book tv on cspan2 starts now. television for serious readers. here are some programs to look out for. tomorrow we are live at the story and ronald reagan biographer craig shirley peart he'll talk about the modern american conservative movement and its legacy. you can participate in the conversation by calling in, posting questions on social media or by e-mailing. tonight, professor chris bell discusses his research on the connection between social media behavior, social divisions online and political polarization. then on her weekly author interview program, "after words", cindy mccain discusses family, country, and her life with her late husband republican senator john mccain of arizona. find full schedule information online @booktv.org. or consult your program guide. now we kick off this weekend with vaccine confidence project founding director heidi larson's look at what

influences the public attitude toward the covid 19 vaccination. >> someone you are all very familiar with. she is a science journalist and award-winning author global epidemics. her book the coming plague newly emerging that 19wl weeks on the near times bestseller list. and her19 new book coming plague diseases in a world c out of balance will be published in august. and get onto amazon and preorderyo that. heidi larson as a professor of anthropology, risk and decision sides at the london school of hygiene and tropical medicine. she's also the founding director of the vaccine confidence project, again headquartered at hygiene and tropical medicine purchase also an author. she wrote how vaccine rumors

start to moderate the discussion he and i have worked together for many, many years. is also the special advisor global health which are prominent scott will engage laurie in heidi in conversation for about 30, 35 minutes. in the open up to q and a. you can use the raised hand icon to ask a question or type it into the chat box. will try get to all of the questions but there is no promise to do that. please ask the question with that i'll hand it over too scott, thank you so much for joining scott. >> thank you so much it's really an honor to host to incredibly accomplish voices

and global health to really help us process all that's happened over the last year but also talk about where it's going and what that means for the field of global public health the coming years. i know many of the students on this college heard me talk more than enough in our time is limited. going to try to speak as little as possible there's a lot of ground to cover. i want to get right into it. as a lot of students on thiss call there's a lot of interest in this field of global public health and international development. where when to start is to get a sense from both of our speakers today, where were you in this all started? what we are working on? what were you thinking about? and tell us a little bit how that change practically and substantively once the pandemic over took all of our lives. laurie, how about we start with you? stu mack was right where i am right now. sitting in my apartment ingh

brooklyn. monitoring reports out of china. i was pulling almost 24 hour shifts because most of the news out of china was breaking it to a.m., 3:00 a.m. 4:00 a.m. in the morning new york time. it started actually christmas day. i became very aware there's a strange outbreak in wuhan. i've only once passed through i've never spent a lot of time there a. i understand it was a major nexus for china. it has virtually all the super fast trains go through wuhan. it is one of the most important domestic airports. 13million people. it's a massively general have a city that large. it's a city most americans have never heard of. and so i was monitoring it and

getting increasingly anxious. by new year's eve i mean i was really freaked out. i thought this is it, this is the big one. at the very least this is sars come back. it might be something worse. but, when i would tweet about it or send out any kind of e-mails about it to keep people i was getting a really, really smashed down, told shut up. one person sent a series of death threats. one person posted on twitter we should skin her live and then toward johor to which i said that is redundant. the mountains of threats i received from scientists, firm random who the heckk are they i do not know, from alleged public, health experts were huge. and yet, by the 30th of december i was aware of

postings. also other chinese scientists for mds actually in wuhan posted. i was just absently dumbfounded as not seeing this reflected in anything from w.h.o. and so as we go into january of 2020, my life is completely consumed with this. there is really nothing else i am doing. it is 24/7. i am absolutely convinced we are looking at a nightmare. i am just not seeing it reflected at the same level anywhere else. i am not seeing people i usually really respect shouting from the rafters. and when i try to shout from the rafters i'm being t told to shut up.

