Global Health Program

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)

New fertility forecasts from the Global Burden of Disease Study stress our world's trajectory towards a low-fertility future. By 2050, fertility rates in three-quarters of countries will not sustain their populations, increasing to ninety-seven percent of countries by 2100. At the same time, relatively high fertility rates in low-income countries in sub-Saharan Africa will continue to drive population growth, leading to a ‘demographically divided world.’ Please join our speakers, Ann Norris, senior fellow for women and foreign policy at the Council on Foreign Relations and Christopher J. Murray, director of the institute that oversees the Global Burden of Disease Study, for a discussion about the latest regional fertility data and how national governments can prepare for projected threats to health, economies, food security, the environment, and geopolitical stability brought on by these demographic changes. 

An outbreak of H5N1 avian influenza that was detected for the first time in a milking herd of cattle in Texas one month ago has now infected thirty-three herds in eight states and at least one farm worker, spurring alarm among some experts that human-to-human transmission could be next. Please join us for a discussion with Dr. Nirav D. Shah, Principal Deputy Director of the U.S Centers for Disease Control and Prevention, on the U.S. response to this avian flu outbreak and on how the CDC and its U.S. government counterparts are applying lessons from COVID-19 to respond to the potential threat.

Yanzhong Huang, senior fellow for global health at CFR, and Rebecca Katz, professor and director of the Center for Global Health Science and Security at Georgetown University, lead the conversation on global health security and diplomacy. FASKIANOS: Welcome to the final session of the Winter/Spring 2024 CFR Academic Series. I am Irina Faskianos, vice president of the National Program and Outreach here at CFR. Thank you for being with us. Today’s discussion is on the record, and the video and transcript will be available on our website, CFR.org/Academic, if you would like to share these materials with your colleagues or classmates. As always, CFR takes no institutional positions on matters of policy. We are delighted to have Yanzhong Huang and Rebecca Katz with us to discuss global health security and diplomacy. We circulated their bios in advance, but I will give you some highlights now. Yanzhong Huang is a senior fellow for global health at CFR. He is also a professor and director of global health studies at Seton Hall University’s School of Diplomacy and International Relationships—sorry, Relations. Dr. Huang has written extensively on China and global health, and is the founding editor of Global Health Governance: The Scholarly Journal for the New Health Security Paradigm. And he is author of—his most recent book is Toxic Politics: China’s Environmental Health Crisis and Its Challenge to the Chinese State (2020). Rebecca Katz is a professor and director of the Center for Global Health Science and Security at Georgetown University. She previously served as faculty in the Milken Institute School of Public Health at the George Washington University. Dr. Katz’s work primarily focuses on the domestic and global implementation of the International Health Regulations, as well as global governance of public health emergencies. And her seventh book is coming out next week, I believe on Monday, and it is entitled Outbreak Atlas (2024). So you should all look for that. Dr. Huang and Dr. Katz coauthored a Council Special Report entitled Negotiating Global Health Security: Priorities for U.S. and Global Governance of Disease, so we did circulate that in advance. And I think we will begin with Dr. Katz to talk a little bit about global health security and diplomacy, and some of the findings from your report. So over to you. KATZ: Thank you so much, and really appreciate the opportunity to speak with everybody today about global health security and diplomacy. I could note—a quick disclaimer that like many people in Washington I wear multiple hats, including one that works for the United States government, but I am speaking today only in my academic capacity and not representing anybody else. So we are—we’re living in interesting times in the global health security and diplomacy space, and just the work of global governance of disease. As we speak, negotiators are working through what is hopefully a final agreement on amendments to the International Health Regulations. And in about a week, yet another version of possible text of a proposed pandemic agreement will be circulated to member states in advance of the resumed—the INB, Intergovernmental Negotiating Body, negotiations that are now scheduled, I believe, starting the 29th of April, where they may possibly finalize substantive negotiations in advance of the World Health Assembly. It is not a surprise, though, that the negotiations themselves have stalled, and they’ve stalled primarily over issues around access and benefit sharing, and the relationship between developed and less-developed countries. There are significant remaining redlines, including related to the way that pathogens are shared or the information around pathogens is shared. It’s related to the production of medical countermeasures, access to medical countermeasures. There continues to be an evolving power dynamic at this time of call it strained geopolitical tensions. And there are some real questions about the future of multilateralism and just the global governance of the disease space in general. So while this is all sorting out, the world is also working on questions like how do we fund pandemic preparedness and response. So there are questions around the World Bank’s Pandemic Fund, and the breadth and scope. There’s the role of what is the evolving role of the more horizontal entities like the Global Fund. There is limited response funding in general and overall kinds of shrinking budgets. In the academic space, there is a really interesting space set evolving looking at predictive analysis, and some of the technologies and scholarship that’s