Welcome. There has been investment in the science and manufacturing of developing a vaccine and rolling it out in record time and getting it to everybody around the world. To tryf us came together andunderstand this journey to quantify the uncertainties in the science and scaling up of such a product and to reflect on what this means for policymakers and societies all over the world. What is the chance of getting a vaccine in the next 12 months, how long will it take to manufacture it to scale, and how governments done in designing their vaccine portfolios, but why does this matter . Taxpayers need to know this information. We are aware of industries and governments that have their own internal models and analyses. The stakes are too high and the information shared so far has been so little and hard to. Erify not only is this needed to plan buildlios, but to help trust, without which a vaccine will never work however successful. Today we are sharing our findings with you including the codes for the models and our approach and conclusions. More will be coming in the next few weeks including a group. Iendly webbased we hope that this web tool that we will launch will allow whoever wants to do their own data and come up with their own products because this is what we are talking about, forecasts, estimates, predictions. We do not have the answers. Resultc will describe a in a minute, but the key take y is that there is portfolio diversification is important, and that refers that the vaccine candidates are not all likely to fail for the same reason. That is important. Andiversify, we need attractive marketplace and the way the development is final also determines the level of diversification. We talked about creating a healthy marketplace and are commitment work here. Suggests that we will most probably get a vaccine and itwill take time, probably will not solve covid for us good we will continue to live with the virus in the meantime, including maintaining social distancing and other measures what working on better treatment. In doing so we must not overlook the Collateral Damage in terms of human lives and livelihoods, but our focus on dealing with , we need to keep on asking voicee data and getting a to those suffering in silence. This work is a collaborative. Ffort it turns out finding a successful vaccine share common methodologies. Today we will tell you what we have found. Work in progress. We want to hear from you. We want to refine what is found. Ofill set out the structure the days event and introduce to you the speakers. Josh to get us started, a vice dean for Public Health practice at Johns HopkinsPublic Health. He is a former Principal Deputy mission or of the u. S. Food and drug administration. We also have the chair of the private sector of the advisory also a from columbia and former minister will respond to someindings and share ideas. I will introduce them further when we get to that point and they will make short comments and there will be an opportunity for you to ask question. I think this conversation is critically important. Without further ado, i will fastforward to josh who will have 10 minutes to share with us his situation with Vaccine Development. We are grateful to have you with us. I think you might be meted. Muted. For having meou and for having this session and for the work that has been done. I appreciate the opportunity shoe to share a few thoughts. I think when this started, the idea that this pandemic, the idea that there would be a vexing to save us was a lifeline , a dream that people could have. Now we are getting to the point where we have an opportunity to understand what that means. It is not a magic solution, not a magic wand that saves us and we wake up from this nightmare. We all wish it were, but that is not the situation. That could make an enormous difference. It could save so many lives, and the idea of using a safe vaccine in the middle of the pandemic is a very important focus for the work that all of us need to do. Howuld like to talk about we can get from here to there at a very high level, what the important tasks are at this stage, how to get from where we are to a vaccine making a difference in saving many lives around the world. The first thing is we need to complete effectively the Scientific Research to know whether vaccines are safe and effective. We have to know not only what works, but for whom it works and what populations and how well. They will only come when the science is there. Asserted orbe legislated. This will require some patience and expertise to look at studies and a willingness to recognize when things are not working. Perhaps above all this stage requires integrity, and the studies, and that regulatory strong commitment to science. Obviously there are some worrisome signs that there are some countries jumping ahead and helping, letting hope jump ahead of their understanding of vaccines. I think the most important thing here is really for the science to become clear. Obviously stage, and work on the stages may happen at the same time, but this is how i think about the key challenges, the ability to make available the vaccine and vaccine acceptance. Like to some people and easy step, you just give the vaccine out. People in the field know how many steps there are, how much management, how people have to roll up their sleeves and do all kinds of specific difficult work to be able to take the potential of a vaccine into the reality of vaccination which actually is the thing that saves lives. Isthis point i think it important for people to have the resources necessary to do that implementingk of with chain of custody for vaccines that may need to be kept cold, reaching different communities as well as engagement, answering questions, having trusted messengers talking about vexing nation but about vaccination. If you skipt t step, we know for many reasons Global Cooperation is important. Vaccines that some countries are developing may be good for some countries but not others. By pooling our resources of the planet, we would be able to share our knowledge across the world and have as many people possible benefit from the correct vaccination. The challenge is to set aside the fears and concerns from competition and get people to work together. We are facing a common enemy for humanity and it is important that at every stage from the studies to the review to distribution and acceptance that we think of this as a Global Enterprise because no country is safe if there are parts of the world where there is enormous pandemic. I want to talk about the ourrtance of maintaining strong precautions against Coronavirus Spread during this process. That you will be