 It's a big pleasure to share with you some insight into these issues that we have now with SARS-CoV-2 COVID-19 pandemic. And it's maybe interesting for you to know that I am also already since the beginning of the crisis. I'm linked with some of your Kenyan colleagues in around Lake Victoria and CIA district around in order to really go at the periphery to look at this problem of SARS-CoV-2 transmission. So it's a thank you very much again for this invitation. What I want to do with you, I want to share some of the issues that we have not only in Switzerland, but actually how we can again, in the spirit that I've always followed is this mutual learning for change that we can learn together when we think about in this case now the pandemic, how we can learn together in order to make a difference in global public health. I have prepared a few slides and I hope you can see the screen. I can see it, that it is shared, but otherwise you just must shout if you don't see it and you see me as well now. And I would like to start with some basics. I want to give you the end of this possibility. The big question in all the countries and in the areas are always the question of which strategies and which approaches that you have to do if something unexpected happens and how you go with all this. So I start with this picture on the strategies. These are some basic slides. You know this is actually when everything was in full swing here we were driving through DRC in 2005 and then suddenly in full swing something happens and in this case it was this snake that went over the street and we were actually, this is an easy case when this happens to you. You just stop and you wait until nicely the snake is over and then you are just admire the beautiful incident that you had the chance to see this python. Now when it came to COVID some people actually and particularly scientists they just looked at it in a strategy in a different way. They looked at the strategy in this way that they would say oh we have a very big problem and without just let's look, let's examine, let's do some research, let's find out. But with this attitude as you can agree I mean the rock, the big rock still remains and they will not move away and you are just doing some very nice descriptions and some analysis. Another important thing for the strategies in such pandemic situation but always actually is this picture is that you need to have the right tools. You know this man here doesn't have the right tool to knock down the tree. So whenever we actually design strategies sometimes very theoretically we are actually challenged to have to also ask which are the right tools. So just keep these pictures that there is another strategy that many people have tried at the beginning of not only the SARS situation they have actually done this what this penguin man does it's do one brave thing today and then run like hell. That's what they sometimes do and this of course as you can see it looks nice it's attractive but it's not the strategy that carries us forward and if you just do one thing that you think is fine you may in danger hear the mama penguin that actually when the ice bear wakes up as a serious problem. So what we are in now in the strategy discussion is actually this one is actually that we do fun and have extreme sports fun means that we do our science with enthusiasm not just happy life enthusiasm committed and we are actually targeted to what we have to solve we protect ourselves but actually we are very much determined to reach that. So this is one of the basics that we always have to think that we are not dropping into these strategy traps that are very often if the strategies are not rooted to the realities as we I don't have to say in Ilri about it is something which I had and this is not to teach you but actually I had actually a really big problem in some other context to actually show people that this whole issue of emerging and re-emerging diseases is actually very much linked to something which is dear to me and what you do is really the one health issue that we have here to deal with sonotic diseases and that means that we are actually not just actually can say it's why we have SARS, SARS-1, SARS-2, MERS and then the thing is over but the potential all over is large and that we have to have a spirit of surveillance in order to really detect what is coming for us and also this surveillance spirit is important in our strategies to fight the pandemic now and I think this comes particularly as you know there are from 1400 pathogens 800 around across the animal human barrier but more important is what you know very well is that we have always not just the neglected disease and emerging disease we always have and that's particularly clear in many settings nowadays it's the triangle the tripod of neglected diseases neglected people but also neglected health and social systems you see when we are now wanting to have a strategy of control then actually we very often see what we have to control but we don't have the systems to carry that through so these are basic slides that you mostly know but I just wanted to remind you that because this is important when people discuss strategy and the most important one is this basic slide that some of you who know me and have seen it before that is actually to understand if we come from an efficacious tool to an effective community action or a health systems action and it is this famous cascade downhill cascade that we actually have here an efficacy of a tool let's say an efficacy of a sorry of a drug which is 80% but actually what counts that you reach effectiveness in a community is that you need to ensure access the blue the target that you need to know whom to target you must have from the provider the compliance and from the consumer the adherence these blue factors are health system factors but they're also factors on how we collaborate together so if you have also a very nice efficacy of 80% if you do not reach here 100% if you are actually low in these health system factors your effectiveness in this example collapses to 29% if we do not effectively work together we collapse the effectiveness and that's at the end what counts and that's particularly important if you take interventions and tools like masks if you take interventions like distancing and if this is not 100% done then you can imagine that the efficacy of a tool reduces then its effectiveness in a substantial