 It's the access that it gets us to important stakeholders that we would not have had an access to before. I think that in and of itself has been so huge and transformational for us in startup. You know that these are some of the top people in the world that you can connect with to try and identify people who get the paradigm shift and who've placed that at the heart of their strategy, whether as a business or a foundation, but really place that internet strategy and not as a peripheral thing. I think that's really where the value is for people like us at DeSolanator. I think the uplink connection has been huge for us because we always have international ambitions. You're always hoping to gain some connections with World Health Organization and get introduced to different health care systems and I think like uplink has done a great job with the excellent process. Being part of this cohort has been absolutely amazing in making sure that we are in touch with the right people again at the right time and ensure that our technologies and services are able to not only help with COVID-19 but in any way that we can impact the overall scientific and medical community. I really think that uplink has the opportunity to do a tremendous amount in connecting in supporting entrepreneurs who really are the vanguards, the entrepreneurs, the ones who are out there pushing for change and reimagining our world. It has to be important stakeholders that we would not have had an access to before. I think that in and of itself has been so huge and transformational for us at Sata. You know that these are some of the top people in the world that you can connect with to try and identify people who get the paradigm shift and who have placed that at the heart of their strategy whether as a business or a foundation but really placed that into their strategy and not as a peripheral thing. I think that's really where the value is for people like us at the Solonator. I think the uplink connection has been huge for us because we always have international ambitions. We are always hoping to gain kind of some communication connections with World Health Organization and get introduced to different healthcare systems and I think like uplink has done a great job with accelerating that process. Being part of this cohort has been absolutely amazing in making sure that we are in touch with the right people again at the right time and ensure that our technologies and services are able to not only help with COVID-19 but in any way that we can impact the overall scientific and medical community. I really think that uplink has the opportunity to do a tremendous amount in connecting in supporting entrepreneurs who really are the vanguards, the entrepreneurs, the ones. Welcome everyone. Today you're joining us for the Davos Agenda of the World Economic Forum and you're joining the panel called Building Crisis Resistant Healthcare Systems in a Post-COVID World. I lead the Access to Medicine Foundation and I'll be moderating the session today. Tomorrow we'll be launching some more results of the Access to Medicine Index on how the pharmaceutical industry has made enough steps to address some of the issues of access to health globally and how they enable or hurt health systems with their actions. But today we're going to discuss resilience of health systems so please join me in giving a warm welcome to our panelists. Let me introduce them real quickly. Jeff Martha, who's the chairman and chief executive officer of Metronic. Helen Clark, who's the Prime Minister of New Zealand from 1999 to 2008 and co-chair of the current independent panel for pandemic preparedness and response. Frances de Souza, president and CEO of Illumina and Mark Harrison, who's president and CEO of Intermountain Healthcare. Now many of you, welcome to all. So many of you would appreciate that the issue of importance of crisis resistance health system has been extremely acute in the past few months to a year. So today we're going to discuss a little bit more about what does it mean to build healthcare systems and strengthen them as we're learning from what COVID has done to our systems itself. So to kick off today, I wanted to kind of reflect a little bit about the parallel session we had this morning. Some parts of this morning covered key issues on how we need to see health as an asset, improve trust and collaborations and prevent the most vulnerable populations left behind. So carrying on in that front, we're going to discuss today a little bit more on some of the core elements that make systems resilient. So just to kick off, Helen, maybe tell us from your experience what do you think are the core elements that make health systems resilient and how can we invest in health systems differently to ensure that these are more crisis resistant? Thanks very much. And my first point was going to be that often discussions on resilience are quite theoretical discussions but sadly we have a very real life experience that we're all living through now where we see that our health systems weren't particularly resilient at all in so many cases but we also see that the situation we were confronted with needed much more than health systems per se to be performing to be able to respond well. So the key thing now and I think this is also central to the concept of resilience is to learn from what has happened so we can be better prepared if and when this happens again. Now investing in resilience in a system, investing