But a little bit about this event. Began in 1995 analyzing issues of critical importance to this Foreign Policy in a nonpartisan way. They are responsible for the content of the new reports and in the task force programs 25th year launching the 78th and id like to welcome you to this discussion called in proving img pandemic. Thus, lessons for covid19. A brief introduction of the panelists. We have Sylvia Burwell the professor at the American University and the former u. S. Secretary of health and Human Services under president obama. Welcome to you. Also joining us is frances townsend, a cochair and former assistant to president bush Homeland Security counterterrorism and vice chairman and general counsel are in chief Administration Officer from the forbes incorporated. Welcome to you. Thomas is a codirector and senior fellow from Global Health economics and Development Director of the Global Health programs. Finally stewart patrick, the senior fellow in governance and director of the International Institution and the Global Governance program. Lets jump right in. Theres a lot to get to. Why issue of the report now in the midst of this pandemic . Sylvia, are you there . Francis, are you there . Shes back. I am back. Why issue the report now in the midst of the pandemic . I apologize i couldnt hear [inaudible] sorry about that. In terms of now we wanted to get the report out as quickly as possible. Information from the report is something we believe is relevant in terms of pandemic. Ms. For the future, which we think is extremely important to focus on and be ready for, but its important for now as we are continuing in the pandemic that we are in and so now as soon we were able to do the assessment with the group of experts, and we want to thank those experts. The four of us are part of this as we were supporting the effort and independent members of the Bipartisan Task force we wanted to get the information out so that it could be used to improve the conditions and the situation both in health and economics in the nation and prepare for the future. Give us the big picture what are the reports about how we are managing this pandemic and how many can we prepare for and prevent the next one . That is the thrust of why we wanted to get the report not only out but couldnt add something to the current pandemic and response as well as preparing for the future. And the fact that another pandemic is inevitable is the key to why i think this report is so important. I want to take the opportunity to thank tom and stuart that did the lions share of the writing here and were able to put together this group of folks and experts some of whom have joined us today. The idea was what could we do better the next time. We had an obligation to protect vulnerable populations who were particularly hardhit. We talk about and sylvia mentioned the Economic Impact of the pandemic. What we found i think everyone agreed was this preparedness is the key to reducing the enormity of that impact on populations and on the economics. What we looked for i look for in ground. The preparedness at the state and local levels and federal levels testing, Contract Tracing and being prepared to do those things in a national and global way is the key to the preparedness and response. Sylvia, and you played a role in the outbreaks such as the george wh administration. How do you think not only the United States the international community, some of the biggest disparities have dealt with the pandemic at this time . I am not sure right now that is what is most helpful. But to assess the things that need to be done better that is what we focused on in the report and i think its clear in terms of the response a National Strategy is needed and would include and approach to testing and Contract Tracing and communications that are scientifically based. I think what we try to focus on are what are the things that can move us forward right now and could make sure we are in good stead for the future. What are the big takeaways you mentioned here is the very idea that there needs to be a plan in place for the next one coming. So generally speaking before we dig in, what does that look like . Certainly at the federal level, you need a single point to coordinate. You look now how many departments. It wasnt just health and Human Services, but all of the expertise that had to be brought to bear across the federal government. The cdc and fda and really it does require a single point of contact in the white house to coordinate the inner agency but also its going to be a global effort and so you also need someone of th at the ambassadorl at the state department to coordinate the international response. I think all of those pieces lead to a quicker more effective and efficient response. Im going to bring tom in right now. There is very Strong Language in the report about [inaudible] before we get to the other part about moving forward and what specifically should be done, there is a lot dedicated to why we are in the place we are now. And i want to start with chinas performance and lack of transparency early on in the pandemic. What are some of the takeaways . Thank you. First, im pleased to be here. Im grateful for your willingness to do this and i want to express my gratitude to sylvia and fran for the job in this task force. Im grateful to have had worked with them and other Task Force Members as well as my colleagues and the large team that is responsible for this large report. So, the report doesnt pull any punches in assessing what has happened globally with this pandemic. The task force is quite clear. China covered up over a crucial two week period in january early cases and delayed sharing Material Information with the who and partners. That contributed to the early spread of the virus domestically in china and internationally the who in terms of its response, lots to say thats heroic about a given the limited resources and authorities, but praising china for its transparency didnt help, and they were a week late in declaring this and international concern. The tendency towards deference manifested itself in and consisteninconsistent commuh Chinese Government claims and unqualified praise for chinas response. Its understandable they have limited resources and authorities and have to work with affected states. Its understandable that they need to maintain a relationship with china. That said, the communications went a bit further than that in the early days of the pandemic where they were praising chinas transparency and that certainly hasnt helped matters. That said, i think what sometimes gets confused by the administration