 Good afternoon. I love a full house and so we're looking forward to a bus dialogue this afternoon where we'll first hear from panelists but what's the most important part of this afternoon's conversation is hearing from all of you and using the panelists to ask the questions that have been nagging you about this issue and giving helping us give voice to a broader community on the big question of how do we address the challenges of pandemics and whose problem is it? We have a great panel this afternoon and on the panel this afternoon of course we have Kofi Annan the chairman of the Kofi Annan Foundation. We have Professor Samba who will be joining us shortly who is the coordinator of the emergency operations for the Center Against Ebola and advisor to the president of Mali. Mr. Jeremy Farah the director of the Welcome Trust, my friend and colleague Valerie Amos who is currently the Undersecretary General for Humanitarian Affairs and Emergency and the Emergency Relief Coordinator for the United Nations and I should say Battle-Ness Amos and of course Stanley Bergman the chairman and CEO of the Henry Shine Group. We could spend all afternoon talking about this issue but we only have a brief time together. So during that time that we have together today what we'd like to do is look at strategically at our world's responses or lack of response and our capacity or lack of capacity to addressing diseases, disease outbreaks, and avoiding a pandemics. Of course Ebola is the key and essential context for this discussion today because as we all know in this room, six to nine months from its beginnings in West Africa we now are addressing the challenges of Ebola creeping into an urban community for the first time and impacting three governments severely and a number of other governments in a less detrimental manner but driving attention around the world and we know Ebola is of course a complex global crisis even if it is now only in three countries because a one Ebola case anywhere is a crisis everywhere because the possibility in a global society is real. So the only way to stop it is to stop transmission, to treat every last case, to get to zero and although the number of cases are decreasing today we know that there is still an active outbreak and we must continue to be vigilant in our response. We also know that with the ever encroaching position of man into more communities where the possibility for transmission of zoonotic diseases is more likely the possibility of new different disease outbreaks is real and the question is are we ready? So together with these panelists today this is esteemed panelists we will discuss the lessons that we've learned as a global community and talk about ways to go forward. How do we avoid pandemics? How do we raise the alarms earlier? How can we work better with communities? How must and should we coordinate to support national governments better and how do we harness a whole of society approach for a safer world? The conversation is only as good as the participants and the participants that we have today starting with Mr. Kofi Annan couldn't get any better and so we'll start with you. You have spoken loudly and strongly Mr. Annan on the need for swift and effective response and for the need for solidarity not only in terms of providing resources for first responders but also for maintaining travel, access and movement to affected countries. Those are lessons that we've learned. What other lessons have we learned from past pandemics as well as from the Ebola outbreak and our responses that should give us guidance as a global community? What should we do differently to ensure that we can build upon lessons from our past experiences? Thank you very much. I'm very happy to be able to join you this afternoon. I think the Ebola epidemic has lots of lessons for us. First of all we discovered Ebola about 40 years ago and we could have really focused on it and done some research as to how we counter it, try and see if we can find vaccine and other medication. So it is a bit surprising that 40 years later we come back to it and in Liberia, Sierra Leone and Guinea we are looking for new medication, untested medication to see how far we could go. We had had foresight. We would have been much further ahead with the cure and treatment that we could have used now. When we discovered it 40 years ago and it was contained, what lessons could we have learned? It broke out on the continent with weak medical system. It broke out on the continent where in quite a few of the countries the public health system was broken. They did not have the capacity to do the research required. They didn't have a CDC, disease control centres. Shouldn't we today be thinking of how do we ensure that when the next pandemic hits, I don't care what the name is, we will be able to tackle it professionally, be able to research it, look for treatment and be ready next time it comes around. I think on Ebola we have failed that test but going forward I think we should consider setting up disease control centres. I think it would be wonderful to see one in East Africa, one in West Africa and possibly one in South Africa. This doesn't have to be necessarily publicly funded. It should be public, private arrangements that can help. We should also understand I was in the States last fall and I was quite amazed at the scare mongering and the fear surrounding the disease and trying to keep out anyone who has been to West Africa, ignoring the scientific knowledge and the advice that has been given by the director of CDC and it was really that forced me to speak out publicly. But I think what we need to do is to understand that in this interconnected world diseases like that will travel. We saw what happened with SARS. SARS came out in Asia within 12 hours. It was in Canada and we should have known and you said one Ebola anywhere is one too many and we should fight it and we have to understand we are in the same boat and it may be in Africa. Where does it hit next? I think I said to the press that the public and the international community did not wake up regarding the Ebola crisis until it got to the US and UK and it is something which is ununderstandable because we should have known even before it got there that it was a question of time given the travel and interaction. So I would say I would also encourage pharmaceutical companies to do more work on diseases like Ebola. Those of us who come from the third world and the poor countries sometimes feel that the diseases of the poor are ignored because the companies feel if you invest in it you may not get your money back. People may not be able to afford the medication but I think we have, it has been proven that pharmaceutical companies and companies can do a lot. I saw what they did with HIV and I see David and we all worked on it together. The pharmaceutical companies helped a lot in bringing down their prices to make it affordable to the poor and in the process today we have millions on HIV medication and they could do similar work in areas like Ebola but of course the governments have to work with them and help. I think I should pause here and let others have the floor. Thank you very much. Thank you. Thank you very much Mr. Anand. The foresight to look ahead to make the right decisions for the future. Baroness Amos listening to what you've just heard from Mr. Anand and as the UN emergency relief coordinator recognizing all the challenges in the world and that the world must respond simultaneously. Let me ask you realistically what tools or mechanisms can or should the broader humanitarian community create and execute that might better assist us in avoiding pandemics or plan for the possibilities or help us better in our response in the future? Thank you and I'm not sure I agree with the way the questions framed because I don't think that this is just an issue for the humanitarian community and therein lies the problem. You described something which is complex, interconnected and which requires a swift, flexible and immediate global response and what we have is very often an assumption that the humanitarian community will step in and respond. I think as a global community we have to be much better at analyzing and identifying risks and then managing those risks together. When I say together I mean the governments themselves, I mean partnerships with the business community, with our NGO colleagues, with UN humanitarian agencies but also with governments that are major donors as well. It has to be a partnership. If you look at the scale of humanitarian crisis across the world, no one organization, no one agency, however big, can