 Welcome everyone. I'm Raj Kumar, the president and chief of DevEx delighted to be with all of you joining us from around the world. For an important session as that video kind of highlights, we are in a pretty unique year. If this pandemic and what's happened this past year hasn't shaken your way of thinking, I think there's no hope. This is a year when we have all had to really ask ourselves the very basic questions about what are we doing as a society? What are we doing in our individual organizations? What are we doing as individuals, the citizens? And this session, which is part of the Davos agenda, we would normally be out in the in the snows in Switzerland, having this kind of a conversation. But this session is, as is typical at Davos, an opportunity to look a little bit ahead of the curve, a little bit around the bend to see what's coming. And the title says it all collateral health damage. I think it's something that all of us know pretty viscerally in our own lives. I mean, how many of us have delayed a routine medical checkup or have a family member who has had to make decisions about an elective surgery and imagine the millions of people around the world who might have had transportation disruptions or medical centers that were closed. So we know that there have been real disruptions. The statistic is 90% disruptions to medical services around the world. What we're going to talk about today is what does that actually mean? What are the health consequences of that? And then how do you get past it? How do we get past what might be a coming and significant health challenge beyond COVID? This is the collateral damage of COVID. This is a session that is designed in an interesting way to bring in the public. So it's open. People from around the world are joining us for the first 30 minutes of the conversation. We will then bid adieu to that group and we will just focus on the forum members in order to open it up to a more interactive conversation. So forum members are invited to stay all the way through for the full hour. The second part of the session we will have you turn on your cameras and your microphones and really join the conversation. So I welcome all of the forum members who are here. Maybe like me, you're in a place where there's some snow today and it makes you think of being in Davos, in fact, although we are doing this virtually. So welcome to everyone. I want to mention, as is befitting for a Davos agenda event, we have an all-star panel. We're joined by Michelle Williams, who's the Dean of the Faculty at the Harvard T.H. Chan School of Public Health. We have Peter Sands, Executive Director of the Global Fund to fight AIDS, Tuberculosis, and Malaria. Michelle Mitchell, who is the Chief Executive Officer of Cancer Research UK. And Charles Gore, the Executive Director of Medicine's Patent Pool. We'll be hearing from all of them and what I hope is a rich and dynamic discussion. And I invite all of you who are following along to put your thoughts, ideas, questions into the chat and try to join us in this discussion as we go forward. I also just want to mention before we begin the conversation that the work today that we're doing as a group here does connect to specific initiatives of the World Economic Forum. There are two in particular I want to highlight that you'll hear more about as we go. There is the forum in collaboration with the Lung Ambition Alliance is today launching a report called Learning Lessons from Across Europe Prioritizing Lung Cancer After COVID-19. Obviously, lung health is something very much in people's minds given the pandemic. So we're going to be hearing more about that today about lung cancer and how we improve resiliency around those services. And the forum is also in partnership with the WHO and other partners in the healthcare industry and patient groups and funders to launch a hepatitis elimination partnership and the idea is to eliminate viral hepatitis B and C by 2030. And so you'll be hearing more about that today and how that connects to this broader idea of collateral health damage. So with that, I just want to begin our conversation. I want to ask Michelle Williams who's with us, again, the Dean of the faculty at the Harvard T.H. Chan School Public Health to kind of give us the lay of the land here on this idea of collateral health damage. What do you see broadly as the impact from people having their health services interrupted due to the focus on the pandemic due to the lockdowns and shutdowns and other disruptions? What are you seeing out there in the broader health landscape? Thanks, Raj. It's a pleasure to join you and our esteemed colleagues on this panel. And I'll start by answering your question in ways that I think will be quite somber because that is really where we are and what we're seeing. COVID-19 has had a profound impact on every aspect of our lives. Biological, economic, and social disruptions have been devastating. In addition to the dramatic loss of human life worldwide, we have seen unprecedented challenges to our public health infrastructure and systems. We've seen our health systems crushed by the massive volume of critically ill patients needing care. Our food systems have been challenged in ways that even in wealthy countries like the U.S., we are seeing unprecedented levels of food insecurity. And housing insecurity are