is this is not particular to this pandemic or to china. The who has exercised the same deference in the previous outbreaks with affected member states. Its a member state organization as strong as its members make it. So the u. S. Severed its relationship with the who for now this report makes recommendations about that. Is it worthwhile to maintain and what are the risks of leaving . Absolutely. The who is not a perfect institution. Many of the imperfections in terms of its processes and its bureaucratic nature has been well displayed. However, there is no alternative on the multilateral level to working with who on International Health crises. And ultimately, you know, where who has primarily been doing these, coordinating internationally particularly in low and middle Income Countries, the pandemic hasnt been quite as devastating as people expect and in my view, who deserves some credit for what we have seen in that regard. What countries did better and why . In the report, and im quoting the single most important determinant has been the quality of Political Leadership and execution. Thats right. Lets use an example. The experienced the first case within 24 hours of each other. South korea having learned from its experience with another coronavirus moved quickly, rapidly and aggressively and tested three times as many citizens on a per capita basis than the United States and they deployed Public Health fundamentals. Exhaustively testing, identifying those who were ill, isolating them, tracing their contacts, quarantining the contacts and a high rate of mask wearing. For the most part, not rocket science, but they responded aggressively. Today, south korea with a population of 52,024,000 roughly reported cases, 420 deaths. The United States has 7. 3 million cases of coronavirus and 211,000 deaths. This wasnt inevitable. Preparedness has made a difference and the ability to execute has made a difference in how the nations have done in the pandemic. This brings us to the United States and i will bring stuart in now. The consequences of a failing Political Leadership it also notes that pandemics are not random events as we earlier. They are predictable and they do happen. The United States was unprepared. Why . This is a problem that goes back certainly prior to this administration. Lots of commissions, frankly like this one, have outlined the threats to human life and the economy and the stability of the international pandemics of this sort and get what we found consistently with some of the emergencies that we have theres been very little investment at the National Level in the pandemic preparedness, so a lot of it is just sort of a structural inability of the u. S. Political system to treat the pandemic preparedness as the National Security threat that it is on par with the national defense. Every year we budget about 700 billion on the pentagon and u. S. Military spending and what brought the United States to its knees in 2020 was a packed and i think we need to recognize that. In terms of getting the longterm lack of preparedness weve already pointed to a few of the major failures once the pandemic was upon us the of the comprehensive system of testing and tracing the political leaders whether in the white house or the governors mansions or city halls were flying blind after the trajectory so you either have the blunt force responses to the Public Health emergencies or you wouldnt really know which way it was going. Another thing is the lack of clear Public Health guidance. I think too often much of what we heard from the president on down is a lack of willingness to put science first so its sort of contradictory and sometimes politicized Public Health guidance that doesnt provide american citizens with what they need to know from their leaders which is what is the risk here and what are some common sense precautions you and i can take to protect our families and communities. I think those things have been lacking. Also before we moved to some of the recommendations, and an important point that the response was slow and the government seemed to have known much earlier on what was going on and yet it wasnt until midmarch that actually anything was mobilized. Again im not sure that i personally can add much more to the revelations involved in the book and other press reports in this regard, but the task force does make the point and has charts if interventions had occurred say one week or even two weeks earlier that there would have been a lot lower loss of life and the discussion of the korea case i think is highly indicative here. We have a death rate that is 80 times that of south korea and infection rates 50 times greater, and ge yet the first infection was within a day of when the United States had its first. So it suggests while china and the who have some answering to do, theres obviously failures in the way the United States responded. You mentioned that a central role of communication and chain of command disseminating information and how that really struggled here. So, moving forward, how should the federal government better work with state and local entities to convey information. Whose responsibility is it to ensure Accurate Information is being shared with the public . As a real imperative to try to get some level of clarity about the role and responsibility the federal government, State Government and municipal authorities so we dont have what one of the casting members described as a caricature and articles in the confederation of the Pandemic Response where you have sort of 50 flowers of th at the state ll blooming and people are adopting quite different approaches. So we call for the executive branch to do a study in terms of trying to remove some of those ambiguities including overuse of the stockpile which became something of a political football as you recall early on in the pandemic. Im going to bring sylvia back in because weve got a little bit of time before we open up to questions about the horrific death rates among indigenous populations from the United States in this disease and as well as you know essential workers and the elderly. How can we better protect the vulnerable . As we think about the vulnerable populations in the country, we need to focus on two things. The here and now in terms of where we are in the pandemic and things that can be done right now to help. Some of that is about making sure we have the right data and information. Some of it is about communicating clearly the scientific information to the populations to make sure that they know and have the tools that they need to prevent it. The third thing on the policy things