 Good afternoon, my name is Mark Schmidt. I'm the director of the political reform program here at New America and we have been navigating the shoals of American politics through the pandemic era and before and kind of adjusting our thinking as we go along. And so we're really excited to have this discussion of a new book called pandemic politics. But it's by by three authors, one of whom will join us and we'll also have commentary from from others that I'll introduce. Shayna Kushner Gadarian, who's a professor at the Maxwell School of Public Policy at Syracuse University and in the political science department there is one of the three authors of the book will be joining us. The other two are Sarah Wallace Goodman and Tom Popinski. Shayna has been a participant in our electoral reform research group here at New America and is really a leading think about about current American politics. Before I turn it over to Shayna to talk a bit about the book. I just want to emphasize that I've been just thrilled by reading this book it's just a fascinating take extremely readable while it also has all the, you know, all the apparatus of solid political science and a lot of survey research that's gone into it, but it's really, it's a real reminder of how what an intense period that was as politics interwoven with the pandemic in really complex ways and they really kind of show the state of American politics as at the point where the pandemic started, and the, all the factors that fed in afterwards which are not just, you know, Trump but also the nature of American federalism and a lot of other, a lot of other challenges we faced. So, I will be, I will turn over Shayna and then we'll have discussion that will include a poor Vamanda Vili who's a reporter at the New York Times who covered the pandemic is deeply and intensely in all its aspects as, as anyone and Ashley Kersinger who's the director of survey methodology at Kaiser Health News Service so we've got a couple different perspectives on this that will kind of flesh out the political science. I want to give you more than that on biographies of either person if you hop back to our events page there's a link where you can see more detail on on on each of the panelists and want to thank all of you for participating with that let me turn it over to Shayna. So I'm going to give a kind of brief overview of the argument of the book and the data my coauthors Sarah Wallace Goodman and Tom Popitsky. Any mistakes are mine and not theirs, but we are full coauthors on this book so I'm going to start by showing you this graph which you may have seen a version of this and a variety of ways this is the kind of cumulative US death toll death toll per capita. Over time from 2020 to 2022 you could expand you could expand this over time but the, what this is showing you is looking at the vote share for Trump in 2016, comparing different counties and their death rates. And so there's a couple of things to note first is that these blue counties start off with much higher death rates from COVID, then are, you know what we would call red counties user more conservative counties they tend to be more rural. We know that's the story of the early part of the pandemic but as of the point where we get more vaccines and capability of people being vaccinated. So we see this kind of shift on the death rates across different counties, and the most kind of Trump conservative counties are the ones where we see the highest death rates. And then we see this pulling apart where we're getting, you know, excess death in places that are more were more likely to vote for Donald Trump in 2016. So this is just another way to see a similar kind of pattern. If you look early on in the pandemic is April 2020 a lot of the early outbreaks of COVID and a lot of the deaths from COVID are coming in places like California and New York on the coast this is where we're kind of moving from coast inward with with as you see more mitigation across places we start to see these kind of excess deaths in Republican versus Democratic states these aren't counties either. These are states. And these red lines being higher than the blue lines tell us that the excess death rates are higher in places that are more likely to vote Republican. And that kind of when we get to vaccines we see again this pulling apart of higher vaccination rates in places that are more likely to vote Democratic and so question might be why, why is this there's any number of explanations. One of the explanations that we talk about in this book is the role of partisanship as an identity that shapes people's responses to the pandemic from very early days and we we show in the book, as early as March of 2020 we're seeing lots of differences in health behaviors, both at the individual level and policies across states that that are wound up with partisanship so we open the book by this little vignette, looking at June of 2020. We are several months into the pandemic there has been no. This is a presidential year in case you forgot, right. This is all a blur but in case you forgot we were the middle primary election and then a general election in 2020. And the both the candidates, Biden and Trump are off the campaign trail in person for quite a long time which is very unusual in a presidential year in June of 2020. Trump goes back on the campaign trail. And this is a picture of him in Tulsa, Oklahoma at his first rally in person since the shutdowns in March. And you can see there's a couple things to notice here first that it is in person where Joe Biden is still as you know Trump says campaigning from his basement he's wearing a mask everywhere he goes even outdoors. He wears at a stadium in Tulsa, he has no mask, no one in the crowd seems to be massed even the social, even the secret service folks. So this tells you that there's, there's something about the way that Trump is acting that's quite different than democratic leadership at this point, but it's as Mark pointed out it's not only about Trump's messages is about broader messages about the pandemic that are coming from the parties that are quite different that that are focused down into the public. The argument we make in this book is that partisanship is the most consistent predictors in US health behaviors and attitudes in the COVID-19 pandemic. This partisan response is not enough was not inevitable. The partisan politics made the crisis worse. COVID-19 we're all encompassing across so mostly today we're going to talk about health behaviors but we show in the book how COVID-19 also mattered for the election and for attitudes about democracy attitudes about immigration and inequality. And then it's not the case that all places that had conservative leaders were were doing as poorly as the US. Okay. In the book we lay out what we call America's preexisting conditions that would have made the pandemic difficult under any circumstances and then point out how partisanship makes all of this worse. Here at a time of deep political polarization or healthcare system is is both weak and deeply unequal. We have economic and racial inequality that make health outcomes very different by income and race of people in the US. We are also in an election year with a president who was very focused on the economy. He saw it as the key to his reelection, a reelection that was going to be built on the Republican base and not reaching out across to many others. We had also had multiple years of a bureaucracy, but you know, not just the deep state bureaucracy but a lot of the bureaucracy that had been underfunded that was understaffed, and we had just come through an impeachment where the president believe that he had been kind of wrongly accused of wrongdoing and was again not very interested in kind of cooperating across party lines. And so into all of that walks coronavirus so we have this again deeply unequal place, a place that does not have as much bureaucratic capacity as one might want for a huge pandemic and then we have this anticipated virus. In the very early days we see the president downplaying the seriousness of the disease. The spatial heterogeneity of the pandemic, like I said, may, if you remember the kind of earliest cases are in the coasts in states that were not key to the reelection of Donald Trump. There are these kind of conflicts between the CDC and executive branch that, in terms of messaging and when to shut down whether to suggest that people are should stay home. And in this very noisy environment with low and conflicting information the public starts to turn toward the people that they see as experts in this area, which is not only health experts but now also their political experts because the political experts are talking to each other across party lines and also disagreeing with what health experts are telling them. Theoretically we might expect that under conditions of a disease or new disease that people's risk aversion and self interest would have led them to be more cautious to pursue public health behaviors that would keep them protected. There's a whole book about anxiety and politics that suggests that that's what people should do under conditions of threat. But that's not exactly what we saw here what we saw was instead what people did instead of taking in information about their risk from disease and changing their attitudes and their behaviors and accordingly. What we see is that people are taking their cues from their trusted political leaders instead of their health leaders and when, and what we know from public opinion is when political elites are united we should see the public follow along but given the public who's been with the elites across the parties divided on whether or not COVID was a risk at all, whether it could, you know, who was at risk and how to protect yourselves. What we saw was both division