Hello again. I'm Ruchika Nitsu. I'm president of the association SS Miloma from Romania, an association of Romanian Miloma patients. And I'm here to introduce today Ananda Plante in Plate, sorry, and Tamas Beretschi, who will introduce us in a session where they will be talking about the patient advocate development strategies and how an umbrella organization can help you. As far as Ananda is concerned, you already know she's the CEO of NPE, and she will explain us a little bit more about the advocate program developed by NPE. And Tamas is currently working as the communication advisor of the European AIDS Treatment Group, the largest European network of individuals living with HIV. And also he's an author at U-Party, the European Patient Academy on therapeutic innovation. Allow me to tell you that Tamas is set to defend his PhD based on research into the significance and perspective of patient organization in Europe late 2016. He firmly believes that by educating people about their disease and making them more aware of their health, they will become able to back up their rights with knowledge and thereby they can make a true impact. And I would say, as the Miloma patients, we couldn't agree more with that. So this being said, allow me to invite Ananda to start the presentation. Thank you. Thank you, Lucika, for that kind introduction. So today I'll be talking a bit around the patient advocate development program that NPE has developed and the reasons behind why we decided to do this. This is something that we talked about yesterday already, that there are different roles in patient advocacy. There are different levels of patient advocacy. You have patient advocacy at a support level and information level where you support the individual patient very closely. You see them nearly every day. You have very small groups of patients even coming into the organization to get information from you first hand. You have advocate level who are active at a health policy level where you fight and advocate for better and patient-centric regulations and laws and also for better access to treatment. And there is a third layer which is about enhancing research where patient advocates collaborate internationally with clinicians and industry and you also help defining priorities and conduct. However, independently of the role that you as a patient advocate choose to have what is clear and that's something that we've also discussed over the weekend is that we all have the same objective in terms of getting the best possible care to the patient at the right moment in time. That is independent of the role we have, of the layers that I showed you before. However, depending on the role in patient advocacy, we will do that at different levels and in different ways. So for this purpose, what is clear is that we need to become involved for stakeholders. So to really pursue that objective that we have in common, we need to be involved and get in touch with medical societies. We need to be in touch with the regulator and need to provide our evidence and bring it to the table for discussions. We need to be at the table, the HTA bodies that sometimes it's difficult to get the foot into the door. However, we need to keep on knocking, payers and reimbursement authorities, industry and so on and so forth. There's a whole range of stakeholders we need to involve in. We also need to be involved at different levels, might be at European level, national or regional level and it is very important for us to know at what level we need to do what in order to save our resources and be as effective and efficient as possible. We also do it for different purposes. So we would get involved with industry, for instance, in order to design better trials or you would get in touch with medical societies to really try to incentivize them to join our common objective and try to achieve that together. However, what is also clear and becomes clearer the more we get involved with these stakeholders is that patient advocates need specific skills and they also need training and it is not something that is a one-off thing. You train yourself but it is a constant that goes throughout your whole period as a patient advocate in the scene. You never stop learning and you never stop improving the ways that you engage with these stakeholders, the way you create evidence, the way you try to convince to get them on your side or try to negotiate. You need to train yourself to know the rules that apply to what you do. You need to know the system in order to change it. You need to challenge them and you need to make a difference. So here in the patient advocate development program, what we will focus on, whereas yesterday we were focusing on the Atlas and how do we train organizations and advocates on improving access, building strategies for access to treatment in the countries. Here we go a level up in terms of not only focusing on policy but really if we have a look at these three layers, it is the layer which tries to improve research, tries to really push for better clinical trials, tries to push for better outcomes for patients, tries to introduce the patient's needs into the design of clinical trials in order to have a better outcome in the end and also have it in a more timely manner. So what areas have we identified where training is needed for the Miloma community? So the areas identified are, some of them are disease specific. You need to know about the disease, about the biology of the disease, about what drugs you have coming up, the pipeline. You need to know what drugs are approved. You also need to know what drugs are reimbursed in your system and so on and so forth. These are all disease specific ones. You then have cross disease areas that need to be covered as well. They are as important as the other ones and you need to know them a bit more systematic about the basics of medicines, research, drug development, about statistics that personally bore me to death but I know that I need them. Regulatory approval process around health technology assessment, how reimbursement works, how HTA works at a European level and what part is national. The attempts of the European Commission to facilitate that at a European level and the failures of it and that comes back to the competencies between the EU and the national level. It is really crucial for patient advocates to know not only the content about what you are going to say but you need to really, as we mentioned yesterday, avoid barking up the wrong tree. Avoid addressing issues to the wrong stakeholder at the wrong time and bringing evidence to the table that is not relevant for that stakeholder particularly. So this is how the advocate development program looks like. It is an intensive training program. We have some of the trainees here. We started the pilot this year and hopefully we only had budget for five trainees despite getting many more applications so we are going to try and get more places available for the next term. So this training, what it tries to do is to increase the number of advocates that know about the topic. All of those topics that we talked about before at the previous slide at a European level. It is really important that you as an advocate join that program not only having in mind what is happening in your own country which is absolutely relevant but what we also need is advocates who know about this and have in mind what they can do at the European level because research does not happen at a national level and that we need to keep in our minds. To join relevant discussions and influence decision making, that is the aim but that needs to happen by understanding how that drug development really works and how that process fits into the context of the whole system. So that learning is based on an online training which Tamash has been kind enough to help us with and he is doing an amazing job with that based on the experience he had at EO-Party. We also have two face-to-face trainings, I will talk about that afterwards and scientific sessions at congresses where trainees can implement what they have learned in the theoretical part. Maybe this is the point where it makes sense to mention before going into detail of the advocate development program as such the first term of it is we always complain about not having the right clinical trials in place not having the right criteria in place for clinical trials to recruit patients not having the focus on the right outcomes. All of that is correct but I think we need to combine that complain modus with something more proactive and that proactivity doesn't come by itself you really need to know your stuff in order to sit down with industry and give input into a clinical trial protocol because you have one shot, if they invite you to an investigator meeting you do it right the first time or you never get invited again and maybe if at that point you go in there, you make your case and they see that that might be useful for them clinicians and industry at the same time you might have a chance that they invite you again and you might have a chance that that protocol in the end will be implemented and that will be the protocol that will recruit your patients so it is kind of a responsibility if you think about it how important it is that we thoroughly study this so I don't know whether you see probably not we've combined the advocate development program into three parts one of it was a capacity building at EHA the European Hematology Association Annual Congress in June where we had all hematology advocates present we then had a tailored day, afternoon with our trainees and clinicians, experts in the myeloma field that would talk about the advances that were presented at EHA in myeloma, the pipeline but also around what is being presented what are the hot topics and then we went into also the clinical guidelines for treatment and diagnosis to really see how is it that a patient should be treated no matter where he or she lives the third part will take place at ESMO in September where we will cover less clinical topics we will go into those topics that we were discussing before that are cross disease and hopefully the idea of doing this with congresses was basically to not only bombard people with theory but to make sure that once you have the theory you can actually link that to where science is presented where it happens to meet the clinicians and then go to the poster sessions and have one of the superstars present to you what he's done in that clinical trial and ask him questions so that combination we found interesting and it's something that we haven't seen anywhere and hopefully that will work I know that at the beginning for some participants it was a bit tough because the presentations can be quite technical but hopefully throughout the online course and the months that are to come will manage to get the trainees to a level where they can actually go into a scientific session and understand everything and write reports for their organizations and so on and so forth so we have a training side as well you can see it over there that will be merged into the MPE website soon but you'll get information on that further in the year and that's basically it that's the structure so the timeline for this as you can see starting May 2017 we have all this what I just discussed the online course and the face-to-face trainings I'm not going to go into detail of that May 2018 we plan to start the course all over again but we will refrain from keeping the trainees that we had this year out of that program so whoever feels the need of still being part of the program and continue the learning process will be able to move up a level in their knowledge and I think that is crucial for us because we cannot with a one-off you can't do it and in 2019 and this is something that Tamash will be speaking about afterwards the plan is to hold our first community