 Today we have with us a special colleague and friend, Dr. David Nabarro. He is joined by his colleagues Florence and Julian. I asked David to speak with us today and he has kindly agreed because he has been on the forefront of some of the world's greatest challenges over the past decade. Let me share with you some of those. David was first WHO's Health Emergency, headed WHO's Health Emergencies Group, a place that is in the forefront of things right now. In 2005 he was appointed the UN Senior Coordinator for Avian and Human Pandemic. You may recall, those of you who are old enough, that time when the world was gripped as it is now by that crisis. Fortunately, avian influenza, though very virulent, the mortality rate was about 60% of the people who were infected. It was not very contagious, fortunately. So we came out of that. That was hardly over when the world food price crisis struck. And again, David was appointed the coordinator for the UN system high level task force on food security. Later the world turned to the issue of nutrition, particularly those before 1000 days where malnutrition, if it occurs, can cause irreversible stunting. So he headed up the movement to scale up nutrition. In 2014 he became the special invoiter of the United Nations Secretary General and Ebola. He chaired the advisory group on reform of WHO's work on outbreaks and emergencies with health and humanitarian consequences. He is currently a special advisor to the UN Secretary General on the 2030 agenda for sustainable development and climate change. David is also co-director of the Imperial College Institute of Global Health Innovations at the Imperial College London and strategic director for SD. Recently he was appointed one of six special envoys to the World Health Organization director general. And in this role, David provides strategic advice and high level political advocacy and engagement in different parts of the world to help WHO coordinate the global response. On a personal note, I met David in 2006. He was at the time, as I said, leading the charge against avian influenza. And I worked at the World Bank at that time. As the disease shifted from focusing mostly on human health and turned to trying to deal with the source of that disease, I became the contact person in the World Bank in the Agriculture Department. And there I worked very closely with David for several years. And I've always been impressed with his commitment and zeal. I often wonder how he's able to be in one capital and having meetings all day. And the very next day he's in a different capital having flown overnight to repeat the same purpose. At that time we worked hard to get heated mostly to get every country with a pandemic preparedness plan. And our role at the bank was largely to help to finance those plans. So David, thank you very much for joining us today. I'm delighted that you have agreed to speak with us. We have just under 300 staff online distributed from all over the world. So we'll ask you to speak. And then there is a mentee code, which staff would have received. And they will provide questions, some of which I could moderate at the end of your talk. So David and colleagues, thank you very much for joining us. And let me turn it over to you, David. Thank you very much indeed, Jimmy. I see you there on the screen. I wish I was there with you physically. I was with all 280 connected people. And I'm sure there are more people listening in because I see some of you are together in groups. Gosh, I wish we were together physically. It makes such a difference. But let's do the best we can through this big zoom meeting. And I want to start by just explaining why I wanted to connect with Hillary today. And why I prioritized this above so many other things that were on my plate. Firstly, it's because of you and what you stand for. I think you are a really important organization because for everybody in the world, livestock are so important. They are the source of savings and security, nutrition and well being for so many billions of people. They are the heart of agriculture systems everywhere. And I am totally committed to supporting those who are involved in livestock, whether they are the producers or whether they are the processors of livestock products, or indeed, whether they are involved in thinking through their patterns of consumption. I also want to stress that I'm here because of my relationship with Jimmy. I was explaining to my close colleagues a little bit about that time when we were together when Jimmy was in the World Bank and I was working in the United Nations on trying to make sure that even influenza did not become a global pandemic. We were really scared about this H5N1 virus that an influenza virus that had the capacity to cause great challenges. And we were watching very carefully to see if it moved from sporadic transmission to humans and then even human to human transmission to sustained human to human transmission. It was with Jimmy at a time that was different from now when I was working with colleagues throughout the world to improve biosecurity and understanding within animal husbandry in order to try to prevent the pandemic emerging. And I think it has to be said we were successful, not only in containing the H5N1, but more importantly, in getting a greater understanding about zoonotic diseases through being there at the beginning of the whole One Health movement, which is still available now. It's still there now and I believe personally that the One Health as a way of thinking and working will have a whole recrudescence in the coming months