in preparedness for what might happen is a bit like attending to the dog which may not have barked. This dog has barked very, very loudly but often I guess when health ministers are lobbying for scarce resources in a budget the attitude may be well it hasn't happened so why do you need to invest in this? Well we now know that being prepared is absolutely critical and part of being prepared for the kind of shock that our health systems and our societies and economies have been going through in recent times is we do need flexible planning around adverse events. In this case a pandemic we need foresight in our health systems and our governments to be able to envisage what the possible threats and risks are and to be able to plan and mitigate around those. In the case of this current pandemic the number one objective has really got to be to try to curb transmission but so many systems have got out of the way of talking about and communicating with publics about the most basic public health measures and to have a system that can really perform in these circumstances and engage public, consistent messaging, good communication, clear leadership. These are so important and they may not be health specific but your health system won't be able to perform if it's not reinforced by all of that. So I think one thing we've very much learned out of this pandemic is a resilient health system has to be one of those characteristics. It has to maintain other basic capacities to test, to trace, to quarantine and now we'll be faced with this huge exercise of mass vaccination on the scale not seen across age groups as well. So all of this I think has been very taxing for our health systems as well and don't have time to go into it now but we've seen in the response how important universal access to services is. Universal healthcare is important but insufficient in itself but if you don't have it and you're faced with circumstances like these, the most marginalised will miss out and that will impact then on the whole society because none of us are safe. None of us are safe until all of us are safe. I think we've also learned a lot during this pandemic about the need to plan for health system or health service continuity because when we go full trust after a pandemic other services can fall by the wayside including in the wealthiest of countries. So much to learn from that. We've learned that vulnerable populations need access to social protection otherwise it's hard to observe some of the strongest provisions like lockdowns. So as I said often we can have theoretical discussions about resilience but this real life experience has caused us to zero in on what are the whole range of factors which would make us more resilient to the kind of extraordinary shock that we've been living through. Great thanks Helen for this. I mean just a quick follow up on this. The panel has received numerous urgent requests from prioritising vaccine delivery and resource poor settings and issues like the lack of medical oxygen which is an essential medicine in name has been already a problem for many years exacerbated by the COVID-19 pandemic. From your experience how can governments engage the right partners to solve these issues when they're in the middle of a crisis? I mean becoming less dependent on goodwill of others and have more security of success. One of the learnings from this has to be to be prepared on an ongoing basis. I actually think every country should be doing the sort of review that the World Health Assembly has asked for of the internationally coordinated response because we just weren't ready in so many respects. It's very hard to build those relationships when you're on the run. What I would say is there has been a tremendous amount of goodwill from private sector, public sector, third sector, fourth sector to come to the party and help in the middle of a crisis. But it's been responses had to be very rapidly assembled. I think we need to go back and look at what's the long-term planning here? What relationships do we need to deal with the worst that life can throw at us? I think that you've touched on an important point that the agility is something that we've counted on in order to address this particular response. Jeff and Francis start with Jeff for addressing this. We've seen numerous initiatives that have emerged in response to COVID-19. How has the private sector engaged in this response, including your company? And how can we transform its to a more sustainable approach so that we're more future-proof when it comes to improving health systems? Sure. Well, I'll hit on a couple of points that I think are obvious. And there's some great examples. And then a few that may not be so obvious. The two that jumps out, you mentioned agility. I'd say agile innovation is one area where the private sector really helped. I mean, obviously the whole story about the vaccine is the multiple vaccines and the speed in which they were developed is truly amazing. Beyond that, in the sector that Tronic plays in medical technologies, there was again innovation played a big role in developing, I'd call it like remote and virtual capabilities and enhancing those very quickly. Whether it be for patient monitoring in and out of the hospital, device management, whether it be remotely managing ventilators which we manufacture from outside of the ICU. So health care workers don't have to enter the ICU to remotely managing patients that have medical devices to keep them