Former Assistant Secretary at the Department of Homeland Security and Harvard professor Juliette Kayyem writes in The Atlantic that the pandemic is unfolding "on a split screen." On one screen, we are close to having a vaccine approved in the United States. On the other, case loads and hospitalizations have risen to the highest levels we've seen since the pandemic began. This dichotomy has made it difficult for some people to figure out which screen to watch and whether they should trust what they are seeing on that screen. GBH Morning Edition host Joe Mathieu spoke with Kayyem about how Massachusetts is handling the logistics of vaccine distribution, and what still needs to be done to earn the public's trust. The transcript below has been edited for clarity.
Joe Mathieu: The split screen is confounding for a lot of us, and we know good news is coming; we've seen remarkable headlines just in the last couple of weeks. They're actually inoculating people now in the U.K., but we don't know exactly when this is going to happen, how many people [or] how many doses. There's been a lot of misinformation, and Juliette, the next few months could make that first surge look small.
Juliette Kayyem: That is right. So the bad screen, let's put it that way, is a brutal winter ahead. We know it [and] we're already starting to see the numbers here in Massachusetts. You have Governor Baker already responding. So I can't say it enough: it's more of the same, if not even more of the same, in terms of protecting yourself and your family because the next six to eight weeks with the cold are going to be really hard — the isolation [and] the economic impact, I get it. But hope springs eternal. So I have to look at the other screen, which is an unfolding, rolling recovery, as I call it. Over the course of 2021, you are going to see the FDA relatively soon approve at least the first two vaccinations, and we will have a rolling recovery over 2021 with manufacturing and then delivery through the United States. It's going to be big and ugly and overinclusive and underinclusive. Everyone's going to be clamoring to get it and then some proportion of the population is going to be wary to get it. So we have to sort of recognize what's coming down the pike. And you have a presidential transition in the middle of it.
Mathieu: Well, to that end, there've been a lot of questions about the distribution plan here, Juliette. The president has suggested the military will play a role in this. We also know that airlines are already moving doses so they're ready, and that companies like McKesson and drugstore chains like CVS and Walgreens are actually going to be the ones that make this happen. Is there a plan?
Kayyem: Yeah, there is. It's at the high level detail. So let me give the Trump administration credit for obviously [getting] a vaccine. It was a private sector investment, but Operation Warp Speed was part of it, including purchasing doses before there was approval, so guaranteeing a market to the private sector. The president, however, tends to invoke the military when he doesn't know the answer to the question or hasn't invested the details. I think we have to assume that the broad pockets of how something like this distributes, which I'll get into in a second, are thought through, but the details are going to fall onto the Biden administration mostly because we don't know what our supply chain looks like, what our surge capacity is. But the good news is we know how this will unfold. There will be allocation decided by the CDC — who goes first, who goes second. The harder ones are who goes fifth, sixth and seventh. You are hearing these ethical debates about should we put critical infrastructure workers before elderly? Where do teachers fall in? Those are hard decisions. And I just remind people lines have to be drawn, right? There is going to be no dearth of seeming unfairness in this. If you are 65, you get into one pool. If you are 64 and 350 days years old, you do not. That is the nature of lines. Then there's distribution, which is the last mile, which will be worked by the military [not] by the states. I was on a call yesterday with our own state about how they're going to do that, how they're thinking about it. There's demand issues around getting people less hesitant to take the vaccine. We need to get to herd immunity. And then finally, verification. That's the brand new world we're going to live [in]. We're going to have to prove that we're vaccinated to do certain things like get on airplanes. And I think employers are going to be a huge part of this, demanding that their employees for a condition of employment get vaccinated. Everything is new, but is following a familiar supply chain, last mile planning. So I think because we are scaling over time, these disruptions can be easily fixed. In other words, if something stops, it gets fixed in a day or two. We're not talking months anymore and we're certainly not talking years.
Mathieu: What's the plan for Massachusetts, then, Juliette? Are we covered here? Are we set to go?
Kayyem: Yeah, so the first wave is going to be the hospital workers and that's going to be defined by states. Does it include administrative workers who are at the hospitals? My preference is yes. In other words, we just want to get lots of people vaccinated — let's draw lines, let's have overgeneralizations rather than underinclusiveness. So those are going to be done at the hospitals because that's easy. That is where your pool of people are and they know how to do that. That also includes senior care facilities, patients there. That will also be done at those senior care facilities or at hospitals, depending. The CDC has not decided the second priority group. That is the debate going on now. Will it include critical infrastructure workers, people with comorbidities or [the] elderly? As I said earlier, I think my preference would be we do the critical infrastructure workers and teachers. We've got to get this economy moving [and] we've got to get our kids back in school. And then that will be done, either at place of work or more likely health facilities, public health facilities. And we know how to surge here in this state because we've done it before.
Mathieu: I wish I had as much time as you normally have on Boston Public Radio because we're just getting started here, but I want to ask you before you go about concerns about trusting the vaccine. This new poll by Macing today finds half the people in Massachusetts — just imagine some other states — say they'd wait for somebody else, at least, before they went to get it. Seven percent say they'd never take it, Juliette. How much of a problem is that?
Kayyem: People ask me, what's the biggest challenge? And I think it might be this one. In the past with polio, we've had influencers come out like Elvis Presley did at The Ed Sullivan Show and you saw polio vaccines skyrocket. So we're going to need influencers to convince communities based on who they are, what their population is. We're seeing weird distinctions between men and women. Women [are] more reluctant. I think that has to do with the fact it hasn't been tested on kids. But one of the things that's important to remember is this is where logistics are policy. I think that the more transparency there is [and] the more that this is functioning in a way that makes sense, the more likely people are willing to take it. In other words, if it seems unfair, disorganized [or] chaotic, they're going to be like, "wait, what the heck is going on here?" But we need to get people on board. I do think that polling will change over time. We've already seen it change a little bit. But if those are the numbers we're seeing from MassINC and if that's the polling, we have a lot of work to do here. So Red Sox and Celtics and all our other Massachusetts influencers, I'm coming up short with others, get out there!
Mathieu: If I can just see Big Papi with a needle in his arm now.
Kayyem: Exactly.
