tv CSIS Discussion on Vaccine Hesitancy CSPAN April 10, 2021 2:34am-3:37am EDT
csis policy center. i direct the women school. a high-level panel on vaccine confidence, misinformation, and national security. in july of 2020, csis joined with the london school to convene experts from public health, cybersecurity, public opinion research, social media and communication. to assess the implications of misinformation and vaccine covenants -- confidence in the context of national security. the panel is cochaired by steve morrison, senior vice president heidi larson, professor of anthropology, risk, and decision science. as the panel met virtually over the summer and fall, the members were clear about three things.
the low levels of public confidence in covid vaccines represented a threat to the potential of the u.s. to effectively control and recover from the pandemic. having an ample supply of safe and effective vaccines would be critical but they must be liver to the public in an effective manner to ensure public confidence. and dealing with the challenges of information and disinformation around vaccines and covid vaccines especially required a multidisciplinary approach. the panel issued a call to action defining the problems as a national security threat. the panel outlined five recommendations including a call for national dialogue. innovative approaches to reaching diverse and underserved populations as well as a focus on activity by mainstream and
digital media to stop the spread of misinformation and accelerate collaboration with health providers. the call to action recommendation was focused on the need for federal reform. greater interagency coordination and leadership as well as increased u.s. support for immunization. as the panel prepares its final report and recommendation, which will be launched in early may, we have initiated a series of events to discuss the call to action. and to foster dialogue about these issues. this is the fourth of those meetings. today, we will hear from experts in the areas of public health, national security, health and foreign policy, and public-private partnerships as well as the co-chair about options for improving federal coordination and response around covid-19 demand and distribution. domestically as well as internationally.
a great deal has happened in the five months since the call to action was released. three covid-19 vaccines have been granted a emergency use authorization. at least 112 million people have had at least one dose. the white house has established an equity task force to better understand and remedy challenges and access. and there is a directed for global security and bio defense. a number of programs have begun, reaching out to key populations. to set the stage for the discussion today, we will hear from heidi larson. she will share some of the recent analysis about global vaccine trends and explain how what is happening in the u.s. compares to other regions. i will turn the conversation over to steve morrison.
co-chair of the panel, to introduce our next speakers and moderate the discussion. before we get started, let me remind those in the audience, there is a button on the events page that will send a question. the mic is yours. heidi: thank you very much. i just have two minutes here to put into context, over the past meetings and discussions, we have noticed and looked at data that has shown the ups and downs of public confidence and willingness since we started the pandemic. last june, these are wave 1, 2, and three. in the u.s.. as well as european countries.
we the sentiment, the context went down. in september and october. that was after higher optimism or encouraging for a vaccine. that was back in june, the first way. and then september and october. toward the end of the year, confidence was going up in most places but not all. as you can see, in france and germany, boost we saw around other countries in face of a second wave, as well as the high efficacy reported around pfizer, in the beginning of the year and end of last year, france and germany started to express concerns about astrazeneca, which contribute it to their flattening confidence.
next one, this is a global survey done by colleagues at imperial college. the point of showing you, this is australia, canada,, denmark, israel, italy, japan, korea. norway, singapore, sweden, and the u.k.. just to give you a scope there. as you can see, between just one month, january and 50, there was extreme volatility -- january and february, there was extreme volatility. the main point in this slide is this is a very volatile space. we can't look at one point in time. this is influenced by external events, not only safety but
political events. it is a varying and dynamic landscape. evidence is not about to, in the immediate future. just to bring that to the four. the last slide is we have seen quite an impact of the astrazeneca reported concerns across africa. in nigeria, we had done a big survey, the first wave last fall. 49% of nigerians strongly agreed they would accept a vaccine. wave three, last month, around the time of the astrazeneca issues, it dropped 25%.
as you can see in the right, even from day to day as we were collecting data, the percentage of people who said they would accept a covid vaccine dropped. the point here is to remember we are not only living in a connected world in multiple ways , but sentiments are incredibly vital. issues that show up in some countries travel quickly. this is particularly concerning and africa because the astrazeneca vaccine has been a core vaccine, one of the main vaccines. this is a concern. sentiments and confidence are highly volatile.