and years as a result of dealing with this current zoonotic disease due to the new coronavirus. That's my introduction. I am going to try to not take too long. It's harder sticking to time when you're on a zoom, not least because you can't always follow the time. So I'm setting my time clock now on my phone, because I want to make absolutely certain we have plenty of time for doing question and answer. And then I want to, in the question answer, I want to be able to weave in some of the points that I might not be able to cover in my opening presentation. In some ways what I'm going to say will be disturbing. In other ways I want it to be hopeful. And so as you're listening, as you sort of, if you're following me, please have in your mind, he's not all doom and gloom this guy. He's not all being a misery. He's got actually some some really positive things that he's moving towards. But let me start at the beginning. Because you will work in livestock, because you're dealing with living creatures, you do understand about viruses, just a tiny bit of revision of the messages that I think we need to tell everybody. The virus has no viability outside a living host, whether it's a plant or an animal, or the human animal, you know, viruses on their own just die. They're just tiny, tiny things containing a little bit of nucleic acid, a membrane and a small amount of tissue within. But basically viruses exist by parasites, by getting into living cells and transforming those living cells into factories that simply reproduce the virus. It's a totally, frankly, single minded existence of virus just wants to reproduce. And so this virus attacks cells in the respiratory tract mostly uses them as their basis for reproduction and able to attack human respiratory epithelia. It's also able to attack some animal respiratory epithelia. But in the human being a Corona virus, which is a particularly beastly form of virus. It's able to cause massive suffering, particularly in people who are not strong. So it attacks those who are frankly weaker, it attacks older people, it attacks people with concomitant diseases, and it kills them. And it kills them really quite, quite effectively. And yet at the same time, it's not very lethal, compared with Ebola or compared with Marburg or compared with Lasser. And that makes it even more dangerous, because when you actually want to have a virus that can really, really cause trouble, you design something like this Corona virus, very stable. Very stable indeed. It's not like flu kind of calming down and becoming softer and less dangerous. Very infectious. One person gets the virus on average. They infect three others under normal circumstances. What we call the R zero is around three and quite low mortality rate one to 2% in most populations. So that means it's a really good candidate to cause a global emergency, a pandemic. It surprises us all the time, because we find that it's capable of causing different kinds of pathology, not just respiratory, but also because it has a rather perverse effect on the immune response of individuals. It also causes a really bad kind of kind of autoimmunity in some people, a cytokine storm, a disruption of the kind in bradykinan system, and it can lead to widespread clotting inside the body. So as well as causing a respiratory disease, in some people it can cause central nervous system disease. It can cause renal disease and it can cause cardiovascular disease, fortunately, not in many cases. And then we're looking at the virus and its capacity to affect children. Again, not very serious, but it worries us. So my starting point is it's a dangerous, stealthy, surprising virus and it's here to stay. It's not going to go away. So what have we got to do? Us humans, we've got to learn to live with it in our midst. We've got to learn to understand it and we've got to learn to act in unity. And I want to stress this, in unity, so that the human race can continue to have our businesses, to have our livelihoods, to have our social lives, despite the fact that the virus is in our midst. And this is a massive collective learning experience for 7.8 billion people and it's got to be done quickly. And right now, my job and the job of others working in the multilateral system, working with the World Health Organization and the broader multilateral agencies. Our job is to try to find everything possible to get collective learning, collective understanding, collective action that works in the interests of people everywhere. So number one, what do we need to do to live with this virus? Answer, when it appears in any community, as soon as we've found it, we must do everything possible to prevent outbreaks from building up. And that means finding people with the disease who've got the virus on board and asking them to stay away from other people and finding those with who they've been in contact since they started getting the disease and getting them to stay away from other people. It's basically interrupting transmission through case detection and through isolation, through contact tracing and through isolation. Not very nice. People don't like it. But what we've seen from countries that have been able to learn to live with this virus, like Vietnam, like Singapore, like South Korea, like Germany and Austria, is that this ability to quickly detect and to isolate if it's done right at the beginning of an outbreak, right at the beginning, if it's done well, can actually create the situations within which normal economic life can continue. Now, you will sometimes get outbreaks building up, as is happening right