Hi everyone we'll just give it a couple of minutes as participants join to let everyone get here before we get started. Got a number of people on here now we'll get started. So hi everyone thank you so much for coming to our last talk of 2020 for our criminal justice coalition speaker series. I'm Maggie McCann. I'm a 3L student at Dalhousie. I'll be joining the talk tonight in a conversation with our speaker Patrick McCann. I just want to let everyone know beforehand that it's going to be recorded throughout but none of your your faces are visible or anything like that. So please ask questions throughout as well. You can see the questions if you hit the question box just at the bottom and so if you see someone has asked a question that you would like to know more about you can vote on it to make sure that it gets asked right at the top there. So tonight we have Patrick McCann here speaking with us and you may have gathered already from the last name that he does happen to be my dad but he is a criminal lawyer who's been practicing at the forefront of criminal law for over 40 years. In 1989 he was among the first group of lawyers in Ontario to be certified by the Law Society of Ontario as a specialist in criminal law. He has been and currently is listed in the best lawyers in the category of criminal defense. He's represented clients in all trial and appellate courts in Ontario and the Supreme Court of Canada and has also appeared before military tribunals. He has been lead counsel in numerous major criminal trials and has handled over 60 homicide cases. Other cases involve drug trafficking armed robberies and commercial fraud. Patrick has been appointed to the list of top secret cleared special advocates appearing in closed national security proceedings. He is a founding member and past president of the defense council association of Ottawa and has lectured extensively at the Ontario bar admission course on criminal procedure and related criminal topics. He has also been a guest lecturer at the University of Ottawa at Carlton University and at the Canadian police college. It's quite a bio and our talk today is about the anatomy of a criminal case. So we're going to be talking through a particular case which my dad will outline but it involves a battered spouse defense. So I will be in and out but I will let that take over. Okay thank you Maggie. Hello everybody this is a little strange sort of talking to some people that I can't see however let's go. As Maggie said I'm going to talk to you about a case that involves a battered spouse syndrome. I picked this case because it's I think one of the most significant cases, murder cases I've had. The case involved a woman by the name of Lillian Getkate and she at the time this happened back in 1995. She at the time was a 35 year old housewife and brownie leader which was married to a fellow by the name of Maury Getkate who was a PhD psychologist employed by the ICMP. They had two children. Dara was nine and Kevin was five. I should mention that Lillian was basically half the size of Maury. She was about five foot and if that and about 100 pounds whereas Maury was about six foot two or three and I believe he was 215 pounds. They lived on a small two-story house off Prince of Wales Drive in Ottawa and in the early morning hours of December 10th 1995 sometime between four and five a.m. Lillian went down to the basement of their house picked up a 223 mini Ruger sniper rifle with a flash eliminator and this is significant I'll mention that later loaded it went back up to the second story of their house to the bedroom where Maury was sleeping and shot him twice in the back. She was charged with first degree murder and I acted for her from about 10 days after the shooting until the end of the process. By the time I became involved she was already already being released on bail but I'm going to tell you basically almost a narrative here of what happened in my involvement but before I get to that I should tell you what happened during this first 10 days. So after the shooting Lillian called 9-1-1 the police arrived they found her and described her as being distraught. She claimed not to know what happened. She was taken to the Central Police Station and when she was there she was interviewed by detectives. The interview went on for about two hours and eventually Lillian admitted that she had in fact shot Maury and she described what I've just said that going to the basement loading the gun going to the bedroom although she didn't recall pulling the trigger and that statement that she gave would become the basis that the ground relied on primarily to support a charge of first degree murder by planning a deliberation. Now the problem here that became a problem obviously for the crown was at that point after the conclusion of that interview the police finally let her call a lawyer. She didn't know any lawyers other than one who was the husband of a friend of her brownies. He practiced almost exclusively in family law and had little or no criminal experience and he continued to represent her for the next 10 days and he was able to get her out on bail but before that he agreed to let Lillian be interviewed by a crown appointed psychiatrist. The interview took place in the jail it lasted for three hours. The psychiatrist who interviewed her was Dr. John Bradford who is probably the most prominent if not one of the most prominent forensic psychiatrists in the Canada. I've done a number of cases with him and he probably would have been the psychiatrist I would have gone to if he hadn't already been retained by the crown. The problem though was that Lillian at the time was in no shape to be given the complete account of the history of the relationship with Maury. She did tell Dr. Bradford to some extent that they had a difficult relationship and she also gave a few examples which I'll get to later. The problem was that this basically gave the crown psychiatric evidence that they would use to try to undermine the eventual defense. The lawyer that was representing her as I said had little or no criminal experience and by letting her be interviewed by the crown psychiatrist that was something that no competent criminal lawyer would do. It gives the crown far too much of an advantage early on. Most criminal lawyers and virtually any criminal lawyer I know would say no you can't be you know do not talk to any psychiatrist unless they are retained by us. So as I said Lillian was released on bail and the main condition was that she lived with her mother June Fuller. Now June Fuller was living at the time in Maple Bridge British Columbia. She came to Ottawa and rented an apartment that she and Lillian lived in for several months. June I think quickly realized that Lillian needed representation by a criminal lawyer. So she contacted me and I arranged to meet with the two of them with her and Lillian. When I first met Lillian I think the first thought I had was yeah how could this little woman who was five foot necessary about 100 pounds be a cold-blooded killer. She just didn't look like it.  She looked like 10 years older than her actual age. She appeared timid, afraid of her shadow almost. She had this brave complexion that was really mousey looking. Didn't look like she'd been taking care of herself in any way be civil for some time not just because she just got out of jail recently or anything like that. But well we first met when we first met them June told me that she had suspected for some time that Maury was abusing Lillian although Lillian had denied it. Since the shooting Lillian had disclosed to June some very disturbing a very disturbing pattern basically of abuse. And so for the next month myself and my two partners and our investigator spent much of the time well not the investigator so much not at this point but myself and my partner spent time interviewing Lillian and going through great detail the history of their relationship. Lillian spoke mainly to one of my partners who was a female woman and she seemed to be much more comfortable talking to her certainly particularly when it came to talking about or describing sexual abuse. So basically in the course of these interviews Lillian described what I think can only be described as a horribly abusive relationship with with Maury and I'm going to get into that now and I'm told that I should perhaps warn people that I'm going to be talking about sexual abuse very significant sexual abuse and which is unavoidable because it's an intricate part of what happened here. Lillian described during our interviews that she and Maury had been together for 16 years. The relationship began normally but at least she was his first girlfriend or he excuse me put that the other way around. Maury was her first boyfriend as she had not had a relationship with anybody else prior to that. They lived together for about three or four years and eventually got married and it was after they got married she said that he became increasingly controlling. Maury began exhibiting angry outbursts when Lillian was pregnant with Dara and these increased afterwards. Maury was studying at the time for his psychology PhD and was she was sorry distracted there because an email stopped popping up on my screen.   