do this on its own and I think this is what this current Ebola crisis has really highlighted for us. That it is a major coordination challenge, that it requires us to work in a way that we have never worked together before. I think pretty much all of the different elements are there but how we connect up together there are glaring gaps in relation to that. And I have to say as the person who has to coordinate some pretty major humanitarian organizations around the world that we have agencies with separate mandates but also overlapping mandates. We are highly bureaucratic. We were set up in one set of circumstances and we are having to deal with a very different set of circumstances. So we have to be honest and clear about that but at the same time we have to make the changes that we require to move along. So what might some of those changes be? Much more support for prevention. We should not be having to scrabble around to raise money to put in place the supply chains that we might need rapidly. There is no point in raising the money after the crisis has happened. We need to have some form of global platform that brings together for example the business community with the public sector. We have elements of that everywhere and of course we see a lot of that here in Davos but it is not linked together. We need to have a funding platform where there is money available, substantial amounts of money available for preparedness that we can tap into immediately. And we need to clarify what roles and responsibilities are before a crisis hits. There is no point trying to sort that out when we are trying to deal with a major crisis at the same time. There has to be a commitment from all of us to do that together and one other point. The three countries we are dealing with are all post-conflict economies. I think we are way too short term in the way that we think about the support that we give to countries like Guinea, Sierra Leone or Liberia. You have to be in it for the long term. You have to say as a global community we are going to be with you for the next 20 years, for example, to help you to build the institutions, to help you to build the capacity and this is not about us from the outside coming in periodically to solve something and then going away again. It is about a real partnership where you are standing side by side and helping a country and its people to grow and develop. I will stop there. Thank you very much, Valerie. Not a humanitarian crisis. All of us in this together. All of us in this together but we know another lesson that we have learned is that the countries where the outbreak occurs, the government, the communities must be in control. Professor Samba Sal, thank you so much for joining us as Mali's coordinator of emergency operation center for the fight against Ebola. Mali was a country that had a case and did what was necessary fast because of country leadership. What lessons did you learn that other governments should take on board? Thank you very much for this question and I would like to thank the organizer for having me here to share some of our small experiences. I am so honored to be able to share a panel with such great personalities, my professor and thank you for having me here, all of you. I am so happy also to see David here who went to Mali on ground helping me to set up my operations. I will start from what my professor and Madam Amos just said. There is no secret this epidemic, this current epidemic, reach the less poor, the poorest countries around the world. Mali is one of them and obviously there were some key elements absolutely missing. Health system very weak as was mentioned by professor and there was no rapid response, solid rapid response system in countries like CDC and disease occurred. People didn't know so it was happening for so long in different communities. So that was something really very, very, very weak to avoid and third there is no vaccine, no treatment. So what we did in Mali, the minute we hear about this epidemic in Guinea, it was March 21st or 22nd, we did our first emergency meeting at the Minister of Health office on March 23rd. So rapid response team was set up the next day and then from there we started to work together. So we didn't wait till we saw the, till we see the first suspected case in country for example. We tried very, very difficult condition to set up rapid team. So rapidness is one key element and while doing that we started very early to work with community. So you cannot, Ebola is not one minister business, it's not like only the Minister of Health business. All the crisis, pandemic diseases, you cannot say that this is only the Minister of Health of your country. This is a government business. This is a national, it should be many, many department in addition to the community. So we started to work very early with all the government departments and the community. So community at the very peripheral level must be involved. So we started to talk to the village leaders and religious leaders. So that was very, very important because people do not believe when you're talking about diseases like Ebola and new disease in West Africa. So it's difficult to have people to believe. So we start to work on that and start to also convince and train community level so that we can help the health workers. And number three, we clearly start to work on border. We did not close our border because there is no border in West Africa. In Africa I must even say it is the same family. It is the same country. Even if you close your border people will still pass. So we start to accompany the border and do that work very closely. And lastly, the government, the highest level in the country, country leaders was involved at the very high level and tried to take the leadership of the control so that other government, ministerial department will take, you know, will take this, we will all take this so seriously. And when, for example, community villages, the president of the country will go on the ground and wash his hands while passing the border and let, you know, the doctors, nurses take his temperature. So that way, if the Imam or the chief of the village will also come, it's very easy to say, if the president did this, why not you? So we did things like that. And I agree with you. We cannot do, we cannot get success if we don't do a little bit of research. We started vaccine trials in Mali and I've been one of the participants, one of the first black African tourist service vaccine. And I'm also the principal investigator of the first vaccine trial. So we must go with vaccines. It's always better to prevent rather to wait for treatment. So I don't know how many time I have left, but I will stop here if there is questions. I have a lot, a lot to say from the ground. Thank you very much. Thank you very much for being with us. And just as is not one agency, but at the entire global community working together, as you said, it's not one agency inside of government. It's the entire government working together and leadership. And speaking of leadership, let's talk about the public health community. Jeremy, tell us from a public health perspective, what should we be thinking about? What lessons from a public health perspective should we incorporate as we move forward? From the public health perspective, what I learned here is that with Ebola, public health services were far away from the community level. So we should think how to get close, how to link so closely with public health services with the local community, you know, traditional healers. Some Ebola suspected cases will go always first to the traditional healer. So they should be, we should find a way to communicate so closely. So communication is the key between those two. And number three, the public health system, routine system should be reviewed so that every country, even if you don't have a right research center, you have to have an emergency center, emergency operating center just for pandemic diseases like this. And be ready, even if there is nothing, public health system should try to do simulation on a regular base so we be ready and data should be collected. So those systems are obviously not working because disease can come in our communities and stay for a long time before the government be aware. So that's what I want to mention here. Thank you. Thank you very much, Professor. So Jeremy Farah, you've heard what it takes from public health at the local level. When we think about public health at a global level, what should we be thinking about as we move forward? Thank you very much indeed. And just a little bit of background compared to the