 This is the first big global pandemic after 1918 influenza epidemic. The world is unprepared in spite of repeated warnings. This is the cycle we have repeated through 2003 SARS epidemic. Swine flu, avian flu, Zika, Nipah and Ebola. The prophetic words of the Global Preparedness Monitoring Board co-convened by WHO and World Bank September 2019. For too long, we have allowed a cycle of panic and neglect when it comes to pandemics. We ramp up efforts when there is a serious threat. Then quickly forget about them when the threat subsides. It is well past time to act. There is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people and wiping out nearly 5% of world's economy. A global pandemic on that scale would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared. As on 10th August, SARS-CoV-2 has infected 20 million people and killed more than 700,000. It shows no sign of abating. We have seen the herd immunity disaster in UK and Sweden and that of ignoring the epidemic by the US and Brazil. Only vaccines and drugs, if we discover an effective treatment can help us. Herd immunity can come only from vaccines. Experts expect vaccines to be available by the beginning of next year. A number of medicines are being repurposed and are in clinical trials. So far, only two have shown some efficacy. Vaccines and drugs may be available, but will they reach the people? We already know the US approach. Warp seed's main goal is to protect the United States. The attitude here is the Oxygen Mask approach, the official says. Swaminathan has cautioned us against vaccine nationalism. Yet money and national interest may win out. The United States and Europe are placing advance orders for hundreds of millions of doses of successful vaccines, potentially leaving little for poorer parts of the world. Will we see a repeat of the AIDS scenario where 15% of children in Uganda had been orphaned by the disease and more than 35% of adults in Botswana were infected. But the three drug antiretroviral cocktail necessary to treat the disease then cost a whopping $10,000 to $15,000 per person annually. In the 13th International AIDS Conference in Durban, South African High Court Justice Edwin Cameron denounced the shocking and monstrous inequity of the global trading system that failed to provide dying AIDS patients in poor countries with affordable treatment options. Thanks to SIPLA and Indian patent laws, generic AIDS medicines were available at $350 and thousands of lives were saved. These are the 92 countries covered by WHO COVAX vaccine facility. There are low-income, lower-middle-income and additional IDA-illegible countries. If vaccine costs around $3 a shot, $6 billion will get us $1 billion doses. Gavi has only raised $600 million and is targeting to raise $6 billion. This will cover only $1 billion out of $7.5 billion of the world's population. So what about the rest? This will not cover most parts of Latin America and the poor in rich countries who will get the drugs at market prices. There are a series of questions that crop up. How do we make vaccines available to all for years to come for all the $7.5 billion people? Vaccines may only give you short-term immunity. So what about vaccines for everyone every year? And now the US buys up three-month stock worth of remdesivir. So then why can't we break Gilead's patent? Though her declaration of 2001 as well as patent laws of most countries allow them to break patents under epidemics and health emergencies. Why can't we? Welcome to the second session of a discussion series organized by NewsClick in collaboration with Brazil Defato, PA TV Gana and People's Dispatch on COVID-19 pandemic and our challenges. The first session was held about two weeks ago. Today we will focus on IT issues and access to medicines and vaccines. There is a plan to organize more sessions in this series so please keep an eye on the information for the next session. My name is Vinita Baal. I'm an immunologist by profession and a women's rights activist beyond that. My interest also includes health located in the science and society context. I'll moderate the discussion apart from setting up the stage for our speakers. Why do we think intellectual property related issues are relevant in the current pandemic? That's the question that we are trying to look at. So before that let's very briefly consider the SARS-CoV-2 virus causing the illness COVID-19. In the last eight months the pandemic has affected more than 20 million individuals and has caused more than 700,000 deaths globally. The infection is still spreading in most of the countries and majority of those who are infected remain without symptoms. Thus their immune response is dealing really well with the infection. A minority of the people who do fall sick and need medical health, oxygen supply, ventilators or ICU based care. There is a large proportion of population which is not infected with the virus yet and hence remains susceptible. If effective vaccines become available they will help in generating virus specific immunity in the recipients. This immune response is likely to last for a long time and hence provide protection from future exposure to the virus. The critical question in today's context is as and when vaccines become available, who will have access to them? Since limited number of vaccine doses will be available at least to begin with, how will priorities be decided? Will money affordability be the primary consideration? And hence will poor people from the developing countries be denied access to vaccines? Will the real needy people who are in the high risk categories such as doctors, paramedics, elderly people, people with comorbidities and so on be given priority? What are the ways in which vaccine access can be and should be regulated? Today's panelists will discuss this issue after this introductory part. This is about prevention. Vaccines are about prevention from COVID-19. The second point is about treatment of COVID-19. And at two different time points treatment is useful or at least is available. When a person is infected but has relatively smaller number of virus particles in her body, drugs can be used effectively to kill the virus. Once the numbers become huge and the person has symptoms such as fever or cough or breathlessness etc, drugs do not remain very effective. However, in most instances infected persons show no symptoms thus identifying such people and treating them is a non-practical option. Alternatively, drugs which can act in this scenario can be used for prevention. But how long does one continue to take such drugs? Hydroxychloroquine or HCQ for short was supposed to be useful at this stage. But clinical trials have not really been useful for it. HCQ may or may not be safe drug to continue taking indefinitely because the pandemic seems to be going on and on. This is the case especially if you have heart disease or kidney problem or diabetes. Remdesivir also falls into the same category. We will discuss about Remdesivir and access to it in our discussion. The second kind of treatment for COVID-19 is for those who are seriously ill. You might have heard a word of cytokine storm which can kill the patient. This is the host immune response which has gone overboard while trying to control viral growth in the body or trying to kill the virus. This stormy condition, to an extent, can be controlled or prevented by drugs like steroids for which there were clinical trials or anti-isle-1 receptor agent which is called anakinra or some other kinase inhibitors like ruxolytinib. These are all biologics. There are also biologics like monoclonal antibodies which are commercially available and which are directed against isle-6 receptor which is a commonly known antibody called toxinizumab. There is also anti-isle-6 monoclonal antibody called siltuximab. I know these are tongue twisting words but people in the field like to use such words so we have to put up with it. So there is also an anti-isle-6 monoclonal antibody which is marketed by Biocon in India and it's called itolizumab. So once again access to these drugs is also a contentious issue and our panellists will discuss that. With this introduction let me introduce today's speaker. Lorena Di Gianno is a lawyer specialized in human rights and HIV-AIDS. Access to medicine and intellectual property. Currently she serves as executive director of Pandasyon Grupo Efecto Positivo FGEP in Argentina and general coordinator of REDLAM. FGEP is the leading organization of REDLAM the Latin American network for the access to medicine. Lorena served as a member of the expert advisory group of the United Nations Secretary Gianno's high level panel on access to medicine and innovation. The second panelist is Kajal Bharadwaj. She is an independent lawyer who has been working on patents and access to medicines for 2D kids. She looks young