 Mae'n hyn i gael o'i gweithio ar y cyfrifio. Dyma yn ymweld, mae'n gweithio'r gweithio'n gwaith. Mae'n meddwl bod yn gweithio'n gweithio. Mae'n ffordd yn rhoi ymddangos ymddangos yw'r gwaith, efallai ei wnaeth eu cyfrifio i'r gweithio. Mae'n meddwl i gael o'ch cyfrifio i'r gweithio'r gweithio, i ni'n meddwl i'r wath, i ni'n meddwl i'r gweithio'r gweithio, we had at the start of the COP process, and I know some people wondered whether or not it would be an effective launch to this convergence of policies, but frankly, as someone who's pretty cynical about some of these things, I thought it was a really excellent launch and credit to the organisers, to the presidency, the UE presidency of the COP process that they got this going, and so this session is very much to follow on from it, and we're now past the stage of polemics when it comes to the issue of AMR, and now that we recognise that the impact of climate change on antimicrobial resistance is significant, whether it's through flooding and therefore, you know, people are having to move from their homes, the increased urbanisation, and the fact that microbes, of course, are much more prevalent in those situations, or the fact that the increased temperatures, of course, mean that the evolution of resistance is actually accelerating, then what we've got to do is look very seriously at how we deal with AMR in this context of climate change, and the reason for having this session today, and I want to thank Glyde, Simon, I know you've had a busy week with everything that you've been doing on the last mile initiative, and also Najat for the International Atomic Energy Agency, who we work very closely with at the G20G7 health and development part, and indeed Najat is one of our global ambassadors on global health and development, so thank you for your support on this. But the aim really, I've got to be honest with you, is not to have a nice afternoon discussion about AMR. We've got 12 months coming up where, in my view, either we make concrete progress, or we will have missed a massive opportunity. And so, for me, as a former politician, and as chair of the G20G7 health and development partnership, we see next year as an important year of convergence around a very small group of recommendations of action on AMR, and then for us to work together as multi-agency, multi-organisations to get some political action to make sure that we can actually get progress in tackling AMR. And I can say this because I'm an independent figure. But, you know, we put all of the work in to get the resolution out of the UN high-level meeting this September on universal health coverage. And to be honest with you, it was a big sigh of relief that the thing got agreed, but the question is what differences is it going to make on universal health coverage? And frankly, if September of next year we have a similar high-level meeting on AMR and we end up with a similar Christmas tree of a resolution, then we will have missed a massive opportunity. And the other thing that is critical, of course, in the difference is that we also, as well as having the high-level meeting at the UN, we also have the high-level ministerial meeting in Riyadh in November. And so there's a series of initiatives next year where we will be able to try and ramp up the political pressure to try and make sure that heads of government and ministers and parliaments actually take action in this critical area. We've got the World Health Assembly meeting in May, there will be the Commonwealth Heads of Government meeting, there will be the UN General Assembly high-level meeting, and then we'll have the ministerial meeting in November. And I think if we get to this point next year, we've got to be clear that we've got a set of very, very concrete actions and we know how we're taking this forward. And some of our speakers will talk about what those actions have to be. We don't need to revisit all of the evidence, we know the scale of the problem with antimicrobial resistance and we know the path that it's taking. It's now time for us to agree on those limited number of actions to deal with. So we've got two presentations or comments first and then we've got an incredible panel and I'm conscious of the time. And the first speaker is Najat Mokhtar, who's the Deputy Director General of the International Atomic Energy Agency. Najat heads up the work on health and has been a fantastic champion, not just on AMR, but on so many of the other issues. So I'll hand over to you, Najat. It's a bit tight. And good afternoon everyone and welcome to our pavilion, Atoms for Climate. And very happy to have you here and a follow-up on Alan's introductory remarks about AMR and the role of each one of us to promote the action. I think we know the issue but we need to have coordinated the action about how we tackle this issue. I'm happy that for this gathering here at COP28 that climate change and health has been tackled and been a declaration. As you have said, that at least it's a beginning and it's something that we need now maybe next COP that we have some funding that follows and AMR is also on the list of action to be followed up. Maybe some of you are wondering why the IAEA and what is nuclear power as you see in that to do with AMR. But you know, we are technical organization, we are offering technology to tackle many global issues, particularly sustainable development issues. And when we talk about antimicrobial resistance, we are working on that because we need science, we need data, we need to understand what is happening. And if we have action, we need to monitor it. We have labs and we hope that next time we will have the meeting in our facilities and see you there in our labs. We are looking at AMRs in the soil using the technology about how much is in there, how we can monitor. We are looking at AMRs from animal health perspectives. We are looking at AMR in the environment, in air, in water. And we are developing technologies to really make sure that what we are measuring is correct and appropriate. But in addition to that, we are transferring this technology to member states, 174 member states to really make sure that this technology is being used properly and data provided are accurate. This is very important. We are talking about artificial intelligence and we need data for artificial intelligence not to only assess what is happening now in the world, but what's going to happen through modeling in the future. And this is, I think, where IAEA can be a major