Transcripts For CSPAN2 Global Vaccination Efforts 20240713

Where they have Good Public Health system and you can make critiques about some aspects but china was able to jump on it quickly. That wasnt true in 2014 when people appeared in west africa. There was no Health System and for three months we were unable to know if it was evil and it turned into an explosive epidemic. We have to have no communities left out. We have to think of this not just as a development or equity issue but a Global Health security issue. If you get sick in one of those communities, you are likely to have side effects or die or have that disease spread among you. For all those reasons it is a good community. 75 , 13 large fractional countries, we are going to get granular with a metric, try to take away at that but also a metric on how those 0 dose children get incorporated into a system and we want to build a resilient Health System for everybody. We have to be more differentiated and targeted. We have to go subnational. There is a reason communities are being reached. Where are they and how do we reach them. We want to Pay Attention to gender issues. Many barriers have a gender component, not just the supply side. We have to deal with hesitancys that are beginning to spread and think of it not just in the Traditional Alliance of who, unicef, the gates foundation. How do we bring others into this, humanitarian players that traditionally havent been involved but have a specific role to play . We changed in vaccination, Public Health is like a sinking ship and everybody else comes last. Thats not true now and we are trying to build a life course platform, with all the different vaccines, with all the concepts we talked about, some of the advantages of working across the platform and where you work with different groups and other interventions are integrated approaches. To say this is a particularly good place to do it, more than half 1 billion contact points with the Health System as part of immunization. This is the way to look at it. Looking at the replenishment and resource needs, and the replenishment is less than that. We absorb the big asp on soul we funded more than we would like. We are looking for at least 7. 4 billion so we see that as 7. 4 as a minimum for being able to do that. If we have more finance we could use that for the equity 0 dose, differentiated approach to the hhs agenda. The finances, you begin to see how changes occurred with countries self financing. The resource share, 71 Owner Financing 1620, now 54 . I will show a slide about the market in a second and here is what that looks like. In 1115 we had 8 of the funding, and 23 , that will be a fool 41 . That number which is 3. 6 billion. If you add in the cost of the Public Health systems, that means the poorest developments, and the cost event of intervention you having health. You talk about the Price Reductions looking at core vaccines and you can see a 50 reduction, in this time period. One of the important things to say cannot lower the price, make sure companies are not able to make adequate profit but also continue to invest in improving their facilities. We cant expect the same dramatic changes up until this point Going Forward but where there are changes, the savings is 900 million, you saved us and we couldnt do that ourselves if we bilaterally purchased vaccines because we are doing it globally but what is more important is countries able to afford their vaccines Going Forward. What you see here are the examples of the vaccines we have and the coverage levels, to shift out coverage of all the vaccines not just dealing with 0 dose but get people fully immunized. That is difficult to do but something we have an alliance are continuing to prioritize. Where are we on replenishment . We did the launcher replenishment in august. In japan and yokohama, traditionally japan has been the g7 country that has been the least largest supporter, wanted to get them whipped up to do more and you can see the Prime Minister, they both spoke, we had six african heads of state speak extemporaneously how important this was to their countries which was really fabulous, in the uk, started building up for this, the Global Fund Replenishment to support them. And the march on science in the uk and the pledging conference in london. This is actually 1. 16 billion, four your commitment from the us. This is the second commitment we received this time. 15 from last time they came out early and made this statement. It will be important to set the bar for other countries, given the fact the rest of the budget, showing fondness for increases for Global Health programs. It shows the values they place on this alliance Going Forward. Where are we going to be from this . By the end of this period we immunized more than 1. 