Vaccine Inequality and the Global Economic Recovery

VELSHI: Thank you, Alexis, and thank you for everybody who's joining today. Please participate and ask questions because we've got a panel here of experts who've really thought about this and have answers to some of the things that concern us about the global application of the vaccine and the way it's being distributed.

As you know, I won't repeat it because it's in the schedule and you have signed up for it, but we are essentially talking about vaccine nationalism here and distribution of vaccines. What is fair, what is just, what is right? Also, what is effective, what is necessary? Something that may not be fair may be important, and something that may be unfair is necessary. So let's talk about some of those things with this fantastic panel.

Şebnem Kalemli-Özcan is the Neil Moskowitz endowed professor of economics at the University of Maryland. She works a lot on public and economic policy and is going to discuss some of the economic impacts of how our vaccines are being distributed right now, and what the consequences are of a number of countries not getting adequate access to vaccine.

Amy Pope is joining us. She is a partner at Schillings International, and she has also worked with the federal government in a number of high profile, diverse challenges including comprehensive efforts to fight Zika, Ebola, and other public health threats.

And Tom Bollyky is the senior fellow for global health, economics, and development at the Council on Foreign Relations. Tom is someone I've spent a lot of time talking to in the last year about the coronavirus as it relates to public policy and health policy in the United States. We identified this, obviously right from the beginning over a year ago, as an issue that is not simply just a health issue, but a public policy and a public health issue. So Tom helped me get through all of that. So welcome to all of you. Thank you for being with us.

Let me start with you Şebnem. What is the lens through which you are looking at vaccine distribution right now? We spent a lot of time, really, in the last year discussing the fact that testing has to be accessible all over the world, equipment has to be accessible all over the world, and vaccines have to be accessible all over the world. We've thought this, we internalized it, we fundamentally believe it. And then when it happens, it doesn't come to pass.

KALEMLI-ÖZCAN: Ali, you're exactly right. And we come exactly at this point in our research and tell everyone that look, if all these things we talk about doesn't happen, what will be the economic cost to us? Okay, so we have been looking through many economic estimates of the damage done by the pandemic. Here, we are taking a different approach and say look if we go down this path of vaccine nationalism, so we don't push global vaccinations, we don't push an equitable distribution of global vaccinations, then the economic costs can be very high. That's what our research shows.

Just to give you a headline number, the global cost in 2021 of not vaccinating everyone globally will be $4 trillion. And if advanced economies, such as the United States, manage to vaccinate everyone sometime in 2021, still, these countries are going to bear half of this cost. So almost $2 trillion, 49 percent of the $4 trillion, is going to be borne by advanced economies, U.S., Europe, Canada and such, even if they managed to vaccinate their own citizens but the rest of the world is not vaccinated. And the key intuition comes from the fact that we are living in a globalized world, countries are connected to each other through trade and production networks, and the economic costs from those networks not working properly can be catastrophic.

VELSHI: And Amy, we're connected, we're interconnected, as Şebnem says because of trade and production networks. But there's also just a basic thing here. If there are large populations in the world that are not vaccinated, we've sort of figured this out whether it's through movies or through real time, that this thing's not going to go away. It'll mutate in different ways. And somehow, you can have vaccine nationalism, but unless you're prepared to seal off parts of the world, this thing is going to be with us for substantially longer than necessary if we don't figure out ways to make sure that this vaccine reaches the far reaches of the world.

POPE: That's exactly right. And we've seen that play out already. So I'm speaking to you from London today. And we all know that there was a mutation–they were calling it the British mutation or the UK mutation–that sort of sent an ostensible alarm around the global community. And we saw here in the UK, it was late December just before Christmas, country after country after country close its doors to travelers coming from the UK. And this is obviously a very well-developed country with a very well-developed national health care system that is really on the cutting edge of the development of vaccines and testing and all of the above. But in no time flat the doors started to close to this traveling population.

And the impact of that if we're thinking about the way the world operates today could be quite devastating. There's just no way around it. If we don't have populations that are vaccinated, if we end up in a position where there are mutations, where the vaccine is not working against it, then it ends up recreating a situation like the one that we've just lived through. And that is bad, bad news for politicians and economies and citizens around the world.

VELSHI: Thomas, nationalism is an interesting word because it manifests in many ways. And sometimes politically, as we've seen here in the United States, or in the UK, or in Europe, it manifests as populism, and people are very open about it and forward about it. But vaccine nationalism is a little bit different. It's latent. I've never met anybody who calls themselves a vaccine nationalist. They would just like, they look at charts comparing how well-vaccinated their country is and compare it to other people and say, well, why aren't we as far as we could be? Or why aren't we further? It's a different way of thinking about things because we've never, generally in my lifetime, I don't remember having to really think about competition for vaccine.

BOLLYKY: Absolutely. So vaccine nationalism is just a me-first approach to vaccine distribution. My country before your country, my health needs before your health needs. And to give an example of how we're seeing that currently, right now we are four months into the global vaccine rollout, starting in December 14. Right now, nine nations represent nearly 80 percent of the vaccine doses distributed around the world. In terms of low-income countries, only four out of twenty-nine have even started administering vaccine doses. There are eighty-six countries worldwide, representing 1.5 billion people, that have yet to administer a single dose of this vaccine.

