 Hello everybody. I'm Jorge Tamayo, Network Manager at SDS in Switzerland. I now have the pleasure of introducing the SDSN transition on monitoring health and well-being. This session is being moderated by Trans Director of ESC Spain. For those of you that don't know trends, Trans is an ESC Sematic Research Network on data and statistics, which is particularly interested in how to harness these innovations of the data revolution in support of sustainable development. They also do a lot of work on data governance, thinking about issues like how to cover all the sources of information at our disposal and ensure governments respect both our rights to information and privacy. In this session, Jess and her panel members will be talking about some of the data challenges emerging during the COVID-19 epidemic. Jess, the floor is yours. Thank you Jorge and good morning everyone. Thank you also to the previous panelists from Afghanistan. That was a really interesting session. It's a pleasure to be with you all. I hope technology will be on side and this will all work seamlessly. But if you have any issues at any time, please feel free to pop your questions or concerns in the chat box on the GoToWebinar control panel. So as Jorge said, I'm Jessica Espey. I'm the Director of SDSN Trends who are facilitating this session. As Jorge said, SDSN Trends is the thematic network of SDSN focused on data and statistics. And we're focused on how to harness the data revolution for the purposes of achieving sustainable development. So how to use all that innovation and all that big data and new data and all those technological changes that we're seeing and how to use them for the purposes of monitoring and achieving the sustainable development goals. But we're also concerned with how you do it safely, how you respect people's rights to both information and privacy and make sure that it's with an effective governance framework. So in this one hour discussion where we've invited two very esteemed panelists to join us and to discuss how we monitor health and well-being, which is of course more pressing than ever as we collectively face the COVID epidemic. I believe you should all be able to see Professor Andy Tatum on your screen already. And I hope that Ms. Irina Dinku is also going to be able to show us her video. There we go. Hi Irina, thanks. Great. So first we're joined by Irina. Irina Dinku is a senior program specialist at the Centre of Excellence for CRBS System housed at the International Development Research Centre in Ottawa, Canada. Although I believe she's joining us from, I think it might be Amman? Yes. Yes, okay, great. In this global world we live, everyone is scattered. Anyway, in this capacity Irina provides strategic direction to the centre of excellence in overseas technical country support. She's got more than 15 years work on civil registration and vital statistics as well as working on social and behaviour change programs. And then you can also see Professor Andy Tatum. Andy is a professor of spatial demography and epidemiology at the University of Southampton in the UK where he also directs world pop and flow mind leading a group of more than 50 researchers and data scientists. And he's very interested in population data and their dynamics, how you can map those different types of population data at different resolutions. And he's done lots of very exciting work, which I'll talk to us more about on how you use satellite, survey, cell phone data and so on to map the distribution of vulnerable populations, which I think he's going to talk to us about specifically with regards to monitoring disease. So over the next hour we're going to hear brief remarks from both Andy and Irina and then I'm going to exploit my position as chair to ask a few questions myself before we turn to you all. So at any point in the next 55 minutes if you have a question, please pop it in the question feature on the go to webinar control panel. If you look on your little panel, there's a little drag down button that says questions. So click on that and you can enter a question. Alternatively, you can put it in the chat box and my colleague Steph, who's also on the line will be managing and curating those to make sure we get to as many as possible. So the topic of our discussion now is how we monitor health and wellbeing. And I'm not really sure the level of expertise of all of our viewers today. So I'm just going to start with a few basics and leave the expert stuff to Andy and Irina. The first thing you need is the building block of any health information system is to understand how big your population is. How many people are you trying to serve and look after? And for that you need population data. Now that's generally collected from a census. And I'm sure you're all familiar with censuses and I filled in the paper forms, the online forms in your country at some point in time, or at least are aware of what they try to do. So that's an account of the population across the whole country done household by household. But complimenting that you might want specific birth data. You might want to know exactly who's being born when, where, to whose parents, what gender and so on. And for that you might need a birth registration system. Then you might also need to know how many people are coming to your facilities. So how many people are coming to your hospital or health care center, what services they need and so on. And that generally comes from health administrative data. So that's the data collected directly at the health at the hospital and reported back to the government. And then finally you need to know outcome data. How many people are getting well again, or tragically how many people go on to die. And the latter is recorded by hospitals, but it's also recorded through your civil registration system again, in which you record the total number of deaths. So these are the really basic building blocks of what you need to monitor health and well-being in any given country. And that's kind of what the basic health monitoring system should look like in practice. But in reality, is this what that looks like all over the world? Well, to see what you all know about this topic, we're going to do a quick