Positioning

Press Briefing by White House Monkeypox Response Team and Public Health Officials – The White House

future-dyanmics






The White House
1600 Pennsylvania Ave NW
Washington, DC 20500
Via Teleconference
 
(August 18, 2022)
MR. FENTON:  Good morning.  I’m Bob Fenton, the White House Monkeypox Response Coordinator.  Today, Secretary Becerra, Assistant Secretary O’Connell, and Dr. Walensky and I will provide a brief update and share some key announcements from the Biden administration’s whole-of-government response to the monkeypox outbreak.  We’re also joined today by Dr. Peter Marks from FDA and my Deputy Coordinator, Dr. Daskalakis, for questions.
Before I turn it over to Secretary Becerra, I want to provide an update in our response efforts.
Last week, FDA and CDC acted to allow JYNNEOS vaccine to be administered intradermally, increasing the number of doses in each vial of vaccine by up to fivefold.
With the announcement, it increased our existing supply significantly without compromising safety or effectiveness.  And as Dawn O’Connell will discuss shortly, we already aggressively are increasing access for jurisdictions to move vac- — to move more vaccine supply.
We’re focused on operationalizing the FDA decision.  Since last week’s announcement, CDC has been working hard to provide help to providers and clinicians with training and other resources to administer the intradermal vaccines.
Already we’re seeing some of the country’s largest jurisdictions, big and small, adopt this strategy, including Los Angeles County and Fulton County, Georgia.
Overall, as of today, HHS has delivered nearly 1 million doses of vaccines to states and cities.
We rapidly scaled up supply of vaccine out in the field, and we are working to meet demand wherever we may find it.
In fact, we have the largest JYNNEOS vaccine program of any country in the globe.  And we’re not done. 
As Assistant Secretary O’Connell will discuss, we have accelerated Phase 4 of our national vaccine strategy.  Starting Monday, an additional 1.8 million doses of vaccine will be available to jurisdictions for ordering.
Jurisdictions that are adopting the intradermal administration of vaccine and have used 90 percent of their current supply of vaccines will be able to order more doses.  And as always, we’re getting those dors- — doses out the door to places as soon as they’re ordered.
In addition to getting vaccines out quickly to where they’re needed, we’re focused on helping states and local partners turn these doses into vaccinations, because more shots in arms is how we get the outbreak under control.
To that end, today we’re announcing that states and localities will be able to request and receive additional vaccines to support vaccination efforts at large LGBT events in the coming weeks and months.
HHS is launching a pilot program that will provide up to 50,000 doses from the national stockpile to be made available for Pride and other events that will have high attendance of gay and bisexual men.  These doses will be on top of jurisdictions’ existing allocations and supply of vaccine.
As Dr. Walensky will discuss in more detail, CDC will also work closely with state and local health departments to ensure they have plans in place for these events, not just around vaccination but also testing and community engagement.
We’re already starting to work with jurisdictions on a number of events taking place in the coming days and weeks.
This is important; it’s innovative — the way that we will bolster local efforts to meet people where they are and mitigate the spread of monkeypox.
Before I turn it over to Secretary Becerra, I want to highlight another step we are taking to make it easier for individuals to access treatment for monkeypox.
Next week, HHS will be pre-positioning 50,000 courses of TPOXX across the country.  That’s nearly five times as many treatment courses than confirmed cases in the U.S.
These courses will be made available to jurisdictions where the outbreak is most severe so individuals can get treatment more quickly from their healthcare providers.
In all, we are making a lot of progress on monkeypox.  This is because of the hard work across government that is scaling access to vaccines and tests, educating the public, and ensures — ensuring jurisdictions are getting what they need.
This is a whole-of-government response that is built on a strong work by Dr. Panjabi and the National Security Council built that allowed us to rapidly accelerate our tools and resources.
Our feet remain on the gas to do everything we can to end this outbreak.
Let me stop there and turn it over to Secretary Becerra.
SECRETARY BECERRA:  Thanks, Bob.  Great to be with everyone again.
Let me start by saying: Most Americans still are learning about monkeypox — what it is and what it is not.  CDC’s website can answer most of those questions.
Here’s what we do want all American’s to know: It’s important that we all take monkeypox seriously, and it’s critical that we do all we can to keep this dangerous virus from spreading.
Here, this team, we continue building on our efforts from the beginning to secure and make available safe and effective vaccines, treatments, and tests.
For the more than 60 jurisdictions that have reported approximately 13,500 cases of monkeypox across the country, we have, to date, made available more than 1 million doses of vaccine, more than 22,000 courses of TPOXX treatment, and capacity for 80,000 tests per week.  And as Coordinator Fenton just mentioned, that number of vaccines will scale up dramatically.
Having declared monkeypox a public health emergency, having safely expanded our supply of effective vaccines, and every day receiving more fertile data about the outbreak from our many state and local partners, we now move into a new phase of our efforts.
The fluid and collaborative allocation of vaccines and treatments to our partners will continue as part of this latest phase, but we will also now surge and target vaccines and treatments when and where that can be most effective, as Administrator O’Connell and Director Walensky will detail.
We know we have more to do to mitigate the spread of this virus and to protect those at risk.
Our work with our state and local partners could be — could not be more critical than at this particular moment.  We know that viruses don’t care about state lines.  They don’t wait to spread.
And so we will continue to do all we can to work together, communicate, and share information.  As I’ve said, we all have a role to play, and working together will lead to our collective success.
So, with that, let me now turn it over to Administrator Dawn O’Connell.  Dawn?
MS. O’CONNELL:  Secretary, thank you so much.
At ASPR, we continue to partner with our sister agencies, industries, and state and jurisdictional health leaders to accelerate access to vaccines and treatments and strengthen our response.
First, as we have done over the past three months, we continue to work with our manufacturer to accelerate the acquisition and delivery of vaccines to states and jurisdictions.
To date, as been mentioned already, we have shipped more than 700,000 vials of the JYNNEOS vaccine nationwide, including over 60,000 additional vials that have been shipped since the second and final round of ordering under Phase 3 opened on Monday.  This represents more than 1 million doses currently delivered and available for use across the country.

