 Thank you Charles for being with us today. I'm very thrilled to have you a warm welcome to our Covid Connect session today. Thank you very much. I'm delighted to take this and again thank you for inviting me. So we'll jump right into the questions for the day. We have many to ask you. We'll start with what does patent pooling mean? So one of the ways to achieve better access to new medicines is patent pooling. And though patent pooling has really existed for several decades in other fields, in public health, this is relatively a new concept to address some of the access challenges, especially in low and middle income countries. So in this context Charles, we wanted to understand if you could explain to our audience what is the patent pooling model and how that may differ from patent sharing or voluntary licensing or compulsory licensing? Yes, of course. Thank you for the question. So we were set up in 2010 by Unitade with this idea that perhaps this model that had been used elsewhere could be very useful in HIV for facilitating the access to the antiretroviral drugs. And our model is actually, it's more like licensing, although there's an element of patent pooling as well. So clearly it's voluntary and how it works is we approach a IP holder who has a drug that we think will be of public health benefit in low and middle income countries and we ask them for a license. If we succeed in persuading them to give a license, we then sub-license that to generic manufacturers, several of them, and they then produce hopefully affordable medicines and register them and provide them in low and middle income countries. And because it's voluntary, it has to work for everyone. It has to work for the IP holder. It has to work for the generic companies because we want a sustainable model. So they've got to make money doing this and it's got to work for public health. And what we're trying to do is to balance all those needs at the same time. So it's a complicated process getting that right. But that's the idea. And generally it's also allowed us through these licenses elements of innovation whereby our generic manufacturers can develop, for example, special formulations for children or combinations. And this brings me to patent pooling because sometimes the medicine you want is a combination of different medicines and the IP is held by different companies. And by putting them all into a pool, our generic manufacturers can get the IP for that and then combine the drugs into a single formulation, which can be extremely beneficial, particularly for communities who might find that big pill board burden is an issue. And to be able to take one pill a day rather than several can be enormously beneficial. So that's essentially how it works. And it differs obviously from compulsory licensing in the voluntary. And it also differs very much from another form of voluntary licensing, which is bilateral agreements between IP holders and generic companies. And that is because that is an entirely commercial arrangement. Whereas ours isn't, ours is much more about public health. And that also means, for example, that ours is more transparent, but it also just has a different focus. And often bilateral deals can be exclusive, whereas ours are non-exclusive. Got it. So while you mentioned, while you were explaining the differences you touched upon, why it is beneficial, what stands out for you as advantage and how does MVP play a role in making this access to low income possible? Right. I mean, I do think that the key advantage is that we are profit driven. It is, our aim is all about maximizing public health impact. So this changes our focus, but it also changes the products that we might look at. So we wanted to choose products where there is a clear science and evidence base that these have a significant impact and are needed in low and middle income countries. And of course, we have to partner with companies that have a profit motive. So, you know, we do, as I say, need to balance their needs with the public health. But the idea is that it really has to be win, win, win to make this work. And of course, if it does work as it has worked extremely well in HIV, it makes an enormous difference. We have, our generic manufacturers have now delivered more than 15 billion doses of HIV and hepatitis C drugs. So it clearly works because if you can lower the price that much, you can suddenly make it much more available to people. And more recently, for example, in hepatitis C, I think the cost of drugs has fallen so much that it is, that is one of the primary reasons why India decided to put in place a national plan for elimination of viral hepatitis. And that was actually both hepatitis C and hepatitis B drugs that we have licenses for. 15 billion doses, those are staggering numbers. So there is an immense amount of coordination that needs to have with manufacturers, both innovators and generic and governments, pull this, pull this together. So what, how does MPP play a role? Right. In one sense, we're a facilitator, I would say, but you're right. Partnership is critical to what we're doing. So there are many, many players in this field and we are one element of that. So as I said, you know, once we, we have a license from a manufacturer, then we also need to work with governments to make sure that this works for them. These are drugs they need. We need to be able to discuss potential prices. We don't, or so far we've fixed prices at all, but we have an idea of where they could go and we need to make sure that that this works for governments. But then also, as I said, there are many other partners involved in this because they're, they're regulatory issues. It's really important that there's no point having the drugs developed by our generic partners and then it takes years and years to get registration in country, for example. The supply and chain issues, we work a lot with other organizations like WHO to help with forecasting because that's very important for the generic companies too, to know the sort of production levels that they should be thinking about. And