 Now, I think that many of the issues which have been covered more or less in this session lead us in a natural way to the next two sessions. The next one is the sequence, technology, economy and ethics and the issue of data, for instance which has been raised many, many times and the issue of treatment of data has a lot to do with technology. So I am happy now to give the floor to Patrick Nicollet who is a friend of a long standing of the World Policy Conference and who will be the moderator of this session. Patrick, the floor is yours. Thank you Thierry for the introduction. We move forward the classical Thierry style so there is no pause so we just continue the discussion and we will make the best we can to do a session as lively as possible. The theme you heard is about technology, economics and ethics in the area of health. We will try to go beyond just COVID but bear with us there is no way that we cannot prefer the lessons learned from COVID in such an impactful event on the entire health sector. I have a panel here of distinguished experts. I will introduce them theme by theme because we have decided in fact to break down the two hours into three topics that would allow, we hope, a more interactive session. The first one will be on technology in health care who is in the driver's seat. I think it is a question we saw in Philly Gran in the first debate. The second one will be in health care does the end of the theme producing the domain of ethics and then eventually does technology care about your health? I think there is a fundamental question about the role of technology and the way we as a citizen consumer employer apprehend technology and this will be the third debate. For each session there will be two times complementary or contradictory intervention from the panelist and then I will open up the floor for about 10 minutes of Q&A on these specific topics and we will wrap up at the end of the session. So without further ado I will introduce the first debate on technology who is in the driver's seat. In order to do this we will have a first introduction by Jacques Biot, board member and advisers to companies in the field of digital transformation and artificial intelligence. Also well known as former president of the Eco-Politique in Paris. So this will be followed by a complementary review of Alexandra Priyat. She is the president of Al Cediaghe. This is a subsidiary of Alzen, a classified technology group focused on innovation. And she has also launched a company, sorry, a skill set. So these will be the two introductions. So Jacques, over to you. Thank you Patrick. And so yeah the question is where is the invisible hand in the healthcare market? And we're going to see that actually there is no invisible hand in my view and we definitely would need one. And we would need one which would be at the end of a long arm which would have a strategic view. So basically my paper will be about managing healthcare the need for and the difficulty of the strategic approach. So if we just look at the situation, do healthcare systems work well? My answer, although the French are very proud about their own healthcare system, is in general healthcare systems don't work well. There are many inefficiencies, costs are growing, burgeoning, and at the same time a number of indicators. And we'll see that one of the difficulties is about finding good indicators of health. Indicators are not necessarily going in the right direction. And so the question is why is that? And my point is that we're going to explore the interests of the various players and we'll see that the interests of various players are extremely different. And there is nobody in the driver's seat, as Thierry said, to really steer the issue. And one of the issues we'll see is that if you want to steer an organization or to steer a system you need to have metrics and we'll see that one of the big issues is that there are no recognized metrics or not enough recognized metrics in healthcare. So basically, where do we start from? Well, strangely enough, I've been working for 30 years about in the healthcare industry. And what strikes me, if you compare it to other high technology intensive industries like the air space industry or the telecom industry, healthcare is extremely fragmented still. It's extremely fragmented, especially when it comes to the provision of healthcare and to the supply of healthcare goods. If you look at basically the major players, the major health provider in the US would really earn only a very little market share of hospitals. They operate less than 200 hospitals among 5,500 facilities which are active in the US. The top US providers are responsible for only 18% of all in patient days. And that's something which basically is in place in almost all countries. If you look at the industry of healthcare goods, drugs or medical device, the current leader in Pharma, which is in pure Pharma, which is Pfizer, earns about 5% of the market. If you look at the medical technology industry, the top 10 earn less than 40% of the market. So very fragmented. The question is why didn't a consolidation happen like what happened in, for instance, the airspace industry or in telecom? And we're going to see that to some extent the market didn't play this role. And we know that the market doesn't play this role in healthcare because actually there is no consumer. There are several players. There is the patient whom I will keep for the end to talk about because he's not truly somebody who has a say on what happens to him until now. And there are prescribers and there are providers, not always the same. And then there will be payers or insurers. And this really splitting of the various functions of consumerism are the real cause for the lack of a strategy. Now as mentioned, the issue is first of all, how do we measure health? WHO has a very demanding definition of health, which is the fact that health is a state of well-being disregarding any question of illness or disability or whatever. So it's all, I mean health according to the WHO definition is almost unachievable. Now, once you get one step deeper, you suddenly discover that still for WHO and for the medical community in the world, there are today 55,000 of pathological situations. And actually there is no ranking between these pathological situations. So 55,000 illnesses, that's according to the ICD, which is now going to become the ICD 11, 11th version, which will be rolled out in January 2022. And to address those 55,000 different diseases, what do we have? We have basically innovation, which is very bottom up and which is not driven by any, I would say, upper force. And those trials, I mean there are about 350,000 clinical trials going on at any time and of which 46,000 are published currently and which all stem from initiatives, which are basically initiatives from the industry. And so you are left with a situation where you have governments or payers who have a hand on the budget, who have very little lever on how to orientate those expenses. Basically if you're a government, what happens? You have a budget, you have to levy from taxpayers or from injured people and you have to allocate it to various silos, some of which are not flexible at all, basically healthcare provision, hospitals are very heavy, I would say ships with heavy investment and the staff. So you can't change the, basically at a very fast pace, the way in which you fund and operate hospitals. And so the only, I would say, leverage that you have short term, if you want to curb expenses, is to cut expenses on healthcare goods. And so that's basically what governments do and without really trying to set priorities. If you look at the priorities currently, I mean WHO priorities are not disease based. They are about health for all or health for women, adolescents and children or healthcare at the time of climate change. So they are very broad and very transverse, but that they don't provide a clue to industry players as to where do we want to orientate our research. And if you look at governments, it's pretty much the same. So if you're a government, you're left with your larger or smaller bulk of money, but you have little opportunity to allocate it in a different way. And the only way to do this is to cut expenses on healthcare goods. Now, if you are a hospital, what can you do? I mean, you earn, again, a very expensive facility. You are chasing for market share locally. You chase for recruiting or in competition to recruit good physicians, which are really the people who are going to attract patients to your place. You are potentially chasing for nurses because that's a resource which often is lacking. And you're not going to have much strategic leeway. If you want to develop a specific pathology, this may take time. If you look at the profitability of healthcare provision, you'll realize that this is the lowest profitability in all the system. It's basically depending on places in the range of just a few persons a few percentage points and very often decreasing. It's decreasing, for instance, in the U.S. And the only exceptions are people who are focused on some specific diseases and who address specific pathologies and try to build differentiation because they address a specific pathology. But basically a very unprofitable, unproductive business, McKinsey showed that over the last, I think, 10 years, basically the contribution of healthcare to the GDP was much less than it should have been if you compare it to the increase in jobs. So healthcare created some growth, but basically it hired many more people and it lost productivity. So a very unproductive world in healthcare provision. If you are head of strategy at a pharma or a medical technology company, what do you do? I mean, you don't have any clue from governments as to where they would like you to develop things. We have a clue currently on vaccines because that's kind of, I would say, anecdotical. It's something that doesn't happen all the time. But in this stable state, there is not much orientation from governments. There are a few exceptions. There is the vaccination quest by the Bill and Melinda Gates Foundation. There are cancer plans in many countries, but not many indication. So you're left with trying to find out from the epidemiology how many patients are going to appear in a given pathology to estimate at which price you will be able to sell a potential solution and then you are going to direct your strategy. And what has changed a lot in the world of the pharma industry is the fact that after outsourcing most of the development to large clinical research organizations, so-called CROs, now the pharma industry relies mostly on startups also to provide even the new molecular entities or the biologicals. So even the science