Public Health Threats and Pandemics

Thomas J. Bollyky, Bloomberg chair in global health at CFR, discusses recent changes to domestic and international health policies and the implications of a U.S. withdrawal from the World Health Organization (WHO) on global health programs and international health coordination. Manisha Juthani, commissioner of the Connecticut Department of Public Health, discusses how state health systems might be affected by changes in federal policies, trusted resources for public health data, and how state and local officials can respond to promote health and safety in their communities. A question-and-answer session follows their opening remarks. TRANSCRIPT FASKIANOS: Thank you. And welcome to the Council on Foreign Relations State and Local Officials Webinar. I’m Irina Faskianos, vice president of the National Program and Outreach here at CFR. CFR is an independent, nonpartisan membership organization, think tank and publisher focused on U.S. foreign policy. CFR is also the publisher of Foreign Affairs magazine. As always, CFR takes no institutional positions on matters of policy. Through our State and Local Officials Initiative, CFR serves as a resource on international issues affecting the priorities and agendas of state and local governments by providing background and analysis on a wide range of policy topics. We’re delighted to have you with us for today’s discussion. We have more than 580 state and local officials confirmed to join us from forty-nine states and two U.S. territories. So, again, this webinar is on the record. The video and transcript will be posted on our website after the fact, at CFR.org. We are pleased to have Tom Bollyky and Manisha Juthani with us to speak on recent changes in public health policy and implications for state and local governments in the United States. We’ve shared their full bios with you, so I will just give you a few highlights. Thomas Bollyky is the inaugural Bloomberg chair in global health at CFR and director of CFR Global Health Program. He is also a senior fellow for international economics, law, and development, and a senior consultant to the Coalition for Epidemic Preparedness Innovations. Tom Bollyky is the founding editor of Think Global Health, an online magazine that examines the ways health shapes economies, societies, and everyday lives around the world. And prior to working at CFR, he served in a variety of positions, including at the office of the U.S. Trade Representative and as a staff attorney at the AIDS Law Project. Manisha Juthani is the commissioner of the Connecticut Department of Public Health. Commissioner Juthani previously served as a professor of medicine and infectious diseases physician at Yale's School of Medicine and currently serves as an adjunct professor there. During the COVID-19 pandemic, Dr. Juthani was a leader in the COVID response at Yale, which led to her appointment as commissioner of the Connecticut Department of Public Health in 2021. So thank you both for being with us today. Tom, I’m going to first turn to you to talk about the most significant changes that we’ve seen to U.S. public health policy in the last month, and what you see is the implication of these changes for future international health coordination and data collection efforts. BOLLYKY: Great. Thank you all for joining us. Thank you to Irina and her team for coordinating this. The state and local network that her team operates is really one of the most useful, I find, resources at CFR, particularly on public health where battles are won at the state and local level. And it’s a privilege to be able to engage with you and learn from what you’re hearing on these issues as well. There's a lot going on, of course, on U.S. public health. So there's a good bit we could talk about. In my initial remarks, I'm really just going to focus on three areas. To start, I'm going to talk about vaccination. And there has been an unfortunate consequence, the cumulative effect of some of the early actions taken over this last month to perhaps undermine the support for vaccination, at a time where we have a quite a large measles outbreak ongoing, the potential emergence of dangerous avian influenza. These are risks not just for a loss of life. On measles, of course, it's also just a huge expense if it shows up in your part of the country. This is new. Vaccination for decades—U.S. immunization efforts provided immense benefits for health and had broad bipartisan support. Underlying these efforts were policies rooted in science that have been adapted and improved over time. Support for that vaccine policy framework is just as important today as it has been ever before. But it really has taken a hit, particularly after the COVID-19 crisis. To see how far we’ve traveled on measles, it was just in 2000 that measles was officially eliminated from the United States—meaning there was no measles spreading in the country. That was driven by vaccination. Typically, you need about—vaccine coverage of around 93 to 95 percent to have a sufficient level of population immunity to prevent outbreaks. There are currently, out of the forty-nine states reporting vaccination rates at the kindergarten level, thirty-one states are below the lower band of that threshold of 93 percent for coverage for the MMR vaccine. In terms of the outbreak, I’m sure most on this call are aware. Yesterday the tragic news was reported of the death of a child from measles in west Texas. An unvaccinated child is the first death from measles in the United States in ten years. Officials have reported, by last count that I’ve seen, 124 cases in Texas, mostly west Texas, since late January. Nine cases in the neighboring New Mexico county. Eighty percent of these cases involve children, who are more susceptible to this vaccine-preventable disease. Vaccination rates in the most affected county, rural Gaines County, at the center of the outbreak, are quite low. We've seen cases in seven other states—Alaska, California, Georgia, New Mexico, of course, New Jersey, New York, and Rhode Island. The total number of cases being just over 130 cases actually is more than we've seen in eight of the last fifteen years. And that's just in the first two months of this calendar year. There are probably more cases than that than we know about. We don't know how large this is going to get, but the rate of increase or the force of infection, as you might say, is strong. For reference, the last major measles outbreak we've had in the United States was in New York in 2019. That hit over a thousand cases. This could be worse. Now it is not too late. With the—with the potential for vaccination, behavioral shifts, tireless work of public health teams we could slow the spread of this outbreak. But it is concerning. At the federal level, we've not seen the type of support one would typically see for vaccination. The CDC has—itself, has been quiet on these issues—relatively quiet. We've had a number of important vaccine advisory committees postponed. The National Vaccine Advisory Committee was meant to discuss the strategic plan for national vaccination in February. That's been postponed. The Advisory Commission on Childhood Vaccination was meant to discuss the vaccine Injury Compensation Program. That's been postponed. There's been questions coming out of—at the secretary level about potential conflicts of interest among the Advisory Committee on Immunization Practice, that considers clinical information on immunization practice. Its findings influence the compensation program. Their credibility has been put in question. We had a Cabinet meeting yesterday at the White House where a reporter afforded an opportunity both to the president and the HHS secretary to speak on this, and although they did, we didn't see the call for vaccination that you would ordinarily see. We also saw in the early days of the administration an executive order restricting any federal funding to states or schools that required COVID-19 vaccination. So a broader—the cumulative effect of these actions, intended or otherwise, diminishes support for vaccination at a point where it's more critical. The second thing I would highlight is the firings of U.S. public health officials as part of the broader reduction of government workers. We’ve seen the National Institutes of Health, the nation’s premier biomedical research agency—we’ve seen an estimated number of a hundred—oh, I’m sorry—1,200 employees, most of them promising young investigators slated for larger roles, have been dismissed. Many of them have specialized knowledge that can’t easily be replaced. The CDC has seen a reduction of around 1,100 individuals. Four hundred of those are people that took the voluntary retirement in response to the request from the Office of Personnel Management. About 750 have been fired. There had been views that we might see a reduction in the Emergency Intelligence Service. Not yet, although that’s still possible. But we have seen significant decreases in personnel in the Laboratory Leadership Service Program, the Public Health Associate Program. And these are linkages between the CDC and states and locality that provide important resources in emerging outbreaks and crises. The last thing I will say is these, of course, also link to what's been happening at the international level, and the information sharing that can go on there. On the first day in office, the president, as many expected, withdrew from the World Health Organization. He did so in a manner that he renewed the withdrawal notice from 2020, suggesting it may be immediate. U.S. officials have already stopped participating in many of the networks that exist around surveillance of emerging infections and around influenza. USAID last night had 580—I’m sorry—5,800 out of 6,200 contracts terminated, in terms of its programming. There’s an expectation that the workforce there will be reduced from around 10,000 to 1,000. And, of course, they provide our eyes and ears with other countries in terms of emerging infections, as well as the good work that USAID does around HIV, malaria, and other concerns. What this boils down to is, you know, frontline public health workers here in the U.S. and abroad provide our network that we detect emerging diseases, prevent and respond to these threats, and protect everyone. That system may be unraveling. The risk of doing so is that we create blind spots, where emerging health threats incubate beyond our knowledge and provide an illusion of safety in public health that we don't—that we don't have. And that is our greatest threat potentially moving forward. So let me stop there. Lots more we can talk about. Looking forward to this exchange. FASKIANOS: Thank you, Tom. And we’re going to go to the commissioner to talk about how you are adapting your health systems in Connecticut to the federal public health policies that are obviously shifting, and the challenges that you’re facing, and where you see the opportunities, so we have a little bit of optimism. (Laughs.) So over to you. JUTHANI: Thank you very much, Irina. Thank you for the opportunity to speak with all of you today. And thank you for laying that foundation, Tom, so that I can speak to how we are dealing with things at the local level and at the state level. So what I would like to start with is that, as we entered these last few months and have seen a number of different orders and actions come through, it has been a time period of uncertainty and a time period of unrest, a bit, in terms of staff in a public health department, and state government writ large. So for us in the Department of Public Health in Connecticut, we have 154 different grants that we receive, largely from the federal government, spanning potentially up to seventeen different agencies at the federal government. And I believe that almost all of them received some sort of cease order in terms of work, initially. Half of my department is funded through federal dollars. And so where we are right now with different temporary restraining orders that have been put in place is that, in fact, at this moment, right now today, we do not have any specific grants that have been given specific terminations or reductions. We also have CDC employees—for example, the EIS officer, CEFOs, which are epidemic field officers that have been positioned in Connecticut—we had threats that they would be fired but they have not, up until this point. So what this has created, though, is a lot of uncertainty in terms of where we are going to be able to move forward, where we are going to potentially have to cut back, and where our work will continue. I think the second point on uncertainty is that, as with all administrations, there's an opportunity to decide what communications should go out, what needs to be paused, what can be resumed. And there was a lot of uncertainty in the first several weeks in terms of what information we would be able to get. And for example, there was the Morbidity and Mortality Weekly Report. The one that was put on pause in the first week after Inauguration Day had three different reports on H5N1 or avian