i want to thank you for joining us for this very important conversation about covid-19 vaccine. i'm joined by san francisco's health officer and the deputy director of health to discuss in more detail san francisco's plan to distribute vaccines as quickly as possible. the doctors are medical experts helping to lead the city's response to covid. we're lucky to have them here to help answer the questions that many san franciscans are asking. i know this is a topic on everybody's mind. we've never done anything like

this before in this country, in this state or city. vaccinating this many people in the midst of a pandemic. it's a process with many moving pieces. while many things are out of our control, we're in good shape in san francisco with a plan in place to get people vaccinated quickly once we have the supply we need. to start off the conversation, i'll give a brief overview of the current situation in san francisco and then we can get right into the conversation. san francisco is moving full speed ahead on covid-19 vaccinations. we're creating a network of vaccination locations across the city. high-volume sites, partnerships with pharmacies, uzbekistaning -- using existing community sites. to do all this, we're coordinating with the health

care providers who are receiving a majority of the vaccine doses from the state, such as kaiser permanente and ucsf health. creating targeted efforts to make sure communities that have been hit the hardest by covid, have access to the vaccine. won friday, we opened the first of three high-volume vaccination sites in san francisco at city college on ocean avenue. they started with 500 doses per day, but will have the capacity to administer at least 3,000 doses per day once we have the supply and are fully ramped up. in addition to the sites opening at the muscone center and the san francisco market and the bayview, we're also working to bring vaccines to people in the communities most impacted by covid through community clinics

and mobile vaccination teams. this has been a collaborative effort and we're so thankful for our partners, the health care providers and the community organizations work with us. we have a plan and we're ready to distribute 10,000 doses at least bare minimum per day once we have enough supply of the vac. so far, the amount of vaccine we're receiving from the state and federal government is inconsistent and unpredictable. we need more vaccines and we'll continue to do everything we can to be ready when our supply of vaccine doses increase. but for now, vaccine supply remains our biggest constraint. so this is such a big piece of the puzzle. why don't we get started in the conversation? and let's ask the two incredible doctors that are joining us today, who are really leading this effort, thank you for joining us and either one of you

can answer this question. what is the current situation with vaccine supply in san francisco? and why are vaccine supplies so limited? >> thank you, mayor. and maybe i will start and then the doctor can fill in if there are pieces i missed. as you said mayor, the main thing, nationwide vaccine production is limited right now and that's the underlying issue. vaccine getting to us in san francisco and getting in the arms of people in san francisco is also very, very complex. so the federal government directly allocates a small portion of the doses that it has and then the rest of it gets divided up and allocated by the federal government to the 50 states. once our california share has arrived, then it gets allocated not just to our 58 counties, but also large health care organizations. in fact, in san francisco, two-thirds of the vaccine that is coming into the county is

going straight to our health care partners. that's important to realize. as you mentioned, not only are we not receiving all of the allocation, but just a minority, but it's very erratic and unpredictable because of the supply issues. that means we can't know from week to week how many spots we'll have available for people to get vaccinated. the state also determines what the priorities are for vaccination. again, as you said, very important to know. and right now, the priority groups are health care workers and they are people that are 65 and older. these are the people who are most likely to get covid-19 and the people who are most likely to die if they do become infected in the case of older adults. so as an example of that, in san francisco, people aged 65 and older make up 15% of the people who get covid-19 in our county, but they make up 85% of the people who die. so that's why they're

prioritized first, but it is that scarcity of vaccine right now that causes the biggest problems. then are logistical problems with the vaccines and being able to get them to people. >> mayor breed: so can you tell us a little more about how this works? how many doses have arrived in san francisco? and how many have been administered? and can you also explain, i think there is confusion around the second dose because there is, you know, a question about the timing of when the second dose should be administered and whether or not we can just administer all the first doses and hope we'll get enough second doses to administer those. can you explain the numbers and specifically explain the second dose so we can have a clear understanding of that? >> yes, thank you. so as of today, san francisco has received 144,000 doses, but

