Mastercard center and we are joining with the global erinnovators group on this effot to present the presentation today. We are very honored that elizabeth of cnn is leading the conversation and as a reminder, you can submit questions when you registered and we are happy to get to those questions as part of the conversation so thank you all and welcome, elizabeth. Peggy, thank you so much and i am so glad to be here with all of these wonderful panelists we are goingha to have with us. For nearly ten months into this outbreak, covid19 is exposing deepep inequities into the systm worldwide. Right now this virusac has killd more than a Million People worldwide. Its infected more than p Million People, millions left without work and economies have been left. Nany left in terrible shape so how do we ensure that Vaccine Development and Distribution Process is unhindered by domestic and international geopolitics. Id like to introduce the guests, kathleenen sebelius is e of Americas NationalGlobal Health issues Human Services executive leadership and the ceo of sibelius resources shehe provides strategic advice to companies, investors and nonprofit organizations. Mike serves as the chairman for mastercard and in that role hes responsible for growing strategic partnership, business opportunities, advancing the companys efforts toch partner with government and other institutions to address major societal and economic issues. We also have with us anita, the director of the Vaccine Development surveillance Diseases Program at the bill and Melinda Gates foundation. The focus on Vaccine Development for people and d some of the poorest parts of the world. And finally we have with us maria, the managing director of resource mobilization, private sector partnerships and innovative finance at the global iliance for vaccines and immunization. Since joining in 2011, her leadership has been instrumental in raising Critical Resources to provide equal access to vaccines for all so thank you. We are all so 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 that Vaccine Development process has been or will be hindered by politics, by the domestically or atternationally and if so, what can we do to tamp that down . [inaudible] maybe i can start this. From the United States, first its great to see you, elizabeth and thank you to the Aspen Institute for organizing this conversation. Im delighted to have a chance to be with you, my colleague from the prior administration. We worked together on lots of issues. But at least from the United States perspective, i think theres no doubt that we are in the middle of a political debate, and unfortunately, that has made huge impacts on vaccine nedistribution here in the u. S. S well as in the world. The United States has withdrawn from our leadership effort with equitable distribution worldwide. We are threatening with the administration to pull out of the who which is a critical platform for transparency and distribution. We have not participated in the large funding conferences that have occurred with our neighbors in europe and others to look at investing in equitable distribution and manufacturing ctand i would say also even with the post 2017 organization focused on a coalition, focused on epidemicio preparedness, congress hasnt really invested. We put a total of 20 million into that entity. But currently it is proceeding with investment in nine vaccine candidates. The u. S. And the u. S. Centric warp speed is only investing in six of those. So we have the possibility in the United States to be at the back of the line if one of the otherf three is actually the first to show effectiveness and safety. So not only are we not providing leadership in the world, we are not participating in this world effort. We are threatening to withdraw resources that could hamper the world effort but we are putting our citizens in a deeply dangerous situation if we dont rejoin the world very soon. Its all about politics. Thank you. Anybody else want to jump in on this question. First, i would broaden the question even further. The same could be said about therapeutics c and diagnostics s well. Its one reason why we joined and said welcome to create therapeutics slip precisely to make sure there was equitable distribution testing and treatments even as we work on the vaccine. Itss important to have that. Its not just the right thing to do. If you dont have that access you see nationalism and protection introduce themselves and the supply chains and you will end up driving up the cost of the drugs of the day and diminish the effectiveness. Its in ourd interest that peoe all over the world are treated prappropriately. Otherwise we will see waves of it coming back onto our shoulders over and over again. There are some useful lessons from the trade investment world in applying principles and reducing export constraints of many countries not just the u. S. Threatening to put restrictions on ventilators and doing some of the savings with the supply chains. Expanding the supply chain so we are not overly dependent on one country or one resource fo soure of the inputs and that would be a good step towards ensuring there is a free flow over time and ultimately over time that requires coordination globally and frankly thedi u. S. Leadershp in having the usb at the table demonstrating leadership in this effort is a difficult question about how to distribute the scarce resources is going to be critically important. Ia can add to that global approach that makes sure the entire world is protected by using safe and effective vaccines we are not going to end this pandemic so anything we can do to bring the world together is critical to be prevented everywhere. Weve been through much effort on the policymakers and other people who understand how the dynamic has evolved and needs to be controlled. The global organizations did in thmany cases come together so ts is how we got through to the accelerator. The Global Alliance that secures and the numerous vaccines in the countries and the coalition for the preparednesss that is responsible for developing the products and who. Theyve come together in this coalition. The entire world is a part of