COVID-19 in the Global South

Karen Bonadio:

Good day everyone. I'm Karen Bonadio director of alumni relations, and I'm delighted to welcome you to our third Alumni Talk Policy Zoom Webinar on COVID-19 in the Global South. The Alumni Talk Policy series features HKS alumni and panel discussions about pressing public issues. While we cannot meet in person, technology allows us to convene virtually, and we appreciate your patience as we navigate this event remotely and apologize in advance for any issues that you may experience.

Karen Bonadio:

This webinar is being recorded and closed captioning is available and can be turned on at the bottom of your screen. Today, I'm happy to introduce Carl Manlan, MCMPA 2012, chief operating officer of the Ecobank Foundation and former member of the HKS Alumni Board, who will moderate this panel discussion. Carl, I'll turn it over to you to kick off today's important and timely discussion. Thank you.

Carl Manlan:

Thank you, Karen. Good morning. Good afternoon, wherever you are in the world. It's a pleasure to be here today. I am Carl Manlan, as Karen said, and I'm very happy to be here today with Lorena, who is the MPP 1999 and is a professor of political science at University of Sao Paulo in Brazil. I'm also here Prerna Makkar, who is MPID 2008, was a founding director of Health Compacting Delhi, New Delhi, India. Also, Diana Samarasan [inaudible 00:01:22]MP 2004, who join us from the city where we all met many years ago in Boston or Cambridge, depending on where you live.

Carl Manlan:

This morning or this afternoon the key part is really for us to look at what has happened across the world with COVID-19. And without further ado, allow me for Prerna to start the conversation. So we'll start in new Delhi, far East, moving to South Paulo, and then coming to Boston. Prerna, please. You're on mute. Thank you.

Prerna Makkar:

Hi everyone, it's a pleasure to be here. I think what I would start with is how I remember this pandemic unfolding in India, if that's all right, Carl. All right. I think the first case in India was reported in late January and February there wasn't much reporting on cases. Early March I think I remember things started moving very quickly in India. Still the cases were very low in India, there wasn't much concern that the disease had yet come to India.

Prerna Makkar:

But in the very first week of March the Delhi government shut down schools as a precautionary measure. And soon after that, by week three, we saw a national level COVID-19 task forces being set up to advise the prime minister, and in the last week of March, we saw one of the harshest global lockdowns that the world had seen. India at that time was looking at countries like Italy, for instance, where the pandemic had suddenly rapidly spread. I think the expert committees advising the prime minister suggested a very harsh lockdown that was in the last week of March.

Prerna Makkar:

So things started rapidly sort of taking hold in India with the COVID-19 pandemic in March. There was a lot of uncertainty at that time, not a lot of things were understood about this disease. And it was a time where we were trying to learn new information about the disease, at the same time trying to understand how best to contribute to it. And the next few months that followed, I think were emotionally and physically quite challenging for those of us working in public health, but also others in terms of just trying to make sense of what was happening around us, and trying to do the best we can.

Prerna Makkar:

And there was always the sense that no matter how much you did, there was still so much more to do. So that's what I remember of the early, early days and months of the pandemic in India.

Carl Manlan:

Very important reminder of the fragility all this that has brought to us. Lorena, in South Paulo, can you tell us what was the experience, or your experience as well?

Lorena Barberia:

Yeah, so I'll talk a little bit about, to get us started and to go back to, actually in early February there was already concern of possible infections in Brazil, but the first case was only detected in late February. I'm a university professor, I teach in the graduate and undergraduate programs. And I remember being in the beginning speaking a lot with my students and especially with my research group, I do a lot of quantitative public policy evaluation analysis.

Lorena Barberia:

And the students and I in the beginning being very concerned, especially because in the beginning there was a lot of uncertainty on the ground about, is this going to be a problem? Is this really something that we should be concerned about? What should governments be doing? How should they be responding?

Lorena Barberia:

And in the case of Brazil, a little bit to contrast with India, there was a situation that was very difficult since early on, in terms of the national government reacting and clarifying the situation and also organizing the response to the pandemic. And what we started to see is a lot of... a very decentralized and fragmented response, but really incredibly rapid response being undertaken by sub national governments at the state and municipal level in Brazil.

Lorena Barberia:

And at that moment my students they turned to me and they said, professor, we're not going to do anything, we have to study this, we have to map it, we have to monitor it. So we started to get really involved since early on in developing indicators and mapping government responses to the pandemic on numerous fronts.

