 I'm Zanny Minton-Bettis from the Economist and I am delighted to welcome you to this conversation about the work of the Coalition for Epidemic Preparedness Innovation, which is, I have to say, one of the more extraordinary initiatives to come out of Davos recently. It is easy for many of us to become cynical about what the World Economic Forum can achieve, particularly in this era of populist anger. But this for me has been a very powerful example of the concrete achievements that this meeting can have. It was born out of a conversation a year ago by all of my fellow panellists here and many others who are in the audience. It's a concrete initiative between governments, foundations and the private sector, governments of Norway, Germany, Japan and India, two of the biggest foundations in the world, the Bill and Melinda Gates Foundation, the Welcome Trust Foundation, strong support from the world's six biggest pharmaceutical companies, GSK, Merck, Johnson & Johnson, Sanoffi, Tachyla and Pfizer. I'm saying this not to make an advertisement for all the individual ones but to say this really is an initiative that has come together and they were just telling me before we came on stage. There was a meeting, one hour meeting last year between about I think you said 24 people saying something has to be done. We know, we've learnt from SARS but most recently from Ebola, the extraordinary danger that epidemics pose. We know that they are one of the greatest threats we have. We also know that vaccines can protect against those threats but we know that there is a challenge getting vaccines into a state of preparedness that they can be used quickly and effectively. There is what we economists call somewhat of a market failure there and so the public and private sector came together and over the past year they went from talking to actually doing. This initiative now has concrete contributions of $460 million and I hear from Bill Gates who I'm sure knows better than anyone that we have promises of $700 million. So this has been a pretty big achievement and we're going to spend the next hour talking about what this initiative, CEPI initiative is going to do and how it will quite frankly change one of the most important threats we face. So with that introduction I will quickly introduce the panel. You know all of them but to my immediate left going left to right for you, the Prime Minister of Norway, Prime Minister Ernest Solberg, next to her Jeremy Farad the director of the Welcome Trust. Next to him is Excellency Alpha Conde, the president of Guinea. Next to him Bill Gates, the co-chair of the Bill and Melinda Gates Foundation and last but not least Andrew Whitty, chief executive of GlaxoSmithCline. So that is six of the members or rather five, I'm counting myself, six of the members of the panel and of this coalition. But before we get into the details of the discussion let's tell you the story of CEPI in a two minute video. This one started with a bat, a tree and a boy called a meal, a life full of wonder and a world to be explored. Soon after he fell sick and his family did too. Disease spread further still. Uncertainty led to fear. Epitemics affect us all. They affect anyone at any time. They don't care about borders or nations. They are one of our greatest threats. And with our densities, easy travel and ecological change, this spread faster and further than ever before. Businesses close and airports shut. Billions are spent and loved ones lost. The sound of a cough becomes the worst sound of all. We've sent people into space, created incredible structures and connected the world in ways we never dream. But we're yet to outsmart epidemics. We're always a step behind. Because we don't plan, we react. We know vaccines can protect us. We just need to be better prepared. So let's come together. Let's research. And invest. Let's save lives. Let's outsmart epidemics. Well, first of all, it's because SIPA is growing out of the lessons learned. Both from what was good about our response to the Ebola crisis, but also what went wrong. Why we didn't respond well enough and what we lacked in the response. We know that the international response came too late. We know that for the affected country it was devastating. And a lot of international actors joined forces. We developed a vaccine against Ebola. They made very rapid progress. And just before Christmas, the Lancet published the results of the final test, showing that the vaccine gives effective protection. And I think in a way this is truly worth celebrating, because now we know how to respond much faster the next time. But although it was nearly a record-breaking development of a vaccine, it was too late for thousands who lost their lives and livelihoods. It has a devastating effect on economics, on human lives and societies. It's matched only by wars and environmental disasters. If you look at what Guinea, Sierra Leone and Liberia suffered on economic loss, of at least $3 billion as a result of Ebola. And we know that SARS caused $40 billion. And a flu epidemic can cause several hundred billion dollars if it really gets strong and affects. We need to be more aware, and this was what we set out a year ago. We thought it would be better to be prepared to be ahead instead of responding afterwards. And in this world, I think taking epidemics seriously, we know that we have problems with antibiotics not functioning anymore, that we get resistance to it. We know that vaccines is a way of handling also known diseases today that might not be vaccine against today, because we think the antibiotics can work it. In the future they might have to be vaccinated