this now. We hope that the u. S. Joins and then everybody can Work Together from the scientific point of view and come together to advance the global vaccines to show they are effective. So a lot of that is happening but much more is needed. In need there is concern and course the work is daunting but we have also seen the movement for the multilateralism coming together and when we hear the idea and the magnitude of itthe work is to pull the resources and adopt this portfolio s approach that can be accelerated and the portfolio we do that in 12 months or 18 months by the end of 2021 a certain number of those seats can be procured and provide a minimum buffer to guarantee access for 20 of the worlds population so we can vaccinate the high risk people and start from there. In the supply constrained environment its very important that corporationon mike was talking about was making sure even the globalization that we have seen, everyone can be protected at theon same time otherwise it just wont work. A few of you mentioned and an audience member had a question, so lets get to that question. For the background, its being led by gabby which is the coalition for academic progress and preparation and the aim is to accelerate the development to the manufacturer of the covid19 vaccine and maintain fair and equitable access worldwide. The audience member notes as many of you have that the u. S. Has not joined on this and the audience member asks how can the u. S. Participate in the Global Development around the vaccine and i would add and i think you touched . On this, what is the problem that the u. S. Hasnt joined and what should be done about this . You are with one of the leaders. Can you address this . There are a lot of ways the u. S. Can contribute. Theres a lot of conversation. You dont to deliver a vaccine alone. Theres a lot of work to be done. Theres a lot of areas where the u. S. Is keen to participate and the u. S. Has been veryry supportive. We have set up the final instrument called the advanced market and that would be targeted at making sure they have access to the vaccine at the same time. Additionally theres a lot of initiatives. So theres areas of collaboration happening that man ought to be inside where there was the collaboration and there theres a great dialogue in that space continuing the support and continuing through that angle to support the initiative. I think maria is very accurate that congress now is very committed and understands this global relationship and they are committed to making sure they are funded and that the funds continues regardless with the administration has intended, i think congress is sort of t a protector. Is that a new entity that was focused on research and development, but i think the threat that the u. S. Would not only not participate and withdraw funding from the who is dangerous in terms of the worlds capacity and the resources needed and i would say our leadership is needed to mobilize the effort of developed countries to look outside of the borders and essay we not only need to vaccinate our own population but we need a global view because disease knows no borders if somebodys ill in africa or asia its a threat potentially to the United States and its the moral thing to do. We are on the eve of an election and there are different views of globalf participation held by te president ial candidates and i dont t think theres any questn that we would rejoin the various global packs and put resources in different places if there is a change in the administration but this is a relatively new and current view that i think is potentially worrisome not just for the safety and security of the American Public but for the security of the world because without the u. S. Resources and the kind of moral call to gather together, the eu has gone to the meetings. It is dangerous when you see a Global Pandemic raging. Do you want to chime in on this issue of the u. S. Not belonging . I would note everything that was said is absolutely right. What is interestingn is even in the absence of the federal involvement, you had a lot of participation of the private sector and pharmaceutical companies and others and lots of activities by the foundation and others to try to at least keep the progress going. Think how outraged the u. S. Would if the vaccine most effective was produced somewhere else and we didnt have access to it because we didnt participate because we didnt global effort, we would be outraged so i think a lot of the research is being done in the u. S. , there is Research Going on elsewhere and we want to make sure we are part of those efforts and support those efforts as well as leaving that difficult conversation about the first 100 million, doses go. Billion is it the healthcare workers, frontline workers, the children as they get back to school, producer countries or non producer, rich or poor countries. There is going to have to be a number of hard decisions made as we go to the 14 billion doses or how many doses are required and its going to be u. S. Involvement involved in that effort. Thank you for that. Anita, you mentioned, but is there anything else you want to add . I would add im optimistic and its one thing to make the vaccine to get to people and a huge opportunity to declare to which so many around the world show so much generosity and there m are many other infectios diseases as we know. I have my fingers crossed [inaudible] even if we missed an opportunity on the development side, the u. S. Research made by Vaccine Networks or it could be by theea Research Done outside of the u. S. Theres much more on the Research Done outside of the u. S. And how that vaccine would get to people everywhere. There isnt so much guarantee right now from the u. S. But if its a Multinational Company that has development can be provided to people around the world and one other point there is a race on this analysis that shows next year we have 2 billion doses of the vaccine. If one is used by high income countries, that would result in potentially twice the number of deaths than if we figure figurew to distribute the vaccines effectively around the world. If the delivery side of this and how