it spreads, it is rapid, and it impacts people's willingness to take a vaccine. we look forward to the discussions. steve: it is great to see you. those are sobering and concerning facts. i want to thank the team that helped put this together. the production team. a special thanks to all of you. we have friends who have joined us. we will have a conversation with them. peggy hamburg is with us. currently, interim vice president at the nuclear threat
initiative. juliet, a senior lecturer in international security. at harvard. bruce is with us. the president for -- our fourth -- i am going to start with peggy. and then we will come back to hear more from heidi. have some conversations among ourselves. i'm going to start with you. there is a lot of turmoil.
around adverse impacts. around production shortfalls. we are seeing some of that in the u.s.. there are the variance, scientific uncertainty. how might challenges we are seeing internationally including changes in dosing schedules and the like, are they having an impact in the united states? will they? >> important question and thank you for doing this session. focused on vaccine hesitancy. this is clearly a challenging time.
to really begin to see a change in the public health landscape. as the landscape is rolling out in this country and others, we are seeing ongoing spread and the emergence of variance that make the task more challenging. there is enhanced transmission. and some concern as well about whether variants can evade the efficacy of vaccines and natural immunity. all of this is in the background. we have to move the vaccine out
to as many people as we can. all the people that have it are not getting it. also recognize, there are pockets of people that are hesitant about taking the vaccine. they do not have confidence. we have heard about that from heidi. trust in the importance, the safety and the efficacy of the vaccine is fundamental. whether or not there is a compatibility with religious leaf, ideology, makes a difference. in the u.s., we are seeing more and more people of a certain political stripe not wanting to be vaccinated. we know there are people who
historically have distrusted the health care system. and are concerned about getting vaccine as well. all of that is in the background. and an active anti-vaccination movement that has been around for a while. when you lay on top of that uncertainty that is brought in by safety concerns that are not fully understood, reports about manufacturing problems, contamination of vaccines, when you hear discussions amongst prominent respected scientists about do we really need two doses or could we just have one. we lower the dose of the vaccine. there seems to be scientific uncertainty about the appropriate use of that. all of that does matter. heidi gave a compelling discussion about how and other countries, it is undermining trust and confidence in uptake
of vaccines. we need to be very attentive to the need for clear messaging, we need to make sure people understand why certain kinds of issues may emerge as we learn more about vaccines. to be able to explain a manufacturing problem. doesn't mean all vaccines are -- science is iterative. recommendations may change. it is important the messaging in our country is aligned with messaging and other countries. from the regulators to the scientists to the public officials. so we can diffuse as much of this uncertainty and confusion, which is already occurring in an atmosphere of five think unprecedented misinformation and
intentional disinformation in many cases. the issue raised with your question being a very important one and one we have to actively address today, tomorrow, and going forward. steve: take you very much. i'm going to turn to bruce to offer some thoughts. the biden administration is shifting its posture to vaccine diplomacy. we have had a few statements made by secretary blinken and president biden. there is still some uncertainty exactly what that will mean. there has been a move toward greater engagement in terms of the pandemic response. these issues around building vaccine confidence, how will he fit? if we see a broader engagement trying to shape the global response, how are these
confidence issues going to be built into that in your view? bruce: i think the fact the u.s. has put down a marker for vaccine diplomacy is a sign they are emerging. i think that is really important. i think your point is an important one. the diplomacy is largely about supply. the degree to which we are going to be able to donate vaccine we have to support financially the efforts to vaccinate around the world. and encourage other countries to do the same. that is really important. let's not forget there is this to amanda element -- demand elementary just because you build it does not mean they will come. i hope a part of this is this conversation about trust and the importance of confidence. that is important as we move
supplies to parts of the world where they are needed. we can export the playbook we are evolving here about engaging communities, make sure communities know what the science is. can communicate what they are learning to patients. at the same time, peggy raised this. these other structures we have put in place, confidence in the vaccine is in the system that brings the vaccines about. to make sure there is adequate regulations. that there is a system to look for safety issues. all those are important. those are the kinds of things we want to build into this, our diplomacy package. so it is not just we are going to get vaccines to places but have them in a way people will want to receive them.
