 Welcome to this session on confronting the challenges of catastrophic outbreaks. And just for those who needed the simultaneous translation, English, French, because the president of Guinea will give his remarks in French. I'm Peter Piot, and I'm the director of the London School of Hygiene and Tropical Medicine. And we have a most distinguished and experienced panel this afternoon, and let me briefly introduce them. Starting here on my left is Dr. Paul Stoffels, who is the chief scientific officer and worldwide chairman pharmaceuticals of Johnson & Johnson. And Paul is, I would say, a serial entrepreneur and unique among pharma executives the fact that he has worked on the ground in sub-Saharan Africa. We have Dr. Margaret Chan, no need to introduce, but director general of WHO after a distinguished career in public health in Hong Kong and globally. Then we have President Alpha Condé, who is a political scientist and the first democratically elected president of his country of Guinea. And as you know, one of the three most affected countries by the Ebola epidemic. We have Seth Berkeley. You could hear him this afternoon when he spoke in the plenary on the 15th birthday of Gavi, the Gavi Alliance, of which he is the CEO. But he was also the founding CEO of IAVI, the International AIDS Vaccine Initiative. And last but not least, we have Tony Elumelu, entrepreneur and philanthropist from Nigeria and founder of the Tony Elumelu Foundation. The objective of this session is to briefly review the Ebola epidemic that's still going on, but particularly to look forward and to answer the question, what critical questions and lessons have we learned and to debate how to respond to similar outbreaks. So I would say let's make this into a forward-looking panel. We have about one hour. The Ebola epidemic in West Africa has been really a black swan event, I would say, together now with the Swiss Frank revaluation. And because there have been 25 outbreaks and before this one in West Africa. And they were all very, very different from the current one. They were occurring in Central Africa. They, you know, and now we have this first outbreak in West Africa affecting entire nations, capital cities, it's been going on for more than a year in the case of Guinea. And whereas definitely there's some good news, the number of cases is going down everywhere, it's not over by any means and we'll hear about what the priorities are. And it will only be over when the last person, whether Ebola is either dead or recovered without having infected other people. So that's quite a daunting task. Now predicting the future as we all know is very difficult, but one thing is sure, there will be other Ebola outbreaks and there will be other epidemics, not the least of influenza. So let's start the conversation. Monsieur le Président, you have been very active in this fight against the Ebola epidemic. What lessons do you think one can draw from your experience in Guinea as well as in other parts? Well, thank you very much for that question. There are other questions that should be put as well. The speed at which Ebola has spread surprised the world, which was not at all prepared to fight Ebola. Ebola existed in Central Africa in a very restricted area, but Ebola was spread in a very surprising way so that it was impossible to control it and it was a little understanding of the mechanism. One didn't explain to the patients that Ebola is a very, very serious epidemic, but that one can be cured from Ebola. International communication was disastrous because it was more panic-creating than anything else. International mobilization only really took place as of September last year, but now we know exactly what has to be done to fight against Ebola and we know what it is. There are three countries in particular, so we have to cut the chain of contamination so that one country does not contaminate or infect another. Secondly, how can we reach the patients early enough because if we can't treat a patient early enough, there's a great chance of recovering. And thirdly, how to keep the patients from having any contact with anyone else for 21 days. So, Ebola itself causes less danger than behavior. If you close the borders, then you only isolate Ebola but not what happens within a country. In Guinea, there are all sorts of organizations that come in when there is a case and there are many people or organizations who are used to dealing with refugees, with migrating people, but the organizations have not really understood that Ebola is a different kind of fight and that one has to give up the old methods and adopt new ones. And this has taken a long time, this learning curve, also coordination. One has to understand that Ebola is now able to reach out to anyone in the world. The world has become very small, so we have to have these new methods of fighting, of combating Ebola. So we need to think of new structures with which we can contend with Ebola. Our countries don't have the same kind of health systems as others do. We've taken time to detect the organism. We had to send the virus to the Pasteur Institute for analysis and we have to have a better health system in our countries if we want to control Ebola and eradicate it. We need to be able to detect all these different viruses ourselves and not always have to rely on aid from the outside. Now it's Ebola, but it could be any other kind of disease or new disease. But the world is simply not able to, or not at present, able to fight against such a widespread epidemic. Medicine Francia was very, very helpful. But there are many failings to actually deal and cope with such an enormous epidemic. Another lesson to learn is that this epidemic has caused a lot of panic and fear. And that has immense consequences on the financial and economic situation of a country. Tourism in human terms, very many of those who have died have left children behind, orphans to now look after. And then there are all the customs. We have a certain way of burial and all these things have to be changed because of the danger