we make the decisions around who gets vaccinated First Supplies would be limited and its important for the world to come together to figure out how we do that in an equitable way which makes the most sense in terms of saving lives. I want to touch on something she said. When the vaccine effort began back in january it was a sort of assumption that people would want to get it to everyone who wants it but in the months that have passed in the u. S. And as well as other countries the polls have shown many people dont want to get this vaccine because they fear that it wont be safe. There is the u. S. Showing that a third or even half of americans say they dont want to get it. And i know theres also a significant chunk of other people in countries that dont want to get it. A vaccine is only good of people rollre up their sleeves and take it. Is there anything we can do to increase the trust in this vaccine . I can go first and im sure my fellow panelists will add. This is a big bite in which there is misinformation on the vaccines right now not just covid but all and we have to work very hard with communities and understanding communities concerns and addressing them. Thats why i like the phrase of building Vaccine Confidence in communities that this vaccine is safe and will work and all of the science that needed to be done to show they will be safe and effective have been done. No corners have been cut which is how we communicate. But theres going to be no shortcut in working with the communities. [inaudible] the ways is to start preparing very well now. Theres a whole process of delivering the vaccine and i think thats where particularly the private sector and expertise especially in tracing and the measurement and implementation to bringn, the right information about the information that will be coming out. By bringing the international expertss and the best of science and also having the stronger monitoring measurement but its also about how we measure it in the countries and thats where the private sector can help a lot. It started before the partnership of being able to trace the digital income country and vaccination and now its been turned into being able to get information about monitoring covid19 situations and getting a better sense of whats needed and as it becomes available this is a type of platform that can be used to help provide information and get feedback. That is a call to everyone because that would be the most important using the communitybased workers and science and technology. I think in some ways in the u. S. At least we will be better off regardless of the outcome and its clear it is and tied to the campaign. That has been asserted over ando over again which has raised the level of skepticism among some in the American Public about our safety guidelines being shortcut in this stage is it a political trick so in some ways just crossing that threshold and letting the scientific process fully be on the front lines of the vaccine approval would be helpful i think to a number of americans. I do think the whole communication strategy not only needs an enormous hel enormous. But globally. We have seen, and my colleagues are more versed in this than i am thatt vaccine workers where they are notrt trusted and they are seen as trying to undercut the leadership in a country or bring illness to people rather than bringing health and safety. Weve seen health and safety workers chased out and weve seen it here in the un. People are refusing or resisting any kind of Contract Tracing when they are asked who you have contact with, they refused to answer, so there is a growing skepticism about is this going to be helpful. Is this going to be beneficial. Hopefully we can get not only a communication strategy in the u. S. , but worldwide and on the front s page that reinforces the science and gets the politicians out of the way and lets the scientists in and reinforces the notion as long as its ruling somewhere, its everywhere but in some ways getting past next week in the u. S. May hopefully diminish the political concerns that have been raised about whether or not the vaccine is closely tied to the president ial election and whether the corners will be cut. Thanks for that. Do you want to talk about Vaccine Confidence of it . In this area and may be other areas, its all about trust. We see surveys about people who perform well on the trust measurements versus others when it comes to covid. Its going quite well. People feel like the employers are sharing a lot of information and help them and have supported them. The local government has bared quite well in terms of how its dealt with covid. But looking at how do you deliver with trust and using the tools of a trusted network to reach out and help the Health Workers collect privacy and the data that helps the government understand where its working and where its not working, to remind a parent or an individual when its time to come in for a second shot or a a booster shot, there are tools out there to give people confidence that if they participate in this program they are going to be protected and that is going to be critical going forward. Thank you all for those insights. Lets talk about distribution for aer minute now. In the u. S. , what are some of the inherent social and racial inequities that might be present in the Vaccine Distribution and what canut we do to counter thoe inequities . You want me to start . Sure, go ahead. I think covid unfortunately has shined a bright light on stts of racial inequities in the country, not the least of which is the death toll on black and brown communities is astounding. Whats happening in native American Communities is even more troubling than the Underlying Health concerns. There itheres lack of access to healthcare. Its front and center in covid and i think if anything, when we get to a National Plan, which we still dont have, and in some areas of the country, leaders are focusing i think like in chicago, the current mayor who has put testing hotspots and Additional Health personnel in major underserved areas in chicago, and that seems to have done a pretty good job lowering the virus transmission and making sure people who