player because we are good at database. We have many and precipitation underground water, surface water. We have labs, network of labs all over the world, 148 laboratories on animal health. We have 146 laboratories on veterinary vet lab network, one of the biggest. And also marine environment laboratories where also we assess marine environment. Underground water also a network of laboratories. And I think the group can use this network and these possibilities to really gather as much information as we can. We are doing our best and I think together we can do more collaborating together. And it's about that, it's about coordinating who is doing what and how we can complement each other, not repeating. Of course we need finance because when we do science and research, I think the finance goes down. And particularly when we talk about IAEA, but we are happy to collaborate with WHO, with FAO, with anybody who want to talk about science and technology because we are a technical organisation. We can work with anybody, private sector or anybody. I'm very happy to be, I mean, championing these these calls and we do whatever we can really to bring solutions on the ground. And I thank you. Thanks Najat and you know lots of people don't realise the outreach that the International Atomic Energy Agency has. And we've certainly been working very closely with you for the last few years. I mentioned that the high level ministerial meeting that will be held in November will be in Riyadh, but in the work that we've been doing in the partnership we've been incredibly impressed by the Public Health Authority in Saudi Arabia and visited many times the facility there and the quality of the scientists and the team that there is incredible. And Dr Abdullah Al Ghwizani is the CEO of that group and we've had a couple of opportunities to have an exchange of views and I know you've got very clear views now on the role that Saudi Arabia can play. And we really hope that beyond the ministerial meeting, Abdullah, that beyond the ministerial meeting you will or Saudi Arabia will continue to champion AMR and we hope you'll champion it through on to 2030 because we need to have some wins when it comes to the sustainable development goals. So please we'd like to hear your remarks. Thank you, Alan, and thank you very much to be part of this lovely event, lovely group and important topic. For sure the climate change and the impact on AMR, it's an important subject. It is the impact of climate in terms of on the AMR. It's one of the hot topic and important to be discussed. The climate and the change around the world will and has been, enhance the urbanization and enhance the human animal interface and human victor as well interface. And that's, for instance, has for a reason or another increased utilization of antimicrobial in healthcare facility, especially in country that it has no policy to regulate in AMR. So in a way or another the climate change, it has an impact on the antimicrobial resistance and may enhance it and that's need to be taken in action and also need to be recognized. Though there is also chance and knowledge need to be filled and how really the climate in the molecular level has changed and how can enhance the resistance. We at Saudi Arabia, we took the two topic at a very importance. We do have a big initiative in Saudi Arabia in terms of climate. We do have the green, Saudi green initiatives with 77 initiatives that's really with ambitious goal and also a pledge for net zero by 2060. In term of the AMR, we do have a one health approach in various parts of our work and what we do. National organization in Saudi Arabia like Public Health Authority, Saudi FDA and National Center for Animal Disease. In their board of director, the multi sectoral part, so represented from various part of organization. So it's debruted in the DNA that not only from organization but also an implementation as well. We had a national action plan and we are one of the few country that they have actually budgeted a national action plan and that's actually we updated it in 2021 with targeted goals and objectives and luckily we are implemented it in a multi sectoral. Not only in government but also private sector and the third sector. We took AMR in a very serious manner. We put AMR as a priority in the G20 during the Kingdom presidency in 2020. We put it also, we play a pivotal role in global health security agenda as the steering group and we work through all these initiatives and plans to enhance AMR in the agenda. Lastly, the Kingdom is, as you mentioned Alan, hosting the high ministerial meeting in 2024 in November and we would like to see you all there and with the ambition to have a very bold targeted outcome and build on the successes of the previous high level ministerial meeting. So it's clearly that a lot of work needs to be done and there's a very busy 12 months as you mentioned Alan. Thank you very much. I don't know whether there's a microphone lurking around here somewhere. No, that's a click there. Someone's sitting on it. Oh you've got it. An incredible panel of people who've joined us today and this is to demonstrate the already the level of cooperation in how we move forward over the next 12 months and I'm delighted that Haile is with us who is running the administration for the quadruparitite organisation at the World Health Organization and this is to get the multi agencies within the United Nations working together whether it's animal health or food you know obviously the World Health Organization and others and Haile's got an incredible backstory in dealing with things like HIV, AIDS and so forth. So he's the ideal person to do that so thank you for joining us today as the director of the quadruparitite secretariat. We've got Simon Bland as I mentioned who heads up the global institute for disease elimination in Abu Dhabi and then Klaus Rung who's the senior vice president for public affairs and sustainability at Bayer and they do an enormous amount of work not just in human health but also in agriculture which will be interesting to hear his comments. We've got Amar Abdu who's the manager for human development at the Islamic Development Bank and thank you so much for for joining us because again ISDB with I think what 56 country shareholders of 57 countries across the Islamic world representing many billions of people and obviously that that development bank plays an important role in this community and then Thomas Taylor who's the head of climate finance