Politics and Government

CFR President Richard Haass, author of the New York Times best seller The Bill of Obligations: The Ten Habits of Good Citizens, discusses how to reenvision citizenship if American democracy is to thrive or even survive. His guide is particularly relevant for religion leaders, given its emphasis on civility, compromise, nonviolence, and promoting the common good. Thomas J. Reese, senior analyst at Religion News Service, moderates. Learn more about CFR's Religion and Foreign Policy Program.   FASKIANOS: Welcome to the Council on Foreign Relations Religion and Foreign Policy Webinar Series. This series convenes religion and faith-based leaders in cross-denominational dialogue on the intersection between religion and international relations. I’m Irina Faskianos, vice president of the National Program and Outreach here at CFR. As a reminder, this webinar is on the record, the video and transcript will be available on CFR’s website, CFR.org, and on the Apple Podcast channel, Religion and Foreign Policy. As always, CFR takes no institutional positions on matters of policy. We’re delighted to have Father Reese with us in conversation with CFR President Richard Haass. Dr. Haass founded CFR’s Religion and Foreign Policy program in 2006, and throughout his tenure, has been a dedicated proponent of CFR serving as a resource for the religion community and deepening the understanding of global issues. Father Reese is a Jesuit priest, and senior analyst at Religion News Service. Previously, he was a columnist at the National Catholic Reporter and editor in chief at America Magazine. Father Reese is a senior fellow at the Woodstock Theological Center at Georgetown University, where he authored three books. And He currently serves on CFR’s Religion Advisory Committee. So I’m now going to turn it over to Father Reese to take the conversation away. Thank you. REESE: Thank you, Irina. I’m delighted to be here with and with Dr. Haass. Everybody—I think, almost everybody on this webinar knows Richard Haass. He has been the president of the Council on Foreign Relations for twenty years now. In fact, he has been a prominent and authoritative spokesperson on foreign policy issues. He’s worked in the State Department, in the Defense Department, in the White House, under four presidents, both Democrat and Republican. Even as a younger man, he worked on Capitol Hill. He has a wide experience of foreign policy issues, and the way in which foreign policy is made. I mentioned that he’s been at the Council now for twenty years. And we are honored that this is actually his last official event for the Council. And I think this shows how seriously he takes the whole question of religion and foreign policy. Because this program was one that he himself started. So maybe I could just begin by asking you, Richard, why did you start this program on religion and foreign policy? Why did you think that that this was important? And what is the role of religion in foreign policy? HAASS: Well, thank you, Tom. Listening to the introduction, I learned something we had in common which is maybe not obvious. But you’re at, is it, the Woodstock Theological Seminary? REESE: Yes, uh-huh. HAASS: And in 1969, I was at Woodstock. (Laughter.) It’s amazing our paths have not crossed. So why did I do this? A couple of reasons. Look, I’ve always been interested in religion both personally but also academically. When I went to college, I went to Oberlin, which used to have a great theological seminary, by the way. And when I got there, I asked people: Who’s the best professor on campus? And people said, “oh, it’s Professor Tom Frank.” And I said, “OK, what does Professor Frank teach?” And they said, “New Testament.” And I said, “well, that’s interesting. We never got around to reading that one in my house, but I’m game.” So I took it. And, as is always the case, a great teacher can make a subject come alive. Professor Frank did that. One thing led to another. I was a religion major. Ultimately, it morphed into Middle Eastern studies. That’s when I first studied, though, Christianity, Islam, I had a background in Judaism. So I’ve been interested in religion. And then when I became something of a Middle East expert, you can’t work in the Middle East and not understand the impact of religion on politics. And actually, I thought so many people coming out of a narrow political science background didn’t often have a feel. One of the rules I made in one of my books, I think it was Intervention—or, maybe it was War of Necessity, War of Choice, that before the United States invades another county, it ought to understand it. And one of the elements of understanding, is to understand the role of religion and its impact on the culture, the society, the politics. So one reason I wanted to do this is I think knowledge of religion is so central if you want to be in the foreign policy or the diplomacy business. But also, you all—the people on this call—have enormous influence and reach. After getting to CFR a few years afterwards, I remember reading somewhere the statistic as to how many Americans once a week went to either a mosque, a church, a synagogue, a temple, what have you. And the number was extraordinary. It was well over 100 million people. Now the poll, I should be honest, did not say how many of them stayed awake for the entire sermon, but they did get exposed to sermons. And I said, wow, these individuals, these men and women, are a powerful force in American society. One of the things we’ve tried to do here is be a resource for groups of individual who, what I call, are “multipliers.” That these individuals reach many. Teachers, obviously, check that box. Journalists check that box. Business leaders do. And congregational and religious leaders do. So I thought it was a major opportunity for us to learn from them about the impact of religion on politics in this country and other societies, and at the same time for us to be a resource for you all. And hopefully some of that would influence what it was people talked about. So that’s how it all came about. REESE: That’s fascinating. It reminds me of Madeline Albright once saying that when she was a young student of foreign policy, they ignored economics. Economics was not something that foreign policy people were worried about. And then she said, today religion was something that foreign policy people didn’t worry about. And— HAASS: You’re right. One of my favorite—Tom, one of—sorry to interrupt. One of my favorite sayings is, “universities have departments, the world doesn’t.” So much of the intellectual preparation is siloed—economics, politics, whatever, religion. There’s very little cross-fertilization or interdisciplinary work. And as soon as you do work at the White House, or the State Department, whatever, just you want to write history or anything, you’ve got to work across silos, across disciplines. So I just think it’s essential. REESE: Let’s talk a little bit about your book, which I think is absolutely fascinating. I just read it this week and was very impressed by it. Your new book is entitled The Bill of Obligations: The Ten Habits of Good Citizens. And it’s already become a bestseller. So why did you decide to write this book? You’re a foreign policy expert. You could have written about Ukraine, you could have written about refugees, you could have written about global warming, a hundred different topics. Why did you pick this one for your book? HAASS: Well, I mean, I have written about all the subjects you mentioned, and I continue to. They’re obviously important. It’s not either/or. But what led me to write this book is that, funnily enough, it’s almost a version of our conversation now. Where I give a talk about Ukraine, or Russia, or terrorism, or climate change, or China, or what have you. And then hands would go up at the end of the talk and people would say: What’s your biggest concern? What keeps you up at night? Is it any one of those things? And I’d say, look, those all worry me, obviously. But what worries me most is us. So I decided to write a book about us. And the intellectual connection was I was worried that if we were at odds with ourselves, or worse at war with ourselves, we wouldn’t be able to set an example that anybody else in the world would want to emulate. We wouldn’t be a partner that anybody wanted to depend on, such as our allies. We wouldn’t have the bandwidth, or the unity, or the resources to be a force for good in the world. And the lesson of history is that good things just don’t happen in the world. Over the last seventy-five years, I’m prepared to argue, a lot of good things happen. And in no small part because of the significant role of the United States. So what led me to write this book is a genuine concern that the foundation, almost the prerequisite of a successful American role in the world of foreign policy, which is a functioning American democracy, was increasingly at risk. My motive, in a sense, was to say: We’ve got to think about ourselves on democracy as a national security issue. And that we’ve got to take it seriously, and we’ve got to understand that it’s in some vulnerability. The good news is things can be addressed, the ship can be righted. The bad news is, good things don’t just happen by themselves. So I wanted to start a national conversation about how to rethink, almost to reimagine citizenship in a contemporary democracy. And that’s what led to this book. REESE: Yeah. You play off the Bill of Rights, the first “ten amendments” of the U.S. Constitution. And you point out how at least since the civil rights movement the question of rights has been an important motivating and just an important intellectual driver in the United States, in our politics. The civil rights movement, the women’s movement, the LGBTQ movement. All of these founded on a concern about rights. And yet, you’re now telling us we ought to be worried about obligations. What’s going on here? HAASS: Funny you should ask. Just so there’s no misconception, I’m not against rights. Rights are obviously at the core of the American democratic experiment. The Constitution, which was, if you will, the second Constitution. The Articles of Confederation proved to be really feckless. The Constitution, which did create a strong central government with a strong executive, that was only ratified by the states with guarantees or assurances about rights. And that’s the first ten amendments. That was the requirement if you were going to get ratification. Several states made that clear. One prism through which to view American history then is the struggle for rights. The Civil War is obviously the most intense moment. The right to be free, not to be a slave. But other rights as well. Again discrimination, whether based on gender, race, religion, sexual preference or identity, what have you. And that is, to use Mr. Lincoln’s phrase, that was or is our “unfinished work.” There’s still a gap between what we proclaim in the Declaration of Independence and the reality. It’s a permanent struggle, I would argue, to make sure that rights are respected. My point in writing the book is that even if somehow you, or I, or anyone on this call had a magic wand and could eliminate the gap between our principles and our practices, essentially to finish Abraham Lincoln’s work, my view is that American democracy would still be in danger. And that’s because rights inevitably collide. Take an issue that, shall we say, is central to the politics and religion of your faith, which is