 So now I am happy to give the floor to Professor Michel Kazachkin who will be the moderator of the first session, the lessons of the COVID-19. Michel, you have the floor. Everyone, ladies and gentlemen, participants and welcome to this first session of the day that is dedicated to the COVID-19 pandemic and the first lessons we can draw from the pandemic. With COVID-19, as has already been said by Thierry de Montbriand, the health and the well-being of millions of people were abruptly put in danger and half of the world's population forced into confinement. Our economies and the very structure of our societies have been shaken, as Dr Tedros just said, and put the multilateral system at a test. And the crisis has yet not finished unwinding its negative aspects. Here in Europe, where only 7% of the people have been infected with the coronavirus so far. A few days ago, the Institute of Health Metrics at the University of Washington predicted that daily deaths from COVID-19 will continue to rise in the coming weeks, reaching a peak, not reaching a peak before maybe mid-January, with hospitals continuing being stretched to breaking point until the end of February, maybe. Now for today's discussion, to me, the key observation is that against a certain lack of interest in health issues that has been prevailing in recent years, the world is now realizing how much, among all global issues, it is health in the short term that has the greatest potential of disruption in our globalized world. And I find it encouraging to see on this occasion a sort of near consensus, forging on the importance of science as a basis of health policies, and on the priority given to the safety of people over other considerations, including economic considerations, even at high costs. Public health is a political choice that most countries have made in this crisis, against competing priorities and interests. Now to say that the virus affects us all doesn't mean, however, that it affects us all equally. What we have seen in the last few months is countries competing for resources, whether it was for masks, for example, as we saw unfortunately in the first wave of the pandemic here in Europe, diagnostic tests or now vaccines. It is not difficult to guess in such a competition who will emerge as a winner in the absence of global regulation, in the absence of global governance, and of common resources for common goods. Since Thierry de Montmoyal and Dr Tedros started discussing this topic, let me say that to me, public health is a public good, because public health is a collective property that depends on the structural, the social, the political forces that produce health of the population. Now, as, again, already said in the introduction, this unprecedented crisis we're facing requires unprecedented global solidarity. Let me remind everyone that is in his wake up call last July, UN Secretary General Antonio Guterres called on the global community to, and I quote, move from international chaos to the construction of an international global community, capable of meeting and solving tomorrow's challenges. And obviously when it comes to health and to pandemics, a pandemic response that would be rooted in global cooperation would make everyone much safer. The pandemic demands an emergency response, but it must also encourage us beyond the emergency to lay the foundations for a world that is more united and more resilient in the face of challenges, which will have to go beyond the current geopolitical constructions to involve more of the merge of the major emerging players, China, obviously, but also India, Russia, Latin America and Africa. The crisis Europe and the world are facing is not only about health. It's about politics too. And this is why today for the first time WPC is dedicating a site conference to health. This session today will run in two parts. First, Professor Antoine Flauot will present us an overview of the pandemic from an epidemiological and global public health perspective. And that will be followed by specific questions and answers that you may direct to him and to his presentation. We will then proceed to a panel discussion with eminent participants from the pharmaceutical industry, the social protection sector, public health and the UN global angle where questions and answers with the panelists between the panelists and between the attendees and the panelists will follow all four speakers presentations. The objective of this session as I see it is to discuss the first lessons from the COVID-19 crisis at the intersect of public health at national level, global health at global level, health systems, social protection, innovation to create health commodities, medicines and vaccines, economy, politics, the global order and global governance. So with that, I would like to call on our first speaker, Professor Antoine Flauot, who is the director of the Institute of Global Health at the University of Geneva. Yes, thank you Mr Chairman, thank you Michel and also thanks to the organizer and Thierry de Montréal for inviting us for this session in this very promising conference. If I can ask for my slides please, I will introduce you a few updates and questions regarding this COVID-19 crisis today. So I am waiting for my slides because I cannot push them myself. Thank you very much. So the first slide shows a recent map we are providing on our dashboard with an everyday update where we forecast for 209 countries and in some countries like in Switzerland or in Canada or in the USA we provide some regional figures. What we can see is that the North hemisphere today is facing a huge surge in cases in most part of the North temperature hemisphere except in Asia where the surge is also going on but in Japan, for instance in South Korea, not in China, but it is very well controlled and at a safety level. I would say much below the incidents we are perceiving in Europe or in the States or in Canada. Canada is not yet controlling its wave, the USA neither. When Europe is for the moment trying to control and to take over control on its epidemic second wave. My next slide shows Africa. We have some troubles in Africa because it's a grey zone if I can say that because we don't have any sufficient tests to analyze the trends in many, many countries. But we can say that there are three profiles. The northern part of Africa seems to have a very similar trend as in Europe where it has seen a winter I would say cold season wave recently like in Morocco or in Libya or in Tunisia. In Sub-Saharan Africa it's very strange of course we as I said we don't have a lot of data in many parts of Africa of Sub-Saharan Africa but in the countries where we have them like in Senegal, in Côte d'Ivoire, in Ghana, in Togo, in Nigeria, in Ethiopia, in Kenya and other countries it seems to report very little activity. So it seems that there is not such a dynamic wave which has been observed in these countries. It's not clear to know why. Of course it's short investing as I said but really if some burden had appeared it would have been detected. It has not. So is it the whole of the climate? I'm not sure. Of course there is no winter season but we see respiratory viruses such as influenza in all parts of inter-tropical zones and in Latin America or in Singapore for instance there were some activities of the coronavirus so it's not very convincing. The whole of demography could be more convincing because the median age is much younger in Sub-Saharan Africa than in Europe where it is 40-45 years. So true but there are still some elderly people in Sub-Saharan Africa and we do not see them fortunately in hospitals. I would say very, very few of them. Cause immunity has been said but has never been documented for the moment that would be the immunity provided by other viruses and which could block the propagation, the spreading of this virus, not very convincing for the moment. And about the protective genetic characteristic of the fact that black people would be protected against the coronavirus is not convincing also because in America it has been seen that black people were deeply hated by the virus. So there is no clear explanation and it's really appending questions that we should explore more. And the third profile is about South Africa which behaved like Australia or Chile or Argentina with their winter wave between June and September which seems to be controlled but if I can show there is some signal of increase again which is worrying in South Africa and also in Brazil and which may be a cause of concern in the coming weeks. As you can see we do not predict long term. We only provide daily prediction for the 209 countries in the world and territories but only seven day predictions. We refrain ourselves for long term predictions. You may remember this CDC, US CDC forecast for Ebola in 2015 when they predicted one million plus cases and fortunately that was only for Liberia but fortunately in all of the world there were less than 30,000 cases which is much too much of course but which is not the same order of magnitude. So let's avoid long term and even midterm predictions. I don't really know what will happen in next February for this pandemic and I don't think we can for the moment. The basic reproductive rate is important to understand well because it's not a constant. It's a variable. When we say it's two to three, it's an average. You have to realize that maybe almost 70% of the cases will not contaminate anyone and maybe 20% will contaminate only one person. They will not contribute at all in the pandemic. We have to focus on those who contaminate, the 10% of them who contaminate more than one person. They only contribute to the pandemic. And that has a consequence is that we have two tracing approaches in the world. One, the Western style one, the forward tracing is the research of contacts of the reported cases. It's not very efficient because for 90% of these reported cases they will not contaminate anyone. So the backward tracing is a lesson we can learn from Japan and from other democratic Asian countries. The research, the contact of the one who has contaminated you, who has contaminated the reported case, because of this over dispersion, because that 90% of cases do not contaminate anyone or only one person. They do not take time to trace their contacts. They only take time to trace the contact of those who have already contaminated me. And if there is someone who has contaminated one person, the probability that he has contaminated more than one person, it's of course much higher. What are the main root of transmission for SARS-CoV-2 is still the debate and even vivid debate. There are three major root, of course, there are some other potential roots, but the three major roots are large droplets, ballistic root, when you cough, when you sneeze, even when sometimes you speak, you may expel some large droplets, more