 Thank you, Christopher, that very kind introduction. Patrick, thank you, Simon. And I want to thank the Rural Society and the Academy for inviting me and giving me this really great pleasure and honor to be here with you this evening. As you can see from this first slide, I'm going to talk about multiple aspects of both COVID and HIV from a scientific public health and policy and show the comparability of these two. We often talk about lessons to be learned, and I think some of the lessons carry over from one disease to another. As Chris had mentioned, I've had the privilege of leading the National Institute of Allergy and Infectious Diseases for almost 40 years. And in that capacity, my responsibilities and my career were bookended by two pandemics that have really described our experience in our lifetime, namely HIV and AIDS. So I'm going to start off before we get to the comparable lessons. Just give a little background that I think this audience probably is thoroughly familiar with, but I'll just mention it. We know now the global burden of HIV that there have been 40 million people who've died, 39 million people living with HIV, over a million newly infected each year, and 630,000 died just in the last recorded year of 2022. With regard to COVID-19, again, we were all familiar with the numbers. The number of deaths globally is seven million, but we all know that that is likely twofold less than what the reality is, is probably closer to 20 million. In the United States alone, we've lost 1.17 million people to COVID, one of the worst, if not the worst in the world. So getting to the lessons, there are eight lessons that I've chosen. There are probably many more than that, but I believe these, in my mind, illustrate how strongly comparable these particular diseases are with regard to the science and society's response to them. So let's go through them and I'll briefly give examples of each. First and foremost is expect the unexpected when you're dealing with the evolution of emerging infectious diseases. I wanna show you this slide because the person who wrote this was one of the mentors of mine and one of the original editors of Harrison's Principles of Internal Medicine, my friend, Bob Petersdorf, at a time when vaccinations and antibiotics and antivirals had diminished the number, particularly if childhood deaths to infectious diseases, in the New England Journal of Medicine, Robert Petersdorf wrote an article called A Doctor's Dilemma, and that was at a time when we were evaluating the number of people who were applying for fellowships in infectious diseases. And this is a quote from his paper, even with my great personal loyalties to infectious disease, I cannot conceive a need for 309 more infectious disease experts unless they spent their time culturing each other. And he published that in the New England Journal of Medicine. However, even great iconic infectious disease people like Dr. Petersdorf can be wrong because three years following the time he wrote that, we had the first indication of a new disease that was thought to have emerged because the first cases were officially reported in the United States of the MMWR Mobility Mortality Weekly Report, which is a newsletter that comes out, you're probably familiar with it from the CDC every week, describing five curiously young gay men presenting with pneumocystis pneumonia, although they had no prior disease. I actually thought at the time that that was a fluke until one month later, when the second MMWR came out in July of 81, now 26 curiously all young gay men who not only presented with pneumocystis, but with capricious sarcoma and other opportunistic infections, not only from Los Angeles, but also from New York City and San Francisco. Little did we know that this had already spread throughout the world because at the time that this was reported, you were seeing cases here in the UK, the French and the Belgians were seeing it in the European Union. It was a disease without a name. Those were one of the darkest periods of my medical career. We were calling it grid or gay related immunodeficiency. Some were calling it gay cancer. And in regard to expect the unexpected, we certainly didn't expect a brand new disease. I mean, who knew about brand new diseases? I know when I was in my training, a brand new disease was something for the history books, but this was a brand new disease. But the surprise kept on, it was the gift, if you wanna call it that, a bad gift that kept on giving. And if you look at the evolution of the disease over time, first we thought it was only in gay men. And then we found out that we were seeing it in Haitians who were heterosexual. Then individuals who received transfusions for hematologic abnormalities. And then there were transfusions for people who had loss of blood. And then there were people who were heterosexual transmitting it women to their infant, so it kept on evolving more and more, expect the unexpected. Now, with regard to pathogenesis, it was something we'd never seen before. It targeted a specific element of the immune system CD4 cells. It evaded immune response and had chronic infection with a viral reservoir that to this day has not been able to spontaneously be cleared from anyone, even people on therapy. And it directly or indirectly impacts all organ systems. The other thing, the unexpected, that we didn't know, this was a slide I made decades ago. And it shows that in the acute stage, you have a burst of aremia. It goes down to below detectable