against. There is a need to be much more prepared. And I co-chair the UN Secretary General's Development Goals Advocacy Group, and I think epidemics is undermining all of those 17 goals. And for Norway, you might say, Ebola was far away. No, it wasn't. We got one of the doctors back home. We know what it was, and we are a highly developed country. We know how much money we used on one patient. And to make sure that it didn't affect the rest. And we know that all of these epidemics move so fast that we were lucky just getting only one patient. We could have got more, and we got a patient we knew was sick when she left and came to Norway. We knew it, we could isolate it. We can make sure that we were prepared to help her, but that's why it comes out. This is not just for the countries that are developing. This is also for developed countries. It's the same problem. I think that's an incredibly important point. This is not just for an assistance, which is something that Norway plays an enormous role in. This is self-interest too. It's enlightened self-interest. Jeremy, let's turn to you, and we've just heard from the Prime Minister the broad background as to why it makes sense for Norway and other governments to support this. From your perspective, as director of the Wellcome Trust, you've been kind of at the cold face of working in and dealing with epidemics. Give me your sense of what the need is here that SEPI is fulfilling. What concretely does it need to do to be successful? I think it's... So I speak now as a clinician when I spent the last 20 years also living in Vietnam and lived through siles and bird flu and then been very involved in the epidemic since then. It's very difficult to get across to an audience just how frightening it is to be at the epicentre of that. You question your whole professionalism, you question whether you should stay at work, you question whether you should go home to your families, and this is what every healthcare worker feels. And I think when we're pausing here just for a second, I think we should all just reach out and thank those healthcare workers around the world who work during Ebola, working during Zika now just to thank them because they are working in extraordinary difficult circumstances. They're protected, we have no vaccines to protect them and they're doing so and they make all of our lives slightly safer. I would like to have a world where we never have to ask a healthcare worker in future to go into an epidemic without knowing that they're protected. And SEPI I think can achieve this. We should bear in mind that with environment change, climate change and of course globalisation and travel what happens in Lagos will affect Davos tomorrow. What happens in New York will happen in Beijing. The world is connected. You will all fly after you leave here at Davos and go to almost every country on the earth within a 12 or 14 hour flight. And yet the world is incredibly vulnerable. If I look to just my own experience over 12 years, SARS, NIPA, bird flu, Zika, Ebola and ask ourselves do we have interventions which fit the 21st century? Yes we have public health, yes we have hand washing and yes we have masks but we had those in the 19th century. And I think what SEPI is going to do, vaccines are not the answer to everything but it will say that the vaccine space for emerging infections we will have a vaccine for the most important potential emerging infections and we will do so by working across governments for philanthropy and industry and we will change the paradigm by which we make vaccines for these epidemics. We will come on to exactly how that will happen a little later in this discussion. I want to first to turn to His Excellency Alpha Conde President of Guinea because I think you Mr President can give us a first hand account of what was the impact that Ebola had on Guinea. What is the world we are now in that SEPI is trying to improve the position of? First of all I would like to thank all of the people who came to Guinea, Sierra Leone, all of the healthcare workers who helped us and put an end. Some of them lost their lives, others fell ill so I would like to thank them. I would like to thank also the Prime Minister of Norway and SEPI for this initiative. We believe that there are two important reasons for this epidemic. Our healthcare system wasn't up to scratch 245 doctors for 100,000 people in the US far less in Guinea and our infrastructure is aren't sufficiently developed either but we really need to focus on our healthcare systems. We need really to promote quality healthcare systems in Africa and we have support for this. We have support from the Pasteur Institute, from other French institutions, American institutions to achieve this goal. So that's one important thing improving healthcare systems. Secondly, community health quite often we have NGOs who come, who do help but who aren't familiar with our customs, our traditions. So in the case of Ebola where you have a cultural impact as well where there are different ethnic groups involved it's important to really understand the customs and traditions as well if you're going to be effective. We also need to work on transfer of technology. I've worked with organisations who are working with us but ultimately it's us who are responsible for our populations. Quite often we find it's difficult to transmit technology and use of technology to the population and it's difficult to get the message across. So when we work with organisations in the field quite often we find that they expect us to do the field work and stay and connect in hotels and really don't get familiar with how to transmit