than 100 micrometers. And it may just hit someone, the nostril, the eyes, the mouth of someone and contaminate him. It's probably not very frequent except maybe in, I would say, home care facilities or for taking care of children and sometimes also of course in hospital settings. Small droplets are the droplets you expel when you breathe, when you speak 10 times more, when you sing or when you yell, which is 50 times more than breathing. Small droplets are aerosols of aerosolized. And in these aerosolized small droplets, because they can float in the air for a couple of hours in poorly ventilated closed settings, these aerosols may contain some coronavirus. And these droplets, when they fall down on surfaces, they contaminate it for mice, which may root of transmission. It's not clear that various attributable parts of each root and it depends on the settings. Outdoors, the aerosols do not play any roles, indoors probably they play a leading role. The intensive hand washing programs have been assessed through randomized clinical trials and they show a risk reduction of 16%, which is substantial but not major. So probably the major root should be droplets, small droplets. I would say there is not one COVID-19 disease. There is three or maybe four according to these colors. I like these Danish series of cases in the first wave. They show that below 50, you do not have a high risk of dying, of having severe complications of COVID-19. You are almost as safe as for many viral respiratory common cold. Between 50 and 70, it becomes a very severe disease and if you have comorbidities and 50% of the population at this age has some comorbidities like hypertension, diabetes or overweight, you have a risk of dying which is very close to the one for SARS in 2003, almost 10%. It's a very, very dangerous disease and above 70, it becomes a very dangerous disease like Ebola in the West Africa. There is four available breaks to slow the dynamic of this pandemic, the spreading of this pandemic, the preventive measures, hand washing, wearing masks, physical distance, ventilation. These are the lockdown measures including homework, including of course the closure of schools, of universities, of non-essential business, of bars and restaurants, restrictions of mass gathering and all these limitations of movement. There are some more personalized lockdown measures which is in fact the testing, tracing, isolating process because you lockdown those who are found infected or at risk. The third force is the seasonal force and environment. The seasonal force, we have seen it in the south hemisphere during the winter time and we are now observing it in the cold seasons in northern hemisphere. The seasonal force is not a blockage, it's a break, it may happen that it's slow the process in summertime in temporary zones. Environment, I will come back later on that. And the fourth one is immunity. Of course, the more the disease progress without any mutation, there is an acquired immunity. Of course, probably in Paris, in London, Geneva today, we may have reached almost 20% of the population being immunized. It's not enough to block, but it's a break, it's slow down the process. And vaccines and treatments, of course, will help a lot for that. The season and climate, what we have recently published is a work where we show in four different situations in tenories that was in canaries that was due to sandstorms. So the dust particles, fine particles in the atmosphere were followed by outbreak of COVID. And in London, in Paris, in Tecino, in Switzerland, we have seen that due to weather, anti-cyclonic conditions, fine particles accumulate in the air atmosphere and were associated with a spike of an outbreak of COVID-19 very soon after. And we have seen that for the first wave, and it has been reproduced also for the second wave. So the climate and seasonal conditions may play a role and also environment. I want to show you this slide. In fact, Ireland, as known as all other European countries, a second wave very recently. And the 21st of October, they decided to lock down again. And the 25th of October, excuse me, the 25th of October, four days after we saw cut in the exponential trend. It is quite exceptional to see in four days the effectiveness of a policy, a political intervention. In fact, we can say that they were a citizen participation to this policymaking. And in fact, you have the Google mobility data in the right side of the panel. And you can see not the red curve, which is the fact that during the summer times, the people in Ireland go in parks and outside, outdoors. But the yellow or brown curves show the mobility to go to work and to go to use public transportation. And it decreased, of course, a lot in the first lockdown, but it decreased a couple of weeks before the official lockdown, second lockdown, this fall. So it is interesting to see that the lockdown methods used the people in Ireland to anticipate the political decision has been shown also in France. Regarding the treatments where we are not very far, we have only confirmed the efficacy of dexamethasone and old corticosteroids. We are on the verge to see some interesting results for monoclonal antibodies. Those who have been administered to the President Trump when he had caught COVID. And we have some non-pharmaceutical treatments like prone positions, assisted ventilations and oxygen. But all the others may be promising and some many of them are still in clinical trials under assessment. So we don't know for the moment if other products will contribute significantly to the treatment. But what we can say more optimistically is that the survival rates in hospitals are dramatically improved in time. In the six previous months, we have improved by 30, maybe 50% of the survival rates just by dexamethasone and better care of using non-pharmaceutical treatment. Regarding the vaccines, we are, of course, and you have noticed that much more advanced and we have very promising results. We have not seen any publication for the moment, but the dossiers are under evaluation in agencies. And today the UK Agency has approved the Biontech Pfizer mRNA vaccine. The Moderna is following soon and AstraZeneca, which is a vector-borne vaccine, will probably follow also very, very soon. But maybe we'll be a bit delayed because of some difficulty in access of some data. But the two very promising vaccine, we will talk about them, Biontech Pfizer and Moderna. There are many others, 150 in development, 40 of them, 50 of them under clinical trials. So probably we will talk today of other options which will come to the market soon. And my last slide, so we don't know exactly for how long the immunity will last. We can hope that it will last for a couple of weeks and months, but of course we don't have enough experience on that. And my last slide will be about the scenarios for the upcoming months, waiting for the effect of the vaccine. First we have to learn towards the safety zone in all countries before easing and lifting the lockdown measures. And after we will have to change and adjust our testing strategy towards a backward tracing strategy and prioritizing it, not maybe giving up with the other one. We will have also to improve isolation of contagious people in dedicated hotels or something like that, as did the Asian and Australian people. We have also to use better and more apps and digital traces we have because it's a very useful partner for catching. And after we have to conduct cell prevalence studies to know exactly what is a quiet immunity, because if we have a low immunity in some areas of the territories, the risk of resurgence will be very high and it will be very difficult to ease the restriction. If we have moderate risk, we will have to take caution. And if we have high prevalence, maybe above 25 or 30%, that will represent a beneficial break and a low risk. And we probably can open bars and restaurants and other non-essential business with some caution with keeping some preventive measures. So the wintertime, the cold season in the northern hemisphere will be a dangerous period and we can try to have some bias proposal according to the situation and particularly the immunological situation. So my last final slide is not a slide, it's more a kind of flyer to say how to avoid COVID-19, avoiding crowding indoors, low ventilated area, keeping distance even with aerosols, the close proximity of these factors, avoiding long duration in these rooms, which is the reason why we are not all with Thierry de Montréal in the same theater today, avoiding to be unmasked, avoiding to talk, to sing and to yell too long in this situation. Thank you for your attention. Thank you very much, Antoine. Thank you for this overview that sets the scene. I'd like now to open Antoine's presentation for discussion and whether there are questions from the audience. I'm looking at the chat so please whenever you wish to ask a question, go to the chat. I see some questions coming. Let me first ask you, Antoine, would you say that the pandemic has now entered an endemic phase? That is, given the map that you've shown us in one of your first slides, since it's everywhere and since we have no ways of eradicating, are we dealing with a chronic endemic state? And in that situation, what are the triggering factors of resurgence of not outbreaks but new waves that have been identified? And is there a way to focus on some of these specific factors, be it the density of the population or, of course, lack of appropriate measures? Thank you, Michel, for this question and it is a very, very difficult question. I could say, you know, we do not foresee beyond seven days so there is no endemic situation within seven days, but only epidemic outbreaks at first. But we could have some scenarios. First, we can also answer to the question, what are the triggering factors? Because you have seen the four breaks. So if you lift any of these four breaks, you have a force for an outbreak and for a burst in the surge of cases. Fourth, the seasonal break was lifted after the warm season in Europe and it represents the most important factor for generating this outbreak in the fall. And the outbreak in the fall was not at the same force as the outbreak in March. The reproductive rate was not three, was 1.5 below 1.5. So that was probably due to another break, which was the protective measures, the mask wearing, mandate mask in most countries in Europe and also the physical distance and hand washing, which play an important role to reduce that. So will it become endemic after the vaccine? I don't know. What I can say is, you know, if the vaccine is administered to high risk groups, particularly the elderly people and also the at risk people, may it be transformed dramatically the prognosis of the disease. And if you have a disease, which is for all the population, like in the green zone I