 Pagodji twitcha padriai. Athuك, is Shabana Kamaneni, who is Executive Vice-Chair of Apollo Hospitals, et cetera, in India. Next to Shabana is Gong Yingying, Founder and Chairwoman of Yaidu Cloud from China, who works in data tech and AI. Next to Ying is Christof Weber, who is President and Chief Executive Officer of Takeda Pharmaceutical in Japan, and then, along the end, the new head of UN AIDS and former head of Oxfam International, Winnie Beyond Yima. So you can see we have multilaterals, we have pharma, we have digital sphere, and we have healthcare provided today. So when we talk around shaping the future of health and healthcare, we need to scope what are the trends, and we've been asked in this session to talk about disruptive trends. What's thrown everything up in the air over the past year? What might we learn from this going forward? What do we think might come out of the near and the next five years, which will influence health and wellbeing and services? And just at the headline level on disruptive events, clearly the re-emergence of Ebola in DRC has been a significant concern of where it occurs in a conflict zone, particularly a hard to grapple with. And now we also have a coronavirus, which is causing Dr Tedros to be chairing a meeting of the International Health Regulations Emergency Committee, as we speak, and we understand there'll be a statement from WHO late today, a disruptive event. Also of concern has been the decline in vaccination rates in a number of countries, leading to significant measles outbreaks. My own country is one of those affected, but let me also reference Samoa, which with a population of 200,000 people has had 5,697 cases. It's said to be 2% of the population with 83 deaths. So this is really quite devastating. So one of the issues has been the extent to which the anti-vaccination campaign is responsible, or to what extent its public services not reaching the poorest and marginalised to get the benefits of vaccination. Of course, we also have the opioid crisis, significant concern in a number of countries, but then there's an upside. There's new therapies, there's new treatments coming on board. Of course, then the question that must follow is, are they affordable? Are they accessible? Will universal health coverage be achieved? We had the high-level event at the UN General Assembly last year. Every member state has signed on to it. Across sectors, people are for it, but are we going to get there? Will there be global action following global declaration? So we have, as I said, a panel from many sectors. I'm really going to probe them on what they think have been the disruptive things, what we can learn from them, what's coming down the tunnel at us as we endeavour to shape resilient and capable health care systems for the future. So I wanted to begin with Winnie Beanyima, because Winnie has had such a strong focus both at Oxfam until recently and now at UNAIDS on advocating for the most marginalised for the poorest. And for sure, people living with HIV and the key populations at risk are among those. So Winnie, throwing the ball to you first. Thank you Helen, and good afternoon. From our world, the world of fighting HIV and AIDS last year was a lot of progress. Let me start there. 24 and a half million people are now on treatment. And another 15 million are still waiting to get on treatment. So progress, but then still a big journey for us. We also saw reductions in new infections. They've been coming down. But still, last year alone, 1.7 million people were newly infected. So we're not at the end yet, but it is declining. 770,000 people died of AIDS. That's unacceptable. We are at a point where we can stop AIDS deaths. We are at a point where the science for prevention, the science for treatment is there. But what we saw last year for the first time is that the increase in new infections is mostly among those we call key populations. Gay men, men who have sex with men, sex workers, prisoners, people who inject drugs. Those on the margins of society, that brings me to the point you just made, that actually it is inequality. Millions are being left behind, not because the science isn't there, but because we make choices that privilege the mainstream and not the weakest and the poorest and the most vulnerable. It's an issue of rights. The human rights of sexual minorities are at stake here. Criminalisation, stigmatisation, discrimination. In Africa, the face of HIV AIDS is the face of a young woman. It's about sexual violence. It's about social norms. We have to address these. We have to continue looking for the science and some new medicines came up last year. But without removing the social barriers, addressing the human rights issues, repeating laws that criminalise, we will not win this. Thank you, Winnie. Wise words and we'll come back to those themes again. Christof, from where you sit, what's been disruptive, what's been happening that has implications for the sector? Well, first, if you look at the theme of Davos this year, it's about sustainability and stakeholder capitalism. I think that's very important. I think it's a real turning point. That will help a lot to reduce inequalities and to make sure that there is more equal access to treatment in the world. I really embrace that. I think it's very important for any actor in healthcare. One major disruption is the fact that we can live longer. That will continue. Many of us statistically will live until 100 years old. The question is the inequality. Who has access to that longevity? That's an amazing disruption that we are seeing. The challenge with this longevity is that it doesn't come free. It's