presenting this model and we cannot let our guard down while these other stages are happening , while we are waiting for the research to come in, building out these distribution networks, because we could have a problem and lossoflife in the interim. I think this is a little bit beyond politics because what we are dealing with is a fatigue from what we are doing. Timeuld take quite a long at least in our current mindset where we went a vaccine next week, quite a long time for us to get there. We can save a lot of lives in the interim. We need to be able to maintain that persistence. For that i would like to quote pointed out that there is the virus does not care how tired we are. In that case it was a bacteria, but the virus does not care how tired we are, how sick we are of having to wear masks are not going to concerts and things like that. But he wrote was, what is natural is the microbe. All of the rest, health, integrity, is the product of the human will, a vigilance that months that must never falter. We need to have the minimum lossoflife and the ability to do the things that are important while we are putting in place the strong protections through a vaccine. Strength is science, understanding, empathy, and it is important to discuss, this aspectsp eliminate key of the path between here and a vaccine that helps the world move through this difficult stage. Thank you for a chance to share some of those thoughts. About forward to reading the Important Research that is going on. I think everybody who is participating today has a role to play to make sure that we are using the best of humanity to fight this virus. Thank you those are inspiring words. I appreciate you taking the time to share your thoughts with us. Anthony toe to ask take us through the actual results. E have released our reports codeso have released error our coats. In the meantime, please read the report if you have the time and interest. Please get in touch with us for questions, suggestions, and right now over the next hour or so, we will collect audience youtube andrough our email, so please get your questions through. I would like to ask you to take us through the results of this to thefore we move on panel discussion. Thank you. She mentioned, this was a diverse team that she got together. We could not have done this without a collaborative effort expert,g our vaccine our physicist who used his knowledge to help us build this rebecca, ourand kalipso,at the lab,. Ho you have already seen thank you. It has been a pleasure to work with everyone. Modelof all, we built a using a range of estimates to try to estimate how long it will. Ake to get a vaccine there was 20 vaccines in the that we could not determine their platform so we excluded those. Types,them into funding those that had large external had externalsome funding, and then vaccines that were taking forward by Large Pharmaceutical Companies or by medium or by Small Companies or academic institutions. We looked at their stage of development. We put all of this information in the model and we come up with this form for how likely each likely is to succeed. We took all of these inputs and put them into a simulation. This is a simulation where we take input and in each simulation the model defines success aced on whether not the probabilities that we put in. You could have a model that checks how likely you are to roll two dices thats a six and it would randomly choose two numbers between one and six each it would be a monte carlo simulation that gives you the likelihood that that would happen. We built assimilation that looked at the whole model and moves forward month by month and vaccines randomly succeed or fail in each run. Each run tells you a lot about the portfolio, but if you combine them all together you should be able to get a picture of what the probability of successes. The model is dynamic and that ,eans if one succeeds or fails the model presumes that another similar vaccine will be more or less likely to succeed. Shown toing vaccine is be very good against covid19, we would presume in the real world this would increase the probability for the expectation that the other vaccine will also work well against the vaccine against the virus. Model can also [indiscernible] the amount of time it takes to adapt or build factories so they can produce s and finally a Global Manufacturing model that looks at the global capacity to produce various vaccines. One of the things that struck me in this project was how little we know about Global Manufacturing capacity. We will create this model and we have created it, and we will make this publicly available so people can put input into the model and they will get different results based on their input. We interviewed 16 experts to get their inputs for this model. These are people from industry and government and people in agencies that are funding vaccines and for people in academia. Three people are leading vaccine candidates, and we are grateful for their time. What did these experts tell us . They told us they would expect about a 66 chance a vaccine in Preclinical Development with proceed to phase one. A vaccine in phase two has about a 67 chance of reaching phase three. For phase 3 we collected input different for each one of the vaccine platforms. The platform that are experts like most was a putting subunit, and the approach the one they like least was the actually is not in this graph. General is that they think that there is a high chance of these vaccines going to preclinical phases that is traditional the case because theres so much pressure and getting a vaccine quickly, but doing this more quickly is not change whether not the vaccine succeeds or fails so we would expect a higher failure rate in phase 3 than you would normally expect. Our experts anticipated a roughly three in four chance and it being submitted for approval. What does this mean . We use all of this information as well as the funding criteria to work out a probability of success for every vaccine and the poor fellow portfolio. What we find is that even the most successful vaccines, theres only about 835 chance will succeed, and theres only two vaccines with over a 30 chance. Even the quickest vaccines are probably six month away from success. 230 vaccines in the portfolio. While the model is not hugely optimistic about anyone vaccine, when you put them together the model becomes optimistic that some of them will succeeds. This is a timeline for when we might see that first one approved. There is a very small chance the model thinks a vaccine will be approved in december and then from january the chance start to rise quickly. April becomes the month that it is or likely than not that we will have one approved. There is an 85 percent chance by by the model21 and thinks that within the next three years there is over 899 chance that one of the vaccines will succeed. Also look at what happens if run the most up a dipstick optimistic and pessimistic outputs, and we moved all of the inputs are down by standard oriations and we multiplied divided the timeline by 1. 