of contamination. So first of all, one should not give in to panic. Even though the communication is such that it does cause a lot of panic, many tourists don't even want to go to Central Africa or Kenya anymore because they feel that they are at risk. Africans also have to understand that Africa is like one single country. We need solidarity between the African countries. The problem in Africa is that there's a lack of solidarity. If there's a problem in Nigeria, it's not the whole of Africa that will become mobilized to help Nigeria, for example. So we have to coordinate better this fight against any other epidemic, strengthen our health systems, public health systems. Everyone has to become mobilized in order to cancel out the debt that the countries have, the ones who have been affected by Ebola. And countries have to, and organizations have to give up their old methods and adopt new ones to see to it that Ebola has dealt within a new way, with new methods. We have to give up our habits. However, these organizations are rooted in their habits, their customs, their traditions, and it's difficult for them to turn to new ways. And there are also interests that the states, the countries have, for example. My country needs a laboratory or laboratories that can detect things very rapidly. We would need transit centers as well, in which we would know within 15 minutes whether a person is positive and needs to be treated or isolated or not. We need a lot of discussion, understanding. We need medicine. We need treatments. We feel that the medication should be on the spot. The doctors should not have to wait for so long to get the necessary medication. There's a lot that we can learn from this epidemic. It has shown us that the whole world needs a new early warning system to treat all these diseases and patients. A new way of communication, France 24 and CNN, could help us rather than spreading panic. And we need more solidarity between the African countries, whether it be with regard to Boko Haram, the war in Mali, Ebola, or any other problem or the problem in Namibia. We have to find new answers to these new situations, if that's what I could say at this point. Thank you very much, Mr. President. A good list for discussion. Margaret, you've been really also at the forefront. And this week, on Sunday, there will be a special session of your executive board, so how you see things for the future and what to do to prepare also for the next epidemics. Thank you, Peter. I think President Alpha Condi has given you the complexity of this Ebola outbreak in 2014. Clearly, I fully agree with him, the comment that the world is unprepared. And that conclusion was actually drawn in 2011. There was an independent expert group of people who reviewed the Global Health Collective Defense System after the 2010 pandemic, H1N1. The conclusion at that time was the world is ill-prepared for severe and sustained severe disease. And this, unfortunately, that conclusion was borne out by the Ebola outbreak that we are seeing, particularly in the three countries, the most affected. Now, Ebola 2014 is truly unprecedented in terms of the highest number of people affected, and so many of them die. It is truly a tragedy. And also, it is unprecedented in terms of its geographical spread. If I tell you, nine countries in three continents were affected, or reporting cases to David Cho. And of course, this is also an outbreak that is lasting the longest period, as we are speaking, we're still managing the outbreak. But I would like to thank the three governments, in particular, for their truly commitment at the highest political level. We are seeing the downward trend in the cases in these three countries. So keep up with your good work, Mr. President. And we would like to continue to see total control of Ebola. Now, for David Cho, you're right. On the 25th of January, there will be a special session where member states of the organization, David Cho is an organization with 195 countries who are members, come around to learn lessons from the Ebola, and how to better prepare the world. And this time, I think the world's leaders would take heed of the lessons that were drawn in 2011 that I refer to. So basically, let me summarize on the three important areas that I would see that needs to be strengthened. Number one, President Alpha Condi mentioned about it, the health system capacity and preparedness. Do they have the people, the infrastructure, and the system to detect disease early? As we all know, Ebola was undetected, spreading undetected for three months in Guinea. The first case happened in December 2013, and it was not detected or tested until March 2014. And in a highly mobile community where young people go around different countries to seek employment, the disease is spread. It is important for us to realize that for those of us who travel, we need a visa. But for virus, virus do not need visas to get across the borders. So we do need to support countries to build very strong health system to have the capability to sound early warning. Second point, and I also agree with President Alpha Condi's observation, the international response need to be much better coordinated and in order to support the countries to do the right thing. And last but not the least, Ebola has been around for 40 years and yet we are empty-handed in terms of vaccine, drugs, diagnostic to help us to make the diagnosis sooner, to isolate patients and treat them well and at the same time do the proper contact tracing to stop the transmission of the diseases. So I would expect member states in Dabit Cho would look at these important gaps and how to plug those gaps. And of course, inside Dabit Cho, we also need to look at is Dabit Cho well-capacitated to do the kind of work that it is mandated to do? I know countries of the world have a lot of expectation for Dabit Cho and we do need to have a very good discussion on what is Dabit Cho and what is not Dabit Cho. People expect us to be a first responder. People expect us to be the fire brigade and people also