1 billion children and prevented more than those death. This is about scale at its best, and helping countries protect themselves. A little bit of a view of what gavi is doing in its path and what it is trying to do in the future. Okay. Thank you all. Go ahead, come on up. You want to go to the end . Go over a. Thank you for that presentation. We want to get back to the issues you touched on in the course of conversation. We want to hear from irene, robin and katherine bliss to get the conversation rolling. As soon as we can and hear from you, we heard the story of marvelous successes and ask 3 speakers, there are plenty of tough challenges. Something to signal to within the presentation. I will introduce our three speakers, i will ask irene koek to lead off, she is acting assistant administrator. You have a speakers bios here. We met when she was in indonesia where she served as help attache, you did everything. And a 4year period, integral on the bureau for Global Health, integral in the Global Health security agenda and the acting assistant administrator and senior advisor, a Broad Spectrum of issues, in 2016. Thank you for joining us. Rob and andy came from new york, thank you for being with us today. Where he is at unicef, chief of the immunizations that unicef headquarters, we are thrilled to have you with us today. Henrietta ford is my boss, she has been connected with csi s, extremely generous to us. We dont miss any opportunity to praise her and have unicef as part of our program. Thank you so much. The new paper that katherine offered. We urge you to read it, extremely as usual wellwritten and well thought out piece around national interest. A powerful and eloquent statement. There is also a short, 5minute video. On strengthening it is ongoing in april, it will be two years. To contain a number of recommendations at the center of looking at issues around immunization. With those infrastructure programs, that have been better predictors in gaps and the like and with senior scholars led our work on water policy, venezuela and other topics. We will quickly go. To give you a fact, we start the conversation from that point forward. Thank you for doing that. It is very exciting. So excited to talk about the commitment for the replenishment period. In the last replenishment period for part of the president s budget. Not only phenomenal impact in reaching 3 quarters of 1 billion and the cost sharing all the way through the cycle, a selling point. One of the things we are excited about, we are excited about the kinds of issues in the gavi 5. Oh strategy. One of the initial donors has been part of the gavi family since the beginning. The underpinning for the reaching those under immunized kids. This is in line with priorities the life course of immunization does touch on a lot of issues we are trying to deal with with usa mobius usaid. Talk about reaching other partners and scale strategies and do so in a sustainable way. We talk about coronavirus, the investments that come through immunization and how it touches primary health care and very much related to what we need to do on Global Health security. A foundational work that has been done for a number of years. The other piece i would note briefly is the life course approach to vaccination we see on 5. Oh does touch on a lot of things we do, not only from the Health Sector across the board, the other sectors we work on. It gives lots of opportunities to move forward. With steve on the broader alliance, unicef is one of the core partners. Civil society and other partners move forward on this agenda. The kind of progress we have seen, the tremendous impact gavi has had in the first 20 years look forward and we look forward to being part of that alliance. Thanks for having me and i will convey greetings to henrietta when we get back. As a founding member, would also like to wish a happy birthday, the point here is the Gavi Alliance is now a mature alliance and i will touch on it a little bit from the perspective of a multilateral process and i hope i can speak for my colleagues at who as well when i say this. I will keep my remarks short leaving time for questions. We set all the important things but i will touch on four specific points. Our southern partnership, what the Gavi Alliances done is harness advantage of all the we had bilateral relationships working in parallel to each other. It was the common vision towards a common goal. This has been a huge achievement. What is gavi . We are all gavi. Everyone in this room is gavi. The United States government, usaid, multilateral and so on. I see a number of our Alliance Partners in this room as well. We talk about gavi 5. 0 and the challenges we face, the challenges are more critical. We cannot we can no longer allow global level partners. We need to go national. We need to go subnational because the low hanging fruit has been exhausted. Everything from now on is much more difficult and things need to be done differently and we need to broaden our partnership. Second point, what the alliance has done very well is promote accountability. Affect a little bit about it but if accountability for delivering results. Alliance Partners Holding each other accountable in a mature relationship, we can agree or disagree but we must move to a common goal and accountability of country governance. That is extremely critical that governments are responsible for the health and wellbeing of their children, their mothers and the Alliance Comes together to promote this accountability. The first thing i would like to say is in terms of innovation. A few slides showing the innovation the Gavi Alliance has been involved in but the thinking that innovation is all about shiny bright objects. Innovation is a mindset. Innovation is the way we think and we Start Talking about achieving a high Vaccine Coverage in remote locations in urban slums. There is no 1sizefitsall anymore. From 50 percent80 , you could do it with a certain extent 1sizefitsall. To address what the barriers are and take it forward from there. My point is gavi importance, this is the most powerful thing that we have. We have our agencies engaging with heads of state on a regular basis and as we are getting to immunization, children and mothers, this is a huge potential we have going in to gavi 5. 