way so I think this is something which is very specific now but is something to think about in all our health interventions when we that we not only aim at the magic bullet the drug or the vaccine but we also think what it means to carry this magic bullet to the community's concern and of course if you have not 100% effectiveness you ask the question do we reach everybody and that's particularly important in a situation where you have a pandemic situation that you are not that you are equitable if you have 80% effectiveness but the remaining 20% are actually the poorest people the most neglected people then you have not the high equity effectiveness this is just now basics I say now when does he come now to SARS-2 COVID-19 then actually it's now the moment but this is the fundamental thinking about the strategies that apply for all the countries and I know very well for instance your Kenya being in Kenya at the Lake Victoria area this issue of just saying we have masks we have distancing and things are fine if we don't have the compliance and adherence we are actually losing the effects and this was actually seen in the first wave in the CIA area very clearly before it was reinforced this is how it started for us for all of us this is an old graph when we actually got these dramatic pictures of doubling times every two days in some countries Spain Iran Italy we got the doubling times here in central Europe Canada Australia and then we had actually that was the very beginning when we didn't have any data a lot on the African situation I show you this is just out of this situation many of the countries were totally totally overwhelmed and particularly it's also true for our country and it's very interesting then when science coming science only came in after we had the lockdown so the scientific task force to inform the government about how we would move in this difficult situation actually came only in force in the first of April that the government created a science task force to assist the federal council at the crisis team and the steering committee but we had the lockdown already on the 16th of March so until the political level realized oh basically we should also involve the scientists to inform us about the scientific basis it took some time and what we do as a scientific task force that's very important for many of the settings we are produced we produce policy briefs and situation analysis and these are all public so on this website and I will give you a whom or others at this presentation and you can distribute it can be distributed we are actually all what we produce as scientists and that's a very important point is not only for the government but it is for the public and for the whole world everybody can read our website where actually these policy briefs are basically in English but also of course in our national languages and what we do in addition as this task force just to show you how we try to inform the government is that we are actually have continuous input into calculating and projecting the effective reproduction rate as well as the TTIQ this reads as TIC it's the TIC that means it's the it's testing it's testing tracing the isolation and quarantine the system that is partly based also on an app and this is actually the scientific contribution to constantly inform not for the whole country but actually for the regions the reproduction rate as well as the contact tracing situation so it's these two elements that flow into the decision-making process the measures are actually then decided in the social political discussion not only by the scientists but by the federal council but with community representatives and with also the different private sector and all the peoples that are then involved in our economic and social tissue so clearly it is not that we say what has to be done but we inform about options of things that could and we sometimes are a little bit stronger by saying should be done but we are not we are actually making policy relevant statements and options to act but we do not do policy prescription as soon as you go into the field and that's internationally an important issue you can see this always if the science does not just makes policy relevant statements but makes policy prescriptions we run into problems of of politics and then the people say science is no longer independent the scientists support are corrupt or actually really only have their own self-interest so as you can see from this very summary we actually face with science to inform policy we actually are walking a tight rope between really these relevant statements the scientific evidence and the policy prescription so this is I'm sorry this is in French but I think this the scientists also have a duty and this is not only just that is epidemiology but also with social science with economics that we are not just saying oh we can actually we can kill corona by just having a heavy caterpillar with a large ball that breaks all the transmissions but then what remains at the end is a heap of an economy that is collapsed a social tissue that is collapsed so this is actually not to discuss in detail that looks wild but that's actually is what we produce in the science is that for the country but also for the different regions we have this the the solid lila line is the reproduction rate effective reproduction rate of transmission and so we follow from the beginning over time if the case reproduction rate is over one and we know now that we have actually we have we went down and it was the terrible situation that we have went into the second wave and and this is something that was known to the politicians and a there is something where science should in my opinion should have been stronger because here what happened in July August our reproduction rate was always above one but we had still lower case numbers but it started to build up and this is actually the period which is important that you have if you have long period over over with a reproduction rate that was over one this would actually predict that you run into troubles as we did at the end of October and beginning of November and I think this is something which is not a justification or an excuse but it shows that despite we had these measures of surveillance and projections in place we were actually not able to bring in the evidence that if you have over a long period reproduction rate that stays over one and