Lorena Barberia:

But I think the situation in terms of Brazil and that's been ongoing and it started that way and continue to be that way, is that there's been a lot of conflict between the national government denying and failing many times to adopt policies that could have made a really big difference in preventing the further spread and transmission, and the States and municipal governments trying to react, but in a very fragile and difficult situation, especially economically. And the federal government did intervene importantly, at least in terms of economic assistance, but the problem is more about acknowledging the severity of the epidemic and around surveillance and the actual implementation of social distancing policies in which the federal government really was reluctant and in some cases even vetoed legislation that could have made a difference.

Lorena Barberia:

So that was the beginning, and it set us on a really important moment of a lot of challenges and a lot of discussions here in Brazil about what is the role of governments.

Carl Manlan:

It's an important one. So Diana, even though you're based in Boston, you spend a lot of time looking at the rest of the world. It would be good for you to give us, first your experience in Boston, but also what you've seen across the world, and being plugged [inaudible 00:07:32].

Diana Samarasan:

Thank you, Carl. So even though I am based in the Boston area I am the founder of a global grant making organization called the Disability Rights Fund, that is a collaboration between donors and global disability rights activists to support the disability rights movement across Africa, Asia, Pacific, and Caribbean. And we work with a diversity of donors, including governments, the UK and Australia are part of our funding family, private foundations like Open Society and Ford Foundation and individuals.

Diana Samarasan:

We've been supporting disability rights movement since 2008 and have given out in total more than $35 million to the Disability Rights Movement. As you can imagine, I have a global staff more than 20 people now. And in the beginning of February, this past year, we were all preparing to and did travel to Rwanda for an all staff meeting, and to also meet with our grantees on the ground in Rwanda.

Diana Samarasan:

That meant that my staff which includes people from 11 different countries around the world, most of them in the global South traveled. And yes, we all had heard that COVID-19 was something starting in China, in fact, I brought with me a box of masks although I didn't end up using them.

Diana Samarasan:

And in the airport coming into Rwanda, they were already taking people's temperatures and talking to people, pulling people to the side if they had a temperature. So luckily none of us got sick in our travels from as distant as Indonesia and Haiti and the US, but that was the last time that we were able to gather together as a team in person.

Diana Samarasan:

Shortly after I returned to the US, we closed our office in Boston, we restricted our staff and our grantee travel as well and any in-person meetings, and we started to do really hard work of figuring out what our grantees that are all organizations of people with disabilities needed during the pandemic.

Diana Samarasan:

And that wasn't easy because most people with disabilities are very marginalized, even the organizations. And when their offices were shut, when there were lockdowns and quarantines, most of them had no access to internet. So my program team really worked hard to reach out to folks in any way they could, my program officers are all people with disabilities on the ground in the places where we work. And to do the very first step of ensuring that our grantees had internet access at home so that they could continue to be in touch and do some of the needed work on the ground.

Diana Samarasan:

Over the next couple of months through about July, we ended up pivoting about 80% of our funding to support our grantees who were doing things like immediate support on the ground providing PPE and food and cash to people with disabilities, but also doing advocacy to governments where there were, for example, inaccessible public health messaging and also lack of inclusion of people with disabilities in COVID-19 task forces.

Diana Samarasan:

So I think I'll leave it there, it's a lot of work since then. But that gives you a sense of where we started.

Carl Manlan:

Absolutely. So let me stay with you, because I think when we think about what has happened during the past few months, it has brought forward issues around inequalities. You just spoke about people with disabilities that are often marginalized groups, and there's this sort of narrative around the global South and the global North.

Carl Manlan:

And in the context of COVID-19 and the AIDS pandemic, and also Ebola, there's something that comes in this experiences where when Ebola started in West Africa in 2014, 2016, it was purely seen as a rural virus. Eventually it cross a few borders without any visas and the world reacted. There were a coalition of 50 countries, billions of dollars were pledged.

Carl Manlan:

So, if I stay with you Diana, and specifically on the issue around marginalized groups, and in the context of course of this three big issues that we have had to face in our lifetime, which are Ebola, AIDS and now COVID-19. What is your take on what the world might have learned or not? And then we move to Sao Paulo and then finish in new Delhi.

Diana Samarasan:

What the world might've learned. That's a difficult question. But I think as we've seen, at least during this pandemic in the US, even people who were already marginalized before the pandemic have been more affected by the pandemic. And that's true of black indigenous people and people of color, it's true of elderly, and it is true of people with disabilities, especially those who are living in institutionalized settings.

Diana Samarasan:

And where identities are intersectional, such as black people with disabilities, the negative impacts are even worse. And people are dying, people are being let go from their jobs, people are not getting access to the supports that they usually have. This is also the case globally for the 1 billion people with disabilities around the world, 80% of whom live in the global South.

