All right, hello everybody. We are live this afternoon with one of my dear friends, Dr. Joy Miller. I am just absolutely delighted to talk to her today because she is a wealth of information and she has done some absolutely amazing things which she'll tell you about today in the last, well, her whole lifetime, but there's been a few really significant things that I've been a part of this last year and we'll hear all about that today. Our keyword today is resiliency and both Joy and I have stories of our patients, our clients, our friends and ourselves and how we have hacked resiliency. And today I just know this is gonna be like listening into two friends with coffee about just stuff that we've learned and every time we get on the phone we can be thousands of miles apart and even like hours or months or years apart and just jump right back in just where we left off. I'm definitely gonna introduce her formally but I wanna tell you about this woman as a friend. I remember back in Pure Illinois when I was medical director of the Integrated Medical Center with Methodist, seems like lifetimes ago and we connected, I think at one of the events that we did and it was just an instant friendship, like an instant recognition of souls and you've heard me rave about friends on this show before but Joy is just a dear precious friend and like I said, it can be sometimes it's a year or two before we talk in between but we just pick right back up where we left off and one of the things recently we were talking about is just how do we take care of ourselves during these times and for two recovering perfectionists and people pleasers, you're gonna hear just a little bit about our stories today because we love to serve, we're healers and that's our gift to the world and we love what we do but our conversation was revolving around how do we actually really set good boundaries and make sure that we're doing the self-care stuff that we teach everybody else how to do so you're gonna hear us talk about that today and hopefully just get some pearls for yourself because it's not even really about us but I'm hoping that our conversation will spark in you just some ideas and things maybe where you've not been taking care of yourself or maybe where you've been worried too much about what other people think and again, this is just coming from a real place in our own hearts of as we walk through life and continue to try to achieve more but also just be better for the people that we serve so I hope you'll enjoy this today of course this will be recorded so if you miss it, you can re-listen to it I'll be sure in any links that we talk about I will add them to the chat box and then this will be on our YouTube channel which is under my name, Jill Carnahan, into infinity so if you wanna watch it we'll be sure and share it there as well so let me give just a little bit of a formal introduction Dr. Joy Miller has so many accolades so I could spend 20 minutes talking about her basic background she's an internationally known licensed psychotherapist professional trained author and she's a founder of a great center in Pure Illinois Joy Miller and Associates she is Illinois state licensed clinical professional counselor as well as certified master addictions counselor additionally she's been part-time instructor at Bradley University and with faculty and mentor at Walden University doctoral psychology program she's a leading authority in relationship issues and holocaust studies that's one of the reasons I love her just cause she's such a wealth of knowledge if you want more information her website is joymiller.com and I hope you'll go there because I am not even coming close to scratching the surface of all the stuff the published books that she's done the programs, the women's lifestyle show and most recently the resiliency 2020 in September so and I'll let her tell you a little bit about some of those things but welcome Dr. Joy Miller and friend it is wonderful to see you it is so good to see you you look wonderful thank you, you too and I know you've been staying safe during COVID and also trying to spend time with your precious son and grand baby is it two now? two so how old are your grand babies? four and one oh gosh and I bet they love grandma Joy they get away with whatever so they love it exactly well thanks so much for taking the time today and what we wanted to dive in today again we just kind of mentioned it on the phone and then I know we both thought that this would be helpful for people is both of us have really been touched by Edith Eager who's an incredible woman written two books recently The Choice and The Gift and I can include links to these and the reason I was introduced to her was actually on your resiliency 2020 tell us just a little bit of what you just did recently and how many people it touched I really wanted people to hear this and go back and sign up for the next one well it was just one of these events that was a miracle in my life I don't even know really where to start we were going to do a resiliency conference and then the pandemic came and we had to punt and I decided to do a streaming webinar and in the process we already had a couple of celebrities but we thought I wonder if we can get some more we already had Arianna Huffington and we had Alainis Morissette and we just started contacting more and more people I called Erin Brockovich because I knew her and she said of course I'll do this and we ended up getting 27 celebrities from all disciplines to talk about resilience and everyone spoke with their own voice they donated their time their energy to the cause and our purpose was to just have different voices speak about resiliency their views of what helped them become resilient and it ended up being a four and a half hour streaming webinar which included 5,000 participants for 69 countries around the world and we also for a final speaker ended up getting Glenn Close which was a surprise to everyone but then we didn't tell who the final person was and we ended up getting Dr. Jill Biden to be our finale speaker it was an amazing event we have at this point we had 444 people that downloaded the webinar after the event and we have a constant kind of barrage of people saying can we watch this, can we see it again so we're making arrangements right now to make that possible oh good and can they where can they find more information about that event about potential future event well they would go to Resiliency20 well now it's Resiliency2021.com and we're hoping in the next two weeks that people will be able to sign up to re-play the webinar and to find out information about next year Jill you're one of the participants for next year I just found out that Ariana Huffington will be joining us Rhonda Ross will be joining us Edith Peter we have, I think at this point we have almost 15 different celebrities that are signed up already and it'll be September 9th of next year oh I am, Joey I am totally beyond honored to be part of it and was this year too I was joking because I'm like I don't belong in this crowd but it's just it's truly an honor that you've asked me and I really enjoyed it and I can't wait till next year I can't either, I can't either so well this is and this is how so I'm gonna tell you a little background I think I shared a little with you but for listeners so I grew up with stories of Holocaust survivors and I grew up with especially the right they call her the righteous Gentile Corrie Ten Boom who actually hid in her house some of the Jewish survivors and her and her sister were in Auschwitz and her sister died and I just, I have had such a heart I'm not Jewish but I love you and I love all my friends who have that heritage so much and I love just the resilience that you have shown and the voice that you bring and I have such, I don't know why but for some reason it touches my heart very deeply of the suffering that your generations have gone through and Edith especially I had not known about her but as I read her books I love them and I love her so much if you haven't read the gift and the choice the choice was the first version of the book of her life story and memoir and it is so impactful and then the gift is more recently and I highly recommend reading these books Edith Eager, E-G-E-R is her name and she is just the most beautiful soul you could ever and you can hear her I actually got the audible version which aren't, they aren't read by her but they're the beautiful voice and you can hear her words and of course I have the book copy I have the copy right here the gift right in front of me and I think this was part of our conversation in the sense of I just felt like what I love about that and she even mentions Cory Timboom in her book one of her books because the theme there is number one is how do we foster resilience in the most horrific things in life and I don't think any of us could come close to what she experienced so as much as you're going through right now which may be really difficult or horrible I don't think any of us could ever claim to come close to what she went through but each of us in our journey in the difficulties it doesn't really matter we can't really compare and even Edith says that but what I loved is the theme of love and forgiveness and how this impacts our life and ability to be resilient I would love would you comment a little bit about how she might have impacted you or how long you've known her or your relationship I'd love to hear more from you Joy well Edith is new to me as well my studies were on the Holocaust and I worked with the United States Holocaust Museum in Washington and I am on the board in Chicago with the Holocaust Museum and I originally worked with 15 different survivors who were all in Auschwitz all women and my study was looking at how women coped so this has been my journey for the last 20 years and as I was teaching a class one of my students said oh today I'm going to go here Edith Eager and I was like who's Edith Eager and he said how could you not know this and he said you know she is so well known and I started looking her up and she her book was recommended by Bill Gates and by Oprah and she said it was the most life-changing book she'd ever read now Edith is an Auschwitz survivor she went in at I think 16 and she came through the lines she came to Dr. Mengele who was at the front of the line and he determined if she was going to live or die what he asked of her was to dance in front of him and so she was an Olympic athlete at that time and the way she actually survived was to take herself to another place in her mind she believes that our freedom comes from our choice of what we do in our mind and that just touched me beyond belief it was something that in all of my research I had never heard anyone say it in that way I knew that somehow people had to take themselves away from the experience but the way she spoke about the choice and how it creates freedom it touched something in me and obviously it touched something in you yeah I feel I love that that's just a beautiful snippet of her beautiful life and same thing what touched me so much is I've not had anything close to her difficulties or trauma in my life but I've had little traumas and I do believe that there's this the resilience core is the belief that and of course Victor Frankel's written extensively about this and then a hero of ours as well that will no one can take away number one Edith talks about what's in her minds and number two that will to survive like you can be physically beaten mentally tortured all kinds of things but that will inside of you the soul level no one can touch that no one can take that and no one can damage that and that should give us all hope because despite the outside world we have that ability to transcend difficulties and I mean again in some of my small difficulties relative I do remember this idea that I could trans I could go to other places I could kind of we call it dissociation right I mean