We established the commission in 2018, it is extending its work in the midst of the intimate through the fall of 2022. These issues are central to the work. We are undertaking. Peggy, one of our commissioners, will be presiding. She recently stepped down from the National Academy of medicine, and was the president of the American Association for the advancement of science, and the former fda commissioner, and former Health Commissioner for the city of new york. We published an analysis that is a companion to this event. S it possible to avert chaos in the vaccine scramble . It is available at csis. Org. The proposition is nationalism dominates the scramble for vaccines. And there is a certain highrisk that low Income Countries will be left out, subject to great delay and uncertainty commander this will have destabilizing consequences. Paper have in our examined operation warp speed, what china is up to, and we have put focus on a Promising Initiative that we will hear about in a moment from peggy. The accelerator and within that the covid facility for vaccines led by gabby. The timing of this event is important as Congress Weighs new covid funding facility in the Senate Republican bill, we will hear about money for that for procurement and distribution. If that step was to be taken, it would be a big step forward in terms of broadening our approach. We are arguing for such a broadening that would blend nationalism in our approach with a more active internationalism. We will hear about that. Other speakers today include Nikolai Gilbert, the president and ceo of pass in seattle. He has agreed to join our commission. With brokering and disturbing vaccines. We are also joined by the thetegic advisor at coalition of her preparedness and innovation. Seppy is the former assistant secretary for fairness in response at health and Human Services department, thank you so much niki. And thank you to kendall for being here. I will turn it over to peggy to lead the conversation. Thank you. Peggy thank you, steve. We have a very distinguished and experienced group of panelists. We really do want to have this as a discussion. This is a critical time to be focused on vaccines. I think it is fair to say that the whole world is very actively waiting and hoping for a vaccine or vaccines to be developed. As a critical measure of protection against what has proven to be a devastating disease, covid19. And there is a lot of reason for optimism, but there are also some real concerns. Certainly, the Scientific Community has galvanized in unprecedented ways, working across sectors and across borders in order to try to develop candidate vaccines and test them. That has been extraordinary. On the other hand, we recognize that this is a Global Pandemic and in order to really combat and control a Global Pandemic, we need to ensure that people around the world have access to tools,l, publichealth importantly vaccines, yet there n enormous sense of responsibility and nationalism around developing vaccines and the access to vaccines that could limit availability, as vaccines are hard to develop, and get them through the whole research process. Manufacture, to and for a Global Response we will literally need billions and billions of doses. So we will be talking about the challenges today, the opportunities and challenges, and we will be talking in particular about an Innovative New model to try to address the issues around how to encourage accelerated research and development of important vaccine candidates, but also how they can be produced and distributed anways that take International Perspective and a perspective of equity, and a Public Health driven distribution approach. So, we will be talking a lot andt the covax activity, there is a slide to help the audience get more grounded in what is covax. That is the vaccine pillar, the act accelerator, which is six the development and production and equitable access to diagnostic, therapeutic and vaccines, the three elements of the necessary tools for an effective medical and Public Health response. This was launched in april. And it was really launched as a collaboration of both governments, importantly including the European Union and their president , but also philanthropy and notforprofit organizations coming together and recognizing this could go was as this Global Pandemic unfolding. Representsid, covax of this, and it is coled by an organization that you just heard about, the coalition for epidemic preparedness and innovation, started after the Ebola Outbreak in order to try to do research and development for vaccines against certain pathogens of pandemic potential. The foresight of that now quite appreciated. And it is coled by the Global Alliance for vaccine immunization, an entity that was created back in 2000, in order vaccines toovide hhe poorest countries throug market shaping, reducing cost and helping with vaccination programs are helped with critical partners in an alliance. So the covax facility is administered by gabi, which has a fairly long history of working in terms of procurement and facility is seen as a marketplace through which many countries, rich and poor, have access to i diversified and actively managed portfolio of vaccines. The poorest countries need Something Like this. They would have no way to actually develop or purchase vaccines for their countrys needs, but high and middle income economies can invest directly in covax vaccines for their own populations. We will talk about why that may be highly desirable. Advancedalso the covax market advanced market commitment aspect of this enterprise. That is very important in terms of the ability through donor financing to secure covid19 doses, make the commitment for purchase ahead of time, and that will help to ensure the access for a very large number of low and middle Income Countries. The goal is to deliver 2 billion doses of covid19 vaccine by the end of 2021. This depends on the successful development, approval, and manufacture of vaccines. Another huge challenge we are unrecognizedously virus and disease. We will talk about that as well. Wheny, i want to mention we turn to the panel the issues of funding. All of this sounds good but it requires the resources, importantly dollar resources although human and political commitment as well to really realize the important goals. Billionated 18. 