abortion. The rights of the unborn versus the rights of the mother. How does a democracy navigate that debate? Or on guns, the rights of individuals pursuant to an interpretation of the Second Amendment, versus the rights of others to public safety? Or we went through lots of struggles during the pandemic. This person’s right not to wear a mask or not to get vaccinated, versus someone else’s right of public health. And, as Justice Breyer said when he was on the court, Steve Breyer, that the most difficult cases are not right versus wrong but right versus right. And when we have this situation they collide. And collisions could lead to gridlock, because we can’t agree. Nothing can get done. Or, worse yet, it spills over into violence. And my view is that somewhere along the way we lost sight of the fact of our obligations, the other side of the citizenship coin, the obligations the two of us have to one another and the obligations all of us have this country of ours, to government and to the country. So this is not a book that’s in any way against rights. Let me make that clear. But it’s a book that says, that’s not enough. As we always used to say in academia, rights are a necessary but not sufficient condition for a democracy to thrive or even survive. So what I wanted to do was start a conversation about what are those obligations, why they’re necessary, what it takes, and why it’s in our collective self-interests. And that’s what I’ve been—it’s been five months or so since the book came out. I’ve been traveling around the country talking about it in front of all sorts of groups and audiences, from college campuses, to high schools, to religious groups, to just town halls of citizens. REESE: Obligations is something that churches are very familiar with. We preach obligation all the time. (Laughter.) We don’t tend to preach rights. We tend to preach obligations. Because of your interest in religion and this very program, I was a little bit surprised that religion is not mentioned very much in the book. If I could talk you into writing an addendum to the book, what would you tell religious leaders about their role here in American politics? I mean, religion can be very divisive also. So I was wondering you could preach to the preachers. (Laughs.) HAASS: Oh, I love this. Turnabout is fair play. It’s what every member of a congregation is desperate to do, is to preach to the preacher. Well, look, I do actually write a little—I mean I draw from my own religious experience in the book. The first idea in the book, and originally I was going to begin it there and then I moved it later in the book, was from the Jewish holiday of Passover. And for much of their history, Jews were denied access to their holy places, to their synagogues or temples, or often persecuted. And what’s so interesting about Passover, it’s the story where Jews tell the story of—it’s a holiday where we tell the story of the exodus of Egypt. It’s central to Jewish identity. And it’s so interesting, because the story is told not in synagogues but in homes. It’s a decentralized holiday. It’s a mobile holiday. It’s Judaism dispersed, often out of necessity. And you have a generational obligation to tell the story, to teach. It’s a teaching holiday. And literally you have this traditional meal. Every food is symbolic. It’s done in a certain order. Indeed, the word for the meal is Seder, which is the Hebrew word for “order.” And the book that informs the meal is called the Haggadah, which is Hebrew for “the telling.” It’s the telling of the story. And that’s what you do. And for me, that’s very similar. We in America have—we fail to tell our story. Which is why I’m so insistent on civics being a staple of education in middle schools, and high schools, and colleges. This is a country founded on ideas. We should not take for granted that these ideas are understood, much less transmitted. So I think we do a terrible job at that. But getting to your question, now that I’ve digressed, I think religious authorities have a big role in at least four of the obligations. And you also have the opportunity to do something about it. Most basically is probably the opposition to violence. I don’t care what your political views are, none of them justifies violence against others. And indeed, let me just make a larger point, none of the obligations involves a political point of view. I’m not taking policy positions on guns, or abortion, or mass, or Ukraine, or anything else. This is—in that sense, I don’t know if it transcends politics or what, but one is to preach the importance of nonviolence. Second of all, the importance of civility—to treat people, in a sense, the way you’d want to be treated. Which, by the way, is just practical. One tends not to be more persuasive if one acts badly. Thirdly, to be open to compromise. Doesn’t mean you have to accept it, but at least consider it. And, fourthly, to look out for one another, to be one’s brother or sister’s keeper. Those seem to me, those four obligations in this secular book, are totally consistent, I would think, with what you and everybody on this call, one way or another, tries to impart to one’s congregants. And so I would argue that people who are in a position to preach have, if you will, an obligation to preach. And so that’s one of the reasons I wanted to do this call, in speaking with Irina, is you’re all in such a position of potential influence that I wanted to give this message. And, by the way, I’ve talked to business leaders about their special obligations. I’ve talked to journalists about theirs. I’ve talked to educators about theirs. I’ve talked to parents about theirs. So I think different groups in American society have special obligations based upon their positions and their roles. But I would think that in at least four of the ten obligations, people who have congregations have an enormous opportunity—though, again, I would prefer to use the word “obligation” as well—to make a difference. REESE: As a former civics teacher, I was really happy to see your second to the last obligation, about supporting the teaching of civics. But what we teach in school has become a battlefield in and of itself. There doesn’t seem to be much consensus there. I mean, all fight over what we teach about race, et cetera. How do we deal with these kinds of conflicts that, before we can even fulfill your obligation of supporting civics, we’ve got to get some agreement about what we’re going to teach. HAASS: You’re right, 100 percent. Because people could agree in principle but may not be able to agree in practice. And, as you said, education’s gotten politicized, or even weaponized. So I get it. I’m not naïve. I spent time as the U.S. envoy in Northern Ireland. Three years as the U.S. envoy. Then I went back for a second tour, for my sins. And I was brought in by the local parties to try to broker a common understanding of the past—which in Northern Ireland, as you know better than anybody, was rather painful and divided. And I tried to get them to support what I called the Museum of the History of the Troubles. For those on the call who are not familiar with the Troubles, these were three decades from the late 1960s to the late 1990s, in which there was an enormous amount of friction that often spilled over into violence between and among various paramilitary groups, some of the Catholic tradition, some of the Protestant, as well as between either of the groups and British police and military. Somewhere in the order of, what, between three (thousand) and four thousand individuals lost their lives. Because I think history can, to some extent, repeat itself, if not exactly, I wanted there to be a museum that was built that would teach people about the Troubles. And in part I figured that it would make them more wary of descending into—or, adopting certain positions, because violence could happen again. I did not succeed, but I learned a lot in the process about how to structure an education that takes into account exactly what you’re getting at. My view is that when it comes to American civics, we can’t impose a single interpretation of history. That would be a nonstarter. But I think we can suggest certain documents be read. The Declaration of Independence, for one. The Constitution, for another. I would love people to have some access to the great literature—The Federalist Papers, de Tocqueville, what have you—to major presidential speeches, to major Supreme Court decisions and dissents, and understanding of the basic history. And then you could expose people to various interpretations of this. You say, this is what happened. Here’s the two or three contending schools of thought. And then you could have debates and classroom conversations about it. I think there are ways you can do it. And, look, I’m not naïve. There’d be massive, intense debates over what to include and what to exclude. This ain’t beanball. This ain’t easy. OK. But I’ll give you another Jewish reference. On Yom Kippur, the day of atonement, there’s a prayer where everyone asks for—goes for forgiveness about the various acts of commission. And there’s a long list because we all sin a lot, as you know on your side. And then the last of the sins is you beg forgiveness for when you should have done something and you didn’t. It’s the act of omission, when you should have acted in the face of something that required action. And that’s how I feel about this. We can persuade ourselves it’s impossible, but in that case then what we have now stands. Either not teaching it, or teaching it terribly. So my view is take a run at it. And, again, look, I’m stepping down from here. I’m not retiring. Despite the rumors, I’m not going to go to Saudi Arabia and joining the LIV golf tour. What I am going to do, among other things, is stay active in this conversation and debate. I’ve already spoken to several governors, several university presidents. And I’m going to devote a chunk of my time to working at this. And I’ll be speaking about it and writing about it. And there are various individuals and groups out there. So I have no illusions, but I’m going to take a run at it. REESE: Terrific. I’m having a lot of fun asking you questions, but I also want to open it up to all the other people. So let me just ask you one last question before we open it up. And anybody who wants to ask a question, use that little hand thing on the Zoom call. In the title of our webinar, we use the term “common good.” And that is also used in your book, where you say “we should promote the common good.” What is the common good? And how do we promote it? And, of course, my particular interest, how can religion promote the common good? HAASS: I’ve thought about it a lot. Not as much as you have, but I’ve thought about it a lot. And there’s different ideas about—and the fact that you had ask the question is revealing, because there is not a single or consensus definition of, quote/unquote, “the common good,” or what is the promotion of it. One is behaviors that avoid harm to others. And that’s where you get at things like—and there’s Supreme Court decisions about it—about the need to be vaccinated if you’re carrying certain types of disease that you could transmit to others. So that’s the way you look out for others. Obviously, controversial in the age of COVID, I understand. But with smallpox and others, that was a decision that was reached by an earlier generation of Americans. And we require all sorts of vaccinations with kids when they go to school, both for their own good, but