 Welcome to what I expect to be an amazing conversation, really a thought-provoking conversation on building resilient health care systems. We are live streaming this session. I want to introduce very, very quickly my guests, the panelists tonight today, but you'll also have their full bios in your WEF materials. Kenji, C, is the CEO and founder of Fortinet, a three billion dollar cybersecurity firm and he is a serial entrepreneur who started his first company I think in 1993. Dr. Anne Firth is not only the dean but also a professor at the Yale School of Nursing and also a professor of epidemiology at the Yale School of Public Health. Michael Needworth is the chairman and CEO of Centine Global 500, a Fortune Global 500 health insurer that last year had something like $60 billion and now is on pace for $100 billion in revenue which makes it quite, quite, quite large. And Dr. J Eyer is the executive director of Access to Medicines, a Netherland-based organization that is hoping to bring access through pharmaceutical company engagement to much of the world that doesn't have it. So that's our group here today and we're gonna kick off. Jay, let me start with you because we do think about building resilient healthcare systems. We often think about access to medicines which is what you fundamentally are focused on. How are we doing actually? You just have a 10-year report so let's just get a baseline here how we are doing compared to where we were a decade ago. So a decade ago we had I think a lot more, that was the beginning of all the awareness when multiple pharmaceutical companies and governments came together to say this is something that we need to prioritize. Access to healthcare needs to be prioritized. We've had the Astana declaration for, our multi-declaration in Astana in looking at primary healthcare. We've got things like the sustainable development goals that have been set up where every pharmaceutical company and multiple governments have subscribed to. So the awareness is definitely there. Our report shows that specifically when you're looking at the pharmaceutical industry that progress has been made in terms of the response the pharmaceutical industry takes in terms of addressing access to healthcare for people living in low and middle income countries. But I think what you're starting to see is that the bulk of the activities is really borne by a small group of companies and that dependence on that small group of companies is I think the biggest issue. We haven't solved two major problems. One is sustainable access for all medicines that are still clinically useful. Some of them are economically not strongly more. So companies are leaving the market and for some of them like antibiotics, for example. And we still don't have a pathway for new innovations, for new medicines. Most of them when they are made available we can't celebrate because we have a new treatment or a new cure. We have to stand there and struggle because the prices are often unaffordable and access is not guaranteed for 83% of the world's population. So there was a wonderful and very diplomatic answer, it seems to me, that giving praise a little bit to the industry. But where are the challenges now? I know you partner, for example, where the drug companies partner with, say, Gavi, the vaccine alliance and others, but are we building enough capacity to deliver these drugs in the developing world? I think the biggest challenge is all the progress that we've made doesn't address the scale of the problem. You need scalable solutions, you need sustainable solutions and these are just words sometimes and we know that this is hard for any organization to tackle on their own. That's why you're looking at more and more collaborative activities that are trying to address this problem. But I feel that the scale of the problem, I mean, we're talking about 83% of the world's population living in low income countries. That's big. But I always say we've managed to, as a society, as a group of individuals, we've guaranteed access to medicine for five billion people in the world. So we only have two billion people who need access to medicine. So it's not an impossible challenge. Michael, you know, there's so many issues with access to medicine, supply chain, procurement issues, but one of the fundamental ones is price. The price of drugs have been just going sky high and even if we have programs for those in need, they still are too expensive in many cases. How are you dealing with that constant escalation of price as a major health insurer? I think a key issue is if we know a drug, one especially farm, and it's still expensive, if it's gonna help somebody, make sure they get it. It's those the right way. But I think what we have to do more of, and we're doing a lot of it ourselves, we have systems now that can do it, is you need to use genomics and determine will that drug help that person? There's too often now we are using a particular pharmaceutical. It's new. Let's try and see if it works. And it's $200,000 or $100,000. And if it's gonna work and it's gonna cure it, hep C drugs came out, you know, and it costs 70,000, that's great. If it's gonna cure the overall cost of that patient, you can do the balance. I'll tell you what I wasn't gonna say. Yeah, please. I think there's some things we can do though to bring drugs down. One of the things, every time I turn on television in the US, they're advertising a drug. And doctors don't like it, because people are coming in and asking, taking time. And I have been asking, what happens if those drugs, those costs