poll. Because I just want to see how familiar you are with the kind of state of health care data around the world. So on your screen, on the right hand side on your control panel, you should see a poll. In fact, thank you, Steph has just popped it up. So that should be on your screen. And it should have a big question that says how many children under five do not have a birth certificate, i.e. do not officially exist. So I'm going to ask you all, you have a go at completing this. How many children around the world do you think are not registered every year? So when they're born, they're not recorded at the health facility or their parents do not take them to be registered and so on. I'm just going to give you another 10 seconds or so for as many people as possible to complete that. So click on what you think is the appropriate answer and then press submit. I'll give you a few more seconds. I hope technology is playing ball and you're all able to see this and complete it. Great. Okay, so we're going to close that poll now. And as you can see from the responses, we have got the majority of people saying one in eight. So an eighth of all children around the world do not have a birth certificate and are not being officially recorded when they're born. I'm sorry to say that the answer that received the least support is the most accurate one. So tragically around the world, a quarter, one in four, the first option, a quarter of all children around the world are not having their birds recorded. And as I'm sure you can imagine that places huge challenges for us trying to understand where these children are, how many are being born, what gender they are, and so on. So it's a pretty tragic state of affairs that we don't even have this most basic information. We're going to do one more poll just to get you all awake. And then we're going to turn to our speakers. So the next question is around reporting of deaths. So obviously in the context of an epidemic like COVID, us knowing how many people are dying is hugely important tragically. And so we need to know countries death statistics and we need to know we need those to be reported as frequently as possible. Now the way countries do that is they collect that information and then they report it to the UN statistics division in the United Nations. So how many countries around the world do you think are reporting the total number of deaths every year? How many countries do you think it's 194? So most of the members of the UN General Assembly, do you think it's about 120? So a good chunk, about two-thirds, or do you think it's 88? Okay, I'm going to give you another 10 seconds to do that. Thanks everyone. I'm glad to see fingers on buzzers, even though it's either very early for you or very late or somewhere in the middle. Great. All right. And Steph, we're now going to close that poll. Okay. So again, everyone's taking the middle line today, but I'm afraid that that's not correct as much as we would love to have 120 countries reporting their death statistics every year. The tragic fact is that it's less than half. It is 88 countries that report their death statistics to the UN every year that have quality statistics and information on how many people are dying and are recording that. That is 88 out of 193 member states within the UN General Assembly, but of course more than 200 countries worldwide. So again, a pretty visible state of affairs that really that's the total number of countries that are able to report their death data every year. So now you've got a good sense, the quality of our civil registration systems around the world and much of our other health and wellbeing data is pretty dire. So in that context, how do we monitor the COVID-19 crisis? So I'm going to hand over to two far more expert colleagues than me to tell us a bit more. So, Arena, starting with you. Did these statistics say it all? Do we really not know how many people are being born and how many people are dying around the world? Can you tell us a little bit more? Thanks. Thank you, Jessica. It's hard to come after a compelling speaker already. The truth of the matter is that we don't really know how many births are happening around the world, how many people have a legal identity. And sadly, we do not know how many deaths are happening around the world. What are the causes? And this aggregation is even more difficult, but I'm going to ask Steph to put my very short presentation on maybe to help those online, if possible. If not, and while she's doing that, you were talking about civil registration and vital statistics systems, but what are these civil registration and vital statistics systems for the people who are listening to us online? Now, these civil registration systems are the book of life. They are actually, they record the vital events, the births, the marriages, the adoptions, the recognitions and the deaths with its causes. And out of it, we can pull out vital statistics, who are an important tool for good governance, and they can provide in the instances where the coverage is good, important statistics about the populations. They can provide important population data. So, for example, fertility data. They can provide fertility data. They can provide information about birth spacing. Most important, they can provide information around mortality, mortality statistics, disaggregated by sex, by gender, and so on. Which are capturing not only the deaths that are happening at the facility level, but also the deaths, or they should capture also the deaths that are happening at community level and something important in the actual conversation. But what is the challenge? Next slide, please. The challenge is that the majority of the deaths are invisible in official statistics from civil registration and there are a lot of births, which are invisible as well. So, why is this happening at the global level? Next slide. I would say that this is happening because of a multitude of reasons, non-investments in these systems as well as, you know, poor or little political will and non-interest and inability also the global community to prove that investments in civil registration and vital statistics systems are cost effective as against investments in other data