Panelists discuss the latest COVID-19 developments, including the evolving U.S. response, updates on vaccine efforts, the disease’s effects globally, and lessons learned thus far.
Senior Associate Dean of Global Health and Director, Center for Innovation in Global Health, Stanford University
Chief Executive Officer, Gavi, the Vaccine Alliance
Commander and Division Engineer, North Atlantic Division, U.S. Army Corps of Engineers; Major General, U.S. Army
STOCKMAN: Welcome, everybody, to the Council on Foreign Relations call on COVID-19. I’m Farah Stockman of the New York Times, and I hope that everyone on this call is at home in their pajamas.
We’re, obviously, in an unprecedented situation in which much of the world is being asked to shelter in place. We have seventeen million Americans out of work and an unemployment rate not seen since the Great Depression, and we have no idea when it’s going to end. We have no idea when my three-year-old is going to go back to daycare. (Laughs.)
So we are very lucky to have three speakers today who have insight into the situation: Michele Barry, senior associate dean of global health and director of Stanford’s Center for Innovation in Global Health; we have Dr. Seth Berkley, chief executive officer of GAVI, a global vaccine alliance that has helped vaccinate about 60 percent of the world’s children in the poorest countries; we have Major General Jeffrey Milhorn, who is commander and division engineer of the North Atlantic Division of the U.S. Army Corps of Engineers, which has been working with FEMA to construct pop-up hospitals, if you will—think of the Javits Center in New York—to combat this pandemic.
And so I’m just going to start by throwing a few questions to each of our panelists to get the discussion going and then we’re going to open up to your questions. We want to hear from you. This is just a reminder that this is not Chatham House rules; this call is being recorded and the transcript will be posted on CFR.org. So let’s just get started.
Dean Barry, I would love to start with you. I want to ask you: How did we get here? Was it just inevitable that this virus was going to reach our shores eventually, or did we screw up somehow?
BARRY: Well, maybe it’s a little bit of a combination of both. I think what was clear is that we have been seeing over the last hundred years these emerging viruses and spillover particularly of animal viruses to humans. We’ve seen—it was inevitable that one of these coronaviruses would spill over. We’ve already seen SARS-1 and MERS—Middle Eastern Respiratory Virus—spill over from bats into the human population. When you have 1,300 species of bats and at any one time six to eight coronaviruses are circulating within them, there’s obviously going to be genetic transmission, and particularly eventually a mutation that allows human spillover and human infection. So, yes, it was inevitable.
I think the wet markets in China are a petri dish. Whether there was an amplifier animal this time—in SARS-1 it was the civet cat; it’s not quite sure in this particular infection if there was an amplifier animal. It could have been just an infected human because many of these vendors come from farms where there’s bats and animals commingling and humans commingling. So it was inevitable that there would be a spillover.
STOCKMAN: Oh, I just want to—I just want to push you on this a little bit because, I mean, here in the United States a lot of us were watching the news in China, watching the news out of Wuhan, and I remember as a journalist interviewing people probably late January or early February who were Chinese people coming back to the United States and they said, my goodness, there’s not very many controls at our border, there’s not—at the U.S. border, there’s—the CDC doesn’t seem to be taking this very seriously, doesn’t seem to understand how contagious this is. And I remember, you know, talking to CDC and saying, well, these people think they were on the plane with somebody with the virus and you haven’t called them, and you know, the CDC did say, hey, we don’t—you know, they had guidelines. So do you think that the United—this was inevitably going to come to the United States and hit the United States as it has, as hard as it has? Or should we have been doing things all along to mitigate it?
BARRY: Well, I think—you know, I don’t want to at all criticize my colleagues in the CDC, but I think if you look at the fact that when the virus was first identified in Wuhan in December 31 and the two weeks—just the two weeks before there was a lockdown of Wuhan, over five million people traveled outside of Wuhan to other countries. So it was inevitable.
I think many felt that this would be just a bad case of seasonal flu when they looked at what they thought the coronavirus would be like. And I think we made a mistake with the testing. We didn’t test early enough. We sent out a test that was not an adequate test, and it put us at least two or three weeks behind the ball. And as you know, this virus has a rapid doubling time. It’s very infectious.
STOCKMAN: Yeah. Yeah. I want to move on to General Milhorn to talk a little bit about where we are right now, today. General Milhorn, you’ve recently toured a field hospital in New Jersey or alternative-care site in New Jersey. Can you—can you tell us what the situation is that you’ve been seeing? And can you tell us what’s involved in setting up these, I don’t know, overnight hospitals?
MILHORN: Sarah (sic; Farah), thank you.
So, yes, not only in New Jersey. I was in—in fact, I was back in the Javits Center yesterday visiting with senior leaders from our U.S. Army Northern Command, donning our N95s and going into the actual spaces where we are intaking COVID patients, visiting the ICU wards as well, to make sure that we’d covered down on the logistics shortfalls, if any, that may be required, of which at this time we’re not tracking any.
You know, one of the things that—and I think you probably noted it—that, you know, first and foremost we have a responsibility to protect the force that are actually contributing the assistance, and so we’re trying to do that through the use of the protective equipment that they—that all of the servicemembers and, quite honestly, all of the services are now integrated on behalf of the Department of Defense in our response, certainly here in New York, and as you see urban augmentation medical taskforces being deployed across the country.
