COVID-19 and Global Equity

Fatema Z. Sumar, vice president of global programs at Oxfam America, and Trevor Zimmer, co-leader of the COVID-19 Vaccine Equity Project, discuss equitable distribution of the COVID-19 vaccine around the world.

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FASKIANOS:  Good afternoon and welcome to the Council on Foreign Relations Social Justice and Foreign Policy webinar series hosted by the Religion and Foreign Policy program. I'm Irina Faskianos, vice president for the National Program and Outreach at the Council on Foreign Relations. As a reminder, this webinar is on the record, and the audio, video, and transcript will be available on our website, cfr.org, and on our iTunes podcast channel, Religion and Foreign Policy. As always, CFR takes no institutional positions on matters of policy. So we're delighted to have with us today, Fatema Sumar and Trevor Zimmer.

Fatema Sumar is vice president of global programs at Oxfam America, where she oversees the regional development and humanitarian response. She comes to Oxfam with a distinguished career in the U.S. government leading efforts to advance sustainable development and economic policy in emerging markets and fragile countries. And she most recently served as regional deputy vice president for Europe, Asia Pacific, and Latin America at the U.S. Millennium Challenge Corporation, where she managed investments focused on international growth and poverty reduction. She also served as deputy assistant secretary for South and Central Asia at the State Department, and as a senior professional staff member on the U.S. Senate Foreign Relations Committee.

Trevor Zimmer is a co-leader of the COVID-19 Vaccine Equity Project, a joint initiative of the Sabine Vaccine Institute, Dalberg, and the GSI Research and Training Institute. He also leads Dalberg Designs's Health and Innovation practice. Mr. Zimmer's recent work includes supporting countries to coordinate their responses to COVID-19, launching a global professional association of immunization managers and helping to scale a maternal health system across Haiti. Prior to Dalberg, he worked with the Clinton Foundation on an HIV treatment optimization study, and on a program to increase access to essential medicines for children in India, Kenya, Nigeria, and Uganda. And he's also worked to mitigate the threat of Zika and Ebola with USAID and focused on reducing neonatal mortality in Nigeria. So thank you very much to you both for being with us to discuss this very important topic, and which is very much on everybody's mind about the COVID-19 and global equity to distribute the vaccine.

Fatema, can you please begin to talk about the relative wealth of a country how that might affect the COVID-19 vaccination distribution and what is happening?

SUMAR:  Sure, well, thanks, Irina. And first, let me just say I'm so delighted to be able to spend this time with all of you, thank you so much to the Council on Foreign Relations, Irina, special thanks to you and your team. And, Trevor, it's such a delight to share this virtual stage with you. So thank you all. And thank you all from all around the country for taking time to join us today. You know, we're kicking off a new year. And Irina, my first thought I wanted to share with everyone is we're all kind of here making history together. And what's really remarkable about this moment is that we have the power to decide how we want to really push an equitable distribution system as a vaccine, here in the United States and all around the world. And the choices we make literally today and tomorrow will really affect the future of our world, and the future of our economy, our health, our political, and our security all around the world. So we're here, we're in it together, we're in it together. And this conversation couldn't be more important. So thank you for taking the time to pull us all together. So the first question is we're here to talk about religion and foreign policy and really with the anchor around social justice. So why does equitable distribution matter? Why are we talking about this? And why does it have to be ground zero of every conversation we talk about? If there's one thing I've taken away, I'm sure all of you, over the past year with COVID-19 is that it doesn't discriminate. This vaccine does not discriminate in terms of we're all affected wherever you are around the world. But that being said, it's exposed different types of inequalities, and some of us face them more than others. They intersect in lots of different ways, whether it's economic, gender, racial, social, or geographic inequalities. We know about 2 million people or so have already died globally from COVID-19. And there's currently close to 100 million cases reported worldwide, according to Johns Hopkins. So we know that we can't keep on the train and tracks that we're on right now with our with our economies with our school systems. Our public health systems continue to be really destroyed and eradicated in so many different ways with devastating impacts, particularly in vulnerable populations on refugees, and women, on girls, and those facing conflict and famine. So the vaccine could be our way out of this global public health nightmare, but only if we do it right. So what I want to leave you with all today is that the way forward really needs to be framed in terms of a people's vaccine, a vaccine that's free, fair, and fully accessible. The way to think about this is around a global public good, right? And so you shouldn't only be able to afford it, if you can pay for it, whether it's your country, or your company.

There's four major challenges today when we think about widespread access and equitable distribution. The first is the price of the vaccine. The price of the vaccine is too expensive, and it's too out of reach for many people and governments all around the world. So unless you're one of the governments or you live in a country that's able to afford the price, or it has already bought up supplies, it may be completely financially out of reach for you. Second, vaccine nationalism. This has been led by the Trump administration. But a handful of rich countries, which represent around 14 percent of the global population have already cornered more than half of the global vaccine supply. This is going to have devastating consequences, particularly for around 67 countries, low- and middle-income countries that are at the risk of being left behind as the rich countries move forward. And really use up more than half the supply. Five of these countries. Kenya, Myanmar, Nigeria, Pakistan, and Ukraine already have nearly 1.5 million cases between them. These are massive populations, massive economies, if we leave behind two thirds of the world, if we leave behind nine out of ten people in poor countries, which is what we're on track to do, Irina, today. This has massive consequences for how we think about living in a global society, not just next year, but for years and decades to come. The third major challenge we're facing right now is that vaccine production is just way too low to meet global demand. We've made tremendous progress, incredible progress in 2020. But despite receiving massive amounts of U.S. taxpayer dollars around more than 12 billion dollars so far, and making record profits during the pandemic, private vaccine producers, exercise monopoly control over vaccine technology, which has artificially constrained the supply. So we really need public officials to take every step possible, including ending monopoly control of production and suspending intellectual property protections for the COVID vaccine, so that we can rapidly scale up production and drop prices, so that everyone everywhere has the right to be protected from COVID-19. And then the fourth major challenge is really about inadequate and unequal investment in public health infrastructure. I know Trevor is going to talk more about the challenges around distribution. But suffice to say, even the last few weeks here in the United States have raised bear the challenges of how difficult it is even here in the U.S. for distribution to actually take place in an efficient manner.

