Hello, good afternoon, and welcome back to our 3.30 plenary session of ACPM's PM21 annual conference. I'm excited to have a special guest with us today for our plenary session, Chelsea Clinton, for our Building Vaccine Confidence and Outreach Efforts session. So Chelsea Clinton is vice chair of the Clinton Foundation, where she works alongside the foundation's leadership and partners to help create economic opportunity, improve public health and inspire civic engagement and service areas across the United States and around the world. In particular, Chelsea focuses on promoting early brain and language development through the Too Small to Fail initiative and uplifting and empowering female entrepreneurs and women-led businesses around the world through initiatives like the Caribbean-focused Women in Renewable Energy or WIRE network. She also serves on the boards of the Clinton Health Access Initiative and the Alliance for a Healthier Generation. In addition to her foundation work, Chelsea also teaches at the Columbia University's Mailman School of Public Health and has written several books for young readers, including the number one New York Times bestseller, She Persisted, 13 American Women Who Changed the World, as well as She Persisted Around the World, She Persisted in Sports, Start Now, You Can Make a Difference, Don't Let Them Disappear, and It's Your World, Get Informed, Get Inspired, and Get Going. She's also the co-author of the book of Gutsy Women and Grandma's Garden with her mom, Hillary Clinton, and also co-wrote Governing Global Health, Who Runs the World and Why with Debbie Sridhar. Chelsea holds a Bachelor of Arts from Stanford University, a Master of Public Health from Columbia's Mailman School of Public Health, and both a Master of Philosophy and a Doctorate in International Relations from Oxford University. She lives with her husband, Mark, and their children, Charlotte, Aiden, and Jasper, and their dog, Soren, in New York City. So Chelsea, welcome. Maybe we'll give her a moment for her camera to get going. So we'll give her just a moment here, jump back in. Yeah. So after the first part of this session, we will go on to the next part of the session, which will include ACPM President, Dr. Stephanie Zaza, who will moderate a session with Peter Marks from the FDA and Amanda Cohen from the CDC. So we hope you'll stick around for that afterward. Sorry, I got frozen or you got frozen, but I'm now unfrozen or you're unfrozen. No problem. Welcome back. How are you today? I'm good. I'm so sorry. You were like in the midst of this overly generous introduction, and then all of a sudden we were static. It's all good. Yes. We are all learning in this Zoom era how to make all this work, but I really, really appreciate you being available today to talk about vaccine hesitancy. So if it's okay, I'll go ahead and get started with the first question. Absolutely. Clinton Foundation has been focused on vaccine hesitancy efforts throughout the rollout of COVID-19 vaccines. Can you tell us a little bit about the work that's being done? Absolutely. So at the foundation, we've particularly focused on supporting the work of our faith leader network. We for many years have been engaged on working with a group of faith leaders, really from across the country on a variety of public health issues. So we've done work together on just trying to de-stigmatize conversations around substance use disorders and addiction, de-stigmatize conversations around HIV and prophylactic surround helping to prevent HIV infections, and then of course on HIV treatments. And we've done a lot of work with our faith leader network, Richard, to help train and equip faith leaders and members of their respective congregations. And we work with ministers and priests and rabbis and imams, really across the country, to help train them on how to use Narcan to help prevent overdose deaths from opioids. And so we've really kind of worked with this group specifically to try to help answer the questions that they and their congregants have around the COVID-19 vaccines, everything from kind of their development, to their approval, to the rollout, to kind of how to figure out kind of where to get a vaccine, will there be a cost associated with the vaccine? And kind of every question that I think you and I, and probably everyone with us today could imagine. And we've supported other efforts too, kind of with educational partners, with early childhood education partners, which I know you mentioned our work with You Smell to Fail earlier, but probably our most extensive and intensive work from the Clinton Foundation's perspective domestically has been with our faith leader network. And then with the Clinton Health Access Initiative at a global level, we've really just tried to support all of WHO's efforts on trying to kind of scale up the ability to vaccinate the world and also to ensure that people around the world have answers to the questions that they also have around the COVID-19 vaccines, their development, kind of which vaccines they're getting, why are they getting certain vaccines? So a lot of work globally, as well as our kind of very intense work here in the United States. And then on a personal level, just personally kind of as me as a kind of public health advocate, I've tried to do everything I can to combat disinformation and misinformation around COVID-19 vaccines to increasingly support kind of the efforts to help educate young people and parents about the now newly kind of granted EUA approval for 12 to 15 year olds. But that's very much in my personal capacity. So just want to be clear about kind of the different