Event 201 Transcript

Feb 26th, 2020
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  1. - Part 1
  2. - 0:05
  3. - Hello, everyone. I'm Anita Cicero, Deputy Director of the Johns Hopkins Center for Health Security. And today I will be your master of ceremonies for event to a one. On behalf of our center and our partners, the World Economic Forum and the Bill and Melinda Gates Foundation, I'd like to extend a very warm welcome to our audience here in New York, as well as our larger virtual audience participating online today.
  4. - 0:31
  5. - The goal of the event to a one exercise is to illustrate the potential consequences of a pandemic and the kinds of societal and economic challenges they would pose. The scenario also highlights the very critical role that global business and public private partnerships play in preparing for and responding to pandemics.
  6. - 0:55
  7. - Today's scenario is going to simulate meetings of a multi stakeholder group
  8. - 1:00
  9. - called the pandemic emergency board. This board has been urgently convened by the World Economic Forum. And Johns Hopkins has been asked to moderate the board meetings and provide expertise during the board's deliberations.
  10. - 1:16
  11. - The mission of the pandemic emergency board is to provide recommendations to deal with a major global challenges arising in response to an unfolding pandemic.
  12. - 1:26
  13. - The board is comprised of highly experienced leaders from business, public health and civil society.
  14. - 1:33
  15. - The board's recommendations are aimed at top decision makers in national governments, global business and international organizations. In this scenario, Tom Inglesby, the director of the Johns Hopkins Center for Health Security, will be chairing the board and serving as the moderator for its discussions. Today's exercise will simulate four meetings of the pandemic emergency board and each meeting will be devoted to one key topic.
  16. - 2:01
  17. - Each meeting will start with a video and a briefing that will provide the information needed for the board members to engage.
  18. - 2:09
  19. - Please note, this is not a test of any particular person, organization or nation, the participants are all playing as themselves, that is senior business executives, NGO leaders and government officials. They're not expected to be pandemic experts. We've really asked them to participate based on their own expertise and their best professional judgment. With the exception of Tom Inglesby, none of the participants know any of the details about how the exercise will unfold.
  20. - 2:39
  21. - The event to a one scenario is fictional, but it's based on public health principles, epidemiologic modeling and assessment of pest outbreaks. In other words, we've created a pandemic that could realistically occur. And for those interested in our assumptions, will have a lot of the background research and of the scenario
  22. - 3:00
  23. - publicly available on our event to a one website at the conclusion of the exercise.
  24. - 3:07
  25. - The policy discussions the challenges to be discussing this exercise represent controversial high stakes issues that would require high level input from business and government leaders. So just a few housekeeping notes before we get started. For our in person audience, please do silence all your electronic devices, but you may tweet at hashtag event to a one.
  26. - 3:34
  27. - We're going to have a 15 minute break in the middle of the exercise. So please try to confine your calls and work to that time.
  28. - 3:42
  29. - Because the event is being video recorded and live streamed, we ask that you remain quiet as much as possible and avoid moving around during the exercise.
  30. - 3:52
  31. - The exercise is going to end at 1230 and there'll be a luncheon in the cotillion room to which you are all invited.
  32. - 4:00
  33. - As you know, there's also an online virtual event to a one exercise that's happening simultaneously. And for those of you online, and I understand there are hundreds of you, you will be seeing the same news videos and briefings as we do here in New York.
  34. - 4:17
  35. - But you will engage in your own online discussion in place of watching the discussions of the players here in the room.
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  37. - The topics and the, the topics and the pacing of the deliberations will be the same both online and in the room.
  38. - 4:33
  39. - So as you can see on this slide, we have an outstanding group of global leaders playing the role of the pandemic emergency board members here in New York. And with that, let's welcome our participants and invite them into the room.
  40. - 4:48
  41. - Tom Inglesby from Johns Hopkins Center for Health Security, Latoya Abbott, Marriott International. Sophia Sophia bore his uncle
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  43. - nation,
  44. - 5:02
  45. - Brad connot Henry Schein
  46. - 5:06
  47. - Chris Elias the Bill and Melinda Gates Foundation.
  48. - 5:11
  49. - Tim Evans formerly of the World Bank,
  50. - 5:15
  51. - George gal from China, CDC, Abraham Haynes, former deputy US national security adviser,
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  53. - Jane Holton, ANZ bank, and former Secretaries of both the Department of Health and finance and Australia.
  54. - 5:34
  55. - Matthew Harrington from Adelman
  56. - 5:38
  57. - Martin Chronicle from Lufthansa group.
  58. - 5:42
  59. - Eduardo Martinez ups foundation.
  60. - 5:46
  61. - Stephen read from USC DC.
  62. - 5:50
  63. - Adrian Thomas from Johnson and Johnson
  64. - 5:54
  65. - and hosty taghi from NBC Universal Media and loving 30
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  67. - From the Monetary Authority of Singapore. Welcome. And before we begin the exercise, I also want to introduce Ryan more hard who's lead of the global health security group at the World Economic Forum and he will say a few words, Ryan.
  68. - 6:23
  69. - Thank you, Anita. Good morning and welcome again, on behalf of the Center for Health Security, the bill and the Gates Foundation, and the World Economic Forum. Welcome to event to a one
  70. - 6:35
  71. - to one.
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  73. - Throughout our session today, I hope that number will represent two dimensions of our work to strengthen global health security.
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  75. - ^^First, today, there are 200 epidemic events every year, and it hasn't always been this way. The number is increasing, driven by globalization, climate change, urbanization, deforestation.^^
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  77. - And other trends of our modern world. In other words, we're in a new era of epidemic risk.
  78. - 7:09
  79. - And the second dimension is that one of these days, one of these epidemic events will be a pandemic, a fast moving pandemic. And mitigating risk and impact of that pandemic will require an all hands on deck approach.
  80. - 7:25
  81. - And we know from past responses that public private cooperation will be essential. We also know from these responses that there are some bright spots when it comes to public private cooperation. But some real critical challenges remain.
  82. - 7:39
  83. - But there's every reason for us to work together to address these challenges. For one, ^^it turns out that at $570 billion, annualised the annualized risk posed by pandemics is a on par and rivals with climate change^^
  84. - 7:57
  85. - which means that the pandemic risk to
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  87. - lives and livelihoods is at a level that governments and the world's biggest businesses can no longer afford to ignore.
  88. - 8:10
  89. - And we are counting on this conversation today to inform our work together to improve our collective preparedness and to protect lives and livelihoods from pandemics. And to provide further context. I'm very pleased to introduce a short video now from Dr. Mike Ryan, the executive director at who and the head of who is emergency program. So with that, we'll turn to a video.
  90. - 8:44
  91. - Greetings, distinguished guests and thank you for this opportunity to say a few words at this year's event to the high level simulation exercise for pandemic preparedness and response. Hosted by john hopkins Center for Health Security, the World Economic Forum
  92. - 9:00
  93. - The Bill and Melinda Gates Foundation. Unfortunately, I was not able to join you today.
  94. - 9:06
  95. - I'm involved in the Hydra Emergency Committee for Ebola. But I had hoped to be in the room with you, because the issues you will be dealing with over the next hours, maybe tabletop exercises today, but they address real and critical threats, which we who take very seriously.
  96. - 9:25
  97. - ^^Without a question, epidemic risk has become a global strategic concern. I don't think we've ever been in a situation where we have had to respond to so many health emergencies at once.^^
  98. - 9:36
  99. - ^^This is a new normal. I don't expect the frequency of these epidemics to reduce and in fact, vulnerabilities all over the world developed and developing countries have increased, not decreased, driven by many, many factors mainly through human behavior, economic development, population density, and many others.^^ The scenario you will be presented with
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  101. - This morning could easily become one shared reality. One day, I fully expect that we will be confronted by a fast moving, highly lethal pandemic of respiratory pathogen.
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  103. - Question is, are we prepared to globally respond to the next major pandemic event? ^^Are we ready to cooperate and perform across countries and across sectors to face such a threat? Have we established the surveillance and risk assessment systems, the communication tools, the supply chains and the business continuity plans that will be needed not only to protect health in a major epidemic or pandemic, but to protect economic development to protect political and social systems?^^
  104. - 10:48
  105. - Do we collectively drive innovation enough to face the evolving global threats which we are anticipating
  106. - 10:58
  107. - the nature of pandemics is that
  108. - 11:00
  109. - ^^Many countries will be affected at the same time. This is particularly true with respiratory pathogens, as they are often transmitted by asymptomatic persons.^^
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  111. - They spread fast. In 2009, the pandemic virus reached all continents in less than nine weeks.
  112. - 11:17
  113. - Who those priorities are to establish a minimum capacity to detect and respond in each country around the world to develop global strategies for the containment control of individual disease threats, and developed a global mechanisms to ensure cross sectoral and multinational multilateral coordination, innovation and partnership across all sectors are leaders, including including joint strategies between global health leaders and the drivers of travel communication data technology industries,
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  115. - who is working at all levels through a variety of partnerships to strengthen national and regional preparedness, such as Gorn, the global outbreak alert and Response Network
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  117. - to
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  119. - The pyp framework adopted by who member states in 2011, who secured 400 million vaccine doses for influenza 10 million antiviral treatments, and 250,000 diagnostic kits for the next pandemic. We have completed external evaluations of surveillance and response systems in over 100 countries and carried out more than 50 simulation exercises at country level, looking for vulnerabilities and weaknesses in national systems. This voluntary collaborative multisectoral process helps countries to assess their capacities and identifies the most critical gaps within their health systems in our to prioritize opportunities for enhanced preparedness and response. The epidemic supply chain network, part of the epidemic readiness accelerator which is a
  120. - 12:48
  121. - project of the World Economic Forum and partnership with mentees, including who it's a public private collaboration to ^^develop a globally connected supply chain that can support health emergency operations during a pandemic.^^
  122. - 13:00
  123. - Stakeholders consist of product manufacturers to logistics providers, distributors and new and partners including ourselves. Michael Griffin is who is focal point for the pandemic supply chain network and he's there with you this week.
  124. - 13:15
  125. - constant innovation and the use of cutting edge technology is key to endemic preparedness. In order to pull data and analytics at a global scale for disease prevention, the epi BRAIN Initiative at global data ecosystem aims to build a collaboration of big data networks to understand and predict epidemics. It supports data science, innovation for outbreak preparedness and response.
  126. - 13:40
  127. - Despite this progress, there is still much to be done. ^^Cross sectoral simulation exercises such as the one you will be experiencing today contribute to a better understanding of the critical gaps. The cooperation required from global businesses, response decisions required from government and public health leaders to minimize large scale economic and societal consequence.^^
  128. - 14:00
  129. - Tourism severe pandemic. I wish you the best of luck. We and we are looking forward to working with each of you to strengthen pandemic preparedness in the future. Thank you.
  130. - 14:13
  131. - And our thanks to Dr. Ryan. And with that, here in New York and online. Welcome to event to one.
  132. - 14:23
  133. - It began in a healthy looking pigs months perhaps years ago, a new Corona virus spread silently within her.
  134. - 14:33
  135. - Gradually farmers started getting sick. infected people got a respiratory illness was symptoms ranging from mild flu like signs to severe pneumonia. the sickest, required intensive care many died. At first, the spread was limited to those with close contacts, health care personnel, co workers and families. But now it's spreading rapidly throughout local community.
  136. - 15:01
  137. - international travel has toured local epidemics into a pandemic spanning the globe. Just three months ago, cap started in South America, but has now reached several countries with more than 30,000 cases and nearly 2000 deaths.
  138. - 15:21
  139. - Good morning. And thank you all for being part of this pandemic emergency board. We're at the start of what's looking like it will be a severe pandemic.
  140. - 15:32
  141. - And there are problems emerging that can only be solved by global business and governments working together.
  142. - 15:39
  143. - The global community has been working to respond to this pandemic since its recognition.
  144. - 15:45
  145. - But its health and economic impacts have become more severe. The World Economic Forum has convened this board because of your combined expertise, your backgrounds and your global voice. We will need all of you to
  146. - 16:00
  147. - Help us respond to urgent policy crises that are emerging.
  148. - 16:05
  149. - The purpose of this board is to advise leaders and national governments, global business and international organizations
  150. - 16:13
  151. - on the response to the pandemic, particularly focused on international problems that require collaboration between business and government.
  152. - 16:21
  153. - recommendations will be critical and will be promulgated and communicated broadly at the end of this meeting.
  154. - 16:29
  155. - On the west screen as we have this meeting, you will find a dashboard of information about the pandemic that will help us in our conversations.
  156. - 16:37
  157. - As important background for this discussion, we want to start the meeting by viewing this news story that just aired on global news network.
  158. - 16:54
  159. - Continuing our coverage of the newly discovered caps disease and the scope of its deadly outbreaks
  160. - 17:00
  161. - There are now more than 30,000 reported cases. Experts warn this may be just the beginning of a global problem. gnn science reporters have produced a video but what we know so far about caps, the virus, the outbreak, and the resulting chaos.
  162. - 17:19
  163. - ^^caps is a novel Corona virus related to those viruses that caused the frightening SARS epidemic in 2003. And the deadly MERS outbreaks in recent years. Scientists think each infected person in turn infects on average two more people. This disease is proving more transmissible than SARS or MERS, and about as contagious as influenza. Essentially, the cumulative number of cases is doubling every week. At this rate we can expect to see 16 times as many cases in a month unless we find a way to interrupt transmission.^^ The virus appears to be spread
  164. - 18:00
  165. - rapidly in densely populated and impoverished neighborhoods in some mega cities in South America, caps is a serious respiratory disease. More than half of the recognized cases have required hospital care, creating a huge strain on healthcare systems, the fatality rate is about 10%. For comparison caps is about as lethal as SARS and two to four times more lethal than the 1918 influenza pandemic, the worst pandemic on record. Even so some people only exhibit mild flu like symptoms, not requiring treatment in a hospital. alarmingly, those people are able to walk around and spread the virus not realizing they are doing so. Even worse, international travelers have been arriving at their destination symptom free, but within a matter of hours becoming ill. Travel related cases have blossomed into outbreaks in a number of locations and have quickly grown faster than
  166. - 19:00
  167. - Health authorities could respond and contain them. In other places physicians have quickly recognize the symptoms of caps and have been able to isolate infected individuals and avoid an outbreak. For now, global public health experts are very concerned about this disease. Because it appears the virus is readily transmitted through the air from person to person. Essentially, all people are susceptible. Experts agree unless it is quickly controlled, it could lead to a severe pandemic, an outbreak that circles the globe and affects people everywhere. ^^Models developed by leading public health authorities indicate a caps pandemic could lead to an outcome worse than the 1918 influenza, which killed 50 to 100 million people worldwide, given the global population is four times larger than it was in 1918.^^ If these models prove accurate, we could be looking at hundred
  168. - 20:00
  169. - Hundreds of millions of deaths over the next year or two.
  170. - 20:05
  171. - Okay, now we're going to get a briefing on the numbers and distribution of cases are Dr. Caitlin reverse. As you've just heard, the outbreak is very worrisome. The vast majority of cases are occurring in Brazil and other South American countries. However, as you can see on the screen, there had been some spread to Portugal, the continental United States and Mainland China.
  172. - 20:27
  173. - Our models project that with continued spread in Latin America, and predicted spread to additional countries, we could be looking at double the number of cases in one week and 16 times as many in a month if we are not able to stop the spread. That would be on the order of half a million cases and it would continue to rise exponentially. In three months, we could be approaching 10 million cases. We are also tracking financial markets as an indicator of the economic impacts of caps. While markets are down worldwide and the past couple of weeks they are still positive for the year.
  174. - 21:00
  175. - Thank you, Dr. Rivers. The first emerging policy crisis for which we need this board's recommendations regarding global allocation and distribution of medical countermeasures, and medical countermeasures. We mean vaccines, drugs, and diagnostics and other medical supplies help us combat the caps pandemic. I know we would all agree that if we had a vaccine in hand for caps, it'd be a game changer. But leading vaccine experts say a vaccine in the near term is highly unlikely.
  176. - 21:32
  177. - But there is an antiviral that does look like it will work. And to understand that better, we will watch one more clip here.
  178. - 21:48
  179. - Continuing our caps to see his coverage and possible solutions. I'm joined by immunologist Dr. You Bonnie bellow and Dr. William Blakey and epidemiologist both highly respected.
  180. - 22:00
  181. - Their fields. Let's get right to it. Why are people saying a vaccine for the caps virus is not likely in the near term, researchers are working on a vaccine. I don't have viable leads. But it's complicated. We have known about caps like viruses in animals and people for decades but have not been successful at developing a licensed vaccine. And sure, there are new technologies that may help but it's going to be difficult. I'm not optimistic about having a vaccine in time to be relevant during this pandemic. Even if we discover a good vaccine candidates. We're starting from scratch, and it takes time to test safety and efficacy, typically years. So even if testing most quickly, global manufacturing will still need to be established. Again, multiple hurdles. We simply cannot rely on these old timelines and processes. This is a crisis we have to move beyond these issues. It may be complicated
  182. - 23:00
  183. - difficult, but if we dedicate all available resources this can happen. Also, keep in mind we need effective treatments sooner rather than later. extron a beer is an antiviral drug. Scientists have told me this could be effective. We need to start treating people immediately. While I agree extraordinary does look promising. It's currently used for treating HIV. However, it's not manufactured on the scale needed for treating this many people.
  184. - 23:29
  185. - And we just stopped using it for HIV treatment. How will we get this drug in the quantities needed? Who decides who has priority for the limited amounts we do have? We both know countries are hoarding external? Doctor In my opinion, you are lost in the details with enough money and political will anything is possible. Let's get going on this now. Thank you both for this extremely important discussion. Our us affiliate has just released pulling
  186. - 24:00
  187. - results on public expectations for a vaccine. A majority of Americans expect a vaccine to be available within two months, and 65% of those polled are eager to take the vaccine, even if it's experimental. In related use a significant demand for personal protective equipment like a 95 masks and gloves are on the rise due to the pandemic. However, globally, hospitals are running low. Additionally, other critical medical supplies such as salen, and antibiotics are dwindling. countries and companies are reportedly stockpiling supplies, disrupting healthcare supply chains, causing dangerous shortages in many parts of the world.
  188. - 24:41
  189. - And finally, for the latest information and what we know about vaccines, and this antiviral, here's medical countermeasure expert Matt Watson.
  190. - 24:51
  191. - As we've just heard, there is no existing vaccine that appears effective against the newly discovered caps virus, governments scientists and company
  192. - 25:00
  193. - These around the world have become working intensively to develop one. But it's highly unlikely that a vaccine could be developed, tested, manufactured and distributed in less than a year and it's likely to take much longer. While there have been efforts to develop vaccines against SARS and MERS, Corona viruses, none have been licensed. And given the distinctions in the caps virus vaccines against those diseases would not be effective for caps.
