Equitable and effective Global Distribution of vaccines. This conversation is part of a series, global inclusive recovery and rebuilding which was developed with the aspen into institute in word joining the global interveners group in this effort to present the presentation today, we are very honored that Elizabeth Cohen of cnn is leading the conversation and as a reminder and we are happy to get to the questions as part of the conversation. Thank you all and welcome elizabeth. Thank you so much im so glad to be here with all of these wonderful panelist that we are going to have with us, nearly ten months into the outbreak, covid19 is exposing equities and Healthcare Systems worldwide in hopes that the vaccines will really change things because right now this virus has killed more than a Million People worldwide and its infected more than 44 Million People, millions have been left without work and economy have been left many in terrible shape. , how do we ensure a Vaccine DevelopmentDistribution Process is unhindered like a domestic and you not politics. I like to introduce my guest, kathleen is one of the foremost experts on national and Global Executive huma services, she prs strategic advice to Companies Investors and nonprofit organizations. Mike serves for mastercard, in that role he is a responsible for growing restrictor turn Enter Partnership and scaling the Business Opportunities and other institutions to address major societal and economic issues. We also have with us anita zadie who is the director of the Vaccine Development surveillance and Diseases Program at the bill and Melinda Gaetz foundation, her teams focuses on Vaccine Development for people in some of the poorest parts of the world. And finally we have with us the managing director resource mobilization private Sector Partnership and innovative finance at gabby the Global Alliance for vaccines and immunizations, since joining gavi and 2011 her leadership has been instrumental in raising Critical Resources for equal access for vaccines for all. Thank you we are also honored and lucky to have you with us today. Thank you so much. Lets start off broadly and whoever wants to jump in, please do, are you concerned the Vaccine Development process has been or will be hindered by politics by the domestically or internationally, if so what can we do to him that down. Lets start this, maybe i can start this, from the United States, first of all its great, thank you to the Aspen Institute for organizing this conversation, im delighted to have a chance to be with marie, anita and mike my colleague from the prior administration, we Work Together on lots of issues, at least from the United States perspective i think there is no doubt that your middle of a political debate. That has a huge impact on vaccines distribution in the u. S. As well as in the world, the United States has withdrawn from our leadership effort with equitable distribution worldwide, we are threatening with this administration to pull out of the w. H. O. Which is a critical platform for transparency and distribution, we have not participated in two of the large funding conferences that have occurred for our neighbors in europe and others to look at investing in equitable distribution and manufacturing i would say also with the post2017 organization focused on a coalition focused on academic preparedness congress has not invested, we put a total of 20 million into the entity but it currently is proceeding with investment and nine vaccine candidates, the u. S. And our u. S. Centered warp speed is only investing in six of those, we have a possibility in the United States to be at the back of the line if one of the other three is actually the first to show effectiveness and safety, not only are we not providing leadership in the world, were not participating in the world effort, we are threatening to withdrawal resources in the feature that can hamper and were putting our citizens in a deeply dangerous situation if we dont rejoin the world collaborative very soon, its all about politics. Anyone else want to jump in. We are here to talk about vaccines, the same could be said about therapeutics as well and is one reason why we joined in welcome to create the therapeutics precisely to make sure there was equitable distribution of testing and treatment even as we work on the vaccine, its very important to have that, it is not just the right thing to do, if you dont have it and if you see nationalism or protectionism introduce themselves in the supply chain and the distribution youll end up driving up the cost of the drugs at the end of the day and you will diminish the effectiveness, its in our interest that people all over the world are treated appropriately, tested appropriately and vaccinated appropriately, we gotta stomp out covid wherever it is or we will see waves of it coming back to our shores over and over again. I think there are useful lessons as a former trade person, i think there are useful lessons from the trade investment world people like chad and thomas have written about applying principles from the trade world to vaccine nationalism reducing expert constraints, many countries, not just the u. S. Threatened to put on restrictions of the exported ppe and ventilators and threaten to do some of the same things with the supply chain that goes into drugs, import barriers that can be reduced tariff and nontariff, expanding the supply chain so were not overly dependent on one country or one source for some of the inputs, the compounds et cetera and will be in good steps towards ensuring there is a free flow of treatments over time and ultimately that requires coordination globally and frankly u. S. Leadership and having the u. S. Be at the table as kathleen said in demonstrating leadership in this effort with very difficult questions about how to distribute with the scarce resources will be critically important. I can add on the point of view that its very clear now without a global approach that make sure the entire world is protected by using safe and effective vaccines that we will not in the pandemic. Anything that we can do to bring the world together including the u. S. Take it astride full place