but she's been working for a while. She has worked with the lawyer's collective HIV-AIDS unit, medicines are from peers in the office and the Delhi network of positive people. She has also spent some time at Yale University as a research fellow. She's involved in advocacy, technical and policy analysis related to implementation of the safeguards in the patent law. The third panelist is Pramir Pulkaster. He founded NewsClick, a progressive news platform which he has run extremely successfully for over a decade now. He's an engineer by training and a science activist in the power, telecom and software sectors. He is a part of movements that opposed the WTO and TRIPS agreements in India. It was the pressure of these movements and the left parties in the parliament that led to India using certain blue holes that existed in TRIPS and limiting the drug pages. This session will be conducted in the form of questions and answers. I also request all of you, whichever medium you are using to view this program, you should send in questions. All of those will be directed to us which we will try and handle towards the end of the session. So now I will start asking questions where the cap of the moderator and start with Kajal first. Kajal, will you elaborate first on whether there is really a problem with intellectual property in COVID-19? And if so, what dimensions has it taken? And it will also be good if you could comment on access to vaccines in India since India has such a huge manufacturing capacity. Kajal. Thanks so much, Vinita, for the great introduction and laying out the field. And thanks to the organizers for setting up this panel. I think like many others, despite all the work that we have done on IP and access to medicines over the years, we are also seeing and learning the many dimensions in which it actually comes into play. And it's been a learning experience even just the last six months. I think for those of us working on IP and access to medicines, the minute the pandemic was announced, the WHO announced the international emergency, we of course immediately knew that there were going to be barriers when it came to new medicines. The focus on repurposing existing medicines also meant that we would be seeing what we have come very familiar with as a tactic from Big Pharma, which is called the evergreening of patents. This is a tactic used by Big Pharma to file for patent applications and patents on new uses and new forms of existing medicines. And indeed with drugs like M-desivir, we are starting to see multiple patent applications in many, many developing countries, which are playing a big role in impeding access to this drug in many of those countries. We'll probably discuss that in a little more detail later. But also over the last decade and a half, having worked on treated agreements and seeing the amount of pressure developed countries put on our countries to expand IP, we've also got a sense of how truly expansive intellectual property has become. And I think that is becoming more and more obvious in the public domain as well. The first realisation of this probably came when news reports emerged about Italian volunteers and researchers who were trying to help out a hospital by 3D printing valves that were used for ventilators so that they could be used for more patients. And they approached the company that was not able to keep up with the valve production and said, you know, share your blueprints with us so that we can make these the valves. And of course the company refused to share the blueprints and understandably so they sell a valve for over 10,000 euros and the 3D printing brought the price down to a euro. These Italian researchers did actually make those valves. It did help the hospitals. But I think what was really worrying to see this refusal to share technology and blueprints was it came at a time when Italy was so hard hit that, you know, page after page in newspapers were covered with obituaries. And yet it was commercial interest that, you know, didn't allow the sharing of this very simple technology and solution to a shortage problem. Then we got the news of this standoff that was happening between the Dutch government and Roche, which was supplying tests to them for COVID-19. Roche had said that they could not keep up with demand and were in fact telling the government that, you know, you should limit your testing only to the symptomatic something that I think we've all dealt with in many countries this limitation of testing and we know what a problem that creates. And they basically wanted the Dutch government wanted access to the recipe for the testing fluid that was used in Roche's test. And Roche tried their best to keep the recipe a secret and eventually the European competition authority threatened to step in and they finally shared the recipe. So this recipe for the fluid isn't actually patented, but suddenly I think in the public domain this idea of what are trade secrets. You know, Koch's recipe, for instance, is a trade secret. What does this mean and how expansive it is. And I think we are also starting to learn what a great concern this issue of trade secrets is starting to become in the context of the COVID-19 pandemic. It can cover techniques, methods, compilations, processes, software applied in medical devices such as ventilators and diagnostic tests. It can include manufacturing processes, test data, medical formulas, cell lines and other biological resources, chemical formulas, processes for manufacturing and for vaccines and biologic medicines and can cover cell lines, genomic information and other biological materials. So this is like a real expanse of what we're looking at when we're talking about looking at trade secrets and how to address that. In terms of patents on diagnostic tests, we had a most peculiar response from the Indian Council of Medical Research in India when the epidemic just started. There was a case in the Supreme Court asking for all testing both in the public and the private sector to be free of cost. You know, I put in an affidavit saying that, well, most of our tests are currently imported, several parts are patented, so we won't be able to make it domestically, so bringing on prices is going to be difficult. Now, this was quite interesting and ICMR never really did clarify what they meant by these patented parts of the tests or how domestic producers of tests have now brought around that. And I think that's an interesting question for Indian advocates to pursue at a later stage, but it seemed to play a role in a pricing cap on tests rather than making testing freely available in the private sector. We've also seen this problem with CB NAT technology, which is, you know, tests that were used for TB have now been repurposed to be used for COVID-19. They deliver test results in 45 minutes and one operator described it to me as idiot-proof technology. So you get really accurate results and it's not dependent on the operator. Except these machines are available in multiple developing countries and they can be used, but the tests cost $20 for tests. We know it could actually be $5. There's enough analysis on that. CB NAT, which is the company that produces gene export machines, has said they can't keep up with the demand, but they don't want to really share the technology or expand their manufacturing partnerships. So again, we're looking at, you know, of course these cartridges, etc, are patented. There's of course the story of the N95 MAS, which I think is now, you know, I think well known to everyone, one of the biggest producers in the world is a company called 3M. They bought hundreds of patents on MAS designs, but most importantly, they're very aggressive enforcers of these patents. They have also enforced these patents in India against a local manufacturer called Venus, where they went through a very lengthy litigation against a patent N95 MAS design to get an injunction against the company. 