 So, good morning everyone and welcome to this session on global health and pandemics. This is the fourth time we have a session on pandemics. The first one was a virtual session in 2020, you may remember. Before anything, I'd like to thank Thierry de Montbriale. Thank you, Madame Kwon, for inviting us and Madame Minister, warmly thank the government of the UAE for the wonderful welcome and hosting this conference. We have an excellent panel of speakers today with broad expertise in global health and geopolitics. But before we start, I'd like to show one slide for everyone to remember about key figures on COVID-19, as the political attention and the public opinion attention is rapidly waning. What people often call the cycle of panic and neglect, we are actually in a phase of neglect. And that's why entitled the slide, COVID-19, are we being dismissive? So, let's not forget that the COVID-19 pandemic has been the worst combined health and socioeconomic crisis in living memory. It has infected at least 250 million people across the globe and the global death toll is estimated to be 27, between 18 and 33 million people. At the highest point of the pandemic, 90% of school children across the world were unable to attend school. At least 150 million people have been pushed to extreme poverty and the economic cost has been huge, estimated by the IMF at being $14 trillion to be lost in the period 2024, the toughest shock to the global economy since World War II. And the last point on the slide is that the pandemic is not over and it continues to have a profound impact on the lives and livelihoods for many people, millions of people with what we call long COVID, but also as the economic recovery, whereas it somehow is taking place in the high income countries. It still is very slow in recovery in the poorest countries. So we'll discuss today about where we are with the pandemic and which are the perspectives of preparing ourselves to a next pandemic. And the question that is posed today is, are we ready for a next pandemic? Now our first speaker will be Professor Antoine Flau, who is the director of the Global Health Institute in Geneva. He is also the director of the Swiss School of Public Health in Zurich. And let me say that sadly and somehow ironically, two of our six panelists today are stuck with COVID in Geneva, that is Professor Flau and El Storelli. Two out of six of us have COVID as we speak. And that can be a strong reminder again to all of us that the epidemic is not over. So Antoine, the floor is yours. Thank you, Michel, for your kind words. And thank you also to Thierry de Montréal for his faithful invitation, World Policy Conference after World Policy Conference, and particularly talking about COVID. I wish I'd be in Abu Dhabi today, here in Geneva where the weather is ugly, windy, rainy and very cold. So I wish you the best for the conference. Yes, you asked me to talk about COVID-19, where are we today and where are we moving to? The next slide, please. What happened in one year? Last year we talked about the situation and what did happen in one year. I would like to mention just two elements, two major events. One, if you remember, that was in December, very shortly after our World Policy Conference in Abu Dhabi last year, when China decided to shift from its zero COVID policy to a more global policy with regard to COVID, more mitigation policy. I mentioned this event because it was a major and tragic event for China. When China officially reported 90,000 deaths in the weeks after the lift of zero COVID strategy, it has been estimated that it is probably more than 1.4 million deaths, which occurred. And many models also mention death toll of 2 million deaths in China only in a few weeks after the lift of the end of the zero COVID strategy. The second very major event was when the general director of WHO in Geneva declared the end of the public health emergency of international concern. He associated this declaration with a call for vigilance because new variants could emerge in the coming months and years. And you can see at the bottom right panel of this slide, in the UK, there is a soup of sub variants of Omicrons which have emerged and which are co-circulating today in the UK, but of course in all over the world. Next slide, please. So where are we now? Michel, you mentioned the tragedy of this COVID pandemic with the cumulative death toll as reported of 7 million deaths, but which has been estimated between 18 and 33 million deaths, as you said. We have to add to that, to these figures, more than 20 million lives which were saved due to the vaccine only in the first year of its deployment. And I think we have to add, but it has not been clearly estimated up to date, is the number of lives saved thanks to the lockdown, thanks to the non-pharmaceutical interventions. Next slide, please. Where are we now? In fact, as you said, Michel, the pandemic is not over. When you see the circulation of the waves, you can see easily that in the last year, we have known a couple of waves of hospitalization and also of deaths due to COVID. Just in Canada, if you see the figures on the right, you can notice that the total number of hospitalizations in 2023 so far is bigger than the total number of hospitalizations due to COVID in the first year of the pandemic in 2020. One of the reasons is that it is not a seasonal disease. It's not like flu. It's all along the year disease which trigger some severe forms of COVID and some hospitalizations and deaths. Next slide, please. Even if we know that it is not over, because probably we want to listen only the positive and optimistic side of the end of the public health emergency of international concern of the alert, of the status of emergency, we have mostly gave up with most of the surveillance tools, a form of disarmament in the middle or maybe at the end of the war, but not when the war is finished. And we can see on the right that's not the case fatality ratio, but the case hospitalization ratio. What does that mean? That means that the number of hospitalizations in the UK divided by the number of infections has dramatically decreased over time, thanks to the vaccines, of course, and also to the repeated waves of COVID which enhance and sustain the immunity against the disease and the severe forms of the disease. So fortunately, now we are much less prone to being hospitalized when we caught COVID. These figures have only been done because of the excellent epidemiological system in the UK. They have some random sampling of the British population in each nation of the British population which provide very precise figures no one in the world today have succeeded to reach. This is a major lesson we should learn from the pandemic, this UK example. On the left of the panel you have a French example which was completely visionary regarding analysis of wastewater. Wastewater surveillance is very well correlated with the circulation of the virus, but also it allows for detecting early new variants and the circulation of new variants in a country. In Switzerland, for instance, we have detected thanks to wastewater, the Pirola sub-variant, the new wearing sub-variant which is emerging today in the world, before in the wastewater, before it was seen in clinical settings. So the wastewater is really a very interesting tool and surprisingly, France, which was visionary and ahead of time, had given up. They have stopped their waste water surveillance in spring 2022, fortunately now they are coming back again. Next slide, please. One of the most important lessons we have learned regarding the mode and the route of transmission is the fact that it is a nerve-borne disease. It is due to the micro droplets which float in the air, indoor, when it is poorly ventilated and which contaminate us because we breath 20 times a minute and we are infected and reinfected and reinfected again in a train, in a coach of a train, in a classroom, in a school, in a hospital, in