has been outsourced, and which means that the pharma industry, which traditionally enjoys, with the exception of generic companies, traditionally enjoys high profitability, the pharma industry has shifted the risk to venture capitalists. And so they have also shifted part of the profitability towards venture capitalists and then we see a decrease in the profitability of pharma. Now the last, so that's basically the situation. What are the solutions? Well, the solutions from my perspective first of all would be to agree on metrics because if you look at health in general, there are not many elements to measure health in a country. Or there are many indicators, but you know, there is of course life expectancy and then you're going to kind of mitigate this with disability. So you reckon in terms of disability adjusted life years, you may use what is called quality adjusted life years. But in the end, nobody has a clue as to whether governments should prioritize the treatment of disease A or of disease B or of the solution which is provided in a disease rather than another one. And so the issue of the metrics, and the metrics issue, I don't have time to go into the issue of metrics in clinical trials, but the issue of the metrics is extremely difficult. If you realize, if you remember that you have like 350,000 clinical trials going on, this means that you're going to have outcomes which are going to be very detailed on different endpoints which have been defined, these per disease and agreed upon by clinicians. But you have no clue of what should I prioritize. And this is one of the big issues of the system. And this is why the whole system is going to a situation where of course the economy will not be sustainable. There are 6,000 about rare diseases with high expectations from patients and patients are organized in groups. And so when a company develops a treatment for a rare disease, patients will go to the governments and they will ask the treatment to be reimbursed. Now, most of those treatments may cost several hundreds of thousands of dollars per patient. And with a rare population of 100 patients, you end up very quickly with a few hundreds of millions of dollars for a rare disease. Times 6,000, you realize that there will be no way to address the expectations of patients. So my point, and I'd like to finish here and to leave room for the discussion. And of course, I think we can provide a lot more data to this discussion. My point is, what should be done? First of all, invest in research in epidemiology and health economics. Because this is something that not many people understand, whether in the population, in the press, in governments, in administrations. So this is a very rare, I would say, club of people who understand amongst themselves, but this is very difficult to translate. And so the idea is first, let's develop the research in epidemiology and in health economics. And then it would make sense to create some kind of a multilateral discussion, like has been suggested by Thierry this morning, to really see how we can prioritize efforts in research and development. And while of course keeping this serendipity-based research, which provides solutions to current who's, but really decide where governments should input resources instead of being always kind of forced to consider solutions that they didn't necessarily have the initiative of launching. So with this, I would like to thank you and I will be happy to answer questions later. Thank you, Jack, for this overview of the economics of the healthcare activity. So it shows both the complexity because it looks like either too many head or headless. How do you navigate in this environment? Well, that's quite a complicated question. So thank you for having me here. Is there someone in the driving seat, complicated to say, I would say, not really? So I'll try perhaps to focus on technology, which is my subject here, and on the challenges and the questions that the person eventually will be in the driver's seat will have to answer. And first, I would like to start by making a quick comparison to assess where technology actually brought us today. So I would like to go back actually to the year 1850. So at that moment, life expectancy was 40 years old. And what does it mean? It means that basically nearly all of us would be statistically dead. And by the way, I also would be dead too, because I would have died in childbirth something like 10 years ago. Oh, and by the way, my child also would be dead because roughly 25% of death were children below five. And the three main causes of death at that moment were pneumonia, tuberculosis, and diarrhea. And basically at that moment, medicine was largely helpless. You had a few elements like the vaccine for smallpox that was invented on the 18th century. But really there was nothing much that could be done. And what do we stand now? Today in the western world, life expectancy has basically doubled. It is around 80 years old. Death of infants, childbirth is very rare. And the three main causes of death are heart disease, cancer, and stroke. So basically we have virtually eradicated the three main causes of death of the 19th century. And how did we do that? Well, mainly hygiene, medicine. But in the end, it is science and technology. So between 1850 and now, there has been countless innovations. We've had antibiotics, very efficient drugs, we've had radiotherapy, immunotherapies, advanced surgery. And it's clearly not over because there are still some innovations that are coming and that will likely change our lives in the year to come. Well, for example, CRISPR-Cas9 or even artificial organs. But of course, when you have such progress, in the same time, you have great challenges and you have a lot of questions. And this basically is a subject that I would like to address today. So I would like to start by the challenge of validating these new innovations. Then I would like to discuss a little bit the place of doctors in all this. And in the end, of course, we need to talk about cost. So let's start by the subject of validation of innovations and more precisely about regulatory validation. So when you want to validate an innovation, you need basically clinical trials, patients, clinicians, regulators. But today, we are in a system that is extremely risk adverse and that requires always more proof of efficacy, more details, and that practically demands that there are no side effects. And it means more preclinical studies, more clinical trials, with more centers and locations, and of course, more money. So it is very easy to stay and to see the limitations of such a system. Already today, there is a real competition for people who want to launch an innovation to have access to the well characterized patients for clinical trials. And that's why we see such a big development of biobanks. And the result today is that sometimes, well, COVID is definitely not a good example here, but most of the time you need more than 10 years to put a new drug on the market. And it can cost above $1 billion. And if we go back to the subject of adverse side effect, I guess, well, in my opinion, it is just an illusion to believe that one drug is going to have the same effect on something like $7 billion people and that will have no side effect. For side effect, we see that very well for genetic manipulation. And the direct result in that is that in some therapeutic areas, only 2 or 3% of the drugs in the end reach the market. So there is a real limitation of what we're going to be able to do in only the step of validating the innovation. Well, the good side of it is that, of course, it protects the patients, but the downside is that it's clearly an obstacle. So now, I would like to switch to the role of doctors. And I know that there are doctors among them, so I'm sorry about what I have to say if they don't agree with that. With all the progress that we have seen, the level of required expertise for doctors dramatically increases, even for general practitioners. And in the end, of course, it's not possible. For example, in France today, you need something like 10 years of study to become a general practitioner. But during these 10 years, there is only one hour and a half that is devoted to the theory of mood disorders, mood disorders that include depression, depression that in the end affect 19% of the population during their lifetimes. And of course, this patient, the problem is that in most cases, they go first and only to the general practitioners for the same disease of depression. So we see that here there is a problem and something that needs to be changed. So on the one side, we have doctors that actually need to be experts. But there is another way of seeing things, another implication of progress. And it is that the progress of technology threatens to transform doctors into highly skilled technicians who operate sophisticated machines and computers and who prescribe paracetamol. Already today, artificial intelligence is sometimes more efficient than trained doctors in detecting cancers in radiographies. So my point here is that as technology advance, as it has such a big impact on the health care, there is probably a real reflection to be had on the role of doctors and how it should evolve and adapt to the progress of science and technology. So another subject, of course, is cost in health care and innovation. The USA today spent something like 17% of their GDP in health and it keeps increasing. Yet the quality of care in the US is often criticized. So where is the problem? Does it mean that we're not spending enough? Or does it mean that we're not spending well? Difficult to say, but obviously there is a limit to the amount of money that can be spent even for health. So the question that can be asked, well, the first one is what do we expect from innovation? And the second, which innovations should we fund? If we want to simplify, there are two categories of innovations. The first category corresponds to the innovations that increase efficiency, meaning the ones that allow to do at least as well as what is already available on the market, but for lower cost. For this one, I would say it's a low-brainer. It's better for cheaper, so it will be adopted. For the second category, it's more complicated. And the second category is basically the innovations that bring something new, that you're a new disease or something equivalent. So how do we evaluate the worth of such an innovation? The answer is we give a price to human life and the concept is simple. We give a worth to one year of a life of a patient and it depends on the country and of the age of the patient. So if we consider innovations that will save one year of life for this patient, if the cost of this innovation is below the