that tourists will pay more for locally grown food. This is a proposition that we will discuss here today because it may or may not be true. We're going to find out exactly what the methodology was in reaching that conclusion, what the data was, and exactly how Jerry found that. Jerry Agusa from the Tim School, the Travel Industry Management School in the Charlotte College of Business who led a team to research that very question. And we're going to test his proposition here today, okay? You know, I would be surprised, Jerry, if you found that tourists would not pay more for locally grown food, but you didn't find that, did you? Oh, well, first Aloha, thank you for having me. We really appreciate the opportunity to share our last latest research project. And yep, to answer your question, we found that the tourists are willing to pay more and help both help support local farming, as well as, you know, by doing that, we help lower the carbon footprint and having Hawaii be more sustainable. But isn't it a question of degree, you know? I mean, if I said to my patron in the restaurant, you can have locally grown food, but it's gonna, we have a premium of three times the regular price, you know, that may not get you to the same result. That's true, and the thing is about that, you mentioned three times, that's 300% more. And that's not always, that's not the case, you know? When you go to most supermarkets, whether it's times or you go to food land or you go to Safeway, when you're looking at the pineapples, the majority of the time, the pineapple that's less expensive does not come from Hawaii. It is coming from a place, I don't know, Thailand, Philippines, et cetera, where labor is so inexpensive that it makes it more cost effective to grow it there, put it on a ship and then ship it halfway across the globe to come here. You know, one of the things that, you know, if you recall, just now during the primaries, especially the gubernatorial and the lieutenant governors, they were all mentioning food security, right? We have, it has been said by many people that 90% of the food that is consumed here in Hawaii is imported, whether by ship or by airplane. And we know that, you know, we've had huge supply chain challenges in the last two years. And we've seen it, you go to the supermarket shelf and, you know, sometimes there's a whole row empty. I mean, a few weeks ago, I went to Target and there wasn't one star of peanut butter, not my kind, not the JF, well, the skipping, none, zero. And even the one that, you know, they mixed the jelly with the peanut butter, which I really despise, but if you have that feeling one left, you might have to do that. That wasn't even there. And I just thought, wow, this is really, really, really taking a toll, this supply chain. And we need to start to look. And I try to explain to my wife all the time, even if you don't need it today, if there's something you like or you might need in a week or two, when we go to Costco or we go to a supermarket, you better buy it because there could be two or three weeks without that shipment coming in. And that's become more and more so with food. It's okay when people would accept it, you know, when we have a shortage of cars, let me say, okay, we just fixed our car, we don't have to get a new car or the price gets so much higher because of that. But when it starts to go to food, then everyone eats, right? Everyone needs to eat. And we can see that there's been a huge challenge with food supply. And here, especially, we saw the prices go really, really up. Now, is that all because of supply chain? Possibly, all because of COVID, maybe. I think that there's been a lot of profit, record profits at some of the supermarket chains across the United States and across the world. And I think everybody said, okay, charge a little more. You know, inflation on food went up 12.9% last year. Me as a state employee, we didn't get a raise last year. Today is the first year that we're getting a raise after three years of zero. So, you know, it really affects those of us that are working for the state. And you can see people must really be in trouble for food. And that's why you see so many more food drives and food banks, et cetera. Now, what we did for this study was to see if the tourist would be willing to pay more, to pay more if it was locally grown food. And this is something that, you know, we asked, we surveyed US residents who are coming to Hawaii or who have been for Hawaii. So the majority of the folks that, everybody was from Hawaii, we got 554, no, 454 respondents. And with that at a 95% confidence level, we're very happy with that size of a sample. And, you know, one of the things that we found is that the majority of the people, almost 80%, 78.2% said, we'll pay more for locally grown food. We'll pay over 16% or more. So you're talking about if something costs $10, they'll be willing to pay another $1.60 or more. Now, there are some people who mentioned they would be 25% to 50% higher and that was about 10% would pay 25% or 50% higher.  They're on vacation. Now, what we need to see is if this, but if we grow more food with the price then go down, we grow more food locally. And do we have enough people that are willing to pay to bring it to scale, to bring it to scale? Now, I've spoken with a number of chefs, both at restaurants and at some of the high end hotels. And what they said is the challenge with buying locally grown food is can they keep it, can they make the delivery when we need it, right? Can they grow it and then at the amount that we need? And that's one of the biggest challenges. And I know that there's been a push, like I mentioned earlier during the gubernatorial elections, all of the candidates, especially on the Democrat side, kept talking about food security. Yesterday, Councilman Tommy Waters was on the news last night and he actually said, can you imagine that we have 90% of our food being imported? And if we have a major disaster, whether it's a hurricane or some other disaster, that we only have food on the island for two days, for two days, then what do we do? Then what do we do? And I thought that was very, sort of dippinous that I came in the news last night and that we were scheduled to talk about it today. But you don't break food down, you just say food. The 16% factor in that chart, you just say food. But is it different like for caviar? Is it different for steak? Is it different for some kind of fancy food? We didn't break it down to that. We didn't break it down to that. But I think what we asked is, would you be willing to pay more for locally grown products, number one? And how much more would you pay for that product? So if we grow a locally grown thing, right? Local beef, big island beef. Would you be willing to pay instead of $20? If you're willing to pay 20% more, then you're really gonna pay $24 for it. Or $40 for 20% more. Now you're up to $48 for the steak. Are you willing to do that, right? We asked them to, if you're willing, yes or no. 80, 78% or almost 80% said yes. And then we had it in the categories. Up to 5%, 6% to 30%. So what are those other bar numbers signified from the blue down to the red? So you got six to 10 at the blue. Green is the top one, right? So green is up to five. Then six to 10 is blue. So 23%, they did that. And then 11 to 15%, another 16.5% said they would pay that. And at 16 to 25%, almost 10%, 9.89%. And at 25, 26% to 50%, 7.91. Which then 50 to 75% is 1.1%. And then those that are more than 75% answered almost 2% answered that. So if you go to the amount 16 or more percent, you have 20% of those who are willing to pay more. So how does this translate? You mentioned early on in your comments that there are food chains out there that take advantage of the situation with the inflation. And they actually create their own inflation by raising the prices of whatever is on the shelf. And I'm sure they have some sort of justification, even if it's only in their own mind. But the reality is they're improving their bottom line. Okay, so I go into a restaurant and I'm one of those respondents on the chart. And I look at the menu and it says this is locally grown, whatever, peas, I don't know, pick a food. And it's gonna cost me a little more, okay? So it's gonna cost me 16%. I'm willing to pay. I don't know, maybe the restaurant owner says, look, I'm gonna give you two choices. You can have it from Peru or you can have it from Waimalu, Waimalu, sorry. Waimalu. Where ever the... Waimanalo, Waimanalo has great forms. Okay, Waimanalo. Coming from Waimanalo and I'm willing to pay more for that. So on the menu, I say to the waiter, I'll have the one, I'll have the piece from Waimanalo. And he says, very good, sir. We're gonna put that on your bill. You're gonna get charged more. Now, how do I know that that 16% is going either... Well, where is it going? Is it going to the bottom line for the restaurant owner? He's like, I don't know, maybe it's going for the waiter. Maybe the waiter is going to encourage me. Take the Waimanalo piece, they're better, you know? Or alternatively, nobody says anything and the farmer gets it somehow. The farmer in Waimanalo, he gets it. And in that way, we encourage local farmers to grow more. And that goes to your other point about food sustainability and all that so that we don't run out of food after two days. So how do these things connect is what I'm saying. How does it connect with the restaurateur making more money, the farmer making more money and us having a more sustainable agricultural industry? How do those things connect? Well, first of all, here in Hawaii, right? You mentioned, you made a comment. How do we know if it's Waimanalo piece? And maybe it's not served on the menu. We have a really strong truth in menu form. Really strong that if you say it's Waimanalo piece or you say it's Big Island beef, it better be. It better be. Well, they'll come and they can hammer you. You can get big, big trouble. You know, if you say New England lobster, you can't be bringing lobster from the Caribbean. You cannot. That's against the law. Same thing here when, you know, when you say it's locally grown and we just had a big court case, right? With the Kona coffee, right? We finally had that being clarified what it has to be, the cold Kona coffee. You can't just have a few beans in there and say it's Kona, you know? And then, and that going back to the state law, the state, the truth and menu law, just like if you're selling a quarter pound hamburger, it better weigh four ounces or more when you put it on the grill. It has to be. So truth in menu, weights and measures here in the state are very, very strong on that. So there's the first thing. Second thing, why do people want to buy locally grown product? One, we found out that they want to support- Wait, wait, wait, let's try it, but this is really important. When you say people, you're talking about tourists, are you talking about everybody? Well, we didn't get a chance to survey. That's our next study. We're gonna do now the local residents. Don't forget to collect, you know, because of the COVID and we're still in the protocol for the internal review board or IRB at the university. We're still not allowed to go and speak directly face to face. We have to subcontract out someone who then does this online. We use Movietvato, which is a online research company and they help us collect the data. In the past, I've used Omnitrac, a local company that helped me collect the data, you know, run by Chris Cam, very good friend of mine. And that's how, you know, the tourism authority as well as the Department of Economic Development and Tourism, they all hire these companies to collect the data for them. We cannot, because of COVID and the protocols, we cannot hand out surveys anymore, face to face, you know. So we found a way around it to keep going. And then the next time, like I said, the next study, we're gonna ask local residents perceptions of. Now, what we found when we asked the tourists, don't forget we asked the tourists from US mainland only, written in English and that they had to have been here. Whether it's the first time, they've only here once or multiple times. Now, the majority of the folks who answered this time were first time visitors. So what we find in other past research, a first time visitor is usually spending more money than a repeat visit, right? They're willing to try everything and so on. You know, if they're here for a special occasion, weddings, honeymoons, anniversaries, these folks spend big bucks. That's why we want, you want the honeymoon because the honeymooner, happy time, willing to spend more money. And then the memories of when they come back, they'll come back. Remember we had our honeymoon? Remember when we were happy? Remember that when you're married and you were happy? I'm joking.  