 Good morning and welcome to this first of two sessions on health. The first session will be focusing on COVID-19 and the second session will be dealing with the issues of global governance and health. As you I'm sure realize COVID-19 is the worst combined health and socioeconomic crisis in living memory. In a little less than three years COVID-19 has infected at least 250 million people across the world and generated a global death toll estimated to be 14 to 17 million people. At the highest point of the epidemic 90 percent of children across the world were unable to attend school and an output of 22 trillion dollars is expected to be lost in the period 2020 to 2025. The deepest shock to the global economy since World War II. By November 2022 at least 125 million people have been pushed into extreme poverty because of the pandemic and the pandemic is not over. As we speak hospitalizations are increasing again at least in Europe and in the US and the pandemic continues to have a profound impact on lives and livelihoods as economy slowly begins to take place in terms of recovery in at least health wealthiest countries but still falters in low income countries as we have been discussing even in the previous session. This is the third time we address COVID-19 at the World Policy Conference. The first event was virtual in 2020. Some of you may have attended it. Then we had a session last year and some of the speakers this year our speakers who were with us in 2021 and now we're meeting again almost three years after the first case of pneumonia due to an unknown new pathogen were identified in Wuhan China. So there are three aims to our session today. The first is to discuss the current pandemic situation and whether epidemiological scenarios can be built for the short and midterm and we'll hear from Professor Antoine Flau who is the director of the Institute of Global Health at the University of Geneva. Then we will hear three regional perspectives and how lessons from the pandemic are being learned in different regions. In Africa, from Dr. Juliet Twakli, chief medical officer at Family Child Associates in Accra, Ghana, in the United Emirates, from Dr. Mahate Sirbarakat, director general of the frontline heroes office in the United Emirates and in China from Iide Chao, secretary general of the Shanghai Development Research Foundation. And we'll close considering how other pandemic threats can arise anytime, particularly from the increasing opportunities of animal human contacts at global level and we'll hear from Professor Christian Breschow from the University of South Florida and president of the global virus network. So I believe we can now start and I'll give the floor to Professor Antoine Flau Antoine. La situation internationale, première chose qu'on peut dire c'est que les données sont assez fragmentaires même si elles nous arrivent en temps réel ou quasi réel et que de façon assez unique on peut en effet tenter de modéliser et de vouloir prédire l'évolution de cette pandémie force est de constater qu'il est très difficile de la prédire même au delà de cette jour. Nous ne pouvons par exemple pas dire aujourd'hui si le 15 décembre la France aura atteint le pic de sa neufième vague on peut penser que les données de Chine sont trompeuses aujourd'hui assez sous-notifiées, la sous-notification affecte pratiquement tous les continents. La deuxième leçon qu'on peut tirer et qui est peut-être pas aussi connu que cela est une très grande synchronisation du phénomène épidémique dans le monde. Lorsqu'une vague émerge quelque part en Europe, toute l'Europe est atteinte mais plus que cela par exemple aujourd'hui cette neufième vague dont on parle en Europe atteint également les États-Unis, le Canada, l'Amérique latine mais aussi l'Asie, le Japon et par exemple la Chine comme on vient de le dire. Il y a au moment de la vague Delta il y avait 80% des pays qui étaient en croissance pandémique également. Troisième leçon qui paraît connu de tous le SARS-CoV-2 a une transmission aerosol quasi exclusive. Aujourd'hui on le sait très peu de contaminations emmanuportées très peu de contaminations directes. L'immense majorité des contaminations rapportées se fait dans des lieux clos, mal ventilés, bondés et dans des transports publics. On le sait mais on n'a toujours pas vraiment tiré les leçons de cela. Il y a des normes travaux d'infrastructure du bâti pour rendre mieux ventilés, mieux aéré avec des normes modernes de construction. Ce qui ne va pas sans problème avec la crise énergétique mais aussi avec la volonté de réduire l'empreinte carbone car le renouvellement de l'air peut avoir son coût collatéral associé. La quatrième leçon est peut-être la moins connue de tous. La pollution atmosphérique au particule fine, celle qui est due dans nos villes, nos milieux urbains à la combustion des énergies fossiles mais aussi celle qui est due au sable du désert beaucoup plus familier ici mais qui est aussi affecte les pays d'Europe et qui entraîne une forme, ces fines particules entraînent une forme d'abrasion du système de l'épithélium, du système respiratoire, qu'il soit supérieur ou même bas parce que ce sont des particules très fines et peut entraîner et est associé à une augmentation et de la fréquence et de la gravité des épidémies de Covid. Ça a été très bien démontré dès le tout début de la pandémie au moment de l'émergence en lombardie zone très polluée d'Europe pour sa pollution atmosphérique de l'épidémie mais aussi en région parisienne à Londres où ça a été étudié mais ça a été montré également au brésil en amazonie avec les feux de forêts, ça a été montré également en Inde en particulier. Essayons de voir puisqu'on ne peut pas les prédire, les différents scénarios qui se présentent à nous pour cet hiver qui va