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From YouTube: Community Vaccine Advisory Committee #13
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A
Okay,
it's
three
o'clock.
I
think
we're
according
to
my
clock,
so
I
think
we
are
ready
to
begin
hey
dave
and
erica.
B
Thank
you
bobby.
I
want
to
welcome
everyone
to
another
meeting
of
the
community
vaccine
advisory
committee
and
and
I'm
dr
nadine
barcara's
california,
surgeon
general
grateful
to
be
co-chairing
this
meeting
with
our
state
epidemiologist,
dr
erica
khan.
We
have
lots
to
accomplish
in
today's
meeting,
so
I'm
just
going
to
go
ahead
and
dive
into
it
and
ask
bobby
if
you
can
go
ahead
and
start
by
reviewing
our
meeting
processes
and
our
public
comment
and
then
we'll
dive
into
opening
comments
from
the
chairs.
A
Yes,
thank
you
so
much
so,
just
as
a
reminder
to
everyone,
both
the
members
of
the
community
vaccine
advisory
committee
and
members
of
the
public.
Our
meetings
are
very
interactive.
We
hope
that
the
members
of
the
committee
will
keep
their
cameras
on
and
stay
on,
mute
until
you're,
ready
to
speak
and
also,
I
think,
everyone's
learned
how
to
use
the
hand
raise
icon.
A
So
we
love
when
you're
able
to
do
that
and
also
to
ask
comments
and
make
ask
questions
and
make
comments
in
the
chat,
as
we
have
in
all
of
our
previous
meetings,
we're
lucky
to
have
katie
sales
and
vicki
kennedy
here
as
our
asl
interpreters,
and
we
also
have
closed
captioning
for
our
members
and
the
public.
A
The
public
is
in
listen
only
mode
both
in
english
and
in
spanish,
on
the
telephone
and
also
viewing
through
the
live
stream
channel
that
we
have
on
youtube.
If
you
have
any
technical
difficulties
during
the
meeting,
please
put
those
in
the
chat
and
we'll
see
if
we
can
help
resolve
those
for
you
as
quickly
as
possible.
A
So
going
on
to
the
public
comment,
all
of
the
public
comment
was
sent
out
in
its
entirety
to
members
of
the
community
vaccine
committee
on
tuesday
morning.
The
public
comment
covers
the
period
march
16th
through
april
12th,
112
individuals
and
organizations
submitted
public
comment
during
this
period
and
I'll
review
that
very
quickly.
For
you,
I
know
you've
all
had
a
chance
to
look
at
it.
A
A
B
Thank
you
so
much
bobby,
and
I
I'll
start
by
making
just
a
few
opening
comments
before
I
turn
it
over
to
my
co-chair,
dr
erica
pond.
B
I,
as
as,
as
usual
I'll
start
the
meeting
by
anchoring
and
grounding
our
work
with
the
values
that
guide
us
in
doing
this,
work,
which
are
the
the
the
values
of
safety,
equity
and
transparency,
and
I
repeat
that
at
every
meeting,
but
it
feels
important
and
all
the
more
important
at
this
meeting,
considering
all
of
the
events
that
have
transpired
since
our
last
meeting
on
march
17th,
most
recently,
the
the
pause
on
the
use
of
the
johnson
johnson
vaccine
nationally
to
take
time
to
investigate
some
safety
questions
and
and
also,
at
the
same
time,
a
recognition
that
this
process
right.
B
This
process,
by
which
we
are
taking
the
pause
and
looking
into
this.
This
is
exactly
how
our
our
vaccine
surveillance
system
was
designed
to
work
and
a.
I
was.
You
know.
We
heard
in
the
public
comments
a
question
about
equity.
A
lot
has
happened
on
the
equity
front
since
our
last
meeting.
B
We're
really
pleased
to
have
an
update
on
that
today,
and
so
when
we
as
we
look
ahead
to
our
agenda
for
today,
you
know
first,
we'll
have
an
update
from
dr
pond
about
our
vaccine
supply
eligibility
for
vaccines
and
guidelines
for
vaccine
verification.
B
We'll
get
an
update
about
that
johnson
and
johnson
covid
vaccine
pause
and
the
acip
recommendations.
As
many
of
you
know,
the
the
cdc's
acip
met
today.
In
fact,
just
before
this
meeting,
many
of
us
were
tuned
in
many
of
you.
B
I
know
we're
tuned
into
that
process
and
so
we'll
hear
an
update
on
that
and
we'll
we
have
the
extraordinary
fortune
of
getting
an
update
from
dr
grace
lee,
who
is
a
member
of
our
western
state,
scientific
safety
review,
work
group
and
also
a
member
of
the
acip,
and
then
following
that,
we
will
hear
an
update
on
achieving
and
monitoring
equity
and
that's
a
conversation.
B
I'm
really
looking
forward
to
because
the
state,
as
well
as
our
partners
at
blue
shield,
have
been
really
working
very,
very
diligently
on
equity,
and
we
want
to
not
only
present
an
update
to
you
all
on
that,
but
also
to,
of
course,
hear
your
feedback
and
comments
so
that
we
can
continue
to
improve
the
process.
B
And
with
that
I
will
go
ahead
and
turn
it
over
to
dr
pon.
For
our
for
opening
remarks
and
and
comments.
C
Ray
thank
you
so
much
nadine
and
good
afternoon.
Everyone.
I
just
wanted
to
start
by
kind
of
thanking
all
of
you,
and
you
know.
C
We
can
be
really
in
a
much
better
place
if
we
can
use
all
these
tools
that
we
have
to
get
to
immunity,
but
also
just
noting
acknowledging
as
we
look
at
that
tight
light
at
the
end
of
that
tunnel,
that
our
tunnel
can
have
twists
and
turns-
and
I
you
know,
continue
to
to
be
humbled
by
again
this
virus
and
this
pandemic,
and
this
situation
and
we're
gonna
have
these
narrower
areas
of
the
tunnel
and
twists
and
turns,
and
some
wider
areas
where
we
make
a
ton
of
progress
so
but
we're
continuing
to
again
move
our
way
through
it
and
again,
using
all
the
tools
that
we
have
and
we're
continuing
to
gain
more
tools.
C
It's
just
incredible
again
that
we
have
vaccines
and
how
quickly
they
we're
developed
to
to
be
here
and
that
we
have
two
widely
available
vaccines
in
our
midst
too.
Well,
we
have
this
pause,
so
we're
gonna
continue
to
move
forward.
We're
gonna,
get
there
faster
and
more
resilient
if
we
do
it
together
and
more
united.
So
I'm
just
so
incredibly
grateful
for
this
committee
and
all
of
your
input
and
all
of
my
colleagues
in
public
health
and
all
team
members
and
colleagues
across
state
agencies
who
continue
to
march
forward
together.
C
You
can
do
the
next
one
now
so,
as
I
often
start
just
kind
of
giving
you
a
quick
snapshot
of
some
of
our
epidemiology,
so
we
are
at
3.6
million
cases
in
california
to
date,
and
our
case
rate,
though,
is
quite
low,
so
we're
at
about
4.7
cases
per
hundred
thousand
per
day
statewide
and
our
deaths
continue
to
decrease
as
well.
C
Our
testing
has
decreased
a
little
bit,
but
our
testing
positivity,
which
is
another
helpful
marker
of
how
we're
doing
as
far
as
disease
transmission
has
remained
less
than
two
percent
for
at
least
a
couple
weeks,
so
we
hit
our
lowest
mark
a
day
or
so
ago.
1.5,
I
think
it's
you
know
bounced
around
a
little
bit
and
hugely
and
we'll
talk
more
about
this.
Of
course,
23
over
23
million
doses
of
vaccine
administered
next
slide.
C
And
so
this
is
kind
of
again
talking
about
when
I,
as
I
first
started,
where
we've
been
and
and
where
we're
headed,
you
can
see
our
first
bump
here
again
in
july
and
our
huge
winter
surge,
and
we
had
this
nice
decline
here
and
you
can
see-
we've
been
nice
and
flat
and
declining
gradually,
since
actually
since
the
end
of
february,
and
we
continue
to
stay
stable.
C
Although
I
will
say
the
other
kind
of
twist
in
our
tunnel
lately
is
that
I
we
are
starting
to
see
some
slight
increases
in
our
cases
and
actually
has
some
slight
increases
in
our
new
admissions
as
well.
So
I
think
just
you
know
to
take
that
moment
as
well
to
remind
everyone
that
there
are
lots
of
tools
and
we
need
to
continue
to
get
people
vaccinated,
but
our
mass
are
working
and
can
work
if
everyone
continues
to
use
those
in
our
physical
distancing.
C
C
So
this
is
some
of
our
great
news
too.
As
far
as
how
far
we've
come,
so
you
all
have
seen
this
dashboard,
hopefully
on
our
website
and
we're
continuing
to
work
on
improving
this.
But
you
can
see
again,
and
actually
the
latest,
since
this
slide
was
created,
is
that
23.7
million
doses
have
been
administered
to
date
and,
as
you
can
see
highlighted
over
here
on
the
right,
I
think
we've
actually
hit
nine
million
individuals
who
are
fully
vaccinated.
C
So
you
know,
over
a
quarter
of
our
people
eligible
in
the
state,
are
fully
vaccinated
and
protected,
which
is
really
great
and
then
of
our
over
65.
We
have
over
3.6
million
fully
vaccinated
and
over
57
percent
of
our
over
65
and
then,
if
you
look
kind
of
at
that
together,
as
far
as
our
partially
vaccinated
fully
vaccinated
we're
getting
really
close
to
having
half
of
our
eligible
people
with
at
least
one
dose
of
vaccine
in
california,
which
is
just
incredibly
exciting.
C
I
think
many
people
point
to
looking
at
the
israel
experience
that
when
you
get
to
kind
of
between
that
40
to
60
percent
is
when
you
start
to
see
some
really
dramatic
impact,
so
continue
to
keep
our
eye
on
that.
Although
you
know
again,
as
I
mentioned,
we're
starting
to
see
some
mild
increases
and
what
we're
seeing
in
other
states
is
some
surges,
and
some
of
that
is
happening
with
with
variants
such
as
the
uk
variant,
which
is
creeping
up
a
little
bit
in
california
as
well.
C
So
we
really
need
to
keep
up
all
of
our
mitigation
efforts
next
slide
and
then
again,
this
is
such
a
nice
illustration
of
again
the
ramp
up
and
how
you
know
we
started
with
our
lower
amounts
in
the
middle
of
our
surge
in
the
middle
of
the
holidays,
and
here
we
are
we're
usually
averaging
over
300
000
doses
of
vaccine
a
day
and
continuing
to
plow
ahead
with
that.
So
that's
been,
you
know
incredibly
encouraging
as
well
to
see
that
we
continue
to
ramp
up
over
time
next
slide.
C
C
You
can
see
the
graph
comparing
how
we're
doing
with
our
health
equity
metric,
so
there's
different
ways:
we've
been
looking
at
this
and
actually
different
ways
we're
going
to
be
posting,
probably
very
soon
as
well,
but
looking
at
our
quartiles,
so
in
quartile
1
we
have
1.4
million
or
about
17.6,
partially
vaccinated
and
then
over
22
percent
who
are
fully
vaccinated,
in
contrast
to
quartal
four
and
there's
another
graphic
on
our
website
and
that's
gonna
be
covered
later,
where
you
can
see
that
the
gap
has
been
decreasing
over
time,
but
we
still
have
work
to
do
to
actually
reach
equity,
we're
getting
closer
to
equality,
but
we
need
to
move
to
equity
where
we're
seeing
a
disproportionate
number
of
people
vaccinated
in
our
quartile
one,
but
compared
to
where
we
started.
C
So
and
then
you
know,
of
course,
top
of
mind
is
the
pause,
but
as
far
as
our
overall
supply
we've
been
currently
receiving
around
2
million
doses
a
week.
Some
of
that,
of
course,
is
allocated
to
california
and
then
there's
a
lot
of
federal
doses
that
come
into
california
as
well.
