 everyone in front of Lacroix from Bloomberg. And we have the next 45 minutes to talk about that pandemic and of course what comes next. Now we'd love all participants to join the conversation on social media using the hashtag Davos agenda. Also please submit eight questions you may have for the panelists via the Slido QR code on the screen. It's popping up shortly. And of course participants can open their camera pointed at QR code. This is the beauty of 2022. We know how QR codes work. And then you can follow the event or the link to the Slido event. You should select COVID-19 what's next. So you select that room. There you go. It's on your screen. You select that room and then enter any questions that you may have for the panelists. And it will be my pleasure to ask them. Now I'm delighted to be joined by Anthony Fauci, Chief Medical Advisor to the President of the United States. Stéphane Bancel, Chief Executive Officer of Moderna. And Lise Wildersmith, Professor of Emerging Infectious Diseases London School of Hygiene and Tropical Medicine. And Richard Hatchett, Chief Executive Officer, Coalition for Epidemic Preparedness and Innovations, CEPI. Now, Dr. Fauci, let me start off with you. We have many questions to get through. Is 2022 actually the year that we go from pandemic to endemic? And does it on speed up the process, given its ability to spread and offer immunity through infection? Well, the answer is we do not know that. And I think we have to be openly honest about that. And when the word endemic is used in different contexts, when I talk about the pandemic, I put it into five phases. The truly pandemic phase, where the whole world is really very negatively impacted as we are right now. Then there's the deceleration of the pandemic. Then there's control. There's elimination and eradication. I think if you look at the history of infectious diseases, we've only eradicated one infectious disease in man and that's smallpox. That's not going to happen with this virus. Then there's elimination. Elimination means when you get rid of it in your own country, but it's somewhere not in your country, but it's there. For example, polio has been eliminated in the United States in many developing nations. So what's the next one up the ladder is control. Control means you have it present, but it is present at a level that does not disrupt society. And I think that's what most people feel when they talk about endemicity, where it is integrated into the broad range of infectious diseases that we experience. For example, the cold weather, upper respiratory infections, the para-influences, the respiratory syncytial viruses, the rhinovirus, the anoviruses. You want to get it at a level that doesn't disrupt society. That's the answer to your first question. That's my definition of what endemicity would mean, a non-disruptive presence without elimination. When you talk about whether or not Omicron, because it's a highly transmissible, but apparently not as pathogenic, for example, as Delta, I would hope that that's the case. But that would only be the case if we don't get another variant that eludes the immune response to the prior variant. For example, we were fortunate that Omicron, although it is highly transmissible, nonetheless is not as pathogenic. But the sheer volume of people who are getting infected overrides that rather less level of pathogenicity. So I really do think, Francine, that it is an open question as to whether or not Omicron is going to be the live virus vaccination that everyone is hoping for, because you have such a great deal of variability with new variants emerging. Thank you, Dr. Fauci. Anlise, what do you think, actually, Omicron means for new variants? And are we focused too much on calling it an endemic? It makes things easier, and people see it at the end of a difficult tunnel. It is indeed too early to call it endemic, and I totally agree with Dr. Fauci. What people want to hear is, when can we resume our normal activities? And Omicron will not be the last variant. Clearly, with such high viral circulation, as we are seeing now, there's a high probability that we will have another variant coming up. The question is, where and when? And will it be more dangerous or less dangerous than the current variant of concerns? Where and when? I do think, if you have high viral circulation, that drives the risk of emergence. You've seen that for alpha, that emerged in the UK. We've seen that for delta in India. Maybe less so for Omicron. Will it be more dangerous? Of course, we all hope it won't. And based on the evolutionary advantage to a virus, it is more likely it will attenuate. That means it will further be associated with less severe disease, just based on the mere fact that a virus has an advantage. If you have high transmissibility, but you don't also kill your hosts at the same time. So we're all hoping for the best case scenario that the next one will be even further attenuated. That said, I think the world needs to be prepared, also for the worst case scenario. And the worst case scenario would be that indeed there could be another viral recombination that would combine maybe the capacity to have high transmissibility and high mortality. That's the worst case. And I still think it is not so likely, but we have to consider all case scenarios. Thank you so much, Anlisa. Stefan, where do you think we're on the pandemic? Oh, you have to unmute. Sorry, thank you. Good morning, all good afternoon. Well, I don't think I have anything to add to those two infectious disease experts. What I can tell you is from