actually expensive. Because, of course, you live longer, but healthcare is becoming more important as you are getting older. This is very important that the society is able to understand that longevity means that financing healthcare is very important. One of the reasons for this longer longevity is new innovation in treatment and technology. I think the next decade will be amazing in terms of the new technology that we will see. We see an acceleration of new treatment, new prophylaxis, because we understand better the biology. Every year, we see more innovation than the previous years. That's really exciting. The key question is how do we finance that, how do we make it affordable, and who has access to this innovative new treatment that is coming every year. Thank you. Ying, coming to you from the technology, AI side, what would you like to reflect on as disruptive trends? Your sector being one of them, of course. Very exciting one. Before this meeting, Christof asked me why I started this company. At the beginning of this meeting, Helen said, how can we make everything affordable? This is why I started the company. On one side, we have a global ageing population that is 290 million elderly in China now, reaching 400 million in 2035, and probably 2 billion elderly globally in 2050. Also, the demand of healthcare, we sub-molecule profiling patients that doctors cannot process those data anymore. On the supply side, in terms of drug development and clinical services, we are still very not primitive, we are not technologically advanced. A lot of infrastructure work that has to be done to make raw data to be evidence and also to enable things like clinical practices and drug developments and better patient care. That's why I started this company and to use AI and medical data technology to make healthcare more affordable, more accessible to the greater population. We have seen very positive results over the past few years in terms of active monitoring, drug development, significantly increased efficiency of clinical trials and also more active patient management. That's where we are now. Shabana, bringing in a perspective from another extremely large country and endeavouring to provide services there. It was fascinating actually coming in this order that we heard about viruses and what's going to happen in the world. We're shortly going to get to this longevity escape velocity that you can choose death and data that is driving it. I'm reminded of a song. I'm sure all of you have heard it. We didn't start the fire with that. He really talks about things in history so fast and that's where we're at. We didn't start the fire but the thing is we're right in the middle of a raging, very complex fire. We have to address the micro communities. We have to address people that don't have access to care. We address people who can actually pay for everything and have money left over and then dying becomes an option. In all this, and this happens in every country, even in India, and you have to give great outcomes. To bring down this huge complexity that we live in, I think that we have to centre it around that patient and what has made that patient different from what he was 10 years ago. I think it's information. In India it's the capability that 350 million of them have a smartphone. I've seen this in the US. Many of them don't have to go to a doctor anymore so you're finding new ways of being able to disseminate health information to get better outcomes, to manage diseases, to NCDs that are going to take trillions of dollars out of this world today. How do we keep those costs down? On one side I say we have more enabled patients because of data but we also have significantly more challenges that will continue to hit countries, GDPs, not just like in India for instance. At $75 per capita patient, lowest in the world, US is $10,000, we still spend something like 10%, 8%, the government spends only 1.5% but the rest is spent by the private. It comes out of your own pocket. But we can't afford this if you want to grow a country that wants to grow and suddenly you're having more than 10% to 20% of your GDP sucked out by health care costs in one way or another. We're not going directly to hospitals but it's all the social determinants of health. I think that's a big challenge of today. And then I think that it's also the fact that how is it that we're going to break down these silos because they're fantastic solutions. We're a very resilient world. We're going to get over the viruses. We're going to find a way to contain them just like we did some great work on AIDS and we continue to push the envelope on that. We're going to find better diseases even though there's going to be resistance that will come from different parts of the world in overuse. We're going to find the fantastic use of data and how we can use artificial intelligence. All of us, there's not a single health care player that is not using data. And finally I leave you with one thought that today now we think of the world as bionic, nothing more than health care. And bionic is not about a body part that works much better but it's about the merging of technology and biology. And biology really comes down to the humans and how we can work technology to work so much better for us. So we've got an age-old problem which is articulated, which is of those who are really left behind and marginalised for a range of reasons. We've got the issue of the ageing societies, well-known in the West, but now very much coming down the track for China and India also. We've got all this innovation in the digital sphere and in the therapy and treatment