 Okay, well, let me start by thanking the organizers from this conference. It's, as Suri mentioned, it really is a great room. A lot of people whose work I've read for a long time, so it's nice to have a chance to meet in person. I'm gonna also talk about a specific problem on access to medicine, specifically the challenge of addressing pandemic preparedness through medical R&D. In some ways, it looks a lot like other neglected disease problems that we've talked about today and that there isn't sufficient commercial incentives to do the R&D development and delivery of these technologies. In other ways, it's different, in part because it's unpredictable. The reality is, if you convene a panel to look at priority pathogens five years ago, nobody would have picked Ebola. Nobody would have picked Zika. Ebola killed 2,000 people in 40 years. Since its discovery, that's very low. Zika, in terms of what people knew about the health burden it caused, is nothing like what we're learning today from its spread. So that's one way it's different. The other way it's different is the emergency context. How do you ensure access in emergency when there's incentives for suppliers to supply their own national market? What I'm gonna talk about today draws from a recent paper I did with Steve Davis, who is the CEO and president of PATH. All right, so as was mentioned before, the world is changing in ways that is conducive to the spread of infectious disease, population growth, urbanization, climate change, trade travel, increasing trade travel and migration has created an environment that is much more conducive to the spread of disease. Ebola and Zika have had a terrible impact. Diseases that are more lethal, and let's be honest, most infectious diseases are more lethal and many infectious diseases are more lethal and easily spread could do a lot worse. We need investments in many things to address this problem. We need investments to build health systems. We need investments in adequately trained workers. We need investments in labs. We need investments in a multilateral health institution like the WHO that has the ability to coordinate and effectively respond to dangerous disease events. Unfortunately, we have needed all these things for a long time and we have had multiple outbreaks recently or multiple epidemics recently from SARS to H1N1 to H5N1 and each time we convene together we talk about all that needs to change, how WHO needs to be reformed, what the funding requirements will be, what we need to do as a global health community and by and large, we have not been willing to undertake the legal, the financial, the government's changes to make that happen. Particularly in that context, medical R&D is going to be important. It's important because point of care diagnostics, vaccines can help control outbreaks before they become epidemics. It's important because you need medical personnel and volunteers to have sustained engagements amid an outbreak and having the availability of treatment and diagnostics is important to that. It's, of course, important to prevention. During my time in South Africa, 2000, 2002, one of the big reasons why access to medicines was so important in that context is there wasn't any incentive to know your HIV status unless there was the possibility of treatment. So it's important for that. It's also important because in areas where you have limited health systems, it's difficult to deliver the quality of care you can in other settings. So the health outcome from a disease may be significantly worse. The case fatality rate for Ebola in West Africa was 74%. Outside of West Africa was only 12.5%. And that's because of the difficulties of giving adequate hydration and medical care in those settings. So it's important for that. How have we done, though, in responding with medical R&Ds amid outbreaks? Not so great. It's been more than two years since the Ebola outbreak. There have been more than a dozen drug and vaccine candidates, hundreds of millions of dollars was spent. Many of it by companies voluntarily, I mean all of it voluntarily, but many of it by the companies themselves. There has been no drug or vaccine submitted for regulatory approval in that time. It's been a year since we've discovered the association between Zika and birth defects and we're not doing much better in that case. There is no clear vaccine candidate. There is not a effective diagnostic either. How can we do better? We can do better by establishing means of trying to coordinate this activity. So we do not have another cycle of wasted resources and scrambled investment. What do we need to coordinate? You need to see more coordination of the upstream R&D of medical tools. This is especially true for vaccine platform technologies. The reality is we're never going to guess what is next. It's important to develop the vaccine platform technologies that can be used to respond to different pathogens. It's important to have point of care diagnostics that can be used in low resource settings, particularly for what we at least can guess might be the priority pathogens. It's also important that we have more coordination of downstream testing, manufacturing, delivery as part of a humanitarian response during an outbreak. It is quite possible that these two coordination functions need to be governed separately. One can easily imagine the R&D, upstream R&D being a network tied to a fund, a loosely governed network time to fund. But in terms of having the authority to work with low and middle income country governments around testing and manufacturing and delivery, you need an institution that has the mandate and the authority to do that. To do that, we should look at lessons though that we already know from the past decade of heavy investment in technologies to address the needs of the world's poorest and low and middle income countries. And there has been a lot of investment. There's, in terms of R&D for neglected disease from 2000 to 2015 has increased 34 fold. So we