Now, distributing different doses to different countries is not necessarily unfair, provided they're going where the crisis is the biggest, and where those doses can do most good. But that isn't happening either. To give you a sense of that, when you look at countries, the share of the world's doses they're administering compared to how many cases they've had since the latest wave in November, the U.S. is actually pretty close to using the amount of doses we have for the crisis. The U.S. is administered about 29 percent of the vaccine doses so far, we also have 29 percent of the world's cases since November. There are lots of countries however, where that is not true. And that is particularly true for Israel, for the UAE, for Singapore, countries that have a very low burden and are consuming a lot of vaccines.

On the other hand, you see central Eastern Europe, which is having a resurgence. Latin America, I'll give you an example, Colombia has close to 2 percent of the world's cases, they've distributed 1/10 of the world's vaccine so far. Argentina, South Africa have a similar situation. So this gives you the dynamic of countries using more doses than their public health situation would demand and that is vaccine nationalism.

VELSHI: Şebnem, so Thomas is suggesting a protocol of sorts about how we should, whatever methodology you want to think about in terms of how much you should be using, whether it's related to how much of the virus you have, or the percentage of the world's cases you have. But the bottom line is, we don't really have anybody who would work that out. Whose job is that? One of the first things that happened in this virus was the undermining of the World Health Organization. I'm not sure if most people in the world thought that's these protocols should be set, but who would set these protocols? Because this is going to happen to us in some form again. How do we even address this at a level higher than the four of us sitting here and talking about it?

KALEMLI-ÖZCAN: I mean, you're right, Ali. This is actually very difficult because different considerations are going to tell you different things. Epidemiologist actually will tell you that it is good to immediately, as soon as possible, to slow down the transmission and get close to herd immunity. That will of course tell you that a country should vaccinate as many as they can before giving some of their supplies to others. But at the same time, as Tom raised this issue, well but maybe we should think about how many cases you have and how much of the vaccine you use.

And then on top of that, you can also think economically and maybe the countries that are central to global supply chains they are the ones who should be vaccinated first, because if they have sick workers then we are going to have a full disruption of world trade and supply chain. Then we cannot produce anything in our country.

So different considerations are going to tell you different things. So in that sense, I think the right thing to push is, to increase the supply and to solve the distribution problems. I mean, we have to, right now we are working with a fixed supply, fixed vaccine supply. And that type of environment, of course, creates all these tensions. We have to increase the production, we have to solve these distributional issues. And of course, we still have to be very careful about countries that boast supplies that overpass the population, right? I mean, I think Canada is in this position. UK is another country. Obviously, you don't need more vaccines than how many people you have in that country. So those immediately should be transferred to other countries. But you know, the crux of the matter here is about increasing the vaccine production and solve the distributional issues.

VELSHI: And it's a way of looking at it. I'm not sure Amy, why we didn't approach this the way we have other coordinated global efforts to do things. So I'm thinking back to the financial crisis in 2008. The world's central banks decided they would come together, and treasury secretaries and the finance ministers and people like that came together and saw this as a global imperative from an economic perspective. For some reason, we didn't see this as a global imperative from a security perspective. There wasn't some sort of sense of, wow, this is really going to be terrible for the world if we don't have a coordinated global effort for it. The problem with the suggestions that we've got is that no national politician, there very few in the world, who have offered to say we're going to figure out supply for countries that don't have it because it's not particularly popular to do so.

POPE: Well, and look, we can't forget that this whole epidemic started when the United States was led with an America First president who had not much interest in collaborating with partners or allies around the world and no interest at all in building a coalition to respond to the outbreak. And I think that is key as to why there hasn't been more collaboration. It's not to say that the world can't collaborate without the leadership of United States and there have been efforts to do so. There's this ACT Accelerator, which is meant to be a collaborative effort to respond to COVID, including the distribution of vaccines. But if you have the United States not only stepping out of it, but actively rejecting it and working against it, then I think you start from a step behind no matter what. And I think that's the key lesson. It's not only that the United States must lead. But if the United States is not leading, you're missing a key piece of the response. And so far, we do not see enough of response by other countries to fill that vacuum.

KALEMLI-ÖZCAN: Right.

VELSHI: Go ahead Şebnem.

KALEMLI-ÖZCAN: If I could just add one thing there. I mean, I fully agree with Amy on that. And then the COVAX is the vaccine part of ACT. And in fact, this is the WHO effort, right? So when you ask whose job it is, it is the WHO's job, right? I mean, if we want to have one body, that's its job. But this undermining of WHO since the start of the pandemic, combined with, an America First approach, just as Amy said, I think contributed a lot to this. I don't even know how many people know about COVAX until the Biden administration said, okay we are going to put $4 billion in COVAX, right? But COVAX is exactly trying to do that, to solve the vaccination nationalism.

VELSHI: So, Tom, let's talk about the antidote to this. What's the opposite of vaccine nationalism? And who has modeled it?

BOLLYKY: Great. Well, I'll say a couple of things. Two things can be true at the same time and are worth remembering for those listening.

It is true that the early vaccine rollout here has been grossly inequitable for all the reasons the four of us have talked about. It is also true, and I think this is worth remembering, that this is by far the fastest we've ever seen vaccines rolled out on a globally equitable basis in any crisis before.