just to put that in perspective, if we talk again about the people who are currently eligible in san francisco, including health care workers and people 65 and over, that group in and of itself is 210,000. so if you think about two doses being required for these vaccines as you said, that requires 420,000 doses. so we don't have nearly that amount. each of these vaccines requires a two-dose course. they have to be repeated at either three or four weeks. the difficulty is you can't mix and match the doses. we have to make sure it's the same dose. of the 144,000 vaccines, we have administered 80,000 of them, 58 percent. and of the remaining doses, they're almost all allocated to ensure that the people who received their first dose are able to get full protection from the vaccine by getting the second dose. when you account for that as

well, there is 98% of the doses that have come to san francisco are going to the people of san francisco who need them. >> mayor breed: can you help understand -- i think some of the questions, too, that people have is, what happens if you don't get it within the third or fourth week? you don't get the second dose at that time, what happens? is it just not effective any longer? >> i can maybe take this one. so this has been study across the nation and right now, at the national level, they're saying that you could get the second dose up to six weeks later. the state is looking at this recommendation and they're finalizing how they want to approach it. so we're waiting for that. right now, we're trying to hit the marks of three to four weeks after, but if we get recommendations to adjust, we'll do so so we can get vaccine out in the most efficient manner possible. >> mayor breed: that's a real

interesting point that dr. phillip made earlier today, just that folks are not completely -- they don't completely understand why we are basically pretty much out of doses. and i think it's important -- and it's complicated, but it's important to talk specifically about the path. we're not just holding onto vaccines. we're getting them out the door as soon as we have them and we don't have control over all the ones that come to san francisco, but maybe you can talk about the path that a vaccine follows from when it is assigned to san francisco to when it is administered. and i know that you can probably only mostly speak to what happens with the department of public health, because we only have control over the vaccines that we receive. >> should i start? or would you? >> maybe i'll start with the logistical part and then you can talk about the clinical

implications. because these vaccines were processed in a very quick manner, they require a little bit more logistical effort than normal vaccines. so the pfizer vaccine needs ultra-cold freezing which is -60° and that's not normally how we distribute vaccines. so that temperature control is extremely important for the vaccines to remain effective. at every stage from when they are produced at the manufacturing and as well as transport across the country into the county, that temperature control has to be maintained. once it's in the county and it's put into a health care system or the department of public health, we have to ensure that that temperature control conditions until it's ready for use. -- continues until it's ready for use. it's required for the health care systems to have ultra-cold freezer storage to do the pfizer vaccine and get it out.

moderna is a little bit better in the fact that it requires freezers. and we can use our own freezers to do that. and the health care system has freezers. but i want to emphasize, the vaccines are fragile. you have to be not only temperature-controlled for storage, but as soon as they're ready for use, there is a lot of requirements around how that use happens. i'll turn it over to dr. phillips to talk about that. >> yes, these vaccines, these are not the type that you and i are used to in our homes. these are specialized equipment in medical centers. and what we know is that once we start the process of thawing the vaccine, that is another process, then it also has a limited life within the refrigerator of several weeks. and once we take the vials, they

actually contain multiple doses of vaccine, so you can get either up to six or 10 doses for individual people from each vial, but once you open the vial, you have six hours to use it for you have to discard the rest of the vial. the last thing anyone wants to happen is wasted vaccine. so the logistics, the planning and equipment for doing this is not parallel. so the idea that, you know, for flu vaccine we're all used to going into the local pharmacy or doctor office and getting it easily. that is a very different scenario than we have right now with covid vaccine. both because of the requirement of the specific vaccine and the scarcity of the vaccine. we're hoping in the future we get to a point that will be -- that it will be like the flu vaccine, but we're not there yet. this is the limitations we're working with in the city to make

