 I can't imagine why folks would want to miss the next event, which is really a quiz. And we're going to find out who really knows what about antigens and epitopes and odd events and a few other things. It's a way to try to focus your attention. I think we've got a quorum, so I'd like to go ahead and get started. It's a treat for me to be here. Some might ask what's the old salt admiral doing here? I think the real truth of the matter is that 45 years of travel and engagement around the world, I'm living proof that a human pin cushion can absorb many scores of vaccines and still function, at least to some extent. So we'll give it a try. In truth, this panel is here to try to make a connection between something that became pretty obvious to me, and that is the link between health and security. And specifically today, we're talking about vaccines and the role they play in this business. To me, it's pretty much of a no-brainer. If you were here this morning and you saw Dr. Fauci's slides, it doesn't take a math major to see the benefit of vaccines and what they've done for people here and certainly can do for others. I think one of the challenges of a group like this and a meeting is that sometimes we, because you have an awful lot of expertise, we're blessed with that, and you're going to see with our panelists up here this afternoon, that we tend to dive down into the weeds, and we start arguing about which vaccine is going to be the best and what ought to be the priority here and how much money from this pot goes to that and so forth. To me, I would suggest as we open this discussion that we may be back out of that and let's just talk a little bit about security. And if you would accept that security runs the gamut from the usual suspects on the international stage with state boundaries and all those things that one tends to associate with militaries and state actors. And the other side is something that's very real and very close to each of us, and that's personal security, and the role that health plays in personal security is quite dramatic. And so as we get into this discussion, tying these things together and seeing what we might be able to do and what we might appreciate in this, I think is really important. So if we go back to Tony Fauci's comments, he showed some data that was, I thought, really compelling. And then he had some numbers. He talked about billions. And I'm here to tell you that that's an understatement. And if you look at it in this context, since I spent an awful lot of time around the world in the military, I learned a couple things very early on. One of them was the value of prevention, preventive maintenance, preventive interaction. And the thing I learned was that a minimum amount of resources devoted to prevention pays huge dividends. And so what would you rather have? Would you rather have some, if you, in the big scheme of things, look at the amount of resources that are actually applied to this issue of vaccines, it's pretty minimal compared to some other resources that are devoted to problems that have gotten out of hand and now we're trying to dig ourselves out of a hole. So it seems to me that if we keep in mind that we can do a tremendous amount of good with a relatively small amount of resources in advance of problems becoming the kind of challenges that cost us trillions of dollars to dig out of very deep holes. And so as we kick this off, we're really fortunate here to have three particularly well-versed and expert people that really cover the gamut in this business of vaccines and security and global health. So first, we're going to hear from Dr. Steve Kochi who is the walk-and-talk and encyclopedic expert in vaccines centers for disease control. Now he's been in this business for a very, very long time. He's a medical doctor with a great pedigree and he's going to start us off. And then we have someone who's actually been down there with his sleeves rolled up, getting his hands dirty if you would, in the field. And that's Marcus Geiser from ICRC, International Committee of the Red Cross who he hails from Switzerland in the high mountains and he spent an awful lot of time in some pretty dirty, dusty places the last several years, the last two years in particular in Afghanistan, doing the Lord's work out there in some very, very difficult situations. And to try to put a bow around this discussion, we're very fortunate to have Eric Schwartz here. He's currently the dean at the Humphrey School up at the University of Minnesota. He's a man with a very, very extensive background that spans the policy world. Used to be here at the NSC, used to be an assistant secretary of state in the academic world. He's been with NGOs, with the UN. He's got a resume that just goes on and on that touches many of you here. And so with these three gentlemen, I think we're pretty well placed to have a discussion about this business of security and tying it to vaccines. So if I could ask Steve to come up here to start us off. Thanks very much for your attention. The place is full. Over to you, Steve. Thank you, Admiral Fallon. And I'd like to kick things off with just a few comments and some ideas that I'd like to throw out there to get the discussion flowing. I'm going to divide my comments into general issues and then taking the U.S. perspective and finally issues that conflict affected countries face. First of all, from the general perspective, I hope it's clear today that we're not talking about bioterrorism related vaccines like smallpox vaccine or anthrax vaccine. But the broader issue of how vaccines promote both global and national security, it all goes back to the fact that social inequities drive conflict and unrest and civil unrest. And vaccines are a tool for achieving health equity. And this is true both on the global level as well as on the national level. Vaccines and immunization are global public