 Why don't we get started. Thanks everybody for being here. We have a great, great panel. My name is Jim Kim. I'm the President of the World Bank Group, also an infectious disease physician and I have worked in this area for a long time. Let me just say I think that the attention to this issue and the discussions that are happening I think are complicated and difficult. We had a terrible scare with Ebola, but as I was just talking with Bill Gates, it was a slow moving epidemic and the scale that we need to get to to be able to have an impact and deflect rapidly moving epidemics is still in the future. But I take great comfort in the level and the intensity, the commitment around the discussions that we're having. And it's one of the questions, it's really the only question that we're going to tackle today. We know that the economic modeling suggests that if there's a 1918 style flu pandemic, 30 plus million people would die. There are estimates of anywhere from 1% to 10% of global GDP loss. That's as much as $7 or $8 trillion. And so I think from an economic perspective this is clearly a downside risk to the global economy. And yet the pieces to stop something like that are clearly not yet in place. So the question is really very, very simple and I'll pose the same one to everybody. What does the world need to do to prepare for the risk of pandemics like Ebola, but epidemics like Ebola, but also the big one and the chances of the big one happening, we're told by virologists and others is really very, very high. So I'll start with President Konde. I would ask everybody to start off with just two to three minutes of observations and then please feel free to ask each other questions and also we'll take some questions from the audience as well. Thank you very much, Chairman. I think that the world will probably be faced with another pandemic in the years to come because of urbanization, population movement will probably make the threat even more acute. What are the measures that need to be taken in order to reduce or attenuate the risk? I would say that there are four points. The first is we need to develop vaccines with research centers as well as with public and private sector. Secondly, I believe that we need to implement prevention measures. We need to strengthen the national health systems in the public sector in different countries, particularly working at the grassroots level. We need to involve the local community. Community has to take things on board. Otherwise, you can't face the crisis easily. And we would like to make that Guinea will be a regional center of excellence and we want it to be able to have a center which can fight pandemics. We've also got to make sure that our different countries provide a budget and that we also have partners. And we need to have predictability. Obviously, you need to have a budget. We need to know exactly what we're going to have available to us in order to be able to organize our own budgets. I think that this is a problem that preoccupies us. And that is the amount of time, the lead time, and the measures that need to be taken for a vaccine to be produced on a large scale. We vaccinated for example, seven thirds and persons, but the vaccine has proven to be very positive. However, we've got to be able to ensure that we can produce the vaccines on a larger scale so we can have max vaccination and not just a vaccination of sensitive persons or threatened persons. What can we do to ensure that the vaccines can be perhaps more reliable and that we can fight not just against Ebola and that we can also make sure that the vaccinations are available to the population. Secondly, how can Africa itself become a producer of vaccines because we're the most directly concerned? So those are the general comments I wanted to make, Jim. Margaret. Thank you, Jim. Happy to be back here. Thank you for moderating this session. Since our last meeting last year, also moderated by you, Jim, a lot have happened. The good news is we are almost at the end of zero Ebola and maintain Ebola, but let's be clear. We need to continue the vigilance, and we have learned from Liberia and now Sierra Leone there are flare ups. So what does that tell us? And since Ebola, a number of review has been conducted, and the latest one is from the NAMM, National Academy of Medicine, IOM. It's a wonderful report. I want to thank you, Victor and Peter Sands. I think you put the right emphasis there. The world, first and foremost, is ill-prepared at the national, regional, global level, as well as in the R&D piece. So your recommendation, putting more emphasis to build a national and subnational capacity, because countries would always be the first responder in any crisis. And their community engagement, as President Alfaq Gandhi said it, is most important. And of course, in the event when countries do overwhelm, the regional and the international community must also get their capacity up, get their coordination better, and be able to move to scale with the kind of speed that is appropriate for the size of the program. And the one piece that, of course, we always talk about the importance of R&D, but where's money coming from? Who's going to put the actors together so that the world is better prepared? It is difficult to go to war with an invisible enemy virus, high-impact pathogen, when you don't have an army, when you don't have war chests, as well as you don't have the logistic mechanisms. I'm sure Irvin will talk about that later, as well as a weapon. So we call weapon, vaccine, medicines, diagnostics, and PPE. So I think this is the right conversation, Jim. Thank you for the PEPF collaboration with WTO to talk about how can we better prepare for the next pandemic so that there are less life-loss and people hurt. And most importantly, countries, economy, are not rolled back. And we should not look at this as a health issue. We should look at it as a growth issue, economic issue, and stability issue, as so well put by the IOM report. Thank you. Bill. Well, I think there's some good things that people agree about. Strengthening primary health care systems, you know, that helps every day, and it gives you, particularly for a slow moving epidemic, a kind of early warning system. There's some report card work that our foundation is doing at the World Bank where we'll be able to look globally at primary health care and have a clear sense of how well they're functioning. And I think people will be responsive to that because the returns on those investments are very, very high. Surveillance, we need to do a lot more, particularly in developing countries. Our foundation is funded a 75 million thing called CHAMPS. I think we'll get some other