for that advertising was not tax deductible? Maybe there'd be a nice way to start to minimize it and put those funds against the cost of the drug. But somewhere it's in the cost. I like that, it's an outside the box thought provoking solution. And, you know, one of the- I just made an enemy of all pharma, but that's okay. Yeah, well that's okay, that's okay. And, you know, one of the issues that we are seeing now is that many, not only emergent diseases, but old infectious diseases or familiar ones like measles and cholera are now sort of spreading in areas, in the case of measles where we have really good vaccines to prevent this disease, we're seeing this happening in many hot spots around the world. Talk a little bit about how we can revitalize that vaccine movement. Yeah, so really it ties through here also with the drug availability and the precision health opportunities, which is you have to have patients who are engaged in their care and informed and educated. They played a role in activism in giving us HIV drugs and fast-tracking approvals for medications. And also then in terms of people understanding in this era of anti-science, frankly, the importance of vaccinations, the facts about their benefits and also the idea that, you know, we're all in this together and you can't just rely on herd immunity from everyone else getting vaccinations. So you're right, there's about 350 emerging and reemerging pathogens that are going to be affecting every health system and that's going to be exacerbated by climate change, which is also the other big issue in front of us in health systems. Now I want to come back to climate change a little bit later, but I want to talk a little bit about these hot spots because when we're talking about, you know, the building resilient healthcare systems there are many places that don't have healthcare systems at all. And the Democratic Republic of Congo where we've been all aware of the frightening Ebola epidemic there with more than 3,000 infections, more than 2,000 dead, the second biggest Ebola epidemic on record. But what's less sort of talked about is that in that same region over that same period of time there've been 18,000 malaria deaths, 500 or so cholera deaths, a massive measles outbreak. I mean, how do we even begin to address these systems? That's right, so there's these acute episodes that come up that stress the health systems but then there's still all the ongoing care that has to happen. And one of the Time Magazine persons of the year, a few years back, was a nurse who got Ebola, survived it and then died because when she was pregnant and was seizing no one would touch her. So being able to educate again and working with communities to be resilient, the places that have done well with Ebola was where the community trusted the health system and you could leverage things to change like funeral practices that would reduce transmission. So it does still come back to trust, education, engagement, but also resources, realistically. Maybe I add, I'm sorry. Please. I just wanna add something. I think if we talk about Africa, if we could just go back to fundamentals and ensure that Africa had clean, pure water and electricity, we could change the face of that continent very quickly. And health workers. And health workers, yes. The greatest deficiencies in the health workforce, of course, are in Sub-Saharan Africa. And nurses and midwives are actually the foundation of every health system everywhere. So being able to empower and engage every cadre to work together, but particularly nurses and midwives. And that's certainly needed, the health workforce capacity building. So Ken, I wanna thank the organizers for putting a technologist on this panel because it's rare that you get a conversation like this and bring in someone who really understands the technology and the vulnerabilities that are happening here. Talk a little bit about, you know, outside of the box that we're so used to thinking about healthcare, where the vulnerabilities are and what you might do to immediately sort of address that. Thank you. And also, that's why I wonder, I'm not only one, not a confrown that healthcare industry on the panel. I know what I'm talking about here. And actually, I would train as an engineer, computer engineer, and being in the cybersecurity space for 30 years, three company. And healthcare actually is one of the biggest industries, same as a finance service, actually has a lot of cybersecurity issue. Because all this healthcare information, once some bad guy take that information, you'll kind of suffer all your lifetime. Sometimes even they take your credit card information, your banking information, and you can change your credit card, you can change the bank. Healthcare information is so critical. So that's where there's a very high spending on IT and healthcare on the cybersecurity. Also going forward, there's a lot of other technology, whether the AI, the 5G, and also healthcare is very interesting. They have a lot of IoT device. So that's probably the most popular IoT device. I think it's the involved in the healthcare system there, which has a lot of a security issue. Because once you connect all this device together, they do collect a lot of data. And most of this data really has a lot of difficulty of securing it, because the device itself, the networking itself, quit a lot of an issue there. So that's where how to secure the data, how to secure all the patient information in healthcare is now always the biggest topic. You know, it's interesting, you know, when you're talking, I was thinking about, these are developed world problems in the healthcare system. But yeah, you know, there are so many issues that cross the boundary between developed and developing world. One of those is drug shortages, where we're seeing that in developed countries. In Europe, for example, it was a WHO report, a World Health Organization report, that said that 20 plus percent of European hospitals have daily drug shortages. 