After covid19 vaccine. We are going to be talking in particular of 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 produced and distributed in ways that take an International Perspective and a perspective of equity and a Public Healthdriven distribution approach. So, were going to be talking a lot about the covax and theres a slide for the audience to get more grounded in what is covax. Its the vaccine pillar of something called the act accelerator to speed up access to diagnostics, therapeutics and vaccines. There are 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 government, importantly including the European Union and their president , but also philanthropy and not for profit organizations coming together, recognizing this critical need as this Global Pandemic was unfolding. As i said, covax helps the vax seep of this accelerator and the coalition for preparedness and innovation which was started after the Ebola Outbreak in order to try to do research and vaccine against pathogens and pandemic potential, the foresight of that is quite appreciated and guy ga vchvgavi. Global access for vaccine innovation. And to provide vaccines for children in the poorest countries through market shaping. Reducing cost of vaccine and helping to support countries with vaccination programs working with critical partners in an alliance. And administered by gavi which works in terms of procurement and distribution of vaccines, and it will be the covax facility is seen as a marketplace through which many countries, rich and poor have access to a diversified and actively managed portfolio the poorest countries need that, and others can procure covax vaccines, why that may bely desirable. And theres the gavi commitment of this exercise and thats 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 and the goal is to deliver two billion doses of covid19 vaccine by the end of 2021. This, of course, depends on the successf successful development, approval and development of vaccines, another huge challenge were facing previously of a recognized virus and disease. Well talk more about that as well. And just lastly, i want to mission before we turn to the panel, you know, the issues of funding because all of this sounds good, but it requires the resources, importantly dollar resources, although Human Resources and political commitment as well, to really realize the important goals and estimated 18. 1 million is needed for covax to deliver on these goals and the advanced manufacturing commitment needs two billion through 2021 and to date has raised 600 million and cepi needs two billion for initial field trials and raised twothirds. But clearly this is absolutely fundamental for the ability of all of this work to move forward. We have to do those studies and as more and more vaccine candidates are moving and taking in clinical trials, this is a critical gap in funding, and it was mentioned as they began this session, we do need to see broader commitment of country, so far, there are a large number of countries, i think 76, that have indicated interest in committing, but we need those countries to truly step up to the plate and make those commitments firm and sadly, the United States has not participated in any of the initial launch meetings, planning meetings or made any active commitment. Currently on the hill there is consideration of monies to support international programs, including money for gavi and potentially money for cepi. And this is a critical time to distance those efforts to ensure that the United States plays a Critical Role in this very innovative and, you know, really essential International Activity to help develop and equitably distribute vaccines. Thats what we want to talk about today. So i will now turn to the panelists. I dont think we need the slide. Thank you. Ill start with nicole lurie to really start the discussion. She, as youve heard, has a long history of working in the realm of Public Health preparedness and responding to epidemics and pandemics, including h1n1, ebola, zika and now covid19. And you know, also an american citizen, has worked for the u. S. Government and i was hoping, nicky, you could sort of layout 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 of the investments the u. S. Is currently making in its own Vaccine Development programs for covid. Socalled operation warp speed. But why is it also of value for the u. S. To invest and commit to a program like covax . Sure, and thanks for the question. I think whats important to remember and i think we hear this a lot, that nobody wins this race unless everybody wins. That we are not safe until everyone is safe. But 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 that there are safe and effective vaccines for americans, but that there are safe and effective vaccines for the rest of the world so that we can end this pandemic. Were seeing right now what we call a lot of vaccine nationalism, understanding lots of countries are taking care of their own needs which they need to and were seeing countries make all kinds of bilateral deals to get vaccines. Thats only going to drive up the price of vaccines for everyone. The u. S. Has invested in a number of candidates. Were optimistic. We dont know if theyre going to be successful. We dont know if theyre going to generate enough doses and so this idea of the u. S. Supporting and buying into a larger pool of candidates so that it hedges its bets, it sees Covid Vaccines as an insurance policy for itself. Makes sense. And secondly thinking of our