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The Next Super Bug | DAVOS 2020

Lars Rebien Sorensen
Chairman of the Board of Directors at Novo Nordisk Foundation
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World Economic Forum 2020
January 22, 2020, Davos, Switzerland
World Economic Forum 2020
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The Next Super Bug | DAVOS 2020
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About speakers

Lars Rebien Sorensen
Chairman of the Board of Directors at Novo Nordisk Foundation
Richard Hatchett
Chief Executive Officer at Coalition for Epidemic Preparedness and Innovations (CEPI)
Heidi Larson
Professor of Anthropology, Risk and Decision Science at London School of Hygiene and Tropical Medicine
Kirsten Salyer
Opinion Editor at World Economic Forum

1981, MSc in Forestry, Faculty of Sciences, University of Copenhagen (formerly the Royal Danish Veterinary & Agricultural University); 1983, BSc in International Economics, Copenhagen Business School. 1982, joined Enzymes Marketing, Novo Nordisk; has completed several overseas postings, including in the Middle East and the US; November 2000, President and Chief Executive Officer. Since October 2007, Adjunct Professor, Faculty of Life Sciences, University of Copenhagen. Recipient, Chevalier de l'Ordre National de la Légion d'Honneur, France (2005).

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Graduate, Vanderbilt University and the Vanderbilt University Medical School; Residency in Internal Medicine, New York Hospital – Cornell Medical Center; Fellowship in Medical Oncology, Duke University Medical Center; MD. Formerly; served on the White House Homeland Security Council under President George W. Bush; Member, White House National Security Staff under President Barack Obama; Chief Medical Officer, Deputy Director and acting Director, US Biomedical Advanced Research and Development Authority (BARDA); oversaw programmes to develop medical countermeasures against chemical, biological, radiological and nuclear threats, pandemic influenza, and emerging infectious diseases and led or helped lead the development of vaccines, therapeutics, and diagnostics for a number of emerging viruses, including the H3N2v and H7N9 influenza viruses, MERS, Ebola, and Zika. Chief Executive Officer, Coalition for Epidemic Preparedness Innovations (CEPI), a partnership of public, private, philanthropic and civil organizations that will finance and coordinate the development of vaccines against high-priority public health threats and vaccine platform technologies to respond rapidly to emerging infectious diseases with pandemic or epidemic potential. Recipient: HHS Secretary’s Award for Distinguished Service; NIH Director’s Merit Award (five-times).

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1979, BA, Harvard; 1985, MA and 1990, PhD, University of California, Berkeley. 1993-98, Social Mobilization Adviser, South Pacific, UNICEF; 1998-2001, Senior Adviser, StopTB Partnership; Chair, GAVI Advocacy Task Force; 2001-2005, Senior Adviser, UNICEF, New York. Currently, Research Associate Professor, Clark University and Research Associate, Harvard Center for Population and Development Studies; Current: Clinical Professor and Director of European Initiatives, Institute for Health Metrics and Evaluation, University of Washington (Seattle); Professor of Anthropology, Risk and Decision Science and Director, The Vaccine Confidence Project, Dept. of Infectious Disease Epidemiology, London School of Hygiene&Tropical Medicine

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More than eight years of experience in communications, public engagement strategy, editing, writing, reporting, ghost-writing, project management, and developing and managing digital strategies for websites, news publications, magazines, and books.Specialties: communications, editing, writing, ghost-writing, reporting, project management, social media, newsletters, web and media analytics, audience development, community management.Areas of expertise: international affairs, technology, business, sustainable development, politics

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About the talk

Drug-resistant infections are undermining modern medicine; vaccine hesitancy is driving a resurgence of preventable disease; and we can be sure that another epidemic is on the horizon. How can we mitigate the risk and impact of pressing global health security challenges?

Get ahead of the issues shaping global health security in 2020.

Speakers: Lars Rebien Sorensen, Richard Hatchett, Heidi Larson, Kirsten Salyer

The World Economic Forum is the International Organization for Public-Private Cooperation. The Forum engages the foremost political, business, cultural and other leaders of society to shape global, regional and industry agendas. We believe that progress happens by bringing together people from all walks of life who have the drive and the influence to make positive change.