flu. Since then, those have all been published, and we do have that information available. Today another MMWR came out as expected. So that is hopeful, that we have been able to see some resumption of communication that had been paused in the first several weeks. I would also comment that we’ve had a few emergent situations where we’ve had to call the CDC for emergency input in terms of how to deal with potential threats. And we were able to get in touch with officers who were working on the ground and be able to help provide us with guidance. As Tom mentioned, a lot of public health—good, old-fashioned public health is done at the local level, at the state level. But where we do really rely on federal partners is for expertise in areas that maybe we only interact with or have exposure to on a one-off basis and not on a regular, standing basis. And that is one of the challenges that we have seen, that we anticipate, and then we worry about in terms of where that is going to take us going forward. Tom mentioned a little bit about vaccinations. I mean, this is a foundational component of our public health advances over the last century. I’ve been talking for the last several months about a Morbidity and Mortality Weekly Report, MMWR report, from 1999 talking about the ten landmark achievements in public health over that previous century. And many of the things that are in there, with vaccinations being one of the top of the list, are the types of things that we worry about every day. If you look back to the early 1900s, influenza was a leading cause of death in this country. Today, we look at diseases like heart disease, and stroke, and diabetes, and cardiovascular disease taking a higher standpoint than influenza. But that is something that can backtrack very quickly. Something that gave me pause today was when I heard that VRBPAC, which is the federal committee that meets to determine which strains of influenza will be in the next season’s flu vaccine, that meeting was canceled. I hope that it is a postponement. I hope that we have an opportunity to see that those particular candidate selections of what should be in next season's flu vaccine are determined pretty quickly because this takes time. When the flu vaccine is identified what should be in the next season, that has to be done in the spring. It takes time to manufacture these vaccines. And this could be threatening to our pharmaceutical industry. This could have impacts on people showing up for work. The impacts of health are so vast. They impact business every single day. They cannot be separated. Health and business go hand in hand because in order to be thriving members of society we need to be healthy and we be able to—we need to be able to live, and work, and participate with each other. So these are some areas of concern, but I am hopeful that we’ve seen some changes where, for example, MMWR did resume. I am a member through the Association of State and Territorial Health Officials on the ACIP, which is the immunization practice committee that evaluates all—you know, all vaccines that come forward to be able to help create that schedule of vaccines. That meeting was postponed. I am hopeful, again, that ACIP will resume and that we will have an opportunity to be able to resume those types of, really on a regular basis, meetings that help inform these things. In Connecticut, we have been fortunate that vaccine uptake is something that has always been strong in our state. Going back to 2014, since we were talking about measles, the measles, mumps, and rubella vaccine, we had a 96.65 percent uptake for kindergarteners with the MMR vaccine. We hit a low during the pandemic in 2020 of 95.28 percent, with 95 percent often being a quoted number for achieving herd immunity. But now in 2024, we are actually higher than we were pre-pandemic, at 97.7 percent. And so we have a lot to, at least, hope that, at least, we’ll be able to, hopefully, avoid a measles outbreak. But we do have under-vaccinated populations, even within that—within our state. Which is true across the country. And so this is something we worry about, and we prep for, and we try to be ready for. The other thing I want people to just be aware of is that vaccinations are a critical thing, but there are so many areas of public health that we often don’t even think about. And I often say this comment that was said to me once, which is that public health saved your life today, you just didn’t know it. So, for example, safe drinking water. If we take our foot off the gas on regulations for drinking water, whether it be toxins, whether it be chemicals, whether it be infectious agents, these are foundational things that we maintain safety in our country. That is something that is under our purview in the Connecticut Department of Public Health. Another example would be food safety. We’ve heard some concerns that there may be less oversight or regulation in terms of food safety. We know right now, for example, there’s a listeria outbreak that’s going on around the country. This is particularly concerning for women, for babies. And we’ve had two cases here in Connecticut. But this is true at our restaurants and at our distributors of food, right at the ground level. For example, our state health department has secret shoppers that go out and buy different types of meat, or dairy, or produce, and do testing to ensure that food that is out in the public that people can purchase is safe. And we get funded, often through collaborations with the federal government and with our state partners, for that type of safety. These are basic things that public health does. And so I'm hopeful because I've seen some things improve over the last several weeks. But I have areas of concern. And it is our goal to work with our federal partners, that we rely on to be able to help provide us expertise and make these broad decisions that implicate all of us and have potential impacts on all of us. And I really hope that going forward we'll be able to continue to work together with federal partners to ensure the safety in our states. Thank you. FASKIANOS: Thank you very much to you both. Let's go now to all of you for your questions and comments. And you can also use this forum to share your experience and your best practices. (Gives queuing instructions.) And nobody’s put up their hand yet. Oh, we do have the first hand. Jennifer Herring. Q: Good afternoon. I’m Jen Herring. I’m from Doylestown Township, Pennsylvania. I’m the chairman of the Board of Supervisors there. My question is, generally speaking we know that there’s—it looks like there’s some limitations on communication between the federal authorities and state and local authorities, as far as health is concerned. And I’m fearful that it’s going to increase—or, actually, decrease—less communication. Where would you recommend we get our information from, if we don’t have access to the information such as, like, a department—the CDC? JUTHANI: I can start with that, at least. I would say that I would lean into your state public health department. One of the challenges that we all face is that state public health departments and local public health departments often rely on the CDC for more expert guidance. But, you know, we're doing the best we can with the information we have, at least at the local level, for what we can communicate out. And so I think as it relates to what's happening right in front of you, and in probably your day-to-day life at a local level, your state health department is probably a good place and a good resource to be able to lean into. One of the challenges we have, to Tom’s point earlier, is we don’t know what we don’t know. When you don’t have eyes on what’s happening on a more global landscape, or potentially even at the federal level, we just may not know it. But one of the things that I would say is that a number of us, as state health officials, do get together on a weekly basis. We do share information with each other. And we may need to do that a little bit more organically. We have sent out statements as we’ve received them. I’ll give an example. Today's MMWR did comment on severe influenza in children resulting in encephalitis and more severe neurologic complications. Before I heard that in the MMWR, I had heard that from some other state health officials. And so that was something we actually also ended up sending out a notice to providers in Connecticut to let us know if they had children who were manifesting with those types of symptoms. I was glad to see that it showed up in the MMWR as well, and I was able to get a better sense of what is the CDC seeing right now in terms of how that relates to what's happening now as opposed to historically. And some of the information shared there is that right now it seems to be 13 percent of children who died from influenza this season had that presentation, historically that was 9 percent. Again, is that outside of the range of variation? We don’t really know, but that was at least helpful for me to be able to read and understand that that was something they were able to share with us. But I would very much lean into, at least from a day-to-day standpoint of your life, leaning into your local and state health departments. Now, if you’re traveling somewhere else often we might have relied on the CDC to be able to see are there certain health advisories or other things like that that may be out there. I have not seen that that is not there. So that may still be available. But I would say also looking at those specific countries and seeing what they may be reporting out on—and, you know, WHO does have a website, it has information out there. Those would be the types of things I would lean into. FASKIANOS: Tom. BOLLYKY: Great. In the arena of more positive developments, after a few weeks where much of CDC’s website, in terms of data and pages, were shut down, there has been a return of much of that information. Now, depending on the area looking there are some concerns that some demographic information has been stripped out, which, from a public health standpoint, is not always helpful. But a lot of the data that had been missing, and some of the advisories that are posted on the CDC website, have returned. So that is, depending on your area, a resource. So, for instance, when I was looking for how many states are below the threshold, at this point, you can get that information from the CDC website, whereas just a few weeks ago you could not. So you’re starting to see some of those resources come online. The only thing I'll say on the WHO side, there are concerns—leaving aside the issue of collaboration with U.S. officials and, you know, a significant number of U.S. public have health staff had been seconded to the CDC—or, to WHO, so it was a real resource there, this will be—the United States was the largest donor to WHO, representing around 16 percent of its overall budget. So they have stopped international travel by most staff unless you're locally there. So to get back to the point that we don't know what we don't know, there is going to be some diminution of the international information we have, simply by reducing the reach of the world's health agency. So that will come at a cost. And part of that cost is the collaboration and the movement of staff. FASKIANOS: I’m going to take the next question from council member Barbara Leary from Folsom, California. Q: Yeah, I’m wondering if there’s—and I don’t know what can be done about this—any movement to reinstate a lot of the research? I know, you know, that you’ve talked, you know, about the MMWR being re-released, but I guess I’m concerned about a lot of scientists and other people who have been let go or who are not being able to pursue their interests in research, tracking problems, et cetera. And does anybody have any idea about how that might be addressed or changed? I think we’re in uncharted territory at this point, so just looking for some other thoughts on that. BOLLYKY: So just a little bit, and then—I'll start. I think there has been some effort for them—in terms of the cuts—at the federal level to U.S. public health employees because it was done largely around probationary employees—so less in a targeted manner and more where there might be the legal flexibility to pursue those reductions in force—you've lost a lot of people with particular expertise. So this was famously, has been reported, you saw that at USDA that the office that they had assembled around tracking the avian influenza outbreak had been gutted. You saw that at parts of the FDA, where, you know, we had brought in—or, the FDA had brought in, rather, people with particular areas of expertise that they've had to now try to hire back. EIS is an area that had been on the chopping block and, at least as of yet, given the outcry about the important role that that program plays, that has not happened. So I do think, in terms of communication, particularly from the state and local level, the importance of programs to the good work that you all do can have an effect when people have a greater appreciation of the value. I do want to