The conditions in terms of the U.S. Army Corps of Engineers responsibility, as you are well aware, early on we came up with just a simple design concept for COVID or non-COVID patients, whether they were to go into convention centers or into—which we described as an arena—or into hotels or dormitories, many of which are vacant right now. And over time we’ve integrated the level of acuity of the patients to be treated so that we could supplement the design that all have to be site-adapted to each of the locations.
I’ll use the Javits Center most recently. As we had designs to build out spaces, initially an effort to achieve about 2,900 spaces, but ultimately over time, working hand in hand with our health and human service counterparts, the hospitals, Northwell Health here in New York City, you have to synchronize that effort largely to make sure that you understand the capacity of the local hospitals as well as refining the requirements within each of the arena formats, or convention center specifically in this case.
You did mention New Jersey. I have visited the three sites there, in the Meadowlands, the New Jersey Regional Convention Center in Edison, and also the convention center in Atlantic City. And so our initial responsibilities were to plan and then assess the facilities, bringing our engineering expertise to review; to make sure that those facilities would be safe to integrate patient care; and then certainly working with contingency contracting to retrofit those either ourselves, through a myriad of contractors that we have available to us and contracting means, or turn that over to the states to do for themselves, many of which are actually able to do.
So, forgive me, go ahead.
STOCKMAN: Can you—can you tell us if these—if these centers are filling up, or are they sparse—are there only a few people in there now? Like, can you just give us a sense of how—
MILHORN: So I would defer, really, if I had our health experts here. But I recognize that we had just under three hundred in the Javits Center yesterday, to include sub-acute care as well as acute ICU patients. So, yes, I watched as patients were coming in and I watched—even better—as patients were going out, as they were completing their quarantine period and actually being able to return home or to a residence that they had previously come from.
STOCKMAN: Well, it’s pretty incredible. I remember watching news reports of the—of the hospitals that China was building, you know, overnight. And now here we are building these—building these hospitals or alternative-care centers overnight. It’s pretty amazing.
I want to bring in Dr. Berkley to talk about the future, to talk about a vaccine. There’s a lot of people who think, hey, we’re never going to get back to normal until we have a vaccine. I’m curious if you agree with that and what’s your best guess for how long this will take. I mean, normally a vaccine could take ten to fifteen years to develop.
BERKLEY: So thanks, Farah.
And of course, the challenge is we want one tomorrow. And for most people what “normal” means is going back to life as it was, and it’s going to be very hard to do that with virus anywhere circulating in the world. And so a vaccine does offer the best potential to be able to protect the population.
As you said, the normal timeline for vaccines is ten to fifteen years, and if it’s difficult maybe even longer. The good news is that this has had an unprecedented effort. There’s now more than seventy vaccines in development around the world; already, three of them have gone into clinical trials; and the first one going in, in forty-two—or put in a vial in forty-two days and then into humans in sixty-three days. So science is responding to this.
Of course, the challenge is that we don’t know if any of these are going to work. And so we do need to have a process that allows careful study of these and to make sure, obviously, they’re safe, that they’ll work in the elderly populations—which is a particularly important population—and that we understand the dosing and how to manufacture at scale. But this is something that is being driven very hard.
My guess when people talk about vaccine availability, they mean how—when can I get it. And I suspect that we’re talking probably eighteen months before we’ll have a vaccine that is, you know, available for general populations. But we may have earlier vaccines available to use in emergency situations, like we did in Ebola.
STOCKMAN: Do you think that we have to have a vaccine before things kind of return to normal, or do you think that things will return to normal before the vaccine?
BERKLEY: Well, I think we’re now in a big debate worldwide about how can people loosen up on the lockdowns when it is the right time. And obviously, you don’t want to loosen up on lockdowns until you have bent the curve and you have your reproductive rates well below one. When that happens there will be a loosening, but one’s going to have to monitor it really carefully, and use testing to determine what’s happening, and be willing to shut down again quickly if we begin to see spread of infection. So going back to the normality of life as it was really would require having population immunity for this virus.
STOCKMAN: And just tell us a little bit about the speed at which vaccines are being created. You had some experience with Ebola that really had a speeded-up timeline. How does that—just walk us through a little bit what’s involved. How can one speed up the creation of a vaccine?
BERKLEY: Well, there’s things you can do even before an outbreak occurs. And as you already heard from Michele, we should have known that coronavirus was going to reappear again. It was evolutionarily certain. There are thirty thousand coronaviruses in the master database. Many of them have similarities to ones that have jumped from humans, so we could have done a better job preparing ahead of time and we also can have vaccines ready to go.
So what happened with Ebola was there were vaccines that had been developed because after September 11, with the anthrax attacks, people began to look at bioterrorism agents and Ebola was on that list for a short period of time. So a set of vaccines were begun, and those were pulled out of the freezer at the time of the West African outbreak. Trials were done in that emergency and we were able to prove efficacy of one vaccine. We then went to make sure that in the interim, before that vaccine was licensed, there would be doses put aside—three hundred thousand doses—and that was lucky because the two outbreaks that have occurred since then in DRC were the ones we vaccinated with three hundred thousand doses of experimental vaccine. It still wasn’t the licensed product. And it took, as you said, about five years for the product to ultimately be licensed.