venir et pour la suite de cette pandémie. Le premier scénario est un scénario qu'on pouvait élaborer encore il y a 15 jours. C'était un scénario très optimiste, c'est-à-dire mais dans le fond tout redescend, on n'a jamais été aussi bas dans les niveaux d'incidence mondiaux de la pandémie, la calmie va peut-être même se prolonger et qui sait, nous n'aurons peut-être pas de nouveaux variants qui va déferler sur le monde. Malheureusement, déjà aujourd'hui, on voit que ce scénario se ferme et que ce ne sera pas le scénario le plus optimiste qui va nous arriver. Le scénario qui paraît être celui qui survient aujourd'hui, c'est celui du business as usual, c'est celui du scénario d'un nouveau variant, on l'appelle en Europe le BQ11, aux États-Unis, au Canada, le BQ11, mais à Singapour ou au Japon, le XBB, peu importe un nouveau variant vient et efface la circulation des précédents variants, c'était B A5, ça avait été B A4, mais avant Omicron, vous vous souvenez, ça avait été Delta, ça avait été Alpha, on connaît la série de ces vagues pandémiques. Le troisième scénario est plus problématique parce qu'il correspond à cette soupe de variants qui n'est pas que BQ11, qui est, en réalité, aujourd'hui, 500, plus de 500 sous-variants descendant d'Omicron, une très grande famille où un certain nombre d'entre eux sont comme tapis à nos portes, prêts à attaquer à nouveau, sans même laisser de répits. On voit dans les dernières données d'hier soir de l'ONS du Royaume-Uni qu'en réalité, on ne connaît plus d'académie. Il y a une sorte de plateau permanent, de circulation permanente de Covid dans nos populations, dans nos sociétés, laissant leur trace, saturant peut-être plus les hôpitaux grâce à la vaccination, mais laissant une très forte tension hospitalière et un très grand nombre de Covid long, ces formes post-infectieuses, particulièrement préoccupantes, parce que souvent handicapantes de Covid qui ferait constituer une sorte de permanence de cette pandémie. Il faut juste savoir aujourd'hui que la mortalité due au Covid reste en Europe parmi les trois premières causes de mortalité de l'Europe. En 2022, en Europe, comme aux États-Unis, où les données sont fiables, on voit qu'on a une mortalité par Covid qui reste très préoccupante. Le quatrième scénario, c'est celui de la Chine qui s'éveille à sa stratégie, qui n'est plus la stratégie zéro Covid. On ne sait pas très bien jusqu'à quel point la Chine va abandonner sa stratégie de suppression, qu'on appelle zéro Covid, ou la stratégie d'élimination du virus. On peut dire, c'est que Hong Kong a tenté, il y a exactement neuf mois en mars dernier, lorsque l'Homicron est arrivé, a tenté de faire un peu comme les autres pays d'Asie, du Pacifique et du monde d'abandonner sa stratégie zéro Covid, mais à constater qu'il n'y a qu'à tombe. C'est-à-dire que ce n'est pas le sous variant Omicron qui est si peu virulent que cela, c'est le vaccin qui fait que Omicron est rendu peu virulent. Or, les Hong Kongais, comme les Chinois, sont bien vaccinés, sauf pour leurs personnes âgées. Les personnes de plus de 80 ans, à Hong Kong, il y a un an ou en Chine aujourd'hui, pour 60% d'entre eux ne sont pas correctement vaccinés. Être correctement vacciné par les vaccins chinois, c'est avoir reçu trois doses. On a trop dit que les vaccins chinois ne seraient pas efficaces. Ce n'est pas vrai, ça a été bien documenté par les autorités de Hong Kong qui ont vu que lorsque l'on avait deux doses de vaccins chinois, on était en effet moins bien protégés qu'avec deux doses de vaccins ARN messager. Mais lorsque l'on a trois doses de vaccins chinois, on est aussi bien protégés qu'avec trois doses de vaccins ARN messager. Mais 60% des plus de 80 ans n'ont pas trois doses de vaccins en Chine aujourd'hui. Les modélisations qui ont essayé de transposer cette Chine miniature qui était le cas de Hong Kong en mars dernier à la Chine continental aujourd'hui laissent penser qu'il pourrait y avoir entre 1 et 2 millions de décès si la levée de la stratégie de zéro Covid est trop brutale en Chine en ce moment. Donc ça c'est une inconnue, la deuxième inconnue qui va avec cela et qui concerne le monde entier c'est quels seront les nouveaux variants qui vont émerger de cette soupe dont on a parlé tout à l'heure si un milliard 400 millions de Chinois en moins d'un an se retrouve infecté par un nouveau coronavirus. Ne seront-ils pas dans une situation beaucoup plus proche de celle que nous avons connue dans les premiers mois de la pandémie où nous avons vu émerger alpha, delta, beta, gamma, d'autres variants donc ce ne sont pas nécessairement aux microns qui va faire de nouveaux petits dans l'émergence qui pourrait se produire. En conclusion, nous avons eu deux vagues en 2020 vous vous souvenez la surprise, les froids même et puis aussi des mesures du Moyen-Âge, confinement, quarantaine, couvre-feu tout cela a été supprimé en 2021 Grâce à l'arrivée de 12 vaccins sur le marché mondial on est arrivés dans l'ère moderne on a combattu avec des vaccins cette pandémie mais en 2022 on voit une accélération de la pandémie ça n'est plus deux vagues c'est cinq vagues que nous connaissons rien que dans l'année 2022 une accélération qui entraîne une fatigue chez tout le monde la fatigue pandémique mais les politiques également veulent tourner la page elles concernent absolument tout le monde que se passera-t-il en 2023 lequel des quatre scénarios ou un cinquième dont nous venons de parler quel variant vont émerger quel impact, quel leçon auront-nous retenu c'est cela dont nous allons continuer de parler merci de votre attention merci beaucoup merci beaucoup Antoine d'avoir quelque sorte sept dessines je ne sais plus entre le français et l'anglais comment m'exprimer nous reviendrons sur plusieurs points que tu as soulevé en particulier