at Aviva investors. Thomas thanks for being here and obviously these initiatives that we're looking at not just on AMR but many of the initiatives we've talked about when it comes to global health and climate change we need the private sector to be involved in this and obviously your comments are important and then David Rippon who is the executive vice president for the Clinton health access initiative and the chief scientific officer so we've got this fantastic array of experts and thanks for joining us and so what I'd like to do is just to pose a few questions we've got a microphone there which assumes functioning and highly perhaps we could start with you if you'd like to join us here and I guess the question is how can the quadripartite AMR secretariat coordinate actions among the four international organizations and what specific initiatives are you currently working on that could take AMR the whole AMR agenda forward. Thank you thank you Alan and good afternoon everyone and it's a pleasure to be here and I'm representing us Alan Sage the quadripartite joint secretariat on AMR which is a standing secretariat of the four organizations food and agriculture organization the world animal organization the UN environment program as well as the world health organization and it is a standing secretariat based in WHO and in fact it was established following a request of the secretary general to the principles of the that time the tripartite UNEP wasn't officially you know joined us in 2018 when the secretary general received the report of the interagency coordination group that was established following the 2016 political declaration as one of the action of that report of the ISG was that the tripartites at that time need to step up their function to actually respond to the multisectoral needs of AMR so as part of that the secretariat was established and when it was established it was established as a functional arrangement what I mean as a functional arrangement is it's at the goodwill of the principles if one of the principles say AMR is not my priority this secretariat may not exist in its current shape so that is why we are actually really looking forward to the Anga high-level meeting next year which we are also you know supporting us quadripartite the co-facilitators of you know Barbaros and Malta is the actual recognition of this secretariat because we have built a functional arrangement without creating a new agency we are not creating a new agency we are actually capitalizing on what is already there and making sure organizations share vision and have common goal and work together on a daily business the secretariat has of course am a director but we have also core staff and liaison officers from the four organizations paid by the organizations they contribute staff time and not only these liaison officers work on a daily basis but they also work by mobilizing the technical capacity of the respective organizations we have clarity of the function of sector specific so for example Fao will be focusing on agrifor system on animal health unip on environment and wh on human health and bringing this clarity and working together as a platform is important but at the same time we've been also working to strengthen sector specific response in human health in animal health in agrifor system as well as in environment and that has been actually a major a major achievement of us because we have developed a strategic framework with clear division of labor and also massive massive progress over the last four years since the secretariat was established as part of the secretariat we are also supporting the global leaders group which is chaired by her excellency prime minister Mia Mormotli of Barbados has been an ardent advocate and supporter of AMR and we have active ministers and former ministers and heads of agencies in the global leaders group which is balanced actually across the sectors it's a we are very careful that this response since it's a one health response we need to ensure that all sectors are equally represented in this type of bodies and that has been you know critically you know important for raising the political profile of AMR just to give you one example about the high level meeting when the geology starts their function in 2020 they developed a plan of action with key performance indicators one of the key performance indicators they put at that time was to advocate for anger high level meeting either in 2024 or in 2026 and that has been pursued and then in march 2022 the general assembly actually you know put a resolution for high level meeting in 2024 and I can list all these key performance indicators which they are actually strictly following and implementing and the other thing also we are bringing sect different you know stakeholders civil society private sector and also you know governments and in addition to that we established also the partnership platform which brings all these three entities into a common goal and it's been actually established and follow as part of the secretariat is taking lead and it was established in mid in November where now we will have action groups action groups of different stakeholders based on their own initiative and vision actually to share common goal and common idea how to move forward and one of the action groups that is established is also how to make the anger high level meeting much more you know action oriented and as Alan said earlier there is real discussion and the geology is also discussing because the resolution the anger resolution that calls for the anger high level meeting actually mentioned the geology to work with the president of the general assembly and the cof facilitators to organize this meeting so the geology as one of its key strategies is looking for you know a very specific you know commitments with actionable language and responsible stakeholder we've been doing analysis of the commitments from the 2016 you know there were eight commitments and it was very clear those commitments with actionable language with the responsible stakeholder are implemented all those with lose soft language they are not so we are actually working towards that and really raising and we hope the global amr community will unify its voice and that is critically important having divergent voices at this critical stage will be extremely missed opportunity so our hope is that the global community will focus really to identify those five for example specific challenges with specific commitments