On Monday, as Bob said, we will make approximately 360,000 vials, or up to 1.8 million more doses, available to states and jurisdictions.
This rounds out the distribution of the nearly 800,000 vials we received in late July. 
In addition, as previously announced, we are accelerating the delivery of another 150,000 doses of vaccine that was initially supposed to come in October; it’ll now be coming in September — which represents up to 750,000 doses under the new FDA EUA.
We are also now receiving administration data from jurisdictions, which helps us ensure we are distributing vaccines equitably across the country while also making sure they get to those who need them most.

And we continue to explore all available options to increase the amount and speed at which we are able to deliver vaccines across the country.
On July 15th, when we announced an order with Bavarian Nordic for an additional 2.5 million vials of the JYNNEOS vaccine, we shared that those doses will be filled at a U.S.-based contract manufacturer using bulk vaccine already manufactured.  We continue to work with Bavarian Nordic and the domestic contract manufacturer to advance that goal.  We hope to be able to share additional details about that arrangement soon.
And, based on feedback from jurisdictions, the Strategic National Stockpile is making arrangements to deliver more vaccine to more locations, beyond the five in each jurisdiction they already deliver to.  More on this as well in the coming weeks, but it represents another example of how this is not a static response.  We are continuing to assess where we are, evaluate what we need, and make improvements in real time.

