 Our last speaker will provide us with a few thoughts about how Europe is preparing for the next pandemic. And the speaker is Jacques Biot, who I suppose is well known to this group, a former director of the Ecole Polytechnique in France. Jacques, the floor is yours. Thank you Michel and thank you to Thierry of course for this kind invitation. It's both a honour and a privilege to be here with all of you and I learn a lot from other panels. So just one word to say that I have no conflict of interest in this one, view of my other positions and that views expressed here are my own. As I was aware that I would be the last hurdle before lunch, I think I have only four slides after this one. So we'll first look into lessons to learn from how Europe fared with COVID-19 and then we'll try to look at the ingredients of a pandemic management and then we'll try to assess the key performance indicators of Europe in terms of preparedness and I will try to make a conclusion. So how did Europe fare with COVID-19? Well, I'd say not that bad, you know. We're very good at really chasing ourselves in Europe but I mean this is not legible from the back of the room but basically the circles show the European countries. This is a graph from the John Hopkins Institute which followed the statistics of COVID and this graph only focuses on the 20 most affected countries. So you see that actually Europe is pretty much in the average. The very good ones were mostly Asian countries, South Korea and Japan and the less good I would say guys were mostly, well, Peru which was clearly an outlier and the US in terms of mortality. The graph on the right is the case fatality ratio which shows that on this respect many Western European countries were pretty good at limiting the impact so they had a high morbidity but they were able to limit the impact of the disease probably because their health systems were pretty good. Now if you go into a more detailed assessment and you look at all countries in Europe you will see that I mean we had some countries especially in Eastern Europe which were pretty badly affected and which she didn't fare as well as those ones. So my take on that one would be that there wasn't really such a thing as Europe because there were pretty I would say unequal responses in terms of time and management. The Europeans for instance left our Italian friends for a long while completely alone with what was happening in Lombardia. The Brits at that time was still I would say in Europe made their own I would say policy but still there is one great success which I think we should recognize which is the decision by the Commission to procure vaccines as soon as they were ready on a centralized basis in order to avoid competition between countries and I think really that was one of the first times where really Europe played a very important role in terms of taking care of its citizens in a practical way. Now what are the ingredients for pandemic management that has been touched upon quite a lot by other speakers? What we should remind is that the next pandemics will not necessarily be like COVID. I mean Antoine showed us that COVID-19 was airborne but if you look at the history of epidemics there were plenty of epidemics which were not airborne which were contact-borne or water-borne and so Michelle said that the next pandemic is a certainty we only don't know when and I would add we only don't know which bug and the bugs may differ in terms of the way of transmission with a big question very often which is at which time does the bug become I mean at which time does the transmission become inter-human if the bug comes from somewhere else? I would add another division in the classification of bugs which is whether they are susceptible or not to a humoral immunity which is what you use basically for COVID vaccination. Let's remember that even with RNA we still don't have a vaccine against AIDS after 30 years of research. We don't have a vaccine against Malaya or we hardly have one etc. and we had issues with the dengue vaccine. So I mean Mankind was pretty lucky and talented to quote Woody Allen but in having a vaccine so fast because I mean with other bugs it could become much more difficult. If on the right side the graph is pretty much a consultant's graph which I borrowed from the European CDC been a consultant for many years so this is not pejorative but basically I tried to see what do you need in terms of practical skills if you want to implement the skill of preparedness and the response and the feedback and I think if you ask the layman in the industry they would pretty much think that I mean pandemic management relies mostly on epidemiology if they know what this means and an infectology and that this is a health issue but it's not just a health issue. It's an issue where you will need to test and trace and contain and protect and so you will need people versus with no in order because if you lock people down you don't do this without having riots or protestations or things like that. You may need environmental measures and I was happy to hear about the climate impact because I mean for instance you may want to reduce a source of pollution which is aggravating the disease etc. So I'm not going into detail of this but let's remember it's not just a health issue it's really a political issue which involves almost every part of an administration. Now where is Europe from this respect? Well first of all you need institutions. I mean pandemic preparedness cannot rely on disorder and that's where you immediately face some I would say questions because I mean for those of you who've been reading the recent book by Agnès Buzin who is a friend and the former minister of health where she explains how she lived the beginning of the