Diana Samarasan:

The Disability Rights Fund that I lead was part of the collaboration of seven global disability rights organizations that did rapid data collection on what was happening on the ground from April through July, gathering information in 25 different [inaudible 00:14:38] more than 2000 persons with disabilities across 134 countries.

Diana Samarasan:

And this data and our known work is summarized in a report called Disability Rights During the Pandemic. It shows that in many cases the situation has been catastrophic. Government and public health messaging as I was saying, did not take into account the need for accessible information. Hand washing stations were not made accessible to those in wheelchairs or people with dwarfism, for example.

Diana Samarasan:

Persons with disabilities lost their lives in institutional settings where the virus spread quickly and unabated, during the lockdowns people with disabilities lost their access to community supports, to personal assistance and in some cases they were jailed or shot for trying to get access to food or other critical supplies sometimes because they could not, for example, hear the police shouting at them.

Diana Samarasan:

Beyond these immediate impacts, of course, the economic recession, I mean, in the US alone has meant that 1 million persons with disabilities have lost their jobs, that's one in every five of the people with disabilities who are employed in the US. So it has had an enormous, an outsized impact on people whose identities were... who already made them more vulnerable before the pandemic. So.

Carl Manlan:

Thank you. Thank you very much for that. Lorena.

Lorena Barberia:

Yes. So I think an important thing to talk a little about my own work, in early March we founded an inter faculty and multi disciplinary initiative that's called the solidarity research in public policy and society. It brings up together researchers from across Brazil, and we also participate in work with other other organizations that are similar and that have been formed and similar across Brazil.

Lorena Barberia:

But one of the things that from the beginning we clearly understood is vulnerable groups, we need to map policies and evaluate policies and show the impact on vulnerable populations and be the voice for those populations in this very difficult moment.

Lorena Barberia:

And so we've tried to do a lot of intensive data collection and looking at assessments, particularly to look at and try to understand how vulnerable groups are being affected by government policies and also develop recommendations in the ... in that, we say it in the speed of the pandemic. So trying to be really dynamic and develop data, use that data and develop recommendations and dialogue with governments to try to improve the types of services and the type of response for vulnerable groups.

Lorena Barberia:

Our research is showing for example, that if we look at hospital mortality, if we look at access to testing, so actually knowing and identifying active cases, there's very, very strong differences, and the vulnerable populations are being really hard hit. And then we have a lot of also heterogeneity across Brazil.

Lorena Barberia:

So I live in the richest state of the country, and when we talk with researchers from across different States and different municipalities, the situation is very different across communities and across the types of challenges that are being faced.

Lorena Barberia:

But I think one of the things that's important to remember thinking about Brazil and also because our research and the types of conversations and work we're doing has worked very closely on with public health and epidemiologists, I mean, public health scientists. What's really interesting is to also remember, in the case of Brazil, if we think about AIDS, AIDS was a really turning point in thinking about Brazil's leadership and working towards guaranteeing antiretroviral treatment to those who are HIV positive.

Lorena Barberia:

And there's been a lot of work systemically to think about how to develop programs and how to respond to programs in moments that are tragic and tremendously painful for countries. And Brazil has experience in making a huge difference in terms of AIDS, and something that was a lot... it's a point of pride for us. So I think it's very hard and it's very sad in this moment for us to say that we have the second highest rate of deaths in the world. And we know that those deaths are not equally spread across all... the poorest and the most vulnerable are the ones that are being hit more.

Lorena Barberia:

And so it's very, very painful, and it's a very sad moment because we have a lot of different cases and different examples of making a difference and being actually a leader globally in trying to pave ways like in AIDS.

Lorena Barberia:

And so I think that that reinforces a little bit, and I think just to talk a little bit, Carl, just one last thing is that, like you said, the virus is something that it doesn't respect any type of borders and it permeates all of society. But the problem and the issues that we see a lot is that the ability and how individuals can protect themselves and how they can socially distance themselves is very different.

Lorena Barberia:

But we also think, and I think since we're interested in policy, and we're also interested in politics, we know that politics and leaders can also make a huge difference, and there's a lot of polarization in terms of ideology that has also made really... it made it very difficult to respond to the pandemic. And it's been very politicized.

Lorena Barberia:

And I think that that's really important and something that we really need to understand, because in HIV and AIDS, there's a lot of parallels and there's a lot of lessons that there's a lot of interesting work to be drawn. But the issue of polarization and how it affects your willingness to expose yourself to risk is something that is very difficult to understand, and to react quickly to and try to address, to save lives and reduce the rate of infection.

Carl Manlan:

Thank you Lorena. Prerna.

