 Good afternoon and I'm very pleased to welcome you all to the eighth and final webinar in the IIEA series Development Matters, which is supported by Irish aid. The series has highlighted important partners of Ireland and Irish aid across a number of sustainable development goals. It has focused on the importance of European and international perspectives to the work of Irish aid. We're delighted to be joined today by Dr Mike Rine, Executive Director of the WHO Health Emergencies Programme and Colin Brophy TD, Minister of State for Overseas Development and diaspora. Dr Mike Rine, a proud West of Ireland man, has worked at the forefront of managing acute risks to global health for nearly 25 years. During his career with the World Health Organization, he has led teams that tackled SARS, Rift Valley fever, meningitis, vascular dysentery, Ebola, and most recently, COVID-19. Since 2019, Dr Rine has held the post of Executive Director of the World Health Organization Health Emergencies Programme. He is a 2020 recipient of the President's Distinguished Service Award for the Irish abroad. Colin Brophy was first elected to the DAWL in 2016 and represents the constituency of Dublin Southwest. He was appointed Minister of State with responsibility for overseas development aid and diaspora in July 2020. Our topic today is enhancing global health preparedness for the future. The format will be a discussion with Dr Rine and Minister Brophy, which will last around 20 minutes, and then we will go to Q&A with our audience. You will be able to join the discussion using the Q&A function on Zoom, which you should see on your screen. When you send in your questions, which you can do from the beginning, we will come to them after 20 minutes. Please identify your name and any relevant organization with which you are associated. Today's discussion is on the record. Feel free to join the discussion on Twitter using the handle at IIEA, and we also are live streaming, so a very warm welcome to those of you joining us on YouTube. I'll start by putting the first question to Mike Rine. Mike, the World Health Assembly met two weeks ago in Geneva and decided to establish an intergovernmental working group to work on a new international accord or agreement to deal with pandemic prevention and response. It hasn't yet met, and I know it's early days, but it is expected to submit its work to the World Health Assembly in 2024. Are there any particular measures which you would like to see included in any new international agreement in this area? Thanks, thanks, Mary. And as you know better than anyone else, this is a process between our member states. Clearly in the Secretary, we have strong views as to what should be in there, but ultimately this is going to come down to 194 member states of recognizing the role you played personally in negotiating the original international health regulations in 2005. And you know how challenging those processes can be finding consensus and finding agreement. For WHO, I think what we need is a new deal, a new agreement between states that prepares the world for the next pandemic in a much better way than we've been prepared so far. That really has to address issues of governance at international level, coordination, cohesion. It's got to address issues around financing and long term sustainable financing for developing national capacities and linking those capacities globally. And it's got to lay out the key systems and tools that we're going to need going forward, better surveillance, better sequencing, better research and innovation, more equity and distribution and allocation, stronger and more deployable health workforce, stronger health supply chains. So all of those key operational and scientific components coming together with an agreement between our member states to do this together, to do this in coordination and to do this with equity as an underlying drive for any convention or treaty that is agreed. Thank you very much, Mike. Minister, what can we in Ireland and indeed what can the EU do to strengthen the global health infrastructure? What's our level of ambition? Well, I think our level of ambition would be quite high on this. I think there is a lot you'd want to see coming out of it. I think one of the things that I think we can take as a focus on is this. I mean, it's possibly if you want to look at it in an odd way, it's one of the silver linings of having COVID-19 at the moment so present and so focused in people's minds is that there is, I think, an understanding on an international level of the need for collective action and a multilateral approach of an integrated solution which means that everybody works together through the structures and organizations we have at the moment strengthening them, developing them. A lot of the things that Mike was referring to just there in terms of it. I think Ireland would be very much on that view and because the experience of what we're living through and going through is so vivid and so immediate. And that will work as a catalyst in terms of helping that process along. Minister, can I stay with you a moment and just the current pandemic has highlighted a number of different areas where international cooperation with the developing countries needs to be strengthened. There are areas in which Ireland and indeed the EU are already involved. But are we doing enough in areas such as research and development and assisting developing countries to build their manufacturing capacity in the pharmaceutical and medical supplies area. Well, I think particularly through the European Union, we're moving in the right direction. There is a willingness to engage. There is a willingness. We're looking at the building of new facilities to produce vaccines in Africa. There's effectively a billion worth of euro investment going in into that area. You can always do more. I mean, that's the bottom line on which you can always do more and you must. I think as both team Europe and as Ireland, we must consistently be looking at what's happening at the moment, evaluating how successful it's been and seeing how we can improve and strengthen that. So while I think there's an awful lot that has been done and is moving in the right direction, particularly in terms of I know about you maybe come to it later strengthening health systems and working together in that area. But the simple I suppose answer is, is yes, we can always and should always be looking to do more. And because building in that level of capacity and infrastructure capacity in terms of what's required is going to I think be one of the key things and dealing with this pandemic through and dealing with future pandemics. And can I turn to the trips agreement this is the intellectual property agreement in the WTO, which has