0. I will end by highlighting one of the last points, that immunization has reached higher coverage. If a child is not vaccinated we can be sure they have not received any other interventions or whatever the case may be. It provides an entry point and we are committed to working less vertically and more horizontally for primary healthcare. Thank you very much. A few words about the report and what i was trying to outline or understand about the relationships between gavi and Global Security and security interests. I want to focus on three aspects, one was to look at this long relationship over 20 years and knows particularly the strong emphasis on equity, improving access and the link to primary Health Services is connected along with efforts around vaccine stockpiles very much connected to the Global Health Security Strategy which has been released and identifies immunization and strengthening Us Engagement with other countries around immunization is a key component of the strategy. The second time one of the aspects of the gavi model that resonates very clearly was the Us Development model, the emphasis on the countrys path to self financing immunization programs and the current focus around the journey to selfreliance and the emphasis on helping countries identify and envision a path towards supporting their vaccine programs in the shortterm and longterm but you have that. The third area that strikes me as consistent with a larger set of diplomatic objectives centered around the incorporation of the private sector into the alliance, the integration of countries multilaterally and in particular the private sector. Longterm partners that have been part of the alliance from the beginning but also those newer startups and Innovative Companies through the program, and other areas that in particular as the United States through diplomacy and larger diplomatic outreach speaks to showcase the last of us internation and entrepreneurship into the gavi model to help show the way. In terms of the recent commitment and longerterm relationship, when i heard about the multiyear commitment which was exciting and interesting to hear, it is important to wonderscore, important to maintain bilateral engagement around immunization as well. It should be part of a larger commitment around immunization. Not only usaid but the centers for Disease Control and prevention play a strong role in supporting global immunization programs and there is quite a bit of overlap between usaid, cdc global immunization priority countries and gavi eligible countries but it is not complete. There are different systems that are important and to maintain those longterm bilateral relationships not only around immunization but Health Systems and strengthening written large in order to reinforce support for countries that move towards transition or engage in other relationships and workaround immunizations, but particularly the models for countries where the United States has passed historic relationships and can be supportive as gavi works its way toward trying to understand how it can engage over the long term with those countries as well so i will stop there. Thank you very much. I had the pleasure on february 14thfifteenth at the Munich Security Conference to be with natosha, bill, and moria and there is great interest in the coronavirus outbreak. We will get to that at some point in the course of our discussion. There was also a Health Security roundtable, a dinner with a norwegian Prime Minister, across all of these activities one thing came through powerfully. What is the degree to which gavi is operating in close think with the coalition for epidemic pandemic epidemic preparedness innovation. With the Welcome Trust with the bill and Melinda Gates foundation. It was very impressive how much are those relationships have become and how central they are in thinking through the response to this new challenge. The second point is how much seth contributes to this debate, the quality of the contributions made and interventions at all those points in time was very striking. We want to shift to some of the tougher in during challenges in the environment, and one issue we have been focusing on in the course of our commission, insecurity, and in fact we are talking about these low Income Countries, the demand, the on meet hand and outbreaks situated, drc, a big focus not just because of the tball are outbreak, measles, cholera, outbreaks reveal the problem. The discussions on the question of what kind of capacities are going to be required to operate in these environments safely and effectively, cant fall back, and risk intolerance. It is a skilled personnel, at the heart zone at the front of the outbreak. In those areas, with different timeline and different set of expectation. You pushed gavi to lean forward and think differently and put policy to gather. It is needed further in terms of the way gavi operates and what you look for what you are operating with. One of the greatest challenges. If you look at immunization, it is 20 less. You have to get the world to