celui de de la circulation permanente du virus à laquelle nous allons être confrontés mais j'aimerais maintenant que nous tournions donc vers le le monde région par région quelque sorte pour entendre trois perspectives régionales and the next speaker would be Juliette Toakley giving us a perspective from Africa and the African continent Juliette good morning, thank you we learned several lessons from the Covid pandemic in Africa not the least from observing what was happening elsewhere and looking into our own resources and one of the major lessons I believe was a recognition of the need for strong political will and a focus on in-country public health systems there was also a greater unity of purpose between countries in Africa yes certainly there was a regional emphasis but there was also a pan-African approach which I think also was very helpful to us in the medical arena there was certainly a recognition of the need to build our own capacities which thankfully was supported by international agencies decision to build up African vaccine responses as a global public good and of course as many of you may remember this was partly in response to the disappointment in how vaccines had been promised and often not delivered we received barely a third of the promised vaccines ultimately and so there was a very rapid recognition of the need to change course that was supported and very strong support from the African CDC that was located in Addis Ababa and we were very fortunate in having a very strong leadership of that institution through a doctor John who was the director of it at that time he was absolutely magnificent unfortunately because he was so magnificent he's now been swiped up by the US government to manage PEPFAR but still he has a worthy successor in place and the CDC harmonized and strengthened surveillance systems in a way that we had not experienced previously as well as strategic sampling frameworks which was very important for identifying the different variants as they arose throughout the continent he also focused on strengthening the supply chain once it had been developed or once it became apparent for the need of a strong supply chain of various goods and shared surveillance data across all country or all in-country programs and you may remember after the B1 Omicron variant had been recognized in South Africa we were given daily if not twice daily accounts of its gradual migration upward from Southern Africa to East Africa West up through North Africa which allowed us to prepare adequately at least to some extent as it made that transmission across the continent and number two vaccine production facilities were developed there were some incipient facilities available but they have been considerably strengthened and enhanced across six African countries we have 12 facilities that are based primarily in Algeria Egypt Morocco, Senegal Rwanda and South Africa and these have been particularly effective and particularly strong in their output we also not we but in Africa there was a group African vaccine acquisition trust established that not only has focused on the manufacture of vaccines but also manufacturing tests treatments and protective equipment even though each country of course took on what they quit locally and certainly Ghana was very busy in this regard the CDC also ensured that there was development of an Africa medical access supply chain for pharmaceuticals this is currently based in Rwanda and has been very very effective because of the impactful funding and support from many bodies that have included the African Union the African Development Bank PEPFAR and WHO to mention but a few I think it's shown that we have worked together as a collective in so far as we have already been faced with our new pandemic well it's not quite a pandemic I take that back our new illness i.e. Ebola which showed up initially in West Africa and then subsequently in Uganda where it's been a little bit more severe but I think it is coming under control not the least because of this group work together especially by our in-country public health systems and so I think we've really learned to work together if you will finally in an aspect an important aspect of our development that being health and politically in so far as it's been necessary to work in the public health arena but I'm quite proud of how we responded overall and I do think we're well prepared for future outbreaks Thank you Thank you very much Juliet and the I think we'll come back to Africa and to regions in the next session because clearly what we're seeing now is a welcome trend to decentralization and the regionalization of manufacturing research and development and manufacturing and that has implication when we will be discussing the governance and whether sort of governance of health in the future how much will that be global at the New York or Geneva level or how much will that be a sort of federation of regional governance hubs and how much regions in the future will be autonomous in their ability to prepare and to respond to pandemics Let's now move to the MRO region Dr. Barakat please Thank you very much and thank you for inviting me today to participate in this panel So I think following on from the talks that we've just heard the W.H.O eastern Mediterranean region consists of 21 countries and one territory and within the MRO region there were 23 million cases of COVID during the pandemic and a reported 348,000 deaths Of course we believe this is an underestimate there are certain countries that weren't fully at capacity in terms of their ability to stress diagnose and to manage the cases so we suspect the numbers are greater in the eastern Mediterranean region and if you allow me to go into the UAE as a specific example