 So welcome, everybody, to putting health at the heart of climate change. So there's been a lot of discussion this week about climate change, and we're really happy to spend some time focusing on health impacts. So we're very fortunate this morning to have Dr. Ahmed Agwa-Uma here with us. He is the director of the Africa CDC, and he's going to share some brief introductory remarks to frame the issue before we get started. So if I may turn it over to you, Dr. Ahmed. Thanks, and a good, I think it's still afternoon. You never know, with jet lag-related problems, morning can look like evening. But welcome, and thank you everyone for coming. Mine is very simple, and let me start with the reality of any sector that fails, it becomes a health problem. It doesn't matter which sector it is, whether it is politicians or the folks who help us with keeping our spaces clean. Any sector that fails, it becomes a health problem. Many sectors have failed over time, and that's why we have climate change now becoming a real, real challenge to not just prevention, but also trying to respond to health problems across the world. And I'll give you a few examples with the situation on the continent of Africa. Today, we have one of the most invasive cholera outbreaks in the southern part of Africa, particularly in Malawi. Many of us have forgotten that there was a hurricane a year back. There was a tropical storm six months later, and that was the genesis of the cholera outbreak, and it has never gone away. But because we've been so focused on other things, nobody has been watching the numbers. Today, literally the whole of Malawi is a crisis region when it comes to cholera. Second is when you look at the small island states that are surrounding the continent of Africa, beautiful seashells, Mauritians, Cape Vards, South Tome, they are as close as it gets to showing us how bad climate change is because of the rising sea water, and also because of the changing climate that results in diseases they had not experienced before. An island supposedly is easy to control things coming in, but today with all the travel that we do when it has come in and you don't have the infrastructure to look after it, it becomes a huge problem. These small island states have for a long time been battling with NCDs largely. But today, communicable diseases are re-emerging on the islands, all because of climate change. Now, we in the public health space, we have to intrude into all other spaces so that the failure of others does not become our problem. We will be accused of stepping on people's toes and walking into areas that are not our jurisdiction, but if we don't do it, then we'll have a lot more work to do. I'm happier debating jurisdiction when there is no outbreak rather than debating jurisdiction when there is an outbreak. So the conversation we are having here today, let us walk into those spaces where there may be failure or where there has been failure so that we can work together to fix the issues in that particular sector in this situation it is climate and we reduce exposure for our populations to preventable illnesses and health emergencies. If any sector fails, it becomes a public health problem. Thank you. Thank you. So this is the challenge that we face and we're going to spend some time walking through it. Let me just give you a sense of what today is going to look like. First, though, I've been asked to remind you that if you are on social media channels, it's hashtag WEF 2023. So I'm Cheryl Moore. I'm the head of a research programs at Welcome. We have four areas, one of which is climate and health that we're focusing on over the next 10 years. So we bring an incredible interest in this particular topic. So today we have a fantastic panel. We're going to, the run of show is that we're going to hear from each of the panelists a bit. Then we'll go into a period for some questions at the very end. So briefly introducing our panel. I have to my left Katherine Russell who's the executive director of UNICEF. UNICEF is tackling the impacts of the intersecting crises on young people of which climate is certainly one. So we'll hear from Kathy in just a moment. Next we have Victor Zau, who is president of the National Academy of Medicine. The National Academy has been leading a number of important collaborative projects in the climate and health space. Welcome. Vanessa Kerry is co-founder and CEO of Seed Global Health, which invests in health and the health workforce, including how to prepare for the shocks that climate change is bringing. Welcome, Vanessa. And last we have Paul Hudson, CEO of Sanofi. Sanofi has very clearly outlined its commitment to sustainability and social responsibility as part of its long-term strategy. So you can see that we have a diversity of perspectives. I'm really looking forward to this conversation. So first, a few introductory comments about what we're looking at. The climate crisis is very clearly a health crisis. And we need to put health at the forefront if we're going to make wise decisions. Since we were last here in Davos six months ago, we've had significant climate events. And they've shown people more broadly that rapid action on climate change is necessary if we're going to protect human health. So the most recent IPCC report from November, the Intergovernmental Panel on Climate Change, talks about increases in climate-related infectious diseases, as we just heard. Premature deaths, whether due to air pollution or excess heat or other sources. Food scarcity, including malnutrition of all types. And increasing threats to mental health and well-being as a result of climate change. The Lancet Countdown recently reported that health-related deaths in the most vulnerable, which they define as babies in the elderly, increased by almost 70% over the last four years, compared with the four