accumulates not too many cases that so politically social politically people said are we are in a low case situation but this low case operation produced then the difficult situation we have with the consequences of cases hospitalization as well as afterwards death below you see another issue which we were often asked from the politics measures you see here it is you don't see it very clearly but it just shows what actually was forbidden in within a short period and it's it's all clear to all of you as scientists of all of scientists that you have a multi causal situation so when people then politicians ask so what is more important distancing or masks then you of course you cannot disentangle this if you have the measures brought in in the same way combined with the effectiveness issues that I showed you before so we went up but this is we went up and I want just to add a few other important characteristics which are also important for your country and for all the country in in SARS-2 corona we have one difficulty and this is the heterogeneity so here is our country Switzerland that the more it's red or dark the red it's more you have a higher proportion infected and what you see the whole of Switzerland is not in any has those doesn't show an equal distribution so we have a heterogeneity in space then we have a heterogeneity in age as you know very well the younger people they can be infected but they are not seriously sick and there is only the problem with those who have a co-morbidities so if you have to deal with a disease that has heterogeneity like this measures on a national level become difficult because as you can imagine if you say it's a big problem now in Switzerland some people in the central part would say what are you talking about we have no hardly any cases it's not our problem so a general measures face a problem or if you say everybody be careful some people say we are in full swing we are not getting infected it doesn't affect us more much so no problem and so the communication and the tailoring of messages and measures is actually absolutely crucial thing and I think this is something where I can say we were failing we were failing because we are too many general measures for a whole of a country but we had less tailored communication also we are in a in a political situation that would help us I mean Switzerland we have 26 cantons and health education is a is continental affairs so we have a a major decentralization and you have also decentralization in Kenya Tanzania decentralization is an important tool to tailor an intervention whatever it is to a given a setting so despite this decentralization possibilities we have a not very well handled in our situation to use decentralization to really go in a very targeted way where things happen so now with with the measures I would say a few thoughts about the measures not to saying which is right and wrong but actually just on what we build on and the interesting thing in in COVID was that the past lies ahead of us this old picture shows you even before we had the germ theory shows you professor Semmelweis and who discovered that the students coming from the anatomy lessons practicals actually had transmitted much more infection to women giving birth and the measure at that time when we didn't know anything about bacteria in the mid 19th century was that one said hand washing so you see the hand washing thing was actually what came up as a first thing in the measures not only in Switzerland these were the posters not from Semmelweis period but from this spring where we said do wash your hands this is so we were actually going back to experience from before but what I would like to think about more about choosing measures and what were considerations you see the basic the basic issue in measures is the question that they are feasible that you can bring it into a population acceptable and it's also proportional that it is actually relative to other risks and measures is it really making a is it justified to have one strict measure compared to the living situation the social tissue the economic tissue and of course it is important that there are joint efforts and that there are actually cross-border issues I mean you had this in very clearly also in Kenya I mean we cannot just sit in a country close up the country New Zealand did it New Zealand sitting on islands was actually just closing everything and then they got actually through very very well we in a country like Switzerland sit in the middle of Europe we have to see what France Germany Austria and Italy do then came the question of the lockdown the rock down the first lockdowns were done because we were overwhelmed and had to stop once to get a little bit quiet and to reflect and we also know that lockdowns severe lockdowns are okay to reflect but then to open again but if we repeat then actually it's a socially and economically fatal if you go up and down into into lockdowns and then you shut down economy you shut down social life to a large extent and then you come up again and this is very important for the period right now and for the festive period people think of the so-called circuit breaker circuit breakers are just short hard lockdowns of two to three weeks or four weeks and there the problem is that if you if you do a circuit breaker now before Christmas and then you open everything again you can still have the risk that you get into a new wave this is the so-called yo-yo effect that many people know from diets you actually do a diet you lose weight and if you don't do anything afterwards with your food behavior you are actually back to your old weight very soon again of course we have the outlooks for for the vaccination but if this major efforts are being completed it still takes time even if now like uk announced that they would start vaccinating this week or next week takes time then the last issue which you are scientists are interested is of course the herd immunity and some of the countries chose a strategy just to say let's have the transmission going on people get infected they are afterwards immune and and and things are fine the problem here in in covid are twofold one that the immunity to corona is not an immunity to measles where you are once infected once vaccinated and you are safe for life we know that the immunity to SARS-CoV-2 is a shorter lift maybe half a year and not everybody has a after exposure a very good immune