now in Singapore in the guest worker dormitories. It's happening right now in South Korea as a route of people coming together in nightclubs. And then what you do is you do a localized movement restriction. You contain and suppress the outbreak through detection and isolation. But if you can do it localized, then the rest of life can go on. And this is so important for everybody to understand. If you get yourself organized, the rest of life can go on. So why is it for the world imposing lockdowns? Quite simply, because they didn't have the capacity for case detection, but isolation and for contact tracing. And that's the primary defense against this virus. And so what they decided to do instead was to restrict movement as much as possible, so as to reduce the opportunities for the virus to be transmitted. And to do that through physical distancing. And the physical distancing, when it's done very intensively, involves doing something called a lockdown. But a lockdown doesn't stop the virus. It just freezes it where it is. You still got to have the capacity to interrupt transmission, because once you lift a lockdown, then the virus will start doing its mischief. If it will start transmitting again, you will get new outbreaks. So within the World Health Organization, we are working tirelessly night and day to push across this message. Living with this virus means being able to interrupt transmission and then being able to suppress outbreaks when they build up. And doing that means everybody's got to understand about this virus and the way it behaves. Everybody's got to be supported through a really well functioning community based public health network with the capacity for testing, tracing and isolation. But there's a problem, and that is over the last few decades, investment in public health has dropped. Instead health budgets have been put into hospitals and public health has been the poor relation in health. And that we're unfortunately now facing consequences as a result of that. Countries that had a coronavirus infection in 2003 that caused a disease called SARS knew what had to be done. They put their community based public health into place during SARS and they did it quickly. And then that was effective. And that's why they are doing pretty, pretty well right now. China had SARS. China knew what to do when the virus was suddenly recognized in Wuhan early in January. They closed the city down. They built up public health. They repurposed their hospitals so that they could cope with cases. And the whole of government moved to ensuring that that isolation capacity was there. But other countries, although they saw what China was doing late January and early February did not follow suit. In Western Europe in particular that he confused coronavirus with flu. And they were slow. So what happened, because this virus spreads exponentially, because it spreads exponentially, they had major, major problems. And so we've actually got a huge amount of virus all over populations in Western Europe, all over the United States. And they are in a very, very difficult situation, because as they release their lockdowns because of public pressure to keep the economy going. And they are going to have recoup distance of the virus in large numbers. But in many developing countries in India, in many countries in Africa, in Pakistan, in parts of Latin America, this capacity to contain the virus and the introduction of movement restrictions has actually put them in a much stronger position. This is the moment when poorer countries, by actually following the learnings from East Asia, are likely to do better. It's going to be difficult because again releasing the lockdown for example in India. It's going to be tough because the moment the virus is spreading in dense urban populations. For example Mumbai, New Delhi, Ahmedabad, Chennai, and the like, and getting it properly contained in these settings is really, really hard. Just to finish my remarks, it's a false choice to say public health versus the economy. The right solution is to say, put the public health in place, then the economy can recover. It's a false choice to say surveillance versus liberty. You're going to have to have tighter population surveillance in order to find people who are sick and to make sure they isolate. And that will lead to liberty. But you can't get on top of this virus if everybody can just do what they like and not worry about whether they've got this disease. It is going to be a disease that affects poor people the worst. Poor people live in circumstances particularly in cities where it's really hard to physically distance. It's really hard to go about protecting ourselves. And so what we're saying to everybody is look after the inequities. Be careful in food systems because they are really straining because of the control of this virus. Be careful of people who work in really difficult employment situations like in meat processing plants in industrialised countries where people are in cold and pushed together. We have coronavirus outbreaks in meat processing in so many parts of the world. Be careful of people who look after older persons in residential care. They seem to be at a particular risk and they're patients at a particular risk. Protect the health workers. Don't steal the PPE away from them and store it in stocks in rich countries because poor health workers in poor countries really need to be looked after. And be careful in places like prisons or in ships where people are crammed closely together often with bad ventilation because they're at risk of COVID. Last