 I think we're going to try to get started. Please grab some coffee or other refreshments at the back if you'd like. Apologies for the delay this morning. I think we had a couple of cold weather related false starts that delayed a couple of us including myself and my other guests from getting here right on time. So thank you very much for your patience. Very good to see you all here this morning. I think we're going to have a very interesting discussion on a very important subject, the UK's new strategy for global health. Let me take a moment to introduce two of our three guests. We have with us this morning Dr. Robin Niblett, an old friend of CSIS, actually a former vice president of CSIS and head of CSIS's European program. Robin is now the director of Chatham House, also known as the Royal Institute of International Affairs and he has written and lectured extensively on transatlantic relations and Robin it's so nice to see you back here this morning. We also have with us this morning Dr. Nick Bonadvala. Nick is currently the head of the global affairs department at the UK's Department of Health and a senior lecturer at Imperial College. Nick has also spent a significant part of his career at DFID and has worked at the British NGO Merlin with a lot of experience I believe in the Middle East, Afghanistan, Pakistan and Iraq. We're going to have a third panelist join us later this morning. Well known to most of you I think Dr. Chris Elias from PATH. Chris is the CEO of PATH and has a very distinguished career as both a researcher and implementer in global health. A word or two about our format. We'll start off with a few introductory words from Robin on the context and why this is an important moment for the UK in introducing its new global health strategy and about a very interesting new relationship that's being forged between the UK government and Chatham House on global health. Nick then will give us an overview of the strategy itself. Then we're going to have a short conversation among the panelists up here on the stage and then we hope to have about 20 to 30 minutes for Q&A. We are going to have to end promptly at 11 so my apologies if we're not going to be able to take all your questions but we can certainly adjourn to the area outside the room here and continue the discussion if we want. Before I give the floor to our guests just three quick points I'd like to make about why I think it's important that we are having this discussion this morning. First I think we all know that we're at a critical moment here in the US in terms of the future of our global health investments. The last eight years has seen an unprecedented increase in the leadership and the resources the US has directed to this field and the challenge now before us has had to sustain and accelerate those investments in a very complicated environment with a new political leadership here in Washington. Second we have a very long history of US UK engagement and leadership in global health and we can learn from that. This is an ideal time for us to stop and look at how our two countries have done things differently and what it is we can take away from that experience and how it can inform our work going forward. And third there are many challenges out there that we're only going to be able to best address if we address them together and I think that goes from things like how we sustain the important work of the global fund look at its financing needs down the road to how we make the G8 a more effective mechanism for advancing global health interests. Finally Nick and Robin as significant as your visit is here today I think we have to acknowledge that there's also another visitor from the UK in Washington this morning. Prime Minister Gordon Brown is here as well. I believe later today he'll have his first meeting since the election with President Obama. That's certainly going to be a very significant discussion. The Prime Minister has said he wants it to focus mostly on global economic issues that's totally understandable but I believe over the weekend he also made a call for something he was calling a new partnership of purpose between the US and the UK and he talked about the importance of that type of partnership forging a global new deal that would focus both on the economic crisis but also on issues around poverty, disease and global inequities. So I think that makes your visit even more timely and we're very anxious to hear what you have to say. We look forward to learning from you and welcome. Robin. Thanks very much Lisa. Thanks for those opening remarks and it is great to be back here and we're particularly excited so if from a Chatham House perspective to be able to re-engage with CSIS and on this particular topic as well. Great to work with you Lisa. It'd be good to be with Steve. Delighted to see you've got this center up and running here at CSIS and we are particularly excited at Chatham House to be launching a center on global health and foreign policy and we will have actually a launch conference taking place in London next week on March 10th and 11th which Nick will be part of along with a number of stakeholders let's say both from the government, from the health sector, from the private sector, from around the world. And I'm not a health expert. I don't come at this from the health angle but we were discussing yesterday with Lisa and with Steve that I think it's almost as if organizations like Chatham House that have worked traditionally on international affairs are becoming aware of how health fits into so many dimensions of other aspects that we would traditionally consider to be part of international relations from post-company reconstruction to changing impacts and externalities of climate change to development policy to trade policy. And from our perspective as we think about the mission I think most of our institutes tend to have which is in various forms to try and build a better, more prosperous, more secure, more just world. Health ends up being a component, a larger or smaller but often a pivotal component within each of these broader areas that we would traditionally consider part of international affairs. So we're looking forward to doing is by having this center on global health and foreign policy at Chatham House to be able to integrate the health dimension into a number of the areas of work that we would traditionally do. Obviously our opportunity to do this wouldn't have arisen without I think the kind of vision that's been laid out in the healthiest global strategy document. The Nick Bennett Valer really was the driving force behind, this is an initiative that has started earlier in 2007 with a first document that set the scene, but this more recent document that he's going to be talking about in a minute really does put health and global health within a much broader framework. I mean there are five components who will be talking about one of which is better global health security. And Chatham House's role within this and the center we've created is very much as a subset of that better global health security ambition. And there are a number of subsets that are laid out within the document which I think you'll be getting access to. And we hope to be able to touch on a number of them as I mentioned earlier using our work on climate change for example, using our work on post-culture reconstruction, thinking about trade policy and access to medicines to move maybe into some new areas, counterfeit medicine and how that fits in with global nice crime and other risks to security, coordination between different governmental agencies on controlling pandemics, whether deliberately caused or organic and natural. To think about the linkages between food security and health, something I know that you're working on at CSIS, which we're also doing quite a bit of work on right now, Chatham House, and perhaps most importantly given our role as international affairs organization, trying to think about building interlinkages and bridge building between what is inevitably a very stovepipe area of governmental inquiry. Health does cut across, as I think Nick will say in a minute, all areas of UK government policy. But its primacy is something that has to be struggled for in areas where it probably should be primary and its pure attention is hard to always capture in areas where it should be attended to. So I think as an organization that tends to work much more broadly in areas of international affairs, foreign policies that might have been known, the chance to bring health into it is part of what I think the British government has said itself a task to do, something that we're very pleased to be able to support it on, something that I think will only become meaningful and productive to the extent to which we can build linkages outside the UK to the United States, to other countries and therefore working, as I