others in the audience. I'm just a very simple infectious disease physician who has spent the last 18 years living and working in Vietnam. But for some reason, and I promise I haven't bought anything with me today, I have been very directly involved in SARS, in bird flu, in EV71, in cholera, now in Ebola for the last decade. And one of the lessons from that and actually pay tribute to a very good friend of mine who lost his life in Vietnam, Carlo Avani, from the World Health Organization during the days of SARS. One of the key lessons for that is these are not rare events. These are actually incredibly common events. I, as a single physician, could talk you through eight or nine epidemics in the last 10 years, either regional or global pandemic, such as the 2009 pandemic. And yet in truth, very, very few countries around the world have got health care systems and public health structures that allow them to deal with the day to day, let alone the surge that comes when you have major new cases. It would be difficult to imagine any western city actually coping with what Monerovius had to cope with over the last year or so. So this is not something that happens to other people far away from wherever you are here in Davos. This is happening all the time and has a possibility because of transport and movement of people and because of the way the world works that it comes to effect as all. So we should all own this. And if you ask the question who's responsible for this, it's everybody in this room. It isn't just ministries of health. It isn't just doctors. It isn't just agencies like we've heard from. It is all of us together. And the key lesson, I think, from all of those, and it was true of SARS, it was true of bird flu, it was true of the pandemic and it's certainly true here of Ebola. And that is that if you don't understand the context of the society that you're working within when these happen, you will not be able to sort these out with purely medical and technical responses. You desperately have to understand the cultural context. And that cultural context and societal context evolves over time. So if I had a criticism of the Ebola response, which I think actually, at a final point, it got to a good place, it is that we didn't appreciate early enough that 2014 is not 1976, that societies have changed, that when you have a disease in a new area, such as in West Africa, where there are no borders, and where people move much more rapidly, where Ebola starts to be transmitted in a major urban center instead of in a rural setting. The people that live there, the way they respond, the way they act is very, very different. And we were too slow to realize that 2014 was not 1976. And that's actually been a lesson, again, over the last decade. Surveillance is critical and setting up public health systems after every single epidemic I've been involved with in the crisis and soon after there is a call for a response. And I'll just quote you something that was stated, the world is ill prepared for this or any other global public health emergency. The review recommends sweeping reforms, strengthening health capacity, understanding society, an international reserve, clear coordination amongst UN agencies and a contingency fund to pay for it. That was written in 2004 after SARS. We're 10 years on and you could write exactly the same today. This is an opportunity, a crisis is always an opportunity, but this time we must seize it. And it isn't just a case of saying we must change or destroy or get rid of the World Health Organization, we desperately need a unified body that works at the global level, because further fragmentation of healthcare around the world is in actually nobody's interests. But if we want that global body, there are two things that we need to provide it with strong leadership and a mandate for that leadership to provide leadership. And secondly, we have to fund it. And we have to appreciate that funding needs to come from governments and philanthropy and from industry and from society. And that all of those players are part of that global health community. There is a phrase within some of your agencies, non-state actors, they are crucial to our ability to respond. And I believe they should have a voice in those agencies at the highest level. Surveillance is critical and we must pick these things up, but we did pick up Ebola in March and we didn't act until September. That six month delay will have cost us a huge amount in lives and economies and money. We must learn to add a response arm to a surveillance arm. Picking things up on its own will not solve the problem. It is critical, but we need an action and that has to be decisive and well-led and it would be better to occasionally overreact than ever underreact. And in this case, I believe, until recently, we've underreacted. So I'll stop there and open it up for the floor. Thank you. Thank you very much. We must act, not just surveil, but respond. Not just surveil, but respond as a community. So let's finish with the private sector. Stanley, are we engaging in the right way today to maximize access to the private sector? And if not, what should we be doing differently? Right. So I've been dying to get into this discussion because I've heard a lot and Baroness, you hit really the soft spot there. Look, I'm from the private sector. What I do know is we buy low and we sell high, but we know a lot more. What we do know is that Ebola is obviously a humanitarian crisis. It's a terrible thing on the ground. We've seen it on TV. We see it in the newspapers. At the same time, it is destroying an economy in three countries and the surrounding area. It is a security risk for the world and there is enlightened self-interest in working on this issue. Having said that, I think we'll get through this one. And I was in a discussion the other day with David Nabarro, where I think he pointed out that there's been a lot of resources that have been brought to bear. That's not the issue. The issue is how do we deal with emergency preparedness in general? I believe the first panel I was on at Davos was about 11 years ago when we spoke about pandemic preparedness. I don't think we've moved it very far. Have we done better? Yes, we have. I would advocate, and again, I'm not a public health person. I'm not a multilateral organization. I don't know much about actually how governments run, but I'm from the business sector. My company is the largest provider of products to dentists, doctors outside of the office, and veterinarians. We ship products, millions of little boxes around the world to about one and a half million doctors in their private offices. We know logistics. Bring us in early on, not at the last minute. Get us in on the foundation. We are good in the private sector at organizing. We don't know about disease management from a public health point of view. Sitting in front of me is the director of the UPS Foundation, Ed Martin is. We got a call one day from the Center for Disease Control, and we were asked, could we send product to West Africa? Well, I think a week later, or two weeks later, a million dollars of supplies, we raise the money, we're on the way. Don't call us in. It's too late. Let's get involved in creating the right kinds of public, private partnerships. I don't know who should convene it. If the UN calls, we come. If any of these agencies call, we'll be there. In fact, most companies today view social responsibility as critical. But we want to be brought in and help in pandemic planning and not in the response to a crisis or tragedy. So I would advocate for a way in which we can advance public-private partnerships to deal with pandemic planning. I see Mr. Naan saying he's got to get back in on this, listening to you. No, I think it's a very important point that if we establish solid relations with the private sector, that we should be able to call on them and share the problems with them. And they have the organization, the capacity, and can react quickly. But there were two other points I wanted to make in this particular crisis. A group of African businessmen worked with the African Union and raised millions of dollars to send health workers to the three countries. And I think that's extremely important that they take that kind of initiative and we don't always look beyond Africa for that kind of help. And I would want to applaud the African Union and businessmen such as Strive Maseewa and Dangote of Nigeria getting everyone organized. And I think they've sent in about a thousand health workers to the region. The other important thing is the creativity at this time that the international, the