and the director of the center for strategy at the council and security. last october, the skull cross center forward defense team reported on effective resilience and national strategy, lessons from the pandemic and the requirements for key medical infrastructure by distinguished fellow kramer. a strategic operational framework for effective resilience is the capacity to withstand shocks of a magnitude of a major pandemic, a strategic shot. today, as president biden confronts covid-19, our report and recommendations on health security remain timeless. to discuss these issues i am , very pleased to welcome a variety of guests to our event. our moderator will help frame the discussion. she will be followed by the report author, frank kramer cool present key findings. jaclyn leavy, chris mcguire, on our panel moderated by the director of our former defense practice area, clementine starley. i would like to -- thanks speakers and the audience for joining us. in accordance with the legacy, it is the mission of the skull cross center to melt sustainable nonpartisan strategies to address the most important security challenges not only that we face today, but of the future. consistent with that mission our , forward defense team seeks to shape the debate against the military challenges facing the u.s. and its allies, looking at assessments of trends, technologies and concepts that will define the future of security. through this work, including this report, and our other work on the future of dhs, we have identified the homeland as a theater increasingly under threat. covid-19 is the most challenging sally and example, but it is not unique. the challenge are reflective of a broader spectrum of risks to u.s. critical infrastructure and national security, like cyber attacks, espionage, potentially bio weapons. unfortunately, the resilience capabilities of health, economic and security sectors remain insufficient to address these risks. if the u.s. is to avoid and mitigate major system shocks like covid-19 in the future, the president will need to prioritize an expanded focus on resilience in the early days of this administration. to kick us off for our event today, i want to turn over to the atlantic council board director, president, and ceo of -- north america. former deputy secretary of homeland security and a wonderful colleague of mine. in her role at dhs, jane was responsible for the management of the department's efforts to secure and manage the nation's orders and strengthen national resilience. she offers a distinguished understanding in the ways of u.s. responding to current crises in preparing for the next ones. jane thank you for joining us , today and for your dedicated service to u.s. security. we look forward to hearing your perspective on these issues. a couple of housekeeping notes before i turn it over to jane, this is a public event on the record. we encourage our audience on zoom to ask questions using the q&a tab that you can find on the bottom of your screen. please identify yourself and your affiliation and your questions. we will be collecting these throughout the event. our moderator will pose them to panelists. we also encourage our audience to join the discussion on twitter using the #forwardbets. again, thank you for joining the council scowcroft center for this important discussion. jane: thanks so much. it is poignant to me and all of us that you spent two minutes talking about brett scowcroft he was laid to rest this past friday. a giant to those of us who knew him. for those of us who did have the privilege of working for him, the thing you come away with impressed, and for me it's now 30 years later than when i first met brent, is his humanity and his humility in how he approached everything. but he was deadly serious about his work and those who worked for him. he had a very dry and wry sense of humor. i remember, he walked in the day after the election in 1992 and said we had all been fired, but we can take some small satisfaction in the fact that, apparently, foreign policy had nothing to do with the outcome of the election. another time, i remember he told me quite directly, he said listen, when you sit down and you write a memorandum for the president, that is where it goes, so be right. it was a lot of pressure as a young professional in this field, but a lesson that i've kept with me my whole life. there's a lot that is right in this report that we will explore today in this conversation. i want to talk about the effective resilience and national strategy. particularly from the perspective of homeland security, but not only. i begin by thinking about, as i have often done when i served in government, is, what if anything is government good for? what does the public expect from government? because, let's face it, most of us don't interact with government unless we have to, with one exception. and that exception is voting. other than that, none of us rushing down to dmv, oh good, let me call the tax office. no, none of us interact with government unless we have to. when we think about it, particularly today, in today's world, what is government good for? government is good for three things fundamentally, delivering threshold conditions of security, well-being, and justice for its citizens. we will talk about well-being today and spend a lot of time on the particular challenges of covid-19, pandemics, public health more broadly, the whole question of health security and resilience. from the perspective of homeland security, this question is not just an academic one, we are not just a policy or regulatory matter. this is a question of action. what should a department be doing? indeed what should the whole of , government be doing? what should it be doing? washington understands policymaking departments. they understand regulatory departments. it doesn't understand too well when there is an active operational requirement that departments are expected to perform. homeland security, we are often four faced with the question, why do we even have this department? the purpose of homeland security is really to help create a safe, secure, resilient place where americans can thrive. -- where the american way of life can thrive. we focused our efforts around five key missions. certainly, preventing another 9/11. that is how the department was founded. and enforcing our immigration laws, our role at the border, cyber security for the nation's critical infrastructure, and building national resilience in the face of disasters. how should we distribute responsibility for building that resilience? and what does resilience really mean anyway? and how do you do resilience? resilience certainly is the ability to bounce back. it is certainly easy enough to fall down. it is surprisingly easy to get pushed down. but it's more difficult to bounce back. so how do we bounce back? what does it mean that we need to do? in the first instance i think , people need to unify around a common cause. a common theme. a common effort. we are in trouble here. we need to agree, and no single one of us can do all that needs doing. all that needs doing cannot be done alone we need to come , together. and we need to have better and smoother processes for doing that, whether it's at the inter-agency or between the federal government and state and local governments. or within communities and even families themselves. unifying a common threat or cause and then pulling ourselves together to reliable systems of interactions. this is what made fema emerge so successfully over the years as i gained more experience. not only interacting with other parts of the federal government, but interacting at the state and local level. fema very often judges its greatest success is to be not what the federal government is doing for communities, but what they are able to do for themselves, and drawing on nearby help for mutual assistance. covid-19 has been something that the likes of which very few of us have ever been through before. remarkably. and it is a testament to the modern medicine that there are some of us alive today who have been through this before. we have an expectation modern medicine will get us through this again. but as we have seen, medicine is not enough. having the vaccines are not enough. they need to get out to where they are needed. we need a steady state of reliable supply in which we can have confidence. and we also need to develop resilience against other unforeseen events. and the unforeseen coincidence of events which can compound the difficulties that we face. i commend this report to you. it is quite extraordinary. it was written by frank kramer, who was not only a distinguished fellow of the scowcroft center but a distinguished member of the board