according to the older aspects of detecting, but now we have sensitive assays and know that cannot be true. And then individuals go over a period of clinical latency, sometimes as long as several years, all along transmitting the virus when they were so-called asymptomatic. So the idea of asymptomatic spread of disease really had its originality in HIV. Now, let's switch over to SARS, a unique pathogen, highly mutable, multiple variants. We've never seen a single disease in a big burst have multiple variants. A symptomatic spread was common, aerosol transmission turned us upside down when we were trying to compare it to flu, which can be asymptomatically transmitted, but not very often. And then we had the post-acute sequela that we call long COVID. Now, here's a family tree, a phylogenetic tree showing on the far left-hand part of the slide. In the beginning, we had the ancestral Wuhan strain. We thought that was the virus we would be dealing with. It would peak in the winter, go away in the summer and that would be it. And look where we are now in our fifth year with multiple variants, alpha, beta, gamma, delta, and then Omicron, which came in the winter of 2021. And since then, we've had multiple, multiple variants of Omicron. The one that's now dominant in the United States is the JN.1. Interestingly, each of these variants increasingly evaded the immune response, something you almost never see in infectious disease. Prior infection does not prevent you from getting infected again. The immunity that you build up likely will protect you from getting severe disease, but it won't protect you. I've been infected twice and vaccinated six times. So that's what we were talking about, so-called herd immunity. It just somehow does not exist. So what are we gonna do? This is a cartoon that shows what we can't do. We can't play whack-a-mole. We can't be making a new vaccine for every single new variant. Otherwise, we would have had about 25 different vaccines right now. However, there is a concern that somehow lurking, we may get a new variant that actually is as variant away from what we're seeing now as Omicron was from Delta. The other issue is the asymptomatic spread. This fooled us from the very beginning. We should have known because they were seeing this in China it was not reported as transparently as it should have been. Is that about 50 to 60% of all transmissions occur from an individual with no symptoms? Aerosol transmission, the whole paradigm that the CDC, our own CDC got wrong, where we used the model of influenza of a symptomatic person, cover your cough, that kind of thing. People were spreading it through aerosol when they were without symptoms. And then we had long COVID. We know that you can have post-viral syndromes associated with influenza mononucleosis, but never to the extent where there's estimated about 17 million people now have long COVID in the United States. Now, the second lesson, political leadership at the highest level is critical for a rapid and effective pandemic response. And now we get into politically sensitive things. So if you look at the estimated high incidence among people with HIV in the United States in the early 80s, the president of the United States who had many good qualities, Ronald Reagan, did not mention the word AIDS until his second term. So he went four years and one year, five years at a time when we were having an explosion of cases in the United States, and the leadership did not mention it. And I felt that was a lost opportunity to use the bully pulpit of the presidency to get people aware of this emerging plague. I met him the first time, and here I am, briefing him for the first time. I tried without much success to get him to go out there and be more forthcoming about it. He's all the way over on the left-hand part of the slide, as you can see, and I was talking to him a little bit about what the NIH is going to do. Now let's switch over to COVID. This is a quote from the former president of the United States. It is going to disappear from February to the end of October. The president declared 38 times that COVID-19 is either going to disappear or is currently disappearing. And these are some of the quotes. You know, a lot of people think that going away in April with the heat and the heat comes in, that'll go away in April. It's going to disappear. It's like a miracle. That's when I had my first confrontation, not in the sense of with him, but when the press asked me, is that going to happen? And I had to say, no, it is actually not going to happen. While he was saying it was going to disappear, this is what it was doing, the deaths in the United States. And this is what the deaths were doing globally. And so in fact, the beginning of trying to get the country galvanized to wear a mask and to understand the seriousness of it, we lost considerable amount of time in January, February, March, and then when April came, there was really a split where he went off and was worried about the election and then we were left with a lot of conflict in the country. And then next one, prior scientific advances enabled robust pandemic responses. And I'm glad I put this next slide in because I just saw the wall of presidents of the society and Isaac Newton, who was president in 1703, said, if I have seen further, it is by standing on the shoulders of giants and that's exactly what we do in science. If you go way back several years before HIV, it was the fundamental basic science discovery of David Baltimore and Howard