point out one thing, though, that I am concerned, particularly as this has largely fallen on probationary government employees, that we are really eviscerating our next generation of public health experts and scientists. And that will have an effect not only, of course, on these people’s careers, but also on people who are considering entering the field. And it comes at a time where state and local—the state and local public health workforce has already been under stress due to the pandemic and is at low numbers. So really, the combination of this disincentive, losing potentially a generation of people, with some of the fatigue that is going on at the state and local level is really quite damaging. So again, you’ve—if you value these programs and particular areas of exchange with the federal government that are important to you, then don’t be quiet about it. JUTHANI: If I can just add one other piece to that, which is in my former role in academia the cut to indirect rates in terms of NIH funding, which funds many different types of support of research in academia, it has also had a chilling effect in the academic world where some academic institutions are not taking on graduate students in a variety of different areas. And in terms of the pipeline you talked about, of people doing research and not being able to pursue that research, some of that is because academia is feeling the pullback, whether it be from NIH dollars, a little bit different than some of the other public health funding that we’ve been talking about, more about scientific research. But really, this is an ecosystem and a continuum where people train in academia and then enter the private sector, enter the public sector, and really continue great scientific work. And it has been the stance of the United States for many, many decades that we wanted to invest in science, and scientific development, and that scientific pipeline. And so I do have concerns and worry that not only are we taking a hit to the public health workforce and generation of public health workers, but also to the scientific workforce writ large. BOLLYKY: Irina, I'm just going to add one quick thing, if I may, on that point. I have a particular concern about infectious disease research. One change, that there's proposed legislation in Congress but also apparently some support of the incoming team at the NIH, is to split NIAID, the portion of NIH that focuses on infectious diseases, into three subgroups—infectious disease, immunology, and autoimmune diseases. The thought is that this might build on some comments made during the campaign to defund or decrease funding to infectious disease research. And it really couldn't come at a worse time, given the range of things we're following. But it is not a lucrative area of medicine, to begin with, and to limit the research opportunities for people in this field is going to be a real disincentive to people pursuing it. FASKIANOS: Thank you. JUTHANI: As a—I’m sorry if I could just say one other thing. FASKIANOS: No, go ahead. JUTHANI: As an infectious disease doctor, I can attest to the fact that it is not one of the most lucrative areas of medicine. But I can also say that when we talk about public health we often think about communicable diseases, and infectious diseases being a large part of that, and the noncommunicable diseases. And we—because we've been able to have great scientific advances on the communicable diseases—in our vaccine programs, and antibiotics, and treatments, and antivirals—we've been able to focus on the noncommunicable diseases, meaning heart disease and cancer, and the things that take many, many decades to get worse in order to then cause worse morbidity and mortality. But if we don't have control of the communicable diseases that generally have morbidity and mortality more immediately, we will be losing decades of progress that we've made in public health. FASKIANOS: Thank you. I’m going to go next to Bill Taupier, who’s the director of administration and safety, in Massachusetts. Q: Oh. Thank you for having me. My question has to do with a little bit about USAID, and where it has been essentially eliminated, for all intents and purposes. My question is about, you know, outbreaks overseas, and how we can—you know, we learn a lot from those to fight diseases at home. But what is your opinion going to happen now with outbreaks of things like Ebola or Hantavirus, or other places—other diseases that could go unchecked? BOLLYKY: We’re going to be at greater risk. I think there might be a perception among some in the U.S. public that because of the struggles we saw around the COVID response, not just in the U.S. but other countries as well, that we really don’t know or are unable to contain—prevent, detect, or respond to outbreaks of dangerous diseases. And it’s not so. If you just take viral hemorrhagic fevers, things like Ebola or Marburg, you think about the Ebola outbreak in West Africa in 2013 to 2015, a little bit in ’16, that took 20,000 lives, or more. It costs billions of dollars in terms of the response. With each subsequent outbreak of Ebola virus, as well as other hemorrhagic fevers, we have gotten much better, even in low-resource countries, in containing this. The reason why you do not hear about these outbreaks in the same way that we heard about that particular West Africa Ebola outbreak is because of the build-up of these systems. USAID funding is responsible for the identification of the first COVID case outside of China. It is responsible for the development of the vaccine that we now have against mpox, and the world uses. I mean, the list just goes on and on and on of how these have kept us safe. And I do have concerns in these environments that—with the cutting of these programs, that we may not see that persist. If you had asked me even at the start of yesterday I would have told you that I think that some of the treatment programs around HIV or malaria, around in terms of the use of insecticide-treated bed nets, that those programs will probably survive in some form, even at the State Department. But we did learn overnight, with the cutting of these programs that I mentioned, or these grants, that many of the programs that had received waivers, the grants supporting those programs have been cut anyway. So I don't—I really can't say what's going to happen, but your question raises a real concern that gets at the heart of safety for all Americans and people worldwide. FASKIANOS: A question from Laura Bellis, Tulsa City Council member. Q: Hello. Yeah, I'm a Tulsa City Council member here in Oklahoma. And I also work in maternal-child health. And obviously, just geographically proximity-wise, too close to Texas for comfort. And our vaccine rates are also, as anyone can imagine, low, relative to where they should be. And so I'm curious if you all have any advisement, when we look at—whether it partnership, as Manisha has mentioned, with, you know, our state or local health departments, just what we can proactively do, acknowledging that we are likely to see a measles outbreak here? That we are in a certain type of policy and health environment that is not always very pro-public health. And just curious if there's anything you all would recommend trying to proactively do in the time we have prior to an outbreak. JUTHANI: Yeah. What I would recommend is, first, getting some knowledge with your local health department and state health department on areas that may be under-vaccinated right now. They should have eyes on that. They should know where those pockets exist. And, you know, like you said, proactively doing some of those interventions. And we do get funding to do this type of work, where we go within communities, identify what some of the barriers to vaccination may be, try to do that type of ground-building and communication with communities in terms of helping to overcome whatever vaccine hesitancy may exist, and then have vaccination campaigns to be able to, in fact, allow increases in vaccination rates. That’s some proactive work that could be done right now. Of course, you know, many health departments are stretched thin as is. Of course, we are dependent on our funding to be able to do that kind of work. But right now, I would say that that type of work is possible, and I would encourage you to connect with your local and state health departments. You know, every state is a little bit different. Connecticut is a home-rule state. We have fifty-nine local health departments and/or districts. I know that there are states like Massachusetts that have many more. There are others that have county-level government, and so there is a lot more economies of scale. But that's where I would really lean in and start there, to try to prepare yourself for what you've identified as a potential risk. FASKIANOS: Tom, do you have anything? BOLLYKY: Yeah. The only thing I would say here is part of what’s been hard about this first month is that, you know, vaccination rates have gone down. I think there is an important national conversation to be had. The part of the secretary of HHS confirmation hearings that resonate with me is being transparent that vaccines have a balance—all medical products have a balance of benefits and risks, and talking in those terms. I think it’s important that we engage in populations in a respectful way. I thought the advice that was just provided is very useful in that regard. I think there is work to be done. I think the fact that we did see a death, tragically, yesterday, hopefully provides an example of what the cost of under-vaccination might be. And there may be more receptivity to these vaccination campaigns than we might otherwise find. So I think looking for a way to have respectful, transparent conversations at this moment, given the national attention to this issue, is important. So I thank you for worrying about it. And, you know, the support you might be able to—or, the partnership you might have with your state and local officials. FASKIANOS: Great. I’m going to go next to Destini Cooper. If you could identify yourself, please. Q: Can you hear me? FASKIANOS: Yes. Q: Hi. This is Destini Cooper. I’m a policy analyst at the Legislative Council here in Nevada. And we're actually in our legislative session right now. I have a public health background. And I kind of want to know what you think the kind of pushback on public health will be when we're already in the world of vaccine hesitancy and things of that nature? And I just feel like in a world where we're trying to restore health—trust in the health care system or in the public health world, do you think that this will have some type of backlash? Because, as we know, as funding goes down or funding is taken away, then we lose services and we lose—you know, vaccine accessibility goes away, and people get sicker because we have more uninsured. And then the blame is, oh, well, vaccines don't work. Now we have more sick people. And now things that we made great strides in are now going backwards. So do you think that public health will kind of get the blame again when, how do I say it, basically options are taken away? Like, when we have to pull back on services and stuff, do you think the increase in health outcomes and, well, the lack of health outcomes—I guess, the decrease in health outcomes, do you think that public health will get the brunt of that again? Because COVID was our fault, right? Nobody believed in public health until COVID came, and then it was, oh, public health is here, and it’s terrible. So do you think that it’ll kind of be our fault again when we lose funding and we have to roll back these programs and the world gets sicker again, for lack of a better term? FASKIANOS: Who wants to start? (Laughs.) JUTHANI: I guess I can start. You know, I—Destini, I appreciate that comment. I don’t know that I would have thought of it that way, but I guess anything is possible. I would not have predicted the way the COVID pandemic happened and the divide that we ended up in after seeing a remarkable development of a vaccine that has saved millions of lives. So, you know, I think, to your point, is there a narrative or dynamic that has been set up that that could happen? I guess it could. You know, I guess I would have liked to think that with a reduction—and more health care problems, with a reduction in public health and preventative measures, that people would see that difference. But, you know, I guess we don’t know. My perspective in general is to try to work within my circle of influence, figure out where I can actually try to make a difference, and make a difference there, in that circle of influence. Because otherwise these questions become existential and feel like we’re never going to be able to make progress. But if I can look at—for the state of Connecticut, can I try to show people that I genuinely care, that I have read the science, and that, in my medical opinion, this is their best path forward, and try to bring people along and meet them where they’re at, then I’ve done my job for the day. And I think that that’s all we can each try to do. I hope we