coming out to think about how do we predict and adapt, both from surveillance and thinking about the evolution of outbreaks. There is the rise of wastewater surveillance. And as the disease threats continue to evolve, we’re also looking at these threats as part of the climate crisis, and a community that’s very keen in looking at the role of artificial intelligence and changing biothreat landscapes. So there is—there’s a lot of movement. There’s a lot of things that are going on. But at the same time, there is diminished interest of governments as competing priorities reenter the fray, and increasing challenges thinking about response capacity in an age of mis- and disinformation and eroding trust in science. So, all this is to say that the space is challenging. It’s dynamic. There is a tremendous amount of work still to be done. Which is one of the reasons that we need to be thinking about how do we use all the roles and approaches that are available to us, including enhanced efforts to focus on the role of diplomacy. I am delighted to see the launch of a Foreign Ministry Channel for Health last month, and we’re now seeing ministries of foreign affairs around the world organize—better organize to address these health challenges. So not all the challenges are easily solvable, but heartened to see this coordinated effort. We’re trying to more fully realize diplomacy for health. There are—there is a lot—there’s a lot of swirl, but why don’t I stop there and turn to my colleague Yanzhong. HUANG: Thank you, Rebecca. Thank you, Irina, and for the Council for invite me to speak at this important event. Thank you for participating. And Rebecca just talked about this progress for the ongoing negotiation over the Pandemic Accord; the need to better organize to address the challenges we are facing. When we’re speaking of the challenges, you know, we—you might have—if you read just the CFR Negotiating Global Health Security—I’m seeking to advertise that one more time—(laughs)—you know, we basically talk about all those different global health security challenges, which are real. We already in the United States experienced a major global health crisis, that officially is not over yet, but—(inaudible). All of the important threat—serious threat we are facing, you know—mind you that COVID caused more than 7 million deaths, right, more than 700 million infections. That 700 million is a clear underestimate, right, because to my knowledge, right, in China alone they have more than 1 billion people infected, right? And now WHO is talking about Disease X, you know, the name given by WHO scientists to an unknown pathogen which they believe could emerge in future, maybe. So it could be, you know, anything, right, with pandemic potential. Like, it could be Zika. It could be Nipah. You know, or it could be another coronavirus, you know, that could cause a serious international epidemic or pandemic. You know, and unfortunately, Rebecca just mentioned climate change is the major contributor to this increasing risk, right? Warmer temperatures can affect the transmission dynamics of pathogens. But the climate change alone could also cause direct loss of life and morbidity, right? The projection is that by the end of this century the millions of heat-related death could be comparable in scope to the total burden of all the infectious diseases. And we also face the threat of antimicrobial resistance, or AMR, which is one of the top global public health threats. The estimate is that bacterial AMR is directly responsible for 1.27 million global deaths and contributes to 4.95 million deaths in 2019. So you combine those two and it’s, like, pretty much close to the COVID death in three years, right? And then there’s the problem of food insecurity. You know, we are facing a global food crisis. This is the largest one in modern history. We talk about nearly 350 million people around the world experiencing, you know, the most extreme form of hunger right now, right? And then—and finally, last but not least, the threats of violence and revolution, you know, that presents new risks to global health security. You know, last time the Council had an event, you know, we saw the former national security advisors participating, speaking, and weighing the—they were asked: Is there an issue that’s on your mind that’s not in the news all the time? I remember former Secretary Condoleezza Rice, you know, said that I worry that we are not paying attention to things like synthetic biology, which could have a huge impact on things like pandemics. So, all the threats call for good health governance, right, global/national level, you know, giving it, right, this—the implication. But I want to emphasize that geopolitics actually are complicating, not undermining, this prospect, right? When you talk about, certainly, right, the armed conflicts, right, worldwide, you know, they can lead to widespread displacement of populations, wide destruction of health-care infrastructure, disruption of supply chains of essential meds and medical equipment, and also increase the risk of the infectious disease outbreaks, right? And certainly, civilian population will bear the brunt of all—most of those impacts, right, that we saw, right, in Ukraine, Syria, now in the Gaza Strip. Sometimes this—that is of particular importance to global health security, the issue of lab safety, right? You know, laboratories taken over by warring parties or in areas under direct attack risk releasing the dangerous pathogens that could start an epidemic, not a pandemic, right? We all—you might recall in April last year, the WHO said, there was a high risk of biological hazard in Sudan’s capital, Khartoum after one of the warring parties seized a lab, holding measles and cholera pathogens and other hazardous materials. Rebecca talked about misinformation and disinformation. You know, the—in a way, the wars and conflicts also encourage, right, disinformation/misinformation, right? For example, the wars in Ukraine, right, they essentially reduced Russia’s incentives to participate constructively in global health governance, right? Russia, in order to justify its invasion, launched a disinformation campaign claiming the