said, with the CSI as center. That seemed like an actually natural partnership, especially for me, with my old CSI as connection, and also knowing that CSI is one of those kind of can-do think tags as opposed to just a studying and observing think tag. So really all I wanted to do with these interactions was A, to say, we're delighted to have this opportunity to work with the UK government on its health global strategy to fulfill, hopefully, a component part of it to make sure that health remains not the second or third or fourth or cousin, but a central part of British thinking and international thinking about prosperity and security internationally. And look forward to working with all of you on it, and hopefully we can have a little bit of discussion. But I guess, Nick, you've been introduced already, but thanks for the opportunity and look forward to your comments. Thank you very much. Thank you very much. Thank you, Robin, Lisa, Steve, and everybody. It's a real pleasure to be here today. What I thought I'd do in 20 minutes or so is give you if you like a whistle stop tour over the global health strategy. You know, there's so many documents in this world that people have on their desk. If at the end of this, you can say, well, okay, you understand what it says. It means that that's one thing less off your mind that you can take it back and you know it's there, but at least you won't feel that you've got to plow through it or each and every page. So that's my objective. And then we'll have a discussion where you can then challenge me on whether it really is going to make a difference and what are the real differences to other work that we've done at the moment. So on September the 30th of last year, we had four ministers together who launched Health is Global, the Secretary of States or Cabinet Minister Alan Johnson from Department of Health, Mark Malik Brown, who many of you will know from the Foreign and Commonwealth Office Department of State, if you like. Jillian Merron, Minister from the Department of International Development, USA equivalent. And Dawn Primarello was there at the event as well from the Department of Health and our Minister of Public Health. So we had a number of stakeholders were at that event. And I guess the first question is, well, why does the UK need a strategy to address global health? And so simply it's because if the UK is to protect the health of its population, harness the benefits of globalization and make the most of its contribution to health and development across the world, it needs a clear, coherent and coordinated, indeed consistent approach to the many issues that influence global health. And as Gordon Brown said in the forward to this document, this strategy is one way for Britain to help build a better and fairer world. Global health, he argues, is not just a question of morality, but of security. In today's new global era, flows of commerce, information and ideas transcend traditional borders, but so too is climate change and pandemics like influenza or SARS. Clearly, the first duty of any government has to be to ensure the safety of its people. But increasingly, we all recognize that this can no longer be achieved in isolation. It's in our interest not only to uphold the values that underpin our policies at home, says Gordon Brown, liberty, security and justice for all, economic opportunity and environmental protection shared by all, but to promote them actively abroad. And nowhere is this more important than in the field of global health. So as Robin said, the proposals for health is global published in 2007 by the chief medical officer, Salim Donelson. And the concept for this actually goes back several years. And the articulation for the need for the global health strategy, important point, was actually came from outside government. An interministerial group chaired by Minister for Public Health in the UK oversaw the production of publication and will oversee the delivery of the strategy of ministers right across government participating. And a high level, across government officials group, is the working level for the development, was the working level for the development of this piece of work. A number of stakeholder workshops were undertaken to try and articulate what people outside thought should go into this strategy. And there were written responses and published commentaries in the last of BMJ and other journals. Now, one of the things that stakeholders said was they thought that we needed an ambitious document, but at the same time, it needed also to be sufficiently specific with clear deliverables. And what they said is it would be incredibly useful if you could articulate a series of principles that would guide the way that you work in government. And so we set out 10 principles. The first one, which I think is extraordinarily ambitious, is that we will set out to do no harm and as far as feasible, evaluate the impact of our domestic and foreign policies on global health to ensure that our intention is fulfilled. Number two, facing policies and practice on sound evidence. And that's a really big ask. We think about what the significance of that is. The third thing for the UK, which is rather new, but you in the US have developed this quite considerably, is thinking about the links between health and foreign policy. And we will discuss that again in a little bit later, but using health as an agent for good in foreign policy. The next one is promoting outcomes that support achievement of the Millennium Development Goals. So this no longer becomes a DFID mantra, poverty eradication and the Millennium Development Goals, but it's something right across government. And we know number 10, and we know that the Foreign and Commonwealth Office are committed to that, but it's now all government departments that need to ensure that policy and practice don't undermine Millennium Development Goals. Promoting health equity is something which we have for a long time promoted and worked with the Commission for Social Determinants of Health most recently. And that's a principle. We want to ensure that the effects of foreign and domestic policies on global health are much more explicit and that we are transparent where objectives of different policies make complete, because as sure as eggs are eggs, there will be conflict. And if we can at least say that, well, we recognize this, but this is what we're doing about it, then at least that's a more transparent approach. Working for strong and effective leadership through the multilateral system, again, something that the UK cares passionately about. Learning from other countries, policies and experience in order to improve health and well-being of the UK population. Recognizing that the opportunity is not just what we do others, but there are huge learning opportunities on the quality issue, on health systems, on determinants of health from others. Protecting the health of the UK proactively by tackling health challenges that begin outside our borders. Coming back to that initial comment from the Prime Minister. And then finally, and perhaps most importantly, working in partnership with other governments, multilateral, civil society and business. And that's why it's so important that Robin is here and I'll describe some of the other initiatives as we go through this presentation. So the first thing one has to decide when one's putting together a strategy is what are going to be the criteria you're going to use to determine the priorities. And these were the five that we selected. That the area had a direct link between important global health issue, or was of course a global health issue of importance in its own right. Secondly, that the UK has particular expertise and experience in working in this area, or able to influence others. That delivery required effective cross-government working. So if one government department was responsible for one area, but none of us were involved in it, fine. This wasn't going to become a mass compendium of everything that existed. But we could identify discrete outcomes. That was about the specificity that stakeholders call for. We want measurable outcomes so we can see how you're doing. And then finally, we were also clear that we wanted to see the UK standing to benefit from this. So the five areas for action that were selected were here. Better global health security, stronger fairer and safer systems to deliver health, more effective international health organizations, stronger, freer and fairer trade for better health. Can you have all of those at one time? I don't know. Strengthening the way we develop and use evidence to improve policy and practice. And we identified 41, we wills, deliverables, commitments, if you like, with lead and supporting government departments. And at the back of the annex of the document, there are those 41 with one lead department for