Today, as Bob mentioned, we are also announcing that we will make available 50,000 patient courses of the antiviral, TPOXX, for jurisdictions to begin ordering next week.  This is nearly five times, as Bob mentioned, more courses than confirmed cases in the United States.
Starting next week, jurisdictions will be allocated courses of TPOXX using a formula that takes into account both the number of cases in their jurisdiction and the number of individuals who have the highest risk of contracting the virus, including individuals who have HIV or other immunocompromised conditions.
And, of course, this allocation is in addition to the over 22,000 courses ASPR has already deployed from the SNS upon request from jurisdictions.
We believe it is important for states and jurisdictions to be able to order and pre-position these doses for quick and easy access for patients who qualify for them. 
As I mentioned at the top, so much of what we do is in partnership with our sister agencies, including the CDC.  With that, it’s my pleasure to turn it over to Dr. Walensky.
DR. WALENSKY:  Thank you, Administrator.  And good morning, everyone.
Today, I’d like to provide the latest information on the current monkeypox outbreak as well as share a few updates on the work we are doing in CDC’s monkeypox response.

So, as of August 17th, over 39,000 cases have been detected globally in 94 countries.  Here in the United States, there have been over 13,500 cases of monkeypox identified across 49 states, as well as Washington, D.C. and Puerto Rico.  

Monkeypox case data reported to CDC show that 98 percent of cases are occurring in men.  Of the more than 6,000 cases for which we have data on race and ethnicity, nearly 35 percent of cases are occurring among those who are white, 33 percent of cases are occurring among those who are Hispanic, and nearly 28 percent are occurring among those who are Black.  The median age of cases is 35.  And among cases with known recent sexual history and gender, 93 percent of cases were among men who reported recent sexual contact with other men.

Today, HHS is announcing a pilot program for additional vaccine allocations to state and local health departments whose jurisdictions are hosting events that draw a majority of people from the MSM community.

Jurisdictions hosting these events can request to receive additional vaccine allocations based on the size and nature of the event and the ability to reach attendees who are at the highest risk of monkeypox, a lar- — again, largely right now, men who are having sex with men.  We’re asking the requests to include a component of how they will promote education and awareness, as well as how they will address health equity in delivery of both messaging as well as vaccine.

CDC and HHS will continue outreach efforts to educate and make resources available to everyone who needs them.  As part of this effort, CDC will publish — be publishing a toolkit for health departments to assist with planning of these large events.

This toolkit, which has been developed based on the needs and feedback we’ve received from state and local health departments, includes ready-to-use resources to support local health department efforts when engaging with organizers of large events to provide and promote further monkeypox prevention strategies and key public health messages at large gatherings.

These events are important opportunities for people to connect with their community and to enjoy themselves.  And they’re also a chance to provide public health messages and resources to otherwise hard-to-reach publications — populations — otherwise hard-to-reach populations.  That includes providing safer sex guidance that empowers people to make choices that can help them avoid monkeypox exposure, including temporarily limiting sexual partners, and messages about monkeypox symptoms and vaccines.  They also provide education opportunities for communities about testing and treatment resources.

Now, I want to emphasize that while we are offering the vaccine at these events to those at high risk, this is a two-dose vaccine series, and receiving the vaccine at these events will not provide protection at the event itself.

Now, much of our work over the last many weeks has been related to the important outreach to clinicians and public health partners, and we have been focused on providing them with the necessary resources and education and tools that they need.

So, related to our announcement last week, some of our recent work has involved answering questions related to intradermal vaccine administration for the JYNNEOS monkeypox vaccine.

Importantly, intradermal administration is not a new vaccination method.  Data suggests that the vaccine administration intradermally will produce the same immune response as the standard dose administered subcutaneously.

We also know many intradermal vaccines may require some training for vaccine providers.  Now, many healthcare providers already have experience administering allergen testing or tuberculosis skin testing by this route.  CDC has resources available to ensure that vaccine providers can receive training and refresh their skills if needed.

To be clear, we’re learning how well these vaccines work against monkeypox and in this specific outbreak.  Although we anticipate vaccines will provide protection, temporarily reducing or avoiding behaviors that increase your risk of monkeypox exposure is important, especially between your first and second doses of vaccine.  From what we know right now, we expect protection to be the highest two weeks after the second dose of the vaccine.

At CDC, we remain committed to providing the necessary guidance, education, and resources as we continue to respond to current — the current monkeypox outbreak.  And we, of course, remain open to feedback on how and where we can provide tailored information to those at highest risk.