also for the good of others. We have all sorts of rules in moral society. Some things are for our own good, a seatbelt rule. But other things are for the common good. We have speed limits, traffic lights, and stop signs. Those are for the common good. In all sorts of areas, we have debates about where to draw the lines between, again, individual rights and common goods. And we can do that. So that’s one sort of thing. That’s the rights, if you would. Individual rights versus collective rights, is one way to think about it. Another thing about common good, some would say, common good needs a social floor or safety net. And there’s a lot of conversation about that. Guaranteed incomes. And we have that to some extent in our society. We have unemployment insurance; we have Medicaid, Social Security for elderly things, different food programs, and so forth. The whole idea is we have social floor, economic floor. And that’s a form of common—debates about where it should be pegged, how conditional it should be, work requirements. Again, but there is a sense that no American should live a life—no citizen in this society—below a certain level. I’m big also on the idea of common good means making equal opportunity a reality, that that’s something we owe one another. That means everything from there should be no discrimination. And I’m radical on this. There should be no negative discrimination, traditional use of the word, but I’m also against certain types of positive discrimination. I’m against legacy admissions. That’s a form of positive, if you will, discrimination in favor of some. I think that perpetuates certain types of unequal opportunities. It means certain people can be born, if you will, on third base. I think that’s unfair for those who aren’t. It also, by the way, lights under me a real fire to make things like public education better than it is. Because that’s one of the ways to make equal opportunity real, rather than simply a slogan. So there’s not a common, if you will, or universal definition of common good. Again, I don’t pretend to have a universal answer. But I want that to be into people’s consciousness, because it gets, some way a little bit—I think this country is, at times, too taken with this notion of rugged individualism, that we only have to worry about ourselves. And the answer is, we may be all born equal in principle under the law, but we’re not born equal in practice in terms of health, or in terms of wealth, or in terms of opportunity. And I just think we need to have an honest conversation about that in this society. REESE: That’s terrific. Thank you. And now I’ll pass it onto get questions from the other people on the webinar. OPERATOR: (Gives queuing instructions.) Our first question will come from Charles Strohmer from the Wisdom Project. STROHMER: Thank you both for being here. I really appreciate it a lot. I’ve followed you for a long time, Dr. Haass. My question is simply: Do you or Father Reese see any ways in which principles in the Sermon on the Mount can help us be better at fulfilling what I call our duties, or what you’re calling our obligations, that we have toward one another, both as human beings who are also American citizens? Thank you. HAASS: Tom, I’m going to defer to you on that one. That’s your text more than mine. And so I’m going to defer to you. REESE: (Laughs.) Yeah, I think it’s pretty clear to anybody who reads the gospels that Jesus has an emphasis on the fact that we are all brothers and sisters, with the same god as father. And of course, we as Christians inherit that from our Jewish brothers and sisters. And I think Jesus really emphasized that. He emphasized it in the Sermon on the Mount, and the parable about the Good Samaritan. Jesus was always concerned about the sick, about the poor, about the hungry—all of these kinds of things, and these people, and it was very personal. And yet, he was also very nonviolent. He was not leading a revolution. In fact, people were upset with him because he wasn’t leading an armed revolution. And so I think there’s a lot of things we can learn from the gospels about our obligation as citizens to be supportive of the common good, as Richard said, and to treat one another as brothers and sisters. And, frankly, not just our neighbors here in the United States, but seeing everyone in the world as our brothers and sisters, whether they’re migrants that are drowning in the Mediterranean, people at our borders. It doesn’t tell us what policy we should enact, but it does tell us that this has got to be a concern. We’re not going to get a plan of action out of the scriptures, but we are going to get an orientation, as Richard said, of our obligations, of our values. And I think those need to guide us as we try and figure out where we go in terms of domestic and foreign policy. HAASS: Can I just add to that? Agree with that totally. Part of what I remember studying that, there’s a lot of norms in there. A lot of the teachings in that are not things you have to do, but they’re things you ought to do, that you should do. And that’s really what a norm is. And religion is filled with laws, but religion is also filled with norms. Not everything can be specifically and narrowly proscribed. So I think a lot of the teachings in any of the faiths are such things. And Sermon on the Mount’s a perfect example of it. Our doing things and asking that others do them as well, because they’re right. I think that’s a powerful thing. And then, again, I think people who were preaching, it’s not a big step from there to talking about the norms in the political space, about how you treat a political opponent or something like that. That there’s something larger in this than your own narrow political ambitions. And I think, again, people who have standing in churches, or synagogues, or mosques have tremendous authority to address these subjects without—again, without getting into you’ve got to support this or that policy. That there’s no—indeed, I think it would be a mistake to politicize these issues. I want to have them be one step removed from policy. REESE: A great example of that was when Pope John Paul II came to New York and preached at Yankee Stadium. He was using the Jesus story about the rich man and Lazarus. And of course, the rich man had walked—just stepped over Lazarus, who was at his front door, poor, hungry, starving, and just ignored him. He didn’t kick him. He just ignored him. And John Paul looked out over the audience, at the congregation at Yankee Stadium and said: You are the rich man, and the third world is Lazarus. Whew! I mean, talk about hitting you right between the eyes. Now, he didn’t say what to do. But he said, you’ve got to do something. Anyway, next question. OPERATOR: We have a written question from Noel Rubinton, who writes: First, kudos to Richard for all he has done for this Religion and Foreign Policy program. My question: In your book, you raise many ideas, more than ten, about citizenship. But if you could get people to take just one action to increase their citizenship, what would it be? HAASS: Well, thank you, Noel. I appreciate it. It’s always a hard question to answer. It’s sort of like asking which one of my children do I love most. (Laughs.) It’s a tough one. Look, at a minimum, I’d say get informed and vote, the first two obligations. It’s no coincidence that the first obligation is to get informed, and the second one is to be involved. Democracy can’t be a spectator sport. It requires informed, involved citizens. So that’s the basic. Probably the one, though, that’s nearest and dearest to my heart is what we’ve talked about a little bit, is civics. It’s where I began this journey that led to this book. And I just think there’s something very wrong that we, quote/unquote, “educate” young Americans, and the great preponderance of our schools, whether they’re high schools or universities, allow students to leave the campus or the building without any exposure to civics. And we’re about to celebrate the 250th anniversary of the Declaration of Independence in three years. I want to make sure we can celebrate the 350th and the 450th. We’d better start teaching civics in a serious way, though I respect Tom’s point before. But we just can’t assume this democracy is somehow permanent. History suggests not. History suggests that just the opposite. So if I could just do one thing, I’d like to kick off something of a civics movement in the United States. That would be my own personal preference. REESE: Great. Next question. OPERATOR: We will take our next question from Ani Zonneveld from Muslims for Progressive Values. ZONNFEVELD: Hi. Good morning. Good afternoon. Thank you, Richard, for all that you’ve done for CFR and religion. Ani Zonneveld from Muslims for Progressive Values. You had a quote there that I’d like for you to repeat that is just fantastic about the world not having departments. That’s number one. And then, number two, you spoke about the Jewish prayer seeking forgiveness for not acting against injustice. And I was just wondering, once you step away from CFR, if you will be using this particular faith/moral compass to poke the politicians and policymakers—(laughs)—towards a more just policy? Thank you. HAASS: First of all, thank you. Yeah, the first quote was just that “universities have departments. The world doesn’t.” That’s actually original. Just something I noticed along the way. But feel free to use it. You can claim it as your own. (Laughs.) I don’t get royalties for it. Look, I’ll be honest, I’m not afraid of poking. I’m a serial poker. And I’m more than comfortable challenging the conventional wisdom, or the powers that be, or the status quo. And whether it’s questions—whether it’s injustice or just things that I think are unwise. I mean, I’ll be honest with you, most of my focus on foreign policy over the decades has been on issues that I think are unwise. That I think are when we do things that are just against what’s in the national interest. I was a very sharp critic of the Iraq War, for example, not so much on the basis—it wasn’t based on injustice. I just thought it was a terrible idea based on my own analysis. And I argued against it from the inside. I continued to argue against it after I left government. I’m a little bit more hesitant to fight against, quote/unquote, “injustice” in other countries because I’m sensitive to several things. One is, we often have a range of interests at stake. We don’t have often the luxury of just focusing on injustice. Second of all, we’ve got to be mindful of our—it’s not enough to posture yourself to say the right things. You have to be confident that by doing so you’ll have the desired effect. And that’s not always the case. So I’m just careful about that sort of involvement in other societies. I’m more comfortable about speaking out on these issues here at home. One, I understand them somewhat better, and you have a certain standing as an American to speak out about American society that you don’t have if you’re not a member of another society. Your words may not be welcome, but they’re seen somehow as a little bit more legitimate, I guess is the word I use. So, yeah, I’ll continue to speak out particularly here at home. And you got a sense of some of the things I feel strongest about. If I had to choose one, again, it’s that we do not have equal access to equal quality education in this country. And that is dangerous for American democracy because education—public education is the ladder—L-A-D-D-E-R—of American mobility. It’s