 Good morning, everyone our afternoon or evening depending on your location. I'm Julie Pavlin the director of the board on global health of the National Academies of Sciences, Engineering and Medicine. And thank you all for joining us today at the first day of the symposium right prioritizing actions for epidemic and pandemic preparedness. This started with discussions with Kavita Berger the director of the board on life sciences and I. She and I had discussions with experts from the CDC Center for Disease Control Prevention the Office of Global Affairs of Health and Human Services, and the World Bank about that there being so many different tools for assessments and recommendations and what to do for preparedness, but not much on the scientific based evidence on how to prioritize efforts at the country level because we know everyone can do everything simultaneously. So Kavita and I work with experts from many organizations to hold two internal meetings and what to do next. And we're starting with this public symposium to hear from others on what they have encountered and where work and evidence is needed. And we're so grateful for you taking the time to share your experiences with us. Today and in two weeks then again in June, we're convening via zoo. All the workshop is being recorded recording will be posted on the event page not long after the conclusion of the workshop. At the outcome of this workshop we will publish a proceedings that serves as a factual accounting of what was presented and discussed during the workshop or during this symposium the proceedings is anticipated for release in the summer and will be available for public access. Importantly, by consenting to be recorded on zoom you are also granting permission for the recording be posted for public access and potentially used in the proceedings. If you're watching this as a webcast, there's a Q&A box where you can post in real time any questions or comments that you have, but this Q&A box will not be available if you're watching on full screen so you need to get out of that in order to put in your questions. So at the National Academy to rely on our volunteer experts and this symposium is no exception. I would like to give a special thanks to all of our planning committee members whose names and bios are listed in the material printed online. And many of you will hear, many of them you're going to hear from through the course of this symposium. And first I'd like to introduce Lisa Hilme who chaired this committee. She's the executive director of core group, a consortium of global health practitioners, nonprofits and academic academies from around the world who are dedicated to improving the health of women, children and adolescents. Lisa has over 30 years leading global health initiatives responding to emergencies and outbreaks as a nurse and public health expert in over 25 countries of note. She enjoys wine and cheese and kayaking and visiting national parks. So over to you Lisa and thank you. Thank you very much Julie. It is my pleasure to be here as good morning good afternoon and good evening for all of you joining us from around the world. It was my pleasure to chair this technical committee. And I'd like to thank all of our distinguished committee members and the National Academy of Science, Engineering and Medicine. As Julie mentioned the symposium prioritizing action for epidemic and pandemic preparedness has that important history leading up to today for these important discussions. We know from the past three years that we have to do better. And so having an science based approach and determining these long term sustainable investments in health security and preparedness capabilities is key. And the discussions that have led up to this the public symposiums on epidemic and pandemic preparedness. It really seeks for us to identify those actions to prioritize sustained efforts to build and enhance these critical capabilities. We hope that speakers and participants of this symposium look beyond this current discourse on the issues. And we really need to clearly identify the needs for the global community and actions that governments, civil society, academia, private sector and all of the other partners can take to enhance our preparedness and response efforts against future pandemics and epidemics. We know from the recent COVID-19 pandemic we have to do better. And we have to base our evidence and interventions and preparedness efforts on science. So our first sessions goal is to have a forward looking discussion and to highlight the critical needs, the challenges and the gaps and international and national governance and financing for developing and maintaining these critical capabilities needed to prevent, detect and respond to future epidemics. We will examine the sustainability of these mechanisms, because we know that recognize that recognize that preparedness and response requires that political will, strategic financing mechanisms, as well as coordination across partners to maintain critical capabilities needed to prevent, detect and respond. Throughout this symposium, you can put your questions in the chat box and we will have a really rich question and answer discussion. We want this to be interactive, even though we're all virtual. I think we have got the hang of this over the past three years. And we are very fortunate to have an incredible moderator today. I'm thrilled to introduce our esteemed moderator for the next two sessions today. Dr. Mercy Wangongi, who is currently the Senior Director of Health Systems Strengthening at Amroth Health Africa based in Nairobi, Kenya. Dr. Mercy had a critical role when she was the former Chief Administrative Secretary in the Ministry of Health Kenya. She had a role in the Health Financing Division and experience in the design of the UHC program and played a very big role in Kenya's risk communication strategy during the coronavirus pandemic. Her ability to link the financing, the primary health care, the UHC conversations and her rich experience with pandemics and that foundation of health systems strengthening will be really valuable to us today. So thank you, Dr. Mercy. I turn it over to you to introduce our speakers and get started on the first session. And remember to put your questions in the chat box as we proceed. Mercy over to you. Thank you. Thank you, Lisa and I'd like to welcome each and every participant to today's session. We have a fantastic panel lined up for you and I'm going to introduce our three speakers today. The first speaker is Sarah Hersey. Sarah Hersey is a Director of Collaborative Intelligence at the World Health Organization Health Emergencies. And Sarah is an infectious disease epidemiologist who has served as a global public health leader in various roles over the past two decades. And currently sits at the World Health Organization and has had experience at the US CDC Control and Prevention Center, the World Bank, and resolve to save lives. So welcome, Sarah. And of course we have Priya. Priya is Executive Head of the Secretariat for the newly formed and established pandemic fund that is hosted by the World Bank. Priya has also been serving as the head of the Secretariat of the COVID-19 Task Force and leading the World Bank's engagement on pandemic prevention preparedness response in the global forum, including in the G20 and G7, coordinating across finance and health. Welcome, Priya. And then we have Saul Walker, who's the Director of Public Partnerships for the Coalition of Epidemic Preparedness and Innovations. He's previously worked as Deputy Director of COVID-19 vaccines, therapeutics and diagnostic strategy for the United Kingdom Foreign Commonwealth Development Office, and has worked in development throughout his career. I'm very excited to have the three of you in this panel, and I do welcome you to be able to share your lived experiences when it comes to epidemic preparedness, pandemic preparedness and financing. And so I'd like to start over with a few questions for all of you. And the idea really of this session is to be able to elicit and, you know, bring out your reflections in terms of critical needs, challenges and gaps when it comes to international and national governance, financing for developing and maintaining critical capabilities needed to prevent, detect and respond to future epidemics. And of course, as you share your experiences, it would be great to center this around the experience that we've just had with COVID-19 pandemic, and perhaps how we can better be prepared for the future. And I'd like to start with you, Sarah. The COVID-19 pandemic and other recent epidemics have highlighted critical needs, challenges and gaps in international and national governance. Could you describe in your perspective how these issues can be mitigated? Welcome, Sarah. Your own mute, Sarah. Thank you. Sorry, multiple screens. Thank you so much, Marcy. Thanks to all of the organizers for having us here. Excellent question to start with. Mitigation is going to be difficult, but I think there's three different levels that we really need to be targeting. One, and I know this is going to be a focus of the conversation here, is looking at how do we bring more of a global coherence and collaboration and coordination towards how are we determining what are our technical priorities? How are we pulling these together in terms of financing, financing packages and financing guidance? How are we also helping to support governance on the ground? A lot of the work that we're doing, even though WHO often plays a very technical role, the questions and the support that we're asking from partners both at the regional and the country level is how do we better support our governance systems? How do we better support collaboration? And how do we coordinate together? So we really need to bring a balance between the technical support as well as the coordination support from the global partners. I think secondarily also is that there are so many valuable regional platforms that have been stood up and to make sure that we're really tapping into that knowledge and supporting our regional platforms. And then again, at the end of the day, if everything that we're doing doesn't have a direct support to the countries, then we have to really think what our strategies are. And so countries and country implementation, country capacity has to be at the forefront of everything that we do. So I'll stop there. Thank you for the question. There are very strong valid points when it comes to global collaboration, looking at the role of regional bodies that are working on this. And of course what you said, you know, country action and country sort of support needs to be at the centre of all this. I'd like to invite Priya to also share her thoughts on the same question. What do you think are the critical needs and challenges when it comes to international and national governance and what have been your experiences, particularly in the pandemic and as you set this up, welcome Priya. Thank you, Mercy. And thank you, the organisers for this, for inviting me to this symposium. It's great to be on this panel with with Sarah and Saul. So, you know, in terms of your question, I mean, I think this is this is kind of really a very important question. The COVID-19 pandemic and other recent epidemics have highlighted critical needs, gaps, challenges in governance and financing for pandemic PPR. You know, I'll focus my comments mostly on the financing piece. Last year, along with the WHO, the World Bank, we prepared a paper for the G20 finance and health ministers on pandemic PPR prevention preparedness and response needs and gaps and we estimated that an additional $1 billion is needed per year over the next five years to strengthen the capacities and capabilities of low income and middle income countries in core domains of the international health regulations IHR 2005 and the World Organization for Animal Health International Standards. And we estimated that of this about two thirds must come from domestic financing, while one third from external financing so about 20 billion per year over the next five years from domestic financing and about 10 billion per year over the next five years in additional external financing. So when it comes to domestic financing, we recognize that many low and middle income countries are facing acute fiscal pressures and external debt burdens that will constrain their ability to increase investments in pandemic prevention preparedness and response. And yet, there are opportunities for reprioritization of expenditures and domestic budgets to assign greater priority to pandemic PPR and health systems strengthening. And, you know, we've we've seen, as was highlighted by the the opening speakers today, we've seen that the costs of not being prepared far outweigh the relatively modest investments that are needed to build these critical capabilities to prevent, detect and respond to impacts and it's important to note that these types of investments in pandemic PPR produce enormous economic and social returns. The challenge of course is that these benefits may not be tangible until an outbreak happens. And even then the benefits may not be visible, but we just need to look at COVID-19 to see what happens if these investments are not made. And then as regards external financing, of course, there are many existing initiatives and mechanisms already out there. The multilateral development banks and particularly the World Bank provides sizable financing to pandemic PPR and health systems strengthening more broadly. Ida, which is the World Bank's fund for the the world's poorest countries, is deepening its support to more than this. And it's also advised that HEOC should have such that they're sent to that email address, the PHOC. I think we have somebody who has access to that email address. So, I was saying that as regards external financing, there are many initiatives out there and they're doing more and they're committed to doing more. But none of them is solely dedicated to pandemic PPR. So against this backdrop and recognizing a gap in global financing, in the global financing architecture, the international community came together last year at record speed to establish the pandemic fund. The pandemic fund is the first and only multilateral financing mechanism that's dedicated to pandemic prevention preparedness and response. So it has a unique role to play and it's a partnership among 25 donors that have provided seed funding of $1.7 billion. 144 developing countries who we refer to as co-investors are a part of this partnership and represented on the board of the pandemic fund. We have civil society and international organizations and its governance and operating structure is really grounded in the spirit of shared responsibilities that are needed to address global public goods. And the board of the fund, it balances the voices of the global north and the global south and includes civil society participation. In fact, Amref is represented on our board as the civil society voting representative representing civil society global south. The World Bank hosts the secretariat and serves as the funds trustee and as an implementing entity. And just very quickly, in terms of the scope, so the scope of the pandemic fund mirrors the needs and gaps that were identified coming out of COVID-19. But I should say also these needs and gaps were highlighted by past pandemics as well. And the pandemic after the other, you know, kind of identified the need to strengthen core capacities at the country and local level along core domains of the IHR 2005 and the war international standards including areas of disease surveillance, emergency communication coordination and management strengthening critical health workforce capacities and community engagement. So those are kind of the areas that that we're focused on at the country and and community level. And we recognize and this has been said before but I think it's important to highlight. We recognize the need to focus on funding, not just stuff, but staff. And we recognize that these investments need to be integrated with health systems strengthening need assessments overall health sector response gaps and performance. Thank you, Priya. Thank you so much for your reflections on the role that the pandemic fund plays. I think there's one of us who has their microphone on and really request you to mute it and I'd like to jump to soul and and, you know, ask him the same question and to share his reflections, particularly as a director in SAP in charge of partnerships. What do you see as those critical gaps when it comes to financing epidemic preparedness pandemic preparedness. Thank you. And thanks to the imitation. I think just reflecting a bit first on COVID one of the things I think that demonstrated it. The areas that went relatively well and the world did see a massive and historically fast response to COVID, although we saw huge inequalities in roll out of medical countermeasures. But the areas that we did see that go went well where where there had been some preparedness and some partnerships in in place before. So on the R&D side, we already had platforms around the RNA. We had some work on viral vectors and Mars that gave us a head start on some of the technology and we saw vaccines developed in 326 days. The first licensure, which historically was incredible. We also saw many countries that respond to outbreaks regularly, particularly in the south, quickly mobilise the non pharmaceutical interventions that really actually teach us all how to respond somewhat to outbreaks and pandemic. So there was there was experience there that we could build on. And there was already partnerships between some international organisations with experience with working at country, regional and international level to mobilise the delivery systems and the procurement that was needed to begin to move medical countermeasures quickly to what was the fastest vaccine roll out in history, not equitable enough, but still we should recognise just how quickly things moved. So if those were the pieces that really helped us, all those elements of COVID that really worked well, how do we build on that sort of understanding preparedness, improving the partnerships and understanding of how organisations, regions, countries, international agencies work together. How can we strengthen those in the pandemic periods so that we're ready to respond more quickly during a pandemic and I think that one of the biggest challenges that we have here is this cycle of neglect and then panic really if you like. So during a pandemic and you know for this period after a pandemic real focus on this really wanting to move things forward, but that will begin to dissipate. Perhaps then we don't focus on the preparedness that we need to take forwards on the R&D side on the system strengthening side on building and understanding how we will need to collaborate operationally in an emergency. And then not being ready to go quickly to re-prioritise the learning, particularly the focus on equitable access that we will need when we see the next pandemic and we know that will come. So how do we get this balance between an inter-pandemic period when we need a different rhythm, a different focus, a focus on sustainability, on system strengthening, on relationship building, inter-pandemic periods and then have a governance or a collaboration approach that allows us to switch into a response mode with partners who already understand how to work with each other, who know how to mobilise resources that are going to have a different financing and risk profile during a pandemic and being able to think those two pieces and be ready to respond in the future. And equally I think recognising the complexity of this response, its health, its economic, its political, its social, its international, its regional, its local. And building collaboration approaches that don't try to have too much of a command and control approach to that. We need innovation, we need adaptability to particular outbreaks or the pandemic threats that we might see in the future. We'll need to be able to reconfigure our approaches. But at the same time have enough understanding, have enough standards, have enough information sharing platforms, have enough organising principles that mean that we can, when we need to, configure and respond together. Recognising that we'll need more leadership and agency across different sectors and also regional, country and global level and bringing those things together. Perhaps in a more adaptable and more agile way than we were able to do against COVID. So I think those are difficult organisational things to bring together. Collaboration on the one hand but recognising complexity on the other. Something that can do preparedness and sustainability so that we're ready but then can also switch into a response mode when we need to. And that's those are the challenges that we're needing to solve for in terms of a governance and finance approach. Thank you. Thank you so you brought out, you know, very, very key points and our sort of trying to have a mind map of all the words you've used you talked about collaboration, but you've highlighted the complexity of all the actors who need to come together you've talked about looking at the ways that we can utilise, you know, what is the place of a command approach what is the place of a more agile approach. And you know how do we work together particularly leveraging on partnerships and strengths to ensure we have enough resources for this. At this point, I would like to ask if any of you has a presentation perhaps you could come in to share that with us right now. I can see Sarah nodding her head. Sorry, do you want to go first. Sure, happy to always a presentation. Thank you. Awesome. Welcome Sarah. Thanks, thanks so much. Maybe if you could go to the next slide please. Thank you. So I thought I'd cover a couple of areas today that might be of interest to the audience. And the first is as as introduced my title is the left director of collaborative intelligence. At the WHO epidemic and pandemic pandemic hub which is based in Berlin. And a lot of people have asked me kind of the question of what what does that mean collaborative intelligence. It isn't it's a new title and it's a new position so I thought it may be very helpful to talk about who we are at the pandemic hub and why we are and I think that this and that should come together about where this position is coming from. And how we're really trying to create a different way of coordination going forward. And the second piece that I really I want to highlight is how we're strengthening preparedness for response to health emergencies through these collaborative systems and I really appreciated a number of the comments that I saw made. We really do need to be prepositioning our thinking and our partnerships and our leadership to both do