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Coronavirus Report: The Hill's Steve Clemons interviews Alex Azar

The Hill's Steve Clemons interviews Secretary of Health and Human Services Alex Azar. Read excerpts from the interview below.

 

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Clemons: Is there anything you can tell us about where we're at on the vaccination front?

Azar: What we're doing with Warp Speed and the president just commissioned us to say I've heard the pharma company timelines and they're all so drawn out. I used to be at a pharmaceutical company. I know these timelines. I know why they're drawn out. And he said, “Can we with the full might of the U.S. government and all of the financial resources that we can bring to bear. Can we compress those timelines while still delivering safety and efficacy on vaccines?” And we said, “Yes, we can.” And so we're following basically two tracks. The first is you compress the development timelines by reducing any unnecessary delay or inefficiency in that system. The second is you actually invest at scale, up front commercial manufacturing rather than waiting until you have phase two-three or even final FDA approval. You build scale and you manufacture products now at risk with that kind of investment, and that's what enables us to fairly dramatically reduce the estimated timelines. So what have we done? We currently have four major investments that we've made in vaccine candidates. ... We now have major bets in all three of the major potential platforms for vaccines. With each of them, we will drive towards manufacturing to have tens of millions of doses by this fall and hundreds of millions into the beginning of next year. And phase two-three clinical trials for many of them will be beginning just later this month probably.

 

Clemons: Do you think it's important to communicate to the public more that there is some risk in this?

Azar: Oh, well, we have and we will continue to do so. We are placing multiple investments across a portfolio, and we're not done because we know that it's science. It's bio pharmaceutical development. Not everything will necessarily hit, and that's why we're placing these investments. But again, it's that commission. When the same country that could do The Apollo project can radically change the speed of development of a vaccine given the urgency.

 

Clemons: How does America position itself both so that it gets vaccines developed and produced here, but it doesn't dismiss the needs of the rest of the world.

Azar: Yes. So let me give you an example just from the AstraZeneca platform, for instance. So they took the Oxford vaccine that adenovirus candidate and AstraZeneca has the I think the development rights in most of the world that they contracted with Oxford for. What we've done is contract for the research and development work here in the United States of clinical trials, but also then for manufacturing here in the United States. Now, that doesn't preclude they're doing manufacturing elsewhere in the world. And in fact, I think they've talked about several billion doses to be manufactured in India and elsewhere for the rest of the world. We certainly don't stand in the way of that. We encourage that. With our candidates, though, where we're investing, we're investing in U.S. manufacturing and U.S. fill and finish capacity so that we're not dependent on any movement of product across borders from outside the United States. But in no way would we do anything to preclude development for the rest of the world. We coordinate closely with the G-7, with the European Union and Andrew Witty, who's leading the Act Accelerator project. So it's a very tight international collaboration here. We're all working towards a common goal. 


Clemons: And because of current tensions are you just basically, are we putting a fence around China right now and just leaving China out of this puzzle?

Azar: Well, China is not a participant in the Act Accelerator project even. And certainly we're not collaborating with them in any direct way on our vaccine or therapeutic manufacturing, so I believe they're doing their own thing.

 

Clemons: Is there an alternative that you've been working on as you look at how we provide health care insurance and an alternative to Obamacare?

Azar: I think what we've learned as part of the experience with the promises that failed with Obamacare is, the American people with health care, they don't really like utopian visions. Most people, when it comes to their health care, are actually relatively happy with what they have. They don't want that taken away, and they would like to see continued incremental improvement with their experience, with the choice, with the cost and the outcomes that they have in health care. But they don't want their settled expectations or delivery, their relationships with their hospitals, their relationships with their doctors. They don't want those taken away or disrupted. And so that's how we've tried to approach health care is how could we deliver more choice, more options for people in the individual market, more options and Medicare for people. How can we deliver lower costs through transparency, through reducing prescription drug prices, through ending surprise medical bills and how can we deliver better health by tackling some of the real discreet and impactable health challenges of our country, like ending the HIV/AIDS epidemic, solving the rural health care crisis, solving the maternal mortality crisis, ending the opioid epidemic, addressing and tackling social determinants of health, fixing how we take care of people of end stage renal disease and preventing it in the first place.

 

Clemons: Is your tenure in this administration committed to maintaining coverage of preexisting conditions?

Azar: Absolutely, the president has made this is an ironclad commitment from him directly, and it's shared by his administration, I can assure you. Which is, first off, it's in statute already in HIPPA that preexisting conditions are covered. But importantly, we added the commitment that people with preexisting conditions will have access to affordable health care financing options. And so that commitment is there. So you know Obamacare, while it has insurance for individuals with preexisting conditions, it's not always an affordable solution for them. So we've got to stop talking about this is if we're sort of living in the land of milk and honey with Obamacare, when you’re a couple that makes a $70,000 a year and you're living in in the part in Nebraska and your having to spend $38,000 a year on premium and $12,000 in deductibles, and you have preexisting conditions, that's not actual affordable health care financing for you. We do believe there are ways to approach this working with Congress, we do believe they're proven mechanisms. You know, one of the fatal conceits of Obamacare was you're gonna make the healthy people in the individual market pay more, excessively more to fund affordable insurance for the less healthy people in that same individual market. We believe in the protection and the affordable access to health insurance for people of preexisting conditions. But we actually think of that as a societal obligation to help them. And so we will work with Congress if the time ever comes to find solutions that actually help those people get real insurance, real affordable insurance, allow them to have the coverage they need, while letting healthy people, those who don't have the preexisting conditions have insurance that meets their needs at the costs that they need also.

 

Clemons: How much of this new world of online health consultations is going to remain, and remain paid for, under our system after we move past this pandemic?

Azar: Well, you know, this pandemic has led to a lot of innovation actually, in health care. Through the president's leadership, the national emergency authorities that we've been able to use to waive some of the embedded requirements that have ossified, and the health care system in America kept it as a 1960s style of delivery. We've been able to actually break through that with deregulation and telehealth is one of those things we wanted to do for so long, but Congress has been unable to actually change the Social Security Act to make Medicare and Medicaid amenable to telehealth. And now that's available. And I'll tell you, I've been traveling all over the country and I visit with doctors and hospitals and nursing homes. I think we'd have a revolution if anyone tried to go backwards on this. This is now, I think, an embedded part of our health care system. It has changed the nature of delivery. It's brought us better up to date in the system, and we're going to do everything we can by regulation to keep the gains that we've had that put the patient and that doctor relationship, the hospital relationship in the center and work with Congress to get statutory changes as needed to make sure that we keep whatever is required by statute.

 

Clemons: How worried are you that America is not getting this right and that we're going the wrong direction on COVID-19?

Azar: Well, what we're experiencing in the southeast and southwest and frankly, seeing emerge and some other areas in the country is a very serious public health situation, very serious. And we've called that out. But it often is phrased as a question of “Is that about reopening?” We don't believe it's about the fact of reopening in terms of a legal or regulatory structure. It's rather how are we behaving within that context? Are we practicing appropriate social distancing? Are we wearing facial masks, facial coverings, especially in circumstances where we can't social distance? Are we practicing good personal hygiene? So we have to take individual responsibility in the construct of reopening work, school and health care systems again. If we don't, we're going to see results like this. ... And that's why we've been talking so much about acting with good individual responsibility here.