secretary general and his team managed to get governments to send informed units, military units, who can hit the ground running, set up field hospitals and allow the work to continue. Because otherwise you are recruiting people individually and it takes time. It's better to get a team that is used to working together and can get it done. Finally, I would want to say that there was quite a lot of blame game at the beginning. When we have crisis and we are trying to save lives, let's focus on that first. The blame game can wait. We can blame people after we've saved lives. But the way it happened this time, it was very disencouraging for some of the aid workers. They felt unappreciated and as I said on television, these are the modern day heroes and heroines who deserve our thanks and appreciation. But the blame game came too early and we should push it back for later. Thanks. Don't let pointing fingers get in the way of ending the epidemic and getting it right. I see David Nabarro about to jump out of his chair. So David, you've been referred to several times here as the secretary general's special envoy for addressing this Ebola crisis. Are we getting it right up here? Is there something that we're missing? What more should we add? I'm sure there's a microphone that they can put into your hand. Right here. David, on your left. Thanks very much indeed. And it's really good that the group is looking at this issue from an analytical perspective. Four things. First of all, I just met Professor So President Ibiketa by chance in the Congress Center and he stopped. He was walking along. He stopped the entourage he was with and he said, Nabarro, I want to talk to you. So we walked over in my bad French. And he said to me Thurin, I assure you that I'm going to continue to make sure that we will keep Mali safe in the face of the threat of Ebola. And so I feel that one of the points that you've all made, but that everybody needs to be aware of, is the absolute importance of powerful leadership from the very top. You see, if the health ministry is left to deal with something like this on its own, very quickly it gets overwhelmed. But when the president says, I'm going to make sure that we get it right, then it makes a huge difference. So I'd really like to reinforce the remarks about leadership. Second point, as we've studied the Ebola outbreak in West Africa, a little bit what Professor Farage said, we've seen how people's behavior has been a really important factor in determining the spread. It's not, this, Ebola is not water-borne, airborne, food-borne, soil-borne. You get it from being in close contact with people and their body fluids touching you. So anything in society that makes that more likely could spread. And I agree that I think it took time for everybody to understand how important it was to get close to communities and work with them on a partnership response. And I think the reason, everybody, why it all changed so quickly in Liberia between September, when as we were hearing we were experiencing terrible scenes in the streets of Monrovia and also out in some of the rural counties. And it changed in two months to a situation now where there are parts of the country that are absolutely free of Ebola is because everybody changed behavior at about the same time. They just got the message. It's dramatic. The third point is to Valerie Amos, our response mechanisms to crisis, they are much better than they were but at times when you're inside the response it feels as though each time we're having to learn what we do. That's not criticizing what you in WFP or Valerie and Archer are doing but we're not globally brilliant at working together. Sometimes I think when we're responding to crisis it would be much better if we could shift and be reactive like a swarm of bees or a flock of birds. You know how you see group birds when they're flying along they all change direction at the same time but globally we haven't quite got that degree of mega-coordination so I do agree with what Valerie Amos said that we've got more work to do. It's not just talking about humanitarian crisis we've got to be talking about the whole variety of crises and a range of new patterns to do with it. I think learning from Ebola will give us rich stuff and then lastly to Kofi Annan and his point which I think also Mr Bergman alluded to and perhaps that's the best lesson of all and that is modern responses involve everybody. They don't involve an agency here or an organization there and perhaps the most important point that I've heard in the remarks so far is let's find a way for all of us to do it together and create these platforms and these mechanisms to fulfill the dream that I really heard again having worked with Mr Anand when he was Secretary General and he said David we're going to get the price of these AIDS medicines down and we'll do it by bringing in the companies and bringing in the NGOs and bringing in the health organizations. I think that spirit is really important and I wish you well. Let's get that right. Thank you. Thank you very much. Before we open up to the public we've heard about what we need to do but we also have the Deputy Executive Director of UNICEF here and so we are now seeing Ebola orphans and so what do we need to do differently to ensure the children are protected as we look to the future. Thanks very much and thanks for giving me the opportunity to to sort of engage in this discussion. I think it's great to hear all these important lessons learned and to emphasize that you know rather than just learning then we should now start implementing them as well. I think also for raising you know the important issue of children in this crisis because you know this crisis has hit the most vulnerable countries, the most vulnerable parts of those countries and the most vulnerable people in these countries and obviously children are part of those vulnerable populations and not only have they been among the victims obviously but what you also see is that children in these circumstances lose their caregivers. We all know that schools are closed so education is becoming a big issue although we're moving at reopening them again but you know caregivers especially also women and mothers have also been disproportionately affected and when you look at orphans and the issue of stigma I think it's really important that again you know in working with communities which I think has been crucial as David has also just pointed out we really only saw getting the real results when we started engaging communities around the real issues here and I think we need to pay tribute to those in communities who have worked here but it's also a little bit the world upside down you know where usually for orphaned and affected children you have extended family mechanisms that work and that actually you know call them in here you know because of stigma it's been more difficult to actually use these extended family mechanisms and you actually see orphans being excluded from those traditional coping mechanisms so again you know in working with communities and in sort of explaining to them how to deal with those specific you know vulnerable group of people we will get the results although in the meantime of course we need to make sure that they cared for and catered for and that's what we're doing with our partners thank you thank you very much Yoko so you've heard from those who are working on the crisis those who have had roles in other disease responses and they say we're all responsible this is an open forum let's hear who you think is responsible the floor is now open and I'd ask you to keep your questions and and comments to two minutes thank you very much Dr. Annie Sparrow from Mount Sinai Global Health to follow on and probably this should be addressed to Mr. Anand and to Baroness these epidemics are fueled as I see it by human rights violations they're not just diseases of poverty we knew about Ebola in March but we didn't respond until two whites were affected and what I see is a revision that we haven't necessarily learned from AIDS the perfect epidemic fostered and fueled by discrimination by stigma where women children gays were with the least agency with the most affected with Ebola it is females on the frontline they are the nurses they are the caregivers they're the ones to prepare the funerals they're the ones who wash the bodies so that here we have again one that is fostered and fueled where it's not only driven by human rights but the fallout is also those on the children on the women and those the education that suffer these are not just diseases of poverty we know that infectious