C
The
allocation
you
know
is
supposed
to
be
increasing
in
the
near
future.
It
is
relatively
flat
for
the
next
three
weeks
again
and
of
course
this
is
impacted
by
a
couple,
different
issues
that
have
come
up
with
the
johnson
and
johnson,
so
both
the
manufacturing
issues
and
then
this
pause
over
the
last
day.
C
But
again
we
have
two
other
vaccines
that
are
continuing
to
increase
in
their
production,
the
pfizer
and
moderna,
and
then
people
have
been
asking
sort
of
what
proportion
of
our
supply
has
been
johnson
and
johnson
to
date,
as
far
as
historically
johnson
johnson
is
about
less
than
five
percent
of
vaccines
given
to
date,
and
then
here
in
california,
just
for
this
week,
johnson
johnson
was
about
four
percent
of
our
allocation
and
probably
looking
at
our
numbers,
including
federal
and
state
allocations,
around
six
to
seven
percent.
C
Over
time
has
been
allocated
to
johnson
johnson
and
again,
we
have
the
opportunity
to
have
dr
grace
lee
join
us
later,
who
not
only
is
on
the
acip
committee,
but
the
co-chair
of
the
vaccine
safety
technical
subgroup
of
that
committee.
So
it'll,
be
it's
really
an
honor
and
a
pleasure
that
she'll
be
able
to
give
us.
The
latest
updates
from
the
acip
discussion
today.
Next
slide.
C
And
I
think
we've
all
thought
and
talked
a
lot
about
eligibility
and
priorities
over
time
and
who
can
vaccinated.
C
As
you
know,
as
of
april
1st,
we
were
individuals,
50
years
of
age
and
older
were
eligible
and
then
starting
tomorrow,
every
californian,
16
years
of
age
or
older
is
eligible
to
be
vaccinated
here
in
california,
and,
as
you
also
probably
know,
I
think
over
half
of
the
jurisdictions
had
actually
already
started,
moving
to
every
californian
16
years
of
age
or
older,
but
you
know
statewide
that
will
be
the
eligibility
starting
tomorrow.
Next
slide.
C
And
then,
as
far
as
verification,
this
is
coming
up
in
a
lot
of
different
ways.
So
I'll
sort
of
before
I
walk
through
this
I'll,
just
tell
you
and
I'm
sure,
you're
also
hearing.
There
are
a
lot
of
conversations
happening
at
the
federal
level
and
certainly
we're
staying
in
tune
with
that
at
the
state
level,
as
well,
around
vaccine
verification
and
what
are
the
best
ways
to
do
that?
How
can
we
make
it
more
convenient?
C
C
So
again,
we're
working
on
this
digital
as
a
state,
especially
these
digital
apps,
that
you
know
many
dozens
of
businesses
have
started
to
develop
these
they're
being
piloted
in
certain
areas
in
the
short
term
as
far
as
vaccine
verification,
since
we
already
have
again
over
nine
million
people
fully
vaccinated
as
far
as
proof
of
verification,
which
will
is
starting
to
come
up
in
other
sectors
and
venues,
people
can
use
their
vaccination
card,
so
their
cdc
card
that
they
got
when
they
got
that
vaccination
a
photo
of
that
card
as
a
separate
document
or
it
can
be
a
photo
on
an
electronic
device
like
a
smartphone
or
some
sort
of
documentation
from
a
healthcare
provider
for
people
that
get
their
vaccine
at
their
regular
clinics.
C
So
again,
I
think
there's
going
to
be
more
to
come
on
this
as
far
as
digital
apps
and
things
like
that.
That
will
make
it
more
convenient,
but
this
is
kind
of
what
we're
putting
into
kind
of
our
addendums
to
the
blueprint
sector.
For
now
is
ways
people
can
verify
their
vaccination
status
next
slide,
and
this
becomes
relevant
because
of
this.
C
So
we
just
added
within
the
last
few
days
as
well
kind
of
addendum
to
the
blueprint
here
and
while
we're
in
transition
over
the
next
couple
months
of
our
blueprint
and
as
we're
moving
our
counties
through
the
blueprint
we
have.
Actually,
we
have
some
what
we're
calling
capacity
bonuses
for,
allowing
for
more
people
to
be
in
shared
spaces
and
be
more
protected,
so
that
actually
entails.
C
If
you
have
people
that
are
fully
vaccinated
and,
as
you
all
know,
the
cdc
and
we're
posting
you
know
very
very
soon,
as
well
are
kind
of
aligned
guidance
around.
If
people
are
fully
vaccinated,
they
can
share
space
with
each
other.
They
can
be
indoors.
C
There's
one
sort
of
caveat
there
too,
that
if
you
have
low
risk
people
in
one
of
the
households
that
are
not
vaccinated
and
really
the
people
in
mind,
for
that
are
young
children
who
are
not
yet
eligibly
vaccinated.
It
is
okay
to
have
some
mixing,
and
this
is
really
geared
towards
grandparents,
which
I
can
say
personally
I've
seen
a
lot
of
joy
from
my
both
my
kids
and
my
parents
and
in-laws
being
able
to
see
each
other
and
hug
each
other.
Now
that
all
the
adults
are
fully
vaccinated.
C
But
as
far
as
this,
just
briefly
in
the
orange
tier
and
the
yellow
tier
we're
adding
these
capacity
bonuses
so
that
in
certain
sectors,
the
capacity
can
be
increased
by
an
additional
50
percent
for
a
maximum
of
50
total
venue
capacity.
If
everyone
shows
some
verification
of
vaccination
or
testing
negative
within
the
last
72
hours
and
then
similarly
in
the
yellow
tier,
the
capacity
can
be
increased
by
an
additional
50
up
to
a
max
of
75.
C
And
then
there
are
ways
that
businesses
can
have.
You
know
vaccinated
only
sections
or
they
can
have
a
vaccine
sort
of
if
they
have
an
event
that
is
vaccinated.
Only
they
don't
have
to
use
physical
distancing,
which
actually
allows
them
to
have
more
guests
or
more
attendees.
Next
slide.
C
And
the
other
thing
that
is
also
actually
really
exciting
and
that
it
got
announced
last
week
as
well
that
we
are
actively
starting
to
plan
for-
and
I
think
will
be
great
topic
for
next
month's
agenda-
to
talk
and
get
more
of
your
input
is
pfizer,
has
applied
to
expand
their
use
in
adolescence,
12
to
15
years
of
age,
and
to
remind
you,
the
one
vaccine
of
the
three
that
have
euas
that
allows
16
to
18
year
olds
is
pfizer,
so
they're
already
authorized
to
do,
16
to
18
year
olds
and
whereas
the
other
two
are
18
and
up
and
they've
just
applied
for
the
12
to
15
year
old.
C
So
we're
waiting
to
see
what
the
fda
approval
is
for
that
some
of
the
people
are
anticipating
in
about
a
month
or
so
there
might
be
a
response
on
this,
but
they
had
really
encouraging
data
in
their
phase
three
trials.
So
this
is
another.
You
know
really
exciting
development
that
we
will
get
another
proportion
of
our
population
vaccinated.
Very
soon.
We
estimate
this
is
around
two
and
a
half.
2.6
million
californians
are
in
that
12
to
15
years
of
age.
C
So
I
think
I
will
pause
there
and,
let's
see
I
know
we
might
have
to
move
around
our
agenda
a
little
bit
just
based
on
how
the
ecip
and
other
things
have
been
going
today.
So
I'll,
let
bobby
explain
our
rearrangement.
A
Yeah,
I
think
we'll
stop
now,
if
it's
okay,
both
nadine
and
erica,
and
have
some
comments
and
questions
from
the
committee
members,
it
is
possible,
as
erica
just
said,
that,
depending
on
dr
lee's
timing
that
we
may
have
to
ship
the
next
two
agenda
items
around
to
accommodate
her
schedule,
but
we
haven't
heard
anything
yet
that
she
won't
be
able
to
make
it
as
planned.
So
maybe
we
can
take
the
slides
down
and
see
everyone,
and
if
you'd
like
to
make
a
comment
or
ask
a
question,
please
use
your
hand
raise
icon.
C
And
actually
quickly
bobby,
while
you're
looking
at
who
to
call
on,
I
am
seeing
one
of
the
first
questions
about
the
other
parts
of
pediatric
vaccination,
the
zero
to
twelve-year-old.
So
there
are
some
trials
happening
now
in
the
zero
to
twelve-year-olds
and
some
of
the
kind
of
projections
or
speculation
I've
seen
or
that
maybe
by
the
end
of
this
calendar
year
or
early
2022,
is
when
we
might
be
able
to
anticipate.
C
But
you
know
I'm
sure
that
will
be
an
evolving
timeline
as
well,
but
that's
kind
of
what
we're
anticipating
the
other
pleasant
surprises
have
often
been
things
have
been
sooner.
I
didn't
anticipate
the
teen
application
would
happen
so
early,
so
maybe
that
will
be
earlier
than
we
hope,
but
that's
kind
of
the
latest
projection
that
I've
heard
of
on
that
right.
D
Yes,
mitch
tiger
with
the
california
labor
federation-
and
these
are,
you
know,
really
encouraging
numbers.
It's
really
great
to
see
all
of
this,
I
just
had
a
quick
question
about
tracking
those
who've
been
vaccinated
to
see
how
well
those
those
percentages
are
still
holding
of
you
know
this
one's
95
effective
against
this,
that
one's
66
effective
against
that
are.
D
C
So
is
your
question
as
we're
getting
new
cases
of
disease
or,
if
we're
finding
out,
if
they've
been
vaccinated
or
not
to
look
for
resistance,
a
vaccine
or
are
you
asking
more
about
tracking,
just
in
general,
who's
been
vaccinated.
D
I
I
I
think
more,
the
first
one,
so
when
folks
come
in
with
a
new
case
and
is
the
whoever
they
take
person,
the
treating
physician
saying
have
you
been
vaccinated
so
that
we
can
kind
of
merge
that
in
so
that
we
can
say,
oh
yeah,
you
know
of
all
the
looking
at
the
numbers
and
being
able
to
somehow
figure
out
we've
given
out
this
many
vaccines.
D
C
Yeah
no
great
question:
there's
a
few
parts
to
that
answer.
So
there
was
some
recent
data
that
the
cdc
put
out
and
sort
of
the
technical
terminology
we
talk
about
is
effective.
Efficacy
is
in
the
trials
which
are
very
kind
of
regulated
and
scripted,
and
then
there's
effectiveness
once
you're
kind
of
post
market
post,
you
know
distribution
and
there
was
some
really
encouraging
data
that
came
out
from
the
cdc
very
recently
about
high
levels
of
effectiveness
for
pfizer
and
moderna,
and
then
your
other
question
about
new
cases.
C
So,
yes,
absolutely,
and
I
think
I
think
the
other
good
thing
it's
very
important
to
talk
to
all
of
you
about
and
to
continue
to
make
sure
we're
communicating
to
the
public
is
that
you
know
these
are
again
outstanding,
95
or
so
effective.
But
that
means
that
five
percent
right
might
still
get
infected
and
when
you're
vaccinating
millions
of
people
like
this,
you
are
going
to
have
people
who
are
vaccinated.
Who
test
positive?
C
So
more
and
more
data
is
accumulating
on
that
and
then
the
other
project
we're
working
on
very
aggressively
because
again,
there
are
sometimes
data
challenges,
but
looking
at
hospitalizations
and
really
closely
monitoring
of
people
who
are
hospitalized,
you
know
have
they
been
vaccinated
or
not,
and
so
there's
some
data
system
integration.
That
needs
to
happen
to
do
that
as
well,
but
we're
actively
working
on
that
as
well,
because
that
to
your
point
I
think
maybe
the
point
you're
getting
at
is.
C
We
want
to
know
if
there's
an
increase
in
cases
that
are
not
vaccinated,
so
we're
watching
that
and
then
of
course,
the
other
pairing
to
that
is
looking
at
whole
genome
sequencing,
which
actually
didn't
touch
on
happy
two
people
interested
next
week,
I
mean
next
month,
but
we
have
increased
the
proportion
of
specimens
we're
sequencing.