good. Now, what exactly does that mean? That means that vaccines are near universally in demand. The benefits of immunization transcend national borders. And we see this come home to roost every time we have importations of vaccine preventable diseases from one country to another, from one region of the world to another. Also, no one need be or should be excluded from receiving these global public goods. So pursuit of global immunization is a huge contribution to global health security and equity. And finally, in general terms, from the point of view of political leaders, good health is good politics. So effective health interventions such as vaccines in the view of many if not most political leaders dramatically improve the health of the population, contribute to economic productivity and foster economic development. So this promotes national security through both political and economic stability. Now, if we look at the US perspective, the US has both a humanitarian and a national security self-interest in reducing the global burden of vaccine preventable diseases. The US has been free, here's some examples. The US has been free of polio since 1979. But the polio virus is just one plane right away from the few remaining countries where the polio virus still circulates. We're all very familiar with the national security threat of a potential pandemic influenza epidemic. And in terms of measles, the US has experienced the highest number of measles cases since 1996. All of these due to importations of measles virus and small outbreaks that have occurred as a result of traveling US travelers to other parts of the world and the visitors to the United States. So these ongoing outbreaks of measles in the US highlight the interconnectedness of the world today and show that outbreaks of measles around the world leave the United States vulnerable to imported measles virus. These cases cause serious illness, hospitalization, disruption of the community and of the health infrastructure, and they are very costly. And I can get later on if time permits to some examples of this. So if we don't support the global side of the effort to reduce measles, then we're being penny wise and pound foolish in the way we approach protection of our citizens. And finally, some of the issues that the conflict-affected countries face. And I'm going to focus a bit on polio eradication since that's the model for delivery right now of immunization services in conflict-affected areas of the world. One of the greatest challenges for polio eradication in the few remaining countries has been getting access to children in conflict-affected and security-compromised areas. We've had a very successful effort in many countries that goes back to 1985 during the Civil War in El Salvador. And at that time, and this has been sustained through today, the development of what's called days of tranquility where there are negotiated ceasefires between the warring factions to allow vaccination teams on either side of the conflict to reach children with vaccination during mass campaigns where this has become a feature. And in countless countries that have been affected by civil conflict leading right up to today, this has been a strategy that has proven effective to get into these areas, at least for a brief interval of time, perhaps one to two weeks, to deliver in this instance a polio vaccine but also in many instances to deliver other health interventions where appropriate and where feasible. And so this is taking advantage of, I think, the primacy of immunization as one of the bedrocks of primary health care and using what health infrastructure is available on the immunization side to deliver the health interventions, including vaccines during these ceasefires. So I'll conclude just by saying that with polar eradication as a model for working in areas of conflict, we have been successful in many, many countries. And this carries over into our work in vaccines and immunization in achieving equity and access to immunization in establishing disease surveillance systems and mechanisms, special mechanisms for delivering health interventions in these very unusual areas. And in some instances in revitalizing and strengthening immunization systems through additional externally provided resources and delivery of additional vaccines besides polio vaccine. So I'll stop there and I hope that gets the discussion ideas flowing. Steve, thanks very much. So you've certainly, I think, got captured now one aspect of this security, the value of vaccines and interventions to helping security. It's another dimension, too, that we might be able to get a draw out from Marcus here because actually doing the health intervention in the field has a couple of prerequisites, one of them being actual local or tactical security. And so he's the man that's actually had a deal with this. Marcus, if you could come up and tell us how things really are out there. Good afternoon, everybody. First of all, yes, I do come from Switzerland, not from the Swiss mountains, from the Swiss lake. Nonetheless, my Swiss German accent, of course, will remain. So I hope you will forgive me. First of all, thank you very much to CIS for having invited the ICRC to come to this event, International Committee of the Red Cross. Very briefly, we are an international humanitarian organization based in Geneva. Our mandate is to protect and seize the victims of war all around the world in all conflict zones. Our mandate is deeply enshrined in the Geneva Conventions, one of the foundations of the law of armed conflict. ICRC is facilitator for the delivery of vaccination in Afghanistan very broadly. It's the issue I want to very quickly touch upon. And what Stephen said, excess, yes, indeed, the question of excess, how do we reach people who are in need of vaccination in very complex environments in Afghanistan probably is one of those. Let me say