sure people are vaccinated. >> mayor breed: the city has made a decision to set up massive sites that require their own logistics. we have city college which we opened with ucsf, the muscone center and the san francisco produce market in the bayview. those are the other two sites that will open. these sites are going to play a huge role in efficiently providing the vaccine to people who live and work in san francisco, but it's a huge logistical undertaking to establish and operate a site like this. tell me about how these sites will work. >> i can talk about that. you know, this site and this planning has been going on for months now. i really have to say that it's been a huge collaboration between city partners, between our health care system and between our community partners to really think about and plan and operate these sites. and part of the planning is that we need to ensure these sites

are high-volume sites. they're able to get to, as you were saying, mayor, up to that 10,000-marker across the city. we need the space requirements we need the infrastructure to store the vaccine. we need the proper electricity. and additionally, people after they get the vaccine, they have to wait 15 minutes after to make sure they don't have a reaction. you have to have the appropriate places for people to be monitored. so based on that, with all of our, you know, all of this collaboration, there have been three sites looked at and deemed really as the right places to get this up and running. and part of how this came to be is that we know the sector of the city has been most hardest hit by covid and covid cases. so really looking at that area to ensure that we have vaccine available for those populations, so city college as you

mentioned, the bayview, were some of the first sites. and then additionally, the muscone site. once they were identified, we worked to determine how is this going to work? as dr. phillips statemented, we're only getting a third of the vaccine coming into the county, so we need our partners to be part of the collaborative to administer the vaccine. for city college, they have 18 lanes available and it can do thousands of doses a day potentially in the future. it launched with ucsf last friday with 500 doses because that's the amount we have now, but as vaccine flows in at a more robust rate, we'll be able to increase the number of people that get vaccinated there. all these sites, we're looking at drive-thru as well as walk-in so people can get to the sites. >> mayor breed: i'm

understanding that the city college site basically, based on the number of doses that they have left, so that the appointments are through tomorrow, is that correct? >> that is correct. they are through tomorrow. and that's, again, based on the vaccine allocation. we will hopefully get more news about allocation in the next 24-48 hours and we can start planning ahead. >> mayor breed: so tell us about who can get vaccinated at these high-volume distribution sites? i think -- are they open to anyone regardless of who their insurer is? >> so, mayor, again, the limiting factor as you've both said, it is limited to health care workers and people that are 65 years of age and older. but as you pointed out, we really want to do all the complicated work on the back end and build these systems so it is simple for the people who live and work in san francisco to know where they can go to get a

vaccine. so, yes, the goal is, and the plan is, as vaccine suppl increases, that anyone will be able to access vaccine at these sites, no matter who is operating the site, whether it's ucsf or kaiser permanente. i don't have to be a kaiser permanente member to go to that site. that is the goal. we're going to be shared resources, sharing accessibility across the city for the benefit of all of the residents and people that work in san francisco. >> just for clarity, we know in san francisco we're still in tier 1a and that includes people over the age of 65 and health care workers, in-home support service workers, emts and we anticipate that network is about 210,000 people. so we've heard a lot of folks who have been a little, you know, bothered by the fact that

san francisco has not gotten to teachers, bus drivers, police officers, and, in fact, ma written has gotten to other counties. can you explain that and why it's a lot different here in san francisco than it is in other counties? >> one important reason is that we have such a robust health care system. we have so many health care workers that are here in san francisco serving our residents every day. that is a strength. that is part of the reason why we have one of the lowest death rates of any major city. and that means that it's going to take us longer to vaccinate all those people that have been serving us throughout this entire year of the pandemic. so that is part of the reason why we have not yet been able to move past the health care workers into -- into the other tier. that is actually a strength that

we have this large health care workforce here. and so we acknowledge that and we also know that with the limited vaccine supply we're getting, we're moving through the group as best we can. with all of my health officer colleagues across the region, all of our goals in every county is to get every resident, every worker vaccinated as quickly as possible. it's a shared goal. some of us, like san francisco, have a larger share of the health care workforce than other counties do. >> mayor breed: i want to express my appreciation for the work you all did early on to get vaccinations to people who are in assisted-living facilities, both laguna honda and other places where some of the highest-risk patients have been. it was a huge undertaking and it was done very well. and although we've had our challenges when you think about a place like laguna honda, with over 700 patients and all of