response and we have the best immune response when you have been ill and and better even if you have been severely ill and actually then you get also a good amount of neutralizing antibodies and then you have the other point if you have solved the immunity side you must solve that that you must protect as a society we have the duty also to protect risk groups not the ones who are in old people's home but those who are actually risk groups that are having comorbidities but are still actually in our social and economic life so these are some of the issues in general about measures what we then need actually and that's something that's a learning from previous situations in in in disease control is that we actually of course went this is you can say the swiss cheese model here is our virus we have the different measures bringing together we know that each measure has some holes in it but if you bring measures together like distancing washing hands wearing masks and early testing of symptomatic people then you can actually protect your population so with this picture you should go back to my initial picture on the effectiveness and then you realize that each of this decay of efficacy of each of the of the measures follows this law and actually it's clear that you are a bit better off if you actually have a multi layered situation but still the question how you you prevent and that's important not just that you don't get the transmission through but that you are detecting very early transmission occurring and so the backbone of the swiss approach but also of some of our neighbors but less was actually a learning that we had from working with neglected emerging and re-emerging diseases that we actually have surveillance response some of you remember that in WHO when we were actually having the scientific advisory group to Tedros on malaria elimination which I had the privilege and pleasure to chair I mean one of the key messages was that we actually have to do surveillance response that means that you actually not collect data in monitoring and evaluation mode but you actually do surveillance and you collect data minimal essential data in space and time in order to find out where transmission occurs and then you can give a tailored intervention we have actually had a technical a technical addition which helped a lot this is the so-called swiss covid up for after the testing you do the tracing and those who are infected are isolated and the main contacts are in quarantine this actually this TTIQ this tick you can do traditionally but if you have an app this helps a lot this app and that's very interesting on this technology I mean initially people said we should just take an app from Singapore or from South Korea but this will not work in our country because of the data protection act where we should actually not create a central database and therefore the swiss covid app is totally free of having a central database the the internet protocol on your computer is destroyed after 14 days so it's really something that is just the help to be alerted when you have the contact with a positive person but it is not not a control issue as you could see you had in the in South Korea Singapore but also in Israel and so on so this there we lost time to develop it because we had to follow our our laws but what we remain with is really surveillance response detector let's see the picture below where a fire starts so that you can go there and act and this is possible if you have the decentralization you do this in the canton's in the districts in your situation and you actually have a public health response package tailored to the transmission setting if you have to have a a transmission starts in a party a parlor if transmission starts in a choir of a church if transmission is in an old people home your your action is different totally different and so this surveillance response is a key issue because as long as you can no longer do the tracing and go early then you run into a wave and that's what happened now is the second wave that our contract tracing system was weak processes were long and therefore we run into the wave that you know very well as many other countries but we have actually with this and compared to say for instance countries with very hard lockdowns where you could only leave your house for one hour for one kilometer as a situation this did not bring a better control of the of the pandemic and but it had a huge effect on the social tissue of the people the key issue in in surveillance response in this approach is communication it's the tailored communication and particularly because of what I said with this heterogeneity you can imagine and some of you remember when we had Ebola in 2014 Ebola was much easier to communicate because from the baby to the grandfather everybody who was infected had a risk of 50 to even 60 percent to die this is a much easier issue to get the community understand the severity and the and the community to engage in measures in SARS with the heterogeneity we we don't have it so therefore communication is key and it comes back to this issue that I've told you before it is really if you want to be effective the question of adequacy appropriateness and acceptance is very important or very important and it is what we learned even if you have very nice TTIQ processes of contact tracing with nice technology it's the processes that count that we are actually in time not only just transmitting by email but also doing the analyze and act quickly otherwise surveillance response does not work and then surveillance response is like this picture so we must through processes through sharing and well definition of roles and responsibilities in a given ethical and legal framework we must accelerate these processes we must not have another new technology another new technology that's how we can make surveillance response work there's something which comes up in all the countries now is really and this is just a an introductory slide to show what is basically necessary is really to look we have in Switzerland we did a stress study concerned about people long time in quarantine having lockdowns having homeschooling and home office together particularly in in poor settings where six people are in two bedroom apartments and have only two computers that is actually the issue where stress comes up and indeed about during lockdown and afterwards 50 to 40 percent had stress and