a home care facility, in office, in bars and restaurants. So we have learned that we should wear a mask, that we should keep distance, that we are better outdoors than indoors not to catch the disease, that we should invest in ventilation, that we should monitor the proxy of the indoor air quality which is CO2 concentration and that we can filter the air when we cannot ventilate enough. Next slide, please. Improving air quality is key. It has been well-setted by a lot of evidence today. Italian, for instance, have demonstrated that just by appropriate ventilation of class rooms in schools, you can reduce by 80% the number of contamination in children and, as Michel said, the kids wear those segments of the populations which pay a lot of tributes to this pandemic. We probably could be able to eliminate most of the viral respiratory disease, not only viral. Tuberculosis is also totally airborne disease. We could eliminate this disease to the same extent as we have succeeded to eliminate waterborne disease like cholera or dysentery in the 20th century thanks to the development and thanks to water sanitation. So with air sanitation, with an indoor air quality which is appropriate, we could probably eliminate most of the burden of this respiratory disease, COVID, but also influenza as we and many others. Next slide, please. As you said, Michel, it remains a lot of unknowns in this pandemic and you mentioned the persistent COVID symptoms and there are more than 50 long-term effects of COVID which is so-called the long COVID today and which is mostly unknown, poorly diagnosed, poorly recognized. Many people are suffering after their COVID, even mild COVID, and it has been estimated that 10% of the infected people will suffer from persistent effects of COVID and we have no treatment or very few treatments so we need to invest much more in this segment of the post-COVID problems. Next slide. I wanted to mention something which is highly political, which is the fact that this information comes from populism and anti-science movement. I apologize, I don't want to be partisan, but it is a fact today to see that those who voted for Trump in America were much less vaccinated than those who voted for Biden and it has a dramatic impact on their mortality and they had a lot of mortality in excess. It has been estimated that more than 200,000 people died were killed due to disinformation, due to anti-science movement and that is a very worrying issue. On the right side of the panel you have the optimistic figures which show that public information campaign is a major key determinant for the success of the response to the pandemic. So going to the stage and talking with evidence, with science on the COVID pandemic is something which save lives. Next slide. And this is my concluding remarks just to say we are probably much better and perform much better in crisis management than in crisis prevention. We are not very good to prevent disease. We have faced a tragedy with, I don't know, 25 million deaths plus 25 saved lives due to the intervention during the crisis. But we are not able today to take the lessons, to learn the lessons we have as a legacy of this pandemic. We are not able to implement an appropriate surveillance tool. We are not able to invest in prevention like proper indoor equality. We are still not able to invest in research against these long COVID issues and we are facing strong anti-science which refrains some politicians to invest and to continue to invest in, for instance, mask mandates or in hospitals or in home care facilities or in things people do not want anymore to hear today. Thank you for your attention. Thank you very much, Antoine. Thank you. Are we able to draw the lessons from the pandemic in terms of prevention, preparedness, in terms also of addressing a major failure of all of us during the crisis which has been the unequal, dramatically unequal access to vaccines across the world. That's the topic that Elstorelle, who is a fellow with the Institute of Innovation and Public Purpose at University College London, will now address. May I just ask all our speakers to stick to their time as we are already a little late on the programme. Else, the floor is yours and thank you. Hope you feel better. Thank you, Michel, for the kind introduction and for the good wishes. I have recovered. Meanwhile, I was just confirmed myself testing negative this morning. But unfortunately, I couldn't travel to be with you. And yes, what I will talk about in the next 10 minutes is really looking back to the COVID response. I think in addition to all the non-pharmaceutical interventions that Antoine Eloquenty talked about, I think one major success without which is our collective scientific community came together and in a record time was able to create and produce effective vaccines that have dramatically limited the risk of severe disease and that's during COVID. We were also lucky. We have to admit that the bet that scientists made that this famous spike protein would indeed be able to elicit an adequate immune response paid off. And also, several of the existing vaccine technology platforms from the classic attenuated viruses to these newer viral vector platforms and especially at the meanwhile famous messenger RNA, mRNA platform, they could rapidly be adapted to this new virus. And this was not just luck. This was also the result of massive investments, public and taxpayers' investments into research and development over many years. And then, of course, massive investments during the response. However, as indicated already by Michel, the main failure of our collective COVID response has been that large parts of the world were precluded from the timely and equitable access to these life-saving vaccines that would have been able to avoid many more deaths and probably would also have been much more effective in controlling the pandemic. And just to remind you that 15 months after the vaccines became available, mainly in high-income countries, and where even persons with very low risks of getting ill, including children, were being vaccinated, most countries in Africa had not been able to vaccinate even their healthcare workers that were at the first line and at high risk of getting ill or the most vulnerable populations. And as you know, the risk of dying increases significantly with age and with co-infections of comorbidities. And so those people, because that is what equity means, right? Equity means that those who need it most, those at the highest risk of getting ill, should be prioritized. And that is not at all what we did. And that was at the extreme inequity that Dr. Tedros, the director of the World Health Organization, referred to as vaccine apartheid. That is really what happened. So are we ready for the next pandemic to do better in terms of vaccine equity or counter-measure equity? Because it's not just vaccines, it's also access to diagnostics and treatments. Now, in order to respond to that, we need to understand why we ended there. And there are many factors that contributed. The initial scarcity led to hoarding and vaccine nationalism with countries buying up all the stocks of these newly produced vaccines to be able, again, to vaccinate their whole population even multiple times while other countries were precluded to even buy vaccines for their health workers. But also a very important reason was that a handful of companies held monopolies on the science and technology and therefore controlled the production and availability of these vaccines and were able to actually decide how much to produce, when, to whom to sell, and at what price. And while wielding monopoly power to control markets and maximize revenues, maybe normal business practice in many economic sectors, but here we're talking life-saving vaccines. Develop, moreover, with massive public investments, and we're in the biggest health crisis of our lifetime. And so while it was astounding that many normal business