 Good afternoon and welcome to this afternoon's webinar from the IIEA, which has as its theme no one is safe until everyone is safe. And a very special welcome to Dr. Sumia Sominathan, the Chief Scientist of the World Health Organization. Today's event will last 45 minutes. There will be a presentation of around 20 minutes by our guest speaker and this will be followed by questions and answers. Please feel free to submit your questions using the question and answer function on Zoom during the presentation and we will come to the questions after the presentation. Both the presentation and the Q&A are on the record. Please feel free to join the discussion on Twitter using the handle at IIEA. It is a very great pleasure for me to welcome Dr. Sumia Sominathan and to introduce her formally to you. After a distinguished career in India where she was a very distinguished pediatrician and researcher in the area of AIDS and the area of tuberculosis, she went on to become Secretary to the Government of India for Health Research and Director General of the Indian Council of Medical Research. In 2017, she was appointed to the position of Deputy Director General for Programs of the World Health Organization. And then in 2019, shortly before COVID, she became the Chief Scientist in charge at the same time of a newly created division on public health. It is a great pleasure for me to hand you the floor. Thank you so much, Mary, and thanks very much to the IIEA for arranging this. What I'd like to do is perhaps share a few thoughts. Of course, there's so much that we can speak about COVID and about the vaccines and the rollout and many other things, the public health measures, the use of diagnostics, the research that's gone behind all of this. But I will touch on a few things which I think are very topical and very important. And then perhaps in the Q&A, we could also address other questions that the audience might have. So I will now share my screen and make the presentation. And I hope you can see the screen and that you can hear me well. So just to recap the global situation, because it changes, it's so dynamic. What you see here is a graph with the different colors representing the different WHO regions and the dark black line representing the daily deaths. And in the last 24 hours or so, of course, this is from yesterday. So it may be a little bit different today. We had almost 400,000 new cases in one day and over 8,000 deaths. And you can see that the cases have fluctuated over a period of time and also by region. And on the other side of the slide, you see the countries with the highest number of cases in the previous 24 hours. Brazil, India, you see a number of countries in different regions. Actually, we have Colombia, Argentina. And then you have Iran. We have Indonesia and India from the Southeast Asia region. Brazil, of course, is number one. And then also South Africa with the worrying third wave and the Russian Federation. This shows us the cases normalized for populations. So the darker the color, the higher the number of cases that have occurred. This is cumulative from the beginning of the pandemic. And you can see that the Americas, both North and South America and the European region have really been badly impacted in terms of cases per 100,000 population. And similarly, deaths we see North and South America, the European region, but also South Africa. I'm sorry, the Southern African countries also quite badly impacted. Now, over the last couple of weeks, we started to see a reduction in a number of cases, as well as slowing down in the number of deaths per day. However, when you look at the last seven days, what is very worrying is an increase in cases. If you look at this column over here, we see that in Africa, cases were up by 18% and deaths by 20% in the last week. And you know that we've been saying over the last year that Africa has been relatively less impacted, that we've had fewer cases and deaths. And there's been a lot of discussion on the reasons for that. But this is a very worrying trend and potentially it's because of the delta variant that we know is more transmissible than the other variants that we've had so far. And it's very rapidly spreading across the world. We have documented a delta variant in 95 countries, but it doesn't mean that it's only limited in the 95 countries, because of course, we know that the sequencing speed and the amount of sequencing is varies from country to country, and many countries in Africa do not have adequate sequencing capacity as of now. We see the Eastern Mediterranean region showing an increase in cases, Europe showing a significant increase in cases and a worrying increase in deaths. Thankfully, in the Americas, there's a slight decline, or we can say stabilizing with a reduction in the number of deaths. Southeast Asia, again, largely driven by India and Indonesia are the two large countries of that region, cases stabilizing, that's reducing a little bit. And overall, a global picture of cases relatively stable, we could say from the previous week and a slight reduction in deaths. But this is, as I said, a dynamic situation and the delta variant makes things particularly hard to predict. And again, by region, we see the Americas sort of stabilizing, plateauing, Europe starting to show a slight increase Southeast Asia on its way down, but also Africa showing an increase in Eastern Mediterranean also