sphere. Winnie, coming back to you, UNAIDS has always been known for its very people-centred human rights-based approach, engaging key populations. Does that lead you to make some broader observations about the engagement of people and communities in designing the care and services that they need? Absolutely. I think where we are, the success that has been achieved against this epidemic is really because of communities and particularly communities of people living with HIV. Let's not forget it was gay men in America, in Europe, who got up and fought for their right to life and we supported them, the rest of civil society, to bring the prices of medicines down and to put now the 24.5 million people in treatment. It took communities, it took people asserting and claiming their rights. But today I fear Helen because we are now in this SDG world and it's universal health coverage, not universal health care. And the coverage thing seems to be more about bringing the private sector in. A way we are saying that public provision isn't possible. Now you need a health insurance paid for by, sold by profit makers. This is going to leave people behind, in my view. This is going to leave behind communities. Communities have been the ones supporting and even providing HIV services. When you go to Africa, for example, you will find small community-based organisations are part of the delivery system, particularly the prevention side, helping people to understand how to prevent young girls, young men. It is communities. Now, without that, the approach is more about giving treatment. It's about putting people in treatment as the main focus. Yet it is prevention we should be at if we are to end this disease. And prevention is the work of communities. It is communities who educate children, who help families, who put in place the ecosystem you need for people to live without a virus. So, yes, communities' rights are at the centre of this epidemic. It's not just a disease. It's a social justice issue. It's an issue of poverty, of exclusion, of denial of rights. These are things that are solved by communities. The approach of focusing on, mainly, on health insurance systems sold by the private sector would get us there. So, Shobana, with your hat on as a health care provider, how do you see the engagement of communities in designing the systems that are going to most benefit then, the interaction with communities? I believe that communities will make a difference. And as long as they are educated enough, they need to make those educated choices. And I don't think there's an either or also in terms of, do you choose between leaving some, not having health insurance or what, you know, I do think that health insurance, creating access, that's really going to help a country like India, for instance, our government is trying to put 500 people under, 500 million people under, you know, the socially challenged people into health insurance. So, we're pushing back and saying, how about the rest? Why don't you make it mandatory? People can pay, have a small insurance. The others that can afford it can do a top-up. But you look at Thailand, you look at even Rwanda, what Korea did and all these other countries, I do think that insurance is a-important. And then you start working in the communities to make sure that they do the right preventive and they're the ones that can make a difference or do you work with, we've created a community in some of our villages where we've planted alternate trees for nutrition. So, you have one that provides iron and the other one that provides another micronutrient. So, now they're trying to have community gardens that they can create food and nutrition. And I do think, so it's simpler in a village, it's tougher in an urban community, but I do think that buildings after buildings, housing societies, so as much as condition management is important, there should be a new terminology like you said of doing conditions from communities. Ying, the tech sector often is thought of as designing things which are satisfying and interesting to it, but not necessarily having people at the centre of it. So, would you like to reflect on how technology and artificial intelligence is going to respond to people's real needs? We're conscious that with AI, who's designing the algorithms? We've got an absence of sufficient numbers of women in the sector that you're in. Can you share a little on that? Yeah, the good thing in our company is half of our scientists are physicians. So, we have data scientists, we have engineers, we have architects, but we also have a lot of physicians and doctors that we work together to design those algorithms. But a friend of mine used to say, a thing that really impacted me, that we focus so much on sick care. We don't focus enough on healthcare. And I also believe healthcare is a care, it's not a transaction, it should not just be a service. So, really for specific use cases and for a specific disease, the needs of the patient varies so vast, so significantly. Our mission exactly is to use AI and data platforms. As cold as it sounds, but it's actually the only, well, at least I think, it's the only way, affordable way to provide more personal care that is accessible to the mass public. Yeah. Well, let's come into what's really going to shake up the health and healthcare in the next five years or so. And I'm going to come to you, Christof, because your sector is a very innovative one. What do you see coming down the track as some of the really big, big developments? Before I go there, I want to insist on the robustness of healthcare system. I'm not using universal health coverage, but I