preparedness, coordinate around the preparedness needs but also so we're preposition for the next emergency. So next slide please. So here doesn't need to be convinced of the value of surveillance within pandemic preparedness and response. But there are many, many different aspects that need to be focused on as we've all experienced surveillance is what detects new diseases such as COVID-19. And also is what detects in this allows us to monitor emerging diseases. This was a global experience with monkeypox, which is endemic in West Africa and which many, many people have, have managed successfully in the past, but we did know that monkeypox was now we saw over the last two years spread to countries that hadn't necessarily had human human transmission in the past. So these are other critical aspects of surveillance systems. We're monitoring disease programs we've seen a huge resurgence of measles, particularly because vaccination levels have gone down during COVID and so it's monitoring that, as well as monitoring the elimination of diseases polio it is a very good example of how new technologies and wastewater surveillance started to pick up a vaccine derived polio in London and New York City. So next slide please. We also know that surveillance and preparedness are extremely important, not just in pure public health emergencies but they're they're important in the larger kind of complex emergencies. So these might include conflicts in your crane, the earthquakes that we just saw in Turkey and Syria, and these have these have public health threats, not just for case management and recovery of people but also underlying potential infectious disease threats. So the new normal is that we have multiple emergencies, they're more severe and they're more complex, and our systems really need to be able to deal with them. Next slide please. So in looking at surveillance and how we're using this for preparedness, there's a very traditional way that we use our data, and that is kind of depicted here anybody that's worked as an epidemiologist or anybody actually that that lived through has seen this. And that is, this is just a very clear linear graph that is mapping new cases of infection against mortality rates. And this seems to show a very direct and very clear picture of what's going on. These are the where the cases are. These are the geographic distribution. This is the time distribution and these are the deaths. But if you can go to the next slide. What we really need to do is to look at data in a completely different way it's not linear, it's not easily packaged. And so, the idea is to kind of turn this on its head and to recognize that COVID as experienced any disease as experienced is more more complicated than monitoring cases and mortality, or even any of the very traditional disease pieces that we that we monitor and these are important, but they have to be looked at in a more complex environment. They're an economic environmental health and social aspects, and they're all impacted by by interventions. So, at the hub what we're doing is saying we're going to embrace this complexity, and we need to start looking at data in a different way and we need to look at our applications of data in a different way. So if you could go to the next slide please. One back. One slide back please. Yes, there. Thank you. So, most of you have worked with WHO with the health emergencies program in the past. And prior to last year, it was, there were two different divisions one was the preparedness division, and the other was the response division the response division does, you know, very classic and emergency response to acute events. The preparedness group does a lot of the work with specialized disease areas like the influenza team, the IHR work, JEs, NAPS, a lot of the preparedness of governance, coordination and monitoring systems. But what wasn't there was really the opportunity to take a step back and take a disease agnostic systems approach to how we're looking at intelligence and surveillance systems. So with support from the German government. And that is why we're based in Berlin, a new, a new division was born so we are within the health emergencies program. And we have three different arms to this one is more of the traditional surveillance and workforce development arm. And the third are colleagues in Geneva, and then there's two different divisions sit here in Berlin, one is called pandemic and epidemic intelligence systems, and the other is called collaborative intelligence and the way I'm trying to describe these is the pandemic intelligence systems team is really trying to connect the dots between the different data pieces so we talk about one health but what do we mean by one health in terms of data preparedness. These are the different data pieces that we need to be bringing into traditional surveillance systems during COVID we had the experience that surveillance systems were not often time sensitive enough for us to know on a day to day basis what was happening. It was the data that was coming out of the health facilities that we were really using to track immediate immediate response. How do we bring these pieces together in a very meaningful way. And then the third team which is collaborative intelligence is the one that sits under me and I'm describing this as kind of connecting the dots between people. So the capital C for collaboration. And so within that we are building networks, secretariat external relationships and support, and then also country supporting engagement so making sure again that everything that we're doing gets defined down to what are the real on the ground needs. And then it might seem a little bit odd there the genomics and analytics that's under me, but I will I will come back to that because that's really around networking. Next slide please. And so, we are supporting the world, the WHO health emergencies program at large, not just the, not just the WHO have team is really supporting preparedness and response across many different arms. One is governance, which is a lot of the discussion here and create, obviously spoke about the importance of the pandemic fund, and the new opportunities for for bringing wide scale financing to preparedness. So our support for that as well as the HR process. And then also the systems architecture and many people will be familiar with the new architecture that has been put out around preparedness and response. Next slide please. And this architecture really free frames it's not, it's not intended to be new guidance, I will, I promise everybody that it's a reframing of how we look at preparedness and response around five different areas, many of which fall under I HR but some which are not as explicit and as we get missed. So that we're calling it the five C's but it's around collaborative surveillance emergency coordination, community protection, clinical care and access to countermeasures. So for instance, clinical care, which includes essential health, maintaining essential health services, often is not built in at the early stages of preparedness response. So how do we make sure that we're not missing that critical community protection element. How are we making sure that access to countermeasures is built in from the start, not as a, as a, as a something that's thought of later. So collaborative surveillance is actually what sits under our coordination with the WHO hub. Next slide please. So we're defining this and I know that there's a lot of eagerness to have the first publications that which are coming out at WHA on the definition for collaborative surveillance, but the intention is to look more there I say holistically across a number of different technical areas and to make sure those are intertwined. So collaborative surveillance includes strengthening the integrated disease threat to vulnerability surveillance. And many of those pieces that are already being used but trying to bring them together into a single into a single approach. It also includes laboratory capacity for pathogen and genomic surveillance, as well as the collaborative approaches for risk risk assessment event detection and response monitoring. And the intention is to bring these pieces together to look at them as a single system, rather than a number of disparate systems. And to look at them across multiple dimensions, not just a disease dimension which is often what, what, what is used. So that would be the disease dimension, the sector dimension so what is meaningful one health multi sectoral engagement in these areas, the event life cycle, as well as geographies so not just defining them in a national but also looking at some national local geographies. And the intention is to bring those all those pieces together for better decision making, grounded by strong governance and regional responsibilities. Next slide. So as I noted, it's two of the things that are completely obvious, particularly when we're often with technical people are talking to technical people is that we need to make sure that it's not just a series of, of new guidelines, but is actually, we're actually looking at capacity building across these. So, so there's the intention is to building capacity building, as well as the strengthening of collaboration which is, is a lot of the discussion that we're having now. And what do we mean by intentional collaboration and how do we do that, but that a global scale but also at a local scale. And so that is connecting the surveillance stakeholders across platforms networks, the increasing of skills and also strengthening the underlying tools that support them. Next slide please. Two examples of how we're trying to do this intentional collaboration. And the first is something called the International Pathogen Surveillance Network or IPSN. And this is a new global network that's bringing together pathogen genomic actors to improve public health decision making this grew out of the pandemic radar which was announced by the G seven two years ago. And it has several iterations since and we have now landed with IPSN. It sits here at the pandemic hub. And we are, we are official as of Monday as an entity and we will be launching at WHA this year. And the vision for IPSN is that every country has equitable access to sustained capacity for genomic sequencing and analytics as part of its public health surveillance system. And for a lot of questions whether this was being stood up is this going to just be a repository for data sets and will we have this big supercomputer in the basement with all of our data analysts crunching data. The expectation is no this is actually a network to bring those types of actors together they're out there in the world they're highly specialized. It's not to try to create something new is trying to harmonize and bring together the different groups that we are bringing into the network are national and international laboratories and disease programs, academic groups, the private sector, philanthropy is a civil society, and then also that both the genomic surveillance specialist is also the specializations that support them so data specialist AI is one of the big questions that's coming up. So how do we try to bring together and harmonize these across networks. We have three different groups that we've stood up. We welcome also as a follow up from anybody in this call. We are, we will be bringing on new members all the time who are interested around the first is a community of practice which is really the technical area. And these are the first community of practice has been defined around data sharing and data standards which is a global question right now, and it's to help. There's a lot of work going on so to help consolidate that work. There's also a lot of other potential technical communities practice, the country scale up accelerator is another group of members which is really trying to foster south south exchange and to make sure every country has the same global stage, the same opportunity for financing, the same visibility as some of the more well resource members and so we are trying to make sure that this is countries first, and that they are defining their priorities and getting those into the discussion for financing. The third is a funders forum so we have stood up a funders forum of philanthropy's bilaterals and multilaterals also were very, very interested in additional membership. And that is to help harmonize what are the investment cases at a global level and regional and then country level, developing advocacy cases for investment, as well as we've designed a small grants fund to allow members to tap into that. This is an advocacy communications coordination piece to this. And so this is, you know, one of the very, this is the type of model that we're trying to use to say, you know, WHO is not in front, WHO is supportive, and that we are kind of leading from the center we do not have to be the face we would like the countries and our membership to be the face. And next slide please. And this is just another example of places we're trying to do a stronger collaboration and that's in the recognition of the roles of national public health agencies in preparedness response, many of us use ministries of health as our natural counterparts, but a lot of the responsibilities sit within the MPHAs. They're increasingly visible around COVID we just there's a photo we just had our first convening for the for across WHE for national public health agencies, and number of them said I never thought that I was going to be a superstar country but there I am stood sitting with the with the head of state, and everybody knows who I am. And I don't think any of us went into public health thinking that we're going to become celebrities, or unfortunately in some countries reviled which is extremely kind of sad that there's a lot of tensions that we need to recognize on MPHAs. How are we supporting them around human and financial resources, as well as the fact that they often don't have the authorities they need to match the responsibilities that they have. And then, and then a third piece is understanding the need to support that they need to support policymakers and political leaders but they also have to have scientific independence. So where we have designed with them, of course, of some interventions support and networks that we can help support them going forward working with many partners, I am being born to be that so there's many partners that are already doing this and how can we help set the stage to support. So I will, I will end there. Thank you very much for the opportunity. Thank you. Thank you so much, Sarah, lots and lots of useful information and insights that you've shared with us. And, you know, thank you. I think awesome. Great. I think we now have our cloud recording all set. So thank you. Thank you, Sarah, for that. And I'd like to, you know, just piggy banking on your presentation to sort of be a little bit deeper in terms of collaboration and cooperation. So you've shared with us. WHO's, you know, strategy, particularly on collaboration and it comes to redefining collaboration across disease areas, sectors, life cycles and geographies. I'd like to hear from you, Priya, as you set up the pandemic fund. What is what is your strategy when it comes to collaboration? How do you intend to foster collaboration in the execution of the pandemic fund? What can you share with us, you know, in the early thinking of setting this up and executing the fund? Welcome, Priya. Thanks. So by very definition, the pandemic fund is a collaborative partnership. It was designed in close collaboration between the World Bank and the WHO. Working with our group of founding donors and with extensive inputs from civil society, as I mentioned earlier, and from a range of international organizations. And we really sort of see this as a mechanism that has collaboration as part of its DNA. So, you know, kind of in terms of how we work, we work, our operational model is that we work through calls for proposals. We announced these calls for proposals from time to time. In fact, our first call for proposals is active right now. And each call for proposals, you know, identifies areas of focus. This current call is focused on strengthening capacity for disease surveillance, laboratories and human resources. But I should say that the scope of the pandemic fund is actually, maybe if you just give me a minute there, because I was, you know, about to speak about that in my earlier intervention. It's beyond just the country level countries are of course, the center of our focus, but as Saul was mentioning, and you know, learning from the experience of COVID-19. I mean, we're also, you know, we've also learned that there's a need to build regional and global support across multiple domains. So when it comes to surveillance reporting information sharing, sort of networking all of that up from local to regional to global level, building shared public health assets, regulatory harmonization, and also capacity to support public health workforce at regional levels and capacity for coordinated development, procurement, distribution and deployment of key medical countermeasures so that, you know, the world isn't faced by the kind of inequities as we were in the wake of COVID-19. So now, you know, just coming back then to do to our to our operational modality and how we seek to promote collaboration. You know, what we're saying is that every time we allocate grant funding for for projects be be those projects at the at the country level or the regional level, we want to see relevant institutions working together and complementing each other so that, you know, every dollar of grant financing that that we provide, you know, kind of is has has a multiplier effect. You know that our partner implementing entities come together around those projects, bringing their technical skills but also bringing their resources to the table in the form of co financing. And then we're also saying that, you know, we want our support to be very strongly anchored in, if it's if it's country level support, then we want it to be anchored in national action plans for health security we want to see a demonstration of how a pandemic fund grant financing along with the financing that our partners will bring as complimentary co financing to these projects is is all kind of tied together to support a country's own national plan or if it's a regional project then how it supports a regional institution. And then we want that country or regional institution to also bring its co investment, if, if there is capacity to do so. And along with that very strong you know policy commitments to ensure sustainability of financing. So, you know, just to emphasize again, every dollar of grant financing that that will provide from the pandemic fund requires, you know, kind of the the actors who are engaged in the space for the particular kind of project that's that's being supported to come together and demonstrate that they're not sort of duplicating but rather, they're, they're bringing a complimentary support both in terms of skills, and, and financing. So, you know, I'm always anchored in either a national plan, or a regional plan and I just want to emphasize that, you know, the global health financing space really has seen, you know, siloed approaches in the past vertical approaches and the, the, the philosophy of the pandemic fund is to, you know, kind of support projects through more integrated horizontal approaches, because we see pandemic prevention preparedness and response as really an integral part of health systems strengthening. So those are kind of just some of the points I wanted to raise and if you look at our poll for proposals documentation which is for the first call which is up on our website. We have a very strong focus on on on partners coming together, sort of horizontally to to work together and you know these criteria will be taken into account as proposals are evaluated by the pandemic funds technical advisory panel we have a technical advisory panel that's chaired by Mike Ryan of the WHO and co-chaired by Joyce and John of the Caribbean Public Health Agency. And there are 20 world experts that will be reviewing every proposal that that comes in for its technical merits and they'll be looking at these criteria you know how, how, how much collaboration is there which entities are are are engaged in in in developing and implementing these proposals, how they're working with counterparts at the country level, or at the regional level with regional organizations like the Africa CDC, you know, is financing really coming together are we able to use this, this grant money to leverage and incentivize both international partners, and our, our government partners to sort of come together holistically around the the the areas that that we want to support over. Great. Thank you prayer. You know I like the use of the word co financing co investing, you know they all started CEO like collaboration so thank you so much for those insights. And I'd like to move over to soul and asking the same question, and perhaps layer second one on to that in terms of sepis insights and reflections on on how can we collaborate when it comes to genomic sequencing how can we collaborate when it comes to, you know really building capacities of laboratories, both national subnational regional laboratories networks and systems when it comes to genomic sequencing. Over to you so. I mean, I actually heard that a few things in my slide presentation that tried to get these network pieces. It was it was slightly different to the format that I think we've got into in the discussion but so I mean this was the first thing was just to demonstrate that how fast we went with vaccine development in code to 326 days for the first approval but but how much we would be able to avert in terms of impact, if we were able to do something even quicker and we'll come on to 100 days in a minute. But the piece I wanted to demonstrate a little bit on the right hand side is a paper from Wang et al recently in in nature communications. And it just demonstrates that actually by thinking about a more global approach to equity and more health impact focused approach in terms of how we use medical map countermeasures and vaccines. We can actually have more global impact but we can also have more impacting countries that actually went first this time around. And you see on the left hand column, these are vaccination strategies and the impacts from those if you prioritize to produce a country's first. And you can see health gains lockdown, easing effects supply chain return benefits and total benefits on the left hand side. And on the right hand side if you took a more public health focus age informed distribution strategy more equitable in terms of health impact. It turns out that not only do you get more impact globally and can see bottom right hand corner and 9.5 trillion dollar