the issue of waiving the trips agreement has been raised as a means of enhancing equitable access to vaccines. Mike, could I ask you, what would the likely impact of such a step now be would it really make a big difference. And how would you respond to some suggestions that such a step could have a dampening impact on the development of vaccines in the future. I think Mary it takes a multi pronged approach, just waiving technology rights, doesn't necessarily make vaccines, we've got to have transfer of technology we've got to transfer of capacity. And we've got to look at this as a global strategic effort, this isn't about taking production from one place and giving it to another place just on a basis of equity. And on a tactical and strategic basis and ensuring that you have enough production facilities strategically located around the world who can both scale up and push out vaccines in a way that will not be interfered with what is understandably when you have production based in certain countries, there are huge political pressures for those vaccines to stay in those countries. That's what's generating a lot of the problem. And that's what's then prioritizing contracts with those very often host countries or countries around that host country. And that's distorting what should be a market that's based on a distribution of vaccine based on need. When you have an emergency in any emergency. If a, if a, if a fire brigade goes to a fire today it doesn't distribute water on the basis of, of who can pay. It's not based on which house is burning, which house is most at risk. So we need a system that is much more coherent. And yes, we need technology transfer we need wavering on waving technology rights will help. And there are arguments and I've heard those from European Union about how that may have have some negative impacts but remember here it was public money who drove most of this investment. The production and scale up of vaccines by the private sector was underwritten by taxpayers money by citizens money all over the world was essentially de-risked. Most companies who produce produce that scale with contracts already in place from government. So there was a significant de-risking of that. So the idea that all of this innovation occurred purely in large companies is not true to either the Ebola vaccines we have today and we're using just finishing an outbreak in Congo, using a licensed vaccine ever after having multiple trials was developed in a public health institute in Canada. It was further developed with a small startup company was only then transferred to large farmer for scale up. So innovation is happening all over the place the question is to coordinate and make that a coherent system where you look at the end point, and you say to yourself, what do we want in the end, maybe in the street you marry. We want a system of vaccine production that is rapid is fast is safe, and they can produce vaccines for those who need them in time to make a difference. And in doing that you have to look at all options as you would in any sector if you're looking at the economic sector or they you're looking at the technology sector if you're looking at the housing sector. One particular solution doesn't solve everything it is usually a compendium of actions taken with an objective in mind. And in our case, the objective must be the ability to produce large amounts of vaccine targeted at a pandemic virus and doing it in time to save lives everywhere. Mike Minister could could I ask you on this question of waving intellectual property rights and the trips agreement I should say is Europe on the wrong side of history here. No I don't think so because I think first of all you have to look at the totality of what Europe's doing by the way in Europe is the single most generous in terms of providing vaccines and getting them out there and making them available. There are countries in the world which are doing a bit of the talk the talk, but we're much much slower at actually making vaccines available. And I think it's to the credit of the EU and what Team Europe has been doing. And that from a very early stage, including in Ireland was one of the very first countries to respond to the World Health Organization's call for funding and to put funding into covax. Look, what Mike was saying there is at the heart of this. It's a multi-pronged approach to how you deal with it. If there is no silver bullet, I think sometimes some of the people who are very passionate around trips, you know, advocate for as if in the world that would be the solution. It's not. It's a combination of solutions. Covax, which is a very good, well developed system for delivering vaccines, which was put in place to do that, to tackle that, I think has great capacity and will be part of any solution. And it's something that we're supporting very strongly. I think we'll be increasing our support for both in terms of actual vaccines and in terms of cash support for it. But I've no problem with other people looking at things and looking at trips and looking at technology transfers and looking at that whole area and saying, how do we mesh this together to have a better solution. But everybody's goal is the same. Everybody's goal is to obviously get vaccines out there and to tackle the pandemic. But I just think we need to be careful that we don't type of take ourselves down a large argument, which might make people feel good in a particular way about what they're saying or doing, but won't necessarily supply the solution. The solution is a very, very multi layered solution. And I've no problem with people having that discussion about trips. But I think there's far more involved if you in the morning in the morning and we I think we'll have by the end of the year a billion vaccines will have been produced. But in the morning, if we had an endless supply of vaccines available, everything we've learned out of the Bola actually tackling HIV AIDS are taking anything is that you must have the support for the health systems. You must be willing to engage on a level with countries, which is far, far greater than just vaccine provision in terms of ensuring that what then is the vaccines that are out there are actually capable of being delivered. And that's something that's key to Ireland's approach. And I also think is key to the EU approach in this. Minister, you mentioned the question of strengthening health capacity and as you say that is a key issue for the present and indeed for the future. How will you ensure that financing going to the health sector and continuing to go to this important area and is ring fenced as it were and that it won't be at the expense of other important areas such as climate change or that. In terms of just speaking in terms of what we're