showing an uptick in cases. Moving on to vaccines, or just maybe before we go to vaccines to clarify the issue of the variants that I talked about, which could be accounting for this shift in epidemiology. We have four variants of concern, the alpha, beta, gamma, and delta. And then you know that we named them with the Greek alphabets, because otherwise they have very complicated scientific names, or they are being called by the names of the countries from where they originated, which sometimes ends up stigmatizing those countries. So this is why we moved to the Greek naming system. And so there are four global variants of concern and why are they variants concerned because they're either more transmissible, or they have some properties that make you more sick with more severe illness, or they have some properties, some mutations that enable them to avoid some of the antibodies that are generated by vaccination. So they need higher levels of antibodies. So the alpha, beta, gamma, and delta all have some properties that the delta by far till date is the most highly transmissible. It's 50% more transmissible than the alpha variant, which was the one that became dominant across the world in 2020 and deltas on its way now to becoming the dominant strain. Luckily, the vaccines still work. Now we've crossed 3 billion doses of vaccines administered across the world, over 215 countries or territories. The COVAX facility has shipped about 90 million doses to 133 participants. There are only five countries that have not started vaccinating yet. But if you look at the color in this graph, you can see that all of Africa is very light green and a large proportion of here, Eastern Europe, Eastern Mediterranean region and large parts of Southeast Asia also light green. COVAX was set up last year in order to both accelerate the development of new vaccines and the equitable access. Now, we aim to distribute at least two billion doses of vaccines by the end of 2021. This graph actually shows the participants in dark blue that have received doses from COVAX, as I mentioned, 133. And there are others in light blue that are vaccinating either through their own vaccines or with bilateral arrangements or donations. The issue has been really with supply into COVAX because by now we should have shipped 400 million doses. We're still at 90 million. And this is because we just don't get the supplies from the manufacturers, including those that have signed contracts and had agreed to supplying COVAX. And we can discuss more the details about that. Here are the top 10 countries in terms of administered doses, clearly China on top with over a billion vaccines administered and 77% doses have been administered by these 10 countries. So this is where the inequity starts becoming obvious. When you look at the WHO member states with coverage of over 20%, you can see that in the Afro region, only two out of the 47 countries have achieved anything close to 20%. And if you remember, 20% is a target that we set, which would have covered the high risk groups. That's the frontline workers, the health workers and social workers, those in vulnerable positions, as well as the elderly and those with underlying illnesses and comorbidities. These are the people who are at highest risk of getting infection, highest risk of dying. And so if we had by now, and with the 3 billion doses, by the way, we could have covered 20% of every country, and we could have protected these people instead of continuing to see the deaths that we're seeing today. But you can see that there's a difference between regions. This shows that the Pfizer and the AstraZeneca vaccines are the two most widely used, but there are, you can see a number of vaccines out there. And this is a success of the scientific work and the R&D collaborations that have happened that have enabled the vaccines to be delivered, but not enabled equitable access. And so this is another way of looking at it. If you look at doses per 100 population, high income countries, 74 doses for every 100 people, the very lowest income countries, only one dose per 100 people. And so there's a huge and widening in equity here. Many countries we know are moving very quickly to covering 60 to 70% of their adult populations, whereas here, not even the elderly, not even the healthcare workers have been vaccinated. Now, what about other things, essential health services? So WHO has done a couple of rounds of two rounds, actually, of the pulse surveys where we look at how has a pandemic impacted other services? And we see that while things have improved a little bit, a drop in disrupted services from 54% in mid 2020 to 37% in early 2021, it's still a large number of essential services, particularly again, in high income countries that in the low income countries, I'm sorry, that are impacted. And you can see across all the major health areas from maternal and child services, immunization, and non communicable diseases, mental, neurological and substance use disorders, communicable diseases like TB and malaria, neglected tropical diseases. So the impact of the pandemic is on people on their health is not just directly people getting ill or dying of COVID, but getting ill and not able to get access to services. If you develop TB, for example, there were lockdowns in many countries, patients unable to access health services, there were supply chain disruptions, there were there