the cdc playbook, doing that. particularly engaging individuals and communities, is going to be important. it is clear communication is a huge component of this. it is clear there is no sound bite that is going to turn this around. to have conversations with clear, honest communications, took me to kate what we know and do not know or are learning about it. two of knowledge it is a learning agenda. we are going to communicate those things because there are things we may have to communicate along the way. if we are open with the populations, whether it is a safety issue or distribution issue or some other science issue, we need to prepare the groundwork.
as we are moving supplies around the world. steve: thank you very much. we have learned a lot, it seems to me, about approaching vaccine hesitancy. what makes communities more hesitant. we have heard a lot about targeted approaches versus broad scale national programs. we know as we are moving from scarcity of supply to abundance of supply, we are beginning to see doses go unused and see the contours of hesitancy defined much more clearly to us. that has taken a lot of people by surprise. it has revealed the scale of this challenge. say a few words about what you have observed.
juliette: hi, everyone. i want to focus on a few things related to homeland security, just the u.s.. vaccine hesitancy has meant a lot of different angst. i think we have to be clear what vaccine hesitancy is as a coast to -- opposed to anti-vaccination. the good news on hesitancy is it is less of a fear than we once believed. i want to commend the kaiser family foundation for their consistent pulling. we were at 50-50 in this country. those numbers are terrifying to somebody like me who is not a doctor. i am a supply demand person and think about what states are building and localities are building. i have seen a lot of mayors and
governors in this regard. vaccine hesitancy, it turns out, what we are looking at now, 40% of americans are, i am going to knock you out of the front of the line because i wanted that badly. the other 40% are at not yet. that is important for people to know. vaccinations beget vaccinations. the more this goes on, the easier it is to get. i understand what category i am in. in particular, delivery is related to hesitancy. i like this move the biden administration is contemplating. i never liked the idea of federal large vaccination sites. they don't work. they are too big. people really want to go cvs and walgreens and they went to see
their pharmacist. the more tactical, the more we are going to have vaccinations beget vaccinations. we have been consistently between 75-80%. there is a problem of vaccine access for minority communities. african americans, despite some of the popular conventional wisdom, they are as gung ho about vaccinations as non-african american committees. hispanic men, we have a problem with but that is also related to ideology. our vaccination problem, the red light a lot of us have been seeing for about two months, i did something i thought i would never do, i went on dr. oz. talking to conservative communities is important.
evangelicals, conservative men, conservative women. childbearing age women. that is going to be our challenge in the months ahead. i will get into the national security issues. it is not an unmovable no. the next is, i don't matter, dr. fauci doesn't matter, dr. oz does not matter. this group moves by conversation. the more we can get people to accept vaccinations, to feel more comfortable. shaming does not work. beating them over the head with politics does not work. it is really community based. the second good news we have been trying to move into, this group of conservatives, the move
i hope becomes very -- every neighborhood corner has it. make it where i have been buying paper towels for the last couple of years. make that where i get my vaccination. i think we can learn a lot from our tribal communities, which if you look at the data are doing gangbusters. not necessarily community that has a lot of confidence in public health, that alone government public health. that is because it was tactical, localized, elders and others were behind it and got behind it early. maybe that is a lesson for evangelicals and other magic conservatives. if you look at the numbers, that is the only thing i start to get
very nervous about. everyone else we'll get there because the number suggest they are. steve: add a bit more on the question around republican voters. a third of republican voters were told, will not accept a vaccine. half of republican men. this particular form of refusal is particularly acute when you are looking at younger voters and rural voters. say a about that. that has become a red flashing light. juliette: that number, i don't know what percentage of the population. there is not a moment of herd immunity but that is going to keep us from at least 50%, 70 percent of the population. i worked tactically on the ground. i advise mayors and stuff.