advisory board he will explain what that is but basically it's around creating a platform by which you invite industry to your table and you ask them questions and you try to turn around the tables in order to give input into their clinical development process and their protocols yeah basically it's that and I'm not going to say anything else about caps otherwise you won't be the last thing I want to say is that this program is a significant investment for us so we haven't just done it for fun it's not that we have spare money and we thought let's just spend it on this and it is important to really think about and not only us but also yourselves what the return is for the community because we've spent a lot of money on it staff and particularly Ana Vallejo has spent many many hours trying to get this working we have Tamash dedicated and he's put soul and strength into the program we have this website, the training platform we even got endorsement from EHA for the clinical program which is wonderful and we've engaged several clinicians who are very passionate about how we're approaching this and I think that's quite something so we've invested a lot in this and for me it would be important to know from your side what you think about this and how you think you can help us to move this forward the other thing that is to highlight in this slide is that we didn't develop this program to satisfy the curiosity of anyone this is not a nice to have thing what we want to create is a real base of knowledge in the myeloma community we want to create the best, the creme de la creme of knowledgeable advocates in the myeloma field and we want them to stay and that is something that we don't have at the moment and something that we need if you think about it so we really need your help for that so who are those advocates and that is my last slide we need people who are active in the field of myeloma and related diseases not limited to myeloma but amylodosis would be included we need them living in a European country we need them to be interested at least interested in the third layer we were talking about myeloma research not only at a national but at a European level we want them to really push for knowledge not do it as a one-off we want them to be persistent to stay there, to continue learning to wanting to learn more they need to speak English which sometimes is an issue but it's a must and open to new approaches and for that we need your help because maybe you're just not interested maybe you're more interested in policy or maybe you don't have time for this however in every single organization I am sure that there is someone interested in science or someone who might fit these criteria that you could identify and send over to us like for instance, Anita did with Lara where she said well I have enough to do but that person, that young lady might be someone with potential and actually it is like that so that is what we need and I'd be super happy to get emails from you proposing people applying for the next round so if you have any questions no questions I scared you all if you allow me, Ananda I would encourage anyone who feels like it to apply for this program because it is really interesting and challenging at the same time and offers a lot of support to sustain our claims towards pharma companies and authorities so Alfonso is telling me move on, questions at the end because Tamash will lose his flight I think that's what he wanted to say you know we have telepathy after so many years of working together so Tamash Thank you Ananda Thank you so much and hello again I'm sorry, I'm going to rush through this because otherwise I'll literally lose my flight so I think that I mentioned it to all of you during the previous session that I will talk about a practical example on how you can do meaningful work in patient involvement and patient advocacy with industry and also with other stakeholders and for this I will use the case study of the European Community Advisory Board on HIV and AIDS it's actually we have expanded our work into hepatitis and viral hepatitis and tuberculosis as well because HIV HIV and AIDS, hepatitis and tuberculosis come in a package so these these three illnesses and some mental conditions as well go together very often so therefore we cover all of these but let's see very quickly what the European Community Advisory Board is about it was established in 1997 and it is meant to be a forum of interaction between the communities of people living with HIV and also the pharmaceutical industry originally as you probably have similar bodies in your disease area originally there were community advisory boards attached to clinical trials or to pharmaceutical companies in the HIV field as well initially but there were a lot of problems with these community advisory boards at the time because it was very difficult to access treatment so often times clinical trials were used as vehicles to access treatment which immediately also created a certain inequality within the community some people who became members of advisory boards found easier access to medication and through the clinical trials in which they were involved there was immediately an element of corruption in this whole thing and also well this was 20 years ago it was a very new thing to work with patients for industry therefore they were also super cautious and terrified that they would do something wrong and also it was a very new concept at all that you would want to work with patient representatives so what happened there was a very specific moment when one of the pharmaceutical companies came to a meeting with patient representatives and they came with bodyguards they came to this meeting with bodyguards so there were the pharmaceutical industry representatives sitting on one side with four armed guys on the other side of the table there were like six guys with AIDS emaciated like really thin ill dying and that immediately went into the press understandably so the pharmaceutical industry said that they wanted to protect the patients that's why they came with bodyguards but obviously they wanted to protect themselves because the AIDS movement was so angry and strong at the time so this momentum this very important moment was then used and understood by the pharmaceutical industry and they sat down all the companies who were involved at the time in HIV research they sat down with the European AIDS treatment group which is my home organization and with an American fellow partner organization and they established the European Community Advisory Board this was a joint initiative by the industry and the patient community so it's not unheard of that you work together with the industry in this format it is right now the European Community Advisory Board is a working group is an integrated part of the European AIDS treatment group which is a network of individuals living with HIV we work in various fields we work in science which is ECAP the European Community Advisory Board but we also work in policy and for this we have a political working group and we also do a lot of training so we also have a separate working group which only does organizes training events at the end of 2016 we had 112 members from approximately 38 countries so there's a bit of coming and going Europe for us is WHO Europe so this includes Central Asia and it extends to into the stands into Central Asia I will not talk a lot about this because I showed you this diagram at the previous sessions but this is actually what we say this is where ECAP plays a role this is where innovation comes about this is where knowledge is produced so we believe we understand ECAP as a vehicle of knowledge production where we provide a neutral space where participants from all these four stakeholders can sit together and can work in order to achieve innovation in biomedical science now there are different models to how community advisory boards can work so these can be therapeutic area specific like in HIV or in CML the CML community advisory board was set up just recently less than a year ago and also there is work ongoing in other disease areas like skin cancer for example where similar movements are starting in order to set up such a community advisory board there can also be advisory board set up within research institutions so that's also not unheard of or specific attached to a single trial and also there can be community advisory boards that are industry initiated now the European community advisory board tries to cover all of these areas so we are we look at all the different clinical trials ongoing in HIV viral hepatitis and tuberculosis and we work with all the companies who are involved in this area be that diagnostics or even generic manufacturers we work with everyone we approach everyone and we invite them to meetings in order to make sure that we keep our communities informed and we also provide this service to the companies it's a very important perspective or aspect it's a service to the companies and I will tell you why this is important so I said the European community advisory board is part of the European AIDS treatment group which means that we are also it is also integrated into the budget of the ATG so it's just one chapter in the patient organization's budget it's not a separate entity also pharmaceutical companies contribute to the funding of eCABs through various channels first of all we get unrestricted research grants unrestricted research grants are what it says these are lump sums of money that the pharmaceutical companies give to the patient organization for them to allow them to carry out their work without any limitation or any requests or any red tape or tags attached to what we are supposed to do with this money so those are unrestricted research grants and in fact we do research from this money also and this is extremely important pharmaceutical companies pay to attend meetings now of course the question comes up why would you pay to attend a meeting where you get criticized but in fact it's not how we frame it it's not about getting criticized it's about getting advice from the patient's perspective what we do is provide input into the pharmaceutical companies research work from the patient's perspective how can you do that you can do that if you're educated if you're educated about your own illness if you're educated about the political area and the environment if you understand what's going on in your body what's going on in what we call the body positive so in the entire community there are people living with HIV so if you have a full knowledge of that if you are an expert patient then the company will be ready to pay for the services that you provide so that's why we charge for attending these meetings and the money that we get we reinvest into educating our members and teaching them about HIV and teaching them about policy so and also we get money through sponsoring of specific projects like information campaigns leaflets, brochures, websites training events also because there's this rigorous ban on direct to consumer marketing in the European Union we used to get a lot of criticism even from the European Union because we accept money from the pharmaceutical industry but in fact if you can prove that the output so what you spend the money on is actually in the public interest it is for the betterment of science and research and the health of the community then the European Union approves that you are an independent NGO and the civil society organization which is happening to the ATG consistently for the last 20 years we have never had any issues because of receiving funding from the pharmaceutical industry a partner to the European Union so it is where we say our arguments are that this is a rigorously scientific interaction we talk about science we never talk about marketing we even stop marketing presentations and send companies out of the room