years beginning in 2000. Over 70%. So that's why we at Wellcome have made climate and health one of the four pillars of our strategy. There is time though if we act now to protect human health. So for example, there's a new analysis that is soon to be published, the first of its kind, that suggests that if England and Wales were to meet their greenhouse gas emissions targets, it would save over 2 million life years between now and 2050. We have to do what we said we were going to do. We heard from John Kerry yesterday that there are a number of opportunities for us to double down and make sure we meet those targets. So, this year's meeting has set up a new pavilion focused exclusively on health, which was opened by the Director General of WHO, underscoring the importance of health. And we heard a lot of conversations about health that we hadn't in the past when we were talking about climate change. So the potential is huge to promote health, to have co-benefits for changes that improve the climate, and also improve health if we focus on that in the development of adaptations and mitigations as we plan them. So today in this panel, we're going to focus on how we move forward, addressing solutions to help us respond to the impacts of climate change on health and the role that different stakeholders can play and should play. So, turning to the panel, Victor, let's start with you. So you've talked a lot about the importance of bringing together disciplines to address the climate change and health intersection. What cross-sectoral developments have you learned about that you're really excited to share? Well, thank you very much. This indeed is a really important topic. When people think about climate, they think about environment and future generations, but people are suffering and dying right now. I think the main message, I believe, is to be sure that everybody knows this is a crisis of public health. It's also a crisis of equity because it affects people in communities and countries who are less prepared, more marginalized, and the resource. It's really important. So when you start thinking about climate and health, of course, you can say these things are coming together, but they read of one. But climate involves so many different aspects of it. When I think about the sectors involved with climate change, transportation, energy, food, you name it, and there's a long list of them. Most of the planning around these are what I call vertical. In other words, each economy has a model looking at consumptions and missions and looking at what can we do of mitigation, innovation, and adaptation. Very little about the impact on health. In fact, I'm not even aware of any of these initiatives or global efforts looking at if we do this, what would happen in health? So the question about intersections is really important when you talk about different sectors because, first of all, most of the policies and decisions are made in the context of this sector alone. But importantly, when we recognize that all these sectors converge, that is agriculture, energy, we're on human health, that I think the current economic model doesn't quite work. So my feeling, our work at the Academy, led by Judy Rodin and Andy Haynes, is to look at a systems transformation. How do you actually look at existing models and how do we actually change the thinking whereby these things are brought together in a more systematic way, holistic way, to look at the impact on health as well altogether. So that's what we're looking at. That's fantastic. I think it is going to take a multi-sectoral response to do something meaningful. Sure. Yeah, thank you for that. Climate change, as we've talked about, is clearly affecting the spread of disease to multiple regions. So estimates are that there will be over a billion people newly at risk by 2080 of dengue, chikungunga, and other arborviruses. So knowing that, we need to be ready to respond. And pharma has a crucial role to play in enabling that. So turning to Paul, what can you tell us about what Sanofi is doing to prepare for the health impacts of climate change? How are you preparing to make vaccines and therapeutics available where and when needed? So there's a very deliberate and broad response from the industry, actually, but to focus on this for a little moment. You know, my own journey on climate and health basically came out of, I've been in healthcare for over 30 years, and then I got very interested in climate and the impact it had on health. And now, more recently, working with a small group for a group that Prince Charles set up, Prince Charles and the SMI, the Sustainable Markets Initiative, we've been working very hard on the fact that if 5% of global emissions are health and 45% of that is delivery of healthcare, what can we do to decarbonise the delivery of healthcare? It surprises people sometimes because, you know, a lot of those emissions are over-heated hospitals or driving to a hospital for a visit that could have been done virtually or, you know, the incidental costs on emissions are pretty staggering, frankly. But the bit that we're really focused on as a company where we can do, I think, a lot of good work before I get to vaccines is, you know, if you're an average adult, you'll create around 15 tonnes of carbon, 10 to 15 tonnes of carbon in your adult life. If you're pre-diabetic, you'll also create about 10 to 15 tonnes of carbon in your adult life. If you go on to be diabetic, you'll create between 30 and 45 tonnes of carbon because the way healthcare is delivered to you, medicines that are made, transportation to a hospital, caregivers getting to a hospital, it's almost 3x. And so preventative health, helping people not make the journey from pre-diabetic to diabetic, for example, can have a simply mind-boggling impact positively, not only on them, but on the