>> book tv in prime time starts now. first, vaccine confidence project founding director heidi larson reports on what influences the public's attitude toward the covid-19 vaccination followed by historian margaret mcmillan's book on how military conflict has affected our lives. also tonight former united states solicitor gentle x clinton impeachment counsel kenneth stark argues religious liberties are under attack and "washington post" staff writer reports on the effects of gun violence on children and find more schedule information and book tv or consult your program guide. now here's the vaccine confidence project heidi larson. suspected morning someone who you are familiar with. she is a science journalist and award-winning author. his book is on global during a pandemic. her book, the coming plate newly emerging diseases spent

19 weeks of the near times bestseller list. her new book the coming plague disease or disaster in a world out of balance of the published in august. you can get onto amazon and preorder that. heidi larson is a professor of anthropology, risk and decision science at the london school of hygiene and tropical medicine. she's also the founding director of the vaccine confidence project. again headquartered at the school of hygiene and tropical medicine. she wrote help vaccine rumors start and why they don't go away. and to moderate the discussion we have pat rosenstein who is the faculty member here at the ja. he and i have worked together for many, many years. he is also the special advisor of global health to the erasure group. which is a very prominent

global group. so scott will engage laurie and heidi in conversation for about 30 -- 35 minutes. and then we will open up the q and a. you can usually raise hand icon to ask a question or enter into your chat box. we will try to get to all the questions but there's no promise on doing that. please ask a question. and with that in going to hand it over too scott. thank you so much for joining, scott. connect thank you so it's really an honor to host to incredibly accomplish voices and global health to really help us process all the passing over the last year but talk about words going what that means for the field of global public health in the coming years. i note many of the students on the skull probably heard me talk more than enough and our time is limited. i'm going to try to speak as little as possible with a lot

of ground to cover want to get right into it. is a lot of students on this call think there's a lot of interest in this field of global public health, international development. where want to start but we are working on will be thinking about once the pandemic overtook our lives. >> i was right where i am right now, sitting in my apartment in brooklyn. monitoring reports out of china. i was pulling almost 24 hour shift because most of the news at coming out of china was breaking at 2:00 a.m., 3:00 a.m., 4:00 a.m. in the morning new york time. starting actually christmas day became very aware there is a strange outbreak in wuhan.

i've only once passed through wuhan i've never spent a lot of time there. i certainly understood it was a major nexus for china. it has virtually all the superfast trains go through wuhan. it has one of the most important domestic airports. and you know, 13 million people. it is a massive parade we do not have a city that large. and it is a city most americans have never heard of. and so i was monitoring it and getting increasingly anxious. my new year's eve, i was really freaked out. i thought this is it, this is the big one. at the very least this is sars comeback. it might be something worse. but, when i would tweet about it or send out a kind we get

death threats. one person posted on twitter we should skin her live in torture her to which i said that is redundant. and the mountains of threats i received from scientists, from random who the heck are they i don't know, from alleged public health experts were huge. and yet, by the 30th of december i was aware of postings. and also other chinese scientists or mds actually in a wuhan posting. and i was absolutely dumbfounded i was not seeing this reflected a thing from w.h.o. so as we go into january of

2020, my life is completely consumed with this. there is really nothing else i'm doing. it is 24/7. i'm absently convinced we are looking at a nightmare and i'm just not seeing it reflected at the same level anywhere else. i'm not seeing people i usually respect shouting from the rafters. when i try to shout from the rafters and been told to shut up. turning point comes generally 1h when fishing ping himself personally steps into the situation, she was out, we do not know this publicly but is chewing at the state council in beijing on the commonest party leadership i have had it, there's clearly something going on a wuhan. we're not getting correct

reports of our own people. i do not want to hear anymore coverups, give me some straight data. the following day we go from everyday they're saying there's some around 30 -- 40 cases in all of china they even have a day when they report fewer cases total than the previous day. somehow death did not happen we made a mistake. suddenly on the 20th we have hundreds of cases. we know now that's the point at which the big lie stops or at least phase into a smaller lie. and w.h.o. finally starts acting like there's a crisis. >> great. heidi, how about you? where were you, what we are working on house that change? >> i was here in london. i'm a school of tropical medicine. there were some conversations

about this emerging. it was sidelined, it was very much like laura was saying was pieces of information. then kind of the discussion started to well, something is going on. but i totally agree the level of concern really did not get going until january. and i remember, i was at davos at the end of january. and jeremy was there. he was saying this is big, this is big. this is big. he was basically in his room most of the time on it. and it just was like a flood at some point.

