments
that
the
public
is
making.
We
received
comments
from
358
individuals
and
organizations
with
another
600
individuals
signing
two
petitions
which
I
will
highlight
in
just
a
moment.
A
So
I'm
just
going
to
summarize
the
topics
and
the
numbers
that
we
received
in
terms
of
the
feedback.
We
had
two
members
of
the
public
asking
to
be
added.
As
members
to
the
community
advisory
committee,
we
had
26
people
writing
to
find
out
how
they
can
as
individuals
obtain
the
vaccine
and
who
to
talk
to
in
their
local
community
to
get
the
vaccine.
A
We
had
one
comment
asking
where
the
scientific
safety
review
committee
from
the
western
states
partnership
gets
its
data
that
it
uses
to
review
when
it
makes
its
statement
on
the
recently
released
vaccines.
We
had
one
comment
asking
that
all
the
public
outreach,
materials
and
communication
toolkits
be
posted
and
made
publicly
available.
A
We
have
many
people
who
make
multiple
comments
within
their
public
comment,
asking
that
certain
classes
of
workers
be
included
in
tier
one
of
phase
1b,
which
we'll
be
talking
about
today,
and
those
include
domestic
violence,
shelter,
staff,
expanding
the
category
of
emergency
services
to
include
non-profit
social
service
agencies,
providing
direct
services
applying
the
equity
lens
using
the
healthy
places
index
to
prioritize
within
each
employment
sector.
A
A
number
of
people,
including
300,
attorneys
and
advocates,
who
signed
a
petition
urging
us
to
consider
workers
in
correctional
facilities
and
the
inmates
and
correctional
facilities
for
first
priority
getting
the
vaccine.
We
had
27
individuals
and
organizations
request
that
workers
and
detainees
in
immigration,
detention
facilities,
both
public
and
private,
be
highlighted
for
early
vaccination.
A
We
have
13
people
a
variety
of
health
care
workers,
including
hospital
pharmacists,
podiatrists,
anesthesiologists,
respiratory
therapists,
other
medical
specialists,
midwives,
nursing
students,
lab
staff
and
dialysis
centers
asked
to
be
at
the
top
of
the
list.
A
In
addition,
we
had
48
comments
asking
us
to
prioritize
these
categories
of
individuals
early
in
the
vaccination
process,
individuals,
65
years
and
older
elderly
residents
living
in
independent
living
situations,
individuals
living
with
hiv
and
aids,
individuals
with
intellectual
and
developmental
disabilities
and
their
caregivers
individuals
who
have
immunosuppressed
conditions,
obese
people,
individuals
in
homeless,
shelters
and
others
who
are
unhoused
and
individuals
with
co-occurring
health
conditions,
and
that
is
a
very
quick
summary
of
those
171
pages
that
all
of
you
received
and
I'm
sure
have
had
a
chance
to
look
at.
Thank
you,
dr
burkhart.
B
Thank
you
so
much
bobby,
and
now
we
will
dive
into
a
discussion
of
the
phase
1b
recommendations.
I'd
like
to
introduce
dr
oliver
brooks
and
dr
rob.
Schechter
co-chairs
of
the
drafting
guidelines
were
group,
and
I
I
want
to
thank
the
drafting
guidelines,
work
group.
They
have
been
working
tirelessly
and
they,
as
they
have
been
drafting
these
guidelines.
They
have
been
taking
into
account
and
considering
listening
to
the
feedback
of
this
body
of
the
cvac
and
actually
many
members
of
the
drafting
guidelines.
B
Work
group
are
on
this
call
today
listening,
so
that
they
can
hear
directly
from
you
the
the
comments
in
regards
to
these
recommendations.
A
summary
of
the
comments
will
be
sent
to
the
drafting
guidelines.
Work
group
for
their
next
meeting
on
december
30th
and
dr
brooks
and
dr
schechter
will
present
their
recommendations
from
the
drafting
guidelines,
work
group,
and
so
they
will
present
those
recommendations
today
and
then
we
want
to
hear
your
feedback
right.
B
We
want
to
hear
your
feedback
on
the
recommendations
and
then
the
drafting
guidelines
work
group
will
take
that
feedback
further
into
consideration
and
think
about
how
to
incorporate
and
then
send
these
recommendations
on
to
the
administration
for
final
approval,
and
so
I
think
so
we'll
hear
right
now
from
dr
brooks
and
dr
schechter
and
then
we
following
their
presentation
that
we
will
invite
discussion
as
to
responses
and
feedback
on
their
recommendations.
K
Thank
you,
surgeon,
general
burke,
harris
and
thank
you
bobby,
and
thank
you,
dr
pan,
for
the
information
thus
far
provide.
I
think
it
sets
the
stage
for
a
very
robust
discussion
regarding
the
activities
that
we
will
be
addressing
today,
so
bobby
next
slide
all
right.
So
this
is
a
recap
of
of
our
meeting
our
last
meeting
a
week
ago.
Next
slide.
L
K
What
what
we've
been
looking
at
in
some
of
this
you've
already
seen
and
dr
schechter
by
the
way,
is
on
as
part
of
this
but
I'll
present
this
right
here
that
you,
you
all
suggested
that
we
look
at
these
four
areas
in
terms
of
how
we
go
forward,
evaluating
the
essential
workers
and
almost
anyone
once
we
look
into
allocating
the
vaccine
so
as
it
relates
to
first
of
all,
1a
1
8
is
health
care
workers.
K
So
what
we
looked
at
is
the
four
bullets
acquiring
infection,
severe
sickness
and
death,
negative
social
or
societal
impact
and
then
spreading
disease.
Brain
disease
is
at
the
bottom
because
we're
there's
not
a
lot
of
good
data
that
immunizing
blocks
transmission,
there's
great
data
that
it
it
reduces
significantly
by
95,
severe
illness
and
death.
So
with
with
that
in
mind,
that's
how
we
did
1a
so
on
the
right.
That's
the
on
the
left
side.
K
Now
on
the
right
side,
as
we
look
at
1b
as
we
have
been
discussing,
we're
looking
at
1b
being
essential
workers.
So
when
we
assessed
them,
we
used
four
primary
areas
that
again
were
suggested
by
you.
All
occupational
exposure,
equity,
societal
impact
and
economic
impact
and
then
based
on
the
amount
of
data
we
had
the
risk
of
covet
19
in
different
sectors
and
importantly,
we're
doing
sectors
as
opposed
to
occupations
at
this
point
and
then
an
economic
analysis
as
it
related
to
the
information
that
we
had
on
essential
workers
next
slide.
K
So
what
we?
What
we
looked
at-
and
this
is
what
we
came
up
with
these-
are
the
sub
bullets
for
the
four
eras
and
it's
including,
but
not
limited
to
so
this
may
have
areas,
for
example,
under
societal
impact
of
job.
There
may
be
other
things
that
aren't
there,
but
this
just
gives
some
context
so
they're
necessarily
survivability
or
daily
living
basis
of
societies.
K
There's
a
scarcity
of
workers,
stuff
that
says
if
something
a
few
of
them
were
lost,
certain
areas
would
shut
down
parents
losing
jobs
because
of
no
child
care,
and
this
for
societal
impact
going
over
to
equity
economic
necessity
so
that
they
need
to
be
vaccinated.
So
they
can
work
there.
M
K
Disproportional
impact
on
already
disadvantaged
communities,
so
we
really
want
to
keep
that
in
mind.
We
want
to
mitigate
death
and
illness
and
the
same
with
the
pressure
on
racial
and
ethnic
communities
going
back
over
to
impact
on
economy
scarcity
of
workers.
So
it
may
be
that
if
one
particular
sector
goes
down,
doesn't
have
a
great
societal
impact,
but
it
may
have
a
great
economic
impact
and
things
like
wage
and
price
stability
and,
lastly,
occupational
exposure,
which
was
again
our
highest
concern
with
the
health
care
professionals
or
personnel.
K
So
those
who
can't
work
from
home,
those
that
are
just
directly
exposed
and
therefore
they're
at
high
risk
for
obtaining
coping
19
and
then
severe
disease
or
death,
and
the
likelihood
of
spreading
that
we
don't
have
clear
data
on
that.
We
were
concerned
about
that
and
then
shared
congregate,
workplace
housing.
So
someone
is
more
highly
likely
to
be
exposed
because,
if
they're
working
in
an
environment
where
they're
around
or
living
in
an
environment
where
they're
around
other
people
next
slide
so.
N
K
That
information,
our
leading
candidates
for
tier
one,
are
education
and
child
care.
1.1
million
emergency
services.
Excuse
me:
1.4
million
education,
child
care,
emergency
services,
1.1
million,
and
then
food
and
agriculture,
based
on
those
four
criteria
that
I
just
referenced:
the
societal
impact,
equity
occupation,
exposure
and
impact
on
the
economy.
K
These
fell
out
as
the
most
important
in
this
arena
to
be
at
the
top
of
t
of
phase
one
b,
so
we're
calling
it
tier
one.
So
we
will
have
more
information
after
we
go
through
the
next
couple
of
slides,
where
we
can
then
discuss
and
get
your
comments
on
phase
one
b.
So
I
will
now
turn
it
back
over
or
turn
it
over
to
rob.
Schechter,
who
is
the
chief
of
innovation,
branch,
cdph.