expect us to do a lot of things. So we also need to do a better job in terms of communication, explaining to people what we are and what we are not. And how can we, Dabit Cho, as an organization, going forward is better prepared and also with the capacity to coordinate actors in the international community, in the UN system, in others, to respond faster to nip the outbreak in the bud. Thank you very much, Margaret. Big task ahead, but I think that like every crisis, this is an opportunity to get things right. Now, Tony, we've heard perspective on government to national organizations. So from where you are, both as a business person, a philanthropist and building perhaps also on Nigeria's a successful containment of cases. How do you see things? I think it's good to say that the private sector should have been involved earlier on in the response to Ebola. And listening to the speakers also, I ask myself, this kind of conversation is actually interesting so that we begin to know that there's a lot of privacy that can do in helping not necessarily to contend per se, but making sure that we rehabilitate the affected communities as fast as possible as a deterrent for future occurrence in these places. In West Africa, we've had certain responses by the private sector, albeit a bit late. We've seen responses by the EU engaging with the private sector in Africa. We've seen responses by the African Development Band, the President, the Nicaragua is here. We also, in our own group, both at my foundation have put a million dollars to support the initiative and beyond that, we also at the bank level, one of our businesses, interestingly, I have business in all the three countries. But good to note, we did not close shops in any of these places because these communities need hope. And if you close shop, you key the hope. So we have banking infrastructure and banks in these places, and we're operating during the period. And up to now, we never closed for one day and yet we protected the lives of our staff that no staff got contaminated at all during the period. But to me, moving forward is what I think we can spend a little more time on because post Ebola, how do we have to rebuild these communities so that we bring economic hope back and opportunities back to the communities and also we make sure that the poverty level that to a large extent predispose these communities to Ebola outbreak will not occur again. So I'd like to, at our level, we're engaging. We're trying to see engaging with the countries. I spoke, I've engaged with presidents to see how we can help mobilize international community, African Africans, African private sector so that we make some investments in these countries and those of us already operating in this country. Let's see how we can expand our economic activities in these countries so that we have to rebuild the communities. I think that the longer sustainability approach to curing these Ebola lies in the private sector's engagement here. Thank you, Tony, and thank you also for continuing to do business because as President Alpha Konde said, some of the measures have been as damaging in a sense as the virus for societies and economies. President Konde said also we need innovation, we need new tools, so on, and some of them have to come from the pharmaceutical industry. So Paul, what is industry doing and how do you see the future of your engagement? Well, industry has done a lot of efforts probably also too late because the epidemic which was in very small focused areas in Africa, 25 outbreaks, something like 1700 patients or deaths until now, until this outbreak and suddenly it shows up as a big problem in the world. The reason the industry and three companies, Mark, JSK and J&J, we are active on vaccines and the reason we are active in vaccines is that at a certain time in 2008, the US started an activity on bioterrorism and Ebola was one of the viruses which was a bioterrorist agent and therefore NIH started research and that's the reason why we now can accelerate the, hopefully I can accelerate the availability of a vaccine. What also was lacking is the platforms and the technologies to do this type of vaccines and there I consider industry and the academic world one and the same. We have to do more research in new platforms to be able to bring new vaccines and for example, the Adeno Vectors in our group with Crusallians and J&J came through a collaboration with the vaccine work on IAVI where we were working on HIV vaccine and that's why we developed the vectors. Other vectors were developed because of the bioterror and in parallel production activities need to be done because these new vectors need very special, and for those of you who don't know what I'm talking about these vectors are viruses. What we do is we use a cold virus which we make replication deficient. We add a piece of Ebola in that, trick the body in fact with the cold virus and have it make also antibodies against Ebola. The same with MVA which is what is called a boosting vector, exactly the same. It's a pox virus, you make it replication deficient, you put a piece of Ebola in and you can inject that in the patient. In the meantime what happened, massive amount of work. I think each of the companies, Merck, GSK and ourselves we are working on a timeframe of 12 months where we are upscaling, doing preclinical work and also doing the clinical work, phase one, phase two, phase three and hopefully within the next six to nine months there will be vaccines available. Same is happening in drugs. The challenge on doing drug research was that Ebola you can't work on in the lab. So to find the drug you need to be able to handle the virus and it took so long to do that. The same with diagnostics was not simple to do that. The industry has massively invested now. In the meantime we have produced more than 400,000 vaccines both vectors prime and boost. The same is happening at GSK and Newling. A massive acceleration of clinical trials and I must very much thank all the regulators, all the healthcare officials in each of the