 Good morning everybody. I'm very pleased to welcome you this morning to the IINA webinar and we're delighted to be joined this morning by Dr Andrea Amon, Director of the European Center for Disease Prevention and Control who has been generous enough to take time out of a very busy schedule to speak to us this morning. Dr Amon will speak for about 20 minutes on the topic Strengthening Crisis Preparedness and Response to Disease Threats and Outbreaks and after the presentation we will go to question and answer and you will be able to join the question and answer function on Zoom which you should see on your screen and please feel free to send your question then throughout the session and stay occur to you and we will pass them to Dr Amon when she has finished her presentation. We would be happy if you could identify yourself and your affiliation as you ask your question and just a reminder that today's presentation and the question and answer are both on the record and please do feel free to join the discussion on Twitter using the handle at IEEA. Just some background on the European agency. It was founded 15 years ago in the aftermath of the SARS pandemic and it is the EU agency aimed at strengthening Europe's defences against infectious diseases and of course the challenges of the COVID pandemic have prompted an increased level of cooperation and coordination at EU level and the ECDC has been very supportive of EU member states and the EU Commission throughout the COVID pandemic by providing the scientific background necessary to help member states to take the complex decisions in these unprecedented times and Dr Amon will outline the role of the agency in her address as an agency responding to the pandemic for the EU and she will also discuss the developments in surveillance preparedness and international cooperation in the context of an enhanced role for the ECDC. But now to introduce formally Dr Amon. Dr Amon was appointed director of the ECDC in June 2017 and prior to this she was deputy director and head of unit for resource management and coordination as well as acting director. And prior to joining the agency Dr Amon served in several roles at the Robert Cook Institute in Berlin most recently as head of department for infectious disease epidemiology and in this capacity she maintained and further developed the German national surveillance system coordinated the national outbreak response team for current and emerging infections and coordinated emergency planning for influenza and directed the field epidemiology training program and coordinated research programs in infectious diseases and provided scientific advice for government members of parliament and the public. Well with that lengthy list of wonderful experiences for the post may I hand over the floor to you Dr Amon and we're waiting eagerly to hear your talk. Thank you. Well thank you very much Mrs Cross for the introduction but also for the invitation. I'm really delighted that I'm here and can share with you my views on the necessary developments and in surveillance preparedness and international cooperation and also the experience that we had before I go to the three areas I would like to give a short summary of what we did in the past 15 months. Because I mean, we have all seen that the COVID-19 pandemic brought suffering, sadness, frustration and exhaustion at all levels of the society, but it also made very clear that we cannot be complacent when it comes to surveillance, pandemic preparedness, health system capacity and nourishing international cooperation among public health institutions. So in the past 15 months what we have done is according to our current mandate constantly assessed the evolving risk. And we have standardized data collections through common case definitions, data standards and protocols and also produced daily epidemiological updates and weekly more in depth analysis by country and for the EU as whole. As a data source we have used the European surveillance system, short TESI, which is the official database for all the surveillance data from where Member States report to ECDC. But we also have used a so-called epidemic intelligence data where we scrape the internet from official sources. We have then searched not only for the epidemiological indicators like number of cases, hospitalizations, intensive care unit admissions and death, but also monitored the ongoing public health measures put in place and changed by Member States. We have with this all this information, our mathematical modeling to deliver 30 days forecast taking such measures into account. And since the measures changed so frequently, we were reluctant to have any further forecasts because then of course when the measures change all the forecasts are rendered a bit invalid. So we have in addition produced numerous guidance documents on all aspects of COVID from infection prevention and control in hospitals to various setting recommendations to the use of non-pharmaceutical interventions, or lockdowns. Now, the difficulty in obtaining data needed to steer the response in an optimal way have really uncovered how inadequate the surveillance systems are for such a situation. The quality of the data is of course relying on the system, health system that it's coming from, and also from the strategy that is employed by a country how to collect whom to test, which kind of surveillance to establish. And here there were initial delays to detect the ongoing community transmissions, and that has led to widespread transmission before these containment measures could actually be taking, and that led to the