5. In the optimistic, every run that we did of the model, all of the vaccines were approved. The average number of approvals in the next three years goes from 5. 7 up to 18, and that medium time is january 2021 with 90 of the simulations seeing one approved by march and 99 being approved by december 2021. However, if you put in more inputs, we see only an 81 chance that one of them in the portfolio will be approved in the next 81 the next three years. Just under 50 of the rounds see approval with the average number isng 1. 7, the median time not until april 2022. It hopefullyis allows people when they have to ,ay how long this could take you can get different outputs and depending on the views you , andn you get area results we will be making this available in just over one month so everyone can see what this leads to. We moved onto the manufacturing model. This model, we took four targets, three aced on the who, target one is having enough vaccine to treat all of the medical professionals in the world, number two is all of the people over 65 and three is all adults with comorbidities and four is the whole world. 18 billionwe need for the population is because the who research presumes we will need two doses to inoculate someone. What we find here is that the is lateime to approval 2021, early 2022, we start to see enough to reach target one. Target two and three follow on fairly quickly. The reason is the model thinks there is a lot of manufacturing capacity, so when we start turning out vaccines can get to two and three quickly. ,our what take longer because even with quite a large amount of vaccine, it will probably take well over a year. Finally we looked at the verification. First of all we looked on the right, at the ideal scenario. We asked the model what are the best six candidates to ensure that one drug is successful . The 85. 7 chance of success based on mostly wellfunded pharmaceutical with three protein , and this kind of goes with the idea that our model likes diverse portfolios. They have five candidates that they like and 67 [indiscernible] ideallose to our portfolio. We also looked at the chance that one of the vaccines gets approved in a run from each of the various platforms. The putting subunit is the most likely. They are something on the order of 90 so it would not make sense to back all of those to get to 87 . These action have very similar endpoints inputs. None of the live attenuated viruses so that, first of all, our experts were not optimistic about the efficacy of these first vaccines. They will be safe, but we might not get a vaccine efficient attenuate the crisis. The second thing to say on this is that the manufacturing capacity in the world is somewhat broken down by different types of vaccines so having a diverse portfolio to come out will allow it to manufacture them more quickly. Theres not enough inactivated viral vaccine in the portfolio. Theres only one outside of asia being pushed forward. There is a lot of capacity to make those types of vaccines. The final thing to say is we did not look at uptake and acceptance in rolling out these vaccines. These are huge challenges that we think the world ought to be looking at now. Some of these are highly unstable and we have not run large campaigns for adults in most of the world for very long times. If you want to know more about this, please read our paper. I would like to say thank you to led all ofors, who. He manufacturing work we are deeply grateful for all of the experts we interviewed and for sharing their data with us. We look forward to hank your thoughts on our research. Thank you. Ou that was great. Anthony has been that key driver behind all of this work, driving the research in the beginning, so very well done. To the chairt over of the private sector for covid19 binds a Vaccine Advisory Council of columbia. We are grateful and honored to have him with us so they will spend a few minutes to share their thoughts in response to what was just presented, and then we will move into our panel. Thank you. We cannot hear you. Minister, over to you. To everyone, the panel, that was interesting what we just heard. Congratulations for that effort. Thise going to split presentation into two parts. Slidesstart sharing the of what is been our performance , and note last month in an approach of judgment but just trying to show the numbers and what we understand from the numbers. This is our Current Situation today. Around 5000 cases, most of them recovered, and still 56,000 active cases 26,000 ine reached the last month. Comparing this to other countries in terms of cases or million, we are in the first 10 places in terms of between 10 ands 20 and are acting in terms of testing per Million People in our country. This is how it looks. I will not get deep into this, but this is how it looks. We have been having a lot of andlenges between july september, and we have different moments in different parts of the country where we have been getting a lot of cases. Like one been just peek for our country, but different small peaks in different regions of our country. Testing, we have been increasing our pcr march andtests since in some parts in august the how we werehanged giving the incentives for testing and the pcr started to drop down while the authorized the new tests of antigens. Not much ass as good results in terms of the , forficity in sensibility some places and regions, this is so thisd to have pcrs is another way of increasing the testing. We are still liking the capability of testing more. , there are response a couple of ideas of how respond. Is trying to january, and we also have the opportunity to prepare the Health System and able to double the numbers in icu beds. I think there has been a lack of focus on primary health care im. There have been a lot of struggles between the Central Government and the local government. The strategy included since march untilged from september, almost 190 days with profound impacts in social and economic aspects. Our communication strategy has driven with logical processes. We have been trying to tell all the bad things about covid19 and we are using some kind of toial punishment in order use the mask and keep safe at their homes. There was this innovation around a corona app that was trying to make an effort