45 percent have weekly drug shortages. We've seen that with cancer medicines, particularly things like methotrexate, which treat childhood cancers as well as other things. You know, we're seeing these problems cascade through the system, starting in many cases in the developed world and moving to the developing world. Talk a little bit about how we really start to address those. So I think we tend to take access for granted. Even in about a couple of months ago, there was a lot of discussion about vincristine, a cancer medicine used for children's childhood cancers. It was already at risk, because there's a very few companies that are today producing vincristine. We've watched company after company leaving the market silently, so that a lot of them do not produce that anymore. And what happened is a company like Tiva said, okay, we're gonna stop production. And luckily Pfizer could still produce, but in order for them to ramp up the production to meet the demand, it would mean there would be sufficient, some level of lag time before supplies could actually reach hospitals. So this tells you that it happens in cancer. Our report that we'll be launching today on anti-Mirkova resistance tells you that in developed markets, there are over 30 forgotten antibiotics, antibiotics that are still clinically useful. Often last resort antibiotics, but they're no longer produced in high-income markets. So what we did in our analysis, we started looking at low-income markets to see are the producers still able to produce? And if so, are they doing something about it? Because potentially demand is actually higher in low-income markets, and there should be. Luckily, we still have some companies that are able to produce, and are committed to produce it, but it's a slippery slope. Companies are looking at, these are not green pastures. So the way to solve it is multi-fold. I mean, you do need companies to kind of stay in there for the long run and stay on, because you can't sell your cancer medicines if the hospitals are not safe. You can't sell your medicines for transplantation if the hospitals are not safe. So you do need to make sure that common antibiotics are available. But I think governments also have an important role to play in the way we procure medicines. We tend to buy medicines from the lowest possible bidder instead of spreading that over multiple manufacturers. UNICEF has a great plan where they don't just buy from the lowest possible bidder, but they also buy from multiple manufacturers that way preventing their concentration and the consolidation of the market. Because when you do have a problem, whether it's a mechanical or a technical failure of a plant, you at least have other manufacturers who can fill up that supply. So shortages, this is talking about stockouts and shortages combined. I think it's a serious issue. And in the US, I think you have chronic shortages of several drugs. In the Netherlands, you have that here. In Switzerland, we've accounted it. My team has found every single week we've gotten somewhere in the news in the developed world and in the developing world a major drug shortage. Some of it cannot be replaced even in the end of the year. So I think this is something which governments and companies need to come together to. You know, this is a conversation we've been having now for decades. You know, there's been a fleeing away from antibiotic development, vaccine development. We're seeing many of these manufacturers, they haven't been in this field for years. We're not seeing new entrants. How do we change that business model? You talk about buying from higher cost producers, but is that enough? Do we need a different kind of a drug development, maybe one in which similar to weapons development where there is a government who's a buyer for this? Michael, I mean, you're a business person. You deal with these kinds of P&L issues, profit and loss issues all the time. How would you recreate a drug industry for specifically developing vaccines and antimicrobials? We have a system we're working on. And I really want to get away from rebasing things. I want to go to that pricing. But that aside, the whole system is that a physician, if they want an antibiotic, they can go in and look at what for respiratory and maybe four or five of them. You list them. And you put a dollar sign beside what the cost is. And we're putting doctors with more at risk contracts and they will, that will be charged to them, the cost of the drug. But we tell them it's no different when you buy wine. You say that tomorrow I don't want the most expensive, I don't want the cheapest, I want the value. And we have to start thinking about what pharmaceuticals we use in terms of value. What's the best drug for that particular disease thing? Versus what's the latest and greatest? Because sometimes a moxa cellan is still really good for a kid's sore throat. You don't need to go to the equivalent of the E-PAC and the higher end ones. So I think what we need to do is educate and help the physician community, put them more at risk, put them in control yet, so that they're making the decision of what's the value, what's the