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We should invent a powerful antibiotics versus a different path of jeans and that we should put them in the closet with a glass but rather not use it because it is easy over usage of antibiotics, which is now leaving again through Evolution to resistance and it leaves us in a very very vulnerable situation. It is the next Super Bug and what is that mean? We actually took a look at this about a week ago in the world economic Forum Global risk report and the new

era of biological risk was actually one of the main rest identified for the year ahead. So today we're going to have a conversation about what that biological wrist looks like what are some of the different issues that we should be looking at when talking about Solutions and so will be looking at Different topics in global Health security one of which what does it mean if another epidemic is on the horizon another what what does it mean? We're for Rising antimicrobial resistance infections coming increasingly prevalence at end of 3rd questions around

vaccine hesitancy and what that means for our overall preparedness response. I'd like to take a moment to introduce my my guest here today to my left eye doctor Richard Hatchet who is the chief executive officer for the Coalition for epidemic preparedness and Innovations Norway who is a professor of anthropology risk and decision science for the London School of hygiene and tropical medicine in the UK. And I next we have Mister lies Sorenson, who is the chairman of the board of directors for Novo Nordisk Foundation Denmark. Thank you so

much for being here with us today at 2 o clock to it to really start start with you and ask you a question that is increasingly on our minds this week in particular on the world has seen a growing number of epidemic in recent years a Bola zika stars, and now we're hearing reports of the coronavirus outbreak in China. Could you speak a bit about the likelihood of these events becoming a global threat and and how prepared are we to respond with the end of the novel Coronavirus?

I've been working on an epidemic threats and epidemic response for about 20 years. So I put in my current role and previously in the US government. I think the risk of epidemic disease you talked about the increasing number of threats. I think that is a real phenomenon that I don't think it's that we're increasingly attentive to them. I think it's a real phenomenon. I think it is related to you how societies are currently organized in the in the complexity of societies are there the speed with which people move around the world changing moods of interacting with Wildlife species climate change

as it as a factor driving the emergence of new disease, so I think it's actually a structural thread and it will be a structural thread for the foreseeable future. I think it's also one of us small plastic prints National threats that require Collective action to be addressed. I think the concern is that the diseases that were that we see emerge have a I would almost say darwinian imperative to to find new communities where they can break out and propagate in a Bola is it is a

great example was discovered more than 40 years ago. And there were 20 or 25 outbreaks between its Discovery in 1976 and the huge outbreak in West Africa a few years ago. And then what you saw over that period of time through those outbreaks with the disease, it was gradually expanding its Geographic range. And looking for Community for its propagate in ultimately found in West Africa sort of a perfect setting in which you could have a large explosive outbreak. And now we're in the midst of the second largest outbreak of

Ebola ever to the two largest Ebola outbreak ever had both occurred in the last five years, and I don't think that's a coincidence now, we're seeing the emergence of a third coronavirus SARS is with the first coronavirus if we had significant concerns about it broke out in 2003 came along a decade later. Neither of those viruses was Very easily transmissible. They've they've worked transmissible. They cost a lot of disease but we knew the coronavirus has as a representative threat to humanity and people are

concerned about now with the current coronavirus is perhaps this is the coronavirus that we've been fearing which is one. It is more easily transmissible nassar's or murderers and with the legality that is sufficiently high. But if it became with a globally disseminated disease could potentially affect a very large number of people in potentially cause tens hundreds of thousands of deaths or even millions of dust and that's the really frightening Prospect. It just to conclude. I think we need to acknowledge. The disease epidemic diseases

are in fact a structural thread for the society that we created for ourselves. And we need to take the appropriate steps to prepare for and be ready to respond to them. Is there anything in particular that we we can do to prepare for when when and and and if we received this cross-border flow of outbreaks in the first quarter collaboration, it requires new establishing transparency in reporting is a norm. It requires developing new technological capabilities to develop definitive countermeasures like vaccines very rapidly. Actually

one of the reasons my organization was set up a few years ago Garrett Douglas. You know, I think we know what we need to do. The question is whether we have the political will to do it and whether we choose to allocate the resources that are required to have turn turn to mr. Sorensen to speak camera talking about the lease offer. Someone element of props responses talking about the drugs necessary to two trucks and take take him to a fact to do something about this.