point. COVID is giving us a chance to understand some of the inequities in our societies and to see how serious they are. COVID is giving us a chance to reimagine life in a way that creates greater dignity and opportunity for people everywhere. COVID is giving us the moment to think about food systems and making them more equitable, better for farmers and better for hungry people who suffer from food insecurity and malnutrition. COVID is giving us a chance to reimagine how we work in our countries and to get better unity of purpose between different parts of government because political disputes create space where COVID can roam around and cause trouble. COVID is giving us a wake-up call on the importance of intergovernmental working and unity of purpose across nations. And it's showing us that simply bickering between countries just creates too much opportunity for the virus to cause problems. COVID is giving an opportunity for the human race to show what it's capable of in dealing with a new enemy that we've only known about for five months. And will give us the strength to focus on inequities more broadly, to focus on the destruction of nature, to focus on climate change with much greater and stronger purpose. COVID is the opportunity that many of us believe was there, waiting for humanity to demonstrate its strength. And of course we can mess it up, and we can see leaders all over the world who seem to determine to mess it up. But people like you working in Illry, working for people who depend on livestock for their livelihoods, you are part of the force that will be for good. And I am absolutely confident because I'm a stubborn optimist that will come through COVID as a much better human race than we were even six months ago. And I thank you for the chance to talk with you today. Thank you. David, thank you so, so much. Direct, clear, realistic, but hopeful in the end, an opportunity for all of us. It's difficult to feel questions with over 300, nearly 350 people, but we have been asking people to send their questions in through Menti, and there are several on screen. First one, David, can you respond to, is antibody testing useful? Is herd immunity going to mean anything? Is there herd immunity? Great. So number one, yes, people develop antibodies after infection with this virus. Antibody testing therefore is useful for finding out who's been infected. Just recently we've seen some very reliable new antibody tests come on the market. And so this is really useful for epidemiology, but it's not useful for finding people who are at the beginning of their infection at the time when they're most infectious, because the antibodies only come up after a few days. So antibody testing for epidemiology for finding out people who've been infected, but not very useful for finding out people who are infectious. For that you need virus testing. Immunity after infection? Well, yes, antibodies develop, but do they protect the person against reinfection? It's not 100% clear. Currently, my public health colleagues who are studying these things estimate that there will be some protection from reinfection, but they're not sure everybody is protected from reinfection. They're not sure that if a person is exposed to a very high viral load, they will be protected. This has implications for the development of a vaccine. Is a vaccine going to be effective? Yes or no? Not sure. One additional problem. The virus causes a disease, but sickness and the degree of sickness is also partly influenced by the way in which the individual's immune system responds. In some people, it seems that the immune response is so strong that it actually itself causes illness. And there seem to be some differences between ethnic groups on that. We're still learning all that. Now, there is a report just come out saying that there's quite widespread transmission of the virus in some African countries, but the actual level of disease is low. I hope this turns out to be true, because it may well be that the actual way in which the host responds to the infection in some African communities is much more potent and powerful, which means that they're less likely to die. And if that's the case, there will be a huge advantage for African people in African populations. At the same time, we find in the US and in the UK, the people who are non-Caucasian, particularly people who are originally from African descent, that they seem to be getting it much worse. That may be because they've got diabetes or it may be other cofactors. So there's an awful lot to work out on the epidemiology and on the immunology, on the host response, as well as on the way in which the virus causes disease. And to many of your questions, I will have to answer, we're hedging because I'm uncertain, but those of you who understand about the natural history of viral infections, then to understand about the epidemiology will perhaps accept the fact that I'm just simply saying, this is what I think, but I'm expecting that my own knowledge will change over time. Back to you, Jimmy. Thank you, David. Yes, it's fast evolving. We're having a difficult time catching up with the news every day about the dimensions of this. There was another question that I noticed. Is it inevitable that everybody will get this disease in the absence of a vaccine? So what we're doing is just slowing down the rate at which people get the disease so that medical services can cover them. So I'm not, I'm not actually convinced that it is inevitable that in the near future, everybody's going to get the disease because of the way in which it's transmitted. Droplet