first severe wave in spring last year. But also the data, the surveillance data that were used, for instance, to put travel measures in place, travel restrictions were not really comparable between the countries. And so based on non comparable data, quite far reaching decisions have been made. And that is what we were observing and we thought, well, we will need to have to change that. Now, recently we saw that with the occurrence of the variants, which are only detectable when you do really whole genome sequencing. There's also a lack of capability and capacity in the countries. And we also missed the capacity to do accompanying studies. There's a lot of time on, for instance, the transmissibility by certain contexts, risk factors for reinfection and these kind of things. These studies are of course done, but not in the systematic way that we would like to have or would like to see. In view of these weaknesses, the European Commission and many member states have called for a stronger role. And in, in, of ECDC in coordinating and standardizing you surveillance and enhancing preparedness. The proposals that the Commission has put forward in November last year are now under discussion at U level by the Council and by the European Parliament, mainly. There are other consultations also ongoing. Now, when I go now a bit more to the surveillance aspect, the European Commission has provided ECDC now with for this year already with additional financial and and human resources. And is also starting this initiative of the European which is basically should facilitate and regulate the secondary use of electronic health records. Now, you also may be aware that as preparation for the new agency that will by the legal proposal is in preparation to European health emergency preparedness and response authority here. This sort of a preparatory work has been initiated that should really secure resources to tackle the variants. And here we have have been on will be given quite large actually exceeding our total annual budget by almost half. So we will resources to strengthen member states whole genome sequencing capacities. And so we are now planning this together with the countries to not only secure the current immediate support, but also the long term capacity building in the countries in terms of technology, just buying the machine. In skill development because you need trained and educated people for interpreting what these machines produce. Now, this, the modernization of these surveillance systems will require a significant change in the mindset. The overall prioritization of resources for public health. And I will explain this a bit. So our intention is to pronged. We want to work with the member states to propose methods and standards that are valuable and applicable for all member states. And at the same time also work with individual member states to address their improvement needs specifically. So it will be a general and a specific work that we will do. And for that, in order to do, there is no way around other than really embrace the huge potential of digitalization. Also agree on key surveillance objectives and suitable methods how we can actually achieve them. Now right now, most of the surveillance is relying on the traditional technologies. So the current development of digitalization in health is looking more at health care and public health has never been prioritized so far. It was public health was basically not included. So the main technologies that we think we can we can harvest here and harness here is the secondary use of electronic health records data. And these are of course in development and also in use in several countries, but they're not sufficiently standardized for for their data to be routinely used. So we need in the EU a clear governance for the secondary use of this data, which is sort of in the make. And the rigorous validation process to ensure the quality data and make use that the data are acceptable and compliant with the data protection regulation, which is not an easy issue. So, but there's another element that also the pandemic showed is that the future surveillance will be dependent on our ability to engage the population in this task and exploit new technologies in a way so that the citizens have the feeling they get the support they need, while trusting that their data are protected and used for their own benefit. I want to use here as an example the apps the contact tracing apps. And we are, we will work with the member states on developing such apps for syndromic surveillance so meaning not specific diseases but syndromes that could mean a lot of diseases like fever acute respiratory infections, and so forth. To rapidly detect then outbreaks and those of community transmission, but for that we need a good confidence and trust of the population because we have all seen that these contact tracing apps never took off because of the low trust and take up in the population. So, that's basically our, our idea for the future surveillance is more digital and more participative. Now when we go to pandemic preparedness, pandemics are by definition having an impact on the whole world. That's sort of inherent and the proposals for the expanded mandate of ecdc entail a number of suggestions, how the preparedness can be improved and how the existing union structures and mechanisms can be enhanced. Now, after well 2003 the SARS outbreak. I mean all member states have developed pandemic preparedness plans, essentially, mainly for influenza. And in spring 2009 when there was the avian, not the the H1N1 influenza pandemic that also led