and then back in london the last thing i did not or i'm sitting elsewhere been since then, was a ted talk in boston on the first week of march. i was actually a bit surprised who's going to be in person. but it was. it was the next week in that same conference center became the hot spot for boston. it was one of the things you get home and you think you know, i got plunge into it pretty deeply. going to transition quickly to what we've seen over the last year. march 10 right now for a lot of people early march is sort of the one-year anniversary.

we've obviously seen a number of chapters in this saga. one of the questions i get is where are we in the story? or in the eighth inning, when the sixth inning? forty vaccines fit into that? where did they think we are, or are we in terms of vaccination and vaccine development? can you talk a little bit what is it me in that type of trajectory. >> in the last year we have been following vaccine concern issues sentiments for the last decade. we just shifted over social media listening and survey work to be focused on covid. but it wasn't on the vaccine to be honest. from last spring which i get the pulse on lockdown, with

masking, there's masks on, masks off, was that 1 meter? was it to meet her the confusion in the information environment was just nuts. what i think the vaccine discussions just started to come into the conversation more in the summer. but last year was really about control. this year's about the vaccine. and this is just kindergarten. i mean, i've been working closely with cdc and see the numbers go up in the uk, the numbers going up every day who's vaccinated. you do not sin the headlines who's not getting vaccinated. that is a real issue.

were understating the complexity of the issue. a lot of bilateral deals going out india, with china, with russia. kovacs a global entities getting a lot of attention. from the low and middle income families need. we have a long haul ahead. who knows how this virus is going to evolve in the variance are no small thing. >> to listen to on the point about information, can you check with the information ecosystem. helvey seen that evolve over the last year? i've got information on some of the challenges we face getting our heads around all this incredibly fat movement of information.

all the uncertainty of goetz's where we are now. the sort of transitional moment, brought ground vaccination thinking about what this next chapter looks like. >> okay so you have four questions to me i think you did. let me start with way back last, end of january and into february, i am on the record at that time saying we are out of the 13 month out of 36. i would still think that is about right. yes, those of us who are fortunate enough to be fully vaccinated may be feeling like the light is at the end of the tunnel. but as heidi just said the light is not in or near the end of the tunnel. the vast majority people on planet earth. we still don't really have a plan for getting vaccines to

90% of the population of this planet. meanwhile we have variance emerging. as heidi alluded to the end of her comment, it is no surprise that they are emerging out of places that have a lot of virus. that is the whole point. we have a lot of virus in circulation you are creating all the proper circumstances for evolutionary selection of vaccine or immune system resistant strain. and so right now the biggest panic concern for me is brazil , which is completely out of control. has at least two really tough variance. one that clearly resist about half of the already approved vaccines. if we don't get this under control can understand this is a global crisis, then we are just going to see a constant flow of variance emerging. this forces us to develop new

ansi boosters that can outdo those very strange for the rich countries. but meanwhile, known as even dealing with the poor countries. they are not even getting their first dose. that goes to a second part of your question about where i think we stand right now the epidemic? my view is that the wealthy world, primarily europe, east asia, japan, and north america is going to be experienced robust economic recovery. and we will see some particular profit sectors start skyrocketing really soon. the tech sector is coming back. were soon going to see the construction sectors. infrastructure development centers. financial sectors they're going to start soaring.