Timmon when they discovered reverse transcriptase that allowed us to least identify a retrovirus, which we would not have been able to do. Bob Gallo showing that you could grow T cells in culture allowed us to first isolate in culture HIV. And then a whole number of other studies, HTLV-1, the first retrovirus that was discovered by Gallo and his colleague and Japanese investigators indicated that this likely was a retrovirus who we're dealing with. And fortunately, in 1983, Luc Montagnier and François Baraissinoussi discovered HIV in a lymph node biopsy of a person who had this brand new syndrome. A year later, Bob Gallo proved epidemiologically and virologically that it was the cause of AIDS and the advances we've had in HIV science have been spectacular. I could spend the entire time discussing it with you but the one that we know that's impacted the field profoundly is the fact that we have now antiviral therapy, which when given to persons with HIV can bring the level of virus to below detectable and have them live essentially a normal lifespan, as well as making it virtually impossible for them to transmit it to someone who they have a sexual relationship with. Switching over to COVID, the comparability there, I wrote an article in science a few years ago on the story behind the COVID-19 vaccines. And it really relates to work that had been done decades before on both platform technology and vaccine immunogen. As you all know, platforms are what you use as your virus, whole-killed, inactivated, viral vector, virus-like particle, and the immunogen is the actual epitope of the virus or the bacteria itself. The dominant platform technology, though not the only one, with COVID was how mRNA technology burst into the field. People don't fully appreciate that Drew Weisman and Katie Carrico did their original studying showing that the molecular modification of an RNA molecule will allow it to be used as a vaccine. That study was done and published in immunity in 2005. Things get even more interesting and complicated when you talk about how we got the optimal immunogen for the COVID vaccine. And it really goes back to HIV where investigators from a number of institutions throughout the world were using structure-based vaccine design, using cryo-EM to get the right confirmation of the immunogen for HIV. At the NIH, the Vaccine Research Center, which I started about 25 years ago, the two investigators there with the red circles around them, the one on the lower left is Peter Kwong, a structural virologist, and the one on the upper right is Barney Graham, who was more interested in respiratory syncytial virus than he was interested in HIV. And what they did is that they partnered in a way that is the beauty of science where people from multiple different disciplines get together. And Peter Kwong, among others, solved the ability to stabilize the HIV envelope trimer in a way that was immunogenic, even though we still don't have an HIV vaccine. Now, that's sort of interesting because the technology that didn't yet give us an HIV vaccine was used to develop an RSV vaccine, namely, use mutations in the molecule to stabilize that molecule in its most immunogenic form, which with RSV was the pre-fusion F protein. The investigators then, as they were trying to make a vaccine for mayors, showed here that they were able to get a successful immunogen, even though we're still working on a mayors vaccine. But when SARS came along, the exact mutations that they had been working for decades on was used to stabilize the spike protein in its pre-fusion form, which was highly immunogenic. And these are some of the vaccines that had been developed. And if you look in the far right, almost all of them use that S2P mutation which stabilized the immunogen. Just another example of it was decades of research, but what were the results of that? You all know that, but let me just mention it to you. This is the fastest by far in history of getting a vaccine from the time you got the sequence. We got the sequence on January 10th. Five days later, we started on the vaccine development. 65 days later, phase one. 139 days later, phase two. 198 days later, phase three. And in less than 11 months, we had a vaccine that was safe and that was 94 to 95% effective. It was going into the arms of individuals throughout the world. Now, I'm gonna show you a slide that's a little bit almost tongue in cheek when you look at the time to develop a vaccine from the time that you have the pathogen. So Typhoid, it only took 105 years. Polio 47, go down the line. Measles even took 10 years, but COVID took 11 months. The global impact of that has been nothing short of breathtaking. Vaccinations prevented 14 million deaths in 185 countries and territories in one year from 2020 to 2021. Appropriately, Drew Weisman and Katie Caracol recently won the Nobel Prize for their work. Next, misinformation and disinformation of the enemies of pandemic control. Some of you may remember Peter Duisburg. Peter Duisburg was a person highly qualified, a professor at Berkeley, a member of our National Academy of Sciences. The claim that AIDS is not caused by HIV, but rather by non-infectious factors such as recreational and pharmaceutical drug use and that the drug was making people sick, not the virus. I spent years debating this person on United States television and I referred to it as I was mentioning to Chris and to Patrick the famous false equivalency. You have one scientist that says one thing, another scientist says that another and the New Yorker magazine said, well, I got so frustrated, I usually don't say things like this. I said, this is murder. He said after listening to Duisburg's speech, it really just that simple. And in some respects it was because in South Africa, Tabo Mabeki and his health minister, Shahbalala Missamon, did not want to subsidize drugs for HIV in South Africa, the country with the most cases. And they said because scientists in the United States don't believe that HIV caused AIDS. And what happened is that when they did a modeling study, they felt that somewhere around 300,000 lives were lost in South Africa because the government did not provide AIDS drugs. Switch over now to COVID. Misinformation, as you all know, is ubiquitous. 