were stockouts in drugs and diagnostics, all of this. And of course, the health workforce, doctors and nurses and other health workers were all mobilized to deal with COVID. And therefore, all of these other things have led. So that's what when we talk about excess mortality, due to the pandemic, it's partly due to COVID itself directly causing deaths, but a lot of deaths which would otherwise have not occurred, if health services had been functioning. What about access to vaccines in general? As I mentioned, routine immunization was disrupted in 2020, this continues in many countries while many countries are really trying to get their systems back up. We saw in May 2020, 67% of countries reported some degree of disruption to immunization a year later, 37% continue to report disruptions, mass campaigns were disrupted, particularly things like measles, yellow fever, polio, this is putting a lot of millions of people, especially children, at risk. And measles is something we're really worried about because measles outbreaks we know can really be devastating. A word about vaccine hesitancy, because I think this is really, really important as we trying to ramp up vaccination coverage, not just for COVID, but for other vaccine preventable diseases. And if you want to achieve what's called herd immunity or population immunity, you need to get to that 70, 80%. What we need to understand is that attitudes are dynamic and evolving and there's substantial variation across demographics and at a sub national level. These are quite context specific, so what applies in Ireland may not specifically apply Nigeria or in India, ethnicity, geography, education, socioeconomic status, employment, all of these matter. Hesitancy is a hurdle that information alone does not address, but it does, there are ways of decreasing hesitancy. An important factor is trust in government, which translates into trust in vaccines and a lack of transparency feeds mistrust. But even when we are transparent, there are still a lot of conspiracy theories out there which impact people's beliefs. And what we need are targeted interventions that are based on local data, local understanding of what people really believe, what their concerns are, and we need to focus on these specific groups where there is a higher level of hesitancy. So this again, a global map to show the vaccine programs that have been disrupted and it shows you actually by antigen or by the type of vaccine. So we did show you, I showed you data on vaccine distribution, but the same applies to therapeutics and diagnostics as well. And you can see that high income countries do this typo here which is high income countries do 125 times more tests per day than low income countries. And we've also all seen what shortages of oxygen look like across the world in India and Brazil and Nepal and now in Africa, Tanzania for example, Uganda really struggling with shortages of oxygen. And therefore there is a need to improve the manufacturing capacity in countries around the world so that there is no reliance on a particular country or countries to supply these products. And we saw at the beginning of the pandemic, a similar disruption in supply chains of personal protective equipment like masks and gloves and PPE suits. And we see that happen time and again. So WHO obviously has been working across all of these areas monitoring the pandemic, making sure that we have the latest in the epidemiology, strengthening local regulatory capacities and ethical guidance. This is something that WHO has been for a long time working with national regulatory agencies with ethics committees, enhancing clinical research, development and trials. I'll say a little bit more about that. The ACT Accelerator was created to mobilize resources for diagnostic therapeutics vaccines and also to support health systems and then ensuring now the latest our efforts on developing capacity for production of particularly vaccines, but also other health products. On the ethics side, we've done a fair amount of work I think over the last year or so with our bioethics working group, excellent external experts, international experts that have come out. This is just an example of some of the products on mandatory vaccination on how to do placebo control trials on human challenge studies for COVID on digital tracking technologies and the ethical considerations around them. And these are useful for people, not just for research, but also just to think about issues. We've also got ethics guidance on what do you do when you have limited vaccine supplies? How do you prioritize groups? The R&D blueprint has been very active. This was set up in 2015 after the Ebola outbreak. Essentially, what it does is it prioritizes pathogens that can cause epidemics and pandemics. It develops a research roadmap with target product profiles with regulatory standards, with trial designs and innovative analytical frameworks. And there was always a pathogen X in the R&D blueprint, which of course turned out to be the SARS-4V2 virus. So very quickly, the expert groups mobilized and started looking at animal models, at assays. There's need for standardizing assays when you're talking about doing studies in different countries. We developed code protocols for clinical trials, target product profiles, which really helped vaccine developers, for example, to have the benchmarks against which their product would be