doing, we are actually very much making sure that financing we put into health systems goes into that. We have a separate area which we're developing around climate finance and how we will develop that and work with that. It is very important. The actual reference to climate finance to the climate area is interesting because it shows, I suppose the complexity of what you're dealing with at any one time. While we have the meet immediacy of COVID and the focus on that is what we're obviously talking about today. Consistently, there is not just the climate issue, but there are other major health issues, which we still have to be aware of HIV AIDS. In this area, you still have a whole host of things that are out there, which are hugely impactful on countries health systems. What we will be doing is obviously making sure in terms of from the Irish aid perspective, that we have targeted finance into that area. We are increasing our financing to which we believe it is absolutely vital because the impact of COVID to date has been actually not just to require more funding to deal with COVID but has been overall a damaging of structures and institutions that were already in place pre COVID. So there is, I believe, a need for increased support in that area, increased funding in that area. We certainly will be stepping up to that. Before opening the floor to the audience. Could I ask you one other question, Mike? The focus obviously for the past two years has been on COVID. Has this impacted or how has it impacted the WHO's work on other communicable diseases such as for example Ebola, TB, malaria. Is it getting difficult to maintain a focus on all of these ongoing issues as well as COVID? Yeah, most certainly is and we've seen huge impacts and that's not just in developing countries north and south on delivery of health services access to the HIV, therapy, TB. Even in cases of seeing malaria stock outs in places we've seen recent outbreaks in places. We don't expect to see them because they've usually got good control. There's an exhaustion in the health system as well. All over that's again north and south health workers are leaving the health systems around the world. So there's a loss of health workforce. So there's a number of different things driving a very serious issue going forward and fiscally as well. Many ministries of health are spending money against budgets next year or the year after. So we're going to see a contraction potentially in health budgets, not only domestically and that's for Minister Brophy as well in terms there will be pressure on all fiscal spaces as governments adjust in we hope in the aftermath of the pandemic. We're having a dramatic effect on the ability of us to reach universal health coverage we're making progress. We were already off off track for the SDGs, and we're further off track now. And when you put it together as well we've got, you know, we need to replace the old four horsemen of the apocalypse. I think they used to be conquest famine and pestilence and war. And now we know we have social inequity climate stress, a pandemic risk and conflict and political instability, and these things are really coming together in an incredibly negative way. If we look across Africa in the Sahel we look across so many different settings around the world, the prolonged social inequity and lack of access to lively good. The impacts of direct impacts of climate change and what that's driving in terms of migration and conflict conflict itself and an absence of government so we are really in a very very difficult space not only for health but for education, and other and other issues. So I do think we're going to have to really think our way through how we recover properly from this and get back to where we work as we are seriously off track. And there are consequences for this that are well beyond, well beyond this pandemic and secondly driving the pandemic impact have been many of these social determinants of health. Most people who are dying in many countries are because prolonged lack of access to health care, nutritional issues, my issues of where people live the old issues of overcrowded unhealthy spaces in which people live these have all driven the negative impacts of the pandemic so you have the self driving self repeating self amplifying effect. And just one last thing going back to your previous question Mary, there are extraordinary circumstances in which we have to really look at things like patents and intellectual property. When, when the patent for seat belts, or was shared Volvo didn't go out of business, and when salt shared and patent polio vaccine, vaccines didn't go out of business and vaccine production, you know has expanded around the world since. There are extraordinary circumstances in which we need to share intellectual property a way of rights. But yes, you're to answer your first question. I'm very concerned about the long term impacts this will have on systems. But I also see tremendous resilience, particularly, you know amongst health systems health workers. Huge lead resilient communities in developing countries and fragile countries. This is not their first disaster they've been through. If they get the right kind of assistance, they will recover. And that's why it's really important that the development community and the humanitarian community maintain that solidarity for the future. Thank you, Mike. I suppose what I'm taking from that is what we really need. And what we need for a long time is a stronger multilateral system with strong support from countries like Ireland. I'm going to group a few questions now there's a number of questions have come in. The first one is from Peter McLoone, an IEA board member. Can you ask for Dr. Ryan give us his assessment of how long it will take under existing funding global aid arrangements to inoculate the majority of the population of the poorest nations, and are we over aligned on voluntary contributions and donations. I've shown a Murray of your own news again back to the waiver I think you've answered this. What is your response to you refuse or to support the trips waiver because it hampers innovation. And then a question from Louise Finn and head of policy and docus. I'm really interested to hear Mike Ryan's thoughts on where he thinks Ireland as a small country and have the most impact through its ODA programming and deep through its diplomatic weight and the minister may have some comments to make on this also. And I just give you those three questions that I've more coming in so over to you Mike. I will try the how long I mean we would Dr. Tedros and the partners in the in the active accelerator, you know have laid out those objectives to get to 70% coverage of of effective. So it's going to vaccines by the middle