partners in that. And so then you would see sequences of things that are emerging very early on. There's a lot of great technology work in terms of platforms and not just vaccines. For a medium or fast moving epidemic, you'd probably want to use antibodies, not vaccines. Vaccines, there's a latency in terms of their benefit, whereas passive immunization works faster. So the science of different vaccine platforms is, is, and antibody identification and production, that's a very positive thing. Another positive thing that I think is an exciting opportunity is to make explicit the connection between the skill sets that can jump in an epidemic and the people who are helping out with disease eradication. So in the case of the Ebola, there was a lot of polio resource globally that because polio is important, but not as fast moving, not as important as polio was, we were able to take resources and move it over. Yes, we should have moved it over a bit faster. So this time, I think as we're looking at designing these regional malaria eradications, I want, I think we can all be very explicit that if an epidemic shows up anywhere in the world, that's something you can interrupt. And instead of having people who don't have tested skills, because they're like an army that's never fought, these are the people who understand emergency operations centers, messaging, logistics, all the things. And so I think we can get a lot of synergy where if you don't have an epidemic, they just keep going on malaria. If you have it, boom, they're at least a group of people that can help. There's some areas that, you know, I'm, I am still concerned about, you know, the NAM report talked about how to stop a slowing epidemic, but it put the economic cost of a fast moving epidemic as though that, you know, were what you're going to get. So if you had a flu or a non-pathogen that was spread respiratorily that were really not addressing what you would need for that, a lot of which has to do with quarantine and, and messaging. I mean, that's a, that's a huge problem that if we did germ games to really look at those things, we'd have some understanding. The funding for things that don't happen very often, you know, it's not clear who steps up for that. The U.S. has a group called BARDA that looks a bit at bioterrorism and epidemics. That's actually the largest pool of money in the world that looks at R&D and manufacturing capacity for these unexpected events. And, you know, should the U.S. do more? Should other countries go in? How do you get that government-private-sector boundary to work well? A lot of interesting challenges there. You know, and the other thing besides the fast-moving epidemic is the intentional epidemic, the, the bioterrorism and that, you know, would not be anything like in a bowl. It would be like a, it'd be in the flu, flu type category. So there's a lot still be done, but I think there's some areas of consensus that, that we're all going to act on. Thank you. So we were supposed to have a CEO of Merck, but our good friend, the fellow HIV doctor from Johnson & Johnson stepped up. Please, tell us what you think. Yes, Paul Soffles, chief scientist from Johnson & Johnson. What we did, what I think is, is it needs to be a really long-term vision, because you can't do research overnight and get, come up with a ready-to-use vaccine. And we were very lucky in Ebola that thanks to the NIH and the, the anti-terrorism activities research, we got starting working in 2002 on Ebola. Yeah, and maybe NIH started early, but we were involved in 2002. And that took up to 12 years to develop the vaccine, the platforms, the capabilities to produce the upscaling. And that made us, and many others, ready to step in immediately in October 2014, when Margaret and the group organized and the global public held authorities organized a call to industry, can you step in and make a vaccine, because this could go very fast and out of hand. But what it then took is 12 to 18 months of very hard work, upscaling. Today, we generated more than one and a half million vaccines ready to use, stability testing, safety testing, clinical testing. So far, 1,400 volunteers in different clinical studies have gone through it. We have shown safety, immunogenicity, humoral, cellular immunity, tolerability, thanks to many partners. We had, I think, very good risk sharing there with, for us mainly, BARDA, which was brought up as a partner in that, but also IMI in Europe, we got a grant of 100 million euro within six weeks from the European Commission to get going. So altogether, that took like almost four, 500 million dollars to get in 18 months to a vaccine ready to use. And so what is needed in my mind for now, learning from Ebola is that basic research is, and funding is critical, having different sources, research, biological research is not engineering. Biological research takes, as many of us researchers know, a lot of different approaches, a lot of different people, a lot of different brains to think on how to get to the solution. And ultimately, to Darwin, you will get to a solution which then can be applied. So you need broad, long-term research funding in order to solve it. Then you need industrial development capacity. I think nobody else than us, as an industry, can bring to bear hundreds of people who are, like Bill was saying, trained to go to war. And you can organize them 24-7, do development, and really 24-7. It's not people work day and night. And then for that, you need cost and risk sharing mechanisms, because the pathogen like Ebola has no commercial opportunity at all. But as industries, we step in when needed. What's further needed is in the time when there is peace, you have to do your study design work. You have to do your regulatory preparation. And I must say, very much appreciated how the regulator stepped in. But that could all be up front. We shouldn't have done it later. Procurement systems, and especially also liability. We have to have a system where we share the liability of using new vaccines in the world. You can't ask us to develop a vaccine in 18 months and then take all the liability for vaccinating a very large population in the world. So all of that. And what there is, we have to have an accelerated capability and stay to the commitment. It is stay to the commitment because one day we'll have all the viruses threatening the world. You've got, you've looked at this from a different perspective. Completely different perspective. As I sit here, and I, I'm Earthworm Cousin, Executive Director of the World Food Program, and I'm sure that people sitting out there going, what in the world is she doing sitting up there? But the reality of it is, we don't, we don't