their technology or become familiar with real life in our country. So this work needs to be done there. There's also important work in the area of research. Vaccinations for example I took the risk of trying a vaccination I was told it wasn't 100% safe but I wanted to go ahead and try it to see that it was safe it's then been rolled out and has been successful. Now we know that there is sometimes difficult to encourage companies to do the necessary research but we need to mobilise this research and we need to increase its effectiveness and be honest about this we need to work in all of these areas. Thank you. Mr President may I just like to push you on one element of that which is you have laid out the many aspects of the response that are needed and you also said that you took and as you did you had the vaccine trial in Guinea what would have happened if you had a vaccine in weeks which is what Cepi is trying to reach what difference would that have made to the experience that you had with Ebola? Well of course if we would have had it a lot quicker then the epidemic wouldn't have spread as far the WHO we feel didn't react in time that's a fact I think we are very grateful to medicine so frontier who did really get into the field quickly when we did have the vaccine we first of all vaccinated the doctors and health care workers many volunteers and they didn't get ill if we'd have had it earlier it would have been effective and it would certainly stop the spread of Ebola protecting the population so it would have been extremely important it would have had a huge effect we want to see a vaccination that is 100% reliable and 100% financed so that we really can take care of people I'm not just talking about Ebola here I'm talking about other hemorrhagic fever diseases so thank you very much for asking me that question Bill Gates there you are it would have been there within weeks you are known as someone who likes concrete numbers and metrics of success so I'd like to get your sense of first of all why did you support this but secondly what do you expect and hope that Cepi will achieve? Well unfortunately even though there's a substantial risk of various types of epidemics there's not a natural marketplace and there's not a natural incentive for people to build products that anticipate that it simply wouldn't make sense for the private sector on its own to do this work and so when we look at this kind of risk the epidemic risk you've got to bring governments and foundations together to create the right incentive structure so the good news is that the ability to make vaccines quickly it may be possible to get that to be dramatically less than it's been there's a new approach that is sometimes called DNA RNA vaccines that the part you would change to go after a new disease would be a very small part of it and so a lot of the work the safety work, the manufacturing work you could cut that out it would be even easier than for flu vaccine today doing this seasonal adaptation that is done on an early basis and so the good news is that if you can get if you can either predict what the pathogen is going to be and get that stockpiled that's the ideal then you have a very very quick response the second best case is if you didn't anticipate the pathogen then you get using the private sector capability that these sepi funded projects will have helped advance you'll very quickly go in and say okay make a vaccine we don't know how quickly that can be done but if we can get it down to a year that would be very good but if we can get it down to a week accounts we have simulation showing that if you can get out in six weeks then even a flu epidemic which is a very fast spreading epidemic you can have a dramatic benefit too that's not to say we know that we can get down to that kind of short of time frame flu is one actually we should invest because we know it's there we should invest in it I'm sure it will get done in the universal vaccine for that so sepi is very exciting it's enough to probably do several of these vaccines and really engage the private sector in a concrete way before the next emergency hits nobody really knew which approach should be taken which diagnostic should be done there are things that sepi does not cover anti-viral drugs or diagnostics and so there should be following efforts of those things nor does it cover some of the governance questions like how do you allocate vaccines during a crisis like this so they're still really important ongoing discussions on those issues but I really want to thank the partners who come in just in the discussions of last year everyone's taken leap of faith to pull this together and even in the next year we'll have the staff and I think we'll actually bid out a couple of these projects so this is a substantial step that deals with a problem that can keep you up at night if you think enough about it which is the world's not really ready for a lot of these epidemics and Ebola was awful it could have been even worse there was even an element of luck in a jury in a big way there was an element of luck that it stopped where it did and it raised so many questions that we need to be better prepared for next time I want to come back in a second and ask you about how big that ambition is of how far you're going to go but first I wanted to bring Andrew in and get your sense from the pharmaceutical industry perspective of what is it that is missing what is it that you need most that Cepi can help bring to push this forward I think what Cepi does for all of the vaccine companies in the six of the companies who joined in to Cepi I think all feel very much the