but you know what we think of that as bad I was like oh it's so bad that I dissociate honestly it's a brilliant skill in the right circumstances and you're the expert here not me but my simple way to look at it is I realize wow that served me well I can go to happy Disneyland when I want to and I saw the other day this is a silly example I was getting an MRI MRIs are incredibly noisy and loud and they're claustrophobic for most of us I don't even have claustrophobia but I knew going into there I would have to mentally have strength to endure this like really really loud noise around my head it was a brain MRI while I was there and so I took it as an opportunity to dissociate consciously and I did I literally had a lucid dream and went to a whole different land had a whole different almost like a dream of being awake and I came out of there and thought wow I can do this like I can dissociate consciously from a difficult situation and have this incredible experience like I literally had probably what average you know person on drugs would have as a high but I can do that naturally and if we can tap in if we can teach people to tap into that level of consciousness and I think it comes from practices like prayer meditation I would love your take on this like how would we teach we think of dissociation as negative but there's this piece here where we can harness energy to to go somewhere and be creative and what do you think of that or what's your thoughts on this you know part of my study was looking at coping strategies and one of those was dissociation or being numb yes to say it in a different way right think about someone who let's say has been raped or let's say there's incest within the family the way they survive many of them is to do exactly what you've said in that circumstance that coping mechanism is very positive and just like with you and the MRI something only becomes destructive when we use it too much or we use it to the point that it no longer is beneficial so let's say we use eating as a coping strategy for stress when you do it too much of course then it becomes negative but the coping strategies are there for a purpose and I think people that practice meditation learn to take themselves to what you use the word transcend to take themselves to another place to whether it's your favorite place by the ocean or flying in the sky over whatever you learn and you practice to become better at it and to get to that location faster or that environment or that feeling or seeing that light and it's a very powerful technique and if you're in a place like Auschwitz you need to find a way to transcend Edith spoke about having hope and she dreamed of going back and being with her boyfriend and some of my other survivors their hope was around going back and being with their family so relational things are always very powerful especially for women because it relates to resiliency oh i love that yeah tell us let's dive in because you really are an expert in your field and um I would like if you were talking to all of us as your clients and we were looking for like say there's you know we've lost a job or we're struggling with the stress of the children at home schooling or all the things are the uncertainty of our our world with whether it's politics which we won't talk about or other things um there's just a lot of things that create stress and we are at an all-time high with stressors I've said this before but from celliers work there's four predictors of stress they're nuts novelty unpredictability threat to ego and sense of control and of course someone like Edith had all of those every day we have them off and on and I think especially in the pandemic we have a lot of them most days what would you advise your clients or your listeners here of ways that they could deal with the stresses right now um you know that's a question that I think we're all asking ourselves and people around us because the the normal things that we used to use are not working right now because we've never been in a situation like this so in the past for me being around other people would have brought me some sense of resilience that connection that that just energy made me alive now I don't have it I I can't connect I can't hug I can't be near someone so if I'm speaking to my client or more importantly speaking to myself I need to look at new ways to find that connection and to speak very personally that would be finding the connection with myself which is the hardest thing for me so I would be talking obviously to my clients about right now let's look at what you've tried in the past what's helped you get through stress what are some other techniques that we could use this humor help you this journaling maybe looking for things to be grateful for every day for me this this whole pandemic the last nine months has been about facing my my worst fear but my greatest fear I guess is being alone and this has been the opportunity and it's been the most amazing journey ever Joy I couldn't agree more and what I was just thinking as you're speaking is I think the thing that's different here is it's really laid bare most people have medicators I just use that term I heard it somewhere for whether it's obviously addictions like alcohol drugs but there's socially acceptable addictions like work which has been my past or like even you might I mean overeating under eating work even relationships or sex or other things can be medicators and of course they can be healthy or unhealthy but anything we use to escape feeling or being in the reality of what's happening to us and what I've found for most people and I will include myself is during this time we either have more time or more emotional space because we don't have so many options for medicators like if we were with people or we were busy or we were doing we might still be busy or doing or or you know on Zoom but there's more space emotionally to actually have to deal with and process the stuff that maybe we've been able to keep buried up until now do you feel like that's accurate? I do and I really think that's an amazing kind of overview of this whole concept it's this space that we've never been used to and I can only speak for myself but I would fill it with doing something else or achieving or writing another book or starting another company or who knows what or taking care of someone at this particular point I've been able to use these nine months to see that that's my way my choice to to not really connect with myself or love myself and once again it was my biggest fear that if I didn't do these things that I wouldn't be loved so it comes back to that whole relational aspect and I think for many people that's what they're discovering right now a relationship with some people their families that they hadn't been close to or this relationship with themselves hopefully without the medicators yes oh gosh and this is where our conversation led we were both in chapter three of the gifts with Edith Eager that we mentioned earlier it's called all other relationships will end and I remember us almost on tears in the phone going oh my gosh can you believe this this is so relevant to us and I wanted to read just a couple little clips and then we'll talk about how it's affected us she talks about just all relationships will end and in the end we have ourselves and we can't abandon ourselves and just like you Joy I have some deep rooted fears around being alone and even more so because of my history I was very dissociated during my cancer at 25 and then Crohn's at 26 I think I had to survive and talk about caring for the people I went into the mode of like making sure everybody was okay because that's what I did up until then and so I never really allowed myself to grieve or feel like the trauma of being diagnosed with an aggressive life life-threatening illness at 25 and so I was taken care of other people but that fear still is in me that I'm working through of like not only being alone but being alone and sick like that's a big fear of mine that I'm grappling with but she talks about this I love it because we can't abandon ourselves we always have ourselves and we start to really understand and integrate this we can't really be alone and for me I have you know my faith in God and that presence in my life and she talks about so how can you be the best loving unconditional no-nonsense caregiver to yourself and then she goes on to say it's difficult to relinquish our old ways of earning A's and discover a new way to build love and connection so for people who are overachievers and use work as a medicator again amen and then also use like like we love to serve and take care of other people and that's a that's a gift that's a beautiful thing but sometimes we can do that instead of either taking care of ourselves or instead of going to the deep roots of why we're doing that and some of the things that you and I talked about were how to no fault of there's our family somehow fostered this idea that achievement and taking care of other people was the way that we got love or we just integrated it wasn't anyone's fault but our own but we did that and so this is kind of breaking that habit and then she says and I love this because my family is very like you know we don't be selfish take care of others first although those kinds of rules and she said it's good to be selfish to practice self love and self care and I'm relearning that it's not selfish to take care of yourself and she goes on one more thing I'll read and then we'll talk when you're free you take responsibility for being who you really are you recognize the coping mechanisms or behavior patterns you've adopted in the past to get your needs met you reconnect with the parts of yourself you had to give up and reclaim the whole person you weren't allowed to be you break the habit of abandoning yourself remember you have something no one else will ever have you have you you have a lifetime and then she says that's why I talk to myself Edie you're one of a kind you're beautiful I just love her may you be more and more Edie every day so joy and Jill may you be more and more joy and Jill every day and then I'm no longer in the habit of denying myself emotionally or physically I'm proud to be a high maintenance woman and I love I'm going to end there and then we'll talk but I love this because I remember when I traveled back in the day I would go for a weekend and take two suitcases because often I took a blender and an air filter and whatever and extra shoes and I got in the habit and I decided you know what I would say in the elevator when someone said are you going to Europe and I'd be like no I'm going for the weekend and I said it's okay to be high maintenance if you're high performance and they would shut up so I'm learning this because I realized you know what to take care of myself it's okay I'm not going to apologize anymore that's a lot but I love comments joy on on that chapter and how it impacted you because it was profound it was a profound chapter and I I keep going back to she has always these little quips I hang on to and she is formally trained as a logo therapist so she's always looking for meaning or purpose but she she has this way of saying things and the the last thing that she that I actually I spoke to her this afternoon and she has something where she says you're depressed because you're not expressed expressing and I think that's so true that when we are taught whether it's a pandemic or in our stress we pull inward we become depressed we we go inside ourselves and the last nine months all of us have a choice we have the freedom to go into that depression and to just become a little ball or we can take it start to express look as we are today or just like everybody that was on the webinar to look at this as what can we be grateful for what have we learned where are we finding freedom I'm finding freedom for the first time to just feel okay with me and I know there's a lot of people