United States was secretly aiding Ukraine developing biological weapons. You know, that conspiracy theory sort of echoed, you know, by the U.S. Five Eyes and in China, right? The wars, of course, also exacerbate the other global health issues like food security, right? We know the war in Ukraine, combined with the COVID pandemic actually disrupted the supply chain, fueled inflation, and aggravated the food insecurity problem. But, I think it’s equally important when we look at the issue of how geopolitics or geopolitical tensions actually curbs the prospect of international cooperation addressing all the threats we just talked about, right? Because geopolitical tension, rivalries between nations, can hinder international cooperation and funding for global health initiatives like disease surveillance, sample sharing, vaccination campaigns, research and development of new treatments and preventive measures. Just to use my familiar area—(laughs)—the U.S.-China geopolitical competition, as an example, most certainly U.S.-China geopolitical competition is not new, right? But it is only recently that China became so-called America’s most consequential geopolitical challenge, right? You know, that sort of leads to zero-sum thinking even by the international cooperation over issues like the probe of the COVID-19 pandemic’s origins, sample sharing, supply-chain resilience. And in fact, during the beginning stage of the pandemic we saw China basically threaten to use this leading—the status of being a leader in pharmaceutical—active pharmaceutical ingredients manufacturing to sort of—like as a weapon, right? When the Xinhua News Agency said that—because the U.S. instituted travel bans on China, basically, China at that time was unhappy and said, you know, here we decided to ban our export of APIs to the U.S., so we are going to be plunged in the what they call the sea of COVID, right? So this is an example of how even the medicine could be weaponized during—as a result of geopolitical tensions. And then if you also look at how this U.S.-China geopolitical rivalry could be combined with the lack of personnel—personal exchange, right, sort of deepened by these mutual misunderstandings and misperception, you know. So, you know, now we’re seeing that even after almost the end of the pandemic, right, that the two nations still have no serious discussions over public health issues, even though we think, like, China is actually one of the biggest risk factors. But there is just not much enthusiasm in supporting, like, a serious dialogue with China on cooperating on disease surveillance, sample sharing—not to mention, like, co-development of vaccines or therapeutics. And finally, I want to add that these geopolitical factors could influence the availability and affordability of health-care services and medical supplies, particularly in developing countries or regions affected by conflict or economic sanction. That sort of leads to disparities between North and South in access to essential health care and drugs. Again, the U.S.-China geopolitical competition during the COVID, when China launched this—the so-called vaccine diplomacy or mask diplomacy, the U.S., you know, sort of viewed that as a threat; they—it launched its own mask—vaccine diplomacy. You know, this competition sort of mitigated this so-called vaccine apartheid between the developed world and developing countries; but it also meant that, you know, the vaccine diplomacy would prioritize those countries that’s viewed as strategically important, right? That, in turn, exacerbated the global disparities in access to the vaccines—(all the ?) COVID vaccines—(inaudible). So, to address these challenges, I think we need to have a global health détente with geopolitical rivals. We need to embed the health diplomacy in a multilateral instead of a bilateral framework, right, and support WHO Global Health and Peace Initiative—the GHPI—to better address the underlying diverse critical health needs in fragile, conflict-ridden settings. So, with that, I can stop there. (Laughs.) Thank you. FASKIANOS: Thank you both. Appreciate it. Let’s go to all of you for your questions and comments. (Gives queuing instructions.) OK, so with that, let’s go to the first question. I’m going to go to Mojúbàolú Olufúnké Okome to ask her question. Q: Thank you very much. I’m Mojúbàolú Olufúnké Okome. And I teach political science at Brooklyn College. I’m also Nigerian. And the pandemic showed a lot of the fault lines in terms of the global governance arrangements for health issues, because there were—I mean, the vaccine—the disparity in access was profound for Africans. And, you know, the lucky thing is that not as many people as could have died, died. But I’m just wondering, because we’ve had the HIV/AIDS epidemic, we had Ebola, what is the learning from that? And how come we had all these challenges with the pandemic that we went through, the COVID-19? The other thing about it—that I want to talk about is food. And then there is—I don’t think the problem is insufficiency of food in this world, but distribution equitably. So, what would it take? I mean, and there are all these really heartbreaking photos and, you know, documentaries and reports. What is it going to take to solve this problem and make things equitable so that lives are not being lost unnecessarily, and then health challenges that come from malnutrition are not generationally affecting human populations? Thank you. FASKIANOS: Who wants to go first? KATZ: I will, very briefly and inadequately, try to address the question around vaccine equity. And then—and then I will—I will punt on food security. Since that’s more of Yanzhong’s expertise. I think the point you bring up is critical. And the issues of vaccine nationalism, of vaccine inequity are what is driving current discussion, debate, the feelings around global governance of disease and the effectiveness of it at all? It is—it is the issue that prompted the beginning of a negotiation for a new—(inaudible). And it is—but the solutions are why nations are actually stalled right now. I think your question around what have we learned, well, I think what we have learned is that there’s—whenever anybody