Higher Education Webinar: Planning for Vaccine Rollouts

Anita L. Barkin, co-chair of the COVID-19 task force at the American College Health Association, leads a discussion on the role of colleges in disseminating vaccines and provide rollout recommendations for campus communities.

FASKIANOS: Thank you. Welcome to CFR's Higher Education Webinar. I'm Irina Faskianos, vice president for the National Program and Outreach at the Council on Foreign Relations. Today's meeting is on the record and the video and transcript will be available on our website, CFR.org/academic. As always, CFR takes no institutional positions on matters of policy.

We're delighted to have Anita Barkin with us to talk about the planning for vaccine rollouts. We have shared her bio with you, but I will give you the highlights. Dr. Barkin is co-chair of the COVID-19 task force at the American College Health Association, known as ACHA for short, and a member of the board of directors for the Healthcare Georgia Foundation. Previously, she was a district nursing director of the North Central Health District. She oversaw operations of the district office, thirteen county clinics, and the Hope Center. She also served as director of Carnegie Mellon University Health Services for twenty-seven years. Dr. Barkin is a board-certified nurse practitioner and an ACHA fellow. Over the course of her career, she has held offices in local, regional, and national college health associations, and the Georgia Public Health Association. And she previously served as chair of the nursing session of GPHA and president of ACHA. She is a leader in pandemic planning for colleges and universities and this is the perfect audience to address today.

So Dr. Barkin, thank you very much for being with us. Will you begin by talking about the role of colleges in disseminating vaccines on campuses and in their communities and provide your recommendations for campuses and what they're doing in their communities?

BARKIN: Certainly, I want to, first of all, thank you for the opportunity to join you and your members this afternoon and discuss this very timely issue. And there are lots of questions that folks have out there regarding the vaccination rollout. If I may start by going through the PowerPoint presentation I gave as kind of a warm-up to our discussion.

[To CFR operator] And so, yes, you can move to the next slide, please.

So, we'll start with a short introduction, overview of the approved vaccines: what does the phase distribution plan look like? And then discuss some of the action plan items that we're recommending for institutions of higher education. Next slide.

So currently, there are two vaccines approved under the Emergency Use Authorization, the EUA, and that is Pfizer's vaccine and Moderna. Now, if you look at them, the efficacy is about the same for both and even the dosing schedules are very similar. Pfizer is intended for use in sixteen years and older individuals and Moderna is eighteen years and older. They are, however, already starting trials to see what happens in younger folks. And so I think we'll see some information coming forth on the applicability for children and young adults, as well. There are some challenges with the Pfizer vaccine in terms of shipping and storage in that they–—that requires an ultra-cold freezer temperature of minus ninety-four degrees approximately, where Moderna is easier to store and ship and it's stable in a refrigerator for longer. And you can order less of it, fewer doses, and that's a big advantage for smaller organizations or smaller schools that really couldn't make use of 195 to 975 doses of Pfizer, in addition to the fact that the storage, as I said, storage capabilities are quite challenging with the Pfizer vaccine. Next slide.

So two facts about COVID mRNA vaccines and those are—that is the technology that has been used to develop the Pfizer and Moderna vaccines is that the—and these are circulating, and so I thought it was important that we address these two particular issues. First of all, the vaccine cannot give you COVID-19. mRNA does not use live virus. It is a small fragment of the RNA that prompts the cell in the human body to make the protein. It does not affect or interact with cell DNA. It never enters the nucleus of the cell where the DNA genetic material's kept. Once the cell breaks down, it gets rid of the mRNA. And as soon as it's finished using the instructions to make the protein piece. So there's a lot of misinformation out there regarding how it works and its ability to interfere with cell DNA so I want to put those two myths to rest. Next slide.