tested and also prioritizing which drugs should move ahead. And then looking beyond the emergency use listing and studies which need to be done post licensure. The Solidarity Therapeutics trial is an example of multi-country collaboration on research over 500 hospitals and over 30 countries coming together to test drugs. We started with repurposed drugs last year and are now moving on to looking at drugs that modulate the immune system and can help to reduce mortality. I mentioned the accelerator that was created with three streams of work on vaccines, diagnostics and treatments, but also a cross-cutting connector on health systems support and a global access and allocation framework that was developed by WHO to ensure that once you have the products, you need to ensure equitable access. I mentioned variants and the problems that we can foresee because of that and how the variants might impact not just the efficacy of vaccines, but also public health measures that could be needed, that may need to be modified to deal with different vaccines and different variants. And so we have a coordination mechanism, a risk assessment and monitoring framework now that works with partners, with researchers, with member states. Does the risk assessments define the research agenda makes recommendations which can then be used by member states to either modify public health measures or change the use of drugs, vaccines, etc., if needed. The most recent work stream in Covax has been the manufacturing task force under which there are four work streams. WHO is leading work stream three, which is on expanding sustainable manufacturing capacity in low and middle-income countries. And there are a number of partners that have come together, including private sectors of society. The idea really is to both unblock immediate supply chain issues, looking at things like export permits and so on, creating an input supply visibility partnership where companies can come together and share their needs on what may be holding up vaccine production and looking at expanding film finish capacity, also landscaping the global manufacturing capacity. For example, we know that Africa as a continent has very little manufacturing capacity and is dependent on imports for most of their health products. So that really needs to change. And that's why we are starting with this concept of a technology transfer hub where a global network of such hubs would of course in the longer term improve the capacity of LMICs. But the first thing we're doing is to start with an mRNA tech transfer hub and the first hub has been announced in South Africa. It will bring together the government along with researchers, with developers, with the holders of intellectual property. This hub will, so if you look at this journey to establish this kind of a hub, we put out an expression of call for expressions of interest. We define the criteria, we've announced the first hub. We are now in the design phase, we need to develop a business plan, secure funding. We don't need to build any buildings because South Africa already has existing companies that will take this on. But then this hub becomes the site for training and then other countries send teams to come and learn the technology and then take it back to their countries and set up production sites, starting with mRNA but then hopefully going on to other technologies. And all of this will lead to better and new vaccines affordable as well as contribute towards regional health security. So that's again just to say that we had a very good response to this. We have done the due diligence. We had over 50 responses, both from potential tech donors and the sites for hubs, but also from countries and manufacturers that would like to be recipients. So you can see that across Latin America, Asia and Africa, there's a lot of interest really in receiving the technology. And I think I will stop just by saying that there's constantly new challenges, more work to be done. Obviously, we're not at the end of this pandemic at all. And in fact, Dr. Tedros has said many times that this year, 2021 actually may turn out to be worse than 2020 because we had many countries taking very strict action in 2020 to limit the impact of the pandemic. But now the pandemic fatigue with the feeling that they are over the worst. And also because of economic compulsions, people have to go back to work on their living, in our schools. In fact, on children has been immense. Hundreds of millions of children have been out of school now for more than a year, missing out not only on education, but very often on their midday means their nutritional needs as well as their psychological and social needs. And so we haven't talked about all of the other impacts that this pandemic has had, but clearly we need to think about those as we rebuild and also ensure that the world is moving ahead together, that we're not in a situation where there are now two diverging worlds, one that's getting back to normal life as we knew it before the pandemic because of the availability of vaccines and the other world, which is still struggling with increasing cases and health system overburdening as well as deaths. So I will stop there and turn it back to Mary to facilitate the discussion. Thank you very much. Thank you. Thank you very, very much for that very detailed and very, very interesting presentation. Can I just ask a question myself