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The CARES Act, a monumentally large relief bill enacted to take on the effects of the pandemic, passed what seems like a century ago. Now there’s a COVID-19 vaccine – a few of them – and yet the government’s distribution plan is, to be charitable, incomplete. Perhaps you’ve noticed? Nicole Clowers, the managing director for health care issues at the Government Accountability Office, joined Federal Drive with Tom Temin for the latest look at how implementation of the CARES Act is going.

Interview transcript:

Tom Temin: Ms. Clowers, good to have you back.

Nicole Clowers: Thanks for having me Tom.

Tom Temin: And this is the latest in a series of looks that the GAO has made of implementation of the CARES Act. And even for GAO, you come down pretty hard on the lack of development of that distribution plan for the vaccine. What did you find?

Nicole Clowers: We found that the distribution today Tom has not met expectations, and frankly has fallen short by a good deal of expectations, as you know. There’s been different goals that were established under the former administration, you heard numbers at 20 million, 40 million — but regardless of what numbers you were using, as of the end of December, we had not met those goals and there was a growing frustration among state, local governments as well as the public about the distribution.

Tom Temin: And there was a pretty complicated apparatus specified, I think CDC had a 75 page plan that’s still on their website. And so HHS had a piece of this, I guess, Defense Department had a piece of this. Do you think, again, this is not a dump on Trump conversation, but do you think that the lack of development of that plan was a result of lack of White House guidance or something else, or a combination of factors?

Nicole Clowers: It’s likely from what we said and what we saw, a combination of factors in terms of what was going on with the distribution. Distribution and administration of a vaccine across the nation is challenging, it’s going to be challenging given to your point, the number of players involved, the number of moving pieces. And that’s why we in September, so was that almost six months ago, recommended that the department take action to pivot and start really looking at this downstream, how we were going to distribute the vaccine and call for them to develop a plan that would address all the stakeholders roles and responsibilities, because their stakeholders not only at the federal level that needed to be involved, but state and local, private sector and nonprofit, make sure everyone understood their roles and responsibilities, what they were doing. And also, in that plan, have a communication strategy. A lot of this has to do with communication, people knowing what to expect, when they might be receiving vaccines, and also the public education part of it as well.

Tom Temin: Yes, because pretty much everyone you talk to in normal conversation is wondering what the heck is going on in their particular locale. We’ve seen this in DC in the Delmarva area, but I’m getting emails from across the country, coast to coast literally. I wrote a column about it last week, saying that, gosh every time we try to sign up, either the site crashes, or we thought we had an appointment and get there — no, no, you don’t meet the rules and so forth. So part of its communication and part of it is logistics. Fair to say?

Nicole Clowers: Absolutely. The coordination and the communication are key. And certainly what we’ve seen both with this current pandemic, but also we had observed it and past public health crises, the importance of consistent communication and making sure everyone was communicating the same message. And so some of the things that we’ve heard that has complicated this particular rollout is changing in priority groups, for example, who was going to be sort of in the priority, who wasn’t, when that would occur, when vaccines would be be ready. And so not only does that frustrate the public and confuses the public, it confuses and frustrates state and local governments that are responsible for distributing the vaccine. And so again, that’s why back in September we started that focus on this and asking the federal government to do so, and in our current report, this January report, we emphasize the importance of developing these plans that are robust and in ensuring that everyone knows what they’re doing.

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Tom Temin: And there is a drug distribution system in the country involves medical practices, hospitals, drug distributors such as Caremark and all these middlemen that get drugs into people’s hands, connected all the way back to the manufacturers. Do you think that maybe that would have been a better mechanism than this big federal government footprint which is kind of interrupting what is normally a fairly efficient flow of medicines to people?

Nicole Clowers: I don’t think we can underestimate the the enormity of this challenge in terms of vaccinating over 300 million Americans and as quickly as possible. What was missing is a plan to do that in terms of making sure people knew what to expect, when to expect it and who was responsible for doing it. One of the things we saw with the H1N1 one pandemic was the lack of consistent communication. And I’ll give you an example. There was inconsistent communication about when vaccines would be ready in the H1N1 outbreak. And what occurred was people lost confidence in the government because those dates weren’t hit. And so that was just one example of the need to be really clear about what to expect and consistently reinforcing that message in terms of what people could expect them. When things aren’t occurring as planned, to talk to the public, to talk to everyone involved to make sure they understand why plans are changing.

Tom Temin: And now you’ve got the Biden administration which has inherited this issue and has made a lot of overtures, public pronouncements on fixing it. What specifically can they do at this point, because it sounds like there’s two problems here? One is to build out the plan itself, and then to implement it, maybe it’s three steps. And then to make sure that everyone understands what is going on now.

Nicole Clowers: I’ll start with saying we had good news last week in terms of another vaccine coming to the market. And so that’s an important step as we get more vaccines ready for FDA review and potential authorization for use. That will help. I know the administration is looking at different sites and facilities that could be used to help push out and distribute those vaccines as needed. And so that will be an important step. But then, ultimately, I think what’s key is as you’re developing that infrastructure, as more vaccines are available, that we have a plan in place that everyone understands their roles and responsibilities, that the government can better track the vaccines going down to the state and local level, as well as to specific hospitals until it gets to the shot in the arm. And that we have a robust communication outreach sort of strategy both for providers that providers understand the vaccine rollout and their responsibilities and roles in it, that they get the necessary training needed, but also the public education awareness too, that needs to start immediately so we can increase the vaccine uptake.

Tom Temin: And you sense that or is it the GAO his belief that because there are so many priority rules, age, ethnicity, and location, and so forth — none of these are bad ideas or badly intentioned ideas, but combined they make an extremely complicated process or add complications to an extremely complicated process. Do you think if the rules were maybe just simplified, just to get the most out there into the most arms as possible, including areas that aren’t as affluent as other areas, that things could be speeded up?

Nicole Clowers: We certainly heard that in terms of the complicated nature of some of the prioritization and the different groups. But what we’ve heard from state and local governments more frequently is just the changing of the rules, so to speak. Which groups should be in priority and when that should occur, that was a greater frustration and a complicating factor for them.

Tom Temin: And what do you think Congress if anything could do at this point, or should they just simply exercise oversight and make sure the government, the executive branch does what it’s supposed to?

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Nicole Clowers: Well, certainly congressional oversight is is key because it will encourage action on the part of the agency officials. Then the new administration has also laid out some of their plans through executive orders and other statements and documents. We’re currently going through those in terms of the plans they have to implement and we’ll continue to monitor them as they’re implemented.

Tom Temin: Nicole Clowers is his Managing Director for Health Care Issues at the Government Accountability Office. As always, thanks so much.

Nicole Clowers: Thanks for having me back Tom.

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