in data and tracing but it was not successful. We lost capability of tracing. Testing increased at the beginning, but it never reached accessible levels and it has been decreasing since august. We have been in containing efforts for highrisk populations especially elderly people. There have been a lot of efforts from the government to give social and Financial Aid for individuals and organizations and there has been a lot of work to adaptof protocols organizations in order to keep on moving the economy. I will stop there and i will leave them the next part of the presentation. Thank you. This is going to help ground this conversation why it is so important. Over to you gabrielle for a few more minutes and then we will pass it to the panel. Thank you. The whole process is not as sophisticated as yours as to how to develop a vaccine. It became obvious that it will be very difficult to do that from a middle income country perspective. As soon as they show the capability of being able to run, we made the recommendation to enter kovacs covax. Basically the conclusions of best reasons for that recommendation. Go ahead. Next slide, to the please . Thank you. The challenges ahead have been mentioned and we all know about. The things that really concern me is how rigid the structures of the ministries of health are to be able to respond to the most sophisticated challenges of covid19. Fatiguestress, lots of after months of dealing with the politics and the realities of fighting the virus and at the same time having to look forward and plan for major challenges. For ais the solution diversified portfolio. But even covax is a work in progress. A lot of questions to be cleared. Thoseat is a space for that want to do individual transactions to go after them. Ofombia has a strong history vaccination but it has never really bought any vaccines. They are all ordered through a bilateral system all the way up through unicef. Here we are with this major challenge in front of us and not being able to be prepared to respond. Go ahead. Vaccine acceptance is a fundamental part as has been intioned already communication and confidence building with the population. It is very difficult to do also from the rigid structures of the industry of health. It is really complicated for them to be able to use all the channels of communication and to monitor every day how confident is shifting or how lack of confidence is shifting and what is worrying people. The local regulatory entities and the authorities believe the framework makes life for them very difficult. At the same time they have been dealing with covid19 without investing additional funds and resources to be able to deal with covid19 over an extended period of time to deal with the approval of solutions and vaccines. You can already see how we will have a bottleneck as a couple of , 1, 2 or in approval three vaccines come up at the same time. It will be very difficult for authorities to sanction. For the monitoring of therapeutic solutions, there is too much emphasis on what is happening on the vaccine and little preparation for therapeutic solutions. Those are sort of left on the side. There is maintaining the diagnostic capacity on testing as well as contact and they emphasize one weng, they drop another and saw the drop in testing that we experience over the last few months. My reflection of this whole there is aat business perspective to managing a portfolio of vaccines. Most Public Sector entities are not ready to deal with that, little experience and clearly we dont have the experience in Health Ministries to be with that deal with that. Buying a vaccine is like responding to a phone call. It is an opportunity, it is an individual transaction. There isthe idea that a portfolio as opposed to having a strategy in the building of that portfolio and then a Dynamic Portfolio as things improve and get better, your portfolio moves in one direction and things start to show some failures and your portfolio will show in a different direction. Funds to buysector , when it places a big service in a difficult situation because if things go wrong a couple of years from now, people will forget the emergency and deal with very liberal circumstances. All in all i think having a solution like covax for a middle income country is clearly the best of all solutions. Yet because covax is not totally , there are enough questions to justify resistance to go through the public market. Thank you. It is great news to see colombia into covax. I heard mexico did too. You said buying a vaccine. Getting to the procurement is only the beginning of a long journey, an uphill battle for most countries gaining Public Confidence and trust, the legal and regulatory processes and capacity that you described. The logistics of rolling it out. Solves for part of a big complex problem. Thank you. With that, we moved to our final discussion. We have about 45 minutes. I will introduce our four panelists and i will ask each one one question to get us going and i will ask them to answer briefly. In the meantime please send us your questions. We are collecting these through , and i will be getting those from the team and sifting through them and putting them through our speaker. Our panelists are anthony mcdonald, anthony mcdonnell. He is at the center for Global Development. Policyis an immunization expert. A faculty director for the Global Health delivery project at harvard. And a senior fellow here at the center for Global Development and expert in supply chains. And also, the professor. I will start with robert who has been in the coal mines in terms of the Clinical Science Development and we are very grateful to him for volunteering his time in helping us get to where weve got right now. Isert, my question to you how are the research and 11 timelines for covid19 research and Development Timelines different for covid19 . How do they differ . What are the risks that you see, if any . You. T thank can i have the first slide, please . While that is coming up i will ok, on the fact that so this is a picture of the normal development of a vaccine. You can ignore the detail. There are two points. One is that the average time is 15 years. The range is between 10 and 24 years. The other thing to note is all of the little segments that a Vaccine Development goes through our done end to end. In other words you do not start the next step until you finish this step. That is because a lot of money toinvolved and nobody wants go onto step three and find out that step two failed. I could go to the next slide. Much we haveee how in theed the process case of the covid19 pandemic to be able to come up with a vaccine within a period of two to three years which is what our model is predicting. There is one overwhelming factor that is enabling us to do this and it is the incredible cooperation and collaboration industry,vernment, biotech companies, academic institutions and regulators. This is unprecedented. I think the last time we have seen that kind of collaboration is in efforts to eradicate smallpox and the efforts to eradicate polio. , the keyid that factors here are that some of the elements have been either eliminated or overlapped so that they are happening at the same time rather than happening end to end. For example, the Technology Assessment and Preclinical Development has been essentially skipped because we already had some experience with sars and mers which we were able to use to rapidly move to a vaccine develop and. Development. 