He engaged in various forms of forced sexual activity. She described one occasion where they were on top of a top level of a four to five story arcade or parking garage. Maury took her to the railing pushed her half over the railing and then raped her from behind and then told her how easy it would be to throw her over. Another occasion he held her at the top of the stairs in their home threatened to throw her down. Other times he would drag her upstairs by the hair. So I was just going to ask do you remember did did she start to tell us to her mom or to you and your partner? Sorry I shouldn't quote I should clarify I did that because my mom was his legal partner that's she she is the the lawyer that he's referring to. Okay she didn't want me to mention that but anyway. But is that was he was she telling this to her mom or? Yeah she told well no this what I just described now is the is what she told what she told Tracy during the course of the interviews. She had already spoken to June about the abuse and much more detail than she had before and that's what partly why June I think realized she got to get herself a real criminal lawyer here and contacted me. Anyway we yeah so I don't know if I mentioned this but among the other things that Maury would do would he would drag her upstairs by the hair, drag her into the bathroom and force sex on her. The other thing that we did or another thing that we did very early in the process was that Lillian had talked about Maury's obsession with paramilitary things including gun collection and various other weapons and ninja outfits. She said he had literature and the subjects such as stealth and concealment and assassination techniques, explosives and so forth. She said he would go out at night and his ninja outfits and and he claimed he was training and a couple of occasions he he would be cleaning his guns and would point a gun at her and pull the trigger and then tell her that it would be so easy to kill her. In any event we before I get now before I get to working with her visit to the scene I'm going to tell you what she told us about the night of the shooting because I think it's probably appropriate we tell you that now and on the night of shooting Maury had dragged her upstairs he had violently raped her with a vibrator afterwards she laid awake for several hours and then went downstairs to Darra's bedroom. She lay down with Darra and within an hour or so Maury appeared in the bedroom dragged her out of bed and raped her again in front of the open doorway to Darra's bedroom and after he finished he made the comment to her that maybe soon she wouldn't need he wouldn't need Lillian because Darra was growing up. This was pretty frightening I mean to Lillian. She was sure that Maury was soon going to be started using Darra. She went back into bed with Darra and some time later got up got the gun as I said went downstairs and went upstairs where Maury was sleeping and shot him. She only had spotty recollection of those actions so like I said during the interviews Lillian told us a lot about the literature and the weapons that Maury had collected. So after the police cured the house I went there with our private investigator a fellow by the name of Russ Taylor. I wanted to view the scene anyway is that something that I always try to do as early as possible. There are many of these types of cases and while we were there Russ continued to search through the basement and found a multitude of things that had not been seized by the police. This included there was books and manuals and I'll give you a list here of things that included martial arts, militia tactics, ninja fighting, hand-to-hand combat, hypnotism, phone tapping, assassination, art of invisibility, camouflage, stealth and concealment, computer hacking. He also recovered handcuffs, locks and machete and the vibrator. This what was beginning to take shape here I think as you can see is that Maury obviously had a double life during the day he went to work as a psychologist at the RCMP and beyond that he had this obsession with this paramilitary stuff and ninja outfits and weaponry. That in itself tended to terrorize Lillian. I know you mentioned that she was aware of it but was he kind of engaging in that practice at home or was he mostly going out to do that stuff? My understanding he would be go out in his ninja outfits and run around doing stuff but as you'll get to when we get to the trial the police had actually found a and this was something actually Lillian had told us that he was experimenting with the explosives but the police had found an improvised explosive device in the basement that was highly ready to go off basically, let's forget the term and it could have been actually could have been could have exploded anytime although as it turned out eventually Lillian wasn't aware of the existence of that but it just sort of showed the type of person this guy was this obsession he had with all of this paramilitary stuff. Now the other thing we had to do was very quickly retain a psychiatrist now that we couldn't retain John Bradford. We contacted Graham Glancy who was a psychologist practicing out of Toronto who specialized in assessing bad women's syndrome. He testified in several other bad women syndrome trials and Lillian met with him over the course of two or three days and he did an extensive work up on her and within five months he was able to complete a detailed assessment of Lillian as showing all of the characteristics of the bad women syndrome. This assessment would form the basis for the defenses we would present the trial. Part of the assessment as part of the assessment Dr. Glancy had diagnosed Lillian is suffering from what he described as complex post-traumatic stress disorder or PTSD which he said is a severe form of the disorder and dysthymia which is a chronic form of depression. Next what we did was we interviewed three of Lillian's brownie volunteer friends. She had mentioned that she had been out for coffee and socialized to some limited extent with these people and we decided we needed to interview them as they were possibly the only independent witnesses who could testify to Lillian's state of mind leading up to the shooting. With the interviews ultimately we were able to flip the effect of their evidence that when they were called a trial by the crown they had all described various observations that fit Dr. Glancy's description of the bad advice syndrome such as Lillian having to call Maury every 10 minutes when they were Tim Horton's having coffee only being allowed to be out for an hour at a time and whenever she was in Maury's presence she would appear submissive and he was totally dominating if her as well they described how he was abusive of the kids slapping them and inflicting physical punishment to them. Also during this first six months we managed to team up very quickly Lillian with another psychiatrist by the name of Wendy Cole who was a treating psychiatrist at the Royal Auto Hospital. The point of this was for Lillian to actually get some psychiatric help for herself but Dr. Cole ultimately became an important witness as we explain when we get to the trial. So just concluding this part of the process the first six months when we basically laid the groundwork for the defense the trial would not take place for another year and two and a half years but it's something that is so crucial in defending these kind of cases is to get as much information and do as much investigation and preparation as you can at the early stages so you know where you're going and you can start planning the defense. Sometimes in other cases it's not possible to do that at an early stage and you have to wait until you get the crown disclosure to be able to do any meaningful investigation. Just thought I'd mention that is sort of a round up the practice to do if you're ever going to do trials like these. Between that point and when we got sort of trial preparation like they say almost two and a half years later there were a couple of things that occurred that played into the narrative. First of all June was anxious to get back home to British Columbia so we managed to get the bail conditions changed so that Lillian could go to BC with June and continue to live with her. The other thing that happened of course was the preliminary hearing. The preliminary inquiries back then were pretty well automatic although they still are I think for homicides. During the preliminary inquiry we were able to build up the evidence to create a charter challenge for the admissibility of the interview that Cranbers were lying on for first degree murder. Ultimately in the pre-trial motion the trial judge would rule that that statement was inadmissible as a violation of the information component section 10B of the charter. Before going on any further I should mention going back to when Lillian went and went back to the Vancouver area to make a rich with her mother.  