 So yeah, thank you. As Selina said, I'm going to be presenting on essentially a large part of my detail and my detailed work, but I'm really honing in on the current area of research, which, as Selina's outlined, is the results of a recent survey and workshop aiming to capture the highest priorities for Banca vigilance in low and middle income countries during the COVID pandemic. Some of you may have seen this survey when it was shared and the workshop and maybe even participated, but before I move on to that, I want to start with a quick outline. So I'm going to begin with the background to the wider project and my thesis and the overall project itself, including a discussion of the rationale and methods. I'll then move on to a discussion of the survey design and the results, then a similar thing for the workshop that I've mentioned, a quick discussion of the conclusions so far and then the next steps and the Q&A afterwards. So very briefly before I start, I'm not going to spend too long on the definitions and the backgrounds of Banca vigilance, but Banca vigilance is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects of any medicine related problem. That's a definition from the WHO. Essentially, the fundamental aim of the science is to limit harm to patients and promote the safe and effective use of medicines. And so with that in mind, the wider projects that this current research is embedded in seeks to understand if a community of practice approach can improve Banca vigilance capacity in low resource settings. And so I've given a brief description of Banca vigilance and its remits and I appreciate this is quite a text heavy slide to start with so I apologize for that, but I do think it gives a good outline of the overall rationale of the project. But essentially, undertaking effective drug safety monitoring can be particularly challenging in low resource settings due to a lack of infrastructure, weak regulatory systems and limited access to training and education opportunities. This project looks to harness the membership of an online Banca vigilance hub, globalfarmcovisions.org and explore its potential to work together in a community of practice on specific challenges facing farmcovisions in low resource settings. Now, this online Farmcovisions hub, Global Farmcovisions exists as a member hub of the Global Health Network. It has over 6,000 members currently around the globe, I think close to 6,500 now. And its position on the Global Health Network also means that we can encourage interaction and knowledge sharing and resource sharing with researchers, healthcare professionals, engagement of wide range of activities in other areas and other research areas based on the Global Health Network. I've mentioned the term community practice quite a few times, so I thought it would be a good idea to define exactly what that is. We can define it as a group of people who share a concern, a set of problems or a passion about a topic and who deepen their knowledge and expertise in this area by interacting on an ongoing basis. And this is a concept that was coined and explored in detail in the early 90s by social anthropologists Jean Leib and Etienne Banger. And their postulation was that education knowledge generation should not just take place in the classroom environment and that learning is an inherently social process, social interaction and personal relationships are key to knowledge sharing and personal development. And so Etienne Banger's later expansion on community of practice theory identified three elements of community of practice and that formed their structures. These are the domain, the community and practice. Now domain here is the subject of focus for the community, the theme that unites the community in a common gong. The community is the individuals who come together to learn and make up the body of the community of practice as it were and address a common challenge. And practice which is perhaps the hardest to define in this incident is a set of shared approaches or common approaches to a certain domain or a certain task. The best way to perhaps conceptualize that at the moment is to think of the idea of good manufacturing practice or good clinical practice, sets of defined ideas and methods to address common areas. I've just skipped ahead a little bit there but you notice that we have as I've mentioned an existing community in the members of this global farm division as well. As I mentioned it was launched in 2016 and since then we've amassed over 6,000 members worldwide it's actually close to 6,500 now and we also have a high usage in LMICs which includes mainly India, South Africa, Egypt and the Philippines. And so our domain as mentioned in the overall project is farm co-vigilance in low resource settings. We have our community which is made up of the global farm co-vigilance members and we have in general a practice which are the farm co-vigilance standards and practices that guide how safety reporting is done. So with this potential community of practice in mind this project as I've identified looks to understand exactly what the current priorities are for medicine safety in low resource settings during the pandemic. So I'll explain each of these aspects in detail shortly but we have the first step of a knowledge synthesis phase. This included both a traditional literature search and a scoping review to identify areas of concern from the literature and from various workshops and discussion with farm co-vigilance experts. We then wanted to run a survey of the farm co-vigilance membership of our community to identify what their thoughts on the current priorities for farm co-vigilance are from what we've identified in the knowledge synthesis phase. The next step was to run an online workshop where the themes identified in the survey were discussed in greater detail. And finally the next step is a plan to form working groups to identify these top priorities that were identified in both the survey and the workshop. I should say here that this project follows a methodology of participatory action research in that each of these steps here will undergo a process of research action and then reflection which will inform the next step. So you see that our knowledge synthesis step informs our survey, the outcomes of our survey inform the design and dissemination of our workshop and the results of our workshop inform what we do with the working groups and I'll explain that in a little more detail shortly. So starting with the survey, the aims of the recent survey were primarily to identify and prioritise farm co-vigilance knowledge gaps in the LMICs with specific relation to the COVID-19 pandemic. We also sought to gather demographic data to better understand the population that makes up this farm co-vigilance community of practice