impact from from taking such an approach. You can also see that if you looked at the impacts in the producer first countries, actually they still benefit more as well. So if you go to the next slide, please next slide. So just briefly on set the organization set up to try and drive forwards that speed in terms of our ability to develop medical countermeasures, but also to really focus on this point around equitable access and build that in from the start. And three sort of key pillars to this that are important. One is about preparing for known epidemics, building our approaches with pathogens such as LASA or MERS or Chikungunya, working with partners, developing ways of working together, building capacity, moving forward to new technology programs. So preparing with known pathogens and actually building our experience. Secondly, transforming how we do R&D and manufacturing. How do we think about approval pathways, clinical trials strategies, technology approaches R&D prioritization that allow us to move faster and fit for purpose for the kinds of pathogen threats that we face now and in the future. And then lastly, how do we connect across multiple partners and sectors, both in the R&D space, which is where SAP has its real focus and its assets and its strengths, but also how do we think end to end so that the R&D work that we do and the way we do that work actually enables and opens up the opportunities for access and delivery downstream. We think that if we do this work appropriately and well and build those partnerships that we can actually get that development from the first sequencing of a pathogen to the first approval of a vaccine down to 100 days and I'll come on to that in a moment. So next slide please. So really the key thing as this goes back to what I said at the beginning is the key here is actually thinking about the preparedness phase, the inter-pandemic phase, and then a response phase. So this 100 day mission that we're aiming to get to is really the sprint at the end of the marathon. And the key things that we actually do the preparedness work that we build the partnerships that we put in place the preparatory R&D, that we support the networks around clinical trials and labs working with country partners and regions, that we also build the relationships between implementing agencies so that when we do need to work together, we know how to do that quickly. All of that can be done during a preparedness phase. All of that needs to be supported. All of that needs to be integrated into a stronger public health and health systems approach where R&D is part of that broader understanding health systems and resilience that is going to be crucial to responding quickly in the future. The key thing again there is embedding this equitable access piece from the start, not only does it give more benefit in the future, but it builds the trust and it builds the basis for the kinds of relationships and collaborations that we really know that we need to see for a global response to global challenges. Next slide please. So I picked out a few things here that we think are sort of key prerequisites for that preparedness approach. One is around kind of an R&D focus, building up vaccine libraries against and vaccine prototype platforms against key viral families, which we think will be the most likely source of threats in the future. Actually getting that head start on R&D, building prototype vaccines with which regulators and agencies can become familiar so that when we need to move quickly in the future, we've got the evidence base that allows us to do so. Secondly, not just on technologies, but thinking about the networks, the capacity that allows us to test those products when we need them quickly. And that's about building clinical trial and laboratory infrastructure. Recognizing that actually that needs to be in the global south, working with researchers and public health institutes in the south, creating that space for leadership, agency and capacity, because that's where, particularly for some of the core pathogens that we work with, you see the real challenges in terms of threat. It's also where we know that there's going to be great huge vulnerability to future threats. So building that collaboration and so on, those networks in the south that will work quickly as part of a regional and global response is going to be crucial. Thirdly is actually thinking about how can we accelerate the development and testing approach to the work with new vaccines or medical countermeasures. We've got a traditional approach in how we do clinical trials and the kinds of efficacy data that we look for, but are there ways to build on some of our experience from COVID to look at things that allow us when the cost benefit ratio allows to actually move forward more quickly. Can we look at earlier immune markers for indication of vaccine efficacy that allow us to move forward more quickly, forward more quickly, apologies. And we've seen some of this actually with how variant specific vaccines for COVID have been developed using immunomarkers actually to accelerate those approvals. Fourthly, on manufacturing capacity and supply. We really know that this was a real challenge with COVID. It will be a challenge with future products. How can we geodiversify and strengthen our supply approach so that we can actually see a more equitable and rapid distribution of products in the future? How do we do that in terms of infrastructure? How do we do it in terms of technology transfer and partnerships that we need? How do we actually link that capacity into routine immunization production and markets that mean that we're actually developing those capacities and using them to deliver benefits in the pandemic period? And lastly, Sarah has already touched on this, which was really about how do we build those global capacities to detect and to characterize pathogens early, whether that's through lab networks or collaborative surveillance is going to be really crucial. Next slide, please. So I did try to kind of focus on some of the questions that were in the brief for the meeting. And if some of what I've outlined in the previous slides are some of what we need to achieve, then what kinds of challenges have that posed for us in terms of how we govern and finance our work between and then during pandemics? I think the first thing we saw this and we continue to see it during COVID and now is that probably investments in R&D in particular will be driven by national and regional investments. Those are going to probably be the locus for a lot of our PPR investments that we see. Now, that's necessary, but it's not sufficient. We need to be thinking about how we can link across these regional and national investments. How can we develop ways that actually help to organize or at least support complementarity and interoperability between some of these efforts? And that's why we hope that sort of developing these ideas around vaccine libraries, around new ways of taking forwards clinical trials actually provide the kind of toolkits that allow us to link together these national and regional efforts that we can build those collaborations, link the nodes in a complex ecosystem, thinking about complementarity and as we go. I think the key point about preparedness investments and collaboration, platforms, innovations in technologies, innovations in manufacturing, what are the enabling pieces that we need around networks are going to be really crucial. And as we think about those, how much of that can be also delivering benefit now during the inter-pandemic periods that can contribute to be embedded in stronger public health, primary health care and community health care systems? Because actually by doing that embedding, that's where we actually build capacity, it's where we build trust between communities and health care systems. It's where we actually develop the kind of operational experience of working together that's going to be really crucial in the future. We touched on how diverse and complex some of these ecosystems are and they include R&D, they include health system strengthening, they include response and delivery pieces. We need an end-to-end view, we need to understand how we go from R&D and health system strengthening and building those capacities through to a response mode. But it's clear that trying to organize this complex system isn't just going to be a command control one system that does everything approach. And particularly as we start to think about financing, the types of financing that we need, sustained investment in systems over time, the rapid financing and at-risk financing we need during a pandemic, those are going to be very different pieces as well and we need to think about how we have bring a range of different instruments together to add up to what we're going to need in that ecosystem. And then crucially and again from COVID, how do we create that space where there is more leadership, more agency, more participation across international country and regional levels, which I think was something that we were challenged with, but how do we do that in a way that those levels can interlink the work together rather than fragment? Country preparedness. Again, I'm free as touch on this with the pandemic fund. How do we build into primary healthcare and beauty healthcare systems a stronger public health function that can respond as and when it's needed, that can be resilient, but which delivers benefits to communities now, building out some of the kinds of networks capacities that link into Sarah's collaborative intelligence, for example, around HMIS or access to closer to community testing types of approaches? How do we make sure that external financing, particularly the Global Health Initiative, and I know, Mercy, you're working on this too. How do we get that stronger alignment between what global health and external financing can do and domestic resource mobilization for health systems? How does that build over time? How do we put countries at the center of driving priorities around our health system strengthening? And then how crucially do we link regional and international functions to support what countries need to do and that countries, in terms of developing their own priorities and systems approaches, that we also then complement those with things that need to be done as regional or public goods at a regional or international level? And then lastly, one of the key things I think we really need to be thinking about is how do we get a coordination across these sectors at a high level, but recognize that really doing this fast is actually going to be about organizations and partners having experience of working together. We will face multiple outbreaks. We face outbreaks every week, every month in many continents. There's opportunities for partners to be working together to really understand how to think about roles and responsibilities, how to look at the different handoffs, risk tolerances and risk transfers that we need between different agencies, so that we really actually come to trust each other, actually know how to do things and can deliver operationally. Next slide, please. I did touch on right at the beginning of CEPI being, there we go. So this is just a quick example of some of the investments CEPI are making and some of those kinds of things in platforms, innovations, neighbors and networks and you can see there some of the work that we're focusing on around manufacturing networks and you can see we have partners already in Senegal and in South Africa and they'll be more joining soon in other regions, also about building out lab networks and building out a true clinical network as well. On the left actually thinking also about vaccines, vaccine platforms, the RNA platform can be adapted to different pandemic threats, but also protein based and other vehicles as well. And thinking about the enablers that allow us to link different parts of an ecosystem, standards and assays, approaches to regulatory approval, some of those things that are going to be the joiners between nodes and networks. And then lastly, next slide, please. This speaks to actually beginning to build that relational experience between different agents, different organizations, different levels of the system, as we think about in response. On the left, we've got the focus on R&D, that orange box at the top, but really we're trying to CEPI think about well who do we hand on the baton to. If we've done our job working with our partners in developing vaccines, getting those to scale through our manufacturing partners, but how do we then hand them off to others downstream and really actually testing that in live fire exercises on various outbreaks. Apologies, I went on a little bit long there, but hopefully Mercier got to some of your questions in terms of networks and collaboration. And I'll stop there, thanks. Thank you. Thank you so much indeed. So you did touch on that. And again, a lot of work that CEPI is doing, a lot of thinking on how perhaps the approach and the solution to all that we're discussing today is not linear. And what I'd like to do because I think we're running out of time is I want to jump into questions that are coming in from the plenary. I've seen a question and so you touched on this, the idea of trust and how trust is so important and how we need to come up with mechanisms to embed this trust. And we have a question from the audience that says, how about a strong mandate to allow a robust on the ground investigation team early in the outbreak for transparency and avat scientific miscommunications on issues such as origin and their symptomatic spread of the virus. And I want to couple this question with, you know, the following question and throw it back to you speakers. The second question says how about revamping the metrics for assessing and monitoring national pandemic preparedness capacity prioritizing readiness with response triggers mitigation guidelines and rehearsals and strengthening protection for the frontliners. Perhaps if we could just, you know, merge these two questions into one a question on other mechanisms that provide robustness in mandate of all the different actors. How do we and try and trust in epidemic and pandemic preparedness and response. And then of course perhaps how do we measure all these, you know, what are those metrics and ways of, you know, identifying trust collaboration and effectiveness in all our engagements. And I'd like to start with you, Sarah. That's fine. I'm not sure I can answer all of it, but maybe maybe a couple of key points. I mean, the question about trust is incredibly important and I think cuts across across across everything. I mean, I think it sounds a little bit simplistic, but you know the best thing that we can do is to actually be building our trusted in country systems, so that there is local ownership and local response to both identifying emerging disease threats as well as responding to them. So I think that nothing that's developed on a global stage will ever be able to supplant the necessary the need for us to be doing localized capacity building and for that ownership to sit with the countries. And if we're not investing in those institutions and those systems we will never get there. And so I think it's really important I think this cuts across all of the conversations we have the incredible importance of the pandemic fund in funding country level systems. That has to be the focus. I do think also you know we've spoken a lot about, you know, not all systems are going to be able to stand up to all disease threats and will need additional support. And that comes back to I think my first comment about those, there are growing regional institutions that also have mandates and have already have trust between partner neighboring countries that already have relationships, and then we need to be thinking about how that is our secondary line of approach to be do to be doing more collaboration across regions. And then I think globally that this that it comes back to the theme of, you know, if we if we don't have those relationships to begin with, we're not going to have them in the middle of an emergency. And so, what can we do to to move that forward. I mean, I think anybody you know we're talking with sepi and the importance of the first 100 days and how integrated that that is with the country level trust. If anybody's trying to set up a material transfer agreement in a couple of days to try to move a sample around to actually participate in a vaccine trial. If you don't have those relationships to begin with you are, it's going to be extremely difficult. So, again, I think we have to make that that time commitment the financing commitment the human commitment to build that trust, as well as we always say we need to center this around communities, and often the communities fall out and then we kind of place them back and so always kind of doing community community centered approach, no matter how difficult that is. And I might just kind of align that with, you know, one of the things is that we have a lot of time chances to test this. So, not every actual event is going to be an is going to be an emergency. So how do we test these and approve these systems, including the trust as we go. And I'm going to put in a plug for my, my, my previous position with resolve to save lives but I think this new metric around the 717 metric of seven days to emergency, emerging disease threat, one day to report it, and then seven days to take a real action to respond is a really helpful way of not waiting. I mean, a J is that this is nothing against J is spars very important to look at testing systems over time, but how are we doing real time learning from acute events and I think it's a really good opportunity for us to be looking at how not just reporting on something but building metrics and for quality improvement so I think there's a lot of opportunities there I think globally we're really thinking about it, and we've come a long way, just in the just in the last two years. So turn it over to others things. Thanks are pre you know your next so please share your insights with us. You know how can we sort of embed trust because this really big, you know it's a recurring theme and how do we also and I like what Sarah said the 717 system how do we, how do we intend to particularly in the pandemic fund monitor progress. I couldn't agree more with everything that Sarah has just said, you know, I think just to maybe, you know, emphasize again. So that that that pandemics begin and end in communities and so you know really starting to build that trust at the community level engaging community, engaging communities in, in, in, you know, prevention detect detection containment, you know it's absolutely vital. And that's why, you know, we at the pandemic fund are also very heavily focused on community engagement as a sort of, you know, integral to to all of the efforts that that we want to fund. And then in terms of, and I would just add, you know, that's very important and then of course leadership matters as well you know we've seen in in in COVID-19 that you know where where leaders focus their decisions on science and on evidence, and we're able to sort of communicate that effectively, you know, those were the settings where you know there was there was more success, you know, in terms of early containment. So now on on the metrics, I would encourage you to to have a look at the results framework that we have for the pandemic fund we we have it on our website and of course it's a live document work in progress, but a lot of thought has been given into it and has been to to developing it, and we are using the 717 metric and you know we think that's that's a really good way to be able to measure progress in the context of ongoing outbreaks and we know that there are many outbreaks that are ongoing as we speak so you know our country is getting better at being able to detect report and contain you know are the investments of the pandemic fund, you know, helping with all of that we will, we will seek to measure that through the 717 metric but on top of that, we're also looking at, you know, we're also using the the JEE spar and BDS tools to to measure progress but we all know that, you know, for a country to move from level two to level three on JEE takes a lot of time so you know it's it's it's hard to measure early results in order to measure early results we feel the 717 is is helpful. And if I can just sort of, but of course, you know, the ability to to track and measure progress through whatever metric depends on data and so you know that that there has to be an emphasis on improving a data collection systematically and then you know being able to aggregate that data up from community to subnational to to national to to regional levels. I also want to make one one more point here on on on the metrics piece that while JEE or UHPR spar, BDS tools are a good starting point, we may want to think about independent peer reviews to assess progress on these metrics to assess country capacity improvements so you know this is something that the the climate space for example has used quite quite effectively you know these independent peer reviews on a sort of countries own capacity is something that you know we may want to think about as we build a more robust system to to measure progress on pandemic prevention preparedness and response and also ways to track, you know, our country is really increasing their their own expenditures in these areas because we all know that domestic investment is, you know, vital to to this piece. So I'll just stop there but with everything that's been said. Thanks. Thank you. Thank you Priya for that. I can see a lot of interest on the pandemic fund and so get on to the website look at the results framework look at how you can participate in that. And I see several hands up I'd like to start with Robert and then Samuel and so I'll be coming back to you I haven't forgotten you. Great. Thanks very much. Really excellent discussion glad to be a part of it Robert Newman I'm executive director amp health. We work with governments to build leadership and management capabilities in Africa. And I'm also a member of the Board of Life Sciences at the academies. So, you know, I really wanted to pick up on a couple things that were said so it's more common than question but just to add my perspective of note I suspend leading the sort of GHS GFSA efforts for the US government so spend a lot of time thinking about the issues that you're all talking about today. I really liked this comment Priya I think this was yours, not just stuff but staff and you just picked up on this around leadership. And I think that that's really really important and and saw you talked about partnerships and you talked about governance. And I think we think a lot about the global stuff but I think I want to bring this sort