Bring this collection of great talent and Close Friends together today for this conversation, and that Susan Glasser of the new yorker kindly agreed to host today. Susan, thank you, and over to you. Susan thank you so much, steve, and to everyone who is joining us on this incredible allstar panel of experts we have with us today. I cannot think of a group that as a citizen, and not just as an observer, im hoping you can help us provide, if not definitive answers, at least some thoughts on what the path ahead looks like, recognizing we are in a world where we could not have predicted what we would have been talking about this week even two weeks ago. So, no one will hold you to it, but i want to thank the panelists in advance for their expertise and insights today. Let me do a quick introduction of everybody so that our guests today can understand just what an allstar lineup this is. I guess in no particular order, but the order i am saying people seeing people on my view screen, i dont know if it looks different to you where you are sitting we are joined by peggy hamburg currently the foreign secretary of the National Academy of medicine, and association for the advancement of science and she 2018. E head of fda and before that, the commissioner of the new York City Department of health and mental hygiene. She brings expertise on the ground and at the federal level. Thank you so much, peggy, for joining us. Next we have julie, the executive Vice President , and patient officer for merck. Before that, she was the u. S. Director of the u. S. Centers for Disease Control and prevention from 2002 until 2009. She has described herself as a vaccine optimist, so im sure in we will have a conversation about what exactly that needs periodic, for one, am looking for some optimism in a moment in time that has not been optimistic. Thank you for everything you bring to this conversation. Steve morrison, you already heard from him is senior vice , president and director of csiss Global Policy center. He brings expertise and background to the question of what america had done to get ready for a Global Pandemic, and now what it is doing when it is experiencing one. And then we are also joined by helene gayle, who right now is the ceo of the Chicago Community trust. Before that, she was a long time ceo of care, deep expertise of international, Global Public health, and spent 20 years working with the cdc on hivaids and the bill and Melinda Gates foundation. We are delighted you are with us today as well. There is an overwhelming number of ways i could jump in and start this conversation, but i feel like it is important to actually begin with a little bit of level setting as far as where everyone in this distinguished group thinks we are today in terms of the pandemic, because you hear a lot of numbers thrown around. You hear a lot of, you know, is it a spike, are we at the end of the first wave, are we talking about the beginning of the second wave . What is your best effort to describe the moment that we are in . I am going to quickly ask each of the panelists to give me their best version of what we are experiencing right now. Just to frame that a little bit, right before this i saw somebody quoting a conversation they recently had with a friend of theirs who is a nurse and saying you know, im a little confused. America is reopening. What exactly is different now than it was two months ago when we were closing down . And the nurses response was simple and quite chilling, nothing is different, really, except we have a hospital bed to offer you when you become sick from all the reopenings. I offer that in a spirit of hoping to understand from each of you. Peggy, why dont you go ahead and start us off on that. Peggy thank you. Clearly, this is the most catastrophic Infectious Disease threat of our lifetime, and, you know, the century. And i think we are still in the early days. We have gotten through some very, very challenging times. Places like new york state and my old stomping ground, new york city, are really showing dramatic declines in the burden of disease, and the same is true in other hotspots across the country, but we are seeing other places with numbers going up, and we are seeing conditions that will clearly make it possible for infection to continue to spread, people to continue to get sick, and all of the risks and concerns that we have been living will persist. You know, we dont know what the summer will look like in terms of the discussions around will there be seasonal waning, . This is a completely novel virus in terms of our human experience. It is clear there are many vulnerable people. We will continue to see infections. People talk about will there be a second wave we are not out of a first wave yet, but we are seeing such enormous mobilization in terms of the Scientific Community and we can take encouragement from that. We will be seeing, i think, meaningful treatments, not magic bullets, but things that will make a difference in our management of this disease. And i hope that julie is right in her optimism about vaccines and that we may have a vaccine or multiple vaccines that are safe, effective, and can make a difference in really preventing this ongoing pandemic, and protecting not just this country, but the world. Susan well, thank you, peggy. Julie, do you agree that we are still in the first wave, as it were . Julie i see this exactly the way peggy described. You have to step back and realize that with rare exception, at least 90 of people are still vulnerable to this virus. What we are really doing right now is conducting a very large social experiment. We have proven that social distancing and lockdown actually does slow spread and protect our health care capability, and with relief from that a lot done, we are observing what happens. We are experimenting with a calibration how much openness can we tolerate before we see a very rapid