thank you very much thanks very much highly and that's why he's head of the secretary I don't know whether the the these microphones are working are they okay they are that's fine in that case you can hand the microphone back because we're going to give it in a moment to to amar I mentioned that Simon runs the glide organization and I was at an event with with glide the other day where you know you really are designing your organization to be the nexus of health and climate change and I know that you're going to be conducting some further work in the next year so perhaps Simon you could talk about that about how that might be relevant to amar and then the other thing of course is how do we need to improve surveillance mechanisms to make sure that for example when it comes to amar we've got better data for the future so over to you son Alan thank you so much it's great to be here highly it's great to see you again congratulations on all your work I was lucky enough to work with highly as a member were we the interagency task force I can't remember what we were called a group that helped set up the tripartite and the quadrapartite and I contributed to the O'Neill commission that looked at the economic cost of amar I now have the privilege of calling the UAE home in Abu Dhabi at the Global Institute for Disease Elimination where we look at disease elimination and we think about malaria a great illustration of resistance both antimicrobial resistance but also insecticide resistance and the challenges there but polio and neglected diseases and as I thought about amar and climate and NTDs they all have a common feature they all are epitomies of market failures they all have inadequate incentive structures to to tackle them and they're all going to demand collective action that isn't easy and it's actually if you think about Garrett Hardin's tragedy of the commons which itself was based on Aristotle's work we're dealing with a really ancient problem here which is how we get collective action and get rational decisions for collective action which at an individual level might not make sense not so very long ago the chances are you would die of an infectious disease over the last hundred years that made that less likely science modern medicine meant that you were actually much more likely to succumb to a lifestyle disease um but then we saw a north south divide and in the south you still had this high burden of infectious disease and a growing burden of ncds and so you had this inequity really pulling the world apart along came covid and started infecting people in the north and killing your people in the north and we saw this relationship of comorbidities with with chronic illness and a new infectious disease and i've just come from a dengue meeting one of the neglected diseases and we're seeing exactly the same as dengue spreads largely due to climate change as dengue spreads into adult populations in adult populations that have chronic illness their outcomes are likely to be pretty bad so more than ever it looks like we're in this together um despite that science and progress what if the drugs don't work what if that science now we we lose and this was uh uh you know sally davis book and others and uh people used to go to hospitals you know it was a place to die and then we'd go to hospitals as a place to be cured and as a risk we go back to hospitals again if we don't have the drugs that we need where it becomes an end of life situation so i just want to basically say a couple of things alan if i may the first is um ohulio frank said if we stand still we go backwards so we can't stand still we need a pipeline of new of new tools of new therapies of new prophylaxis of diagnostics which i'll come on to in a second but we have to think about equitable equitable access okay a lot of the world has excess use talk antibiotics and misuse of antibiotics and a lot of the world doesn't have access to antibiotics so we still have that north south divide so equity has to be a a a key point a key principle of the work that we that we work on um we must bolster r and d to develop the pipeline um and we need a pipeline of tools to help with advocacy because if advocacy is just about problems and challenges and need we're not going to get to where we need we need to go with advocacy with with solutions and tools and opportunities so we need a massive input of r and d to give us the tools we need we don't know enough about the interface of health and climate change gliders just commissioned nine pieces of formative research to start to understand better particularly vector-borne diseases and and climate but if there's one thing that i think the world could use it would be a cheap rapid point of care multiplex diagnostic tool that would allow you to test and surveil it would allow you to look at changes in endemicity and spread of disease it would allow you to diagnose correctly and understand where to treat where not to treat essentially i'm talking about precision public health and what the west could do now not worrying too much about this development assistance for health but is really help invest in global knowledge for public goods that allow that precision public health thank you Alan thanks very much Simon and uh and we'll be looking with interest at the reports that you've commissioned during the course of next year and as a as a member of the G20 G7 partnership we'd like to help you with that so on the the issue of precision medicines class from from bear and this idea particularly of a a diagnostic i mean where do you see the pharmaceutical industry going during the course of the next couple of years yeah thank you for the question and and thank you for for the invitation to today's panel um let me just go back in history i mean our company is like 160 years old and and one of the first antibiotics really was invented by a Bayer researcher do mark was his name he introduced sulfonate sulfonamides in 1935 drastically cutting death rates for some infectious diseases and we've been in antibiotic research since then but roughly 15 years ago we decided to stop research in this end development in this area we still have we still produce existing antibiotics in our portfolio but to Simon's point um there is somehow a lack of incentives so the market doesn't function as other markets do so usually you would develop a new antibiotic would bring it to market and then usually people would say hmm let's have it last line if the others don't work so you