O
K
O
You
thank
you
and
thank
you
to
dr
burke
harris
dr
pan
and
bobby
as
usual
and
happy
holiday
season
to
you
all.
So,
with
that
background
about
the
deliberations
up
to
our
last
meeting,
I
will
now
switch
to
the
discussion
that
occurred
over
the
meeting
over
the
weekend
from
the
national
advisory
committee
on
immunization
practices,
which
advises,
cdc
and
hhs
next
slide.
O
Please,
on
saturday,
the
acip
met
to
recommend
the
use
of
the
moderna
vaccine,
which
has
arrived
over
the
last
few
days
around
the
country,
and
then
they
met
again
on
sunday
to
talk
about
who
should
be
recommended
to
receive
vaccine
during
subsequent
phases
after
phase
one
a
next
slide,
please,
as
you
may
have
seen
or
heard
the
acip
voted
on
sunday
for
who
should
be
in
phase
1b
and
phase
1c
and
for
phase
1b.
O
They
recommended
persons
aged
75
years
and
older
and
what
they
called
in
line
with
some
of
the
definitions
of
the
national
academy,
frontline
essential
workers
and
then
leaving
other
worthy
high-risk
groups
in
phase
one
c
to
follow,
as
vaccine
becomes
more
available,
and
the
persons
in
1c
include
those
65
to
74
years.
O
So
in
reaching
that
conclusion,
the
committee
saw
balancing
goals
throughout
each
each
phase
in
in
groups
that
are
a
special
risk
of
severe
illness
and
then
of
of
of
workers
or
groups
that
are
critical
for
societal
functioning
and
so
that
for
1a
you
have
a
long-term
care
residents,
as
well
as
workers
in
in
health
care
settings
in
1b
age,
a
person's
age,
75
years
and
older,
as
well
as
frontline
essential
workers
and
then
for
the
national
recommendations.
One
c
includes
again
a
a
mix
of
groups
that
address
both
of
these
concerns.
O
May
I
have
the
next
slide.
Please.
O
And
thinking
about
california's
criteria
and
in
california's
deliberation,
it's
not
necessarily
just
one
or
the
other,
as
you
could
see
in
in,
for
instance,
healthcare
workers,
there's
play
both
a
role
in
dealing
with
the
surge
and
and
providing
health
care
for
covid
and
for
everything
else,
as
well
as
healthcare
workers
who
may
be
at
risk
of
exposure
or
health,
individual
healthcare
workers
who
may
have
risk
factors
for
severe
illness.
So
some
overlap
between
between
these
goals
and
in
thinking
about
societal
functioning.
O
That
incorporates
many
of
the
key
concerns
that
the
work
group
has
been
considering,
including
impact
to
society.
O
O
So
this
is
a
busy
chart
with
a
lot
of
shapes
and
different
colors
and
what
it
shows
is
in
the
widest
blue,
the
phase
1a
groups
and
healthcare
personnel,
healthcare
providers,
healthcare
personnel
and
long-term
care
facilities
and
those
70
and
then
going
to
the
in
phase
1a
healthcare
providers
long-term
care,
a
slightly
darker
blue
for
phase
one
baby,
frontline
essential
workers
and
65
to
74..
O
I'm
sorry
75
years
and
older
once
again,
frontline
workers
and
75
years
and
older
and
then
in
the
darker
blue,
what
they
selected
for
phase
1c
and
then
after
phase
1c
considerations
for
for
the
for
others
in
society.
O
Please
so
in
in
this
slide,
trying
to
compare
and
contrast
where
the
work
groups
deliberations
had
gone
through
last
weekend
compared
to
compared
to
the
what
acip
proposed
over
the
weekend
and
there's
a
lot
of
overlap.
In
the
left
hand
column.
O
They
also
include
persons
75
years
and
older
for
the
extreme
risk
of
severe
disease,
and
then
there
were
other
groups
that
have
been
in
deliberation
over
the
other
groups
that
have
been
in
deliberation
by
the
work
group
that
have
been
considered,
that
are
that
were
not
proposed
by
acip,
so
in.
In
short,
there
was
a
lot
of
overlap
for
the
work
group
to
consider
on
monday,
as
it
convened
and
a
few
differences
as
well.
O
This
slide
borrowed
from
the
presentation
on
sunday
by
dr
dooling
to
the
advisory
committee,
shows
the
number
of
deaths
per
100
000
population
by
age
group
and,
as
you
can
see,
the
bars
are
very
long
at
the
top
and
the
oldest
groups,
the
85
and
plus
have
a
rate
500
times
or
more,
that
of
young
adults
rate
of
death
and
very
high
rates,
as
well,
in
the
75
to
84
group,
with
significantly
high
rates,
but
at
lower
levels,
and
as
going
the
65
to
74
group
in
the
50
to
64
group.
O
So
a
substantial
increase
in
the
risk
of
death
at
that
75
year
old
cut
point,
but
not
not
to
ignore
that
rates
are
high
in
in
other
groups
as
well.
O
O
So
the
work
group
reviewing
the
work
of
of
acip
and
comparing
and
contrasting
to
its
deliberations
over
these
last
months
came
up
with
the
following
proposals.
Next
slide,
please.
O
I
think
there
was
also
a
specific
concern
in
education
that,
while
many
can
work
at
home
right
now
that
educa
that
there's
a
substantial
impact
upon
quality
of
education,
access
to
education
from
from
that
teleworking
or
from
that
distance
learning,
and
so
this
consideration
of
risk
of
exposure
would
not
be
a
consideration
for
those
who
would
ordinarily
be
in
the
classroom.
Teaching
next
slide,
please
as
a
result
of
that
different
definition
of
phase
c
phase
1
b.
O
The
work
group
also
proposes
for
phase
1
c
inclusion
for
the
other
critical
sectors,
essential
critical
infrastructure
sectors
that
are
not
included
in
phase
b
to
be
in
one
c
and
then
for
in
terms
of
the
medical
risk
to
include
the
remainder
of
persons
65
to
74
years
of
age,
who
are
not
included
in
phase
1b,
along
with
persons
16
to
64
years
with
conditions
or
disabilities
that
place
them
at
high
risk
of
severe
copay
19.
O
So
and
thinking
about
the
the
implications
in
terms
of
the
numbers
of
persons
in
each
of
these
tiers
and
phases,
this
gives
estimates
based
on
state
statistics
for
the
sizes
of
these
sectors.
But
again
going
back
to
that
definition.
O
There's
a
longer
name
for
this:
it's
industrial,
commercial
and
other
facilities
and
services,
as
well
as
transportation
and
logistics
based
on
both
the
essential
work
done
by
those
sectors
and
the
exposures
and
the
risks
of
many
occupations
within
those
sectors.
O
On
the
risk
side
again
for
for
phase
one
b
tier
two
have
included
there,
those
at
a
high
risk
of
severe
of
severe
covid19
who
are
65
to
74
years
old,
high
risk
because
of
their
underlying
conditions
or
disabilities
and
then
and
then
looking
at
congregate
settings
with
outbreak
risk
during
the
pandemic
over
the
last
year,
including
those
who
are
incarcerated
and
those
who
are
experiencing
homelessness
next
slide.
O
O
O
In
addition,
these
are
the
remaining
sectors:
chemical
communications
and
I.t,
critical
defense
industries,
energy
finance,
government
operations
and
community-based
sector
and
waste
and
wastewater.
Let
the
oweth
in
one
see
next
slide.
Please.
O
So
nearing
the
end
of
of
the
presentation:
how
do
these
numbers
in
the
sectors
compare
to
the
flow
of
vaccine
into
california?
O
As
of
the
orders
that
are
going
in
this
week,
the
orders
that
will
be
delivered
next
week
will
be
somewhere
in
the
two
million
range
by
the
end
of
by
the
end
of
december
and
reaching
doses
near
near
to
or
reaching
doses
that
might
be
sufficient
or
close
to
sufficient
for
phase
one
a
through
the
end
of
december
or
into
early
january
and
then
in
january,
the
according
to
the
the
federal
estimate,
another
three
to
four
million
doses
in
january,
which
would
be
doses
for
phase
1b
and
then
in
february.
O
Another
6
million
projected
for
a
cumulative
total
of
12
and
a
half
million
first
doses.
So
these
would
be.
These
are
the
numbers
of
people
rather
than
a
two-dose
series.
So
you
can
count
these
numbers
as
californians,
rather
than
having
to
divide
them
in
half
a
two
dose
series
and
given
the
numbers
and
the
proposed
tiers
for
1b,
that
there
will
be
sufficient
doses
to
for
1b,
perhaps
by
the
end
of
february,
and
perhaps
the
ability
to
start
in
1c
within
february.
O
O
Where
the,
where
the
worker
or
eligible
person
lives
or
works,
and
how
that
community
has
been
affected
by
the
pandemic,
the
likelihood
of
spreading
disease
to
co-workers
in
the
public.
As
dr
brooks
said,
that's
and
as
we've
talked
about
in
prior
meetings,
whether
or
not
to
consider
that,
given
the
incomplete
information
we
have
at
present
about
the
effect
of
the
vaccines
and
potentially
other
factors
as
well.