of directors at the atlantic council. frank i'm going to turn it over , to you and our colleagues, for a very rich discussion, and i thank you all for joining us today. frank: thanks very much, barry and jane. i couldn't agree more with what you said about brent scowcroft. i came to know him well starting in the 1990's, and for many years thereafter. if we could all be like brent, we would be very well off. i want to take off with what jane said. this is a report about security well-being and we should be , doing, as she put it. the report basically says, what we want to try and do is avoid another covid-19 scenario. a future health crisis. we need to start to take action now to do so. the goal is resilience. we want the united states to have the capacity to deal with, ideally by heading off, and if not by coping better, with a , future pandemic, than we have been able to do with the current crisis. to that end the report makes , five broad recommendations. first, it says we need to undertake major r&d programs focused on emerging and infectious diseases. [phone ringing] we need high levels of constant targeted funding. we need to engage both the public and the private sector and have them work together. we need to look for major breakthroughs. some people talk about new -- moon shots. they could be things like a universal flu vaccine. they could be antimicrobial capabilities. they could be a global health surveillance system. we have to put all of those together. so r&d is the first instance. secondly, we really need to enhance public health. public health is really the first line of defense in coping with the pandemic, and dealing with preventing and responding to pandemics. public health operates at the local level. but the funding in the u.s. largely comes from the federal government. and it is generally agreed, say for the past 20 years or so, that public health has been significantly underfunded. the best estimates are that it would take about $4.5 billion annually to bring public health up to where it needs to be. that is a lot of money, but it's not a lot of money compared to the devastation from covid-19. and it is terribly important, as we think about spending that money, to focus on the people who are critical to making public health effective. we are facing a deficit over the next 10 years of doctors, nurses, laboratory technicians, pharmacists. the full spectrum of people engaged in public health. so as we spend, hopefully our additional money, we need to spend it wisely and really focus on the people. third, we really need to make effective use of artificial intelligence. one of the great capabilities that has arisen, and can be used, and has been used already with respect to the pandemic, is the national security commission on artificial intelligence. the report recommends the ai commission create a framework for using data for research and development, for prevention, and if necessary, for operations in the context of a pandemic. there's a lot of data out there and more being generated every. -- every day. but not all data is relevant to all problems. it needs to be organized properly and it needs to be made available to both researchers and analysts. a lot of that data is personal health data. and that needs to be appropriately protected. so, one of the key issues is to create, you might call them cybersecurity programs, create cybersecurity programs that allow for both personal health data to be utilized, at the same time, protecting the individuals' security of the data. lastly, with respect to the ai commission, we have seen cyber attacks on health providers. we have seen cyber attacks on researchers. and we need to make sure that those entities are protected, as they go about doing their work. so, a cybersecurity program that will help in the course of a pandemic, make sure these entities can be effective. fourthly, the pandemic is a national problem. we really need to have an organized national approach if we are going to deal effectively with future pandemics. that will involve three key elements. the first is to recognize the current system, which works fairly well, with respect to national disasters and similar things, needs for states and localities to take the first steps and only bring in the federal government when necessary. that will not work when we have a national problem, such as a pandemic. we need to turn things around. and we need to say, it is a national problem if it is a pandemic. the federal government has to be engaged from the get-go. the current legislation and the stafford act and the report calls for the stafford act plus to immediately to work with states and localities. the last point is also critical. it is the states and localities are going to do the work. that one of the things the federal government has to do is to provide the technical support, provide the resources, provide the appropriate testing system that could be utilized, that can work and integrate from one state to another. it needs also to plan and organize, and plan what will be done in the context of a future pandemic? in the federal government, there ought to be a joint interagency task force that brings in all the departments together. that joint interagency task force would work with states and localities to plan, train, to exercise together, so that in the event something happens, we are not exchanging business cards, as a disaster continues going. we know one another, we have worked together, and we know how to work together. lastly, barry raised this point, we need to think hard about the problems of bioterrorism and bio defense. synthetic biology has made a lot of strides. many to the good, and many good that are coming in the future. but malign actors can also use synthetic biology for bad ends. so we need to do a number of things. we need to create a bio surveillance program. we need to include in the stockpile, material that can respond to potential pathogens. we need to undertake significant r&d by agencies with significant advanced capabilities. like the defense advanced research project agency, or agencies within the nih, to get ahead of the curve with respect to bioterrorism. we had some early warning. we need to utilize that. to sum up, dealing with a future pandemic, those five things are important. one, increased research and development. two, greater support to public health. three, best use of our artificial intelligence. four, create a national plan. five, utilize the other warnings we have with respect bioterrorism. those are all things i think are important, they are all doable in the context of resilience. i look forward to the discussion on these issues. thanks very much. jane: -- >> thank you, frank. terrific. that was very helpful, to have such a run-through of your comprehensive report. i'm looking forward to delving into many of the issues you highlighted in our discussion. hello, i'm clementine the deputy , director for forward defense at the atlantic council. i am delighted to be moderating this conversation today with such esteemed experts in the health and security sectors. to introduce our panel,i would like to welcome peter jacobson, the professor emeritus of health law and policy and the director of the center for law, ethics, and health in the school of public health at the university of michigan. and we have chris maguire, the director of research and analysis at the u.s. national security commission on special intelligence. an independent commission which considers the advancements of ai among other technologies, for u.s. national security. then we have jaclyn ready the , director of the science and research policy at the infectious diseases society of america. she is also an atlantic council millennium fellow. then we have the director of the atlantic council geotech center and director of the geopolitical impact of new technologies and data. last but not least, frank kramer, the author of the effective resilience and national security report and distinguished fellow of the scope croft center at the atlantic council. we have a range of expertise and i'm eager to delve and. reminder if you have questions for panelists, keep them in the q&a section at the bottom of your chat and i will come to them in due course. to dive in i want to start and kick off with questions. as frank summarized in the effective resilience report, this was released in october but the discussion remains as we continue to grapple with covid-19 in the u.s. and globally. to begin, i would love to hear it too far panelists'perspective on the gaps in that u.s.