 So ladies and gentlemen, let's start right away and this second session on health is Entitled global governance and public health And let me just say as an introduction that issues of governance of health and governance for health have become particularly prominent on the international agenda with the COVID pandemic and not least of course because of the increasing geopolitical dimension of global health New challenges have emerged around the vaccine nationalism vaccine and mask diplomacy access to supply chains and intellectual property waivers and as the pandemic progressed health moved from being a sort of soft power agenda to becoming a critical Economic and security issue and took up large parts of the deliberations of regional summits Like the European Council the G20 the G7 the World Trade Organization Organization No meeting of G7 G20 or European Council in the last two years wasn't Including or having as a dominant component the issue of health the independent panel on Pandemic preparedness and response of which both Anders Nordstrom and myself were were part In our report in May 2021 We had come up with a number of recommendations and within in those recommendations one was about governance and Suggesting that in order to for the world to be better prepared for the future. We need to elevate the level of leadership to prepare in response to global health threats and one of the suggestions that the panel Put forward was the establishment of what we call a global health threats Council if you wish some sort like a security council for for health threats Something similar to what had been negotiated on in the nuclear field after the Chernobyl Catastrophe to ensure accountable and Multisectoral action in the future. We also discussed the to strengthen and WHO in its independence and capacity to React to to an emergency several of the recommendations of this panel were overlapping with recommendations from other groups such as the G20 high-level group on Pandemic Finance and the so-called Monty Commission in in Europe so where are we today with these discussions and Negotiations well first Negotiations have now started in Geneva at multilateral level on Revising the so-called international health care health regulations and on a new pandemic a new binding pandemic treaty Following a resolution of the World Health Assembly in November last year Second the US together with a number of other countries and the World Bank Have called on the establishment and have actually launched a new pandemic financing facility On the way for which there are pros and cons maybe we'll discuss that later and third The General Assembly of the UN has called on a special session of the UN General Assembly on Pandemic preparedness and response which will be held in 2023 and if you remember it was the first special session high-level session of the UN General Assembly in 2001 on HIV AIDS that really was the turning point mobilizing the world against the AIDS pandemic and also a special session of the UN General Assembly on Ebola in 2014 that brought the issue at the highest level of Public and political awareness, so we're looking forward to very much to the ongoing Negotiations now already of a political resolution at that special session of the UN but also as we Work now at global level And most importantly, I believe structural institutional and political changes are occurring at regional level and As we heard from Juliette during the the pandemic the African Union behind United somehow behind President Ramaphosa and Continental plan to to procure vaccines and pandemic goods We saw the emergence of a remarkable African CDC that took leadership at both continental and and global levels and the EU created an African Regulatory agency for medicines on the model of the FDA or the EMA, so let us now discuss These issues at global and regional level and we have a great panel today with Anders Nordstrom ambassador for global health from Sweden Who may also maybe say a word about the forthcoming Swedish presidency of the of the Union Dr. Aruka Sakamoto Senior fellow at the National Graduate Institute for Policy Studies in Tokyo who is online Good morning, Aruka, and thank you for being again with us Dr. Farida Alhosani, who is the spokesperson on health from UAE Lionel Zinsu co-chair of Southbridge chair of Teranova and former prime minister of Benin and finally Jacques Biot former president of Ecole Polytechnique in France Whom I have asked somehow to provide a perspective from I call him an informed Outsider at the at the end of our discussion. So let's start right away and maybe with you Anders. Thank you Oh, thank you. I'm delighted to be here today Let me just look back somebody was asking whether we are better prepared today Then what we were in the past in 2006. I was the acting director general then for the World Health Organization I was at the g8 meeting in St. Petersburg No one knew of course who I was but president Bush took me to the Chinese president During the coffee break and told him you better tell this man the health man if you have an outbreak of a disease This was in 2006 Are we more prepared better prepared today the panel the previous panel came up with a one-year report called Transforming or tinkering and the answering was that the world is still tinkering. I Would like to say a few words about the lessons what we have learned in terms of governance in different dimensions global governance regional governance governance across Sectors and across