So we wanted to have this be an interactive round table style exchange, and I've asked all three of our speakers to come prepared to talk about two subjects. And the first one is about should we, as a government, of many different constituent parts, should we make a special effort now to better unify, to better integrate our R&D efforts in the area of tuberculosis? And if so, why? And in what critical areas and what are the concrete steps that we need to take? So we're going to start with asking, we'll start with Tony and Eric and Peter, and try and dig into that subject and we'll take a portion of our time to cover that. And our second topic that we'll turn to is really about one of the points made in the report and made in the paper that Peter was lead author on, which is about thinking strategically in long term about the need to build bigger and better long term platforms with emerging outcomes are going to be found. And should that be a priority of our strategy? And if so, what is it going to take to make that happen? So those are the two, those are the two start-off, the two questions that we're going to use as a frame here. Tony, would you like to leave off? And that first question? Yeah. Thank you very much, Steve. I appreciate the opportunity to be here. I couldn't help but think when you asked the question, and I actually just checked it on my iPhone, of we go back because I've heard much analogies and relationships between the HIV effort and the effort which all of us would like to see done with tuberculosis as an individual disease in and of itself and the obvious overlap with HIV. And at the end of about 20 years of a phenomenal effort that we put into HIV AIDS, my colleague and I, Greg Fokers at the NIAID, wrote a commentary in JAMA in 2001. And I entitled it just almost as if I was planning on this meeting. And it was the HIV AIDS pandemic, a model for diseases of other global health importance. And I was thinking specifically of TB as number one malaria and then neglected tropical diseases, which actually gets right to your question. Should there be a concerted effort in the arena of R&D? And the answer is yes and be careful because one of the things is that when I think about the R&D effort, I just have this picture in my mind which I translate into slides of fundamental concept development all the way on the left upstream through the early preclinical development, understanding pathogenesis, developing a concept with the thought in mind of three interventions, diagnostic treatment and prevention, and as you work your way from upstream to downstream, you get to phase one, you get to phase two, you get to early product development, advance the product development and licensure. So when you look at that spectrum, the answer is if you take it as a whole, yes, we could benefit from unification, coordination, a lot of which we're doing, but we're doing it in a way that I think is very productive but that we could benefit from doing it better and doing it a little bit more intensively. The only caveat that I have about attempts in other arenas to unify, coordinate, develop some ZAR that's on top of it all is that that gets pretty dangerous when you're doing the concept development and the fundamental research because that almost invariably gets in the way of that spontaneous creativity that you need, but as you go further upstream, clearly you want to synergize and utilize all of the possibilities that are available. So you said three minutes, I'm at three minutes, may summarize by saying that I think it is a good idea depending upon what stage. When I wrote that article 13 years ago, I was referring to the entire spectrum and as I said early on you still need new concepts, investigative initiated ideas that don't need to be coordinated. Once you get into the line towards developing something then it becomes more and more productive to do that. Thank you Eric. Well thank you Steve, it's a pleasure to be here with my friends and colleagues, mentors for this discussion. I think that the importance of coordination at all levels has been echoed all day to day in many of the discussions. But I think that we have under-emphasized the real importance of coordination at the ground level. We can be coordinated in Geneva, Washington where we really need to converge our effort is at the country level and holding our colleagues in country responsible for the planning and implementation elements of putting and realizing the benefit that the science affords but needs to be put to ground in a program so individuals who are burdened with the disease can take advantage of it. I think that we need to take that to heart and look at what are the elements that we currently have in our toolbox to support that definition of the problem, the ability for us to define and understand the geomapping of where the populations are in each country, how that country's medical delivery system does or does not interface with those populations and are they able to identify, enter and retain those individuals in care over the duration of what is in the case of TB a cure intervention. We're not talking about a long period on antiretroviral drugs like with HIV but we have a disease here that we know how to prevent, we know how to diagnose it and we know how to treat it to cure it but we are unable to put that machinery in place to kind of orchestrate and ensure that impact. Yeah, so let me just make two quick points. I mean, I think the first is that we're at a critical juncture in global TV control and this is a juncture in which research and development is particularly important. I mean, we heard it from Mario and I don't think he can say it better. You know, 56 million people treated, 22 million lives saved. I mean, that's an enormously successful enterprise and yet this TV situation is evolving rapidly with the drug resistance, TB, HIV, other comorbidities, we've got migration, we've got increasingly complicated health systems and so if we don't move with the epidemic, we will not get on top of things and I think that we desperately need innovative tools and we need new approaches and what's great is that after decades of neglect, I think we're starting to see some really remarkable progress and I think if we look at what the NIH has done, the funding is bringing in some of the brightest young minds using the coolest technology and this is really transforming the field. Equally importantly, we're looking at public-private partnerships who are taking that knowledge and turning it into products which are already affecting people's lives and I know that because when I was in India for a couple of years, I met people whose lives were literally saved by the gene expert. I think the second point that I would make is that the U.S. has, I'll just say it, we've always been the unsung hero in global TV control and I think that we are poised to actually drive global efforts to modernize TV control and in the report it's pointed out that almost 60% of the world's R&D is funded by the United States and I think that's fantastic. I think that's an incredible, incredible good investment. What we've seen from that are a number of new diagnostics, two entirely new drugs and we've seen a growing pipeline of vaccine candidates. I'm super excited about PAMSI. This is a new drug regimen which will, within five years of launching the Phase 3 trial, we will know whether this is going to be able to change the lives of hundreds of thousands of people with drug-resistant TV and if I could just make the one specific recommendation is I think that we all need to really rally behind that Phase 3 trial, fully fund it as quickly as possible because this is a truly transformational progress. So if you are trying to make the case to the White House that the R&D issues are prioritizing, giving visibility, giving energy, better coordination and unity of effort at the right stage and what would the case look like? How would you make the case to a political leadership that the R&D sphere is an area where we already are in a strong leadership position, where the returns are there and the U.S. national interests have reached a point where you could feel comfortable making that case? Yeah, what do you think, Tom? Well, I'll tell you what I've been talking about for a really long time. Yeah. Multiple times a year and testifying before the Congress, multiple times and testifying before the administration everywhere from the department level up through and including the White House and OMB. You know, and sometimes it's not on the radar screen that you'd like it to be on, but when it is, it's the time to jump on it. The argument I make from the standpoint of the U.S. government is that something that we really began to realize in its full form when HIV came along and that is that we live in a global community and we cannot just think of other people's diseases and our disease. And it's more than just humanitarian, it's enlightened self-interest, it's economic, it's security, it's all the things that many people in this room have spoken about. And I bring examples of the extrapolation of how we went from fundamental basic research to extraordinarily dramatic interventions that anybody and everybody would agree have been essentially game changers. And I think that we should use the HIV story, not in a competition with TB, but as a phenomenal example of what you can do when you make an investment of basic research through early clinical research through product development. I think that the drugs that have been developed over the years for HIV, they just speak for themselves. That's the first thing. The other point that I make is I use the issue of the history of vaccinology with diseases that have now disappeared. I mean, the obvious one is smallpox and hopefully soon polio, but also what we did not too long ago with some fundamental basic science observations and development with the conjugated homophilus influenza B vaccine, which went from a disease which was the leading cause of bacterially related deafness and mental retardation to disappearing. Those are the things that they listen to. Things disappearing. They don't like things lingering. They like things disappearing. And I think the point that Eric made is a good one because the thing about TB that we can really argue for is that you can cure it. You can actually cure it. And that's the reason why there's a lot of activity right now talking about vaccine and cure for HIV. Because those are the ones that are the showstoppers. You cure, you don't have 35 million people that you need to keep on therapy forever. You get a vaccine and then you turn the dynamics of the epidemic around. Those are the kind of arguments you make that there's an end game here. It's not just give us more money and check with me in a few years. We're going to put an end to something that's an extraordinarily plague. It's about argumentation and the atmosphere. I mean what I hear from Tony is that there is an excitement around the return to a much more scientific focus discussion around HIV. It greets an open. People have an appetite and an openness to talking about these issues in a new and different way. As Peter was saying you've got options in development that you can push hard on that are specific and concrete. Well I would really emphasize what Tony is saying. I think that our political colleagues have different metrics and different pressures on them to produce. We, and I think that Tony was really central in this kind of epiphany that occurred, where scientists began a different dialogue with HIV with the political elements in our country that resulted in accelerating our ability to take a scientific finding, a discovery to the individuals that would benefit from it. And I think we saw in HIV the convergence and orchestration as Mario was saying of the critical role that civil society plays in facilitating that glide path. It takes all of it and without any one component we cannot put program on ground to benefit those that are suffering or dying from the disease that we now may have an understanding that has true application that can drop morbidity and mortality. I think TB is a frustration in that we have had answers to many of those questions for a very long time but have been unable to move it to benefit those who carry the heaviest burden of disease. 