don’t end up in a place like you’ve outlined. Is it possible? I guess it could be. BOLLYKY: Two things, just to say quickly. We do a lot of work—have done a lot of research here on the drivers of differences between countries, how they did during the pandemic, controlling for relevant biological factors, and at the state level. And what a lot of that research has shown—and I’m happy through Irina to circulate the Lancet studies we’ve done on these things—is that, you know, trust—social trust, how communities interact with one another, played an outsized role in the differences between outcomes. There is actually a fair amount of research on how to engage with people who may not be trusting of public health or more inclined to blame public health for the problems. It is leveraging local—the people that are more trusted in those communities, physicians and nurses, the people that you engage with every day, the institutions you engage with every day, maintaining those relationships even in between crises, I think, is honestly one of the major lessons of the COVID pandemic for me, at least. And I think one that is going to be important in this moment. The second point I would make is I read an op-ed by a former Democratic political operative in the New York Times that talked about one strategy around this moment, from that political perspective, is waiting for the consequences of some of these actions to manifest, and therefore pointing out the folly of them. And I will say, from a public health standpoint, I don’t want that. I don’t want to wait that long. (Laughs.) I think we really need to be clear about what the consequences might be and try to engage with communities in an open and transparent way up front. And, you know, I think it’s really incumbent on all of us to do as much of that as possible. FASKIANOS: Thank you. There’s a raised hand, a number begins with 856, no name. So you’ll have to really help us identify yourself, your name and affiliation, please. Q: Yes. This is Laurie Lehmann. I’m City Council, Cape Coral, Florida. And I just want a clarification. You know, obviously, no one has mentioned Florida. Would my best bet be to talk to the county-level or the state-level public health departments to find out where we are lacking and what we can do about things? JUTHANI: Your local health department is always the group that is the most close and proximate to the conditions of what's going on, on the ground in your situation. So I think that that would most certainly be what I advise anybody, honestly, in any state, because they really know what's going on, on the ground most close to you. They can reach out to experts, whether it be at the state level or at the CDC level, to get additional information should it be necessary. So I think your instincts are correct to lean on the people who are closest to the ground where you are. FASKIANOS: Great. There are no more raised hands, but just a question about sources of good data. At the state level are there other organizations who are compiling the data that you could commend to people? JUTHANI: I would say that I think that this is a fluid and evolving situation. I think, to Tom’s point, we know that a number of CDC websites came down, and then now are back up. There are other things that are coming down and are—look to be permanently down in other agencies, as he mentioned the most recent changes that we’ve heard from USAID. So I think we’re going to need to keep on evolving and reassessing as time goes on. You know, I think there is the opportunity that maybe there will be other organizations, whether it be foundations, whether it be independent organizations, whether it be philanthropy, whether it be academia, whether it be partnerships of the like, who may try to fill voids that may develop, but I think we really don’t know what those voids are just yet. And trying to figure that out is, I think, where we are right now. FASKIANOS: Great. And, Tom, how would you say that other countries are beginning to fill the void of the leadership role of the United States in the global public health space? You know, with the exit from WHO, I mean, what is on the horizon here? BOLLYKY: Great question. I think, unfortunately, the events of the last month have had several knock-on effects. One is that governments who might be more politically aligned with the White House at the moment, some of them have—Argentina withdrew also from the World Health Organization, to emulate the action taken by the U.S. Reportedly, Hungary and Russia are considering doing the same. So this may spur, among some governments, emulation. In terms of the broader conversation about the Ukraine conflict, and indicating a potential need for more of a European role on defense on the European continent. This week, the U.K.—which outside of the U.S. is the largest government donor to global health—announced that it would decrease its foreign aid budget from 0.5 percent of GDP to 0.3 by 2027, so that it could invest more in the military, in response. Germany just, of course, had an election. There's enormous economic pressures going on in Germany right now. Germany has historically been a supporter of multilateralism, in the World Health Organization in particular. The World Health Organization has an office in Germany that does surveillance, data surveillance. I think there is some risk that you will see a pullback there as well. In terms of in-country, I think there have been some moves by aid-recipient countries to assume more of the burden. You've seen that in South Africa and Ghana, some conversations for that. But right now, the average government in sub-Saharan Africa spends $92 per person on health, which is less than a fifth of what it is in the less—the next lowest region. And their ability to assume some of these programs is going to be limited, outside of a handful of countries that are better resourced. Where we do see some governments responding has been China, particularly in countries where the U.S. has—or—and China has been grappling for influence, Southeast Asia and some Latin American countries. You've seen China offer to pay for some of the programs. I think in those strategic countries you will see that. I think overall China is not likely to assume the burden for U.S. programs in less strategic regions, or focusing on cross-border health threats. They tend to focus more on infrastructure projects. So we will see less of the focus on global health security and infectious disease or mother-child programs and more focus on healthcare infrastructure and products. FASKIANOS: Great. Roberta Smith from Routt County Public Health asked about programs like the polio eradication programs and Peace Corps, assuming they are also in danger. And then there's another question from MaryAnn O'Connor, who's the Massachusetts director in the city of Medford. Who's on the ground working on the outbreak in the Congo? So maybe you can just put those together. BOLLYKY: Yeah. So just quickly, on polio eradication, the U.S. provided money to the World Health Organization in two forms. One, like all governments, it pays assessed contributions, effectively membership dues. And then the other way is voluntary contributions. We, the U.S., historically provided significantly more in voluntary contributions. Much of that money went to two areas—the emergency program of the World Health Organization and polio eradication. So the withdrawal from the U.S. from WHO is going to have a consequence. Another major funder of polio eradication has been the U.K. government. So I don't know what will happen there in this area. It has been a priority for the Gates Foundation, so you may see them step up somewhat. But you may see some consequences. I have not seen anything in terms of the Peace Corps program. And maybe that will continue, but it’s difficult to know if they just haven’t gotten to it yet or if that’s more of a decision. I just haven’t seen any discussion. FASKIANOS: Great. Manisha, I wanted to give you a minute just to wrap up, and then I wanted to go back to you, Tom, just to say a few words about Think Global Health, because I think this community, this group could really benefit from it. So, Manisha, over to you before we close. And then we’ll go to Tom. JUTHANI: I think I would just make a plug to everybody that a lot of public health is local. And we do rely on federal partnerships and, obviously, international partnerships. But all of you are on the ground in your local communities. Advocate for public health locally. Press on and support the public health people that are doing that hard work and getting a lot of, potentially, counter messages to the work that they’re trying to do. And support them. Support the young people who are trying to do this work in that space in your local communities. And don’t be silent if you value public health, because I think that is going to be helpful not only in your state legislatures but at the federal government as well, to be able to show how public health has helped in terms of our society. FASKIANOS: Tom. BOLLYKY: Great. Thank you for the kind opportunity just to put in a plug for Think Global Health. It’s our online magazine that looks at how—tries to take—much focus on health is how things affect our—other things affect our health. This website looks at how health shapes economies, societies, and everyday lives. It looks from the other way. It’s a form of investment. I think we saw that in the pandemic. I think some of the political upheavals here are also related to what happened in the COVID pandemic. It is a multi-contributor site, so we do have a fair amount of domestic coverage of what’s happening in the U.S. So I would encourage you all to read it, but also, for those that are looking to write on these areas, we have that opportunity as well, and we welcome that. FASKIANOS: Wonderful. Well, thank you both for this hour. We really appreciate your taking the time and for the work you are obviously doing. And to all of you on the call for the work that you’re doing in your communities. It does take a village. We will be sending out the video and transcript. And we can put together some of the resources that were mentioned during this call. And, as always, we encourage you to visit CFR.org, ForeignAffairs.com, and, of course, ThinkGlobalHealth.org, that Tom just mentioned, for the latest analysis on international trends and how they are affecting the United States. And we welcome your suggestions for future webinars. You can email us at [email protected]. So, again, thank you to Commissioner Juthani and Tom Bollyky for this conversation. And we look forward to continuing it down the line. So thank you all.

In When the World Closed Its Doors:The Covid-19 Tragedy and the Future of Borders, Edward Alden and Laurie Trautman tell the story of how nearly every country in the world shut its borders to respond to the pandemic threat. The book details the enormous human costs of the travel restrictions and argues that governments are becoming overly reliant on borders to address external threats from terrorism to drugs to migration. This wide-angle view of a singular shock to the international systems of travel and migration highlights why those living across borders need better protections and governments more robust guardrails. The CFR Fellows’ Book Launch series highlights new books by CFR fellows.

Dr. Mandy K. Cohen reflects on her time as CDC director, highlighting the progress of the Biden administration both domestically and globally, as well as the public health challenges that lie ahead at the state and federal levels.Please note there is no virtual component to the meeting. The audio, video, and transcript of this meeting will be posted on the CFR website.Members may bring a guest to this event. 

Dr. Vivek Murthy, the 19th and 21st U.S. Surgeon General, discusses his role as the nation's doctor, including addressing the loneliness epidemic, the importance of social connection, and combatting the youth mental health crisis.  

The COVID-19 pandemic and chronic U.S. drug shortages highlight the health security and strategic importance of U.S. pharmaceutical and biotechnology capabilities during and between pathogenic crises. Geopolitical competition and interest in industrial policy for biotechnology further underscore the national security role of domestic biopharmaceutical infrastructure. Policymakers confront competing health, economic, and strategic priorities in maximizing innovation in technology, business models, and health-care systems in facilitating safe, accessible, secure, and sustainable products, services, and supply chains.   Please join our speakers, Monique K. Mansoura, executive director for global health security and biotechnology at The MITRE Corporation, and Victor Suarez, Colonel (ret.), U.S. Army, senior fellow (visiting) at The Council on Strategic Risks and founder of BluZoneBio, to explore challenges facing the U.S. pharma and biotech industries and approaches to strengthening the national security resilience of those industries in a world marked by health and geopolitical threats.