practices were interrupted or dramatically changed, I mean, think about lockdowns. I mean, we've never done such a dramatic intervention in our economy. Somehow the powers that be didn't think that it was needed to do something about the pharmaceutical business ecosystem and trusting that the market mechanisms could be relied upon to deliver. And so we know how that ended. Now, we have to acknowledge that some vaccine producers, AstraZeneca, together with the Oxford vaccine and some Chinese producers, did enable some local production in a few countries. But this was largely insufficient. It was too little, too late to really supply the world. And many producers that were trying to obtain such licenses were refused. And very importantly, the producers of the mRNA vaccines that became very quickly the preferred option in many countries, they totally refused to share their technology, instead doubling down on scaling up their own production capabilities. And this was even more dramatic because one of the key advantages of this novel technology is that it's actually relatively easy to produce as compared to traditional vaccines. It's also very suitable for this decentralized medium-scale production and it can quickly be adapted to new variants. But both Moderna and Pfizer and Biotech chose to keep tight control of their technology. So what is it that we must do differently? The first is to really have a change of perspectives. Livesaving health technologies, especially in times of pandemics, cannot be viewed as private commercial goods. This should first of all be considered as essential public health tools, instruments for public policy. And that's not a technical issue. That is really a political choice. And it means also that policymakers must be able to use these tools and implement such policies as they see fit to control the pandemic. And in wealthy countries, the market-based pharmaceutical ecosystem may be able to deliver. And that's clearly what most Western policymakers think. But as we have seen, that doesn't deliver for the rest of the world. And so governments in other parts of the world were not able to use these tools to implement the best public health response. They couldn't buy and they couldn't produce. So what can we do to ensure that countries on the global side, and we're talking actually about a majority of the world population, let's be clear, can do differently to secure the health of their populations? Well, what they say is, we do no longer want to be recipients and beggars. We actually want to be part of the solutions to contribute as full participants to the research and development of diagnostics, vaccines and treatments, and to be able to respond to epidemic outbreaks when and where they occur, not waiting until it is a pandemic, but actually or waiting until Western pharmaceutical business models develop the products that we can use to stop outbreaks when and where they occur. And so for that, what they need is access to the technologies and the know-how for health innovation and the freedom to do research and produce without any constraints such as intellectual property rights, which again are a policy tool, they're not a natural right, and you also need access to, of course, the capital to build and sustain the needed infrastructure, for instance, through regional R&D hubs. And of course, all of this, that it needs to be considered as common goods for health, not private commodities for business, because we're talking about the biggest health crisis in our lifetime, and maybe future ones. And so you all know the saying, give a person a fish, and they will eat today, teach them how to fish, and especially allow them to fish in the collective knowledge point, and they will actually be able to take care of themselves. And because that's actually what we do today, we stop them from actually using the knowledge and technology to develop their own solutions. And again, this is a political choice that we have done. And we know in military, there is this concept of technological arms race, and you don't want to share your technology, but it's a mistake, and actually we do it too often to compare health security with military security. And it's a mistake to use that language and that thinking and that narrative for global public health. Health threats are very different. Advantages in health technologies in one country do not translate in health security. No one is safe until everybody is safe against epidemic threats. We all know that viruses and other pathogens, they cannot be contained by borders. And that's why it's so critical that more countries and regions are allowed to and empowered to be part of that health innovation ecosystem, not as competitors in a global market, but as contributors to global health security that then can be viewed as a global common good. And so that is the essence, in essence, the type of transformational change we need for troop preparedness. And that will allow to put equity at its heart as demanded today by many global South countries, for instance, in the discussions about the pandemic treaty. That is what they want to be allowed to establish maybe a parallel ecosystem in other parts of the world. If the Western world says we want to continue how we do it, fine. But can we create space such that in other parts of the world there can be different ways of addressing that? And this is not your topic for today, for instance. There is an initiative driven by the World Health Organization in which a hub for mRNA technology has been created in South Africa and where this technology is being shared with researchers and developers and companies in 15 other middle-income countries such that they can actually develop their own mRNA-based health tools, vaccines, and other maybe treatments to protect themselves against the health threats that they are facing. I will ask you to come to the conclusion. Sorry. Yes, sorry, Michel. As you know, I tend to be a little bit long-winding because this is such an important topic. Maybe just one final thing to say is that quite often what we hear today is that there is investments in local manufacturing capacity. Now, that will not by itself create the equity we need. What we need is to actually share the knowledge and technology such that developers and researchers in the global side are no longer dependent on the charity response of the global north and that they actually can develop the solutions they need for their own health needs. And so one final line, health security cannot be gained by technological competition and business as usual. It's not a war against each other for technological dominance. It actually requires collaboration and sharing because we are all in this together against the virus. I thank you. Thank you very much, Els. As you know, the question is not whether we will have another pandemic in the future, but when. And one of the factors that we may well push us towards an imminent new pandemic are actually is the impact of climate and health. So I'm really grateful to Honorable Minister Barakat to be with us today and talk to us about climate and health and, of course, ahead of the COP28 that will be held here in the UAE. Minister, thank you very much. Thank you very much and good morning, everybody. One of our senior colleagues in the global health world, Peter Piot, was one of the first to say you cannot consider pandemic preparedness without taking into consideration climate and how true that is. And if you allow me, I'll just share with you some slides to highlight the connection between climate and health. The WHO has stated that climate is the biggest challenge to health of the 21st century. And if you look at a recent report of the IPCC, the Intergovernmental Panel on Climate Change, they say that under a high-emissions scenario, we're expecting 9 million deaths every year by the end of the century, just on climate reasons alone. If countries implement the Paris Agreement