return to the upslope of the curve that we saw when the virus first arrived . We have some sobering news about that in places that are demonstrating more flexibility, less social distancing, so forth, we are seeing more cases. In some places that might have relieved some of the requirements, we see many citizens continuing to wear masks, avoid crowds, so the topdown decisions have not necessarily changed the way individual people are behaving. There is a lot of variability, a lot of uncertainty about where this is going to go, but i am not optimistic about the consequences of reducing social distancing, and i think we need to be very cautious before we fully return to any kind of, sort of, business as usual approach. I will just qualified the qualify the vaccine optimism, cautiously optimistic is probably the best way to characterize it, and i say that only because there are 130 vaccines in progress. The speed is enormous. The collaboration is enormous. The investment is enormous. In addition, we know from animal coronaviruses, that these vaccines as a family are something that you can create successful mammalian vaccines, too. I think the site is on our side, but that does not say anything about the speed, the safety, the durability, and all of the other criteria that have to come into play before we have something we can count on to give us that population immunity and end this pandemic. Susan im so glad you brought that up, that there is a distinction between your optimism, tempered as it is, on the vaccine, versus the situation on the virus as it is right now without the vaccine. Quickly, before we go to steve, you hear a lot of things thrown around in terms of timetables and the like when it comes to vaccines, even assuming there are one or multiple that are found to be effective. Help us understand what you think is the way we should hear those things. We hear the president of the United States saying apparently october now, conveniently before the election, is the latest date he has been throwing around. Is there any possibility of that . Julie setting aside the politics, i think it is important to understand that there are some early potential candidates there that are moving very quickly into the more advanced phases of clinical trial, and if we are extremely fortunate, those vaccines will have the desired properties that would make them good vaccines for widespread use, but those properties are stringent. It is not just enough to get an antibody response here to me to wee need to have an antibody response that is protective, one that is broad enough so that minor variations in the virus over the time are not going to attenuate the effectiveness of the vaccine. We need one that is durable so that we dont have to get it periodically. Ideally we should have a vaccine that of the requires one dose, just from a logistic perspective. Safe enough tone be used in broad populations of people, young children, infants, elderly people. We have to be very mindful that this is likely to end in a situation where we have more than one vaccine, and that we will be learning how to use them in the most effective way in the target populations where they make sense. All of that is a tall order, and although we can compress the timeline by doing things in parallel and not in series, we cannot shortcut safety. That is one of the things needs to be paying attention to. I am relieved in admiring colleagues that are on the frontlines of this right now because they are finding ways to work with the regulatory agencies and make sure that the safety data are assessed before starting the next phase of the Clinical Development process, but at the same time doing a lot of other things in parallel to shorten what is normally a fairly prolonged timeline. Having said all of that, through experience from merck, bringing the ebola virus vaccine across the finish line, which we really went into clinical studies and phase three in 2014, and it took until 2019 to get the vaccine fully licensed. I can assure you we were doing everything we could to move through the process quickly, but it takes time, and you cannot always predict what the manufacturing productivity is going to be like, or how the vaccine is going to behave in reallife circumstances. So a little scientific humility is an important component of the communication here. Susan so, somewhere between five months and five years. Thank you so much. Steve, i want to bring you in to get your sense of where you would say our Baseline Assessment of right now, and then we can go bigger. Can you take your mute off, steve . Steve sorry. A couple of quick points. We have crossed the 2 million mark of cases in america of a global total of 7. 3, and we are adding 20,000 a day. We have lost 112 thousand people to this disease out of 410,000 globally. To 1000 a day,00 and there are 14 states that have reopened that are seeing accelerated infection rates that are at the highest in the sevenday cycle the highest that they have experienced. So, it is a dangerous situation, and obviously it raises the question, was the reopening premature at least in those states, and where does it go . What actions need to be taken . Oregon has postponed the next phase of reopening, but it begs this question, where do you go from here . We are seeing in this rebound period, quite aggressive spread in rural areas rural areas that are poorly prepared for this. Second, the complexity of this disease, we are discovering it affects the kidney, the brain, it throws off clocks. Clots. We have seen in children this frightening syndrome, the kawasaki syndrome. Were coming to terms with the really dangerous and complex nature of this. It is posing a huge burden on those who are poor and people of color, and those who are marginalized. It is striking them with an impact that is far more ferocious than what the rest of the population is experiencing. These are people