what the ICRC is doing, first of all. How do we actually facilitate delivery of vaccination? The ICRC's involvement as a facilitator in the polio campaign started in 2007 in Afghanistan. At that time, the Afghan Minister of Public Health suggested to WHO to contact the ICRC for support to access areas with strong armed opposition presence, that means Taliban. ICRC distinguishes itself to consider itself as a neutral, independent, humanitarian actor. I do not want to talk about these concepts at length, but nonetheless, what do we mean by that? I think we from the ICRC have to realize that aid is always an injection into a social, political, and also economical environment. So principles of humanitarian action are here very important to provide an organization like the ICRC. Guidance and regulation. Humanity stands for respect for human being. Impartiality means assisting those most in need with no discrimination. Neutrality involves no taking part in military operations or ideological controversies. Neutrality, in that sense, is an operational posture. The independence is the obvious operational predisposition that's the result of those principles. That explains why the ICRC has developed contacts with the armed opposition, the Taliban, in Afghanistan over the last few years. Let me now quickly go back again. ICRC is a facilitator for the delivery of vaccination in Afghanistan. Back in 2007, when we got this explicit request by the Afghan MOPH, this was by the authorized by President Karzai, to actually see the ICRC as a facilitator to bring other actors, such as WHO, UNICEF, and of course, first and foremost, the Minister of Public Health into those disputed areas. For each polio campaign, the ICRC receives a letter from the Taliban with a letterhead, Islamic Emirate of Afghanistan, as they called themselves. And this letter is handed over to WHO, and this letter is then handed over to the teams of vaccinators that actually can carry this particular letter in all those areas where they think are more disputed areas, where the Afghan Ministry of Public Health would not have an easy access. And this all sounds very simple. Of course, on the ground realities, things are a bit more complicated. For example, when I was working for the ICRC in southern Afghanistan, in our office in Kandahar, we would indeed bring together in a meeting room representatives of the Afghan Ministry of Public Health, of course, representatives of UNICEF, WHO, and of course, also people that we know through our work, through our network, who are close to the armed opposition, who are tolerated by the armed opposition, at times even our members of the armed opposition. The ICRC was considered to be, and still is considered to be a credible actor as this facilitates, because in the southern part of Afghanistan, the ICRC has a very comprehensive approach in how to actually access, respond to needs, health needs. We support the second largest hospital in Kandahar. We run a very complicated network of private taxis that retrieve wounded, bring them over the front line, and bring them to those hospitals, and we also run a few first aid posts. That particular law, and I conclude on this, that particular response to the needs of health, the health needs, I'm sorry, of course, made us a very credible actor to indeed have this all as facilitator, and of course, we from the ICRC believe strongly that our neutral independent humanitarian action, the way I explained it, actually helps us to do that. I would conclude with a few challenges. Today's, it is very clear that in many areas in Afghanistan, the provision of health, in particular vaccination, is very complex. I think it has gotten more complex. A simple letter, unfortunately, does not always do the job anymore. We see the fragmentation of various parties with the conflict, the armed opposition. We also see the proliferation of irregular armed forces. They are nonetheless accepted by the government of President Karzai, also supported by NATO forces. We continue to see, unfortunately, a rather dysfunctional ministry of public health, that is a very clear center and periphery divide. If you talk to the, or if you talk to the ministry of public health in Kandahar, he may not have leverage of what's going on, of how actually the teams of vaccinations operate, okay. The same, and I conclude on this one, the same with the armed opposition. Again, a letter from the Kuwaita juror of the Taliban that does not necessarily mean that the small commander, if I may say so, who may not even be able to read that letter, may actually accept that. So yes, the role of facilitator depends very much on the commitment of all of those who are around the table, the various health actors, but also the political actors or the armed actors. Thank you so much. Marcus, thank you very much. And to try to tie this together, I'd like to invite Dean Schwartz to share, among other things, the perspective of how policymakers view this nexus between health and vaccines and security and what factors go through their minds as they're making decisions regarding resources and allocation of effort. Thank you very much. Thank you. And I'd like to thank CSIS as well for putting on this important meeting. I should say, parenthetically, as I was preparing for this in my new perch at the University of Minnesota, it was heartening to see how serious that institution, as I know so many other institutions, have taken on the challenge of dealing with infectious diseases. Let me offer five observations in this area from the perspective of somebody who spent most of the last several years dealing with international humanitarian response. First, my first observation would be that those of us who are concerned about this issue should adopt Sutton's law, which is that you should consider the obvious before you look to other alternatives. Willie Sutton, the bank robber, is