climate. And I think we've always, in our industry, we've always looked at it in reverse, which is, you know, air pollution causing respiratory disease, it's still very valid. But it is interesting to think about disease prevention. Vaccination is a big part of that. We're one of the world's leading vaccine companies. And I can tell you, we provide vaccines at little to no cost in almost all countries. In fact, we are working even harder on helping provide places of care, which could be at places of worship in some of the hardest hit countries because where people gather is where we can try and do some good because we can't expect sophisticated healthcare delivery systems in cities in many of these countries. So we work tirelessly to try and make sure that we can bridge that gap. The last thing is about our own emissions ourselves as a company. And, you know, we've committed to net zero by 2045. Like many, we've committed to neutrality by 2030. We've committed to 100% renewable by 2030. You know, we've worked across all the levers to try and make sure that we're not adding to it. And as the CEO, I have to say, you know, when you get these roles, you know, it's exciting, of course, and you think about transforming your company great. But I think more and more, particularly with the times I spent at Davos, you realize your responsibility to use your role to do good for the planet and population health like never before. And I've been coming here a long time, but just simply changing role over the last few years for me has been, you know, a real moment of truth for my own role in trying to bring all those things together to do something significant. And if we don't, nobody's going to. Yeah, I think that's right, like never before. I mean, leaders, as has been said here this week, leaders are having to step up in a completely different way at a different level to address these intersecting challenges. Yeah. In order to roll these things out, we're going to need robust health systems and workforces. So we need the right skills and capacity globally. So Vanessa, what do local health systems need to prepare and manage for these kind of changes? Well, I mean, I think, first of all, it's lovely to see everyone and to have this discussion because it is critically important. And I, you know, we think a lot about communicable diseases being led to, you know, related to climate change, but the truth is non-communicable diseases being driven by climate change too. In fact, air pollution is the second leading cause of non-communicable diseases globally right now and the first in Southeast Asia. And when you think about what that impact looks like, that's actually about $47 trillion in costs globally between 2010 and 2030 just to manage some of that disease. And so as we're looking at this, it affects every aspect of health. There's higher maternal risk that's led to from climate change increases in stillbirths, premature births. So we're seeing this impact across every sector, the malnutrition, every aspect of health is being impacted by climate change. But what that actually relates to ultimately then is every other sector at the same time too because that is our security. If a mother dies, her child is more likely to die. Growing up, their child's more likely to be socioeconomically disadvantaged. They don't go to school. When you think about what most people's main assets are, it's their ability to work. And if you're sick, you can't work, you can't participate in markets, GDPs don't grow. And so we have a real opportunity to address this. A quarter of the world's deaths currently are from preventable environmental causes. So we're just, if we don't tackle this issue in this nexus, we are really setting ourselves up for a much harder pathway. And I think as we think about what the solutions are to address this, and it's really in building strong, resilient health systems that can address all of these diseases. And for me and for the work that we do at Seed Global Health, that is very much rooted in health systems and the health workforce that makes up those systems. We've done an incredible job of promoting technology and trying to leapfrog right these solutions. But we are actually leapfrogging the fundamental people who are needed to deliver care. And it doesn't mean that there isn't a need for technology, but you leverage it through the humans that hold it, know how to use it. And when a woman is in preterm labor, from extreme heat, and she's hemorrhaging, it is a human who hangs the bag of blood that will save her life. And so we have to really think about what these connections are. Dr. Ahmed, I'm really glad that you raised Malawi. Malawi has the largest cholera outbreak it's seen in 20 years. There's been 25,000 cases, and it's all being driven by the climate changes, the cyclones, the environmental hit to the communities. This is a country that is already struggling with many other health problems. President Chuck Guerra of Malawi wanted to be here in Davos today to try to seek private investment to grow his country, but he's home dealing with this domestic crisis, which is now seeing 500 new cases a day of cholera. And that's happening as we're all sitting here in Switzerland. And so there's a really real crisis of where we're going. But we do have the ability to make these changes, and in fact it's actually cost saving. So we invest in a health workforce and we invest in this resilience. We invest in dressing this problem. It actually would lead to about 4.4 trillion in GDP growth for these countries. That means there's a $2 to $4 return on investment for every dollar invested. So we have incredible capability, but it comes down to very simple things. It comes down to political will. It comes down to mobilizing finances. We just have a fundamental financing gap that we're going to have to close. But if we do close, we are going to see the savings at the back end that can be quantified. And far more importantly, we're going to save lives and create a better well-being and a better security for all of us. Thanks. Yeah, we have to take action early. And I think we saw this in COVID, right? So COVID cost us $11 trillion over nine months, right? And we knew we needed to do more on global pandemic preparedness, right? So now this is staring us in the face and it's time to take action. The issue about food security. The IPCC report also talks about the reduction in land that's suitable for farming due to extreme drought. There's a reduction of about 30% since 1950. 