O
The
last
topic
I
want
to
raise
today
is
how
the
the
transition
between
phases-
and
this
is
a
slide
from
the
cdc
cdc
this
acit
meeting
on
sunday-
that
the
transitioning
between
phases
will
be
necessary
as
supply
increases
and
demand
within
a
phase
subsides
and
that
acip
raised
the
potential
of
phases
may
overlap
rather
than
being
a
date
where
everybody
in
one
phase
has
been
immunized
and
the
next
day
everybody
in
the
next
phase
begins.
O
There
would
rather
be
overlapping
transitions
between
phases
and
subphases,
and
that
these
decisions
would
be
being
made
not
by
acip
per
se,
but
but
at
a
state
or
local
level.
The
next
slide,
please.
O
And
this
is
a
graphic
representation
from
the
city
of
the
cdc's
presented
over
the
last
less
meetings
as
well,
where
again,
the
next
phase.
This
is
not
meant
to
be
exact
either
in
number
of
doses
or
time,
but
just
the
the
concept
that
there
are
there
is
an
overlap
as
phased
as
more
doses
come
in
and
as
demand
subsides
in
the
in
the
group.
O
Please-
and
this
is,
I
think,
a
repeat
from
last
week-
is
that
at
the
end
of
the
day,
we've
made
these
prioritizations.
But
how
will
they?
How
will
the
local
health
department,
colleagues
about
to
speak,
actually
achieve
this
in
partnership
with
immunizers
around
the
state,
and
it
will
again,
the
bottom
line
is
that
the
partnerships
such
as
represented
by
by
your
participation
in
this
group
will
be
critical
to
our
ability
to
make
this
all
work.
O
So
again,
I
want
to
thank
you
for
attention
and
we'll
lead
into
leading
to
the
discussion.
B
Thank
you
very
much,
dr
schechter
and
dr
brooks,
and
thank
you
for
the
hard
work
on
the
tracking
guidelines,
work,
group
and,
and
so
now
we
want
to
open
up
for
conversation
and
discussion.
We
really
want
to
hear
your
feedback
on
these
recommendations.
B
Are
there
additional
concepts,
ideas
that
you
think
the
drafting
guidelines
needs
to
consider?
Is
there
something
that
you
feel
like
they
missed
that
they
didn't
consider.
Please
keep
in
mind
that
the
recommendations
as
we
as
presented
today
is
really
the
the
the
reflects
the
drafting
guidelines
work
group,
taking
into
consideration
many
of
the
the
comments
and
suggestions
that
were
made
by
all
of
you
at
our
last
meeting
and
really
working
to
look
at
the
public
health
data
to
look
at
the
national
guidelines
and
to
craft
that,
together
into
something
that
is
responsive.
B
We
know
that
one
of
the
things
that
the
drafting
guidelines
work
group
took
into
heavily
into
account
as
a
result
of
the
recommendations
of
this
group,
is
the
concept
of
intersectionality
and
so
really
looking
at
how
some
of
these
how
an
individual
may
fall
into
several
different
groups
or
be
at
risk
in
in
several
different
ways.
B
We'll
ask
that
you
raise
your
use.
The
raise
your
hand,
feature
and
and
bobby
wunge
can
facilitate
our
our
conversation
as
we're
jumping
into
the
conversation
I
do
want
to
highlight.
There
were
a
couple
of
things
that
I
was.
I
was
kind
of
monitoring
the
chat
a
bit.
There
were
a
number
of
questions
that
came
that
were
really
logistic
questions
right,
like
how
do
people
know
if
they're
on
the
list?
B
B
There
were
also
several
questions
about
our
long-term
care
pharmacy
partnership,
and
what
we
will
do
is
that
we
will
bring
those
questions
to
dr
pan
and
have
her
be
able
to
bring
those
responses
back
at
our
next
meeting.
So
we
can.
We
can
do
that
and
then
there
are
also
some
specific
questions
about
who
is
included
in
what
sector
and
how
do
folks
know
well
whether
they
are
included
ones
in
which
sector,
for
example,
mental
health
providers
or
are
individuals
in
immigration,
detention
centers?
B
Is
that
considered
under
correctional,
and
so
these
are
all
factors
that
we
will
make
sure
to
get
these
answers
and
then
bring
them
back
to
you
all.
But
if
dr
dr
brooks
or
dr
schechter
or
dr
chapman,
if
any
of
you
have
any
quick
responses
that
you
wanted
to
to
throw
out
there
before
we
have
open
up
the
conversation,
please
feel
free
to
jump
in
as
well.
K
A
Okay,
well,
let's
get
started.
I
just
want
to
remind
everybody
if
you
could
last
time,
everybody
asked
three
questions
in
one
and
it
really
limits
the
number
of
people
that
we
can
hear
from.
So
don't
try
to
trick
us.
Just
ask
one
question
very
directly
and
we'll
see
if
we
can
either
get
an
answer
for
you
today
or
at
future
meetings.
A
So
let's
start
with
jake
jake
snow
and
then
we'll
go
to
jackie
garman
and
then
to
ronnie
kelly
and
then
to
andy
and
to
kieran
and
then
we'll
see
where
we
are
with
the
time.
D
Hi
everyone,
and-
and
thank
you
bobby,
my
name-
is
jacob
snow.
I'm
an
attorney
with
the
aclu
of
northern
california.
I
put
I
put
three
questions
in
the
chat,
but
in
in
to
comply
with
bobby's
recommendation.
I
will
just
include
one
of
those,
and
that
is
does
it?
Does
the
inclusion
of
incarcerated
people
in
phase
b
phase
one
b
tier
two
include
people
who
are
in
federal
prisons.
D
Dr
burkhart
has
already
already
mentioned
that
we'll
be
getting
word
on
immigration,
detention,
so
I'll
just
ask
about
federal
prisons.
You
know
just
to
to
underscore
the
point
we
think
federal
prisons
should
be
included
and
they
should
be
offered
the
vaccine
when
other
incarcerated
people
are
offered
the
vaccine,
given
the
risk
that
incarcerated
populations
are
under,
and
thank
you
very
much.
A
Thanks
jake
rob
had
to
go
off
for
a
minute.
I
don't
know
if
he's
back.
O
O
O
O
O
The
the
conclusion
at
that
time,
at
least,
was
that
a
federal
that
pardon
that
correctional
facilities
could
be
immunized
with
both
staff
and
and
inmates
at
the
same
time,
but
that
it
was,
it
was
a
case-by-case
decision
where
there
was
discretion
about,
at
the
same
time
of
immunizing
the
staff
whether
to
immunize
the
residents.
O
So
we
will
need
to
check
in
with
our
federal
counterparts
about
how
they
anticipate
implementing
in
in
federal
prisons
within
california,
but
at
this
at
this
time
it
would
be
applying
at
least
to
state
and
state
prisons
and
local
jails.
A
P
Thank
you,
ronnie
kelly,
county
behavioral,
health
directors,
association
and
thank
you,
dr
burke,
harrison
and
dr
brooks
for
addressing
the
behavioral
health
component
of
this.
Can
we
please
get
in
writing
that
health
care
includes
behavioral
health,
those
words
because
counties
are
ignoring
that
from
theirs
from
their
public
health
offices,
and
many
of
our
folks
are
not
getting
access
to
vaccine
and
we
need
it
now.
Thank
you.
A
Thank
you,
ronnie,
let's
go
to
andy
and
then
kieran
and
then
susan.
Q
Yes,
hi
andy
imperato
with
disability
rights,
california,
it
seems
like
in
the
tiers
in
phase
1b
we're
using
age
as
a
proxy,
and
I
guess
I'm
I'm
trying
to
understand
better
what
the
goal
is.
If
the
goal
is
to
prevent
people
who
are
at
highest
risk
of
dying
from
covid
from
getting
coveted
dying
or
having
severe
health
consequences,
then
why
we
would
why?
Wouldn't
we
put
anybody
who
is
at
that
level
of
risk
in
that
tier
and
not
worry
about
how
old
they
are
like?
Q
O
I
think
that
you
bring
up
a
a
a
very
important
point,
that
the
risk
of
a
of
an
individual
may
not
be
the
same
as
the
risk
of
the
groups
that
they're
they're
placed
in,
and
I
think
this
was
a
an
active
topic
of
discussion
over
the
last
months,
both
on
the
the
federal
discussions
that
led
to
that
led
to
a
similar
categorization,
and
I
think
it
it
as
well
as
as
well
as
the
state
group,
and
I
think
that
it
it
comes
it's
based
on
that
graph
of
the
extreme
level
of
risk
at
the
at
those
older
ages
or
that
we've
seen
from
the
hospitalization
of
death
rates
in
1a
and
in
long-term
care
facilities.
O
And
you
raise
the
question:
are
there
individuals
are
there,
people
are
there
loved
ones
or
family
members
who
are
outside
of
those
groups
who
might
be
at
a
similar
risk
than
and
excluded
from
the
group
that
that's?
That
is
a
possibility
and
the
the
guidelines
attempt
to
try
and
strike
a
balance
between
that
balance
between
severe
disease
and
and
societal,
societal
function
and
societal
impact.
B
If
I
could,
if
I
could
add,
I
think
it
speaks
to
the
the
concept
of
intersectionality
that
this
group
has
brought
up.
So
if
you
take
an
individual,
any
individual
is,
it
is,
might
be
characterized
by
membership
in
a
number
of
groups
right.
But
when
we
look
at
the
data
the
data
looking
at
age,
the
the
risk
based
on,
for
example,
the
75
plus
the
associated
risk,
far
exceeds
the
associated
risk
for
when
we
slice
the
data
other
ways
right.
