 We should invent more powerful antibiotics versus different pathogens and then we should put them in a closet with a glass cover and only to be broken in case of an emergency but rather not use it because it is the over usage of antibiotics which is now leading again through evolution to resistance and leaves us in a very very vulnerable situation. We have a really interesting topic to talk about here today. It is the next super bug and what does that mean? Well we actually took a look at this about a week ago in the World Economic Forum's Global Risk Report and the new era of biological risk was actually one of the main risks identified for the year ahead. So today we're going to have a conversation about what that biological risk looks like. What are some of the different issues that we should be looking at when talking about solutions and so we'll be looking at different topics in global health security one of which what does it mean if another epidemic is on the horizon? Another what what does it mean we're for rising antimicrobial resistance infections coming increasingly prevalent and the third questions around vaccine hesitancy and what that means for our overall preparedness and response. So I'd like to take a moment to introduce my my guests here today. To my left Dr. Richard Hatchett who is the chief executive officer for the Coalition for Epidemic Preparedness and Innovations Norway. Next we have Professor Heidi Larson who is a professor of anthropology risk and decision science for the London School of Hygiene and Tropical Medicine in the UK and next we have Mr. Lars Sorensen who is the chairman of the board of directors for Novo Nordus Foundation Denmark. Thank you so much for being here with us today. Thank you thank you. So Dr. Hatchett I'd like to to really start start with you and ask you a question that is increasingly on our minds this week in particular the world has seen a growing number of epidemics in recent years Ebola, Zika, SARS and now we're hearing reports of the coronavirus outbreak in China. Could you speak a bit about the likelihood of these events becoming a global threat and and how prepared are we to respond? Well I thank you for the question it's a very timely question obviously with the emergence of the novel coronavirus. I've been working on epidemic threats and epidemic response for about 20 years both in my current role and previously in the U.S. government. I think the the risk of epidemic disease you talked about the increasing number of threats I think that is a real phenomenon I don't think it's that we're increasingly attentive to them I think it's a real phenomenon I think it is related to you know how societies are currently organized in the in the complexity of societies they're the speed with which people move around the world changing modes of interacting with wildlife species climate change as a factor driving the emergence of new disease so I think it's actually a structural threat and it will be a structural threat for the foreseeable future. I think it's also one of a small class of transnational threats that require collective action to be addressed. I think the concern is that the diseases that were that we see emerge have a I would almost say Darwinian imperative to find you know communities where they can break out and propagate and Ebola is a great example. Ebola was discovered more than 40 years ago and there were 20 or 25 outbreaks between its discovery in 1976 and a huge outbreak in West Africa a few years ago and what you saw over that period of time through those outbreaks was a disease that was gradually expanding its geographic range and looking for communities where to propagate and ultimately found in West Africa sort of a perfect setting in which you could have a large explosive outbreak and and now we're in the midst of the second largest outbreak of Ebola ever so the two largest Ebola outbreaks ever have both occurred in the last five years and I don't think that's a coincidence now we're seeing the emergence of a third coronavirus SARS is was the first coronavirus that we had significant concerns about it broke out in 2003 MERS came along a decade later neither of those viruses was very easily transmissible they they were transmissible they caused a lot of disease but we knew that coronaviruses as a class represented a threat to humanity and in what people are concerned about now with the current coronavirus is perhaps this is the coronavirus that we've been fearing which is one that is more easily transmissible than SARS or MERS and with the lethality that is sufficiently high that if it became a globally disseminated disease could potentially you know affect a very large number of people and potentially cause tens hundreds of thousands of deaths or even millions of deaths and that's a really frightening prospect it just to conclude I think we need to acknowledge that these epidemic diseases are in fact a structural threat for the societies that we've created for ourselves and we need to take the appropriate steps to prepare for and be ready to respond to them as just a brief follow-up is there anything in particular that we we can do to prepare for when when and and and if we we see this cross-border flow of of these outbreaks well absolutely I mean I think it requires you know cross-border collaboration it requires you know establishing transparency in reporting as a norm it requires developing new technological capabilities to develop definitive countermeasures like vaccines very rapidly that's actually one of the reasons my organization was set up a few years ago here at Davos I you know I think we know what we need to do the question is whether we have the political will to do it and whether we choose to allocate the resources that are required thank you yeah sure um I'd like to now turn turn to you mr sorenson um to speak we're talking about the these outbreaks and one element of perhaps a response is talking about the drugs necessary to to to actually take take into effect to do something about this um but we're also seeing this growing um case of drug resistance and I'd love to to hear from you you've written about that antimicrobial resistance is actually one of the most serious threats to humanity today um why is it such an urgent threat and what do you think we can do about it yeah it is it's actually just making what we just heard even worse it's it's it's a different