out there that are probably oh what is wrong with this woman I can do that all the time I'm not I can't do that because I'm used to taking care of everyone being a therapist and checking on my patients my clients doing 10 other things and I got the love that way but I found that if I this is really maybe stepping too far over but I felt like if I didn't do that I wouldn't have the love I wouldn't get what I needed and so I it was like this constantly being on this performance treadmill with no way out yeah oh thank you for expressing what we're all feeling because that's I couldn't agree more it's just my whole journey same exact parallel that's what we we were just like I so understand you on the phone recently the same thing is like I feel this responsibility to respond to every inquiry every text every phone call every need and I'm realizing in the last nine months that I humanly can't do it like that amount of response even if I want to I can't and a few months ago it took me to a really kind of a down I've really never been depressed but I was as close as to that as I ever could have been because I was just like the joy was not as bright it was like my light instead of being bright shining was just more of a flicker and it was this depletion because I was responding to everybody's needs about my own and again there's no selfishness in making sure you get sleep and food and rest and even quiet time and I wasn't able to take care of all the needs of the world that were demanding on me and then also take care of myself and so for a while I chose the world and then I realized oh my gosh I'm not going to be I'm not going to be okay my light is going to dim if I don't really go back to the foundation and turn off the phone and stop answering every request that comes my way and again I loved we both love to help people it's not a obligation it's not something that we don't enjoy like to me and I know for you too it brings great joy to our lives but there's a limit to our capacity and I realized I had hit my limit like I couldn't go on like this and so this whole reformatting of this time for me has been what is the priority where do I want to pour out my energies and what's going to happen is as I say yes to some things that means I have to say no to others and that's hard wow that's a really big question I know you know I think first of all it's the exploration of just finding out how far you're stretching yourself and to really look at that and we do a you know one of the things that I do a lot for people that are always over responsible for other people is to have them become aware of how often they're doing that so it sounds silly but I have them put a rubber band on their wrist and every time they find themselves feeling like they have to take care of someone or they have to take care of something else aside from themselves they have to snap their wrist with the rubber band and most people come back and say oh my gosh after two days my wrist was going to be sore I had to take this off and I think it's just so unconscious for many of us that we forget ourselves and it's so easy especially as women to care for everyone else you know like you I was taught that I should not be selfish that my job my purpose my role and especially as a therapist is to take care of everyone else that's as you said it's not bad yeah unless I'm not caring for my own health but at this point in my life my purpose and my meaning has changed it's now about giving giving back in a different way with my heart and more honesty and and trying to do it not as a way to achieve love or achievement but to just be with someone in a different way and to be with life in a different way where I'm part of it not not a vehicle for fixing things for people I don't know if that needs sense but that totally makes sense I love how you how you explain this because again so relevant and the thing that came to mind that I know I've struggled with in the past is like having needs right like expressing needs and having needs I think I had somewhere learned along the line where it's better to not have needs and you definitely don't express them so like this idea that I might actually need something from somebody else but what you realize is like say you call a friend and like I'm really struggling can you go on a walk with me or I would love some time with you would you have time for coffee or I am in such a bind is there any way you could pick up the dog for me I would never try to ask those things of other people right but the truth is that's a that's a ability to allow them to love you back and so you're actually denying them of some of the love that a friendship or relationship could have but that's a struggle I've had is actually expressing or or acknowledging that I actually have needs absolutely and that I can't do it all myself and I think to be resilient you have to be able to to see that you can you need other people or to allow people to be part of your life and as you said sharing whether we're miles apart years apart we can ask of each other and it feels safe I think it's also important that we mention that to do this you have to be with safe people yes yeah yeah and that really is a disclaimer that needs to be said to be resilient you have to find safe people in your life if you keep going back to the people that have harmed you you're probably going to get harmed again yeah and so it's important as a part of resiliency to really kind of and I know this is hard for so many people but to just let some relationships go by the side yeah joey I again I love your words of wisdom because I feel like I've learned that the last several years and I have so many beautiful friendships and relationships and I've had a very few that have been pretty toxic and what I realized is for someone who's an empath and an energetic being and the extreme level I really feel other people it's this gift because it helps me to feel patience and understand where they're coming from and understand what they need from diagnostic perspective but on the other side of it I realized more than ever especially recently I really have to protect that inner circle like I can't have any negativity I just can't I would love to but I I my body won't allow it it won't function because energetically I feel it it takes me down so I've been really working on that as well and setting good boundaries not that they can't be you know connections or relationships in some capacity but the inner circle I'm really specific about who I allow there because my body and my mind and my spirit don't do negativity well and and I think it's relational and also environmental because you wouldn't put bad food into your body at this time but you have things surrounding you I look at I look at your room and it's so Jill because I see the things around you that you love and when you choose to be more yourself you you put more things around you that that illustrate the real you and and I see it there I think as we clear out our lives we do bring things around us that are more nurturing and loving versus things that we feel like we have to have oh I love that and I have to tell you a funny story about this room because you'll get this and I'm sure the people listening might too but it's a it's a funny story so I used to love the color red I bought a red BMW motorcycle I like bright red I'd wear red like bright you know in your face red and I recently redecorated got some new things in the kitchen and probably in the last year so all of a sudden I look around my house and I have a lot of this beautiful teal and I joke like this is a metaphor for my transformation in the last several years because red is very very masculine very in your face very very vibrant and loud and I think it was compensation for the fear of like either not being protected or not that being in touch with that feminine side and lots of things I won't go into this is a whole psychological discussion but all of that to say you get the idea red is a little different than this very gentle teal color like I come in here and I literally I'm like I love this room it so feels like my soul feels refreshed and calm and then now in my kitchen everything has it was accidental I had no plan but I looked around subconsciously everything's now teal so I joked with a friend I'm going to have to repaint my BMW motorcycle to a beautiful teal color but this like it's a metaphor for the transformation from accepting all parts of ourselves and I've talked to another fellow medical doctor who's a woman in this masculine world and we talked about the years 10 years ago you remember this I would wear a black pants suit when I'd speak that's not me like I but I did because I had to fit into this masculine world I'm actually this delicate flower I hate saying that I'm actually really tough too but I'm really sensitive and I never acknowledged that half of me for most of my life I felt like I had to be tough I had to be masculine I had to be red and all of a sudden in this transformation I'm embracing this delicate tender sensitive side I'm sitting and meditating instead of running out and doing orange theory these transformations are very very real and so most of us have a bent towards one side or the other but when we acknowledge the full spectrum of ourselves all of a sudden we redecorate so interesting and I never really considered the red part of you you remember right like you probably I do you know me you know but didn't wouldn't you say the years ago when you I was much more masculine and I feel like I've really transformed and tried to embrace that other side of me well I feel like you or me I mean you'll people behind me I've got the red my world is in red here and then very Asian but I feel that tranquility from the environment and the color allows me to be expressive for the first time for myself I love it it's like we have these both sides again the red is there's nothing wrong with I love red and I love my red BMW and I love the teal but it's almost like how do we find these and I think the environment the color can actually help us be more of who we were meant to be because I love your decor I'm I've seen other parts of your home and other places and I think it's absolutely stunning and I can see how it would encourage you to have more of a voice absolutely and you know we're talking about this and it's funny because I've been talking to two people who are actually decorators and designers about being part of the resiliency conference because I really believe that our environment and shaping it and creating a design around us in all ways is a very very powerful tool to kind of express not only ourselves but to find some peace and some tranquility I mean it's kind of like if you go to a hospital you'd never paint the the room red yeah there's a reason why they paint it yellow or blue I want you to be calm exactly I love that and I love how this is because it really is an expression this transformed when I painted this room and who knew and now everything's teal instead of red one thing as we were talking before it reminded me of one of the last summaries of this chapter and just a practical tip we could give to listeners is Edith talks about writing for a day or a week in your journal what percentage of time do you spend on work love and play and sometimes like say you're in the clinic say either one of us are seeing clients we might be loving and working at the same time and I just thought about that I haven't really done the exercise yet like over a 24 hour period but I'm guessing I might be like 80% work and 10% play well the love I think would be in there so maybe 50 to 60% love or yeah love 80% work and then like 10% play I'm not very good at playing but I was encouraged by that because I think like that's an area of growth and one thing I've done three years ago I had some friends who loved to color and I was like oh brother I never I don't have time for that like who would sit down and color it's