So you asked before, why are we not seeing cooperation? What's different about this crisis? Unfortunately, in every health crisis in the past, whether it's H1N1 in 2009, whether it was HIV in the late ’90s, early 2000s, every crisis we've had previously where there has been limited supply of a health medical intervention that could make a difference, wealthy nations have hoarded it. So to have four months into this rollout with a completely novel vaccine, and we saw over the last couple of weeks Ghana, Angola, a handful of other countries starting to receive vaccines from COVAX, that's actually groundbreaking, not sufficient, but groundbreaking. So I am actually with Şebnem here on the issue of supply.

At the end of the day, the only nation that has said and taken affirmative action to sharing doses, scarce doses, now is Norway. Every other nation is largely behaving as a nationalist. There are some countries that are donating, but they're largely donating to, first of all, resource-rich countries and strategic allies and they are donating because they have a limited capacity to distribute doses domestically. The only country that's truly donating doses right now that it could otherwise use is Norway. Every other nation is using the doses they have.

So what we really need to see, and I think it's, this part is an embarrassment, is we need to see a global initiative to ramp up vaccine manufacturing. And we're far too long in this crisis to be waiting for that. Countries have given money, late, to COVAX to secure doses. But because vaccine manufacturing is scarce, they can't use the money to get doses now. The only way to address that is through increasing supply. And that's really been the hurdle. So if you're asking for a positive example, it's Norway. But that's not the way out of this crisis. Ultimately, we need more countries to build supply.

VELSHI: So this is an interesting point, you're not talking about charity and donation. We're talking about the fact that when there's no scarcity, everybody can be generous. So how do we eliminate, before we sort of have a big moral discussion on what people should do, if we didn't face the scarcity of supply it probably wouldn't be an issue. Because everyone would say, I've got extra you can have it.

So the issue here is in the United States, what we've done recently with the Johnson & Johnson vaccine, Amy, is the administration has made some sort of deal in which Merck will help to produce more Johnson & Johnson vaccine. May not seem all that important to some people, but it's actually a big deal. Some think that this is the kind of moral-suasion an administration can use, short of invoking the Defense Production Act to make companies make the vaccine. But there has to be some sort of global equivalent of that, right? Some sort of global equivalent to say, not just invent vaccines, which has gone relatively well. But now that we've got vaccines, let's put a global version of a Defense Production Act into place so that we are making lots and lots and lots of it and eliminating this basic scarcity.

POPE: And there isn't really a precedent for doing something just like that. I mean, if you look at the global reaction to COVID, start with the global reaction to Ebola. That reaction demonstrated that states were just not making the kind of investment in their pandemic or global health response that they needed to. And if you compare the amount of money and political will invested in global health response to the amount of money and political will invested in terrorism response, there's just no, it's so disproportionate, especially when you think about the ultimate impact on the number of citizens.

So I mean, you know, we can get to a DPA for vaccine development. But if we don't have at the heart of the national security strategies of countries to prioritize this issue, we're just never going to be able to make it a reality.

VELSHI: Yeah, this is an interesting point, you brought up terrorism. Now, we've talked about economic models for major coordinated global efforts, the terrorism safety model for coordinated global efforts. Şebnem, it's interesting, because what would be the best motivation? In order to overcome vaccine nationalism, you have to have people who might be in line for that vaccine in a given country saying it's okay to give one drop, one vial of that vaccine that I would like to have in my arm to somebody in a country I don't know. What's the motivator to get people to want to do that? Your argument is largely economic. But that doesn't, it's a little hard for the individual who wants a vaccine to register that.

KALEMLI-ÖZCAN: I fully agree. I mean, we have to be pragmatic here, right? I don't think that's realistic, that individuals will do that. But your point, like how governments can intervene, moral-suasion to full-scale some sort of production axiom, that's what should come in place here because individuals are not going to do that. And all the numbers actually show the importance of that type of government intervention because the cost, economic cost is really high. Right now, the narrative is okay, once we vaccinate enough people we have some sort of herd immunity in country X, then my restaurants are going to be open, consumer demand is up. Great. This is behind me. Normalization, right? I'm back to normal life as of September or December of this year.

We are we are saying no, you're not going to back to normal. Yes, you can go to a restaurant in your country, but you can still be unemployed because you are working for a factory and then that factory has to cut down production. I mean the car issue, right? I mean, we have been reading this in the news last two weeks that, how serious is the chip shortage, how serious is the shipping problems?

So, we may still be in a position even when the restaurants are open and the service sector is kind of coming back, we have a serious unemployment issue in our countries. And this says it is in the best interest of rich country governments to do something about it. Even if the individuals do not think, exactly as you say, because individuals don't internalize these types of costs.

VELSHI: So, Tom, now Şebnem has made this point and Amy has made this point, that the elephant in the room here is that this is leadership. This is political leadership, to be able to take something of an abstraction about security generally and economic prosperity generally and turn it into, this is something we have to do. In fact, this COVAX commitment that Şebnem was talking about, kind of quiet and buried in this big bill that just passed. It's not something that the Biden administration has come out and made speeches on, because I think the calculus is that nobody wants to hear a speech about how we're providing $8 billion of U.S. taxpayer money to a global vaccination effort. So I guess that's one way of doing it, just doing it. But people are going to need to be convinced because you can imagine a whole bunch of people who voted no to this bill that just passed and that is going to pass the house tomorrow, have all sorts of line item arguments about why are my tax dollars going to X, and this might be one of those X's.

