Well, we're gonna get started for the next panel discussion Okay, if everyone can please take your seats, I think we're gonna get started Good afternoon everyone and welcome to the next generation global health security leaders panel like to thank our George Washington University hosts as well as the NGO steering committee for putting together a really fantastic event about the global health security agenda and thank all of you for joining us So we have a really impressive group of speakers Who will share their proposals on ways to strengthen the global health security agenda? These speakers represent a new group the next generation global health security leaders Which we are launching today at this event The idea behind the next gen GHS leaders group is that in addition to engagement by governments International organizations and non-government stakeholders The global health security agenda will also benefit from novel and creative thinking from young professionals and students from around the world The purpose of this group is to provide the next generation leaders with a platform to exchange ideas about the GHSA and to empower them to Contribute to implementing its goals Going forward we seek to establish an international community of young professionals and students interested in Contributing to global health security Our vision is that these individuals will have an opportunity to inject new ideas and energy into the respective organizations governments and professional communities Launching this group has been truly a team effort across multiple organizations and we have many people to thank It's been established as a collaborative effort between the American Association for the Advancement of Science the UPMC Center for Health Security The National Defense University Program for emerging leaders and Georgetown University We also owe special thanks to Ambassador Bonnie Jenkins from the US State Department who's provided leadership in this effort and To a number of global health security agenda partner countries who've brought with their delegations representatives from their respective countries from around the world So that this is truly an international project And we're just we're just getting started With this project and we've already gathered an impressive group that includes representatives from 15 partner countries affiliated with the global health security agenda and we're looking to gather more and more international representation and Many of those many of those participants are here today in the room So if you're interested in joining this next generation GHSA leaders group We encourage you to attend our afternoon breakout session, which will be taking place here in this room up from 430 to 530 p.m And it will also be webcast Live and we'll have a virtual breakout session on Twitter and Kate for those of you watching online so Like to introduce our speakers We'll have four presentations And then and which will be approximately 10 minutes each and then we'll open the floor to questions and discussion So here to my left We have Dr. Aaron Sorrell and she'll be talking about prevention of emerging zoonotic diseases Dr. Sorrell is a senior research scientist here at the Milken's Institute School of Public Health and Previously she was a program officer at the US State Department biosecurity engagement program And then we have Rebecca fish and she'll be discussing a new business model for health security Rebecca is a senior policy advisor to the deputy assistant secretary of health and director of national vaccine program office at the US Department of Health and Human Services Dr. Lode Boa Tang From from Ghana is going to be talking about biosecurity training for public health education programs in Ghana He's a Mandela Washington fellow and a physician. We spent nearly five years working in rural regions in Ghana He's also managing the Bola campaign which seeks to increase education and awareness among African youth and Finally, Dr. Ellie Graydon She'll be talking about data and modeling to inform emergency response to biological events She founded and directs the division of strategic systems and analysis at Griffin Scientific where she and her team perform Complex systems analysis to support the use of data and modeling to inform decision-making And so without further ado, I'll turn it over to Aaron Thank you, Jamie. Good afternoon everybody So today I'm just going to talk briefly about the prevention of zoonotic diseases and that is one of The major targets of the global health security agenda. So as an NGO community, what can we do to assist with that? Just some opening remarks about zoonoses You know and the emergence and spread of microbes is one of the major risks associated with global health security today And we have to consider both wildlife and domestic species when thinking about the reservoirs of diseases that are of public health Importance 75% of emerging infectious disease is zoonotic in nature And many of these zoonotic diseases are neglected Basically because ministries and other sectors have other very important things to consider including clean water maternal and child health And other infectious diseases including non-communicable diseases and as our colleague from Kenya mentioned That's a huge problem when you consider having to prioritize within the global health security agenda Community communication and coordination is for national surveillance and response Networks is essential for Preventing the spillover of zoonotic diseases and there needs to be a systemic and systematic Avenue for information sharing for this coordination however, resource strengths are a Big player in preventing cross-sharing and information sharing So looking at really trying to prevent this spillover is again stressing has been discussed in a lot of the morning panels Collaboration across the sectors both traditional and non-traditional players in the role of public health and animal health And really looking to either establish or build on already existing networks taking advantage of lessons learned from previous outbreaks and situations and looking at aligning priorities with already existing frameworks that are either National regional as mentioned with the IDSR as well as international looking at the international health regulations as well as OIE's PBS pathway and and terrestrial code Looking at identifying priorities across all stakeholders I think one of them the very important things to look up up up front is having a conversation With every stakeholder imaginable to figure out priorities across the board to really have an effective Mechanism for implementation making sure the conversations are had and priorities are identified Not only from a public health or animal health sector, but looking also at environment potentially even tourism important export As well as interior and and defense And and with that really looking at what are the priority diseases the global health security agenda