there will be a sense of euphoria as a result. golden saxes predicting unemployment in the united states by the end of this year will be at 4%. that is like unbelievable. i without the blockades on immigration it actually means are going to have whole sectors of the economy desperate for workers. begging for employees. when we hit unemployment as an entire 20% here in the city of new york we are going to flip all the way. i think we will see therefore a lot of oh, let's just forget the epidemic it's in the past now. but it won't be in the past. i hope you will ask heidi she is way the expert on this. we will have a stubborn roughly 20% of americans that will refuse to get vaccinated. some of them will refuse for legitimate concerns about

historic racial abuse of key population groups by the medical sector in america such as the tuskegee experience. they will feel in the african-american community that look, we have faced abuse why should we trust you? a lot of it will also be off-the-wall conspiracy theory, excuse my french i'm talking at university. [applause] it's hard resume to remember they were actually in a formal setting. excuse me. so a lot of it will be queuing on, we are arty seeing a clear party divide, partisan divide of the republicans less likely to get vaccinated than democrats. i mean that is insane. so that is going to continue to play out. to your information question, my friend john cohen who is a writer for science magazine, many months ago we were in a

group call and said you know what i'm sick of the firehose. that is exactly what it is. we are working at home so there's no separation between home and office in our lives. i roll out of bed, i hope the firehose up to my mouth. and incomes information. and it goes until i finally collapsed and go to sleep. and it repeats the next day. you cannot keep up with it. and what is unique in this epidemic that we have never ever seen before that outbreak , is on the plus side and enormous amount of sharing of information. scientists are not holding back info to await prestigious publication. there's an understanding in a crisis you must release information. but on the downside that means a lot of what is pouring out of that firehose has never been peer-reviewed. has never been subjected to scrutiny that can help us

assess, is this accurate? is this crab? are there fundamental flaws in the statistics in this paper? or the methodology or what have you? all of which contribute to the things i'm sure heidi will talk about in terms of conspiracy thinking. because if you put out a paper that says we are absolutely sure that this particular group that's getting benefit from hydroxyquinoline, than a week later the paper is retracted as fake or inaccurate, but meanwhile it's concert news cycle after new cycle after new cycle, website after website after website, as if it were valid information. after you do a google search in her comes a thoroughly debunked paper. we now have a legacy that's

built up after a year of a mountain of thoroughly debunked science still rests somewhere in the ethernet in cyberspace. we are never going to completely purge them out. you are conspiracy and sign individual if you are a level it jerk you're sitting in your basement in st. petersburg russia and your mission is to create distrust and havoc against western government there is so much for you to draw from now. there is just a mountain of bs out there for you to pluck from oliver cyberspace to weave together this elegant conspiracy about how dangerous the vaccines are help masks don't work. or how social distancing is actually population control. it goes on and on and on. >> so heidi let's get the

vaccine hesitancy question. here's a question i get a lot. lack of pull something you been working on a lot. one of the features of these polls tend to be what you get vaccinated immediately versus what you get vaccinated eventually? i wonder how movable it is. what is the feeling on that question how many people do we think in the u.s. or in general are immovable and what is that made for vaccination moving forward? >> we have been pulling this on and often different ways over the past year. we know was really up-and-down. and doing at multiple countries. i don't see any two countries that are the same.

when you look more sub nationally it's more varied. edit changes. danielle offer coded arc around h1n1 the pandemic as it were. she talked about emotional epidemiology. i think it's really a perfect term. and last may/june there was more enthusiasm for the vaccine than there is now. it kind of went further down in september, october. there seem to be a waning pandemic. and people, all they heard was misinformation. there's a lot of information about vaccines. there's a lot of misinformation. there is a bit of increasing confidence around november/december. think that was a bit with the pfizer announcement 95%.

that's a really good efficacy. that was a confidence booster for people who were uncertain. many flu vaccine can be 50/50% sometimes. and going into a second very serious wave. i do think sometimes we underestimate people's putting a bit of reason in here. because there are ups and downs are constantly weighing the risk. and the risk of this brand-new vaccine has never been made this way before. keep getting didn't different information. and looking at that next in my really at risk? is it worth taking that risk for what became an emergency authorization? i think a lot more people are ready to take that risk than they were. it's a solid group and i think

it depends where you live and who you are. as a whole mix of reasons globally. frankly we did 15 global perception studies listening in africa, a top five reasons for refusing a vaccine could come out of ohio. they could have come out of berlin. they were really, don't trust it, made to fast the speed thing, i think as a medical and scientific community we really failed. instead it's going to be like we are going to be the first to get there has a vaccine or a scientific community the narrative. there's no discussion of why it was so fast. there's some great

