 Thank you very much. Thanks to all the participants and to all who will be watching this in the coming days. We're very lucky to have some of the global leaders in health systems and in public health to reflect on the ongoing pandemic and the recommendations of the Lancet COVID-19 Commission. We issued the final report of the Lancet COVID-19 Commission on September 14th of this year. The pandemic was not over, but the commission is finishing this year with recommendations based on the lessons learned during these three years of the pandemic. And we, for purposes of our discussion today, a central focus is the reflection throughout the report of the commission that functioning health systems are the sine qua non of an effective response to a pandemic and of course to multiple other health challenges that are faced by every part of the world. Health system entails two interrelated but distinct components. The components of medical response, curative health, clinical response at all levels from nurses, doctors and community health workers to hospital services. And the other pillar of a health system is the public health system. That is the epidemiology, the surveillance capacity, and the ability in a trusted manner to convey to the broad population health recommendations to protect populations in the midst of multiple kinds of crises, whether it's an endemic disease or whether it is a pandemic as we have confronted in the last three years, or whether it is the challenges of seasonal flu or countless other areas of health where the relationship between health experts and the public is essential, a trusting relationship is essential, and of course a high quality coder of experts is indispensable. Let me review very briefly core recommendations of the Lancet COVID-19 Commission with regard to health system strengthening because our conclusion was that many parts of the world lacked one or the other of these two pillars of clinical health or of public health and some parts of the world are bereft of both pillars in part because of chronic poverty, which in turn is reinforced by the poor public health conditions of the population. So if you'll permit me, I'll just review briefly some of the core recommendations of the Lancet COVID-19 Commission. And I'm happy to say that in a recent workshop with the World Health Organization leadership, we had a very, very good discussion as well on these critical issues. So I will briefly share my screen and let's see if I can close that and do that and go back to the beginning. So building strong health systems recommendations of the Lancet COVID-19 Commission, three broad recommendations that I want to highlight. First, countries should strengthen national health systems on the foundations of public health and universal health coverage grounded in human rights and gender equality. And then we describe what these two facets of a health system, the public health system and the health coverage system entails. I won't go into the details in this brief introduction, but this power point and of course the Commission report itself are available online and this entire workshop today will of course be taped and available online for further study. In addition to strengthening health systems, we recommend that each country should determine and expand the national pandemic preparedness plans to prevent and to respond to newly emerging infectious diseases. Sad to say, but COVID-19 of course will not be the last of the pandemics that we face for multiple reasons. The world will continue to experience new emerging infectious diseases and no doubt some of them as dangerous and serious as the SARS-CoV-2 virus which has been afflicting us with the pandemic and which has claimed an estimated 18 million lives to date. There will be others. We can say that most countries were not prepared for this pandemic. They did not have preparedness plans in place. Many, many countries were unable for a variety of reasons, all resulting from a lack of preparedness to respond effectively to the pandemic. And that is indeed why the pandemic has continued with such force, with the arrival of new variants and with such a shockingly high level of deaths worldwide. The third recommendation that I want to highlight is the financial dimension of an effective health system. Of course, for high-income countries, the basic question is choosing to use the high levels of the income in the country in a propitious manner to properly fund the two pillars of the health system. For a low-income country, however, this is not merely a national choice because poor countries simply do not have the public revenues that are necessary to be able to maintain and sustain a proper public health system. And so for this purpose, we recommend establishing a new global health fund that should be closely aligned with WHO. This fund should combine and expand on the operations of several existing health funds, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, or the Global Alliance for Vaccines and Immunizations, and should include the new pandemic preparedness and response funding, which is just getting underway. And in addition to those three windows, we strongly urge a fourth window of financing, which truly does not exist properly in the world today, and that is funding for poor countries to be able to train and deploy health workers at an adequate level to maintain an effective national health system. Shockingly, there is no established mechanism for funding the health workforce that is essential for global public health. Let me very briefly summarize a few points. Even before the pandemic, the span of life expectancy from the poor countries to the rich countries was a shocking 30 years. Even before the pandemic, the poor countries in Sub-Saharan Africa have life expectancies in the mid-50s, whereas the high-income countries in Northern Europe and in East Asia have life expectancy in the mid-80s. This is a shocking fact because the excess deaths in the low-income countries are from identifiable and preventable or treatable causes, and not only that, preventable and treatable at quite low cost. But poor countries are too poor on their own to be able to mobilize effective health systems. And one of the facets of that is simply the lack of health workers. In the poorest countries in Africa, there are two or three doctors per 100,000 population, two or three per 100,000. Whereas in the high-income countries, there are five or six doctors per 1,000 population. So it's more than 100 times gap between the poor countries and the rich countries in doctors per person. In terms of health expenditures, we also have a gap of 100 times. In the low-income countries, health outlays are 60 or 70 or 80 dollars per person for an entire year. Whereas in the high-income countries, they are five or six or seven thousand dollars per person per year. In other words, 100 times larger. And when you factor in the realization that much of the spending in poor countries is private, indeed out-of-pocket spending, not public spending, which is the most effective kind of health system spending, the gap in expenditures is even larger. If you statistically analyze where does money matter, it's in public outlays for the health system much more than in the private out-of-pocket outlays. And I run through one example of a very poor country like Chad or Malawi or Niger at 600 dollars per capita. Typically, the public spending in such a country is on the order of 18 or 20 dollars per capita because that's all there is in the budget. And that means that it's one 200th or 300th of what is spent in a high-income country. And what the evidence shows us is that even small increments of spending per capita, raising that level from say 18 dollars to four times that, about 72 dollars per capita, still tiny compared to the high-income world, could add five years of life expectancy by addressing the causes of maternal death at pregnancy and childbirth, the deaths of infants and children under the age of five because of lack of immunization or doses of antimalarials or other low-cost interventions that have a tremendously important life-saving feature. So our estimates are that we need an increment of perhaps one tenth of one percent of the GDP of the high-income countries. That would be 60 billion dollars a year. And that would raise the life expectancy and the functionality of the health systems of the low-income countries in remarkable ways. And for that, as I mentioned, and I'll close here, our recommendation is for a global health fund led by the World Health Organization that combines the global fund, GAVI, pandemic preparedness, and primary health system strengthening and finance so that we have the capacity to respond not only to pandemics but to the year-in-year-out life-threatening conditions that are causing so much excess disease burden and so much tragic and unnecessary loss of life in the poorer countries of the world. So now we're going to hear from remarkable experts who have been in the front lines of the battle of the pandemic. And I'm really grateful to you for joining today and really want to hear your takeaways, your lessons, having been in this battle for three years of what you see, what we really need to do. We need to advocate together. We're on one dramatic mission to help the world learn the lessons of this pandemic, which still is not over, but in order to really come out of this at least with the saving grace of strengthened health systems around the world. So with that, I will turn it back over to you, Julie, and thank you for moderating the session and thanks to all the esteemed public health leaders who are going to be discussing these issues with us today. Thank you. Thank you very much, Jeff, for your remarks. First, I would like to welcome Dr. Andrea Amon, Director of the European CDC, to speak about the lessons learned regarding health system strengthening from the European experience of the COVID-19 pandemic. Dr. Amon has been the director of the European CDC since 2017 and brings her many years of experience in national disease surveillance and outbreak response to current and emerging infectious diseases in Germany to this webinar. Thank you very much, Dr. Amon, for joining us. Yeah, thank you. And I don't know how many time zones are assembled here. So good morning, good afternoon, good evening to everybody who listens. I think it's very important to look now what can we learn from this, because as Professor Sacks has said, it was a devastating three years that we have behind us. On the other hand, it also has highlighted where we have to improve. And many of the lessons that we have learned are in line with what the Lancet COVID-19 Commission has highlighted. Just a word to the European Center for Disease Prevention and Control. As the name says, we are in charge, our core