have very small volumes and then you cannot really recuperate the the investment that you have had into r&d and it's not just the case for for large companies such as ours is also the case for biotech companies so if they go and find venture capital the venture capitalists would say well i would love to invest into pharmaceutical r&d but better not in antibiotics because afterwards should you be successful the return on investment will not be so sufficient and i think there are discussions that we've seen of the past few years to improve the situation we as Bayer have come back to the table indirectly so we have given roughly 50 million euros together with our industry peers into a fund the AMR action fund the antimicrobial resistant action fund we've collected roughly a billion with actually three goals the one being investing into small and mid-sized companies helping them to develop new novel antibiotics so the goal is to get to two to four by the end of the decade secondly to build partnerships to to help building partnerships in the ecosystem especially also when it comes to proper use of these these treatments and thirdly it's also advocating and we see first signals that decision makers react upon it so we see for example that in in the EU there is discussions around granting an extra year of extorsivity to a product if if you successfully develop an antibiotic and you can transfer it into other into other product categories making it commercially attractive other things like in the UK would be that you have subscription models so you it's a flat payment annual fee so to say for endless use unlimited use of a novel antibiotic so i think we need these kinds of mechanisms to to make it more attractive and if i might just end on the vector born diseases so in my work and as of January i will be responsible for for the commercial business also in 30 countries covering 1.5 billion people but these countries are the countries where we are not present as Bayer it's roughly 30 countries worldwide where we are not present so and these are the countries in the global south that do not have the proper means and as a company we have a range a broad range of products that are also fighting neglect the tropical diseases chagas river blindness african sleeping disease and others but again it's it's the same issue in terms of there is no market so you have to partner you have to partner with governments and other institutions to to make it a viable case going forward because ultimately the burden is super high i mean every year 1.3 million people die because of antimicrobial resistance and if if we are on the wrong track it will be 10 million by 2050 so i think also industry coming back to your question and has understood the message that we really have to add and that's why we have somehow reinvigorated our commitments by at least financially building this this pool of money for smaller and mid-sized companies to do research in the field thanks very much clausen we really do count on the pharma community to to step up to the plate on this issue and as you say it's very sad i mean i meet small small and medium-sized biotech companies who've chosen to move out of the research and development in AMR tools because some of them have gone bust having worked and produced something but then there's no market so on that point we've got ammar with us from the islamic development bank and i have to say ammar under the new president of the of the bank and with you they're doing the work you're doing it's incredible to see how the how flexible the bank can be in supporting initiatives on climate change and also on health and i know you've got some financial mechanisms that you've been using to support initiatives amongst your 57 countries and i just wonder if you'd like to say a few words about what some of those innovative initiatives are thank you allen as usual it's really a great pleasure to to see you and thank you for all the organizers those who are behind the scene julia and hattis i think and thank you for for being here i think we have a key partners here so the arabia one of our member countries the big share the biggest shareholders so and a key partners also i a and uh who so and other also partners from the private sector so thank you very much it's really a pleasure to have all of you so uh i will start by by saying that the bank has increased its its support to um to the climate change uh since it has been identified actually by our 50 seven member countries as really a big challenge but in same time we are trying to make it an opportunities for them and so how we are going how we are trying to make it an opportunity across three main areas the first one is promoting the health infrastructure so to be like more resilient so you know so reusing your own renewable energy clean technologies and and so on this is one and the second also to enhance the mitigation the resilience of climate risk related to health so and the impact the interaction is is for us too obvious and also the third one is to promote to mitigate the environment at the environmental safeguard so contributing to uh to the uh to the health issues uh so on strategic level let us say like uh there is one strategic direction that uh it has been signed in Qatar during the world cup last year in november with the who director general related to the anti-microbio resistance and we have signed a strategic framework agreement trying to address i am our through the one health spectrum actually so through health human and and then environment and we have two let me say to be practical we have two activities that have been identified the first one is to develop in and implement with the who the anti-microbio resistance stewardship program to enhance the capacity of our member countries in terms of fighting against the amr or preventing them and the second is to provide lending to the member countries that will be requesting to improve or to create their national public health laboratories you know it's a network from central level up to downstream so these are the two keys activities that we have agreed with who to walk together across the whole at at global level but also at regional and at country level and the person that has led that discussion is actually uh she's not here but i'm asking my colleague dr helesius to to convey to her our our greetings uh is dr hanan el-bachi so the new the new rd for immro region actually she was the one as assistant dji at that time in charge of amr