tools such as surveys, for example, as it stands, we are actually doing a lot of surveys instead of investing in these systems to have something more sustainable and real time. But one of the other things which is coming out is because of our inability as a community of practitioners to understand where the unregistered people are, why they are unregistered and who they are. And it's only then when we are going to be able to support better the governments in how actually to improve the coverage rates in particular for death registration. And why I'm saying in particular, if we look next slide, if we look at the birth registration data around the world and this is data pulled from the UN statistics division, you are going to see that many continents and many countries are faring pretty well. If we are to believe this data, some of whom it is pulled from civil registration and the National Institute of Statistics Compilation, but much of whom, for example, for Sub-Saharan Africa, for parts of Asia as well, it's pulled from surveys, the multi indicator cluster is an indicator, the DHS and so on, most recently the census. However, this map, very interesting as it might be here, it's not actually revealing the inequalities at country level and disparities within the countries. And you were talking about how many children are not registered. Yes, there are 166 million, some one in four under five are not registered, but this is telling us only one side of the story, the side of the story from what the parents think they know. Actually, data from the multi indicator cluster survey is telling us another story, 237 million children under five do not have a birth certificate, which actually shows that the situation is much more complex. Now, when we go to death registration, what it is happening and in between that is marriage, but that is not space for it. What is happening in death registration, can you go to next slide please. In death registration, the situation is dire, as you can see, most of Africa cannot produce vital statistics from civil registration, right. You have very little information from Asia, with countries, for example, such as India and China, where you have big numbers of population lagging behind. Many of these countries are not at 80%, and many in sub-Saharan Africa are under 5% and they are not able to produce any statistics. What this means, it means that practically only 50% of the deaths in the world are currently registered in civil registration, and most of the deaths are in the developed countries. In this developed country, the cost of deaths is also registered. In the low and middle income countries, this is mostly not being the case. There are two different processes in terms of that the civil registration systems is not able to actually give us vital statistics with regard to the causes of death. It's only able to give us absolute numbers desegregated by sex, age, and geography, but not mortality causes. So we have 50% invisible in the causes of death. I think this is really tragic as a community, and in the context of the pandemic, this might have an impact in particular in these low and middle income countries. And why I'm saying so is that it's absolutely commendable the efforts that the governments and the stakeholders are doing during this pandemic in terms of compiling on a daily basis the mortality statistics. However, these mortality statistics are mostly compiled and coming from the health facilities. As the death registration in coming in, and we have seen this, for example, with UK and US most recently, the numbers are changing. They are starting to reflect also what it is happening at the community level. Now, if you switch a little bit to the map and you're looking at Africa and parts of Asia and Latin America, when many of these systems are not working and not capturing the causes of death and they are not capturing the deaths into the civil registration systems, the truth of the matter is that probably perhaps we will never know the real size of this epidemic in the low and middle income countries. There we are going to remain mostly in terms of estimates, as I would say, it's a particular challenge because the governments are going to take informed decisions, but they're going to take decision based on some evidence, incomplete evidence, whether this is going to be relevant or not, it's only the future who is going to be able to tell us. So what I'm going to try to advance here is that it's the data from civil registration system. So civil registration derived from data, vital statistics derived from civil registration are the gold standard for vital statistics and deaths not only during the pandemic but during normal time. Can you go to the next slide please? The civil registration systems actually they are able to capture the events, the most important live events through the life course, so from cradle to grave of the population and it's able to provide us important statistical data for health and for good governance reasons. Next slide please. So it remains actually to us. Next slide please. It remains to us actually on see how this health system should collaborate in particular during the pandemic with the civil registration system so that they reflect the entire mortality at the country level and it's very difficult to do so in terms of the pandemic. And also us as a community of practitioners and the UN systems and other and other stakeholders to support low and middle income countries to actually try to fill to the extent possible the data gap during the pandemic and I'm going to end with a number here. Next slide please. And this is 75,000 and by the end of this 24 hours marathon 75,000 deaths will remain unregistered within the civil registration systems across the world. So this is giving you a little bit of view of where we are and with the civil registration system. Thank you very much. Thanks Irina that was fabulous a really good overview if if rather harrowing, I would say, and to have a sense that so many people out there are going through, you know, either but major major traumatic events or they're losing loved ones and that information is not being recorded and we're not able to respond appropriately. And