235ty much all of the candidates for a vaccine were already being developed for some other vaccine whether a cancer vaccine or some other infectious disease. They were already in the Early Development stage. Companies simply switched what they were doing and jumped into focusing on covid19. A lot of time was saved there. The Clinical Trials were rlapped, and eliminating cutting the time to at least one third just by the overlapping process. Is fact that the pandemic raging so intently has also byowed to shorten each phase engaging with the rapid enrollment and the high incidence is allowing us to determine efficacy much quicker than we would if there was no raging incidence of disease. The last factor that has allowed waso speed it up, scale up already being done because the work was being done on other platforms and finally, manufacturing was sped up mainly due to the Financial Support from governments to encourage manufacturers to manufacture product at risk. These are the main factors and in terms of the outcome, we sped it up but we have not necessarily increased the risk. , about nine of the major vaccine manufacturers in the world have recently signed a pledge that they will commit to adhering to the Regulatory Approval practices that were in existence before this process of condensing the time frames started and that they will not notit data that does adequately prove safety and efficacy of the vaccine. What i take from this is again, because of the collaboration, we or left outle to any of the steps in the process. Thanks. Thank you. You,xt question goes to rebecca. Beyond the approval of a covid19 vaccine, what steps should governments taking now to prepare for vaccine rollout and uptake . Many thanks and first, thank you so much to the team at center for Global Development and particularly anthony. I was thinking about in this time of shelter and quarantine it is extraordinary to collaborate alongside a new tame new team. Thank you, anthony. We think of this model as an essential toolkit because of its complexity and upgrading their vaccine delivery services. The diversity of the covid19 vaccine portfolio reminds us that we are doing two things. The first is we are trying to reduce covid19 related illness, hospitalizations and mortality and the indirect effects of the vaccine, to decrease mobile transmission and restore the global economy. Governments are looking for evidencebased strategies which indicate the knowledge and uncertainty only of vaccine safety and efficacy, but ongoing updates regarding translation transmission and immunity. Vaccines lead to vaccination, we believe governments need to upgrade their vaccine delivery system. There are four interconnected services, distribution, allocation, verification, and demand for the vaccine, promoting vaccine topics. All of these Services Require investment. For distribution the uncertainty in diversity of the portfolio means you can think about multiple vaccines with various dosage and administration requirements. Allocation with limited supplies, prioritizing is a necessity. Committing to the strategy is vital and it is ideal to hear about columbias commitment in future strategies. , the nationalday academy for science and medicine will finalize its guidance regarding equitable vaccine allocation. Prioritization will require updates to public data sets to estimate the priority population. There, verification. Interrupting transmission of covid19 will wire verifying the Vaccine Coverage of population. Not only to reduce waste and duplication, but also to monitor for failure. This will require investment in technical architectures to integrate identity services. Investing in Global Standards and secure biometric we supported technologies will become essential. We are looking at a diverse portfolio. We need to upgrade our verification system to match. ,s history reminds us vaccination is a health and social intervention. Government needs to upgrade their demand strategy for vaccine competence. Confidence. Many of our experts remind us about three efforts that we can conduct to promote confidence and trust in the portfolio. Mentioned,as robert they need to be accountable for vaccine safety. We must invest in robust safety monitoring systems. And number three, we have to understand the risk and heterogeneity of vaccines. Only then can we tailor our strategies. Not only on safety, but the timeline. With the unprecedented investment in a vaccine discovery, the covid19 vaccine requires an investment in the delivery strategies. I hope this model and other tools go upstream in the planning for vaccine delivery. Leaders must detect problems early, target leverage point of complex systems, find reliable ways to measure success, find a new way of working together and enable successes into systems. This are equipped with model to prepare for vaccine delivery. Back to you. You. Ank thanks very much. Et me move on now what do you see as the greatest challenge for rolling out a covid19 vaccine and assuring sufficient manufacturing capacity . Thank you. Before i respond to that question, i want to take a few seconds to reflect on the fact that this project is a preview evidence generation in the future will occur and the nature of multidisciplinary teams that will have to come physicists,we have operations researchers, vaccine manufacturing, Political Development specialists. The ability to bring all of those disciplines together is our only bet that trying to find answers to questions which have intrinsic uncertainty in them. Anthony fornd pulling us all together and taking our varying perspectives at times and integrating them in a meaningful manner. Question, we see a lot of things that have happened for the first time in how we think about manufacturing capacity. Rob mentioned some of them. Most of the manufacturers are building at risk. They have done to Grant Contracting