 Good afternoon and good evening here from Singapore. Welcome to the Doubles Agenda 2021, which is a series of virtual meetings across the planet to discuss some of our biggest challenges facing all of us across the world. My name is Warren Fernandez and I'm Editor-in-Chief of The Straits Times here in Singapore. I'm also President of the World Editors Forum, which is based in Frankfurt. And I have colleagues from around the world who are also joining virtually. And after the focus of our panel, which is on building crisis resilient healthcare systems in a post-COVID-19 world, it's really on the global response to COVID-19 crisis and what learnings we might take away from that to help us prepare for future challenges that might come. And to tackle this subject, the WEF as always has put together a very distinguished panel, a group of leaders who are active in this field. Let me just introduce them very briefly. First of all, we have Pascal Soryo, who is Chief Executive Officer of AstraZeneca. Then we have Katharina Burm, who is CEO of the Foundation for Innovative New Diagnostics. Thirdly, Kevin Washington, President and Chief Executive Officer of YMCA-USA. And last but certainly not least, Maazan Dawaze, Executive Vice Chairman and President Middle East and North Africa for Higmar Pharmaceuticals. Thank you all for making time to be with us. I'm sure we're going to have an interesting session on this very important topic. It happens almost a year to the day when cases of viruses started popping up all around the world. In Singapore here, the first reports in my newspaper and others was on January 23rd. And what a lot has happened to all of us in that time. We've had multiple lockdowns to flatten the infection curve and to help our healthcare systems cope with the outbreak and prevent them from being overwhelmed. We've had national and state level travel restrictions and the closing on borders, quite counterintuitive in our globalized world. And we've had the rapid efforts to find a vaccine at warp speed, which was nothing less than a tribe of human ingenuity and collaboration. Unfortunately, the rollout of those vaccines and the general global response has not been so salutary. It's been less global, more national, less cooperation, more contention and division. The WHO panel on pandemic preparedness said this, despite the brilliant shiny examples on every continent of human ingenuity in response to the virus, we have failed in our collective capacity to come together in solidarity to create a protective web of human security. In diplomatic speed, that's quite an indictment. But we're not here to point fingers or fort fine or assign blame. I think the purpose of our session today is really to see what learnings we can take away from what we've experienced to help us prepare for the next crisis, which will come inevitably, whether it's another pandemic or the dreaded disease X or something related to climate change, for example. And this is what I've asked each of my panel members to start with, to share with us very briefly the two or three big ideas that they think we need to focus on to help us do better for the next crisis. And I'd like to start with Pascal, please. Yes, please go ahead. Yeah. Do you want me to? Did you have a question you wanted me to ask? Oh, yes. I like first of all, the broad question is, what are some of the things you think we can draw from the experience with dealing with COVID-19 to help us prepare for the next challenge that is going to come inevitably? Okay, well, thanks, Juan. And it's really a pleasure to be with you today, join the panelists and contribute to these discussions. So let me first of all say that I think globally, it's fair to say we could and should have been better prepared for this pandemic. There are many good examples of tremendous public-private collaboration actually in many countries. I think really what has not worked very well, in my opinion, is global collaboration and also, you know, better preparedness. So if we think about health care systems in the future and how do we invest and shape what we do to be better prepared, the first thing to do is to invest in prevention and early detection and early treatment. If you think about how the money today is deployed in the OECD countries for instance, about 3% of total health expenditure is spent on prevention. Only 3%. You know, we always say it's better to prevent and cure or treat and everybody will agree, but the reality of the numbers is that only 3% of health care expenditure is spent on prevention. 20% of this 3%, which is 0.6% of total health care expenditures, is spent on immunization and early detection of disease. So essentially, we kind of tend to wait for people to become sick to kind of try to address that as opposed to early detecting disease and preventing it. On the other hand, for instance, an example of a disease that where we spent all of money is chronic kidney disease and about 80% of chronic kidney disease patients are not diagnosed. So a lot of people have chronic kidney disease, they are not diagnosed and they get worse and worse and worse all the time until they end up quite sick, potentially in dialysis and of course becoming very expensive for health care budgets on top of the miserable life that they end up living being on dialysis. So again, investing in diagnosing those patients early, treating them early would be a much better investment of health care dollars. So whether it's, you know, viral infections or whether it's just other diseases, a lot more investment in preventions need to go. We also need to optimize, I think, the place where health care is delivered. There's a lot of reliance on hospitals and we need to try and shift care to the outpatient services to GPs in particular and a number of countries are doing this but need to increase that and rely more on digital tools to facilitate the treatment of patients outside hospitals. You know, digital innovation is really helping a lot. In our case, in our company, we have really leveraged digital tools a lot over the last 12 months, 10 to 12 months to help patients continue to be treated outside the hospital because they didn't want to go to the