Prerna Makkar:

So, in the early 2000s, I spent a few years working on HIV/AIDS issues in India. And and I have some specific observations in how I see the similarities between the HIV/AIDS pandemic at that time. Of course now WHO calls it an epidemic, and the COVID 19 pandemic today.

Prerna Makkar:

One is I think that the international cooperation and mobilization of resources at the size and scale we saw in HIV was quite remarkable. And I think that is happening, but needs to happen more in COVID-19.

Prerna Makkar:

The second is that I think behavior change interventions and communication is very important in COVID-19 as it was in HIV/AIDS. The infection, behaviors of high-risk groups for HIV/AIDS and also their behaviors with the general population in transmitting the spread and what we see in terms of you know behaviors which are important to control the spread of COVID-19 like social distancing, mask wearing, washing hands, et cetera. And I think some medical interventions are important, but so is behavior change intervention and communication.

Prerna Makkar:

I think the third thing that I find that is common is, there has been stigma on both of these, particularly in the early days of COVID-19, there was stigma when the disease was less understood, there was stigma even towards healthcare workers, who were at the front lines.

Prerna Makkar:

So I think management of stigma and management of misinformation in both HIV and COVID-19, in HIV was important and COVID-19 remains important. The other things are that in HIV, a big battle was won when South Africa led the fight to do away with intellectual property on the antiretrovirals. And that fight was won 20 years back, and South Africa and India are again starting on a similar path with the WTO to waive intellectual property for COVID-19 vaccines.

Prerna Makkar:

So, I hope this endeavor is also successful because as we know things stand, while the intent is there the reality is that they will not be, if things continue the way they are, there will not be equitable and fair and affordable access to vaccines. So, that is one similarity. And the other is during HIV/AIDS, we saw the setup of some new and innovative financing mechanisms, like the Global fund PEPFAR, et cetera. And COVAX is one example we have from COVID-19 that is trying, that is innovative, it's very innovative, obviously it's not had the kind of success we wish it had so far, but that's another similarity I see of global financing mechanisms being set up for these two diseases.

Carl Manlan:

Thank you. We had a few questions that were submitting during [inaudible 00:24:45]. So I'll start with the one on the vaccine, which I think is a good point, and I'll focus on Brazil and India. And this morning I heard that the president of Brazil is actually looking at the massive rollout of vaccination in this country.

Carl Manlan:

So, what are the plans and priorities for the rollout of the vaccine in your respective countries or regions? So I think Prerna, you can look at Southeast Asia and then Lorena, you can look at Brazil and also Latin America. And while you're thinking about your answer.

Carl Manlan:

Diana, it would be interesting to think about how does your work prioritize mental health? And I think this is an important point that we need to look at mental health conditions and individuals with mental health that have been impacted by the pandemic. So that we stick to the element around what do we do as a community to continue to focus on those that may not have a voice, and for which we have the ability because of what we do to focus on policy. So Pr erna, let's start on the vaccines, looking at India and Southeast Asia. We'll move to Lorena and then finish with Diana on this one.

Prerna Makkar:

So India's flannel vaccines, is one of the largest vaccine manufacturers is in India. And we have the deal with AstraZeneca, which is a two dose regimen capped at about 3 or $4, so it's a very affordable vaccine that is going to be manufactured in India. Serum Institute is one of the front channels in their trials. And there are more, I mean, there are lots more companies in India which are doing trials at different stages. So the credibility of India is good in the region and in the world as a supplier of vaccines.

Prerna Makkar:

India itself has already pre-ordered about 1.6 billion doses, so a two dose regimen which means about 800,000 people, if there are no leakages, which is always the case, but there about. And the rollout plan in India as in many other countries, is the phase one, about 300 million people will be vaccinated, which will include healthcare workers, then other frontline workers like fully sanitation workers, et cetera, and people over 50 years of age. So this is about 300 million people.

Prerna Makkar:

The next phase will include people who are below 50 with comorbidities, and the third phase will be the general population depending on vaccine availability and also disease epidemiology. So I explained earlier that COVAX facility exists, which is where the rich countries pay for vaccines for the resource poor countries, at least the vulnerable populations in the resource poor countries, which we're estimating at about 20%, but it's under-resourced, that facility is under-resourced right now.

Prerna Makkar:

So for world population of about 4 billion people, only four 50 million doses have been committed so far in COVAX. So, which is woefully short, which will cover about 5% of their population, right? And a lot of the manufacturing capacity of the front channels today, the three companies which are looking promising, which is Pfizer, BeyondTech, Moderna and AstraZeneca. A lot of their supplies have already been pre-ordered by the developed countries.