but, the turning point comes generally 19th. when xi jinping himself steps into the situation, choose out, we do not know this publicly but is chewing out the council in beijing. ten the commonest party leadership i've had it, there's coolly something going on a wuhan, we are not getting correct reports from our own people. i do not want to anymore cover up so i hear straight data. the next day we go everywhere from going 30 to 40 cases in all of china. they even have a date they report fewer cases total in the previous day. as if somehow death and not happen when made ata mistake. suddenly on the 20th we have hundreds of cases. we know now that's when the big lier stop or at least phase into a smaller lie and w.h.o.

finally starts acting like there's aal crisis. >> greats, heidi how about you? where were you? what we are working on? how is that changed. >> i was here in london. in the school of tropical medicine to the was some thisrsations about emerging. it was sidelined it was very much like laurie was saying, bits and pieces of information. and then kind of the discussion started something is going on. but i totally agree level of concern did not get going until january. i remember, laurie i was davos at the end of january and

jeremy was there. he was saying this is big, this is big. and was basically was in his room most of the time. and then it just like a flood at some point. and then back in london, the last thing i did where i've been since then. was a ted talk in boston. the first week of march. i was a bit surprised it was going to be in person. but it was. the next week in that same conference on became the hotspot for boston. it was one of these things you

know been here since and then got plunged into it pretty deeply. that great. i think i want to transition quickly to what we have seen over the past year. bert march 10 right now, for a lot of people early march was the one year anniversary. we've obviously seen a number of chapters in this saga. one of the questions i get a lot is where are we in the story? when the sixth inning, where do vaccines fit into that. where are we, where you think we are, can you talk about what the last 30 minutes have been like towards that trajectory?

think the last year we've been following my group has been following a vaccine concerns issues sentiments for the last decade. social media listening and survey work to be focused on covid. was really not on the vaccine to be honest. last spring or shank at the polls on how people are doing with lockdown, with masking. then there was a phone mask -- masks on, masks off, 1 meter, 2-meter confusion in the information environment and then yeah come into the conversation this year is about the vaccine this is just kindergarten.

ben worked with africa cdc in going here the numbers up to the headlines whose not getting vaccinated got global got a long ways to go with china with russia that's just about 20% of what we have a long haulg ahead. who knows how this virus is going to evolve. you talk a little bit how you

seen that evolve over the last year but have the get information, targets consumed by the different peoples of the challenges we take all that incredibly fast movement of information which is this transitional moment around vaccination. with the next chapter looks like. way back last i am on the record at that time saying i felt this was a 36 month battle. we are out of this 13 month out of 36. i would still think that is abouti right.

yes, those of us were fortunate enough to be fully vaccinated may be feeling like the light is at the end of the tonsil. it is heidi just said the light is not anywhere near the end of the tunnel. the vast majority people on planet earth. we still don't really have a plan. meanwhile we have variance as no surprise that are emerging out of places that have a lot lof virus. that is the whole point. we have a lot of virus in circulation, your credit all the proper circumstances your evolutionary selection of vaccine or immune system resistantm strains. 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 which clearly is one of the already approved vaccines. and if we don't get this under control and understand this is a u global crisis, then we are just going to see a constant flow of variance emerging that forces us to develop new fancy boosters that can outdo those variants strange for the rich countries. meanwhile nobodies dealing with the poor countries. they are not even getting their first dose. not just to a second part of your question about word i think we stand with the epidemic? the wealthy world primarily would experience we will see

some particular profit sectors start skyrocketing really soon. the tech sectors coming back braver single into see the construction sectors will all start soaring goldman zach's could predicting unemployment in the night states. get up to 4%. that is like a believable. and with all the blockades on immigration it actually means were going to have whole sectors of the economy desperate for workers. begging for employees after a f period we get unemployment as high as 20% in the city of new york or indio flipped all the way. i think were going to see therefore a lot of let's just forget the epidemic it's in the past now.

