At the first Business Program of NACDS Annual Virtual, the National Association of Chain Drug Stores welcomed former FDA commissioner, Dr. Scott Gottlieb, as the morning’s keynote speaker. Gottlieb, who led the agency from 2017 to 2019, offered an overview of where the COVID-19 pandemic stands, then took questions from NACDS officials about the industry and what the future might hold for chain pharmacy.
In sizing up the current state of the pandemic, Gottlieb noted that the United States has made big strides in terms of vaccinations, and even as smaller outbreaks happen across the country, the country still is avoiding a fourth wave of the novel coronavirus. An important caveat to the increasing number of vaccinated Americans is the likelihood of them needing a booster down the road.
Gottlieb said that a Danish study found that previously infected patients saw immunity begin to wane roughly 6 to 8 months after acquiring immunity, particularly older patients, whose immunity was roughly 42% in that time frame. While he noted that vaccine-induced immunity likely is stronger than those who achieved immunity through infection, he said that booster shots would likely be in order, particularly among vulnerable populations who would be going into next winter with nearly year-old immunity.
In addition to reflecting on the current state of the pandemic, Gottlieb answered questions that saw him reflecting on the early days and size up where the country fell short in its initial response. He highlighted a pandemic -preparedness effort that was insufficient, in part because of its reliance on a flu-based model, but also because the country’s stockpile and countermeasures had been left to atrophy after 2006 and the H5N1 pandemic. He also said that the slow rollout of testing hindered the early response, and that the number of asymptomatic cases impacted the country’s ability to handle the pandemic on a case-by case basis to slow the spread.
"By the time we actually were able to track the spread in the US, which really wasn't until April, it was already widely epidemic here, That's why we had to reach toward population-based engagement. We lost the ability to use case-based interventions — testing, tracing and tracking down people. By the time we had any semblance of those tools in place, it was already widely epidemic."
Gottlieb also noted that, while other countries succeeded in case-based interventions — among them China, South Korea, Australia and New Zealand — the U.S. still had its strengths in its response. “A lot of aspects of our early response failed us, but we were able to pivot, adapt, deploy technology quickly and on a massive scale,” he said. “We were able to industrialize the development of some of the equipment we would need fairly quickly.”
He also discussed the role of the pharmacy in COVID-19 vaccination, and how distribution through pharmacies has been particularly effective — especially as the country increases its vaccinated population.
“Once we hit 160 million adults vaccinated, we're going to start to hit the upper limit of where demand is,” he said. “You'll start to need to entice into getting vaccinated the more marginal customers, someone who's younger, someone who might feel less at risk of COVID. The way that we're going to continue to get vaccination rates up is ... the pharmacies.”
Beyond the pandemic and response to it, Gottlieb also fielded questions about what the future holds for such areas as drug pricing and the importance of a hybrid care model that incorporates telehealth and patient touchpoints.
On the drug pricing issue, he noted that a bill from Sens. Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore., would likely form the basis of the Biden administration’s approach to drug pricing.
"What the bill does is it tries to provide richer coverage for consumers — tries to plug some of the out-of-pocket costs, particularly in the Medicare program,” he said. “In order to help pay for that, it puts government caps on the ability of drug makers to take price increases. So I think the implicit bargain, if you will, that the drug industry would be making under that construct is giving up margin for the ability to expand access and expand the size of your market.”
He also said that COVID-19 has had a lasting impact on how patients approach their health care journey. They now are looking for ways to access care in less cumbersome ways — making pharmacies a prime area of opportunity for delivering a hybrid care model that combines a human touch with telehealth offerings and self-guided diagnostic tools.
“Consumer behavior really has changed, and I think people are going to be looking for ways to get medical care through more disintermediated means,” he said. “I think that the pharmacies are positioned to offer a more integrated solution where you can couple some sort of in-person interaction with some in-home interaction."