mentioned below 50, it will become a very common cold disease again. And maybe due to that, I mean, without any hospitalization, without any surge in intensive care units, without any death or almost no death, due to the COVID-19, it will become much more imagined, even if it is chronic condition. Yeah, thank you very much. Important comments so that we should be able to develop the tools to prevent high mortality in high risk groups and have this disease no more a threat, a public threat at serious level, but something that we can live with. You know, related to this discussion, I see a question from Stanislas Kozon saying it seems that demography would be a likely driver. How close are we from being pretty sure that this is the case? Of course, demography is a key factor in terms of severity and in terms of mortality. So it's understandable that when you have a very young country, you have more protection against mortality and single cases because of that. What is not clear is if the young segment of the population is a driver of the pandemic, it is possible that school and school age, children and students are a key driver of the pandemic in terms of spreading, not in terms of severity, not in terms of search in hospitals, but in terms of spreading within the community is highly probable that the young segment of the population are the driver of the pandemic. Thank you. I have two questions around Africa. So maybe Assi and Juliet, Tuakili would like to ask questions. Yes, Ass. Yeah. Thank you very much. And I'm trying to introduce Africa by saying it's a grey zone. Well, we have to define what the grey zone is. And I heard a number of factors that seem to be playing a role there. And you mentioned demography with a question mark. You mentioned cross-immunity with a question mark. You mentioned climate with a question mark. You mentioned even race and blackness with a question mark. But I've not heard anything about what Africans are doing. You know, is it shouldn't it be also considered that people are not just sitting and waiting for those factors, you know, to be determined and to protect it? But also people responded. There was action taken. And how much, you know, that action was contributed to that. And that is not referred to one single time. You know, measures that are extremely difficult and powerful has been taken in very difficult context and under very difficult circumstances. You know, religious leaders close mosques and churches. Markets, you know, were closed. You know, the economy is where 80% of people rely on an informal sector, you know, to go for a daily living. And the curfews, you know, were imposed on people. You know, many measures, which I think if it happened in many countries in Europe, would then lead to a rebellion, you know, or a kind of a public dilemma, as you would say. But I think, you know, we cannot simply, you know, look at Africa as a gray zone where there are a number of factors that may be contributing or not, you know, to the millions of deaths that we may or may not see. But I think it would be helpful to also understand what are the kind of accumulated experience in preparing for and responding to pandemics and epidemics over time. And the measures that have been taken and made are contributed to that and conserved, you know, for further action and incentive for Africa and for the rest of the world. And I'm missing that part every time we're talking about, you know, the response. It is just a positive, you know, kind of a waiting for protective factors and I think we need to correct that. Thank you. Thank you. And of course, Senegal is quite an example. When, when one talks about public public action, maybe, Antoine, before you answer, let's hear from Juliet Tuakli that has also a question relating to to Africa Juliet. Yes, thank you. Looking at the slides, I totally agree with the previous speaker, by the way, but then that comes to the other issue of climatic changes. Given what you've said, would we therefore expect in the upcoming harm attend season, which we're about ready to enter an upsurge in our COVID incidents, because I think that would prove whether or not that in fact has been gained to Africa as well as in the West, which alludes to my other concern and that is, I think there are some social behaviors that we tend to ignore smoking being one of them. Much of the parts of Africa which have been spared are generally non smoking. Most parts of the continent, despite their high GDP, despite their strong public health systems tend to have a much higher proportion of people engaging in behaviors that compromise their respiratory systems. Thank you, Antoine. Yes, thank you very much for this comment. I fully share with you your comments. On the fact that the level of answers of response was huge, impactful, impactful in many other aspects than the sanitary one, and it has to be taken into account. I will also suggest or maybe suspect that there are some contributing factors in Africa, which is outdoor life, which is probably more important than in European or Northern countries. So the fact that people are ventilating at a higher pace also may contribute to help blocking the pathway. Regarding the question of smokers, I will say it is controversial for the moment, because as you mentioned, definitely smoking alters the respiratory functions and should play a negative role on COVID. But it has not been seen as a risk factor, surprisingly. I'm not talking about COPD, I'm not talking about the consequence of chronic smoking habits which have deteriorated the respiratory functions, which is a risk factor. But smoking has been found as a protective factor for COVID-19 surprisingly, meaning that those in the series which has been studied in China, in Europe or in the USA, there are fewer smokers in COVID series and even in severe cases than in the population. So it's something which seems to be a bit strange that maybe nicotine could play a role in protecting people. It has not been scientifically clearly demonstrated, although I know that there are some trials using a patch of nicotine or electronic cigarettes to see if there is an effect against COVID-19. But so it's controversial, it's conflicting and not so clear that the fact that no smoking in Africa could be protected. While we're talking about Africa, since we will move in the next panel session to global governance and global issues that are the core of this conference, although Antoine you told us that you don't want to predict even in the midterm what will be happening. It seems to me that there are fairly, let's call them stable, quote, stable patterns of the epidemic in different regions of the world that is regional patterns. Would you agree with this? And if so, do you think this should have implications for bringing a regional governance level to global governance of health in addition to the global solidarity and cooperation effort that is required? Yes, it's such a good question. I would be very cautious regarding the stable patterns. For instance, Austria, Germany, Switzerland had expressed a very good response for the first wave in Europe. It was not so true for the second wave. Austria and Switzerland in particular had among the worst incidents in Europe. Norway and Finland behaved as champions in Europe, almost the same patterns as in Asia for the first wave. But now they're experiencing a search, a bit delayed from the search experience in southern Europe. So I don't know exactly how it will go to. So for the moment, it's true that Asia experienced a very, very good response in terms of incidents and mortality. When you see that in Taiwan, 24 million people, there are seven deaths, accumulated deaths from the beginning of the pandemic when they are so close to the continent and China, you can see that they have a very, very good response. Japan is not far. It's not completely sure that they will keep the pace of the whole pandemic. So it's a bit early. And when I say I don't want to predict too long, it's also with that. It's a bit early to be sure that they will not experience a search. And for Africa, I so much hope that they will not have to face the trouble of the Latin America countries or India experienced recently. But who can predict that it will not happen? Fortunately, it may not happen never. And maybe the vaccine will be before anything can happen. But who can know? And I think it's better to keep some protections and some modesty also on these protections. Thank you very much. I hope we return to this issue of regional global later. There is a specific question from Alexandre de Germais on the spreaders. Alexandre, would you. Yeah, thank you, Michel, Professor Flau, thanks for your interesting perspective. I had a question on the spreaders. Do we have a way to better identify those spreaders? And do you know if we are running real-world evidence studies somewhere to actually narrow down some characteristic of those spreaders? Because it would, of course, allow us to focus our attention around the spreaders so that we don't stop or block our overall society. Yes, thank you for your question. I think we should not have a too much romantic view of these super spreaders. I mean, the Japanese approach, you know, was a parsimonious approach initially. It was because of a shortage in testing that they decided to focus on the super spreaders. And the pragmatic approach mentioned that it is very hard to find the one, the super spreader. And now there are more talking about super spreading events. So we can know that you attended to a wedding party or to a dinner in a restaurant, which was quarantinated, or to, you know, a call in a church. And during this event, you have been contaminated and some others also. And we are more focusing on the event rather than on the person. But sometimes it has been possible to identify these persons and they are like you and me. I mean, anyone can become a super spreader if he is contagious, at a contagious phase of his disease, of his infection, sometimes four is mostly before the symptoms of Z-local. In the two days before, highly contagious in a closed, poorly ventilated room, which can be in a bathtub, which can be a core, which can be a restaurant or a bath or an auditorium. So that is more the environment where you are placed in, I would say at the time where you were the most contagious that you were triggering a screening event. Thank you. I see two other questions from Stanislas Cozon and Michael van den Berg, but I think they may come better at a later point in our discussion after we hear from our panelists. So thank you, Antoine, for, as I said, setting the scene. And let's move now to the panel. And may I call on the first speaker, Alexandre de Germais, who is Senior Vice President, Global Head of Cardiovascular and Established Products at Sandovi. Thank you, Mr. Chairman, and thank you for the