at the elite level that trickled down to the mass level and we saw division. So how do we in the book, look at this what we did a series of surveys, we started in March of 2020. My coauthors and I got a rapid grant from the National Science Foundation to fund a set of two surveys and then we just kept applying for grants and so we have a series of six surveys where we follow the same respondents from March of 2020 to March of 2021. We interview them six times, we start off with 3,000 people, we ask about, this is through UGOV, it's online but weighted to match the census, we have questions about health behaviors, attitudes, emotions, we also have a Russell Sage grant and other funding to do all this. So what I'm showing you here, this graph is just looking over time at the cumulative death rate and then those gray bars, those vertical bars are the places where we have our surveys. So I'm going to just give you a sense of the survey data just focusing on health behaviors at this point. So we asked a series of questions and I'm sure Ash is going to talk more about how we measure health behaviors and attitudes, but we just asked these questions starting in March of 2020 and went over time about whether or not people are doing these activities to try and keep themselves safe from COVID. And this is just the percentages of respondents who said yes I am doing this thing including visiting the doctor, getting information from COVID-19 washing your hands more. You can see lots of people are doing things like avoiding gatherings and washing their hands more. But again we are arguing and we show as early as March of 2020 that you can see differences across people's partisanship in the behaviors that they are doing. So I'm just looking at those same behaviors and looking by the identity of the respond, whether they're Republican, Democrat. Other here is independence who don't lean toward the parties. So across all of our measures, Democrats who are that middle gray bar are reporting much higher levels of these health mitigation measures than they're reporting to Republicans and Democrats, the Republicans and independence, and this is just the the averages but we can also look within the same state we can compare within the same zip code and even, you know, facing the same kinds of health risks we see these differences across. So you might say, well March of 2020 this is COVID is just a blue state problem. And so maybe it's just that people like Democrats are being rational but Republicans are also being rational. And so that would be true and so we look over time to see if it's the case that elites at some point come together, and then we should see shifts where Republicans and Democrats look more like each other. What we, in this time period that we're looking at, we would have required that, you know, Democrats and Republicans again have the same message in order for them to look similar and that's not what we find. In fact, what we see is it's these moves in parallel and polarization, more than we see Republicans and Democrats starting to look like each other, even in the same states as the risk was similar. So again, this is slightly fuzzy. I don't expect you to read this over time, all of these little dots, but what this is showing you is the same six questions that I told you that we asked about washing hands avoiding gatherings, looking at by by partisanship of the over all six waves of the data that we have. And so again, the takeaway here is that these squares here these gray squares that are on top. Those are Democrats, Democrats always report that they are doing these things more even at high levels where Republicans many like 80% of Republicans are hands more 90% of Democrats are saying so we have this, this difference, and at no point do we see that the Republicans and Democrats are really coming together in the either move in parallel or they're polarizing. So I'm just going to show you. You may have noticed that we didn't ask about face masks in March because there was a lot of difference about of opinion from the CDC and others about whether or not people should be wearing masks whether you should leave them for healthcare workers. So we start to ask about mass in April 2020, and then we asked about them over time. And it's a kind of, I think helpful case study to see why this matters and how partisanship works here. So, you know, masking is a kind of major cultural shift in the United States people like their individualism they like their freedom. They're less likely to be making decisions based on like what's good for the community. And very early on, President Trump is undercutting the message from public health officials about wearing a mask and telling people that it's wrapped up in the identity your partisan identity about where you why you wear a mask or not right so and you know he he is in July. There's like one picture of him wearing a mask, but early on and later after that he says I'm not going to do it. I don't think you know everyone can make their own choice but I'm not going to do it. You know, Trump himself gets Kobe in October of 2020 he tells people in a tweet, as he's leaving the hospital, don't be afraid of Kobe right it's not a risk I feel great. And the first thing he does when he comes home from Walter Reed is go to the White House and take his mask off even though it's likely that he is probably still contagious. So we see this in our data as well right so you ask people have you worn a mask. Democrats and Republicans are very different they're kind of different in terms of this is the percentages of Democrats and Republicans who say they're wearing a mask over time. Democrats are always higher. You know, it becomes a marker of identity in ways that makes it very difficult to change that behavior when people and, and getting people to take in information about whether or not it is a risk or not to, to, not to wear a mask but to wear a mask when it gets wrapped up in identity like we think these health behaviors do. They're very hard to separate from what is good for you from what is you. Okay, so again this is just where we're going to stop again. What did we get here where the deaths themselves are partisan what we saw this as early as March of 2020 in that the, all of the behaviors were partisan, and the elites dividing on that are is a kind of indication of what we would what we saw for that first year of the pandemic. Fantastic I mean I'm continually remind there's a lot I learned from this book but I'm also continually reminded of just how compressed and intense that period was. And I think no one feels that intensity as much as somebody who was a journalist covering a day today so I want to turn it over to a poor for some thoughts and perspective. Thank you. Yeah, as I was listening to Shayna talk I was having some PTSD of covering a year of lies from the White House which is an unprecedented situation for a health reporter to be and to have to fact check the administration on an active basis. But you know I do want to talk a little bit beyond that I mean I come from the perspective of an infectious disease reporter you know I wrote about the first SARS outbreak. I've covered malaria HIV TV and you know I live in a world where people expected a pandemic to happen and so there were lots of what we call tabletop exercises, trying to model what might happen if a virus like the current virus came along. And in fact the year before the pandemic. This organization the global health security council they sort of. It's a it's a international consortium of experts rated all of the countries of the world and how they could deal with a pandemic. And they ranked the United States number one in pretty much every category, except communication in which they ranked second after the United Kingdom but essentially they thought that the US would do a fantastic job because we have all the resources we have all the money and the expertise and the knowledge. And I think they really did not take into account the kind of partisanship that chain has been talking about and came as a huge shock to just about every expert I talked to you know the everybody was of course aware of the anti backs movement and just to sort of divide and to the 2016 election of the sort of partisanship that exists in this country and could be a problem, but I don't think anybody expected the the extent of how this would play out. And you know Shane talked a lot about Trump and there's no doubt that if we had had a different president in power things would have been very different. I also don't think it stops there I think a lot of it was already in place, even before he arrived you know we heard, for example after the 2016 election that he was a symptom not the cause is a little bit like that and you know in in writing about the pandemic since then and writing about you know what went wrong, and how we cope with pandemics in this country what's become really clear is that there are some things that are baked into the United States of America baked into how we are structured that make it next to impossible to fight a pandemic so you know I think you mentioned federalism mark when you were giving your introduction and that's a huge part of it you know it's a big strength of the United States that we have this much diversity. And there are some very good reasons for why certain states make the choices they do you know in health for example if you have a small state like Vermont or Alaska they may not want to share the their health data because it makes people really easily identifiable. So there are reasons for why there are blockades in place, but what it does mean is that when you have a pandemic. The government just can't move as fast as it needs to they don't have access to information they don't have access to all of the records they don't know what's