So, with that, I’ll say thank you.  And I will turn things back to you, Kevin. 

MR. MUNOZ:  Thanks so much, Dr. Walensky. 

We’re going to try to get through as many questions as possible, so keep your questions to one question.

First, let’s go to Chris Johnson at the Washington Blade.

All right.  I think, Chris, you might be having some challenge.  So, let’s go to the next question, and we’ll go — we’ll come back to you.

Jacqueline Howard at CNN.

Q    Yes, thanks for taking my question.  We’ve heard from the manufacturer that there are some concerns on the manufacturers’ end, as far as having its manufacturing capacity meet demand.  So, my question is: Are you working to help find domestic manufacturing partners to help supply JYNNEOS doses?  Or what are you doing to help meet demand just in case the capacity is not there?  How would that impact how much vaccine we have?  Thank you.

MR. FENTON:  Dawn, do you want to start with an answer for that one?

MS. O’CONNELL:  Sure, Bob.  I’ll be happy to.  And then, of course, feel free to jump in. 

So, thank you, Jacqueline, for the question.  We continue to work closely with Bavarian Nordic, the manufacturer.  As you know, they’re a small manufacturer.

So, one of the first things we did as this monkeypox outbreak took hold was begin conversations with them about how they might expand that capacity.  They currently have one active line in the Copenhagen area that we’re relying on for 2.5 million doses to be filled and finished.  But when we ordered that second 2.5 million to be filled and finished, we made it a requirement that they work with a domestic U.S. contract manufacturing organization.  And we continue to partner with Bavarian Nordic as they solidify that relationship.

We are also helping them in other ways consider manufacturing capacity increases — potentially working with a larger pharmaceutical company, for example.  We don’t have anything to announce in particular at this time, but we are working very closely in support of Bavarian Nordic’s interest in increasing their capacity.

MR. MUNOZ:  Thanks.  Let’s try Chris Johnson again.

Q    Hi, thank you so much.  I just kind of want to build off of that regarding the reported issues that the manufacturer of JYNNEOS vaccine has said with the proposal, the strategy of administration for the vaccines announced last week by the administration.

It seems like we’re having a lot of contradictory information from various health officials.  We have the federal government being critical of localities for opting to undergo a one-dose strategy.  Now we have the manufacturer of the vaccine being critical of the federal government for the new vaccine implementation.

I mean, with so many, you know, contradictory information, how can the public be trust — be trustful of the information they’re getting from health officials?

MR. FENTON:  Yeah, let me start — this is Bob Fenton — and then I’m going to turn it over to Rochelle Walensky at CDC to — and Dr. Peter Marks to talk about the dosing strategy.

I think anytime that you have change, you’re going to have the need to update, educate the community on those changes.  And I think, last week, FDA with the EUA did a really good job of doing that, providing scientific data on those changes.

And then, what needs to happen is the training, which CDC is providing, to go to the intradermal shots for those that need help.

As I said in my opening comments, the day that we made that decision — the day that we made that decision, or the FDA made that decision, and we signaled the week before that this was being undertaken by FDA, there already were a number of jurisdictions that started the training in anticipation of that decision.  And that day, there were organiza- — jurisdictions actually delivering the intradermal shot that day, and yet five- — up to fivefold the number of shots.  And did that to — you know, to areas of high risk and did that to areas that — that, you know, made equity a factor in those decisions of where they vaccinated.

So, it is happening; it is being successful.  We’ll continue to work with those that have questions.

But let me turn it over to Dr. Walensky and to Peter Marks to talk about the science behind the decision and any questions they’re getting as they’re providing technical assistance to jurisdictions.

DR. WALENSKY:  Thank you very much.  Maybe I’ll just add how closely we’re working with state and local health departments through this outbreak, really hand-in-glove, and in really fluid communication through this outbreak.

As articulated, we don’t yet know how well this vaccine will work in this outbreak.  And as those data are evolving, as we had some resource constraints early on with vaccine, we were working closely with health departments as a way that they could maximize their coverage.