All right, so let's see. Some of the other things that we found, one of the great things is that we found that people, this study provided quantitative evidence that people will be willing to pay more from the tourist perspective. And that could help our local officials understand the hate. You know, you get, this year, we probably hit almost nine million tourists, maybe a little shy because the Japanese, we were hoping the Japanese were gonna come at half, right? We had 1.6 million in 2019. We were hoping that they'd get to about, you know, 800,000 this year due to a lot of challenges. The biggest challenge today is the end. The end today went to 143. I mean, this is just way out of line. You know, 110 is the number, right? We're looking at one. No, no, the reality though, when I read about this yesterday, the reality is the American dollar is very strong all over the world, not only in Japan. I'm not sure I understand the process, but that will make it difficult for tourists from many places to come. But the thing is that Japanese are by far our number one tourist market, right? They want 1.6 million, the highest spenders. We really needed them to start to come. Their government had all these restrictions by you had to take a COVID test before you come back. You had to quarantine, then they only allowed 10,000 people. At first 7,000 people a day then, 10,000 people a day. Tourists had to stay in groups going there. You had to stay with the tour guide. You couldn't be around groups of other Japanese residents. And that was because it's an airborne disease. They were just looking out for their residents. And then as this is happening, the end was at 130, then 133, then 135. And then the other day I was talking to a reporter, it was on Friday, it was 136, 138, I said 138. And then today, 143. And it looks like it's not even slowing down. It's gonna keep going. So the Japanese tourists as a whole, they booked their travel 90 days, 180 days out. And they usually pay for a package. And with that package being the dollar being so high right now, they're just saying, we'll go to Okinawa instead of coming to Hawaii. Nope. That's what I think is gonna happen. Well, what's the long-term effect is that they may say that they'll pay more in a restaurant, 16% more or whatever. But if there are fewer of them, because the barrier, the yen barrier is so high, then the amount of money that goes either into the restaurant or the farmer is ultimately less. Right. And one of the things that, we have some unique thing here in Hawaii versus say other destinations with this Hawaiian local. First of all, the food is so integrated into the Hawaiian culture, right? So when people come here, they want to eat a Hawaiian meal, right? Everybody goes to a luau. And a luau is almost majority is locally grown food, right? Food that comes from here. Whether it's the pork, it's the chicken, it's the luau luau, the poi. So they're experiencing both the culture as well as eating the local food. So there's the first thing. Number two, they realize that they're helping the local farmer. Number three, it's more sustainable. As I mentioned earlier, because so much of our food is imported shipped in by air, by freight, by shipping is brought in here. When oil was at $128 a barrel two months ago and we were paying six something for a gallon of gas at Costco, right? Now they've lowered it, but still these big giant ships that cargo ships they're all run on fuel they're not running on nuclear, they're not running on wind, right? So because of that, we're making it, it's costing more. Number one and number two, we're also right now with the environment, right? We're talking about global warming, carbon footprints. It's just so huge and it's on people's minds. It's on people's minds when they travel now. It's on people's minds when they travel. What's important to them when they travel and that came up in our study as well. We have some results on that too. Environmentally responsible, would you describe yourself as being environmentally responsible? And you can see that the majority of the folks that answered said yes, with the age group of 60 and above having the highest, but everyone believed that they are environmentally responsible and believed that they want to be environmentally responsible. Is it fair to say that the younger they are, the smaller the number? It was on this study. Those that were 18 to 29 were lower than those that are above 60. That's really interesting because you would think that young people would be- It's in themselves more environmentally responsible. But I think what's happened is, and I see this in the classroom, is that that generation is, what we consider to be more environmentally conscious is normal. It's normal not to use plastic. It's normal not to let the water run when you shade or brush your teeth. Where you and I, when we were growing up, it was normal to run the water. And now we consider ourselves, when we turn the water off, or when we leave a room, we shut the light off. To us, that's more being more environmentally responsible. And to them, that's just become normal. Yeah, so de facto, even though the chart may show less of an awareness response, in fact, they may be more responsive. They may be more conscious of environmental issues. They might be more action. Yeah. They're not as great as some of their friends who come on vacation and don't spend one day cleaning the beach, but spend seven of the seven days cleaning the beach. Yeah, that sounds right to me. Right, right. So in their mindset, don't forget this was from their perception, I would describe myself as being environmentally responsible. Some people think they're kind because they didn't take the parking place from the old lady, right? Oh, I'm kind, right? I held the door for her. See how kind I am, right? Some people, in their mind, I held the door for them. I mean, and we have the opposite too, right? We have people that hold the door and then don't even say thank you. They think it's a given. Or I had one case, one time I held the door for somebody at a university and the person said, I can hold my own door. Okay. Okay. Chivalry, chivalry is passe. Oh, of course. Okay, so then the second, next slide. When choosing a vacation destination, it is important to me that the tourism industry supports environmentally sustainable tourism practices. And you can see male and female both agree, but female slightly higher, slightly higher. And then for the potential impacts, the level of agreement with the question, I consider the potential impacts of my action when making many of my travel trips. Again, both groups very much so agree with this, with female slightly higher. Culturally respectful tourism practices. When we asked, it's important to me that the tourism industry supports culturally respectful tourism practices. Again, female slightly higher, but both agree with this. So one of the things that we really, we looked at is we had some open-ended questions and we use this formula called word cloud where the computer then will look at. So the first one was the tourist supporting local farmers and purchasing locally grown food. And as you can see by some of the words that keep coming up here, important products, local, food, offerings, quality. These were words that were put out in the open-ended questions of these 454 folks. And then the computer picked the words that were used the most. And you can see willing, premium, visiting, excellence, right? And then I mentioned here, when they're talking about farming, you get coffee. You have gold, meaning probably pineapple gold, et cetera. The second question that we used was environmentally friendly tourism practices when a person comes. And you can see here, the big thing, it was very important and menus reduce damage. This was very important. Need to preserve for the future generations, lower carbon footprint. Over tourism is a concern. So this was a major concern of what, when they had the open-ended question that came out. Greening, agriculture, carbon again, carbon seeing there, carbon footprint, restaurants reducing damage. Again, reducing the damage to be available for the future generation. And then the final slide, the industry supporting sustainable practices. And one of the things that came out is that the government must educate the public and promote the islands in a way that protects nature and Hawaiian culture. And we found that, this is what HDA is doing now with the Malama project. They've got a lot of the TV ads. They have it on the airplanes as well, trying to explain to the tourists what is behavior that's acceptable, as well as, if you look here, some of the words that come up, consumption, culture, Hawaiian, what's important, sustainable. And part of that is intertwined, Hawaiian culture and sustainability go hand in hand. Go hand in hand because, Hawaii was sustainable, especially food-wise for a thousand years before any outsiders came. And they were supporting 400, 500,000 residents without any machines, et cetera. So we could do better. We could do better than what we're doing now. So with these responses and the conclusions you make from them, who would be most interested in looking at this and in changing their systems, changing their perceptions, improving the way it works? Who is this directed to? Well, I think it looks at a number of things, right? We can use us as an example for other destinations, island destinations, especially specifically. We hear, because we're so far from anywhere, right? We're the most isolated land mass with a million people in the world. And that's what makes it so, that's why we have no pollution. We have the best water, the best air. You know what I mean? When I travel, I say this or not, and I'm on your last on, you're sure I said it too. When I travel, I don't remember. I don't realize how good the air is here.  