so we walk together very closely and by the way during her appointment in october in caros she told me amar why you didn't tell them that i'm the one that has prepared that that strategic framework agreement uh so now in terms of financing in terms of financing we are offering here i will list a three practical uh let us say uh framework that we have put in place the first one is at global level with who and which is the health uh you heard about it maybe the health investment impact platform so this platform is its objective is to invest in a healthier features and mainly targeting the primary healthcare and you know we have to start from there so and uh this investment has been uh actually approved by who and signed and we are a contributor with the african development bank with the european investment bank uh the inter american development bank and the um and the asian development bank are joining us too so uh this will be one platform that could support all member countries that we'd be requiring to uh develop and implement dear uh their agenda related to amr the second one is related to the member countries that may be requesting a direct support so a lending directly so we have uh this facility i think you heard about it which is the lives and livelihood fund that is available and we are supporting also here thanks also to our donors uh so uh the saudi fund uh for uh so the uh sorry the king salman humanitarian center uh we have a would-be fund for development we have catarfor for development and uh they are uh and co-ed fund for development so we are supporting our member countries by providing them a grant element that is rendering concessional any lending that we will be providing to them so depending on the countries it's varying between 15 percent up to 30 percent of a grant element uh now i will be going to the third one which is the uh the private sector so private sector also we have not forgotten you but we have a joint initiative at continental level with the african development bank you have heard about the health industry financing of the african development bank and we have joined the african development bank in a deep dive exercise not only deep dive exercise but also in business development in the member country so we started by north africa actually we had last month uh no two months ago in october we had uh our first mission business development mission in egypt and the next one will be in morocco in november and then we will move to the sub-saharian countries so uh this and in this regard so we are provided we are thinking of providing line of financing to major banks in in our member countries to support uh either SMEs or to support uh the big pharma industry in terms of of of producing uh and and also not only that at the biophile but also we will be supporting all the the blockchain all the the the valuation so the all the chain so uh so this are the the three financing that uh it comes to my uh to to my mind here well with you but we are happy also to discuss uh new financing as we go uh with our partners i a uh w h o and for sure the g 20 g 7 team that have already been there has always been there to to support us in in in our discussion and this high level uh uh think thank let us say you are really a think thank island in this regard thank you yeah we're very proud to be a knowledge partner with the um the islamic development bank and as i say under the new leadership of the new president and also of amar it's we're seeing significant uh difference in the way in which the isdv is operating so talking about the involvement of the the private sector that seems to be an appropriate point tomas for to ask you to say some uh some remarks here um and what i'm really interested in is obviously we had the uh covid pandemic uh how did that how has that impacted private investment in health and what you see the prospects of picking up some of these innovative health initiatives that we're hearing about this afternoon and aviva's involvement in those sort of things thank you um allen thank you for um inviting me to to join this i think um the the intersection between between health issues and climate issues uh as allen as others have have said is is is well established and i think unfortunately the covid pandemic has brought home to the world the the financial and global impact of a health crisis um and what we see um as we as we look at this issue is that um the sort of silent pandemic as sally describes it of of of amr is is is no different in terms of its potential impacts across the world particularly from it from a financial point of view um we've heard from from simon and from claus that it represents a market failure um the incentives not being right but it also represents as climate change does a macro financial stability risk so a threat to the stability and integrity of the financial system um because because without as well as the um the the issues sort of relating to acute diseases as you described simon in terms of hospital uh admissions and so on actually the um the health impact on productivity of antibiotics not being available would be an enormous hit to the global economy um with estimates of 100 trillion by 2050 being wiped off the the global economy which is essentially equivalent to global GDP um so this extraordinary long-term hit uh to productivity that could be um could come from amr um so not only is it a um a macro financial stability risk but for us as um a financial institution that offers health insurance that offers life insurance and that holds investments um it's uh it's a threat to uh to us on a on a financial level two we saw in 2021 with the pandemic an enormous hit to uh to financial valuations and then unprecedented stimulus three times the amount that the 2008 financial crisis um was uh um the stimulus in in 2008 was put in to to prop markets up and ultimately governments don't have the fiscal headroom to do the same again so this is something that we've got to avoid preemptively and that's why we need action to um to protect the integrity of the antibiotic system of the health system from the spectre of um of antimicrobial resistance and um that's why we need global leadership of the sort that we're hearing described on the on the panel um the uh the g7 has has stepped up the g20 stepping up so seeing um finance ministers in the g7 talking about the pull incentives the subscription models um that we've heard from from other panelists because we do need novel antibiotics and the