BOLLYKY: Great, absolutely. So what I said before about the history of every past global crisis with a limited supply of an intervention, every nation hoarding, is at the end of the day charity is going to be a second order concern for government. If this is not an issue of self-interest, you will not see it. But that exists here. It's a matter of leadership to convey it to the public. And let me tell you why. Two things. First, the issue of variants. As we have seen over the last several months, you have new genetic variants of the dominant strain of this virus emerging. And there is some evidence that our vaccines may be less effective, these variants may spread more easily. It may be that they are more deadly.

With that in mind, we are going to have increased demand for global vaccine manufacturing because we may need to make booster shots, we may need to make vaccines that are bivalent, which means you have antigen for the different strains out there that we need to address for. So more demand for vaccine manufacturing. That is double fold, because if our vaccines are less effective, we need to vaccinate more people to achieve the public health benefits of these vaccines. So that's going to increase demand. It also increases the demand, third thing on the variant issue, is it also increases the demand for getting distribution of vaccine out there because the only effective way to stop variants from emerging is vaccinate people to prevent new infections.

So it is in the U.S.'s deep interest to try to reduce the number of variants. That only can be done through the spread of vaccines.

I will also make a pitch, given that we're at the Council on Foreign Relations, for a second issue, which of course is geopolitical. If we cannot cooperate on sharing a medical intervention in the midst of a crisis, that it is in the interest of every nation to share, we have no prospects for working together on future pandemic threats, climate change, nuclear non-proliferation, any collective action challenge. If we fail in this crisis, nations that have been left behind and waiting months or years for vaccines will be less likely to work for us, work with us rather, when we need them.

VELSHI: This is obvious to you, Tom, as somebody who is affiliated with the Council on Foreign Relations. It's probably obvious to almost everybody who is participating in this today and who's joining us. But Amy, this is the problem. It's not obvious to everybody why this isn't charity, but why this is important global infrastructure. And the damage that has been done over the last few years. And I'm not saying it's just the last few years of an administration that has not taken a view about multilateral cooperation. It is a trend that we have seen. We have had this trend about take care of your own first. And so it's sort of a reversal of some of the global political thinking we have seen in order to say coordinating on vaccination strategy is not charity. It's important for all these reasons that Tom and Şebnem and you have outlined.

POPE: Yeah, and I can tell you from my own experience, so I served as President Obama's deputy homeland security advisor. My primary concerns were threats to the United States. But almost without exception, whether it was migration, infectious disease, terrorism, cyberattacks, everything that we were dealing with that posed a significant risk to the United States was coming from outside of the United States. And if you can't have the partnerships, if you don't have the information sharing, if you don't have the relationships, if you don't have the ability to enhance your response through these partnerships, you're at risk.

I found it particularly problematic that the last administration really failed to grasp that concept. You can't wall off the United States to protect its citizens. Any effective homeland security strategy really needs to focus on our strategic alliances.

VELSHI: So let me ask you Şebnem, let's figure out how we fix this for the next pandemic. Because fixing this now for the vaccines is important. But we're in the middle of the process now. And what I think might be better is we think about the process differently the next time around. When you look at what has happened in the last year, basically, what could we have done differently right from the beginning? And I say we, I mean the global we. What could we have done differently right from the beginning to suggest that we were tackling this whole thing from a multilateral coordinated global perspective?

KALEMLI-ÖZCAN: Yes. So this is I think very important for the future, because I do think that we are going to be living with these pandemics from time to time. So it has to be clear from the start that this is a global issue. It's a global public health issue, and we have to adopt a multilateral approach. So here, of course, multilateral institutions are very important, and the most important of them in a health crisis is going to be the WHO. The WHO is a critically underfunded institution. So we have to look into that, right? I mean, WHO has to be as important as International Monetary Fund or World Bank.

And when it comes to economics, we have these institutions that actually they also did a lot during this crisis, but we know how important they are during the global financial crisis, for example, similar to the U.S. Federal Reserve and other important institutions during financial events.

So we understand that when the financial crisis was happening it was global, and a global response was needed, that's exactly one of the points you made. So we have to put the same amount of money, same amount of effort and funding in terms of these global public health institutions, and the approach. That it has to be from the start should be something that is done globally.

VELSHI: So this is interesting. You compared it to other global organizations, like IMF, or other ones that you named. Tom, the World Health Organization has faced criticism and structural criticism. But there's something about these organizations where they all face criticism, and some of it is deserved. But we have accepted the idea that there is some infrastructure that exists that will help us at times like this. How do we get back to that place? Because we have, globally, gone to a place where people don't like these global institutions. It's not just the U.S. The America First thing that has happened over the last few years, was in the midst of a global setting where people were saying I don't really want these international organizations, they don't play an important role in my life. It's my country first. So how do we strengthen these organizations while being cognizant of valid criticisms that people may have?

BOLLYKY: Yeah, so I do think with regard to WHO, it's not a perfect institution, by any stretch, they've had challenges in this pandemic. They likely declared this to be a public health emergency of international concern a week late. And they were very credulous of the government of China indicating that it had reported on time and was sharing information when it was clear that neither were true.

That said, the World Health Organization has been commendable in terms of marshaling response with very limited resources and low and middle income countries. Many people are looking what's to explain why low and middle income countries have done so well in this pandemic. Part of it is WHO and the investments that Amy and other colleagues made after Ebola to revamp that organization. So I think they deserve credit.