it is not at all clear that pulling will remain consistent two or three months from now. most states are still in the divided allocation phase. massachusetts is at 55% and older. these are people responding to conspiracy theories, disinformation. a year of the white house, president and others minimizing the threat. the threat is minimized, why do i need to get the vaccine for something that really wasn't a problem? shame that the trump family has not been photographed taking vaccines. good for mcconnell, good for these religious evangelicals leaders for coming out there. we are going to need more of that. the dolly parton's of the world means having to conservative communities. she has been epic in that
regard. we need more of that. steve: julia spencer, thank you for being with us. what is it going to take to pull these programs together? we are talking about families and communities. public private partnerships. tell us more about your thinking on that. i know you are quite engaged. julia: thank you so much. it is a pleasure be -- to be joining my panelists. your question is the question. how do we know what we know -- how do we take what we know about hesitancy and apply that toward strengthening confidence and building trust in the institutions? we know who people trust can look different.
as juliette articulated. when it comes to vaccination, we know hearing a consistent message is important. that tells us transforming hesitancy into confidence will take a diverse, multi-sectoral set of partners and collaborations, working from the hyper local conversation in the church within a peer group, across the fence with your neighbor or your local pharmacy, and amplifying that with information that is being conveyed in states as well as places like washington, london, johannesburg. it is connected globally. as we have discussed in our panel meeting, vaccine confidence has been an issue for many years. this did not start with covid. we saw implications plane out and things like the reemergence of measles. we were not in a great place in
terms of complacency, trust and vaccination in certain communities going into this pandemic. we have seen declines in the percentage of americans who believe it is important to have their children vaccinated and who believe they have benefited from vaccines. that is a worrying picture that tells us vaccine hesitancy will not end with this pandemic. the increased dialogue does present us with a tremendous opportunity. and a tremendous risk as we navigate what is the most aggressive vaccination campaign in this country and likely in the world we have undertaken. there is no one-size-fits-all approach. there are tenants we can all use in our efforts, whether we are regulators or employers or community leaders. improving confidence starts at the community level.
led by trusted members within that community. people need to trust the messenger if they are going to trust the message. they have to understand how to access credible information. national surveys show people trust religious leaders and employers. we need to engage these leaders, give them the information they need. that sounds easy but as bruce and peggy were telling us, this information is evolving rapidly and it is not always easy to convey this in a way people do find trusting and credible. this takes ongoing resources. coordination. it takes capacity building. i think we were all really happy to see what has been going on in the u.s. over the last month or so with the federal government making significant advances in resources and coordination and
capacity building. the biden administration announced it would dedicate $10 billion from the american rescue plan to expand access to vaccines and build confidence in our most vulnerable and underserved communities. these funds will be treated to states and localities. the administration is planning to amplify these efforts by establishing an all volunteer group called the covid 19 community core, which is made up of nonprofits and others so people are hearing from trusted voices in a way that is culturally sensitive and applies the principles of health literacy which are important. the goal is to meet people where they are and to tailor the intervention that will drive uptake and vaccination for those committees. this focus on equity is essential in the ability to reach these communities depends on our ability to understand the
causes behind hesitancy, whether those are political or historic. institutional racism, unethical medical experimentation. or what they are hearing from their political leaders. there have been a lot of studies done looking at trust in specific communities. one recent study shows just one in three latinx americans and only one in seven black americans mostly or completely trust a vaccine will be safe. we are optimistic but we recognize there is work to do to change perceptions and beliefs in these pockets of communities where you do have deep-seated perceptions. it is important to understand these may suffer from access barriers. it is going to be important once people make a decision to get
vaccinated, vaccines must be accessible. expanding the places where people can get vaccinated, these are critically important to ensure the intent to get vaccinated results in vaccinations. we are seeing these solutions being deployed for covid. we have an opportunity to ensure they remain in place long-term. while we are working to address confidence in covid-19 vaccines, we are in jeopardy and losing ground in routine immunization. we have seen troubling information on the reduction in orders for vaccines for children. these are the providers serving those most at risk and vulnerable. people on medicaid. as we are trying to focus our
efforts on building confidence, we should take a long view as we are responding to this crisis, recognizing the next health emergency is only a plane right away. we have an opportunity, i think, to provide the lessons we are learning now and the public private partnerships we are standing up for two have those sustained after the pandemic is over and share that technical information, the system strengthening work being done that can help not only the u.s. but also our allies and neighbors around the world. i will close by saying we all have a role to play, whether we are an employer, community group, religious organization, health care practitioner, also, the pta president.