of next year. We had a target for 40% percent by the end of the year but we are so far short of that target. Vaccine availability is accelerating, as was indicated through the coax initiative, and there is some improvement. Some countries have absorption capacity issues as well the primary cause is still supply and allocation. But there are still countries particularly fragile and conflict affected countries which are having some difficulties in absorbing vaccine. What we're concerned about right now as we face delta and Omicron is is not the absolute coverage of the population but ensuring that vulnerable at risk people get at least a primary course of an effective vaccine, because the people who die and this pandemic are the older people, you know compromise people people with underlying conditions frontline health workers. So we have to refocus our efforts now as we deal with Omicron on ensuring that we get primary vaccination into the maximum number of people it is possible to reach that 70% by the middle of next year, but it's going to take a huge push. It's going to take manufacturers prioritizing coax contracts it's going to require a and it is heavily dependent on od a funding and emergency funding there is no path. And that's one of the things that will be discussed as part of the treaty discussions that there's already discussions in the G20 on financing mechanisms for pandemic preparedness and response so that you don't have to go to emergency funding when you need to do this for future because that's exactly where the funding is coming from. But that's again has not been the biggest obstacle to the provision of vaccine funding has not been the biggest it's been an obstacle, but generous contributions from the European Union and others have helped create a good fund for buying vaccine the biggest problem has been access to those vaccines. I won't go back on the on the trips thing yeah I think you know I think everyone knows the WHO's view on that. The in terms of the most important thing I mean first of all I think it's important to recognize that Ireland has been an incredible country in terms of its service abroad through its NGOs through its aid programs over the years and highly effective and very much a donor and a partner to countries and it's I think it's used its money very wisely over time and in terms of what our I think Ireland has tended to focus on priority countries to try and maximize the impact that individual investments have on building long term partnerships with governments with NGOs inside countries like this still think that's a very good way to go. I think we have to recognize in this and it's the same when it comes to so many other issues and development and humanitarian intervention, but in this case, epidemics, pandemics begin and end in communities. Community empowerment community trust community based surveillance community based interventions primary healthcare, empowering a local workforce volunteers community health workers and and and focusing on building that local capacity. I have a bit of a concern at the moment Mary that everyone is talking about global treesies and it's great and global technologies which is great. But in the end, global health security emerges from strong local communities that are empowered. They're formed that trust the government and the governance systems around them that can access the resources they need to protect themselves and protect their families and connecting those communities through civil society through non governmental organizations through government organizations at national level and then connecting all of that in a global chain, an unbreakable chain of security so I think that focus on really getting out into communities. Because sometimes some aid is so strategic and it's so high level that it's very hard sometimes to see what it actually does on the ground. Thank you there. Minister, would you like to come in on that question about priorities for Irish age you have touched on it a little already but. No, no, I think it's a very important point. I mean, what we try and do in Irish age and it's really really important is there's a clear recognition of obviously the size and scale of us as a country we are a small country. So we try and do and Mike very kindly in his comments about it captured a lot of the essence of it. We try and target the resources we have in a particular way to get the best benefit out of it. One of the guiding principles of that, therefore is very much an ethical based approach as to how we would target and how we would engage in using the benefit of some excellent NGOs which we have, and also working very much within that multi lateral framework of organizations, working on the basis of, you know, reaching to the furthest behind and helping where it's most needed. But in terms that are taking that into what we do and what we want to see and what's been done for many years in terms of what we then do is an influencer is to try and lead by example, is to try and look at what we can say on a world stage including using positions that we hold on the Security Council, and our membership of the European Union, etc, to say right, but we want the bigger players to do. And if that's doing things like, you know, wanting to double our own donation of vaccine in kind over the next 12 months, if it's increasing our own support, we're, we'll lead by example, and then use that example to give strength to our voice in the bigger institutions in the bigger players. It is though I think really important that core central point that, you know, a lot of the very big highlight a lot of the very big organizations are countries with aid. It doesn't really impact on the, the local on the ground it doesn't really have that trickle down effect to make it most effective. And we try at every opportunity to take the experience we've built up over many, many decades. In terms of what I wish it does to make sure that what we're engaged with has a very direct a very immediate impact. And that does mean having to to look and choose and make type of contributions whether it's looking around HIV AIDS and the program you put a place in supporting that are in Ebola or whatever, where we as a country can use what we have and use it to most effect, and we'll continue to do that. Thank you, we've a lot of questions coming in, and a lot of them are about vaccine availability the trips waiver, and we've already dealt with that so I'm not going back to those questions again. But there are other questions that I will take up here. There's one from Sarah Fitzgerald UNEP Jamaica, and she says in some developing countries the availability of vaccines isn't the problem in Jamaica for instance, 12% of the country's vaccine supply has been discarded