hats I wear at different times, very much a strong commitment to vaccine access and equity. Yeah, that's wonderful. And yes, you wear many, many hats, and it's very appreciated to see all the work that you're doing around the country and around the world. And I think it really just takes a lot of messaging coming from multiple sources so that people can start to hear the importance of getting the vaccine from not just friends and neighbors, but their pastor, their reverend, their faith leader, and their physicians as well. It seems like every day in clinic, I'm having conversations with people who are on the fence about getting vaccinated about COVID-19. And some of their concerns focused on sort of the speedy approval process or the side effects they've heard about. But what are some good messaging points that you think physicians can highlight in their conversations with individual patients or in public health messaging? Well, certainly, Richard, I would say every physician knows their patients the best and knows how best to talk with patients and talk often with the families of patients, because we know that often the decision to get vaccinated really is often a family decision and not kind of just an individual patient one. I do think as more people have become more aware that the mRNA vaccines kind of weren't just developed overnight, that really we've been working on these technologies for decades. I think, thankfully, that's gone quite a ways to ameliorating some people's concerns. Certainly, we're seeing, especially with people in their 20s and 30s who kind of really have not thought that COVID-19 was a real risk to they themselves. And we know that as kind of now we've administered many, many, many millions of shots across the United States, that kind of that group specifically is starting to think, oh, well, my friends thankfully haven't had kind of severe side effects, or even if kind of they've been tired or their arms hurt, it's been over in a day. I actually don't think that's as bad as now the stories I'm reading about long COVID and how hard it is for a 28-year-old to even run a mile who maybe was running a marathon two years ago. And so I do think, thankfully, it really is kind of the collective experience of seeing what's happening across our country that is starting to persuade some people who maybe were on the fence. And yet, I think, as you know better than I do, certainly, Richard, it really is often these one-on-one conversations over time with people who are trusted in someone's life. And often it's many conversations with many trusted individuals, whether it's kind of the right kind of equation of a parent, a doctor, a faith leader, and a friend, just ensuring that kind of all of us who do believe it is really important not only for individual health, but for our shared public health, our shared public health protection to get as many people vaccinated as quickly as possible, that we all kind of are aware of the language that kind of really best works, as well as the facts that really we know are persuading people. And yet, I think we also have to continue, Richard, as you and I have talked about now for many years, try to also help inoculate people against kind of the seduction of the kind of anti-vaccine misinformation and malinformation that we know, unfortunately, is often very effective. So it's both about, I think, arming people with kind of what they need to know about the COVID-19 vaccine and also equipping them to kind of be critical thinkers and skeptical about often the anti-vaccine information that unfortunately is far too accessible and still far too pervasive on our social media platforms. Yeah, absolutely. It's very difficult to try and have conversations with people about these misinformed arguments that they're seeing, whether it's on news or from various sources online, social media. It's something that certain parts of the country have sometimes pockets of folks who maybe more have these kinds of ideas than other parts of the country. But I wonder if you have any suggestions or if you have any thoughts, or is the Clinton Foundation, what are we doing? What are you working on to directly address some of the hesitancy efforts or the anti-vaccination movement that's sort of putting out all of this information out there? So from the Clinton Foundation, the Clinton Health Access Initiative very much is trying to have good information as readily available to anyone and everyone. And so kind of how that information is delivered and who may be delivering that information varies around the world. So kind of we can think about you may be someone coming into your clinic where you can walk away with a pamphlet and maybe in other parts of the world, it might be kind of a series of SMS messages that are being delivered. And so certainly kind of the consistent thread is a consistent focus on kind of the facts and the evidence and the science kind of underlying the vaccines. And increasingly also, we know it really matters to people not just here in the United States, but around the world to know how many hundreds of millions of shots have been now delivered. That's certainly because we have real kind of evidence now speaking to this, it goes a lot to helping build confidence when people feel like, oh, like they're not in the first wave of vaccinations that now kind of these shots have been administered really kind of at an incredibly kind of high level. And that probably people know kind of someone or many someone's who have been vaccinated, even in counties that have very low vaccination rates. It's more likely than not that you're going to know at