COVID-19

For two years, the world has been battling COVID-19 with masks, vaccines, and lockdowns. But countries have largely failed to channel their shared experiences into a blueprint for action.
Feb 4, 2022
For two years, the world has been battling COVID-19 with masks, vaccines, and lockdowns. But countries have largely failed to channel their shared experiences into a blueprint for action.
Feb 4, 2022
  • COVID-19
    Higher Education Webinar: Targeting, Testing, and Mitigating the Spread of COVID-19
    Play
    Martin D. Burke, chair of the SHIELD COVID-19 strategy for the University of Illinois system, and May and Ving Lee professor for chemical innovation and professor of chemistry at the University of Illinois at Urbana-Champaign, discusses targeting, mass testing, and mitigating the spread of COVID-19 on campus. FASKIANOS: Thank you so much, Erica, and good afternoon to all of you. Welcome to today's Higher Education Webinar. I'm Irina Faskianos, vice president of the National Program and Outreach at the Council on Foreign Relations. Today's meeting is on the record and the video and transcript will be available on our website Cfr.org/academic. As always, CFR takes no institutional positions on matters of policy. We're delighted to have Martin Burke with us today to talk about targeting, mass testing,  and mitigating the spread of COVID-19 on college campuses. Dr. Burke has chaired the SHIELD COVID-19 strategy for the University of Illinois system, and is the May and Ving Lee professor for chemical innovation, and a professor of chemistry at the University of Illinois at Urbana-Champaign. In addition, he serves as associate dean for research at the Carle Illinois College of Medicine, and teaches at the University of Illinois Beckman Institute for Advanced Science and Technology, and the Carl R. Woese Institute for Genomic Biology. So Dr. Burke, thank you very much for being with us. The university, your university, has been in the news with the systems that you're putting into place. So we'd love to hear about the test that you've developed for the University of Illinois to target and mitigate the spread of COVID-19 and share some of the challenges and lessons that you're learning from the implementation as we are starting out this semester. BURKE: Great Irina, thank you so much. And thank you to the Council on Foreign Relations for the opportunity to share our story. I'll go ahead and share my screen if that's okay. Okay, great. So thank you so much again. And yes, as we all I think went through this same challenge last spring, when the pandemic kind of came upon us. I was asked by our Provost to figure out how to stand up and strategically deploy scalable testing as part of the university strategy to try to reopen and stay open safely in the fall. The first thing that really struck me was that this is all about safety to empower the community. We called this our SHIELD platform to represent that focus on safety as the highest priority. We also recognize that while testing was going to be really important, testing is not a silver bullet. And so we really went after a comprehensive program to deploy fast, scalable testing as kind of part of a comprehensive effort. We call this our target, test, and tell initiative, and I'll explain exactly what each of those pieces is meant to represent. Really kind of a comprehensive data science-driven, strategic deployment of testing with fast communication so we can maximize its impact. The other piece is that there was a lot of challenges that required a lot of innovation, and in Illinois we love to innovate. And we use this as an opportunity to try to do that. I'll explain those things, as well. The target, test, and tell platform is meant to represent on the target side, using frontier data science and modeling to help us figure out who to test and how often to test them in a way that would maximally mitigate the spread on our campus. And I'll show a little bit about exactly how we've done that. The second test piece is we recognized quickly that the kind of traditional nasal swab-based approach was not going to be sufficient for the testing frequency that we were aiming for and the speed. And so we innovated and developed a new saliva-based test that's very fast and scalable, which I'll describe. And then the last piece was to figure out how to communicate the information from that test and put it into action as fast and as effectively as possible. And so I'll tell you about a new app that we developed called Safer in Illinois, which is available free on the App Store, which is an app that allows results directly to the user's phone as soon as we have them. Within hours, we get the results out to individuals, as well as digital exposure notifications that are proximity based. And, actually, the last piece, an access screen that if you're up to date on your testing, and you're not positive, you get access to buildings. But if you're not, you can't and so this has been a key aspect of the program that's been very helpful. The last is this entire process has been in lockstep partnership with Champaign-Urbana Public Health District, which is our local public health, which we think has been a critical piece of our success. And so we always like to say we're running a program that utilizes fast frequent testing, rather than running a testing program, because it really is a comprehensive, multidimensional effort that's critical, I think, for making this work. And I'll try to describe why we say that. Just very briefly, some of the modeling that we did as the take off point was if we did nothing and we have fifty thousand people in our community as faculty, students, and staff, so if we did nothing to mitigate spread, pretty much everybody would come infected very quickly. This is obviously not the goal we wanted to achieve. And so we alternatively looked at really a layered approach. If we implied a range of mitigation tactics in combination, we found that we could actually predict a really good outcome. So, two times per week testing of everyone, so that’s fifty thousand people twice per week was the target. We also wanted to have a high degree of compliance with masks, classes greater than fifty online, and both manual and digital contact tracing. And if we put all of these together, we predicted that we would get a very safe outcome. So we would have a bump when the students came back. This was because they're coming from all over the country with positivity rates commensurate with several hundred of them who would actually have COVID when they came, and that we would be able to find them quickly, help them get isolated, and then hit a nice, safe, steady state and have a safe environment for teaching and research and also not cause infections in our community. So this was obviously the goal. And this led us to really understand that we had to have multiple layers in order to make this work. So we're looking at the R0 or the chances of any individual spreading it to others if they get infected. As we can see, testing twice per week does a lot, it really helps in a major way. But, it's not enough on its own. Just wearing masks that makes a really big difference. But, it's not enough to get us below one. If we start combining just masks and testing twice per week. Now we actually predict that we would be below one and head towards a really good situation. If you start adding in classes greater than fifty online as well as other ways to kind of mitigate spread, including contact tracing, now we get to R0s that are very desirable. And this is the situation obviously we're aiming for.  When we started looking at this, we realized we're going to have to test everyone, probably twice per week, at least to start. And again, that's fifty thousand people twice per week, that was a very large testing load. And this nasal swab was not going to work. And the problem is, many of you've heard, people first of all don't like to do it. There's also a lot of supply chain issues associated with it. We wanted to find something that was good at kind of easy and rapid self-collection that would not require as much in terms of health care workers and much easier. And there were a lot of reasons why saliva started to look really attractive. Okay. The first is people will be much more likely to do it twice per week, because it's noninvasive. And there were reports showing that even if the detection level was lower, if you were doing it frequently, you can still get very good mitigation of spread. Now the really exciting news is there was a paper that came out last April showing that in fact, you can detect SARS-CoV-2 in saliva even more sensitively than the nasal pharyngeal swab. Okay, so this was very encouraging to us. And it's also the medium that matters. When you look at saliva, of course, that's how we spread SARS-CoV-2, we know now by droplets, as well as aerosols, and so you're directly testing the medium that matters and really testing for infectiousness. We also get a quantitative readout by PCR, so you're actually getting number of copies per mil in saliva, and really start to understand in a data driven way, how to mitigate this. The standard method was the NP swab, which then involves viral transport media, as well as RNA purification, all of which are supply chain costs and time bottlenecks. There was a very encouraging report that had come out in April, a new saliva-based method that had come out of Rutgers. But the challenge was, it still required a very specialized collection device, and it still required RNA purification. So it kind of slows things down, supply chain bottlenecks, and was still very expensive. My colleague, Paul Hergenrother, had, I think, a really bold idea to take directly from saliva to PCR. Could we cut out all the supply chain, make a very simple process, thereby making this scalable, cheap, and very fast? And so we launched kind of a Manhattan Project-style effort over about six weeks, we looked at thousands of different possible ways to do this. And the bottom line is, we found that if you simply heat saliva at 95 degrees for thirty minutes, it inactivates the virus but also we think breaks it open, exposes the RNA, and you can go directly then in a buffer to a PCR reaction. Excellent level of detection down to five hundred. So even more sensitive than the nasal pharyngeal swab, consistent with some previous reports, without the RNA steps being skipped, so we were really able to keep that really nice component. And all the details are in this manuscript that we put on the bio archive. We also then had to create a lab that could actually do these tests. And long story short, we converted our veterinary lab into a human COVID-19 testing facility. We had actually tested that tiger at the Bronx Zoo back in February, you may have heard about, so we had a leader in this area of animal coronaviruses. And we transfer that into a lab that can do up to twenty thousand tests per day right on our campus. That was led by Tim Fan and Paul Hergenrother. So, just to give you a sense, real quick, of how we did that, the logistics, so we popped up twenty different tents all over campus, we set them up so you literally can't walk to class without walking by a tent. It takes about seven minutes to come in and submit your saliva sample. We've actually now performed almost 400 thousand tests since July. The results are back within hours, which is critical. And inside the lab we're using these Thermo Fisher QuantStudio 7s and some robotics to make this process fast.  The last piece is the app that I mentioned. This allows you to get your results directly to your phone in a HIPAA compliant and very privacy-first manner. It's only decoded when it hits your phone. You can also opt-in for a digital exposure notification, which is proximity-based so it'll tell you if you've been close to somebody who is exposed. And you can also self-report symptoms, etc. The other key feature is that if you are up to date on your testing and you are not positive, you get a checkmark. And this is actually now required at any building in our campus, you have to show your app on the way in to show that you're up to date, and that you're not bringing in COVID. If you aren't up to date, you get an X. And this means you have to go get your test or you've tested positive and you should be isolated. And so actually entry into any of our buildings is now predicated upon being a safe member of the community to be able to enter that building. The really exciting thing is this has now been picked up by our community. So actually, to get into any bars or restaurants or coffee shops around here, you have to also show your app. And this is a really nice way for us to integrate with the community to maximize safety. The last, I think most important slides I'll show you is some of our recent data. This is our dashboard, I think, from yesterday. And you can see we've performed a very large number of tests. So far, our seven-day positivity rate, I'm happy to tell you is now 0.31 percent. We were able to open and never have to shut down our classes since we started and still maintain that rate at this point. That's been a big exciting success in that regard. And just to show you a little bit of the story, the daily new cases is on the y-axis on the left, that's the blue lines. And here on the right, we actually have the positivity rate. Okay, so number of new cases divided by the number of tests for that day, that's the line in orange. And then the bars in green on the bottom is number of tests per day. And you can see this access goes up to twenty thousand. So, on some of these days, we're performing about two and a half percent of all the tests in the entire United States just in our one lab, so it really shows the max, the scalability of this test is actually quite high.  So really quickly, I'll just say over the summer, we did a pilot, we were testing our faculty, staff, and our graduate students. And you can see that we actually started about one and a half percent, we were able to bring that down almost to eradication. We saw some really encouraging signs over the summer, then our undergraduates came back, okay, and we knew we were going to get a couple hundred cases. That's almost exactly what we got so the modeling was very close to what we expected. But the models had predicted then that this would come right back down. And we had actually worked into our model that some of the students would go to parties. In fact, we had seven to eight thousand going to parties three times a week and not wearing masks. So we knew there would be noncompliance. That still should have been okay with what the modeling has shown. What we didn't predict is that some of our students would make really bad choices when they knew they were positive. The vast majority of our students have done a fantastic job. We've got great students in Illinois, and they've been great partners. But, unfortunately, a small number of our students who knew they were positive from our test, chose to go to parties, host parties, or otherwise break isolation and interact. And that caused a real problem. So we saw a spike. Actually, we saw increase in our positivity rate. Interestingly, before we saw the increase in the cases substantially, and this very much both spatially and temporally correlated with unsafe activities that were reported. So again, I think the key here is, we hit this challenge, but we had a very fast frequent testing program, so we could see it early. Okay, so we got a very early warning signal that something was wrong. And we saw it before the cases even rose. So with that, we instituted, very quickly, changes. The first was, we looked at all the data and greater than 95 percent of all the cases were with the undergraduates. We actually started essential activities only just for the undergraduates, we didn't disrupt research and faculty could maintain their normal activities. But the undergraduates were only allowed to go to class, go to lab, go to work, exercise outside or go to religious activities, otherwise, they were grounded. And this was at the risk of getting suspended if they broke that. We also started prioritized testing, so we knew the undergrads were the challenge. And so we started testing some of them three times a week, the rest twice a week, and everybody else only once a week. So rather than fishing in the whole ocean, we just fished in the smaller pond, faster testing, faster results. And that also helped. The last was we saw a gap. Even though we were trying really hard to work with our Champaign-Urbana Public Health, to isolate as quickly as possible, there was still a delay in communicating to Public Health, and then them finding our students. So we launched our own team, we called it Shield Team 30. The goal is to find and help safely isolate all new positives within thirty minutes. That's actually been a big success and really helped move things along faster. We started texting the students, instead of calling them. Apparently they like text better. And the text said, you know, you're positive, we want to support you, here's all the things we can do to help you. And if you don't respond, you're suspended. So we coupled the carrots and the stick. And I think that got us a really good level of compliance. You can see the result as we were able to bring the numbers quickly right back down. And a couple of things I want to emphasize, we looked very closely, and we didn't see any crossover between our students and our faculty and staff. Okay, zero. We actually tried very hard to find even a single case and we couldn't. We also have seen no evidence of crossover from our students into our surrounding community. And so I think because we're able to turn it around very quickly, we're able to stop that obviously very undesired outcome. We're not letting our guard down. We figure this could also, of course, get back into trouble very quickly if people make bad choices. And so the other thing we're doing is really amping up our efforts to partner with our students to really help them have the tools they need to make really good choices, have lots of safe socialization options, and have severe consequences if they choose otherwise.  Okay, so just to summarize, we've learned that fast, frequent testing can help mitigate the spread in a large university community. The testing is not a silver bullet. It has to be integrated with all these other aspects to make sure it works. Our I-COVID test, as we're calling it, is a direct saliva to PCR test that enables fast, frequent testing on scale. Prioritized testing can make a big difference. Mechanisms to help people isolate quickly and safely is really important. And if anyone's interested, we're working very hard to try to make our platform accessible to as many people as possible. We're a land-grant institution, it's our mission, just to try to make impact and serve the public good. And if you're interested, Bill Jackson would be happy to talk to you about how we're trying to do that. And there's his email address. Thank you so much. Very happy to take any questions. FASKIANOS: This was fantastic. Thank you so much for that overview. So, first question, how much has this cost the university? BURKE: It took us about $10 million to stand it up. And it's going take about $10 million to run it through the semester. FASKIANOS: And have you made your test, the saliva test, offered it to other communities? I know you're partnering with your community, but it seems like in other parts of the country, it would be a useful tool. BURKE: Yes. We are on a mission to try to help anyone who wants access to what we've done, to help them replicate it in their own community. And so we've launched a collection of programs to try to do that. One is called Illinois SHIELD, the goal of which is to try to get our testing capability out to our entire state. The other one is called Shield T3, which is trying to help get it beyond Illinois, to the rest of the country and to the world. And both of those organizations are actively in the process of trying to build those partnerships and expand access. Shield T3 is working with I think now thirty or thirty-five other institutions, at different levels down the road of engagement, and about five or six other universities are already using our approach. And there's about seven different countries that have now teamed up with Shield T3 and are working on that to try to help get it out beyond the U.S. So, we're all in on trying to help expand access as best we can and really looking forward to partnering on doing that. FASKIANOS: Fantastic. All right, let's go to all of you.  (Gives queuing instructions.)  FASKIANOS: First question. What is the degree of efficacy as compared with the no swab test? And what is the cost per test? I know you gave us the cost for the overall. BURKE: Sure. FASKIANOS: This question comes from Mojubaolu Olufunke Okome, professor of political science, Brooklyn College, CUNY. BURKE: Great, thanks for the question. And we've included the data I’ll describe in a manuscript that we published on the bio archive that I included in the presentation. Happy to send it if people want to find the link as a follow up. We did some comparisons to the nasal swab, the overall concordance looked really good in general, things matched really well. There's some times where things don't match because we think that the nasal swab will stay positive, far beyond when people are infectious. That's actually been an issue with the nasal swab. But overall, the concordance is really high. And now as I mentioned, we've run 350 thousand tests or more, and we track the CT values, which is the number of times you have to go through this thermocycler to see the virus. And we routinely see detection limits down to like five hundred copies per mil, which if you look at all the literature for the nasal swab, that's actually substantially lower than typically what you see with the nasal swab, or at least on point with the best cases. We've also done direct comparisons with other saliva tests that had been authorized via EUA authorization from the FDA. And we found ours to be more sensitive than the other tests, particularly one, for example from Yale. We think we've got an excellent level of sensitivity. And again, we've now applied it on population scale and seen it working. So we think it's got lots of data behind the fact that this test can work really, really well. FASKIANOS: Great. The next written question comes from Bob McCoy. Perhaps this is not relevant to the intent of this presentation, but a significant barrier to successfully fighting COVID-19 is the politicization of what ought to be a purely medical matter by the current administration. How can this be countered?  FASKIANOS: I'm not sure you want to take that on. But if you do, go ahead. BURKE: I'd say we're a land-grant institution. Our mission is to serve the public good, and we feel like we have found something that can be helpful and our goal is to help make it as accessible as possible. FASKIANOS: Great, thank you. Other questions. I see another one in the chat box. People are doing that instead of... FASKIANOS: Bob McCoy is a fellow with the University of Montana. So thank you for giving us your affiliation, appreciate that. FASKIANOS: You said you have very severe consequences for the students that are going to parties when they know they're positive. Are you suspending people? What are the consequences that you've implemented? BURKE: They get suspended. FASKIANOS: They get suspended. BURKE: The people who are the most upset when that happens is the 97+ percent of all the other students who are doing a really great job and trying really hard to make this work. And I think what we've seen is, again, the overwhelming majority of students have been fantastic partners in this. And they're really proud that their university is being viewed as a model for maybe how we can stay open safely. And they also don't want to go home and have to take the rest of their courses online, in their parents’ basement. So they've been on social media, and in every other way the loudest advocates for let's all team up and make this happen. It's been a relatively small number of students who have made really bad choices. The brutality of this situation is the math is not on our side. Small numbers of people can make really tough situations very quickly, and I think this is 2020, we're in the middle of a pandemic, we all have to do our part. And that includes the students, they have to understand. You cannot throw parties, and you certainly cannot throw parties when you know you're positive. It just doesn't work. And I think the etiquette has to change. As a society, we have to say you just cannot act that way. And there has to be severe consequences when people make that choice. FASKIANOS: Just as a note, we've passed the threshold in the United States of 200 thousand dead to this virus, and I think the projections now for January 2021 is, I think I heard today, 400 thousand. So, or somewhere there. So clearly, our behavior needs to change as a society.  There's another written question from Sunny Jha, an anesthesiologist at USC in Los Angeles, and a frontline COVID doctor. What are your thoughts on the idea of an immunity vaccination passport? BURKE: Great. So first, Dr. Jha, thank you so much for your courage, and you're protecting all of us as a frontline health care worker. It's obviously heroic, and we really appreciate everything you and your colleagues are doing to keep us all safe. And I would say that we have tried to look very closely at the science behind the potential for reinfection. And the likelihood that someone may or may not be infectious post their kind of standard isolation period. And bottom line is, we're still trying to convince ourselves that there is a period of time during which someone would not be able to transmit the virus. We're being cautious and very data driven around this. So for us, we're not doing like an immunity passport. If someone does test positive, and they go through the standard isolation, and then are released by our Champaign-Urbana Public Health District, we actually put them back into our testing pool. And so you still have to test twice per week, we can follow their CT values, and we're doing this and if their CT value is very high, which is typical, that would translate to them having a very low level of virus in their saliva. And the science that's available would tell us they're not going to be infectious. If your CT value is very high, we actually allow them to continue. If their CT value is low, we put them back in isolation, and we track it. And if it ever drops back down, we put them back in isolation. And the idea is if they get reinfected, we would see it and as you probably know, there's been about five cases that have been confirmed around the world of people being reinfected with COVID-19. So we're playing it very cautious right now. But we'll continue to follow the science and the data. And if we can get to the point where we convince ourselves that for a period of time, the risk of reinfection is very low, then we will change to give a window of time where the person probably doesn't have to test but we're not there yet. That doesn't mean we're saying we think that you are infectious. We're just saying we want to be super cautious and careful about when we make that decision. FASKIANOS: And in terms of the isolation, when a student tests positive or somebody on campus, is isolation in their dorm room or do you have a special isolation unit? Or where are you quarantining people? BURKE: We set aside 5 percent of our total housing at the outset for isolation and support. And typically, for example, if it's a building, we have thirty thousand students in Illinois, so there's a lot of different housing situations. And so, in a large building, one of the floors would be set aside for isolation, for example. Students then are moved from their room into one of these isolation rooms, and we provide them a lot of support. I think that's obviously really important. We need to make sure that they have access to food and social support as well as any healthcare needs that they have. We partnered with a local health care provider through what's called a pandemic health worker program. They can get a kit that helps them track their symptoms. And they have telehealth, we have our Champaign-Urbana checking with them every day. We check in with them every day. There's a voluntary support Zoom meeting every day for everybody who's in isolation if they want to kind of talk to others and try to talk through challenges together. We really try to take a very supportive approach to this. That said, there's also, as mentioned, severe consequences if people don't stick to the isolation plan, they can be suspended. And I think that's actually important that we have both. FASKIANOS: There's a question in the chat. I don't know who asked this question. Maybe they'll identify themself. Would this model work for nonresidential universities, like a commuter campus, community colleges, and city colleges? What recommendations would you make for these institutions? BURKE: Yeah, it's a very different challenge, and we recognize that. So we are in some ways, fortunate to be in a very, somewhat contained situation. We call it a semi-contained community, because of course, there is travel in and out. But in general, it's much less than, let's say, for living in a major city or urban setting where there's lots and lots of mixing, or students are going home every night and having lots of interactions, and then coming back. So it's a different problem, we think that it's probably going to require customized kind of variant of what we've done. And that's actually going to be true in a lot of other situations as well. We're now trying to work with folks, think about army bases, and prisons, and vacation destinations, and K through 12. And they're all these different archetypes that are going to require customization or optimization of the program in the process. We don't have all the answers for those. And I can't give you data, because we haven't done it yet. But we think there's lots of opportunities to customize what we've done for different situations and try to figure out how best to mitigate the unique challenges associated with those different situations. And so that's what Bill Jackson and his team are working on, is trying to come up with these archetypical programs that could be in a sense, utilized in different situations and the learnings from each could then cross-fertilize each other. We're trying to set it up that way, so we can learn as much as we can quickly. FASKIANOS: Fantastic. That question was from Elsa Dias in Colorado. So thanks for identifying yourself.  FASKIANOS: The next question in the chat comes from Bob Klein at Ohio University. He likes the art behind you, by the way. He is also an ACE fellow. COVID-19 pandemic is happening alongside mass protests against black lives matter. For, as one example, how are you balancing rights together and exercise free speech with the need to manage the COVID-19 pandemic? ASU had some issues with this and he's wondering how you're dealing with it. BURKE: Obviously a really important question and something that we all need to think about. How to help enable and empower those really important protests in that conversation to happen. We've been working very closely with our student affairs, academic affairs groups who really think very carefully about these types of challenges. And we've been cognizant of the fact that we have to be able to be open and flexible to allow those things to happen. We've had protests also on our campus, and those are allowed to happen. And I think the idea is to try, of course, to promote social distancing and safety as much as possible. And there's been, of course, many examples where people have been protesting very safely and socially responsibly, and of course, are really important things to protest about. I think that's really where we understand it's really important and we're really trying to make sure that that's able to happen. FASKIANOS: Great. The next question comes from Dick Foster. Coronavirus blood tests were among the first solutions attempted. Blood was traditionally fluid tested. Saliva was dismissed as not having the potential for accurate diagnosis. If you agree that the sequence is correct, what was the breakthrough that led to saliva testing? We almost never hear about blood testing these days. BURKE: I think that way back in March and April was when there was some initial hints that perhaps saliva could be used. I think a paper that really was helpful to us because we were already really trying to figure out if saliva could work. There was a paper from Anne Wyllie at Yale that they put on the archive, where they had shown as I showed in the presentation that you could detect SARS-CoV-2 and saliva more sensitively than the nasal pharyngeal swab. So that was a very helpful, I think, discovery. It still used RNA isolation, and I think we've all heard about through the team here were able to discover is that you can actually skip that RNA isolation and then go directly from the saliva to PCR, which really helped make a big difference in terms of its usability and scalability. I think the evidence accumulated quickly, and then the team here was able to breakthrough on the skipping RNA isolation. And now it looks like a really good way to do it. I think there's an inertia associated with the nasal pharyngeal swab because it's been around and it's been widely used. But there's lots of reasons why I think saliva-based testing can make a big difference, especially start thinking about fast reading testing of entire populations, started by K through 12. And there's just so many advantages to the saliva-based test. We're really trying to get the word out there that this can really be helpful and hopefully our story can really move the needle and people switching to saliva. FASKIANOS: Bob has a follow up about the protests. Did you build that kind of activity into your models? BURKE: We didn't specifically build protests into the models, but we did build seven to eight thousand students going to parties and probably not wearing their masks into the model. So some level of noncompliance to make sure that we were being very eyes wide open about the fact that these are young people, they're going to want to socialize. Again, what we didn't build into the model was willful noncompliance with known positivity. That's something we've now had to reckon with and deal with. We're working on trying to become increasingly cognizant of the challenge in the real world, as opposed to what we hope for, and we're learning every step of the way. That said, we don't view the noncompliance as something that can't be changed either. So, in addition, to continuing to now make our models better, we're also trying to push back against that noncompliance and really bring that down, because it's critical. I think it's humbling to recognize, we could build, we could test everybody every day. And still, if you go to parties, when you're positive, it's not going to work, right. So it really does have to be a really robust program. It's multidimensional, multilayered, and you've got to get community buy-in and a really good level of compliance. Everybody's got to do their part. That's just the reality of the situation. FASKIANOS: I know, you said, you were working with colleges and universities and trying to get the word out. Is there any central repository of information that universities and colleges can consult for best practices and models of success? BURKE: Yes. We have a repository of information about our system and how to deploy it. And that's where Bill Jackson is leading this effort called Shield T3 to try to help do that. So if anyone's interested, if you would contact Bill Jackson he would be very happy to work with you. And as I mentioned, I think thirty plus universities are already engaged with him. And we're aware of about five that have already been able to stand up our testing capability on their own campuses. And our goal, again, is just to maximize the impact as best we can and to try to help everybody benefit from our experience here. I think there'll be the best point of contact if people are interested. FASKIANOS: Great. I'll get the contact information and share out that information to the group on this call, and maybe even to people not on this call, because I think this information is very much needed. Have you been working with the CDC? BURKE: We've met with them. And we've been sharing all of our information with them. Because obviously, if it's at all helpful, we're really happy to do it. We have actually been sharing pretty regularly our information with them in the hopes that it can be of some benefit. They're very engaging, and they ask great questions, and lots of back and forth. It's been a good dialogue with them. FASKIANOS: Great. And in terms of your partnership with state and local officials, how has that been working? Again, it's so important to have those synergies between the health officials and the local leadership at the sub-national level. So I think that would be informative to people on this discussion. BURKE: Sure. Yeah, we've been very fortunate. We have fantastic leadership at the University of Illinois. The university level here, at our systems level, and we have a fantastic partnership in relationship with our Governor Pritzker. And it's been a huge asset. I can't begin to say how strong and important that's been. And we've also got a great relationship with our local Champaign-Urbana Public Health District. Decades of history around that and getting through some other tough situations. Of course, nothing like this. But measles outbreaks and things like this that have really tightened those bonds and learn how to work together. And we have a great relationship with our Illinois Department of Public Health as well. And we've been in close contact with all of them. So Chancellor Jones, our chancellor here at the University of Illinois, just a passionate advocate for our land-grant mission and doing everything we can to try to maximize our impact and serve the public good. Tim Killeen, who's our university president, very early on, he called this an Illinois moment in the making, and asked us to make sure we made it as big as possible. So that kind of visionary leadership has just been tremendous. And we have worked closely with Governor Pritzker, his office, and the entire state. It's just been tremendous partnership throughout the whole process, which we're very grateful for, and looking forward to continue to leverage to try to make the impact as broad as we can. FASKIANOS: Another question in the chat box. Given how this virus disproportionately affects black and brown communities, what are you doing to promote this test as a public health benefit to those communities? BURKE: Yeah, absolutely. So it's a critically important point. And we're working very hard to try to figure out how we can do that. That obviously means those are the communities we have the chance to having the most positive impact. And so, we want to figure out a way to do that as active conversation, the discussions going on right now. Exactly along those lines. And up till now, we've been focused on just trying to get it up and running and successful here at our university. Again, we're not celebrating anything. And we know we've got a long way to go because there's a very dynamic situation. That said, we feel like we've finally been able to show that it can work in our setting. And so now, a very large amount of effort is being pivoted towards how do we try to get this out to as many communities that need it as possible? And as the question correctly points out, there are groups who are very disproportionately affected by COVID-19. And so of course, a very important goal is to try to get this to those groups in a way that can really help turn that around. So it's a very high priority. FASKIANOS: So in terms of your mode of instruction, you said over fifty students in a class is remote. So obviously, under fifty, you're meeting in classrooms. How have you reconfigured your classrooms in order to be socially distance? What are your professors doing, etc.? Do your professors have the option to be remote? Or is everybody in person? BURKE: Okay, great. So yes, we have offered online option for both the students and the professors. If it's done live, it's by choice, everyone chose to do that. And so in terms of maximizing social distancing, there was a whole other team that spent the whole summer trying