how over these decades and longer people have been able to improve their lives. And what worries me, if that ladder is lifted up then what becomes of us? It’s a very, very different society if the American dream, if the idea of improvement is just a dream and is no longer an achievable reality for a meaningful number of Americans. I worry about that. So, yeah, I’ll continue to speak out on that, trust me. REESE: Next question. OPERATOR: We have a written question from Erik Owens, a professor of theology at Boston College. Who writes: Your list of obligations is excellent and well-advised. But they all seem to require a baseline of social trust that is in short supply these days in American society. People mistrust their government, scientific experts, academic experts, lawyers, politicians, et cetera, et cetera. Do you think we must first rebuild social trust in order to enhance the commitment to these obligations? Or are social trust and a sense of civic obligation really the same thing? HAASS: It’s an interesting question. You’re right, we have a social trust deficit in this country. I think it’s a fair, and good, and important insight. One of the ways we build social trust, in my experience, is by people doing things together. When Tom Brokaw and others would write about the Greatest Generation, the fact that so many Americans from wildly different backgrounds, geographies, you name it, went into the military and fought in World War II, that became a great generator of social trust. I think one of the problems now is we have fewer and fewer experiences which Americans have in common. And indeed, because of modern technologies, we’re going the other way. Increasingly, we’re getting separated so we tune into our own social media site, or this or that, cable channel, or radio station. People stare at their devices all day long, and so forth. It’s one of the reasons I’m such a supporter of a public service, is I want to bring some people together to do things that are inherently good things and valuable things for the community, but also gets people to work together who normally would never have the experience. One of the reasons I’m working with lots of universities on what’s called “freshman year experience.” When people come to campus, I want to start building some social trust. Have them talk about some of the issues we’re talking here today. They don’t have to always agree, but I want them to hear what other people have to say, and so forth. One of the reasons I like debates, it exposes you to different points of view and it has certain norms and rules associated with it. But I don’t have any magic wand for building social trust. But, again, I think people on this call can help also. There’s things that happen within your congregations, various activities you can—the kind of conversations you have. And that when somebody shouts somebody down, or acts really uncivilly, or whatever, I think there’s ways in which you can structure a conversation. Just bringing people together can build social trust. So I’m not sure what’s the sequencing, but I think it goes hand-in-hand with a lot of what we’re talking about here. REESE: Great. Next question. OPERATOR: Our next question is from Galen Carey from the National Association of Evangelicals. CAREY: Thank you, Richard. You talk about civics education. Our civic system doesn’t seem to be very good at encouraging long-term thinking, whether it’s thinking about our budget deficit and the debt we’re passing on, or our stewardship in the environment. What could we do, what could faith leaders in particular do, to help foster more courage, political courage, for thinking about long-term issues when we have short-term elections? HAASS: I wish I could disagree with your premise, but I cannot. We’re short termers in how we think. And part of looking out for your fellow citizen, being your brother and your sister’s keeper, is one has an intergenerational responsibility. It’s not just for people of your own generation. We have a responsibility to one another. And I think older people have a responsibility and obligation to—and I’m leaving this institution after running it for twenty years—or, leading it for twenty years. One of the things I saw my obligation was to leave the institution considerably better off than I found it. Not a criticism of my predecessor, and I hope my successor can say the same thing. I think we’re stewards. I think you all have a particular potential on environmental issues, on climate change. Last I checked, one of the things God did in the beginning was to create the heavens and the Earth. OK. Well, He created them. We’re the stewards. We’re not doing such a hot job. So I’m surprised actually there has not been more involvement of religious leadership in this country on behalf of protecting, if you will, the commons here. I think that’s—I’m surprised that people who would say we agree in the gospel, we read about this in the Bible, the creation and so forth. OK. Well, creation is the beginning. Then we want to see the continuity. We want to see the protection, the stewardship, the custodianship. So I believe that religious leaders should take a larger role in that. I think it could make a real difference. I’ve spoken to Evangelicals leaders about doing it. I think they could have a real impact. Budget deficit is more complicated because everybody can agree the deficit is bad, or the debt. We now have a $34 trillion debt. That is a bad, bad thing. And we can agree in principle that it’s a very bad thing. We cannot, however, agree on what to do about it and whether the answer is this on discretionary spending, this on defense, this on taxes, this on entitlements. So very quickly you get into fundamental policy debates indeed at the heart of some of the divides within and between the major political parties. So even if one preaches, if you will, responsibility on the debt, I’m not sure that takes you very far because very quickly you get into policy prescription. And I’m not sure that’s the comparative advantage of the people on this call. I’m not sure whose comparative advantage it is, because nobody seems successful at moving us on that. We’re on a terrible trajectory. The consequences of a larger debt, particularly with high interest rates, it just crowds out all sorts of other forms of useful spending. So we’re on a terrible trajectory. We’re not investing in our own future. But I’m not sure, again, how you translate agreement in principle to agreement on policy. REESE: Yeah. I’m really glad you brought this up, Galen. I mean, frankly, one of the things that gives me pride as a Catholic is Pope Francis’s leadership on the global warming issue, with his encyclical Laudato Si’. The sad thing is I don’t see a lot of bishops in the United States making this a priority in their preaching or in their work in their diocese. For me, it’s the issue of the twenty-first century. It’s going to determine what kind of Earth we leave to our grandchildren and great grandchildren, and whether we have a civilization to leave to them. So I’m glad you brought that up, the importance of the long-term vision. Next question. OPERATOR: Our next question is from Hays Rockwell, a retired Episcopal bishop of Missouri. HAASS: You probably want to unmute yourself. ROCKWELL: Hi. I just want to say about thirty-five years ago, at a weekend meeting in the summer, to which I attended a number over the years after we left the city, stimulating always. But this particular one I stood up at the end and said: It’s wonderful to have these brilliant discussions, but one factor of human experience has been left out. And I mentioned religion—no mention of religion and its effect and importance to foreign policy in a variety of ways, both for good and ill. Well, I don’t think that Richard was there to hear that observation of mine, but very shortly thereafter he took hold of it and it became a significant part of the life of the Council on Foreign Relations. And I just want to thank him for that with all my heart. HAASS: Well that’s very generous. Thank you. I feel very fortunate that early on I was a religion major in college. I actually think it did infinitely more for me as I went through my life, either as a practitioner in government or as an academic, in my foreign policy-centered life, than any amount of theory would have done. I actually see the theory that we teach our international relations studies, and I think it’s mostly a colossal waste of time. And, by the way, I would say that if this were a call of international relations professors. I’d lose them all, but I can live with that. I actually think religion turns out to be not just a useful, but an essential component, I think, in preparing people for public life, be it in this country or in my field of foreign policy. And I always thought it gave me a great advantage when we were sitting around the State Department or the White House talking about this or that effort to transform this society in the Middle East, or some other part of the world, or going to war in this or that society. I just thought I had a massive leg-up, because I actually not only had studied it and had some appreciation of the culture. And, by the way, what it usually did was make me—it kind of added—it’s not my most natural default position, but it made me a little bit more humble, a little bit more careful about what I thought we could do. It turns out religion is so intimately connected to culture that it becomes a really powerful force. And for those of us who want to transform other societies, and we preach universalism on certain things, I just think we also have to be mindful of local realities and differences. REESE: Yeah. Thank you, Bishop. Next question. OPERATOR: We will take our final question from Father Rafael Capó from the St. Thomas School of Theology and Ministry in Florida. CAPÓ: Well, good afternoon and thank you for your leadership, Dr. Haass. It’s been amazing what you have done throughout the years in supporting our contributions from the religious academia and pastoral ministries with our collaboration with the Council on Foreign Relations. So thank you. My question is, how do you see peacebuilding efforts on the part of the religious community—specifically, the role of religious diplomacy to contribute to conflict resolution and peacebuilding efforts in regions marked by war? HAASS: First of all, thank you for what you said. There’s this old line that war is too important to be left to the generals. I think there’s an argument that peacemaking or peacebuilding is too important to be left just to the diplomats. I think religious authorities can have tremendous impact, because they have tremendous influence on people and on civil society, just society across the board. I spent a lot of time in Northern Ireland. I spent a lot of time with religious leaders in Northern Ireland. I knew that they had to be partners in what I did. If we were going to get rid of violence, get rid of guns, if we were going to have some possibility of normalization between the principal religious traditions of Northern Ireland, it would only happen if it were supported by religious leaders. Northern Ireland is a perfect example of, if you will, a post-conflict society. It’s been twenty-five years now since the Good Friday Agreement. And where it still has a long way to go, in part because certain religious leaders haven’t done as much as they could or should. So it turns out religious leaders have an enormous role to play. Where it is played, it makes a positive difference. Where we’ve seen it not play, then we see the potential for backsliding much, much, much greater. I see religious leaders as essentially partners in the peace enterprise, whether it’s in the pre-negotiating phase, the negotiating phase, or the post-negotiating phase. Religious leaders just have tremendous actual and potential voice and influence. REESE: Well, I want to thank all of our participants, especially those that gave questions. Really contributed to the discussion, and excellent questions. And especially, I want to thank Richard. I mean, your work here for the Council and especially for this Religion and Foreign Policy program is really, really—we are all very, very grateful to you for all the wonderful work you have done. Thank you. I really appreciate being able to moderate this last event that you are doing for the Council. I’ll now hand it over to Irina. FASKIANOS: Thank you both again. Richard is going to continue to be very prolific. You can follow him on Twitter at @richardhaass and subscribe to his weekly newsletter, Home and Away. It’s published on Substack. You can get it at richardhaass.substack.com. You can follow Father Tom at @thomasreesesj. Thank you all for your questions. We also encourage you to follow CFR’s Religion and Foreign Policy program on Twitter at @CFR_religion. You can write to us at [email protected] with suggestions or questions. We appreciate your joining us. Richard, do you want to say one last word? HAASS: Yeah, I just want to thank you all for your participation. You’re all busy. I appreciate your time. And may you all be well and go in peace. FASKIANOS: Thank you.