30%. So we're seeing growing hunger. So the heat waves in 2020 were associated with almost 100 million more people suffering from food insecurity than in decades past. So this is one of the key ways that climate change will affect health is through food and water supply. So as we've said, many regions are experiencing this right now. It's not in the future. It's right now. So turning to you, Kathy. So how is UNICEF seeing climate change affect health in children's lives in particular? Well, if I could just put it in a little perspective. We've seen over the last few decades some real progress in children's health related mostly to vaccines and to sort of lowering child mortality. And it's been impressive to see that. But I think we're seeing climate as a real threat to that and for several reasons. One, as you said, these heat waves are incredibly damaging to children. Their bodies and Vanessa would know this better than I, but are susceptible to this or more vulnerable to this. And it's hard for them to deal with it. And we're also seeing these patterns of infectious disease. Malaria is something that we're very concerned about for children. And in part because of COVID, we've been less able to do some of our more routine vaccines. So it's just adding to this really difficult situation. The drought and the water insecurity are really challenging for children. I saw it in Ethiopia. This land is so dry. And it means that these children are literally wasting away. We're doing a lot of work trying to deal with severe acute malnutrition. To see it is something that really is just heartbreaking. And you see first the animals waste away, then the children start to waste away. And what happens then is the population starts to move. We end up with more conflict and challenges like that. So really difficult. I think we're seeing so many children who have no idea where their next meal is coming from. I saw it again in Yemen where children are just literally so vulnerable. And all of these climate threats, everything that happens in the world, every bad thing that happens is a little bit worse for children. And that's what we're seeing. So we see the climate crisis as really a child health crisis. Yeah, no question. One of the other four pillars of welcome strategy is about mental health. And we focus in particular on young people and looking at what's happening and trying to intervene early. It sounds like you are seeing some changes in mental health among children. The interesting thing is there's more awareness of mental health issues. That's a positive. But we also know that the impact of so many of these crises is having a real damaging effect on children. I've seen it in Ukraine where these children are talking about seeing horrible violence and the impact of that on children. I saw it in the DRC where I met this young boy. I mean, you know, it was it was just something that stuck with me because he was talking about having seen just horrific violence where he saw his friend killed in front of him. And I, you know, it was a sad story, but not unlike other stories I've heard before. But he was such a profoundly sad child. And afterwards I found out that not only had he seen his friend killed, he had seen his friend decapitated. So for children to try to figure out how to adjust to things like that is really difficult. For UNICEF, we're trying to address mental health issues and we're providing psychosocial support where we can. It's not easy. I mean, if you look even in my country in the United States, it's not always readily available. In other countries, you can imagine how hard it is, but we're trying to incorporate it into our more general health response. Yeah. I think we've talked about a lot of things that we're seeing on the ground, that we're seeing every day and what we interact with. But what I think we need to do to make progress is to make this real to those who are setting policy, who are setting policy for adaptation and mitigation to climate change. So for anyone on the panel, what can we do to make this real so that policymakers, when they consider action to address climate change, consider the downstream effects on health? Victor, yeah. There's certainly not enough work done in research in climate change and health. Actually, this is very little. Most of the evidence are associative evidence. As been discussed, there's air pollution. This is 700,000 deaths. Therefore, it's climate change. And so we need to do some serious research in linking climate and health outcomes, providing the evidence. That's absolutely key. But I think that's simply the beginning. So as we can all imagine, you know, we learned from COVID that how poor data is being collected in the United States or globally. And so it's really difficult to know who's affected, how's it been affected, and what's the outcome. So I think that kind of a data network is absolutely necessary to a systematic collection of that information, particularly in the poor countries, where they have the most effect and less the least emission, if you will. But I think there needs to be more action-oriented research to say, what do we need to do? What are the