set of problems here we're talking about our ability to to combat bacterial infections and I would say so this the epidemic of viruses isn't immediate emergence of a huge threat this is more like a slow-moving tsunami where human life as we know it today might not be the same kind of life we see just 30 years from now the reason being it is is if you think about safe childbirth if you think about uh surgery if you think about uh immunotherapy for cancer and many many of the medical interventions uh that makes our lives longer and more healthy more productive might no longer be possible if we do not invent and preserve new antibiotics and and there is a a dysfunctional marketplace because in reality we would like these drugs never to be used it's like a fire extinguisher uh we should invent more powerful antibiotics versus different pathogens and then we should put them in a closet with a glass cover and only to be broken in case of an emergency but rather not use it because it is the over usage of antibiotics which is now leading again through evolution to resistance and leaves us in a very very vulnerable situation so I think and we can come back to solutions of how we might deal with this I think it's a problem that we can solve I mean I think the epidemic threat might be more difficult to deal with also because the immediate effect is so large but when I think about the climate crisis that people is talking about and think think about the the size of that the complexity of that the cost of that this this this lack of of new antibiotics is something we can fix if we really want it in collaboration but we can come back to the solutions a little bit later perhaps absolutely well thank you so much um professor lives in uh let's turn for a moment to the the social and the political side of this conversation um yeah we really would be helpful to understand kind of what are these factors that help determine how we respond um and I I'm curious to hear your thoughts in understanding the recent rise in vaccine hesitancy and what really how this contributes to global health crises and what you would suggest should should be done to combat that well I think that um there's a few things I mean this societal and political issues contribute to the spread of diseases as much as efforts to mitigate them I mean Ebola is classic I've been working closely with Richard's team on on a Ebola vaccine trial and working on the community dimensions the trust building and whatever and um I think that you know politics is is can be messy and can interfere with efforts to get in to to deal with the situations um but there's something that's even more basic that um is is about just individuals and communities and that's vaccine acceptance and we really were we're slipping in our global um vaccine efforts we did really great I mean when you think about it it's not too long ago I mean in 1980 um we only have 20 of the world's children we're getting the basic six vaccines that's not that long ago and then there was a global concerted effort to get that up to 80 85 uh percent it was amazing but we're we're stuck there and we're actually dropping in some countries and it's almost like we've reached a saturation point and in addition to that in the meanwhile we have a lot more than six vaccines we've got combinations of vaccines we have a lot of vaccines but we also have a much more questioning public and I think that um there's a lot of things that are converging right now that I it's it's about complex threats I mean there's the whole digital revolution that has added a whole level of opportunity on the one hand and yet um threat I mean the global risk report the 2013 one um coined this term digital wildfires and a hyper connected world I've I've referred to that phrase a lot and actually I really like the parallel to wildfires particularly right now when we look at what's happening in in Australia one of the things the physicists and engineers have said about trying to you know analyze these patterns of these new fires and what they've said is they're burning hotter faster and less predictably and I couldn't think of a better metaphor than some of the diseases but also what's happening in in vaccine confidence and vaccine resistance these connected networks of people who are from uncertain to resisting vaccines not necessarily because of the vaccine but because of what they represent they're uh regulated and mediated by government they're produced by big business they're often mandated they have chemicals in them according I mean they're not natural as some of them say when in fact actually I think we need a new brand for vaccine because they actually kickstart your natural immune system couldn't be better and it's not like pulling up to a petrol pump and getting you know a lot of chemicals in your arm it's more like a mosquito bite frankly and it triggers your own system so I think that we need to do much better now before the next big outbreak to get people's confidence back in vaccines because one if we prevent a lot of these currently circulating diseases we won't have to use antibiotics I mean it's one of our best feet forward in mitigating the risk of AMR um when you've prevented in the first place so the more we can prevent these diseases the more we can keep these strong antibiotics in the fire in the break and only in a fire cabinet fire cabinet um so yeah I think that's that's an important we we actually had a panel last year at the WEF on on this whole issue of social media and the loss of confidence and trust in authority and science in general which has led and contributed and this is exactly what you were alluding to contributed to this uneasiness on certain in certain communities of taking uh public health advice and and taking a vaccination and this very sad and and it's it's pervasive it's it's not just in health areas it's a fake news dissemination it seems to more become the norm than than an anomaly yeah and I think Heidi made a very important point which is worth underscoring which is how particularly with vaccine hesitancy but even to some extent with antimicrobial resistance or with epidemics I mean these are kind of represented here these are the three great narratives you know in sort of infectious disease at the moment and then each of them underneath and I think you've you've outlined it for vaccine hesitancy very well brings together a constellation