pretend to be the healthcare specialist. That's not our comparative advantage. Because WP for the past 50 years has moved food to support the most vulnerable people in the most vulnerable and difficult places in the world. It gives us the logistics and a comparative advantage in logistics, warehousing, supply chain management. And at Margaret's request in the Ebola response, what we did was deployed about 1,000 staff, 800 African staff, in fact, to, into the Ebola region over that entire period. We built 30,000 square meters of warehousing facilities to house critical medical supplies and protection. We had, we moved more than 24,000 responders, whether it was by air through the United Nations Humanitarian Air Service, which we operate, or by road, which through our transport, our transportation systems. And you, we have a global network of humanitarian response depots that we also use to support the, the response. So I guess that gives me a bit of credibility for sitting up here to say, what do we do next? What do we do next? When we left here last year, the question became, how do we create a public private partnership that would support the kind of logistics capacity that is necessary to do exactly what Bill was just saying, move the right people, the right tools at the right time to ensure that we can address the challenge of a pandemic. And so over the last year, what has happened is that public private partnership has come together to create what is now called the global supply network for pandemic preparedness and response. The team met this morning, I understand we've gone from five partners to 10 partners just this morning. And J&J was just telling us that they've come on board. We have Henry Shine, UPS, Cardinal Health, Bechton Dixon, the UN system represented by WFP, WHO and UNICEF, the World Bank and the WEF. And this group is working together to create a trusted, accessible, neutral platform for cohesive network, cohesive networking, and sharing supply chain information, cutting lead time, cutting cost, moving all of the the tools that have been described, the vaccines, the other healthcare tools that are required faster to those who need it better. But what's also exciting is that as we talk about the fourth revolution, this is a web based pandemic supply chain platform that has the potential to revolutionize supply chain management in for pandemic responses, as well as for other humanitarian responses, more broadly, we recognize that there's some significant challenges that we need to overcome things like private sector companies sharing their production stock and their scale up capacity. That's an unprecedented endeavor. But the private sector has come to the table and said they want to address those challenges to make their tools available to make their services available. So we need to create the models for data management and institutional safeguards to protect their proprietary information. But that shouldn't stop us. So the next steps is creating an institutional framework and a governance structure. Margaret and I are knitted up as we always are, but even more so on this one. She's leading, we're following what we believe our responsibility is to do is to ensure that as the answers are being developed, that we have the ability to deliver those answers where they're needed. So can I just, and anyone can respond, but as I said, things are happening. But listening to Bill and Paul, we still got a long way to go in terms of a system capable of stopping the fast moving, the quick ones. And the things you mentioned, Paul, cost sharing, risk sharing, that's not happened to any great extent yet. So I'm wondering, we've been able to maintain attention and political will, Margaret, you tell me if I'm wrong, compared to 2011 for a longer period of time. But I have to tell you, I'm still worried that we'll go back to the same pattern, which is panic, complete panic. Why haven't we done more to neglect, panic to neglect. So we're actually at the neglect phase. But there's still more people today paying attention to it. What do we need to do? Margaret, I'll start with you, but I really absolutely spot on countries of the world, leaders of the world are very good. When they see, you know, stories on the TV set, and then they get panic, they put in funds. When we control the disease, they say that things are okay. But this is not the first time Member States or leaders in the world ignore recommendations. You know, in 2003, the signals from SARS, 2009 and 10, IOM did a wonderful report. All the recommendations that are coming out from all the review now are actually very similar to what was recommended in 2010. So ladies and gentlemen, leaders of the world, this time we cannot miss the signal. Now, we are doing three things in the Big Show. We are learning the lessons from Ebola. First and foremost, we will support countries, particularly those countries that does not have the preparedness capacity, the primary healthcare that Bill talked about, so that they are they have the capability to prevent, detect and response. The second thing we are doing is we are transforming the organization so that we can be, you know, the coordinating organization, operational Big Show. Some countries call us, you need to move towards not just normative Big Show, but operation Big Show. So Bruce L. Way is helping me to revamp the whole program to do that. The last point I want to make is, you know, another area where the R&D, Future Development, my Dr. Paul, you know, Mary Paul Keeney is working with Welcome Trust, NIH and many other colleagues who have made major contribution to the Ebola vaccine, but we need to further the work in this area. Of course, you know, Norway and others, I want to thank the generous support from all these countries, but to you, President Alpha Conde, to enable us to do the clinical trial in your country. So now we are on the verge of having an effective vaccine, but Jim, you are absolutely correct. When things are getting well, people walk away. We should not allow that to happen again. So let me put it to Bill and Paul. So a friend of mine who is the CEO of a major pharmaceutical company said to me, look, Jim, we can solve this problem for you. Just promise that you'll give us two-year extension on the drug of our choice on the patent and we'll solve the problem for you. To which I said, or not, right? And that's a particular payment model. You're asking the developed countries to pay a premium for two more years and then you'll solve the problem. So I've just heard this discussion for so long. Bill has done more than any human on earth to try to solve this problem. But how do we get there? Is there a path there? Well, one