you can do to make a difference. We know that these populations and vulnerable populations have certain types of determinants that may prevent their ability to prevent the spread. For example, we know certain populations may be living close together. So, how do you provide policy options for people if they need to isolate so they dont spread the disease further to their family if they dont have the ability to do that in their own home. We have a focus on the longerterm issues that have created some of that disparity and in equity that we see. The underlining Health Conditions of people of color in the nation and minority populations result from years of structural issues and so thats the other thing as we come out of the pandemic, we need to focus on why is it that there are more and more of the preexisting conditions that make this disease worse in the population and whether that is access to healthcare. We know the number of uninsured is another place there is an equity in the country. The Affordable Care act made great progress against that but its not enough to exist. We also know there is an equitys when, in terms of who participates in the trials for drugs, for vaccines, for all kinds of things. So there are issues now and then in the longerterm that need to be focused on so the next time this happens we are not in the same place and as we move through that we do everything we can to take care of some of the inequities. Fran, id like to ask you your thoughts. The report talks about being the need to provide a safety net for the country. Picking up on where sylvia left off. What you find is if you look across the 50 states, the capability in each of the states is quite different. And nowhere is it adequately funded or staffed. This is where the federal government can really provide sort of funding. If we funded this i think that it was stewart that referred to the budgeting. If we believe that this is a National Security threat, we need to fund it like it is, not just talk about it. And when we look at the impact we realize why its so important to have a comprehensive federal Health Security budget that is a funded and regularly supported replenished part of our federal procurement system. The Strategic National stockpile is kind of the and equity among the state that can be the central procurer of ppe so there is an adequate supply even in the states where the Public Health system is weaker than other parts of the country. Part of the federal governments responsibility here is to be able to even out the inequities that exist among the states. Back to the role about the responsibilities. The federal government isnt going to be more solvent and the states have a responsibility to prepare themselves or to identify their shortfalls that the federal government can help them. Im going to bring you in, stewart. And if you can speak to this as well, we are going to see a vaccine probably several at some point. How do you ensure equitable access within the United States and globally . I will be brief on this because the expert is tom. The report does talk about the importance of supporting based on Public Health and not trying to lock up supplies but i think that tom is the man for this. Thank you for that. Its a great question. We are weeks and potentially months away from a vaccine. There is a Multilateral Initiative the report speaks to supporting to share vaccines. Its being led by the World Health Organization. That said, many wealthy nations are engaged in these agreements that are inherently rival risks with the use of resources and the need to succeed and vaccine manufacturing capacity. If that is the case, we will have a situation where we have medical intervention in the midst of a deadly pandemic. Its in everyones interest to share it because it would bring it under control faster and we may have a scenario where wealthy nations have it first. Thats something thats important to avoid. The report recommends instead of trying to build the airplane while flying it which is what we have had to do and the constant context of the pandemic and standing up an international initiative, its important to do this in advance. Its also important to address the fact that what weve also seen in the pandemic is boarding supplies and personal protective equipment and other essential medical technologies. If that happens with vaccines you will see a breakdown there as well. So the nations at least in the context of a pandemic to forgo those type of efforts with vaccines otherwise you will see a breakdown in the system. And that provides primarily the pediatric vaccines the us needs to play more of a role in this effort there are a number of entities with the bill and Melinda Gates foundation with those are doing their best to pull us together they need some support and currently they are not getting it from the us are china and russia. And before we see a different result. Clearly one of the issues for the next pandemic how do we improve the International Disease surveillance for the next time touching on chinas lack of transparency with devastating consequences. So it needs to be put in place . Is not be entirely transport of the future outbreaks and other sources of information. That doesnt mean not supporting the who and their role to have other sources of information. But the Court Recommends is a network that regularly and voluntarily incentivizes my partners but also has regular hospitalization data to identify trends that may have made a difference in this case where we are showing up a better part of the month the funding in china to recognize that pattern so with that surveillance with Public Health agencies to act upon it. Including the who thats one way to make us better prepared and less reliant for what they have not exercised with this pandemic. I would like to invite members to join us on the conversation everything is on the record. Ladies and gentlemens please proceed with your name and affiliation the first question is from leslie roberts. Caller i thought this was wonderful especially the part of what thomas summarized i am wondering where that logic that applied to the cdc and they say this because everyone going from the New York Times in the most recent data and we understand the white house was manipulating them on a level we have never seen before. And those opposed to the cdc scientist and we learned last month the morbidity report that they have released scientific findings so i am wondering if there is a way to get the cdc independence back just the hallmark independent you dont touch them on abortion or gun control and that we are just in completely new