That said, I don't think WHO is the answer for this vaccine manufacturing challenge. They have historically struggled to work with pharmaceutical companies, they don't have the financing, they don't have the clout. I think we need something more along the lines of what we saw after the financial crisis, where you saw the engagement of the G20 on these issues. What we need is a comparable effort to Operation Warp Speed on a global level, where you have subsidies, you have coordination, you have advanced purchase agreements, you have a coordinating entity to try to ramp up the supplies of vaccine to meet global demands to scale out that manufacturing. And that's going to be important in this crisis. But frankly, it's going to be important in the next pandemic threat too. People refer to this as a once in one-hundred-year crisis. As if this could not happen again next year, or next month, or next week. We could easily see threats. If we have all our vaccine manufacturing located in a handful of countries, that does not make anyone safe. We need to really see more regional distribution of this capacity to address this crisis and the next one.

VELSHI: Amy, I want to go off topic for one second. And that is that the global coordination is one aspect of it. The other one was, certainly in the United States, a subjugation of expertise, a popular subjugation of expertise, something that people actually held up and continues to this day, even in the United Kingdom, which did not handle things as smoothly as it could have. What you did see was you saw the Prime Minister there with just two health experts in most of those cases. So at least you have that, whereas we were fighting to get our health experts listened to for most of 2020. Was that a uniquely American problem, or did you see this around the world?

POPE: No, it's certainly not uniquely American. I mean, it did benefit from the bully pulpit that the president brought to the subject. So it's one thing when it's the leader of the country who is advocating a rejection of expertise and of science, there's probably no better fuel for that fire. But we're seeing it across the world. And this sort of coincides with a much bigger issue, which is that of disinformation and the proliferation of inaccurate information across social media. And for me, this is just a very, very clear example of why that problem is so dangerous to the public, and that there is a much, much, much bigger issue here for governments to take on, for companies to take on ultimately.

But to Tom's point earlier, I just wanted to touch on the fact that I think sometimes we expect too much of our multilateral institutions. We underfund them, we do not give them the independence, we do not invest the political will that they need. And then we expect them to effectively fix these global problems. And that's just not realistic. You can't not pay your dues, and then expect that they're going to perform a miracle when there's something like this happening. So there's there needs to be that connection, if we want them to play that role.

VELSHI: Yeah. So that's, that's an interesting question. Does that mean that we do something else? Or do you think that we better fund and better let people understand what the role of some of these multilateral organizations are?

POPE: I don't disagree that there's room for the G20 or other organizations to play. But ultimately, we have these institutions, we have the WHO, it has the mandate. To build something new at this point in time doesn't make a lot of sense to me, especially when we have such difficulty building consensus on anything. So I personally think the answer is to make serious investments. There has been WHO reform that started post-Ebola. There's a real question. Has it gone far enough? What more needs to happen? We need to be critical and take a good look at how the institutions are working. But then we need to fix them. If we want them to play this role in the future, we need to be serious about making those changes.

VELSHI: Well, you know, I'll remind everybody about the attacks on NATO in the last four years. There are people under a certain age who don't really understand why we need a NATO and people over a certain age who can't imagine a free world without it. So it's a big PR marketing issue too.

To the disinformation point, Amy, I think it's important. Our disinformation people at NBC tell me that disinformation in medical science is the top of the pile. It's the most disinformation, and vaccination is at the top of that pile. So you are confronting something that there is so much disinformation and misinformation out there on, that's another topic. I'd like to ask Alexis from CFR to introduce some questions. We've got some of you who would like to ask questions, please. We welcome you to do so. Alexis?

STAFF: [Gives Queuing Instructions]. We will take the first question from Katherine Hagen.

Q: Thank you so much. I'm with the Global Social Observatory, have worked for years with both the World Trade Organization and the WHO on global health issues. And I appreciate the discussion today that you all had about the importance of mobilizing support for global engagement in organizations like the WHO, and I would like to ask you to talk a bit more about how that might connect as well to the WTO. We have a new head of the WTO, Dr. Ngozi, who has launched a commitment to finding a third way at the WTO on the manufacturing issue that you all have been talking about, which has to do with opening up the floodgates to have more manufacturing capacity around the world for the vaccines in this situation. But then more generally, to look at the way in which intellectual property and health can be managed. I know Dr. Tedros has endorsed the idea of acting forwardly in this way through the WTO's rules on IP and trade and waving those rules. And it would be good to hear your thoughts on how that can actually mobilize the kind of engagement and support that you're talking about to make this a workable solution.

VELSHI: Katherine, thank you so much for that excellent question that, Şebnem, speaks to a lot of the complexity that you deal with?

KALEMLI-ÖZCAN: Yep. I mean, I fully agree. I mean, this is exactly what I meant. So we have to bring all these multilateral institutions together. I mean, it is not a job only for WHO, or only for WTO, or only for IMF, right? They have to come together and coordinate it. And, work on changing the narrative, definitely. And also, giving the right information about what these institutions do, and then increasing the production capacity. And this is a great initiative and idea, and it has been done before. This is what we did for HIV/AIDS. I mean, this is exactly what we did for HIV/AIDS with licensing generic versions and all that.