obviously, one of our advantages is that we have the sales data from all our generic partners. So we have an overall picture and that makes it much easier to do forecasting. If you know what happened in the last three months, for example, in a particular HIV drug, you have some idea of where it's going to go in the future. So it's partnering with all these people to make this work. And we are, as I say, sort of in the middle of it. One of those pieces that's critical without the licenses, this whole thing won't work. But we are only a bit of making it happen. Thank you. So MPP has been working to partner with everyone to ensure access. So we understand access to affordable HIV, AIDS, tuberculosis and HEXY medicines in low and middle income countries. And there's been huge milestones that have been achieved, like the reduction in the price of first generation HIV medicines from $10,000 per patient just as 20 years ago to less than $70 per patient today. So this is great success. If this is the kind of success we are experiencing, why is it that this model has been confined only to a few categories? And there's a long list of products that are probably needed. So how is the selection process working for patent pooling? For which medicines will be included? So to answer your first question, it's a very good question. And it's a question, exactly that question that WHO and some other international organisations asked us a couple of years ago. You have this great model, why are you just limiting it? And so with funding from the Swiss government, we undertook a feasibility study to explore whether there was a role for us in other disease areas. And our focus was really on WHO's model list of essential medicines, the EML. And the feasibility study suggested, yes, there was a strong need for better access to a number of therapeutic areas and that our licensing or patent pooling model could play a really important role. And so what we did was we decided following that our board said, yes, let us expand to start with small molecules that are included on the essential medicines list or have a strong possibility for future inclusion because there can be a lag between the arrival of a new medicine and its listing on the EML. And so that's what we've done at the moment. And we're now working with WHO and other organisations in the field to really target particular medicines. And so how do we do that? You asked the question about how we select medicines. So we've developed quite a comprehensive methodology on how to prioritise medicines. And in fact, we did it in HIV and we've expanded it and amended it over time and now it is, as I said, more comprehensive now that we're looking at other areas. And we essentially ask ourselves three questions. The first question is, is this drug of medical significance in low and middle-income countries? In other words, will it make a public health impact if we make it available? And we try and rely on WHO assessments because, as I said before, it's really important that we do this on a scientific evidence-based approach. And so this may be things that are already on the EML or there may be treatment guidelines from WHO on them. And then we ask ourselves, if it's an important medicine, are there access challenges to it in low and middle-income countries? And so we go out and look at what data there is to see what's happening, whether in fact there are any sales in those countries. And then we ask ourselves, finally, if we got licences, could we make a difference? Could we ask some of these access challenges if there are access challenges? And there are obviously price, which is where we largely concentrated, is only one element. There may be others. And this becomes particularly important in areas outside HIV, for example, where you don't have big guaranteed buyers, like the global fund or PEPFAR. So this is coming largely out of countries own domestic funding. Do they have the funding for a program? Are the diagnostics in place to make the demand there? Does it require very complex health systems to deliver the treatment? So all these questions are taken into account. But we work, I must say, very closely with WHO on this, on the selection of medicines, because we don't want to be selecting medicines that they really don't think have value. And this collaboration is actually an integral part of WHO's roadmap for access that was presented to the World Health Assembly two years ago. That's a very comprehensive method and various steps involved. So for the products that you have decided on by 2020, whatever you would like to expand the coverage to, what are the challenges and opportunities you foresee in actually being able to do that? Well, we certainly think there are opportunities. There are some key medicines in the areas of diabetes, heart disease, cancer that we think could make a big difference if they were affordable in low and middle income countries. The challenges are, as I said, without guaranteed buyers, the demand is potentially uncertain. Also, we don't have what we had in HIV, a very strong community voice demanding access to treatment. It's considerably less well developed yet in the noncommunicable disease space. And I think also government programs are not in place the way HIV programs are in essentially every country. There may well not be cancer programs or diabetes programs, or they may be very nascent, poorly funded and so on. So there's undoubtedly quite a lot of challenges and we do not yet have a license in that area. We've begun really engaging with companies around this, but that's been quite badly impacted by COVID. But we don't have a license and I think that indicates that this is quite challenging. But it's a challenge we've got to address and get over because it is so important. NCDs are, most of the mortality in low and middle income countries is actually driven by NCDs. So it's crucial that we get this right. We may not be able to do it immediately, but I think we have to do it. And where I think our model differs from some of the industry models is ours is much