because the uptake was so low and the vials expired. Meanwhile, only 18% of the population has been fully vaccinated. So if you're interested in your thoughts on this, and she raises the question, isn't a question of health literacy. Can I add a little rider to this question. It seems to me that a huge issue now is reliable sources of information. Like Mike and the minister maybe to address this issue. Our governments doing enough to get good information out their population. And is there a role which the World Health Organization can can play here in stressing the importance of adequate communication and information. Another question then is from Anthony Brogan freelance journalist, and he said that David Nabarro has said a H5N1 pandemic could lead to anywhere from 5 to 150 million people dying. It's very done to contain risk of further pandemic such as this given factory farming practices and reluctance by authorities to adopt a one health approach. And there is another question here, which is actually very detailed. Let me read it out. It's from Pory Kalpen of Reuters. He says a major study today has found that two doses of the fights are biotech COVID-19 vaccine appear to have given 70% protection against hospitalization in South Africa, suggesting weaker efficacy against the new Omicron variant. Does the WHO have concerns about these results and should it hasten people and governments on getting boosters bearing in mind that WHO has suggested that primary vaccines are the priority first in all countries. Micah, I'll go to you on that question. That's a lot of questions. Okay. On the issue of, yeah, the current Omicron variant is spreading very, very rapidly and is in many cases beginning to replace the circulating Delta or other strains. There's no doubt that the rising number, the force of infection, will generate more hospitalizations in the coming weeks. Just not because the virus is more, but just the sheer weight of numbers will generate that. There is clear and there's some preliminary studies around vaccination, which show that the neutralizing antibodies are decreased. That can be found with many different vaccines over time. The issue here is whether protection against severe illness and hospitalization is maintained. There is some preliminary data from South Africa, another place which actually showing that the vaccines seem to be holding up quite well in terms of protecting against severe disease and illness. And some data that suggests that there aren't the same number of hospitalizations that would have been expected given the numbers of cases compared to the Delta wave. But again, all of that is extremely preliminary. In terms of the people who need to be most vaccinated and we look at places even like the United Kingdom where you have 95% coverage amongst white British people but 75% coverage amongst black British people who are in vulnerable groups. So the issue is not just the coverage in each individual country, it's the targeted coverage within countries who has been missed. The reality is that people over 55 years of age, people with underlying conditions, people who are immunocompromised are much more likely to be severely ill and die from this disease. So primary vaccination in those groups all over the world is a top priority. There are circumstances clearly where giving a third primary dose or a booster dose to vulnerable people is very much justified. What I was asking is should we be going for primary vaccination or boosters. The reality is, we should be doing both. We should be focusing on getting those who are unvaccinated vaccinated as quickly as possible, and then being able to give booster doses to those in vulnerable groups. And that is the best use of the vaccine. Now we separate here what is national policy in the face of a national event, what governments do individually to protect their own citizens, which is their duty from what is a global issue around the best use of vaccine at population level, at global level. And the best use of any given dose of vaccine right now is to vaccinate a vulnerable person who has not been vaccinated, wherever they are. And then to look at the issues around booster doses. But again, to reassure people because I know you're putting this out live. It's really important. We don't have enough data yet to make a full determination of whether there is no doubt that with the Delta variant, the vaccines last a little protection against infection but they held up very well against hospitalization and death. We're waiting to get the data on that. There is some preliminary data coming through but it is very preliminary. And I would expect the current vaccines to provide significant protection against hospitalization and death. And in people who had a full primary course. The question then is whether there are certain groups who should receive a booster dose, regardless of the Omicron variant, it's to do with two circulating bears the Delta variant is circulating. In most of the world Omicron may replace it and will most likely replace it over time. But I'm most concerned about right now today is the fact that there are unvaccinated people in every country who are at high risk. People have moved away from applying even the most basic measures to protect themselves and others via government policy or individual behavior in terms of mask wearing, avoiding crowded places in terms of hand washing in terms of ventilated spaces. All of those issues. We are likely to drive transmission and have huge numbers of cases, and even even if Omicron turns out to be a milder disease than an individual patient. If we get millions and millions and millions of cases, we will fill the hospitals up, we will fill the ICUs up. So we need to refocus on public health and social measures, vaccinate the unvaccinated. We need to make sure that hospitals are ready now. We saw last year with India in other places the crisis and oxygen every single health system needs to get ready. It needs to look at its health workforce, look at its clinical management and triage. Look at oxygen and other supplies. Look at PPE for its health workers, because whatever happens, a wave of Omicron, whether it's less virulent or not will generate pressure in the health system. And within all of that, doing all of that, giving boosters to specific groups in the population who will benefit from that because they likely have lost some protection, particularly older persons, people who got underlying conditions. So I would like to use data to suggest that that will provide an extra level of protection. Sorry for the long answer, Mary, but I just wanted to make sure we got the broad spectrum, everything in this response so far has been a little bit about people looking for silver bullets looking for