On equitable distribution of vaccine. My name is peggy clarke im the executive director of the Innovators Group and Vice President of the Aspen Institute. Thank you so much for joining u us. Today the Global Inclusive Growth Partnership which is a partnership between the Aspen Institute and the Mastercard Center for inclusive growth, is presenting an important conversation on ensuring the equitable and effective local distribution of vaccines. On this conversation is part of a series, global inclusive recovery and rebuilding which was developed through the Mastercard Center were joining with the group in this effort to present this presentation today. Were very honored that Elizabeth Cohen of cnn is leading this conversation. And as a reminder you can submit questions when you registered. Theyre happy to get to those questions as part of this conversation. So thank you all and welcome elizabeth. Peggy thank you so much im so glad to be here with all of these wonderful panelists that we are going to have with us. Nearly ten months into this outbreak, covid19 is exposing deep inequities in Healthcare Systems worldwide. Their hopes are the vaccine will really change things. Because right now this virus is killed more than a Million People worldwide. It is has infected more than 44 Million People. Millions have been left without work. And economies have been left, many of them in terrible shape. So how do we ensure the Vaccine Development and Distribution Process is unhindered by domestic and International Geopolitics . I like to introduce my guest. Kathleen is one of Americas NationalHuman Services in executive leadership as ceo of the resources, she provides strategic advice to Company Investors and nonprofit organizations. Mike froman serves as a chairman for mastercard. In that role he is responsible for growing strategic partnerships, scaling new business opportunities, advancing the companys efforts to partner with governments and other institutions economic issues. We also have with this anita she is the director of the Vaccine Development surveillance and Diseases Program at the bill and Melinda Gates program. Her team works on the focus of Vaccine Development for people in some of the worst parts of the world. Finally we have with this maria, she is the managing director, resource mobilization, private Sector Partnership and innovative finance the Global Alliance for vaccine and immunizations. Her leadership has been instrumental in raising Critical Resources to provide equal access to vaccines to all. So thank you we are also honored and lucky to have you with us today. So thank you so much. Lets start off broadly. Whoever wants to jump in, please do. Are you concerned that the Vaccine Development process has been or will be hindered by politics . Whether domestically or internationally. And if so, but can we do to tamp that down . Let me start this. Maybe i can start this. From the United States. First of all it is great to see elizabeth, thank you for the Aspen Institute for organizing this conversation. Im delighted to have the opportunity to be here with all of you. Mike and i worked together on a lot of issues. But lace in the United States perspective i think there is no doubt we are in the middle of a political debate. And unfortunately, that has a huge impact on Vaccine Distribution here in the u. S. As well as in the world. The United States has withdrawn from some of our leadership efforts 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 with our neighbors in europe in europe and investing in equitable distribution and manufacturing. I would say also, even with a post 2017 focus on a coalition, focused on epidemic preparedness, congress is not really invested. We took a total of 20 million into that entity. But currently is proceeding investment and nine vaccine candidates. The u. S. Entered u. S. Centric warp speed is only investing in the six of those nine. We have the possibility in the United States to be at the back of the line if one of the other three is actually the first first not only are we not providing leadership in the world, we are not participating in this world efforts. We are threatening to withdrawal resources in the future which could really hamper the world effort. But we are putting i would say our citizens in a deeply dangerous situation if we do not rejoin the world collaborative really soon. Its all about politics, not about science. Thank you kathleen peart anybody else would jump in on this . Spread not the question even further. Want to talk about the vaccine of course but we want to talk about therapeutics and diagnostics as well. Its one reason we join with gates to create this therapeutics accelerator, precisely make sure theres equitable distribution, testing of treatments even as we work on the vaccine. Very important to have that. Not just the right thing to do, if you dont have nationalism or protectionism introduce themselves into the supply chain and into the distribution or going to end up driving up the cost of the drugs at the end of the day. And youre going to diminish the effectiveness. Its in our interests that people all over the world are treated appropriately, tested appropriately and vaccinated appropriately. With got to stop at covid wherever it is. Otherwise well see waves of it coming back onto our shores over and over again. I think theyre actually some useful lessons. I hate to be myopic as a former trades person. But there are some lessons in the trade and investment world. Theyve written about applying some principles from the trade world to vaccine nationalism, reducing export constraints, to many countries not just the u. S. Threaten to put on restrictions on the exported pp p, on ventilators, some of the same things but the supply chain that goes into drugs. Import barriers that could be reduced, both tariff and nontariff barriers. Expanding the supply chains were not overly dependent on one country or one source for some of the input compounds et ceter cetera. It will