increasingly at astronomical levels. So on a macro public health, global health security agenda, we are seeing devastating impacts. And this is being evidenced by observing gains that we were making in the sustainable development goals, for example, where the U.N. now are finding reversals on the gains that we were making globally in the area of poverty, education, and healthcare. We're seeing tens of millions of people falling back into extreme poverty. And global under nutrition is on the trend to double from 690 million people experiencing global under nutrition to upwards of 140 million by the end of this year. And additionally, health disparities preexisting prior to COVID are becoming more pronounced and the vulnerable are increasingly more vulnerable. And I would say one last point and that is the mental health challenges that we are facing are at unprecedented levels and are likely to persist long after we begin to emerge from the pandemic. So I would say there are threats to our health systems that are really going to challenge our cancer control and prevention work as well as our work on eliminating and attenuating viral hepatitis. And I'll stop there. Admittedly, these are somber responses, but I think they're appropriate for framing the conversation. They've been very helpful for framing. And two themes that I pick up from your comments, Michelle, that maybe we'll get back to in the course of the discussion. One is, you know, we remember at the very beginning of this crisis hearing, well, this is sort of the great equalizer. Everyone is affected by the pandemic. And to a degree that it's true, everyone has been affected, but not in the same ways. And these inequalities that you describe, which lead to inequalities of outcome, significant differences in outcome, are probably a big component of the collateral health damage that we're going to see. And I think the other thing you brought up, which is so important is that when we think of public health, it's not just literally medical care in a medical facility, it's everything from nutrition to, you know, livelihoods, all these things are connected. And I think the way you put that together is extremely helpful. Maybe we can just move now to another panelist. I'd like to ask Michelle Mitchell to join the discussion, because one of the elements when we think about ongoing access to health services is non-communicable diseases. Obviously these affect a large portion of people around the world, and many of these are chronic conditions that need regular care. We are today quite focused on lung cancer in addition to that. So I'd just like to get your take on where did non-communicable diseases specifically fit in when we think of the collateral damage to health from COVID? Thanks, Roger. And great to be here with you, the panel, and our guests. And Michelle painted a very somber picture, but a very realistic and true picture of the impact of COVID. So I would just want to take the opportunity to drill down a little and talk about what's happening in the UK, and particularly in relation to what's happening with lung cancer. As Michelle said, health services across the board have been significantly impacted by COVID. And in the first wave of the pandemic, cancer services were very hard here, screening pools, treatments postponed, fewer people coming forward with signs and symptoms. And right now, COVID cases are very high in the UK. Cancer treatments have been better protected this time, but there is some serious disruption. And of course, this is a time of great worry for cancer patients, whether you have lung cancer or other types of cancer, knowing and understanding whether the services and treatment will be available for them. Look, the specific picture to give you a sense of lung cancer between March and November last year, we saw a 34% drop. That's 6,800 people who weren't referred for lung cancer in England. That was mainly due to them not coming forward and contacting their doctors about worrying symptoms. And 25% fewer patients started treatment compared to the previous year. And today, the numbers of people presenting with symptoms of lung cancer is still lower than before the pandemic. And even if they are referred, it's very difficult to get patients through the system and get respiratory symptoms investigated so they can start treatments quickly. And why this matters? I mean, it matters a huge amount generally, but also specifically because we know people have a much better prognosis when diagnosed early. A person diagnosed with stage 4 lung cancer has a 15% chance of surviving one year compared to, and listen to this, compared to 80% if detected at stage one. So early diagnosis really, really matters in lung cancer. We've also seen here in the UK a big impact on clinical trials. Most were postponed as COVID trials got up and running. And unfortunately, this has meant that thousands of patients have missed out on the opportunity to take part in potentially life-saving cancer research and cancer trials. This is partly recovered over the summer and autumn, but not anywhere near as much as we would hope. So we're saying, and our understanding is it's too early to know the impact yet based on the current data, particularly impact around survival with cancer. But unfortunately, we do expect there to be a huge impact. And that's why we completely support