And there are more vaccines in the pipeline using different technologies. AstraZeneca, Janssen, Novavax are all in phase three clinical trials. And we need lots of vaccine in the pipeline. The limitations on the ability to manufacture enough vaccine to vaccinate the U.S. population quickly is really going to be dependent on having a variety of vaccines available to immunize the population. Next slide, please.

So there are three questions that are yet to be answered. Does vaccination stop asymptomatic transmission? How long will the protection last once a person is vaccinated? And how will vaccines deal with various mutations that are making their way on the scene? Next slide.

So especially relevant to the higher ed population are two phases of the ACIP recommendations. ACIP is the Advisory Council on Immunization Practice. And this phase structure was accepted by ACIP and rolled out. In phase 1A, the jumpstart phase, first group to be vaccinated says high-risk health workers and first responders. It is important to know, and ACHA certainly was interested in ACIP understanding and being very explicit in its intent to include healthcare workers on college campuses and first responders on college campuses. So if you have a health service and EMTs or paramedics, first responders on your college campus, they do fit into phase 1A of the distribution cycle, so they should be first in line.

In phase two, you'll note that it says K-12 teachers and school staff and childcare workers. That has been interpreted to also include faculty and staff of colleges and universities. So “teacher” used in the broader sense of the word. And so we are seeing some places where faculty and staff are being vaccinated. And that is most commonly happening in schools that have—schools with health care professionals: medical schools, nursing schools, dental schools. But in, for example, in West Virginia, they have gone ahead and distributed vaccines to college campuses so that faculty are covered under phase two. So now that's jumping ahead of the phase-in recommendations of ACIP, but I do want you to know where this all falls in the conversation as it relates to higher education. Next slide.

So the vaccine rollout plan from a federal standpoint was to—that the vaccine would be rolled out and managed at the state, tribal, territorial, and local level. And that states would be responsible for promoting confidence and uptake. The second set of partners that were engaged on a federal level were private corporate partners like CVS and Walmart. And some CVS and Walmart sites have received vaccines and many others haven't. And the major role that they anticipated CVS would play was especially in vaccination efforts for nursing homes and other conjugate settings, like prisons. Next slide.

The federal plan has presented a number of challenges and missteps. There's been no unified nationwide government plan or strategy as a result of the decision to move this to the state level. There has been miscommunication and miscalculation on how many doses states would receive. States are already experiencing lack of human and financial resources to manage the rollout. And so many states are struggling, more so than some others, dependent on what their resources and human capabilities are. This is resulting in inconsistencies across the country in the prioritization of residents to receive the vaccine, how to alert people to sign up, promoting vaccine acceptance, and configuration of immunization sites.

And I think you—just one example that I will give you is, for example, in Georgia, the governor decided to expand phase 1A to include individuals who are sixty-five and older. And that was a jump ahead of what had been planned by ACIP. Other states have not done that. So we're seeing a lot of inconsistency. As I told you, WV, you know, West Virginia has gone ahead and distributed to colleges and universities to immunize their faculty which fell into the second phase according to ACIP. So we're seeing a lot of inconsistency.

The states are overwhelmed. Complicating the matter is a surge in cases, which is overwhelming the healthcare systems in states. So there's a shortage of personnel to even conduct these mass vaccination clinics.

And I think also what we're seeing is a lack of funding for public health over the years has come home to rest. And the lack of funding in public health has resulted in strained resources in terms of the ability to conduct mass clinics and to inform the public about the benefits of vaccination and the safety of these vaccines. Next slide.

So what can institutions of higher education do, given that there is all of this confusion about the distribution? It varies from state to state. How do we proceed? How do we become proactive in this situation so that when that vaccine becomes available to our populations, we have already worked to inform resistance to vaccination?

Well, right now, our advice to institutions of higher education would be to immediately develop a comprehensive communication plan and health promotion strategy that increases vaccine acceptance and confidence in the community. And you need to do that while continuing to reinforce the need for ongoing public health strategies for mask wearing, social distancing, and hand hygiene. All of those strategies as mitigation strategies that were in place in the fall need to be continued and reinforced in the campus community, while also providing this information that will facilitate vaccine acceptance and confidence when the vaccine becomes available to you.