it's only 26 percent 30 percent after lockdown that said no I'm fine I'm in top shape it's very interesting that those who didn't have stress during these times they all said I have it more relaxations I have less obligations and I can actually have less to do also for the schooling so I'm fine but more important for society is actually what those mention about stress I mean the burden through the workplace changes to child care changes for being alone for and worrying about the future the job worrying about that you are actually don't have so much freedom anymore that was very significant and this study is now being brought is continued because this is really the issue where science must contribute a lot on long-term effects the mental health as well as then the societal tissue to what extent actually the societal tissue is actually affected so I think this is something which when we talk about science and such a pandemic the lesson from this small slide here is not just to concentrate on epidemiology and infection control but also look at the not just to do social science but really do at the effects on well-being on the social tissue because it's the social tissue that carries the economic tissue and not the other way around and I think this is a key area where science still must contribute a lot and I mean talking to Ilri you have actually there the issue that you have always populations that are in a one health situation where one must optimally balance really the well-being of the society that is actually largely carried in the pastoralist groups by the well-being also of the of the animals and the productivity of the animals so this is an outlook where science still has a lot to do even if we have a vaccine these longer-term effects of this one year of a relatively dramatic situation that has touched the world has to be looked at because that will certainly determine on how we are actually interacting together not just traveling but actually how meaningful are some of the relations and how meaningful or not meaningful are just to to work in distance with zooms and so here I mean the outlook for vaccination is now good and you read also the the journals and I think just wanted to have summarized on one slide that this is all fine and but we know that we still have I mentioned it before on herd immunity that we have the natural immunity which is not as fantastic as in a case like like measles the positive thing is that we have nowadays thanks to the work that we did in Ebola thanks to the work that we did for instance in malaria we have new ways of doing clinical studies in rolling procedure overlapping phases this is actually what we have installed quite a lot through the work in in particularly Africa where we have actually learned how we can ethically correct develop tools quicker than standard procedures we have all these of candidates that's all very nice we should not be a bit careful about the intermediate results because they were only taken after a shorter period and we really need to see that full phase 3 results are there because that determines registration but also post-registration registration conditionalities also these preliminary results that are looking very well we have to see there is a immunity induced against infection and or disease or and very important how long does this go the good thing again is that we have this iterative process with regulatory agencies to go on and accelerate registration but on the other hand each country will have a huge challenge where also science can help is really to have the whole supply chain the supply chain management of such a major operation is not the easiest thing in the world how do you set priorities for risk groups and in this case health staff and their families and how is the communication again so this is a slide to show that we are on good track what we have to think about and that we have really to maintain not just to maintain the scientific standards but also the ethical standards because that determines acceptance in the in in in the in the communities so we here we have something to come we could actually discuss a lot about these many discussions which are really the ways of transmission and the roles of aerosols we have the issue of the children here as a key sentence is that children are not the drivers of the epidemic they can be infected they can transmit but they are not the drivers you have all the discussion on what does what does actually the PCR tests do and not do and also which rapid diagnostics tests are now being used even using saliva no longer the difficult nose throat swaps that you have to go through then the famous discussion on masks where the difference is very often not made between masks as a barrier versus mask wearing behavior most of the risk with masks is how you wear it and how you keep it clean it then it's the mask as such and the immune and the vaccines we discussed these may be questions that will come up afterwards but what we have learned in academics and also is the discussion with the the politician is actually what I want to come back is here the title we must be humble we must say that we are scientists we show what we know and what we don't know but we must also be pragmatic and this goes back to this scientist here you saw at the beginning who is looking and studying and here when when I see such a scientist and coming out of this crisis I would say remember my dear friends always the sentence that Sir Bradford Hill made in the time when Sir Bradford Hill was discovering the relationship between smoking and lung cancer initially people said oh you need more studies you need more studies you need more studies before you can say this is a real something that is connected and many of you have written in your thesis the sentence this problem warrants more research when I saw this with a student I said you can write this and I agree but if you don't know what the more research is if you are not able to formulate the research question you better should not write this sentence so what does this mean for public health and for the link with the politicians is actually what Bradford Hill said in this nice long sentence but it basically says the science does not know all at once but this does not mean that we are not doing anything in public health even if you don't know all and you have to do more studies you know enough to already do something and I think this