to many member states updating and and revising their plans. So, retrospectively, unfortunately this pandemic was very mild, and countries thought well our plans, we could cope with this it's actually quite fine. So in 2013, based on these experiences, there was a new legal framework for put forward to combat cross border health threats. And according to this legal framework the member states had to report every three years on the pandemic preparedness status of their countries. And now what we have seen is that and of course in theory we knew is that having such a preparedness plan is good. And it's necessary, but it's only the first step, and you can sort of stop at that. During an emergency, it's the it's most relevant how quickly these plans can be put into action and into efficient and sometimes also flexible measures. And that is sort of part of a whole preparedness cycle where you have the preparedness, then you either test in in the practical example right now, or in simulation exercises, and then you learn lessons, and take measures for improving. So that's a whole cycle that needs to go on permanently. The next stage is really to understand the merging threat landscape so what are we actually looking at identify and map vulnerabilities and capacity gaps, and then work to address these. Testing simulation exercises stress tests, and you learn what where there are still weaknesses and start improving them. And so, ideally, you have an upwards spiral here. So, we have, there is, of course, all kinds of evaluation tools and assessment tools. And one is for instance, from WHO the joint external evaluation assessments, where we have joined those missions to your member states. And that is looking at the whole, the whole setup, but also these protocols will need to be at the light of the experience that we have right now. So our idea is and we have already published documents for in action and after action reviews that the countries either do themselves, or with support either from us, or from, from other institutions. And these should be a routine component of the preparedness so whenever there is an outbreak it doesn't have to be a big pandemic. It can be a local outbreak. Learn the lessons and try to work in these, these lessons in improving the weaknesses. So, we want to come that member to a point where member states really systematically learn from all these outbreaks. Now, one aspect of the proposal for, for, for extending the ECDC mandate is actually the establishment of an EU health task force to facilitate the support for quick outbreak response in the EU, but also outside of the EU. And to ensure and strengthen the needed capacities and capability force the collaboration between stakeholders. There are other elements as well, like that ECDC should be able to provide non binding recommendations for risk management, which right now is a big no no for us we can't enter risk management we can only get options for response. That we monitor and assess, not only sort of the little tiny part of the health system related to infectious diseases, but also health system related indicators. Like, for instance, the bad capacity, the workforce capacity and so forth. And that we also go better about defining specific population groups at risk and can then also device targeted prevention and response measures. So, I think a very important weakness that showed here in in the past month is also the interoperability of the plans with the neighboring countries, because I mean, especially for the border regions. It was sometimes really people were called out of the border, because of measures implementing on one side. So here, really, that some consideration have to has to be given. And the other element that needs to be implemented in the preparedness plans is the community engagement, because what we're seeing right now with the pandemic fatigue is also a failure to engage the communities in a in a in a way that they see the necessity, why they still have to follow all these measures. So coming now to the international cooperation. We have since the beginning of our, our center being closely working with the EU member states and the EU institutions, as well as international partners, but our focus is always on the EU. And so, we have seen now that in the pandemic, it's hugely important to have a strong international cooperation and coordination with partners for sharing data. And in particular, for sharing knowledge, because you know the pandemic started in in Asia and then it came to us. So by the time we were dealing with the first wave. The Asian countries were already sort of recovering from their first wave. So we had contact actually with Singapore, South Korea, and Japan and China. So also to learn how they managed and take these, these, this, this experience also into into our guidance here. We have this year starting a new seven year strategy where we have five objectives, and one is exclusively dedicated to increasing the health security in the EU through international collaboration and alignment. And of course the first, well area where we look at is our neighboring countries. So that means the western Balkans and Turkey, where we have been working already, I think in the last 10 years, bringing them closer to the EU standards, gradually integrating them into our activities, and assisting them to strengthen surveillance preparedness and response capacities. So then the next ring would be the European neighborhood policy partner countries, where, which is essentially the countries surrounding the Black Sea and the Mediterranean Sea. And we have