 Rwy'n dweud ddyfodol fod wedi gwaith sy'n cyfnoddol a chyfwyrd. A'r ddewodd如果你ad ar gweithio'r ffordd. Rwy'n dod os ymchwilio'r ddewodd a'r ddewodd nad oedd gennym eu cyfwyrd, ydych chi'n mynd i'r ddiwedd o ddyddyr o'r dweud o'r ddewodd. Rwy'n addysg gyfru, mae'r ddewodd yn ei gweithio'r ddewodd? Ieithi d****r ddewodd i chi mewn cyfeithio ddewodd? Y cwyl yn ar-eged. I'm Barry Rooney. I've worked with MSF for about 10 years in the field as a volunteer on sleeping sickness. Sorry, we're not hearing you so well. There's a microphone on. I'll speak closer into it. That might also be enough. Is it on? Hi, I'm Barry Rooney. I've worked for about 10 years in the field with MSF on sleeping sickness. So, diagnosing sleeping sickness, as you may know, involves lumbar punctures. My day job, as it were, is as a scientist in a lab working in biotechnology. So, the last couple of years, I've been working on making better oddities and diagnostic tests. So, bioengineering antigens based on the whole genome information that's there. So, that's possible and we need better, more specific antigens and tests and new variants. Now, the problem that we have, and there's a group of us scientists without borders who work on this project, and the problem we have is getting, there's two issues, maybe Terry or whoever could address this. One is having availability of good samples, so biobanks, serum samples from field isolates, up to date, not isolates that came from 30 years ago. And then the other thing is obviously, when you make a prototype, it's quickly testing this and again all the other speakers have addressed that. If you make a prototype and we often make maybe 10 different things in six months, we want to check them off really quickly. So, that's biobanks and access to those samples, which is a major issue. And the other then is access to field trials for prototypes. Thank you. Thank you. And the question here, and then we'll go, there's a question at the back, just at the middle. Yes, so my name's Ciaran from MSF. This is a message, a question for Pete, with a message in it. Thank you. No, so the approach of using Josie and Annab, when they weren't actually in the field, that makes sense from the HR point of view in that you're not pulling people out of the field to be part of a design team. But I wanted to ask, did you feel there were any shortcomings in not actually physically running the whole design process in the field? And how did you overcome that? Okay. And then the last, actually last question at the back. Yeah. Vanessa Stair from MSF. I was wondering with, do you ever have, for MSF's suite and the innovation team, do you ever have companies that come to you with their own innovations for the field? And is there any, I guess, conscious in working with these companies that might be in conflict with the work we're doing? Wonderful. Thank you. So let's start with those three. Mike, turn to Terry first on the first question around sleep and sickness diagnostics. Yeah. So you're certainly not the first person to have asked for this. I mean, I speak to many manufacturers, and these are the two things they always ask. Can MSF help with samples? And can they help test prototypes? And I haven't had that much luck intersectionally with this. So I think there's a broader question to ask of MSF. Do they want to get involved more upstream in both the design? So coming from the target product profile already, which, as we've seen from the talks this morning, has been hugely valuable. Do we actually want to wait until a product is launched and more difficult to redesign before we start going, oh, we wish we could tweak that or do this? So how much upstream do we want to be involved right from the target product profile stage? That would be the easiest. And how much do we want to contribute to biobanks and prototype validation in our fields and based on what? Episodes are really doing a lot. For example, for the multiplex, they have biobanks and they will contribute towards studies in the field, including prevalent studies. Beyond that, beyond the episodes, there's not such great availability. It's also quite difficult to have a biobank. You need big freezes, it's minus 80, it's a lot of electricity, it costs a lot of money. There are other organisations like FIND that work through other biobanks, so they just pay a fee to a professional biobanking organisation like Zeptometrics, whose job it is to hold these biobanks and ensure the quality of samples. But for Hep C, for example, they couldn't get any recent samples. I mean, manufacturers were battling to find anything before like 1997 in terms of sampling from bloodbanks, so it's a real problem that I think we need a broader discussion in them and so forth. Also, in terms of some of the, I just wanted to mention, I think some of these questions involving contract, how do we approach contracts with manufacturers and so on? Some of it might be that they've approached you because they want to do something for the social good, which is wonderful, but I think also it's about the leverage that we have. So how much are we putting into it and so how much can we ask for? And I don't know how to define that very well, but if we don't want them to have a patent, if we wanted to be open source, if we wanted to be including all the excess provisions, we would usually want to see that often comes down to how much leverage we have in terms of demonstrating how much we've put into it to ask for what we want. So like on that, actually me and Pete have just starting up a project focused around looking at the options for partnerships with commercial partners and also IP questions, the aim being that we can better define early on what we do want to get out of it in terms of licensing and putting these in place. And I think we ran a workshop two days ago on this and just by seeing some of the current cases which we're engaged in and how advanced some of them are when it comes to IP questions compared to some other ones where no IP lawyers have been engaged and things like that. I think what we intend to do is like a mapping of some of the existing projects around the movement really to see where we are and the best way of moving forward to formalise that more. Anything to add from the panel on access to samples and field testing before we move on? My question is kind of on field testing anyway. So it's important to note that although the participants felt it was a successful prototype it was only a successful prototype. It's not a product because it hasn't