the front office professional and the local health clinic. the work we do now is going to be critical to build confidence in vaccinations. it is a down payment in preventing outbreaks in the future. my hope is we take the opportunities learning about what works when it comes to confidence and think about how we apply those so our systems are more able to deal with this kind of thing on a day to day basis. steve: thank you very much julia. i want to go back to heidi. the astrazeneca drama has been going on for some time. it has gone in multiple directions, starting with production shortfalls read got close with confrontations with the u.k. and the eu, all those
tensions associated with brexit. it is communications and scientific reporting stumbles. reports of led clots. the confusion or shifting policies of many different governments and regulatory authorities. this has had an impact in the u.k. and europe. i don't think we are insulated. our newspapers, our press accounts are full of stories of all this. what can you tell us? heidi: we are very lucky this came up after 20 million people had been given the vaccine and the u.k. alone. because we all knew, when we do mass vaccinations, of the scale
and scope this campaign has been globally, somewhere along the line we would see risks that were not picked up in the trial stage. rare, presumably, but this could have happened in the first few weeks of rollout which would have been a much more complicated picture. we have as we heard before, i think it was juliet talking about social proof. the more people see other people get vaccinated, it builds confidence. i remind people, when asked about this, there are 20 million people who did well in this vaccine and are going to be protected. there has been a confirmation of this risk, particularly cerebral related clots but it is one in a
million. one in a million in terms of death. it is extremely rare. the idea is to detect as many symptoms as you can as early as you can. if indeed this happens. if that has been clear in the beginning, it would have saved a bit of the angst that went on. it is still not good news for everybody, but putting it into perspective, it is small and rare relative to preventing covid. what has happened, because different ages were given the vaccine across europe in the beginning. germany said do not give it to over 65. there were nobody in trials over 65. now this has switched to read we
have the u.k. saying don't give it under 30 because the actual benefit and risk which is high and clear for older people, is less of a benefit -- the benefit relative to the risk is less compelling, i should say. all of this to say it has been a difficult time. we are lucky this happened as late as it did. it is pretty amazing across the different vaccines that have been ruled out, we have had very good safety experiences. i think we should champion that. we have to be extremely empathetic with anybody who reports symptoms of any kind afterwards. and not just say go home and
take a drug. this is an intense time. these things do travel, as i said in the opening. i think in terms of framing of hesitancy, we have to change the tone of hesitancy. i have seen some language were people talked about eliminating hesitancy. i think hesitancy in the context of risk, it can be a very responsible thing. first time mother. who is hesitant, she wants to have all the information she can in this current environment of uncertainty, it is ok to be hesitant. we have to make sure we are not judging people for their questions. trying to make sure we get the right information to get that
movable metal to a place of confidence. i agree access is part of that mix. steve: juliet, did you want to say anything in response? juliette: i can quickly respond. conservative women, women who want to have kids and are just not sure, the scope of the trials for the three vaccines, it was not 10 people, it was not 100 people it is a couple hundred thousand people. when they get that information, it changes the way they think about it. you and i, we read every piece of paper, every filing to the fda, we know how big these tests were. that is one piece of information that can go very far.
the other point heidi just made about social proof, vaccinations beget vaccinations in crowd studies. we call it social cohesion. it is a phenomena of the empty parking lot. why are the eight cars all in the same place? this idea of social cohesion, the idea of the first car knew something. they had the other cars parked near it. that is what you are starting to see with vaccinations. we have to move that first car to the right parking space. then you see the social cohesion fill -- form about that. i am optimistic by nature. i am hopeful we can move those reluctant, but in hesitant group. -- beyond hesitant group.