hospital and therefore were not treated properly. People who have chronic asthma, people who have other chronic conditions, cancer, the use of digital innovation has been a tremendous tool to help keep these patients been treated without having to necessarily go to the hospital as much as before and we all know because we've experienced it, doctors are now using a lot more digital tools to interact with their patients and it's improving productivity but also improving the way care is delivered at scale, frankly. The last thing I would say is that we also need a shift in mindset and we need to consider health as a strategic asset that you invest in as opposed to the cost that you try to minimize and a lot of efforts they're going to minimizing the cost of healthcare when in fact we realize when people are sick the economy can be pretty much damaged and of course Korea is a great example of this so it's important for government and people around the world to shift the mindset to health is an asset that we invest in as opposed to a cost to you minimize and of course we try to improve equity because typically especially in case of infections we're only safe when everybody's safe and that's why at AstraZeneca we decided to provide this vaccine to everybody around the world at no profit and as quickly as possible so that we could stop the virus from spreading and potentially mutating and returning to the rich countries. Thank you Pascal so early detection and prevention and diagnostics which is really up the street of Katharina because that's what she focuses on so let me draw her in at this point on the same question that I had for you what are some of the two or three big ideas you think we need to take away from our experience? Katharina. Sure thank you and let me just say that I'm speaking here on behalf of FIND but also on behalf of the ACT accelerator you know the global response to COVID where we co-lead with the global fund the the diagnostic pillar so as has been said the world has been paying a price for the chronic underinvestment in tests and diagnostic infrastructure testing as Pascal has said is the backbone for resilient healthcare systems it's really our eyes and ears and for every outbreak it will be our first line of defense to halt it. Industry and the ACT accelerator during this crisis have moved fast in terms of high speed development of and scale up of tests you know that have allowed implementing now of mass testing in care homes in schools in workplaces but while we have been moving fast so has the virus right as you know every day we're seeing new strains emerge more easily more transmissible and potentially more deadly and for 70% of the world we barely know what's going on you know we have very little testing rates in low and middle income countries we test an average 10 times less than in high-income countries we have very little on no sequencing capacity in most countries and so we fly blind in a lot of places this situation has to change not just to exit this crisis but to prevent future crisis you know we owe it to all those that die and died from COVID-19 to make sure that we build on the investments during this crisis we will have tripled our manufacturing capacity for diagnostics we will have advanced digital technologies and you know will will be at the forefront in terms of in terms of CRISPR and other cutting edge technologies and so let's make sure to together that this investment in testing is sustained and can be used for the next crisis and to avoid the next crisis thanks Katherine just a very quick follow-up for you I just come from a conference that was held here here in Singapore where every delegate had to go through a very quick test an antigen test and the results came back within 20 minutes or so and so that technology has been improving over the last year or so how far have we progressed and in terms of managing the technology as well as getting the cost down so that we can get it after more and more people absolutely so we've made a lot of progress both in terms of the high performance of these tests they're very accurate now but especially also when it comes to the cost we've just announced with several industry partners on Friday an agreement that enables testing at $2.50 per test for low and middle income countries and that is compared to starting price in in august of over $20 so it's a big that's great okay thank you Katherine let me move to Kevin from from the US Kevin I mean let's hear your your opening thoughts especially because a pandemic like this also involves getting the community involved and they have to be part of the solution certainly absolutely thank you again for me being here appreciate the opportunity to speak on behalf of why you said and from a non-conditioned perspective first of all I think it's important that there's a stronger connection from clinic to community because we all know that at least 80 percent of health outcomes happen outside of the clinical system secondarily particularly in the United States we absolutely have to move toward universal health care that is a particular issue that has to happen and the other thing that's important in the states is we as you know we have a system a systemic racism issue that is prevalent in our country and that has been built breaking down that trust to ensure people of low income or different backgrounds get the opportunity to engage in the health care system without that we will never be able to tackle pandemics even now as we're going through the vaccine process there are several people of color who distrust the system and will not accept the vaccine because of the historical nature of what they had to deal with so stronger clinical to to community connections making sure we move toward a universal health care system because in the states your health care in most instances is protected is directed to your occupation so in this pandemic and you lose your occupation they'll lose many folks are losing health care so universal health care and more importantly stronger clinic connection issues and continuing to address the racial inequities in the systemic racism that have prevented so many people from seeking health