It's
up
to
about
seven
percent
of
the
of
the
cases
we're
sequencing
to
look
at
variants
and
again
we're
seeing
an
increase
in
the
b117
uk
variant.
C
It's
getting
close
to
10
percent
of
what
we're
sequencing
and
we're
trying
to
get
more
systematic
about
what
we're
sequencing
as
well,
including
really
aggressive
sequencing
of
hospitalized
cases
and,
specifically
we'll
be
looking
more
for
intensive
care
unit.
Cases
too,
to
just
make
sure
we're
we're.
Looking
for
that.
A
Thanks
mitch
for
that
question,
let's
go
to
deborah
and
then
we'll
go
to
anthony.
E
Don't
forget
to
introduce
yourself:
okay,
my
name
is
deborah
shade.
I
represent
the
california
school
board
association,
and
so
my
question
has
to
do
with
really
talking
about
our
kids
in
this
population.
Now
I'm
hearing
from
very
well-educated
moms
who
have
extreme
concerns
about
the
vax,
the
vaccine
and
how
it
affects
long-term
reproductive
health
of
their
daughters
and
now,
with
the
j
j
coming
out
today
with
women
with
blood
clots.
E
You
know,
I
just
think
we're
doing
a
lot
of
work
to
get
the
information
out
the
correct
information,
the
hesitancy
we're
seeing
in
communities,
but
I
think
there's
a
level
of
hesitancy
that
you're
not
aware
of,
and
certainly
any
parent
anybody
who's
involved
in
school
districts
know
there
are
a
lot
of
parents
that
have
any
kind
of
immunization
hesitancy,
so
I'm
hoping
maybe
next
week
next
month,
we
can
talk
about
this.
I
think
it's
going
to
be
an
issue
and
you
know
for
schools
to
get
open
and
to
get
every.
E
So
I
didn't
know
if
you
want
to
comment
on
that
now,
but
I
certainly
would
like
to
get
that
out
there
today,
since
we
were
talking
about
the
16
and
older,
because
that's
one
population,
but
when
you
get
to
anything
lower
than
that,
it's
a
whole
nother
ball
game.
C
Yeah
and
sure
no,
I
can
speak
briefly
to
that.
I
think
really
helpful
good
point
and
I
I
want
to
acknowledge
that
you
know
in
some
ways
we're
opening
up
earlier
to
eligibility
because
it
does
seem
like
you
know,
demand
is,
is
not
as
high
as
it
was,
and
so
we
do
need
to
work
really
hard
on.
C
What
are
those
I
do
think
there's
a
lot
of
great
work
that
you've
been
hearing
about
we'll
continue
to
work
on
as
far
as
the
let's
get
to
immunity
campaign
and
other
parts
throughout
that,
and
I
think
you
know
the
other
grand
rounds
I
just
was
on
yesterday
was
thinking
about
you
know
we
don't
know
yet
what
we're
just
had
this
vaccine
with
us
for
six
months,
but
we
do
know
that
we're
seeing
a
lot
of
long-term
impacts
of
covet
itself
and
kids
amongst
that
as
well,
and
really
kind
of
that's
really
the
unknown
to
me
and
and
just
looking
at
that
ratio
again
of
we've
had
over
3.5
million
cases
and
60
000
deaths
right
and
and
for
this
one
vaccine,
we've
had
almost
7
million
doses
given
and
only
six
people
with
these
serious
side
effects.
C
C
I
think
a
big
emphasis
from
the
governor
today
on
schools
and
reopening
and
we
want
to
use
all
of
our
tools-
and
you
know
vaccination
is
one
of
them,
but
in
schools
we're
going
to
be
really
focusing
on
all
the
other
kind
of
tools
we
have
for
mitigation,
so
continuing
to
mask
and
really
thinking
about
testing
as
another
tool
to
use
to
make
sure
we
can
get
our
kids
back
in
school,
because
that's
so
incredibly
important-
and
I.
B
I
want
to
jump
in
and
add
to
that
in
in
the
fact
that,
especially
now
as
we
are
responding
to
what's
happening
with
johnson
and
johnson,
I
think
that
it's
really
important
for
us
to
allow
people
to
answer
questions
to
ask
questions.
I
think
it's
important
for
us
to
really
walk
the
walk
in
terms
of
safety,
equity
and
transparency,
and
I
think
that
the
immunity
let's
get
to
immunity
campaign
really
reflects
that.
B
It's
okay
for
people
to
have
questions.
It's
okay
for
folks
to
feel
nervous
or
a
little
bit
anxious,
and
I
see
an
important
part
of
our
role
is
to
provide
trusted.
B
You
know
rigorous
information
that
that
people
can
believe
in,
and
I
think
that
if
we
continue
to
do
that
and
continue
to
walk
in
that
way
over
time,
you
know
if
it
may
be
that
it.
It
takes
us
a
little
longer
right,
but
we
would
rather,
you
know
from
my
perspective.
I
would
rather
have
folks
have
that
level
of
trust
right
and
and
ultimately
get
there
in
a
way
that
feels
good
and
that
they
can
trust
in
than
feel
like.
B
We
have
to
be
rushing
because
I
think
one
of
the
pieces
that
we
do
want
to
communicate
to
the
public
is
that
we
do
take
any
concerns
about
safety
very,
very
seriously
and
we
will
pause
and
we
will
investigate
it
right.
So,
if
folks
are
worried
about
so
the
fact
to
dr
pond's
point
that
six
out
of
6.8
million
cases
were
identified
and
the
cdc
and
the
fda
said:
okay,
let's
pause,
and
you
know
all
of
the
states
have
said:
okay,
let's
pause
and
let's
take
a
deep
dive.
B
Into
it,
we
will
do
that
deep
dive
and
have
a
very
rigorous
scientific
assessment
before
we
make
any
decisions
on
moving
forward,
and
I
that's
something
that
I
hope
that
the
public
is
is
seeing
now
and
can
trust
in.
A
G
You
know,
starting
tomorrow
with
just
getting
people
connected
and
not
having
to
worry
about.
You
know
these
various
tears
as
much.
I
I
do
think
that
and-
and
I
look
forward
to
these
existing
conver
and
ongoing
conversations.
I
hope
that
the
covers
I
I'd
love
to
always
just
hear
more
about
the
issues
of
vaccine.
G
You
know
this
proof
of
vaccination
conversation.
Hopefully
that
is
also
a
short-term
conversation,
as
we
get
to
closer
to
the
to
the
herd
and
unity
where
we
don't
need
to
have
those
conversations,
but
you
know
in
the
in
the
meantime,
if
there's
anything
else,
to
sort
of
support
that
or
hear
more
about
the
thinking
about
what
the
role
of
the
state
is
to
would
be
helpful.
But
my
main
question
is
just
as
we're
trying
to
get
the
information
better
information.
G
I
know
that
many
people
have
been
getting
their
vaccines
through
a
lot
of
different
ways:
some
through
their
health
providers,
but
many
not
through
you
know,
county
sites,
mass
vaccination
sites
etc.
And
so
I
guess
I'm
just
curious
if
there
is
any
effort
on
the
back
end
to
so
that
that
information
is
getting
integrated
into
people's
medical
records
or
if
that
is
a
recommendation
that
people
have
should
be
doing
on
the
you
know
in
individually
with
their
own
selves.
G
I
know
that
that
was
an
issue
with
regard
to
the
j
j
vaccination
that
people
you
know
let
their
at
least.
I
heard
some
recommendations.
I
don't
know
if
that
does
recommendation
that
is
being
provided
here
in
california,
that
people
let
them
let
their
provider
know
if
they
have
the
j
j
shot
so
that
they
can
be
some
tracking
on
this,
and
I
don't
know
if,
if
there's
some
back-end
way
to
do
that
more
automatically
than
just
everybody
having
to
call
their
doctor
and
just
curious
about.
C
Yeah,
that's
a
great
question,
so
I
think
in
general,
there's
before
covid
and
before
the
pandemic,
we
have
a
california
immunization
registry,
and
then
there
are
a
couple
other
subsets
that
communicate
with
the
california
immunization
registry,
but
are
separate.
There's
a
san
joaquin
valley,
one
and
the
san
diego
one.
C
So
we've
had
these
and
they're,
of
course,
most
robust
as
far
as
children's
vaccinations
actually,
and
they
have
not
been
a
requirement
for
all
that
all
healthcare
providers,
but
many
more
and
more
and
pharmacies
as
well
required
to
submit
their
data
to
that.
So
that
is
the
sort
of
state
database
that
we
have
that
all
these
all
of
these
covadentine
vaccines
are
being
integrated
with,
on
the
other
side
of
that
in
general.
C
Again
previously,
even
with
the
californization
registry,
there
have
been
increasing
work
on
kind
of
you
know,
along
the
lines
of
health
information
exchanges
and
certainly
bi-directional
exchange
with
large
systems
and
health
electronic
health
records.
C
I
will
acknowledge
it's
another
area
that
data
integration
is,
you
know
it's
always
I
as
a
non-I.t
person,
I'm
always
humbled
by
how
much
more
complex
it
is
than
I
realize,
and
I
think
some
of
the
really
big
systems
have
pretty
good
interfaces
that
go
back
and
forth
that
are
bi-directional
and
many
don't
and
many
of
the
certainly
small
providers
might
be
able
to
do
data
entry
separately
and
might
be
able
to
look
and
have
access,
but
it's
not
integrated
into
the
actual
electronic
health
record,
so
it
does
vary
by
provider.
C
Just
like
our
overall
health
system
and
electronic
health
records
use
is
really
varied.
So
I
think
it's
sort
of
a
yes
and
no
a
lot
of
the
large
systems
again
do
have
more
exchange
and
and
some
don't
and
people
are
not
entering.
At
least
my
I
am
my
understanding
is
people
are
not
entering
their
primary
care
provider
into
my
turn
or
when
they
enroll
and
get
their
vaccine.
So
it's
not
necessarily
listed
if
they're
getting
their
vaccine
at
another
site.
G
So
just
a
quick
follow-up
do
you.
I
can
appreciate
that
not
everybody
will
have
their
information
automatically
sent
to
their
health
plan
or
their
medical
home,
etc.
But
do
you
have,
but
do
you
as
a
central
place,
have
enough
data
from
enough
large
systems
that
you
feel
that
you
could
identify
trends
like
well
like
what
you
know
identified.
You
know
that
caused
the
pause
for
this
j
j
plus.
C
C
I
can
quickly
outline
you
know
more
at
the
state
level,
but
even
just
in
the
last
36
hours
we
have,
you
know
once
we
put
out
the
message
to
all
the
vaccine
providers
to
press
pause,
we're
basically
working
on
clinician
alerts
that
you
know.
The
cdc
has
also
sent
out
clinician
alerts
directly
to
clinicians
to
really
sort
of
be
on
the
lookout
for
this
and
some
of
the
messaging
around
around
all
that.
C
But
there
is
not
a
seamless
integration
electronic
records,
the
way
like
so
it
is
the
need
to
be,
but
the
the
system
that
actually
picked
this
up
is
the
vaccine
adverse
in
that
reporting
system
right
and
and
again
now
that
there's
heightened
awareness,
both
from
providers
and
just
the
public
in
general
and
anyone
who's
received.
Any
vaccine
should
just
know
in
general.
That's
always
a
way
to
report
a
potential
side
effect
and
then
it
gets
investigated
and
it
can
be
very
rigorous
and
that's
how
how
this
whole
situation
was
detected.
A
H
H
I
want
to
also
you
know,
share
and
and
and
underscore
dr
brooke
harris's
comment
about
the
importance
of
building
trust,
and
you
know
answering
questions
making
sure
that
our
our
patients
and
clients
and
community
members
understand
and
have
the
ques
their
questions
answered.
H
I
I
think
to
extend
upon
that.