looks at prioritizing at least five zoonotic diseases for each country I think that that can be Discussed at both national and regional levels again cross-border surveillance and response and coordination and looking at mechanisms for action And coordination and defining rules and responsibilities I think it'll be very important to have not only as mentioned this morning a lot of activity and networking at the community level But also very important to have the political will And support at the highest levels for this integration and coordination It'll be important to identify gaps that limit the information sharing and then develop strategies to Fill those gaps Whether they're short-term or long-term, and I think something that again had been brought up this morning and would like to reiterate is In development of these plans taking the opportunity to continually review and revise strategies test them out Make sure they're applicable not only for current situations But potential and future concerns and priorities as they arise And I think that in coordination with the global health security agenda and the IHR as well as OIE regulations These are all measures targets objectives, whatever we'd like to call them that are living documents Checking the box to say that we've met a target does not mean that the the project or the work ends And so it would be very important to keep Working towards this collaboration and prevention of zoonotics. Thank you Thank you so My comments today are really about the importance of using business strategies to address health security challenges If you think about it health security is really a product It's something that we want people to buy into and support and given that there's a lot that can be learned from Business about how to have a rapid launch how to have effective uptake and generate support for what it is that you're trying to accomplish Many of my remarks today really focus on incentivizing innovation and drug development But these same concepts apply to many of the challenges that we face and the idea here is really to look at these challenges through a different lens So the first rule of business is to know your customer and notice I didn't say partner and I didn't say stakeholder I said customer because it's about understanding somebody else's interests and objectives their motivations and needs something We've talked a little bit about this morning Take drug companies as one example the government would like them to invest in countermeasures development It's a lot easier to do that if you understand their business model their core competencies And really what they're good at and what they're not good at when you have that kind of information You can make better investments and more sustainable investments It's equally important to know all of your customers I go to many preparedness events, and I don't see any pharmacists any wholesalers any IT vendors any faith-based groups These organizations are critical in a response, and they're often not at the table It's fairly alarming to realize that here in the US We can track our online shoe orders more effectively than we could distribution of a pandemic vaccine It's not that that technology doesn't exist it does it just hasn't been prioritized So I think that we need a much more strategic approach to understanding this health security market and the customer segments in order to have a more effective response Now another goal as many of you know of the global health security agenda is to elevate attention And you do that by crafting a compelling message through effective marketing strategies It's about building a brand and to be clear the brand is not an image of an eagle It's not a catchphrase. It's what you do and what you deliver consistently over time an Organization that's building a very strong brand right now is Isis They know their target audience they control their message. They use a wide variety of platforms to reach their audience It's very alarming to compare that reach and that agility with some of the messaging that we're doing around health security right now In the US the organization that sort of coordinates many of these preparedness initiatives It's called FEMC or the public health emergency medical countermeasures enterprise Which is quite a mouthful that term has 5,000 Google hits Compare that to al-Qaeda that has 20 million or zombie that has 60 million My point is simply that we've got a little bit of a brand or awareness gap or possibly an opportunity And it's really easy to discount the marketing or the messaging But if you can't communicate with your target audience if you can't make people care about these issues then we failed before we started So again, we need a much more sophisticated strategic approach to customer marketing and this health security Brand has got to be owned and managed by one team. So we don't dilute the messaging across so many different agencies and groups Now a lot of people would say that there's not a lot of investment in countermeasures because there's not enough money That's part of it. But the bigger issue is that it's confusing. Who's in charge? How do these organizations work together? A Lot of companies don't even know where to start Companies invest in what they know Congress funds what they understand. So there's a big opportunity to make this simpler There would be a lot of value in having a more detailed training program about how to do business with the government and medical countermeasures Development we also want to highlight the organizations that are getting it right like the DoD who are building a global coalition Unfortunately, many of the existing options to try to learn more about this space are insufficient So we've got to make it easier the goal here is make it easier for the investors The volunteers people who want to contribute funding make it less easy for the people who don't and I know that sounds really obvious But it's a big challenge in this space Now when people talk about incentives and drug development what they usually mean is money and the economics are important But there are other things that your customers value and care about For example access to decision makers access to new markets reputation Good press increases a company's stock price. It increases their likelihood of getting bought out It increases their likelihood of a co-development agreement Take a look at those three headlines that are fairly recent If you're a board member at this company, you'd be pretty concerned You'd want to fix this and you would probably have a very strong incentive and making a sizable Investment in something with a big public health message to send the message to the media and to the public that you're trying to fix things Or change things and the point there is simply that there's more to an incentive than the drug price or the contract size Now as many of you know, there are many kinds of incentives for drug development And I think that at the