think that was a norm with the immunization on that population. In a disease specific approach i am here with the Polio Program but we will eradicate polio and i wont do anything else. Eventually you begin to see pushback from the population and how does that work. We need a norm that is doing this for everybody. Immunization, for every dollar spent you get 54 return. This is where you should be putting your money. If you get to the point we all agree this is a countries are to be financing, then you have to begin to ask how do you work in places that are fragile and have problems. How do you see that immune nation is available to both sides. Working in yemen, how do you make sure not just the government but the north is engaged trying to immunize their kids in somalia or drc. What i would postulate is what we need to do is build out those systems so that those systems are available for all the other activities. That was not a great place to have an Ebola Outbreak given the years of fighting. To stop the election there, there was ebola. The local rumor was the reason they brought ebola here, opposition, a place where the opposition would win and the norms are so critical. The last thing i say about that is prior to ebola, we worked with the Previous Administration with the current president to create a plan named after one of their own leaders, and in i was on this trip, he has called all the state governors together, they signed immune nation and we try to get healthy competition going at the local border to get better coverage. It has been done in the past but has to be normalized. In a world that is becoming more national in its focus, it is critical to success. Let me ask you and to weapon i social media around distrust. This information that is so pervasive these days, how do you combat that . How do you bring quality, trust, trusted science to a public that is confused, disoriented, not sure who to trust. What have you learned in terms of that. Complicated question because it is a different solution in the industrialized world. The industrialized world we are complacent. You have a child, that child is going to live and be healthy and live up to its full potential more or less. That is what you expect. This idea that if youre going to inject people with things that maintain and make him cry, not organic, or things that are not good in it. We didnt have that problem in developing countries, we walk a huge distance, a kid that died, your neighbor was sick, saw these devices, that is changing a little bit. Slightly different mindset, what was it like ten years ago . If youre in Northern Nigeria and have questions about vaccines. What the alliance tried to do is think about demand is a continuum. And a small number of people. And focusing on demand, to do that. And it is to get rid of the patently fake information shouldnt be there. When a mother is looking for information how do you steer that to get good information. To go to the cdc website or those are authoritative, how do you think there are voices that would help them do it. Lastly, how do you get rid of the destructive things like russian bots that are provided using vaccines, it is a broader problem, a problem for elections the idea of misinformation more broadly. The last thing i say is it is mostly about local trust. What is the country that has lois faxing confidence in the world . It is france, the country of louis pasteur. Very interesting. The really important thing we know, people trust local Healthcare Providers more than they trust governments or pharmaceutical, how do we make sure they are prepared with the right information. Both of your organizations are active on these issues. I want to congratulate gavi on recognizing getting good information out, whether it is extreme hesitancy or misinformation is a critical piece and really critical to the objective of reaching every kid. And into the hand of Health Providers interested in the community. We have a long history of getting good messages to communities and people in a way that is trusted so families can act on the messages. Using those techniques in child health and other areas is the way to go. In usaid in partnering with gavi on this. Going to the previous point, with Health Emergencies and others, that is the reality we are living in. And whether they be manmade or natural disasters, the normal Development Side is becoming a big overlap. It does mean, this point before, it does mean doing business differently. May not be able to use the same set of partners we used before and how to tail your approaches in ways to work in those settings. In addition to what lorraine said, it is complex and just to draw on a few things that havent been said yet, i was once described, what it takes to get a kid vaccinated and dropped. Take the kid out of school, taken to a pediatrician and get a prescription, go back to school. Get the vaccines comedic of the vaccines, bring it to the house, put it in a refrigerator, take it to the pediatrician and get vaccinated. This is not vaccine hesitancy. This is vaccine inconvenience. Right . As we talk about vaccine, talk about convenience, context, delivery of services. That is easy to be delivered. Talking about the strategies that are not completely different. It is difficult to that the way services are delivered, often time in a marginalized community or a Minority Community you