a waste of time well now Joy I literally drive around in my car and I have a bag of coloring books colored pencils and pens because if I happen to stop at a coffee shop and meet a friend we will often now color and I love it and it's plain and it's playful it's interesting because it also connects you back to your inner child and part of your inner child that you didn't get to have yeah and I think that's for many people one way to really not only express themselves in a new way but also to connect to parts of themselves that many times as children we find ways to protect ourselves we find ways to be more resilient and then we lose those techniques and those capabilities because it's not cool or we think it's stupid but you know I find myself coloring all the time it's great to have a granddaughter because oh I love it all the time and do crafts I love it and I've seen some of your darling videos and they just make me smile oh I love it gosh there's so much else we could say you know one thing else that might be practical to leave with people I remember this I wrote this this is in my journal from Edel's book that it was she was talking about when she sees clients she's a psychotherapist and she would always ask these four questions and so this might be practical for you guys listening she'd say and this would be to liberate yourself from victimhood so kind of part of that chapter she said what do you want like for yourself not for anybody else and the second question is who wants it because often we're like oh well my dad wants me to go to school to be a doctor well what do you want you know what do you want so it's just like separating that out from not just what you want or think people want you to want but what you actually want so the second question is who wants it is it you or somebody else the third question is well what are you going to do about it because often we have these dreams these ideas these things to free us to be the person who was meant to really be but the last question is when like when are you going to do it so making a plan and I just I wrote this down because I thought what a great thing for me to really check in with myself every bit about what do we really want and how do we get there and I'd love to hear joy you've done so many amazing things and I can't even begin to name them all you've written at least seven books and you've you've done the women's lifestyle show in Puria that's been super successful for decades because it was when I was back there now the resiliency and many many many other things what's next for Joy Miller what where are you what would you like to see yourself it's an interesting question because someone said to me once we we spend half a year in Florida and there's a our dear friends one of them is a physician and he knows me and he's saying joy why do you keep doing these things you know you've done it all you you see something you do it whatever why can't it just be enough and the point for me and I've heard either say the same thing because it was when I was sorry is that time is limited I want to be able to experience and feel everything that I possibly can so whether it's spending time with my grandchildren or walking on the beach or whatever I I really think that what I want at this point the when is now for me and it's really to allow myself to not necessarily get awards achievements whatever but to really be with the universe and breath and life and to watch the ocean and to really be with people right now I can't tell you how wonderful it is to just meet someone and to say tell me how you got where you got I want to hear about you I don't want to hear your achievements I mean all that stuff is just different clothes yes I've done a lot of things yes I've had achievements but I really want people to know the real inside of me and if they're not willing or they have no interest then I need to move on and so right now the when is for me is now and it's to be the the most real I can possibly be gosh we are so aligned I feel the same way just like what does this really look like because am I on I always joke about the dancing bear which is like a performer and a lot of times in my life I felt like I had to perform to achieve love or achieve compensation whatever and I'm moving away from that model I want to just be myself and not be dancing for accolades any longer and like you said just be seen and loved for me now I love what I do in medicine don't worry I'm not going to stop seeing patients that's such a joy for me it gives me such a joy and I love to do that but the other thing is maybe that I traveled a lot before March of this year and it was really hard on my body I don't think I acknowledged it and so I think things are going to be different and then writing is this creative kind of solo endeavor and it takes a lot of time alone I love it it's still very difficult but that's a whole different thing so who knows but I'm doing the same thing is reevaluating where are you know where does the most joy come from and the relationships that we have and the connections and even like our conversations spending time with you I have such great joy with with our conversations joy can I just add that I think it's really important that people that are listening take time and look at what have they learned during these last nine months what what can you be grateful for what have you I guess there's so many there's terrible parts of it I've lost one of my dearest friends during this time and I'm fearful that I'm going to lose my husband who has cancer but there are so many wonderful things here and I'm hoping that people can see that part of resiliency is about looking at those things and celebrating the successes that you've made you've made it through nine months you've done whatever you need to do you're taking steps and I think sometimes we forget what we're accomplishing and no one has ever done what we have done in these last nine months we are really amazing if you have made it through this this is something that no one else has ever done and you deserve to get a lot of credit because we've been through something pretty dramatic and we hopefully are coming out the other end soon yes yes I love that you say that because it is it's just that building that confidence that we are going to make it and and yeah if you need some encouragement go get Edith's books they're both so good I can't recommend one of the other final words Joy what would you say to leave people you've just given us some great tidbits of hope anything else you want to leave people with as far as just hope or resilience or tools to get through I think I'd like to leave people with I guess the hope that you take time to look at what is your purpose to try and to discover that but more importantly to look at right now who you are and what you can be grateful for within yourself and it's not about where we're going it's about what we're discovering within ourselves wow I love that because that means anything outside can be changing and and uncertain and you still have this groundedness here that transcends all of that so I love it and it's also you know I've always heard what we focus on grows and so we can focus on the good the grateful the relationships the people we love the people we have in our inner circle our patients our clients all those things or we can focus on the negative and I choose to focus on the good and that definitely gets me through a lot of days and I have the choice to find wonderful people in my life and you are one of them and everyone that's listening to you right now they are so lucky to have you in their life you are really amazing thank you joy I feel the same about you you have touched so many lives and I just I'm grateful you ever set a definite plan for us to connect and who knows what the future holds um well where can people what we gave your website is it joymiller.com your your main website and then resiliency2021.com is there anywhere else you want to give for people to find you or no I think they can find me at one of those two places I don't find too well and be sure and join next year I'm sure the information is already on the site for 2021 it's a great event and joy just did an amazing work putting that on well thank you all for listening joy thank you for coming on today I have so enjoyed talking to you as always I hope you have a great evening thank you so much


We have sessions on epidemics. Ebola and so on was very high on the agenda but now we have also let's say man-made epidemic and an epidemic threat and that's the an epidemic of untreatable infections and you know with the question will we go back in the doom scenario to the area from before the West Penicillin and we'll hear from our experts here what the causes are and particularly what we can do about it and the good news is that there's real momentum building up in terms of awareness in terms of action at all fronts because this problem is extremely complex and requires multiple actors and multiple solutions in order to get it under control so we had also an industry declaration that just came out yesterday so that's from the side of the pharmaceutical industry we have the G7 it was on the the summit in Germany was one of the of the topics and now we're here so our panel is also represents the diversity of the issue we have Andrew Witte CEO of JSK Minister Skippers from the Netherlands Minister of Health another Minister of Health from Minister Greur as you know the Minister of Health of the G7 Jeremy Farra from the Welcome Trust Director and Joanne Liu from as president of MSF, let me start with asking Jeremy how do you see things what's the problem thanks very much Peter and it's pleasure to be here there is obviously a huge problem we it's been talked about many times but I'd like to start on a bit of an optimistic note if you we are not passive observers of history if you identify an issue and then you work towards solutions you can change the course of things and I think we're at that tipping point now where if we make the right choices we can actually change the dynamic of what's happening I think I'd like to frame it we need to think of it infectious diseases but we need to be aware that all of the progress that's being made in some of the non-communicable diseases the major breakthroughs in cancer therapy diabetes care surgery all of these are actually dependent on on antibiotics and so therefore we cannot just frame this in the context of infectious diseases and we cannot just frame this in the context of the lower middle-income countries this truly affects every billion I believe we're at that tipping point where if we act we can have an optimistic scenario if we fail to act we could be into doomsday we portray this as a market failure and I think sometimes a market failure is a bad use of terms I think this is a failure of public health and I think we're going to need a new contract between the public sector the private sector academia philanthropy in order to address this this is just not a failure of industry industry is undoubtedly part of the solution but it is going to have to change its models of working in order to address issues around access in particular like to frame it in five areas firstly we have to learn how to conserve what we've got in a better way that means prevention it means changes of behavior it means engagement with society and it means of course things like vaccination we have to involve both the human and animal sector because the vast majority of antibiotics are actually used in the animal sector and the resistance comes through into the human sector and vice versa and we've got to frame it in terms of innovation in research and development whether in new drugs in conserving existing drugs or in the development of preventative measures and we've got to understand the value of this class of of interventions we've on the whole talked about them in they have to be cheap and they have to be affordable