opportunity to contribute to this roundtable. I think we all recognize it's been well said previously that the pandemic has put extraordinary pressure on the healthcare system around the world. Most healthcare systems were already a straight theme before the pandemic and now they've been pushed to near breaking points in many parts of the world. COVID-19, as our Chairman said in the opening, affirmed the kind of importance of health and medical priority. The highlight of COVID-19 could mean to significantly increase our investments to bring those healthcare systems to the next level. As part of a statistical company, we have, of course, an essential role to play in bringing solutions to address the immediate crisis. And obviously, I can tell you that we were under incredible pressure at the first lockdown to ensure that our essential medicine, in particular for the intensive care units, were actually available around the world in all the hospitals because we had, of course, surged demand and predictable demand, of course, but also a very complex supply chain, as you can imagine, with different parts of our components coming from all over the world. So that was our priority. I think the industry in general stepped up to the task and delivered, I think, continuous supply during those times of pressure. At the same time, I think the pharmaceutical industry in general can contribute to strengthening the healthcare system. And in that context, I'd like to share with you three areas of consideration. The first one, I think it was very well actually introduced by Professor Flau when he talked about the chronic diseases. Most healthcare systems today are set as sick care systems, where the intervention happened only when the person gets sick. This is a true healthcare systems where you would focus on helping people stay healthy, and we all agree on that. But what we know is that the so-called lifestyle disease can be managed effectively through preventive approaches, behavioral intervention, as well as appropriate medical intervention, where it's needed. And yet, even after decades of effective treatments and increased attention on the importance of healthy lifestyle choices, today, more than 21 million people are still dying prematurely from the consequence of cardiovascular metabolic conditions such as heart attack, stroke, or diabetic decompensation. This is the first cause of premature morphology. And that's incredible because, as I said, the condition to actually treat and manage properly, those conditions exist. And COVID-19 was, if you want to put in the forefront this underlying condition of our population. Because, as you know, having underlying conditions as cardio-metabolic can increase the risk of likely to suffer severe consequences from COVID-19. So he brought that to the forefront. Outside of the pandemic, those burden of those chronic conditions weighed heavily on the healthcare system. Just as an example, diabetic affects 463 million adults worldwide, and it will account for $760 billion, or roughly 10% of the global health expenditure. So clearly, and it's still growing as we speak, the growth is actually double digits. So there is an expansion of those conditions, despite the fact that we can address them. And they were, as I said, brought to the forefront with the pandemic. So to me, the pandemic of COVID-19 forced us to rethink how to reverse the course of such a condition. And it has become clear that simply managing them is no longer enough. How should we do, I think, one avenue that has the biggest potential to me is by fully embracing the potential of data. And this leads to actually, to my second point, which is how do we accelerate the adoption of digital technology and data integration to manage those conditions. COVID-19 has shown us the important role of that technology in so many fronts in healthcare. It has accelerated the adoption of telemedicine as an essential way to engage with our system and providing support to patients. No longer that actually this week, and I was looking at the latest data on telemedicine around different continents. And it was really striking in the US, as we enter the pandemic, we only had about a few percentage points of interaction between patients and doctors done through telemedicine. I think it was around 2%. Now it's around 20%. It rose to 20% quite quickly, and it's now stable for 20%. That will transform radically the way this interaction can be improved between patient and physician. Data and technology were critical in shaping our response to COVID-19 from helping us understand the speed of evolution of the virus to searching for cures and implement measures to stop the virus on its track. We need to embrace the power of data and technology. If we want to help build a more effective response to healthcare challenges, such as what I said at the beginning, which is this cardio-metabolic chronic diseases. We know the benefit of managing chronic disease effectively. I mean, if we were to apply the guidelines and treat those populations, we know the incredible effect we will have on the lives of millions of people. Yet, despite the innovative and the effective treatment, these diseases remain minimally uncontrolled. Data integration, leveraging worldwide evidence, will allow healthcare systems to be much more effective in their management of chronic conditions, because we will be in a position to identify the population at most risk. Primary prevention that actually affect all population is very hard to force adherence. But when you really target the address, leveraging worldwide evidence, and you can also help clinicians understand in their population what could be the projection with predictive models of the treatment and guidelines, you can really see a very different behavior of both parties. Together with solutions beyond medicine, meaning integrated care where the Internet of Things or connected devices are brought to the patient, we can also increase patient adherence and improve their outcome at the end of the day. So we need to collectively continue to push for a wider adoption of more efficient use of data and digital technology. It's complex, we know there is a lot of heterogeneity, there is a lot of noise under data, but of course we need to continue to work together in ensuring that that data is widely available and the quality of the data is improved because it will help to increase the connection of the ecosystem and increase the outcome. The third point that I wanted to bring to the discussion around table is how we'll build a cross sector approach to stimulate investment and resources behind innovative approaches. This transformation can only happen if all parts of the system works together toward the same goal. We must build sustained goal, global and cross sector collaboration. Over the last past months, we saw exceptional partnership rising that would have not been even conceivable a few months ago, just like our collaboration with the GSK or the US Bada on our recombinant protein-based COVID-19 vaccine. The crisis has demonstrated the importance of joining our forces to tackle COVID-19, bringing together our resources and expertise across all sectors. I'd like to mention two, I believe, are transformative developments triggered by the pandemics. The one that comes is of course the COVAX Facility, called by Gavi, CEPI and WHO, in which Salofi and GSK intend to make 200 million doses of our adjuvant recombinant protein-based COVID-19 vaccine when it's available and when it's approved by regulatory authorities. The second one is of course around this intention to create the European Bada. I just heard actually this morning the name, which is HERA, which is the Health Emergency Response Authority, announced by the European Commission Presidents. Policymakers, academic civil society industry colleagues are coming together, taking the learning from the COVID-19 to ensure that we are not caught off guard by the next pandemic and then we can work together in more effective way. To conclude, I would like to say that we can already learn one thing from these current pandemics, which is when all stakeholders actively work together behind a critical goal, we increase our chance of finding solution. And that's been very evident for me during the COVID-19, even in the most difficult challenges where we were all locked down and communication was complex. The crisis is starting to show the potential for a more robust, prioritised healthcare system, one that can move effectively, help prevent disease and avoid a much larger portion of the current healthcare costs burdened in critical hospitalisation and long-term care where actually prevention could actually work in avoiding those costs so that we can invest this capital in long-term management. There are two key questions for us to keep in mind to ensure that we can create the right level of coordination for these to happen. One is, how do we continue to increase an effective coordination amongst all the players of the healthcare system and especially between public and private? We said that the European version of VARDA is one, but what else? The second one is, how can we create greater alignments and coordination cross-country? That's complex one, and WHO of course is in the core of that, but that's of course a key element as we progress. The COVID-19 and numbers of initiatives have been made possible with incredible speed, public-private, COVAX and others, digital acceleration. Now we must build on this to continue to work together across public and private sector and across countries for a more sustainable healthcare system. Thank you. Thank you very much and thank you for focusing on prevention, data, cross-sectoral collaboration. We will come back to that in the discussion. I suggest that we listen to our four panellists in a row. But of course the questions that comes immediately to mind for the discussion and maybe like already to draw us sees attention to that point. What does cross-sector collaboration means for governance? How does that translate into governance? As and I have had some very good experience in that regard, but we've also seen some limits to cross-sectoral governance. So, Alexandre, maybe this is a question I'll put to you right when we start the panel. Since this is a key theme of this conference. So, let's move to the second speaker of the panel who is Jean Tramart, Head of Business Line Health at AXA Partners. Thank you, Mr. Chairman. Good morning to all the panellists and to the audience. As you know, insurance is about covering for unexpected events in a predictable, measurable environment. And COVID taught us in a hard way that the health environment, unfortunately, is less predictable and measurable than we all thought. And as we know the impact on health, of course, the impact on the global economy is of a very large magnitude. We