the recommendations of the task force, which I think we're going to get on to later, which will be in central elements of getting cancer services back up and running here in the UK. And there's lessons for countries across Western Europe and beyond. It sounds like it's too early now, but what you're anticipating is at some point, maybe later this year, that you will see a spike in people who do present with symptoms, but they're much further in the progression of their disease, much harder to treat as a result. Is that fair to say? Is this a 2021 issue, a second half of the year issue as you look at it? Well, I think as we look towards mid to end of 2021, we'll potentially be seeing signs of people who have died because they haven't had the treatment who present later in there. That means the stage of presentation reduces their survival rates. So that would be a big problem. We've talked about how important it is to be diagnosed early. And of course, a number of the treatments available will be harsher as well, the later you get them. So it's going to have a big impact potentially on mortality, on the stage in which people are diagnosed, the treatments they have and of course, drawing it back out to the broader point Michelle made around inequality. Cancer is an issue that affects us all, but particularly for lung cancer, there is a socioeconomic dimension to it. We know that smoking is a very big driver of smoking tobacco is a very big driver of lung cancer. And some of our poorest communities will be hit hard because of COVID and because at the moment we're struggling to get cancer services for lung back up and running at the same scale as other areas. Right. So the outcomes will be unequal just as Michelle described across many areas. I want to get Peter Sand into the discussion. If I can, Peter, you of course, lead the Global Fund and you're focused on fighting HIV and malaria tuberculosis. So let's turn our attention to infectious diseases if we can. What does the picture look like in the disease areas that you focus on? Well, to build on the points both Michelle's have made, it's a bit of a perfect storm of concurrent health, economic, social crises, which are both disrupting health interventions, programs to fight diseases like HIV, TB and malaria. But also all the issues around nutrition, enhanced inequality have direct health impacts. Lockdowns have increased rates of gender-based violence. We've seen access to health services actually being reduced for the poorest and most vulnerable. And we've seen resurfacing of stigma and discrimination against key populations. We've also seen because COVID-19 disproportionately affects health workers really acute pressure on health systems, which has, in the way that both Michelle's were describing, a sort of cascading impact on all sorts of other types of health service. I think the thing that makes the countries, this particularly acute in the countries of the global fund focuses on is the combination of the fact that because many of these countries, particularly the lowest income countries are very young, the kind of demographics means that the mortality rate from COVID is relatively low. But the extent of the other disease burdens and the fragility of the health systems means that the collateral damage is relatively high. To the extent that I think the collateral damage in most really low income countries is going to be greater than the direct impact of COVID. You're going to see relatively low mortality from COVID itself and relatively high mortality from these knock-on consequences. Is that something we're seeing now or is it similar to what Michelle described for lung cancer, something you're expecting to see in the second half of this year? Are those impacts coming today? Do you see greater mortality around TB or malaria, for example? We're seeing some pretty high rates of disruption on different aspects of it. So case management, for example, in malaria is down 22%, which means effectively 22% cases aren't being treated. TB case notification, i.e. diagnosis and then enrolling people on treatment, is down in some of the highest burden countries by 25 or 30%. And if you've got TB and you're not being treated, then a proportion of those people will die and also you'll get more people being infected by contact with them. So we are seeing an impact. How big an impact is, frankly, we don't know yet. And one of the sort of stark comparisons between COVID and some of these other diseases is that, well, if I take TB, for example, TB is the second largest killer among infectious diseases after COVID. COVID killed about 1.8 million people in 2020. TB would have killed about 1.5 million. The trouble is, on January the 1st, anybody could go on Google and get an estimate of how many people had died of COVID. It wasn't accurate, but it was actually pretty good. That number won't be around for TB until October of this year. We just haven't put the kind of money and attention on the second largest killer among infectious diseases as we have on COVID itself. But the knock-on impact on TB will be measured in hundreds of thousands of lights. I have no doubt about that at all. And similarly significant and large impact on the other big infectious diseases such as HEIP and TB. And I think it's important to recognize that we're by no means through this yet. And the longer