care system the health care system in our country thank you Kevin you you touch on the issue of trust and I think that's so critical because you know people don't have trust in the system and the science then it's hard to communicate basic information about the importance of hygiene and very mass and things like that but trust is something you need to build up outside of the crisis you know it's like a bank account you were to build it up so you can draw it down when the crisis hits and we're just to hear your thoughts on that issue of what we can do to build up the trust ahead of the next crisis I think the most important thing is working with those agencies and organizations and I'll say like the law who are in these communities that have built up a levels of trust there's so many churches non-profit entities that the clinicians can work through and with to help build their trust people trust those organizations because they've been around there for quite a while so the opportunity to work collaborative with them I can give you a specific example I know in Philadelphia where I live I'm quite a bit of my time at the Black Doctors Association having been on the ground doing quite a bit of work and that is because people know them they've had the opportunity to connect with them that's building quite a bit of trust so they're being able to expedite the vaccine program because of the level of trust and they're going to barbershops they're going to churches they're going to community entities where people have access to get to those entities and that has helped build up some of the trust that shouldn't stop at this pandemic it should be something that continues all the time that's how you continue to build up trust thank you let me join Marsden at this point Marsden your your initial thoughts about what we can do better for the next pandemic especially to help you know communities that are less well off and more in need of help to deal with these crises thank you Warren actually in the Middle East what we witnessed was basically the vulnerable communities where the hardest hit number one number two we saw a lot of slow response from the decision-making institutions in the public sector the governments so what we did and I think a very good lesson learned was to support the vulnerable communities by giving them access to medicine the doctors in many countries where they don't have communication also we did what Pascal has said this has been a very good tool for the telehealth communication of doctors especially in countries where vulnerable like Sudan like Algeria like Syria 11 11 11 all of these countries were very vulnerable the communities in them in the era so we reached out by avoiding by trying to provide the latest of what's going on we work with the governments in providing them with the necessary protocols especially for the outbreak because our countries the 18 different countries every country have different response from other countries so we were very closely with the healthcare communities in providing them with what's the latest in terms of technology one of the other issues was very important is basically the supply linkages to enhance global trade we witnessed the shortages in many countries what they started doing by introducing global trade by having national hoarding for APIs and supply of raw materials and this really hurt a lot the supply chain going forward especially at the beginning then we were able to overcome this by getting in contact with the governments directly by some backdoor negotiations I would say with these governments in order to show them the seriousness of what has been done at the same time responding quickly to the supply chain demand of hospitals because for example when they were shortages in the US for the generic pharmaceuticals we were able to shift our production lines to produce more injectables in order to provide the healthcare providers with medications especially in the injectable line for treating COVID patients so all of this because we are a genetic company and we expand our regions in a very different market segment than the European and the other markets so we were able to focus on these things and basically been trust that going forward I think there must be more co-operation between the different healthcare communities and especially in this part of the world the Arab world I'm talking about and supporting the vulnerable communities but where we have witnessed a huge a huge under I would say healthcare infrastructure with these communities so we went in and we worked a lot with the governments and with the local communities with the NGOs in order to build also trust with them in order to accept what's going on and see how we can get through this pandemic going forward. Mazan the World Health Organization has spoken about a catastrophic moral failure in terms of the delivery of vaccines to less well-off communities I mean 40 billion jabs in nearly 50 rich countries but only 25 in poor countries do you think that's something we're going to have to do much better on in terms of you know making sure everybody is safe because nobody is safe until all of us are safe. Yeah and I think what Pascal I said I commend what AstraZeneca and the other multinationals have done in providing with the different programs vaccinations for the vulnerable communities because really what you what you see the vulnerability of these communities they will have a very long list of the supply chain when it comes to them and we're witnessing that in many countries and I think the world has to live up to the standards of providing better healthcare for everyone so the report about the WHO I believe has been actual but also the WHO what we noticed at the beginning they were giving very contradicting statements so also this is something I think we have to build trust again in these international institutions I hope now for the things that are going on in the world politics it will allow people to have more trust in these multinational organizations to provide better healthcare solutions for the communities going forward. Thank you I'd like to bring the discussion back to the issue of collaboration between