have discovered that we were less prepared and more vulnerable than we would have liked. In other words, COVID reminded us that health is strategic. Health is not a commodity. And as a result, poor management of health in sufficient anticipation, wrong decisions, can turn into a disaster for individuals, of course, but also for the global economy. So what could it mean to manage health more like a strategic asset and less like a commodity? I would insist on three factors, three areas where personally I anticipate a change in the future. The first one is prevention, not at an individual level as Mr. De Germay told previously, more at a sociality level or a nation level. The second one is data. Thanks to Antoine Flau, we saw that there is a lot of data which fortunately is available, but there is also probably a lot of data which is not available or not exploited in the right way. And lastly, we touched the point a bit. It is about behaviours. How can we handle this pandemic bitter? How can we influence better behaviours? And there is a huge question in my opinion about social networks. It is in my opinion the first time that social networks have such an impact on health issues. First of all, prevention, vulnerabilities which were detected in the supply chain of countries. I will not go into the details, conscious of time, but you have all in mind the debate about the masks, the stocks. Should they be managed like a strategic stock like oil for instance? And then you have the coming debate about the supply chain of a vaccine, the supply chain tomorrow of basic drugs. I can say that health products, health goods, drugs have been managed somewhere in between a pure commodity and something which must be a bit regulated. My guess is that it will be more regulated and that public opinions will no more accept or will accept less that health goods are managed on the basis of free trade. On the basis that if you are a rich country, if you have money then no problem, you will get what you need in terms of health. And we have discovered it was a little bit more complex. Shall we have less free trade, more health nationalism to protect the supply chain? Or shall we have more international regulation, international cooperation? I don't know. But if it was a bet, I would bet for less free trade and much more nationalism and health protectionism. This is for me the first lesson, the first guess. The second one is about data. For the layman, for the man in the street, it is a bit frustrating to see that at the same time we have a pandemic where everybody is collecting data, everybody is working, everybody is doing guesses, as we have just seen on is smoking protective? Are the people who die essentially the older ones, like for any disease I would say? Is there something about genetic or not? Are such and such drug effective? Is it effective in the first days of the contamination? Is this more effective when you are in the hospital? There are a lot of data, there are still a lot of questions. For doctors in the room, probably there is an answer which is to say it is the first time in history that such an amount of knowledge is collected in such a little number of months. But also there is a feeling, and maybe the panelist will correct me if I am wrong, is that data is not yet managed as big data. Many hospitals, many countries, many companies are working their data on a very individual basis. And probably much more could be shared, much more could be analyzed, but we don't have the infrastructure for that. Antoine Flau has quoted a list of drugs which are used. I must say that it is not completely clear which drug is efficient and why and for whom. Could we do better? I don't know, but my guess is that in the future, part of the response, part of the efficiency of the response will be about working better on the data and maybe creating more international, more trustworthy, most more bulletproof data systems. Lastly, I would like to come to behaviors, and I will just focus on the vaccine. They are coming, they are coming like a relief, like the solution. And at the same time, in many countries, you can have more than 50% of the population who says, no, I don't want a vaccine. I'm afraid of it. For some good and some bad reasons. And this will not be managed with, let's say, coercion. This will not be managed with curfews. This will not be managed with lockdowns. This will be managed with conviction. How do we better manage the public opinions without being accused of manipulation? How do we handle better communication on the social networks? And this will not be only with control for binding some messages. This will be, in my opinion, a key lesson of COVID and a key issue for the future. How do we convince? How do we communicate better? Because this will be part of the solution. Mr. Chairman, this is what I wanted to say. Thank you very, very much. You raised a number of very interesting points for the discussion. You called health a strategic asset and I hear this as an echo to Tedros' statement that health should be seen as an investment rather than an expenditure. You raised a very interesting discussion, I thought, on the fact that the public, let's call it the global public opinion, if there is such a thing, is not accepting anymore that medicines, vaccines would be only managed on the basis of liberal free trade. And that, of course, echoes to the question of common goods and regulation. I'm saying common goods, not public goods here. And you also made an interesting set of comments on behaviors and the fact that they cannot be imposed. First, I come from the HIV world and, of course, we've seen in the 80s and 90s, we learned that prevention needs a responsible citizen to own the preventative behavior. Using condoms cannot be imposed on people. It calls on their personal responsible behavior and we succeeded with regard to HIV and condoms in most part of the world. It takes time, but we have to keep those examples as we think of prevention and one more last point that is implicitly raised in your remarks and I'd like to come back to that in the discussion is behaviors and determinants. Our behaviors are what we do, what we decide, but they're also shaped by the environment, the social, the economic, the political, the cultural environment in which we are. And we're not equal in making, in our ability to make good decisions, if I may call them that way, because of the structural determinants that can be constrained to us if you live in the streets. You know, your behavior, your capacity to control your behavior is much different from socially inserted person. Okay. You also called on doctors. So here is one. Our third panelist, Dr. Juliette Toakley, Medical Director, Chief Executive Officer of Family, Child and Associates and Chair of the Board of Trustees of United Way Worldwide. Juliette, thank you. It's a pleasure having you on the panel. Thank you, Mr. Chairman, for inviting me. It's, it's an honor to be here on such an important topic. Some of us have long awaited, if you will, the day when we will be speaking about public health as a strategic asset, health even as a strategic asset. Because it has been so evident to us the cost of your health to economies, but it has not been evident in terms of the governance systems that control the purse, if you will. Earlier, the point was made that Africa repeatedly stands the risk of being seen as a monolithic narrative. For those of us who read a lot, it's the equivalent of the danger of the single story that Jim Amanda DJ has referred to when it does come to narratives out of Africa. You know, a continent that is written by communicable disease as well as and non commit communicable diseases warfare and failed week health systems. I am not saying those aren't true, but I am saying that we have a young population in most parts of the continent. As you pointed out, the average age is under 18. They do tend to be educated, albeit not educated for the economies within which they live. And I think that one of the big lessons here was seeing how committed the youth got involved in some of the national directives that came down around lockdowns, social distancing, masking, et cetera, et cetera, et cetera. Because unlike in the West, as you know, most of our economy is in fact in the informal sector to which these youths and other population members partake. And so locking down the system, the economic system affected them in particular. And I think that one of the things that we saw here in Ghana was how the fishermen, the teachers, farmers, as well as politicians suddenly recognized one another as all being contributors to both the health of the nation and the economy of the nation. And that awareness was so critical and so important because as has been mentioned by the previous speaker, it does determine health and the outcomes of health and population behaviors. I think one of the other lessons we learned here in Ghana, but I know it happened in other parts of the continent, was where governments had always shied away from being involved with the public with the private health system. They found themselves forced into partnerships, triangular partnerships, if you will, with both the public health sector and the private health sector. And whilst this might not seem like a big deal in some parts of the world, on this continent, it was a big deal because I think it has set the template for future work, especially in the preventive health arena. So we had the lesson of triangular partnerships. We had the lessons of south-south risk sharing. You had mentioned, Mr. Chairman, about the issue of regional governance. I think this has been very important on the continent for us. And I think has been fostered by the fact that we've had a very effective African CDC that has promoted and supported such local governance structures coming together regionally and supporting one another where it's been necessary. I think that regional risk and knowledge sharing was very much in play, and particularly around data collection. And I think this is why we've been able, most unusually, to have such good data available. But the point has been correctly made that we now have to know how to use this data in an effective manner, both on the local stage, the regional stage, the global stage. And as, you know, Thierry said, let's be frank here, Africa has once again become the nexus for a lot of geopolitical activities. So it's going to be extremely important that we within the countries look at how our data is both collected and used here on. I think that's one of the biggest lessons for the continent. And I think that there are many lessons to learn from prior presentations that have been made to give ideas and guidance as to what would be most effective for the continent. I think the important point that 90% of health occurs outside of clinics and hospitals