-covid-19 response and , lessons learned moving forward. peter, what are your top lessons learned on how we have dealt with this pandemic thus far, and how can they lead us to better approaches on pandemics moving forward? is a greater investment in health sectors, resilience, is that part of the answer? one of the key areas, funding for public health that must be increased? peter: thanks very much for having me on this panel. it is a terrific report. i commend frank for writing it. in particular, i want to focus on public health on the , inadequacy of public health funding which frank mentioned and documents in the report. most of us in public health are well aware of underfunding. one other point, i was a chair on the local port of health in ann arbor. we, right now, our budget is based on $1992. imagine trying to deal with an opioid epidemic and suicide. obviously the pandemic and covid-19, all based on those 1992 dollars. plus everything we are responsible for, as a health department. so having the atlantic council , recognizing the problem is a great benefit to the public health community. and i commend you for it. let's start with the success, the vaccine development and procurement. whatever else one might want to say about the trump administration operation warp , speed was a tremendous success. i have had two vaccinations i am pleased to say. but there were a lot of failures. that is to your question we , could spend a couple of hours just talking about what went wrong. i will highlight a few and i'm sure my fellow panelists will have others. as mentioned, the pandemic exposed the consequences of underfunding. the inadequate staffing. the poor messaging. i want to come back to that. the lack of distribution channels. lack of leadership, on all levels, federal, state, and local. what to i mean by that? i mean there is poor communication. if you think about it, you heard, masks don't work. well maybe they work. you must wear a mask. how do people respond? how do they understand what they're supposed to do when you have these mixed messages? you have this poor planning for how to distribute vaccines. it is an implementation failure. i would add one thing frank alludes to. you cannot just think at a high level developing policies at all levels of government. you have to think about the implementation. we can see the distribution failures in our daily lives. i am one of the lucky ones to have gotten both vaccines, poor coordination within an across levels of government, we have seen in many areas. the bio terrorism planning, expose poor communication and poor communication across governmental levels. i have seen it in studies of preparedness. bioterrorism funding. you have federal streams, they three didn't talk to one another in the federal government let alone talking to states and localities on what they need. so what happened? local public health asked for and got equipment they did not need because there was money. it brings an important point. if we look back at the bioterrorism funding, it was first bioterrorism only. public health departments used it to hire staff. the money ran out a decade later though staff had to be fired. we have to think about what is sustainable. it is not just funding, but it is sustainable funding. ok? we failed to anticipate the effects of covid-19 on vulnerable populations. in other words, the people most dying and exposed our communities of color and low income. that is again a failure of mentation, of anticipation. we failed to keep people home economically. so we are asking them to stay home and many do not have the luxury those of us on the panel have, of working from home. essential workers, health care workers, the health system is overwhelmed. there was no sense that the health system needed not just equipment, the ppe, the masks, the ventilators, equipment. but we know that people didn't get other health care they needed because the hospitals were at capacity. and finally, i don't think we anticipated the depth of the resistance to science in public health. we knew that there was vaccine resistance. that is nothing new. but the depth to the resistance to public health, to science, i think it surprised even me. and i was prepared. so you have attacks on public health officials. you have that horrible scene in lansing, michigan, when people were asked to stay home, to wear masks and social distancing. they are linked together in a , sense. i've taken time so i will come back to what we do with the money with specific suggestions for that. [captions copyright national cable satellite corp. 2021] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] clementine: thank you, peter. i think you laid a lot on the table that i'm sure others will have thoughts about, too. kathleen, you played a role in covid-19 planning and response efforts. i'd like to hear your reflections on what peter said, but also, what would you do differently to build resilience, not just in managing covid-19, but building resilience to future health shocks, such as a future pandemic or another health security threat? >> absolutely. thank you for having me today. frank and peter have shared statistics already about public health infrastructure. i have one more to start. the proportion of public health spending has been decreasing for 20 years. as a result, in the last decade, the workforce has shrunk by about 56,000 physicians. that was our starting point in the u.s. in terms of our response when covid hit. frank also discussed in his report in terms of the greatest barriers to an effective response, the u.s. government had developed, prior to a number 2020, of pandemic preparedness programs and resources, but operationalizing them during the pandemic moved to be a challenge. so while effective pandemic , response is contingent on surveillance and containment and public health infrastructure at the local levels, as we like to say in infectious diseases, an ounce of prevention is worth a pound of cure. coordination and support are federalcoordination and support are critical to mounting a successful response. part of that includes increased research funding for r&d, a sustained reinvestment in public health infrastructure that's already been noted, and finally, this has not been mentioned. a lack of coordinated testing strategy funded by federal dollars. without that, this past year, the pandemic was allowed to flourish and health systems became overburdened. i imagine we will get into r&d in a bit. taking lessons learned from covid in research infrastructure and diagnostics and testing infrastructure and regulatory spaces. and saying, how do we continue to make this progress that we have while facing future unknown challenges? clementine: thanks, jaclyn. you mentioned r&d, which is definitely something i want to delve into. i may up to whoever has thoughts what are , the most important areas and what are the most important areas for future research and development? how would you go about setting up r&d programs now to focus on the next pandemic, and the next future shock to come? if you have thoughts on that, david, chris, we would love to hear your perspectives, as well. >> i think first and foremost, it is important to remember a pandemic doesn't change the fact that we continue to see a number of critical infectious disease threats. two things frank mentioned in the report that i wholeheartedly agree with is the search for a universal flu vaccine as well as antimicrobial resistance, both of which are perennial issues that threaten to exacerbate any novel issues or bioterrorism issues that we may face in the future. that said, we have an excellent opportunity now, at the start of a new congress and administration, and as we begin to turn the course on the pandemic, to sort of rethink biomedical research enterprise based on these lessons learned. so, repurpose and successful research and refresh structure to target other high-priority unmet needs can be done if we take what we have built in the last year. nih has multiple programs devoted to health equity, testing, clinical trial capacity, taking these and leveraging them with additional federal and private partners, coalitions, etc. to keep the momentum moving forward and keep those relationships and the lines of communication open. this has been mentioned a couple times. i'm sure it will be mentioned a few more. appropriate funding to maintain that clinical trial infrastructure, investigating things like platform trials, networks so you can expand these clinical trial networks. there needs to be more pragmatic research for community-based settings. a lot of participants are more proportionately impacted by pandemics like covid. they are unable oftentimes to participate in trials funded through larger academic medical centers and in very specific regional locations. just a few thoughts to kickoff. i would be happy to dive deeper into any of this. >> i would