end of the day, there's not likely to be any single fix That changes the situation It's more likely that there will be a series of incremental improvements that kind of change the value equation for some of these products particularly for antibiotics another thing that we hear a lot is that there's no market and Again, the funding process does certainly add risk the way it's structured right now But maybe there's an opportunity to build or redefine the market Maybe the opportunity is helping that small company access a global market Maybe it's leveraging scale so that instead of getting one purchase order as a company You get a whole bunch all at the same time from participating countries Maybe it's using the money that we have more efficiently and Certainly they're also new markets There are three to four million preppers in the United States and that is a multi-billion dollar market opportunity Obviously these people cannot buy all countermeasures nor would we want them to but the point is that good businesses think creatively about their market They look to expand to evolve and they don't just accept the status quo Another thing that we talked a lot about this morning is that good businesses Establish performance metrics when they have a billion dollars on the line. They want to draw attention to some key issues We need to do the same thing UPMC has made some nice strides in this area But it does appear that there would be an opportunity to develop a global health security dashboard to measure and monitor progress That might include new antibiotics and development creative uses of contracting authority Customer satisfaction scores their perception on how things are going Measurement can be incredibly powerful, but it loses its impact if we try to measure too many things So there's a big opportunity here, but a need to really craft this measurement tool carefully But the single biggest problem I would say in health security is not the funding. It's not the regulatory hurdles It's the lack of clear accountable leadership who owns this space in business. They develop the strategy Then they create the structure the government has the exact opposite paradigm We take all these groups all these organizations. We put them in the same room and we say make it work That sounds really nice and decades of business research shows it doesn't work Decades so a small team with clear authority is infinitely more effective So there could be some value in more of a Manhattan project approach To some of these challenges and when I say that what I mean is trying to replicate this idea of a clear mandate for action Or urgency or passion for cause Some of the challenges in this space go so far beyond just simple requirements or contracting improvements So I had proposed the creation of a dedicated global health security team This team would be tasked with developing the integrated strategic plan that includes the operational piece The who the how and the when The idea here was not to detract from any organizations role But to really add clarity and urgency to the process to build a framework so that we could leverage the strength of these groups Leverage some of these action plans and really add urgency to this process And again as we've sort of discussed this morning that team needs to be able to communicate across sectors They have to be creative. They have to be able to catalyze change and be agile In the words of Steve Jobs a small team of a plus players can run circles around a giant team of B's and C's We need a good team on this In the corporate world, they say businesses don't fail leaders do if a business fails They face bankruptcy if we fail lives are at stake Take take a look at this photo of this little boy First his mother and siblings died of Ebola Then he got sick with the disease by the time this photograph was taken He was too weak to put on a shirt or to cover himself The people in the background are afraid to help him or touch him for fear that might they might get infected and The local clinic refused him care because they just didn't have the capacity or the capability I include that image today because it's a reminder of the faces of health security This little boy was named saw Exco. He died in Monrovia a month ago That's why we don't want to fail. So my question to all of you today Into the leaders in this space is what else needs to happen before we write the integrated strategic plan Everything we've heard here today. Everything we see in the news Indicates that there is a fierce urgency to do this now and to do it right. Thank you Good afternoon. I hope you enjoy your lunch So my name is Lord what they all thank come on with for inviting me to this Next generation event actually I was sitting At a meeting alone designing an Ebola awareness campaign and she came said by me and asked what I was doing Eight weeks later here. I am so I'm talking about the capacity building For biosecurity and disaster management preparedness and I'll give an update on my Ebola awareness campaign I finished my MPH and it's surprising to note that despite the fact that many of the disasters that Severely affect us or care within West Africa and East Africa. You don't have any dedicated Academic institution that runs programs that are able to research and train multidisciplinary specialists on Emergency preparedness I just thought it's me a lot. So my proposal was that We need a center of disaster preparedness in one of the institutions within West Africa or East Africa, how are we going to do that? How are we going to make this sustainable? How are we going to do this within one or two years? CDC has an field epidemiology Masters program that runs in Ghana and Kenya I believe my good friend is one of the products of this great collaborative. Now all we need is to piggyback this Masters program on this event because many of the institutions have showed good Good Good efforts at deploying this program would need just lecturers both local and From any other country willing to participate. We could have a George Washington University Partnering of the University of Ghana or universities in Kenya to do this and this would Mainly affect the second semester programs because the first semester programs you'd have people taking basic Epidemiology or public health programs then in the second semester people do the specialty training in Biosecurity training now. Let me borrow your term What and how who are coming to these events? We're picking individuals from the security agencies from the medical institutions We've we've seen how disaster preparedness during the roller campaign was not coordinated We need biotechnologists involved in this program and the good thing is that because of cost-sharing the budget of security agencies are quite Sufficient they'll be able to sponsor various staff for this event for this program and Be able to train them and when they finish we're gonna have an alumni network of security biosecurity conscious young