that has been repeatedly stated by the prior speakers and I'm so glad to hear that because it is so true. And I think that the farmer, the whole farmer industry at one point had too much of an influence on health from their perspective and not from the recognition of health being a communal, a result of communal activities, communal social determinants. And I think, again, we now are back, if you will, we've righted that wrong to some extent and are able to perhaps be a little bit more comprehensive in how we look at our public health here on. I am also very pleased to hear the recognition that regulatory bodies do need to start coming together and in fact in Europe are coming together but we also have to recognize that one of the lessons we learned in Africa was the contribution of agility, if you will. I think Africa really demonstrated an agile response and most countries that did well actually demonstrated that. When you look at a country like South Africa, the Republic of South Africa, they have sustained a third of all COVID cases as well as nearly 50% of all of the deaths. They have the strongest public health system on the continent. They have one of the highest GDPs on the continent. There are lessons to be learned there. I'm not going to say that I am here to teach those lessons, but I think we have to be open minded because some of those lessons are very important. And COVID will not be the end of RNA jumpovers, viral jumpovers from animals to humans. So we really need to take learning these lessons very seriously. I think that when we looked at how the African CDC behave, for example, we could see the difference between some of these older more established global leaders in their responses and their behaviors and the relative agility that we showed. And I think we have a lesson to teach others there. I think that it's very fortunate that the African Free Trade, African Continental Free Trade Agreement has been signed and located here in Ghana, I may say, because I think this serves as another reinforcement level for regional regulation, regional governance, which I think ultimately is going to be the most effective format in health for the continent. I think that we shouldn't overlook what was mentioned earlier, the fact that we've all learned that vaccines can be prepared and ready to go in less than a year. I mean, that has been an extraordinary lesson here. And again, I think that in partly results from pharma having to revisit its role in the whole notion of common good public health, public health as an asset versus commodity, etc, etc. But I want to just come back to the issue of the, I think it was Professor Alexander that raised it about he mentioned that the whole digital technology and how important that has been. It has been hugely, but not just from the perspective of physicians providing tele, telemedicine and telehealth, or even virtual education. But I think it has shown, as in other parts of the world, the digital divide that exists in Africa. We have a continent of hand held holders, but the reality is that the smartphones, the smartphones are located in in less far fewer hands than one would think. And I think this is an area that we have to start really looking at both from the government level down there. We have to expand our digital exposure, our technological exposure. It's critical. It's urgent. And I think that I was glad to hear Professor Alexandra alluded to that, but we've also found it useful for learning. I physicians receiving education from lessons learned elsewhere, in addition to providing virtual services to the populace. So that whole area of the digital divide was where we realized that there was some structural inequalities that needed to be addressed and addressed very quickly. And I'm quite sure the telecos are probably paying attention to this, and we'll probably look at this as well. And then, of course, I don't want to beat a dead horse, but data, data, data, control of data, accumulation of accurate data, the use of the data in establishing and redefining how we intervene as physicians, as politicians, as community members. It's going to be so, so, so important. Yes, the influence of social networks is as prevalent on the continent as it is anywhere else in the world. And sometimes one regrets the fact that certain leaders have encouraged this mouth your sense, if you will, in the exposition of false data, because it is an area that we will need to have all hands on deck, and there are many lessons to be learned there. I will stop. Otherwise, I'll stand at risk of repeating things that have already been said, but thank you very much. And thank you for, again, stressing a number of very important points. Of course, everything you said about data and importance of data for policymaking and for taking the right action. I want to remark on the fact that despite South Africa having the strongest health systems, at least by the way we measure health system efficiency at this time, you know, didn't prevent the country from having a severe outbreak. But that's true, of course, for the, for the global world and for the U.S. and Europe that thought by the, you know, the ways we currently measure efficiency of the health systems that that wasn't enough, maybe something to which, Antoine, on which Antoine could comment later. Thank you also for your very interesting point on how fishermen, you said, teachers, people felt that they were contributing to building public health. And this is exactly the point I was making in my introductory remark that to me, public health is a public good or a collective good because it is the result of the social political forces that produce the health of a population. So our fourth panelist is us see who until recently was the Secretary General of the IFRC, the International Federation of Red Cross and Red Crescent Societies, who's been for a long time with the United Nations in various capacities and is currently the chair of the board of the Kofi Annan Foundation. And I must say a long standing friend. So it's a pleasure having you on the panel. Thank you very much, Michelle. And I would like to thank also the previous speakers who have touched on the most important aspect of the subject matter we are discussing today. So my task will be a little bit easier because I don't have to repeat all of that, but maybe just comment on some of the other issues which I feel are relevant. And I will start by maybe quoting Mr. Monbriel who in the introduction talked about the shocks that we are confronted with over time. Yes, I agree. We will always be confronted with political shocks. We will always be confronted with climate shocks. We will always be confronted with health shocks. But the question is, will those shocks necessarily become crisis or will they be leading to catastrophic situations or to unprecedented, you know, pandemic like the ones in the middle of which we are. The answer I believe, you know, lies in many things that we all have alluded to. I believe that answer lies in preparedness or lack thereof. I believe it lies in responsible leadership or lack thereof. It lies in active citizenship that must go hand in hand, you know, with responsible leadership. It lies in science that should be guiding our analysis, as well as our response. It lies in politics, politics that can be part of the solution or part of the problem. And we are hoping and aspiring to those politics that will be part of the solution. So it lies in action and activism or lack thereof. So we are seeing children on the street reminding us the importance of the climate. We're seeing people living with HIV AIDS, not telling us that they're experts because they post the virus in their own bodies. By the way, yesterday was World AIDS Day, talking about the pandemic and there are still 38 million people infected and many more affected. It lies in partnership or lack thereof. It lies in solidarity. It lies in local action and global action as well. And I would say it lies in trust, but there will be no trust to without accountability. It is in the context, against the context that we see how we respond or we react. We often react than responding, honestly, because we find ourselves in what we call the cycle of panic and neglect. When we are confronted with an unprecedented shock, we are all panic and we put all our resources and our attention focusing on one. When it subsides, well, you know, we seem to go back, you know, to whatever we consider to be normal. And this time we are being reminded that maybe we shouldn't go back to normal because normal has not worked. We have not moved forward and then shaping the future that we really would like, you know, to see. COVID-19 has revealed all of that. And it has also exacerbated some of those dysfunctionalities, you know, that we have seen in our national and in our international institutions. It has shown that there is a real breakdown in leadership, Frank. The word is crying, crying for leadership. And we don't have a critical mass, you know, of leaders, political, and otherwise, or the global level that could, you know, chart the way forward. So what we are seeing is now, and it's functioning in our national and international institutions, that is mainly caused, you know, by not the institutions, you know, themselves, all the bureaucrats themselves, but the very members, you know, that should be either funding, supporting, guiding, and also giving the authority to those institutions not to do the work they're supposed to be doing. Mr. Mombrial has invited us in order to be naive. Well, I think I would like to be naive. I would like to be naive, you know, to believe that, you know, the United Nations has a charter that started with with the people and not with the government. And then we will have maybe go back, you know, to putting the people at the center of what we do, to make sure that, you know, leadership is about delivering on promises that we make to people and people's well-being. And if we do not break, we do not deliver on those promises, we don't have the trust that is required. And unfortunately, we will have a deficit. We are having a deficit, you know, of trust right now, so in the global system, you know, that we are seeing now. We started, I think I can belong to the generation that started learning for studying international relations with the first chapter being called the World Order. And we're talking about the global order, even, but I think today what we are seeing or risking to see is that global order is turning into not to a global disorder. Why? Because the very member states and the very partners and the very members, you know, of an institution that make it work, you know, tend to be the very ones, you know, that are weakening it. And we see in that, Dableto is a good example of that. Well, if I list, you know, the three biggest funders of