but it won't be in the past. roughly 10% some of them will refuse historical racial abuse of key population groups such as the dusky experiments. the off-the-wall spirit see, sorry my friends i'm talking and university it's hard and zoomed to remedy setting, excuse me. so a lot of it will be queuing

on, we are arty seeing a clear party divide partisan divide with partisans less likely to get vaccinated than democrats. that is insane. too that is going to continue to play out. information question, my friend john : who is a writer for science magazine, many months ago when we were in a group 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. incomes information. and it goes until i finally collapse and go to sleep. and it repeats the next day. you cannot keep up with it. and what is new ye can this epidemic that we have never ever seen before with an outbreak, is on the plus side and enormous amount of sharing of information.

these scientists are not holding back info to await prestigious publication. there's anre understanding that in a crisis you must release information. on the downside that means a lot of what's pouring out of that firehouse has ever been peer-reviewed. has ever beenn subjected to scrutiny thatt can help us assess is this accurate? is this crab? are there fundamental flaws in the statistics of this paper the mythology or what have you? all w the things that contribute to it heidi is talking of conspiracy thinking. because if youg. put out a paper that says we are absolutely sure that this particular group that's getting benefit. and then a week letter the paper is retracted as fake or in accurate, but meanwhile he

does come through news cycle after new cycle after new cycle, website after website after website. it's as if it were invalid information out there do a google search and outcomes this thoroughly debunks paper. and we now have a legacy that's built up after a year of a mountain of thoroughly debunked science that still arrests somewhere in the ethernet, in cyberspace. i'm were never to completely purge the mound. and so if you are a conspiracy inclined individual, or if you are just the malevolent jerk, you're sitting in your basement in st. petersburg, russia and your mission is to create distrust in havoc against western governments, there is m so much for you to draw from now. there is just a mountain of bs

out there for you to pluck from all over cyberspace. to weave together thiss elegant conspiracy about how dangerous the vaccines are. or how it masks don't work. or how social distancing is actually population control. go on and on and on. >> great. so heidi let's get into the vaccine hesitancy question. this is a question i get a lot. i was a lot of polls out there something you been working out a lot. one of the features of these polls tends to be the distinction tween will you get vaccinated immediately versus what you get vaccinated eventually. i wonder how movable you think that is. and also to laurie's question, what is the feeling on that? how many people do we really think in the uso and in general are removable on this question what is that mean on vaccines moving forward?

>> we have been pulling on and off in different ways over the past year. it's really up-and-down. were doing it in multiple countries. i do not see any two countries that are the same when you kind of look more subnational is even more varied. and the changes, daniel had written an article early h1n1 pandemic, as it were, she talked about emotional epidemiology. i think it's a really perfect term because unless -- night in june there's less efficacy for the vaccine that it is now. kind of went further down in september and october. there seem to be a bit of a waning pandemic.

and people all they heard was information there is a lot of information about vaccines. we've got a lot of misinformation. there is a bit of increasing confidence around november and december. i think that was a bit with the pfizer announcement, 95% that's a really high efficacy. i think that was a confidence booster for people who were uncertain. the flu vaccinene can be 50% -- 50% sometimes and we're going into a second very serious wave. so i do think that sometimes we underestimate kind of people putting a bit of reason in here. because the ups and downs have very much been constantly weighing their risk. the risk of this brand-new vaccine that has never been made this way before, this new

virus that keeps a changing keep getting different information. and you know looking at that next, and might really at risk? is it worth the taking and a risk for what became an emergencyth authorization? i think a lot more people now are ready to risk than they were. there's definitely a solid group. i think it depends where you live and who you are. and as a whole mix of reasons globally. frankly we just did 15 country perception studies and listening andnd africa, i will tell you almost every single one of the top five reasons for refusing a vaccine could come out of ohio. they could've come out of berlin. they were really, don't trust it. t made it to fast, the speed thing is really -- as a

medical and scientific community we really failed to talk about why it's fast. instead it's like were going to be the first to get there as a vaccine or scientific community, or the warp speed narrative. but there is not discussion about why it was so fast. andss it's fast for good reasons we have some great technologies. there isud budget therefor. there is a fund it was only there because of ebola. weac unpacked a linear process to work in parallel. there are some great innovation. people have not talked about that enough to get less anxiety in a little more understanding. >> if i just add to that, imagine about this time last year we had roughly 200 prototypes for vaccines in some stage of development around the world.