She had gained weight and that was in a good way. She started looking her age. She looked healthy and she smiled a lot and she was basically a bright and all healthy looking woman and it would be difficult and then a bit of a dilemma for us as to how then when we got to trial preparation to if you like bring a rack down the ground and go back to reliving the events of December 1995 and the lead up to that. I'll get to that in more detail when we get to the trial but that was significant. What had happened was she was there. She joined some self-help groups, became involved in a support group for battered women and had gained an enormous amount of self-confidence in the process. The other thing that happened right after the preliminary inquiry was that the crown then offered Lillian to plead guilty to manslaughter if we would agree to a joint submission of 15 years and there was no way I was going to recommend that to Lillian and Lillian was not interested in it anyway. So the next step in the narrative is where we get to the trial preparation getting ready for trial and in a case like this we started it I think about six weeks before the trial date. The preparation involved basically three things. First, preparing the motions to exclude evidence which was the only one we did was the motion to exclude the statement which I've already mentioned. The other two things are prepared cross-examinations of crown witnesses and prepare defense witnesses to testify. Now the crown witnesses were basically the police that responded to the scene, the forensic identification team that searched the house afterwards, Dr. Bradford and Brownie friends. The police evidence was very important. From our perspective in introducing all of the material that they found in the house when they did their search, this is before our investigator got in and found the other things that I was telling you about. I'll get into what that was when we get into the trial, but it was significant that it was important that we be prepared to properly produce all of those items. We already of course had the interviews with the Brownie witnesses and all we had to do really was ready those to cross-examine the Brownie witnesses when they were presented by the crown. The preparation on the other hand, preparation of our own witnesses was another story. The preparation of Dr. Glancy took some time but only to ensure that I had the right questions to ask to bring out the evidence in a way that the jury could understand. Dr. Glancy testified many times before and was quite comfortable in relating his evidence without a lot of prompting, but we still needed to make sure we went and covered all the bases if I can put it that way. The main job was preparing William to testify and getting her to revisit the hours that she spent the last two years trying to bury. Most of that work, as I said, was done by my partner who had done the initial interviewing and let's say she did a great job. Ultimately, Lillian was an excellent witness. She managed to get her to recall and detail all of the abuse that she'd suffered and was able to do it in a reasonably strong voice that and as well was able to handle cross-examination by the crown better than we would ever ever have expected. I found that part of this case really interesting so I just wanted to stop for a second there. Do you find that that is a really big challenge in a lot of cases or is it in particular I guess with spousal abuse related crimes but is that forward and backward where they're in the time that they're waiting for their trial where they're trying to move forward with their lives and then trying to deal with jury perceptions and stuff. I just wanted you to talk a little more on that. Yeah, it happens. This was I think the most obvious one that I encountered in my practice where Lillian was like two different people and when we first met her she was like I say there's this timid little mouse and when she came back to get ready for the trial she was full of bringing with self-confidence looking so much better and so you know well confident and the dilemma of course was how to get the jury to understand that what she was like back at the time and so say that was the the job that Tracy did and and pulled her back into it. It was difficult but she understood that this is what she had to do and was able to be quite dramatic about describing it all. And do you find I don't know if you did this in this case specifically but do you use like photos of her at the time and stuff like that? Like are there or is it really just about trying to work with the witness and they're the way that they deliver themselves on the stand? Okay, well the the other thing is that the main help we got in explaining this was through the evidence of Dr. Wendy Cole, the treating psychiatrist. When Lillian came back for the begin the trial perhaps you saw Wendy Cole a couple of times as well again and so Dr. Cole was able to able to explain to the jury that the incredible difference between the before and after situation with Lillian. So the trial was in the fall of 1998 and lasted for three weeks and interestingly after the crown opening I was permitted to give an opening address. Now that's normally not done in fact the criminal code says that the defense may open prior to calling the defense. Around that time and subsequently many judges have been permitting defense counsel to give an opening address if they wish after the crown in order to particularly if there's a complex defense or and if the the defense undertakes it they will be they will be calling evidence. And it was I think pretty crucial because we've docked into the jury right off the bat what we were going to be doing and what they should be paying attention to and tied in the the evidence that they were going to hear from the police witnesses about what they had seized at the house and what and what we would present through our investigator and what Lillian would testify to and what Dr. Clancy would say. There was normally there's some debate about whether it's a good idea to do a crown defense opening a crown or a defense opening early in the proceedings like that is he could be tipping off the crown to things the defense that he they're not aware of but in this case that we really really no secrets the crown was well aware of what the defense was going to be working with. So after the opening addresses the crown began by calling the police witnesses first of all the witnesses that recounted the scene when they arrived and then the difference of identification witnesses who searched the house and I'm going to again give you another list of the things they found because again I think this is this was key to this case this material that we found that they found the and this was their beginning the beginning of our establishing this sort of bizarre double life that Maury was leaving was living they found various firearms I'm going to the details of those and ammunition and of course I mentioned the explosive device but they also found books and manuals about booby traps stiking infiltration lockpicking fake identification principles of quick kill surveillance surreptitious entry disguise how to commit crimes would be no evidence they also found machetes various partial arts weapons and explosives as I mentioned earlier they also introduced the the mini-ruger that Lillian had used the night of the shooting with a flash eliminator and I was able to get the police officer introduced them to confirm that the only there is no non-military use for a flash eliminator a flash eliminator is used by military snipers to hide their location when they're doing their jobs again it was another example of Maury's obsession with paramilitary matters I should mention that I'll get to that when I get to Lillian's evidence I think but he had Lillian convinced that he could basically disappear at any time he wanted