thing, if you're serious about something, then you do simulations of tough things. And issues come up then about messaging, quarantine, manufacturing capacity, indemnity, you'd get a pretty long list that would come out of that. There was a smallpox simulation done in the United States and the list of things that needed to be done to deal with it was pretty long and not much follow-up took place. So I don't know. I don't think it's likely that we'll have some dramatic response. Budgets are very tight and you'd need real leadership where you're taking a very tough scenario and getting people to set aside resources for it. So some good things are coming out of this. The primary health care stuff is good. I think that'll happen. The surveillance stuff is good. These new platforms will come along. But no, it's not a sufficient set of things to say that the world is serious about dealing with a fast moving epidemic, which unfortunately would probably be an unknown path. So Paul, I want you to know I've said many, many times I've worked with research based pharmaceutical industry for a long time. It's the most generous industry in the world in terms of what you've done around HIV and other things. But I just don't see how the incentives align. And that's really, that's really the most honest, you know, my friend, the most honest conversation over a couple of beers. That's what he basically was telling me that this is kind of politically impossible. What would you say to that, Paul? Well, it's, let me first say, the motivation of working on Ebola in our company has been tremendous, not just for the people working on it for the entire company. So I'm a believer that working on things in the world, which make a difference for the world, while you're in a large commercial business, the engagement you get from your scientists, your physicians, they all say, wow, we are stepping in here. And it beefs up your, your, your, if you're, I'm running a 16,000 people research organization, I can tell you, if I get 10% more out of that, it's 1,600 people because they're motivated. So that's a big factor why the other thing is we are the largest healthcare company in the world as J&J. And for us, participating in solving big problems in the world is just part of who we are and what we do. But we can do this from time to time, not every year, another, another $500 million investment. And so for me, the, the, what I would, and I owe it to our partners, that we need to deliver on this one. Yeah, like President Kander was saying, there are people and patients who are waiting to, to be protected. So we need to deliver on this one. So much money went into these vaccines in the three companies who invested in it, that first of all, to the NIH, to BARDA, to the European Commission, to the WHO, to all the regulators in the world, to the patients. We owe it to bring this to conclusion that we have a vaccine preventing patients. I think if we can show the world we can do that, then let's prepare for the next one, how we start tackling it. And it will require basic research funding from two senior executives here around, from Francis and from Jeremy and from Gates and from other people from us also. We have to share, we have to share resources to solve the problem, share our capabilities and we'll step in whenever needed. But you have to do, today you have three willing parties to do that. Yeah, who stepped in? Mark, JSK and J&J. You want to have 10 to 20 willing parties to step in and solve and help to solve it. And there has to be a system in place that the whole pharmaceutical capability in the world could come to bear on production or helping to work on global problems. Some will work on antibiotics, others will work on vaccines, others will work on TB drugs. But we'll have to mobilize more people in order to solve critical problems in the world. So Paul, if you don't mind the panelists, we've got Jeremy Farrer and I think Francis Collins in the audience. Can we, can we give them the mic? I'd love to hear your, your view that the, you know, Francis is back to the largest funder of basic science research and medicine in the world. Can we get Francis and Mike? We'd just love to hear your take on this Francis. Well, we talked about this yesterday in another panel and certainly got the message loud and clear from Paul and representatives of the other companies that have already put a lot into getting us where we are with Ebola, that we need to have some kind of a plan that makes them feel that there's a sustainable solution and not just one-shot deal over and over again because their boards were not all that happy with all the money that they had to spend in the circumstance that will probably not get recouped commercially. We'll understand that. But it is still, I think, scientifically challenging and I guess I'd be curious what, what Bill and Paul would say about this issue. Bill, you just said that the next epidemic will probably be with an unknown pathogen. So the idea that we would set up sort of as a prospective effort to develop vaccines against somebody's favorite list might not actually be the best way to use the resources we have. Would we be better off to really work hard on getting those platforms, both for vaccines and antibodies, so that they're totally ready to go at short notice with some pathogen, I think Zika for instance, that we didn't know about and that suddenly becomes really important. Jeremy? It's difficult to add so much. Jeremy, Jeremy for our head of the Welcome Trust. It's difficult to add very much to what's already been said and agree with what's been said from the panel and from Francis just now. I think going back to the series of reports that we've had and we must be honest we've had a number of reports over the last decade since SARS and whilst Victor's report from the National Academies of Medicine I think is a very very comprehensive report, Victor there wasn't that much in it which to be honest you wouldn't have said a decade ago. I think we know what needs to be done. The question is now moving on to do it and actually the three things that I think I think Bill mentioned it surveillance and improvements of primary care will improve health globally for everybody and it will be an incredibly well spent dollar around the world. Number two I think we do have to talk about the reform of the World Health Organization and the structures and Margaret is leading that and Bruce is working very hard to create that center which will bring everything together and will be the place that convenes the world's nations to address this at a global level and the third one is to invest in research and development for the long term both in