both private and public partners Then a few words as Michelle said about the Regalization and what that means in terms of what we still need to do at the global level and then finally a few words as again Michelle was indicating what is happening right now in terms of global processes and how can we Collectively make sure that those are successful and more successful than in the past So if we look back at the lessons to start with again as Michelle and the previous panel was saying the world was warned And the way that we had to measure whether the world was prepared did not work if we look at the graph Countries with the highest scores did the worst had the highest numbers of deaths So the way that the world had listened to previous reports suggestions We reviewed 16 previous commissions and panels and the recommendations had been made but the world had not taken action First lesson this time we need to take action Second was and again as was indicated here before that the international alarm system the surveillance system did not work effectively enough China reported 48 hours after the when they should have reported according to the international regulation It should be done in 24 hours so 48 instead of 24 But that was not the big problem The big problem was then three weeks later when WS shows director general had the advice for the committee to come in and to advise They did not agree took another week before the director general said here We have a public health emergence of international concern 30s of January But now we have the big problem the world did not understand what that meant So the international alarm system did not work 30s of January then we lost another six weeks Before he used the word pandemic on the 10th of May 10th of March then the world reacts and at that time We had lost basically and most importantly the whole month of February So the international system is not about just alarming and empowering double-edged to do that But it's a way that the international we basically understand what that alarm system means Third we did 28 country studies looking at some of the best countries and some of the worst countries And I'm not going to go into this. This is published in international literature But this is about governance And if we look that some of the best performing countries bespoke about four C's and that had to do with good governance at the national level In between different ministries, but also working across private and public working with communities I would say South Korea was possibly one of the best examples of having an early aggressive containment strategy and then you had governments where we Classified them as the four D's that they evaluated created distrust among people And I don't think I need to name the countries that did the worst that basically devaluated the whole The whole challenge the fourth lessons was again what has been discussed here That was about diagnostics and vaccines and the genetic sequence was chaired and on the 10th of January rep It's never been done so quickly before it was published in an international journey And we have not have a vaccine being developed so quickly, but not just one but a number of vaccines So that was a big success so a lot of lessons But the big failure was of course the access to the vaccines and not just from an equity perspective But from an effective public health perspective Did we use the vaccines and diagnostic in the most effective way to stop the pandemic as quickly as possible? The simple answer is no next time we need to do better not just get the vaccines the volumes But using them in a more effective way to be able to stop the pandemic quicker. So those are some of the lessons Second dimension to this is also what has happened here is that we have a much stronger regionalization I would say politically generally but also of help When I was the head of the double a show country office during the able-out break in Sierra Leone The African CDC did not exist when I left in 2017 today. It's a power The African Union what we have seen happening here during just the last years is a totally different situation As Michelle said from the European side the European Commission presented now a new strategy for global health I was there in Brussels and when Sweden takes on the presidency for the European Union With the European Council next year. We will also ensure that there is political support For a new strategy a new direction for global health But with stronger regions and it's not just in African Europe is also here in the Middle East is in Asia What does it mean in terms of global actions global responsibilities because that agenda needs to change? I don't think we need a global platform for vaccines in the future Well, we need stronger regional platforms, but we still need global cooperation sharing information data But also ways of working the management to flow of then access to products So we need to rethink the global functions based on that we have stronger regions today Are we ready? No, we are not ready as I said and Michelle you were saying that they are two major sort of processes happening now One sets of processes in Geneva a new treaty and in New York a potential then political agreement Both of those are extremely difficult and cumbersome. It's going too slow the political environment right now It's not the best we need all support from you From people across the world from both private and public saying that we need Certain political