National Vaccine Advisory Committee Recap with Chair Robert Hopkins

October 30, 2020

Robert Hopkins, chair of the National Vaccine Advisory Committee, discusses the most pressing issues coming out of the recent NVAC meeting, and pharmacy's role amid the COVID-19 pandemic.

Drug Topics®: Hi, I'm Gabrielle Ientile with Drug Topics® and today I'm going to be speaking with Dr. Robert Hopkins, the chair of the Health and Human Services’ (HHS) National Vaccine Advisory Committee (NVAC) about their sessions that were held virtually in September.

Dr. Hopkins is a professor of internal medicine and pediatrics and director of the Division of General Internal Medicine at the University of Arkansas for Medical Sciences in Little Rock, Arkansas. He is also associate program director of the UAMS internal medicine-pediatrics combined residency, and chief of adult medicine at Arkansas Children's Hospital, and we're very excited to have him on Drug Topics® and Medical World News from MJH Life Sciences.

To start out, can we start with you introducing yourself, a little bit of your professional background and your work with NVAC?

Hopkins: I'm Robert Hopkins. I'm a professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences. I trained in a combined med-peds, or internal medicine pediatrics residency, and I've been on faculty here at UAMS since I completed my training in 1993.

And currently, I'm the director of the division of General Internal Medicine. I'm an associate program director for our med-peds residency program. My most recent role is that I'm running our drive-thru COVID screening program.

I'll give you my philosophical intro first. Particularly when it comes to the issue of pharmacy and medicine in general, and in the topic of vaccines, I think right now we're in a time where we have to recognize that really everything we do, when it comes to prevention, when it comes to interacting with the public, if we're not focusing on them as team-based activities - meaning me as a clinician at an academic medical center, my colleagues in our on-campus outpatient pharmacy, those at Walgreens or CVS or the mom and pop pharmacy, that's 2 blocks up the street - if we're not all trying to work together to get our patients vaccinated, whether it be a 3 to 18 year old or somebody that we've traditionally done 18 and above, we've got to communicate back and forth from both directions.

But if the pharmacist, the practices, the public health, folks, the hospitals aren't working toward the same goal, we're never going to get where we need to be with vaccination. And, we've done really pretty well with childhood vaccination up until COVID slapped us in the face. But I think given the extraordinary situation, I know many of my colleagues and pediatrics are pursuing administrating vaccines to kids, because of the concern about that being 1 of the things that really gets kids into the primary care office. But right now, we're not getting a lot of those folks, those families and kids coming in anyway. And we need to do anything we can to try to support the vaccination efforts. And so that's my philosophical underpinning to everything I say.

Drug Topics®: Given the unprecedented nature of COVID-19 and this flu season also coming up, how do you rate the success of the September NVAC meeting, and what do you see as some of the biggest achievements of these sessions?

Hopkins: Well, I think we've had some very fruitful discussions talking about what our group would advise HHS to do to try to improve vaccine confidence.

I think we had some very fruitful discussions around what lessons we can learn from the current efforts to develop COVID vaccines that may be translatable into other future vaccine programs.

We had, I think, some very good discussions about how we need to engage many of our, in particular, minority communities in our communities that are otherwise under supported from a lot of health care settings. And the critical need to really reach out and make connections within those communities if we're going to effectively vaccinate for flu. Get the messages out about public health protections from COVID-19, and once we get to COVID-19 vaccine available, try to get it into those communities where we're having a greater impact from COVID-19 that we are in a lot of other communities.

Drug Topics®: And I won't ask you to choose a favorite session, but I just wanted to get what presentations or agenda items really resonated with you.

Hopkins: I think the sessions where we talked about engaging with communities that are underrepresented. I think that that is probably the most critical piece the most critical gap that we have. I think the discussion we had about allocation and prioritization efforts are also important.

I have to say I am continually amazed by the challenge we face in information around vaccines. The session on “info-demic,” and on public health messaging and how we need to strike back against some of the anti-vaccine and anti-science messages continue to be a challenge for all of us.

And then I see some hope in our discussions around using immunization information systems as tools to help support implementing COVID-19 vaccination, as well as their growing importance in adult vaccination in general. And the really critical role in where we've gotten with childhood vaccination.

Drug Topics®: And then in regard to COVID-19, vaccines, where are we at in the stages of developing COVID-19 vaccine? And is the Operation Warp Speed (OWS) estimation of a vaccine ready by January 2021 realistic?

Hopkins: Well, I think we're making great deal of progress. We currently have 5 vaccines that are in the phase 3 trial process or getting ready to start in the phase 3 process. And those are not typical phase 3 vaccine trials. These are phase 3 vaccine trials with 30,000 or more participants.

We're going to have a lot of data on these vaccines.

I am hopeful that we'll have at least the first 1 or 2 of these submitted to the FDA for evaluation, either under a biologic license agreement or biological license assessment process, or through the emergency use authorization (EUA) process that FDA has laid out specifically related to COVID-19 vaccines.

And I think based on some of the preliminary reports, we're likely to have at least 1 or 2 of those vaccines submitted to FDA for evaluation before the end of the year. I don't think we'll reach 300 million doses available for injection by the end of the year, which was 1 of the targets. But I think that we will have made tremendous progress toward that by the end of this calendar year.

Drug Topics®: My next question was what is the kind of the current thinking in terms of how these vaccines will be rolled out?

Hopkins: Well, the CDC and state health departments and other public health agencies around the country are communicating, I'm sure on an on if not weekly, on an almost daily basis, on developing their plans for distribution.

I've looked at our state plan for Arkansas. We are looking at widespread collaborations between the health department and those of us at academic medical centers and other places, talking about how we're going to get vaccine out and disseminated.

One of those challenges is going to be what degree of cold chain we need to maintain, how cool we need to keep that vaccine. I think there are going to be limited number of facilities that are going to be able to stock hundreds or thousands of doses of vaccine that has to be kept at -25 or -70 degrees centigrade. And I think that's going to drive a lot of the dissemination processes.

Our institution, and I'm sure many others around the country, are having discussions around detailed plans on how we're going to start vaccinating those tier 1A workers. Are you going to start with folks in the ICU, the ER, the nurses, the doctors, the respiratory therapist - I think all of those decisions are going to have to be made locally.

But we've all got to be open minded. We've all got to be collaborating. And we've all got to be continuing to learn what we know about the current vaccines, so that we're best prepared to implement once we get vaccine available.

Drug Topics®: And in terms of that collaboration in healthcare, what do you see as the pharmacist’s role in facilitating COVID-19 vaccinations once they are available?

Hopkins: Well, I see a number of critical roles. Number 1, if we think about vaccine storage and being able to get it from, once it arrives at health department, to an institution, you've got to have appropriate storage. Our pharmacists are often going to be on the front line of making sure we've got the right refrigeration and freezing processes to maintain that cold chain.

I think our pharmacists and our clinicians, physicians, and nurses are going to have to collaborate very closely on making sure that we track giving the appropriate vaccine, particularly if you have a 2 dose series, the appropriate COVID-19 vaccine to each individual that gets the first dose of vaccine, that they get the second dose of the correct vaccine.

We're going to all have to be talking about the particular characteristics of a particular vaccine when it's available. I see the pharmacist’s role is as integral as our nurses and physicians are if we're going to be successful in this campaign.

Drug Topics®: Dr. Hopkins, thank you so much for taking the time to offer your expertise today. I really appreciate it.