Dableto, well, among them, I will find a non-member states. I will find a private foundation. Well, and those were supposed, you know, to maybe leading. We see in the result examples are even withdrawing their funding and questioning their membership of the organization that is called the World Order. But at the same time, we expect an authority and a guidance from this organization, and that will not, you know, happen, you know, that way. So what we are saying also is that I'm glad, you know, that Mr. Kramas has mentioned that the centrality of human behavior in that it is not only the behavior to prevent, you know, disease. It is our behaviors and attitudes, and when we face, you know, shocks and hazards, and how we respond to that rather than reacting, you know, to them. Changing our behaviors when it's right. It happens. What is most difficult is to sustain it. We may have heard, you know, the saying many times, no, stop smoking is very easy. I did it 10 times. And that's what we are facing now, even in the times of COVID, we're talking about second wave. Well, they are full respect of the experts that say so. But I believe we're still in the first wave, the same way, because nothing has changed in the general virus. Nothing has changed in the way it is transmitted. There must have changed in the way it can be prevented. But what has changed is dramatically our behaviors. When we relax, when we relax, it will relax. And that we are seeing now happening, you know, more and more, you know, that in the different situations that we are facing. It will also be naive, want to be naive to believe that there will be a growing critical global citizenship beyond borders, that will be challenging leadership, and then putting networks of solidarity that are required, and putting the pressure and decision levels, all decision making levels, local communities, private sector, government, international institutions, you know, so that equity and inclusion is not only a wish, but it is something that we apply to make sure, you know, that we all are safe. Michelle, in the introduction, you were talking about, well, that is not surprising to see who will be the winner in the competition, you know, start and continue the way you're starting. You know, my answer is, there will be no winner at all, because we tend to forget that in a pandemic, indeed, none of us is safe, you know, until we all are. So what we are seeing now when we're talking about the mathematical system, maybe two things that we will be thinking about moving forward. A global response is more than a UN response. So multilateralism is right beyond the UN. Of course we need the UN, we need international financial institutions. We need multinationals that are even becoming subject of international law and very important factors in international relations. We need, you know, pharma, we need, you know, the economies, you know, all of that, so that it becomes a true global response. In the same vein, we will have also to need that a national response is more than a government response. We will have to have communities, you know, at the center, you will have to reveal, you know, the trust which is broken between leaders and national level and their citizens. And finally, what I would like maybe to continue thinking of and reflecting together with you that we always continue to try to strike the balance that we need the science. Definitely, we shouldn't take that for granted. Science has been challenged by so many naysayers, by anti-vax campaigners, by social media amplifying all kinds of fake news. And we need politics, but politics that are part of the problem, part of the solution, not the problem. And we need the activism, you know, that will be holding us, you know, all up and fall. And I think, you know, that is maybe the utopia and naivety, you know, that's, I truly believe in, and that will be required to guide us, you know, so that all of that will be leading to local action and global response, as well as, you know, the solidarity that is required. So finally, if COVID is really a global public bad, maybe we need a response that is called a global public good. And that doesn't matter how we define it. If it is in the spirit of solidarity, in the spirit of equity, in the spirit of just making sure that we all are safe. You know, a realistic way of making sure that, you know, the investment that we are making within our geographic border on fine, you know, will not be challenged by the lack of investment in action somewhere else, you know, in the world. Because again, none of us is safe. Thank you very much. Thank you. Thank you very much. Thank you for the important points you raised on trust on the global citizenship building up. And that echoes some of what Jean Cremac said earlier around the weaker and weaker acceptability by global citizens that that goods, public goods are just managed by on the basis of free trade. Thank you for your comments on the need at national and global level to to see beyond governments and intergovernmental multilateralism. But to a broader common citizen partnership involving all sectors and responsible citizens that trust each other and trust in the project. Thank you also for introducing a new terminology a global public bad. And that brings me to the fact that we're now opening the discussion. Please post your questions. And here I have one question by Stanislas Couson. Let me read the question. The question is I have read references to common good public good for possibly also common goods. Could you please elaborate on how you define these and how to avoid being naive about governance. Let me just say to me here, you know, a public good is a collective good as opposed to a private good. And the global good is global as opposed to being national, just to make it simple. And the common good is a good that we all need to to sustain and we all need to collectively sustain. And this is why we need it to be regulated, for example, access to clean water or non polluted air. That is a common good for us. But if we do not collectively regulate that common good, it won't be a common good it can turn into what us would would call a global bad. But let me turn to you as would you like to comment on the last part of the question, which is how do you define the how do you avoid being naive about global governance. Well, so naivety is a subjective feeling. And so how do you avoid to do that? Well, for me, I belong to the naive. And I assume that because you have to be naive, you know, to be optimistic. You have to be naive to not only think out of the box but maybe get rid of the box altogether. You have to be naive, you know, to also engage, I think, in what seems to be impossible, you know, today, and then putting the action to shape, you know, the future, you know, that you want. So someone I think that was back in 68 to say there's no revolution without utopia. And I don't think, you know, we won't have, you know, the future won't if we don't have a certain doses, you know, of naive. You know, the lack of that will just be to accept, you know, the status quo, you know, to put it to be realistic and be realistic to what meaning and not taking any action to change or to do what we have to do today to have the future we want tomorrow. Thank you. Here's some how there's a question from Daniel Andler that Chris crosses with a number of points that were raised by several of the panelists. Daniel Andler, would you like to ask your question. Thank you, Mr. Chairman. It wasn't really a question. It was just emphasizing, especially what Mr. Kamas was saying how important it is to be able to nudge behaviors in the right direction, and what we think is the right direction without somehow committing paternalism or other ethical sins. And I was just pointing out that these topics, how do you, how do you make norms, new norms emerge, how do you make old norms which are toxic, vanish or be seduced somehow. How do you create an atmosphere of trust on social networks. All of this has become the focus of scientific research program that isn't often mentioned. I mean, all of you are obviously aware and the importance of this topic, but I don't hear very much very often in such circles. Mention of cognitive science, social psychology, behavioral economics that are all conducting extremely interesting empirical research and conceptual research on these topics. For example, anti-vax. There's lots of excellent, excellent insights on what, on the deeper reasons of this anti-vax movement that could, profitably, I think, be exploited by people such as yourself. So I just wanted to say that there's an ongoing research program on these topics that doesn't cost very much and would be well worth investing in. Thank you. Can I ask the panelists to sort of comment on Mr. Handler's remarks, be it from a vaccine, a confidence perspective, maybe Antoine being from referring to what Jean Camarque had said, or other panelists. And may I bring in something I tried to bring in earlier in the conversation, which is, it isn't that there are just, you know, it isn't just about nudging behaviors into the right directions. It's also about fighting the structural inequities, the structural determinants that actually will shape and the capacity of an individual to change or not to change behavior. We've been hearing anecdotes here and there of people who, fearing to lose their fragile work, would hide their COVID infection rather than, you know, reporting and going to contact tracing. So when you have no choice, not easy to change behavior. So comments would like to go, Jean, maybe. Okay, my point is about social networks and behaviors. We have talked about Ebola. Ebola, I would say nobody would have criticized the fact that Ebola was very dangerous disease. COVID, we discovered that you could have one million different opinions. Some people telling you COVID is not dangerous at all. It's a joke. It is a small flu. Some others, of course, explaining that it is very dangerous for some people and as Antoine has shown on the slides, both are true. It is not dangerous for rather young people, very dangerous for old people. One example. Social networks, we saw also doctors not trusting doctors, governments not trusting some doctors and some doctors not trusting some governments. It is a huge mess. How can we expect the general population to trust public messages when doctors do not trust the other doctors? It is a blunt way to say it, but this is what was very visible on the social networks when in the past it existed, but it was hidden. And suddenly distrust has become the new normal. I'm sorry to say that as bluntly as that, but any government efforts, any prevention efforts will not work if distrust is the new normal. And as we all know, people abiding by some rules, people doing some things and not doing other things will be key in