Council on Foreign Relations
New York, NY
SHERYL WUDUNN: Well, this is the last panel of the day. You have all talked just about the business community, so now we get to look into a crystal ball with my panelists here.
My name is Sheryl WuDunn. I’m an editor at the New York Times. And to my right is Laurie Garrett. Everybody knows who she is. She’s an expert on HIV—(inaudible)—security.
To my left we have Huang Yanzhong. He’s a professor at Seton Hall University and specializes in bioterrorism and infectious diseases.
And then to my far left we have David Malpass, who is an economist at Bear Stearns—the chief economist.
So for today’s—for this afternoon’s session, picture this: We are looking at the post-pandemic world—130 million people have bird flu—have flu—have died from the flu. Everybody probably knows someone who is dying or who is dead. About 2 percent—at least 2 percent of the world’s population has died from it.
And we are now going to figure out what we do. So the first question I will raise for our panelists is, please spell out the worst-case scenario, Laurie.
LAURIE GARRETT: Oh, goodness. You know it is axiomatic in American politics, and probably not just American, that when a situation comes to have a great deal of public attention, and rises on the agenda to the point of being one of grave concern at the highest levels, there is eventually a backlash—a naysayer backlash—that says that those of us who talk about such scenarios are, to use a very bad, tasteless pun, chicken littles.
And we’re already seeing that backlash actually. In the last—in the last—this week we’ve seen long editorials in both the Washington Times and the Weekly Standard denouncing this institution and our recent publication in Foreign Affairs on pandemic issues and denouncing some of the individuals in this room by name for raising the alarms.
So I say that only by way of saying, before launching into worst-case scenario, I want to be very clear that I consider this a remote possibility.
Nevertheless, a worst-case scenario—we’re now looking at a virus that claims 55 percent of the humans it infects, but has a very low what’s called attack rate—a virtually zero attack rate—in terms of the numbers of humans likely to get infected by the virus at any given moment.
If—one of the things that was very important that Robert Webster said to us this morning was that we don’t know—there is actually no biological understanding of how much the virus would have to give up its virulence—its capacity to kill its host—in order to have a very high attack rate.
Let’s consider an attack rate in the range of 50 to 60 percent of all human beings that might be exposed would become infected, and half of them develop symptomatic disease—just a ballpark way of looking at it.
So if we’re going to look at worst-case scenario, you would be imagining that the virus—H5N1—would not need to lose almost all of its virulence in order to acquire a high attack rate. So let’s just assume a logarithmic loss. So it goes down from 55 to a 5.5 percent mortality rate and with an attack rate in the neighborhood of 50 percent, with half those people having symptomatic disease.
So you could do the math. You end up with such staggering and enormous numbers of human beings both severely ill and dying and then, among survivors, judging by what we’ve seen with those who have H5N1 so far, a significant percentage of them would have very difficult recuperative periods—(inaudible).
Suppose 150 million people have died. Let’s just take that as a given. Now, people are panicking all across the world—not just in the U.S., all across the world. People are running out—fear of the unknown. They are clearing the shelves of peanut butter, of water, of crackers, of anything they can get their hands on. They are not going to work, because they don’t want to, you know, take the subways; they don’t want to go into any place where there are other people.
What is the government doing? What—the hospitals are overflowing. There’s chaos.
You know, I felt that some of the responses in the prior session were perhaps lacking the same level of that imagination as I see in some of our government response. So let’s really seriously think about this.
You know all you have to do is say there’s meningitis in the high school next door, and long before any school systems are closing the schools, the parents have all taken their kids home, and they’re not coming back until somebody intervenes with an answer.
So let’s just for a moment think about this. If tomorrow there was word out of Hunan province, just as a random choice—semi-random in light of the three cases confirmed today—one death. But at any rate, one of the—(inaudible)—Hunan province, and what we are hearing is that there is widespread bulk purchasing of vinegar and that all the stores are out of vinegar.
Why vinegar? Because in China it’s widely believe that vinegar protects you against infectious diseases, and people drink it; they wash themselves with it; they do all sorts of things with it. All right, so vinegar—so first, before we start hearing this, that there’s panic purchasing of vinegar throughout Hunan province. And from there it begins to spiral into more information that seems to indicate that the government in China is not confirming something, but we’re getting Pro Med (ph) reports; we’re getting Internet accounts. Some independent news organizations are trying to get into Hunan and are sending reports out, and perhaps some companies that have—multinational companies—that have businesses in Hunan would send information out through their own networks, the sorts of things we heard about in the prior session.
And so all of a sudden what happens? Well, first of all, way before anybody says, we’re closing airports, or we’re shutting down our flights, all flight unions say, uh-uh, we ain’t flying to China. And you are going to find that every kind of air delivery system that you count on, whether it’s FedEx and UPS and that sort of thing, or various kinds of Chinese transport systems, these will suddenly come a halt, because people will not want to go where it is known that there is now human-to-human transmission.
But it can be well presumed that long before it’s identified that there’s an outbreak in this one site in Hunan, it has, in fact, already managed to escape that area.
WUDUNN: At what point do you think this starts to happen?
GARRETT: Oh, I think that escape, if you are talking about China, or if you are talking about Jakarta, as we were in the first session, escape has occurred before you know you have a problem.
WUDUNN: Dr. Huang, let me turn to you. You probably know a lot about China. Good luck in the situation.
YANZHONG HUANG: Thank you. I hate the worst scenario. But, as we all know that—
WUDUNN: We’ll get to the realistic—
HUANG:—trying to prepare for the worst how many times.
But in terms of the worst scenario, I would imagine, indeed, if there is some outbreak occurs in China, preferably in Guangdong (ph) province, or in urban center of Guangdon (ph) province, in—during China’s spring festival, we know this is a time that, you know, the Chinese migrant labor will return to their homes for the spring festival.
And China has 130 million people on the move. Just imagine that the crowds in the trains, buses and stations, and also so many people on the move, actually will exaggerate—exacerbate the crises, so people, before you got to—(inaudible)—would carry the disease, traveling all across the country,—(inaudible)—also to Hong Kong, to the entire world, the consequences, of course, will be disastrous for China as other countries impose restrictions on trade and travel. China’s economy would be seriously influenced, and eventually that is going to affect its manufacturing sector, which I think takes about a hefty 35 percent of its economy.