And you say, oh, it's because it's humid. And then you realize afterwards a couple of days, it's the pollution. And we have the best air here. You know, when people say that to you, when they come to visit, we have the best, we have the clean water, we have the best weather. You know, and that's why people, that's one of the reasons they come here. And they come for other reasons too. They come for the Hawaiian culture. They come for the natural beauty. They come to surf, they come to swim, et cetera. But this is one of the great things that we have to. And, you know, if we can be a leader in helping to be less, using less carbon footprint, right? Instead of having all that food imported and it would help us with food security, right? As we learned through COVID, when we had the lockdowns, et cetera, you know, there are times when people, you know, there's just no, nothing on the, on the shelf. And we could, you know, if we scale it up, if the farming goes back to scale, the price will come down. The price will come down. I noticed that last week in the news, there was a gentleman, a big developer who was giving out lots of land to farmers, small farmers to start, Savio, right? Is that his name? This is Savio. Right, so he gave out, I think, 100 blocks of land last week. And then you could see it on other outer islands as well. You could see some of the city councils on Maui and on Kauai wanting to do this so that we become less dependent on input. Is it easier to input? It's easier today, but it might not be the right answer for the future. And, you know, the new farmer is a different person. There's a gentleman that, you know, works at the university. He's a younger guy at 29 years old and he works for the Tropical Ag. And he tells me, the new farmer is got all heavy technology and, you know, learns, you know, lots, where water is used out of premium, where we don't have that waste. And, you know, we never thought about having a water problem here in Hawaii. Until now, who knows, one of our aquifers might be gone forever. Due to the oil, right? And the red hill. So, you know, learning how to grow things, growing in on walls, right? I don't think you watch some of the hydroponics. I know at the Sherrith and Waikiki, they have it in one of the restaurants where they pick the herbs right off the wall there. And this is just taking all these steps, all these steps, having gardens on roofs, rooftops. My wife on our little lanai outside, she grows all these little tie slices where you could smell them from inside the house, even before she starts to pound them. And it's just accessibility for her and the cost, because it's not the accessible here. You know, on a high scale, it's more of a premium price. And this is just some of the things that people are starting. One of the things that happened during COVID, they said lots of folks tried to get into growing their own gardens. And there's like a shortage, there's a waiting list, right? Of some couple of hundred from the city that are wanting to grow out, they have open garden near Alawai, right? On the opposite side of the Alawai, there's a couple hundred people on the waiting list. So it's getting back to nature. It's becoming more sustainable. It's understanding that this is our Juliana too, right? Okay, but here, if I put half a dozen smart guys in a room, including you, and I said, look, would you design some expression of this public policy? For example, you get a deduction, okay? If you have your own garden, we're gonna let you deduct all the costs of that. We're going to give land away like Savio or whoever else to young farmers so they can have entrepreneurial experiences. We'll give you a tax holiday. We're gonna get incentives left and right. We're gonna try to get you to do all these things that will save us. Will save us from supply line issues. Will save us from the two-day limited McDonald's or whatever it is. We want Hawaii to be self-sustaining. We want an agricultural industry that will support the tourists and the locals, both. And we understand we have to pay more. And I'll bet your subsequent study will find out that local people are even happier to pay more. I believe that's so, but you have to offer them the choice. If they don't know the choice, they go into Safeway, they're gonna buy the cheapest thing on the rack because they don't know the difference. All I'm saying is to express this policy, you have to take action. And query, how does a survey like this or like the one that with I believe, which I believe will find similar results, similar responses on local buyers, how does a survey like that actually get to the action part? Well, one of the things is you share the results with the people who cater to the tourists, right? So you look at the hotel restaurants and the restaurants that cater directly, right? Those inside the hotels and catering. And they can use this as part of marketing, right? They can say, hey, we are more sustainable because we're buying local, grown produce. We use this. And it's been done in the past. It's been done in the past. There's been a number of restaurants that have used that all local, local beef, right? We got a number of burger places that use local beef, and et cetera, et cetera. So by doing that, that helps with the marketing. Then people want to support local, right? Buy local, buy local. They didn't come about buy local because of a hamburger. It was to buy local to help the small businesses. You know, I'm on the board of the restaurant association. The number one people who lost their businesses are the small mom and pop during COVID. Businesses that have been around for 20, 30 years, they just said, I just can't do it anymore. When we went totally to delivery and then first we went to shut down, then we went to delivery. They just couldn't. Now today, again, we have now the new laws on plastics. I understand there's a reason to stop plastic containers. The challenge is supply chain. There's a limited number of it coming in so the price is paying even higher than what it should be. And the restaurants are hurting. Right now, food's up. Now, the gold products are up. And people have to start, when something that used to be $15, all of a sudden is now $19. You know what the people say? Maybe I can't eat there. Maybe I can't get that food to go now because the price has gone up that much. Now, if you go to the Safeway, the price has gone up that much in Safeway, you just say, I don't have a choice there. Well, in the restaurant, it's a choice. And this is what's really the margins are really small. They're squeezed, they're squeezed. So- What do you think about an organization that favors local growers, local production of food, that will have a sticker, a sticker, a decal, and put it on the window of a restaurant. And it says, we serve only local food in this restaurant. Right. Wouldn't that help? Yep. And I know that, like for instance, high school, Kamehameha, they buy all local food. This is what was said on the news the other day, that they are one of the first. And a couple of other high schools are doing it as well. And they're being subsidized, this Kamehameha doesn't really need subsidized, but some of the local other high schools or grammar school, they're being subsidized by the city or the council to help buy locally grown products. And then teaching the young kids that this is a future, this is an opportunity, that you can do something that you might have a passion for. You know, yes, we all need money. We all need money. I work for money, we all need money. But if you have something you love that you get a passion for it, money won't be the only answer. Because farmers don't make a lot of money. Just like teachers, we don't make a lot of money. Can I make more money if I went into the industry? Of course, of course. I could have fainted. So I suggest that, you know, I would be very interested in doing a show with you on the next survey about local people.  Will you buy into, across the board, increases for that decal, for that kind of restaurant and still go there knowing you're going to pay across the board more? So, query, if that happens, it seems to me that there would be a huge incentive, okay, for that restaurant, I mean, if your next survey comes out to say people will go, local people will go. Yep, I'll add that question, Jake. I'll add that question for the next survey, just to see. And you know, like, yes, of course, I know everything because I'm the professor, but you know, one of the things is when I share this knowledge with people and somebody shocked like yourself says, hey, did you think of this question? No, I didn't think of that, but I will add that question. And that's how we can get a better, another viewpoint, a better result and possibly help change what we're doing here in Hawaii. And I agree with you, if there was a detail that showed that they all locally grown products, you know, I mean, you could see that in retail, we have a number of retails that say locally made products, right? And that helps. The ultimate thing here is what you said at the very beginning of the show. We have to become sustainable. We can't keep taking this huge, huge, life and death risk of not having food to eat.  So I mean, to me, this is a highly emergent issue and you are right in the middle of being able to explain to people how important it is. So let me give you one more minute because we're really out of time, Jerry, to leave a message, whatever message you want with our viewership. Well, I first thank you again for having us on the show. We really appreciate sharing the results of this study. And, you know, we will be doing it, a follow-up study with the local residents on all the islands. And if somebody, you know, if any of you see that there's a study survey online on the internet that might say we're looking at residents' perceptions of purchasing locally grown food, please fill it out. Please fill it out. And that would help us gain the sample size that we need. You know, and we're gonna, you know, we'll do it on all the islands. And then we'll try to get, you know, we'll try to see what their perceptions are. And, you know, we really appreciate that people see the value in buying or purchasing locally grown food. Absolutely, but you gotta help them along with that. Yeah, and from a first standpoint, I think that there's a number of reasons. One is they get the opportunity to eat local food because that's part of Hawaiian culture. So that's, it's, it's, it's dovetailing into what the tourism authority is doing at this. Yeah, but arguably it's better tasting is fresher, it's a better meal. And in my view, Hawaii ought to have a global reputation for better food. That's where we're going in terms of the tourism aspect. Jerry Agrusa of the Travel Industry Management School at the Schuyler College of Business, a professor who has been the leader in a study to see whether tourists would pay more for locally grown food. Very important issue of very important direction. Thank you so much, Jerry. Thank you, Jay. And thank you everybody. Aloha. Aloha. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter and LinkedIn and donate to us at thinktechhawaii.com. Mahalo.


