Dean of the cathedral. On the behalf of the bishop of the diocese of washington and all of us who serve this cathedral, welcome we are so glad you have decided to join us for this important conversation this evening. Convening conversations, bringing people together to discuss some of the most important issues of the day [inaudible] priorities since 2008, the nancy and Paul Ignatius program has 8 given the cathedral [inaudibl] y the nancy and Paul Ignatius fd wasta established by their children, david, sarah, amy and audie. Their friends and other relatives and as a recognition of their service and commitment to Washington Cathedral while we said goodbye last year, her legacy lives on here at the cathedral and we are so pleased to have paul as the mainstay of the cathedral community. Not to mention that this years ignatius program is especially important because yesterday Paul Ignatius celebrated his 100th birthday. Happy birthday and god bless and keep you. Thank you for all that you have done. [applause] my topic for tonight couldnt be more relevant or timely. The impact of the pandemic on the nation has been immense. Every week, this cathedral holds a service specifically to pray for those by name for many of those that have lost their lives to covid19 and who among us this time last year could have imagined that we would see 230,000 americans that have lost their lives and the number only growing. The past ten months we have experienced a lot of loss and heartbreak yet at the same time we have witnessed the selfsacrifice and heroic efforts of First Responders and medical personnel and workers. Moreover, we are beginning to see the fruits of the efforts made by scientists around the world to find a vaccine for this virus and to do so at a pace never seen before. The truth is there has been much suffering and loss butss theres also much to be thankful for so where do we go from here . My thanks to the doctors and doctor Anthony Fauci for being the guests tonight to tackle that question and so many others. If you will permit me i would like to begin this evening with a prayer. If its something meaningful in your life i hope that you will join me. Let us pray. Our refuge and strength, very present help and trouble we pray for all those affected by covid19 around the world. Remove the presence of fear and anxiety from our hearts and heal those who are sick with the virus. Give skill and sympathy and resilience to allan of those tht are caring for the sick and your wisdom to those searching for am cure. Strengthen them with your spirit that through their work many will be restored to health all these things we pray in your name, amen. Now it is my pleasure to turn this over to the oldest of the children, david ignatius. Im david ignatius, columnist for the washington post. On behalf of all of the family and with thanks to this wonderful cathedral, i would like to welcome you to a special discussion of the topic the nation and the world are thinking about more thanhe any other, covid19 and where do we go from here. We have have some hopeful news in the past week with the announcement ofst a vaccine whoe phase three test results the keynote speaker not a man given to hyperbole described as really quite good. I mean, extraordinary. And we have had the chilling news of what appears to be a surge of the virus with infections totals rising every day and hospitals around the country straining to treat patients. We are blessed tonight to have three of the wisest doctors in america and of the world to help us think about where we are going and how to protect our families, our country and the world from this scourge of a pandemic. We will open with a conversation between my brother, audi, editorinchief for the review and doctoror Anthony Fauci. Many of you may not have heard of doctor fauci so i will explain hes the director of thh national institutnational instiy and Infectious Disease and has been the leading expert on any person that gives us faith that science and reason will prevail in the end. Following their discussion, my sister amy, the judge in New Hampshire will moderate from doctor Francis Collins director of the institute of health and the Obama Administration is acting chief scientist at the fda, then directed medical and bio defense preparedness for the Trump Administration from 2017 to 2019 and is now a member of president elect joe bidens Coronavirus Task force. Finally a word about the program. As the dean said, my siblings and i helped establish this event 12 years ago to honor our parents, paul and Nancy Ignatius who cherished thei the relationp with this cathedral. Over these dozen years we have had many important speakers including brezinski, brent scowcroft, bill perry, john kerry, susan rice and many others. But weve never had a more important topic or more compelling panelists than tonight. As you know, Paul Ignatius our father celebrated his 100th birthday last night. If you want to think about how to stay healthy in these covid times, hes your man. Its fitting his birthday is veterans day because he spent a lifetime serving his country as a combat veteran in world war ii, later secretary of the navy and truly in everything he does. My brother, my sister, and my other sister sarah who runs the association of our arminian studies and research and is the only ignatius you will not see on stage tonight we would like to dedicate this program to our father in the memory of his wife of 71 years, our late mother, Nancy Ignatius. Now to doctor fauci and my brother. Thank you very much, david and dean for getting us started. David introduced doctor fauci. I wont add to that except to say he left out two things, he has his own top Baseball Card and a bobble head doll that somehow in this year that is 2020 americas leading rockstar is an epidemiologist. [laughter]r] so heres my question President Trump suggested he might fire you. President elect joe biden said he might promote you. You are a 