 I expect now some reaction of the participants. Do you have questions on this first question that is who is in the driver's seat when it comes to health care? Maybe I may comment on two points that Alexandra made. One of them is the fact that I'm a great believer of course of therapeutic innovation and not been pushing it all my life. Basically it's not the only determinant of health and for instance if you look at the stomach cancer the fridge was the best was the solution which brought an end to stomach cancer and it was not the the pharma industry but still a great tribute to the pharma industry indeed. Now Alexandra mentioned for instance antibiotics as having solve issues. If you look at research today very very little research is done on antibiotics for just kind I would say economic reasons because if you are a pharma company with that of obligations to shareholders to return nice profits you will never go into that field because you know that antibiotics will not be priced at a high level they are usually used for one week so that's not a business and so at the same time where we say there may be very dangerous pathologies you know I mean the next epidemics will maybe not be a viral one but bacterial because there will be a resisting bacteria and we will be caught because nobody has pushed for research in the antibiotics field. Coming to the cost of human life Alexandra is right in saying that there is a price but it's not the same for everybody and if you look at for instance the British decided that they would not reimburse drugs if they cost more than 20 to 30 000 pounds per quality adjusted life here. Now once they've decided this all the enzyme replacement therapies come which cost much much more and the Brits had to create a special envelope which means that you price the life for instance of a kid with an enzyme deficit much higher than the price of somebody else so that's really one of the issues that society is facing and this debate has not been brought to the public I mean it's a debate which remains within the hands of a few specialists who debate on what should we reimburse but the public is never called to say what they want what they want maybe because the public wants everything. Yeah as we see it in other areas but building on this and before we move to the next thing I would say both you Jacques and Alexandra you said in fact there is no order giver so it's a kind of self-organized industry I caricature a little bit that is very dependent from one country to the other maybe it's very good because the sensibility to healthcare are very different based on your culture for sure so but we understand the waste we understand that's what you stated we understand that we need to do it everybody knows it's one of the biggest policy issues for every government. You called Jacques for establishing the matrix Alex, you were more on okay let's categorize the type of innovation and focus on the industry agenda but how we start we know it it's a very complex challenge where do you suggest we should start. Well that's quite a complicated question starting to organize a world that has never been. The panelists as well if they want to contribute but yeah go ahead Alexandra. Well I think I would agree with Jacques view on that there is no point in trying to organize when you don't know what you're trying to organize and today today we don't know we only know that it is the law of the market so more or less in the end regulates the whole industry and that's exactly what happens for antibiotics so yeah perhaps I would say organizing giving some metrics so that we have something like a clear understanding of what it's going on and I would add to that also perhaps having a clear view of what we can do. Yeah what's interesting is if you look OECD just published a very interesting report the head at the glance where they provide indicators of performance of various healthcare systems on a number of indicators and it's extremely strange to see that performances are extremely different from one country to the other and that and so countries have set some kind of priorities but it's unclear whether this was I would say an explicit decision or whether it's just because there was a kind of a drift of the whole system in that direction and my point is that basically we need to develop research I said in epidemiology and health economics but also education and probably educate the public the preceding panel talked a lot about this information and I think that's a field where people really don't understand the basics of the economy they don't know how many drugs are in development they don't know what the budget which budget is allocated they don't realize that resources are scarce and we would need more public debate but I would say at the world level WHO does a great job of collecting data and fostering specific specific plans but I mean like Sandra mentioned Malaya and and that's that's a really good question how comes that with all I mean maybe more money is needed for you know but Malaya kills more people than than COVID so why is it that there hasn't been a big effort on Malaya except the Billion Million Gates Foundation and and with the limited outcome that Alexander mentioned so where should this debate take place well first of all in countries at parliamentary level probably and then this would need an education of politicians and and then probably a multilateral discussion you know there was a big progress I mean what we see with vaccines is that the COVID vaccine will come all over the world and that's the basic the outcome of a work which was done 20 to 30 years ago I was very young at that time which was called ICH's international conferences on on harmonization where all administrations work together and together with industry to be trained what will be expected to register a new drug this is like today you can register a new drug all over the world at the same time and and we need more consultation like that on on what are the big issues in terms of health also at international level and that's why I think the initially but of Thierry is so important and why we need to push it through the next world policy conference okay so yep thank you I see one comment from Stanislaus on the the cost of life and I think it's that leads to the the next debate I think if I would retain and I don't intend to summarize to be clear but to retain one idea I think what I hear is that you say basically we lack transparency as well in the way this market is operating the fact that there is not clear order giver is of course the initial sin but the lack of transparency and possibly as Alexandra alluded to some topics and we've seen it probably during the last covid crisis that are difficult to expose in today's society where they are not welcome as part of the conversation as they might have been before but to be the point on the cost of life and the necessary sometimes to make choices and they happen or tend to happen more randomly