is just critical. For everybody to be protected everywhere. We have been through much effort of scientists, policymakers, other people who understand how the pandemic has evolved and needs to be controlled the global organizations did and in many cases they come together and this is how we got to the act and the access within accelerator of pullback in the filler in existing entities on vaccines, gavi, Global Alliance which helps secures and delivers vaccines to developing countries in the coalition for epidemic preparedness which is responsible for developing epidemic products and government control, organizations have come together to help in the coalition pullback. Now im looking with the exception of the u. S. And russia. We hope that the u. S. Joins, then everybody can Work Together from the scientific point of view its been disheartening to see how people come together to advance covid vaccines in a safeway and to show that they are effective to control the pandemic. A lot of collaboration is happening but much more is needed. To your point, i think indeed there is concern because obviously theres never been such a pandemic of that size and the work is daunting but as you just said, weve also seen a wakeup call in a sense and a movement for coming together and to pullback opportunities which today is in 184 countries. The idea of the magnitude of the work is to pull the resources and really adopt this portfolio approach of investing vaccines that can accelerated together and because of the portfolio since we need to give the risk of the view that in 12 month or 18 months by the end of 2021 a certain number can be procured and provide a buffer to actually guarantee access for 20 of the World Population so we can vaccinate the high risk people in frontline workers and stop from there. One of the difficulties in the supply constrained environment in the first time you need to vaccine for 7 Million People, is very important the corporation that mike was talking about in a sense making sure that everybody has access at the same time even the globalization, everyone can be protected at the same time otherwise it just wont work. I a few of you mentioned kovacs, of audience member had a question, kovacs is being led by gavi which is the coalition for epidemic preparedness innovation and to accelerate the develop of manufacturing, 19 vaccines and to guarantee fair and equitable access to every country worldwide, this audience member knows as many of you have that the u. S. Has not joined kovacs in the audience member asked how can they participate in Global Developments around covid vaccines and i would add, i think you touched on this, what is the problem that the u. S. Is not joined this and what should be done about it, marie back to you you are one of the leaders f covax can you address this. Theres lots of ways that the u. S. Could contribute and the gavi board where the u. S. Is very active theres a lot of conversation and because you dont deliver a vaccine alone so theres a lot of work to be done in delivering in the u. S. Can come in and participate and also where the u. S. Has been very supportive of gavi we have set up innovative instrument called the advanced market and that will be targeted at making sure the lowincome country has access to the vaccine at the same time and theres a keen interest from the u. S. But also delivery and a lot of the initiative that are being discussed in the Initiative Work speed in the u. S. Or theres various collaboration happening that may not be inside but the ability of collaboration in the positive sign that theres a great dialogue in that space and continuing the support because he is also a key supporter of gavi and continuing with the angle to support the initiativ initiatives. I think maria is very accurate and that congress now is very committed to gavi, congress understands this global relationship, they are committed to making sure that gavi is funded in the u. S. Funds continue so regardless of what the administration has intended, i think congress is a protector and a newer entity that was focused on research and development but i think the threat that the u. S. Would not only not participate but withdraw funding from the w. H. O. Is really dangerous in terms of the world capacity, our resources are needed and i was here leadership is needed to mobilize an effort of developed countries to look outside of the borders and say we not only need to vaccinate our own population but we need a global view because diseases know no borders if somebody is ill and africa or asia, that still a threat potentially to the United States and also the moral thing to do, i think were on the eve of an election and there are two very different views of global participation and held by the two president ial candidates and i dont think theres any question that we would rejoin various global packs and resources in different places if there is a change in administration, this is not relatively new and current view that is potentially worrisome not just for the safety and security of the American Public but the safety and security of the world because without their u. S. Resources and moral call to gather together, the ae you has done to spring meetings, the United States did not participate, they did the giving conference in the u. S. To not participate. Gavi is protected by congress, that is still very dangerous when you see a Global Pandemic raging. Thank you kathleen, mike or anita do you want to chime in on the issue of the u. S. Not belonging to covax. I would just say everything that they said is absolutely right, what is interesting in the absence of u. S. Federal government involvement you have a lot of participation of private sector, the pharmaceutical companies and other biotech companies, lots of activity by fully enter p and elsewhere to try to keep the progress going, the danger think how outraged the u. S. Would be if the vaccine that emerges was produced somewhere else that we did not have access to because we did not participate in we did not support the global effort, we would be outraged, i think a lot of the research is being done in the u. S. , there is some Research Going on elsewhere