and he could kill her and leave no traces and he would be gone and she believed that it was just another aspect of the abuse and terror that she lived through and after the police witnesses were called Dr Bradford testified he best testified basically in line with his report but in cross examination he acknowledged that Lillian had described being dragged upstairs by the air which wasn't in his report the the brownies friends and then were called by the crown and as I've already mentioned they were more helpful to the defense than they were to the crown the crown hoped to get from them established with them that Lillian had the opportunity to complain about the abuse to these women but didn't and but as I said they were also very helpful in giving their observations of Lillian at the time which fit perfectly with Dr Glancy's evidence of the characteristics of the battered spouse that the conclusion of the crown's case I then brought a successful motion for a direct verdict on first degree of course the the main evidence the crown had been relying on was the the statement which had been excluded so they were left with some notes that they found that were found in the house written by Lillian which referred to the death benefits that Maury would have through the insurance that he had at the RCMP trial judge agreed that that there was no evidence as to when that was done and what circumstances was it was done and couldn't reasonably support the finding of planning and deliberation at the time of the murder okay so we then began the defense evidence the first witness I called was Russ Taylor the investigator and he introduced the items he had seized from the home when he and I went there shortly after the shooting and of course this first further added to the picture for the jury of Maury's secret life that of course coupled with everything that the police had seized as well we then called Lillian to the stand and she testified to all of the abuse that she described in her earlier interviews and I won't repeat it all and as I said before that she was an excellent witness and was certainly held her own on cross-examination the next witness we called was Dr Glancy he began by describing the characteristics of better women syndrome and why some women and men cannot disclose the abuse as it escalates the reasons include self-blame he said fear of retaliation fear of losing custody of their children he explained that psychological and sexual abuse is more debilitating than physical abuse as it's aimed at destroying the self-worth of the woman the defense would eventually advance three defenses self-defense which would result in a full acquittal lack of intent to kill which would result in a conviction for manslaughter and provocation that would result in a conviction for manslaughter and dr glancy's evidence was key to all three of them self-defense as you may know required that Lillian reasonably believed that death or serious harm was imminent and that she couldn't otherwise defend herself although Lillian told dr glancy that she feared mori would eventually kill her that didn't help the imminent's requirement but she also had the fear of ongoing sexual abuse which I felt and dr glancy agreed would consist of fear of imminent fear of serious harm dr glancy's evidence as to why Lillian believed she could not leave supported the absence of the alternative requirements those are the the items I mentioned earlier in describing the the syndrome dr glancy's diagnosis of dysthenia and complex PTSD he said would certainly interfere with Lillian's ability to form the necessary intent so that addressed the second line of defense the lack of intent to kill it also supported the provocation requirement that Lillian was deprived of self-control by nori's actions and that she acted before there was time to cool off that's very very summary form of what the defense of provocation is the final defense witness we had was dr colin as I mentioned earlier she was important in being able to speak to the drastic change between Lillian and their first reading and Lillian the trial she also was able to give her own opinion as a psychiatrist supporting dr glancy's diagnosis um I don't know if I'm running out of time here I was going to throw in something about the reply evidence us very quickly because it's kind of interesting yeah yeah the the crown then in reply called um three or four of morris colleagues from work to say what a great guy he was at work and what a good psychologist he was and how everybody respected him etc and the the simple thing in cross examination was then to show them all of the array of of weaponry and outfits and literature that have been found in the house and asking them that this was this consistent with their view of mori at work and they all shook their heads and disbelief and says no that's totally inconsistent with mori and that just just cemented in my view the uh the idea of mori living to sort of basically a double life one of the you know upstanding members society is a psychologist the other is a terror terror basically a I'd say a domestic terrorist if you use domestic in the sense of a marriage or relationship so that that was the end of the evidence the next step with the jury addresses and I won't go into that in details the main focus of my jury address was basically asking the question of the jury like how could this timid torment of a person with no history of violence or aggression shoot her sleeping husband unless you know basically she could not see any other way out of the nightmare that she was in and the judge then charged the jury and they retired to consider their verdict now they were out four days and I got to tell you I was having more than my usual anxiety waiting for the verdict I primarily because of who Lillian was I mean what if they found her guilty of murder and the thought of forgetting an automatic life sentence was very frightening uh and and on top of that I've had a long-standing distrust of juries although they're not supposed to jurors do occasionally speak to us after the trial and tell us things that impressed them and didn't impress them and some of the things that I've heard from jurors have a very disturbing and and lead you to believe that they never really understood the issues or the illegal issues anyway and then or the the effect of the evidence so all of that added to my anxiety of course but eventually after four four days the jury came back much to my relief found Lillian not guilty of murder but did find her guilty of manslaughter now as I say I was relieved for that because I wasn't really hanging my head on a not guilty verdict based on self-defense as that is a bit of a stretch in these circumstances when uh it happened over a period of time but um once we had the verdict the manslaughter verdict and we weren't tied into as some joints crazy joint submission for 15 years I was pretty confident that with all of the the psychiatric evidence and all the character evidence that June forward managed to put together for us uh and knowing that the judge appeared to be sympathetic to the Lillian situation I was pretty sure that we could keep her out of jail and ultimately that's what happened and we kept her out of jail she was sentenced to two years less a day to be served in the community which is a conditional sentence under section 742.1 and that is the end of the story I could say a little bit about if there is time a little bit about the um the the reaction in the media after that the reaction of the crown's office uh have you got time for that yeah okay the um crown attorney uh handled the case was a a woman by the name of Julian Parfatt who happens to be somebody I've done a number of trials with and I like her very much that uh and generally she's a pretty decent crown but just give me a second I'm just going to pull something up I don't want this to get me there but yeah it does um but she went a little bananas after the verdict after the after the sentencing um and I'm referring to if any any of you want to get into the real uh the weeds on this case um Elizabeth Sheehy is Sheehy who is a uh law professor at Ottawa U has written a book on the um battered women's syndrome and devotes a chapter to the get cake case and she talks about at the end of it about uh the response to or reaction to the sentencing and she she wrote Parfatt contested the sentence she took the unusual step uh of speaking to the news media calling the sentence an appalling message to send to the public and claiming that there was no corroborating evidence that Lillian was abused which was obviously not true um maybe they had lots of corroborating evidence on it yeah and then that