at the international study. i direct our global health policy center. we are honored to host dr. raj panjabi. special assistant to the president and senior director of global health security and bio defense at the white house national security council. welcome. you are a physician professor, social entrepreneur at a public servant. you previously served under this administration. the malaria initiative, which he led. in 2007, he founded last mile health, which remains one of the most innovative, nongovernmental enterprises in providing community-based health services across africa. raj came to everyone's attention in a gray surge during ebola in west africa, where it distinguished itself in many settings. he was born and raised in monrovia, liberia after civil war broke out in the 80's. he and his family migrated to north carolina. we were talking earlier, this is a pattern that parallels the star new york times reporter. she came here to share with us reflections on her memoir. for the next hour, we will be discussing the release by the white house of the national bow defense strategy implementation plan for biological threats and pandemic preparedness and achieving security. at the same time, president biden signed a companion order national security memorandum. we will hear more about what is in that. this is undertaken under the commission on strengthening america's health security. special thanks to some of the key people who made this all happen. from raj, among your colleagues, hilary carter, and of course, dr. raj panjabi himself. from my team, and our production team, special thanks. erik redid ski. thank you. andrew schwartz. the next 45 minutes, the next 35 to 40 minutes, we will have a conversation around different dimensions of this strategy implementation plan. we will open at the backend of this hour, we will open the floor for comment and questions from the in person audience. please step to the microphone here. we will have three or four remarks and come back to a couple of cycles. we welcome those. a few comments on the current situation we face. the strategy and implementation plan follows the release of the first american pandemic preparedness plan on june 3, 2020 one, before labor day. the subsequent $88 billion mandatory budget plan contained in the president's budget submission. the strategy and implementation plan are adding new detail on targets, responsibilities of agencies among the 20 different agencies that fall under the strategy, other aspects of how to operationalize the vision contained in that. the strategy comes forward at a difficult time. the cycle of crisis and complacency is fully upon us. many in the interventions most critical have become politicized and subject to partisan division. many people are turning away from the pandemic. we have been moving into a normalized period. the president himself has acknowledged that in remarks. there have been repeated efforts to find additional resources for the response. those have run up against an impasse, a continued impasse over several different moments in time. particularly around calculations on the hill. money, and lots of it, is a prerequisite for success. that remains highly problematic. skepticism has settled over the world of pandemic preparedness. high-level political will remains an essential element at a time of many competing pressures. i'm quite impressed in reading over the documents and determination to push back against our divisions to make the case very strongly on national security grounds, to remind everyone of the continuing threat, and a deep and abiding optimism in american leadership at home and abroad, and the powers of innovation in this era. as we will discuss, strategy speaks repeatedly about transformation, and a belief in good governance. it is a chapter in laying out what good governance would look like in the agenda. and we need a pep talk around these issues and this strategy provides this for us. there are a lot of key elements. i want to start the conversation with you by asking the basics. lay out for us the key elements and what distinguishes this strategy and implementation plan from what we had before in terms of 2018, but also the earlier versions of the ap3. what does it represent in your mind? >> thank you for having me. when the president moved to sign the national security memorandum on countering biological threats and enhancing pandemic preparedness and strengthening global health security, along with launching this yesterday, there were a few things. one is the increased challenge in the last several years. we have all come to recognize in our own families of infectious diseases and how they really don't know borders and can disrupt society. covid has killed over one million americans, millions more around the world. they are also concurrently fighting outbreaks of monkeypox, ebola, polio. that is not to mention the other infectious diseases we have dealt with for a long time. the other threat that has grown has been the risk of laboratory accidents. there is a burgeoning biotechnology economy, the president signed an executive order to put even more financing and support behind that effort. with increased access to that technology comes to dual risk as accidents can happen. the third threat we are concerned about is the threat of state actors, in particular, using and developing biological weapons. using biological agents to harm us. remembering that long ago, the anthrax attacks following september 11. this is the threat landscape we are concerned about. last week, the national security advisor announced the national security strategy foundational in that set of components is focused on pandemics and bio defense. the new national bio defense strategy implementation plan really gains to articulate further the objectives, the targets to make good on that focus of ensuring pandemics and bio defense is national security. there are a few things in the plan that are critical. let me give you a quick outline. it pushes the vision forward that we can create a world free of pandemics and other catastrophic biological incidents by focusing on five key concrete actions. one is to prevent, to ensure early warnings for biological threats. second is to ensure that we prevent the spread of biological threats. the third is to ensure we are prepared to reduce the impact should we have another pandemic, another epidemic, that we are prepared to reduce the impact on people and communities. the fourth is to impact rapidly responding when we have these outbreaks. and other biological incidents. the fifth is to ensure we are