with funding from the engineer now a program for health security for the next four years. And the aim is to have tailor made support for those countries to strengthen their public health systems and build also workforce oriented capacity. Now we work very closely with WHO, especially the European office. And that has developed over the last 15 years and intensified last year, immensely. So we try to align the guidance as much as possible. Since last year we have also intensified our collaboration with the Africa CDC that is has a responsibility for all of Africa. And also here we have from BG INPA a considerable grant to strengthen the capabilities of the Africa CDC in terms of harmonized surveillance across the African continent data sharing early detection of threats preparedness and capacity building. And then is the wider world, where we have already since years an ongoing collaboration with other centers for disease prevention and control. And like in the US in China and Canada, Israel, and as I mentioned Africa recently, but now we have made new connections, as I mentioned Singapore, South Korea, but also Mexico and the Caribbean. So, and that group we have convened on a regular basis. And it has been has proven to be very, very useful for us. So, I see the clear potential for us to support crisis response in Europe, but also in outside and also reap the benefits of working internationally for enhancing the EU health security. So, in that sense, we really support to enforce our mandate. So I have now a few take home messages. We have seen that we are even more connected than we thought globally, an infectious disease anywhere in the world can be around the globe and arrive here in Europe within 24 to 48 hours in infectious diseases. Nothing on this earth is remote. All is close to home. Then we have also seen that disruptions in movement of goods and people have really far reaching consequences. So we should do our utmost to avoid that. So avoiding it not in saying well we don't take these measures if it's necessary but really avoid making them necessary. So detecting outbreaks early and and having having strong measures also very early. The WHO and easy to see along with other international organizations have a crucial role in the global health security, health security architecture, and it is important to capitalize on each other's experience in several specific area. Now, I think it became clear that strengthening and maintaining preparedness. Currently and internationally is an investment and not as a not a cost as it's seen mostly. And lastly, we have also seen that no country can cope with such a crisis alone, and not even one region, only if we are prepared together. We are also safe together. Thank you. Thank you very much indeed, Dr Amon. That was really wide ranging and I think you touched on so many areas and so many important points. I'm not sure there are any questions left but indeed, indeed there are. And so, just to go to the questions. Now, and I have one of my own. I'm exercising the privilege of chairman but also merging it with one from retired army officer Brigadier General Aaron. My question is, why was the spread of covert so universal, unlike SARS and Ebola which were contained. That that is the question I had, and Jera herns question is, there is a mindset in Asia that is used to dealing with pandemics. Is that a factor. When you consider how they have been dealt with in Asia, as opposed to in say Western Europe, where you are stressing the need to get the population engaged. The population in Asia seems to be more attuned and prepared for pandemics. But firstly, why was it not contained like the previous ones, and the Asian mentality. Is that a factor that we should look more closely at. Okay, I come to the first question that the universal spread. This has to do with the, with the characteristics of this virus. The Ebola is not transmitted via respiratory infections it's transmitted through blood. And, and also the SARS virus in 2003 had different different characteristics of transmissibility than this one. I think at the beginning, when we didn't know much about this virus, we always try to do analogies to the other side, SARS virus that we have heard about about, and that we have actually I have been dealing with also. But it was wrong, because at the beginning it was said, it's only transmissible from animals to humans. But then it turned out very quickly it's also transmissible from human to human. And what really made the transmission so, so widespread is the fact that even someone with no symptoms can infect someone else. And it makes it quite very, very difficult virus to control. So, and as for the mindset. It's, it's true. I mean, in Asia, Asia was also from the first SARS virus, much more heavily affected than we were. We had a few hospital clusters in Europe, but basically the first SARS outbreak didn't really affect Europe. So we had, we didn't have this, this experience. So, and ever since this first SARS outbreak, the in Asia, the use of masks was widely widespread. So in Europe, it's still in some of the countries it's still very difficult. When you go out with a mask, you are really looked at like an alien. And in other countries it has become more normal now as well. So there is, of course, also of course how the society is organized makes makes makes a difference. And I think for our populations to cope with something that restricts their daily freedom was very, very difficult to cope with. Yes, yes, yes. Yes, that is true. And we see that in the various countries. I have a question, Dr. Arman from