countries including the affected countries as well as the US and Europe and many others on their collaboration on accelerating. Today we have unprecedented review timings. Normally we need to wait two, three, four months. Today it's happening in 24, 48 hours. Everyone who is collaborating in Ebola is unprecedented collaboration happening between the companies, between the regulators and between all the organizations. And I trust that looking forward we'll continue to go forward with the vaccine even if Ebola will hopefully eradicate it faster than there is a vaccine. I truly hope that that's done. We'll still will do it because Ebola will be back and then we should be ready with vaccines and you have our commitment as an industry and also from I think from the other partners all the partners in industry that will make sure new vaccines and new drugs will be available that next time nobody should die anymore from Ebola. Thanks Paul. So let's hope that this will be the last epidemic where all we have is isolation, quarantine, safe barriers. And also I think that both in terms of review of grants not only by regulators but also for research grants we now have the empirical evidence that you can do that in a very, very short time. And so I think for the future there's no excuse for when it comes to other drug and vaccine development to go back to the business as usual. So if I may, Peter I want to add one more point is that also the funding has been unprecedented through to the different governments in the world. They have absolutely supported massively including the US government, the European government, the European Commission. Everyone is contributing to accelerating the fund. On the issues to welcome trust. Welcome trust case foundation. Everyone is doing what they are supposed to do is help this type of disease to be solved. Great. So Seth, you know, Gavi is the main funder of immunization programs in the world. So how do you fit in hoping that soon we'll have a vaccine and because I know you've been thinking about it and also working on it. Thank you Peter. And let me just make a couple of comments before I answer your question. One is, you know, the panic that occurred in the rest of the world was a lot of the reason that we got those resources. And as Paul has already said, you know, this was a vaccine. These were vaccines that got worked on because of bioterrorism. They were not worked on because of Africa and we still today have a market failure. So one of the goals that we have to come up with are new public private ways to support the important research going on against antigens that don't have a natural marketplace. And so Paul talked about in my previous like at IAVI, we were using public money to fund work on AIDS vaccines and moving forward a range of candidates and not just the one that Paul talked about but all three lead candidates were invested in by IAVI and ARIS which is a TB vaccine program and others and having that type of funding available is important. It often is the first thing that gets cut when money gets tough but we need research and as the president said, what we need is research also occurring in every one of these countries. We need capacity in those countries. We need a scientific community who can help with this and I think that's been some of the successes in some of the countries. So in terms of your question, Peter, we work in all of the Ebola affected countries at least in the developing world and when it was clear that people were working towards a vaccine, the board asked us to look at what we could do and we then put together a program of the board has agreed that we would purchase up to 12 million doses of vaccine. Now that number comes from the combined adult populations of the three most affected countries but knowing that they may not be needed in all those three countries or in fact we could have outbreaks in other places and important in that is we must get to zero. You can't emphasize that enough. A few cases is not good enough. We have to get to zero. So purchasing the vaccines, the second thing the board asked us to do is to prepare for the rollout of those vaccines and we don't yet know what WHO is gonna recommend. Is this gonna be ring vaccination at that point? Is it gonna be whole country vaccination, just health workers or maybe no vaccination depending upon where we are. So we have some preparation work to do. There's special characteristics around this vaccine, social mobilization, et cetera. The third point is to have a stockpile. So there will be other outbreaks as you've already heard and we need to have a stockpile of these vaccines if they work. Now this is against one strain. These are monovalent but we also need to work with the pharmaceutical industry and put incentives in place because they shouldn't do all this as a lost leader. We need to put incentives in place for them to create stockpiles of a second generation Ebola vaccine that would cover not just Ebola Zaire but Ebola Sudan, perhaps Marburg, perhaps Lhasa. The idea would be to try to have vaccines that would work across different places and also optimize them for temperature, for shelf life, for the other things you'd want in a stockpile and make sure that is regularly refreshed. And the last thing the board asked us to do was to work with the countries and help strengthen their immunization systems again and in particular also to help catch up with the things have been completely shut down and the truth is it's an unbelievable tragedy. We have to get to zero 8,000 cases but the destruction of the health system in these countries have killed far more people and far more people are dying of the diseases that exist in these countries, the malaria's, the measles, other diseases and so we've got to rebuild those systems and not just rebuild them but build them to a better place. And so these are some of the priorities that we're doing moving forward. Last thing I'd say is that looking forward we have to think and this is where we'll talk next but we have to think about