worth of one year, then it's economically viable. If it's not, then adoption of this innovation will be compromised or impossible. A very good example is that the cost of one dose to cure and save infants with spinal muscular atrophy is over two million dollars. And this figure, it is already giving an idea of how much a baby is worth. So this is one way of seeing the problem of cost, but there is another one. And it concerns R&D and investment. When should we invest and for what? Here the problem is that money is not enough. R&D is about searching and it's not necessarily about finding. Concerning the vaccine for COVID-19 that has been discussed a lot previously today, I've heard a lot of people say around me, oh, it's noble that they found so quickly, the government's gave tons of money. Well, I guess we would know if it was that simple, because for example, the Bill and Melinda Geth Foundation has massively invested for malaria. And what is the conclusion of their research? Use mosquito nets impregnated with insecticide. So it's not really a revolution here. So if we want to wrap up on technology and cost, perhaps a key takeaway would be, in the end, there is no choice. Technology will have to allow for a global reduction of cost because only at this condition will the system be sustainable. So progress, where will it all lead us? I would like to do here a little analogy with financial bubbles and financial crisis. In a financial bubble, everything is accelerating, especially profit. And people tend to think that it will never end, which leads, in the end, to the crisis. In health care, these last years and decades, it has been quite the same thing. Progress has always been quicker and more spectacular. And we tend to think that it will never end. And my opinion is that these beliefs that progress is everlasting affects our position as a society towards tests. Deep inside us, a lot of people believe that technology will find a solution to everything, to AIDS, to cancer, to Alzheimer, to everything. And the consequence is that today, most deaths are unacceptable. Dying during a surgery of a random disease, unacceptable. Childbirth, let's not even talk about that. For example, even dying of COVID-19 when you are 90 years old is not accepted. Today, you're allowed to die in a car crash of cancer of all the age, the rest will not do. But as it is a case with financial bubble, technology in health care, will one day or another reach its limits? And the question are, will we understand when we reach that point, will we see it, and how will we react? And to conclude, I would like to go back to the other theme of this session and which is ethics. And I would like to ask one question. Is innovation necessarily the synonym of progress? I would say no. Let's take, for example, human cloning and genetic manipulation and human embryos. Endotably, these are big innovations. But most countries agree that they are also very unethical. So the immediate question is where is a red line? Where should science and technology stop? And at what point must we decide that we need to stop trying to cure and that we need to stop trying to save? And I guess that this is going to be a huge challenge for anyone who in the end will find itself in the driver position. Thank you very much. Thank you, Alessandra, for very lively and at least still provoking, if not simply provoking presentation. I like it very much. And I expect now some reaction of the participants. Do you have question on this first question that is who is in the driver seat when it comes to healthcare? Maybe I may comment on two points that Alessandra made. One of them is the fact that I'm a great believer, of course, of therapeutic innovation and I've been pushing it all my life. Basically, it's not the only determinant of health. And for instance, if you look at the stomach cancer, the fridge was the best, was the solution which brought an end to stomach cancer. And it was not the pharma industry but still a great tribute to the pharma industry indeed. Now, Alessandra mentioned, for instance, antibiotics as having soul issues. If you look at research today, very little research is done on antibiotics for just, I would say, economic reasons. Because if you are a pharma company with obligations to shareholders to return nice profits, you will never go into that field because you know that antibiotics will not be priced at a high level. They are usually used for one week. So that's not a business. And so at the same time where we say there may be very dangerous pathologies, you know, I mean the next epidemics will maybe not be a viral one but bacterial because there will be a resisting bacteria. And we will be caught because nobody has pushed for research in the antibiotics field. Coming to the cost of human life, Alessandra is right in saying that there is a price but it's not the same for everybody. And if you look at, for instance, the British, the British decided that they would not reimburse drugs if they cost more than 20,000 to 30,000 pounds per quality adjusted life here. Now once they've decided this, all the enzyme replacement therapies come, which cost much, much more. And the Brits had to create a special envelope, which means that you price the life of, for instance, of a kid with an enzyme deficit much higher than the price of somebody else. So that's really one of the issues that society is facing. And this debate has not been brought to the public. I mean, it's a debate which remains within the hands of a few specialists who debate on what should we reimburse. But the public is never called to say what they want. Maybe because the public wants everything. Yeah, as we see it in other areas. But building on this and before we move to the next thing, I would say both you, Jacques and Alex Salman, you said in fact there is no order giver. So it's a kind of self-organized industry, I can recap you a little bit, that is very dependent from one country to the other. Maybe it's very good because the sensibility to healthcare are very different based on your culture for sure. But we understand the waste, we understand that's what you stated, we understand that we need to do it. Everybody knows it's one of the biggest policy issues for every government. You called, Jacques, for establishing the matrix. Alex Salman, you were more on, okay, let's categorize the type of innovation and focus on at least three agenda. But how would we start? We know it, it's a very complex challenge. Where do you suggest we should start? Well, that's quite a complicated question. Starting to organize a world that has never been. The participants as well if they want to contribute. But yeah, go ahead, Alex Salman. Well, I think I would agree with Jacques Buon that there is no point in trying to organize when you don't know what you're trying to organize. And today, today we don't know, we only know that it is the law of the market that more or less in the end regulates the whole industry. And that's exactly what happens for antibiotics. So yeah, perhaps I would say organizing, giving some metrics so that we have something like a clear understanding of what it's going on. And I would add to that also perhaps having a clear view of what we can do. Yeah, what's interesting is if you look, OECD just published a very interesting report, Health at a Glance, where they provide indicators of performance of various healthcare systems on a number of indicators. And it's extremely strange to see that performances are extremely different from one country to the other. And so countries have set some kind of priorities. But it's unclear whether this was I would say an explicit decision or whether it's just because there was kind of a drift of the whole system in that direction. And my point is that basically we need to develop research, I say in epidemiology and health economics, but also education and probably educate the public. The preceding panel talked a lot about this information. And I think that's a field where people really don't understand the basics of the economy. They don't know how many drugs are in development. They don't know what the budget, which budget is allocated. They don't realize that resources are scarce. And we would need more public debate. But I would say at the world level, WHO does a great job of collecting data and fostering specific plans. But like Sandra mentioned, Malaya, and that's a really good question. How comes that with all, I mean, maybe more money is needed for, but Malaya kills more people than COVID. So why is it that there hasn't been a big effort on Malaya, except the Billion and Billion Gates Foundation, and with the limited outcome that Alexandra mentioned? So where should this debate take place? Well, first of all in countries, parliamentary level, probably, and then this would need an education of politicians. And then probably a multilateral discussion, you know, there was a big progress. I mean, what we see with vaccines is that the COVID vaccine will come all over the world. And that's the basic, the outcome of a work which was done 20 to 30 years ago. I was very young at that time, which was called ICHs, International Conferences on Harmonization, where all administrations work together and together with industry, to be trained what will be expected to register a new drug. This is like today, you can register a new drug all over the world at the same time. And we need more consultation like that on what are the big issues in terms of health, also at the international level. And that's why I think the initiative of Thierry is so important and why we need to push it through the next World Policy Conference. Okay. So, yep, thank you. I see one comment from Stanislaus on the cost of life. And I think it's that leads to the next debate. I think if I would retain, and I don't intend to summarize to be clear, but to retain one idea, I think what I hear is that you say basically we lack transparency as well in the way this market is operating. The fact that there is not clear order giver is of course the initial sin, but the lack of transparency and possibly as Alexandre alluded to some topics and we've seen it probably during the last COVID crisis that are difficult to expose in today's society where they are not welcome as part of the conversation as they might have been before, but to be the point on the cost of life and the necessary sometimes to make choices and they happen or tend to happen more randomly. That leads well to the next topic about does the end justify the means and this raises a question of ethics, but not only. We see there is a problem of transparency. There is a problem of an open conversation. There is a problem of what we can say or talk about or not. And for this session, I'm pleased to have