to figure out how to do that as best that we can. The decision was made, any classes that are greater than fifty are moved online. Okay, so as you point out, the classes have to be fifty or less. And what we did was just tried to use our largest lecture halls as much as possible is one of the key strategies. So many of the classes that were, let's say, thirty, people usually would be in a small classroom, you do the exact same thirty people, but in a large lecture hall, and then you can, of course, space everybody out. There's a lot of people who've chosen to try to go outside and have their classes, especially while the weather's nice and small groups, types of classes, which can also really help. There was a huge effort towards maximizing cleaning protocols and trying to figure out how to clean between classes and avoid any cross-contamination that way. And also a lot of thought around, of course, aerosolization and ventilation and trying to really think through issues associated with how to minimize the chances of spread through aerosols. It was really a comprehensive effort led by another team that was deployed just to think about those issues. And we've been working closely in concert with them to try to synergize with what we're doing with what they're doing. And so far, as I mentioned, I think the most important statistic I can tell you is, we have not seen any evidence of transmission in the classroom. And so I think that's really encouraging. And the problem is actually outside the classroom, in the residence halls, and mostly actually off campus. That's where we've had our biggest challenges, actually, is residence halls off campus. And so again, we're pivoting and flexing and trying to focus all of our energy on as much as possible mitigating that. But I think it does argue you can have in-person classes safely if you've got a very strong mitigation strategy. And of course we all want to get back to teaching our students and performing research and helping educate the leaders of tomorrow. And that's what we're committed to doing. And so I think it's very encouraging in that regard, that we've been able to do that. FASKIANOS: And have you had a drop in your international students? BURKE: I don't know the numbers, but we've actually had remarkably little loss of students coming in. We had a very high percentage of our students came and are actively participating in in-person classes. I don't have the exact breakdown between national and international. But overall, we've actually had most of undergraduates come back. FASKIANOS: Noe Ramirez just raised his hand. Noe, go ahead, and accept the unmute prompt please. Q: There we go. Thank you very much. Appreciate this opportunity to ask this important question. When you mentioned the high prevalence rate with the Latino and Black communities. I recently read some research that diet could be highly correlated with risk to COVID, especially the diet involving, for example, the gluten that is oftentimes found in, that is common in Latino diets like with flour tortillas, or the pastas, for instance, that other groups may consume regularly. Are you familiar with any research that might point to the diet also being a risk factor for COVID, particularly among the nonelderly population? BURKE: Thanks for the question. I'm not an expert in that space. And I don't have any additional information or I'm not read up on that issue. I actually don't think I'll be able to comment specifically. Otherwise, to reiterate, as already has been discussed, the numbers are clear that there's certain communities that are being disproportionately affected by COVID-19. And so I think, of course, obviously, we need to help understand why that is and what we can do to try to address it. I don't have any specifics to add on the question you're asking. But just to acknowledge that it's a really important issue, we really need to better understand it and try to help. FASKIANOS: Bob Klein has a follow-up question from Ohio University. How's the concern over clinical placements, internships, and student teaching being managed when students are going off campus? BURKE: We have here at the University of Illinois, the Carle Illinois College of Medicine, which I'm very grateful to serve as the associate dean for research, and we have our students in the clinics. And the answer I guess I can give you is that they all have to go through the exact same kind of rigorous, twice weekly testing program, at the beginning, that everybody else did. They've also been switched to once per week, since we've changed the progress testing towards undergraduates, because we didn't see challenges in that space, but they're all being tested frequently, like everyone else. And I think that by having it be comprehensive, and having all of that data, it's allowed us to make sure that we look out for any issues in those spaces, and we haven't seen them yet. And so without evidence that there's any challenges there, the plan is to keep them on the same testing frequency we have now. FASKIANOS: You mentioned that in order to enter bars and public spaces in town, you have to have this check. So how are the locals taking that? And do they have access to the test as well? And how often are locals who aren't part of the university system being tested? BURKE: So first, the bars have voluntarily chosen some of them to use this, if you're an Illinois student. They did actually make a provision, if you're not an Illinois student, you can just show that you've been tested recently by printing out your test. And I think they use that to let them in. I've not actually seen the process working myself. But that's why I've heard that it's being done. If you're not able to get the app with the test from the university, there are alternative ways to show that you're not positive. And, and again, it's not all of them. But what's been really good, it's been the bars and restaurants that are most frequented by our students. They've been able to use this as a vehicle to help kind of partner towards creating that safe socialization environment. We have not, yet, been able to expand our testing to our local community. But it's a very important goal, and we're working very hard to try to get there. So as I mentioned, up till now, we've just been trying to make sure we got it up and running in our own university’s faculty, students, and staff and make sure we can make it work. And as we continue to try to refine that process now that we've seen evidence that it can, we're really working hard to try to expand access to our community. FASKIANOS: Bob Klein had a clarifying point he meant also student teachers in the schools. BURKE: Okay. Everything I've been describing is for the University of Illinois, not for the K through 12. Just to make sure we're being clear. K through 12 is a critically important goal. We're trying really hard to figure out how to help in that space. But everything I've been describing is for faculty, students, and staff at the university. And actually everyone in any of those groups is participating in the testing program. That would include any of our teachers or members of the community who are teaching the students. FASKIANOS: Thank you. The next question comes from Nel Martinez. Once the vaccine is available, have you thought about making the vaccine a requirement of all students, faculty, and staff? Clearly this is going to be a year, we hope, and it may be even longer before this may be an option, but will you make it mandatory or optional? BURKE: So we haven't made any decisions as to whether a vaccine would be mandatory or optional. FASKIANOS: If there are any last questions, I'm happy to take them. Otherwise, we can bring this to a close. You've given us so much information. And it's clear that this model should be taken to other parts of the country and other communities. Because, as you said, if you're not testing, then it's hard to control this, or contain it. So any other last questions? I think the queue is done. Martin Burke, thank you very much for doing this. We really appreciate it. I will circle back to you if you would be willing to share the presentation, or at least your bio archives and contact information, so people can follow up with the members of your team who could help push some of these things forward. We will also include with that a video and transcript of this session so that you can share it. Because I think the information that you've given us is so important, and we need to get it out there. So thank you very much. BURKE: Thank you so much for having me, and giving us a chance to tell our story. Thank you. FASKIANOS: For all of you, in between the first and second presidential debates, we are hosting a Virtual Election 2020 U.S. Foreign Policy Forum on Thursday, October 1, from 3:00 to 4:30 p.m. Eastern Time. The discussion will address foreign policy challenges awaiting the winner of the election, and what Americans need to consider as they cast their vote in the coming days. So I hope you'll join us for that event, and you'll share the invitation or the announcement widely with your networks. So again, please follow us on @CFR_org and @CFR_Academic on Twitter, and go to Cfr.org, Thinkglobalhealth.org, and Foreignaffairs.com for additional information and analysis on COVID-19 and a whole array of topics and issues, and I hope you all stay safe and well. So thank you. Thank you again, Martin Burke. BURKE: Thank you very much. (END)
  • Health
    Academic Webinar: Global Health During COVID-19
    Play
    Ilona Kickbusch, founding director and chair of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, discusses global health during COVID-19. FASKIANOS: Good afternoon and welcome to the CFR Fall 2020 Academic Webinar series. I'm Irina Faskianos, Vice President of the National Program and Outreach at CFR. Today's webinar is on the record and the video and transcript will be available on our website CFR.org/academic. As always, CFR takes no institutional positions on matters of policy. We are excited to have Ilona Kickbusch with us today. She is founding director and chair of the Global Health Center at the Graduate Institute of International Development Studies in Geneva. Dr. Kickbusch is also a member of the global preparedness monitoring board established by the World Health Organization and World Bank. She serves as a council chair to the World Health Summit in Berlin. She has been involved in German G7 and G20 activities relating to global health, and chaired the international advisory board for the development of global health strategy. Previously, she was director of the global health program at Yale University, and was responsible for the first Fulbright program on global health. So Ilona, thank you very much for being with us today. Last week, the World Health Organization reported a one-day record for COVID-19 cases. Perhaps you can begin by providing an overview of global health priorities responding to the pandemic, how the World Health Organization is thinking about equitable access to therapeutics and vaccines, as well as reaction to President Trump withdrawing support from the WHO. So, over to you. KICKBUSCH: Thank you very much, Irina, and thanks a lot for having me. And that was quite a barrage of opening questions already, that imply a lot of different dimensions and answers. I'd actually like to start with a theoretical concept, if I might, or, theoretical political concept. There is a German political sociologist, Ulrich Beck, who died recently, and Adam Tooze, actually also has been using his work. And he spoke about cosmopolitan moments. And he said these are moments of crises in international society, where we then have a political choice, either to act, or in a sense, to make the crises even worse. And, as you know, in the COVID-19 response, there has been this question of why are we constantly in this cycle of panic and neglect? So, first we have SARS, and then we have Ebola, and then we have COVID-19. And then we sort of say, oh, we must, we must, we must, and then we don't, both at the global and at the international level. So I think one of the questions is are we going to use that opportunity of learning that we're actually given in this sort of trick of history, if I can call it that, with COVID-19? And that leads to some of your other questions that I'd just like to unravel a little bit. First is the geopolitical situation. And you've alluded to the threat of the United States leaving the World Health Organization, something I don't think anybody who is either committed to multilateralism on the one hand, or anybody who's just a pragmatist in global health—we can only solve certain problems if we work together. So that, of course, is a threat, many people can't understand, but also a threat that has shown us that we need to work together differently politically in the global health arena. Of course, the United States has been an incredibly important partner. It's been an incredibly important funder, not only of the World Health Organization, but of course of global health in general. But that, of course, has also led to an imbalance, an imbalance of power and an imbalance of responsibility. Because in a sense, as long as the U.S. does this, why should we? And so what we're seeing now is something really, really interesting with this threat, this Damocles sword hanging up there. We see that other actors are, should I say, waking up. And what we have seen over the last six months is, for example, the European Union being a very, very proactive partner in global health, within the context of the World Health Organization, and in helping build some of these new institutions or processes that are starting to emerge, for vaccines, for therapeutics, for diagnostics, etc. And I'm sure we'll come back to them. So we're seeing power shifts happening. And it's not as you frequently describe it in a lot of your U.S. discussions. Oh, America moves, China moves in. It's actually a much more complex and interesting situation that's happening now. I think people who are involved in sort of political analyses would say the middle powers are trying to assert themselves. And they're doing that also in reflecting how should the World Health Organization be reformed? Because it must be, and how should the International Health Regulations be changed in order to really function. Because those are two problems we have encountered, WHO has been under pressure, WHO does not have enough money to act, and the International Health Regulations are a form of an international agreement, that isn't tough enough, if I can put it that way. It doesn't ask enough of the countries. And it doesn't bear any consequences if people don't live up to their responsibilities. So we're seeing a tremendous discussion. Also in the G7, also in the G20. Also at the U.N. Security Council, also at the U.N. General Assembly. So we're seeing that global health push through COVID-19 is—or you might call it global health security—is really at the forefront of everyone's agenda. And a big part of that agenda is what are we going to finance jointly? And that leads us to the vaccine discussion. Are we going to say, okay this vaccine, as many have said, is a common good, all countries need access to it. Nobody is safe, unless we are all safe. And so WHO together with other partners, and I might put that in brackets. Never has there been so much cooperation between the international health organizations in Geneva as right now, you will know that for money, for power, for everything, there has been competition between the Vaccine Alliance the Global Fund for AIDS, tuberculosis, and malaria, WHO, and everyone else that's there, suddenly, there is a joint purpose. The joint purpose has been formulated as the act accelerator, saying jointly, we have to ensure that therapeutics, medicines are available, that diagnostics testing is available, and that a vaccine is developed, produced, and is made available. And we have a new form of cooperation and within basically three months, we've created, or the colleagues in Geneva together with member states and others have created, a mechanism that at present has about 160 countries in it, saying we're going to work together to make a vaccine available. Quite extraordinary. Seth Berkley from GAVI has said, this is truly a historic moment. It has flaws, it has problems, we'll come to those I'm sure. But, we can see again, something new is happening, something is there in the bud that we need to look at. And maybe the last point as an introduction, is that we're seeing that the present financing models in global health don't work. First of all, you know, the financing of WHO doesn't work, WHO does not have enough money, and we can come back to the assessed contributions, the money by member states and other funding, but it's just not enough in terms of what we're asking of this organization. But if you look at the fact that for COVAX, we would now need $35 billion to be able to make it available to all countries and we can talk about the percentages that are being discussed, between 20 and 50 percent of the population. That means we're no longer talking millions. We're talking billions and actually, there's people who are talking trillions in global health. And that means our model of overseas development assistance to help countries move their health systems forward a little bit to finance vaccine programs, etc., is just not sufficient if we face a truly global problem. And we have to look at how are we going to do this? And this is why, maybe the last thing I'll say right now, is that it's been so important that in the context of the G20, it's no longer just the health ministers meeting. I mean, it was a revolution that there were health ministers meetings in the context of the G20. But now what the health ministers are doing, they're meeting with the finance ministers, they're meeting with the development banks, they're meeting with investors, and saying, we need a new financing model for this. And I think that's really a wakeup call. So we have a political opportunity, we need to look at financial opportunities, and we need to look at new solidarity opportunities that are out there in global health. FASKIANOS: Fantastic, thank you so much Ilona that was terrific. Let's turn to all of you now for your questions. And hopefully, from lots of students. If you click on the participant icon at the bottom of your screen, you can raise your hand there. If you're on a tablet, you can click on the more button and raise your hand there. you can also put a question in the Q&A, and I'll read it out. So let's go now to all of you. We already have questions, hands raised. Noe Ramirez.  