79yearold man. What sounds like a better deal . [laughter] i think the important response that i get asked often is my job as the director of the nih institute and Public Health official is to focus entirely on what my mission and our goal is which is to use science and health to preserve the health, so safety and welfare of the American People regardless of what the administration as you know and many people know that ive had the privilege of serving six president s since i tsbecame director in 1984 and thats what we focus on his scientists. We are livingis in a charged political environment, but that is something that isnt primary for us we just continue to do our job, to force Public Health and also to do the science that leads to things like the vaccine that you mentioned in the introduction that was just mentioned by the dean in the introduction, so thats what i focus on. When you hear those things in the newspaper many people think i get shaken back and forth by that but to be honest i dont. Let me followup a little bit on that. As people started the program they probably thought thats great this is the guy. They are probably democrats. You have a very high Approval Rating among have the country, democrats and not so high among republicans although the independent did a survey and said you are the only person serving under President Trump his Approval Ratings have gone up instead of down. But on a serious note, you and your family have had threats against your life because youve defended science instead of the white house so how did science become so politicized . Thats an important question but also its sad that you have to ask because that is what we have seen a lot in the United States but not just restricted to the United States because we are also seeing it with my colleagues in the uk and europe and other regions of the world. I dont think theres a simple explanation for it but theres been an authority component. We had antivaccination people. Scientists are often perceived as authoritarian and sometimes in fact made that perception themselves by the way they act. I think we can improve on that but right now its just been lumped into the politics of whats going on. We live in a divisive society and even if we didnt have a pandemic it would be a divisive society and the fact thatet we o have a pandemic and its a Public Health issue and Public Health is intimately related to science, all of a sudden science gets caught in a lot of this and that is unfortunate. What we hope and i hope that my colleague feels the same way when we get past this, science will resume its place and being homething thats for everyone without division. Will we get past this meaning covid19 . Covid19. When we get out of the charged ennature of the stress and the strain putth upon us by the outbreak, people will realize the importance of science. Theres been a spike in new cases andd hospitalizations, death. As you looks at this, where are we in the cycle . The data speaks for itself we are in a difficult situation and its quite problematic. Ive said that publicly to bring a reality check too where we a. If we look we have 10 million infections in the United States almost 250,000 deaths. We had 60,000 hospitalizations and now last count we had 143,000 infections in a single day. When i testified before the congress four months ago i said if we didnt get control of this we could reach 100,000 a day and people thought i was being hyperbolic and now look whats happening. Thats the bad news. I think the encouraging news people need to understand Public Health measures, not to lock down of the country but public measures that are simple and easy to understand, the universe of wearing a mask and physical distancing, avoiding crowded places come outdoors, or than indoors, washing hands. It sounds simple in the context of this ominous outbreak but in fact it can turn around and that is what we need to do. So to beat this level now is it a lethal pandemic kind of working its way through the ntcountry or are we doing something horribly wrong to be at that place again . I wouldnt say that its horribly wrong. What we havent done and it isnt just the United States. If you look whats going on in europek and the uk they are the same with many of the surges but if you look at what happens in our own country we didnt act in a unified way and i say one of wonderful things i love so much is that we are the United States of america and we are a federalist country and have states that are independent and in some respects its important that they are that way however when you are dealing with an Infectious Disease, the Infectious Disease doesnt know the difference of the border between mississippi and louisiana or between florida and georgia and South Carolina and an Infectious Disease meets the entire country. We didnt approach it that way. We had too much individual approaches towards how we were going to handle the outbreak so our baseline never came down to the low level we wanted it to be so when the Community Spread came in as we tried to open the country, it soared right up and its a self propagating issue because the Community Spread, then the more difficult it is to contain by identification isolation and Contact Tracing because theres so much of it going on it becomes very difficult. Thats the problem we are in right now we have an enormous amount of Community Spread. If you were told a while back we couldve 100,000 cases a day, what does it tell you now as you look forward to the winter and cold weather what are we facing ex models are as good as the assumption. Ive been one to challenge the models, not the validity of the modeling process, but the assumptions that are put into it. If we literally push together and didid it in a uniform way we do not necessarily need to see the 1,000 to 1300. We dont need to see the 140,000 infections per day. We can turn it around so if we stay the way we are you do the math. A thousandd deaths