with us, Daniel Lundler, who is a professor at Sorbonne University, member of the French Academy of Moral and Political Sciences, and he will be a company by Arthur Street, who is Vice President of Corporate Development of Selectis, a biotechnology firm and a member of the Corps des Minnes. So Daniel, I let you set the scene for this debate. Thank you. Thank you very much. So ethics is important. Why is it especially important in healthcare? Because on the receiving end are people who singly and collectively have a lot at stake, are a captive market and are vulnerable. And because on the providing end in both public and private arenas, the budgets are enormous as are the opportunities for enrichment. And because, finally, research and clinic are intermingled yet pursue different agendas, raising serious conflict of interest issues. That much is obvious. The question before us today is whether the advent of hugely powerful disruptive technologies alters the problem situation and in what ways? Part of the problem is globalization, which both amplifies these technologies and is largely enabled by them. Their governance must accommodate interdependence between nations on pain of remaining ineffectual and intergovernmental ethics is no simple matter. But first we must ask a more basic question. What is ethics? We know an ethical issue when we see one. When we hear about handicapped children having been injected cancerous cells to further research programs in oncology, our ethical bell gives out a loud ring. When we find out that Boeing let the 737 max fly after the first crash, although they knew what caused it, our bell sounds again. These are cases of what we think of as clear violations of ethical norms. A different sort of case is exemplified by end of life decisions in intensive care units. Ethics is involved, we clearly sense, but in the form of dilemmas rather than violations. Being familiar with a phenomenon doesn't entail being clear about it. Knowledgeable sources struggle to provide the definition of ethics. The best I can offer today is that of philosopher Joseph Raz. Ethics is the endeavor to give substance to the abstract category of the good. To give substance can be understood in two ways. If we allow ourselves to look back in time, we can imagine a moment where oncological experimentation on handicapped children was seen as a dilemma, not a violation. Physicians looking for a cure were laboring for the long-term benefits of humanity and pondered about whether this noble end justified the means. Going back just a little further, it perhaps did not occur to physicians that it may raise any ethical issue at all. It is precisely that sort of case which gave rise birth to the field of bioethics. And what these examples show is that ethics isn't just about making sure that established ethical norms are followed. It is also, in fact, for the most part, about creating and discussing the norms to be established. Moral codes connect these two ways of giving substance to the good. They provide a temporary conclusion to the search for norms, and they make precise what it is to violate them. The ten commandments specify what it is to honor the good in a number of generic familiar situations. It may be thought that such a code of conduct suitably amended and completed should suffice. It is important to recognize that it does not. First, because no code can come close to covering all the types of situations that people, organizations, and societies run into. Second, because when new possibilities arise and new practices emerge, they often require fresh ethical treatment. The existing ethical blanket, so to speak, cannot be stretched to cover the new territory. And this is precisely what technology brings about, new possibilities and new practices. The more powerful the technology, the more areas it can penetrate, the more numerous the possibilities, the more outlandish and possibly transgressive the practices. The potential for disruption is even greater when cutting edge innovations converge, creating synergies that defy extrapolations. Examples in the health sector abound were about to hear from Arthur about genetic engineering and the ethical red line of germline modification, and in the next session about enhancement and the goals of transhumanism. The commodification of DNA sequencing raises a series of ethical conundrums bearing on privacy violations and incidental findings. E-health can lead to the accumulation of untoward amounts of personal information on some or all members of a population with the attendant risks of surveillance and control or unequal protection and coverage. Generalization of systems of e-health can cause increased inequalities, either because the underprivileged lack access to the minimum skills to navigate the system or because the more opulent sectors of the health system can afford the best up-to-date information and apps, or again because personal face-to-face care might increasingly become a privilege and so on. So what is the right time for ethics? It is often suggested that intractable ethical issues arise when technology is allowed to release new tools before due consideration is given to what consequences may follow. Look at artificial intelligence, which is at last wondering how it can be redirected toward the good. Look at the internet, which is due for a reset according to critics, including its founding father Tim Berners-Lee and our speaker in the next session, Carlos Marrero. Look at digital social networks whose destructive effects are well known. Notice also that these three are mutual enablers. So the suggested cure in the face of these examples is to think first, but this is generally inapplicable. One reason is that before the technology is at least somewhat developed and deployed, debating about its potential risks remain abstract and general. No consensus can be reached. Even when one can begin to discern the shape of the proposed device or setup, it is impossible to foresee how, once deployed, it will interact with other novel systems emerging at the same time. And yet more importantly, it is impossible to guess what scenarios will play out as society at large and communities take hold of the new technology. So the right time for ethics is neither after nor before. It is now. Ethics is a permanent feature of human action. It is guided by action as much as it guides it. It's an ongoing task that proceeds by spurs on the fly as fresh challenges are brought about by new types of situations arising, new practices crystallizing, new expectations being expressed, new understandings emerging. Finally, how can ethics find its place in today's technological surge? The present technological wave creates urgent problems for ethics. And at the same time, it makes things especially difficult. The responsibility for developing new technologies rests on a miniscule group of people with exclusive access to knowledge, power, and money, and who answer to virtually no one. Deployment involves governments, and thus to some limited extent, via democratic representation, a larger set of people. In practice, however, the decisions rest essentially on the technocratic structure. The social gap remains immense. Just as wide is the temporal gap by the time of technology, which has been selected for development and employment hits the world, it has gone from emerging to already entrenched. And previous ways of doing things or inhabiting one's surroundings have been foreclosed. And as I said at the beginning, governance is the large extender global affair. National policies are mutually dependent and must be coordinated in order to have any lasting effect. Indeed, there are many obstacles standing in our way. Anthemological fatalism may convince too many people that any attempt to change the course of events is futile. The battle cry of putting humanity first, founders on the issue of who do we take humanity to be? Values, situations, and priorities differ. And we know from experience then that when push comes to shove, ethics tends to be an afterthought. In the face of these obstacles, we need to be imaginative and tenacious. But there's no reason to despair. We must be naive. We're witnessing a vigorous pushback as a matter of fact against fatalism. I do have a worry though. We also need to be patient for, as Joseph Rass puts it, and I quote, the new forms of the good take time and require the density of repeated actions and interactions to crystallize and take a definite shape, one that is specific enough to allow people to intentionally realize it in their life or in or through their actions. What we're witnessing in AI, robotics, and above all, biotechnology is the beginning of a beginning of a revolution or so we are told. The rush to dominance by nations, corporations, scientists is underway. In such a moment in history, how on earth can we be collectively persuaded to slow down so to leave time for the new forms of the good to take shape? This is the question with which I lead you. Thank you. Thank you very much. I'm sure you've triggered a lot of thinking within our participants and broader when we communicate. Now, Arthur, you will have to explain to us how you navigate in this kind of ethics on the fly that Danielle described to us in your day-to-day life and then I will open for Curie. Go ahead, Arthur. So, I would like to warmly thank Thierry and Patrick for the opportunity to speak on this particular panel. As a scientist by training, one of my deepest fascination is the unrelenting power of technological progress to transform human society, in many cases, and regardless of our attempts to try to control or organize it. And I think in the 20th century has been the century of chemistry and physics. The 21st century will be the century of biology and medicine with the promise of a flurry of medical innovation stemming from a better and deeper understanding of fundamental biological mechanisms underpinning the human body and mind. And to understand how these provide challenging use cases for ethicists and policymakers today, we can come back at the very birth of the century in 2003 with the completion of the human genome project and mapping of the entire human genome. And interestingly for this WPC health, this was actually a brilliant product of successful global scientific governance, with genome sequencing being performed across the US, Europe, Japan and China, and the resulting world being immediately published worldwide. And this global scientific effort was later deemed a public good. So, to come back to Thierry's introductory words, this is one of the rare cases where I would argue we have a public good, the human genome, when in 2013, in the case association for molecular pathology versus myriad genetics incorporated, the US