least one person who's been vaccinated. We still do need to be doing more. And this is something from a personal level, at least domestically, I'm pushing for whether like here in New York City or really around the country, we have to do a better job of kind of whatever the 21st century kind of door to door. And it might actually just be a door to door campaign to help make it even easier for people to get vaccinated because we know that access remains a real barrier for many people. And we know kind of at a global level, there are different access challenges and that there are kind of many, many countries that haven't administered kind of any vaccines and even more countries that have only been able to have kind of vaccines available to vaccinate less than one percent of their populations. And so that's a different sort of and yet still like a very kind of morally and public health urgent access challenge. I think that your kind of question too, though, around kind of misinformation is a really important one. The Center for Countering Digital Hate a couple of weeks ago really called out kind of what they termed the dirty dozen, the kind of dozen social media accounts across Facebook and Instagram, Twitter that account for truly a majority of the content that is generated that is totally factually inaccurate around vaccines and vaccinations. And while some of those accounts have now been deplatformed in the last couple of weeks, they often haven't been deplatformed consistently. So, you know, Facebook may have taken down someone's Instagram account, but their Facebook account is still live. Or maybe kind of Twitter has taken down the account, but the kind of Facebook and Instagram accounts are still live. And we know because we have a lot of painful evidence over the last year that kind of these accounts that were already more powerful than certainly I would have liked them to have been, you know, at the beginning of COVID-19 have just grown there, the audiences truly by the many, many millions of followers. And Facebook has said repeatedly that it would deplatform not only content, but users who persistently post content that is counter to what the CDC is saying, kind of what public health authorities are saying. And yet they're not even meeting their own standards. And so, you know, I and many others have been calling on them to at least live up to their own standards. You know, certainly I wish that kind of it was more extensive than kind of just kind of applicable to COVID-19. But they have repeatedly said last year and even early this year that they would take down content that was, you know, non-factual, kind of non-evidence based, non-kind of scientific based, anti-science around both COVID-19, the disease and the COVID-19 vaccines. And yet kind of every day they fail to do that. And we see kind of how dangerous that is, too, especially now in India, where misinformation isn't only flourishing on the Facebook platforms of kind of traditional Facebook and Instagram, but also on WhatsApp, which Facebook also owns, where kind of the anti-science content, you know, has really twinned in really horrific ways with kind of Islamophobic kind of anti-Muslim content, blaming kind of, you know, Muslims for causing COVID-19, for spreading COVID-19, which kind of is only more endangering to more people and kind of more counter to public health and safety. So, you know, I do think we just have to continue to pressure Facebook to live up to its own standards and hopefully pressure them to even have higher standards when it comes to public health content more broadly. Right. Yeah, we can rely somewhat on these platforms to sort of self-police, but I think it also is impingent on organizations like ours, entrusted medical organizations across the U.S. to really put their expertise out there. I wanted to turn now to a question that came from the audience as we're sort of on this topic of sort of global vaccine inequity, just specifically on vaccine access in Asia and in Africa. Are you familiar with some of the work that's being done in these two continents around COVID distribution? Yeah, I mean, so, yeah, so it's different kind of country to country, and I certainly want to say that I think COVAX, which is the partnership between CEPI, the Coalition for Epidemic Preparedness, GAVI, kind of what used to be known as the Global Alliance for Vaccine Initiative, the WHO, the World Health Organization, you know, COVAX, I think, has done really extraordinary work to kind of marshal resources, financial resources to be able to purchase vaccines from various vaccine manufacturers, also to solicit donations not only of vaccines, but also kind of in partnership with WHO, and I will not kind of try to trip down too many acronyms, kind of through something else called the ACT Accelerator to, you know, be able to kind of galvanize the donation of PPE and tests, both kind of, you know, across kind of antigen and antibody tests. I really think, you know, it's important to not only acknowledge, but really recognize how extraordinary the work of COVAX and the ACT Accelerator have been, and yet also to recognize how insufficient they've been, partly because they have not been adequately resourced at the levels that WHO and the founding partners kind of said initially were needed, and also just because our challenge is far more grave than I think kind of was first believed when COVAX was initiated now a year ago. And so I think it's important to continue to invest in COVAX. I think it's very good that, you know, the Biden administration today said it would donate additional doses of the Pfizer, Moderna, and