talks about future of global governance of disease, you could probably count the number of times somebody says the word “equity.” Yet, operationalizing that is extraordinarily complicated. And unfortunately, we haven’t seen it yet. And I think that you can see that with, you know, the mpox outbreaks and the number of cases that were—you said, you’re from Nigeria—the number of cases that were in Nigeria, the number of cases that have been in the DRC. And the, I think it’s fair to say, insufficient amount of medical countermeasures that have reached populations in sub-Saharan Africa, just for mpox. So, I think there is—there is certainly widespread understanding, realization that we need to fix this—we need to fix this. Because we can’t—we can’t actually talk about we’re all in this together, disease spreads, knows no borders, we all need to work together, and then have situations like you did during COVID where populations just didn’t get access to lifesaving vaccine. So but now getting to the point of trying to figure out how we solve that is exactly what is—what is causing the discord in Geneva right now. And I’m not sure there’s an easy answer for you on how it’s going to be solved. HUANG: Well, I have—(laughs)—well, I really agree with Rebecca, right? There’s no easy answer, right, to all these questions that the professor just raised, you know, that—like the vaccine aspect, right? We know many of the low-income countries, right, that the vaccine—the vaccination rate was even low—very low even by the end of the COVID pandemic. But you know, there’s, like, multiple factors that contributed to that. Certainly, vaccine nationalism is one reason. But you know, even weighing we have all these vaccines available, right, they—the COVAX did a very good job of trying to reach this segment of the population, but then there’s the other issues, right? The shipment, right? How do we make sure they ship and distribute these vaccines in a timely manner? That’s become another issue. And so, I think, well, at this moment the solution that—for the—I think the transport technology for the vaccine technology, that is important. Now, I believe that the Pandemic Accord will talk about—is talking about that in the negotiation. But in the meantime, I think we should also invest to make sure those countries, especially with the manufacturing capacity, will repeatedly sort of have that—some investing there, like their capacity to manufacture the vaccine, right, to sort of—to scale the access. You know, that could be one of the solutions. Then, speaking of the lessons we learned from the pandemic, certainly what we have, right, the—(laughs)—I think it’s fair to say we know the problems, right? The experts—the global health experts, public health experts—they know where the problems are. It’s just that, you know, many of the issues—(inaudible)—only, you know, that it can easily slow them down. For example, we know that the WHO—(inaudible)—by strengthening its capability, enforced by the International Health Regulations. But in the—(laughs)—international system, where anarchy is the rule of the game, you know, that, yeah, I think much of this improvement will be still, you know, state-centric, that—and driven by national interest, just like we saw during the pandemic. Essentially, the IHR was talking about avoiding the disruptions in trade, disruptions to people’s movement, essentially tend to be ignored, right, by the nations there. But there’s another issue, is the lack of coordination. When states tried to use to institute all the travel, you know, the trade barriers, you know, they—there was no, like, coordination, no cooperation. You know, that sort of created this little tragedy of common situation, that then everybody actually was hurt. Finally, the issue of the food insecurity. Well, this is, again, not something new, but that clearly the pandemic, right, exacerbated the problem, in part because of the—this disruption of the supply chain. But in the meantime, there’s some other issues that, you know, could exacerbate that problem. Yeah, like in particular countries like North Korea, for example, we know that in this country—what is arguably the world’s most isolated state, right—they say—the people say—suggested a situation where it’s the worst, right, it has been since the 1990s, you know. But you know, people—the North Korean government certainly could blame the international sanctions. But in the meantime, the government mismanagement, right, is also to blame. In actually still—better still in the pandemic 2020 that cut off, right, the virus supplies, and that is also to blame. You could also talk about the—(inaudible)—killed more by starvation. Is this part of the humanitarian warfare, and especially, you know, in the war setting, where the humanitarian aid is twisted into the conflict by the—(inaudible)—and warlords that seeks to control the food supply as a means of increasing their military and political power, right? So, you know, that—the deliberate use of starvation, this the term we use, kind of war by starvation, right, that’s also was exacerbating in those that conflict zones. FASKIANOS: Thank you. I’m going to go next to the Fordham IPED. Q: Hello. I’m Genevieve Connell with Fordham Program for International Political Economy and Development. Thank you for being with us today. And my question is: During the COVID-19 pandemic we saw dissent where many people blamed China for the pandemic, which has catalyzed racial violence against people of Chinese or Asian descent in many cases. What implications do such social upheavals and demonization of a specific group have on global diplomacy and our ability to collaborate in future health response efforts? HUANG: Well, I’ll try to be—(laughs)—to be the first, whether Rebecca could weigh in. Well, this is, again, not something new, right? During the SARS epidemic, you know, that you also saw that the Chinese were sort of, like, blamed, you know, for sort of causing epidemic. You always, you know, target the certain group of people to blame. You know, you could—(inaudible)—like, historical, that could be traced—there’s a pattern there, right, that during the Bubonic Plague, for example, European