But that’s a good example of how vaccines work. There was a vaccine that came out of the Public Health Institute (sic; Agency) of Canada; was licensed to a U.S. biotech company; then Merck and Company, the U.S. multinational, took it forward; and it’s being manufactured now in Germany. That’s how science works, and in a sense this is how it’s going to work going forward.
STOCKMAN: Just a last question on the same line. I mean, is it evolutionarily certain that a new coronavirus that could be even more deadly than this one will—I mean, should we already be preparing for that as soon as we catch our breath now?
STOCKMAN: I mean—(laughs)—
BERKLEY: Absolutely. Not just for coronaviruses. I mean, the point is, as Michele said at the beginning, we see constantly new agents come out. And with global warming and with the increase in population around the world, cutting down of forests, desertifications, we are going to have more exposure to zoonoses. And animal viruses are—you know, about two-thirds of the infectious diseases that we suffer in humans came from animals. So we’re going to see more of this. And that’s why we need to prepare resilient health systems, we have to invest in prevention, we have to invest in vaccine development and drug development so we’re as prepared as possible, so when something like this happens we can move as quickly as possible to get agents that can really help us.
BARRY: And, Farah, can I jump in here?
BARRY: I completely, completely agree with Seth, but I would add one other thing, is that we need to invest in better surveillance around the world. It’s not inevitable.
BERKLEY: Absolutely agree.
BARRY: It’s not inevitable. I mean, we just have a—very weak international health regulations. We have a weak WHO. Not that they’re weak, but they don’t have money or money to put teeth behind doing better surveillance and strengthening other countries, particularly countries in fragile—well, fragile states or countries in conflict. I think that we need to—this is a clarion call that we need to strengthen our surveillance as well as pay attention to things that we’re doing to this planet with deforestation and commingling of animals and humans. But we need to do better surveillance of animals, or—I don’t know if this term “one health” has come up, but one health and planetary health are two things we’re trying to develop very strongly at Stanford, this concept that we need to look at our animals and do better surveillance as well.
STOCKMAN: Well, Dean Barry, I want to—I want to—
BARRY: And an example of—go ahead.
STOCKMAN: I just want to ask—
BARRY: I’m just going to say an example of—yeah, go ahead.
STOCKMAN: Well, if you’re on the same line you can add that, and then I want to ask Dean Barry one last question before we open up to questions.
BARRY: Yeah, I was just going to say in West Africa in 2014 it took three months to make that diagnosis of Ebola because there was no surveillance system because the system—the health system wasn’t there. And you know, in this case China luckily had a strong public-health system, so they were able to identify it, they were able to grow and sequence the virus and make that available rather quickly. But that’s the example of having really strong systems in place. Over.
STOCKMAN: So both of you are talking about the strength of public-health systems abroad, maybe in the developing world, but what about our own public-health system here in the United States? I wanted to ask Dean Barry about how well we are doing here in the U.S., as we have a unique system where states and the federal government each have their own sort of responsibilities, and other countries are much more centralized. So can you tell us, Dean Barry, what you are seeing with our own public-health system here in the United States?
BARRY: First, I would like to start and applaud our public-health officials that are trying the best they can to contain this virus. And then I’ll give you my honest opinion, which I think we have a broken system.
I think we have a broken, underfunded system, and it’s bottom-up, state by state, even county by county in California. We have one county that has different guidelines for COVID-19 released to another adjacent county. This just does not make—this patchwork public health does not make for good public health.
And also, you know, when you—you know, if you think about—and what Seth was saying—yes, we need the vaccine, but we’re also going to need amazing case contact-tracing and quarantining, and we do not have a public-health force to be able to do this. We’re just completely underfunded compared to other countries. When you look at a country like South Korea and Singapore, how they’ve been able to contain, it’s all been with epidemiologists and case-contact control.
STOCKMAN: Yeah, I’m also struck by how a lot of research out of China talks about how it’s not—it’s not just quarantining at home if you have the virus, but they would take you to a hospital and your family.
BARRY: Absolutely. Absolutely.
STOCKMAN: Whereas here people are expected—people who are positive, if they’re not too sick, are expected to go home and stay home with their children and grandparents. And—
BARRY: I think 75 percent of the transmission in China as family transmission with a sick person until they realized they needed to get that sick person out. And I think that’s why we’re seeing this explosion in Italy, because there are multi generations that live within one house as opposed to Germany, where there aren’t multi generations living in one house.
STOCKMAN: Yeah. Yeah.
Well, I think it’s time for us to—I know there’s a lot of people on the line who want to ask questions. I’m hoping the operator can come on and give some instructions on how to ask questions, and then we can keep this conversation going. I do want to say that when you ask a question, please identify yourself and your affiliation. And deep thoughts are welcome, but let’s have a question mark at the end of the deep thought. And please try to keep your questions concise and identify which panelist the question is going to.
OPERATOR: Thank you very much.
