 We'll have a little time to delve into some of the details as well in our discussion. But I want to turn it over to Hans Freick, to give us a little bit of perspective on the experiment that we've experienced, that Novartis has kind of been markedly in the drug coartan in the malaria context. Thank you, Quinton. Let me just get this. Yeah, it is here. Good morning. Thank you, Quinton, for organizing this meeting and for inviting me. I'm very privileged to be here. I've been working on this program, the Malaria Initiative within Novartis, for well over a decade, and started really at the time when this was actually a very marginal program. It was marginal at the time. There was a groundbreaking memorandum of understanding in place between Novartis and the World Health Organization, but that was actually a piece of paper. It wasn't really something that had been operationalized in any meaningful way. So the question is, is this a best practice that is scalable and replicable? I put a question mark, really, because you will see that there are a number of points that we learned across this journey that we as a company would not be willing to replicate in exactly the same way. The good news is that if you look at the World Malaria Report, that in the last 15 years, the disease burden from malaria, especially mortality numbers, have come down significantly. Estimates are that more than 6 million deaths have been averted between 2000 and 2015. And a great deal is really thanks to higher rates of international funding, as we also saw, was a key drive in the HFAs programs, but also the work of companies making bed nets, making medicines, making diagnostics. That has really come a long way together with partners in countries to make those available. So for Novartis, the vision is really to collaborate with everybody who has that same vision to end malaria for good. Some people say, in my generation, depends which perspective you still have. I think there's sometimes more optimism than realism, but I think there's a good sense of urgency that we need to make this happen. I need to really go beyond this objective of reducing controlling malaria, because as long as you don't eliminate it, this disease can be around there forever, causing death as it is today. Every two minutes, a child dies from malaria. Can you imagine? It's really simple to treat disease. It's still causing so much havoc. We do this as a company by basically pursuing four strategies. It's making the life-saving treatment quartum available in the right quantity, quality, right packaging, right formulation. Improving access, making sure that prices are right, and we'll talk about that. Supportive interventions with healthcare workers, with disease awareness programs for communities, for school children, disease education, and with an eye to what is going to be needed at some point in time, new medicines because parasites have proven to be able to outsmart any drug that is being thrown at them. Over the years, we've been quite successful in many ways. Novartis was the very first company to come up with an Artemis based combination therapy in one single pill, and I should really give credit to our Chinese partners who are the ones that made the invention, as I would say, a byproduct of the Vietnam War for those who are not familiar with you, but that was really the time when the research in China to find new intramarials was actually kick-started. Over the years, cumulatively, we have supplied well over 750 million coartum treatments. In Europe, there's a European championship for football ongoing, and just to kind of give an idea of what this represents in terms of pills. So 750 million treatments, if you put all those pills next to each other on the green of a football area, you can fill more than 100 football fields and turn them from green into yellow, which is the color of these pills. Or alternatively, if you imagine the Eiffel Tower in Paris and the amount of steel made to direct this tower, these pills weigh three times as much as the steel of the Eiffel Tower. Now, that is for today. We are also having an eye to the future with two molecules currently for malaria treatment in research, in phase A and phase B, and we continue to support malaria teams in ministries of health but also in the health facilities more downstream in the healthcare system to provide support with malaria diagnosis treatments. A number of considerations have really informed our work in the malaria initiative. Clearly, obtaining marketing authorizations with well over 70 countries in the malaria endemic world has been quite an undertaking. In some places, we don't have offices, so we need to work through different mechanisms to try and get that organized. Segmenting the market is very important. We have come to realize that the offering that we initially went out with wasn't really adapted to the diversity of the markets that we were serving. Again, the formulation. We talk about very small pills, but they are still too big for a baby or a young child to swallow. So, as we launched the program, it took a number of years for us to actually improve the formulation to make it really pediatric-friendly as a dispersable tablet that is easy to take and actually sweet tasting unlike every intramural tablet, which is typically tasting very bitter. We also worked on packaging, realizing that the packaging as such is actually a vehicle and can be used in the dialogue between the healthcare professional and the patient or the caregiver as a means of conveying not only when and how the medicine shall be taken, but also why you need to comply to the full three-day course of treatment. Basically explaining very pictorially that even after two days you might find yourselves healed from malaria infection, actually if you analyze the blood, there is most likely still going to be a few circling parasites and those ones you need to take out by taking your third day of dosing. So, very schematically we also incorporate that into the packaging. Tiered pricing. Very important topic. I'll come to that in a moment. The markup in the distribution chain. Challenging, of course, but not only so much that a manufacturer of medicines can actually do to really influence that. So here comes then the scheme that we developed during the journey. In the beginning of the journey, basically the pyramid was much more simplified. It was only a bottom part, which was what we called the public sector, government-led and NGO and donor-funded business. And that was the top part, the premium market where perhaps three to five percent of people living in malaria in the countries can go to purchase out-of-pocket medicines to treat a disease. But in between, we didn't really have the right offering. And so, you know, it was really at some point in, I think, when was it, 2004, that the Institute of Medicine published this report, Buying Time Saving Lives. A program to really get everybody thinking, how can you provide a kind of a global subsidy to then make medicines that are being sold in private sector outlets available to people at very affordable prices? Now, the report has been gathering dust, if you will, for a number of years. It took really until 2010 that finally an experiment was launched to make anti-malaria medicines, particularly in these Artemis and Invasive Combination Therapies, available at an affordable retail price, thanks to initially approximately 90 percent or even 95 percent of donor subsidies. So the mechanism was here to follow. It was a global fund that set aside monies to send to manufacturers of these products, let's say 95 percent of the price of the medicine, whereas then a distributor in Africa would place an order with the manufacturers and would receive an invoice just for 5 percent of the cost of the medicine. The idea then was that the distributor in Africa