a day, 140,00 cases a day you multiply it by 31 days in december, two weeks in november and by the time you get to january 1st we have a really bad situation so what i am saying is as a Public Health official and my colleagues say we do not need to accept that and i want to make a point i may one of the things about a vaccine that is really important not only in and of itself as being a tool that is essential to end this outbreak, when people know help is on the way and what, i mean, by health is on the way, we will start giving vaccines in december and then as we get into january, february, march we will get the prioritization of the people who needed them most. If we can focus that that is there, that there is a light at the end of the tunnel, i hope we can get over what we called covid fatigue where people are so exhausted with the Public Health measures that they feel like they almost want to either give up and say lets do what you want to do which isnt the time to do that now. We need to double down on the Public Health measures as we are waiting for the vaccine to come and helpto us out. So theres covid fatigue and resistance or the resistance to taking the measures you are t talking about. In your mind is there hard data or evidence that these behaviors that you would call reckless, big political rallies where people are not wearing masks, motorcycle rallies, whatever, is there data that those have led to outbreaks . I think its pretty clear when youve seen the settings with people gathered indoors without a mask theres no doubt. Weve seen that with the Sturgis Rally and a number of other situations. Weve seen it in clearcut examples of people getting together in a congregant way ooparticularly indoor where thee is clear outbreaks. But you talked about vaccines, so lets talk about that. Pfizer got our attention with its announcement recently about 90 efficacy for its trial. Tell me what you know. Theres a lot of tests. You said there would be vaccines rolled out in december. Tell us what youre excited about and specifically what youve seen. If you look at Infectious Diseases in general, what you need to get the society protected, you need a certain number of the people that are protected because they are immune. Theres a couple of ways to do that. One way is very painful. Everybody gets infected. That leads to a lot of deaths and that is an unacceptable way to get this virus under control. The other way is to have a highly effective vaccine that the vast majority of the population takes. So in other words, if you have a 50 or 60 effective vaccine even if the majority take it theres of the segment population that is not immune but we are fortunate because the first one out of the gate is more than 90 probably close to 95 effective so we are hoping those thatve have the Vaccine Hesitancy and skeptical will see that the efficacy of this is so high that they may change their mind about wanting to get vaccinated. The other part of the good news is that there are other vaccines. Some that are almost identical. If that is the case then you have two of them, so we have the capability with what science has done in an unprecedented way and if this were 15 or 20 years ago it would have taken a few years to get to where we are now. The idea that you went from a recognition of the virus on jula phase one trial literally 60 some days later to a phase three trial to a vaccine that we are going to be giving to people next month is extraordinary. And when i said how we described it, ive been doing this for 40 years and this is extraordinary. We are not done. We still need to implement Public Health measures in a very intense way. When you say that it will bee rolled out in december, that means for the front line workers, people at risk. The standard way this happens when you have a vaccine that isnt readily w available to everybody at once, you do prioritization. Thats the responsibility of the centers of Disease Control cdc. They rely heavily on an Advisory Committee called the Advisory Committee immunization practices. They help them make the prioritization. Thee only advisory, this year we complemented that by asking the academy of medicine to also weigh in. Im not going to get ahead of them in their decision but likely it will be front line workers like healthcare workers taking care of individuals, people who have underlining conditions that make them susceptible to severe outcome. People in Nursing Homes for example, people with underlining conditions, children in schools, adults, teachers and school, fundamental people responsible for making the society run in an orderly way. Thats the kind of prioritization you get. We hope by the time we get into the Second Quarter of 2021 we will have enough vaccines we will have progressively vaccinated people so that when we get there people will be able to get in the general population. So that isnt a particular high risk level will. I would think anywhere by the end of the First Quarter and end of the Second Quarter. Then we have the problem with the people who say they will not take the vaccine and that number has actually increased in the past six months or so. I think for the people who are resistant because they didnt trust what anybody was saying, you talk about that early efficacy. But the people who justhe thinki dont want to take the vaccine or anybody to tell me to, how do we move the needle on that . Youve got to continually try to out reach to them and do what we Call Community engagement. There will be a core of people who will not take a vaccine no matter what you do. I dont think we should give up on them but we shouldnt necessarily expect. But theres a larger group of people who just probably have misinformation and dont understand the process. What we have been trying to do, myself, doctor collins and others weve tried to explain clearly what the process is of making a decision that a vaccine is i safe and effective. Its an orderly process and