and then we can explain how within the UAE there were initiatives that helped other regions in MRO other countries So within the United Arab Emirates where you are today the population is approximately 10 million people and in the last almost three years we've had 1 million cases of COVID diagnosed or of whom unfortunately 2348 passed away so that gives us a kind of average case fatality ratio of around 0.2% The way that the country dealt with the pandemic so the UAE's response had several pillars in it but if we can concentrate on some of the most important one was wise leadership at the highest level so a governance at the highest level that was able to coordinate the national response so the whole of government response, the whole of society response all coordinated in a seamless manner I think all too often we see cases where resources may be available but something goes wrong with the governance or the leadership outcomes I think leadership is extremely important other pillars to the response obviously the infection prevention and control program nationally that's comprehensive, robust protecting the most vulnerable protecting frontline workers you have I'd say the third pillar is laboratory testing if you can't diagnose it accurately you lose the ability to fight COVID when you can diagnose it urgently within 24 hours you can implement your isolation and preventive measures much more effectively the UAE actually conducted 200 million tests PCR tests in the last three years that's 20 times the size of the population so on average an individual would have had 20-20 tests on average then comes vaccination so no country could have protected itself against hospitalization and mortality without an effective vaccination program and the UAE started clinical trials and vaccination as early as summer 2020 by September there was emergency use of vaccination and by June 2022 the United Arab Emirates had achieved 100% of its target of vaccination of its target groups so I think this is really a key component of a country's ability to reduce hospitalizations and death furthermore last year the construction started on a local vaccine manufacturing plant that will produce 200 million doses of vaccines and again this goes back to the emerald region and Africa and other countries that are in need these 200 million doses every year will go to support not just the UAE but the region and other countries in the world there are other pillars and if I can in the interest of time maybe just concentrate on one more which is urgent and critical resource mobilization so both in terms of prioritizing domestic budget towards COVID getting equipment mobilized and supplied to hospitals where they need it and of course human resource how do you mobilize a team at urgent times in very short with very short notice the question is who are these people who makes up the front line the UAE is unique in that China's Sheikh Mohammed bin Zayed launched the front line heroes office in June 2020 to dedicated to looking after all front line workers in the country to champion them, to listen to their needs to support them and the office set up a registry the registry has now 135,000 files for each front line worker we know their individual circumstances their personal needs the office has supported them with education for themselves, for their children with health needs, physical and mental health support it's worked with the central bank to ease the stress of repaying loans and for those that are expatriates they've given them golden visas to help retain them and support them in the country and for the category of front line workers that have sacrificed the most, those that have died we call them the fallen heroes the office actually has adopted their children and spouses we look after them we make sure they have their schooling covered their healthcare covered, their housing covered so we don't forget those that have sacrificed the most and I think my final point is it's not enough just to look within your own country the United Arab Emirates was one of the first to help internationally and in the course of the pandemic over 2,000 tons of medical aid has been distributed to 135 countries so Mr Chairman I think in summary if you ask me what was the most important element of the UAE's response or any other countries I would say wise leadership you need wise leadership to coordinate national efforts and to help with urgent and critical resource mobilization thank you thank you very much and thank you for that focus on healthcare front line healthcare workers I must say I'm not aware of any other countries that would have set up a special office dedicated to healthcare workers reporting basically to the highest level of government maybe before we move to Yide Chow Juliet can I turn to you and ask you what's the current status what's the current vaccine coverage of healthcare workers in Africa that was an issue of course in the first year of the pandemic well as you know we did have an initial problem with accessing the vaccines we had a political problem of which vaccines we would encourage per country and within certain countries and regions but I would say that right now and I'm not basing it on very specific facts but certainly anecdotally I would say that most healthcare workers perhaps 60% thereabouts have been vaccinated because I think we will put into the position of having to recommend vaccination to populations that were somewhat skeptical about the need for them was skeptical about the onset and origin of Covid and their own exposure rates to it because as you know notwithstanding the discrepancy of numbers of cases I do think that Africa still did come in a little bit lower in terms of active cases and mortality and so I think