Jews were blamed, right, the—for causing the pandemic, you know, that sort of to enforce to them to migrate towards Eastern Europe. You know, that certainly sort of the—poisons the atmosphere for tackling the crises, especially, like, when there’s intertwining geopolitical tensions between China and the United States. You know, that—remember that—and also, you have internal politics by the way, the Trump administration trying to find a scapegoat, right, for its mismanagement of the crisis, you know, that China become an easy one. So he sort of, like, started to talk about, you know, this is sort of a China virus, or kung flu, right, the thing that only—that sort of intoxicated the atmosphere of cooperation with China, making it even less willing to cooperate with the United States, especially on issues like the origin probe. So now, you know, we’ve seen how that—we were probably—given this sort of lack of cooperation, China, you know, really probably we are never going to find where that virus actually come from. But in the meantime, you know, also this created—sort of contributed to, like, a more divisive society in countries like the U.S. given this anti-Asian sentiment. Rebecca? KATZ: You know, I don’t have too much more to add, except that I just—it’s an interesting question. And I actually would put it back to you a bit too. That I think it’s important to separate out the challenge—I bucket the challenges slightly differently. So the challenges of the types of stigma and bias that might arise for subpopulations within our own country. And we’ve, as Yanzhong just mentioned, we’ve seen that over and over and over again. And so you think about the types of ways that that can be addressed, and people can be protected, and how we can think about, you know, it’s not really a vulnerable population, but populations at risk of inappropriate stigma. So I think there’s that question. And then there’s—I bucket into a separate issue of how the government response and dealing with other countries, and the geopolitical tensions that might arise, and how that affects the response into a different category. And that’s—and Yanzhong already kind of addressed some of those—some of those challenges along the way. But none of it—none of it is easy. And it’s often not done sufficiently. FASKIANOS: Thank you. I’m going to take the next question from a written question from José David Valbuena. He’s an undergraduate student at Buffalo State University. And the question is, what are the potential risks and limitations of implementing economic structuralism to improve global health security? HUANG: Define economic structuralism. KATZ: Yeah, I was going to say, I’m not sure how to answer that because I’m not sure what your—what you want us to get at? FASKIANOS: All right. So, José, I think if you’re in a place where you can—you can join in live, or unmute yourself, why don’t you do that? And if not, then we’ll move to the next question. KATZ: Here he comes. HUANG: To use that—something like the Marxism sort of argument, the economy, right, just determines the—(laughs)—almost the upper infrastructure, or whatever. If that if that is the case, right, there, you know, they—I think, you know, a single focus on economic development certainly does not help, right, in improving public health, even though a well-developed economy, you could find the policy high correlation, right, between the, like, high level of economic development improved, right, the health-care standards and, like, the average life expectancy increased. But in the meantime, the single focus on economic development could hurt the public health and global health, you know? One of the examples is urbanization, the industrialization, like, the—could, right, the—sort of make us more likely to be exposed to those dangerous pathogens that increase the likelihood of a dangerous pathogen of jumping species to human beings, you know, then start a—potentially, right, that if it obtained that capacity for efficient human-to-human transmission, right, the potential for a pandemic. KATZ: I think I just saw a note that he’s going to reframe the question, but maybe talk about economics, just one point I would love to be able to add to maybe help frame some of the—some of that discussion with a little bit of data. When we talk about what do we need for health security—and we can talk about the threats, and Yanzhong was talking about, you know, the challenges of urbanization and globalization—(inaudible)—land, and the competing challenges of looking at economic development and—but I do want to note—so one of the things that our research team has been doing for about a decade is trying to figure out what it costs each country to be able to develop their capacity to be able to prevent, detect, and respond effectively to public health emergencies, based off of their international legal obligations and then also looking at each region in context. And it—just so everybody has a number in the back of their head, the number that we currently have is approximately $300 billion that would cost at the global scale for every nation to be able to build sufficient—and sustain—sufficient capacity for health security. That’s in addition to approximately $60 to $80 billion that’s required at a global scale for things like research and development, and supply chain, and manufacturing. So just to note, we have approximately $380 billion problem. And we are definitely not spending that right now. And if we think about it as a problem, the pandemic itself cost—well, we’re not exactly sure what it cost—but somewhere around $15 trillion dollars. So $300 billion dollars sounds like a lot, but it’s actually very little if you’re looking at your return on investment for being able to address a future pandemic. But it’s a lot in the world of public health, where there’s very little money, and there’s shrinking budgets, and there’s shrinking opportunity for nations to be able to actually invest themselves, as well as international financing. So I’m using—I’m using the question as an opportunity to just throw that out there, so folks understand. HUANG: Yeah. I forgot to throw out, again, with the pandemic example, right, that the