think a country is as good as its healthcare system, and the healthcare system should be designed to cover the entire population. I think a healthcare system is as good as not the best covered, but the least covered. That's where you measure how effective your healthcare system is. Not the population which is the best covered, but the population which is the least covered. And I think this is what we should all focus on. How can we improve the healthcare systems? If you are a country today which spends 10% of your GDP on healthcare, there is a lot of data showing that three points out of the 10 could be optimised. It's wasted. It's mismanagement. And yet you know that you will need to spend more because of the trend of ageing population. That's the work we have to do, is to optimise the healthcare system, making sure that there is nobody left behind and progress like that. And it's difficult. Even if you look at developed countries, United States, Europe, everywhere, the healthcare system is far from perfect. This is a huge debate in every country. This is really where we should continue to focus on. And back to your question, because the innovation that is coming will accelerate this tension, if you like. Because the innovation is not cheap. Innovation will always be expensive. So the concept of affordability is how can you finance innovation? But when you treat for the first time a disease, and you increase the longevity of people, it is often an incremental cost. Sometimes it's not, but often it is. So I think this is what we need to be prepared for because gene therapy is coming, cell therapy is coming. People with cancer will survive for much longer. Many cancer are now a chronic disease. We might cure cancer one day, but it's not for now, except in a few cases. I think it is extremely exciting to look at the future, but there is a challenge of how robust the healthcare system is to face that tension that is coming. Winnie, you want to come back in? A number of things. I want to agree with you that it's the health system and you will know how good it is by seeing how well it caters for the poorest, most vulnerable. But here's the problems that I see. And I will use two examples. One is in Africa, the face of this epidemic is the face of a girl, as I said. Out of every five infections amongst adolescents, four out of five young girls. This is clearly an issue of protecting young girls, preventing them from getting infections, a lot to do with sexual violence and so on. Pepfa was looking at how it had spent recently. It found it had spent, for example, on voluntary medical male circumcision, which is preventive, about $5 billion in the region. But it had spent only about $600 million on section reproductive health. Imagine the difference there. The amount spent on voluntary medical male circumcision, the amount spent on prevention was for women, for young girls. So there are inequities in the system and they are worse when you sell health. Let me give you another example that shows that point. I met a woman called Victoria. She lives in Islam in Kenya. She was infected when she was about 12 years old. She was raped. And then she found out when she was 16 because she was falling sick and she was expelled from school. But she fought and she became an activist and she got on treatment and now she's a community volunteer, communities. She goes to the facility, helps people in the community to go to test, helps women to understand how to prevent it from moving from passing it on to their children, deals with so many issues. For all that work she does, getting, solving the problems of people from their home to the facility. It's her. She gets, as a volunteer, $20 a month. That's all she lives on in her Islam. $20 a month for all the work that gets people from their homes to the facility. The facility is free, okay? It's free. It's a government provision. But the government doesn't take care of the whole issue. It takes only at the facility. So what I'm trying to say is that unless we have a system where the whole need is taken care of, you're passing the burden to a few people in the community. They are not paid for it. And this is why I fear about these health insurance systems that are privately provided, that are profits-centered. We narrow the healthcare to the facility and everything else becomes paid for by volunteerism, mostly of women. Inequity continues to grow. Thank you. We're going to give the opportunity for the audience to come in. We've got a fascinating range of perspectives here. So when you speak, and I'm going to recognise you right in the front row, just say who you are and please stand up as well. We are live streaming this, and people like to see you. Thank you. OK. Hola a todos. Good morning to everyone. Good afternoon. My name is Jorge Alejandro, a medical doctor from Colombia. I'm part of the global shapers community supported by WEF. When I was hearing you, I was concerned about the actor who is not present. Who do you think is not present here? It's called stakeholder capitalism. And the government is not present here. I'm concerned about the fact that more and more public institutions are seen to be relegated in their ability and in their responsibility to guarantee healthcare coverage and access as well to the population. Given the fact that we have a good representation of pharma, providers, multilaterals, what do you think is the role governments and public institutions should play the future of healthcare? Should they just let everyone play from the private perspective? Should they regulate? What do you think? There's a moderator. I've got a strong view. Please