accountability, except for one where we couldn't get agreement. And supporting departments next to them. And the five areas for action are linked to economic prosperity, security and stability. And there are those first four columns, there's four areas, and underpinning all those, strengthening the way we develop and use evidence to improve policy and practice. And this leading to improvement in the health of the UK and world's population against again the link there. And then finally economic prosperity, security and stability. Now you go through each in turn, better global health security, combating global poverty and health inequalities, tackling climate change and environmental factors, tackling the effect of conflict on health and health care, reducing the threat from infectious diseases and managing the health of migrants and tackling human trafficking. So some examples of we wills to combat global poverty and health inequalities, we will work with WHO, the EU and others to take forward key recommendations from WHO Commission on social determinants of health and ensure that action to address these issues remains high on the international agenda. With regards to tackling climate change and environmental factors, we will work with international partners, in particular the WHO and the EU to develop evidence on health impacts on climate change and use this to draw public and policymakers attention to the potential health risks associated with climate change. With regards to reducing the threat from infectious diseases, we have provided funding to the health protection agency, if you like our equivalent of CDC, to increase UK and global health security and for them to do more internationally. We also said that we would publish and implement a new cross-government international pandemic influenza strategy. We have our domestic one, this is an international one that came out at the end of last year. With regards to tackling the effects of conflict on health and health care, there are two dimensions to this. One is tackling the health impacts of violent conflict and chronic instability. The second one is the role of health and health care workers in preventing conflict and acting as a bridged peace. A really big challenge here is coherence and consistency across government. For example, the role of the armed forces, the Afghanistan and the real risk or the perceived risk of politicisation of activities. And even with joint objectives, the need to retain distinct civilian led and military led activities. Now what we say in the global health strategy is the precise response to any given scenario will be specific to the context. But that makes me anxious because is that the potential excuse for always saying why in a particular area we will have to perform in a particular way or we cannot make any firm guidance or principles in the way that we act. But I think we can move forward and there are two opportunities that I will briefly describe. One is a cross government joint stabilisation unit with DFID, the foreign office, Ministry of Defence and the Department of Health that feeds into that in terms of what we actually are trying to do in conflict with different government departments harmonising activities. And then secondly, a joint academic NGO network, a health and fragile states network which we will want to work with in terms of developing guidance and policy. So that over the lifetime of this strategy, we have committed to developing more coherent and consistent policy on health and conflict. What will that look like? I hope that will look as a guidance, operational guidance that people can see in the form of a manual or a document. And to that extent, we have seconded an individual from the Department of Health into an NGO and academic unit to support that work. Number two, stronger, fairer and safer systems to deliver health, increasing finance for health systems with universal healthcare coverage. Stronger health systems through the international health partnerships, international health partnership. Number three, addressing the global workforce crisis, the 4.2 million missing healthcare workers, increasing access to medicines, technologies and innovations and increased patient safety. Number five, increasing sexual reproductive and maternal health and finally, focusing on non-communicable diseases and injuries. So in terms of addressing the global workforce crisis, as a whole of government, we are committed to combating the global workforce crisis by becoming more self sufficient in training our own healthcare workers. We will also support multilateral initiatives and codes of practice to promote self-sufficiency, effective development assistance and innovative policies for health worker migration. We will provide effective development assistance to low income countries to help them train and retain staff and work with others to ensure that fair healthcare worker migration policies are in place and adhered to. We will increase our support for distance learning resources for professionals in low and middle income countries and currently we're doing a piece of work to try and establish what are the most effective approaches for distance learning. And finally, strengthen medical workforce development by seeking to expand the UK's training program for overseas doctors, not for them to come and stay but for them to have short periods of time in the UK before they return. A particular area of interest to many at the moment is the links between UK health establishments and overseas health establishments. Some of you will be aware of a report that was commissioned by Tony Blair and undertaken by Nigel Crisp, global health partnerships used not as in global health partnerships such as Gavi and the Global Fund but in terms of partnerships and linkages between UK institutions and overseas institutions. How could the UK step up its contribution to supporting health care in developing countries and a response was produced by the government, principally the Department of Health and DFID but others as well, looking at each 16 recommendations and I think they're one or two copies outside and of course these are available on the web. Say we will support health systems to deliver high quality and affordable medicines particularly through the medicines transparency alliance and international health partnership. Both of those initiatives are more than just DFID run, foreign office, business departments, Department of Innovation, universities and skills and the Department of Health as examples partners. We will continue our commitment to emphasising sexual reproductive and maternal health. Many of you will be aware that there was an HIV strategy that was launched across government last year and this year there will be a DFID led strategy looking at maternal health for the next few years. One of the things that's very exciting about this particular document is a focus on non-communicable diseases and injuries because it is a hugely neglected area for many development agencies and development partners. And so what we say is that we will develop a clear action plan for the UK to scale up its efforts in tackling non-communicable diseases globally including mental health and early prevention. And we will continue our work on key risk factors. For instance, by working with WHO to develop a protocol on the illicit trade in tobacco and to provide an internationally agreed approach for reducing the problem of tobacco smuggling. Now if we go to the third column, more effective international health organisations, the Prime Minister has, since he came into office, had as one of his priorities a reformed UN system with an effective WHO. We will continue to push through the strategy for that as well as supporting the EU play an effective role in global health. And for our own part ensure that there is a coherent approach to resourcing health programmes and projects in lower middle-income countries and to the way that we resource international agencies. Many government departments resource WHO, resource other key partners, let's make sure that we're doing that even more coherently and consistently. Say that we will work to ensure that reform of the international architecture supports stronger and more effective leadership and coordinated action on health. And here is an example of a report which we produced recently in response to a House of Lords, our upper house report on intergovernmental organisations. Diseases, no frontiers, how effective are international organisations controlling their spray. And again, there's a copy of two outside there. We said that we would publish a first joint government, FCO, Department of Health, DFID, institutional strategy outlining how the UK will work with WHO. And that was published last week. And again, there are some copies out there in a rather uninspiring bound form because we haven't