As delivered on Thursday, December 8, 2022, in Washington D.C., United States
It is an honor to be here today, especially to rejoin my former federal colleagues at this table – Dr. Mark McClellan and Dr. Robert Kadlec — who I worked with when I ran the National Vaccine Program Office at the Department of Health and Human Services and led the development of HHS’s first pandemic influenza preparedness plan.
It’s equally an honor to have the opportunity to represent The Rockefeller Foundation in these important discussions today where I lead The Foundation’s Global Health Strategy portfolio.
The mission of The Rockefeller Foundation is unchanged since its origin over 100 years ago: to promote the well-being of humanity throughout the world.
And while we don’t have a specific program in biodefense, from our earliest days The Foundation took on infectious disease threats including hookworm, yellow fever, and malaria. Further, we have a long history of investments in health system strengthening and capacity building in low- and middle-income countries. These investments not only benefit day-to-day public health and health care, but also strengthen preparedness and response to infectious diseases threats and the potential for outbreaks anywhere to become a pandemic everywhere.
As we were reminded over the past three years, a pandemic is not just a health problem, but has economic, social, and national security implications – thus, pandemic preparedness, prevention and response and biodefense preparedness are deeply connected, and the focus of our discussions today.
While the bulk our health work is in low- and middle-income countries, like many, we repositioned resources to respond to Covid-19 in the United States and around the world.
On the domestic front I would like to highlight three our recent programs
- Equitable Vaccination
- Countering the Threat of Mis- and Disinformation
- Testing: Early on, in the U.S., we brought together 45 companies, and with input from Dr. MacClellan’s group and others, we developed an implementation plan for K-12 testing in all 50 states. This prompted a $10B federal investment in school testing capacity and accelerated the implementation of school testing nationwide.
- Equitable Vaccination: We took an equity-first approach and recognized the critical importance of local leadership to ensure accessible Covid-19 vaccination. With our $23M investment, we partnered with more than 80 community-based organizations across five U.S. cities (Baltimore, Chicago, Houston, Newark, Oakland) to ensure accurate vaccine information came from trusted local sources. We are proud that this effort was highlighted at the recent White House Summit: Covid-19 Equity and What Works.
Of the many things we learned in this program, I would like to highlight three things that we need to carry forward for both preparedness and resilience.
- The importance of real-time, reliable data and modern data systems to inform decision-making and adjust strategies and to be able to tell what’s working and not and where you need to redirect your efforts;
- Community resilience happens at a community level – and the health of communities is amplified through partnerships;
- Just because you build it doesn’t mean they will come: the critical importance of meeting people where they are – geographically and philosophically – is the essential ingredient in building trust.
- The third project is The Mercury Project (which alludes to the ancient Roman god Mercury of messages and communication). We partnered RWJF and the Craig Newmark Foundation to support the Social Science Research Council (SSRC) and a dozen social and behavioral science research teams to conduct community-based research to understand the magnitude of the threat of misinformation on Covid-vaccination and to design strategies to counter this threat. In an environment where mis- and disinformation has the ability to harm the health of individuals and communities, we recognize that this is not limited to Covid-19.
The recent surgeon general advisory Confronting Health Misinformation to Build a Healthy Information Environment, is an important first step and call to action of a problem that will be part of our landscape for the foreseeable future. As he highlighted in his call to action, the Surgeon General underscored that “health misinformation is a serious threat to public health. It can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts. Limiting the spread of health misinformation is a moral and civic imperative that will require a whole-of-society effort.”
We need to match our investments in vaccine research and development with a serious effort on the demand side of the equation: the social, behavioral and communication science research that is sorely needed to be sure that vaccines turn into vaccinations.
The HHS and DoD effort Operation Warp Speed is historic for what it accomplished in record time in developing several life-saving vaccines that we weren’t sure could even be made when all of this started. Despite the mounds of data on vaccine safety and effectiveness, as we are watch hospitalization pick up again with the triple threat of Covid, flu and RSV, we know that fewer than 15% of Americans have received their updated booster and fewer than 40% have received their annual flu vaccine. This data tells us that we need to better understand what drives vaccine uptake. The last mile represents the logistics needed for vaccines to reach communities.
When we invest in understanding and combating mis- and disinformation, we’re looking at the last inch of the last mile—the one that turns vaccines into vaccinations. Vaccines don’t save lives, but vaccination does.
Globally, The Rockefeller Foundation has been investing in pandemic prevention and response to create a global public health system better equipped to prepare, predict, prevent, and respond to the next pandemic and the spread of infectious diseases. And as we develop a Foundation-wide focus on mitigating the impacts of climate change, we are currently focusing on climate-sensitive infectious diseases.
At the heart of our work – past and future – is data and the need to connect fragmented data systems, bring together traditional (health, epidemiological, laboratory) data with “non-traditional data” (mobility, climate, geospatial, consumer) and apply modern analytics to derive insights sooner that can keep outbreaks from becoming global pandemics.
We have invested in creating a global data analytics platform and a data science team with broad subject matter expertise in global health, product, engineering, and science that researches and develops tools that can be used in collaboration with partner organizations and institutions to identify signals of emerging pandemics. Our mantra: See the signals. Speed the response. Stop outbreaks.
We have formed a network of over 40 partner organizations that bridge sectors and geographies to strengthen partnerships and enable an early warning system – again, with data at the center.
- We have committed over $60M to network partners in the U.S. and around the world, including $10M commitment to World Bank’s Pandemic Fund and $15M Global Fund, the latter to expand capacity across low- and middle-income countries for more robust pathogen surveillance.
- Among the areas where these investments are already adding to our pandemic preparedness are expanding genomic surveillance, especially in low- and middle-income countries, we are seeing the more rapid detection of emerging Covid-19 variants.
- We’re also exploring the information value in wastewater data where researchers are able to spot community transmission in wastewater samples before it appeared in clinical samples.
I put the spotlight on just a few of our investments to provide a sense of what our philanthropic efforts have put in place. But for this commission, I want to highlight just three of the many things we’ve learned from our pandemic work that should be considered in your updated biodefense strategy:
- First and foremost, we need a revolution in data gathering and analysis. Since the emergence of Covid-19, global systems of data capture and sharing have taken a big leap forward, but we still have work to do. We are using only a small percentage of the information available, and it tends to be siloed. To get a more complete picture of the infectious disease landscape, there is an urgent and compelling need to integrate clinical, epidemiological, and genomic data with non-health data in areas as diverse as weather patterns, wastewater surveillance, consumer behavior, social media, and mobility data.
- Second: the panic and neglect cycle is not a recipe for success. Sustainable financing is needed to build and strengthen the systems we will need for the next public health emergency – and those same systems that will be of benefit in peacetime as well as in a crisis. And the funding should be designed to address several problems that are intertwined but may appear on different agendas: the impacts of climate change on the health of communities not a future problem: it’s already here. We’re seeing the impact of warming, severe weather, flooding, and disease. Climate change will only accelerate the pandemic threat. And, through our equity lens, we know that the impacts will be greatest in the most marginalized communities at home and abroad.
- Finally, we’ve learned from the Covid-19 pandemic that community trust and involvement is vital for and effective response and a resilient recovery. Pandemics are global, but they play out locally in communities across the globe. Community-based organizations and civil society have demonstrated their critical roles listening to community concerns and providing trusted sources of information. It may sound trite, but we need to put the public squarely in the center of public health.
Thank you. I look forward to the discussions that follow and to address any questions you may have.