Okay, it's 5 past 12. Welcome to this webinar, the last of the year for the EMCDDA, on Displaced Population and Lessons Learned for Preparedness and Responses. I'll give immediately the floor to Jane Montenay, our Public Health Head of Unit for the opening remarks. Jane, the floor is yours. Thank you very much, Marika. And a very warm welcome to all our webinar attendees and a special welcome to our speakers today on this very important topic. Our objective is to engage in a dialogue, dialogue that will hopefully enhance our ability to support people who use drugs, both in the Ukraine and people displaced by war in Ukraine. And also the professionals who are working in this area. We're going to do this today by engaging in a conversation with a range of colleagues who are deeply involved in the field, and we're not forgetting the wide range of humanitarian issues arising from war and mass displacement. Today's webinar will focus on one particular area on getting an insight into the issues arising for health systems, particularly drug services, both in the Ukraine and in countries receiving displaced people. We're going to use PowerPoints today, but rather have a conversation with experts, including experts here from international organizations, government representatives, researchers, civil society representatives, and our speakers are from the Ukraine, from Georgia, Poland, WHO, and the Eurasian Harm Reduction Association. We especially appreciate the time our colleagues in Ukraine took to participate today, given the many challenges created by the ongoing war, and including I understand overnight bombings and air raids in Kiev, and widespread power cuts in the country. So thank you. I'd just like to say the EMCDDA has a long standing collaboration with the government in Ukraine, most recently reinforced by a partnership through our international technical cooperation project, we know it as EU for monitoring drugs. We've also been trying to support EU member states to ensure their drug services are prepared to support displaced people who may be in need. And in July we published findings of a rapid assessment study on the topic, which among other things encouraged EU countries to have contingency plans in place to meet future service demand. We found on our website, and maybe we can put a link in the chat, and it's now been translated into Ukrainian, and this version will also be available for people. Also just to let you know we have a web page which we call EMCDDA for Ukraine Health Preparedness Hub. This is available in both English and now also translated into Ukrainian. So I put a link into the chat for you for that. And I think that's probably enough from me, just to kick off and welcome. And it's time to hear from our guests. And I understand today's webinar will benefit from simultaneous interpretation into Ukrainian and Romanian. And I'll hand over to my colleagues, Ann and Marika, who perhaps can share a little bit more on that. So thank you. Thank you very much, Jane, for your introductory remarks and I would just like to welcome a warmly our six panelists. I will just run through who we have invited to participate in today's webinar, starting from from you, our panelists from Ukraine. We have Mrs. Olka, who is the Deputy Director General of the Public Health Centre of the Ministry of Health of Ukraine. In addition, from Ukraine, we also have Dr. Konstantin Dumechev, who works as scientific director of the Ukrainian Institute of Public Health Policy in Ukraine. Then we have panelists from international organizations, including Stella Bevol, who is the strategic advisor for TB, HIV, hepatitis and sexually transmitted infections in WHO based in Copenhagen. We have Executive Director of Eurasian Home Reduction Association, Ganna Dovbach, welcome also to you. And in Georgia, we have Dr. David Otyashvili, who is the Director of the Addiction Research Centre, Alternative Georgia. And in Poland, we have Mr. Artur Malczewski, who is the Polish Raytox focal point of the EMCDDA, and he is based at the National Centre for Prevention of Addictions in Warsaw. So welcome to all the panelists once more, once again, and we really appreciate it has been a challenging year for many of you. You are working on the ground. You are supporting in different ways. You are all involved one way or the other in support in Ukraine. Just a couple of practical announcements. We have simultaneous interpretation into Ukrainian and Romanian. So any participant who would like to listen to the webinar in either Ukrainian or Romanian, please click on the interpretation symbol at the lower part of the zoom screen. And you can select the language, English, Ukrainian or Romanian. Secondly, also at the lower part of the screen, you will see a Q&A question and answer symbol. So for any webinar, anybody who's following today's webinar, you are most welcome to post questions or comments in the Q&A or also the chat. But if you want to pose a question to any panelist, please, we would like you to use the Q&A symbol, not the chat function, because there may be many posts in the chat. But for any question for the panelists, please use the Q&A. I think that is all about the practicalities. I will now I would like to invite Olga, the Deputy Director General of the Public Health Center in the Ministry of Health of Ukraine, to tell us about the current challenges and needs of the healthcare system in Ukraine at this time of war. Olga, the floor or should I say the screen is yours. Thank you very much. Thank you again for thank you first of all for invitation. Thank you for the possibility to be here. And thank you for possibility to show our lessons learned and our current situation. I will switch to Ukraine. It will be a week for me. Please, the participants use translation button. So if you don't mind, I will start in Ukraine to use my 10 minutes. Well, as a public health center responsible for three national programs program on the CITB and HIV aid, we understood last year that we couldn't possibly avoid the war. And at the end of the last year, we started developing this contingency plan, much had been done. We didn't have time to finalize it because the war started the full scale invasion started the war started in February and we had to really quickly respond to the situation that we face. No one realized all the whole scale of what could happen and what we had to experience but starting from the third day of the full scale war, the public health center jointly with national stakeholders and civil society organizations as well as international organizations introduced a system to contact class meetings where we would regularly discuss the current situation and the first priority steps. We had to respond really quickly because certainly panic was there, the situation was unclear, people were fleeing. Can you hear the interpreter in English? Yes, people were fleeing. Don't worry, we'll watch this shown in the chat, I will manage it, okay? Okay, thank you. So yes, we had to take really fast decisions. Starting from the first days of the war, we allowed the doctors to provide medicines against the STIs for 30 days so that people could have them in stock and homes. We also allowed delivery of the medicines. You know that the logistics was disrupted. We had some supplies for our patients and I think that the healed must be treated with the medicines and there were international representatives and we discussed how we had to react, how we had to respond and we plan to make procurements on the state level and these procurements on the level of the health ministry were directed at the needs of the time of the war. Other medicaments, so every week we had meetings with physicians and we have meetings with patients and we discussed with them these methods. We had a chat board, we had a hotline and we tried to share our information to workers of the services so that they could have access to this information. Despite the war, during the quarter of 2022, we had in our program to about 500 people, they started the treatment they need. In September 2022, we have done a lot of work but from the beginning of the war, we didn't understand how we will manage this issue. They commenced their hands, our program embraces 23,000 persons despite of leaving their regions and many people from Eastern regions replace themselves to other regions and I would like to say that among people that fled from Ukraine, it cannot be comparable with people in Ukraine. Ukrainian men are not allowed to leave the Ukrainian territory now and we registered about and they registered many people. I would like to mention that we hope that the war is over soon and this will be our victory. And from September, we started or formed our recovery plan, HIV for tuberculosis for other infections and this plan is being digitalized now and we understand that from the first phase of our victory, we must do our best so that the implementation of these programs is stable and that the patients will be treated on the necessary level. So I hope that I used my time efficiently. Our international partners, our civil society representatives helped us, we were in close contact. We did everything that these programs continue and this was one of the main foundation to make access for our patients to have the treatment they need and glory to Ukraine. Thank you very much. Thank you very much indeed Olga for sharing the current situation and challenges and what is the plan about the recovery of the country. Thank you. This was excellent to start to set the scene for the webinar today. I would now like to invite Dr. Dungchev to tell us a little bit about what we know about the drug related health services, especially focusing on what are the challenges in continuation of the opioid agonist treatment or opioid substitution treatment program in Ukraine based on a review of the situation of the OSD program. So over to you, Konstantin. Thank you. I will continue in English so please stay on the respective translation channel. Also, I'd like to start with thanking you for this opportunity to speak at this webinar and share our experience and our stories. I think it's important that global community medical and not only medical continue to receive accurate information about what's happening and what efforts we are undertaking to overcome this crisis. Okay, so Olga gave an excellent general overview of the health sector response, in particular with treating people with opioid use disorder. I will probably give a few more details from the data that we collected during this year. My institute together with the public health center of the Ministry of Health of Ukraine, we've conducted several surveys actually this year. One of them was done among people who inject drugs who are not in treatment, and another one among patients of opioid substitution treatment program. We wanted to assess of course the impact of war on the aspects related to drug use and to treatment, first of all. So I will share some of that and then you know a few more experiences and lessons learned from our efforts in the OSD program in general. And a review of these experiences and prepare the publication which is now in submission hopefully it will come out soon. Okay, so now to some of the results that we've obtained. First of all about drug use. Secondly, we did not see major changes. We did ask about you know the level of practice before the war and then currently, and we're able to compare. So among people who inject drugs there was a slight increase in almost all substances. There was like you know few percent more in the recent drug use and almost all substances and you know in groups like opioids and stimulants and both of them. In the OSD patients it was vice versa there was a reduction in substance use. And it's hard to, you know, we did not, you know, do not yet understand the reasons but you know that this is what we got with drug use. We also asked about their general sort of subjective experience with accessing drugs and their opinion about quality and availability of drugs. It was similar to what we have done, you know, during the COVID epidemic to assess the changes during that time. So more about half of people who inject drugs noted that you know access to their usual drugs became more complicated in the initial phase of the war. Then, you know, it was mostly restored. So at the time of the survey they, I mean, the access to the drugs was pretty similar to what it was before. And again, this was similar to the situation that we had during the COVID. I mean the initial lockdown period we had, you know, reduction in excess or you know decreased excess and then it was restored same thing here. There was an increase in prices for most of the drugs. But I think it relates with, you know, general sort of inflation in Ukraine and prices increase, but it was not too dramatic I would say it was like, you know, 20 to 50%. Also, there was an important question about the access to harm reduction programs.  