3M again has said they can't keep up with the demand. In the US, they have been called by state governors saying release your patents so that other companies can start manufacturing them, but of course they won't. I think the cherry on the icing on the cake of 3M story is that they then launched litigation against distributors who are price gouging because of the artificial shortage it was created by 3M itself. So I found this rather hilarious moral high ground to take against the price gougers when you yourself are creating, you know, the artificial shortage. So I think what we started to realize is there's a range of intellectual property that can directly or indirectly impact COVID-19. I think since vaccines are foremost on everyone's minds and to be, let me be upfront, it's an issue that I'm only starting to deal with and it's extremely complicated. There's this big question on whether patents on vaccines can actually impact access and production. And I think for the longest time, if you go into literature, there was this notion that actually IP is not so much of a concern with vaccines. It's the processing technology, it's the regulatory landscape, and that's what inhibits how competitors come into the field. But I think research over the, you know, as we've learned from one infectious outbreak to another, whether it was SARS or H1N1 or MERS, there's been more research to show that this is an extremely naive view of the role that IP plays when it comes to vaccines. So one of the interesting things I would tell our viewers to do and attendees, and I would hope that Benita would also have time to do this, is to go to the European Patent Office's website on COVID-19. They've set up these searches that you can do for various candidates for medicines, et cetera, but also for COVID-19 vaccines, where you can look at the patent applications and patents on it. And it's quite fascinating to see what that throws up. Not only does it throw up hundreds of patents at patent applications that are probably still active because they trace this from 1995 onwards. The subcategories of patents is quite interesting because it covers and hopefully Benita can work us through some of this terminology. They cover live, attenuated and inactivated vaccines. They cover virus-like particles. They cover viral vectors as vaccines, nucleic acid-based vaccines, antigen-presenting cells, nanoparticles, adjuvanted vaccines, and administration route, which could be intranasal, mucosal or oral. So that's just the categorization that the EPO, the European Patent Office, has done in their searches on COVID-19 vaccines. And other studies have found that most patent applications on vaccines are extremely broad. They can cover starting materials including chemical reagents, host cells, vectors, DNA, RNA sequences. There are composition patents. There are patents related to vaccine process technologies, method of use, including how you administer to children. The populations you can use it in the elderly and those regimens. So the world of vaccine patents is apparently open for anyone and everyone to micro patent any and every aspect of vaccine production. There was a recent study in nature that also looked at the patenting activity on mRNA vaccines, which is the newer sort of vaccine, which I think we will see new outcomes. I think it's the first time we will see mRNA vaccines in COVID-19. And they looked at the level of patenting and found 113 patent families. They found that Moderna, CureVac, BioNTech and GSK collectively own nearly half of the patent applications. And these are also the companies that are pursuing these candidates. And there's an increasing filing that's happening in multiple countries on these vaccines. I just wanted to end with a couple of points on this expanse of what we're looking at in vaccines. Is that there's some interesting case studies on the Hepatitis B vaccine that used to be played out regularly in international agencies, saying that IP is really not a problem. And the Hepi vaccine show that you could have multiple producers and the prices would come down. Now what those studies actually missed was that when the recombinant Hepatitis B vaccines came out, the two producers, Merck and Swiftline Beecham, had to get licenses to nearly 90 patents, 90, from public universities, public institutes and private companies before they could produce their vaccines. This is daunting for any manufacturer in any country. If that is the sort of licensing and landscape and, you know, I mean, good for my fraternity, the legal fraternity and how much we would make out of this. But you know, it's a daunting idea to think of the maze and the landscape you would have to go through. And I think this complicated landscape, even in COVID-19, is showing its effects. Moderna has just lost an attempt to try and, you know, invalidate a patent held by another patent holder, which impacts their vaccine that they're pursuing. They have recently said in their filings that they cannot be certain that we were the first to make the inventions claimed in our patents or patent-pending applications, which are scary news for their shareholders and so on. It's also emerged that the U.S. government has many patents on this, and hopefully that public holding of patents may, you know, one can only hope result in more manufacturers. Inovio, another COVID-19 hopeful, is now currently showing another partner saying that they're not releasing their IP that could allow them to get faster regulatory access. So this litigation around the vaccines is already starting and is probably worrying. And I thought I would just end with a very telling statement that was made by an Indian vaccine producer, Serum Institute, which basically when they were talking about the two candidates that they are looking at, I think it's two or three that they are maybe developing, and they said that, you know, whoever makes and develops the vaccine will need multiple partners to manufacture the vaccine. I hope that whichever company develops the vaccine will not hide behind patents and makes it available even on royalties or some commercial understanding to as many manufacturers across the world to make billions of doses quickly. I can speak for my company, we're not going to patent this product and we will make it available to as many people as we can. And then he says something really interesting. We are able to do this because we are a private limited company and this is a part of why we didn't list because we are not accountable to shareholders. And I thought that was a really interesting statement for them to make, you know, other issues would set them an affordable PSI. So I'll probably stop with that background of how complex the field seems to be getting. Thanks. Thanks, Kajal. I'll ask Lorena to sort of make a comparison. So what differences do you perceive in the access to vaccines in Latin America as compared to the picture somewhat global but also somewhat India specific that Kajal already highlighted and what are the differences between capabilities in Argentina where you are from and the other Latin American countries? Thank you. Thank you for your invitation. Well, for us as treatment activists, we have been working for so long on the access with the special focus on intellectual property. So for us, the most important experience that we have is working with access to medicines because we started working on HIV and also on hepatitis C with a different logic of the COVID-19 pandemic is showing us as you explained in your presentation. So we were used to be concerned about the sustainability of our treatments because we have to take the treatment every day. So this is why we started working on patterns that are blocking the access and production and accessibility of the medicines. Well, the world of vaccines is a bit new for us because as I explained in HIV, there is no vaccine available and maybe this is the logic that the companies that really have the power in this pattern system that is globalized and every part of the world we have the same problems. The companies didn't have any interest to develop vaccines for HIV because they prefer as they don't want as healthy, they don't want as dead, they want as with illnesses and with a chronic treatment. So this is new and we have really facing challenges in order to adequate our capacity to work civil society on the access to vaccines. As Gadiel explains, the pattern issue is also linked to the access which is also blocking or will block the access to the new vaccines. We are doing research and we have found that they are at least 119 patterns that are related to the clinical trials. Basically these vaccines studied the clinical trials for other illnesses or with SARS, with MERS and Ebola. And that's why we have an advanced stage of the clinical trials because with MERS it is impossible to reach a treatment or to a vaccine. So we have to highlight that the proximity of having a really effective treatment or vaccine is because we have a lot of research on medicines with broad spectrum. So, but let me tell you, you asked me about what are the differences between Latin America and India. And in Latin America we have a strong capacity to produce, especially in Brazil, in Argentina. And Argentina is a key source to export for the region. Also Colombia has a private strong private sector to produce medicines and vaccines. But in this framework the patterns are of great concern because they block the local production. And most of these health technologies are coming from the United States, from Europe or from Japan. And I mean, what we have in our countries here are patterns that are foreign patterns. It's not a local pattern. So this means that we have really a concern