And just some general principles about good communication. You want to communicate often and in a transparent manner. Anytime you receive updates on what's happening with the vaccine or your ability to access vaccine for your populations, you need to be communicating that and remain current. And also establish an advisory group that's comprised of diverse members of the campus community and student leaders. What messaging is going to resonate with the different populations that are on your campus? And who are those individuals on your campus who serve in leadership roles, who are respected sources of information and trust, who will be out there and willing to communicate their confidence in the vaccine and in reinforcing the public health messaging? Next slide.

Of course, maintaining close contact with the appropriate public health authority to discuss planning and distribution of the vaccine is critical because these decisions, at least under the current strategy, and this may change with the new administration. The new administration may decide that they need to create and develop a national strategy for more consistency across the state lines. But right now, as it stands, it is critical that you be in touch with the local appropriate health authority, public health authority for the location near your campus.

And you need to do some advocacy work upfront. Public health authorities need to understand the role that healthcare providers and first responders play on campuses. And I think many are aware of the important role of student health services on campuses, but some may not be. And understanding that they are providing patient care, they are at risk for exposure to the virus from their population, and that they need to be considered in the vaccination plan when that distribution occurs locally.

The other thing that ACHA has done is to explain and advocate the importance of vaccinating college students before the end of the spring term, if at all possible. We have identified the end of the semester as a mass migration event. Students go back home, not only to different communities within the United States, but they are traveling internationally. And we're not sure what the travel requirements will be for international students. Their countries, their home countries, may develop travel requirements, and vaccination may be one of them. So if we can get our students vaccinated before the end of the spring term, right now, the way ACIP phased-in vaccination program is structured, college students would kind of be at the end of the line, unless they have a comorbidity or a pre-existing medical condition that pushes them further up as a high-risk individual. So we're trying to lobby for students to be vaccinated before the end of the spring term. And that advocacy at the local level will be critical because these decisions are being made at those local levels. Next slide.

You need to start thinking right now about your institution's ability to serve as a distribution site for vaccination. This is a resource intensive activity. And certainly, colleges have experience with mass vaccination programs. Certainly, that experience comes with the meningitis outbreaks that we've experienced on college campuses where mass vaccination strategies were employed. But it takes a lot of resources to pull off a mass immunization strategy.

And there are some particulars that come with mass immunization as it relates to the COVID vaccines because we need to think about social distancing, having people six feet apart, which typically we wouldn't have to worry about with other types of mass vaccination events. We need to worry about having the ability to react for an anaphylactic reaction, a severe allergic reaction, and rendering the appropriate care. You need to have your protective equipment, masks and gloves and gowns. And there's also paperwork that's involved because we will need to be informing the state of who has been vaccinated and then tracking who needs the second vaccination. So, there are certain specific criteria that would apply in a mass immunization event for COVID that will need to be taken into consideration. If after you assess your institution's ability to do so, a conversation with your local public health is important, right? ‘Hey, we believe we have the resources available to do this.’ And then they will expect you to fill out paperwork to apply to be a pod for a vaccination.

We did—during H1N1, many campuses acted in this role as a pod for distribution. I know that at Carnegie Mellon, we vaccinated students, staff, faculty, and their family members during that event, and so it was a great help to our local public health in Allegheny County.

But if your resources do not allow you to move forward with a mass immunization event on campus, it's important to have discussions with local public health and with a network of surrounding providers to see who can act as a referral source for vaccinating community members. The other option is to consider hiring a company to provide the on-campus experience vaccination. And then, of course, you need to continue to assess the effectiveness of your current mitigation strategies and adjust them accordingly. Next slide.