spread. It's just me trying to not talk about it. Droplet spread. And meaning that it's really only transmitted through close contact means that it's unlike airborne viruses, it's, it's person carried viruses. And that means that as an outbreak develops, it's really through person to person contact. And so even though there's been a lot of cases and a lot of deaths, for example, in northern Italy, serological services surveys suggest there's still an awful lot of uninfected people. Over time, of course, more and more people will get the disease. Over time, we expect that there may be a buildup of immunity among the wider population. But right now, there are so many uninfected people that we're saying, don't rely on the buildup of population immunity and use that as your basic control strategy. Instead, maintain a strategy of constant defense through interrupting transmission and suppressing outbreaks, not least because if you do get the virus going far and wide, at least in, say, temperate communities like in Europe and in North America, you will get a very large number of people dying or getting complications while they survive. But herd immunity is not a satisfactory strategy. And I don't think that I don't think it will be a quick process of more widespread development of population immunity, Jimmy. Thank you, David. You recall each one and one, so-called swine flu, and the eventual emergence of a vaccine. But at the time, people like you and us at the bank working on this found that most of the developed countries hoarded the vaccine when it became available. I hear roughly the same discussion about squabbling about who will get a vaccine or vaccines should they emerge. Do you think we can resolve this question so that if a vaccine were to emerge, more equitable distribution can occur than was able to be achieved during swine flu? Jimmy, it won't surprise you when I if I tell you this that, of course, within the World Health Organization, there is a huge amount of emphasis on equity, equity on protective equipment, equity on testing, equity on access to treatment, equity on vaccines. And of course, that's what most nations are working for. And we've got the organizations now that can make it happen. The global alliance on vaccines immunization is an equity focused organization. But we're so dependent on the behavior of the member states. If they are prepared to come at this and treat it as a global issue, and to recognize that vaccines, when they appear, are going to be most important for people in resourceful settings, then we have a chance of an equitable approach. But at the same time, we've seen even on masks and protective equipment for health workers, there has been stockpiling in the end. Please go ahead. In humanity's ability to deal with this is going to depend entirely on the extent to which there is international solidarity. My plea is to the people of the world to use their power as citizens to demand world leaders to actually get a grip and to behave as though they're leading for the world, rather than leading for subsets of their own populations. Because it's only through global collective action that we will be able to have an equitable approach to this vaccine. And the signs are bad at the moment we saw probably some of you saw story about a French based vaccine manufacturer saying that it was going to give its vaccine first of all to the US seem to be based on commercial considerations. We've got to move away from that sort of stuff. Got to have an approach that treats the vaccine as it arrives as a common good, rather than something just to be taken by those who've got the most money. I'm working flat out on that Jimmy. So many people, but we need a mass movement of global citizens, the demand of their leaders to properly properly, and not simply just to behave as though they're leading just for those who vote for them. Thank you. Thank you much. David a question here. Have there been any cases of reinfection. Do we know of any. So there was some reports from Republic of Korea, the people who had tested positive, been infected then tested negative and considered cured, and then a number of them tested positive again. And there was a question as to whether or not they were reinfected, or whether perhaps the test results were wrong, or whether perhaps there was infection, and it gone away and then virus had hidden away somewhere in the body, and then to come back again. I think that it's more likely to be the third one, that this is recrudescence rather than the reinfection. We saw that with another virus disease with Ebola. Towards the end of the West Africa Ebola outbreak in 2015, suddenly new cases emerging who had actually been diagnosed before. And then we found that the virus had hidden away in cystic form at the back of the eye or in other parts of the body. So I kind of suspect that it's not reinfection that is recrudescence and it looks as though it's possible. Okay. David you said that we have to learn to live with this virus. So for Ilri for example, we're all working from home, except in a few places like Vietnam which is reopened and you may have seen that they can gather together in their conference room. I could see them on screen right now. But there are not many places like that. We're still working from home and we're thinking about how we might live with this virus and get back to work as normally as we can. You suggested that the way to deal with this is obviously to detect very quickly, trace those contacts and contain. Could testing become something that you can do at the workplace? Would