countries that are most developed, doesn’t necessarily mean that is the most—or, the best prepared for a pandemic, right? Before the pandemic, there was Global Health Security Index, that showed the U.S. was one of the best prepared. But as it turn out, it was the worst—one of the worst hit by the pandemic. FASKIANOS: Thank you. I’m going to take the next question, raised hand from Braeden Lowe, who also wrote his question. But why don’t you ask it? And if you could identify yourself, that would be great. Q: Yes. Can you hear me? FASKIANOS: Yes. Q: Perfect. My name is Braeden Lowe. I’m a graduate student at Middlebury Institute of International Studies at Monterey, studying international trade. My question is, how effective have multilateral development banks been in the development of health infrastructure in countries that need them? And could there be a greater role for them in the future, such as maybe development banks that are focused primarily on the development of medical infrastructure, and facilities, and the development of medical technologies? Thank you. HUANG: Rebecca. KATZ: Yeah. I mean, Braeden, it’s an excellent question. And I think that the history of the development banks has been mixed over—pre-pandemic and in the current situation. Let me start with—well, so, yes. The banks have been involved in developing health security capacity and including medical countermeasures—less on the medical countermeasures, more on mostly national capacity and regional capacity. And some have been more involved than others. The Asian Development Bank was really engaged for a long time. ASEAN was really the driving factor for coordination in that region. The Inter-American Development Bank has been engaged. IMF had programs. So there have been programs. And prior to the pandemic, the World Bank had something called the PEFF, the Pandemic Emergency Financing Facility, that they stood up both for preparedness as well as a response window. That came under a decent amount of criticism because the triggers for using that mechanism were so stringent that it basically became not helpful. And while the Bank and IMF and the regional development banks did assist throughout the pandemic, you could have a pretty lively debate on how effective they were, how fast they got into the game, where they could have done more. I think the general lesson is everybody could have done more. But where we are right now is that the G20 High-Level Independent Panel—well, the G20 appointed a high-level independent panel that was—that came up with some proposals for how to better position the world for being able to support national-level development of pandemic preparedness and response. And the recommendation was to use the World Bank as the mechanism for that. So about a year and a half ago, the World Bank—the World Bank board approved the creation of the Pandemic Fund. As I mentioned before, we have about a $300 billion problem. The first round of funds that was given out over the summer was for $337 million dollars. So we got a—$337 million dollars went out on a $300 billion problem. And there were—and that went to thirty-seven different countries where there were proposals, however, from—there were 600 proposals that were submitted. And these thirty-seven went out. So the next round is out right now. And the plan is for the Pandemic Fund to provide approximately $500 million dollars in this round. But, again, so it kind of—it depends on if you’re a glass half empty, glass half full kind of person, and whether you think that the banks are super engaged in doing all that they can, or if they’re really—if there’s a lot more that they could do. And that’s not even getting into all the other mechanisms that that they have contemplated and thought about in terms of being able to use to help countries, particularly being able to mobilize resources quickly. FASKIANOS: Great. Thank you. I’m going to take two—combine two written questions. The first is from Nicole Rudolph, who is an assistant professor at Adelphi University. Who is leading initiatives to integrate health security with climate resilience efforts? And then there’s a question from Izabella Smith. I don’t know her affiliation. How do you deal with the mass politicization of health safety, specifically before and after COVID-19? KATZ: Easy ones, right? (Laughs.) FASKIANOS: Yeah, very easy. (Laughs.) KATZ: Well, Yanzhong, why don’t I—why don’t I do a really quick answer, and then and then turn to you, particularly on the health and climate space. Except for, Nicole, I would say that I’m glad you’re working on this. We’ve always considered one health and climate as first principles of health security and health security threats. So they are, in our head, completely intertwined, and really need to be addressed that way. I think to Izabella’s, man, how you deal with the politics? It’s—we are in a really, really complicated environment right now. I’m a public health professional. Before the pandemic, most people did not know we existed. (Laughs.) And maybe that was OK. It was difficult because there was no money, but we were kind of quietly left to do our job. And we were most successful when people didn’t know we existed. What happened during the pandemic, particularly in the United States but also around the world, we saw the—a lot of these issues have always been political. They had never been partisan before. They became very partisan. And there was a tremendous amount of backlash against public health officials. There are—there are academic efforts underway to help and capture the—just the type of backlash that existed. The fact that there are academics who are measuring—there is categories for how many public health officials were threatened with gun violence and didn’t get support from their local law enforcement. And the fact that that number is so large, that there is a category for counting it, gives you a sense of the type of backlash that’s been experienced. I think what we’re seeing right now—I can talk to the United States—but a massive movement to roll back public health authority legislation and regulations. There are state legislatures across the country that are stripping their governors