33% in India is a shocking statistic. Peter has been there for the last few years trying to understand on a more granular level what are those bottlenecks that prevent the benefits that we already have identified from being realized. And it's the orchestration and all of those components that need to converge in the same time period to make it happen. I think our inability to turn up the volume on the elements of implementation that allow you to put program on ground from my perspective remains the rate limiting step. Joanne alluded to what's the rate limiting step? The rate limiting step is really not the science. It's not having models or examples of high impact or efficacious interventions. It's the variety and variation in the substrate you can use in any given clinical community, medical delivery system interface that allow you to put that program in front of the person who needs it, when they need it, on every day that they need it. And I think TB has evaded our ability to pull those all together to have the impact that we know we can produce. The political will is critical. Without it, it stops. The science without it, it doesn't happen. The community orchestration without it, we do not have the feedback loop created that comes back to both the scientists, the providers, and the political layer to continue, maintain or change, augment, discover something new that allows the changing needs of that population to continue to be addressed. Let's shift and talk a bit about the emerging economies. We've posited in the paper and in the summary paper and the overview and in the R&D paper that Peter led on that it's important that we think long term about building research partnerships and platforms in those key emerging economies which are heavy burden. Peter can you talk a little bit about that and what is it going to take? If we agree to that proposition, what is it likely to take? It's not like we're starting from scratch by any means. Well, first of all, let's recognize they're one and the same, right? The emerging economies are all high burdened TV countries. They just take India, China, and South Africa and you're talking already about roughly 40% of the world's TV and maybe 60% of the world's drug resistance. But I think we have to give them credit for more than their disease burden. I think what we're seeing is that they have increasing R&D capacities. They have growing science and technology budgets. They are increasingly seeing themselves as leaders on a global stage and showing leadership in particular, I think, some on TV. I think that the key is really to foster local expertise and platforms. And it was mentioned several times today and I think what we just have to really double down on our efforts to increase the R&D capacity amongst key partners, these emerging economies, these are not short-term projects. We have to make long-term commitments, nothing less than a decade. But I think that if you do that, you will bring in some brilliant new minds. I think you will find that R&D is much more locally relevant. The products are likely to be much more frugal and globally applicable. And I think ultimately you're going to bring in the support of the countries themselves to sustain it. I couldn't agree more with what Peter said. We found from my perspective that I operate in as the director of an institute that the interaction with low-income and to some extent middle-income countries that don't yet have a research capacity that are really in their own incipient stages, we can get a lot done by helping build up that capacity as well as back and forth training. With the BRICS countries, it's a different experience and it's actually a very energizing experience. It's something different because you have in those countries some really, really good people who really need the collaboration. I mean, we've done it in three separate ways. One that I think the audience is familiar with, the report international, which is the regional perspective on observational research in TB, which involved the countries that Peter mentioned. It's an observational cohort study, but it really kind of opens the door to two separate approaches that we've been taking that are synergistic. One is to take our intramural scientists and develop country-to-country and individual-to-individual collaborations, where we have people in Brazil, in South Africa, in China, in India, in South Korea doing development as fundamental as basic to screening drugs to developing clinical trials. And we also have a program now where we're funding extramural investigators in an interesting way of collaborating. That's somewhat novel, and that is instead of funding our investigators to go to one of those countries or giving money to do work here that's relevant there, we make a deal with the country in question, and we have this with China, we have this with others, in which the Chinese funded investigator, we funded investigators, so we both have skin in the game, but we're working on a collaborative project. And that's really been very successful, and I think that's the kind of thing that's going to lead to enduring results and enduring collaboration, so I totally agree with what Peter said. Eric, what are the political obstacles, do you think? We've seen the sensitivities around Russia, right? I mean, it's the complications of trying to make sure, in the midst of a very turbulent situation, that you don't sacrifice those standing relationships, and we're seeing, the nature of this is that you're going to have sovereign sensitivities, you're going to have tensions, you're going to have to anticipate those and deal with those as you work ahead, how do you do that? Well, I think the long, I think you have to have a familiarity on part of the political leadership with the challenges that are present in the healthcare delivery systems that they are responsible for. I think that comes from activities like the co-principal investigator, one in one country, one in another country, working on a common project. It comes in elevating the scientific investigation agenda in the political campaign, political party that comes from a grassroots understanding of the importance of that for themselves, for their children, for their people. It is almost as if a light bulb goes off for some leaders in countries where they realize that this is their electorate and that if their electorate isn't healthy, that it impacts their political viability, longevity, but it is a threshold has to be reached on part of that political leader where they realize that they are the individual who's responsible for investing in their people through health and education, and I've seen it in country after country. If that understanding is not there, you're often talking to an individual who doesn't take your information and move with it. It's a delicate convergence of information, understanding, pressure, and fear that I think has to be generated in that political leader to act. It comes from the World Health Organization, the United Nations, making these issues important and relevant. It comes from our ability to describe that with epidemiologic surveillance data that is not at one point in time but continuous. The 17 years that Mario showed on the reports allowed us to have high levels of confidence in saying that this is where we are at this moment in time with all of the problems in sampling errors. And it then takes somebody close to that political leader to translate the jargon into here's the bottom line common sense act that you need now to put in play. It is rare that a political leader, even political leaders coming from medical backgrounds, see the political utility of focusing on the health of its population. It's not the first thing they think of. And I think it takes that ongoing narrative to get them there and keep them there. Thank you. We're going to turn to the audience for some comments and questions. We're thrilled to be joined today by Debbie Burks, the new Global AIDS Coordinator. Deborah, thank you for joining us. If you care to offer any comments, we welcome that. Sorry to put you on the spot, but since you're here, maybe you'd like to say a few words. And then behind you, I think, Tiaji, did I see you? Yes. Yes. So, Deborah. Well, excuse me. I just flew inside. I just came to support this illustrious panel. So they're all mentors of mine. We just came from South Africa with our annual meeting. And the gap even among the TB identified in clinic patients between them and access to ART is still a phenomenal gap. Because it's not an excuse. We no longer have the excuse of not having the patient. The patient is in the clinic. It's getting, patient is getting dots every single day. Yet they've not been tested for HIV and they're not receiving ART. And that gap is between about 45% as a mean to about 80% coverage. So there's still, even though we have the patients and we've had that dialogue, we still have that gap. So from my perspective, from where I sit, that's still inexcusable that we have that gap. Now when Ambassador Goosby took over that gap was huge. It was more like only 10% or 15% were on ART. But with the new WHO guidelines, 100% should be on ART. So that gap is quite compelling for us. And we worked very hard in discussing that and what we need to do. So sometimes you can have all the tools and all the knowledge and all the ability and you still have this programmatic pieces Ambassador Goosby was saying. So I think we still have our work to do to even implement what we're supposed to be doing right in this very moment. The gene expert pieces in South Africa, we heard report after report that there's a backlog of about 50,000 diagnostics that have not led to patients being treated. So the samples have been run, but the patients have not been, have not, and then they had MDR and they have not received MDR treatment. I think sometimes our technology is superb, but we don't often follow that with program. And I think we have to ensure that as we roll out these really amazing instruments that we have the program behind it to ensure that that happens. So it was a great meeting. We had our annual PEPFAR meeting, but it was also still sure that we have a lot of work to do together. Thank you. Tiaju? Other hands. Thank you all for coming. My name is Tiaju Salam Blyther. I'm with Congressional Research Service. I just want to say I'm such a DC nerd because I'm so excited to be in the room with the current and former ambassadors of a PEPFAR. So it's just like exciting. Thank you for being here. So I would like to say I want to thank Ambassador Goosby for mentioning something that I think, I don't know if it kind of, he kind of said it so smoothly. I don't know how many people picked up on it, and it's the health systems piece. I think part of the reason we're seeing such a challenge with TB is because if any of us who have been out in the field know much of the resources, the health resources are concentrated in the cities and in the major cities and in the capitals. And TB is a problem that obviously hits the more vulnerable people. So when you get to the rural areas and when you get to the peri-urban areas, there's a lack of diagnostic capacity as well as human resource constraints. I wanted to ask the panel, since this is about R&D, what type of field-based research is happening that may excite us like maybe how we've seen the use of vinegar to detect possible cancer in women if we could possibly talk about something like that, some low resource research happening in the field with TB. Also not just in terms of clinical research, but also operational research, how we may be able to get around basic diagnostics in areas with human resource constraints and diagnostic constraints. Thank you. Thank you. Let's take one other in this round. Yes, sir. Thank you. It's working. It's working. Peter Hale, Foundation for Vaccine Research here in Washington. I think we all agree that political leadership and political will is critical, as Eric said. But so I'm very concerned that there seems to be a disconnect between the administration and Congress on increased funding for TB. My special concern is a recommended budget cut of 18% by the administration for USAID. It's not just USAID. What do we do about that? Okay. Thank you. Who would like to start off? There's a couple of different questions on the table, Peter. The health systems issue, you know, maybe it was 20 years ago, but when I was doing NIH funded research, I thought that few things could be as complicated as my bacterial genome. And having spent two years in India, I'm sobered by the complexity of health systems. And I spent months really just putting my head in the space of the patient who's sick and poor in India. And the completely insufficient choices that they're faced with. And from that perspective, and I think Debbie mentions it as well, when you actually look at the realities on the ground, you wonder how anything is actually happening. And it's possible to get incredibly depressed. And I won't say there aren't many days that I was. But for me, the focus on implementation science, implementation research, how do we roll these things out here? How do we change those anecdotes to data and then track that data and actually hold ourselves accountable for it? And I'll just mention one project I'm super excited about, and that are standardized patients. So beginning in a few months, we'll be having about 400 trained patient encounters in Mumbai and in Patna, two big Indian cities.  