In response to COVID-19, member states of the World Health Organization (WHO) have been negotiating to create a pandemic agreement and to amend the existing International Health Regulations (IHR). The negotiations have been closely watched as indicators of global health diplomacy's future in an increasingly divided world. On June 1, the WHO's World Health Assembly approved amendments to the IHR and extended negotiations on a pandemic agreement. Dr. Suerie Moon, codirector of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva; David Fidler, senior fellow for global health and cybersecurity at the Council on Foreign Relations (CFR); and presider Thomas J. Bollyky, Bloomberg Chair in Global Health at CFR discuss what the World Health Assembly's decisions on the IHR amendments and the pandemic agreement negotiations mean for global health security, equity, and governance.  

David Fidler, senior fellow for global health and cybersecurity at CFR, discusses the factors shaping U.S. health and climate policy included in his Council Special Report, A New U.S. Foreign Policy for Global Health. Penelope Overton, climate reporter at the Portland Press Herald, speaks about her experiences reporting on climate and environment stories in Maine and their intersection with public health outcomes. The host of the webinar is Carla Anne Robbins, senior fellow at CFR and former deputy editorial page editor at the New York Times.  TRANSCRIPT FASKIANOS: Thank you. Welcome to the Council on Foreign Relations Local Journalists Webinar. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. CFR is an independent and nonpartisan membership organization, think tank, and publisher focused on U.S. foreign policy. CFR is also the publisher of Foreign Affairs magazine. As always, CFR takes no institutional positions on matters of policy. This webinar is part of CFR’s Local Journalists Initiative, created to help you draw connections between the local issues you cover and national and international dynamics. Our programming puts you in touch with CFR resources and expertise on international issues and provides a forum for sharing best practices. We’re delighted to have over thirty-five participants from twenty-two states and U.S. territories with us today, so thank you for joining this discussion, which is on the record. The video and transcript will be posted on our website after the fact at CFR.org/localjournalists. So we are pleased to have David Fidler, Penelope Overton, and host Carla Anne Robbins to lead today’s discussion on “Climate Change and Public Health Policy.” David Fidler is a senior fellow for global health and cybersecurity at CFR. He is the author of the Council special report A New U.S. Foreign Policy for Global Health. Professor Fidler has served as an international legal consultant to the World Bank, the U.S. Department of Defense, the World Health Organization, and the U.S. Centers for Disease Control and Prevention. And his other publications include The Snowden Reader, Responding to National Security Letters: A Practical Guide for Legal Counsel, and Biosecurity in the Global Age: Biological Weapons, Public Health, and the Rule of Law. Penelope Overton is the Portland Press Herald’s first climate reporter. She’s written extensively on Maine’s lobster and cannabis industries. She also covers Maine state politics and other health and environmental topics. In 2021, she spent a year as a spotlight fellow with the Boston Globe exploring the impact of climate change on the U.S. lobster fishery. And before moving to Maine, Ms. Overton covered politics, environment, casino gambling, and tribal issues in Florida, Connecticut, and Arizona. And, finally, Carla Anne Robbins is a senior fellow at CFR and cohost of the CFR podcast The World Next Week. She also serves as the faculty director of the Master of International Affairs Program and clinical professor of national security studies at Baruch College’s Marxe School of Public and International Affairs. And previously, she was deputy editorial page editor at the New York Times and chief diplomatic correspondent at the Wall Street Journal. So thank you all for being with us. I’m going to turn the conversation over to Carla to run it, and then we’re going to open up to all of you for your questions, which you can either write in the Q&A box but we would actually prefer you to raise your hand so we can hear your voice, and really open up this forum to share best practices and hear what you’re doing in your communities. So with that, Carla, over to you. ROBBINS: Thank you, Irina. And I’m glad you’re feeling better, although your voice still sounds scratchy. (Laughs.) Welcome back. So, David and Penny, thank you for doing this. And thank you, everybody, for joining us here today. This is—Penny, at some point I want to get into the notion of covering cannabis and lobsters because they seem to go very well together, but—(laughs)—and how you got that beat. But, David, if we can start with you, can you talk about the relationship between the climate and public health threats like the COVID pandemic? I think people would tend to see these as somewhat separate. They’re both global threats. But you know, why would rising temperatures increase, you know, the emergence or spread of pathogens? I mean, are they directly driving—one driving the other? FIDLER: Yes. I’ll just give a quick public health snapshot of climate change as an issue. In public health, the most important thing you can do is to prevent disease threats or other types of threats to human health. In the climate world, that’s mitigation of greenhouse gas emissions. That hasn’t gone so well. That creates, then, the second problem: If you have—if you’re not preventing problems from emerging, threatening human health and the infrastructure that supports human health, then you have to respond. And that’s climate adaptation. And in climate adaptation, we deal—public health officials and experts are going to have to deal with a range of issues. Close to if not at the top of the list is the way in which the changing nature of the global climate through global warming could increase—and some experts would argue is increasing—the threat of pathogenic infections and diseases within countries and then being transmitted internationally. And this leads to a concern about what’s called a one health approach because you have to combine environmental health, animal health, and human health to be able to understand what threats are coming. And climate change plays—is playing a role in that, and the fear is that it will play an even bigger role. Coming out of the problems that we had with dealing with the COVID-19 pandemic, this also fills public health officials with alarm because we didn’t do so well on that pathogenic threat. Are we ready to deal with potential pathogenic threats that global warming exacerbates in addition to all the other health threats that are going to come with climate change? ROBBINS: So can we just drill down a little bit more on that, as well as a variety of other health threats from climate change? So, like, with malaria, like, more water; water, you know, pools; mosquitoes; malaria spreads itself. With COVID, there was this whole question about, you know, loss of jungles, and maybe animals come in closer to humans, and things spread that way. Can you talk some more about what changes happen to the world around us that—with climate change that could increase the possibility of people getting sick, as well as other stresses on our bodies? FIDLER: Yes. In terms of vector-borne diseases such as malaria or dengue fever, the concern is that as global warming happens the area in which the vectors that carry these diseases will expand. So if you have malaria-carrying mosquitoes, if global warming is expanding the range of possibilities for those mosquitoes to inhabit, then there’s a(n) increased public health threat from those vector-borne diseases. If you have a situation in which that global warming is also happening in connection with waterborne diseases, it’s both the excess amount of water that you might have with flooding as well as potential shortages of water that you have could also increase the threat of waterborne diseases. So global warming has these effects on potential pathogenic threats. Deforestation is a concern in connection also with humans coming more into contact with pathogens that we haven’t experienced before. Unfortunately, we still don’t really know what the origin of the COVID-19 virus was, largely because of geopolitical problems. But also, as global warming affects forested areas or other types of ecosystems, the possibility for pathogens to emerge and effect public health increases. ROBBINS: And then there are other effects, like loss of access to water, and rising heat, and all these other things which are part of—because I would suppose that in a lot of places, you know, people would think, well, you know, I live in Kansas; I’m not going to be really worried about loss of a jungle or something of that sort. So in the United States, if you’re a public health official, and you haven’t thought about climate change as a—as a public health issue, and you want to go make the pitch, what would you say that—how climate is already potentially affecting people’s health? FIDLER: Yes, and this is one of the most interesting policy challenges about climate adaptation. Different areas of every country are going to experience climate change differently. So in some parts it might be wildfires. In another part it might be extreme heat. In another part it might be the spread of vector-borne diseases. And in other—in coastal areas, you know, sea level rise. In other areas, shortage of water because of drought. And so for any given locality, right, there could be diverse and different effects of climate change on public health from even a neighboring state or certainly a state, you know, across the country. City and county public health officials and state public health officials are already trying to start to get their head around the types of threats that their communities are going to face. And that’s what’s going to be interesting to me about today’s conversation, is how those types of effects are being discussed at the local level. A critical principle that’s usually put in—on the table for any policy discussion, whether it’s foreign policy or local policy, is that if you don’t have community buy-in, you don’t have community commitment to dealing with some of these problems, the policy solutions are going to be far more difficult. ROBBINS: So, Penny, you are new—reasonably new to this beat, and your newspaper created this beat, which is—you know, which is a sort of extraordinary thing. I mean, how big is your newsroom? OVERTON: I think it’s about fifty people— ROBBINS: And the notion— OVERTON: —if you include, you know, sports reporters and everybody. ROBBINS: So the notion that they would—maybe your newspaper’s the rare local newspaper that’s doing really well, but most local newspapers are, you know—(laughs)—are battling these days. Why did they decide that they wanted to create a climate beat? OVERTON: I think that our readers were asking for it. I mean, everybody—I think you find that every newspaper is writing climate stories, you know, in some way, even if it’s just running wire—like, national wire stories. And of course, papers are and every news outlet is obsessed with metrics, and we know what readers are looking for. Sometimes the stories aren’t necessarily labeled climate, but they are, you know, climate-related. And so in trying to sort out during a general newsroom kind of reshuffle about what readers, especially what our online readers—since that’s where everything is kind of moving towards—what they were really looking for, climate was one of the topics that kind of rose to the top. And then also we’re part of a newspaper family in Maine where there’s a—you know, every—a lot of weeklies, several dailies that all belong under one ownership. It’s actually a nonprofit ownership now, as of about a year ago. So I don’t think it’s a coincidence that it went nonprofit at the same time that they decided to do a climate beat. But one of the topics that unite all of the papers across a really, you know, far-flung state with the areas where you have really well-off people that live along the shore, people who aren’t so well-off in the interior, there’s not a lot that sometimes unites our state, but everybody was interested in this from the fishermen—who may not want to call it climate change, but they know that things are changing and it’s impacting their bottom line; to the loggers up north who can’t get into their—you know, their forest roads are now basically mud season for much longer than they used to be, they’re not frozen anymore for as long as they were so they can’t get in and harvest the way that they were; farmers. I mean, the three Fs in Maine—forestry, farming, and fishing—are, you know, pretty big, and they all care immensely about climate because they know it’s affecting their bottom line. So I think that that really united