technologies. there is a budget there heard there is a fund that was only there because of a bowler. there were a lot of great -- we unpacked a linear process to work in parallel. to get more anxiety. >> just imagine about this time last year we had roughly 200 prototypes for vaccines and some stage of development around the world. and so far only two, so far have dropped out and says it doesn't work. everything else is still in the pipeline are property in emergency approval. and these safety profiles are phenomenal. if you look at in the other vaccine that we have rolled out in recent years, including

once it took ten years to rollout of went through safety trials of never seen success of this. and, other than a very small handful of people suffering anaphylaxis, none of which was life-threatening all was reversed. all with prior history with responses to other insults in their environment. other than that, the worst thing people have is some people on second dose of vaccine are down with what feels like the flu for couple of days. that is the worst. now i can't really remember a vaccine that rolled out for emergency approval that prove that safe. and on the efficacy side, even the j&j vaccine which is single-dose, and which people have tended to downplay and

saves not as good as the madrona, or the pfizer, or whatever. it's also the only one that was tested in south africa and brazil amid circulating variant strains of virus after enterprise and still performed at 65 -- 70% efficacy. that is kind of amazing. we have childhood vaccines that we use that are not that efficacious right now. final question before we open it up, moving forward is there case to be made for vaccine optimism before this vaccine that will have an effect for broader levels of acceptance of enthusiasm of support for vaccine. >> g heidi say one quick thing

on that i think heidi should answer. you all remember back a year ago we had a toilet paper fanatic response. i don't know why, i still don't understand why. but all over the world people freaked out about covid and the response was to go by toilet paper and paper towels until stores all over were empty. they had no toilet paper paper towels. finger starting to see in america is a toilet paper like response to vaccine. all the sudden people are in seeing a difference in their neighbor. they are more relaxed. they seem to feel better about life all the sudden because they are protected against this deadly virus. we are seeing younger adults clamoring can't take it on the list? why do i have to be 65? i actually think it could reverse completely. even that 20% stubborn group

could begin to erode just because it's like a fad effect. gee, i don't feel hip unless i'm vaccinated. i don't know, you chime in. >> i think there really is a power to what is going on. they are talking about it as the social proof. so when people start seeing really how it can change their life, i don't think we've ever had such a huge opportunity societywide to see the power of a vaccine. you could have cost effectiveness studies about vaccine at the wild zoo. that is going to have zero impact on public acceptance. but when you see is going to let you go back to school for it's going to let you go back to work. it's going to let you hug your grandmother or whoever else you want to hug or whatever, it is a whole different

ballgame. i think there is real potential for changing the landscape around it, if we get it right. >> all right, we take some questions >> great, great, use the razor hand icon or you can type in a question in the chat box and we can read that. matt can you talk b can't hear you. >> sorry, you can use the raise hand icon. or you can type requested in the chat box. ^-caret once to go ahead you had your hand up. >> okay hi everybody thank you for this. my quick theory about toilet paper is no one's going to work and using their toilet paper. that's why i'll be home toilet paper. my real question though is.

[inaudible] we are all witnessing it either when you gals could answer this, if it were up to you how would we set up a global organization that would clearly have the truth, the right clients and the right distribution ideas. that's probably also very political question two. i would like to hear what you think. >> i will start and handed out to you, heidi. first of all of courses has been anticipated and attempted over, and over, and over again. we actually have a plethora of multi- organizational and the global health space that overlap into different parts of vaccines, of pandemic and epidemic responses in general global health. some performed very wellin narrow functions such as the

hiv drug distribution and developing countries really outstanding success of global health. the problem is in terms of what about truth? at the organizations that have the greatest acceptance are those in our united nations institute such as unicef and w.h.o. by virtue of being united states institution they have eroding body that backs them up and that voting body is the national government. so in the end, if you are the president of the united states and all the people that are going to actually implement your policies are the governors of 50 states, and half of them oppose you one 100% politically are in your opposition party and are

determined to sabotage you, there is a limit to what you can accomplish by issuing a fiat or putting out truth at the top if you are going to be undercut every step of the way by the governors. and in a very real way that is debbie way chose problem. it has got 194 member states and a fair percentage of the states are more than happy to accept services and information from w.h.o. but don't you dare demand they provide truth act of the institution. and you know, fortunately this all started in china which from the get-go was not providing accurate information to w.h.o. heidi. >> high totally agree, that is part of the complication right now. actually there are some corners of the world that do not trust global entities who they see as counting and