Now, of course, as an economist, I understand and it's generally understood that the vaccine companies should have a profit. Otherwise without profit, there wouldn't be innovation, but we can still do it. Because I think the profit is definitely going to be realized, that's not the problem right now. The problem is exactly acknowledged with this WTO initiative that, okay, let's open the floodgates. And all these countries can really scale up the production like India, like Brazil, and let's help them do that. And that is going to require several of these institutions to come together with the leadership. And I think that's where the importance of U.S. and G20 comes in. You know, it has to be coordinated effort, these institutions have to come together, and then the leadership should be there at a global level.

VELSHI: Tom, you made a comment in one of your last answers about manufacturing capacity around the world. What's your sense of the best way to solve for that?

BOLLYKY: Great. So first, let me say great question, Katherine. I think it's really exciting what Ngozi Okonjo-Iweala brings to the World Trade Organization. She used to be, as you may know, the chairperson for Gavi, which was one of those partners in COVAX. She is has great expertise, both in trade and health. So what a person to lead this initiative.

I do think it's important to distinguish, though, the difference between–I completely agree with many things that Şebnem said, but I want to distinguish a little bit–between HIV and the current crisis. HIV largely involved drugs. Lots of countries in the world can make them. The challenge with vaccine manufacturing is it's scarce, particularly for some of these newer vaccines. So the issue you have there is less around IP and more about know-how and technology transfer and the capital investments you need to make vaccines. So that's an investment program.

Where I think the WTO could make a big difference is around export restrictions. What does that mean? That means what happened last week in Italy, saying we're not gonna let our doses go to Australia. Or what happened with personal protective equipment and medical supplies and ventilators where nations, more than eighty plus the EU, seized them in the early days of this crisis. If we're not able to have some sense that vaccine doses can actually get out of the country if we invest there, nobody is going to invest in that manufacturing. What you'll see instead is some of what you're seeing in the U.S., which is an effort to reshore, bring as much of that back as possible to the United States. And the issue you have then is what do you do in a crisis if there's not enough capacity, distributed around the world. to meet it?

So we have a real challenge there. There it's ultimately about coordination, trying to give people confidence they can get doses out of places, using advanced purchase agreements in the future, trying to facilitate the technology transfer, and give companies the confidence that they can share their know-how and IP without it being stolen from countries. That's really what's going to facilitate building this larger production capacity.

VELSHI: Excellent. Thank you. Alexis, let's go to the next question please.

STAFF: We'll take our next question from Kenneth Bernard.

Q: Hi, really interesting discussion this morning. I was the head of biosecurity and biodefense for both the Clinton and Bush administrations. Vaccine nationalism, you can't wish it away. We all talked about why it's there and why it's bad, but it's there. And it's not going to go away by just saying, it's horrible, we shouldn't do this. There are poor people in the world or there people who need it more than we do. Somebody trying to get vaccine for their mother in Nebraska is not going to give that dose to a medical worker in India, they're just not going to do it.

So starting from that point, we also need to know that legislatures and like what's happened in Italy and elsewhere, will block export within twenty-four hours of any pandemic crisis if they think their own people are not going to get it. We saw this over and over and over after 9/11 with various antibiotics and such related to anthrax, etc. Many tabletop exercises, Amy you've participated in lots of them I'm sure, show this. The first thing legislatures do is block export, that's a reality. They represent people in their own states, period. You know, they don't represent people in India or Africa.

So given those realities, the solution is exactly what Tom has been discussing, we have to regionalize production. It's all about production. It's not about export. So the big problem comes with, as just mentioned by WTO, the problem comes with vaccine companies not wanting to license their product to places that can do it like the Serum Institute, etc. in India. So that's where we need to fix it. And I think we know what the solution is, I think we need to not spend so much time talking about why it's outrageous that there's vaccine nationalism and more applying practical end points to what Tom has suggested.

VELSHI: That's well said, Kenneth, thank you. You're right. Books have been written and can be written and will be written on all sorts of nationalism and why it exists. But the infrastructure to deal with it, so that a mother in Nebraska who needs a dose isn't having to have this moral question about whether somebody in India gets the dose, but that we have an infrastructure that distributes vaccine fairly around the world. And that is set up by policymakers and people who can manage that infrastructure makes a lot of sense. Your point is very well taken, Kenneth. Thank you. Alexis, another question.

STAFF: We'll take our next question from Clara Adams-Ender. Ms. Adams-Ender if you could accept the unmute now prompt.

Q: I'm sorry, I raised my hand erroneously.

VELSHI: All right. Well, thank you nonetheless.

Q: We can take our next question from Dee Smith.

VELSHI: Okay.

Q: Thank you very much, fascinating panel. I'm Dee Smith, CEO of Strategic Insight Group and a board chair of the Institute of Latin American Studies at University of Texas at Austin. And I wanted to ask the question, going back to the issue of WHO or any potential successor organization and the bias that it seems inherent based on national funding, which is ultimately the source of those sorts of organizations' ability to operate. And there's been some discussion in this panel in other places, about how the WHO had a naive reaction to China, and its claims about reporting and so forth. How do you insulate against that in a practical way, with any kind of multilateral institution in healthcare or otherwise, that needs to facilitate the free flow of information, but that is beholden to the large powers ultimately in majority funding? Thank you.