It
raises
an
issue
that
actually
some
of
my
students
have
have
raised
as
an
issue
of
concern,
and
that
is
that
you
know,
while
the
well
the
j
j
vaccine
is
is
so
has
been
so
helpful
from
a
public
health
standpoint
and
getting
a
vaccine
into
arms
of
hard-to-reach
communities.
H
I
think
the
challenge
that
we
have
to
really
be
aware
of
cognizant
of
is
the
issue
of
choice,
the
issue
of
informed
consent
and
choice
that,
for
those
who
are
privileged,
are
we
do
do
those
who
have
privilege
have
the
choice
to
get
pfizer,
moderna
or
jnj,
and
does
it-
and
I
I
I
worry-
that
for
those
of
us
in
the
community
that
don't
have
good
access
if
the
choice
is
limited
to
a
certain
vaccine
and
in
this
case
jng,
and
what
are
the
implications
of
that
long-term?
H
If
there
are,
you
know,
differential
outcomes
associated
with
the
vaccines?
H
I
know
that
that
you
know
in
in
in
times
of
scarcity,
we
just
we
we
need
to
get
as
much
and
what
whatever
we
can
into
into
the
communities,
but
we're
we're
sort
of
we're
going
to
make
a
turn
where
there
will
be
more
plentiful
vaccine
for
many
people,
but
not
all
people,
and
so
part
of
what
I
think
we
need
to
consider
is
is
how
are
we
going
to
make
sure
that
people's
that,
as
people
ask
questions
that
those
questions
can
translate
into
their
ability
to
have
choice
which
is
which
should
be
equitably
distributed
as
well?
C
Yeah,
no,
I
think
those
are
great
comments.
I
think
one
initial
response-
and
you
know
I
think
someone
else
brought
up
other
important
sort
of
similar
points
that
we
are
lucky.
I
mean
this
has
actually
been
pointed
out
as
well.
You
know
in
the
united
states
we
do
have
we've
had
these
three
vaccines
right
and
we're
pressing
pause
to
take
this
seriously
and
investigate,
and
we
have
we
are
going
to
have
a
point.
C
It
has
been
really
hard
for
the
last
couple
months
to
not
have
enough,
but
we
are
you
know
we
are
feeling
confident.
We
will
have
enough
that
every
person
who
wants
vaccine-
and
in
fact
that
was
part
of
the
the
benchmark
put
forward
from
mid-june-
that
every
person
who's
eligible
can
get
access
to
vaccine,
and
there
has
always
been
that
choice.
C
I
think
it's
really
important
to
to
keep
in
mind
as
you're
talking
about
you
know
where
different
vaccines
are
offered,
but
we
very
much
prior
to
this
pause
have
really
felt
that
all
three
vaccines
are.
You
know
outstanding
outcomes.
You
know
equal
safety
efforts
and
now
we're
investigating
this
particular
situation
to
see
if
we
do
feel
comfortable
or
not
with
moving
forward.
So
I
think,
really
important
points,
and
I
think
you
know
again
we're
really
fortunate
here
and
now
there
are
some
countries
that
are
not.
C
You
know
anything
talk
about
sort
of
global
equity.
We
are
we're
really
fortunate
that
we
are
going
to
have
choices
both
as
a
country
and
as
individuals
about
about
vaccines,
whereas
I
think
that's
been
the
challenges
in
other
countries
that
are
seeing
surges
again
and
high
mortality
and
having
to
make
really
tough
decisions.
I
Thank
you
bobby
I'm
going
to
just
highlight
what
I
put
in
the
chat
room
number
one
regarding
data
and
specificity
of
the
data.
I
You
know
we're
showing
9
000
deaths
in
nursing
homes,
but
if
someone
is
discharged
to
the
hospital
and
dies
in
the
hospital
two
weeks
later,
they're
not
counted
if
someone
dies
in
an
assisted
living
in
the
hospital
or
if
they
were
in
memory
care.
We
don't
know
that
if
someone
lives
in
multi-generational
household
and
they're
poor,
we
don't
it's
not
clear
and-
and
I
think
data
matters
with
60
000
deaths
in
terms
of
how
we
respond.
How
quickly
we
respond.
I
C
Yeah,
thank
you
and
again
there's
a
lot
of
work
on
both
sides
of
that,
in
that
we
have
a
lot
of
data
that
is
being
validated
because
we
want
to
be
able
to
share
data
that
we
feel
has
been
looked
at,
and
you
know
one
of
the
examples
is
as
far
as
looking
at
race,
ethnicity.
One
of
the
reasons
is
taking
us
a
while
to
get
that
posted
is
there's
different,
just
sort
of
coding
about
multiracial
versus
specific
reason.
It
looked
like
we
were.
C
You
know,
vaccinating
200
of
people
that
were
multiracial
like
clearly,
that's
not
possible.
So
that's
just
a
specific,
very
concrete
example
of
why
we
want.
We
agree
with
you.
We
want
to
have
good
data
and
we
want
to
get
it
posted
and
show
it
so
working
there
is
going
to
be
some
updates
on
sort
of
based
on
hpi.
Actually
within
the
next
few
days.
I
think
the
race
ethnicity
data
is
taking
us
longer
because
of
a
lot
of
these
nuances
that
are
really
important
and
we
do
have
an
excess
deaths.
C
I
believe
publication
talking
about
the
various
thing
you're
talking
about
so
you're
right.
We
have
to
keep
our
end
because
we
have
a
lot
of
work
to
do,
which
is
why
we're
spending
some
of
our
time
later
today,
talking
about
equity
and
really
improving,
where
we
are
and
getting
vaccine
to
to
the
people
that
need
it.
The
most.
B
I
do
want
to
add
on
to
that
that
to
your
to
your
point,
there
are
I'm
really
excited
that
you
said
that,
because
in
our
strategy,
in
terms
of
operationalizing
equity,
I
think
that
sometimes
folks
think
that,
if
equity
is
in
the
thought
bubble,
when
you
you
know
we're
deciding
your
plans
that
it
is
then
equitable.
So
we
have
a
lot
of
work
to
do.
B
We
have
been
doing
a
lot
of
work
in
terms
of
looking
at
lots
of
different
types
of
data
when
we're
thinking
about
operationalizing
equity,
and
I-
and
I
want
to
I'm-
I'm
grateful
for
dr
kimberly
good
at
blue
shield,
who
has
been
a
partner
in
this
in
in
really
looking
at.
How
do
we?
B
B
If
you
will-
and
I
think
that
in
light
of
that,
I
know
that
we
are
waiting
for
for
dr
lee
to
join
us,
but
it
might
make
sense
actually
for
us
to
move
forward
to
our
conversation
about
equity,
so
that
we
can
make
sure
to
preserve
time
for
a
robust
discussion
about
jnj
and
also
have
adequate
time
for
for
a
conversation
about
equity.
B
So
maybe
what
we
can
do
now
is
go
ahead
and
switch
our
order
and
move
forward
with
hearing
from
hearing
from
our
partners
on
how
we
are
operationalizing
and
measuring
equity,
and
in
in
talking
about
that,
I
I
want
to
again
reinforce
that
equity,
for
us
is
not
just
a
target
right.
It
is
a
system.
B
It
is
a
series
of
dozens,
hundreds,
thousands
of
decisions
that
we
are
making
on
a
daily
basis
to
drive
towards
a
north
star
and
really
be
very
rigorous
in
how
we
are
implementing
and
applying
that,
and
I'm
really
grateful
to
have
marta
greene
in
california,
op
government
operations
agency,
kimberly
good
at
blue
shield
and
peter
long
as
at
blue
shield,
who
really
have
been
leading
this
effort
and
has
been
a
wonderful
partner
in
partnership
with
our
teams
at
cdph
and
driving
us
towards
equity.
J
First,
no,
no
okay,
I'll
go
ahead
and
go
I'll,
go
ahead
and
jump
in.
Let's
go
to
the
next
slide.
Please.
J
Okay,
I
think
we've
seen
this
slide
in
the
past,
but
I'll
just
do
a
brief
refresher
on
our
five
point
plan
for
equity.
So,
first
and
one
of
the
things
I
care
most
about
is
our
allocation
strategy.
So
that's
that
I
call
it
the
40,
20,
2020
or
our
geographic
are
our
equal
weighting
and
then
our
equity
waiting
as
I
like
to
call
it,
and
there
we'll
talk
a
little
bit
more
about
that
on
a
later
slide,
then
our
network
strategy.
J
We
are
very
close
to
executing
our
contract
on
a
our
transportation
vendor,
which
will
also
help
us
reach
those
most
in
need
of
vaccination,
also
making
allocation
adjustments
to
meet
our
network
providers
that
are
doing
a
really
great
job
in
vaccinating,
our
lowest
quartile
or
those
those
individuals
that
reside
in
the
lowest
quartile
of
the
healthy
places,
index
tracks
and
making
adjustments
based
upon
performance
and
more
on
this
on
a
later
slide
as
well
and
supporting
our
community
partners.
J
J
We've
also
done
some
targeted
funding,
so
6.7.6
million
to
bay
area
counties,
another
15
million
to
organizations
in
los
angeles
and
we're
going
to
be
expanding
that
program
statewide
in
the
coming
weeks.
Data
analytics
we're
going
to
go
into
a
deep
dive
in
that
in
the
coming
slides.
So
I
won't
bore
you
with
it
on
this
one
and,
of
course,
we're
continuing
to
support
the
state's
public
education
campaign
next
slide.
Please.
J
You
know
what
our
network
look
like,
looks
like
and
how
we
have
built
a
network
that
right
now
today,
if
we
had
the
supply
could
deliver
six
million
vaccines
to
californians
on
a
weekly
basis
and
as
as
dr
pond
mentioned
earlier,
we've
we've
only
got
about
2
million
coming
in
per
week,
but
we're
ready
for
that
supply
when
it
comes
and
it
can,
we
can
we're
there
we're
ready
for
that
scale
and
we've
we've
been
able
to
very
rapidly
scale
to
this
to
this
level
and,
as
you
can
tell,
we
have
overall
a
99
access
based
upon
our
metric,
even
in
the
in
the
first
quartile,
and
we're
continuing
to
provide
additional
access
points
to
ensure
that
all
californians
can
access
vaccine
next
slide.
J
J
So
again,
this
is
that
equity
allocation
and
I'll
spend
a
couple
minutes
here.
So
first,
you
know
we
get
that
first
dose
allocation.
So
as
an
example
this
week,
it's
just
over
a
million
doses.
We
take
off
the
top
anything
we
need
for
state
populations.
So
this
is
when
this
is,
for
you
know
the
california
department
of
corrections
and
rehabilitation
department
of
state
hospitals,
any
any
population
says
the
state
is
specifically
responsible
for
so
then
after
we
take
that
off.
J
The
top
80
of
the
remaining
vaccine
is
equally
distributed,
based
on
the
eligible
population
and
as
of
tomorrow,
as
we
all
know,
that's
16
and
up.
So
it's
equally
distributed
based
on
where
the
16
and
over
population
lives,
and
we
take
that
remaining
20,
and
we
concentrate
that
in
the
zip
codes,
the
lowest
quartile
hpi
tracks
because,
as
we
know,
only
25
percent
of
californians
live
in
those
zip
codes,
but
they
have
seen
40
of
the
disease
burden.
J
So
we
need
to
concentrate
40
of
those
doses
where
40
of
the
disease
burden
has
been
so
we're
double
weighting.
The
amount
of
vaccine.
That's
in
those
zip
codes,
next
slide.
Please-
and
here
I'm
going
to
start
to
pass
it
over
to
kimberly,
but
this
is
how
we
then,
within
those
zip
codes,
concentrate
those
doses
in
the
right
types
of
providers
to
reach
those
populations
kimberly.
J
Oh,
we
might
be
having
technical
challenges,
so
I
will
go
ahead
and
continue
on
so
the
current.
So,
as
you
can
see,
the
current
allocation
approach
is
is
doubling
the
weight
on
the
zip
codes
and
in
the
lowest
quartile
hpi
tracks.