78% of the public in the United States believes or is unsure of at least one false statement and a third believe at least four of eight. And here are some of the examples. COVID-19 is a hoax, conspiracy therapists, Europe's coronavirus cases rise, so do voices crying hoax. Now misinformation, as I've often said, is the enemy of public health. We have someone right now who is gonna be running for president of the United States, Robert F. Kennedy, Jr., who doesn't believe in vaccines and thinks COVID vaccines are killing people as opposed to COVID killing people. So in the United States, there was a modeling study that showed that over 200,000 deaths could have been prevented among people who did not get vaccinated because they thought vaccinations were unsafe and did not work. Despite the data I showed you in a prior slide. Moving on, increased attention to the human-animal interface is critical for pandemic control. We know that the one health issue is that emerging and re-emerging zoonotic diseases are a perpetual challenge. 75% of all emerging pathogens are zoonotic. They jump from an animal reservoir to a human. Some of them adapt well and spread among humans. HIV. It took years before investigators were able to show that the reservoir was a chimpanzee and that it spread slowly decades before we noticed it and only in the early 1980s that it become a pandemic. I wrote an article in Cell with my colleague a few years ago talking about the unbalanced interaction in the animal-human interface. And as I was discussing with Patrick and with Chris a little bit ago, the evidence now, we don't know what the origin is but there's so much effort that's put into conspiracy theories about what the origin is, is that we don't know for sure but the prevailing evidence from scientists throughout the world including here in the UK indicate strongly that it likely, though without definitive proof, came from a natural spillover in the Wuhan market. So what are you gonna do about it? One, you expand pathogens surveillance at interfaces between human domestic animals and wildlife. Stop clearing and degrading tropical and subtropical forests. Improve health and economic security of communities living and emerging infectious diseases hotspots. Enhance biosecurity in animal husbandry and importantly, which did not happen in Wuhan. Shut down or strictly regulate wildlife markets and trade. Because as Eddie Holmes, another member of your community and his colleagues have shown that there were in fact illegal animals in the Wuhan market the year before the outbreak occurred. Next lessons, inequities, health disparities, stigma and discrimination are amplified in pandemic settings. We have a lot of that, sadly, in the United States. So if you look at HIV disproportionately, affects the global south. 67% of all infections are in sub-Saharan Africa. 90% are in the developing world. In the United States, African Americans comprise 13.6% of our population. Yet 40% of all new infections are among African Americans. If you look at the use of pre-exposure prophylaxis, which when used properly is 99% effective in preventing the acquisition of HIV. Take a look at the availability in the trends in the blue line among whites and in the darker lines, red and black, among Hispanics and African Americans. Move now to COVID-19. We saw the same thing in the United States, a disproportionate amount of infection, hospitalization and deaths among minority populations, African Americans, Latinos, Native Americans, Alaskan natives. The longstanding systemic health and social inequities drive these disparities. Discrimination, significant in the United States, sadly to this day, limited healthcare access and use. The occupation of people with essential jobs is disproportionately among lower income people, particularly among minorities. Education income and wealth gaps and housing issues where multi-generational families spread it among them. This is an interesting slide. If you look at people with lower incomes, they're much less likely to work from home during COVID. So if you go from the lowest income on the left to the highest income on the right, and the vertical access is the percent of households that switch to telework. So if you're poor, you're not gonna be able to switch to telework. If you look at the vaccine doses administered again, sadly, look at this by the income of the country. Lower income in the lower part with blue, lower middle and then high income gets vaccinated. Next, community engagement is critical. The birth of AIDS activism sometimes is confused with the pushback against scientists with COVID. It's entirely different. As I mentioned with Ronald Reagan, he triggered the beginning of activism because he didn't recognize or use his office to call