Please accept the unmute prompt and tell us what institution you are with, to give us context. And maybe for Ilona's sake, what state. Q:  Thank you very much. I'm with the University of Texas Rio Grande Valley, that's in south Texas. My question is very simple. What's your opinion with respect to the polarization between science and politics? That is before us now the outcome of that polarization and so far as science, for example, gaining greater leverage, greater prestige, integrity, and so far as making the decision-making process more rational, if you will, worldwide, so that these matters having to do with the welfare of the world population are more recently addressed and intervened on? What's your opinion? I really appreciate your input. KICKBUSCH: Thank you very much for that question. First of all, I think COVID-19 is an excellent example of, first of all, being confronted with a health condition, a virus, about whom we know very, very little. And that as the virus spreads, we start to learn about the virus and we start to learn different things. And one of the difficult things in the discussion around this virus has been if the knowledge has changed, just think of at what point were we sure that there was person to person transmission. At what point did we get more convinced that aerosols were really important. And so, what has been a major factor over the last six months is, first of all, how science communicates, how science learns that the kind of really critical debates you have within the science community are not necessarily the kind of debates you would have in a television talk show. And the way that science needs to interact with policy. And we have found that there's a very big difference in different countries. From what I gather, there has been more conflict between science and politics in the United States, than there, for example, has been in my country in Germany, where there has been a much more regular interface between the scientists. At first the virologist, then the epidemiologists, and now very much social scientists, because it's all about trust of people, behavioral issues. How can you discuss with people how important it is to wear a mask or not, a virologist can't answer that question. So what we're seeing is that in some countries, actually, a very good interface between science and politics has been established, in other countries, has actually been much more divisive. And I think that has really, really been a problem. In terms of the World Health Organization, of course, what has been a big issue is how quickly can we pull all that scientific knowledge from around the world, and how quickly can WHO as an international organization, then give the recommendation, this is where we stand, this is something that would apply to all countries. And some scientists have criticized the World Health Organization, think of the aerosol discussion, and have said, you're taking much too long. This is much more serious or partly, in the masks discussion. So one of the things that is also being discussed is that this science policy interface also has to be improved at the global level. It's worked very well in vaccines. We've never had that much scientific cooperation as we have had in vaccine development. It's absolutely extraordinary. It's absolutely historical. But we can see where a society is divided, where politics is tough and divided, then science is used and abused. And then, scientists find it very difficult to find a role for themselves. FASKIANOS: Thank you. I'm going to take the next question from the chat from Chaney Howard, who is an international business major at Howard University. How is the 160 country mechanism established? How do they typically collaborate? KICKBUSCH: Well, it's been established, basically, on the run. If you talk to people who established COVAX, they would say, we're flying a plane while we're constructing it. I think that's a very appropriate picture. What one wanted initially was a mechanism that every country will join and would agree that it was kind of an insurance policy, if I could say that, a pooling of risk that countries would join and say we joined this COVAX facility, and no matter what vaccines we have invested in, we would bring that to that facility, and then we would all benefit from the vaccines that are successful.  It turns out that it was more complicated than that, and that it was very important on the one hand, to be able to ensure that the poorer countries got access, that there was a mechanism that vaccines could be bought on their behalf. And on the other hand, that it was interesting enough for the rich countries, as we tend to say, to participate. And so now, a new kind of mechanism has been developed where countries on the one hand can join in order to access a certain amount of vaccines at a special price, others join so that they might have access to that pooling possibility, and others join in order to bring their investment into that COVAX facility. And that has made it so complicated because you need quite different legal agreements depending on which kind of membership of COVAX that you have. Initially, it was very much modeled on the Vaccine Alliance GAVI, which is also based on tiered pricing. But it became clear that you couldn't use that model one to one for COVAX. So actually, COVAX is being developed as we speak. And so of course, at first, when it was built more on the old ODA model of donors and recipients, initially it was more of the low and middle income countries that joined and the others were sort of holding back and saying what does this bring for us, and they were already making agreements individually with vaccine producers and the like, and no one has tried to bring that together. It's still a work in progress, if I can call it that, some countries, even though there was a deadline, some countries are still sorting out the legal dimensions of it. And some countries have more or less—well, one country has said we're definitely not joining, and that is the United States. Russia is not yet clear what it does, and China also hasn't yet said what it would do. Also, because these countries obviously use the vaccine, and all three have vaccine candidates, use that for geopolitical purposes. So we can already see that China is indicating with countries that it has close relationships with that they would have preferential access to the Chinese vaccine. We can see a similar thing probably happening in Russia. And of course, the United States has also said that it would make overseas development resources available for countries that it is in close cooperation with. So again, you see, there's the geopolitical development and tension that is also a part of the whole vaccine health diplomacy and the COVAX health diplomacy. But what we can see is, as I said earlier, is that the middle powers—so it's not just oh, it's the poor countries that want to be part of it, but that the middle powers want to be part of this game. So Germany is part of it, Japan is part of it, France is part of it, Australia has joined etc. FASKIANOS: Great. Let's go to Maya Prakash. Q:  Hi, I'm Maya from University of Southern California. So internationally, but especially in the U.S., COVID-19 has eclipsed other, maybe what we would have considered previously cured, epidemics like malaria, HIV, opioids, and other substance abuse disorders. Why haven't we, being countries domestically and international organizations globally, been prepared, at least, for countering those? KICKBUSCH: Well, what has happened is that internationally, also, what you described for the U.S. has happened internationally as well, that many of the disease based programs as we say, ranging from malaria, tuberculosis, to polio, to programs for maternal and child health, etc., have seen first of all, reduced political attention, it's very difficult to do any fundraising, advocacy, etc., for those issues right now. But also, of course, have seen money pulled away to be invested in COVAX and in other COVID-19 initiatives, which is why initially also, when the COVAX initiative was created, it was explicitly said at the fundraising events, that one would not accept normal ODA money because there was an awareness, we can't be robbing Peter to pay Paul. But it's a stark reality right now. And we also see that because the funding of so many health programs is so volatile anyhow, I mean, even the strong organizations like GAVI and the Global Fund, have every three years to go around with a hat and do fundraising initiatives to do their replenishment. So there is no real stable funding in global health, even for the World Health Organization, there is no real stable funding. And then much of that funding, and that's a major criticism. And to some extent, I think it might apply also domestically to the United States. Funding is very focused on diseases or vaccination, we will vaccinate so and so many children, we will reduce tuberculosis by so and so much, we will bring HIV/AIDS medicines to so and so many people. It's very pushed by measurable outcomes and by saving lives, which is incredibly important, but it definitely neglects building any kind of primary healthcare infrastructure, of building a reliable and sustainable health system. And so if in countries, people are dependent on totally separate, fragmented programs for whatever disease they might have, then of course, the fragility of that system comes to bear, the minute there's a big crisis. We saw that with Ebola in West Africa. We see it everywhere now, everywhere, with COVID-19. And, of course, at the same time, and I think that's something I must add, people are losing their jobs, their livelihoods, they're falling into poverty. And we have an immense increase in poverty now throughout the world. They have less income, and many people have to pay for their health care out of pocket, they can't afford it anymore. And so this is a sort of—you have several waves, in a way, that come on top of each other. And as with all health crises, it's the poorest and the disadvantaged, and then all the special problems you have faced in your country with structural racism, etc., that then bear the brunt of such a pandemic. FASKIANOS: Thank you. I'm going to go to Zero Lin now, he's a senior international relations major at Maxwell School at Syracuse University in New York. Here's my question: As the COVID-19 outbreak exasperates, the Trump administration filed a departure from the WHO and criticized it for being virtually controlled by China. So how would you comment on the U.S. departure? I think we did touch upon that a little bit at the outset. But how would you predict the global health governance of the WHO in the future? Do you think China would become a new leader and the biggest contributor in WHO? KICKBUSCH: Well, I think one has to look at that in its complexity that first of all, if I start with the latest question about the financial contribution, there is in WHO what we call the assessed contributions, that's the contributions countries must pay to be a member. And that is calculated according to U.N. rules, size of population, size of domestic product, etc. And it is the case that I think it was about five years ago, those assessed contributions were recalculated, because countries have been developing. And so I think as far as assessed contributions go, China actually now is the second or third contributor in terms of assessed contributions. So if the United States were to leave—I guess that depends on the outcomes of your elections— then for the assessed contributions, China would be the largest contributor. But that's the smallest part of the WHO budget, because the assessed contributions are only 20 percent of WHO's budget, and then the contribution by China in assessed contributions would be about 16 percent of that. So with that 16 percent of 20 percent, with that, you don't dominate an organization. China has not been like—contrary to the United States, which gives or has given an extraordinary amount of what WHO calls voluntary contributions to the organization for special programs, polio, tuberculosis, etc. China has not done that. Actually, we see that many of the European member states and the European Union itself are those that give significant amounts of voluntary contributions. Actually, of those 80 percent that are not assessed contributions, 80 percent are contributions by member states and the European Union. And so, within those again, you see countries giving a different amount and then of the remaining 20 percent, I think around—I forget now—between 11 and 15 percent, are, for example, from the Bill and Melinda Gates Foundation, the majority of which goes to the polio program. So it's not U.S. moves out, China moves in. Actually China is, right now, expressing solidarity It's said vaccines are a global public good. It's very supportive verbally of multilateralism, etc. But quite honestly, we don't yet know how that will play out, which is why another group of countries has been incredibly active, particularly a coalition between the African Union and the European Union. And they have, in a sense, politically, taken on the shaping of the World Health Organization agenda, they have put forward reform proposals, and they are working on the revision of the International Health Regulations. So it's quite a different ballgame than is sometimes seen in the United States, where much of that WHO conflict is interpreted as a U.S.–China conflict, as which your president has defined it. But on the ground in Geneva, in the regional offices of WHO all around the world, that's not what's happening. FASKIANOS: That's very helpful. I'm going to now call upon Lusia Sari, who had put a couple of questions in the Q&A, and also raised her hand. So Lusia, I'm going to let you answer it, or ask it. And please accept the unmute prompt. Q: Hi, Ilona and Irina, thank you for the nice presentation. So my question is, first, if the fiscal capacity—sorry, I'm Lusia, from NYU, graduate student of master in global affairs, my question is, if fiscal capacity is the single most important factor to determine, on how developing countries handling the pandemic situation, what are another influential factor that should come to mind in such a situation? Sure, people living in poor countries rely to foreign debt or ODA, and who is the greatest lender in power. Is it the U.S., China, or who else? And my second question is, do you think intellectual property rights regime will prevent vaccines from becoming global public goods? Thank you. KICKBUSCH: Thank you, Lusia, and hello to whoever is there with you, so next generation in global health. So you've touched on a number of very, very big issues for which we would need a lot of time. I think the intellectual property issue is an important one. And in general, intellectual property has not been that much of a key issue in relation to vaccines, because vaccines up to now, have not been such a profitable part of global health. And that's why also a number of innovations that I mentioned with tiered pricing and the Vaccine Alliance, etc. were possible. There was only, there's very few pharmaceutical companies up to now that continue to produce vaccines, because other parts of pharmaceutical products were or are much more profitable, we might see that change with COVID-19. And suddenly everyone wants vaccines. And that is something that also the COVAX facility is trying to address. But it leads me to one point that's absolutely critical: we're all staring at the WHO right now, I think we should be looking very carefully at the elections happening at the World Trade Organization. Because a lot of the issues around intellectual property are resolved there, the Doha Agreements, on access to medicines and for public health needs, etc. And so, I think the whole issue of pricing and IP is one that is really going to be at the forefront also of negotiations at the World Trade Organization. So, one has to look at that triangle WHO, World Trade Organization, and World Intellectual Property Organization, and one has to have a great interest as to who would become the next the director general of the World Trade Organization, because that person will be taking forward a very, very important IP discussion, which also relates to vaccines. I urge you to look at the candidates, and actually one of the candidates is the president of the board of the Vaccine Alliance. And she has stated very clearly, she would want to take up the issue of vaccines as a global public good within the World Trade Organization. So I think a big agenda that is really also breaking open, in a new way, a lot of the intellectual property and access to medicines discussions, and transparency issues, the push to say that pharmaceutical industry should show exactly where they stand with vaccine development, they open trial protocols, and things like that, an issue that was critical at the World Health Assembly a year ago, about transparency and transparency of pricing. So I think we're going to see a big, big discussion there in the NGO civil society is critical medicine [inaudible] is pushing for this access agenda at the Global Health Center, the new co-directors of the center have made that one of their priorities. So I think that's very, very important. Fiscal space is critical for building universal health coverage, we have just seen just before COVID hit, WHO did a number of very, very in depth economic studies of how financing for universal health coverage is improving. And one actually saw an increase of public investment in universal health coverage in a whole range of low and middle income countries. That of course, at this stage has come to a halt. And that again means less people will have access out of pocket payments will probably increase again. What we can't resolve that with is small sums of ODA, and we can't resolve with through a whole bunch of fragmented disease-based programs. You know, perhaps, that last year at the UN General Assembly, there was a number of declarations around universal health coverage. I'm the co-chair of UHC 2030, which is an advocacy platform for UHC. And we said very, very clearly that international funders, development banks, the World Bank, etc., need to invest much more in health systems and not just in health programs. And this is the really worrisome thing that we don't see this investment right now. And we don't know how it will play out. And that's the third dimension of your question, in terms of geopolitics. I mentioned that China is indicating it's going to give its vaccine to certain countries. We will see if we get into a real geopolitical standoff, whether the same thing that we had in the cold war is going to happen, that meaning you will only get our health support, if you also support our ideological position. And that is the issue that's worrying people most in political global health right now, that we get into a health cold war that we have not had over the last thirty years. FASKIANOS: Thank you. I'm going to go to Catherine Zeman. Q:  I have a question here from one of our students, Nadir, would you like to read your question? FASKIANOS: And Catherine, can you tell us where you are? Q:  This is Catherine Zeman, from the University of Northern Iowa, and Nadir Khan from the University of Northern Iowa has a question. Hello, thank you so much for this discussion. So I'm Nadir Kahn from University of Northern Iowa. My question is that how the country or the people behavior is changing, or will change, as a result of this current pandemic with the respect of environmental and its effect of COVID. How do those two things are making a change in people's behavior or country's behavior. KICKBUSCH: Well, thank you for that again, it's a big issue. First of all, we're seeing very, very different responses in different countries. And we're seeing right now, for example, in your country that, it seems to be a very divisive issue, which is actually even linked to politics. You know, if you belong to one party, you wear a mask, if you don't, you don't wear one. So it's very different in different parts of the world in terms of behavior. Also, we see changes in behavior at different stages of the pandemic. If I take our European example that I'm most familiar with, that there was a very, very big wave of solidarity in the first phase of the pandemic linked, not only to extreme lockdowns, but also to, more just restrictions in movement, etc, and new neighborhood initiatives were created, and everyone went on their balcony and sort of clapped for the health professionals, etc. So that was a feeling oh, our society's coming together. But then, in the next situation, particularly when summer came, there was this push, oh, gosh, you know, we've had enough of that we want to move forward, we want to live and particularly young people, fully understandable, wanted to live a life again. And so there's been a lot of discussion, how can there be good information from the side of the authorities, from the side of politics? How can there be consistent information? It's a big question of political trust. And in societies where in general, there is no trust in the political system, there will be no trust in the messages that come, in terms of behavior in relation to the pandemic. What one is trying to do as a message is to say, you're actually doing two things if you behave responsibly in terms of COVID. And, countries have tried to make sort of simple rules, like Japan has three C's, and Germany has something it's called AHA, which is about wearing masks and washing your hands and keeping the distance. So things people will remember that easy to think about and relatively easy to do. But we have found that in many cases, there does need to be rule setting. To give you an example, in Switzerland, where I live, there was a question about masks, and the survey said 80 percent of the people thought, one should wear masks in public transport, for one's own safety and for the safety of the