best drug for this. And we also have programs that use step therapy. In other words, if you want the highest end drug, that's great, but show that you've tried some of the others first. One last thought, I was reading recently, the lack of development of pharmaceuticals is really become a very high risk for the population in general. Because you have more and more of antibiotic-resistant problems in hospitals. And they're not developing the new drugs to deal with those infections. So I have to finalize. I want to just talk about how we build up this armamentarium, this arsenal of weapons to fight these new and emerging diseases. And so part of that is the fact that we're going to have even more of them emerging. We've already seen an increase in emerging diseases. But you've studied now climate change and can talk a little bit about how that is raising stakes dramatically in the case of ID. Yes, infectious disease, but also it will affect every disease state because it will affect every health system. So just pulling through the idea of fundamentally, when someone is writing a prescription and trying to have the patient engaged in understanding how to use it, there are pressures and also approaches that you can use to try to influence the providers. So in the United States, we have something called choosing wisely program to try to educate providers about making best use of the meds that we do have. And then engaging the patients, you can walk into a pediatric's office and the sign will say don't ask us for antibiotics, right? So educating the patient about what's effective also. But when we think about these existing stresses that we've talked about, anti-focusing resistance, supply chain disruption, now add in climate change, right? So this is really the existential crisis that's in front of us. I'm actually quite always astonished at the degree to which the health sector often gets left out of planning. So certainly mitigation effects are underway and the health sector is anywhere from about 6% to 10% of all greenhouse gas emissions around the world. Just by note, we all flew here. The airline industry is about 2.6% of emissions, so it's considerable. So we have health systems that are trying to green up and really reduce their carbon footprint. But the other thing we have to do is adapt the health systems. Get health systems ready for the short-term and longer-term impacts that are coming, both from vector shifts and infectious disease changes. Now you're dealing with dengue, where you weren't dealing with that before, for example, or particulate matter. Are you tracking air pollution? So you know you're gonna have enough ticket asthma cases coming into your emergency department and you're ready for that. So utilizing data systems effectively to really think about what's coming and including things like supply chain disruption, which IV bags were produced in Puerto Rico in the United States market, huge market. And disrupted by the hurricane. So really anticipate, being more anticipatory because what I always say about the health system is it has its first responder and it has to be the last building standing and climate change and other ecosystem stresses are gonna really put a lot of impact on that. So you mentioned data systems and Ken, that's a perfect segue to you. You know, last year I was on a panel here with Bill Gates and Tedros, Dr. Tedros, the director of the World Health Organization and others, and we specifically talked about the need for really good data to identify on a real-time basis what where there were infections of malaria that were outbreaks of malaria or places in which there was clear resistance to the mosquito repellents and things like that. How are we even beginning to tackle the data problem in healthcare? I think we're doing that for the, probably the last few decades already, right? So like 25 years ago, I was helping Jim Clark when he built his like a health young, then it became a WIPMD, they tried to bring all the internet technology into the healthcare system there. And so that's where collected data eventually makes some good decision, including some drug decision, right? So that's where the data is very important and also how to protect this data also are important. And also leverage all this data, internet technology, you can also connect different part of what together, right? So leverage whatever some people, better train, try to help in some other area of people, maybe not quite about training yet. So that's where we see the technology starting all merged together. I know in Stanford, which I am also involved, they started having the medical school working with the engineering school. They create all the bioengineers that are kind of in the discipline, kind of a study and the research together. So that's, I think, eventually will help in changing is healthcare the biggest in that tree. And we see a lot of technology all starting coming now. So you need the data but you also need transparency. And recently there's been some criticism about emerging coronavirus in China. There are other areas where what we saw, for example in SARS and other viruses in Saudi Arabia where we don't fully get the information fast enough from the governments, from the healthcare systems on the ground. How are we moving towards a more transparency and more real-time disclosures from these healthcare systems? Please, Jen. Yes, so I have a view. So in our work on antimicrobial resistance, we also have invited companies to tell us what they're doing on surveillance. By nature, some of the companies have to