and perhaps the more tertiary aims were to assess attitudes towards farm co-vigilance within that community and also to gather data on the usage and user experience of the farm co-vigilance hub. As I've mentioned from the knowledge synthesis from our literature review and a scoping review we identified 43 farm co-vigilance themes, topics within medicine safety that were being highlighted as current areas were improved and these were grouped into five overarching themes within the survey. Again I'll elaborate a little bit more on those later but essentially during the survey our members were asked do they need to know more about the specific areas within farm co-vigilance? You can see this was an area that was specific to general vaccine farm co-vigilance and it perhaps included some of the more introductory and base elements of farm co-vigilance including terminology how to recognise adverse events and then I'll explain the other themes in detail shortly. The survey was distributed in September 2021, it was live for five weeks and was put live on the farm co-vigilance hub on social media and also was distributed by the farm co-vigilance, the global farm co-vigilance email lists and imitation emails as well. So in terms of demographics the survey received 155 responses from 54 countries, you can see this on this Atlas chart here. Of those 54 countries 38 were low middle-income countries around 70% but the key figure is that of the overall respondents which was 155, 85% were based in low middle-income countries. Of those based in high-income countries they were asked to identify their interest in farm co-vigilance in LMICs and this interest ranged from active work or previous work supporting farm co-vigilance activities in LMICs or that person's interest in the subject. What you can see from here is the majority of our respondents to the survey were based in either India or Kenya but we also have good responses from the rest of West, South and East Africa, Latin America, Southeast Asia as well and I think it demonstrates a good distribution of responses from the global south including but in addition to Europe and Oshiana. A wide range of roles was represented within the community, pharmacists being the most prevalent role but also large representation of the epidemic community, healthcare professionals in general so doctors, nurses, we have dentists and then perhaps more specialized farm co-vigilance roles like pharmacovision scientists and qualified people for farm co-vigilance. We're well aware that many people who work in medicine safety wear many hats and have different roles and so almost half 45% of respondents indicated they hold more than one role. A wide range of institutions was also represented again the academic sector you can see University College there was very widely represented but also the hospital sector if you combine both the public and the private sector was well represented as well. So in terms of the current priorities, as I mentioned earlier 43 topics were listed in the survey and these were grouped in five different themes. What I'm going to present here is a top 10 of these 43 topics that were prioritized by our community in the survey. So to simplify things these topics were grouped by theme as I mentioned the one we saw earlier was general vaccine pharmacovigilance but we also had a theme relating to COVID-19 vaccine pharmacovigilance. Vaccine pharmacovigilance according to patient group, pharmacovigilance of medicines used to manage COVID-19 and pharmacovision systems and communication during the pandemic. As I said we'll be presenting a top 10 of these themes of the overall priorities but you can group these by theme. These the size of these fears is representative of the frequency of these themes in our top 10 priorities. So you can see that the third theme topics that were grouped according to COVID vaccine patient group were very much represented in the top 10 list of priorities. We also saw equal representation of the pharmacovigilance of COVID-19 medicines, systems and communication and COVID-19 vaccine PV in the top 10. We didn't see any of the more general vaccine pharmacovigilance topics ranked particularly highly in our areas of prioritization at the moment. But breaking this down further into the the actual topics this diagram shows our top 10 list of pharmacovigilance priorities. They're listed on the left hand side going from our highest ranked priority to the lowest and what you can see on the blue bars on the left is the level of agreement that respondents indicated that they need to know more about that particular area. So the further to the left that the entirety of the blue shape goes that indicates a level of agreement. The lighter blue bling somewhat agree, darker blue being strongly agree. So you can see for our top priority that was the safety of COVID-19 medicines and special patient groups. Almost 95% of the respondents indicated that they need to know more about that topic and there's quite a high and close level of agreement in this top 10. It ranges between about 92% to 95% agreement that respondents need to know more about these areas. Now I appreciate in this list format it's not perhaps the most straightforward list to classify and to understand. So we can break that back down into our themes that I showed earlier here classified by color and this makes a little bit more sense of this diagram. You can see that in the top 10 themes topics from the theme of vaccine safety according to patient group feature very highly in the top 10 so we have four instances of them occurring and then equal instances of the other smallness as well. But breaking those priorities down when we look at vaccine safety according to patient group we can see that there's quite a range of groups that are identified. So we have the safety of COVID-19 vaccination in children and adolescents, the safety of COVID-19 vaccination in people who are immunosuppressed, the safety of COVID-19 vaccination in people with existing co-morbidities and the safety of COVID-19 vaccination in pregnancy. So staying on this theme of grouping safety by patient group if we also look at our theme of pharmacovision according to COVID-19 medicines we also see in that category that one of the most highest ranked topics was the safety of COVID-19 medicines in special patient groups. What we can also see across the board is an interest in drug-drug and vaccine-drug interactions. So both an interest in the interactions of COVID-19 medicines and the interactions of the vaccines ranked very highly in our overall 43 themes. We also see concerns relating to how to communicate COVID-19 vaccine safety information, safety data analysis, and a desire to understand more about ongoing global COVID-19 pharmacovigilance work and the global pharmacovigilance