big companies or like people like Ilri which has the capability use testing as part of the management strategy for opening up? What are your thoughts? Thanks for that question Jimmy. I'm working with a number of businesses who are looking at this as part of their own strategy for helping their workforce to stay safe and for actually creating the conditions for return to work. And in theory it's a great idea. I think there's one practical challenge and that is that if you adopt a very different approach from the country within which you're working, there could be some perhaps discomfort. And so I would ask people to think through very carefully whether or not they're adopting a different process for their own staff from what's happening more broadly in the population. You're quite right of course Jimmy that Ilri has the capacity in many of its laboratories to do PCR. But those of you who don't know about it, just let me say the only way in which the virus at the moment can reliably be detected is through doing a deep nasal swab or a throat swab and then subjecting the product of that swab to a technique called polymerase-trained reaction which amplifies the RNA in the virus if it's there and then detects it using a variety of chemical procedures. It's not an easy test to do and that's why it's not widespread throughout the world. It's why it's proved so hard in many countries to ramp up testing to the level that is necessary. One of the things that I'm very keen to see developed is a new kind of virus test that's much easier to do. It doesn't require so many steps in the process and that could perhaps be done more locally for example in a factory or at an airport security. And there are new techniques beginning to emerge what's called lateral flow immunoassay where the virus is coming onto a piece of strip and then there's an antibody on the strip. And when the virus and the antibody meet and connect then there's an electrical signal produced which changes the color in a compound nearby and you can quickly detect whether it's there. If such tests become available Jimmy then I actually believe we're going to see virus testing much more widespread in factories, in hotels, in airports and that will radically change the way in which we're able to move around. Because once we can be sure that we can find people who've got the virus and get them looked after and then it's much easier to go about normal business. In the meantime, learning to live with the virus will mean physical distancing where possible, base protection where appropriate, protecting those who are most vulnerable always and then being able to respond quickly when there's an outbreak. And testing will be part of that there to be a constant struggle because of the difficulties of doing PCI. What is the future of low income countries given the lack of capabilities to implement recommended restrictions you touched on this, David. And I suppose if they're not able to recommend to implement the recommendations as well as richer countries that means higher exposure and so on, but this might be mediated by cultural and ethnic and other factors. How do you think countries like Africa will respond? Do we expect to see bigger flare ups? We've been wondering why we've been seeing so slow progression of the disease in Africa, even though in several places there have been very minimal efforts. For example, we understand that Tanzania has done nothing about lockdown and all this and how do you see the developing world responding to this? Thank you very much, Jimmy. So many unanswered questions, so much work to do. India is struggling, particularly in urban areas, whereas in the rural areas, they've got more than half the districts without virus. In Africa, so far reports are suggesting relatively low mortality compared with the amount of virus. But whilst that might be good for African people, let's keep focusing on that. It's not good for African countries because whilst within a country, the mortality might be low. What's going to happen is that other countries, if they know the virus is circulating within a particular nation, other countries may be thinking twice, three or four, five times before encouraging immigration or visits from a country where there's a lot of virus. And so the thing that most concerns me for poorer countries is that they might end up being discriminated against when it comes to the resumption of international travel. If you've got a strong public health system, then you can keep the virus at bay and you can stop circulation. And then a kind of bubble can be created so that your people can travel to another country with a similar capacity of keeping the virus at bay. It's already happening, looks like, between Australia and New Zealand. So for me, poorer countries need all the help that can possibly be given to reinforce and reestablish and then build up their public health services to keep the virus at bay. They need all the help they possibly can to be able then at the same time to stop their businesses and institutions from being without resources. And then they need all the help that they can to be able to negotiate to have access to other countries, perhaps wealthier countries, that are more easily able to hold the virus back. I think we're going to have some big, big challenges in the coming months to reestablish international relations without there being discrimination against poorer countries. I'm more inspired now than ever before to fight for health equity, to fight for support for decent quality public health in poor countries. And it's particularly