understand where the pathogens are, where resistance pathogens are in geographies where they're gonna register their drugs in order to find out whether their potential drugs, the new drugs that they're launching or vaccines are gonna be effective. So what we've actually found is quite a few companies are open and willing to share this data. Pfizer was the only company who is sharing the data, the raw data, which is useful for researchers, useful also for clinical decision-making on where potential outbreaks could be, where drug choices and treatment guidelines need to be adapted. And I think this is a movement which is not linked to the stability or the instability of the market. This is something which every company could do if they have access to particular data, working with governments to make sure that surveillance information is shared. I think it makes a big difference, and especially with climate change on the way and drug resistance growing, especially with shortages right in front of us, this is a surefire way to get involved in this particular issue. Johnson Johnson, for example, looks at TB surveillance data and shares that. Companies like Pfizer look at pneumococcal diseases, which affect children all over the world. So these large-scale programs actually are quite useful, and that's where data needs to be in place. So the drug companies who are on the ground can share that data quickly, even if the governments don't. And also, and just to bring this back to people, you talked about the need for more people in the infrastructure, more healthcare workers. The effort to have community healthcare workers, we've seen tremendous success of that program in places like Liberia, with Last Mile Health, Raj Punjabi runs a fantastic group there. There are other examples of this being really effective as sentinels for emerging diseases, not only providing care, but also offering early warning systems. How do we reinforce that system? Yeah, so I appreciate your emphasis of the use of dynamic or real-time data. So there are a couple of thoughts there. Certainly, again, having a whole range of health workers, including activated patients at the center is important. So community health workers, the evidence base is growing about the best ways to support them, utilizing tools like smartphones and being able to text data in. And you can have a very virtuous closed loop right there in someone's hut out in a rural village, right to the Ministry of Health database about what antiretroviral regimen that person might be eligible for, and then right back to the health worker who can connect them with the clinic. So we see that in places like Rwanda that are using health systems effectively. The wearables data is another question. How will health systems use that? But I guess I'm coming back to, it's certainly mining it for patterns, population patterns, is crucial in terms of public health planning and responding to epidemics. Now I'll come back to the human factor also, which is how many of you have sat in a clinician room and the clinicians basically has their back turned to you and they're putting the data into the computer and they're addressing the computer, right? This has actually become a barrier to sort of in real time communication between the provider and the patient and we're doing things like hiring scribes and trying to go with audio transcription of data. So I mentioned it just as an aside because we still need that human element of the basis of all good healthcare is an excellent physical exam and that communication between the provider and the patient and then turning that data into something that makes sense for that person as well as for a population is really an exciting challenge. Just to put some numbers on that. So in the United States there was a medical journal that came out with a study that said that the amount of time that the physician spends on his EHR is electronic health record has actually exceeded the amount of time for the interactive visit with where he's examining or years to years examining you. So we've now crossed that tipping point, if you will. The name of the session is Building Resilient Healthcare System. So I want to start about, how can we talk a little bit about building? And so I'm giving you each a unlimited budget for now and I want to have you talk about what you would begin to do, what you would begin to build. Let's start with you, Ken. What would you start to build first? I think if you look at the internet, it changed a lot about data life, right? But in the healthcare system, it's the same thing. But even to this, you know, technology is still come from like 30, 40 years ago all the design architecture protocol. So they only address the kind of take-day and the speed. So whether the 5G or whatever, the new SD-WAN or internal Wi-Fi, all these kinds of things, they just kind of everything you lay together. But in a healthcare system, all different data, different application, different content, different device, different user patient, you need to have a different way to handle the data. So that's because so far we're using the infrastructure which cannot differentiate any of this content or user application device. That's where security become biggest issue. So my biggest reason is really, if you really design a new system, whether the 5G or the new healthcare system or kind of a lot of new device, you need to build security and networking together at the same time instead of build security after that. I said your budget was unlimited, but I guess that's gonna really be a lot to