happening. Even with doctors and there's also a massive divide between what we call you know public health community health and medicine in this country because we don't have a national health care system. All of our medical care is privatized and so there's not a lot of communication between the government structures that respond to a pandemic and the medical establishment that actually sees the patients with the disease, and all of those things played into this pandemic so it's not just partisanship but also all of these other things and I think now you know, delving into sort of disinformation and misinformation, looking at it, it's startling how much, how far we've come and whether we'll ever be able to turn back. My colleagues actually published a story a couple weeks ago, sort of tracing the path of misinformation and you know they said on July 8, President Trump went on truth social, and he said that he won the election in Wisconsin. He also said on truth social, but then it went on to all these other social media platforms you know parlayer gab Facebook, Twitter to talk you name it and within 48 hours a million people had seen it. And then of course then you have talk radio your podcast your TV and before you know it, a very significant chunk of the country believes that he did when the election in Wisconsin and we're seeing something very similar play out, even with health. You know when monkeypox came along it became really obvious that this is not COVID specific. This is now actually baked into how we look at infectious diseases, how we might react to any pandemic that comes along. Almost immediately there was misinformation, you know on on social media I anecdotally saw tons of people saying oh look you're done fear mongering about COVID. So now you're going to use monkeypox to control us and what's next lockdowns for monkeypox, etc. Actually, there was this team of researchers at the University of Alberta who scraped tick tock, which you know has a billion monthly users. And in May, before monkeypox was even really a big thing in the United States, they scraped 800 videos with misinformation in one day. So we're just looking at a completely different landscape than we were, you know, five years ago. And I think that has to play into every single pandemic plan we put into place and you know I have a feeling that if Shayna wrote another book after the next pandemic it would not be all that different probably would be much worse. Last week there was a Pew Research Center poll that said that 70% of Republicans think that scientists should stay out of public policy decisions and Democrats, the numbers were almost exactly flipped 66% of Democrats thought that scientists should play a very active role in public policy decisions. So I think we are at a place where we have a very divided country and I'm not sure where we go from here. And of course, all of that will also apply to climate and host of other issues that they were facing abortion, all kinds of things. Yeah, Ashley. Yeah, thank you so much. I'm happy to be here with you today and share some of what we at KFF have learned about politics and COVID through our own public opinion research so KFF has been conducting regular surveys of the US public on healthcare and health policy for over 20 years. We focus a lot about health care affordability and access and as you can imagine, as a survey researcher who regularly asked the public about their views of health policy. I'm well versed on partisanship, and it's an impact on the public's attitudes and reported experiences. But I think it's especially important and what this book does is to think about how the party, these partisan divides and public health play out with this unprecedented effort and unprecedented pandemic and effort to vaccinate Americans against COVID. In late 2020, like other survey researchers, my organization launched a big effort to track the public's views and experiences with vaccinations through our COVID-19 vaccine monitor. The monitor still active is a nationally representative survey run by my team to initially it was used to track vaccine uptake and hesitancy and is now tracking everything from booster uptake to vaccinations among kids. And as Apuro mentioned the prevalence of misinformation, similar to others reading this book, it was a little triggering for me, because it reminded me of such pivotal moments during the pandemic, and Shayna alluded to some of them. But you know what's the so influential was the early and consistent rhetoric from President Trump. As early as 20 January 2020 on the former president was saying things like it's under control it's going to be fine by February he was blaming Democrats for politicizing the virus and perpetuating hoax. His tone was really consistent throughout his term right that churches we're going to be full by Easter we're going to get back to normal it's going to disappear. So given this early messaging from President Trump it's perhaps not surprising that the response by to the pandemic was characterized by at least some partisan divide from the start. But across a variety of measures as Shayna mentioned, we saw those trends in the gaps getting larger over time. So looking back to spring 2020 when we were thinking we were asking the public how worried they were about getting sick from coven 19 we saw only a slight gap between Democrats and Republicans was 11 percentage points, 56% said of Democrats said they were worried compared to 45% of Republicans by October of that same year just a few months before the vaccines were becoming available. That gap had ballooned to more than 40% input percentage points. We saw more than tripled. And by November 2021 we saw Democrats about twice as likely as Republicans to say they're worried about someone in their family getting sick from coven. And our own data I'm just going to add a little bit of our own data to continue the narrative where the data in the book kind of ends. In April 2021. Democrats were already out, seeing Republicans on vaccine uptake. And now it's about nine and 10 Democrats have reported getting at least one shot compared to about just half a little bit more than half of Republicans. These differences are magnified when it comes to boosters. Our latest survey finds that about three fourths of Democrats, compared to one fourth of Republicans report being both vaccinated and boosted. That means that Democrats are almost what is that three times as likely as Republicans to be up to date with vaccinations, according to the CDC guidelines. And I should note that you know partisanship is not the only thing that predicts whether someone will get a COVID-19 vaccine. In fact, when we developed our measure, our question measuring vaccine update, we designed it in order to measure both uptake hesitancy and resistance. So we asked people whether they would get vaccinated as soon as possible. Whether they wanted to wait and see whether they would only get vaccinated if required, or if they would definitely not get vaccinated. And if you remember back to when the vaccines were first available there was a considerable share of adults who were in that wait and see group. This was especially true among black and Hispanic adults who had legitimate questions and concerns about the safety of the vaccines. We didn't extend from distrust in the medical system, or that the vaccines were developed something use something called operation warp speed which was a little alarming to some people by, but by the end of the summer. We found that those populations have become less less vaccine hesitant. They saw friends and family members get vaccinated. They talked to a healthcare provider. They, their concerns dissipated. What we didn't see shift was the share of Republicans in that definitely not category right so they were, they were not vaccine hesitant they were vaccine resistant. So yes, vaccine uptake is driven by demographic differences like age, education, race, ethnicity, geography, but when we, you know, like the good political scientists that I am and are all of those into a multivariate model. So I find that partisanship turned out to be the strongest predictor of any of the other demographic variables and, and vaccine uptake and now booster uptake as well. I just want to add a little bit to what of course was talked about about misinformation, before we get to the conversation and it's something that we are paying a lot of attention to and several of our surveys we've been testing people's beliefs and different types or misleading statements around the safety of vaccines and the risk of COVID. For almost every piece of misinformation that we're looking at Republicans are substantially more likely to believe it compared to Democrats. This includes the false belief that vaccines can cause infertility, change their your DNA, and that COVID is not really that deadly, and the government is inflating the number of deaths. I think we find such a strong correlation between belief in this type of misinformation and being unvaccinated so it's a lesson for all of us going forward, figuring out how to do a better job of countering misinformation early on during a public health emergency, and trying to do a better job of understanding the role that partisanship may be playing and belief information and misinformation and disinformation, and I think with that I'll stop and let us get to the conversation and I'm looking forward to it. Great. Thank you very much, Ashley. First, I want to apologize. I think I identified you Ashley as being affiliated with Kaiser Health News, which we're familiar with because they're right around the corner from us, but you're with Kaiser Family Foundation. It's all one organization. That's what I figured. Shayna, do you want to comment on any comment? I mean, I think this is really the focus on