Andy. So arenas painted a pretty bleak picture. Are there opportunities for innovation that might help us monitor health and well being more effectively and perhaps even give us some tools to be able to track covid and give us a bit of optimism. Thanks. Yes. And thanks Irina. Yeah, I have a few slides as well that that although don't solve the problem we would ideally like everywhere in the world to have this CRBS data. There are possibilities and this is the work of our group at Southampton and well pop is to try and utilize geospatial data to find fill in some of these gaps. So we, yeah, we work to integrate different types of data to try and fill these gaps where they exist. Ideally, we do have we want CRBS data, but if they're not in not existing then there's possibilities. And so if we go to the next slide, what we what we work towards is a small area demographic data and that has multiple uses you see here I've flagged on the right hand side there those that relate to health the health system planning supply chain management health metrics and very relevant at the moment controlling infectious diseases and modeling the spread and intervention effects. So we go to the next slide. And what we do is try and firstly get that basic denominator how many people are then how many people are in the different demographic groups of interest and so that could be the elderly in the case of covid. They access and use and quality of health care. So can we actually reach those people can they reach health services, and then other people actually utilizing those health services. So if we go to the next slide. And what we've heard about, and what is a continual problem, particularly in Sub-Saharan Africa, other low and middle income countries is the data is either course resolution that can be outdated it can be incomplete or it can just be completely missing. We go to the next slide. The kind of data that isn't missing or incomplete are things that we can start to gather together from correlates from things that relate to population distributions and their characteristics. So we try and build up a picture of the landscape to go to the next animation here. So we have data from satellites mapping individual building locations so we know where people are and whether or not we have data from household surveys to look at poverty rates, neighborhood sizes, roads, schools markets all relate to how populations distribute themselves and some relation to their characteristics. So we go to the next slide and demonstrate if we have data here that may be a sample of census data and it's data that's course resolution we know maybe in one of these units there's 20,000 people we don't really know where they are to be able to direct services to them to be able to identify and target interventions. If we go to the next slide. What we do have is data at much more detailed resolution and mapping of buildings from satellites. On the next slide. We have the mapping of the earth at night from satellites to identify where, where is that actually economic activity where the people doing things. So if we go to the next slide, we can go from this course resolution picture. And on the next slide, we can use statistical modeling approaches to move those people and give a much more consistent and detailed picture. On the next slide that gives us the population distributions. And this is something that's available now across the world and estimates of those distributions. And on the next slide, we have the kind of detail that's available. And also on the next slide, the demographic characteristics and how those change across time when we're integrating get together survey sensors sensors micro data to give us that picture. So on the next slide. And we can bring together also household survey data has arena mentioned there are multiple of these household surveys in the places where CRBS does not exist to give us things like age specific fertility data. So we can look out those subnational patterns and use those to adjust our population maps to identify distributions of births and pregnancies. Of course, these are, these are estimates with high levels of uncertainty, but they are giving us data to start at the basis of some estimates. We go to the next slide. And these, again, these data are openly available with uncertainty around them, but really the estimates of pregnancies and births. So on the next slide. We can then start to integrate these types of data with the mapping of hospitals health centers clinics and identifying how far they away from where those people are and how easy is it to get to them by integrating them with road network data. So on the next slide. We can then start to highlight where those areas that were where women who are pregnant have a have a challenge in physically reaching a health care. And then on the next slide. And we can also start to go through click through this slides we can identify that the physical access, but also then integrate it with the location of household surveys that give us information how health services are being utilized. And on the next slide. Build a multi level model that takes into account both the characteristics of the population that ease of accessing health services and the geographical characteristics so that finally on the next slide. We can identify smaller areas where those those hotspots of poor health service utilization is that in this case skilled birth attendants and to natal care and post natal care with the East African community. So I'll stop there, but that's hopefully gives some indication of trying to fill some of those gaps that exist for the lack of CRBS data. But obviously, ideally we would focus on improving those systems so that we can actually get the data rather than estimates from modeling from household surveys. Thanks. Thanks Andy. That's brilliant. And really exciting and interesting to see how many different kind of new innovative approaches are emerging. We'll we'll dig into this in a bit more decent minute but Andy one of the things that you know a lot of what you've said seems very feasible right is then obviously you need statistical you know good models and you need to have access to this data but why aren't these