same way planning prioritisation and a mechanism to essentially create increased capacity in the space of research into these rare unusual but potentially deadly pathogenic threats so if you think about what happens in an epidemic or a pandemic situation first of all there's almost no spare capacity in the global vaccine industry if you walk around any of our vaccine plants they are running full on all the lines are busy because the world is growing there is more and more need for vaccine so the red phone rings and it's the WHO saying there's a crisis and we need any bowl of vaccine immediately after the WHO rings a couple of countries start ringing to say we want this vaccine now that's an almost impossible situation for a company to try and to react to so and it's so disorganised because actually the world doesn't know if there's a vaccine candidate ready they don't know whether there's any capacity lined up ready to go the companies aren't anticipating that phone call and what Cepi starts to do is to take the kind of things where we've had to react in the middle of the battle of the epidemic and take those things back to peacetime so that we can start to react to peacetime so that we can start to resolve these issues start to say yes we're not perfect we haven't got perfect foresight but we can more or less estimate that from these 12 potential pathogens there's a reasonable chance one of them could be the next pandemic so let's start working on them it doesn't mean we're going to get everything right but let's at least start working how do we start to think about taking vaccine candidates through to the end of phase 2 so that when a pandemic starts instead of discussing and debating on phase 2 trial we go straight to phase 3 those are the sorts of progress points we can make why is that sensible for us because at the end of the day when it really boils down to it the only people who are going to make a vaccine for the world are the six vaccine manufacturers and so it's in our interest to make this situation much less stressful much easier for us to react to without disrupting all of the other day to day vaccine because we were very close I think in the three companies who are most advanced in Ebola if it had indeed got worse we would have all been put in the very difficult position of saying do we make Ebola vaccine at scale or do we make rotavirus vaccine or another vaccine and then the world is making a completely invidious choice which could have been avoided and that's why we're so supportive of CEPI and I think all six companies who are represented here today were very very well to help bring this to fruition so CEPI will mean that for a certain number of pathogens there will be vaccines at the beginning of stage 2 trials now I guess then for me the question is money is not limitless what is the and you mentioned this was in some sense self-interest insurance you're buying insurance what is the right level of insurance to buy how much, how many vaccines should you, how many pathogens should you go after and what should the scale of this be, you're clearly just starting this is a very big start but how do you think of that and Bill Gates I'm looking at you because I know that you think in these terms so what's the ambition in terms of what's the right number to go after or the right scale of this the number of potential pathogens out there is far greater than we're likely to do specific constructs for so you know maybe if we're lucky we can cover the things that are 50% or 60% of the risk flu is kind of a special one that we should just go and do but even putting that aside there'll be some predictability and even the surprising ones will have may have some relationship so that you're able to just change the vaccine modestly particularly with these these new platforms ideally I think we do five or six at our current funding level it's more likely that we'll be able to do two or three but there are some major actors who will participate in the space including the UK and the US and China who whether they come into SEPTI formally or they simply take their programs and make sure that they're complementary like the US BARDA investments this endeavor will be bigger than the SEPTI organization itself and I'd say broadly maybe we will get the 10 or so that I think would be attractive once we get the 10 then I think the global health community should have a great debate about should we do 11 and are 12 did it go as quickly as we want at least we will have exercised the how do you go to the regulator and what do you do about stockpiles you wouldn't believe every question that should have been resolved in advance of the Ebola epidemic was not resolved in advance in fact we can still sort of debate some of these things about trial design that the SEPTI construct will force the dialogue to continue and even to be more prepared Prime Minister Selbot I think I'd just follow up on the last part there because besides actually working on concrete vaccines it's also important to have that discussion on how do we have preparedness for scaling up how do we have a priority on how we do it you can do all those discussions that can take lengthy time when the problem arises you can have a scheme you can have an international discussion on the priorities that you are making in a crisis like this because you are already there seeing the problems that will arise so I think it's important to say yes it's a workable initiative for innovation on vaccines but it's also a way of having somebody pushing this agenda so that we discuss how we are better prepared in the future and I think that is needed because