1 to deliver these goals. The advanced manufacturing needs about 2 billion through 2021. To date has raised 800 million. They need to billion dollars for initial field trials 2 billion for initial field trials. This is absolutely fundamental to the availability for all this work to move forward. We have to do the studies. As more and more vaccine candidates are moving into Clinical Trials this is a critical gap in funding. We Steve Morrison mentioned, do need to see broader commitment of countries. A large numbere of countries, 76, that have indicated interest in committing but we need those countries to truly step up to the plate and make those commitments firm. The United States has not participated in any of the initial planning meetings or made any active commitment. Currently on the hill there was consideration of moneys to support international programs, anduding money for gave money for this is a critical time to advance those efforts the unitedensure states plays a Critical Role in this very innovative and essential International Activity to help develop and equity distribute vaccines. That is what we want to top out. I will now turn to the panelists. I dont think we need the slide. Toill start with nicole really start the discussion. She has a long history of of public the realm Health Preparedness and responding to epidemics and pandemics, including h1n1, ebola, zika, and now covid19. Also an american citizen who worked for the u. S. Government. I was told you could lay out for us a little bit why this initiative is so important and why it is in fact in the u. S. National Interest Despite all the investments the u. S. Is currently making in its own Vaccine Development programs for covid, operation warp speed. Why is it also a value for the commit to ast and program like covax . Nicole thank you for the question. I think what is important to remember, and we hear this a lot, nobody wins this race unless everybody wins. We are not safe until everyone is safe. I think from the u. S. Perspective there are a couple of really important components. It is obviously in our own interest to be sure not only their is a safe and effective vaccines for americans, but safe and effective vaccines for the world so we can end this pandemic. Vaccineeeing nationalism. Lots of countries are taking care of their own needs, which they need to, and we are seeing countries make bilateral deals to get vaccines. That is only going to drive up the price of vaccine for everyone. The u. S. Is invested in a number of candidates. We are optimistic. We dont know if they will be successful. We dont know if they will generate enough doses. This idea of the u. S. Supporting and buying into a larger pool of candidates so that it hedges its bets, it sees covax as an insurance policy for itself, makes really good sense. Finally, just thinking about our own economic recovery, our economy cant recover just by vaccinating americans. Our economy will need markets around the world to be strong and functional for our own economy to recover. That means vaccinating people around the world. Probably starting with the first tier of frontline workers. Peggy thank you, nikki. I will turn to kendall hoyt, who has been working to study some of the issues around models of collaboration and also when the market does not always work to address critical Public Health or global need. And why would a model like this necessary . Why cant the free market just recognize these needs . Nikki just laid out a critical set of reasons why the u. S. National interest, but why more broadly ways need to proceed in that might be different than we might normally expect in a global marketplace . Kendall that is a very good question. Demand is high. The market does work. It is not a market failure. But competition is a timehonored way to generate innovation. In this case it might actually hinder efforts to develop a covid vaccine. And to make it equitably available. Market vaccines will go to the highest bidder. There is limited supply early on. We did a bottle of the market. It shows if you allow free Market Forces to operate, it will cost 13 times more than if we were to do a collective procurement under a global mechanism such as covax. Cost. It is also going to reduce access to the vaccines that are available if you do it through these bilateral deals. You want covax to allow equitable distribution on the basis of need and vulnerability as opposed to nationality and ability to pay. As nikki said, we have a vested interest in ending chains of transmission as quickly as possible. It would get in the way of that. Furthermore, allowing the free market to operate through these bilateral deals is going to create incentives for protectionist measures. Things that will snarl supply chains and which will then hinder development and extend the amount of time it takes for us to effectively