approaches more commonplace already you know why are more country governments doing this kind of thing. I think it actually the growth of geographic information systems and spatial data has been huge over the last 10 years and we are seeing quite a wealth of skills in these countries. But it takes it does take time to filter through to very busy statistics offices very overworked ministries of health. And so that's something that has always takes time for these kind of innovations to get through. But as I've shown in the East African community, we've worked closely with them for the last couple of years, and there's, there's a lot of skilled people who are starting to utilize these kinds of data and approaches. I think there's a lot of promise out there but it again it takes it does take time and it needs it needs people to have time away from very busy schedules. Yeah, and I think you know one of the things you said is it's obviously it takes time because of capacity development and training right a lot of this is using GIS data or developing models which might be approaches that statistician within national statistical offices or other ministries might not necessarily have skills, you know with this, you know, at the moment. So arena, a question I had for you is, is is a lot of the lack of progress for seeing on CRBS systems because of that, the lack of skills, or is it much more about money or what are the sort of major barriers to investments in in something as fundamental as a, as a civil registration system. I wouldn't say so I wouldn't say it's only lack of skills, you know, I think that the lack of progress, it's probably due to multiple reasons and it has to be assessed per country, you know, I mean, when, and this is why there are a lot of tools and ways to actually assess the civil registration systems into the country and why are the reasons of non progress. Some, for example, are related to the fact that civil registration and vital statistics systems have not been a priority of governments, and then a real investment over the last 60 years and we are seeing gradual investment into the system only from 2013 2014 onwards before that from the from late 90s beginning of the year 2000 progress has been uneven so there has been a lot of progress in first registration, but nothing in in this registration and nothing in marriage registration at this point, for example, we don't know anything about marriage registration we don't know how many marriages are registered all over the world, for example, because of this reason. So, because of lack of investments and lack of prioritization for the entire system, this has resulted into low skilled, for instance, stuff. It has resulted into allocation of resources on paper but not releasing the funds in reality to the civil registration services, for example. So, consequently, there is no digitization of the systems, there is no investment into, you know, innovations, everything which is happening, it's happening mostly in pilots and so on. And I'm afraid to say that albeit progress on birth registration has been bought. We are assisting, and for those who are health experts, maybe they, you know, correct me if I'm wrong, to something similar to what we have assisted into polio eradication, you know, there have been huge investments in polio eradication, which has been detrimental to the routine immunization per se. So, I'd say these are some of the reasons. And another reason which I would say is that we never spent time with the communities to actually understand why there is no demand for these services. For example, recent results who are coming in from different countries is showing us that people are interested only in birth registration. They see no reason why they should register to death. You know, they have, there are community practices and there are customs which are preventing them from going towards the services. So, I think it's a multitude of factors and so. But I think that low and middle income countries have the use who have capacity and have the interest and the fact that they are innovating in so many domain. It is actually a ray of hope because I think that there is possibility to innovate also what scale in CRB system provided of course that substantial resources are available to be invested into these systems. Thanks, Irina. So you just referred to the polio problem, the fact that investments in polio in polio campaign has sort of moved attention away from core statistical strength, I mean core strengthening of the health services around generalized vaccination campaigns. Is that a bit of a risk during COVID? Do you think during COVID we're seeing a lot of innovation and a lot of excitement around new ways of monitoring this particular epidemic, which risks taking money away from general system strengthening both for the health sex but also for CRB. I wouldn't like to venture myself in making this kind of predictions because I don't have really a globe on that. I think, however, that in terms of the current pandemic, this is showing us the weaknesses of our systems. It's not only in low and middle income countries but across the world and it has taken the entire world by surprise. So that's why there are revisions constantly also with regards to mortality statistics and so on. We are looking back, for example, at the statistics from January and February in UK and in the US, most recently, the statisticians general offices have said that as comparative data from 2019 and 2018 show that there was significant increase of pneumonia like causes of death, you know, but nobody actually has spent enough time in analyzing those data. So actually it's not showing us a failure. What I think it shows us it is a way to actually work better. And that hopefully this pandemic, it's going to show us that we need integrated systems. We need sustainable investments in reliable data systems and we need statisticians and demographers who are able to actually help us analyze this data, interpret it and help the decision maker take informed decision. So I say more, it's like an opportunity. I don't think that there will be, I think that there will be, of course, restraining significant pressure on resources as economies