how we're going to have better ability to diagnose and then to react institutionally but this other part of how do we think about which products are next and what we're going to need and it's a real challenge because the future is very hard to predict but that being said, we need to do our best. We have to have platforms ready that we can drop antigens into. We have to have the ability to scale up quickly and these are some of the things that should be discussed and maybe the silver lining in this cloud. No, thanks, Seth. Thanks for reminding us about the vaccine. I just wanted to make a comment regarding vaccines. I don't think that laboratories can find the vaccine just as the president of the World Bank cannot find the solutions. When we speak about vaccines, we are speaking about having a large clientele and this is not the case for Ebola. Ebola is affecting poor people so we need to get more and more mobilization to ensure that it is laboratories who are carrying out the research because otherwise we see that the market is a weak market. We let poor people die. If Ebola was a disease of the developed countries then we would have found a vaccine by now and that is not the case. I think that if we just leave laboratories up to the task of finding the vaccine, we will never find a vaccine. We will never find the vaccine if we leave it in the hands of laboratories because everyone who is developing vaccines is not necessarily a philanthropist. They are also looking to make a profit. Thank you very much. Just said, and that is that funding for treatment, for vaccines, not only for Ebola but for other potential epidemics and rare or nearly unpredictable epidemics must be considered as a global public good and therefore there is a place and a need for public-private investments together because it's companies that make the vaccine. So that is, I think, one of the lessons in establishing such fund could be really good. And said, I think also very important to remind us that the impact of the Ebola epidemic goes way beyond the figures we see of people who died directly from Ebola. I mean, there probably, as you said, more people who died from treatable and vaccine-preventable diseases because with the dwindling immunization levels for, you know, regular childhood immunizations, we can probably expect some epidemics of measles and so on. So let's now open the conversation and then we'll come back to the panel. Who would like to contribute? Gary, please, can you identify yourself and then... Do I need a microphone or not? I think for the translation you probably need, yes. So President Kande, I had the opportunity to attend a meeting with you at the U.S. Department of State in August. And it was a time there was really no mobilization of support for what was happening in your country or the other two affected countries. Then mobilization started to happen afterwards, as you said. And I know that the Centers for Disease Control Prevention started to deploy people and set up emergency operation centers and start to do the type of contact tracing and other work that needed to be done to help get the virus under control. How important is it to establish those types of public health capabilities in your country? And do you feel you're getting the support, if it is important, to establish those so that in the future you'll have the ability to be able to do that type of work, or, of course, still supported by international organizations? Okay, Monsieur le Président, vous avez... President, you have the floor. Yes, we have to focus on this. What we are trying to do is establish a CDC in Guinea so that we can have a CDC that is able to identify all the viruses. But the problem that we have nowadays is that a lot of people came to us to help us establish a center to combat Ebola. However, at this time we had about 15 cases or something. So the problem that we face now is not so much a question of building these centers. It is putting an end to Ebola immediately. And we have to also establish these transit centers. So the most important for us today is to try and build community health care centers. These community health centers will allow communities to have health care, for example, for mothers in maternity wards. And we need to ensure that local communities have access to health care and doctors. We need these community centers, which will be in the different areas. But we also need to reinforce the health care centers that we have. The fight against Ebola is very important. But we also have to take into consideration that we are training our own populations on how to counter this disease. We have to realize that Ebola is a very important and a very important issue to tackle. And we need to end it. And it is as from this moment that we need to start building health care centers. Because currently, Ebola is now going on the downward trend. And we also have problems, for example, with cholera, because we have less chlorine, we have less typhoid fever and less cholera. But despite this, we have to focus our attention on fighting Ebola by building these health care centers in Guinea. Because as soon as we have done that, we know that we will be responding. We cannot wait from now until the next 30 years to respond, President. That means that we are entering a new phase in the fight against Ebola. Yeah, I want to add on what the President said, because he talked about the health systems and the health care side. But we do need a strong public health system as well. And what's important about that is that this is often getting ignored. The research side, having codders of public health workers, having professionally trained post-doctorates. And look at some of the other countries and what happened. We've seen control in Mali. They're doing vaccine trials there and doing them well. At IAVI, we did trials across Africa with faster enrollment times than in Europe. We've seen in Uganda control of the disease over and over again with trained public health workers and DRC. So the point is that you need to have the health