helping communities, the economy, the environment recover when these events happen. that is the outline of the plan. we can get more detailed about what it means. you asked about what is different from those 2018 and the last time there was a bio defense strategy and what is different from the american pandemic plan last year. first of all, from 2018, those areas are pretty similar to detect, prepare, respond, recover. the discipline of fighting biological threats should be becoming more clear. within each of those, we have described a set of concrete, bold targets, such as ensuring we have vaccines available within 100 days of a new pandemic. such as ensuring we have greater investments with health workers across the country, and that we support other countries around the world to develop their capacity to prevent diseases. there are more concrete targets. there is clarity. you mentioned over 20 federal agencies helped develop the plan. each has put themselves on the record for which one will be in charge of each one of them. every target has a lead federal agency and several support federal agencies. the third big difference is the national security memorandum 15, which places through the national security advisor, the white house in charge of the federal policy and coordination by the defense. and the number of associated activities in that. the federal agencies will commit to them as the president has ordered. provide reports against those targets on what is going well, what is not going well, also, ensuring the office of management and budget provides the ability for us to assess how much funding is being requested, whether it is enough to meet the target, and with the national security council, the ability to help federal agencies refine that. there are a number of other pcs, but trying to hold accountable the bow defense enterprise. i will turn back to you. but when you compare -- this plan is coming in at the second year. we have been busy, the president order monday one this review, a deep review, learn lessons with covid and other responses. what we have been active trying to ensure the nation is better prepared for future pandemics. by releasing the american pandemic preparedness plan last year. this national bow defense strategy takes a number of those efforts, largely around technological breakthroughs, vaccines within 100 days, therapeutics within 80 days, tens of thousands of tests in a week when we have a new biological incident. it brings it within the platform of the bow defense strategy and allows us to use the policy tools through the implementation with monitoring, and reinforces the effort while having a number of investments and actions that preparedness is not about medical breakthroughs. >> just a couple of remarks on that. putting the white house unequivocally front and center in managing this was an important step. this put the president behind this. it puts an enormous weight on your shoulders, on your team's shoulders, to hold those 20 agencies to account to bring the vision forward. that seems pretty clearly a significant step of clarifying that. i don't think that has been the case before this. there has been an assumption the white house is going to play. but it had not been spelled out. instructing the agencies to amp their budgetary commitments and to report back on a routine basis, to have a review of budgets, this begins to suggest a pathway forward for financing the program. you are estimating it at 16 billion, 17 billion per year, without being reliant on emergency provisions. beginning to move towards a sober incrementalism around get the agency to begin to show greater commitment in their own budgetary prioritization. assigning the lead institutions for this under those categories you have mentioned, you also instruct in this strategy the intelligence community to do far more, which i'm hoping you say more about that. that, timmy me, also is important. when we turn the corner dramatically into the 90's, the intelligence committee played a vitally important role in what was being put forward, in legitimizing the notion of quantifying, capturing the degree to which these threats touched national security and offering projections and the like. another thing is annual exercises. also another way of readying ourselves and keeping them very inactive. think about those elements. they jump out when you look at this. >> by how well you have read that, thank you for raising those very important questions. let me start with your first point about the intent behind the white house playing a more significant role in coordinating federal bio defense. it is consistent with what the president ordered on -- in january of 2021 when he came into office. he asked the national security advisor to take on the coordination role. this affirms the national security advisor role in doing that for preparedness. what that means and what it conveys is we understand whether it is covid or another epidemic, an accidental or delivered biological incident, that it requires interagency coordination. the white house has a unique role to play in making sure everybody, all of those agencies play to their greatest value. not just during responses, but during preparedness. hhs on the health side still has statutory requirements, the department of health and human services. the work they are doing to strengthen the cdc's role, to strengthen the administration of strategic preparedness and response are still relevant, they will manage the day to day operations. you can see how many things they signed up to leave on. that is similar on the global side. they have a role to play in strengthening global health security, a good segue to the other part of your question. dod, the intelligence community has key roles. they have been clear about those roles. we will play a role in enabling that, holding the group to account in quarterly reporting so that it can be shared with the national security advisor to ensure that we are there. also to your point, about engaging them in providing threat assessments. so the national security memorandum tasks provide them with a threat assessment across the naturally occurring deliberate and accidental sources of biological threats. it also tasks -- you asked about senior-level engagement, it tasks an annual exercise by the highest levels of government. cabinet level leaders, to conduct exercises annually on health emergencies. the first time there has been a specific tasking on a specific type of exercise around an event in health emergencies. in addition to the day to day work they are doing to deliver on