  194. - 25:26
  195. - The antiviral drug astronomy or has demonstrated some efficacy against the caps virus. It reduces the severity of illness and save saves lives in those who are infected, but does not prevent infection like a vaccine would. Astronomy here is a generic drug primarily used to treat HIV. It is manufactured in five countries including the United States and China.
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  197. - Approximately 1 million people take astronomy or everyday for HIV. If all of those HIV patients could be switched to other antiretroviral drugs, we could potentially free up and
  198. - 26:00
  199. - Enough astronomy here to treat 26 million caps patients.
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  201. - Assuming further that we could double production over the course of a year by bringing additional manufacturing online, we could eventually have 52 million treatment courses per year, but it will take many months to get there.
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  203. - And there is not likely ever to be enough to keep up with the need as long as the disease continues to spread at this accelerating rate. Experts agree that while many lives will be saved by this antiviral there's it is not going to slow the pandemic in the same way a vaccine could if we had one available, however, we do have the potential capacity to save many people. Now the question is how do we distribute the supplies we have
  204. - 26:47
  205. - existing global supply chains and logistics networks for astronomy or run efficiently under normal conditions, but the pandemic is likely to be very different.
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  207. - We are hearing that one country where astronomy is produced
  208. - 27:00
  209. - Wanting to block some or all of the export of this medicine to hold on to it for their own people. Tensions are rising between governments and pharmaceutical and medical supply companies about how supply should be allocated and who gets to make those decisions. international humanitarian organizations are raising serious concerns about access to antivirals for people in low and middle income countries.
  210. - 27:26
  211. - In addition to antivirals, other medical supplies are not reaching those who need them in many parts of the world. This is especially pronounced in low and middle income countries, which are reporting the highest rates of disease transmission and mortality. In part this is due to last minute stockpiling and hoarding by customers and in part it is due to cost and logistics issues.
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  213. - personal protective equipment such as a 95 respirators are in critical critically short supply in some areas, and 95 respirators are manufactured by many countries or companies around the world.
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  215. - But there are no reliable estimates of how many are, how many are produced, or what global production surge capacity is.
  216. - 28:10
  217. - All we can say is that production capacity covers normal demand, and it is not uncommon to have temporary shortages during severe flu seasons.
  218. - 28:18
  219. - In a severe pandemic, we can expect the need to increase by a factor of at least two to three.
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  221. - Given the supply issues, there are a number of potential proposals being floated aimed at coordinating and facilitating medical countermeasure allocation and delivery around the world.
  222. - 28:35
  223. - Politicians, business leaders, scientists and policymakers are weighing and some some are suggesting that suppliers and buyers continue to work independently to decide where to send antivirals and medical supplies. Others are suggesting that countries where these products are made should be able to decide where those drugs and supplies go.
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  225. - Still others or recommend
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  227. - That suppliers, buyers and countries and trust a central international entity organization with the job of allocation and distribution decisions for at least a portion of antivirals and other medical supplies.
  228. - 29:14
  229. - Thank you, Mr. Watson. So the policy crisis and question for this board in this meeting is this. How should government's business and international organizations allocate and distribute pandemic antivirals and medical supplies to the people who need the most?
  230. - 29:34
  231. - Now I've time for discussion about this matter. This is the focus of this meeting.
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  233. - Any reactions?
  234. - 29:47
  235. - We have too few antivirals for the needs that we have and we're projecting to have increasing needs.
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  237. - So should we let normal suppliers and buyers manage the manage the distribution network
  238. - 30:00
  239. - of this medication should government step in? If so, with what rules?
  240. - 30:08
  241. - Steve,
  242. - 30:09
  243. - let me let me start by saying it is fantastic how much has been learned about this disease and just a short period of time since his discovery?
  244. - 30:20
  245. - I think one issue that hasn't yet been explored is
  246. - 30:27
  247. - what could be done to suppress transmission apart from the use of countermeasures. And so I think that's something that needs to be an active area of study, learnings were transmission is occurring, would be helpful in order to implement measures that don't require
  248. - 30:45
  249. - medicines to suppress transmission, maybe hospital settings, school settings, or its places where transmission could be occurring.
  250. - 30:54
  251. - With regards to the question of sharing this scarce resource, we do have
  252. - 31:00
  253. - Some models that I think could be, can be built upon the PIP framework, the things that were done during h1 In one, two, to share vaccine. I think each of those, those models should be explored as ways of some sort of distribution process. One, one of the specific things that was done during each one in one was to examine the critical individuals in countries as a as a sort of a minimum level of countermeasures that would be needed and to
  254. - 31:36
  255. - offer structure, exactly critical infrastructure and country's going security. We aspire, we know what number of treatment courses, you know, if we had enough to share, okay, what would that what would that minimum number be just as a starting point for negotiation? Great, Adrian. And I think I think before we before we agree that we have a finite resource, we need to
  256. - 32:00
  257. - The challenge ourselves on the vaccine production. We've seen historically that we can actually produce an Ebola vaccine in a year. It requires flexibility on the regulatory side, it requires commitment from companies. And I do think that before we say that America is not available, we should not slow down that we should pursue that. And I think similarly, we need to explore how could we accelerate production of our entry of antivirals. We've seen it happen before the HIV crisis, it's possible, but decisions need to be made, and we need to bring the right people together to do that. Okay. And for the moment before we are able to accelerate production of the antiviral, do you have any initial reaction since you are potentially one of the companies that could be
  258. - 32:42
  259. - part of this deliberation? What we've seen work very well in the HIV field is in fact procurement through the Global Fund. So having a centralized mechanism, so financially, financially able to procure on behalf of affected countries can be critical. I think the second thing The second thing is it's going to be
  260. - 33:00
  261. - Very important that for the business sector for manufacturers of NT antivirals that we have clarity around what the need is and where the need is and who was making the decisions, or who's deciding on where they're going. Okay, so can I add to that? Yes. So one of the challenges we have is what to do in the really short term about the supply of vaccines, antivirals, etc. Because low middle income countries will be concerned that the entire supply chain will be tied up by the time they can even figure out how to finance their purchases. We know and we know this from what happened with h one in one, that if you can stop something early in terms of everything from ring fencing in particular countries, but also to look at the transmission from country to country. And there's a variety of measures that can be taken to do that. But unless that is done in a global context, and it's done very early, we will end up with a situation where the entire supply chain will have gone. So what we need to do at the very outset is figure out
  262. - 34:00
  263. - What the likely route of transmission is and move very quickly to secure supplies and distribute supplies, according to whatever epidemiological protocol we and based on what Steve says, as we know, we already know some things about the transmission of this disease. But unless we do that, whilst doing what we can do on vaccine, I agree. We will have this get out of control. Okay. Yeah. It's important and since fantastic to have this information in front of us, because if you look across the countries, you've got very different patterns already. Sheila seems to have the 3% case fatality rate, Ecuador, a 5%. So what's going on there? And are there lessons in terms of how they're managing the outbreak, which might inform ways in which you're going to decrease the need for scarce resources? Are they more effective that in their support of treatment, or what is it that's explaining what looked to be significantly different patterns and the break
  264. - 35:00
  265. - The epidemic.
  266. - 35:01
  267. - The second point is that these are all middle income countries or high income countries. And as Jane mentioned, low income countries are either their surveillance systems aren't sensitive enough to detect cases that are already there, or are worried that in fact,
  268. - 35:23
  269. - they will be at the bottom of the food chain. And in this respect, the World Bank would probably be proactively moving into exercising what we call a Cirque, which is a contingency emergency response component to existing loans to low middle income countries in which they can repurpose those loans for these types of emergencies. So I think on the financing side, the circs which are built into every loan made by the bank could be exercised in such a way that you don't
  270. - 36:00
  271. - The problem of the lack of resources being the primary constraint for the purchase of those scarce commodities, okay, between hungry, green because financially that's one of the things we'll have to look at, we have to have the financial means to start production, mass production and getting companies on board is about buy in, and having an understanding of where we're moving forward with this disease process, how quickly and rapidly it's it's proliferating. And also utilizing the materials that we do know like the protective equipment that we already have. We know it's airborne. So ensuring that companies that are manufacturing these products have their financial have the financial ability to be able to do such so that way, even if we are in the process of continuing to,
  272. - 36:57
  273. - you know develop this drug, there is some type of
  274. - 37:00
  275. - Protection that's going on to the lower. Okay, we're great. So I'm going to keep going down the line. But just in terms of initial reactions, do we think, as Adrian suggested that there should be some kind of international
  276. - 37:17
  277. - resource or distribution method? Or really, are we is this is this going to be every country for itself, doing what it can to procure, and 95 masks anti-virals for itself? And so just think about that as you're making your comments? Well, I do think that there needs to be sort of an honest broker, a centralized command and control organization that really brings together the public private sector, both on a global approach and also on a local approach because we can't forget that transparency and Communications at the local level are going to be critical and the continued to stop the continued spread, but I do think there needs to be some form of Central
  278. - 38:00
  279. - The approach to really organize all the various efforts that are going to be undertaken. Okay, I think a lot of people want to get in here.
  280. - 38:08
  281. - We'll go around the table Martin here, Chris and and George, thank you. I fully support the centralized approach in this state we have already if it comes also to global distribution of any products, and I would like to go back to Stevens, first statement, we have power to this, we should really focus on how this spread could be controlled better or easily. If I talk about logistics for for globally distributed topics, we need to protect the stuff that is responsible for this if data protected, they won't do this, and then the entire chain breaks apart within no days. So we really have to go both parallel to find out possible ways to protect the people that aren't trained for this and it should be centralized, organized, otherwise it will not not work. sure you're saying that the people who are delivering these medicines and moving them around the world they should be protected. Yes, it is medicine. Yes. I mean, days, days, basic, protect
  282. - 39:00
  283. - anywhere in the face like this, but every show the largest with the newest
  284. - 39:04
  285. - information we have about spreading only with this, we can guarantee that any furniture distribution is support. Is it possible at all? Sofia? Thank you. Yes, I agree. And I wanted to speak to the point about having the honest broken I think in disregard the United Nations fits the bill.
  286. - 39:22
  287. - I think that given that the country's most affected are those that are low and middle income countries with unequal access to technology to to finances, the UN has a worldwide footprint universally recognized and universal membership. And I think taking the example of the Ebola crisis last round when a trust fund was established, and calling on member states who are capable of contributing to that trust fund in order to help those that are least capable, the low and middle income countries. Thank you.
  288. - 40:00
  289. - Chris, thanks, Tom, I want to agree with a couple of comments. One is about the need to prioritize for the, the basic the frontline health workers, the basic people to keep the system working. I think it's important to recognize that we have the data that you're showing because of some remarkable international collaboration, about sharing information in real time about the patterns of disease. And that's come out of the International Health Regulations. And that's a good first step, if we're now going to try to prioritize the allocation of scarce commodities, having this kind of dashboard to know where those masks and drugs are, and, and to get some of the psychology that's behind some of the hoarding. People may be making bad decisions because they they think it's more scarce than it actually is. So if we could have the equivalent of this dashboard to understand where the supplies are to map to the needs, a global stockpile would certainly help ensure more rational
  290. - 41:00
  291. - And strategic allocation. But the reality is that we don't have the logistics capability even within the UN to bring that together in one place and run it. So this is where I think a collaboration between the international organizations like the world organization, and the private sector, which runs the supply chains, for many purposes every day, understand where the supplies are, make smart decisions about how to allocate them to the people who need them in the places that need the most. And then work with the industry to move those supplies from where they are today to where they need to be. On your point of transparency and data about where supplies are where medicines are, we're in 95 masks are. We couldn't agree more. We have been unable to find that data. So I think it's an important need that you just surface George, as I would support for the proposal, you can centralize the code coordinated efforts, not just NASA also you to massively you know, at in such a situation. That's very, very important and rarely read all this about the application.
  292. - 42:00
  293. - are not it's true, you know, it's relatively you can see the number is there, especially when you are talking about some country like China or any countries who have lots of population, the swine peak production. So if the virus yet still you know transmitted from pig pigs to unicycles cycle, so that could be very serious. So we have to prioritize, so maybe the farmers or wherever have access to that's very important to have the expert to accept to assess the possibility you see the aeronaut but you also see his slide origin, I will still have some new virus from Swan Swan peaks, all the virus already circulating in the human beings. That's also we should put that into account for the strategy for the location of the
  294. - 42:47
  295. - actual runner. And also I got the information for my stuff looks like of course, you know, we have capacity to produce the extra Nova but even you know, think about the population we have, we can expand our capacity
  296. - 43:00
  297. - But you know, the water we have even not enough our own population? That's the question we should take. Yes, I think I think it's important and in 2019, to remember that in 2016, at the World Economic Forum together with the World Food Program, who presented a global supply chain management approach for this exact scenario, and what might be helpful, but given that everybody suffers from short term memory deficit is to have an emergency briefing on those resources that are global public goods that are there to facilitate supply chain management and where those can be deployed, but also seppie, which was established three years ago at to accelerate vaccines exactly in development in the settings where a coronavirus is, in fact, one of its indications and first areas of focus that may not be coming
  298. - 44:00
  299. - And knowledge likewise on the financing, there is global financing. The criteria identified here would be triggers for the pandemic emergency financing facility, which would disperse a significant amount of money into that international pool on the basis of this trajectory, the epidemic. So those are resources that may not be well understood amongst the set of players that would appreciate having some understanding. So an emergency briefing on those resources, I think might make sure that they're not overload us to that. So a couple of things, first of all the patients who are currently on astronomy or need to receive different medication so I think this is something that the team needs to look into how do we make sure that we have the right resources to make sure that they're not being panicked and we're not causing panic with them and and that we're having to use this drug for a different use at this time? Secondly, I think it's very important that we make sure that there is concise communication with all healthcare facility
  300. - 45:00
  301. - is where these patients are being treated so that there isn't mass panic. And perhaps a member of this team could be part of that task force to ensure that whether it's in the news by social media or to these hospitals, we have the right communications channel to be able to make sure that the public does not have mass panic
  302. - 45:19
  303. - was just going to I'll add to that in as much as the value of a centralized convening group body that is addressing both the production and supply chain also serves as a convening enterprise around the communications, because there is a lot of great data that's been collected, but probably more can be done from a public education perspective around containment prevention. While the supply chain is managed, Yvonne just want to echo met point and my question here is what's what's happening around the world while you know we know that there are cases here in these few countries, what's happening to the rest of Asia, what a government's doing to
  304. - 46:00
  305. - assure the people and this will help to relax some of the stress that you see in terms of people holding personal protection equipment. So I think it requires a global coordination, and not just at the individual countries specific level. Yeah, Brad. Yeah, I just wanted to come on. Chris was a scarcity comment. It's not just scarcity. It's also severity. And that's where we see different rates of fatalities 5% to 3%. And there seems to be a stakeholder maybe missing here and I may be wrong, but there's the provider and who's taking care of these patients. Because there's there's definitely discrepancies here on on fatality rates. We know and panic in psychology of panic. People start hoarding people start, you know, freaking out and wondering, what what should I do and then countries start doing it, then there's all kinds of dysfunctional decisions made. Providers really need to be at the table, talking about how they taking care of the patients, and diagnostics and what they're doing with him because we're jumping to a little bit of
  306. - 47:00
  307. - conclusion that this is going to spread everywhere, same degree. And this leads to hoarding and I'll share with you the insane SARS and 95. They're still in 95 sitting in boxes that were never used. I mean, the wording of that was was atrocious. I mean, and and then there were knockoffs of in 95 that really weren't truly impervious masks that were made and then spin and then distributed. So I think there's a need to other providers in the discussion to see really what they're doing to treat the patients how severe is the the the academic. So just on severity, it's important for you all to know that are that the estimate from our team and from other ministries of health is that the distinctions and case fatality rate represents distinctions in data collection, not that the disease is any different than it looks like the virus is the same around the world. These are different healthcare systems, different data collection, different surveillance, so overall are all in case fatality rate is somewhere in the order of 7% to 10%. depends on where we are in the world.
  308. - 48:00
  309. - In terms of where the disease is in the world, we see lots of blank spots. And we think that's partly were largely due to surveillance systems, and the slowness and collecting this data, certain parts of the world. We expect that to come online quickly. Steve, and then are a real chance. Go ahead. I think you have a chance. Okay. Sure. I mean, I think it's just in terms of the precise question being asked, it's clear that having everybody go on their own, it's not going to be the most effective answer. Right. So I absolutely agree with the comments that have been made that we need to have some kind of international mechanism for coordinating what it is that we would be doing also for collecting information also for understanding what the resources are that are available through international mechanisms to execute on that allocation and coordination. I think it's challenging to set it up in a way that says that international mechanism has to be the body that decides in all circumstances, what the allocation is. In other words, I think states are going to want to be able to decide the
  310. - 49:00
  311. - themselves on, in some circumstances, some of the issues that are relevant. So one of the challenges will be ensuring that you're using an existing mechanism. And I think Sophie is right about the UN is being sort of the base of operations in a sense, both for the funding but also for a whole series of other issues that you would be looking at for allocation, coordination, etc. But then making sure that states are stepping up to actually tell people what it is that they're doing, what their decisions are in that context and creating transparency about what the proper allocation should be for containing this issue so that there can be pressure put to bear on ensuring that states are actually doing what the larger plan needs to be in that context. Can I ask a follow up question if there if there is a centralized stockpile developed, either at the who, or perhaps somewhere else in the UN system suggests that or some other entity? How much can you imagine states contributing of the supplies that are being made in their own country
  312. - 50:00
  313. - Is this a 1% allocation 20% of the supply that they're making? We've already heard from George that China is not making nearly enough medication to take care of China at this point. So what is desired end state here? Can you from a from a state security perspective of someone who's worked at the top of government? What do you imagine states who have this medication doing?