of emergency powers and putting that authority into the state legislative branches, which is basically going to make it almost impossible to take rapid action in the—in the next event. And, you know, there will be a next event. So it is—it is really difficult. We are seeing the—based on the vaccine—the increase in vaccine hesitancy, and in part due to the rise in mis- and disinformation. And now we’re seeing measles outbreaks across the country. And, you know, situations where the current public health officials are not taking scientifically based action to stop those outbreaks. So we’re—it’s rough out there. Let me just put it that way. As well—at the same time that people are quitting in droves because people did not sign up for this. So just that. HUANG: Yeah— FASKIANOS: So before—Yanzhong, before you—before you weigh in, and I’ll give you an opportunity. Rebecca, this is a group of professors and students. And so what would you advise—what’s the call to action for this group to—you know, to help, you know, push back on or help sort of make—to ensure that guardrails remain? KATZ: I don’t have any—I don’t have a great one-liner on that, right? Except there is, how do we—how do we rebuild trust in science, in public officials, in governance? There is a need to raise public literacy. And so I start there. There are a lot of folks who are working on how do we counter mis- and disinformation. I think those are two very different things. There is—you know, there’s a need to—you know, it’s everything from being able to do the policy surveillance of what’s happening in the world, to being able to—all the way towards advocacy and trying to help, you know, get programs and policies sufficiently implemented. But I think also just having kind of a strong evidence-informed voice. I wish I had a great, better answer that said, if you just pushed this button or did this thing, it would all be better. But I don’t. And I think—I think this is why a lot of people in the community are really struggling with how do we—how did we get here, and how do we fix it? FASKIANOS: Great. Yanzhong. HUANG: Well, I—just follow what Rebecca said, I think trust is, like, the key, right? You know, our colleague Tom Bollyky, his research has just already, like, demonstrated how important trust is in fighting the—dealing with a public health crisis, like COVID-19. You know, and to the question, actually, the challenge is how to build the trust, right? You can talk about maybe better transparency, better accountability. But you know, I think in a country like the U.S. which is so divided now, I think in order to rebuild that trust it’s very important for the—these different groups, like even—like, I’m talking about, you know, the two groups, they need to be able to have a dialogue, basically, need to speak with each other. There needs to be able to build consensus. But maybe I’m asking for the impossible. But the—so when we talk about politicization, I want to also add that it’s not just happened at the national level; it certainly has been—this past pandemic has shown that this also occurs at the international level. In fact, you know, I think, you know, we never have, you know, a public health event that has been so politicized as the COVID-19. You know, just to give you an example, the SARS, right, when we talk about the origins of SARS, you know, people never thought of, like, politicizing the origin probe. But it’s become a big issue during the COVID pandemic, in part because this is, like, the first time we’re seeing, like, ideology being encouraged by the pandemic response. This entire response to the pandemic is sort of framed as a competition between authoritarianism and liberal democracy, right. And also, geopolitics, like, again, right, the tensions between U.S.-China sort of also was driving, right, the global pandemic response. So I think, you know, in order to sort of—we need to start to depoliticize—(laughs)—this process of depoliticization. We need to reduce the geopolitical tensions. But in the meantime, we need to start the—sort of have—investing in those trust—or, confidence-building measures like having, like, a track-1.5 dialogue between the two countries. FASKIANOS: Thank you. I’m going to go next to JY Zhou, please. Q: Hello. FASKIANOS: Yes. Thank you. Q: Hi. Awesome. Well, my name is Chris Nomes. I’m an intelligence analysis student at James Madison University. And my question is about threats to global health. Specifically, do we—do we face any risks, like, from our adversaries or from lone groups that want to purposely tear down global health? Are there any risks? And how do we counter those risks, if they exist? HUANG: That is Rebecca’s expertise. (Laughs.) KATZ: I got it. Maybe I got it. I mean, I think—listen, you know, when you start the question you asked about threats to global health. And immediately I start making lists of, like, oh my gosh, right, how are we going to talk about the signal—the, what, 90,000 signals that WHO received this month and the, you know, 300 that they’re investigating, and then the thirty, like, field investigations are happening in a given month, and all the—all the emerging infectious disease challenges, including, you know, H5N1 in cows in the U.S., to mpox, to, you know, again the long list of infectious disease challenges that nature throws at us every day. But your question then pivoted to talk more about the threats of deliberate biological events. And that is definitely a thing. I mean, so let’s just say that. That is a thing. That is an area of work. I will say that for about fifteen years I supported the U.S. delegation for the Biological Weapons Convention. So there are—there are people who get together often and work through trying to assess what that threat is and how it’s best addressed. There are—there are mechanisms for trying to investigate allegations of deliberate biological weapons use, and the use of the UN Secretary-General’s Mechanism. And there are now a lot of folks who are deeply concerned about how AI is changing the threat space. And so, you know, in this forum, I think the answer we can give you is, yes. It is a threat. It is a thing. And there is a world of people who work on