The world has seen this growing case of drug and I'd love to see hear from you you written about that. Enter microbial resistance is actually one of the most serious threats to to humanity today. Why is it such a hurry just read it and what do you think we can do about it? Yeah, I just said it's actually just making what we just heard even worse. It is it's a it's a different set of problems here. We talkin about our ability to combat bacterial infections and I would say so

this the epidemic of a virus is an immediate emergency huge threat. This is more like a slow-moving tsunami and where human life as we know it today. It might not be the same kind of life. We see just 30 years from now the reason being it is it is if you think about save childbirth if you think about surgery if you think about immunotherapy for cancer and many many of the medical interventions that did makes our lives longer and more healthy. productive and not might no longer be possible if we do not invent

and preserve new antibiotics and and there is a bit dysfunctional Marketplace because Reality, we would like these drugs never to be used. It's like a fire extinguisher. We should invent a powerful antibiotics versus a different path to put them in the closet with a glass cover and only to be broken in case of an emergency but not use it because it is antibiotics which is now meeting again through Evolution to resistance and it leaves us in a very very vulnerable situation so we can come back to

Solutions of how we might deal with this. I think it's a problem that we can solve. I mean, I think the epidemic might be more difficult to deal with it because the immediate effect is so large. Think about this the size of that the complexity of that the cost of that. This this this lack of a new antibiotic is something we can fix if we really wanted in collaboration, but we can come back later. Thank you so much Professor lights, then let's turn for a moment to the Social and the political side of this conversation.

We really would be helpful to understand kind of what are these factors that help determine how we respond and I am curious to hear your thoughts and understanding the recent rise in vaccine hesitancy and what really how this contributes to global Health crises and what you would suggest to be done to combat that. Well, I think that there's a few things that means of societal and political issues contribute to the spread of diseases as much as efforts to mitigate that I mean a Bola is classic. I've been working

closely with Richard tieman on Ebola vaccine trial and working on the community Dimensions the truss building in whatever and I think that you know Politics as is can be messy and can interfere with efforts to get into to deal with the situations, but there's something that's even more basic that is is about just individuals and communities and that's facts scene acceptance and we really were were slipping in our Global vaccine efforts. We did really great. I mean when you think about it, it's Not too long ago. I mean in 1980.

We only have 20% of the world's children were getting the basics vaccines. That's not that long ago. And then there was a global concerted effort to get that up to eighty 85% It was amazing, but we're stuck there and we're actually dropping in some countries that it's almost like we've reached the saturation point and in addition to that in the meanwhile, we have a lot more than 6 vaccines. We've got combination to vaccines. We have a lot of vaccines but we also have a much more questioning public and I think that there's a lot

of things that are converging right now that it's, it's about complex threats. I mean, there's the whole digital Revolution that is added a whole level of opportunity on the one hand and yet I mean the global risk report 23rd. 81 coins this term digital wildfires and a hyper-connected world. I've referred to that phrase a lot. And actually I really like the parallel to wildfires particularly right now. When we look at what's happening in in Australia, one of the things that physicists and Engineers

have said about trying to you know, analyze these patterns of these new fires and what they said, is there burning hotter faster and less predictably and I couldn't think of a better metaphor than some of the diseases but also what's happening in vaccine confidence in boxing resistance. These connected networks of people who are from uncertain to resisting vaccines, not necessarily because of the vaccine, but because of what they represent their regulated and mediated by government are produced by Big

Business there off of mandated, They have chemicals in them according. I mean, they're not not natural as some of them say when in fact actually, I think we need a new brand for vaccine because they actually kick start your natural immune system couldn't be better and it's not like pulling up to a petrol pump and getting you know a lot of chemicals in your arm. It's more like a mosquito bite frankly and it triggers your own system. So I think that we need to do much better now before the next big outbreaks to get people's confidence back in

vaccine because one if we prevent a lot of these current currently circulating diseases, we won't have to use antibiotics. I mean, it's one of our best Cheap Ford in mitigating the risk of AMR when you prevent it in the first place. So the more we can prevent these diseases the more we can keep these strong antibiotics in the fire in the break and wait. We actually had a panel last year at the wef on Monday and the loss of confidence and Trust in in Authority in science in general which contributed and this is exactly what you were doing to

contributed to this on easy in certain Community is taking Public Health advice and and taking their vaccinations and at this very sad. And any space space if it's is not just inhale there is fake news dissemination. It seems to think I made a very important point which is worth underscoring which is how particularly with that team has an empty but even some extent with any microbial resistance or wear with epidemics, I mean did these are kind of represented here leaders at 3 great narratives, you know any sort of infectious disease at the moment and then each of them

underneath and I think you've outlined it for vaccine hesitancy very well. Brings together a constellation of narrative that interact in ways that are very unpredictable and then you superimpose digital wildfires in social media and it becomes really really toxic and in so you're about to see I would predict with Wuhan you're about to see social reactions that are probably going to be disproportionate to the current threat at least and they're going to cuss tremendous damage in much the same way that you see social reaction to these