professionals who would begin research and begin to advance this This course in your various institutions. So this is on the biosecurity Capacity building program that I'm encouraging that is be should be formed within West Africa to coordinate all the regional efforts by different universities This is not something that I want for Ghana is something I want for the region many people have said that we failed Liberia when we feel to have a High leadership response. I say we failed Liberia when we accepted that a country of forming on deserves and doctors of 50 doctors I mean if we accept that four million people should have 50 doctors we failed So this is and the global health security agenda wants or seeks to build, you know, the capacity to prevent such a thing So the second thing was is on the Ebola awareness campaign Fortunately, I was selected as one of 500 young African leaders to come to the US as part of President Obama's initiative to For some leadership training. We had an even a summit in at the White House and Following that it is was July the Ebola was like a big issue But in terms of education and awareness, I felt that not much was being done on the night of the The last summit we prepared an Ebola Emergency or public service announcement. Now I had this 500 young Africans who spoke different languages We want an Ebola message in English and French to Liberians who Organians who have not gone to school. So quickly we've we've just gathered young Africans Translated the message in your local dialect and we spread this across social media. This was very effective It it's triggered many young people to start doing their only emergency or door-to-door campaigns on Ebola But this is not enough. So how do I effectively get to the local blessing the The Minimally educated we've got the information on Ebola. So that's the next step. We're doing to I'm so excited everybody was talking about Community leaders and this is so key and this is so fight out I'll talk about two community leaders that we have identified there for our next step Drivers and religious leaders know for religious leaders Target and Kruger's are able to predict that a woman is pregnant even earlier than his Relatives now if you come back to in our setting who's able to do this Religious leaders are able to tell who whom is church who didn't show up in the market Sometimes when someone is sick the first person they call is or with something like Ebola where we are saying that You are not likely to survive. They are likely to call the religious leaders yet We are not engaging them when we're educating them on how to Educate them how to relay information to community health workers who then pass the information on to health personnel the second The second group of people that will be planning using our drivers I don't know how many people have been to Africa but like to take public transport in driving in in Africa It's a dream that you should participate in so you sit You sit in you sit in this bus and You are you are used to the bus stop another bus stop you sit in any moves. It doesn't happen You just sitting and wait for this 50 seater bus to get full in between. What happens you have? Fatal leaders you have people who sell drugs come into the bath and they sell Drugs or they give you a whole brilliant nice amount and sell drugs at the end of the day So now what we're going to do we're going to try and get the drivers and educate each one of them on Ebola awareness this is a fantastic focus group discussion of people trapped in a bus and We're going to focus on border border border town So drivers that move from Ghana to Cote d'Ivoire and drivers that move from the rural or peripheral areas to the city We're giving them good information on Ebola not only on prevention and control We need to tell them about quarantine how difficult quarantine is how difficult Treatment is because all they see is does your if a relative is picked up Send to current time you don't even get to call the pressing one day You're told a patient your relatives pass the way you even get to see the body These things should be done or should be part of the educational campaign then we we like daily call the Drivers to collate the information if there's any this is this will be like a rumor registry if someone is going to sneaking from Liberia with Ebola who's gonna pick it is gonna be these drivers and you these drivers are going to accept Passengers on board and they don't think they seem sick But it doesn't click them to them that this may be a Ebola and Ebola Suspect we are going to lose and it's very key and vital that we use people like Freight leaders are drivers our queen mothers, you know our market leaders They can tell that Mr. A. Mr. B They did not come to the market today and it's all about habits just like Google uses Such two items to predict influencer we need to use our Informants, you know to gather real quality data and we can type them by place We can type them by time and over time we over time we can be able to develop an algorithm to see What's happening beyond Ebola all this group do they would be able to help with them should a vaccine be developed They would be able to help in educating people on Its benefits if we develop a vaccine right now we are using it and someone gets any reaction. This is going to be, you know The rejection is going to be very high We need these people can talk to committee members and then educate them and help them, you know with the control of the border so in summary, this is the an update of the awareness campaign that we are doing we In the our direction now is to engage more community leaders not politicians who never show up apart from election time Coming to tell them what to do. I hope I go home safe. Thank you very much So one of the things that loud just spoke to was this importance of Knowing how to use the data and the information that you have to then actually make the decisions on the ground that have to be made and That's the main focus of my work is figuring out how to take all of the quantitative data and the computational models that we have access to and Actually turn them into something that is useful on the ground in the context of emergency response and it doesn't as I'm highlighting in this in this image and Public health emergency can be the result of a large-scale hurricane typhoon Haiyan, but it can also be the The outcome of an Ebola outbreak and the real question is how do you take these data that we now have and are now swimming in and Turn them into informed decision-making and coordinated operations. How do you transform those data into something useful? So one of the things that we've done is to first start thinking about how to think about data and models in a way that moves from these very computationally intensive models that are performed that are built by scientists half the time run on supercomputer clusters and Require a huge amount of data, but then the outputs are of limited