  314. - 50:23
  315. - I mean, I think the percentage will depend on the details, right, and what it is capable of actually producing context of the particular crisis. But and I don't know how much we're able to produce. Under this circumstance, I think there should be and there would be from a public perspective in a public health perspective, right. enormous interest in promoting an allocation to international efforts
  316. - 50:49
  317. - that would actually contain the issue as quickly as possible, right. And that should be the focus for everybody in the sense of that's what's going to actually help you prevent the downstream impact of
  318. - 51:00
  319. - The trajectory holds for us. So the question is, can you through this international mechanism really promote commitments to doing this as quickly as possible and give people the sense that actually if they contribute more, that they will have a better chance of protecting their own populations in their country secure? Good. Remember comments, y'all just jump in. So thank you. So to be completely clear, most of this production would already be committed in contracts. Yes, it is almost unheard of that people are producing product without having a forward commitment for the consumption of that product. So the first thing needs to be done because this is not something that the countries currently control and those countries are going to bring about emergency situations and co OPT an existing supply chain. So the first thing to do is to figure out where that's going now in h1 in one in a number of cases. So the Australian Government we bought vaccine to the extent we could get it and in some instances, we actually gave some
  320. - 52:00
  321. - That vaccine, we actually gave that vaccine to the United States who actually ended up with a supply shortage at that particular point. So inconsistent we is working out where the biggest vulnerabilities are, the first thing you need to do is figure out who's got control of those supply chains and those products, and then figure out where for the greater global good, it should be deployed. But we need to be clear. Any government who says I'm going to ship every single dose of a particular product offshore is going to end up with a challenge domestically. So giving governments the capacity to manage both their domestic concerns together with being good players. And we know from the pyp framework that companies will similarly contribute, but it's got to be in an organized framework. Okay. challenge I think is being proved out with a freaking rhetoric both by candidates in the US, UK and Germany who are saying that globalism is responsible for this pandemic and therefore, there's a rising for
  322. - 53:00
  323. - protectionist nature to take care of their own. And so I think it's an instance where the Business Health and scientific communities need to combat that rising rhetoric and misleading information. Yeah. And last couple of comments here, we have about two minutes before we have to close. So I think one thing that's going to be very important is to define the aim of using the countermeasure. And from what we know right now, it doesn't seem likely from the data we've had presented that this countermeasure is going to suppress transmission is going to lead to containment. So our aim really would be to minimize the severe severity and to prevent death rather than to prevent the use of this emerging pandemic. And second thing I wanted to say is just how important communication is and that is true to the public. This is a very alarming situation. And I think public communications shouldn't be alarming but should be truthful about how severe it is. I think also internally, as negotiations are going
  324. - 54:00
  325. - On to share countermeasures. I think it's not likely I agree that countries are not going to buy by countermeasure to put into a global supply without retaining a large portion of it for themselves. Last thing I'd say is this is a very dynamic situation, countries will be negotiating with manufacturers. And I think that's got to be figured into whatever agreement is reached. And whatever that sharing agreement is, it won't be perfect. And I think we shouldn't it's got to be done quickly. So that sharing can actually take place rather than trying to get something that's exactly the way everyone wants it. Do you think that governments are going to need to break contracts, have companies break contracts in order to redirect antivirals? I think that that would work best for the countries to make the decisions with the countermeasures that they purchased. Okay, I think that's a very you know, from a lot talking about one supply chain with with multiple supply chains here. I think you know, before we start talking about companies withdrawing
  326. - 55:00
  327. - antiretrovirals from patients with HIV who have a disease need to really understand how those are these will be used in patients who may or may not have a disease. So demand forecasting be critical. And I also want to point out, it's not just the, the healthcare workers, that we have supply chains in middle income countries, often those are very resource dense people in small spaces producing masks, we have to think about the integrity and the health of the supply chain. Okay, going Miss Stevens. Now, real quick about the public communication, my team has been monitoring the public response. And on various social media channels and cable networks, there's been some conspiracy theories that are around about the potential that pharmaceutical companies or the UN have released this for their own benefit. So as we move forward, obviously, trust and pharmaceuticals and government is very important at this moment. And so as we move forward with developing the right scenarios, we have to make sure that the public communication is a major part of that because of these conspiracy theories. So do we have to
  328. - 56:00
  329. - Or give you 30 seconds. Okay, I'm not these fully supports this input, we should not search for the perfect solution right now. We run against time. And if conspiracy theories like this come up already, so we are on the edge of hysterical reactions, and then it gets out of control. And that's the thing, what should be the main driver for us now to find a solution? Okay. Okay, thank you. We're going to bring these recommendations together and communicate them broadly at the conclusion of this meeting. Thank you all for your input. We will conclude this meeting, and we'll reconvene shortly. Yes. And that does conclude the first meeting of the Board.
  330. - Transcribed by
  331. - Part 2
  332. - 0:05
  333. - This scenario now advances three weeks to November 7 2019, to the second meaning of the pandemic emergency board. Thank you all for reconvening on short notice. Let's get an update on the
  334. - 0:19
  335. - short notice.
  336. - 0:21
  337. - In the last three weeks, we've seen a significant escalation of the pandemic. Previous projections appear to have been accurate. We've gone from about 35,000 cases to more than 260,000 estimated case cases, with 13,000 deaths. This may be an underestimate. We know that there is a good deal of underreporting due to lack of surveillance in many parts of the world. The greatest number of reported cases are still in South America where the pandemic started, but the number of countries affected has risen from eight to 23. across the Americas, Africa, the Middle East, Europe and Asia. We expect a spread will continue to accelerate as we have more outbreaks we project
  338. - 1:00
  339. - In one month, we could see upwards of 2 million cases and over 100,000 deaths, and in three months, there could be as many as 20 million cases and 1.6 million deaths. The markets are reacting negatively to these projections with some markets now in the red for the year. Thank you, Dr. Rivers. All right, we want to show you the latest news on the impacts of the pandemic on trade and travel which will be the focus of this discussion.
  340. - 1:32
  341. - In addition to global public health crisis caps is creating havoc with a trade and travel industries. The frightening public health toll of caps continues to mount patients are overwhelming healthcare facilities around the world, including many of the makeshift triage and temporary care facilities. People are avoiding public spaces out of fear of infection and in compliance with public health recommendations. These has had a dramatic effect on
  342. - 2:00
  343. - Under retail and service sectors, businesses of all kinds are struggling to operate, let alone provide basic services as their workers have fallen sick or refused to come to work. Some companies have allowed telecommuting, but for most businesses and employees, this is not an option. Public health agencies have issued travel advisories Well, some countries have been traveled from the worst affected areas. As a result, the travel sector is taking a huge hit travel bookings are down four to 5% and many flights have been canceled. a ripple effect is racing through the service sector. Governments that rely on travel and tourism as a large part of their economies are being hit particularly hard. Consumer confidence has fallen dramatically and people are delaying or canceling discretionary purchases. As a result, manufacturers are scaling back production on many goods. On the other hand, staples like food and medicine are being hoarded
  344. - 3:00
  345. - mandated border closures and trade restrictions are creating severe localized shortages. The Purchasing Managers index suffered its sharpest decline in 50 years, a leading indicator that markets are preparing for a prolonged period of economic disruption. In some regions politicians are adding to the noise and confusion through social media, ban all goods and travel from infected countries and boycott companies that spread disease are common Twitter refrains, often led by public figures, it's safe to say we face a tough dilemma. The movement of people may facilitate the spread of gaps, but interruptions to travel and trade may have economic consequences that are just as bad.
  346. - 3:44
  347. - And to give us more detail on these issues before discussion with him all caps is spreading and it's largely due to the movement of people, individuals from affected regions traveling to unaffected areas and susceptible people.
  348. - 4:00
  349. - Traveling to affected areas and getting sick. Travel poses real health risks both of spreading the disease and of travelers getting sick. In fact, many travelers to affected regions have gotten sick and some have died. Many countries have issued travel advisories for affected parts of South America. Additionally, politicians in a number of countries have called for bands on old travel and imports from affected countries. A few countries have actually banned all inbound travel and some trade from those countries.
  350. - 4:35
  351. - The total number of reported cases is currently about 30 times the total we saw with SARS and 100 times the number of MERS cases so far, and disruptions to both local and global travel and trade are commensurately greater. On the other hand, public health experts inform us that travel and trade bands and fever screens are not effective at preventing importation of a
  352. - 5:00
  353. - highly contagious respiratory illness. Studies suggest that at best they can delay importation by a few weeks. Some countries have advised against travel to countries in South America, others are advising against traveling to any country with cases. A few countries have even put bands in place for persons are goods coming from countries with cases. These disruptions are beginning to have major economic consequences for the South American region, and will soon have cascading effects globally.
  354. - 5:33
  355. - We are anticipating far greater disruptions to trade and travel may be on the horizon. One prominent economist estimates that global GDP could fall an additional 4% as a result of traveling trade restrictions. This would cause a severe global recession. Such a severe recession has a potential to result in both high unemployment and runaway inflation, creating the groundwork for national and
  356. - 6:00
  357. - stability and change in the global political landscape.
  358. - 6:06
  359. - The policy crisis for the board to consider in this meeting is this. How should national leaders, businesses and international organizations balance the risk of worsening disease that would be caused by the continued movement of people around the world against the risks of profound economic consequence of travel and trade bands? So what does this board recommend? And remember, as we're thinking about this, that this pandemic is now already 10 times as large as the 2014 West Africa Ebola outbreak and growing exponentially.
  360. - 6:40
  361. - So your views we've got a big dilemma?
  362. - 6:45
  363. - people moving carrying disease, we can't stop trading, travel or else we risk economic consequence? Well, I think that we need to evaluate the capacity of these communities that are being severely impacted in
  364. - 7:00
  365. - Brazil and Ecuador to assure that we don't create a humanitarian crisis there, and that they don't have the ability to sustain the community, which will just create more widespread panic, and hence more spreading of the disease.
  366. - 7:18
  367. - I support this way that should maintain that basic interaction between those countries. I remember sauce at the time for us Hong Kong was mainly affected, and we still maintained an exchange of travel and exchange of transporting goods. And it helped both parties. Of course, there was the risk of importing infected persons to Europe. But we maintained it with the respective countermeasures, and it was successful at the end of the day, it was difficult, but it should be our basic philosophy to go through this as long as possible.
  368. - 7:52
  369. - I think Thank you. For that example. I think in this case, we can be sure that if we allow trade and travel to happen, we will have continued to spread
  370. - 8:00
  371. - But I think for us, the question is, is it worth it anyway? People are going to spread the disease. But we have to keep trading travel going in the world despite that. That's the question, or one of the questions. I think that this is a complex question. But I think there is an analytic approach to this that would provide an answer, which is, what benefit is there from those interventions that you could implement or use there any at all? And if there's not, yeah, at least from an analytic standpoint, it's a pretty clear cut decision as to what should be done that that doesn't make the decision, but it needs to be a part of the decision making process. It could you imagine conditions in which for example, CDC, would withdraw travel advisories
  372. - 8:45
  373. - if y'all knew that they were contributing to Well, I think I think the the, I could give the example from h1 in one where we had a time limited advisory
  374. - 8:57
  375. - against travel to affected areas and Mexico
  376. - 9:00
  377. - After a short period of time, it became clear that if you live in the United States, your risk of getting disease is greater in the United States than it would be from a person traveling. Okay, Mexico. So that that is actually very, very helpful kind of analysis just to make sure that you're not just pure harm, Christian. Yeah, I think we have to avoid thinking of whether this is a binary decision of whether there should be trade or travel or not. I think there has to be informed travel, I think, you know, having advisories that let people know about what if they are going to travel what they need to do to stay safe, and that has to incorporate some of the things we talked about in the last meeting, about what's the likely availability of personal protection equipment or treatment should they follow while they're traveling? And in trade, we have to understand again, how do we protect the people who were involved in keeping the global infrastructure of trade and logistics going we need that infrastructure to move healthcare workers to move healthcare commodities. We we shouldn't take blunt instruments we
  378. - 10:00
  379. - We should actually protect the people engaged in making the international trading system work and inform people who are going to travel with or without a band
  380. - 10:09
  381. - and make sure they're making informed decisions rather than saying travel yes or no. Okay, Jane, I was going to make some very similar points. So let me make a slightly different book. I agree with everything that Chris has said. We know that if you try and put a border between peoples who actually have reason to travel, they will go around you. And we also know that people will then hide issues around disease. So the question about how you give people the best information so they can protect themselves. And in Australia's case, in theory, we could close our borders. But let's be completely clear, we probably have enough fuel supplies to last us maybe a month. So in in a practical sense, very, very often, there's not a lot you can do but to keep trade and travel going. But exactly as Chris says, it has to be done in a nuanced way. And for those of us who travel to
  382. - 11:00
  383. - through Asia during size, I was one of those people being informed about what I needed to do to myself was a really important part of how we handle that. Thank you. So yeah, I think in the same vein, the last two comments first is I think the international regulatory regulations committee, emergency committee should be issuing rational advice on how to best protect oneself recognizing that this is this, this is already out of the bottle. But there may be ways in which certain constituencies can protect themselves. And and those should be issued as guidance to to manage unnecessary spread or prevent unnecessary risk. Secondly,
  384. - 11:44
  385. - I think it's really important for this board to be looking at one month in three months and saying what is the essential business continuity that we have to establish now, because this is only going to get worse and we need to look at what's
  386. - 12:00
  387. - What are the most important functions to keep not only the global economy going but also essential basic commodities to make sure that we're not going to get into fuel and food and other critical shortages that are going to accelerate economic contraction. So I think it's very important now to start projecting out to identify with the key constituencies that are responsible as part of the global ecosystem for managing
  388. - 12:30
  389. - life.
  390. - 12:32
  391. - You know, critical supply, trade and activity to get those constituencies mobilized and begin to identify essential continuity plans. We are going to actually talk about that explicitly in a bit and thank you for raising that. And looking at my sector we know that travel is the basis and hospitality, travel and hospitality is the basis of what we do and lemonade bands.
  392. - 13:00
  393. - Putting potential bands, and that has a wide economic effect on those particular areas. And so and devastating consequences because we're looking at individuals who may not be able to earn a living, and it moves forward from that point. One thing you look at is your business continuity plan that you have as a private sector industry, and see where you can manipulate or even look at the minutiae of the plan to see how you can assist those areas in which the most effective to lessen the economic string. Thank you, number of people want to get in around the table this way. For those who have another comment. Yeah. Yeah. So I've received a note to say that the supply chains are already being disrupted with employees refusing to come to work, unless they provide it with pp. So, you know, along the same lines, the business continuity plan actually kicks in already and I would say that for the
  394. - 14:00
  395. - Rest of the business activity. So those that may not be directly impacted, they should start exercising some of those business continuity plans as well. And I think there needs to be a concerted effort by the government to get the message out. This is a good time for us to use social media as well, to try to get people to be a little bit more calm. So the message needs to come across quite strongly I believe. getting the message out is one important thing that we really should follow. Clearly also, from our industry. I mean, there are so many rumors around so many aspects around and this has a very, very heavy impact. Like Latoya also mentioned for the industry, you have to keep this up we have to try to maintain a basic service all over Otherwise, the system will collapse. And it at the moment, it really faces on rumors and on aspects that are affect that we transport affected passengers. Yes, that's the fact that cannot, cannot neglect this but we should deal with this somehow and still travel and maintaining the system.
  396. - 15:00
  397. - Partial and crucial that we can have any efforts also with the outlook to the future to the next month. And travel advisories are also impacting reporters who aren't able to get to the impacted areas. So the right information is not being disseminated. A lot of the information that is going out to the public is through social media. So as we put out those travel advisories, there is a real need to make sure that newsrooms have the right information to know when their news reporters are going to be safe. And how can we get the right information disseminated rather than hearsay on social media. We can link to Tim's point about long, short and mid term planning of stakeholder community that needs to be engaged as a technology and telecommunications industries. more remote work could be a possible help. In this instance, technology can be the platform, but in an increasingly mobile dependent world, we need to make certain that the telecommunication system can hold up to increase demand and pressure. Okay, and I think we're concerned that the varying travel policies are going to allow corporations
  398. - 16:00
  399. - To apply inconsistently what those policies are, and it's just going to continue to aggravate me national policies. Yes, sir. An international approach would be highly desirable for companies that are moving goods. A real. Yeah. So I would absolutely agree with the comments that were made by Chris and Jane. And, Tim, in terms of how we would think about this moving forward. I think the other things that I would
  400. - 16:25
  401. - just add into that is that it seems to me that travel bans one of the concerns with that is also in relation to not just the economic consequences, but your ability to actually respond effectively to the health issue to begin with. So that clearly has to be a factor that should be addressed in the context of, you know, analyzing what the right balances. In addition, I understand. My staff has told me that there is concern from the State Department in the White House about instability that would be essentially breaking down potentially in in South and Central America as a consequence of this and that's obviously another issue that we would want
  402. - 17:00
  403. - Want to factor into what would be the right balance for for travel. But the final thing I just say is that in the United States, certainly we have experienced in the past
  404. - 17:11
  405. - political pressure to basically stop travel when there's panic in the country. And one thing that I think we learned from the Ebola crisis in particular was that stepping out early communicating as effectively as possible with the public about what it is that you're doing, what you know, informed travels should and should not be and so on. And, but also having a policy and establishing that policy early so that states and others can understand this is how we're supposed to be sort of communicating and working with the federal policy on travel, news issues. And I think internationally, you might have a similar scenario in which the World Health Organization, un and others are saying, This is what we believe to be the best practices for travel, that can be very helpful in trying to manage what sort of public panic might be. So you would advise a common international approach to this today.
  406. - 18:00
  407. - Stanford that's possible, as opposed to country to country is what I coordinated. Okay. Yes, Adrian, and I'm going to George just heard from us my stuff. In fact, you know, we need to differentiate between trade and travel. Because what we're seeing now is we're substituting one medical crisis for another medical crisis, we can't get the precursors for a drug shipped to manufacturing plants to be able to supply other conditions not not just this, this outbreak. And so we need to think about what is travel is it non essential travel is a business travel, I think we have to be clear about our own country is created equal in terms of risk, need have real clarity of communication around that if we're going to maintain and medical supplies globally, and for global business for your company, where should that communication be coming from? It should be coming from respected authorities. So it should be coming from CDC who has departments of health and then we should probably get those as an industry as we already do through organizations like internationalists ways. So that we have that there is clearly identified show you
  408. - 19:00
  409. - raise the question of essential versus non essential I just would ask the group what is essential trade and travel
  410. - 19:06
  411. - we have a common definition or even the beginnings of a definition of essential trade and travel
  412. - 19:13
  413. - who analysts who are so essential for medicine Yeah. For medicines and supplies are for all trade and travel and no it's just medicine specialist. It's i think
  414. - 19:26
  415. - it's it's the right question. Okay. I'm sorry George. Yes, I've got some the different brisa for my side looks like the some countries are these band or travel travel.