interventions that will result in any evidence? It's better. I think the policy makers would be willing to listen to those issues. We've told the narratives and data to say, it's really hurting people, lives. But here's what actions needs to be taken. And these are adaptation and mitigation strategy, as well as innovation. New ways to do things. I'd like to come back a little bit and also make sure I address some of Paul's comments, but I want to make sure my other colleagues have a chance to answer. Great. I think Vanessa has something to contribute. I fully agree with the need for research. I'm an academic at heart, you know, and I think that's critically important. I think there's a yes and there, because as much as we have to generate the knowledge and the information, there are actions we can take now that we know will create positive change and that we can support because it fundamentally can sort of be the right or can do the right thing, if you will. And just to give an example, you know, we, when I think about the problem of climate and health and we're training workforce to help address the growing burdens of disease and all burdens of disease, prioritizing the ability to train, for example, it takes time to do that. We have to start that now because to build that workforce that is going to manage the extra 250,000 deaths that we're going to see from climate change, the growing non-communicable disease, the existing disease that is already there, we already know that that's a win-win and we can be pushing for it. And we also know it's possible. So I think that if we can give policymakers already what some of the solutions can be and the answers and the fact that there's already partners in the community and at the willing. And I think, you know, Dr. Ahmed here is leading at the Africa CDC a huge initiative on the new public health order, which includes investing workforce and building out local manufacturing to help address some of the, you know, the vaccine readiness for the changes we're going to see in disease and being able to invest in those now when we know that they're also just going to have a good outcome. Let's also get started on this. And I think giving those solutions that we know and the examples like the work we've been doing at SEED in our countries in Africa or the work that our other colleagues have been doing or the, you know, countries have been leading on can go a long way also to getting us started to adapt to something that the train's already at a station on climate change. We have to start action now. I think, yeah. Let me go to Paul and then I'll come back to you. Sure. Okay. Thank you. You know, maybe a couple of comments. One is sort of the urgent. You know, we have a foundation, foundation S. We used to, we had a foundation as a company a very long time, but it felt like it was more for posters by the elevator, you know, in the building. It didn't feel like it was really where it needed to be urgently. You know, right now we're in Bangladesh and doing what we can helps establish satellite care centers running long term mangroves and locations that are needed and doing things that we see much more directly connected to the purpose of the company and, you know, hoping to build those at the foundation into a business strategy so that it's everybody every day, everywhere in our company is responsible for helping Bangladesh, even if you're not directly connected. So there's the urgent piece. I touched a little bit on some of the work we're doing. We're giving to the 40 poorest countries in the world the 30 most essential medicines mostly for non-communicable diseases at cost just because we can and we think it's the right thing to do. But more interesting than that is we created a tech fund in Africa. We put 25 million euros in to get it started. And it's, I call it frugal tech. It's perhaps not the right expression. I'll probably learn a real expression while I'm here. But it is, you know, for most of the continent that's using first generation cellular, it's tech innovated within the boundaries of what's available to help support healthcare delivery. So it's not trips to Silicon Valley thinking how can we conjure up a new app on our smartphone or iPhone 14. It is tech enabled initiatives and startups we're investing in in the communities. We know banking happens on GSM. We know health records can happen there. We know communities can be built there. We're doing, we find it very important to innovate locally because everywhere else is effectively for show, to be honest. The last thing and Victor and I talked about this a little bit too and maybe he's going to touch on it, which is we went to COP 27 to try and affect policy change. We went to try and say in our world of delivery of healthcare decarbonizing the healthcare journey requires data, radical amounts of data, publications, policy updates, open-mindedness, multi-stakeholder progress, patients themselves to be aware about the journey from pre-diabetic to diabetic but also what it's like in the cities of the future to try and take the carbon piece down in your delivery of health. If we learn nothing maybe the last comment, the US insurers in the pandemic reimbursed virtual visits to talk to doctors. This is the US right, should know how to deliver health. Reimbursed virtual visits right through your insurance plan as soon as the and patients like them they can do more of them as soon as the pandemic was over said there were no longer reimbursing virtual visits, you had to go in person because there was too much cost in infrastructure. Instead of a blended approach even which would have been better, which would have been better for the environment making everybody get in the car for routine consultation it's like how crazy is that? We have lots of work to do on getting people into the spotlight and