initially? You pointed to work really at great speed to address deficiencies that were there for a long time, building capacity, manufacturing capacity, building manufacturing hubs, transfer of technology, but all of these, even with the sense of urgency you have conveyed, will take time. Is there anything that can be done at the covex end to speed up delivery of vaccines in the next few weeks and months? Yes, that's a very good point. Thank you for that question. Absolutely. So we are taking a longer-term approach, but in the short term, what is it that we can do? I think the first thing is the sharing of vaccines. Many countries now have adequate vaccines. They have already covered 30, 40, 50 percent of their populations, and this is the time to start really sharing those doses with countries which, as I showed, haven't even gone beyond 1 percent. So I think that can make a huge difference. It started happening. Several countries have already started sharing what they have and through covex so that it goes equitably to countries which really need it. So in the immediate, we are asking that we receive at least 250 million doses. In fact, we're already through June. We were asking for it in June and July, but very much in the short term because our goal is, let's get to at least 10 percent coverage of every country by September and 40 percent of population of every country by the end of the year. That's the goal. And it can be done, as I showed, with the three billion doses had been equitably distributed. We would have gotten to 20 percent everywhere by now. So that's the most urgent is the sharing of doses from countries that have it or excess supplies many countries have before they start vaccinating the children, before they start giving the second doses as boosters to the adults. Please share with covex so the vulnerable can be protected. The second is for manufacturers to prioritize covex. Many manufacturers are prioritizing countries which are paying them maybe higher prices. So it's not very transparent how the deals are being done. And even though covex has deals with companies, we find that we often are at the end of the priority list and not at the at the top. So that's the request for manufacturers. And thirdly, we request all countries to facilitate exports and imports of substances, raw materials, ingredients, because, you know, vaccine manufacturing is complex. No one country has everything needed for a vaccine. So there are, you know, hundreds of ingredients that go into vaccines. We need to move across borders and we've seen that many countries are imposed restrictions, which make it very difficult. So I think these three actions will facilitate in the short term, the increase of the supplies into covex and then out into countries very rapidly. That happens very rapidly. It happens in a matter of days. And then the more longer term sustainable supply will come later. Thank you. I have a question here from Chloe De Quayne, one of our researchers at the Institute. And she asks, how can states design longer term strategies beyond current measures to help societies live with COVID-19? And how has your timeline for the pandemic changed since the emergence of the new strains? Yes. So this is a very good question. And situation is dynamic. I think there are still a lot of things we don't know about this virus. On the immune system, I think there's good news. It looks like we do mount a good immune response, both to natural infection and to the vaccine. And we believe that this immune response will be longer lived. So hopefully we're not going to need boosters every year and so on. But again, we're not sure till we do the follow up and the studies. Can we eradicate this virus at this point? I don't think so. It's going to be difficult because it's everywhere. And it's also shown that it can go between animals and humans. It's a number of animal species that have shown that they can be infected. But so what we need to do is get it to a point where it becomes a manageable respiratory infection, perhaps something like influenza or other respiratory viruses, which for the majority of mild infections that most people recover from, a few people could get sick. But those are the people who need to be protected through vaccines. And I think the big difference here is we have safe and effective vaccines, much, much better than the vaccines we have for influenza. We have diagnostics. We also know how to treat sick people now. Corticosteroids work. We still don't have good antivirals, but that's again under development. Maybe we will have an oral antiviral drug that can stop if taken early. So there needs to be continued research and development investment in that there needs to be more clinical trials. But we need to make sure that in the short term, I'm talking about the next six months as vaccine coverage expands across the world, the public health measures, the wearing of masks, maintaining the distance, not gathering in huge groups and mass gatherings, avoiding all of that, because we've seen how the variants can take off. You need one infected person in a crowd of people to infect a lot of other people. And then, of course, it spreads so quickly across boundaries and national borders. We cannot keep these viruses away from borders. So this is why all countries need to still show that people need to show that discipline for some more time to come while we