that there was a moral imperative for those involved in health to take the vaccine themselves and then persuade the citizenry especially high risk citizenry to vaccinate Thank you very much Can I now turn to you Eide with a view from China and on China Thank you Chairman First of all I have to say I'm not expert on public health like other member of this panel I guess because I'm the only Chinese in person at WPC so organiser want to double my assignment That's a lot of responsibility on your shoulders But anyway as an observer as someone gone through lockdown in China in past three years I would like to share my view on what's going on in China what experience and the lesson I learned from China to deal with future X disease or unknown violence First of all I guess being trans trans currency should be the first principle of deal unknown virus or X disease in the future Here I mean the virus origin gene composition evolution of a virus and it's possible harm on the human being etc should be released all this information should be released to the public government department and the CDC on time I understand there is a controversy that the Chinese government do enough on this area honestly I'm not positioned to make judgments on the issue but the one factor I wanted to raise here actually the one professor at Fudan University in Shanghai published the gene composition on the internet that's enabled to other company to produce PCR tasting material to produce a vaccine very soon without his release it's harder to imagine in period of time a vaccine can be produced Secondly the action should be taken quickly I want to use the term yesterday rapidity of action that's also very important when local authority find the unknown virus they should immediately report to national CDC while national CDC should immediately report to WHO according to the retired procedure in case of China I have to say the local government should quickly report case to national CDC that's the lesson I guess we should take it third point is physical separation and it's extreme form lockdown is effective at the beginning to prevent expansion of virus at the beginning it's effective the earlier it take the more effective would be and the small scope could be you know in the beginning of 2020 Chinese government shut down the Wuhan city Wuhan is capital of Hubei province that lockdown in 2020 was successful example it help much less case occurred in China in that year relative to other countries it also help China become only one of large economy which get positive GDP growth in 2020 the fourth point first lesson the flexibility and the sensibility are necessary to deal variation of virus different measures should be taken to different variation past success successful measure doesn't mean a future success in China I guess at the beginning they did good job but starting from this year I guess Chinese government has been slow to reaction of Omicron the Omicron occur in China December of last year it take several months at least Chinese government should understand the nature of Omicron they should not continue to take zero Covid policy until recently I guess they lift the restriction immediately I guess in past one or two weeks that's fortunately for Chinese also fortunately for Chinese people because in past several months China went through very tough time the cost is very high the economy is slow down but now the policy has been changing we will see what happen in new future the last point is the awareness public on the virus or an X disease are also very important I came here a little bit earlier due to the availability of a flight I met some stuff a bank of China here in UAE interesting case one stuff originally came from Wuhan in January 16 2020 his family including his parents wife two kids from Wuhan fly to Dubai he read some article in youth he knows something happened but he doesn't know the detail but he is very smart he keep all of the family members stay at home don't go outside but later on one by one some symptoms appear he first of all he send his mom to hospital here the doctor check it no answer they don't know what's going on here they came back all midnight the doctor and the nurse came to their home because they find do some PCR test they found some virus then whole family be moved to the hospital quarantine he brought it to me yes we brought the virus to UAE but we never infect anyone here in UAE that's a very good example now what happened in China I guess Chinese government should do more on public understand what's going on otherwise it will create serious consequence might be the wave will occur in China I guess Chinese government will start to do that I just stop here thank you thank you very much and thank you for emphasizing from the start how China very very early on made the sequence of the virus available that if I remember well was on January 2nd 2020 I mean within days after the first cases were reported to WHO that had not been the case with some other viruses in the history but this issue of sharing sequences is clearly one of the key issues of the ongoing negotiations of a new pandemic treaty at international level so you know within the new field of health diplomacy there is a subfield of genomic sequence sharing diplomacy nowadays maybe before we move to Christian can I ask Antoine to say a few words about the other countries that went into lockdown very early on in the pandemic because of course we saw two patterns in the first months of 2020 countries that had experienced SARS in the past China South Korea Hong Kong Singapore Taiwan to some extent Australia and New Zealand went directly and reacted very fast with strict measures whereas many other countries across the world including in Europe in the