 Welcome everyone and thank you for joining us at the World Economic Forum as we discuss how to meet the challenge of vaccine equity. First and foremost, I would love to hear from you are encouraged to ask questions via social media. You can use the hashtag Davos agenda. You can also use the Slido QR code which should be visible on your screen. If you just slide your camera phone over that, follow the link to this panel and you can ask your questions. We would love to hear from you. First and foremost, I think we can all agree. Science, vaccines save many lives in 2021. What's more, according to the World Health Organization, we can end the pandemic this year and we should even have enough vaccines to vaccinate all those who want one by the middle of 2022, that's according to the IFPMA. The problem is at the current weight, we are nowhere near that. This far into the pandemic, one year into vaccine delivery, caseloads are soaring around the world, we're threatened by new variants, putting economies under pressure once again. And while some nations are giving out fourth vaccine doses, three quarters of healthcare workers in Africa are yet to receive one. We need to understand why and we also need to understand how to do better and how we fix this. I have the best panel to help us address this. We are joined by the Deputy Director, Director General of the World Health Organization, Dr. Mike Ryan. The CEO of Gavirid Vaccine Alliance, Dr. Seth Berkley. The CEO of the Serum Institute of India, Arapunawala. The Director of the African CDC, the Centers for Disease Control, John McKengesong. And the Executive Director of Oxfam International, Gabriella Boucher. My panel, welcome. Mike, I want you to set the scene for us. The WHO has described vaccine inequality as the biggest failure of 2021. And now you're campaigning to get 70% of every nation in the world vaccinated by mid-2022. Where are we? It feels like we have a lot of work to do. Yes, we do and it's fantastic and honored to be amongst such a wonderful group. Yeah, it is. I mean, right now, over half the world's, if we look at the population of the world in total, over half of the world's population has received two doses of vaccine. But if we look at in Africa and our African regional office states, only 7%. So the reality is that the world is moving towards the 70%. Well, the problem is we are leaving huge swades of the world behind. So it's not a matter, are we in the race? Yes, as a global population, science, innovation has worked. But our ability to distribute those vaccines equitably, both in terms of protecting the most vulnerable everywhere, but also in giving us the best chance to end the public health emergency. Because at the end of the day, this virus will continue to transmit. This virus will be around for a very long time. What we need to do is end the public health emergency. We can end the public health emergency if we end the hospitalizations, if we end the debts, and if we reduce transmission to a minimum level. We can do that using vaccines and other measures, but vaccines are absolutely central. There is no way out of this pandemic right now without vaccines as the central strategic pillar. And being able to use those vaccines equitably is not only a fair and important humanitarian objective. It is the best way for us all to get out of the pandemic phase that we're currently in right now. Yeah, and the vaccine vacuum, I think, as you described it in parts of the world, puts the entire world at risk. We're all at risk here. Seth, come in, because you've just announced, your COVAX has announced that they've delivered their one billionth dose, which is incredible. And I know vaccine productivity and the supply accelerated, particularly in the month of December, into January, but it's way off target from where we hope to be. Are the challenges of 2021 the same challenges in 2022, be it supplies, be it logistics, be it money? So thanks, Julia, and I'll agree with Mike, a great panel to take this on. First of all, we are actually not behind. We actually hit the milestone we originally had set, which was 950 million doses to AMC countries by the end of 2021. But that target was set at a time when we didn't know if any of the vaccines were gonna work. And we've been lucky that science has really delivered here. Now, in terms of getting vaccines out, the first vaccine went to a developing country 39 days after the first vaccine in a high-income country. That's never been done before. But then we hit barrier after barrier. We had export bans. We had vaccine nationalisms. We had companies not meeting their requirements to put doses forth. And so what we've had to do is solve each of those problems, raise the money to purchase doses, and ultimately to ask for dose donations, which were not part of the original mandate. With that, we were able to get this back on track. And now you're seeing an accelerated drive towards getting vaccines out. We expect right now the next billion to take somewhere between four and five months versus a year. And so we're on our way. Now, the new challenge that is here is making sure that every country is ready to receive them. Countries have tripled their absorption capacity. That's great. But there's 20 to 25 countries that have problems with absorption. And with this, us with our partners like the AU and AVAT and PAHO and others have been working to try to make sure that we can create