and so far, only to fill far dropped out and said it doesn't work. everything else is still new pipeline are already an emergency approval. and the safety profiles are phenomenal. if you looked at any other vaccine that we have rolled out in recent years including the ones that took ten years to rollout never seen anything like the success of this. and, other than a very small handful people suffering anaphylaxis, of which was life-threatening. all of which was reversed in involve people with prior history of anaphylactic responses to other insults in their environment. other than that, the worst thing people have is that some people on the second dose of vaccine are down with what

feels like the flu for couple days. that is the worst. now i cannot 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. in which people have tended to downplay and say it's not as good asnd the moderna, the pfizer or what have you. it's also the untested in south africa and brazil amid circulating variant strains of virus that could resist neutralizing antibiotics and still performed at 65% -- 70% efficacy. that is kind of amazing, really amazing. we have childhood vaccines that we use that are not that efficacious. right now. >> is to build off that the final question for open it up, moving forward as their case

to be made for vaccine optimism that many people who did not appreciate the value of vaccines before this pandemic now will appreciate it, and that have an effect for broader levels of acceptance of enthusiasm of support for vaccine? infectious diseases in many countries and on the top of people's mind. mack g heidi the abuse well would not? [laughter]r] let me say one quick thing on that and heidi should answer. you all remember back a year ago we had a toilet paper fanatic response. i don't know why i still do not understand why. all over the world people freaked outut about covid the response was to go buy toilet paper and paper towels until stores all over were empty. they had a toilet paper paper towels. okay, i think were starting to see in america's a toilet paper like response to vaccine. all this and people are 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 clambering, can't i getg 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 fat effect. gee i don't feel hip unless i'm vaccinated. i don't know, heidi, you chime in. >> i think there really is a power to what is going on. talking about is the social proof so that when people start seeing really how it can change their life. think we've ever had such a huge opportunity society wide to see the power of the

vaccine. you could have cost effectiveness studies about vaccines up the wild a soup. that is going to have zero impact on public acceptance. when you see it's going to let you go back to school. 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, is a whole ballgame. think there is real potential for changing the landscape around it, if we get it right. >> alright. how how about we take some questions are there questions? >> rates. use the razor hand icon or you can type a question in the chat boxox and we can read that off. >> can you talk louder? cannot hear you. >> sorry, youse can use the raise hand icon or you can

type in yourou question into the chat box. carol, you had your hand out. >> okay. hi everybody thank you for this. my quick theory about the toilety paper knowing is going to work to use their toilet paper that's why all the toilet paper. my real question though is where witnessing about global basis either one of you can 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 aou very political question two. i like to hear what you think. >> i will start and handed out to you, heidi. first of all, of course this

has been anticipated and attempted over and over and over again. we actually have a plethora of multinational organizations in 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. [inaudible] there's acceptance are those that are essentially united nations institution such as unicef and w.h.o. but by virtue of being united nations institutions, they have a voting body that backs them up and that voting a body is the national government.

and so in the ends, you are the president of the united states and all the people who are actually going to implement your policies are the governors of 50 states, and half of them oppose you 100% of politically or in your opposition party and are determined to sabotage you, there is a limit to what you can accomplish by issuing eight fiat or putting out truth at the top if you were going to be undercut every step of the way by the governors. and in a very real way that is w.h.o.'s problem. it is got one had 94 member states and a fair percentage of the states are more than happy to accept services andac information from w.h.o. but don't you dare demand they provide truth back toru the institutionn.