of back to the countries in the country level. I think we're repeatedly guilty of magical thinking. We talked about leadership, but most people who are responsible for pandemic preparedness or technicians right I mean there are people, you know, and we're also guilty thinking of it very much where the health had on I'm very glad to hear the one health approach because we need to think about that as a multi sectoral approach which I think Cambodia by the way has been very good at. But leadership isn't going to happen magically right it's not going to happen and this issue of trust came up again again we also often think of trust okay trust between these big global institutions it's a bit like watching mammoths mate. But we're also talking about trust with community, but that if we're going to think about what really is required for pandemic preparedness or in spots at country level. A large team of people who are not a functional team on a day to day basis necessarily from across different pieces of the health enterprise into other ministries who need to learn to work together. Develop a shared leadership vocabulary and learn to trust one another, and that can't happen in the middle of a pandemic right so how do we invest in the leadership journey of a team that needs to be responsible for preparedness at a country level. Start that now figure out what that team looks like embed the sort of mentorship and coaching with that team, not on the technical side, I mean, okay maybe that means doing to but I think we're also so focused on the technical. But this is about vision setting strategic planning work planning, managing without you know influencing without authority you can go on and on you know we have a catalog of competencies and you know we do this. We do a day job with teams and government, more typically a functional team on malaria team, a tuberculosis team, but we just did scoping missions to to go in Ghana and there's a lot of traction for this idea of how can we get a team of people to gain that sort of, you know, time and knowledge together so that they are really ready. When, when the time comes to work together so again, but for thought to add again, building on the very excellent points that you've all made. Thanks very much. Thank you, thank you Robert Samo. I'm Sam Scarpino I'm the director of AI and life sciences at Northeastern University also on the faculty and health and computer sciences. One of the points that was mentioned. I apologize for not remembering which of you said it was that there were a number of countries, some of whom low and middle income that did quite well with respect to controlling SARS code to. There will be this package of response that involved highly effective test trace isolate leveraging of real time mobility data, reverse contact tracing or for cluster busting, and we saw again the sort of failure of scaling up testing and test trace isolate in the EU UK the US during MPOC and so curious about what we can learn from the countries that were quite successful with with SARS code to in the response and how we can bring some of those tools and capabilities, more broadly into the pandemic preparedness and in the next few days. Thank you. Thanks Samo. Sarah, I'll ask you to respond to that but let me bring in Jennifer and Bali and then come to you Sarah. Thank you. I'm Jennifer Lastly, the senior program coordinator for the PBS pathway and for WHO IHR connections at the World Organization for animal health. I want to thank Priya for all of her comments related to the animal health sector bringing in their boy international standards and the PBS pathway. And I think that when you're you know you're talking about data and data collection and and intelligence. There's so much information that we already have that is not in any kind of format that we can actually act on take decisions on so we do have an evidence base that's unstructured unorganized, unlinked. It's going to be very much more leveraged than what it is today to be able to allow us to think about trend analysis to understand where countries have been you mentioned the challenges related to PVE level one to two or PBS level two to three takes time. It's not something that can happen over a one year two year three year period. It sometimes can take 10 years 15 or generation, depending on the nature of the of the interventions and the, and the challenges that are encountered. So we at the World Organization for animal health are currently using artificial artificial intelligence and machine learning to be able to harness all of the information that we have in the PBS pathway. Right now we're migrating all of the data using artificial intelligence into a transactional databases so that we can determine the high leverage opportunities for related to strengths weaknesses and recommendations for every area of critical competency in the PBS tool so very similar to the structure of the JEE. So very soon, hopefully the end of 2023 we're going to have a lot of that information to be able to leverage and to be able to inform one of the weakest performing areas which we all know is on the animal health side so be able to think about investment in animal health side so that we can prevent spillover and think more about prevention and preparedness and response and recovery. Thank you. Thanks Jennifer so we only have about three minutes left so I'm afraid I won't be able to take any more hands. What we could do is you could type out your questions and I'd like to go back to the speakers and ask them to just share it really in 20 seconds one action that you think is is really absolutely necessary for us to move our agenda forward when it comes to financing and governance for epidemic and pandemic preparedness. And of course Sarah I'll start with you and you could lead on to the question that was raised. Great, thank you. I think maybe the two big picture ones that are really critical. One is as I noted before the investment in institutional capacity building and that is realizing that this doesn't happen as a project it doesn't happen in a year. It doesn't happen based on your funding cycle it is it's a long term investment, both domestically as well as with the international community on building systems and building capacities and so I think that we will go back right back to where we started, if we can make this the center of what we do. I think also the interdependence that we have to all recognize, you know, solves a very good point on what it takes to achieve that 100 days, and it's completely integrated with do you have strong surveillance systems on the ground that can identify a new public health threat. Do you have the workforce development that can manage it. Do you have a laboratory that can help support the testing so, so I think we have to realize that we are breaking down those silos that the, there are, there are technical silos also because without one we can't achieve the other. And I think that's something that we learned the question about some of the countries that maybe didn't do as well in the day capacity scores that actually had much stronger, much stronger than I expected responses. And I was fully guilty of that having spent 20 years doing surveillance and response in the field. And COVID was my, my first is in the United States and I left the United States via Paris and New York where there's population level to go to West Africa to help support them with COVID and there's their, their coordination and their, their was much stronger I would say than many other countries and one was because they recognize the importance to their populations and their economy because they have been through it many times and they tested systems, and they often had coordination systems so it wasn't not ideal, but the, but it, keeping that level of governance and leadership support is absolutely critical. So I'll stop there. Thank you. Thank you, Sarah, Priya just 20 seconds and then so 20 seconds. So I think, you know what Sarah said, I would just say I would just underscore that sustained long term commitment, both at global level but also at national level, and you know a commitment and an understanding of the importance of all of government approaches and commitment multi-sectoral approaches to, to addressing pandemic prevention preparedness and response. We are seeing from our call for proposals process our expression of interest process, there's strong commitment amongst low and middle income country governments for this agenda we've received expressions of interest for more than, for more than 100 countries for $7 billion of investments in pandemic prevention preparedness and response. So that's really encouraging. But this, this kind of commitment absolutely has to be sustained at the national level, and we need for the pandemic fund if I could just make a plug you know we need that to be accompanied by resources globally to meet this to meet this demand that we're seeing. So just again, sustained long term commitment to all of government approaches to strengthen PPR now, before we face the next pandemic and there's a real urgency and I don't think we'll be able to answer to our children and grandchildren if we don't, you know really seize the moment right now and make those investments that are needed. Thank you Priya. So, well, I'd probably echo Priya and Sarah in terms of investing in institutions of capacity seeing how we can link that though into actually delivering benefits now I think that that's really crucial in terms of making that dual impact argument to ministries of health and actually delivering benefit for communities. And then the second thing is how we can actually then test some of those capabilities in outbreak settings in simulated settings, because the best way to build trust and management capability going back to Rob's point is actually by doing things together and getting feedback on what worked and what didn't work and how we need to adapt because we will need to adapt because this is a dynamic space both in terms of the threats that we face, but also in terms of the tools and the opportunities that we have to work together. And then lastly in terms of the political and geopolitical circumstances that we're working with, these will be complicated so we have to test how we can work together to build trust and know how to do this quickly when we need to. Thank you. Thank you so I'd like to summarize all our discussions today and I think I'd probably need a whole day to do this but I think for me, what I've heard today is that one that definitely has to be a way in which as stakeholders we build trust when it comes to epidemic preparedness and response. Number two, I've had a lot of discussions on financing the need to ensure complementarity, perhaps even a multiply effects when it comes to external financing and domestic resource financing from different countries. I've had a lot of discussions about aligning to country plans, but also regional plans and ensuring that there's that sort of perfect orchestra in the implementation of those plans. I've had a lot of discussion and this was, I think, quite, how do I say, quite personal to me, having been in the front lines in the COVID response in Kenya last year. We have to find a way of measuring in a manner that's intuitive and gives us a little bit more information that's not linear. I like the idea of being able to actually look at all these other sectors that play a instrumental role in preparedness and in response and coming up with more intelligent ways of measuring progress. I'll be going in August, I'll be going to a friend's wedding and she's already been married for 30 years and part of African culture is to actually go back to your family 30 years later to tell them how your marriage has been going for 30 years. And why I'm telling you this story is for us to all to appreciate that it is a journey. It is a journey when it comes to building these mechanisms and systems. It is a journey when it comes to countries actually putting resources and ensuring that there's actually effective governance and multi-sectoral action. It is a journey and I think this is perhaps a reflection of the JEE system and other tools of measurement that we have out there. And so I like the idea of unpacking that particularly Priya mentioned this. How do we look at early response? How do we measure that? And I think that will be very crucial in moving our agenda forward. Now, because of time, I'd like to invite Lisa to come in and share her closing remarks before we move into the next session. Thank you so much to my panelists. I thoroughly enjoyed this and thank you to also the comments that came in from the Zoom. So Lisa, take it away. Thank you so much. And Sarah, Priya, Mercy, and Saul, thank you so much. We've heard a lot about different initiatives as well as your recommendations for how we move forward. And if I could say you've just laid the perfect foundation and some of you talks about trust, country and regional leadership, as well as the mention of community based surveillance for our next panel. So do not go away. We have a 10 minute bio break, but what we have in store for you for our second session on community and regional efforts and building trust as well as some of the preparedness needs, as well as our action groups that will take place on May 18, you'll get a preview and you will get a chance to vote at which action group you want to become part of to do the deep dive technical work to move things forward for science based approaches. So starting now, once again, thank you to everyone that has joined us. We'll take a 10 minute break and then come back for some more rich discussions and dialogue up to move things forward. Thank you so much. 10 minutes. Thank you everyone. I hope that you had a great 10 minute break so that we can be jazzed up and ready and energized for our next two sessions. And once again, I'd like to thank the National Academies for hosting this action forward science based approach symposium. First in a series of three, the other two to be held on May 18 and June 9, where you will actually really get a chance for deep dive so more on that later. This next session is really vital when we speak about country and regional efforts and the preparedness and response. It's clear without this country and regional leadership and buy in our efforts of preparedness and response will fail. Trust is critical at all levels we heard about the community component we heard of civil society as well as our political leaders, and it's vital for success of our preparedness and response. Equity, political will health security and the link between science and public health interventions and preparedness will contribute to our future success. We know there are economic considerations within the ministries of finance external funding sources and donors the banks and regional economic mechanisms and they have to be coordinated. So how will we move forward with a more sustainable and equitable response at the regional and country levels. What role will the many partners involved have and how will science guide our preparedness efforts are data surveillance response. So we're going to find out in this next session. So, at this point I'd like to introduce once again, Dr mercy and one gangie from Amra Kenya with a rich history at the Ministry of Health and Kenya to introduce our speakers for this next session that will look at regional and country efforts and building trust for sustainable international epidemic preparedness. Dr mercy over to you and thank you. Thank you Lisa. And thank you to the National Academy is really for hosting this very, very important symposium. We have our second session that we're really drawing from the faster and where we had a global view of the challenges and investments and opportunities that exist when it comes to epidemic and pandemic preparedness. And we are now having a more granular focus on what is happening regionally and at country level, and who the different actors are in that space and their contributions to this. And so I'd like to introduce our panel today. Our first speaker is Dr Ali Kija. She's the co-chair of African unions of vaccine delivery alliance. Ali Kija is also a special envoy who has led collective advocacy for the act accelerator mobilizing support and resources so that it can deliver against its new strategic plan and budget that was launched in October. She has ensured that the process was characterized by accountability inclusion and solidarity, and she will be sharing with us through a video. We do then also have our second speaker, Dr Irma Macaliano who's a professor from the department of pharmacology and toxicology from the University of Philippines College of Medicine. Dr Irma has been a faculty of the university since 1994 and has been instrumental in institutionalizing the fast only toxicology fellowship program in the Philippines in 1996 at the University of Philippines in Manila, where she served as a fast program director of clinical toxicology. And then on to the National Poison Control and Information Service at the Philippine General Hospital. Welcome, Dr Professor Irma. And then we have Professor Duncan, who's president of the International Association of National Public Health Institutes and has been serving there since December 2020. He was the founding chief executive of Public Health England from 2013 to 2020, and he has been an executive board member of IAMPHI since 2016 and has served as foundation board trustee and treasurer. Welcome, Professor Duncan. And then we have Dr Ilson Correa, who's a research director at Instituto de Medicina Integral, Professor Fernando Figuera, forgive my Portuguese Spanish there, and he's an associate professor of pediatric infectious diseases at the University of Penambuco in Recife in Brazil. Dr Correa is also a researcher for the National Council for Scientific and Technological Development of Brazil. Welcome, Professor. And we have Dr Osam Mancola from the Africa Center for Disease Control. He's a healthcare professional with over 11 years experience in the public health emergency management, epidemiology, and practices medicine. Welcome to my panelists and I'd like to start us off with Dr Likija by video. We can play the video please. Thank you so much to the National Academy of Medicine for this invitation to join the symposium today and I'm so sorry to be unable to be with you live for these important discussions. Pandemic preparedness does not occur in a vacuum but in a wider ecosystem of socio-political and economic drivers, influenced by history, by culture, by politics. And even today we see that with an ongoing COVID-19 crisis which has been discussed today about whether it's going to remain a public health emergency of international concern or not. There are so many competing crises such as the war in Ukraine for us here in Africa, the war in Sudan, and the economic challenges that are shifting the political focus from pandemic preparedness and response. And yet that is the reason why we're here today. That is the reason why three plus years later we're still in a raging COVID pandemic. We're hearing about Arcturus, the latest sort of, you know, offshoot of the Omicron Strait that some would argue should have its own name causing havoc in places like India and other parts of the world. And yet the world has let its guard down because of political attention that the sort of more socio-economic factors have pressured us into moving away from what is causing devastating illness and disease and unacceptable numbers of deaths yet still today. COVID has demonstrated in times of crisis public trust is not just important, it is indispensable. It is the glue that holds societies together, the foundation upon which successful responses are built and the light truly that carries us through the darkest of times. Even on personal levels trust is what really holds us together. And we've seen in recent years crises can arise suddenly and without warning, leaving societies reeling and unsure of what to do. And in such times it is often the trust that people having their leaders and institutions that makes all the difference. I wrote recently in the Lancet highlighting five fundamental crucial, crucial efforts to strengthen global health security and to rebuild a common sense of optimism in our ability to collectively achieve equitable health for all. I've proposed a pact standing for preparedness, access, countermeasures, tools and trust. While resources can provide the first four financial resources sheer weight of power of big governments, the absence of the fifth seemingly the least tangible and the most ephemeral can undermine progress even in the most advanced of societies. Trust enables public institutions to thrive and makes private enterprises grow. It serves as a link that strengthens the bonds between communities, between generations, between organizations and between the public and the institutions and governments established to make their lives better. Trust is a fundamental pillar of modern society, one that underpins social order and the functioning of our institutions. We see this for example in financial systems that are also beginning to shake and wobble. Without trust the soft stock market would cease to function and the entire edifice of the global financial system would come crashing down. This is because stock markets operate on the principle of uncertainty where investors make decisions based on incomplete information. They trust that companies are providing accurate and truthful information about their financial health and prospects and they trust that the regulators are enforcing the rules that ensure a level paid playing field, equity, as one may say. But when trust is broken, when companies engage in fraudulent activities, when greed comes into play and regulators fail to enforce the rules, investors lose confidence and the stock market crashes. So it is for public policy in general and public health in particular. Our global health world has seen an erosion of trust that has caused us to begin to question the very institutions that are meant to regulate trust, our health, health for all. And yet equity, justice and inclusion are the lifeblood of this trust and interventions for epidemic prevention, detection and response must take into account building long term relationships with communities, countries, nations, especially those who have been most undeserved. In creating and implementing approaches to building disease surveillance and risk communication capacities, capabilities, the context must be expansive and include not just political and economic context, but also social and cultural context. A true commitment to equity and inclusion will treat communities and people not just as data points, but as complex living beings with valid responses to histories of privation, injustice and dysfunction, all which erode trust in the very