Thomas J. Bollyky, senior fellow for global health, economics, and development and director of the Global Health program at CFR, leads a conversation on observations and lessons learned from states’ public health responses to the COVID-19 pandemic.  TRANSCRIPT FASKIANOS: Thank you and welcome to the Council on Foreign Relations State and Local Officials Webinar. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. We’re delighted to have participants from fifty-one states and U.S. territories for today’s conversation. Thank you for taking the time to join us for this discussion, which is on the record. CFR is an independent and nonpartisan membership organization, think tank, publisher, and educational institution, focusing on U.S. foreign and domestic policy. CFR is also the publisher of Foreign Affairs magazine. As always, CFR takes no institutional positions on matters of policy. Through our State and Local Officials Initiative, CFR serves as a resource on international issues affecting the priorities and agendas of state and local governments, by providing analysis on a wide range of policy topics. We are pleased to have Tom Bollyky with us for today’s conversation on public health and lessons learned from the COVID-19 pandemic. We’ve shared his bio with you, so I will just give you a few highlights. Thomas Bollyky is the senior fellow for global health, economics, and development at CFR, and the director of CFR’s Global Health program. He’s also an adjunct professor of law at Georgetown University, and a senior consultant to the Coalition for Epidemic Preparedness Innovations. Mr. Bollyky is also the author of the book Plagues and the Paradox of Progress: Why the World is Getting Healthier in Worrisome Ways, and the founder and editor of Think Global Health, an online magazine that examines the ways health shapes economies, societies, and everyday lives around the world. So, Tom, thanks very much for being with us today. You recently co-authored a report on COVID-19 pandemic policies and behaviors. I thought you could talk us through the differences in public health responses that influenced states’ infection and mortality rates, and what you came away through this research for recommendations for future pandemics. BOLLYKY: Great. Well, thank you, Irina, for the kind invitation to be here and that nice introduction. It is—this is, I think, my third time, maybe fourth time, speaking to the State and Local Officials network. And it is one of my favorites in terms of a resource at the Council. I always learn as much from these discussions as I think I am able to impart, so I’m really looking forward the chance—to the chance to speak with all of you. And congratulate Irina and team for pulling together such a useful network. What the thing we’re here to talk about today is—it is—Irina, are you making faces? Is my internet causing trouble? FASKIANOS: Yeah, your internet—I was like, oh, no, his internet is freezing. So— BOLLYKY: Hmm, ah. Well, let’s keep going. FASKIANOS: Let’s keep going. BOLLYKY: And perhaps at some point I will turn off my video and do it just with the audio if it remains a problem. But apologies for that. Again, this paper appeared in Lancet six weeks ago. It’s a year-long study, the product of five different institutions. And I had the pleasure of co-leading that group. And it—what it was meant to look at is what explains the very large differences we have seen between how states, U.S. states, performed in the pandemic. And I think it’s been underreported, but perhaps not a surprise to this group, that while the U.S. overall struggled in the COVID-19 pandemic, not all U.S. states struggled equally. There is, in fact, a nearly four-fold difference in cumulative total COVID deaths from the worst to best performing U.S. states, even once you adjust for all the relevant biological factors—differences in the age of the population or key preexisting health conditions. For most of the pandemic, states like New Hampshire, Vermont, or Washington have actually posted COVID-19 death rates that are comparable to countries in Scandinavia, like Denmark, or in Europe, like Germany. While mortality rates from some other states have actually rivaled the worst-performing countries in the world during the pandemic—Russia, Bulgaria, and Peru. That difference, between top performers and poor performers, is large in health standards, even by American standards. For instance. The U.S. states with the shortest average lifespans come nowhere close to matching Chad, Nigeria, or the worst countries in the world on that measure of longevity. The state variation, though, is a reason for hope. Because if poorly performing U.S. states could more closely match their more successful counterparts when the next health crisis emerges, many lives might be saved. One estimate we have from that Lancet study is that if every state had performed as well as New Hampshire, the second—state with the second-lowest COVID mortality rate—there would have been 504,000 fewer U.S. deaths from COVID-19 during—just during our study period. That would have made the U.S. again, in terms of overall death tolls, very similar to other high-income countries, as opposed to one of the worst-performing countries, which is sadly where we were. I’m going to pull out just four specific themes about what drove those differences, and then I’m going to save most of the discussion about what do we do for this, because I really do intend for those to be mostly a conversation about looking forward and how do we respond to this. But four themes that came out from our analysis in the Lancet. One is—or, theme number one is that the role of health equity, socioeconomic and racial disparities, loomed very large in this pandemic. Larger than it does in many other—even larger than it does in many other U.S. health measures. So what we—what we saw was a cluster of factors—low educational attainment, limited access to high-quality health care, the percentage of people living below the poverty line—had a strong association both with differences between states, and their infection rates, and in their COVID-19 death rates. In many ways, this reaffirms what we’ve seen in the past, that these disparities played a large role in H1N1 and the response there. These disparities combined with racial disparities, which were also significantly associated with state variations in our study, also play a role in differences in seasonal flu vaccination. It’s not just in pandemics or infectious disease. Of course, in other health crises,­ you see these social, economic, and racial disparities loom large. And it will be important to proactively seek to mitigate these differences ahead of the next emergency. And we can talk a little bit about in the discussion of ways to do that. All right. Theme number two that came out from here. Trust, interpersonal trust in particular, played a large role in this pandemic in the U.S. Interpersonal trust, if that term isn’t familiar to you, is the trust we have in one another. And it is actually a finding that has been shown also in many international studies. For example, we did a—the same group did a study in the Lancet the year earlier on the global level. And we were unable in that study to find any connection between country variation and COVID outcomes in many of the leading theories or pet theories of what made a difference in the pandemic—like economic inequality, or pandemic preparedness metrics, or democracy, what have you. We didn’t find any links. But interpersonal trust had a very large and significant association with differences in how countries did. We see the same thing in the U.S. context, that the trust—how we feel about one another, the trust we have in one another, is tied to vaccination rate­s and adoption of health-protective behaviors. And that, in the end, has a large tie to the outcomes and how states did. Meaning that when confronted by contagious novel virus, government—most effective ways for governments to protect their citizens is ultimately by convincing them to protect themselves. And their willingness to do that, particularly in free societies and in U.S. states, depends on the trust we have in one another. And that’s going to be important to foster stronger in the future in thinking about how we respond to these things. Theme number three: The role of politics was nuanced in this pandemic. There is a perception political parties mattered a great deal in the response to this pandemic. But at least from our study, there is no association between the party of the leading state official, or state governor, or, in Washington, D.C.’s context, mayor, and COVID deaths. In fact, out of top ten states that did best, half—five of them are Republican and—five of them are led by Republican governors and five of them are led by Democratic governors. That said, there is certainly a role for politics in this pandemic. And the degree to which states voted for a particular candidate in the last election does seem tied to the adoption of health-protective behaviors, and vaccination rates, and the application of mandates. And that does seem to have had some effect. Which brings me to the last theme to draw out, which is mandates. And by mandates, I mean bar and restaurant closures, gathering restrictions, mandates around vaccination use—or, vaccination, or mask use, or stay-at-home orders. What we find in this study is that the package of mandates, or the broader use—because states tended to use many of them together, and nearly all states used some mandates in this pandemic, usually for roughly—for about a sixteen-month period. And what we found is they were generally associated with fewer infections. But it was vaccine mandates that had the largest effect on deaths. And there’s been a discussion around tradeoffs in this pandemic. We did find some. There weren’t any tradeoffs