outside of the hospital. So people with pacemakers and implanted defibrillators that normally would have to come into the healthcare system every couple months to get the devices checked or reprogramed to do that remotely, so to keep the hospitals free of these types of patients so they can be able to COVID patients. And also, remote training and medical education doing this virtually, and things like getting back to the ventilator example, creating training venues, virtual training venues so healthcare workers knew quickly how to work on all types of ventilators because they were working on new ventilators in many cases they weren't trained on. So I'd say Agile Innovation is a big one. Second one is supply chain working with, there's a lot of work that went on in the private sector, working with governments to keep supply chains open. Some of it was advocacy and explanation. For a while there, on the ventilator side of things, there was a period of time back in April-May where governments were considering not just behind states but also in Europe, some nationalistic moves that would have really hurt the movement of ventilators around the world and I think industry helped to keep those, through explaining the impact of what those would do, keep the supply chain about the borders open. And I think just collaborating across different industries to help the supply chain, to source critical parts that were in short supply or creating surge capacity like in the case of working with contract manufacturers to create surge capacity. And again as the Prime Minister said before, it's hard to do this when you're on the run and it would be better to do this in advance but we were able to quickly create not just improve the production of ventilators by five times in just a matter of months but within our own walls at Medtronic but working with contract manufacturers to increase the capacity of orders of magnitude. Or like working with companies that aren't healthcare related like SpaceX for example to source critical parts for ventilators. I mean they're definitely a unique bedfellow for medical technology but it worked. And so these are things, the innovation, the supply chain, not just ramping up the capacity but partnering with other companies even outside of healthcare to improve supply chain and provide surge capacity. And then areas that I think that weren't as well discussed during the pandemic was just even the allocation of supplies and equipment. Doing this based on need. I mean they're really during the pandemic even within countries it was difficult and working across countries was there was really no, they're really at least in the Medtech space there wasn't much in the way of help if you will from the international governments to help make these supplies. And so I think private sector is a good job doing this and doing it based on need and filling a gap that was there. And then finally distribution. We've got field representatives all around the world and every hospital and it may not be the most efficient way to do it but it is agile when you are in a crisis getting these critical supplies down all the way to the patient at the right time industry played a big role. So there's a lot of areas and I think going forward though and the Prime Minister started with this in her opening remarks was in a trust and collaboration to make this more resilient. I do think we need industry and public sector and the health systems need to work better together. And I think industry needs to be part of the conversation earlier on. We've got to break down what I would argue is still a bit of a trust barrier and really move to a short list of partnerships versus a list of long list of vendors because in a crisis the vendor transactional relationship doesn't work. And so look I think the different segments whether it be a hospital and an industry player like Metronic and we've got to start communicating on a more strategic level versus through RFPs. And finally I do think as we move forward we're talking about continuing to prove outcomes, continuing to lower costs and at the same time improve access. Technology is really the only way you can do this to do these what seem to be diametrically opposed forces sometimes. Technology has to be part of the answer. So I think going forward technology, partnerships with industry you fully leverage the technology to drive these three things at the same time. Great thanks Jeff for this. Francis what are your thoughts on this and how do you actually transform some of the efforts that you've been making into a more sustainable approach especially when you think of other companies around this sector? Yeah this pandemic has highlighted that a deep and effective partnership between the public, private and not for profit sectors are essential for successful global health. The private sector brings a number of things to the equation specifically innovation especially around technology, the agility in deploying that innovation expertise and also just experience. We had work in over 130 countries around the world. We have partnerships with health systems in those countries and that's really played out in this pandemic. We were called into Wuhan in December 2019 to work with the local health authorities to try and identify the causative agent behind what was then an ammonia of unknown origin and we were working then through January with the Shanghai Public Health Clinic to sequence and then publish the first