systems that provide crucial health interventions in times of crisis. In order for us all to be able to achieve sustainable epidemic and pandemic preparedness, investment in cultural and social competency, something best done by local experts, local people with lived experience is necessary. While hard data provides important insights into what is needed for national action planning and specific needs for prevention and intervention, intimate knowledge of our own context often revealed crucial factors that require specific cultural interpretations for one to make sense of them. Technical expertise must also include understanding of the sensibilities which often inform political leanings, actions and reactions of any particular region. Too often the world has gotten it wrong. Too often the world has read it wrong. We read it wrong as Afghanistan was being cobbled, was falling. We read it wrong as Sudan burst into war over the last two weeks. The world has read it wrong because we're leaning on hard data points. They have no understanding of the political economy, of the social, of the current context. We're reading it wrong on vaccine implementation and vaccinations and what we call hesitancy because we're relying on historical data. We're relying on those who did work in Africa 20 years ago and yet Africa or Asia or the Pacific are very different places today. The intersections of climate and health, the intersections of the pandemic and the economic crises, the intersections of youth uprisings and gender transformations in societies is making these all very, very different. It's very difficult to predict. We cannot do pandemic preparedness. We cannot do epidemic preparedness in a vacuum. I personally am committed to regional institutions and regional groupings and regional framings like the Africa vaccine delivery alliance, Avda, which I chair and have chaired through the pandemic, initially with Professor John and Pegasong, who is one of your own, and is now the head of PEPFAR. Africa vaccine delivery alliance was set up for that with a particular reason. It was set up and has been instrumental in facilitating the delivery of vaccine interventions to communities, particularly in the context of COVID-19. The Avda's Ports to Arms Initiative played a vital role in getting vaccines from ports to arms once we had dealt with the initial issues of vaccine apartheid, of hoarding, of our inability to access the product itself. Our role as interlocutor between countries, private sector, logistic partners and international organizations such as UNICEF, WHO and GABI have helped to coordinate the community engagement efforts and also focusing on risk communication and also understanding the political and the local context. These are critical, these are key. Avda has brought multi-sectoral stakeholders around the table to address these critical challenges. Initially we were focused on delivery of vaccine, but now on much wider health interventions in a manner that builds consensus and collective accountability. I personally believe that this, amongst other things, is what is missing at different levels in our preparedness ecosystems. One example of the importance of cultural context in public health programs, I will use the case of polio in Nigeria, which is my home country. Even within Nigeria the cultural context varies greatly, the political context varies greatly. It requires careful understanding, not every community is the same. Christian, Muslim, animist communities, they're all different, north, south. Certain predominantly Muslim communities in the north of Nigeria were refusing initially the polio vaccine, even though northern Nigeria was most affected by the disease. In 2003, Nigeria alone had almost 40% of all the few polio cases worldwide. And there was a boycott of the General Global Polio Eradication Initiative. It was boycotted in five more Muslim northern states of Nigeria. But this was due to politics. The world at what large did not understand. It was due to the fact that one year before, Nigeria had returned to democracy after many, many years of military dictatorships. There were high intentions between certain northern Muslim states and the federal government over a stricter form of Islamic law, over a stricter form of Sharia law. In northern states sentiments that might be described as religious nationalism had started to gain traction and many northern Nigeria saw that as a way out of the decades of poor governance and dysfunction. The power of religious leaders was at an all-time high and vaccine hesitancy had taken root. Unsurprisingly respondents explicitly cited earlier Pfizer drug trials in their explanation of support for the boycott. Because Pfizer had been sued after 11 children died in a clinical trial when the northern state of Karno was hit by Africa's worst ever meningitis epidemic in 1996. A tentative adult court settlement with the Karno state government worth $75 million was only reached in 2009. This example, this one example, explains so much and highlights the importance of understanding the political, the cultural, the social context. Had that polio vaccine campaign considered the political context, it would have been raised that the outset of the program in Nigeria would not have had to experience a 30% increase in polio prevalence, setting back that global polio eradication efforts by over a decade. This has also led, by the way, to vaccine hesitancy beyond polio. Health is not separate from other aspects of development and people who experience other forms of injustice and ain't in equity are far more likely to have hesitancy rooted in their mistrust of institutions and governments. Policies that are equitable and inclusive to help address historical disparities and injustices are needed. Equity and inclusion also help build resilience in communities by addressing the underlying social determinants of health such as poverty and discrimination. As the World Health Organization has stated, public health surveillance is the bedrock of outbreak and epidemic response. This, however, also raises issues of trust. It is more challenging to gather health, surveillance data in communities and countries with low public trust. We've talked about trust, we've talked about preparedness, we've talked about the social and political context. We all know the text, we know the technicalities of what we're talking about and you ever asked me to end with one or two calls to action. My call to action for policymakers is to ensure that community leaders, those who have the intimate knowledge of the socioeconomic and political drivers of the ecosystems, those in countries, at national level, at state level, at community level, who understand who and what is most at risk and most vulnerable and know where they live and have the lived experience, that those people included in decision making processes for pandemic preparedness. Trust can only be built in when we ourselves are included in the process. Trust cannot be an afterthought, we cannot be included later, we cannot be brought in as a bookend to take the box to ensure that all groups have been included. These conversations have to begin with those with the lived experience. These conversations have to begin with those in the places where what health matters are beginning to become of great concern, where zoolotic spillovers are beginning potentially to happen, where cholera is breaking out because dams are overflowing because floods are happening due to climate change. That is the call to action. Trust must be built and nurtured over periods of time because Rome was not built in a day. To every actor in the health ecosystem, let's rebuild the trust we have lost in and between individuals, organizations, institutions. Let us rebuild that trust, let this become about collaboration, not about competition because it is one planet and as has been said before, there is no planet B and we have no other lives to live. Let us rebuild trust for the sake of humanity and let us build a pact for the future. Thank you so much for your time. Fantastic. Thank you so much Yodi as we call her back home for that fantastic presentation on the role of trust and the experience that you had in leading after during the COVID-19 pandemic and perhaps also the sharing that you've given us and the reflections that you had when it comes to building trust. I'd like to bring in the other panelists and I want to sort of start them off from where Yodi has left us when it comes to the political economy of pandemic preparedness and epidemic preparedness. And I'll be starting with Irma. What challenges and critical needs would you like to share with us when it comes to epidemic and pandemic preparedness and what issues and what pillars, etc. Can we put in place to be able to mitigate against these challenges? Irma, you're welcome. Yes. Good morning, good afternoon and good evening to people in this platform. First of all, I'd like to always say that when I speak in a forum like this, this actually follows the principle of no attribution. I am not an expert really on pandemic preparedness. I am a neophyte, but I carry with me perhaps the experience built over the years related to CBRN preparedness and response. And of course, as one who has been working in a hospital that was transformed into a COVID-19 facility, I would like to share our challenges and experiences. So certainly the COVID-19 pandemic exposed our strengths, our weaknesses, opportunities, and of course, again, this actually also highlighted certain needs that we need, certain needs that are actually very important in the preparation for future epidemics and pandemics. But I'd like to always say that when we talk about preparedness, it's very important for us to look at what we have, the capabilities that actually already exist and build on them. Because this is a very good starting point to be able to really understand what a country will actually need to be able to face a pandemic. So what I saw during the COVID-19 pandemic, especially at the start of the pandemic, was that we needed to look into what we have as resources within our respective agencies, whether this is government, private, academia, or research facilities. Again, we were able to look at the, as I've said, one of my work now is really to coordinate as an advisor to the government, the issues related to CBRN. And CBRN, or chemical, biological, radiological, nuclear, of course, includes the bio part, which is the bio thread. And therefore we were able to look at what we have in terms of CBRN preparedness, detection, and response. So I'd like to give you a very clear example of how the Bureau of Fire Protection, which is a non-traditional player in public health response, actually before the pandemic was even declared as a pandemic. I remember this particular day because the fire director, General Jose M. Bang, called upon his men to prepare for the eventuality that there will be a pandemic declaration. And so he gathered his men using his leadership and training as a CBRN responder to design a transport ambulance. We know that this particular need to make sure that the first responders will be safe and they will not be, again, the next victims because in the dictum of CBRN preparedness and response, we usually talk in terms of not being, the first responder should not be the second victim. So here they were able to do this using their own resources and were able to successfully transport the very ill, seriously ill COVID-19 patients to the designated medical facilities and they did not have any personnel from the ambulance who got infected. So which means that if we only closely look at what we have, we might find there are some gems that we can need in the next pandemic. So again, because of the knowledge of CBRN preparedness and response, the Bureau of Fire Protection designed a protocol for decontamination of personnel, of vehicles, of hospital facilities, which they cascaded to different agencies of the government. They also assisted the different hospitals in the proper way of wearing the personal protective equipment. We know that medical doctors and healthcare personnel are not usually trained in wearing these PPEs. And of course under his anticipatory leadership, the Bureau of Fire Protection was able to supply frontline healthcare workers to augment the resources of the different hospitals because the healthcare workers were already very exhausted and they needed a time out. So they were also able to man quarantine and isolation facilities, their men were also able, men and women were also sent to be the people taking the samples properly and then transporting them again to the swabbing facilities. So this particular aspect of using the CBRN preparedness protection and response training that people had were also exhibited by the Philippine National Police and the Army, and this contributed greatly and significantly to the public health response. So going back to this issue of harnessing existing capabilities and building new capacities, I think this is what COVID-19 also showed us. In the Philippines for example, we realized that we really lacked molecular diagnostic facilities, but at the beginning of the pandemic we tried to look at what we had. We actually had the gene expert machine because of the TB surveillance and detection that is ongoing to the World Health Organization. We also had upgraded regional animal diagnostic facilities which had the real time PCRs. And of course eventually we relied on the resources that already existed within the Research Institute for Tropical Medicine and also our own University of the Philippines had a genome center which was able to do the sequencing for the Philippines. So it means that we need to build more of those capacities so that in the end we will be able to address better the detection part of the pandemic. So we also looked at what we had in terms of people who were trained for the design of containment facilities and low resource settings and asked them to assist in ensuring that the quarantine and isolation facilities that were already being built were safe and secure for people who will be placed in those facilities and the people who will be manning the facilities. One of the greatest challenge I believe at the beginning of the pandemic was the designation of our own hospital as a COVID-19 referral and treatment facility because we were really not designed for infectious disease. We were a general hospital but of course when the government mandated us to do this task we transformed ourselves within two to three weeks into the most thought after COVID referral hospital because we treated the most ill patients. And we had of course a complement of people who were really trained in infectious disease were able to do the laboratory testing quickly and manage the pandemic. We also were able to place our role in the rollout of vaccines. But one important development that we recognized is that because we were a general hospital it was important now for us to consider the possibility of building negative pressure rooms. So again with the help of the men and women of the Bureau of Fire Protection, private parties and also other organizations, the Philippine General Hospital now has several negative pressure rooms in a facility that will now be transitioning to become an institute for emerging infectious diseases. So we can see here that the academia like the University of the Philippines has really played a very important role in this COVID-19 pandemic. We also utilized our students and other healthcare providers to be able to answer calls from the public because it was really very important to have a very good channel of communication, people who will listen to their problems because mental health was also an important issue during the pandemic. Again in the end we were looking at the different clinical trials that our university and academic researchers and other research institutions in the Philippines who were able to really look at doing some kind of clinical trial within the context of that pandemic. So again in the search for medical countermeasures, the academic institutions and researchers would really be an important asset for the country. One very actual intervention in terms of research that was done during the pandemic was we recognized in the Philippines that some of the masks do not fit the faces of our doctors and healthcare providers. So we actually were able to design together with our medical researchers and the engineering component of our university powered air purifying respirators which were really used and tested during the pandemic. So again we are also enhancing now our genomic sequencing capability to be able to do further genomic sequences and testing in the future pandemics. So what are we now also concerned about? Of course the pandemic was one time in human history where again misinformation and this information really were circulating a lot, not only about the origins of the pandemic but also in the medical countermeasures sphere. We know that there were certain people who took advantage of promoting certain therapeutics which were never really proven to be of good value but can sometimes also be harmful. These are some of the things we need to be prepared for in terms of answering this particular kind of interventions because they become very popular very quickly because of the lack of appropriate therapeutics. And of course again we need to be able to have more trust in the government and the healthcare system that it will be able to respond adequately to the healthcare needs. One issue of course in the pandemic preparedness that resulted in some kind of problem is during the vaccine hesitancy that came about at some point because of some personnel or prominence figures who came out in the trying media saying that the vaccines do not really work. Of course this is something that we need to be cautious about because this is again an issue that can prevent people from accepting the vaccine. So what else did we learn from COVID-19? Again it is very important for us to invest in primary care. I think that even as we think about advanced science, technology and surveillance, the primary care system must be strengthened. Our university, the medical school where I come from, we always have a vision of serving the underserved and we can really see that for example in the Philippines because we have very remote islands as well. We are separated by bodies of water and that there can also be issues related to extreme weather events. We need to make sure that the primary care system will really work. We saw for example also that in parts of long areas or perhaps even in fourth class municipalities, it is not easy to roll out the vaccine. One because it's difficult to reach them. There may be certain beliefs that actually prevent people from the uptake of the vaccine and also because there is no suitable infrastructure to make it to deliver and ensure that the vaccines will not be wasted. But again, one very good example of investing resources in parts of long areas was seen in the case of Kabuga which is in the northern part of the Philippines in a mountainous area. Where the assistance from UNICEF and the government of Japan was able to really promote safe use of the vaccine and prevented the wastage because they actually donated solar powered refrigerators. So I think the training of community workers in the primary care setting for surveillance and early detection will be an important way of again preparing for the future pandemic. So we need to strengthen surveillance at the community level and of course improve also testing at the community level. In a country like the Philippines, we also realize that a holistic approach to assessing threats, risk and vulnerabilities will always be important in the face of a pandemic. We cannot isolate the fact that there will be other threats such as for example what the Philippines experienced in August 2020. When even in the face of the heightened alert for the COVID-19, we still had a major event between bombings in Holosolou that happened. Of course, this was related to a terrorist event. And again, we always have to consider that in a country like the Philippines and in Southeast Asia, the possibility of a natural disaster. The Philippines is preparing for what we call the big one. And therefore if a pandemic happens to be occurring at the time of a big earthquake or even in a natural calamity related to extreme weather events because the climate change, then we have to think about how we can mitigate the risk associated with multiple threats. So again, we know we have to remember that preparing for a future epidemic or pandemic does not exist in a vacuum. So what is our government doing now for future pandemics? We are now creating or there is an act for the creation of the Philippine Center for Disease Prevention and Control. This is of course in preparation for future pandemics and threats to public health. And in the proposed act, our existing research Institute for Tropical Medicine will now be put together with the Center for Health Statistics and the Center for Surveillance and Epidemiology. There is also an act pending in our legislative body for the creation of the virology Institute of the Philippines. But I have actually also seen the national security strategy of the Philippines is still in a draft form. But there is now a very strong inclusion for health security as a major priority of the Philippine government. And so it says that something like a healthy society will improve public safety and cultural cohesion and contributes to a higher productivity. And so the government shall feed health security as a top national security. So in summary, preparing for future pandemics, for me, this is a personal reflection. Being prepared for the unknown, because this was a challenge at the beginning of COVID-19. Looking back to what we did right and what actually did not work with COVID-19. And it also becomes important for people to have a stronger way of detection. And again, we need to now invest in training the next generation of healthcare personnel and include in the medical curriculum and probably even in the nursing curriculum simulation exercises. Allow them to work to be able to work comfort where the PPE is correctly and be comfortable in working in such an environment. Invest in better laboratory capabilities, better risk communication strategies, and look at the value of one health approach in the Philippines. Because for example, in the Philippines, we had to deal with African swine fever that coexisted with the COVID-19 threat. And of course, we also have to look at the environment and the ecosystem, especially in countries like the Philippines where we know that natural calamities. And again, earthquakes and extreme weather events from climate change can coexist with the pandemic. So we also need to understand that we need to utilize the