between overall economy and the adoption of health protective measures, but there were some tradeoffs particularly on restaurant closures and employment and there were some tradeoffs on educational performance in this pandemic. It will be important in the future to adopt—to apply these mandates in a way that they target the most vulnerable and are designed in a manner that it promotes getting back to work and getting into schools as soon as possible. They will also be important to combine with mitigation measures for the period in which they are in place. We can, again, talk a little bit about that. But those are the four themes to start us off, to draw us out. I’m really interested to hear about the experiences you all have had in the pandemic, and questions you might have about this study. And I will put the link to the study in the chat, if it’s not already available to attendees. Irina, do they have it already? Sorry, you’re on mute. FASKIANOS: Oh, can you hear me now? BOLLYKY: Yes. FASKIANOS: Great. Yes. They do have a link to the report. So we did send it out in advance. BOLLYKY: Great. FASKIANOS: So that’s great. I’m going to—now it’s great to turn to all of you. Again, this is a forum to share best practices, ask questions, and whatnot. And I want to go first to Dr. Jonathan Ballard, who’s the chief medical officer in New Hampshire—the New Hampshire Department of Health and Human Services in the office of the commissioner, since, Tom, you mentioned New Hampshire being in second—the second good story. I guess Hawaii was number one. So it would be great if you could just react and maybe share your thinking of what you—what else you will do in the future, Dr. Ballard. And if you accept the unmute prompt, that would be great. There you go. Q: Thank you, Irina. Thank you. So the question I have is around health equity and the diversity of the population. So some of the questions I have, particularly around your study, is does this study adequately adjust for the disparities in—related to health equity that we see between New Hampshire? New Hampshire’s one of the healthiest states in the country. And so, you know, the theory is that, well, you’re already a healthy population, you do not have obesity to the degree, you have lower smoking rates, you have high rates of physical activity in New Hampshire. And so is that—was that taken into account already into your study about why some states are performing well? Was it the underlying population was already healthy or not? I would conjecture that it’s not—it’s not simply that underlying fact, because there are several states in your report that are just as—nearly as health or heathier than New Hampshire but did not have the same outcome with the mortality rate. And I think that there several things that New Hampshire did do that was quite protective and did kind of go against the strain of what the national guidance was. Each time there was a recommendation that came out from the CDC or any other national body, we did look at it carefully, and noting particularly the recommendations around the vaccination priority populations. New Hampshire did not follow the national guidance on vaccinating frontline workers. We did a different approach. We looked at social vulnerability index and vaccinated those who had the highest risk of social vulnerability—of vulnerability, but then also looked at—made a big effort to vaccinate the other vulnerable populations, those in congregant facilities, nursing facilities, and other locations. And New Hampshire was the first to get to kind of whatever number you would—each state would get to with its vaccination rate. We had a lot of emphasis on speed, on delivery of the vaccines, and very seldom had any in reserve during the early months. They were all used. And I think a lot of that relates to what you talked to around the interpersonal trust, resulting in us being fastest to get the vaccines out. New Hampshire’s known as a—you know, the live free or die state, and individual liberty, individualism. But we didn’t have a lot of the culture wars. We’re a purple state. We have split government as far as state government versus our federal delegation. And we just didn’t see vaccines getting caught up in that, especially early on. So I just wanted to stop there and, Thomas, would be appreciative of your response on the was—what were the adjustment rates that you used, and did it account for just these healthier states did better, or not? BOLLYKY: Great. So the first one it’s a relatively quick answer, fortunately, which is the adjustment, it does, in fact, account for BMI, it accounts for rates of diabetes, cardiovascular disease. Really, an expansive view of the key comorbidities that might have made a difference in how states performed in the pandemic. So it is adjusted for that. And, of course, it is adjusted for age. I would draw out a couple things at least from our study, but obviously you lived the experience so I take your insights more—as seriously. But, you know, New Hampshire, as a state, is a little healthier than other states. Though New Hampshire’s average life expectancy at birth actually only ranks twenty-third in the U.S. out of states. So it’s around the middle. And its performance in this pandemic was better than that metric might have suggested. There are a few—about New Hampshire. It does have the lowest poverty rate, or percentage of population under the poverty line. It has the highest levels of interpersonal trust in the country. It has relatively few uninsured. Reasonably—among the top ten in terms of access to quality health care. It is also, you know, not a—as states go—not a particularly diverse state in terms of its racial makeup. But the—what people identify as in the U.S. Census. However, as you rightly pointed out, one of the things we’ve—in a follow-up piece that we wrote—pointed out that to the extent that New Hampshire does have social, economic, or racial disparities, the state was quite aggressive about addressing them in its vaccination program. And that seems to have made a large difference as well. In terms of our research, or talking to local officials, also they reaffirmed the view that you had put forward about a strong partnership between states and local communities in terms of enabling some of the local actors to have some agency to respond to what they were seeing as well. But we highlight New Hampshire, in terms of an example because, of course, unlike Hawaii it is not an island. But there is a lot—you know, New Hampshire has many advantages but again, as we pointed out, the health circumstances has some challenges too. And through aggressively addressing some of those challenges, the state did well in this pandemic. And hopefully more states are able to match it in the future. FASKIANOS: Thank you. So we have two questions on interpersonal trust, which I will—I will ask together. So the first one is from Colorado State Representative Parenti. How were levels of interpersonal trust measured? And then, from Alder Regina Vidaver in Madison, Wisconsin, she asked: What are evidence-based approaches to improving interpersonal trust? BOLLYKY: Great. So two fantastic questions. I will start with how we—the data sources we used for interpersonal trust in this study, and then I’ll just briefly reference how it can be measured more broadly. So the short answer is surveys. We have a set of surveys reflecting nine thousand respondents throughout the country, all conducted in 2019. Those surveys asked the question: Do you—how often do you trust others to do the right thing? The responses coded for most of the time being high levels of interpersonal trust. This would seem like a subjective question, but surveys—social scientists have been actually asking that question since the 1950s internationally. And you would be amazed how stable the values are for countries and communities. So that is the way people measure interpersonal trust through surveys. There are also, of course, experiments people do to measure them in a community, or they look to proxy behaviors that are suggestive of interpersonal trust. We use for this—for this study surveys. Now, what would you do with it? Well, a couple of things. Or, what’s the evidence-based interventions for interpersonal trust? First thing I will say is the government of Denmark actually monitored trust at the community level throughout the pandemic and adjusted its public health interventions to reflect those changing levels of trust. That’s just running a survey at the community level. Not cheap, but not impossibly expensive. But to give you an idea, for instance—because they convinced people that they will not the only who is vaccinated, that there won’t be holdouts. But in low-trust populations, they have the opposite effect, where they tend to inculcate hostility and a reaction. So that was used to tailor public health policies for different populations, just to give one example. As a general matter of how you build trust, and how you identify where there is low trust, and what you need to do differently to respond to that in the future. But hopefully that gives at least a start of the conversation around trust. FASKIANOS: Thanks. All right, the next question, we’ll take an oral question from Pennsylvania Representative Arvind Venkat. Q: Hello. My name is Arvind Venkat. I’m a state representative in Pennsylvania. I’m also an emergency physician. I had two questions. One is on did you distinguish in a large state like Pennsylvania, when you’re looking at it, between urban—or, among urban, suburban, and rural areas? Because the response in all of these area was very different in our state during the height of the pandemic. And the second question is, what specific legislative recommendations do you have coming out of your study? Thank you. BOLLYKY: Great. We did look at population density, but we only looked at population density at the state level. So the study in general functions at the state level. We don’t look at whether it’s at the ZIP code level or the community level. So that will have to be a future study. I will say population density, as the pandemic progressed, was less meaningful in terms of having a tie to either infection rates or deaths. And perhaps that might make sense from what we—what you’ve seen, what others—what we all have seen in the rural communities and how the pandemic experience has changed in those over time. In terms of legislative approaches, I think there are a few. I do think it’s important for states with high rates of uninsured, or states that have not extended Medicaid use or are reversing those policies. The study suggests that rates of uninsured did have a significant association with how states performed in this pandemic. Perhaps not surprisingly, and high death rates. So those are one area. Another is we did see an association between states that had adopted more generous family leave policies, or personal leave policies, and infection rates as well. And it will be important, whether they’re adopted on an ongoing basis or adopted in a manner that allows them to be expeditiously exercised in a health crisis, or extended in a health crisis. It’ll be important to have those structures in place. As I mentioned, whether it’s on politics or on social, economic, and racial disparities it’s really important to have ongoing community engagement, or to build these partnerships between state officials and community organizations or faith-based organizations. That’s perhaps less of a legislative matter, but