and agreements. They are incentivizing that manufacturing capacity scale up and also relieving bottlenecks in the supply source. Surges and other things. One thing we struggle with is that we are solving the manufacturing capacity problem one candidate at a time. What we need is a Portfolio Network approach. The same way the project highlights the need for portfolio justification diversification, we need to think of it as a portfolio and say what could happen if a candidate fails. What would enable us to create a rapid reconfiguration facility which can take the capacity for the candidate which does not succeed and allocate it to a candidate that has succeeded and shown. That requires information that at this point is unclear where this fits in the global structure globally and even for National Efforts that we see. Certain things come out which are worth thinking about and reflecting. How do we direct that for this covid19 vaccine portfolio and there is still an opportunity. I think covax and other groups could think about an orchestration role for managing that better. The second is that for a mediumterm future, we should think about Something Like a registry for capturing forfacturing capacity multiple upstream steps. Having such a registry should in store that next time we want to think about the problem of manufacturing capacity, we can true optimal sense of allocating and changing and configuring as needed. That is one part. The second part is that this is highlighting that a few years many manufacturing issues are being expected about the fact that we have technologies that will give us the ability to do Rapid Response development and manufacturing. Reach that 12 billion plus target, some of the vaccines are not at a disadvantage because the manufacturing capacity needed for the rollout and those assets do not exist. These are challenges of disputing and allocating. We need a more coordinated way to think about how in the world would we have enough manufacturing capacity for upcoming, same technology such as the newer platforms we have seen coming up for the first time this time. Time, hedging our bets and risks by continuing to for enough capacity intensive platforms. That Risk Management has not think i enough and i see an opportunity for us to use both the output project and our ongoing conversation along with covax and other National Efforts to make that happen both in the short term and for the mediumterm. Thank you, prashant that is very thoughtful. Anthony, i will send it to you. If you have questions, we have received a few. Do send them through to us so we can convey to the panel. What is your main take away from the research . You gave us the results. If there was one key thing that jumps at you having done all this work, what is that . Over to you. Anthony what has really stressed me is that there is a lot of uncertainty within this space. Weveof the experts, struggled with questions like what is the probability that we will go to a stage iii trial or how long will trials take. Because research and development is about the unknown, if we knew which ones work, we would not have to employ people in labs and we would not have to run large trials. Given this huge uncertainty in manufacturing. We have not put together a scale before. Uncertainty about the ,istribution, Vaccine Hesitancy about how many vaccines you should put in your portfolio, we are trying to give some direction on this but we are in this uncertain world. Amount ofave a huge information about what those answers look like. And yet we have done our best to try and clarify some of these things but ultimately we have been using what we can do with the uncertain knowledge that exists. I think the answer to that is we should continue to invest widely in his Committee Types of vaccines as we can. We should continue to increase investment into treatment and diagnostics and looking at ways we can use the technology we have to open things up in can test andat we trace people very rapidly and return to a degree of normality with the knowledge that it might be a while before this goes away because we really dont know the answers are yet and so we want to back his many forces as possible. As many forces as possible. Many horses as possible is a good take away. We have some questions and reflections from colleagues online. I will send it to you prashant with a comment on something that we did not discuss in great detail because we did not actually model supply chain distributions. Bile bags, mentions that may push down the chances of a vaccine. What are your thoughts on that and then i will move onto the next question. Over to you prashant. This are ant from input to distribution in our model which we have yet to do. Our supply issue is such that do we have enough vials. I am more or less resolved through the work that there are other vacancies. I think the key questions that remain are how will the supplies get distribution globally and within the country and when we asked the question how will they get distributed some of it depends on what are the supplies, what are the attributes of the product you are talking about. Vaccine, is it a protein vaccine. The outcomes and the probabilities can help us do some planning and say if we are to build a Global Distribution model, what portfolio product should it look at. It would allow us to think about variables such as how often do you distribute from the National Storage point to if they have a vaccination clinic in the country, if it is a vaccine that requires coaching, you will only be able to have protein capacity at this nature at a few points in the country that they would have to do almost daily or at least multiple times a week distribution which we have never done before. Work is a vaccine that can in a routine chain, we can rely on channels to distribute with less frequency, once every week or once every month. We still need to ramp up the capacity of our routine mainstream chain. It is one thing to say we can set up a new and you fracturing using manufacturing site reactors outside of london or india or wherever those sites are being located. But is another thing to say that you go out in many committees around the world and you will increase the capacity by 5x or 7x. That is oftentimes a much more research intensive endeavor and researches are not necessarily for money. They are researches in terms of people, technician and staff and so on. We know from the work that unicef has done on building our coaching for routine vaccines to the stage that it is today, how ,ong it has taken, how complex we only have a few months. I think the next step should be to take the portfolio output from this to