is one of the key issues in the dialogue between the scientists and the politicians it's always to say what you know and what you don't know but also what is what you know and what you don't know already can be done for the benefit of the population for benefit of a country in order to move and this is not just a scientific issue that's also an ethical issue so I like very much this sentence because this has guided me through four decades of research throughout and I'm very happy that I had the privilege particularly also through collaboration and particularly through collaboration and partnership with Africa to learn these issues on how one actually generates scientific evidence and one can translate it into into public health action and you have certainly now seen that the road to success has no shortcuts this is this driver saw this as well and I would say what the what the thing is please don't give up let's be committed we are sitting in one boat as our colleague says don't give up and I thank you very very much thank you very much Max and for this beautiful and excellent talk there's a lot of take-home message from the talk you know going really from the deep science into the policy and also the reflection of the public health career applied for this particular pandemic at the moment so a very rich talk and you know I look at the time thank you very much for you and I feel and so now you are you know I hope that you are okay because I feel a little bit sense in the voice but you talk with people in Nairobi but also our colleague in different countries including Ethiopia Vietnam but even you know our colleague has been sitting in Switzerland for that so time is almost up but we during the you talk you know our colleague put a lot of questions and the question has been answered with the long of the talk so some of this thing was clarified but here I would like us to take one or two questions from the group and our colleague Eric Ferrer asked you I think that is quite two interesting questions and I read two and you can you know give some element answer if you like Mark said my question is about the role of science and policy making there has been a lot of confusion and disagreement in the science community on how to manage COVID-19 how should scientists have prepared politicians to respond so that is the first one but I link also to the second question maybe it's dear to you because of Switzerland the question is about shutting down the economy Europe is about to have a big fight over whether to open ski resorts in Switzerland or other country versus allowing that important sector of the economy to continue working so in Kenya for example there are arguments over opening bars and churches it is making people you know mark and politician and so nervous so how can science be convincing on this thank you Mark said thank you very much everybody thank you very much whom I mean I still have the time and I've seen these questions also in the chat I was reading that one now to this first question the great parent in declaration and so on I think the point is that the scientists should as I tried to say at the beginning always make scientific relevant statements based on the evidence they put together and I think this is the key issue as soon as you're making with a declaration basically a prescription you run into into a discussion that is not helpful because in a crisis situation it is important to work together and not to say I believe this I think this and I think this is something where away from covid I in my work in the academies I it's my biggest problem to in also other topic like gene technology in issues like biodiversity climate energy is really to find this interface between what do we know as scientists and what actually are options to act but not prescriptions to act and I think this is the that is the first part of the question I think that we remain there so I if a if a if a great barrington declaration is is written in a way where you take all the evidence together and you scrutinize this evidence be it meta-analysis and other procedures on how we do comparative analysis of what we know and we don't know then this is fine all these issues become difficult when scientists become leaders of a group of beliefs because then we are back to more touchy religious issues and you know mankind has not profited a lot from religious wars over a thousand years and more so this is the point now the skiing resort issue is a very good discussion it's not just because of skiing and Switzerland it's because a typical example of where a one must reconcile the issue you know skiing as such is not a problem you never get infected while skiing the problem is where actually when you are going in your cable car so when you are going in the evening when it's cold into a small hut in the mountains and so on that's where your transmission can occur so the scientist must only just state that's the scientific statement and it is to say what matters is distance what matters is hygiene what matters is contact if we need to go out of this situation that we are now we need to give in case numbers down we should see how we can avoid these these these multiple contacts also contacts across the different the different bubbles where people interact that's why we have restrictions that you can only meet 10 people out of two bubbles maybe two families and so on and i think this is something which is there the scientist should not say let this skiing resort in the eastern part open and in the central part not but actually really only say this is what we know as scientists what favors transmission so for the inside rooms it's also the aerosols the non-errated places of bars and discos and so on and actually this is what we state but we don't say close it now that is actually after the social-political discussion where also the economic considerations come in and Switzerland has now a policy for instance that we want to keep certain social life we are not like other neighboring countries where they say we make a hard lockdown we want to keep some economy and therefore also social life going and we keep the schools open in order to allow this but in these situations one must really respect these basic measures the problem is that everybody understands that and is basically happy but once they are in the situation and once the restaurants are open people are getting less careful this doesn't mean they