if they come with marketing presentations we talk about science because that's why we are there these meetings are confidential so even if we take minutes these minutes are not shared beyond the participants it's a targeted information exchange also it's on the highest possible level so it's not the marketing and not the PR people who come but medical leads research leads lead investigators who from the various companies who will come to these meetings and will talk to us and we will look at their data often before the official presentation or publication of the data and also it's outside the usual scope of interaction so it's not what pharmaceutical companies usually do it is in this case they come to an organization into a patient organization where they pay for an advisory service so it's outside the regular scope of activity so therefore it's accepted that it's not marketing and it really isn't marketing because that's not I can read the advertisements on the internet I don't need to travel to Brussels for a meeting for that so nevertheless of course we also do a lot of work to diversify our funding and it's not only pharmaceutical company funding that we receive but we also source funding from European Union projects and foundations and other sources that we can find and we do what do community advisory boards do well first of all we have an involvement in ethics which means that our members who are expert patients and educated in their illnesses or conditions and also about ethics they sit in ethics boards and data safety monitoring boards as patient representatives I don't know about your countries but in Hungary for example it's quite common that in ethics sports we have a priest who is the civil society representative why we say no way we don't need priests, pastors or rabbis in ethics sports but we need patients and we provide these expert patients who understand science and who understand ethics also we are involved in research priorities so we can tell the companies what is it that our community needs what is it that the body positive that people living with HIV or at threat from HIV need what is it where you have to do some more work also study procedures we review protocols almost all protocols currently implemented in HIV research are previously reviewed by the previously reviewed by the European Community Advisory Board before implementation not afterwards but before implementation this is also extremely important and then we can make an input into the protocol and we also certainly work in information dissemination we also do a lot of policy work so we try to intervene in pricing and also in post marketing surveillance how do these meetings or how are these meetings conducted it's usually over weekends when members don't get paid for their participation the money goes to the organization you do this as a volunteer it's usually over the weekend all your meals and your travel is covered but you get nothing else than that it's divided into five units each of them is three and a half hours and then companies can buy units so they pay for one or two units two units would be a whole day and and also as I already mentioned it's strictly confidential and then usually we stay for Sunday morning and we take care of internal business taking decisions, talking about procedures whatever there's always it's a large organization so there's always something that needs to be done and we also have a scientific officer sitting in Brussels one of my colleagues who's a full-time employee and he does nothing else but takes care of HIV, viral hepatitis and tuberculosis related science so he monitors his biologist has a PhD and he monitors what's going on in the field follows up with companies keeps the membership informed organizes the meetings what we have achieved so far of course it's been going on for 20 years so there's a huge amount of things that we've done already first of all keeping this dialogue going has been a very important point also we could achieve a number of important amendments to protocols in order to serve the interests of the patients better we could for example lower the limit of CD4 cell counts you know so we said that you shouldn't wait so long or you shouldn't start or exclude rather patients from the clinical trial just because their CD4 can their immune system is not in the shape that the original protocol for so also we maintain a full table of access difficulties and issues across Europe with all the pharmaceutical companies is it registered, is it reimbursed, is it available these three things are not the same so even if it is on the market maybe it's not prescribed so we also monitor that and try to find out what the reasons are I already mentioned the DSMB participation and also we have several members who sit in various commissions of the EMA yes we also work with WHO Europe for example the HIV guidelines of WHO Europe are usually developed as a joint effort with ECAB and the ATG but of course it's not all roses so we also have a number of challenges here first of all are we representative enough it's always a question can we always effectively reach out to all the groups who are affected by HIV you know HIV advocacy tends to be white, gay, middle class men like myself but HIV affects sex workers it affects black people disproportionately it also affects transgender people and injecting drug users so these are disadvantaged communities that are difficult to reach it takes a lot of effort to include them in our work and this also leads to a number of conflicts within the organization which need to be managed also maintaining our independence is something that we have to do on a consistent basis it's not enough to do it once but you always have to follow up on the numbers that everybody remains at arms length from industry and from all the other stakeholders and of course sustainability has always been an issue but so far so good so there's a couple of ground rules that I will not go into much detail with for example we never quarrel in front of any company or anyone who's there we also never upload companies because I mean why do you clap if someone presents their science we're not there to celebrate also we don't complain too much because that's not interesting everybody knows that there are problems so that's not why we are there we are there to follow up on scientific advancement and then it's it's your time and you invest your volunteer, you do this in your free time so if it's useless you stop it that's what I said if it's a marketing exercise then we just send the company home provide a service so you should always remain humble of course you make claims but you don't really quarrel with the companies because you I mean you are there because they pay you for a service this I was spring over and also we do a number of other activities that are there to promote science such as the journal club we organize structured readings of scientific papers we also consistently ask for unpublished data and negative results you know if everybody is so incredibly successful in science then why is progress so slow and the reason is because you don't get the negative results because of publication bias so we ask for the negative results because they are there you just don't see them and we always ask everything and anything it's a ground you always ask there's no wrong question and we allow time for complaints from the company and from our members and we try to reflect on them and we do science and policy together because we believe that as Ananda said that you can only remain credible in policy work you can only influence political decisions or policy decisions if you know what you're talking about then you are credible to get your science right and that's what we focus on that's why we educate our members consistently and we try to understand how this becomes more than just 20 people together in a room so we try to act as a group and maintain this cohesion within the group and you can read more about this in my paper which is on the internet free access it's long and boring but the paper is short and understandable thank you very much I would be happy to answer your questions but I can't because I don't have time so you can reach me on my email address and then I'm happy to answer any questions seriously by now it was good to be here thank you Thomas we go back to the session presented by Ananda if there are any questions please for Ananda yes please can I have a microphone over here please actually maybe I'm not very informed when did you start this program patient advocate development strategies investment is 50,000 euros and up to now are you happy what you have achieved and for how long this program will go on and what is your final plan or target is that okay so yeah so this is the first year we're doing it and we just had the first face to face meeting two weeks ago at the European hematology association in Madrid so so we can't really say whether we have been successful or not because we just started in May 2017 with a program we have I think a pretty good platform by now with quite some information on it and the online tool we have the tutor so I think from that side from the infrastructure side I think it has been successful but the outcomes you don't know until you know at least you have finished the first course which will be in December this year I think in one course as I said you also don't expect any miracles but my hope is that the trainees that are enrolled at the moment will keep coming back to the program will stick to it and that you know along the years we can build a knowledge base for that if it works and if we see that you know we have people that are committed to continue learning the idea is to create the eCAPs to have that kind of forum together with industry by 2019 for that we need knowledgeable patient advocates otherwise industry won't be interested in that and if we see that it's fruitful that people really move up a level in knowledge then the program will be a permanent one and hopefully you know we can expand that to anyone who's successful in the application and I don't know hopefully once you move over you have the platform and the reduction in cost is also something something realistic but for now we don't know it's a bit of an experiment because we know that in the HIV community they already have been doing this for many years so they have reached that knowledge level but they continue learning so you do these things but you are only entitled of going to the CAPs if you also agree to joining the training and advocacy for 15 years so yeah at the moment it's five persons I have to say if we manage to have a handful of people that can do this I would be super happy that would be amazing but the hope is that next year we can open it up for more kind of pilot is that to encourage national organization or to make stronger MPE I don't know you tell me so it's around building knowledge in the Miloma community so I guess it's not around national organizations or MPE at all it's it's around moving up a level the discussion we're having at the moment with industry and with other stakeholders to really get to the point where you're taken seriously and can have that one on one same level discussions with the stakeholders in order to really make a difference yeah Tamash is the trainer of the advocate development program and he's doing that very well but yeah it's not around organizations it's around the community leveling up the knowledge within the community any more questions yeah any more questions Lisa I just wanted to investment for the future I just wanted to make a comment so I think it's a good investment for the future and if we want to get into a situation that patients and patients advocates can put their interests how industries and maybe also clinics have to work with patients it would be a fantastic situation so I think it's good