And the shocking data that comes out of that is that only 8% of the doctors are even talking or thinking about tuberculosis, right? So this is enough to make a person who's spent their whole life in TB completely morose. And then you think, well, but at least we have something to track now, we know what the challenge is. So I do think that this issue of implementation science is really critical and that rather than getting depressed by the early results, we just look at like how much easy, how, what a low hurdle we've got for ourselves right now. Eric, do you want to speak to the issues around programmatic, what Deborah was arguing about? Well, it's really gratifying to hear the current global aid ambassador speak to the undone part of this effort, because it is going to take that kind of intellectual honesty on part of our USG efforts, but also our colleagues as a multilateral sector. But mostly our colleagues in the ministries around to look at what they're doing, what they aren't doing. And to be willing to ask for the technical assistance to put the program in place. We need to be able to be ready to respond to that request in a way that allows for a sustained relationship to capacity expand that ministry or that planning body in country. It may not be the ministry in other settings to implement. And so I really want to echo the importance of that. There are many efforts that PEPFAR has already initiated, trying to look at the elements of identification, entry and retention of individuals over time. Both Zambia, Kenya, Tanzania, South Africa have at kind of the site level studies going on that will give us insights into where those bottlenecks are. I'm old enough to know that the solutions often are idiosyncratic and country specific, almost site specific. So a one size fits all approach is not going to work, but what we need to do is to support, nurture and create that creative mind in the country who's there all the time, who sees a new wrinkle on a problem, but has the ability to take that in, fold it back out with a solution. We need to be in a supportive role, but a constant role with it. It's not going to happen with a two week technical assistance visit. The question that Peter raised about the budget cuts and a gap between Congress and ministers, I mean the bigger problem it seems to me is that we're in a constrained budgetary situation in which there's going to be further tightening and it's going to be more difficult looking forward and there's just many competing priorities, right? There's many good work to be done and so TV is competing, right? It's competing against a whole bunch of other things. So how do you think about that and how do you proactively energize and make sure that the priorities are aligned with what you think is really important? Steve, I'm glad you asked that question because when you talk about R&D, it's a different picture than the question that was just asked because when it's R&D, I mean real research and real development, TV isn't a line item. So I think what people don't appreciate is that the administration or any of the Congress could not, unless they do something extremely unprecedented, cut TV research. The perverse aspect of what's going on with a flat budget is that you can't take advantage of scientific opportunities that are more intense in TV now because we're in such an incipient phase. We felt so far behind when I became director of NIAID a really long time ago, the budget for TV I thought was a typo. It was like $600,000 for two grants that we had. It's now $165 million, $170 million. And the reason we were able to do that is because when the research, and I'm talking not about TV implementation and USAID, I'm talking about the fundamental NIH type research. As the NIH budget increased dramatically over years from the usual, the NIH budget doubles generally every 10 years from 1998 to 2003. It doubled in five years that when it increases, you have a lot of flexibility in jumping on scientific opportunities. So I have a slide, Steve, that you've seen that has what we do is balanced by the scientific opportunity and the public health imperative. So right now TV is smacking with scientific opportunity and public health imperative. So I was able to do a lot of pushing towards TV research without hurting anybody else because there was an increase in the NIH budget, particularly during the doubling years. When we used to get 14-13% per year increase, for the last 10 years the NIH budget has been flat. So with a 2-plus percent inflationary index, we have lost in the last 10 years 25% purchasing power. The budget that I had to defend before the Congress last month and the month before was a 0.7% increase for NIH. So it isn't that I'm going to cut anything, it's just that I have no flexibility to jump on opportunities with TV research unless I, okay, you pick it. I was at an influenza meeting before I came here. Should I tell the influenza people we're not going to go for a universal flu vaccine? I'm talking a little bit longer than I usually do, but I just want to make the point. The solution is one, no, I didn't say the solution. A solution in my mind is to change how we in this country think about innovation and research. It is part of the discretionary bucket of our budget, which means that it doesn't keep up with inflation during difficult times. And I have been arguing with somewhat deaf ears, except for a few people who are starting to listen now, some good people in the Congress, that if you really value innovation as part of an important part of ourselves as a nation, that innovation, particularly in the biomedical sciences, but also in the physical sciences, should be a set formula like cost of living increases on the paycheck. So that if you have an X percent of inflation, biomedical research inflation is 2%, add 2 to 3% on that, and make it almost automatic. So you don't spend time arguing about it, but we're not there yet. So I think the only way you're going to be able to have flexibility in taking advantage of scientific opportunities if you have even a modest increase in the biomedical research budget. I'm not saying double the NIH budget every five years, because that's non-sustainable over decades. But what is sustainable, and we've proven it, is a modest increase each year to keep up with inflation and to take advantage of opportunities. That's how I think we're going to meet the scientific challenge. Other comments? I'm also going to invite Mario to offer a thought, and then David has his hand up. Mario, do you want to offer a thought? Not easy after this, because this is very clear, but just to emphasize once again what I said before. Without new tools, we are not going to get to that level of ambitious targets that have been highlighted in the new strategy. That is very clear, and this is based not on speculation. It's based on the fact that, as we well know, the maximum ever reached in TB is what was reached in the Netherlands or in some other countries of Europe, a bit in North America, I believe it was not 10%, it was slightly less, 7%, 8%. In the 50s and 60s, when the new chemotherapy became available, when there was access, and that's why we insist so much on universal coverage and social protection. These were all elements that were put into especially the European portfolio of the governments, you know, social protection, universal coverage and things like that. That is when the maximum possible 10% decline was reached. Now we know that this is going to be very difficult and a challenge in BRICS, because they dominate, Peter said it again, but they dominate tuberculosis, 45% of cases are in the BRICS, two-thirds of MDR are in the BRICS. So in these countries it's going to be very difficult to reach something that is near 7%, 8%, 9% as it was in Western Europe or in North America half a century ago. We need new tools, that is very clear. So the investments have to be presented under that logic. I believe the US government cannot do it by itself, because we just heard the difficulties in getting more money. Here you need a major investment in basic research that has been underlined. You need a pipeline that is constantly like the HIV pipeline. You know, if I open a parenthesis here, if I look at HIV, I came to this country in 1984 to train. So at the time we didn't have the HIV test. The AIDS was described in 1981, if I recall, in 1983-84, after that, 85 is when the HIV test became available, because I got a needle stick and I was tested in 85, I remember. ACT was available in 1986-87, so four or five years after we had drugs, we had the test, we had everything. And 15 years after, we had the triple therapy as it was called at the time, heart and so on and so forth. So that means that if you invest, you can achieve. Now AIDS is probably different from TB, I think it's less complex in certain ways, but it's something that you can address if you invest. If you don't invest, if you maintain the status quo, it's going to be very difficult to progress in a rapid way. And so, again, it's an appeal that perhaps the leverage issue that was raised with the BRICS, because they have major institutions and the technical assistance that can be given to improve further. The mobilization of resources from other entities, for instance, the European Commission, $27 million is what they spend every year in the Horizon 2020 project now, $27 million. That's what we're talking about. The Gates Foundation spent 150, 160 NIH with just 30, 160, 170. So that cannot be. So it's really an issue of mobilization of opinions and pushing others, using the leverage that the United States can have in order to really get to the point that we need to get to, because otherwise it's not going to work, in my view. Thank you. David Briden. Yeah, David Briden with the results. I mean, I think this is a really urgent discussion. I think we should find it morally offensive that we're out distributing medications that, yes, save people's lives, but cause psychosis and hearing loss, permanent hearing loss. That we should find morally problematic. So this investment that Mary was talking about is just extremely important. I want to just differ a little bit, and correct me if I'm wrong, with Dr. Fauci, but I think that the reduction for USAID would impinge on R&D resources in the sense that USAID is tasked with providing funding for late-stage trials. So that would constrain the amount of money, as I understand it, for late-stage trials for the PAMZ combination, for instance, or for the stream trial, other medications that would be much faster acting and would not cause psychosis and hearing loss. And so I think that it is an important point. I don't know what the strategy is. I'm not sure it makes the best sense for USAID to be tasked with those late-stage trials if its funding is going to be cut in this way. But I'd be interested in your reaction and also children. I mean, when we talk about the interest of the administration, maybe that's the answer. What do we do about this? Maybe we emphasize the impact of TB on children and the need for medications and vaccines that will address their needs and get them diagnosed and treated and cured. I