unicorns, the perfect answers they don't exist. What has worked through this pandemic is layered risk oriented evidence based consistent advice to people support to communities. There is no way out of this. There is no we can't vaccinate our way out of this. We can't lock down our way out of this. What we have to do is have coherent multi layered strategies that get us through to the end of this pandemic. Thank you for on that Mike and Minister, could I ask you to maybe take the question on communication strategy. It seems to have been very difficult, not just in developing countries but even in Europe to get across to some populations the importance of basic health measures as Mike has outlined the very basic measures and the importance of vaccines. In your view, is this something that should be left to national governments or is there a greater role, which the World Health Organization could play in this area. It comes back to the central point of, I suppose all the answers that I have been giving I think it ties into the central point that all the answers that Mike's been given as well, which is, it's all a multi layered approach, and there's no one way of doing it. Yes, of course, there is a need for national governments to lead and lead very strongly on this. There also is a need for an international response. There is a need from whether it's the World Health Organization or whether it's on UN or wherever it's coming out of. There is a need for an information deficit that's out there. I think to be dealt with. It's interesting. I took the opportunity to do some reading on, you know, the last global pandemic in terms of Spanish flu and you had so much of the same arguments being made about at the time about vaccines and their dangers and all this type of stuff being spread was then the medium of a newspaper or public meetings or whatever. Nobody had at that stage obviously social media to contend with. There is I think a real issue and particularly in some of the poorest countries of misinformation and of information being spread, maybe because of a lack of belief in what their governments are saying or what authority figures within a country might say, that's where I think there is a very particular role for communication by respected international bodies being able to communicate that necessity, that absolute overwhelming necessity. So we do need more communication. We need to deal with it. We need to recognize that there always has always will be and will be in the future groups and people and individuals who for whatever their motivation will seek to disseminate misleading information or hang on to misguided beliefs, but there is a need as well as the provision of vaccines and improved health systems to actually tackle the information deficit that's out there so I would very much strongly support that. And Mary, if I could maybe that issue of because you know this as public servants, you know trust takes years, sometimes decades to build and it can take minutes to lose. And we have a trust deficit but it's not just around the pandemic, it's a trust in government a trust in governance a trust in new information coming from public authorities. That exists in developed and in developing countries. And it is very hard to make that trust up it's very hard to construct a trusting relationship if that hasn't existed before I think I'm just actually done particularly well in terms of its vaccination program overall because there still is regardless of all the criticisms, a very high level of trust the in the government, you know, and there's a there's an open debate there's open media there's questioning this hesitant there are all those things but ultimately at its core. I believe people and I believe the government is trying to help them might not like the way it's trying to help them but it's trying to help them that is not the case you know that has been an ambassador abroad. It's a relationship that all governments have with their population. When you're in areas of extreme poverty and urban degradation and exploitation and migration, and all of that put together and then you come in to populations who've had no health, no assistance, no development, no equity for decades and decades and you say here we are we're going to save you all now. I mean really if I'm there in that situation I'm saying who the hell are you you haven't been here. We've been struggling to live to eat to survive. We've been struggling to educate our kids we've been struggling to get the basics. And now because you think it's an important thing. You want to vaccinate us. I've seen that with Ebola vaccine I've seen that will pull your vaccination. It is incredible. And it's not just about literacy. It's about a much deeper issue, which is who you trust. It's the motivation of who speaking to you that convinces you more than anything else it's not the color of the posters. It's not how nice the, the advertising campaign is, is what do I believe about the motivation of someone trying to convince me to do something. If I believe their motivations are well founded. If I believe that person has my interest at heart, I will tend to listen to them and do what they're asking of me. That is not a situation that exists in a whole lot of countries right now. And we've seen that on top of that, we have genuine hesitancy and we should not criticize hesitancy. People can be vaccine hesitant for any number of reasons our job in the public sector is to engage with those people and engage with them with influencers and communicators who they trust and governments need to learn to branch out and open up and involve civil society, involve non-governmental organization in that process of trust building. The other issue is people are overwhelmed. There's an infodemic. There's so much information. It's not that people aren't getting the right information. They can't separate the good information from all of the other rubbish that they're getting pounded with every day. We're giving people the ability to select the information, the sources that they need to make good decisions. We need to provide that sort of architecture and those tools to people to be able to do that. And then at the very core of it, there's a very small group that's usually influential of anti-vaccination who are essentially, you know, driving misinformation and driving that negative thing. They're exploiting that environment where trust is weak. They're exploiting that environment where health literacy is not so good. So I think it's a very complex issue and if we're going to go into the next pandemic, to be honest with you, the biggest weakness in this pandemic has not been, we've had a scientific revolution. We've had huge technological success. We've been able to develop vaccines and drugs