of narratives that interact in ways that are very unpredictable and then you superimpose digital wildfires and social media and it becomes really really toxic and and so you're about to see I would predict with Wuhan you're about to see social reactions that are probably going to be disproportionate to the current threat at least and they're going to cause tremendous damage in much the same way that you see social reactions to these narratives swirling around that's in hesitancy there's also the issue of timing I mean this is happening on the I mean Friday is New Year's Eve for the Chinese this next week is like the biggest traveling time of the year so this could have happened in the middle of the year and it would have been different but the timing of these things is is you know often and that's not predictable I mean also you don't want to have outbreaks or introduce new vaccines around political elections you know I mean there are certain things that you you don't you want to try to keep things as least complicated as possible in DRC our challenge is also there's conflict insecurity we haven't eradicated polio because of conflict insecurity in the northwest frontier in Pakistan and in northeast Boko Hilaram in in Nigeria it's no coincidence that they're harboring the remaining wild virus in the world and by the way polio is coming back you know we've had the the back the Philippines case it's come up now in Malaysia we had a case in Ukraine a few years ago you know this is something we're we're like almost there but it's really such a it's I've been working on polio for a long time I mean I used to have UNICEF's global immunization strategy and communication for introducing new vaccines but also for initiatives like polio and it was we didn't have the security issues that we have now in Pakistan and Nigeria it was actually we weren't even worried about Pakistan we were more focused on a small section in India and a boycott in Nigeria and which we resolved but we wouldn't have been able to do that in the current environment so the other thing is things change things can change your setting if you're you know you do your plans and you know you do your five-year plan and we'll do this then but stuff happens we didn't plan for the digital I mean we didn't anticipate some of the aspects of the environment we're working now when we planned or or produced certain new vaccines and antigens so absolutely thank you so much I think it's raised a lot of questions around around uncertainty and unpredictability across you know across global health issues you know real large in terms of preparing for the next epidemic you know understanding political considerations timing issues and then of course you know questions around well are the drugs we're using today going to kind of work for for tomorrow so I think I'd love if you if you could each share briefly um just a note on on the preparedness aspect how do you prepare for something that is so filled with this this uncertainty I'll start I mean I think in in the domain of epidemic diseases where you're talking about newly emerging epidemic diseases there is a lot of uncertainty you can't predict what the next disease is going to be by definition you can't predict when it's going to happen but you I think you from a preparedness perspective and this goes back to the point that I was making about these being sort of an inherent risk in the societies that we've constructed for ourselves there is a almost an actuarial risk and you know we we saw NEPA in 1999 and SARS in 2003 H5N1 in 2005 H1N1 in 2009 these things you they're all different you can't predict what it's going to be next time but but they're coming along at you know every two to three maybe four years at the outset and the the risk tolerance of society for infectious diseases is has decreased dramatically and part of the reason it's decreased dramatically is because the disruption that they cause because of the interdependencies within society the economic costs have become astronomical in 2015 there was a MERS outbreak in South Korea it caused 186 cases that's a lot of cases it cost 36 deaths but it led to the closure of 2000 schools it led to the disruption of the tourist economy in South Korea it probably caused around 10 billion dollars of damage which is more than 50 million dollars per case and and and so if that's the risk we need to take steps to prepare for it and and even though we can't predict what the next disease is going to be we know what the components of preparedness are and we can invest in the components of preparedness and its surveillance capability its public health capability its laboratory capability it's the ability to rapidly develop new definitive medical countermeasures like therapeutics and vaccines so we can we can invest in those capabilities if we internalize that this is a recurrent risk the problem is that people historically have not perceived the class risk they have perceived the individual events and so when SARS comes and goes away you forget about it when Ebola comes and goes away you forget about it when Zika comes and goes away you forget about it people are not perceiving the pattern and so they're not making the necessary investments I'll just finish very quickly I like to analogize with cybersecurity risk 30 years ago when computers were not connected people tended to discount cybersecurity risk they knew computer viruses existed but you had to insert an infected disk into your computer in order to get the virus so people discounted the risk and they didn't make the investments in cybersecurity in our interconnected digital world now that would be suicidal people have now internalized the class risk they don't know what the next computer virus is going to be but they accept that we have to be prepared for them so they now routinely invest in what's required to be prepared for it and they do patches as soon as new vulnerabilities are identified we need to take that same kind of mentality and apply it to biological risk thank you yeah I was thinking also about um you know fire companies we all think of you know the engines and the loud sirens when there's a fire they're there but that's not the only thing they do I mean fire departments are spending a lot of time thinking about strategies plans and systems in place getting hoses in the right places you know this is the fire box so I think that's a very