those employees, the work that was done there with your partners, in this case, walgreen's, it was significant to be able to accomplish that. let's talk about eligibility for this vaccine. how does one go about getting one? >> so i can talk about that. operational side. there is a couple of different ways. if you're a health care worker, generally we recommend you start with your employer because a lot of them have been able to get vaccine through themselves or the big health care systems. if you are an independent person that is not associated and has not been able to through your employer get a vaccine, is it talk to the health care system. as dr. phillips remarked and stated earlier, the health care systems are now vaccinating all health care workers. and have made this available to people outside of their network. so that is one way to access

vaccine. the other way is, you know, we are working on trying to get networks up and running. not only through the health care system, but also through other partnerships like our pharmacy partnerships. and our community health care clinics. again, hopefully as the vaccine becomes more accessible to san francisco, some of these other partnerships can start to vaccinate our health care workers. for the over 65 population, again, this is a large population. we're, you know, saying that those that are in the higher age ranges should be the priority because they're at higher risk of death. so a lot of the health care systems are starting with 75 and over which is appropriate. but the goal is to get to as much as of this population as quickly as possible. it is dependent on the vaccine allocated. we will get to you. i know there is frustration and anxiety around this, but we're

getting it out as fast as we can. we hear your concerns. given the limited supply, we're having to prioritize. that does not mean if you're in the priority groups you will not get the vaccine. they will get this phase done hopefully in the next 2-3 weeks, but that depends on the allocation we receive. >> mayor breed: dr. bobba, i know some have questions about the safety of the vaccine. can you tell us about the safety record on both types of the vaccine and why they should take the vaccine when the opportunity presents itself? >> yeah. both of these vaccines have gone through extensive trials in terms of safety records. now they have been studied across a major part of the population. actually, recently, there was literature released by the cdc showing of the more than four million doses given, there were only 10 anaphylaxis episodes

across the entire country. so very minor amount. and all of those were reversed immediately. that's been in the media, that anaphylaxis the concern, but it's a very rare concern and that is why we monitor for 15 minutes afterwards. in terms of other side effects, the main side effect is probably after your second dose, you can get muscle aches, feel fatigued. you might get an injection site redness or soreness. all of that generally, you know, resolves within 24-48 hours. so the ability to have a 95% effective vaccine to covid for outweighs the concerns around the vaccine. especially in our communities that are really being devastated by the disease, where we're seeing hospitalizations and death, the benefits outweigh the risk. >> mayor breed: so basically you are strongly recommending the two doses. can you tell us why -- and then tell us who is going to be

keeping track of the first and second dose and how that works to ensure that the second doses are available for the person that receives the first dose? >> absolutely. so, yes, two doses are recommended and depending on the type of vaccine that you start with. remember, they're nearly identical in terms of high efficacy, 95% for both of them. whatever one you get that is available, that is the one you should take. doses are in short supply. but you need the same kind fort follow-up dose. that is going to be three weeks if you get pfizer and four weeks if you get moderna. we are keeping and we're tracking and there is very detailed documentation that is required, another one of the logistical challenges that has to go to the state. we know who has gotten the vaccine and when they're due for the follow-up. that is part of the system that is being built across the city.