like to bring you in here. [indiscernible] are there areas where funding is not a good level? david: that is a great question. r&d needs to be linked to the federal response. [indiscernible] we were told we didn't need to exist. why do you need a program for bioterrorism? the cold war is over. september 11, 2001, we had an actual terrorism event. the briefing was postponed. i ended up briefing the interagency committee. it was a very busy time. what we think about when we think about r&d, first responders will use what they trained on and what they are used to doing. [indiscernible] we want to be ready for future pandemics and other types of outbreaks, whether they be human caused like bioterrorism, or shocks from climate change, things like that. we have to act as an integrative r&d. in some respects, what covid-19 was for the u.s. was past success has -- past successes setting us up for future failures. without we had gotten past acute respiratory syndrome, h1n1, ebola, things like that. what we found out is -- eventually there will be a low probability, high consequence act that actually surprises you. whatever r&d we do, we must link them together in a coordinated strategy to have early warnings from biomonitoring, wastewater monitoring. back in 2003, we knew about sars before it was actually surfacing as acute respiratory syndrome because of two things. monetary price indicators can be an early warning of the market looking for a cure all. in this case, garlic, because of something that was going on. the second was observations from space. at that time, they were not commercial space assets. now we have commercial satellite imagery that in 15 minutes, or less, at 25mm resolution, show patterns of life changing. and saying they're not going to the factories anymore and there seem to be a lot of cars in the parking lot. that happened in 2003 and happened in 2019. it is almost an early health -- public health network that can be tipping. that solves the talent and his -- sustainability problem and gets us ready for, guess what? covid-19 is a dress rehearsal for shocks that are coming. if we don't put that in place now whether it is 2003, 2025, or , onwards, we will have more of this. >> thank you, david. chris, given your role on the national security commission on ai, you raised some thoughts related to congress and r&d. can you offer your thoughts here and discuss how ai might create transformative effects in the health and biotech space, how we need to be thinking about that, focusing on ai in terms of r&d and responses to security and resilience in the face of other diseases? >> thank you for having me. really appreciate the chance to talk about this topic. there's been a lot of great points made already. i will largely build on top of those. first and foremost, i will say, really appreciate frank's report, highlighting the important roles of ai going forward in either public health responses or really biotech across-the-board. i think we as a commission look at, what are the key technologies ai is really going to enable and transform in the future? biotechnology is always near or at the top of the list. the fundamental reason is that biology has basically become programmable. it's become a matter of code. and ai is a way to optimize code. especially when integrated with crispr editing, it enables all sorts of new outcomes. that is where we come at these issues in general. particular, it is important to look at ai as a decision-making tool. that is something we see across the government a lot of need for. obviously with respect to the pandemics, if you have that kind of robust data set, you will be the data that david highlighted on economic pricing, satellite imagery, these are the type of things that ai can see correlations on where humans cannot and do it much more equally. as we are thinking about biotech going forward, across-the-board, we really need to see it as a link with ai. we are thinking about r&d and not only think about funding for traditional biomedical methods, but also our funding for basic research in our artificial intelligence development. i think the commission has recommended that we double r&d spending annually for ai. $32 billion a year by 2026. which is about the level of biomedical r&d. so we see a lot of links. i will just say one other thing. i think that going forward, we also really need to think about bio data as a strategic asset. i think we don't do that nearly enough right now. there's a lot of ways this can manifest in terms of better producing the infrastructure to enable this type of analysis. but that can be in terms of pandemic related things were things like genomics. much more big data picture sets that are going to transform health impacts. the government really needs to serve that integrated function, because it plays a unique role there. that is going to be key to the u.s. biotech industry across-the-board going forward. >> i just want to amplify what chris just said here about bio data being a critical national lesson. -- national asset and global as well. one of the things i think the u.s. has the opportunity to lead on is showing a model that involves individuals making choices. that is anything, what covid-19 has been also, a long time coming, that a top-down approach will not succeed at turbulence such as this. this idea of, can you involve people in a participatory way to choose when and where they share their data and with home? and also having the equivalent of a citizen jury that can actually provide some auditing and oversight and actually imagine if we had the 50 different states each having citizen juries about what is being done with their bio data or how it relates to testing or covid-19. the thing about bio data also being critical is, i remember someone saying who is following around the president of the united states being sure we sprinkle false dna everywhere you go? we are not going to be in the future that when someone shakes your hand, they are going to be able to figure out what you are immune to or not immune to and what you are susceptible to. i always tell people, the good news is medicine is being democratized, the bad news is, technology is being democratized. >> i want to come back to that, actually, because i think it is a critical issue just raised in terms of biotech and biowarfare. just in that point, frank raises in his report a balance on data collection. what is that balance? how can the u.s. government balance data collection and usage for bio security with privacy requirements, which the public will be asking about? an open question as to your thoughts. >> a quick response, if i may. it is a very difficult balance to maintain. one thing, we have already seen the misunderstanding of hippa in terms of sharing public health data. how do we secure the data? to david's specific last point, we have some experience with democratic deliberation from bio banks. from munich we take sample and in michigan, with a bio bank with all of these tissue samples. do people know what they are agreeing to? do they care if they use these data when the tissues are used to follow them do they want to, , or to take -- have the government take it and use it. so you've got these problems on the ground that i think have not been resolved yet. i think it is definitely the right question. i'm not sure balance is the right word at this point. additional thinking would be needed, in my opinion. >> just real quick to build on what peter just said, it actually goes to the next level. we have to show the next level of representative forms of government, empowering people to have the necessary biological literacy. if you don't have that, you can't make an informed choice here. but then the connectivity, the necessary access and opportunities to data. it's great that we are saying we want people to go online and make these choices, but not everyone is connected in the united states, so we have to address that, too. this is about thinking about, how do we take it to the next level? this is a mandate in open society to let people have choice. part of that freedom of choice is being able to be informed about your biological self and -- and what's being done and how it links to the collective. this also points to a larger problem. it is about resiliency plus. how we can effectively govern at speeds that have not been done before. in a participatory way. if anything, covid-19 shows that people's way of governing is not going to work for the new way going forward. >> if i could just jump in for a minute. one of the things i think about, with respect to data, is, there are techniques that allow you to keep individuals' information protected, but still allow you to use the full data set. and those techniques, i