So the effect will be disastrous, and not just the economic impact; it’s also going to hurt the regime’s legitimacy, because we know that the regime’s legitimacy is rooted in its ability to deliver economic growth. Now, the economic growth is hurt, it’s eventually going to hurt the political legitimacy of the communist regime. So in that sense, this is going to cause probably the most serious social-political crisis for the Chinese government.
And in the meantime the international impact is also going to be felt in Jakarta, East Africa, in the United States. In Jakarta, I didn’t attend this morning’s session. I believe probably you’ve already talked about that, given those widespread communal religions and ethnic conflicts in that region, and given that this—the countries, the governments in this region, do not have the strong capacity to maintain social, political and—political control. It is very likely the pandemic is going to be playing into the hands of the Islamic radicals, terrorists, rebels and pose a serious challenge to the—nascent democracies or—(inaudible)—regimes in this region.
So the impact also could be disastrous. In the meantime, let’s return to Africa. Now again, here, you found that many of the countries in this region do not have the state capacity to ensure political, social, economic control. In fact, many states are actually failed states in the sense that they are even unable to deliver even the minimum requirements of being a state.
So the fact is that if the pandemic flu spread Africa, it’s going to exacerbate the humanitarian crisis that is reaching, destroy the local economies and eventually, I would say plunge the entire—this region into like a Hobbesian war of everyone against everyone.
WUDUNN: Will we see more deaths in places like Africa and in developing countries that don’t have any kind of antidote or don’t have a system set up to do containment, any kind of control?
HUANG: Well, the uniqueness of the sub-Saharan Africa is that we all know they have a serious—(inaudible)—of HIV/AIDS. While we still do not know how the HIV/AIDS will interact with the H5N1 in human bodies, I’m pretty sure that this is going to magnify the disasters—political, economic and social consequences of the HIV pandemic.
So in that sense the effect is also disastrous, I would think.
WUDUNN: David, it—after SARS we saw that travel was—the travel industry was killed. I mean CAFE reported passenger traffic dropped from like 55 percent to like 45 percent overnight after SARS. Hotel occupancies were way down in the region.
What will be the economic and the—the impact on businesses of a pandemic?
DAVID MALPASS: Cheryl, I’m happy to be here. And I’m a late addition to the panel. I’m not an expert on pandemics. And so I’m going to have to participate in the discussion and think it through as we go.
WUDUNN: Possibly none of us are experts.
MALPASS: That’s right. We don’t have much experience, though the human race has been through some terrible times in terms of war, in terms of Stalin and the deaths in Russia, which were huge, and Mao in the deaths in China, which were huge, and on down.
And so I guess one of the things I would stress is the flexibility of both economic systems and of human nature in dealing with something new, and even if it’s terrible.
Now what we saw with SARS, remember, was a short-term rather abrupt economic slowdown for certain parts of the world as people paused and started sorting out what were the facts. And so I think there’s a natural immediate reaction, a risk-averse kind of reaction to assume something is particularly bad and then begin to analyze it, begin to apply technology to it, begin to try to deal with it and protect various parts of the system.
Now, within the world economy, there’s quite a bit of that kind of behavior that goes on all the time. People have thought about what happens if a nuclear weapon goes off. They’ve thought about what happens under severe terrorist kinds of incidents, so we have central banks that are expected to provide liquidity under world crisis-kind of scenarios;we have banking systems that have insurance.
So we’ve seen, one of the things that happened prior to the Great—or during the Great Depression was that bank failures were—became a natural outgrowth of other things going on and became self-fulfilling.
That probably wouldn’t happen. We’ve seen some pretty terrible economic collapses in the last 20 years in various countries, and yet the people leave their money in banks, because at least that part of the system they trust.
So from a financial standpoint, you could expect to see an equity sell off, and then a lot of people actually taking the reaction of they want to buy the crisis. Now, we don’t know how far that would be. That would certainly be disruptive.
But I have trouble having the economy get us to the worst-case kind of scenario that you are discussing.
One thing I think we should worry about is, depending on what actual science comes out of this or what the facts are of the actual virus, is some degree of deglobalization. We have to recognize that some part of the world’s growth rate over the last, especially 10 years—15 years, has been the open communication and travel. And to the extent that is reduced, that would be a negative.
Remember, that was the big worry about 9/11, the idea that people wouldn’t travel as much. Well, and that actually happened for a few months after 9/11, and then the systems began coming back.
So I guess that would be, in my view, the general nature of things, a very severe initial negative reaction, followed by flexibility and a response.
GARRETT: If I may, one thing I want to be sure we’re understanding here is, a pandemic is not a hurricane. It doesn’t come once and then you deal with the aftermath.
What we would probably be looking at, because of the very, very mobile nature of our world today that might be a little different from 1918, but the 1918 helps informs us about, is that a pandemic is a long-lasting event. You’re looking at something between 18 and 24 months of waves of virus and waves that will sweep over parts of the world in different way so that, indeed, the wave would be like a mosaic of variable epidemics at any given snapshot moment, and the virus itself would not be a stationary object. It would be transforming itself in waves.
Indeed, in 1918, the first wave that went around the world was mild enough that the British high command in World War I dismissed it as an irrelevant confounding factor in their war effort. It was the second mutant wave that came through that proved to be the truly lethal one.
What we don’t know today is—would—you know, would a pandemic today play out the way 1918 did? Or would we, in fact, see hundreds of wavelets, if you will, and multiple forms of virus circulating at once?
We can’t even, for example, say—I don’t think there is a biologist with any credibility that could answer the question, would a vaccine directed against the first-wave form of a circulating virus still be effective against a wave form that happens to come back to the United States 18 months later? We don’t actually know the answer to that question.
So when you think about the political and economic impact, you have to be imagining economic resilience that, you know, David was talking about surviving through an event that is trauma after trauma.
So you think, for example, New York City. We might have a wave come through, have a devastating impact, traumatize the society, and then we have a breathing period. And people try to get back to normal for some amount of time. And then just as they think they’re coming back to normal, they are traumatized again by another wave.
Each trauma has an economic set of repercussions, a political set of repercussions. And then the other piece of this is that, as things proceed, history shows us, we see an erosion in trust in government, because government isn’t able to wave a magic wand to instantly solve the problem and protect you and your children. And you find that more and more the protection and the safety is what you can do in your own home, what you have in your own wits, what things you can dream up to protect you and your own family.
And I think that then you start asking the question, how can government intervene to protect economic structures if, you know, the very relevance of government is being questioned by the populace.