there are so many problems it's overwhelming in a lot of body also in the World Health Organization that you should deal with so maybe there have to be somebody who is advocating and pushing this agenda It's unusual for me to quote Donald's Rumsfield but I think he sometimes did frame some things sensibly you have a known pathogen that Bill was talking about and for his world not to be prepared for the known pathogens that could cause an epidemic is unacceptable and that's honestly the situation we're in today and Cepi will address that issue but I think Cepi will do far more than that my hope is it actually catalyzes a new partnership and in these cynical times I think a global partnership with the various players and Cepi coming together is actually a real sense of optimism and hope and I think that's very important but it will also catalyze the whole technological advance that RNA and DNA technologies for vaccines of platform approaches so that we're not reinventing a new vaccine approach every time an unknown pathogen comes but I think Cepi has to earn its you have to earn the right to exist first and you have to earn respect first and that's why it's critical that Cepi chooses one, two, three, four vaccines and in the next few years absolutely delivers on those including in my view finishing the job on Ebola we have a safe and effective vaccine for Ebola and we actually have more than one candidate Johnson, Johnson, GSK Merck all have very good candidates but we don't have a licensed vaccine that has to be finished we have to be able to have a licensed vaccine that could be used tomorrow when the inevitable epidemic of Ebola comes back so the central focus of Cepi will be getting the vaccines and getting the vaccines to the second stage but as you've all mentioned there are things beyond that there's improving distribution schemes and then presumably there's also something about streamlining regulatory approval and isn't part of the problem or wasn't part of the problem the difficulty of having the time it takes to get regulatory approval so Andrew let's start with you there do you think Cepi can play an important role in these things that are sort of it's actually outside the lab if you will yeah and I think really is to the point that Bill just made and what Cepi does is it takes something which historically in between pandemics has been treated as a theoretical debate and makes it very crystallised so if we're working on a MERS vaccine we can actually sit down with the regulators right now and say okay if we have a MERS vaccine which is based on this platform what do you want to know to discharge your anxieties of safety and the like and quality those debate it wasn't really about timeline to get regulatory approval it was having the argument over how do you do what is the question you are going to ask in the first place I'll never forget in September of the Ebola pandemic being in Geneva listening to global regulatory organisations arguing with each other over the heads of the industry and the countries involved whether or not the trials should be placebo controlled or not that debate could have and should have happened years in advance and there should be a pandemic response kit which said right to phase 3 with this candidate we've all agreed this is the basis liability the same we still don't have a practical solution for global deployment of emergency vaccines from a liability point of view and while some people will say well how important is that the reality is when you take what will always be even after CEPI essentially extremely accelerated development programme and you deploy in an emergency situation you will find private sector companies reluctant to embark on an open-ended global liability risk we all know that the American government resolved it with the prep act years ago but the rest of the world hasn't moved those are the sorts of things which I hope won't be done by CEPI but in a way CEPI takes away the excuse not to talk about it because what CEPI does is it turns the theoretical into real and then everybody around the real issue has to start to step forward with their resolutions and I think then you start to deliver something much more comprehensive in terms of pandemic readiness so it's at the very least the right people around the table with the right incentives to make sure that before the pandemic hits you actually have some of this stuff I just want to make one other slightly more technical point if I can if this works the way I think we all hope it works it's a network and the way I like to think about CEPI from the manufacturing point of view of volunteers first of all who volunteer into the network whatever capability knowledge that's relevant and they feel willing to volunteer if that works effectively that creates the most extraordinarily novel open innovation environment and what we're really potentially buying here is not insurance for the first time but ultra-high quality insurance in a way which we have not been able to do in the past and I don't think we should lose sight of the novelty of how that network could work together if this plays out the way we hope it does Mr President let me bring you into the discussion here what would you we've heard now various different ways in which CEPI will move things forward particularly in vaccine preparedness what would you hope that it brings what would you want it to achieve so that it really changes on the ground the environment you face well first of all we'd like better collaboration with the government vaccinations of course but prevention is even better certainly in Africa if we see epidemics develop