disease and disease of poverty go together we have to be in it for the long time for the long term because infectious diseases are and they affect all of us but I see it although I am a physician and a pediatric and care intensivist that there are real parallels between the neglect of human rights and public health and these are reflected with the rise of infectious disease and how they become issues of global security and how they become issues of global governance so I'd love to hear a response okay let's get a couple more questions before we come back to the panel I see a hand back here would you stand up can we get a mic over there uh Dr Baoli I have worked with the WFP in Africa in different capacities at the height of the Ebola ADME it went through the Western press that a female al-Qaeda member held in the United States had been recommending that her group spread Ebola in the Western countries my question is it scientifically possible and secondly do you take this into account and how thank you okay one more before we come back to the panel right here so you were talking about taking actions and responding to the outbreak as soon as it happens as soon as it is identified but probably a number of outbreaks is happening in countries with the big public health system or even not exist in public health system and we simply don't see them so do you think that the actual surveillance system is sufficient for the moment okay let's start with the first question Mr Anand do you want to address what is epidemic filed by the neglect of human rights and public health in these communities it's an interesting question because one way you bring in human rights which is a an interesting concept that one has a right to life one has a right to good health and good education and you are confronted with this problem in societies which have very little means societies where the health system is broken societies coming out of war and they alone are unable to tackle it what responsibility does the international community have to assist them and how quickly should they offer that help do we accept and realize that we are in the same boat and whether it's happening in in Liberia, Sierra Leone or Guinea that it consents us all and we should rally to help I think this has been basic it's based if this underlines all the discussion we are we are having here and I would suggest that it is our responsibility living in this interconnected world to help wherever this epidemic breaks because you cannot be safe at the expense of the other or prosper at the expense of the other thank you Baron Samus did you want to add something just to add that I think that we're quite often overwhelmed by the complexity of situations and Kofi has talked about the interconnectedness of all these issues and you see it very very clearly in the three countries but in in the whole region and we've been talking a lot about global risks and the complexity of global risks and the list is actually very long I think the important thing is to ensure that the complexity doesn't prevent us acting because we get so concerned about you know is it this element that element or that element what we need to do is to take a comprehensive approach and think how best different parts of the system can address different elements of it and just very quickly to come to the question of the last question I think we there's a huge amount of data that we have available to us it's not just surveillance data it's other data it's how do we analyze and read that data and take the warning systems the warnings that that data flags up for us and how do we support countries with weak systems to ensure that that data is available and how do we ensure that communities and countries aren't frightened by what the data is actually telling them communities and countries will hide things because actually they don't necessarily want to and I don't mean just in the development world I mean this is across the world because it's a it becomes a political leadership challenge and we have to encourage countries leaders communities to actually be open and honest about what the information is and what it's telling us anyone else want to come in on the other question yes so I think it's yes it is this human rights issue but there's a more fundamental issue these three economies are really failed healthcare systems now when we have a failed political system or a failed security issue the world tends to respond sometimes too late but in this case we haven't responded correctly yes we're trying to deal with the issue on the top on the surface the Teflon the medical issue but we put these countries in an isolation ward from an economic point of view we stopped the airlines going there we stopped commerce I think I read an article the other day that 25 billion dollars of economic activity in the amongst the poorest countries in the world has been destroyed so what we've done here is we've taken failed economies and made them even more failed so I think there are two things we have to deal with one is we have to figure a way to get the economy back I think we were talking early on we have to allow people to get back to fishing and not give them food of course we have to give food and we have to deal with this medical system but we have to get these economies back again and my big fear is what's next are these the three poorest countries of the world not necessarily there are even more poorer countries and even countries that are not necessarily as poor but that don't have medical systems that work and then I'll add one last thing the world's health organization yes it may not be functioning perfectly but if we don't fix it if we don't give them funding we don't give them a mandate who is going to fix this may I say a word about the economic situation no I agree with him that the economic and social aspects of the crisis in the three countries are not being given enough attention you've had situations where companies working on major infrastructure projects and important projects have withdrawn their personnel invoking forced majeure people tell the government why don't you fire them and recruit somebody else what guarantee do they have that another company would want to bring in the staff they would use the same argument and besides if they invoke forced majeure they have to pay the cost this poor government so it's a very difficult situation and Stan is right that as we move forward this these economic and social issues are going to really become come to the fore and create problems for us we often tend to focus on the political and other things on the surface while the economic and social bottom is for falling out and this is going to be the next crisis in these countries this is not three distant countries you cannot stop the stuff at passport control it affects everyone Switzerland affects the United States everyone if we don't deal with these issues it's going to have a global effect Jeremy take a moment and debunk the myth about the transmission of this disease but david's already talked about it it is it is very important to understand the transmission of diseases and it was misunderstandings wherever it was early on Ebola can only be transmitted by very close contact with bodily fluids I can't cough it over you you can't cough it over me if I had it here today she wouldn't be giving it to me at the moment I'd be very happy to sit next to her unless she was going to be sick or whatever it's difficult to catch the average person will pass it on to just one other person or less it's only around funerals it's only around the social context only around the cultural context is which this epidemic has been allowed to go beyond it's actually not very transmissible we must let the science lead us and not our own xenophobia with that more questions here I am Adam up on from the World Trade Institute uh I was discussing with my distinguished professor and uh he asked me Adam how do you access the situation of Ebola in uh West Africa I hear that West Africans or Africans kiss their deaths I mean like I was like come on you know just like uh Kofi and Anna said blame shifting you know here and there how do we assess the role of the press in this scenario that's my question the role of the press let's take a couple more questions a hand over here yes hi I'm um Peter Neiman I work as a hospital doctor in the United States and I remember last year as I was working in the United States around September everybody started to talk about Ebola and um essentially was a big scare there's no question about that people even from India were being quarantined we were