(Gives queuing instructions.)
Our first question will come from Ed Cox, Patterson Belknap.
Q: Yes. The Army seems to be the reserves for local hospitals and are being used that way, with the Javits Center here in New York for the overflow, as the governor says. What are—I would like to know the capabilities of those reserves, both in the number of field hospitals and the mobility of them. If you had to take down Javits, how quickly could you do it if it’s not needed here in New York? We’re beyond the peak, way down the curve. And then if it’s needed in Houston, let’s say, how mobile are the reserves and how large are the reserves, not just for our field hospitals but also for the personnel that need to go into a hotspot to supplement and relieve the personnel who are in the local hospitals?
STOCKMAN: And I’m assuming your question is for General Milhorn?
Q: I think that’s right, yes. (Laughter.)
MILHORN: Yeah. OK. Ed, hey, thank you very much for the question.
And again, I’m not a medical expert, and certainly as the Corps of Engineer(s) senior lead, but I can share with you my observations, and certainly as we’ve seen this play out, if you will. And you know, I should have prefaced, you know—prefaced upfront that all of the work that we have done has been in response to our emergency-support function for or on behalf of the lead federal agency, which is FEMA or the Federal Emergency Management Agency. And as requests both top-down and bottom-up are made through the mission-assignment process so that federal dollars are made available, likely also with a CASIA (ph) requirement for some of the states, the requests even for Department of Defense support—some of which, as you all have seen, have played out, certainly, on television, where you’ve watched the governors make requests to the president of the United States. And then certainly, the president’s acknowledgement of those requests in consultation with the secretary of defense to determine the availability of forces—not just Army; across all the services, across all components, active, reserve, and National Guard.
And so the contributions have been immense. And as you look to the two field Army hospitals, which were active hospitals that were employed in the Javits as well as one that was originally directed to the West Coast which is no longer needed, there is time that is required to receive those forces, integrate their personnel and sometimes the equipment. We can move faster if we don’t bring all of our kit with us. But in the case of the Javits Center specifically, they have an integrated ICU capability that they’ve had to pull out of their kits that were largely containerized and dispatched forward. These movements, to include the advance parties, were literally within two or three days of notification. And then, similarly, as the larger forces come behind them with the equipment, again, could take just days. You’re not talking weeks and months, obviously, as you can see the integration of those forces today.
Not only the Department of Defense, but as was mentioned the Public Health Service professionals. If you were to go into the Javits today, you would see camouflage uniforms of all type(s), to include the Public Health Service, integrated with colleagues from our civilian and private communities as well. And we’ve also witnessed even nonprofit organizations that are operating in the spaces.
Does that answer your question, sir?
STOCKMAN: So it sounds like days. That’s pretty—that’s pretty impressive. Yeah, let’s have—let’s have the next one.
OPERATOR: Thank you. Our next question will come from Patrick Durkin, Atlas Merchant Capital.
Q: Thank you. And I’m—(audio break)—great. Thank you.
And I’m actually going to put this out to whoever will answer it first. Who is—who is ultimately responsible for our lack of preparedness? And one would think, at least at a—at a first glance, that—and this is not a question to seek blame, but it’s to find answers as we move forward. Is there some—was there some lack of preparedness by the National Institute of Infectious Disease or the CDC, or both?
BARRY: So I’ll be glad to take that. So the CDC, as it—
Q: Thank you.
BARRY: Hi. Can you hear me?
Q: Yes, indeed.
BARRY: The CDC is—the CDC is the public health service that is not allowed to go into any state unless it’s actually invited into the state. So it is not responsible for preparedness. There was a group that was—there was a person—Nicole Lurie was the person in charge of pandemic preparedness during the Obama administration. And there was a person at the NSA, and maybe the general can comment upon this, who Trump basically dismissed. So we did not have a—and I really think that we need at the national Cabinet level—at the national security level, because I think global health is a security issue, we need a group that does pandemic preparedness. And I’ll let Seth and the general comment also.
BERKLEY: I mean, in general people tend not to prioritize prevention, and they tend to over-prioritize treatment. And so a system that doesn’t make this as a—you know, and investment because they’re listening to what the threats are and having a long-term perspective will automatically spend much more on treatment than on prevention. So what this requires is having a system that is set up and amply funded. The critical issue here is it isn’t only a national system. It has to be a global system. And even more in the world, when you’re in a resource constrained environment, people are less likely to invest in long-term prevention when they have, you know, calls for cure.
One of the things I’m most worried about in this particular situation now in developing countries is that we’re going to see outbreaks of other epidemic diseases. In Ebola in DRC we saw two and a half times as many people die of measles than died of Ebola. And now that people are pulling back from routine vaccinations, we could see that repeated. So one of the challenges is the long-term surveillance, the long-term public health, and making sure we invest in prevention in a global scale if we want to be able to have systems that are ready when outbreaks like this occur. Over.
BARRY: There is an entity—there is an entity called the Global Health Security Agenda that started under the Obama administration, where several countries of the high-income countries were helping to strengthen other countries’ surveillance. But prevention—I totally agree, prevention is what we need.