primitive analogy in a way but I think from a from a vaccine front I mean I mentioned things like that but I'm thinking back about um 9-11 I was in New York that's when I was at UN headquarters we realized that as a UN we were very busy with particularly with UNICEF in being prepared for emergencies in a lot of other countries and our offices they had never thought that something would happen in New York they didn't the heads of agencies across the UN agencies did not even have each other's mobile phone numbers unless they happened to have asked for it we didn't have a plan we didn't have an evacuation plan I mean we had like for fire but there were things that you know you you kind of think it's over there the risk um and just after that we had the anthrax and then there was avian flu and then there was a whole series of things that were like whoa wait a minute and a lot of simulations were going on but I think at a very simple level do you know your neighbor do you know what you would do um if you needed to if all of a sudden because there was a circulating virus you couldn't leave your house do you have anything extra food or water in the house do you know do you have a plan to contact family members or do you have a place you would meet or you know simple things just think about your own situation have you talked to your neighbors do you know you know how you as a family or friends or whoever you're you know something some kind of network the other thing is in we I'm got worried that we're taking down so many phone booths because when 9 11 it hit the cell tower we couldn't count on the cell phone I mean I was lucky I still I still had a landline in my apartment and I happened to be living walking distance I mean I had a lot of colleagues who were really um stranded and couldn't call and phones were down there were landlines so I think we need you know we shouldn't be so dependent on our mobile devices and have a plan B what how what would you do if you didn't have it it was all the lines were cut which is a very real possibility and not just about the connectivity I was at a in a session with the head of the international Red Cross Red Crescent and they were saying for some of these refugee populations that they'll be on the other side helping them move through the one thing that people want to give before they go into an uncertain setting is their phone um only not nothing to do with connectivity they want them to save their data they don't want the the government or the situation they're going through or to to get hold of their contacts so do you have backups for your contacts that aren't dependent on you having your mobile phone do you have it frankly I'm sorry to be so old-fashioned is it somewhere written down or at least the core important ones I mean I think we need this is serious stuff um we need we need to be more uh reflective of what would happen if I didn't have x or the water stopped or the water was the infective agent do we have something else on that happy note yeah well it is interesting I just attended a session uh where his Royal Highness uh Prince Charles was was talking about sustainable uh business community and uh John Kerry the former uh Secretary of State of America was attending and he made the point in terms of being able to deal with the climate crisis that in his view to deal with it we need to be at wartime footing that's how serious he sees this in order for society to develop the necessary technologies to deal with carbon capture and and new technologies can replace the fossil fuels and so in this whole context I would say that that I have a somewhat easier solution to the long-term replenishment of of antibiotics that are not functional today because we've invested 150 million dollars in in trying to develop new scientific concepts and startup companies uh with new ideas this has stranded not because of lack of scientific progress but it has stranded because if we were successful even our foundation and we work together with the welcome foundation uh we would be bankrupted because the cost of developing these drugs through the regulatory phases would be prohibitive and then oh by the way if we succeeded uh there would be no recuperation of investments so what is needed to develop new antibiotics which we can then keep in the fire safe if we have good stewardship would be additional risk willing capital provided by foundations like my own and other foundations from from governments and from the pharmaceutical industry which has even though it is not their responsibility that there's not a market they they have the capabilities of making their resources available to solve a problem where I would advise them to do so because they would be seen as taking a public interest for once and not just a corporate interest and and then we need to have the regulatory process amended and adjusted so that we can have a faster regulatory approval and then finally we need the national states regions to to look at a subscription model whereby they subscribe to the availability of new drugs even though they may not be using them and the companies would be obliged to provide these and have safety stocks but preferably not use them and this is a very simple thing to do compared to the complications that has just been described by epidemics I mean I can only I mean I wouldn't know how to deal with that other than try to work on the plan B that you described already of making sure I have food and water and and my bicycle is pumped and and whatever we can do on our own so the anti-microbial resistance problem can be dealt with and it is not very costly there's just not any marketplace today thank you I know I have many more questions but I'd like to take a moment to offer it up to the audience if we can just take these two questions here and then we'll answer. Mr. Hachet there is also one patient in the U.S. that is also diagnosed at the same disease that's discovered in China so the disease is really like cross-border so given your knowledge about the White House and your background so in your opinion should China and the U.S. work together on this while they've been able to work together on this and if yes what kind of medical measurements they could already possibly take and Mrs. Larson you speak about the individual role in fighting against this kind of a big crisis and we know in China that China has a long tradition of using