Elizabeth Harding, who is EUK consulting. And she asks, to what extent will the ECDC threat assessment capacity develop under new legislation to expand its mandate. And what about vis-a-vis the new HERA. Now you may know what that means, but I'm afraid I don't. Yeah, this here is the is this new agency that is in in the making right now. And we don't know exactly how it will look like. We are in short that this will not overlap with our activities and the threat assessment capacity that we have is actually depending on how on the quality of the data that we can collect, and how quickly we can collect those. And there is, of course, a facilitation through also electronic and digitalized methods. We are considering looking into how far we can also use machine learning for, you know, collecting all this data. And so increase the, let's say, decrease the human input in the scraping of the data and put this more to the analysis of the data. And we are in the process of using the additional human resources that we get of also getting more modeling capacity. Thank you. The question I have is an environmental one, in fact, that touches obviously on aspects of pandemics, and it's from Emily Pinchu, who is a researcher in the Institute. And she asks that in terms of assessing emerging threats, Mike Ryan of the WHO recently outlined the need to ensure protection of the environment and biodiversity. And is this something the ECDC is looking at as a weakness which could result in future pandemics. And of course climate change, which is another question will come into this. Is this an aspect that the ECDC looks at or considers in terms of future pandemics. I mean, we will certainly work together with those institutions that look into this, but we don't right now consider this as a focus area for ourselves. Because I mean, although we have now a bit more resources, we're still only have 311 people. I mean, we focus on the human health aspects, knowing that they are influenced by the interaction with animals and the environment. But I think our capacities to cover those areas ourselves is limited. So I would rather expand our collaborations in this area. And definitely climate changes are already working on in a way of looking at the impact of rising temperatures for the sort of potpourri of infectious diseases. And there we have in particular under our radar the vector born diseases, where we see already for certain vector born diseases and North Ward extension by year. Thank you. Thank you for that. Another question from James McGinn, you mentioned the maintaining popular support which I think has every government has felt this is absolutely necessary for for containing the disease but also for the acceptance of the vaccines. James McGinn asks, given the signs of covert fatigue visible in many EU countries, could you suggest how EU governments could improve their approach to maintaining popular support. In other words, Dr. Roman, have you seen any techniques or approaches that have worked better in some countries than in others to to get the the acquiescence and agreement of the population. I mean, the basis for all of for the support of the population is the trust of the population into the government. And that is, there's a vast variation in this in the in the EU countries. But when this is there. And of course it's also a matter of increasing the trust and maintaining the trust. We have seen that in countries where the government was very frank, open, transparent and unified in the messaging that that helps. And I mean, techniques are for instance, to to engage certain community leaders. That's of course, most important for specific communities marginalized communities, but also in the for the general community you know, engaging in public figures, you know, popular pop stars, football stars, whatever. I mean, you know, people or figures that that are trusted to to really also help carry the messages. But in general, I have to say, all of us have to still learn a lot in this area. Well, obviously the agency is still helping a lot. I have a question now from David Byrne, who's a former EU Commissioner for Health Irish EU Commissioner for Health. And he thanks you for your interesting remarks and also for the work of the ECDC in this during this pandemic. And he asks, following our recent experience with rapid alert on this Coronavirus. Do you think there's a need for a review or even replacement of the international health regulations. If so, what fundamentals are necessary. I mean, that's, I believe that the international health regulations are sufficient, but they're not implemented. So it's more a matter of really implementing this everywhere and not only sort of in a, in a paper at the national level, but really as a life exercise down to the local level because what we have seen is that there are sometimes national plans and national exercises and these kind of things, but the local level that is the first line, the first ones that deal with these outbreaks, they're often not as well prepared. And that I think is for me also an focus area for when we are now looking at improving the preparedness status. Thank you. Thank you for that. That's something to be to remember. I have a question from a member of the press all around from the journal and she has a number of fairly practical and specific questions. She asks questions about your view on antigen testing, what the value of that for people to use at home, the importance of contact tracing should countries have undertaken this very much earlier. She has a question about a topic that's very much of course in