had a significant increase. So lesson number one of what we need to see is we need to see more of an adequate and sustained investment to produce that. Now, it's currently $3.4 billion, which doesn't sound like a lot and isn't. It isn't a lot to address the health needs that disproportionately affect 5.7 billion people. It's not a lot even in terms of global health aid. It's 1% of global health aid. But it has made a big difference in this environment. How has it made a difference? Well, right now we have 360 different drug vaccine, contraceptive, diagnostic candidates in development from that funding. There have been 45 global health products that were registered as a result of this funding. So it has made a difference around that. Some of them have been very impactful. The vaccine for meningitis A, the Menafovac vaccine has been delivered to 230 million people at 50 cents per dose and has saved tens of thousands of lives. So that is a good example. But the second thing we need to see is more coordination of R&D and a roadmap of priority goals because it has had this rush to spur more development for neglected diseases has had some major hiccups. And one of them was that to build on Kevin's comment before about thinking about access beforehand, there was a very large rush to form product development partnerships to develop candidates without a lot of thinking of how the late stage funding of these candidates would occur and how they would actually reach market. That led to a significant transition period in global health where there was a lot of products and PDPs weeded out of the market for that. So avoiding that transition period would be important. Another lesson that was learned from the last decade in global health is having a better geographic distribution of multi-sector partners. We talk a lot about working with multinational pharmaceutical companies which is important and they've played a huge role in global health. But what you increasingly see in global health is a focus on low and middle income country emerging manufacturers that often have better cost structures and better ability to respond to their own domestic markets. This is also important in the context of pandemic preparedness because as I mentioned, amid an emergency outbreak, it's hard to give everybody in the system confidence that they will have ability to access vaccines. And if all the vaccines are produced simply in high income countries, there's not a lot of confidence in low and middle income countries that this would occur, thank you. And people will remember the H1N1 outbreak where Indonesia was reluctant to share its influenza samples without some greater guarantee that they would receive the benefits from that. Having a more distributed manufacturing system can play a large role in that. To do that though, you need to have that manufacturing base used. So there's a lot of thinking currently about how to develop a warm manufacturing base and what you would use them for prior to an outbreak occurring so that it would be ready, should one occur. And there's also the issue of how to negotiate the necessary contractual arrangements in advance. The fourth area, and to be honest with you, this I think was probably the most painful lesson of the last decade in global health was the initial lack of investment in systems. There was a view that we would have catalytic investments in technology and that the countries, this ties to the keynote speakers remarks as well, but that the countries themselves would develop the regulatory systems or the health systems to support the delivery of these products and it would all somehow work out. And this draws from work that I did at the Center for Global Development as part of a working group, I'm sorry that for some reason the caption at the bottom has gotten compressed, but it shows where the vaccine trials for neglected diseases were occurring. And what you see not surprisingly on the right hand side or the trials that are happening in high income settings and the left hand side of the trials that are occurring in lower middle income settings, Africa being the largest. Now the challenge in this context of course is many of the countries that were hosting these trials had never seen a novel vaccine trial. There was no need for them because sadly people weren't developing products for use in those settings, but as you move to later stage clinical development it's important to do these things. It's not just on clinical trials, you have the same challenges around registration, you have the same challenges around post-market safety surveillance and there are similar projects that have gone on in all those spaces. In the initial years of global health there was very little investment in this area that is starting to change and will be very important to support in the context of pandemic preparedness. The second part of that of course and this to be honest in the neglected disease context has been somewhat less of a challenge is how to design equitable access systems. We're obviously here to talk about access to medicines and IP management has played a large role in this. Part of the difference around neglected diseases of course these are by and large diseases for which there is no commercial market and that creates a different context around this. But two different approaches, standard approaches that I've been involved in through my work at the Gates Foundation is one is looking at use of access principles. So IP management and global health and the funder typically sets up the standards and milestones, IP stays with the grant and it's one of these non-exclusable sub-license licenses that we've talked about here. The second is collaborations that you can have tied to a pool of funding where all the members of that collaboration agree to standard material sharing agreements, shared data and their access commitments that provide that. That would be useful in this space as well and something we should look at. Let me pause there.