been field tested. So this would need to happen. That would be part of the process. Alan, the GD of Fasem in the interview afterwards had said beforehand he thought this was kind of the poor cousin of sending a designer to the field having MSF staff come to the workshop. However, by the end he'd actually flipped that over and he thought actually it was much more valuable to bring the MSF experience in first so that you do have a prototype that you have a high level of confidence in before investing that kind of time and money and resource in going to the field. So actually I think it was a positive thing that it started outside the field. Interestingly we completely shot ourselves in the foot because we'd planned in the project planning that the two MSF design team would also have a field partner in North Kivu who they could bounce ideas off. But obviously one of our barriers is that MSF staff don't have any time so they didn't end up bouncing any ideas back. But actually even though that was the case we're still confident that this was the right way to go about this. Thank you. Next batch of questions. So we have a cluster on this side, those three. Okay. Raphael from MSF Brussels. I think a general question to the panel. Would you say that MSF is a good environment for innovation in general? We've got four successful examples of successful innovation but then my inner epi yells reporting bias because you wouldn't be sitting here if you weren't successful. So would you say in general is this the four examples that you gave is this typical of your experience with innovation or are these kind of cherry picked successful examples? And maybe as a corollate to that question are there certain codders or departments in MSF which are more amenable to innovation? I mean is it more the medicals? I have the impression that it's often the logisticians, the Watsons which are the more creative ones. Is that a general truth or is that my personal bias there? Thanks. Okay. So why do you think about that? Another two. Nils from Pearson. I wondered Louie if you had any feedback from the manufacturer that you worked with on the value of the input from MSF innovation and the stakeholders that you spoke to compared with their usual process, the usual process they would set about designing a new product. There was one more question on that left side. Hi, I'm Kira Anderson from Services Design Agency, SNCC. This is a question for Andres. I am an equal measure enthusiast and sceptic of hacks, I think as any that's been involved in one is. And I really agree with what you're saying about the importance of follow up and feedback loops. So I just wondered if you had any examples of outcomes from MSF hacks, not necessarily innovations but maybe relationships, partnerships and how you've supported those and how you've been able to move those forwards afterwards. Okay. And one last question from our online audience, I think. We have an online question for Pete Masters. Can you really expect a nurse or midwife with a good idea to also have project planning or management skills? Okay. I would like to kick off. I mean my gut response is that our MSF is that the R&D is not the core and yes this is kind of an exception but then just thinking off the top of my head how many projects we're currently involved in with R&D or innovation or have at least initiated and have been taken up by others. I mean we have the three piece which is the push pull pull for TB drug development. We have DNDI. We have the mini lab for feasible blood culture. We have the multiplegs that I just presented. We have Child's Play which is an episome posterior collaboration for a pathogen test for fever diagnosis in children under five years. We have the Elmanac which Clotill can tell you more about which is for fever diagnostic on a tablet. It's basically an easy flow system for nurses to use whereby all the complicated thought processing that would usually be done by a more specialised physician is built into the back end and so you can simplify fever diagnosis on the front end so there's actually plenty and I think we can be very proud of what we've been involved in in much more upstream ways. Also one example I wanted to give on hackathon was actually the access campaign office in the US had hackathon to try and get shareholders who had pension funds invested in for example Pfizer as shareholders to put pressure on Pfizer to drop the price of PCV which was part of the fair shot campaign so I'm sure others have other examples that work pretty well. Louie, did you want to answer the question about your... Yeah, so that's quite an easy question to answer because Ludovic is here, if you raise your hand. You can speak to him and find out he's from MDS, the manufacturer. Wonderful, so Andreas on hacks? Yeah, I would just say that I agree. I'm also enthusiastic and sceptic and I think what I find when I talk to people about this it's a mixed bag to be honest and I don't want to point out some specific things like this solution is a great example because people might hurt me afterwards but I mean the missing maps people, Pete and others with the map at hand so obviously that's concrete results. We had people reporting on body bags that have been designed and now are getting scaled up. IT systems apps, personal protective equipment and so on but everyone, even those that would be considered successful they point to the problems of implementation. So the prototype is not the implementation. The prototype even with this autoclave that we have in the field it's not the final thing. It's quite a long gap or large gap even after that. So if you can't sustain it, if you can't support this prototype if you don't have a plan for how to scale it and how to support it, it's a nice prototype and it's a success so to speak as a prototype but it's not the final solution. And Pete. Yeah, just like for the epidemiologist I think I agree and I think last year Scientific Day was the first time a failure had been presented and I think we have anecdotal evidence of failures and successes but actually we don't really have any kind of view of a portfolio of MSF design and innovation and it's something we're actually trying to address and that sharing of success, whatever that means but also the lessons learned is equally valuable so I think it's a really good point and I'd just like to point out that we met fearsome at a mapathon. Okay, so next batch of questions. So we have a gentleman here and a lady here. We'll take those two first. Okay, I'm Jeff from