  416. - 19:37
  417. - Looks like also huge China we have few hundred cases and also have a dozen test cases. But look at the data so far we collected looks like you know,
  418. - 19:47
  419. - slick about think about the to nine pandemic h one one and also Ebola. Of course, it can stop everything you know, it looks like the numbers will decrease but you have to balance between the trade
  420. - 20:00
  421. - Travel economics and you know, the social activity to everything together. So you might be me think about age 41 and Ebola and maybe risk communication and public understanding the whole situation is more important than bad of the traveling and everything. So, this is I would agree with the Matthews you know, spread the spread the knowledge, spread the knowledge to the public, by all BIOS, all these, you know, accessible device. Okay. So fear Cannot you want to comment on that?
  422. - 20:32
  423. - I want to agree with that. Okay. And, and my staff have advised me that basically the level of support for travel restrictions is somewhere between 57 and 90%. Now, we all know politicians will be influenced by the the general view in the community, but we can use that in a positive way. The truth of the matter is if we find ways to retard spread, and if we can work with people so what we're doing is one consistent with me
  424. - 21:00
  425. - their concerns but we do it in a way that actually meets the science need. And we did this we have done this with a bola. We've done it with flu. So we've got history here, but we need to do it in an orderly and in science informed way. Okay, so fair. Thank you. And just a note that the UN is now concerned that the travel restriction is now impacting countries that have not even report in any cases and recommends that Member States actually follow the who guidance and that means not to implement a travel ban. I think it goes back to the communications
  426. - 21:35
  427. - point that has been made around the table about the informed travel etc etc. Thank you Brad. Yeah, we've reached a point in where travel discussions and bands whether it's personal or commercial is affecting supply chain and there's fear and panic about ships and coming to the docks and you know, supply so it's starting to interrupt supply chain. So we just we have just be cautious at this point in the time.
  428. - 22:00
  429. - crisis that is not just about travel, because now it's spreading to supply chain issues. Because, you know, countries or even companies are saying don't let that ship come into the dock because it's coming from an area that's nothing. So it's a, we we can't be silent and are thinking about, oh, it's just travel ban right now. Right. So it's starting to affect a broader part of the crisis. So those of you who work in the global supply chain, what kind of strategic interventions are going to be necessary to keep trade and travel going? Are we going to need to have government bailouts of companies or companies going to be able to make it through this crisis? For example, Lufthansa, or others in your industry are going to need subsidies, liability, remediation, countermeasures. What's it going to take to keep Lufthansa flying out? First of all, it is really that we have open communication that we try to convince a Sofia fed government not to ban each other, especially if it's companies that are not affected. We realized that take again the example from from the south
  430. - 23:00
  431. - crisis. Hong Kong was heavily affected. We had good communication with the government there with the CDC. And we could find a way to maintain operation, although it was economically a nightmare 20% booking figures in the planes for certain periods to your flying planes or 20%. Booking Yes, but we knew we kept flying. Okay, that time it was one destination, if its worldwide 20% for configures. We have to adapt the network. We will not maintain this for several weeks. That's the case. But that's why it's so important that once again with Sofia, we have to spread this out clearly, countries that are not affected should be served on a normal basis. countries that are affected should be served on a adaptive basis, what is necessary but still should be served. And we need a clear and open communication chain mentioned as well. What is essentially what is non essential travel, we have to clarify this. Otherwise, if we go down to 20% bookings over a long period, the company will run down. That's the fact I should just say on this chart. This is what we have, but I think most people
  432. - 24:00
  433. - Public health experts presume that there are cases in many more countries. So I think it'd be false reassurance to say, we can keep flying to this country because there are no cases. We don't know that there are cases, but we believe that there are cases they haven't been detected yet. Yeah. Tim? Yeah, I think I think it's really important to have a plan that identifies
  434. - 24:24
  435. - the dozen or two dozen trade and travel sector players that need to get together and agree on how they're going to have a collective business continuity. And, and, and it's the sort of thing where you need the leadership of those industries to gather and they have to come together in a in a in a way, which perhaps is unusual, but where there should be some government incentive to collectively organize and perhaps help to buffer the crisis and with with whatever fiscal measures might do that
  436. - 25:00
  437. - collectively to make it clear that the on the imperative for keeping the system moving. But I want to suggest that it's really important that that be done in a pluralistic way rather than a singular effort across all sectors. Because if there's some sense that there's a un institution that can do all of this, then I worry we're suffering from a delusional disorder on the power of the UN. It's really important to get those industries and their trade associations and an efficient leadership established, which is decentralized app but has a collective responsibility and accountability. And that needs to be supported by the public leadership. And government leaders. Yes, should be behind that. Yes, totally agree with that 100%. And looking at your business continuity plans and getting together with industries, that subset subsidize what we're
  438. - 26:00
  439. - Your company is doing and using the government as a alternative or a method of understanding what's going on and utilize in their leadership have a decentralized, because that way no one particular industry is getting more than the next. So that went leads everything even across the board, actually. So you industry should be the travel industry should be broadly part of that we need to coordinate international approach. Okay. Right. Yeah, I think we also need to think about the health care workers who are traveling to some of these countries on a normal basis, a lot of these healthcare workers from different hospitals that are going to provide aid on a normal basis for different diseases. Are we now helping them understand how to take care of those patients in those countries? And how do we make sure that we're not causing panic among among the hospitals and other healthcare organizations like Doctors Without Borders or various hospitals that have global efforts to ensure that they're not causing panic and pulling their teams away?
  440. - 27:00
  441. - from those countries that may really need them right now, and Sophia and Chris are
  442. - 27:05
  443. - jumping on that, and to utilize companies such as ourselves that have a best health care system within our properties. So that's one thing we've done before we have actually mobilized. We have nurses and nurse practitioners that work around the world for our company, and we can mobilize them and assist in you know, providing care.
  444. - 27:30
  445. - Thank you. I just wanted to get back to your point about the non reporting and
  446. - 27:35
  447. - in some instances, it could come down to capability and capacities of the health sector in the particular country concerned. And I think this is where an organization like the United Nations can be of help, by providing framework guidance that others could use and to help in the deployment of health professionals to these those parts of the world that are lacking in the in the capability but ultimately, governments have to be capable
  448. - 28:00
  449. - Asking for help, and also to take action in themselves.
  450. - 28:05
  451. - I agree with Tim can be there and in a supportive capacity to coordinate to assist, but
  452. - 28:12
  453. - people run into the question of sovereignty every time and so governments need to be empowered and capable of helping their citizens. Thank you, Chris. Thanks, Tom. Two points I'd like to make one is to just second the comments that Adrian and Brad made about the need for us to distinguish between travel and trade and to really begin to focus especially given some of the projections of two and maybe 20 million cases within three months to really define what is the critical part of the global supply chain infrastructure. We won't have the drugs if we can't move the active pharmaceutical agents from one place to another. And we really need to focus on what will it take to keep that global logistics infrastructure running. We've heard already that some workers are not willing to come to work because they don't they aren't confident they'll have the
  454. - 29:00
  455. - Personal Protective Equipment, they need to be prioritized in terms of access to the countermeasures, etc. And that I you know, I think the travel issue, I think, you know, we shouldn't use blunt instruments have bands when bands don't work have make sure that people are making informed decisions if we go to two or 20 million cases people are going to make decisions not to travel. And and so we need to really focus on the the critical infrastructure necessary to move health commodities, to move fuel to places that are going to require fuel to keep their hospitals running, to keep fluids moving. You know, there's a whole complex set of issues in a highly interdependent world on supply chains that are just in time, we need to think about how much flex there is in that just in time supply chain system and make sure it keeps running. I think it's going to take specificity, and it's going to take knowledge that only the private sector has. The UN can play an important coordinating facilitation role, but the companies know where those commodities are where they move
  456. - 30:00
  457. - How to move them. And that's where a type of public private collaboration that we have not generally add in these crises needs to be put together pretty quickly. Some very similar to what Tim was saying. I think, if I could just follow up on that, I think the compliment might be mobilizing the G 20 finance ministers.
  458. - 30:20
  459. - The reason that g 20 got together initially was the Asian financial crisis. And, and it may be that, in fact that there's a role for them to to not only incense, the private sector, but then also look what those complementary set of public sector financing measures could be, which would actually lower the bar or make it much more attractive to ride this out into the future in a way that companies are going to be able to get shareholder engagement, etc. Thank you, Eduardo. Your your business is moving things around. Yeah, it's going to take to keep it going. And just to underscore the point that cooperation among suppliers
  460. - 31:00
  461. - Chain providers or businesses that have huge supply chains can add a lot of efficiency to the whole process and be protective of health care workers to make sure that even the delivery systems workers are also taking care of using multimodal right air, land and sea. So there could be a lot of cooperation with the live stances and the UPS is and others throughout the world to really consolidate trade lanes to make sure that the commodities get to where they need to get. Does that happen now? Or is that something that has been imagined already and worked on or no, I think that happens that happens today. There is a huge freight forwarder network.
  462. - 31:43
  463. - You know, we do not land ups brown tails everywhere in the in the world, so there are cooperations among companies. Yes. Okay. Steve.
  464. - 31:54
  465. - I think the statement about what would happen even in the absence of any government intervention, travel would decrease people
  466. - 32:00
  467. - People are not going to they're going to know what the information is about where diseases and not travel there. I think that there is an important role for government to not make a bad situation worse, and that is largely going to be communicating valid and trusted information about where the problem is, so that people can make their own decisions and that whatever guidance the government, national governments do provide is, is tailored to what the situation actually is. I think there is a spectrum of interventions all the way from just saying, you know, hey, there's a disease here to something that exists today. If you're pregnant, don't travel to a malaria, Syria. I mean, that's there are travel guidances in place all the time of that sort. But let's be clear, people trust trust less and less what comes from government, actually enabling many sources of information, Google, Facebook, the freedom here, your networks that ensuring that they are acquitted.
  468. - 33:00
  469. - companies who will talk to this stuff and we know that very often these days people believe much more something that will come from their company, then they will believe something that comes from government. So we have two part what we I just wanted to say that we are actually going to get explicitly into communication shortly in a subsequent discussion, so maybe could hold that thought for one moment. But just in closing, it sounds like there is a kind of a support here the table for developing some kind of international coordinated approach for identifying the most important trade it's happening in the world the essential services for their collaboration between business and governments. Any final comment? Last 30 seconds, make a comment about the the security of supply industries need to take a leading role in making sure that the key providers upstream of commodities for their final products, that there are simple things in place like for example, if going to a factory is a dangerous place, what are we doing in the factories to change that are people wearing masks? So probably very simple things that industry and trade associations can work on critical commodities.
  470. - 34:01
  471. - Okay, well then we'll leave it there. We have to leave it there for time. Thank you all for your input. Our team again will take the board recommendations and promulgate them widely to decision makers around the world. And this concludes this meeting. Great and we will now take a 15 minute break and reconvene the exercise at 1035. Thank you.
  472. - Transcribed by
  473. - Part 3
  474. - 0:06
  475. - Welcome back, please silence your phones. We now pick up this scenario Three weeks later at the third meeting of the Board on November 29 2019.
  476. - 0:18
  477. - Thank you all for reconvening and short notice we need to present to this board a serious new issue related to the economic fallout that is accruing over the pandemic. Let's start by getting the latest numbers and distribution from Dr. Rivers. The caps pandemic continues to grow with more than 1 million cases and an estimated 73,000 deaths worldwide. There. These are only estimates because many countries are having trouble keeping up with surveillance and laboratory testing. Our models are showing that with this continued rate of spread, there may be five and a half million cases and almost 350,000 deaths in one month. The three month projection is alarming with potential for over 30 million cases and three
  478. - 1:00
  479. - million deaths. The Americans are still the most severely affected. But there are large outbreaks occurring in many countries across the globe. Countries with limited healthcare infrastructure have seen the highest death rates so far. But healthcare systems in high income countries are also becoming overwhelmed. Financial markets have tumbled with all down significantly for the year, economic disruptions are being felt across the globe. Thank you, Dr. Rivers. So now let's look at this recent exchange on gnn that focused on the economic and financial crises that are rippling around the world.
  480. - 1:41
  481. - The response to the caps pandemic is now the most expensive international emergency ever. Political leaders around the globe are faced with many impossible dilemmas, including financial. We have two guests today to discuss the bottom line of catastrophic response. First up is the economist
  482. - 2:00
  483. - gambled? Are we out of money? The best way to answer that is No, we are not out of money yet. But the fact is we are trending in a dangerous direction and something needs to change. He has been quite vocal about that and generated some controversy along the way. Well, look, you know me, I try to avoid controversy. But come on common sense says it shouldn't be controversial to suggest our response should prioritize both lives and livelihoods. Absolutely. We need to save lives. We all know someone who's been affected by cats. But we literally cannot afford a heavy handed response that suffocates our economy. pragmatism is a wise choice. I mean, what exactly are the risks and benefits of slowing air travel of staying home from work, closing schools, disrupting supply chains, interfering with our reliable channels of communication and news? Sure, some of these steps can help slow caps but often only most
  484. - 3:00
  485. - Generally and with serious costs, when this is all over some families, some cities will have suffered more from our interventions, then from caps, no questions, there is a lot of suffering. Let me welcome Dr. Juan Paris to this discussion. is Dr. gamble wrong? Actually, in a way we agree, responders, whether international organizations, governments or even employers and families, each are weighing risks and benefits. And there is not a one size fits all approach as there are different appetites for risk. What I will say in my mind, our response should aim to protect every life we can. Of course, it should be. But let's be frank, letting the global economy slowed to a halt puts lives at risk. Yes, yes, but there does need to be a balance. Okay, you both agree, balance is paramount. Theoretically, that's an easy choice. But leaders are now faced with very real and very tough decisions.
  486. - 4:00
  487. - Just last week, traditional sources for emergency funding had exceeded their limits. As new mechanisms are being discussed, there is consideration is whether funds should primarily support health emergency response or prop up economies. Precisely. And we do need these funds sooner rather than later, funding shortfalls are putting lives at risk and extending this devastating crisis. Again, we seem to agree, we cannot shortchange the health response, but I suspect we disagree. When I suggest that some of these funds are best used to save jobs and critical industries. national leaders certainly have this on top of their minds during the ongoing debates. Look, I am not an economist or a politician for that matter. But as a physician, I am comfortable saying that our health response to caps cannot afford to wait for an incredibly complex debate about what sounds to me like history's most expensive economic bailout. Thank you both and we will be watching and listening
  488. - 5:00
  489. - The outcome of this vital discussions and certainly the market is eagerly watching for any signs of hope. okay to go deeper on this Dr. Eric toner from our team is going to give details about the financial situation. Thank you, the economic impacts are being felt in all countries. In fact, losses are greater in the wealthier countries despite having fewer cases. This chart shows economic projections for global per capita GDP.
  490. - 5:27
  491. - If trends continue, preliminary modeling from leading economists suggests there could be an 11% decline in GDP at the one year mark into the pandemic and at 25% fall in GDP at the two year point when after the full effects of the pandemic or felt
  492. - 5:44
  493. - there is significant uncertainty about how quickly GDP would recover. But economists fear that pandemic could push the world into a prolonged period of significantly slower growth. Unlike recessions due to normal business cycles, and my
  494. - 6:00
  495. - forces and recession caused by a severe pandemic would be unprecedented in the modern age. Because of a huge loss of both workers and customers. The closest parallel parallel may be the Great Depression. But the anticipated global recession due to the caps pandemic could be much deeper, and it could take much longer to recover their number of places where financial resources could be helpful in reducing the economic impact, including public health medical response, helping national economies and supporting struggling businesses. But there are a lot of needs, and there's not enough money to go around. To organizations that provide loans regularly, the World Bank and IMF would not have enough money to get us out of this crisis.
  496. - 6:48
  497. - The World Bank and IMF together dispersed about 180 $5 billion per year in funds. And they've already distributed a substantial portion of that money in this crisis.
  498. - 7:00
  499. - Experts estimate that it would take $400 billion just to bolster the overwhelmed healthcare systems and low to middle income countries and alone just to cope with a pandemic. To put this in perspective, to financial bailouts of Greece, Portugal and Ireland falling the European debt crisis amounted to approximately 350 billion dollars, and that was only three countries. Without bailouts for national economies, economic failure in the most desperate countries could lead to a collapse of national governments which could further exacerbate the caps pandemic. Of course, funds are still needed support pandemic response. In addition, there are concerns that if some highly important companies or industries fail, there could be a domino effect that undermines the already faltering economy.
  500. - 7:53
  501. - Many countries and in greatest need of financial support have historically been labeled as risky investments due to a combination of equity
  502. - 8:00
  503. - nomic social and political instability, they would be an even higher risk of default now. Very rough estimates are that collectively, donors, countries, foundations, international organizations may have as much as 100 billion dollars to land or donate over the coming year in this crisis. The question is, what is the strategy for the don't what Shouldn't the strategy for the owners be? This require a huge and unprecedented mobilization of funds from many different sources?
  504. - 8:34
  505. - toner. So the policy question for this board now is how should financial resources be prioritized?
  506. - 8:43
  507. - Experts are discussing a number of options. The first option is to direct funds to public health and healthcare systems directly in countries that are struggling to keep those systems functioning in phase of the pandemic. Another option would be to use funding
  508. - 9:00
  509. - For pandemic response,
  510. - 9:03
  511. - to give to companies that are doing work directly related to the response, either in the making of vaccines, or pharmaceuticals, medicines, and 95, masks, or others directly involved in the response. A third priority would be to direct funds towards stabilizing governments that are beginning to falter in the face of pandemics. And yet another could be to direct funds towards industries or companies that might take down the global economy in some way, in some kind of domino effect, or in some way, companies that are too big to fail.
  512. - 9:39
  513. - So the question here is, are there nodes that we cannot allow to fail? What is your sense of priorities, we don't have money to pay for all of these urgent problems.
  514. - 9:50
  515. - Let me stop Jane. And we need to be really clear unless we bring this pandemic under control.
  516. - 9:59
  517. - The end of the day
  518. - 10:00
  519. - The question of the economy is redundant. So prioritizing what we need to spend, where we need to spend it to actually get the public health interventions, and that includes the supply chain for PP and pharmaceuticals, it seems to me is the thing we need to focus on. In truth. And I'm note the comment that the impact economically on developed countries has been greater than low to middle income countries. That is what has happened previously. This is not unusual. We accept that and in truth, those developed economies, they do have still a capacity to borrow on the markets. And while some countries are very determined about having surplus budgets, there are times when you dip into your reserves and you don't sometimes run a deficit. So I don't think we should be prioritizing and stepping into the role that domestic governments particularly where there are competent governments in place, but we certainly should prioritize bringing the pandemic itself under control.