antibiotics and now there's already kind of like panic that a lot of season will just run out and buy antibiotics which is not necessarily helping with the cost of this specific type of virus so what is your suggestion you know as the individual we could do to help the community in facing this kind of a crisis and Mr. Larson you speak a little bit about the corporate's responsibility already but I still want to know you know like from the corporate perspective what kind of role you think a big pharmaceutical company could possibly take in this kind of a situation you know to ensure the access of medicine for ordinary people instead of just cashing out of the situation thank you thank you let's take one more question now I just want to follow questions about the investment in this virus protecting is there any suggestions to for the you know public sector to follow that you know cyber because it's quite different how to put those pressures on you know in the public who could do those investments government to lead those investments or companies what kind of any you know people would take that option to do those investment we'd like to just start with just the perhaps that final question sure investment protection so I think the the sources of the investment are are necessarily going to be multiple I think there does have to be private sector investment but they're very clearly has to be public sector investment and I think an important source of investment could be philanthropic capital which doesn't have the same kinds of constraints that private sector investment or even governmental investment by elected officials will face I think another very important thing to explore and this is something that has been explored in the cyber world is the regulatory environment that some of the necessary investments in cyber for example have been shifted from the end user to internet service providers or to banks for example in terms of fraud protection by new laws or new regulatory requirements and I think the problem with epidemic preparedness right now is that it is all sort of left to the end user and left to specific individual countries and you need new governance that appropriately moves the incentives to where they can make the most difference it's a complicated story but I think I think you have to have all three sectors you have to have private public and philanthropic capital working together I would argue that governments have the most important role the question that you asked about can China and the US work together you know China was unfortunate in that that's where the epidemic started but it is now a global problem this is not China's problem this is the world's problem and China and the US even despite the current tensions that characterize parts of the relationship both have incredible scientific capital scientific resources and they do need to be working together because they will accomplish much more much more rapidly working together than they will if they continue to think through a national lens and similarly to come back to your question governments have to recognize that individual governments working by themselves will not be able to solve this problem they have to pull their resources and pull their efforts that's actually a fantastic transition if we could turn to you Lars about the corporate side what's the private sector's responsibility and role here yeah I mean as I think I stated the in relationship to the antibiotics market the antibiotics market have collapsed becoming generic and prices have become so low that they cannot profit create enough profit to warrant research activities into new and improved antibiotics so then you ask me what is the role of the pharmaceutical industry so it is not you cannot really directly hold the pharmaceutical industry responsible for taking action but it reminds me of I think it was a quote by Dante that said that in time of crisis the hottest place in hell is reserved for those that remain neutral and and and and this just reminds me of the capabilities that the pharmaceutical industries have they can contribute in both financially but also skill-wise they have the technologies that are required to develop new antibiotics they have manufacturing capabilities they have patents science which they have invested in over time which they consider proprietary which could be bring to the brought to the fore to solve this problem so I'm encouraging all participants in the life science industry this can be other players as well people from the medical device industry others that have capabilities in life science to step forward and help us solve this problem this is I think the least problem that we're facing and Heidi if you if you would give us the final word on the last question on community preparedness I think just your question was Chinese using a lot of antibiotics they're not the only ones but I appreciate what you're saying and and how to deal with how to mitigate the risk of of AMR well aside from I think the biggest thing is trying to prevent the infections in the first place but I also think I mean shifting more to the community role just I think you need people to encourage each other and and this needs to be this is not about individuals this is about you know a contagion this is about the keeping communities alive this is about keeping nation states alive and I think one thing that really concerns me with the whole vaccine hesitancy thing is that it's just a another symptom of underlying issues of the iPhone I I personalization of pretty much everything but that's not the way the world is going to survive I mean vaccines when you think about touch every single life on the planet it is the greatest social experiment in cooperation I mean we depend the whole the whole model of vaccination depends on cooperation so it's really putting us to the test and frankly for any kind of resilience we're going to need cooperation big time so that's my final comment thank you so much to all of our speakers here today if I may put my fireman's helmet on for a moment and try to summarize the topics we've talked about today I think three main points stood out one is preparedness the second is the importance of building trust and the third as you as you put it just now is the importance of collaboration and cooperation so thank you so much again to the speakers and to those of you joining us for this session