responsible for that law, which when they asked him why do you rob banks, he said that's where the money is. And the analogy, of course, is obvious. Why is it important to pursue vaccination in situations of conflict and failed states? And the answer is that that's where the people in greatest, the large number of people in great need are. These statistics may be somewhat outdated, but in review for this presentation, statistics from several years ago suggested that 65% of internationally significant outbreaks of vaccine-preventable diseases are in areas of civil conflict and collapsed states, that the leading cause of morbidity and mortality in such settings are such diseases. And so I would say we should start with Sutton's law, and which underscores the importance of focusing on this area, even if it's hard to do. The second point that I would make from a policy perspective with respect to international humanitarian response is that movement matters. What I mean by that is we need to address the problem due to its migration impacts on issues with humanitarian, but also national security implications. And this plays out in several ways. First, people on the run who are not vaccinated, who have not encountered host populations, refugees encounter host populations, many of whom then thereby become far more susceptible. Secondly, as we've seen, diseases easily cross borders and have implications for foreign populations. We resettle upwards of 75,000 refugees every year from places like the Dobb in northeast Kenya. So the idea that the impact of the absence of immunization on us might not be significant and profound I think may be very short-sighted. And then third, there are humanitarian implications because people who are fleeing, who cross borders, hopefully, and in many cases, at least a couple of million cases in Africa over the last decade, they go home, they go home. Better they should go home having been vaccinated rather than go home and increase the risks to those who never left in the first place. So my second proposition is that movement matters. My third proposition is that we need to tailor solutions to meet problems. Be aware of the need to modify interventions to the special dimensions of humanitarian settings. For example, there is evidence, and I'm not the expert on this, I just read the evidence, but there is some evidence that in humanitarian settings there is a stronger rationale for vaccinations, for diseases, for to vaccinate children to a higher age, to a greater age. Because many of them, many of them who are refugees or who have suffered conditions of poverty and conflict may not have been, may not have had access to vaccinations. So there is some evidence that increasing the age level for vaccinations in those settings makes sense. There's evidence that a focus, if you have limited priorities on those diseases that spread most easily or have the gravest consequences. So without trying to dictate the specific outcomes, I think the point is still is very valid, that you need to tailor interventions to the special circumstances of humanitarian settings. The fourth observation I made is that not all humanitarian settings are created equal. And this is sort of a cortisol to the previous point. For example, beyond the urgent quick onset emergency, there are millions and millions of people of people in humanitarian distress who are in protracted humanitarian situations where their circumstances may be tragic, but ironically there may be opportunities for the building of local capacity in circumstances where in contrast to quick onset emergencies where that possibility may be more remote. Similarly, not similarly, but along the same lines, we have the challenge of urban refugees, people who are fleeing, who may be in need of immunization, but who are not in camp light settings, increasingly in urban environments with host populations. That also imposes more significant challenges, but in different challenges. So my fourth point again is not all humanitarian settings are created equal. And my fifth and final point is don't assume that doing the right thing is an inadequate rationale to do the right thing. Did everyone get that? What I mean by that is, I think the national security rationales for action in this area are clear and convincing. But also sometimes I felt in government, I certainly did it, sometimes I felt that we made these rationales. I said probably a thousand times as assistant secretary that if we address humanitarian suffering and we create conditions for peace and reconciliation, then we offer the prospect of stability and circumstances where despair and chaos can ultimately undermine our national security interests. I said that, I probably said that 300 times. And I believe it. But sometimes I think policy makers say it because we feel that it resonates with those who are gonna be funding us. And I would submit at least in the case of humanitarian response, response to people who are in the most desperate need. The evidence that I'm aware of is that it's really the doing the right thing rationale that has resonated more significantly with our strongest supporters in the Congress and our strongest supporters in the non-governmental community. And I think that's important. That's not always the case, I think, with development. But in the area of humanitarian response, that's been the case. And so to the extent that there is an interest in pursuing greater resources in this area in the area of humanitarian response, I would not assume that doing the right thing is necessarily an inadequate argument to get the right outcome. Thank you. Eric, thanks. Thank you. Eric, thanks. Great point on which to end the tea up here. So I'd like to open it up to questions or comments from the audience. Any additional thoughts or ideas that you might want to toss in front of these experts before we let them get into a