and we want to make sure its part of the efforts in support of those efforts in leading the very difficult conversation on rated the first hundred million or billion or 2 billion doses go, is it the healthcare workers in frontline workers, is that elderly and vulnerable is that the children taken back to school, as a producer countries on producer, rich or poor countries, they will have to be a number of hard decisions even as you go to the 7 billion doses or 14 billion doses, how many are required and it will need to be u. S. Involvement and leadership in the effort or it will be chaotic. Thank you for that mike, you mentioned but did you have anything that you wanted to add. I would add that im really optimistic from the gavi side, it is one thing to make the vaccine in the vaccine is so important and theres a huge opportunity from the u. S. In gavi in the u. S. Social much generosity by immunizing children everywhere and theres many other Infectious Diseases like the measles and gavi plays a huge role in getting those vaccines for every child around the world so i have my fingers crossed that we will see the u. S. Play a huge role even if we missed the opportunity on the Development Side although we havent missed opportunity because the u. S. Research may find a vaccine that works or as mike was saying something from the Research Done outside the u. S. , there is much more clarity on how this research has done outside of the u. S. And get to people everywhere and not so much clarity right now from the u. S. But one can hope the private sector takes on the role on the r d side in a company that has companies all around the world with vaccines and provided to people around the world and one other point, theres an interesting analysis that was done and shows next year if all of those vaccines are used by high Income Countries and twice the number of deaths if we figure out how to get around the world. There is every side on this and how we make the decisions on who gets vaccinated first then supplies will be limited which would be the situation and to figure out at how we do that an equitable way which makes the most sense in terms of saving lives in getting the word back. I want to touch on something that anita said when his vaccine really beginning january, this was an assumption that people would want to get in fact the concern is how do we get it to everyone that wanted but in the months in the past is the u. S. In another country pulls have shown that many people dont want his vaccine because they fear that it will not be safe, in the u. S. There is polls showing that a third or half of americans say that they dont want to get it in anothers also a significant chunk of people in other countries who dont want to give it, a vaccine is only good of people roll up their sleeves and take it, anything we can do to increase the trust in this taxing . I go first, and im sure this ought a lot more color, there is an empathetic of misinformation on vaccines right now, not with just some but all vaccines and all of us will have to work really hard which involves working with communities and understanding communities in addressing those concerns and i like the confidence in communities that this vaccine is safe and will work and protect people and all of the signs that needed to be done that will be safe and effective have been done corners have not been cut which is why we communicate and there will be no shortcut when working with communities. One of the two ways is to prepare now there is a whole process of delivering the vaccine and i see the that is where all of us in particular in the private sector even as expertise especially in tracing and the measurement and also the communication that brings the right information, by really bringing International Expert that can bring the best and the approach but also having a measurement and also how we measure and countries, thats where the private sector comes in, gavi started much before coburn of being able to trace and some of the lowIncome Countries, now you know this is being turn to get information about covid19 situation, get the better sense of what we need and once a vaccine becomes available that we can use and a lot of countries to provide information and also get feedback, i think thats where theres a much bigger effort to everyone and in the real to participate in the cycle of effort, i think it would be the most important to communicating and using communitybased workers and also science and technology. I think in some ways in the u. S. At least we will be better off regardless of the outcome once we crossed the threshold of the election and its clear that vaccine approval is not tied to the campaign, fortunately that has been asserted over and over again which i think has raised the level of skepticism of some of the American Public about our safety guidelines being shortcut, is this a political trick, is this an october surprise, some ways crossing the threshold of november 3 and letting the scientific process fully be on the front line of vaccine approval will be helpful to a number of americans, i do think the whole communication strategy around vaccines itself not only needs a norm is helping the u. S. But globally, unfortunately my colleagues are better diverse tennis than i am but vaccine workers killed in parts of the world where theyre not trusted and were there seeing as trying to undercut the leadership in a country where bring illness to people rather than bringing health and safety weve seen health and safety workers being chased out and we see it in the u. S. People refusing or resisting any Contact Tracing when they call and announce who you had contact with a refuse to answer. There is a growing skepticism is this going to be helpful, is is going to be beneficial in the faster not only a communication strategy in the u. S. But worldwide on the same page that reinforces the science that gets a politicians outoftheway and lets the scientists lead in reinforces the notion that as long as the viruses swirling somewhere its whirling everywhere and i think in some ways getting past the next week in the u. S. May hopefully diminish the political concern that have been