and that's very very important but we also have to truly value their contribution to modern medicine and that's going to require changes in the way we see volume and access and we're going to have to require policy changes and that gets back to my comment about public health so I believe we need this new contract between industry between the public sector and with society in order to value what we've got to conserve what we've got and develop new approaches thanks for that. Thanks Jeremy that's very clear Mr Schippers the good news is also that antimicrobial resistance has made it to the the political level because without that we won't be able to to move and particularly the reports also by Jim O'Neill in the UK have been really instrumental in waking up you know the world to say so so how do you see things from your position as Minister of Health? I think we had also a momentum 10 years ago but we failed to be determined enough to make a big steps and solutions it's a global problem that is an advantage but also one of the difficult things to solve secondly I think it's a silent killer Ebola we talk a lot everybody is talking about it seeking for solutions but antibiotic resistance we talk a lot about it but the public industry the citizens don't know so I think it's very crucial for us also to make them aware about prevention prudent use but also about that we have a problem with each other because if they don't know we have a problem they're not open for solutions either and the solutions are not only in the medical world they're also very necessary to make measures to take action in the veterinarian world and that's also very a topic that is that is very sensitive sensitive in many countries because it means that also farmers have to change the way they have their business models the way they treat their livestock and no preventive use of antibiotics or and for a whole cattle and not using antibiotics as a grow facilitator to to to see how growing gets faster so the one health approach is also necessary but also difficult and last I want to make a real we need to make come from paper to paper to implementation because we have a lot of sessions and we talk how important it is to make a solution so as a president of the European Union we organize in February a conference for the first time in its existence between ministers of health and ministers of agriculture to see how we can really make solutions and come from paper to action not to have a national action plan but to implement your national action plan to have peer reviews not to control each other but to help each other to see obstacles and see how we can overcome them and of course also very important new business models new working together in PPP with the industry to see how we can get new alternatives and new antibiotics not to use them but to have them when we need them all very good points for any action now Joanne and you're not only president of MSF but you're also still practicing emergency physician you go there where the patients are how do you see things well for us you know as I would say our first line worker is the big driver for antibiotic use is fever and then I think it's the same everywhere and our main issue about fever is the fact that we don't know what are the causes of fever so somehow we overuse antibiotic so we see it you know right away now in in Pakistan 80 percent of our newborns have in their bloodstream with a concrete fever resistance bacteria same thing you know we have appalling figures in AMAM where our well-winded patient come with a 55 percent miscarriage resistance when they have a steomylitis so we are seeing the same musical situation that we will save a patient from his in Syria from his amputation but he's going to die from pneumonia but in Montreal my old relative will be saved from his triple bypass was going to die from pneumonia so it's the same category of problem and we probably can find similar solution that would benefits everybody the the reality is in developing countries and less developed countries we don't know the scale of the issue we have no micro data especially the primary healthcare so what we see you know in our context of work it's everything is magnified easy earthquake slums rural remote area it's it's it's crisis time and so patient or either not immunized they malnourished remember the medallion children so when we see those patients we have only one shot because they will not going to come they won't come back they won't cross another front line to come and see me so by default often we overuse antibiotic so solution i was thinking about that is there's good there are solutions upstream and downstream and there are like technical solution and political solutions on the technical side upstream is we we have vaccine we know that the chemical vaccine you know if we are using it will prevent lower sleep track infection he just need to be available for all the countries we need to do more in friction control we need to in our healthcare facilities we need mini lab to be able to identify the box but we all know that all we've talked about it's so difficult to change behavior so difficult and then we've seen it you know with hiv we've seen it with malaria but what we have achieved from 2000 to 2015 is we decreased by 60 percent the mortality rate uh in malaria because we have the right new diagnostic tests rapid diagnostic tests and the treatment so we need new rapid diagnostic tests for fever that will differentiate you know a viral illness from a bacterial illness or at least will tell us the which one or the severe bacterial infection and this will allow to treat the patient who need antibiotic and the one that doesn't need it won't get it this would be the real game changer and then downstream we need new drugs of course so all those tools if we find them they're going to benefit everybody last point it's about political solution it's the global security agenda is driven by national self interest we've seen it in Ebola we're still seeing it in the migrant refugee crisis and we're still there about the Middle East but drug resistance infection is not about security is not about national interest it's about health it's about saving lives it's about government taking action because health is a public good and then we need we do need to provide but the reality we're working in failed state and so we need the right trigger to work in those states and our issue is we don't think that fear can be the driving force we've seen in Ebola we're just going to hack when nations feel threatened so we need political will beyond self-interest to find the right trigger so my summary hashtag rapid diagnostic tests for fever hashtag health is probably good thank you thank you that's the mother way of addressing it and also thanks for putting it in context but also diagnostics I mean the key there is the longitude price which is you know has launched the price for actually exactly that to discover a rapid inexpensive diagnostic point of care and that would rationalize the use of antibiotics and thereby also limit the spread of infectious and resistant factions andro we had the declaration of the industry so companies are taking up the challenge although after years there was not much investment in antibiotic development so how well just maybe just this highlight a couple of points so the declaration was published yesterday I think it's pretty unprecedented actually and there's about 85 private industry companies now biotech large companies many companies some involve some not directly involved in the space all signing up to very much the kind of themes you've just heard actually from all three of the previous commentators in terms of conservance in terms of focusing on things like diagnostics in terms on in terms of thinking about how to develop the marketplace to be responsible but at the same time incentivize so that's all in there I'd like to do I'm sure we'll come back to some of those I'd just like to drive the focus a little bit at least in these comments on something which I think is a little bit taken for granted which is that actually discovering new effective antibiotics is really difficult really really difficult we've been in antibiotic research since the early 1940s and we've never stopped in fact in the last decade at GSK we spent a billion US dollars on antibiotic research in the company and I'm very pleased to say that we have a new first in class product about to go to file looks excellent highly effective in plague tells you something immediately the fact that we're developing an antibiotic in plague and was the last time anybody talked about plague great collaboration with bar the US and other organizations to make that happen but the point of that antibiotic is its future is likely to go towards things like complicated gonorrhea and the kind of very difficult infections which were starting to see around the world so we're there now we did some work we look back over our history over the last nine or ten years and we were able to get we worked with one or two other big farmers and we looked at three companies between the three companies on average over the period of nine or ten years we've done something like 60 or 70 high throughput screens in the antibiotic space to look for particularly gram negative antibiotics so about 200 hts intervention so hts essentially is screening your molecular libraries so in our case that's probably two million chemical structures now you can then say okay the other two companies let's imagine they have broadly similar kind of volumes you're talking gigantic amounts of data to be trying to be exposed to look for starting points for products out of the 200 high throughput screens in three different companies over a period of nine years there were precisely zero hits now it's not because we're all completely stupid it's because it's a really really difficult space to make progress so that the bit i'd like to just draw attention to is first of all just by writing checks out isn't going to solve anything i honestly don't believe that i think what this is really about at the first point and this obviously is what will give us some cause for optimism in 10 15 20 years not tomorrow morning we have got to drive some really strong basic science coming from academia in research in biotech everywhere in the normal way if i can put it that way we have got to drive a greater level of open innovation we've managed to construct some very interesting semi open relationships with synovia i think Olivier is in the room with where we've seen some great progress there with the two teams working together we've seen a much broader open academic collaboration with multiple companies involved what do we need to focus on gram negative how to get drug load into patients without creating toxicity because even when we do find a hit the drug load is driving too much host toxicity and it kills the programs how many times have you turned on the radio in the morning and heard a university professor claim they've discovered the first new class of antibiotics in 20 years how many of those classes have been launched and they all go down on drug talks because we're killing the hose quick and they're killing the bug so that that for me is a big space so something around academic industrial collaboration how to energize which bridges into the market incentivization how do we turn on the biotech sector how do we turn on that incredibly inventive layer of companies who bridge ideas out of universities how do we get them excited in this space at a scale which really moves things forward and then how do we get lessons learned so that we've got pre-competitive understanding on things like tox management all of the things which are killing these drugs as they come through the system just as we've done through things like IMI and other programs in things like liver tox on traditional small molecule non antibiotics so that's a big focus for us vaccination