decisions. We need certain rules. We need to empower the HHO to share information quickly We need ways of engaging across private and public to be able to have access to resources and tools more rapidly in the future so we need both the rules that are basically negotiated in Geneva and We need also the political commitment that is our hope that we will have from this meeting in New York Two critical things to this those agendas one is about this platform to access to what we call the medical countermeasures The vaccines the diagnostics, etc. And then the financing of that and the second one is then the suggestion from the panel of also establishing some sort of platform with senior leaders From both potentially both private and public to be able to be the sounding board to problem solve if something like this is happening So we don't have the very bad situation where we had at the beginning of the pandemic when the US and China couldn't agree on Anything basically so the need for a platform where we can work across regions and sectors Let me finish that just by just to say that this pandemic is Still not just about the virus. It's not only about getting the vaccines this pandemic as again Michelle was saying initially has been about Economies it's been people losing their jobs. It's been about children not having access to school And we have not seen the impact of this jet So for the future we need to think about that we have Countries systems commitments at all levels national regional globally That is not only focusing making sure we get the vaccines But that we have national system international system that can also deal with those broader challenges Because that is what we've seen and I can't help saying then something at the end that might be a bit surprising because somebody was mentioning nutrition One of the critical factors whether you were successful or whether you had a number of you lost a number of lives was actually The rate of obesity's if you look at the US the most important factor whether you were at high risk was obesity So if you speak now about climate and what we need to do in terms of changing our food system It's about climate which is also about health and the biggest epidemic we have in the world today is actually obesity's and That is all in some way should trigger thinking that this is more than just a virus. Thank you Thank you, excellent so let's Thank you Anders for setting the scene And maybe I'll first turn to you, you know Because Africa has obviously come as one of the regions that despite its diversity and Really came together in an amazing way in response to the pandemic and could you elaborate on that and share a few thoughts on Whether global governance will be regional governance still has to be global in the future and Could be about health, but why not about all other issues that we deal with here at the WPC Merci monsieur le Président, vous m'autorisez à parler en français, mais bien sûr Merci alors en fait vous m'avez demandé de me dédoubler et de ne pas être que moi-même dans ce panel et vous avez tout à fait raison parce que un de mes collègues qui était très attaché à être présent aujourd'hui Michel Sidibé ancien ministre de la santé de la République du Mali mais surtout très marquant responsable patron Donucida Ne pouvait pas être là physiquement mais voulait être là Intellectuellement et donc il m'a demandé de partager quelques messages qui vont tout à fait dans le même sens que ce que notre excellent collègue vient de dire l'Union africaine a été complètement différente en 2020-2021 de ce qu'on pouvait penser et de ce qu'elle avait été au paravant et est un exemple assez remarquable d'une réponse rapide et assez prometteuse alors Michel Sidibé me demande de vous dire que la situation est très préoccupante au sens où nous ne sommes absolument pas prêts pour les évolutions et en même temps assez prometteuse au sens où il y a eu beaucoup d'innovation notamment de gouvernance dans la période actuelle qui vient de prévaloir pendant trois ans il me demande d'attirer votre attention sur un certain nombre de chiffres symboliques mais mais quand même assez éclairant l'Afrique n'est rien en matière de production de distribution d'administration de capacité d'accès au médicament au traitement et aux équipements je fais quand même beaucoup c'est-à-dire que même si la l'utilisation des vaccins en afrique est devenue importante 1% de ces vaccins sont produits par l'Afrique elle-même même si il y a un développement important récent des traitements et de la consommation du médicament 95% des consommations de médicaments sont importés sur le continent africain c'est évidemment un record en revanche là où il y a des sujets proches du crime organisé d'après l'OMS 40% des volumes de faux médicaments dans le monde concernent le continent africain et on a clairement donc un système de santé publique mais qui n'est pas simplement l'administration des soins qui est la prévention qui est la répartition pharmaceutique l'accès au médicament qui est l'équipement qui est et reste profondément défaillant c'est une idée le marché pharmaceutique mondial dans les chiffres de Michel est de l'ordre de 1,4 trillion de dollars 1400 milliards de dollars le marché médicament d'industrie pharmaceutique en Afrique est un peu inférieur à un milliard de dollars on est très en dessous d'un millième pour un continent de même 18% de la population du monde donc on est véritablement devant des chiffres qui indiquent une situation extrêmement