controlling basically. so, i think also in this era we are in, we see obsolete change public in a decade or two decades ago. they don't want one universal truth. they would not trust it. they want something that is locally evidenced that they feel is more tangible. in fact they feel like the truth has become far too remote from them. they do not have a say in it anymore. i don't have any ownership of it. i do think we need credible sources. but it also needs to be endorsed locally. because if it's not it's not worth its weight in whatever. >> i wanted to shout out to heidi. one big learning experience for me this was like 15 -- 20 years ago when heidi worked for unicef, as an

anthropologist was that she taught me about why some parents would refuse to vaccinate their children in places like india or fiji, or the middle of indonesia. there's so much vaccination was campaign, correct me if i misunderstood. you taught me and learn from you that so many of these vaccines were campaigns and the parents would say, the only time you come to this village is when you want to stick needles in her children's arms. but what about when they have a fever? what about when they have malaria? where are you when they are sick with something else. all you care about are these needles why should we trust within those needles? >> you got it. what i've said before about vaccinations and if we get it right is we are in a point in society now where everybody is

fragile at some level. and if we only get out there for, with the vaccines have got to the highest risk groups. but now we start yet more vaccine in the pipeline start to reach more society we have got a job to get vaccinated part and look at -- if you are in marketing you not just marketing for instance in the airline industry the flight. you advertise the beach. you advertise the destination. i think that we need to be thinking about the destination of us as a society getting back. when we are trying 2ingage people to get vaccinated to remember to not just say, here is your vaccine, thank you very much. but how are you doing?

how are things going? particularly for the hardest most resistant group. they want to know that your motive is not just to get that vaccine in their arm. but actually really care about their well-being. there are simple ways we can do that better. i think we have to make really sure were going to be doing that. spent at the counter them think it's all about bill gates putting a microchip in them. [laughter] >> nevermind the fact that's arty going on with the phone you've got in your hand. >> is already there they already know everything you're doing. [laughter] who needs to put a microchip in your? [laughter] >> clinical back on that more broadly from the global architecture perspective. i think historically people in the pandemic are familiar with the panic and do nothing cycle. obviously this is a really big a global catastrophe. you think that cycle around investments into long-term public health and pandemic

preparedness into all the issues around trust, truth and understanding between the systems and the large entities and large public health entities and communities on the ground, do you think we will see -- michael would be breaking that cycle? are we still at risk from a few years from now still looking at an underwhelming environment. a lot of people distract five whatever the next crisis is. where are we in that story? >> will actually think. [inaudible] things i know are very far along in development already propelled by a covid from

positions they were probably in before, but would have just lumbered through the pipeline for many years otherwise. we should buy sometime in 2022 or 2023 have the following technological capacity. number one, multiplatform surveillance tools that will allow you to take a sample from any container, put it on a microchip and have a breakdown of what is in it rapidly in real time that will allow us to say, wow people are sick in this village and it's a new virus. it's a new bat virus, what have you. and that will also allow more rapid integration between the animal host, the one health approach. the audience here may not all know about one health but the concept is, humans don't exist

in isolation on this planet. we are part of an animal kingdom. and many of the viruses we suffer from including this current pandemic come from animals. we can do a lot better if we are focusing on the animal host before we have an epidemic in humans. so the toolkit to do that will not only be realized and it will be a crisper based technology. but it will be affordable. it will be rapid, it will be available. i do think then the onus is on the wealthy countries to subsidize distribution around the world so it is equitably distributed. and the capacity to use the technology, the knowledge base is equitably distributed. the second thing that's clearly happening is the mrna vaccine, pfizer and moderna have revolutionized the whole concept of how you make a

vaccine. so it's already being ultimately discussed. there is no reason whatsoever that we can't have a window of nearly 100 days between identification of a new outbreak and the actual putting into people's arms a new vaccine. because we now have that technological genome, make the rna pieces from the genome that is appropriate as antigens, develop the antigen, package it, vaccine is done. and if the platform is uniquely used repeatedly the same way, and the platform is what is approved by the fda. or its equivalent agencies overseas. the platform then becomes a streamlining of the whole regulatory process. so now, you hear scientist talking about a seven day window.