it goes on, and the longer the disruption, and the longer the impact, the more the collateral damage will escalate. So we face a very big challenge. Of course, we're not standing still. We deployed another billion dollars on top of what we normally fund last year in supporting countries in their COVID-19 responses. But that money is spent. We deployed it completely. So we will need more resources to be able to support countries in both direct COVID-19 responses and in mitigating the damage, this collateral damage we're talking about here. Yeah, I do want to get into, as we continue the discussion, Peter, where do we go? What new funding? What new instruments? What are the new policies? How do we actually address this? But I do want to bring Charles into the discussion because you have been a leader on viral hepatitis. You yourself were a patient. You were cured. There was a cure for hepatitis C. What are the impacts like in that fight, which you're leading to stay by 2030? We will eliminate these diseases. Where do they stand? How much of a hit has that effort taken due to this pandemic? I'm afraid it's not good news. Thank you very much, incidentally, for the question and for inviting me to be part of this panel. I think, like everybody else has said, there are significant hits. There have been three recent surveys by the Centre of Disease Analysis, the Global Task Force for Global Health, and the World Hepatitis Alliance. They've all come pretty much the same figures of somewhere around 50% reduction in diagnosis and treatment. And diagnosis and treatment are two of the key areas in the global strategy where we are really as a world lagging the elimination by 2030. And of course, unfortunately, the hit is even bigger in low and mid-income countries. So where we may be talking about 40% to 60% in high-income countries, we're talking 60% to 90% in low and middle-income countries. So again, it's the same picture of a lot of collateral damage so far. And there's an estimate that a one-year hiatus in national programs for hepatitis elimination will lead to an extra 45,000 liver cancers and 72,000 deaths by 2030. So this is only modeling, and we'll have to wait to see if that bears out, but it's not very encouraging. And of course, in viral hepatitis series, people affect hepatitis as interest came out with HIV and are very vascular. Well, I want to thank you for that, Charles. And I want to kind of move our conversation in the direction of where do we go from here? So essentially what all four of you are saying, and you provided different contexts for your comments, but what you're all saying is there is a massive wave of additional health consequences beyond COVID itself, either here already and not entirely detected or coming fairly soon. So what do we do about that? When I look at the global landscape, and of course, there's quite a bit of diversity depending on country and resources and policies, but in general, there's a lot of focus on COVID itself and on economic stimulus in general. But what about directly addressing these kinds of health consequences? And Michelle Williams, maybe I can begin with you. When you think about the Build Back Better concept, sort of where we go from here, is there a big idea out there that's missing from a conversation like this? Is there somewhere that governments and societies should be looking based on this experience to go? Yeah, that's a great question, Raj. Let me just say the big idea is not so novel, and it's not so new, but it is fundamental. And that big idea is if we continue to underinvest and undervalue public health, which is really central to population health, economic security, as we now all know, and national security, we do so at our peril because what COVID has done is really show how weak public health, global public health infrastructure can bring us all to our knees. So I would say the Build Back Better is first recognize the importance and the value of public health and invest accordingly. That means reengaging and properly investing in global governance of public health leadership, WHO, making the governance structure nimble and equipped with all of the necessary surveillance tools, communication tools, and resources to not only respond to persistent issues like climate change, antimicrobial resistance, but to be ready to have the surge capacity to address threats to our health systems, to have a workforce that is adequately trained and protected, and to have stockpiles of necessary equipment, therapeutics, and diagnostic tests ready to go when we need. Because it's not if it's when the next manmade or natural disaster or pathogen emerges or reemerges and threatens all of us. So I don't think the idea is new. I think we have to go back to basic principles and invest in the necessary systems and infrastructure and workforce to protect our economy, our people, our security. I mean maybe if there's a new element to it, Michelle, it's that every country now has seen this at once, right? It's hobbled economies around the world, rich and poor. And I know Peter Sands has said this before, that his nightmare is that his institution becomes known as the global fund to fight HIV, TB, malaria, and COVID, right? Because we have such an unequal response to a disease like this where we end up getting vaccinated in advanced economies and not in others. So