dialogue? I think we've got some mics, yeah, coming up at your six. Thanks, Admiral. Since so much of the narrative of enemies in open society is that the West doesn't care enough about the poor and the disenfranchised, how much of a policy issue can you bring to the Hill about things like inoculations and alike? And how much can the military help encourage the benefit that vaccinations do in bringing the good of the West to the disenfranchised of the world? Yes, Eric, you want to start off with the policy piece? Yeah, I think to the extent that, you know, I think if the goal is, and this is a preliminary response, I could be dead wrong, right? So please appreciate that. But because the stakes are very high, right? And so if you're wrong and the stakes are high, then the implicate. So take everything I say with a great assault, but my reaction to your comment is if you're talking about increasing the magnitude of resources for vaccinations, for immunization in humanitarian settings, one strategy might be not to take aim at the Congress but to take aim at the administration. And what I mean by that is that I think if there are any foreign aid accounts that are gonna be generously funded, it's the humanitarian accounts. At least that's what history, recent history seems to suggest. My bureau got 100 million dollars, consistently 100 to 200 million dollars more than we asked for in an environment that was extremely difficult for the budget, right? And so I think if the goal is to increase the magnitude of resources, and I think the goal is to increase the magnitude of resources in humanitarian settings, in addition to taking aim at Congress, of course you should, but I would also, I would look at the administration, I would look at the accounts of PRM and DCHA and USAID and ask the question, are you allocating enough support for this area? Are you pressing your international partners, UNHCR and others to WHO, whatever? Are you pressing your partners to commit institutionally and resource-wise? So I think I would, on the humanitarian side, I think I would do both, I would look at the Congress, but also the administration. If I could just add a couple of thoughts on the military aspect of your question. The military certainly can and does respond to humanitarian situations, crises around the world, key attributes or organization and speed. But for the longer term, the bigger picture seems to me, someone mentioned this morning, in this for the long haul, set longer term goals and that's where you need to be prepping the battle ground in terms of basically the end of the day, trying to build host nation capabilities, it seems to me, to be able to sustain the kinds of things. So we can intervene, we can do all kinds of things, many in this room do magnificent work, but for the long term, key thing I believe is to get folks on the ground to be able to sustain this and keep going. So the military can help, but primarily your speedy responders. What else, folks? Okay, while you're... If I may just add, yes, the role of the military down in Afghanistan, of course the military has played an important role, certainly not as a provider of vaccination as Edward has just said, yes. I see the role of the military very much as trying to support the environment, it is conducive to allow a vaccination to take place. That is, I think, this is the unique role that the military can play, yes. I think we have both a challenge and an opportunity in advocating for vaccines and immunization as a very concrete way to gain and sustain trust with the communities and build that trust and that engagement over a long period of time. Afghanistan, Pakistan, these are major complex situations that have the military dimension that goes far beyond that. So we have a need to do our best in advocacy to demonstrate that the way that, for the longer term that we gain, that we win the hearts and minds of the population are through other concrete means such as delivery of vaccines. Steve, you mentioned in your discussion the topic of pandemics, and since this is a wildly held perception as a real challenge to security internationally, what would you see as the recommendations for dealing with this in advance? What can we do to get better prepared and to be more rapidly forthcoming if we're faced with these in the future? Well, that's a very good question, a very complex issue. I'm certainly not an expert in this, but we need to keep this very high on the priority list in terms of our preparedness. And as Dr. Fauci indicated this morning, from the US perspective, building as strong as possible a seasonal influenza vaccination program really creates the infrastructure, the vaccine capacity to deal with a pandemic if and when it should occur. And that applies globally as well. I think our role from the US side is to support developing countries to build that capacity to implement seasonal influenza vaccination programs to build the global supply of influenza vaccines so that when a pandemic occurs, we have the capacity both human and financial and from the manufacturers to address that pandemic as quickly as possible. Thanks. Marcus, you mentioned in your remarks your perception that the things were changing in the arena that we're making distribution to health services more difficult. Did you see this as a local issue in Afghanistan or there's some structural larger picture items here? Of course, in Afghanistan it's very obvious that things have become more complex and it's simply linked to the fact, to the circumstances that we see very often in internal wars where you have indeed this fragmentation of armed actors, this proliferation of armed actors and where you also have competing authorities. You have not only state and non-state actors having guns. You have also a non-state actors, for example, in Afghanistan, the Taliban who actually run their own Ministry of Public