attention. The scientific community, me included early on, did what we scientists often do. Retrospectively, it doesn't make sense, but we did it and we thought it was right. To tell the patient, we know what's best for you. Our scientific principles, entry and exclusion criteria and clinical trials, regulatory constraints, we know better. The activist was saying, well, that works for a disease like hypertension where you have multiple drugs or you're not gonna die in the matter of a year, but for us, we need to have a voice in how things roll out. The scientific community didn't listen. However, the activists decided they were gonna call our attention to it. So Larry Cramer, who is one of the icons of activism in the United States, playwright and author, ultimately became a good friend, wrote this article in the San Francisco Examiner. I call you murderers an open letter to an incompetent idiot, Dr. Anthony Fauci, at the National Institutes of Health. He got my attention. And then what I did, I started to actually listen to what the activists were saying. And this is a New York Times article when I broke with the establishment and said we should allow people to have compassionate use access to drugs at the same time we do a clinical trial without interfering with the integrity of the clinical trial. Now, the activists, I get credit for calling it parallel track, but the activists deserve the credit because they came up with that terminology, a parallel track. Do the clinical trial, but also have access. Now, this next picture is a classic example of what I said, the difference between people who are trying to harm me and even people in this room who are anti-science, anti-vax, and the activists during the AIDS era back in the 80s. This is a picture of me in 1989 when I went alone with my assistant, the young woman next to me, into Greenwich Village in the Gay and Lesbian Community Center with a hundred angry, frightened, sick, gay men. Never for a moment did I feel in danger of anything sitting among them because they just wanted me to listen to them. They stormed the NIH, they made the needs known and we listened. This is very well documented in a Academy Award-nominated documentary, How to Survive a Plague. The leader of that pack is a person named Peter Staley, a very articulate AIDS activist. Fast forward 30 years and here's he and I discussing the history of AIDS at the Harvard Kennedy School Institute of Politics. And these individuals now are some of my closest friends. Switch over to COVID now. We had to outreach to the Native American population. I spent a lot of time reaching out on TV by Zoom and in person with the Native American nations, the Indian nations in the United States. We did that with the African American community and we continued to do that with regard to COVID. In addition, we've reached out to the long COVID patients and are now listening much more carefully to their needs. Finally, infectious diseases are a perpetual challenge and HIV and COVID clearly show that. If you look at thing, I say this often and it's true that emerging infectious diseases existed before recorded history. I mean, we know that with a plague of Athens, we had no idea what that was. We have a good idea now. In fact, we know for sure what the bubonic or the black death plague of the 14th century was Yersinia pestis. We also know now the Spanish flu, as we used to call it, in 1918. When I first started at the NIH, I would testify before Congress and it was in the beginning of HIV. I drew a map of the United States and I put HIV in there as an emerging infectious diseases. I've testified before the United States Congress, I say this smiling, it's painful, about 285 times over the last 40 years and every time I come with the same map, but each year I put a new emerging infection. This is what the last time I testified in the fall of 2022. These were all emerging diseases. Now to be certain, some of these are one-offs and they're trivial and they don't cause pandemics, but as we know, some of them are in fact the beginning of a significant outbreak. So if you look at selective events in infectious disease emergence from 1981 to 2024, which I showed you on the second slide, there have been many. Again, the two bookends that really called our attention was HIV and COVID, but there are others in there. So the real last lesson that I've learned will you bring COVID and HIV together is something I wrote in 2008 with my colleagues, Dave Morins and Greg Fokers, is that emerging infectious diseases are a perpetual challenge. They've always been with us, they're with us now and they will continue to be with us. The only way to address a perpetual challenge is by perpetual preparedness. Thank you. Well, Tony, thank you very much. That was absolutely spectacular, both in terms of the content and in terms of your personal contribution over many years, as Chris said in his opening remarks. It was really amazing to see that pulled together in that way and to reflect on the different time points and the differences that they've made to what happens now and what needs to happen in the future. I want to actually also take this chance to say a big thank you to you because during COVID, you, me and Chris spoke very often and it was a wonderful therapy session. Thank you. Me too. The other thing that occurred to me as you were speaking was that your quote from Peter's door reminded me of a quote from a very senior person in the R&D part of a pharmaceutical company who produced a