care facilities to deal with the patients to take care of them and do isolation. But you also need people who are trained to go out and look for cases and do the contact tracing and the follow-up and the epidemiology that's necessary. And this in the development field hasn't been the most trendy stuff to invest in. And yet this also is a global public good, these networks of people with the labs associated with them. Yeah, if we agree, Margaret, please. Peter, I think it is important for 2015, what are the priorities? First and foremost, we must get to zero, support these countries. What I'm afraid is the complacency are setting in in these countries. So we need to guard against that. And the second point is we must not have what we call fatigue, the development partners. And I have to thank banks, Donald, World Bank and other countries. The outpouring of generosity have helped us to bend the curve, to prevent Ebola to go in an exponential manner. So that's the good news. Please guard against donor fatigue. As we are speaking, we focus our attention to get to zero in these three countries. But if I tell you, 129 countries in the world have very weak public health systems to even to prepare themselves for importation of Ebola or other equally severe diseases. So we also not to forget supporting those countries to build a public health system that Gary you were referring to. Now that brings me to the important point about health system recovery. Seth put his finger on the most important point. We often talk about disease specific approach to the way we build a system. No country in this world can afford to have a health system for HIV, a health system for TB, and one for maternal and child health and then one for public health. So WTO has been advocating for universal health coverage based on primary health care to make sure an integrated approach, a system approach to deal with the common diseases, the important MDG diseases, as well as public health. And that's the only way the world can afford. And you don't have to be rich to start thinking about universal health coverage. And so this is a very important message for the development community. And if I see some development ministers here, MDG support is extremely important. Commodities are important, but those are low hanging fruits. I commend you, Seth. You are responsible for vaccine, but you talk about the importance of health system. Without health system, vaccines do not fly to the arms of children. Without coaching, without human resources, without infrastructure, delivery of services would not happen. And if you look at Nigeria, Senegal and Mali, these countries, they have some health system, but they also have political commitment, political leadership and engagement, full engagement of the community and communication right at the beginning. And I know for a fact, Nigeria, they were able to control the so many chains of transmission in Port Harcourt. It's because the private sector provided the logistics support in a big way. And WTO was using our polio asset on the ground to do CDC surveillance. So and CDC, MSF and all partners were coming together. So again, let me go back. There is plenty of resources in the world to help countries who are not capable to deal with the outbreak yet, but we need transparency. We need countries to sound the alert and the international community would come around to support countries who do not have the means to do so yet because it is in our collective interest to have a very strong defense system against all these very serious pathogens. Great, thank you. Donald, please. So microphone here please, Professor. Thank you, thank you Peter. Let me first of all say that I want to express my thanks to everybody in this room and all governments and organizations who have in the last few months, through everything they have to address this issue. At the beginning, we may have got it wrong, but I think towards the end, we come together and we're having this result. The beginning, it was a disaster. As all of us will have to pull back and look carefully where could we have done things differently. But now I have a question for all of you here. Now that you know that, if today there was an outbreak of Ebola in South Sudan, in the Central African Republic, or in a place like that, are we able to act differently? Thanks, that's a challenge to all of us I think who would like to respond to that. I mean, it's really while we're building the system what if something would happen now, what can we do? And I think let's hope we learn from history because we've had reports as Margaret said that we're then, for whatever reason, not implement. I think Donald asked an excellent question. When it is small, I mean the outbreak, when it is small in size or even medium size, we have the capability to deal with it. Dabik Cho has been in existence for 60 years. Every year, we have 700 disasters, humanitarian crisis, and outbreaks. And the world did not hear about that. Now that means when they are small, when they are medium size, we have the capability to deal with it. So that's why it goes back to the important point about transparency and the capability to detect early. And then once we know that we can parachute people in with partners, of course, with the commitment and agreement of the country and to nib it in the bud. As I said earlier, the circumstances allow this disease to spread undetected for three months before it was diagnosed, that added to the challenge. And President Alvacondi was correct. We did not really pay attention to the culture enough. We need to learn going forward for the communities. It is important to respect their tradition. How the Muslim community bury their loved ones. This is something we really need to learn lessons. How can we do dignified, safe burial that are acceptable to the community? Color of the body bag makes a difference. Black or white? White is acceptable, black is not. And so some agencies send black color body bag and that created objection and resistance. And of course, good-hearted