préoccupante et pourtant quels sont les éléments prometteurs ils sont précisément de l'évolution de la gouvernance il est vrai qu'on avait la chance d'avoir en 2020 comme président de l'Union africaine le président du pays le plus avancé quel que soit les paramètres d'équipement, d'accès aux soins de laboratoire de répartition pharmaceutique et il est vrai que indépendamment de la gouvernance de santé publique et donc une réponse rapide il y a eu aussi dans le domaine de la dette il y a eu aussi dans le domaine des conséquences économiques de la pandémie des réponses également rapides Michel Sidibé est chargé de créer l'agence africaine des médicaments qui va être un progrès très important aujourd'hui sur 55 pays membres de l'Union africaine 2 sont considérés comme ayant des agences nationales du médicament qui soit de niveau international il y a un classement de l'OMS 2, celle de l'Egypte du Sud sont au sommet des qualifications ça laisse 53 pays qui sont en-dessas de ce niveau de créer cette agence et il est envoyé spécial de l'Union africaine pour la créer et très significative elle sera akigali avec un support politique important ça sera une façon de prolonger qui a été saluée je crois par vous qui a été saluée dans le panel précédent comme étant une institution qui a permis d'harmoniser beaucoup de choses en Afrique très très vite pendant la pandémie en 2020 ça ira aussi dans le sens des plateformes numériques qui ont été mis au point extraordinairement vite avec le secteur privé à l'initiative de l'Union africaine et qui ont permis d'importer tout ce qu'on pouvait importer à des prix très bas parce que c'était des plateformes numériques permettant d'avoir une vision complète des prix en s'affranchissant des lourdeurs des marchés publiques et en ayant des marchés continentaux et non pas des marchés par pays et en ayant un mécanisme automatique de paiement financé par Afrique Simbanque c'est-à-dire un dispositif d'une efficacité incroyable efficacité incroyable sauf que ce qui était incroyable c'est qu'il n'y avait pas dans beaucoup de domaines notamment de la vaccination d'offres disponibles c'était différent pour les équipements les respirateurs les masques etc mais pour les vaccins on a eu quelque chose qui imagine l'objet du traité sur la pandémie un protectionnisme incroyable et l'Afrique a été la grande victime d'une non-accès en réalité aux vaccins mais du point de vue de la gouvernance et de l'efficience on a eu une réponse très complète et tout de même extrêmement rapide parce qu'elle était opérationnelle à l'automne de 2020 je n'ai rien à ajouter à ces deux constats c'est très préoccupant c'est la vaccination et plus que l'institution de passage à l'acte si ce n'est que il faut souligner que le secteur privé vous avez évoqué l'idée qu'il y aurait de la coproduction de la gouvernance avec le secteur privé ou le secteur disons associatif des grandes fondations ou la capacité de réaction du fond mondial qui a inscrit le Covid très rapidement donc à côté des autres une grande pandémie c'est aussi tout un secteur très important et juste un témoignage comme banquier d'affaires, comme financier aujourd'hui évidemment il y a une mobilisation importante de fonds et le secteur privé réagit avec des perspectives d'investissement très significatives dans l'ensemble du health care de la santé publique et évidemment sur les vaccins mais là encore nous nous travaillons par exemple avec la fondation Bill and Melinda Gates parce qu'il nous faut des moyens d'ensements financiers de cils monnaies et avec la fondation Gates on est en train de les déployer pour créer un tissu de PME des cliniques aux répartiteurs de pharmacies il y a dans le secteur privé beaucoup de ressources sauf les ressources financières sauf les ressources en capital et aujourd'hui c'est un compartiment important du développement financier le secteur privé existe merci merci beaucoup j'aimerais dire ici que les évaluations financiers du G20 et de notre panel indépendant sont que pour la préparation au pandémie les besoins seraient de l'ordre de 15 milliards par an avec la possibilité d'avoir une sorte de réserve immédiatement mobilisable de 50 à 100 milliards je vais pas rentrer dans les détails mais ces sommes sont évidemment comme vous l'avez souligné sans comparaison avec les 22 milliards de milliards du coup estimé de la pandémie sur les années 2020 2025 nous avons parlé de Anders mentionné la présidence de l'Union européenne l'année prochaine c'est aussi l'année où Japan hostera le G7 et bien sûr les pandémies sont très bas sur l'agenda G7 pour les dernières années peut-être que Aroca, peut-il me turner à vous maintenant merci oui, salut tout le monde merci beaucoup pour me donner cette opportunité aujourd'hui, j'aimerais avoir un perspective de sécurité pour la santé globale pour les mesures médicales la pandémie est 3 ans et l'impact socio-economic a été si significatif que la crise publique de la pandémie globale leade à la sécurité nationale alors que les interventions non-pharmaceuticales sont essentielles les changements sont les mesures médicales ou MGM en même temps les mesures médicales ont été claires donc en général considering the value chain of MGMs the flow can be divided into the three part the upstream, midstream and downstream part the upstream part is a surveillance or intelligence function which is to quickly grasp the information and the event of some infectious disease outbreak the midstream correspond to actual research and development and the final