others. Actually was only about ten people who wore masks in public transport no matter what they thought. And then it needed a rule to say it's mandatory to wear masks in public transport. And then, I'd say roughly 95 percent of all Swiss wear masks in public transport. So it's—that's why we say we need to involve more social scientists, psychologists, behavioral economists, etc., in the COVID response, because getting a change of a whole society is an enormous challenge. And we can't just say, we are all going to go back to normal. We have to learn to live with COVID-19, at least another two years. And that means there needs to be a systemic approach to behavior change to responsibility for one another. Not just I keep myself safe, but through the actions that I do, we keep each other safe. And the messages are moving in that direction. But it's very difficult. And it's very dependent also on the messages of political decision makers. FASKIANOS: I can take Morton Holbrook's question next. And he is talking about the U.S. election, Joe Biden has expressed taking a stronger stance on COVID. Can we expect, if he won, that the United States will rejoin the WHO and what effect that would have. And obviously, you see here in the United States, President Trump saying masks aren't necessary and Joe Biden saying we should wear them. So what is your response to that? KICKBUSCH: Well, I think that's an illustration of what I just said, I mean, a public health measure for the whole community should be built. And, now we're going back to a whole lot of the other questions that were raised, should be built on the best knowledge that we have. And on the best way we want to organize our society. And we have learned, for example, in COVID-19, that we don't need to make a tradeoff between the economy and between our health, because we've seen, you know, where there has been a consistent public health approach, the fallout of the economy has not been as large, and the bounce back has been quicker than in other places. So I think making public health, or global health for that matter, a divisive issue and ideological issue is the worst thing that can happen to a health issue. And that's exactly where we are right now in some countries. And that is very, very worrisome. FASKIANOS: Yes well, health does not know ideology, doesn't choose one or the other. KICKBUSCH: Well we have got to be very careful, health is always political. And we see that certain approaches to health are more linked to one political ideology than the other. Wanting a national health service is more linked to, as we in our part of the world would say, a leftist, social democratic agenda, than having, another type of health system that is more linked, to the private markets, etc. So those things, go on all the time. But that is different, particularly within a democratic society. That's the kind of debate we need to have, and people can go to elections. But if there's a virus out there, that's killing people, that virus isn't left or right or anything. That virus is just killing people. But what the virus does do, it in particular, kills people who are disadvantaged, who don't have access to health services, and who are not protected. And so that is why in our report from the global preparedness monitoring board, we have said, there can be no health security without social security. And that seems to us to be an absolutely critical message. FASKIANOS: Perfect. Let's go to Jonathan Azuri next. And go ahead, we see you're unmuted. KICKBUSCH: Jonathan? FASKIANOS: Okay, we're having technological issues. We're not—his sound is not coming through. So I'm going to move on, I will try to come back. So I'm going to go now to the chat function. Malik Majeed, who is—Oh, are you there? Q: Yes, I am. FASKIANOS: Okay, go ahead. Go ahead, Jonathan. Then I'll continue. Q: Thank you. Thanks. So I'm Jonathan. I'm an MBA student at the University of Southern California. So I'm wondering, as we're going through this pandemic, I wanted to better understand if it was really unprecedented. And as I was reading, through the 1918 pandemic, and how that kind of evolved, it wasn't really unprecedented, right? I mean, not in our lifetime, it didn't happen. But it did happen before. And I was able to draw a lot of correlations between the way in which humanity dealt with the pandemic a hundred years ago, and the way that we're dealing with it now. And, the virus was different, technology was different, medicine was different. But I'm wondering, if we ought to leave a better world for our children and grandchildren, and we had a lamp similar to the one that Aladdin had with the genie, and we had three wishes that we could ask for, what would we do differently? What would we ask for to be better prepared for the next pandemic? KICKBUSCH: Well, thank you for that, Jonathan. And you know, you're very, very right. And actually people are digging out suddenly, all kinds of information and stories and analyses of the so called Spanish Flu from a hundred years ago. And that was an event that most of us even in public health had forgotten, it just wasn't there. And I'm sure I'm much older than you, and even going back, asking my parents at the time about the Spanish flu when I was studying public health, it wasn't so part of their mindset. And we're seeing now, as you rightly say, that a lot of the things one has to do are actually not that different from then, despite this enormous technological advance. So we don't learn from history, that's point one. And so, maybe that would be one wish, that in some areas, particularly in public health, we do learn from history, because so much analysis is done. We did so much analyses following SARS, we did so much analyses following Ebola. And the political decisions that were necessary, were not taken. So in that sense, that might be my second wish to Aladdin, to say that we have, at least for a certain period of time, a bunch of really globally minded, politically responsible decision takers, that would put in place, the kind of infrastructure and the kind of communication mechanisms, we need to be better prepared. And, the list is this long. But if I take my own country, Germany, finally it's woken up, that we need to invest more in public health. And as a start, you know, 4 billion euros have been made available to strengthen the German CDC, to strengthen local public health systems, etc. And that would be a third component to strengthen the institutional infrastructure and the legal infrastructure, both at the national and at the international level, that makes us work together that allows us to work together, and that allows us to take responsibility for each other. So I think those are three things, we know what to do, but it needs to be done. And therefore, that would be my wish to Aladdin, get people in charge who will do it, and let's build the institutions that can help with that preparedness. There will be more pandemics. There is no question about that. And unless we're prepared, we're going to continue to spend trillions on the negative effects rather than having invested, as I said earlier, the billions that can actually help us be prepared. So I hope there's an Aladdin somewhere that will help us. Well, no worries.  Sorry about my phone here. FASKIANOS: That's okay. So I am going to group three questions, since we're running out of time and we have a slew of questions. So from Mark Storella, Boston University, can you talk about what COVID-19 pandemic has taught us about the weakness of the International Health Regulations in terms of the obligation of member states to share information? How do we reform the IHR or is a new structure needed? And then there are two questions that are on vaccines. From Heather Carleton, who's in the doctoral program at the University of Mississippi, how great are variances in requirements on vaccines throughout the world and how will this affect access to vaccinations and their effectiveness? And the follow on to that is from Malik Majeed and Tsinghua University. While mechanisms like COVAX may be successful in developing procuring vaccines, they do not solve the delivery challenge. How should the global community mobilize to solve the delivery challenge, especially in developing countries where public health systems are weak. So hopefully you can thread all that together. KICKBUSCH: Well, first of all, going to the IHR. I mentioned before that so many suggestions have been made, particularly after Ebola, how to revise the IHR. Definitely there's a strong feeling that the requirements and the pressure on countries to report needs to be strengthened. That there need to be, there are discussions of incentives, there are discussions of sanctions. There are questions, how can WHO gain more authority and independence to actually go into a country and check what's really happening. There's a whole range of things, but most of them are related to what countries would define as sovereignty. And what they were not willing to concede when the International Health Regulations were negotiated, I was in the room when they were negotiated. And countries were very keen not to give any kind of additional power to the World Health Organization. So unless countries are willing to concede some of that sovereignty for the common good, we are not going to get it anywhere. That's why I said, I hope we have a—everyone is so frightened right now that we have a cosmopolitan moment where they might be willing to do something. WHO has called the IHR revision committee, they are working on all the proposals. There's a good document by the CSIS in the United States on the various components that where the IHR would be changed, strengthened, revised, maybe you want to look at that. And I find that is very helpful, but it's about independence, it's about reporting, and it's about authority of the World Health Organization very, very clearly. And then, a whole lot of subcategories that are not strong enough, scientific cooperation, supply chains, and one area is very weak, because it's outdated. And that is the whole area of trade and travel, because this was written at a time where we didn't tap you know, the amount of tourist movement that we have now, etc. So, a very critical area that needs to be looked at. And you will remember there was all this question, which borders can and should be closed and all of that very, very political. Vaccines, I think, the delivery is really the key issue. WHO has started to try and work on ethical guidelines. But I said Berkley has said recently, in this case, there's one thing you can do to sort of try with you know, the various mechanisms COVID is trying to—COVAX is trying to put into place to get that to countries, but how it is going to be distributed in countries, meaning, first of all, who gets it, has to be an issue also of the countries. You would define that very differently in Japan with a very aged population compared to Nigeria, with a very, very young population. You would do it differently in countries that have a high percentage of health workers, than those that have hardly any. And you've indicated already a key problem, how can you do that in countries that don't have reliable health systems? Then you have to rely, for example, on the mechanisms and structures that have been put in place by polio program, for example. A key issue is we don't know yet what kind of vaccine or vaccines because actually, increasingly, we're talking of several types of vaccines, because the vaccine might not work in the same way for all people, for people with preconditions, for children, for younger people, for older people. The key issue is, do I have a vaccine that needs to be stored at minus 70 degrees, then it can only be given to people mainly in the urban areas, because nowhere else do you have a cold chain like that. So the problems are enormous. So we remain in that situation of building the plane, as we're flying it. So, as you rightly say, once we have the vaccine or we have a group of vaccines, we will have to see what's the best vaccine, first of all for what kind of population, and then we have to see how we get it to that population. And that will be such an enormous effort, which is why you know, we're talking $35 billion right now. FASKIANOS: Well, we are at the end of our hour. Ilona, thank you very much for taking the time to be with us, this was terrific. And to all of you for your questions. I'm sorry, we could not get to you all. There are a number of still raised hands, but we do try to end on time. So I encourage you to follow Ilona on Twitter @IlonaKickbusch. And again, thank you very much for being with us. Next week in between the first and second presidential debates, we are hosting a virtual election 2020 U.S. foreign policy forum on Thursday, October 1, from 3:00 to 4:30 p.m. Eastern Time. This discussion will address the foreign policy challenges awaiting the winner of the 2020 election and critical issues for Americans to consider as we all cast our vote this November. So I hope you will join us for that discussion and share the invitation widely with your friends and your colleagues. And our next Academic Webinar will take place on Wednesday, October 7, at 1:00 p.m. Eastern Time with Matthias Matthijs, senior fellow for Europe at CFR and associate professor of international political economy at Johns Hopkins University on European integration and Brexit. So thank you all. Please follow us CFR Academic on Twitter @CFR_Academic and go to CFR.org for more resources and I hope you're all staying safe and well and school is going well for you all. So, take care and we look forward to your continued participation. (END)
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    Edward Alden, Bernard L. Schwartz senior fellow at CFR, discusses the economic implications of COVID-19. Carla Anne Robbins, CFR adjunct senior fellow and former deputy editorial page editor at the New York Times, hosts the webinar. FASKIANOS: Good afternoon and welcome to the Council on Foreign Relations’ Local Journalists Webinar series. Today we will be talking about the economic implications of the COVID-19 pandemic, with Edward Alden and Carla Anne Robbins. I'm Irina Faskianos, vice president for the National Program and Outreach at CFR. As you know, CFR is an independent and nonpartisan organization and think tank focusing on U.S. foreign policy. This webinar is part of CFR’s Local Journalists Initiative, created to help you connect the local issues you cover in your communities with global dynamics. Our programming puts you in touch with CFR resources and expertise on international issues and provides a forum for sharing best practices. Today's webinar is on the record and the video and transcript will be posted online on our website after the fact at CFR.org/localjournalists. I previously shared the speakers’ bios but let me just give you a few highlights. Edward Alden is the Bernard L. Schwartz senior fellow at CFR, specializing in U.S. economic competitiveness, trade, and immigration policy. He's also the Ross distinguished visiting professor at Western Washington University. He's the author of the book Failure To Adjust: How Americans Got Left Behind in The Global Economy, and has served as the project director on several CFR-sponsored Independent Task Forces on subjects including the future of work, trade and investment policy, and immigration. He was previously the Washington bureau chief for the Financial Times and has reported for the Vancouver Sun and other publications. Carla Anne Robbins is an adjunct senior fellow at CFR. She's the faculty director of the master of international affairs program and clinical professor of national security studies at Baruch College’s Marxe School of Public and International Affairs. Prior to that, she was deputy editorial page editor at the New York Times and the chief diplomatic correspondent at the Wall Street Journal. So Ted and Carla, thanks for being with us, I'm going to turn it now to Carla, to get the conversation going. ROBBINS: Thanks Irina and thank you all for joining us today. I was reading a column I think it was in the times it might have been Ben Smith, who was saying we're not supposed to thank journalists for what they do and I've made a decision. I'm not going to thank national journalists for what they do. But I'm definitely going to thank local journalists for what you do, because you guys are frontline and in extraordinary times to work in. And so thank you for what you do and thank you for continuing to report on what is happening out there. So, Ted, let's go into it. Let's do the numbers as they say. So the Fed projected this week that the U.S. economy would shrink by 3.5% this year, which is less than the 6.5% decline they were fearing in June and the 9% contraction we saw between April and June. The Fed also said they expected the U.S. unemployment rate to fall to about 7.6% from the current 8.4% by the end of the year. So how should we read the U.S. economic numbers? Are things turning around in the U.S. faster than expected? I mean, it's hard to celebrate numbers like that. But are things getting better? ALDEN: Oh, let me let me just say at the outset, thanks very much, Irina, for having me on the call. It's great to be here with you, Carla, and also delight to be with all the journalists on the call. I mean, yeah, I think there's no question the recovery has been stronger than a lot of economists had anticipated. The U.S. rebound is a little better than most of the European economies. Germany’s expected a lot better than what we've seen in the UK and other places. So yeah, I think there is some good news there. The not so good news is that unemployment remains extremely high. I mean, we had the new numbers again this morning. We're now twenty-six weeks into having weekly unemployment claims that are higher than any other week going all the way back to 1967. So you know we had, including the temporary and gig workers, about one and a half million new claims this week. So unemployment is a huge problem. It's particularly hitting lower wage workers in service industries of all sorts, restaurant, entertainment, you know, sports is back on television, which I enjoy. But you know, there's nobody in the stands and there's nobody working at food service in the stadiums and all of the spin off jobs that get created in those communities from sporting events, those are not back on the job. So we're still in, I would argue a very, very dire situation and without a sort of clear path out of it, there's more talk in the past couple of weeks that I've heard about the possibility of a double dip recession, partly because there's expectations that we'll see a new surge in the pandemic in the fall as the weather gets colder. So you know, the economic situation is still pretty bleak. You wouldn't know that from the stock market, you know, the tech companies that make up so much of the Dow Jones and S&P are doing very well, right? We're all on Zoom and Zoom stock is now more than $400 a share, right, basically, three times up from the beginning of the pandemic. So they're parts of the economy, they're doing very well. But on the whole, still a pretty desperate situation. ROBBINS:  So even that improvement, which is the numbers are still horrifying, but they're better than were predicted. And certainly, you said, like a 20 % drop in the UK. So you know, 9% , or 8.5% , whatever it is, it looks comparatively better. Can we expect that steady improvement? Because Jerome Powelll seemed to suggest even in the moderate sort of Fed speak, that you know Fed chair speaks, can we expect that improvement if Congress fails to pass another round of stimulus? And does that stimulus have to have money for state and local? Because it looks like the Republicans for reasons that escape me are determined not to give money to state and local. ALDEN: Yeah, I mean, the state and local situation is dire. For the reporters on this call, all those states are required to balance their budgets and they're facing huge revenue shortfalls as a result of the economic downturn triggered by the pandemic. Chairman Powell was pretty clear yesterday, as you say, in cautious Fed speak that, you know, what he calls the fiscal dimension needs to be an important part of this. There's only so much that the Fed can do, I mean, money