B
If
you
slice
the
data
by
comorbid
conditions
right,
there's,
not
one
group
that
has
that
dramatic,
increased
risk
as
being
75
and
over,
and
so
that's
the
reason
that
when
we
look-
and
we
look
at
multiple
different
data
analyses-
and
we
say:
okay,
we
we
have
age,
we
have
race,
we
have
socioeconomic
status
or
income,
we
have
geography,
we
have
comorbid
conditions,
we
have,
you
know
all
of
these
different
pieces
and
if
you
look
statewide,
if
you
look
nationally
and
it
cuts
across
that,
that
age
is
the
greatest
risk
factor
of
death
from
cobit
19,
and
that
is
why
we
used
age
as
the
criteria
for
inclusion
in
in
that
that
tier.
A
Okay,
karen:
let's
go
to
you
next
and
then
we'll
go
to
to
susan
demaro
and
david
lound,
and
then,
if
we
have
still
have
time,
anthony
wright.
J
Sure,
thanks
bobby
this
is
karen
savage
california,
pan-ethnic
health
network
and
I
actually
sort
of
want
to
pick
up
the
point
around
intersectionality
and
what
I'm
really
concerned
about-
and
I
know
we're
getting
to
logistics
later,
but
I
might
differentiate
a
little
bit
is
operationalizing
equity
within
these
guidelines,
and
so
I
am
concerned
when
we
look
at.
For
example,
people
have
a
high
risk
medical
condition
that
in
fact,
it's
very
difficult
to
do
that
with
equity.
J
If
we're
going
to
require
people
to
demonstrate
their
medical
condition
or
even
know
about
it,
when
we
know
that
people
of
color
are
likely
to
lack
access
to
health
care,
often
be
misdiagnosed,
and
so
a
number
of
us.
I
think,
12
of
us
on
this
committee
sent
a
letter
or
a
comment,
really
encouraging
consideration
of
a
place-based
approach
and
looking
at
something
which
the
state
already
does
right
tools
that
sort
of
aggregate
different
risk
factors
for
us
like
the
healthy
places
index
and
really
focusing
some
level
of
our
prioritization
on
place.
J
Where
we
know
we
can
identify
the
places
where
people
are
most
likely
to
have
a
high-risk
medical
condition
to
work
in
a
front-line,
essential
occupation
to
live
in
crowded
housing.
And
so
I
guess
my
question
is-
and
I've
seen
it
mentioned
on
several
slides
but
sort
of.
Where
are
we
in
the
consideration
of
really
looking
at
place
and
location
within
these
prioritization
tiers?.
B
Thank
you
for
that
question
karen,
and
I
will
jump
in
and
say
that
we
did
receive
your
note.
Thank
you
very
much,
and
we
absolutely
are
that
absolutely
is
under
consideration
and,
of
course,
as
we
as
I
mentioned
on
at
at
the
beginning,
that,
as
we
are
responding
to
this
pandemic,
it
requires
lots
of
lit
different
logistical
considerations
among
many
different
teams.
B
Some
of
the
local
level,
some
of
the
state
level,
certainly
at
the
at
the
federal
level
as
well,
and
so
as
we
are
as
as
we
are,
you
know,
working
through
all
of
these
plans.
That
is
something
that
is
under
consideration
and
and
you'll
hear
further
feedback
on
that
at
a
later
meeting,.
K
And
and
very
quickly,
a
couple
of
facts
when
we
looked
at
essential
workers
in
california,
it's
68
of
the
population,
so
a
lot
of
the
equity
will
come
just
by
the
fact
that
a
lot
a
lot
of
people
right
now
are
they're
employed.
They
may
be
underemployed,
but
they're
employed
number
two,
the
the
ages.
K
There
are
less
interesting.
There
are
less
black
people
that
are
older
in
proportion
to
the
white
population,
so
that
does
factor
out
embrace
race
and
age.
However,
when
you
look
at
it,
our
tier
2
is
those
65
to
74
with
high
risk.
So
I
mean
there
will
be
some
that
just
don't
know
they're
high
risk,
but
I
would
submit
that
probably
eighty
percent
of
those
with
high
risk
are
diagnosed.
There
are
undiagnosed,
hypertensive
undiagnosed
diabetics,
but
then
they
may
be
in
one
other
group.
So
what
we're
going
to
find?
K
I
believe,
by
the
time
we
vaccinate
based
on
what
we're
looking
at
we're
going
to
capture
a
lot
of
those
that
you
are
discussing
and
the
last
point
buddy.
It
looks
like
by
the
end
of
february
we're
going
to
have
about
12.5
million
doses
and
in
phase
1b
they're.
A
total
of
15
million
people
does
that
after
healthcare
providers
and
long-term
care
facility
residents,
but
just
by
the
sheer
numbers
of
vaccine
coming
in
and
the
numbers
in
the
group.
K
E
A
Let's
go
on
to
david
lown
david
now
introduce
yourself
and
then
we'll
hopefully
have
time
for
anthony
and
then
we'll
have
to
hold
the
rest
of
the
questions
until
after
the
next
discussion.
So
if
those
of
you
have
your
hands
up
want
to
put
your
comments
in
the
chat,
it
would
be
great
so
david
and
then
anthony.
R
You
know
this,
this
will
be
quick
and
it
builds
off.
What
dr
brooks
is
just
saying,
so
we
I'm
from
the
public
hospital
healthcare
systems
in
california
and
as
our
systems
can
get
beyond
vaccinating
their
own
people
to
start
thinking
about
planning
for
actually
all
the
patients
and
community
members.
Dr
brooks,
you
just
said
that
we
estimated
to
have
12.5
million
doses
by
february.
R
that
I'm
wondering
how
those
estimations
of
doses
are
actually
lining
up
with
what
california's
actually
receiving
it
seems
to
be
in
the
december
estimates
based
on
what
I
understand
is
actually
much
higher
than
what
we're
actually
receiving
is
that?
Can
you
clarify
those.
O
Hi,
this
is
rob
schechter
again.
We
will,
by
the
end
of
next
week,
we'll
be
around
somewhere
in
around
the
two
million
mark
in
in
california,
on
the
state
side
and
some
more
doses
from
our
federal
and
tribal
partners
with
and
probably
somewhere
in
towards
two
and
a
half
million
or
more
into
early.
O
Those
first
days
of
january
was
the
first
week
days
in
january
and,
and
so
the
numbers
are,
there
were
some
differences
between
the
projections
and
what
the
final
numbers
were
over
the
last
weeks.
But
the
total
december
numbers
are
fairly
close
and
it
remains
to
be
seen
what
the
pace
will
be
going
into
to
january
and
beyond.
A
Thanks
rob:
let's
go
to
anthony.
H
Yeah
quickly,
in
order
to
advance
the
discussion,
I
just
wanted
to
just
get
clarity
about
what
we're
being
asked
to
comment
on
today
and
what
opportunity
there
is
to
further
comment.
You
know
when
is
the
next
time
that
the
the
drafting
work
group
will
be
considering
what
we're
we're
doing.
H
So,
if
we
don't
have
comments
at
the
moment,
when
is
the
opportunity
to
provide
that
opportunity
that
input,
but
from
what
I
understand
this
is
this
follows
the
asic
recommendations
from
this
weekend
with
adding
the
75
plus
category,
which
is
compelling
to
me,
but
then
also
adding,
but
the
difference
with
the
asip
is
adding
also
the
65
plus
with
high
risk
comorbidities.
H
If,
if
you
will
and
if,
if
that's,
if
that's
what
we're
asked
to
be
comment
on,
that's
helpful
clarification
and
again,
I
would
just
say
that
I
do
think
that
there's
compelling
about
things
that
are
logistically
simple
and
that
have
equity
like
age
and
like
place
and-
and
that
does
raise
the
question
of
why
65,
plus
with
high
risk
rather
than
65
plus
period,
which
I
believe
was
what
the
dissent.
The
one
dissenting
vote
from
this
weekend
suggested
was
just
to
do
the
65
plus
there.
H
Just
because,
as
I
think
dr
burke
harris
was
very
compelling
and
just
how
age-based,
hospitalization
and
and
death
are
correlated
with
with
cobit
19.
B
Yes,
so
I'm
happy
to
share
so
to
speak
directly
to
your
question.
This
is
going
back,
so
the
input
from
this
conversation
will
go
is
going
to
the
drafting
guidelines
work
group.
Their
next
meeting
is
on
december
30th
and
then
at
that
point
they
will
send
their
recommendations
to
the
governor's
office.
So
so
this
is
our.
This
is
an
opportunity.
B
Certainly
anyone
can
send
further
input
through
public
comment
or
you
know
if
you
have
another
question
that
occurs
to
you
later
in
the
conversation
where
we've
moved
on
to
another
topic,
go
ahead
and
put
it
in
the
chat,
and
all
of
that
will
be
shared
with
the
drafting
guidelines,
work
group
before
they're
december
30th
meeting
and
to
speak
to
the
the
second
half
of
that
question:
around
65,
plus
and
and
plus
or
minus
the
morbidity.
B
K
Can
I
can
say
something
that
so
I
think
an
important
thing
to
remember.
First
of
all
that
there's
going
to
be
a
blend
from
phase
one
be
the
different
tiers.