And again, in the initial phase of the war, there was, you know, it was became more complicated. About 30% of people who inject drugs noted that, but then, you know, within a few months again, the programs adapted and all coverage and services were restored in the areas that we surveyed. It relates to the incredible, you know, commitment and dedication of harm reduction programs. And I think, you know, this, this is really, you know, positive, positive example. Now, going back to the opioid evidence treatment. I have said, most important things I will highlight several of them. Of course, you know, during the first weeks and months of the war, you know, there was an incredible stress and, you know, to do to various factors intensifying occupation. There are several regions destruction of infrastructure. And of course, you know, many people have to have to move. And not only from, you know, from the battlefield regions but also from other regions because you know we had constant shelling and rockets, missile strikes all over the country so you know that there was sort of countrywide migration. And disruption of all the logistical chains and this has of course brought, you know, very, very significant challenges to the treatment program, not only OST but any treatment programs that require, you know, chronic treatment. And there were incredible efforts first led by the Public Health Center to restore the medication supply and really cannot stress how, you know, how dedicated they were and how, you know, the commitment was really impressive and they managed to really, they sort of managed it on a daily basis and the supply of the medication was done basically from one facility to another from because the main warehouse where the medications were located. It's just north of Kiev and it was, you know, really like a battlefield at the time and it was not possible to access it. And, you know, before the Russian forces withdrew from Kiev, I mean, we really had to manage the remaining stock of medication that was left in pharmacies and in facilities. So when the Public Health Center was doing it basically manually. It brought us to maintain the services and maintain treatment and really only a few reasons, you know, there was some reduction in the number of patients, but it was mostly, you know, from the sites that were closed due to like real fighting and destruction of facilities in the system regions. And, but that quickly the programs resumed operation and we're rolling new patients pretty quickly so overall now we have plus 5000 patients which is really impressive, I think.  From our survey we learned that, you know, some sites did have to reduce the doses of medications because, you know, during this uncertainty period, they were not sure when the next supply would come and just to an extent, the remaining stock they had to reduce the doses, and about 20% of patients in our survey reported that. But we think that, you know, it was relatively minor. It was, you know, we had to do it. It probably caused some discomfort in some patients, but overall I think it helped a lot, you know, to ensure that there will be no complete interruption. And then again when the supply was restored then, you know, if the doses came back to normal and we see that this in the as well. We also did a survey of providers and they come from this that they had to reduce the doses to some patients that some sites and but then, you know, it was now came back to normal. What else should they say. Yes, something or another important thing was, was the you know, previously we had the take home dosing was allowed for patients who had to, you know, be confirmed as stable had to have you know negative urine and had to have like at least three months in treatment. It was during this initial phase of the full scale invasion and all the factors that it was allowed to, you know, provide take home doses to all patients for up to 30 days previously the limit was 10 days. And it was a really, you know, good thing and it helped many people to move across the country without interruption. So this was another adaptation and they think that we have to, you know, sort of keep it as a sort of a backup plan in case you know there will be another wave of migration. And overall, we don't have, you know, our sort of monitoring system for the program is not yet fully online, I would say not fully national. So we cannot really, you know, have a precise figure of how many patients have migrated but again, the public health center was collecting from the site directly and our accounts are about 1800 patients have moved during the initial months. Some of them have come back some of them remain in the western regions. Yeah, this is the number for the internally displaced people and you know certain number was, you know, went abroad. And, but it was, and Olga said that there were about 100 or something patients that we sort of managed to confirm that they were improved, but probably there are many more than that. So we have to remember that these are mostly women because men are not allowed to leave the country. So probably now that there could be more. Do another study to assess the effects of migration and how it affected treatment interruption and whether it was, and of course there were some interruptions. And then in the survey we bought 5% of our respondents said that they will, you know, they had interruption of OST treatment. And for HIV treatment, you know, those who were seeing HIV treatment, about 10% said that they had an interruption so I mean, there could be clinical consequences to that. But again, and sort of summarize I think, due to the incredible commitment and resilience of our healthcare workers, and also our public health professionals. We managed to sort of mitigate the most, the biggest risks and, you know, the majority of patients continued treatment and and heart reduction services also were remained in place. There were many more stories that we could tell, including from her son region in which was occupied, but there were about nine sites there and I think seven or eight of them were continuing treatment during occupation. And she was, you know, really risky for their lives because you know OST is banned in Russia, but they were sort of not doing this anyway, using the remaining medications and you know there was even one at one point. I don't know if I have been her son but you know that there was an instance when, when we were able to shift meditations to an occupied territory through, you know, through all the checkpoints and it again was a risk. So yes, the commitment was incredible and you know, I really want to thank all the healthcare workers and public health professionals for that. And also I would like to thank all the international community because all the support that we are receiving from our friends from all over the world is also very important to us and really help us to help us to, you know, continue our struggle and our fight for freedom. So, thank you. Thanks very much Constantine for giving us this update based on the surveys, looking into the situation of the OPS substitution treatment program. I think many challenges but also a lot of positive feedback you've given us about how the staff and the patients have shown bravery in actually continuing to, staff continuing to provide the treatment and people in need of treatment who continue to assist us, especially in the eastern part of the country in the occupied territory so this is really interesting to hear. Thank you very much. I would also like to move on to our next panelist Stella Bivol from World Health Organization, you're a European office based in Copenhagen. Stella will tell us, we would like to hear from you how WHO has been responding to the humanitarian crisis in Ukraine, and also if you can tell us a little bit about how WHO has supported addressing problems of people who use drugs or people in need of drug related health services. As we know WHO has been very active and we'd like to, I'll give the floor to you to tell us what you have been doing. Thank you. Thank you and good afternoon to everyone who joined the call. These last nine months have been indeed very difficult for Ukraine and the region and as you know, WHO is directly engaged in both Ukraine and the countries in the European region and there are hosting people who are displaced from Ukraine in providing overall support to health services and the health and humanitarian response. Actually in Ukraine WHO is the leader of the health cluster and outside it's actually the UNHCR but WHO country office is supporting through various programs and this part of the health cluster emergency response in the region in various areas of public health and health services. Before I go specifically to the area that I am directly involved, I wanted to cover maybe a bit more broader areas. What is on mental health is that first of all there was already a high toll of the war in Ukraine on the people in Ukraine and those who are fleeing the horrors of war. The devastating energy crisis and the deepening mental health emergency constraints and the constraints on access to health services will make this winter and even more formidable test for the Ukrainian health system and the Ukrainian people. We anticipate that millions more people will be challenged to ensure their homes in warmth and safety and they will face unique health challenges including respiratory infections, also COVID pneumonia and influenza in addition to specific health issues. All of this is also taking toll on mental health of Ukrainians and in a WHO estimations that one in five people in conflict settings would have a mental health condition and that means that today in Ukraine about 10 million people are potentially at risk of mental disorders such as depression, post-traumatic stress disorder. In Ukraine, WHO with the Ministry of Health have signed a memorandum on cooperation to strengthen the provision of mental health services and to make mental health and psychosocial support and primary care level more accessible to people. And WHO is supporting the mental health and psychosocial support coordination group across 200 local partners and including with placing experts deploying them in Ukraine, in Hungary, Moldova, Poland, Czechia and other neighboring countries to provide technical support to local authorities and humanitarian responses. Tens of thousands of psychosocial support and mental health consultations have already been held in the for health care workers as well as the general public including mobile mental health teams who go out to community to offer care and this is very a lot of support from the first lady, her Excellency Miss Olena Zelenska as well. Another aspect that I want to mention is the attacks on healthcare that WHO is mandated to monitor and report and the attacks on health and the energy infrastructure have left hundreds of hospitals and healthcare facilities lacking fuel, water, electricity to meet the basic needs. And as of December, WHO has verified over 700 incidents of attacks on healthcare in Ukraine, although the actual number may be higher and at least 100 people have died and 129 people have injured as a result of these attacks. Following the attacks on the key energy infrastructure in Ukraine, it is important to ensure that healthcare facilities can continue to function and that the pharmacies are also functioning. And we are supporting delivering life saving supplies of medical supplies in the new accessible areas of Ukraine as well. I mean, in the short run, there needs to be practical solutions to allow healthcare services to continue through the winter as best as they can. But obviously this is not a sustainable solution, the war must end then the healthcare and health of Ukrainians can be improved. Now, in terms of needs, the humanitarian ask at this point is about 