was going to just comment on the role the diplomatic side of things plays. The reason that the Global AIDS Coordinator had an ambassador title was really because every relationship that PEPFAR had in moving into countries, 36 in a big way, 78 total, it really comes in through a relationship of one country through another. And I think that there is a growing appreciation of the opportunity that a diplomatic discourse affords in that bilateral relationship. I think that Debbie and the State Department with Leslie Rowe's office, the Global Health Diplomacy Office is learning how to better prepare our AIDS ambassadors, all of our ambassadors to be AIDS ambassadors in each of the country's settings, and take a leadership role in making sure the disease is understood, the prevention and treatment opportunities are understood. And as Robert was saying earlier today, that that happened at the embassy level, orchestrated through our agency, networks in country, but with a new and invigorated dialogue with country leadership, ministries of health mostly, but also civil society to crystallize the advantages and the gains that can be won with putting the science that's known on the ground. Our relationship with that effort needs to be increased, strengthened, as not a primary implementer as the United States, but as a partnership. And I think that's really right in front of us right now. Peter? No, I agree. You had one more intervention. I'm speaking too much, but there is one issue that has not been faced. We talked a lot about governmental structures putting money into Gates Foundation because Peter is there. What's the strategy for the industry? We are learning a lot of interesting things now with expert monopoly, the factor, and you know, push down the price, push down thanks to again US government and Gates Foundation in unity. We are learning now from the two new drugs that after 40 plus years have been made available, Bedakulin and the Lamanit, both obviously developed by industry. There is no other major development entity except for the TB Alliance that is now working on the new regiments and so on. But what's the strategy? Shouldn't we think about again a strategy with the industry? I think in 2009 there was the Pacifica summit where there was a purpose of a name there, was that of getting the industry involved. I think that in TB we have a major challenge there because that is probably the most unattractive disease that we can think of for industry to invest. And without industry, I'm not so sure if public agencies, under the situations we are in, in the rest of the world and not only in the United States, so what are we going to do? So this is one of the things probably several you can do that we've been doing with pharmaceutical companies. One of the big pharma and little biotechs is that in that spectrum of upstream to downstream that I spoke about, it's the question of de-risking the company's efforts. So if a company makes a decision about whether they want to get involved in developing a new drug, they look at the investment they have to make and what the chance of what their return is going to be. And if they're taking a risk on an unsuccessful drug, as we all know, everybody in the room knows, it's anywhere from 700 million to a billion dollars per intervention at the drug level. So what we've tried to do on the upstream level is to provide for companies by things that we do on contract or all the time research resources, sequencing and informatics capabilities, proteomic capabilities, clinical trial networks. We've just started a leadership group for clinical trials in antimicrobial resistance. And one of the reasons for that was to provide for companies the capability of doing clinical trials for new drugs. We've integrated TB into our HIV AIDS research networks. And again, that's TB with or without HIV. We just, you know, hopefully get as much TB mileage out of it as we can. So there are things you can do on that end of the spectrum. The other thing is that when we were dealing with trying to get companies involved with HIV, even when there's much, much more of a return on HIV drugs, even when you tear price it for the developing world, you've got to try and figure out what the companies really, really want. What they really want is tax benefits, but even more so, they want extensions on patents.  It's going to cost you $700 million to a billion to fund a new TB drug. I tell you what, you go into the TB business and we'll extend your patent for another year on your blockbuster. So they wind up making three to four billion that one of the billion goes away there. That sounds great. You do the math, it's great. Except that somebody is going to have to pay for that drug being an extra year being an expensive drug. And the insurers are the ones that pay that and that's the wall you hit when you want to make that suggestion. I would not stop trying. One of these days we'll get a sympathetic ear, but that's... Peter, your reflections on this? I alluded to tools and approaches and I think this falls in the category of approaches. How do we actually use IP and legal and business practices which were frankly developed in another space with another intention and adapt them for promoting the Global Health Agenda and TB in particular? It's something that Foundation has thought a lot about. I think right now what I'm particularly excited about are some of the branded generics companies where you can't get some big companies to touch a 40, 80, 100 million dollar a year market. There are other companies who are actually credible, very competent manufacturers who will jump right in. So I think that that's another thing and then it also becomes a domestic product in some of our high burdened countries and that also gives it a lot of steam. Good. We're getting towards the end of our hour. Is there any closing comments or questions? Yes, please. Then we'll come back to our panelists for one last round of thoughts. So please jump in. Yes, please. Newlymore with American Thoracic Society. So we've discussed this at different points today but I think this last panel you may be uniquely positioned in your various positions to try to come back to one of the central recommendations of the report which is increased funding and prioritization and maybe even just getting to the point where this big funding cut for USAID is not outlined every year. There's a lot of advocates in the room. So if there's any couple of central messages that we can use including this report to try and make TB stick more and get that prioritization more, what do you think those would be? That's a great question to close the hour. Why don't we start with Eric and Tony and Peter just sort of top-line thoughts around messaging and communications themes and looking forward to it? Well, I guess I would focus on the fact that we know a lot about the natural history of the disease. We know a lot about the pathophysiology of the disease. We know a lot about the epidemiology of it. We know how to map and identify where individuals are within a population. The ability to identify the individual, establish that they're infected, bring them into a relationship with a medical delivery system to cure them is I think the critical piece that I would emphasize, matched with the inherent risk to the United States government and its people with MDR and XDR TB and the importance of keeping and helping our colleagues in country who are in front of that outbreak to be successful in containing it with the elements of implementing it in their country because it will move across the border and come to our country. So I think that we know the science. We know how to respond to it. We need to help our colleagues in country who are burdened with high burdens of disease to be excellent in their ability to do that. So I agree totally with Eric's message. My contribution to the dialogue is that in the multiple times that I've beseeched the Congress and the administration, I don't think I have ever gotten what I wanted the first time I asked ever. It's like never, hey, what a great idea, Tony, let's do that. It's always been going back and back and back. So take word for word with Eric said and you just got to keep going back and back and back because nothing gets done the first time around. You get the benediction. Well, in the presence of these guys, I'm not going to even hazard a guess as to how to talk to Congress. But I know what compels me. And frankly, I get tired of the sky falling and the doom and gloom and I know that motivates some people. But for me, I get totally energized by the successes that we've had in this field and saving 22 million lives. And then the U.S. role in this, which is truly phenomenal. I just think about the gene expert. And I have a really close association with that because I myself got a gene expert when I was coughing from the air pollution in India. And after spending two weeks chugging cough medicine and quietly in self-denial assuming that I'd contracted MBRTB. And I'll tell you, you know, the experience of thinking you're having TB and knowing you don't is a phenomenal thing that this government has enabled the world in. And there's no part of our government as best I can tell that hasn't touched it. I mean, I think DARPA put a lot of money into it. You guys put a lot of money into taking the DARPA thing and turning it into a public health thing. You know, I think that USAID put a lot of money into making an affordable thing. And I believe that CDC has done a lot in terms of, like, how do you put that thing out there? And OGAC has really put a lot of these things out there. So, I mean, here's a real thing that is changing lives. And that's a story that just hasn't been told. So I'd start with that. Thank you. That's a wonderful endpoint for this. Please join me in thanking our speakers today.


Hey guys, it's Nate, AKA The Foot Accountant. Welcome back to the channel. We have a huge video today because there is a big time SPC that is leaked to becoming to FIFA 22 Ultimate Team today. And that is the mid-icon SPC. I want to talk everything related to how the market could react to a mid-icon SPC pack that is supposedly and is leaked to be dropping today on Monday in this game. I want to take a look at the price point, how much it's going to cost. I want to take a look at SPC fodder. Is that going to go up finally after being so low in price? And what's going to happen to the rest of the market as we are already starting to see some people prepare for this very anticipated SPC to drop on this game on a Monday. I also want to talk about the rest of the market, probably upgrade packs coming today along the lines as these headliner cards and still what we're looking at in this current market at the moment. So if you're excited for today's video, make sure to hit a thumbs up. And of course, subscribe if you're new. Big thanks again for the milestone 50,000 subscribers. That is legendary. You guys are amazing. Thank you very much. So let's get right into it, right? Because this is the big news and this is what we're here to talk about today. These are the official leaks, right? This is one of our very trusty sources from Twitter. Both of these guys mentioned in this tweet, foot sheriff and trusty foot trader. They have both said that a mid-icon SPC is coming and that say tomorrow, they tweeted it yesterday on Sunday, January 2nd. And it's supposedly coming today on Monday at the 6 p.m. content drop. Now it also has been leaked and confirmed that it is a non-repeatable SPC. So I want to clear that up first. Unless they change things, it sounds like this is a non-repeatable. It's a one-time get it done, do the SPC. But this raises a lot of questions, right? How much is this going to cost? And I want to kind of break it down and talk about that because this is a big SPC. A lot of people in FIFA right now have fodder. They've got a lot of fodder to put into something like an icon SPC because we have not had a big icon SPC like this in like two weeks. And people have been opening 85 times tens. They got their icon swap packs. People have fodder in clubs full of those types of cards to turn into an SPC. So let's talk about how much this SPC could cost. I'm going to take it back to FIFA 21 when we had our first mid-icon upgrade. I believe, and this is also very interesting