had them printed as yet. We say that we will ensure that new projects and programmes across government align with the principles of the international partnership and UN reform and the Paris principles of effectiveness. That doesn't just mean DFID, it means right across the government. Number four, column number four, stronger, freer and fairer trade for better health. Three areas here, stronger, fairer and more ethical trade in the health sector. Number two, a robust system of intellectual property rights used inevitably and flexibly to promote access to medicines. And thirdly, enhancing the UK as a market leader in well-being, health services and medical products. We say that we will support the work of the British Medical Association led medical, fair and ethical trading group. We will foster good practice in the NHS and private health care system and work with industry and others to encourage fairer and ethical trade. We've seen very unfortunate that if we are delivering health care to our own population, it is at the expense of the health of others. We say that we will continue to support the right of developing countries to make use of trips, flexibilities and to improve access to medicines. We will provide practical assistance to support this and promote innovative ways to use the intellectual property system to encourage innovation and access to medicines. For example, investigating patient tools for antivirus. Finally, number five, the one that underpins those four is strengthening the way we develop and use evidence to improve policy and practice. We say that we will identify and support research and innovation that tackles global health priorities will continue to do so. We will use evidence and innovation to strengthen policy and practice and maintain the UK as a global leader in research and innovation for health, well-being and development. We will work with the new UK Funders Forum for Health Research in developing countries and a relatively new initiative, UK Collaborative for Development Sciences, which consists of different government departments, the MRC and the Welcome as major funders of research in the UK to ensure better coordination of UK global health research. We also say that we will use the Government Office of Science Foresight Programme, Horizon Scanning Centre in the Department of Innovation, Universities and Skills to identify future trends and important issues in global health with non-governmental partners. So how are we going to implement and monitor progress? It's a five-year strategy. We're having each commitment led by one department. We have a senior officials steering group that meet regularly to assess progress and to try and iron out any inconsistencies and incoherence. Where that can't be done, we have an interministerial group that will, A, drive forward delivery of the strategy, B, review the impact of government policy and funding on global health. C, enhance policy coherence, so when we think there's inconsistency, that is the forum to bring it to. And finally, monitor and evaluate health as global. As I said, this is a partnership. This is working with others. As Alan Johnson said when he launched this, this cannot be done by the UK government alone. We say that we will work with non-governmental partners when developing, implementing and evaluating government policy. We will foster greater coherence and consistency of policy and action. And we will be working with non-governmental partners to be more transparent. We say that we will fund a new centre on global health and foreign policy at Chatham House. Say we will co-fund the emerging European Council on global health. We say that we will host regular partners forum to review the challenges and to assess the impact of health as global. And finally, we will hold stakeholder meetings prior to key multilateral events that impact on health. So, for example, before the WHO Executive Board and World Health Assembly, we have groups of people, stakeholders who come together. And we have been increasingly trying to bring together different groups, industry and the NGOs as one rather than having separate meetings for those individuals so that we can be more transparent together in terms of what we're trying to achieve. More details, as I said, are available on the web. But at this stage, I'll stop and hand it back to you, Lisa. Thanks, Nick. That was a great presentation. And extremely comprehensive and I for one am very impressed by the scope of the efforts that you've outlined. But before we go on to our conversation, I'd actually like to invite Dr. Chris Elias, pleased to come up and join us. Welcome, Chris. We did introduce you even though you weren't with us earlier this morning, but we're glad you're we're glad you're here now. So I think maybe I'll take the liberty as the chair of starting off with a first question. And it's a very basic question. And you are allowed to not answer it directly if you'd rather not. But five years from now, how are you going to know you've succeeded? What are the most important, if you had a name the most important three or four things that you'd like to see in place, what might they be? And you won't be held to answer. So I think that although there are a number of deliverables and we wills that are there, and we will want to see all 41 of those if you like ticked off. And that will be a way. What I would like to see is people saying there is just more transparency in government. Actually, we feel that we are engaged much more in policymaking. We feel that when you are thinking about approaches for development, or you're thinking about the way that you're going to work with the EU, or the way that you're going to work with WHO, we are increasingly consulted and information on how you have gone about your business is fed back to us. Now, how do you measure that? It's kind of quite difficult. You have these stakeholder forums, and you will start getting an idea, you'll start getting some atmosphere as to whether people think that you're actually doing that. So to me, a lot of it is about that. The second thing I would like to see is that within government, there is more understanding about each other's perspectives, so that if you were, let us say, to have a survey of different people in government departments, they would be increasingly able to articulate where other people are coming from. They would be increasingly able to articulate the links between health and foreign policy. And that's why I think some of Robin's work is going to be so important in bringing those disparate groups together to start speaking from a common message. Lisa, just to come in on one point that is referenced in the document as a whole, this idea of creating a global health impact assessment that the Department of Health is actually going to provide a service, as I understand it, to other departments to try and work out where the health dimension fits in within the particular domestic or foreign policy that they will undertake. As a way, I think, of doing what you just said a minute ago, which is time to embed the awareness and so on. How's that going to go? How's it going? Obviously, this could be an important tool. It could be something that's resisted. What's your take on that? Well, that's interesting. We do have a commitment across government that when we are developing new policies to do a health impact assessment. And up till now, that's been about domestic health. And what we've said in this is that we're going to expand that to look at the global health impact of domestic and foreign policy. And the Department of Health will lead on that and support other government departments. It's not for the Department of Health to do the impact assessments for other government departments. But in terms of developing good guidance, looking at what is out there from WHO, from you or other people, it will be for the Department of Health to do some work on that. And we have got one or two people who are working full-time on that. But I think that's going to be a really tough one because it's challenging. It's difficult, technically. We don't have a lot of very good examples out there. It's going to be potentially an area where people feel that particular policies are going to be held indiscriminately. But I think it's another good example of where, you know, five years from now, will we see that a number of domestic and foreign policies have been opened up to global health, as well as domestic health, perhaps? There might be some of the ends up being done more from outside, as well as from inside, I would have thought, from us to others. I mean, you've set up, obviously, some objectives and challenges, and so others will start doing their own types of assessments. Well, I think that's right. And I think that whether or not this flies, to some extent, depends on how much other partners are