investment money, thank you and I mean the knowledge the need for that knowledge is not only at a European level it's also within the countries because there you have the same discussions even though research is a European matter it's not a national matter the discussions you have with affiliates of industry in the countries are exactly the same and when you go to HTA bodies it's the same when you go or you try to convince your ministry it's the same it's around having that level where people take you seriously actually not only take you seriously but have the need of involving you they see a benefit at the moment it's us trying to convince them to involve us and we want them to want us and need us Thank you I think we have another question over there I'm not sure if it will be a question as I was sitting in Tamas workshop he was talking that we need to make a structure of something that we have to offer and as I see it maybe mostly from my point of view we should be the voice of our patients and as you were saying the point that we can actually get learned it came to me like we should become informed about what the industry is doing and study actually their job and become like that we understand them and I just want to offer or maybe in my opinion it's also important to really be the voice of a patient like as a patient I have different health problems but as a patient I don't care about the name of my treatment about the name of the medicine I care about being healthy and feeling good having I will say having full quality of life so maybe that's the voice of a patient I mean as a patient I don't see my point at becoming a doctor or a scientist I see my point at becoming healthy so it's just like the idea about I know that this quality of life is something we cannot touch we can touch the medicine but we cannot touch the quality of life but just something we need to bring so yeah so it's good that you raise that so you're here as a patient advocate not as a patient I know that sometimes is difficult to but you're not here for yourself you're here for the community you represent at home and yeah let me just finish my point so that's one thing that often you know is forgotten when we get even invited by industry in order to represent that community it is good to have an idea what you know the patients you're in touch with think and so on however having hardcore evidence that demonstrates what the needs of your patients are that is the key it's not around saying I think that quality of life is good or not let's do a questionnaire let's get a thousand responses and let's bring that to industry and say there you have the response that's the answer because that is what moves and shifts and changes protocols not the fact that one of us is sitting somewhere in an advisory board over and over again one day it's in company A the next day it's in company B because we talk about the same things and we've been doing it for many years but nothing changes so it's really time for us to do that step and say yes I am a patient because I am a patient too and I'm standing here now representing the myeloma community and what I want to bring is not an anecdote of something that I heard or what I heard at the discussions with my patients it's evidence, hardcore evidence that you will not be able to ignore that's I don't know whether that clarifies okay I don't see here what for instance patient in Bosnia will have from this if you can explain that how it will influence their life their okay I'll give you a practical example maybe it's the easiest one are there any clinical trials in Bosnia okay so my example is are you aware if there are any clinical trials in Bosnia okay so I can tell you the most probable I don't know either but I can most certainly say that probably there is none yeah why why are there no clinical trials in Bosnia they even have a good treatment and nothing helps so the reason why there are no clinical trials in Bosnia is because industry is not interested in having clinical trials in Bosnia it's commercially not interesting so we and you as a patient advocate here have a duty of finding a way to convince industry to bring clinical trials to Bosnia and not stop and not sleep until that happens and that is what I do every day and that is the impact we have in patients


And now we'll have a look at the present perfect continuous tense. As its name suggests, what we're going to do is combine the present continuous usages and the present perfect usages into a tense that basically expresses the fact that we've got an action continuing up until the present point in time. For the form of this tense, again we're going to combine the various aspects of both the perfect and the continuous tenses. If we have a look, we always begin with our subjects. Then we have our two now helping verbs. The helping verb to have for the perfect tenses, as well as the helping verb be for the continuous tenses. For our subjects I, you, we, and they, we leave have as have. For he, she, and it, we conjugate it to has. Because it's a continuous tense, of course we need to use the verb plus ing. This results in sentences such as I have been teaching quite some time or she has been teaching for 15 years. The negative form of the present perfect continuous remains the same as the positive form and we simply add not in between our two helping verbs have and be. In order to make the present perfect continuous questions, again following with that pattern of inversion, what we've done is put the auxiliary verb have at the beginning of the sentence followed now by the subject. Have I been teaching for five years, could be a sentence used there, and again we're going to conjugate our verb to has for he, she, it, resulting in has she been teaching for five years. The usages for the present perfect continuous tense are very similar to that of the present perfect tense. But here the focus is on the action and the fact that it has been continuing for some time leading up to the present. Let's have a look. We've got incomplete and ongoing activities with duration. I have been teaching for 10 years. Then we have our recently finished activities with present results. Our recently finished activity is chopping trees, but the present result is he is tired. So results in a sentence reading he is tired because he's been chopping trees.


Good afternoon everybody. Good afternoon. My name is Nancy Lindborg. I'd like to welcome everybody to the US Institute of Peace. For those who are here for the first time, the US Institute of Peace was founded in 1984 by Congress and dedicated to the proposition that peace is possible, peace is practical, and that it is essential for the security of the United States and of the world. And we do this by working with partners around the world, on the ground, providing people, organizations, and governments with the tools, the knowledge, and the training to help manage conflict so that it doesn't become violent and to help resolve it when it does. And I'm delighted to welcome all of you here today, including the Connecticut Senator Chris Murphy. We're delighted you could join us here today, sir. And the ambassador to Georgia, Ian Kelly, both of whom care deeply about this region. A very warm welcome to Prime Minister Giorgi Kavir Kavashvili. I practiced ten times. Kavir Kavashvili, he is in Washington, D.C., to advance the US-Georgia bilateral ties on a wide range of mutual interests. Including economics, business, governance, and security. And I learned a great deal about toasting from Georgian colleagues. If we were toasting right now, I would offer a toast to congratulate you on the 25th anniversary of the restoration of Georgian independence, which you will celebrate next month. So please accept those congratulations. But I also want to recognize your government's strong and very important commitment to peace and the two pillars around economic progress and inclusion of civil society, which you have pursued with great energy since you assumed office. Today's event comes at a very important time when Georgia is playing a critical role in an increasingly volatile region and doing so from addressing human rights in Abkhazia and South Ossetia, to offering to host talks between Azerbaijan and Armenia over the recent escalation of conflict in Nagorno-Karabakh. You have these strong ties to NATO and the European Union and with the pragmatic approach to Russia, Georgia is continuing to build bridges both regionally and to the international community at an important time. The Prime Minister's visit this month is an extension of that effort. So I look very forward to your remarks today for prospects for regional peace, which we hope are anchored by Georgia's commitment to democratic development, internal reconciliation, and regional stability in the South Caucasus. And it's now my pleasure to introduce Connecticut Senator Chris Murphy. Senator Murphy's career has been defined by public service. He began in the Connecticut House and Senate before being elected to represent Connecticut's fifth district in 2007. And now in his first term in the U.S. Senate, Senator Murphy has advocated a balanced approach to foreign policy and one that relies as much on the tools of diplomacy and development as it does on the tools of defense. He serves on the critically important committees on foreign relations and appropriations. Senator Murphy, you've often said that it is absolutely essential that America continue to be a voice for peace. Obviously, as the President of the U.S. Institute for Peace, I highly subscribe to that notion. I thank you for those words. Please join me in welcoming Senator Murphy to the podium. Well, thank you very much, Nancy, for those kind words. Thank you to all of the personnel here at the Institute for Peace for the groundbreaking work that you do all around the world for the leadership that you help provide in the halls of the United States Congress and the Senate and in the House, to both of our ambassadors. Thank you very much for gracing us with your presence here today. And it's really my pleasure and honor to introduce to you Prime Minister Kavira Kashvili. Since becoming Prime Minister late last year, he has impressed so many of us in the United States Senate who count ourselves as friends of Georgia with his skilled leadership, his vision, and his commitment to the sovereignty of his homeland. We have also taken note over the course of these last few critical months of his constructive engagement with Georgia's political opposition. We may not always be, that we may not always have the ability to practice what we preach here in the United States in this regard, but we know that a hallmark of any healthy democracy is engagement with political opponents. And before I turn the stage over to him, I just want to say a few additional words to those of Nancy about the friendship between the United States and Georgia. It's been now several years since I got the chance to personally visit my friends in Georgia, but we have had a special relationship, certainly forged even deeper in the fire of the 2008 invasion by Russia. And the Prime Minister's visit to Washington today demonstrates the enduring bond between our countries. Georgia has many friends in both the administration and in Congress, and I'm proud to place myself, I hope, at the top of that list. Now Georgia's strategic location as a bridge between Europe and Asia, it boasts enormous potential for Georgia both economically and strategically. And the United States continues to support that vision for Georgia, especially as it relates to Georgia's future NATO membership. And my main message to the people of Georgia is this, continue to believe in Georgia's Euro-Atlantic future, plan for it, fight for it. Many of us firmly believe that Russia should not have a veto over the security partnerships of its neighbors. And while I believe that Georgia deserves