are shrinking across the one. But I think that the importance of data is coming more and more prominent in the today's world. Thank you. That's great, Irina. And I couldn't agree more. I think, you know, hopefully this is going to really push or turn the tide towards a much more real time evidence based decision making process. And particularly given the fact that we can now have, you know, daily satellite information, we can have real time data on a huge number of variables. So there's no reason why policy and decision makers shouldn't be able to use that sort of suite of information or dashboards of information as they make investment decisions. Andy, a lot of the methods that you were talking about and you were showing lots of maps are derived from satellite imagery, right? So using aerial images of a given land area to estimate, you know, infrastructure and then from that population and so on. Are there any risks to be to be using this kind of satellite observation aerial observation, particularly with quite high resolution, more often and more frequently, and particularly, you know, if that's all in the hands of government. Are there any particular risks to having high resolution daily satellite imagery within national government? Yes. I mean, firstly, I think that the satellite data is is one component, but the most the most important component of all of that that I showed is household survey data is census data and it's ideally CLBS data. And the satellite data is really then we're looking at correlations are looking at things that can help us fill in those gaps where there hasn't been any data collection. And so that's that's one component and and the fact that these is really detailed satellite images. And there is those moves that certainly moves towards getting daily really detailed satellite imagery, but we're certainly we're not there yet. Most of the images we're using are ones that a collection of images taken across the course of months or years. And still we're back we're still battling against cloud cover and we're battling against the satellites not being pointed in the right direction to collect data. So although it seems like we're getting to a point with daily detailed satellite imagery, we're really not there yet. And yes, there is, of course, a risk of we can now identify we can map out individual buildings across an entire country. Yes, that's that's been the case in the UK in the US across most of the world for a long time with Google Google data Google Maps. I think the benefits out of certainly outweigh the disadvantages of actually people being being on the map and people can and we can then intervene and know that those people are there and for decades there's been large areas just not on the map at all and neglected by government policy neglected by aid agencies, because it just weren't there. So I think the benefits significantly outweigh the disadvantages. Thanks Andy and there was a very good point put in the question box which is that of course sometimes areas or people are not recorded in sensors and other social surveys because they don't want to be availed or countered by the population by the government for political reasons and I think that's a good point and does obviously in the context of more aerial imagery and so on that does raise questions about the implications for political systems and governments. And anyway, a very good point thanks Andy. There was also another question from a gentleman called Samhadi Khan who I believe was probably in our previous session being run by our colleagues in Afghanistan, asking about the how we can monitor these issues in places like Afghanistan and Andy I know you've done quite a lot of work in low income countries and particularly in Afghanistan. Can you just tell us a little bit about why your approach has been really basically helpful, essentially in Afghanistan in being able to get a more robust handle on how many people there are how many people you need to serve, how to build health facilities and so on. Yeah, so I'll work with Afghanistan started to a collaboration with UNFPA, and the last census in Afghanistan was in 1979. And all decisions or allocation resources or aid agencies are using projections from a 1979 baseline which are, which the government just takes it at 2.2% linear growth rate. So huge uncertainties, particularly at subnational scales on the number of people. So we worked with UNFPA with with the government. This was a request that came from President Ghani to firstly map out where all the settlements were, and then work with the government and survey teams to get more recent collection of population data and use that in statistical models of the kind that I've shown to estimate population numbers across the country, and then cross validate with the different surveys that were going on. And it's suggested that we're using more accurate numbers and those those numbers have since been used for planning household surveys for the vaccination efforts. So it's, again, there's big uncertainties, but it's a step forward we think from a 1979 projection. Absolutely. Thanks, Andy. I think that's been hugely exciting and crucial work for the government as they try to plan for the further development of infrastructure and essential services. And arena, I want to come back to you and just ask, you know, with all this innovation, and particularly in the context of COVID we're seeing a lot of, you know, telecommunications companies coming forward and big data companies coming forward and everyone offering a new solution to try and monitor the crisis. Do you worry that all of this innovation, all of this hype about innovation is going to detract attention and investment away from building core systems likes the obvious. No, actually, on the contrary, I believe that the fact that there are, you know, the private sector is coming in maybe this is really a call for the private sector to invest more in this civil registration and vital statistics systems. In some of the places I believe that this restraint of the private private sector to invest in it it's also due to the reluctance of the governments to collaborate with the private sector on these systems which, you know, is ideal