is basically free. The Fed is buying up bonds to keep down long term interest rates on things like, you know, car buying and home buying. Thirty-year mortgages are still at record lows, the Federal Reserve has been buying up corporate bonds, which has helped the balance sheets of big companies. The Fed is really doing everything it can do and some things we probably never expected it to do. And so the ball is very much in Congress's court right now. There's no question that the CARES Act, the first stimulus package, made a huge difference particularly, I think, the $600 a week in extra payments for those who are unemployed. I think that is a big explanation for why the U.S. rebound has been as strong as it is. You see it in the in the trade numbers, you know, my focus tends to be a bit more international than domestic. And what you've seen kind of, ironically, is a surge in imports from China into the United States, the U.S. trade deficit with China is now back at the record levels it was in 2008, despite President Trump's desire to see it shrink, and a lot of that has to do with Chinese production recovering, and the U.S. economy growing more strongly than expected, in large measure, because so much money was going into people's pockets through that first package. Without another one, I think clearly the economy is not going to continue to recover at the pace it has been. State and local governments, you know, I think we're looking at significant cuts in education and fire and police service. It's going to have some health care impacts. So yeah, some of that will be delayed. I mean just speaking from the situation at my own university, which is a public university, there's a lot of conversation about what this means for the budget this year, we're going to take a hit. We'll probably be down sort of in the 3% to 5% range on the budget. But the concern is all about next year, because the way a lot of the state governments operate, you know, a lot of them, the legislature said early in the year and then they're looking at the budget forecast for that coming year. And if there's no money coming nationally, I think we're looking at really, really deep cuts in 2021, which is likely, of course, to further prolong the economic weakness into 2021. ROBBINS:  So yeah, I mean, that's sort of, we're in a situation at the university I work with, in which all bets are off. Nobody knows what's going on because if you don't know if there's federal money coming in and how the impact that has on states, it’s impossible to plan, it's impossible for businesses to plan, impossible for local government to plan. How important is it you know, the relationship between local economies and the national economy? I know that like in New York City in late August, the MTA the people that oversee the bridges and the subways and everything else said that because of the loss of fares, tolls, and subsidies, that they're going to have to reduce subway and bus service by 40 percent next year unless they got a $12 billion federal bailout. I don't know if that number is the right number, or if they're crying wolf. But they haven't been collecting—they only just started collecting fares and going to New York City a few weeks ago. And ridership was down you know, for months by 90%. So, the impact on whether it is on firefighters, it's on teachers, it's on keeping local hospitals open people have to be feeling this pain. And so there are two things. One is, you say they have to balance the budget and are we going to see states and localities going under or are they just going to strip themselves? There's so many services, and does that lead to a national depression anyway? Or is there something else that's magically keeping the economy going that it bears no relationship to what's going on in people's own hometowns? ALDEN: That's a big complicated question, to which there are a lot of dimensions. So let's start at the level of massive regional inequalities. I mean, if the journalists on this call do not already take advantage of the work that, apologies for this Irina, that Brookings Metropolitan Policy Program is doing the work, to give CFR credit, my former research associate, Rob Maxim, is now doing work at Brookings on this project. It’s this incredible wealth of data on regional inequalities in the United States, I mean, the big, particularly tech-enabled cities in the United States are doing very well, right. I mean, Seattle, for all of the political unrest, the economy is booming. You look at Amazon, you look at Microsoft, these companies are doing tremendously well, you wouldn't know that there was any kind of economic downturn from the way these cities are performing. That's part of why the markets doing so well, so much of the market is driven by the companies in these, these very successful tech-enabled cities. The rest of the country, you know, a lot of smaller towns and cities around the country have struggled much more. This is not a new story, this is a two decade long story and Mark Muro’s work and Amy Liu and others at Brookings has really charted this out very well, I would encourage people to have a look at it, because one of the nice things they do is, you know, they collect data that goes down to kind of every small municipality across the country. So there's something in your local area that you can draw on there, that's helpful. They are arguing, I think, persuasively that the pandemic is hitting the places that were already struggling much harder than it's hitting the more successful places. So that's kind of top line. It's a very, very uneven picture. It's hard to, it's why it's increasingly hard to make statements about the U.S. economy, because there are some very different U.S. economies, depending on where you're living. On the state and local point, I mean, state government budgets are not, you know, big enough that in and of themselves they're going to make a huge difference to kind of top line economic growth. I think there are two significant consequences. One, a lot of these are good middle class jobs, you know, cops and firefighters and teachers and nurses and others. So you know, given that we're already facing a big unemployment problem, you see a lot of those people laid off as well, that's just a whole other big hit on top of what we've already experienced. And then the other will be, you know, a crunch on services. I mean, we're, you know, out here in the West we're in the middle of the worst wildfire season we've ever seen. And, you know, firefighters just utterly overwhelmed. I mean, I'm not sure you could have a firefighting force who is big enough to deal with what we're facing this summer. But obviously, the demands on firefighters, the demands on police, both the expectations of how they're supposed to do their job and, you know, I mean rising crime issues and a lot place huge demands on police. Teachers have never faced a more difficult time. So if you're seeing cutbacks in those areas, that's going to have big negative consequences on the quality of life in the states they're making deep cuts. ROBBINS: Right. Now, I do want to talk about the global economy, which is, of course, your transcendent area as a well of expertise. But I want to turn it over to the people on the call and as Irina knows, I always have twenty more questions to ask. But well, let's throw it back to Irina, thank you. FASKIANOS: Thank you both. So now we're going to go to all of you. If you click on the Participants icon at the bottom of your screen, raise your hand there or else if you're on a tablet, click on “More,” and you'll find the raise hand button there. Please tell us who you are and the news outlet that you're with to give us context. So we're going first to Rickey Bevington. And please accept the unmute prompt. Q: Hi, there. Can you all hear me? Great, thanks so much for this. This is right on topic for me, I'm looking for economic stories in the Southeast. This is Rickey Bevington, I’m with Georgia Public Broadcasting in Atlanta. I'm wondering what industries you see actually pivoting successfully from this pandemic and maybe absorbing the shock and then actually really getting creative and innovative in a way that may actually create new industries of the future or forever positively change those industries. That's a big question, but we have a lot of Fortune 500’s in Atlanta, we have a huge agriculture industry, we've got a very busy port that actually saw a boost last month. So I'm just looking for any broad trends that come to mind, thank you. ALDEN: Great, thank you. That's an excellent question. The port numbers I fear are probably going to be a blip. I mean, part of what we are seeing is the recovery from the collapse of trade in March, April, May, in the early stages of the pandemic. And now that we've got production capacity recovering, it's actually very high demand in the United States, some of that going back to the stimulus package and the relatively better economic recovery. So I'm not sure we're going to see those port numbers stay up. But you know, trade is likely to continue to be depressed for the rest of the year. And that's going to be a big issue for companies like UPS and FedEx.  I'm giving you a negative answer when you want it a positive one, but let me finish the thought anyway. UPS and FedEx I mean there's, you know, there's a lot of struggling in the delivery industry, in part because of the curbing of passenger flights of all sorts, because a lot of those packages actually travel on or near commercial passenger flights, as opposed to special flights specifically for those companies and for their delivery services. So we've seen costs rise somewhat in the package delivery sector. So I think they're going to struggle a bit to deal with that. I mean, in terms of innovation, I hate to point to Amazon, but I mean, Amazon is going gangbusters, right? They've announced they're going to hire 100,000 new people. They have been clearly the biggest single winners. I think, you know— FASKIANOS: I think we lost him at right at the Amazon point. So we'll have to get him to pick up right there. ROBBINS: We will do that, yes, absolutely. So, Irina, what other ideas and maybe we can ask the group what other topics they would like to see, while we're waiting for Ted to come back. FASKIANOS: That's a great idea. People can raise their hand or put it in the chat. Because we are collecting ideas for the next session of what we want to cover. We also have two questions in queue. Let's see. So just you know, please do feel free to send us suggestions, speakers, any aspects that you want us to cover. And I'm seeing great, why don't we Maureen, can you open up Wayne Heilman’s line? Great. While you're getting Ted, that's great. Q: Okay, I'm really a tale of two economies here. The struggling part is leisure and hospitality, mainly tourism and restaurants. Although hotel occupancy here is the highest in the nation because we're an outdoor recreation market other services are also struggling, that's call centers, we have a lot of those too. But the big benefit, beneficiaries are business and professional services, mainly scientific and technical. That's defense contractors, they have 500 openings here, which is a like an 8% increase, and 4,000 jobs added in the last year and 500 openings now. Huge job growth for a sector of about 50,000 people. And then the other growth coming back to Amazon, we have a four million square foot Amazon fulfillment and sorting center under construction here. So that’s going to provide some huge growth in the first half of 2021. ROBBINS: Where are you? Q: Colorado Springs. ROBBINS: And so that's the good economy. What's the bad economy? Q: Like I said, leisure and hospitality, which is tourism and hotels and restaurants and call centers, other services. You know, they don't need as many people on the call centers because they're not selling as much, although most call centers are operating remotely now. ROBBINS: Good, that's really helpful. ALDEN: Apologies for my temporary internet outage there. I am back I'm sorry about that. ROBBINS: You were talking about Amazon? Being creative. ALDEN: Yeah, just I mean, you know, everything associated with the digital online economy, I think is going to come out of this very well. I mean, they're doing well, somebody was mentioning, you know, and, you know, online educational services, of all types that are responding with a lot of creativity to this. So I think really what, you know, what the pandemic has done is to accelerate trends that that were already out there, which is that businesses that have transitioned well to the online environment are doing even better. I mean, Walmart, for instance, was smart enough to start making that transition some years ago and is doing quite well, through this despite the, you know, the challenges at the at the retail. And so I think, you know, that's not a surprise, but I think that's, that's what's happened this was going to continue. FASKIANOS: Great. Wayne, I know you contributed your thoughts on what was happening in Colorado. But do you want to give us, do you have a specific question or comment for Ted? Q: Okay, I can tell you that two things to look for in your markets. Amazon is building a ton of these delivery stations, which are about the size of a grocery store. But they're also building a lot of fulfillment centers, which are about twice the size of a regional mall. Now, be conscious that those employ twice as many robots as people. And but they still employ, the average Amazon delivery state or fulfillment center employs about 1,500 to 2,000 people. So they're huge operations. And highly automated. So look for those in your markets. Those are Amazon's trying to build out its infrastructure nationwide, and I think they're spending, what didn't they say 100 billion dollars on that, if I'm right, Edward? ALDEN: I think that's right, I'd have to double check. But they are, you know, they're using this as an opportunity to expand an already dominant position. And I don't see anything getting in the way of that, quite honestly. I mean, in a different era, this would raise anti-competitive concerns. But I don't hear any conversation on that at all, really in Washington right now. I mean, the president doesn't like Jeff Bezos, but apart from that, I think the issue is not really on the table. ROBBINS: Although, you know, when the pandemic started, and we all realized how dependent we were on Amazon, Amazon realized how, you know, the potential opportunity, the huge opportunity there was there was a reaction from workers who A, felt that they weren't being adequately protected, knew that they were frontline workers. And there was a lot of talk about job action and some limited job action. Did Amazon just weather that or did they adapt, or are they just in so transcendently powerful that these really aren't middle class jobs? ALDEN: No I think yeah, I mean, I think so far they've mostly weathered it, as you say, there was a kind of, you know, brief swelling up of small protests but they actually fired one of the main organizers of those protests, there was no significant consequences for the company. That is an issue I actually think will come back, particularly if we have a democratic administration. Obviously, you know, the position in the party for raising the minimum wage nationally I think is much more central to Biden's campaign than it was to the Democrats in the past. That's a piece I think Amazon will be under a lot of pressure over. I mean, it's employing a larger and larger share of the US workforce. The question of what those you know, distribution center, fulfillment center workers are getting paid and the working conditions that they're offering, I think that's going to become a bigger and bigger issue. FASKIANOS: Great, let's go next, Amy Rivers, please. And tell us who you work for. Q: Yeah, hi, I work for the Courier in Waterloo, Iowa. I've done a couple of these stories on, you know, businesses, especially small businesses, and how they're weathering the pandemic. But I was wondering more, like the larger industries, you know, our hospitals or universities and even our local governments, what do you see is that the canaries in the coal mine for when we should be looking as journalists for when they're struggling? ALDEN: That's a really good question. Can I ask you just quickly before I answer your question, what you've seen in terms of the smaller businesses and how they're weathering it, if you could just share that. And then I'll give you my thoughts on the larger ones. Q: I talked to several categories of businesses that had to be shut down. So here in Iowa, we did have a partial shutdown of all restaurants for a while, so that really affected people. And then some of them decided to come back online, and some of them didn't. I just talked to them about why they decided to do that. And a lot of people are sort of  split along partisan lines, you know, on that. They're seeing a lot of their customers either not wanting to wear masks or really wanting to wear masks to come back. So they're sort of making that decision on the fly and they don't know what's happening. So it’s really interesting. ALDEN:  Yeah, very, very much. I mean, you know, I think with the larger companies again, it's hard to generalize. I mean, one of the one of the things that the larger companies have going for them is that they can weather, you know, long downturns in business. If you look at, you know, the airlines are managing to cope despite a severe drop off in passengers. They were recipients of significant federal aid which helped them through that. Live Nation, which does concerts, I mean, there's very little happening for Live Nation at all and yet it seems to have the resources to weather this. So a lot of this, I think, is going to depend on the duration of the downturn. So, you know, if we begin to see in the next few month’s signs of a double dip recession, where the economy, rather than continuing to recover the fairly good pace it has been, starts to slow, then I think it would really be worth looking into the situations of the larger companies. Because I don't think that many of them are in a position where they're going to weather a double dip recession very well, unless there's a whole new round of assistance from Washington. So I actually think this fall is going to be is going to be critical. I think if the, you know, if the economy continues to climb out of the hole the pace it has been, I think most of the larger companies will get through this just fine. I think if we see a second significant slowdown, then I think that's when you're going to see the crunch happen. ROBBINS: And the double dip recession will be driven, if it were to happen, and let us hope more by a return of the virus, how much how important is this is another round of stimulus and certainly the extension of federal support for unemployment? ALDEN: I mean, I think it's almost certainly critical, because I think, you know, what we're seeing —economic numbers always have a lag is as you know, Carla, so what we're seeing reported is the relatively good news coming out of July and August. And that was, you know, that was driven in part, I mean, I don't want to overstate it, but certainly driven in part by the fact the federal government's putting a lot of money in people's pockets. And that has stopped, there's some still with the, you know, the sort of partial top up the administration managed to maneuver by moving some money around in the budget. But that aid is really gone now and I think we're going to start to see the effect of that into the fall. The part of the economy that's still very confusing to me and a lot of other people is, is how much you can continue to prop things up, basically, on the on the spending of people at the higher end. I mean, people who are working, thanks Wayne. Yeah, I mean, it's, you know, we're seeing a lot of these programs, just, you know, running their limits right now. You know, the people at the higher end, those who can work remotely and face at work kind of in that category, are still doing pretty well. And so, you know, that's again one of the explanations of why, you know, the tech companies are doing so well, because there's huge demand for their products, for companies that have got a lot of workers working remotely now. And so, you