start doing those scenario exercises which some have started to do but i think we need to further amplify that. Thanks. Absolutely. We are looking at the panel and will beoping that this similar to other exercises and hopefully bringing it all together. How much disagreement was there between experts on the probability of success and how did you bring together combined estimates in the model combined the estimates in the model . We have a lot of disagreements around point estimates among quantitative results for success. Those are areas experts struggled with. There is a lot of similarity , trees what the actual work. There is nonreplicating and replicating. Some people told us the replicating factors would be less likely to succeed because there is more safety issue. Some people told us they would be more likely to succeed because they were more efficacious because they keep replicating. True butnced both are we have to do a lot of work to frame those questions for the types of answers people were getting. To answer the second part of your question, we put the average response to our model as our main result but then we also used as an optimistic scenario to use in our presentation which one standard deviation up and one standard deviation down and ultimately the reason we want to make our model available to the public is because some people out there might have different responses to our experts and the experts are what drive the models and we want to give them the opportunity to see what the world would look like using their input. Thank you. Weve got one more question which builds on what you have been talking about prashant. To ensureill it take access for all taking into account previous Vaccine Distribution processes and the particularities of the Current Situation we are in . It depends on what access for all means. Perhaps you can reflect on this. Yeah. I dont know if i have access to this because the only thing i would say is that our model tells us when would we have or what is the likelihood of having tough manufacture capacity meet the 12 billion plus target. 2023 forline goes into having sufficient capacity. Depending upon which candidate, it may be sooner if it is manufacturing for more strident tested vaccines for which we have larger capacity and more access. The steps that happened after that, once the vaccine has to be distributed, that is still often times a very big bottleneck unless we invest in building those networks now. After 2023 when we have sufficient capacity we have all of the vaccines distributed in the clinics depends upon similar to how many of the things became compressed in terms of timeline, can we put together a similar effort to do all the things that typically take a couple of years and do them in a few months and if that is the case, by the time we are talking about vaccine doses for global use, it would have all of the manufacturing. That requires all that planning to be done now. The planning is happening. In addition to the planning, we need resource investments tied to that plan to start happening now. That is what i think we are still a little bit focused in the global effort in figuring out how to purchase the vaccine and how to get enough money to buy it. But we need equivalent resourcing attached to how it will be distributed and how the infrastructure will be in the best distributed. Distributed. So many distinct activities and bringing them together in an orchestrated matter is oftentimes a very challenging endeavor. Absolutely. Not a question that is explicitly modeled. It is about the strategy for vaccinating. To target the most vulnerable or to increase the immunity across the population to reduce the risk of people catching the virus, something that is reflected looking forward to what the National Academies will come up with. Rob. To you, well, this is a good question. I have always said what you want to do with a vaccine depends on what vaccine you select. A highlyan by that is efficacious vaccine can be used too hopefully really limit the spread of the disease or even stop it. And that kind of vaccine could be used to really control a pandemic, open up the economy and do a lot of things. Effectivethat is 60 is not going to do that. And so you have to use it in a way, and perhaps use a different target group to use it more effectively. Might be like that useful in reducing the spread, but it is not going to stop it. So how else could we use it . Certainly one thing would be to provide as much protection as it offers to our most vulnerable population and to our frontline medical people and approach it that way. If i had a really highly efficacious vaccine, you might think about using it more the working age stop the spread and get the economy open which the economy itself is going to take lives as much as the disease is and we often need to think about how that plays out. It is not just the disease, it is what the disease does to our entire society. It is a complex issue but i think, again, it is a matter of looking at what the vaccines have to offer. And like prashant said, some , wefront forethought have a wonderful window right now to start thinking about these things and that is what we should be doing right now. Fantastic. Thank you. Rebecca, this was on my mind as well. Robert was showing us those great graphs of how the whole process has been compressed. What we are is doing, can it offer lessons for the future . Do you think these will be lasting lessons that result in more timely ways of producing getting things to people that need them in the future . Over to you, rebecca. Rebecca thank you. I will try and answer that question. Absolutely. I think there is tremendous work being done across the world to document what we could have done. Even in this moment, we think about the speed at which we can communicate as the front runners. That in and of itself will lead to Vaccine Hesitancy. The way in which we framed this conversation, this is a portfolio vaccine candidate, we are going to wait to understand their safety, which vaccine is right for you considering your risk factors. Can pivot ase academics and researchers to remind the public that we are here to ensure that a safe and effective vaccine is delivered to you. I think that expectation is part of our responsibility to establish trust. Dok we can do aside that alongside leadership of those who have been saying a very clear and accurate message about the timeline for allowing the science, Clinical Trials, development and data that will unfold and become public in the future. I want to build on that, about the workforce because build on the comment about the workforce. There is an important not to