Health. And what I think is very important is that in such a context, if those who want to provide vaccination simply talk only to the state Minister of Public Health but do not consider the presence of other actors on the ground, that will simply not allow the provision of vaccination. I think that's something that I have seen or the ICC has seen in many contexts, yes. And I think this is a key issue here, yes. Vaccination in a date, I think it was said, yes, there are no, vaccination doesn't know any borders, yes indeed, not only state borders between Pakistan and Afghanistan, but actually also within a country, yes. Yes, just to re-emphasize what Marcus has been saying and to put it in very concrete terms and applies to Afghanistan and the cooperation with the Taliban, it applies in Somalia with cooperation with the warlords and the clan chiefs, but in the Afghanistan circumstance, for years a agreement was worked out for one round of immunization after another over a period of years. The Taliban appointed the vaccination teams from the communities, the vaccine was supplied by the government of Afghanistan and international partners, and then the Taliban reported back in on the results and this was, it was a very workable strategy and ICRC had a central role in making this happen and sustaining it over time. Great, thanks, that's ma'am. We'll get a mic up here please. Thank you, again, my name is Ann Thompson, I'm with the Core Group Polio Project with World Vision and my question is just to the panel in general, if you could highlight the three main things that need to happen to best promote worldwide immunization and address those to the US government or the Western world, what would they be? Anybody like to take a shot at that one? So, three things, three top priority tasks to accelerate the value of immunizations in the world. This is a panel stumper, huh? The problem with answering the question is I think that, at least from my perspective, I think our presence on this panel may suggest, and in my own view, you've heard, that a focus on the most challenging environments, environments of conflict, of humanitarian suffering, of state failure, my own view is a sustained and substantial focus on those areas as my comment suggested is critical. Because, as I said before, Sutton's law applies. And if you're gonna solve a disastrous problem, you've gotta go where the bulk of the suffering really is. And I think it will take a significant commitment of resources, but it will also take a commitment to best practices because the challenges of access in those kinds of environments are significant and substantial. So, there are ways you can address that under any circumstances, careful serving of the population, careful site selection in these sorts of situations, careful preparation, but ultimately, the most significant challenges in my view are gonna be challenges related to access. And I would say one thing that our government should be doing and I suspect we already are doing it is preparing a very careful look at how we managed, how the international community managed the outbreak, the measles outbreak in the context of the horn humanitarian disaster. We've got, I think there are probably going to be some important lessons learned from that experience, both in terms of why it wasn't better prevented and in terms of how we responded, how the international community responded and whether that response could have been more effective. Sort of a non-answer to your question. 30 seconds. A very good question. When you put the question, I was sitting here having done a background paper giving my top 10 wondering, let's see which three of those top 10 am I gonna use? But I think what I wanted to say is to me, the most important issue is partnership and in the global vaccine enterprise, the road to success is to have a fully elaborated partnership that combines government ownership, industry, community leaders, the private sector and the non-government organizations, especially given the topic we're talking about and NGOs that can work in these conflict-affected areas. And that's the secret to success, the number one secret to success in my view. Marcus Quirkland? If I just would like to develop a little bit what my colleagues have just said, the value of immunization, I think that was your question. I agree, of course, and I think Eric very well with his five points has actually already given you in my opinion an answer to your question. Develop this a little bit further. Just how do we, as we from the ICC talk to non-state actors, how do we try to, how can we manage to convince them of the value of immunization? That is sometimes quite complicated, yes. And sometimes very simple solutions actually are probably the best in the case of Afghanistan. If you have someone from the Taliban who doesn't like the idea, it's something from the West, et cetera, what you do, you make sure that, for example, that's what I tried to do and managed a few times, you make sure that he takes his sum, okay. We talked to his sum, you can tell him, you may not be interested in that, but you're certainly interested in the well-being of your sum. And that usually really brought this debate about yes or no vaccination to a very abrupt end because it was very clear. I think it's also about responsibility leadership. So small personal things matter. If I could wrap this up, and with one of my own observations, maybe a corollary to where we started with Sutton's first law, and that would be if we ought to focus on the obvious, then maybe we ought to also take a little bit sharper focus on the obvious low-hanging fruit. And so one of the key roles of leadership is to make decisions and let's decide there's some things that can be done very quickly to great effect and let's do them. So thanks very much for your attention and thanks to the panelists for their views. Thank you.