by the year 2050, we could be saving 1 million lives every year just from pollution alone. And of course, there's a financial toll in that, by the end of this decade, by the year 2030, we're looking at a cost of climate impact on health of between two to four billion dollars every year. So climate does a lot of things that impact human health. And you will have seen tragic news of flooding, heatwaves, of course, zoonoses, which means the jump of an infection, a disease from an animal to humans. And that's what triggered the COVID-19 pandemic. Vector-borne diseases. Vectors are essentially organisms that carry other organisms that cause disease in humans, for instance, mosquitoes. And I'll talk more on mosquitoes in a minute. And other things that affect what we call non-communicable disease like mental health. So climate change has a real impact on human health, and we need to take this very seriously. I'm just going to talk a little on mosquitoes, and forgive me, this is not a nice topic. But just to tell you, there are many mosquitoes in the world. But these are three of the nastiest on the screen. The one on the left, Anopheles carries malaria. The one in the middle, IDs carries dengue. And the one on the right, Kulax carries West Nile fever. These are all nasty diseases. Many of, in many scenarios, especially with children, will cause death. The WHO has stated that climate change is causing a surge in mosquito-related illnesses, particularly malaria and dengue. And we believe it's related to warmer temperatures, redistribution of water, human activity. So many things are related to climate are causing a surge on these illnesses. And this is the burden of malaria. We're talking about children under the age of five dying from cerebral malaria, entirely preventable. And this tragic scenario happens over and over again. We're talking about, you know, of the 619,000 deaths from malaria in the year 2021. About 80% were for children under the age of five. That's half a million children. So half a million children every year. And that's expected to rise. These children are dying from an entirely preventable disease. To add to this, another of the mosquitoes that's called Anopheles Defensi, having been largely confined to South Asia, is now entering Africa because of warmer temperatures and other things. And the problem with this particular mosquito vector, so this Defensi carries malaria, the problem with this one is it actually likes to bite during the daytime. So a big mainstay of managing malaria in the Sub-Saharan region has been giving children bed nets that are covered in insecticides. The problem with this mosquito is it bites during the day. And if it bites during the daytime, the bed nets are mostly ineffective. You know, you don't, it's no point protecting them at night when the biting is also happening in the daytime. And the other worrying thing about this mosquito is that it seems to be resistant to most of the insecticides, particularly the ones used in indoor room spraying. So this is of a concern. Anopheles has a cousin, it's called ID's, we saw it in the slide of the mosquitoes. This mosquito carries dengue. And climate change has accelerated the invasion of this mosquito into warmer, into other climates that are not prepared for it. It carries dengue and dengue is now spread in many, many countries. And the WHO has said that it's actually present in every WHO region. It will soon be endemic in the United States and many countries in Europe. And the number of people that are predisposed to it are almost half the numbers of people in the world. The numbers of people who have been modeled to have quoted last year were 390 million, of whom just under 100 million were symptomatic and the number of deaths are in the thousands. So this is what we're talking about when we are worried about climate change. Moving on to other non-vector issues like air pollution. We know that over 90% of people breathe unhealthy levels of air. A senior surgeon in North India in New Delhi is well known to speak about these topics. And he said that whereas in the 80s, 90% of his patients with lung cancer were smokers, he's saying that now half of them are non-smokers. And of those, a fifth are actually between the ages, are under the age of 50. So we really need to take stock of this and start acting. And this is where COP28 comes in. For the first time, ACOP is hosting a dedicated day for health issues brought on by climate change. And that day will be on the 3rd of December while COP is being hosted here in the United Arab Emirates in Dubai. And on that day, what we hope will happen is that it'll be a watershed moment for climate and health where we will raise the issues of the seriousness of climate and health issues, lobby support, and hopefully raise the issue of health on the political agenda. There will be the first ever ministerial on climate and health. We will be discussing public health issues, how to build systems, health systems that are strong enough to deal with the climate changes. And also we'll address how to do this in a low carbon way. So there's no point building hospitals that will generate more carbon. We're talking about looking at ways of doing it in a low carbon method. Of course, climate change disproportionately affects the most vulnerable in the world. Women, children, ethnic minorities, poor communities, migrants for displaced people, other populations, and those with underlying health conditions. And we have to address how to help developing countries deal with this problem. This is what health systems strengthening looks like. We won't go through all the topics, but it's a holistic approach. You can't just take one element and say, this is what a strong health system will look like. You need all the elements. And I will always emphasize leadership and governance. Number one is a very important component of a country's response to threats. And of course, the last one is financing. You can't do any of this without dedicated financing for dealing with the adaptation. On the health day in COP28, we are hoping to proceed with endorsement for a declaration on climate and health. This declaration was announced during the World Health Summit in Berlin on the 17th of October this year. And we're hoping that before the start of COP, we would have had many countries endorse it. And the declaration essentially is split into three parts. It talks about adaptation, the importance of adaptation to deal with climate health issues. It talks about increasing financing. Because it isn't a matter of taking more money from the climate budget. This needs to find its own source of funding. And then it also talks about the importance of mainstreaming health in all the climate agendas. And on my last note, what is the legacy of COP28 when it comes to health? At the end of the day, it's trying to save as many lives as we can by urgent catalytic action. And including novel mechanisms for looking at response. So in summary, COP28 will be a call for action for the first time for climate and health issues. So thank you. Thank you very much, honorable minister. And congratulations for this initiative on bringing health into the COP28. A major challenge for the future and pandemic preparedness. At this stage, let me say a few words about where are we as a global community from an institutional perspective? Where are we at the global level in moving towards better preparedness to pandemics? Are we drawing the lessons? So starting point I already mentioned is that despite warnings and past lessons of SARS, H1N1, Ebola, Zika, the world was not prepared to COVID-19 because we're going into these cycles of panic and then neglect. And to repeat myself, I do think we are in a phase of neglect again at this time. Last year at this conference, where do I have to press? Can I have the next slide? I have trouble. Thank you. The next one, press again. Last year at this conference, Ambassador Anders Nordstrom who