VELSHI: That's a great question that could apply to so many of these other topics that we've touched on, but in this particular case, who would like to take that?

POPE: Go ahead Tom.

BOLLYKY: I'll be brief, and then turn it over to Amy, who's no doubt going to say something more interesting than I will. But what I would say here is that it's true. The World Health Organization, a lot of inter-governmental institutions like it tend to have a bias towards member states in a crisis. That's not specific to China. In every previous health crisis, WHO has tended to defer to the directly affected state.

WHO is not talking about distributing vaccine doses to where the crisis is the biggest either. They want it to be equitable so every country receives a certain percentage and then to ramp up. So they do have a challenge– being a member state-driven organization, how do you prioritize in a crisis? And I think we need to recognize that that's an institutional dynamic that we're not going to solve. WHO has a lot of benefits. And it’s in this case, I think supplementing it with something that can prioritize in a crisis. Can, on the surveillance side get information out, so we're not so reliant on directly affected countries. But the dynamic of having that member-state bias is real. And it's something we just need to acknowledge on how we approach to global crises.

VELSHI: Amy?

POPE: No, I agree with Tom, it's difficult when you're getting, when you're dealing with member-state organizations to get true independence. And the question is, can you create independence through other bodies that would hold the WHO and others to account? And then can you create the political will to implement whatever reforms or demands are coming out of that? And that doesn't really exist right now, and that's one of the very, very real lessons that have been learned from this crisis. We certainly saw it with Ebola too. I mean, there was a hesitancy to really call out what was happening in the West African region with Ebola because of concerns about the impact that might have in the region and on its economy. But that suggests that we need some independent level of review if we're ever going to get where we need to be.

VELSHI: Şebnem, I think you had something.

KALEMLI-ÖZCAN: I mean, I fully agree. But at the end of the day, all these institutions are going to have this problem, right? All these multilateral institutions are going to have this problem. There's going to be this member bias. But at the same time, these are accountable institutions. They have boards, and then they have accountability and transparency, and we should fix them. And then fixing is going to go through both ways. Like if they're underfunded, we fix the funding. And if you fix the representation, I mean, they have their representation on their boards, right? Otherwise, I mean, ask the question to yourself. Why on earth do we have these multilateral institutions? If they're not going to do their job, why on earth do we have them? I mean, seriously.

VELSHI: But Şebnem lots of people do ask those questions, and they get angry, right?

KALEMLI-ÖZCAN: But the answer should be not abolish them, but to fix them. The answer should be to fix them, on both the funding side and representation side. And just going back to this, the realism of this. I mean, this is exactly why we push the economic side, right? I mean, yes, the solution is the production, increasing production capacity. This is the first thing we say in our work. It's not like give 10 percent of your vaccines. It is like increase the production, increase the manufacturing of the vaccine. But that has to link to the self-interest. This is when rich country governments get it. Rich country governments has to understand it is in their self-interest, from an economic point of view, to increase the production, and tell that narrative to the public. That's the only way you are going to make the companies, convince the companies to increase production.

VELSHI: That last part is simple and straightforward, and probably the hardest part. Sell that to the public. Thank you for that, Dee. What a great provocative question. Alexis?

STAFF: We'll take our next question from Calvin Sims.

Q: I'm Calvin Sims. I'm with CNN. I have a question about the disproportionate number of communities of color, who really trust that the vaccine will work for them in the United States. And it's not just limited to the United States, it's happening overseas as well. And I'm wondering what can be done to address that? Because if we're seeing it here in the U.S., obviously, in other countries and third world countries, it's going to happen there as well. What can be done to address this inequity?

VELSHI: That's a great question, Calvin. Thank you. Who on the panel would like to take that first?

POPE: There are two issues here. The first is level of trust in the vaccine. And the second issue is access to the vaccine. And we were seeing both issues play out. And I know here in the UK, ensuring access of the vaccine in an equitable way across communities has been really tough. And so in the first instance, you need to make sure, policymakers need to be sure that they are accounting for ability to access the vaccine, in addition to establishing trust in the vaccine. But this goes back to the disinformation point. Again, not to hammer on it too hard, but I think it's quite disturbing that we have a proliferation of disinformation about the impact of the vaccine, and there's effectively no check on it. And the impact on communities around the world is going to be extremely problematic until we get a hold of that particular issue.

VELSHI: Yes, Tom?

BOLLYKY: Yeah, I just wanted to weigh in here. The way I think of constraints on vaccination are threefold. You have your supply constraints. Do you have enough of it? You have your administrative constraints, getting it into people's arms. And then you have your demand constraints. Do people actually want to take it? We spent billions on addressing our supply constraints, in the lead-in to this year and relatively little on addressing local and state administration constraints or demand constraints. How do we get populations that are likely to be more hesitant than others? How do we communicate with them? How do we engage with them? It's not because we don't know how. There's a lot of research on this. We simply just didn't, particularly the previous administration I'm sorry to say, didn't invest in it. So we need to ramp up that.

The one good news I will tell you globally, is that actually a lot of low- and middle-income countries have much lower rates of vaccine hesitancy than we have in wealthy countries because they see the benefits being more immediate to the vaccinations around them. So if you look at polls, by and large, it's unfortunately in countries like the United States and some countries in Europe that tend to have the highest levels of vaccine hesitancy. We've started to see that decline a little bit with regard to these vaccines. And I will point out that unfortunately, the population that remains most hesitant is actually is not Black and Latinx populations, it's white Republicans. And we do have a political challenge in trying to address the fact that, for some populations, this has been politicized a little bit. So it crosses a number of different issues. But great question and great issue.