get treated really valuable so the other aspects, the linkage with a broader primary health care, Health Workers and what advice you give it. You will read many things on the internet, you will not believe it if you have trust in the source of information you have, when the trust is eroded you will believe and other things. It is not vaccine misinformation but misinformation about a host of other things and vaccine misinformation, back to the 1800s, what was operating at that time as well. In his remark, mentioned the middle Income Countries can become problematic. They graduate into middle income status. To be supportive and revise their approaches to this but there are risks for that population of countries, motivating leadership to keep this up. What can you do in this context to lower the risk these countries fall back because it is too expensive, too difficult, they are not committed in the same way. What can be done to have more success. There are two things we can look at. One is identifying ways for countries to access in a some middleIncome Countries, the americas have access to other schemes that might be developed in that sense but another goes back to the point about the importance of strong bilateral engagement by the United States and other Development Partners to help countries really start looking at transition like gavi or Something Else way in advance, they get notifications that they are approaching the threshold but start with the Health Sector working together to support the kind of dialogues. What can you do to motivate the leaders of middle Income Countries to step forward in ways required for their not to be aggression. There is a set of answers to this. First of all the countries that are transitioning, when we started working on transition we relate to the game on preparations. Now that we have gotten experience on a we understand that and we are preparing every country for transition way out, countries that were not gavi ineligible, there is an interesting challenge here but there are two sides to the challenge. If you go to the countries they are fine with what they are doing the prices are too high to have access so they if you go to the companies they say it is too risky for us in these communities. The question is is there a sweet spot. That companies would say here is a market that is not currently filled, a new set of countries we can engage with that is not guaranteed for us. We have the investment is scale up in doing that, we are willing to get to a lower price point. It is inconvenient for you to work through a mechanism of having pulled procurement. And if you dont make these sweet spots. Just a little bit above the gavi threshold. They havent introduced the pneumonia, diarrhea or Cervical Cancer vaccines. And and industry initially, and and what i wanted every child in the world to be immunized, not just the poorest or the wreckage that is where the rich but every child. Those on the lowest end of the middle income strata. Turned to the audience momentarily. Does this create an opportunity to reanimate the g7 orgy 20. The critical level health issues, lower visibility. It is looking increasingly dangerous and longterm. What is your view . Certainly there is an opportunity. Back to five years ago, i did a ted talk at the same time. They put us back to back and he talks specifically in the military context. And see what is happening at have preparedness exercises, that was his talk and my talk was we need a new mechanism to make vaccines for platform technologies and that was around the ebola era and we have exercises that have been done so we are better prepared. We are right now on a very severe dress rehearsal for the big one and we are at the beginning of the big one and we are not perfectly prepared. The answer is we a lot to the talking about it. At the Munich Security Conference all the generals that were there, all the intelligence people, all the Nuclear Weapon people were talking about things that were much more unlikely to happen than the evolutionary certainty of Infectious Disease outbreaks, but i think this is an opportunity. We could end up where we were with ebola. Is a funny side story when we raise that 300 or said we would put that 390 million on the table, go raise the money. Talking to governments, no problem. Money is not the object. We will do whatever it takes. I went out and raised money. Im good at raising money. I got one government to make one commitment, the Us Government made a commitment of 20 million. That was it. Nobody else, ebola is yesterdays problem and they went back to it. The challenge is we dont do that with the military. We put Nuclear Submarines under the polar ice caps, keep the systems going even if we are not at a raised devcon level. Can we do that for Global Health security . We must get there. This is an evolutionary circumstance. Lets bundle together several different questions, interventions and what i ask each person to be very 6 things, single intervention and identify yourself. We have a hand here. Thank you, seth berkley and panelists for the interesting presentation and discussion. To bring up the elephant in the room, an article posted from the atlantic in which a harvard epidemiologist predicts 40 percent70 of the worlds population will get the coronavirus. Any idea how to handle that . Okay. Hold that for a moment. Right here, right here, please