the news and interest at the moment, blood clotting and and should people take this vaccine who have blood clots and mandatory hotel quarantine are all of these of use the values of these in combating the disease. What is the agency and your view in terms of stopping covert 19 the various measures that have been undertaken and the successor otherwise. So what we have said, basically it's kind of a mantra since, since a year that what needs to be done is put a good surveillance in place, test and trace so contact tracing is an essential element of controlling the spread. The rigorous contact tracing is also something besides the face mask using that these Asian countries that have fairly well controlled the outbreak have been implementing they have invested massively in contact tracing. So that is something that we that we still think is necessary and that will be necessary throughout, regardless of whether we are in a wave or whether we are in a localized outbreak situation contact tracing will be a key tool for for controlling and and and reducing the spread. So the antigen tests, we have put out guidance. The, the, of course, it's very good that someone can do the test. And of course, a necessity that if the test turns out positive that there is a recourse where these people can can turn to for for further support that there's clear what kind of behavior they they they should now adopt. And it's important that some sort of follow up is done so that these cases are not lost to the to the to the general surveillance. So that is something that is still the modalities are still under discussion but I think that is something that needs to be ensured. Regarding the mandatory mandatory hotel quarantine. That is something as countries have introduced as measure for travelers. There it really depends on what situation epidemiological situation is in the country, how big the contribution of such measures to the control of the spread in the country it will be because, nonetheless, even if the people come out of this quarantine, they still have to follow all the measures in the country, not to to to get infected. And regarding the side effects with with the blood clotting. I mean, here this is not our expertise expertise, we do not have the information that our colleagues in the Medicines Agency have so they are right now examining all these cases and I know that their committee, they have given already opinions but they are sort of under constant review with with those cases. Indeed for that, that very, very specific and comprehensive advice. Our director general in the Institute Michael Collins has a question. He asks, has Brexit complicated the work of the agency, and what is the level of cooperation currently with the UK. So, yeah, of course, it has complicated things. That's the bottom line, but I mean, there are also, of course, measures taken for instance the European Commission has granted the UK access to the European early warning and response system so the UK is still able to access all the messages from the colleagues and give their own messages. And we are currently in negotiation with a discussion with the public health England colleagues, how we can set up a future collaboration. That's, yes, that's, that's useful. Could I just add on and add on to that, Dr Aman cooperation. I mean, there are a great many tensions internationally at the moment between Russia and China and the West and other countries. Do you find you have good cooperation on a technical level with the viral agencies in these countries. I know you mentioned you had widespread cooperation with the agencies and you have the the new Africa agreement in 2020 but do are you satisfied that from a technical medical level you are getting cooperation across across the globe. I mean, as I said, we have not no cooperation with every country in the world. But that I mentioned, and especially also with China, which was very relevant here in this pandemic, in particular at the beginning, we have already a collaboration agreement since more than 10 years. And it was, I think the colleagues the technical colleagues there gave us the information they had available. I, for me, it's not possible to assess whether they had all the information available. But I have, I'm confident that what they had available they made accessible for us. Thank you, that's useful. And Peter Hulahan is asking, due to covered lockdown and virus fatigue, are member states in danger of repeated lockdowns for the foreseeable future. What is your, your crystal ball view. Well, I have lost my crystal ball. But I, I believe that after the first wave last spring, and during during the summer where we had really low case numbers countries got a bit too enthusiastic, and they paid high price with with much higher second wave. So some countries are already entering a third wave, but I have the feeling they have learned that this virus is not to be trifled with. So we have to be very, very prudent in easing measures and so that we can actually avoid to have to strengthen them again. 