vaccines, in diagnostics, in drugs and in other interventions including social sciences and anthropology to understand the culture of the societies in which it's operated and that was a key lesson from Ebola. But to end on an optimistic note I'm also not sure obviously organizations can bring about change but individuals within organizations play critical roles and if you look at the World Bank at the Blinville and the Gates Foundation at the WHO, Paul Stoffels at Johnson and Johnson, GSK at Merck, I hope at the Wellcome Trust, NIH. You've got individuals who all emotionally and viscerally get global health and are committed to this. You will never have individuals at the top of all of those organizations so aligned in the future. So this is the moment to seize and to move on. 2016 has to be the year that we bring those together and act and actually I feel very optimistic that we will do this. Thank you Jeremy. Bill can I ask you and I'm going to go President Conde, what I'd like to hear from you is what can we do now in the aftermath of Ibello? What do we need to do to build up these health systems, to build up your capacity? We'll go to you in just a second. But one question that came up, you know we've been playing with this idea of the germ games and you just been talking about it. And one of my colleagues, Dr. Melanie Walker, showed me the game plague. And my kids all knew about it and they played it and they were killing people and they've become kind of sort of what's the right word, they were kind of immune to it, they didn't think it was very cool. But what if we were to really do this seriously and maybe every year do it at the G20 leaders meeting or something like that. Would it help us to keep it in front of people's eyes? Or you know because we haven't done it and I was wondering if we can just make a decision maybe with Francis and Jeremy and you and WHO and us that we would actually build that game and commit to actually doing it. So first, as you said, we'd know what the things were that we'd need to get in place that or not. But also, could it work as a way of sort of maintaining political will in the times of neglect? Well, capturing the complex dynamics of fragile supply chains, panic, limited capacities, I think it'd be hard to really get all the things. People who do war game simulation, you know, probably should go to them and get them to help out. We did, Bill. And the guy who invented Plague said, give me $50,000. I can do it. So that didn't strike. It didn't, you know, it didn't strike us as true because it seems like it's so complicated. There's so many things. And so I think you'd need a group of experts in many different fields to get this done. I mean, what do you think? Because I'm thinking about it not only as a way for us to plan more effectively, but as a way of maintaining political will. It should be done. I don't know who would take responsibility for it. And you have to decide, are you just dealing with natural epidemics or are you also trying to address bioterrorism at the same time? Okay, Margaret, did you want to jump in here? I think, you know, Germany and under the G7 leadership invited Bill and to start looking at, you know, the experience of what can be done. I would certainly encourage the G20 and G70 leader because G7 does not include some of the developing countries. G20 and maybe bigger, the sustainability on the conversation. It has to be done and it has to be maintained. We will not be able to find the answer in 2016, but work has to be done. And this cannot stop. And so I would encourage leaders, you know, who have influence on the G7. Germany is here. Japan is here. And then Italy will be the next year. And China is G20 this year. And next year, you know, I have a sense who is going to be G20 so Germany can think about that and engage Bill. He's the best, he's the best ambassador, envoy, and he's can open doors to all the leaders. Bill, you know, just keep the conversation going. And we need you. Well, nobody really wants to sign up to be Cassandra, honestly, including me. Well, but I work in an organization full of economists. That's our job. So can we just, before we go to President Kandy, can we just make a little pact here, Francis, Jeremy, that we will find some way forward so that we build a team that can build this kind of simulation. Can we make that? We'll find the funding for it. Bill, will you help us? I mean, I'm not talking about funding. Can we get the military establishment involved to some degree? Then I think that would be good. OK, so Francis, so we'll follow up right after this next week, right? Jeremy, can we? Because I know Prime Minister Cameron's also very interested in this. So why don't we start with a conversation? We'll find funding as needed. But let's talk, I think that's right. I think the military, they do war games all the time. And it's essentially a war game, a version of a war game. Why don't we do that? OK, and Ursula, and it includes you guys. What I was going to suggest is that whatever we build, we don't just build it for the leaders of G7 and G20. We build it for people so that we're building a narrative with the public that will drive that public will that we're trying to create with this with this tool. Yeah, but we did a movie. And other than the happy ending that didn't correspond to the rest of the movie, it was really well done. Yeah. Well, I worry about it becoming a really popular video game because then it will deaden everybody to the reality of it. Right? So minister Groh, let me just say, first of all, Chancellor Merkel's been a tremendous champion of continuing this work. And she's promised that if she were to be the chair of the G20, that she would make all of the G20 leaders go through this game. So they understood really what was at stake, which is great. You have the floor, sir. Jim Herrmann-Gröhe, Minister of Health from Germany. I would like to make a remark on G7 and the results. Margaret remind us always that we need to walk the talk to not to forget the panic when time has come and we can neglect things. During the Elmau summit, G7 declared that they want to support 60 countries to have implementation of international health regulation. And when we talk about insurance being a part of and response capacity, we need a risk assessment. And that means we need to change the implementation of international health regulation. Being not just self-reporting but in a much more objective way, saying that's reached so far. And since there was agreement that 60 countries should be supported by G7 and to be frank, before the Elmau meeting, there was some debate whether 60 is the number we could reach. Today, the chancellor announced that 