broader and we think it's more sustainable. Industry definitely has some great access programs, but they tend to be quite focused on a few areas, for example, or they tend to be involving giveaways, which donations are not really sustainable. And we think that our model is not the answer to everything by any means, but we do think it has a real place to play in essential medicines. But we're waiting to see. We're working on it very hard at the moment. So that brings me back to asking the question on the pattern pooling system itself, the challenges in getting these new categories on board. So patents have encouraged R&D, they incentivize R&D, but they have spurred the innovation of so many systems, so many new medicines, but at the same time, they limit competition. So if we really want to understand why companies agree to give their license for patent pooling and how does MPP give sub-licenses then to generic companies and how are they distributed among multiple companies and not just one. So how does that work? Why do they even agree to give their licenses for patent pooling? Okay, thank you. I put my headphones on to hope that will make it easier for you. So there are many answers to that question, I think, as to why companies give us licenses. For example, it may be that they're simply not set up to do very large volumes at very low cost. One has to remember that if you like comparative advantage of big pharma is in discovering drugs and then bringing them to market through the clinical trial process. The comparative advantage of generic companies is very often in production, how to produce something at high volume at very low cost. So that does make sense that where you want to do that in low and middle income countries where potentially you have very large volumes, that it should be generic to who can do that. But it's also things like the big pharma may not have a footprint in all parts of the world. They may not actually they may not have the resources to register in 150 countries at the same time. Then if they do bilateral licenses, they have to manage those licensees if they decide to go that route rather than literally distributing themselves. And we I think now I think we can claim with pretty much certainty that we have way the best alliance management on the planet. The level of relationship we have built up with the generic companies over years and it's very much a give and take arrangement allows us to oversee what's happening and support them in a way that I do not think that big pharma are able to. And of course we do it for free, which is a big advantage for pharma. And then of course reputation counts in the pharmaceutical world. In fact in the corporate world it counts. And there is something called the access to medicines index which I'm sure you're familiar with which rates companies on how well they do access. And broadly speaking if they give us licenses they tend to do well. So GSK for example has just come out number one in the new index that's just been released. And that is at least in part because their subsidiary Veev licenses its HRV drugs through us. So there's that. But even more than that now there is a growing understanding amongst the pharma companies that investors are looking more at ethical investing. And ethical investors are considering pharma by how well they do access. It's one of the key considerations in what is ethical in a big pharma. So there aren't you a lot of reasons as to why pharma might want to give us licenses. And then you asked how do we select our sub licenses. So over the years we have developed a model to make sure that it is completely fair. When we've spoken to our generic partners they all said what you have to do in your process is be transparently fair. And judge each company's application objectively. So when we get a license we then start a process which we call our expression of interest process. And we invite any generic company to apply for a sub license. And then we score them in a very objective way using some internal but external advisors as well. And it's done on a blinded basis. So none of them know which are the companies. And then once that's done they present to me I had a business development and our general counsel and say these are our recommendations for a license. And then we unblind them and make sure there's no issue with any of the companies because it might be and we haven't done this. But it might happen that a company we've had as a licensee in the past has behaved very badly and broken the terms and we would not want them as a licensee again. I mean that hasn't happened but it could. So we unblind it to check that. And that's how we do the selection. Thank you. So license from one company is also given as a sub license to other companies in some instances. So why is it important to have transparency in these licenses? And how do you ensure that there is this transparency in the licensing and sub licensing process? Yes, I should say what we do in the selection process is our model is predicated on the empirical fact that whether it's competition, prices go down. And so we select a number of sub licensees based on what will be sustainable but at the same time will provide the kind of competition that will drive down prices. And also it has to be said secure supply because where you have just one company, there are always risks around supply security. And then the transparency issue. So we think in public health that transparency is by itself a good thing. More transparency is better than less transparency in general. And so we decided at the beginning that we would be transparent in our licenses, which means we put them in full on our well, essentially in full on our website. We have a provision that if there is something very commercially sensitive, we might redact that little bit. But essentially our licenses are on our website for anyone to see. And interestingly, when I joined MPP, I had a meeting with a certain Indian generic company that I will not name who said to me, you know what, we don't need you anymore because it's so great