misinformation is not one that we take up very much in the book, but I do think that's a huge part of the story and that some of my colleagues in communication do a really good job thinking about. I hadn't thought much about TikTok. I prefer not to think about TikTok if possible, but I do think the smart people who are working on social media platforms are really important here. I also think I love that I'm just like a super fan of the Kaiser Family Foundation and the polling and so I'm so happy to hear about that they're still thinking and asking about boosters and kids vaccines and one of the things that I think maybe we can talk about is that the the uptake of kids vaccines is very low, especially for kids under the age of five, and that I don't think that is only explainable by partisanship because it's much lower than you would expect, given the kind of the breakdown of partisanship in the US. And so I think one of the things we might want to think about in terms of vaccination or other things is why that is why it's why we're seeing these very low levels of booster uptake. So I think that's the difference vaccines and how much of that is about a lack of communication from the CDC and other and kind of local health agencies and how much of that is like people just wanting to believe that this is over. I don't know if either one of you have a sense of that. Yeah, I mean definitely I think a lot of people want to believe that it's over. And I also do think that the government did not take all the opportunities that it could have to get the message across on vaccines. That you know they didn't talk about this early enough in the pandemic but I think they didn't talk about it early enough in the technologies development I mean you know, mRNA vaccines were being developed for 20 years at the NIH and there were a lot of opportunities that were missed to be able to say this is actually your tax dollars that work this is not new technology this is you know you put money into this this is your doing and you should benefit from it. And, you know, we're not the only country that saw vaccine hesitancy there was a lot of vaccine hesitancy in Germany, and in other countries but what they did differently was they sort of did very targeted campaigns. They had, they figured out who the people trusted and they put those people in front, and they had them say you know you this is the medical benefit for you from, you know, getting a vaccine and you shouldn't not get it for these other reasons here's some information and I think it's important to reach people where they are you know whether that's religious leaders whether that's community leaders, you know about 70 million people are members of social media platforms like you know parlayer and gab and truth social that as you know alternatives to the the usual, you know the big Facebook, Twitter platforms and so that's those are the places that information needs to go. But if you look at the CDC, or the FDA, you know, one of my big criticisms during the pandemic was that I could barely get information out of them, you know, and I worked for the New York Times, it was kind of insane to me that how hard I had to work to get the most basic information and I was getting emails from tons and tons of readers saying, I'm going to a wedding I'm doing this I'm doing that how you know how can I be safe and there was no place for those people to go there was no place for people to be able to go ask very simple questions. There were auto bots for a lot of these social media accounts from government agencies and even when there were people it was so stiff and stilted and not interactive not responsive that you know people didn't have anywhere to go and I think we can't do that with that again, it has to be so much more easy to get information for everybody, not just for reporters. How much of that was a function of the Trump era CDC, you know that that's kind of changed a bit and how much is it just the nature of a, an agency that's not actually very good at interfacing with the public. I mean it was definitely a different kind of secrecy during the Trump era there was a lot of active obfuscation and lying and doctoring of documents. That's not always the case but I will say the CDC is almost always secretive. This is not new I mean they are really really not great at communicating with people which is such a shame right when you think about it. How much could have been improved by letting reporters actually behind the scenes saying this is what we do look this is who we are because the individual CDC scientists I know are for the most part amazing. They are so hardworking they mean so well and instead of showing us what they did, they did they had the sort of faceless institution that didn't seem to care about the average person and that I think really worked against all of us. We put some numbers to the children vaccination because I think it's, it's really striking so when we first started tracking this among adults we had about one in five adults that were in that definitely not category. And that's actually where vaccination when we asked parents what about vaccinating their kids, that's where most like that's about the share for parents said about their kids too. And what we saw is as there was lack of information and the rollout of vaccinating for especially for the youngest kiddos was really tough. We saw that number increase and now it's about half of parents of kids less than five say that they definitely will not get their, their youngest kiddos vaccinated I think that's really striking to show, you know, where vaccine hesitancy was and where it increased to because of the rollout and the confusion. And when we asked them you know why, why don't you want to get your kids vaccinated, they talk about lack of research they talk about the vaccines are too new they're not tested enough. They're worried about side effects so all of the same concerns that existed for adults to but that then we're able to address using public health messaging, it hasn't been effective especially among those youngest six months to five under five. So, I think it's really striking. You know I can add to that for a second it's also I think that the CDC and other agencies didn't really talk about the importance of getting vaccinated, even if you were infected by the time the vaccines came for kids just what everybody was infected already. And people already had this perception of kids is not being at high risk and I don't think that the messaging was nuanced enough to be able to say yeah I know we got you got infected already. But here's why you might still need a booster I think it was just all no get vaccinated get vaccinated and there was no subtlety about that message so people just turned away from it, because they they didn't hear themselves in it. I was infected. Why should I still get one. They didn't hear a satisfactory response to that. What's the relationship actually you might have a sense of this from your surveys or China between the overall movement of vaccine hesitancy about kids which has been going on for like 20 years now, and the specific hesitancy about COVID. Is it one driving the other or, you know, or is the bigger one irrelevant. So I think, but maybe actually can speak to this about the numbers my sense from reading the literature on on kids vaccination and Jennifer writes work on childhood vaccines is that it's a pretty small number of parents who don't vaccinate broadly. They have their reasons and, but schools are such a mechanism to to basically get kids vaccinated because every there are very few exceptions in very in a handful of states that would allow you to be fully unvaccinated to go to schools. And so I think that COVID night. I think there is this anti-vax movement that has spread and has spread misinformation through COVID-19. But I think this, this hesitancy about the COVID-19 vaccines is something bigger than a general anti-vax movement because there's no school that requires you to have it to be there so there's no state mechanism to actually force parents at this point. There's just recommendations. I think that's absolutely true. And, you know, going back to the role that partisanship was playing in this, what we're finding is, you know, this increased distrust in science that came along during the pandemic, especially among Republicans has led these parents to call into question the legitimacy of other vaccines in a way that we hadn't seen prior to the pandemic that that could be quite troubling. Yes, there are mechanisms in schools that, you know, that get kids vaccinated. But this overall mistrust and distrust in science, I think, could play out in lots of different ways, you know, taking their child to the doctor to see a health care provider to take the health care providers advice on, on medications, you know, all of that could be playing out in a way that we hadn't seen prior to the pandemic. We have some questions from the audience, but before we go to that, I want to loop back a little bit, because I was really struck that both of you, Ashley and Apoorva, used the words misinformation and disinformation, and Shayna, you really didn't. I want to just like dig into that a little bit more, because I'm really, I'm sort of hesitant, beginning to hesitate myself about using, you know, glibly using words, mis and disinformation. And I wonder if we can disaggregate a little bit, you know, misinformation, legitimate uncertainty, and maybe you know there's kind of cultivated uncertainty, there's people, you know, so the sewers of doubt theory that like about like about election denial, you know, which you know can support and spread misinformation obviously I'm probably a little influenced by having read this morning Emily Oster's piece about how, you know, we should sort of have a general amnesty