with the data of the citizens. There are a lot of discussions around data protections, you know, not only in Europe across the world, this is coming to be to become more and more important. But what it is, what this is showing us it is that it would be good to actually leverage the know how and the power and the resources of the private sector in particular of the big data companies, you know, big telecommunication companies and so on, to strengthen the civil registration system and make them sustainable and reliable over time, you know. But let's, again, what I'm saying it's good to have the data but to have the data you really need the people to go to the services. So into this equation, let us not forget, not only the governments and the state. Let us not forget that the most and also. I think you're in another webinar. I think that an important part of the equation it is how do we bring the population to the services. How can we leverage the power of knowledge of the communities around all these vital events and make what they know into civil registration records. Which then translates into data. I think that this is really a vital part of the conversation. I mean we are talking about high tech and you can have a most high tech system with the most data and phones and iPads and whatsoever. If people don't go to the services if they don't use the services you're going to be exactly in the same place and you're going to do this nice surveys and estimates and wonderful things which Andy is doing. But you're still not going to have your reliable system so I think the next step is also bring the population to the system and the system to the population make it mobile you know make it flexible to the population while keeping data protection and privacy rules so that you have a system which is collaborating so the demand side and the supply side are collaborating to produce one's protection for the entire population through the life course. And second reliable which is translated then in vital statistics from civil registration with important parts as I said around fertility whatever mortality morbidity whatever it is. Thanks Irina. Really good comments and points that you know it's ultimately about demands and uptake and we need to focus a lot on trying to encourage more people to use these systems to seek the amount to demand these kinds of these kinds of systems. One other thing a question I was thinking about as we were talking about the private sector getting more involved and innovation and so on. In the context of building CRBS systems some countries are moving towards digital ID programs instead and thinking for example about India which of course has a very famous digital ID system and we won't go into the specifics of that necessarily but what I'm interested to know is do you think that in the future. We're going to move towards a digital ID system which will be linked to the health system so governments have information about births, deaths, all major events but also sort of a major health status events all in one place. I mean do you think that's kind of the way technology is evolving and ways that private companies might potentially be getting more involved. I think that the technology and the systems are already evolving in many parts of the world in this direction you know and the health system it is an incredibly integrant part and supportive part of this identity management information systems if you want it larger which contain you know not only digital identity but ID cards, CV registration and so on and so forth because health produces the notification. It's also a way to monitor actually if everything which is happening at the health level it's reflected into a CV registration and vital statistic systems if it would be at least the mortality statistics and the death statistics would be reflected into the CV registration systems. This is not the case for the moment, but we are seeing progress into that, into that, you know, direction into the sense that many countries these are the recommendations of the UN statistics division. Many countries are working on integrating systems on making, you know, alignment between health and CV registration and vital statistics systems we are seeing this a lot with the raising of the global financing facility which is buying investments. We are seeing a lot of progress around that, there are cases which we have been monitoring around it and I think that this is what future looks like. Thanks Irina. Interesting sighting to think about that. I think that raises lots of questions too. A couple of questions that have come up from the audience. I mean one question that was raised, which really strikes at the heart of everything we've been discussing is why don't you rely on national data agencies for COVID data that came from Raker. I think Raker we've been kind of getting to the crux of that through all of our presentations which is that you know where possible we should but very, very often they don't have the population data, the civil registration data that you need in order to really understand the extent of the epidemic. Andy, I'm turning to you. I mean you've been doing some work specifically on helping to track COVID. What's the kind of data that you're producing for national governments? How are you kind of complimenting what they're collecting themselves? So we are trying to build and statistical models to try and help guide broad decisions about firstly which types of interventions work where and when and then exit strategies as well so we can't all remain locked down forever. It's thinking about what happens next and that involves integrating together broad spatial data on the populations, their characteristics. So where are the men over 80, the really high risk groups where there's populations who are much higher risk than others. Are there hotspots of those? Is it different by different country which is certainly the case we've seen excess mortality in Italy that's related substantially to the fact that they're the second eldest population in the world. And then we're looking at broadly the flows between those different regions through things like mobile data, aggregating those together to understand how