viral genome of SARS-CoV-2 and since then we've been working with CDC's and health systems around the world to identify the mutations in the virus and watch how the virus is spreading. So we've played an important role in genomics has played an important role in the identification of this pandemic and then in the surveillance of how this pandemic is spreading. We've also played an essential role in the development of these new generations of nucleic acid vaccines and therapies. The Moderna team and the BioNTech team depend on genomic sequences to develop their mRNA vaccines. In fact, Stefan the CEO of Moderna talks about the fact that they've never really had a live virus on their campus. They've really relied completely on the genomic sequences coming off aluminum machines to develop these vaccines and so we've played the private sector has played an important role in terms of helping develop the therapies and the vaccines to fight this pandemic. There's an important surveillance need right now to watch how the virus is mutating. We're seeing the emergence of new strains and mutations around the world, you know 501 YV1 in the UK, V2 in South Africa and around the world and it's essential we monitor the mutations of this virus for a couple of reasons. One, it'll tell us whether the tools we're using to fight the pandemic, whether it's the diagnostic tools, the PCR tools or the therapies, the vaccines and the therapies will continue to be effective and that it's essential we know that and so we should watch how the virus is mutating and then test our tools and our vaccines against the new mutations and companies are doing that and you can only do that if you're monitoring the mutations. In addition, understanding how the virus is mutating and watching what strains you have in your community is essential to drive policy decisions and public health policy decisions so for example, if in your community you see that the infections are coming from the outside then an effective policy decision could be to actually shut travel for a while but if you're starting to see that the strains are local strains and that you have community-based transmission then stopping people from coming in isn't really going to help that much and so understanding the spread of this virus geographically is essential from a public health policy perspective and so it's a surveillance need that we've been able to help with as a private sector company. It's a therapy and vaccine development need. It's also a need around research and one of the things we are learning is that there's a big spectrum. It's very different how people react differently to COVID. For some people, there are almost no symptoms and for others, it's fatal and we're really doing research to understand what are the genomic drivers of that difference in reaction and that over time should help us prioritize people that need the vaccine first or need the protection or people who need hospitalization and scarce resources and so there's a lot of work around the research behind both the virus and its mechanism of operation but also human genomes and what causes susceptibility and then finally there's a huge need around testing and so whether it's PCR testing or sequencing based testing and private sector sort of stepped in to really drive a surge in testing capacity and help roll that out. Overall as we look at the stories of this pandemic we're seeing that there's a transition to a new model of healthcare that's more proactive, more targeted, more personalized and more connected than ever before and again it's going to be essential that there is a deep partnership between public, private and not-for-profit sectors to deliver on this. Great, thanks Francis for this. Mark, I think you've already can see that multiple people are talking about the power of technology to amplify access to healthcare and at least efficiency and cost. So how do we use technology better and invest in this in order to benefit global populations? Is this truly able to solve the global access to health challenge or only a few patients truly benefit from this? It depends Jay. First of all, thank you and boy am I in the unenviable position of following three really smart people at their great comments. I think that technology is just a tool in the toolbox. And you know, the great philosopher Mike Tyson said everyone's got a plan until they get punched in the face. And I think that the pandemic has really proven Mike to be right. Everyone had a plan for how they were going to deal with things and then all the rules got turned on their head. And what you've heard about private public partnerships and robust supply chains and nimbleness is extraordinarily true. And one of the things that's most impressive is how quickly things like evidence based medicine can change and how quickly and be incorporated into day to day practice and how quickly tele and digital and AI powered tools can be put into place. These work if incentives are aligned. If they're not they become tools for rich people who would probably do fine anyhow. And I think it's really important to make the distinction between health systems and health care systems. And if we focus too much on health care technology, whether it's hospital at home or whether it's remote monitoring or whether it's remote visits. They really become the benefit of the rich only. The pandemic has actually allowed us to understand how to touch poor people via technology much more effectively. And