know, there's a whole economy there that's in some way a little bit disconnected from the situations of, you know, half or more of the country. And so, I don't have a crystal ball and exactly how that plays out in the fall. I think the tech companies are still going to do well, I think the people working remotely are going to do fine, but I think those who got hit hardest at the beginning are about to get hit again. And I mean, we can say with absolute confidence that that's going to hurt their lives and their towns and their cities. The effect on the larger economy in the aggregate, I don't have a great prediction on that. FASKIANOS: Let's go to Lori Valigra. OPERATOR: All right. Looks like we're having some technical difficulties if you could live chat your question? FASKIANOS: All right. Let's go to Jerry DiColo. And Laurie, please chat your question so we can take it. We could not hear you. Q: Hi, everybody. Thanks for holding this. My name is Jerry DiColo. I am at the Times Picayune in New Orleans. My question is related to you know, something we've all a lot of us been talking about, which is the accelerating trends to remote work and video conferencing that we've seen. New Orleans is incredibly tourism-dependent but outside of tourism and people taking trips and coming down here, it's also very dependent on business, travel and corporate events and filling our convention center. My question is on that end, have things, what you could guess at what the end state looks like in terms of — Do conferences and events come back? Do big corporations say this is an expense that we really didn't need, that was more of a luxury that allowed people to go take a free ticket to New Orleans or wherever they were going and say, well, we're doing business fine otherwise? Or does it become more like a luxury good where, you know, companies that, you know, are flush with cash can do this. And so they sort of start to return and do it. I just love to get your sense of how corporations might, how big corporations might be thinking about this, and what that end state might look like. Thank you. ALDEN: That's a great question. So I think, you know, every major corporation right now is trying to take a careful look at its productivity during the shutdown. What has remote work meant for the performance of its employees, and its bottom line? And they're reaching very different, I'm going to go directly into the business travel, but they're reaching very different conclusions. I mean, if you look in, you know, particularly the Bay Area, tech companies, they all seem extremely comfortable with remote work. I mean, there's some exceptions, you know, some of the software engineers are going to return and work out of office situations because of the benefits of collaboration. But you know, Facebook and Twitter, and a whole bunch of others who basically told employees, you know, you can work at home, you know, for the foreseeable future. JP Morgan, you know, going to the other coast, has announced that it wants to bring a lot of its employees back into the office in New York, that they have seen fall offs in productivity, particularly kind of Monday- Friday among younger workers can't figure out why that might be. But they're urging more of their people to come back home. And so I think that relates directly to the business travel question, because I think every company is trying to make an assessment of how much the face to face interaction matters in terms of their bottom line. And if they determine that it does, then I think we'll see a lot of the business travel conventions, everything else, recover. My guess is, this going to be an unsatisfying answer, but my guess is, it'll be somewhere in between. I think what they will discover is that a fair bit of business travel is probably unnecessary; that you can do, you know, things 95% as well, virtually as you can do them face to face. And so it will become more a question of, you know, the assumption, and a lot of companies and this is true in our organization, Irina, to be fair, that assumption, a lot of companies was travel's an integral part of what we do and the threshold for saying I need to get on a plane and go meet somebody was very, very low. I think that was the same with a lot of companies, you know, business conventions, which part of the way they did things business travel was routine. I think increasingly, companies are going to need justifications, managers are going to have to say this is something I critically need to do face to face, this is a meeting that's going to produce these kinds of returns, this convention has this value in terms of our future business, and then having once you've got people, the top of the company demanding that what we're going to discover is that business travel is curved fairly significantly, because a lot of what was done face to face can be done remotely. I think, you know, it's hard to overestimate the technological changes that we are seeing, I mean, I do a thought experiment sometimes of this pandemic and ten years ago, in the infancy of a lot of these technologies, you know, I mean, we wouldn't be able to do any of this. And I think what we're discovering is all this stuff's on fast forward now. So the remote capabilities are going to get better and better and better. And, and that's, you know, if you look into what's going to happen with the coming of 5G and artificial intelligence and virtual reality, it's not even just meetings that we're able to do remotely. More and more actual physical work, you'll have people directing from abroad and operating robots at remote locations, and so I think, generally, I think business related travel is in for a long term secular decline, which is not greater New Orleans. FASKIANOS: Right, but Ted, there will still be a huge inequity with those rural communities that don't have 5G, don't have access and of course, you know, people that can't afford the technology. So the disparity is going to widen. ALDEN: I know, I agree. And, you know, if I mean, there are, you know, so many urgent national priorities right now, but very near the top of the list, it seems to me is, you know, the rollout of universal high speed broadband, there's a lot of parts of the country that still don't have good access and subsidies to make that affordable to everyone. I mean, you see in the educational context, right? I mean if you don't have access, and I see this with some of my students, if you don't have access to high speed internet and a laptop, then you're not getting educated. I mean, that's, that's an enormous national problem. So I agree, and I think it needs to be addressed urgently. FASKIANOS: So Laurie has chatted her question, which is great. She's worked with the Bangor Daily News in Maine. How much might new types of businesses to help offset the declines of other industries like tourism and retail, for example, Maine legal recreational marijuana sales will start on October 9, could that help the economy to any significant degree? ALDEN: I think, you know, unfortunately marijuana sales are kind of like gambling, you know, they tend to, its local money, right. And so, what places like Maine need is ways to bring in outside money, either selling products to the rest of country and abroad that brings in outside wealth or, you know, people coming as tourists or otherwise investing in the state. You know, marijuana just kind of takes money out of the pockets of people locally, so I don't think it drives economic growth in any significant way, though, it'll certainly create some new small businesses. I think the most interesting possibility for a lot of a lot of smaller places is in this remote work, right? As more and more companies have embraced remote work, geographical location doesn't matter as much as it once did, you know, you don't have to be in New York or in DC, or in Seattle, to do these jobs. And so I think that the, you know, I've encouraged us here in Bellingham, where I live, to the local planners will take advantage of this opportunity. Bellingham is historically a resource town, we're about to lose our aluminum smelter just north that employs about 600 people at really good wages. I mean, you know, the timber industry is declining, a lot of the sort of traditional resource industries are going down, we've got a university, we've got a hospital, but clearly the economy of the future here is going to be wealthy tech refugees from Seattle who are going to come up and live here in a place like Maine. I think you have exactly that same sort of possibility, you know, you're within hailing distance of Boston, as we're within hailing distance of Seattle. And these places, I think, because they're, you know, generally less expensive, often very nice to live in, are going to become more and more attractive to tech refugees from the larger cities. So that may be I think, where some of the new opportunities arise. And then of course, once you have people like that coming, then there's all sorts of local businesses that can start to take advantage of that because you've essentially got outside money coming in. At that point, you've got you know, money coming from Seattle or from Boston or elsewhere into the community. And so that's when you start to get small businesses of various sorts pop up to cater to the needs of the people who are moving to the area. I mean there are, you know, I understand sometimes their cultural tensions around that I see this here in Bellingham, you know, the Seattle tech people are not the aluminum workers, right? They're, you know, they're a certain number of tensions there. But I think you're going to see that play out in a lot of parts of the country and I think local planners are going to start to pivot to that as a way to capitalize on some of the trends we're seeing towards remote work. FASKIANOS: Ted, Frank Zufall put something in the chat, which I think you should address since you're Canadian. ALDEN: Well, American growing up in— FASKIANOS: Right, American growing up in Canada and you're right on the border there so maybe you can address the fishing industry and what not. If you see that chat there. ALDEN: Let me let me open it up. Sorry. FASKIANOS: I'll read it to you then. On the other side of tourism for like New Orleans here in Northwest Wisconsin have seen a surge in tourism this summer as more people travel regionally and spend dollars regionally versus long distance destinations or overseas. Even the fishing has benefit as Canada close the border to the US and all those fishermen who might have gone there over the summer or coming to Northwest Wisconsin in other northern destinations. ALDEN: That's, thank you for thank you for sharing that because you know you realize and all these things that that there are there are always two sides to these stories. I mean, where I am here you know, the places just across the border from Vancouver are absolutely reeling right you know, Blaine, Washington, Point Roberts Washington, which has literally been cut off from the rest of the country. Point Roberts is this funny little, you know, peninsula, which has got U.S. territory and then Canada and then the rest of the U.S. is here. Nobody from Point Roberts can get out of Point Roberts, their economy has tanked. The Blaine economy has tanked. All of the sort of regional economies that depended on Canadians coming down from the cities have really hurt but you're giving here a wonderful example of kind of the opposite, which is, you know, somewhat, you know, regions where tourists might have gone on over the border to holiday in Canada are now staying inside the United States. And you're seeing, you know, you're seeing the tourism industry try to pivot on this right, you know, travel local and take advantage. So I, you know, I don't have any grand conclusion to draw from that, except that, you know, that there are always winners and losers in these things. And that's a really executive interesting example of, you know, a place where perhaps the border closure has benefited, you know, Wayne pointing out (inaudible) You know, I’ve traveled to Olympic National Park here recently and watching, you see a lot of people there, too. So I think a lot of people have done, you know, kind of camping vacations and, and hiking and other things. So it has moved, it's moved the dollars around some rather than just drying them up entirely. FASKIANOS: Wayne has his hand raised. And then we can go back to Carla for other questions, while we wait for others to queue up. Q: Question about the real estate market. Low interest rates, on the other hand, has forced up prices because people can afford to pay more. You combine that with historically low inventory of homes on the market. Is that eroding some of the advantage of these suburban and urban areas? ALDEN: I mean, yes, you have not seen the sort of weakness in real estate that some people thought I partly again, it's kind of working out of home. So suddenly, people want larger houses, right, that have got workspaces in them. And as you say that historically low interest rates, I mean, the answer is probably, you know, the farther away you go from the big cities, the more affordable the real estate is, even if prices are going up in those places, right? I mean, prices have gone up where I'm living substantially, it's still a third of the cost of living in Seattle. And I think you see that in a lot of other areas. So relatively speaking, I think those advantages are there. Even if we haven't actually seen a real weakness in the in the real estate market. Again, one of the kind of interesting things out of this, and I think, you know, a lot of that has to do with historically low interest rates that we see, Q: Although it's hitting the low wage workers the hardest in terms of apartment rents and things like that. The rent prices are going up two to three times the rate of wages. ALDEN: Yep, no question. Yeah. I mean, you know, almost across the board in this, we've seen low wage workers take the brunt of this. Both in terms of, you know, their wages and job security and also, of course, in health terms, right? I mean, you know, work that you have to do face to face, which is true for almost all service work obviously for a lot of, you know, a lot of meatpacking and other kinds of jobs, those are the ones where people are taking the highest, the highest risks. You know, there was some of the early reporting on the pandemic was, oh, it'll be a great equalizer because everybody is vulnerable. But that's, of course, not at all what we've seen. Tt has exacerbated, already severe underlying inequality. ROBBINS: So we're going into debate season. So allegedly, we're going to actually discuss some substance in politics, we'll see. And you noted in a very good piece in Foreign Policy recently, that when President Trump signed an executive order requiring federal agencies to purchase essential drugs and equip equipment in the United States only, he said, quote, we must never be reliant on a foreign nation for America's medical or other needs, end quote. So here's the question, and I think we're gonna hear a lot more of this in the political debates unfolding, which is buy American buy at home. Look what happened when we were dependent on foreign supply chains. And I think, interestingly enough, I'm not sure you're gonna get all that much pushback from the Democrats who have been traditionally, yeah, more than the Republicans, not the Trump Republicans, you know, traditionally, you know, the defenders of American produced goods. Why not? Why is it not the lesson from this pent up anger that we should control our borders more vigilantly going forward and produce our most basic needs at home? You know, I know that you are a globalist, I'm a globalist. But, you know, in this political debate A, who's going to push back and B, other than Ted Alden, you know, make the argument on the other side? ALDEN: Yeah, I mean, I think you're right. I don't think you're going to see a lot of pushback. If you look at Biden's economic plan, it strikes many of the same notes as Trump's in terms of ramping up American capacity. I mean, to be fair, I think there are areas where U.S. capacities gotten weaker than it should be. And I, you know, I think some of these medical equipment, pharmaceutical areas, the country definitely needs to take a look at and make sure that we are prepared for crisis situations of one sort or another. And one of the problems of, you know, make it all at home solves, I mean, there are two problems. One is just cost, it's more expensive, in many cases to make this stuff at home. But the other is just, you know, it doesn't actually necessarily provide you with security of supply. I mean, remember what took place in the pandemic here, which was a broad shut down of the economy, including a lot of the places that, you know, would produce these kinds of goods. And so the fact that you produce everything domestically, I mean, say, you know, we have a, you know, massive hurricane, we're seeing more and more of those that wipes out significant production capacity, or an earthquake or a pandemic, that forces a shutdown. Making it in America doesn't necessarily provide you with the resilience you want. That's not to say there doesn't need to be some rebalancing, I think there does, I think global supply chains became overextended. But you can easily go too far the other way. So that's, that's one concern. Second concern, as I mentioned, is cost. We will we will pay for this as consumers and that may be a reasonable political judgment, that that's worth it, that we're prepared to pay higher prices for a little more security and assurance. The third issue, which I think is going to be the most, you know, this is more of a sort of DC issue, what I think is gonna be really interesting is, what are we willing to pay for it in terms of subsidies, right? Because these things are not going to happen without massive government incentives. I mean, the semiconductor industry to take an example this is the right now a lot of the, you know, debate vis-à-vis the United States and China is about the security of technologies. We've already kind of banned Huawei from the United States, which is going to slow the rollout of 5G, which we were talking about earlier, you know, you're reporting them and probably been following the TikTok Microsoft Oracle debacle. And so you know, the United States is moving to try to decouple itself from China technologically. A huge area of concern here is semiconductor production. A lot of our semiconductors, even though they're designed in the United States, buy companies like Qualcomm and Intel and others, a lot of them are fabricated abroad. And so there's this big push to establish new semiconductor fabrication plants here in the United States. Those are enormously expensive enterprises, billions of dollars to set one of those up. Semiconductor industry came out, you know, yesterday, or maybe it was this morning saying, you know, we need at least $25 billion from the government to begin building new fab capacity here in the United States. Well, that's $25 billion that's not going into education, that's not going into roads, that's not going into health care, a bunch of other areas. You've seen the same thing in the pharmaceutical area. I mean, some of the people on the call probably followed the sort of laughable debacle that Peter Navarro exercise, you know. Peter Navarro carried out vis-à-vis Kodak, right? The Kodak was going to be revived as a producer of precursors for drugs, for pharmaceuticals. And, you know, the government was going to give them money was a $760 million loan to make this transition and Kodak stock soared. Well, it turned out the insiders and Kodak were making out like bandits from this announcement that they knew was coming in, the whole thing seems to have collapsed. So you get, you know, when you're pumping government money into trying to get companies to do what they would otherwise not do for their own bottom line reasons, you have a lot of problems, both in terms of expenditures of tax payers money and cronyism. And there are gonna be lots of opportunities for good reporting of money that gets misused under the umbrella of oh, let's reassure production. ROBBINS: So would you expect that sort of industrial policy to come in the recovery whether a Republican