that you put your license on the website because we just use that as a template when we go and do bilaterals with the IP holders. And I think perhaps at the time they weren't really thinking about the advantages of having licenses from us rather than going bilaterals. And within nine months they were back asking for a license. So because we really try and make it a win-win, the support we give to our generic partners is something that I really do not think big pharma do. So as I say, transparency, that's how we do it. And I think it's become part of our brand and our business model that we are transparent. And we're a bit unique in the space as to how transparent we are. But our feeling is on principle, everything that we do should be transparent. It's public money that we're dealing with. The public should know how it's being spent. So that's our kind of philosophy on this. And I think we're quite proud of it. And we're often held up as an example. And I also think one other thing on transparency, I think that when we began, and there was still a lot of hesitation amongst big pharma to give us a license, they looked at the licenses on the website and realized these aren't scary things at all. This makes sense. We could do that kind of licensing to the MPP So I think it also worked if you like a little bit of advertising. Everything you said sounded great. It's very clear that patent pooling is leading to much more access at much more affordable prices for many countries. I'm going to come to the topic that is core to us at USP. So while we are ensuring access at low pricing, which is affordable for many countries, how does MPP try to assure the quality of the medicines going in so that we ensure not just access, but access to quality medicines? Yes, thank you. That's a really important question. Quality is essential to what we do. It's essential to our relationship in many respects with WHO because it's essential to public health. Substandard medicines lead to lots of problems, and particularly as it happens in infectious diseases, which is where we started, because this can really encourage resistance aside from the impact it has on people for whom the medicine doesn't work. So all of our licenses have very strong quality assurance language and require our licensees to comply with standards of the most stringent regulatory authorities. We monitor that closely, and if they don't, then they can lose the license and would not therefore be able to continue to manufacture. Over the past couple of years, we've been thinking more about quality. In fact, when I joined MPP in the summer of 2018, it was one of the first things that I wanted to take a look at, were we doing enough? And so we engaged with USP, and USP have been extremely kind and supportive in providing your expertise to us. And so we've looked at how we can improve this, and we're taking a step-by-step process at the moment. And that's partly because we are a very small organization. We have less than 30 people, and we have operations where drugs have been delivered in more than 130 countries. And of course, one of the reasons I was particularly concerned about it, in HIV, you have these big multinational players in the market, like Petfar or the Global Fund, who can do the quality assurance? When we move out into other areas, particularly things like oncology and cardiovascular disease, they're not those players there. So we need to be assured. And so USP is this is something that we're taking forward with USP to see what we can continue to do to improve this. But as I say, we're doing a step-by-step process, but it's clear it's important. And we do have a whistleblower policy where anybody concerned about the quality of one of our drugs can reach out to us for further investigation. And then that's what we will then put in place, almost certainly with your help. Thank you, Charles. The quality is absolutely critical. Since we are called the COVID Connect series for this webinar, I am going to come to the topic of COVID-19. We've seen COVID-19 just bring forth a whole series of innovations, both on COVID treatments as well as on vaccines. Many of these across the globe. And it has encouraged several pharma companies and researchers to speed up the process on both of these, whether it's a treatment or a vaccine. How has the pandemic affected your work and what have been learnings so far based on this pandemic? Okay, thank you. Well, in terms of our more general work, it's absolutely disrupted it in many ways. It's disrupted our interactions with the pharmaceutical companies whose attention has really shifted to COVID. So when we're saying, can we talk about potential license for a diabetic medicine, they're like, I'm really sorry, we just don't have the time at the moment. It's also disrupted some important interactions with governments about other areas, which is problematic. And of course, in the areas in which we work, there's a real danger that a lot of what we've done in terms of delivering HIV drugs and hepatitis C drugs will be undone by this. And it's a real worry as to how fragile the gains are that we've made over the past few years by making medicines affordable in really trying to tackle the HIV and hepatitis epidemics that this could be undone. But we're going to have to think about making sure that that doesn't happen. And then in terms of COVID itself, it's obviously offered, as you said, the opportunities to do things in a different way. And I think that's really one of the learnings on this. I participated in a World Economic Forum Davos meeting day before yesterday. That was called collateral damage from COVID and was really talking about what's happening in all these other disease areas. And I said at the end, look, I think there is a lot of collateral damage. But what we also have to think about is the collateral benefits. And it's really important that we focus on those in order to take things forward. People talk about build back better and so on. Well, we need to focus on what's come out of COVID. And what I think for us is that products