putting people into isolation I really didn't have to be in isolation I think it was an exaggeration but in hindsight I think it was actually a good tendency I think the media played a very important role in this I think by making the public afraid of Ebola I think by getting people thinking about Ebola President Obama finally President Obama finally decided to talk about it and things changed so my question is shouldn't we get the media faster into the boat and isn't it good if we actually scare the public a little bit scaring the public as a tool that's interesting okay anybody else want to add anything before we go back to the panel okay let's go back to the panel so what's the role of the press in our response and how do we what's the role of the public Jeremy the press is absolutely critical to this and in fact if you go back to 1918 and the pandemic everybody frightened of influenza and the reason why it's called Spanish Flu the only reason it's called Spanish Flu is the Spanish press was the only free press in 1918 American press the British press the German press the French press were all constrained it was only the Spanish press that could actually raise the profile of the disease the press is absolutely critical and it's no good just blaming them for the message if the community and those of us on the panel and those in the on don't get out there and explain things to the press they will invent stories sometimes because they'll fill a vacuum so I think we cannot just blame the press for the bad things that are said if we don't go out there and explain to them what the true situation is on the issue of fear I think it's a very very careful thing to get right as a young doctor I grew up at the start of the HIV epidemic and I don't think we got the messaging right around that and there's a very delicate balance between terrifying people leading to chaos and bad actions versus being sensible and in the middle and I would caution against over overfearing the public around things Ben Seamus I think it's I think it's really important to have an informed public and the press has a huge role to play in relation to that but of course the press itself needs to be informed I think there's another element of this which Kofi I think touched on but which we haven't addressed which is that there is a whole history of the way the African continent has been perceived the way that African people are perceived the way that disease in African countries is perceived stereotypes abound and this has played right into all of that and it's been very difficult to extract the elements that relates to that that fear and the elements which relate to just lack of information and knowledge about the the nature of Ebola itself and this has made it extremely difficult to deal with some of the ways in which the countries the governments the peoples have been portrayed in the media globally and it's something that we're going to have to address for the longer term Professor Samba Yeah, thank you so much I would like to just add on to that by saying that the press actually is a key component of the Ebola emergency center Ebola is only maybe 10 percent medical medicine and maybe 90 to 95 percent overs so I would like to say that it's important to not to scare maybe to worry your community so to have them worried about this but first of all you have to make sure your boss whoever is the boss in your country you have to do your best to worry him a lot to get him be you can correct my English my job is since my boss is not in this room is to worry him so if your boss worries about something then you will get him down you do the same with the press you have to train we organize a lot of training sessions an information session for the press and for the local leaders not only the traditional healers in Africa because this Ebola crisis doctors and traditional healers and imam died first from this that's where that's what we use actually to convince them to say this is a contagious thing you cannot treat this thank you Kofi I think it's a double-edged sword the press can be very constructive and very helpful when it has the right information and the right message and it puts it out but on Ebola in some situations the health workers were competing with the politicians politicians who wanted to get to make a political capital out of this and they are much more visible and they got their language out there and their position out long before the health people caught up and when that happens you scare people not only do you scare family members and the public at large but they tell their wives and husbands and cousins who want to go to this area to help you are not going we are not going to encourage you to do this and I think maybe David will confirm this at one point everybody thought they were going to be loss of international health workers going in became difficult and then they had to rely more on local health workers train them and prepare them which I think is right but the scare tactics had a negative effect to some extent so I would say that we need the press the press should be informed and perhaps those of us who are dealing with these issues should rush out press case to them give them the information early before the politicians turn them in the wrong direction yeah I'm definitely for freedom of the press I believe in that one here's the issue the press has a responsibility to educate yes they sell newspapers through headlines the more newspapers are sold the more the advertising dollars are but there's a responsibility to educate so in 1986 after was alleged that the first patient passed on aids to a dentist people stopped going to the dentist in the United States dentists at that time were not wearing gloves masks were not sterilizing the public public private partnership was put together organizations called OSAP to educate the American public and the dentists on how to deal with infection control we dealt with that we worked with the press and the press got the word out that if you go to a dentist there's wearing a glove a mask and sterilizes between procedures you'll be totally safe I think we got the same issue here with Ebola we got the press out trying to sell newspapers a couple of politicians and my wife and I live in the New York area and there were a couple in that area that got a little bit crazy there and tried to stop they wanted to quarantine healthcare workers they're a completely wrong thing the press should have gotten out and explained how Ebola has passed on not to quarantine healthcare workers which sold newspapers I see a hand down here in front go ahead before you can have the press you actually have to have the information there is a long, long history of cover-ups the Guinea government covered up Ebola the Syrian government covered up Polio there are real parallels between the re-emergence of Polio and Syria after 18 years and the rise of Ebola in West Africa one was a destroyed public health system one was the others and neglected health systems but both had government cover-ups I worked on the cholera epidemic and saw where the government also covered it up there what I didn't know at the time was the government of Syria had also covered up successfully a cholera outbreak so before we can even get to the press which can be used and must be used wisely you have to have the information and that's when it comes back to the government the stigma attached to a government which may want to cover up for economic reasons for tourist reasons for reasons of stigma no one in Europe wants to get Polio Europe doesn't want to lose its certification of Polio I don't think it was any accident last year that we had two public health emergencies of international concern both in Polio and in Ebola thank you so that's the information as part of the wait for it the the need for information as the government themselves to actually provide it with that David I saw you wanted to come in again okay anyone there's a hand back here can we get a microphone back here a good afternoon it is really a great pleasure to hear you all talk about the missions that you have to face I am Fernando Morales de la Cruz and I was born in Guatemala which unfortunately is still a poor country but when we talk about the challenges with Ebola or the challenges that Mrs. Cousin and her team face on emergency relief or Mrs. Amos or Mr. Nanan have faced in their mission perhaps we should consider the analogy of when you have a little fire in the kitchen and you don't extinguish that little fire and then the whole building burns down or even worse the whole block burns down and the reason why I bring this