group of countries in charge is the European Union, characterized as high income countries. And nonetheless, we see or even in our region, a span of differences and inequities in life, expectancies in incomes and in possibilities and capabilities. So our remit is infectious diseases to identify, analyze and assess, communicate threats from infectious diseases. And my lessons are, of course, based on this remit. So what we have learned is that in the future, to deal better with situations like this, we have to develop preparedness that is transferable from between different threats. And as we have seen, not only includes the health sector, but it's multi-sectoral and multi-disciplinary. So one health is written all over the lessons that we have seen. And I think that is very much in line with what the Commission has put forward. Now, being one of the richest regions in the world, our preparedness should have shown the way in how to deal with the pandemic. But the preparedness plans were not up to this. Also, in our region, basically, every country has recognized they were not prepared. And one of the big areas where we will invest in the coming years is the resilient modernization of the surveillance systems. Because although the data is not everything, everything starts from there. And that is why we start now modernizing and think as much as we can, the European surveillance system, but also then support the countries in transforming their systems. In terms of preparedness plans, I mean, the Commission has outlined very much the key ingredients. For me, the learnings are a bit more specific. In addition to the cross-sectoral preparedness plan, we also need to pay attention on the cross-border issues. We have many regions where people live on one side of the border and work on the other side. And we have witnessed very difficult situations when countries on both sides decided to do different things without any prior notice. I also believe that the local level needs particularly strengthening in both in the primary care and the public health, because they bear the brunt. They see the first and they see the worst. And without their resilience, everything else is at risk. Particularly care and attention should be paid to the hospital preparedness at all levels in terms of search capacity for beds, but also for staffing. I mean, throughout the countries, there were solutions found, but it took some time and it was not prethought, which I think a preparedness plan should do. The other element for the hospital preparedness is the stockpiles. I think we have seen in particular at the beginning of the pandemic that essential elements have been missing in equipment, in ventilators, in personal protective equipment, but also in medicines, in the general medicines for ICU, for instance. Now, for me, one of the most critical learnings is the value and the emphasis that needs to be given to risk communication and community engagement. We have lost the community, our general population. Along the pandemic, they were very adherent to the measures at the beginning. And throughout the three years, we lost them. And I think it was that we that we haven't the communication and the engagement to the change of the face and the context of the pandemic. So here, for me, we have to really do a lot because the coming threats that we can already see in terms of, for instance, global warming and climate change, we need the population. Everybody has to do their part. And if we don't engage properly, it will not happen. Now, based on all these learnings, we have the legislator in the EU have put forward revisions of our legal mandate that will require us to change a few things. It will tasks us to work more closely with the countries, have a more interactive dialogue with the countries and not treat them as a blob in the region, but really also on an individual basis. So the surveillance strength thing I have already said, but it is also helping countries to monitor and assess how their health systems are doing to agree and build indicators for the countries with the countries that allow them and us to assess where are they in the preparedness. Because so far, we have to rely on them saying, oh, yeah, we are prepared, which didn't turn out to be true. There are other elements that turned out to be very important during the pandemic, and that is the modeling and the foresight. We have started the pandemic with one modeler, which was woefully inadequate, of course. Now we have four with two more to come. And they have now built, without the modeling teams, forecasting hubs where the modeling teams can bounce their ideas for the shorter term forecasting, scenario hubs for the midterm forecasting. And we have started this year a foresight project that looks really 10, 15 years, what are the drivers in the future that might impact what kind of threats come, because that can also then direct which way the preparedness can go. We will also intensify our global collaboration. We have already started in 2019, shortly before the pandemic, to develop a network of CDCs around the world that proved very helpful, because colleagues in areas that were already dealing early with the pandemic could tell us, others, how they did and we could learn from them. We also saw that we all had the same questions, what are the masks, the schools and this and that. And by exchanging the views, I'm not sure we achieved an alignment, but that could also be used for sort of a principal alignment that could help around the world. We have been even more closely than before working with our colleagues in WHO Euro. Many of the documents that we have, guidance documents that we have prepared are done together with them. And we have received a grant for working and strengthening the Africa CDC. So that is a particular focus now also for our work. So concluding, I think we have a lot of work also in our region to do. We saw the advantage to be connected globally for dealing with the crisis, but also now we have to continue this for the preparedness. And from our side, this partnership that we have within the EU, but also globally, should be really based on the principles of solidarity and equity, that these inequalities that still exist in our region and globally can be reduced. Now, this is, of course, based on trust and consistency that has to be built not in a crisis, but afterwards or in between, because what we have seen is that no single continent, no region and definitely can deal with such a crisis on its own. We have to all work together. Thank you. Happy to have any questions. Thank you so much, Dr. Ramon, for your very insightful remarks and in the spirit of sharing these from different global regions. It's my pleasure to now introduce Dr. James Fitzgerald, the director of the Health Systems and Services Department at the Pan American Health Organization or PAHO. Dr. Fitzgerald oversees PAHO's work on health systems and services organization oriented towards universal health. Thank you very much, Dr. Fitzgerald, for sharing your insights and reflections on health systems strengthening from the Latin American region. Thank you and a very good morning to you from Washington. Let me start by thanking Professor Sacks and the Sustainable Development Solutions Network and the Center for Sustainable Development for organizing this webinar on health systems strengthening. It really represents an opportunity for us, I think, to reflect on some of the main challenges and opportunities that within our context the region of the Americas is facing to introduce real substantive and transformational change in our health systems with strategies that build resilience, but underpinned by values of equity, solidarity, and most importantly the right to health. We at PAHO, we welcome the recommendations of the Lancet Commission, its final report, and we celebrate the global perspective and intersectoral composition of the recommendations being proposed. This is a fundamental condition to develop greater resiliency in health systems, but more so to recover the lost public health gains that we witnessed over the last three years. PAHO is playing and continues to play a key role in supporting our member states in responding to the global crisis in the Americas, and we are working intensively now with our countries in building sustainable and long-term strategies for the post-pandemic period. But it's within this context that I'd like to present some observations on the context of health and health systems prior to the pandemic and how that context impacted the capacity of the region to respond during the pandemic. Before the COVID-19 pandemic, the region of the Americas was making steady progress towards the achievement of universal health coverage, but systemic deficiencies and inequalities persisted and gains were overall slow. For example, if we look at the SDG 3.8 target on service coverage, we see that it was improving as shown by the UHC Service Coverage Index from 65 in 2000 to 77 in 2019, and the Americas was the third highest average value across WHO regions. In addition, between 2000 and 2017, the Americas was the only WHO region that experienced reductions in the incident of catastrophic and impoverishing health spending. But despite this progress, inequalities in service coverage persist, and about a third of the population continue to face multiple barriers to access health services, a situation that was more prevalent amongst vulnerable populations. While public spending is slowly improving, spending was still insufficient and low priority has been given to investments of the first-level care. This is relevant because prioritizing our the first-level care is really a necessary condition to improve the resolution of capacity and provide quality health services to people and communities. The deficit of human resource for health in the Americas is enormous. It remains unacceptably high. We estimate that we will need approximately 600,000 additional health professionals in the region of the Americas to be able to recover the lost public health gains and retake the path to achieve the health-related SDGs by 2013. So, in summary, the COVID-19 pandemic has reversed progress made toward the achievement of universal health coverage over the past 20 years, exposing and exacerbating structural weaknesses of health systems and health inequalities. The response to the pandemic has been limited by the historical weaknesses of the region's health systems, additionally compounded by the long-provelling structural inequities and social exclusion and the lack of adequate financing. The challenges of segmentation and fragmentation of health systems characterized by weak stewardship and governance mechanisms reflected in the poor system's performances even before the pandemic. As a result, simply maintaining the continuity