working on policy. So I think that points to something else I'd like us to touch on which is how can we listen to the priorities that are locally derived because each environment is different. So let me work rapidly over time so let me go quickly to Victor for his comment and then maybe Kathy you can reflect on that a little bit. First of all I want to agree with my colleagues strongly and certainly with Vanessa's and but that being said I want to be sure that we think about the bigger picture which requires not only the health side to change the equation the way to do things but globally as I said the other sectors have to understand government understand this is all about health as it relates to all the other sectors but back to Paul's point in the globally health sectors emit 4 to 5% United States about 8.5% of all carbon emissions it's an important percent but if we look at health care and many of the innovations that Vanessa talked about it's still a very small piece of what we're dealing with it's absolutely important because we as health professionals myself being one need to really think about this as part of our mission when we think about caring for the patient looking at how to do the best we can we have to now take the environmental equation into the issue and so all our health care workers should be trained in this whole issue of understanding climate and health care and our initiative involves all the education medical schools etc in doing this in the National Academy but importantly what Paul was saying is bringing together all the sectors or the sub sectors in health care so the private industry we have a similar one that I work on with the Biden administration it's co-chair by Andrew Woody and George Barrett like how to decarbonize the U.S. health sector I mean back to this point of waste and telehealth, energy, consumption I was looking at this data one hospital in the United States generates as much waste as 93 hospitals in eye surgery in eye surgery in India so that's a great segue I know we're already over so apologies maybe we can talk about looking at local context and local priorities and making sure that we're addressing the most urgent needs based upon what's going on in country there's a big picture here which is obviously there are leaders who need to do better by all of us to reduce carbon, to help countries do better with that we in UNICEF are dealing with the consequences of it and what we see is really at the community level the most important thing we can do is support community health community health workers, doctors the people that Vanessa trains because they are there they're dealing with these problems in the front lines they're the first people who can identify what's happening, try to help remediate the problems but we're always just trying to fix something here and this is a problem that children did not create and children suffer the most from and we all need to do better this is an important data point in the broader discussion about climate that it's affecting everyone's health it's really affecting children's health and what does that mean for the future if we can't get hold of it that brings us back full circle to what Dr. Ahmed said in the very beginning about solving for systems that need fixing so great, this has been a fantastic discussion and I'm sorry I think designing research is exactly the point I think many research are not designed with a community in mind people with lived experience participating in looking at where the issues are where the needs are and how to co-design the research questions that's great, so we have just five minutes for a question or two from the audience so it may only be one but if I could have somebody take a mic to this gentleman right here, please first of all, thank you my name is Roman, I'm from Ukraine and I'm from the Global Shepherds community and also I'm an anesthesiology resident from the biggest hospital in Ukraine and in 2022 we faced the biggest war since World War II and our health care system challenges extraordinary challenges, severe blast injuries post-traumatic disorder mental health problems insufficient nutrition for new burns antibiotic resistance because when we have trauma we have a lot of antibiotics and so on and these challenges that the best specialist in the world should work on and what is the best way how the world could deal with this and help thank you a challenging question I would like to respond I would make a general point which is war is the worst enemy of children everywhere we see it in every conflict they suffer the most I saw it in Ukraine where people were operating in hospital facilities underground it's almost impossible to have a good outcome in a situation like that I would advocate for the end of war if we want to try to do well by children and certainly Ukraine is a good case example of that certainly I think there's lots of effort at least when I can see I'm reaching out to not only Ukrainian scientists and clinicians but also to the neighboring countries like Poland where you can see a lot of displacement so we have major initiatives to look at how to support looking at underground working with the Ukrainian health systems etc and trying to raise a lot of money and enable also students to go to Poland to continue education so I think your point is well taken I think that there's a real you outlined for me the real crisis for the health workers that are on the front lines that are putting their lives at risk every day to take care of patients and that speaks to a broader issue of how we value health care workers I think globally at this time the kind of investments we were putting it and I think there are a lot of institutions I hope there's a lot of institutions I know Mass General where I am a physician and I work to support some of the acute care needs