use to an operational community I doesn't matter whether you're working with public health folk on the ground in Africa Or whether you're working with your local fire department in the middle of Minnesota They're not going to be able to use those data to make a decision And so one of the things that we've done is to start thinking about how you transform data from these raw data And do the event characterization Ultimately you you need to start to be able to answer the question of what happened That's where those computational models in the computationally intensive models are really useful But then you need to process those with Consequence models ultimately those generate the impact estimates that really define what the event is What is this event and and who and what were affected and to which degree? And then ultimately you can then start to build decision support tools that can transform those data into mission specific requirements Those are really the data that end up answering the question of what needs to be done on the ground We can then start looking at this at a systems level and the nice part about the systems level analysis Is it instead of just looking at so typically systems analysis has been used in the context of social interactions and mapping But you can start looking at this in terms of how information moves within within the system as well Well, they're each one of these images So if each one of these nodes can be a person it can be an organization or it can be a data set or a model And what you're looking at is actually the movement of information between those different characters in the system So how is information transferring? Who is it passing between who are the big players in the system? And if you can collate all of those data into one place and perform that analysis all of a sudden a single image Draws the eye to the primary nodes and you can figure out who the big players are in the system and where the information is flowing And even more importantly you can figure out where the information isn't flowing, right? So you can see a whole cluster on the left that where none of those nodes are connected to anybody else in the system Well, that's going to be a that's a gap, right? That's something that we needed we need to improve information to flow or to information transfer there But now you can actually see it and you can highlight it You can also see a cluster on the right Which you can imagine is just one sort of one community that's doing a good job of sharing information within that community But then not actually reaching back to that larger system So we can also then use the same sort of method to then algorithmically look at who the primary Information bridges are in the system sometimes those are going to be the big players in the system, right? If you look at nodes one and two they're they're very central in the system They have a lot of connection points coming in a lot of connection points flowing out But if you look at nodes three and four, they're much smaller players But they're absolutely critical and as as information bridges and there's a lot of data coming out of the social networking Literature that suggests that it's actually these smaller players that are important linkages between different Ends of the organization that if you remove those linkages, that's when your whole system collapses And in fact, it isn't your largest nodes that are always the most important But again, these are the sorts of information that when you actually do that analysis and you look at it from the whole system at At the whole system and look at the way that information is flowing through it You can see these take-home messages and really understand them intuitively You can also then clump or cluster these resources or the organizations by type and say well How is information transferring between these type different types of organizations? So what you're seeing here is a transformation or transfer from the raw data on the on the left-hand side all The way through to the decision support and mission-specific information on the right-hand side This is actually a map of all of the resources in the US federal government related to emergency management And what you'll notice is that there's a huge taper off on the right-hand side And this is what we see no matter what system we end up looking at that There is a that there is a lot of good work being done in terms of the raw data collection and the analysis and the event characterization and what isn't being done effectively is Translating those data into something that people can use to inform the operations on the ground So ultimately what you can do is if you have these data and you actually can build out a simple Decision support tool and this is speaking to Rebecca's point of keep it simple what we have here You have one you have a very operationally relevant question right? Does access to a new medical connoisseur actually make a difference for the for the spread of an outbreak and as it turns out so every one of these boxes has a Value behind it and it's the output from a from a computationally intensive Epidemiological model, but what we've done is organize it simply by what percentage of the population actually has received prophylaxis and How contagious the disease is in that instance in that community and with this particular disease The real sweet spot is right in the middle there right if if you're on that far upper left-hand corner It doesn't really matter if you have access to the disease It's not going to progress or access to the new medical connoisseur rather You're not going to have spread of that outbreak But beyond a point where the public health community can respond to it Likewise on the this bottom lower corner You're in trouble anyway Even if you do have access to it, you're probably not going to be able to really contain the outbreak in that quadrant But now a public health decision-maker on the ground can say okay, you know what we fall into this sweet spot We think we have a are not of a prosclamately five We think we're going to be able to get about fifty percent coverage We now really need to worry about the speed at which we're going to administer that medical connoisseur and actually get it into This location and that can also allow a public health decision-maker to make those Prioritization decisions for where they put that send those medical connoisseurs where they roll out those activities and actually use the basis these These computationally intensive models, but also these data to really then inform those operationally relevant decisions and Ultimately what we're trying to make sure and and what I'm really interested in and I what I think there's a lot of space to grow for the Global Health Security Agenda is in making sure that these sorts of data Can be can keep up with the transfer of people as they move across borders I mean that the image that you're looking at is coming out of Dr. Brownstein's