health systems have ways of doing it and we're doing that in covid command as well, to know when to call people back and schedule them for the follow-up shot. the efficacy, that very high 95% protection, is really only shown when people get the two doses three or four weeks apart, depending on the vaccine. so after people get the first dose, they shouldn't feel i've gotten the vaccine and i'm in the clear. they really need to have the second dose. so as we were talking about, this is part of the thinking, when we get our allocations, we want to make sure we can for now schedule people at the 3-4 week interval, so we're planning accordingly. we want to be able to give people the second dose. that is part of the logistics and the thinking through how to do this well for the people who need the vaccination. >> mayor breed: one of the things that i wanted to just kind of touch upon, because you know, i think there are concerns

that the city should be completely responsible for this, right? like that we should take on the responsibility even though it's not necessarily within our control. we remember the beginning of this pandemic. we had to set up these testing sites from scratch. we didn't have enough needles. we didn't have enough p.p.e. there were challenges with setting up the sites and a lot of the testing fell on the hands of the city and county of san francisco. and there were challenges with the private health care providers who were also receiving test kits, but we were then, as a city, held responsible for administering all the testing and in many cases there are still people who are using the city system to test, even though they have private health care insurance. it's been one of the most challenging things that we've had to face. and part of, you know, of course, my push as mayor to the state and the feds is to provide

more supply to our public health care system so we're administering more faster, because of our lack of control over the private health care providers. luckily, at least, the private health care providers are working with us, even though we don't have the data completely. how is this system that we have set up now? how is this plan we have set up now to administer the vaccine, how is this going to be better than what we had to deal with with testing especially with our private health care providers? >> yeah, i think i can start and then dr. phillip can weigh in. one of the big things, a lot of the lessons we learned with testing, we're using them to plan for vaccine. what do these sites have to look like? how do we get a large number of people through them? how do we meet the demand? one of the major differences here, is that testing potentially had an open market

that you could go purchase test kits. that's not the same with vaccine, right? this is a very limited supply. it is being tightly controlled at the federal and state level. there are specific allocations coming in. we have to work in partnership because if we don't collaboratively work with our health care system, it will be decentralized and not well-run process. and so this is actually, you know, i will say, it's making -- we have to ensure that there is collaboration. in some ways, it's forcing collaboration because this cannot be successful if the health care system does it on their own and the city does it on their own, we have to come together to serve the residents of san francisco based on the allocations we're getting. so far, that collaboration is abundantly clear, the health care system is really being in partnership with us at these mass vac sites. the mass vac sites are looking

at one way to distribute the vaccine, but there needs to be a community focus here with community sites and community hubs that can give the vaccine with a much more personal level, with community providers that know the community, have trust with their residents. so we're looking at multiple ways to get the vaccine out. again, the health care system, whether they're large or smaller doctor offices, it will be part of this and working collaboratively. >> mayor breed: the last question i want to ask, because i think one of the biggest concerns i have is a lot of the misinformation and the criticism about san francisco and our rollout for the vaccine. the impression we just started planning for this yesterday. the impression that we're not prepared, that we're not getting the vaccines out fast enough. there is a lot of information and, sadly, it's causing a lot of confusion out there. and it's really causing a lot of

frustration amongst many san franciscans. and i just want, you know, either one of you or both of you to talk about the fact that we have prepared for this early on. we're getting the vaccines out as quickly as we can. and how well we're doing in san francisco, especially compared to other places, even though it might seem confusing, especially because of the second dose. tell us your perspective as the two leaders of this effort, you know, how you believe san francisco is doing? and how we can anticipate that we will do even better, especially once we get the supply? >> yeah, i'll start and dr. phillip, you can finish. so in terms of our planning, our planning started as soon as we heard that the vaccine trials were occurring and they were promising results. over the summer, we started planning over this and we dusted off the previous summer with

h1n1. when we came to fall, the flu vaccine clinics as a model, even though the flu vaccine, the requirements around storage is different, we have to think about what is the impact of covid on administering the flu vaccine? what is the spacing requirement? the protective gear? so that happened all through the fall into the winter to get the flu vaccine out. we built on that to think about, we know the understanding around flu vaccines. we know past experience of mass vaccination clinics. as we understood how allocations were going to happen, we worked closely with the health care system to develop these different strategies in addressing the needs of the community in terms of getting vaccine. so the mass vaccination sites, the community sites, our pharmacy partnerships are really