10 million per month US dollars for response in Ukraine and there needs to be steady support from the donors and to make sure that the health needs of refugees and internally displaced people also met. So now when if to talk about, I mean, support to what we call winterization is also to help Ukraine health system work in the winter and this includes emergency repairs to health facilities and heating infrastructure, as well as providing generators, providing prefabricated structures in newly regained areas, portable heating devices, survival blankets, diesel generators, etc. So really, if to look ahead, the challenges are going to be quite important. And now when it comes to people who use substances and the double chose work in this is basically through an important mechanism to support the health sector is the weekly cluster a working group that works on medicines medical supplies and procurement for the treatment of both the work loads as HIV and which is coordinated by Ukraine Public Health Center and WHO and this has become a large scale working platform for updating the real status of these areas and already Olga has presented the, you know, how this mechanism has helped support the planning and the finalization of this work. Also, which was supported Ukraine with facilitating a technical working group on opioid substitution treatment to address the immediate needs of OST patients and to advise on how to scale up and increase access. It's been too long ago and we have David also here, the WHO conducted a program review in October that included the review of opioids, opioid substitution treatment program. And with some preliminary findings have been presented to the countries in country stakeholders and we are in the process of finalizing the report. What you heard already from Konstantin and Olga is definitely the findings of this external program review is that, first of all, the, that Ukraine has an impressive opioid therapy program since 2004. Since 2017 it's basically has been fully covered by its own government support and this can this not only did not impede the scale up but actually it was a high an impressive scale up since 2017 on the government funding of the program. And this also continued during the war, the scale up continued even during the conditions of war, and they have been also from decisions and at program management level to ensure service continuity and to also ensure continued access to opioid agonist therapy and Konstantin provided those details more but some of the key decisions were to extend the take home doses at the beginning for 30 days that made a huge difference for people to be able to stay on the treatment. Also to during this active war phase, there was also an increase in the new clients enrolled including a reshifting of people from the east to the west. Obviously this has put a strain on the providers service providers and many of the physicians and the service providers are increasing their patient load at very very high numbers and this obviously puts a strain on the also the quality of services maybe declining in this and I think we need to also see more support for the providers themselves and to expand the opportunities to diversify the number of people who are engaged in providing services. Outside Ukraine has already been mentioned but because of this reduction I mean in position of men not being able to be to be leaving the country there's not as many people as anticipated initially to be looking for opioid agonist services continuation and I understand it's less than a hundred people who have continued according to the UPHC reports who have continued the treatment outside Ukraine and mostly in a couple of countries and here we were more of a facilitator role to connect Ukraine Public Health Center with EMC DDA network to ensure that this exchange is happening. So I'll stop here to not take more time but just to say that indeed the resilience of the program and the commitment of service providers both on the provider side in the clinical side that also NGO support has been quite important and tremendous to ensure that the service continue, supplies are not interrupted, the local manufacturing continues and there's a lot of support to continue scale up under these conditions and that is something to really remarkable so full support for the Ukrainian counterparts, thank you. Thanks so much Stella for giving us the very comprehensive picture of the challenges and the impact of the war on the healthcare infrastructure, or an on individual people and I'm especially happy that you started by talking about the impact of the war on the mental health of people of Ukraine because we do know from literature that use of alcohol and drug illicit drugs goes hand in hand with post traumatic stress disorder, anxiety, depression and coping with bereavement so I think we can draw that connection so it's really I'm happy that you spoke about the mental health issue. So thanks very much and we'll now move on to Ghana, who is the Executive Director of Eurasian Harm Reduction Association based in Lithuania. And we would like to hear from you Ghana about how Eurasian Harm Reduction Association has been involved in supporting a networking with other harm reduction associations or people who use drugs representatives of the user community, both because you have been supporting people who have left Ukraine who have fled the war to different countries in the European Union and beyond so we please tell us what has been happening in the last few months. Thank you very much for this opportunity and I will speak English, but that would want to speak Ukrainian, and I need to say that for the networks like ours, uniting harm reductionist all over the Eastern Europe Central Asia. That's become the real mobilizing factor the war in Ukraine and this genocide which is happening and from first of all, we were mobilized to help Ukrainians who are fleeing from the war. And even though officially it's lower numbers but in reality people who are looking for not only OST but harm reduction services. So in all countries, first of all in European countries, including first of all, Moldova, Poland, Czechia, and all neighboring countries and then Lithuania, Latvia, Estonia, and then again Central Asia and other countries who were not so like governmentally that this people's initiative and helping absolutely unprecedented help from the volunteers and services and drug treatment services and HIV treatment services, medical care facilities were shown all around the Europe. And actually what we did and what we helped, it's to connect the community of people using drugs who are fleeing from the country to connect social workers who are stealing the contact with people who are fleeing with those who could support. And there were several like databases and information sources to show what is happening where to get support. And I need to say what happened with the harm reduction and harm reduction as a civil society and community based service, which was on the frontline in the first steps where people were looking for everything, what we see and it's important lesson learned that in the crisis situation and humanitarian crisis harm reduction becoming shelter becoming such comprehensive social medical care that these people are even being supported for harm reduction being outreach. They start working 24 seven providing humanitarian aid evacuation costs, sleeping bags, some generators to plug in and all the services and this is true for Ukrainian organizations who are really community based organizations are working hand in hand with the medical doctors but that's also heroic work on supporting all these people fleeing around the same with Moldova they were united together to provide services and to coordinate this work the same with Poland that's absolutely amazing work. And now we see harm reduction as a very comprehensive which address in this in addition to general harm reduction services, it's redirecting to medical care, it's kids packages, it's food, it's evacuation costs and that's important issue to take into account that it's impossible to feed the services only with HIV response money and what we see like we are also as a harm reduction is facing mental health challenges need to have mental health doctors and sometimes even anti-depressant treatment. We need to address gender based violence and violence against girls and women and, and again, sexual reproductive health it's so connected in one life in one crisis, and it's impossible to support only with the HIV response that that's important to understand for all of us, and especially for European countries who are facing, we all in economic crisis we're all in humanitarian crisis but at the same time are funding for harm reduction and sustainability of harm reduction and OST and low, how low threshold to OST services to access or OST services, what the Ukrainians who came in countries became catalysts of very problematic situation in Southeast Europe where we have no harm reduction left or very few countries have real harm reduction services with OST services the very high level thresholds to access for local people but for migrants and for Ukrainians who are coming like we were reporting everybody not coming to Hungary sorry because it's impossible to get or you need to try to make the appointment with the addiction doctors two weeks before your treatment which you take home from Ukraine will finish just to start OST in majority of European countries and this shows us how how big barrier for the services we exist in in the majority of Europe and what is important also for us respond in this crisis that's that we all united and that's important very important moment when HIV response addiction services medical care and government are committed really to respond and they were shown absolutely extremely flexibility of services and we are we are thankful to all countries who were ready to change their systems to accommodate all these people and to help them but in the same time thinking strategically about lessons what we have now it's not only addressing this humanitarian crisis which we will face in in nearest years and I'm very happy that Olga address this rebuilding or revitalizing the medical system issue but then and and I'm absolutely impressed in Ukraine harm reduction services was supported from state funding during the war period which is not not possible in Romania, Bulgaria or Serbia or Bosnia in absolutely peaceful time so so that that's impressed me the most in the situation and in Ukraine they are speaking about the opening or opioid substitution treatment sites in recently they occupied territories in in a weeks after the territories where the occupied so so it's absolutely an example of heroism and and coping with challenges but what is important for us all to understand that region European region broad in broader meaning including Central Asia and caucus will not be the same and we are facing crisis with the values and war with the values it's not just the genocide against the Ukrainian people which is happening. It's also the war for the values of human rights and values for the drug policy which is built and services for people using drugs which is built on the human rights values and this is important to understand in our advocacy work and in our political political dialogue because it will not be the same and we as a regional networks we do have this communication will share in the chart understanding that cooperation with authoritarian states like Russia Belarus is impossible and dialogue need to be built in a different in a different way and and only after the the winning of Ukraine and after they will respect the human rights values. Thank you. Thanks so much