Think about what that means for poor countries all around the world, that are already under-invested in public health infrastructure, and the challenges it takes to reach people, particularly in rural markets. Women, of course, will face the brunt of the challenges and absorb the cost of these under investments in public infrastructure the most. I want to take a minute, Irina, to talk about women in particular, because too often we talk we make our problems gender neutral, and COVID-19 is not gender neutral as all of us have known and experienced this past year. Women before the pandemic and especially during the pandemic have really shouldered a disproportionate burden around unpaid care. And that is stepped up during COVID-19. I'm sure some of you see that in your household when it comes to education. When it comes to childcare. A McKinsey study found that employees at 317 companies, that one in four senior women, so senior women, are already considering downshifting their role in their careers to reduce work hours. The trickle-down effect throughout all parts of the economy are really severe. And this can stall and reverse improvements that we've made in the wage gap over the past decades. So these inequalities with the vaccine will only deepen these gender inequalities, particularly around distribution and access. Women in care roles in particular are going to have to give up their time and either paid or unpaid jobs, to either travel to get access to vaccinations, to be able to actually get distribution and access and majority of healthcare workers all around the world are women. So the delivery and their role is particularly acute and requires some study to really understand how we can really support women during this time.

So I want to talk a little bit about the way forward and what we can all do here today with this incredible group together. Oxfam has worked with many organizations, including Amnesty, Frontline Aid, Global Justice Now, and over one hundred former and current heads of state, economists, public health experts, and artists to launch what we are calling the People's Vaccine Alliance. It's on our webpage if you go to oxfamamerica.org. And our vision is really simple but profound. It's the vision to ensure that the approved COVID-19 vaccines are available for all people everywhere equitably. We've made a concerted effort, particularly for the People's Vaccine Alliance to reach out to a number of faith leaders as part of our push. And many have signed on to our public letter to President-Elect Biden, which you can also see from our webpage. There's three really simple components, and I'll end here with this around it. First, if we're going to have a free people's vaccine for all, it needs to be free of charge to the public in all countries. No one, not any of us should be denied the protection of our health and livelihoods because we can't afford the vaccine. The second is fair distribution, which I know Trevor is going to talk about. And that should be based on need and risk, not wealth and nationality. And those are very powerful ways we can think about shifting the paradigm of how we think about working to do free and equitable distribution. And the third piece is around openly licensed, free of monopolies, and propriety protection for the vaccine, because that prevents the rapid scale up of production that we need in order to meet the global demand. So those are the different components, we've been really blown away by the type of support that we've received here in the United States and all around the world. And people understanding that the solution and the way forward, even as we all rush and can't wait to get our vaccinations and our shots that were protected, that our lives, our societies, our borders will never open and reopen in the ways we want them to, unless we're all protected wherever we are, and whatever we can afford. So that's the work we're doing at Oxfam in partnership with so many others and delighted to be able to talk about with you. Thanks, Irina.

FASKIANOS:  Thank you, Fatema. That was terrific. Trevor, over to you about the logistics of vaccine distribution around the world, lessons learned from your experience in dealing with Zika and Ebola, and what barriers you see preventing equitable distribution and what we can do about it.

ZIMMER:  Thank you. I first want to reiterate Fatema's gratitude for being part of this forum. Most of my day is spent talking to doctors, ministries of health, epidemiologists, logisticians. And the moment to actually zoom out with religious leaders and social justice advocates, and talk about equity, which is at the core of my personal mission and values, is a real treat for me. So I can't wait to get to the Q&A and discussion portion of this conversation. I also think Fatema did a great job at providing an overview of major supply issues related to vaccines in the advocacy that Oxfam, The People's Vaccine Alliance is doing to address that. And so I don't want to give that short shrift, but I'm just going to be speaking about the distribution. So assuming that the vaccine is there, which is the big assumption, because that is what I'm working on and thinking through. But before getting to that, there's really, two mechanisms countries are really tapping into in order to access the vaccine. That's the kind of self-financing bilateral agreements with pharmaceutical companies themselves, that's both countries, as well as providers of private health.