when pattern application is filed in our pattern office. Also an important thing to understand Argentina pattern system is that we have what we call patentability guidelines that is a measure that was adopted in 2012. And it has a rigorous system for pattern examination. And it determines which pattern applications are eligible to grant a pattern on what not. These patentability guidelines are attacked by big pharma. A joint is a chamber of multinational companies are attacking in a judicial case these patentability guidelines. So they want to weakness our system. A civil society we identified some years ago and we started with this opposition work that is in the TRIPS agreement. It's a health network. Very important from the point of view of civil society is in the TRIPS agreement but also is in our national law that is the possibility of third parties to participate and collaborate during the pattern examination. Mostly to give arguments and also proves that pattern application is not meeting the patentability requirement. This is a very important tool that we have been using for HIV for example and also for hepatitis C. And the most important objective of using this instrument is to have a market without patterns so we can produce locally. This is very important for example in the case of hospital VA that is a drug to cure hepatitis C. When we started this work when this drug entered the market it was very expensive $84,000 per person per treatment. This is the price that Gilead who was seeking patents in Argentina for 14 different patents as Kajali explained that these companies abuse the system. They are using but they abuse the system. When we started this work the company was offering these very high prices that are not affordable for our government. We started analyzing taking the photocopies of the patent applications and analyzing them and we realized that they were not meeting the patentability requirements that are in place in Argentina. So what we did is to provide the patent office with very key information about this and we requested the patent office to reject the patents. Finally, we also talked with local producers that were interested in software and they also filed patent oppositions. So at the end what we have is that the patent application, the main that blocked the production were rejected by the patent office in Argentina. So we don't have any patent barriers and because of this many local producers because now we have five different registries for local producers in Argentina and they compete in the public tender. And in the last public purchase of Sophotovid we could get 350 per person, the price 350 per person per treatment. So as you see, the result of our work on patent oppositions is effective and is really helping us to blow up the access and secure the sustainability of the public programs that procure free medicines for all the people who need. This is the same with HIV. The problem when we have a patent granted is that we must depend on international procurement and on the prices, the high prices that the companies who hold a patent want to sell their products. So now maybe for the next question, but regarding to COVID-19, we are also using the opposition work on treatment basically. We are doing a research on vaccines. Lorena, let's talk about COVID specific responses in the next round. Yeah, so that I can get more specific responses from all three of you in COVID-19 drug context. Let me move on to thanks Lorena. Let me move on to asking Prabheel a little more to provide us with a little more historical perspective. So how would you describe the developments linked to WTO and TRIPS and countries going back and forth on their promises globally? And in this context, as I had introduced the achievements in your name, you were part of the team or part of the people who actually managed to do these negotiations or bring the sense in a sense into the process. So give us a flavor of that process in the context of touching upon the context of COVID-19 as well. I guess it is right that you ask me about history because given my age, I really belong to history and not the future like Kajal and Lorena. So coming to the history of disease in this particular case, you know, we were very young infectious diseases were around, at least in our countries, though in the West it somehow had started waning, but infectious diseases is very much a part of our lives and therefore, patents under which India operated and so did most of the, what would be called today developing countries and that time we were still in the colonial phase and that period we suffered from what would be called colonial patent loss, which persisted even after countries became free and it was a 20-25 years struggle in India for to free the Indian public sector as well as the private sector from the patent regime and we did away with that that time product patents. This is also done in Latin America. Latin America also at that virtually in the same period did away with product patents. They only permitted process patents and the prices of drugs, which according to an American Congressional Committee was the highest in India. At that time in that committee's report, they examined about I think 30, 35 countries. We were the poorest in that list and the drug prices in India for antibiotics used against infectious diseases, we were the highest. So all that changed and we got into finally a situation where we could produce drugs in sufficient amounts and also at prices that people could afford. Then we got to the TRIPS agreement and we saw reversal of that. We thought we had won the battle with the AIDS epidemic and the fact that in Doha 2001, in the Doha declaration, there was an acceptance that in a health emergency or in a pandemic epidemic, patents could be broken and countries could be allowed to produce without the patent is approval if required and they could even ask companies in other parts of the world to produce for them even if that country did not place that order, they themselves could place the order in that country. So it was possible for Indian companies for instance to produce drugs for other countries. Now this today we seem to have reversed again and here it's not a question of the laws. It's really a question of the political will of the countries and whether the health authorities of countries are willing to fight those who are the patent holders and those countries which are backing patents. Let's be very clear. It is not the companies we are fighting. It's also the countries which are behind the patent holders. For instance, a lot of examples have been given that we give another example where Bayer's next of our patent was actually a compulsory license which was issued in 2012 in India. Bayer said that this is theft, that we didn't make these drugs for Indians. We made it for rich western patients who could afford it. So it might be a life saving drug but if you are poor and you can't afford it too bad. That was Bayer's CEO statement. Now after that the US trade body got into what is called the USTR. The trade representatives office got into that. India was threatened that you would do any other compulsory licensing your head. So after that we haven't issued any other compulsory licensing. Even today when you are talking about vaccines and medicines whether it's remdesivir or whether it is the vaccines. The question is, is it possible for those patents to hold under the current conditions of pandemic and what is accepted by every country as a health emergency? Even Mr. Trump seems to have accepted it. I think the only exception is Bolsonaro. So having accepted all of this, is it possible for the law to be implemented that the patents would be worked and the public cannot get access to vaccines or medicine? The answer is no. There is no legal bar that I think has already been cleared. Whether it's Argentina, whether it's India, whether it is most countries in the world have the provision for compulsory licensing. This is there in almost every country's laws. And as I said the Doha declaration, WTO has also accepted. Yes, this is there and countries can do this. The question is why aren't we doing it? Why is it that we still want to operate under the patent regime? Why is it that 3M is even if it fails, why are compulsory licensing not being made available to others? You have the details also in the patent application. So it's easy to replicate it. There's no rocket science in making masks for Christ's sake. So when you don't do this, that means you are afraid to buck the big brother. United States and its trade regime. So that's where we are coming from today. It's not a legal bar that we are really talking about. It's a political bar that we are facing and the unwillingness of the developing countries to get together and say, okay, we don't recognize