rule out vaccines roll out vaccines. Those are some things to consider. Peggy thank you, thank you. Turning to our european colleague, let me welcome Nikolai Gilbert both to the panel into his new leadership role. It is morning in washington, d. C. He has movers at his home in denmark, in copenhagen to help prepare him to make the journey to seattle where path is located. Path has a long history of forging partnerships across withrs and across borders government, philanthropy, notforprofit organizations, and the private sector. Perspective clearly is important as we are thinking about how to shape and hopefully support the success of a novel. Ntity like kovacs covax i was hoping you could speak a bit to the issues about how you , why thiserships Work Partnership is so critical now, and potentially provide a little nonus perspective on vaccines, nationalism versus globalism. Nikolai thank you so much, peggy. It is a pleasure to be with you all today. Those are Big Questions that you raise. There is good news. Its great timing for having a discussion on this topic. Aware ofhave became covid19 there has been an unprecedented global collaboration in the r d state in the Scientific Community. That is great. It meant r d has been able to be accelerated at an unprecedented scale. That is great news. This is what it is probably realistic we will have a vaccine available in a short time. What we have seen in terms of partnerships is a way of breaking down the barriers between public and private sector. We talked about covax. We talked about accelerator and all these new and novel approaches. Upon public and private partnerships. Academic institutions, universities, pharmaceutical companies and so forth. This is how we have been operating for the last 40 years. This isseen how extremely effective and can help accelerate development. Way, it seems to be proven on a completely unprecedented scale and with some actors. We are seeing new models. I think this covax is a unique approach, which is actually trying to also pull in all the countries around the world, no matter if they are low Income Countries, high Income Countries. Everyone has a role to play in this global effort to get a vaccine out that works and become available to all. Theously it is not only science, it is the manufacturing. Thesek you mentioned all candidates for vaccines, those that are manufactured upfront, we need to start that work now. We need to use all the resources and approaches to prepare that and provide the funding that is needed for that effort. And, from the european perspective, we talk about nationalism in the u. S. Context today. I would say as a danish citizen from europe nationalism has also been a part of the response in europe. Equipment,tarting on who has access to that, and then went on. How do you make sure who has access to the vaccines first . Now we see the European Commissioner, the head of the hard andn is pushing has been very helpful at conferences to launch the facilities and giving support from the European Union. The latest is that to counteract the eu was, negotiating on behalf of all Member States with manufacturers and producers, which is a new approach. They would have to deliver on that approach, otherwise probably the government, the National Governments are going to maybe turn towards a more nationalistic approach, which i dont hope for. Covax is a great response for the world in that sense. Peggy thank you. Wonder if nationalism even possible when it comes to vaccines or other areas of bioscience products, innovation and development. Science is a Global Enterprise now. The underlying work behind all these vaccines has been very collaborative and very international. So many of the companies are multinational in terms of how they do their work. Labs in one place, manufacturing facilities, else, critical supplies coming from Different Countries. Etc. Done wheree to be there are cases. U. S. Is not proud of its number of cases at the moment, it does mean we have a lot of opportunity to do Clinical Trials. In china, because they have more successfully controlled the spread of this Novel Coronavirus, they are having to go to other countries to do their Clinical Trials. Crossing is a lot of of borders and requirements for collaboration or benefits of collaboration to matter what. I am sort off curious. Maybe i will go back to nikki on this. Do you think it would be possible for the u. S. To just try to go it alone . This haswatched how unfolded in other instances. I should say in framing the question also, would we be where we are if china had not posted the genome in early january in terms of our ability to develop important medical countermeasures . Science has unfolded quickly and spread. People have gotten access to it without a problem. Thats another issue with Vaccine Development and collaboration in the past. Curious, from years of curious, from years of experience you now have had working on these issues. Nicole it is such a good question. When i first got into this whole field the world looked pretty different. There were lots of efforts at collaboration, particularly in the Public Health side, the surveillance side between the u. S. And other countries around the world. But from a scientific perspective, the u. S. Scientific enterprise, particularly bioscience was the envy of the world. What we have seen over the time i have done this work is a lot of the world has caught up in so many ways. As he said, we have lots of Vaccine Development and manufacturing going on in china, Vaccine Development and manufacturing in europe. We have lots and lots of int