its done by independent groups that have no allegiance to an administration or companyy or anyone. They make that decision. They lookk at the data and determine if it is safe and effective then there are Advisory Committees. The career scientists at the fda that i trust. There is scientists like myself and doctor collins who will be looking at the data so its going to be a very transparent process. I dont think people that are antivaccination fully appreciate how transparent the process is. They may think theres something being hidden and people are trying to put something over on them. We need to reach out and make them realize that is not the case and it is to their benefit and the benefit of society to get vaccinated. So if 50 of the population or maybebe not that many but a large chunk of people do not take the vaccination, how does that play out, what does that mean for me . That would be quite problematic and it wouldnt be good for the country in general because if you really want to essentially crush, that word we use insh the outbreak to get the level of transmission so low that its no longer a Public Health problem, if you have 50 of the people dont get vaccinated, theres a lot of infection thats going to be going around the community. If you get a 90 to 95 effective vaccine and 80 of the population gets vaccinated, you have an un umbrella of protection already that the virus has no place to go. Ldit would be looking for Vulnerable People but not finding it. Thats when it goes way down and then it is no longer a threat. If 50 of the people dont want to get vaccinated, its going to take quite a while to get to that point. Covid19 seems to be mutating in concerning ways. Is there anything we do not yet know about covid19, a mystery i dont know, that continues to surprise you or we need to unlock . Let me count the ways. Theres a lot we dont know and i think we have to be humble that weve learned an extraordinary amount over the last ten months but theres a lot we do not know and that is the reason why the studies, the courts, the research is going to be going on even after we have the outbreak under control, so we solicited questions from the viewers and a lot of themti were about ive had covid19, and i save both for myself and in terms of infecting anybody else. Do i have the antibodies, am i safe. He at this point in time we do not know the durability of protection. We know if you get in affected its very likely for a finite period of time that you are protected. Its almost certain that that is the case. Weveti already seen specific instances of reinfection, people who were infected, recovered and got infected withei another source. We dont know how extensive thats going to be, so even though antibodies are present in a lot of the people who recover, we dont know what level is related to protection and we dont know how long that lasts. We dont want to scare people to think i got infected and now im going to again. Unlikely, but we have a lot to learn about the durability of protection. One thing iil can say as an Infectious Disease person is that its very unlikely its going to be like measles. If i got infected, i did as a child and im sure you did also. You are essentially protected for life. Its not of that magnitude because of what we know about the common cold it keeps three infecting people. We feel it is likely measured several months to a year or more, but it doesnt look like its going to be 20 to 30 years, which means people need to get vaccinated even if theyve been infected before, which we think is going to happen and it is conceivable b. More generally are we more susceptible now . This seems like a onceinalifetime occurrence. Pandemic outbreaks have occurredut before even recorded, before understanding what thend pathogens. Theyve occurred in oure own lifetime. Within the memory of some people. 1918 was a disaster in the world withth the flu pandemic. Have seen outbreaks, some of which have been trivial and some of which have had a major impact. Right now this is the most serious outbreakhat we have had in this planet in 100 to two yes. Will it happen again, yes. Will it have bn ten, 15, 20 years from now, we dont know. The thing about outbreaks is they are unpredictable so as scientists what we say is you likely cannot prevent. What you can prevent is the emergence from becoming a castrophic pandemic. That is what we mean by pandemic preparedness, to prevent the inevitable emeence as long as we have an interface with the animal world that is 75 of all of the new pathogens that have emerged have jumped from an animal species to a human, they are zoonotic and jumped to human. That is going to continu to havhappen. The questionnd the challenge is to be prepared enough so that it doesnt becoma catastrophic outbreak. So weidnt do very well this time. We didnt. So how do we avoid or mitigate the next one . Theres a number of things we can do. First, we have to think globally. Pandemics are global, so we had to pull together globally. Thers a thing called T Global Health security netwo that was estlished several years ago. We nd to strengthen that. We need to strengthen our internional collaborations. Wenaeed to have people speing to each other and surveillanc its got to be open and transparent. You can detectt it early and respond early. Scientific approaches are going to allow us to dohat we did with this outbreak and rapidly vaccine. We can do even better than that but you cannot do science alone. Its got to be Public Health and classic science. Are there countries that seem and nowto be doing well hold up this mel for pretty good responsiveness . The answer is yes but right now it seems every coury is suffing. We are often compared with countries that are not comparable to us. We are not a Little Island of 5 million ople became shut off. We are not a country that would accept if a ruler tells us you must do this. I was talking with our uk colleagues just today who were saying