is a huge opportunity we we we think I think Lancet published recently that effective PCV vaccination reduces subsequent antibiotic use by about half something like that huge impact we're very committed to try and do our part to make that happen the the role of Gavi in the advanced market commitment which without which there would be no PCV vaccination of scale going on in the developing world is an extraordinary example where the right intervention can absolutely drive the right behavior is not perfect but it can really move things in the right direction I don't know if that's what we need to do in antibiotics probably not but we should be inspired by the idea that we did something in a field it worked we should we should scratch our heads to come up with what the version of that is in this space yeah so also innovation is really going to be important but also I think we we may have to look at what's still on the shelf and what we don't use a combination therapy and then and then your point about vaccines I mean someone who doesn't get a child doesn't develop pneumonia the three seeds the pneumonia a vaccine against pneumococcal pneumonia doesn't need antibiotics so it's it's like contraception saves mothers reduces maternal mortality just just your point about on the shelf I think I'm Ryan saying that the PD1 inhibitors which are creating the most extraordinary excitement in immunology have been on the shelf a while yeah took as molecules right took as a took a while to figure out their role but it you know that is what we need and we've seen it in TB actually I think in TB where almost nothing happened really really really for 20 or 30 years as there's been a mobilization of frankly you know the Bill and Melinda Gates Foundation welcome the Tres Cantos operation that we run all of the various at that opening up of thinking and that plurality of innovation we're now starting to see some real prospects of something in tuberculosis and malaria also yeah so I think I think there are good reasons to be inspired the question now is as Edith said how do we connect the words and the aspiration on antibiotics to some of the models which we know work and how do we just shape those a bit and then industrialize in it and making something happen go to scale so minister good Germany has been really in a strong leadership position on this can you tell a bit about what you're doing the plans and the action that your colleague from the Netherlands thank you so much first of all I would agree with you Peter that we have a momentum in Germany people were surprised that the G7 summit of the heads of state and government addressed an issue like AMR and suddenly it was not only an expert issue but it was in public debate for a while and I hope that by the work that is done now by the Dutch presidency in the European Union as a it's not just a firework but it's continuing to be an issue that is to be addressed strictly Edith mentioned correctly the work of a silent killer it's not like an earthquake everybody can see it similar maybe to climate change that you are slipping in a catastrophe without seeing in that direct way like a Vulcan or a earthquake that's dramatic things are happening I would divide the things we are debating now and those were it's a question of political will of preparedness to change behavior and mentioned I would describe the whole area of prudent use one health approach good stewardship mostly being a question of political will we know about hygiene about diminishing misuse one health approach these things are thought through in a way but they need to be implemented and that is that area where we have a lot of things to do of course also a new invention where we talk about fast speed diagnosis to help prudent use there is also need of new intellectual work but I would say mainly to say it's needed to have one health approach it's a question of political will when it comes to the point Andrew Whitty mentioned a lot of intellectual work is still in front of us I think the market failure Jeremy Farrow mentioned that we asked and Whitty and his team invest a lot if you have something to fight superbacks please sell it carefully that's not an easy business model of course so the way how to delink the profitability and the quantity of sales is an intellectual challenge for a market economy for using market powers for innovative activities and so we have to debate these models there are some on the table we used our g7 presidency to ask uscd and the boston consulting group to make studies about incentives they are all available on our website because we want to make it a public debate not just an expert issue how we can use prices like the price that is the award that is made by the UK government the question of a market entry award could that be one or not we see the contribution of the declaration published by the pharmaceutical industry yesterday as this morning to be frank we have to debate about details some of it is a commitment thank you some of it as a request we have to debate that and we did when we debate about fair risk sharing for example you're talking a lot about predictable market conditions if we take the risk by the public sector in a new way of public private partnership what is the benefit for the public side for example the affordability for those in need even if they cannot be the high price payers so I think we need to balance out in a fair way we have not too much time how to reach that delinkage between investment in research profitability on the one side but also clearly to have a predictability that makes it possible thank you very much Herman to really to highlight these very practical golden quote details but that's what will make or break the whole you know the the new innovation that we that we need and and Jim O'Neill's report has some very practical proposals but again have to be worked out and there has to be not only consensus but agreement about that one point I'd like to make is that we should also not forget that there are still millions of people who do not have access to antibiotics to life-saving ones and and as a result there are people who die from kind of pretty banal very treatable infection so we have to really work on both sides I mean access where it's where it's none and then making sure this rational use that we don't create that pressure maybe Peter I can just add a short point we talked during the G7 summit and during the G7 health ministers meeting about supporting WHO in implementing IHR and here there is a link if we talk for example about obligatory prescription we need of course a basic structure also poorer countries to implement such an obligatory prescription and that means we have not only to take health care but really health system put in place in states in Africa and elsewhere and the G7 summit declared that they want to reach the aim to stop 60 countries yes in implementing IHR and we will in the end of the presidency we will publish and I'm confident but it's still work to be done that we reach that aim because it's needed to have prudent stewardship not only in rich countries to enable countries to have these fundamental things started with obligatory prescription with hygiene and all these basic fundamental things absolutely and I said it said it is a global issue and and I'd like to support what Joanne said and that is that you know this is not only about global security and these initiatives if one can link epidemic preparedness and tomorrow there will be a big session on that with surveillance and action on antimicrobial resistance I think that's a very rational use of resources if these things are going to be handled in in parallel there's going to be a waste of resources so okay the floor is open for discussion we there's a lot to the discussion please identify yourself and and limit your intervention also to very well one minute okay yes please sir you have the behind yeah first and then Francis my name is Stefan Tanda I'm a board member of royal DSM we've been producing antibiotics for 70 years proudly and in a very clean biotechnology manner very much welcome the O'Neill report thank you for supporting that and the one additional component I wanted to make is I missed in all your discussion one of the points that the O'Neill report highlighted which is there's a third major source of antimicrobial resistance next to human overuse and animal use it is heavy pollution in the manufacturing of antibiotics particularly in the developing world if you YouTube polluting to heal polluting to heal it's a documentary made by an investment management company Nordea I don't need to describe anything else and I think you need that third pillar in your efforts and I would ask the minister skippers in the in the February event to add that third pillar to address this issue we are fully behind you we offer tests we discourage all using animals we offer alternatives to antibiotics we need to get at that but we need to get it with all three pillars and to be honest the polluting is a major pillar we source many products from those countries not for medical use but the other use is an often the trace amounts of antibiotics because it's everywhere in the water from those pollution thank you thank you very good point at uh Francis Collins hi Francis Collins director of the national institutes of health in the U.S. certainly welcome the momentum that we see represented by this group here gathered this morning about a problem which as has been said has been with us for a while but we haven't really pulled all the resources together in the way that we need to from NIH's perspective we're fortunate that in the recent budget we were granted an extra 100 million dollars to work specifically on antimicrobial resistance and look forward to working in partnership with all of you in that regard I really welcome the comments from Andrew witty about the opportunity for additional open innovation partnerships about discovery there are some interesting things happening there such as the use of chips to discover soil microbes that are making natural products which we didn't know about before like tycho back then we have methods for doing toxicity testing that are perhaps more rapid than what we've had in the past and certainly recognize the need for that if we're going to be able to identify compounds that are actually useful for human use we also as the UK have put out a prize for rapid ability to detect resistance particularly from gram negative rods so that in the clinical setting one knows when you're dealing with a highly resistant organism one pitch though i'd like to make is for databases the more that we can collect genomic information which is not that complicated or expensive anymore on resistant organisms to develop a national international database of what's out there the more rapidly we'll be able to understand the epidemiology of how these particular organisms are spreading and how their resistance is encoded and presently that still hasn't quite come together that way that it might finally i might say clinical trials remain a challenge because you would like to have ready to go examples of people who are infected with highly resistant organisms whether it's pneumonia or urinary tract infection or septicemia so that when a drug is ready for testing you don't have to try to line up those individuals which is very complicated and difficult to do and i don't think that's a solved problem but we're certainly interested in international collaboration around that space as well yeah thanks Francis all very practical options and congratulations on the budget for NIH in general Seth Berkeley please thank you Peter and i just want to build on some of the comments that Andrew and others made it's interesting you talked about the pneumococcal vaccine pneumococcal resistance began in South Africa it was interesting as they rolled out the seven valent pneumococcal vaccine we saw a drop obviously a pneumococcal disease