Okay.
So
I
I
think
that,
and
you
have
to
understand
tier
one
two
and
then
one
c,
so
it
was,
I
won't
say,
arbitrary,
but
we
we
felt
that
the
data
is
clearly
showing
I
mean
dr
schechter
slows
75,
plus
they
they
just
they're
outliers
they're
10
times
20
times
higher
death
rates,
so
they're
they're,
obvious
65
to
74.
K
They
could
have
been
in
tier
two.
We
moved
them
to
I'm
just
gonna
meet
one
b,
the
second
tier
versus
one
c,
merely
because
it
they're
just
so
there's
so
much
in
n1b.
They
were
really
worried
about.
I
mean
put
the
65
to
70
year
olds
that
are
high
risk
and
then
following
them,
if
you
will,
by
a
65
to
74
year
old,
no
high
risk,
probably
what
you're
going
to
find
is
the
majority.
K
I
I
don't
have
the
numbers
in
front
of
me,
but
there
is
the
number
greater
than
50
percent
of
people
that
are
65
and
older
have
at
least
one
risk
factor.
So
when
you're
talking
about
that
you're
going
to
end
up
again
the
intersectionality
that
50
of
the
people
65
to
74
are
going
to
be
in
tier
2
instead
of
1c,
just
because
they
end
up
having
a
risk
factor
and
importantly
and
fundamentally,
there's
less
vaccine
than
people
who
need
it.
So
we're
just
having
to
make
very
difficult
decisions.
K
And
so
that's
again
we
appreciate
your
input
because
your
input
allows
us
to.
You
know
to
give
some
suggestions
to
to
incorporate
into
our
final
determinations
to
our
final
decisions.
A
B
Wonderful,
thank
you
bobby
and
thank
you
everyone
for
that.
Robust
feedback,
we're
very
grateful,
and
and
and
now
we're
diving
into
a
discussion
we'll
hear
from
our
local
health
departments
about
operationalizing
distributions
of
vaccines.
B
So
we've
heard
lots
of
questions
about
you
know
how
does
this
work
on
the
ground
and
that's
why
we've
invited
local
health
officers
to
to
share
some
of
the
details
on
how
these
logistics
will
work
out
in
distribution
and
a
couple
of
the
questions
that
I
wanted
to
pull
out
for
the
chat
and
go
ahead
and
tee
up
for
our
conversation
was
number
one.
There
were
a
number
of
questions
of
how
do
people
know
that
they're
on
the
list?
How
do
they?
How
do
you
get
vaccine?
B
How
do
you
get
the
vaccine
if
you're
a
healthcare
worker,
but
you
don't
work
in
a
hospital
and
how
do?
How
are
we
getting
the
word
out
to
those
who
are
healthcare
workers
who
are
not
working
in
hospitals?
Those
are
a
couple
of
the
questions
that
I
pulled
out
of
the
chat
that,
as
we
hear
from
dr
sergenko
and
dr
saru
atari.
S
I
Sorry
had
a
little
trouble
with
mute.
Yes,
I
am
on
thank
you
and
just
to
clarify.
I
actually
am
a
public
health
director,
so
not
a
physician,
I'm
an
epidemiologist.
Sorry,
dr
burkharis.
S
Please
is
to
talk
a
little
bit
about
what
public
health
does
look
like
at
the
local
level
and
there
are
61
separate
local
health
jurisdictions
in
the
all
of
the
58
counties,
but
also
three
cities:
berkeley,
pasadena
and
long
beach
have
their
own
independent
local
health
departments
and
then
a
phrase
that
I
like
to
use.
S
All
the
time
is,
if
you've
seen
one
local
health
jurisdiction,
you've
seen
one
local
health
jurisdiction
they're
all
in
some
ways
similar,
but
in
in
many
ways
the
services
they
deliver
can
be
done
in
different
ways
in
different
organizations,
and
sometimes
they
are
standalone
health
departments.
Sometimes
they
are
part
of
a
larger
health
and
human
services
agency.
S
So
because
of
that,
the
scope
of
the
work
may
vary,
but
as
seen
in
the
pinwheel
on
the
right,
any
health
agency
has
to
address
the
10
essential
public
services,
public
health
services
that
are
indicated
in
that
diagram
that
assess
the
health
problems
that
exist
in
that
community.
Develop
policy
around
that
and
then
assure
that
that
policy
is
making
change.
But
I
want
to
bring
your
attention
to
the
center.
Is
that
really
central
to
all
things?
Public
health
is
addressing
equity
and
equitable
services
and
improving
the
public's
health?
S
I
will
say
that
it
does
vary
from
health
department
to
health
department
or
local
health
jurisdiction
to
a
local
health
jurisdiction
about
whether
or
not
they
include
some
element
of
direct
patient
services.
Some
don't
see
patients
at
all.
They
just
do
population
health
and
defer
that
to
the
health
care
system.
Next
slide.
Please.
S
That
said,
we
do
work
in
coordination
with
the
state
and,
I
would
say,
during
the
covid
pandemic,
we
have
been
in
continuous
contact
daily
meetings,
but
we
coordinate
those
through
three
organizations.
S
One
is
the
california
conference
of
local
health
officers
and
that's
different
than
the
other
two
organizations.
That's
a
statutory
body
created
in
1947
to
advise
policy
makers
on
all
health
matters
are
all
matters
affecting
health,
with
the
intent
that
it's
to
prevent
disease
and
improve
the
health
of
all
california
residents.
S
That
is
an
advocacy
body,
as
is
the
health
officers
association
of
california
or
hoac,
and
that
is
a
membership
organization
representing
the
physician
health
officers.
So
again,
cclh
has
a
statutory
body
that
has
an
advisory
role
to
the
state
health
officer,
whereas
chiac
and
hoac
are
advocacy
but
do
represent
the
counties
and
their
health
agencies
and
in
messaging
with
the
state.
I
Great,
thank
you
very
much,
so
I
wanted
to
touch
briefly
on
california's
history
of
vaccinating
individuals,
because
there
have
been
a
lot
of
questions
that
have
come
up
around
capacity
over
the
last
few
minutes.
A
few
meetings
excuse
me,
and
so
I
want
to
just
share
a
little
bit
about
the
history
of
what
california
and
local
health
departments
have
done
and
I'm
by
no
means
trying
to
imply
that
vaccinating
for
covid
won't
be
challenging.
I
But
I
do
want
folks
to
understand
that
we
have
a
strong
foundation
and
we're
building
on
that
strong
foundation
that
has
been
in
existence
for
many
decades
next
slide,
please
so
vaccinations
look
different
in
different
counties,
just
as
eric
had
talked
about
in
his
previous
slides
and
some
of
the
things
that
may
influence
what
vaccinations
look
like
are
things
like
resources,
the
availability
of
different
partnerships,
the
size
of
a
jurisdiction
and
a
number
of
other
other
items.
I
Some
areas
do
mass
vaccination,
influenza
clinics
and
you
may
hear
about
those
through
different
social
media
or
or
even
news
coverage,
and
then
vaccines
for
children
is
another
program
that
provides
a
network
of
providers
for
immunization
resources.
I
California
actually
purchased
more
than
10
million
doses
of
vaccine
and
distributed
it
through
their
network
of
providers,
and
that
was
10
million
per
year
with
bfc
and
that's
just
one
program,
the
vfc
and
at
the
local
level,
just
in
2020
between
the
beginning
of
the
year
and
december
21st
in
riverside
county,
we
have
over
a
million
and
a
half
doses
of
vaccine
administered
and
registered
through
our
california
immunization
registry.
I
Next
slide,
please
so
I
mentioned
the
california
immunization
registry,
and
so
that's
what
we
use
to
track
immunizations
throughout
california,
and
these
are
data
as
of
2016.
But
again
just
to
give
you
an
idea
of
magnitude.
I
We
have
over
a
hundred
percent
of
the
population
between
zero
and
18
years
registered
in
cares,
and
the
reason
for
over
a
hundred
percent
is
just
the
fact
that
there
are
limitations
to
population
estimates
and
there
there
are
occasional
duplicate
entries
that
haven't
been
caught.
So
so
that's
why?
But
essentially
we
capture
all
of
the
population
0
to
18
years
and
when
we
look
across
the
spectrum
of
age,
we're
actually
at
61
of
the
population.
S
Next,
please,
there
is
covid
ready,
which
is
the
ordering
system
established
by
cdph,
to
have
local
health
departments
work
with
providers
to
ensure
ordering
of
vaccines,
and
it
starts
by
enrolling
providers
and
then,
at
the
same
time,
looking
at
the
prioritization
guidance,
and
so
both
kim
and
I
have
been
on
these
calls
representing
cclho
and
chiac,
respectively
and
kind
of
been
the
listening
audience
and
sharing
your
concerns
with
cciho
and
shiac
and
making
sure
there's
this
understanding
of
the
prioritization
guidance
and
then
based
on
that
guidance,
allocate
vaccine
doses
through
covet
ready
to
providers
and
then,
with
those
approved
orders,
forwarding
them
to
cdph
for
processing
next
slide.
S
Please,
and
what
I've
done
here
is
again.
These
were
slides
that
ron
chapman
had
put
out
a
couple
of
sessions
ago.
This
is
condenses
steps
two
through
five,
which
honestly
the
local
health
jurisdictions
have
no
role
in
once
we
put
our
orders
in,
we
are
tracking
them
and
we're
hoping
to
see
information
coming
back,
sometimes
better
than
others.