of essential health services while responding to the pandemic was a challenge in our region. In December of last year, nearly all countries in the region reported disruptions to essential health services with 93% of 28 countries reporting disruptions of at least one essential health service. During that time, these disruptions were reported across all health service delivery platforms with the first level of care and community-based care services amongst the most effective. The pandemic has led to shortages and inequities in access to essential medicines and other health technologies as well, limiting and jeopardizing the delivery of essential health services. It further has revealed the dependence of Latin America and the Caribbean on imports of medicines and other health technologies from outside the region, the vulnerability of global supply chains and emergencies, and the high degree of heterogeneity in the Americas in terms of COVID-19 vaccine research, development, and production capacity. So the region of the Americas really urgently needs to act to reverse the socioeconomic and health losses caused by the COVID-19 pandemic and to address the critical issue of foreground care and recover lost public health gains. The pandemic reaffirms that the strategy around universal access to health and universal health coverage based on the primary health care approach constitutes and remains the foundation for resilience in health systems that have the capacity to prepare for and respond effectively to crises, to maintain core functions when a crisis hits, and to reorganize and transform if conditions are required. Given this, we at PAHO are working with our member states to accelerate and expand coordinated action between social sectors to promote systemic transformation. In 2021, our country has adopted a strategy for building resilient health systems and post-COVID-19 pandemic recovery to sustain and promote public health gains. This strategy has four critical lines of action. These lines of action call for first, transforming health systems based on the foundation of primary health care, second, strengthening leadership, stewardship, and governance through a renewed focus on the essential public health functions, third, strengthening capacities of health service delivery networks, and finally, increasing and sustaining public financing in health and social protection. In addition, our countries have called for renewed efforts to increase research and innovation for vaccines, medicines, and other health technologies, strengthening regulatory systems, and promoting greater region-wide integration and solidarity in these efforts. And they are seeking to leverage the power of digital health to accelerate all transformations. This framework, we believe, provides us with a path moving forward, and our approach constituted the foundation for the action plan on health and resilience adopted by our heads of state at the ninth summit of the Americas in June Los Angeles and the United States. At the summit, PAHO and the United States Government announced within this context the launch of the America's Health Corps as one of the strategic efforts to build a regional character of health workers that we need to address public health needs and to be better prepared for future international public health emergencies. And so as we continue to mitigate the effects of COVID-19, countries in the Americas are already envisioning a post-COVID-19 development era that will need to build and embed resilience within societies and health systems. Countries will need to prioritize the strengthening of health systems towards the achievement of universal access to health and universal health coverage, but of course, embedding pandemic preparedness and response as a key component. Barriers to access, fragmentation and segmentation in health systems must be addressed through coherent policy reform and a progressive integration of subsystems if the goals of the 2030 agenda for sustainable development are to be achieved. Thank you very much. Thank you very much, Dr. Fitzgerald, for your presentation. Next, we are very lucky to be joined by Ms. Pauline Orungu, who serves as the Global Policy and Advocacy Advisor for PATH, where she leads PATH's advocacy for equitable access to quality maternal, newborn and child health. Previously, Ms. Orungu served as the Advocacy and Policy Country Lead for Kenya and she brings nearly two decades of leadership in public health advocacy, policy and engagement with governments in the African region to advocate for stronger policies and investments in women and children's health. Thank you for joining us. Thank you so much and good morning, good afternoon, good evening, wherever you are. So, but just to start off, let me start off by painting a picture of what has happened in Africa when COVID-19 hit. As we are all aware, Africa has very weak health care systems, whether you look at it from primary health care or you look at it from tertiary care. One thing that stood out is how much Africa is left out of global supply chains and really stood far behind other countries and was really unable to access essential medical products, whether you think about PPEs or masks. It took a really long time for Africa to access this. Secondly, it's the issue of inequities in the international health systems that were really amplified and characterized by vaccine equity in Africa. To date, there are many countries that have not even achieved vaccination of two million people, despite having large populations. While in other parts of the world, especially in developed countries, people are now doing third and fourth doses of vaccines, while many Africans are standing in line waiting. They have a challenge that while Africa experienced low deaths compared to other regions of the world, the impact of COVID-19 on health systems on social development and economy remains enormous. And really, issues such as gender concerns have become more amplified. And something to notice that although the deaths that are reported are low, there are many, many, many deaths and many COVID infections that went unreported due to weak data systems on the continent. COVID-19 did erode a lot of games that African countries have made in essential health services, whether you think about reproductive maternal or child health care points. It is a response to other infectious diseases. Those have really taken a hit in some countries. You had a 0.5% reduction in vaccination services for children in 2020 compared to other times. So these all show how much Africa has taken a huge hit due to COVID-19. If you compare 2019 and 2020, the number of zero-dose children on immunization increased by a 0.6% point if you look at DPT1 and DPT3 on the African region. This just as an example that shows how much regression has happened on essential health services on a continent that's really been struggling to keep up. Another impact of COVID-19 was the tightening of resources as well as reorientation of health services. When COVID-19 hit African countries, many governments changed and channeled resources to the pandemic response, leaving essential health services exposed to lack of inadequate financing. And yet these services were really struggling. An example of a country like Kenya, you had a diversion of about 9.4 million US dollars that were designed, designated for primary health care being channeled to support the COVID-19 response. Although governments in African countries have devoted a lot of their limited health budgets to PhD, the need exists for funding and therefore systems remain weak. When you think about what the Lancet Commission did show, and we really learned from a civil society perspective, from a non-governmental institution that works on public health, we learned the efforts of the Lancet Commission in really drawing good lessons and enabling us as a global community in health to think about what needs to be done in the future. One really good thing that the Commission did was not just to look at the health system's impact, but also to think about what does this mean for economies and for social development of populations, countries, and regions that are enlarged. So some of the lessons and observations from Africa is that COVID-19 emphasized the need to strengthen health systems, especially primary health care, alongside building higher levels of care. And in primary health care, what's noting is the need to really focus on strengthening, preventing services, as well as health promotion efforts in different countries. These have lagged behind and largely have been left to be done through volunteer experience. There's a lot of countries, like when I come from in Kenya, you have community health volunteers as opposed to community health workers, and therefore there's a workforce that is ready to be deployed, ready to support health systems, but it's expected to work on a voluntary basis. You'll have smaller pockets of compensation or savings, but that doesn't work. There are countries that have invested in primary health care and invested in community health services on the African continent have proven that we can make progress, even where you have very limited investment of the country, or very limited resources for countries. If you're okay with a good example, they have really included their community health services into formal health services, and that has helped the country make progress, even where resources are very, very limited. Another lesson to take away from the COVID-19 pandemic is that while governments are making efforts in PhD, they do need to reorganize the way they deliver services, and that sort of reorganization cannot be done without engaging new strategic partners, and partners here don't just mean within the health sector, but also include communities, include private sector, include multi-stakeholders, because the response to health goes beyond those in the health sector. It must go to other sectors. It must embrace agriculture through the security. It must also think about those who deal with infrastructure for purposes of accessability, and ensuring that health is well supported, because I think in previous years, African governments have looked at health as a cost investment, quote-unquote. It was seen as that sector that doesn't really deliver for the economy, but COVID taught African governments, and I think the world of large has had lessons that health is a core part of economic and national development, and therefore it must be treated as such, in general, in the resources and in investment. Another thing we want to make recommendations is, as we think about what does the future look like? There's need to revitalize policies around primary health care and that focus on strengthening health systems. The past has largely been focused on, yes, building