These are a couple of resources available on the ACHA website. Our COVID resources are open to the general public so you don't have to be a member organization to access these resources. The first one is specific to mass vaccination guidance. The second document listed is a consideration for reopening in the spring and includes everything from how you—considerations for opening your health department, your mental health counseling services, and communication processes, and athletic considerations. So it's a broad umbrella in that document.

So I will leave it there to kind of kick off the discussion and open it up for questions and answers.

FASKIANOS: Terrific, thank you very much. That was really comprehensive. And I know we want to invite you all now to ask questions, to share what you're doing on your campuses. So if you want to click on the Participants icon at the bottom of your screen to raise your hand there. You can also click on—if you're on an e-tablet, on the More button in the upper right hand corner to raise your hand there. And we also have a Q&A box where you can type your question if you would prefer. And I see that our good colleague Mojubaolu Okome has her hand raised and if you could identify your institution to give us context, that would be terrific. And please remember to unmute yourself.

Q: Thank you. My name is Mojubaolu Olufunke Okome and I teach political science at Brooklyn College, which is a commuter campus and an institution of modest means. So one of my concerns is that it does not seem as safe this—I mean, the presentation is wonderful, but it does not seem to be tailored to the needs of commuter campuses. And anyway, for the spring semester, we're still doing online education mostly. That's one thing.

The other thing is if we have a—I know we have to focus on the U.S., but we have international students. And if there is no worldwide strategy on this vaccine, I mean vaccination, I fear that we're just going to be facing increased challenges because people are traveling back and forth. So I wonder the extent to which there's going to be a difference in strategy by the incoming administration on whether or not the U.S. should still do unilateral decision making and administration of whatever strategies there are, or multilateral.

Then the other thing is, for poor institutions with commuter students, what kind of strategy is going to work, really?

BARKIN: Okay, well, let's start with your first comment about commuter campuses and being online. So if students are online, there still is an opportunity to use social media platforms and your internet to educate your student population about the vaccines, vaccine safety, and strategies, public health strategies for keeping themselves as safe as possible.

The other thing you might consider for a commuter campus is a drive-through clinic. So if you have large parking lots, students can sign up and drive through. Now, obviously, that's going to require you to develop some kind of a sign-up structure or engage public health and see if they can help you with the drive-through clinic. Because it is resource intense, and our public health departments are under a lot of strain. So how much assistance they're going to be able to provide institutions of higher education is really in question. And whether you can even secure the vaccine to conduct the mass immunization strategy, again, it involves a pretty significant conversation with your local public health.

In regard to the challenges we face with international students, I'll give you one example of a challenge that came up with ACHA in the fall. The Chinese embassy had determined that they wanted to put testing requirements in for Chinese students who intended to return home for the winter recess. And the testing requirement was going to involve test results that were delivered within seventy-two hours of departure, which, in many locations around the country would have been extremely challenging. We heard from our partner institutions that have Chinese students who were struggling with this requirement. We did contact the Chinese embassy and we advocated for them to consider either forgoing or loosening up, changing that requirement to allow for more time. They really didn't change their strategy. But they did say that they were receiving a lot of concerns, not only from colleges and universities, but from Chinese students saying that they were having difficulty meeting the requirement or they were concerned they couldn't get the result in seventy-two hours. Now, fortunately, they did assure us that they would work with every student to help them through the process.

But I think it certainly supports the point you're making. One issue is what if a student manages to get one shot of the vaccine here in the U.S.? What happens when they're due for the second shot and they're back home? Will they be able to access that same vaccine? These are questions that we certainly are thinking about, you obviously are thinking about, and it would require a national and international conversation.

So I know that isn't an answer to your question, but I think that your concerns are well-placed.

FASKIANOS: Thank you. Let's go next to Nicolle Taylor.

Q: Hi, thank you so much for this opportunity, really appreciate your time. I serve as the chief business officer at Pepperdine University and work closely with Dr. Lucy Larson, who is our medical director. And I was wondering if you could just elaborate a little bit on the first responder description that you gave earlier as to where they fit in the phases. First responders, we have a public safety department on our campus. And so would all of those folks who are—I understand administration is probably separate than officers, but is there even a further differentiation to, EMT service versus dispatch or something like that?