up is because as a former journalist I think that often people ignore that there's a little fire in the kitchen the government is looking the other way the private sector or citizens look the other way and those who could have helped extinguish it didn't do it so on bringing everything to the media the challenge is often how do we make governments wake up and do what they have to do when the fire is still small and when it can be extinguished because in the case of Ebola we have something very clear that not enough was done at the very beginning and now that everybody's trying to do enough perhaps it's not enough again so I would just like to leave my comment like that and again thank you Mrs. Cousin, Mr. Nanan, Mrs. Seimos and everyone else for your job I really admire it Thank you very much for the question We have one more back here All right so we talked about that countries should work together on a global scale and that leadership is extremely important in for example Africa to keep the citizens from away from chaos but IST has a major problem since in the last century globalization has is a key feature of pandemics which means that in a blink of an eye you can have diseases spreading from one place to another in less than 24 hours and I'm wondering if we look more in the future not to Ebola now but for example Ebola could mutate or in the future are we if we're so tightly linked do we have enough resources in the future to for example prevent a pandemic that is as fatal as Ebola or more but as well airborne So do we have the resources all good questions how do we keep the information or make sure the information is public and available not just to governments but to people to ensure the right answers can occur and to reframe the question a bit from the second speaker how do we keep rooms like this filled when there is no epidemic to ensure that we can continue to give voice to the work that is necessary and then finally because it's not easy do we have enough money do we have the resources to address the challenges ahead of us with that I'd open it up to the panel let's start down here with you Mr. Farrar Chairman At some point we always have the resources when there's a crisis but crises are best prevented rather than reacting to so rooms like this will be filled if we had the same one two years from now I doubt if there'd be quite so many people here and it's it's retaining that interest over the long term in things which are preventative for which many politicians will never get credit for because if you prevent things people assume they wouldn't have happened anyway and it's critical that we realize that public health and preventative work is critical if we want to prevent these sorts of issues and that needs investing and it needs investing over the long term in answer to the question about we should act early I could not agree more the difficulty we've got is we don't understand enough of the science to know when we have to act quickly and decisively and in a major way and when we can leave it and I was very involved in the pandemic in 2009 and many people criticize the response there for being exaggerated and unnecessary I would strongly disagree with that but that was the criticism and I would even venture that actually that criticism of organizations like the World Health Organization had an impact on the willingness and the ability to act quickly in the Ebola crisis because they were burned by the criticisms before that they'd overreacted globalization I think is a force for good infectious diseases spread around the world long before globalization as a word was invented plague spread through the whole of the world in the middle ages globalization is not going to go away travel is not going to go away what we need to learn is to work in the world as it is and it will be in the future not as it was in the past and that's the critical element to me I would like to fully agree with what you just mentioned but I would like to add into that few things that we are doing in Mali and that we think we believe will help us to keep the community local the most remote community informed on a regular basis one is our U.S.C. as part of the U.S.C. we are trying to expand and have at every district level and village level very small local committees actually very local so that they keep with weekly meetings and we at the central level we feed them with weekly information very local small epidemiological data routine data collected on Ebola from the borders the cordons and itters so we send we share those information down with them so they know what's going on and we also keep reminding them about iGNs and not only for Ebola but to keep up you know stay in touch with us if they observe any other new events coming in their localities so they will let us know so those local committees are really playing a key role in both informing keeping the community informed local community informed but also giving us feedback so there is a good link between us this is a very good way also to keep the community coffee nothing valley yeah so i'd like to combine both questions and an answer we have fire brigades in most civilized countries but we don't have an emergency response method methodology globally the world health organization said it earlier on needs to get the resources to get the job done then we need to have the right kind of strategic resources of materials ready to go we have them in some countries but we also need to have a reserve of trained healthcare professionals that are ready to go out and keep that list current and not call on people when it's too late so i would suggest that we need to have that fire brigade ready in public health for emergency preparedness and i think with public private partnerships we could get that done fire brigade ready valley should we well i completely agree we need more investment in preparedness i mean this is something that we've been talking about for a very very long time but it is it is not the thing that that grabs anybody's imagination and politically it is not the thing that political leaders get a great deal of credit for so we have to turn that around in some way the second thing that i think is absolutely crucial is making sure that there is greater public awareness and that this has to be from the local level right the way through to the global level and communication and public awareness campaigns are critical if the prevention and the preparedness is going to have the impact that we want it to have so koviat ask you if we have greater public awareness we build on the fire brigade to make it something that is sexy that ensures we have it how do we ensure that we have the public will to continue to move forward to do the things that are necessary for the future i think if you do have public awareness and the public makes it clear to the political leaders that this is important to them and push it higher up the political agenda you will get action if the pressure is not on it's not going to happen and i think valerian stand are right and so if you get the public engaged the pressure must be sustained and civil society must put the pressure and fire under the leaders to do the right thing so jamie you've seen it before you've been in all of these if not all of them a lot of the diseases that have caught the public's imagination in the past but we've lost that imagination how do we maintain the public it's called if you're right keeping the pressure on absolutely and i'm all in favor of the sort of fire brigade model but we must remember we put fire brigades into villages and towns we don't expect to fly in a fire brigade from very far away and the center of gravity for this response has to be local with a capacity and confidence to ask externally and i accept the challenges of countries that may want to keep things under wraps but those are less and less now than they were even a decade ago in my view but we have this is initially it has to be a local response with the ability and willingness to ask outside when other help is needed and that actual structure does exist now it's just over the last five years we've paired it down to a smaller and smaller response but it does exist yeah but i think if it does exist and we have these units in individual communities and we're able to sustain it and reactivate it on time in time of need is fine but even when you take you and peacekeeping the way we operate today is when the is when the crisis has broken and the conflicts are to speak that we begin to look for troops and sometimes it takes three six months to get the troops there and i think we we use i used to use