come in, Shabana. The government is the elephant in the room. They don't need to be here with this. And I spoke about it when I spoke about the government coming in to do 500 million people, insurance, and in every country, if you look at Medicare, Medicaid, or if you look at the NHS, or any country in the world, Thailand, country after country, the government is supposed to stand up and that's the basic human right that they have to provide it with this. But what happens is that when they don't do enough, the person, the stakeholder, is the patient, is the one in need. And all of us serve to them. The government serves them. If it doesn't serve them enough, then it's our job with that. And that's where I think that you have to understand where governments play and where we play. Winnie and Christof are going to come in on this. But you see, you have a point. Helen, I agree with him. Governments have been taking a back seat and passing the back to private actors on health. Health is a right. It is a human right. It should not depend your health, whether you're sick or you live long, should not depend on the money in your pocket. The government should provide health care. You get up in the morning, you work hard, you pay your taxes, when you fall sick, the government should take care. But they are taking a back seat. The whole system now is very much about we can't manage let others come in. But yet we know everywhere where universal health care has been guaranteed. Public provision was the primary way. There could be some amounts of private, but public provision, and it's possible. Whether you are a rich country or poor country, you can do it. I keep talking about Thailand. Thailand has got like one-tenth of the GDP of the very rich countries. But it is able to provide quality, public health, public provided health care up to 90% or so. Publicly provided. But you're right to say that this question of the right of people to health, we are shifting towards, let us find solutions. And the solutions seem to be lying more and more in private provision. Christof, come back in. Of course you need government to step in because otherwise it will not be universal. So if you only rely on a private sector, they will always focus on the population where they can have the best possible management. So if you want to have a truly universal health care system, you need government to step in. And in many countries, people are there to remind government that they expect health care system. I mean, look in many democracy in many countries, health care system is very high on the election agenda. So it shows that people know that this is the government responsibility. But I think it's very easy also to criticize government and to say, oh, they don't do their job properly or they don't want to do it. But I think it's a little bit cynical to say that because I think this is very hard to do. It's very hard to do. It's not a slam dunk. I mean, talk to health ministers. This is a headache. To create an efficient health care system is very hard to do. And there has been so many testing. So you say, oh, free health care for all. Fantastic idea. Doesn't work. Too expensive. So what is the balance? How do you manage properly health care system? That's the challenge. We are testing other options to have the efficiency of the private sectors but with safeguards. The safeguards are more or less efficient. So I think that's what is going on is that everybody is trying to build the best possible health care system with at minimum cost, if you like, for the nation. And that's very hard. And I think there will be more and more tests and try. The health care system are better today than 50 years ago. I think in 50 years, they will be better than today. We have a lot of data to optimise as well. But that's what's going on, I think. I've been a health minister. OK. There's never enough money, right? It's very hard. It's all about resource allocation and you're trying to channel more to the health promotion end and get smoking rates down and alcohol consumption down. And what was your relation with the finance minister, right? Well, not so good. Within the first two weeks, I think, of becoming health ministry, wanted 2% cuts across every department and that is painful on health. I can't tell you how painful. So I know a little about the strains that our ministers are under. I was a health minister actually 30 years ago. Now the technologies and treatments are so much greater than they ever were then. So the pressures are so much more too. Now, we're going to have gender balance on the questions. I want a woman's hand up. I've got your hand up. Because we've got such a gender balance panel that we have to carry on. Alexis Miguel Johnson, I'm the president of Planned Parenthood and so gender was directly in my conversation. Particularly because when you spoke so beautifully and painfully about the young girls, really, who are at the centre of HIV and AIDS crisis and many others. We are at the 47th anniversary of Roe in the US and in a couple of days will be the third year of the global gag rule. So my question as we talk at this conference around gender equity, like how are we actually centering gender equity in healthcare for the future because it seems like we are really going backwards. And I'm going to make the response to your question the last sort of round for the panellists because at 143 I need to bring Wef back in to close us up. So gender health, who'd like to come and ying? You haven't had a round for a while. So I guess that, you know, there's gender equality and accreties in the problem but there's also, you know, age. The