all of our newsrooms. ROBBINS: So can you talk a little bit more about that? Because I—you know, you’ve lived in places other than Maine, right? I mean, I used to live in Miami, and it’s really hot in Miami these days. And the New York Times had this really interesting interactive a couple of years ago in which you could put in the year you were born and your hometown, and it would tell you how many more days of the year would be over 90 degrees. And it was just wild how many more days in Miami it would be. I mean, it’s pretty hot in Miami, but many more days now than it was. And you’ve seen already this spring how bad it is in Miami. So I think to myself, Maine. I mean, Maine—I went to school in Massachusetts; I know what Maine is like. So I would think that Maine would be—it’s going to take a while for—you know, for it to come to Maine, but what you’re saying is it’s already in Maine. So can you talk about how—you know, how it is? And, obviously, it’s affecting Maine for them to create a beat like that. So what sort of stories are you writing? OVERTON: Well, I mean, Maine is definitely—you know, its impacts are going to be different. The actual climate threats are different in Maine than they are, say, like in Arizona where I used to live and report. You know, but contrary to what you might think, we actually do have heatwaves—(laughs)—and we have marine heatwaves. The Gulf of Maine is warming faster than 99 percent of the, you know, world’s ocean bodies, and so the warming is definitely occurring here. But what we’re seeing is that just because it’s not—the summer highs are not as high as, like, you know, Nevada, Arizona, Southern California, the Midwest, we also are completely unprepared for what’s actually happening because nobody here has ever really had to worry about it. Our temperate climate just didn’t make air conditioning a big, you know, high-level priority. So the increasing temperatures that are occurring even now are—we don’t have the same ability to roll with it. Warming stations in the winter? Yes, we have those. Cooling stations in the summer? No, we don’t have those. And I mean, there are a few cities that are now developing that, but if you don’t have a large homeless population in your city in Maine you probably don’t have a public cooling station. It’s really just the public library is your cooling station. So some of those—that kind of illustrates how sometimes it’s not the public health threat; it’s actually the public health vulnerability that a local reporter might want to be focusing in on. So you can go to the National Climate Assessment and you can pull up, like, exactly what, you know—even if you don’t have a state climate office or a climate action plan, you can go to one of those National Climate Assessments, drill down, and you can get the data on how, you know, the projected temperature increases, and precipitation increases, and the extreme weather that’s projected for 2050 and 2100 in your area. And those might not be, you know, nightmare stuff the way that it would be for other parts of the country, but then you’d want to be focusing in on how—what the infrastructure in your state is like. Are you prepared for what will be happening? And I think the air conditioning thing is a really good example. Maine also happens to be, you know—Florida will love this, but Maine’s actually the oldest state as far as demographics go. And so you have a lot of seniors here that have been identified as a vulnerable population, and so with the combination of a lot of seniors, with housing stock that’s old and doesn’t have air conditioning, and that they’re a long distance from hospitals, you know, don’t always—they don’t have a lot of emergency responder capability, that’s kind of a recipe for disaster when you start talking to your local public health officers who are going to start focusing in on what happens when we have extreme weather, and the power goes out, and these people who need—are reliant on electricity-fed medical devices, they don’t have access, they can’t get into the hospital. You can see kind of where I’m going with the vulnerability issue. ROBBINS: David, Penny has just identified the sort of things that one hopes a public health official on a state, or county, or local town or city level is thinking about. But in your report, it says the United States faces a domestic climate adaptation crisis. And when we think about climate and adaptation, and when we look at the COP meetings, the international climate change meetings, the Paris meetings, we usually think about adaptation as something that we’re going to pay for for other countries to deal with, or something of the sort. But can you talk about the concerns of our, you know, adaptation policies, and particularly state-level weaknesses? FIDLER: Yes, and I think Penny gave a nice overview of what, you know, the jurisdiction in Maine, you know, faces, and public health officials and experts are beginning to think about how do we respond to these new types of threats, which for most public health agencies and authorities across the United States is a new issue. The data is getting better, the research is getting better. The problems that public health agencies face sort of a across the United States are, one, they were never really built to deal with this problem. Some of it overlaps, so for example, if you have increased ferocity of, you know, extreme weather events—tornados, hurricanes—public health officials in those jurisdictions that are vulnerable know how to respond to those. They work with emergency management. As the scale of those types of events increases, however, there is a stress on their capabilities and their resources. Other things are new—air pollution from wildfire, the extreme heat of that; sea level rise, salination of drinking water from that; or even sinking in places where groundwater is being drawn out because of a lack of rainfall. Part of the problem that we have, that I talk about in my report coming out of COVID, is that among many issues today, the authority that public health agencies have at the federal and state level is polarized. We don’t have national consensus about public health as an issue. So unfortunately, coming out of COVID, we’re even less prepared for a pandemic as well as climate change adaptation. And that’s something that we need to have better federal, state, local cooperation and coordination on going forward. Again, it’s going to be very different from dealing with a pandemic, or even dealing with a non-communicable disease like tobacco consumption or, you know, hypertension because of the diversity—geographic—as well as the particular problem itself. So this is going to be a real challenge for federal and public health agencies, which at the moment are in some of the weakest conditions that I’ve seen in decades. ROBBINS: Penny, how much do you have to deal with your local public health, state public health agencies? And do they have a climate action plan? How developed are they on this? You talked about going to a particular website. Do you want to talk a little bit about that, as well? The assessments that you are making, is that information that you’ve gotten from your local public health agencies or from your state, or is this something that you yourself have come up with? OVERTON: Well, the state is—I think that the state of Maine is actually pretty far down the road for its size. It’s like punching above its weight, I guess, when it comes to climate. They have—they published their first climate action plan in 2020, and they updated it with a—kind of like how close are we coming to our goals in 2022, and then they’re in the process of developing the next four-year kind of installment, which will be due out in December. So the first one was kind of like—to me as an outsider, it felt like a “climate change is happening, folks” kind of report. In Maine we definitely—we have a split. We have an urban, you know, core that’s kind of—it’s liberal, and you don’t have to convince those people. We have a lot of rural parts of the state where, if you ask, you know, is climate change real, you’re still going to get a pretty good discussion, if not an outright fight. (Laughs.) But one of the things that I’ve found in this latest update is that, as they are focusing in on impacts, you get a different discussion. You don’t have to discuss with people about why the change is happening; you can just agree to discuss the changes, and that pulls in more communities that might have not applied for any type of, you know, federal ARPA funds or even—Maine makes a lot of state grants available for communities that want to do adaptation. So if you can get away from talking about, you know, the man-made contributions, which, I mean, I still include in every one of my stories because it’s just—you know, that’s actually not really debatable, but as far as the policy viewpoint goes, if you can just focus in on the impact that’s already occurring in Maine, you get a lot of people pulled into the process, and they actually want to participate. And I also have found that the two—the two impacts in Maine of climate change that are most successful at pulling in readers—(laughs)—as well as communities into planning processes are public health and extreme weather. I don’t know if it’s, you know, all the Mainers love their Farmers’ Almanacs—I’m not sure. I mean, I’m originally from West Virginia. I still have a Farmers’ Almanac every year, but I just kind of feel like extreme weather has been a wakeup call in Maine. We got hammered with three bad storms in December and January that washed a lot of our coastal infrastructure away. And, I mean, privately owned docks that fishermen rely on in order to bring in the lobster catch every year, and that’s a $1.5 billion industry in Maine. Maine is small—1.5 billion (dollars), that dwarves everything, so anything the messes with the lobster industry is going to have people—even in interior Maine—very concerned. And everybody could agree that the extreme storms, the not just sea level rise, but sea level rise and storm surge, nobody was prepared for that, even in places like Maine, where I think that they are ahead of a lot of other states. So you start pulling people in around the resiliency discussion. I think you kind of have them at that point. You’ve got their attention and they are willing to talk, and they’re willing to accept adaptations that they might not be if you were sitting there still debating whether or not climate change is real. The public health has been something that has really helped bring interior Maine into the discussion. Everybody does care. Nobody wants to lose the lobster industry because that’s an income, like a tax revenue that you just wouldn’t be able to make up any other way, even if you are in a Rumford or a Lewiston that have nothing to do with the shoreline. But public health, that unites—that’s everybody’s problem, and asthma, and, you know, all of our natural resource employees who are out working in the forests, and the blueberry fields, and whatnot, extreme heat and heat stroke—those things really do matter to them. They may disagree with you about what’s causing them, but they want to make sure that they are taking steps to adapt and prepare for them. So I just have found public health to be a real rallying point. And I also think that, for local reporters, if you don’t have a state action plan—because even though Maine has one—we’re a lean government state—they don’t—you know, they’re still gathering data, and it can be pretty slim pickings. But you can go to certain things like the U.S. Climate Vulnerability Index, and you can start looking for—drilling down into your local Census tract even. So you don’t need something at your state. Even if you’re in a state that, say, politically doesn’t want to touch climate change with a ten-foot pole, you can still use those national tools to drill down and find out where your community is both vulnerable to climate threats, but then also the areas that are least prepared to deal with it. And then you can start reporting on what nobody else wants to write about or talk about even. And isn’t that the best kind of reporting—is you kind of get the discussion going? So I think public health is a real opportunity for reporters to do that, and also your medical—the medical associations. If you talk to doctors here at the Maine Medical Association, they may not want to talk about humanity’s contribution to climate change, but they already know that climate change is posing an existing health risks to their patients, whether that be, you know, asthma, allergies, heat stroke, Lyme disease, or just mental health issues; whether you’re a lobsterman worried that you’re not going to be able to pay off that million-dollar boat because the lobsters are moving north, or if you are a young person who has climate fatigue. We don’t have enough mental health providers as it is. Anything that’s going to exacerbate a mental health issue in Maine, I mean, we don’t have the tools to deal with what’s already here. That’s a gap that reporters