narratives swirling around there's also the issue of timing or I mean, this is happening on the I mean Friday is New Year's Eve next week is like the biggest traveling time of the year. So this could have happened in the middle of the year and it would have been different but the timing of these things is is you know often and that's not Edible, I mean also you don't want to have outbreaks or introduce new vaccines around political elections. You don't mean there are certain things that you you don't

you want to try to keep things as Least Complicated as possible in Des Arc AR challenges. Also, there's conflict and security. We having to ride a kid is polio because of conflict and Security in the north west Frontier in Pakistan and in Northeast the Boko Haram in Nigeria, it's no coincidence that they're harboring the remaining Wild Virus in the world. And by the way, it probably is coming back. You know, we've had the the back the Philippines case, it's come up now in Malaysia. We had a case in Ukraine and a

few years ago. You know, this is something we're almost there, but it's really such a I've been working on polio for a long time. I mean I used to have unicef's Global immunization strategy and communication for introducing new vaccines but also for initiatives like polio and it was we didn't have the security issues that we have now in Pakistan and Nigeria. It was actually we weren't even worried about Pakistan. We were more focused on a small section in

India and a boycott in Nigeria and which we resolved but we wouldn't have been able to do that in the current environment. So the other thing is things change things can change your settings. If you're in a you do your plan and you know, you do your Five-Year Plan and we'll do this then but stuff happens we didn't plan for the digital. I mean, we didn't anticipate some of the aspects of the environment will working now when we planned or produced a certain new vaccines at the antigens, so

Thank you so much. I think it's raised a lot of questions around around uncertainty and unpredictability cross no Crown Global health issues in a real large and terms of preparing for the next epidemic, you know, understanding political consideration timing issues. And of course that unit questions around 12 are the drugs freezing today going to work for 4 tomorrow. So I think I love if you if you could eat share briefly just a note on on the preparedness ask that how do you prepare for something that is So filled with this this uncertainty.

I love about start. I mean I think in in the domain of epidemic diseases where you're talking about newly emerging at the Dimock diseases. There is a lot of uncertainty. You can't predict what the next disease is going to be by definition. You can't predict when it's going to happen. But you I think you from a preparedness perspective in this goes back to the point that I was making about these things sort of an inherent risk in the societies that we've constructed for ourselves. If there is a almost an Actuarial risk, and you know, we we saw Anita in

1999 and stars in 2003 Age 5 in 1 in 2005 H1, N1 in 2009 lease thinks they're all different. You can't predict what is going to be next time but they're coming along with it, you know, every two to three maybe four years of debt outside and the the risk tolerance of society for infectious diseases is is his beak Grammatically and part of the reason to decrease dramatically is because the destruction that they caused because of the interdependencies within society that you can nominate cost had become astronomical in 2015. There was a murderous

outbreak in South Korea it cost 186 cases. That's a lot of cases it cost thirty-six desk, but it went to the closure of 2,000 schools it led to the destruction of the tourist economy in South Korea. It probably cost to rent in billion dollars of damage, which is more than 50 million dollars per case. In in sinful if that's the risk. We need to take steps to prepare for den den. Even though. We can't predict what the next disease is going to be. We know what the components of preparedness are and we can invest in the

components of preparedness and its surveillance capabilities Public Health laboratory capability. It's the ability to rapidly develop new definitive medical countermeasures like Therapeutics in vaccines so we can we can invest in this capability if we internalize that this is a recurrent risk. The problem is that people historically have not received the science risk. They have perceived the individual events influence ours comes and goes away. You forget about it when a bowl of comes and goes away you forget about it when he comes and goes away you

forget about it. People are not receiving the pattern and so they're not making the necessary investment just finished pretty quickly. I like to analogize with cybersecurity risk. 30 years ago when computers were not connected people tended to Discount cybersecurity risk buy a new computer viruses existed, but he had to insert an infected disc into your computer in order to get the virus of people discounted the risk and they didn't make the investments in cybersecurity and I are interconnected Digital World. Now, that would be suicidal people have now internalized

the clathrus. They don't know what the next computer virus is going to be but they accept that we have to be prepared for them. So they now routinely invest in what's required to be prepared for it and they do patches as soon as you love her ability to identify. We need to take that same kind of mentality and apply it to biological risk. Thank you are companies. We all think of the engines in the loud sirens when there's a fire there there but this is not the only thing they do and mean fire departments are