As
you
can
see,
we've
got
our
federally
qualified
health
centers,
so
those
serve
our
medi-cal
population.
Those
populations
that
are
reside
in
the
in
the
lowest
quartile
track
so
use
as
you
can
see
in
quartile,
one
46
of
our
the
vaccine.
J
Administrators
are
fqhcs,
so
we're
directing
the
doses
to
those
providers
that
serve
the
residents
of
those
tracks,
28
our
local
providers
and
medical
groups.
12
are
those
large
provider
groups.
We
call
these
multi-county
entities.
These
are
entities
like
kaiser,
sutter
and
the
like,
and
15
are
pharmacies
and
what
you
see
is,
as
you
go
up
the
quartiles
to
more
affluent
areas,
you'll
see
it
more
heavily
weighted
towards
pharmacies
and
much
less
heavily
weighted
towards
fqhcs
next
slide.
Please,
martin.
K
So
thank
you,
marta
and
thank
you,
dr
burke,
harris
and
first
thing
I'll
do
is
clarify
I'm
not
a
doctor,
but
I
do
get
to
hang
around
some
really
smart
ones
on
this
project
and
on
that
previous
slide,
where
you
saw
the
diversity
of
the
provider
network,
that's
one
of
the
the
keys
that
we
want
to
make
sure
that
we
have
from
a
robust
and
broad
range
within
the
network.
K
One
of
the
things
that
secretary
richardson,
made
very
clear
to
us,
as
we
took
on
this
work,
is
that
there
are
no
equity
providers.
Everyone
in
the
network
is
an
equity
provider.
Everyone
in
the
network
needs
to
be
serving
the
most
vulnerable
and
we
wanted
to
make
sure
that
we
have
within
the
network
a
composition
of
that
includes
those
who
are
readily
and
have
been
reaching
vulnerable
populations
as
part
of
their
business.
K
But
we
also
want
to
make
sure
that,
as
we
extend
access
across
all
provider
groups
that
everyone
is
engaged
in
supporting
our
equity
goals,
as
you
heard
martis
say
we
have
the
capacity
to
reach
more
than
6
million
doses
per
week.
That
exceeds
the
goal
of
4
million
doses,
and
our
challenge
was
to
ensure
that
we
were
ready
for
the
surge
when
that
happens,
and
so
clearly
we
are
well
positioned
to
do
that.
We
do
know
now,
as
this
process
iterates
and
you've
heard.
K
K
This
slide
shows
that,
as
we
would
all
suspect,
federally
qualified
health
centers
are
critical
to
achieving
our
equity
goals,
the
work
that
they
do
in
reaching
the
community
and
we're
very
pleased
with
the
progress
that
we've
made
in
getting
fcus
on
board
in
the
network.
You'll
see
the
numbers
here
on
the
slide
and
certainly
we're
pleased
that
we
have
75
percent
of
fqs
one
way
or
another
engaged
or
contracted,
and
those
who
are
not
are
are
the
reasons
for
that
are
explained
on
the
slide.
K
K
The
next
slide
shows
one
example
of
a
provider
that
has
played
a
key
role
in
extending
our
our
reach.
Optum
serve
is
an
example
of
a
really
wide
distribution
across
the
state
through
their
27
sites.
They
have
70
percent
of
their
capacity
is
in
the
hpi
first
quartile.
K
That
gives
us
a
lot
of
optionality:
a
lot
of
flexibility
on
rapidly
standing
up
additional
sites
driving
for
not
only
throughput
but
to
get
to
those
remote
areas,
whether
it's
through
mobile
solutions,
temporary
pop-up
sites
or
other
opportunities.
So
this
is
just
an
example
of
how
we
not
only
have
built
this
robust
network
but
make
sure
that
we've
got
a
network
that
can
be
flexible.
Dialed
up
as
we
get
more
information
on
reaching
the
most
vulnerable,
let's
go
to
the
next
slide,
and
this
is
how
you
know.
K
I
really
want
to
emphasize
one
of
the
points
beyond
allocation
and
network.
One
of
the
important
points
of
the
five-point
equity
plan
for
the
state
is
around
data
and
we
are
using
the
data
as
we
get
it
to
address
challenges
that
may
come
along
the
way.
So
access
clearly
is
important,
as
we
certainly
celebrate
the
success
that
we
heard
dr
pond
say,
and
the
progress
that
we're
making
but
understanding
that
there
still
is
a
long
way
to
go.
So
as
we
get
more
data
week
to
week.
K
So
this
is
just
a
screen
capture,
because
I
didn't
trust
the
ability
to
try
and
show
live,
but
what
this
does
is
it
gives
you
a
sense
as
to
how
we
look
at
the
results
to
know
how
is
the
network
performing
across
each
of
the
quartiles,
and
then
we
have
a
view
here
and
it's
by
by
county
and
local
health
jurisdiction,
but
we
also
have
it
more
specifically
by
zip
codes.
We
have
other
views
that
will
also
help
us
see
the
same
data
by
provider.
This
is
by
by
age
here.
K
I
know
that
you
heard
the
comments
earlier
about
the
work
that's
being
done
to
make
sure
we
have
accurate
data
on
race
and
ethnicity,
and
so
we
also
can
see
this
data
by
gen
by
gender.
We
also
so
this
is
by
dose.
We
also
have
a
view
by
recipient,
so
we're
able
to
use
this
data
on
an
ongoing
basis
to
know
where
are
the
vaccines,
where
are
they
being
allocated?
K
K
K
So
by
having
this
data,
we're
able
to
understand,
we
have
to
do
better
there
to
create
access,
and
it
would
be
great
if
there
are
in
ideas
and
inputs
that
anyone
in
the
group
has.
We
also
are
actively
working
that
in
our
in
discussions
right
now
with
the
tpa
and
with
providers
in
the
network
to
do
what
we
can
to
get
more
extended
hours,
particularly
in
the
weekend
time
frame.
K
The
next
slide
just
gives
you-
and
you
saw
a
sense
of
this
earlier
in
dr
pan,
but
the
bottom
line
is
we're
moving
in
the
right
direction.
You'll
see
that
the
trend
line
at
the
bottom
for
vaccinating
in
the
first
quartile
is
going
up.
So
we
like
that
we're
closing
the
gap,
but
clearly
we
are
not
where
we
need
to
be.
We
absolutely
agree
with
earlier
comments
about
needing
to
increase
to
match
the
disease
burden.
K
The
goal
is
to
save
more
lives
and
for
those
who
are
dying
and
being
infected
at
higher
rates,
we
got
to
get
more
vaccine
there.
So
what
we're
doing
is
using
the
data
using
the
partnership
at
the
local
health
jurisdiction
level
and
with
all
stakeholders
to
really
help
us
optimize
how
we
can
make
good
on
that
increased
allocation
and
get
more
doses
in
arms.
K
K
Cdph
is
doing
a
fantastic
job
working
directly
and
in
partnership
with
everyone
in
activating
on
those
cdph
will
be
launching,
with
support
from
the
tpa,
a
pilot
for
some
counties
that
are
doing
that
have
lower
vaccination
rates
in
the
first
hpi
quartile
and
we'll
be
really
doing
some
very
targeted
efforts
there
to
understand.
What
exactly
are
the
levers
that
we
can
pull
to
see
those
numbers
move
up,
as
we
do
this
pilot
with
sort
of
a
handful
of
counties.
K
K
Why
we
felt
the
tpa
was
brought
on
board
to
partner
with
the
state
in
this
effort
and
the
bottom
line
is
we
are
moving
in
the
right
direction
together,
you
know,
at
the
end
of
the
day,
our
goal
was
to
ensure
that
we
had
a
robust
network
and,
as
we've
described,
we
have
that
the
collective
goal
is
to
save
more
lives
and
based
upon
what
I
think
I
heard
the
governor
say
recently
we're
doing
great
as
a
state
compared
to
everyone
else
in
terms
of
case
rate
reduction.
K
So
that
certainly
is
very
a
very
proud
moment.
We
should
all
celebrate.
We
also
talked
about
improving
and
connecting
the
experience,
and
you
know
we
certainly
heard
in
the
earliest
of
days
a
lot
of
questions
and
concerns
about
my
term,
but
we've
just
seen
phenomenal
progress
and
improvement
there.
The
number
of
appointments
being
set
through
my
turn
and
the
ability
to
use
that
central
source
of
data
to
make
quick
decisions
is
really
quite
critical.
We
think
about
today's
j
j
news.
K
So
I
I
will
end
by
saying
we
think
that
there's
been
great
progress,
yet
there
still
is
opportunity
for
us
to
learn
and
do
more.
If
you
have
insight
you
want
to
share
on
both,
you
know
how
to
extend
hours,
particularly
on
the
weekends,
any
thoughts
there,
as
well
as
any
other
ways
to
better
coordinate
the
equity
tools
that
are
available,
whether
they're
coded
clinics,
etc.
We
we
welcome
that
input
as
well.
K
We're
gonna
keep
pushing
and
keep
iterating
every
step
of
the
way,
and
I
want
to
just
echo
what
dr
pond
said:
there
is
light
at
the
end
of
the
tunnel
and
but
we
just
got
to
stay
patient
and
stay
diligent
in
these
coming
weeks
to
get
us
all
the
way
to
the
other
side.
So
thank
you
for
the
opportunity.
K
B
So
much
thank
you
so
much
kimberly.
I
apologize
for
missing
your
your
title.
I
think
I
just
assume
that
every
black
woman
is
a
doctor.
B
But
in
any
case,
this
is
fantastic.
I
think
I
think
what
what
kimberly
pointed
out
and
and
highlighted
is
how
important
it
is
for
us
to
have
data
and
metrics
and
goals
and
targets
at
every
step
of
the
way.
And
you
know
even
I
I
will
tell
you
for
me-
I
I
I
I
asked
to
have
that
slide
included
about
the
vaccine
about
the
clinic
hour
availability,
because
I
really
wanted
to
highlight
the
the
role
of
structural
factors
right.
We
can
designate
vaccine
allocation
proportional
to
disease
burden,
but.
F
B
B
Resources
in
line
with
with
the
need.
A
Okay,
thank
you
kimberly
and
marta
and
nadine
for
that
and
let's
hear
from
the
rest
of
the
group
danny.
Maybe
we
can
start
with
you,
because
you
had
wanted
to
ask
a
question
earlier
so
denny
chan.
Would
you
like
to
still
make
a
comment
and
then
we'll
go
to
kieran?
Indeed
great.
L
Thanks
bobby
hi,
everyone,
danny
chan,
justice
and
aging,
I
want
to
give
a
big
thank
you
to
everyone
at
the
state
for
really
all
the
hard
work
for
so
many
months
now
it's
been
such
a
rewarding
process
to
see
all
the
progress
we've
been
making.
L
I
originally
wasn't
actually
gonna
say
anything,
but
then
dr
wasserman's
comments
got
me
going,
so
I
wanted
to
lift
up
something
that
I've
been
mentioning
in
multiple
meetings
now,
which
is
that
this
point
about
race
and
ethnicity,
data
specifically
for
older
adults.
I've
raised
it
at
multiple
meetings.
I
don't
want
to
be
the
broken
record
here,
but
I
I
guess
I
will,
in
march
at
our
march
17th
meeting
this
was
raised
in
the
chat
box
and
the
cdph
answer.
L
I
have
checked
the
state
dashboard
and
it
is
still
only
by
age
and
then
by
race
and
then
by
gender.
The
little
information
we
have
at
a
county
by
county
level,
for
example
in
orange
county,
indicates
that
latino,
older
adults
65
and
up
are
10
behind
white,
older
adults
in
terms
of
their
vaccination
rates.
So
I
understand
there's
a
big
focus
on
hpi.
I
get
it.
I
support
it.
I'm
fully
on
board
justice
staging
is
signing.
L
L
The
story
of
race
in
this
country
is
not
perfect,
so
give
us
the
data
that
you
have
that
counties
have
been
collecting.
We
know
it's
been
reporting
that
some
counties
have
been
reporting
out
on
this
on
a
county-by-county
level.