the uk is similar to whe we are now becau each of our countries have been independent in spirit and we dont want to be told what to do. I undersnd that, but now is the timeo do what you are told. It is something we should be doing rightt now. You talk about walking a fine line between lock down on one extreme d opene activities on the other extreme. You as a professional medical person probably air on the side of caution but if you wer president elect, how would you balance those priorities . I believe you have to be sensitive to the strainf lockdown, the economic and psychological consequences. I do not believe athis point that we need to lk down. We have to leave it on the table. We are not going to push it off the table. I dont think we need to do it because my experience is when as a group, as a nation when you implement the public healt measures i mentioned to you, we can turn this around without walking the country down. You answered the question im about to ask but its useful for people tuning in to hear there are those that think of the herd immunitytrategy as aun good strategy. A. No, i is not it just is not. I dont want to disrespect those who feel that way. That is their opinion, but it just is not the case because if u look now, 25 willay that got hibadly in new york, 1 of the country as a whole, the cdc did a very go study and said about 1 of the people in the country, quote, have gotten infectednd are therefore protected. We he 245 to 250,000 deaths and 10 million infections. You wi not get to the herd immunity until you get up to 70 or so . Now if you want to go from ten to 70, multiply that by seven d look at the number of people who will have to have died to get to the natural herd immunity. Itan isnt feasible or acceptab. Ive read a lot about people who feel theres longterm effes, survivors who are having secondary longterm effects. What is the medical view on that . It is a phenomenon. We are right now as we speak in fact this aernoon i think it was about 3 30 we had a phone call about the approache are going to be ting to investigate that. Its a phenomenon where people clear the virus but variable periods of time and we dont know the perntage whether its 20, 25, 30 have the persistence of symptoms that are bothersome, fatigue, shortness of breath, muscle aches, inability to control temperature, what they ll brain fog which is a difficulty in concentrating or focusing. It sometimes can be incapacitating to people. We need to figure out whatop tht is and what we can d about it so we are doing a big look at what we can dond there will be somewi large studies. Another that seemed hopeful was a nasal spray that was tested. Is that sometng you are taking seriously . Whenever you have a study that looks favorable you are almost obliged in many respects to go ahead and carefully do a phase one study on humans in phase two and then full effacy study. So we wille studying that but i think we need to warn the people that often we find things look promising in an animal but it doesnt hold out on a human. Again the questions we received before we started this, some were very personal. Everyones experience either with covid19 or fear of contracting its personal. I know youve talkede about ths a lot but people would love to know what do they do at thanksgiving. Youve talkedd about what you will do and wonto, but any general advice you can give . I think every family unit needs to do a Risk Assessment and riskbenefit ratio if you have people in your family that are elderly or ve underlining conditions that make them susceptible to severeutcomes youve got to make a decision to you want people to travel and spend time in a crowded airrt and maybeot have time for quarantining after they get here or not have the ability or understanding of how they can get a test quickly eugh you want to make a decision that you are just going to forestall it. Enever i say tt, im t grinch that ste thanksgiving. Im not saying that. Im saying Everyone Needs to seriously thi about the riskbenefit. U might say i had a wonderful vaccine, excuse me, i h a wonderful thanksgiving last year. Im looking forward to a wonderful thanksgiving next year. But maybe right now is not the time to have 2people in the house en you take your mask off as you are eating. We have time for a couple of more questions. You mentioned this is t most serious pandemic that we faced in over 1 years and i think we can go back to 1918. Looking back is there something to learn from that and how it plays out and whether we go path a or b and learning from 1918 what do we need too . We know from hisrical anecdotes that actually became sties that when people took seriously the kind of things im talking about, wearing a mask, separation, they did better in the cities than those that just said the heck with it we are going to do whatever we want to do. History is kind of repting itself 1 years later. You started to talk about this at the beginni. You worked for many president s and for many yea. What keeps you in this game . Its not like you get congratulatis. You have a lot of grief and bodyguards. We choose the ph we want to take in our lives. Ive chosen Public Service in the context of medicine and science and theres nothing more exciting to me than that or more challenging so it totally energizes me when peoe talk about myge and how long ive been doing it it seems like ive only been doing it for a short time and i have a long way to go. Tha you very much for your work and for being here tonight. Thank you for having me. [applause] good evening. Im happy to be able to continue e conversations with two extremely knowledgeable peoe. These are lon days for you and weppreciate your willingness to keep on woing a few extra hours and share with us and continue the conversatio i alsoant to say speaking about someby that recently left, our treasured justice giburg once sai i am a strong believer in listening and learning from others. And this program was created