own recovery. Our economy can recover just by vaccinating americans. Our economy is going to need markets around the world to be strong and functional for our own economy to recover and that means vaccinating people around the world, probably starting with the first tier of frontline workers that theyre likely to do in the u. S. Thank you, nicky. Ill turn now to kendall hoyt who has been working to serve study on some of the issues around models of collaboration, but also, thinking about when the market doesnt always work to address the critical Public Health or global need and why would a model like this be necessary . Why cant the free market just recognize these needs . Why do we need to nicky just laid out a critical set of reasons why its in the u. S. National interests, but why more broadly do we need to proceed in ways that might be different than we might normal normally expect in a global marketplace . Yeah, thats a very good question. You know, this is the demand is high. The market does work. This is not a market failure. But you know, its what competition, sort of a time honored way to generate innovation, but in this case it might actually hinder efforts to develop a Covid Vaccine and to make it equitably available. In a free market, vaccines are going to the highest bidder and theres limited supply early on. And we did a model of the market and it shows that if you allow free Market Forces to operate, its going to cost 13 times more than if we were to do a collective procurement under a global mechanism such as covax. So the cost. Its the going to reduce access to the Vaccines Available if you do it through these bilateral deals. Covax will allow equitable distribution on the basis of need and vulnerability, as opposed to nationality and ability to pay. And as nicky said, we all have an interest in ending chains of transmission as quickly as possible. So, it would get in the way of that. And furthermore, allowing the free market to operate through the bilateral deals is going to create incentives for protectionist measures, expert controls, things that will snarl supply chains which will then hinder development and extend the amount of time that it takes for us to effectively rule out vaccines. So those are some reasons to consider. Thank you, thank you. And now turning to our european colleague. Let me welcome nicolai to his new leadership role at path. And i understand as were speaking, he is this morning here in washington d. C. Where i am, he has movers at his home in denmark and copenhagen to help prepare him to make the journey to seattle where path is located. And it has a long history of forging partnerships across sectors and across borders with government, with philanthropy, with not for profit organizations and the private sector. So that perspective clearly is important as were thinking about how to shape and hopefully support the success of a novel entity like covax. So i was hoping you might be able to speak a bit to the seven issues about how do you make partnerships work, why is this partnership so critical now, and potentially, you know, provide a little nonu. S. Perspective on vaccines nationalism versus globalism. Thank you so much, peggy. Its a pleasure to be with you all today. Those are Big Questions that you raise and i would say there has been good news and this is obviously a great timing for having a discussion on this topic, i mean, since we became aware of covid19, there have been an unprecedented global collaboration, thats great, that means that the they have been able to be accelerated on unprecedented scale so thats really great news. This is why its probably realistic that well have a vaccine available in a short time frame. Also, what we have seen in terms of partnerships and Global Cooperation is the way of breaking down the barriers between public and private sectors. And we talked about the covax. We talked about the accelerator and all of these view and novelty approaches between the public and private partnerships. Economic institutions, universities, pharmaceutical companies and so forth. This is how we at path have been operating for the past 40 years and weve seen how this is actually extremely effective and can help accelerate developments and now, in a way, this needs to be proven that its a completely unprecedented scale and with so many actors. So, actually, were seeing new models and 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. To become available to all. But obviously, its not only the science piece, its also the manufacturing piece and i think you mentioned this in your introduction that for all of these candidates for vaccines, for those to be produced and manufactured upfront, we need to start that work now. That means that we need to use all the resources and all of the approaches to prepare that and provide the funding that is needed for that effort. And for the european perspective, i know we talk about nationalism and the u. S. Conflicts cod. What i would say as a danish citizen and sitting from here in europe, that national has also been a part of the response here in europe. Obviously, starting on equipment, who has the access to that, and then it went on. I mean, how do you make sure who should get access to the vaccines first. Now the European Commissioner, the head of the commission is actually pushing hard and has been very helpful at conferences and giving the support from the European Union side. And the latest is that to counter act nationalism, that eu is now negotiating on behalf of