But
again
we
maintain
situational
awareness
of
where
all
of
those
orders
are,
while
they're
being
processed
while
they're
coming
back
from
the
manufacturer
into
california
and
into
our
region.
Next,.
S
They
will
be
maintained
in
a
cold
chain,
as
required
by
the
vaccines.
Both
moderna
and
pfizer
require
a
maintenance
of
a
cold
chain
and
then,
as
indicated,
we'll
use
the
vaccine
registry
to
track
administration
of
the
vaccine
and
actually
get
those
vaccines
into
people's
arms.
So
again,
as
indicated,
the
initial
distribution
of
vaccines,
we
served
as
the
recipients
and
redistributed
to
vaccinators
within
our
jurisdictions.
S
Again,
some
hospitals
and
multi-county
entities
will
receive
their
vaccine
directly
next,
so
to
ensure
that
there
is
equitable
distribution,
there
have
been
coving
coveted
vaccine
plans,
using
templates
developed
by
the
cdc
at
both
the
state
and
local
health
jurisdiction
levels
and
the
intent
behind
that
was
was
to
identify
and
quantify
those
at-risk
populations,
and
it
does
ask
the
question,
within
those
vaccine
plans,
with
an
eye
on
equitable
distribution.
S
How
do
you
plan
on
reaching
other
populations
that
will
need
vaccinations
in
the
subsequent
phases
because
we
have
found
it
rather
straightforward
to
at
least
within
my
jurisdictions,
to
address
the
phase?
One
folks
and-
and
I
appreciated
the
comments
from
behavioral
health
workers
and
and
we've
been
doing,
that
I
will
say
again
ron
chapman
when
he
talked
about
sectors.
I
applied
that
same
guidances
you're,
not
just
thinking
about
the
individual's
job
title,
but
what
sector
they
work
in,
and
that
applies
equally
to
phase
1a.
S
We
truly
appreciate
the
discussion,
that's
ongoing
with
phase
1b
and
as
we
further
delineate
that
we
kind
of
can
see
this
the
same
questions
that
you're
posing
and
again
the
more
delineation
the
better.
We
can
adhere
to
guidance
and
implement
that
in
the
field,
but
regardless
ongoing
throughout
the
phases,
we
will
continue
to
monitor
distribution
because
we
will
look
at
that
data
and
make
sure
that
the
vaccinators
are
adhering
to
the
tears
and
the
phases
as
best
practical
and
providing
feedback
to
the
vaccinators
on
their
adherence
to
that.
Next,
please.
I
All
right,
so
we
we
hear
the
concern
about
making
sure
that
we
are
considering
equity
at
the
local
level
and
and
really
want
to
ensure
the
group
today
that
public
health
really
lives
in
this
equity
space
on
a
day-to-day
basis.
And
yes,
it
may
vary
from
county
to
county
a
little
bit,
but
equity
is
really
key
to
our
core
public
health
mission,
as
eric
showed
you
on
the
initial
slide.
I
Just
a
couple
of
examples
I
wanted
to
highlight
for
the
group
these
are.
These
are
from
riverside
since
that's
where
I'm
from,
but
many
counties
are
doing
something
very
similar.
We
have
our
own
vaccine
equity
task
force
in
riverside
county
and
you
can
see
from
the
slide.
We
include,
of
course,
public
health,
emergency
management,
our
office
on
aging,
social
services,
our
cbo's
and
I
didn't
list
them
all
out,
but
we
have
cbo's
representing
agriculture
and
farm
workers,
polenko
parks,
the
lgbtqia
community,
the
hiv
aids
community.
I
And
so
a
couple
of
examples
we've
been
putting
together
videos
for
the
ag
community
so
that
we
can
get
information
out
in
english,
spanish
peripecta
and
whatever
the
need
is
so
that
we
can
start
talking
about
that
and
the
cbo's
as
trusted
messengers
are
working
with
us
to
make
sure
that
the
information
is
out
there
before
the
vaccine's
even
available,
so
that
we
can
get
questions
answered
and
get
people
comfortable
and
and
hopefully
ready
to
take
the
vaccine.
I
I
also
mentioned
on
the
last
meeting
the
benefits
of
working
with
the
faith-based
community,
and
so
we've
been
working
with
the
catholic
archdiocese
and
they
have
put
out
a
video
to
all
of
their
parishioners,
encouraging
them
to
get
vaccinated.
So
I
think
that
really
the
cbo's
that
the
fbo
community
are
really
forced
multipliers
in
terms
of
getting
information
out
and
they
really
are
those
trusted
messengers
that
people
will
listen
to
and
and
are
effective
at
getting
that
messaging
out
and
overall
communication
really
being
bi-directional.
I
So
not
just
government
saying
this
is
how
it's
going
to
work
but
getting
input
from
these
groups.
I
think
that
that's
something
that
public
health
really
excels
at.
We
are
used
to
working
with
community
and
and
like
to
get
feedback.
So
with
the
first
group
of
vaccines
that
went
out,
hospitals
identified
their
highest-risk
employees,
we
worked
with
them
to
help
talk
through
that
we're
using
surveys
with
first
responders
to
get
a
better
feel
of
of
who
is
going
to
be
vaccinated.
I
I
So
to
that
end,
I
think
that
one
of
the
take-home
messages
for
both
eric
and
and
me
is
that
we
want
you
to
feel
comfortable
reaching
out
to
the
local
health
jurisdiction,
and
so
this
is
just
a
little
bit
of
a
cheat
sheet
on
who
might
be
helpful
when
you
do
reach
out
so,
of
course,
the
department
director.
So
that
would
be
your
public
health
director
or
your
health
and
human
services
agency
director.
I
I
Of
course,
the
vaccine
or
immunization
coordinator,
all
of
the
health
departments,
have
one
of
those
and
then
many
of
our
public
health
departments
have
what
we
call
a
department
operations
center.
That
is
set
up,
and
this
is
a
centralized
place
where
we
are
coordinating
all
of
the
covid
response
and
all
of
the
operations
from
testing
contact
tracing
case
investigation
to
vaccination.
I
So
I
think,
with
that,
we
I
will
stop
and
just
again
thank
you
for
the
opportunity
to
speak
with.
All
of
you
today
really
appreciate
the
partnership,
and
I
learned
so
much
at
all
of
these
meetings,
and
so
I
really
really
value
the
time
that
we
have
with
you,
and
I
know
eric,
and
I
are
happy
to
answer
questions
if
there
are
any.
B
Thank
you
so
much
kim
and
eric
for
taking
the
time.
I
know
it
is
an
insane
time
to
be
a
public
health
officer
right
now
and
we're
grateful
for
your
participation
in
this
process
and
you're
taking
the
time
to
answer
questions
of
the
committee
members
and
and
so
now,
it's
a
time
for
folks,
if
you
have
additional
questions
for
eric
and
kim,
if
you
want
to
go
ahead
and
raise
your
hands
and
bobby
can
help
to
facilitate
our
conversation.
A
F
Thanks
bobby
melissa,
stafford
jones,
first,
five
association
of
california,
thanks
to
you
both
for
being
on
given
the
incredible
work
that
you
are
doing,
my
question
is:
how
are
you
think
about
thinking
about
building
on
the
local
vaccine
infrastructure
you
just
described
in
some
of
the
planning
and
messaging
efforts
that
are
already
happening
at
the
local
level
to
correlate
with
some
of
these
phases
and
tears
that
we've
been
talking
about
over
the
last
several
meetings
for
particular
groups?
F
F
There
are
specific
logistical
issues
like
first
fives
are
very
focused
on
child
care
workers,
and
we
know,
for
example,
the
vaccine
is
going
to
have
to
be
available
outside
of
the
hours
of
you
know,
eight
to
five
in
order
for
them
to
to
access
it
because
they're
caring
for
children,
otherwise-
and
there
are
numerous
examples
like
that
for
child
care
workers,
but
for
every
group-
so
is
it?
Are
you
envisioning
that
there
might
be
work
groups
at
the
local
level?
F
That
would
sort
of
focus
on
a
particular
group,
and
you
would
welcome
partners
stepping
up
and
saying
hey.
We
could
partner
with
the
local
health
department
to
lead
that
group,
or
is
there
some
other
structure?
How
can
we
be
strong,
effective
partners
with
you
to
start
really
building
out
sort
of
the
outreach
and
logistical
planning
for
these
various
groups.
I
Sure
so,
thank
you
for
that
and
first
five
has
been
such
a
huge
partner
for
us
since
the
beginning
of
this
pandemic,
and
and
just
to
give
you
an
idea,
we
did
work
with
our
first
five
folks
to
do
guidance,
documents
and
materials
out
to
all
of
the
child
care
providers
and
to
to
provide
them
with
specific
contact
tracers
that
they
could
reach
out
to
and
have
consistent
access
and
consistent
information
for
child
care
providers,
and
I
think
that
we
build
on
that
going
forward,
and
so
yes,
exactly
how
you
described
it.
I
I
talked
to
our
first
five
director
all
the
time,
and
so
I
I
tap
her
on
the
shoulder
and
say:
hey.
We
need
help
with
vaccine
and
getting
it
out
to
your
constituent
group
and
she
has
those
networks.