start a new 5G. Yeah, what? Security is still like 100 times more expensive with the same support compared to networking because they need so much computing power due with so many different content data. So that's where, if you have all the budget, build it through. Right, all right. And you're a nurse, I'm assuming you're more practical. You're, talk a little bit what you would invest in. Yeah, so getting health systems ready, I think is really very important. And when we think about existing health systems, adapting so that you are ready for those supply chain disruptions, you're anticipating the disease and extreme weather effects, you are able to inform your community, you know where your vulnerable patients are in terms of older vulnerable patients. For example, we haven't talked about vulnerable patients populations yet, so that you can bring them in for heating, warming and cooling. Is your hospital a cooling center? Is it also a warming center? Because we will have more extreme weather events. When we think about building out the health system, because remember, 40% of the world lives in coastal cities, 60% of the cities of the future haven't even been built yet. We have an opportunity when we build new health systems, both hospitals and clinics, to make sure that they engage in green principles. You put your mechanic, it's common sense. Put your mechanicals on the roof, not in the basement, right? Make sure that your IT infrastructure will be available. Know how you're able to keep your health workers resilient because they're gonna be affected by these events too. So we think about the wildfires in Australia, California, people being burned out of their homes, being hurt and having to go to the hospital system. Who's staffing those hospitals? It's the same people who were burned out of their houses. So you have to think about mobile healthcare and being able to activate workforces in an immediate way. And some of that comes back to data and some of it comes back to, you know, sort of the ability to plan across systems. Michael, you have a hundred billion in revenue as I just mentioned, I've just magically eliminated your shareholders. I still go ahead and spend it for us. I don't subscribe to that, but go ahead. I think there's no one approach. I think we have to think about it in terms of, I knew some of the things Anne's been saying that you have your developed world where it's an educational process. We have to help people understand that things they're doing today may not affect them today, but will affect them in the future. And help them look at that. We have to help them think about anticipating, as you said, what are some of the things that could go wrong? What's your response to it? And it's gonna vary from the vulnerable populations we have in this country to the more fluent. So there's a balance there. And then you shift to the developing world where we've talked a lot about the need for health workers, giving them just basic fundamental tools, whether it be the iPhone or whatever, or the smartphone I should say, that gives them the information. But I think we also need to look at the data. And there are ways to analyze it. Everybody talks about the data. There's two factors, one, who owns it? But then two, what are the analytical tools available to make it practical or bring it to practical use? Jay, you've had more time to think about this than any of the others. So what are you gonna spend your money on? I'll split it four ways. And when you think about health system, I think it starts off with prevention and improving vaccination of children, including teenagers for HPV. I was split the next way into supporting community health workers, including information and education programs, including making sure that they remain in the countries, because I think after some certain amount of training, the demand for them also spreads wider. Third part is access to healthcare products and services, specifically looking at some of the gaps. I think if I had really an unlimited budget or some limits on the budget, I would look at where the specific gaps are. Women underserved are young people underserved, are working men underserved because they're working and they're not actually accessing healthcare. Systems is education, a barrier, it's language, literacy, a barrier. So looking at the, well, some people call it the determinant, social determinants of health will be an important third arm of it. And I guess to complete all of it, I would look at universal health coverage, whether it truly is universal or other particular gaps in it. That should be a little bit future proof. I mean, it should also cover what would happen if pressures remain on the healthcare budgets because of new innovation. It should be able to bring in the new innovations. You all talked about vulnerable populations here. You all talked about the gaps in the healthcare system and really those who are slipping through. You know, one of the obvious groups here and an area where we're seeing again a potential for catastrophic issues are in the large refugee populations around the world. Can you talk about how we begin to bring beyond just the nonprofits that work in these areas into these massive tent cities or into the populations where you have a lot of internally displaced people and how we get them access to healthcare? Yeah, no, thank you for bringing that up. 75 million people on foot now involuntarily, the highest rate since World War II and World Bank and WHO estimations are with climate change impacts that there will be hundreds of millions