 Thank you for a very entertaining last session, both the panel and very good work with many different methodologies and really representing some impressive research that is still ongoing in many areas and as many questions have been raised as yet have been answered. Before I come to some closing remarks, I do have some announcements to give. And one of the things, and I'm hoping a poster is going to magically appear, I wanted to announce the poster prize winner. This is the first time we've done this and trying to build a meritocracy for those who've done the posters, we had online and in audience voting and so congratulations to Sylvia Mancini's group looking at missed immunisation opportunities in Niger and South Sudan and in short, lots of missed opportunities, lots of gaps between implementation and the policy and efforts with the evaluation to improve that didn't lead to much improvements, there's still much to learn and more research to follow and action needed. So Sylvia, or someone from your group, if you want to come up and collect your prize, if not we'll try and post it out to you. One of you, I mean I'm surprised, thanks to Isabella and Katrina and the rest of our group and thanks a lot. They will actually get a small prize that's been sponsored by one of our sponsors F1000 which goes not towards drinks but actually towards further research so research breeds research it seems. But congratulations and to all the people who've participated today, I particularly want to thank all our speakers, our chairs, our keynote speaker Jeremy Farrah, all of the delegates both here in the auditorium and also online. We've been doing this mammoth event two days yesterday innovation, technology new models today on research but also going a little bit into conference without borders because lo and behold there's very little that we do really here in the UK. Our theatre of operation is out in the world and so it's nice to actually have had a concurrent session in India at the same time. So also thanks to the Royal Society of Medicine especially the digital and logistics team who've made things work, all of the organisers here in London and India there's a massive amount of people and they've done a fantastic job and they've made my life very easy and it's not an easy thing to make me look good I can tell you. Thank you to the editorial reviewing team which is listed in your booklets but people from across all the disparate parts of MSF and external people as well helping us try to put together a very challenging agenda. You have no idea researchers in MSF how hard you make our life trying to pick between you and what's a talk and what's a poster. We'd like to say it's a meritocracy. The research is definitely getting better but sometimes it's a little subjective what gets a talk and a poster and keep pushing us we encourage you to continue to lift the level of our research so that we can do better with our activities in the field. A big thank you to our sponsors the London School of Hygiene and Tropical Medicine the Royal Society of Tropical Medicine and Hygiene, Biomed Central and with their journal Conflict and Health they've got a call for papers for non-communicable diseases we heard a lot about that yesterday and the challenges especially from the the war in Syria where there was one quote where probably the populations who've been affected by that war have had more deaths from non-communicable diseases than they have necessarily from from violence. Also thank you to Plos Medicine, Lancet Global Health, F1000 and the Wellcome Trust, the Wellcome Trust we heard from Jeremy Farrah, Wellcome Trust, Difford, Elra they have a call out in the next few weeks for applications for operational research to the R2HC fund. Please look at the guidelines. If you put in good research then this isn't I have it on good authority that it will encourage more funding from the donors to be put into this area so please pay attention to that. We will have a drink in the atrium afterwards and then for those who are really keen there's the dinner and an after-party and for those who are really really keen there's an after-party where there may be karaoke. Please hand in your evaluation forms to one of the volunteers or reception. For those who need continuing professional development accreditation please go to reception to get your necessary sign off and please hand in your badges at reception. So I really need to try and wrap up two days in two places with fantastic presentations and that's really no small ask because the quality of the work that MSF does and the quality of the research that we managed to pull off is something that just humbles me year after year and I need to do it succinctly which is also not one of my talents. So maybe I can leave you with just three thoughts. I want to talk briefly about gaps I want to talk about questions and I want to talk about impact. Gaps we've heard from very diverse programs from many different countries and wherever MSF is working we see gaps between evidence and policy. We see gaps between policy and practice and we see gaps between the practice and actually back to what should be producing evidence. So we heard this morning both in the India Day around the problems of adolescents attending an HIV clinic in Burma and they were attending really well but their virological outcomes were actually much worse than adults. So it's not just people attending for care it's not just access to care it's what you do in terms of how you interact with patients and how you provide the care. We also heard similarly from a systematic review but also the challenges of dealing with kids who are failing on art and if you put those two together those two presentations were telling us well the policy tells us we should be starting kids on treatment with kids who have HIV earlier but we also should be thinking about how we can adapt to having our care being focused on the patients who really need the care. So there was some lessons around how we need to think about just simply organising to have more time with patients. There was a fantastic disclosure of someone's age but we were reminded in the morning that disclosure of HIV is still a big problem and even disclosure in families can affect other family members or lack of disclosure as such. Many gaps and I'm not going to go through all the presentations that we're trying to deal with those kind of gaps but I wanted to think about questions for a moment because