certainly a matter of appropriations. And it’ll be important to have those partnerships established ahead of a crisis, because it is difficult to build them and use them and harness them effectively once the crisis has begun. But great questions. Thanks for participating in today’s call. FASKIANOS: So the next question is a written question from police chief Patrick Finlon, who’s in Village Cary, Illinois. And I’m not sure that this is in your area, Tom, but I will ask it: What were your findings related to the ability/desire to use/exercise governmental authority related to the shutting down of businesses and the application of constitutional provisions? I’m in law enforcement, and our risk management provider advised us not to close businesses for fear of a potential civil rights violation. BOLLYKY: Well, in terms of—what I can use on the use of mandates, in general, is there—although underreported—there is actually a surprising level of uniformity across states. There’s a perception that some states locked down and other states didn’t, and that that tends to vary politically. As an initial matter, lockdowns or use of mandates, rather, at the state level really over occurred over a sixteen-month period. Virtually all states from March until June of 2020 used some policy mandates. Where really you started to see the big differences in the outset of the Omicron wave, between some states reimposing them and others doing less so. But there’s a lot of uniformity to that at the state level. I will—I will forgo the—opining on the legal merits of the adoption of these, but there have been, of course, a good number of cases that have worked their way through the courts, some of which have gone to the Supreme Court, and they point to a few lessons on, you know, public health authorities/powers, and where they draw from and what they extend to. But, again, I will save that for a more legal discussion. FASKIANOS: Thanks. We’ll take the next question, raised hand, from Georgia Representative Imani Barnes. Q: Hello. Thank you for having me. I don’t think I can turn my camera on. But I was wondering, what type of educational data did you gather from this study? I was wondering the data compared to New Hampshire with other states that—I wanted to understand the disparities, educational disparities, that you gathered—the data that you gathered for educational disparities. And what suggestions do you have to mitigate the learning loss that the children experienced during virtual learning? BOLLYKY: Great. So the educational data we used for is average educational attainment. Again, like our metrics in the study, it is statewide. So by disparities, we’re talking the difference between states, and that average level of educational attainment. It does—didn’t matter a great deal in terms of showing differences between how states performed in this pandemic. Levels of—or access to high-quality health care or percentage of people below the poverty line does seem to have a pathway through vaccination rates, that states with lower rates of—or, a lower average of educational attainment had lower vaccination rates, by and large. So that’s the way we address that. On the learning gap question, I think the real answer is people don’t know as of yet, in terms of we haven’t really had a disruption of this duration and length before. So there are theories of what matters, from tutoring to, you know, more extended engagement or programs with students that fell behind. What I can say from our study is that the tradeoffs on the educational side were significant. All states suffered from an educational standpoint in this pandemic. Some states suffered more than others. It is unfortunately true that the same racial disparities and socioeconomic disparities we see in educational attainment, by other studies that have been done, suggests those were exacerbated in this pandemic. So it will be important to redouble and be aggressive about addressing those gaps. FASKIANOS: I’m going to take the next written question from Crystal Goodwin, who is with the Texas Council for Developmental Disabilities, and serves as a public health and disability integration specialist: If this were something that—if this was something that the study looked at, did the findings show any difference among states based on disability status or disability services offered? Something we found during the pandemic, and studies show, that individual with intellectual and developmental disabilities as a comorbid condition were in the top three of deaths here in Texas. BOLLYKY: I wish it was something our study looked at. It’s an important issue, and I really appreciate you raising it as something that deserves more attention, both by my colleagues and I but others in the future. So thank you for raising the question and, unfortunately, it was not in our study. But I wish it had been. FASKIANOS: It can be the subject of your next study. BOLLYKY: Indeed. FASKIANOS: Let’s go next to W. Abdullah Brooks with a raised hand. Q: Hello. This is—yeah, I’m W. Abdullah Brooks. I’m actually standing in for a representative from the state of Maryland, Scott Phillips. In full disclosure, I’m a faculty at the Bloomberg School of Public Health at Johns Hopkins, and with a background in infectious disease and global public health. First of all, congratulations on a brilliant study. And I haven’t had time to go into a deep dive, but I had just two questions that maybe you could elaborate on, if they’re not in your paper. One is, you talked about the correlation with employment and health outcomes. And given the structure of health care access in the U.S. often being tied to employment status, I’m wondering if you adjusted for access through, for example, those who have public assisted health access. Just to look at the question of health equity or equity in health outcomes, and whether or not there was any difference between those who are on public assistance, had access to public—to health access, hospital, and so forth, versus those who only had access through private insurance. That’s one question, just getting at the issue of equity of outcomes. The second, you have a reference to interpersonal trust. And during the beginning part of the COVID pandemic, the American Society of Tropical Medicine and Hygiene held a series of discussions around this and looked at specifically the issue of trust towards health experts—trust or distrust. And I’m wondering whether or not your paper looks at this specifically with regard to health communicators and health communications, and whether or not you gleaned any insights into messaging. And, you know, whether there were better or worse strategies with respect to trying to get messages regarding, you know, responses to the pandemic, and access to things such as vaccines. Thank you. BOLLYKY: Great. Thank you for such a rich group of questions. And thank you for the kind words about the study. On the employment side, the employment results are fascinating in the study, in that by and large most of the use of policy mandates are not associated with differences in employment. There is an association, in particular, with restaurant closures, which perhaps not surprisingly, given that sector. But there is an association between higher infections and higher employment. And that actually reaffirms what we’ve seen in other studies of the economic impacts of the pandemic. That it may have been less a matter of policy in terms of differences in economic impacts, and more in the responses of the population. So, meaning people that stayed home more cautiously, whether the state ordered you or not, had broader economic impacts. As a general matter, economically what you see in the pandemic is often a fair amount—and this is perhaps why the GDP levels aren’t shifted—or, have no association with the degree of public health response—is that you’re largely shifting economic activity between sectors. So less activity in restaurants and bars means more grocery. And you see some of that shift where all states suffered in the pandemic economically, but it tends to net out, to some degree, in terms of the various sectors positively and negatively affected. In terms of equity in the private and public insurance, we do include both public, private, and out-of-pocket spending—estimates of out-of-pocket spendings in our measure of health spending. We, unfortunately, do not break them down and see how the results might be different depending on the level of spending between each. But that too, like Irina suggested before on the disabilities, would make for an interesting follow-up analysis. So thank you for proposing it. On the trust in health experts, we do look at trust in government. Now, that is not—and we also looked at trust in science in the studies. Both of them also the product of surveys. As you rightly perhaps intimated, you know, trust in government does tend to vary by agency and area. There have been some good studies that have come out that have looked at trust in health authorities. And what you have seen are declines, particularly in trust in state governors, trust in federal health authorities. What I’ve—from what I’ve seen from multiple surveys or studies of this kind, what has really held up are your family physician. Local hospitals, local health clinics still enjoy high trust. They enjoy it across political lines. And that too may be something we can seek to leverage in the future but would be a different lesson than we’ve had in the past, where we have really emphasized having one voice speak in a pandemic, having it be at the federal level, perhaps having it be CDC. What the lessons of this pandemic suggest is that we need more community and local engagement, engaging trusted health sources of information. FASKIANOS: Thank you. I’m going to take the next written question from Commissioner Keith Baker from Colorado. Was the level of interagency—county, municipalities, healthcare, school districts, et cetera—coordination and collaboration evaluated in your report? And were there any lessons drawn from that? So we have another question too on this, about, you know, measurement of the level of intergovernmental cooperation and outcomes. BOLLYKY: Great. Thank you for the good question. No. I haven’t seen a good standardized data source of measuring the cooperation that occurred in the pandemic. There are different measures of polarization people have looked at, but they typically look at the legislature, state legislature, or surveys of the population and how polarized they are on particular issues, or politically. But the interagency cooperation’s an interesting question. But I have unfortunately not seen it well measured, particularly across U.S. states. FASKIANOS: All right. So the next question I will take a written—I see no more raised hands, so I will continue to go for our written questions. Next one from Vice Chair Mary Alford from the Alachua County Board of Commissioners, in Alachua County, Florida: Was good information found in states like Florida, where information shared was of questionable accuracy? How was that information treated—margin of error, sampling from other sources, et cetera? BOLLYKY: Great. So in terms of our study, we do—these are estimated death rates and infection rates. They do tend to be backed up by a variety of sources, including both state-reported data but also zero-prevalence studies and peer-reviewed data, is what we used from that. So that’s how we tried to adjust for the fact that some states may not have been reporting