to be offered a membership action plan followed shortly by an offer of full membership, and I've been very vocal about this as a member of the Foreign Relations Committee, in the meantime we've got to look for meaningful ways to deepen our partnership with Georgia. And while much of our attention has rightly focused on the conflict in eastern Ukraine, be assured that Georgia's sovereignty and territorial integrity also remain a priority for the United States Congress. In the face of continued Russian occupation of Georgian land and continued security challenges on Georgia's border, I commend the Prime Minister's determination to keep Georgia on this path towards Euro-Atlantic integration. And I'm confident that his government understands that strength and stability, they start at home with good governance. The Prime Minister's efforts to embark on a series of reforms of its judicial and security sectors, they're vital, and they'll ultimately make Georgia more resilient as a country, as its institutions increase in transparency and accountability to the Georgian people. And as Georgia looks ahead to elections this fall, as do we of course, we of course encourage Georgia's leaders to support free and open political space for a range of views to be expressed. Protecting the freedom of political discourse can only strengthen Georgia's democracy. The United States, and particularly the United States Senate in which I serve, is committed to Georgia's peaceful, prosperous future. And I look forward to hearing from the Prime Minister on how we, his friends in the Congress, can best support that vision. So it gives me great privilege and honor to turn the podium over to our friends, the Prime Minister of Georgia, Giorgi Kiviris-Kashvili. Thank you very much, Senator, Madam President, Ambassador, former ambassadors, and I see many friendly faces here in this hall. I'm very glad to be here. Thank you very much for this opportunity to speak to this audience. The United States Institute of Peace work is as important as ever at a time of upheaval and instability in many parts of the world. Today I hope to provide a good news story to lift your spirits. This year, as it was said, Georgia celebrates 25th anniversary of restoring its independence. We have much to be proud of, even if there is still work to be done. Georgia has transformed itself from a country ravaged by civil war into a modern democratic and dynamic state. After a decade of transition, we are now in a new stage of democratic consolidation. Despite external challenges, Georgia's commitment to peace at home and in the region endures. And in this, we share common purpose with the United States and, of course, with USIP. The support to Georgian government from the United States has been vital during these many years. Georgia has been through several military conflicts and without United States support, it would have been impossible to retain Georgia's independence and sovereignty. Georgia is a dedicated friend of the United States in South Caucasus. We proved to be reliable friends during many difficult periods. Georgia remains committed to the western path of foreign policy. Georgia is Europeanizing its democratic institutions, approximating its institutional standards to the European standards. And, of course, Georgia remains committed to NATO aspirations. Georgia has one of the largest contributions in the Resolute Support Mission in Afghanistan. And I think this is something we are proud of to stand alongside with our American friends to establish peace in the region. Let me tell you briefly about economy and economic development, since part of the purpose of our trip is a roadshow to attract US investments to Georgia. This is a very difficult balance to establish when on one side we need to talk about security and challenges in the region and on the other side to talk about stability and attractiveness of Georgia for foreign direct investments. And I believe that we can strike this right balance and we are a country that despite all the challenges outside of the country, despite internal challenges, we are very consistent on our European integration path and very consistent with our NATO aspirations. Recently, Georgia signed association agreement with European Union, part of which is deep and comprehensive free trade area agreement, which envisages fundamental changes in Georgia's institutional setting and fundamental changes in legislation of Georgia to make it more European to raise the standards of democracy in Georgia and which also on its side establishes good ground for investments and Georgia is outstanding country with its excellent ranking of doing of business, one of the lowest corruption rates, one of the lowest tax burden in the world. And these are not Georgia's government observation, these are observations of respectful international institutions such as World Bank, such as World Economic Forum and recently Freedom House published its observation of improving of rule of law in Georgia and improving media freedom in Georgia, which are of course crucial for attracting investments. There are numerous opportunities in Georgia for attracting U.S. investments. I can say that gladly that the recently we announced results of the tender for investment and construction of the deep sea port at Black Sea shore, which will be able to serve panamax type of ships, which will be one of the largest in the Black Sea basin. And this is, this will be done together with American company New Jersey based company Conti Group, which will invest together with Georgian company TBC Group to build one of the largest port again in the region. The port will be able to handle 100 million tons per year and it will be done in several phases, which is even more important, several thousand kilometers, square kilometers surrounding the port will be free industrial zone where we will attract important investments from United States and from other countries. I can say that Georgia has shown excellent growth rates despite the downturn in the region. We outstanding the region by showing from three to five percent growth rates and this is under the conditions which are not really favorable to investments and foreign direct attracting of foreign direct investments. The foreign economy turned out to be resilient during these crisis times and we do not benefit from the fall of oil prices. We are not heavily industrialized country to benefit from falling oil prices. Our main FDI providers are oil countries, so when oil prices are down investment appetite in the oil countries are down too. So despite all that we retained from three to five percent growth rate and this is something that we can be proud of. FDI attraction in Georgia in 2014 it was higher than 80 percent growth of FDI. Total number of FDI annual and FDI was 1.83 billion dollars. In 2015 it was down to 1.35 billion but still that number remained one of the highest during the last five year period. So again Georgia remains one of the most attractive places for investment. We are the only free economy and open economy in this region. We are not protectionist. We are protectionist only in terms of providing reciprocity in our free trade agreements with other countries. Some of them tend to be protectionist so we have to be very active in defending our exporter's interests. Georgia has free trade agreements. As I said with all the EU countries we have free trade agreements with our neighbors and recently we launched negotiating free trade agreement with China. We are working with EU to explore the possibility to be plugged into TTIP agreement as a country with similar regulations and institutions like EU standards and I think it will be excellent chance to establish also free trade with the United States. There are several important industries in our country which are interesting for FDI. First of all this is transport and communications. Georgia as it was mentioned by Senator lies at an important geographic location which is a bridge between Europe and Asia. And prospects for developing transport and communication industries are enormous. But beyond that our hydropower sector remains one of the most important for FDI attraction. Our tourism and hospitality sector remains booming and occupancy rates in Georgia's hotels are above 70% which creates excellent ground for hospitality investments. Our traditional agriculture sector is very attractive for investments and of course financial sector is one of the most attractive and with very lucrative return on equity figures remains one of the most attractive as we have two major banks listed at London Stock Exchange recently. So I will not continue more about economic development. I will tell you briefly that our four point reform agenda envisages important changes in the economic policies, further liberalizing tax system, fundamentally changing the mentality of tax administrators, banning the freezing of current accounts of companies without court decisions and also introducing startup financing mechanisms for innovative young people, young entrepreneurs without pledging their parents properties to the banks. This is briefly about economic block of the reforms but three other blocks are important education reform to channel government financing to those professions which are most needed for Georgia and also emphasizing more importance of professional education. And third block is introducing new model and strategy for infrastructure projects and we have excellent cooperation with World Bank. Yesterday we had an important meeting with the president of World Bank discussing strategy change to speed up infrastructure development to create important spinal infrastructure, transit infrastructure and build the roads connecting the main tourist destination. But fourth block of the reforms maybe one of the most important is governance reform to change the spirit of the government to make it more customer friendly to make it more service oriented to expand the existing public service whole concept to cover all the needs of legal entities and companies under one roof and single window principle and of course to create digital space where all these services will be available. Beyond that we have important reforms such as pension system reform that will be launched in the third quarter of the next year which will be based on compulsory savings and also which is done again with the help of World Bank and also capital market fundamental overhaul that is very important to absorb the resources accumulated by new pension system and also to give the exit opportunities for portfolio investors in Georgia. This is about economic reforms but this cannot be reached without improving security outlook for Georgia. And unfortunately we are in a situation where we have two of our genuine territories occupied by Russia. We have Russian military bases back to our soil and recently it was announced about proposed referendum of South Africa. It is out of satious potential joining of Russian Federation to keep this instrument hanging above Georgia's head in case worse of summit delivers something that can be discussed as an important progress on Georgia's NATO aspirations. Also this morning we heard that President of Russia signed the ratification document of border delimitation with South Ossetia, Republic of South Ossetia which again is absolutely against international law and serves as a way to deteriorate security outlook in the region further. Under these circumstances and under the circumstances where we have tensions in mountainous Karabakh, when we have tensions in Ukraine and occupation problems again for Ukraine, it is becoming more and more important to consider Georgia as an important ally and friend for the United States and to expand existing format of military cooperation with the United States where we have European reassurance initiative to build Georgia's interoperability