We’ve met with them to talk about what data might be available for one dose, which are really limited — and, in fact, if anything, concerning — in terms of how well it would work. 

And so when the strategy for intradermal dosing, which we anticipate will work just as well as subcutaneous dosing, we again met closely with the health departments — Dr. Marks was on those calls — so that we could provide the data to them.

So, yes, this has been fluid, but we have been in close touch with our state and local health departments, providing them all the data and all the information that we have when we have it.

Dr. Marks, do you have anything to add there?

DR. MARKS:  No, I just — I would just very briefly add that, you know, some of this was in response to seeing additional use of a one-dose delayed strategy, which was, as Dr. Walensky noted, very concerning because of the absence of data and the emergence of some data to suggest that that might be a strategy that is not as effective as we would like it to be.

So, this was done very carefully, with a lot of thought, and we are working very actively to make sure the community has the information that we reviewed and can see the thought process that we used to come to the conclusion that giving this intradermally provided the same kind of protection that giving it by the subcutaneous route.

MR. FENTON:  And just real quick, let me just ask Dr. Daskalakis if he wants to add anything to what’s been said.

DR. DASKALAKIS:  I would just add, just briefly, that it’s really also part of our job, I think from the perspective of governmental public health, to make sure that we’re communicating about the vaccine in a way that makes sense, that actually engenders trust in the population. 

So I think our clear, sort of, view that this is equivalent, whether it is the intradermal dose or the subcutaneous dose, and the thorough review of the data that Dr. Marks and Dr. Walensky talk about, really give us the confidence to, I think, signal to folks that this strategy is not only important to protect themselves, but also to allow us to get more vaccines in arms. 

So it’s safe, it’s equally effective, and also allows us to expa- — extend vaccine so that we can maximize protection in the community.

MR. MUNOZ:  All right, next question.  Let’s go to Sheryl Stolberg at the New York Times

Q    Hi, thank you for taking my call.  Dr. Walensky mentioned some events coming up, and there are two big ones coming on Labor Day weekend: Black Pride in Atlanta and also Southern Decadence in New Orleans, where monkeypox forced the cancellation of a concert.  And we also have back to school — college, in particular — coming up. 

And I’m wondering if maybe Dr. Walensky, or Dr. Daskalakis — Daskalakis can talk about specifically what are you doing to help officials in Atlanta and New Orleans, and how are you advising colleges and universities in handling the return to campus and dorm life.

DR. WALENSKY:  Maybe I’ll start and pass it to Dr. Daskalakis.  Thank you for that question, Sheryl. 

Part of the motivation for this pilot is for those large events.  There were actually a few before those large events.  But we’ve been working closely with the jurisdictions, both in Fulton County and New Orleans, in anticipation of these events. 
And specifically, we’re asking for plans for how the education will happen; how we can do more outreach; in some cases where they’re testing, we can make testing available, how we can make vaccine available; how we can do this in an equitable fashion so that we get messaging in — out in an equitable fashion but also vaccine out in an equitable fashion. 

As I’m sure you can appreciate, these are opportunities for us to reach populations that we might otherwise not be able to reach, which we feel is a really good opportunity to get these messages out there. 

So, not only are we working to set up vaccination stands and activities with personnel in the local health departments, but we’re also working hard to ensure that we have the right messaging for the right people during those events.  And there are several other events, not just those that we’re closely working with — jurisdictions who are requesting our assistance ahead of time as well. 

We do have messaging for our college campuses.  We do have — which is very consistent with the messaging that is up on our website.  And we’re, of course, carefully monitoring that as well. 

Demetre, I don’t know if you — Dr. Daskalakis, I don’t know if you have anything to add. 

DR. DASKALAKIS:  I would just — I just want to emphasize the importance of really creating more opportunity for vaccine access.  It’s really allowing us to do intervention such as this and pilots to try to get vaccine closer to where the people are rather than have people come to always try to find the vaccine. 