for that purpose, to listen and to learn. So it is a great pleasure to be able to work with the t of you to continue that conversation. Yohave such expertise, each of you in such difficult times. So lets get right to it. Thers so much to talk about we could spend all night but i wont make you do that. President electoe biden created acr new task force and e has named you to be on the task force. I dont know if you are allowed to say much about what your particular mission or role will be and wther it started its work oror not, but what can you tell us about the task force . The president elect made very cleare. He wants toe ready on the first day t begin to establish programs to counter this horrific pandec and hes going to work closely with state and local officials and the american publito turn around the explosive numbers were seeing because we need to be able to reopen schools and businesses in a safe and sustainable way. We want to go bk to our way of life and that is the work ahead. Are you able to coordinate your efforts, how does that work with you in the next couple of months . The good news is the ability to Work Together on this Public Health crisis has been truly amazing. When you look at t t t scientifc effort i have a lot of opportunities to tryo steer people in coordinated funions and it has been phenomenal to see the way people have dropped everything we had a few initial discussis and in the two weeks put together the largest Publicprivate Partnership on an Infectious Disease thats ever been assembled, sothing called active from the therapeutic interventionsrv vaccinend this is about half industry people and half academics, fda, cdc, the veterans administration, the department of defensee managedy the foundation for the nih with extremely high levels of skill. And there wasomething said i didnt think was possible. Usually they take about two years and at least 39 lawyers to sign off on everything and this just got done. People actually were willing to drop everything, but what they were doing outside, work 24 7, design protocols we could test therapeutic agents, prioritize themo pick the ones most likely to have some promise figure out how to do these Clinical Trials overnight with the netwks that were out there that hadever been organized in this way. All of that happened in the spe of just a few months. Where we are now with vaccines and therapeutics and antibodies causing a lot of excitement as a treatment for people that are abfecteded and might be able toe kept out of the hospital with this intervention, that is just exhilarating. I get to people, get twork with peopleike tony fauci and its remarkable. The science has been breathtaking in theifferent coming out in these and policy groups it hasnt felt ke a ordinatedu effort movin at a pace never seenefore meanwhile theres a lot of noise around all of this and it comes across in the evening new has more noise than science. Maybe we have these results tha have 90 lost efficacy. At will start to be more of th news people were anxious to hear. And lets bclear, this is a very polarized time in our country and other countri as well. E fact you had an advance and ran a trial with a good outcome, thats nice but its not what people are fighting. We have our own issues in terms ofhe way that information gets shared. Scientistsan do a better job of portraying what we do andn the fashion that makes it more gestible and offputting and we need to work on tha as well. A moment ago you said one of the things the task force will beio looking at is not a full buckdown the sort of conols to get us back onrack. Can you tell us a little bit mo about what youre thinking and more of the strategic decion making about what to restrict and wan what to keep o . I thi doctor fau mentioned in the measures that are prudent and consistently were able to contain the outbreak without having to do lockdown. Inhe lockdown, a lot of measures are curtailed that didnt need to be because ty do not offer an advantage to the epidem, but ii think it is the facthat the American Public is tired. I think it is natural people can beired and fatigued about whattu the best course of actions are for them. And the measures about the clear and Consistent Communications and what measures they can follow to help the communities. We need to devop a strategy r howst we use the diagnostic tests and the use of these tests when we think aboutou how to amplify the Public Health workforce to do Contact Tracing. We needwo to also increase the delivery of medical care and capaty and access to care. We have seen theyve been a very significant sad story for us. We need to be ae to turn this arou. Theres a lot of work ahead but i am confident that working together we can replicatehe success of the respoe and the other domains in the comprehensive response. Tres so much to follow up i dont knowhere to begin. It seems like one of the most critical questions and so hardest to dealith the disproportionate impacthat we have seen on people of color, pele of low income in this country. And im sure theres other sort of targeted communities tha are harder hit than others. As wthink about treatment and vaccines, how do we target in a way that makes them want to embrace the early use o the vaccine because it is out of cari and not for them to assume that they are being experimented on. People say i will take you vaccine after we havead plenty of time to see how it works, but im not going to be the one early on. And so to be targeted it may be the last thing people want. It is a really important question and one that is occupied the attention of a lot of us in the course of the last few months now that these largescale trials are underway. Do you really want to, no, you want to particularly find outth they work in vulnerable groups and people with chronicllness, who shouldered and undo amount of the burden and yes this happens at the time you are pointing out to your question whether there is a distrust