And then there's also what's been called COVAX, which is a consortium of over 150 countries who have come together to have massive purchasing power to pull resources and go through equity distribution across the countries to figure out as they're doing these bulk purchases, and have that bulk purchasing power to negotiate with pharma themselves, to not to kind of address that vaccine nationalism and make sure there's some kind of fairness and equity of distribution across countries. But where I pick up is once we've got, let me also note that COVAX is very underfunded. We're grateful that the Biden administration is seemingly going to prioritize funding this and providing the funding gap that currently exists between what we need to fully inoculate 150 countries, especially the 92 countries that need to be subsidized for this vaccine that can't sell finance, to subsidize COVAX to provide those vaccines, there's still a big gap remaining. So that's why the advocacy work that Oxfam is doing is essential. But assuming the vaccines actually arrive in country, what are the challenges countries have to then make sure that it is getting out to the right target priority populations in an equitable way. Now, there's, I guess, a couple of different considerations that are front of mind for countries. First, is emergency use authorizations, for countries for vaccines that are kind of rushing through clinical trials, that have shown great efficacy, that they need to actually kind of address some of those issues. Once they've actually kind of prepared the regulation emergency use authorization based on what's coming out of the clinical trials and WHO emergency use authorization of lists and procedures, it's been really about costing in fundraising for the distribution within the country. And that is where there's a role, potentially, for interfaith organizations in fundraising as well as multi and bilateral donors such as the WHO, USCDC, World Bank, Asian Development Bank, and their various development banks, other donors like the Gates Foundation can pitch it. After that, it's really about countries need to target and prioritize population. We know these vaccines are going to be coming out in different tranches. So it's not like we're going to get enough to create herd immunity from day one. With the estimates, countries that are committed to receiving vaccine through COVAX will be able to inoculate up to twenty percent of their populations by the end of 2021 calendar year.

But who are those folks that should actually receive those vaccines? First, COVAX, and a WHO organization called Sage has provided guidance, and those are guidance put forward by bioethicists. But there's only so much that global standard setting bodies can actually encourage countries to adopt that guidance. Countries are, and we have to make sure there's not political chicanery going to prioritize populations based on favoritism, I want to be clear, this is not just an issue in low-income countries, we see that in the U.S., in other countries, and similar levels have huge challenges around this too. But what we're realizing is countries really do want to prioritize and target vulnerable populations. I'm defining vulnerable populations in two ways. One, there's really those health impacts, folks that are at risk of mortality with COVID, those are elderly, those are people with comorbidities, such as type one diabetes, those are also people with outsized impacts on households' well-being, those are essential health, essential workers. And we need to consider essential workers as also women heads of households. We need to actually think about as we think about who are the central workers are and really be honest about how we define that. So a lot of my work is helping identify and target those priority populations. Because right now, there's not a lot of clarity. They might have a register at a country level, who has type one diabetes, but that's not broken down to the sub-national or even household level. Once those priority populations have been identified, it's been a matter of making sure that vaccines get to those populations. So in those health catchment areas, making sure they have, if they're getting a Pfizer vaccine ultra cold chain requirements, which is a huge infrastructure logistical challenge. And if it's say that Astra Zeneca, which is more normal refrigeration, make sure they have the capability capacity for that, if they capability capacity to track those vaccines. And then they start canvassing the population to identify those target populations, convince them to come in for the vaccine, mobilize interfaith leaders and influencers with the community to make sure that people accept the vaccine. And once they accept the vaccine, they go in and get it at the right place at the right time. And then they also get their second dose.

Related to that is really training the health workforce. So both vaccinators themselves, logisticians, as well as community healthcare workers that aren't vaccinators themselves, but really those people at the frontline in the communities that really can get ahead of misinformation around vaccines. Vaccine safety moderating and managing adverse events is something that you also need to create and establish mechanisms for and then of course, there's monitoring, ongoing surveillance of COVID-19 outbreaks as well as going to vaccine introductions. So the wrap around with all of that, the good news, is the world is experienced with vaccine production. We've done it before. And we have a lot of lessons learned. However, some things make COVID-19 unique. One is really the urgency of it. This needs to be done as urgently as possible. And across the population. Another challenge is, it's a different population that is typically getting vaccinated within programs. And so this includes elderly, this includes folks with comorbidities, most vaccination programs in most countries target those under five years old. Some other challenges include the ultra cold chain requirements I alluded to, as well as living in a world awash with misinformation, and relative distrust of the institutions that we really rely on for collective action. I'm hopeful we can address this, not have this crisis go to waste. And I do have to say a lot of low-income countries, in some ways are better equipped than countries where I'm from, like the United States, because they've had experience with outbreaks such as HIV, where they've really strengthen the primary healthcare system in Ebola vaccine rollout in the last few years there also require ultra cold chain. So we also have lessons learned from these environments as well.

FASKIANOS:  Thank you very much, Trevor, I appreciate that. We're going to turn now to all of you for your questions. There are already a few questions, people have written out their questions, I also encourage you to raise your hand, if you click on the look at the bottom of your screen, you can raise your hand there, if you're on an A tablet, on the upper right hand corner in the "more" button, you can raise your hand in that way. And we also raise hands. So I'm going to first go to, because this picks up on your last point, one of your last points, Trevor, from Elaine Howard Ecklund at Rice University. How can religious leaders and others work together to address the suspicion of COVID-19 vaccines, which we're seeing here in the U.S., and you can tell us how much of what's being what's happening around the world too.