this mission. once a year, we will be running through the exercises to ensure we are prepared for the next pandemic. >> thank you. a couple of other observations. you already mentioned the targets are very ambitious. speed is at the top of your concern. the 130 day clinical trials in 14 days, therapies by 180 days, very ambitious uptake levels. these are putting very high aspirational goals with speed and coverage as a dominant thing. a lot of data, a lot of domestic workforce, which was important to teams giving depletion and exhaustion of our domestic workforce, signaling out biosafety and bio security. we have been arguing for that. it was very welcome. it is a difficult issue. it appeals to norm. there is no single mechanism by which you can track and enforce. but i want to get more about how you see the prioritization around biosafety and bio security playing itself out in terms of our global diplomacy, just information, misinformation singled out, as well. global partnerships with 50 countries saying we will build relationships with any country. and you highlight the financial intermediary fund and the cfa. more about the biosafety, bio security and disinformation. these are new. a much higher focus than in the past. >> both of those areas of focus with what the agencies have done. i want to give credit to my colleagues. my predecessor who really launched the process at the interagency level. we have been working hard on this issue for many years. when we say biosafety, what do we mean? biochemistry labs, not a great one. i do think back more than 20 years ago sitting in a lab and how much change has happened in the last 20 years of science. the advent of crisper, the advent of an burgeoning the acceleration of the biotech industry. essentially means more major companies, as well as smaller companies, and folks and their garages can get access to the ability to edit the genome. this is not science fiction, it is possible to quantify this. a few weeks ago, when the president signed the executive order for accelerating biotechnology and bio manufacturing, we were looking at the data. the colleagues at technology and national security advisor were looking at the data over the next decade globally, biotechnology will contribute approximately $30 trillion of value economically to the world. the access to technology is only going to grow. if there was ever a time to get serious about ensuring that norms for how biological research is conducted were adhered to, understood, and communicated. if there was a time that safety measures were in place so when conduct experiments being as thoughtful about ppe and infection control training, if there was ever a time to ensure that coming to biological weapons that if you look at the way biological weapons convention has been the attack from the russian government on the norms that have already been in place for over 50 years. this is the time to get serious about that. that is why biosafety and a commitment to reinforce the norms set forward by member states on the biological weapons convention is critical to our national security. >> turning to money. this is the biggest uncertainty, the biggest bear reaction you can argue. a factor in the sense people have grown tired of the struggles around this. there is a certain skepticism that has set in to discussion about getting adequate resources in this period where the cycle of crisis and complacency goes away from this. it seems out of this strategy, there is an ambiguous set of messages coming forward around resources. on one hand, you are not backing away from the need for a major sustained five-year effort under the 88 billion proposed mandatory to your plan. on the other hand, you say the baseline requirement allows you to move forward without specifying what the resources amount two. and implicitly, you say if we demand more of the 20 agencies, we will get greater resources. if we simply make it a requirement, we can begin to shift the ground at an incremental and realistic in a longer-term way. this also seems to be a renewed challenge to congress to take these issues up and think differently. there's been an impasse. you are trying to revisit these issues implicitly. in the discussion with complex around the current budget. >> say a bit more of that. you are not sounding off, you are not being disabled by the impasse. you are moving forward in a variety of ways. there is still ambiguity and uncertainty. the question of cracking the code on the hill goes back to the political leadership. >> the financing for this plan is based currently on the baseline budgets each of the departments and agencies are putting forward. it amounts to some billions of dollars. on an annual basis. a few things have already been done in this plan. in global health security, we want to help other countries build better, help systems stop these threats at the source. we put forward $450 million in commitments to the pandemic front at the world bank to help stand that up with over 20 other countries with $1.5 billion of financing. $150 million over the next three years, the coalition for academic preparedness to accelerate vaccines, they are playing a critical role trying to enable ugandans to set up vaccine trials along with niaid to provide that opportunity. a number of other places, the center for forecasting outbreaks and analytics, a national service for infectious disease. that's how we are spending the financing. that said, it is not enough. for us to hit the bold outcomes in the plan, such as having a vaccine when the new pandemic happens, we get 100 days. such as ensuring we have treatments available within 180 days. testing available within 12 hours. and having tens of thousands of specific tests within a week. these are moonshot targets that are not all possible today. as the president articulated in his 88 billion dollars five year mandatory request, requiring additional financing. it is not scientifically impossible to do it. one asks why we are spending that money. given all of the requests and all of the demands that the impacts for your dollar faces. here's the simple reason. if we spend billions of dollars, we can save trillions in the future. including saving millions of lives. that is not just a theoretical statement. we have seen when congress comes together to invest of bow defense, a bipartisan effort, the bipartisan bow defense commission of many former congressional leaders focus on this issue for almost the last decade. when they come together, we make some extraordinary investments that pay very high returns to the taxpayer. example number one,