epidemics you see that it was really difficult for her to find who would make the right decision and she was kind of going from one person to another one and although she was a medic and she had a feeling that something bad was coming so the coordination between WHO and the ECDC and HERA which is a new agency which Europe created which is basically for health emergency response and awareness and the role of the commission and the role of the governance in view of subsidiarity I mean nobody really could say how this is going to be coordinated we in France are very good at creating coordinators but usually we create so many of them that you need somebody to coordinate the coordinators and so we are still at the stage where I mean we will need some agreement between the various parties as mentioned it's not just health, it's health but it also involves foreign ministers if you need to close borders you need the home office if you need to lock people down and check that they don't get out from their homes you need local authorities and here again you will need to balance the responsibilities and certainly you need central decision making but also you need local action and in Europe it often happens that there is kind of a divide between both ends of the chain in terms of epidemiology and public health I think we had a lot of scientific de-globalization just in the wake of the global I would say de-globalization and I think scientists really need to speak together whatever happens I mean whenever kind of fighters and the combatants are fighting each other or distrusting each other but we need scientists to be able to travel and talk and exchange data and that's certainly something which we must emphasize for the next pandemics in terms of containment Europe has a specific issue because we have what is called the Schengen setting and so you don't close borders like that so if we have to lock down this will be a difficult issue and finally in terms of finding the cure and the protection really I think we need to realize that there has been a steep decline in life science research and if you look at the Nobel Prizes and at many many publications many of them were not done in Europe we still have very strong research institutions and I'm not going to quote them all but in Germany, in the UK, in Italy, in France, in Switzerland I mean we really have great institutions but they don't receive the amount of public funding that their American or Chinese counterparts or probably Japanese counterparts would receive we clearly have a pharma industry decline I mean because of course containment for decades and we also face the same issue that was mentioned of drug shortages which I would want to emphasize is mostly due to the fact that I mean authorities have not been attentive enough to the fact that within a production chain which usually includes tens of steps one step is in the hands of a lonely of only one producer and whether he's Chinese or wherever I mean we had shortages in Europe which were due to problems in facilities in Sweden or in Italy or in France so it's not once again it's not just blame the Chinese for having taken the industry I think it's more a question of procurement and making procurement safer in the pharma industry plus the pharma industry has completely I would say outsourced its research and that's by the way good thing because that's how we had the vaccines for Covid but I mean the French the sorry the European pharma industry is certainly much weaker than what it was 20 years ago and then finally we have and this was emphasized by Antoine I mean with the Trump example but we also have a high level of anti-vax sentiment in Europe and that's something which would make protection difficult so my takeaways I think really must everybody who is responsible in politics we must avoid looking for scapegoats I think in the beginning of the epidemics there were many people who tried to blame others and I mean when there is pandemics it's not the time to blame others it's the time to work together and that's something very important and at the time of ex-Twitter now ex and social networks it's really difficult to protect those who make decisions and that's a big issue not just in healthcare but it's an issue here we really I mean need to see how we can prolong the idea of the centralized vaccine procurement scheme because at this stage it was to some extent one shot but how can we make this happen in the future because with another commission you don't know what might happen we need to really build again medical staff because all over Europe we are lacking physicians and that's a big issue not just for pandemics but it will be an issue for pandemics we have in general a profound decay of public health systems because of course containment that has been going for years we definitely need more public education education was raised in several panels during this conference and I think it has to do with the economy but I mean much of the anti-vax sentiment and the resistance to lockdowns etc. is due to the fact that our populations are less and less educated and we need to really put a focus on education and that's my last bullet point really improve the priority for science I'm struck by the distrust for science which you can find in the population but also among politicians and among media and decision makers and so I think we should all strive to say that humanity would prosper if we encourage science and rely on science thank you for your attention thank you very much Jacques and thank you for your plea for science if there's one success to the Covid pandemic it's really open science there's been no borders and new systems put in place that really have allowed a wide and rapid communication of scientific innovation