for everybody who screwed up. And I, which has infuriated a lot of people I'm not sure I wasn't quite as infuriated about the piece, but I wonder if you could think about, you know, not just misinformation but actual or cultivated uncertainty as institutions trying to grapple with this. I mean, I think that's what's new in what we're facing now, you know, before I joined the Times I ran an autism news website so I was very familiar with the kind of anti-vax messaging you see among parents and a lot of that is what we would call misinformation. People who are anxious for various reasons and have just heard the wrong information want to do the right thing but genuinely believe that giving the vaccines to their kids is going to harm them in some way. And that, I think has existed for quite a while now since you know Andrew Wakefield in the late 80s but the kind of thing that we're seeing now where, you know, respected figures, respected figures in the community are actively spreading information or previously respected figures I should say, some of them have genuinely swallowed the misinformation themselves and they also think that they're doing the right thing but then there is a whole segment now of disinformation, that is actively maliciously being placed to cause harm and I think that is a new beast that, you know, it was there before but now it's a huge monster and we're not really sure how to get rid of that. I'm going to take a slightly different, not different position like a slightly different angle which is that I worry, I don't think disinformation is something to scoff at. I worry a lot more that most people pay little attention, most of the time, and that for them any amount of information might be helpful and but that we don't have a great way to think about both general uncertainty as Mark said but also statistical uncertainty right and so I think that is so when people start to think about like what is the risk from taking a vaccine or from masking versus not right. We don't have a great way to explain to people how they should think about counterfactuals we don't have a great way to think about statistical uncertainty and what it means that sometimes you're going to get the vaccine and you're still going to get COVID. And so I think the kind of there's a general discomfort that people have with the way that we have to think in these these terms of that confidence intervals and thinking about uncertainty and that that is more my concern and that's partially why we also in the book we don't talk very much about misinformation or disinformation because there's lots of really smart people doing that work, but also because so much of politics is like not paying any attention and then be having like being forced to pay attention and then thinking about how do we grapple with this, this information that we don't know what to do with. So that's, that's kind of my slightly different angle on this. I think it's a good insight about politics in general like a lot of it is about how you manage attention and the fact that most people are not, you know, so we often look at politics in terms of people having certain beliefs but it's often more a matter of what they're paying attention to when, which is often very little. I was just going to, you know, adding on to that is like, as Shane started with right like they were taking their, their cues from political leaders right and and thinking about political leaders, passing on disinformation to the public and how really troubling that can, that can be for, you know, our democracy in terms of elections, or in public health emergencies and so I'm thinking about the role of politicians in perpetuating disinformation and misinformation. And if we can't, you know, we can't put the burden entirely on the public, you know, there we have working moms and dads and, you know, people just trying to get by and, you know, they, they're not supposed to be the experts they're supposed to be able to trust their, their leaders and so thinking about what how we can do a better job of making sure politicians are are sharing factual information. And this is really playing out in the midterms right now right leading up to that you know you see Dr. Oz spouting misinformation or disinformation or however we want to categorize that I don't know his intentions, but you know that the Democrats, the Democratic candidates are not really countering it with information the best way to counter miss or disinformation right is with good information to be able to point out what's wrong and I think most of the Democratic candidates right now or don't want to bring up COVID don't want to talk about the pandemic. So there's not no counter to these bits. That's actually the first question from the audience so let me just do that which is to which is about the midterms and question is many people are still experiencing the aftermath of the inequalities created by COVID and the response yet COVID seems to be far from voters minds in the midterm election. Why is that I'm not sure it is actually but that's that's the question. But I think it is you know you considering that we are coming up to a point where there is going to be most likely a winter wave we don't know how big but there probably will be one, and we have influenza and RSV and everything else you would expect the government to be talking more about COVID and they're not really. I mean, we had President Biden saying September that the pandemic is over which you know they walked back later but basically that seems to be the approach I think they're afraid to talk about the pandemic it seems like nobody wants to touch it with a 10 foot pole. I mean if you just ask voters you know what they're thinking about right. You know, COVID is not in the top five right I mean it's the economy it's inflation it's. I think even maybe Ukraine might be above the pandemic at this point and that's partially because the right the people in charge don't want to talk about it it's a right one you don't want to get blamed for management. And to you're not getting very much credit for it at this point. And you also want to be like, don't look at the fact that 800 people a day you're still dying right like there's there, you know, it's a fine line, and they you know, Biden wants to talk about what he thinks is going to help the Democrats who are running and it's, and they made a calculation that is not COVID at this point. So I think it's pretty clear that they made the calculation that the Supreme Court overturning row was going to be a more winning issue for Democratic candidates than talking about COVID I think even I think climate change is even above COVID in terms of voters top issues which I think is really striking because that it that climate change rarely comes up in the top top issues so yeah I think that's absolutely true. And Shayna as somebody who's written a book about anxiety and politics, I wonder how he like, I often have the I have a little bit of a theory that sometimes kind of traumatic events, kind of effect voters, you know, years on as they do people in our in our families. So I, like, I think part of the story behind Trump was just the trauma of the financial crisis that recession, the really long term unemployment that ensued that's just a theory in my head because obviously, it was finally over by there's any kind of underlying, you know, this experience of having your kids out of school, you know, all the, all the disruption of coven, even if it doesn't show up in polls as the most important issue. So I think that's, that's very true right I think there's echo, there's going to be echoes in Kobe about Kobe and the whole experience right because it's not just about the disease it's about all the like you said the disruption. It's about the educational effects, it's about that there's a million, more than a million less people now than there were in 2020, and that's over and above what we expect the lifespan of many of our, you know, groups in the United States has dropped the lifespan of Native Americans has dropped by six years and since 2020. I mean, there are absolutely going to be after effects, the kind of undercutting of democratic norms and and the election that's all part and parcel of this moment in time that's not just about the pandemic but it's all wrapped up in it, whether or not people actually ascribe it that to the pandemic I think would take some work from from elites. I'm not sure that people necessarily know like the long tail of the effects but they're certainly going to be felt. I think, oh, it's just about inflation because, you know, elites talk you know political leaders talk in two year increments and four year increments but like the effects of public policy or are long right just think about the last time you went to an airport and had to take your shoes off. Right, that's a 20 year tail from one of, you know, from an event in time. So, there, there are long tails from events, although I think voters don't always ascribe that to particular events unless kind of politicians make that connection for them. You know, we just wrapped up a big survey with CNN and looking at mental health and I think the mental health impacts of the pandemic are going to be long lasting and especially among young adults. The groups 18 to 29 year olds that were really informative ages during this pandemic I think it's going to be really troubling to watch the share of them that suffer from anxiety and depression and and don't have the resources to access care, but they don't really contribute it to the pandemic they, they, you know, it's much bigger than that for them they kind of think of the pandemic as an isolated event, and not really thinking about the long lasting impacts of it. One thing I'm really curious about is how the perception of the pandemic will