this. Let us exchange knowledge among ourselves and see how we can do this. Now, when it comes to vaccines, vaccines. You are absolutely right that vaccines are the only solution at the moment to large scale protection against the pandemic. There's no question. That's the only thing that's going to do what is called herd immunity. Not Boris Johnson's herd immunity, but real herd immunity. I think Boris Johnson thought that he was not a part of the herd till he got infected. So given all of that, I think the vaccine issue is the key one today. Will we get vaccines at the right time at the right price? Now, here this is an issue that we have discussed at least in various other bodies as well. That India as well as countries like Argentina as well as countries like Brazil have the infrastructure to produce the vaccine. Have the science and technology resources available in terms of human beings to be able to replicate a successful vaccine. They don't really have to ask once you know that this is a successful vaccine, duplicating it is much easier. So if that is possible, then the only question is, do you have the science and technological infrastructure to reproduce the vaccine in your country and supply to all the other parts of the world? And the answer is yes, again, provided you have the political will to do it and make the investments possible. Let's also look at what are the costs of what we are talking about. If we take at $3 a vaccine, which is what the price that is being talked of at Serum Institute has talked about that that's what their price cap is going to be. Then for seven and a half billion people population of the world, you are talking of something like $22.5 billion. It might sound big for you and me sitting on this table, because after all $22.5 billion is a very large number. But look at the kind of losses that the global economy is facing. It's in trillions. Just I think the airlines industry is threatening to lose $1.2 trillion. You are talking about countries which have actually given trillions of dollars in what is called bailouts. Of course, the bailout is not for you and me or the poor people. Bailout is really for big capital. But when you are even India is talking about something like $265 billion of bailout that the current pandemic is going to cause them to give. So when you are talking of these scale of bailouts, what is $22.5 billion? It's really nothing. So why is it that we are not planning for it? And we are expecting the GAVI WHO program, which I think Kajal can tell us more about to bail the world out. They are planning for $1 billion in the first year of their operation and they require $10 billion for the program. I think they have raised $600 billion and the plan to get about $2 billion. Maybe they'll reach $10 billion. But even if they do, it's only $1 billion they are talking about. And it will not be available, for instance, for large parts of Latin America who are not covered as the least developed countries. They don't fall below $4,000 or per capita income, which is the benchmark that has been set. So given all of this, I think we need a movement of the people, articulation of these demands that must come in the world. That we need to prepare for vaccines and neither patent nor political values should be there against countries to do these, make these vaccines and prepare the infrastructure right from today. So I think these are the things that we need to take up as movements. Of course, I'm too old for movements. I'm going to leave it to younger people on this panel to now take up these demands. I think we have done our duties. So it's now Kajal and Lorena who have to take up this battle. And of course, we dutifully will follow whatever they do. Thank you. So after this very interesting discussion and raising of issues, let's try and focus in this round of questions on drugs. And maybe we could be a little more brief than the conversations in the first round. And the drugs are of two kinds, as I said earlier, I had mentioned drugs in different contexts. But if you simply look at all the drugs available, either they are small chemical entities as drugs, which is the common traditional description of the drug. And the others are what we describe as biologics. So for these two kinds of drugs, the difficulties that are encountered will also be different in terms of gaining access. And I'm going to turn to Prabir first to describe the differences between the traditional drugs and relatively newer kinds of drugs, which is biologics. As the differences in their IT issues, production capabilities, and then we will go to what India can do and what Latin America can do with our next two experts. This is an answer which actually Vidita should have given us. What is a small molecule and what is a biologic drugs? But she's lobbed the ball on to me. So I'm going to answer that. Small molecules are a traditional drugs, which are small chemical, small meaning the compounds are relatively simpler. The number of atoms in the molecules are less for those who remember school chemistry. Biologics are complex molecules and long chains of long chains of elements, compounds. And therefore the relatively complexity of those drugs make it different from the small molecule. Incidentally, vaccines should be classed as biologics, but they're not medicines because they're preventive. But in terms of the processes and what they are, they're very similar to the biologic drugs which are now anti-cancer drugs, hepsy drugs, and some of the also some of the drugs which Vidita had talked about the zoom apps, the Tosilli zoom apps, the Ethyl zoom apps, other maps and so on. So these two broad class of drugs, if for instance you take remdesivir or you take small molecules like dexamethasone, which has been proven it's an off patent drug, it works very well. If you are in the stage where you are you're needing oxygen or you are in a ventilator, then it seems to provide at the significant benefits. The death rates have come down about 25 to 30% if you use these drugs, particularly in ventilator patients. So this has a value, these are small molecules. But when it comes to biologics, yes, scaling of production quickly is not that easy. It also because they're complex molecules, therefore you require more planning and you require a higher level of technological infrastructure, both also in terms of human beings. But the point is you cannot scale up as rapidly as you can if it is really small molecules. Those are the pros and cons of it. But let's not forget the oldest that we have are vaccines. Before the small molecules, antibiotics, sulphurs came to the market, which really reduced infectious diseases, at least in the West. Those came after vaccines. So the most complex molecules came first. Then we had simple molecules, which is what we were talking about as the ones we saw as antibiotics or sulphur. Then we have the biologics again, which are complex molecules. In that also there are various class of biologics which I'm not going to go into. The point is that biologics, there is a different issue of what is a patent or not. In fact, the barriers there are not so much patents as regulatory barriers that if you have to show, you can't show a common structure. Unlike a small molecule where the structure is completely defined. A biologic does not have a completely defined structure in the same way. So you are really trying to show similarity between two biologics. And that's why the whole issue has been talked of as biosimilars or biogenetics. You don't talk about genetics versus a patent in the same way. So the biosimilars are similar, they're not identical. While for small molecules, they're identical. So the patent law is only one part of the barrier. The second barrier is really regulatory barriers. What is considered similar, what is not and there's a whole fight over. I'll simply say that as far as biologics are concerned, we are seeing that maybe, maybe some of the biologics will be useful, particularly the ones against inflammation. Vidita had talked about this, the Zoomab's ILF-6 and so on. But at the moment, it does not appear that you have too much of a success on our hands. Some modest success with interferons maybe, inhaled for small studies seem to show there could be advantages to doing inhaled interferons at the early stage. Interferon, I think one alpha and one beta. I will leave the details of this to Vinita. She's the expert on this. But having said that, the issue is that I would like to go back to what I was saying. In all of this, in the medicines case as well, it's very easy to break the patent. When it comes to remdesivir, it's even easier to reproduce it because it's also the earlier variant of which Gillian had patented in 2009. I think that's the figure, I think Kajal will have better figures. Gillian never produced it, but