be a good step toward ensuring theres a free flow of treatments over time. And ultimately that requires coordination globally. And frankly, u. S. Leadership and having it at the table and demonstrating leadership in this effort prints a very difficult question how to distribute these scarce resources going to be critically important. I can add from the accommodations point of view that it is very, very the covid approach but it makes sure the entire board is protected by using safe and effective vaccines. So anything that we can do to bring the world together including the u. S. , is just critical. For everyone to be protected everywhere. We are being through much effort applying to policymakers other people who understand how the pandemic has evolved and needs to be controlled. The global organizations did and many, many cases come together. This is how week got through access to the accelerator. It is a consortium of existing entities that work on vaccines. [inaudible] as you mention the coalition for epidemic preparedness and innovation which is responsible for epidemic products and vaccines. And the organizations have come together. In this coalition. And now almost the entire world is part of. Its off of u. S. And russia. Its the hope that the u. S. Joins, that would be that everyone can Work Together from a scientific point of view. To see how people come together with vaccines at a safeway. Into show that they are effective. Because of the pandemic. The collaboration is happening that much more is needed. Back so to your points, i think indeed there is concern. Theres never been such a pandemic of that size. And of course the work is daunting. But as the color before just said, we have seen actually a wakeup call and a movement for coming together. We gathered together. Which is to be regrouped and fork countries. In the idea is to even the magnitude of the work is to pull the resources. And the approach of investing at the same time in the vaccine that can be together. With the view that in 12 months or 18 months, by the end of 2021, certain member of doses can be procured. And provide a minimum buffer to actually quote unquote guarantee access for 20 of the world population. So that is again at least vaccinate the high risk people. The frontline workers. And from there one of the difficulties as being first in the supply constrained environments. The first time you need a vaccine for 7 billion people. It is very important the cooperation that mike was talking about. Its making sure that everybody has access at the same time. So even the globalization you know, everyone can be protected at the same time. Otherwise it will not work. A few of you mention kovacs. And an audience member had a question about that. Lets get to that audience members question. Kovacs is being led by gabby and steffi was the coalition for economic preparedness. And the aim is to accelerate the manufacture of covid19 vaccine and guarantee fair and equitable access to every country worldwide. This audience member knows come as many of you have, the u. S. Is not joined kovacs. In the audience member asked how can the u. S. Participate in Global Development around Covid Vaccine . And i would add, i think kathleen you touched on this. Is this a problem that the u. S. Is not join this . Then what should be done about this . Really got you up here now and you are with one of the leaders of kovacs can your dresses . I think there are a lot of ways the u. S. Can contribute. I think, there is a lot of conversation. Dont deliver the vaccine alone for theres a lot of work to be done. Where the u. S. Is come in and participate. And also in the country were the u. S. Has been very supportive. We have set up actually Research Specialists with the advance market commitment. And that will be targeted at making sure the low and middle income country at the same time. But also on the deliverance. At the same time being discussed in the u. S. There is very collaboration happening. That may not be inside the act about collaboration. On the positive sign is there really is a great dialogue in that space. In continuing the support, the key support. And continue that angle to support the initiative. Elizabeth, if i might. I think maria is very accurate and that congress now is very committed. Congress understands this global relationship. They are committed to making sure it is funded. In those funds continue. So regardless of what the administration has in ten did, i think congress is sort of a protector. It is a newer entity that was focused on research and development but i think the threat the u. S. Would not only participate but withdraw funding from the w. H. O. Is really dangerous in terms of the world capacity or capacity and resources are needed. Our leadership is needed to mobilize to look outside of the boris and say we not only need to vaccinate our own population, that we need a global view. Because disease knows no borders. If someone is ill and africa or asia, that is still a threat potentially to the United States. And its also the moral thing to do. I think, we are on the eve of an election. There are two very different views of global participation and health that are held by the two president ial candidates. I dont think there is any question that we would rejoin serious global packs and put resources in different places. If there is a change in administration. But this is a relatively new and current view that i think potentially worrisome. Not just for the safety and security of the American Public, but for the safety and security of the entire world. Without the u. S. Resources and moral call to gathered together, the eu has gone to spring meetings the United States did not participate. The un conference, the United States did not participate. Wildes protected by congress, that is still very dangerous when you see a Global Pandemic raging. Thank you kathleen. Do you to try an while chime in on the issue . I would just note that everything they said is absently