but we also saw the pressure from antibiotics going away and we saw resistance disappearing as they moved to a higher valent vaccine we saw the drop again but the other points you didn't make which i think is really important is that if you get rid of the disease in the children the elderly then don't get infected and of course that's the problem this was the old man's friend always and so you know we've rolled out the vaccine in 54 countries now we're trying to do the same thing with rotavirus vaccine which is also obviously in diarrhea over use of antibiotics so i think as we think about not only antibiotics we have to think about creating new vaccines which there'll be some sessions here as well but then what are the mechanisms to make sure that these are made rapidly available and the amc was interesting because within one year of the new pneumococcal vaccines coming out they were rolled out in the developing world unprecedented all good point and illustrating we need more than just new antibiotics yes please do we have two requests here from Jeremy Garrocox from the UK could i maybe follow on from that just maybe ask the panel for some comment on the ability and the challenges of delivering new vaccines that's been mentioned on a number of comments earlier in today's discussion and secondly within that within the the ability to speed vaccines to the market is the framework the regulatory framework right to enable or to enable the challenges to achieve an approved vaccine and by that i mean the burden of proof of negative proof i.e. proving what a vaccine doesn't do to be able to enable it to get to market we'll come back to when we have a panel discussion afterwards you know so let's see we can yes please my name is carolina sacks i'm from axe foundation a swedish-based foundation and we are running a big project that is industry driven from the retail food retail sector on the use of antibiotics to land-based animals and what my worry is who's really taking the lead in this subject because we have the WHO and we have the FAO and we have lots of different but who's really taking the lead so we won't have like a climate discussion that goes on for years until we get to an actual deal that needs to be taken probably in the UN assembly but that is really my who's taking the lead and why i think we really need the lead to get fast action i agree i think that's why it has to be at the political level that goes beyond the sector and but we'll go around first and then we have post office i see and then mario polkini well we developed a new antibiotic a new drug for xdr mdr tb bidak polin sorry from well post office from johnson and johnson the answer and we developed a new drug for an atp synthase and very unexpected target for for tb only for tb mdr tb and lepra i must say mid fantastic collaboration from the regulators in the world we did a very accelerated program one phase two b study with the fda the fda approved it today it's available in many countries xdr tb mainly russia south africa in southern africa but the challenge is of course then you have to limit to really xdr tb so first we went to the cdc within six months guidance only for that area then with the who within six months guidance only for that area we priced it very responsible so that it was accessible but you end up with a non-commercial non viable product and that you can it shows that you can get to new antibiotics fast if needed but we have to find a way to do that much broader than a one time off yeah and basic research the regulatory part is there the clinical part is there but the right incentives we got the voucher an accelerated review voucher from the fda which is an incentive but it's not big enough to massively mobilize the industry and i think the industry and i agree with andrew we can do a lot in order to bring new antibiotics if we work together with the basic research institutions the academia and and the regulators um but the experience is good when you have one you get it there thank you paul and marie paul kini from the world health organization just thank you indeed as was discussed this is an this is an area which is beyond health alone and uh and there has been a request uh to the secretary general to organize a high-level meeting on amr in september in the unga so i hope that this will again incentivize all sectors to work together so at who on the global action plan on antimicrobial resistance we work already with oie and and f a o but but you know we need we need more of that so uh there needs also to be a few experiment to work on to work out new systems to and new models so we have just launched dnd i n w h of a drug for neglected diseases initiative n w show an initiative to look at existing drugs to look at combination of those to look at drugs for children and we hope that this is where this will be another approach in addition to developing new antibiotics to find new avenues to treat people and this will also give an opportunity to test new model for for stewardship uh how can these be preserved in the future thank you very much thank you my people and i i think um let's address some of the questions and that that came up and um some i think is a very important one on uh where will all this be uh taken on that um you know since it is not only one health but it will involve and uh lots of individuals was quite interested by what you said it about the the EU initiative where you bring at least the minister of health and minister of agriculture together and also have accountability can you say a bit more about that and then indeed what the marie poll says so how how do you see that because it is an important question where will it all come together um politically did did you need to have a dialogue between the ministers of agriculture and health and also environment but i think we invested as dutch government quite a lot of money in uh investigations in the environmental impact but i think that um it's important to have this dialogue not only in health but between different sectors and also to put it on the agenda of the general assembly of the united nations because you can't solve this as a country alone so you need leadership political leadership uh internationally and so you had the g7 we are all members of who uh who works together with fio and oid so this is the way to go on a political level to see how you can make not only strategics and not only agreements but the second step i say it again is implementation because we make all kinds of declarations and we sign this but we really have to implement them and we have also to see that other countries overcome obstacles that they meet and we know these obstacles from each other so we can share how to overcome them so i really think that an open transparent dialogue on a political level is very important for amr and i'm very happy that it's not only a problem of ministers of health because then we won't solve this problem we really need to involve the cabinets we really need to involve the international political um decision makers absolutely and i think your point about that um learning from each other is important we particularly use in um promotion of uh growing of animals and uh prevention of infections it's a huge economic issue but there are countries that have managed to do it to control it without let's say economic damage to the farmers i mean the danmark and sweet and you have in several years exactly but it was not a dutch invention we looked at danmark exactly and saw how danmark did it and then of course it was not copy paste but we uh translated it to the dutch situation and so we can learn from each other and then really you can make big steps it's because 60 percent lower use of antibiotics in uh and we're still the second largest exporter of agricultural products so it doesn't mean that you have a bad um your business case worsens exactly that's why i think also a peer review can be very useful not to you know to punish anybody but to learn yes have one you have a global action plane uh made in jeniva last year during the world health assembly is a good framework right and it was connected with oie and others that brought in their expertise so i think there is a framework but during it was during these world health assembly that we launched with some colleagues's initiative to the u.n general secretary to make that high-level meeting also at the general assembly because we believe that it should be on that level also to be visible for all sectors that's the first thing uh concerning what edith mentioned learn from each other one of the small steps we did during the g7 work was to make a best practice uh brochure for all of us in g7 and uh brought it also to other friends and just to show what we can learn we can learn if we debate with our farmers we immediately hear hey what's with those in the Netherlands and danmark and all these others if we do it together and we learn from each other it's much easier the last point since it was mentioned the collaboration with regulatory work we have on the german side we have a dialogue between pharmaceutical industry academia and the government that will finish its work with a report in april and we have a working group there especially on the regulatory framework on antibiotics so what we can do on the national side is now under debate and we will publish that and we will look what are the needed international steps that should be added chairman please can i speak up on um a comment francis made francis collins just made and that's around data there's no doubt the world's so-called experts know of this problem um but the truth is the the willingness to engage on this outside that group of experts we we've talked too long amongst ourselves and not enough with either the general public or or i think the policy makers if you look at the recent emergence of the ecoli resistance in in ashore when people have then gone back that that bug has been around for more than six years um and yet our data around the world has not been sufficiently in time and shared sufficiently and then the benefits of sharing that information sufficiently robust for allows to that if that had bug had been able to transmit easily between people it would be worldwide by now would be causing a major problem and that is going to happen this has to be the data around the world has to be uh shared and the benefits of sharing that data uh in terms of access to subsequent uh science and benefits has also to be shared but unless we know what's going on and we talk beyond the experts we won't be able to transform this great so let's make that a uh an objective for 2016 to get out of the ground initiatives and uh ourselves uh the Fleming fund from the UK uh the Chinese government are and WHO talking about now a global observatory where the data will be shared and i think that has to be one of the the critical things that we we move forward i think it needs a bit of a uh a push so that it becomes reality john you have the some reflections on this so no no okay you're at the same point please okay yes we debated it now in WHO in the EU in the G7 since in 2017 there is the G20 presidency in Germany so far G20 was not a debate on healthcare in general and if we see that we see there the uh huge developing countries with great agricultural sectors it's it's it's really a needed platform for combined things of the industrialized and the development pink countries the huge agricultural states so i hope that these G20 can also used to be an instrument for that i think it's absolutely crucial and it's only i think last year or so in in australia was the first time first time was there because of ebola but so let's make ebola the game changer for that because it has to be on where vaccines were mentioned also john you want to it's about introduction of new vaccines what i just wanted to answer uh you about some of your question i think it's we we know how challenging it is and then we we know what you