this, including within the intelligence communities around the world, to better address that threat and then feed that into response and planning efforts. I will say, though, that in the—in the event—the challenge is if there is an actual event, the response may not be very different from a naturally occurring event, at least not initially. And putting attribution assessments aside, and any kind of political response you might have. But that that’s the other thing that is trying to be sorted out, is that, you know, if you are in the midst of a response to what looks like a naturally occurring event and suddenly there is information there or an entity claims responsibility for having released an agent, how does that change? What stakeholders now need to be involved? And also, who—how is that managed at the national, regional, and international system? So, basically, you opened a can of—a huge can of worms for me. But I think the answer is, yes, it is a—it is a thing. And it is a thing that there are—there is a community of people who think very deeply about it. HUANG: Yeah. I’ll just—you know, I think what the problem we’re dealing with, like, deliberate-caused outbreaks, right, the challenge here is that this is not like a war against, you know, terror, because we are facing—we don’t know, actually, even who actually started the attack, right, whether it’s from individuals or states, because in part of this—(inaudible)—of the biological weapons or the use of, you know, the dangerous pathogens, you’re not going to find out whether, like, something unusual is happening. And here, right, a large number of people flooded the ER rooms complaining about the same kind of acute symptoms. So the logic of, like—of deterring such an attack would be different from logic of deterring, like, a nuclear attack, right? Because we have to rely on the building of the health infrastructure, greater trained health professionals, you know, the so-called deterrence by denial, in order to sort of decentivize the potential perpetrators from giving up such an attack. FASKIANOS: (Off mic.) HUANG: Irina, you are on mute. FASKIANOS: I am muted. And how long have I been doing this? (Laughs.) We’ve had a lot of questions and written and raised hands that we could not get to. So I apologize to all of you. Rebecca, I want to give you thirty seconds to talk about your book, Outbreak Atlas. KATZ: Oh, yay! (Laughs.) Sure! I was telling folks before we started the webinar, in academia we write a lot of words, and often we write words and they’re, you know, meant for four people in the world to read. But we put a book together that is designed for hopefully addressing some of the public literacy issues that we brought up earlier. For years we had been supporting public health emergency operation centers around the world in helping provide information about kind of all the activities that happen in an outbreak response. And what we’ve done is we’ve taken that and we’ve written it for a public audience. So, it is illustrated. It has 120 different case studies. Anything you ever wanted to know about what happens in an outbreak, or every epidemiologic term that you heard your grandmother talk about that you’re, like, wait a second, is that right? So we’ve written it all out. If anybody’s interested, Outbreak Atlas. And it comes out on Monday on Amazon, and all those other places. So I’m really excited. FASKIANOS: Great. Fantastic. And, Yanzhong, is there anything you want to highlight that we’re doing at CFR in the global health space? HUANG: Well, thank you, Irina. Thank you for your patience of staying through that one-hour conversation. So, yeah, we are facing a lot of threats. We are—you know, we are aware of many of these challenges we are facing. We know the loopholes in the global health governance areas. It’s just that, I think the—(laughs)—the challenge is how to fix them; you know, don’t expect those negotiations in Geneva can you solve all the problems. The problems are going to rise up all the time in many decades to come. But if you want to learn more about this area, in addition to reading Rebecca’s Outbreak Atlas, read our—this is more CFR’s Negotiating Global Health Security. Thank you. FASKIANOS: Thank you. Thank you both. So you can also follow them on X, formerly known as Twitter, at @YanzhongHuang and at @RebeccaKatz5. This is the last webinar for this semester. Good luck with your finals, and everything that comes with this lovely month of April and May. And for some of you who are graduating, you can learn about CFR paid internships for students and fellowship for professors at CFR.org/careers. We’re open right now. We’re accepting applications for summer internships. And they can be virtual. So that’s always a plus. And they are paid. Please follow us at @CFR_Academic, visit CFR.org, ForeignAffairs.com—and I’m going to really highlight; I do it every call—but our ThinkGlobalHealth.org site, which provides a forum to examine why global health matters and to engage in efforts to improve health worldwide. So, if you’re interested in these issues, you can—you should go there. We hope to be a resource for you all. Again, good luck with your finals. Enjoy the summer. And we look forward to reconvening in fall 2024. So thank you, again, to Dr. Katz and Dr. Huang. (END)

In January, the U.S. Supreme Court debated whether to overturn Chevron v. Natural Resources Defense Council—one of the most cited U.S. cases of all time, which established the principle that the courts should defer to federal agencies when they interpret the law in the course of carrying out their duties. During the COVID-19 pandemic, the deference owed to federal agencies’ exercise of public health authorities was already heavily litigated. How much overruling Chevron would alter U.S. health policymaking is a matter of debate, with some claiming the change would be modest while others argue that FDA decision-making and Medicare administration would be rendered unworkable. Mr. Nicholas Bagley, the Thomas G. Long Professor of Law at Michigan Law and an expert on administrative law and health law, and Thomas J. Bollyky discuss what replacing the Chevron doctrine might mean for U.S. health.