Ghana for a very powerful speech I think you've drawn drawn light or spotlight to the fragility of the harm reduction services in many countries in the European Union. We all know that global fund used to support harm reduction service provision in many countries and then after global funds started to face out, many of the EU countries are they are finding it challenging to continue to provide harm reduction services and once there was a large displacement of millions of people from Ukraine. We have seen in practice what it means when you still I mentioned that only some hundred people who fled Ukraine, needed to continue or so far have accessed OSD, but we've seen that in some countries even a small number of displays of Ukrainians in need of OSD, found challenges in practice to access healthcare insurance needed to be able to continue their treatment for opioid dependence or HIV or other infectious diseases. So I think Ghana you've you've given us a nice insight into that what's happening across the border from Ukraine and many of the challenges. Thank you very much for that I see also people appreciating your contribution in the chat, along with a contribution of other panelists. So now we would like to move on to another country, Georgia, which has also been impacted by the war or the invasion of Ukraine. So I would like to invite Dr. Otia Svili, director of the Addiction Research Center from Alternative Georgia, to tell us what is the situation in Georgia and what responses are in place, given that war has resulted in a mass, you know, movement of people across the borders, including crossing over to Georgia. So I look forward to hearing what is the current situation in Georgia. Thank you. Thank you. And I appreciate having opportunity to share our understanding of the issue and share what we would situation we have here. First, let me start with my understanding why I'm here and why many Ukrainians who fled the country after Russian invasion decided to come to Georgia. I believe that these two countries, traditional and historically have many, many shared values and common goals, which is, for example, European integration. And so for many Ukrainians, that's my understanding Georgia is a safe and friendly place to have a temporary shelter, at least. And actually there are a lot of examples of very close and excellent collaboration and partnership between individuals and organizations in our field. And my organization and Kostya's organization, one good example of such partnership. Let me first share what we know about the situation and challenges faced by Ukrainian refugees here and then share with you what we actually want to know in order to be able to better respond to their possible needs. I have two exact numbers how many Ukrainians right now staying in Georgia. There are numbers of daily crosses of borders in and out, but it seems that for some people, Georgia was just a temporary place and many Ukrainians left to other countries after staying for some weeks or months here in Georgia. There are no numbers. If you go out in streets of Tbilisi or Batumi, it's really unusual and you will see a lot of people, Slavic people speaking Russian, however, it's really difficult to understand. So those people, Ukrainians, all they are from Belarus or Russia actually, many Russians left and came to Georgia following this, you know, mobilization. So let me start with the state response in parallel with assistance in terms of assisting with finding accommodation and several lot of initiatives from government from non-governmental organizations from individuals in terms of humanitarian assistance to refugees from Ukraine. One of major steps, I believe, was a government decision in form of decree by the Ministry of Health, which entailed Ukrainian citizens access to healthcare services equal to that of Georgia citizens. Anything available in this country to citizens of Georgia is currently available to Ukrainian citizens in terms of healthcare generally and obviously including HIV and the drug-related services. This was, I believe, really a major step. In terms of numbers, I have few numbers. Right now, for example, there are 38 Ukrainian citizens receiving AFT treatment and it's free, of course. But there is like situation, you know, I mean, someone came, started and then left to another country and left the treatment. In terms of OST, right now no one from Ukraine is receiving methadone or buprenorphine and in general there were about 10 individuals who at some point entered treatment but then left it. And I have to stress that harm reduction system and infrastructure is pretty well developed and well functioning here in Georgia, so we have nice network of sites offering methadone or buprenorphine, mostly methadone, but also low-trash harm reduction services. So there is not, I mean, geographical accessibility is not usually a major barrier. To continue with services, right now in needle exchange, I was unable to receive any information except for two Ukrainian female drug users who are visiting needle exchange programs in Batumi and they are taking sterile instruments and other consumables for their friends as well. So they are given a specific amount of disposable sterile equipment to supply their peers. How many? I don't have exact numbers. In terms of the changes in situation, we have some fragmented anecdotal information about specific changes in drug scene, not necessarily due to Ukrainian refugees, Belarusians and Russians probably also influenced that, for example, there is increased availability of illicit street methadone, which is not usually a preferable substance for Georgians who use drugs. And also reflection from a couple of my personal interviews, general prices for illicit substances have increased since we have this influence of migrants from these countries. That's probably it. I again have to reiterate, although we realize these people have various needs. I speak about refugees from Ukraine, both in general terms, in terms of adaptation and coping with challenging new situations, but also specifically on top of that in relation to their substance use. We don't have a full picture of those needs and demands. That's why this is a major reason that we actually are planning to do a study and we really want to understand what are the challenges that these people are facing and how best we can respond to those challenges. So I speak about very specific studies that we plan to implement, qualitative study and work with community of people who use drugs from Ukraine in coming weeks, actually. That's probably it from my side. Thank you. Thank you very much, Dato, for for your contribution, telling us what is the situation in Georgia. I think we are running. It would be great to have some time at the end for some question and answer and dialogue. So I would like to invite our final panelist to tell us about situation in Poland. As Poland shares its border with Ukraine and we know that the first wave of refugees people fleeing war. In the beginning, they mostly went to Poland. So Poland was at the doorstep of Ukraine and welcoming millions of Ukrainians literally, and and was quickly in action to provide responses. I'm Artur Malczewski, who is EMCDDA's Polish national focal point, the Redox focal point in Poland. So please, Artur, tell us about what has been happening in the last few months. Hello, everybody. Thank you very much for inviting me. It's very important talking for us for focal point for Poland as whole. Every meeting which we have organized or co-organized, like the Polish focal point, we talk about helping Ukrainian refugees. Doesn't matter it was the regional expert, our annual harm reduction conference, or Redox Baltic Academy in Gdańsk with EMCDDA on study visit of our experts in Lisbon. Always we are talking about helping Ukrainian refugees. Maybe some figures in the beginning, some statistics I'm working in the monitoring center, it is like some figures. After 24 February, the border, Ukrainian-Polish border crosses 6.5 million people from Ukraine. Some of them stay with us, some of them go to another countries. We have in Polish school on 1st of September started to attend 185,000 Ukrainian children. It's quite a lot. We have around 100 clients, refugees from Ukraine in OSD programs. Generally it's that to get OSD in Poland is the gossip like this. It's easier if you are Ukrainian than in Poland because it was the big support from the people from Ukraine to access to OSD. Generally I fully agree that it was the big work of our NGOs, which make sometimes like case management, try to help people to find the programs because some of you know that the ability of the OSD in Poland is not so high. We don't have so many programs and the figures is not so high too. And the NGOs, especially harm reduction NGOs make a very good job in this matter. Generally when I'm thinking about the helping to the people doesn't matter coming to us from Ukraine on Belarus, NGOs are the main source of the helping these people. From my perspective, I'm working in the National Institutions and the Minister of Health. Sorry that I was in the current the beginning, but I attended in the Health Commission in Parliament today. We we opening the telephone helpline free of charge with Ukrainian Russian language in the beginning. We also commissioned prevention selective prevention programs in pre-city Lublin, Warsaw and Białystok. And also we commissioned the study of the well-being of people in particular mothers and children resident in Poland as a result of hostility in Ukraine. The study should help us to improve the quality of life of the children and youth in situation of refugees and for planning prevention measurements because unfortunately we have the feeling that this war in Ukraine will not finish tomorrow, not finishing next three weeks. I would love to have the situation that most of the people in all Ukrainians can come back to the Ukrainian. But it looks that we should prepare for the long march to think how to help these people who can stay with us longer being the Polish school, going to the Polish treatment centers and so on. Because still we have some some language and culture challenge because we have quite a lot of drug free treatment programs, which you know it's completely different situation to go to OST and to go to inpatient, outpatient, drug oriented programs. There should be drapeutes speaking fluently Ukrainian or maybe Russian language and also the issue of the culture challenging. What I should also add that the Polish drug alcohol prevention system is based not only on NGOs but also on the local communities. We are using alcohol taxes to giving the money to the NGOs and other organization talking with alcohol drug problems and it was the decision that this money from alcohol taxes is quite a lot. It's like 150 millions every year on the local level, mostly city level. Also the city can use not only for the drug alcohol prevention but also to help Ukrainian refugees. We don't have the data how much this money going in this in this direction but just to give the opportunity cities to find additional additional sources to help this. This people and one figure which I found it that in RV treatment is more 2,647 from October Ukrainian refugees and the same like in Georgia all this treatment is free of charge OST and RV in Poland. Thank you. I think that's all. Thank you very much for inviting me. Thank you very much Arthur I think you've drawn attention to the situation of also women and children and I think that's really important especially since particularly in the early days of the displacement of mass displacement of people. It was predominantly women and children and I think that's important to keep in mind because women and children have specific needs sexual and reproductive health needs, which kind of mentioned, and also prevention of violence and drug issues, alcohol. So these are multiple needs and I think all all of you panelists have nicely drawn attention to many of these factors and considerations. So, very, very much. Thank you to all panelists and I, I would now like to hand over back to my co-chair Marika Ferry, Marika over to you. Yes, there are only few questions. And I think they are addressing all the speakers so I will read them for you and you decide who would like to talk. So when the war ends there are likely to be major social and psychological problems in Ukraine. This may lead to large scale increases in drug use and alcohol problems what plans are being made to detect this and to prevent it to provide needed services. Konstantin or Ganna, would you like to comment on this? Yeah, well, I may. I'm not on the government side, but Olga mentioned that the Ministry of Health is preparing recovery plans for three major programs that as far as I know there is no separate plan for mental health, although probably there should be because what is and will, you know, continue to be a major, major issue here with, you know, all the psychological trauma PTSD and so on.   