ZIMMER:  Thanks, I really appreciate that.  I think many people on this call actually know how to inspire and motivate people more than I do. So I would say you have the tools to do that. But, some of the sources to actually surface that information is first of all, sharing, listening to people's concerns in addressing it, and just creating a forum for people to discuss and share information. One of the partners of the Vaccine Equity Consortium, the project is working with is called the Meedan Digital Health Lab that actually provides real time information to address misinformation. And so there are resources out there, that while acknowledging the misinformation being fed out there, really can provide better information. But it's really hard work. I would say, one thing as influencers within communities, it's very important that you can keep a consistent message, you acknowledge people's misinformation, and don't give legitimate people's source of frustration and mistrust. This is a time that a lot of people feel alone. This is a time and a lot of the institutions that we rely on for collective response, is it as ever, but I would say, encourage, provide people great information, say you'll get vaccinated yourself, have people share around testimonials, if they've gotten vaccinated and why it's important to them. You maybe encourage vaccination drives within the community. Reinforce that message is going to be as important as possible. Because it is something that really concerns me, and there's no one-size-fits-all, different communications, and different mistrust. I know in the U.S., communities of color, especially, African-Americans have a lot of distrust for pharmaceutical testing on those communities in the past. So they're very well-founded. And that's a little bit different than perhaps misinformation around Big Pharma seeing this as an opportunity to create a dependency in money. So I would say start with listing and then pointing to the right resources, and then showing as a proof point, that you've gotten vaccinated and then encourage people to share those testimonials and do the same.

FASKIANOS:  Thank you. Let's go next to Seemi Ahmed, who has raised her hand and if you could tell us who you are.

AHMED:  Hi, this Seemi Ahmed. Thank you so much, Fatema and Trevor, for all the information you provided. I just had a thought which I wanted to share with you. You were talking about the, we were addressing the equity as far as vaccination is concerned, and so, I felt that at a time, when there's a pandemic, it's, I think, rather than expect the rich countries to be altruistic and all that, I think the poorer countries also should try and do something themselves. I have heard India has come up with a vaccine on their own. They're also using Astra Zeneca from the UK, but they've also come up with a vaccine of their own. So I thought it might be helpful to encourage the poor countries to also work hard to come up with something rather than be dependent on others during such a time, thank you.

ZIMMER:  Thank you, Seemi, I think that is being discussed as a medium-term solution, to create manufacturing, research, and development capacity. I know India this year is a great example of that. I know, there is support to create manufacturing facility in South Africa as well, and this is something that Africa, CDC is a high priority of theirs. And so it's been addressed. One thing that has been revealed in this is the importance of that very much. And one way poor countries are accessing the vaccines is volunteering, raising their hand for clinical trials. But the problem is a lot of misinformation in that for the kind of aforementioned reasons, a lot of times, less, I guess, countries with less, financial resources to buy vaccines have raised their hand for pharmaceutical trials, it's been seen almost as like a dumping ground and not as much quality control. So there's a lot of misinformation there. So I think in the medium-term, definitely countries have the capacity and capability to manufacture themselves. And I know this is a high priority agenda. And we'll be starting to see some movement in the space in the next six months, building off for example, this institute in India, within the sub-Saharan Africa as well.

FASKIANOS:  Just curious, what is the price of the vaccine? The cost?

ZIMMER:  Yeah, I mean, it depends. It's a great question. It depends on the vaccine, if it's Pfizer, if it's AstraZeneca, and it depends on who's purchasing it. So is it COVAX? Is it the U.S.? Is it Canada? Is it Ecuador? And so, you know, across the different candidates, anywhere from about five to twenty dollars.

SUMAR:  Could I just add to Trevor's point, to Seemi's question around as we think about expanding to 2021 and beyond, one of the things so that we want to really keep pushing, particularly leadership from the United States and others, is that in order to empower other countries, to be able to either expand manufacturing, in their own capacity, or countries or regions, the technology and the know-how of how to make the vaccine should be shared with the world. There's no reason that we need to recreate the wheel every single time and that every company, countries don't have time and capacity. And there's no need for that. So the patents need to be licensed, the data published, technical assistance provided to teach appropriate vaccine production, so that qualified manufacturers, wherever they are, whether they're in India and South Africa, they can really help us quickly expand world supply and prevent artificial scarcity, which is otherwise the world we're headed towards, right, we're artificially keeping supply low, even though the technology and the know-how actually exists. And so as we think about whether an equitable means in this context, it's beyond altruism in the way I would think about it in order to really making sure that we're setting a stage where if you don't share the technology, it'll be hard to do that on a timeframe that actually leads to the kind of progress we all want to see.

FASKIANOS:  Fatema, is the will there to do that? I mean, is there movement to loosen that kind of control in the intellectual property?

ZIMMER:  I think leadership is what's really needed here, and putting political leadership from the United States and others, I'm hopeful we'll start seeing that type of leadership. And it's going to take a concerted effort with the manufacturers, with pharmaceutical companies, and with governments to really set the scene for what the expectations are. And frankly, it's going to take voices from people on this very call from the faith-based community, from social justice communities to demand this, and to say that this is what we expect, this is what we expect. And anything short of that, it's not just enough for you and I to go get vaccinated in the next few months, it's not going to solve the problem until we get the world vaccinated. And so that demand signal from civil society, from our religious communities, our social justice communities is more important than ever as well.

FASKIANOS:  Thank you. Let's go next to Shaun Casey, who typed his question and raised his hand. So Shaun, unmute yourself and ask it yourself.