and diagnostics in amazing time. We've had workers of safe, countless lives in intensive care units. The biggest single failing in this pandemic has been in this area of trust, of governance, of consistent coherent strategies that communities can buy into. And I'm not saying that it's great. I think Ireland has done a particularly good job. And I'm sure there's people online who are going to come at me for saying that. I think Ireland has done, you know, when you compare it around the world has done a good job in maintaining that basic trust and in trying to create a measured strategy for this. No one is right all of the time. But I've seen this again and again and again. And if we're going to be successful in preventing and responding to the next pandemic, we need to invest in trust as one of the primary outcomes, and we need to create platforms on which we can do large scale emergency response in the future. Thank you. Our questions are still coming. Let me just take two now. One, just to go back on that issue of animal health and the impact on human health. Yeah, that needs to be looked at more closely, perhaps in the context of the, you know, the, the next agreement or a court or whatever that's coming down the line. And the second question is, excuse me, and from Neve Caffrey of Mission Kara, and she says there's quite a discrepancy between covax delivered and covax pledged vaccines. Would you like to make any comment on that. So animal health and human health is that something that should come up in the, in the upcoming negotiations. Yeah, and in one health is even broader than the animal human if we take animal human and environment, you know, we live on a stressed planet. We live now in a very stressed by on in a biologic system that's deeply stressed because of climate stress, because of exploitation of pristine environments because of animal husbandry practices. We're generating risks every single day, and we are seeing breaches of that animal human species barrier, we want to prevent or reduce the risk of the next pandemic, we have to operate at that barrier. And that means changing the relationship we have with the animal kingdom changing the relationship we have with nature and managing that and being good stewards of our planet good stewards of our environment, because we are going to pay a heavy price. The percentage of all emerging diseases over the last 4050 years have been zoonotic diseases diseases directly transferring from animals to humans was the same in all of the previous pandemics of influenza we see the same with Ebola we see the same with many nipah virus all of these potentially pandemic viruses live and exist in animal in animals. We're also stressing those animals they're having because of climate stress because of exploitation, they're moving closer and closer to human populations as human populations move closer and closer to them. And then we've got these intermediate species, large scale animal husbandry of domestic species being done without adequate biosecurity, and they can act as amplifiers and they can act as intermediate hosts. It's complex, but it's very dangerous and we're playing with fire we are playing Russian relaxed with our environment not just in terms of climate change, and in terms of temperature change and in terms of extreme weather events but we're playing Russian relaxed with the environment in terms of pandemic risk. And there's no point is preparing for the next pandemic and getting ready for it. If we're not prepared to reduce the risk of it occurring in the first place. So we have to be able to do risk reduction, and then be ready for any risk we can manage there's always a risk of a pandemic no matter what we did, but the risks of those pandemics increase exponentially with the way we're treating our environment and the way we're treating the animal kingdom right now. Minister would you like to come in on this issue. To add to a point I was making earlier on towards the start of this that we must use, not just lessons learned out of covert, but the immediacy of covert to drive that agenda that Mike was just referring to, because there is an opportunity that the response has to be inclusive and multilateral. We unfortunately, I think, both in the wherever you want to call it in the world through to various governments which you could have maybe have historically relied on the past, which which treated the certainly the start to covert in a very populist way in terms of response. We lost a lot of time and a lot of ground I think as an international community in terms of how we would respond to covert. What we need now is to put in place that structure that looks at all of the regulations to how you prevent pandemic, as well as how you treat a pandemic, and Mike is quite right in this that if, if you don't do that if you're not willing to engage at that level, then all you're really doing is, you know, effectively saying well we will fund the fire brigade to put out the fire, but we won't fund any of the logical things to stop a fire breaking out in the first place. And that is insane. And that that attitude has to change. And it has to change at a multilateral international level, where countries are willing to engage on a whole range of issues, which include absolutely everything to do with animal husband and how we treat agriculture and how we actually look at the fact that because of the interconnectivity of our planet in the 21st century. The impact is immediate. I mean it is absolutely in a way that couldn't maybe be envisaged 100 years ago, the impact of something happening in one very small part of the world has a billions of billions of pound impact on countries on the other side of the world that have millions or hundreds of millions of debts in terms of a global issue as a response to something breaking out in one very small part of the world. That's that big, big change that we now need to say well how are we going to put in place the structures to not only tackle it, but to help it out to try to try and stop it happening in the future. Three things Mary that spark a pandemic. There's the actual disease emergence the breach of the animal human species barrier. Then there's amplification of that new virus within a human environment and within, you know, within a slum setting within an overcrowded human setting within a poorly managed hospital with very poor infection prevention and control as we've seen with the Ebola. So what we need is that disease emergence occurs then that disease amplifies sometimes locally. And sometimes within the nation and then we have dissemination that ability for the disease has come to spread around the world in 24 hours. We're pushing each of those three buttons. We're pushing the emergence button, we're pushing