to note, we didn't get an icon upgrade last year until like the 29th or 30th of January. And it's the third of January today. So a little bit earlier on this year's timeframe of FIFA 22, last year the mid-icon upgrade costed 600,000 coins. But also this was in the height of team of the year where there's tons of SPCs. Yes, there's a lot of packs. But last year fodder was at a whole different level than what it is right now. If they required an 84, 85, 86 and 86 rated squad in this game of FIFA 22, like right now at the moment with the current prices that we have, it would not be anywhere near 600,000 coins. I think with the current fodder prices, like 86s are 10,000 coins, 85s are like four and a half. I think that if they dropped the exact same requirements as they did last year in FIFA 21 for this SPC, this SPC would only cost you like 300,000 coins. And that to me is too cheap. I think today what they're going to do as I think they're gonna make this SPC about 500K because if you take a look, the base mid upgrades that we've had so far this year have been kind of cheap, right? And fodder is very low right now. But with the abominin SPC that they released yesterday as definitely an overpriced card in my opinion, 440,000 coins, I think that they know that a lot of people have invested in SPC cards, fodder cards, they have a lot of these higher rated players in their clubs and they're gonna pay the extra cost to do this SPC because right now in this game, there's not a lot going on. So I think this SPC, this is just my opinion personally, somewhere between 400 and 500,000 coins. If it's less than that, that's crazy. If it's more than that, a lot of people are probably not gonna want to do the SPC. So that's kind of like the sweet spot for me. Of course, these icon upgrade SPCs this year, of course we looked last year and see 600,000 coins. All of them have been a little bit cheaper this year, but that just goes with the whole market, right? Icon upgrades for 300, 296,000 coins, everything is cheaper this year. So hopefully this mid icon upgrades maybe around the 400K range, that would be very nice. But I think that 400 to 500K is right around where it will be. And I think a decent amount of people are going to do it, right? Let's say it is in that 400 to 500,000 coin price range. Especially around the 400K range, if a lot of people are looking to do this, will SPC fodder go up? That's a big question. I really don't expect fodder to go crazy today, especially because this SPC is confirmed to be non-repeatable, right? You've already got some cards rising in price. Bruno Fernandez 22,000, basically 23,000 coins. These cards were, you know, these eight rated cards were 20,000 coins flat. Just a couple days ago on the weekend, they were even under 20,000 coins for some of these 88s at their lowest. Some fodder has already started to rise up in price as people are buying into this and investing in fodder. Once again, fodder has not done very well at all this year in terms of, you know, except for the very first time earlier on this year when you guys know that fodder absolutely exploded. It was right in here, right? In early November, in the early to the mid-November timeframes, but fodder has absolutely dropped off a cliff since the 85 times 10 came out, right? Like right on the 26th of December. And a lot of these fodder prices have really gone down. Now they're starting to come back. Again, as you see, people are buying fodder. We went from 73 points on the index 86 all the way up into the mid-80s. So upon this announcement of the leak, people are already investing. People have clubs full of fodder. I don't see a way today that a lot of these types of cards really go that high. Unless you bought 86 rated cards, which I know for a fact that some of these 86s were down at like 8,000 coins, you know, literally on Saturday, like during lightning rounds and stuff, yeah, check this out. 9,000 coins, 8,900. I know that some of them were even cheaper on Friday. I think that, you know, 86s might go to like 11, 12K today. Your 88s might go to like 24, 25,000 coins. I don't expect fodder to boom. That's all I'm trying to say. I don't expect fodder to go crazy. I literally just expect SBC fodder to bump up in price a little bit. And then everybody who invested and everybody who's been holding onto fodder for forever and is trying to get it out of their club or even like myself having a decent amount of those types of players on my transfer list that I'm just trying to sell at the moment. I've got lazy listed for like 10 to 15,000 coins over their cheapest buy and now I've had this stuff on my transfer list for like a month, right? A lot of people have fodder like this and they're tired of holding it and this might be an opportunity for them where they go and sell it. So I don't think these types of cards are gonna have a crazy rise today but what this could be is this could be kind of the beginning of the next two weeks where SBC fodder actually might go up. And you're like, Nate, what? SBC fodder going up? Well, think about it. We are probably after this headliners promo we are heading into team of the year. And you know, they even, EA is starting to very, I think this is a very not conservative. That's not the word I'm looking for but a very perspective or smart or they're already starting to look ahead towards team of the year because releasing this Pierre Emmerich Obamian SBC for 37 days. This puts this SBC available for this next two weeks of headliners and also throughout, you know, at least half or most of team of the year which should be coming in the next month, right? During this month of January. This is the type of SBC that people are going to complete slowly over this next month as they have extra SBC fodder during the team of the year packs, upgrade packs for headliners, more icon swap packs, stuff like that. So EA is getting kind of smart with this stuff and they're starting to put more demand in the store for SBCs. I will see, you're not in the store but in the SBC section, we will really see. Now the thing that I kept saying about SBC fodder going up is that the supply had to stop. And yes, we're still seeing lightning rounds but they are not running near as many lightning rounds as they did during winter wildcards. We're not seeing the late night, not the early morning lightning rounds and especially we're not seeing like the 85 plus star packs, 86 plus star packs. We're just seeing the normal 50K, 100K and 125,000 coin lightning rounds. So if they continue that trend over these next couple of weeks if they release multiple icon SBCs and if they, you know, start putting out other types of SBC content, more flashbacks. And if they really go into this mode of, hey, we're trying to drain people's coins before they get to team of the year which is probably a couple of weeks away then we actually might see fodder slowly rise throughout the next two to three weeks if that's the scenario. So even if fodder goes up a little bit today I would consider if you're in it for the long haul maybe not even selling. That's just kind of my thoughts. Again, EA does whatever with the content but that's just kind of my preliminary thoughts because we're entering a timeframe where it might be time for EA sports to try to drain some coins off this market before team of the year. So that's the whole scenario with the SBC fodder with the price of the SBC about the icon SBC today. Now, there's already people starting to prepare and as you would expect when a leak like this goes alive when people start talking about this you're gonna start to see people sell some cards off. Now there really haven't been cards that are like crashing on the market by any means but even using some of these most recent Winter Wild Cards for example. I know that this Gen-Duzi was affected in price by the brand new Sabineer that was dropped in the game yesterday as a headliner Sabineer. Gen-Duzi was like 230,000 coins. He was actually 205, close to 200 flat earlier just a couple hours ago. He's now 213K but if we take a look across the market some of these cards have dropped off decent amounts today and I think this is people selling their weakening teams yes but also starting to prepare for the SBC that is to come. Take a look at Kingsley Coleman. He was like 650,000 coins multiple points 670 on Saturday. Now yesterday kind of going down to 592 bouncing between there and 640K. That was just a card that I noticed was down. Fabinho was 500,000 coins early in the day. He's now 100 or 467,000 coins. Modric is down like 20,000 coins. So if you take a look across the market you're gonna see multiple instances of these cards dropping a little bit. Gomez Ice is down like 10,000 coins 15K and Babu is down a little bit.  So I think you're gonna see a little bit more of that today heading into the Monday content timeframe. Now also what I think you're gonna see is you're gonna see people sell off icons and you already started to see this and the market's slowly trending down just a little bit. But one of the things that we saw yesterday on the Twitch live stream that was very, very honest, it was very funny to me is that there was a big drop in price on rude hullet. He was like 4.2 or 4.3 million coins which he's usually like 46, 47. And it just, it seems crazy to me that people are, think about the small amount of people that are actually gonna pack a mid-hullet on the game today from this mid icon SBC. So that's the kind of stuff, mid icons, prime icons, even baby icons that are out of packs. One thing you could do today is depending on what your budget is you could absolutely look for panic selling on icons because when this SBC drops today it is probably gonna take some coins off the market. And that's the number one thing that I would say to watch out for on this game today is panic selling on some of the icons because we've seen it time in and time out. Like this, this Mid Maldini is down to 1.65. That's really low for him. You know, these types of icons bounce back. So take a look and try to find some icons if you wanna try to trade in this market today. Watch for those out of pack special cards that are very popular and very meta like the Winter Wild cards or stuff like that. Maybe even some of the headliners. Those of course are in packs. But your most popular and your most meta out of pack special cards people are gonna go do that SBC today. Let's say they have Anthony Martial on their team. They wanna go do the icon SBC. They sell Martial to go do it. They get some coins. They do the SBC. Oh man, I didn't get anything good. Then I go buy stuff for my team back. So just be aware that probably today on the market there are gonna be some coins taken away. I think when the SBC drops you are gonna see some more prices drop down as people react to it. People that didn't know about the leaks will go and maybe sell some cards and go and do the SBC. So that's where I would be looking on the market today. Some panic selling after the SBC has dropped on your most meta popular and rare items that you would expect to bounce back in price because they're just again, very popular, a rare and meta cards that are popular to use right now and that most people are using right now in this game. So I would 100% watch for that. Again, a slight fodder rise and then some icon panic and a bounce as well. I really do think that the market would bounce back from this just because the market right now with the content not being that hot.  