can be developed a great deal faster than people said beforehand. The regulatory process could be much faster. We can establish new partnerships much quicker. All these things mean that potentially in other areas, we will be able to bring new patented medicines to LMICs faster than we've ever done. And I think that's kind of really exciting. I also hope that in some of these areas where there aren't government programs, perhaps there's not much government funding, COVID will really focus people's minds on the fact that health is not a cost. Health is an investment. And it's more than an investment. It is one of the key pillars along with education and a couple of others that underpin a society. And it's like with individuals. When you're well, you don't value health. As soon as you're ill, you understand how important it is. And that's exactly what's happened to the world. We've all got ill at the same time. And suddenly we're realizing you have to have this. And I hope that realization stays with people. And as I said, they start thinking of health as an investment because it is actually ridiculous the amount of the percentage of GDP that some really quite rich countries are putting into health. And so everybody's got to play a part in this. And I hope that those learnings are taken forward. And there is more investment in health. And that will help us to have programs for oncology for diabetes and so on in low and middle income countries. That's a very positive way of looking at what we've learned from COVID. That was very insightful. Thank you, Charles. In terms of COVID treatments and vaccines themselves, we understand from recent news and your statements in the press that while it would be fantastic to get some of that IP or technology transfer for COVID vaccines and treatments to give licenses to other companies, that has not yet happened. So could you share your experience with for the particular disease that we're all looking to and everybody seems to want to partner, but somehow MPP is not being utilized at the moment? Could you share the challenges with that? Yes, thank you. So at the beginning of the pandemic, there was a lot of talk about licensing and what a role it could play. And then it got rather overtaken by many more considerations around capacity. And the big pharmaceutical companies started worrying much more about that and thinking about contract manufacturing arrangements with generic companies and biosimilar companies rather than licensing. And we were sort of astonished in a way that we were suddenly being sidelined, I guess. And we really felt that our expertise, our experience and the model of voluntary licensing, non-exclusive public health voluntary licensing could be incredibly useful, not just for pricing, but also for supply. And so one of the things that we did, we got together with our generic partners, 21 of them before Christmas, and they came out with this pledge, pledging their capacity individually and collectively to help with this and really saying we think voluntary licensing has a critical role to play for the middle-income countries. And that was very useful and on the back of that pledge from the Indian generic manufacturers, we were able to reach out to pharmaceutical companies who began to engage with us. So we are at the moment all the early discussions with some companies more than we had before, so that at least is positive. I mean, we've done a few other things in COVID too, but our mandate had to be expanded by our board because it didn't cover COVID. So in March last year, our board said, yes, look, let's offer our experience and expertise to the global community for COVID. And then the first thing we sort of set out to do is to map the patent landscape. We have a patent database called MEDSPAL that is actually patents and licensing and is used a lot by procurers, for example, also by governments to see the status of drugs in their territory, whether the patent's there, whether there's the license and so on. So we expanded that to cover COVID. We're now looking at expanding it further to, we just did therapeutics, now looking at vaccines. To greatly win when it looked like Lepinavir and Retonavir might be very useful for COVID. In fact, it isn't, but ABV withdrew their patents, which was great because we already had intergeneric manufacturers producing it for HIV, which is what its primary indication is for. And suddenly, they could supply the whole world with it under our agreements. So that was really important. One of our Hep C drugs is still being investigated for COVID. And that would be great if that turns out to work because we've got a lot of manufacturers ready to deliver that. And so there's a lot going on in this space, but we're not at the point yet of having a license. But it has to be said in vaccines, the feeling has been we don't really have a role at the moment. COVAX, the Act Accelerator Pillar, dealing with vaccines feels that they've got everything under control. We've offered our experience there. We are doing a major mapping around capacity, although others have also done this. And to see if we could have a role in vaccines, obviously, because it's a biologic, there's complications around tech transfer and regulatory issues and so on. And we've offered our licensing expertise, if that's necessary. So we're watching that space. And certainly in the therapeutics, we do feel we have a role to play. But as you know, the first therapeutics out there have been the monoclonal antibodies. And already, there's considerable disquiet about their efficacy with the new variants. And just as important for low and middle income countries at the moment, they require intravenous infusion, meaning that that's not necessarily what you'd want in a low and middle income country. So until we have a subcutaneous or maybe even intramuscular formulation, it may not be really suitable. And for small molecules, we don't really have a patented small molecule that's been shown to be safe and effective under development, but we're not there yet. And so that is another reason why