work, but it's actually looking at the transfer of people between location between different countries and across borders So can our data keep up with that and can the operational decisions on the basis of those data keep up with that flow? Thank you. As you can see we have a really diverse range of presentations from our next generation Leaders group and we have some time for questions. So I'd like to open the Florida questions. I presume we have microphones Available while you guys are thinking I'll I'll start with a question or two So maybe I'll start with you Ellie actually Can you can you give us perhaps? So this is really interesting presentation. Can you give us an example of a? Specific scenario because this is a very sort of high order abstract very interesting presentation Can you talk about a specific scenario where these this kind of planning could be useful or perhaps a scenario where we have lessons learned? So most of my experience is coming out of the US emergency management But I think this is So if you start looking at hurricanes You there's a lot of work that's been done in terms of taking really robust Hurricane models weather models and translating that into inundation models or flooding models That then speak to which populations are being impacted to what degree so this is you know What percentage of lower Manhattan is going to be flooded in the middle of Hurricane Sandy? and The types of decisions for tools that can be developed range from say the Army Corps of Engineers who needs to actually calculate the cubic yards of debris that need to be pulled out of a specific of a specific area for Behind a flood of a specific region In a certain depth, but it also speaks to how many patients are going to need to be moved from the hospital They got flooded and the generators that went down in lower Manhattan and when you set up your emergency response shelters What percentage of people are there that are going to be on ventilators? And how do you actually make sure that they have the resources that they need? You know, I think in the context of a much more resource constrained Region what we start then looking at is well Who do you who do they even call to find out who is running the public health lab in the in the neighboring country? How do they know who to call? How do they get that information? What do those data look like and how do they know even who to call and what to do with that data once they get it? You know, what kinds of decisions are they going to make on the basis of it? And I think right now They may not even know who to call when they call They may not know what questions to ask and there's certainly no centralized location to go and get those data and just get Starting at the stage of collecting those data so that then the next few steps can be taken I think is is really the next the next step to go. Great. Thank you I'll ask one more question For you Rebecca So you spoke about the need to Consider the possibility of broader markets for for business to sort of think about new ways to redefine the market And perhaps looking internationally, so I wanted to ask I mean we know that that's very challenging I was gonna ask if you could speak to some of those challenges of working internationally And then perhaps also comment on the recent Scenario where we tried to share medical countermeasures in response to the Ebola outbreak in Africa See what kind of lessons we've learned from that and perhaps Propose ways we could work with industry to do a better be better prepared for those kinds of news in the future Well like Ellie most of my experience is in the US But to me The bigger opportunity is sort of what I had highlighted in my slide which is to make it easier here first It's you know when I attend certain Events in my old role when I was working in industry You would have hundreds of organizations showing up who want to develop countermeasures who are interested in innovation and it's very difficult to understand How to work throughout the system because there are so many organizations within the Femsey enterprise and I think to me We hear so often about this limited market and obviously look at the group we have assembled here today This is obviously a priority. We want to encourage development of new products So the key one outcome of this global health security agenda has got to be trying to figure out a Workgroup or a team who can look at harmonizing some of these contracting rules And improving this process because if you listen to dr. Frieden or anti-weber speak yesterday They were doing a briefing on the hill There's such a need for urgency here And I think you know we've got to prioritize some of these challenges a little bit more than we have It's kind of like my comment about the inability to track distribution of a pandemic vaccine Like we've got to move some of these challenges up to the forefront so that they get Executed and and completed so my experience personally is more here in the US But I feel like if we tackle that challenge that's going to facilitate the international phase Do we have some questions from the floor? Please raise your hand if you'd like to ask a question. Yes at the back Hi Liz Dempsey Becker from the Danish Embassy. I'd like to underscore exactly what Rebecca just said Many of the embassies here in Washington DC are in fact the first point of questioning from our From the private sector and from the public sector about how to engage With the US government and various programs and in terms of where do you get answers? so in addition to trying to Address the issue here domestically. I just want to put forth that there is a great interest internationally and that There are many people that are already asking for a question for answers to these questions Okay Did you want to well perhaps we'll take another question here at the front? I had a question for Lord So I'm really interested in in your ideas of getting religious leaders, but also trocho drivers and Yeah, I've sat on them and But I'm interested again I mean there are a lot of different infections that cause febrile illnesses in Ghana in West Africa So I think that messaging has to be really careful that you don't end up with them actually rejecting people who actually Generally need to get to health care and generate a process of fear that leads to somebody who's got malaria Not not being able to get on a on a trocho and gut a hospital So I think again, it's all about messaging and marketing have to be really careful about that information and just another comment Just it's really interesting that it takes Ebola to get people to think about doing some of these things Which just saddens me actually Thank you Hi Lin Goldman George Washington University, so actually I have a question for each member of the panel And I just want to imagine a scenario that we have some kind of a global health leaders ward Okay, and you each have been awarded money say $500,000 to do whatever you think is best What would