think, have to be well understood, worked on some more, but we need the data overall for some of these solutions, and we probably can protect the individual if we set it up correctly. i will leave that to the technical people. maybe chris wants to speak to that. but there are other areas besides from biology, where one is able to work with full data sets, but not have to go to the individual piece of data. >> yeah, i will jump into that. there are very promising areas that are most applicable in terms of the bio space, just given the obvious privacy concerns, but are going to be really important across-the-board as data becomes more and more key to the operation. you will be able to identify individuals from that. i think pursuing these technical means is one element of that. i think the other element is sort of what david alluded to, in terms of setting norms and standards and expectations, in terms of how we are going to deal with data. i think that is how the u.s. can differentiate itself from some other countries, especially competitors, that i don't think take this approach. that can provide competitive advantages. but the u.s. government has to be clear that this is really key. and where other countries are less good about this, and violating it because it's putting even allies and their own people at risk. >> just a quick caveat, if i may. we need to solve the distrust and government problem. it is going to be problematic. a quick anecdote -- despite the ravages of the flint water crisis, it is really difficult to get people to sign up for the flint registry, because they don't trust in the government. and i suspect if people don't have the nomenclature, the understanding, it is going to compound itself. >> that's a really interesting point. i'd like to turn that around to another thought. i think that david mentioned public involvement in decisions about the data. that obviously involves illiteracy. in talking about the covid-19 response, addressing public education, understanding of science being critical to , mitigating future health security challenges. just to that point of public literacy, education, health issues, that will be critical moving forward. what are your thoughts on how we address that? >> i have a thought. i agree with peter's concerns. one of the things i think helps very much with the public is, we actually see successes. so the fact that there has been success with respect to the vaccine will not solve things for everybody. but it's still going to, i think, because substantial shifts in a big portion of public attitudes. same thing, to the extent we can build an effective plan that has public health working more effectively, and i think there will be a greater degree of trust. flint, by way of example, was just the opposite. if the government has actually been effective, that allows you to have a greater degree of confidence. just to use an example, somebody mentioned nobody wants to go to the dmv. but a lot of dmv's now are online and pretty efficient and it works a lot better. people feel, okay, i don't want to go to the dmv, but at least i can have a result. we need to start getting some good results, as a way of building public trust. >> certainly, and transparency. saying what you know and what you don't know, what the level of uncertainty is. and i think you build on successes. >> with some respects, that is going against u.s. history. we through a revolution against the king. we don't trust authority figures. that is also the story of the revolution. we may need to look for governance, which is distinct from government. not trusting a public authority figure as part of the u.s. culture, but we still accept decisions made by individuals on a jury, and we seem to be ok with that. how can we accept that, government is a partner, but also people at the local level? it's going to have to be ways of doing governance that may include government, but it is not up-down from government. that is going to be key. just to recognize our history, unlike canada, we do not have a peaceful separation from our king-like individual. >> i would add to david's point quickly, when we talk about genomic data and privacy, the position management efforts we have been going after on the national level may yield some helpful hints here. the nih's research program that launched a couple of years ago launched an idea to develop a million person cohort, with the idea that in addition to biological indicators, all participants have genomic sequences stored in a biobank, housed by the mayo clinic. there are also private partnerships with google and alphabet. it is your true sort of public-private partnership, where there have been a couple of lessons learned we can glean as far as multiple language translations, for communication to communities, awards to work on uptake, etc. i think it would be remiss for us to reinvent the wheel without turning our approach to this and seeing what is working. it's still a drop in the bucket, so to speak, population wise. >> thanks, jacqueline. you raise it something i wanted to touch on public-private partnerships, the role they play in pandemic response. perhaps specifically dealing with protecting key critical infrastructure. frank, in your report, you mentioned the criticality of u.s. climate change and will -- vulnerabilities there, as well as funding, significance in the health care sector. it would be great to hear more on the public-private partnership side, but also fostering the resilience of our cybersecurity architecture. you are on mute, frank. >> you would think after all these zoom conferences, i would know how to unmute. with respect to public-private partnerships, one of the things that is a tremendous success in terms of vaccine development is the incredible number of projects going on that have come to fruition, but there are 200 to 300 different projects. that is a lot. all of -- almost all of those were in some sense private sector. what that shows is, with the right incentive, i don't think incentive was so much money, but actually trying to do the right and important thing for the country in the world, we really can find the innovation capacities both in the u.s. and with allies and partners to work on these issues much more effectively. i think one way to help do that is to have, i will say nih, maybe it is the national institute for allergy and infectious diseases, they have significant programming, with the goal of essentially enhancing this kind of program. we need to have a, maybe not exactly a five-year plan, but a 10 year plan, we need to have some things that are going to be hard to achieve, and maybe they will only win on 1 out of 10, but when we get the 1, that will be a big deal. and don't beat us up because not everything succeeded. even the venture capitalist is not even succeed on every part of venture capital. i think it is a somewhat different approach to encouraging entrepreneurship, innovation, making sure the support is there through congress and funding i think can make a difference. on the cybersecurity side, the u.s. and our allies and partners really are very innovative. but one of the things is, those concerned me. i some of the others know, i've written quite a lot on cybersecurity, also. i mentioned in the report that we have seen a tremendous amount of attacks on both hospitals and on researchers. we need to make sure -- some of this is a relatively small entity. they don't have time to have a very effective cybersecurity set of capabilities to protect what they are doing. so we need to create in my opinion cybersecurity resilience architecture, but basically a system small and medium-size businesses could plug into, provide the cybersecurity for their information that needs to be proprietary information, that needs to be guarded, and have that set of capabilities actually run by experts, who know how to run cybersecurity. the analogy i would use would be financial. most of us do not keep our money under the mattress anymore. we use banks. the banks run all that for us. all we have is kind of an electronic link and a bunch of electrons. the system works very well. we need to have a similar system for cybersecurity. it's too hard to ask a small or medium-size business or individual to protect themselves against enemies like russia that have been identified as publicly attacking, or in some significant criminal enterprises. so they -- those are two significant things i would do, a much more structured and supported research program and a somewhat changed cybersecurity program. >> if i can build on what frank said oath here and in his report, the analogy, most of us now don't keep money for ourselves, we trust the banks will do the right thing. most of us also