Supreme Court ruled that human gene could not be patented because DNA is a product of nature. In parallel, the rapid accumulation of technological breakthroughs further accelerated the field of saline gene therapy. One, gene editing technologies such as mega nucleases, zinc finger nucleases, talon, and most recently and crowned by a noble prize this year, CRISPR, allowed any research center to seamlessly copy, cut and paste human genes. Two, viral vector technologies allowed to reprogram cells of patients suffering from genetic disorders by making them express healthy genes. And three, reproductive technologies drastically opened up the toolbox available to humans to operate on their own germ line. Of course, the COVID-19 pandemic provides a fantastic use case of such paradigm with highly complex and innovative biotechnologies such as synthetic messenger RNA or engineered viral vectors being at the cornerstone of the most promising vaccines. But of course, and as usual, COVID-19 is just a currently visible tip of the iceberg. And the ethical questions raised by these technological evolutions are certainly not new, but the practical applications are. First, and this was mentioned in the previous session, while the initial use cases of saline gene therapy are hardly debatable, we're talking treating certain forms of cancer or genetic disorders, the R&D and manufacturing costs of these extremely complex technologies lead to often unbearable price tags. The first gene therapy, Novartis tisigan lacluso, commercially known as Chemriah, was approved by the US FDA in 2017. It's a customized cancer treatment created using an individual patient's own white blood cells, which are genetically modified to target and kill leukemia cells. And it also carry a monster for 475,000 price tag pre-discounts. Just two years later, in 2019, the US FDA approved a vexis on Saleno gene apaparvovex y, the name also has to be complicated, commercially known as Zorgansma, which is another gene therapy to treat spinal muscular trophy, a rare neuromuscular disorder in small children. And as Alexandra highlighted just before, with the bewildering price of $2.1 million, this became the world's most expensive drug and explained a vexis future further acquisition by Novartis for $8.7 billion. And what are currently isolated cases are bound to become the norm for healthcare systems in the coming years, with close to 400 saline gene therapies being in development in the US alone. As Jack pointed out, most of these development come from academic institution and biotechnology companies and are only taken at a very late stage by pharma companies. So the questions of access that are particularly acutely felt for vaccines and treatment during this COVID-19 crisis will continue to rise. So the first question is how can governments and payers better coordinate and negotiate to ensure that patients in need access those treatments while keeping healthy incentive systems for biotechnology innovation? But also from a manufacturing perspective, how can efficient technology platform and supply chains be built across the globe to further industrialize and make these highly complex technology truly accessible off the shelf to those in need? Second, we have profound societal changes to be expected from the rise of these technologies. And I like to take as an example the evolution of the concept of family and parenthood, which has been partly driven by technology, starting with the first in vitro fertilization baby in 1978. But today the questions are already infinitely more complex. In 2016, the first three-parent baby was born from mitochondrial transfer. This intervention involved the prospective mother with disease mitochondria, these are the structures that provide energy to cells, which were exchanged by mitochondria of an healthy unrelated donor. So the newborn thereby carried genetic information from three parents, the sperm donor, the egg donor, and the mitochondria donor. This came from a very ethically acceptable principle, offering mothers the ability to avoid passing on metabolic diseases caused by faulty mitochondria to their offspring. Yet this technological prowess triggered the need to rethink once again or preconceived notions of parenthood, genetic transmission, and family structures. Today countries across the world battle with a place to give to culturally complex situations rendered possible by modern reproductive technologies, such as IVF or surrogate pregnancies. How can we ensure that such cultural concepts are being regularly revisited and debated at the local and global level as scientific innovation will offer increasingly practical challenges to fundamental societal frameworks? Third, and most importantly, more debatable use cases are coming to life, and we've talked about the first genome-edited human embryos by Chinese scientist Hei Zhengui in 2018. Interestingly, this has led to a very rapid Chinese and international outcry, but one must remember that the original purpose of such intervention, at least on paper, was as much a medical one as the one of the others previously highlighted. Indeed, the purpose was to offer an HIV-positive father and an HIV-negative mother the possibility to have children that would be free of infection. To do so, the embryos were edited by CRISPR gene editing technology to inactivate the CCR5 gene, which encodes a protein that HIV uses to enter and infect human cells. The purpose of this was to reproduce a naturally occurring rare phenomenon seen on the so-called Berlin patient and London patient, where a mutation in CCR5 conferred innate resistance to HIV. But here, the world quickly asked a difficult question. Did this commendable end justify the mean of human germline editing? Thankfully, this led to a rapid global response through the creation of the International Commission on the Clinical Use of Human Germline Genome Editing, which provided guidance at a global level this September 2020. The key conclusion, I quote, no attempt to establish a pregnancy with a human embryo that has undergone genome editing should proceed unless and until it has been clearly established that it is possible to efficiently and reliably make precise genomic changes without undesired changes in human embryos. And importantly, they add, these criterias have not been yet met, and further research will be necessary to meet them. Some of the key scientific concerns include the specificity of gene editing, that is the ability to avoid off-target undesired gene edits, mosaicism, which is what happens when not all cells continue to carry the genetic mutation during embryo development, as well as chromosomal abnormalities which can lead to severe genetic defects. The evolution of gene editing tools is very likely to reduce and eliminate these issues. But importantly, this review did not wish to conclude on whether these interventions should be permitted by countries once this technology matures. It calls to continue ongoing national and international conversations on ethical, moral, and religious views for potential long-term societal implications without forgetting issues of cost and access, as highlighted previously. This is essentially aimed to provide a sound scientific foundation for ethics to be guided by action confronted with cases and produced on the flight in the words of my co-panelist, Daniel, in order to aim for global science-driven consensus while avoiding the dramatic pitfall of ethics dumping. So to conclude, it is evident that with the rapid progress of technology and absence of international consensus on ethics, such dilemmas are going to continue flourishing in the future and our societies will need to understand and address them. The risk otherwise is to fuel a rising tide of scientific defiance, misinformation, and actual fake news, as we have seen for instance with anti-vaccine movements which were discussed in the previous panel, and as panelists have aptly pointed out, will be extremely damageable to health care system across the world. Instead, I strongly believe the recipe for success is neither to hand over societal and ethical choices to scientists and technologists, but also not to shy away from the multiplication of such technological use cases. Instead, we should keep building bridges between scientific, medical, and technological expertise together with political systems as this WPC health is offering an excellent example. So my overarching final question will be, can we ensure that we put in place the appropriate global governance structure to promote a healthy dialogue between scientific progress and ethical guidance so that society can truly choose the medical and biological future they want to live in? Thank you, Arthur, for your presentation, grounded on very practical examples and that was a good balance with Daniel's introduction more on the framework and what you are confronted or what we've been confronted in history. Maybe to open the discussion, I see, I heard three things or three levels of intervention and I would try to give some form of hierarchy. I think, Daniel, listening to you, there is an element that is missing and we heard it from Jacques and Alexander before, is what is the future that we want? I mean, probably, and you will react, maybe, and for me, if I would relate to technology, that's what I would define as what helps you identify the design principle. If you take an example of a smart city project in Japan, it starts with happiness. What is happiness in this mega-concentration, concentrated environment? And here it could be the same. What is the future that we want? And the answer will be different region by region, community by community. I would be happy to hear about this. On the ethics on the fly, we have this concept already, you mentioned it for regulation. The problem you have is how you bring all the participants at the same speed. Very often, the regulator use the tools of the past to assess the new situation, because the legal process makes it complex to have everybody to be on the fly at the same time. So what would be your view on this? And then the last point is about the global governance, but that relates to what we heard before on the need for debate and to educate and create some form of transparency so that society as itself can really appropriate the topic and define their future. But maybe on the first thing, Daniel, ethics on the fly and the video. Would you like me to try and respond? These are both very difficult questions. I can very quickly comment. I think to the first question, which is extremely interesting, what is the future that we want? That's definitely a question that has to be kept in mind by communities that are in the process of trying to make decisions and set up systems and so on. But you