bespoke plans for these countries to help them with their absorption capacity. Gabriela, come in here because Richard Hashtaget, who was speaking yesterday, he's the Coalition for Epidemic Preparedness, CEPI. He was saying, it's the last mile is the challenge in 2022, whereas supply was the challenge in 2021. And that's almost what we're hearing. There's a difference between delivering vaccine doses and actually getting them in people's arms, which is a huge challenge too. From your experience, Gabriela. Well, thanks very much, Julia. And I'm very pleased to be on this panel. And I have to reiterate, looking back on Web's panels last year, of course, at the time, it was a moment when we were celebrating the fact that science had managed to create this vaccine at such speed and also the investment of some of the rich governments around 100 billion was invested in accelerating all that process of getting vaccines out and there was a lot of hope. But of course, in this meantime, we have seen that in fact, there has been significant vaccine inequality. And as we launched our report yesterday, inequality kills. And of course, this vaccine inequality demonstrates it's more than anything else. So differences between countries have grown beyond what was seen before. So in this generation, we hadn't seen inequality grow between countries. And we know that at the moment, inequality is a higher predictor of COVID death than age. And that is from a survey done by The Economist magazine. So that demonstrates that we could have actually prevented many of those deaths. We have 5.5 million deaths. And if we had had a different system of approaching this from the beginning, things would have changed. So there were some errors of judgment from the leaders mostly in the rich world. So vaccine nationalism that was mentioned by Seth was one of them. So hoarding vaccines for themselves from the beginning and leaving other countries to the back of the queue over and over again because boosters when they're needed. And so they jumped again to the front. So this has created that. And then of course, protecting those monopolies that pharmaceutical companies have over the vaccines, which has meant that it's a laborious process to get those vaccines out where there could have been a much more immediate way by lifting intellectual property rights from the beginning and allowing vaccines to be produced at scale across the world. That would have been a game changer. And we would have avoided not only deaths directly from COVID, but all the deaths that have been associated with growing inequality and crippled health systems across the world. So it's really tragic. And that's the state in which we are when we could have foreseen possible solutions. And they mean really thinking differently about how to address this pandemic and any pandemic to come as well. You basically touched on everything we're going to discuss over the next 30 minutes in that answer there because there is much in there that we saw and we challenged by last year that we have to tackle and hope to do better this year. But on your point about monopolies, I think this was very important too and some of the other challenges. I'd have come in here because you are the biggest vaccine maker in the world by dose. You've partnered with some of the vaccine developers. You manufacture your own. You understand the challenges of distribution. You see both supply and demand. You've pointed in the past few weeks that actually you think it's more of a demand problem and you cited Africa specifically. Tell me what you see and what you're thinking at this moment. Well, you know, if you just rewind firstly, pleasure to talk to you, Julia and to be on this esteemed panel. If you just rewind a little bit to a year ago, we had committed about producing a billion doses a year. We've actually produced a billion and a half and actually had to stop production in December because we had 500 million in stock which meant that we produced 2 billion between January 21 and December 21. It was in October that I was sort of being a little vocal when I was celebrating the fact that the export restrictions had finally been lifted from India and in no way was I trying to call out or blame anyone. I was only trying to articulate and send the message out there that vaccine supply is no longer a constraint. And you know, the African continent that we've supplied vaccines to and supported over the last many decades, you know, we're ready to support you again. Please get in touch and you know, address the vaccine inequality issue wherever you have it and you know, here are the doses available for you. Now, they've done a tremendous job as Seth and everyone else has said in terms of increasing their absorption capability and that's happening as well. So we're gonna see a shift in the trends hopefully and probably supply a billion plus doses in the first quarter or two, you know, combined through COVAX to the African continent. So we're in a far different and better place than we were last year. Yes, and I didn't mean to make it sound acute or true. We all have to work together on this. John, we've spent some time talking about the continent. Please give me your take on this, whether it's the demand, whether it's the need, what more can be done to help? I think thank you for inviting me to be part of this panel and let me use the opportunity to wish all of you a very happy and less