and unfortunately this all in china which right from the get-go which is not providing accurate information to w.h.o. heidi. >> yes. i totally agree with laurie. that's part of the complication right now. actually there are some corners of the world that do not trust global entities who theyin see as counting and controlling basically. i think also in this era we are in, we sent absolutely change publix than a decade or certainly 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. and they do not have a say in it anymore they do not have any ownership of it.

i do think we need credible sources. but it also needs to be endorsed locally. i just want to shout out to heidi. one big learning experience for me this was 15 -- 20 years ago and heidi worked for unicef, as an anthropologist was that shehe taught me about why some parents refuse to vaccinatere their children in places like india, or fiji, or the middle of indonesia. it was so much of the vaccination's campaigns, correct me if i'm misunderstanding what you taught me, he learned from you.u so many of these vaccines are campaigns and the parents would say you know, the only time you come to this village has been you want to stick needles in her children's arms. what about when they have a favor? what about when they have

malaria? where are you and they are sick with somethingy else. all you care about are these needles why should we trust within those needles? >> you got it. what i'm saying before about vaccinations and if we get it right is we are in a point in society now or everybody is fragile at someom level. and if we only get out there for, we've basically gotten the vaccine to the highest risk groups. but now if we start to get more vaccines in the pipeline start to reach a broader society, have got a job to get vaccinated part i mean if you are in marketing not just marketing for instance the airline industry, the flights. he advertised the beach, advertise these destination.

and ide 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 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 your motive is notti just to get that vaccine in their t arm. you actually care about their well-being. there are simple ways we can better and i think we have to make really sure were going to be doing that. we have to counter them thinking it's all about bill gates putting a microchip in them. [laughter] nevermind the factr] that 30 going on with the phony of god in your hand. really it's arty there they arty know everything you're doing. [laughter] who need to put a microchip in you? >> back on the upper second

more broadly from the global architecture perspective, i think historically people on the pandemic preparedness world are familiar with the panicky do-nothing cycle. obviously this is a really big global catastrophe. to think that cycle around investment into long-term public health and pandemic preparedness and into all the issues around trust, truth and understanding betweennd the systemsem and the sort of large entities, public health entities and commuters on the ground, do you think we will see -- would be breaking that cycle? or are we still at risk a few years from now still looking at am pretty underwhelming funding environment? a lot of people distracted by the next crisis is where are we in that story?

spit actually the technology is pushing us to pretty dramatic change. if all of the promises are realized of things i know are very far along in development already, propelled by covid from positions they were probably in before but would have just lumbered through the pipeline for many years otherwise. the show by sometime in 2022 or 2023 show the following technological capacity. number one multiplatform surveillance from a sample from any container rapidly in real-time.

that will allow us to say a while, people are sick in this village and it's a new virus. it's a new that virus, what have you. that will also allow more rapid integration between the animal hosts, the one health approach. the audience here may not all know about one health. but the concept is humans do not exist in isolation on this planet. we are part of an animal kingdom. many of the viruses that we suffer from including this current pandemic come from animals. we can do a lot better for 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 willab be rapid, it will be available. i do think then it becomes the onus is on the wealthy

countries to subsidize distribution around the world so that itd is equitably distributed. in the capacity to use the technology the knowledge pages equitably distribute it. the second thing was clearly happening is the mrna vaccine, pfizer andr moderna have revolutionized the whole concept of how you make a vaccine. so it's already being openly discussed, there iss no reason whatsoever we can't have a window 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 sequence, make the rna peace that are appropriate as antigens, develop the antigen package it, vaccine is done teta. and if the platform is

uniquely used repeatedly the same way than the platform is what is approved by the fda or its equivalent agencies overseas. the platform then becomes the streamlining of the whole regulatory process. sola now you even hear some scientist talking about a seven day window, one week from there is a new vaccine. so that could shift everything sometime in 2025, 2026 to a modality that could actually mean, i cannot believe i'm saying this is someone who spent my whole life screaming about emerging diseases, plagues and outbreaks. it could lead us to a place where the only stumbling blocks to blocking pandemics as we areas experiencing now,