the pillars of how we're going to get vaccine out. all of this is going to be ongoing improvement. as things start to rollout, as things change, we're going to be adept and nimble to change with them. but at this point, the city has a robust plan to get the vaccine out as quickly as possible as long as we get more supply. >> thank you. dr. phillip, you want to add anything? >> i agree 100% with dr. bobba. i think the only other piece i want to emphasize, this planning has been going on for months and it's why we're poised to be in such a good position when the vaccine is available. looking around, i think the approach you alluded to, having any door be the right door for a person in san francisco to get the vaccine is unique. it is community-centered, individual-centered. it really makes the system work the people instead of the other way around.

and i think this is the right way to get vaccine out to people quickly. so now we just need the vaccine. i also want to say that this is a good problem to have. there was no guarantee that we would have highly effective vaccine at all just a year after this brand new coronavirus was identified. so, we are up to this challenge in san francisco. we have built an amazing infrastructure. we have great people as a city with the health care partners in the community working on this, as we heard this afternoon. and we're looking forward to getting more vaccine and really rolling up peoples' sleeves and getting vaccine in there. >> mayor breed: let me thank you both for the work since the beginning of the pandemic. thank you, dr. phillip and dr. bobba. you've been incredible leaders in the effort. we appreciate all the work done by the people who are part of the department of public health. i know that everyone is ready t. i'm so ready to be done

covid myself. and just know that we are doing everything we can and i have confidence and faith in the work of the department of public health here in san francisco because they're the reason why you see san francisco, one of the second densest cities in the country, have one of the lowest death rates in the country. it's because of their work. it's because we acted fast. we have been a leader. so now is not the time to fall apart. more than ever, we're going to have to be patient. we know that the vaccines are here. we know that with a new president who is prioritizing covid vaccine production, that we anticipate that more will be to come. and so it just means that we have to just be patient. we have to wait our turn. and we will get there. we got great news yesterday we'll be reopening san francisco with outdoor dining and a number of other salons and places of business that could not open in

the past. that's good news. we're headed there. so now is not the time for us to, i think, question the decisions of the department of public health or lose faith. we're going to get through this. the light is finally there. we know there is clearly a lot to discuss on the vaccine. we can't get to it all today, but we'll continue to provide regular updates to the public about the vaccine in san francisco. and we're regularly updating information, which is available online at sf.gov/covidvaccine. we know we're at the mercy of the state for supply. as soon as we have supply and information, we'll get the vaccines out the door. as a reminder, anyone who lives or works in san francisco, can sign up for a notification when they're eligible to get a

vaccine. we really appreciate the time you took to listen to dr. phillip and dr. bobba on what we're doing here in san francisco to address the questions and the challenges around the vaccine. it's clearly complicated, but we'll still get there. i have faith and confidence in what i think is one of the most incredible department of public health anywhere in the country. our numbers speak to that. we will get through this and we appreciate everything that you all have done to follow our health care orders. looking forward to seeing you all in person fairly soon. thank you for joining us. [ ♪♪♪ ].

>> working for the city and county of san francisco will immerse you in a vibrate and dynamic city on sfroert of the art and social change we've been on the edge after all we're at the meeting of land and sea world-class style it is the burn of blew jeans where the rock holds court over the harbor the city's information

technology xoflz work on the rulers project for free wifi and developing projects and insuring patient state of at san francisco general hospital our it professionals make guilty or innocent available and support the house/senate regional wear-out system your our employees joy excessive salaries but working for the city and county of san francisco give us employees the unities to contribute their ideas and energy and commitment to shape the city's future but for considering a career with the city and county of san francisc

>> clerk: she's joined by vice president honda, commissioners santacana, chan, and swig. at the controls is the board's legal clerk, and i'm julie rosenberg, the board's executive director. we will also be joined by representatives from the city departments that will be presenting before the board this