>> one of our audience members raised a question around the weaknesses at the federal, state, and local systems. what kind of collaboration could ensure a better outcome? they relate to some and we had talked about. we are seeing very dramatic increases under the american rescue plan. in that context, it is early days. there is a big shift. how do we expect federal agencies are going to work differently in this coming phase? to make sure funding is moved? it goes to these purposes we have heard about of building capacity but also confidence? i want to ask peggy and bruce.
peggy: we are still having trouble with in muting. early on, we had so much fragmentation. we saw states pitted amongst themselves. what was needed at the state and local -- i think that has been recognized as having been detrimental. efforts are being made to have a whole of government approach, both across the components at the federal level but also integrating state and local. that is crucial. we are at a critical moment for that. a time to get vaccine out to as many people as possible. we need to have clear
communication. coming from agencies like fda and cdc to help state and local policymakers and public health officials and the public understand about the state of knowledge, what can and should be done. we have to have two way communications. we need to hear from states and localities about their experience on the ground. and what is needed. the best strategies to make a difference. as we thing about the vaccine rollout, we need to make sure we are aligning the vaccine with pockets that remain under immunized and the capacity to provide the vaccination. i hope we will and it has been noted, continue to build out the system that matters in places
where people live. that ultimately will help us complete this journey. we need to not be thinking about federally sponsored big stadium vaccination campaigns but making it available where people know where to go, trust the providers, and have confidence in the system. one last thought on local, state, federal coordination, we need to make sure there is adequate collection of data about who is getting vaccines, which vaccine they are getting, enabling the ongoing collection of experience with the vaccine so we can better understand if
there are emerging safety issues. also better understand appropriate use is of these vaccines. there are still unanswered questions. the durability of the protection. it is important we have that data collection and monitoring as well. bruce: the silver lining in the states having been left on their own, these are now 50 laboratories. building on what peggy and julia was saying, there's a lot of learning going on in the ability to develop that community of practice. that is true in the u.s. and around the world. to be able to share those kind of experiences. i have been privileged to hear a number of states talk about their experience. i will share one. the ships -- shift away from the
word mass. there is nothing good after mass. let's talk about community level programs. this is one of dozens of insights from the ground that i think will be help full improving the experience everywhere. not just here but around the world. steve: you must have some thoughts. julia: i agree with everything that has been said. i will put a positive spin on some things i think have helped in the u.s., that we can export to other places. practice laws. in a lot of places, only physicians are able to provide vaccines or a limited number of providers. in the u.s., because you have pharmacists in states, vaccinations that can happen in
pharmacies, a big step to increasing the surge capacity we have in the u.s.. how do we look at both where the gaps are but where we do have infrastructure and making sure we are sustaining that infrastructure. so it can support d to date immunizations and concerns when needed. on the downside, going into this pandemic, state and local public health has been under resourced and crumbling in terms of infrastructure for too many years. when public health is not able to do it stay today job, -- it's a to day job -- day to day job, it is difficult to do that and to surge to this once in a century event. thinking about going forward,
how do we make sure state and local public health and the u.s. is at a level of capability and capacity so in a given day, it can carry out its mission but is able to surge and do the kinds of things asked of it right now. steve: i wanted to ask you a question around security. this high level panel, we make a strong case these issues around vaccine confidence trust, misinformation, are matters of national security. they get in the way of us being able to control the pandemic, get out from underneath it. and contribute to the reopening of the world. there is tension between the public health community, and
talking in terms of security. what are your thoughts on how to reinforce after this profound drama the security consequences. juliette: great question. there is probably less of attention. as we talked about in the meeting, we should see this security benefit of public health communications and strategies. that they really do align. they align in three important ways. we have a real security issue. we have a supply-chain issue, protection of the supply chain. we have seen vaccine trucks get moved over. we saw a mass killing. we don't know the motivation, at a market delivering vaccinations. we have this pure tactical
security issue we need to address for the long-term. especially if there is a third shot necessary. also as people come out, the stress, the tension, the unease may show itself in violence. the second is disinformation is actually a national security issue. we know the russians are amplifying an anti-vax campaign. we need to treat this as the voting issue and treated as such, call it out, bring it down. get the social media platforms to do it. the third is the bigger issue. america's resiliency. i love america but, it is hard
for us to say we are a legitimate alternative to say china, for example, which whatever blame we went to put on them, its capacity to respond. our exceptionalism is only in our heads now. it is going to be very hard for a lot of americans to accept it. you talk to our kids and they burst out laughing when you talk about american exceptionalism. you look at this country and say, we haven't exerted strength for the last four years. we have to view us getting back to normal as the beginning -- president biden likes to say, america is back. i am kind of like, not quite yet. we have to be able to help other countries, huge trade partners.