one week from there is a new crêpe microbe to there's a new vaccine. so, that could shift everything sometime in 2025, 2026 to a modality that could actually mean, i can't believe i'm saying this is someone who spent a whole life screaming about emerging diseases, plagues and outbreaks, actually lead us to a place where the only stumbling blocks to blocking pandemics as we are experiencing now, will be about money resources and social organization. there will no longer be any technological peace that is in the way. >> heidi how about you? you think the commitment from the international community will stay strong over the coming years? what was he a repeat of 2003, 2009, that kind of thing?

>> this is big. we've not seen anything like this since 1918 in terms of pandemic. and we did not have -- vaccines were not a part of the equation then. nevermind multiple vaccines. i think we have got a lot of -- this is going to change things. maybe in different ways than we expect. but i think this is really shaking up the planet in different ways. i think one reason is going to provoke change is that it's not just about health. i think there there is one big failing of the un response, it is to health centric. this should be sitting in the secretary-general's office. this has knocked out every single sector of society. this should involve, labor and transport, education, travel,

economics and commerce. this is everyone. and i think, not to underestimate the importance of the health sector which is crucial, this is way bigger. and for that reason i think things are going to change. how they change, we are yet to see the story unfolds. >> almira other questions? i see a few of the chapter eight. >> joyce asks about the variance in new york city. and then anthony is asking about any thoughts on increasing information about high mass index being correlated with covid complications and death. >> okay has really still very

hard to hear you. i did not hear second question at all. i think i vaguely heard about variance in new york in the first part of your comment. if there's any way you can boost your volume or speak closer to the mic it would be very helpful. i'll talk about the variance in new york that's what hurt you ask about. so far we have not seen the new york variance or the california variant spread widely out of either narrow locations. that is a good thing. the new york variance is something to worry about because it is showing two key features of the virus that we probably underplayed. the first it how did it arrive? who's in hiv patient. so we are looking at, we have large of people who are immunosuppressed for one rear

their this gives the virus a chance to keep trying. you put selection pressure on a walking petri dish. that is a big lesson we have to pay attention to this and think carefully about what we are doing this promoting evolution. as far as the california variant goes, it seems to have a big role in los angeles. but not much beyond their so far. not sure why it is not spread further. it may have to do with social mobility issues and lockdown. if so that is good news. and it tells us the social measures are effective and must continue. and there will be more variance there will be more

revolution. by no mean pulling tricks out of its bag and we are just at the beginning of the coexistence with sars cob two. >> growing evidence around the linkage between obesity and severe covid outcome. when you think of that? what is that more broadly in the obesity epidemic pandemic that we are dealing with. >> i'll start with that, that evidence is very solid. i would say there are three things that are really solidly linked to risk of especially dire outcomes if you get infected with covid. hypertension without a doubt, solidly linked. obesity, solidly linked. diabetes and high blood sugar solidly linked.

note those three overlap obviously. people who are obese tend to have hypertension and diabetes. and if you look for diabetes you find it more in in obese individuals et cetera. in simple we have not seen is a lot of good studies that try to separate them. so we can really see what the lead factors are. i've said repeatedly for a year now that it is a great disappointment to me. great disappointment to me and a failure of public health, something i have condemned repeatedly. we have not taken advantage of wide spread testing for covid infection as an opportunity to provide a direct intervention in the form of the cheapest thing imaginable. cuffing an individual to see what their high blood pressure is. before we give you your covid tests, who like you to go over

to tend to where you are going to get an intervention regarding purdue going to be offered free cardiology workup, free access to anti- hypertension drugs and about nutrition. similarly we shouldn't have been pinprick and people as they go in for a covid test to see if they have diabetes or are free hyperglycemia. so they could also be diverted to interventions. and in that way we could radically address the two big epidemic set up in the background all along, high blood pressure and diabetes. >> you think diet and lifestyle are big indicator here for different countries, different outcomes that we are seeing? >> for sure, but also age. worst case scenario is to be 100 pounds overweight, 75

years old with a history of cardiac problems. that individual if in fact it is very likely to end up in icu. >> great, any other questions, comments, connect there was one question i got in a direct message i'm not sure who sent it. the question has to do with kovacs and them curious about this as well. number one how does kovacs work? and second, the question is the country of georgia was commenting there membership thing they cannot buy vaccines independently. but they are also not low income enough to get vaccines early bird they stuck in this great middle. can you talk about how global access is being managed or prioritize? heidi you take it.