downstream part involves clinical trials, regulatory approval manufacturing procurement and allocation of the MGMs the important point is that such an MGM value chain cannot be completed in a single country in the past the semiconductor industry has shifted from a vertically integrated model and which a single major company was responsible for the entire value chain to a horizontal division of labor in which the pharmaceutical industry is also shifting from a vertically integrated model to a horizontal division of labor in which each process is divided into separate companies and organizations the horizontal division of labor was also the mainstream in the vaccine production during the COVID-19 and then this type of production structure will continue to be the mainstream for rapid vaccine R&D in the future at the same time it is very important how to establish and diversify a value chain system that can be completed among like-minded companies as I said previously that MGM value chain cannot be completed in any one country in particular since access to the vaccine isn't marked as that directly affects the lives of its own citizens it is very important security matter for any country and geopolitical risks should be reduced as much as possible when securing MGMs for their own citizens so for example currently the low material for all kinds of medicines are mainly dependent on China and India in other words it is presently quite challenging to complete in any pharmaceutical value chain without China and India it will become more important complete a diversified supply chain taking into account the cost and environment impact also in addition to the security perspective and the case of a pandemic on the scale of COVID-19 there is an issue of how to prepare the capacity to manufacture vaccines for the entire population on the global scale local production of COVID-19 vaccines took place outside of western countries mainly in the African and Asian countries without the manufacturing capacity of these countries it would not have been possible to rapidly manufacture and distribute as many vaccines worldwide as it did for the COVID-19 and technological transfer is critical during the global pandemic on the other hand technological transfer to low and middle income country is not always easy mainly due to the intellectual property rights in the past even if western countries develop new pharmaceutical the transfer of technology to low and middle income country was limited because they had been a strong stance for protection of intellectual property rights and then there was an absolute gap and access to pharmaceuticals between high income and low and middle income countries this time of COVID-19 China has rewritten the power structure actively providing the COVID-19 vaccine to countries that traditionally would not have had access to western medicine due to price issues by offering home ground vaccines at a lower price and actively transfer technologies so in the field of pharmaceuticals which is a major industry for many countries there is a desire to continue to protect the industries with the intellectual property rights but there also moves to restrain rulemaking by China and the sphere so how to handle IP and technology transfer especially in times of emergency will continue to be an important issue to be considered so in the wake of the COVID-19 pandemic there is a trend toward shifting coordination body from the global level so the status of each region was already introduced by the other panelists but in the earlier pandemic control including R&D for new medical counter measures is expected to be controlled jointly at the regional level so regarding the regional level but it should be noted here that in Asia where Japan is located is a complicated region to establish a single regional body so for example the WHO has a six regional office but Asia is an only region where the WHO has a two regional office because of the historical and political reasons also Asia includes larger countries in terms of population size and economies such as Japan, China, Korea, Australia and India as well as in smaller countries smaller populations such as island nations so while we generally have the coordination by the regional body or at the regional level how to unite Asia in terms of the pandemic control will be a major issue in the future so the G7 presidency in the UK focus on R&D for the medical counter measures and the Germany G7 focus on the intelligence and human resource for pandemic preparedness so the G7 in Japan which will start soon is expected to focus on the global health governance including the promotion of regional bodies and pharmaceutical R&D innovations based on the discussion in the UK and Germany also the full agenda is not yet known the G7 summit will be held in Hiroshima and the G7 health ministers meeting will be in Nagasaki for cities experience in the public health crisis is a different sense than infectious diseases namely the health hazards caused by the atomic bombs and both are symbol cities of the peace so I hope that the Japanese government will actively lead the discussion in Hiroshima and Nagasaki the cities of the peace on how we should confront the global health challenge that continue to threaten our lives based on our lessons from the COVID-19 thank you very much for your attention thank you thank you very much Haruka for these perspectives and also giving us already a flavor of the forthcoming G7 can I now Dr. Farida turn to