My
impression,
and
one
of
the
reasons
that
we
were
switching
to
the
tpa,
was
that
we
would
get
more
timely
and
better
data,
and
so
I
understand
there
are
a
lot
of
challenges
and
I'm
humbled
by
learning
of
those
challenges.
L
But
you
know,
as
we
think
about
tomorrow,
we're
opening
up
to
everybody
and
we
put
older
adults
back
in
the
queue
in
january
and
I
still
don't
have
any
real,
concrete
sense
on
a
county
by
county
level.
How
older
adults
of
color
are
faring
and
only
hypotheses.
I
mean
it
feels
a
little
bit
like
you
know.
I
I
want
to
talk
about
the
kids
too,
but
I
feel
like
we
haven't
finished
the
job
that
we
were
supposed
to
do.
L
We
haven't
finished
really
making
sure
that
the
most
at-risk
folks
to
dr
wasserman's
point
earlier
have
gotten
the
vaccine,
and
so,
if
there's
anything
again,
I
implore
the
state
like
release
the
data
release.
What
you
have,
I
don't
want
thing.
I
don't
want
perfect
to
be
the
ending
of
the
good
here,
as
we
are
trying
so
hard
to
make
sure
that
people
get
what
they
need.
L
B
Typically
before
we
have
these
meetings,
we
we've
implemented
a
system
where
we
run
a
check
to
make
sure
that
we
have
responded
to
your
questions
and
try
to
make
sure
that
we
in
light
of
the
acip
meeting
that
was
today
and
the
news
that
came
out
yesterday
about
johnson
and
johnson,
I
think
folks
have
been
sprinting
to
gather
a
tremendous
amount
of
data
about
the
the
johnson
johnson
vaccine
situation,
and
so
we
did
not
follow
up
on
that.
A
Okay,
thank
you
danny.
Let's
go
on
to
karen
karen,
don't
forget
to
introduce
yourself.
N
Sure,
thanks
bobby
karen
savage
california,
pan
ethnic
health
network
denny,
said
some
of
what
I
was
going
to
say.
So
I
can
be
pretty
quick,
just
want
to
say
on
the
race
data
I
you
know
there
was
a
reason
to
use
the
hpi
first
when
we
were
thinking
about
reopening
that
made
a
lot
of
sense.
N
That's
on
the
cdph
webpage
really
isn't
budging
in
terms
of
the
disparities,
and
so
you
know,
I
hope
we're
looking
at
that
as
well,
and
I'm
wondering
you
know,
I
understand,
there's
a
lot
of
issues.
The
data
is
incomplete.
We
have
nearly
a
third,
that's
probably
wrong
that
we're
looking
at
so
I
do
get
that.
But
I'm
wondering
sort
of
what
the
analysis
is
of,
why
that
data
is
not
showing
progress
when
the
hpi
data
is
and
what
that
means
is
happening,
and
I
think
you
know
my
assumption
would
be.
N
It
really
goes
to
the
access
barriers
that
I
appreciate
so
much
you
talking
about
dr
burke
harris
and
the
only
suggestion
I
have
on
that.
In
addition
to
what's
been
said
already,
is
we're
hearing
a
surprising
amount
concerns
about
cost
and
I
know
we're
all
very
clear:
the
vaccine
is
free,
but
I
hear
that
more
than
anything
else
right
now
about
why
people
aren't
getting
vaccinated,
is
they
think
they're
going
to
have
to
pay.
So
I
think
as
much
as
we
can
like
really
lift
that
up
in
the
messaging
that
we're
doing.
N
I
think
that's
going
to
be
really
helpful,
because
you
know
people
are
used
to
nothing
in
health
care
is
free
right.
So
it's
I
think
it's
taking
a
lot
to
make
sure
people
understand,
even
if
you
don't
have
insurance,
even
if
you're
undocumented
the
vaccine
is
free
right.
So
just
want
to
really
encourage
us
to
push
that
message
as
much
as
possible.
O
Thank
you
bobby
I'm
dean
chalice
with
the
california
association
for
health
services
at
home,
serving
home
health
and
hospice
providers,
and
I'd
like
to
know
how
vaccinating
homebound
californians
is
being
addressed.
We
know
that
there's
two
million
at
least
homebound
seniors
and
that
number
doesn't
include
those
that
are
development,
developmentally
disabled
children
that
are
homebound
temporarily
homebound
folks
that
are
post-acute,
and
I'm
just
curious
of
how
how
we're
going
to
address
that.
O
J
Sure
I'll
briefly
address
that
one.
If
my
colleague
trisha
from
the
department
of
public
health
is
on,
I
would
invite
her
to
jump
in
because
she's
more
of
an
expert
than
I
am,
but
we're
working
on
a
partnership
with
the
emergency
medical
services
authority
to
actually
deploy
ambulance
strike
teams,
so
emt
strike
teams
to
homebound
individuals
and
their
families
to
vaccinate
we're
going
to
identify
homebound
individuals
through
a
variety
of
different
sources,
so
through
health
plans.
J
So
as
health
plans
can
look
at
their
claims
and
identify
individuals
who
are
receiving
vaccinations
in
a
home
setting,
so
that's
one
way
through
existing
providers
is
another
way
also
through
local
health
jurisdictions
are
aware
of
where
some
homebound
individuals
live.
That
information
is
going
to
be
given
to
each
local
health
jurisdiction
so
that
they
can
monitor
in
their
community
where
the
homebound
individuals
live
and
they
will
coordinate
with
the
ambulance
strike
teams.
So
it's
through
the
mutual
aid
system
that
we
have
here
in
california.
So
that's
the
process.
That's
going
to
be
used.
J
We're
going
to
actually
also
have
a
toggle
on
the
my
turn.ca.gov
website
that
an
individual
or
family
member
can
click.
That
basically
says.
I
either
have
a
transportation
issue
or
I
cannot
leave
my
home.
The
language
is
still
being
worked
out,
exactly
what
it's
going
to
say
and
that
will
trigger
actually
a
call
center
agent
to
call
reach
out
to
the
individual
and
walk
through.
Is
this
an
access
meeting,
a
transportation
issue
you
cannot
get
to
the
appointment
or
that
you
cannot
leave
your
home
and
then
arrange
for
either
transportation?
J
A
Thanks
martha
and
thank
you
dean
for
raising
up
that
question.
I
think
we
don't
have
any
other
questions
at
this
point,
so
I
think
it's
a
great
time,
nadine
and
erica
to
introduce
grace
lee
who's
here
with
us
again.
She
was
at
an
earlier
meeting
and
talk
about
johnson
and
johnson.
C
C
So
I
just
really
want
to
thank
her
for
her
service
to
the
whole
nation
and
to
us
as
a
state,
as
I
mentioned,
and
as
dr
barcara's
mentioned
she's,
not
only
a
member
of
the
advisory
committee
on
immunization
practices,
but
she's
sort
of
an
expert
in
vaccine
safety,
and
she,
I
think,
co-chairs
the
vaccine
safety.
Technical
subgroup,
I
think,
is
the
right
title
of
the
acip
group
as
well
as
vaccine
safety
data
links.
So
if
you
have
a
moment
even
to
highlight
some
of
that
work
grace
that
would
be
excellent
as
well.
M
Sure
and
if
it's
okay
I'll
plan
to
share
my
screen,
I
just
pulled
together
a
high
level
summary
of
the
information
from
earlier
today.
Let
me
see
if
I
can
do
this
yeah.
M
So
much
today,
sorry,
I
know
you've
been
through
it,
terrific
thanks.
So
this
was
all
presented
earlier
today
and
I
just
pulled
out
what
I
think
are
the
some
of
the
key
points
for
discussion
today.
So
first
there
was
an
introduction
by
dr
beth
bell,
who
chairs
our
covid19
vaccines
work
group
just
providing
the
context
that's
needed
about
the
adenovirus
vector
vaccines.
There
are
two
currently
available:
one
is
the
jansen
slash
j,
j
vaccine?
M
It
is
awaiting
eua
application
in
the
u.s
and
what
happened
over
the
past
week
has
been
that
astrazeneca
on
april
7th,
sorry,
not
astrazeneca
the
ema
and
the
mhra,
I
believe,
announced
their
concerns
for
these
rare
clotting
events
seen
after
astrazeneca
vaccination
in
the
uk
and
europe,
and
we
also
at
the
same
time
we're
starting
to
query
some
of
our
data
across
the
vaccine
safety
surveillance
systems
and
found
that
some
of
the
clinical
syndromes
and
presentations
were
similar
for
these
adenovirus
vector
vaccines.
But
lots
of
questions
still
remain.
M
There's
lots
that
still
need
to
be
explored.
In
brief,
the
the
presentations
that
have
been
most
notable
have
been
these
cerebral,
venous
sinus
thrombosis
presentations,
which
is
essentially
clotting
of
the
large
vessels
draining
blood
from
the
brain
in
general.
M
You
know
persistent
and
worsening
over
time
I
we
saw
vast,
which
is
the
the
vaccine
safety
technical
subgroup
that
dr
pan
mentioned
as
a
review
of
the
data,
did
a
review
of
the
data
on
monday
april
12th.
So
we
saw
that
data
from
the
vares
reporting
system
through
april
10th,
and
this
was
as
of
monday.
There
were
three
cases
following
the
moderna
vaccine.
What's
interesting
is
that
these
cases
in
general
you'll
see
the
six
cases
below
following
the
j
j
vaccine
were
associated
with
thrombocytopenia
and
that's
not
typical
for
us.
M
Typically,
we
don't
see
cases
associated
with
rhombocytopenia,
so
the
three
moderna
cases
that
were
observed
were
thought
to
be
most
likely
due
to
background
rates,
since
they
were
not
associated
with
thrombocytopenia.
Amongst
83
million
doses
administered.
There
were
no
cases
reported
in
bears
following
the
pfizer
beyond
tech
vaccine,
with
95
million
doses
administered
and
then
six
cases
following
the
johnson
vaccine,
but
with
thrombocytopenia
in
six
million
doses
administered
and
the
characteristics
of
these
cases
were
similar
to
what
was
reported
out
of
europe
with
thrombosis.
M
So
that's
clotting
with
thrombocytopenia
and
elevated
d,
dimer
and
antibodies
to
platelet
factor.
Four
you'll
see
here
on
the
right
that
the
age
group
again
is
in
younger
individuals.
M
M
All
the
cases
that
were
reported
to
date
were
in
white
individuals.
We
don't
have
race,
ethnicity
from
the
astrazeneca
data,
or
we
haven't
seen
that
data
and
then
the
timing
of
onset
really
has
been
within
two
weeks
of
receding.
Vaccine
and
I'll.
Just
note
that
you
know
these
are
just
these
are
case
reports
that
are
coming
into
theirs.
M
So
this
particular
vaccine
safety,
technical
subgroup
were
vast,
discussed
some
of
the
key
issues
in
an
independent
meeting
and
identified
that
this
was,
you
know,
clearly
a
rare
but
a
serious
adverse
event
that
risk
factors
are
not
yet
well
understood
from
the
six
cases.
And
if
you
go
to
the
meeting
minutes
today
from
acip,
you
can
see
all
of
the
details
of
those
six
cases.
M
I
didn't
bring
them
here
in
interest
of
time,
but
it's
not
there's
not
a
clear
pattern
of
these
cases
exactly
so,
we
feel
like
there's
more
information
that
needs
to
be
explored.
The
main
concern
and
the
reason
that
the
pause
happened
was
really
because
this
is
an
unusual
presentation.
So
there
was
concern
for
delayed
recognition
by
healthcare
providers
in
this
cerebral
venous
thrombosis
with
thrombocytopenia
and
it's
important
because
in
order
to
be
able
to
provide
appropriate
management
in
a
timely
way,
in
this
case,
the
recommendation
would
be
ivig
or
anticoagulation
with
non-heparin-based
therapy.