76 countries are on the list and it's still an open one. But it means that at least there is now a clear list where G7 countries say we should do it and we should support it and others could step in. European others could step in and say we go on with other states on the list and that's the primary systems, the detections, the contact tracing and all these capacity that's need to put in place. Bill before mentioned the army that never fought a battle and no police department, no fire brigade would ever miss the need to train in times of peace. And I'm convinced and as you mentioned that it could be that G20 is some useful instrument for that, I think we need such an exercise for the top level to be trained what should be done if it's much more of a high speed infection. And so I would support that and I would say there is needed preparation for such an exercise. So to go back and then right after this we'll open it up for questions and comments from the floor. But to go back to President Kondé you know you provided very strong leadership but your people suffered so much and now there should be some upside meaning we really need to commit to helping you build back your health care system get growth going again. And what are your expectations and what can we as a global community do to help build back Guinea in a way that there will be some benefit even if small for all the suffering that you and the people went through. I think that the first thing is to give a greater responsibility to the countries because we were saying in the case of Ebald that when the countries are involved you've got a better transfer of technology and I think that the countries themselves are best placed to know exactly what they need. But I think that we also need to see is that you know we're looking at things fragmented you've got pandemics, etc. What we need to see is that we don't have the same roots to all these problems. Of course we were brought on by Ebola because our health system wasn't very good and we didn't have the infrastructure. But as you said it's often these are poor people's illnesses so the problem isn't this due to the fact that injustice and I think that we need to have a primary health care we need to have grass fruits services and the less poor people are the more they will have access to hygiene and the more certain illnesses will disappear. The problem that we have today is shouldn't we be allowing Africa to achieve two things we need to have renewable energies and new technologies so that we can have the resources to ensure that these poor people's illnesses disappear because you know we've got an increasing population in Guinea. You know with Ebola we had to wash our hands you had to have thermometers to measure people's temperature so you've got to look at the problem globally and that is a question of the development of countries. So if you're going to help us today we've got to find innovative financing and not to just apply one-off measures. So what we really need is to have strengthening of an economic system instead of sending us food through the food program. We've got capacity you know we could also become self-sufficient and perhaps so we could also export things rather than bring in things from the World Food Programme same thing in the agro-industry same thing with natural resources we sell bauxite I think that what is important is to look at things not from a fragmented manner we're going to say you know we're going to fight against epidemics then we're going to deal with this other problem we need to do things globally so that we can improve the lot of people. Thank you. Thank you very much. So why don't we open it up there's so we have quite an audience we'll start in the back right there do we have the microphone? Hi thank you my name is Elaine I'm with Erickson and during Ebola we were active both with World Food Programme in supporting the connectivity for some close to 100 emergency treatment units that were set up by World Food Programme and others but I was thinking a lot about the cross sector type of partnerships that's needed here you have been discussing a lot about vaccines but also war games and simulations and I wonder how you look at ICT actually because if you think about the community health worker on the ground in equipping that person with different tools that can help them do their job more efficiently whether that's transfer of data or you know just basic communication needs I think you know that could speed up a lot the response so it's you know it's not the drug itself but it's actually the role that you know the ICT sector could play together with the health sector I think that's an under leveraged opportunity in crises such as these so I don't know if anyone has any comments on that Well over the next decade for normal situations primary health care will be digitized that is health care workers will register patients you'll have digital records and that'll be a huge benefit there's good pilots of that taking place in India back boned off the universal ID system the network coverage needs to be improved the training needs to be improved there's a lot of steps but you're absolutely right that the cell phone system is a huge aid and as we get it built into these systems on a regular basis it'll help us drive quality and follow up and help us in an acute emergency as well You know I had an experience I in Davos I sat with the CEO Vodafone and he said why didn't you guys ever call us you know we have cell phone towers in a suitcase that can and it just these agreements and these ideas had never been worked out ahead of time I think one of the things that we'd get from a war game kind of situation is that when it struck we'd see all the kinds of agreements we have to get in place ahead of time and this is why what Earthworm is doing is so exciting because that's the other thing you know there were a lot of transport needs but we had not sat down and made the agreement with FedEx and others to do it and you know Paul I remember just how much we struggled with indemnification right and all those things should have been worked out way ahead of time and I think that's one of the good things about the fact that we're still engaged but you know I think what if we had a war game type thing we could keep putting in new developments and show that it's getting better right it's getting better but then it could help us shape the kinds of agreements that we make yeah. Jim may I say that on the emergency telecommunications cluster we have already created that after Ebola and the companies have committed to so many hours of free service to support setting up the response and in getting for example we were able