Johnson & Johnson vaccines on top of the 60 million doses of AstraZeneca that it said it would donate by July 4th. But, you know, we're speaking here on May 17th, and July 4th is more than six weeks away. And so I would hope that the administration would accelerate those donations, because we know that, you know, the vast majority of vaccinations have occurred, you know, in the wealthy world, kind of less than 2% of the developing world has been vaccinated. So this is not, you know, a slight inequity. It's a really gross inequity. And yet we won't be able to donate our way out of this challenge. And so, you know, I am one of many who have now called for many months for kind of a comprehensive plan to invest in the world's ability to vaccinate the world. And so, you know, that has a few pillars. You know, yes, we do need the TRIPS waiver. And no, it is not sufficient. The WTO has said that it would hopefully have an agreement by December 3rd, which is kind of the current horizon. Again, it's May. December's a long ways away. And there's been a proposal from South Africa and India, kind of in front of the WTO, you know, for more than six months since last October. And I strongly believe the United States should agree to that language and move forward. And we also know that we need kind of robust tech transfer. So not only kind of the kind of patents for making the vaccines, but also the underlying kind of recipe and knowledge to make the vaccines. And we need, you know, the investment of significant resources. I mean, different organizations and experts from, you know, my colleague, one of my mentors, Wafel Sater at Columbia, to kind of PrEP4ALL, to the people's vaccine, kind of pioneered initially by Oxfam and many others, you know, said somewhere between 24 and 25 billion dollars. So, you know, in the grand scheme of the American budget, like not a lot of money would really help kind of invest in adapting and building new manufacturing capabilities to produce these vaccines, kind of to help inoculate the world against COVID-19. And yet to build the manufacturing capabilities in such a way that that competency would be flexible to then be able to manufacture other vaccines for the future. Because we know that kind of all of our various infectious disease threats may be kind of less pernicious because we've been social distancing in much of the world, but certainly haven't gone away. And we need to desperately catch up kids, including here in the United States, you know, on routine childhood and adolescent vaccination. So, you know, I think we have a lot to do, and yet I think it's quite clear what we need to do. And I just think, you know, the best time to have made these investments and to have worked out kind of these intellectual property dynamics would have been last year. But, you know, the second best time is this year. And every day we're not doing that is a day that we're not vaccinating the world, which, of course, kind of only puts the progress that we have made kind of in greater peril. So I am quite frustrated, admittedly, that we haven't been able to have real agreement on this. And so while I am incredibly thankful to the Biden administration's agreement in principle to the TRIPS waiver at the WTO. I remain kind of deeply bewildered as to kind of why then we're willing to wait six months kind of toward that goal, especially when, you know, Moderna has said it will not enforce its patents. We, the American public, the American taxpayers paid for 100% of the Moderna vaccine development. We also paid for probably about 75% of the J&J vaccine development. And so we certainly have, I think, moral authority, but we also have legal authority. And with the Defense Production Act, we have kind of effectively kind of the muscle to compel not only the knowledge sharing, which we've already seen happen kind of with the arrangements between Johnson & Johnson and Merck for Merck to be producing the J&J vaccine, but also to help kind of scale up the production of everything else we know that we need, right? Because it's not just kind of the vaccine itself, it's kind of everything that has to happen kind of around the production of the vaccine, you know, the storage of the vaccine and the administration of the vaccine. And so while it certainly has a lot of moving parts, it's eminently doable if we were to really exert the leadership in the doing of it. And clearly I feel quite passionate and wish that we would kind of assume the leadership role that I think very much is in America's interest and our public health interest and our economic interest and even in our national security interest. Yeah, absolutely. And I think this is definitely an advocacy campaign that ACPM could consider getting behind and sort of helping bring that message to the White House and trying to make sure that this happens in a very quick manner. We have some more questions from other attendees. So kind of jumping back on the sort of, on the messaging on the state side. So one person asked, they said, I answer questions all the time at work regarding vaccines and their possible side effects. Any pearls that you can provide in regards to messaging to millennials and Gen Z? They're often the ones who seem to be most concerned. I think because we have just really started vaccinating kids we're still trying to figure out what really works for kind of 12 to 15 year olds and candidly even for 16 and 17 year olds. And I don't think we have good data there. Certainly for millennials, and I mean, I don't know Richard, I like read something a few days ago that I'm considered a geriatric millennial. I guess like people