writes even in the absence of the u. S. Federal government involvement, that a lot of participation in the private sector. Obviously theres a Pharmaceutical Company and others, biotech company. Others like our own support these efforts. Lots of activity by philanthropy. Chief among them. The Gates Foundation and number of others. And elsewhere to try and at least keep the progress going. The danger is, just think how outraged the u. S. Would be if the vaccine that emerges is being most effective was produced somewhere else. And we did not have access to it because we did not participate. And because we did not support the global effort. Youd be outraged. So a lot of the research is being done in the u. S. There certainly Research Going on elsewhere. We want to make sure the u. S. Is part of those efforts and supportive of those efforts. As far as leading a difficult conversation worded the first 100 million or 2 billion doses go . Is it to healthcare workers and frontline workers . Is it to the elderly invulnerable . Is it the children setting back to school . Is it in producer countries, non producer countries . Rich or poor countries . Its going to be half dead be a number of hard choices made as were building up to the doses, however many doses are required. It will need to be more u. S. Involvement in that leadership effort. Or will be quite chaotic. by immunizing children everywhere and there are many, many other Infectious Diseases such as measles and it plays a huge role in getting vaccines for every child around the world and so i have my fingers crossed that we will see that u. S. Play a huge role even if we miss the opportunity on the Development Side although we havent totally missed opportunity because the u. S. Research may find a vaccine that works and it could be from the Research Done outside of the u. S. , there is much more clarity on how the research is done outside of the u. S. And against to people everywhere, and there is not so much clarity on the u. S. But one can hope that the private sector takes on that role on the r d side so a company that has developments around the world and the provider to people around the world and also one other point is there is a very interesting analysis that was done by northeastern, and the next year we have 2 billion doses of vaccines, if all of those vaccines are used by Income Countries that is where there is quite the number of deaths and if they distribute those equity around the world. The side of this and mike was referring to this how we make the decisions on how you get vaccinated first then supplies will be limited and would be the situation in 2021 in the world to come together and figure out how we do that in an equitable way which makes the most sense in getting the word back on its feet again. I want to touch on something that anita said, when the vaccine effort began in january, there was an assumption that people would want to get it in the fact the concern was how do we get it to everyone who wants it, and the months that have passed in the u. S. As well as another country. Shown that many people dont want to get this vaccine because they fear that it wont be safe, in the u. S. There is pull showing that a third or half of americans say that they dont want to get it and i know there is also a significant chunk of people in other countries who dont want to get it, can you comment on that vaccine is only good if people roll up their sleeves and take it. Anything we can do to increase the trust in this vaccine. I go first and im sure my panelist will add a lot more color, this is a big one where there is a pandemic of misinformation on vaccines not just on coping vaccine but all vaccines, all of us will have to work really hard which involves working with communities, understanding communities in addressing those concerns, i really like the Vaccine Confidence in communities of this vaccine is safe and will work and protect people. And that is all that needed to be done to show that these vaccines will be safe and effective in the corners have not been cut which is why but there is going to be no shortcut with working with communities. Anyone else. I think one of the ways is to prepare very well now and were seeing this with the vaccine but a good process of delivering the vaccine and thats where all of us in particular the private sector even expertise especially in tracing and that measurement but also of course the communication, that will bring the right information that we have been coming up, we talked really and thats part of reaching out by bringing International Expert that can bring the best the finance and an approach and also have varying entered very measurement but then also about how we measure and country and thats where the private sector can help a lot and being able to trace in the lowIncome Countries within vaccination and now this is being able to get information about covid19 situation and get the better sense of what is needed and im sure once a vaccine becomes available this is a platform that we can use in a lot of countries to provide information and also get the feedback to. I think that is where there is a much bigger effort and a call to everyone in the sense of having to participate in this type of effort because its a most important preparing Community Using communitybased workers in 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 it is clear that vaccine approval is not tied to the campaign, fortunately that has been asserted over and over again about the American Public in our safety guidelines being shortcut, is this a political trick, an october surprise, in some ways crossing this 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 has helped in that only means enormous help in the u. S. But globally and fortunately we have seen in my colleagues here much better diverse msn im but vaccine workers an are killed ad parts of the world where theyre not trusted with her seen as trying to undercut the leadership in a country or actually