Finally, we’ve heard a lot of talk today about the whole question of just-in-time delivery systems and how they would be disrupted. Let’s think about this for a second. We’ve got an entire global economy now that’s based on—everything gets made in China, and we don’t make anything. We just buy.
I live right—I bicycle all the time down along the waterfront in Brooklyn and sometimes sit there under the Verrazano Bridge watching huge ships, fully loaded, sitting low on the water coming in and huge ships, sitting high on the water, completely empty, going out.
What happens to that economic model if (for ?) two years that trade is disrupted?
WUDUNN: Well, even—yes, I mean these are some of the interesting issues that I think if we take sector by sector, I mean we will have to raise the issue of whether or not it will happen. I mean, will trade stop and not only international trade, what about inter-state trade?
Let’s talk about, you raised the role of the government and the erosion of trust. What about—we saw what happened with Katrina, that there was even interstate in-fighting. There was certainly cooperation, but there was also a lot of divisiveness. What happens in this kind of situation where you have state versus state pitted against each other?
GARRETT: Every single tabletop exercise I know of—and if there’s any—there are plenty of public health people in the room here who can correct me if I’m overstating it—but every tabletop exercise I know of that’s been carried out for a bioterrorism threat or an epidemic threat in the United States eventually results in some political leader deciding to close some kind of a border. Either a whole state closes off itself against a whole other state, or a city gets on shut down. And, you know, officially, there was no quarantine or martial law in China during SARS. But I was there. And I tried for days to drive out of Beijing. It was impossible. Beijing was indeed under martial law. It was indeed under mass quarantine. You could not leave the city for several days at the peak of the SARS epidemic there.
And that was an obvious reaction by that government. And I think we will see all over the world that governments, based on their own sort of, you know, ideological trends and the style of government we’re looking at, you know, wherever it may be elsewhere in the world, will take actions that will be very severe, because they want to appear to be doing something.
They won’t have vaccine stockpiles. They won’t have drugs stockpiles.
WUDUNN: Even basic necessities—syringes, latex gloves that are all made in China—
GARRETT: Well, let’s talk about food. How much of what we all had for lunch here today was actually grown in the state of New York?
MALPASS: May I interject? So the U.S. is the world’s biggest exporter by far. It’s not correct to say we don’t make things in the U.S. The U.S. makes—has a vibrant, strong manufacturing sector of the economy. And I think there’s a little too much emphasis being put on the inadequacies on the U.S. side.
Obviously, it would be a traumatic change of how global commerce runs if you had multiple waves of an infectious disease, and it turned out that technology didn’t offer any of the responses.
I’m not sure—we haven’t discussed, and I think it’s relevant to put the probabilities in. Are we thinking that this is at all a probable scenario so we’re dealing with a very low-probability scenario.
And there are a lot of other terrible scenarios that we could lay out, from nuclear terrorism to other things that would also be low-probability scenarios. So maybe those can be put into the same—
GARRETT: But none of them would be global in scale except for a nuclear exchange. Only pandemic flu is really the whole world is a single ship sinking or swimming or whatever it’s doing together.
HUANG: I want to point out that actually the economics of the epidemic remains underresearched or underexplored. While we recognize that the pandemic flu, if indeed it occurs, could cause demand and supply shocks to the economy. We also need to keep in mind that sometimes these apparently obvious microeconomic effects not likely to be reflected in the macroeconomic data.
For example, the—we say that pandemic flu is going to cause a demand shock because of the change in people’s consumption and social pattern. But, you know, in the case of pandemic flu, it is also likely that people, when their time horizon is shortened, they adopted this, you know, today-we-drink-for-tomorrow-we-die attitude, it’s very likely that this is going to increase the demand—you know, the consumption.
Also, I want to point out that this negative shock to the population growth is not necessarily a negative thing—sorry—
WUDUNN: No more energy shortages.
HUANG: We saw, actually, a historical example—Black Death, you know, caused this traumatic shock to the population growth, but that didn’t cause economic downturn. In fact, because they are now—it only attacked maybe the weak, you know, the young, actually while the people—in the economy, the prime age remains standing, then that you have fewer people sharing the wealth, you know. And in the meantime that leads to the fast accumulation of capital that actually—it’s good for the economic growth.
In addition, I want to point out, again,—(inaudible)—the Black Death case, you have now a small number of—smaller number of people, then, that would provide incentives for technological innovation.
That is exactly what happened after the Black Death. We saw the invention of the wind and water wheels, and that eventually gets us out of the feudal state.
WUDUNN: Well, I’m looking at this altogether. I mean SARS in some ways did force a lot of people—scientists—to come up with the genetic—they broke the code very quickly. Laurie, you’re saying a number of things about—a pandemic is the first time we’re in international—it affects the whole world. And then, David, you are saying, well, you know, let’s make it a realistic scenario.
The (S&P ?) has said that, in their vision of what might happen 40 percent of school age children will no longer go to school; health care costs could hit $181 billion in one year; GDP could lose 1 percent of the world growth around the world.
So let’s, now, look at the probabilities. What is a realistic play out of the pandemic?
GARRETT: Well, you know, it’s interesting, we’ve have numbers all over the place. Asian Development Bank’s estimate released last week was a pandemic would cost the Asian economy $400 billion.
The World Bank’s report, also released last week, got a little misunderstood in a lot of the media coverage. Their figure was 800 billion (dollars) in cost, but that was just Asia. And then another 550 billion (dollars) to the OECD. And then they stated we can’t make an estimate for Latin America, Africa, et cetera.
So, you know, you are getting up over a trillion dollars there. All of it is predicated on somebody’s, you know, data input into the computer that starts out with, what’s your attack rate on the virus, what’s the virulence on the virus. So it’s all garbage-in-garbage-out—you’re just guessing.
I—you know, I think what is more useful to focus on when you try to figure these things out are—some of the things that have been touched on here I’ll just go a little bit further.
Africa, in particular, worries me deeply. Africa has, as we all know, and is well documented by now, virtually the most fragile public health infrastructure in the world. In many parts of Africa, it really doesn’t have any infrastructure to speak of.
And with some parts of Africa having HIV prevalences well above 30 percent of the adult population, us now knowing exactly how HIV and H5N1 will interact—it could go a number of ways—but anybody who looks at it, Africa could be truly devastated, and we could be looking at a world in which the whole continent of Africa plays a very, very different role in the world in, you know, two years down the road.