dramatic 2022. We hope that 2022 should be the year that we remember it as the year that brought this pandemic to an end. And 2022 is, as we move into 2022, it's three years into this pandemic. If we record a history of a similar pandemic 100 years ago, it took them maybe two years to clear that pandemic. And if you bring back the people that fought that pandemic 100 years ago, they will be amazed by the science. They will truly be tantalized by how speedy science has progressed and how much we could tackle this virus. They will also be very amazed and maybe very, very shameful of the fact that the amount of inequality and inequity that exists, even though science has made tremendous progress. So I think I really wish that we could go back to history and bring back some of those people and ask them their views of if they were here today, what they would do. So what we have seen over the last two years is a total collapse of a global cooperation and solidarity period. I think there's absolutely, absolutely no reason why a continent of Africa should be lagging behind with I'm having a 7% of the population fully immunized. A continent of 1.2 billion people is totally unacceptable. It's not a word that the humanity that we want to project. Yes, so I think that has to be underscored. We have to be optimistic in moving forward, but we have to record the past. A famous historian said, if you don't know where you are coming from, you really don't know where you are going to. I think that has to continue to guide us that the moral failures that we witnessed, we witnessed over the last two years, cannot repeat itself again in 2022. We remain optimistic in Africa that as a continent, we should strive to get to the 70% target, but we are around 10%. How do we get from 10% to 70%? We really have to bring all forces to bear, bring increase our global cooperation, partnership, solidarity and coordination to try to move from where we are to 70%. Recognizing that it is only through that massive efforts, coordinated efforts that we shall all be safe. We've seen what Omicron has done. I mean, Omicron and we all said this at the start that if we did not protect this and vaccinate at scale and at speed, even those who have been vaccinated will be challenged and we have seen what Omicron has done. We truly don't know what the next variant will look like and the only way to prevent other variants, challenging the global efforts and the advances that we have seen is to vaccinate at scale and at speed, including Africa. The question is how? Seth, come in here, because Liz, you had that and you have the greatest sense. There's a few things here, would... And if we tackle supply and we've suggested that the supply is there now, the question is, does it come down to demand? Does it come down to that last mile and getting it into people's arms? You also have a diverse range of vaccines available now and depending on where they're going, be it a city, be it a rural area, whatever country it is, you have specific vaccines that perhaps fit better locations geographically too. Does that help unlock some of the challenges? Do you think this... So thanks on that and first of all, I wanna say that we have to keep in mind the inter-country inequities that exist now as well. So it is absolutely true what John has said of the shame of not having a global response. The original plan we put out was to have every high-risk person in the world vaccinated at the same time, every health worker and then moving to low-risk people. And of course, that's not what happened. But we also have to keep in mind that some of the forces in wealthy countries that are actually making immunization be politicized there are spilling out into the rest of the world. So we're seeing more vaccine hesitancy, we're seeing more challenge. Now the good news is that in general, developing countries actually appreciate vaccines more because they see the diseases. And so the vaccine demand has always been higher and vaccine hesitancy has actually been lower, but it's more complicated at this point. Now, into your specific question, supply is better, but it's not finished yet. I think we'll still have rocky supply for the next six months or so. And I'm a little worried, frankly, if there are new variant vaccines that we might have an inequity 2.0. So we have to be careful that that doesn't happen. And we have to make sure that the supply chain stay open. What then has to happen is, as I said, there are some countries where absorption is not at the pace it needs to be. And that needs to be really bespoke programs to look at what are the problems solving those problems. And then there may be new problems. It may be political commitment in one place. It may be cold chain or supply chain or having enough vaccinators. And we need to solve those problems as we go forward. Last point is it is great that we have a portfolio of vaccines right now. Not every vaccine is as easy to use as others and therefore may not be appropriate. So if I think about a country that has challenges, a big country, maybe you wanna use your minus 80 degree vaccines that require special syringes in your capital city, in your teaching hospitals, maybe you wanna use a single dose in your unstable areas or in refugee camps and do it as a campaign. And maybe you want a work horse vaccine like Novavax, AstraZeneca, others in your rural areas where temperature stability and shelf life is