>> let's see, it could not be true that you could not get your vaccine somewhere else because they're only giving, now up to 20%. that is just not feasible, africa it right now is developing their own approach to try to meet that 20 -- 60 -- 65% that gap in there. because they know there's not enough to go around for more than not exactly sure there's different europewide arrangements and kovacs but the principal in short is that a lot of countries have put funds into a facility to bring down -- to basically try to procure at scale and apply for

the vaccines as they become available. it is been off to a slow start to say the least. and people put funds and therefore a mix of vaccines. because it was a gamble. a lot of countries put money, it was really like gambling. you put your money on a bunch of different cars and hope one wins. and that is what some countries like canada, the u.s. it's different with the arrangement there. you do not know which one is going to get to the finish line. now that starting to come up. laurie if you want to weigh in there, i did very simplistic version of what the principle is. but it is playing out slowly. >> is just a step backward 2009 we had the h1n1 flu

pandemic. and in the beginning it was thought to be a very dangerous influenza. later fortune it turned out to be a pretty routine garden-variety flu that was simply far more contagious than usual and did indeed spread to every single country on earth in about six months. but what we found is the vast majority of the planet either never got vaccine or got it after their flu had come through and passed on. and this led to tremendous resentment against the countries that were perceived as hoarding flu vaccine early on. so, the idea was coming come up with a mechanism that allows us to widely disperse an equitable fashion in the world. kovacs really came out of a small meeting of a handful of individuals w that runs w.h.o.

, the folks from the world bank to fight malaria, come up with a mechanism that was the intent behind kovacs in 194 nations signed onto the kovacs mechanism either committing to a bide bite and provide funding and vaccine, or committing to receiving vaccine. the problem of course is that everybody, soon as they heard johnson & johnson, novak's has a vaccine, moderna, whoever, everybody started placing orders. and the orders at the front of the line or the ones that put the most money up front. so canada actually put in

enough orders to vaccinate every single american canadian four times over. the united states put in enough to vaccinate every single american two times over. the uk is up around three times over in theory. and so on. this of course means that chad has none. molly has zero. and vietnam struggles. so, where we are now i think is first of all as long as donald trump was president of the united states the u.s. was not part of kovacs absolutely refused to participate in any way, shape, form. what are the first things and biden did in his first week in august was to commit $4 billion of u.s. money to the kovacs effort. and i assumed that money will process through sometime in the next three or four months. that will certainly help. last i looked, heidi may know

better than i but last time that funding is essential to outbidding the rich countries to get actual vaccines in the facility for poor and middle income families. >> i can take a quick stab at the georgia question. i think one of the challenges for countries that are classified as upper they don't qualify and they're not the front of the line that's where the challenges kovacs is facing stuck in the middle. i think more generally people been talking about this for a long time, was an incredible success of the same time is doing much better than a lot of people predicted but it still is a long way to go pray that's where we are now. i think that is what the open

question is moving forward, how do these countries make up this gap? make up this shortfall for vaccine and access the vaccine. we see a lot of things playing out that heidi said earlier they do not fit prior patterns. who would have thought is the wealthiest for the country in the world. it's also the third richest country on the planet has almost no vaccine this is not a straight arrow kind of phenomenon that can fit into neat narratives, either left-wing or right-wing it's a more complicated picture. >> the only prediction i was willing to make in the beginning of this is i'll guarantee they would continue to be surprised at the course of this pandemic. i think that still the case. the wii or a few minutes over are there any other questions or anything you would like to

add? spinning i want to thank you, scott, or moderating what was really interesting discussion. i think you got it right when you said we are just overwhelmed with information. i certainly read a lot about covid-19 part i was still very surprised and i learned a tremendous amount. a big thanks to you laurie and heidi for joining us. ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪

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