led to uh okay I think I may be stuck here yeah yeah I am my computer's corroborating anyway then there were a series of uh of editorials and comments and stuff in the news media uh basically talking about licensed kill and uh the you know that all you have to do is say you're abused and uh you're going to get off of you get away with murder um ultimately and and also crashing the trial judge you know I'm totally unfairly for imposing the sentence even though it was backed up by they ignored the amputee supported by other cases uh I'm not writing a letter to the editor on it which I was going to try to quote from but I can't get it back up quickly on my computer and in which I sort of basically went to the judge's defense because judges can't go to the press and write to the press and defend themselves and occasionally once in a while I think you have to do that anyway that's all I wanted to say about that so I don't know if anybody's got questions but that's it for my presentation yeah we've got a couple of questions so thank you Mr. McCann for for your talk um all right we've got three questions right now so um just trying to think of which one makes the most sense to ask first um okay so actually most relevant to to the end of the talk um were there no ethical implications of the crowns comments to the press um I think there are I think there are um the uh the irony it is that the the actual the the crown attorney for Ottawa um backed up Julian Parfait and said similar things uh you know crowns have done that before I think it's totally unethical to take shots that basically I've had them take shots of the judges in the press uh and nothing happens to you know they all think they're you know to some extent they feel they're above them the answer to why are god you know that type of thing right um the 12 questions so um it seems like you did have a lot of evidence before crown disclosure was this mostly conducted on your part and the doctor instead of the police well yeah I mean the police did very little in the way of investigation other than you know they established that that that that uh Lilian had shot Maury and uh and that was sort of basically where they stopped they did seize all these this stuff from the house which was very helpful to us but yeah um we got on it right away I mean this was you know dealing with this kind of any kind of a psychiatric case like this um you got to get on it you got to get the psychiatrist involved you got to make sure you get start looking for evidence that will support the the psychiatric diagnosis that you're hoping that you will get uh and but the same is true with other cases too I mean the earlier you can get into investigating it the better do you have um when you so you mentioned earlier that you like to go to the crime scene yourself whenever possible and I was kind of curious actually I forgot to ask at the time um are our crime scenes closed off to to um defense counsel or anything like that like is that uh is that dependent on the case or how does that tend to work well it sometimes complicated because the police first of all will cordon off the area where there's a crime if it's outside or will close it you know close the house where the shooting takes place until until they've completed their investigation and you can't get in what let's happening you might be able to if you you know with a in certain circumstance it might be possible but normally you know you wouldn't get in wildly uh until the police have completed their their investigation um sorry there was another part to your question what was it the it was just uh I guess um the at like at what point so you said already that you like you wouldn't be able to get in before the police are done their investigation but is it case dependent on whether you're able to get in afterward like is it yeah I mean you know it's it sometimes you know it happens on somebody's private property and you've got to get permission from the owner of the property to go in and see it um there was uh yeah depending on the situation they may not be anxious for that to happen but you know I don't kind of think if I've ever had ever been refused I don't think so but I've had to you know I've had to ask for permission and make all kinds of undertakings and stuff before we go in sometimes but most yeah most murders I've been told would actually take place outdoors so that's not a problem yeah um okay so um do you think it would be easier to run a case like this today given the changes in the law of self-defense you know I don't know that it would be any different um I think I think what is key in the law quite frankly is the uh is the lavalier decision where Justice Wilson um basically takes issue with the concept of imminence that she notes that that's not really in the code it never was in the code and that um it has it um is really sort of a judge made requirement in the in the jurisprudence and she said basically says it should be you know taken on a case-by-case basis and in situations like this imminent doesn't mean immediate it could be sort of something that you know is coming or you feel is coming and it's not and you can't get away from it yeah I mean in this in this case too there was only so much like what is she gonna wait for you know like for for him to be coming at her with a weapon when he is has been training as a combat artist I guess I don't know how else to call it yeah and the size difference too and I you noted that but but I think in terms of the imagery of um you know the reality of suggesting that someone should be in the moment in a threat to to have a valid self-defense seems a little bit crazy when you consider that type of circumstance yeah um you know I I'm not sure whether the you know the amendments to the self-defense and the criminal code would have any bearing on it I don't think it would I think you know the same principles still apply I mean really what happened when they amended the criminal code was they just simplified the the criminal the the defense basically adopting what the jurisprudence or how the jurisprudence had interpreted the previous provisions okay so we've got one more question um do you think that if the self-defense would have failed that provocation may have been successful with the jury well it had to be the provocation or or lack of intent I'm not sure which one it would have been I would have think more likely lack of intent but then the other thing the other thing of course is it could have simply been a compromise verdict where you got some of the jurors wanted wanted wanted to convict her murder some of the jurors wanted to acquit her and they just sought it off of manslaughter that that sort of thing happens on jury trials I think and that's another reason why I don't like jury trials not not always consistent with the law yes is that a form of jury nullification uh no not really not really because there were defenses there I mean there was you know the evidence supported the verdict I don't think it was right they're just they're just averaging their opinions yeah yeah no I think so I you know I know it happens it's happened in a lot of jury trials I mean and we're I got stories I could tell you we would take way too long but but the old courthouse in Ottawa actually had a if you went to the press room was right beside one of the jury rooms and if you went there and listen to the brother arguing you could actually hear what they were saying who was never never told anybody oh well there was a few of us knew about it but that's certainly not the case anymore that was many years ago and that that's in the press room they can hear it was in the press room the press room was right beside the or adjacent to the to the to the jury the the jury deliberation room and I guess the walls were a bit thin it was an old courthouse and uh soundproofing wasn't great it just it seems like that would be particularly exciting for the for the press well the guy that the reporter from the citizen at the time was the one that told me about it here that they didn't and of course never never disclosed it and nobody ever disclosed it it was just a secret amongst people that knew about it right not much you could do about it but I mean it was you know it was kind of interesting the year that they were yeah some of the things we're talking about you couldn't hear everything but you could certainly hear some of the stuff they were talking about and we had one case where the jury went out to um and uh yeah I won't get into that sorry I could be telling tales on people that I okay well that's perfect timing anyways because we're we're pretty well just at seven um so yeah thank you so much dad for for joining us for this talk and for sharing your your stories this is super interesting and um I would like to encourage everyone to uh follow our social media we're on uh facebook is the um uh the da housey criminal law students association is our facebook page for uh twitter and instagram it's the criminal justice coalition and uh you can find out about uh our speaker series for 2021 on there and you can uh learn about our faculty and our students our alumni and uh other cool events that are happening so definitely check out our social media and uh this talk if you weren't able to catch all of it or if you know someone else who is interested this talk will be uh up on our shulik school of law youtube page uh usually we get them up within two to three days so it should be there pretty soon um yeah and that's it so thanks okay bye bye