  520. - 11:01
  521. - And I agree and I need to add from our constituency that we need help we need public funding to be able to expand the capacity of Andrew retrovirals. Without that we cannot meet the demand. Okay. Other comments? Yeah. Tim? Yeah, I really think they're two questions here is one is how to find more money, and then how to best allocate that money and and on finding more money. I go back to the suggestion of G 20. finance ministers, because I think it's it's that perspective that's needed to understand where those pools are, both nationally and internationally. David Malpass, the president World Bank makes a big point that there are $15 trillion sitting in zero or negative interest rate
  522. - 11:46
  523. - settings at the moment.
  524. - 11:49
  525. - The those who are proprietaries proprietors of those money might be interested in
  526. - 11:56
  527. - using some of them if it's half
  528. - 12:00
  529. - A trillion that's a small portion of them significant but small. But if that was going to stabilize or have the chance to stabilizing things such that there isn't
  530. - 12:10
  531. - a massive contraction of the global economy, then that might be a reasonable value proposition to put to that group. Secondly, what are the contingency capabilities of national governments and this is an area that we found is universally lacking, which is that ability to search finance and and some countries because they've been hit multiple times by crises have developed surge capacity, but many still have no ability for surge capacity. So this would be another one where you could look at national efforts to mobilize resources, again, as Jane said, borrowing in the near term, May May buffer in the in the longer term, and then into the issue of allocation. I think that these are the right things, but I think we have
  532. - 13:00
  533. - An ability to draw or would be better informed if we have evidence on where value for money is, where are the investments, that would actually make a difference? Because there is a bit of a problem in the settings at which is people see a gravy train. And everybody says they need a billion dollars. And then you look at the implementation capability of some of those institutions or what it is they're doing. And is there real evidence to support that those things, in fact, would be value added? So I think some discipline with respect to where value for money might be got along those various axes would be helpful. And when you say valued you mean value, what end value to the ending of a pandemic? That's right, and as one or sustaining, sustaining the livelihoods because you do have I think this this tension is a healthy tension. Right? If you if you really neglect the livelihoods, then it's going to come back and exacerbate the health crisis. So you'll have the internet
  534. - 14:00
  535. - health crisis is which is what we saw in West Africa, that many more people were affected by the closure of health facilities and Nixon shutdown of the economy and the falling of screens like that.
  536. - 14:14
  537. - That's
  538. - 14:17
  539. - that's George. Yeah. I mean, we already discussed about coordination and centralized efforts. So we'll think about it, you know, the system being kinda, it's good for the public health actually. So even good example for the West African outbreak of 2014 for the Ebola and also the tool nine, pandemic a 21. So obviously for when you centralize the farm from the government, you know, for example, so you in China we are we were quickly we got enough fund for to develop new kind of vaccine for each one on one. So with 89 days, 89 days, we got a new vaccine available.
  540. - 15:00
  541. - 421 2014 effort to West Africa Africa. So, I will see the team. So, we went there with your, you know, one half month we made a decision we rather So, again, all these when you are talking about a prioritize the fund, definitely you need a centralized and coordinated effort. Otherwise, you know, the money will disperse somewhere. So you you could you would envision a some kind of centralized, centralized in the UN system, are you thinking oh no see the system? Because we are now we are we're in a, you know, we are in a risk for a pandemic, right. So, I'm not seeing the centralized system, centralized the effort, you have to coordinate my work. So at the moment, we want the funds, right, you need the money. So where's the money? So government kind of supplies our money, a lot of you know, private sectors, you know, someone said you here you have some money, but now you need a really coordinated centralized efforts. The comments
  542. - 16:01
  543. - Yeah.
  544. - 16:04
  545. - And piggybacking on to what he just said,
  546. - 16:07
  547. - hotels will be will be experiencing, you know, crippling losses during that. And we know that the hotel business in itself makes up 5% of the GDP. And with that being said, we also have to make a count for that when we're trying to increase funding and look for extra ways to financially commit to this endeavor that we're on to find a vaccine and to provide resources to, you know, all of our constituents. So, thank you. Yeah, comments here. I think it's important to recognize that this really is an unprecedented situation. And we need to be willing governments need to be willing to do things that are out of their historical perspective or
  548. - 16:56
  549. - for the most part, it's it's really a war footing that we need to be
  550. - 17:00
  551. - On. And massive mobilization of resources is appropriate to stem the tide of this of this event. So when you say things that they haven't been in the past, you're talking about financial mobilization. kraske Okay, Brett, I wouldn't under we shouldn't underestimate the power of entrepreneurship and
  552. - 17:21
  553. - 2008 we saw the GDP GDP go down about six and a half percent I'm not trying to mitigate with with the crisis is happening here. But it's it we can we have time, a little bit of time here. And so the power of entrepreneurs coming right now most of our personal protection devices are manufactured in just a few countries that used to be manufactured and are much broader base around the world. That can happen fairly quickly. We're already seeing things move from different parts of the country, different parts of the world now and we need to escalate that whether it's through you know, the government's helping with tax breaks or you know, subsidies of that nature to increase manufacturing of those types of products. It can happen
  554. - 18:00
  555. - Quickly a Marshall type plan, you know, don't mean to say that exactly but a Marshall playing, they can go into effect can stimulate a change very quickly. Okay, thank you couple comments here and I'll come back yeah fo to support Steve or to save me a new dimension for everybody. And we have to think out of the box if I'm allowed to say that easy. We have to use the international measures that we have like the World Bank and the IMF. But we also have to be ready a national to to deal with this. And chain I agree fully with you. The main focus should be to somehow get this pandemic under control. If we don't progress on this, what is left after all, honestly to say, and speaking for my industry, I mean reality. In a situation like this, many of our competitors would have been gone for the time being, they will be on ground, they will not be able to continue business, and also a major group like Lufthansa group will be heavily affected and we depend on the governmental support now to be ready for the test.
  556. - 19:00
  557. - After this, I mean, we all hope we get through this. And we have to be ready on limited resources to come back in business all around the globe, if all our industries, sure, or the airline industries, would you consider them in some ways, industries that we can't let fail? Some of them I would support I mean,
  558. - 19:21
  559. - otherwise the entire system breaks apart, falls apart. And still in the period very odd. The high pandemic crisis situation, we still need transportation, we still need logistics with other partners, and even for the time after this should be a basic service available otherwise, we can't get back. Eduardo, did you want to come in? Well, I think I would like to think that we're too big to fail or let fail. But I do believe that you need to keep the supply chains open for the containment and prevention and amelioration. We are not I believe at the risk of the travel
  560. - 20:00
  561. - hospitality industries, because you still need that backbone for logistics and supply chain.
  562. - 20:07
  563. - Yeah, so I've got information that does too big to fail is now moving into the financial sector. And reinsurance companies in in wherever they are operating might be in risk of bankruptcy. So the question then is, as a regulator or as a central bank, what then do we do? So, the question here, I think, is about getting the rest of the financial sector. So it's obvious that the stress test that we have implemented over the years hasn't worked very well. Or this is a case which is really beyond what has been expected. So for the ones that are failing, I think you need to step in, because if you don't step in, then what's going to happen is you probably didn't give a systemic failure across the financial institutions. So we need to give confidence to the market. And and you know, once the event is over, then to go back and review the models again, can I just ask you to say what and what is the implication at the reinsuring
  564. - 21:00
  565. - companies aren't enabled operate. Is that worried? Yeah, definitely, you know, because this is a global market. So if the one reinsurer falls in one country, what does it mean across the globe that it's occupying and, and one of the issues here is then
  566. - 21:17
  567. - that's that reinsurer pull back all its funds to a head office. Okay, and then the other countries then have an issue, a real thing. So I've been told that some governments have now fallen and the others are teetering, and that there's widespread social unrest. And governments are asking for emergency aid to stabilize their economies. And I think this highlights from my perspective, there's the existing need for funding that relates to essentially the stabilization of government so that they can continue to provide services which frankly, still contributes to the point that Jane made, which is that we need to prioritize bringing the pandemic under control. And if those governments fail, that will actually make it much harder for us to do that. As we're moving forward. I think
  568. - 22:00
  569. - In addition to that, there's likely to be significant amount of
  570. - 22:06
  571. - other forms of security unrest, essentially, that can be concerning. And that can come in the form of, you know, terrorist groups or others taking advantage of the situation. But it can also come in the form of, you know, famines because of the fact that there are no longer people who are supposed to be providing food in the chain there because of, you know, disease outbreaks in an area or things along those lines. And so I think there's a need to focus on assistance, humanitarian assistance, other types of assistance, that can help to prevent sort of widespread death and destruction in certain areas where we see it and where it's actually going to make it more challenging in particular, to address the pandemic as it continues. But there's also the need, from my perspective to be looking for the next few months if we still believe that a vaccine is not going to be available for many, many months to come. Then we're going to continue to see a trajectory of an expansion of this and
  572. - 23:00
  573. - And as a consequence, we're going to want to be able to make sure that we actually have the infrastructure in place to deliver the kind of assistance that we need in these different areas across the board so that we can actually continue to manage the situation not just economically, but political instability and violence that might outbreak as a consequence as well.
  574. - 23:19
  575. - Yeah, Jane, and then we'll come right down. My staff has rightly reminded me that, particularly depending on the kind of finance mechanisms that you put in place, they will be shoes for particular lower middle income countries concerned based on history, about what that implies for those countries going forward. So I think the search for liquidity and the search for financing mechanisms that give people collectively confidence, and acknowledging that governments that are in stable or a politically vulnerable will find that even difficult to participate in the conversation
  576. - 24:00
  577. - I do think the engagement of finance ministers and the big global mechanisms, but including the private sector, and the banks will be important. When we went through the GFC. It did require a very significant collective effort to maintain liquidity and to actually keep some of our big financial institutions have float, this would be the same. And if this is the rolling new norm, sometimes it delaying spread. So you can actually keep confidence in your institutions and keep your economy moving, albeit at a sluggish rate will be a really important part of the agenda. I think, Sophie, thank you. And just an update that un leadership has now put out a statement that infused the health and the this pandemic as a health and humanitarian crisis. And I note the point that Tim was saying earlier about the healthy tension between lives and livelihood, and that
  578. - 25:00
  579. - The UN agencies are now calling for the establishment of a pandemic related Trust Fund, and calling for contributions. I wanted to say that if we're now heading into the situation where governments are falling and you having political instability, that if you end up then going into the other spectrum of conflict in it, that's also going to compound the effects and also much more costly in In response, Chris? Yeah. Thanks, Tom. A couple points to make. I think, you know, this is going to take unprecedented effort to raise additional resources. But I think what resources we have have to prioritize public health. It's a little bit like first aid, you have to stop the bleeding month ago, we predicted there might be another million cases that came true if these projections are true. They're 32 million cases and three months, the need for government industries, companies is going to outstrip any possibility of our are mobilizing the resources, we can't keep up with the shape of that curve. So we have to stop this pandemic and that's where we put
  580. - 26:00
  581. - First amount of money, what what do we have to do to make sure we're doing everything we can to stop the growth of this pandemic, then assuming there's some resources left over, we have to think about who are critical partners. And you know, are the companies that will be our best partner. So this are the companies who have been thinking about this ahead of time, who were prepared, who had redundancies and plans for their their supply chains. They're going to be our strongest partners. So we aren't going to have to help work through public private partnerships to support companies but not all companies, the ones that are critical to sustaining that global supply chain, keeping commodities, people food, other essential things to sustain the stability that we need to prevent governments from faltering, etc. So we're going to need much more specific information. And we're going to need a lot of that information to come from the industry itself. And a complicating factor I think this goes to advancing understanding in the public marketplace also is impacted by the fact that
  582. - 27:00
  583. - The investor community is not discerning properly from misinformation disinformation. And so to your point about public private, it also is incumbent to ensure that everybody's advancing genuine understanding of the spread of the epidemic. And the efforts being made to mitigate it, because they invest in community needs to be a part of this as well in terms of their the role they play in the financial markets tend to minister to points of Hearst, our country directors at the World Bank are reporting in that there's quite a bit of unethical activity with respect to time emergency on a bilateral basis to longer term conditions related to access to natural resources in low income countries which could be compromise the economic viability of these countries moving forward. So there is an issue related to making sure that the emergency doesn't
  584. - 27:56
  585. - facilitate worst practice or unethical practice.
  586. - 28:00
  587. - In terms of financing,
  588. - 28:02
  589. - secondly, I think part of what will stimulate the mobilization of resources not only having a sense of the cost, but what the return on investment would be, if we actually made it over this. And so I think one critical piece is we need to project out recognizing various scenarios of, of when we're going to get on top of this. The the world's population is finite. We know it's, it's doubling, you know, at this rate exponential will get to global coverage of this soon enough, with a some sense of cost scenario. And if we could project what a sufficient investment in Best Buys would get us in terms of minimizing not only the costs going into this but also the accelerated uptake of the recovery.
  590. - 29:00
  591. - I think that would be helpful in getting investor confidence. Is that something that world bank could do this kind of projection? Or is that going to require? We do business with incredible scientific accuracy? 2.001?
  592. - 29:14
  593. - Yes, it is the sort of thing that the bank could do. And, and, and really focusing on projecting to that medium term set of outcomes where you can begin to look at the ROI.
  594. - 29:26
  595. - I think as we talk about prioritization of funding as someone who worked in a hospital before, during before, during the Ebola crisis, when so much of the funding for as hospitals go towards combating this specific disease, we can't forget that there are going to be patients that are impacted by other diseases who would have otherwise lived receive the care they needed, they would be in the ICU that they need to be in. And with those hospitals inundated with these specific patient cases, we can't forget to help them first and foremost, to be able to stop not just this disease, but all the others that are impacting patients.
  596. - 30:00
  597. - Become chair Adrian and Steve. So I think first of all, you know, if you think about three, three broad buckets, pets, first of all, we have to accelerate, shutting down this current outbreak. The second is we have to prioritize industries that allow us to bounce back. But there's the third piece, which is how we there's 200 epidemics a year. So how many times can we continue to respond to an outbreak so how we prioritizing investments and preventing this from happening again, having a faster emergency response, having better data, having better systems to isolate quarantine and control?
  598. - 30:31
  599. - I think that there's a risk that we assume that our interventions are going to be more effective on the health side than they really will be. So I think there's a need, really to be honest with ourselves about what we're able to accomplish. Having said that, I think that prioritizing resources to health and public health response is going to be very important and my staff tells me that those resources are running very low. That prioritization isn't
  600. - 31:00
  601. - important element in sustaining the trust of the population in the system that they're living under and a lot of ways that has to be a high priority to try to track that and make sure that public trust doesn't road any further than it already has.
  602. - 31:16
  603. - 10 very quickly on this point, I think
  604. - 31:19
  605. - the financial resource may be most limited by the human resource. And and we I don't think we've moved far enough fast enough
  606. - 31:29
  607. - in recognizing the need for a global search capacity with respect to multipurpose workers that could be deployed in this setting that are required,
  608. - 31:42
  609. - have the competencies and can plug into the system in ways that there's no way existing staff couldn't manage all of the all of the challenges. So I just think that we really need to put some, some serious thinking about what that surge workforce capacity looks like.
  610. - 32:00
  611. - What are the set of competencies? Where do they where can they get plugged in and really be additional in a setting like this? So, just to add kind of a focus back on the last question here as well, a number of people have talked about critical nodes or industries that we can't let fail or they're critical to survival through this or an economic survival. Other things that we haven't talked about that should be surfaced knows that we should, I think, to echo what he said, you look at Mariana internationally thing, hotels, but they are diversified in many different fields. Many people do not know that we have a whole healthcare team across the world that have nurses, doctors and nurse practitioners. So when he says mobilization and getting other healthcare providers to jump in to help with the situation, you can use private sector, companies that are diversified and many
  612. - 33:00
  613. - Different areas to help utilize and, you know, really get into the groundwork of what needs to be done to get this accomplished.
  614. - 33:10
  615. - Okay.
  616. - 33:12
  617. - first moment for comments. Well, I think we should acknowledge that since the start of the pandemic, one of our members has succumbed to the disease. And I note that
  618. - 33:23
  619. - Dr. chuckwei, who was a very upstanding member of this committee, sadly is not with us today because he is fighting the disease. Thank you. Yes.
  620. - 33:35
  621. - So
  622. - 33:39
  623. - is there any priority that's on this list before we close any priority that we have not talked about that you think should be amongst those that should be receiving global priority for for donors financing
  624. - 33:52
  625. - spots, the stabilize the faltering garments as I want to add one more comment as Sophia said, in a garment is falling. We
  626. - 34:00
  627. - cannot afford or 40
  628. - 34:02
  629. - we caught a big sword with really destroying government here. This is a, you know, with a point we should address.
  630. - 34:10
  631. - And I agree with him. So we come to a status now where we have to stabilize the resources that we have anyway.
  632. - 34:16
  633. - If it really falls apart any sector, we will have resources all around the globe, but how to get them where we want them, how to work them together, how to exchange them. It's beyond borders of companies of countries in that status that we are right now.
  634. - 34:36
  635. - Oh, sorry. Oh, so real. But something that I mentioned earlier to that's not up there, I think which is basically
  636. - 34:44
  637. - ensuring that we actually have on the list of things that would receive funding infrastructure that would allow for both public and private sector help for humanitarian assistance that would then actually help to provide
  638. - 34:58
  639. - to address the challenge.
  640. - 35:00
  641. - genes that are exacerbating the, you know, the spread of the disease under certain circumstances got it
  642. - 35:08
  643. - may be inherent in the prop of industry. But trade associations should be added to that there's some really effective trade associations today Haida being one of them and is bringing manufacturers and distributors together. Henry Schein is part of it. Bd Johnson and Johnson, three that are very effective in coordinated in collaboration, and just should be, we should make sure we're enabling and empowering them. Okay, Tim, very quickly, I it's not just about allocation. It's about accountability. If you get money out quickly, you've got to get accounts in quickly. We still don't have that capacity. And without it, you don't have confidence, the money's being well, and can I add one. And that is notwithstanding the fact that everyone is very stretched. One of the things we always need to do is to learn from the circumstances that we're in. So if we don't use this circumstance to collect data, actually do an analytical
  644. - 36:00
  645. - sort of check if you like, which for future circumstances we can then rely on in terms of preparedness, we will also be missing something we should be focused on. Okay, Chris and one other area to modest amount of resource in the context. But also, one thing we've been doing since the start of this endemic is actually increasing some of our focus on on the cutting edge science and research and development. This is an unknown pathogen where we live in a in a period of of amazing scientific discovery that may not have been focused on coronavirus. So we're putting some of our philanthropic resources into cutting edge research on getting countermeasures faster, trying to accelerate that one year to a vaccine, trying to reduce the cost because even though the numbers don't currently reflect it, given the pattern, we're going to see lots of cases in some very poor countries. And so getting the cost of commodities down getting additional manufacturing capability and trying to harness the cutting edge of Science and Technology. Maybe help
  646. - 37:00
  647. - pandemics. Thanks, Steve. True last word, the what we're doing here is really a larger version of what we did in last move. And I would hope that the systems that were put in place to determine how to share the medical resources would be able to operate at this level as well. They'd be scaled. Thank you, Steve. Thank you all for this discussion will bring these recommendations forward. And we will close this meeting and reconvene as needed.