bring illness to people rather than bringing health and safety and were bringing health and safety workers being chased out, we see it here in the u. S. And people refusing or resisting they refuse to answer. There is a growing skepticism, is this going to be helpful, is this going to be beneficial and hopefully we can get not only a communication strategy in the u. S. But worldwide that is on the same page that reinforces the science to get the politician out of the way and lets a scientist lead in reinforces the notion that as long as the virus is twirling somewhere it is twirling everywhere. But in some ways getting past the week in the u. S. , they 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 corners will be cut. Thank you for that, mike do you want to talk about Vaccine Confidence. The only thing i would add in this area greater than many other areas, it is all about trust and we see surveys of people of what institutions and societies have performed well when it comes to covid, interesting the private sector has done quite well, people feel like their employers have been sharing a lot of information and are in support of them, local governments has fared quite well, and how its felt with covid in the trust is built but to go to his point, looking at how do you deliver with trust and using the tools of a trusted network to be able to reach out, to collect privacy focused way with the data that helps governments understand where the Country Program is working and where its not working, to be able to mind a parent or an individual and its time to come in for the second shot or the booster shot, there is a lot of that could give people confidence if they participate in this program theyre going to be protected and that will be absolutely critical going forward. Thank you offer those insights, lets talk about distribution, in the u. S. What are some of the inherent social and racial inequities with Vaccine Distribution what can we do to counteract those inequities. Want me too start . Sure, go ahead. I think covid unfortunately has unpacked or shined 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, what is happening in native American Communities is more troubling and its Underlying Health concerns in density concerns, lack of access to healthcare and social disparities in really front and center in covid and if anything it when we get to a National Plan which we still dont have in some areas of the country local leaders are focusing in chicago the current mayor who has put testing hotspots and Additional Health personnel in major underserved areas in the city of chicago and that seemed to have done a pretty effective job in lowering the virus transmission and making sure that people who were positive and had safe and secure places to live in isolation and other parts of the country that has not happened at all, the death toll is extremely high and it just highlights whatever our Covid Recovery plan in the u. S. Has to have real focused attention on healthcare access, testing, tracing, safe places and isolate and vaccination in densely Populated Areas who often dont have the luxury of working from home in 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 and the Critical Healthcare workers, right now we dont have a National Plan for vaccination, each state is submitting their own plans there is no transparency around those plans and again, hopefully we will get back to the point of not only having the cdc identify priority vaccination groups but making sure the Delivery System is wellequipped to get into areas that typically lack access to healthcare and providers and identify folks who need to be on the front line, that is a big order and we have not done it very well in the virus in the eight months it has raged but we have a playbook of how to do in the future. Anyone else have any thoughts on racial and social inequities that will affect not just anywhere but the u. S. This is an issue of this virus to expose the inequities that are racial, where you live, its in Nursing Homes, its been unbelievable to see how the virus has affected society and shown a light on all the inequities that exist in countries around the world so that particular legacy in the u. S. Is particular difficult issue of access and information in the system, its an extra effort and it will be needed in the u. S. To reach out to communities and to make sure they understand the importance of vaccine and have access to the vaccine and dont have to worry about access to testing access to care, from the foundation we are historically back in the colleges to testing for urban populations of color and also information, access to information about a vaccine in similar efforts have to be made in other populations and around the world to decide how to distribute the vaccine in 2021 and based on the criteria because that is the most approach to protecting people and saving lives. Before i move on to the next question does anybody else 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 been the unfortunate perfect storm of the health disparity, economic disparity and Racial Disparity among the George Floyd Murder and the combination has shined a bright light on the structural issues in the country that create this disparities. When theres a vaccine available its going to be totally important to the governments private sector all come together in a way that recognize that to make sure this is not another fourth disparity in terms of how treatment arsonists fenced to this community. You and mention Priority Groups in the flipside of what were talking about, we might have a lot of people who dont want to vaccine and we might have people who were getting in line for vaccine who are not a part of whatever Priority Group is being prioritized at that moment, do you folks proceed 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 is not going to go smoothly, for example if it Just Healthcare workers or if its just people with underlying conditions, is not going to