It's always a little challenging to be speaking about research, particularly right after lunch. But I hope that the panelists who have joined me and some of you out in the audience upon whom I will call, will really be able to talk about how this relates to the challenges that we're facing in the field and how this will change what we're trying to do. As I was thinking about it, what we're asking technologies to do largely is to help us bridge the gap between what is controlled today to elimination, whether we're replacing drugs and drug strategies or we're replacing diagnostics with somewhat different tools that will accomplish different goals or potentially introducing entirely new constructs like a malaria vaccine. Now, this concept of bridging that gap is really important because over the day and particularly last night we had almost two conversations going. One was a control conversation, what we're doing today to control malaria. And then the other one was an elimination conversation in which we're talking about the infectious reservoir and different strategies that are going to have to be taken. Ultimately, these will need to be combined. It will need to be one strategy. But we're not quite there yet. And so the job of this panel is to really address what innovation can bring. And I really want to emphasize that for whether it's polio or smallpox, even Rinderpist had moments where innovation saw some of the problems that they were facing. And I think that is actually accentuated when it comes to malaria. So let me ask Chris Plow to start off. I was fortunate to engage with him as he was leading some of the work on malaria on drug strategies. So I know who to call. Thanks, Gina. So I'll try to set the stage a little bit for conversation about drugs and also some of the other technologies and tools in the pipeline. But I first want to go back to the notion of the Gina just brought up about control versus elimination and what we're talking about doing here. So when I was a medical student working in Kenya in 1986, loosely supervised by somebody sitting here who was in the military at the time, we went out and did a survey pricking the fingers of adult men in western Kenya in a village called Saraditi and checking under the microscope who was infected. We surveyed 100 men, none of them had symptoms of malaria, and 90% were walking around with plasmidium fulciferum parasites in their blood. So we've known this is the case for a long time in Africa where there's a lot of malaria, people build up immunity, people can tolerate parasites after enough years of exposure without being sick. So we talked about the asymptomatic reservoir. What's a surprise to us is that we always thought that in lower transmission settings, Asia, Latin America, this would be very rare.  But with some very sensitive diagnostic tools, molecular diagnosis, we're learning now that perhaps as much as 40% or more of people on the Thai Myanmar border, for example, might be walking around with asymptomatic parasites. And this really changes the dynamic of surveillance, drugs, and ultimately even vaccines, what we want these tools to do. So with that as background, I will say that the diagnostic tests that are being used to show these kinds of shockingly high levels of infection in Asia are not something that we can roll out, not something that community health workers can collect the samples and do. It involves drawing a couple of mills of venous blood, you actually have to centrifuge the sample out in the field, do some other fancy things and plunk it in liquid nitrogen. That's not scalable. So what we're trying to do is take technologies that are very promising, tests that can do exciting new things, and really get them to a stage where they're robust enough to work in the field in scalable conditions. And Paul Labari will talk more about some of these technologies in just a minute. If we're trying to use drugs, one of our earlier speakers mentioned targeted mass treatment, where it's basically using drugs to eliminate all the parasites in the human population. The reason I put the eyes of the hippo up there, as opposed to the tip of the iceberg, is to give you the sense of this very large amount, this very large reservoir that you can't see. The eyes of the hippo represent the clinical malaria. It's just a more tropically appropriate analogy. I'm glad you told us what that was, because it's not entirely obvious. Those are the eyes of the hippo. That's the malaria you can see, the clinical disease. And what we have to tackle if we want to eradicate malaria is everything that's under the surface of the water. So if we're going to be using drugs to treat people who don't have symptoms, and that's what we're talking about now, that's being piloted along the Thailand-Myanmar border, and soon in other parts of Myanmar as well as Vietnam, I think, and Bangladesh, and elsewhere in the world, these drugs have to be extremely safe because you're treating people who aren't sick. They need to be effective in Southeast Asia against artemiscent resistant parasites, and ideally they should be administered in a single dose. So they're something that you can give in a campaign and not to have to have people coming back when people aren't sick, they're not as motivated. So there's been progress with some promising new drugs that are in early stages of clinical testing. A lot of this work is supported through the Medicines for Malaria venture, notably with some partners in the pharmaceutical industry, Novartis in Glass of Smithcline come to mind. None of these candidates yet are ideal. To finish when the very long-acting drug the U.S. military has also been involved with is something that requires some testing before it's safe to use. Others have multiple doses, so we really are years away from having a drug that's going to be widely available for elimination indications. Vaccines, again, we're not talking just about the clinical disease, the eyes of the hippo. There is a vaccine that I'm sure Ashley will talk about, RTSS, that's moving toward licensure that has efficacy against clinical malaria. We don't know what that vaccine will do to the risk of transmission. And so I'm sure we'll hear more about next-generation vaccines building on the success of RTSS from Ashley. There's been some really interesting results recently from a very different approach with vaccines taking the whole organism that's been irradiated in the mosquito, something that was tried at University of Maryland 40 years ago. If you give 1,000 infected bites from irradiated mosquitoes, basically using the mosquitoes, a needle and a syringe, to immunize with an attenuated whole organism vaccine, eventually you can get protection. So we've been involved in some tests with scenario Steve Hoffman is here and recently in a study done at NIH, much of their support for this, by the way, from NIH in a very small study, 100% protection was achieved against experimental challenge. So this is now moving into the field. There are many obstacles to getting this ready to go for elimination, but something that completely abrogates infection, that prevents not just the clinical disease above the surface, but the infection below the surface is what we're going to need for elimination. So that's the kind of approach that will be needed. There are more kind of high-tech approaches just from a finger stick of blood the same way you get blood for a rapid diagnostic test or for microscopy. You can actually now get genetic information from the whole genome of malaria parasites and there are ways of then analyzing that information to try and predict the parasite migration patterns, where parasites are genetically communicating with other populations and potentially highlighting areas of risk. When I talk about this kind of work, I'm challenged by people from the Gates Foundation, for