CASEY:  Thanks so much, Irina. And thank you, Fatema and Trevor, this is just a hugely important issue. I have two quick questions. One is I haven't been able to see if the existing faith-based and religiously affiliated global healthcare delivery networks, for even part of the WHO discussions. I think the analogy here would be to the distribution of ARV drugs in the HIV pandemic, where, in many parts of the world, the existing indigenous healthcare provision network is religiously affiliated, they have to be brought into the delivery conversations, and I don't see that going on. And maybe it's just because my perspective is too narrow. But secondly, I want to push you a little bit beyond just advocacy when talking about religious communities, particularly here in the U.S. Again, in terms of underserved neighborhoods, and addressing communities where anti-vaccine sentiments are very deep, many times the only ecosystem or providing social services is yet again, churches, synagogues, mosques, and NGOs that are religiously affiliated. I'm watching all over the country, and it seems that none of those communities, none of those religious communities are actually being integrated to the state distribution plans, which I think is a huge mistake, that state governments who seem to be handling the vaccination distribution, are not connecting with clergy. They're not trying to systematically knock down the misinformation. And I think there's a lot of confusion in underserved populations and in some of the more conservative anti-vaccine parts of the country. And it's really only going to be religious leaders collaborating with the state governments that are going to knock down those problems. Do you see any coordinated efforts at the state level to reach out to religious communities beyond advocacy, but actually for service delivery?

SUMAR:  Maybe I'll take the first part of Shaun's question. And Shaun, great, it's nice to see you and hear from you. One of the things when you talk about the World Health Organization, I think there's a real opportunity when President-Elect Biden is saying that one of the day one priorities for the United States is to rejoin the World Health Organization, I think that type of U.S. leadership in the WHO, in particular, to make sure that we are partnering, we are bringing in religious communities, faith-based communities on day one, the new Biden administration is going to be really key and important. And it's going to be beyond just hearing from voices of different members, it's going to be integration of both distribution plans, but also the additional in my mind, the additional support financially, and otherwise, they're going to need to actually do the public disinformation or the public information campaigns as well. So it won't be enough to just do distribution in terms of, getting the technical, the hardware, so to speak of the shots and the cold storage, it's also going to have to be the software around public information campaigns that are really tailored to distinct, to specific communities, and really speak, as Trevor was saying, where they're starting from and where they're coming from. And I don't want to speak too much in the U.S. context, but I'll say in the global context, where Oxfam works in dozens of countries, we saw that also in West Africa, we saw that in many places around pandemics in the past where it took both the hardware and the software, and resources for that or, you're right, Shaun. It's not just the advocacy, but it's also the resources and this has to be a priority for how we think about partnership, particularly at local levels for local distribution to succeed. So those are areas that I hope we see some political leadership that hasn't been there to date but I hope we can start seeing that in really loud force in seven days, in a week.

ZIMMER: Yeah, great, and just to add on to Fatema, my experience, my work right now is not in the U.S. So I can't speak about service provision at the state and federal level and not necessarily collaborating on the service provision with faith leaders. However, in the international context, it just made me think that this is absolutely an opportunity that's not being utilized in most of the countries I'm observing and working in. I'm just going to be honest with you, people are tired. People in ministries of health and working in kind of global health and vaccine distribution and COVID response are tired. What are they tired from? Well they're tired from this outbreak, of first testing, and diagnostics, and surveillance, and then maintaining a certain level of primary health care amongst this. Routine immunization programs. People are, women are still having children and delivering kids, people are still getting in car accidents, all of these other things, the world's not stopping. And so when we're getting to vaccines, I can tell you the focus right now is on just securing those initial tranches of vaccines and getting them out the door. And so this, there is really an opportunity, I think, for faith leaders, to not just be involved, but take a leadership position, and don't expect that it's going to happen on its own. I think folks are going to be receptive. I know, both at kind of global standard setting bodies, and partners like the WHO and the multi- and bilaterals and the regional and country offices, as well as the ministries of health themselves. There was an acknowledgement that communities need to be mobilized not just in vaccine acceptance, but in service provision. Some countries have more capacity and focus on doing that than others a lot. They just don't really have the capacity energy right now to do that, and do need help. So that's kind of a long-winded way of saying that, I think you're really hitting on something, Shaun, that is a big opportunity to pace right now, in the resource constraints is not elevating as much as a priority as it should be. And I think it's a real opportunity for the faith community to take some leadership.

FASKIANOS:  Thank you. I'm going to go next to Jessica Therkelsen, if you could ask your question.

THERKELSEN:  Hi, and thank you for inviting me to this forum. And thank you for taking my question. So we have about 80 million forcibly-displaced people worldwide, 45 million internal, 26 million refugees. There are a lot of forced migrants right now. Internally Displaced Persons will likely represent a population within a country that is less favored, and may have less access to the vaccine. And we are definitely seeing that refugees are not being able to access the vaccine at the moment. And I was wondering if you have thoughts on how we can work together to ensure that we include vulnerable migrants in the vaccination pools since we are all in this together, as you mentioned, and whether you have thoughts on whether it is more effective to include migrant populations in existing systems or for us to work together to run specialized campaigns.

FASKIANOS  And Jessica's with HIAS

THERKELSEN:  I'm with HIAS, thank you.

FASKIANOS:  Who wants to take that first?

SUMAR:  Should I take that first, Trevor? Okay, so hi, thank you, Jessica. We have the largest number of people on the move in human history right now, right, because of conflict, because of climate, because of forced migration. And then because of economic migration issues. And so we are we are seeing that we were not meeting these needs before COVID-19. We were struggling to meet most humanitarian needs before COVID-19. And now we are adding the burdens of COVID-19 on an already stretched system worldwide. One way that I think we're going to have to start thinking differently about 2021 and the way forward, is really prioritizing protections for those most in need, those most at risk, and those most vulnerable. And those conversations need to really happen in a deep way within each country and globally. So that it's not just first come first serve or whoever can afford access and where we can afford to get it the quickest. Those conversations done through a social justice lens really then forces us to think about well, who really needs it the most? And how do we then plan distribution and access to those communities in ways that are successful? So obviously, here in the United States, we've started with prioritizing frontline healthcare and social care workers, essential workers, moving on quickly to old, our older populations, to people with pre-existing conditions who are at higher risks. And then we're looking at higher transmission communities here in the United States before we get to a general population. And there's something here where we have we have accepted that kind of in our social construct that not everyone's going to get it first, we are going to prioritize.