make sure that once every country is up to say, let's say 40% or 50% of vaccine coverage, things definitely should start to improve. So that should be our focus in the next six months. Thank you for that. There's a question here from Alex Conway from the IIEA. And he asks if, from your slides, he noted that there seem to be very few EU countries and either the tech donor or tech hub list in your presentation. Could the EU be doing more in this area? So we're actually working very closely with the EU and they're a very strong partner with us, the European Commission and both DG Santé and the INTPA are committed to working with us to funding. We are also talking with some of the companies that reside in the European Union on technology transfer. These take time and these are complex discussions, but certainly the EU has a very important role to play here because they have the capacity, both for research and development and the clinical trials as well as the medicine agency, the European Medicines Agency, which Africa is now trying to replicate as an African Medicines Agency. So there's a lot of capacity building and training that can be done, as well as, of course, on the technology transfer and the experience with manufacturing that Europe has can now be taken to Africa and then to other regions as well. So we have very good partnership, both with member states as well as with the European Commission itself. Another question here from Oxfam Ireland, Michael McCarthy Flynn, and he references the fact that the WHO Director General has supported the TRIPS waiver and praised the commitment by the United States in support of the temporary waiver of intellectual property. How do you see this issue developing? What sort of, is this something that is a long term issue is distinct from getting the vaccines in the arms of those who need them as quickly as possible? Yeah, and you know the TRIPS waiver obviously is something under discussion at the World Trade Organization. That's where the negotiations are taking place. But I think the reason that DG Tedros and the WHO supported it is that in a pandemic, we have to have different modes of operation. We cannot go by the rules that may have been agreed to in a normal time. So we need the TRIPS waivers and flexibilities to be operational because you don't want a country by country approach to dealing with the TRIPS flexibilities, which of course every country can now, I think under the rules. But if you had a waiver, then it would not need that intensive work that would need to be done by each country and all the legal issues. So that's one. But having said that, I think the TRIPS waiver alone is not going to result miraculously in suddenly scaling up vaccine manufacturing in countries because it's not just a question of the patents or the IP, it's really the know-how. And it is years of R&D and the know-how that's been developed and has been shown to work. If the owners of that know-how were willing to share that and train others, then this could happen very quickly. It might still happen without that. So you could have a group in a country X that decides that they want to create the same vaccine that Moderna created or BioNTech created, but it could take them years to do that. So patents could be a barrier. They're not necessarily a barrier in every country because in many low-income countries, you find that the patents are not the barrier, but it's the know-how. And in a pandemic, we cannot waste years of time trying to develop something when somebody knows how to do it. So this is why we're saying that tech transfer needs to happen. And we need many more manufacturing sites across the world producing vaccines now. And of course, for the future, once you learn the technology, then you can use it hopefully to make other vaccines as well. So it's a two-pronged approach. The TRIPS waiver addresses some of the issues. It's also a very good signal. I think to say that in a pandemic, we should not bring any obstructions, but then beyond that, we do need this kind of collaboration to actually make it happen. That leads me into the next question. And that is, has this pandemic better informed our understanding of public health from a World Health Organization perspective? And I ask you this as the head of the division dealing with public health. And how can we ensure the lessons are not forgotten, as has happened with previous epidemics or pandemics? Yes. It's a big question. And maybe you have some thoughts on how do we make sure that we don't go back into the cycles of panic and neglect that we've seen in the past. That's exactly our concern. And that is why we want countries to come together and discuss a pandemic treaty, so that we put in place some binding rules and regulations. But what the pandemic has done has exposed, I think, the inadequacies of investment in public health. And I'm saying this for all countries, high income to low income. We've seen how systems got overwhelmed, not necessarily, I mean, the tertiary hospital systems got overwhelmed. But what we saw was the public health systems were not strong enough to do the contact tracing and the tracking of people and the quarantining and the scaling up of those essential services that were needed. There wasn't the resilience or the capacity in most health systems. So this is why it needs investment. And again, WHO and Dr. Ted Ross in particular has been talking