going to be up for supporting us, constructively challenging us, and helping us move forward in these different areas. Chris, you bring a number of interesting perspectives to this discussion, and you can take your pick from which one you might like to comment. But I mean, I, for one, knowing the very important work path does in research and innovation and technology would be interested in your thoughts on what you see in the strategy vis-a-vis that set of issues and how this can take things further down the road. Yeah, well, first, let me apologize for being late. I was on the train from New York, and we had a frozen switch in Philadelphia, and so I had more time to look at the report, even though I missed the beginning of your presentation. One of the questions that came out to me, particularly in the area of research, was, first, let me say, I think it's a great vision, and it's a great effort to bring so many different UK government groups together around a coherent strategy. But one of the things I looked at, actually, sitting on the train while we were not moving, was in one of the appendix in box 18, it maps the architecture of global health research funding in the UK, and it's the kind of map that you often see with these complex, multiple funders, multiple implementers. Only about half of which, as if I understand it, is direct UK government. So there's private sector partners. There are, by private sector, meaning commercial sector. There are foundations. There are other funders. And then there's the work in the UK, as we experience, highly interrelated with the product development research that's being done in other countries through other complex global partnerships. So I guess the question I had in thinking about that is, to what extent do you think that this will, this and the more specific different research strategy, will serve as a focal point for bringing together not just the government, but the non-governmental and commercial actors in the UK, and perhaps even beyond? I think you're right, first of all, to say that the architecture there is extraordinarily complex. And the editors and the printers came back to me on a couple of occasions to say, are you sure that you really want this? Because it's a bit complicated. I don't think anyone will understand it. And I said, that's precisely the point. If people just look at it and say, I'll understand this, then that's the point of that diagram. And then what's interesting is one or two people came out and said, you missed out this particular link or that sort of stuff. I think that we have a big opportunity to see how we can try and rationalise some of the work that we're doing. And certainly, this UK collaborative for development science that I was talking about is a very important way of doing that with a group of people that sit around the table and start to try and articulate the links. I think one of the big challenges, again, is the way that we work with developing countries on helping them with their research commitments and making sure that things aren't maybe more complex for them. And I think the other thing which is really important that perhaps doesn't come out quite as strongly in there, but I'm increasingly committed to it, is thinking about how we work with some of those middle income and emerging countries like the Indias and the China who are going to be right at the cutting edge of much of this research technology. And if they come into the game increasingly, that has the potential for much, much benefit. But it's also the potential for even more chaos and confusion. I guess that one of the things that probably I didn't stress enough in my presentation, but it is worth saying, is the important links between global health and the Brazils, the Chinas, the Indias, increasingly important players. And as they start ramping up their assistance over the next five years, we recognize they're going to be coming to the current economic climate, but over the next five years, it means that countries like the UK, I think, have got to increasingly start thinking, well, do we continue engaging with our friends and family, if you like, our normal, like-minded people, or do we start trying to understand the culture and the environment that people like India and China bring to the party? And I think much more of our time needs to be focused there. I'll just jump on the back of that, because I think one point that may be helpful for a non-UK audience is just to remind people, Nick, at the extent to which Diffid does hold the largest pot of money in terms of promoting much of the direct health benefits that you refer to here in the strategy. And as you've pointed out in the past, I think it's worth pointing out again, Diffid's focus is quite specifically on the poorest of the poor. And therefore, this ability to link together a strategy that does, as you quite rightly point out, bring in those middle, let's call, countries and get an infrastructure that we have in the UK that perhaps is focused more heavily right now from a financial standpoint on the poorest. I mean, how do you see this playing out, or is that just a problem and fair enough? No, I think that, Robin, you're absolutely right to highlight the difference. If you think about global aid spend, global health spend, where does it come from in the UK? Yes, almost all of it comes from Diffid. How much? Well, in last year's aid strategy, Diffid said that it would be spending around six billion over the next five years on global health plus another billion for the global fund. Now, if you look at the amount of money that the Department of Health or the Foreign and Commonwealth Office state-like spend, it's really very, very much smaller. It's several millions, but nothing like the amount that Diffid spends. And a number of people have asked me yesterday at various meetings, well, how do I think this plays out and what's the significance? Well, I think that there was some anxiety from a number of quarters in Diffid. So, well, where does this add value to what we're doing? How does this add to our approach? And one of the nicest stories was the previous head of profession came up to me and he said, you know, this has been an incredibly useful tool. I've had a colleague in Canada who has used strong linkages between their work with poorest countries and health security issues back at home to articulate that in the economic downturn they need to continue resourcing this sort of work. But I guess that the important thing here is that you have got a Department for International Development that, as you say, focus on the poorest countries. And rightly so, for the moment, you've got to have a clear strategy and a clear focus. And there are three white papers that are out there and possibly a fourth one that will be developed fairly shortly. But here you've got the whole of government recognizing that global health is more than just international development, the millennium development goals and the poorest countries of the world. Yeah, one of the ways I think some of those strains will come together, as I read through the different parts of it. You know, one of the things I noticed, obviously, is the significant increase in support for product development partnerships, doubling of support as part of the research strategy. And if you combine that increased level of support and numbers of product development partnerships being supported with the push for more affordable access to medicine, I think what you'll see is that many, certainly in past experience, many of our product development efforts are increasingly harnessing the innovation capability of the emerging countries in China, India, Brazil as good-quality, low-cost manufacturers of product. So you'll see, I think, turning to some of the emerging middle income countries as a source of innovation for producing the products that are affordable for the poorest of the poorest. I think some of the things that DFID is already doing are beginning to bring some of the strands of this together. I suspect we have maybe some good questions and comments in the audience. I can see already we do. That's great. So what we'll probably do, maybe, is take them in groups of two and three. And please just identify yourself and your organization and which panelists you'd like to direct the questions to. So the gentleman in the third row here, please. Samuel Adini Jones from the U.S. Department of Health and Human Services. Just two quick questions. I want to do a little more clarification about what the center of global health at Chatham House would do. Chatham House is now the government organization. So it would be good to see how it fits into the image. The other one is a more practical question. You have a lot of disparate groups that have their own funding within government and have their own strategy and implement their own programs. The layers