Similarly, we need to be thinking for global distribution around communities most at risk communities, most vulnerable, whether those are migrant communities, whether those are refugees, IDPs, what is going to be the distribution system in both formal camps like we have in Jordan and other places, but in the informal settlements as well, where it's been a challenge and a struggle. Here, I think we have tons to learn from previous vaccination efforts that have taken place. And, thinking even in hard places, in Pakistan and elsewhere, in reaching very hard areas around polio vaccination and strategies that we've employed to be able to do that. The good news is I actually think we have strategies, and we have research and evidence of what works, we've actually seen this not with COVID-19, but we've seen this in other contexts, whether that's with Ebola, whether that's with Polio, whether that's with other things that we've worked on. It's now time to take all of that and making sure we are both doing the analysis and then bringing those learnings and applying them to these populations. But just, I think it starts also with political will, that these communities are worth protecting, and that we're going to prioritize, and we're going to make sure that we then figure out the access and distribution plans. And so that really, the social justice piece of that starts first and foremost, to make those decisions. Because once you make those decisions, then we know actually how to do this, we do know how to do this. And I do want to leave you all with some hope. We know how to do this in the international community, I firmly believe that we have decades of experience in this space. But we do need to make sure we're all on the same page in terms of how we do it. And once we are then then it becomes, then it's just a question of logistics in some ways to make, and resourcing to get it done.

ZIMMER: Just to dovetail just on that last point, not specific to the question because I feel like Fatema did a brilliant job, in terms of we know how to do this, what makes this different is the urgency and speed of it. But that can't come, we can't cut corners around equity. And that is the big thing that I have my “spidey sense” out for. Oftentimes, we said we know how to do it, but we need to make little sacrifices, to make things as urgent as possible, coming at the expense of equity of not just outcomes, but also partnerships and process and true collaboration. And we know that often leads to big unintended consequences. So I don't think haste and speed has to come at crosshairs with equity. But not everyone agrees with that. So I just think holding decision makers, policymakers accountable to that, and ensuring that all the best practices around equity that's being learned is not being put by the wayside, to cut corners, is something that's paramount and also a role for, you know, faith-based organizations, and folks that are focused on ethics and justice.

FASKIANOS:  Thank you. And Adem Carroll raises a great point about picking up on the displaced people that were discussed, adding to that prisoners. While international access to incarcerated populations may be limited, it may be that faith communities need to work to include these among the most vulnerable. So I think that is a terrific point, especially as we see here in this country, how COVID is on the rampage in our prison system. I'm going to go to Darius Makuja, who asked what is the impact globally of those who cast COVID-19 as a hoax, especially in third world countries. Fatema you did mention though, that other countries know how to do this better than we do, so maybe this isn't an issue. But if you could pick up on that, that would be great.

SUMAR:  Sure, Trevor, go ahead, first, go ahead.

ZIMMER:  Sure. You know, the incarceration question, I think it's a great one. And you know, it really depends who's making the decision. If bioethicists and epidemiologists have full decision making power, I can tell you incarcerated populations will be probably prioritized. If policymakers and politicians accountable to populations, are making big decisions, they may be de-emphasized, but we know the importance of holding their feet to the fire and making sure that they're led by justice as well as epidemiology and bioethics, and that those folks have a seat at the table. So when I would assess how decisions are being made at the state level, seeing within the leadership who's making the decisions, that's going to be a pretty good indication of who gets prioritized first. And if it ends up being politicians accountable, election cycles, and swaying public opinion, that's a role for advocacy and persuasion. Over to you, Fatema.

SUMAR: Thanks. Thanks, Trevor. So I think to the, I'm just going to go back to the question here from Darius. So Trevor said this a little earlier. so let me build on this point around, we have to start where people are at in local communities, I think that's really important. And if we're working in certain contexts in different countries where there's deep suspicion of the virus first, perhaps, before we even get to the vaccine, we need to work on solutions that really help educate and inform. And really going back to science, and using science as a way to communicate out with what we know, with the best information possible. The impact, Darius to your question, if enough political leaders and countries treat both either the virus as a hoax or the vaccine as a hoax, it will be devastating. Because the reality with a pandemic like this is there is no safety and security for any of us whether we get vaccinated or not, if enough of us and all of us don't get vaccinated, and have that kind of herd immunity that we need. And that's the way our economy is set up, our global economy, our borders, our cultures, our people, we live in a global society. So this is happening here in the United States, you don't have to go very far to see, with pockets of that here in the United States, as well. So I think there's a real challenge we're facing in our society, broader Irina, than this conversation around the role of information, the role of science and making those types of policy choices, that's been under attack, frankly, over the last few years. There's a rise of authoritarianism all around the world. And in the West, as well, that's impacting the way we have these public policy discourses. So just say I don't want to underestimate the real, the context of the world we're living in today. And how challenging it's become to then respond using science using best practice using evidence. That's all doable, but the political and social environment in which we coexist right now makes it really challenging. And in some ways, because we're in a race against time, and there's such a speed and urgency to do this, we have to deconstruct quickly some of those contexts that we live in. And it it's going to be deep. And it's going to take a lot of dialogue and healing, I think, in certain contexts to be able to do that.