Prerna Makkar:

In India, the largest vaccine manufacturer, which is Serum Institute has said that they will divert 50% of their capacity to requirements in India, but another 50% to our neighboring countries, which are Bangladesh, Bhutan, Nepal and Myanmar. So that's roughly the status. There is a lot of promise, I think for resource poor countries in the COVAX facility, but we have to resource it more, the COVAX facility, and hope that we don't end up in a situation where most of the populations in the rich world are vaccinated, but even the vulnerable populations in poor countries don't have access to vaccines.

Carl Manlan:

Lorena. [crosstalk 00:29:00]-

Lorena Barberia:

So I think it's really important to remember that initially there was a lot of concern about, we didn't even know if the vaccines would be, if they would be able to be developed and if we would have results so quickly, so first it's really amazing to see the progress, but we also, there's a lot of heterogeneity in terms of big pharma and how those developments were funded. And there's a lot of different initiatives in different phases of trials, correct?

Lorena Barberia:

So I think that's important to remember because each government kind of had to make up their own assessment and negotiate agreements with different distributors without knowing the results of what would be the outcome of the trials. And in the case of Brazil, the negotiation was made at the national government level with AstraZeneca, and at the state government level in the state of Sao Paulo with a Chinese pharmaceutical company, and there was an agreement made to distribute and manufacture the vaccine locally in the state of Sao Paolo as part of the agreement.

Lorena Barberia:

So part would be imported and part would then be an agreement to help increase production and both agreements. So much the AstraZeneca agreement, as well as the agreement with Sinovac in Sao Paulo, both involved that there was going to be production at the local level in Brazil as part of the agreement. But I think in both cases, both agreements that were made that didn't guarantee and they don't guarantee full coverage of the population.

Lorena Barberia:

Unfortunately what happened, was that even that has been politicized. So the president of Brazil has made a very strong issue of making clear that he will not... he opposed the Chinese vaccine and that there was issues with the vaccine because of where it was developed. And several statements publicly have been made at several times.

Lorena Barberia:

And so there's... actually what's happening right now in Brazil, even though neither of those vaccines is yet approved, and neither of those vaccines has yet to publish phase three results, there's a NAD negotiation occurring to close agreements at the state level, because since the national government announced the program, that it didn't seem very clearly to guarantee coverage to the population and to look very clearly how the vaccine would be rolled out. And we also know that there's a lot of issues with AstraZeneca right now because of the way that the phase three trial results were published, and they're being repeated and further studies they're being done right now, that there's going to be delays with that vaccine.

Lorena Barberia:

So now States are running to make agreements with Sao Paulo state, because Sao Paulo state has a total production capacity of a hundred million doses. So it could potentially become an important supplier for many States in Brazil. But there's also other States and even municipal governments that are trying to go out on their own and negotiate and procuring agreements. And even there's a discussion to try to run now to make an agreement with Pfizer, which we know because of past commitments of the Pfizer vaccine, will arrive very late in Brazil if they do in 2021.

Lorena Barberia:

But I think it shows a little bit of, there's a mad rush in this moment to try to secure access, but at the same time that access is being politicized, and it's creating also a lot of distressed by the population about which vaccine to take and what's going on with this vaccine and that vaccine. And I think...

Lorena Barberia:

So there's a lot of really, really difficult issues right now going on with the vaccine. Combined with the fact that there's a lot of confusion because we know that social distancing and testing as we've been talking about in the case of India, it's going to take significant time for the population to be covered as the whole. And in that time, nothing has changed, everything that we were doing with lots of problems and work with lots of difficulties and even poorly in a lot of cases were we need to keep going, we need to keep investing in testing, we need to keep getting people to comply with using masks and maintain physical distancing.

Lorena Barberia:

So another part of the issue with vaccines is that it's also diverted a lot of attention from the policies and the resources that need to be allocated right now to the interventions that we really know that in the immediate term are the ones that will save the most lives. Because we have several months before vaccines arrive in Brazil and our best hope in this moment is to keep doing the basics correctly, which we haven't yet done correctly unfortunately over the last nine months.

Carl Manlan:

Thank you. Diana and [inaudible 00:34:31] to the audience, if they have questions.

Diana Samarasan:

Okay. So I just wanted to say a little bit about the vaccine issue before I address mental health. And that is on a more personal note as an international global organization. It's really becoming a discussion of inequity even within our organization, right? Because those staff that I have that are in the US or in Australia are likely to have earlier access to the vaccine and better treatment potential than any of my staff in Africa, Asia and the Caribbean and the Pacific.

