Public Health Threats and Pandemics

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.