The other thing to think about is, the wealthy nations may be able to, in the midst of crisis, and I think they will, come up with some technological innovations very rapidly. You know, the feet will be at the fire of the biotech industry, the pharmaceutical industry, to come through. And government will, indeed, create numerous incentives to make that possible in that panic moment.
But I think it’s virtually a guarantee that unless there is a very adamant political agenda on the table today that pushes things in an appropriate direction, whatever innovations do arise will only be available to, you know, the nine wealthiest nations in the world, and you’ll see a higher survival rate as a result for those who are fortunate enough to happen to live in the United States, Canada, Western Europe, Japan, Singapore, a handful of other places.
And then we will all deal with the foreign policy impact after the fact of how the rest of the world—particularly our immediate neighbor to the south, Mexico—feels about the fact that we had a higher survival rate and we were not in the position and did not consciously from the get-go in the beginning of our technology and our financial commitment, plan for sharing the assets.
WUDUNN: I want to get back to that. First David, I wanted—you mentioned that you could have a few other scenarios. Can you talk about those—the realistic ones?
MALPASS: I think a scenario is that there’s an initial very negative effect and then a recovery process as people sort out the technology. And from the standpoint of, say, GDP factors, the numbers that we’re talking about are within the context of a global recession. In other words, those happen periodically.
So in a way we may want to say—it’s not the—clearly the world’s not going to stop; it’s going to be a horrific case if this actually materializes. And we still have to deal with that it’s a very low- probability scenario that we’re talking about here.
I wanted to—I wanted to go into some of the variables on the response. It seems to me that panic is a critical event. How do you not have panic?
So when England was facing the rockets coming from Germany early in World War II, they managed to find a way that the populace didn’t panic. And that’s clearly going to be one of the issues if this becomes more serious.
Communications planning—I think it’s useful to have the types of planning that your conference has been doing today.
WUDUNN: Well, that is the last question I wanted to address here before we open it up for questions. What steps can we take now, given that we can envision some kind of scenario? What steps can we take now?
MALPASS: And so—technological exploration right now, which is good.
One of the positive side effects of this is there’s more—there’s a lot of communication going on, so this is truly one of those issues where multilateralism is critical, is necessary; everybody agrees on that, and it seems to be working. There’s a lot of communication. We may see some big scientific advances before the probabilities actually play out on a—on a infectious process. That would be a huge scientific advance. So I’m thinking along those lines.
Also, simply the global leaders emerge as the crisis—we don’t know today who would be the best communicator and the best global leader in the crisis scenario, and it may surprise that someone comes out and actually talks sensibly, communicates loudly and so on during the crisis. Those are thoughts.
HUANG: I would say that even as, you know, the lack of surge capacity—Mike’ll like this term—(chuckles)—the widespread lack of surge capacity, especially in the developing world; it’s not just this lack of surge capacity, but also in general, this lack of spare capacities in handling a potential crisis like the pandemic flu. I think it’s imperative for the developing countries to beef up its capacities in addressing this potential pandemic flu. Certainly it’s important for those countries to mobilize more resources in handling this potential pandemic. But in the meantime, given that those countries don’t have these financial/administrative capacities, it’s important that these capacities can be brought from outside.
These exogenous resources are also very important. That is why I always believed that international cooperation is important. For the developed countries, including the United States, it’s in our interest to provide the support necessary; financial, administrative, technological support, to promote a transparency, accountability, to help train the medical personnel. Also to help them to develop the capacities, to develop the vaccines, and antiviral drugs; I think this is also very important.
WUDUNN: Laurie, so how much money should the U.S. cough up for this planning?
GARRETT: Well, I don’t—I was going to give you a different answer to your other—
WUDUNN: That’s fine—
GARRETT: Let me agree with most of what Dr. Huang said. I think he’s right on the money, and let me add, right now, we have the first sort of baby steps in formal international agreements being made, beginning with what I think will prove to have been an historic meeting between Hu Jintao and President George Bush in September, in which they mutually agreed on the 10 core principles of pandemic response. And as of last week, 88 nations have signed on to these 10 core principles. Well, the number one principle is total transparency and exchange of scientific expertise and information and so on and so forth.
That is a great start, but what we really need to be doing now is going the next step to truly negotiate in advance some rules of the game internationally, so that the international trade regime does not collapse; so that we don’t see countries thinking that they have a legitimate right to completely shut off certain borders or, as we’ve seen in the past, certainly, with HIV and with Nipa virus in Malaysia and so on, to use an epidemic as an excuse to exercise punitive controls of subpopulations within their own societies that they’ve long sought means to control.
We have to create some rules of the game, and we have to have some sense of what do you do about the violators of those rules of the game; the countries, or parts of countries that absolutely refuse to play in a global community. You know, what we’re really looking at now is we’re entering the age of globalization. We’re in the age of globalization economically and in terms of trade, but we’re just beginning to tiptoe into it in terms of true global cooperation outside of economic sector. And this is—
WUDUNN: Well, we—(inaudible)—to test it.
GARRETT: This is the test of all tests.
I’d like to open up to questions, but first I would like to hear from Washington, if you all don’t mind. Washington?
QUESTIONER: (By telephone.) Thank you very much. I actually have a quick question. We know that the perception of infectious disease is different in different countries, and that’s primarily because there are many countries out there that people die of infectious disease all the time. And I wonder to what degree that would impact the ability for the economy and people to get back to work and function. And thinking about would we have an advantage in economies where, say in India or China, where they’re used to having a higher toll in health status and impacts than we would in, say, the U.S. or other developed countries where—where people might have much more residual fear for longer. And how would that difference ultimately impact the resilience and getting back to work after a pandemic were to have occurred?
WUDUNN: Dave, do you want to—
MALPASS: Just a small comment; that the U.S. has moved extremely to—an insurance system away from “buyer beware,” or away from—it’s an extreme risk aversion here that may hobble us, if we’re presented with that. You can imagine a U.S. calculation that if there’s any chance of any deaths in this business, we’re not going to have anyone come to work, whereas in India or China, they may say, you know, there’s risks all the time; we’ve got to keep moving ahead.
GARRETT: In fact, you know, during the SARS epidemic, one of the reasons China had excellent GDP growth during the quarter in which SARS was circulating in China was because the Chinese factory owners basically said, Workers, this is for your own good. There’s a bad virus out there, so we’re locking you all down inside the factory—(laughter)—and really, you shouldn’t ever go outside. It’s very dangerous out there. While you’re all locked in here, we’re going to increase the production schedule.