STOCKMAN: Let’s get to some more—let’s get to some more questions. And I want to ask the operator how many questions are waiting, just so that we have a sense of how many people are hoping to speak.
OPERATOR: Thank you. We have about twenty-one questions in the queue.
OPERATOR: Thank you. Our next question will come from Joan Spiro, Columbia University.
Q: Hello. This is Joan Spiro. Can you hear me?
Q: OK. One of the things that—and this could be to anyone, maybe particularly to Seth. I haven’t heard a lot about the idea of treatment or therapy. I mean, is it possible there could be a penicillin for the COVID virus?
BERKLEY: So thank you, Joan, for that question. Of course, if you ask what the expectation would be, obviously the first thing we want is to have good diagnostics to be able to figure out where this virus is, not only in people acutely infected but also is the asymptomatics infected, and how’s the transmission patterns? And we also need antibody tests to see who’s been infected and is no longer transmitting the virus. The next thing that’s likely to happen is some therapeutic. And therapeutics—you know, we’re living in a world where there’s lots of work on antiviral drugs that have been done in the past, although these days it isn’t as sexy and we don’t have as many companies invested in that space. But there is an effort now, and lots of controlled trials that are being done on a range of potential therapeutics. And they’re likely to come out before there’s a vaccine.
Of course, to our previous discussion, prevention is better than cure. So the reason that we see the vaccine as the long-term goal is because if you can prevent this you can go back to normal. Obviously if we had a highly efficacious treatment, you know, that would make a big difference and would reduce some of the fear factor that’s associated here. But it’s still likely to require then engagement with the medical community and, you know, a worry about still having physical distancing. Over.
STOCKMAN: All right. Can we have the next question? And we’ve got about twenty questions in the queue. We want to try to get as many people as possible.
OPERATOR: Thank you. Our next question will come from Patricia Rosenfield, Rockefeller Archive Center.
Q: Thank you very much. Thank you very much. Patricia Rosenfield.
And greetings and thank you to the panelists. This was possibly one of the most important if not the most important of the Council’s excellent calls because of the discussion on preparedness and prevention. And my question focuses on that. It’s kind of a pipe dream, as Seth made clear. How are we going to move toward a communication—and this maybe also for Farah—how are we going to move to a better communications strategy that not only reaches the political and economic policymakers, but the public at large, where you see a large measure of cognitive dissonance in some of the behavioral responses, and bring in the military as well. So I’m wondering what is the—who’s best placed to promote a sort of intersectoral, interdisciplinary approach to building a global focus on prevention and preparedness.
BERKLEY: Well, I can—I can take a crack. And it’s nice to hear your voice, Pat. I think the critical issue here is that we have to follow science. That is the most important point here, because if we have—we don’t follow science, we’re lost, because then it’s all about rumors and who said what and what sorts of information are you looking at. Obviously this issue of trying to get a strong prevention program is going to require an intensity of planning and engagement and, as you say, by all different groups. But it needs to be based upon scientific principles that will allow us then as a society to have the surveillance systems, to have the investment in the mitigation tools that are going to be necessary, and to make sure that we’re going to be adequately resourced to do that both domestically and globally.
Of course, over time we have begun to shift mindsets on this. And I think things like smoking are an example, where in the U.S. smoking rates are obviously down, but it’s not 100 percent. And there are still people who continue to smoke, or seatbelts, or any of those other issues. So I think it’s something that we need to get the best cognitive scientists also thinking about how we can be as convincing as possible to try to get people to take on these approaches. Over.
BARRY: I’d like to add one other thing to do that. And that’s the concept of interdependent sovereignty, that we should not just be thinking about this as what we’re doing in the U.S., but as we reopen we’re going to reopen as a planet, as globalized. And we need to think about staging of that as well. As far as the U.S., when we reopen it’s clear that we are right now unprepared for the workforce that we need, not only for the serologic testing but also for the contract tracing, as we stage reopening.
OPERATOR: Thank you very much. Our next question will come from Eliza Barclay, Vox.
Q: Hello. Hello.
STOCKMAN: We hear you.
Q: Just to be clear, I’m with—hi. Just to be clear, I’m with Vox, V-O-X. (Laughter.)
I wanted to ask about—(laughs)—about the ongoing theory that I see continuing to get promoted on actually media like Fox, with an F, that the virus could have potentially leaked out of the Wuhan Institute of Virology. I’ve interviewed scientists about this, and they have lots of reasons why they don’t think that’s a possibility. But given that this is a persistent rumor, I would just love to hear you all address that, and your current thinking on whether that is possible, or likely, or very unlikely.
BERKLEY: Very unlikely. (Laughs.) I think the science reports that you have seen have tracked back the viruses and looking at the changes that have occurred. And this is a virus that looks like it came out of animals. And so, you know, I mean, that’s what science tell us. You know, people can put out theories all they want, but the best science tell us that, at least right now.
OPERATOR: Thank you very much.
BARRY: And it’s not—and it’s not coming from 5G.
STOCKMAN: I’ve seen that too. It’s incredible what’s out there. Just to speak to the earlier questioner talking about communication and how difficult it is to communicate to the whole country, there are people who are much more attracted to those kinds of conspiracy theories than they are to, let’s say, the New York Times. I don’t know—it’s a problem I don’t know how to solve at this stage. But I’m hoping the operator can tell us how many questions are in queue, and let’s get to some more of them.