the vaccine maker standpoint, what we are first very happy is that we've such a change with Omicron and Valentina Comicron that the vaccines are holding very well. And those are proven to be very important. What we're doing right now is to prepare for what should the vaccine be in the fall of 2022 and what should it contain. And all experts are working with public health experts like Dr. Fauci's team to figure this out because soon we're gonna have to decide what goes into a vaccine for fall of 2022. The other piece we are doing, of course, is around manufacturing capacity. You know, in 2021, we shipped 807 million doses. We are very proud that around 25% went to middle-income and low-income countries. And we're continuing to ramp up. We have a lot of capacity coming online in Q1. This quarter, we have a goal to be able to make two to three billion doses for this year. And the other piece we are working on is for 2023 is how do we make it possible from a societal standpoint that people want to be vaccinated? And we're trying to do this by preparing combinations. You know, we're working on the flu vaccine, we're working on the RSU vaccine, and our goal is to be able to have a single annual booster so that we don't have compliance issues where people don't want to get two to three shots a winter, but to get one dose where we get, you know, a booster for corona and a booster for flu and RSV to make sure that people get their vaccine. So, Stefan, how close are we to that, actually? One single, you know, shot for various protection against COVID-19, but also flu. So the RSU program is now in phase three. The flu program is in phase two and soon in phase three. I hope as soon as the second quarter of this year. So a best-case scenario will be the fall of 2023. As a best-case scenario, I don't think it will happen in every country, but we believe it's possible to happen in some countries next year. Richard, what do you see as the shape of this future endemic phase? Well, I certainly don't disagree with anything that Annalise and Tony have said, and Stefan's reporting on moving towards a combined shot is certainly encouraging. I would say that when most people talk about a disease becoming endemic, what they really mean or what they're anticipating is a disease and equilibrium with the human population. Flu is endemic, and we have annual epidemics as the virus evolves over time. And I think, I mean, if I would hazard a guess in terms of the near-term dynamics of our interactions with COVID over the next few months, Omicron will sweep the world. It may hopefully sweep out other variants, eliminate Delta, ideally. That wouldn't be completely unanticipated. And I do think that we will get to a point this year where populations around the world either have been infected or had the benefits of vaccination, and we will get closer to that equilibrium with COVID. And we're likely probably post-Omicron. Many countries will have a new variant emerging, which it can do at any moment, unpredictably. We will have a quieter period with the virus. But I think the long-term view on COVID, we have to anticipate that COVID is going to behave more like flu in terms of it will continue to circulate. It will be around people, will get sick, and there will be continual evolution of the virus. And unpredictably, the virus appears to have the capacity to become essentially pandemic at any time. I mean, Omicron has moved very, very rapidly. It's behaving exactly like an acute pandemic as Tony, I think, was describing. And the virus is going to retain that capability in the future. And that's something that, you know, I think should be quite concerning to all of us. Thank you so much. I'm getting a lot of great questions from everyone listening. So thank you for those. Dr. Fauci, this is basically a person writing and saying, what is the best case scenario? As per the daily prediction to achieve herd immunity combining the vaccine administration COVID infections? How difficult is it to actually calibrate something like that? Well, certainly the experience that we've had right now with COVID-19 and with SARS-CoV-2 is that that is going to be very difficult calculation because when you talk about herd immunity and you talk about the protection in the community where you combine those who've been vaccinated with durable protection and those who've been infected, recovered with durable protection. However, when you have a virus in which the infection causes immunity that seems to wane rather quickly. In addition, when you're dealing with a vaccine that's an extraordinarily successful and protective vaccine where the immunity also wanes there and you have then the third ingredient is a virus which as was recently described by several of the panelists myself included, which has this extraordinary capability of mutating, developing new variants and the new variants can be alluding the immune response. And we're seeing that with Omicron where Omicron fortunately is not as pathogenic inherently but when you look at its protection particularly against infection to a lesser degree against severe disease it does allude the immune response. That's a different scenario than what we see when you have a virus like measles which does not really change very much and gives you almost lifelong immunity and you have a measles vaccine which does not give you anything changing but allows you to have rather lifelong protection. That's the ideal herd immunity with dealing with a very complicated situation here that makes our classic definition of herd immunity very elusive. Thank