the amplification button, and we're pushing the dissemination button, all at the same time. And we expect us that we're going to be, you know, have less pandemic risk in future know pandemic risks are arising. But I wouldn't like to come to the end of this webinar and say we don't have hope I have seen the most incredible innovation. I have seen the most incredible community resilience and community support. I've seen young people do the most amazing things I've seen people now with essentially saying, look, we need a new deal we need a new future we need a fair future. We need social equity. We need climate justice is very promises speaks about. We need health justice. We need to refocus what we consider to be important on this planet, but we consider to be important for our civilization going forward. What we mean by development what we mean by equity. And I actually think we have a big choice ahead of us and it's not just about having a new treaty in Geneva, we love to have it. But this is a bigger it's even bigger it's really about the future of this planet the future of this civilization and we have choices to make together around what future we want because we have much more control over the future. So what we think the problem is we're continue to make bad choices. It's about making good choices for the future of our people. And right now, and you said it called populism, and other things have driven a whole lot of bad choices on unfettered globalization lack of regulation of the exploitation of the environment. So many things have driven bad choices that are leading to worse outcomes. We need to start making good choices as local national and as a global enterprise as a global civilization, or we're going to you know run ourselves over the edge of it but I do think that the will is there. I do think that the young people are the young younger people in our populations want a different future. We're just not providing it for them right now. Thank you. Thank you both very much and I'm going to give you one last question. And a lot of people. I suppose we do know we're lucky in Ireland. We don't agree with everything but we know that our vaccination rates are very high. We know that we are contributing through Irish aid. And through the NGO sector we're contributing a lot to try and help others. But is there one final message you could give to people as to what we can do over the next few weeks. And in this effort to help others in the current crisis and plan for a better future and maybe Colin Brophy you take the question first. Okay. Well, it always comes down to if you want to have a better future and plan for a better future. The first thing you do is you protect yourself. And I just take the opportunity to mention for people who are coming back to Ireland and we want people to be able to come back to Ireland this Christmas and people are coming back and we think that's going to be for a lot of families and everything a really joyous moment. And just to reemphasize that key health message to, you know, to follow the precautions to do the things like wearing masks to get the tests to keep checking your, your, your, your, by testing your own health. So most small actions have a direct impact where you immediately are, and then obviously what we want to see. And I think it's most important is we want to see a global response that is increased and focused, and is all about. And Mike is saying that one of his most often quotient quotes I'm sure he's heard it back a thousand times but Mike, that line about no one is safe until everyone is safe. It is I think at the essence of what we all need to remember when it comes to what we can do that no one is safe to everyone is safe and that means all our collective actions, both as individuals as governments and as multi lateral organizations, we must all wrap that into our thinking for how we tackle the pandemic in 2022. Mike, the last word to you. Well, one of your previous questions was asking about the pledges. So first thing I would say if the countries have made pledges of vaccine, make good on your pledges, make good on your pledges now because we can put pledges on people's arms, we can only put vaccines in the markets. And there is a real shortfall on pledges versus the vaccines given, we need to accelerate the distribution of vaccines around the world. And we need to help those countries that that have issues with delivery of vaccine at some national level we need to give them immediate assistance to be able to deliver on those vaccines. And it was sad to hear about the situation in Jamaica, but there are real issues in a number of countries around hesitancy but there are also issues around logistics and other things in other countries. I would say the next few weeks in terms of everybody in the world but in Ireland particularly given that you amend the Irish audience. People need to look out for each other, look out for themselves. Absolutely work to reduce your risk of being exposed to any of these variants they're all potentially deadly get vaccinated. And just be careful, just be very, very careful and I just like to give a shout out because I've done a lot of sort of webinars and not so many like this and not so much media but I've done a lot of stuff with the Traveler community in Ireland with cope and Galway with the with the with the alone movement with hospice movement and I've been really amazed. I must say, absolutely amazed with the non governmental sector in Ireland I'm not talking about abroad. I mean, the work abroad is fantastic but it's based on a well of of immense solidarity that exists in Ireland in in Irish society. And I just like to recognize the role that community organizations have played in Ireland, forever, but certainly over the last two weeks because I believe that's the future of when we talk about development to it's about building communities, it's about building representation and building ownership of communities to work with government to find solutions that are best adapted for people's needs. So that's the longer term but in the short term, please just look after yourselves for the coming weeks, we are going to see likely a very large Omicron wave. We need to protect the health system we need to protect those that we love it. It is not rocket science. Everyone knows how to do it. We just need to get on and do it, especially over the coming over the coming two or three months. Thank you for that and thank you very, very much, Mike Ryan. Thank you very much Colin Brophy for participating and thank you the audience for sending in so many questions. I'm sorry if I didn't get your question. Hope you all have a good Christmas. And if I could leave you with the thought, which I think is from UNICEF get a job, give a job.