100% guarantee of course because I mean the variants can still occur and we never know what kind of capacities they have the new if they're new ones. And what we will do now and I think it will come out next week is basically a toolbox for member states where they can give their parameters of the current situation, and then see what is the the range of options that they that they can can have to employ, either to go to a lower level of epidemic situation, and what is it that they have to employ when they go to a higher level of the epidemic in a situation, so that they can have this a bit more. I mean it will not be standardized in the thing in the sense that everybody in Europe does everything at the same time in the same way, but at least that the range of measures is the same across the EU we will have to see how how well this is accepted. But when we introduced this a month ago to the concept to the member states they were very interested in this. You mentioned surveillance and digital as being absolutely vital the digital tools being absolutely vital. Are you approaching some sort of level in the EU where everybody will be able to contribute in an even way towards surveillance information, or is the situation very different between countries because this seems to be an absolutely vital tool in monitoring the future. I think we still have long ways to go with this. And some countries are further ahead than others. And here, contrary to some other situations the smaller countries have an advantage, because of course they can roll out things in a in a more standardized way more quickly. But that's what what we are trying to do now to really see with those countries that are willing to participate, how can we use what is available already, what are the obstacles so what do we have to overcome in order to make this useful. So, it's, it will be a process and it will not go quickly. So don't expect anything, let's say by the end of next year that it's already fully fully fledged available, but we have to move towards this. In that context, Dr. Armen, how quickly do you feel the new proposed expansion of legislation for the agency will be passed. I wish I knew. I know the timeframe for the parliament they will vote in June, I think in the plenary. But then it's still the council and they haven't committed yet to a timeframe. And for me, of course, it would be rather sooner than later, but I don't have the final, the final verdict. Yes, because it would seem an important issue to move forward. And then a press question from Kate McCurry, she's the press association of Belfast. And I suppose one of great interest to the population. Can Dr. Armen say when she believes European travel will reopen among member states. Well, that's another crystal ball question. No, I can, I cannot say when it depends on what you mean by reopen reopen in the way as we were in 2019 that will still take some time. We open in a way that is maybe without without all these restrictions, that will depend on how quickly we can roll out the vaccinations and how effective the vaccine protection is in the longer run. Thank you. Thank you. And Alex Conway from the IIA asks, does Dr. Aman have any insights or comments on the Dutch government's recent experiments on safely facilitating large gatherings like festival. Are they realistic or do they pose a risk to public health and the spread. It's a question about trying to get large gatherings safely. Do you have any advice on how that might safely be done. We have not yet assessed that experiment. I understand that there are efforts and wishes, desires to bring these big gatherings together. But I mean we should keep in mind as long as a large part of the population is not protected they always, that is always bears a high risk. Yes, yes. I think that's a good warning and Hannah DC from the Institute asks and what overall timeline would you foresee for the pandemic perhaps five years. Will it be with us is it a type of influenza but more serious. Have you any vision of perhaps how long it might, it might be around. We don't have of course a timeline yet, but we are working right now on scenarios, how the kind of end stage could look like, and of course more favorable and more disastrous scenarios. And so we will start discussing these with our stakeholders are expert colleagues in the member states, and then also discuss with them. What we should do now and should do now today to move to a favorable scenario, because I think, although the measures probably will not be different than what we are saying right. We should also help in the communication that we say look, this is the scenario where we get to. Now the scenarios range from there is no SARS CoV around anymore. Second, it's endemic but controlled by a high level of vaccination with a good effectiveness so that we have to deal with maybe smaller outbreaks. A good scenario is a situation more like what we have right now, where it's going up and down in different countries and lockdown and vaccine coverage for whatever reasons may not be sufficient to actually bring it down. And the fourth scenario is the catastrophic scenario where we say well nothing works and more nobody cares anymore and the virus is rampaging, which I don't think is likely. So be very honest, I don't think it's likely. And I mean the most for me the most likely scenario will be the second scenario where it's endemic, where we have it around, but with a high level of vaccination with good effectiveness of this vaccination of these vaccines. We can maintain a normal life. That's my vision. Yes, well I think as we have reached our time limit, Dr. Amman, that's a very good vision I think on which to end an extraordinarily interesting talk. And on behalf of everybody, I really want to thank you what you have shared with us. And in particular we would like to wish you and the agency very best good wishes going forward in your work. And to thank you on behalf of all Europeans for what you are providing for us and will continue to provide. Thank you again. Thank you so much for being with us today. It was a pleasure for me and thank you for all the interesting questions.