was part of the independent panel on pandemic preparedness and response of which I was also privileged to be a member talked about the six main recommendations that came out of the independent panel work to the international community. One is the need for sustained high-level political attention and leadership. We have lacked strong leadership and coordination in our response to COVID-19. The second is modernizing our surveillance and alert system so that we can respond much faster to infectious outbreaks in the future. The third, as El Storelli discussed, is to build a new platform that will ensure equitable access to all in need to medical countermeasures. The fourth, and thank you Minister Barakat for mentioning that, is that we need new funding. We need new funding for pandemic preparedness and response. Fifth, we need a strong, independent, well-funded, well-functioning, world health organization. And sixth, at national level, all governments must start investing in better preparedness now. And following what Antoine Flau said earlier, one of the obvious areas of work is improving ventilation and quality of the air. The next slide. So at the global level, there are three ongoing processes out of the four that we had been recommending as an independent panel. The first is that for the first time in history, a special session, high-level meeting on pandemic preparedness and response was held at the UN in September 23 in the margins of the last General Assembly with a political declaration. I must say that this was a high-level meeting, but it was hardly attended by any high-level head of state. And none of the European major heads of states was there. No Chancellor Schultz, no President Macron, no British Prime Minister, no Madame van der Leyen, no one present, which to me is a strong signal of the phase of neglect where we are. Minister Barakat, we met in New York, so you were there. Congratulations to the UAE. The second is that we have now started negotiations in Geneva since February 2022 of a new pandemic treaty, a treaty that would be a binding treaty according to international law. And this is negotiated under the auspices of WHO. You may know that in the constitution of WHO, there is room for negotiation of international treaties. The first one that WHO had negotiated was the International Convention on Tobacco. Third, there is a more technical process of revising what is called the International Health Regulations, but that is a very, very sensitive negotiation, because this is where we're discussing about how countries will inform the world about a new pathogens and also whether WHO will have or will not have the ability to move to a country and investigate a new outbreak in case it happens. The fourth, which is not currently in discussions, is that we had proposed that there is a Global Health Threat Council established, something like a Security Council on threats, so to elevate the issue of leadership. As we were discussing with Madam Barakat, the Secretary General of the UN, Antonio Guterres, came with an alternative suggestion a few months ago suggesting that the UN creates next to the Security Council a platform on all threats that are, let's say, non-military, food, water, climate and health. And that will be discussed at the Summit of the Future next year. Next slide. So the big issues, next slide, please. The big issues at stake in these discussions are governance, the topic of this conference, financing, and in terms of financing, we need financing in order to prepare ourselves to the next pandemic. We also need surge financing in case something happens, and then as Elz alluded to, we need to build regional resilience so that in every region of the world there is now an ability to develop, research, manufacture and distribute global common goods that are personal protective equipment, oxygen, vaccines, therapies that are essential in containing an infectious outbreak where and when it occurs. The next slide. As we speak, the latest draft of the pandemic treaty is on the table in Geneva and there are four very sensitive issues that are being debated. One is access to pathogens. You may know that in 2007 during H1N1, Indonesia said that it will not communicate the sequence of the virus to the global community because, and I make it simpler here, they said if we give this sequence to the world and then it serves the rich country industry to produce vaccines that will be sold to us at unaffordable prices, then this is unfair. So there is a lot of discussion now in the pandemic treaty negotiations around whether country should always give free sort of access to their new pathogens or whether a country that provides the information should have benefits from that information. Then there are major debates around medical countermeasures as Elz Torelli alluded to, including the sensitive issues of intellectual property, of research and development, modalities of technology transfer. There are discussions about financing. Financing pandemic preparedness is a global issue for everyone, so we all agree that everyone should contribute to funding pandemic preparedness, whether you're a rich country or a poor country, but of course with so-called differentiated responsibilities and that's what is difficult to define in the negotiations. And finally, WHO had suggested that it could come up itself with a system of providing equitable access of countermeasures, vaccines, therapeutics to the world and that is being negotiated. I don't think at this time that it is likely that these negotiations will come to an agreement by the deadline of May 2024. More time will probably be needed, but viruses don't wait and that's the problem. Let me add an optimistic note here, which is that whatever the challenge is, there is a word that is everywhere, every day in the negotiations which is equity and I think the main lessons that everyone has been drawing from the pandemic is unequitable access and now we need to find a system that would guarantee equity. Next slide. Now as in every negotiation, now the geopolitics are there and the difficult negotiations that we're currently witnessing in Geneva show how closely health is now intertwined with geopolitics and particularly between the tensions between the global north and the global south. Your Holiness Bartholomew, you alluded to that in your speech talking about the fact that they occur so strongly despite the diversity of the south, I think I'm quoting you here and that is what we're seeing, vaccine nationalism, the fact that the rich countries overbought all of the vaccines as they became available with no access to poor country has really left profound scars that we see in the negotiating scene in Geneva and then of course there is much less trust at this time in the multilateral system and then domestic international but also partisan political agendas has somehow forcefully entered into the global health discussions. Think of the attacks on WHO by President Trump and his administration or the misinformation campaigns from the Bolsonaro team. So that unfortunately the pandemic and health is no longer the one issue that brings countries together in those negotiations, it's in fact contributing to the polarization of our geopolitical world. Next slide. So what is clear now is that global health as I put it is a matter of global politics and that is why Thierry we need global health in the WPC as you allowed it to happen because the pandemic at national level has impacted every sector of policymaking and therefore at national level it is no more just an issue of ministers of health, it's an issue of all of government and at global level it's an issue that is negotiated now at the level of heads of states, ministers of finance, ministers of trade, ministers of development, it's a key issue at the G7 we will hear from Aruka in a minute at the G20 it is on the agenda of the UN General Assembly and all regional organizations such as the African