the health systems, but there's been too many vertical processes and vertical investments that are either focused on responding to specific diseases or specific emergencies, but not leaving the health system building process behind, and that has cost a price, and that price has been a decline of essential health services, especially with the impact of COVID-19 too. When you look at services like maternal newborn child health, they can teach you, and that would have been avoided if both system strengthening would go alongside investment in particles of Iraqi policy. In terms of thinking about what should the investment look like for the future, I think it's important to think about building efficiencies in resource allocation by African governments and strengthening, to strengthen health system expenditure. Many times you have budgets that are written on paper, but when you compare what is planned for against what is actually expended, you realize that they are measured up. So creating efficiencies and ensuring that the resource allocation and expenditure go hand in hand, and prioritization goes to the right places. I've seen in many African countries where you have governments build health facilities and look at the standard, and the ability of those health facilities to function is really challenged, and that speaks to where the prioritization is in terms of investment. It's important within Africa to build a strong either national or social insurance health system as a way of protecting people from catastrophic health costs and expenditures. Majority of services in Kenya are paid from people's pockets, and these are particularly people paying for or missing to access health care services because of cost. If we look at countries like where I come from in Kenya, you have about 40% of services being delivered in the private sector and the rest of about another 47 being delivered by the public system and the non-profit forming the remainder. That speaks to the fact that while the population has limited resources, majority of them have to access services through their pockets, and that contributes to slowing down development at the family level as people prioritize resources for health, against making progress forward in terms of the economic standard. It's essential that global players think about what kind of investments, what kind of systems need to be put in place that international resources are well coordinated and that the funds that are veiled also build off each other. I hope and I truly think that COVID-19 teaches a lesson that donors when they come into African countries will more or less invest on what their priorities are or they will only invest in certain sections that doesn't help the system to move forward. I think it's essential that donors align better and back up country systems and invest in country systems, put up higher standards for efficiencies and for tracking what is invested, where it goes, what kind of results it produces so that there can be real progress on the continent. Examples could be drawn from what the African Development Bank has stated in its current strategy that runs up to 2030 that they will invest where other funders are investing so that they can build on those resources to build strong primary health care systems. I think that's an important one. I agree with the commission when you talk about building investments for human resources for health on the African continent and that needs to go further than just building capacity of people by thinking and supporting governments to think about and to plan for retention of such human resources. There are two forms of drain where it's internal drain where people will live like the public sector and go to do something different within their own country but also where people live their country could go and work especially in higher income countries that needs to be thought through and systems for developed and for designed with African countries so that the issue of human resources can be addressed in a way that is sustainable and builds strong systems. I think as I come towards at the end it's important to think about what models of primary health care have worked well. Lessons from possibly Brazil and Cuba could be helpful in terms of informing African countries in how they build primary health care services and ensure that they're well integrated and they can continue to try. Thinking about regional institutions and thank you so much EU CDC for mentioning the work you're doing with the Africa CDC, it's important to strengthen regional institutions within the African continent as they really are critical for driving the African response and strengthening African health systems working in partner catalyzing collaboration across countries and really thinking about how do you create systems and policies that will work for multiple countries so that countries can also be able to share resources and can be able to benefit from specialized human capacity for example when it comes to regulation of medical products that is essential to continue to do. A last point or two last point is to think about building Africa's manufacturing capacity. The fact that Africa stood at the back of the line is a key highlight that Africa's manufacturing capacity needs to be accelerated, supported and driven so that it can provide feed for purpose technologies for African communities and African people when it comes to improving health and well-being. And finally is to support African countries build stronger data systems that really show the reality on the ground and those data systems to be sufficiently linked such that when they can even help share information across regions. If you look at the East African situation, Tanzania did not respond to COVID like all other countries and there we are as neighbors whether you're looking at Malawi when you're looking at Uganda, Kenya, Rwanda all these are their neighbors and the impact of such different ways of responding do highlight the fact that it's essential to have strong data systems that help countries even to convince their neighbors that we need to be working together in terms of moving forward in response to health emergencies but also in strengthening our systems. And I think I'll wrap it around by saying civil society remains a critical player. I am a member of the civil society engagement mechanism for the civil society did an incredible job during the pandemic of building trust with communities of engaging and communicating with communities and encouraging governments to really step down the information that was complex so that communities could understand and to be able to take up the messaging that was needed but also provided feedback upwards to government to say this is where communities are at and this is where you should be going. So really calling for engaging communities as partners in the global response to strengthening health systems to pandemic and to investment thank you very much. Thank you very very much miss Ringo and your call to civil society is extremely important and well heard thank you very much. Next we'll hear our final presentation is from Mr. Martin Taylor the director of health systems and services for the WHO western pacific region. Mr. Taylor leads the division's work on health financing health workforce essential medicines and technologies and he brings over 20 years of experience supporting countries to strengthen health systems. Thank you Mr. Taylor for sharing your insights into the health systems strengthening efforts of the western pacific region of the WHO. Thank you very much and thank you very much for inviting me good morning good afternoon good evening colleagues and first of all a huge thank you to the sustainable development solutions network for organizing this webinar it's actually for me preparing for this has been fantastic in terms of casting my mind back and thinking about so much that's happened in the last few years and I'd say that I think the Lancet commission is fantastic for that both in terms of summarizing very concisely a lot of what we did around the world but also stimulating extra extra thoughts. In terms of what I'm going to say today for our western pacific region first of all a quick reminder this is a hugely diverse region we have countries like China we have some of the smallest pacific islands in the world with populations of thousands and in between that we have a lot of low middle income countries for example Cambodia Laos and we have high income countries Australia Korea South Korea Japan so so what I say does not refer to all of those countries but some of the points that we pick are from a number of those countries that we've seen across our region our response was broadly guided by the Asia pacific strategy for emerging diseases and public health emergencies and we're in the third iteration of this strategy so member states have been using this for many years now to prepare and of course it has a lot of the basic principles in there about equity about doing what we can with no regrets to avoid preventable mortality morbidity and of course so that's guided a lot of what we've seen across the region. In terms of what I'm going to share now I've grouped my reflections under five broad categories and what I did when thinking back was looked at some of the actions we saw that strengthen systems hopefully systems that would be of benefiting the longer term for achieving universal health coverage so not just for the immediate short term for the emergency but that could have lasting impact as a pointer for some of the things that went well but also some of the areas where I feel that we missed opportunities and where there's a huge amount still to do so five broad categories first of all this one is a really basic level one but I think it's important to say a number of countries in our region went into this pandemic without some of the basic equipment that they needed oxygen supplies PCR testing, laboratory capacity and if you're a pacific island country with one intensive care unit and you don't have the capacity or the oxygen supplies there you only need one case for your ICU to become overwhelmed and you have a problem preventing mortality so I think that's an important point to note is that there's quite a lot of basic equipment that has been supplied to countries that is not just relevant for COVID but for their longer term health care delivery and of course for future outbreaks. Secondly moving up slightly in the scale facilities and operational preparedness and management. One of the things that we noticed across our region was the process that countries went through at the very practical delivery level of preparing their health care pathways with the referrals so that the right people could be treated at the right place at the right time vitally