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 are anyways ways to address this polarization . Fundamentally, it is an assault on the credibility of science, and a questioning of its validity of shaping decisions for the public Going Forward. Has this surprised you . Do you have any constructive thoughts about how it might be addressed Going Forward . Peggy well, as you laid out all of the issues and how divisive our nation is at the moment, it just fills me with a wave of greatest sadness, because as this Global Pandemic was unfolding, i thought if there was anything that would help us to unify the nation, help us pull together, and to help really renew trust in the importance of science and evidence, and the Critical Role of Public Health, i thought this would be it. Instead, as you know, we have seen just a tremendous amount of politicization of issues, and in an unfortunate number of instances, actions as well. I do think that the public is still listening. I found it quite extraordinary overall it was not perfect, but the way people adopted the tenets of social distancing, learned about the nature of this virus and what was needed to control it, understood about the notion of flattening the curve, and importantly understood that their own individual actions and those of their families matters not only for their own safety, health, and wellbeing, but also for the Broader Community and the public at large. So, i do take some heart in that. What is happening now, though, as steve noted, is dangerous, where the best possible signs science and understanding from Public Health about what you need in terms of declines in cases, hospitalizations and deaths strategies for continuing social distancing, maskwearing, hygiene, etc. , while you go back to more public settings, that that is not being followed as states open up. And, of course, the issues that we are seeing around this trust distrust of scientific information, Public Health leaders, and the insertion of politics into the activities of some of our very important Public Health agencies, i think, you know, really is a signal of enormous concern for us. But i guess i do feel that, as others have noted, you know, this virus is going to continue to do its deadly work, and it is a formidable foe. And we cannot wish it away. We cannot invoke political we cannot invoke political ideologies or media spin to change what will unfold, so we have to really monitor and learn as we go in ways that will be hard, because we may need to pull back, as oregon is doing, from some of the opening up as the numbers and the burden on Health Care Systems demonstrates itself. Susan i just lost you for a second. Peggy i can hear you. Can you hear me . Susan julie, speaking of the credibility issues that surround things, i think a lot of people would love your insights in what you think has been happening with the cdc over the last few months. Most people thought that would be the agency that would be front and center in a pandemic. For the first time they are holding a briefing for the First Time Since march. It is an agency, when you were there, that worked hard to prepare americas response for a pandemic. How can you help us understand what role the cdc is playing right now, and how we should understand why it appears to have been sidelined. Julie i would just like to respond to the broader question first. On a global basis, people crave leadership. They are looking for that from the w. H. O, so anytime there is a misstep, or something that does not go the way that they hope it would, there is a loss of confidence. People are craving federal leadership. They are looking for it from their state and local officials as well. That need for leadership is, i think, a root cause for a lot of the challenges we are having in being able to effectively manage this. When there is not unified leadership, individual leaders will do their own thing. They will take action, they will make decisions, but they wont necessarily be the right decisions. They are far less likely to be the right decisions if they are not listening to scientific advisors, particularly those in the Public Health domain. So, that leadership vacuum is something we are all watching. In the business environment, what kind of leadership can we provide . Stake in theong consequences of this pandemic. Our businesses are at risk. Our longterm success is at risk. For those in the pharmaceutical space, we need patients that need vaccines. How can Business Leaders fill in the gap in this partisan environment to provide the kind of leaders that we need. As far as i know, this virus doesnt check Voter Registration cards before deciding who to infect. We need someone that can be broader than the political process to create examples of appropriate policies for employees or collectively, or advice and thought leadership as policies are being crafted. That will b increasingly important into the election season. Fromrespect to th cdc, where i stood, i know the scientists leading this effort. There the same scientists that were there when i was at cdc. These are the same scientists who led through numerous outbreak investigations successfully. I dont think there has been a deterioration in the caliber of science. Sound issuesround you made reference to, but i also think the ability of our entire Public Health system to be able to respond to a crisis like this requires people keep their eye on the prize over long arcs of time. This brings me back to something csis has been working on, that we operate in our preparedness domain between crisis and complexity. The cdc budget revs up with the emergency supplementals after a crisis like a flu pandemic or ebola. That relaxes and money gets used for other purposes. The same longterm commitment to continuously improving and evolving our preparedness is not something our country has ever accomplished. I think the cdc and the Public Health system at the local and state level paid a big price and play