raised about whether or not the vaccine is too closely tied to the president ial election and whether the corners will be cut. Thank you for that, do you want to talk about vaccine confidence. The only thing i would add, may be greater than many other areas, it is all about trust and we see surveys of people and what institution in society have porn underperformed well when it comes to coburn, interest in the private sector has done well, people feel like their employers have shared a lot of information to help them in support of them, local governments have fared quite well, the u. S. Has fared quite well and how its dealt with coburn in the trusted is built, to go to his maries point heidi delivered with trust in the trusted network to reach out and help workers collect privacy in the data that helps governments understand written up country and where its working where its not working and be able to remind apparent or an individual when it is time to come in, there are lots of schools i can get people confident that if they participate in this program they will be protected, that will be absolutely critical going forward. Thank you offer those insights, lets talk about distribution for a minute, and the u. S. What are the inherent social and racial inequities that might be present in Vaccine Distribution and what can we do to counteract those inequities. Do you want me too start. Go ahead kathleen. I think covid unfortunately has unpacked her shine a bright light on lots of racial inequities in this country , not the least of which the death toll on black and brown communities is astounding, whats happening in native American Communities is even more troubling so their Underlying Health concerns, there is lack of access to healthcare, a lot of what we call the disparities are really front and center in covid and i think if anything when we get to a National Plan which we still do not have and in some areas of the country local leaders are focusing, we like chicago the current mayor who has tested hotspots and Additional Health personnel in major underserved areas in the city of chicago and that seems to have done a pretty effective job in lowering the virus transmission and in making sure people who were positive and isolated and had safe in secret places to live and in other parts of the country that has not happened at all so the death toll is extremely high and i think it highlights whatever our Covid Recovery plan in the u. S. Has to have real focused attention on healthcare access, testing, tracing, safe places to quarantines and isolate and then vaccination for people who are in densely Populated Areas on frontline jobs who often dont have the luxury of working from home and the luxury of being in the zoom meeting in a private space, people who have to go to work need to be on the front line of the vaccine along with Critical Healthcare workers, right now we dont have a National Plan for vaccination each state is submitting their own plan, no transparency around the plans and again, hopefully we will get back to the point of not only having the cdc identify priority vaccination groups but making sure that the Delivery System to access to providers, thats a big order and in the eight months it has raged but we have a playbook for how to do in the future. Anyone else have any thoughts on racial and social inequities, actually anywhere not just in the u. S. This is the ability of the virus to expose the inequities of societies that are racial income, where you live has just been age, Nursing Homes, its just been unbelievable on how the virus has affected society and shined a light on all the inequities that exist in countries around the world. The particular legacy is a particular difficult issue in this Health System and extra effort is going to be needed in the u. S. To reach out to communities to make sure that they are understanding the vaccine and have access to the vaccine and dont have to worry about testing, care from the foundation we have historically backed with access to urban populations of color and also information and access to information about vaccines, and similar efforts that have to be made in other populations which is why its really important to come together around the world who decide how to distribute the vaccine in 2021 and who are the first groups i get the vaccine based on criteria about what we understand about risk because that is the most rational approach to protecting and saving lives. Before i move on to the next question anybody want to talk about racial and social inequities and how they relate to Vaccine Distribution. If you look back over the last eight months this is really been unfortunate perfect storm of a health disparity, economic disparity in a Racial Disparity among the george floyd murder, the combination has really shined a bright light on the structural issues in the country that create these disparities. When there is a vaccine available, its going to be important that governments and the private sector come together that recognize that and make sure this is not another disparity in terms of how treatments and vaccines are suspense. Anita mention Priority Groups in the flipside of what we were talking about before we might have a lot of people who do not want to vaccine and we might have people who are getting in line for a vaccine who are not a part of whatever Priority Group is being prioritized at that moment, do you folks perceive any issues with that with verifying that people belong to the Priority Group that is first in line at the moment, is not going to get messy or do you think that will go smoothly for example if its healthcare workers were people with underlying conditions, is not going to get messy. I think kathleen could answer this in more details but i can quickly say you cant have a statebystate approach you need centralized thinking on this and to figure out what this tragedy should be in the u. S. And so everybody is doing the same thing. And competing. I think that is true, the statebystate approach to put a fine point on it is pretty nuts if im concerned, it leaves a very high possibility of very inequitable distribution and chaotic transportation to get