But I also think people are gonna buy those cards right back and if you pick the right ones you'll be able to make some really good flips out of this market today on Monday in this game. Now also we are at a very interesting impasse with these headliners because today is also the worldwide payout of foot champions rewards early today on Monday. We have the new mini release cards, Surge Nabri and the Saver near card which we talked about in yesterday's video are definitely the top two in terms of most popular and most sought after. This Nabri card looks really great. I mean 98 acceleration. Some people have said this card is really, really good in game. Sprint speed is not there for sure but he's probably very, very quick on the ball. 200,000 coins. I think the one thing about the market that I have to say today is that with this mid icon SBC coming out I do believe there would be a lot of people that would hold off from buying cards. A lot of times after week in the rewards we saw this last week with the Winter Wild card items their prices really started to rise after week in the rewards because there was nothing else to do except go out on the market and maybe buy these cards to try out the brand new cards that everybody wanted to try out and that were hype and stuff like that. But at the moment with the headliners that we have the promo isn't really that hype and I think more people are gonna be excited about the potential icon SBC for today and other content like player picks and stuff like that. So I really can't sit here and say, hey, I think these Winter Wild or the headliner cards are gonna fly today after week in the rewards because I really don't think that's gonna be the case. Some of them have bounced around very nicely in price and some of them are down like Van Dyke at 600K, Kula Bali's 200,000 coins, that's down. Mbappe, you watch it, I actually flipped an Mbappe today. I bought Mbappe a 4.15 mil and sold it at 4.5 million coins for a nice little over 100,000 coins of profit. He is back down to like 4.25. So his price is down for sure. I just don't see with not a lot of hype on these cards. I think they're going to go lower later this week, especially with the compensation in which we talked about in yesterday's video still looming on this game and on this market at the moment for today. That's kind of how I'm feeling about the market today. I think there is gonna be some drop-off. I think there is gonna be some pain excelling this morning. You might see a few cards rise after rewards, but you're also gonna see people sell stuff continually. Maybe some of these out-of-packs cards. Trading right now on this market is very interesting because it's very quiet. You're doing a lot of fluctuation trading, a lot of chem style, position change trading with the brand new cards. That's what I did with Acunia and Savornir. I bought a lot of these Savornirs at like 110,000 coins or even like 105 to 110 sold them at 120 to 130 with chemistry styles and position changes applied to them like the shadow or something like that. So that's kind of how I was making coins, but today there's gonna be a lot of market movements because that Icon SBC to trade around. So it's gonna be a good day for movements on the market. I don't know if EA is gonna bring out any sort of store content. Again, like we've said, when they dropped the first base icon pack, you guys will all remember this. Two months ago at the beginning of November, they dropped preview packs as well. I would be very surprised that they dropped preview packs on the same day as a mid icon upgrade SBC. I really feel like today's content is going to be the mid icon upgrade SBC and some sort of upgrade pack, whether it's the 80 plus player pick, the 78 plus player pick getting re-released, some sort of upgrade pack or maybe even multiple. We had the 81 to 87 that was released last week too. That's a potential SBC, upgrade SBC that could be coming out. Last call for Thomas Muller SBC, his is expiring. Of course, the Brandt has definitely not had that high of reviews on this game at the moment. Not a lot of other stuff is really expiring. That means much. But again, the Obamian SBC yesterday was just, I mean, this SBC alone is 440,000 coins. And a lot of people are saying you should do this instead of the mid icon upgrade, which is honestly not that bad of a shout.  I just think that that Obamian on the market would be somewhere around like 250 to 300,000 coins or maybe even a little less than that. So that's why I'm not a huge fan of that card, being the price that it is in the SBC section right now. So again, as we're looking at the market right now and as we're looking at a lot of these cards prices, stuff is dropping down a little bit. And I think you're just going to see a little bit more of that today on Monday. A few cards will rise after rewards like I mentioned, but it's all going to be about this icon pack. And when people get worried about an icon SBC coming out, they just panic, right? Because everybody loves these icons. Even though it's not repeatable, I still think there's going to be a lot of hype for it today. And one thing that's going to be very interesting to watch out for when they drop this SBC today is we're going to have to see how long is this SBC available? Because if it's only available for like three or four days, maybe less than that, usually they give you more than two or three or four days to finish an icon upgrade. It's usually available for seven days. But if it's only available for a short timeframe, that would almost tell me that EA plans to release another one sometime later on or to keep them fresh and to keep the coins being drained off of the market. That would be something I'd watch out for. And we'll just have to kind of keep in mind today as well. So it's going to be a big day, a lot to talk about, a lot to watch. We're going to watch it all live from twitch.tv slash the foot account. That link is down below in the description. When the content goes live, we will be live taking a look at it and watching the market and trading and reacting to that. It'll be a lot of fun. So make sure you get involved there. And of course, happy Monday. Start to a new week. Hopefully this week is accompanied by some nice content by EA Sports because the weekend has been a bit of an L. Obamying is a cool card, definitely overpriced. Brandt was just okay. And the cards that are in packs are just okay as well. Slight update. I know you guys probably saw the game yesterday, but the Kovacic versus the Chieta Chelsea Liverpool game, what a crazy game. Both players are going to get a plus one. So Chieta is going to go to an 88. Kovacic is going to go to an 88 as well as those teams drew. So a plus one is what we are in for from those cards. Probably in the next two to three days, I would imagine that they update those. And again, EA Sports, can you please add dynamic images to these items? Cause they just look weird seeing them on footbin or on the like the little logos inside of the game with dynamics and then nothing here on the game. So that's my other question to EA. Can we please update these dynamic images? Also be on the lookout for an update today from EA FIFA Direct about the whole compensation situation because that'll probably be updated here pretty soon. And then I think we'll actually see that compensation later on this week. That's just my opinion, but we will see. So that's the video for today, boys. It's going to be a massive day on FIFA with a mid-icon SBC, a lot of hype around that. I think people are going to get excited for it. It all depends on the price, in my opinion, to see how much activity that SBC gets on the game today. But if you enjoyed this video, smash the thumbs up on it, comment down below if you have any questions and subscribe if you're new. It's been Nathan Foot Account and I'll catch you guys later. Peace out.


Here in the last three years or so I've really spent a lot of time searching for the perfect keyboard and mouse mainly to reduce Strain and fatigue especially on my wrist. I've really been looking for more Ergonomic keyboards especially and mice as well and one of the best purchases I ever made was the ErgoDocs easy keyboard from ZSA if I go to my web browser here I'll show you a quick picture of the ErgoDocs easy as the split keyboard They come in two different colors white and black. I actually purchased the black variant of it if I switch to my desktop here This is the ErgoDocs easy. This is the one I purchased two and a half years ago And I've been using that keyboard ever since that's actually the keyboard I use for my home computer now earlier this year in 2021 I was moving into this office and I knew I paid rent to move in on May 1st So in April of 2021 I didn't want to get into this office and not have one of these split keyboards for the office as well Because I didn't want to have to take my ErgoDocs easy to my home computer and then to the office computer I'd have to take it with me every day So I wanted to buy a second split keyboard from ZSA and originally I thought I would just buy another ErgoDocs easy and then I realized that ZSA also has this new Keyboard a newer keyboard than the ErgoDocs a newer design called the Moonlander Mark 1 So I thought you know what I'll buy the Moonlander for the office I'll keep the ErgoDocs easy at home and that's what I've done This is actually the black variant of the Moonlander Mark 1 anytime you guys see me doing videos in the office I'm typing on a keyboard. I'm doing it on the Moonlander Mark 1 anytime you guys see me doing anything from home on a Keyboard I'm doing that on the ErgoDocs easy now I've done a couple of videos on both the ErgoDocs and the Moonlander in the past I did unboxing videos on both keyboards when I first purchased them But people want to know how I'm getting along with them because I haven't really done any kind of a Revisit, you know on what my thoughts are having spent You know about six seven months now with the Moonlander and about two and a half years with the ErgoDocs And my thoughts on it is I love these keyboards. I could never go back to using a normal keyboard again There's just so many advantages now in my opinion The biggest advantage of using these split keyboards is the fact that they are split keyboards If I switch back to my desktop and I've got the Moonlander in front of me What is the advantage of the split design versus your standard keyboard? That's not split Well split keyboards allow you to position each half of the keyboard where it makes sense for you You know depending on really your size your frame typically the best placement for a keyboard as far as these split keyboards Would be going about a shoulder-width apart because when your shoulder-width apart, you know Your hands are out like this. It really opens your chest up and really forces you to have correct posture It makes you much more relaxed as far as posture We're on a standard keyboard where all the keys are kind of close together and of course your hands are close together You naturally kind of lean into it and you're naturally kind of hunched over that keyboard and For prolonged work at a keyboard. That is not a healthy posture so by far the biggest advantage of these keyboards and Even if this was the only advantage of this keyboard, this would be the reason I purchased this keyboard Is because of the split design another really big advantage with these keyboards is the fact that they have a ortho linear design Now what is ortho linear ortho linear keyboard is a keyboard with a ortho linear or a straight layout Meaning all the keys line up exactly, you know vertically and horizontally if I actually let me pull up Another keyboard from ZSA ZSA makes a small little keyboard here called the plank I actually don't own the plank I would love to purchase one at some point if I ever do I will take a look at it on the channel But you guys can see what ortho linear means all the keys line up exactly vertically and exactly horizontally That is ortho linear now the ergo docks easy and the moon lender mark one are not strictly Ortho linear they're more what ZSA refers to as column ner because they're only ortho linear in the vertical position Not in the horizontal position if I switch back over to my desktop you can see the keys line up perfectly Vertically just straight vertical lines, but horizontally. There is a little bit of a difference there That is not straight across right so that is the difference between Ortho linear and column ner, but honestly when we're talking about being ortho linear the most important ortho linear Aspect is that vertical aspect because it never made sense if you actually take a look at a standard 110 keyboard for example take ASDF on the home row of a keyboard and then the keys Directly above it are not actually directly above it Q W E and R Which you would use the same fingers ASDF to actuate those keys Why do you have to stretch so far to get to Q W E and R? Why are they so far offset? Well, of course This is not a problem on a keyboard like the moon lander or the ogre ergo docks because ASDF Q W E R are exactly on top of each other And that really is the advantage of ortho linear