get messy. I just quickly say this is why you could not have a statebystate approach, and figuring out what the strategy to vaccinate in the u. S. , everybody is doing the same thing, if you are competing which we saw you will have very messy. The statebystate approach to put a fine point on it is pretty nuts as far as im concerned, it leaves a hyper stability the u. S. We had an issue with the h1n1 vaccine in their part of the group identified at the front of the line were healthcare workers and yet it was an objection from any of the healthcare workers to be vaccinated, i think this is a situation which ramps up the contagious possibility to a higher level and whether or not the u. S. Will actually have a mandatory vaccination, that conversation is very complicated but maybe essential in this ca case, its very difficult to think about healthcare workers dealing with Covid Patients and not being vaccinated themselves and things like that, Nursing Homes and the aides who work in Nursing Homes, are the essential workers or not, we have a lot of internal decisions, the rest of the world, anita mightve said this that having a worldwide discussion of where the Priority Groups are, a worldwide discussion of what the protocol looks like, i think it would be a normatively helpful to get out of u. S. Centric view but help workers and vulnerable population are likely to be at the front of the 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 and some people would say im just not going there or in choosing not to participate which still leaves a whole lot of people at risk. I want to impact with what you said for a minute, 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 state certainly will be responsible for location, where to get vaccinated, recruiting the vaccine providers what the logistics look like, that is a very appropriate, in terms of north dakota having a whole Different Group of individuals who were prioritized as opposed to texas and then trying to figure out the logistics of that, right now this is another area that our federal government for the first time in a National Health emergency has pushed off what should be a National Plan to a state and local level and what weve 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 i hopefully get the vaccine we will have a National Framework with a clear National Identification of priority, we know the vaccine will not arrive all at the same time, we know you wont have all the doses ready at once, where they go, how they get there, who gets in line i think needs to have some transparency in some National Framework and that it can be delivered and administered at the local and regional level but without the National Strategy, i am very worried it could look like the ppe where every state is fighting with every other state and the federal government and some have a supply chain of their own and you have 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, there is something thats a little crazy about this localized food fight and weve seen it on protective equipment, i hate to see it play out again on vaccines. We only have a few minutes left but i want to finish up with looking into the future about distribution and supply chain, are there things that we could do right now to enhance those networks and the supply chain so this goes smoothly when we do have vaccines to distribute. Definitely some of the point that you raised earlier and to your question evolved inequality and actually what we see bests immunization program, now that we have talked about we have seen all over the world is not just in one country, really some of the weaknesses and to better prepare the rollout of the vaccine that we did actually in history and prepare the head systems and have a Better Network and a better distribution but of course what we know or so of the vaccine and depending on the technology that we may have for example lids quite different and theres a need to start preparing for the just stick and we have to be that it depends on coaching and the technology in these type of things in earlier communication for the allocation framework in the law has to do with the Health System into rollout the vaccine, this weekend especially now. Workers stop tiring them because we have seen thats how some people have been more effective than others. We have to plan and prepare how many doses will be available and there is a couple of vaccines that may be front runner vaccines i have how do we do that around the world, are we prepared for situation where some countries so theres a sixmonth leader with an equitable situation, we will start preparing right now and we can do a lot to get ready in the next months but again this is a pandemic, everyone is affected but we have to have a global coordinator, this is for sure not going to be an effective way. Take you on that, thank you to all the panelists, you have all been great and made so many wonderful important points, i feel like we should all get together in three months and do another one and see some of the concerns that we talked about in some of the challenges we can look at those and see if they were met, thank you so much and im going to hand it back to peggy. Thank you so much elizabeth with the allstar lineup of people who devoted their lives to tackle these issues, its a fascinating conversation to takeaways without a global approach we are not going to get to this pandemic, you said is all about trust and you consider the Critical Role of the private sector, kathleen your clear call for a National Framework and a strategy for Vaccine Distribution and you are saying the strength and weakness of Health Systems will make or break whether were able to distribute vaccines. Thank you all and to all of her listeners both on cspan and thank you for two tuning in we already have a request to do the serial number two which i hope we will be able to do then, thank you for joining us today. Thank you. Thank you. 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