you with a perspective from the Emirates and the region thank you it's really a very interesting and very important discussion that we have regarding the global governance and being more prepared to pandemics I think that there is a lot to be done there are six main priority areas that we need to focus on starting from the leadership commitment and I see that the global conversation to revise the governance structure is really going on but it is slower compared to the risk of having a new global pandemic which is existing to all to all of us at the global level but also at the regional level I think the region is very unique in terms of the structure we have a wide disparity of economics we have major insecurity and political instability in certain areas of our region that really increase the risk of outbreaks and also increase the risk of any future pandemics so in terms of leadership commitment I see that COVID-19 pandemic was a very interesting listen to the political leadership across the world because of the huge impact to not only to the health but also to the economics and to the political systems across the world however we need also to realize that some of the challenges that we faced are really constraints for the global community to work together in collaborative approach we could see for example nationalism towards vaccines which prevented us from good access to different vaccinations so in terms of the global governance systems we need to think of what are the priorities that we need to focus on and the having strong healthcare systems is one of the critical issues we know and we understand that there are fragile healthcare systems in certain countries in certain regions but we cannot really afford those systems to affect the global health security in terms of emerging new diseases so we need to work together to strengthen those healthcare systems in the minimum requirements in terms of the disease surveillance in terms of the access to care and in terms of the vaccination I think my colleagues covered vaccination very comprehensively I would like to add to that the access to immunotherapies and this have been really a game-changing during COVID-19 however we could see that immunotherapies are not affordable because of the high pricing that have been really an issue to many countries so it was limited to certain countries who can afford it so I think thinking about the global governance and preparedness immunotherapies should be really part of the priority areas for the discussions in addition to vaccinations because they are easier in terms of the manufacturing and faster in terms of mobilization and effectiveness for the high risk affected groups so immunotherapies really are very important part of the discussion I think also talking about innovation and research is very important because we need to not stop in terms of accelerating research time was critical during COVID and our governance in terms of the research approvals and prioritizations are really very slow that are not matching the need the global need so we need to talk collectively on how best we can revise the governance systems and revise our research regulations to accelerate research and to align our research priorities to the risks that we have in terms of the global health security to the world the last point that I would like to cover is related to surveillance and I believe that we have really historically been working closely at international government to define the surveillance requirements across the globe however I think our surveillance needs to be revised in terms of being more comprehensive we had a lot many disease based surveillance systems that are really defined well at the global community but it's not covering all the risks that we have so we need to do a risk assessment in terms of what are the potential risks in terms of the future pandemics and what how we can enhance our surveillance systems to be more comprehensive more integrated and more adaptive to the new technologies to support our preparedness in the future thank you and thank you for bringing the issue of research we are talking of regionalization and decentralization of manufacturing capacity but obviously research is an essential component can I now turn to you Jacques for a few thoughts again as I said from an informed outsider if you allow me to call you that way thank you Mr Chairman thank you for the invitation and just a caveat to state the fact that views expressed here on my own and not involving any organization with which I collaborate just a few excerpts from my daily medical literature review over the last few weeks two weeks ago the FDA approved the most expensive drug ever 3.5 million per patient to treat hemophilia B a very rare disorder and which affects just a few patients at the same time almost at the same time in the wake of COP 27 230 medical journals published in the editorial calling for urgent action urgent climate action in the interest of healthcare pointing out the terrible increase in the burden of disease induced by global heating mostly in poor countries and the Lancet added a comment stating that many countries still provide societies to fossil energy which are potentially higher than the health budget so we see that governance may be improved and finally there was a flurry of articles criticizing culminating with very good article dating back to February this year by Jean-Pizanie Ferri and the Bruegel team and the title is explicit it says health governance