through either telemedicine directly sending support teams I think the degree to which both your government but also your professional societies can make connections with other professional societies outside of the country to be explicit about what the needs are we can then as a community of health workers who want to stand in solidarity can try to motivate both the resources, the support the expertise and think about where there's lessons learned and other times of conflict crisis I think a lot of blast injuries also there might be lessons learned from the giant earthquake in Haiti and the crush injuries we saw and how we figured out systems to be able to take care of mass casualty it's but I think there's the solidarity piece there is a community that wants to support and I think there's we can make those connections and really try to reinforce the extraordinary work that you all are doing every day on this front line and to know that there's many ways that we can mobilize the resources that are in existence and we will continue to try to do so Thank you Well, I mean it is awful in so many ways and brutally tragic and we know that and for us the first order of business as a healthcare company was to make sure that the medicines could make it go through there was over 33 checkpoints often our trucks had to get through distribution centers were damaged our staff in the centers that were distributing to hospitals which were already severely structurally impacted the staff had gone to fight so we had to retrain people get everybody in the right place to make sure the medicines could get through no different by the way to any other pharmaceutical company I think everybody kept trying to do it I think the real step up from us will be the rebuilding effort and how we help retrain how we help set up new infrastructure what we can do and there's been many connections with the Ukrainian government on trying to get that started planning for the return if you like which feels hard to be optimistic about it today but I think it's part of our duty as a healthcare company to play a part in that and I find that the requests from the Ukrainian government representatives have been very considered and very long term in their planning and I think we have to remember once hopefully this thing is over as awful as it is that we don't forget the urgency and the reconstruction which I think we all have to play a part in Thanks Paul and I think this underscores how challenging it will be to keep health at the forefront of our climate action because there are so many other competing crises that we need to take into account right now and the challenge that we all face so if there's anything that we've learned from COVID though it's that there are reasons to be optimistic right so we've seen that when we come together when we bring together industry government leaders civil society leaders together we can find a way forward as we consider the development of adaptations and mitigation around climate change we have to keep health at the forefront if we do we can ensure health and prosperity for the long term if we don't we will I think it was Kathy who said when people can't work when they're not healthy they can't work so we'll start to tumble one after the other more rapidly than we'd like to see but we can do it if we come together so thank you so much to this panel for a really exciting and stimulating conversation thank you and now I'd like to turn it over for one moment to Shyam Bishan who has a closing comment oh there you are sorry thank you, thank you Cheryl NF has been said so I don't want to take up a lot of time rehashing those but the one thing I want to emphasize is the impact of climate change on health is here and now it's not 10 years from now so we must come together and take action now we have seen that with rising temperatures more than half of the infectious diseases are increasing there is a big increase in those infectious diseases over 20 million people are being displaced every year with rising heat, with flood with drought, with all kinds of things so those are some really some ring numbers we see the WHO is projecting 250,000 deaths every year because of the direct impact of climate change on health 2 to 3 billion dollars losses every year because of that and this is just the direct cost indirect cost is obviously much more much much more that so that time for action is now and the answer is as you said Cheryl multi-sectoral action people from different sectors have to come together and act on it the answer is in global public-private partnership and we at the World Economic Forum as you know we pride on providing that platform so that's something that we pledged today and actually today the World Economic Forum together with Welcome Trust will launch an initiative to look at that initiative that is to look at the impact of climate change on health as Victor was also saying we want to make sure that there is and I think Vanessa said too that there is enough research based data research based evidence so we want to collect that and I think Welcome Trust is already doing quite a bit of work on that other people are World Bank and others are also collecting information but it's not in one place and more needs to be done so we want to make sure that we have good amount of research based data that we can take to policy makers we can bring it all together to respond to it I mean the one thing we need to do is prepare our health system if we want to tackle the impact of climate change on health your health system has to be prepared it has to be sustainable it has to be resilient so that's something that we would be working on but with that without taking any more time I would like to thank Cheryl, Kathy Victor, Vanessa and Paul for being here and all of you for participating in this Thank you