who live in poverty. People who are living close to one another, who are in jobs that have special exposure to risks, and people with underlying conditions. On the vaccine, i would just say that we are seeing exceptional collaboration across governments, industry foundations, international bodies, which is very encouraging. When we look at the moment where we need to manufacture and distribute to somewhere between 5 billion and 7 billion people, that is an enormous undertaking, replicated, and very expensive. The ranges of what we require our between 25 billion and 65 billion in order to meet that requirement. That is a daunting challenge. Thank you. Susan thank you for your patience. Has anyone said anything that strikes you as wildly off at this point, or are you also a believer that we are at a risky moment as far as their first wave goes . Helene i would totally agree with everything everyone has said. One of the things that is so scary about this, we both dont have the tools and dont have anything historically, really, that we can look to to give us a road map, and i think the newness of this the fact that we are still evolving in our knowledge and that we have such limited tools makes this a very difficult and dangerous time. Added to that, in many ways we are weaker as a nation in our ability to come together around this. The fact that we are seeing states do very Different Things that may or may not go along with what is best Public Health guidance at a time when we really need to have a much more, i think, harmonized response is very scary. I also think some of the challenges steve laid out in terms of populations that are impacting one of the things that is so different about this is that this is the first time we have had a Public Health crisis that also caused an economic crisis at the same time. And as we think about the ramifications of what the economic crisis has done, who it has most impacted, we really have this kind of double jeopardy that we are dealing with. It is difficult in challenging waters to wade through when we dont have any roadmap that gives us answers. Susan you framed up so many of the issues that we need to talk about further today. Just to name a few of them, you know, the, sort of, very unequal impact and outcomes that have been an aspect of this in the United States from the very beginning, which are very striking, and may be accelerated or emphasized even more with the combination of the economic or Public Health aspect of it. The other thing that you flag that is very hard to talk about in a Public Health setting is the Political Polarization and the radically different approaches in our already very decentralized system. You might have had that no matter what. I was just making a list before this conversation about the number of different manifestations of the polarization on concrete actions being taken at the individual and the government level, and i wanted to ask everyone, about that. Maskwearing is one example where it is more criticized here more politicized here in the United States and perhaps anywhere else. You can literally overlay peoples political affiliations with whether they are taking this Public Health advice. Number two, the authority of the very people who are on this panel has been, sort of, turned into a partisan issue in a way that is quite striking. Actually there was a very interesting number that i saw in a new piece in the atlantic, that suggested at the beginning of this crisis both democrats and republicans had a similarly high view of the authority and their willingness to listen to Public Health experts. That changed significantly, actually, after months of it being under assault. Now you have a far, far higher number of republicans who no longer believe in the credibility, or will take the advice of Public Health professionals. Number three, in terms of ways we are seeing this Political Division in our country exacerbating and complicating the ability to have a national response, not only do we have states taking different approaches to reopening, but you have very very different views depending on peoples political beliefs about what the correct next steps are. I will ask you, that we will go then we will go back to the others, is it too late to correct for that . Is there any way that we can stop the polarization from further hindering a disease that has already claimed 115,000 american lives, or do we have to accept that from a Public Health standpoint as a reality of this coronavirus pandemic at this point . Helene well, you know, i think the horse is out of the barn, so to speak, to a certain extent. It has become, unfortunately, taken out of the Public Health realm in many ways and the realm of knowledge and science, and i think has been politicized. That said, i think there continues to be voices that trying very hard to get people refocused on this as a Public Health issue, and i think all of us, and in our own way, and it is why i am glad we are having this discussion, need to keep thinking about what is the Public Health imperative here . How do we get people thinking about lives being lost and all the Collateral Damage that goes along with it . And, you know, i think it was julie who said we are living through a National Experiment. Perhaps that National Experiment will also open up peoples eyes. You hate to think we have to go through seeing more deaths, but when you start seeing spikes and increases in places that opened up early, and we know that all of the social distancing and all of the rest of the Public Health guidance really did make a difference, perhaps that will start opening peoples eyes and take this out of the political realm and put it back into the Public Health realm where it belongs. Susan julie and peggy julie referred to lets have some scientific humility here about all the things we dont know. Do you think, peggy, that helene is right, that there ar