BARKIN: Yes. So, again, the decision ultimately rests with your local health authority. But the way we are interpreting the first responder is anyone on your campus who serves in a capacity that they would be first on the scene for a medical emergency or responding to a student injury, accident, illness. So we would include—if your security forces, your police department, are serving in that capacity and have that role, then we would include them in that phase 1A, according to our definition. However, again, I have to say that it largely will be dependent upon how your local health authorities interpret that.

But you can certainly advocate for that. And I think the way you advocate is by giving them real examples of how your security staff, police department, EMTs function on your college campuses because public health, all public health folks, may not be aware of how medical services, emergency services are delivered on college campuses. So I see your role as an advocate and as an educator in that regard.

Q: That really helps. I apologize, I appreciate that. Can I ask you a follow-up question with a different population?

FASKIANOS: Sure, go ahead.

Q: We have a very limited number of essential staff who are working on campus, whether that is in a facilities role or in something related like that. Would those folks fit into the phase two definition that you were describing when you talk about teachers and staff? And then I'll certainly yield the floor. Thank you.

BARKIN: Yes, there is not—if you go to the ACIP guidance, they spell out kind of whom they include as essential personnel. I think that what we have heard from some public health sources is that there is a real interest and concern about getting our educational systems back up and running. And so to the extent that we can make, again, make a case for the importance of having specific staff, employees engaged in critical functions for the university, you certainly can advocate and make that case, even though you may receive one answer in California and someone in Georgia may receive another answer. It's certainly the advocacy and the explanation behind it is important. And so if you have those relationships established with your local public health, it's worth making sure that you continue to nurture them and stay in close contact with them. But I think there is an interest in that and it would fall under essential workers in the second phase.

Q: Thank you. So Richard Arnold, who is a professor at Muskingum University in Ohio, wrote a question: "I live in Ohio was under the impression that college faculty did not fall under the teacher category. Does this vary by state or can you just clarify on that?”

BARKIN: Again, it very well may vary by state. I can tell you here in Georgia, faculty have been told that they do fall under the teachers group. I can tell you that in West Virginia they have already started to vaccinate faculty. So it could very well be that Ohio makes a different decision.

And that's part of the problem with the rollout. As I said, without a firm national strategy, you have lots of iterations on the theme. And the interpretation for this has been placed in the hands of the states.

Now what I will say is this. And again, I'll use Georgia as an example, simply because I'm real familiar with the Georgia public health system. Governor Kemp made a decision to expand 1A to include sixty-five and older. So if you have faculty and staff who are sixty-five and older, you can certainly message to them, in Georgia, at least, 'Hey, this decision has been made by our governor and this is how you can get in line for an appointment for vaccination.'

So I think the institution has to stay abreast of the decisions that are being made by the governor, by the state departments of public health, so that if there is an opportunity for folks to get vaccinated who, maybe it's not a faculty designation, per se, but it's some other designation, maybe anyone over the age of fifty-five with another health condition, you want to be putting that information out because the more folks that get vaccinated, the safer your community becomes. We know that. And so this does become an advocacy point.

And I think it's more—it's been a struggle to get the vaccine out. And if you— there is information that I've looked at recently where they've actually ranked the states in terms of who's doing a better job of using the vaccine that has already been shipped to them. And there's great variation on that. So I would say that, yes, you need to be in communication with your Ohio officials and say, 'Hey, I've heard that, in other states, faculty are being included in that teaching category and beyond K-12. What's happening here?’ And that may be an advocacy point for you.

FASKIANOS: Anita, is ACHA doing any kind of—do you have any plans to do a sort of a tracking project that would sort of collate what all the states are doing to be a resource for the colleges across the country and administrators?