avoiding massive economic impact of this disease. Whether it is pandemic andemic, we will know. But if we wanted to be manageable, we need trust. We need people to follow some rules. And I must say that governmental bodies, international health bodies are very junior in managing social networks, in communicating on social networks. The first impressive thing that I saw was more than 10 years ago, the Center for Disease Control of Atlanta communicating on Twitter. Super smart, super easy, super efficient. It took a few years for other governments to follow that trend. But we live in a new world and public communication on Twitter, public communication on Facebook, public communication on YouTube is, let's say, conflicting public communication by one million people who don't trust them. If we don't hack it, if we don't collectively find ways to be efficient on the social networks, many things will not work. And this touches the point about data. Data, I hope, will bring more confidence. And today there is not enough confidence in each little bit of data which is published. So this is maybe the way we can work together, data, social networks, building trust. This is my overall comment. Thank you. It certainly echoes parts of the interventions of every single panelist today. So may I call on the other panelists for a brief comment around this issue of trust, which, you know, as also mentioned as a key element of building order. So maybe a few comments because of course the trust on vaccines is. Yes, thank you for taking, please take a bit of this topic that was also a question from, I'm sorry. Anyway, there was a question that I neglected to put to the panel on this, so please elaborate. Of course the trust on vaccines is, of course, high on the media today is an increased feeling of challenges on the trust, on the quality of the data. In a way, we have to remember that normally textiles today we have sequenced the virus. And we found the antigen and actually found the way to manufacture this antigen in less than 10 months. So obviously the question around safety and efficacy associated with these vaccines is it's okay that people are wondering what are the facts behind the development of those vaccines. And that's why the health authorities are actually digging into it. And I just want to say that vaccines, vaccines has always been in the center of polymix. And, but at the same time, we see that year to date in the US, the numbers of vaccines have increased by 50% for the flu. Okay, so yes, you will always hear a lot about the the the septic around the utilization of vaccines. But at the same time, you see that this type of crisis increased the willingness of actually getting access to vaccines. So to your point, the question is, okay, who is getting the voice in social media and who is representing the majority in terms of behavior. And as we know, to actually take on the on the point of the intervention of someone previously, we know that a negative news is twice more tweeted or retweeted than a positive. It's just because they create the buzz. So that the problem is on social media and on the network of influence that you will generate, you will see higher influence on the negative and lower influence on the positive. But we also know that there are ways to actually address those those questions in in bringing more or in sharing more positive news also through through influencers and influencers in this category. That is also something that we know are not the classic key opinion leader that sits in a hospital university that knows the subject very well, but often a general practitioner that just happened to be followed by millions of people. Followed by millions or hundreds of thousands of doctors and individuals that just get the point across so we need to structure that better than this community of influence and ensure that what is also positive facts are also shared because it's incredible. Let's put it that way. I never thought, honestly, in March that we will have a vaccine ready in December. Yes, it's incredible. We just sequenced these vaccines virus in January. It's amazing what has been done. Thank you. Thank you. Can I call on comments from you around this issue of vaccine and confidence. Maybe Juliet, you want to start. Can you hear me? Yes, we can. Oh, good. Sorry, I got disconnected accidentally. The whole issue of misinformation around vaccines has been one of the most unfortunate aspects of I think the whole covert experience over the past nine months. But I think that the reality has had there had been a building up of misinformation on prominent social networks such as Facebook. I think Twitter was better controlled, but certainly Facebook was relatively uncontrolled. And I think that this, I think certain unscrupulous leaders unfortunately took advantage of this to promote a lot of the anti-vax messaging because when I think it was Alexander, I think who mentioned that we know where it's coming from. The research is there. We know how this has evolved lack of trust has been an important issue. Yes. However, it has collated it has collided, if you will, with the, the whole sense of needing to be protected and needing to be governed because everything has become such a mess on account of the facts of covert 19 being this strange thing that has taken over the world. And people's belief in sound structures no longer, you know, holding them up any longer. But I think there has to be some more regulatory activity on the major social media networks because that's where a lot of this comes from. I can't tell you how many of my patients here in Ghana ask me about some of these ridiculous comments. And I find that I try to break it down the scientific details down into a communicative style that they can understand what exactly is going on. And I find that that is usually enough because they're smart enough to put one plus one together and come up with two. But it does show me that irrespective of the socioeconomic skills because that we do see people at the top level, all the way down. It's it's really the social media that have been driving this and I really have been most disheartened by this particular aspect. Thank you. If I can say, I would think that we could use as an opportunity this anti-vax movement, surprisingly, because we need vaccine for the at-risk groups for the whole world population. What we need to avoid is that the richest countries are vaccinated at the at the entire level, and if we can use the anti-vax movement to protect the at-risk group and the elderly, we will have in fact secured the fact that the most important thing is to share the vaccine with the whole population. So if some people don't want it, let's not fight against that. We are very happy to refrain more than 20, maybe 40 percent of the richest countries populations to take vaccine. And I am rather confident that the elderly people, that those who would like to travel, because it will be probably mandatory to travel from a country to another country to be vaccinated, they will get the vaccine and those who do want to refrain to be vaccinated, we can let them for the moment. It's not our priority. The priority is to protect the elderly, to protect the at-risk groups and the healthcare workers. If they don't want it and if they don't want to travel and they don't want to be accepted in some settings, in some home care facilities and nursing home and so on, they will not. That's their responsibility. Thank you, Antoine. I'm now seeing it's 11.28 Geneva time. So we are at the end of this very interesting session. I would like to warmly thank the panelists for an extraordinary wealth of ideas, concepts, questions that were raised. Thank all those who asked the question and sort of triggered the discussion. We touched on many topics, data prevention, information, misinformation. But let me just focus on three things that I think came out of the discussion. One, again, as an echo to what Tedros said on health is an investment, health is a strategic asset. The second, the fact that it is more and more unacceptable to the global citizenship to see the chaos, the lack of equity, the lack of inclusion in what we do in responding to a pandemic. A lesson learned from this pandemic is that we can't repeat the cacophony of the response of the first months where every country went on its own way. And without, with a clear failure of global regulation and governance. And the third point is of course, from all of you, a call for some sort of regulation in order to build, I'll be, again, I'll call here a collective good that is public health. That just as other common and collective goods requires regulation and governance be of course at national level, but also regional and global. And that is why I truly believe and I'm sure all my fellow panelists believe that it is a great initiative to move WPC also in this area of health and health governance. So thank you again to everyone and back to you in Paris. Well, thank you very much, Michel, and thank you very much. All the panelists I think it was a fascinating session and a very good start. So before switching to session number two, let me react very briefly on this question of public goods and also naiveness. First and issue of common good public goods. Global health as such if you take global health as an entity. Yes, it is public good or a collective good that can be discussed, but particular health products, medicine, I don't know the instruments, drugs are private goods. And there is a confusion uses very often, you know, between the two, the two levels. But, you know, whatever the world is, the concept is clear. The concept is global governance because if you name global health, a public good or a collective good, the issue is how to implement it concretely. And this is exactly what we are talking about. And indeed, Ted Ross, Dr Ted Ross is right when he speak of investment versus immediate consumption and so forth and so on. So that my first point, but I cannot but react on the question of being naive or not. Let me tell you that I am naive. I am very naive because just launching the WPC would have been impossible if I were not naive. And I am sure that Mr SC is naive and I admire him for being naive. Now the question is that to succeed that you have to have a long term objective, you have to be an idealist, a long term objective. It has to be naive in that sense. But in order to have a chance to move from where you are to the utopia if you use the world, you have to be realistic in the short term. So there is no contradiction. One has to be naive in the long term and a realist in the short term. And if we agree on that, I think we are all, all of us, we are both naive and realistic. Now, I think that many of the issues which have been dealt with covered more or less in this session lead us in a natural way to the next two sessions.