you, Dr. Fauci. And this is another question which we touched on but basically this person is maybe turning it a little bit more political. Should we be worried about future variants? And this person writes in, sometimes it feels like big pharma company are taking advantage of the situation. Let me ask you and we'll go to Stefan on this. Like how can we bridge the divide between believers and non-believers? Because there are some inherent non-believers that no matter what you say, they give you a real problem. And one of the things that we, I believe the entire world is facing but we certainly are facing it in a very, very disconcerting way in the United States is the amount of disinformation that is accompanying what should be a problem where everyone pulls together against the common enemy which is the virus. We have disinformation that is entirely destructive to a comprehensive public health endeavor. And I'm not sure how we're going to account to that except by getting out as much correct information as we possibly can and use the social media in a positive way as opposed to in the somewhat destructive way that it is being used right now. And Liz, your thoughts also, there's a difference right between what virologists say. So looking at how worried we should be at these variants and sometimes what politicians say because they focus more on reopening the economy. Well, let me share a word of optimism. We are in a different space than we were two years ago. Two years ago, we had a population of 7.7 billion people with zero immunity to this virus. Now more than 50% of the world's population has received two doses. And this is further strengthened with now the rapid also immunity being built up by natural infection. So in a different space and we now need to rethink and reevaluate some of our strategies. Stefan, your take. First of all, there has been quite a lot of questions on pharmaceutical companies. Also, how do you encourage vaccination, right? Is there a way that companies such as Moderna need to communicate differently or put up data differently that encourages people to get vaccinated? Yeah, so the vaccination question is of course a very complicated one. I mean, many public experts and governments have tried really hard for now two years to get people to believe in the vaccines. And of course, there's always a better job that we can all do starting from the companies in terms of explaining the science, explaining the side effects, explaining the long-term benefits and the risk reward of getting a vaccine versus not getting a vaccine. I think a lot has been done but clearly more can be done. But as Tony said, what he said is all the misinformation that we are seeing every day online, sometimes on TV, about the vaccine and what they do and what they don't do is really sad in today's world. Stefan, can I ask you something specifically about some of these vaccines? And this person is also writing in, look, does a vaccine designed for Alpha or Delta also works well enough against Omicron? And how much faster have you been able to adapt some of these vaccines for every new variant? Sure, so the vaccines that are currently available, we have been for the original strain. They have not been adapted that I'm aware of to the Alpha or to the Beta strain, at least ours has not. As we've seen and shared the data very quickly when we had it and we had a strong partnership with Dr. Fauci's team on the data generation in the fall around Thanksgiving when Omicron appeared, what was seen is we saw an important drop of neutralizing antibody after two dose of the vaccine but what we saw thankfully is after a third dose there was very strong protection which is why you saw around the world all the public health experts and governments urging people that have not been boosted to get a third dose to protect them especially people at a high risk. What we are doing and we started this the Wednesday before Thanksgiving the day we saw a sequence is developing an Omicron specific vaccine. The vaccine is being finished to be made, it should be in the clinic in the coming weeks and we're hoping in the March timeframe we should be able to have data to share with regulators to figure out the next step forward. And that's always been a great partnership between public health experts, the regulators and vaccine makers to figure out what's the best path. As Tony said, for two years we've all worked literally seven days a week together to figure out how to fight this common enemy of the virus. The enemy is not another company or another group. The enemy has only been the virus and we still have ours. Richard, a better, more broadly protective vaccine that would be effective against all future variants of course is what everyone's hoping for. How far away do you think we are from that goal and what more is needed to make that vision a reality? Well, I mean, I think the first thing that's needed to make the vision a reality is investment in the research and development and Dr. Fauci and his team at NIA have already begun to make investments. We've already begun to make investments. There's some private sector partners that are pursuing it. There's a lot of science that we still need to sort through to figure out how to capture the benefits that we have seen. And I'll talk about that in a minute in a specific vaccine. There was a really important proof of concept, biological proof of concept observation that was reported from Singapore. Linfa Wang is a scientist very prominent in the coronavirus research community. Actually administered an mRNA vaccine to