So I think that also, Dr. Walensky — I think that the point that this is a multidomain intervention, it’s not just about vaccine, but also about clear communication about how the vaccine works, which I think you covered so well with the idea that first dose isn’t enough for protection; second dose is what you need, plus.  But then also, there’s so many strategies that folks can use to prevent monkeypox exposure. 

And so that package of interventions put in the right place means that it gets to the right people.  So we’re really enthusiastic that increasing vaccine availability allows us a bridge to do such events like that. 

And again, great, great collaboration with jurisdictions who I think are very enthusiastic about working with CDC and all of us on this topic. 

MR. MUNOZ:  Thanks both. 

Let’s go to Pien Huang at NPR.

Q    Hi, thanks for taking my question.  I’ve been hearing from some states that the doses being sent this week are being counted using the intradermal dosing regimen.  So, I just wanted to confirm how doses are being counted.  You know, is every vial sent before this to be considered one dose?  Every vial sent this week and after considered five?  Just hoping for a clarification on that.

MR. FENTON: Yeah, let me start and then send it over to Dawn to provide some additional detail.  So the doses that we provided this week were counted as doses based on the new intradermal strategy and the ability to get up to five doses per vial.  That’s how they’ve been sent.  And — and with the announcement of going to Phase 4, we’ll continue with that strategy if vaccine administration was at the 90 percent level.  So if they’re providing the vaccine, especially to the at-risk community, then they would be able to continue to order. 

What we want to do is accelerate this response, which is why we not only provide 3b but 3c at one time this week, and why we’re now moving forward with 4 is because those that are moving forward and vaccinating individuals at risk quickly, we want to be able to continue to provide the vaccine to protect as many people as possible. 

Let me turn it over to Dawn from ASPR to add to that. 

MS. O’CONNELL:  Terrific, Bob.  I actually think you covered it very, very well.  What’s most important to us is to be able to get as many doses out as quickly as possible to those that need it.  And the FDA EUA allowed us to do that with each vial turning into five doses.  So we’ve been counting it that way.  Since that change — so the beginning of Phase 3, second ordering tranche on Monday — we sent it out according to that new calculation.

We do know there are situations — in a pediatric indication, for example — where a single vial still will equal a single dose.  And if a jurisdiction runs into some situations where they’ve administered more of those — and we would certainly hope for in an outbreak like this — you know, we’d be happy to work with them.  We do understand that there are some circumstances where we will need to adjust slightly.

But for — you know, as a rule of thumb, it’s been now five doses per vial. 

Thanks, Bob.

MR. MUNOZ:  A couple more questions.  Let’s go to Mike Stobbe at the Associated Press.

Q    Hi, thank you for taking my call.  I just was hoping for a little more clarity on the pilot project you announced.  I heard at one point “50,000 doses.”  At another point, I heard “50,000 courses.”  “Courses” I take to mean two-dose series.  Is it 50,000 courses or doses?  And how will you follow up?  Like, if someone goes to an event and they — they are traveling from another place and they come in and then they leave, how will you follow up to make sure that they get that second dose?  Thank you.

MR. FENTON:  Yeah, so I think two different things announced.  One was an announcement with regard to doses available for vaccine, and the ability to go into Phase 4 ordering started Monday for those that have vaccinated 90 percent. 

The second thing that was discussed was pre-positioning of TPOXX, which is the treatment for those that are positive with monkeypox, and that’s the 50,000 courses. 

So two different — you know, two different things: one vaccine, one medication.