don't walk into buildings and start wondering if the building is fireproof. we assumed there's been something done, the government has made sure it has smoke detectors and we assume they are working and everything like that. we need the equivalent if you work to go back 100 years from now and say we can let you know there's a fire going on and what fort happening on, but they called the fire department and at the same time turn on the sprinkler system. we need the same thing for cyber. we need to pay attention to all the angles. at the same time we need the same thing for biology. success five years from now swing look back and say we used to think it was his separation between responding and monitoring for unknown pathogens of human or natural origin. were just continuously monitoring adverse cyber events. we're looking for that as well to automatically call the fire department that should be responding and if possible activate remediation efforts so monitoring the identifying of therapies and then putting it out. >> i want to raise one other question, frank raised the idea of an organized national approach for future pandemics. there is currently no national plan for pandemic response and we've obviously talked about the lack of funding with public health. opening this up to whomever which is to answer -- wishes to answer, what would be your recommendations for establishing such a national plan, and can we replicate successes to create this? this panel, we have experience spanning various u.s. agencies from dhs, dod, the cdc, which agencies we need to be involved in building a national plan, and does that involve creating a top-down system for future pandemic management? what are the benefits of that and some of the issues that might raise? >> david earlier mentioned opposition to the top-down approach. while i largely agree, think what we're really talking about is cooperative federalism, the term used to talk about how federal government can collaborate with state and local government. to me, it's narrowing practice -- there are some examples from the environmental area, whether they could be extrapolated to deal with climate change remains to be seen. a superfine, for example with federal and state responsibilities. there have been lots of delays and lack of cooperation. it seems to me that this can't be a bottom up effort. that there has to be a fair amount of federal governmental involvement for all the reasons that we've been talking about. take cybersecurity, for example. you can expect state and local health departments for example to be developers. and possibly even pay for the technology that is needed, which was an earlier issue i don't know if we will come back to. what is the federal government's imperative advantage, what are its core companies in research and development and procurement? one thing i think the government did well in the bioterrorism planning was donating payment for tabletop exercises so we have all the agencies at the state and local level in the same room and identifying the challenges. the onus is going to be on the federal government to provide funding, use a full range of government to implement from a global -- what is needed. we saw some of that with covid-19, global distribution centers. best planning practices valid in collaboration with state and local governments. i think state and local handle the distribution with adequate funding from the federal government. i would make one point, we need a rigorous after action report when the pandemic inns so that we can really assess what went right, what went wrong, how can we [indiscernible] there were some great ideas, but we need to do more of that. >> i agree it needs to be a collaborative approach, and all public health is local. i always tell people it needs to be an ecosystem approach. there are three things we can use. first you think about what can government do as a public-private partnership with private organizations and with state and local government on infrastructure if we don't have the necessary infrastructure. i remember back when i was responding to 9/11 and the amtrak events, we had to go to the library across the street to use a fax machine, and that was challenging. the second is the literacy. the general population needs to at least be aware of these issues. i want to be sure i can walk around and not be worried about how a pathogen adversely affects me. and finally it's about opportunities at the private sector, local and state. it really is recognizing that this is an iceberg moment of a larger trend and i tell people the great news is, the challenging news is it's being democratized. where there's cyber or bio, the shocks that will occur within this. >> david has frozen, so we will wait for him to come back. chris, is there anything you wanted to add? >> think he's exactly right, zooming out a little bit, into the framework that frank provided in his paper, where he's talking about the strategic framework for critical infrastructure. i think that's exactly right, and the three things that david highlighted their was specific to the pandemic response which are what are we going to do in public private partnerships in infrastructure, the need for greater literacy and how do we convene collectively for more opportunities? all our challenges across the emerging technology threat factor. the government needs not only specific strategies with respect to -- also a reconstituted vision of what constitutes a critical supply chain and a more comprehensive assessment of the technology competitiveness going forward and the steps necessary for that. so from the commission standpoint we're looking at some of the -- what it needs to do in the name of national security, broadening that definition for all of these emerging technologies, because that is exactly what our competitors are doing, and until we do that, we are going to be behind. clementine: you raised interesting question in terms of national security. i'm keen to hear your thoughts here. obviously, in terms of advances in biology, they come quickly. now that the technology is out there. and you have witnessed the profound potential that diseases, such as covid-19, have to disrupt entire nations institutions, our forces that , support them, and it incentivizes malign actors, and -- to develop targeted biological weapons. and how the united states and allies get ahead of the curve to prevent future people potentially using bio security scenarios. >> yes, it has been a perennial question going on for 20 years, and we are closer. it is still easier said than done in many respects, but with the advent crispr and other technologies, we are at the step of a whole new landscape of synthetic biology. oftentimes, a lot of precursors for something like that. we are talking about bad actors. it resides often in government sponsored laboratories, so there is a bit of an overlap, and the picture is sort of a venn diagram of synthetic biology and bio security threats and then another circle of emerging infectious diseases and pandemic threats. there may be a lot of overlap. the u.s. has done a lot of work over the last decade to really try to thread that needle about how we research that and keep the information secure while staying ahead of the curvature -- curve in terms of knowledge. so back in 2012, dhs and dod and other agencies were part of mounting dual use research of concern regulation which apply to pandemics with pathogen potential, and that work has been expanded. dhhs has a framework that is supposed to guide their planning decisions on research that may create or transfer or use enhanced pathogens with pandemic potential, so in answer to your question, this time in our country may bring it up to really evaluate this and to make sure that the directions we are moving in are the best ones. i certainly agree with peter's mention about tabletop exercises. we have been doing that for a very long time. it always seemed a great way to get disparate views in the room. one more specific thing would be ramping up global health surveillance and particularly genetic surveillance. it was largely genetic surveillance that indicated that covid-19 was not a synthesized strain, for example, and while most states have the capacity to decode genomes, we really lack the unified national surveillance program, reporting not only of coronavirus variants but anything being targeted, and beyond the current covid, they can use a system like this to help identify emerging pathogens. the other side of that venn diagram. clementine: we just have david back. david: taking out my internet connection. i am now joining by way of my phone connection, which hopefully will provide some resiliency. clementine: glad to have you back. we