important when intensive care unit space is limited to make sure that we can prevent avoidable mortality and in this area we worked on what we were calling the red line working with countries to try to identify when they were approaching the red line of their health care systems being overwhelmed and what they could do to try to optimize the health care system. Interesting in this was of course it puts a huge focus on referral systems and this is something that we hope is going to have a longer term benefit in terms of referral systems between primary care and between specialist secondary and tertiary care in the future but it also requires some quite careful thought in terms of not just the referral up the chain to the specialist care and the ICUs but back out of that as well and what we noticed actually was that a number of countries in our region especially when Omicron hit some people were staying too long in those intensive care units and we weren't making the best use of that whilst other people were dying in corridors and at home not being admitted. So there were some certain benefits I think that we saw in some systems proper systems work in strengthening how those systems would work and the referrals to try to maximize the efficiency of the health care system alongside that of course is work around infection prevention control operational planning at a sub-national level in terms of identifying your priority facilities the use of digital tools and of course the planning for the ongoing delivery of other essential health services all vital and very sub-national a lot of it. Next I turn to some of the kind of behind-the-scenes systems work that was essential to make some of this frontline service delivery effective. Firstly I think some of our unsung heroes in our region those who work on the national regulatory authorities to make sure that new vaccines were available licensed regulated and available in the country as soon as they could possibly be and this is a huge challenge when you have stretch regulators without the capacity and the capability in their countries especially the case in many of our pacific island countries a huge amount of work was done and there was a lot of solidarity between regulators in the region sharing the dossiers sharing their information to be able to make sure that those vaccines could be available quickly and another another set of our unsung heroes the legislators who had to work to update public health emergency legislation the kind of legislation that outlines under what circumstances people can be asked to stay at home and who has the power authority to do that what triggers that and how long that can be done for many countries in our region went into this pandemic with legislation from the 1940s from the 1950s some even from the 1920s in a digital era with what we know now there's a huge task there so some have already gone through that process of updating their legislation and many are still on that journey but we've learned a lot from COVID to help guide us for the future on that and then I think another area where we saw some mixed progress in terms of systems is this linking of the public health side with the health curative care site and we really noticed that as a huge challenge early on when your contact tracing in the early stage of a wave to try to minimize and suppress as much as possible it's absolutely vital to get those connections to build the contact tracing capability the surveillance laboratory and link that with the curative care in many countries I think we were a bit slow on that and it took us some time and then lastly I think I'd say obviously we can't say anything in terms of the background systems without financing this posed a huge challenge for many countries for a couple of reasons first of all in our region financial protection is still a major challenge many countries I think we're one of the worst if not the worst of all of the WHO regions for catastrophic health expenditure we have many countries large where large populations still pay out of pocket this clearly is a disincentive for people who are sick or symptomatic presenting to healthcare systems when they know that they're going to have to pay out of pocket and also because of the other consequences that this could could entail in terms of lost income quarantine etc. So that also put huge budgetary challenges and many countries in our region actually were quite innovative in how they could access budget streamline public financial management to make services available to the population at no cost and I think there are some lessons there that I hope we don't miss when we go forward in the challenges of financial protection and universal health coverage. Moving next from the some of those kind of background systems the next area I think we should turn to is community engagement and risk communication and I notice I think a number of the other speakers have already spoken quite a lot about this. This was absolutely vital and something that many countries in our region innovated with and tried to build up but I think it was an area that we were particularly ill-prepared for and this of course was vital when we're talking about those vulnerable populations. Those who are most at risk often those who were most early affected with huge consequences. We've seen and I hope we can sustain this but we've seen in some countries that the investments that were put in around community engagement during COVID in particular around mobilizing populations for vaccination. We're hoping that this can actually have a lasting benefit in terms of the engagement between public primary health care and populations for future of health care delivery. One particular example that actually I just was was reading about just a few days ago in Laos PDR some of the work on community engagement to increase COVID vaccination rates which had depending on the parts of Laos PDR increases of 5 to 16 percent we're seeing it's translating now in terms of increasing antenatal care by up to 60 percent so if we can sustain some of those innovations that is a huge benefit especially in those rural areas and areas where people are afraid to or for whatever reason have barriers to access health care. Next after that and the last of the broad areas I want to touch on again an area that's been spoken about by other speakers COVID forced us to work with other parts of government in a way that we hadn't been forced to before in a way that in the public health community we knew we should and we wanted to but often we didn't quite know the language to do it or we couldn't find the time to do it and I think ministries of finance is the first that comes to mind not surprisingly but in many countries in our region where health care is quite decentralized and the responsibilities and the authority and the mandates are quite decentralized working with ministries of internal affairs ministries of decentralizations ministries of local government and also the provincial governments themselves the governors and the vice governors who are in charge of health care and who can link health care with other sectors was really vital and on work that I was doing actually just a couple of weeks ago in Cambodia supporting our Cambodia office it's very clear to see that we still have based on that work with local government around COVID an opportunity to use that for stronger health systems for the future and I don't know how long that window of opportunity will stay open but I think it's incumbent upon us to make the most of it while we can and while local governments still want to listen to us the public health people about how we can work together around common agendas and objectives. Turning now to some of the areas where I feel we probably missed some tricks and where there's challenges for the future. Six in no particular order of priority at the first of all equity and vulnerable populations I think it was revealed so much we've done something we had some successes I think in so in many countries we've managed to make sure that the elderly were first in the queue for vaccination but we know that there are many vulnerable populations which we didn't quite do enough for this time around and when we think about that and the social determinants of health for the future that's a huge challenge for us. Secondly the healthcare workforce. James spoke earlier about the numbers needed in the in in in his region we have a similar challenge in numbers but I think there's more actually for the healthcare workforce that that we're seeing in our region trying to make sure that they can have health workers can have a career that pays a decent living wage that is valued by the community and society that people want to go into and don't get burnt out in is a huge challenge. How we make that shift I'm not quite sure but COVID has revealed to us that we need to do something on that for our healthcare workers and in particular the nurses and the primary healthcare workers. Third I've mentioned a little bit about health financing already financial protection making sure there's enough investment in in health I don't think I need to say anymore that is going to be a huge challenge for us and in our region from WHO perspective we're going to continue to work in particular with the Asian Development Bank we held a number of virtual meetings with health and finance ministers during COVID we're planning a face-to-face one next year we know it's going to be difficult given the global financial situation at the moment but we need to keep our eyes on the long-term goals of the sustainable development goals for financial protection for healthcare. Fourth primary healthcare being mentioned by others and I think an area which is going to require some major investment and thinking particularly as we think about primary healthcare as the foundation for healthcare systems in the future. Fifth and others have mentioned it I think in particular Dr Aman mentioned this data and surveillance forecasting and bringing all of that together so that it is available in a real-time situation for those operational leaders and planners as they are making critical decisions on a daily basis that was something that was really apparent that we had some progress in being able to make real-time data available for planners in some countries but there's much more that we need to do. And then sixth going back to one of the points earlier actually making sure that we have all of those other links between the public health functions and the curative functions I think is an area where at times we were making it up a little bit as we went along we need more thinking on how we can plan in advance for that and the area of contact tracing was one that really was in the early days vital and so in the early days for the future. So I think I