But again, it's still very important to monitor that and we are planning some studies, you know, to monitor mental health among different groups and different populations, including, you know, general population and veterans and, you know, other key populations. So, but yeah, it will be also important that there are some projects that that sort of provide training and scale up from like brief interventions, like MHCAP and CETA.  So this is sort of my understanding of this issue. Thank you. Gana, would you like to add something? Olya is here maybe from the governmental side, she will say, but what I see from the shelters and our members, home reductionists, home reduction organization in Ukraine, they are already raising capacity to be the humanitarian health receivers as organizations and that's different kind of work. They already equipped shelters, so all of them will continue to be the comprehensive social care, medical care providers, and I hope that they will recognize not only in the HIV response but also by local administration and we see it in Kultava, we see it in Chernihiv, in Cherkasy region in Kiev, that this organization become playing different role in health and social challenges response for key populations. That's important point and I know that the country is aware about this and will find the sources like from Global Fund, from other donors and together with the integration of all this services for people using drugs including those who are with PTSD coming from the front, but also to respond in cooperation with the other big programs like mental health program coordinated by the First Lady and other programs which are now start building. So we are in absolutely key moment to develop and to reform the system to continue reform of health system but also to integrate all together. Thank you very much. This also gives me the opportunity to summarize two questions, both of them having to do with the lessons learned. So how the lessons you are learning on the health and security emergency can be also applied to other situations of displacement in other countries. Yes, a comment. Can you provide us with a comment, including Stella perhaps for a broader overview. Well, I think before that Olga may comment on the situation and the plans in Ukraine. Yes. I will drop off for a minute because the blackout period started and we switched to the generator. Can you repeat, sorry, the question Marika. Yes, yes. The question was about the preparedness to maintain some of the services because this situation also probably highlighted emergency that may not be resolved with the end of the world. What are the resources that will be put in place to continue taking care for example mental health of other emerging problems. Thank you. I will start from mental health actually started from the from New York from January 1 the new package will be presented by National Health Service it's mental health package. It's a new one and all of healthcare facilities are able to apply along with a new package is a training materials training online courses and all other support documents will be provided to healthcare providers. I think it's a really very necessary step, which was done and approved and calculated and due to our recent recent analysis mental health is top one issue among challenges and it will be addressed like in this. I think it's more stable approach because National Health Service will will reimburse or provide funds for providing such services. We have had that Hannah presented the National Group on Mental Health, just been started, like started a couple of time ago, and all issues are also discussed on this newly established working group under the first lady, we're heading. I think it's what we were able to do as so as now, but I think it's even a lot of as well we have NGOs and all other technical assistance projects, and even a cluster cluster and the Minister of under the WHO on mental health. The best practices will be shared within other service providers and other technical assistance programs. I think that is the best will be choose for for all out and for implementation. Thank you. Thank you very much. We have just five minutes left. Stella, would you like to address this issue of exporting the lessons learned to other possible display situation. Well, thank you. I mean for us in the European region this is probably the first experience direct experience to address such a large scale humanitarian response in the in the as a result of war in Ukraine at this level and being so engaged. And I want to say that, I mean, before there was the response and it's still ongoing as a response between the two regional offices. The EMRO office and the Euro office as a response to the war in Syria and the displacement in Syria. And many of those lessons learned that were already accumulated in the European region and in the countries, hosting the people from Syria and from Afghanistan are now already informing and the mobilization that has happened in the host countries is already being informed by those lessons learned, I think. So, on the other hand, what I see different compared to the previous responses this prominence of mental health. And this is definitely something that is in a new kind of mobilization around this acute needs of supporting the mental health challenges in in a country that is affected by war and especially it probably also received this high level of prominence because of the leadership of at the level of first lady. And I think that's something that will help other countries to address mental health needs at in the same way that is Ukraine is is doing. So, Ghana also mentioned this that this crisis has highlighted something that we were aware but the contrast has been especially remarkable. The fact that Ukraine was such a pioneer in the TB response HIV response and the responding to the, you know, substance use in the progressive responsive responding in progressive ways that the countries that are hosting people that are affected by these diseases and are using drugs, they are not able to match sometimes the level and the quality of service the comprehensiveness of services that Ukrainians have been used to receive at home and this is something that was already highlighted by the situation in Poland that there are so many barriers in accessing some of these services that the Ukrainians are not used to to have when when when they were accessing these services at home that that is something that we can use in the European on the European side to improve the services for the host populations as well. So this is something that probably is going to be a positive lesson learned for all the countries in the EU. Thank you. Thank you very much, Stella, and I now give the floor to Jane Montaigne for some conclusive remarks. Jane, the floor is yours. Thank you, Marika. And thank you so much to all our speakers for their input. I'm extremely impressed and and also a little moved about what I've heard today in terms of the energy and the experiences on the ground and thank you for sharing your particularly Olga and Constantine who made a real extra effort to join us today. I noted down a few takeaways just as a sort of summary. In a way that I'm hearing so much about the massive challenges but also the commitment to the strong mobilization from health services admirable and they're both within the Ukraine. I think in part I heard there were supply issues at the start of the invasion that the often services were were restored within the country. Also, I'm hearing about strong mobilization amongst externals amongst international civil society organizations NGOs and the importance of networks and networking. I'm getting the message that the numbers currently needing particularly treatment services in neighboring countries the numbers are pretty low. I'm hearing there's an expanded role for harm reduction that's that's emerged during this crisis and that that we definitely need to stay vigilant. The numbers and the needs around infectious diseases are emerging and possibly higher than for the substitution treatment right now. Big concerns for the future that are being raised at the end particularly the mental health issues coming up but I heard earlier about the harsh winter the winterization ideas the problems with health system, the health systems and the damage. And also the morale the staffing challenges. Importantly, I think we've mentioned a few things that this crisis has shown a light on as well which includes poorly funded and low accessibility of services already in some of the neighboring countries are now kind of highlighted a little bit more than they were. And also lessons just that last point I take away the lessons learned from for other groups of migrants that perhaps we're learning some better skills in terms of preparedness and and how we might offer services to different groups. With the EMC DGA perspective, a couple of thoughts so that for us it's it's been really important today to provide a platform in for our colleagues in Ukraine and their supporters, so that they can stay connected to us and connected to colleagues in Europe during this challenging time and that they can share their needs and we can hear them. And I think that's that's from all my colleagues that's really feels very important for us. We also continue to offer our support in the ways that we can within a mandate noticing that we've secured new funding for a big project, working with Ukraine and EU for monitoring drugs project which will be working with other countries including Ukraine into the future now for a number of years. So just to remark the EU's granted Ukraine more over candidate country status which also increases our possibilities and opportunities to work together which is just really positive. So thank you. And it's our last webinar of the year so I'm just going to say thank you to my colleagues. Particularly America and Ali, Marco and Marisa who have have actually run a series of webinars this is our last for this year, but they've done an amazing job and I just want to thank them for all the hard work they've done giving us an opportunity to meet with a wider online audience, a global, and really raise issues like today, with people working on the front line in practice in policy. So thank you to colleagues. And for those present. Thanks for coming. Thanks for joining us. We really value your engagement. So stay in touch with us. Please, and please stay safe. Thank you.