Union or the European Union and it's become particularly an important interface between health and foreign affairs and I think it is remarkable that in the UAE we have a minister an assistant minister of health and research within the ministry of foreign affairs so the next slide and the last slide the question is are we ready for the next pandemic to me the answer is no we're not but it is our choice if we wanted to be so it's a choice now to put in place measures that will allow us to identify new outbreaks rapidly and to respond to them in speed where and when they occur and prevent an infectious outbreak from becoming an epidemic or becoming a pandemic and becoming a social and economic catastrophe such as the one we've seen and to quote here Ellen Johnson Sirleaf President Sirleaf who was the chair of the with Madame Clark of the independent panel she said new pandemic threats are inevitable but pandemics are a political choice the political choice whether we stop an outbreak or whether we let it move to the pandemic stage let me say I think the ongoing processes however difficult they are offer an unprecedented opportunity now for the world for focus and transformative change thank you so with this let's move to our next speaker and our next speaker is Haruka Sakamoto and she has been she is a senior fellow at the Tokyo Foundation for Policy Research and she has been tightly involved in the work of the G7 health and the G7 in preparation for the Hiroshima summit this year and I must say that to us in the global health community achievements in the declarations of the health G7 and of the G7 have been remarkable in the tense climate of negotiations that we currently face so Haruka thank you thank you very much for inviting me today so Japan hosted G7 summit this year in the Hiroshima and then pandemic preparedness was one of the major topic at the G7 this year but in 2016 Japan hosted the last G7 summit pandemic preparedness was also a main topic at that time there was a Ebola virus outbreak in the West African countries and then the significant amount of discussion has been made how we can prepare for the future pandemics since then many effort has been done for preventing the another pandemic but as we all know we could not prevent the COVID-19 so in this backdrop Japanese government again picked up pandemic preparedness is one of the key topic at the G7 with a specific focus on governance financing and global rulemaking first is about governance I think this is not only the issue for the health sectors but if any kind of global crisis happens such as climate change energy crisis or recent Gaza situation food or which country or which organization to taking a leadership role is a really difficult question I think this is the same to the health sector so if the pandemic of the global scale happens which country or which organization or food takes the leadership role is a really really big issues of course we have the WHO but as just Michelle mentioned now global pandemic or global health is not only the issues within the health sector but this is intertwined with several other sectors and this regard which of which organization which country or food taking leadership role is a really really big issues in the governance so Japanese government pick up the governance of the pandemic preparedness as one of the key point of this year's summit and of course we have the WHO where health ministers across the globe gathers and then discuss with the technical aspect of the pandemic preparedness but this year's G7 also highlighted the importance of having a higher level head of the state's level dialogue platform which head of the states of the each country discuss not only the impact on the health sectors but also the pandemic poses on the other sectors such as trade or economy and next point is about financing we need money in order to prevent spread of the viruses but question is who make a financial contribution to the global pandemic especially like the COVID-19 many high income countries are also largely affected by the COVID-19 and then those country has no not adequate capacity to financially support low and middle income countries in that case who or which country make a financial contribution to a global scale so g20 not g7 took a leadership role and then created the new financing mechanism so called a pandemic fund and that this is the basic idea of the pandemic fund is asking the donor country to make a financial contribution to the pandemic fund and then g7 this year also highlighted importance of the pandemic fund and then actually financially contributed to the pandemic fund and then showing their support to the pandemic fund but still because the since after the Lehman shock the money coming from the g7 countries or traditional donor country has been stagnated and then when global scale of pandemic happens the money coming from the those traditional donor is not adequate at all and we really need to mobilize resource other than g7 countries including the private sector or market and then there is a still ongoing debate that how we can mobilize the money from the private sector or market as an ongoing debate and we really need to consider such kind of the financial mechanism and third one is about the global rulemaking which michelle already explained the detail about the pandemic treaty and i think this is not an easy roadmap to agree upon the pandemic treaty because there is so many conflicting interests between or among countries but again this year of the g7 i think g7 is a country with a shared value showing the support for the pandemic treaty is kind of the sending a political message that we need to unite in order to prevent for the future pandemics i also would like to highlight the importance of the innovation of the pharmaceuticals so when next pandemic happens and if we can create vaccines more quickly we can save more lives which is good so of course innovation is a key for the future pandemics at the same time there are many challenges and concerns regarding the innovation for the pharmaceuticals first one is the supply chain risks second one is technological transfer it together with intellectual property rights issues and the third one is equitable access and delivery first one is the supply chain risks so now most of all pharmaceuticals its ingredients or original materials are largely rely on china and any country even the united states cannot complete the supply chain of the pharmaceuticals without china and which now recognize as a kind of the security risks and then there's now considering how we can secure or diversify the supply chain is one issues and second point is the technological transfer so even if we succeed in the vaccination research and development we need to the several millions of vaccination but usually country does not have such manufacturing capacities so whenever global pandemic happens we need to collaborate with the country having the manufacturing capacity at a large scale such as china india or south africa or several other countries but laboratory transfer the new technology isn't always a concern especially together with the intellectual property rights so we also need to enhance the capacity at the global scale together we need to consider how we transfer those technology at a timely manner and then we also need to consider how we deal with the intellectual property rights especially during the pandemic and lastly about equitable access and delivery of the vaccines i think this point has already echoed with the other panelists but the equitable access was a very key issue during the COVID-19 so many high income countries bore a huge amount of vaccine while the low income countries has no access to such vaccination so we also need to create how we secure the equitable access and delivery of those medical countermeasures so lastly i'd like to touch upon the relationship between the climate change and then health which are already