industry needs the security of predictable financial support to bring those to market and as as claus was saying to allow them to be held in reserve as as antibiotics of of last resort um so this is huge incentive on us as a business and on the financial community in general to act on this issue um and um there's there's a variety of ways that we can we can do that one is in our portfolios we own healthcare companies and we can we can engage with them and encourage them to both protect um the um the integrity of of the the bringing um novel antibiotics to to to market but also the production and make sure we've got responsible production and stewardship of the of the antibiotics and particularly in production the um the the the the risks associated with with waste produced um but also across different sectors so for example our engagement with the agriculture sector uh and looking to avoid the prophylactic use of anti um of antibiotics and dealing with waste from um from agriculture in the food industry so we're seeing big international brands like mcdonald's like domino's like yum brands making commitments to ensure that antibiotic use is responsible in their supply chains um and then globally we the financial industry has a voice in um in engaging with governments and policy makers to make sure that we get the um the the things that we we need on this issue so in the context of climate change um a huge amount um is is is set on the work of the the body of scientists so the the intergovernmental panel on climate change the reports that they produce um are the sort of the um the the touchstone of of the science on the issue and and our belief is that we need the same to broaden the um the knowledge base and create capacity building across the on on on anti um microbial resistance um we think also learning again from from climate change and and atmospheric science the way that one of the success stories for climate change is the way that the montreal protocol um has largely dealt with the problem of the whole in the ozone layer one of the reasons that worked is that there was a system where rich countries gave financial support to developing countries to phase out the use of cfcs we believe a similar model could be used in terms of protecting antibiotics from prophylactic use but the key is the finance mechanism as it was in the montreal protocol needs to be there so those sorts of issues are things that financial um financial bodies can can can bring into the discussion at both the micro and the macro level thank you thank you very much and we're going to be following up certainly on that last point with you because uh this is i think this is going to be the crux of the the issues we try to get more investment i'm conscious that that highly has to disappear at some point because he's rushing off what to get a plane but um uh before he goes i wanted to um just ask david rippon from the the clinton health access initiative who's chief scientist and executive vice president if you'd just like to say something about this issue of the i don't call it equity i call it justice the fact that we've got uh you know a large part of the world that doesn't get access to any antibiotics while we're talking here about new tools and i just wouldn't have given your experience david what's your uh what's your view on that and what's chai doing in this area thank you so much for inviting me and simon i'm going to pay you for setting me up so perfectly a little bit later um sally davies joined our board of directors of directors and sally doesn't ask sally tells um and sally told us we will be working on amr in in in all serious though the lack of a collective market action is half of the market failure issue we have we have a global fund to fight aids tb and malaria and we've seen increases in research funding and development of hiv medicines tb medicines and malaria medicines there is no global fund for bacterial infections now we've also learned from the global fund that we need to be thoughtful of how we transition beyond a funding mechanism and uh you know we have patients in the market right now who are willing to pay for treatment so you know i i'm not advocating a direct copy of the global fund model however the global fund enabled a large number of countries across the low and middle income spectrum to collectively act and signal demand and collectively procure and execute both diagnoses and treatments um which has fundamentally improved the shape of the market and we see suppliers entering those spaces with new products to compete i i also want to say you know fundamentally um i struggle with the concept of stewardship because uh you know in a way the the way i hear it at least is uh a bit of protecting our arsenal against uh bacteria becoming resistant fundamentally if a patient gets the wrong treatment or takes an antibiotic presumptively the biggest failure is our failure to that patient to appropriately diagnose them first and treat them second um you know as a parent whose child woke up with ear infection and screamed you know i i was guilty of this i went to the doctor and i was not going to leave without an antibiotic i should have demanded a diagnosis um and so um uh as a result of the lack of the global financing mechanism a lot of bacterial infections are treated in the private sector but we actually have some experience with this in the malaria space where many years ago patients were going into the private sector and buying exceptionally cheap ineffective anti-malarial cost of roughly a dollar or less to the patient we had a wonderful new discovery the artemisen and combination therapies that cost roughly 10 dollars and patients didn't have the incentive to do it we developed a mechanism called the affordable medicines for malaria uh or AMFM now it wasn't executed perfectly but i think there's a lot to learn and at the end of only a few years of programming and the mechanism there was a subsidy to suppliers to essentially bring the cost of those acts entering private sector supply chains to the same prices the ineffective drugs we have seen a wholesale shift in consumer behavior in the private sector and now that that mechanism is over acts still predominate as the product patients go out and buy i think we need to think about that in the context of AMR and so i have one specific program where i am most failing the patients who are coming to our programs and that is our malaria program now we've set out to eliminate malaria um and i