born from 1985 are geriatric millennials. So that means you're a geriatric millennial too. And I just was like, I didn't, I wasn't quite ready to like be a geriatric anything. But we know he's from New York. So I'm not as familiar with the data nationally except for kind of the, what we have very much seen in New York state and in New York city. And what I know kind of the Kaiser Former Foundation has been tracking kind of through their surveys that for a lot of millennials, people in their twenties and thirties, there's very much a sense of, the vaccine side effects are probably more serious than COVID. I was speaking also with Frank Luntz, the Republican pollster and strategist who's been running a series of face, excuse me, focus groups with the Benison Foundation and the Washington Post now for many months really examining kind of why certain groups seem to be kind of less enthusiastic, vaccine questioning, vaccine hesitant than others. And when I spoke to him last week and I interviewed him for my podcast and this episode will be available tomorrow. He had just conducted a focus group with millennial women and kind of an older, I guess older Gen Z and millennial women, kind of 18 to I think 45 year old women. And there were some women who were concerned about kind of the effects on fertility, which we know has been a concern and unfortunately one that the anti-vaccine kind of purveyors and actors have really seized upon. It's also quite an old canard in kind of the anti-vaccine movement. That kind of vaccines in general will disrupt your fertility or render you infertile. So while it is newly purposed around the COVID-19 vaccines, it is one that we have seen not just here in the United States, but around the world now over many years, unfortunately kind of pushed by kind of the anti-vaccine movement. But Frank was sharing how other groups but Frank was sharing how a larger concern, which is certainly what we've seen in New York City as well. Richard, are just people again, kind of in their twenties, thirties, early forties, who think just not that serious, like I'm not gonna get that sick even if I get COVID. Whereas I keep reading all these stories that like my arm's really gonna hurt for a few days or I'm gonna be lethargic or maybe I'm gonna have a bad headache of like as a side effect of getting the vaccine and they're less concerned about getting COVID even though we know that a majority of people in our ICUs across the country right now are under 50. And we know the long COVID can be very serious even for people who were otherwise quite healthy, even for people who had mild cases of COVID, the mild cases of COVID, the symptoms at least seem to not get better even if kind of the infection is sensibly, is no longer perceptible in someone's body. And so, I think Richard, we have really very real questions that we still have to ask and answer about kind of what messaging and what messengers are most effective on kind of ameliorating the concerns that millennials have about the COVID-19 vaccine but also in helping to kind of readjust the risk assessment that a lot of young people are making, which is that the vaccine feels riskier to them than actually the COVID-19 infection. Whereas we of course know that that's not backed up, you know, not only by science, but it's also not backed up by now the, you know, many millions of anecdotes and kind of people's experiences that we have who have been vaccinated, who are in their 20s and 30s. And so, we don't quite know what those messages are yet, but I'm hopeful that kind of through the very kind of deep work that's happening kind of with focus groups and surveys that we will have good answers to those questions soon. And I think we'll also see, you know, as a secondary point, kind of which if any of the incentives effectively that various states and communities are trying, you may actually help catalyze a greater uptick of vaccination. So, you know, whether it's kind of a free drink in New Jersey, or it's free like sporting tickets in various cities, or it's the, you know, $100 state bond from West Virginia, or it's kind of entering a million dollar lottery in Ohio, if you're, you know, above 21, and if you're, you know, 16 or 17, entering the lottery for a full ride, including kind of room and board and tuition to one of the Ohio kind of state colleges and universities. I do think we will also have real evidence as to whether or not kind of any of those incentives worked and if some did kind of which were particularly effective at motivating which groups to get vaccinated. Hugh, you may not have been like hesitant per se, like don't doubt the underlying science of the kind of vaccines, or don't doubt the importance of vaccinations for other people, but just didn't feel like it was relevant, you know, to them and to their lives. So I think we don't have good answers yet, but I think we thankfully will soon. Yeah, that's very, very interesting. And I'm looking forward to hearing your podcasts tomorrow for some more details on that. I can tell you personally, so my 12 year old daughter, Tilly, she got vaccinated on Saturday. And one of the biggest, I know, go Tilly. One of the biggest incentives for her was knowing that her favorite actress, Millie Bobby Brown, got vaccinated. She's 17, you know, and she's been vaccinated for a long time. She got vaccinated. She's 17, you know, famous movie star and TV star. And, you know, I think that was probably more influential than her mom and dad who, you know, telling her you're going to get the vaccine, you're going to get the vaccine. She's like, well, when she found out Millie Bobby Brown got