you have put up above them, what sort of power would they have to align what people are making with what you're struggling for. Thank you. Maybe in the white jacket here. Thank you. Carmen Valenzuela Dahl from the Center for Health and Gender Equity, also known as Change. This is a question for Dr. Bala. We have seen some analysis and about the model of DFID as a model for all of us. Ever since 2005, recently the heads of the International Rescue Committee published a paper comparing the system of the UK versus the United States. My question is, have the US authorities, specifically USAID, have their approach? The UK authorities or DFID to, I don't know, to have some talks about these who take these as a serious, I don't know, possibility? And let's take maybe one other question. I'm going to go to my brother. This question is for Dr. Bonavalle as well. I threw my skimming of, you know, the document really briefly. It's a very ambitious strategy and given that you mentioned that this has been many years in the works, taking into account now the economic environment, how likely do you think it'll be that these priorities will actually be achieved? Are there priorities within these priorities? Do you think that, you know, in terms of reading some of the economic contributions that they're pledging, do you think those will come through? And could you just tell us who you are? I'm sorry. My name is Erin Conta, I'm from App Associates. So why don't we start with that group of questions? OK. Shall I go first and then you can do the channel house with that bit reasonable? The first one was a little bit about the power in terms of how you're going to ensure that these people work together and whether you can have this overarching strategy that will make people do things differently. My experience in the UK government suggests that actually people do want to work together but that the default position is that they don't because they're so busy and because they just don't think about it. So I don't think that actually it's the lack of will, very occasionally it is, but it's not usually. I think usually people do want to have as many people engaging in that. So I think this is less about forcing people and power. It's about trying to alter that culture and trying to make people understand where each other's coming from. So to give you an example, it was very heartening at when DFID was developing its maternal health strategy and having a stakeholder group that they were inviting all sorts of partners from different government departments as well as the NGOs and the academics involved. And there was a vigorous and robust discussion as to whether or not this should be a DFID maternal health strategy or this should be a government maternal health strategy. You know, whatever it turns out, it's not, that doesn't matter so much. It's the fact that you're actually engaged in dialogue. So that's how I would sort of look at that. With regard to the DFID USAID access, actually there's a lot of discussion that has been for many years between the two different partners, it's particularly effective in the field. And I've seen it myself when I was in Pakistan and elsewhere where one plays to each other's strengths. USAID may have a particular strength or a particular ability to do something or may politically not be able to do something but could work in partnership with the UK government in another way. So I think in the field it works very well. I think of headquarters. It again, you see many partnerships that get played out as one goes into big multinational meetings whether it's WHO, whether it's the Global Fund or G8 meetings. So I think there are significant linkages there. One of the more interesting ideas that I've been discussing with a few people this week is whether or not there is the opportunity to have a joint bilateral between a number of government departments in the UK and in the US. Let's say department of state USAID and DHHS and on the equivalents back in the UK. And that would be challenging from both sides who would be nervous about where they were going on that. But I think there's quite a lot of interest there. The final thing is that it hasn't happened for the last few years, but there was a time where there were regular bilaterals between DFID and USA every year, one year in the US, one year in the UK. Whether that needs to be re-established, no, it's a very exciting time for you at the moment. It's a very exciting time for us because of what's happening to you at the moment. So there are all sorts of options up for grabs. Finally, with regards to the economic downturn, big questions and big issues. The political line is very, very strong at the moment that our development budgets and our aid commitments are there and will not be undermined. We are still committed to getting to 0.7% over the next few years. We were very strong supporters of Margaret Chan's discussion just before the executive board in January, the event that was chaired by Richard Hawthorne, which had a number of different members of the executive board standing up and speaking up. And we were very strongly, Donaldson was a very strong proponent of the fact that actually our commitment to A, was not gonna be undermined by this, but B, the importance of us as a member state saying that our commitment to health within the UK and actually others as well should not be undermined by this. And Margaret Chan is a really very strong believer that now is not the time to go soft and flabby on our domestic health commitments right across the globe. The final thing to say is that next week there is a DFID-led conference which has been designed to run back to back with the Chatham House event. So on Monday and Tuesday we've got the different event and Tuesday and Wednesday we've got the Chatham House event. And that will be exploring exactly this. What is they new script, if you like, for international development following the economic downturn? Yes, we may be committed to our responsibilities and getting to 0.7% of our others. What should we do about that? What's it gonna be the impact on the Indies and China's? What's it gonna be the impact on domestic health budgets of sub-Saharan African countries and other places? So big questions that need to be answered. Yeah, very fair and a specific question about what is Chatham House gonna do. And as you point out, we're not a government department. We are privately funded like CSI is. We don't get any government subsidy at all. We do get some government grants for project work generally and which we compete for on universities or think tanks and so on. And in a way this grant fits more in that kind of a mold. Importantly, I think, through our being able to set up the center of this grant, there's an opportunity for this vision to be ceded in a part of the British political debate that hopefully will persist and persist beyond the comings and goings of ministers and governments. We have pretty rapid turnover of ministers from different departments set up to the U.S. system. And certainly from my perspective as the director of Chatham House, I see it always as a responsibility to make sure that this investment now can be embedded in the institute but within our work and be something that persists indefinitely into the future. You should know as well that very different in the U.K. from the U.S., my experience of American think tanks is they probably focus 95%, 90% on U.S. policy, on what the U.S. government should be doing and how it interacts and improving that process, et cetera. And given the very open system of government that you have here, there are all sorts of avenues to do that very effectively. The U.K. has, strikes me as somebody who's gone back to London from Washington, set itself a quite fascinating challenge of being a thought leader in all sorts of interesting global areas because ultimately what Britain does can't by itself necessarily change the global context but leveraging its vision or its narrative or its idea, the Stern report, Climate Change, the very creation of DFID and the very central role it has in the British government on British thinking about development approaches, the health strategy. I certainly see it as part of this sequence of ideas. And therefore the British government is very comfortable about being global and international in its outreach. And Chatham House probably does 85%, 90% of his work is actually not focused on what the British government should do. It's on global strategy and international solutions because that's what you do from London and ultimately that sort of fits. So I think we see it as part of our mission in essence as therefore internationalizing partly the ideas that have been developed here in this document and also whatever we might develop in partnership with others who work in the health community, outside, who work