video at one point in which he made the mistake of saying that as long as he was around, there would always be infectious diseases. I'm quite sure that's what he meant, but that's what he said. We're going to open this up to questions and I'm sure there'll be lots, but let me just kick off and just ask you, what do you think in terms of the immediate need for vaccines, therapeutics and diagnostics, what does the world need to do to be ready for that? Yeah, well, we need to do a few things, Patrick, but I think the thing that stood out more to me than anything else was the extraordinary lack of equitable access and the disparities. So I look at these responses, there's pandemic preparedness and pandemic response, and I look at it in two buckets, the scientific preparedness and response and the public health preparedness. The question you're asking, Patrick, is the scientific preparedness but also the implementation of it. I think if we want to look at how we're going to prepare for the next outbreak, which inevitably will occur, we can have a situation where there are real sharp distinctions between the haves and the have-nots, where you get a vaccine and you have countries like the United States, who are talking about their second and third booster, and other countries have not even yet gotten access to the vaccine, I think that's what, and it goes for therapeutics and monoclonal antibodies also. Thank you. Let's open this up for questions who would like to kick off. Yeah, Chris. That was a superb talk. Can we give a microphone, please, about the game, yeah. That was a superb talk, and you covered a rather wide range of things. I just wanted to ask you about a comparison between pre-exposure prophylaxis, in fact, which has been, obviously, for HIV, a very interesting area. And what do you think of this in relationship to COVID? Because here in the UK, we have about 4 million people who are effectively not able to have, by virtue of being immune deficient, et cetera. And we, at the moment, don't seem to have an effective treatment for that, and I wonder if you have views on that. Yeah, I mean, when you're talking about pre-exposure, you're referring to people who are maybe immune deficient and they won't respond to a vaccine. Yeah, I mean, there's good news about that now because we have, and early on in the outbreak, we had good monoclonal antibodies that were very specific for the particular circulating variant. We got into trouble with the monoclonal antibodies because when you went from the ancestral strain to gamma to delta, the monoclonal antibodies that worked beautifully as a pre-exposure prophylaxis for immunocompromised individuals didn't work anymore. So if you're dealing with a COVID-like illness in which you have this unprecedented multiple, multiple variants, you're just gonna have to put a lot of investment in making monoclonal antibodies for the different variants. The trouble is the pharmaceutical companies are not excited about doing that. That is something that has to be subsidized by the government. And that's one of the things that the United States government will try to do to de-risk a company saying I'm gonna make an antibody and then if the variant changes, it won't work. Hopefully, even though I know we will have another pandemic, it's not gonna be one that has multiple successive variants where you can get a group of monoclonal antibodies that will serve as good prophylaxis for people who are not gonna respond to a vaccine because of immune compromise. Okay. Give the mic over. I think that one of the big problems in a pandemic is we all live in a silo-based world and it is very, very difficult to get out of your silo. If you look at that, that's an incredibly expensive solution to produce a monoclonal antibody. In fact, and as you say, it's a specificity changes, et cetera. If you look at actually the world at large and you look at people, in fact, in a number of studies which show quite clearly that there is a drug which is available, which produces about 65% of coverants of a vaccine, which is extremely cheaper, which is being widely used. So if we just look at epidemiology, you can get a very clear idea of what might be an effective way of treating this. Right. No, that's a good point. That's a good point. I think the other problem and it'd be interesting to pick up on this maybe at some point is in HIV, you've got a chance to give a drug which can have a long-lasting effect and can be given frequently. In COVID, if you missed the window of opportunity, you probably had no effect at all. Yeah. And that ability to get things done. I was just thinking of that. In HIV right now, the pre-exposure prophylaxis is just an unbelievably effective tool. To the point now you have an injectable that you can give every couple of months and likely be able to give it every six months and the effectiveness is over 90%. And by the way, when we made that in GSK, the commercial people were totally opposed to it. Yeah. One there and then somebody here. I'll ask about genetic susceptibility and genetic resistance. In the UK, we had the distressing observation that most of the doctors who died of COVID early before vaccines were available were actually ethnically of Asian origin. And I wondered if that has held up in more widespread analysis of genetic susceptibility on an ethnic basis. No, a great question, but the answer is no. There really is not anything like we have with HIV with a Delta 32 heterozygote or homozygote that makes you less susceptible