non-traditional players in the pandemic such as the uniform personnel from the Bureau of Health Protection, the police and the army to help in a future pandemic. And so last but not least, while we are thinking of advanced science and technology, better infrastructure, we always, always have to remember to invest in people. Thank you very much. Thank you. Thank you, Professor for all those valuable insights. I think, you know, very, very important points in terms of how do we invest in people? How do we invest in the normative frontliners and non-traditional frontliners? How do we always take into account other events that may be concurrently present during pandemics and epidemics? I'd like to sort of pose the same question and hear reflections from Duncan as you, you know, play your role as president in the International Association of National Public Health Institutes. What are your reflections? What was the experience of MPHIs when it comes to the COVID-19 pandemic? What critical needs did MPHIs identify or go through? What challenges were there? And more importantly, how do you think we can mitigate against these issues? Welcome, Professor Duncan. Unmute. Listen, that was great. And I loved what Professor Irma had to say and the strong way in which Professor Irma ended about this is all about people, but also listening to the video as well, context is context of everything. I am, is the world's gathering of about 115 national institutes of public health to essentially inform from science and evidence, not only about infectious diseases, non-clinical diseases, supporting health care services and so on, but also and crucially to implement policies, so to inform and to implement. And, you know, it's a great honour to contribute this afternoon because with all humility, National Public Health Institutes are a crucial part of preparing and responding. But as has been explained and shared earlier and in the last two sessions, this is a whole of society concern. You can't have good health without prosperity. And unless people are all enjoying prosperity, they're not going to enjoy good health. The world is not safe unless and until there is more equity in the walls. So I'm not going to add to what's already been said. I want to pick up, I think, three things. The first is to speak very positively about the work of the World Health Organization and its focus on strengthening surveillance. There are a number of colleagues that have spoken about this. We call it integrated surveillance. Essentially, it's the traditional surveillance about knowing fast and sharing quickly about outbreaks of infectious disease. But we learned through the pandemic, we needed to know more than the traditional forms of surveillance. We needed to understand how and where people were moving and what food they were buying, what was going on on social media, what were people concerned about. I'm working with the WHO in its national countries. All the countries across the world are working on a better form of surveillance. Not one that works for some, but one that would work for all. And that's work underway. And then I'm sure you've spoken about the global health, the sort of emergency core idea that we identify country by country. Two or three people who can train together and act together, get to know each other. There's been a very big theme about trust, knowing each other, spending time with each other, building relationships and trust so that when the next big, big event happens, we're faster off the mark because we know each other and we're trusting each other. And then as Professor Irma spoke, and others have as well, about the importance of the workforce. And I want to emphasise that the experience during the pandemic, huge sacrifice, the loss of life and loved ones and on the economy, but also amongst the public health professionals who every day went into situations that were certainly initially very dangerous. And there was a lot that wasn't known. And they went in the next day and the day after that as well. And the people who were making the difficult decisions were also the ones that were making the good decisions. And there were the people that were sometimes decisions that were just proven not to be good decisions, so good decisions and bad decisions, but the same people were making those decisions. And we need to have maybe again a bit more humility that people don't wake up in the morning to make bad decisions. And we need to be supportive looking out for and after our public health professionals, recognising that if we ever needed them before, we need them more, even more so into the future. And then I want to briefly talk about investment and the decisions that governments make about how much to invest in prevention in preparedness. Very few countries, there were examples, but very few countries had invested in preparedness. And as a consequence, we spend trillions as a world, billions as countries. And had we invested in preparedness in the way that others have spoken, we might have spent millions to save billions, certainly billions to save trillions. And we're in this cycle of panic and forget, which is, oh my goodness, and we spend a whole lot of money, and then we think, oh well that's done, and then we forget until the next time and we're in that same cycle. So my message is, and my single biggest message is that we need to have a different, you know, we need a new approach about investment. We need to have the courage to invest to save. The investment is not a cost. It's ensuring that we have resilience. We will save lives. We will save money. We will have the same damage to economies. But for investing in preparedness. And I'll end if I may, because I know time is short, that when I listen to decision makers and politicians and policy makers, and they tell me that public health, the public health prevention, it matters. It really matters. I say to them, don't show me your strategy. Show me your budget. And then I'll know what you care about. I'll end there. Thank you. Thank you Duncan. That's a fantastic place to sort of end your remarks and show me your budget. And I'd like to move on to Jelson, who is a research director. Could you share with us your experiences in the same line and keep it short because we don't have much time Jelson. Thank you. Well, thank you very much. I'm very honored to be here. I'd like just to thank the organizers, the National Academies and the previous speakers because they made my work much easier. I will skip lots of points I would make, perhaps reinforce some of them, but perhaps bring something stress some of the aspects I think are very relevant. And all is already been set and so it makes really my work much easier. I'm not expert in the field as, but I am probably here because I used to be the Secretary of Health of a municipality in Brazil, a city called Recife. I also worked as a Director of Science and Technology of the Minister of Health in Brazil, so it gave me a little bit of a broader perspective in the country but perhaps I would share with you my slides so that we can go very quickly through the issues that I plan to talk about. So, I think to summarize, maybe I should start by saying that we need more translators in this, interpreters in this equation. Everyone is talking about different cross sectorial approaches and everyone is talking about the different approaches but I think we need people who can understand more than one area of knowledge, of more than one aspect of the whole complex problem so that we can make this continuous dialogue something more you know cultural in terms of public health response. Well, I come from this city in the northeast of Brazil. It's metropolitan region has four million people. And it is, I think it somehow summarizes the world if you wish. So you have the skyscrapers on the back that it's on the shore and the front sea one of the more, more expensive square meters in Brazil. But then you are this road, busy road crosses a favela, a community, and in one of the other sides of the city so it's a very diverse city and it summarizes inequalities in the world and to an extent it serves as a lab of things that can happen in different parts of the world. We are going to share very quickly some of the previous experience with Zika and Chikungunya epidemics and then talk about, about COVID and how we respond to that and how the previous experience of having to deal with microcephaly and Zika has taught us some important lessons so that we could make a better job and respond to COVID, but then come to some of the important questions that there were made to everyone else. This is a common sense act to locally think globally I think that's my perspective. What I can bring to the discussion so this is a UNICEF picture of a child with microcephaly so it speaks for itself it's a huge human problem and drama of it provoked huge response in terms of human resources and also emotional response to that kind of situation and of course it also made it more and more clear the inequalities within our own country and in our own world. So this is really just to summarize that Zika the first report, first sample taking from a patient suspected of something different going on back in 2015 was here in this epidemiological weekly graph. The sample was taken here but because we didn't have the capacity to look at molecular new pathogens for instance it took months so that we could really report back in those first analysis to a new novel virus with at least a new novel to us that was Zika virus so we probably in these few months here we experienced a huge circulation of Zika virus which is not noticeable here because most of the cases were too mild to bring to healthcare centers. This is the dark green is people with suspected dengue that went to hospitals or to primary care but most of the people stayed at home and then of course the ring bell when the first case of microcephaly were then came about and it took a couple of neurologists to call the attention of the health secretary of the state so that something was going on and the notification system did not pick it up very quickly. But then just to say that we had a second wave of disease and again by motto distribution here and then we also had our first case of Shikungunya and if I only spoke of Shikungunya I could be saying that that created a major burden to the health system locally but then we had to face the triple epidemics of Zika, Shikungunya and dengue and in Brazil by then and in 2015 we had a deep economic crisis, high levels of unemployment, a high level political divide it was a pre-electory year the president was about to be impeached and the minister of health staff was very much engaged but there were many changes in the chain of command. On average one minister of health per year during the 80 years I was secretary of health for his city. Rio de Janeiro was about to host some of the Olympic Games but his city was perceived as the global epicenter of the problem because that's where the first cases were described. And our shelter for this, what I call it, the perfect storm here, our shelter was the national health system as we call it, Sistema Unico de Saoji. So just to summarize, there was plenty of evidence that what we used to was not working in terms of preventing epidemics and we had to change the population as a vector born disease we had to change the population's attitude and actually behavior in terms of prevention. So we introduced ourselves as a laboratory city where different new approaches would be tested and we welcome every bit of innovation actually from the low hanging fruits, things that were proving to work out all the way to more proof of concept approaches. Very quickly we were open to innovation and here it looks like a lung to the clinicians in the audience but that's actually a map of one of the districts of the city where we could have hotspots of transmission at that time and of course we also used sterile mosquito technique to sort of speed up the response and try different new technologies. But eventually the most important things were around talking to people discussing engaging people from our mosquito tears in the schools all the way to companies who had a seal of compliance if they did what was supposed for them to do in terms of control measures. And then let's shift time a little bit to closer to the present time and resilient in 1920 was again in deep economic crisis political divide was on its peak. There is a change in the chain of command, and the system only could just our national health system was again our safe and shelter, and I'm emphasizing that because we've been discussing global or national policies and that's in the first part of part of the panel. But I, of course, I'm trying to emphasize the need, and I think Sarah Hersey very much very well put it the need for local involvement and engagement and local leadership as well. And this is our response to COVID from, you know, in 45 days, having out of a warehouse, an old warehouse, having intensive care unit in 45 days, places where we would have tents when there was no full lockdown tends to distribute masks and inform the population. I would like just to stress this little app here that allowed people, depending on their responses they would get a reply saying, Okay, you are doing fine. Don't need to go to a health unit so you don't have to transmit disease to other people, but it will keep in touch with you in two days we'll come back to you, all the way to if the patient answered that they had some problems with, with a more severe presentation or, for instance, comorbidity, they would then speak live, a live call with a doctor that was working from home, because was over 60 years old and couldn't be at the health unit in the first place. Because fake news is also a problem for everyone. So I'll skip that. These are the, just to make it quicker. So, perhaps I should skip that as well it's a special movement of cell phones as a proxy of, of, of population movement and social isolation. And then I mentioned translation so we have to have everyone in on the table but we have to have people who understand their language by language I mean their culture there, they are, you know, academics think of publication grants and you know that's that's how they survive. Of course, everyone wants to solve the problems but everyone comes with a view of themselves for the effected affected families, the number or percentage mean nothing that for them that that child is 100% of the of the issue. And we have to take to take all of that into account. And of course, to stress the need for leadership someone who understands a bit of a bit of different aspects of these but also can can lead the response. So, this is just just summarize and finalize my proposal is that these common language for the for the epidemic preparedness but also dealing with the current and chronic problems in, in, in, in health is actually to create, you know, the wheel of translation epidemiology if you wish so gather data and sometimes we need to be to do the very basic data gathering because there's none in many places of the world, and then move all the way to getting the, all this knowledge systematically reviewed and made available. We need to know to invest in knowledge translation, because the decision makers don't don't don't read epidemiological graphs you have to translate to in a language that they, they can understand locally and engage take hold of the citizen citizens implementation, and then all the way back. The circle is always moving and as I've learned earlier today, you cannot be analogical, it needs to be digital and almost on real time because things and societies change much faster. Trust building this is my last slide so trust for relations need to be built over time my proposal is that that dialogue is it should be continued to it should be in a common language that people can understand. But again can over overstretched under staff that underfunded the health system cope with new threats in an effective way so that's, you know, we need to think about that so we need to strengthen health systems. In general, we'll make we'll make them, we've made ourselves more prepared when a pandemic comes in equalities of course a major issue when we need to see a genuine effort. Without that, I think that the level of suspicion between the parts of the dialogue and the communication it's often jeopardized. And then we have the problem of science denies science denies to me is more than you know just a trend or something. This is actually part of a very clear political strategy to gain and sustain power in many places so we have to deal with that as as as highest political risk for health and for our live life conditions in the world. So, I should say democracy transparency and multi lateral, lateralism and a finish off with this message. Thank you. Thank you so much, Dr. Jelson again very very pertinent key issues you've raised on trust key issues you've raised on on the role that digital technology plays key issues you've raised when it comes to translational epidemiology. I'd like to move over to wassame and wassame we only have about 10 minutes left to this session so I'd like to give you just two or three minutes to share with us, your experience particularly because you are the center of it all as the lead of the EOC at Africa CDC. And I can see we have 25 slides, I hope you'll be able to run through really quickly wassame and I might have to cut you off, but please, please take it over wassame. Okay, thank you mercy and thank you, National Academies for science engineering and medicine for giving us this opportunity. I'd skip most of those slides, but as I understand from the context of this decision we're focusing mainly on the political engagement work and how this political engagement can ensure the sustainability for the pandemic preparedness and response. Next, let's skip the situation of COVID-19 pandemic in the continent around 12.2 million cases reported in the continent was more than unfortunately 257 southern case that reported in Africa. Let's skip this one next. Next, when it comes to vaccine supply, currently we got access to 1.1 billion doses and we succeeded to consume around 95% of those doses that we got access to them in the continent. Next, okay, next. Okay, we, when we're trying to manage this pandemic we depend on six pronged approach I'll touch base on each one of those quickly and the next few slides. Next, political engagement, we don't buy political engagement. We build political engagement and we believe that this kind of political engagement and Africa CDC to be embedded within political organization like African Union, give us this access to high level political leadership within the continent. And if we engage them correctly, if we inform them, engage them, talk their language will be able to move lots of things within the continent. This was clear for Africa CDC since day one in this pandemic. One week after reporting the first case of COVID-19 in the continent in Egypt, we invited for emergency ministerial meeting for health minister in the continent to have unified approach for addressing this pandemic in the continent. Later on we'll discover failure of global health security infrastructure, but with this unified approach since day one to have Africa joint continental strategy to guide the movement in the continent and showing solidarity. This make Africa pass this COVID-19 with less losses. Next. And it was not enough to engage health minister because we believe since beginning this pandemic is not an issue for minister of health only, but we need to ensure engaging of other ministers and also engage the highest level in the continent, heads of state and government. So this is summary for the governance structure for managing the COVID-19 response in Africa. At the top of this structure you find African Union Bureau of heads of state. It's composed for around 10 heads of state and African Union Chairperson Commission and Africa CDC director at this time is member of this Bureau and preved them regularly on a weekly basis about the progress and what is required from heads of state and government. This is in addition to other ministerial committee, committee for finance minister, committee for transport and logistics minister and health minister as well. Next. We can move to next slide. One of the key challenges also that we faced at the beginning is getting access to different commodities, especially lab testing and also how can we deploy our human resources was the challenges that is happening, not only the continent, but also outside the airport are closed, airspace are closed. Next. So we set the target that we need to deploy more than one million tests within a month and 10 million COVID-19 tests within four months and we managed to do so. And this photo that you are seeing now in your side, this part of engaging different stakeholder and high level political engagement within the continent. So, why the airport are closed where airspace are closed, we managed to collaborate with peace and security within African Union Commission where they have air lifting capabilities, communicating with militaries within African Union member state and get access to air lifting capabilities and supporting the deployment of our human resources to support member state and respond to those COVID-19 airspace was open exceptionally for African CDC responder, airport open exceptionally for African CDC responder to deploy and support member state. Next. Next. Let's skip this one. Next. Next. Access to the vaccine was critically challenge for for us in the continent and to ensure that we have access to the vaccine we need also engaging at highest level possible within the continent. So we established what is called African vaccine acquisition task team led by his excellency President Ramakosa to start negotiating on behalf of the continent and to have poor procurement mechanism to ensure that the continent will have access to COVID-19 vaccine. Next. And also we learned of the hard lesson that if we're not producing many of those critical commodities will not have a timely access to those community commodity. This is why we established what is called by them initiative partnership for African vaccine and this is led by his excellency President Chester Keady, President of DRC. Next. Let's skip this one. And go for one last example about the ensuring the high level political engagement. Next. Okay. This is my last example that I want to highlight and also ensure this high level political engagement. We believe that public health emergency operation center is a critical element to not only ensure better response and effective and efficient response, but also had a great rule to play in coordination and also ensure preparedness to respond to various emergency. And the situation was not that good within the continent. So we took this to