will be about money or resourcesrg and social organizations. there will no longer be any technological peace that's in the way. >> heidi how about you? you think the commitments on the international community f will stay strong over the coming years? o or will be a repeat of 2003, 2009, that kind of thing? >> this is big. we have not seen anything like this since 1918 in terms of a pandemic. and we did not have -- i mean vaccines were not part of the equation then, nevermind multiple vaccines. i think we've got a lots, this is going to change things. maybe in different ways than we expect. but i think this is really shaken upp the planet in different ways. and one reason i think it's

going to remote changes it's not just about health. i think if there is one big failing of the un t response, is that it is to health centric. this should be sitting in the secretary-general's office. this is knocked at every single sector of society. this should involve labor, transport, education, travel, economics, business and commerce. this is everyone. 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 unfold. [laughter] >> other questions i think there are a few in the chat.

sue max of joyce asks about the variance in new york city. and then anthony is asking about any thoughts on increasing information in the press about high body mass indexit correlated with complications and death. >> really still very hard to hear you. i didot not hear second question at all. i think i vaguely heard you're asking about variance in new york in the first part of your comments. if there's any way you can boost your volume or speak closer to a mic it would be very helpful. i'll talk about the variance that's what i heard you ask about. so far we have not seen the new york variance ornc the california variant spread widely out of either narrow location. 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 have probably underplayed. the first is how did it arrive? it was an hiv patient. so we are looking at -- we have large number of people who are immunosuppressed out there for one reason or another cancer treatment, hiv. they can come under certain circumstances carry virus in their body for very long time. this gives the virus a chance to keep trying. you are putting selection pressure on a walking petri dish. that is a big lesson, we have to pay attention to this and think carefully about what were doing that's promoting evolution of sars cob two. as far as the california variant goes, it seems to have h 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 social mobility issues and lockdowns. if so that's good news. and it tells us one more reason that the social measures are effective, are important and must continue. and the only last thing i would say is there will be more variance. there will be more evolution. this virus is not finished by any means pulling tricks out of its bag. we are just at the beginning of our coexistence with sars cob two. >> great the other question was wrong growing evidence around the linkage between obesity and severe covid outcomes. what you think of that? what does that mean more broadly in the obesity epidemic, pandemic were dealing with. >> i will start with that. yes, that evidence is very

solid. i would say there are three things solidly linked to risk of especially dire outcomes if you get infected w with covid. hypertension without a doubt solidly linked. obesity solidly links, diabetes and high blood sugar solidly linked. now those three overlap obviously. people who are obese tend to have hypertension and diabetes. and if you look for diabetes you find it more and obese individuals et cetera. we've not really seen is a lot of good studies that try to separate them. so we can really see with the lead factors are. i have 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 that we have not

taken advantage of wide spread testing for covid infection. as an opportunity to provide direct intervention in the form of the cheapest thing imaginable, cuffing an individual sing with her blood pressure is an offering if they have high blood pressure saying hey, before we give you your covid tests would like you to go over to tend to where you are going to get an intervention regarding hypertension. you're going to be offered free cardiology workup, free access to anti- hypertension drugs and counseling about nutrition. and similarly we should have been a pin pricking people as they go in for a covid test to see if they have diabetes or free hyperglycemic. so they could also be diverted to interventions. and in that way we could have radically address the two big

epidemics this morning all along with high blood pressure and diabetes. >> to think diet and lifestyle are sort of b a big indicator here around different countries, different outcomes that we are seeing? maxor 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 infected is very likely to end up in icu. great. any other questions, comments? say mech there's one question i got in a direct message i'm not really sure who sent it. but the question has to do with kovacs. i'm curious about this as well. number one, how does kovacs work? and then seconds, the question is the country of georgia was

commentingen that their membership in kovacs means they cannot buy vaccines independently. but they're also not low income enough to get vaccines early so they are stuck in this gray middle. laurie and heidi, can you talk aboutut how global access is being managed or prioritized? heidi you take it. >> okay. well let's l see. it's not -- could not be true that you couldn't get your vaccines somewhere else. because they're only giving up to right now up to 20%. africa right now is developing their own to try to meet that 20 -- 60 or 65%. it is not enough to go around. they are trying to extend that limits.