As far as the events in providing one dose, we will work with the jurisdictions to make sure that there’s — that those individuals that were given one dose, if they travel back to their home of origin, that there’s a — that within their allotment, that there’s sufficient vaccine for a second dose. 
Let me turn to Dawn or Dr. Walensky and see if they want to add anything to that.
MS. O’CONNELL:  Bob, I think you nailed it.  Rochelle, I’m not sure if there’s more that you wanted to add, but it is — in the TPOXX pre-positioning, it’s the 50,000 patient courses.  In the special events, I believe it is the 50,000 doses.  But, Rochelle, you might have more on that.
DR. WALENSKY:  Yeah, no.  What I was going to add is: We recognize that there are going to be some people who have traveled to large-scale events and that they’re going to have to receive dose one of their vaccine at the event, and then they will necessarily receive dose two at their local jurisdiction.  And we anticipate that.
We’ve seen that before when we’ve had to do — when we’ve done mass vaccination, for example, with COVID.  So we are prepared to collect the immunization data.  And among the messaging that we will convey, as I noted before, is that people will understand that this is a two-dose vaccine and that they are getting their first dose at the event, that they will need to follow up for their second dose.

MR. MUNOZ:  All right, two more questions.  Let’s go to Cheyenne Haslett at ABC.
Q    Hi.  Thank you.  I was wondering if you had any data on who is doing intradermal injections, if you’re keeping track of what providers are actually performing it that way, and if you can share that with us.
MR. FENTON:  Yeah, the information is just coming in this week on that.  I’ve been in contact with a number of providers that are doing intradermal doses.  Los Angeles is doing a lot.  We were just on a call with Philadelphia that’s doing that.  Atlanta, there’s a number of them.
But let me turn to Dr. Walensky, who is starting to get a lot of data on that, and see if she wants to add anything.  And then I know Dr. Daskalakis has also been on a number of calls with providers.
DR. WALENSKY:  Thank you.  Really, what I will say: The data are coming in.  What we’re doing really — working really hard is to work with jurisdictions so they all get to this intradermal dosing.
As we see the administration come in — the administration data come in, we will also have a better sense.  But ultimately, this is a precious resource that we want to be used efficiently and wisely, and that’s the purpose of this, without sacrificing anything on safety and effectiveness, as far as our data show so far.  And so we’re really moving to get all jurisdictions to intradermal dosing.
MR. FENTON:  Dr. Daskalakis, anything to add?
DR. DASKALAKIS:  No, I think it’s covered well.  Just, we’re hearing, you know — just, jurisdictions are very enthusiastically starting this.  And I think, you know, the training provided by CDC and the technical support has been really important.  So, you know, I think it’s exciting from the perspective of access.  Thank you.
MR. MUNOZ:  Last question.  Let’s go to Krista Mahr at Politico.
Q    Thanks so much for taking my question and for providing the updated data on the case breakdown of how this is impacting different communities really are.  A question about that.  You mentioned the events as a particular opportunity to get particularly at-risk communities.  Can you please talk a little bit about more specific messaging that is going out to Black and Hispanic communities in particular, which are being disproportionately impacted in the outbreak?  Thank you.
MR. FENTON:  Yeah, let me start with Dr. Daskalakis and then go over to Dr. Walensky if she wants to add anything.
DR. DASKALAKIS:  So I’ll start and say that we know really — working really closely with organizations and trusted messengers for those populations has been really critical.  We continue to do the work and go deeper and deeper into engagement to make sure that messages are coming out. 
And also, I think it’s important to note that many of the events that we’re focusing on that are coming down the pike, to foreshadow, are really events that do focus on populations who are overrepresented in this outbreak, including the trends that we’re seeing in — among Black and Latino individuals.
So I think it’s really about positioning both messaging and biomedical intervention where people can reach it, but then also making sure that we’re going to the right places and talking to the right people.
Dr. Walensky?
DR. WALENSKY:  I don’t have much to add there except to say how closely we’re working and how critically important it is to collaborate with communities and people on the ground.  And so we continue to do so and certainly welcome any other ideas of how, where we can do that outreach.
MR. FENTON:  With that, I really appreciate everyone participating in today’s call and the questions.  This is really a whole-of-community effort.
As you heard today, we’re accelerating our response to ensure that we’re able to vaccinate, provide testing, improve the ability to quickly treat and really focus on educating and communicating a whole of nation through this effort.
So, thank you for tuning in today.  I appreciate your questions
 END
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