OPERATOR: Currently you have sixteen questioners in queue.
STOCKMAN: All right. Let’s have a few more.
OPERATOR: Thank you. Our next question will come from Ella Gudwin, VisionSpring.
Q: Hi. This is Ella.
Seth, you had brought up the topic of what’s happening in in low income areas. The issue with social distancing is it’s almost impossible when you’ve got population densities of seventy-three thousand people per square mile in place like Mumbai or even higher in Dhaka. Ans o I’m wondering what the thoughts are with regard to mass wearing of masks, hand hygiene, and track and trace. And the further thought on the idea that this—you know, the cure of the lockdown is almost worse than the disease with regard to the secondary impact on rates like maternal mortality and then what we might see with regard to food insecurity. We just did some food distributions in a slum over the weekend and, you know, people have been on lockdown for eighteen days and have had no way to feed themselves except through handouts.
STOCKMAN: I’m sorry, can the questioner add—can you tell us what slum, what country?
Q: We were in Delhi and India.
STOCKMAN: Gotcha. OK. Sorry, go ahead.
BERKLEY: So you raise the incredible difficult, you know, point. And so, you know, there are some silver linings in the developing world. There are some countries that have, you know, still populations that are somewhat rural. We obviously have younger aged population. The demographics are more attractive. On the other hand, we’ve got malnourished people. We’ve got people that are immunosuppressed. And we frankly don’t know yet how the epidemic is going to move through these countries. But of course, we have to worry that the situation will be much more severe, for the reason you just described.
So one of the questions is, you know, how—one of my favorite epidemiologists in Nigeria said: You know, I’m tired of people calling me and asking me: Are you just going to do what South Korea did? And he says, no. I can’t do what South Korea did, because most of our houses don’t have running water, and for the reason you said. They may not have refrigeration and be able to keep food for a period, et cetera, et cetera. So what you need is those principles followed, but you need local solutions that need to be, you know, taken on. And we’ve seen a lot of examples of what doesn’t work—for example, putting food in a central square and then having everybody run, and having, you know, the opposite of social distancing.
And then we’ve seen experiences where people are beginning to adapt those based upon the local cultures and local situations. And that’s what’s going to happen in this situation. But there are some parts of this that are going to be extremely difficult and, you know, we’re just going to have to, you know, do the best we can during this period and, you know, get an understanding of how the epidemiology is moving in these countries.
BARRY: But don’t discount how creative these countries can be. Just talking to—because I spend most of my time in sub-Saharan Africa, in Zimbabwe and Malawi. And it’s interesting how they’re actually innovating around social distancing and water. You know, kickstands for water handwashing. Now, admittedly, access to water is going to be a problem in some of the rural areas for handwashing. But don’t discount that. And certainly, you know, they have many other diseases that they’re worried about as well. And there isn’t a ventilator problem, obviously. But I think Seth’s point about it’s a younger population, so we’re all holding with bated breath that there’ll be a much lower CFR, case fatality rate—I’m sorry.
STOCKMAN: I just want to note that the social—the difficult of social distancing is also existing here in the United States among low-income populations that are crowded together in apartments. And it’s not just something for the developing world. We have it right here. We have it right here too.
Let’s have the next question.
BERKLEY: Now more than—now more than 50 percent of the world’s population lives in urban areas. And so this is going to be a, you know, recurrent problem. And it’s one of those reasons that evolutionarily we’re going to see more and more outbreaks move quickly.
OPERATOR: Thank you. Our next question will come from Marshall Voton (sp), University of Pennsylvania.
Q: I’d like to address a question to, I guess, mostly to Michele and Seth about testing. Over these calls, Council calls, I just don’t—have not gotten an understanding of what the problem is, and why we can’t test more widely in the United States. Everywhere you turn you find both anecdotally and in the statistics that testing has not—despite what the president has said—testing has just not reached the levels we need. And we all know it’s absolutely essential to move forward in a safe way to come out of this eventually. I’d love to have the insights—your insights—on this question. What went wrong? Thank you.
BARRY: I can give you an example of a country that did it right, and maybe what went wrong for us, and that’s what happened in South Korea. South Korea was the most aggressive testing. And what happened, and the reason why, was because they have a very close relationship with the private sector. When the first couple of cases, the first four cases, happened, Park got together all the major manufacturers and basically asked them to step up to the plate. And what happened was that South Korea wound up doing about up to fifteen thousand tests per day. So we still to this day have tested less than 1 percent of our population. And what is wrong with that is that we’re just not manufacturing it. Many of these manufacturers are overseas, and our public—our private sector has not—you know, I don’t know whether it’s a communication problem with Trump. Seth, maybe you want to say because you’re more on that sector, with vaccines. Do you want to make a few comments upon it? I mean, we had a gerrymandered—we gerrymandered at Stanford the first serology and swabs on our own, because we just were not getting any support federally or by private sector.