BARKIN: We have not developed any kind of toolkit that we are currently using for those decisions. When ACIP—and these decisions were just made recently. And the ACIP just firmed up that phase distribution process in December. And we were at the table and we were advocating for, as I said, anyone in college health and emergency medical services to be included.

We also are looking at and making the case for schools, professional health schools, dental schools, medical schools, nursing schools, and saying to them, 'You know, if you vaccinate those individuals, they can help you with mass vaccination clinics.' And that was not spelled out in that phased distribution process. But now we're calling attention to it.

And this is another advocacy point for folks on the call. If you have a dental school, if you have health professional schools, on your campuses, you can make that case to your public health authorities and say, 'Look if you help us get these folks vaccinated, they can provide—they will be a pool of human resource for you as you develop you mass vaccination clinics and as we get more vaccine in the pipeline to the public.'

But lowering our resistance to vaccines will be critical. And there are populations that are more likely to resist vaccination than others. And we know that the African-American population holds a high degree of skepticism about these things based on historical events. And some—I saw a very good PSA done by Howard University that featured leadership, student leaders, diverse population, talking about why they're getting vaccinated, kind of in front of the camera, to try to build that confidence up in the community so that when that vaccine becomes available, people are ready and willing to accept it.

FASKIANOS: Thank you. So I'm going to go next to Rey Koslowski, who has his hand raised and so if you can accept the unmute prompt. Thank you.

Q: Hi, Rey Koslowski, I am a professor of political science at the University at Albany, part of the SUNY system. And we're actually going to have a—I guess, it's a drive-through mass vaccination beginning on our campus tomorrow.

BARKIN: Great.

Q: Yeah. And things have moved very quickly this week. And seeing messages from our United University Professions, our union, President Fred Kowal, saying basically, that when that definition of teacher was put out to say we want college professors as well. And what has happened is that the state put out its list and it's for professors or faculty who are teaching in-person classes. So that's the way it's working for us. Now, if you are teaching online, no, but for example, our campus, thirty percent of our classes will be in-person or hybrid this spring. But here is the thing that has happened—which, as I said, it went very quickly—but on Tuesday, the I guess it's phase 1A went to including people sixty-five and older with comorbidities. And there's a website where you can sign up, the New York State Department of Health, and friends of mine started trying to get in there. One got an appointment in March. And then, if you missed out and didn't get in, got booted out for whatever reason, you waited and another one got in April, and by Tuesday night, no more slots at our university, and they would get it at our university through the State Department of Health.

I'm somewhat skeptical about your suggestion that we might be able to inoculate students because, as I understand it, as this 1A has redefined and opened up to sixty-five and older in so many states, we're up to about one hundred fifty million people who are eligible as this happens, and I don't think the production rate is getting anywhere near that to be able to handle that.

My question for you is actually about, in a sense, triaging and thinking about those prioritizations. Could a negative antibody test be utilized in prioritizing? Because, again, the question's that somebody has been infected with the coronavirus, perhaps has been asymptomatic, do they have some immunity ready and perhaps shouldn't be prioritized? For example, again, with some students, if they have a negative antibody test, maybe that they haven't had COVID, for example?

BARKIN: Right. Well, that's certainly an interesting thought. However, I can tell you that in discussions with—in presentations that I've heard from the FDA and the CDC, they've said that to do any kind of testing to determine who's qualified to get COVID, to get the vaccine, is not going to be practical or feasible. That it adds another layer of administration, resource, and expense. So while it's an interesting proposition, it's really not a feasible one.

I share your concern about how much vaccine will be on the market by April, May, which we would commonly call the end of the spring term. But what we are saying is that the reason that college students should be prioritized is because that is a mass migration event. And that the advantage to vaccinating those students in terms of preventing infection and outbreaks in the communities to which they're returning and the countries they are returning to outweighs concerns about—or outweighs the idea that they're in the main healthy and their chances of sustaining serious consequences as a result of infection are not great. So we are making the argument that these people are highly mobile, they have the opportunity to spread disease, right? So it's a mass migration event. We should prioritize that.