about if they have the best interest of the communities at heart and the first thing that often comes up in conversation is tuskegee. We had a really unfortunate history of how the medical research hasnt always behaved when it came time to represent groups and we have to get out there and explain that and apologize for that and try to make the case that this isnt like that. We want to be inclusive. We want to offer the opportunity so that we can find out does this work for all the people who might need the most. And i can tell you having me as the head of the nih say that doest help that much. What helps is engaginghe community and finding who are the spokespersons in the communities that are trusted and who can look at the evidence and say we should be part of this. By bringing on board in the alliance we were able at the enrollmenthat theenrollment morf those, more than 20 were latina and 27 the group were people of color. It could be even better but that is so much better than where it was. We learned a lot about that and i think we could apply that more broadly. There are studies that offer data about the vaccine safety and effectivess, but its Still Limited information to the population, so it is going to be important after the tals are completeand after three are rolled out to a larger segment of the population to continually monitor the safety because the communications can be trust, can be built on strong safety data. Its going to be critical for the work that ends once the trials are completed. Both of you have worked through the response to that. How t transferable is the social science aspect how to prepare for ople to be wilng to be vaccinated and get into a community that might be skeptical worldwide in order to make it as effecve as possible, or is each one of these events so different from the other that its hard to translate from one to another . It never bame a major threat to the United States despite the intense population and anxiety about it. We didnt have the experience of trying toee if people would be willing to roll up their sleeves fothe vaccine. The vaccitions were done where the diseaseci was happeningn west africa and most recently in the drc. Im not sure we learned aut the social side of i we did learn abo some other things. The antibodies that are now showing promise. A similar approach for ebola in a challenging trial that was run essentially in a war zone that shows they could be lifesaving and gave confidence that this could work for other diseases. I think when it comes to the social science part in our own country, you have to look at other examples and there is nothing quite likehat we are looking at now in terms of something so devastating the most horrible paemic we he had and all of the public attention that comes with it its a little hard to extrapolate. We can look at the fact theres been growing in some quarters a Vaccine Hesitancy and this has certainly given an opportunity for those anxieties to expand. Social media has been great at promotin conspiracy theories. I dont know if youve looked at that on the social media. Some of them are creative but there are people i talke to that say im not going to have th vaccine because bill gates put chip in it and its going to wire my brain, people read that and probably think thats real. Co on, people, lets look at the evidence of whats really happening. I am hopeful as tony articated a bit ago when people have the data in front of them, its been hypothetical and very muchte overwritten by claims about timetables and political agendas. Lets get past that and lookt the data and tell me why would you not want to take advantage of something that might proct you and your family a other people that you love from a terrible disease. If y have a good answer to that, that is good. But lets not have it be the bill gates chip. You brought aonderful show and tell police. Weve been talking about this for ten months or something and we dont know what we are really talking about most of us. You see this symbol in almost everything now, it is on every pumpkin now. This is what it looks like, the coronavirus. It is spherical but i has a routine on the service which are real important because they are the ones that enable it to get inside of your cells. That prote finds a match in a protein called phase ii and that lets it into start copying self. So, what do we want to do in terms of develing aaccine. You want to get away to attach like chewing gum stuckll over them and that is what we are trying to do so all of the vaccines are basically trying to raiseof antibodies against tse proteins. This is a fancy version with the spike pertains have two different colors because they have a sort of open and closed coiguration that is a fine point. It looks like i is working prettyell out of the gate. There are six now that are in the works. Operational warp speed which the taxpayers are paying for, and they should b because of the critical need for this its not only hel helping support many oe trials but also supporting manufacturing and even we didnt dohat, we ran the trials and we had a big announcement. Weve got a vaccine that works great but you have to work six months to make enough doses for people. That isnt m happening. Warp speed is doing what you call at risk manufacturing, making mlions, tens ofed billions of doses. Ev before you find out if it is going to work. And if it doesnt, you throw them out but if it does, you are ready to go whh we hope will be in december. We say probly many months and many lives and that is unprecedented. It ant health issue it makes itery clear and those naturallyat occurring threats against those fdamental issues with the fabric of our ciety. One off theost concerning factors someone deliberaty that at the end of the day its about saving lives. E if this was an intentional release in order to harm an accidental release jumping from animal to human or created in the lab but it is the blics