US until March 10 or March 15 2020 before they would put in measures in place so how did the transition and when did that transition to a more liberal system occurred in those countries and how much maybe then either you could react how much could that serve as a model for the transition that you mentioned is now occurring in China you go ahead Antoine in fact you remember my slide where I mentioned that Hong Kong in March 22 had experienced a huge wave with high mortality at the same time New Zealand, Japan South Korea, Singapore Taiwan did not experience such a wave of mortality but the experience as we did a huge wave of Omicron of Covid-19 so they quit their zero Covid strategy in early 2022 just because they thought Omicron was mild but in addition to that they had a high level of vaccine coverage more than 80% like in Europe and so they thought they could now really face the Omicron wave because they were vaccinated enough Hong Kong thought that too but that was not true due to the low coverage of elderly 80 plus person I guess you are right could you also say a few words about the current acceptance of the virus by people over the age of 65 or 70 in China I guess you are right several eastern countries did similar things look down at the beginning of 2020 but now you are right they transferred to another model, another panel interestingly what happened in Hong Kong because Hong Kong had a close relation with the mainland China but finally they changed the model actually we as an organization I have a good contact with the professor of medical school of Hong Kong University he showed his view to experience what happened in Hong Kong he said to me actually Xinhua news agency asked him to write a report which sent to central government of China what I try to say what happened in this country have some impact on the changing of Chinese government policy on zero Covid policy that's my feeling thank you very much Christian let me now turn to you is the next pandemic tonight thank you Michel and thank you Thierry de Montbriel and first surveillance will we face new pandemics yes can we predict these pandemics no so surveillance is key we are still struggling with Covid-19 that's the topic of the conversation but at the same time we have been witnessing monkeypox, some births of Marburg and researches of Ebola so the problem is not to predict we cannot do it the problem is early detection of the warning signals and we have to recognize that on Covid-19 we have at least in part failed how can we improve a main point is to focus on the interface between humans and animals we are all of us aware that most of these epidemics stem from contaminations of humans by animals this is where we need to concentrate the effort not to disperse and this seems obvious but this is not at all what has been done in most geographical areas surveillance means early detections it also means evaluating the long-term impact of a viral infection and I really believe and Antoine alluded to it that long Covid is a potentially a major challenge and what is new is that now we have for the first time for a few months longitudinal prospective studies of cohorts of a high number of individuals in a relatively homogeneous environment and the figures show that about 30 to 50 percent of individuals infected by the beta and delta variants will show at least one symptom of Covid-19 at six months and about 20 percent one out of five at 18 months the good news is that the figures are much lower with Omicron and Omicron-related variants and likely vaccination we are talking about to 15 to 18 percent but considering the huge number of infected individuals this is very significant so this only emphasize the need for this surveillance mechanisms to be tightly connected to local and regional health system second reinforcing local and regional capacities this point has been well described by the previous speakers I find it very striking that we have everything in hand we have modern epidemiology bioinformatics, biostatistics we know how to share data to analyze them we can analyze wastewater samples which provide an accurate and very early detection of an ongoing epidemics and at the same time we are not sufficiently efficient today is all of this on local and regional capacities and as it has been well described it's about human resource equipment, overall facilities third, reactivity and innovation we all know the huge success of vaccine it's about innovation for solving a problem when a virus is detected when a problem is identified and we can do better with vaccines but in particular for antivirals and diagnostics so it's really about consortia networks problem solving of academics and industrial partners with novel approach to intellectual property regulations and financial incentives and also I personally believe that diagnostics has been very much underappreciated in this crisis there is a huge progress which has not been translated enough to the daily life so again this is about consortia and financial incentive also I believe it's obvious we need to embrace these problems in a real comprehensive view it's about global and one health merging human and animal health it's about taking in consideration environment and also nutrition nutrition is a key factor and in particular through microbiomes fourth point novel schemes of organization that point will be taken in the next session but really we need much more flexibles, networks consortia of individuals again merging industrial and academic problem solving science driven independent also including education and training of the next generation of virologists and the global network is an example but there are many others other networks will be created it will be key to coordinate these efforts