you have to be able to travel. none of that is happening. i think they complement the public health issue and honestly i hope we can get many in the military to move. we have vaccine hesitancy way too high the military. peggy: i just want to do underscore we also have to help the american people and some of our political leaders understand our national security really does also depend on our reaching out and helping to ensure the rest of the world gets access to vaccines. we cannot just protect ourselves by looking at what happens within our borders and managing all of that. we have to make sure we are controlling disease wherever it
is happening because the more the virus is spreading, wherever it is spreading, the more opportunities there are for our country to be at risk. whether it is through variants that continue to emerge, or simply because as we open up, there will be more travel and trade and opportunities for a disease somewhere else, even a remote part of the world, to be in our backyard tomorrow. we need to be thinking about security in a global context as well. steve: thank you so much. bruce or julia, would you like to add to this discussion? i am going to turn to heidi to do the closing benediction. bruce: we talked about this a lot, are whole security is linked to national security. the most compelling piece is
while there is a lot of moral concern about equity and the like, it is pretty clear unless we keep variants from proliferating, we are going to be at risk. steve: thank you. julia: just to punctuate what has been said, strong systems are what is going to keep us all safe in the future. in addition to all the things we have talked about today. ensuring we have data infrastructure, vigilance, safety systems. as well as ensuring we are able to deploy the medical countermeasures and tracking those, it's critically important. it is the role the u.s. can help to play. until everyone has it, we are not safe. steve: thank you so much. can you share with us your
closing thoughts? heidi: thank you to everyone. this has been a rich conversation and crucial. i think that coming back to what peggy was saying in the beginning, recognizing there are multiple lovers -- levers of confidence from historical to belief based to the uncertainty of the scientific environment. uncertainty in the pandemic environment, including variants you just mentioned. julia, i think the point you made, vaccine hesitancy did not start with covid and it will not end with covid. i would add how we handle this moving forward, especially in this more sensitive time, when the eager ones have gotten their vaccines and we are going to hit a more bumpy road, how we handle
that. the engagement, the approaches -- we won't lose vaccine hesitancy, but we can change that trust relationship. what bruce said, i have been moved with some of the smaller, local level initiatives in the u.s., and the u.k., with bangladeshi restaurant owners to tribal leaders. it is fantastic when you look at that level. we can use that to rebuild relationships that will only be of benefit moving forward. this is all global. the slide i opened with, we need the u.s. strong in the world.
i look forward to building that confidence. and new type of diplomacy. thank you. steve: thanks so much, and i jut want to thank julie, juliette, bruce, peggy for your time and dedication to this panel over the last 10 months. it has been terrifically generous. i want to offer special thanks to my colleague catherine for her leadership in directing this project which has proven to be so fruitful and to michaela who has kept us all online so successfully over the months. thank you all for joining us, thanks to our audience members who have tuned in.