to leave behind equipment that will help build on the telecommunication system in the country. In the front row. And Victor afterwards yeah. Thank you Dr. Kim, Stan Bergman, Henry Shine the largest provider of dental products products to positions and veterinarians. I want to commend you on this panel and I want to take you back to about this time last year it was at the end of the day on Friday you were chairing a panel it was actually a small group of people got together Dr. Chan was there, Ms. Cousin was in the room and what we spoke about was the need to make sure that products were at the right place at the right time, plan in advance and you said well what can we do about it and Mrs. Chan gave a card, Ms. Cousin gave a card and you said you'd call and convene that exactly happened and today we have a reserve of products, virtual and in reality that are ready to move 62 of the major products that are needed in some kind of God forbid a repeat of Ebola. So I would encourage you and everyone here on this panel to advance public-private partnerships in actually making things happen that could happen right away. Great, thank you. Victor. Thank you very much for citing our report. I think what we're mainly are messengers if you will of the important issue when I think about what we did and what we're trying to do I think it's how you framed the gym and also Margaret with regards to the global security impact. You started talking about trillion dollars and our analysis if you look over a 10 year span the economic cost of pandemic epidemics is $60 billion a year. Now that's not enough to get world leaders to stop I think the simulation game is great you're looking at what's going on in an acute event but in fact what you have to do is look at long-term security issue and it's been pointed out by Larry Summers the issue is as big as climate change and he said that in fact this area is a area where the ratio of seriousness to policy is very high and so I think the main point is how do you get first framing the issue? We framed it as a security issue not just a health issue. Second is how do you disseminate the message? This is what we're all here for so I'm determined with our reports not going to sit on the shelf but in fact find a way to disseminate to the many leaders and third is political influence and political will. This is where you guys come in and fourth of course is all the public-private partnership so I don't see that our report has a finite point in fact I think the important issue is to point out to the world leaders and to everybody in the globe this is serious business. If you think about the amount of money you spend in cybersecurity and military and climate this is a fraction of what's being spent and so I just want to emphasize if we can take that message consistently that's when you're going to get a lot of attention. Thank you. Yeah, front row. Hi, Sangyeop Lee from Kaised Korea. Thank you very much for a very insightful action plan. My main, I think the topic you covered is on the pandemic viruses. What about the multi-drug resistant bacteria and fungi? Can you plan same great action plans you just talked about about those multi-drug resistant pathogens? You want to have one? Thank you for that important question. In fact, in WTO all the member states agree that when we talk about global health security primarily it cover pandemic preparedness and response capability but also need to look at antimicrobial resistance because that is becoming so serious and of course we were talking about the discovery in China of the MCL-1 gene and it is not just in China but also in many other countries that is a very important and serious finding that we need to look at because if we are down to the last effective antibiotics in whatever field be it for malaria, for HIV and others the impact is huge and also modern medicine. We need to think of modern medicine I mean hip replacement I mean you know prolonged hospital state and we heard it from UK and US your experience and I'm sure these are the things that we are looking at. WTO with the support of many countries particularly I mean UK is taking a strong leadership as well as Sweden and others Netherlands we have a global action plan so working with OIE and FAO under the one health approach to take it forward but the important piece is again going back to R&D coming up with new antibiotics and other effective medicines so we are moving in parallel thank you So most of the major pharmaceutical companies are getting out of the business of antibiotics and Bill you've worked so hard on getting new drugs for tuberculosis and malaria but you know without a paying market like with HIV drugs if you compare the number of new HIV drugs to TV and malaria drugs there's no comparison because there's a market in the developed world so where are we with that? You know I've been an MDR-TV doctor that's how I started my life and there are maybe two new drugs but the companies that own those drugs don't want to release them and this is I don't seriously I don't know the details this is what my friends tell me but there hasn't been anything new try as we might so what does that tell us about the absence of incentives in the market and how we're going to do with problems like this? Well TV specifically actually there is some good stuff going on J&J came out with badachlan which is used for MDR you know they're looking at long acting formulation there's a whole TV drug accelerator that's drawn in a lot of pharmaceutical partnerships now because it's triple drug therapy the trials are fairly complex we'll need more partners to get those approved but we have a much better TV drug pipeline than ever in history a lot of that's NIH funded a lot of it's Gates Foundation funded I think it's maybe over 80% is those two entities anti-microbial resistance as a whole is sort of a different thing because actually scientifically in terms of looking at gene patterns or different ways of culturing you can create more antibiotic candidates today with some great work that's gone on than ever before and so understanding what are the bottlenecks in terms of people productizing those things you know I think it's valuable there was the declaration by the 80 companies I really need to understand what they were asking for you don't want 80 companies to go into the field then there won't be enough room you need three or four really serious companies who feel like they have the right business model but Bill to be as I've admitted I've not been in the business for a while but the one sort of incontrovertible sort of principle of drug resistance in TV treatment is you never add a single drug to a failing regiment so if we have