spending a lot of time. Combat, strategies and plans and and systems in place getting hoses in the right places, you know, this is the Firebox. So I think that's a very primitive analogy in a way but I think from a from a vaccine front. I mean, I mentioned things like that but I'm thinking back about 9:11. I was in New York City on headquarters. We realized that as a us we were very busy with particularly with UNICEF in big prepared for emergencies in a lot

of other countries and our offices. They had never thought that something would happen in New York. They didn't at the heads of agencies across the UN agency did not even have each other's mobile phone numbers unless they happen to have a sport. We didn't have a plan. We didn't have an evacuation plan. We had lights for fire but there were things that you know, you you kind of think it's Over there the risk and just after that we had the anthrax and then there was avian flu and then there was a whole series of things that were like, whoa, wait a minute

and a lot of simulations were going on, but I think it a very simple level. Do you know your neighbor? Do you know what you would do if you needed took if all of a sudden because there was a circulating virus you couldn't leave your house. Do you have anything extra food or water in the house? Do you know do you have a plan to contact family members or two of a place you would need or you know simple things just think about your own situation. Have you talked to your neighbors do know, you know how you would as the family or friends or whoever you're you know, something some kind

of network. The other thing is in which I am not worried that we're taking down so many phone booths because When 9/11 is hit the cell tower we couldn't count on the cell phone. I mean, I was lucky. I still I still had a landline in my apartment and I happen to be living walking distance. I mean I had a lot of colleagues. So we're really stranded and couldn't call and phones were down. There were landline. So I think we need you know, we shouldn't be so dependent on our mobile devices and have a

plan B. What how what would you do? If you didn't have it? It was all the lines were cut which is a very real possibility and not just about the connectivity. I was at a session with the head of the International Red Cross red crescent and they were saying for some of these Refugee populations that they'll be on the other side helping them move through the one thing that people want to give before they go into it. Insert setting is their phone only not nothing to do with connectivity. They want them to save their data. They don't

want the the government or the situation. They're going through or two to get hold of their contacts. So do you have backups for your contacts that aren't dependent on you having your mobile phone to have it frankly. I'm sorry to be so old-fashioned. We're written down or at least the court important ones. I mean, I think we need this is serious stuff. We need we need to be more reflective of what would happen. If I didn't have X or the water stopped or the water was the infective agent. Do we

have something else? I'm not happy. No. I just attended the station about sustainable business community and I John Kerry secretary of state and he made the point in terms of being able to deal with the climate crisis. It in his view to deal with it. We need to be at wartime footing that sounds serious. He's useless in order for it to deal with carbon capture and n n a new technologies can replace the fossil fuels and so I would say that I have an easier solution

the long-term and replenishment of of antibiotics that are not functional today because we've invested $150 in in trying to develop new scientific Concepts and start-up companies with new ideas. This is stranded not because of lack of scientific progress, but it has stranded because If we were successful, even our foundation and we work together with welcome Foundation. We would be bankrupt because of cost of developing these would be prohibitive. And then oh, by the way, if we succeeded that there would be no recuperation

Investments. So what is needed to develop new antibiotics which week and then keep in the thighs save if we have good stewardship it would be Additional risk and capital are provided by the foundation's like my own and other foundations from from governments and from the pharmaceutical industry, which has even though it's not their responsibility that there's not a market they they have the capabilities of making their resources available to solve the problem

where I would advise them to do so because they would be seen as taking a public interest for once and not just a corporate interest and then we need to have the regulatory process amended and adjusted so that we can have a regulatory approval. And then finally we need a national States regions to look at a subscription model whereby they subscribe to the availability of new drugs, even though they may not be using them and the companies would be obliged. To provide these and have safety stocks, but preferably not use

them compared to the weather has been described by epidemics. I mean I can only I mean, I wouldn't know how to deal with that other than try to work on the plan B that you just drive side of a making sure I have food and water and and my bicycle has bumps and and whatever we can do on our own self microbial resistance and it is not very costly. That's just not my place today. Thank you. I know I have many more questions by like to take a moment to offer that to the audience if we can just take that these two questions here

and then we'll meet there is also one patient in the US that is also diagnose Addison's disease. That's the stopper in China. So so given your knowledge about the White House and your background. So you are opinions are switched China us work together on this while they be able to work together on this and if yes, and what kind of medical mask They could already are possibly at 8 and Macy's the larsons you speak about the individual role in fighting against the