BERKLEY: So one of the things that I think we have to think about is, you know, we either need to be a world working together or we need to be a set of separate nations that are fully self-sufficient for everything in the world. And, you know, as a world working together, we can produce large amounts of things and drive together solutions for this problem. I mean, this disease did start in one country and was in over 180 counties in three months. It’s a global problem. And if the disease continues to exist in many parts of the world, it is going to threaten the whole world, because if there are big outbreaks going on, virus can be reintroduced or even can become more virulent and adapt. So the question is going to be, do we think of it that way? And if we do think of it that way, then it’s about being able to source from anywhere in the world these tests, these pieces of equipment and to be prepared for surge capacity during outbreaks. Those are some of the preparedness activities that need to be done. Over.
STOCKMAN: My understanding from speaking with a doctor in New York, was that she couldn’t order more than two tests per shift because LabCorp, which was the testing agency that was doing the test, was sourcing some of the reagents for the test in Italy. And Italy was only able to produce so much, because they themselves are hampered by an outbreak. So I think there’s very complex layers of problems.
Let’s go onto get a couple more. We’ve got ten more minutes left on this call, so let’s try to get a couple more questions in.
OPERATOR: Thank you. Our next question will come from Rachel Oswald, Roll Call Report.
Q: Hi. Thank you for this call. My question is probably for Michele or Seth. It’s about diplomatic coordination around a vaccine, once a vaccine is looking like it’s going to happen. What things should happen right now if we don’t want to kind of have a really toxic free-for-all, where you have wealthy nations trying to bid for the vaccine, and maybe the country that feels like it owns the vaccine wants to first give it to its entire population before allowing other countries to bid on it? And what might a good framework be for, I think, dispersing the vaccine in an ideal world? Like, medical workers get it first, or how would you go about that? Thank you.
BERKLEY: So from my perspective we do have to think about this globally. And in terms of the priorities, obviously those needs should be discussed. But, you know, my sense of the priorities would be health workers globally should be protected, because they are at risk of the disease but also being able to transmit it. Then one needs to go to places that have epidemics that are out of control and try to bring them under control because, as I said before, having large reservoirs of the virus anywhere in the world threaten the world. The next priority would probably be the elderly and people with risk factors, given the worse outcomes in those, and eventually the rest of the population.
We will not have enough vaccine when we start to serve the entire world. So there needs to be a prioritization effort and there also needs to be a look at equity. And the way to do this is not to wait until there’s a vaccine that’s ready, but now to start preparing the scaleup of manufacturing capability at risk for a range of particular candidates, so we can have as large volumes as possible, you know, as soon as it’s ready. And of course, if the vaccine isn’t licensed, you can also use the vaccine temporarily under clinical trial guidelines for health care workers and others to protect them, if we know it works.
STOCKMAN: Quick yes or no question, Seth. Is there a precedent for this kind of negotiations between nations over who gets a limited supply?
BERKLEY: There are precedents around pandemic influenza, frankly, that didn’t work so well. There’s precedent around—
STOCKMAN: Didn’t work?
BERKLEY: Did not work so well.
BERKLEY: We’ve never had this type of epidemic in the modern era, but if you look at it we’ve been able to provide vaccines, all the modern vaccines, to, you know, the poorest countries in the world. We provide vaccines for 60 percent of the world’s population. And it is an agreed funding mechanism by all of the major countries, including the U.S. So I think there’s a way to do this, but it requires working together and having these discussions ahead of time.
STOCKMAN: Gotcha. All right. Let’s do another question from the operator.
BARRY: Can I make just one quick comment on that? We can also look to science about who will effectively actually respond to the vaccine. And also think about looking at our seropositivity, if we see that there are people immune we can actually choose to vaccinate them once it is seronegative.
OPERATOR: Thank you.
STOCKMAN: Gotcha. All right. Let’s go onto—we’ve got another question.
OPERATOR: Our next question is Ron Christie, CFR member.
Q: Good afternoon. Thank you, panel, very much for this informative discussion.
I want to ask a question as an academic lecturer. And my students at NYU and Georgetown are so worried about what the new reality will look like. And they wonder whether or not in the near term, the near term meaning say the fall of 2020 or the spring of 2021, whether we will go back to instruction in the university setting as we knew it before?
BARRY: I’ll take it from the university—I’ll take it from the university side. We are staring to plan to see how we would stage coming back in the fall. But all of us are taking this with a grain of salt because, as we know with the 1918 Spanish flu, although that’s a completely different virus, there was a resurge in the fall. So we’re being cautiously—but we’re thinking about the way we would do it.
BERKLEY: And of course, you’d need testing because you’d need to be able to see whether there was transmission occurring in that community or in that group. And so the prerequisite is going to be having adequate testing available.
BARRY: But I can tell you that we are full steam ahead in our spring term, doing it all virtually. And it’s working. I haven’t heard—I haven’t gotten the student evaluations yet, though. (Laughs.)
STOCKMAN: Let’s try—let’s try one more question, and then I’m going to—we’re going to wrap it up because we’ve only got six minutes left on this call. It’s been incredibly informative. Let’s try one more—one more person. Let’s try to be quick, so that we can get to this last question.
OPERATOR: Thank you. Our next question, John Barry, Air Force.