to sites where you vaccinate. The u. S. , i dont know how the rest of the world will deal with this, we had an issue with the h1n1 vaccine where part of the group identified as the front of the line healthcare workers and there was an objection from any of the healthcare workers to be vaccinated. I think this is a situation which ramps up the contagious possibilities to a higher level and whether or not the u. S. Will have and look at mandatory vaccinations, i dont know that conversation is very complicated but maybe essential in this case, its very difficult to think about healthcare workers dealing with Covid Patients and not being vaccinated themselves so they continue to spread, things like that, Nursing Homes and the aides who work at Nursing Homes are the essential workers or not, we have a lot of internal decisions but i think the rest of the world, i think anita may have said this warm rheology, having a worldwide discussion of where the Priority Groups are, worldwide discussion of what the protocol looks like would be enormously helpful to get out of a u. S. Centric and a Health Worker and vulnerable population are likely to be at the front of a line, theres no way possible to identify from the outside people with preexisting conditions, that is self identified because all ages and all strikes of folks, i worry more about the groups of individuals but still leaves a lot of people at risk. What would be nuts about having a statebystate role, what would be chaotic, specifically what do you think would happen if this is done statebystate. The states will be responsible for location, where to get vaccinated, recruiting the vaccine providers, what the logistics would look like, thats a very appropriate but in terms of north dakota having a whole Different Group of individuals who were prioritized as close to texas, then trying to figure out the logistics of that, right now this is another area that our federal government for the First Time InternationalHealth Emergency has pushed off what should be a National Plan to a state and local level, what we seen so far, that is not work very well, not having a National Strategy on everything from communication to Health Protection has not really been very effective, im hoping we get the vaccine that we will have a National Framework with a clear National Identification of priority, we know that the vaccine will not arrive at al at the same time, we know that you will not have all the doses ready at once, where they go, how they get there, who gets in line needs to have some transparency in some National Framework and then can be delivered and administered at the local and regional level but without the National Strategy and worried it can look like the enter ppe everybodys fighting with the federal government and some dont have a supply chain of their own, young governors flying in all due respect to the private sector and the role that they can play, you dont want to rely on the football teams playing to get ppe into the states, theres something a little crazy about this localized food fight and we seen it on protective equipment, i would hate to see it play out again on vaccines. We only have a few minutes left but i want to finish up looking into the future of distribution and supply chain, are there things we could be doing right now to enhance the networks and supply chain so this goes smoothly when we do have vaccines to distribute. Definitely elizabeth, some of the points that you raise earlier into your question about inequality and so one is what we see best and in unitization programs when you have strong systems, now that we have seen all over the world is not just one country, really some of the weaknesses is actually ready to better prepare us for the rollout of the vaccine with the exceptional history and prepare the head systems and a better distribution the Health Workers but what we know of the vaccines and depending on the technology that we made have a logistics needs that are quite different and to start preparing and we have to remember that vaccines has a lot on coaching in the technology to acquire these types of things but also as we said earlier, communication preparing for the framework, a lot has to do with the Health System in preparing. I think on that workers stop hiring them because somehow in some places thats how they have been more affected than others. The magic word is preparing, we have to plan and prepare, various scenarios depending on how many doses are gonna be available and theres a couple of vaccines that may be front runner vaccines with 14 requirements, how do we do that around the world, are we prepared for a situation, they are like six months which have inequitable situations and we will be doing a lot to get ready and this is a pandemic, everyone is affected and we have to have a global coordinator, we cannot have the situation of doing a different thing in every state doing something different, that is for sure not going to be an effective way. Thank you on that and thank you to all the panelists you have all been great in so many wonderful important points and i feel like we should all get together in three months into another one to see if some of the concerns that we talked about if its happened and some of the challenges that we can look at and see if they were met. Thank you so much and i will hand it back to peggy. Thank you so much elizabeth and kathleen and marie and mike and anita, the allstar lineup of people who devoted their lives to tackle the issues, this is a fascinating conversation and if you take a ways without a global approach we are not going to beat this pandemic, mike you said its all about trust and then you asked us to consider the Critical Role of the private sector, kathleen your call for a National Framework for Vaccine Distribution and using the strengths and weakness of Health Systems will make or break whether were able to distribute vaccines, thank you all into all of our listeners on cspan and elsewhere today, thank you for tuning in and we have a request to do serial number two which i hope thank you all for joining us. Thank you. Thank you. Thank you. 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