it, she's like, fine, like, okay, I'll go get it. So yeah, whatever it is. Yeah, no, but I don't mean to interrupt. I just want to say like, I think we actually have not seen great evidence of kind of celebrity vaccinations leading to a greater uptick for adults, but I know there has been, and I have like friends, you know, I have friends who are watching this and studying this, you know, has been a real hope that for younger people where there is a greater feeling of connection, of kind of connectedness and of like looking up to whether it's an athlete or an actress or, you know, musician that hopefully and thankfully we have had many, you know, athletes, actresses, musicians who have very publicly like shared photos of themselves getting vaccinated, who have talked about the importance of getting vaccinated to be able to play their sport or engage in their craft or like when you make their movie or their TV show, you know, I know there is a lot of hope, but again, we don't have data to kind of back this up yet, but I know there's a lot of hope that maybe for younger people, those role models will really help inspire, you know, adolescents to get vaccinated, even if they didn't inspire their, you know, their parents, their grandparents, like maybe, you know, maybe they really will have an effect on teenagers. So I certainly hope so, especially now having heard that that mattered for Tilly. Thanks. Yeah, now if we could get some, you know, YouTubers that my son watches to get vaccinated, maybe he'll be influenced as well. No, I'm always like, I'm a big believer. I'm happy to ask anyone to do like anything, you know, to help public health. I always think the worst thing anyone's gonna say is no. So. Yeah. Yeah. Okay. I'm happy to ask. I might take you up on that. I wanna turn now to sort of, you know, some of the lifting of mask restrictions that's going on into various parts of the country. And some may be a little bit prematurely before they've reached, you know, herd immunity, but it seems like in some of the areas of country, it's gonna be quite clear, if not already, that, you know, you either have to remain in a mask or get a vaccine to, you know, participate in various activities outside the home. And even as some retailers like Walmart and Costco and Trader Joe's are relaxing some of their mask restrictions and kind of moving to this honor system to try and encourage hesitant folks to choose vaccination, I get a little worried that maybe unvaccinated people may instead use it as an excuse to kind of shed their mask and take advantage of that honor system. What, do you have any kind of thoughts on what we can do public health-wise to sort of help support and convince people not to? Yeah, I mean, I would say, unfortunately, you know, my governor, Governor Cuomo, announced earlier today that he was removing the indoor mask mandate. And I share your concerns that we're not quite at the point where I would have hoped that we would be. I mean, in New York, we're not even at, you know, 50% of our population that's been fully vaccinated yet. And then we look at, you know, our home state of Arkansas, and, you know, it's less than 30%. And then you look at Mississippi and it's 25%. And so I am really concerned and I'm not, you know, impervious to why Dr. Walensky and the CDC, you know, hoped that this would, you know, help, as you said, Richard, you know, maybe inspire some people to get vaccinated. But I would not have made that choice. I think, you know, we went from a couple of weeks ago to having like many different scenarios of kind of how to think about, you know, households kind of being together in different places or kind of how individuals could think about our relative risk. And that arguably was too complicated. There were, I think, too many kind of different kind of options for people to try to think about, but to kind of swing from that to now kind of the bifurcation of like vaccinated, unvaccinated, makes me quite nervous, given all that we've learned about how people behave and the choices that people make over the last 15 months. And I worry that the burden again will fall most heavily on our essential workers, will fall most heavily again on the most vulnerable Americans, people who are least likely to be able to ask someone to wear a mask, especially if that's not the choice that their employer has made, because it's not the leadership that their kind of local or state government has demonstrated, because it's not the leadership that the CDC itself had demonstrated. And so I do worry about kind of making people who have always been vulnerable, especially vulnerable kind of over the last 15 months of the pandemic, particularly vulnerable once again. And then I just would say as a parent of three children who aren't eligible to be vaccinated yet, and while it is encouraging that Pfizer said a couple of weeks ago that it expects to file for an EUA for two to 11 year olds in September, even if kind of they're right about that, optimistically then my children won't be fully vaccinated until, I don't know, like early November, maybe. And to be clear, I would have like enrolled my kids in a trial if there was one closer to us than Rochester, which for those of you who don't live in New York is like a five and a half hour drive from New York City. I just couldn't like quite justify like trekking my children there. So I'm like incredibly eager and excited for when my children will be able to be vaccinated. But I worry that, you know, it's not only people who are structurally vulnerable in our society, kind of structurally, kind of on the downside of a lot of like structural