persons who had actually survived SARS-1 back in 2003 and 2004, they'd been infected with SARS. He administered a mRNA vaccine to them, the Pfizer vaccine, and then looked at their antibodies and they produced neutralizing antibodies, not only against SARS-1, against SARS-2, against MERS, and against a number of other known animal coronaviruses. So that proves that the human immune response can generate neutralizing antibodies against coronaviruses broadly. How we capture that, put that into a vaccine is something that we're looking at in a variety of different ways, a variety of different clinical approaches. I would say that that would be the Holy Grail because we really don't want to be in a position where we are chasing the new variants that are going to come when they will and unexpectedly and potentially with quite, even if they're milder, as Omicron is, the capability potentially to overwhelm healthcare systems. And so I think that needs to be, even as we support the vaccines that we've got, which is Tony says, are very, very good vaccines. They have done a great job, particularly in preventing severe disease and death. But we don't want to be in a position where we're having to vaccinate everybody in the world every three or six months or even annually, ideally. Yeah, and this is something, the reports that also, if you do too many boosters, I'm not a virologist. Everybody thinks they're virologists. Very few people are virologists, but there have been reports that actually if you boost too much, then it's counterproductive to the immune system. Where are we on that? Well, I mean, I think it's fine maybe. I'm not aware of any data that strongly suggests that the administration of the third dose is a fourth dose, and in any case, we can see immune response. What we're seeing is a very robust response with the administration of the booster doses. Tony or Stefan or Emily said that. If you have anything to add to that. You're absolutely correct, Richard. There really is no evidence that if you boost. I mean, obviously if you just overwhelm the immune system by just giving a person an antigen all the time, you get a hyperactivity of immunity, but giving boosters at different times, there's no evidence that that's going to hinder it. One of the things that we've got to be careful of, and I really want to underscore what Richard said, we really don't want to get into the whack-a-mole approach towards every new variant where it comes up and you all of a sudden have to make a new booster against a particular variant. It gets up because you'll be chasing it forever. So that's the reason why one of the things we are really all pushing for is what Richard just mentioned, of finding out what the mechanisms are that induces a response to a commonality among all of the different real and potential variants that we're seeing and that can occur. And that's something that I think is a very, very important scientific goal to be able to do that. Once we get there, whether or not you have to intermittently boost someone with that, you use the word universal. I think before we talk about a universal coronavirus, we want to get a universal SARS-CoV-2 virus. Let's take it one step at a time. Otherwise, I think we're really going to be jumping ahead of ourselves, but we really need to also point out to people that when you have a virus that has such a high degree of transmissibility, a very, very good vaccine may not necessarily prevent initial infection and may allow it to be very mild. But what you really wanted to do is to prevent you from getting significant systemic disease. That would be a very, very successful hand SARS-CoV-2 vaccine. Stefan, do you think, are you working on this better, more broadly protective vaccine to outdo them all or is it something that we already have because it has been pretty efficient in tackling the variants that we've had so far? As Richard and Tony said, I mean, we definitely, all of us want better protection for people and the broader vaccines. There's a lot of work going on in academia and around the world. We are looking and partnering with a lot of people, but unfortunately we are not there yet, but hopefully we're making progress to other direction. And Lise, what would you do differently in terms of maybe explaining some of these variants to the broader population? It's already being said. The key message remains the vaccine still really worked very well against severe disease. And what we really want, the primary objective is we want to avoid deaths and protect healthcare systems. We're still in the epidemic. Our healthcare systems are still overwhelmed. We still need to continue our public health and social measures, but as population level immunity is increasing, both through natural infection and vaccines, we will now have a stronger hybrid immunity that will protect us against new variants. So even if we have more severe new variants, this population now is different. We do now have a cellular immunity from background exposure with vaccines or infection that will protect us against more severe disease. Dr. Trouch, I'm also getting a lot of questions from the US or for the US specifically. So why is the US, this is a broad, but actually quite deep question, why is the US a first world developed rich economy struggling to contain COVID? Well, that's a very good question. And I think some of the answer to that question is already articulated by our panel members. One of the most important thing is that we have, somewhat, and I think it'd be perfectly honest, somewhat of a fraction and just disparate,