not exactly sure what that references too. i do not know how much of that -- there's a different europewide arrangements and kovacs. but the principal ensure that a lot of countries have put funds into a facility to bring down, to basically try to procure at scale, which brings costs down. and then apply for the vaccines as they become available. but it has been off to a slow start to say the least. and people putd funds in there for a mix of vaccines because it was a gamble. a lot of countries put money onto, i mean is like gambling. put your money on a bunch of different cards and hope that one wins. that is what some countries like canada and some other

countries, with the u.s. it's different with the arrangement there. you do not know which ones going to get to the finish line. so now that is starting to come up. but laurie you want to weigh in there, i did very simplistic version of what the principlenc is. but, it is playing out slowly. >> is just a step backward in 2009 we t had the swine flu h1n1 flu pandemic. in the beginning a it was thought to be a very dangerous influenza, later fortunately turned out to be a pretty routine, garden-variety flu though simply far more contagious than usual and did indeed spread to every single country on earth and about six months. but what we found that the vast majority of the planet either never got vaccine forgot it after their flu had come through and passed on. this led to tremendous resentment against the countries who are perceived as

hoarding flu vaccine early on. so, the idea was can we come up with a mechanism that allows us to widely dispersed the vaccine and equitable fashion around the world. kovacs really came out of a small meeting of adf handful of individuals and davos atvi the world economic forum including seth berkley who runs the global vaccine alliance, doctor tenders who runs w.h.o., the folks from the world bank. the folks from the global fund to fight aids and tuberculosis. the idea was can we come up with a mechanism that can ensure some kind of equity? that was the intent behind kovacs. 194 nations have in fact sign onto the kovacs mechanism. either committing to abide bite and provide funding and

vaccine, or committing to receiving vaccine. the problem of course is everybody soon as they heard johnson & johnson has a vaccine, novak has a vaccine. moderna, whoever. everyone started placing orders. and the orders at the front of the line were the ones that put the most money up front. set up cannot ship put in enough orders to vaccinate i believe every single canadian four times over. the united states has put enough into vaccinate every american i think two times over. the uk is up around three times over in theory. and so on. this of course means chad has none. molly c has zero. vietnam struggles. where we arere 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, absalom refused to participate in any way, shape, form. one of the first things biden did in his first week in office was to commit $4 billion of u.s. money to the kovacs effort. i assume that money will process through the next three or four months without certainly help. certainly look heidi mena better than i that funding is essential to outbidding the rich countries to get actual vaccines in the facility for distribution to poor and middle income countries?or >> i can take a quick stab at the georgia question. i think one of the challenges for countries classified as upper middle income they do not qualify for discounts and vaccine n for the challenges for

these countries stuck in the middle. more generally i think people have been talking about this for a long time i feel like kovacs is both an incredible success and a disappointment at the same time. they're doing much better than a lot of people predicted the silver really long way to go. that's we are now. so i think that is what the open question moving forward is how to these countries make up this gap? make up this shortfall for access to vaccine. just add to that. we see a lot of things playing out as heidi said earlier that do not f fit prior patterns. i mean who would've thought the country with the worst epidemic be the wealthiest country in the world. but it's also the third richest country on the planet has almost no vaccine and cannot seem to get any, that is japan. : : : f

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, o >> i want to thank you for moderating an interesting discussion. lori got it right saying we are overwhelmed with information and i still was very surprised and learned a tremendous amount. a big thanks to you and a big thanks to heidi for joining us.

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