countries and collaboration between the nations and national level and the state level as well as collaboration between the public and private sector because I think it's absolutely critical if we if we can sort of get people working together and maybe I could start by asking Katharina to address that question better collaboration at different levels maybe industry state governments. Absolutely I think a couple of successful examples have already been highlighted but let me maybe speak a little bit more concretely about the vital role of industry in in the COVID-19 crisis response now but then also in helping us build sustainable resilient health systems so you know industry has a vital role to play for me in in two regards and that goes far beyond healthcare industry a lead and advocate so what we need from a testing perspective today is that industry takes a leadership position builds you know builds good workplace testing strategies and advocates with governments to help us get the funding necessary to drive an equitable testing response in all countries that is absolutely key to restart the global economy and avoid a much deeper crisis going forward you know with the focus on vaccines we see that many countries even sort of decrease their testing and and that we're at a very dangerous point here and then second we need industry to continue to commit and invest invest in R&D of course and also the scale up of testing to help us for example build a strong sequencing network that relies also on digital solutions on supply chain solutions but we need a globally connected sequencing network second you know the commitment part you know we we have been successful in getting the costs down but we have to get the price down further especially if we want to enable mass testing now for COVID but then why testing for differential diagnosis going forward right for example identifying any kind of respiratory virus and outbreak early so for that we need industry for example to join our buyer's consortium very concretely you know to set up best in class testing strategies at their workplaces for their own workforce but then also contribute to the global effort you know and by having a pooled buyer's consortium to allow us to get the price down and and to enable greater forecasting abilities etc in terms of supply chain manufacturing and so forth thank you I'd like to turn back to Pascal I mean on the issue of collaboration I mean AstraZeneca has been working with the WEP as well as LSE on an initiative to help bring you know parties together to help promote collaboration and mutual sharing of information maybe you could tell us a little bit about that initiative so that folks who are watching this might be informed about that yeah collaboration I think is absolutely critical and it is in the DNA of our company you cannot be in innovation if you're not prepared to collaborate because it's out of collaboration that innovation emerges so we do this constantly with academia and various other parties I think the COVID is a good example of a situation where we have many many good examples of public private partnerships our partnership with Oxford University being an academic center and also governments around the world is a good one with Barda, Pfizer, Moderna and JNJ everybody has collaborated with various private and public actors to really deliver the vaccine as quickly as possible and we should remember that what we're trying to do collectively here has never been done in the history of the world to develop a vaccine or several vaccines in that instance in in a year and then scale up to billions of doses when we know today the biggest manufacturer has only got a capacity of a billion doses per year across all their vaccines so it's a huge undertaking that has only been possible because we've collaborated in our case an important collaboration is with Siam Institute of Inja which is really enabling us to supply the vaccine to the low minority countries at a very very low cost so in fact we do it at no profit so we make sure that everybody around the world is protected and so you know we also believe that we can apply this collaboration to the future to bring again public and private actors to to work on how can we make healthcare system more resilient more sustainable in the future and we have a partnership with the WEF and the London School of Economics that started that is called a partnership for health systems sustainability and resilience and the idea really is to work on how what policies should be put in place so we we you know we bring a better collaboration I have to say the first phase of the of COVID is full of good examples but it's also full of places where we see international collaboration hasn't been the best could have been a first of july independence day kind of a moment but it unfortunately wasn't because there was a little bit of me first behavior but I can see that things are changing and international collaboration is is emerging around areas of identifying early signs of of new infections new pandemics looking at mutations this virus is going to mutate we need to track it and we need to look at the emerging strengths so there is more and more I think collaboration that is actually emerging out of this crisis thanks Pascal I was watching your collaboration with my my alma mater and cheering you on all the way so I was glad to see that collaboration between industry and universities working so well and delivering the vaccine so quickly we do need to wrap up the public session of this of this discussion before we move into the closed private discussion on the on ways in which we can collaborate more closely if you want more information on the on the collaboration between AstraZeneca Web and LSE you can look at it on the website I need to wrap up this session to say basically that some of the big ideas that have been put forward about early detection and prevention better diagnostics linking up outpatient care and moving it more to the community building up testing as well as trust in the system and in the science are all things we need to do if we are going to build crisis resistance and crisis resilience systems for future crisis