you each do? I mean just very briefly if you had that opportunity? What would you do? Thinking off the cuff. I'd be pretty excited about getting $500,000 To do some work. I think that there's a lot of work to do and I think something that was discussed earlier today about looking at a particular region and really focusing on neighboring countries that can work together that have worked together and building on existing frameworks and projects that have already Shown progress and success in one aspect whether it is focused on a particular disease and building that network up to expand on current capacities From my perspective my interests are very much in the interface of surveillance and laboratory response So building up those networks From regional perspective is what I would focus on and and really getting that not only communication and coordination across Non-traditional partners, but really looking at building up laboratory capacity for for rapid response. You can do Amazing things with surveillance and collect samples, but if you do not have a laboratory that can tell you what you have You don't have an effective surveillance response. So that's that's what I would be focused on Do you probably tell from my remarks? I think the first thing I'd focus on is creating the team I think that we have a ton of great people involved in this space And there's a ton of great ideas and you see a lot of that reflected in these action plans but I still think we're missing an overall strategic plan how this all ladders up into one sort of overarching vision and Coordination point and I'd want to get that team assembled And then I'd want to do some market research with these countries and what we have talked about as some of our key Organizations because it's one thing to say what we think they need one of the messages that we've heard here today Is let's make sure we really understand what people need and then try to prioritize Some of the key things that I thought we're gonna have the greatest impact, but to me The most pressing need in this space is getting that core team assembled who can try to build this framework to leverage all of the partner Strengths, and I think there's a little bit of research that needs to go into That project after you get the team assembled Thank you, I do hope the money comes because I'm gonna get I'm giving my best answers so So the CDC put a call out for doctors to volunteer to work in Liberia and Sierra Leone and I do talk about Ebola a lot I'm running an Ebola campaign and So I said I have to you know apply or submit my name So I went on a site and I just have made my name and they were there's a questionnaire Have you been involved in disaster management? No, have you had experience and no all the I mean All the questions that they were asking no, no, no for me And I felt that this was sad because here was a willing person and who liked the training so I'll go back to my custom presentation, which is Let's get the center of disease disaster training. You're nodding. I hope the money comes so Let's get a send a regional center where we can train people irrespective of what's happening. So that when such an Epidemic happens or a disaster happens, we do our people who are ready who need just a little Training and we can deploy them and not people like me who are just you know, it's you know, happy and you know want to go and zero with our knowledge as the Bible says is Thank you Again, I think we all speak to our To our pet projects, but I think from my perspective I'm most interested in in met in pairing up with Aaron To pull in the data that are actually being collected in the public health labs that are already there and already doing sample testing And make sure that those data can actually be shared so that then the information that can be passed on down the line both for Both in the context of this outbreak But for the next to make sure that the data aren't lost that they don't just disappear So that they can be used to actually inform better decisions for the next time around Be used for the training that loud loud wants to get and make sure that that's actually all based on Unreal data and on historical data from the locations where they're going to need it the next time around instead of all being based on lab data that are done in CDC labs or You know in in labs where what we you know There are a lot of great data coming out, but it's not with the local populations Hi Emily Kelly Defense Threat Reduction Agency I Believe I've heard quite a bit about How to get involved with community leaders and faith-based organizations and it's refreshing to hear it come from multiple angles With the DoD specifically we've mentioned before that we are focused on sustainability Often that is directly with the ministries of health or agriculture or higher education How do we make those community leaders understand the impact? the room that you're speaking to now is a sympathetic audience and Everyone's going to nod your head because we all understand what you're saying But perhaps the bus driver does not understand Maybe it's more important to him to learn how to use the emergency break than it is to recognize a passenger who might have signs of ebola Is this Something that we can do through marketing and campaigning or does it need to be brought to a higher level such as legislation? This is my personal opinion, but having worked in a couple different regions across the world I think that there has to be a tailored message depending on the country depending on the person and the level that you're having the conversation I think having that political will and that high-level awareness of the importance of The the spread of an infectious disease the impact on tourism and trade the impact on import export both livestock of agriculture Of of food safety all of these things play a major role at very high levels But they can they continuously translate down at the community level and it might just be changing the message I've seen a lot of very effective Posters and commercials that have been put out both on TV and on radio looking at how to make it a very Conversation piece at the community level and just making it relatable to the individual so for the bus driver for example I think it would be important to explain how His interaction with an infected individual may then bring that back to his family or his community and understanding that the basic mechanism of transmission or exposure So I think unfortunately it is changing the message depending on the target audience I was sorry I was gonna add to that again sort of come back to knowing your customer and market research Where again, we have to be really careful of not coming out and trying to sort of say This is the message or we know what you need to hear but rather to hear from these groups This is what we think now or this is what we believe I thought Nigel's comments this morning were really interesting in that regard about the importance of Choosing and how careful we need to be in crafting that so I do think there's a lot of value and some of these sort of concepts of research As you refine that message. I think that they would Indeed understanding the impact of some of these public health disasters if you have a flood in some part of Ghana You for like one week you see a huge drop in the number of people who would use these buses and it affects Wages so we can really explain to them the the impact of this but the message the message should be tailored But we're not going to use these drivers for this one time Ebola thing and it ends, you know We want them to be partners in the health promotion campaign so that beyond Ebola every quarter if there's something that's going to be done if it's Talking about family planning if it's about talking about Immunization for case if you're talking about non-communicable disease We can use them as ambassadors.  