FASKIANOS:  Yes, and I will just note that a week ago today was an insurrection on our U.S. Capitol. So we have a lot of work to do here at home. Let's go next to Mohammed Elsanousi, who has his hand raised, thank you.

ELSANOUSI:  Yes, Irina thank you so much, Irina, thank you for putting this together. I am Mohammed Elsanousi, I'm the executive director for the Network for Religious and Traditional Peacemakers. And I'm delighted to see that both of you, Fatema and Trevor, you lifted up the critical role of religious actors and leaders. And I just want to build on what Shaun Casey has said earlier, and the critical role of religious leaders in terms of the distribution strategy, in terms of their moral influence. So what I'm saying here, I want their role to be part of the strategy of distribution, because they could issue theologically motivated opinion that will reflect positively in people taking the vaccine. And we have experience from this. I remember you Fatema mentioned polio, and particularly mentioned Pakistan and that border of Pakistan or Afghanistan, and Nigeria. We have three countries in the world, Nigeria, Pakistan, and Afghanistan that are still struggling with the polio situation. And I remember clearly, we worked with Bill Gates on this. Actually, he met with us, with scholars, to appeal to Muslim scholars to gather and issue opinion to encourage people to take vaccine. And we did that meeting in Senegal, hosted by President Mackey Sall. And we brought physicians, they talked about the ingredients of the vaccine to convince the scholars, then the scholars made the opinion. And the photo was distributed in Nigeria and Pakistan, Afghanistan, and, and considerably help in the reduction of polio because it encourages people. So the point I want to make, let's learn from this experience, let's get religious and theological leaders, and rulers, and imams, and these people as a part of this distribution process to basically uplift their voice, they should not be after thought, like what we have done with polio, but let's integrate them into the strategy so that we can have an effective distribution and have people to accept it, and basically address all of this,  conspiracy theories that are going, and the hoax that you talked about. Thank you.

FASKIANOS:  Thank you. I'm going to go to Katherine Marshall. Katherine, do you want just ask your question? I know you've typed it as well.

MARSHALL:  I think you've made very strong cases for the ethical, but also the political needs for equitable vaccine distribution at the global and the national level in a very moving way. But then the question is what comes next? So I'm interested in where you see the potential for leadership coming? What institutions? Are you looking to the WHO? To the G20? The UN? How is this, who would you put the onus on? And then secondly, there are a lot of people thinking about this religious issue on the vaccine, particularly on the misinformation issues. But the religious communities of the world are immensely complex. And I'm interested in any views you have on how this strategic religious engagement, where do you see pressure points, or potential avenues, beyond just saying the faith community, which frankly, doesn't really mean very much, because it's so big.

ZIMMER:   I'll just jump in here, I'll talk and then pass it over to you.  I would say in kind of well-resourced countries, to put pressure on a federal level to contribute to COVAX. That's a very concrete way, because that is how most countries will, low-income countries will access vaccines, that's one immediate intervention point, I would say. Following up on that, so there's a need for more money and resources to be addressed to that. I think, within countries, be it the U.S. at the state level, or countries in West Africa, then making sure that political leaders are held accountable for equal distribution and access, that's a bit in the advocacy that we're talking about. And then in terms of actually parishioners, people of faith, I would say, really kind of above line and below line marketing, right, it's the example of that Senegal convenia putting out that faith within the vaccines, in the above line way in that's widely distributed. And then more of the below line, within the actual churches, mosques, place of worship itself to convince to support that above line message, to reinforce that message is going to be very, very important itself. And then also we know, in a lot of countries I've spent a lot of time, the last year, within, for example, Tanzania, in Ghana, for example, you know, faith-based providers are some of the biggest providers in the country. So there's a role even right there within supporting those institutions directly as well. Over to you Fatema, if you have any thoughts as well.

SUMAR:  Sure, Katherine, thank you for the question. And I'm going to also just really appreciate Mohammed's comments earlier to which really resonated with me and I think there's so much for us to learn from. Katherine, I would first start with the United States. So when you say who and what comes next. I mean, for me personally, I mean, look at what happens when you don't have U.S. global leadership, look at what happens here in the in our own country and around the world and the position we're in today. I mean, if we, if any of us question why the United States is important for global and national leadership and what it looks like when we don't have it, that for me was at least my 2020. And so the first and foremost is really looking at the role of the incoming U.S. president. President-Elect Biden will have tremendous, tremendous power to help decide who gets access to the protection from this virus when, and at what cost. So with that, really tremendous power comes a historic opportunity for the United States to lead again, by leveraging both the strength and know how, and the generosity of the American people and spirit to combat this disease here in the United States, and all around the world. Now, we can't do it alone, we never could, and we won't be able to do it again. So it's going to really require very sophisticated public health and vaccine diplomacy within the international community. So that means rejoining the World Health Alliance and World Health Organization, the WHO on day one. It means really empowering WHO, the United Nations, the G7, the G20, to prioritize this, and to making sure we actually have a really effective plan going forward in terms of one of the top priorities of our entire global architecture.