protect the Health Care Workers and we have seen this in previous pandemics as well. In ebola vaccine was made available to protect the workforce. Not only they themselves are at risk, but the risk of transmission. I common sense to understand who was on the front line, extending what it means to be part of the Global Workforce and protecting the workforce will be a vital lesson as we begin the delivery of the portfolio. Indeed. Absolutely. The end of ouro session. The finalistser would have any final thoughts before we have a very rich discussion. I will start perhaps with you, anthony. Any thoughts . Bemy final thought would that this is kind of the first piece we introduced in this space. The first time we tried to model this. You can never capture all of the complexities of the world in the model. Some of the questions we asked were fundamentally unknowable. How long will it take for vaccine to go to a phase 3 trial. There are going to be different ways to model this. We want to build on this research. We want to continue to update the model as we learn more about the vaccine and we might want to think about things like a distribution side of stuff that came up today. It is just something you are interested if this is something youre interested in or you have insights you want to. Se, please do get in touch we are happy to expand and build on this work subject to time and funding. Thank you. Rieluld like to bring in gab for any thoughts. Thisthink the value of goes in the Business World of great significance for our with ases to plan ahead perspective of a longerterm, a long run rather than this idea that things are going to be sold by the end of the year with a vaccine. You for congratulate doing it and for the courage of doing it in the middle of so much uncertainty. Thank you very much. Minister . Thank you. Congratulations all. I think it has been a wonderful moment. A very important study. Hardnk it is going to be a landing for anxiety. Needs. What the world joshve to stop dreaming as said. We have to work in nontherapeutic interventions and continue to compare countries. This type of information is useful for government and for ministers in order to plan what is coming ahead. Thanks a lot. Congratulations. Thank you. Rebecca . Just to reiterate, thank you for including us. Decisions in Public Health professionals, we think about the integration of the sciences. This exercise of collaborating is a phenomenal example of what is possible and looking forward to iterating together as the data becomes more available and the model will become better. Thank you so much. Thank you. Rob . Thanks, calypso. It has been an honor to work with everybody involved in this. I think for me, if we did nothing else, and i think we did a lot more, but if we did nothing else than speak the truth about how long this is going to take and what it looks then we have done a good thing because now is a time to strengthen the things that we are already doing as Public Health interventions like distancing, masks and Everything Else we are doing and to keep going with that. Secondly as i think was mentioned by anthony, now is the time to be working on treatments and other things that we can be doing to reduce the number of the the morbidity and mortality rather than sitting around waiting for a vaccine. I would focus attention on that. Having said that, the interim period while we are waiting for that vaccine to make it down the line is a wonderful opportunity for us to get it right. And as prashant pointed out, now is the time to think about getting it right when it comes to distribution and getting the vaccine into peoples arms because 40 years in the vaccine field, the one thing i learned is that vaccines are absolutely useless unless they go into somebodys arm. Thank you. Prashant . Things come to mind. One is this model is a start. We acknowledged there is further work that can be done. We will look for everybodys input. Outside of the team of people that worked on the model, if we can make a larger effort where people come and try and share the assumptions and change the data, we will get something useful. That thing im calling useful may not just be for covid19 vaccines. It may become a methodology we want to use for looking at new Health Technologies and interventions and portfolios. The second thing i will mention while this work has focused on vaccines, as we see the therapeutic pipeline and the portfolio of the therapeutic pipeline expand including repurposed drugs, new candidates, antibody cocktails, it needs to be similar. Does not have to be as involved. Out, asriel pointed countries are thinking about therapeutic options, they have something similar to go and look at. That is another plea. We can be a part of that. Other groups may start thinking about this. Thank you. Thank you, everybody. I would like to wrap up the session now. As josh put it when he opened the session, the vaccine is not the magic want in our strength is empathy and i hope we can build on that. Jackl finish by quoting who wrote that, the Important Message is that when one has a candidate for the same disease as is the case today, estimating and managing correlations in the portfolio can be more important than adding another winter. This is how we estimate correlations and empower others to manage those correlations. We have no answers but hopefully we are in a better position in terms of understanding and being able to battle the inevitable uncertainty surrounding our journey to getting a covid19 vaccine. It is not easy. Ande is little transparency individual stress in the process as rob put it. A vaccine is useless unless it gets into somebodys arm. Hedging ones bets and encouraging and undermining transparency. Global corporation is really important and it is encouraging to see columbia joining covax. Maturity in acknowledging uncertainty. Go. Is not the way to will quote john who wrote, no man is an island. Thank you very much for attending our session. Thank you to our panelists for their time and efforts and for the communication and event and take care. Goodbye. Announcer senator Bernie Sanders speaks at a Campaign Rally for joe biden in new hampshire. Senator sanders won the 2020 democratic primary but later endorsed the former vice president. Live coverage starts at 3 00 eastern on cspan, cspan. Org or listen with the free cspan radio app. Our campaign 2020 coverage continues with candidates campaigning and debating. Cspan, your unfiltered view of politics. Incumbent republican senator Lindsey Graham and democratic challenger Jamie Harrison participate in a televised South Carolina u. S. Senate debate tonight. The first time they will meet facetoface