about investment in universal health coverage as the primary thing that every country needs to do because universal health coverage basically covers all of these things that we're talking about from surveillance to the health workforce, to having the medical products, to having the data systems, and to be able to have a good governance that responds and was able to quickly pivot to whatever the urgent needs may be. And also we, of course, with universal health coverage, we also, that includes investments in upstream determinants of health, like addressing air pollution, like making sure there's clean water and sanitation, making sure that nutrition needs are addressed, that mental health needs are addressed. So we often think about the health system only as a healthcare delivery. And we forget that many of these upstream factors, the risk factors, the determinants are actually what keep us healthy and well, and we need to prevent ourselves from getting ill. So I think it's all interconnected and it deals with prioritizing health. And I hope that all countries have seen today that if you do not prioritize health, that everything else can collapse, and the economy will be in shambles. And it's not just a pandemic that can do that, right? We have so many existing issues that we're not dealing with that are impacting health. So, yes, I think the question is a very good question. How do we keep that focused? I think there are suggestions now from many bodies, from the G7, the G20 and all of these, the IPPR that was set up by WHO, the Independent Pandemic Preparedness Review, have all, I think more or less recommended that there should be a kind of a global health council or a board, or a global health security council that will perhaps be the G20 represented at the highest level, which would constantly be alive to these issues and be able to address and also to hold each other accountable. I think it's important that there should be accountability as well, that we should not be pointing fingers at each other, but really trying to address the fundamental issues. I'm coming to the end of the time, and we are very, very appreciative of your participation. Can I ask you one final question? Because I've been reading what you had to say about the need for better data collection, and you had some extremely interesting things to say in that area, and it ties in with what you said in your presentation about countering vaccine hesitancy. This may be finished with a few comments on how you see the issue of better data collection going forward as a means of combating these health threats. Yes, I think data is critical, because without data you're completely flying blind, and in fact, when we say that Africa has very few cases and deaths, a lot of it is the lack of data and surveys that have been done actually have shown that there have been many more cases than have been reported, and this is true for many countries, because I mentioned about the lack of diagnostics. There's data on deaths, what we call the civil registration system, which in many high-income countries is taken for granted, every birth and death is registered and accounted for, but in many countries even that basic system is not available, so you don't know how many people die, you don't know what they're dying off, and so you don't know what your disease burden is, so starting with very fundamentally vital registration systems, but then moving on to these integrated health data information systems, which are linked, again we see silos within health systems, we see a program for TB data and a program for malaria and nothing talks to each other, so this is why we have prioritized data and digital health as areas of focus over the next several years, and there's a science division, there's also the data and delivery division that looks at how to strengthen health systems, and within science we have digital health, where we now have a global strategy, which lays out a roadmap for the next 10 years, and we'll be working closely with countries to build those capacities, but we see the deficiencies because countries report their health data to us, and very often we have data which is not even disaggregated by sex or age, that's the very basic what you would expect, and so if you don't know how many men, how many women, which age group, your particular disease is impacting, it's very hard to do anything about it, and to have policies that will have an impact, so it's again, I think the pandemic brought out the weaknesses in the systems we have, and so as we think about these investments in health, I think data and health information systems are going to be very critical, and just to end perhaps with the hesitancy again, you need social science and behavioral science here as well, because public health needs that connection with public, and with understanding and with the attitudes and views and practices, and that's contextual, so every country needs to be able to invest in, when we talk about research, it's not only biomedical research, but it's also social sciences research and interdisciplinary research, which will ultimately lead to better program implementation, thank you. Thank you very, very much, thank you for your time, thank you for the breadth of your knowledge, and above all, thank you for the work you're doing on behalf of all of us in the World Health Organization. Thank you so much, it's a pleasure.