Diana Samarasan:

So we're talking internally, how do we handle this question? I mean, this is really a in a staff of little over 20 people, it's a huge issue of inequality that really is hitting us smack in the face. I don't have any... sorry, that's my dog in the background. I don't have any answers at the moment, but it is a very relevant discussion for global organizations.

Diana Samarasan:

In terms of mental health, we, the global disability rights movement is very diverse and broad and does not limit itself to any particular impairment group, people with mental illness are considered people with disabilities. In fact the term that is most often used is people with psychosocial disabilities. And when you look at the 1 billion people with disabilities around the world, the vast majority of them are people with psychosocial disabilities.

Diana Samarasan:

Now the issue there is that often psychosocial disability is invisible, so it's very hard to count, it's also very stigmatized and governments already do not do a good job of data collection on people with visible disabilities and people with invisible disabilities like autism in some cases or people with learning disabilities, or people with depression, people with anxiety, it's very hard to get accurate numbers.

Diana Samarasan:

So that's one issue is that data is not available, official data. Another issue is that, many people with psychosocial disabilities, mental illness around the world have had their legal capacity removed, so they are not considered legally legal persons. That means that they can not make decisions on their own, they can't make health decisions, they can't make contracting decisions, they can't buy property, they can't sign employment contracts, et cetera, et cetera. So they become one of the most marginalized groups, and many of them are in fact in, where they're erroneously termed social care institutions or in other types of institutions.

Diana Samarasan:

And as we know, from here in the US many people who are in institutional settings, whether they're nursing homes, group homes, hospitals have been more vulnerable to the spread of COVID and other diseases. So, that's another issue, is that there is a huge vulnerability.

Diana Samarasan:

And then finally, I think when you say mental health, you're talking about all of our mental health and all of us are impacted by this pandemic, it is a stressor on everybody and I certainly see that on myself, I'm a mother of a 14 year old who hasn't been in school and hasn't been socially able to get together with friends. I run a global organization where we've been taxed to the limits with all my staff working round the clock to try to address the issues on the ground and help as much as we can and I've had staff break down in tears over what is happening.

Diana Samarasan:

So yes, this impacts all of our mental health, and it's not being addressed very well generally. But I think what I see is that mental health always comes up as an issue to be addressed during disasters for those people who in kind of usual times aren't dealing with mental health issues. And there's much more acceptance of the need to address mental health issues of quote unquote, folks who aren't labeled with a psychosocial disability.

Diana Samarasan:

And just, I would like to say that is the major third issue that we really need to get to a place where mental health is not something that is prioritized only during a disaster, but that it is something that is considered all the time as a regular part of health, that it is part of how health systems address the health of everyone, and that it is not segregated out into some kind of mental health system or health law, but it is part of the accepted full whole health of a person.

Carl Manlan:

Thank you. So it was very great comment from Diana and Lorena and Prerna. We're going to open up for questions, so please note that this webinar is being recorded and will be posted later online by the wonderful team at the HKS alum. If you want to ask a question, please raise your hand function, and then our colleagues will make sure that you are able to do so. There might be a short delay, a short lag time between, so mute yourself when you're asked to, and then please ask your question.

Carl Manlan:

So while we wait for that, I think it's important that we also think about what was positive in these times. And in my case, I spent seven and a half months with my family uninterrupted, that was the first time in a very long time. And those moments I think each one of you has experienced that. So while we wait for questions to come, please make sure that you have that element that you want to share with the audience around what was a positive in these times.

Carl Manlan:

There's a question that was pre recorded, that focused on, should the Biden administration in US have a role in helping countries in the global south with the pandemic, and what role should this be? So as you think about this question, start by the positive that you had, from my part I think what is key and interesting in the role of the president elect is that he was part of the administration that supported the Ebola response across the world.

Carl Manlan:

With a difference though, Ebola hit, when it hit West Africa, it was about less than 1% of Africa's GDP. And Africa GDP is 3% of the global GDP. This time around everybody is affected. So even in terms of a policy decision, the resources and [inaudible 00:42:58] that are available to the present elect might be different. And it's hard to say today what would that be?

Carl Manlan:

So, Rachel, if there are no questions, I will go with this question that we ask around the US administration and what role should that be, but before that, please make sure that you start by something positive that you've experienced during this time. So we'll start in Brazil, then move to New Delhi and come back to Boston.

Lorena Barberia:

So, I think for me what's been really something positive and really inspiring, and this is something that I hear a lot from the students that are working in my group as researchers, is that we found that social science was really important to understanding the pandemic and to monitoring public policy. And the students in my group have said, they're working more than ever, they're studying more than ever, they're really involved, because I think that they feel like this is my way to make a difference, and this is my way to save a life.