GARRETT: So they had warehouses just ready and packed to the gills the second the word came out SARS is over, flood the markets. And so we do see really different—
Let me put two thoughts in response to that excellent question. One, you know, I worry very much about parts of the world where the background rates of infectious diseases are already very high. If we don’t have an affordable diagnostic method to tell who has flu and who doesn’t, how in the world do you differentially diagnose? I mean, there’s physicians in the room; anybody got a genius idea, if a patient walks in and their symptoms are high fever, dizziness, loss of appetite, muscle fatigue and weakness. You want to list the several thousand diseases that might be? And if you are in a place with a background of vivax malaria in Indonesia, or you have got a background of falciparum malaria and tuberculosis in Africa and so on, you know, you’re going to have a really hard time sorting out who are your patients.
And then the other issue is, in terms of who might have an advantage here, on the flip side is, you know, in America and increasingly in Europe and Canada we’ve really lost our sense of community. Most people in this room probably don’t know the names of their immediate neighbors who live physically near them, and you don’t know much about them. And if you live in an apartment building, you probably don’t know who else in the building is infirm and would need help if there were a fire to be carried out of the building, and have a sense that you’re part of a community. So we kind of blithely assume that either government, whatever that means, or your company or the school district will somehow take care of you and your loved ones, because we are so divorced from the notion that we’re part of a community and we’re supposed to help each other. Whereas in many parts of the world that notion of community is very much the concrete basis in which how day-to-day governance proceeds and, in fact, in some parts of the world the local community leaders are far more powerful than anybody higher up in the political system. And they may actually have greater capacity to pull together and find ways to respond, keep the food supplies moving, and keep the supply chains moving, simply because they have that sense of community.
WUDUNN: Witness the contrast in reaction to the tsunami and what happened in New Orleans. That’s an interesting—
GARRETT: America was willing to watch a lot of people sit in an Astrodome.
HUANG: Thank you. I think ( Lydia ?) raised a very important question; that is, how to maintain the basic services with a reduced labor force? Because if you look at the study conducted by Asian Development Bank, basically this huge attack rate of 20 percent, that is very low. In fact, we know that the pandemic flu, if it strikes, the range of the attack rate would be between 20 percent to 40 percent. And yet, according to a study, if the infection rate, or attack rate, is over 25 percent, then the food and fuel supply, those basic services, will be seriously affected unless we find a way to maintain those basic services with a reduced labor force. And I think this is the challenge we now face.
QUESTIONER: I’m Dan Sharp with the Royal Institution World Science Assembly.
Sheryl, you asked us what should be done, and I wanted to very briefly describe the three kinds of things that our pandemic preparedness project is planning, and ask for comments or advice or participation.
The first is to continue alerting the world to the updated situation. We’re very proud that our partnership with Foreign Affairs led to their special issue, with support from the Stone Foundation, and we’re planning some sequel publications and some meetings built around those in cross-sectoral workshops around the world to try to get more integration among the different sectors.
Secondly, and perhaps more differently, is we’re considering a global tabletop exercise that is cross-sectoral, in order to bring corporate leaders, NGO leaders, media people, together with the government people. It’s a transformative experience that will give a greater sense of reality to what the gaps are and the sort of things Laurie was mentioning about their leading to a realization of what’s likely to happen.
And as part of that, we’re thinking of creating sectoral working groups that would be committed to developing action plans for their sector that would be discussed during the tabletop, and we would hold them accountable for producing action.
These are three sets of things that might be done. We welcome comments on those or others that perhaps we can do, rather than just wait for government.
GARRETT: That’s not a question—
HUANG: We’ll take it as a comment.
WUDUNN: Well, but you can respond. There’s a dialogue going here. Anybody else have a question?
QUESTIONER: My name is James Tunkey (sp), Eye on Asia.
Thank you to the panel for your comments today. Beginning with David, my question’s for the panel. What do you see as the weak points in economic resiliency? And I would pick two countries; the United States and Indonesia. Thank you.
MALPASS: Simply thinking out loud on this, it seems to me that the financial system may not be the weakest link, nor the dollar; that it’s actually the physical distribution systems, and this just-in-time issue. So we have a whole global economy set up on the idea that the flow continues.
So my thought we be, that would—I might worry a little less about what the equity markets and the bond markets and the banks and so on do, and worry a lot more about how do you keep the dimension of the border closings and so on?
Now as far as—well, and then simply that daily security issues would be clear focuses. I don’t know; in Indonesia, what’s your reference? Would it fall into civil war?
QUESTIONER: It’s just that a country that’s not the United States.
MALPASS: I see. Taking—well, I think this goes to the community spirit that—so we’re all human beings around the world, and lots of people are flexible and face crises, as we’re seeing in Pakistan right now. This is a true, gigantic crisis going on, from the earthquake in Pakistan.
And so I guess my thought is, you get a lot of common reactions from people around the world, and the physical side of things is probably the most important and the most immediate, and one that maybe people can deal with. You know, it’s not something super complex; it’s something very direct, of how do you keep things flowing when people are sick?
HUANG: May I just add?
HUANG: I think, again, it depends, in terms of the social impact, you know. We know that the Spanish flu in 1918 actually, in a sense, increased the social cohesiveness in this country. You know, when people lend hands to those who need help, naturally it increased—it didn’t cause any social breakdown. But for those countries like Indonesia that do not have a robust civil society or well-functioning government, I mean, that would cause some big problems.
So I would propose that maybe in terms of social impact, in those countries that have a strong state or a robust autonomous civil society, the impact would not be that serious as compared to countries that do not have a strong society or a strong state to maintain social, economic and political control.
GARRETT: Any other questions? Oh, please, actually, here.
QUESTIONER: I have a question for Laurie. What would you do differently if you were in charge of $7 billion administration funding?
GARRETT: Oh, goodness. (Laughs.)
All right, so the president put out a $7.1 billion budget proposal for 2006 for dealing with the pandemic flu threat for America. I guess I would say that I’m distressed to see that only 4 percent of it is aimed at dealing with the international picture. It has been referred to in interesting ways.
In testimony to the Senate Foreign Relations Committee last week, Undersecretary of State Paula Dobriansky said, Well, our thinking is that we’re using this to leverage donations from other, you know, sectors of the world so that, you know, Britain or the E.U. or whoever may also pony up. The E.U. has ponied up 34 million (dollars); we, 251 million (dollars). There is a $500 million announcement out of the World Bank. And as far as I know, that’s just about it. The rest is pretty small potatoes, after that.