are just talking a little bit about bio security and biowarfare. jaclyn has talked about a surveillance system, so i wanted to get your thoughts on that and what you discussed with regard to early warning systems and preparedness. david: we are going into a world in which because of technology, things that used to be done solely by government now need public-private partnerships that involve people, and back in 2000, 2001, he could talk about pandemic surveillance, and people were less concerned about that term. now, in 2020 and 2021, if i use the word surveillance, even if it is not about people personally, it makes some suspicious, so we have to find a way about the early warning and make sure we show the values that involve making sure it is not about you personally. it is about large-scale buying habits, things going up and down. one of the things we used to do is about five days before a vip event like where the president was speaking, we would plug into over-the-counter drug sales, 911 calls, school absenteeism. not because we wanted to know the individual calls that were coming in but if we saw over-the-counter sales going up, we could see something possibly going on at that vip event, and at major sporting events, we saw after the event a huge sale of gastrointestinal items. it's -- not knowing if what people ate at the event caused them to go for over the counter drugs. it is looking for the non-obvious signs to tell us what is going on, and the fact that now in 2021, we could have companies that could inform, not specifically someone walking out of his house, but i want to know what are the general trends of people going to work or not. and if there is a shift in behavior, it could be a warning, but it could also be an early warning for something else we care about on the planet, so democracies and other forms of government to deal with the data tech that have impacts on how people live, and we don't think -- if we don't think about how we integrate everybody. if we do it in a small set of conversations, i think people will be suspicious in open societies. clementine: ok, well. i wanted to turn out to some audience questions, because we have had interesting questions from folks. i will open the floor to whomever would like to respond. one from sarah, at the global public policy institute in germany. she says resilience is key to the european union's global strategy, the eu increasingly understands resilience is not merely the ability to bounce back but to adapt dynamically to new conditions. do you think challenges like covid-19 calls for adaptive resilience and if so, how can , u.s. institutions evolve for adaptive resilience? david: that is what i saw in 9/11. that is what i saw with sars. also with west nile virus. these are things now almost 15, 20 years ago. while i'm not against some top-down approaches, what i've seen, and my research and i did , a phd in this, where the environment is turbulent. the conviction i had back in 2007 is the world becoming more and more turbulent, so we have to figure out some way to keep some essence of the top-down approach as well as the bottom-up and peer-to-peer. that's what i use the ecosystem model. you don't tell ants where to go. they figure out where to go. otherwise, you're absolutely right. if we do not figure out how to govern and adapt at a speed that heretofore we have not seen, issues for open societies like us, so i would hope this is something we can do collaboratively with our partners, our partners in canada. as we figure this out, how can we be adaptive and resilient for the decade ahead, because we know shocks are coming, and we also know our current rate is insufficient for those shocks. peter: i would just add that without investment at the state and local level, we do not have the infrastructure to be able to adapt. for a number of reasons, that is a biggie. clementine: yes, that point is critical. the next question is from maria, a master's student at st. petersburg state university in russia. she asks, as the threat of bioterrorism grows more prevalent, will we see increased activity by the united states within the framework of biological weapons conventions? furthermore, will bioterrorism reveal potential for mechanisms and frameworks of the biological weapons conventions? jaclyn or, chris, i see you are unmuting. >> i detail to the commission from the arms control bureau -- [indiscernible] i will just say that i think the u.s. concerns about the verification protocols have more to do with the fact it would not be effectively verifiable, and it would instill a false sense of confidence in states if we were to pass any kind of regime, because given how proliferative it is, there is no way you could have confidence -- so i think the concerns about the proposals remain. i think it certainly highlights the importance of multilateral collaboration on biological weapons and other pathogens, in general. so i would think that there would be increased international focus on this and particularly increased focus on the u.s. side, but i do not think it would change the position in regards to protocols. >> this is where in some cases frank's report is so spot on. these are both areas where attribution for sophisticated actors is really difficult to do. you can get a high degree, but both of these are going to be areas in which, again, and like all things, capabilities that used to be very exclusive and only in the hands of a few can go more mainstream and get democratized, as well, so we have to prepare for a future when personalized medicine will be here, and the challenge is personalized medicine will be here. clementine: ok. so we have two other audience questions that i want to squeeze in, and we are nearing the end of our time. james, a scholar at the university of birmingham in the u.k., says that the comments about the u.s. and its nonchalant stance resonate with the u.k. response. they do not sufficiently fund pandemic preparedness, because previous outbreaks have been less serious. in the long term, 10 to 20 years down the line, which is exactly the timeline we are thinking about, do you believe again that governments will reduce pandemic preparedness and disregard the lessons from covid-19? how do we prevent that from happening? >> if we are not careful, yes. if anything, they are programmed to do with the short term. they are not programmed to deal with the long-term well. you can look at an example with singapore, they create a 50 year plan every 10 years and spending a lot of money working towards it. i cannot imagine in the united states where we have a five- -- 50 year plan or 10-your plan and reaching consensus. government by itself will be insufficient, because until we start seeing representative forms of government being more long-term in their thinking, and i do not think it is in their dna, we may have to have other ways of encouraging long-term thinking, ngo' is playing a role, and the private sector short-term, so if we can at least reach consensus of a system that should be in place, regardless of whether there is a pandemic or not as a system of creating data streams so they can inform machine learning and detect it that is something we , can build and always have running in the background so that 20 years from now, we do not lose attention from it. if anything, we just say that is part of how we do building codes and that is part of how we do things. peter: our history, certainly, would not be positive for learning lessons. a lot depends on what actions we take over the next three to five years to respond, do we implement frank's vision? do we take it seriously? getting to the difficult questions to move forward. if you do, and i think we might get a different result, because a lot of people are scarred. this has been a searing event for all of us, and it may be different for some who, as it turned out, were more transitory. frank: can i jump in? i am perhaps more of an optimist then perhaps some other people and i agree, we have not been , very good in this arena, and in the past 15 years we've had about 10 different statutes but , none of them brought us to the level we needed. but, on the other hand, for example, in the environmental area, we started about 1970 or thereabouts and have done quite a lot of good with respect to clean air, clean water, and the standards got better. we are obviously at the front end now with respect to climate. david mentioned safety standards with respect to fires. and if you go into the classic national security era, what we did during the cold war, that was bipartisan and continued. so i think one of the roles of government, but not just government, leaders at all levels, is to say this is really a significant problem that