well that's essentially down to an ineffective health system so we need to improve the health system and that can be done through better research if we take the case of Ebola in Guinea we weren't quick enough in analysing the strain to see that it was Ebola it wasn't until it got to Conakry that we were able to get in touch with the Pasteur Institute and find out actually what it was it's far too slow so we need support in that regard and we need to ensure not only that it is a high level in densely populated areas but that it reaches right down out into remote areas as well so that there can be very quick response throughout the country so yes we want better vaccinations but we believe that with a high performing health system it won't then be necessary for people to send as international experts etc we would be able to take care of it ourselves on the ground and that for us is better obviously it's great if people come and help us but it would be even better within the capability of our own health care system thank you Jeremy how is sepi planning to work with agencies on the ground with the rest of the infrastructure that exists I think again it goes back to one of the strengths of sepi and as you can imagine over the last year there's been quite heated debate at various times there's people coming from a very different perspective but particularly following on from Ebola and what the president just said countries in west Africa have been involved in all of these discussions we've been fortunate to have medicines on frontier as a member of civic society there and often at the front line of the epidemics and I think all of the partners have absolutely brought into the idea of the technological advances, the regulatory environment that we've heard changing and the actual making of vaccines but there's another piece which is I think critically important to all of us and it's not just the foundation and that is that ultimately sepi also has to deliver vaccines to the world and make them accessible independence of people and countries ability to pay for them and the public-private partnership as well as with WHO on board is absolutely committed to make sure that we make those vaccines available and affordable to everybody that needs them and that's a core principle of sepi which all of us have signed up to so that's within sepi's remit to ensure that welcome trust and I'm sure the foundation would not be part of this if that were not true and from the industries perspective Andrew? We've made it very clear so I speak for GSK specifically we're engaging in this on a cost coverage basis so we're not looking at a kind of no gain, no loss basis it's up to each individual company to think about how it engages obviously it's not for any given company or entity to dictate terms but certainly from our perspective it's on a right basis to go forward and we're looking forward to activating essentially we think there's significant benefit for everybody here we think it's right for patients we think it's right for countries we think it's right to simplify this space and as a consequence it's good for us because it's going to take away the disruption risk for us and it's going to mean that when the phone does ring we can say yes more often than we would otherwise be able to do in very illuminating detail an extraordinary initiative but I would not be doing my job as a sceptical journalist if I didn't ask you about what are the potential risks what are the potential downsides what's the danger that this becomes a well-meaning talking shop but it doesn't actually achieve very much so Bill Gates let's start with you what worries you if anything about sepi actually achieving what it's set out to do is it that not enough people will cough up is it that the admirable partnership here that exists on this stage will break down is it that the incentives won't be right what are the biggest concerns do you think I still think we need to do more about epidemics about and the president talked about investments in high quality healthcare for normal diseases being a piece of that very specialized surveillance where when you see unusual circumstance you have sophisticated labs nearby that there are some initiatives like one called champs that we're working on that will bring a piece of that but still not cover it fully so my greatest concern is that if people think oh we have sepi therefore this epidemic thing we solve that and even a straightforward thing like how we get probably govi to buy the stockpile how big the stockpile should be we have worked that out and I think that piece actually fairly straightforward because govi is amazing one of the best things we've done countries including all the supporters here of sepi have been generous enough with govi that I think we do have the resources there for the stockpile the diagnostics will be very important when you're in an epidemic the idea of who's infected and who's not infected if you can't tell then your whole quarantine thing gets you into these very tough situations the countries were given very contradictory advice about what to do about quarantine because we didn't we didn't have a diagnostic test it was still a fairly complex machine that took too long to get the results from so my main worry yes there's still some time to risk on these new platforms but my main worry is that the world will still fall short of taking care of epidemic response Prime Minister Selberg how do you share that concern and how will you make sure that Norway is pushing everyone else to make sure that sepi is not the tick we've done enough now now we can stop worrying we are