that was used against cat coronavirus. Cats in America, as you know, the cat owners are very particular about their pets. Of course, other people also. So they found out that China, there were some people who were willing to make what would be called garage production of the drug and they could ship it in the gray market to the United States to mail orders. And this was being used to cure cats. Now, the point that I'm making here is not China, not United States, not Gillian. It is that the production can be done in a garage. It can be done in your basement. If that is so, then yes, this drug can be widely produced. What does it cost? According to calculation, Gillian's drug, which has been actually developed under support by the United States government and United States people have funded that. But even the cost of production of remdesivir for a whole treatment is $10. It's I think six files, the cost is $10. And in India, it's probably about 300 to 350 rupees. What's the cost of which is selling $3,000 in the United States? Why? Because Gillian says it's avoided cost. If you fall ill, we save 20% of your hospitalization fees and therefore give us $3,000. That's not much. And India, we are getting it for 32 to 34,000 rupees, which is at the cost that it is coming. It's not affordable by 95% of the Indian people. Plus, as Vinita has talked about, it is useful in the early stages when large scale use of remdesivir is then something which is not likely because at 35,000 rupees or 32,000 rupees, you're not really going to use this in the large, in the population of the large scale, but per capita income is much, much lower than in advanced countries. So given that, why can't we break Gillian's patent? Particularly, as the US has said, first three months of Gillian supplies belong to us. In India, at least we are trying, we're starting to see some remdesivir entering the market. But large scale production and like aspirin, like paracetamol should be possible. And people then should be able to take it even in the early stages of the infection when it is effective. So I think all of this are, again, coming back to this issue is really not one of anything but the political will to do so. So I'll come back to my familiar song that I'm singing right through this conversation that essentially it is the governments which are failing. It's the governments which are not willing to buck the big patent holders because behind that is the will of the United States and they don't at this point when there is already a tech war, a vaccine war, all going on between the United States and China and they would like to be on the right side of the United States. This seems to be the logic with which countries like India, a lot of other countries are going along. And therefore the basic demand of cheap vaccines, cheap medicines, cheap medicines and this is the question that Benita had raised in this particular case is not there. It's not very different from the complicated biologics as well. The calculation is biologics which are selling for $60,000. Well, they'll still be expensive then they'll be selling for at least $1.40 the cost. That's an exavar price that when it was compulsory license was issued is $1.40 the cost of what buyer was charging. Okay. Thank you. With that background, Kajar, can you tell us whether the situation about these drugs which are available for COVID-19, very similar in Indian subcontinent? We are talking about India but it's also Pakistan, Bangladesh, Sri Lanka. Are we all in the same boat or are we different in details? Okay. I'm just going to actually just try and take a few examples to take off from where Praveed left. I think Praveed has actually covered a lot of the issues related to India and genetics but I did want to highlight and connect a little bit back to this earlier discussion about trips and access to medicines and where we found ourselves in India when we were complying with trips and there was this very vibrant movement and I think you can read about that in the tribute book to Amit Sen Gupta which left what brought out and which Praveed, Indra Neelan, which I have edited about this big movement that happened both inside and outside parliament to make sure that even as you were complying with trips we ensured that there were enough public health safeguards and we have the famous section 3D that is supposed to prevent evergreening of patents. We had a huge litigation on this which was the Novates case which was one and we all thought great the Indian Patent Office is now going to apply 3D we will not have the kind of patents that Lorena was talking about which in her country also there are these guidelines and unfortunately it really is a dream unfulfilled because we've seen this almost collapse of 3D because of the pressure that has been put by developed countries on India and you have thousands of these evergreening patents that have now been granted but there is a second thing I want to focus on especially in the COVID-19 context one is the access to the drugs in India but the second is the behaviour of the generic companies and I think that's part of the puzzle that we have to look at and I agree with Praveed that the signal comes from the political will but look at what the signal actually leads to so I'll just take 3 examples from the COVID-19 drugs we have Faber Piravir which is supposed to be used early on and apparently according to some trials in 60% of people allows early clearance of the virus you have Remdesivir which we discussed extensively and then you have Tossilism and look at the three different scenarios so Faber Piravir was launched initially by one company at 103 rupees per tablet and within a very short time we had multiple companies who were manufacturing it because there was no real patent barrier to it and the prices come down to 35 rupees so we've seen a huge improvement in the cost and in availability because availability is the other part that we often don't discuss with Remdesivir I feel Gilead has given licenses and because there are multiple patents in the country, there are a few companies that have got the licenses and I agree with Praveed that the price is lower but you know it's all relative as he pointed out so we saw a launch at about 5000 rupees and I think the lowest price at the moment is SIPLA which is 4000 rupees there are probably two more entries that are coming in for a while I'm sorry I should specify that which still leads to high prices as Praveed pointed out you see that the price reduction is not as dramatic even though it's 5-6 companies Remdesivir it's 5-6 companies because those 5-6 companies know that they are the only ones who are making it so they are almost cartilizing around this price and then you see Tossilism which is the biologic and how is it available in India it's available only through a marketing and distribution agreement between Roshan SIPLA and it's 14000 rupees 40-50,000 rupees the prices keep differing you can't get an actual and you see this high price so you know if you're connecting back to HIV you had the SIPLA of 2001 which was not going to wait for any license or any permission and was going to go out and manufacture HIV medicines at a dollar a day and we know what a dramatic impact that had and then you have the SIPLA of today that is waiting for the licenses and for permission for certain drugs before getting on to the market and this is a huge you know what a difference two decades and a terrible international trade regime can make on the manufacturing capacity of a country it's a really short period of time historically and we're seeing the impact in COVID-19 the difference, the other difference we've seen is that we had a huge vibrant patent opposition and challenging environment where genetic companies and civil society groups would challenge these patents today because the genetics have launched through you know expensive pricey litigation because they are sued regularly for patent infringement a government that is refusing to back them up when they do want to challenge patents and an international community that has for the last ten you know ten years beaten the drum saying licenses are the way to go licenses are the way to go that our generics are now following that route you know you asked about the region Bangladesh had been ready before the Indian companies did and is exporting it to other countries because they're a least developed country they don't have to enforce patents yet so we're seeing this very dramatically in India now and I think with COVID-19 we're going to see the impact many people will say okay you know fine this is the drugs are at least available in India but I think you have to look at what's happening with remdesivir and toslizumon because the prices are high and the availability is low there is an enormous black market that has