or even completely protected. We don't see that. I mean, we have seen situations. I'm wondering if there's anything other than just being Asian. Is there something about access to care? But you're saying if they're the physicians that are dying, that kind of normalizes them with everybody else. So I don't have the answer to that. We've got one here. And then I'm gonna go right to the back after that and then we'll come down to the front again, but here first. Professor Fauci, thank you for that terrific talk. And I was wondering, you've been talking about emerging new disease, but I've been following the increase in rates or missile in Europe, in Italy and in France. And it's really a shame that we have a vaccine that we know it works. We have access to it, but people have lost faith in using vaccine even for disease that disappeared from Europe. And I was wondering what is your view on how we can re-engage the general population in using what we already have? Well, that's an incredibly important question that we are struggling with not only in the USA, but throughout the world. The anti-vax sentiment, there was always a lower level of that. We've always had that in the United States, but when you're dealing with measles, make that the prototype. You know, if you're over 90%, 91, 92, 93% of the people vaccinated, you're in good shape with regard to herd immunity. Because of the anti-science, anti-vax approach that we see related to COVID, the Robert F. Kennedy Jr. approach about vaccine, that it's spilling over now into vaccines of any type. And what we're seeing in the United States literally in real time last week and the week before, we had 25 cases or so of measles, mostly imported people who come in from out of the country. We now just already this year have like 115 cases of measles, which is four times what we had. And it's the same thing. When you have pockets of people in different areas, get below the threshold for herd immunity, you're gonna get a measles outbreak. I'm really concerned that we are gonna see that in the United States, even though the United States still, as a country, is over 90% vaccinated. There are regions of the country where it's down to 80s and 75, and that's really dangerous with measles, as you well know. One there, and then one at the back. Yeah. Hello. Thank you very much. Anogara here from Francis Crick Institute. Wonderful talk. And your comment about the countries and have nots is a really important comment about Africa and not receiving vaccines. And what are we going to do about it? And you speak about HIV and COVID, and COVID received amazing funding in the developed countries, but Africa, as we know, the vaccine didn't get to very successfully. And tuberculosis still remains a major problem where funding is not really going in that direction for the same reason. So you speak to the governments, you have connections and vision of how this could be brought about. In the past years, there were cuts to the funding, for example, that the UK provided towards developing countries' research. At a global level, how do we, how should we tackle this if you had the power to do so and to influence? Yeah. Well, that's a question that's being hotly debated right now with the WHO trying to get, you know, it started off with the word treaty, a treaty where all countries agree of certain equity of distribution of a certain percentage of your product, be that a vaccine or an antiviral or a monoclonal antibody, that you would give it out to the developing world. Interestingly, there's a lot of pushback about that even from the United States. In fact, I was mentioning to Patrick and Chris that one of the chairs of the committee that's investigating COVID, Brad Winstrup from Ohio, is pushing back completely on that, saying taking away the autonomy of a country to decide what they wanna do. When really it's the natural thing to do, if you don't like the word treaty, call it an agreement, you know, just do some semantics to make you feel a little bit more comfortable about it. But there is a pushback, but you bring up a very, very good point. And that was one of the questions that Patrick asked me right when we sat down, is that to me is really one of the big obstacles that we have about equity, about not getting it to the developing world. We also saw right now, and again, it becomes a financial thing. I'm not a, I don't, I never criticize pharmaceutical companies because I don't really understand in there what they do, but sorry. But, you know, Moderna was gonna build a plant in Africa and last week pulled out a vaccine plant because they didn't think it was gonna be economically feasible for them to do that. So everybody's talking about wanting to do something, but when it comes down to, you know, getting down to the actual doing it, it's always seems to be something getting in the way. I think question at the back. Thank you, Dr. Fauci, for a wonderful talk. And my name's Lynn Laidlaw and I'm a patient and I work closely with the Academy of Medical Sciences. And I just want to say thank you for mentioning the importance of community engagement and involvement in this context. And I just wondered if you had any tips or hints actually so that other people would understand how fundamental it was and make it something that we absolutely do, just maybe against looking at it as a nice to have. Yeah, well, I went quickly through the slides, but I alluded to that, is that my experience with the AIDS activist in actually sitting down and