were positive were isolated and have safe and secure places to live. And other parts of the country it hasnt happened at all so the deathou toll is extremely high. And i think it highlights that whatever our Covid Recovery plan is in the u. S. Has to have real focused attention on healthcare access, testing, tracing, safe places to quarantine and isolate and then vaccination for people who are in populated areas, frontline jobs, who often dont have the luxury of working from home and the luxury of being in a zoom meeting in a private space. People that have to go to work need to be on the front line of the vaccine along with criticalt healthcare workers. So, right now we dont have a National Plan for vaccination. Submitting their own plan. There is no transparency around the plan. And again hopefully we will get back to the point of not only having the cdc identify priorities for vaccination groups, but making sure that the Delivery System is equipped to get into areas with typically access t to providers and identifying the folks that need to be on the front lines. Nursing homes it has been unbelievable to see how it has affected society and all the inequities that exist. So with our legacy it is a particularly difficult issue so the extra ever will be needed in the us to make sure they understand these vaccines and worry about access to testing and access to care. From the foundation and with those populations of color and access to information about vaccines and similar efforts to be made in other populations and for those groups because that is the most rational approach and saving lives. Before i move on to the next question does anybody else want to talk about inequities relating to Vaccine Distribution . R looking back over the last statements, it has been the unfortunate perfect storm of the Health Disparity in noeconomic disparity and the combination of those issues in the country that create these disparities. But there is a vaccine available on the government philanthropy that recognize that to make sure how treatment is dispensed. Mentioning priority on the flipside which is a lot of people who dont want a vaccine but also those getting in line who are not a part of whatever parities they are prioritized at that moment. Do you perceive any issues with that to verify that people belong to the Priority Group at the moment . Were baguette messy or go smoothly . Or healthcare workers or people with underlying conditions . Itoi messy . This is why you cannot have a statebystate approach and you need centralized thinking to figure out what the strategy should be to vaccinate in the us. Otherwise it will be very messy schedule. The statebystate approach to put a fine point on it with a high possibility of Equity Distribution and chaotic transportation so the us at least how the rest of the world to one deal with this. With each one and one vaccine and then to identify at the front of the line or healthcare workers and it was an exemption one and exemption. This is a situation to ramp up at a higher level and whether or not us those mandatory vaccinations. s and then healthcare workers to do with Covid Patients not be vaccinated themselves. Nursing homes are the essential workers are not . And the rest of the world that having a worldwide discussion of whether parity groupss are of what that will call looks like would be enormously helpful and with movable populations are more likely to be at the front of the line that is self identified because all stripes of outside worry more about the groups are choosing not to participate that leaves a lot of people at risk. W will would be nuts and chaotic a statebystate so what would happen if this is done statebystate. The state certainly is responsible for location with the vaccine providers and what the logistics look like that is appropriate but in terms of north dakota having a whole Different Group of individuals who are poor ties as opposed to texas and then trying to figure out the Logistics Committee is another area the federal government for the first time with the National Health emergency has pushed off what i think is a national ean to the state and local level. Not having a National Strategy for communication and that to havee a National Framework and a clear National Identification and where the government how they get there. And with that National Framework. And then to be administered at the local and regional level but without the National Strategy i am very worried that the ppe fighting with every other state in the federal government governors are flying and the role that they can play but you dont want to rely on those teams trying to get ppe into a state. Maria seen that protective equipment but not on the vaccine. And with the patient not just distribution and supply chain we can be doing right now to enhance and buttress those supply chain. And what you raise earlier actually to raise the back that with that system. So now we have seen all over the world and with those witnesses one those weaknesses. And solar systems. So depending on the technology is that a logistics needs are quite different. And to start preparing is a new normal and with some of that technology and as we said earlier with communication and then to throughout the vaccine. You have to plan and prepare. There are a couple of vaccines. Are we prepared for a situation and the what they are preparing right now that this is a pandemic. And then this is not an effective way to distribute the vaccine. Thank you for that and thank you to the panel you have all been great. And for those important points i feel we should all get together in three months to see the concerns that we talked about and the challenges. We can look at those to see if they are met. Thank you very much i will hand it back to peggy. This is an allstar lineup of people to tackle thes issues. And without the global approach. And a clear call for national alframework and the strength or weakness of the Health System will make or break to distribute vaccines. Thank you for tuning in i think we already have a request to do part two. Thank you. s i am from aei welcome to our event has trump populism succeeded . He has been a mix of