with NATO troops and to expand this format and to cover more deterrence capabilities and to build deterrence capabilities of Georgia military in order to protect itself from foreign invaders. And this is something to underline that during these 25 years Georgia remained as an important ally and strategic partner for the United States. Loyal friend in which we need to continue this trend, we need to expand and deepen our cooperation with the United States including building more presence for U.S. corporations, more economic presence for U.S. companies. Now situation in occupied regions remains very fragile. Humanitarian situation remains is deteriorating every day. Two days ago 17-year-old boy was captured by South Ossetian militia and is kept in prison just for crossing this so-called border occupation line or administrative border line. We can put it either way and just chasing his cows. He was just an ordinary shepherd who was chasing his cows and it happens almost every day, every week. We have Georgian education in Georgian language banned in Abkhazia Gali district which is a violation of fundamental rights of Georgian nationals living across the administrative border line. But despite all that our commitment to rebuild peaceful, friendly relations with our Abkhazian and South Ossetian friends and citizens remains absolutely fundamental in our future policy considerations. And for this we are building our relations. We are proposing numerous social projects, free healthcare, free education for our Abkhazian and South Ossetian friends and we definitely see ice melting. But for this to sustain this path again we need international support especially from our strongest international partner United States. Now about democratic reforms and here I think we can be proud of promoting several important reforms in law enforcement institutions, in prosecutor's office, in Minister of Internal Affairs where we have chief prosecutor reporting not only to government but also to the parliament today. And we have already passed two ways of judicial reforms in the parliament and the third way of the reforms is already sent to the parliament. This does not mean that we feel satisfaction with the results that we have reached. Of course we are not perfect. We fully realize that there is a long way to go until reaching higher and higher standards of democracy but there is definite positive trend in Georgia and no one can resist and no one can reject observations of international institutions such as world governance indicators, recent figures showing the improvement by 10 to 15 percentiles in each of the areas such as freedom of expression, absence of violence, stability, quality of regulations, etc. These are remarkable achievements and again Georgia remains in this region where we have different styles of the countries and where we have absolutely fundamental existential challenges to our freedom and to our democracy. We remain democratic. We remain dynamic in our development. We have important milestones this year. This is first of all our parliamentary elections of this October which will be continuation of a row of free and fair elections in Georgia and we had several consecutive elections of a very high standard and we have committed ourselves to hold excellent one of the best elections in Georgia's recent history. For this again I proposed different format and style of communication among the political stakeholders in Georgia. I have already met with major opposition parties. I have already met with major NGO leaders discussing how to further improve election environment in Georgia and how to make political process even more civilized and we have clear positive results in that area too. Before the October election we have important milestone. This is NATO Warsaw Summit and we aim at reaching appreciation of Georgia's progress and deepening and widening cooperation with NATO. We have important achievements in the recent period. Inauguration of NATO training and evaluation center close to Tbilisi where we have important training of our military. We also aim at plugging into Blexi security platform which was proposed recently which will be important platform for Georgia's further integration to Euro-Atlantic family and community. In conclusion I would like to mention and assure you all that Georgia remains reliable friend for the United States in South Caucasus. Georgia is changing towards better standards. Georgia is Europeanizing its institution, consolidating its democracy and going to higher standards. And this path is not reversible. There is a very strong commitment for Georgian government, Georgian parliament, but most importantly for Georgian from Georgian people and no one can change this path. Despite all the challenges we will continue to develop our country in that direction. Thank you very much. Your support is crucial and I am very glad to be here and I will be very glad to answer your questions. Thank you. Welcome. I'm Bill Taylor. I'm the Executive Vice President here and I'm very pleased to be able to moderate this discussion with the Prime Minister of Georgia. Prime Minister, a great opening statement, a great speech, a great description of the kinds of things you've been talking about here in Washington. You will continue over the next couple of days. Already spoken to the Vice President, opportunity to now speak to the American people. You talked about the economic promise of Georgia. You talked about the security challenges of Georgia. And finally you talked about the democratic progress and the direction that you're going in, most pointedly on the elections coming up in October. As you said, the progress in both the economic and in the democratic depends on security. And as Nancy Limbaugh mentioned, in her opening the world has noticed your pragmatic approach to one of the biggest threats that you have acknowledged, that is the Russian occupation of part of your country. Other nations have taken a more confrontational approach. You have taken a more pragmatic approach. But you just mentioned that recently with the threat of a referendum with the signature of delimitation of the border, there have been indications that that pragmatic approach may not be effective. And I'd be interested in your description, your thoughts about where your relations with the Russians may be going. Well, thank you very much. And I will just say briefly that despite the challenges that you just listed and we described here, I think pragmatic approach works. Because we have been able to avoid further deterioration of the security situation in Georgia. We call it a survival policy. Because we need to be constructive in order to not provoke our neighbors for further conflicts. Because there is no military solution to this conflict. There is no military solution to our occupation problems. The one thing that stays most important in Georgia is to stay very consistent in our foreign policy. And the fact that we have several formats of negotiations. This is first of all Geneva International Discussion format. And we have informal format between representative of Georgia Prime Minister and Deputy Foreign Minister of Russia. They discuss humanitarian and economic issues. We need to sustain these formats in order to cool down the temperature and again to allow Georgia to attract investments and to grow and to continue democratic reforms. And I think this strategy works because during these last four years, despite signing of treaties with Abkhazia and South Ossetia on cooperation and integration, despite severe humanitarian issues on the occupied territories, again despite announcements of proposed referendums, this will not prevent Georgia going forward with its foreign policy aspirations. And this is to build European Georgia. This is why we need European Georgia. We need to build better life conditions for our citizens. We need to build strong economy. We need to protect human rights in Georgia and Georgia out stands in the region with all these achievements. So the fact that we are occupied, the fact that different agreements are being signed should not prevent Georgia to continue its path with the West. And to continue this path with the West, we need to cool down the temperature. And this constructive, so-called constructive approach is for creating enough space for Georgia's Western development. Prime Minister, I've already gotten some questions from people here in the audience, which I will read. But if you have other questions, please hand them to people who will be coming up and down the aisles. On your last point about moving in the direction of the West, both integration into the EU as well as NATO, you say cooling down the atmosphere, cooling the temperature is important. But you also mentioned military cooperation. We here at the Institute of Peace are looking for the non-violent ways of solving those disputes. Are you saying that there are military component as well as this, as you say, constructive or pragmatic approach? Well, I mentioned building Georgia's deterrence capabilities, which means that we don't want this military capacity to use it against somebody. We need this capacity to defend our territory and our territorial integrity. And for this, I think Georgian people have absolutely all rights to continue strategic partnership with the United States and to build this essential capacity for Georgia. Prime Minister, one of the questions reminds us, if we need a reminding, that your defense minister has been here several times. And she's been very clear about the direction of Georgia and reinforces a lot of what you said here. She mentioned in this building that NATO is peace. And that would tend to reinforce, I think, your statement that deterring conflict is better than engaging in conflict. However, as you have also pointed out, movement towards NATO can be seen by some quarters as provocative. Your defense minister has, she's moved clearly in that direction. You have made the same point. Your thoughts about the NATO summit coming up in Warsaw? Well, one thing should be very clear for everyone. Any talks with Russia, any constructiveness, any trade that Georgia has with Russia today, and we consider this trade as not something strategic. This trade accounts for less than 10% in Georgia's trade portfolio because we have developed trade with EU and it accounts for 33% now in Georgia's trade portfolio, trade with EU. And any constructiveness, as I said, cannot be at the expense of Georgia's territorial integrity and sovereign decisions. Sovereignty and sovereign decisions, which means that the fact that we are trying to cool down temperature does not happen at the expense of any compromises in our territorial integrity and in our sovereign decisions. Our sovereign decisions to continue foreign policy towards EU and towards NATO and to continue our strategic relations with the United States is a decision of more than 80% of Georgian population. And this is a very strong statement from Georgian population after all from our constituents, the opinion of which is very important for us. And this is also our internal emotional decision to continue this path towards Europe and NATO and strengthen the relations with the United States. So NATO summit, even if there is no consensus among the NATO members, it is a very important summit to mark the progress towards NATO, to mark the progress that we have achieved in implementation of substantial package that we have after the Welsh summit. An opening of training and evaluation center was a remarkable achievement for Georgia, but also to expand the existing formats of cooperation with NATO towards something else. And that something else can be Black Sea security platform that was recently announced by the NATO leadership and also having more cooperation, military cooperation with the United States in a bilateral format to create, to build deterrence capabilities