emerged so that the drugs are being sold for five to ten times the price which means actually they're not affordable and they're not that available so I think that's really something that we have to look at in terms of what this has done for India what this means for India's claim to being the pharmacy of the developing world this is now a hollow claim because our generics regularly take very limited licenses where they cannot supply to Latin America they cannot supply to many countries in Asia and we've seen it with HIV we've seen it with hepatitis C and now it's really unfortunate that we're seeing it with COVID-19 and we're seeing that impact not just in developing countries the US has bought up 90% of the supply for the next few months Europe has bought up 10% of whatever is remaining can you look at India to supply our drug regulator has said that by this month we should be producing 20,000 vials a day I think that's probably going to be enough for India and maybe a little bit of export but not sufficient export there are some more licenses elsewhere but we know that remdesivir is not going to be available and Lorena can talk to whether they've even seen a single vial in Argentina or in Latin America so this infrastructure that was built up over the years has quite swiftly been undermined by this trade regime and I agree that a lot of it is the signal from the top that if generic companies want to take the leap if they want to challenge, if they want to manufacture if they want to supply there does not seem to be government support for it and this is not possible without political world or government support it's interesting that in developed countries in Canada, in Germany and France we have to facilitate compulsory licensing in Latin America this has been done Israel has already issued a compulsory license for one of the potential earlier drugs lupinabir, atonabir which we now know doesn't work but they should have seen a compulsory license already and yet there isn't that much that you're hearing out of the region out of the Asia-Pacific region on taking similar steps and we know if we take those steps it would ease up access not just for us but for the rest of the world and I think that's really a big question as activists in India about not just access in India but what does this reticence actually mean for the rest of the world I think it's a big question on the vaccines there's carnage out there there are bilateral deals being struck for millions and billions of dollars by the UK, by the US by European countries just buying up all the initial doses so Praveer asked about GAVI, WHO CEPI, you know unfortunately there's a lot of work being done on that front where civil society is knocking on the doors of these agencies saying let us in but that's not really happening effectively but I have to wonder what is the setup that they're looking at when all the initial vaccine doses already seem to be bought off and why aren't you then focusing on the vaccine capacities that exist in developing countries build that up, do the technology transfer these are things that can be done right now before we have a vaccine in six months or a year but you know it's baffling to see where why the interest is still in trying to negotiate with the big companies who are more interested in negotiating with the big governments so yeah so I think I'll just leave it at that Thanks Kajal and before I ask questions to Lorena I am going to request our viewers if you have any will you please send it on the server platform that you are using they will eventually reach us and we'll try to answer those so in continuation with what Kajal was saying Lorena the last question to you so you have been working a lot on HIV Hep C drugs and making them available in Latin America and as everybody has been saying that there is a major difference between what they saw 20 years ago some wins now it is looking like there are more losses and not because of the trips or agreements but because of something else obviously the political scenario so what is your experience in the Remdesivir which again Kajal referred to but in Latin American countries then Thank you for the question as I said the pattern system is affecting all countries in the world even high income countries because when we started the discussion they said well this is a problem for developing countries but this was shown that it is also a problem for developed countries rich countries because the price of the medicines go really high well let me tell you what happened here in Argentina when the pandemic started we started seeking for information around medicines and we saw that Remdesivir that is a product of Gilead US company that we know very well their behavior had this Remdesivir as a promising most promising drug to treat COVID-19 as we don't have the capacity to really work on all the drugs because this is another problem that we have to highlight we go drug by drug country by country but the problem of the patterns blocking access for people really is a concern and I would like to highlight that issue but we would we would really propose a change in the system let me refer before go to Remdesivir to recently it was a meeting of the trips council in this trip council there was a very important statement by South Africa that described the hard situation of developing countries facing to access COVID-19 technologies and South Africa says that business as usual approaches are simply inadequate to tackle the pandemic because of the abuses of the system so we think that countries that gave up sovereignty in the 90s at the WTO level with these trips agreement should go back and really recover this sovereignty and really don't apply any more the trips agreement to health technologies because health technologies are not commodities, are medicines are public goods so we have to treat this public good as what they are so now I go to what we did with Remdesivir as with the suppose we went to the pattern office and we realized that there were five different pattern applications that needed submitted to the pattern office on Remdesivir and we had the copies of these pattern applications and analyzed them and we realized that they are not meeting patternability criteria patternability requirements of the law and that's why we did as we did with the suppose we oppose at least two and we are working on the third pattern opposition on Remdesivir and we gave information to the pattern office proving that Remdesivir pattern applications do not meet the conditions of novelty, inventive steps, Gillil is claiming methods of treatment that are expressly excluded by our national pattern law as a subject of patterns also they claim pharmaceutical salts and compositions that are not new which are obvious for a technical in this matter as well as they try to claim combinations that already exist having active ingredients that are not patentable here in Argentina also the pattern applications lack of sufficient descriptive information that is required by the pattern law so what we are doing is asking, requesting the pattern office in Argentina to reject these pattern applications from Gillil because they are not meeting the the patentability requirements and let me go also to the compulsory license what we do with the health safeguard as we call this instrument to protect the health that are commonly called TRIPS flexibilities, we classify them in preventive those that have preventive use use, sorry English is not my native language okay so preventive use and those that are more remedies and in the preventive use we put this rigorous patentability criteria that are included in our patentability guidelines but also the work on the pattern examination and also the work that we do on pattern opposition and on the side of the remedy is this compulsory license instrument that our colleague was referring that we need political will and in Latin America we have some examples of using of compulsory license and let me also refer to work that civil society is doing in Brazil to make law reform and have automatic compulsory license this can be a very effective instrument because what they are proposing is that not the issuance of a compulsory license as we are used to but what this patent can be produced by generic producers and pay a royalty to the patent holder so this can be a good solution and that is also discussed now in Chile and also local producers in Argentina are proposing this in the congress so I think that we have to frame in a way the system that is useful to provide to stop the abuse as I said that the companies are doing and to provide universal access and particularly in this context of pandemic that we really need the same with the vaccines candidates the Argentine governments has been talking with different companies that are in phase three with