mean from that in conclusion for our region what I'd say is there's a lot of positives to learn from there's a lot of positives that we need to make sure we don't slip back on and we try and sustain them for the future but there are still some fundamental challenges there and as we think about trying to get back on track for the sustainable development goals and for universal health coverage in our region when we try to get back on track in terms of building health care systems that are based on the foundations of primary health care can deliver universal health coverage and the public health functions there's a lot to do but there's a lot to build on and certainly across our region I think what we're seeing at the moment is that we still have the energy for that the political windows are changing in different countries but there's still an energy in the public health community which we may need to tap in to to make the most of it in the coming months and years ahead so thank you very much and I'm looking very much forward to the discussion and the questions. Thank you very much Mr. Taylor so I'm going to hand it back to Professor Sacks to start the discussion off. Thanks to all of you and what a great discussion and a lot of wisdom and I hope that all of the students who are going to be viewing this webinar in their classes in the months ahead also will be studying carefully the things that all of you are saying there's a lot of commonality. Questions of finance came up everywhere this is clear even in rich countries the questions in some rich countries like my own the United States the questions of health coverage are pertinent but in poor countries even in middle income countries absolutely central is our catastrophic health costs covered our basic primary health costs covered is there a primary health system in a low income setting that can actually function or is the under financing so serious the question of human resources is essential and thank you for the observations of that many of you made about the quality of work decent compensation and as Pauline said compensation period because why is it that the community health workers in Africa who do heroic work and I've watched the in-person face-to-face why is this a voluntary sector of course it's it's heroic that it is but this is a skilled workforce that's absolutely essential and needs to be on a proper payroll and the basic answer is governments don't have the budgets for it and traditionally have relied on this kind of volunteerism but that's why we're calling for a global health fund with an explicit window to fund this crucial part of the workforce and others in the primary health sector so finance essential all of you spoke about the challenges of cross sector work because I think health ministers and finance ministers probably talk to each other more in the last couple of years than probably in the 20 years before that although health finance is always central to a budget it was absolutely urgent at at this point I'd like to ask you all of you to reflect on two questions one to what extent was there real regional cooperation it seems to me in the Asia Pacific from what I could see the fact that there was an Asia Pacific strategy actually in its third variant because of SARS probably being so vivid in memory as well as other pandemics that came afterwards or not pandemics but epidemics that came NEPA and mirrors and H1N1 and others the Asia Pacific at least seems to have had a real true regional strategy but of course when the pandemic hit it seemed to me that it was assumed by political leaders everywhere that this was a national issue this was not a regional issue so the question was was anybody listening at a regional level because the politicians who are not expert in this but suddenly were in the in the front line seemed to go in their varied directions based on their hunches their beliefs their whatever or what they were being advised but not necessarily regionally so I'd like just a reflection in in the Africa case Europe PAHO and and of course in the Asia Pacific to what extent was their regional strategy and to what extent did it matter in fact and the other thing that I'd like to ask a reflection on is this question of public communication in most cases I think the politic the politicians had the lead in communication what they knew or didn't know about public health really varied we saw a lot of strange cases a lot of politicians that fed so much misinformation or so much confusion what do we do about this and how do we build the communications trust because really it's one of the lessons of this I am a fan I've long been a believer in this I think you wear face masks when you have an ongoing pandemic but even that became a absolutely most contested battleground of this pandemic partly because of the communications issues people didn't understand it in the U.S. we were first told don't wear them that do wear them it was it really was a confusion and I just like your reflection on how to build the trust really on an operational basis and how to in a crisis how are we going to do better in in that communications challenge so I know there are a lot of other questions in in in the queue but those are the ones that I would like to start with again remembering that we're going to have lots of students and policymakers and others viewing this for months to come what can we learn about regional cooperation when viruses cross borders when workers cross borders daily as as Andrea mentioned so wisely what do we do about this regional cooperation issue and and then second what do we do about the trust in communications and I think anyone could jump in and start and then I'd love the reflections of each of you maybe maybe Andrea you would start yeah these are really very very crucial questions now to the regional cooperation at the beginning there wasn't any uh countries sort of withdrew to to to themselves they they they stopped even the export of critical goods like like PPE and so forth but they quickly realized that they are that we're in the interdependent and I think for for our region the the best example of cooperation was really the joint procurement of the vaccines because we have the size of our countries goes from 80 something million to below one million and these small countries would never ever have a chance to get anything so that was certainly something where also the bigger countries that could have of course negotiated any any uh contracts for vaccines they waited until the the consensus building among 27 countries was done and the contracts were were declared so that we could start all in the whole region uh at the same time there was other parts of the cooperation that were working very well and that was the exchange of patients or the the transfer of patients when the the services in one country were overwhelmed there were there was very quickly a mechanism how to to offer beds in other countries and how to transfer the patients so that worked also very well um they did the border issue with the with the the closures that took a bit longer and I'm not sure it it really worked but countries had some agreement and understanding how this how this would go so I think there was a process of being focused on oneself to the recognition we have to work together now there are certainly improvements to be done and now there are several several reviews looking into how this response was and how it can be further improved regarding the the the communication I think um in principle the situation highlighted what theory already knew that in situations where there is big uncertainty it's very difficult to communicate and that is true for the politicians but also true for our scientists because I found that also my experts were very reluctant to communicate if they didn't have any evidence and I said yeah well but we have to to give the politicians something because we'll make any some decisions so we have to give them something and here I think uh it's it's what I uh the second part is the understandability uh of our messages and also the political messages so that that it fits into the context of people and here I think we can learn what I meant before with the community engagement so that we engage with those community authorities and leaders to help us to translate our messages in in in ways that the community understands and that is then also in my view a way how to build the trust if you can explain what is happening that the scientific evidence is changing but in in ways and in that that is understandable and not just in technical jargon then I think there is a trust and there were examples that some countries even their prime ministers did this very well where the adherence of the public to measures what that was then much better over oops sorry I'm on mute the the endless mistake um thank you very much maybe Pauline you could reflect on the africa cdc and and what kind of cooperation you found and and should be promoted thank you so much and thank thank you dr amon for highlighting uh those points really critical in terms of cooperation I think regional cooperation that played out uh as a good example in Africa was through the african cdc I think really covid 19 gave an opportunity to the africa cdc to really stand up and execute its mandate and become a leader in terms of not just pandemic response but driving the overall dispute response and public health in Africa so just uh two quick examples from the africa cdc the establishment of the africa vaccine acquisition task team was really critical in bringing together african countries to think about and plan for how to access vaccines together as a regional you know as a as a region and that has helped countries access vaccine in ways that would not have been possible if they were not negotiating as individual countries um the the second and not and not just getting access to vaccines but also thinking about when countries have access or vaccines are just about to expire what what do you do how do you really turn channel them so that's that's really been a a major outcome and a good outcome out of uh this this whole covid pandemic there's the second piece for to the africa cdc is the cdc hosted regular dialogues to think about critical topics and to engage players from across the african continent particularly from governments and and lead agencies to to discuss share lessons explore what could be done and what isn't working what has worked well and and those lessons have been important in terms of moving the response to the pandemic forward the third piece is the african citizens now established a conference on public health in africa that enables africans to come together also bring in international partners to discuss public health issues in africa in a very targeted and structured way that conference there is