gave a very interesting response yourself, asking the question, saying it will depend on the community. It will depend on the society. And so what we really want is what mathematicians call a scheme, an axiom scheme. You can't have an axiom, but you can have an axiom scheme that is sort of a way of thinking and a conceptual framework in which you can go from a certain specific, more or less specific answer to what is the future that we want. So it's going to be maybe more collective in Asia, in Asian societies and more individualistic in Western societies, say, I mean, this is just schematic. And so you go from one sort of view on the future, on the future you want to a way of reflecting on how, what place you're going to leave for innovation and technology. And that's going to change from community to community. But we can make progress on the conceptual structure of the discussion and the democratic consultation. Ethics on the fly, you said it again, I have no, I just don't know how to do it. I just don't know how to do it. Clearly we need to put much more thought and much more time into trying to think ahead of time. How would that work? In fact, Arthur said that towards this conclusion, we need to take the time and energy and intelligence to think of consulting reflection structures at the various levels and various time scales. But I know what I'm saying is extremely generic, not a recipe, not a recipe at all. No, no, there are no recipes. But yeah, any other comments on this? If I can add, I think you raise a very important question, which is how do we ensure that people are put up to speed and how do you ensure there's not a lag between regulators and policymakers and the speed of technology, which is something that you highlighted with pharmaceutical regulation in particular. And I think we will increasingly need more translators, that is people that have one foot in innovation technology, but also one foot in policymaking and regulation to be able to kind of bridge the sort of raw data and raw information that is coming from these flurry of scientific innovation into actionable recommendation and thought process for policymakers. So you will need people that play this role, but you will also need fora. And I think, again, the WPC Health is a fantastic example of this, where you can have debates with all the key decision makers that are being put to a common ground before moving into any kind of decision. No, I think definitely that's interesting to relate this to a point that was made on the previous debate about the problem of trust. Are they trustable translators in today's society? At least that would be recognized as such. And I think it's part of the debate. Moving on, on this session, we have a third debate now on does technology care about health? I will have the pleasure to interact with Carlos Moerera. Carlos Moerera is a founder and the CEO of Wisekey with a cybersecurity company based out of Geneva. And before that, he spent about 17 years in the United Nations as an expert on cybersecurity and trust models. So no doubt he will come back on this question. It is my pleasure to introduce this debate, does technology care about health? And I would say, having been in technology for decades, I'm always anxious to start with technology because very rapidly, if you don't have people passionate about a certain type of technology, can the answer what question? Technology is always a solution in search of a problem by design. So that's the challenge. So I will try to put some context. And for this debate, I was thinking of referring to the work of Carlota Perez, who is an economist and published a seminal book at least for people in technology in 2002 called Technology Revolution and Financial Capital. And I'm sorry for her because I will go very fast, but it basically says they are in the fifth technology revolution. They are like congrats of cycle for technology. And basically they have three phases. There is the boom and then it leads to a crisis because the boom always entails excess leads to a crisis. And then ultimately when society understand the potential and it takes some time of this new technology, they appropriate the technology and put it at work to solve more critical problems. And I think this wave started with mass production of processors. That's a foundation of the information technology. Thank you, Intel. And then it has grown. We've seen the excess. I don't need to explain them. And we suffer from some of them. And notably the monopolies that have been built around technology and the incredible power of this organization. So they are excess in the way technology is used. But now we see we have major challenges at society level where technology will be part of the answer. And we will put it to put it to work. And I'm a promoter of what I say is we call I call the planet centric design. I think when you discuss with enterprise, and there is one not to be influenced, I won't name them, but some will recognize who is a large entire company. And what does it help? What does it bring if we develop the most efficient, the most effective, the best ever entire company? And if the world, as we know it, will have disappeared in 10, 15 years. So the conscious of this overarching problem is very high across. And I think it affects health as well. Health is part of it. You can't be healthy if you're in a dying or unhealthy ecosystem. So you saw a lot of craze in technology around the ultimate customer experience about the way you look. And I'll come back to handle your citizens. But my view, this is passé. The problem is to address the human being, the consumer, the citizen, the employee in the planet context. And we should think more broadly on a planet centric design. And it's not only about being sustainable, you hear a lot of commitment. Given the way we consume, it's about also regeneration. So Arthur will see if the next revolution is biotechnology or clean tech. But hopefully they will work hand in hand and together with information technology. So that's a little bit of the context we've all done that I would see for this session of the WPC on health. So planet centric design based on this evolution and the need to regain control of technology. When you think of taking control of technology, for me, there are always three dimensions that you need to check for whatever technology you are. I speak information technology, you're looking at. Number one is data. We heard about data. We'll develop a view. Of course, data is the object of information technology. The second thing and Carlos will develop afterwards more on this is security. Security has not been part of the initial design of information technology. Again, back to Intel, if you think of Moore's law, Moore's law is just about performance and cost. That's how all of information technology has been built. And now you start to see because of the transfer of value online on information technology, of course, the more value, the more interest there is for people accessing either the information. That's what we call through advanced persistent threat, primarily the government agencies or organized crime. There is not a week without you read about a ransomware attack, but Carlos will develop this topic and understand it. I think people don't pay enough attention to the standards when they look at technology. It was mentioned in the previous debate slightly. It's because all these technologies are built in silos, most of them. And then we have an issue of the interoperability between the different system and for the information exchange. And if we want to have a debate, now we'll come on practical examples. If I develop briefly on data, the first thing that strikes me this year and I would like to share is that how come we had two major events. First, the pandemic, obviously. Second, the US presidential election. How can it be that with available data, available data brokers, you can manage your political arguments street by street, house by house, individual by individual in every family, and you can deliver it constantly for weeks. And then we are told we cannot track clusters. For me, that's something I have some ideas, but that's something extremely striking. How come we are faced with this? And we heard this morning from unrightly so, from the representative of the industry, be it Sanofi or AXA, the data is key. That's what we need, not only the technical data, but the data about the behavior. And yes, I hear about GDPR, so general data protection rules. Yes, but it exists today. You can run a billion dollar for each camp, a billion dollar more campaign and get the success that you want, the goal that you want. And probably Jacques, it's because there is another giver there. Very clearly, there is someone setting the direction, that's in our case. But I think data, and when you go a little bit deeper, it's the same situation. Today, according to a study done recently by IFRI on the GovTech governance tech market, what is called the GAFAM, so the big U.S. Technology Group, represents 73.3% of global investment in artificial intelligence for healthcare. So it's another edge taken. What do we do? There are initiatives, and luckily, under the leadership of Commissioner Thierry Breton, who was rightly, rightly raised around the bell about the enterprise data, which is the last thing that Europe can protect against the U.S. and China. We've published on this with the IFRI back in 2018 on the geopolitical importance of data. So I don't want to develop more, but clearly, yes, there is a big topic. As I mentioned, the second pillar is security. I will leave it to Carlos later on. He will not cover only this, but certainly this part. And I will conclude my introduction on the importance of the standards. Standards are important in technology. If you think of the Internet that allows us to, you heard IPv4, IPv6 stands for Internet Protocol. It is a standard. You heard about Ethereum, maybe in blockchain. It is a standard. I mean, every time there is a big battle, what allows us to cooperate, and you heard maybe about open whatever, unproperatory technology. It's this battle, this constant battle. I don't want to refer to common goods because we are not there, but certainly it's fundamental. And we heard this morning the difficulties. If you think of what's happening and back to the COVID, who won where the pandemic started, at least that's what we're told, was a smart city. It's a Chinese smart city. And Chinese smart city means a security city, meaning they have all the means, and we've done a study as well with the E3 on this, to do the surveillance, to monitor the behavior of the people. Still, they could not identify it, but the response was a very centrally managed response, as you would expect