One of the things I'm struck by in President- Elect Biden's messaging so far is that the COVID-19 vaccine, it doesn't matter where you sit in his government, you could be sitting in DOD, you can be sitting in the State Department, you could be sitting in DOJ, you could be sitting in HUD, you're going to be working on COVID-19. And that really for him reflects his vision that this is something that affects anything we do, because we can't do any of our jobs, we can't do anything if we don't have that kind of security, if we don't have health security, so that's the first set a very global level in terms of really bringing us global leadership back and reigniting the global architecture around this enormous public health challenge. The second, to get more granular from that level, is really thinking through well as those decisions are made around who, when, and how much. And those are three critical decision points that have to be made at a global level, making sure that civil society, the faith-based community, social justice leaders have influence around making those decisions, which means you need a seat at the table, you need to have a voice so that it's not just an afterthought at the end when it comes to local distribution. But really making sure that at the very top levels, that those inputs are crafted at the very top in terms of making those decisions and determinations. Then, as those decisions are made, and you think about, okay, we now have a plan, the plan looks like this, whatever the plan is, then there's a role at national and local levels to thinking about whether it's distribution, whether it's socialization, whether it's the marketing, whether it's manufacturing, there's so many different roles and elements that different groups can play, and we'll need to play to do that.

But it starts with a plan. It starts at the top. And I think again, the good news, there's a silver linings as that's now is this moment to have these conversations. And that's why Irina, I think this conversation today, the timeliness of it is so important. And then Katherine, just at a local level, as you think about, you're right, it's so complex to say "religious communities," or "faith-based communities," it means so many different things depending on where we are, we need a much more localized approach. So Shaun was asking, for instance, at the state level, are governors reaching out and making sure that they're on their COVID-19 task forces at the very start? Our provincial leaders, our mayors. I mean, I'm thinking about countries like the Philippines, for instance, where mayors are so incredibly powerful in making sure that they can work with their community leaders and making and making sure they have these types of community distribution plans. So I think there are many opportunities. It starts at the top, I think, in terms of having global leadership and a global plan. And the time is now I think, to help influence, not just lobby and advocate, but to really make sure that you have a seat at the table, your voices are heard, and you're informing your points of view for the way forward, because I don't think it's going to work globally, otherwise, if it's an afterthought.

FASKIANOS:  That is a great place. There have been a number of rich comments in the Q&A, Shaik Ubaid talked about how important it is for religious leaders to be proactive in defending modern medicine, and teaching people to trust scientists and doctors, so that we can even talk about vaccine equity. And I don't want to leave without just touching upon Cecelia Lynch's question about the effect on the indigenous population and are you working with the indigenous traditional religion leaders, and if so at what capacity? Because we know this population has been severely affected by this disease as well. So if you could answer that, and we'll wrap up. Sorry to go over, but I didn't want to leave without talking about that.

ZIMMER:  Fatema, would you like to say something? Okay. So, again, I'm not working in the U.S., but I am working in the Andes region in Latin America, and there are big distribution challenges, both based on historical inequities and geography, that we are working closely with indigenous leaders in communities and really influencers there to address that. So the short answer is yes. In the U.S., again, I don't have purview over that, but it's absolutely essential. And I'm concerned that historic inequities up to this day, we're not going to get there as quickly as we need to.

FASKIANOS:  Fatema, I'll give you the last.

SUMAR:   Oxfam works in so many countries around the world, and I know it's a concerted effort to really reach out to the most vulnerable and different groups, including indigenous groups. And so I know that's always a really important type of partnership. Maybe I'll just summarize by saying if you go to our website, oxfamamerica.org, there's a lot of information and we'll definitely share the links with all of you, I've lots to share in terms of resources with all of you about our People’s Vaccine, open letter, our alliance, and if you're interested in joining, or helping spread the word.

I guess I just wanted to end with maybe on a more personal note Irina, if that's okay. We're all doing this in terms of our communities and the organizations we represent. But we're all doing this in solidarity as people, as individuals. And one of the ways I think faith-based communities in particular can really help change quickly, some of the conversations we're having is through our youth. And we didn't talk about youth today in particular, but I mean, I learn so much from my kids actually learn it from their Sunday schools, that they're going to, or they're learning it from activities or their public schools. And so also not underestimating the role of our youth. Our youth are online, every second, at least my kids are, every second of every day now, they're learning. They will never forget COVID-19. They can be part of the solution too, in terms of helping really shape our thinking of how we can, how different faith communities can really think about you talking about science, talking about modern medicine, talking about the vaccine in ways that resonate with the ethos of our respective faiths, and the ethics of where we stand on social justice. And our children, our children have such an incredible role, I think they can play with us as well. So anyway, I just wanted to end by a huge personal gratitude from me to all of you. The work you're doing, your voices, your leadership, there's never been a more important moment to live the ethos of our collected faiths, and to fight this fight. So thank you all for your tremendous leadership, and just gratitude to be with all of you today.

ZIMMER:  Thank you, and gratitude as well.

FASKIANOS:  Thank you, Fatema Sumar and Trevor Zimmer, we really appreciate it. And as you mentioned, we will send out links to everybody on the webinar, to the resources mentioned and other things that we pulled together. We encourage you to stay updated on Fatema's work on Twitter, @FatemaDC, and Trevor's work @DalbergTweet. We also encourage you to follow CFR's Religion and Foreign Policy Program on Twitter @CFR_religion for information about the latest CFR resources, and reach out to us at [email protected] with any suggestions on future webinars or speakers, topics, etc. Thank you all again. We look forward to continuing the conversation. Stay well, stay safe. And we will reconvene. Thank you.