really important. And so this is the type of conversation we have to have working with countries to make sure they have the right vaccine in the right place at the right time. Are those conversations being had? Yes, absolutely they are being had now, but not at the pace that we would like because initially this was a, we're so short of vaccines, we'll take any vaccine that comes and there was a scramble, there were vaccines that were sent with early shelf life, we're sorry, short shelf life there, we're small quantities, we're now in a different place where we have the luxury to plan and I have confidence in developing countries because even the poorest developing country has high vaccination rates, is able to do campaigns, they've shown it over and over again. In fact, they're better prepared than wealthy countries. The issue is giving them the tools, the finance and the planning time to be able to roll these products out. Yeah, I mean, you said just before the end of the year, we need an extra 5.2 billion dollars of additional funding in the next three months if we hope to hit that 70% target. So that's the kind of numbers that we're talking about. Mike, come in here please. Would manufacturing hubs, patent sharing in certain locations? And I know Cape Town and John, I'll come back to you on this because you and I have talked about this a number of times. Would that help even today to have the vaccines in the right places whether we're tackling the additional supply that's going to be required, trust and hesitancy if it's manufactured in a country by the nation's own production facilities, does that make a difference in your mind? Mike? One of the most scarce commodities in this whole pandemic response has been trust, trust between communities and government, trust between countries, trust between manufacturers and businesses. Trust has been the missing magic dust that makes everything work in life in our society. I think we are faced with the next existential crisis as a race and as a civilization on this planet. What is very clear that the current mechanisms that are in place for the production of vaccines do not lead to the equitable distribution of these vaccines. We consider all night and we can discuss why that is, but that needs to be fixed because we can't go around one more time like this. We are, I mean, we have a tragedy on our hands, but we don't have an earth-killing virus. We have a virus that's killing millions of people. It's disrupting our hospitals, disrupting our society, but that's not necessarily the big one. There are other challenges down the line. And we, if we're looking at this for the future, we don't have a system fit for purpose. And we don't have a system that we have. If we have a system that can produce enough vaccine, then tell me why it's not with the people who need it. And therefore there is a great breach of trust. And I think many countries are looking now to say, okay, we need to strategically distribute that production capacity in a way that we can trust more in our likelihood of receiving vaccines from that at scale and more quickly. And I think it needs everything. We need to increase, sustain our ability to carry out surveillance of this virus. We need to beef up and sustain our clinical care. We need to focus on vaccine production, delivery right down to the last mile. And we need to do all of those things. So yes, we need to get involved in creating these technology transfer hubs. We need to have a multi-layered approach to this problem. Too much in this response, Julia, we've had the unicorn hunters and the silver bullet hunters of everyone looking for the single solution. In my experience in public health, there rarely is a single solution. Most complex problems in life require change at all levels. They require looking at every element of the system and defining what you need to do. Therefore sometimes you don't need a massive change in the system, what you need is targeted change in the way business is done to make the system fit for purpose. Right now it's very clear. We do not have a multilateral global system that is fit for purpose in dealing with what our global existential threats to our lives, to our societies and to our economies. And it is the responsibility of the multilateral sector, the public and private sector to come together and make the changes needed to make our system fit for purpose. Everyone has a stake in that. Everyone is a partner, nobody is a master. And we've been too long discussing this issue around who's in charge. Everybody's in charge because everybody's at risk. So we need a multilateral transnational solution with public-private engagement to find a robust mechanism and a robust means not only to finish this pandemic, because what we come out of this pandemic will be what we take into the next one. And therefore the lessons we learn now will define our performance in the next pandemic. There's no point saying let's finish this one and we will see then what we do over the next 10 years. That's not the way it works. I'm doing this for the last 30 years. What you've learned at the end of the last one is usually what you take into the next one. That's the reality of life because the world will move on to the next priority, the next crisis. So we also have a responsibility to come out of this pandemic with the skills and infrastructure that we need for the next one. That's our best chance of being