the highest level in the continent. His excellency President Hakenda, President of Zambia. He is a champion for public health emergency operation center in the continent. And we secured sideline event to discuss one agenda item in front of the last Africanian summit in Lusaka Zambia last year to discuss the importance of public health emergency operation center. And as the outcome for this side event, we had Lusaka call to action where all heads of state and government committed to have national functional public health emergency operation center in the country. So this is some example that we had in the continent about engaging the top leadership heads of state minister to push the agenda of public health and ensure better preparedness and response to various public health emergency. Thank you. Thank you so much for some and thank you really for for moving really quickly with the slides and I think from your presentation. One of the key things that you've highlighted really is the role of political leadership when it comes to epidemic and pandemic preparedness. You've been able to share with us the journey that Africa underwent in terms of vaccine manufacturing in terms of vaccine acquisition in terms of financing in terms of partnerships with different actors, multilateral banks, private sector players. Thank you so much for that presentation. I'm looking through the chat and we had one more question and really what I'd like to do is to put it as one of our last remarks where we've had one participant mentioned the need to look at investments in pandemic preparedness from a different angle. They need to be able to look at these investments not as cost centers, but you know really as elements that really build into the health system. And I've seen a lot of questions as well on on how can we sort of extend the role of all the different participants and players. When it comes to looking at non normative players for example like law enforcement agencies, the military and their role in public health. Thank you so much to my panelists we don't have much time but by way of summary, if I could so humbly is say that you know when we look at this at a more regional and country level. Again, the same insights that came from the global sort of health panel are the same in that one we need to look at our surveillance systems, we need to ensure that they're integrated. There needs to be an investment in people I think Professor Irma summed this up really well that people people people we do need to invest in people. I like the idea of looking and harnessing at existing capacities and capabilities. I think as human beings we often look at things from a negative approach but really we do need to look at what we already have in our talent basket and how can we use that how can we sort of apply that even as we build more resources and more capacities. I like what what Duncan shared with us, particularly his call on investments, and that if he was speaking to to to presidents and governments he would say show me the budget. And really I cannot, you know, stress that any father, the money is what spells out the intention and so really it becomes very important really to to ensure that we have domestic resources. We need to be in place and have a complimentary multiply effect of external resources, and then Dr Jason has given us a really, really good reflection on the role of behavior change communication on on on having people as center to looking at how we can harness digital technologies I like the idea of using applications to check on people are they better they getting better do they need to go to a health center. And it reminds me of a question that I saw in the chat box that was talking about civil liberties how do we not infringe on on on privacy and civil liberties even as we use digital technology I think that's something that we need to perhaps explore in the next that we'll be having. And then of course we're some the role of all our political leaders, particularly in the African continent, the idea of ensuring that there is shared responsibility and a whole society approach when it comes to pandemic preparedness and thank you so much my panelists for your time today for your contributions for those who share the contributions on online as well. Thank you and yes Claudia he moved so quickly it was such a pity but fantastic fantastic information. I think Lisa you will guide us on whether the slides can be shared to the members. I can see people asking for slides and thank you so much over to you Lisa. Thank you so much, Erma Duncan, Jailson, a Yoda and Wessum, and of course mercy. You know these has been a really incredible discussion so so far and it really leads us to some critical action points for follow up. And Dr Wessum again, you know, and to all of you but congratulations I know that Africa CDC was empowered, it was funded more all that you achieved during COVID-19 was simply amazing and so people will have access to all these slides and the presentations to learn more. We have heard a lot right now but there I'd like to take about 20 seconds for all of you to think about what did you not hear, what do you want to hear more about and what wasn't addressed, because we want to be able to capture that. So in the next 10 seconds I'd like you to put in the chat box whether it be on Slido for those that are joining us virtually, or the chat box on zoom. And in one sentence or one word, what did you not hear what do you think we need to focus on besides these amazing discussions. So a couple seconds for that. You want to make sure to capture it so that it goes into the report as well as it informs our next two sessions on May 18 and June 9. And while you're starting to think about that that and write about, I'm going to pivot, and we're going to give you a sampling a preview of what lies in store for the next part of the symposium, and the further dialogue and the action points on May 18. And these are really critical because it is really deep dive discussions and technical discussions to move things forward on, on several key areas. The symposium technical committee has been working for the past months to develop these action group sessions, based on four to five themes. So please listen carefully to all, because after their presentations we're going to send out a zoom poll. And you'll get to pick which session you think that you'd like to contribute your technical expertise through for action on May 18, and maybe even beforehand, you'll be receiving some, some tools, some resources, some previews before May 18. And probably in the next day you'll receive more information on how to sign up for that, as well as action point action on June 9. So the way what this will work is I will be introducing the theme of each action group, and one of the committee members that is working on it. They'll present their sessions for about five minutes for the May 18 session, five to 10 minutes. And then remember to leave your questions, your comments in the chat box so that we can ask, make sure we address your questions for those deep dive technical sessions. The poll will be opened up afterwards for those technical deep dives, and all of your voices, your expertise is important. So it's going to be really challenging to select just one, for sure. So we'll start off with our first action group preview with Dr. Larry brilliant on situational awareness in the context of health and diseases. So Larry over to you for your preview of what's to come on May 18. Thank you Lisa. It's so nice to see so many old friends and new friends. I first want to say all five of these action groups are excellent and you can't go wrong with any choice you make. But I want to put in a pitch to invite you to join us for our action session on situational awareness and surveillance. In situational awareness, we mean to encompass not only early detection of novel diseases, but also threat assessments and risk assessments, and importantly a continuous one health surveillance system that allows health decision makers to make science based decisions about why this is so important, why surveillance systems are so important, why 717 and other metrics for following how good we're doing at detecting new and emerging and reemerging diseases and responding to them. But now we need to discuss not only the why, but the how, how to learn about some of the best innovations in surveillance systems, the best success stories in situational awareness programs, and how the lessons from these successes can help you, each one of us. So we can take away these lessons and bring them to our own cities and states and districts and countries and regions and even globally. In our session, we will drill down on another how, how can we raise expectations in our communities for how these innovative new situational awareness systems can help give confidence that the next time we will do better. We will do better by looking into conventional situational awareness, novel surveillance systems, human and animal, and how they can help us build and run better global health systems and become better prepared for the inevitable outbreaks, the inevitable epidemics and prevent them from being pandemics. So please join us on the 14th of May. We have a lively panel in store. We've got a review of all situational awareness and surveillance systems we've got some review on the role of genomics. And most importantly, we're going to present two case studies of countries with different levels of economic development and resources, and the amazing success stories that have come from their innovative systems. Thank you very much to the National Academy for including this as one of the options for May 14. Thank you so much, Larry. And it will be such a challenge to choose because each one of these has not only leading experts leading the session, there'll be actually speakers within and there'll be a lot of deep dives into the technical action forward. So our next speaker at committee member Dr Richard Garfield will be presenting on the action group building trust transparency and risk communication capabilities. Richard over to you. Thank you Lisa. I'm not going to be anywhere near as elegant as Larry. For two reasons first this is the last piece that we've started to organize and identify the key people for it, but also because I've been traveling in countries organizing pandemic fund applications and so my attention is elsewhere. We also happen to be running reviews of 717 right now here in Columbia and finding their bottlenecks, but the session will focus on the different approaches that have been more effective or less effective on communicating and trust will come up again a great deal. There will be case studies that build on those that we've been doing today and focus on ways of getting through and looking at different approaches that come that that individuals or countries have used that make this work. Let me leave it there because a lot of the terms that Larry used actually for situation awareness fit very much for this work as well that Lisa and Larry and I have been starting to organize over. And thanks for all the work that you're doing in real time on actual pandemic preparedness. Our next session will be led by Julie wall, and the title of that is strengthening global health security through strong country level infrastructure for effective governance financing and accountability. And I am told that the poll is open now, but so listen carefully and make sure you vote for one that you would like to contribute your efforts to Julie over to you. Thanks Lisa. Good morning, good afternoon, good evening to everyone. I feel like today's first session really teed us up well for for this session on May 18. We heard from our panelists today several times highlight how country level action needs to be at the center of international governance and the value of investing in country level preparedness as part of a greater global health security effort. The next session on May 18 will examine how improving global health security really does begin at country level, and how countries can strengthen their public health architecture for epidemic preparedness and response through effective mechanisms for governance financing and accountability. As discussed today we know that a country's performance during an infectious disease outbreak is only as strong as their ability to leverage multi sectoral partnerships and coordinate at the national sub national and community levels. And so this session will really take a look at two key questions which are how might countries and organizations ensure effective multi sectoral governance at country level and how might countries organize and foster accountability among partners and stakeholders in a way that drives continuous quality improvement and well prioritized investments. So we have really great discussions for this for this session. And together we'll examine real world examples of different mechanisms and approaches that countries and organizations in Africa, and in PAHO are taking to ensure and foster governance accountability and well prioritized investments for preparedness at country level. So, hope you can join us. Thanks Lisa back to you. Great. Thank you so much. Next is Dr. Jessica Pichullo. We have her topic of global health capacity and functionality assessment. Jessica. Thank you so much. As we've heard today. There's been a lot of discussion about how an effort to prioritize investments to improve pandemic and epidemic preparedness and response really depend on timely access to quality and actionable data. I do actually have a slide deck. So I don't. Is it showing. Not yet. Can someone pull that up please. So, I'll just keep going. And so, hopefully, are the slides showing. Not yet. Okay. Wonderful. Thank you. The goal of the session is really to look at sort of and help identify what is needed to improve sort of this assessment ecosystem to really inform decision making and what we're looking at is both capacity as well as functionality assessments. We're looking at the critical needs, challenges, gaps and opportunities for improvement. And we also want to look at sort of the tools, their use and the use of the data they generate and sort of a third. The last kind of bucket is related to when we're looking at, you know, with this context is also strengthening and maintaining capabilities. And so we have our two moderators I've indicated myself and Dr. and next slide. So the way we're really going to structure the session is around three discussion topics. So, the first is about identifying challenges in the use of existing tools and so this includes things like accessibility, you know, and are the tools in languages that can be used any of these other sort of issues. You know, how available are they how easy are they to use, and also sort of like the opportunities to improve them. Second topic area is identifying opportunities to improve interoperability, interconnectedness and integration of assessment tools and the data they generate. And, you know, we'll talk a little bit more but this also includes, you know, one of the critical points that was raised was across sectors. You know, when we're really looking at a one health approach, how do we leverage and get the systems to be for these assessments and for sort of the guidance that that's provided for strengthening them, looking in the context of really supporting this one health approach. And then the third topic area is identifying opportunities to improve linkages between sort of these assessment tools, and then, you know, the results that they they generate, but then the capacity or capability guidance documents, the tools that are out there that help people address the gaps that they have. And so each of these topics will, we have a wonderful discussant that will speak for a couple minutes related to this and then open it up for for the participants be able to really have a dialogue on these individual subtopic areas within our session. Next slide. And just a quick example and this is just illustrative to get people thinking is like if we're looking at IPC infection prevention and control, you know, in sort of healthcare facilities, we've got tools like the IPCAF tool that can help with determining sort of at a facility how they're doing with the basic IPC. And so their questions is a, you know, how accessible are these tools. Second is sort of, how does that data then integrate into what we have as things like the joint external evaluation or the AMR tracks studies which is really at the national level, where a lot of these what we end up seeing as national plans developed off of, are these individual results from sort of the facility level integrating up to inform those higher level decisions. And then how is that, you know, once you get to the national plans, how does that then link back to the guidances that exist for identifying the gaps, you know, sort of when you do those high level assessments. And then I'll also say there's that sort of at sort of a national cycle level, but there's also at sort of the facility level, you know, once the gaps have been identified how easy is it to then connect with the guidances and then kind of do this iterative approach to really really make, you know, kind of that maintain developing and sustaining and strengthening and that constant continuous monitoring and evaluation of capacity. And so that's just sort of an illustrative thought exercise, in relation to sort of the issues that we're going to be looking at in the session. And if we can go to the next and last side. And so really, you know, want to just touch quickly that this entire meeting, you know, and in this session in particular but the entire meeting is really existing at a critical time in sort of the global national local landscape, whether it be from policy negotiations in the, like the World Health Organization, the UN high level meeting on pandemic preparedness response, a renewed focus and a really strengthening of the quadripartite effort. The release last year of the joint external value updated joint external valuation tool where countries are looking now, you know, sort of this new baseline of as we're transitioning out of covert response into, you know, sort of endemic what is our new baseline. And then we have, as I mentioned, you know, we've got 717 is starting to be rolled out the pandemic fund, which is looking to strategically invest in, you know, priority areas gaps identified, you know, to really make tangible progress towards, you know, improvements in joining external evaluation, technical areas, you know, the IHR technical areas. And so we've got this really dynamic time right now, for which the data that we end up, you know, the ideas, the conclusions that we developed in relation to sort of this topic area really has the potential to inform from the local up to the global levels as this landscape and as this attention is focused right now. So what we hope to do as an outcome from this session is really, again, it's gearing towards informing decision making, whether it be at the UN or the WHO or at local levels. So by sort of assembling the insights on both challenges and opportunities in relation to those sort of three topic areas. Also, you know, we're going to ask folks to really kind of think through what are one or two key actions that need to be taken you know how can we prioritize out of that list. In reference, we do have an assessment tool worksheet that we're asking everybody, not just in this session but everybody you know throughout this, the period of this symposium is to really contribute to let's help develop sort of that library of what are the tools that are out there from, you know, national tools global tools local tools facility tools really help build out this library both as a resource for this meeting but also, you know, a resource more globally afterwards. And that is my last slide and my sales pitch for our group but definitely just note that, you know, love to have people involved but also there is the homework to be able to contribute to. And I believe we will also be sharing a jam board that has sort of those three topic areas so people can continue to contribute their thoughts throughout. So, thank you very much. Thank you Jessica, and our fifth action group will be Dr Erwin Calgua and his presentation on countries and organizations experiences in preparedness and response planning. Dr Erwin over to you please. Good morning everybody and thank you so much for joining us this morning. It is a honor. And I've enjoyed so much this talks. And of course, our action group wants to be able to share with all of you a perspective from what is like what is being done in other countries and identify those lessons and best practices for preparedness and response at the national levels, and also to identify actions and policy and practice for improving this preparedness and planning for the next pandemic. Based on what as you've seen when well and want what when less well in some national context. So the next slide please. Another is then again a panel discussion. We've been very fortunate to have to experience panelists that have been invited and accepted this invitation. Each panelist will share a 10 minute talk. And then we want to move forward with a very enriching discussion with all of you so we have the chance to have questions and answers for 40 minutes. And for those of you who are notators that I will share with you who they are also and highly prepared this panel as well. We'll close the discussion, sharing a brief summary of commonalities in child just encounter, and during this, this panel. Next slide please. So much about our panelists. So Jeffrey Carter is a public health specialist with 20 years experience he's a master in science and epidemiology. He's been a director and communicable diseases division in the Ministry of Health Singapore. And as the acting director of the national tuberculosis program step and a John associate professor at the National Center of infectious diseases in Singapore. He's also an adjunct professor at the National University of Singapore, with vast experience, especially, especially in these areas of infectious diseases and COVID-19. Next slide please. Then we have also Julio Corroda, who is an infectious disease physician scientist is used different cell, our university, and it's both a professor at the University Federal, but also Brazil and actually an associate professor in epidemiology at Yale School of Public Health. He's the president of the Brazilian Society of Tropical Medicine and chief of the Department of Epidemic Obesity of Secretary of the Health Surveillance in Brazil in 2019 and 2020. So both bring beautiful experiences both from two different areas, Asia and South America, which will be very enriching and I think will be very interesting to hear and to receive feedback and I'm sure they will be very willing to