 Are we able to draw the lessons from the pandemic in terms of prevention, preparedness, in terms also of addressing a major failure of all of us during the crisis, which has been the unequal, dramatically unequal access to vaccines across the world? That's the topic that Elstorelle, who is a fellow with the Institute of Innovation and Public Purpose at University College London will now address. May I just ask all our speakers to stick to their time as we are already a little late on the programme. Else, the floor is yours and thank you. Thank you Michelle for the kind introduction and for the good wishes. I have recovered. Meanwhile, I was just confirmed myself testing negative this morning, but unfortunately I couldn't travel to be with you. And yes, what I will talk about in the next 10 minutes is really looking back to the COVID response. I think in addition to all the non-pharmaceutical interventions that Antoine Eloquenty talked about, I think one major success to it, which is our collective scientific community came together and in a record time was able to create and produce effective vaccines that have dramatically limited the risk of severe disease and that's during COVID. We were also lucky. We have to admit that the bet that scientists made that this famous spike protein would indeed be able to elicit an adequate immune response paid off. And also several of the existing vaccine technology platforms from the classic attenuated viruses to these newer viral vector platforms and especially at the meanwhile famous messenger RNA, MRNA platform, they could rapidly be adapted to these new virus and this was not just luck. This was also the result of massive investments, public and taxpayers investments into research and development over many years and then of course massive investments during the response. However, as indicated already by Michelle, the main failure of our collective COVID response has been that large parts of the world were precluded from the timely and equitable access to these life-saving vaccines that would have been able to avoid many more deaths and probably would also have been much more effective in controlling the pandemic and just to remind you that 15 months after the vaccines became available mainly in high income countries and where even persons with very low risks of getting ill including children were being vaccinated most countries in Africa had not been able to vaccinate even their healthcare workers that were at the first line and at high risk of getting ill or the most vulnerable populations and as you know the risk of dying increases significantly with age and with co-infections of comorbidities and so those people because that is what equity means, right? Equity means that those who need it most those at the highest risk of getting ill should be prioritized and that is not at all what we did and that was at the extreme inequity that Dr. Tedros, the director of the World Health Organization referred to as vaccine apartheid that is really what happened. So are we ready for the next pandemic to do better in terms of vaccine equity or countermeasure equity because it's not just vaccines it's also access to diagnostics and treatments. Now in order to respond to that we need to understand why we ended there and there are many factors that contributed the initial scarcity led to hoarding and vaccine nationalism with countries buying up all the stocks of these newly produced vaccines were able again to vaccinate their whole population even multiple times while other countries were recruited to even buy vaccines for their health workers but also a very important reason was that a handful of companies held monopolies on the science and technology and therefore controlled the production and availability of these vaccines and were able to actually decide how much to produce when to whom to sell and at what price while wielding monopoly power to control markets and maximize revenues maybe normal business practice in many economic sectors but here we're talking life-saving vaccines developed moreover with massive public investments and we're in the biggest health crisis of our lifetime and so while it was astounding that many normal business practices were interrupted or dramatically changed think about log downs we've never done such a dramatic intervention in our economy somehow the powers that we didn't think that it was needed to do something about the pharmaceutical business ecosystem and trusting that the market mechanisms could be relied upon to deliver and so we know how that ended now we have to acknowledge that some vaccine producers AstraZeneca together with Oxford vaccine and some Chinese producers did enable some local production in a few countries but this was largely insufficient it was too little too late to really supply the world and many producers that were trying to obtain such licenses were refused and very importantly the producers of the mRNA vaccines that became very quickly the preferred option in many countries they totally refused to share their technology instead doubling down on scaling of their own production capabilities and this was even more dramatic because one of the key advantages of this novel technology that it's actually relatively easy to produce as compared to traditional vaccines it's also very suitable for this centralized medium scale production and they can quickly be adapted to new variants but both Moderna and Pfizer and Biotech chose to keep tight control of their technology so what is it that we must do differently the first is to really have a change of perspectives life-saving health technologies especially in times of pandemics cannot be viewed as private commercial goods this should first of all be considered as essential public health tools instruments for public policy and that's not a technical issue that is really a political choice and it means also that policymakers must be able to use these tools and implement such policies as they see fit to control the pandemic and in wealthy countries the market-based pharmaceutical ecosystem may be able to deliver and that's clearly what most western policymakers think but as we have seen that doesn't deliver for the rest of the world and so governments in other parts of the world were not able to use these tools to implement the best public health response they couldn't buy and they couldn't produce so what can we do to ensure that countries in the global side and we're talking actually about a majority of the world population let's be clear can do differently to secure the health of their populations well what they say is we do no longer want to be recipients and beggars we actually want to be part of the solutions to contribute as full participants to the research and development of diagnostics, vaccines and treatments and to be able to respond to epidemic outbreaks when and where they occur not waiting until it is a pandemic but actually or waiting until western pharmaceutical business models develop the products that we can use to stop outbreaks when and where they occur and so for that what they need is access to the technologies and the know-how for health innovation and the freedom to do research and produce without any constraints such as intellectual property rights which again are a policy tool they're not a natural right and also need access to of course the capital to build and sustain the needed infrastructure for instance through regional R&D hubs and of course all of this that it needs to be considered as common goods for health not private commodities for business because we're talking about the biggest life health crisis in our lifetime and maybe future ones and so you all know the saying give a person a fish and they will eat today teach them how to fish and especially allow them to fish in the collective knowledge point and they will actually be able to take care of themselves and because that's actually what we do today we stop them from actually using the knowledge and technology to develop their own solutions and again this is a political choice that we have done and we know in military there is this concept of technological arms race and you don't want to share your technology but it's a mistake and actually we do it too often to compare health security with military security and it's a mistake to use that language and that thinking and that narrative for global public health health threats are very different advantages in health technologies in one country do not translate in health security no one is safe until everybody is safe against epidemic threats we all know that viruses and other pathogens they cannot be contained by borders and that's why it's so critical that more countries and regions are allowed to and empowered to be part of that health innovation ecosystem not as competitors in a global market but as contributors to global health security that can be viewed as a global common good and so that is the essence in essence the type of transformational change we need for true preparedness and that will allow to put equity at its heart as demanded today by many global countries for instance in the discussions about the pandemic treaty that is what they want to be allowed to establish maybe a parallel ecosystem in other parts of the world we don't we can if the western world says we want to continue how we do it fine but can we create space such that in other parts of the world there can be different ways of addressing that and this is not your topic for today for instance there is an initiative driven by the World Health Organization in which a hub for mRNA technology has been created in South Africa and where this technology is being shared with researchers and developers and companies in 15 other middle income countries such that they can actually develop their own mRNA based health vaccines and other maybe treatments to protect themselves against the health threats that they are facing we also I will ask you to come to the conclusion sorry yes sorry Michelle as you know I tend to be a little bit long winding because this is such an important topic maybe just one final thing to say is that quite often what we hear today is that there is investments in local manufacturing capacity now that will not by itself create the equity we need what we need is to actually share the knowledge and technology such that developers and researchers in the global side are no longer dependent on the charity response of the global north and that they actually can develop the solutions they need for their own health needs and so one final line health security cannot be gained by technological competition and business as usual it's not a war against each other for technological dominance it actually requires collaboration and sharing because we are all in this together against the virus thank you thank you very much Elz