identify right here on the other side here, thank you. My name is Kelly Richardson and i work with global water 2020. Thank you for these insightful remarks that it is great to see the commitment or more horizontal versus vertical approach. With that in mind i would like to ask how should the Wash Community build that infrastructure with the need for the next Vaccine Campaign . Right behind here . The technical director with johnson no immunization center. A few of us saw the birth of gavi. I want to ask how we address the real twofold issue of financing, one around the operational delivery finance data subNational Level and challenges with sustaining that. With the second part around the centralized vaccine procurement the global and National Budgets control that create the mortgages or financing challenges for the sustainability factor. What we have seen that does work, doable actions the champion communities enabled them to sustain prevention during outbreaks, and the former minister of health who got the program moving, how do we match had to address operational funding issues . A hand in the back. Chris collins, thank you for the great presentations and the wonderful work. We are invested in the fight against malaria and you are grappling with the relationship with stronger Health Systems and helping countries move toward uhc. I wonder what you are learning about that work, the bridge, without compromising, with agency in terms of keeping of the effort in fighting those diseases . I suggest we hold on carls mega question for a moment. And the uhc question. We have another question. After we have a moment here. This is an important question. When the board began to look at cholera and similarly on rabies we began to say the solution for these problems are not the vaccines. They are interventions temporarily to help but the solution has to be on the rabies side animal rabies control. On the other side, clean water and sanitation. That being said, we should not use the tools we have so the challenge is coming together and the board agonized about it, do we mandate that, we cant negotiate it, how do we move it forward . We hope to have a gentlemens agreement with groups working on it and i have become a champion of talking about lack of investments, being able to move forward but we have to be synergistic and keep in mind longterm development. Even when we talk about in pakistan, winning hearts and minds, not just give them all vaccines but other things. We love to give them water and sanitation. That may take longer, dont make that the only barrier but make sure you continue to work on it. On the financing issue, this, as part of we didnt talk about it here, gavi, the global fund and the World Bank Working on the financing accelerator, the focus is to make more money for help to move towards 15 , to get countries to invest more. The other side is more help for the money and that located efficiency is even more important for the poorest countries. Rich countries have more resources. They can waste more. You have to be focused and what that means is you have got to get local communities to understand the importance of financing these basic services the cover 85 of Health Interventions will come out of basic primary health care and make sure people are putting the money in and that is the conversation at the National Level, regional level and the local level. I will mention for chris, looking at communities to look at that. Start with uhc, what does that mean, whats that mean for Central African republic. The challenge is to get very concrete. Basic Services Building them out but that is not just vaccination but also malaria. It is different for other interventions, we have to take those lessons and work together. Financing, thinking about the discussion around how to address Immunization Coverage and conflict and disordered settings. We talked about this directly but the issue of having to wait for emergency funds until theres an outbreak can be too little too late whereas being able to think about flex ability with contingency or emergency funds it becomes apparent that Immunization Coverage is lower and there are problems likely to happen. If there are better ways for that kind of setting. Building on a couple things seth berkley said, the subsets, part of the concession of how we go over immunization and connect larger issues, that is related to chriss point. You need to look at immunization as part of a larger system and connect to the primary health care and to your question it has been a debate, do you just go after one thing or get everybody covered with measles or built into the system and you need to do both. Built into the system as well which the debates that are happening to procure your commitment to those issues but has to be part of the system. The other thing i would add is for all these issues we are talking about reaching a larger set of partners. We have to touch the bilateral partners who are working on these issues like strengthening the water and sanitation and immunization folks at unicef. It is reaching a broad array of partners and lastly in response to a question, so much for we are talking about his political commitment and that is where financing comes in. A really good example of work happening at the National Level and the state level. As gavi works with partners which it really has a phenomenal