ready. John, I want you to come in here because you laid out the big picture and the failures, I think, but I need you to be specific about why more Africans at this stage, if some of the supplies are there and we can even use South Africa as an example because I know they've had the supplies and they still have less than 25% of their country vaccinated. What specifically is required? Is it help with logistics? Is it money? Or would it in fact help if you could manufacture those vaccines on the continent? Would that help with some of the skepticism that's being faced all around the world? But as we all recognize, I think, and you and I have talked about, John, before it is faced on the continent, too. So, no, thank you. I'll come back to that, but let me pick up on where Mike ended up about learning from this pandemic and taking the lessons to the next pandemic, you know. And because of the trust capital, what the diminishing effect of the trust capital, people have become cynical. And to the extent that we believe that we may not actually learn anything from this pandemic that will take us to the next pandemic just because of the way we have conducted ourselves. I think behavior, in addition to the trust capital, the behavior, our behavior at multiple levels have actually created cynicism where you really think that we may document lessons but not actually learn lessons to take it to the future. I mean, the Ebola outbreak, if you take those Ebola outbreak reports that were reaching in 2016, you just need to Google, do search and replace Ebola and COVID-19, you get a report, okay? You get a report ready to be submitted anyway to characterize all what we need to fight the next pandemic. So, with respect to what are we doing, what should we do at the continent? I think, as Seth mentioned this as well, we need better coordination. We need to look at this as a program. I think now that vaccines are beginning to come to the continent in a more predictable manner, let's sit down and set up some very specific targets and say, how do we get to 70%? You don't get to 70% by jumping from 10 to 70, but you set some very specific targets. Say this quarter, what do we need to do? And we build a coalition of partnerships that will enable us to get there. What the limitations that a continent is having is mainly a challenge of logistics, okay? And Seth mentioned that vaccine hesitancy, study after study, including our studies is showing that 80% of the populations are ready to take vaccines if the vaccines are available. Studies after studies, I think no one can dispute that, including one published in Nature Medicine. We just published one ourselves recently, the World Bank, so there's no doubt about that. The key is what are the logistic challenges that we need to work on? We are engaging, I just had a meeting last week with colleagues from USAID and said, look, let's work together. Seth and I, we all have our teams working in Morocco and Rwanda building coalitions that can actually go in country and do that. We need more of such coordination so that we can do their delivery in a more systematic way and set short-term targets and achieve them. Why don't we say at the end of March, we should be able to show, demonstrate that we've arrived at 40% of the vaccination. If we do that by March then, we know that we are on our way, right, to get into 70% by June or July. But without such targets, aggressive targets and working together in a coordinated way, I don't think we are going together. Yeah, and I think there's a chicken and egg problem here as well to get back to out of your point about perhaps the demand versus supply. You don't want to ask for the vaccines if you don't have a logistics in place to get them in people's arms or you end up with vaccines that are very close to expiring and you have to throw them away and they're too precious and too expensive for that. And I come in here, please, of everything that you've heard. What do you see as some way to getting a solution? Because you have years and years and years of experience of providing vaccines for the world, for other diseases. So, you know, I'd just like to add to what Mike and John and Seth have mentioned, that if you were to look at the lessons we've learned in the last 18 months, the only way, and I agree with Mike, there's no silver bullet or there's no magic solution, but there's a multiple number of things we can put in place for the future. And I think if you look at getting governments to sign agreements and coming together, I don't know through the WTO or wherever else, to address a couple of issues. For example, export restrictions. To what extent can a country restrict exports, you know, irrespective of their population? Because we're all in this together. That would be one point, you know, which would help going forward. You know, if we were to develop new vaccines, have another situation like this, you know, in the meanwhile, I know we're trying to set up manufacturing hubs, and I hope we succeed doing something on the African continent as well. So they have their local manufacturing, but in the meanwhile, whilst we're still dependent on a number of limited manufacturers across the globe, you need export restriction, bans to be addressed by governments. And I mean all governments. I'm talking about vaccine, you know, trials and CMP, GMP standards being regularized, where, you know, we all agree that this is one