example, is this information that the NMCP directors are clamoring for right now that the people in the field need. And so I think the onus is on researchers to show how this kind of information can be actually made useful to make decisions right now on what's needed for controlling and eliminating malaria. But I want to come back to something that we've been talking about intermittently throughout the day and that's the political will. I think even with some of these higher-tech approaches, high-throughput molecular surveillance to map infection or drug resistance, we shouldn't underestimate the political will benefits of a pretty modest investment in capacity development in the malaria endemic countries. We're looking here at some pictures from training workshops both in the lab and in the field with surveillance in Myanmar. And there's just a tremendous amount of ownership and buy-in you can get from working with the local partners to analyze samples in the country, not ship them out and to establish the capacity for surveillance. And I think ultimately for this to work in the long term, as we've heard in the finance discussion, the countries are going to have to invest. And if this is seen as something that the development partners are doing and kind of owning, it's hard to imagine how we're going to get the kind of local buy-in that we need for the long-term success. So I really want to emphasize that. And I will just say, apropos the last discussion on the upper right there, you're looking at somebody who was once living and working on the border, attempting to overthrow the Burmese military, standing next to a brigadier general who is a malariologist and one of our partners now on malaria control and elimination. So I think if this can work at an individual level, I would hope it could work at a military-to-military level between the U.S. and Myanmar. And my last slide just to kind of finish up then kind of takes a step back to highlight the importance of cross-border collaboration and cross-sectorial cooperation. On the bottom left is a border post between China and Myanmar. On the upper area there is a refugee camp on the China-Myanmar border. And then on the bottom right, there's a river crossing. And a kilometer away from the official border crossing, you have people coming back and forth from the jade market in China into Myanmar. And this just, again, highlights the importance of having tools that can be used in these kind of settings and refugee camps and in areas where there's not much infrastructure. And on the bottom right, the building on the far right there is actually the Ministry of Health of the Kachin Independence Organization. So this is an area of Myanmar that neither the military nor the civilian government has access to, but working with the Chinese CDC, you can work on this in this part of the world. And we're beginning to do surveillance here. So as we talk about these tools, I think we always have to bring it back to what's really going to be scalable out there in the places, in the border areas where we need to be working. Great. Thank you. Won't you pass it down to Ashley? Thank you. We've seen a huge shift in the focus of malaria vaccine development over the last few years. Back when resources started to flow into translational R&D for malaria vaccines around, you know, 2000, the focus was really on developing vaccines that could minimize the disease and death in the highest burden population. So young African children exposed to felsiparum malaria. And there's been a, as we've discussed today, you know, a big shift towards not just focused on that population, but more broadly the role that vaccines could potentially have in elimination or eradication of malaria. A lot of the gains that we've seen over the last 15 years have been down in the absence of a vaccine. And so we shouldn't take for granted that a vaccine is absolutely essential. And I think the next slide I find is a really, you know, great example of what a vaccine could have done to leverage some of the gains that have been made by other interventions over the years. So this is a very nice review article that looks at 75 different resurgence events in 61 countries from the 1930s to the 2000s. And the main take-home message from this article is that almost all of these events, over 90% of them, were attributed in part to weakening of control programs. So you can see pretty much across the board here, and there's more examples in the paper, but if you look across the top three, these are all parasite prevalence data. The others are on malaria cases. But if you look across the top there, the impact of various other interventions to get transmission down to very low levels has been proven over and over again. But as soon as you pull back, then the parasite comes back with the vengeance and within a few years you're back where you started. So we really do look at this data in the context of the role that a vaccine could have had to harness those gains and leave those individuals when you were maybe forced to move out of those populations, political well-died resources were limited, that you could have left those individuals with an immunity that they would have carried with them independent of their behavior during the days and the intervening months and years. So I think this is a really good example of how we see vaccines for elimination, really leveraging what can be done with other tools to get transmission down to very low levels and then have vaccines really do the job in terms of preventing reintroduction and reinfections. So I think our timing was probably as bad as it could have been in terms of the first malaria vaccine technology roadmap, which was an effort that involved hundreds of people around the world to define what are the real goals for malaria vaccine development. And this was published back in 2006 with a lot of involvement from WHO, many of you in this room, to really define what are our goals? What are we trying to achieve from malaria vaccines? And the strategic goal was a highly efficacious vaccine against Plasmodium falciparum malaria that could be implemented in young African children by 2025, and then a landmark goal of 2015 to develop a partially efficacious vaccine, 50% efficacy against severe disease and death. And that's what we were working for. I think it's sort of from 2000 on, this was really the main focus, this was solidified in this roadmap in 2006, and then of course in 2007 the field began to shift as the call for a renewed focus on elimination and eradication came. So over the last few years we've been working very closely with WHO, all of the other funding agencies, the Gates Foundation, USAID, EU and others to define a new set of priority goals that are really aligned with where the field is today in terms of not just thinking about vaccines to minimize disease and death, but more long term the role vaccines might have in elimination and eradication. So the original landmark from 2006 still stands and RTSS GSK vaccine that we've been very heavily involved in developing a path malaria vaccine initiative has the potential to achieve the landmark goal if it receives a positive recommendation as early as next year. So that landmark is still in play, but now the goals going forward are really focused around two endpoints. One, a vaccine with high level of protective efficacy against clinical malaria. This is both falciparum and bivax malaria. And then goal two is really the new one which focuses on vaccines that reduce transmission of the parasite that are going to be particularly important for supporting future elimination and eradication efforts. In alignment with this roadmap, the WHO has led a process to define what are called preferred product characteristics to give further guidance to vaccine developments on what the key parameters are for vaccines that could be favorably reviewed for pre-qualification, things like the number of doses, how those doses are administered, the thermostability of the vaccine and what have you, and those preferred product characteristics should be available over the coming months and will be important in guiding future decisions and investments in malaria vaccine development. So we've got long-term goals with the roadmap which is really important for us to have. In terms of the short-term goals, in the next few years obviously the 2015 landmark goal with RTSS, we're all watching that. The preferred product characteristics that I mentioned to guide the development of vaccines that are going to meet those new technology roadmap goals. And then the regulatory approval process for transmission blocking vaccines is a challenge. We've made a lot of