was able to bring in this medicine at a very low cost and then pass it on into the distribution chain, making hopefully reasonable but not too excessive margins so that in the end, at the pharmacy level, patients could actually buy a life-saving anti-malaria medicine which had the right quality around it for a very affordable price. And so that was started as an experiment in 2010. It has worked or it has not worked. I mean, this depends on how you look at it. One of the shortcomings one could say is that in the private sector still today there is hardly any practice of diagnosing first to confirm your infection of malaria and then treating. So there is most likely quite significant over-treatment. So that's probably one of the downsides of this program. But it allowed actually to serve kind of an emerging middle class of patients that would not want to seek healthcare in a public structure where they might have to wait in line or may not get the right service or they might be confronted with stock-outs. And here they could actually pay out of pocket at a very reasonable price. Now this is basically the overview of the numbers of treatments that we have sold of Covertum over the years. As I said, this Memorandum of Understanding with the WHO started in 2001. There was really no government at that time really interested in taking this type of medicines. Although there was already quite significant concern about treatment resistance against the older treatments like chloroquine and sulfidoxin-paramethamin. But the absence of basically interest to update this type of new treatment was really because there was no donor funding for it. And so the government said, well, we can't really afford to change our treatment guidelines even though in a country like Zambia by then half of the patients that were treated with chloroquine didn't get a cure and went either into severe malaria or ultimately didn't really survive it. So it took in fact that donor funding to really propel the uptake of this type of treatments. The declining trend is really driven by mostly the advent of generic suppliers who have joined this battle as of 2008. Here's actually an example of one of the Covertum packages. It really depends on the body weight whether you take two pills per dose or less or more. But it also has this kind of row here where you see those parasites, which I was just talking about, to really encourage people to take that very last few doses because this is one of the challenges with these type of treatments. They are so powerful and so quick acting that people might want to save them for an infection to save some money. Now coming to some of the key success factors, the key learnings. Indeed, the dual branding, that was what we actually started with. York is also available here in the United States, by the way. You can buy it in small bottles, 24 tablets, for an adult dose. You can buy it in Australia and Europe. And there the pricing is kind of comparable to what you would take if you go to a malaria endemic country, if you would take a prophylactic treatment, whereas this is not prophylactic, this is more a standby treatment. For Western travelers as a safety blanket in case you are somewhere and you think you have malaria and there is no medical care around, you start treatment and you get a diagnosis later. The implementation of the intra-country differential pricing proved very important. We actually had, in some countries, still have today four price points coming from public sector facilities up to the different levels in the private sector. I personally find that it is difficult to maintain those four price points. Three price points are probably more logic to achieve in the long term. The financial sustainability actually has been a huge challenge for this program. I should say that if you really take everything into account, that means also the early work of research and development in the quarter, then the financial sustainability is still not there. 15, 16 years after launch of this program. If you take that out and look quarter by quarter, we have just recently actually been able to pay our own bills entirely. This is the point I was going to make. That's something that we hadn't really expected when we were starting on the program and certainly as we are contemplating for new generation of the millerials, we will have to approach things differently in that respect. Clearly the success factor is the partnerships. We would not have been able to achieve what we achieved with the millerial program without partnerships across all phases in the value chain. Beating research and development. I just wanted to say that, for example, we approved the formulation to treat infants and children with malaria. It was medicines for malaria venture who gave some catalytic funding that also then helped senior management in our company to make the decisions we go and continue to pay for development even though this is not a financially attractive area. Now, over time the challenges and you have seen on that pyramid, we have gotten over the year an explosion of the number of different quart and packaging because we, of course, are serving very different tiers in the socioeconomic pyramid. Then you get the next kind of country customization requests. For example, in Nigeria where the health authority has mandated manufacturers of certain classes of medicines including into millerials and antibiotics to put in a small code or a sticker, kind of a scratch thing that you need to scratch and then a 12-digit number appears which you can then SMS toll-free and then it actually helps to authenticate the products. That comes with the cost, clearly. If other countries would expect the same, this would drive cost up even further. It's also difficult for us to plan all these different quantities of packs. You have less flexibility. There was a time when the Global Fund was just starting with its malaria disbursement practices. Things went very slow, for example, in country one and things went a little bit more smoothly in other countries and so our huge stock, at some point I should say, we had 23 million quart and treatments on stock without a firm purchase order behind it. Imagine the cost and the working capital and the risk of a product that only has 24 months of shelf life. So that flexibility with all those multiple packaging differentiations is becoming a challenge for us. We've also, and that was actually surprising really, seen that product diversion has become a bit of an issue in a number of countries and even counterfeits. We thought we are selling this at such a rock bottom low price but even counterfeiters would move into this market and try to get some margins there. Financial sustainability, as far as a key consideration, the forecasting uncertainty has been very huge and has caused a lot of concern because it's such an artificial market. Ultimately, 90% of the products of the quart and medicines that are being sold are either 100% or around 60 to 70% donor funded. So you get a very distorted way of ordering and supplying in a way. And then the question that we ask ourselves is now that there is much more, let's say, generic competition in the place. What do malaria programs in Africa and what do donors find of a value in our capacity building programs that we offer free of charge alongside with the product transactions? And that is actually something which, at the end of the day, as people say, price is king. And so those additional value programs that we're doing that are costing money don't get as much of a valuation. So these are just a few thoughts that I would like to leave you with, but we remain determined to make sure that no child should die from malaria in the future. Thank you. Thank you very much, Hans. That's terrific. And so now we have two potential models on the table. We have...