nationally, who work internationally and then to do all the usual stuff that policy institutes do, research, convening, capitalizing meetings, in particular what I said at the beginning, bridge building, to get the people who really just don't see health as being relevant at all to what they're into in international affairs and like I said, there's plenty of people who want to want to know health and foreign policy have to do with each other still today, very much so. Bringing, we've almost got to be at the other end of the telescope, I'll say this at least when I was, we've got to be sitting at the end of people who don't think about health and be able to bridge over. There's plenty of people who think about health and security, health and all sorts of international partnerships from the health end. We've got to be sitting at completely at the other end. We will, back to your other point, probably reach out to some, this shouldn't just be funded by the British government. So, challenging times and all that, but in any case, the idea is obviously to have it funded much more internationally, but also to have visiting colors from other parts of the world, from these middle-income, emerging countries, perhaps be based at Chatham House, to have an advisory council as well as British, all the usual stuff that one might do at the institute that we can do in collaboration with CSI as a minority. Thanks, Ryan. Let's take some more questions please. Let's go maybe to the back over here, please. Thanks, good morning. My name is Natasha Sikolsky and I'm with the International HIV-AIDS Alliance. Thank you all for being here, taking the training and snow and so on. But my question is for Dr. Banatav. You talked a little bit about the International Health Partnership and I'm wondering how that will work in combination with bilateral efforts of other governments, and particularly KEPFAR, for example. And then I'm also curious what the UK government position is on the currency transaction tax. The currency transaction level that's similar to the eight-nation tax that would help support some of the achievement of the women's development goal during any time. Thank you very much, Steve Morrison, CSI. Nick, our experience here in the last few years looking at the President's Emergency Plan on HIV, you had agencies forced to cooperate with one to a very significant degree because you had a White House that was embracing this issue and driving it forward and empowering the coordinator to pull the pieces together. And you had the exceptionalism of HIV and this sort of thing as well. When I read this plan, you've got several powerful agencies and departments and ministries that you're asking to cooperate across a multitude of issues, not just one or two core drivers, but you're trying to be rather strategic and comprehensive in the approach. And these are, you know, your Ministry of Defense does not necessarily feel comfortable in all environments and cooperating with HIV and vice versa. And the power and control of resources is very concentrated in one or two of these. The FCO is probably deeply ambivalent around some of these issues or certainly doesn't rank order them in the same way. The question is, within your system, with this ambitious plan, who's gonna drive things forward and hold these parties accountable in the next several years? Is it the Prime Minister's office? One delegated ministerial partner, I know you've allocated your five objectives across five different agencies or ministries, but who ultimately is responsible for driving this forward and holding parties accountable? Let's take one more, please. The gentleman in the strike shirt. Hi, my name is James Hill, I'm with the Pan-American Health Organization, which is the regional office of WHO in America. My question has to do with non-communical chronic diseases engaging the private sector. We've, just recently, we had the visit of Dr. Alawan, who's ADG from WHO and the new head of non-communical diseases, Fiona Adzhead from UK. The question has to do with, I agree that I'm glad to see that there is some attention to chronic non-communical diseases in the strategy, because I think that in the United States, it's 75% of the birth disease, but even the developing countries, it's becoming more like 55%. So, this is the big challenge of the future, not so much infectious diseases. My question is to all of you, really, both civil society and government, is that I think in order to tackle chronic diseases, we need to engage the private sector, and we have reached out to many companies, we've talked to the Grocer Manufacturers Association, we've talked to the National Pharmaceutical Manufacturers Association. They're very interested in working in partnership with WHO on the issue of chronic diseases. The issue that we're grappling with, and I seek your advice on this, is there's a lot of initiatives in the private sector in health and wellness and in the workplace that are already existing. They're looking to WHO to recognize these initiatives and to take that into account in promoting any kind of regional, global strategy for chronic diseases. How can we do that without being seen as endorsing a product or a company? We by all means want to commend them for our efforts, but do we do it with an independent commission? Should WHO be directly involved? Should we defer it to the civil society and NGOs to take on that role? Thank you. Let's do one last question the lady directly behind. Hi, I'm Erin Holfelder from the Saban Vaccine Institute, and this is for Dr. Bonnet Bala. I was just curious to how you see this document evolving over the next five years, particularly as the UK and other countries may reevaluate health priorities or as new disease issues may come up. For instance, DFID recently made a 50 million pound commitment for the control of neglected tropical diseases. And I assume there may be other new changes and innovations as well. So do you see this document as a static mission statement or something that may change and evolve with shifting priorities? Thank you. So Nick, I think again, I think others can help it. I think you have to take the lead. Natasha, you know the international health partnership was born out of trying to make a reality of the past principles of aid effectiveness. And one of the great, I think, tributes has been that it's now moved very much from a UK initiative through to one that's being held and run by WHO and the Bank and the H8 agencies. So I think that I'm not going to stand up here and I'm not going to now start to either to defend or promote the international health partnership as a UK initiative. The UK is a supporter of it, but the lead we now see clearly as coming from others outside. How will it work in the form of sub-time? I don't know, the fact remains that the coordination of development systems has been notoriously poor up till now. Any efforts to try and enhance that and get that working better together and to get heads of agencies talking together has got to be a good thing. What we want to avoid clearly is having an overarching bureaucracy on nodding because that is the potential danger with additional meetings, additional strategies, additional approaches. So we've got to be very wary about that. But I think we would all agree that having agencies trying to work together is increasingly important. There was a leader in the Lancet that came out, I think, at the end of January following that meeting in Geneva, the one that I mentioned just before the executive board, which said we now have an unprecedented opportunity with the economic downturn to think about the health architecture in terms of, if you like, mergers and acquisitions. How many mergers and acquisitions have there been over the years? Is this an opportunity to try and do that? Could the international health partnership provide a vehicle or a role in facilitating some of those impossibly difficult political discussions? Inhibitive financing schemes, we talk about in this, it runs into the same problem that there is a me-too approach to inhibitive financing that every country wants its own approach. And they all have merits and they all have disadvantages. And of course, every country will want everybody else to get involved on the page as well. And I think what we've got to be careful about yet again is complicating the organization and the structure of these as we build on those so that yet again we don't have different modalities. That's not decrying the opportunities that come from inhibitive financing, many of which as you know, UK has promoted. Steve, who drives all this? So it's a really good question. One of the discussions that we had throughout was whether or not the Department of Health was the right agency to be leading on this both in its development and then further. Now, you could argue that it is, you could argue that it's not. There