the analogy it's like telling me a bloomberg that we know new york needs firehouses but will build it for you when the fire breaks not to have it in place to be able to this is where the problem is so let's go out for one more round of questions i see a hand back here in the back so good afternoon everybody i would i would like to talk about our responsibility we in europe and the western world we feel responsible for such things that happened in africa like ebola but my question is what is the sense when we spend the money and it goes to the corrupt government and because when i want to give money i want i would like to help the people the poor people who fight to survive and i don't want to spend government a new palace or a new airplane or such something thank you government corruption a good question and it's a fact that we should we must contend with in responding to these issues so we'll ask the panel let's get a couple more to add on to this martin desipinto economic crime intelligence we've heard a lot of talk about public-private partnerships and i'd want to ask how would this actually work because on the one hand we've got a government and public whose theoretical objective is prevention on the other hand we've got private enterprise where as far as i can see it the more people you cure the more money you make the more courses of treatment that you sell the higher your profitability so i just wonder how you intend to align these incentives second question would be should in the case of public-private partnerships should private enterprises that use artificial tax structures to avoid paying their fair share of tax which ultimately damages the companies the countries that they're supposed to be helping and that they're supposed to be working in should these companies that use artificial structures be excluded from any form of public-private partnership okay one more question there is one more question from this side i will add another question because normally we discuss in the way they are corrupt government and so on and i will say we are a part of the problem i will jump to the question the most of the epidemies come from a weak economy bad condition hunger and so and so on and before they come to hunger we have too much war in all this region and we send too much weapons not help to fight against epony we create many crises before and this is a reason why i give you kofi anan the appeal for a human right to peace this is another i know it's a big jump but this is the real reason that we countries destabilize countries we have to make another politic it's not only the question of corruption corruption begins in the bad condition from all these countries so i give you this question to make this context behind the big economy and this is a question of this weapons militarization and so on okay you've heard the questions who wants to start i'm happy to start go ahead i think i mean these questions are all interrelated and i would say two key things one is that it is absolutely crucial that leaders and governments are held accountable and we have systems and structures for doing that which we very often don't apply and i think it's important that we apply them and that indeed the there are often cases where governments that are donors to these countries don't necessarily have anti-corruption legislation themselves in place so i think there's something there that we need to deal with the second element of this is that in the kind of work in which you and i are engaged earth rin we have to put the people in need of support at the center of the work that we do and of course we recognize that we're working in a very complicated and complex geopolitical environment which includes you know corruption conflict and everything else but that's the nature of humanitarian work it's a recognition that you have that complex geopolitical environment and that we have a responsibility as a humanitarian community to put the most vulnerable at the center of what we do Jeremy Epidemics often do start yes in countries struggling with public health systems governance and economies but they don't only start there if i had to say what i think was the most frightening probable epidemic of the 21st century it'll be anti-microbial drug resistance it is highly probable that will be driven by large western economies and transported to other countries so these epidemics don't start somewhere and go somewhere with somebody to blame and somebody to accept the the consequences of it these affect all of us and just as likely to start here in Davos as they are to start in Ho Chi Minh City or Jakarta we are all a part of this and we can't just say this is going to be coming from somewhere else on the issue of probably private partnerships we have that it is absolutely essential I as a infectious disease physician have never invented an antibiotic or an anti-malarial drug they have come through partnerships with industry that's actually ultimately and there were problems along the route how we managed to have decent treatment for HIV drugs in the end it was that public private partnership which people on this panel helped to forge that was critical to the delivery of those and we do have to get those incentives right and then companies have to take the responsibility we heard from Stan earlier to meet those responsibilities Professor Sa thank you very much and thank you for the questions just want to add on what have been said that it's true there are corruption in Africa but not only in Africa corruption everywhere at a certain degree that's one number two I know Ebola for example this specific crisis in West Africa the way we manage the epidemic itself and most of the funding for the epidemic it was so specific and we had many many partners like UN agencies and others for example my emergency operating center I decided to hire a specific managing office I do not sign checks I do not see the money I all I see is if I need a pen or a gloves I'll ask for that and they will bring it for me so we decided to do that in Mali so that the money will be managed money and all the materials by an auditing office whose job is only to do this and to provide weekly and monthly audit report to the head of operating center so we are encouraging to do this so we have to work together and most of the time we also ask donors not to give money if they can just bring their help in like materials and equipment to try to handle corruption at this level so lastly we're talking about Ebola if you don't take Ebola seriously for example somebody like me if I'm working in Ebola and thinking about money if two things if I have a lot of money I have to be aware I will also have a lot of viruses maybe I will die from Ebola before getting that money so it's better seriously work not if you work on Ebola you can't think about money thank you we're coming to the close of this panel what I'd like to do we're in the age of Twitter when you only have so many characters to say what you mean so I go back to our panel and say to the original question of who's responsible as people leave this room today what is the message that you would want them to tweet about who's responsible starting with you Stanley I don't think any one party is responsible we're collectively responsible and we can collectively fix the next pandemic and prevent it from happening Professor Sal for me we have to work so closely what worries me now is I don't want this Ebola it's epidemic so far I do not want this to become pandemic in West Africa so we have to work hands-on together with UN agencies to strengthen our health infrastructures to keep up with more and more training and to do more capacity building and information and to push for vaccines vaccines Birna Samus we have to work at the community national regional global level we all have to work together Jeremy Foua prevention is going to be much better than response and we need to make sure that we have robust healthcare systems and when we do have to act we act with great leadership and decisive action Kofi Annan I think we need to be ready for the next pandemic pandemics will not care Ebola is not going to be the next one the last one and if it does happen we are all responsible we are in the same boat and we need to pull our efforts and resources to tackle it so we are all responsible and we need your help to ensure that the world knows that we're all responsible and we all share that responsibility as we leave here and we move forward so that the next room that we're in when we're talking about pandemics we can talk about what we've done not what we must do thank you all for your attention