  648. - Transcribed by
  649. - Part 4
  650. - 0:05
  651. - Okay, we will now advance three weeks to the fourth and final meeting of the pandemic emergency board on December 18 2019.
  652. - 0:14
  653. - Okay, thank you for reconvening, and let's get an update from Dr. Rivers. In the last three weeks case numbers have continued to grow exponentially. We now have an estimated 4.2 million cases and 240,000 deaths. Almost every country is now reporting cases, and those who aren't may simply not have the resources to conduct surveillance. We don't see any change in the rate of rapid spread and models estimate that we could have more than 12 million cases and close to a million deaths by mid January. We're not sure how big this could get but there's no end in sight. Financial Markets are universally down by 15% or more on the year, fear of a catastrophic pandemic and uncertainty about the capacity for governments to respond and remain viable. Our future
  654. - 1:00
  655. - investor uncertainty.
  656. - 1:03
  657. - We have called this meeting today because of major strategic problems around communication that are happening globally. And here's a media debate that just happened to on air today.
  658. - 1:22
  659. - alarming news emerging from social media companies today about the caps pandemic, Twitter and Facebook are reporting they've identified and deleted a disturbing number of accounts dedicated to spreading this information about the outbreak. For more on this we go to our correspondent Catalina parks Chen. These accounts were created by several state sponsored groups intending to sow political discord, and some individuals are seemingly seeking to gain financial advantages. Violence against healthcare workers and minority populations has been increasing. A recent ride highlights the real danger in these posts. Countries are reacting
  660. - 2:00
  661. - Different ways as to how best to manage the overwhelming amounts of dis and misinformation circulating over the internet. In some cases, limited internet shutdowns are being implemented to quell panic. Thank you Catalina. For more of this we are joined by experts on crisis communications and social media, Kevin McAleese and Sarah Lee. To me, it is clear countries need to make strong efforts to manage both Miss and this information. We know social media companies are working around the clock to combat these disinformation campaigns. The task of identifying every bad actor is immense. And experts agree that new disinformation campaigns are being generated every day. This is a huge problem that's going to keep us from ending the pandemic and might even lead to the fall of governments, as we saw in the Arab Spring. If the solution means controlling and reducing access to information, I think it's the right choice.
  662. - 3:00
  663. - I agree with Kevin, this is a big problem and doesn't even account for the massive amounts of misinformation being generated by legitimate users about the pandemic. But it's not just trolls who are spreading the fake news. It's often political leaders themselves, who's to judge what's real or not, would be trust every government to separate truth and lies. I think this is more than just keeping the bad information out. It's also about making sure real public health information reaches the public news is found from outlets other than social media, news organizations, public health groups and companies need to help people take the right actions to protect themselves by promoting accurate, real information about the outbreak. Okay, For more on this, we're going to get a briefing from our communications expert Dr. cell. Global Health experts have highlighted that dis and misinformation are wreaking havoc on the caps response. health workers are under attack in a number of locations due to rumors that
  664. - 4:00
  665. - They're purposely spreading the disease and response efforts and many places have had to be suspended because of concerns around violence. pharmaceutical companies are being accused of introducing the caps virus so they can make money on drugs and vaccines. And I've seen public faith in their products plummet. unrest due to false rumors and divisive messaging is rising and is exacerbating exacerbating spread of the disease. As levels of trust fall and people stop cooperating with response efforts. This is a massive problem, one that threatens governments and trusted institutions. polls have shown that mis and disinformation are ubiquitous. At least 90% of the public has been exposed to these messages. At the same time, misinformation messages come from a variety of sources, even government officials and often governments are contradicting one another. We know that social media is now the primary way that many people get their news. So interruptions to these platforms could curb
  666. - 5:00
  667. - The spread of misinformation, but could also limit access to information from legitimate sources. Health ministries around the world are attempting to combat Miss and disinformation by amplifying public health messaging through social and traditional media, but they are being outpaced by false and misleading information. national governments are considering or have already implemented a range of interventions to combat misinformation. Some governments have taken control of national access to the internet. Others are censoring websites and social media content, and a small number have shut down internet access completely to prevent the spread of misinformation. Penalties have been put in place for spreading harmful falsehoods, including arrests. Other countries have taken a more moderate approach and have focused on promoting fact checking efforts and working with traditional media outlets. Yet these approaches are limited in scope. Social media companies report that they're doing all they can to limit the use of their platforms for nefarious or misleading purposes.
  668. - 6:00
  669. - But this is a technically difficult problem and false misleading or half true information is difficult to sort without limiting potentially true messages. The bottom line is that members of the public no longer know who to trust. Both the misinformation and the measures to control it have led to a crisis of confidence.
  670. - 6:21
  671. - Thank you, Dr. cell. So here's the policy crisis for this meeting of the Board. How can governments international businesses, international organizations ensure that reliable information is getting to the public and prevent highly damaging and false information to the extent that's possible, about the pandemic from spreading and causing deepening crisis around the world? How much control of information should there be? and by whom? And how can false information be effectively challenged?
  672. - 6:54
  673. - And what if that false information is coming from companies or from governments
  674. - 7:00
  675. - So
  676. - 7:02
  677. - your views welcome.
  678. - 7:04
  679. - So I would start by pursuing where trust exists in the ecosystem. Jane, in a prior meeting mentioned that there's considerable trust by employees of their employer. And that's been borne out by our own trust barometer. And in the last several years, where there is it's extraordinary the amount of trust given to the employer. And coupled with that in times of crisis as we're living, the role of the CEO, and the trust given to the CEO for advocacy and for advancement of accurate information is considerable. I would marry the business leadership of the employer, with business leadership organizations, such as the BRT and like enterprises around the globe. But I also think we're at a moment where the social media platforms have to step forward and recognize the moment to assert that
  680. - 8:00
  681. - They're a technology platform and not a broadcaster is over. They in fact have to be a participant in broadcasting accurate information and partnering with the scientific and health communities to counterweight if not flood the zone of accurate information, because to try to put the genie back in the bottle of the misinformation disinformation is nigh impossible. So flood for good information. Okay, others Yeah, Jane? Yeah. So can I agree with that? And my factor did come from the Edelman trust index, you'll be pleased to know.
  682. - 8:35
  683. - But also borne out by the work I've done as a CEO in my time, can I also add that I think there are real technology opportunities here. I personally do not believe that try to shut things down in terms of information is either practical or desirable. And we do have I think, a couple of strategies that are available to us, one of which is the flood strategy second of which is relying and informing and equipping
  684. - 9:00
  685. - trusted sources of information with the facts, so they can then pass that on. But we also need to actually think about a technological answer to this. So there is work that's being done to actually create algorithms to sift through information on these kinds of social media platforms.
  686. - 9:19
  687. - And I know that the Gates Foundation and others are funding organizations to work on things like this, in order that people can actually have more confidence in the sources that they will use in any event. So I think both a detailed solution with with individuals but then also thinking about technology is something we have to advance mostly. So looping back into the trust barometer last year, and Davos was released that trust in traditional media sources has ground wild trust and social media sources has gone down specifically after the last elections in the United States. So I think one of the ways that we need to approach this is to make sure that we have the right representatives.
  688. - 10:00
  689. - on traditional media networks in order to portray our side of the story and make sure that there there isn't misinformation, I agree with Jane that shutting down internet is only going to cause extra panic and extra anxiety. In fact, that staff tells me places where internet access has been shut down, there is unrest growing. So we're not only dealing with this specific situation, but really people not trusting their governments at this point. And so I think we really need to make sure one from a news perspective that that information being is being disseminated correctly and that we have the right source resources out there to provide this information. I also think that there is a good point in trusting in employees and your employers. There are lots of communications channel for example, during the Ebola crisis at Texas Children's Hospital, we had daily briefings with the CDC to tell us what the situation was. And because of the daily briefings we use, between the internet internal global communications and town halls,
  690. - 11:00
  691. - We use those sources to be able to disseminate information and make sure that our employees knew exactly what was going on coming straight from the source, whether it was from our CEO or chief nursing officer others within the hospital.
  692. - 11:12
  693. - Sure, no, I think a complimentary tactic to is to, to tap faith based organizations and civil society and other institutions to recruit them also, to basically almost at a grassroots level, continue to to basically have the integrity of the information. I just pick up on the daily briefings or twice daily briefings during each one in one who filled the parking lot with the global press and provided them daily updates on what was happening. And I think that's, that's, that's a manifestation of flood, meaning you have to lead and lead regularly. And I think in the terms of the content is what we know and point to work in.
  694. - 12:00
  695. - indications have actually been pretty good. I think we've projected the exponential increase in this quite well, and therefore there's legitimacy to what's being communicated. And so be clear about what's being communicated that we know. And that is right. But also be very clear about communicating what is absolutely wrong. And being clear about that, and then also being clear about uncertainty, and that that's being managed. So I think in those three domains are very important not to, not to,
  696. - 12:31
  697. - but to speak to them very clearly in the context of a daily briefing from in this case, I can't imagine any other institution then who being the focal point, Martha, Chris, come down the slide. Thank you. I fully fully agree that this is pure crisis, communication and crisis communication today. Also social media is part of it. And just to limit or even or even stop, social media would create a huge damage, and we should use it, we should get it on our site.
  698. - 13:00
  699. - We should work together with them and we should try to avoid dismiss misinformation. And another topic is I mean, our our industry. There are indications meanwhile that we are getting this social conspiracy theory topic that we are part of this conspiracy theory that we are supporting this that the wealthy countries will spread out perhaps to, to poor countries. And this is clearly clearly thing of social media that could be directed by a clear crisis communication, and confirmed and regularly updated information. So I also agree with Matthew company's
  700. - 13:35
  701. - responsibility that the CEO talks to the stuff the CEO improves this information flow, and then you have a chance to get a channel. Sure, in this case, our governments do you think governments are the point where they need to require social media companies to operate in certain way. I hear you saying social media companies should not be impaired. But are they do they need to operate under different conditions? I think Matt alluded to that as well. As I will say that there are specific conditions now and we have to find
  702. - 14:00
  703. - A way to cooperate and to have to find solutions for this, but not to hampered him. Chris, so I just want to build on Ed's comment about the importance of civil society and faith based communities. I think, in you know, in addition to employers, people trust their neighbors trust their local community organizations with 3 million cases in the Americas, you know, that local communities around the countries have been responding, whether it's to manage daycare so people can stay in school, or go to go to work. So the you know, while the social media can provide better quality information, I think actually local community organizations can help individuals understand how to filter out some of the noise and to act on the good, good information that's there. I think that's an important lesson that we've learned recently. We're learning as we speak in in East Africa with the Ebola outbreak. If you don't have the Community Trust and engagement, you can't deliver even effective countermeasures, even when you have so
  704. - 15:00
  705. - Think the importance of local community perhaps married to and as a filter for helping to discern the truth from the misinformation on the on the technology platforms is going to be an important part of this response.
  706. - 15:12
  707. - Steve, Brad, and then we'll go down the table here. I just two points. First is that
  708. - 15:19
  709. - we have to recognize that we are all susceptible to misinformation based on our our proper beliefs and experience. And I think with the social media platforms, there's an opportunity to understand
  710. - 15:32
  711. - who it is that susceptible in what form to misinformation. So I think there's an opportunity to collect data from the from from that communication mechanism. The second thing is, with that ability, we can identify false information more quickly. We are actually receiving reports about people trying treatments that are purported to be effective but are actually harmful. And the quicker we
  712. - 16:00
  713. - That's recognized and can be be countered, the fewer people will fall susceptible to those things. Okay, thanks, Brad. Yeah, I don't wanna be repetitive I agree with almost everything was said. But when we talk about our health, who do we typically trust our physician? And we're not talking about that right now. So, I mean, we need the physicians and the medical community, really out there on the forefront talking about this. I remember I had access to local news in Atlanta when the patient was taken care of for Ebola came back. And physicians were on their nightly talking about, you know, don't panic, it's okay, this isn't going to go spread. So I would add physicians to okay. Yeah, important news to share from our member companies. Rumors are actually spreading that the anti viral is causing gaps, and so patients are not taking them anymore. And and this is particularly an area where we have government mistrust. On the other hand, it's interesting because we are doing clinical trials and new antiretrovirals, and in fact, in vaccines and
  714. - 17:00
  715. - Social media including Facebook is actually enhancing recruitment people are going to it. And they're actually seeking information on where they can participate and sign up. And so I sort of wonder that maybe we're in the mistake of reporting and counting all the fatalities and infections and we're not sharing with people. What are the winds? You know, who are the patient advocates that can say what worked for me and maybe you should try that. I think we have an opportunity here. Okay. George, I'm sorry. Go ahead.
  716. - 17:30
  717. - Yeah,
  718. - 17:31
  719. - you know by now, no, we have
  720. - 17:34
  721. - more more cases in China and also death cases reported and also my staff told me
  722. - 17:41
  723. - the folks this misinformation and there are some believe people believe you know, this is a man made. pharmaceutical company made the virus. So there are some violations and even you know, that is because of this misinformation.
  724. - 17:56
  725. - So, you know, from like a city saying and I don't want to stay pretty busy.
  726. - 18:00
  727. - You agree with me when you are doing the field work, and you like to do some so called to T training of trainers. So we really need to train the health workers inside health care workers, they are access to the pieces to the public. So make sure they got the right information. So not necessarily, you know, sometimes the healthcare workers they knew something, but they if they are not well trained, they might give the wrong information. But also they might see some things Oh, I don't know. You were I don't know that could hurt. So when I remember that really that's, that's such a security reminded me when I was you said early on, and I was interviewed by radio and national radio. I was asked by one of the audience to say, okay, we believe Ebola was man made is transported from you know, somewhere. So this is I think this is very important. We do the tilty. So make sure the healthcare workers have the right information.
  728. - 19:00
  729. - Thank you a real agree with that. So, I mean, I think I agree with a lot of what's been said I just add to it maybe by saying that I think one of the things we want to do is work with telecommunication companies to actually ensure that everybody has access to the kind of communications that we're interested in providing, because that's going to be critical for dealing with, you know, obviously, the explosion of the disease and, and then another issue as business is just through that if you have a trusted source, I believe in the idea that we shouldn't be trying to control communication, but rather flood the zone in the sense with a trusted source that then is influential community leaders, as well as health workers, as Brad noted, and others on these issues in order to try to amplify the message that's coming through and I think Tim's absolutely right. I certainly seen the value of communicating constantly on these issues. So is to continue to, to deal with, you know, sort of the vacuum that can be treated.
  730. - 20:00
  731. - in this circumstance, but then also with the comments made about the fact that for all of the disinformation that will be put out, it's going to be important to actually have a response to those questions into those concerns, as Steven said, and and I understand from staff that actually there are also intelligence sources, identifying multiple foreign disinformation campaigns, and so on, but it's all a part of a larger piece, which is to say that every time there is something that comes out that is, in fact false information that is starting to actually hamper our ability to address the pandemic, then we need to be able to respond quickly to it. So the number of comments here,
  732. - 20:36
  733. - people wouldn't react to what real just said, see a couple of fingers just went up, man. Just to build a little bit on whatever I said is, I think as in previous conversations, where we've talked about centralization around management of information or public health needs, there needs to be a centralized response around the communications approach that then is cascaded to informed advocates
  734. - 21:00
  735. - represented the NGO communities, the medical professionals, etc. Internationally centralized on an international basis, because I think there needs to be a central repository of data facts and key messages to move on to comment on that, and then we'll go back to regular order here. Yeah, I think one important thing is it needs to there needs to be a sense of two way communication, which is, people on the front lines may be finding out that actually, the system's not working as it should. And I think there should be a culture in the communications to feed back to authorities places where the system is broken down where supplies are too short, where there are no health workers where hospitals are dysfunctional, etc. Because that and then with some credible investigation process, which is that then values the the client, the second dimension of it, I think that's really important is that is to get individual narratives on this
  736. - 22:00
  737. - I mean, the fact is that most people will survive. And that's probably not a widespread public perception. And so people who have lived and survived and can say that they got good care, or that they retreated properly will help build confidence in the system in a way that's perhaps the data doesn't do as effectively hosty between Sophia and Jane. So they can a couple of things we have to consider are even before this began, the anti vaccine movement was very strong. And this is something specifically through social media that has spread. So as we do the research to come up with the right vaccines to help prevent the continuation of this, how do we get the right information out there? How do we communicate the right information to ensure that the public has trust in these vaccines that we're creating? And secondly, news organizations in some countries are right now under a lot of pressure from their governments to provide politically favorable news. And so we have to think about, you know, this isn't just the United
  738. - 23:00
  739. - states where we sometimes take the freedom of press for granted. There are countries where the news organizations are owned by the government and how are they disseminating information? And what do we need to be thinking about? How do we communicate with those governments to ensure that misinformation and disinformation is not being spread?
  740. - 23:15
  741. - that goes along with her, you know, received information from my staff saying there's they're confused about the different authorities or public health messages that are coming out from all the different sectors, the countries of the states and different cities. And they were concerned about the differences, what the World Health Organization is, you know, saying versus what their government is saying and what the total consensus are. So with that being said, you know, looking at hotels from that perspective, we're in a bind and knowing how to proceed, and she Sophia.
  742. - 23:56
  743. - Thank you. I wanted to I mean, the discussion has been
  744. - 24:00
  745. - Focusing on missing this information. But I think what's important to counter some of that is to actually put out information or good good news stories of people who have actually beat the disease or best practices in other parts of the world that is, is delivering results and sharing that. But also, I agree on the point on having a centralized source of information and a world body that could have garnered the respect of everyone and I think, who in this instance might be that source of information. And again, using the UN networks on the ground and many of these countries has a un presence through its resident coordinator systems. And I think based on the Edelman trust barometer, the UN still enjoys a lot of trust around the world, so it's a it's it's a good fit. Thank you. Thanks, James. So I just want to focus if I could have for a second on why we communicate what the
  746. - 25:00
  747. - focus of this communication is. So there seem to be several elements to this conversation, one of which is to get the facts however you define them out there. But let's be completely clear. We have known for many years that tobacco kills you if you consume it. It's affect it crapshoot, whether you're going to be in the 50% proportion is going to die very young. But we know this as a fact, there are some things we know that are widely held, doesn't mean it always changes people's behavior. So I think we should also focus in a conversation about communication about what the purpose of that communication is. And think about what we know about incentivizing the kind of behaviors we want to see I agree with Tim completely, it needs to be two way. So governments and people who are organizing service delivery businesses who are trying to operate in this environment, they can do that optimally. But we should also think in a communication sense. It's not just about handing people a piece of knowledge.