out now. That President Trump said there was no pandemic playbook and he inherited a mess and we were not ready for this at all. Is it a case of institutional and bureaucratic failure, or does it look more like a political or social one . It is an excellent point about the ebb and flow of budgets, which is a cycle that long predates this evisceration. Can you unmute . The commission julie referenced on strengthening Americas Health security which julie cochairs and peggy is a member of that, we spent a lot of time looking at the cycle of crises and complacency. What was required in terms of government capacity, one of the alarming things was the decision taken by john bolton in the spring of 2018 to dismantle the senior directorate in the white house charged with leading the effort and being vigilant, and exercising a level of coordination and discipline across a fragmented field. In relating to those outside interests in industry, congress, and elsewhere. That dismantling of capacity left us vulnerable going into this. And elsewhere. At the level of the white house , President Trump, i think there were many other things going on that this was seen as a distraction or unwanted competition, this pandemic, in terms of the reelection campaign, impeachment was unfolding, so there was not a will at the top to seize on the first disclosures, which started december 31. The president didnt even begin to address this until january 18. Even then, it was not taken very seriously. There were questions of political prioritization at that level, but our institutional capacities had been weakened and we are under investing what we are seeing across our country is the Public Health constituencies or jurisdictions in this country are woefully underfinanced and understaffed. That traces back to the 20082009 great recession. Right now, you are working in chicago, but you spent a long career in International Health and Global Public health responses. I wanted to ask a quick question before we turn back to what is happening in the United States about the international cooperation, or lack thereof right now, and how important that will be once there are treatments or vaccines available. Is it have we already settled upon, essentially, a series of and do a vigil a stick series of individualistic, nationalistic approaches . Can we imagine an international approach . Also quickly, what do you make of the withdrawal from the w. H. O. And how consequential is that . And where does that come from . We only have 25 minutes . [laughter] well i just want to make sure we talk about the international so i think there are so many ways to unpack that. First and foremost, global collaboration is absolutely essential when you have a Global Pandemic. This has been an example again where i think the lack of National Leadership within the United States has a real impact on the rest of the world. We are seen as the national the international Public Health leaders. The relationship between cdc and w. H. O. Has been vital for every other Global Pandemic. I think the fact that, not only at a national level, but now at an international level, we are not coordinated the way we should be leaves the whole world very vulnerable. Particularly things like when the the w. H. O. U. S. Is the largest contributor and u. S. Collaboration is so critical is wrongheaded and we will pay the price for that. I think the fact that the u. S. Is not entering into this with the spirit of global collaboration that we are used to has meant nations are starting to go into their own camps at a time when we need this global collaboration. A lot of discussion has gone about when we have a vaccine. Depending on which country is the one to first develop a vaccine, are we all going to worry about how we get the vaccine for our own population and not think about what is the most rational way of Vaccine Distribution so we are making sure we meet the needs of the most vulnerable population . There is a lot in there, but the big message is global collaboration is more important than ever, and we are seeing a retreat from that kind of collaboration. If you look at any Global Health successes, they have all been successes because of the global collaboration, including making sure that the w. H. O. Is able to play its role, its leadership role in coming together around addressing the issue. Challenging times. Susan peggy, what are some specific consequences of the u. S. Withdraw from essentially a more international approach to this and the w. H. O. . What specific ways should we look for that to affect the course of the pandemic . Peggy as helene was laying out, global collaboration is absolutely essential in a Global Pandemic. We are only as safe in this country as other countries are prepared and capable of responding. We need to share information. We need to share lessons learned. We need to be able to harness the best minds in technology wherever it is in a collaborative way to help build the medical countermeasure tools we need, as a public good. W. H. O. Is the only entity that exists in the world that has membership from almost every country in the world. They have rich and poor, north and south, sophisticated and still developing economies. They provide a lot of important, normative guidance, standards. They represent an opportunity to convene, to develop Important Research agendas for how we are going to really try to develop diagnostic drugs and vaccines we need. They enable countries to have access to Important Information and even regulatory review of certain critical products. Most importantly, looking forward in terms of continuing vulnerability to other potential global catastrophic threats, the ability to have eyes and ears around the world for early recognition of an emerging problem and rapid dissemination of information about the nature of the threat and strategies to address it is critically important. I think, as helene said, although i might say it is stronger, it is just