as actively or as rigorously as others. FASKIANOS: All right. Next question from Ellyan Veronica from the Puerto Rico Senate: What data did you find regarding unvaccinated people who suffered violations and interference in educational, medical, or other services by their vaccinated status? Not sure—Senator Martinez, do you want to ask your question? Maybe clarify it a bit? OK. Don’t think—oh, if you unmute yourself, you can clarify. No, that is not working. OK. Q: Yes. FASKIANOS: Oh, good. Thank you. Q: OK. Yes. I’m referring that what is the data did you find regarding the unvaccinated people who suffer interference with their educational, medical, and other services because they didn’t want to be vaccinated? Did you study that matter? BOLLYKY: We did, actually. So we look at vaccine mandates for state employees and vaccine mandates for school employees, and both their association with health outcomes, infection rates, and death rates, as well as whether they have any tie to shifts in employment or in lower educational performance, particularly for fourth graders. We used NAEP test scores. On infections and deaths, they are very much associated with lower rates of both. State employees, of course, it will not surprise people on this call, represent millions of people in the United States. So it’s not a small group. And you do see a strong association with fewer deaths from the use of those mandates. We did not find any tie between the use of those mandates and lower state GDP or lower employment. So nothing on the economic side. You do see an association with lower math test scores. However, almost all mandates were associated with lower math test scores. And what our theory there—so this includes things that have, you know, restaurant or bar closures—. And so the hypothesis is that association reflects the caution in the population. People who were less likely to send their children to in-person schooling, those children tended to—or, those states where that was happening at a greater rate—to do more poorly educationally. Because math is something that, I can say as a parent myself, parents don’t teach as well as the school settings do. So it really does seem to be a stronger tie between in-person schooling and better math test performance, at least for fourth graders. Sorry, that’s a long-winded answer. But most of what you could say is, no, I don’t see any educational, economic, or deleterious health outcomes from those vaccine mandates. FASKIANOS: So I’m going to take the next written question from Dawn Gresham, who is a community liaison in Senator Liz Krueger’s office of New York Senator Liz Krueger: It seems as though it would have been helpful if messaging had communicated that there would be saves in community infection levels requiring additional safety measures to be followed at times, and relaxing safety measures where possible. Because this did not happen, it made it more difficult to discuss reinstating certain measures when it would have been helpful. Can you share thoughts on best practices for handling communication? And, Tom, I’m going to add onto that. I think we’ve seen some backlash against other vaccines because of the experience of COVID-19, which could be potentially alarming for things that we have not had problems with, because vaccinations have been measles, and whatever, and how we deal with that. So can you talk about messaging and vaccines going forward for other diseases? BOLLYKY: Great. So on the communication side, I completely agree with the questioner on the premise that we struggled to educate the population on the fact that this was likely to evolve and to change. That is actually—there have been a relatively large literature on communication in this regard. And this ties to the earlier question we got about trust. In addition to monitoring levels of trust to try to tailor programs to low-trust communities, we do have good research on communication strategies that preserve the levels of trust you already have. So less on how do you build it in crisis, and more about how you slow its erosion. And one of them is—or, two of them are related to your question. One is transparency. So saying the quiet part out loud. For instance, there is a great study that looked at—they presented two groups of individuals with—or, two groups of individuals, rather, with information about a hypothetical vaccine. One of those groups received information about—that was vague about the side effects but suggesting that there may be some but somewhat vague about what they were. Another was very specific about the range of things you might find in those circumstances with the vaccine. And what you found in that is not that you had a higher rate of people willing to take the vaccine between those two populations, but the population that received more detailed and complete information expressed higher levels of—or, more sustained levels of trust in the health authorities that provided it. Suggesting, again, that transparency is important, but also—and this is the second lesson—trusting the population. In order to be trusted, governments have to be trustworthy, but they also need to trust the population to be able to understand what they’re communicating. And that is something we struggled with throughout in this pandemic. FASKIANOS: Thank you. I’m going to go next to a raised hand from Paul Rotello from the city of Danbury in Connecticut. Q: Thank you. Yeah. Paul Rotello, City Council, Danbury, Connecticut. Connecticut, in terms of geography, is one of the smaller states. In terms of population, it’s relatively moderate. I think it’s about thirtieth. Both Vermont and New Hampshire are not particularly big when it comes to geography, but they’re much bigger than Connecticut. Their populations are quite a bit smaller. So I was just curious as to what—there seems to be a little bit more elbow room, or maybe a lot more elbow room, in Vermont and New Hampshire, compared to Connecticut. I was curious as to what density played in your statistics and your analysis. And how would you even go about figuring that, because while you can live in a somewhat agrarian community, you may spend a lot of time in town at diners, and post offices, and things like that, or even at jobs? How do you tease that out? And were you able to tease that out? And did you see a difference? Thank you. BOLLYKY: Great. Well, I’m happy to get the question. I actually grew up in Stamford, Connecticut. So I know Danbury quite well. I went to high school in Fairfield. And so it’s nice to meet you and have this engagement on this. Connecticut, as a state, actually does well in our study also. It is ranked seventh in terms of standardized deaths. So, again, adjusting for the biologically relevant factors. We did not see a strong tie between population density and infection or deaths in this study. The reason why is over time—in the beginning, it mattered, in terms of the spread of the virus to communities in the initial wave of the pandemic. But over time it was more around economic geography. Congregant housing, people—percentage of essential health workers, people with a greater ability to avoid people that are infected or isolate on their own is tied more to economic geography than the population density. So there are some fairly rural states that don’t do well in this study because of, we suspect, these broader questions of economic geography. FASKIANOS: I’m going to take the last question from Alison Despathy, who has raised her hand, from Vermont. You need to unmute yourself. Q: Thank you. FASKIANOS: There we go. Q: OK, good. All right, thank you so much. So I’m here in Vermont. And my question relates to, back to the trust issue. And this is also sort of stemming from some of the swine flu history and what we saw go on there with a bit of the sort of marketing and propaganda around the safety and effectiveness of vaccines. So with regards to the trust, did you see any data or results surface around the fact that the COVID vaccines were originally sold as safe and effective, and included the ability to prevent COVID and prevent transmission? So there was clearly a level of propaganda, not necessarily intended. But many heard that, you know, this is the pandemic of the unvaccinated. So as actual vaccine impact surfaced vis-à-vis safe and the failure of COVID vaccines to prevent infection and transmission, did you assess the role of propaganda, marketing of pharmaceutical products, and any—? And thank you. BOLLYKY: Great. So we did not assess the role of mis- or disinformation in the study, other than trust levels. The trust levels that we had, of course, they had to, for the study to work, predate the pandemic. So we looked at levels of trust in 2019, the situation, effectively, the virus found us in. So we did not assess ways that might have changed over the course of the pandemic. Other studies certainly have. I will say that levels of trust declined everywhere, even in countries like Denmark or Scandinavia, famously high levels of interpersonal trust. The question is, how quickly and to what degree. And, you know, some of the good communication practices that we’ve talked about, and I’m happy to communicate more about with people via email, do seem to have been effective in slowing that erosion. But we didn’t look at the mis- or disinformation and how that changed trust in the United States. FASKIANOS: Thank you. Unfortunately, we are out of time. I’m sorry we couldn’t get to all of the questions. But I just want to ask you, Tom, to take just thirty seconds to talk about Think Global Health, since we have so many health commissioners and medical officers on this call. If you could talk a little bit about your magazine and what you’re doing there. BOLLYKY: Great. I will do that in twenty seconds, because in ten seconds I want to say that health crises are fought at the state and local level. And I am grateful to all of you for what you did during the pandemic, and what we will need to rely on you for in future health emergencies. I don’t think we’re getting enough attention on what states and localities need to succeed in the future. And hopefully, this study can help spotlight that. Now, that said, on Think Global Health, it’s an online magazine that’s meant to look at how health affects economies, societies, and everyday lives. It’s been up for about three years. It has been—it’s analysis has really been picked up everywhere, from the New York Times to the Atlantic to Fox, across the aisle. More than eight hundred pieces published, from authors from sixty countries around the world. We would welcome state and local members of this network contributing. And it’s ThinkGlobalHealth.org. And thanks, again, for your time today. FASKIANOS: Thank you. And thanks to all of you. We will disseminate the link to this webinar recording and the transcript. We will circulate again the report that Tom Bollyky authored—co-authored, as well as the link to ThinkGlobalHealth.org. We’ve also dropped those links in the chat. You can follow Tom on Twitter at @tombollyky. And, as always, we encourage you to visit CFR.org, ForeignAffairs.com and, of course, ThinkGlobalHealth.org for more expertise and analysis. You can also email [email protected] to let us know how CFR can support the important work that you are doing. And we do recognize all the hard work that you are doing. As Tom does go—not enough attention is given to it. So thank you for all you’re doing. Thank you for being with us. And thank you to Tom Bollyky for your efforts.