standard of clinical trials and other things that we follow, which perhaps the WHO, for example, would take the lead and everyone else would have to follow that. And I give that example because, you know, there were so many different trials being done for different vaccines. And you talk about trust being misplaced and lost with the public, with all these different trials, different efficacy, oh my gosh, this, that and the other. You know, naturally to a layman or a public, you would be confused, is this vaccine good? Is that vaccine good? What we saw happening is that everyone said, oh, we only want this vaccine. Oh, we only want this vaccine. All that needs to be addressed going forward also. So one harmonized regulatory framework for pandemic level, you know, development of vaccines as far as clinical trials and other regulatory, you know, licenses are concerned. Thirdly, for example, you know, you saw this business about vaccine certificates. Some vaccines were approved, some were not. Even today you have that, you know, disparity. So causing huge trauma to people who've suffered and now when they wanna travel for work or pleasure, they can't do that. So, you know, if we have one harmonized version of all of this, which countries come together and agree upon in the future, this would be a way of addressing and learning from the lessons so we don't make the same mistakes again going forward. I think some of those things we could tackle now as we head towards trying to produce vaccines for variants as well. Because as Seth pointed out earlier on the panel, we're at risk of inequality mark two as we try to fight variants if we don't address getting vaccines to the whole world. But before we move on to that, because I do want to talk about that, Gabriella, you were nodding during that as well. And you raised a very important point about monopolies earlier on, whether that was nations hoarding the export controls that we saw around the world. And I want to ask about price too. What's your sense of price? Is price part of the reason why we see inequality around the world and pecking order as far as nation states, COVAX, for example, or anyone else? Is that a worry based on what you're saying, Gabriella? Well, thanks very much for raising the question in that way because yes, I was reflecting as a fellow panelists were speaking, we're not talking about that market logic that is at the center of what we're discussing here. So that's not being questioned, that there's a cost and pharmaceutical companies are setting those prices and different countries are paying them. And as a result, there are new billionaires in the pharmaceutical sector, CEOs and shareholders of Moderna or Pfizer and others. There's different ways and different pharma companies have shown different approaches. So some of the COVID vaccines are being sold at cost. And there could be a way of coordinating. So that word that was used by John and Michael, however we coordinate differently, but coordinating would require us to think of a vaccine that is there to enable the end of the pandemic, not there to fuel further profit and further hoarding as it is currently. So there is no need to continue within that logic because in fact it is self-defeating for all. And this issue of the trust deficit that has been mentioned in this panel is a problem now, it's a problem for the addressing of this urgent challenge that we have, but it may be a very long-term consequence that we really need to address. So there's huge urgency and there are several mechanisms to ensure that we have a much more collaborative approach that really addresses ending the pandemic, ending the cycle of inequality that is causing and that includes collaboration and World Health Organization has set up those hubs that enable collaboration, but most pharma companies are not inclined to participate at the moment. And we see that they're holding power that is beyond the power that some national leaders have. So we need to question that we want to continue supporting a system that puts profits first instead of people's lives. And we believe that can be addressed by really comprehensively listing intellectual property restrictions that currently mean those monopolies are held by a few people. Yeah, I was gonna say certainly from the perspective and we heard from the Moderna CEO earlier this week on a panel in the World Economic Forum and I know that Moderna have said that they're not going to enforce those patents even if they're not participating directly in the hub that I know that opened up in Cape Town, but I do believe you're the person to respond to that. Some tough criticism there I think for the pharma industry, justified or not, we need to be better coordinated either way surely. Well, I think it's a balanced situation. See, from our angle, we've always been in the non-patented space working and providing vaccines at $2 and $3 a dose. I can certainly understand innovators backed by shareholders and innovation does come at a price. So we have to balance it in a way that you can still fund innovation and new development because without that, there's no progress on science, but of course it can be balanced in a manner that you don't just put profits ahead of lives and you come upon agreements where you can for say low income countries, out licensed products, which can be manufactured at a lower price with manufacturers in India, China, Korea, so many