territory. Cindy them to you and then to join in. And then to rebuild that confidence then to look at the question of what occurred at the cdc that will be an important part of the building and the confidence of the cdc and also with ebola in terms of that incredible work so do south korea as an example that outbreak that we had learned from and talked about that is dependent on the cdc experts and a period in time those are the largest cases ever the middle east respiratory syndrome outside of the middle east they called the cdc as a partner to develop that response. We have to return to the place you have described and then on how we depend on scientific information and the cdc is where we can turn what we have to do is assess what happened and understand and rebuild that confidence. The next question from kathleen hunt unmute your microphone. Caller. Host we have technical difficulties the next question comes from mark. Please unmute your microphone. Caller good to see you. I have a question about the language that is likely to unfold how do you think Health Security will be defined . And how the Us Government responded to 9 11 so apparels might there be so one of the biggest mistakes that are the errors of commission versus omission . I really do think its the old thing the ounce of prevention is a pound of cure but the investment whether the cdc to build that capability and resources as part of the independent review investing in Public Health at the state and local level. When you have the capability and whether a covid pandemic whether the seasonal flu or murders or ebola you need that expertise to be sufficiently deployed but it is that capability to lead that i think is the key mark to being prepared not just to fight the next covid but to fight the next pandemic this is nationally recurring incident but it could be. And in 9 11 we are very much in that will take so regardless of the cause and to adjust and respond but you do put your finger on the important issue of the dependency of many form policy and domestic concerns with National Security and with that security interest also with those Development Actors ever and then to come to bear on those things. We also talked what is a National Security threat and questions through Human Dignity and social justice. They are letting down from that perspective of justice and thats the way i try to bring it. The first the pandemic as expose the fact that it reveals the existing weaknesses and in that context and then as those immunizations drop is not a robust capacity a lot of those nations targeted and then to tackle the pandemic which i dont think that is accidental to low and middle Income Countries if its primarily about to have a balance and how we engage with countries to maintain their interest and frankly those that are hit the hardest and those are the wealthiest nations. Host the next question comes from catherine hagan. Caller thank you so much this is been a fantastic program at an excellent report very timely. What questions are oriented to the global focus but so much of that is automated to those own communities rather than to broaden it but clearly the american engagement has been lacking at one level sensor has been so many Different Research efforts with americans very much involved in them. So the fact there is so much going on with those private sector entities how can you more effectively integrate these efforts into the global coalitions you are talking about . And then related to that can there be enough negotiating power with other manufacturing countries to have some clout to make a global focus with the treatments and vaccines and preventive strategies . And then to talk about that vaccine issue. And that the fundamentally different crisis from what we saw today around hiv talk about the active ingredient of the vaccine with those producers worldwide there are reports to ramp it up we havent had first doses of vaccines so if that is locked up in advance by those wealthy nations have multilateral by the time the resources to compete will not have it most of the vaccine purchase agreements are with those large primarily wealthy nations but not exclusively. If they will not play ball to share the early doses the rest of the world or wait months or a year or longer to receive the vaccine they need to protect their Health Workers and most vulnerable populations of that will leave a legacy that isnt just about this pandemic but undermining Global Cooperation on a host of other issues. And on those other Global Health problems and with that i will stop. Thats also question the role of philanthropy and with private sector entities and right now the bill and Melinda Gates foundation is engaged to make sure it can occur in the developing world. One of the things thinking about the Philanthropic Organization it spreads across a number of different elements fighting a pandemic so with that previous question or when there were cases of ebola or nigeria one of the darkest days for me and the challenges one would face a country as popular as nigeria as nigeria and on the back of the polio work things put in place what they do Contact Tracing in the Gates Foundation in terms of trying to wipe out polio for many years so everything from the vaccine and the scientific knowledge from the Gates Foundation and others have invested with vaccines and therapeutics and what we are using places like the nih do that and that is important so as the who moves forward one of the places they need to improve is think about partners that are broader although philanthropy also contributes and then to support the World Health Organization so we need places where those conversations can occur and with governments at the table from the vaccine. We seem to have lost sylvia for a moment. We will way to get her back and go on to the next question. Host the next question is from brad. Caller i am with the Gates Foundation but i am curious to hear those perspectives on Public Financing that this is more than a Health Crisis with those overseas partners so then we can do that more effectively. Thank you. In terms of a number of different places with the financing of the effort and what fran had said earlier what others had said is the important part of taking this to the level of a National Security issue and Economic Security issue and the resources within the federal government at the state and local level of the Public Health has gone down from the federal government even that is been reduced over a period of time so one of the things we need to do is have a system thats funded at the federal level but also state and local communities