it in China. And then we heard this morning that other Asian country has had very good results in their response, and to be mentioned by Professor Flau and Japan, Korea. This is not a centrally managed response. This is, there are different authorities. The individual rights to my data, my information are respected, but it's organized in a way that they can cooperate, that the exchange takes place. If you don't enter this concept into your design, and you don't pay attention to technology choices on which standard you're going to run, then you will have no choice, but a centrally managed model, because that's the only way you can have an end to end view. But it doesn't fit most of our political regime, and I would say likely so, at least personally. But then if you're outside of a centrally managed government, then you need to be able to cooperate. You need to be able to aggregate the data. You need to be able to trace the data. And this can only be done if you paid attention to the standards. So again, a context to summarize beyond health and full health, a planet-centric design, and then looking at your technology choices and the way you design your data. We've discussed about it. Probably there will be other questions. We'll cover security now with Carlos and the question of standards, which by the way, going back to the UN is a big debate on distributed and decentralized form of governance. And I think there are difficulties, but it's also a direction in which to go. And to finish on this, I think we won't find a big global solution, be it to your health problem, your climate problem or whatever. We'll need to act locally. That's what we've seen. The big challenge is how do you bring the global power to the local initiative so that they can then communicate and work together and leverage what they can? That's the problem with circular economy. If you just circle it locally, it's good for the few hundreds you're there. You just don't move the needles for the rest of the planet. So how do you make it? You have the scaling effect and that goes through interoperability understanding. So that's for my quick interaction on the technology principles in my view that matter in this debate. And now over to you, Carlos. Thank you very much, Patrick. So first of all, thinking also, Thierry de Montréal for the invitation. This is the second time I joined these type of forums with the World Policy Conference. So just to get you on what I think is essentially what you say, Patrick, is the, first of all, is defined technology. Because when we talk about technology and everything that sits on the top of the technology, we mean so many different things. The technology that we are using now, it is a legacy technology that was invented actually in 89 when the worldwide web was launched in Geneva, CERN between Geneva and France. And the web was already one of the disruptions because at that time, and I was in the U.N., actually I developed the Node Zero on the web because the U.N. was one of the first agencies connected due to proximity. The problem, and this has been reflected by Professor Antler, when he mentioned Tim Vansli on the ethical connotation of the use of this infrastructure, what we realized already at that time, at least 30 years ago, 31 years ago, is that although there was a huge disruption because we moved from a centralized system, our panettes and the internet, which was a legacy military system, to a totally decentralized system where universities and governments and people will hyperconnect between themselves. And that was transforming, that was a great need for developers like us because we saw a bright future. We saw, wow, I mean, this is the big opportunity to decentralize data to let people access anywhere in the world and being able to share international global knowledge from the nodes down to the terminals. But we also detected a problem, and I was one of the first ones to detect that problem, and I based my entire career on that problem, is that the web, the internet doesn't know who you are. I mean, you remember this famous image of the internet, it doesn't know you're a dog or it does not make the difference between a dog and a person. So because the person was now designing the original architecture of the worldwide web, what has happened is that the web doesn't know what a human person is. The web knows what a video camera is, where our computers and we are connecting nowadays, where a microphone it is, that's a machine identity interconnectivity, and the web is very good for that. But the humans, we need to connect via something to represent ourselves, but we don't have nothing in our body or in our DNA that will connect immediately to the internet, to make sure that the internet recognizes me as a human, and will make the difference between me and a robot or me on a connected car or me on a video camera. So that has created an unprecedented issue because obviously, when we started the web was only a bunch of people connected, now we are connecting the entire world population, and we are also connecting now one trillion devices by the year 2030, what we call the IoT. So all that infrastructure that we are building is sitting on this deficient base infrastructure. So this is like building very sophisticated cars that will run in a very dangerous roads. You have to put the security on the car rather than investing in the road. And that's why you have now a 10 trillion dollar economy that has been very smart in detecting that actually, because the human was not protected on the internet, the human has become the product on the internet. And this is the media, kind of social media company has made fortunes sitting in a 10 trillion dollar economy. So those companies are worth more than one trillion dollar. So how can we undo that? And what is the two or three things that needs to happen in order not to continue in this exponential curve? Because if we do so, and I wrote a book with an interest human code, human will disappear. I mean, we are totally a liability for that infrastructure. We are slow, we are, we are biological, self is full of issues and we die and we lose our capacities over the lifetime. So the internet as it is now, the web will reach the conclusion very soon, at the time the singularity connects with AI, that the humans are not required anymore. And what will disappear? The humans will disappear and there's a very concrete risk that the human will disappear. Many companies and many areas in the world, including Silicon Valley, they are already working into that possibility and the humans are not required. So how can we undo that? What please prevent that to happen? It's basically to solve the legacy issue. The human needs its digital identity to be controlled by the human. And that means that when you are talking in health, there is a regulation. I mean, you have HIPAA regulation in the United States, H-I-P-P-A, that basically protects your records, protects your, the right to control your medical information, to download information in your cloud and encrypt your cloud and only give a T to anybody that you will trust to access that cloud. But there is no international consensus or even practice to generalize that process. So we are in a situation where the companies, these multinationals that have gained a huge amount of power and control in your personal data, they are making this process very slow and very complicated. So we are reaching a situation where I think if we don't do something and maybe COVID is the activator and I am always an optimist person, so I see the COVID as an opportunity to do something, we will accelerate the problems in that space. Another problem we are facing is that, I mean, obviously the consequences of fake data, identity theft, manipulation of websites, illicit trade, $1 trillion economy, all that is based on the fact that we are unable to a strong authenticated persons and objects related to that person. I just received this morning an alert from Homeland Security as a cybersecurity company will receive alert. And one of the alerts says next year COVID is going to be an unprecedented problem for the certification of objects. So this is a fake news year, next year is going to be a fake object year. And imagine the consequences of millions of vaccines will be infiltrated by mafias around the world. I gave yesterday a presentation with economists where we discussed exactly that problem where people might actually die because what they are injecting themselves is a fake product. And that imagine the consequences of the public opinion is something like that happens. So we are reaching a situation where if we will be serious about it and if we really want to convert the digital economy and the transformation economy into something that is viable and will not hamper the human, we will need to sit in a situation where a private public partnership needs to happen. Where we decide that individuals need to have control of their digital identity. Digital identity as I mentioned before is the connector of who I am to the internet. So the internet recognizes an eye and a human. But that digital identity shall not be issued by Facebook or by Amazon or by Apple or whatever. That digital identity shall be owned by me. It's my birth certificate. It's like I am entitled to a birth certificate. And that birth certificate is mine that does not belong to anybody. Actually it is the birth certificate that allows me to have my identity car, my passport and so on which are attributes to that identity. So in that model of a digital identity owned by a person with blockchain technology and decentralization which is what you just mentioned before. We enter into a decentralization model of a third generation of the internet. It will allow us basically to be able to control our consent. Consent is very important. I understand that ethics is very important and it's fundamental but the internet doesn't know what an ethical thing is. The internet is blind. The internet just transmits whatever you put into the internet. The internet doesn't have any model, doesn't have any ethics, doesn't have anything. It's just a method of transmission and interconnectivity. So in order for the internet to be able to do something like ethical processes, you need to install the concept of consent. So what is consent? Digital consent. So digital consent is your capability as a user to decide if you want to share something. So if you own your identity, then you want everything that goes around that identity, your personal record, your health record, your medical and government record, your education record. All that information is under the control of your identity. Your identity is able to anonymize the rest of the data. So if the data is being collected