Now, whether we'll have enough vaccine on the market, who knows. Moderna has promised eighty million doses for 2021. Pfizer is far less than that. However, we are looking. AstraZeneca is pretty close to ending their clinical trial and may be considered for EUA as early as before the end of this month. I think that we need to get more vaccine in the pipeline, and it's going to take more than just Pfizer and Moderna to do that. So, yes, I hear your concerns. I wonder about the feasibility. But what we're saying is there's good reason to prioritize college students because of because of that migration.

FASKIANOS: Thank you. I am going to go to Pearl Robinson next, who chatted her question. But, Pearl, do you just want to ask it? Pearl is at Tufts University. [Pause] Okay, I will read it, then. "As someone who personally benefits from the strategy outlined that seems to be promoting special treatment for privileged educational elite, who stands to lose from higher education's gain?"

BARKIN: Okay, I'm not understanding the question.

FASKIANOS: I guess it is, by putting the higher ed community first, there are going to be a lot of people in the community that are disadvantaged and are further back in the queue.

BARKIN: Okay. Well, first of all—

FASKIANOS: Pearl can jump in and clarify if she wants.

BARKIN: Well, first of all, I don't know that we can call all members of the campus community privileged and elite. And I think that there is—but there is a good bit of concern about ensuring that there's equity in this distribution process. And so, I think that we're not asking for institutions of higher education to be placed above people, but that there be consideration for where you get the greatest mitigation effect from vaccinating different populations.

We are—I would argue that it is going to be tough to penetrate underprivileged populations, populations of color, they—and that is part of the problem here is the, again, the messaging, the communication about safety, the outreach. There's a lot of work to be done to bring people to the table, especially communities where we know there is greater resistance historically to vaccinations, areas where folks are disadvantaged in a number of ways in terms of transportation and shelter. That is a big part of why they put essential workers in so early, because we know the folks who are essential workers, your grocery store employees, the folks who are serving us in fast food restaurants, there are a lot of minorities that are working in those capacities. Custodians, custodial staff. So, that was an attempt to ensure that we get people who are working in those types of situations covered.

So it is a very difficult situation to maneuver. This is a complicated issue and nothing short of having a lot of vaccine and enough vaccine is going to remedy it.

I can tell you even here—I am seeing a lot of frustration by people trying to—who now are qualified as sixty-five and older, trying to call in to get an appointment. Well, if I'm an economically disadvantaged sixty-five year old or older and I don't have transportation to a clinic that is an hour away, I may get the appointment, but I can't get there.

Q: May I speak?

BARKIN: Go ahead, I am sorry.

Q: Oh, yes, I just had to unmute. I just wanted to—I thought it was important to raise this issue. So I teach at Tufts, and I am African American. Last spring, I heard that our university was trying to get this opportunity that you're talking about. And already, people were saying we're in a situation where this is a zero-sum game, limited amount of vaccines, the communities where the disease is in higher incidence, where you have a problem trying to persuade people to take it, quickly, the available vaccine is taken up.

And so it's like the privileged people who know how to lobby and everything, they grab up what's available and then later on, somebody says, 'Well, that's too bad.' And then somebody else says, 'Black lives don't matter.' So I just wanted to put that on the table as we're thinking about this.

BARKIN: Right, and if you–

Q: And I will benefit from this policy.

BARKIN: Well, I think if you—and you probably may very well be aware of this, but if you look at the CDC site under an ACIP site on how they made these determinations, the ethical considerations are outlined there. And many certainly speak to what you are pointing out.