prices and the wheel in China. China has a long tradition of a U of A Using antibiotics and now there's already kind of like a panic that a lot of the last season of Outlander by antibiotics, which is not necessarily helping with the cost of a d specific type of a virus. So what what is your suggestion, you know as an individual with food to to help the community in facing discount of the prices and meesters of Sorensen's you speak a little bit about the corporate responsibility already, but I still want to know if you know what I can from the corporate

perspective what kind of row using the phone because I'm a soda company could possibly take in this kind of a situation and two Tours of status of the Madison for ordinary people instead of a just cashing out of the situation. Thank you. Swan to fill out questions about the investment and in this virus protecting, is there any suggestions to two before the you know public sector to follow that all cyborgs because he's cracks are friends how to put those preachers on, you know in the public

who could do those investment governance leave those Englishmen tour companies what any you know, people would take that option to give it to those investment. To start with just thought that final question are necessarily going to be multiple does have to be private sector investment stay very clearly has to be public sector investment and I think an important source of investment to be philanthropic Capital which doesn't have the same kinds of constraints that private sector investment or even governmental

investment by elected officials will face. I think of another very important thing to explore in this is something that has been explored in the cyber world is the regulatory environment some of the necessary investments in cyber for example have been shifted from the end-user to internet service providers or two banks for example in terms of fraud protection. Buy new laws or new regulatory requirements and I think the problem with epidemic preparedness right now is it it's all sort of

Left To the End user and in and left his specific individual countries and you need new governance that appropriately moves the incentives to where they can make the most difference if it's a complicated story, but I think you have to have all three sectors you have to have private public and philanthropic Capital working together. I would argue the governments have the most important role in the question that you asked about and China and the US work together in China was unfortunate in the debt for the epidemic started

but it is now a global problem. This is not China's problem. This is the world's problem and China and the US even despite the current tensions the parts of the relationship both have incredible scientific Capital scientific resources, and they do need to be working together because they will accomplish much more much more rapidly working together then they will if they continue to think through a national lens and similarly to come back to your question governments have to recognize an individual governments working by themselves will not be able to solve this problem. They have

to pool their resources and pool their efforts. Fantastic transition on if we could turn take to you guys about the corporate side. What's the private sector's responsibility and enroll here is I think I stayed at the in relationship to it the antibiotics Mark the antibiotics Market have collapsed becoming generic and prices become so low and it's at they cannot profit create enough profit Warren research activities into a new and improved antibiotics.

So then you ask me if what is the role of the pharmaceutical industry? So it is not you cannot really directly hold a pharmaceutical industry responsible for taking action, but it reminds me of I think it was so cold by then to the hottest place in hell is reserved. For those that remain neutral and the capabilities that the pharmaceutical Industries have their they can contribute. In both financially but also skill-wise. They had two technologies that are required to

science which they have invested in overtime which they considered proprietary that we could be brings to the ball to the 4 mm problem. So what is the prince in the life science Industry? This can be all the players as well medical device industry that have capabilities in the step forward and help us solve this problem. This is I think the least problem that we are facing. And I had a few if you would die. Give us the final word on my last question on on to the community yet. I think just your question was.

The Chinese using a lot of antibiotics are not the only ones that I appreciate what you're saying and and how to deal with how to mitigate the risk of of AMR aside from I think the biggest thing is trying to prevent infections in the first place. But I also think I mean shifting more to the community roll. I think you need people to encourage each other and end this needs to be this is not about individuals. This is about, you know, a contagion. This is about the full keeping

communities to live. This is about keeping nation-states for a wise and I think one thing that really concerns me with the whole vaccine hesitancy thing is that it's just a another symptom of underlying issues of the iPhone. I Personalization of pretty much everything but that's not the way the world is going to survive. I mean vaccines when you think about touch every single life on the planet it is the greatest social experiment in cooperation. I mean,

we depend the hold the hold model of vaccination depends on cooperation. So it's really putting us to the test and frankly for any kind of resilient. We're going to need cooperation big time. So that's my final count. Thank you so much with all of our speakers here today. If I may put my fireman helmet on for a moment and try to summarize the topics we've talked about today. I think three main points to that one is preparedness II is importance of building trust and the third as he put it just now with the importance of

collaboration and Operation. So thank you so much again to the speakers and to those of you joining us for the session.

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