or a column ner layout It's the fact that it's less fatigue less stress for you having to reach certain keys So that really in itself is another big selling point for these kinds of split keyboards and these ortho linear keyboards now one aspect of these keyboards that initially when I purchased them I didn't know I'd like but I've grown to love and that's the thumb clusters If I go back to that picture of the ergo docks the ergo docks has six keys on each thumb cluster So each thumb has six keys that they can actuate on the moon lander slightly different They've reduced the number of keys on the thumb cluster from six to four and for me That's a minor difference because honestly, I've got small hands and I never could actually use all six keys on the ergo Docks, especially that one right there and that corner right there It would require me to adjust my hands in a weird way to reach that key anyway So I never really use that key or I would assign it a key That I never typically use like the print screen key or the insert key You know some random key on a keyboard that you probably hit three times a year I would always assign that to something weird like that, but I never really used that key anyway So for me the moon lander only having four keys and the four keys actually being slightly Bigger rather than on the ergo docks where you have two big keys and then four smaller keys I think I like the the moon landers a thumb cluster a little better But again, that's for me with my hands for those of you with bigger hands You may enjoy the fact that you've got more keys on the thumb clusters with the ergo docks One of the things I noticed right away when I first started using the ergo docks Was I had been typing wrong all of my life if I switch over to the screen here And this is the moon lander in front of me But the ergo docks was the first keyboard I bought but they have similar thumb clusters and you know I'm sitting on the home row and I've got thumbs that are in use that I can just hit keys with right and On a standard keyboard Realized I had never actually used one of my thumbs I'd always use the thumb on my left hand never the thumb on my right hand and that thumb all it did was hit the spacebar The other thumb just never did anything so I had one finger on one hand that never actually did anything while I was typing It was just a wasted digit, right? That's no longer the case by switching to these kinds of keyboards with these thumb clusters I'm actually forced to do something with all ten fingers now where before again I was just kind of wasting one thumb another huge advantage of these keyboards are the fact that they're mechanical keyboards and For those of you that haven't typed on a mechanical keyboard I know many of you guys have never ventured into mechanical keyboards It seemed like it's scary or it's kind of nerdy many cases the keyboards themselves are expensive and to be honest The moon lander and the ergo docks are both very expensive mechanical keyboards I get that but once you start using them you realize They're so much better than your traditional keyboards your traditional standard keyboard, you know you press the keys and they're squishy They're spongy, you know, sometimes you have to guess did I press the key? Did I not press the key on a mechanical keyboard each key press is distinct and tactile and you've got many different switches from many different Manufacturers that you can swap out some switches take more pressure to actuate than others So if you're a really heavy typer, you know, you may want a different kind of switch than somebody that's a really light typer Now, you know, some switches also make a louder tactile noise than others So some people like the really loud clicky switches some people want silent switches and again It's gonna depend on what kind of environment you're working in if you are Mainly typing at home in a bedroom with your spouse You probably don't want the really loud clicky switches You probably want silent switches, but some people if they're alone in office like I am I like having some click I don't want the really loud click, but I like a little click because again I want that that distinct tactile noise that kind of reaffirms. Yes I actually did press that key and since I mentioned changing out key switches I should mention that on many brands of mechanical keyboards Changing the key switches is a lot of work on some brands changing the key switches actually involves Soldering because the switches themselves are soldered to the board Which means if you have to change switches you have to desolder and then resolder These new key switches that you put in place and not everybody has a soldering I or not everybody knows how to do that kind of work and sometimes doing that kind of work on your mechanical keyboard Will actually void the warranty. That's not the case on the ZSA keyboards because on both the Ergo Ducks and the Moonlander the switches, they're not soldered in place. They're just popped in place There's a little tool almost like a little tweezer tool that you can get in there pop the key cap out It just pops out, you know, very easy and then you put the new one in place and just press it in place and It's very easy to swap out switches. They're hot swappable, right? You can do this again in seconds if you're just changing one switch even if you're changing the whole keyboard I mean you're talking about maybe a five-minute process of swapping out all the switches on the keyboard now A neat little bonus feature of both the Ergo Ducks and the Moonlander is the fact that both of them have these tilt arms These little arms that you can adjust to change the tilt and let me show you on the Ergo Ducks here The Ergo Ducks has two tilt arms on the inside nothing on the outside on the Moonlander you have two tilt arms on the back and You also have adjustable thumb cluster keys as far as they have some slight adjustment There's a bolt here that you can adjust the thumb clusters on the Moonlander where the Ergo Ducks the thumb clusters are a part of the board And there's no hinge or anything. They can't move now. I actually I'll call this like a bonus feature the tilting feature of these keyboards because I don't think most people will ever use them Most people have never tilted a keyboard ever in their life, right? They just sit it flat on the desk and that's what most people are gonna do with both the Ergo Ducks and the Moonlander Anyway, again, it's just a bonus feature there for those that want to play with it Another nice bonus feature for both these keyboards is the wrist rests now The earlier keyboard is the Ergo Ducks and initially the Ergo Ducks did not come with like a built-in wrist rest You see there's no wrist rest attached to the keyboard.  I actually really like the rubber wrist rests on the Ergo Ducks They're very comfortable one downside though They attract a lot of dirt and a lot of crud They're kind of tough to clean because rubber just doesn't wipe up that fast and easy sometimes you have to scrub it and sometimes you can actually discolor the rubber and You can nick the rubber and you cause abrasions in it and one of the big advantages of the moon lander Was the moon lander has these built-in wrist rests if I show you my desk on the black one You see it's just hinged and it's just that you can fold it away If you don't want to use it or fold it out if you want to use it But it's smooth plastic It's the same plastic or polymer that's part of the moon lander chassis anyway And because it's so smooth and because it's plastic and not rubber I can just take a wet paper towel and just wipe that thing one time and a spotless But also because it's plastic and it's smooth I never really noticed this the wrist rest on the moon landers really attracting a lot of dirt and crud the way those rubber pads on The Ergo Ducks really it's like a dirt magnet another cool bonus feature of both these keyboards is the LED lighting you guys I'm sure have noticed the LED lighting on my moon lander because it's plugged in. I'm currently using it This is again the keyboard. I typically use here at the office I don't have the Ergo Ducks plugged in but the Ergo Ducks has the exact same LED Backlighting and a lot of cool features. I can change the backlighting. I can actually change the colors and the style and I want to you know, adjust, you know how it lights up and different things. I can do that as well So a really cool little feature again. This is more I would say LED lighting I know I'm gonna stereotype people but this is for the young gamer kind of crowd I actually don't really care about the LED lighting It's just a nice bonus feature for me because oftentimes if I'm in a well-lit room like this office You know if I have the overhead fluorescent lights in this office on like if I'm not recording I just have the standard lights on it's really bright in this room and honestly I'm never gonna notice LED lights going on on my keyboard because it's so bright in the room. These aren't bright enough to actually You know get me to notice them But when I have the lights a little bit dimmer a little bit lower like right now I don't have any of the overhead fluorescence on I just have a couple of studio lamps here Spotlighting me to record so really the lighting in this room You probably don't notice it on camera, but it's actually quite low right now And because of the lower lighting I can actually see the the backlighting on these LED keyboards And honestly, they are a nice little accent now I really cool feature of these keyboards are the multiple layers that are available on the keyboard if I switch back over You know There's not a lot of keys on the moon lander Not a lot of keys on the ergo docks either if I show you you know the the ergo docks here Where's the numpad right? Where's the function keys? Oh? There's a lot of keys missing where if I go to like a standard 110 Keyboard here, you know, you don't have any of this stuff that's at the top You don't have all these function keys well f1 through 12 You don't have a lot of these extra keys as well You don't have the numpad at all on either the moon lander or the ergo docks or do you yes? They are there they're just on a different layer what it is is if you know I've got one through zero You know standard numbers on the moon lander here and the ergo docks both work the same way I have a key that if I hold it down Switches me to a second layer and if I hold it down and hit one instead of one being the numeral it will be f1 You see the blue LED light that's letting me know I just switched from layer zero to layer one So that's that's all that is doing so if I hit that key and hold it down and hit two on the keyboard I'm hitting f2 instead of just two the numeral so basically think of that second layer as being a whole new Keyboard you know everything that you see here. It's just alpha numeric the keys themselves And then if I hold that key or on the other end that key and also switches me to that second layer now I have a whole new set of keys. I have those function keys I also have a lot of the programmer friendly symbols such as your brackets braces the tilde the grub You know those kind of weird symbols You don't use that often but you need them occasionally and you don't have keys for them You know in that default layer the other thing that numpad well I just hold that and then you I owe JKLM and then greater than less than these nine keys here That's actually my numpad when I'm in that second layer if I release it And they just become the letters themselves by default on both the moon lander and the ergo docks You actually have three layers and what's on the third layer? Well if I hit that key I will be on the third layer the third layer. I actually don't use that often It's got some keys to adjust the lighting and thanks for the LED lighting It also has keys for instead of using a mouse I can use the keyboard to actually move the cursor on the screen essentially if you didn't have a mouse plugged in you Could switch to this third layer on the moon lander and the ergo docks and use your keyboard as a mouse Another really cool thing is that you have dual function keys on the moon lander and the ergo docks easy What is a dual function key? Well, let me go back to a standard keyboard Let's talk about the control key because