of people involuntarily displaced. So how are we delivering mobile healthcare? How are we, people often, especially the internally displaced folks, maybe moved out of their home and they'll be there for some period of, for a long period of time, much longer period of time. So now you're having to deliver education as well as healthcare across generations. So I think this is both an underfunded area and one that really requires cross national engagement because the numbers are going to go up exponentially, basically an order of magnitude from what we have now. So we've got to use all the tools available to us, policy funding as well as the healthcare delivery. Yeah, I mean, we think in terms of the old healthcare system of these hospitals, which are big buildings with legacy costs inside of them. And we're really moving more towards if everybody has the cell phone cam and everybody has that ability to get a 5G connection with cybersecurity, that their mobile phones will become their interface to a healthcare system. So this is something that if we're building resilient healthcare systems, should we start with that mobile phone? Yeah, mobile phone, but it's also going forward, they call the immersive technology, that's made replace your mobile phone. So when it's your wearable, whatever, so you may not carry phone five to ten years later because everything you have is all kind of connected and give you all the data you need it, right? So that's also can solve all this kind of like underserved community there and with all this remote diagnostic and with all this technology sharing and that's also eventually can solve a lot of this issue. Are you, Michael, are you moving a lot of the people that you cover into these sort of mobile type of relationships with healthcare providers? This sum, we're just ensuring that there's access where there is, then we'll build a clinic we'll do some of that nature. Coming back to your fundamental question and we heard it before, if you have these camps start off with making sure everybody that comes to the camp is inoculated. So you can start to minimize some of those transferable diseases. Two, take a community approach to healthcare. Start to educate leaders within and every organization, every camp has some kind of informal leadership. Start to educate them on what's necessary. If you can start to do that, that's important. The final thing is, think about what genomics is gonna mean, I'm a big fan of it. I don't think hospitals, you mentioned legacy are not gonna look like they do today. Most things are gonna be outpatient most, they're gonna map the genome, the church allows all the embryonic cells and things so that you'll be able to mix up a concoction, inject it and be curative. So I think, start looking at that and say how do we use that in these communities to make it available, because it becomes curative and avoids the transmission of diseases. That becomes the key in my mind. Still comes back to workforce though. I mean, so you can have all the personalized omics in the world, who's gonna do the counseling to interpret your sequence? And what if you were right? I agree, that's part of the community. And it's not gonna be generated counselors alone, they're a small subset of every health workforce. So we certainly need to do the sort of provider education as well as expanding. Just education, you mentioned this before and you mentioned it, Michael and Jay, the sort of anti-science view, the fear of vaccines, this sort of radical anti-vaccine rhetoric that you sometimes see. In fact, we just, Fortune did a fantastic story on Sanofi's effort to develop a dengue vaccine and the sort of huge blowback that came back from communities who were testing this in very heavy dengue infected areas. But all this kind of starts with education. When we're talking about building a resilient healthcare system, we're talking about really educating people about the need for healthcare or basic vaccines. Yeah, it starts with that. It starts with people understanding their responsibility. And then we also need to focus, as I said, on the community because it becomes a community event where one starts to help the other and even in camps and places like that, that informal structure can make a big difference. Jay, talk about that. So I wanna echo this point. I think the point of enforcing healthcare and the benefits of healthcare, especially to unseen enemies, right? Vaccination is all about preventing the unseen enemy from getting to you. Antibiotics I think is also something which we take for granted because we think that we're gonna live forever. We're all super people. But I think the point of community... We're not gonna live forever? All right, all right. 20 years, okay. No, but I think one of the main things that you realize with healthcare is that you need to build that sense of trust. And that's the biggest drawback with the work that we do. The pharmaceutical industry is just not trusted by the community. So when the pharmaceutical industry brings out a new product, whether it's a vaccine or medicine, people hesitate to take it on board. And it is the role of governments to definitely try to educate more and more people into why this is okay, but then you also need governments to be trusted. And that's also waning down. So I go back to the point on the grassroots. The community is where you get the... That's where you build trust, trust in the healthcare, trust in healthcare products. And when they work, then people take them. So this is so interesting because the healthcare, health workers used