Lorena Barberia:

And so I think what's been super inspiring to me is to see so many researchers, I've spoken with across Brazil in so many different areas, and there's so much transparency, willingness to share data, in a very difficult and very sad and very fresh straightening environment where we see a lot of failures, but we see so much resilience and so much commitment of knowing the things that we can do to make a difference and saying, we don't have the data, then let's build it. We don't have the evaluations that we need to hold governments accountable, so then let's produce them. We don't know the methods, so let's study a little bit more.

Lorena Barberia:

And I think that that's been very inspiring to me, and I know it's really helped the students and personally, very young students that I know will have a, this is going to have a lasting impact on their entire careers to be a part of, and to see a report I produced went to the government, and the government had to issue or had to issue a response to why students were left without public education programs in my city for 200 days, without any remote education program. And I helped to produce that report, that was my way. And so I think that that's very inspiring.

Lorena Barberia:

The other thing that's really inspiring, I think is, like you said, Carl, the time to spend with our family and with our loved ones once. And the privilege it is that I have that ability to stay home and spend time and those difficult conversations that we've had to have, but that I'm alive here to have them with my kids. And I'm alive here to cry with them and to feel the pain of this moment and reflect and try to produce with them a way of talking through and understanding. And my kids I think have been super examples of how to be resilient for me.

Lorena Barberia:

So, kids are a great thing to be around, because they remind you, mom, this is how we do it. So my daughter, I'm just going to say she started a campaign on video, sending by WhatsApp saying, save the life of a grandpa, parent, stay home. And she reached lots of different kids through WhatsApp in the public school that she was studying, and it was a way of saying how she translated the experienced to do something. And I think that's been super positive.

Lorena Barberia:

On the issue of the Biden administration and couldn't underscore how important it is, especially in light of the issues and the way that the experience has been during the pandemic and the discussions we've had with the Trump administration in Brazil, and even how the Trump administration has been directly a lot of times inspiring the president of Brazil in the types of messages and policies he's adopted.

Lorena Barberia:

So I think we're all very eager, and we really do need US leadership and we need US collaboration, I think we've spoken a lot, there's a lot of really important issues around equity that the pandemic has really underscored. And we can talk about vaccines, we can also talk about the IMF, the world bank about equity in terms of what's going on with financing. There's a lots of different issues that at a global scale, we need to co cooperate together.

Lorena Barberia:

And if there's one thing that's clear, that we really need US leadership in that conversation. And so I think it's very important and we're really, really hoping that the Biden administration is aware of that at a global level. Because I know there is also, it's a very difficult moment for the US and the urgency of the crisis on the ground in the US is very severe, so I think we understand, and we sympathize with the challenge, but we really need US leadership.

Carl Manlan:

So, we have 10 minutes to go, so Diana and Prerna, I will ask you to be concise in your remarks, and then we'll have one more question and then we'll wrap up. So Prerna, please.

Prerna Makkar:

Thank you Carl, so I think in addition to of course spending time with family and just gratitude to be able to continue working in these difficult times. I think what has been inspiring for me is just to see the voluntary coming together of citizen groups to support what's going on in the crown, either with food arrangements for the poor, transport arrangements for migrants, with medical support for COVID and non COVID, and these were organic groups which overnight started forming in India and [inaudible 00:49:00] took a lot of ownership.

Prerna Makkar:

And these were people across the board, not necessarily people in public health or medicine, but people, lawyers, volunteers, students. So that was very heartening for me to see.

Prerna Makkar:

The second thing is, of course the circumstances were very hard, but I think public health became everybody's interest, and I think that is so important, asking the right questions about public health, thinking through, or just thinking about what makes health systems work for everyone. I think public health suddenly became a very important issue for everyone.

Prerna Makkar:

And I think third is examples of women leadership around the world, be it at the highest levels of heads of state or intermediate levels of health ministers in India who were women in certain States which did well, or just at the grassroots level. I think that I saw a lot of examples of women leadership around the world, which was very inspiring.

Prerna Makkar:

I think very quickly to touch upon what we expect from the Biden administration, I think the first thing is just heartening to see that science is back on the table. There is a firm belief in science and very quickly they have demonstrated by putting experts and listening to experts that they are serious about this.

Prerna Makkar:

The second thing is a recommitment to multi-lateralism and internationalism, there was a move away from it in the earlier administration, but I think just recommitting to that in this era would be important. And the third thing is as Lorena said, both in terms of financial leadership and also in terms of modern leadership, I think the world will relook at the US to take that position, so.