wrongheaded what the u. S. Is proposing to do. Luckily, we havent implemented that decision yet, but it is reckless in the midst of a Global Pandemic, to pull out from an entity that is usually important to our nation hugely important to our nation but also important to making a secure world. Susan we are talking about social, political, economic fissures that are exacerbated. We see that in the u. S. And the very unequal consequences of the coronavirus. Internationally as well. One fissure being exaggerated is china u. S. Rift we are seeing. I want to ask, as a medical and scientific manner, about that. Is there anything, putting aside the rhetoric, and it is quite striking how political it has become in our american context. I was watching the president in dallas and he said i call it the chinese virus, and it was a laugh line. People started laughing and applauding. I thought wow, that is probably a risky place for us all to be in, but putting that aside, what i want to ask you, julie, is is there anything, from the point of view of science, both in terms of how much would you like lay concern or blame at the feet of the chinese for the timetable in which they informed the rest of the world about this, and what other consequences of what appears to be not sufficient scientific cooperation at this point . How can you help us understand that . Julie i have a different perspective than some people because i was leading the cdc during sars when it first emerged in 2003. In that outbreak, there was a substantial delay in notification and global alerting. The virus emerged in november and we were not aware until march. That was long enough for the virus to basically have already globalized and set off hotspots in a number of other countries. By comparison to my experience, i was impressed with how fast we knew there was a virus and had the genome, and could initiate some of the protoculture developing testing and, ultimately, countermeasures. I will also say, from a Public Health perspective, the china cdc is an extraordinary organization. Outstanding Health Scientists at the china cdc. My predecessor established a people to people relationship with the china cdc that i perpetuated and dr. Friedman perpetuated. We signed a memorandum of understanding, and every other year, we would visit each others agencies. The cdc Center Leaders and i went to china. We helped inaugurate their new laboratories. We linked in an Emergency Operation center there to the various provinces in china. All of this came in the aftermath of sars, because china not want to be caught out unprepared on other emerging Infectious Diseases. During that time, scientific cooperation was as good as it gets between two countries that exchange the training, the collaborations, and it is shocking to me right now to see that change. I dont understand the precipitants of it, i dont understand the politics of it entirely, but i think it is a terrible loss. And it is that kind of science to science engagement that helps overcome some of the political differences that divide us and creates Common Ground that, when we are dealing with a Global Pandemic, we are all in this together, and no one is safe until everyone is safe. The loss of that conduit of exchange and Public Health sharing, basically, is something i hope we can remedy quick, because it leaves us in a tremendously disadvantaged place. What will happen when the next virus emerges . What will be the consequence of this divide that we have created now . Susan steve, do you see us and other countries pursuing a national at the expense of International Incentive . What is the lasting damage . What are the specific ripple effects from this w. H. O. And this rift between the United States and china at the scientific level that im now even more scared about, having heard julies answer. The dismantling of the relationship between ourselves and china with science started earlier. We dismantled our cdc presence in beijing a couple years ago, and we have been very involved. We hosted the u. S. china summit at csis when secretary price was head of hhs in the fall of 2017. It was remarkable. These were decades longs relationships. We had the vice premier, four ministers and all of the chief agency heads of china in the room. It was remarkable to see the interaction with american counterparts who had been working with these folks for decades. That is pretty much gone at this moment in time. It will have to be resurrected. The problem is the overall unraveling of the u. S. china relationship. That is was pushing all of this right now. Health is no exception. It has been swept into this. We are now in an arms race for a vaccine. The drive to have the narrative that whether u. S. Or china emerges first will give it the key to reopening the economy and dominating the world. That logic and spirit is the opposite of what helene and j about in termsg of the need for equity, transparency, in the way these vaccines will be produced and allocated. We need to have a chorus of agreement around dedicating vaccines to the Health Workers in every country, and those most vulnerable. We need to be apportioning that out ahead of time. If we have no dialogue going on we need to have a chorus of agreement between the u. S. And china on these matters, it will set us back enormously. I think we are at high risk. Fortunately, we have something called the act accelerator on the vaccine, which is driven by the gates foundation, the eu, a number of other players that is pushing out those norms around equity, fairness, full access, and transparency in the allocation of the vaccine, but the u. S. Has boycotted those sessions. China appeared at one of the conferences, but has been on the margin. We need to pull them into this type of effort. Helene if i could just jump in for one second. U. S. And china scientists are still trying very hard to Work Together around covid19 and other issues, but this governmental attitude is also creating a Chilling