inequities and inequalities in our society, in our country. But I also think about people who are immunocompromised, people who actually may have been able to get vaccinated but have autoimmune diseases. So we believe we're probably still more vulnerable to COVID. And then the, you know, many, many, many millions of Americans who are under the age of 12. And so I just, I'm also worried, Richard, that, you know, there may not be kind of the choices that I wish kind of still would be being made by state and local leaders, kind of by kind of big corporations, kind of by kind of local, you know, restaurants or coffee shops, and that that just makes her already vulnerable more so. Yeah, absolutely. I think that we have time for one more audience question. Going to share this one. This person says, thanks so much, Dr. Clinton, for sharing your thoughts and experience on COVID-19 vaccine acceptance. We are seeing drop-off rates from the public presenting to mass vaccination clinics. We're moving into phase two and three where supply outpaces demand, where the people who are eager to get vaccinated have gotten vaccinated. What's the Clinton Foundation doing and what do you personally think is important to get vaccines to those who experience not just the most hesitancy, but the greatest social and economic barriers to getting able to get vaccinated? I mean, we know that there are a lot of people who actually still do want to get vaccinated and still don't know where to go. So I think that, you know, for those of us who like think about vaccines and vaccinations, you know, that is sometimes not so immediately apparent, but clearly to the person who asked the question, it is, and certainly, you know, from my perspective in New York and in New York City, it is, I mean, we know we have not great vaccine equity in New York City, to put it mildly. And I'm thankful that both the city and the state, as well as kind of with the Health and Hospitals Corporation or public hospital system, as well as some of the kind of larger kind of private hospital networks kind of are all trying to admittedly in their own ways. And I wish that it were more coordinated, but thankfully you are all trying to figure out how to kind of get more vaccines to more places where people are. And so, you know, in New York, we have, you know, mobile clinics, we're starting to kind of have more routine kind of pop-ups in not only kind of, you know, churches and mosques and synagogues, but also in schools and YMCAs. You know, there's an effort to also kind of do it with local firehouses and in kind of places where kind of there is already kind of visibility in different communities and often relationships kind of with communities. And you're trying to kind of push out more vaccine to more places. And there is an effort now being considered as to whether or not there really should be, if not kind of door to door, at least kind of building to building, which I would strongly support in New York. Because I think until we truly bring kind of vaccines to people, we will continue to struggle with real access barriers where people, we may think that it's easy to go to your local Walgreens, but if it's still kind of 10 blocks away, that's not easy. If you're undocumented, even though we don't ask for kind of citizenship status, that may still dissuade you. But if someone showed up and kind of, you know, offered you the vaccine and you could trust that they were who they said they were, hopefully you would get vaccinated. And hopefully then it would be easy for them to come back a few weeks later to administer your second shot if you're getting Pfizer or Moderna. And so I just think we have to be willing, we, those of us who know this is so important, have to be willing to invest in going kind of that last proverbial mile. And certainly, I think the Biden administration's efforts that have really ramped up over the last week to kind of push more kind of vaccine and vaccine distribution into more rural communities, I think has also been hugely important. And hopefully we'll start to see that kind of really lead to kind of greater rates of vaccinations in more rural counties and communities across our country. I just think now we're at the point exactly as you said, where, you know, our rates have fallen off in our mass vaccination sites. I do think there's probably still some logic to having mass vaccination sites, you know, for kids like in school-based settings, you know, kind of school by school even. But we do need to just bring it, we need to pivot and redeploy kind of energies and intentions and vaccines and vaccinators, you know, really out into the communities because even in New York City, we see kind of the pharmacy approach I think has made a real difference, but isn't still sufficiently rooted in equity and rooted in kind of where people are. But we know how to do this, we just don't need to do it. Absolutely. Well, it's just been so wonderful to have this conversation with you and you've thought so much about this. It's just so wonderful to hear all the work that you're doing with the Clinton Foundation and personally on this issue. I hope that we can continue to support each other through these hard times and continue to get as many folks vaccinated as we possibly can. And with that, I think we will close out the session. So thank you so much, Dr. Clinton, for joining us. Thank you so much. Thank you, Dr. Bruno. Thank you to everyone for having me today.

Clinton Foundation

vaccine hesitancy

faith leaders

global vaccine distribution

disinformation

vaccine equity

vulnerable groups

access to vaccines

mask restrictions