to be among the most trusted people on the planet and the institutions, the healthcare institutions were incredibly trusted. And when you look at survey data, they've dropped down quite a lot. What did you people do? Well, I will count of that by saying that nurses tend to be most trusted. No, I'm sorry. But actually, let me give you an example of what we're doing with that. So in the United States, there are about 600 different candidate schools trying to teach different kinds of people to go out and run for office. We're gonna do the first nurses candidate school because again, trusted profession, four million in the United States, 2% of the voting population. I don't care if you're right-wing, left-wing, centrist, just run for something locally and get engaged in policymaking and leverage whatever trust you do have towards better health policies. I'm on the record and you have my vote if you run. Jay, what can we do to sort of rebuild trust here? And what's causing the sort of lack of trust? My question right now, would being in politics help build trust? I mean, I think there's a lot of distrust in this. There is, but we have to invert that. I mean, that's a very good question. Yes, okay. Policy affects your life every day. That starts in a simple way. I mean, even in the place of AMR, I mean, do you really need to promote your antibiotics? Do you really need to spend all the money on marketing that then puts back the pressure on price, on health systems? I think it starts simple. Those things are not rocket science. Trust also comes in the fact that stop doing all the bad things that any industry or any government is known to be and really fight corruption, fight that urge to also deal with bribery in an unethical area. Bringing back that human-to-human interaction, I mean, as I'm coming back to my favorite subject, which is community health workers, I really think this is the answer in many cases, because you're building those human interfaces and those deeply trusted connections in villages, in communities around the world. 30 seconds for each of you. What, sort of talk about how you would rebuild the trust. Ken, how would you start by rebuilding trust in this? I think share the data and also leverage the technology and do the training education. That's all will help a lot. Leverage the trust of health workers, like community health workers, and near peers and others who are connected to their communities. But remember that if they're identifying a problem, they have to refer that person to a functioning health system. So you have to also have a functioning health system. I think it's just a patient interface. You have to be very patient when you talk to the person. Take the time to help them understand what the issues are and what you're doing about it. And instead of the rapid, what's the algorithm and that type of thing, you can start to rebuild a lot of trust quickly. Jay? It comes down to making sure that the community health workers are also from the community itself. And some of them need to be potentially reskilled and educated, but they're members of the community. They have people trust each other more than they would trust foreigners, like ourselves or industries and governments in that sense. So I think comes right down to hire from the community, get the community, get involved in that whole process. So speaking of drawing from the community, we actually have Desi Dimitrova from the World Economic Forum to sort of say a few wrap up comments here. Thank you, Cliffing. And thank you to this distinguished panel for kicking us off this week in such a diverse way of setting the foundation of what a resilient health system is. And thank you to the audience for coming today. One common thread that I see among what we spoke about, we talked a lot about what we would invest in and everybody is saying about a different aspect that they would invest in. And actually we'll never be done investing because the building of resilience is not something that we ever finish a job, that we tick the box and we say now let's move on to the next thing. It is an iterative process. It reminds me a bit of actually living in a house. We have a system that already exists. Maybe it's not perfect, we trust. We go inside and we start living, but then there is something, a disaster that comes in and we make and fortify the walls a bit more. And we're never finished, but we trust that we have created the foundation which we heard is primary care. It's good financing, universal health coverage, good health workers, data, being ready for all the disasters that might come that we might not know but we would anticipate and looking at the gaps. And that's exactly what we do at the World Economic Forum. We try to anticipate, to understand what are the gaps and then when we identify one, see who are the stakeholders that can actually address it. One example that we worked on recently in the aftermath of Ebola was, how can we address health security threats? And with many of you here that I see today, we launched the coalition for epidemic readiness and innovation. In the area of financial resilience, we're looking at what are the value-based healthcare models that can make access greater for more populations. We're looking at social determinants of health, precision medicine, mental health, and this is gonna be the program for us throughout the week. We look forward to seeing many of you there and continuing the discussions and then the coalitions and the actions that we can take together. Thank you very much. Thank you. Thank you. Thank you.