Peter, maybe I can bring you into the discussion. I hear you say you spend a billion dollars in some way. It's a huge amount of money, and you have to go raise that, which is not easy. On the other hand, when I hear Michelle and the scale of what's really required in countries that have very weak health systems, are we being ambitious enough, or do you see an opening or an opportunity to get ahead of this curve when we think of collateral health damage? We're not being remotely ambitious enough. I mean this year we are deploying about $4.7 billion on HIV, TB, and malaria actually to mitigate the collateral damage and help countries respond. Not on the vaccine side, on the diagnostic therapeutics, basically keeping the health system. We need another $5 billion. That's the global fund alone. But that's the way we've got to be thinking about this. I mean, the worst way to fight infectious diseases is slowly. Because if you fight them slowly, not only do they kill a lot of people, not only does it cause enormous economic damage and collateral damage, but it mutates as well. And you give it the time and space to mutate. And that's just a really bad strategy. We need simultaneously to be doing things to mitigate the knock-on impact on other diseases, be it HIV, TB, malaria, or hepatitis, or cancer, or other conditions. And actually I've seen a lot of great innovation and great collaboration among the different disease communities to do that. But we've also got to get Michelle Mitchell into the discussion, Peter. Pardon me, but just Michelle, on this point about lung cancer, you've focused on research prevention detection. Is there a new normal that we will go into? Will we have learned some lesson from this experience as we see these negative numbers come in? What would have been prevented to death? Is there something new you're hoping we will take out of this? Yeah, there's several innovations, but I think we have to not only set an ambition, which is currently shaped as get back to pre-pandemic levels of Covid. Well, that's not good enough because we weren't doing well enough before Covid in detecting and diagnosing cancer early, especially lung cancer. So we have to set a bold ambition, which is about improving cancer survival at a much greater degree than we currently have in the UK at the moment. And to do that, I think we need investment in our workforce, investment in diagnostics, we need the public to be confident about coming forward with signs and symptoms. But we also need to pull the benefits of new technologies and innovations that are out there at the moment. We're working on the crest of a wave. So we're increasingly funding excellent early detection research, bringing disciplines together and forging partnerships that will consolidate expertise, whether that's a transatlantic partnership we have with the International Alliance for Cancer Early Detection, which is a fantastic in bringing translational work together, or also funding research in new areas, for example, liquid biopsies, blood tests, which could detect cancer early through circulating tumor DNA, which is very strong in Manchester led by a professor called Caroline Dive. So research innovation can transform the system in the future. And we've got to transform the health system through these innovations. But also, I think governments and health systems have to establish much bolder ambitions about what is required, not only to come through COVID and get back to pre COVID levels of service, but also to meet those big ambitions about improving cancer survival. And they won't be able to do that without investment in workforce, diagnostics, bringing forward innovation and research. And of course, the partnership we have between NGOs, corporate partners, commercial partners is also part of the team who need to to transform cancer survival. Right, it is actually that collaboration, right? And maybe that's something we've learned from during this COVID effort. It does take all elements of society working together to ramp things up very quickly. Charles, a final word from you before we close out our public part of the session. Again, on on what you've learned from this process, sort of where we go from here, you have a big ambition you set out 2030 to eliminate viral hepatitis. I mean, I just think that we have to have a different approach to health globally. We've got to stop thinking of health as a cost and thinking it as a key investment pillar. And I think COVID has shown why that is so important. If you don't have health, you have these mammoths across all areas. And there are many trees still that do not devote enough budget to their health system. And, you know, we heard from Michelle Williams about the kind of investment we need. That's a lot more spending to put public health on that kind of footing. And so it's a mindset change that we need in order to do this. But I think maybe COVID will make us do that. At least that's what I'm hoping. Well, let's use that mindset shift as maybe a starting off point as we enter our private session. So I want to say thank you to everyone who's been joining us from around the world for the public session. We really appreciate your participation in this event. I want to thank the panelists. I know if we were in person, there would be Roris applause for this group and all their great insights. So thank you.