example of bringing partners to the table but pushing not only the National Government but also State Government to take action and put money on the table. Would you like to add remarks . On the wash issuance widening issue, it can never be one or the other, at some point, vaccine should not lead us into complacency, Public Health intervention, extremely critical, and with lower efficacy in the loan that measles vaccines have. Second point on horizontal and it will not be adequate to build Health Systems everywhere all the time and we have to identify where the entry point is. A huge opportunity. The huge point of convergence, take the individual parts of the ministration. How can they do more on interpersonal communication and so on and the final point, resource allocation in addition to our located efficiency. A lot of the resource decisions made at subNational Levels, a lot of these countries are highly decentralized, and and with resource modernization. This is globalizing and were moving into a strategy of mitigation. The sudden outbreaks and iran and italy, korea just in the last several days, the geographic spread within china itself, prisons, a couple hospitals under lockdown in beijing, that were getting out of the ability to do case isolation, case investigation. The scale of this is moving ahead. We have reports that the u. S. , that the u. S. Administration is preparing an emergency supplemental to present to congress which is a signal that something very important happening there. We see the rejected economic consequences being tabulated in very new ways. The g20 finance ministers issued, the imf issued a pretty harrowing estimation earlier today. And then we see what i think modelers at the Imperial College at harvard and elsewhere coming forward and putting out well, this is what we might imagine in terms of spread, a pattern of globalization and what that may mean. Seth, given what we are today, how should we be thinking about what lies ahead in the still very uncertain period . First of all, modeling against wood of the one about what of the pot populace willt affected. We just dont know. We dont understand enough about the epidemiology yet. There are differential mortality rates now in china than there are in countries outside we dont understand that. Is that a case reporting issue . We need a lot more information. We dont fully understand the virus. Are you fully transmissible during an asymptomatic case . Is that a a subset of people . We dont know if theres seasonality which be a very important point, and we dont know if it spreads in tropical regions. Given all of that, the more i learn the more worried i am about this because of reasons that stephen has talked about. On the best Case Scenario which one is time to hold it down so we can develop countermeasures. As you know there are a series of Drug Development adequate on, medical trials have been started of existing drugs that could be ready to go. No idea whether the work or not. They have been used in compassionate settings but again its what we do, controlled studies that we dont know. Vaccines were launched within a few weeks of having the actual knowing what the genetics of the organism were. Those are started. Theres a lot more work going on on vaccines. The interesting question there is, how far could you accelerate that work, if this truly is a Global Pandemic . We dont know the edge to that. We have to keep in mind though that, for ebola, we were all guns roaring and it took us five years to get a license product although we did a Clinical Trial quite quickly. The Regulatory Agency step forward. Mark r mark r broccoli were to o make the vaccine available. Could we do it in a faster time. Lot of people think doing an adaptive trial design moving forward with everything in parallel you could move it but the other problem is some of the approaches that are being used now for Vaccine Development are attractive because they are quick but theyre not. If not been inhibits. I get for agencies would ask questions about the safety about the distribution. Are we better off with an existing technology that might take longer but then is easier from a regulatory point of view or are we better off with a new technology for my take longer from a regulatory point of view. If this is the big one we should be running those in parallel. At the end what i think we should be is, we should be driving forward as if this is the big one, as if those numbers are as bad as they are. But try to control as much as we can so that we can get the interventions out there. The biggest problem is if this into peaking like this, then all of the Health System will be overwhelmed with the need for intensive care, ventilators, all of those other issues, whereas if you could flatten it out and do it over time you have a bigger chance for other interventions to be there but you also allow the Health System to take the brunt over a long time. If this becomes the big one, as you described, and with the vaccine online i i your in halr two years, whats going to be the biggest constraint in your estimation of actually getting that produced and in the hands of people . The good news, i sure do the data. We know how to get vaccines up. Thats the alliance is really good at that. The scary part though is lets just say this vaccine is now produced in the United States. Are we going to make it available in other countries before we vaccinate the 350 Million People in the u. S. . If that isnt a you he will eu will be the same issue, but lets say we know produce in india for developing countries. Well, if india has got a big epidemic are they going to make it available, other going to vaccinate the 1. 