talking to them and getting past the iconoclastic, confrontative and theatrical behavior, activists sometimes have to do that because they get frustrated with the lack of appreciation on the part of authorities of their issues. And that taints it because it looks like they're just pushing back for the sake of pushing back. So I try and when I speak to my scientific colleagues to tell them to take the time to actually sit down and listen to what they have to say. It's more often than not, it's going to be value added to what you're doing. Thank you. John Radford, University of Manchester. Dr. Fauci, thank you very much for your excellent talk. You mentioned two key principles, one, the importance of science, and the other was the importance of leadership. Now, there's a tension there because many leaders are not, they don't have origins in science. How do you actually manage that interaction in a positive way? Yeah. Well, you try to, in a leadership role, base decisions on solid information. When you don't have all the information that you need, you need to be very explicit that science is an iterative, self-corrective process. We got into significant trouble early on, particularly because you had people who were perched to push back on science. And as the COVID outbreak was evolving, the scientists would use the data that they had in January for decisions in January, the data they had in February and March for decisions in February and March. What the public got confused at is that they looked upon science and the scientific process as something that's static. In other words, it doesn't change, not appreciating that if you're gonna be showing leadership, you have to use correct information, data, and evidence. I sometimes jokingly try to explain it to a lay audience that they look upon the biological sciences as almost the mathematical sciences. And I always say that two plus two equals four in January of 2020. And in April of 2024, two plus two still equals four. SARS-CoV-2 in January of 2020 is very different from SARS-CoV-2 right now. So if you're gonna be a leader, you've gotta make sure you articulate the changing nature and how you've gotta go with the evidence. Our politicians who attack our scientists call us either misleading or flip-floppers. So there really is a big anti-science feeling among several of elected officials in the United States. What we call changing our advice in response to evidence, they call doing a U-turn. Yeah. One here, we've got time for two quick questions and then we're going to have to wrap up. Thank you. What arguments do you use to persuade governments to make the necessary investments for preparedness when the politicians are elected on a four, five year cycle and to make the necessary investments for a pandemic or an epidemic, which might occur next year, might occur in 10 years time, it might not occur in their elected cycle. So what arguments do you use to try and persuade the governments to make those investments? You know, I have failed in the preparedness aspect. I've been rather successful in certain circumstances for the response part. We came up with that in actual reality as the COVID third year came down and we said, okay, now the lesson is we've got to invest $88 billion in preparedness and response for the next pandemic, which as I said, would be inevitable even though we don't know exactly when. And there was some modicum of enthusiasm about it. But as you alluded to, the politicians who were worrying about what their immediate problem is now to get re-elected were not being concerned about what was going to happen five years, 10 years from now. It's a very, very difficult thing to do. The United States had one period that I was involved with President Bush and Vice President Cheney after the anthrax attack, which was felt to be an al-Qaeda attack and was a homegrown terrorist in the United States, that they were afraid that we were gonna have bio warfare against us in the United States. And they put in an extraordinary amount of money in a preparation for bioterror. But the thing that drove it was the fear that there would be a bioterror attack. If you just start off and say, by the way, as I've said in my last slide, you need to be perpetually challenged. People's eyes are gonna roll over and say, what are you talking about? We have our own problems right now. So I don't have a good answer for you because I have not been successful in that long range preparedness. We're out of time. I'm sorry, we're gonna have to draw this to a close now. Look, thank you very much, Tony, absolutely superb. And Julie Maxson is gonna come up and say a few words. But thank you very much indeed, Tony. Thank you. So Tony, a final thank you. You've been extraordinarily generous with your time in coming here and with such a frank and lucid talk. We want you to come often to London. And so we have a little gift from the Royal Society and the Academy of Medical Sciences. It's a copy of a letter which is in the Royal Society Archives and it has an American slant. But just to know, we want you to come back. So it's a letter written by Benjamin Franklin in 1754, which outlines his experiment with the kite, the key, the thunderstorm and the charge. And we thought, you might like to take it home with you. Don't worry, we'll get it to you. You don't need to take it in your bag. But anyway, here it is. Oh, thank you, my goodness. Wow, thank you, thank you, thank you. Thank you, thank you so much, take a picture. She wants to take a picture.