the control key is for me One of the things that caused me the most pain as far as hand pain and wrist pain is using a keyboard It's because that's a long stretch for me again I don't have very big hands and I'm stretching all the time for this control key because I use programs that use the control key a lot Emax I'm looking at you. Anyway, that is a big stretch for that pinky to get to that control key all the time Well in these ESA keyboards What the control key is is actually the Z key and at least in my layout So I don't have to stretch at all. All I do is hold the Z key and if I hold it instead of just tap it It becomes the control key. So if I just tap it, that's just typing Z on the keyboard I actually just changed layouts on the screen because I'm in OBS Z switches to a different layout But if I actually held it it becomes the control key So if I hold Z and then press something else, you know, that's the same as doing control and then plus that key and again for Ergonomics that is an absolute game changer because now instead of my pinky having to stretch all the way over here to hit the control key Which I use all the time again in programs like Emax for example Now all I have to do is just stretch to the Z key, which is right under my fingers I don't have to stretch at all. It's just right there. I just hold the Z key It becomes the control key and then on the other side of the keyboard if I held the slash key That's also my other control key and that's the same on both the Moonlander and the Ergo docks. So my two control keys are right here exactly where my pinky is I don't have to now stretch on our standard keyboard to get to those way out there control key and The same could be done for your alt key your super key Any of those keys that sometimes require you to do a stretch another unique aspect of the Moonlander and the Ergo docks is They include some keys that are not available on a standard keyboard So even though, you know, it looks like they're missing a lot of keys They actually have keys that you don't have on your standard 110 key keyboard if I go back to this picture of the Ergo docks you see in this inner column here you have three keys and These typically by default until you change them unless you change them are keys hyper and meh Yes, that's hyper and then meh meh. What are the hyper key and the meh key? meh is Super alt plus control Hyper is super alt control shift Now what kind of crazy key binding would you ever use where you needed something to be set to? Super alt control shift plus another key Well, you'd never use that not on a standard keyboard, but again, you're not limited the way you are on a normal keyboard So you have these extra modifier keys these two extra modifier keys that you don't have on your standard keyboard And that's really great Especially for those of you that use a ton of different key bindings especially those of you on Linux You're using tiling window managers. It's very easy to run out of key bindings using your standard modifier key Which is typically either super or alt and at some point you you maybe you use both super and alt and you front out of keys Key bindings that you can set to those keys Well, now you have both hyper and meh available now I mentioned earlier that both the Ergo docks and the moonlander use open source software to flash the firmware and This open source software is called QMK. It's available over on get up You can go take a look at the source code if you want, but there's a graphical Configurator tool on the zsa website. That's really nice. So I'm on the Ergo docks page here And if I go to graphical configurator graphical configurator try it out And let this page load and I guess instead of taking us directly to the Ergo docks configurator We get a screen which keyboard are we configuring moonlander Ergo docks or the plank easy Let's say we're configuring the Ergo docks and we get a visual representation of a Ergo docks keyboard With all the default keys, it'll tell us exactly what the key does what the key does when it's tapped What the key does when it's pressed for example z my right click you can see when tapped It's just a z when held it's left control now you can adjust these keys You can actually change them to anything you can imagine I would just go over here to modify layout I get into a different kind of mode where we can actually change the keys then later you can download this layout And what it does it saves a file locally to your system And then you use a piece of free and open-source software called Wally Wally is actually available in the arch user repository I believe I'm pretty sure I downloaded it from there. Wally is also available on the zsa website It's a graphical program that you just open up and you tell it where the location of that layout You save to your computer is and it just flashes the firmware on your keyboard super easy There's also a command line version of Wally, which is typically what I use I just open a terminal I type Wally dash CLI space and then the path to that layout file that I saved on my computer and again Boom super easy really easy to change your layouts and change layers and everything else And you can change anything you want to change about these keyboards because they're programmable So the possibilities are endless and what you want to do with these things And since I mentioned that you can change everything about the keyboard One of the things is a lot of you guys are probably thinking about eventually switching away from QWERTY to other layouts like Dvorak or Colmag or things like that and honestly when you purchase your ergo docs or your moonlander That's a perfect time to go ahead and make that switch because honestly these keyboards are so different than a standard keyboard Anyway, even if you use the QWERTY layout, you're gonna have to learn how to type again because of the thumb clusters It's a little weird You know, it's gonna take you two three weeks to really get comfortable with this keyboard Anyway, so it's a perfect time to go ahead and make that switch from QWERTY to Dvorak or Colmak or whatever it is You're interested in switching over to anyway because again, you're gonna have to learn how to type anyway You might as well go ahead and flash the firmware to that Dvorak layout You can go ahead and pop the keycaps off and arrange them in the proper Dvorak configuration or Colmak configuration as well Now one of my favorite aspects of these keyboards is the fact that these are sustainable keyboards because You know too many devices including keyboards are built to break They they're built basically to become obsolete in a year or two because this is good for the companies that make these keyboards It's good for them that their devices break or become obsolete And then they get thrown away and then you the customer has to go back and buy the new version of that particular device from that company It makes them more money But that's not what ZSA is doing here because ZSA they're building products to last the ergo docs and The moon lander are really sturdy proud. I mean when you hold it in your hand You know these things are built to last just handling them You can tell they're well built and the fact that the switches and the keycaps They're all so easily swappable mean it means that these things are less likely to break In a in a major way as far as they no longer work because if it's just a problem with a key cap or a key switch They're hot swappable Means longer lasting life for your keyboards and thus it's just better for the environment I really appreciate that from a company now one of the questions I've been getting from a lot of you guys is which one do I prefer the ergo docs which I use at home Or the moon lander which I use at the office and this is a tough question because honestly There's not a lot of difference between these two keyboards Let me quickly highlight some of the differences again The ergo docs weighs a little more if I switch back to this layout the ergo docs Versus the moon lander weighs a little more even though the ergo docs doesn't come with a built-in wrist pad Now if you throw in the really heavy rubber wrist pad The ergo docs actually is gonna have quite a bit more weight than the moon lander because of that the ergo docs is not Really as portable as the moon lander the moon lander because it folds away the wrist wrist It's a little bit smaller than the ergo docs keypads And plus the moon lander comes with a carrying case that you can quickly fold this thing up store in a carrying case And then you know if it was a situation where you needed a portable keyboard The moon lander is probably the best choice to buy for me. I'm not really moving these keyboards The ergo docs stays at home. The moon lander stays here. So it's not a big deal for me The ergo docs I mentioned has more thumb clusters as far as keys on the thumb cluster six keys on each thumb cluster Where the moon lander only has four keys again for me That's not a big deal. It doesn't make much of a difference for for me typing for some of you It may make a big deal. So that may Make that might be a deciding factor in your choice as far as which one to buy The moon lander also has a smaller keys on the thumb clusters slightly smaller keys compared to the keys The big keys on the ergo docs also the keys on the outside Columns here the very far outside. These are bigger keys on the ergo docs Compared to those same keys on the moon lander. You can see on the moon lander They're just your standard key caps standard size key caps where they're double sized key caps On the ergo doc. So of course that makes the moon lander again a little smaller than the ergo docs So overall, I mean which one do I like more? Honestly, I like both of them equally even though I just highlighted a bunch of differences The differences really don't make a difference because the main selling points for these keyboards again If I was talking about the big selling points is the split key design the ortho linear design the thumb clusters The fact that they're mechanical keyboards and really both the ergo docs and the moon lander All have that right as the minor differences are really just minor differences and to be honest I really don't care, you know that one has four keys on the thumb cluster and one has six really doesn't affect me either Anyway, so I I have no problems with the fact that I purchased a ergo docs and a moon lander And I I would be happy with either one if I could only have one keyboard And you gave me either one of these keyboards I would be absolutely thrilled and again I don't think I'll ever buy a standard keyboard again because I could never be happy I could never use such a limiting keyboard having used the split key design of the ergo docs and the moon lander and again I've been using them now for a little over two and a half years So I it's ingrained in my brain now, right? It's all muscle memory now and using a standard 110 key keyboard I can't do it now if I had to come up with one negative for these keyboards And this is really being nitpicky But if there was one negative with both the ergo docs and the moon lander is the fact that they are expensive These are not cheap keyboards. You're gonna spend about 350 to 400 dollars us for these keyboards and that's not cheap these are not cheap devices But in my opinion, you do get what you pay for I can't recommend these keyboards highly enough Now before I go I need to thank a few special people. I need to thank the producers of this episode I'm talking about Gabe James Mitchell Paul Scott west the commie Alan Chuck commander angry dieokai David Dillon Gregory Heiko Lee max and michael mike nitrix alexander peace arch and fedora polytech raver red prophet steven and willy these guys They're my highest dude patrons over on patreon. They are the producers of this episode I also want to thank each and every one of these ladies and gentlemen as well I can't call out all their names because this list is incredibly long It's an ever-growing list of names. These are all my supporters over on patreon because I don't have any corporate sponsors I'm just sponsored by you guys the community. If you like my work and want to help support me Please subscribe to distro tube over on patreon. All right guys peace And yes, I love the Kensington track ball as well