mentioned from the assistant health ministers so health secretary also emits significant amount of the co2 so if health secretary is a country the total amount of emission of co2 is the fourth largest in the world during the COVID-19 thanks to the vaccination we could save many lives but at the same time there was a huge amount of medical waste and they put a significant burden on the environment so before health secretary only to concentrate saving lives anyway but now health secretary is also recognized that health secretary also have a load to the climate change which means we need to prepare for the future pandemic we need to promote innovation for the pharmaceuticals or we need to attain equitable access of the pharmaceutical while we need to decrease the green gas emission or we need to attain net zero emission in the health sector but let's think that is it really possible that we delivered the vaccine at the last one mile of every country with no green gas emission i think this is a really quite tough question but we need to consider it so in the conclusion i think the are the question to the uh are we ready for the future pandemic i think still you know but we need to learn from the lessons from the COVID-19 and then also now we need to think about the climate change perspective whenever we do something for the future pandemic thank you thank you very much haruka and thank you to japan for emphasizing so strongly equity in the g7 and also in in new york i i heard minister takemi speak and equity was always at the top and the forefront of his interventions our last speaker will provide us with a few thoughts about how europe is preparing for the next pandemic and the speaker is jack bio who i suppose is well known to this group a former director of the eco polytechnic in france jack the floor is yours thank you michel and thank you to cherry of course for this kind invitation it's uh it's both a honor and a privilege to be here with all of you and i learn a lot from other panels so we're just one word to say that i have no conflict of interest on this one view of my other positions and that views expressed here are my own um as i was aware that i would be the last hurdle before the before lunch i think i have only four slides after this one so we'll first look into lessons to learn from how europe fared with the covet 19 and then we'll try to look at the ingredients of of a pandemic management and then we'll try to assess the key performance indicators of europe in terms of preparedness and and i will try to make a conclusion so how did europe fare with covet 19 well i'd say not not that bad you know we're very good at really uh uh chasting ourselves in europe but but i mean this is not legible from the back of the room but basically the circles show the european countries this is a graph from the john hopkins institute which followed the statistics of of covet and and this graph only focuses on the 20 most affected countries so you see and you see that actually europe is pretty much uh in the average the very good ones uh were mostly asian countries uh south korea and Japan and the less good i would say uh guys were mostly well peru which was clearly an outlier and uh and and the us in terms of mortality the graph on the right is not is is the case fatality ratio which shows that on disrespect many western european countries were pretty good at limiting the impact so they had a high mobility but they were able to limit the uh i would say the impact of the disease probably because they have systems were were pretty good now if you go into a more detailed assessment and you look at all countries in europe you will see that i mean we had some countries especially in eastern europe which were pretty badly affected and which didn't fair as well as those ones so my take on that one would be that well there there wasn't really such a thing as europe because there were pretty uh i would say unequal responses in terms of time and management uh the europeans for instance left our italian friends for a long while uh completely alone with what was happening in lombardia um the brit sweet at that time was still i would say uh in europe made their own i would say policy but still there is one great success which i think we should recognize which is the decision by the commission to procure vaccines as soon as they were ready on a centralized basis in order to avoid competition between countries and i think really that was the one of the first times where really europe played a very important role in terms of taking care of of its citizen in a in a practical way now what are the ingredients for pandemics management that has been touched upon quite a lot by by other speakers what we should remind is that the next pandemics will not necessarily be like like covid you know i mean uh entran showed us that uh covid-19 was airborne but if you look at his the history of epidemics there were plenty of epidemics which were not airborne which were contact born water born or and and so um michelle say that the the next pandemic is a certainty we don't know we only don't know when and i would add we only don't know which bug and and the bugs may differ in terms of the uh way of transmission uh with a big question very often which is at which time does the bug become i mean at which time does the transmission become interhuman if the bug comes from somewhere else i would add another division in in the classification of bugs which is whether they are susceptible or not to uh humoral immunity and to which is what you use basically for for covid vaccination let's remember that even with RNA we still don't have a vaccine against AIDS after 20 years like 30 years of research we don't have a vaccine against malaya or we hardly have one etc and and we had issues with the dengue vaccine so i mean mankind was pretty lucky and talented to quote Woody Allen but but uh in having a vaccine so fast because i mean with other bugs it could become much more much more difficult if on the right side the the graph is much pretty much a consultant's graph which i borrowed from the european cdc i've been a consultant for many years so i'm not this is not pejorative but basically i tried to see what do you need in terms of practical skills if you want to implement the skill of preparedness and the response and the feedback and i think if you ask the layman in the in the street they would pretty much think that i mean pandemic management relies mostly on epidemiology if they know what this means and an infectiology and that this is a health issue but it's it's not just a health issue it's an issue where you will need to test and trace and contain and protect and and so you will need people versus with no in order because if you lock people down you don't do this without having riots or protestations or things like that you will need you may need environmental measures and and i was happy to hear about the climate impact because i mean for instance you may want to reduce a source of pollution which is aggravating the disease etc so i'm not going into detail of this but let's remember it's not just a health issue it's it's really a political issue which involves almost every part of an administration now where is europe from this respect well first of all you need institutions i mean i mean pandemic preparedness cannot rely on on disorder and and that's where you immediately face some i would say questions uh because i mean if you for those of you who've been really who've been reading the uh recent book by Agnès Buzin who is a friend and the former minister of health where she explains how she lived the beginning of the epidemics you see that it was really difficult for her to find who would make the right decision and and she was kind of going from one person to another one and although she was a medic and she had the feeling that something bad was coming so the coordination between WHO and the ecc ecc ecc ecc and here are which