planning to use our best people on this to work with sepi to make sure that we put a focus on finding the good solutions it might be challenging that maybe there will be other bodies who should have taken more care of that who have not done that and they will now take one step even further behind I think it's important that we are we also see that there is a responsibility for us all to push this on the World Health Organization's agenda to make sure that because that's the platform where you can have all the governments all the health authorities around the world to operate together on how you deal with this when the crisis come because you have to go from step 2 towards in fact use the vaccine make sure and then of course when there is no need of if there is not a feeling of emergency things take off in too long time and that's also a challenge in this I mean the regulatory system yes we are good at bending all of those regulatory systems when people are dying but when we are just thinking about the potential of people are dying then maybe the whole regulatory system will be going too slow so I think there is a that might lead to having an organization and having a work and a cooperation and coalition on this but not being not reaching the time limit for the next epidemic which we should try to do Jeremy how do you maintain that sense of urgency what should be and what is on Cepi's to-do list in the next let's say year or two so Cepi's already there's a long list of potential pathogens and there's a short list and Cepi's quite rightly said we're going to focus on some initial pathogens because they may not be the right pathogens to focus on let's be honest but what any new organization needs to do is to earn the right to exist and I think by focusing in the next one to two years on delivering on those promises that have been made there's nothing better than getting support than if you're successful and if we do that in the next one to three years I believe and having watched the history of Garvey's development and the amazing contribution it's made then the world will really get behind and back it so I think the biggest most important thing to do is focus on what it's setting out to achieve transparently and delivering on that and the greatest risk the greatest risk is to do what we did after SARS and that's to forget it and move on but the metric if the metric of success is to find to bring vaccines for these three pathogens that you've identified those pathogens haven't been hopefully will not be the basis of the next epidemic so it will still be preventative it will still be insurance how will you ensure that you maintain the political momentum to say this is really something we need to keep pushing for when your output is hopefully something that will never be used can I start that's where I have this special interest in the combination of this towards the whole change of antibiotics now because we need more vaccines because antibiotics will not function in the same way in the future and you know the British government made an estimate that in 2040-50 there will be more people dying because of antibiotics that are not functioning and of the all diseases and there are people dying of cancer so this is an agenda that will move forward because it interlinks between if you get the flu yes you can do a lot of work and you can work on antibiotics to make sure that people are getting cured but a lot of people will die if you have more resistance resistance than antibiotics I think we have to see that this fits into also this big agenda that you have discussed that summits in September and which is going to be an increasing big problem for us Jeremy you will but one thing that this doesn't directly address is bioterrorism intentionally caused epidemics and so the broader agenda for governments is going to have to include that and I'll be at the Munich Security Conference next month and this idea that some of these investments that are made for the diseases that are already out there the likely case of epidemics and what preparedness would look like for the intentionally caused things that needs to be discussed it's very hard to rate the probability of bioterrorism but the potential damage is very, very huge and SEPI appropriately is not in that space we've got very finite resources but some of the governments that are in and some that are not in I'm hoping over the next few years there's some substantial investments SEPI will catalyze that in part even though it's not in that space itself it will help frame and catalyze and some of these platforms are exactly what you would do if your only goal was to create some protection there these platforms are very helpful so the two things relate but we do not say this is a solution for that Jeremy you wanted to add some what is also critical is and SEPI has a crucial role in this and that is to maintain the sense of urgency and be a focal point for some of these discussions and as the World Health Organization is strengthening its epidemic preparedness as the World Bank is playing an increasing role to ensure that financing as GAVI is involved these players have all been part of this SEPI initiative so if we move on after the horrors of what we went through in Ebola then that would be the greatest mistake I think this is the chance having had numerous warnings over the last 12 years and the coming together of many people in this room and around this plenary now I think this is the moment to change things and the commitment from Norwegian Government Gates Foundation, industry well contrast etc has been staggering One question that may seem to go back