change over time as some of these longer term effects become apparent. You know, if you hear a lot of the rhetoric around learning loss it's just the pandemic wasn't actually as big a deal, we did a lot of harm in trying to counter this little problem that could have been fine. And over time as more people you know are diagnosed with having long COVID you know a lot of the people who have long covered now hopefully it'll resolve but even if it's a very small percent that continue to have long term problems that will be a significant number of people and will probably know somebody with debilitating symptoms and I wonder you know once the, the sort of partisan rhetoric is behind them and the anger and the, you know, the sort of the instant instinctive sort of survival mode. How much people will look back and realize you know what actually was pretty terrible. A lot of people and you died. A lot of people I know have long COVID and how that might change the perception long term. Although plenty of us who will never mind. I'm going to go to another another question from the from the audience, which is what lessons can we learn to help the country better navigate the next global national threat. What systems in place do we need to have to ensure safety. Not quite any of your focus but I'm curious what partly I suppose mine, but I just don't think I have any answers you know I wrote about this really recently actually what why we may not be able to do so well with handling pandemics and what we need to change and of course money is a big part of it we need to fund public health in a big way we need better data systems we need more coordination between federal and state but some of those things as we were talking about earlier are baked into the country and unless there are some real changes it's not clear that those are going to go away. And in terms of just countering, you know getting ahead of the misinformation I think we've been talking here about how to get, you know, do it early and do it often and do it clearly. If a pandemic wasn't going to isn't going to make the public support more funding for public health I don't know what will right and, and we haven't seen that to be the case it doesn't seem like one of the lessons learned among the public or even among politicians is is more financial support for public health system so unfortunately, I don't have any answers either. Corva you were talking earlier. I think you alluded to the kind of a disconnect between public health and doctors who are working with patients. Is there something there that you that suggests a solution. There might be. I mean so one of the things that has happened is you know doctors are the ones who on the front lines they see the patients they know when there's a new virus coming along some cluster of cases. And the lines of communication between medicine and public health are just not very clear like you, there's not a good way for the CDC to know when doctors are starting to see this you know there's steps that have to happen in the future and so if we had a sort of better data systems that are connected. If we, for example, made it sort of mandatory for hospitals to report data into public health agencies in return for say, you know, Medicaid or whatever it's some, if you receive Medicaid dollars you must contribute data that kind of sort of legal binding agreements, then maybe we would see better data flow and we might be able to respond a little faster so that's one potential solution. I think also as electronic medical records get better they're just a mess right now they're huge, huge mess, but the ones that the ones that we have start to look similar and work out the bugs and figure out you know how they can communicate with each other. There will be better data, hopefully. I'm going to make a completely self serving recommendation which which we do in the book as well which is that social scientists should be part of the discussion about pandemics and and public health and there was just not as much engagement on the government side to people who work in areas of social science and humanities right it's very much like the doctors and the public health folks and not the sociologists and the political scientists and the folks who are kind of understand decision really and understand how people think about issues and consider them and I don't think the social sciences are going to fix this entirely but I do think that there's there needs to be more places of discussion and thinking about you know a lot of my colleagues wrote these kind of op-eds and science and in JAMA about like here's the messages that we know might be most effective. We don't know how much uptake there was on the government side from that right like I think a lot of us were kind of like shouting about this but I'm not sure how much engagement there was from kind of formal, formal, you know, institutions of folks who do work in social sciences. I can agree actually in the CDC there are people there are economists social scientists behavioral psychologists, the kinds of people you would need to make a sort of more holistic decision about things and my understanding from the reporting I've done is that, even though those people exist they were not in the room, they were not actually being asked for specific things. And I think that's why we saw a lot of the, this is based on science kind of language, when really was based appropriately on science but also on some other economic considerations and all of those things and if they had said look we considered the science but we also looked at this economics of it we looked at the social science we looked at those psychology blah blah blah. We had all these people put their input in and this is where we've arrived as the best thing for our country, that would have gone over a lot better than this is all based on science when it's not. I guess I don't even know what people mean when they they say like the trust they trust in science or not like I use those questions but I'm not sure what people are thinking about like when they're thinking. I mean, actually do you have a sense from either kind of open ended or qualitative like what are people thinking about is it like guy in a white jacket with a beaker is that like, exactly, exactly. I mean that that's, and that you know I alluded to this like operation warp speed right they're thinking about like, you know, labs and secrecy, and you know all of all of that when they're talking about like science and, and we all know that science is like companies encompasses much more than that right involves economists social scientists. You know behavioral scientists, as well as those that are they actually, you know, conducting physical lab experiments. Yeah, that's a really a really persuasive point I'm sorry I dropped off there for a minute. I have a question from the audience, which I'm going to restate a little bit covered force people to pay attention to state and local governments. Did this have any notable effects were views towards state and local government just as polarized. And I wonder if you can comment a little bit on, I mean I feel like, as we went through the experience. We saw different states highlight, you know some states would seem good and then they, then they would, you know they were obviously the diploma and diploma press conferences and all that. There was Ohio seemed different from Florida, you know they kind of popped up and down. How did, how should we see that in retrospect, the role of state government and attitudes towards state and local government, which are traditionally more trusted than the federal Yeah, I mean I think, you know in a federal system in the way you know as of course it as the way our health systems are set up they're both private but also they're at the state level. Right and and all of the regulation on on health, or almost all the regulation on health is at the state level states decide whether they're going to take, you know, they're going to expand for the affordable care act and whether they're going to sign up for the nation and so there's so much variation by states, which also lines up on partisanship of the state, but you know those state level decisions are really important in helping to structure health more broadly and they have this big impact on life span and access to health care and access to drug treatment and all sorts of things my colleague in sociology Jennifer Charest Montez does really fabulous work looking at state legislatures and health outcomes. I think generally in our data we find that the kind of health, like the local leaders are seen, like you said as more trustworthy. The difficulty on the state level is just the lack of information that people have right the lack of local newspaper newspapers are dying. A lot of the local television stations are owned by the same national companies. And so you get kind of a national message rather than these more, you know, these as more than you get kind of the tailored state and local kinds of information so I think. I mean, I don't have much to say about the performance of the states as much as a people I think trust their state health agencies more. But they don't have as much access to information about what they're doing or how to get information about them because local newspapers are hard to find and also like state agencies have terrible websites generally. So just adding on to that. Absolutely we find the same thing in our data that the public is more likely to trust their local health agencies they're more like mostly more likely to put faith in local leaders. But if you really want to see the way that partisanship played out in this is Democrats living in Republican led states and how angry they became when mask mandates got lifted, or any of those requirements got lifted, or on the