M
So
the
typical
treatment
is
heparin
use,
and
in
this
case,
actually
you
would
want
to
avoid
heparin
use
if
there
was
concern
for
this
particular
entity,
and
for
these
reasons
that
pause
was
discussed
yesterday.
M
Sorry,
just
a
few
more
key
points,
so
there
was
a
strong
feeling
that,
given
this
potential
life-threatening
adverse
event
was
now
emerging
as
a
potential
signal,
even
though
there
were
only
six
cases
reported,
there
was
a
strong
feeling
that
we
should
provide
this
information
to
clinicians,
to
enhance
early
recognition
and
appropriate
treatment
of
individuals
who
develop
thrombosis
with
thrombocytopenia
following
vaccination
and
that
we
needed
to
have
a
further
evaluation
of
the
benefit
risk
balance
of
using
this
vaccine
in
specific
subgroups
and
importantly,
that
timely
and
transparent
communication
with
healthcare
providers
and
the
public
would
be
crucial
to
maintain
confidence
in
the
vaccine
program
so
24
hours
after
that
meeting,
this
information
was
released.
M
The
health
alert
network
to
all
our
states
and
providers
across
the
country
focused
in
on
this
particular
unusual
potential
adverse
event,
with
recommendations
for
clinicians,
specifically
to
evaluate
looking
for
this
anti-platelet
four
antibody,
as
would
be
performed
for
another
similar
type
of
syndrome.
This
heparin
induced
thrombocytopenia
and
to
not
treat
with
heparin
unless
this
hit
testing
is
negative
and
encouraging
case
reporting
from
our
public
health
colleagues
and
from
the
public,
especially
for
those
who
may
have
received
the
vaccine.
M
So
the
next
steps,
in
brief,
are
to
ensure
that
we
can
continue
to
enhance
case
identification
over
the
coming
weeks.
Through
these
notifications
and
increasing
awareness
amongst
patients
and
providers,
we
are
strongly
encouraging
all
patients
to
report
into
vsaf,
so
this
system
has
been
available
for
a
long
time.
M
We
really,
you
know,
want
individuals
and
to
report
in
any
potential
adverse
events,
but
that
is
one
system
that
allows
us
to
have
patients
report
directly
to
the
cdc
and
then
vares
is
a
system
that
anyone
can
report
into
it
can
be
providers,
patients,
industry,
anyone
and
also
strongly
encouraging
that
any
reports
be
reported
intubators,
and
then
we
talk
briefly
about
the
what
happens
after
a
signal,
a
safety
signal
is
identified
and
what
typically
happens
is
we
move
into
a
signal,
refinement
and
a
signal
evaluation
stage?
M
The
signal
refinement
stage
really
focuses
on
getting
a
better
estimate
of
the
risk
and
understanding
the
clinical
characteristics.
Signal.
Evaluation
is
sort
of
formal
epidemiologic
studies
that
really
try
and
get
at
whether
or
not
there
is
causality
and
for
the
short
term,
we're
really
focused
on
making
sure
that
we
can
review
these
findings
and
other
vaccine
safety
surveillance
systems.
M
So,
in
terms
of
what
was
reported
today
prior
to
march
30th,
there
were
about
3.5
million
jensen,
doses
administered
and
since
march
30th
to
april
13th,
when
the
safety
pause
was
put
into
effect,
there
were
a
3.8
million
doses
administered
and
the
reason
this
is,
and
most
of
those
events
will
develop
within
six
to
13
days
after
a
vaccine
receipt.
M
M
M
I
believe
the
fda
at
the
meeting
mentioned
that
they
were,
you
know,
put
out
information
to
providers
and
in
the
label
to
delineate
this
in
or
to
educate
the
public.
Sorry
and
the
questions
that
were
put
to
acip
today
were
whether
or
not
we
had
enough
information
to
make
interim
age
or
risk
factor
based
recommendations
for
use
of
the
vaccine
and
what
recommendation
did
acip
feel
was
appropriate
today,
given
the
current
available
information
for
use
of
the
onsen
vaccine
and
where
we
ended
up
was
that
we
felt
that
additional
information
would
be
needed.
M
You
know
we
had
48
hours
to
review
all
available
data
and
to
have
a
you
know,
discussion,
but
that
data
is
evolving
and
even
in
that
48
hours,
I
continue
to
see
new
details
that
are
emerging
because
all
of
our
vaccine
safety
colleagues
are
intensely
working
on
the
evaluation.
A
Great,
thank
you
grace
so
much.
It's
been
such
a
long
day
for
you,
and
we
really
appreciate
your
presenting
this
data
to
everyone
erica
put
in
the
chat,
the
link
to
all
the
slides
from
acip
and
we'll
send
out
grace's
digest
and
the
full
deck
after
the
meeting
for
all
of
you.
So
I
think
this
would
be
a
great
time
for
anyone
who
has
questions
for
grace
or
erica
about
the
johnson
johnson
situation
and
what
the
next
steps
might
be.
P
P
You
mentioned
at
the
end
of
that
that
there's
there
is
an
attempt
to
be
looking
at
age-specific
safety,
and
I
think
I've
been
thinking
especially
of
how
the
the
johnson
johnson
vaccine,
in
particular
offered
potentially
a
faster,
more
efficient
way
of
reaching
those
who
needed
house
call
vaccination
and
maybe
certain
other
specific,
specific
groups
of
individuals
who
would
benefit
greatly
from
a
one-shot
dosage
or
from
vaccines
that
don't
need
deep
sub-zero
temperatures,
and
I
I
think
especially
of
this
population,
of
this
sort
of
older
population
who
may
be
living
in
the
communities
isolated,
who
can't
leave
their
homes,
because
I
think
it's
a
similar
population
to
those
who
have
been
in
nursing
homes
who
who
basically
for
a
year,
didn't
get
informed
choice.
P
And
now
I
think,
we're
looking
at
a
population
who
are
isolated
in
their
homes
and
able
to
get
out
for
vaccination
and
and
facing
much
of
that
sort
of
someone
has
decided
that
the
risk
to
their
life
is
more
important
than
the
quality
of
their
life
to
to
a
certain
degree,
and
I'm
just
trying
to
think
through
in
the
in
the
prioritization
of
the
the
kinds
of
information
you're
getting
whether
there
is
really
an
a
strong
attempt
to
be
thinking
about
the
safety
of
ministering.
P
This
vaccine
to
those
who
are
older,
looking
specifically,
maybe
at
groups
of
people
with
disabilities
as
well,
who
are
who
are
unable
to
get
out
for
vaccination,
who
need
a
house
call
vaccination
and
logistically
could
benefit
greatly
from
the
johnson
and
johnson
vaccine
in
particular,
and
I
appreciate
that
there
are
additional
issues
of
perception
equity,
how
you
know
who
is
willing
to
have
the
vaccine,
etc.
M
Yeah,
I
really
appreciate
your
comments
and
it's
actually
really
helpful
for
me
to
hear-
and
I
thank
you
so
much
for
inviting
me
today
and
for
just
you
know
letting
me
hear
your
feedback
on
this
issue.
Certainly,
this
vaccine
offers
many
unique
advantages
and
I
think
that
on
the
call
today,
maybe
I'll
just
reflect
on
the
call,
which
was
that
it's
a
combination
of
population
benefit
risk
balance
and
individual
benefit
risk
balance,
and
I
think
that
the
goal
is
to
ensure
that
we
can,
wherever
possible,
mitigate
the
risks.
M
So,
in
some
ways
I
it's
not
analogous
exactly
but
anaphylaxis
is
a
known
risk
associated
with
vaccination
and
we
spent
a
lot
of
time
initially
in
the
initial
weeks
of
the
vaccination
program,
ensuring
that
we
could
recognize
that
the
risk
exists
and
mitigate
those
risks
as
much
as
possible,
and
I
think
you
know,
as
with
any
medical
product
or
anything
that
we're
doing
you
know
even
like
the
risks
of
travel
or
the
risks
of
you
know
going
into
the
community.
M
To
ensure
that
we
can,
via
acip
make
recommendations
that
support
population
level
risk
mitigation,
wherever
we
can
number
two
that
we
support.
Individual
level
benefit
risk
assessment
by
educating
the
public
and
by
educating
providers
about
how
to
ensure
that
we
have
early
recognition
and
appropriate
and
timely
management,
and
I
think
those
are
the
strategies
we
can
put
together
in
place
for
what
needs
to
happen
now
what
the
decision
will
be.
M
I
can't
I
don't
know,
but
I,
but
I
do
think
that
all
of
the
comments
that
you
made
are
extremely
important,
because
I
think
that
this
vaccine
has
been
found
to
be
efficacious
and
not
only
did
the
question
of
equity
come
up
in
the
u.s,
but
also
internationally
globally,
in
that
many
countries
still
are
awaiting
access
to
vaccines,
and
so
I
think
it's
really
important
and
we're
going
to
continue
to.
Basically,
our
goal
is
to
decrease
our
uncertainty
around
what
those
risk
estimates
are.
M
I
think
it
was
really
difficult
today
because
we're
talking
about
six
cases
and
we
need
to
be
able
to
make
sure
that
we
have
a
good
quantitative
understanding
of
both
the
benefits
and
the
risks
in
context
in
order
to
be
able
to
make
an
informed
decision.
So
my
hope
is
that
it
won't
take
too
long
for
us
to
ensure
that
we
have
reasonably
robust
information
available
on
this.
But
it
is,
we
literally
have
had
48
hours
and,
I
would
say,
I'm
still,
processing
all
the
information
as
we
go
to
so.
Thank
you.
A
Q
Q
We
know
that
trans
women
who
are
taking
estrogen,
you
know
or
other
hormones,
are
at
increased
blood,
clot
risk
and
also
trans
trans
men
who
are
on
testosterone
and
other
hormones,
can
have
increased
risk
of
hypothycemia,
and
you
know
thickening
of
the
blood
and
other
things
that
put
them
at
higher
risks
of
stroke,
heart
disease
and,
like
other
related
illnesses,
and
so
I
I
expect
that
I
will
be
getting
questions
about
that
from
folks
in
lgbtq
communities
and
I
would
love
to
be
able
to
give
them
an
answer
about.
Q
You
know
what
is
the
safety?
What
are
you
know?
Is
it?
Is
it
similar?
What
should
folks
be
looking
out
for,
and
you
know
I
I
I
think
you
know-
we've
been
really
trying
to
encourage
folks
to
get
vaccinated,
make
sure
that
we're
getting
good
information
out
there
instilling
confidence
about
the
safety
and
effectiveness
of
these
vaccines,
and
so
just
want
to
get
out
ahead
of
some
of
those
potential
concerns
as
much
as
possible.
M
Thank
you.
Yes,
I
mean,
I
think,
that's
we're
we're
also
wanting
to
try
and
take
a
deeper
dive
to
get
some
of
that
information
again
to
understand
if
there
are
risk
factors
associated
with
a
higher
risk
of
this
potential
adverse
event
that
could
really
help
us
in
terms
of
thinking
about
how
to
advise
individual
benefit
risk
balance,
and
so
we
will
also
be
asking
the
same
questions,
but
I
appreciate
your
comment
and
your
thoughtfulness
about
it.
A
E
E
I
can't
believe
you're
here
it
was
a
long
day,
but
I
I
did
want
to
ask
you
what
you
see
the
outcome
I
mean:
do
you
see
recommendations
that
would
say
for
the
j
vaccine
in
the
u.s,
if
you're
this
age
you're
this
gender,
this
ethnicity,
it's
not
recommended
that
kind
of
specificity,
or
are
you
just
trying
to
weigh
the
risk
benefit
and
give
sort
of
you
know
what
type
of
care
you
know
response
you
would
have
if
you
see
somebody
with
that
type
of
reaction,
so
thank
you.
M
I
I
so
I
can't
really.
I
can't
really
predict
in
terms
of
what
I
would
say
is
there's
supposed
to
be
another
acip
meeting
soon.
So
I
think
we'll
get
at
specifically
the
questions
around
this
and
I
think
the
challenge
today
was
you
know.