this is entirely feasible with financial incentive but very much worth compared to the impact of such crisis so to conclude it's about surveillance it's about local and regional capacities it's about innovation and reactivity it's about a comprehensive view of the problem and it's about novel schemes of organizations and flexible networks thank you thank you very much Christian and you pointed out this key issue of preparedness one of the first lessons that we learned from COVID-19 was that the world was not prepared and that investments in preparedness have been much much too low over the years and then also the way we thought we would measure the preparedness of a country actually proved to be wrong so there is a so-called global preparedness index and that index showed that the US were among the best prepared countries in the world but then this is one of the countries that failed totally in responding to the pandemic so we need only to invest strongly in preparedness now with all of these including the science and industry and other networks that Christian mentioned but we need to totally revise the way we monitor preparedness and our indicators with that we have a few minutes for discussion so what I suggest is that the questions and then I'll ask my colleagues to answer the questions they'd like to address so let's start with Massoud Thank you very much Michel first of all let me just say the terrific panel and I really want to thank all of you for your interventions I hope we can make the slides available that were used by Professor Flano as well I have one question for you and it picks up from your last comment Michel which is how well do you think we are prepared for the next pandemic if it were to strike us in the next 12 months one thing about Covid is that we developed a vaccine that works within a year faster than at any time in history no guarantee that we will be able to do it for the next pandemic and the mortality rate was quite low less than 5% and that again, no guarantee that the next pandemic will have a low mortality rate so you just identified Christian what is needed and the question I have for all of you is how much progress have we made globally and regionally to be prepared if the next pandemic were to hit us within the next 18 months that will also be discussed in the next session 2 quick questions does the panel draw any lesson from the difference in policies even in western Europe for example the difference between Sweden and France for example, no lockdown at least during the first weeks or even month in Sweden and going beyond Europe a complete different policy in Australia for example so with these vast differences in the western world the second question is on the refusal of vaccination the refusal of vaccination can be regional problems in Africa but also problems in some parts of French overseas territories and now some sort of sequential refusal of vaccination for example the low level of vaccination in France presently for the new repeats of the vaccination that are required and not actually carried particularly by the elderly so what's the answer to some sort of fatigue as to vaccination thank you next to you thanks Christian for sharing valuable information my question is how artificial intelligence will help in checking COVID-19 in future thank you very much there are two more questions and then we'll stop it now so three questions please be brief good morning thank you very much while I agree we are a think tank that does a lot of work on virus and the growth of it for about 20 years so the question is more on why we accept the premise of zoonotic diseases I just wondered your insight especially Christian on the gain for function where these researchers are outsourced to labs outside and the strong belief that we have some intelligence and information we have that the Wuhan was not an accident because we had a discussion with the Wuhan medical officer soon after the virus that it may have been an accident that came out of the lab so how do you at a global level prevent this because if you do that the way to stop it and the cure will be extremely difficult thank you you know that Israel had been in way a laboratory for developing the Pfizer immunity matter of fact we became to be like a laboratory for all the world in Israel it was not compulsory to take the vaccination but of course it is it was possible to do it fast because in Israel there is a special construction of the health system people belong to one of the branches we have 3 or 4 companies which deal with health and every person every family belongs to one of them so it was very easy to arrive to all most of the people and it works now one of the questions that I have about this about this immunization is there are a lot of people who are spreading up in Israel and all over the world you don't have to be vaccinated that's wrong, that's have a lot of all kind of all kind of in my opinion rubbish and it is really a lot of people accept their opinion and refuse to be vaccinated the fact is that when we cancel the closure in Israel so we were in a very bad situation because people who had been vaccinated were ok but the people who had been vaccinated would come also to the centres etc and make people to be again having what do you think about the possibility to make it compulsory last question second question is do you think that in the future the mRNA vaccinations would work also for other other problems in the world like cancer etc thank you very much for this futuristic outlook and yes Israel is a sort of living clinical trial cohort on COVID-19 and the data from Israel is the most precious at population level Monsieur Dossou very briefly please because we are going to be late we will take 5 minutes