That still is a fairly modest commitment, if it is a one-shot, one-time commitment to trying to deal with improving all of the surveillance, animal control, response capacities, basic public health services and everything of all the developing countries in the world, or even the key areas that people have been talking about in Asia. So I’m a little distressed that it’s so overbalanced.
And then this morning, I think Jeff Levi already rather persuasively raised—laid out the arguments for why the commitment to the state and local preparedness in the United States is woefully inadequate at $100 million, with the rest of it being money the states are meant to come up with themselves in order to purchase back vaccines and so on.
I can only say that in response to, you know, a handful of mailings containing anthrax spores, we put out considerably more than that to deal with bioterrorism preparedness at the state and local level. And as I—I’ve been in 47 U.S. states looking at public health since 9/11, and I can tell you that in most cases the public health leadership is feeling really under the gun. Because most states have required budget balance acts, so the governors have been cutting like crazy, and one of the places they said, Gee, we got all this federal money coming in for bioterrorism preparedness. I guess we can cut our state commitment to public health programs. So that you have this weird skewing that’s happened, where a lot of states are—and local areas—are very well prepared in America to respond if smallpox happens. I mean, they know how to do ring quarantines and all that for smallpox.
But if you really look at it, there’s not a whole lot of duplication between what specific organizational expertise is necessary to deal with smallpox and what specific organizational expertise might be necessary for flu. And that goes to the final point.
We haven’t even really got in the budget some serious consideration of how you determine what those needs are. We don’t have a process that brings—that works from the bottom or works at all levels at once, that answers the question, What really do you need in Indonesia right now to make Indonesia able to spot and respond? And what do you really need in Indiana right now to make Indiana able to spot and respond?
David, what would you do with $7 billion? Is that enough?
MALPASS: Yeah, I don’t have anything to add to that.
GARRETT: Okay. Yanzhong?
HUANG: Oh, hi—just a quick point. I think 7.1 billion (dollars), I think that’s a large amount, of course, and if you compare that to China’s 2 billion Chinese ren, that is just about 1.2—2 billion U.S. dollars, or 2.5 billion U.S. dollars; you know, the same amount that the mobilized in addressing SARS.
But if you compare with that money, 7.1 billion (dollars), to the amount they earmarked for international cooperation, that is, 250 million (dollars), I think the gap is very obvious. (Chuckles.) And if we believe that the disease does not recognize international borders, and if we believe that pandemic flu is going to spread, indeed occurs, very quickly to the United States, then helping them is also helping us.
And so I think in this sense, this distribution of the money still reflects our fortress mentality here in the decision-making apparatus.
GARRETT: Other questions?
QUESTIONER: This is a question really to David, and it’s more a comment first. I’m Mike Osterholm from Public Health, University of Minnesota.
And obviously you are a very bright economist; you wouldn’t have gotten where you’re at today if you weren’t. And you’re obviously a leading-edge economist, as far as the world goes, given the position of your company and where you’re at. But I heard you say just now that you thought that the probability of a pandemic was probably very low when, in fact, some of us this morning talked about the probability of a pandemic’s 100 percent. It’s 100 percent. Very few things can we say in public health as 100 percent. The question we don’t know is when will it occur, where will it actually start, and how bad will it be?
So in that sense, and in that context also, I heard you talked about we’re a major exporting country. Yet for those of us that looked at the critical products we need to get through a pandemic like medical supplies, pharmaceutical products, even our food supply, is all—a very large part of that is imported, so that it’s not just which products, it’s which key products are really there.
I guess the question I have for you is, do most of the other economists of the world of your caliber think the same way about this?
MALPASS: Are, are they all—
QUESTIONER: Because if they do, I think that part of our planning is in trouble already, and we need to do a great education job on economists to better give us a sense of where we are so that we can start informing better about what the risks are and what we need to do about it.
WUDUNN: Can you round out your question a little bit more? (Laughter.)
MALPASS: I don’t know how you want me to respond. So I think the idea that there’s 100 percent probability of a global pandemic doesn’t really need a response to that. Maybe that’s been the thrust of the whole day. Is that the thrust of the whole day?
WUDUNN: As—well, I see—I see—
MALPASS: 100 percent—
WUDUNN: Let me just—
WUDUNN:—let me parse that out because I think I can fairly represent what Michael’s trying to say.
In—among biologists there is a sense of certainty that an influenza pandemic will some time visit upon us. Whether this particular strain of H5N1 now circulating in Asia in birds will be a—the next pandemic is not a matter of 100 percent certainty at all.
MALPASS: Well it’s true that there are people killed, millions of people killed every year by flu globally, right?
QUESTIONER: About (5,000 ?)—
QUESTIONER:—in the United States annually.
MALPASS: As far as the availability—the flexibility theme that I’m putting out, we have seen experts talk about each of the pending world crises or U.S. crises. Remember the—and it’s very hard here because in this case we’re dealing with the threat of a lot of deaths, which is more serious than a lot of the crises.
The California energy crisis of 2000/2001 was analyzed heavily. There were volumes produced. And then when it actually occurred, the flexibility surprised everyone. And so you’re talking about can the U.S. produce the goods needed if there’s a decline in global trade? And I think the economy’s shown over and over again that it can do lots of very impressive things when it needs to.
So I don’t think it’s a—I’ll defend my—
WUDUNN: So probably—
MALPASS:—point of view that we have the world’s biggest by far flexible economy, and it is the world’s biggest exporter—it’s not a major exporter; it’s the world’s biggest exporter by far—and we have to recognize the capacities that we have to respond to a lot of crises.
WUDUNN: So in the end, we’re all dead anyway, right? (Laughter.) So the world goes on, it’s just that there will be pain and there will be a lot of it, we just don’t know much. Is that what you’re basically trying to ask?
QUESTIONER: No, the idea is that there’s a lot of economists with their heads stuck in the sand. (Laughter.)
And I think—I again want to say financial markets are frequently faced with probabilities and outcomes, and they do a pretty good job in responding to that. And one of the constructive things that can be done today is really talk about the technology—the way to get money to the technologies that will help if this particular virus begins to spread among people.
WUDUNN: Okay. Another question please, in the back. How about you?
QUESTIONER: Carol Brokaw (sp) at Gilead Sciences.