the vaccines but none of them are open to transfer technology so this will be really a problem for us even when we have a strong capacity to produce because the local producers are saying that they can do it they can do it in the city and also vaccines but here we will have problems if we have these barriers to access the technology very much we have covered a very wide canvas in the past hour and a bit and we will turn to the audience questions and from what I gather there is a huge interest in the announcement which we read in the newspaper since yesterday it has been getting repeatedly relayed that the Russian vaccine is ready for use for anybody and everybody who wants it I am not aware that there are already these kinds of agreements which have been made between Russian manufacturers and Indian manufacturers but do we really think that whether there is a the Russian vaccine is actually ready to be marketed and if I have to give a one word answer I think no because the vaccines are supposed to go through at least three phases of testing vaccines are supposed to be received by healthy people which means the level of safety that one needs to ensure it is phenomenally high as compared to even drugs because if I am sick I might be willing to put up a little bit of here and there as side effects but if I am a healthy person I may not want any side effects that is the attitude that many people have as a result we need very rigorous testing of the vaccines for not just safety which is normally ensured by so called phase one and also to some extent the ability of the vaccine to induce or trigger a proper response is tested in so called phase two and both these phases is phase one and phase two together even if we try to combine it together tend to take at least three months if not more and what we had heard earlier from Russian sources where they had registered their vaccine for clinical trials in sometime in June they were trying to start phase one to phase two so today is 12th of August 10th of August whatever date you think of that by this time finishing phase three is a clear impossibility and the phase three is a very long drawn process because people have to be vaccinated they have to develop an immune response and this immune response should prove to protect them from the exposure re-exposure to the or fresh exposure to the virus this natural free exposure to the virus is sort of a an occurrence by chance and hence we need to wait for a long time for the exposure to happen the immune response to get triggered and then to be tested in the recipients of the vaccine for protection in the sense they should not be falling ill and this needs to be done by a very large number of people and that is why any vaccine development that you must have seen in the past takes something like five years to ten years even if we assume that this is a pandemic and hence we need to rush things through three weeks or three months is too short a duration for anybody to ensure one the safety of the vaccine so that recipient should not fall ill and two even more critically efficacy means that vaccine can provide protection this testing of providing protection is impossible to test in such a short duration and as a result I do not know what to make out of it make out of the Russian declaration that the vaccine is ready for use in a sense properly a vaccine which is not properly tested is being released for use how to use it whether anybody would want to use it and whether anybody outside Russia because obviously in Russia the control will be of Russian government but outside Russia whether anybody should be trying this vaccine in today's day is a major major question and as an immunologist my response would be that you should not try it for all you know it may not be harmful but what we also need to know is whether it is useful that question useful question will not have an answer in three months time that is why it's too premature for Russian authorities to declare that their vaccine is ready for use it may be ready for production but it should not be ready for use that's the distinction that I'm trying to make so that was sort of you know covering many questions on the vaccine and let's see if we have a few more questions that we can answer seems like it is one question is what is the status of Indian vaccine or is it just hollow claim like Gomutra, Coronel very well controlling COVID-19 crisis and so on and so forth so if any of the panelists want to respond to this otherwise I will be willing yes Kachan please I mean I think Venita would know a little bit more about this I can just add that hopefully it is not a hollow claim I think lies in the case of drugs Indian vaccine manufacturers actually supply vaccines to most of the developing world so we do have quite a robust manufacturing a vaccine production and manufacturing industry I think there are about three companies that are already in phase one phase two trials there are multiple others who have partnerships but Bharat Biotech is working with the National Institute of Biology Serum Institute has tie ups I think with the Oxford vaccine and a couple of others I think is working with the Department of Biotechnology so hopefully these are not just hollow claims and they are actually looking at vaccines and we have had a historical reference to this when the H1N1 outbreak happened and we saw a very similar situation happening with the West saying that no vaccines are going to leave other than I think they pledge 10% of doses to developing countries until their own vaccine capacities were fulfilled within a year India had actually I think Caddler was the first to launch and then Serum Institute launched after that we actually had vaccines that were ready and I remember this image of the health minister taking the vaccine and things like that so no hopefully it is not a hollow claim but I think I agree with Benita that I think the biggest thing we have to look out for is testing and proper supervised regulatory control over these vaccines before they are approved and I think the scientific community in India is definitely being quite active on keeping the government on its toes on that we did see quite a ludicrous claim put out at one point that by the 15th of August we would have some results and I think that was very quickly rubbish and I think that is a very important role that the scientific community plays and Benita could probably then add to that yes I think the two aspects as a scientific endeavour we are capable of producing a vaccine and especially of the kind which is a very traditional vaccine which is the inactivated vaccine which we will be able to produce and which is the one that Bharat biotech is taking on the other riders Caddler and Serum have other things also in the pipeline but the traditional vaccines we are certainly capable of and the regulatory mechanisms are curatically in place so if we adhere to that we will be able to come up even with the so called ICMR NIV made or originally claimed and Bharat biotech manufactured tested and manufactured vaccine at some point and I do feel we don't need to bank only on one vaccine but we can possibly bank on many vaccines if they show upper efficacy as I was mentioning that hasn't been tested for the Russian vaccine so I'm afraid we have been we are really at the end of our session and pretty much running out of time so normally one gives a minute or two for each of the candidates to say something and I'm going to use my moderator's privilege and not give this opportunity but I also think we don't need to really summarize the session because it has been talking about various aspects about which we know which we don't know what are the difficulties and political will legal limitations and so on and so forth the panelists have provided very sharp explanation and highlighted critical issues which we will have to continue debate and we can't just stop with getting access to drugs and vaccines for COVID-19 this may not unlikely to be the last pandemic that we face we are likely to face even more pandemics in the future because we are encroaching the so called jungles and the ecosystem of the birds and beasts so that the zoonotic diseases as we call them this also as it happens the COVID-19 also is a zoonotic disease which has reached human beings so such more such zoonotic diseases are likely to reach us this is not trying to frighten anybody but this is sort of saying that this may not be the last pandemic especially the young ones may see another one and we will I hope we don't have to reinvent the wheel on the patents and IP issues and we might have a better world tomorrow I'm not necessarily saying that's going to happen but one can hope for that and with that I thank Kajal Lorena for giving wonderful answers and we will stop the session there thank you very much