forensic analysis so is governance really dead I think it is not I'm not going into the history of WHO creation back in 1948 the declaration of Altma Attab back in 1978 then Astana declaration in 2018 calling for the rollout of universal health coverage in line with sustainable development goals but I do think that although WHO has been criticized mostly for political reasons it did a good job with a mix the globalization did a good job because it really took millions of people out of poverty and improved the health care system the health care, sorry so I think criticism is certainly in excess also there are a number of levels for additional governance the regulatory governance works very well agencies collaborate and we've seen a lot of people who have come to the conclusion they have been to approve new vaccines there is a level of international governance which has an influence of health care and which is heavily criticized which pertains to intellectual property and which has to do with sovereignty with science with scientific policy with economic policy and then we all know that all countries do try to have a governance of the health system with very varied means but which all resolve to cost containment there are other angles of governance moral or intellectual scientific societies doing a very good job in their discipline to kind of disseminate good practice based on science but by definition they have no mandate to propose to prioritize between various disciplines stock markets exercise the governance on health product and technology manufacturers but they have an obvious bias which is shareholders interests and finally we have philanthropic and humanitarians humanitarians on the terren who too often have to establish a governance of their own because they really have to do a triage between immediate cons so how to improve the edifice well my plea is that before thinking of structure we need to really agree on metrics because it's very difficult to measure health care actually once you've gone out from mortality it's very difficult then I would really encourage institutions to agree on objectives and to submit those objectives to democratic criticism and debate because it always ends up in allocating two scarce resources and so the need for the population to accept this is very important I would certainly advise to governance to relinquish the power in health care to health professionals because my 30 years experience actually with health care is that it's much easier to turn a doctor to teach a doctor in economics or mathematics or management than to take a lay person kind of an administrative or business person and teach the medicine so and very often the power in countries in terms of managing budgets is far too much in the hands of the administration and not enough in the hands of the physicians and as mentioned I'm not a physician but I love the physicians so my prescriptions in summary to kind of keep time in line once again work on metrics I mean really measuring health is a difficult issue and reinforce epidemiology I think epidemiology is a science at the level of mathematics and medicine and it's essential to really understand and propose the appropriate metrics educate the population I think this was mentioned in the previous panel and because the choices are so difficult we need to educate the population turn the power to health professionals and finally I would definitely advocate for decentralization so we can turn the power in as much as possible to local players because they often know better than the people who are in the offices in the central offices thank you for your attention thank you very much thank you Jacques so now I must confess I have a problem because we started this session 10-15 minutes late and I'm told that we have to stick and therefore we have no time unfortunately for discussion apologies because I was looking forward to a discussion so with apologies please let me just give a very short conclusion from what I've heard in the previous and in this session one the world is not better prepared today in December 2022 to face a new pandemic as compared or hardly better prepared than it was in 2020 second a number of processes have started many of these processes including the negotiation of a treaty the negotiation of a new global health strategy in Europe the negotiation of a political resolution at the UN General Assembly are slow cumbersome as Anders said and yet as many of you have said including Lionel when it comes to some of the regional innovations these processes are opening new encouraging perspectives third there are two key issues in global health and preparedness pandemic preparedness and response that we still not have clarity on one is governance and the second is the financing and clearly the international financing facility as it called that was recently established is far from being where we would like it to be and my last point is that I hope that as a public of the world policy conference you realize that health is not just anymore about health health is of course on the health agenda but it is on the development agenda it's on the global security agenda it's on the economic agenda it's on the social justice agenda and as we heard from Christian and the one health issue is it's on the agenda of all of the interrelated crisis in which to which the world is currently confronted so with that please join me in thanking our panelists for this session I like to comment in terms of matrix