to the beginning of our discussion but it's one that I think is important is how do you and you've all come together and it's extraordinarily impressive how do you actually decide which pathogen you're going to go take first when you had that discussion around there you've got limited resources Andrew how do you choose them? Well what SEPI does is rely on an independent scientific advisory board so it's really important to understand that this isn't the vaccine companies cooking up in a corner with Jeremy and Bill let's do what we can do this is coming much more from an independent scientific advisory group who look at the potential threats look at the likelihoods look at the various pathogens which are out there and starts to prioritise those then essentially what SEPI will do is issue requests to the world essentially you don't have to be a member of SEPI but essentially to say to people you've got research capacity in these fields have you got technology capability which could be put to bear on MERS or on NEPA or on LASA or whatever it is and then that's what starts to populate the knowledge base and the research capability and hopefully we see some significant progress and I think a lot of really good work was done at the very beginning of this to make sure that there was a really strong independence created around the scientific decision making and prioritisation setting and as the last set of questions that I'm going to ask each of you I'd like you to look forward and do a little bit of prediction in slightly different ways each and Andrew I'm going to start with you if we meet again this time next year what will you hope SEPI has achieved? In one year I think in one year that we would have successfully initiated on at least one if not two pathogens that we would have life wouldn't be perfect but we would have got into a rhythm of learning very quickly so I think we have to be realistic on the things I like about SEPI is we haven't waited for perfection before we've begun everybody's gone into this with a sense of optimism but taking a bit of risk we're all putting our business models a little bit in play here and that's required so we need to learn as we go through this year what I hope a year from today we've got work in progress on one or two pathogens that we're feeling like we're making progress that we're feeling like we're building scientific synergy somehow in the program and we're beginning to spin off challenges to organizations functions outside of SEPI that others have to start responding to and they indeed start responding because they believe there's some credibility around SEPI. That's a very concrete to-do list Bill Gates I'm going to ask you to look a little further ahead in the crystal ball five years Well with any luck in a five year time frame the initial two or three projects would have had success that is we see the correlates that we hope to see and in many cases we will have chosen to stockpile those things and so we will really be ready particularly if we do complementary work on a diagnostic and we improve these surveillance networks we will be far more ready than we are today and Mr President I'm not going to ask you to cast look ahead too far but what is for you the most concrete contribution that SEPI will make in let's say a two to three year framework? We have possibilities now we are looking at the possibilities for research in Africa working with SEPI and African governments hopefully we can move forward and see vaccinations no longer rely on foreign laboratories but on African laboratories who can then produce those vaccines and we believe that that can be a very positive contribution over the next two to three years Thank you Jeremy, I'm going to ask you about the financial side how big does SEPI need to be? 700 million now, what does it need to be? I'm happy with 700 million but if anybody wants to contribute they're very welcome a number of governments and other agencies I think 700 million is an enormous starting point and I think with the focus that we are going to bring in the next few years that should be able to deliver the initial mission and I believe that with the success of that then like with Gavi like with Medicines for Malaria then success will demand future success and more financial resources will come but I think we've made a phenomenal start Prime Minister, the last word is yours what are your expectations? Well, my expectation is very simple we have to be prepared for the next epidemic and the next one after that and the next one after that because they are coming and we might hope that we will manage to stop it from coming but we have more people the nature is playing with us sometimes too so it changes and so we have to be prepared for the next epidemic and the next one after that changes and so we just have to be prepared and I think this is as I said in my early statement the economic consequences are as devastating for those who are hit as worse and conflicts are the human suffering as we saw is immensely and it should be therefore absolutely not just the countries that are standing behind it now it should be more countries more organisations more focus in the future on the older sides of how epidemic awareness should be better. Thank you, the stakes are enormously high but this is a very big step forward with that our conversation I'm afraid has to come to an end but I would like to call on to the stage all of the other founding members of CEPI there were more than the five panellists here for a team photo to mark this occasion so if you would thank our panellists for the conversation and those of you come up thank you.