And it is a real, difficult, and complicated matter, especially when states are, at this point, not well enough resourced to address those issues. And we can say, 'Oh, yes, these populations should have access to vaccine and we should be able to educate them about the safety issues and certainly talk to them about public health strategies in addition to the vaccine.' But saying that and actually doing that are two different matters. It requires a lot of resources and our states have not been well resourced in that manner, nor has public health. I mean, public health in Georgia, we serve the folks who are those disadvantaged individuals that you are talking about. And for many of them, the transportation issues are overwhelming even to try to get to an appointment. How they access vaccines, how they can—whether it is online, some health departments have online forms. Well, you have to have a computer, you have to have adequate internet. And we haven't even addressed the issue of rural areas where internet capabilities are pretty compromised. So yes, I appreciate your comments and, as I said, the ethical considerations in that discussion is available online through the CDC.

FASKIANOS: Thank you. I think we have time for one question.

If you all are looking at the Q&A questions, there's some—Craig Klugman has put in there—people have shared what's going on in their communities. And Craig Klugman has cited an article, Inside Higher Ed, that talks about—I'm not going to click on it because I'll be taken out of this—but how faculty and staff outside healthcare fields become eligible for the vaccine, I believe.

So I'm going to take the last question from Diana Newton, who is at Southern Methodist University in Dallas, Texas, who asks that you speak to the health risks to a campus community where the large majority are vaccinated, but a small minority refuse to receive the vaccine for a variety of reasons.

And I wanted to tack on to that. I think in your presentation, you talked about asymptomatic. And what do we know really about if you get the vaccine and asymptomatic transmission? Because I think that there's not a lot of clarity around that. It may be there has not been enough—we do not know enough about it. So that would be great.

BARKIN: We still do not know enough about that. I just was on a call with, as I said, with leadership in biologics at the FDA. And those three questions that I have in my PowerPoint were the three questions that they said keep them up at night.

So they feel that the vaccine will handle the mutations, but they are not sure about the asymptomatic transmission. And when you talk about herd immunity, which is referencing the first part of this. What if we have students who get vaccinated and some who refuse to be vaccinated? What does it take to create a safe environment? I think that, without a doubt, we are going to be wearing masks and social distancing even after folks become vaccinated for some period of time until these questions are answered. What does it take on the herd immunity side? I've heard number percentages from sixty to eighty percent of the population, somewhere in that range, they feel that this rigorous surveillance, rigorous testing can stop. College campuses have set up these robust testing strategies which have been critical, I will tell you, in mitigating against outbreaks and identifying cases early on and containing those cases to a smaller number. And we are advocating for twice a week testing in terms of surveillance and certainly testing students upon arrival.

But I think we are going to be in this cycle for a while until we get more experienced with a vaccine and the scientists can determine and our epidemiologists can determine how this is all playing out in terms of asymptomatic transmission and the effectiveness of the vaccine. How long we are protected.

FASKIANOS: Well with that, Dr. Barkin, thank you very much for being with us and for your presentation. I have gotten a few questions about whether or not you would be willing for us to circulate it to the group because they would like to share it with their administrators on campus. So that's fantastic. And if there are any other resources you would like to share with me that we can disseminate to the group, we'd love to do that.

BARKIN: Yeah.

FASKIANOS: But it's really—thank you very much for this. This is obviously—it's changing quickly.

BARKIN: [Laughs.] Yes, it is.

FASKIANOS: And so we just keep on the news every day. And just as we discover more about this awful disease and how to deal with it. So we really appreciate it.

And we hope that all of you will continue to follow us on @CFR_Academic on Twitter and go to CFR.org, ThinkGlobalHealth.org, and ForeignAffairs.com for resources on COVID-19 and much, much more on international affairs. So I hope you're all staying well, good luck with the beginning of your semester, beginning of 2021.

And again, Dr. Barkin, thank you very much for being with us.

BARKIN: Thank you. I enjoyed it and stay safe, everyone, out there. I'm happy to share the PowerPoint and any additional resources I think would be helpful.

FASKIANOS: Thank you very much.

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