we don't at the moment have a license. But we're certainly working on it. Because as I said, I think we have a potentially important role to play here. And we're certainly trying. We do hope you're able to. We have 15 minutes more. So I'm just going to prompt the audience to please share any questions you may have under the Q&A box while I continue to ask a couple of wrap up with my final questions. If you have any questions, please type into the Q&A box. So with the pandemic, has there been impact on universal health coverage and how new initiatives or activities taken during the pandemic affect licensing process going forward in the future? Yes, well, thanks. I mean, I think I've covered some of this. I mean, the thing about universal health coverage is that we absolutely believe that you can't do universal health coverage without affordable medicines. I mean, there are lots of other aspects of it. But if you don't have affordable medicines, frankly, forget UHC, which is why we think that, you know, our move into essential medicines is so important, because those are the sort of medicines that you would want to cover in our health package for your populations. So as I said that there's been a big slowdown in our discussions around these medicines because COVID has taken center stage. So, you know, it hasn't derailed it. It's just put a bit of hiatus in what's happening. But we hope that as the vaccines are being rolled out, we start actually having some medicines available. We'll be able to concentrate again on some of these other medicines that are critical to UHC. Thank you, Charles. We have a question from the audience. Would MPP consider in the future looking into biologic and biosimilar products, especially in the light of potential expansion of the mandate into cancer? Thank you. That's a very good question. Yes. Even before COVID, we'd started to look at this. Clearly, that is a large element of the direction of travel of healthcare, as you say in cancer, but not just in cancer. And so we decided to do an in-depth investigation to see whether our model would work. And it's not immediately obvious for a number of reasons. First of all, the length of time it takes a biosimilar company to develop a biosimilar. Then the complications of the regulatory pathway could mean that most of the things were off-patent by the time they were ready to go to market. Secondly, the expense. The investment required from a biosimilar company is way higher than for a generic small molecule. Thirdly, the demand is far less certain. And that's connected to the fact that could we make it affordable? So you might be able to get a significant price reduction, but that's not really what we're aiming for. It's not price reduction. What we're aiming for is affordability. It could come down 50% or 75% or 90%. But if it started out at a million dollars, is it going to be affordable when you get to the end price? And if it's not, there's going to be no demand. Who's going to take one of our licenses? So I think that our investigation, which is not finished yet, and which has changed in the light of COVID for the positive, because it has shown that we can actually speed up the development of these drugs way more. The regulatory process could be much quicker. A lot of the generic companies, particularly in India actually, are really upskilling in this area to such an extent. Gaining experience already have a lot of the investment required and so on. So a lot of these questions, I think, are being answered positively. And I think there's a very high likelihood that we will move into this area. Great. Thank you. The next question is you mentioned there was difficulty in tech transfer, even if companies were wanting to give licenses to other companies or use the MPP during COVID for COVID treatments. Could you elaborate what that tech transfer issue was and what challenges? Yes. I mean, one of the tech transfer issues is clearly around biologics. They are a lot more complex than small molecules. And whereas you might be able to, with a biologic, give a fairly simple few pages of very useful instructions in biologics in particular, but also if you want to speed things up. Ideally, the IP holder, the people who develop the drug, would send people to the company that they're trying to do the tech transfer to. In the case of COVID, where everybody is so stretched, there's a real human resource problem. And so where we have discussed with one or two companies in the biologics field for COVID, they have gone, we just couldn't do this. We might be able to do this to one company to do contract manufacturing. There's just no way that we could do it to six sub-licenses. We just don't have that kind of manpower available. And that's totally understandable while companies are just trying to make as many as possible as quickly as they can. Any other questions from the audience? Please do share. I have one last question for you, Charles, which is out of curiosity. You have spent years, decades, with so much passion on public health. So what was your draw into that? And what is the journey that you have been on your motivation or your passion behind it? Okay, thank you. Yes, well, I was diagnosed with hepatitis C in 1995. And when I was diagnosed, my doctor said to me, oh, don't worry about it. Just try not to drink too much. That was the total extent of his advice, around hepatitis C. So three years later, I was actually diagnosed with cirrhosis and then was not very well at all. And as a result of that, I found out as much as I could about it. But I found it was impossible in the UK to get some proper support. And I didn't know which information to trust on the web. And I happened to meet three other people with hepatitis C with exactly the same experience. And they said, people should not have to go through this. We should set up a charity. And at the time, there were more than 500 HIV charities in the UK, and no charities for people with hepatitis C, no support organization. So we set that up. And by mistake, I ended up running it. I had no intention of doing