feast on, right? We write about those gaps to try and point them out, and hopefully somebody steps in to resolve them. So I rambled a bit, but there’s—I feel like this bee— ROBBINS: No, no, no, you— OVERTON: —it’s like never like what stories—boy, what stories can I write; it’s more like how am I going to get to them all, you know, because I feel like everybody out there, even if you are not a climate reporter, I guarantee you there is a climate aspect to your beat, and there is probably a public health climate aspect to your beat. I mean, if you are a crime reporter, are your prisons—(laughs)—I mean, most prisons aren’t air conditioned. Just think about the amount of money that’s being spent to deal with heat stroke, and think about the amount of—I mean, I’m making this up as you go, but I guarantee you if you are a prison reporter, that you’re going to find, if you drill down, you’re going to see disciplinary issues go through the roof when you have a heat wave. That’s what I mean by, like, you can find a climate story in any beat at a newsroom. ROBBINS: That’s great. I always loved the editors who had story ideas if they gave me the time to do them. David, can we go back to this—the United States faces a domestic climate adaptation crisis? If I wanted to assess the level of preparation in my state to deal with some of the problems that Penny is doing, how do I do that? What do I look for—climate action plans? Where do I start? FIDLER: Well, I think you would start at the—you’ve got to start both at the federal level, so what is the federal government willing to do to help jurisdictions—local, county, state—deal with the different kinds of climate adaptation problems that they’re facing. And even as a domestic policy issue, this is relatively new. I think Penny gave a great description of how that has unfolded in one state. This is happening also in other jurisdictions. But again, because of the polarization about climate change, as well as fiscal constraints on any federal spending, how the federal government is going to interface with the jurisdictions that are going to handle adaptation on the ground is important—state government planning, thinking, how they talk about it, how they frame the issue, do they have a plan, is it integrated with emergency management, is it part of the authority that public health officials are supposed to have, how is that drilling down to the county, municipal, and local level. Again, it’s going to be different if it’s a big urban area or if it’s a rural community, and so, as the impacts—and Penny is right about it—it’s the impacts on human lives, direct and indirect, including damage to economic infrastructure, which supports jobs, supports economic well-being. That’s a social determinant of health. And as I indicated, there are efforts underway, not only in individual states, but also in terms of networks of county and city health officials, tribal health officials, as well, for Native American areas—that they’re beginning to pool best practices. They’re beginning to share information. So I would look not only at those governmental levels, but I would look at the networks that are developing to try to create coordination, cooperation and sharing of best practices for how to deal with different issues. So if you have a situation where you are like Penny described in Maine, you know, you really haven’t had to have air conditioning before; now you’ve got a problem. What are the most efficient and effective ways of dealing with that problem? Share information. Research, I think, is also ongoing in that context. And so there is a level of activism and excitement about this as a new, emerging area in public health. Again, there are lots of constraints on that that have to be taken seriously. At some point, it’s just also a core principle of public health and epidemiology that you need to address the cause of these problems. And if we still can’t talk about climate change and causes for that, this problem is only going to metastasize in our country as well as the rest of the world. And there are not enough public health officials at the state, county, local level, and there’s not enough money if we don’t try to bring this more under control. That’s mitigation. We’ve squandered four decades on this issue. We have no consensus nationally about that question, and so that just darkens the shadow in, you know, looking forward in terms of what public health officials are going to have to handle. ROBBINS: So I want to throw it open to our group, and if you could raise your hand. We do have a question already from Aparna Zalani. Do you want to ask your question yourself, or shall I read it? Q: Can you guys hear? ROBBINS: I will—I’m sorry. Yes, please. Q: OK, yeah, basically I just wanted to know if you guys know if anybody is collecting good heat-related death data—data on heat-related deaths. ROBBINS: And Aparna, where do you work? Q: I work for CBS News. ROBBINS: Thank you. OVERTON: I’m just looking through my bookmarks because, yes—(laughs)—there are. I know that those are factored into Maine’s climate action plan, and I can guarantee you that is not a Maine-only stat. That would be coming from a federal—there’s just not enough—the government here is not big enough to be tracking that on its own. It is definitely pulling that down from a federal database. And I’m just trying to see if I can find the right bookmark for you. If you—and I’m not going to because, of course, I’m on the spot—but if you add your contact information to the chat, or you can send it, you know, to me somehow, I will—I’ll send that to you because there is, and it’s a great—there’s emergency room visits, and there are other ways. They actually break it down to heatstroke versus exacerbating other existing problems. It’s not necessarily just—you don’t have to have heatstroke to have, like, say, a pregnancy complication related to heat illness, or an asthma situation that’s made far worse. So they do have, even broken down to that level. FIDLER: And when I’m often looking for aggregate data that gives me a picture of what’s happening in the United States, I often turn to the U.S. Centers for Disease Control and Prevention, CDC. And so they’re often collecting that kind of data to build into their own models and their research, also in terms of the assistance that provide state and local governments on all sorts of issues. And because adaptation is now on the radar screen of the federal public health enterprise, there might be data on the CDC website. And then you can identify where they are getting their sources of information, and then build out a constellation of possible sources. Again, it’s something—there’s the National Association of City and County Health Officers—NACCHO is the acronym—that, again, it’s one of those networks where you could probably see those health officers that are having to deal with extreme heat and the morbidity and mortality associated with that. There could be data that they are generating and sharing through that sort of network. And on the— OVERTON: And one thing I would add— FIDLER: Sorry. Drilling at the global level, WHO would be another place to think about looking if you wanted a global snapshot at data. OVERTON: I was going to add that will probably be underreported, as well, because in talking to, like, say—because, I mean, we’re just ultra-local, right—talking to the emergency room directors at our hospitals, there are—the number of cases that might come in and really should be classified as heatstroke, but then end up being listed instead in the data, you know, in the documentation as, like, a cardiac problem. You know, it’s—I think you are limited to how quickly someone on the ground might identify what’s coming in as actually being heat-related versus like just whatever the underlying problem was. They might list that instead. And the other thing, too, is to make sure that—this is the hardest part about climate reporting is the correlation aspect versus causation. You’re going to mostly be finding, look, heat waves are—when we have heat waves, you see this spike. You have to be really careful because it could be that the spike that’s coming in emergency rooms is actually because there was also a power outage. Now I would argue extreme weather still adds that—you know, makes that linked, but you have to be careful about making sure you don’t jump from correlation to causation. I’m sure you know this, but it’s the same thing with every statistic, but sometimes my first draft of a story I’m like, oh, look at that. I just made climate change responsible for everything. (Laughter.) And I have to go back and like, you know, really check myself because the minute you overstep in any way is the minute that you, like, lose all credibility with the people out there who are already skeptical. FIDLER: And this is sort of—it’s often where adaptation becomes a much more complicated problem for public health officials because there are underlying health problems that have nothing to do with climate change, that when you meet, you know, warming, extreme temperatures or even, you know, problems with, you know, sanitation, or water, or jobs, it can manifest itself in very dangerous diseases or health conditions that then lead to hospitalization and to biased statistics. So what Penny is saying is absolutely right, and there needs to be care here, but from a public health point of view, this is why this is going to be a monster problem. ROBBINS: Can we just—because we have other questions, but talking about bookmarks, Penny, you had—when you were talking before, you went through some other places that you go to for data and information. Can you just repeat some of those you were talking about? OVERTON: Yeah, the National Climate Assessment, the U.S. Climate Vulnerability Index, good old Census Bureau. (Laughs.) I mean, there are a couple of—the other thing, too, I would say that if you are in a state that doesn’t have—say that public health officers are under intense pressure not to talk about climate change, still go to your local university because I guarantee you that there are grad students, you know, coming in from the blue states someplace that might be going to school in a red state, but they’re going to be studying those topics, and they are going to be collecting data. I, you know—geez, countless stories based on grad student work. So I would keep those folks in mind, as well. And the other thing is that, if we’re talking about public health, I always think of public health and climate in three ways. It’s the threat, you know, the actual increase, something like tick-borne illness if you are Mainer because we never had ticks here really before because our winters were so awful, and the ticks couldn’t last. Well, now they’re here, and Lyme disease has gone through the roof. So I think about it—that’s like a threat. And then there’s the vulnerability issue that I was mentioning. But there’s also the accountability issue—is that you want to make sure as a reporter that you are following the infrastructure money that’s coming through, and that they are actually going to the places that need it the most. And public health is something that I think is a good lens to look at that. If all your money is going into the shoreline communities in Maine because they’re the ones with grant officers that are writing the grant applications to get the infrastructure money, do they really need it, or is it that town in the middle of the state with no grant officer, and huge public health needs and vulnerabilities that really need it. So I would think about public health as being an important accountability tool, as well, because if you’ve got public health data, you can easily point out the communities that need that money the most, and then find out who is actually getting the cash. ROBBINS: So Debra Krol from the—environmental reporter from the Arizona Republic, you had your hand up. OVERTON: I love your stories, Deb. Q: Thank you very much. Just a brief aside before I ask the question because I know we’re running short on time. We did a story here a few months ago about a nonprofit group that’s helping these underserved communities obtain grants and do the grant reporting, and I remembered something that we learned at a local journalist get-together at CFR, so that’s what influenced me to do that. So kudos to our friends over there. But my question is, is data sharing between agencies—you know, we’re always trying to get statistics out of the Indian Health Service, and every other state that has tribal communities or tribal health has the same problem. So how much of these stats do you think are actually coming from tribal health departments? OVERTON: I know in Maine they are coming. In fact, Maine’s five federally recognized tribes are kind of blazing a path as far as looking for grant applications. And of course, once they apply for a grant, you could go through all that data when they’re looking to justify the need, right? And that will help you in just getting the, you know, situation on the ground. But I—yes, I mean, I don’t know