landscape. In addition to gathering all of this quantitative data by means of a liquid scale we also ask for feedback for people to expand on their responses and with free text questions and to give give us some qualitative data. There was an enormous amount of qualitative data generated I'm not going to go through it all but I thought it'd be useful just to identify from our most common theme that is COVID-19 vaccine pharmacovigilance according to patient group some of the areas that people wanted to expand on in the survey. And so for example when we look at one of the themes which was COVID-19 vaccine safety it's people with comorbidities we see that chronic illness and disability was an area that people had a real interest in especially in those with cancer, endocrine diseases, and autoimmune diseases were of great interest as well. We also see people expanding on items in the survey for example in children and adolescents people wanted to understand about research on vaccinating neonates and in relation to pregnancy as well there was an interest in understanding safety of vaccination in women planning pregnancy and there are a great amount of overlaps in the topics and themes that are sort of encompassed by these areas it's all quite a broad description at the moment of various pharmacovigilance themes and so what we wanted to do is narrow that down and really understand where the consensus lies as to exactly what it is that these topic areas that people want to know more about. And so for that reason we decided to host a online open workshop. As I mentioned part of the reason we wanted to do this is because we identified a very broad range of priorities we wanted to understand exactly what it was about these areas that people wanted to know more about. I've also identified that in our top 10 there was a very close grouping of levels of agreement so we wanted to perhaps allow a more robust examination of exactly which of these people were ranking the highest but perhaps more importantly we wanted to understand how these top 10 priorities related to our community's individual settings. Have they experienced any have they come up against any problems with these priorities themselves? Have they experienced it in their practice? Have they done any research in this area? And how it affected them? And so we held this online workshop last Thursday again some of the people on this forum may have attended thank you very much if you did. It had the format of two presentations one which was to give a background into global pharmacovigilance and the global health network but also we presented the results of this recent survey that we've discussed so far in this in this webinar and the priorities identified. We then had an hour long open discussion to encourage the attendees to elaborate on whether they thought these priorities were relevant to their setting, whether they were now greater priorities as the survey itself was run four months ago and to talk more generally about their experience with these areas and then finally we ran a poll in the workshop to list these top 10 priorities and ask people to identify from the top 10 if they were to pick a top three what would they say the highest priorities for pharmacovigilance in their setting is right now. This workshop was very briefly chaired by a group from the International Society of Pharmacovigilance. The International Society of Pharmacovigilance has regional chapters and we were very fortunate to have the workshop chaired by the ISOP Africa chapter who facilitated the running of the workshop and the discussion as well. As I mentioned we ran a workshop poll which sought to identify the three highest priorities from 10 identified in the survey the 10 identified in the survey are listed here in no particular order. As I said we looked to assess the relevance of the priorities to attend the setting and there was also a shift in the survey we saw primarily to identify whether knowledge gaps lay but now we look to really consolidate exactly what priorities for support and training and guidance were and to sort of validate that knowledge gap approach to identifying priorities. Now we have some technical glitches at the end of the workshop in relation to the poll and identifying our priorities so we have run a post workshop poll to a survey sorry to gather data from those that weren't able to identify or weren't able to see the poll in the workshop. So what I'm not going to present now is our top three priorities. What I will just quickly demonstrate is some demographic data we had 257 attendees 61 countries represented and of those attendees and almost 80% were based in LMICs. Again this shows a good I think geographic spread of attendees and good representation from the local cell. Just a quick comparison with the survey response as you can see that we do get a lot of interaction with this community from Kenya and southern and east Africa and also India and South America as well. So conclusion so far global farm conventions membership is a diverse global community representing a broad range of farm provisions stakeholders with a large membership base in LMICs and this I think is demonstrated from our demographic data. In terms of the priorities for farm provisions at the moment they are as I've mentioned to be determined and I'd say watch this space the our survey and following the workshop is due to close on Friday and we'll have a far greater idea then of exactly how these priorities are going to be ranked. What we can say is that there is a need for greater information and guidance on the safety of COVID-19 vaccine therapies it's in different clinical groups in LMICs. We can also make very similar conclusions in relation to drug-drug and vaccine-drug interactions and again further research is needed on the needs to improve communication and safety data analysis and also an awareness of the global PV landscape too. As I've alluded to the next steps of this work will be to form working groups to address the priorities identified from our survey that would then carry forward into the working groups and that will be identified from this working group poll when that closes. The groups will be formed to address the highest priorities identified and all participants of the workshop and all members of global farm provisions our farm provisions community of practice will be invited to join the working groups. Members of the working groups will be invited to work together to address the highest rank priorities with the support of the global health network and using the global farm provisions platform as a space for communication, learning and dissemination of outcomes. These are my references I appreciate that was a very quick run-through of quite a large and complex project but thank you very much.