Carl Manlan:

Thank you. Diana.

Diana Samarasan:

Thank you. So, what I've found maybe ironically from the pandemic is that while people with disabilities are being very harshly impacted, at the same time their stories, their voices are being lifted up in the media and in public dialogue, in policy and I've seen more media than ever talking about the situation of people with disabilities both in the US and around the world.

Diana Samarasan:

And that has also led to greater recognition of our work, for example. And this year we have gotten more funding than we've ever had before, from foundations, from individuals, and that is really heartening. I hope it lasts, I hope that this recognition of the situation that people with disabilities, for example, and other marginalized groups are in, is not short-term, but long-term recognizing that what happened during the pandemic is also because of long-term inequality, and that needs to be addressed in a long-term and sustainable way.

Diana Samarasan:

So, I think the other thing that I've found really inspiring is the actions of our grantees organizations of people with disabilities in Africa and Asia and the Caribbean and the Pacific, they have done incredible work during the pandemic, during lockdown, during quarantine, during times when it was really hard. Things like in Indonesia, for example, a coalition of organizations of people with disabilities got media attention and conducted a petition that led to the president ordering that there be sign language interpretation on all main TV broadcasting.

Diana Samarasan:

In Uganda, another coalition of organizations of people with disabilities were able to obtain a seat for a representative on the national COVID-19 task force, which was developing response measures across the country. And in Rwanda, the national umbrella organization for persons with disabilities lobbied successfully for member organizations to be a part of the distribution of humanitarian products so that people with disabilities would not be left out.

Diana Samarasan:

So, they haven't stopped working, they found innovative ways to use WhatsApp and other methods to continue to conduct the advocacy that is needed. In terms of the Biden administration, what I hope is that the commitment of the administration to including people with disabilities among hires in the administration, which has been a deeper commitment than we've seen ever before. In fact, there was a call just like a month ago from the administration for people with disabilities to apply for positions.

Diana Samarasan:

That that will not be limited to a vision of what needs to happen in the United States, but also what needs to happen globally, because 80% of people with disabilities live in the global South. And so we really need the Biden administration to consider disability inclusion not only domestically, but globally.

Carl Manlan:

Thank you. So, in February next year, there will be the African Union Summit. And at the moment, the president of South Africa is the president of the African union. If you have the opportunity to sit in front of the president of the African union, and there's been a lot of talk about building back better, in the context of marginalized groups inequalities, this whole global South, global North, which clearly doesn't seem to exist with COVID-19, what would be the one thing that you would advise him? Each one of you. So we'll start with Diana, move to Lorena and then Prerna.

Diana Samarasan:

Well, there is an African union protocol on the elderly and people with disabilities. So I would suggest that protocol be followed and be raised in importance and that there be a high level... If there is a high level task force on building back better on response and recovery, that representatives of people with disabilities be included.

Carl Manlan:

Thank you.

Lorena Barberia:

If I had a chance, I think it's important to remember that this has been a very painful experience, but it's potentially that have the likelihood to face future crisis similar to this one, and we need to learn some lessons and make investments now to potentially be able to respond better to future threats. And I think with COVID, we have to remember that the sequencing was available January 8th, but many developing countries didn't have the laboratory capacities and resources in the beginning to do large scale testing and diagnostics, and that cost us a lot of cases and a lot of deaths in developing countries.

Lorena Barberia:

So we really need to be thinking about more proactively, how to invest in those types of infrastructure issues to leave developing countries in a situation that they're better able to respond on the ground to future threats similar to this. And even thinking about this current threat that we still are studying, and we're still trying to understand where it will evolve. So we really need infrastructure that is pandemic prepared in developing countries. And for that to be a top priority issue globally to be discussed.

Carl Manlan:

Prerna.

Prerna Makkar:

So, my advice is not specific to COVID times, but I think if I had one thing to say, is Africa as a continent I see a lot of potential, particularly with it's youth, every time I've interacted with the youth or see their projects of what they're dreaming of, it's very inspiring. So one thing I would say is empower your youth, give them the tools to succeed, listen to them to create the Africa of the future, and take it to the level that it truly needs to get to.

Carl Manlan:

Thank you so much. I had the pleasure of talking to all three of you today, it's been a rich conversation. From my part, I want to wish everybody happy holidays, and remember that always building back better is also a conversation about communities. So wherever you are in the world, make sure that you strengthen your communityl. Over to your Karen.

Karen Bonadio:

I just want to say thank you all for joining us today and thank you to our panelists and the very rich conversation that you had. And we look forward to keeping you connected to HKS in the coming months. Thank you all. Stay safe and healthy everyone.