important, given that as we are starting to talk about, poor countries have acted very quickly to get on top of this virus, whereas a number of rich countries waited four or five weeks. And there are some signs, as you've just said, that in Africa at least, that virus is not so serious as a cause of disease as it is perhaps in Europe or the US. So lots and lots and lots of issues to do with trying to maintain equity between rich world and poor world. I hope that's clear. Quite a lot of complex ideas and what I just said, and I'm not very clear in expressing them, but the underlying messages I and many others who are working in public health are more focused than ever before on making sure that poor countries are not further disadvantaged as a result of this virus. David, we've kept you longer than we had told your staff we would, but if you would indulge one or two more questions and then we'll let you go. Shirley is going to ask one from the screen that is scrolling. Hi, David. Thank you so much for this. We've seen several questions scrolling past that are asking about other potential cures. The Madagascar tonic is being mentioned quite often. Would you like to comment on those? Yeah, I mean, of course, we're all hoping beyond the hope that there's a cure that can be found. And so we know that hydroxychloroquine and chloroquine have mild antiviral activity. It's something that's all of us have known about for a long time, but it doesn't cure. We know that Remcidivir, as you mentioned, Jimmy has some capacity and perhaps leads to some cure, but it's not universal. We know that one particular leader is promoting an Artemisian-based tonic. We don't know how effective that is. So what many of us are doing is saying, let's hear the results of all trials. Let's have them reviewed, peer reviewed. Let's recognize that we haven't got time to do proper randomized controlled studies, but we can at least do observational studies and case control studies. And let's try to assemble all the evidence that's available. Let's not be biased in any way. But at the same time, let's be honest, hydroxychloroquine is not a safe drug. It can cause arrhythmias and other problems. And there has been some conflicting evidence as to whether or not it really works. There's a virologist based in the south of France who believes in it and is talking about it a lot. But there are other studies that suggest that hydroxychloroquine is less effective and perhaps not effective at all. We keep an open mind. There's a completely different approach to treatment that I just want to mention, which is if part of the disease caused by the virus is due to the response of the individual, their immune systems overreacting, perhaps there are certain medications that may tame the immune response and make it less violent and perhaps they can be helpful. I'm beginning to see some interesting results that statins and what's called ARBs might be useful because they modulate the immune response. Again, they are early stage, but surely I have to stress we don't yet have a cure that's a definitive cure. Even though we see lots of claims, particularly on social media, none of us in the WHO is able to put our hand on heart and say we've got a cure that works. But at the same time, we're not being biased. We're totally keeping an open mind. And if any of you hear of anything that sounds absolutely amazing, please let us know because that matters. Thank you very much. Okay, if you'd let us have one more question, we'd like to explore a little bit more the One Health. You mentioned it, Jimmy mentioned it, and it seems it's been really well recognized. Ilry itself is pursuing a One Health approach. But what do you think are the broader global and institutional pieces that need to be really looked at to make that work? I've always believed that we need to bring together environmental health, veterinary health, and human health into a single overarching discipline, the One Health discipline. And I've always advocated for it. There are challenges. There are cultural differences between the health specialists in the different communities. But it's time to put those aside. And I believe that we're going to see a really massive resurgence of interest in One Health. I encourage everybody in Ilry to do three things. One, to use your knowledge of biology and animal health to make certain that we're all learning from examples that you've got of viral disease in animals to apply and to think through when we're talking about humans. Number two, to be advocates for the One Health movement, because it's so important within countries. Number three, never to feel depressed about some of the inappropriate remarks and claims and pushing around livestock and the value of livestock to humanity. It's so important that we continue to stress that from billions of people in our world, livestock are a vital, vital source of the basis for their well-being and also a key contributor to modern sustainable agriculture. And let's keep working hard for a proper approach to livestock in our world. And let's make sure that Ilry and Ilry's people are able to be strong and active for the future of livestock and for the future of One Health. Thanks for the chance to be with you today. If there's any value in remaining connected, Shirley and Jimmy know how to get hold of me. And I'm very, very happy to be an ambassador for Ilry as much as I can and for what you stand for, because I believe in you so much. Thank you very much. Thank you very much, David, and for your colleagues. Thank you so much. Thank you very much. Thank you.