are they connected. And that although it's again very uncertain data, it does give a guidance on how the disease might spread. What happens if you release interventions in one place, what effect will it have on all places. So it's the kind of data that we're assembling together and sharing insights with those response agencies to guide their decision making. Great. Thanks, Andy. Another question that's coming from the audience before I ask some final questions of you both. What do you think of the initiatives that EUROSTAT, the European statistical entity has instigated to collect weekly data on deaths around EU countries. Is that something that's being used in the context of monitoring COVID-19? Or do you have any other reflections on kind of EUROSTAT's efforts to try and improve the quality of death statistics across Europe? I think that this is really a commendable effort of EUROSTAT. It would be very good to have at least data from a big block of countries who are in the members of EUROSTAT. So this is really commendable. It will also show us trends and possibilities to make the comparisons where comparisons are possible against among countries and within the countries to look at different disparities and the data which Andy was just mentioning. Thank you. And I have to apologise that I have accidentally deleted one of the questions that came up in the question box. So I have to ask you ever to submit that final question. If you could please add it back in. That would be much appreciated. Normally we'll get to it. So apologies for that. Okay, a couple of other questions for you both. Andy, a general reflection. Do you think that during a crisis this is kind of a good time or a very risky time to be innovating? I mean a lot of people say that a crisis is the last time we should be trying innovative approaches because of concerns about governance and so on. What do you think? It's certainly driven a huge amount of innovation. There's a vast number of academic papers and new things that are being put forward. There's a need for coming up with solutions fast for something like this. On the other side of things, the bar of quality has dropped a bit, necessarily. There's a kind of valid, the kind of test, statistical test we would do, the kind of rigorous checking of data we would normally do. Just as a necessity for getting the supporting decision makers has to be reduced a bit. And it's up to the scientific community generally to now self, almost self police itself to point out something where corners have been cut too much. And the kind of innovation is pushing the data too far or giving false insights and poor guidance. So yeah, it's a double-edged sword there. I think it's certainly driving some great innovation that I think will last, but also some innovation that is not as high quality as it could be. And Andy, I mean, you referred to the scientific immunity, but personally I'd also say that this is a big area that citizens need to be attentive to and hold their governments to account on. I mean, for example, we've seen some countries in Latin America, one in particular has recently reneged on their Freedom of Information Act on the grounds that they need to be able to move quickly and innovate quickly and use data as they so choose. But I would argue that you should never be able to really go on your Freedom of Information Act and actually make sure that those methods are fully transparent. It's hugely important for after COVID and as we come out this crisis making sure we have ethical data management systems. So yeah, great. Irina, a final question for both of you actually, but I'll start with you Irina. For countries that have really limited resources that are really struggling in general, but also in the context of COVID, where do you think they should invest right now to have the greatest impact? What are one or other aspects of the statistical system do you think could really help countries make sure that they are kind of as equipped as possible to respond and monitor this crisis? I think it would be around quickly, fairly quickly speeding up the process of capacity strengthening in particular around estimates of the coverage and completeness of Registration of Vital Events. I think that this would be really one. Another one, it would be massive public information and the wordness raising campaigns to just make the population coming through the towers, the systems and integrated investments in health, monitoring information systems linked with CRVS and large identity management systems. That I think it should be really the priority with of course legislation which are respecting data and enforcing data protection and privacy for the citizens. Great, thanks Irina. And Andy, same question to you. If there's one area for focused attention and investment right now, what do you think it should be? Yeah, I agree with Irina. I think this integrated health system capacity strengthening is important, although we expect coronavirus to cause major excess death. We shouldn't, and in the course of addressing that neglect the rest of the health system and the fact that there will be continually deaths from malaria. There will be disruptions to vaccination programs that could ultimately outweigh the deaths that we see from COVID and until we have some integrated assessments and keep that data collection we actually won't know and we won't be able to guide how we balance up those systems to make sure those issues are continuing to be addressed and that the right resources are put in the right place. Absolutely, absolutely. So we can't of course do sight of some of those huge repetitive causes of death and morbidity and so on and make sure that we're straight from the whole system to be able to respond to that as well. So it just remains for me to thank our amazing speakers Irina and Andy for their great input. And also thank you to the organizers of this, my colleagues at SDSN. One of the things I love about this 24 hour webinar is that, you know, you can be talking about health systems and suddenly the former Prime Minister of Greece just pops in and then disappears again. Lovely to have so many interesting and high level people on the line. And yeah, thank you very much.