illegally, it has no use because it's anonymized. It's deep pride from your PII, personal information, which is the information that brings you to your name, to your house, to your information that you will only share with your family. So that consent has a huge value because that consent then is monetizable. Now we are entering to what we call the third internet revolution, the fourth industrial revolution, but it's actually the third cycle of the internet, which is the possibility with the decentralization of ledgers to share your consent with other people that will basically need to access to that information. And you can monetize. You can say, okay, you want to know something about me? You want to monetize my behavior? Fine. I might want to agree to do that to you, but I want to agree on some specific conditions, time stamping. I will only do that for one day, two days, and you have to reward me for something like that. So that is obviously the model. Technology exists. I mean, my company and many partners, we are developing systems like that. But obviously, you have a 10 trillion dollar economy. And in closer than now, you have a huge, and I go back again to that thinking of Teoridius Marni, what he says, the world is becoming, you know, like American fighting against China for world dominance. It is actually a technology dominance. It's not going to be anything else. It's going to be, who is going to be the country that is going to own the data of the world? And we'll be able, because they will have AI and other tools to monetize that data and to analyze that data and to advance in decisions, in design, in development of new drugs, because that data will be controlled by them and will be accessible to them before to anybody else. And this is the fight. So the solution, as I say, is what I call the decentralization of power in the digital economy. And COVID is actually an accelerator. What happened, and I am involved in several COVID projects in Switzerland with the app. We are also involved in Germany. We are also working with WHO in some project. We are also thinking about, for instance, the yellow vaccination card, which is an analog technology and could become actually a very easy way to vaccinate the world and being able to digitalize the vaccines, writing in a paper, putting that in your mobile phone or your USB. And at the same time, with that technology, being able to decentralize the data. So the data is on a national level. And we give the country back again what they show on, which is the data of their country. Data is like water. It's like electricity. It's something you don't want in another country to serve to you, because you create dependency on that country. So in order for the health system to progress, and I think, you know, to be very honest, I think we have a historical opportunity because we already transformed the telco system that was the first one to be transformed and digitally transformed. Then we transformed the banking system. And you see the, you know, the WhatsApp of the world and the internet payments and the KYC compliant process has accelerated. But the health system has never been digitally transformed. And the reason, and that has been raised during the panel, it's so decentralized. It's impossible to standardize a process because it's totally decentralized. I remember I assisted once at conference in the United States with President-elected Biden, where he says something that stays in my mind. He said that when his son was sick of cancer, he was vice president at that time. He wanted to bring all the cancer research in the United States together so they could analyze the data being collected by the different universities. And that was impossible because the data was sitting in silence. And not even him with his vice president position was able to create that interoperability that was required. So we are in a situation where if we transform the health system with a vision of user-centric and consumer-centric or patient-centric, which is me as a user, I shoot all my data. How many places in the world, if you get sick and you go to the doctor and the doctor do an x-ray on you, you will never see that x-ray. And if you want to change doctor, eventually you will have to negotiate with your doctor to get all of your records. So that's a violation of my personal data. The x-ray belongs to me. The doctor can obviously check the x-ray but under my consent. So the issue of consent will allow us to advance enormously in the health system. It will be possible, as you say, by creating standards. And there are many standards available. Those are international standards. By the way, the standard of digital identity belongs to ITU. It's the X519 standard. It was one of the oldest standards. And if we will be adopting those standards, we will be in a very strong position to be interoperable. The other subject which I think is critical and has been raised during this time is data, the ownership of data. So data should be owned by the source and not by the destination. So that means that with the quantity of data that we are collecting now, if we apply the GDPR principles that we have for instance in Europe, and I think Europe is one of the most advanced countries on protecting data and protecting identity with the IDA certification process, that could be extrapolated to many other countries. Because in the future what it's going to be is that, you know, China, United States, Russia and Europe, we're going to be platforms. We're not going to be any more that naive internet, that naive web than I had the privilege to see burn in Geneva 30 years ago. That was a naivety to think that this will be the solution to the world. That tool that was designed to solve many of the problems has become the problem itself. And where we are now realizing is that countries are getting into platforms. So platforms in the digital world are acting like aircraft carriers. You know, an aircraft carrier is very important when you go to fight, because your planes can land and then take off and then go to the war and come back in a trusted area and get refueled and get reactivated with the weapons so you can go on fight again. So America has obviously a huge amount of Facebook, Apple, all the other aircraft carriers for the startups and innovations, then they will need to expand the supremacy on the digital era. China is taking over. Europe is still in infancy. We are still maybe the more naivety in all that. And why? Because we're so difficult in Europe to bring all those platforms together. But I think in the future, you're going to see the future of platforms. Those platforms are going to be interoperable, but we have to make their life difficult in collecting so much data and making going, which are conclusions that humans are not important anymore. I think the big danger also on the human part is the combination between biological research, and you have been discussing that in this panel, and technology because both of them are exponential. And the biotechnology without understanding the exponentiality of each of them in a separate way is very dangerous because you're creating another quantum leap, another layer of development that could be very dangerous if you don't understand the complexity of the previous one. So I don't want to take more your time. I think my big message is that COVID, and especially the vaccination process after COVID, which is going to be the largest social experiment ever conducted in the world. I mean, this will be not anymore. Can I take your data? This is going to be, I'm going to be wearing a product in my body. My body is going to be open to you, and I need to trust you, whatever you are, go from a hospital or clinic to have something in my body. Then obviously, it will have many advantages, but it's another layer of human intervention that we are not yet in the technology area ready to trust, and that's the message. Thank you, Carlos. And I think excellent point on identity. We see the enterprise level as well. It's not only a society question at enterprise as well, and it's another consequence of the COVID, at least an acceleration, because when you read people work from home, it means they are outside of the corporate network, which means from a security standpoint, the protection of the corporate network doesn't help a lot. And the problem is this hybrid world, and I think it will accelerate the debate on identity, and it could well, I'm sure it will be part of the answer to the question we had on this debate. I want to open the floor on this as a partially contributor moderator. I don't know if one of my colleagues on the panel has questions to how, if technology care about your health, the way it has been presented. Otherwise, I will go into the closing of this session. Are there questions or comments? No. If not, then I will conclude. First, I would thank all the participants for their contribution. I think personally, I learned a lot, even if I read it before. It was extremely dense, well prepared. Thank you very much. You know, I think this second session was extraordinarily rich, and I fully share what Patrick just said, that is, as both of you should say, a problem which is well posed is half resolved. And I think that with this panel and the previous one, we have put clearly a number of quite big problems, and I think there is a future for the WPC health for many years to come. The only problem being that if we are too slow to move on, we will be in trouble. One of the characteristics of the, whatever you call it, the fourth industrial revolution, or if you would define it with another name, is that the technological evolution goes much faster than diplomacy. I remember the time of my own beginnings in international affairs in the 70s, at the time the start, the salt negotiations between the US and the Soviet Union, we had observed that technological progress was moving much faster than the capacity of diplomats to come to an agreement. And I think that the sort of problems we are facing in the contemporary global world is a bit of this nature that affects all aspects, that we have discussed in the second session, including ethics, because I think, as I think Daniel said quite clearly, one thing is the abstract philosophical definition of the good, and the other is how to translate that in concrete actions, and it's very difficult. And we come back also to this issue with which we started on what is a public good or global public good. This is also the same nature, but it is relatively easy to define abstractly, but when you want to translate that into collective action, it becomes much more difficult. Anyway, I think it is time, again, thank you very much. I'm very happy with this second session, as I was with the first one.