NGOs who go in in space suit and that created suspicion. So these are some of the lessons we really need to learn going forward. We must look at what is the cultural context and also what is the social economic context to facilitate or to drive the disease? Yeah, I think that the early detection is going to be a problem in some of these areas. And also you only can find what you're looking for. Like nobody thought that Ebola was happening and circulating in West Africa. Although we know today that it has been there for a while. But I think that maybe the biggest lesson is that act very promptly immediately and at the risk of being accused of overreacting. And I think, for example, that WHO was unfairly criticized for reacting a few years ago for the pandemic flu. And I would rather be accused of being overacting than not. So, but Donald, so you've been at the forefront also with engaging the African Development Bank. I think it was also a very, very important element of the African response that President Alpha Konde alluded to. Thanks. Any other comments? Yes, please. I'm blinded by the spots. In the back, please. Yes. Not the back. In the middle of the back, yes. Sorry, perhaps I should have stood up. My name's Grenville Beifert, I'm a writer. I wonder if you could comment on what makes Ebola such a dangerous virus and how common are those characteristics amongst other viruses? Shall I say a few words about that? Yes, you're one of the discoverers. Yes, yes, even, yeah, there was a newspaper in Hong Kong, the front page, it called me the father of Ebola. So, but that's, no, it depends what your question is, whether it creates an epidemic or the intrinsic biological characteristics. But what I think, what we've been seeing in West Africa was what I called, in editorial science, a perfect storm. It's not that the virus is, per se, very different. Of course, it mutates, but there is no evidence that it is spreading faster. It is spreading in a different way than the classic limited outbreaks. That may happen at some point, but there's no evidence at the moment. And it is really a combination of slow response, of the cultural factors, the traditions of defunct health systems, that all brought together high mobility. When you take the outbreaks in DRC in Congo, it's actually not so easy to go from one place to another. Whereas in the areas of the three countries, I saw it myself, I mean, the roads are quite good and people are moving and there's trans-border traffic and all that. That's not only good for trade, but commerce, but also for spreading viruses. At the biological side, the virus and disinfection really needs more study, because up to now, the outbreaks were usually in very isolated places. We don't have really all the information we need, but in theory, it should be very easy to contain, because the spread of a virus depends on the risk of infection, of transmission to another person. Here you need really immediate body contact. It's not like measles, where for every case, you have 20 or more people become infected. It depends on the duration of infectiousness, since people in general die within a week or two. There are not that many who are exposed, and the number of contacts, and with the exception of some funerals, I mean, that's also limited. So in theory, it should all be simple, but in practice, it turned out not to be the case. Thank you. But Peter, can I, at one point, you talk about funeral, just for your information. Now we did a retrospective study and look at all the cases. 60 to 70% of the initial cases were due to participation in traditional burial. So when people come into contact with disease patients and very close contact, and even now, with all the communication, community mobilization anthropologists helping us to engage the community, we're still seeing about 20% of the cases still related to attendance in funeral. So we need to continue to really engage local chiefs, religious leaders, woman group, and youth group, and get their support that for this very important period, perhaps we can find a way of dignified and respectful burial that are safe. Yes, please. Thank you so much. My name is Mariam Jam. I'm one of the young global leaders here at the World Economic Forum. Where are you from, please? I'm originally from Senegal, and I'm one of the young global leaders here at the World Economic Forum. One of the things that really, I also blog and write quite a lot on African issues, the new narratives in Africa. One other thing that struck us, as the youth of Africa, the new leaders of Africa, what really struck us is, our leaders gave $28 million for the Ebola crisis. We didn't hear that. We just heard the WHO really praising themselves for what they've done wrong and what they've done right. How can we learn from this now to give the voice to the young women in Africa? We have so many deaths. So many people are suffering in Africa because of Ebola in Guinea, Sierra Leone, Liberia. What can we do as leaders to learn from this next time there's not much suffering? And then we really give credit to our leaders who are giving money rather than waiting for the West to do it for us. Any thoughts, Tony? Would you like to, and then Seth? The point here is very interesting. The Ebola pandemic that occurred in West Africa again, let me go back a bit. I agree with the President of the World Health Organization that transparency is key. You need to understand, know that there's a problem. Raise a lamp early enough, take measures, don't protect or hide it, conceal it, and the whole world will help. In Nigeria, communication actually helped a lot because the literacy level has gone quite high now until people were easily mobilized and everyone understood what they needed to do or not do in the area. And I also think that the entire system was, I think the private sector worked very well with government. It was a national mobilization factor. It brought everyone together and we worked with the government to provide solution. And talking about the local support, I saw during