as our school based clinics here in the intermountain west got shut down because kids weren't in school anymore. We realize that the people who are particularly deeply affected were in our brown and black communities. And here in Utah a lot of these folks are Latinx. And what we've done instead now is we've we've tele-enabled these nurses clinics and families can come in and they can get even if they don't have their own Wi-Fi or cellular access and they can get distance help without exposing themselves to crowded waiting rooms etc. So to answer your questions succinctly, I do think that digital and tele AI powered tools become essential to the democratization of health care and more importantly preserving health. But you need to look upstream and understand whether the social determinants of health are met so that the most vulnerable people have access to these tools. Great, thanks for that. I'd like to tell everyone that they should stay on the session as we end the public live stream in about five minutes and we'll move to a private 30-minute discussion where I can take your questions and the panelists will be able to answer them. I think I wanted to put just one question back on the table back to Helen. It's clear that choices made at both national and sub-national levels and what policies and measures are meant to be implemented by whom and when have shaped the severity of the epidemic in every country. As co-chair of the panel, we know that the probability of new emerging infectious diseases to become pandemics is also a real threat. So could or should we develop accountability systems for nations and industry to prevent new pandemics? Helen, I think you're muted. Sorry, that was beyond my control. I lost track of the questions. I was flipping with that. So sorry, Jay, repeat it again. Yeah, sure. Should we develop accountability systems for nations and industry to prevent new pandemics? How do we make sure that we're ready for the future? Well, one of the things we're discussing is what changes you might need to the international health regulations and the obligations we accept for ourselves and the commitments we accept for ourselves as countries in the international system on these things. At the moment, it very much depends on countries doing the right thing. Reporting when they should act, when they should, following the best advice and so on, and clearly that doesn't always happen. The problem in the international system is, yes, you can try to negotiate stronger conventions and regulations, but if people are not of a mind to abide by them, will they sign up to them in the first place? The whole global health system has been a bit of a balance that WHO, for example, is quite underpowered to do the job expected of it. It can't inspect as a right, it doesn't have access as a right and so on, but would it ever get that right? Would nation states concede that sort of sovereignty that's the $64 question? Look, to cut to the chase, I think that this pandemic is for global health what Chernobyl was to the international controlled system over nuclear materials. Now, when Chernobyl happened, the IAEA got new powers, which were quite significant. Will this be this moment for the global health system? Will the WHO get the power and sovereignty that it needs to hold nation states to account? With respect to the private sector, well, the issues are a bit different, I think, but I think it has been fantastic the way the private sector has rallied, particularly around the innovation that we've been hearing about today. You know, the genomic sequencing, the innovation in testing, innovation in a whole range of treatment and vaccine development has been spectacular. Because this isn't going away any time soon, I think that advances in therapeutics need a lot of attention now and private sector innovation and drive is going to be extremely important in that. But we're all in it together, public and private, and I've seen my country including my own specific platforms put together to engage the private sector and just ensure that we're all rowing in the same boat to the end which we want, which is reducing transmission and trying to get our societies and economies back to some sort of normal. Great, thanks Helen for taking that up. So far we've actually spoken about how we need the right amount of foresight, going beyond the theoretical framework, looking at ensuring communication, leadership, and a continuity of a strong response. We've spoken a bit about the agility of the industry and the agility of governments to act when needed. Also, agile innovation, improvements in supply chains and distribution systems. We've spoken briefly about the value of collaborations and the ability to step up when needs to happen and how multiple public and private partners have rallied together in the response, including in testing and delivery of much needed products here. So I'd like to just put a few words here that the World Economic Forum has entered a partnership that's been initiated called the Partnership for Health Systems Sustainability and Resilience PHSSR and it's initiative out at London School Economics, the World Economic Forum and AstraZeneca and it's this will be used to identify transferable solutions of new models of care, innovative financing, with the greatest potential to support the reduction to the world. So if you'd like to hear more about this, please reach out to the World Economic Forum and follow the discussion.