for Georgia troops. Prime Minister, one more question from people here, still on the Russia question. And that is, Russia's economic decline looks to continue. Thank you. As Moscow runs out of economic options to shore up its economy, what are the implications for the Georgian economy? Well, we cannot predict what will be the future actions of Russian leadership. We can only say that what we need to do is we need to build our own country and to strengthen our own capacity in order to defend ourselves from any potential foreign aggression. We cannot predict what will be the continuation of the pattern of foreign policy from Russia. We have seen occupation in Georgia. We have seen occupation in Ukraine. Again, we experience severe humanitarian issues on the occupied territories. As the economy downturns in Russian Federation, it may result in several scenarios. One of the scenarios can be shifting Russia inward towards its internal problems. Another scenario which is something that creates worries for Georgia is concentrating more and distracting more internal attention from Russia towards external issues and more severe actions in terms of occupying maybe more territories surrounding Russia in its immediate neighborhood. So nobody knows. But, of course, we need to be prepared for any kind of scenarios. We need to continue and try to do all that is possible in order to avoid any further complications with Russian Federation because it can kill the chances for Georgia to continue this very, very positive trend. Prime Minister, it's not just the Russians that are causing problems in the region. And we have a question here from Dr. Susan Allen from George Mason University close by. Mr. Prime Minister, you mentioned your efforts to reconcile peacefully with the Abkhaz and South Asetian people. You mentioned free healthcare and other incentives to move them in your direction. And you noted the need for U.S. support for your efforts in this area. What specifically can the U.S. do to help? And at George Mason University, she says, we convene Georgian South Asetian discussions. We would love to host Georgia and Abkhaz and South Asetian students to study conflict resolution together. So the general question is, what can the U.S. and Georgia do together in that part of the conflict? Thank you. It's a very interesting question. First of all, U.S. is doing already a lot by, through participation in Geneva international discussions at a very high level, which is very important for leading successfully these talks. And I can say that several recent rounds were more or less successful. At least it did not end up with work out of the participants of these discussions. And we have some progress through re-establishing conflict and problem prevention mechanisms in the Gali districts of Abkhazia. I can only say that there are different ways to help Georgia to rebuild these relations. And again, building peaceful Georgia, attractive Georgia for our Abkhazian and Asetian citizens is a way, is the most important and most productive way to reconcile these conflicts. And I think U.S. is helping a lot Georgia to improve the country, to improve the living conditions of Georgian citizens, to make Georgia more attractive for Abkhazians and South Asetians. But it cannot happen automatically because during these years the trust was lost. We need to admit mistakes from both sides. Unfortunately, we went too far. We could have taken more decisive steps during these 25 years. And unfortunately this did not happen because this was very sensitive issue internally for Georgia and there was no progress during these 25 years. Now we need to, and we are drafting peace roadmap for which we need to first of all consolidate opinion in the society, in internally in the society in Georgia, among Georgians, and after this put this roadmap forward for discussion with our Abkhazian and South Asetian citizens. I am cautiously optimistic that we can reach progress. We can observe Abkhazians crossing ABL to attend Interpolisi football final last year. We observe so-called MacDonald diplomacy close to the ABL in several kilometers from ABL where we have Abkhazian representatives. We have representatives of young generation coming and talking at the patio with their Georgian peers. So this is not enough of course. We need to make decisive, brave steps in order to improve the chemistry, people-to-people chemistry. We are determined to compare very attractive road map for our citizens in Abkhazia and South Asetian. Prime Minister, another conflict in the South Caucasus region of course is Nagorno-Karabakh. And Georgia, as I understand it, has offered to be of assistance in trying to resolve that. The conflict has tapped down a bit, but that was a constructive offer that Georgia made. Thoughts on that conflict? Well first of all we are very concerned with the tensions in Nagorno-Karabakh because it can destabilize not only Armenia and Azerbaijan, but it can destabilize the whole region and even the wider Caucasus region. I made statement expressing hopes that with the involvement of representatives of international community and politicians we will be able to cool down this conflict and to decrease the tensions. And fortunately we have some de-escalation recently, but of course this is not enough. This conflict needs a long-term solution and there is means format that does not reach any important results. And what we could do in that difficult moment just to offer Georgia as a venue for discussions of long-term solutions for this conflict. Fortunately again tensions are down a little bit today. We hope very much that it will not aggravate in the next days and in the future because again it can destabilize the whole region. There are Russian commitments to Armenia in case it goes beyond Nagorno-Karabakh. There are Turkish commitments to Azerbaijan and you can imagine how disastrous it can be if this conflict goes further and further. Prime Minister, you have mentioned, Nancy mentioned, the senator mentioned 25 years of independence anniversary. There is another anniversary of today. 30 years ago it was the Chernobyl explosion. And you have mentioned Ukraine, others have mentioned Ukraine here today. Georgia has played a role in political developments in Ukraine and indeed in the reform attempts at Ukraine. Georgia has a problem with occupied territories. Ukraine has a problem with occupied territories. What lessons do Georgians have for Ukrainians as they face similar threats, similar challenges? Well first of all I would like to confirm that Georgia stays very supportive to Ukraine's territorial integrity and sovereignty. We extended different types of support including humanitarian aid from the very beginning of military clashes in Donetsk and of course we made a number of condemning statements after Crimea occupation. Lesson that we learned from the history is staying consistent where you are and staying consistent with your goals of developing country and developing internally the country towards higher democratic standards is a remedy against everything. If you compromise, if you make some compromise in territorial integrity, in your foreign policy aspirations, if you make compromises in democracy development within the country in fighting corruption, this works on the hands of occupants of course. And of course there should be consistency and there should be will to change the country. And this is lesson that we learned. We hope very much that Ukraine stays engaged in Eastern partnership format. Ukraine stays engaged in its reforms towards EU. And we are very glad to hear recent statements about fulfillment of liberal visa liberalization and a technical assignment by Ukraine. So we are very supportive to Ukraine and we hope very much that we will remain in the same club towards Europe together. Prime Minister you mentioned elections coming up. We have elections coming up of course. One of the questions here says that polling in Georgia shows unemployment and the economy or vote are the main voter concerns as you approach these elections. How will the Georgian dream political party convince the electorate that it would address these issues after losing support? And a related question has to do with the Rostavi 2 television, which is part of the democratic openness, the transparency that you addressed as well. Thank you very much. First of all on job creation. The 4.34 agenda first of all that I mentioned is designed directly for job creation, towards job creation. Education system to make it more need based, to place more emphasis on professional education, to engage private sector in education projects is something that directly plays on the hands of job creation process. Startup financing facilities, liberalizing further tax system where we are introducing Estonian type of taxing where there will be no profit tax if the earnings are invested, reinvested. It means that only distributed earnings will be taxed. It means that we are consolidating internal investment resources and at the same time creating a success story to be sold outside of Georgia for attracting foreign direct investments. And Georgia stays one of the most open economies in the region. Georgia has excellent potential for becoming a trade and logistics hub regionally. We see more and more international companies opening representative offices in South Caucasus in Georgia in Tbilisi, which means that Georgia is on the right way. We have a slight decrease of unemployment rate in Georgia. And of course we will continue these important reforms, including upgrading and modernizing Georgia's infrastructure to increase transit flow through Georgia, which of course will create additional jobs. During the recent years we came up with important initiatives such as producing Georgia, such as various incentive projects for agriculture, which of course turned out to be very successful. And of course we will continue that project. But most importantly, the governance reform that I mentioned, and making a major shift within the mentality of the government officials to make government more service-oriented, to eliminate further any barriers for getting services from the government and to make it user-friendly and to make it inclusive. And recently we created investor council. We have World Bank, EBRD, IFC, American Chamber of Commerce, all major business association leaders sitting at this council discussing all the upcoming changes in legislation so that there are no negative surprises for business communities. So all these changes of course will dramatically improve business climate in Georgia. And it is already very favorable, but of course there is room for improvement always. And I think that by conducting these important reforms, we will create Georgia as an important place, attractive place for investments. And there is no other way. There is no room for Georgia for becoming protectionist. There is no room for Georgia to close the borders for imports. We are 4 million population country. The only thing we need to do is provide good climate to provide protection for our exporters and to provide excellent doing business climate for any international investor. To promote our free agreement with European Union countries, to attract investment from regional countries, from Gulf region in order to create enterprises for further exporting goods and services to Europe. So this is basically what we are doing. But for all these to be efficient, we need security, we need democracy, we need rule of law in the country. And these are of course one of the most important issues in our agenda. Prime Minister, we are out of time. You have given us a great description of both the challenges and the way forward in Georgia. We want to thank you very much. You said you wanted to lift our spirits. Well, you have done that. Thank you. Please join me in thanking the Prime Minister of Georgia. Thank you.