wins or a Democrat wins the next administration? Once we begin to crawl out, I mean, if you could just talk a little bit about sort of what the crawl out is going to look like and what it's going to take to rebuild the economy, beyond just getting a vaccine? ALDEN: I mean, that's, that's a huge question. There are a whole bunch of dimensions. But I do think, you know, the narrow question of where maybe the election doesn't matter that much. I think the United States are moving much more in the direction of industrial policy, and a lot of that could be good. I mean, I think there are areas where we have really needed one. But there are very few differences between the Biden platform and the Trump platform such as it is, on the importance of reshoring production, on the importance of using by America laws vigorously. Keep in mind, of course, that when we use by America laws, other countries are going to do the same, you know, it's going to be by Canadian laws and by European laws and other things. So we're, you know, our companies are going to are going to lose on that side of the equation. But there's a, there's a real sort of inter party consensus on this. It's a rare area of bipartisan consensus. So I think, I think, regardless of the outcome, we're going to see a lot more of these initiatives. ROBBINS: So back to the earlier question, which was the first question, which is, where do we look at, for what industries could be winners or at least early, you know, early crawling out of ooze possibilities here, for an industrial policy, for reshoring? If I'm looking in my town, is it going to be the local pharmaceutical manufacturers? Is it gonna be medical equipment manufacturers? Where is it, if you had to bet, where are the subsidies going to go and the reshoring possibilities going to be focused in the short term or in the near term in the medium term? ALDEN: Yeah, I mean, I think we kind of know what the list is. And of course, you know, Carla, you know how Washington operates, there are lobbyists right now who are busy working to try to get their industries added to the list. But the list at the moment, I think is clearly pharmaceuticals, that's going to be a big one. The United States is heavily dependent on China and sort of, by extension, India, where a lot of the precursor chemicals are made for our critical pharmaceutical supplies. So I think that's very near the top of the list setting, you know, medical protective equipment, ventilators, all that stuff, I think that's on the list. As I say, semiconductors, they'll probably be other elements of the tech economy, semiconductors is already out there actively being discussed. The United States I think is going to try pretty clearly through subsidies to find a way to create new competitors in 5G and in the rollout of 5G infrastructure. We don't have a company in that space. Cisco kind of moved out of it some years ago. So you got Ericsson and Nokia and Europe and Huawei in China, which has now been banned from the United States and for many other countries. I mean, to be to be clear, we're not we're not just banning Huawei, we're killing Huawei. The United States has choked off sales of semiconductors to Huawei, which is strangling the company, and is going to be a source of enormous tension between the United States and China because Huawei is their flagship corporate success. I mean, there are others like Tencent and others, but Huawei is very much at the top of that list. So I think, you know, there are going to be various subsidies that go into both, you know, creating competitors in the 5G space, and then rolling it out, because 5G is the enabling technology for the future economy. Somebody mentioned renewable energy, that will be clearly, that'll be more of a political thing. Like I think those four that I list is going to happen Democrat or Republican. Renewable energy I think will be much more of a democratic thing, I mean, I don't see any waning of President Trump's enthusiasm for fossil fuels. So I don't see heavy subsidies for renewable energy in a Donald Trump administration. In a Biden ministration, yeah, I think that's another area clearly where we will see significant subsidies. ROBBINS: Other questions, or I can go on, I can continue to torture Ted. ALDEN: Everybody’s staying on the call. So they must be good questions. FASKIANOS: Kala West had just mentioned, we should cover homelessness in the pandemic and we can think about how we do that. But I don't know if you want to say a few words about that, and then Carla, if you have another question, which I'm sure you have many, we’ll go back to you. ALDEN: Yeah, I mean, I'm not sure I have any, you know, special insights on the on the question of homelessness, but I think  it's going to get worse, right? I mean, we had, you know, eviction moratorium in various places. And Wayne mentioned rising rents in a lot of places I think the, I think the problem is going to multiply and, you know, our services for the homeless are hopelessly inadequate already. So I expected that that problem is only going to grow. It's pretty prominent here, where I live, you know, any place on the West Coast with a benign climate tends to tends to attract a lot of people who don't have other places to live. So I see it, you know, just anecdotally see it growing here, and I think it's going to grow elsewhere, too. ROBBINS: So if we're turning around, somewhat, cut off from the rest of the world. And you wrote a book, which had a title that suggested that we were being left behind and other people were doing better. Compare us to the rest of the world. I mean, obviously, our COVID numbers are terrible. Our economy is doing better certainly than the Brits and other people. But what does this tell us about when, you know, the virus has beaten back about our competitive position globally? And do we have to worry about that? Or is the lesson here that we shouldn't be worrying about our global position anyway because we're such a big economy that we seem to be able to drag ourselves out anyway? ALDEN: Yeah, I mean, that's another great question, Carla, to which I do not have an easy answer. I mean, we're potentially at an inflection point, right? And, you know, one possibility is that we make adjustments, you know, I talked about failure to adjust that we adjust and adjusting would be recognizing that we have some enormous competitive advantages as an economy and the quality of our universities, the quality of our top companies, I mean, those, those advantages have not really waned significantly. And we take advantage of those and that that does, I believe mean we still need access to global markets, I don't think we can cut the Chinese off entirely and succeed, we've got to figure out ways to be able to keep doing business with them. But we tackle this huge and growing list of problems at home, you know, healthcare being the top of the list, but infrastructure and, you know, a whole bunch of other issues that that we've known for years we need to be dealing with. So that would be kind of the positive outcome for, you know, my value judgment positive outcome. The other possibility, though, is I think we move, you know, much more in a 1920s and 1930s style direction. I think, you know, the argument is, that we're big enough we can go it alone is very attractive to a lot of people, kind of makes intuitive sense even though, you know, if you look at growth, which is what fuels the economy, you know, that's all taking place in the developing world, and China and India and other places. I mean, if U.S. companies are forced to just deal with the U.S. market, then I think their competitiveness is going to erode significantly, because the market isn't growing fast enough to sustain the kind of innovation and competitiveness that we need to stay on the top. But I mean, we are in this moment, where come home America arguments of all sorts, I mean, you do national security stuff, so you're paying attention to it on that front, feel free to talk about that. But come home America arguments of all sorts have a lot of resonance. I mean, this is, you know, I say this with a little bit of caution, but I'll say it anyway, I guess I wrote it in another Foreign Policy article. I mean, we're in a kind of tribalist moment and a lot of ways it's not even, it's not even just national, right? I mean, the pandemic is forced us all into narrower and narrower circles, you know, even states requiring quarantines on travelers from other states; when we're scared, we tend to turn inward, that's just a very kind of human thing to do. You know, you gather a smaller and smaller group that where you feel safe, and you try to build walls around all that uncertainty. Well, that's the moment that we're in right now. And we have a leadership, I think that is really accelerating those tendencies. So yeah, I think both of those directions are possible, I don't know which way we're gonna go as a country. I know which way I hope we go. ROBBINS: Can we end on a more hopeful note? We were hopeful because we know there's some great journalism out there. And we look forward to, send us your stories that you do in your local communities, both, you know, both the stories of companies and governments that are struggling, but also innovation that's out there. And we'll share them around and I will turn it over to Irina now because we do end on time, because we know everybody's got to go back to work. So thank you, Ted. This has been great. It’s lovely to see you again. ALDEN: Thank you so much Carla, thanks to everyone on the webinar. ROBBINS: And back to Irina. FASKIANOS: Yes, and thank you both Ted and Carla, and as Carla said, we are going to circulate the recording of this and transcript for you to share with you and your colleagues to review again. I encourage you to follow Carla on Twitter @RobbinsCarla and Ted @EdwardAlden. And of course, please go to CFR.org, ForeignAffairs.com, and ThinkGlobalHealth.org for resources, the latest analysis on the pandemic, and we have a whole Election 2020 hub as well. Send us your suggestions to [email protected]. And thank you all for being with us and we will be reconvening in a couple of weeks.
  • COVID-19
    Beating COVID-19 in Africa Begins With National Labs
    Farouk Umaru, M.Sc., MBA, Ph.D., is Director of Global Public Health Laboratory Programs at U.S. Pharmacopeia. When the African continent's first reported cases of COVID-19 surfaced in February, the African Union and Africa Centres for Disease Control and Prevention (CDC) quickly devised their strategy to contain the pandemic: rapidly diagnose and isolate patients, and temporarily quarantine their contacts. Since then, as nations across Africa implement a patchwork of different approaches – from imposing strict lockdowns to declaring the pandemic's end and resuming business as usual – it has become clear that most countries lack the data needed to effectively respond. Although testing efforts have detected over 1.3 million cases of COVID-19 across Africa, experts agree that limited testing capacity has masked the full extent of disease spread and hampered control efforts. To scale up testing, health sectors must not only find ways to procure more test kits, but also dramatically increase the continent's laboratory capacity to process tests, as delays allow the virus to spread.  Progress is already being made. The Africa Joint Continental Strategy for COVID-19 Outbreak identified equipping, training, and strengthening public health laboratories for quality-assured diagnostic testing as one of its key pillars. Within the first two months of COVID-19 touching down in Africa, sub-Saharan Africa went from having two laboratories equipped for testing – in South Africa and Senegal – to creating some testing capacity in all countries by adapting labs that previously focused on diagnosing HIV and tuberculosis (TB). Work to scale up clinical laboratory capacity across Africa is needed not just for COVID-19 but also for other endemic and emerging diseases, and the pandemic offers the impetus to accelerate efforts. A group of partners convened by Africa CDC – including the African Society for Laboratory Medicine, WHO-AFRO, UNITAID, United States Pharmacopeia (USP), and others – is working to increase access to quality diagnostics through the Africa Collaborative Initiative to Advance Diagnostics (AFCAD).  Both quantity and quality of diagnostics are major priorities. If data produced by diagnostic tools are not reliable, treatment decisions and prevention measures won't be, either. Poor-quality testing that produces inaccurate results would undermine public confidence in the health system at a time when trust in healthcare and medical products will be essential to ending the pandemic. USP – an independent scientific organization that sets quality standards for medical products that are used in over 150 countries and integrated into the laws of more than 40 governments – has collaborated with 34 countries to strengthen more than 90 laboratories, enabling them to assure quality of medical products and vaccines and increase capacity for clinical diagnosis. USP is supporting select national laboratories in Ghana, Ethiopia, and Nigeria to strengthen clinical laboratory capacity for HIV, TB, malaria, and COVID-19, including through strategic planning, emergency preparedness, and building capabilities in laboratory testing and quality management systems. USP is also supporting these labs to ensure that poor-quality test kits – such as falsified tests peddled by criminal networks looking to profit from the crisis – don't reach patients and compromise the pandemic response. Scaling up these efforts to meet the substantial challenges posed by COVID-19 will require urgent and sustained investments from governments; donors that have already made substantial contributions in this area such as USAID, the Global Fund, the World Bank, and the Bill & Melinda Gates Foundation; and new funders. It will be well worth the effort. To achieve the African Union's Agenda 2063 toward a prosperous, healthy, self-reliant continent, being able to successfully address disease outbreaks through state-of-the-art medical science is essential. Continuing this rapid scale-up of laboratory capacity across the continent, while ensuring the quality of test results, will allow African health workers and decisionmakers to understand the disease dynamics essential in informing control and prevention measures, not only for COVID-19, but also for other ongoing epidemics and emerging diseases.
  • Cybersecurity
    The Cyber Side of Vaccine Nationalism
    Vaccine nationalism has given rise to a new wave of cyber espionage targeting COVID-19 vaccine research.
  • Diplomacy and International Institutions
    The UN at Seventy-Five: How to Make it Relevant Again
    Council of Councils global perspectives roundups gather opinions from experts on major international developments. In this edition, members of six leading global think tanks reflect on what reforms are the most important for the United Nations as it looks toward its next seventy-five years.
  • Americas
    The Pandemic Is Eroding Bolivians’ Trust in Democracy
    Interim President Jeanine Áñez’s decision to postpone Bolivia’s election twice has sparked protests, revealing the threat COVID-19 poses to democratic governance worldwide.
  • China
    How China Ramped Up Disinformation Efforts During the Pandemic
    Beijing has increased its manipulation of information as well as disinformation efforts around COVID-19 to damage democracies and boost itself, but its strategies have had mixed results.
  • Namibia
    Remembering Dirk Mudge, Pioneer of Multiracial Democracy in Namibia
    Anthony Carroll is founding director of Acorus Capital, a private equity fund investing in Africa, and a vice president of Manchester Trade Limited, an international business advisory firm. He has over forty years of experience working with Africa and is an adjunct professor at Johns Hopkins School of Advanced International Studies. As a part of its series "Those We've Lost," the New York Times last week published the obituary of Dirk Mudge, who died of COVID-19 in Windhoek, Namibia on August 26, which was, fittingly, Namibia's Heroes Day. While Mr. Mudge had retired from politics in 1993, he played a crucial role in Namibia's independence and, as a result, in ending apartheid in neighboring South Africa. I first heard the unforgettable name Dirk Mudge in 1977 while serving as a Peace Corps volunteer in neighboring Botswana. Mudge's ancestors were Afrikaner farmers who trekked northward from South Africa in the 18th century. Their descendants are still very influential in the beef industries of both Namibia and Botswana. These Afrikaner settlers later came under the colonial rule of Germany during the late 19th century’s "scramble for Africa." That scramble created South West Africa, where German colonial rulers perpetrated the first genocide of the 20th century, mostly against the Herero people. After Germany's defeat in World War I, Namibia was placed under South African administration, a rule that continued in contravention of international law until 1990. (Actually 1994, with the handover of the port of Walvis Bay – the last "vestige" of that ruinous treaty, according to Namibia's first chief justice Hans Berker).   After the 1948 election, South Africa came under the governance of the National Party, which instituted the odious system of apartheid. As its de facto "Fifth Province," South West Africa was subjected to the same legal regime based upon exclusion and enforced by terror. By the 1970s, South Africa was embroiled in a costly and unpopular "border" war with Angola and fighters from the South West Africa People's Organization (SWAPO). SWAPO has been Namibia's ruling party since independence. By the mid-1980s, it became clear that a military solution to South Africa's continued illegal rule of Namibia was not viable. The U.S. government under the guidance of Assistant Secretary Chester A. Crocker played an important facilitating role in ending the Angolan war as did the UN special representative and Finnish Nobel Laureate Martti Ahtisaari.  However, no amount of external pressure would have worked without an insider to show South Africa the door. Dirk Mudge provided the needed "nudge."  While serving in the country's All White Executive Committee, in 1977 he abandoned the National Party and formed a multiracial party, the Democratic Turnhalle Alliance (DTA). Despite the enmity of White Namibians and the historic mistrust of Black Namibians, Mudge played a pivotal role in disengaging South Africa (without the help of its administrator Louis Pienaar and South African intelligence and its "Third Force") and began the negotiations for independence in 1990 and the drafting of a model democratic constitution. His "inside" role was similar to that of the UDF and DP in South Africa and perhaps provided a road map for the winding down of apartheid in South Africa. Conversely, had things gone badly in Namibia, resistance by conservative "verkramp" Afrikaner elements could have led to a different outcome. Upon learning of his death, Secretary Crocker paid tribute to this vital contribution, describing Mr. Mudge as "a serious and committed person who played a key transitional role in the country he cared deeply about." After independence, the formation of a new constitution, and the conclusion of negotiations on the reintegration of Walvis Bay, Mr. Mudge returned to his "cattle post" in 1993 and raised champion Brahmin cattle. Even with the challenges of corruption and weak opposition to the ruling party, many observers still believe that Namibia has been the most successful nation in southern Africa to emerge from a protracted and violent armed struggle. While there are many heroes who contributed to that success, including some who paid with their lives, Dirk Mudge certainly deserves recognition for his commitment to bringing democracy and majority rule to his country.
  • United States
    Winners and Losers of the Pandemic Economy
    While it is true that bullish equity markets are out of step with the historic contraction in the real economy, to say that they are disconnected from it misses the point. In fact, the lofty valuations of companies with high intangible capital per employee make perfect sense in today's economy.