that, but they forced me to do it. And I said, I had never done this before. I don't know what I'm doing, whatever. But anyway, when we started, so the first thing we did was set up a really comprehensive website, answering all the questions that we thought people would have. And in fact, that website was taken by a number of other Hep C charities around the world and simply translated into their language. And then a support service. But then also we got very involved quite soon in advocacy, because I realized in the UK, Hep C had a very low priority. And in the UK, a lot of the people with Hep C are marginalized or vulnerable populations, people who inject drugs, people in prison, some immigrant communities from high burden countries and so on. And I realized that I enjoyed this. These people didn't have a voice. And I liked being their voice. And the fact that they were being ignored because they didn't have a voice just struck me as massively unfair. And so I became incredibly passionate about that. And then I took that into the European arena and then into the world arena, where again, I felt that hepatitis had just been inexplicably forgotten, despite killing as many people as HIV or TB or malaria. And it just, it didn't seem right. And I guess that there's a streak in me that doesn't like to see things that are not right. And so it was in my power to try and do something about that. So I did. And I continued to do that. And then when I got involved with sort of viral hepatitis more broadly, came across and at a world level, you know, more groups of people who didn't have a voice who were disproportionately affected, like a lot of indigenous people in different parts of the world, very badly affected with hepatitis B. So it was really a privilege, I think, to be allowed to stand up and speak for them, to try and make sure that their needs were addressed. So to take something that was so negative that happened to you and turn it into such a force of positivity for global public health, that is a very inspirational story. Thank you, Charles for sharing and kudos to you for all the work. I do have one question from the audience, addressing something that was partially discussed already. Once you have identified the need for a particular disease or drug, how successful were you in engaging the patent holder and when not successful, which were the main obstacles you had to engage, which were the main obstacles to be able to convince them? Okay. It's a good question, but it's got slightly different answers depending what disease area you're talking about. In HIV, at the beginning of the medicine's patent pool, it was difficult to engage, to be honest, because this model hadn't been used in public health before. As you said, it had been used in other areas, aircraft manufacture, but not in public health and people were wary of it. But very quickly, once the licenses started to come, it became the thing to do in HIV. You couldn't really not offer us a license, to be honest, and that's where we are today. So that became very easy. And then a lot of the advocacy that had been in HIV switched into hepatitis C. And so there was already quite a voice there. In the new areas, cardiovascular oncology, diabetes, etc., etc., it's a lot harder. And the fact we don't have a license just shows what the challenges are. And I think because this seems like a different area, the model has not been used in this area. And so there's still caution, I would say, on the part of the IP holders around this. So it's a slow process of educating them about how this might work for them that could be advantageous for them. Because as I said, this is voluntary, it has to be win-win. And we think there are lots of ways in which this could be important to them. So it's a process, we're in the middle of it. I think we'll overcome the challenges. But it's just, I think it's caution. Caution more than anything else. What are the ramifications if we give a license? Does that mean MPP will then be coming after us for a license for all of our drugs? And no, it's just the ones that are patented on the essential medicines list, which actually is quite a limited number, it has to be said. But also they worry about things like how will we ensure that the territory that we get in the license is absolutely properly respected. And drugs, generic products do not leak into their commercial markets. Well, we have an amazing system for doing that where with lots and lots of checks as to how that works. So we can reassure them on that. But clearly, until they see it in practice, they worry. So, yes, I guess it's a lot of caution around things like their commercial markets, around what does this mean going forward? Is this setting a precedent for something? And I mean, you know, in some respects, one wants it to set a precedent because when it took up the job, I gave myself a target. And my target is that by the time I step down from the medicine's patent pool, every new drug should have a credible access plan attached to it to make sure that everybody who needs the drug, no matter where they live, can get it in a very short space of time. Because we can't go on like this, where drugs are available quickly in high-income countries and years later in low- and middle-income countries. They've got to be as near as possible, simultaneously available. And that requires right at the beginning an access plan. And it doesn't have to be through MPP. There are other models, but there has to be one. And it has to be a comprehensive one for everybody who needs it. Because it's, honestly, unethical not to do that. Where you live should not determine whether you live. That's amazing, Charles. Thank you for all that you do to make these things happen. And I have comments coming in that we need more like you, where you mentioned there are a whole other busy states who don't have that voice. So kudos to you and thank you for taking the time today. We sure hope we could work with you in the future. It was very insightful today and I learned a ton and I'm sure the audience did too. Thank you.