for the answers thank you Mr President it is almost a personal consultation taking advantage of the quality of this panel but the medical secret no no no it is public it is a pandemic I am fully octogenarian I have already taken the vaccine four times and I was eligible two months ago and then we said no it is not yet sure so I hesitated my concrete question can I go directly to the 5th vaccine the 5th time thank you very much thank you very much thank you I would like either Antoine or Christian to address this because that relates to your point of either continuing waves or continuing ongoing circulation of what we now call a soup of variants and as we face that and as we know that immunity is waning in people aged let's say over 70 within 4 to 5 months and that was shown in Israel with the last booster what does that imply in terms of continuous boosters let's start with this question and then I'll then ask let's have Antoine and Christian react then I'd like to turn to Juliette, Idé and Maha for just the final points for the question of the vaccine clearly we have today a vaccine that is not dangerous that is very well tolerated especially for elderly people it doesn't even react reactogenic and therefore advise a new reminder for anyone who hasn't had a reminder in the next 6 months seems to be good politics there is no higher level of evidence today on the scientific plan because manufacturers run constantly and don't have the time to put in place formal clinical tests as powerful as those who had been done at the beginning but we can today reasonably recommend a vaccine dose to anyone eligible to the vaccine who hasn't had a dose for 6 months and then, sorry, go ahead Christian, just to follow up on this on a more general basis and this goes with the question in Israel we have RNA based vaccines they are being adjusted to other viruses possibly on cancer but this is another story the problem of these vaccines is that they do not generate a strong cellular immune response so this is why there is still very much ongoing research on other vaccines for the future which would provide a longer lasting memory for the time being we have this, it can be adjusted very rapidly to a new situation and this is very valuable but you must just take in consideration that there is at the same time a huge effort of novel vaccines and I just take this opportunity for the question on artificial intelligence this is very interesting because artificial intelligence is being tested on the data sharing for example, long COVID which is very multifactorial very much beneficiary of this but artificial intelligence can only be effective if you nurture it with the good data and with the accurate data and then it always come back to local and regional capacities, otherwise you are working on nothing and one of the things that is currently being discussed is establishing at regional level across the world different hubs that would master some of the basic technologies mRNA and Juliet you mentioned the hub in South Africa but also adenovirus based vaccines also all inactivated vaccines because let's not remember within one year 2020 we saw the mRNA vaccines from the US and European industry we saw the Chinese cinepharm based on inactivated vaccines we saw the adenovirus vaccines AstraZeneca and Sputnik we saw a Cuban vaccine we saw an Indian vaccine so within a year the world based on existing technological platforms could innovate and bring effective vaccines I'm not entering the discussion here of the relative efficacy but thank you Antoine for making the point and I'd like to make this clear because several people ask that question two doses of cinepharm plus one dose of Pfizer or three doses of cinepharm are equivalent to three doses of Pfizer as far as we know at population level maybe a last turn of hearing the questions maybe Maha would you say something Thank you clearly very important questions and again I reinforce the need for the strongest surveillance systems in every country the next you know virus that may be predisposing to a pandemic could be in any country and investment in surveillance systems and looking into the zoonotic side so very much a one health support countries need to invest in developing a strong one health system thank you okay no we can't hear you I'm afraid okay we can have a microphone for Mr Chiaot Juliette I want to go back to the question said almost in passing about the relationship of humans and wild animals not just wild animals but also the environment and our nutritional changes the distortion of our nutritional changes increasingly I do believe that there are huge impacts of focusing on our microbiomes through an increase in our plant based within dietary in our diets and minimizing distortion and destruction of our environments wherein we then become exposed to wild animals with viruses that have been causing many of the pandemics we have been subject to over the past few decades and I think that's only going to increase until we recognize that man has to be a little bit more circumspect with the environment thank you addressing the question how we should deal future X disease as I said I want to emphasize the most important is awareness of public yes because it's unknown violence people don't know the detail but they should understand how to deal with these things as a model to point out due to the SARS happen in Asia several years ago that gives some awareness of public in eastern Asia they know something very seriously that's the I guess the point even we don't know the detail in future but public should know how to deal with these unknown violence thank you please join me in thanking our panelists for the very good session and see you in a minute thank you thank you very much