We
have
six
cases
and
I
will
say
one
of
those
cases
actually
did
have
oral
contraceptive
use
but
other
than
those
six
cases,
and
then
the
other
reports
coming
out
of
europe
and
the
uk,
of
which
you
know
we're
able
to
see
the
summarized
reports.
M
But
we
haven't,
you
know,
reviewed
the
data
directly.
I
think
that
it's
really
hard
for
us
to
be
able
to
make
an
informed,
evidence-based
decision
on
six
cases.
So
as
the
data
evolve
and
as
we
continue
to
learn
more,
my
hope
is
that
we
will
be
able
to
again
refine
the
information
that
you
know
and
we'll
still
be
to
be
fair,
we're
going
to
be
stuck
with
uncertain
information,
but
I
just
I
still
want
us
to
have
a
little
bit
more
clarity
around
the
risks
and
the
risk
factors
as
much
as
possible.
M
Again,
because
I
do
feel
like
we
are.
Our
purpose
is
to
ensure
that
we
are
protecting
public
health
and
you
know
safeguarding
the
safety
and
the
benefit
risk
balance
really
of
vaccination.
It's
really
critical
to
our
vaccination
program.
We
want
to
make
sure
we're
enhancing
confidence.
M
I
know
that
some
people
will
feel
like
the
safety
pause
that
was
put
out
by
cdc
and
fda
was
too
soon.
Some
people
will
say
it's
not
enough,
I'm
pretty
sure
like
no
one's
happy
with
it
with
this
information,
but
I
think
what
we
just
have
to
do
is
work
with
what
we
have
right
now
move
it
forward,
and
you
know
the
role
of
acip
is
to
review
all
of
the
data
and
make
the
best
evidence-based
decision
possible.
M
We
often
do
it
under
huge
degrees
of
uncertainty,
but
I
think
for
today
we
just
needed
more
information.
A
Thanks
grace
eric
is
there
anything
you
want
to
add
now
that
grace
has
reviewed
the
acip
discussion
about
how
our
supply
or
reinforce
how
our
supply
will
be
affected
over
the
next
few
weeks.
Anything
more
you
want
to
say.
C
I
mean
I
think
I
could
just
recap
a
little
bit
of
what
I
just
sort
of
mentioned
before,
which
is
we
already
had
anticipated
decreased
j
j
because
of
the
manufacturing
issues
that
had
come
about,
and
then
you
know
it
has
varied
from
in
the
past
from
you
know,
when
you
look
at
all
of
our
doses,
cumulatively
only
about
four
or
five
percent,
I
think
when
you
look
at
the
federal
allocations
as
well
in
the
state
it's
been
as
high
as
67,
and
I
think
there
was
hope
that
it
could
be
more
moving
forward
as
far
as
expanding,
but
I
do
think,
as
I
also
kind
of
just
alluded
to
earlier,
but
I
think
we
are
lucky
in
the
united
states
that
we
do
have
a
lot
of
other
options
as
far
as
volume
of
moderna
and
pfizer
vaccines.
C
So
I
think
it's
it's
definitely.
You
know
it's
definitely
a
disappointment
right
that
as
we're
all
talking
about.
There
are
a
lot
of
really
great
aspects
of
this
vaccine
specifically,
and
so
we
look
forward
to
you
know
to
hearing
you
know
more
about
the
overall
assessment
about
is
this
is
safe
or
safer.
In
certain
populations
and
how
do
we
kind
of
do
exactly
what
grace
is
outlining?
As
far
as
you
know,
thinking
about
that
population
risk
and
then
individual
risk
and
informed
consent
around
this?
C
So
but
again,
thankfully,
you
know-
and
it's
just
so
much
easier,
of
course-
to
be
the
one
and
done,
but
I
think
we
do
have
other
options
which
again
we're
grateful.
There
are
some
other
countries
that
are
really
challenged.
This
is
one
of
the
analogous
vaccine
that
may
or
may
not
be
related,
but
you
know
they
don't
have
a
lot
of
other
options
and
they're
experiencing
deaths
from
the
disease
itself.
C
So
I
think
this
is
these,
yet
another
really
challenging
sort
of
broad
decisions
for
all
of
us
that
you
know
this
other
twist
in
our
and
our
tunnel
turn
that
I
was
mentioning
earlier
so
yeah.
We
will
stay
tuned
and
I
can't
remember
if
I
already
said
so
this
evening,
we'll
get
a
little
more
of
a
recap
again.
Poor
grace
we'll
be
really
tired
of
talking
about
this,
because.
C
To
be
meeting
at
least
briefly
later
this
evening
with
the
rest
of
the
western
state
scientific
safety
group,
you
know
and
then
have
a
more
kind
of
california
specific
follow-up
tomorrow,
but
really
grateful
again
to
grace
for
her
willingness
to
come
here
after
she's
probably
also
been
reviewing
all
this
data
over
the
last
48
hours
as
well,
in
addition
to
being
in
a
lot
of
long
meetings.
So
thank
you
very
much.
A
Okay,
maybe
we
could
have
a
round
of
applause
for
grace
and
her
stamina,
because
she
has
another
meeting
with
all
of
us
tonight
for
the
western
states
scientific
group
grace.
Thank
you
so
much
and
I
think
nadine
and
erica
we're
ready
to
begin
to
close
the
meeting.
B
Thank
you
so
much
bobby.
Thank
you,
dr
lee,
for
joining
us.
I
I
did
want
to
say
in
response
to.
I
think
it
was
amanda's
comment
or
or
question
in
regards
to
the
demographics.
B
I
think
that
the
what
we
in
listening
to
the
the
acip
meeting
today,
one
thing
that
I
heard
that
I
thought
might
be
of
interest
to
this
group-
was
a
little
bit
about
the
demographics
of
the
of
the
of
the
six
out
of
6.8
million
individuals
who
have
this
rare
but
serious
event,
and
that
was
that
they
were
all
women
and
that
the
age
range
was
between
between
20
and
50
years
old.
B
B
So
that's
our
data
for
here
in
the
u.s,
and
I
think
that
I
think
that
one
of
the
things
that,
as
dr
lee
mentioned
as
they're,
going
through
their
process,
looking
comparing
our
data
on
on
johnson
and
johnson,
looking
at
potentially
the
data
for
astrazeneca.
B
Given
that
that
also
is
a
a
vaccine
that
uses
the
same
vector,
which
is
the
adenovirus
vector
to
to
understand,
if
there
is
any
relationship
there
and
fully
explore
that,
given
that
there
were
similar
clotting
events
that
were
also
seen
with
the
astrazeneca
vaccine
in
europe-
and
so
I
just
wanted
to
to
share
that
information
because
I
felt
like
that
was
something
that
would
be
helpful
to
this
body.
B
And
so
I
want
to
thank
all
of
our.
I
want
to
thank
all
of
our
presenters
and
all
of
our
members
today
for
another
wonderful
and
robust
discussion
as
I
was.
I
was
doing
my
best
to
keep
up
with
some
of
the
comments
and
the
questions
in
the
chat,
but
clearly
because
of
this
emergent
issue.
B
We
there
were
some
things
on
our
agenda
that
we
had
anticipated
for
today
that
got
bumped
so
that
we
could
bring
you
the
latest
information
and
that
we
could
make
sure
to
have
time
for
dr
lee
to
be
able
to
present
to
you
all
today,
and
so
we
will
have
more
information
at
future
meetings
regarding
some
of
our
outreach
and
communication
and
particularly
connection
to
what
we
are,
how
we're
looking
at
supporting
and
vaccinations
for
our
unhoused
population,
and
so
we
can
look
forward
to
that.
B
I
want
to
give
an
opportunity
for
so.
I
want
to
say
that
if
any
of
you
all
again
have
suggestions
for
us
or
for
the
the
tpa
on
strategies
that
to
improve
our
operationalization
of
equity,
we
took
away
the
importance
of
data
by
both
age
and
race
and
we're
taking
away
information.
B
B
You
guys
have
done
a
wonderful
job
of
sending
resources
in
between
meetings
or
strategies
or
suggestions,
and,
in
addition,
we
will
share
with
you
some
information
that
we
had
prepared
to
share
with
you
all
about
some
of
our
outreach
and
community
engagement
efforts
as
we
recognize
that
equity
is
not
about
allocation
alone,
as
was
lifted
up,
but
but
really
is
a
a
multi-tiered
multi-pronged
strategy
that
has
to
be
deployed
and
very
thoughtfully
and
and
followed
up
and
and
continually
driven
towards.
B
So
you
all
will
receive
those
materials
after
these.
This
meeting
bobby
will
send
that
out,
and
I
want
to
give
an
opportunity
for
dr
pond
to
to
share
any
additional
words.
C
Thank
you
similarly
want
to
again
thank
dr
lee
for
coming
and
thank
all
of
you
for
the
ongoing
constructive
dialogue.
I
think
you
know,
as
mentioned
we've
come
a
long
way.
We
can
always
continue
to
get
better.
C
I
think
data
specifically
as
the
as
a
state
epidemiologist
feeling
that
my
role
is
that
the
data
is
really
important
has
been,
I
think,
yeah
one
of
the
biggest
challenges
actually
for
this
pandemic
and-
and
I
think
another
illustration
of
along
with
kind
of
this
panoramic
magnifying
disparities
you
know
in
our
by
race
and
by
you
know,
sort
of
poverty
and
other
things
I
think,
looking
at
the
I
just
have
to
put
a
little
bit
of
my
soapbox
on
public
health
right
like
we
have
been
using
faxes,
for
you
know
much
longer
than
reals.
C
We
we
have
not.
We've
not
had
investments
in
our
infrastructure
and
our
information
technology
and
our
workforce,
and
so
that
was
really
magnifying
this
pandemic,
and
that
is
so
just
you
know.
Thanks
for
your
patience
with
us,
we
absolutely
you
know
our
heart
isn't
exactly
the
same
place
and
we
really
appreciate
the
pushing
and
the
dialogue
and
actually
it
it
does
make
us
better,
and
it
helps
push
for
the
resources
to
help
us
too
to
to
do
what
we
all
have
as
a
collective
goal.
C
I
think,
which
is
to
really
serve
the
entire
population
and
also
lift
up
for
equity,
and
then
I
think
you
know
today
again
really
highlighted
the
transparency
and
safety,
and
I
think
the
other
part
is
we.
You
know,
six
individuals
is
not
much
as
far
as
data,
so
we're
gonna
have,
to
you
know,
as
a
nation
and
as
a
state
going
to
be
making
yet
another
really
tough
decision.
So
we
appreciate
the
dialogue
around
that
and
I
think
just
it
is
always
weighing
benefits
and
risks.
C
So
thank
you
for
your
partnership
in
that
and
for
patients
with
us
and
and
really
looking
forward
to
the
next
meeting
and
and
continue
to
work
with
all
of
you.
Thank
you
and.
B
I
wanna
before
we
adjourn,
I
just
wanna,
remember,
to
to
highlight
and
remind
all
of
us
about
the
bi-directional
nature
of
the
partnership
and
information
exchange
in
this
gathering.
So
we've
shared
a
lot
of
information
with
you
today
about
our
you
know
where
we
are
with
our
implementation
and
allocation.
B
B
The
information
about,
what's
happening
with
johnson
and
johnson,
share
the
information
about
what's
happening
with
our
equity
strategy
and
really
be
a
conduit
to
lift
up
the
voices
of
the
communities
that
you
all
represent
back
to
us
back
to
the
state
so
that
we
can
continue
to
do
this
work
on
behalf
of
the
people
of
california
to
the
best
of
our
ability
and
with
that,
our
next
meeting.
B
On
may
12th
from
3
to
5
pm,
we
will
send
out
the
agenda
ahead
of
time.
As
always,
we
invite
the
public
to
make
comment
and
public
can
do
that
at
covet.
19
vaccine
outreach,
cdph.ca.gov
and,
in
the
meantime,
thank
you
again
so
much
for
your
continued
hard
work
and
partnership
on
this
effort,
and
we
look
forward
to
seeing
you
at
the
next
meeting
be
well.