I spent my entire career taking care of infectious diseases on the front line before going to industry and I can tell you that in my entire time in infectious disease in public health, seasonal flu was never taken seriously. If seasonal flu, which kills people every year, had been taken seriously, we would have universal vaccination, we would have rapid diagnostic tests that are easily available, and we would make it easy for patients, whether they’re young, medium aged, or very old, to see physicians and be diagnosed appropriately or be diagnosed in the home so they don’t infect others. But we’re not doing that today for seasonal flu. And when we got the wake-up call in 1997 with avian flu, we didn’t say you know what, let’s get our act together and take care of seasonal flu because if we did that, then lo and behold, it would be a lot easier to see avian flu.
So my question and I’ll go to, I’ll start with Laurie to answer it is, there’s been a lot you know in the last few weeks and months, particularly since Katrina, is it going to shake people out of their complacency to begin to even deal with seasonal flu? Because I would say if we’re not dealing with seasonal flu, we won’t answer avian flu.
Getting a better diagnostic test is not going to help if you don’t have people who are sick being seen in the health care system early enough to prevent human-to-human transmission, it’s going to be too late.
GARRETT: Your point is taken in the sense that you know, in a typical year, we lose a very hefty number of Americans to flu and globally we lose, I don’t know, a half a million estimate is one number I’ve heard, every year to influenza.
And you know, it’s worth asking why have we had such a complacent, sort of nonchalant view of flu. I think the main reason is that most people get the flu every year and are sick for a couple of days and then they tough it out. So there’s this sense that this is this awful winter thing and you have to kind of, you know, struggle through it, but you know, it’s no biggie of course until you hit that magic age that we call senior citizens when suddenly your risk escalates because of your lower immunological capacity to respond.
I think that what we have seen and that should have been the serious warning shot across the bow is that in addition to the 1997 emergence of bird flu originally in Hong Kong, we have seen almost every year since then that in this country we fail to meet the flu vaccine production quota. Or we’ve met in, but in fact not met it until January or February, which is well and deep into the flu season. And what this means then is that we’ve seen or been watching almost without anybody doing anything about it, our flu vaccine production capacity deteriorate, right before our eyes in real time, and in 10 years it’s just collapsed.
Chiron, you know, just a couple weeks ago said they won’t make quota again this year. And yet when the HHS plan was released, Chiron was immediately awarded a huge contract to make the H5N1 prototype vaccine, along with Senopi-Aventis Pasteur. So apparently failure gets rewarded or whatever.
WUDUNN: The economics of flu vaccine making are quite tough, and so—and perhaps the government should step in because it isn’t—
QUESTIONER: Can I add to the question along these lines?
WUDUNN: Go ahead.
QUESTIONER: And I think that’s a really constructive issue of are there things that would flow into the normal course of what we’re doing that would also help them in the event of a pandemic. Pneumonia vaccinations, are they part of that?
GARRETT: Well certainly for senior citizens, pneumocouccus vaccination would be yet another useful barrier to buy them survival time.
One big difference that we do have to keep in mind, that huge difference between what we’re talking about with pandemic flu and you know, garden variety seasonal flu is you know, most cases of influenza that become mortal cases of influenza are not the result of the flu virus directly, but rather secondary bacterial infection with pneumocouccus, streptocouccus, whatever the individual may be exposed to, and thankfully most people who get a secondary infection in this country will respond to antibiotic therapy unless they’re so unfortunate that they have a drug resistant bacterial strain, which is an increasing problem as well.
Pandemic flu however what we know both from the analysis of the 1918 flu virus and from the analysis of those clinical cases that have occurred and been reasonably well documented so far of H5N1 infection is that death is not due to the secondary bacterial infection, it is due directly to the impact of the virus and the over response of the individual’s immune system to the foreign body that it has detected resulting in an absolute devastation collateral damage if you will to their lungs, their central nervous system and perhaps other organ systems.
So while the pneumococcus vaccine would be very useful in routine years, would that it were more affordable to most of the world, it’s a very expensive vaccine, but while it’s useful in routine years, it might not really be particularly helpful in a pandemic.
HUANG: May I just, a couple?
I think we live pathetically in a political world that you know, that so many important things competing for the attention of our principal leaders. In that sense, I agree with you as to the pandemic flu, how this potential pandemic flu actually provides sort of an open political policy window for strengthening this country’s health care or public health system. We know that in this country 45 million people not covered by any health insurance. Now that is actual indeed very pathetic, you know, because in cases of outbreak you expect that those people would not have the strong incentive to seek help. You know, that is not a good thing, of course.
But in the meantime, I also get a sense in this, today we have this strong political commitment. This—our leadership commitment to the pandemic flu can also be a mixed blessing, you know, in the sense that we keep really vigilant of a potential pandemic flu, but we don’t know—we know it is going to happen, but we don’t know when this can happen.
So let’s assume that after a couple of years the pandemic flu does not come and then the fatigue, you know, would kick in, you know, and people lost vigilance. Well, then the pandemic flu are coming. And historically what is often the case, the pandemics often caught people off guard.
So you know, I’m a little bit worried that if, you know, climb walls you know, after sometimes, you know, would not be—would not be of any help in terms of preparing for the pandemic flu.
WUDUNN: Other questions? How about in the back? Anybody in the back, way in the back?
QUESTIONER: The question is for Professor Huang principally. Vanessa Vanee (ph) from Epoch Times.
I just want now have you to have a comment on the health system in China because in this way to help the people here to understand the real situation in China in preparation of this prevention of the pandemic flu because last months—a few months ago, the minister of the health department in Goujoutiang (ph) came out to say this year China actually (visit to the ?) clinic and—(inaudible)—the occupy the bed in hospitals decrease. But income of the hospital actually increased. And so he could—(inaudible)—the system, the health system—(inaudible)—have an unreasonable charge to the people. And—(inaudible)—in addition, unemployment increased and the uninsured the Chinese people actually increased dramatically. I just want to have your comment about how the China system in your sense is well being prepared for this pandemic flu, and what kind of monitoring system in national wide for this preparation?
HUANG: Thank you. Obviously the Chinese government draw some important lessons from the 2003 SARS outbreak. The central government has paid much more attention to the public health issues, including this upcoming pandemic flu. It has restructured this country’s public health system so that now people at the bottom—at that (grassroot ?) actually could report disease to the Ministry of Health. And also earmarked large amounts of resources to address as public health, health care issues. Just recently, the Chinese premier pledged that by 2008—(inaudible)—spread this so called new cooperative health care insurance system to the countryside.