fundamentally you know when you're taught about research you're taught you know you're always asked when you're learning what's your research question you know if you tell me your question then then we'll be able to work out your methodology. Get your question right and it seems to me that actually one of MSF's talents is continuing to question. Maybe it's not our talent to be the best researchers but at least we're bringing up the questions and I'm struck by three types of questions. For me there's the questions of compassion, the pragmatic questions and the questions of outrage. And what do I mean by that? I mean the questions of compassion is looking at a program treating drug resistant TB and just saying you know 20 months with eight months of injections is just with lots of side effects we just can't put up with that. We need to try something else. We need to do some research into what can improve outcomes with a pretty crappy treatment. Pragmatic questions and we heard a lot of those yesterday in the Innovation Day and the new models. We had things ranging from why do boreholes stop working and if you put a camera down can you diagnose problems with boreholes that lets you fix them and save money and means that we get clean water and prevent diseases. We also had people just pragmatically saying you know what it's really hard in an Ebola suit to collect data. How can we find ways of making the clinicians life easier so they spend more time with the patients? And we had different solutions emerging in different parts of MSF and that was nice to see that people sprung into action to try and come up with practical solutions. Neither of them perfect but a lot to learn from there. But then questions of outrage. Sometimes we're struck by the situation in Syria and the overwhelming violence that has affected so many lives and really the lack of access to health care for many, many people. And on this day we have 50 million people displaced from violence around the world and that figure is not unfortunately decreasing. And yet if we look at the problems that many of those populations face, especially in countries like Ukraine, like also in the Middle East, we're faced with problems of non-communicable diseases and how we do better. And I was struck by two things. Yesterday a great presentation looking at the simple question of does insulin cannot be delivered without cold chain and actually showing that insulin, many different formulations, actually four weeks storage in a normal field conditions will actually be okay and you can still use it. That's an amazing revolution, great work from a group in Geneva. But also just people pragmatically saying we don't have an answer around whether MSF should be doing non-communicable diseases. We don't have an answer on the best way of doing it but just getting in there and acting. And at the same time building in some simple evaluations and learning within those programs. And I think the key is don't wait until you have the answers but get in there and act. We were reminded by Jeremy and his keynote speech and also in a lot of the talks yesterday about silos, the danger of silos. We've become these big organizations, big communities that aren't talking across silos. So we need more discussions between researchers and field operations. But also even within MSF we need more discussions between the multidisciplinary teams to try and do better. We need more openness and sharing of data is one of the things that we heard about. But not just sharing of data but how do we actually share some of the benefits. So one of the things when I hear about biobanks that goes through my mind is I'm wondering what would Henrietta Lacks and her family think about all these biobanks for Ebola. And that's just a side ways reference to the fact of have we really thought through all of those ethical issues and have we involved the populations within the countries that we've been trying to serve in those discussions. Who represents those communities is it just their political leaders. And that's a massive challenge and I'll just leave it hanging. We heard a comment around we cannot think that surveillance on its own without the ability to act is enough. So if Amon's great quote as well that you know if we'd had if we'd had the better surveillance we would have just failed a month earlier to prevent the outbreak. So really it's not just enough to have surveillance. It's not one magic bullet that's going to solve our outbreak response. There is a lot of work ahead of us. Otherwise we really are going to look back at this time of massive missed opportunities and why didn't we learn the lessons that we said we were learning. Because this there is a big danger that this will happen again as we all sit around in these lovely lovely conferences learning lessons. I think we really need to think about how we act how we act faster how the epidemic of research that comes after the outbreak could actually happen sooner and not to have an epidemic of research but to ensure that the research is answering the key research questions. There may be a hundred research questions on Ebola. What are the two or the three that are really going to make the biggest difference for the response to the next outbreak. I don't have the answers to that but we should be debating that now. So the last two days if I can sum up a lot of innovation a lot of research but innovation and research if it doesn't go on and lead to action and impact is basically a waste of our time. We really need to take what we've learned here. Maybe it's only the question for the next change in our program. Maybe it's a piece of evidence. We need to continue those discussions and we need to provoke change. We need to look at how our outbreak response can be more of a meritocracy and that the skills of management and the skills of the multidisciplinary team needed actually can be made to function. Not just within organizations but across organizations and that is a massive challenge. So in short I'm just simply asking for better and faster action really and a little bit more research. Not much to ask for. Please carry on the discussions. Please put your hands together and thank you for two fantastic days. The quick update just so you know who's been watching us online 115 countries and we've had I'm told over four thousand four hundred unique views over the two days. People are interested in what we're talking about. Keep the discussions going. Thank you very much.