also get feedback from you. In regards to the moderators. So he boy is a PhD public health from Johns Hopkins Middlemore University of Public Health, he's the director of the Office of International Cooperation with the Department of Disease Control in the Ministry of Public Health in Thailand and chief of recent test scores of an emergency operation center in the Department of Disease Controls in Thailand. And so she will be one of the moderators. Next one, please. And then, Armander Cardiol, who is a master in science and PhD in epidemiology with an emphasis on mathematical modeling from Imperial College of London, head of data science and advanced analysis at CEPI, and an honorary assistant professor at infectious disease modeling and epidemiology at the London School of I gene and tropical medicine. And last will be me with that I am a master in clinical epidemiology from the program school of medicine at the University of Pennsylvania and research professor at the Research Center of Health Sciences at the School of Medicine at San Carlos University in Guatemala. And I serve as an advisor to the National Congress President and Minister of Health here in Guatemala. And to finish, we look forward to have an active and enriching discussion with all of you. We happen on May 18 and 40, from 940 a.m. to 11. And thank you so much to participate and I will look forward to this meeting and that'll be my presentation for you. Thank you so much, Erwin. I know it's very challenging to pick from those excellent five action groups. I'm going to open it up for questions right now. And first, Claudia Osorio you had a great question would you like to come on screen and introduce yourself and then ask your question. Hi, everyone. I'm Claudio Osorio-Casso from the National School of Public Health in Pio Cruz. Julio Crodd is a colleague. He's at another site, but I'm very pleased to see him belong into this group and it kind of treacherous to choose. I don't know what to do anyway. I was thinking, because in the last meeting I brought up this issue of trust, which is actually something I have great interest in. And of course it's very, it has a lot to do with the security framework, right, in disasters, and I don't know what to do. I'm actually so divided between so many interesting groups, but I would like to understand if what Jessica Petrillo presented is a kind of an ideal framework that everybody would fit in. Because this is in my view a little problematic in the sense that not everybody adheres to national security framework. So you see this is kind of a baseline kind of doubt I have. Thank you. Jessica, over to you. Yeah, no, I'm happy. I mean, I think that the, I will say it wasn't, you know, a goal is not having, you know, one assessment to rule them all type thing, you know what I mean, like one massive thing it was more. I want to create a structured environment for people to discuss. What are the challenges like what you just, you know, raise like there are concerns you know there are these sorts of things and so what we tried to do was set up three distinct sort of buckets of the problem set to really be able to explore again. What are the realities that we need to take into consideration. To prove that ecosystem of doing assessments and so what are the challenges and what do we have proposals on how best to address those so I think the point, the points raised you know the concerns right the things that you flag are exactly the types of things that we're also trying to help bring to the fore through this setting to be able to have, you know, informed discussions in these set you know in whatever the settings are more globally about sort of assessments as writ large and I'll also hand over to Amir if he wants to add in as well as I came on the video. Thank you so much. I just want to add to that. What Jessica is saying, I mean, see this this is this has been one of the main aims. This remind me of an old song at 57 channels and nothing on you know you've got so many channels but you don't know what to watch. This is exactly what is going on we've got huge number, huge number of tools available. And especially we have got the new GE tool. So they must be even gaps in that now based upon the covert experience coming out of it and translating into true actionable point. And remember one side would never fit for all the countries. I mean you talk of security you talk of health security within different regions and their domains. And here, the main interest would be revolving around finding the gaps, and then trying to optimize the tools, which again can be modified country for exactly translating into meaningful strategies, and those strategies lead to policies, and then lead to implementation. Thank you so much. And I'd like to open the floor to any others that might have some questions for the group. Overall, or for a specific action group leader. You can raise your hand, and we'll call on you. I'm not sure if we have Slido questions. All right. Any Slido questions I don't think so. Trying to check the multiple chat box. So the poll is open and I'm not sure if the zoom poll popped up I know that the, that the Slido poll popped up so I don't know if, if we're launching the zoom poll now for those on zoom that can also select their May 18 slot. If we if that can be, is that happening now or maybe it will maybe they're getting it set up. I did ask for some of the things that we didn't get a chance to talk about and I can see that there's been some great responses in the chat box about a report back from the pandemic fund on the nature of the applications they reviewed. I think there was 600 applications overall which is great. And then we did also see about the crossover of zoonotic a spillover preventing zoo zoonotic spill over and articulating the experiences between the health sector and other government sectors, as well as the involvement of communities and population in facing emergencies. One of the Slido questions we just got for our group is I know our goal is to get systems talking to each other. But what is the plan to build up the infrastructure to get the information to help in the response. So with any of our action group leaders like to answer that were multiple action group leaders. So the question again was, go ahead. I was going to ask you if you can receive the question because I couldn't. Sure. I know our goal is to get systems talking to each other but what's the plan to build up the infrastructure to get the information to help the response. Lisa I'd like to comment on that if I could it's Larry. Yes, please go ahead, Larry. You know, we hear that somehow the world has entered into a post truth world. A post science world. We know that's not true. But we don't have a standard of mutually agreed upon data information that is trusted. And that's why I put so much attention on situational awareness. We don't have a source of data and we could be talking about cases we could be talking about hospitalizations or even deaths we could be talking about vaccine coverage. We could be talking about progress, comparing one place to another over time. We don't have a trusted source that is agreed upon to be the gold standard or to be the standard from which we can make these decisions. Then for what reason are we building this infrastructure and how can it react. I have to say that the, the two panels that are taking place at the same time, one is on trust and the other is on surveillance. And if each of you could kindly split yourself into two and attend both of them. But I do think if you are from an organization that has two or more people attending, it might be a good idea to have one attend one and one attend the other. And if that source of data that we we've shared agreement on is the best data or is at least trustworthy data, then decisions will not, whatever decision you make will not have the trust of the full population the full community. Thank you. Thank you, Larry and I think you made a great distinction distinction between information as well as data, and that quality component also so thank you for that. We have another question from Slido. How do we center equity, even indeed, especially in the midst of crisis. We've heard a lot about equity today but how do we center that in the midst of crisis, when we're, as they say building the plane as we fly it. Who would like to take that. See any hands up yet. For our action group leaders. How do we center equity in the midst of crisis. Well, I think this is a very important aspect. Prior to this, this activity today, we actually thought about the differences they happen between different contexts. And I think one of the most important aspects bringing equity is setting setting fundamentally a common goal of what what we want to achieve globally in a global perspective, taking into account. Every nation's interests coming from different contexts, and putting them and lever leverage each one of these interests, and that will will require to think out of the box. In a very complex area, which I will say first of all, just to give you an example not thinking only from the health perspective of how to approach a pandemic and an emergency. Thinking out of the box that this fundamentally and what taught us COVID-19 has very strong political implications from one end. I'm from the other end, it has a very strong economical implications that's beginning to think out of the box. And knowing that there is advantages and advantages from different contexts, different countries, so that we can come together and know that for example, if you need vaccines or if you need personal protective equipment. Globally, we have thought of how we can make this available by strengthening each of the nations and by strengthening the focus of a global response, using the tools that are telling us how well we did and what we didn't do well in regards to this. So, I think what we're looking forward is to have put this into a reflection, even put this in a report that can bring these issues together will be the starting point to move forward in the future to come, because we know there will be a next pandemic closer than we think. And this discussion, this context bringing this into context in each one of the discussions that you will hear and that you will participate will be a key aspect to address equity. Thank you, Erwin. And I think one of the points that you brought up about how do we take things forward, whether they be reports whether they be publications or technical briefs, and then all the work that will be going on within those action groups will be really key and that's why the participation of all of you online as well as in our zoom room today will be critical for May 18 and June 9. Richard, I know that you put a comment in the in the chat box about really the start of how this started this symposium and I'm wondering if you'd like to elaborate on that. We inevitably, when we're discussing these issues we have to go wide, considering governance coordination, public relations and epidemiology. And bring us back to the core of the concern that I had had and that we at CDC have in our work on global health security. We are concerned about the multiplication of tools and the inevitable enormous burden that then is laid upon countries to do endless assessments. So I'm reinforcing some of the point that Jessica made that I hope that we end up at the end making some orientation or some some some common approach to where assessment does help to focus efforts and make results that change the capacities and the and the functional actions of countries. And so the existing tools are focused heavily on the epidemiology. And here we're thinking about many other topics that are related to the utilization of the skill and abilities. So, in our next session, I think we need to come together at the end of that and make some time to focus on where does this come into tools where where our tools not that helpful that ought to be retired or made as secondary efforts by researchers rather than the recommended core for countries in working with governments in low income countries. My, my profound experience is the remarkable burden on them to try to learn everything, rather than to learn what they need to do. And I just don't think that we're helping them. Sometimes we're hindering them. And, and so if we have an outcome from these series of events, how to actually help people do a better job is the outcome. Now this is excellent and I think sometimes there is a tension between globally, globally created tools as well as country adaptation and management of that and when there are multiple tools and multiple initiatives that are requesting data and requesting feedback and mechanisms to track things but perhaps the countries don't have the capabilities or they are just overwhelmed. We learned even with the financing end of that and the finance the financing mechanisms and the mere burden of paperwork, as well as trying to coordinate different requirements from different organizations and trying to access that funding during the pandemic was a challenge. So thank you for that Richard. Larry I see your hands up. I'd like to make a comment on the question about how we can reduce the unconscionable disparity in equity. In the smallpox program, we understood very quickly that it was the migrant workers who had to be vaccinated and had to be searched and protected, because they were some of the carriers of smallpox from state to state we learned within states. And that was the people who were doing brick building brick manufacturing, because they were the poorest. And recently I've been reading Paul farmers incredible book that he wrote about his correspondence and his conversations with Father Gutierrez who was the one of the creators of liberation theology. The book is called accompanying the poor. And Paul writes that if you want to reduce the disparity between rich and poor, you must have a preferential option for the poor a preferential option for the ones farthest away from power a preferential option for the most vulnerable. And how that gets operationalized was in the battle over approximate manufacturing the vaccines. It was operationalized in the hoarding of antivirals and vaccines by the rich countries who could buy them first found out about them first. But a preferential option for the poorest the most vulnerable in epidemiology is exactly the same as using good epidemiological intelligence. I want to again echo how important it is as we think about what we do in dealing with outbreaks, preventing them from becoming epidemics and pandemics is this idea of a preferential option for the most vulnerable for the poorest for those furthest away from power is key to both bridging the gap in equity, but also stopping onward transmission of disease. Thank you, Larry those are those are pretty impactful words and thoughts and I think translating that into action will be our biggest challenge. Some of the words thrown around during the pandemic and regarding equity regarding health systems strengthening. How do we translate that into actual evidence and what we learned and to translate into action will be a real key follow up in some of these groups and how we proceed forward. I don't see any more hands so I'm going to turn it over to could be to right now from the National Academies for any reflections or statements on today, what's been said. Thank you so much. We really appreciate all your time and effort today and hopefully in the coming weeks as you can see, we're trying to take sort of a bigger picture at some of these issues, and really want to hear from all of you and sort of get a broader space out on these topics and really kind of think more critically about how we move forward as Larry had said, we are really also very interested in making sure that we have maximum maximum inclusion and participation from across the world so we have been extremely interested in trying to include not only, you know, experts who are viewing and participating on zoom but also been given participant speaker roles in this in this symposium. And one of the things that maybe we'll just leave with because everybody probably would love to have 20 minutes of their day back is, is that we really want you to sort of think through, you know, what are those actions, and how do we what steps do we take going forward based on all the things that we've learned and we continue to learn. And, and how does that fit with within the current systems that we have are there things that different actors whether they're governmental inner governmental or non governmental can take going forward to try and sort of address some of the issues that you heard earlier today and probably will continue to hear on the May 18. The next session which is on May 18 and then the final session which is on June 9. And also, you know, if there are actions or activities that you know larger organizations or organizations like the academies, you know, could assist with. Those are also things that might be helpful for us to hear as well because this is such a complex issue and really involves everybody. So with that, I will just say thank you all and hope to see you in two weeks. Yeah, thank Dr. Wessum I ask his question or have his comment. Dr. Wessum over to you for your question or comment. Okay, maybe, maybe he stepped away. All right, well if he does raise his hand and come back what we'll call on him but I do want to say today we've heard a lot about from multiple about the multiple intersections of governance and financing sustainable ways forward, how science, people and communities have to be included in the approaches and moving forward, and really ensuring that trust is rebuilt, and that science is guiding us and governments are supporting the science and evidence for the safety of our world. I did reflect on things that we might not have heard today and I think it's important to mention a couple of those things some of you put it in the chat box. Maybe we can think about those for unpacking either in the action groups in May 18 through on June 9. So we did hear a lot about translating policy into practice about different partners, whether it be civil society, political leaders and in that there might be some more opportunities for private sector for parliamentarians for our faith based communities to have access to the evidence and to the science. We, we heard about many different types of initiatives, but I think one of the biggest challenges, and having worked in 30 years and emergency and disaster response myself is the coordination factor. One is leading who is guiding how do all the work that the partners work together whether in the political arena or in the financing piece. So I think we do have to explore a little bit about the coordination piece especially when we're talking about assessments and tools. We heard a lot today about mention of the polio response, as well as small pop response and what can be learned about community based surveillance. And we know that there are also other global health initiatives that are beach will be trans transitioning off. And we utilize this infrastructure. How do we explore the evidence from previous outbreaks or eradication efforts. And as we see reemergence of of pathogens from one health perspective. How can we utilize them in our global global health security response and preparedness and train different groups and bring them their capabilities up. The links to PhD or primary health care were mentioned a little bit but it would be great to maybe in the action groups see how the integration of all this and preparedness and response fits into the bigger PhD conversation and investment that many are many are leading forward. I did not hear anything on gender, and we know that from health workers, which are 80% of women to the pay differential during pandemic outbreak in response to our frontline health workers are sometimes often the serve conducting surveillance, who are women and women scientists and who gets to speak who has power, who is in publications I think that this has to be explored a little bit more I didn't hear mention about it at all. And yet we know that there were many implications in the past pandemic as well as possible future ones. Equity, we've, how do we talk about access to vaccines funding access to information access access to tech transfer access to quality data gaps and participation access of power and access of research and research opportunities for science and scientists. I think it's been explored a little bit people mentioned bringing researchers, especially for a symposium with such esteemed colleagues and researchers as this. I think we have to unpack that a little bit more. And then lastly, the word accountability which is a politically charged word. So sometimes people prefer to say performance management at the country level. How do we integrate that into all the systems and all of the response that we're talking about for not only COVID-19 but future outbreaks, and build that accountability and performance management mechanism into all of the different tools, whether it be technical tools, governance mechanisms or financing mechanisms so that we can have better accountability on all levels. At this time I just like to thank all once again all of our committee members. I'd like to ask you to put on your videos so people can see you. You've contributed a lot as well as all of our colleagues at the National Academies, whether through support technical leadership can you please put your cameras on so people can give you a virtual clap for all of your hard work. We've made it through almost four hours for this first section of dynamic dialogue and thinking about what we need to do more. This is an action oriented symposium and the next three. And then in the next this first symposium date and the next two. So on May 18 at the same time, which will be 8am and Eastern Standard Time will host the action groups that you as experts have the opportunity to contribute. It really is a critical point in moving forward we are at the nexus here learning a lot from the recent pandemic but we know there are more to come. We see outbreaks happening more viruses that already show animal to human interface so it is the time. So make sure to register for the event you will receive the information and the communication right after this as well as the opportunity to review some of these important tools and the resources prior to the event. So yes you might get a little bit of homework, but that is part of moving us forward this multi stakeholder participation. We applaud the national academies once again for hosting such a country and global series of technical dialogues to move us forward for real action to shape our future for scientific approaches to preparedness and response. Thank you very much, and we look forward to seeing you on May 18 and June 9. Have a good rest of the day everyone.