Effect for what have been very productive scientific collaborations outside of government as well. Really, proceeding covid19, there was a lot of pressure on even chineseamerican scientists in this country, and suspicion about the work they were doing and the nature of any collaboration they might have with chinese scientists, that they had come from china and trained and state here. We have seen unfortunate defunding of grants that involve collaborative work in china. The breakdown of the work between reticle Public Health agencies that julie was describing, i had a similar experience at the fda where we worked closely with the chinese fda, and it was important because a large percentage of medical supplies used in this country come in whole or in part from china. Having that transparency, that collaborative working relationship, and being able to actually help them improve their Regulatory Oversight to better ensure the quality of goods that americans depended on here was very beneficial. One really does worry about the near and longterm impacts on science, health care, and beyond of the political cold war that seems to be underway. Susan i realize we dont have that much longer, so i want to bring you back here to even a slightly more what is happening now conversation compared with what is going to happen this fall. Helene, you are in chicago, leading a foundation. Tell us what you are seeing on the ground, in particular over the last few weeks as you have this convergence the ending of the lockdowns and people reemerging. You have the extraordinary outpouring of protests and discussion and dialogue over race. At the exact same time, the scale of the disparity between how covid19 is hitting different communities has become apparent. Tell us a little about what the experience is in chicago, and what conclusions you draw from that about this disease Going Forward. Are we doing enough to have targeted interventions, or targeted ways of thinking about different populations, given their different experiences so far with the disease . Helene going back to what i was saying earlier about how this is kind of a dual pandemic, if you will, both as a Public Health crisis as well as an economic crisis, which we created in order to control the Public Health crisis. So those two key points go hand in hand. Over the last few weeks, as we have seen how covid19 has disproportionately impacted communities that were already both healthwise as well as economically vulnerable. In some ways, it has exacerbated and highlighted those inequities. What we are seeing is incredible amounts of need, desperation, and pain that is occurring as a result of those twin impacts. As we know, as this has rolled hitting the elderly, a clearly vulnerable population, it has hit black and brown communities the hardest. The economic consequences have been grave. All across the country, like in chicago, we have mounted large response funds to get people basics like food, shelter, cash to pay their bills and not be kicked out of their homes and apartments, etc. It really is heartbreaking, because you realize the same populations were living in very vulnerable situations before and have been thrown into sheer desperation. Then of course, as you mentioned, on top of that, we have this horrific murder that we all had to watch over and over again, which really, i think, highlighted in a way that many people had denied, that racism is still very much a force in our society. So again, you have this perfect storm of collision of issues that just bring to the surface many things we has a nation have not dealt with. My only hope coming out of this is that we have been thrown into such a stark reality around these issues that maybe, once and for all, we will start thinking about how do we look at these issues of inequity, many of which were created, if you will, because of policies and structures put in place. Can we look at what it takes to really shift and come out of this, perhaps, in a better place, coming up with solutions that address some of the root causes, both to Health Challenges because as we know, a lot of the reasons why black and brown populations are so hardhit has to do with their economic circumstances. Lowwage workers who couldnt make choices about staying home in order to social distance. All of these realities that are as we call the social determinants of health that we have to address if we are going to address the challenges of Public Health crises like this as well as collateral economic damage. Susan i think there is also the fear right now that people have spent the last two weeks since this horrible videotaped murder many of them in the streets putting their lives potentially even at more risk. I know we dont have numbers yet that will show us whether there is a new wave of infections as a result of these protests, but im sure that must be a concern for you as well. Helene it is a concern. I think a lot of these marches and protests have gone to Great Lengths to ask people to continue safety measures. You see a lot of people wearing masks, trying to social distance, but people i have heard a lot of people weigh the alternatives. You can either worry about whether you are putting yourself at risk for coronavirus, and none of us want to do that, or risk not tackling these root cause issues that have killed people for centuries. I think we have to think about both the immediate, which is how do we keep people safe in the context of this pandemic, while we address some of these longstanding, root cause issues that have been putting peoples lives at risk for centuries. Lives at risk for centuries. Susan i know they will pull the plug on us soon. Let me do a final lightning round with everybody. Im so grateful for all of you for sharing your time and expertise with us. I want to go back to that and ask two very quick questions for everybody. Number i want to go back to that and ask two very quick questions for everybody. Number one, what is a