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The game does cater to those who are colorblind and there are even more extra characters. Puzzle Bobble Every Bubble is available on Nintendo Switch right now. Why don't you go check out Puzzle Bobble Every Bubble by clicking on the links down in the description. So this is a little bit of a strange video because it involves a leak for a Nintendo Direct that isn't even confirmed yet to be happening and it's coming in a way that we've already been taught a harsh lesson on in the past about stuff like this. However, I mean, at least this is an account that's been around since 2019. So they're not new and look, we learned a lesson about this a while ago, but we were gonna talk about it anyways on the off chance that this person is not just pulling another fast one and because frankly speculating on the next Direct is just a hell of a lot of fun. So what are we talking about? Well, we got a couple of game supposed leaks from a Twitter account that has gotten stuff correct in the past. Now raise your hands down in the comment section. If you've heard that one before, you guys remember some of the other ones we've covered in the past, it turned out to not actually be legit leakers even though they had gotten the stuff correct in the past as well. Turns out one of them in particular, Samus Hunter, was just taking leaks from actual insiders and posing them as their own in a public facing way and claiming all of the credit. You know, that's a pretty shady thing to do. Can't credit Emily Rogers or Nate The Hater or the people that actually put this information out there. And hey, I'm just as much to blame there because I was giving Samus Hunter credit. Oh, and remember Waddle Dee knows? Yeah, a fake account made by a certain well-known person in the YouTube area, especially in John who now works at CVG.  Now, I did do a little digging into this Twitter account we're about to talk to, looking at other websites for deleted tweets and I didn't see anything or any red flags to suggest that they are pulling a Waddle Dee nose but as we've had to learn over time, this is a Twitter account I've never heard of. It is one that follows nobody and honestly, I found out about it because of my Nintendo news, not because of somebody like messaging me about it. It appeared on a news website. So we're gonna talk about it because the account we're talking about is pyoro underscore ND. Now again, again, I put my disclaimers out there. This could be another Waddle Dee nose situation but the reason they're getting attention is because of some stuff they've already done this year. As an example, on June 6th, they said hashtag Sonic Superstars, which by the way, Sonic Superstars was technically not known. That was a surprise heading into or coming out of Summer Game Fest. So to be fair, nailing the exact name of a Sonic game, that's pretty interesting and look, that's something, right? Again, could have just been a lucky guess. They also said back on May 29th that that would be the week that everybody's one-two switch would be announced. They said Nintendo will announce a new first party game this week, which is a sequel to a game released in 2017. And obviously we find out that was everybody's one-two switch. They also got some other stuff like saying like a new Samba Amigo game will be announced soon and that happened in the February Direct, a new Armored Core and that, you know, whatever and that was announced way back when. So the point is that they have a little bit of a track record here of getting stuff correct. But of note, again, we've been down this road before. I don't really know how else to verify the track record of this Twitter user. If you guys have a way that you could verify it, hey, go ahead and do a form and provide the evidence because I went through three different websites looking at old tweets, looking at deleted tweets and not seeing any red flags. So what is this person saying? Anyways, it's gonna happen at this Direct that either happens tomorrow or not tomorrow, but either happens Wednesday or Thursday, right? And those are the two days as we can happen to either be announced tomorrow for Wednesday or be announced on Wednesday for Thursday. At least that's what people are saying. I don't really know. Nate, the hate so far is only commented that it would be happening like in June or that we shouldn't rule out June, but other people have like that Brazilian website we talked about yesterday is literally saying it's happening this week, either Wednesday or Thursday. Look, I don't have any sources on this, but we're gonna talk about this because this is very interesting. So this person put out there and said, in case you're wondering what games will be announced in this week's Nintendo Direct, there will be a new 2D Super Mario Bros. game, any remake of a Super Nintendo entertainment system classic. Now, that could be anything. That could be anything. We don't really know what it is, but it could be anything. Now they went on to post a few things that have people making some guesses as an example that this will not appear in the title, if you guys remember the last 2D Mario games, all had like new Super Mario Bros. and stuff. So it's not gonna be part of that line, apparently it's gonna be an all new 2D side scrolling Mario game, which I think is what most people expected. And the other weird thing is they posted up a jiff, a meme jiff of Yoshi, making people think obviously of games like Yoshi's Island, especially the one that used that FX chip back in the day on the Super Nintendo. So yeah, you have people kind of speculating that maybe that's the other Super Nintendo game coming back, getting a remake, et cetera. I don't know, guys, this is just a lot of speculation and guesswork at this time. Now, there's obviously some things we do expect to see if there is a direct this week. As an example, the next wave of the Mario Kart 8 deluxe DLC, right? Like that, we should be seeing that or at least getting it teased. Even if it doesn't come out this month, let's say it doesn't come out till July. We don't know. We should be seeing it though, right? It should be getting advertised. We should be getting advertisements for other DLC that's already been announced. I know many of you are expecting tears of the kingdom DLC at the next direct, be it this week, next week, whenever. And you know, that's probably a reasonable expectation at this point. They've really slowed down on updating the game ever since they released that update that kind of nixed the most popular duplication glitch, at least the easiest ones to pull off, but it hasn't really been any more updates to the game. So people kind of figure maybe they're just all in on this DLC and sure, that possibly could happen. I haven't beaten tears of the kingdom story yet. So I don't even know what directions this could take, especially if there's story DLC, but a lot of people think that could be happening. There's a lot of possibilities here. Some people even think we might hear about a 3D Mario. There was that fake leak. Oh my gosh, we even go over this.  It came from Reddit or something. It's not. I'm gonna tell you right now, Nintendo Directs have had leaks in the past of some of the games in the presentation. They've had leaks of half or a third of the games in their presentation, but they've never released in a document form like this. So all these documents, and by the way, I used to cover these years and years like decade ago, they're just not something that are worth doing anything but either having fun speculation about or just laughing at, right? They're not meant to really be taken seriously or at least they shouldn't be taken seriously because they're always fake. There's no PDF files or magic emails floating around that have the entire list of everything that's in the Direct. In fact, I don't even think that's how Nintendo, I don't even think Nintendo has a giant compilation list of everything that's in the Direct and one reason is to prevent leaks. So anyways, you guys let me know what you think about this down in the comments below. Are you excited for a potential new 2D Super Mario Bros. game? By the way, Zippo said that there was gonna be a 2D thing as well. I don't know how much you guys trust Zippo anymore. He hasn't been right in a very long time. So at this point, he's got so many, you know, I don't know, flies stuck on the flypaper that one of them is gonna turn out to be real at some point. Oh man, this is what happens guys. We are so hyped for the next Direct. We're so excited for what it is. We want every little morsel there can be. Really, we just need the event to get here and all I know is if there's a new 2D Mario game here or a Yoshi's Island or something like that, I'm gonna be really, really excited because those are some of my favorite franchises. And Yoshi's Island in particular, we hardly basically don't get anymore. We get Yoshi games still. And the new Yoshi line of games is certainly really, really good. But not on the, you know, they're not Yoshi Island games. That's a very specific line of Yoshi games. And yeah, obviously a side scrolling Mario game. Last one we got was back in 2012 at the launch of Wii U. So it's been over a decade. It's definitely time for another one. But what are they gonna do with it? What's the art direction gonna look like? That's another thing people wanna know because if you're gonna differentiate from the new Super Mario Brothers line then you can't really go with that style. So you're gonna have something that's different. I don't know. You guys let me know what you think about this down in the comments below. Do you believe in this? Do you just wanna believe because you wanna believe a Direct is happening? I wanna believe a Direct is happening. And hopefully we find out in less than 24 hours. Thank you guys so much for being here and I'll catch you in the next video.