know people are the different pharmaceutical industries going through uh the reality for us is and then we have to keep you know the global picture is 80 percent of the world is basically living in less developed countries so somehow we need to find things that works in those countries and so um and and acknowledging all the difficulty myself pitch on that is the fact that vaccines need to be adapted to some part of the world and then so we need to be adapted to the strain of where it is it's not the same everywhere the strains in africa is not the same that in asia or in the north in the northern hemisphere and the the other thing is it's it's needs it needs to be uh as well um uh thermostable because this is our challenge in africa and so one of the thing is is we we have to go and i know there's the the usual suspect would develop things but what we realize there's other industry that are able to develop and then and it's in in asia india and and and china just to take a few example and then msf you know for rotavirus for example we develop something that is the strains adapted to africa that is thermostable and then hopefully you know we'll we'll we'll go through the pre-qualification so but what what i want you to realize is is we may develop some things that is good for one part of the world but that might be a manner is like a fraction of the world and 80 percent of the world is in less developed world and so you need to develop as world tools that will benefit uh as well this part of the population because anyway it's going to backfire eventually so it's we we we need to look at the global picture so uh just to just to tell you that that's my take on vaccine yeah there's another dimension there and that's uh public trust believes in sound and that's in uh in in high-income countries particularly we have mesons epidemics in europe we had one in disney land so that got a lot of attention um there's yes there is there are children dying today in europe from vaccine preventable infections there's zero excuse for that it's a and but it's because of a lack of trust in then conferencing lots of things i i see that in my er all the time having to convince my parents to to vaccinate the children you see and and i just want to make one point you know set is gone for gavi i just want because ever since i was being portrayed that you know we don't like the idea of gavi and all that you know actually we love gavi to the next step the the thing is we just want to expand it to other countries that are in crisis that not only the low-income countries but today you know we are facing the reality that in the middle east we're going to be with a crisis that's probably going to last for a decade and then these are middle income country and they need to have access to vaccine at cheap price that's it that's that's that's we we want Syrian little children to have access to vaccine as well so not only important for the middle east but for the surrounding countries also i should i should say and coming back to my point public trust is this example of a human papillomavirus vaccine it's a vaccine that prevents cancer in japan today the coverage is below one percent it collapsed because of rumors because people think this causes i don't know what in girls and some besides then the whole paranoia side why is polio still not eliminated it it's not a technical issue it's because of war and of you know trust and polio work is being killed so i think it's again an area that you cannot address just in a technical fashion now we yes we uh we have i didn't know if you've fallen back in love together which is great but but i think we sometimes we sometimes become cynical about the ability of global organizations to pull things together in the modern world but just a very strong push for keeping the idealism that came out of the second world war those global organizations may not be functioning as well as they could but they still are a critical player to bring everybody together and make sure this is not just addressed through the narrow prism of national security but this is addressed through the prism of global health and i and i think we have to keep a sight of that idealism that came out of the second world war these organizations are needed more than ever in fact to bring us all together and gavi's a very good example of that no i i think your point is absolutely important and it's even there's even a stronger need and it's after world war two because the world is far more connected mobility is higher etc so there's no no doubt about that and and this year is the year of the replenishment of the global fund to fight htb malaria the the results have been spectacular it's rare that you can count so many lives saved and so it's it's a year there's a lot of demand on resources but that is crucial we have about good five minutes can i ask each of the my fellow panel members to what is your thought what what you would you like to see happening action this year in in terms to move the agenda we're not going to solve this in one year but what could we do this year who would like to start with that maybe it since you you have something very concrete today i think that we have to be aware that we don't make the same mistake as we did fault as we did 10 years ago so be determined to really make steps and it's very important to work together and to allow for example peer views not only between european countries because in the global health security agenda we also have peer reviews we also have that you sign up to help other countries to make their systems more robust and efficient and to help them to prevent for antibiotic resistance so i really think that we have a lot of actions and a lot of paper but i keep repeating come from paper to implementation that is really i think the core business for the coming year i would say last year the ebola crisis as a wake-up call made public global health a global issue we have to prove this year that this is not a one-year firework and that if we talk now about terrorism about refugees and all these things and some of them had much more common ground with these global health issues and people think about that we prove this year for example by taking our promises during the world health assembly that every state should have a national plan to go that way and this year is crucial to make it really a process so it is going to be a crucial year chairman i think my worry at the moment is that this space is too fragmented we've got the human sector we've got the animal sector we've got industry academia philanthropy etc i think if we're going to truly change this and it has to be at a global level we've got to rise it above microbiologists infectious disease people like myself and to a different level within the political discussion so that this is actually something owned yes at the level that climate change is owned at at the political level and if we don't do that we won't get the changes in regulation we won't get the changes of the human animal sector we won't get the incentives for industry and we won't get the control of use but also access so i'd like to see it raised above the level of experts to a higher political level and owned somewhere with accountability yeah very good yeah shuman well you told me that i asked to use sleep sentence but i know if i had to use buzzword i know for me for this year would be innovation for access is whatever we're going to do needs to be accessible and need to be accessible for everybody but of course you know jeremy said you know idealisms and msf we're full of the idealism but if we weren't there there would be a tough word so the thing is is is is i'm dreaming and i'm asking again for that rapid diagnostic test because i think it's going to make a difference in the the the less developed country but it would make a difference in my er in montreal and so i made that because i think it's a big driver and then i really do think that we need to agree on the trigger to how to help fail state when they all look facing a health emergency and and that we don't have to do that while it's happening so we need to agree before that what would be the trigger to come and help and not just to pass the buck you know like we're doing right now with the migrants we need a different model and then last i would just say that and i agree somehow with with jeremy when he talks about to portrait as a market failure actually there's not really a market failure per se with antibiotic because if we get the right antibiotic people would purchase it it's it's it's it's it's about for me is that more of of the same in that respect is the fact that the the it's it's it's all the model of of the market that's what we need to fix but it's not a market failure per se people's if we get the right antibiotic people's huge amount of needs andrew two or three things i think member states need to keep the voice that they've discovered at sinsebo and since germany's lead on the amr agenda i think that makes the multilateral agencies way more powerful multilateral agents can only go where the member states wants it to go and i think we've seen a lot of benefit from that but i really hope this doesn't just recede into yesterday's story and we move on to the next thing because like member states are really pivotal within this absolutely crucially you've got to start making some decisions i mean just we're going to go to a vaccine session right now i'm going to talk about a proposal on by a preparedness which we proposed a year ago we could have had three or four vaccine research programs into rare disease commissioned by now but nobody's made any decisions whether or not we should go forward or not now it may be a terrible idea in which case tell us it's a terrible idea and we'll stop talking about it or tell us it's a good idea and let's do it but i think we are we're in a mode at the moment where we're all saying this is super important whenever something specific comes up it that again it typically is being pushed into a sequence of well let's have a year's reflection on it let's send another working group off to talk about it and we're burning years up in this process we probably get there in the end but we're burning years up in the process so so i would really encourage member states to just be clear make some choices we're going to make some mistakes we're going to get some things right but we have to do some stuff so i think moving into that phase and i think really this conversation is really amplified how this is if you really want to get ahead of this it's it's definitely conservance it's definitely whole system agriculture as well as human health it's definitely prevention whether that's healthy living clean you know washing hands all of that and it's vaccination within vaccination to the question of how we move that forward is we need to understand there are modern vaccination looks different technically from traditional vaccination and somehow we as a society and regulators are going to have we've got to we've got to get ourselves comfortable with that step forward in technology and we've got to somehow try and achieve a standard which says we've ticked the boxes on this new set of innovation or not and if we have let's move forward but at the moment every new vaccine that's coming along is getting trapped in the kind of let's go back and recheck whether or not we're yet comfortable with adjuvant technology there was no new adjuvants for 50 years now we've got new adjuvants but somehow as a society and as a system we've got to get ourselves comfortable or not make the call or not but that's the kind of area where we should be focused i think thank you very much this is this is the end so let 2016 be the year of decisions and actions i think the roadmap is clear we have enough studies and working groups and all that so to and the hashtag would be it's not only about delivery of innovations but also innovation in delivery thank you very much