understanding going on for many months maybe getting in the way to trust the informaon. Ultimaty wean from t work that needs to be done becausat the end of the day we jt need to focus on how to get there. How do we prevent that from happening . And there is a time if there is any possibility that it has been ruled out and a deliberate iu issue. But i will just say that it shows how important it is to be ready to address these biological threats. Hope it doesnt grow to be significant in the future and with thosend a a mall habitats with density it makes it easier for spillover viruses from animals to humans. And i hope Going Forward to apply more technology not just withiscovery and medical i response and surveillanceore effectivelyly spent president from the whow us and president elect biden says he wants to put us back into it again. What is the practical effect . Is that useful in what you describe as being ready if that does become apparent or is that coordinaon of data or researc research . That sounds like a good idea but i dont know why. Its important. Its a good thing tt Infectious Disease research has beennternational for decades. Even with the intentions of the who its fair to say a fair amount of international exange has been going on. And we interact almost every day it has not been a severe downturn it would be interesting to see what happens. And ao with that Economic Security so the interest is wherehey are boots on the ground that is very difficult for americans to be and it is essential to coordinate the global response. Are we Getting Better and our preparedness of the upward trajectory of the improved response capability yeartoyea yeartoyear. The council of foreign relation efforts. Yes my fulltime job is a not for profit and the chief Technology Officer saide do more than technology. Our busins is optimism and it is remarkable with the diagnost and talk about where we are today . I would. Love to. We agree if we could snap our fingers to have a homebased test to take every morning if you werenfected in which case you should not be going toot work, that would be fantastic. So you just findut when you get your day started but we are not there yet. So testing with people of symptoms we are pretty good at that now. But what we really need is testing for people who dont haveis symptoms because that is where communities spread is happeningha and what colleges need to keep students and facultyy safe with that pot of care and you have to send seit off to a cenal lab to get it right there or and 30 now one and 30 minutes. Now red x rapid acceleration diagnostics. And then to stand up Venture Capital system in Small Business labs that have cool ideas how to do rapidooid detection and in the space of that very short period of time we funded 22 of these technologies that clectively are on 3 million test the day that are pointofcare this is an example where the fire that wouldve been technology. Was pronounced into other applications as well. And to get the testing situation where it needs to be. As we waite for the vaccines to be t available we have a better chance of capturing. An amazing period of time and e anxiety that people are demonstrating isti so extreme for those that a resistant you have heard about those but or 100 questions came in and many jus express a geine uncertainty about what to do for thanksgiving. And a child with a preexisting condition and send them back t school. And afraid to do what they dont know if theyan travel and have been planni on a trip the pastwo years. It is sad to read how many people are troubled and where do you go for a gd, reliable and unbiased information . There is a place the government is collecting that information . Nih . Me help people be smart about decisionaking quick. Thats the job for the cdc there is lots of information there. They are not the only place. Doctor fauci is the source of thisnformation that mos people have heard and h depended on saying it like it should be said. But the facts are changing lets be clear about that. We have new informion all theime if they said Something Different this time its probably because there is no information and that needed toe change. So i question many timesue a day people desperately want to get togeth for the holid maybe because they think this is e last tnksgiving with grandmother and then they say ats not safe. I getaf it. Its hard to hear. I will not have thanksgiving with my family thisec year and i will miss that. Thfirst time in 27 years not the gathering of 30 people around the tablele but if you put all the evidence together , we can get by without that. Getting through a sious worldwid crisis and his tony said if we can appreciate maybe that will allow us to get through in the meantime and come o to the point wherwe say that is in the rearview mirror. This is part of working and optimism. [l you are a man of faith is there any data that shows peoples outcomes are better if they have an important faith no matter what it may be . At did the Research Support that quick. I dont know about covid19 somebody should be psuing that if not already. Pay attention. But another circumstances, yes there is evidence those who have a spiritual part of their daily life seem to have more resilience its not a huge effect but it is in their the dean setff with psalm 46 that has been on myind god is our refuge and strength. We are in tuble and to ha that sense we are not all alone and then to hp herself and we have a lot of strength and capabilities lets do so. And this is a great source of comfort. That would be a great way to invite the dean back on again we could go on forever but the time is limited than you so much for your time and wisdom all the work you are doing to advance our response and keing us saf safe. [applause] is. The honorable the chief justice and the associate justice of the Supreme Court of the United States, all persons having business before the Honorable Supre Court of the unitedhe states