3 billion people . The thing went to think that now that is different is how to reproduce vaccines specifically for the developing world if this is a truly local epidemic . That conversation we havent had before. It was different for ebola where there was no market and so the issue is how to with a fork to be produced and merck is producing it. They may move into a developing country, manufacture by their producing that. But in this witch of the unrestricted demand, its going to be a real challenge. Thats what we have to think about. Do you want me to use this . [laughing] i think thats the subtle inference giving you. Thank you. Others like to weigh in on the Covid Response . No. I would just certainly agree with seth. Theres so much about this we dont know, which is what are the big issues we have. It could go in any way. That said, a lot of investment we have been making a Laboratory Systems and in work referral systems and in Information Systems are all extraordinarily important now. Thats will be can continue to put resources and one of the things were starting to do now, put resources into, beef up the labs, can we make sure theres good Infection Prevention control practices in place. Is there good information out . Even though the information is changing dramatically as we move forward and those are things we can do to mitigate as much as possible. We didnt talk about this innovation but its quite important which is innovative financing. One of the questions, weve already used our innovative Financing Facility for immunization, the u. S. Doesnt engage in this because the u. S. Doesnt and under budget process but for countries can do multiple processes, countries have given us guarantees out a long time and with those as weo to the market and raise money. We immunize 80 million children if always have money from donors. We have only done to help a donor spread out its innovation. This would be for examples something that could be done if we had to come up with a very large amount of money quickly to produce vaccines, to finance research if we could get government to make a a longtem commitment because no government has billions of dollars sitting there with nothing to do. We could get them to guarantee out and then raise that money and use it for this. These are other innovations were to think about in these unprecedented times. So theres going to be a financing if we get to the point where were trying to produce 300 million or 500 million doses, theres going to be all the distribution equity issues. We may be talking up 15 billion doses if we are talking up a whole world, two dough sexing. Its all different ballgame than hundreds of billions, okay. That raises all sorts of manufacturing capacity issues as well as financing, and we are nowhere near that. Were getting to the end of the time here. Robin, in your last remarks . Theres one thing i forgot to say. I make is in my opening presentation is, with gavi theres another opportunity. Because the immunization agenda 2030 is being developed at the same time. This has not happened to my knowledge in the past. Development of gavi and the global vaccine action plan happened at different times and the predecessor happened different types of will. Working together with w. H. O. , with all the departments in the room is an alignment. Because obviously the 2030 is going to dress a lot of the middle Income Countries and even high income country issues as well. I think identifying what common monitoring and evaluation mechanisms are and so on. Basically the focus of both these Strategic Vision documents if you like focusing on similar things, zero does equity, horizontal approaches, and all the things that we have discussed. Id. Kathryn, you have the last word. Oh, my goodness. Just to reinforce the, i think the u. S. And moment in this allies has been very strong since the beginning and as a conversation has i think really highlighted that involvement both at the alliance and Partnership Level and through sustained longterm involvement at the Community Level is fundamental to the preparation and work that is needed to address the importance of improving immunization, it also being ready to address these kinds of emergency that we have just been talking about. Thank you for what you again thank michaela for all her work in putting this all together, and to natasha in the gavi officer and ten for all the support they provided us. And please join me in thanking our speakers. [applause] thank you. [inaudible conversations] [inaudible conversations] heres a look at our live coverage tuesday. The South Carolina primary is saturday. Join us to the candidates reaction to the results. Live coverage saturday evening on cspan, on demand at cspan. Org or the slide on the free cspan radio app. Next, sky news political reporter annelise nielsen gets an update of events in the latest setting of australias parliament. This session lasted from february 4 through february 13 and chose Prime Minister Scott Morrison answering questions on the coronavirus, middle east security, climate change, the recent australian