because whats different as we compare these things pandemic at the state and local level we all know as citizens we need to do our part when everybody gets the flu shot we need to think about all those levels thats the health of those different entities and that brings us back to those disparities we were talking about or in the International Scene if we have a strong platform of health that is a part of the funding when you describe it because you that base to build on. Is already some great points but since 1995 we have never spent more than 1 percent of global assistance on pandemic preparedness people talked about engaging for the pandemic it has been consistently unmentionable but in terms of support the federal government the states own preparedness it has gone down from 2005 Public Health departments cut 56000 positions in the years before the pandemic so spending trillions of dollars in responding think its fair to say about the federal governments we spend more on the spaces demonstrated but the report does put forward some ideas another source of financing as well and talks about leveraging more finance institutions looking at those possibilities to mobilize that clearly so many activities are tied to academic preparedness this may provide the moment from those financing as well. Briefly to for us and International Funding for Global Health in general it does note one of the annual budget is smaller than the New York Presbyterian Hospital and obviously in that Development Arena to make sure that external assistance and with that Pandemic Response should also be on the table. The next question comes from gregory. Caller. Thank you for a great conversation and that pandemics for one of two existential threats out there that we still didnt have a very good warning in this case as i read the record and the first warning sign was done by an ngo at the end of december probably two months after we shouldve seen something happening in china so do you all suggest meaning on major changes in the way the cdc works for the National Security council so they interact with the private sector . I can just imagine fran might have some thoughts on this i will quickly say that on this issue as we talked about before other sources of surveillance i can bolster the system. It is unfortunate we have a revision of regulation to address a past episode not sharing information only to have that happen we dont need to make that mistake twice. Thats dead on i said i want to be clear the who to declare a National Health emergency january 30th every nation at that point was dealt the same hand and many nations do with a better. Surveillance could help Early Warning and also leverage that but those fundamental feelings but they didnt respond to what was available to everyone else. I will pick up on those comments. There were multiple layers of responsibility in terms of Early Warning with the Global HealthSurveillance System to pull that information together and put this into a picture absolutely the private sector has a role with the extended supply chain but the private sector can see that they are responsible and with that supply chain and then gregory asked the question about the intelligence with those intelligence parties and requirements and to see the economic that the argument why Health Surveillance has to be very high up and to be on those list of intelligence priorities and in the community because by a large they are part of the policy community to think about what the response would look like. Next question from patricia rosenfield. Caller thank you very much for this important and timely report so almost as a throwaway point so im wondering about the individual and Civic Responsibility and how you are addressing that especially with future pandemics because it seems to me as they work at Different Levels that there is now a focus was this responsibility and in new york state for instance very good leadership communication but then asking them to wear masks. Had inculcate a Public Health understanding and perspective for those individuals that feel their rights are abrogated to get a vaccine not only in the United States and other countries as well it is the weak link that requires additional attention. And to take on this issue and then the rules and obligation of our leaders about what we know are the basic fundamental Public Health tools and in the simple form and the question so you dont go to places so that clarity of communication and those are simple things and a number of things and communicating on a factual based perspective but if you think about the dust that we have had and we are inching closer to those caused by cancer in a given year if you communicated clearly to most of your politicians you could not die of cancer this year if you took the steps, it is about basic health communication. And to make sure that people have the information and it is clear. In pandemic situations communication of clarity one of the largest we have learned that importance of clarity of communications factbased and gets to the public because they do play a role is more than ever not just because of the role citizens play but the information evolves we are learning every day almost 40 percent of the cases are a symptomatically transmitted thats what you should think about your behavior you can be doing it unintentional so that is about the role of all levels of the nation but also the fact that things even all its very important in the world and uncertainty. I think we have time for another question but what do you do for the world there is disinformation . Now waiting with this with the election that russia and china and iran are trying to influence operations with the current president ial election we struggle with this so really this is no different so speaking personally i actually believe if there is any indication the Early Childhood education to be critical leaders and thinkers for we are skeptical of everything we read and see many kids now are relying on social media for their information and you just have to be skeptical of what is motivating. These campaigns are very sophisticated whether race or economics and then to drive of pledge and what existed in our society so we have to be skeptical consumers of information far more so and to be on notice. We have to ended their thank you for joining us today and of course to sylvia and tom and Stuart Patrick for that incredibly important and enlightening report the transcript will be on the Senate Confirmation hearings for judge Amy Coney Barrett again monday at 9 00 a. M. 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