one drug it actually doesn't help us very much and so how do we get to the point where there are four and five new drugs at a time the market's not doing it let's if you permit to please please well I think thanks to the TB Alliance and funded mainly by Bill and his team and the NIH a lot of work has happened and we happen to discover a new target and that's too very very important for new antibiotics is getting off the new targets now it was only XDR and it's only TB so we developed the drug in MDR TB XDR TB you bring it to the market it was approved in an accelerator to it by the FDA thank you very much they did massive work in helping us getting it through now in Europe South Africa, China, Russia everywhere in the world but the challenge is the first thing we do we had to do was go to CDC and say limited to this number of patients because it's important for MDR TB in the US 100 patients a year then you go to we went to the WHO to the program and said limited on a global basis to only MDR XDR because if it is widely used there is no use anymore within a few years that limits the market drastically we did a very differentiated pricing model we said $30,000 in the US $3,000 in the developing in the emerging markets $900 in the developing world and those who can't pay will get it to another mechanism but you have to limit it you have to organize that it's not used in a broad way now project that to a new antibiotic and if you limit the use on a global basis of an antibiotic the cost to develop it is high and there is no commercial market at this moment we have to test it but I think the world would stand up in arms if we would say well this multidrug resistant antibiotics would cost you $200,000 for three week therapy everyone would say this is crazy but if you have to invest $500 million to get there or a billion then you never get your money back and so there is no incentive to get there so what we ask as an industry is can we all think together what is the mechanism for basic funding and what is the mechanism to pull these new drugs through and we are committing to put our resources at work but again like in the vaccine industry now for Ebola or for the let's say the non-profitable viruses you we have to find a risk-sharing mechanism and that could be regulatory that could be upfront some payments that could be whatever procurement but we have to find that mechanism Are we making progress on that discussion? Yeah the discussion is going pulled by the UK funded by a few people in the room here a lot of progress is made industry has signed up to say let's participate in the discussion we are committed to adhere to better antibiotic management and committing to research in order to get to the next phase of this All right we're almost out of time I'm going to give everyone on the panel a last chance to make a comment and we'll start with Mr. President Any thoughts, reflections on the discussion today? First of all we'd like to say thank you to the laboratory that provided the vaccine which allowed us to provide the protection but I think that the presence of Bill Gates allows us to broaden things I think that this will allow us to get to the grassroots communities and also to control the developments and to fight against these pathogens I think that our situation is in difficulty and we need budget to support this is a message to the World Bank and our message is that our situation is a situation of crisis so I think we need really it's a call for you to provide help to people in danger I just want to say Mr. President I understand, I got the message very clearly Margaret Yes just to say that investment in health is good for economy as well as security this time walk your talk Bill Well we haven't solved this problem and I think the simulation thing is a good next step because it really will highlight both things of it and brought up here and things that we may not have thought of but I will say the positive things again the emphasis on primary health care is great the emphasis on surveillance is great the new platforms are coming along and particularly for antibodies or antibody factories those are probably what you need rather than the vaccine for the fast moving case and then this idea of getting synergy between the eradication platform which the next big one will be malaria I think that's pretty great because you'll have people who know what they're doing and will have a formal plan for how they would be switched over to deal with the crisis Right, Paul Well first of all I would make sure that we focus on first on the patients making sure that finally we get to solutions that is critical and you have the commitment of the pharmaceutical industry and I can speak on behalf of all of us we are there to make new medicines to make people better let's find and vaccines let's find a way with the public sector to work together in order to solve this crisis problems but also overall global public health in the world we have to increase the health status of the world as we do all this it's not just about crisis it's much more we need to get much broader building health infrastructure and make sure that people benefit from all the technologies we generate in the West First of all let me say in hearing Mr. President we know we must think globally but act locally and respond to you and I don't want to bring food into Guinea either we want to ensure that we're supporting market developments in Guinea that by our cash based transfers we're supporting the rebuilding of the agricultural markets in Guinea today so I hear you then let me also say very quickly that we need to ensure that the motivation of fear that got us all together in the first place should not be what drives us in the future it's the opportunity that should drive us in the future the possibility of dreaming bigger and working together and coming developing outcomes that will provide us with the tools that are necessary to meet the needs of the people who need us most great thank you, Richard so thank you very much for everybody for coming so we've got something very concrete coming out of this Francis, Jeremy, the people on this panel we'll work together, right, we'll work together and by next year, by next year when we come back here we should commit to having developed something that will illustrate where the holes are but maybe even Paul, maybe even generate more political will so that we move forward on these agreements that we need and most importantly help us stop small, medium and large epidemics on behalf of poor people, on behalf of the global economy but most especially on behalf of people in places who've suffered so much like in Guinea thank you very much everybody