parts so that that way you can balance innovation and you get rewarded for it in the high price markets but then you offer it at a very low cost or at cost for the countries and nations which have very large populations and perhaps don't have the budgets to vaccinate everyone so that there's no inequality when it comes to saving one's life or protecting their lives. So I think that's a balance which everyone can strike even if you're a Pfizer, Moderna and others and I think they're doing that probably by donating doses and things like that that you've seen going on today. I don't know. I can't see anything. Go on. Yeah. So I mean, I think the interesting thing in this is it is in everybody's best incentive to get the right price and the reason that's important to understand in the routine vaccine market if you can have a set of tiered prices what it means is you maximize access and you maximize profit and of course that's what you're trying to do in an emergency situation like this it's much harder because obviously there are people who will pay anything for a vaccine and it makes it very, very difficult but if we look at the Serum Institute of India in this particular case they had two technology transfers that they were able to take and frankly perform as well if not better than the parent companies in producing it. Now, unfortunately they were sitting in a very large country that ended up with export bans but if you could be in a situation where you had a Serum Institute of India sitting in Singapore for example you could saturate the whole population in an engineering run or if you had two serums in Africa then what you've got is the ability to move production around as is necessary during a pandemic and Gavi's gone from having five manufacturers in 2000 to now 18 so we have seen an expansion of large capable manufacturers we don't need 200 but we need better geographic distribution of them and they have to be sustainable manufacturers that can pivot to a pandemic vaccine but not just for pandemics, that's critical. I want to, because I'm conscious of time I want to talk about fork doses and the risk as we've touched already upon the fact that we're trying to tackle inequality mark one and perhaps variant vaccines becomes inequality mark two as the rich nations try and protect their populations first with those should the countries now that are not yet doing fork doses but considering or third doses consider donating those to some of the poor nations this is a question for my audience and Mike I think it's a very valid one because at some point it feels like this year we have to decide whether we're vaccinating against a virus or we're vaccinating against severe disease and death and those two things are very different because otherwise we're constantly chasing new variants versus just preventing death and severe illness. Yeah, that's a good question, that's a fair question and I think Seth said it out in the beginning when COVAX was established between the partners the primary aim was to protect at the beginning that 10% most vulnerable people around the world it was around 10% that became 20% as we looked at a wider group the health workers, the most elderly people with underlying conditions that was the primary objective at the beginning was to take the death and hospitalization out of the pandemic by giving immediate protection to the most vulnerable everywhere at the same time we failed miserably in that and the history books will note that now we come to where we are now a slightly larger vaccine supply but still some constraints and we have choices to make there is no question in my mind we need to still focus on those most likely to do worst by getting exposed or re-exposed, infected or re-infected and that reality means that there are people living in high vaccine coverage countries who will require a third dose and that is beneficial to them if I'm an older person if I'm someone with an underlying condition it is very hard to, these equations are made should I give it to that person or should I give that? It doesn't matter what country you're in the most vulnerable should get the proper primary course of treatment of vaccines some of those vaccines require a third primary dose it's increasingly I think set becoming clear that we are looking at you know what we haven't really established Julia is we have a primary course of two doses but what as knowledge develops and as we see the way the immune system matures in response to either re-exposure or to an extra dose of vaccine we may end up in a future where the primary course of vaccination for a vulnerable person might be three or four doses they won't be called boosters it will be seen that you need three to four doses to develop that long lasting robust immunity that protects you from hospitalization and death over a prolonged period so from my perspective a vulnerable person living in an industrialized country who needs a third dose because they're very old and their immune system hasn't generated a response has an equity issue too because their chance of dying is high so we have to balance that but the reality is there are 85% of people on the African continent haven't received a single dose of vaccine yet vulnerable or not vulnerable so there are literally millions of people living in low income countries who are highly vulnerable who haven't received a single dose of vaccine now surely we can do both surely