Thank you Thank you My name is through the fall on and I'm working at the Norwegian public health Institute My comment is towards Rebecca fish and about your interesting thoughts about using business models in health security and I'm partly wondering if this isn't a kind of Situation or a setting where the business models don't work And and where the markets are failing because they're I as I see it We need to here build kind of very very future directed Investments long-term investments in strong health systems that can yield the benefit Maybe after 10 years, maybe after 20 years where the markets are not present Where people cannot pay for these services where people cannot invest in these systems by today? And there is no market to buy these services in many of the countries where the needs is where the needs are highest and I think we have some strong Very strong examples of good not market-driven health systems development invest in Europe Which are extremely much less expensive than the market-driven systems in the US for instance And and of course you can say there is a kind of market system here by investing in health systems and investing in education I think also there might be a market for these and For these countries and for customers in the future But for the time being I think also we have to look mostly into public investments and having the funders interested It's kind of an idea of using market forces because the funders so far have been interested mostly in counting Numbers of vaccines given numbers of lives saved not maybe seeing how many lives can be saved in the next ten years somewhere else So I think there are some challenges also of using the market models Thank you all for your comments. They've been really great to hear My question was sort of in a similar vein I was just curious to hear how in a country like Liberia that's recovering from a civil war or even in other countries with Nascent public health and health care delivery infrastructures. What is the appropriate balance between investing in vertical health programming that targets specific conditions versus horizontal health Programming that sort of boost the general health capacities of a country and could some of these Epidemiological modeling capabilities that we have informed those decisions So my question is for Rebecca. I thought it was a great Presentation that you gave I have worked in the medical countermeasures efforts on both the DOD and HHS And if everything you said can come true, I would weep with joy And one of my concerns that I see though is I understand that you know business the same people making the policy and spending the money It's it's one person so that was singular message is quite clear But in in our government in different departments even we split up usually who's who's in charge of logistic Acquisition and who's in charge of policy? And so while we've explicitly named You know some groups are in charge of policy There is a lot of policy that has made and how we spend our money and how our resources are used And I see the same kind of dichotomy and so the message gets blurred because you actually have different people in charge And so I see this I fear the same site kind of dichotomy Arising here and that in this one team and the global health security agenda will not be directly resource But you've got to persuade the resources to be used in a particular way And so how do you prevent? How do you maintain that singular message when the people making the policy won't ever be in charge of the resources explicitly? Well, I to answer a few of the questions. I still firmly believe that there's a lot of value in the Sort of taking a business approach to some of these challenges because one of the messages that we've heard here consistently It's about know your customers know what they care about Control your messaging established metrics, so I think there's a lot of value in some of the business approach In terms of my proposal about the idea of a dedicated team Which I do think is critical because I think that's one of the biggest challenges where we have all of these groups involved And it's not quite clear who's fully in charge The idea behind that though is that they would have a clear mandate coming from the president or these associated Organizations like the World Health Organization and others Which is sort of that idea of the Manhattan Project piece of it So in other words, hopefully they are resourced because the relevant organizations have made the case that this is a global Issue of importance and that they need the resources because that is a challenge when you have one team Doing something, but they don't have the resources or the support to make it happen But that was part of the reason Why I invoked that idea of the Manhattan Project specifically for that purpose And then just to speak to the point of how exactly do we use? Epidemiological models but models in general to start addressing these issues You know, I think actually the greatest value in a lot of the modeling that's done isn't in coming up with a number an answer It's in doing sensitivity analysis around which aspects that you're looking at for a public health response Actually make a difference to the output as it turns out when you start to model something What you're doing is you pulling in all of the different pieces that influence the system and then you ask how they work together to generate an outcome and What you can do with that is say, okay well if I vary this one by this much does the outcome vary by this much or by this much and So what you're looking for is which aspects when we put investment there and we and we make a shift on That input where do we get a big change in the output versus a little change? And I think that's really the most effective use of the of that type of analysis is looking at How do we most effectively use the investments that we can make to make a big change in the outcome? If everyone will join me in thanking our panelists again And now we'll proceed directly to the next panel respond