the first physical one will take place in ronda coming week so i hope a lot of us will find ourselves there and i think it's a really important space for for the african continent to ask itself what do we do about our public health concerns because the continent has a history of being you know plagued by various diseases various epidemics um on now rising concern of non-communicable diseases how do we address all us africans and have a response that works for the citizens africa i think link to that is also the issue of what accelerating work for regulatory system strengthening for medical product in africa it's been an initiative that's been running for years and it's been a slow process but i think covid-19 provided an impetus for people to really focus and say africa does need to strengthen its regulatory systems we cannot do it as individual countries to as much as we would love to but it makes sense for us to work together as institutions so a lot of countries have now come in and sign on what they call the africa medicine agency it's at a level where it is is good to go and the location for for hosting is already implicitly posted by rwanda the government of rwanda and those are outcomes that has come that has stemmed out of cooperation on the continent and finally for the for cooperation is uh the dialogue and steps towards building african manufacturing capacity and i think uh dr armond the ucdc is working very closely with with with africa cdc to build manufacturing to build systems that enable africa to to do manufacturing i think i i i i i i i i i i i i i think that you know come it came with a lot of challenges but there are some good things that happened out of this when pps were really difficult to access from uh from importation african companies stood up and started manufacturing mass so now you see big good quality mass that are coming out of african uh industry and similarly uh you know products like syringes that have supported uh african countries to be able to deliver vaccine so all these are coming out of the need to take care of our people but recognizing that there are certain hindrances that have been in place and this is an opportunity for manufacturing in africa to to really move forward and maybe just a quick comment on building public trust in communications i think i'll i'll pull an example from kenya and and many other countries like uganda public communications was was not just driven by a political leader but i think in kenya the the political leaders stepped back and allowed technical leaders within the ministries of health to communicate consistently to community so two things technical leaders with the right knowledge and information communicating communities and then the consistency of communication many times in i think in previous years we've had like start stop but i think that start stop creates opportunity for filling the gap when there is the stop the consistency with covid was amazing of course there were some messages that you know were counterproductive but largely people took the messages seriously and misunderstood government there's there's much more trust in government messages in public health now that i think than we've had in the past there was also a lot of innovation around uh public communication some old methods where people would go around the the rural areas especially the estates with drama phones and you know talk to people it's important for you to take one two three steps wear your mask wash your hands you know do this and that to prevent covid but also when you came to to vaccine there's been a lot of public communications using the regular methods that you know somehow had gotten discarded that that would say there'll be a vaccination center in point x i think my first vaccine that i took if i had that message on on somebody who went around estates and said we'll set up a center at x point so now you don't have to go to the main facility you can come to this center and people queued up in those centers to to get their vaccination and i think also leveraging technology one thing we we did as an organization allow me to speak about this was to set up um the the the director general of health in kenya came to us and said i need the communications person and communication support i need to communicate better communication communities and use technologies and we set up what we called hashtag ask the dg and this was a twitter handle that enabled the dg to dedicate one hour every week to answering questions from from people generally so people would post where can i get my my covid test what do i need to do do must work do vaccines um from what are the side effects all these critical questions and the dg was very consistent working with a technical team behind him in responding to these questions on on on a weekly basis he built a lot of traffic and a lot of trust that is accessible he can respond to technical questions even if they're coming from anybody in the country and combine that with with facebook messaging that then would provide additional information then of course must meet with multiple channels but technical people providing that right information and under the support of partners and once it was covid messaging were going out we also built in components of essential health services so that people could could be able to say where can i go for antinatal care facilities are largely closed where should i go and that was was being answered so these are some ways that are really important for communicating and building public trust so i think let me pull down thank you very much crystal clear thank you very very much extremely helpful lots lots of powerful lessons there uh martin may you come in now and then james thank you um yeah two two two excellent questions so three three reflections in terms of regional cooperation um the first uh i mean you you spoke quite generously about cooperation in our region but um we noted of course when it came to establishing travel restrictions and even port and export restrictions related to that countries went it alone um so at that kind of political level those decisions were made made quickly and in isolation what we did see though was um i think a lot of regional cooperation at the clinical and the scientific and the technical level um between experts in their fields um and that was certainly the case very early on as um scientists were sharing as we were learning more about the virus and the how it presented and how the disease presented and progressed in in population so there was a lot of that early on um and it and it and it continued um i mentioned also earlier the kind of the regulatory authority um solidarity across our region particularly in the small island states in the pacific um the third area i'd note of course was and maybe we call this subregional even um countries some of the larger countries in the region um supporting the pacific island countries who were very isolated had little purchase in power um so whether we're talking about essential medicine sorry emergency medical teams go into those countries um provision of PPE sharing of vaccines so there was that kind of subregional bilateral or to a number of countries across the region um cooperation that was extremely important for those pacific island countries extremely important in their response um on uh public communication i think i mean i agree a lot with what's been said by dr mon and pauline already so i i won't repeat that i mean two points to to highlight um one when we're thinking about communication and it's vitally important to do the listening to do the listening at what's being said on shared on social media um in in other platforms to understand where your populations are to help segment and think about the different audiences and we certainly expanded within wh o but i think a number of countries in our region did our listening capability throughout the course of the um the pandemic in particular when we're dealing for example with vaccine hesitancy to be able to distinguish the different categories of vaccine hesitance because they're not all the same um and something can be done on that and then the second point um uh who who has influence pauline touched i think on the vital importance of civil society in that in that regard but who do populations listen to and then build in alliances with who the populations listen to who do the population trust um was vitally important thank you back over to excellent thank you so much and uh to james for the americas yeah thanks thanks very much professor sex and just to really complement what what the others have said i think you know the issue of cooperation um solidarity um it's a mixed bag um i think in the americas um you know we have we've seen some good experiences um through countries coming together once a month ministers of health convening once a month through paul to discuss the current context get updates uh weekly briefings um sharing of of surveillance data uh these are all i think very good experiences another good experience i think that we saw was how um the external relations um uh sectors within within the country is really mobilized and worked collectively in some areas taking this issue of particularly access to ppe's diagnostics and vaccines to a whole other level this was all led not by ministries of health but in particular by the departments of foreign affairs or their equivalents in countries um this raised to a whole other discussion uh whole other level of discussion within obviously the un system with who and and bilaterally amongst country so i think that that in itself was a good experience um i think the the somewhat um negative aspects really relates to the fact that everybody is you know it was a zero sum game at the at the beginning everybody is scurrying for the same uh products of limited availability the closure of um the closure of borders um the i i was you know we have been somewhat um um i think positively critical if i can put it that way of the mechanisms that have been established uh through the consortiums at the global level uh to ensure the supply of of equipment and diagnostics um the considerations around equity in the decision making of some of those mechanisms and how many countries in the americas really felt that they were left behind not just in the allocation frameworks but also subsequently in in decisions uh relating to the distribution of vaccines through covex um as a consequence of i think unilateral decisions that were taken also by the pharmaceutical industry um we refer here to i think decisions were um perhaps uh bilateral uh bilateral agreements were favored as opposed to commitments to covex which ultimately meant that those that really needed vaccines didn't get them so this is a real concern i think for for countries in the region and we're