But in the meantime, these countries still suffer many problems in preparing for a future disease outbreak. And certainly information control remains, you know, especially at the local level. This transparency, lack of capacity remains a big problem. But I sense the most important thing is this gap, saying they increased the central commitment to the lack of state capacities in preparing for the disease outbreak.
A recent example, in Liaoning—(inaudible)—6 million chickens were killed, and the government paid each chicken with 10 ren, the total would be 60 million ren. And the central government only shouldered that small proportion of that money. And the local government—(inaudible)—are not very well developed country, actually shouldered a large proportion of that expense. So they had—they were unable actually to pay the full amount to the farmers who lost their poultry, and instead they just paid IOUs. I think if this trend continues, that is beginning to provide significant disincentives for the people, you know, who raised this poultry—(inaudible)—sustenance—you know, primary sustenance farmers—they would not have strong incentives to report that to the government.
WUDUNN: One last question please. I think you were—
QUESTIONER: David Fedson again.
There’s been a lot of discussion about economic impacts, and because I’m not biased by a lot of economic facts, they don’t worry me so much. (Laughter.) I actually think that as long as buildings still stand and power systems are still operating and the physical infrastructure of the world economy is in tact and we haven’t killed off all of the people who know how to keep it working, that we will get along.
What really worries me much more is the political fall out, and it’s the fall out that’s going to be very obvious between the have and the have not countries. And if I could use just one example, the European Union right now is going through a period of uncertainty, some would say crisis, what is its future. And if a pandemic were to come and for example, the German government is producing 160 million doses to give two doses of vaccine to everybody in the country before it exports a single dose to any other country, including its neighbor Poland, what does this mean for the future of our political order worldwide? It seems to me that if we look at the impact of wars, I mean we see a lot of economic dislocation because of the physical destruction, but once that physical infrastructure is rebuilt after five or eight years or so and we saw that with the Marshall Plan and everything else that went on in Western Europe, what remains is the social and political memories of having other people kill you.
GARRETT: Okay. So, so—
QUESTIONER: And, and we’re going to have a situation where if vaccines and other things that will save lives are denied people in certain cultures, we may have to wait a generation or more before these kinds of, this kind of damage works its way through human society.
GARRETT: So one can both argue that the impact of pandemic would be to lead to further exacerbation of tensions that are the antithesis of social cohesion. So everywhere in the world where there already are tensions relating to haves versus have not’s to access to patented drugs versus objection to the World Trade Organization, patent regimes, where there have been long standing tensions between impoverished communities within a nation as we saw in New Orleans versus the larger population where there have been racial tensions. All these, you can very easily weave scenarios to see them exacerbated deeply.
The other flip side is, and this is again back to why do we have a discussion of preparedness now? You know, for Mike Osterholm is sitting here, he has personally taken a lot of heat for being very outspoken about this issue for a long time. And I happen to know a few editorial writers that have nearly, you know, skewered him quite unfairly because what he’s been trying to say, what a number of other key players some of whom have been here today have been trying to say there’s a reason to be alert now because we have moments to prepare. And we may be really lucky and that preparation envelope may be ten years. We may be very unlucky and that preparation envelope is a matter of months. Most of the discussion of preparedness both in our government, at the recent meeting in Geneva, on the international level, and within all the other governments that I’m aware of in terms of having seen their plans, have focused on preparedness as fundamentally a technological question with a bit of a government functioning insularly issue.
But this larger question of what is the nature of globalization and social cohesion as a world community? How do we build structures, understandings and alliances now that anticipate all of that being stressed to the maximum and try to understand how to build technological production and distribution regimes that do not just satisfy the needs of the wealthiest countries of the world? And do not just satisfy the nine nations that control 71.2 percent of the global wealth, but in fact think beyond that envelope.
We have time now to try and add that issue, that set of issues into our planning, into our preparedness, into our discussion as a global community and I think if we ignore those issues or consider them too big to think about or consider them wild political speculation and stay in that realm for the next period, we will indeed pay the kind of price you’re eluding to and the question I immediately ask is Mexico at our border.
You know, earlier we were discussing what would be the role of the U.S. military? That’s a discussion that is still evolving and I look forward to seeing the eventual DOD document on that. But that could go several ways. It could be the role of the U.S. military is to create a great wall across the Mexican border to say sorry amigos but we ain’t sharing the technology with you and you’re not coming in here to survive and we’ll see you, “hasta luego,” who’s left when the pandemic is over, right?
Or it could be that the role of the U.S. military is to step up to the plate in the global movement of essential goods, of the sorts of key medical goods we’ve been talking about many times today, key food goods and so on because they are such a great mover on a mass scale of goods, services and people.
And that we saw them perform that so brilliantly at Aceh, the question is can we create mechanisms that imagine engaging not just the United States military but the Armed Forces of other key countries around the world to play that kind of a role that puts us in a better stead as a global community, a more cohesive community, down the road.
WUDUNN: Do you have a—
MALPASS: Can I add to that?
MALPASS: It seems useful to me to think about it as being a pandemic that is certain say ten years from now, how would we act differently if we thought for sure there was going to be something ten years from now? And so in the case of Germany, what would they—so this year, maybe they feel like making only vaccinations for their own population? Okay, but over the next ten years, what’s really the plan for handling Eastern Europe and what’s our plan for working with Mexico? And to me, that seems like a very kind of constructive way, maybe that bridge is—I’m willing to accept the idea that we should for planning purposes think of it as a certainty, put it far enough out that people make logical preparations over a period of time rather, not so much a panic this month, but what would we be doing differently over the next ten years? Maybe that gives time to set up a health care system for the elderly—I mean, for the seasonal flu for example, where you really would want to change your whole process. So that seems constructive.
WUDUNN: Last word?
HUANG: Okay, you probably want. I want to add that it’s likely that the pandemic flu given its varied impact in different regions is going to affect the balance of power in the international system. That is going to change the strategic and security landscape in the war because, again, if you look at history, the Plague of Justinian in the 6th century actually led to the collapse of the Byzantine Empire, and the Black Death undermined the Mongol military might in the 14th century, and in fact was the harbinger for the modern international system we now live in. And so if we recognize that some countries will suffer more and some countries will suffer less from the pandemic, then it is likely that this could be a factor that will set the new balance of power in the world.
WUDUNN: Well, that’s a nice note to end on.
Thank you very much, all of you. (Applause.)
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