is a new agency which uh europe created which is the basically for a health emergency response and the awareness and the role of the commission and the role of the governance in view of subsidiarity i mean nobody really could say how this is going to be coordinated we in France are very good at creating coordinators but usually we create so many of them that you need somebody to coordinate the coordinators and so we are still at the stage where i mean we will need some uh agreement between the various parties as mentioned it's not just health it's health but it also involves foreign ministers if you need to close borders you need the home office if you need to lock people down and check that they don't get from out from their homes you need local authorities and here again you will need to balance the the responsibilities and certainly you need central decision making but also you need local action and uh in in europe it often happens that there is kind of a divide between both ends of the chain uh in terms of of epidemiology and public health i think we had a lot of of scientific deglobalization just in the wake of the global i would say deglobalization and and i think scientists really need to speak together whatever happens i mean whenever kind of fighters and the combatants are fighting each other or or distrusting each other but we need scientists to be able to travel and talk and exchange data and that's certainly something which we must emphasize for the next pandemics in terms of containment europe has a specific issue because we have what we call the shengen setting and so you don't close borders like that so if we have to lock down this will be a difficult issue and finally in terms of finding the cure and the protection i really i think we need to realize that there has been a steep decline in the uh in life science research and uh if you look at the noble prizes and at many many publications certainly many of them were not done in in europe we still have very strong research institutions and i'm not going to quote them all but they in germany in the uk in italy in in france in switzerland i mean we really have great institutions but they don't receive the amount the amount of public funding that their american or chinese counterparts or probably japanese counterparts would receive um we clearly have a pharma industry decline i mean because of course containment for decades and we also face the same issue that was mentioned of uh of drug shortages which i would want to emphasize is mostly due to the fact that i mean authorities have not been attentive enough to the fact that within a production chain which usually includes tens of steps one step is in the hands of of a of a lonely of only one producer and whether he's chinese or wherever i mean we had shortages in europe which were due to problems in facilities in in sweden or in italy or in france so it's not once again that's not just blame the chinese for having taken the industry i think it's more a question of procurement and and making procurement safer in in the pharma industry plus the pharma industry has completely i would say outsourced its research and and that's by the way good thing because that's how we had the vaccines for for for covid but but i mean the french the sorry the european pharma industry is certainly much weaker than what it was 20 years ago and and and then finally we have and this was emphasized by antoine i mean with a trump example but we also have a high level of anti-vax sentiment in europe and that's something which would make protection difficult so my takeaways i think really must everybody who is responsible in politics we must avoid looking for scapegoats i think in the beginning of the epidemics there were many people who tried to blame others and i mean when when there is pandemics it's not the time to blame others it's the time to work together and that's something very important and and at the time of x twitter now x and and social networks it's it's really difficult to protect those who make decisions and and that's a big issue not just in healthcare but it's an issue here um we really i mean need to see how we can prolong the idea of the of the centralized vaccine procurement scheme because at this stage it was to some extent one shot but but how can we make this happen in the future because with another commission you don't know what what might happen we need to really build again medical staff because all over europe we are lacking physicians and that's a that's a big issue not just for pandemics but it will be an issue for pandemics we have in general a profound decay of of public health systems because of course containment that has been going for for years we definitely need more public education you know education was raised in several panels during this conference and i think it has to do with the economy but i mean much of the anti-vax sentiment and the resistance to lockdowns etc is due to the fact that our populations are are less and less educated and we need to really put a focus on education and that's my last bullet point really improve the priority for science i'm struck by the distrust for science which you can find in the the population but also among politicians and and among media and decision makers and so i think we should all strive to say that humanity would prosper if you if we encourage science and rely on science thank you for your attention thank you very much jack and thank you for your plea for science if there's one success to the covid pandemic it's really open science there's been no borders and there have been new systems put in place that really have allowed a wide and rapid communication of scientific innovations we have time for one or two burning questions yes Jean there's a can we have the microphone oh i just wanted to ask is a diffusion of insects has to do with a ban on pesticide because you assume that he was related to climate change from what i know insects love water more than eat so we had malaria in europe in the 19th century and malaria disappeared because we use insecticide so what do you think of that point of view thank you maybe can i turn that question first to entran and then maybe minister would you like to add something entran yes thank you for for this question jean de carvas do i i think um you're right it's a complex issue and it's not just a question of climate change about the insect what is not completely true is that the role of of the temperature is key when there is it depends on the vector when for for anopheles for instance having warm temperature and flooding favor it's it's propagation and proliferation and we have seen in for instance in the highlands of some of of zimbabwe to take one example when the the mosquito was not able to proliferate where harare the capital is is now a place due to the global warming which is prone to the vector proliferation for the dengue mosquito it is a bit another story because it's the warm weather and the dry conditions which favor surprisingly or paradoxically the proliferation of the mosquito and because of the drought you collect waters and you store the water close to your home and then the the mosquito proliferate very close to you in the garden where you have this collection of of dormant water for for weeks so it's a complex issue it's not only a question of global warming but global warming play a leading role thank you minister thank you and just very briefly to add to that just to show the point there are areas in the world that have eliminated malaria that are now seeing new locally sourced malaria so for instance some states in in the united states of america they're facing new cases of malaria caught within the country and not brought from another that that's the a real example of implications of what we're talking about thank you so with this i see we're on time and i'd like to ask you to join me in thanking all our panelists for a fantastic session thank you all