infants cannot express their needs and the elderly's you know, sometimes they have, you know, like they feel lonely and so, you know, how's the sickness, when people become ill the situation become very, very complicated and everybody is very different and that's why, you know, I emphasize two things. One is, you know, personal. It has to be very personal and you know, people have to be empowered with enough information and they have to have the will to find out things themselves but secondly, you know, it's a service, right? It's women, men, you know, it's a infant, it's the elderly's, you know, there's a huge diversity. You know, I don't want to emphasize into a particular group because when people become ill and, you know, or sick they, you know, it's very personal. It's beyond gender or age or, you know, like ethics. It's beyond a lot of things, right? Thank you, Shabana. You belong to a nice country. I do think that there are prejudices. I agree with you. Do you think we are moving backward or forward? I think that even today as it stands there are some areas in the world where there is a disparity and we cannot take that away. And I think this is where the social determinants really are so important and why we have to continue to push the envelope and the second part of it is where we have to continue to push the envelope and the second part of it is where we have to push the envelope. We have to push the envelope and the second part of it is where this is where education and health really intertwine because we have seen in societies where the women are more educated they make better choices not only for themselves but also for their families. So true, yeah. Christof, my old view, I mean, I think we should fight against any prejudice and inequality and I agree with you health care is right and I think that countries are focusing on that. I visit many countries and the health care system health is always a key priority but it's very hard to do and I think that we will continue to test and try and improve the health care system as we go. I think many of that are hopefully will help a lot. Many health care system are designed today as they were designed 50 years ago and it's very difficult to manage the patient and they are extremely difficult to optimise. I am optimistic that in the next 20-30 years health care system will be much more efficient. I'm going to ask Winnie for a minute on a subject she could talk for hours on. Winnie? First I want to say that Christof is not being very honest here. Christof, if you listen to him I ask him, I said you must be French. His accent is French. He's a French man. So now you have a French health care system. There is a health system like the American one. How can you tell me that this too that this one is also trying some system to see how it works one health system is based on public provision the other one is based on private insurance. That's the difference between the two. It seems simple words. None of them are perfect. But I think that one is trying to deliver the human right to health and the government is saying it's our responsibility to deliver human rights to be a country based on fairness, on social equity and addressing the barriers that people face to health. But the other one is saying if you can work and get some money or you get an insurance and you're on your own basically that's the difference between the two in my view. So I'm ending by saying it's a human right and people who are who face different barriers social barriers in society if you are a woman if you are a racial minority a sexual minority if you combine all of those you're probably going to suffer more ill health than someone with fewer barriers. And that's why governments must deliver for people. So a system that doesn't give privacy to public provision is not delivering on human rights. So how to summarise this conversation which I think will continue in the corridors as we go so many possibilities in innovation. Whether it's the tech sphere, the treatment sphere innovations one hopes to in health care delivery the way we did half a century ago. The role of government I think everyone's affirmed as important but there's a feeling that some are missing in action or not active enough. The demographics are challenging with the ageing society but come back to the point we're still leaving people behind and if the universal health coverage agenda the SDG agenda is to mean anything it's don't leave people behind design systems that will go to all. So that's my headline summary but if you want to come forward just talk a little one million on the platform. Yeah so thank you for summarising so well the mega trends I think at the work we're doing at the forum is very very aligned with what you're suggesting I think there are two things to it it's a matter of sustainability like you said Christof the costs are rising very fast 7% annually and 2 billion on the planet have no access so you need to do two things the equation is pretty simple solutions are pretty complex keeping people healthy addressing social determinants of health protecting populations from epidemics and then people unfortunately one day or another will be sick then providing optimal care appropriate cost personalised medicine and do that universally so focus on universal health care coverage and also on mental health that is very very often understated so that's really where our platform is operating we are hosting 25 coalition projects on those various themes we would be very very hopeful that you express an interest and you want to lead more of those projects moving forward thank you very much Thank you