that period initially, initially I think the national community did not either dimension well or appreciate what was going on in West Africa at the time. When my foundation sent some support to Guinea, Liberia, and Sierra Leone, and Nigeria also at the time, I think we were the first, even the President could confirm this, to make such a regional support to people. But later the national community came into the same and I think the pocket got deeper and really helped. So my take here is, one, Ebola is a problem, but two, maybe we should dwell in my viewpoint less about the problem we've had and less learn from it and see how to prevent it going forward. And also let us see how the road, the private sector can play to help these fragile economies that have been affected by Ebola to rebuild advance back quickly. Otherwise, these cultural issues to talk about have a correlation with poverty. And so they will go back again to the same place or it can spread in all that parts of the world. Thanks Tony, and Seth. If I can just compliment what Tony said and I think young people could advocate, the leaders of Africa have said in the Abuja Declaration that we should put 15% of our resources into health. And one of the challenges for finance ministers is they see health as an expense and not yet necessarily an investment. Hopefully, eyes have been woken up because it is really important. You keep people healthy and they are productive, they go on to productive lives, they spend less out of their pocket, there's less people tipped into poverty and this is really an important point. So in addition to the private sector work and specific money on this, we do have to raise the level of local investment in health if we are going to build the type of resilient health and public health systems we need. Very good, yes, any other questions? Yes, please. Second one. How to manage the tension between transparency and stigmatization? Because sometimes countries are afraid to declare that they have Ebola or a pandemic. So, and this is a big question. Yeah, it's a big issue. Can you also introduce yourself please? Because the point you raised about stigma is really important. It's mine of President Kondé. Okay, thank you very much, sir. Can I attempt to start here? I think if you look at your question spotter, by the way, and this is being transparent also with our question, the truth is if you look at the case of Nigeria, Nigeria, when Nigerian government decided, and I comment highly, President Jonathan's political will and the audacity to do what they did at the time, when they announced that there was Ebola in Nigeria, some even within Nigeria, some people didn't like the fact that we are like stigmatizing the country. But we went about the transparency and at the end of the day, World Health Organization came certified and Nigeria was not Ebola free. I think it gained respect for the country. So instead of a country being stigmatized, I actually think it helped to raise the level of international respect for that country. And in fact, even the citizenry begin to have more confidence in their own government. Because by announcing this, it caught a lot of poor habits, a lot of habits and cultural practices that could have led to more of this. There was massive education in the country. And in fact, the hygiene level in Nigeria today has never been as high as it is today. So I think honestly, you know, it's cartoon too, but countries should move towards disclosure, early disclosure. And you know, I like the fact that almost on the weekly basis in Nigeria at the time there was communication. The health minister will come out and announce today we have 22 out of 22. This number have come back home. The following people died. So there was transparency and it created a lot of confidence that ourselves. So let's go for disclosure. It helps. Yeah, Margaret please. I like to reinforce what Tony says. I mean, I've been in public health for 40 years and I have managed many unusual and new diseases outbreak. Across the board, all countries are very afraid to report outbreaks because number one, they think this may be a loss of face. Number two, they are also about stigmatization. There may be political reasons and economic reasons not to report. Experience in the past is that the sooner you report and being transparent, you would get all the support you need. You may suffer a little bit at the beginning, but the price you pay for not reporting earlier is way higher. And that's the experience in many big outbreaks. SARS in 2003 and now we are dealing with Ebola. I think this is a lesson we must take home for all of us. And I'm not saying it's just the poor countries who are not reporting. I have to tell you, rich countries, middle-income countries, low-income countries, they are anxiety. We must provide incentives for governments to recognize that it is in their interest to report early. Thank you. Thank you, Margaret. And I think that goes even for businesses. I mean, you know, because you could be stigmatized because you continue the business. I discussed this with like one of the few airlines that are still flying from Europe. Well, actually only one. So those airlines, in the beginning, they were stigmatized and they said, you know, people wanted to avoid them. Now they're kind of nearly heroes because they continue to do it. So, and I think that goes at all levels. Time is up and thank you very much for all the interventions. And I think that the first statement we should make is that everybody said it's not over and that we have to be very, very careful that complacency doesn't set in because that's a recipe for, you know, a reignition of the epidemic. So that's the first priority to end it. And then even if the world is ill-prepared, I think this is an opportunity not to be missed this crisis, to make ourselves all better, be better prepared in some way or another. I won't go into all the details, but we have very concrete ideas and suggestions and I hope we will follow up on that. Thank you very much indeed. Thank you.