MSF and I have a question for Terry. Is that for the pathogens identification is there any opportunity maybe in the future to look also at pathogens in water because here it's all for patients which I think is okay but also for water in hospitals especially where we have outbreaks that might be something to consider. Thank you. The second question was just a bit further up. Yes, Sylvia from MSF and I have two questions, one for Pete and one for Andreas. For Pete is how you see the adoption of this innovation approach in MSF and for Andreas is related to the scoping of the challenges. You said it's a key element so did you see in the study some criteria of the type of challenges presented that are more suited for this type of techniques? Okay. There are a couple more questions on this side. A gentleman just here in the green. Hi. Hello. Hi. I just have the previous MSF now, NHS, on the medical microbiologist. I'm very interested by Terry's talk. We are currently evaluating multiplex commercial PCR for viral and bacterial infection on CSF. Have you got any partnership with big microbiology labs? Because we could help basically with any organisms on that list apart from probably this, living sickness, sorry. So, yeah, I mean I just would like to ask you that. Thanks. Last one, just a couple of votes forward. This lady here. Hi. I got from Missing Maps events team as this question for Andreas. I was wondering, we don't seem to have much trouble generating the initial enthusiasm and interest in the project, but I was wondering if you had any insight on how to then encourage people to take up more advanced training and kind of move up the ladder in the hackathon, makeathon, mapathon community. Okay. Well, I think that's the questions we'll get to answer. So, Terry, do you want to start us off for the two? Sure. And so the initial cartridge that is being envisaged is for patient use, but really the sky's the limit. And one of the big reasons why we want this to be an open platform also because it's in line with MSF principles and not having monopolies, but also because it's very customizable and any cartridge could be developed for anything. So we have to have very transparent... Basically, we have to be very transparent in terms of how the instrument works, what is the interoperability, how the cartridge will be designed so that the moulding would be standard, but then whatever you want to load on that is fine. And in fact, there are really prototypes like that, like the lab disk from University of Freiburg. It's already following that concept, so it's not unprecedented. Yeah, sure. And then the partnerships, yes. So there are of course some labs in MSF, but the product development partnership would be with FIND, and they already have very well-established partnerships with key laboratories, but they're also contributing towards a biobank for fever from a globally representative laboratories' insights. OK. So I'll go to Pete next. A question about adoption. Yeah, thanks, Sylvia. So one of the things to note is that this isn't... We haven't taken this to its conclusion yet. We're at a prototype stage, so as an approach it's not complete. So there are various kind of mechanisms that are doing innovation in MSF. Some of them are funds, and one of them is called the sapling nursery, which is run from the UK. And one of the criticisms of the sapling nursery is it gives you time and it gives you money, and then that's it. So if you are coming from the field and you're a logistician with an idea, you give an X amount of euros and you give an X amount of months, and off you go. So we see this possibly as being kind of a recipe that can help people within MSF to make more of the time and money that is available to them. But we've just kind of finished doing it, so what the next step side, I don't know, documenting it is important and making it available and showing what can be done maybe and talking about how to develop it further. Thank you. And Andreas, the last couple of questions then around scoping challenges. Yes, the scoping challenge. Do you hear me, by the way? Well, let's create clean water for everyone, very broad. If you can code whatever you want for 24 hours, I mean that happens, that people do make a thumbs and hack a thumbs with those kind of very broad challenges. I think, you know, as the overall headline for the thon, that might be the thing. But to scope it down to, you know, the specific context, the specific constraints, what kind of, are we talking rural, Nigeria, are we talking this small village, are we talking, you know, city, big cities and what are we talking about. And basically having clear scenarios, I would say, is a good way of doing it because in those particular scenarios you can find a way to talk, okay, we now talk about this specific person or this mother of two and the specific things rather than, you know, solving climate change in a workshop. So that's a suggestion for me. When it comes to this moving up the ladder a bit, for example, missing maps and other activities that you might get initial enthusiasm and then you've done it once and you might not come back or that kind of stuff. I think that's, at least from the people I talk to, that's a huge problem, obviously. But one thing that I heard that some are talking about is you need to allow these enthusiasts as well to kind of create their own kind of hacks or make a thumbs and that kind of stuff. So you're not controlling everything that needs to be done by MSF where everything needs to be done because you're afraid that they will run off with your brand. I mean, if you will give them some freedom as well to do that then I think missing maps have been able to spread the word, so to speak. But in general to allow people that are super enthusiastic to kind of create their own, you know, make a thumbs and hack a thumbs, that seems to be quite successful because then they feel ownership and not only like I'm a participant. I'll wrap up now. Thank you to the panel. It's clear that MSF has a lot of opportunity to find innovations in ways the market hasn't quite solved. And I guess that some of the lessons here are around taking those learnings forward and making sure we can move beyond prototype for some of those great ideas. Thank you for your questions and now I'll pass over to Javits. Yes, thank you all. Wasn't that an incredible session about learning about innovation? I think some potential game changes there and real frameworks about which to bring innovation along. So round of applause.