flip side Republicans living in Democrat led areas and still having masks in place and so you could really see the partisanship playing out in the data in that way as well. We saw a lot of this play out with schools especially right locals and school districts going a certain way and then the people of that district, rebelling or the states deciding to sue them or pass law saying no you can't do that I mean it was there was so much conflict at every level which is just incredibly confusing to people do you listen to your local leader do you listen to your governor do you listen to the president, do you listen to the CDC. You know one CDC official I talked to recently said, it's not just the lack of information right at times there was also too much information, like the sum of their guidance was so detailed. And if you looked at some of the guidance for schools it was like a school superintendent was supposed to be able to interpret this incredibly complicated information and this official basically said, you know, I think we did a bad job. We gave way too much information we should have given you know we gave it at the level of like what a doctor would need to know instead of what the average person would need to know. And there's also a good reminder like that the section on federalism in the book is really valuable interplaying with I mean we've we've looked a little bit at preemption of local initiatives across a lot of areas really interesting you know, state preempting labor laws LGBT protections environmental laws that local communities have passed as a, like that's a real undercurrent right now American politics and also played a role in in covered response and in the in the schools. I mean it's also playing a role now you know with their overturning of row is now with abortion policy being set on a state level and so I think we're seeing that play out in a way that, you know, people living in states where abortion is no longer legal, and while their neighbors across the county lines and living in a different state have access to abortion and play. I think it's going to be really interesting to see how, you know when we have all these health decisions being made at at the non federal level how it all plays out and for the people living in these different states. Yeah, including how do people who live in states where abortion rights have not changed, you know, react to the changes in other states. It's a pretty broad question but I think we can put it on the table how is the pandemic shifted the way people view the role of health and government institutions and service delivery I mean I guess, again to restate a little bit is there anything that's happened that changes permanently changes the relationship with those institutions in either a good or bad way. There's less trust so much less confidence I mean I think we're going to see that reverberate for a really long time you know I've never reported on something where people mistrusted the CDC to this extent and I count myself among those people. You know even reporters I think a really wary of what comes out of these federal agencies now it's just a very different environment. I think this is a. I had a project where I was looking at you can trust in different federal agencies and the CDC always ranked pretty high. It was like a it was a kind of well respected agency now we might wonder like what does it matter if the public trust the CDC. You need the public to understand that what they're being asked to do and comply with that right. And so the CDC was ranked pretty high but like you can see like it like it's just cratered and that that's how agencies start to rebuild that I mean I think the Biden administration has tried. I'm not sure they've been particularly successful with this this new team at the CDC. So I think that is one of those things is that like. The agencies that deal with health were always the ones that people turn to particularly in a crisis and then now it's, you know if you can't trust what government is telling you where you're going to turn you're going to turn to alternative sources which are much less regulated and more likely to have misinformation as we've talked about. And so that's a, that's a real problem you may be, you know, you may not know how to kind of weigh risks versus benefits. And so I think that's, that's a long term problem and the agencies have to think about how they maybe are more transparent maybe they're, you know, thinking about doing town halls or something like, I kind of laugh at the idea like the CDC coming into a town hall but it's like probably not a bad idea to try and like work with people where they are. They need something right I mean one of the big sorry. One of the big problems I think has been that you know CDC CDC season Atlanta and they were always seen as sort of separate from White House politics and that really worked to their advantage because it's like okay this is about public health. And one of the things they have not done yet is to separate that, you know, Dr. Walensky is still part of the White House briefings. It still sort of all mixed up in there and it doesn't look as separate as it needs to and the CDC still isn't doing as many briefings of its own, as it used to. And so it's just, you know, until we separate those, there's no Republican that's going to watch a White House briefing, you know, and say okay I believe everything coming out of that briefing. I think if they really want everybody to listen to what the CDC has to say, the CDC has to say not just the White House and the CDC makes up. I love it when I can just bring the data points to, to further back up everyone's point so we actually asked how much trust people had in the CDC in April 2020. And the share of Republicans and Democrats you said they had a great deal, or a fair amount of trust was equal about nine and 10. Years later, it's still about nine and 10 among Democrats, less than half of Republicans. So I think, you know, and we also look at Fauci, Fauci drops even lower among Republicans. So I think it's really striking right that that prior to this there was a seemingly high level of trust of the CDC that has really plummeted and and the CDC is going to have to do work in order to regain that trust. What was the, what was the level of recognition of the CDC, I mean, name recognition or like understanding of what it does. The average scientist in the CDC huge, hugely demoralized understanding that they were once seen as heroes and now they're basically the lens in people's eyes, really really like depression, wanting to retire wanting to quit feeling just so upset I've had to tell me you know that somebody threw a glass of water in their face because they, you know, they said they were from the CDC. That would never have happened before and so you just there is a level of sadness, I think, and, and there is some acknowledgement that they need to change, but maybe not as much as their needs to be. That was super useful I actually think I must have misstated my question a little bit, because I was just, I was just wondering when you look at approval and trust in the CDC, like how many people have actually heard of the CDC, or know what it does. I'm not actually sure that the public needs to know exactly what the CDC does on every different level because the CDC does so much right, but it's just that the, I don't know. Yeah, they are the organization that makes recommendations and the safety and health right and, and a large share of the public is aware of that aspect of the CDC. Now whether they understand the nuances, you know, that probably not, not half as well as a porpoise right so. Right. Okay. Are there other countries that we can learn from that that their responses or experiences I mean you do something part you know one of your co authors has that more comparative as perspective or there and you, and it's woven through the book or countries that we can look to in the future for. I mean I think we can think about you know what are kind of cases that look like the US and did better and some that look like the US and did just as poorly right so yes both, both Tom and Sarah are comparative so Sarah mostly works in Europe and Tom works. And so throughout the book we kind of think about the UK as a potential model right we can think about, you know, it's very different in that it has a national healthcare system, but it also has its highly polarized, like the US had a kind of conservative and in their performance on all the metrics in terms of excess deaths and is much better right and part of that is, you know, Boris Johnson, never makes it you know this an issue of like conservatives do this and everyone else does this other thing and there was much less, there was much more kind of consistency in terms of the messaging. Obviously we know that he was kind of partying while you know during lockdowns and that kind of thing but at least the kind of messaging was much more consistent about in lockdowns and and vaccination. Brazil is another kind of case study that we look at right with a very upright when populist leader deep inequality, racial inequality in, you know, historic ways like in the US and, you know, the excess deaths are a lot like the US on the kind of polarized on the kind of ideological grounds in ways that we are more similar to the US than other places in Latin America. So those are the kinds of things, you know, do we want to take lessons from there I don't know I mean, probably a national healthcare system would have been better. In the US more general access to medical care and less inequality but even in places that are deeply polarized we didn't see the same kinds of. We didn't see the same kind of challenges in terms of getting people vaccinated and getting them, you know, wearing masks and all that as we did in