all Member States with manufacturers and producers, which is a new approach, and they would have to deliver on that approach, otherwise probably the governments and National Governments are also going to maybe turn towards a more nationalistic plan which i dont hope. Covid, a great response from the world. Thank you, i almost wonder is nationalism even possible when it comes to vaccines or other areas of bioscience, product, innovation and development . For one thing, science is a Global Enterprise now and the underlying work behind all of these vaccines has been, you know, i think very collaborative and very international. Also, so many of the companies are multinational, how they do their work, labs in one place and manufacturing facilities somewhere else, critical supplies coming from Different Countries, et cetera. And of course, studies have to be done where there are cases and the u. S. Is not proud of its number of cases at the moment. It does mean that we have a lot of opportunity to do clinical trials, but in china, for example, because they have more successfully controlled the spread of this Novel Coronavirus, theyre actually having to go to other countries to do their clinical trials. So theres just a lot of in the real world, theres a lot of crossing of borders and requirements for collaboration, or benefits from collaboration no matter what. So, im sort of curious, you know, maybe ill go back to nicky first on this, do you really think it would be possible for the u. S. To just try to go it alone . And youve watched how this has unfolded in other instances and i should say in framing the question, also, you know, would we be where we are if china hadnt posted the genome in early january in terms of our ability to develop important medical count are measures . Obviously, the science has unfolded quickly and as its spread, people have gotten access to without a problem, but thats another issue with Vaccine Development and collaboration in the past. So im just curious, nicky, from the years of experience that you now have had thinking about and working on these issues . Its such a good question, peggy. Ill reflect when i first got into this whole field, the world looked pretty different. There were lots of efforts at collaboration, particularly on the Public Health side. On the surveillance side between the u. S. And other countries around the world, but from a scientific perspective, you know, the u. S. Scientific enterprise, particularly it was really the envy of the world. What i feel like weve seen over the time ive been doing this work, is that a lot of the world has caught up in so many ways. As you said, weve got lots of Vaccine Development in china, Vaccine Development and manufacturing going on in europe. We have lots and lots of interdependencies. But for those interdependencies to function, i think the relationship has to be built on a relationship of collaboration and trust. And the u. S. Has been a sort of precarious position right now because its been choosing, by and large, to go it alone. In a lot of different ways. And so my perspective as an american now working with a number of global organizations, is that were viewed with increasing amounts of skepticism about whether we can be trusted. I hope that we can and certainly the scientific advancements that have been made, both in the United States and across the world, come from this whole area of global collaboration and science. But you also know when push comes to shove, sovereign leaders are under a lot of pressure to protect their own populations first and it takes an enormous amount of leadership and skill and explaining to explain to ones citizens around the world that taking care of my citizens also involves taking care of citizens around the world. If this hasnt shown us that Infectious Diseases know no borders, none have. So on the one hand were all dependent on this collaboration to an incredible degree. On another hand, just as weve seen the lockdowns and export controls and import bans, we have personal protective equipment and all kind of supplies and weve seen lots of border closures around the world, this kind of nationalism is still alive and well and i think its going to really inhibit our ability to deal with this pandemic and frankly for the u. S. To sort of continue to regain trust as a trusted International Partner of Going Forward and thats an initiative. And kendall, i know that youve done work on sort of trying to think about and frame vaccines as a Global Public good, and that is, i think, from my perspective as a Public Health professional certainly true, but thats a hard thing to communicate in many instances, especially in the context of a crisis like this, where every country is trying to look after their own. What, can you tell us a little about the work youve done in that domain . Sure. But just refer back to the first question about nationalism, i would say that, you know, our political instincts are not in sync. And thats part of the problem. And one of the things that i would like to see are creating some. Institutions and the frameworks that would make collaboration more easier, an easier political sell, and sort of reduce some of the disincentives. You know, tom boike and chad brown sort of had this idea for sort of an Investment Fund or a pandemic agreement and i sort of enqvist envision a treaty that would come into force with a code of conduct that nations would agree to, whether its sharing samples and data in a timely fashion, coordinating on clinical trials,