about whether there may be certain parts of the country where that’s not leading the way, but also—I would also urge you to look at—go through the Veterans Administration, as well, just because I’m sure that, you know, that there’s a large overlap between Indian Health Services, BIA, and the VA. And it’s the way the VA provides public health care and the outcomes they get when they are serving indigenous veterans are far different than what Indian Health Services and BIA sometimes get. And they are more forthcoming with their data. FIDLER: I know that one of the issues that’s on my list to do some more research for my foreign policy analysis is to look at the way the federal governments, state governments, and tribal authorities interact on climate adaptation. And that comes loaded with lots of complicated problems—just the history of relations between tribes and the federal government, the concerns that the Indian Health Service has about problems that have been around for decades, layering on top of that adaptation. So some of it, I think, gets involved in just political disputes between tribes and the federal government. Some of the data-sharing problems I think relate to a lack of capabilities to assess, process, and share the data. The tribal authorities are on the list, at least, of the federal government’s radar screen for improving how they do adaptation. I personally think that how that jurisdictional tension is resolved could be a very valuable model for thinking about U.S. foreign policy and how we help other countries in adaptation. I also think there is variable experiences between tribal authorities and the federal government. A lot of activity is happening in Alaska with adaptation that I think is more advanced than it is with some of the tribal authorities’ relations with the federal government in the continental United States. So we just also need to start looking, you know, beyond for best practices, principles, ways of making this work better as adaptation becomes a bigger problem. ROBBINS: Debra is—Debra Krol is offering to speak with you offline. She has some recommendations on research. Debra, thank you for that. Q: You are welcome. ROBBINS: And for the shoutout. Garrick Moritz, an editor of a small town newspaper in South Dakota. Can you tell us the name of your paper and ask your question? Q: Yeah, I am the Garretson Gazette. Hello, if you can hear me. ROBBINS: Absolutely. Q: Oh, yeah, we just get frequent—we get frequent notifications from the state health department about, you know, like West Nile and several other, you know, vector diseases, and it mostly comes from mosquitos, and mosquito populations are a real problem in a lot of places. And it’s definitely one here. And so, I guess, in my own reporting and in basically reporting from people across the country, how can—what are practical tips that we can give to people, and things we can recommend to our city, state or county officials? ROBBINS: To protect themselves. OVERTON: You know, I think that if you were to go to the, you know, U.S. CDC, you’re going to see that there’s a lot of, you know, straight up PSAs about how to handle, you know, even right down to the degree of, like, you know, the kinds of mosquito repellent you can use that doesn’t have DEET in it, you know, like it gets pretty specific. I think that that’s—you could probably—and in fact I think they even have infographics that, you know, are public domain that you are able to just lift, as long as you credit the U.S. CDC. So it’s almost like—and also Climate Central. And there’s a couple of—I would say a couple of kind of groups out there that basically serve it up for reporters. I mean, I love Climate Central. I love Inside Climate News. These are some places that specifically work with reporters, and for smaller markets, they even do the graphic work. And it’s a great resource. I would urge you to look there, too. ROBBINS: Can we talk a little bit more about other— FIDLER: And I think one of the— ROBBINS: Yeah, David, can you also talk about other resources, as well as answering—whatever answer to your question. What should we be reading and looking to for information? FIDLER: Well, in terms of vector-borne diseases, many states and the federal government has vast experience dealing with these. There’s a fundamental problem—is that as the geographic range of vector-borne diseases begins to expand into areas where the history of that type of vector control just really hasn’t been, you know, part of what public health officials have had to worry about, so the infrastructure, the capabilities. And then, also importantly, how you communicate with the public about those kinds of threats: what the government is doing, what they can do to protect themselves. We’re sort of present at the creation in many ways, and some of these places have a whole new way of doing public health. One of the things that worries people the most in our polarized society is the disinformation and misinformation that gets in the way of accurate public health communication—whether it’s COVID-19, or whether it’s climate change, or whether it’s something else. So that communication piece is going to be vital to making sure that people can take the measures to protect themselves, and they understand what the state governments and the local governments are doing to try to control vectors. ROBBINS: And Inside Climate News—where else do you get your information that you would recommend for our— OVERTON: Well, I just— FIDLER: Sorry, go ahead, Penny. OVERTON: Oh, no. You can go ahead. I’m actually pulling some up right now that I can put in the chat. FIDLER: Again, my go-to source is the CDC, and the CDC then also has its own information sources that you can track in terms of how, you know, public health authorities, public health policies, practices, implementation plans can be put together for all kinds of different public health threats. And the spread of vector-borne diseases has been near the top of the list longer, I think, than some of these other health threats from climate change. So that’s a little bit more advanced, I think, based on the history of controlling vectors as well as the identification of that being an ongoing threat. There are synergies with what we’ve done in the past. With some of these other problems we don’t have those synergies. We’re having to create it from scratch. ROBBINS: Penny, you were talking about places that actually—smaller, you know, that newspapers can—or other news organizations can get info, can actually, you know, get graphics gratis, or something of the sort. Does Poynter also have help on climate or are there other reporting centers where people are focusing on climate that provide resources for news organizations? OVERTON: Yes, I mean, Climate Central has—I should have just like made them like the co-beat, you know, reporters for me in the first six months when I was starting this because anything that I needed to—you know, every day it was something new. OK, geez, today I’ve got to know everything there is to know about extreme weather and climate, you know, in such a way that I can bulletproof myself when the troll inevitably calls me and says, you know, this isn’t true. And I need to have, you know, a little bit of armor prepared, right down to I need graphics, and I don’t have—we don’t have a graphics person, but—so Climate Central is a great place for a reporter in a small market to start. They actually, like just this past week, came out with what they call a summer package, and it basically has an overarching umbrella viewpoint of, like, here’s like the climate topics that are going to brought up this summer. Inevitably it’s going to be heat waves, it’s going to be drought, or extreme rainfall. It’s going to be, you know, summer nights getting warmer and what that means—the benefits, the longer growing seasons than some areas that, like in Maine, for example, climate change will not be all bad for Maine. It’s going to mean that we have longer growing seasons in a place that has been pretty limited by the—you know, the temperature and by the amount of time that we could actually grow a crop. And then, also, I mean, we’re going to have—we’re going to have migration in because, like I was saying earlier, we are not going to be dealing with the extreme heat of like the Southwest, so people who are escaping like the California wildfires—we’re already seeing groups of people moving to Maine because it is more temperate, and you do have a longer horizon line before you—you know, you get miserable here. And I think that if you look at those issues and you figure out how do I even start, going to Climate Central where they can actually—not only do they have the infographics, but you can type in, like, the major city in your state, you know. I can’t tell you the number of times I’ve typed in Portland, Maine, and I get some amazing number, and it's, oh, wait, this is Portland, Oregon. So you could pull, like, your individual state, and even Maine has three states that Climate Central—or excuse me, three cities that Climate Central lists. I guarantee you that your state will probably have many more. So it will be probably a place pretty close to where you are located. And you can have the infographic actually detailed, without doing anything besides entering in the city. It will be information that’s detailed to your location. That’s an incredible asset for a small market reporter who doesn’t have a graphics person or the ability to, like, download data sets and crunch a lot of numbers. Also— ROBBINS: That’s great. OVERTON: —I would urge you to look at the National Climate Assessment. There is a data explorer that comes out with those, and that allows you to drill down to the local level. That’s the way that I found out that there’s a small place in Aroostook County, Maine, which is like potato country, that’s going to see the greatest increase in high precipitation days in the next—I think it’s in the next 50 years. I can’t think of many things that aren’t potato related that Aroostook County stands out for, but the fact that you play around with the data enough, and you see, look, there’s a small place here in Maine that’s going to be the number one greatest increase. That’s why I think the climate assessment and the data explorer is so important. ROBBINS: So we’re almost done, David. I wanted to throw the last question to you. I’m a real believer in comparison. I always say that to my students: Comparison is your friend. Is there any city or state in the United States, or perhaps someplace overseas that has a really good state plan for dealing with the health impacts of climate change that we could look at and say, this is really what we should be doing here? FIDLER: I mean, given that I’m a foreign policy person, I’m probably not the best person to inquire about that, but as I began to do my research to see how this is happening in the United States, I’ve been surprised at the number of cities, counties, state governments that have really begun to dig into the data, develop plans, you know, for whatever problem that they’re going, you know, to face. I live in the—you know, the Chicagoland area. The city of Chicago has been working on adaptation for a while. The problems that it faces are going to be different than the problems that Miami faces. There’s also, again, networks of cities that are starting to talk to each other about what they are doing in regards to these issues. The data is becoming better, more accessible, data visualization tools. Penny just described those sorts of things. My recommendation to those working in local journalism is to begin to probe what your jurisdictions are doing, where they are getting their information. How are they implementing and turning that information into actionable intelligence and actionable programs? And I think that local journalism will help fill out our understanding of who is taking the lead, where should we look, what are the best practices and principles around the country. ROBBINS: Well, I want to thank David Fidler, and I want to thank Penny Overton for this. And I want to turn you back to Irina. This has been a great conversation. FASKIANOS: It really has been a fantastic conversation. Again, we will send out the video, and transcript, and links to resources that were mentioned during this conversation. Thank you for your comments. We will connect people that want to be connected, as well, so thank you very much to David and Penny for sharing your expertise, and to Carla for moderating. You can follow everybody on X at @D_P_fidler, Penny Overton at @plovertonpph, and at @robbinscarla. And as always, we encourage you to go to CFR.org, ForeignAffairs.com, and ThinkGlobalHealth.org for the latest developments and analysis on international trends and how they are affecting the United States. Again, please do share your suggestions for future webinars by emailing us at [email protected]. So again, thank you to you all for today’s conversation, and enjoy the rest of the day. ROBBINS: Thanks, everybody. (END) This is an uncorrected transcript.