very aware we're working with them because as you know we have the the true revolving fund mechanisms that paho um the vaccine revolving funds that supplies over a billion dollars of vaccines for priority programs to to um to our countries and then the strategic fund for medicines and and both were very active and really cruel one other area i think um a very good cooperation related to um the educational and digital digital educational um sharing of information and the platforms that were utilized um we saw an exponential growth in demand for our state of the art knowledge um clinical guidance um patient management through digital platforms and we ourselves at the paho virtual campus um with now over two million health workers participating actively in in um in courses within the platform and we delivered through you know during the pandemic uh to over one million health workers 26 different courses on cofit 19 um and so this was really a success story that we believe that can be replicated also in other regions and it's a very good and positive um i think initiative to to converge uh technical guidance around care and treatment of management with the context of health emergencies while reaching directly into health services and i think this is something to look at finally on the um on the trust issue one of the biggest concerns i think we have relates to um and i think this is globally we've seen the unicef report relates to immunization and not just in cofit 19 but how the cofit 19 situation has exacerbated them also a continuing lack of trust in vaccines and debilitating immunization programs so we are this is going to be a priority for for the incoming director of paho we know that dr jarvis bravosa um and and how we approach that it will have to be multi multi-faceted from from the primary healthcare approach um but looking also at certain aspects of of behavioral science um the impact of social media and then just basic public health uh really retaking the issue of core public health functions and education of health workers what are the real areas concerned we saw in the caribbean was whereby um we noted a complete lack of trust in cofit 19 vaccines amongst uh nurses in particular and so how can we deliver cofit 19 vaccines if we can't even get our health workers to trust in them um so these are some of the issues i think that we we have to address uh moving forward thanks very much excellent everybody thank you we're coming to the close of the session but julie i think probably has uh one or two questions for one or two of you and then i'll wrap up for everybody but i think we've we've heard a lot of very important wisdom for our agenda for 2023 so i'll conclude on that note but julie over to you excellent so i just want to ask one quick two-part question about health workers um so from the audience we received a question asking about um why high income countries have not been able to train enough health workers for their needs and then end up actually sort of poaching um poor country health workers um who come to the higher income countries for many different reasons and the second part of that is understanding that the issue of human resources resources for health is also about training and education so what are the efforts that multilateral and regional organizations are taking to help fund and strengthen health workforce education especially in low and low and middle income countries so anybody can take that up sure dr amon yeah maybe i i start um now the the matter is not that we don't train enough uh in uh of our our uh people for for for these services the the problem is that they don't stay um and that is the the um the reasons are of course manifold but uh uh miss taylor has has has mentioned them they see uh that um uh health care workers especially nurses especially in long-term care facilities um but even more in public health because public health in the healthcare sector is really the lowest part um uh they they don't have a career they often they cannot uh even do a living uh make a living uh in some countries and and then the training alone uh so we um we have i mean we are focusing only on public health of course but we have a training program where we train people uh from countries where they either never go back or when they go back they go in the private sector um where they got to get a lot more money so in the end the training uh that didn't help so here i think it's really something beyond what we as a public health institution can do it's the salary structure and the revision of the whole whole system of where these um professions are placed that that will help and of course the attractiveness of of of positions in the high income countries will only increase if we if we do um we increase the salaries and the the um that make them more attractive for for health care workers in in low and middle income countries so i think this has to be um uh uh equally done with a strengthening of the health workforce in in the countries now for the um our work program with the africa is also uh the the public public health workforce training in africa where there are many efforts uh that are now africa cdc tries now to bring together so that first of all it can be more coordinated and and maybe then also it is better visible where specific efforts will be needed in the future excellent thank you um perhaps for just one final question um we'd like to ask about data so many of the speakers today have talked about the importance of accurate real-time data and modeling on infections disease burden and deaths during the covid pandemic um what are the strategies that we can employ to collect the important data on these metrics and make sure that it is used to inform policy and public health interventions um anybody would like to speak to that please mr taylor thank you um del i'll say a quick word on that um and then if i may also a quick word on the previous question um so one of the one of the things that we noticed um during during the the covid pandemic is is that we at times i apologize i'm in a hotel room and they're ringing i don't know why um was um we were at times awash with data too much data but the question was which data do we need for the critical decisions that needed to be taken at the time and i think that is a kind of a vital part of this in terms of understanding what your policy decisions are which data they depend upon and then do we have those data sources um and one of the gaps that we noticed in a number of countries in our region um was the the data around um hospital utilization getting real-time data on hospital utilization and in particular breaking that down into icu was vital um so i think there's a a number of of aspects to this but the the important part is what's the policy or operational decision you're taking and what data do you need to help you inform you on that um if i may quickly on the health workforce question um this is this is an incredibly complex one and i think it's one where we're going to need uh a lot of thinking and discussion in the coming years because this has been an issue that's been around for many decades it's not new um and i'm in a region where the philippines um positively encourages the export of nurses around the world um and has been waiting desperately for borders to reopen or was waiting desperately for borders to reopen to be able to continue that and then we've got pacific island countries now raising a very loud voice in the last few months because of their loss of health care workers so um and i don't really have a direct direct answer to your question but it's it's very complex i think it also is possibly linked um with the fact that preparing the health work for the health workforce is a long-term endeavour you're you're not preparing for next year you're preparing for eight ten fifteen years ahead um and that's not very consistent with the political cycles of many governments in the high-income countries over please dr yeah i don't want to monopolize this but i think for the data um i i agree you need to have objectives that you need data for and that the data uh uh fulfill but i want to go on the real time i mean real time i don't i think it's important to define what is meant by this because even if we catch the data as soon as they enter the system via laboratory diagnosis or medical diagnosis it's not real time because there is a certain period has elapsed since the infection has occurred and that depends on the incubation period and health care seeking behaviour and what and other aspects so real time is not giving us a real picture on when the infection occurs it's always a bit retrospective we should keep this in mind that we don't create expectations that that we cannot meet of course if you catch it immediately when there is a lab diagnosis by electronic health records or whatever then you shorten the reporting delay that that is the the gain that you can can can get but certain labs will always be there let me close our our session by thanking all of you for your leadership and for your clarity in in this webinar we will be using this what posting it of course and a summary of the session and also using it extensively in education programs around the world in the 1,700 member institutions of the UN Sustainable Development Solutions Network will also be strongly engaged and I I hope and expect together with all of you in 2023 on furthering this agenda there's no doubt that we're going to be debating these issues especially health finance but also I think all of you emphasize the career paths of health workers the the training the new ways of training the possibility of using online training which I think is extremely important obviously because of the reach and what Pahu has done I I hope can be generalized worldwide and SDSN would like to help carry that forward but also the proper compensation and basic funding of of the health workforce as an absolutely vital component of of the national health systems well I know that this is going to be central at the World Health Assembly it's going to be central on the continuing discussions of the G20 on SDG financing the preparedness funding is still being mobilized but I I hope will be mobilized in a much broader context than it has been discussed so far rather than a standalone fund as part of this bigger picture and all that you've added in insights to this I think will will very much support that cause so let me give thanks to all of you thanks to the participants and thanks to all the students who are going to be learning from this in in the months ahead my gratitude to the team at the UN Sustainable Development Solutions Network for facilitating this webinar and let me wish everybody a good day and very happy holidays and a very happy and healthy 2023 thank you so much thank you thank you bye bye