Q: Yes. Thank you for the panel today.
One quick question in regards to the science. There is rumors now about it being airborne. And if you could comment on that. And maybe the six-foot distance is not large enough? Appreciate some insight there.
STOCKMAN: Anybody want to take that?
BARRY: So the best data on this is coming out of Singapore, and also is reported in the CDC MMWR. Yes, there is probably short distance aerosol, if someone is vigorously singing in a choir or vigorously talking. But certainly well-within the six week. Nobody thinks that we need to increase the six feet.
BERKLEY: So the one thing is that this can be spread by droplet. And as Michelle has said, there is some aerosol. If people are vigorously exercising and, you know, there are issues in terms of slipstream. We need to think about that as well. And that’s why the nuance of the—you know, the public health has to think about that. if somebody’s coughing on a bicycle, you don’t want to be right behind them in the slipstream. So these are some of the nuances that will occur over time as studies are being done. Over.
STOCKMAN: All right. Let’s try one more question from the operator, and then I’m going to—I’m going to ask you all to wrap it up with a thought. Let’s try one more quick question from the operator.
OPERATOR: Thank you. Our next question from Clara Adams-Ender, United States Army, retired.
Q: The question that I had was, it was mentioned earlier that we need to increase funding for preventive care. And by the way, I’ve been in health care as a nurse for sixty-five years. When will we get the services and deal with the—get serious about what happens after this pandemic, since we know how many more resources we need once illness therapy beings?
STOCKMAN: Thank you for your service, by the way. Thank you for your service in the health care field. Does somebody want to take that?
BARRY: I think you need to vote in November for a person that actually is committed to building our public health infrastructure.
BERKLEY: I think the silver lining behind this terrible pandemic is that hopefully this really is a wake-up call. We didn’t have the wake-up call, you know, perceived and followed post-Ebola, post-SARS, post- MERS, post-H1N1. I’m hoping that, given the severity of this, people will wake up and say: Yes, it is true what people have been saying. I was called a coronavirus Cassandra the other day. People were saying this and what we need to do is have these investments. So again, thank you for your service, but let’s hope that this time people will get serious about it.
STOCKMAN: And so this is good segue into my last question for the panelists, which is: What changes permanently in America after this? Do we—do we—do we come out with a public health system that is stronger after this? Do we come out with a safety net that is stronger after this? Or do you—you know, I guess I’d love to have quick thoughts on whether you feel we’re going to come out of this with better a structural system in the United States? And I’d love any other quick thoughts you have with the two minutes we’ve got left, along the lines of the future and how we come out of this in the future.
Can we start with Dean Barry, and then go to Seth, and then go to General Milhorn?
BARRY: Well, I think there is—I’d like to end on a positive note, because I do agree that this is a clarion call for public health infrastructure. And I’m committed to the November elections and making voting for someone that really is committed to this. But I think there’s a silver lining here. I think we’ve seen that telehealth and telecommuting has really made a difference. The amount of road traffic accidents has gone down. The amount of pollution has gone down. It’s actually said in—(laughs)—in some—in certain countries that the diminishment—particularly in Wuhan—the diminishment of pollution, that that may save more lives than actually corona took.
I think we’ll find less conferencing. You know, I lived on a plane because my—obviously, my area is global health. And, you know, we’ve been running our major conferences virtually. And it’s not great, but it works. But if you believe in climate, global warming, I think that this may have a silver lining that we will change some of our routine travel and see less pollution and less climate. And then I have to tell you, my elderly patients love telehealth.
STOCKMAN: OK. Good. All right, let’s move—
BARRY: I think it’s here to stay.
STOCKMAN: Dr. Berkley.
BERKLEY: So for me, I think the—I’m an optimist as well. So I think this time it will lead to changes. I hope we begin to care about the globe, and understand that for infectious diseases we have to take a global perspective and we have to worry about controlling those diseases at source, and building the systems, and investing in that for the good of the world, as well as being the right thing to do. And if we do that, we’ll be in a much better position. Lastly, I do hope we’re going to invest in preparing for future vaccine development for disease X, and having platforms ready to go, so that when there is the next one—which will occur—we are able to move much more quickly in moving that vaccine forward.
STOCKMAN: General Milhorn.
MILHORN: Sure. I think as I look at the interpersonal behaviors of individuals today, some of that’s changed certainly just based on social distancing. The teleworking and commuting that we’re seeing occur, I think you probably will see more of that expand. I’m hopeful that what we won’t see change is really the collaborative efforts by so many different organizations on the ground. And I get to see the goodness of that day in and day out, whether they’re federal, state, or local organizations and agencies all getting together to fight the pandemic. Not to mention the research and development that I think you’ll also start to see increase over time, given the preventive practices that are required.
Thank you very much for allowing me to participate today.
STOCKMAN: Thank you to the panelists for all the time they spent with us and thank every participant who took the time to be on this call. And it’s amazing that we’re having this shared experience not only across the United States but around the world. And I can only hope that we are—we come out of the other side of this better for it. So thank you, everyone, for being here.
BARRY: Thank you, Farah.
BERKLEY: Thank you, Farah.
MILHORN: Thank you.