So
we
don't
need
to
rebuild
and
reinvent
the
wheel.
We
really
just
want
to
leverage
the
existing
networks
that
are
already
out
there
and
and
use
that
network
to
get
information
out
to
encourage
people
to
vaccinate
and
to
give
out
the
details
about
how
that
will
happen.
S
I
think
just
more
broadly
is
in
working
with
other
organizations
and
getting
to
the
you
know.
How
do
we
best
work
is
in
addition
to
that
departmental
operations
center.
S
We
set
up
a
joint
information
center
that
coordinates
messaging
across
the
community
and
so
having
your
expertise
in
reaching
your
wedge
of
the
community
is
essential,
and
so,
as
you
reach
out
to
the
chem
equivalent
of
the
eric
equivalent
is
we
may
steer
you
towards
that
joint
information
center
and
help
you
craft
that
method
for
whatever
particular
interests
you
have,
because
that
has
been
critical
for
us.
I
will
say
as
an
example,
we
are
into
tier
two
in
the
second
bullet.
S
If
you're,
following
the
cdph
webpage
of
we
were
able
to
get
into
our
ihss
workers,
and
that
has
been
a
challenge
for
us,
but
we
have
reached
out
to
partner
groups
and
been
able
to
we're
even
mailing
people
as
it
boggled
my
mind
that
there
are
ihs.
There
are
people
that
don't
have
email
yet.
S
I
know
there
are
mobile
populations
transient
populations,
but
these
are
people
who
live
at
a
home,
provide
services,
and
so
we've
been
reaching
out
to
them
via
mail,
because
phone
didn't
always
work
and
we
didn't
have
email
access
so
having
that
list,
and
those
contacts
has
been
very
helpful.
So
again,
as
you
think
about
building
partnerships
with
the
local
health
jurisdiction,
you
may
get
no,
I
won't
say,
pushed
but
coordinated
with
the
joint
information
center,
because
that's
their
expertise
is
reaching
out
to
our
publics.
A
A
N
I
thank
you,
matthew,
maldonado
united
domestic
workers,
just
a
couple
questions
regarding
the
notification
of
a
group
in
a
identified
tier,
for
example,
tier
1a,
tier
2,
ihss
workers,
including
regional
center
employees
and
other
groups
who
may
come
up
beyond
that.
How?
How
are
they
being
notified
that
they're
in
a
category
that
has
access
to
the
vaccine?
Where
do
they
go
who's
tracking
the
data
of
of
them
these
workers?
Is
it
a
state
responsibility?
N
Because
you
know
isis
says
it's
a
statewide
program
and
the
same
thing
goes
for
child
care
workers
so
who
is
notifying
child
care
workers?
You
know:
there's
40
000,
child
care
workers
across
the
state
of
california
who
are
doing
this
work
and
they're
in
this
list,
but
there's
no
information.
N
I
think
who's
taking
responsibility
to
notify
these
folks
and
then
the
last
thing
just
wanted
to
add
and
see.
If
we
can
get
some
traction
on
this,
the
local
health
departments
that
are
working-
and
I
hear
about
riverside
there-
they
do
great
work
there.
We
have
25
000
caregivers
in
riverside.
N
However,
I
would
I
would
hope
that
these
groups,
who
are
working
on
these
local
committees,
vaccine
community
committees,
now
work
with
the
I
work
for
labor
unit
work
with
the
labor
unions,
who
can
help
assist
with
notification
of
the
people
who
are
coming
in
the
next
wave
of
groups
to
to
be
back,
have
access
to
the
vaccine.
N
So,
hopefully
you
guys
can
hear
that
I
reached
out
to
several
health
departments
throughout
the
state
to
see
if
we
can
get
some
traction
and
being
part
of
those
discussions.
Thank
you.
M
Perfectly
loud
and
clear,
thank
you
so
much
bobby
and
thank
you
to
our
two
guests.
So
my
name
is
deeper
nandeep
singh,
I'm
the
executive
director
of
the
jagata
movement
and,
as
I
guess
many
of
my
questions
go,
I
had
a
question
potentially
two
or
two
guests,
but
but
maybe
it's
it's
it's
also
some
others
can
share
as
well.
M
What
room
in
terms
of
implementation
do
do
oftentimes
board
of
supervisors
or
other
potential
political
parties
have
the
ability
to
intercede
within
I
mean
throughout
this
process
I've
seen
extremely
courageous
people
at
local
public
health
offices.
I've
seen
many
amazing
plans
actually
get
derailed.
I
know
those
are
the
democratic.
You
know
political
constraints
that
we
that
we
live
in
but,
from
you
know,
equity
investment
plans
that
I've
seen
cdph
asked
to
be
drawn
up,
but
not
actually
implemented
at
the
county
level.
M
I'm
concerned
in
terms
of
many
of
the
most
vulnerable
communities,
our
communities
that
are
most
marginalized
and
oftentimes
do
not
have
the
most
political
power.
Nor
the
largest
political
voice,
so
my
concern
is,
is
in
terms
of
the
directives
and
guidelines
we're
drawing
up
and
and
in
terms
of
how
the
implementation
actually
occurs
at
the
local
public
county
health
level.
M
I
Sure-
and
maybe
I
can
try
to
answer
matthew's
questions
also
because
I
know
that
he
has
some
really
good
questions.
So
I
think
I
mentioned
earlier.
We
have
a
department
operations
center,
and
so
our
department
operations
center
regularly
briefs
our
board
of
supervisors
and
and
keeps
them
in
the
loop
in
terms
of
what's
going
on
at
the
local
level.
I
What
recommendations
are
coming
out
of
the
state
of
california
and
and
how
we're
proceeding,
whether
it's
with
investigations
and
case
finding
testing
or
now
vaccination,
and
so
far,
at
least
in
our
county.
Our
board
has
been
supportive
of
the
efforts
that
we
have
been
rolling
out
and
they
are
also
a
mechanism
by
which
we
get
information
out.
They
have
large
followings
through
social
media
they're
out
in
the
community
a
lot,
and
so
they
have
been
really
supportive
and
helpful
in
that
way.
I
What
we
do
in
our
department
operations
center
is,
we
actually
look
at
the
tiers
and
we
look
at
who's
coming
up,
and
then
we
have
a
planning
section
and
I
don't
want
to
get
into
the
details,
but
but
we
have
a
planning
session
that
looks
at
okay.
Our
next
group
is
x.
How
are
we
going
to
reach
them?
I
Who
are
they
what's
the
best
way
for
us
to
administer
vaccines
to
that
group,
whether
it
is
through
points
of
distribution,
whether
it's
through
going
out
into
the
community,
and
so
all
of
those
things
are
really
considered
as
we
are
moving
through
the
tiers
so,
for
example,
with
first
responders,
we
actually
met
today
and
we
are
going
to
be
setting
up
a
number
of
pods
so
that
they
can
come
to
us
because
that
works
best
for
them.
I
When
we're
talking
about
the
point
in
time
where
we
get
to
some
of
our
farm
workers
or
other
members
of
our
more
vulnerable
populations,
we're
going
to
be
taking
vaccine
out
to
them,
so
it
really
is
again.
I
think
just
I
would
emphasize
the
importance
of
communication
so
that
we
can
determine
needs
of
the
population,
and
then
all
of
that
for
us
is
coordinated
through
our
department
operations
center.
That
way
it's
centralized.
We
don't
have
people
that
are
going
off
and
doing
their
own
things.
I
S
The
only
thing
I
would
add
on
to
that
is,
I
feel,
markedly
more
comfortable
with
vaccine
distribution
than
other
elements
of
the
pandemic
response,
because
it's
really
within
public
health
and
healthcare's
wheelhouse.
Whereas
if
we
look
at
things
like
non-pharmaceutical
interventions
and
those
closures
of
success
of
sectors,
you
know
social,
distancing
and
closing
restaurants,
etc.
S
That
really
requires
us
to
rely
on
partners
in
public
safety,
and
sometimes
we
don't
get
the
level
of
coordination
and
collaboration
we'd
like
to
have
with
that,
but
again,
because
this
resides
within
really
it's
just
an
expansion
of
our
10
core
functions
that
we
started
the
discussion
with,
and
and
so
we
do
that.
Well,
so
I
don't
feel
like
getting
to
deep's
question
that
we'll
see
influence
from
board
of
supervisors
or
from
other
elected
officials
they'll
try.
I
mean,
I
think,
that's
that's
a
given.
A
Thank
you
guys,
so
we're
going
to
take
a
very
succinct
question
from
aaron
carruthers
one
question
aaron
and
then
we'll
have
time
for
a
question
from
sylvia
yee
before
we
unfortunately
have
to
end
our
meeting
go
ahead.
L
Excuse
me:
hi
everybody
erica
at
the
state
council
on
development
disability
is
going
to
be
so
succinct,
I'm
actually
going
to
just
bounce
it.
If
I
can
back
to
matt
maldonado,
he
had
the
questions
they
were
there.
I
see
in
the
chat.
People
are
wanting
answers
and
kind
of
got
cross
communication.
So
if
that's
okay,
I'd
like
to
just
hand
it
over
to
matt.
N
That's
okay
bobby!
Thank
you
yeah!
So
again,
I
guess
the
question
is
you
know
for
home
care,
hss
workers,
regional
center
workers
who
are
you
know
a
lot
of
them
do
for
home
care
and
child
care?