  748. - 26:00
  749. - It's also about how we incentivize them to manage their behaviors, which in any communicable disease outbreak, behavior of one sort will minimize your chance of getting a disease versus behavior of another sort, which may maximize that chance. Thanks, Chris. Yeah, I just want to come back to the community. You know, struggling from the statistics, we currently have 4 million survivors, we may in a month have 11 million survivors, assuming this is like other respiratory pathogens, they're now immune. And they they live in the communities almost by definition that are affected. So can we turn the survivors into an effective community based source of accurate information, they're going to be the least likely to be wanting spread false information. They're going to be motivated by having survived this outbreak and known loved ones who are also affected. I think they can become a very effective force for intervention at the community level. Thanks. I'm going to turn to live I just want to ask one other question.
  750. - 27:00
  751. - has to think about as avans. commenting. We've talked a lot about misinformation and flooding, good information. We've just started to talk a bit about disinformation and the strategy around that. And I've real or others. Actual Yvonne comments if you have any additional thoughts about the particular approaches to disinformation that may be distinguished from misinformation and be good to hear about those.
  752. - 27:21
  753. - Yeah, so I've received a note to say that some bad actors are actually using social media to spread rumors about specific companies in order to profit from short selling. So you know, along along the lines of what we've been talking about, you know, this is going to cause companies to come up now to get some of the screen time as well because they need to spread the correct information. But one thing we haven't spoken about, and I'm wondering whether it's time to talk about this is a step up from the part of the government's on enforcement actions against fake news, right some some of us this new regulations that come in place about how we we deal with fake news, and maybe this is time for us to share
  754. - 28:00
  755. - Okay, some cases where we are able to, to bring forward some bad actors and leave it before the courts to decide whether they have actually spread some fake news. So we have about three minutes left for this discussion. I just want to throw one more question out for your final thoughts on what if it is, as some people have raised governments that are spreading misinformation, either inadvertently or to some political advantage? How do we work around that with international organizations or business? Are there particular things that people haven't mentioned already that are worth talking about? But does anyone want to talk about either that or just information or other topics in the last couple of minutes?
  756. - 28:36
  757. - Please.
  758. - 28:39
  759. - So I want to talk to touch a little bit about size. I want to follow Chris talk, you know, because that's a very good charge. We have survivors, because we have so many summers, the epidemic already for two months. We have low this model technologies and the platforms and this is time to think about it to try to isolate the human antibodies for this participant. The very serious
  760. - 29:00
  761. - Academic, but we also want to see the future that's will help size based information. Thanks. Thanks, real sure. If you have a state sponsored disinformation, there's obviously additional tools that you can bring to bear to try to address that situation, not the least of which is bringing together other countries to effectively, you know, take action against them for the kind of campaigns that they're propagating. But it's but generally, I mean, I would say the disinformation, the line between disinformation and misinformation is not always an easy one to find. And the reality is the greatest, you know, way to impact it in my experiences, not to let it sit. So in other words, find your trusted interlocutors that are capable of saying this is not acceptable. This is in fact, the truth here is information and I think the community of survivors is one example. But there's a whole series employers, trusted faith leaders, bright health workers and so on can be part of that. In addition, obviously, you want to work with the private sector and
  762. - 30:00
  763. - Those who are spreading information generally, to see that they can bring things down that are in fact lies or, you know, false
  764. - 30:08
  765. - information that's being put forward as a way to minimize it. But having a source, national source and international source, other trusted sources, and really guiding everybody towards that information is one of the most effective ways to deal with a situation like that great as Martin term. If it if it comes back to misinformation on a level of governments of countries, then we need a sphere mentioned trustable international organizations, un who, and they have to come together to get together to spread this trust and to work against this. We cannot hold governments from doing this information on their own. So I fully trust on these informal organizations. And Tom, just to build on that. I think you're right. It's important that the UN and who remain very clear, but when they challenge
  766. - 31:00
  767. - Governments directly, they often get into this issue of sovereignty. And so I think it's really important not to have that as the only response. I think it's really critical to think about soft power influence, which is other influentials, who can call up the head of state, or powerful constituencies within those countries. We've seen this in the context of mobilizing religious leaders in the context of polio,
  768. - 31:28
  769. - or specific business leaders where you can soften perhaps a very hard line from government through less more stealth
  770. - 31:41
  771. - in entry points, rather than trying to punish them through the International Health Regulations or something like that. Great. And I, Adrian, I think, last comment. I think it's important think about what a typical players in the private sector can we bring to bear in this, so bringing multinational pharmaceutical companies to talk about
  772. - 32:00
  773. - Why, who is selfish interested about why their products the site could be seen as non credible but but think about
  774. - 32:06
  775. - this, you know, the champion for TB in South Africa was Nando's chicken. And so I think if you think about these large a typical players who have no credible vested interest in this issue, but have a strong voice that's economically differentiated for their governments as well in their country, they're gonna listen to them with some respect, I think will be very important. Okay, we're going to have to leave that conversation there. Thank you all for another very highly valuable discussion will take what you've advised bring it to the attention of leaders and we deeply appreciate all you have done here in these meetings.
  776. - 32:39
  777. - Right, so that concludes the exercise portion of the event. How did this pandemic turnout, we please watch this epilogue video and you can see the outcome.
  778. - 32:53
  779. - The outcome of the caps pandemic and event 201 was catastrophic. 65 million people
  780. - 33:00
  781. - died in the first 18 months. The outbreak was small at first and initially seemed controllable, but then it started spreading in densely crowded and impoverished neighborhoods of mega cities. From that point on the spread of the disease was explosive. Within six months cases were occurring in nearly every country. At first, wealthy countries with advanced health care and public health systems were primarily able to limit the spread of the disease within their borders. As systems became overwhelmed, however, no countries were able to control it spread. And the disease affected people of all socioeconomic status from the very poor to the extremely rich, from sanitation workers, to CEOs and national leaders. The economic consequences were dramatic. The high death toll and even greater numbers of sick heard of productivity in many industries. manufacturers were having trouble filling orders and countless companies in the service sector simply shut down.
  782. - 34:00
  783. - The global economy was in a freefall. The GDP down 11%. Stock markets around the world plummeted between 20 and 40% and headed into a downward cycle of fear and low expectation. businesses were not borrowing banks were not lending. Everyone was just hoping to hunker down and weather the storm. While nearly all businesses were affected, certain sectors were especially hard hit travel finance service, manufacturing, healthcare and insurance among them, with some major companies going bankrupt. And there were seismic societal consequences as well. The world saw large scale protests and in some places riots, people were angry about the lack of access to health care and medicine, as well as government's inability to protect them from the disease. This led to violent crackdowns in some countries and even martial law. political upheaval became the rule across the globe.
  784. - 35:00
  785. - Public lost trust and their respective administrations, several governments fell, while others were desperately striving to hold on to power. This spurred further crackdowns, attempt to control media messaging originally aimed only at health related misinformation became used increasingly to quash political dissent. economists say the economic turmoil caused by such a pandemic will last for years, perhaps a decade, the societal impacts the loss of faith in government, the distrust of news and the breakdown of social cohesion could last even longer. We have to ask, did this need to be so bad? Are there things we could have done in the five to 10 years leading up to the pandemic that would have lessened the catastrophic consequences? We believe the answer is yes. So are we as a global community now finally ready to do the hard work needed to create
  786. - 36:00
  787. - Prepare for the next pandemic.
  788. - Transcribed by
  789. - Part 5
  790. - 0:06
  791. - So as you can see the caps pandemic was catastrophic. And as we've said, the impact of a severe pandemic is not only a result of the disease itself, but really the cascading economic and societal consequences that would follow. Now, we don't want to give you the impression that traditional public health measures aren't valuable because they absolutely are. In fact, in the 200, some outbreaks that who responds to each year, interventions such as isolation of the sick social distancing, disease surveillance, really do help to interrupt the spread of disease and control epidemics before they become pandemics. But in a severe fast moving pandemic, it may not be possible to contain the spread through these kinds of traditional measures. And as we saw in the scenario, it's there's a limit to
  792. - 1:00
  793. - What government NGOs and global business can do on the fly, to stop a widespread and lethal pandemic. That's why prior planning and promotion of routine public private cooperation in advance of the next pandemic is really critical.
  794. - 1:16
  795. - So we dealt with four you dealt with for serious international policy challenges today, but in an actual pandemic, there would be many more. In the exercise, the board wrestled with a series of very difficult problems. And you did a terrific job with no ability to prepare and a really fast paced, paced and complex set of issues. But assuming we do have a few years to prepare, what should we do to prevent this from becoming a reality? In advance of the exercise today, we drafted a set list of actions that we think would start to move us in the right direction. And now that you participated in the exercise, we really want to seek your input on other things we could do to be better prepared.
  796. - 2:01
  797. - Our initial suggestions are these first, global business should recognize the economic burden of pandemics and really fight for stronger preparedness. business leaders and their shareholders could actively engage with governments and advocate for increased resources for pandemic preparedness. Second, governments and businesses should plan now for how corporate capabilities could be used for large scale pandemic. Industry assets, if swiftly and appropriately deployed, really could help to save lives and reduce economic losses. So governments could work now to identify the most critical areas of need, and reach out to industry players with the goal of finalizing agreements in advance of a large pandemic.
  798. - 2:48
  799. - Third, we think industry and national governments should work with who to enhance internationally held stockpiles of MCs and personal protective equipment.
  800. - 3:00
  801. - In so that it could be equitably distributed during a large pandemic. The who is existing influenza vaccine virtual stockpile is a good model that could be expanded and augment who has ability to distribute vaccines therapeutics diagnostics, other PP to countries and the greatest need.
  802. - 3:21
  803. - Countries that would have to support this effort through the provision of additional funding to who
  804. - 3:27
  805. - fourth countries and global transportation companies we believe should work together to maintain travel and trade during a severe pandemic. I think you all agreed that travel and trade are essential to the global economy as well as to national and local economies, and they need to be maintained. But public private cooperation is necessary in order to explore potential solutions to that really difficult problem.
  806. - 3:54
  807. - Fifth government should provide more resources and support for the development of surge manufacturing.
  808. - 4:00
  809. - vaccines, therapeutics and diagnostics, countries may need population level supplies of safe and effective MCs and append demick. So we're therefore really going to have the need to rapidly develop, manufacture, distribute and dispense large quantities of MCs. Countries with enough resources should make this more of a priority than they do today.
  810. - 4:25
  811. - Six we should increase and reassess pandemic financial support.
  812. - 4:31
  813. - The World Bank The International Monetary Fund, regional development bank's national governments and foundations should explore ways to increase the availability of funds in a pandemic and ensure that they could be flexibly used when they're needed.
  814. - 4:46
  815. - And finally, governments and the private sector should assign a greater priority to developing methods to combat missing disinformation related to pandemic response. Governments will need to partner with
  816. - 5:00
  817. - Traditional and social media to to in order to research and develop nimble approaches to countering misinformation.
  818. - 5:09
  819. - For their part media companies we believe should commit to ensuring that authoritative messages are prioritized, and, and really false messages are suppressed. So those were our initial thoughts, and we'd love your ideas of what else should be on this list. So we have asked gene reserve, formerly of CNN and ABC News, who anchored that final epilogue video to moderate a discussion now and solicit your ideas, gene.
  820. - 5:41
  821. - So first, I want to ask you for your reactions to these proposals that have been put on the table and also ask you do you have some additional action steps that you think could perhaps should be taken?
  822. - 5:55
  823. - Yes, please go ahead.
  824. - 6:01
  825. - There's
  826. - 6:04
  827. - I agree with all of this.
  828. - 6:06
  829. - But I think there are other things that can and should be done if Mike Ryan were here, the gentleman we saw at the outset, he would tell us that the mechanisms to actually do the prevention work that's very hard to actually get enough funding for that around the world. And if I similarly look so I chair a body called CP the Coalition for epidemic preparedness innovations, we are investing in the development of vaccines in the neglected and space for example, most vaccines have this cart that coronavirus, we do not invest enough as a globe in even having the basic options that we could scale up for manufacture. And that's both in the vaccine space but also in also diagnostics, you know, etc, etc. So I do think, putting on this list, the financing of both preparedness in a number of countries but also the technology preparedness.
  830. - 7:00
  831. - Particularly in the vaccines etc would be a welcome addition to the list. Any thoughts from among you on how to increase that funding? yeah can I support change and by say something about what I said about a science based you know information earlier. Officer we are living in the 21st century. So we need to build up the capacity and the facilities make sure you For example, today the event we discuss about tumor epidemic or the tumor, say we have a half year epidemic sake think about xima played during during 2014 Ebola outbreak in
  832. - 7:39
  833. - West Africa, though we are what we are talking about keps It's a new virus and all the vaccine all the available antibiotic woodwork but give you half a year or two months. We are ready even have the capacity at the facility. We are to produce from the survival for some modern cornetta bodies.
  834. - 8:00
  835. - What do you have zip the map like antibodies or antivirals, I think you will restore the confidence of the public. So this is our stairs, we put that one to say unite together under the who put for some pharmaceutical companies to have the capacity or, you know, facility to get prepared for monoclonal antibody producing.
  836. - 8:24
  837. - Go ahead.
  838. - 8:27
  839. - Yeah, so first of all, I think we should end the
  840. - 8:31
  841. - spirit of accountability assess the effectiveness of this board.
  842. - 8:39
  843. - And as a no go first, I'd like to say that we take full responsibility for the not reaching 100 million deaths or 200 million deaths, it was only 65 million. So there was some effectiveness of the board. But I think the question more seriously is is what sort of
  844. - 9:00
  845. - coordination Do we have, and I didn't see, I saw collaboration and things that should be done. But I think in the when the rubber hits the road, if you don't have well established standalone coordination mechanisms that bring the right players to get together to make decisions on how best to respond across a sector, of course, and will be, will be, we will not achieve the collective efficiency that I think many of us would hope that as stimulate a simulation exercise. So any ideas on how to do that? How do we centralize that information in order to get situational awareness, set the priorities, establish the communications protocols? So I don't I would just say I'm missing here. And it may be that, you know, you don't want to recommend what you're doing, but I think we need a series of simulations, which get us much more efficient.
  846. - 10:00
  847. - Find in terms of working with the different dimensions of the response that have to be mobilized in a fast moving pandemic will see and then develop a set of standard operating procedures that could be agreed around with with designated leadership, which could then be drawn upon, should we reach or enter into a fast moving pandemic. So more more of this line? I'm so just to agree with both I agree with these recommended actions and with Tim, that we should do more simulations, I think particularly doing them in places where decisions will get made between locally and local public health authorities, I think particularly in urban areas, as we saw in this and spread quickly and mega cities first, and I think in as it's spread to other regions, some of the regional economic communities in eastern Southern Africa, West, West Africa, I think those simulations will be important with the people who will actually be making those decisions. But I wanted to build on on Jane's comment
  848. - 11:00
  849. - About the research and development enterprise because I think it highlights another gap. I do think we need to put more financing into things like the Coalition for epidemic preparedness innovators,
  850. - 11:11
  851. - to to prepare as as their strategy is for things we can predict Murs, other Ebola, other things that we know are coming NEPA, but I think like we saw in this scenario, there will be emergence of pathogens we can't predict. So we have to really work at disease x, they were kept, you know, platforms that can be rapidly mobilized using reverse vaccinology. I think we have to go beyond vaccines to other countermeasures, diagnostics, etc. And they're one of the stumbling blocks has been, and I think George was getting at this the rapid sharing of information, particularly gene sequencing information. Often countries are reluctant to share samples or sequence information because they're concerned about the distributive justice.
  852. - 12:00
  853. - If we contribute to the science will we benefit from the science and I think, as Mike referred to in the opening video, we've have some a partial solution for that in the pandemic influenza area through the pyp. But we need to expand that to other potential pathogens so that in the event of a fast moving pandemic, countries, don't hesitate to share the information that will be vital for science to do its job and develop countermeasures. Because and they won't hesitate because they'll know they'll also benefit. And that regime doesn't exist yet. And whether we approach it through the World Health Assembly, tag, yeah, build on the International Health Regulations, we need to have that in place ahead of time, because establishing that kind of trust in the face of a fast moving pandemic is even harder to do. And just to add to that, to be completely clear, it took us years to negotiate the framework. It chaired the inter governmental working relationship, meeting that did that
  854. - 13:00
  855. - That was when one country lost confidence in the global viral sharing mechanism chose not to share. And it took us years to rebuild that trust and that confidence and I would argue it's not completely there yet, just like to observe that there's a there's a convergence of the two ideas that we've just heard, I think if there's confidence among countries, that the governance in the sharing exists, and that it can be relied upon, there'll be a greater willingness to share samples and information. So I think those those two things really fit together, which was, which was keep, we have to keep the awareness alive. And it's our responsibility to do this, and to do simulations to do actions to recommend actions like this. But I know exactly what happens when I go home to Zurich. And when I talk about this next week in my company, they will tell me, yes, we know, but there are the daily businesses to do. And I think we have to keep this alive. We all know that there is Ebola right now. And we all know that there is a risk that it spreads out. We all know
  856. - 14:00
  857. - that there will be a next virus. But let's face it, we have to keep the awareness up, we have to talk about it, we have to get ready in due time, we have to set up platforms to exchange our information in due time. And that's the way how we can convince the companies, the leaders and the organizations about this neat
  858. - 14:19
  859. - agenda, an observation. I mean, all of us here from large companies, but you know, in an increasingly globalized world, how do we bring the small and medium sized enterprises along with us? And I think maybe we didn't speak about that enough today. So you're only as strong as your weakest link. And so, you know, some of these things that we talked about, like business continuity plans, how do you build capacity in small and medium sized enterprises, they need to have some of these plans and I think, you know, to your question, financing is definitely going to be an issue, right? Because you need to set aside resources. And this is where I think we spoke about might come to place probably a PPP type framework, where the government will
  860. - 15:00
  861. - With the industry associations and the companies to set aside some fundings to make sure that everyone has some of these basic plans in place. To follow on from that, I mean, I think there are a number of good examples of collaborative sort of forums like the where flag, private sector, round table for judges and so on. But, you know, there's this notion that the private sector should get behind something and develop solutions for things that aren't here in the absence of real committed resources, number one from the public sector or others. And number two, with without really having any form of formal decision making contribution, and I think that's an important one because for example, we might be a large company. So we're working on a bottle working HIV vaccine, you know, work in tuberculosis, we're doing stuff in Zika and Dengue fever, but there's a limit and that's an opportunity cost that noncommercial applications humanitarian sure economically important. Sure.