VELSHI: Thank you. Alexis?

STAFF: We'll take our next question from Lyric Hale.

Q: Hi, yes. Hello, this is Lyric Hale from Chicago, I'm editor in chief of EconVue. I think we as Americans tend to beat ourselves up about what we haven't done. But shouldn't we also celebrate what we've been able to create? If you had told me a year ago two things, the extent of the pandemic and the fact that we have multiple effective vaccines in twelve months, I'm not sure I would have believed you. And the distribution that's taking place here as well. It's not just the creation, I think it's been actually pretty amazing, which also leads into this disinformation.

I think it's understandable that people are hesitant and I think it's also understandable that many people realize that science is evolutionary. And the things we believe today, a year from now might be somewhat different. So I what I'm saying is I think we need to be more realistic and also celebrate a little bit what we've been able to accomplish, not just look at what we haven't yet been able to accomplish. Thank you.

VELSHI: I think that you make an interesting point Lyric because I've been traveling across the country for almost a whole year. And with respect to the vaccine, I hear two responses particularly to Warp Speed. I hear some people saying, isn't that amazing? That we have this thing that created vaccines and Warp Speed, and I have a whole bunch of people saying I'm not touching a vaccine that was made by something called Warp Speed. I would like a very long process of testing and all that so, it is a double-edged sword. But you're right Lyric, it's kind of amazing. And to me, Amy, I do understand some people who are saying this has, the whole thing, it's unfolded so quickly that I just don't fully have my head around what's good and what's safe.

POPE: Right I think that's fair. But look, Lyric makes a great point. I mean, what we saw play out over the last year was investment in research and development of vaccine trials without regard for how it was going to turn out. And that suggests a model that will work in the future, right? You just make these investments, you need to move fast, you wait to see which pans out, you recognize some of them won't work out. And that is really an important and innovative concept that we should use moving forward. So I take Lyric's point. But I do also think there's there is a gap, this goes to what Tom was saying earlier, there is a gap on how we're educating people about how these vaccines work, their safety, their efficacy, the trials that have gone forward to date. And right now, we're just not winning that the information campaign, forget the distribution campaign.

KALEMLI-ÖZCAN: Yeah, I fully agree. I mean, it is all about information. I mean, I agree with Lyric that it is a success, we should celebrate. But at the same time, to economists, we weren't that surprised about it, because it is an upfront investment. We have many models that show that when there's an externality, you do the upfront investment, you are going to improve the social welfare. Because the individual company is not going to internalize that, because that can be a loss if it doesn't work, but it is going to be benefit of society. And that's what Warp Speed realized, right? I mean, that's basically what government took on. I'm going to take on your loss, I'm going to put up this investment upfront because this is going to be better for us. This is very standard economics. So when this came up, none of the economists are surprised and meaning that it's going to work.

The surprising thing is the size part worked, right? I mean, like how fast it is. But that's also, let's not forget, it builds on the existing cancer treatment technology. I mean, this is how science works, right? You build over the shoulders of the giants, so I'm not trying to diminish the amazing success. We are in much, much better shape. But at the same time, we are at the point where we go to Mars. And not being able to produce more and distribute it more quickly is also mind blowing. So we should we should definitely do better on those fronts given that’s what we achieved.

VELSHI: Alex, I think we want to try and take one more question if we can.

STAFF: We'll take one more question from Tom McDonald.

Q: Hi, good morning. Great question. Tom McDonald, partner, Vorys, LLP. I was the U.S. ambassador to Zimbabwe in the second Clinton term. I not only went toe-to-toe with the Russians there selling arms out the back door, but the Chinese who continue to be very uncooperative in Africa. In my opinion trying to sort of jointly do things with them is problematic. And of course, we have the whole issue of COVID and its origin. What is the panel say, going forward about working with the Chinese on these matters when they are such an adversary, but both in places like I was in Zimbabwe, and saw in spades, and also militarily, South China Sea exact, otherwise, we have to find ways to coexist with them. But they obviously as Tom pointed out -

VELSHI: Good question. I love your question. I want to get see if I can get quick answers to it. Because I think it's a really important question. Tom, let me start with you.

BOLLYKY: A great question. The world needs as much vaccine as possible to end this crisis. So the fact that China is developing vaccines and manufacturing them and starting to donate them is a good thing.

There are two problems though that would help moving forward. The first is publication of their underlying data. And the second is to for all those vaccines achieve WHO prequalification the vetting that you need to give the signal to low and middle income countries that safe to take it. Because right now, countries are using it without that data. And that undermines the system moving forward but it puts people potentially at risk. So we can cooperate together on vaccinating the world they need to take the steps necessary to prove that they're doing so safely and effectively.

VELSHI: We are out of time. What amazing questions. CFR shame on you for not allowing more time for this thing. This is coulda gone on for six hours. You are all terrific. Thank you to our fantastic panelists, Amy Şebnem, and Tom. Thanks to Alexis and the team at CFR. Thanks to all of you for joining for this very, very important conversation and remarkable questions that you put to our panel. So thank you, everybody, and have yourself an excellent rest of the day.