metric that you think we all should be paying attention to that will help us understand, over the next few weeks and months, where things are really at . What is a metric you personally Pay Attention to . Number two, what is the worry that keeps you up at night about this, either something we dont all understand that we should or a scenario that particularly worries you . Peggy, can you start us off . Dr. Hamburg one metric for where we are as a nation is challenging with respect to covid. Hospitalizations and death is a concrete measure. Number of measures depends on testing, but im searching for a broader metric to get some sense of social stability and transformation, and light in light of all of these overlapping epidemics and tragedies we are experiencing that would really reflect more of what we need for the longerterm. My hope is that we have seen cycles of crisis and complacency in the world of Infectious Disease threats and epidemics, and we have also seen cycles of crisis and complacency with respect to racism and Police Brutality and a broad set of inequities in our country. Y andf inequities in our country. Im hoping, for both of these issues, maybe because of coming together at a time when we are very mindful of our vulnerabilities and needs to come together as a nation and to be the nation we want to be, maybe we actually can and will make sustainable change. Susan if i call you at 3 00 in the morning and say but what are you freaking out about, what would you answer me . I wont do that. Dr. Hamburg ok. I will let you go to others but we are in the middle of a very dangerous situation on many fronts from a disease front and also in terms of how we address much more meaningful and Sustainable Way the truths about systemic racism and all of its sequela in our country. Susan julie, what should we Pay Attention to . Dr. Gergerding i agree with peggy that the most important metric are hospitalizations and deaths, because those are hard data, not dependent on testing. The thing that worries me besides concern for my mom and the senior members of my own family, i do worry, from a business perspective, that we provide lifesaving medicines and depend on the medicines. That is a really high priority for all of us and why the rest of us are staying home, because we want to do our part to protect the supply. Beyond that, im concerned about what is going to happen in the fall when flu season starts. If this thing takes off again the way i think many of us are worried it will, will people be able to go back into a state where we can flatten the curve . I think it will be heart the second time around. Susan steve . Stephen thank you, susan. You have done a masterful job. I think the broad measure we talked about the other speakers talked about the measures for hospitalizations. I think one broad measure is whether we are stuck in a cycle of a very chaotic, divisive, violently contested environment, or whether we move into a civic dialogue around these reform measures with some vision. There was quick talk and quick turn on the racial justice, Police Reform this week on the hill, which i found encouraging. I think the peaceful protests moves that into a different place. I think that will dislodges our dysfunctional and broken political system at the moment, but i would use that as a way of grading. Are we moving toward some type of unified vision of reform both on the public outside and also on the social, racial justice, Police Reform agenda. In terms of what i worry about, i worry we are already at this very perilous moment with these triple crises. We are in an electoral cycle, we have a president that is fueling and stoking the conflict and chaos, and we are heading into a season with the virus as well as our electoral season. I worry we are not that far away from a breaking point. And what might that look like . My feeling is that these peaceful protests that emerge, if we have another terrible incident or series of incidents, it could reignite the rage and frustration, and anger people have. We need to show progress in listening to what has happened, in a visible and concrete way so people have confidence that all of this is resulting in some action. Susan thank you. Helene, you get the last word. Helene its hard to add to my brilliant colleagues, but on what metric, i would also agree that the real measure is how many people are getting seriously sick and dying. So i think that is what is important to keep our eyes on. In terms of the things that keep me awake, and ive kind of been an insomniac so i stay awake a lot worrying. I worry this could spin back out of control, clearly. My bigger worry is that, having gone through all of this, that we wont be prepared the next time. This is not the last time we will face Something Like this. The fact that we let our guard down, like we did, didnt have Public Health preparedness in place, and as julie said, we had a playbook but we didnt have it up and ready when we needed it. My hope is that, for once and for all, we recognize the value of Public Health and Public Health preparedness so that, when this happens again, we will be prepared. Finally, that we dont lose this moment to really, once and for all, look at what it takes to make us a fair, just, and equal society, and look at this moment where there is this much passion and rage. When i look at the young people who are putting themselves at risk, as they go out in march and march because they believe in a better world, that we dont miss this opportunity to give that to them. Susan thank you. That is an optimistic note to end on. I think we are all reaching for that. I want to thank you and the panelists today, and everyone who took time out of their day to tune in on zoom and others. Good luck with that vaccine. [laughter] thank you, everybody. Legislation to please violence in the wake of George Floyds death. Live coverage b is monday at 2 30 p. M. Eastern he spent
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