don't respect but as you could see from my very the second the third slide on effectiveness if you are only doing things half two thirds it has already a huge impact on effectiveness and this is actually the biggest problem that's why my point also communication and not propaganda communication in order to keep compliance and adherence high and this is that's the key thing today at two o'clock our federal council will actually decide how they want to handle ski resorts and christmas and we were actually advising exactly in this way saying you can basically always find a concept that works but it is afterwards the big issue and that's also a scientific issue communication science how you can maintain high degrees of adherence and compliance very good it's just another point which comes in is the rapid uh test brief I mean the rapid test question of course these rapid tests and particularly the ones now on the saliva if well validated have an important point because they can it's not that they replace all the tests but it can be used for instance if somebody wants to travel or wants to visit also people in an old people's home you can do a rapid test because we know they have a very good specificity have a lower sensitivity but if you are positive in these rapid tests you are infectious so you can bring this into your control strategy in a very effective way and even with the vaccine we are not uh we are not then free and can forget about tests so if you see this rapid test now coming plus the vaccine coming we will have some more tools tools for an integrated control over okay thank you very much max and actually you are reading also the message and actually very nice that you brought this rapid test time so not up but you know max and maybe I take the ability because I have the microphone now to ask a short question and I want you to tell us only in one minute maybe you always talked about mutual learning for change among us in research partnership and now for this COVID context you see example of Vietnam where I come from and sometimes I'm proud of that we control COVID quite well with China so and you know that's kind of low you know in middle income countries and when you look at Europe and North America as a situation it's much more you know uh you know it's a very drastic increase on this thing so so what what is the short comment on the you know mutual learning for change within these two contexts how how we can learn from you and how some of this you know heavily hit by COVID-19 can learn a bit from from some countries they have you know they have a better control in the sense of number of cases number of death at the moment where I refer to Vietnam and China thank you thank you very much I think it is an important discussion and I think it's actually we looked a lot about the Southeast Asian situation and here as I tried to mention briefly with the with the app I mean it would have been an easy thing and we would have done better if we would have just taken the South Korean and Chinese app systems but this actually leads to a situation where we are not being capable to introduce that in the population the biggest hesitation is also Birgit Habermann asks similar questions the the the situation is that we are having we are people are suspicious to have a central database and to be controlled also Israel we did very well at the beginning and in Israel you they just had to switch over the contact tracing to the secret service system and they could actually have each smartphone in the whole of Israel and in the occupied territories look and this is something which was not accepted so the learning was that we needed such apps the learning was also that it could not be transferred immediately and we we had it to detach in the case of the swiss covid app it from a a gps-based link so that people could not be linked where they are and actually it had to be uh delinked from a central database and so it was a learning in in in a situation but it is also comes acceptance and feasibility in a given social political uh system and that's very important so the same thing is when Birgit in the same context asks about the ample system that the traffic light system i mean a traffic light system for a whole of a country is basically not possible with the heterogeneities we have because if you would do this then some parts of the country would say for us it's green it's not red and and if you want to to do this by by canton or by district it becomes very complex to have really real-time information and not creating also systems that the situation that we have we had in Geneva we had a lot of cases as a consequence people they they they close the bars and restaurants and everything what happens they went to the neighboring canton and they had there the big parties and so on and then as a consequence these cantons run into a much quicker second wave so having this ample system or this traffic light system is is is is is is a tricky issue and particularly if you are close together of course nobody if you close the bars in Kenya in Nairobi will then run to Mombasa for a party but i mean it's it's a different situation if you are are are very close so this this adaptation to the local setting is in these situations absolutely important thank you very much that is very nice comment and input from you Mark said time is up but i would like to say that it was really a big privilege to have you today with our in-risk staff and thank you very much for your contribution and sharing and i wish you all the best and we hope that you know we keep this contact going on and i take this opportunity to thank you you very much for the past support to our partnership in Riyan Suti Pesh thank you very much Mark said thank you all everybody thank you very much i will send whom the slides and the geek and then distributed to all this is our open and free for everybody and and without any doubt i mean we will continue our partnership and i still remember the time when i was at Ilri when it was still Ilrat and i i i now see where you are and i i followed your your part from actually 1976 onwards when i was working with Hiromi on the cultivation of the cultivation of the bloodstream forms of tripanosomes that was actually part of my PhD thesis in 1977 so i mean i i'm very much linked to all of you and i admire the work you do and uh we Bila Shaka we tuna in the lay up a mocha a Sunday nissana thank you very much