They
don't
have
a
common
workplace.
How?
How
will
they
be
notified
that
they're
in
line
they're
in
one
tier
one,
a
or
one
b,
wherever
they
fall
in
the
category?
N
These
are
these
are
questions
that
we're
you
know
we're
trying
to
get
questions,
so
we
can
communicate
this
to
our
members
and
I'm
sorry,
a
social
media
account
from
a
county
board
of
supervisor
my
11
year
old
daughter,
might
have
more
reach
than
some
of
these
people.
No,
no
pun
intended.
N
I'm
j
I'm
serious
about
this,
because
it's
very
important
that
we're
able
to
communicate
to
people
about
the
decisions
we're
making
if
we
don't
follow
the
guidelines
that
we're
all
talking
about
right
here
and
leave
it
in
the
hands
for
you
guys
to
figure
out
without
there
being
input
and
things
change,
then
this
is
all
for
nothing.
S
No,
I
so,
as
as
I
think,
both
kim
and
I
have
mentioned,
is
you
know
we
message
via
lots
of
ways:
yeah,
it's
the
first
time
I've
ever
used
tik
tok
in
my
life,
so
I
don't
think,
there's
a
single
avenue
that
will
reach
every
at-risk
person,
so
it
gets
back
to
how
do
we
build
those
partnerships
with
you
with
those
groups
that
have
in
reach
inroads
to
those
groups,
because
I
do
look
at
the
messaging
and
you
know
working
with
cbo's
it's
something
again.
S
S
I
will
say
again
with
ihss
workers.
Specifically,
we
started
with
a
roster
because
they
are
providers
under
the
state
system,
but
we
maintain
a
roster
at
the
county
level.
That
was
actually
really
straightforward.
What
I'm
concerned
about
is
other
more
informal
groups
like
again
with
child
care
workers.
Some
of
those
are
registered.
Some
of
them
are
informal,
but
they're,
both
in
an
at-risk
population.
So
again,
the
ability
to
reach
those
populations
will
be
multifactorial,
and
I
think
that's
the
important
thing
to
recognize
is
that
we
do
need
those
partnerships
to
make
those
inroads.
S
So
again,
if
you've
not
been,
if
you've
not
had
that
outreach
as
an
organization
into
the
health
department,
like
our
last
slide
said,
is
please
touch
bases
with
our
you
know
the
agency
director,
the
health
officer,
the
doc
director.
We
may
end
up
again
because
it's
a
messaging
issue,
push
you
towards
our
joint
information
or
public
information
officer,
but
that's
our
best
way
to
get
the
message
out.
S
Let's
see
other
things,
you
asked
verifying
again
in
some
ways
it's
much
easier
than
others,
so
ihss
you're
going
to
be
a
registered
person
and
we
can
track
that
less
so
with
informal
and
really
where
I
get
into
concerns-
and
I
probably
given
that
we
have
like
two
minutes
left
my
answer.
I
do
have
questions
for
this
group
and
again
kim-
and
I
are
here
all
the
time
that
we
are
usually
quiet.
S
One
of
the
questions
I
have
for
those
highly
mobile
populations
does
it
make
sense
to
wait
until
we
have
a
johnson
johnson
or
some
other
vaccine,
which
is
a
single
dose
and
as
effective
as
a
single
dose.
So
no
need
for
an
answer
that
just
think
about
that,
as
we
move
forward
with
prioritization
kim
anything
else,.
I
The
only
thing
I
would
just
add,
because
I
keep
seeing
comments
in
the
chat
so
as
again
as
part
of
our
department
operations
center,
we
would
look
at
the
tiers
and
say:
okay,
ihss
you're,
coming
up
so
we're
coordinating
with
our
social
services
department,
identifying
the
list
of
who
they
are
communicating
out
through
the
network
that
exists
there
as
well
as
any
other
way
that
we
have
to
do
that.
I
I
Do
we
have
to
do
it
over
the
course
of
six
or
seven
vaccination
clinics
so
really
trying
to
be
accommodating
so
that
we
can
reach
people
where,
where
they
need
to
be
and
get
vaccine
out
to
them
same
as
the
true
for
child
care
providers
and
and
working
through
child
care
consortiums
and
first
five,
really
anything
that
we
have
that's
a
network
we're
trying
to
leverage
that
to
get
information
out
right.
A
Matt
we
will
be
pushing
on
these
issues
at
our
next
meeting.
I'm
sure
we'll
continue
this
conversation
as
well
as
talking
at
our
next
meeting
on
january
6
lots
about
outreach.
I
want
to
give
sylvia
a
chance
to
ask
one
very
quick
question
which
we
may
or
may
not
be
able
to
answer,
but
it's
important
to
get
it
on
the
table
before
we
have
to
wrap
the
meeting
up.
G
Go
ahead,
thank
you.
I'm
sylvia
yeah,
I'm
with
disability
rights,
education
and
defense
fund.
It
builds
a
little
on
what
matt
has
actually
been
talking
about,
and
I'm
wondering
if
the
counties
are
thinking
through
how
to
reach
populations
very
vulnerable
populations
who
are
at
home.
Even
if
we
look
at
category
1b
without
any
changes,
those
over
75,
some
of
who
are
in
their
homes,
have
mobility.
Disabilities
have
various
disabilities
very,
very
worried
about
getting
infected.
G
They
cannot
necessarily
go
to
a
center,
they
need
to
be
vaccinated
at
their
home,
and
that
also
includes
considerations
of
sticking
around
to
see
if
there's
an
allergic
reaction
and
so
forth.
I
think
that's,
that's
very.
Those
logistics
need
to
be
thought
through
now,
and
it's
not
something
necessarily
that
public
health
has
dealt
with
in
a
way
when
flu
hasn't
hasn't
been
that
issue,
let's
say,
and
I
just
think
it
has
to
be
thought
through
right
now.
B
Thank
you
well,
thank
you
again,
kim
and
eric
number
one
for
your
time
and
dedication
in
attending
in
being
members
of
this
committee
and
attending
all
of
these
meetings.
I
want
to
let
all
of
our
other
committee
members
know
that
that
you
all
have
been
listening
for
for
all
of
our
meetings,
not
just
this
one,
but
we're
grateful
for
you
being
sharing
out
and
explaining
a
little
bit
more
about
how
things
work
on
the
ground.
B
I
want
to
again
thank
everyone
for
your
robust
input
and
engagement
in
this
meeting
and
in
this
process.
I
think
there's
if
there's
one
thing
that
I'm
struck
by
with
this
covet
pandemic
is
the
way
in
which
it
requires
all
of
us
to
come
together.
Right,
like
the
only
way
that
we
get
through
is
together
and
I've
been
really
impressed
by
the
way
that
folks
have
shown
up
for
this
process
with
really
sharing
their
best
thoughts,
their
best
ideas
and
a
recognition.
B
At
the
same
time
of
you
know
the
scope
of
the
challenge
and
also
the
fact
that
at
the
now
right
now,
while
we
have
limited
vaccine
right
that
this
there,
while
there
are
so
many
worthy
roles-
sectors,
groups,
jobs
right,
the
the
the
work
of
this
group
is
to
inform
the
drafting
work
guidelines,
work
group
as
to
you
know
how
does
that
process
go
in
terms
of
who
comes
first
and
who
comes
next
right,
and
we
heard
a
lot
about
that
today.
So
I
just
want
to
flag.
B
So
we
all
of
that
is
being
shared
with
the
drafting
guidelines
work
group.
We
also
will
be
responding
to
all
of
your
questions,
all
everything
that
you
put
in
the
chat
and
and
with
that.
I
just
want
to
highlight
that
our
next
meeting
will
be
on
january
6th
from
3
to
6
pm.
I
look
forward
to
seeing
all
of
you
then,
and
in
the
meantime
we
want
to
encourage
everyone
to
practice.
The
4ws
of
you
know
wearing
that
mask
washing
hands,
watching
our
distance
and
waiting
to
gather.
B
So
I
hope
that
everyone
has
a
very
safe
and
healthy
holiday
and
that
we
all
are
doing
that
with
our
individual
households
and
with
that
bobby,
do
you
have
any
final
comments
to
take
us
out.
A
Only
if
you
have
additional
comments
for
the
drafting
guidelines
work
group-
if
you
could
send
them
to
me
directly
after
today's
meeting
before
december
by
december
29th,
so
we
can
make
sure
to
gather
them
all
together
and
get
them
out.
So
they
can
be
thoughtful
about
res
thinking
about
your
comments
and
incorporating
them
into
your
discussion.
That
would
be
great.
A
I
T
Well,
I
I
am-
I
am
in
the
middle
of
all
of
that
I
was
just
fixing
to
craft
you
an
email,
glad
you
called
called
out
to
me.
I
want
to
say
thank
you
for
the
forthright
where
you're,
giving
and
providing
leadership,
and
dr
harris
also,
I
think,
has
been
very
helpful
to
everybody
and
we're
very
excited
about
how
we
engage
and
how
we
assist
you
guys
in
the
effort
and
make
certain
that
california,
as
a
state,
leads
the
way
across
the
country.
L
T
Yeah
just
find
it
on
the
treasures
website,
www.uhla.org
and
yeah
we're
there,
so
you
will
enjoy
it.
A
Okay,
aaron:
let's
stop
the
recording.
Let's
get
it.