we have. we need to get the country broadly speaking to come along with it and get the country to understand as we did 50 years ago why environmental changes are important, why safety codes are important, and we succeeded in that, so this is, perhaps, just another way of saying what peter has said, that we need to take advantage of the crisis and put ourselves on a route that allows us to effectively mobilize what needs to be mobilized. clementine: ok, well with five minutes to go, i want to kind of pose a final question. and allow you to give any concluding thoughts. we talked a lot about covid-19, lessons learned. we have spent a considerable amount of time thinking about future health security challenges. i think for those of us in the general public who do not work in the health security sector, i'd be interested to hear what each of you think about what are the major health security issues in the u.s. and nations worldwide, what they might be -- face in the future that we need to be preparing for now, and what are your recommendations for how to mitigate that? going beyond what frank touched on. what other areas of opportunities have we not discussed? i would be interesting to hear your thoughts on both of those questions, so maybe i will turn to david first, given that he is unmuted. david: [laughs] we really do need to look at this, as frank said, we can do these things with enough attention and focus. it needs leadership at all levels. we will not succeed if we say it is someone else's job to do. the government's job. or the private sector's job. it will require the whole of society's response. that is really going to be our challenge. assembling the necessary momentum to make a whole of society response is challenging but is doable, and to peter's point, maybe this has been enough of a scarring moment that it is going to provide that catalyst we do not forget 50 -- 10 or 15 years from now. obviously, the focus on public health but recognizing it is broader than that. this is dealing with the fact that we are now approaching 8 billion people on the planet. the number of network devices is anywhere from 35,000,000,000-45 billion and will probably go up in the next five years. the planet and another few years will be approaching 120 billion terabytes of data. three times the conversation we are drowning in data. it could be really tempting for some societies to say, fun, done. we do not want that to happen. a broader issue beyond responding to pandemics and being resilient and adaptive. to climate change and other things like this. this is really the order of how do we make sure we do not become a surveillance state as we use these technologies for good. clementine: chris? chris: yes. i completely agree with what david said there. i will build on that a little. in terms of major health security issues, i think the competitiveness of the u.s. biotech sector is going to be of a critical national security problem going forward. not a problem, a challenge. i think that right now, the biotech sector has provided the light at the end of the tunnel in terms of our covid response, obviously, and what people have talked to at length, but the fact that we have gotten to where we have gotten with these vaccines puts us hopefully in a better spot right now, and i think if we were in a situation where it was not the u.s. industry but was a competitor's industry, like a chinese or russian industry, that was leading on those, this would be a very different world right now. and our competitors will see especially how data and artificial intelligence and computing power are being merged with biology to create these kind of systemic advantages. and they are seeking to overthrow our leadership in this realm, and it is going to be critical that we focus on it as a national imperative so we make sure that we maintain our current status of leadership, because experiencing covid, how -- highlights how much worse it would have been if that was not the case right now. clementine: peter, and then jaclyn. any final thoughts? peter, you are on mute. peter: how many of these do i have to do before i can figure out how to unmute? going in a slightly different direction, i have nothing to add to what david and chris said. how does the government use the money that frank is talking about allocating to state-level public health? infrastructure funding defined as investment in technology and you've got to have security at the state and local level -- otherwise, it is very problematic in terms of protecting data, and then that includes buildings, labs, enhanced surveillance capacity, testing, contact tracing, and woeful staffing needs, public health nurses, for example. we have way, way too few in the pandemic. we need, to chris's points, we need enhanced analytic capabilities at the local level. right now, health departments cannot even tell us what works. how to measure the value of public health services. that has to be ramped up. we need to fund the community level grants and public health under the aca. all those things will strengthen state and local public health. >> jaclyn, any final thoughts? jaclyn: covid-19 was a perfect storm of events. generally, global interconnectedness plus climate change is good for emerging infectious diseases. focusing on what an outbreak becomes a pandemic, how do we catch it, how to we contain it, investment in those realms is really critical, and as we have talked about staffing and personnel, i think one thing that has not been mentioned yet is the severely declining biomedical research workforce. the pipeline is drying up on the front end. the training is expensive. compensation is insufficient. starting with strengthening -- strengthening on the front-end is the beginning of an investment we need to make in medical countermeasures, by way of the advanced research and development authority as well as the biomedical research workforce overall. >> last but not least, the service report, any final things? >> i appreciate the panelists, i took a lot of notes and this is one of those things where has somebody mentioned at the beginning, i've been in government -- i wrote a report so maybe you can have decision-makers both in government at all levels and in the private sector to take action, so i think that is the key thing. one additional thought, i didn't discuss earlier, but at the end of the report, i recommend their be created what i call a resilience commission, something akin to the 9/11 commission. participants from the administration, congress, state and local governments, the private sector, academia, to try and sort out not so much what happened, but what do we need to do to go forward and to figure out some of the structural things that we can do that can make future horrible events less likely, so we do not always want to respond. we want to head things off in advance if we can and we also could use the commission if it were created, perhaps in a leadership role to avoid that desire to get back to normal. if they have major recommendations, then maybe we can help put those in place and the equivalent of creating environmental standards or data -- dhs, significant structural changes, so, again, i just want to thank all of the participants, and as i said, i have learned a lot, and i appreciate it. >> thank you so much to our fantastic panel. it has really been an informative conversation. we have gone all over the map. this deserves attention and extreme resources and research and thought, so thank you for everyone visiting at home and to our panelists for joining. [captions copyright national cable satellite corp. 2021] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> follow the latest on the pandemic response, search news conferences as well as remarks from members of congress and use the interactive gallery of maps to follow the cases in the u.s. and worldwide. go to www.c-span.org/ coronavirus. live today, the senate agriculture committee hears from tom vilsack, president biden's nominee to be agriculture secretary that's at 10:30 a.m. eastern on c-span. at 2 p.m., the house returns to take up an apprenticeship bill and begin the process for taking a president biden's coronavirus relief legislation. on c-span two at 9:30 a.m., washington post live hears from dr. anthony fauci on covid-19 vaccine distribution and virus mutation. at 10:30 a.m. come the senate returns for debate on nominations and at noon, members vote on the nomination of pete buttigieg to be transportation secretary. at 2:30 p.m. come a vote on the nomination of alejandro majorca to be transportation secretary. at 9:30 a.m. on c-span3, the senate hears from kathlyn hicks. coming up, the heightened domestic

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