we can achieve both objectives we can begin to accelerate as John has advised to accelerate coverage starting with the most vulnerable in all countries specifically targeting and prioritizing low income countries and particularly those on the African continent and at the same time we can give the extra protection to those vulnerable people in industrialized countries who already have high background levels of vaccination I do not see these as opposing principles, Junior and I would hope as we move forward we look at these are two problems that have equal validity and both need to be solved and both need to be solved right now because both are having an impact on the death rates around the world Yeah, an extricably linked we have just a couple of minutes left but I do just want to give you all just a brief moment to wrap up and my final question is based on the challenges that we've presented but how far we've come and the brilliance of science and the dedication of people like yourselves so I thank you on behalf of those watching for all the efforts that you've put in and we were joking at the beginning of this panel how tired everybody is and I know the work will continue Do you believe that we end the pandemic this year? That we can end? We know we can but do we end the pandemic this year? You've got response and just two sentences if you can sum up for me Adam, you first please Well, I think the definition of what we call a pandemic today is evolving every day, isn't it? Every month I think as we see different variants of concern that might be milder as we see vaccination coverage going up and there will be a point I mean, I'm not an expert but I think there will be a point where we reach a certain level of vaccine coverage everywhere and I hope that happens sooner than later based on the hospitalizations coming down I think we will have to make a shift and say at some point hopefully by end of this year that if you're double triple vaccinated and the hospitalization rates come down and deaths come down we can make that statement of course that's for the experts to decide that but I don't think that's outside of our grasp if all these things fall into place and if we don't get new variants of concern and we press on with the vaccination coverage I think that should be possible I don't see why not two very long sentences but where you were headed there which is where I was pushing you is end the equality we hopefully end the pandemic at least what it looks like Gabriela Yes, I think it is possible if we change the model if we radically overhaul it and understand the enormous urgency and the importance of equitable distribution which means production at scale across the world where needed and the more it looks expensive or different of this it's not and it doesn't have to be it's about distributing those resources differently at the moment they are being hoarded by a few companies and a few shareholders that can be invested to really transform the way we're addressing the pandemic Yes, John I think greater cooperation greater solidarity is the route to ending this pandemic whether we end it in 2022 or in 2023 we need to re-estate that cooperation and solidarity Thank you Sat I don't disagree with Gabriela but distributed vaccine across the world is not going to happen in time for this year today we have to get the vaccines out the best we know right now is they protect against severe disease and death and we got to do it before there is a variant that changes the equation but right now we have the tools and the issue is making those available to everybody who needs them across the world and we can do that Yeah, we have to get ahead of the next the worst variants that we face and the way we do that is to try and get a majority of the world vaccinated wherever they are in the world Final word, Mike? We won't end the virus this year we may never end the virus these viruses the pandemic viruses end up becoming part of the ecosystem but we can end as the public health emergency and that's why the director general Dr. Tedros declared that emergency the end of January 2020 the issue is it's the death it's the hospitalizations it's the disruption of our social economic political systems that's caused the tragedy not the virus the virus is a vehicle it's how society has reacted to that virus and the presence of it and as Gabriela said long-standing inequities in the hospital in health access long-standing social inequities huge internal inequities within countries not just between countries so yes we have a chance to end the public health emergency this year if we do the things that we've been talking about for the last hour but it won't end if we don't and that's the reality that this tragedy will continue there is a chance and remember in this people talk about pandemic versus endemic this word endemic endemic malaria kills hundreds of thousands of people endemic HIV endemic violence in our inner cities endemic in itself does not mean good endemic just means it's here forever what we need to do is get to low levels of disease incidents with maximum vaccination of our populations so nobody has to die that's the end of the emergency in my view that's the end of the pandemic yeah define the fight and then you can win it ladies gentlemen thank you so much a pleasure to have the opportunity to talk to you and thank you to our audience once again for participating and for viewing thank you