  862. - 16:00
  863. - There's a huge opportunity cost of pursuing that, that many other companies can't take. And, you know, if you look at the interaction scientifically with organizations like the UN, who then it's like, you know, non state actors stay up. And so if you're asking the private sector to get together to commit, which I think they would, by the way, then you know, the value of that investment and the likelihood that it's going to end up anywhere meaningful, has to be addressed at some level. Otherwise, why would we take the opportunity cost? Any idea how to do that? Yeah, step establish a True Cross sectoral body that actually develops, develops guidelines, thinks about mechanisms, talks about these broader issues together and actually allow allow, not single companies but industry bodies to have some kind of important voting rights into them. Otherwise, it's it's stuck the common good theory and it's all very well, but we will have to get back to our companies on Monday.
  864. - 16:56
  865. - Tim, go ahead. Yeah, I'm
  866. - 17:00
  867. - Want to build on this? Because what I worry about is that and these last two comments, which is everybody gets excited around a table like this in the moment. And then you you move on. And it's back to business as usual. And this this panicked and neglect problem that we have, which is very difficult to prospectively develop real preparedness. So I think there should be somewhere maybe it started the GPM v. and a number of people here are the global preparedness monitoring board, there should be a time bound plan with very clear targets with respect to what would constitute
  868. - 17:42
  869. - a new level of global preparedness. And we should look at what's required to get that financed in such a way that it's not purely, you know, the goodwill of everybody coming together occasionally because they're at Davos or they're in New York, but that it
  870. - 18:00
  871. - It has some real accountability to agents that are live behind or are advocating for stronger global governance. But a practical one, it's not that who will do everything. It's that the various constituencies that have to be mobilized, have identified what I would call so piece on how to move forward in discrete areas that we know are going to be critical and moving this agenda so that we're not in the next outbreak saying, geez, we should have done this. And only if we've done that, well, let's do more learning, you know, after after learning the little late at that point, man. So I share the concern about how to maintain sustained interest, let alone a sense of urgency around what would appear to be an inevitable and the thought one thought I have is, you know, to the point of do we create a moment in time that we work toward and the now
  872. - 19:00
  873. - or analog to that would for me be y2k, public private sector understood that there was a definitive moment at midnight in 2000, that we that people had to address the situation and prepare accordingly. And even if it didn't reach down to the individual, in many instances, that ladder up to or larger organizations, and I think, again to a point I made earlier about the absence of technology at this table, the lessons learned from how that sector advanced, both awareness and remediation is something that can be brought to this conversation. Can I just want counsel, can I just make one comment about y2k when I was trying to advocate inside government in relation to the potential threat from age five in one that was endemic in Indonesia, I was actually told by an extremely senior person who I will not name that actually, I was basically just on about y2k with feathers.
  874. - 19:59
  875. - Okay,
  876. - 20:00
  877. - Okay, so Could I just advocate for finding some other way to
  878. - 20:06
  879. - which I had to come up with in that circumstance. So I just share that one of the threads that I pulled from the conversation around the table today was the lack of data, that you don't have enough data to really have situational awareness. When an outbreak begins, that you don't know where the resources are, you don't know how to move them and where to move them. In this world, where there is an abundance of data, is there a way to better coordinate between the public and private sectors in order to capitalize on that data to learn more and learn it faster and move faster?
  880. - 20:44
  881. - I think you've you've hit on a couple of points that are really important in an event like this.
  882. - 20:50
  883. - Moving or having a scale of operation larger than we've done for health event is going to be very important. So it's really outside of the bounds of experience.
  884. - 21:00
  885. - The other, the other element is to move the able to move quickly and at a speed necessary. I think that the the opportunity to develop those kinds of mechanisms would be the kind of governance system that we're talking about that that that could be part of the agenda for a preparedness activity at a at a at a governmental scale. The other thing I would I would just comment is that
  886. - 21:25
  887. - an event like this is going to be outside of the health sphere. And so it'll be really important that this not be seen as a health event, but really as as an as a global crisis, and that those parts of government outside of health that are going to be in the lead are leading in this, this preparedness work as well.
  888. - 21:45
  889. - Any other thoughts on the database?
  890. - 21:48
  891. - Well, yeah, I think the data is critical, but and I'll use that to segue to another area if I may,
  892. - 21:56
  893. - but which is the human resource and again,
  894. - 22:00
  895. - Actor, given that I now have moved to academia, but it is the academic or the training sector, because if we're really going to develop a search capacity for something like this, where you're going to have to bring in the the reserves, the Global Health reserves in some respect, and it requires an incredible
  896. - 22:25
  897. - coordination across training institutions, both in terms of pre service and deployment, how people keep up skills that would be relevant, and that plan out won't emerge from global businesses and governments collaborating. It's really got to bring in the higher education sector much more fundamental, and I would argue with national public health and
  898. - 22:48
  899. - I wanted to follow up on the trusted voice idea.
  900. - 22:51
  901. - I think everyone around the table spoke about how important is to find those voices. Do we need to find them down
  902. - 23:00
  903. - establish trust in those voices now, so that when the crisis hits, people already have the established trust.
  904. - 23:11
  905. - But
  906. - 23:13
  907. - I mean, I would say without question, and because you're in a better position to build up that bank of goodwill, in advance of a crisis, and I'm very intrigued, and I think very heartened by the conversation about the identification of community and faith based leaders in particular, because they do foster enormous trust at a local level and that but there are people who at this point probably know very little about pandemic preparedness, and hence education is necessary in advance. Yes.
  908. - 23:46
  909. - I think newsrooms in particular, there's a reason why they have people on the staff, actual former physicians and things that are constantly talking about different diseases or illnesses that are coming up so that they continue to build that
  910. - 24:00
  911. - trusted that when there is a situation like this, there is already somebody on staff on the medical medical professional, that's a trusted voice, whether it's on any of the networks, that's able to speak up. We actually you made a point earlier about the anti vaccine movement that's going forward right now. And there was going to be a community event tomorrow in New York City. That actually was ended up being cancelled yesterday, because it was only anti vaccine advocates as a part of a community event. And nobody from the professional medical community would join even in the conversation. So the organizers ultimately because they were shamed into that imbalance, canceled the event, but it doesn't fall out. That that's a real issue at the moment that needs to be addressed and should probably serve as a beta, if you will, for this kind of moment. on this issue of trust, I think there's something that's specific with respect
  912. - 25:00
  913. - pandemics. But I think if we look at DRC, at the moment, the distrust relates to the health system. More generally, we didn't detect the first case in this 10th outbreak for three months because health workers were on strike because they weren't being paid. And so I think this community needs to pay particularly attention to
  914. - 25:22
  915. - health systems that have very low levels of public trust. Because they, then if you don't have that as a foundation, you're not going to gain it in the context. So it's very difficult to gain in the context of an outbreak.
  916. - 25:38
  917. - Go ahead. Yeah.
  918. - 25:40
  919. - similar lines, maybe, but in the spirit of we're gonna learn from history and 19 1816 million people died, it was more than the two great wars. And one of the impending results was a massive shortage of physicians, care providers. So I don't see that on the list. I don't have a solution. If you ask me. What do we do about it? That would be a subject
  920. - 26:00
  921. - committee of this wonderful lady, which I'm only a guest of, so I'm not ready.
  922. - 26:05
  923. - But the shortage of physicians is looming anyway, in the United States, I don't know about the broader world. But that's something should be considered in this. And second point I would only make is that if it really were catastrophic, I don't know if we're prepared for the civil unrest that could result in it. And we haven't really talked much about our public safety.
  924. - 26:28
  925. - Vehicles, not just public safety avenues ready, including military Are they ready for such civil unrest? If it were to get out of hand, I don't see those on the recommended actions.
  926. - 26:41
  927. - I'd love to get down to the surprises and the big takeaways. And I'd love to if you guys are willing to do around the table thing and get everybody's input on what they learned here, and if anything, shocked them, everyone, can we start with you?
  928. - 26:56
  929. - Sure. Let's take a few minutes to think about
  930. - 27:00
  931. - That.
  932. - 27:02
  933. - I do think that
  934. - 27:07
  935. - I think that generally, and this comes out of our conversation that we've just been having the areas that it seems to me require enlightened leadership, in a sense, is the issue of funding right and actually attracting greater funding to this issue. We all know that by spending money on preparedness now we can save money later. And the fact that we don't have the mechanisms in place that allow us to more effectively address a crisis in the moment is critically attached to that. It does seem to me another piece of this is the, from my perspective.
  936. - 27:43
  937. - You know, it's not a surprise, but it's certainly a takeaway from the discussion is the need for greater communication mechanisms between the private sector and the public sector and the healthcare sector in actually trying to manage a situation and to best leverage each other's
  938. - 28:00
  939. - Essentially resources under the circumstances. And I think that's a critical aspect of what has to happen. And one that, frankly, the current system isn't well positioned to do because we're, we're frequently work through the public sector. And we have a variety of challenges in creating those sort of private sector and other industry, you know, connections to what we're doing another piece of it that really didn't come up in the discussion, but from my perspective is another aspect of it. And there's far more experience and knowledge about health public health issues in this room than than I have, but it's but those frontline health workers, I mean, the World Health Organization has talked about the enormous shortfall and that, that that they are utterly critical to identifying, detecting and allowing for response very quickly and that's, you know, sort of the key. If we can do that quickly, then we can get to a possible answer vaccine, other countermeasures that need to be brought in more quickly and so that's fundamental and if we're able to establish
  940. - 29:00
  941. - communication networks that, you know, as Tim mentioned, go both ways to allow us to both take advantage of, you know, the opportunity to communicate outwards, but also to take advantage of the opportunity here from those frontline health care workers, we're going to be more effective, but we do need to train them so that they're a surely capable of identifying the symptoms and issues that we should be responding to, and developing those triggers. And I think that that larger pieces, the, you know, sort of the most important part of it is if you can actually create the preparedness systems and you actually have a plan that triggers the investment that you need at the time that you needed in the communication that you need. Time is going short, quickly. Okay. You know, I get to this type of because I've been in many, many cities already your response our meeting, so I would follow agents comments, you know, financially, we're all you know, more server,
  942. - 29:55
  943. - cross sectoral coordination. I already mentioned that
  944. - 30:00
  945. - Very lucky. So we have meetings and meetings and discussions. But how would we have either private or governmental or, you know, political, diplomatic or sorry, equal data sharing? How would we have a cold kind of a coordinated effort and course sexual coordinated efforts? I we still have, we still haven't got an answer for that. So that's the key. Okay. And there are a lot of barriers.
  946. - 30:27
  947. - It takes a lot to shock me. So I can't say anything shocked me. I think what this is reinforced to me, is there is there is an absence of a center to convene. What is something that is broader than just a health issue?
  948. - 30:43
  949. - It's reinforced for me, the fatigue problem.
  950. - 30:48
  951. - The truth is, more people did die in the 1918 pandemic then died in World War One and World War two combined. And yet we talk about that all the time, and we
  952. - 31:00
  953. - Don't talk about the pandemic 25% of people in Samoa died, because people are allowed off the ship. So that those impacts are not talked about anymore. And then I guess the other thing that it's reinforced to me is how much more work there is to do on this issue, particularly from if I can describe it this way, a more ecosystem perspective. So it's not just from a health perspective, it's not just respective of private interests, not just perspective of government, it's from the entire ecosystem.
  954. - 31:33
  955. - I think this is really technical argument. And it's a bit like, honestly, it's a bit like, when's the next asteroid going to hit us? And I think people get lost in that. And if you if you wouldn't take this into something that's really actionable. You have to get down to, you know, the consumer level, the person who doesn't live in West Africa, waiting for a ball over the person who actually like it lives in New Hope Pennsylvania doesn't see it, until until you get to that level, then you're not going to get the traction and the actionability behind it. Like
  956. - 32:00
  957. - But I do different on Monday. You know, it's kind of a question for people living, not living, but now in West Africa. So I think, for me the bigger about this is
  958. - 32:09
  959. - it's not bad, but it's a technical discussion with technical people who are involved in this every day. And to the exclusion of the community, I'd say.
  960. - 32:18
  961. - I'm struck by how probably this is, the broader public is unaware of just how severe this could be. that strikes me and I would, I would share that, I think, an increase of knowledge on that which could hopefully lead to more prevention and wellness in our healthcare system, rather than the acuity that we deal with, at least in the United States. More more focus on prevention and wellness, and specifically primary care oral care, which has a direct correlation with, you know, overall health, and that helps immunity system. So I'm really struck by that. Mostly, I
  962. - 32:50
  963. - think it's very important to not be shocked. I think if when we're shocked we're not able to make decisions to do the right thing. And I think some of what we've done today is just help us think
  964. - 33:00
  965. - through what's what a really bad scenario might look like. Before an event like this, having the systems in place to coordinate more effectively is essential in the long term
  966. - 33:13
  967. - biotechnology in as Chris said, the ability to rapidly develop a specific countermeasure is important. The the requirements there are incredibly difficult within weeks have something that everybody could could take. I'd say in the response,
  968. - 33:31
  969. - it will be really important to think about what the aim of the response is and how much can actually be accomplished. actually think in this event. Given what we heard up through the first moves, the outcome was really not as bad as it might have been. And I think we need to as we're as we're responding to this, we need to be clear about what is achievable with the interventions that we have and not overestimate the impact we can have. Chris, I guess I'm my surprise.
  970. - 34:00
  971. - not shocked. But surprise is that the presumption of competence of the system? I want to
  972. - 34:07
  973. - be sitting in a in the earliest video was that the poll show that two thirds I think it was of the population, thought a vaccine would be available in two months. This is population that is least in my state, significant minority people willing to question that whether they should give the kids the vaccines we have today that have been around for decades proven to be safe and effective. And yet in the face of a crisis, two thirds of them presume that the scientific community will come up with a vaccine within two months. That's dangerous, magical thinking. And we have to, you know, get a better set of messages out about what what the threat is and what could be happening. I think there's a an implicit presume competence of governments and the UN system that's probably greater than it should be as well. I think governments being clear about what they can do and what they can do on the face of it.
  974. - 35:00
  975. - epidemic will help him increase individual and community preparedness. Yeah, don't over promise sphere.
  976. - 35:08
  977. - Thank you. I mean, for me, this really exposed the vulnerabilities
  978. - 35:13
  979. - not around the room, but in terms of the country comparisons and those vulnerabilities already exists in the poorer countries. And so how are we going to strengthen those capabilities, whether it's through the health sector or governments and these solutions that we've been talking? The discussion for me has been sectorial. And we need to figure out a way i'm not saying that United Nations has the the answer to all of this, but we need to figure out a way that can bring all stakeholders to the table in a situation like this to be able to bring the best solutions to private sector and small government to him. Great, I
  980. - 35:54
  981. - convinced increasingly that simulations are stimulating, and I think they
  982. - 36:00
  983. - Have a real value. And so I want to make sure that that gets added to the list of recommended actions. I think
  984. - 36:08
  985. - we have to look and compliment that stimulation with a much clear commitment to driving change in behavior in a very complex system in specific areas. And I think this is helpful. But if we lay this on the four reports that were produced, following the West Africa crisis, if we link it into the ongoing activities of the global panda preparedness monitoring board, I think we would come up with a,
  986. - 36:40
  987. - an ambitious agenda, but one that gets sufficiently refined, that we can begin to hold ourselves accountable to that. Okay, this side of the table, I'm going to have to ask you to be very brief, but do I go for Yes, to take a look at the takeaways from our history and we speak
  988. - 37:00
  989. - 1918 flu epidemic and a bola basically look at all the matches that were taking their bring those together, prepare a regulatory or protocol, which you can start to work on and trying to increase communication from government to government. So we'll be able to share healthcare information, whether it is Dino therapy, whatever is taking place to try to come back the hours. Okay? appreciate the focus on preparedness. As we look at communities that are, let's say vulnerable to natural disasters or crisis. I mean, we look at trying to foster that community hub, bringing together bringing together faith based organizations, academia, government, small businesses all together. On the other end of the spectrum. We believe that the World Economic Forum is a great platform that brought together post Ebola a great group of who the World Food
  990. - 38:00
  991. - program led by Henry Schein j&j. And we are all loosely together because again, sustainability, keeping the interest of these institutions is always the challenge. Yeah.
  992. - 38:12
  993. - I think first of all major global corporations. You know, when you think about even the, the regulations, there are four how many executives can get on one plane at a time there are all these succession plans already in place. So what are the plans that global organizations are having in place in case of such a situation like this? And then I think the thing I'm surprised about, we didn't bring this into this at all, but politics, if this is taking place from October to December 18 2019, with what's going on and presidential election, and about a year, I think that would play a major part in this kind of scenario. Interesting point, Martin quickly, three points. Use the time that you actually have for preparation, but the best way to set up and maintain information exchange platforms and keep your awareness. It's our responsibility to do this. Excellent. For me, my learning was
  994. - 39:00
  995. - The risks of misinformation and this information, I think it requires a lot more thought and coordination across the stakeholders. At one point, despite the alignment around the room about the importance of some central leadership, I think the challenge in the green on the central leadership.
  996. - 39:19
  997. - Thank you all, I think, summing this up as I see it investment, planning, preparation, coordinating prioritization. And obviously, all the advanced thought and effort given to those things, will hopefully mitigate the effects when the pandemic comes. Thank you all very much.
  998. - 39:44
  999. - Thank you, gene. And thanks to all of our players for these excellent suggestions. Our plan now is to consider your ideas, the results of today and come forward with a set of recommendations and a call to action and we hope
  1000. - 40:00
  1001. - That with your experience today you will continue to be amazing champions for this issue. It's extremely valuable but very rare for a group of this diversity to come and spend part of the day talking about these issues. So on behalf of our partners at the World Economic Forum and the Bill and Melinda Gates Foundation, I want to thank our players again for their participation and insights. Today, you did an amazing job and a really difficult scenario. And I also like to thank our broader audience here in New York as well as those participating online and of course, our amazing center faculty and staff and the larger event to a one team from the Gates Foundation and the World Economic Forum for putting together today's events. So please join us down the hall in the cotillion room for the luncheon and we stand adjourned. Thank you.
  1002. - Transcribed by
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