was some discussion as to whether the Cabinet Office, which is if you like an overarching group, would be the right one for taking it forward. All I can say is at the moment, the lead is with the Department of Health, not in terms of delivering, but in terms of having a secretariat that will monitor and evaluate this. So if you like to put this into very basic terms, what does that mean? It means that we have developed with other government departments an action plan for making sure that each of these deliverables is developed. We will then pull those to account, we will then bring people together with the steering group and then with the ministerial group. Will it always be the Department of Health? I don't know. Should it always be Department of Health? I don't know, but that's where we are at the moment. But I think there is an understanding that it is the Department of Health that is leading on the coordination of bringing together all of this. But clearly, individual departments and the Department of International Development, as the lead for aid to developing countries, is the lead in that area. Please, one of the things that people have said to me together, is this some sort of effort for the Department of Health to try and take over what DFID is trying to do? Is this some sort of warfare? The answer is absolutely not, categorically not. So I don't think that there is any sort of attempts with that. A par who questions about non-communicable diseases. You know, there are some things that we've got in this strategy, which are so new and so difficult that I'm not sure that I necessarily have an answer to you in terms of how we're going to work effectively. Okay, we've given ourselves five years and we need to think through precisely the sort of questions because they're kind of tough questions in terms how we're going to work with the private sector, how we're going to work with industry, how we're going to learn lessons about what we'll be doing within the UK with other countries for the benefit of the UK, but also with multiracals such as WHO. I had some interesting discussions with the Bugatis Centre yesterday who were talking about some interesting initiatives they were trying to promote on non-communicable diseases where they were asking for partners to come forward for new working arrangements with other countries. And what was interesting is they said we're not looking for individuals that have a really strong track record in this because we don't think there are that many. So we're looking for people to put their hand up to start working in this area. So I think it's all up for discussion and anything you can contribute to that dialogue would be well received. Chris, just to say a quick point. Maybe I could just build on that because we've been doing a little bit of thinking about that at half. I think the good news about the chronic diseases is that in seeking new innovations for poorer countries we have a greater opportunity to leverage the innovation of companies that are inventing for this country. So whereas malaria vaccines are primarily needed in the developing world, good medicines and approaches for hypertension and heart disease, et cetera, are shared. So I think we're gonna see the cost will be less in terms of because we're not gonna be developing new products where the markets have completely failed. We're gonna be adapting products for less well-resourced health systems. So that's the good news. I think the other piece of good news is that we've learned a lot through the existing public-private partnerships about how to work with companies in a fair and balanced way by applying sort of a portfolio approach of where we're sort of racing many horses at the same time, if you will. And in particular, I think the WHO has an important role. We have a path now to what are essentially joint ventures with the World Health Organization for our meningitis vaccine project and the optimized project for strengthening the immunization cold chain where we have developed joint projects, joint governance of those projects with the World Health Organization. And path as the international nonprofit partner is the one working more closely with the companies but then through the partnership and joint planning with WHO, when we're country-facing, we're able to use the credibility and in-country resources of WHO and its offices. So I think there are some very interesting models that have been developed for infectious diseases in terms of public-private partnership that we can adapt for looking at chronic diseases as they become higher priorities for countries as well as for international funding organization. Just one observation, I suppose, on Steve's comment, which is something I could say something about, which is on the political front and the governance of this and who drives it. It was a very important point to me about PEPFAR having this double focus of the Presidential Initiative and also focused on one particular issue. I think it's better to say that the Department of Health in the UK, it's a big department. It may not be as big internationally but within the body politic of the UK, the minister is in the, the Secretary of State is an important Secretary of State within the Cabinet Office and to the extent that every ministry is increasingly engaged in looking internationally, even if it's a smaller pointy part of its operations, this is gonna be the main focus and therefore it will live and will be a focal part for this particular department. You put it in the Cabinet Office, you've got other departments to do it, they may be part of the mix, but it could fall apart and fall under the waves as it is in everything, as we've talked about in this presentation shows, health at various levels, essential aspects of national security, of international globalization, of international prosperity and security. So, at least it strikes me that from a practical standpoint, that there's a logic to being where it is, I have no insight as to what the long-term plans are. I can see that'd be quite logical. I should just finish off the last question, which was last night. I'll ask you to finish off the last question and since it's just about 11, maybe any closing thoughts that any of our group would like to leave, please. Okay, so the question from the vaccine institute about will this go out of date and how do you keep it up to date? Well, the difficulty with any documents as far as I see is that as soon as it's published, it's immediately out of date. Whether that's a strategy, a policy document out, it's just the fact of life. I suppose you could say that if you publish things electronically, you can update them, but the work of producing a new iteration is going to be meaningful, is significant indeed. So while that's going on, it's always going to be out of date. What I think that's kind of important about this document is the first thing is that there are a set of principles and what I hope is that those principles won't change over the five years. What I also think that's worth looking through when you look at the strategy itself, there is a series of how we want to see the world looking in five years' time, the difference we want to see in five years' time. I suspect that probably we still will want to see that in five years. There will be different ways of getting to that, so you're absolutely right. And to that extent, this is to a large extent an aspirational document. We are also clear, however, that we say on page 11 of the summary, we will use expert independent evaluations to assess progress and inform future iterations of the strategy. So it will not be a static document. In terms of summing up in conclusions, I think I've said quite enough today, so I think we'll have to start. It's all been very valuable. Robin, any thoughts? I've got no particular additional things to say. Just look forward to working with CSIS in particular and you and Steve. And there's a huge amount to do. And we're just, we're the front end of the map, so I'm delighted to be working with Nick. And the final thing I'd say is good luck because I think it's an ambitious plan and an ambitious task and it's potentially a very important model. So I'm wishing you success because I think there's some lessons we can learn here if it succeeds, when it succeeds. And actually, I liked very much the way Nick described the document just in those last few sentences as an aspirational document because I think this actually is a time when we all need to be aspiring to things that are even bigger and better than what has already been accomplished. And my hope is that we find in this document and we find in U.S. strategies as they evolve areas where we can collaborate all the more closely. So I want to thank our audience, but I'd also ask our audience to join me in thanking our panelists for a great discussion tonight.