think this is entirely relevant to glides portfolio into your comments on a variety of neglected tropical diseases as you approach elimination from a ministry of health perspective i have very few patients who suffer from that illness and i have quite a number of other issues and consequently my level of resource and focus comes down on the program side i now have 99 out of 100 children coming in with a fever who have a negative malaria rapid test result and i have nothing to do for them except send them on their way perhaps take a few antibiotics presumptively and call me if it gets worse if i had a financing mechanism then that is the poll that's the impetus for training healthcare workers to use exactly that point of care diagnostic that you're dreaming of and i'm going to start picking up the neglected tropical diseases in low prevalence because i'm going to do i'm going to have a principle of diagnose first treat second that's going to drive not entirely the the financial incentive you need but more predictable market behavior on the demand side of the market so ultimately um you know this is what i advocate let's look from the patient perspective i think we need some type of pooled collective action it may look more like a an episodic insurance scheme or something of the like but um you know we need to think about that poll otherwise you know wonderful developers and organizations putting resource into bringing new products to the market push them into a vacuum and right now it's a lot cheaper to buy an antibiotic than it is to buy a diagnostic test result so if i'm a patient i follow the economic incentives in order for me to rewrite an economic model which incentivizes the principles of stewardship uh we need that collective mechanism so thank you thanks very thanks very much david and i want to thank i'm going to ask teacher our executive director just to see a few words and summing up but i want to thank the whole panel the purpose of this uh meeting was to in the context of cop 28 was to demonstrate how many different organizations from government to not-for-profit organizations to the private sector are prepared to cooperate uh during the course certainly of the next year and one of the things we will do was the g 20 g seven health and development partnership is to very much work with you all to try and get some really concrete ideas here and um uh highly i hope you've got some food for thought to go back uh when you when you travel back to geneva and we will all want to continue to support and work with you uh to make sure that it's a really successful um 2024 so with that her teacher if you'd like to just conclude our session good afternoon everyone um i hope you're not cop fatigued thank you for the amazing uh discussions there was a reason why we brought this eclectic group together because you all um represent the global economy ecosystem in every basically part of um the activities that you do and what what we heard when alan and i arrived here and cop on friday is that everyone agrees on what to do actually and that was mentioned even in your panel class a few days ago but um no one really talks about how to do it and i hope having had the first health day as well at cop this year uh we walk out of this and especially you sitting here to really discuss tangibly how to put policy to action and just a few reflections and um then we will close off the session for today the late henry christinger said the contemporary structure of international norms and rules if it is to prove relevant cannot be affirmed by joint declarations it must be fostered by a matter of common conviction and i think you guys have the common conviction and that's what you can show in in the next few months but we heard from hailey uh w h o that um the un sg un secretary general and the leaders group have to not create another plethora of communication but an action oriented recommendation pipeline which we will strongly support as the partnership we heard from simon the power of science the power of testing to treat properly and um the threat of entities in the next few years uh affected by climate change claus we heard that obviously incentives are hard in the market but you also said that there's appetite again from your pharma company and others to invest into the antibiotic pipeline which is good news ammar you uh have actually amongst other 500 international development banks um there are around 500 banks national development banks and multilateral banks worldwide uh under asset management together combined you have at the moment over 22 trillion of funding so if you were to work with some of these folks here you could unlock loans and grants uh in blended financing uh conditionalities going forward so no pressure there and uh david uh you said it's actually now cheaper to buy uh an antibiotic than a test i think that's something that Saudi Arabia can look into to see how we can bring a better testing regime in to strengthen stewardship for next year for your ministerial and um thomas you said that um that there is definitely a macro financial stability risk here so i think there is a key responsibility for the investor community and the asset management community and insurance sector to work closely with uh the health community and the climate change community to build a better infrastructure because i mean i if i was an investor in a low and middle income country i wouldn't want to create a new plant and business if there is a risk of water being contaminated by ammar and my employee is being affected long term so we have to think of the whole cycle that's what you outlined here and Najad last but not least you spoke about the power of data and the last day's conversations were all about the lack of data in this space especially with health and climate change related risks looking at ammar as well and that's um i think what we are focusing on as the g20 partnership like allen mentioned in the beginning how we can bring better surveillance and data gathering in this space uh by putting politicians also and giving um at the centre and uh creating better accountability mechanisms between um policymakers governments and the private sector i didn't do enough justice to summarize the great value of these discussions but i do hope it triggers your brain you're going into the christmas holiday period so lots of time to think and start the new year with hopefully new partnerships and i think that shows a great way forward thank you for coming today