the US so I think a lot of that is about leadership, even like if the preconditions are pretty similar. But Johnson about Boris Johnson and the parties and all that made me think about something in the book because obviously it took a while but there have been there were consequences for that action by Johnson and one of the there's one section earlier in your book where you talk about how, you know, there were fewer consequences. There didn't seem to be quite the same level of consequence for the early mismanagement of coven as that were for like, we think there were consequences for George W Bush is handling Katrina, for example, like other disasters have seemed to have more immediate political consequences. I mean, yeah, I mean, overall, you know, because of polarization, a kind of lack of consequence for mismanagement. Yeah, I mean, I think this is one of the downstream effects of polarization and the kind of rolling of all of our identities together is that like your team, you have to believe in your team and believe that they're doing a good job. And that's the basis of whether they are in fact doing a good job or not. And so the kind of accountability, it like breaks the accountability mechanism, that's not to say that no, I mean, Donald Trump doesn't get reelected. So like that's a pretty big consequence, but, but it's not, but, but Ron DeSantis is still in office and will probably get reelected and you know, a lot of the folks where we're seeing that, you know, Christie and other folks where we see like, what is quite bad management of public health are still in office stills, rising stars in the party and there seems to be not a lot of accountability for covert itself right maybe that, you know, trumpet kind of is up in lots of other things. So polarization means that, and the deep polarization and the kind of Trumpian way of like taking little accountability also means that voters are free to kind of discount things that they that even that that are in fact bad like that we have had a million excess deaths right from coven. I do think that the lack of trust and even that statistic is playing a role here too right. It's the, the Republicans perhaps don't don't feel the need to hold anyone accountable because they think the death toll has been inflated and it's not as bad as it was portrayed in the media and so if anything they are favoring their politicians for standing up to scientists and not requiring vaccines and for state workers or whatever it may be right so I think I think all of this is so wrapped up in all of these topics we've been talking about so you have any thoughts on that. Oh, I mean, I agree I think it's, we've seen sort of both sides of it people being punished, so to speak for going a certain way but also a lot of people saying oh I'm so glad that you went this way and you know really called the bluff on the scientists because COVID was nothing and so it's going to be I think a longer term. You know, space to see how it happens over the longer term because I really do believe as I said earlier that things are going to look very different in a couple of years in terms of how people view the pandemic, at least I think so we'll see. I do want to just make a point that was related to something a porpoise earlier about the CDC is that one of this I think consequences. That's not about accountability but it's about like wrong and blame and wrong accountability is that there has been an increase in threats and assaults on healthcare workers in in the last two years both the people who run these systems but also like just people who are working as nurses and doctors and a lot of that is partially about misinformation but part of it is. If you can't take your accountability if like you blame, you know the doctor for not saving, you know your family member from COVID, or you know that there's just a lot of. There's a lot of misplaced blame about who actually, you know, messed up in this terrible pandemic that I think it's being taken out on people who are lower down and who are probably have not no responsibility for, you know that the outcomes but are easier to get to essentially right so that we've seen increases in political violence generally in the last decade but specifically on healthcare workers and I think that is relatively new. Yeah, I think the last question here kind of goes directly to that issue of blame and credit. The questioner says that the book shows the relationship between blame and credit blame credit and the actual understanding of the problem itself and the information and I get and the question I think is, is there ways we could use or, you know, kind of manipulate blame and credit in the future like for example, if you named all the vaccines after Trump or you know really did more to, you know, identify him with with vaccines being you know, I think that probably doesn't examples of that about how you could sort of create different Yeah, no, I think this is a great point and Tom Sarah and I have talked about this a lot like it's actually puzzling in some sense that Trump didn't take more credit for the vaccine right he doesn't write like this guy loves branding everything just called the vaccine right I don't think you would have necessarily, you know, that's one of the things his administration did right they put all this money and they into the vaccine development and they did it quickly and they got a safe vaccine within less than a year which is, I know like, that's pretty stunning right and they got it in people's arms in less than a year like take some credit for that that's what politicians do and it's a little bit surprising in some ways that that was not the choice that they made because I think it would have made a difference right do I don't think it would have necessarily depressed Democrats willingness to get vaccinated and it may have on the margins increase, but what has happened is that, you know, Trump has, has advocated for the vaccine publicly, but not while he rallies and he gets booed right now right but had they done it earlier had they taken it had he taken more credit I think it would have mattered a great deal in terms of vaccine uptake. But yeah I mean I a lot of what politicians do right as they try and take credit for good things and put the blame on other people and so I think that certainly is the case that there could have been different ways that his administration and also I mean Biden takes credit for all the for the vaccines right like he took he took office after the vaccines were developed I mean they got them in people's arms but that you know like that's what he's been doing since he got an office was taking credit for the vaccines. I think it was difficult for the Trump administration to embrace the vaccines publicly after framing the virus as not as big of a health risk that you don't need to be worried about it that it then it's very hard to be like but you should get vaccinated and so I think that was had had they not done that framing from the beginning then I think we would have seen them embrace the vaccines in the way that you're alluding to it but I think because they were trying to frame the pandemic early on as you know, not something that they needed that the public need to be worried about that they then could not embrace the vaccines. But I think there was a choice they had to make either the virus is a big deal and you need the vaccines or it's not and you can just yet don't don't have to do it. I mean he never really got photographed getting the vaccine right he didn't kind of want visual proof of that even if he was going to talk about it I think that was a very conscious choice. And I actually I wonder some Democrats would actually not have wanted to get the vaccine if it was called Trump vaccine already the warp speed was making everybody nervous not just Republicans, you know the idea that this thing was developed in the year as miraculous as we know it to be now at the time it was like, did they cut corners. I mean I myself was also like well the FDA really push things through under pressure from the White House perhaps. There were so many questions about it that if you then on top of it called the Trump vaccine I don't know maybe there would have been some some hesitation there. Right. I mean they also dramatically. He always wanted to overstate cures rather than vaccines included you know including like when he got sick and he announced that everybody would get whatever the experiment body body was a weird, a weird reaction. Alright, and this has been a really wonderful conversation any last thoughts from Shayna or or. Thank you so much for engaging this has been so so great to, I mean I'm sorry to give you all PTSD and relive the first year the pandemic, but it's really helpful to think you know think through it with other with other people. Yeah, I mean I hope that this book is a one off and it doesn't apply to any other pandemics that come our way that's my closing but you'll have to find other topics for the future for your future books. Yes. Yeah, and you know, as much as I said that this was triggering it it's really an excellent book and really excellent research so thank you for for taking the time to write it and and having it as part of the public history. Yeah, it's really a wonderful book and you know for those still watching on the event page there's a link to purchase the book which I totally recommend I think it's really one of the best. It's not just a book about the pandemic or public health but as a snapshot of American politics or not not even a snapshot, a kind of moving picture of American politics over the last, you know, five years really I think it's just just amazing. Thank you. So I'm proud to have been able to be to host this conversation really appreciate all of you being part of it. Thank you for asking.