progress over the last few years working with FDA including some discussions in the last few months to define what the pathway would be to license a vaccine that doesn't provide a direct immediate benefit to vaccine recipients but provides a community effect through high coverage and high efficacy and we may get a chance to talk about that a little bit more when we talk about some of the key challenges. I think in the midterm, hopefully we're going to do this before 2020, maybe in the next couple of years, evidence that the high level of efficacy that's needed to support elimination agenda could be achieved hopefully before 2020 including with platforms that are really fit for purpose for implementation in endemic settings. Just to finish, this is the global malaria vaccine pipeline. We're starting to see some new transmission blocking vaccine candidates coming on. Those are shown in yellow here. These were not on the road on the pipeline a few years ago. These are vaccines designed to induce immunity that can block human to mosquito transmission, the herd immunity effects I mentioned. Very heavily represented a prerecitic vaccines as you might expect can prevent infections as well as provide a direct and immediate benefit. So the best of all cases really these are all shown in pink. And then in blue you have the blood stage vaccines which are really primarily focused on the individual benefit from prevention of clinical disease. And we've definitely seen a somewhat of a waning in the pipeline for blood stage vaccines as there's been a resurgence in the focus on elimination and eradication. I think a point I wanted to make on this is really the importance of a portfolio based approach to achieving these malaria vaccine development goals. Until you get through phase 2B data, we really do advocate strongly that investments are made in the context of a portfolio that enables trade-offs to be made as new data emerges and that we don't commit ourselves too early to a single vaccine approach and certainly until it's reached proof of concept in the field and then of course it makes perfect sense to advocate for a product specific investment in alignment with a specific target product profile as we've seen with the RTSS vaccine. So with that hopefully that's a helpful introduction. Great. Thanks for setting that stage, Ashley. Sorry? Thanks for setting that stage. Great. Now, Paul. Thank you. The world of diagnostics. Great. Thank you, Stephen. Thanks, Gina. Thanks, Katie and the rest of the CSIS team for setting this up and inviting me to be on the panel here. I think many of you guys were thinking that you might make it through an afternoon of elimination discussions without seeing a single iceberg, but scrolling through a few more slides here, we'll get to it. There we go. There it is. The iceberg. And very similar to the eyes of the hippo, I think the iceberg is a great way to describe what Ellen referred to as defense above the water. Very successful efforts over the last couple of decades in attacking the clinical side, but the offense needed for the asymptomatic reservoir is really going to require new tools and a transition or a bridging period, as Gina's been referring to. Good question. Last night we talked about the advances in technologies and the ridiculous amount of new tools that are available. And perhaps it's easy to have one lulled into the thinking that maybe we don't need new tools in the area of diagnostics. I think this is a good example that Lisa White's been using to describe how inadequate current RDTs actually are in detecting the asymptomatic reservoir. So what you have here is a cohort of PCR-positive malaria specimens that they've detected the DNA to prove that each of these specimens can, in fact, transmit the disease. And yet the RDTs in the bag represent all of the negative tests from that cohort, and there's only two positive tests in that cohort. Now, I'm not quite clear on whether this is representative of all RDTs. I suspect this had to do with the specific commercially available RDT chosen. But I think in general that the statistics I've seen is that up to 90% of the asymptomatic DNA positive tests out there are, in fact, RDT negative. And so I would argue that, in fact, we really do need some advances in the world of diagnostics in order to see that lower part of the asymptomatic reservoir, the lower part of the reservoir underwater. The question is, how would we use them if I could advance? There we go. How would we use those tests? Well, if you look at the upper part of this graphic, this is a framework the diameter team created to help work through the discussion of how diagnostics are used. And the symptomatics or the clinical cases are covered really in the control phase through passive case detection. People are walking into a clinic. And that's relatively not so complex as compared to all of the different use scenarios for how diagnostics get used in the elimination context when you're seeking that asymptomatic population. We call those active infection detection because you have to actively go out and find these people. It gets more complex. We talk about reactive where you're reacting to an index case or proactive where you might be going into an area of unknown malaria and trying to find out whether that's a hot spot or not. It gets even more detailed than that. I won't go into the details, but it is a much more complex set of use scenarios. And sometimes the actual performance characteristics for one use scenario might be in contrast to the use or the performance requirements for another use scenario. So building good target product profiles is really key to product development in this area and getting the users of those tests involved. At the bottom, we have laboratory testing. And as you go for the asymptomatic cases, the actual parasitic density goes down. So whereas historically microscopy has been an excellent gold standard in the control phase, it is, in fact, a static measure of a dynamic infection. And in fact, we really do need reference tests, laboratory tests that are capable of 10 times to 100 times or even better limit of detection than currently available with microscopy. So how are we doing in that pipeline? Well, it's not a very rich pipeline compared to vaccines. And I think we've got a lot more work to do. This is a pipeline. It's an abbreviated pipeline, representative of some of the leading technologies that are under development and working through towards commercialization. And it's a lot more rich than it was, say, five years ago. A lot of good money has gone into R&D. Working through this, you can see there's really three categories. We really do need true positive point-of-care tests. So you can go out and conduct that active infection detection with a test and treat people on the spot. You don't want loss to follow up. You don't want a three-day gap. So the positive test at the point of care is really important. The IDT initiative led by the Gates Foundation, the diameter team at PATH, is the managing partner of this initiative, is advancing an HRP2 or an antigen-specific infection detection test. Using the form factor of R&DT is why? Because this is an accepted form factor. It's got an ease of use that's hard to beat. We want to get more of these out there. We want them more sensitive so that we can support the active infection detection. Isothermal methods have come a long way. Are they really point-of-care tests? Well, there's a lot of gray area there. You've seen some commercialized lamp tests and also a lot of more research going into isothermal looking at Vivex, higher throughput tests, other isothermal methods listed there, helicase-dependent cross-priming amplification. I think really exciting, although it may be a few years out, is the idea of being able to have a non-instrumented or an electricity-free disposable version of molecular. There are some efforts in the product development pipeline focusing on that. There you would have the ease of use of an R&DT.  For a true positive lab test, as I said, you really do need very, very sensitive reference methods. And in the pipeline are PCR for both DNA, which is a high volume, high blood volume test, as well as PCR for RNA, which allows a much smaller, even a finger stick volume of blood. If you're going to have an HRP2 infection detection test, well, you really do need reference standards that are even more sensitive in the laboratory. And so that's why we have the HRP2Q ELISA reference method there. And then finally, there's the same in quality control and manufacturing that you can't quality inspect something that you can't measure. And if our goal is eradication and the elimination of parasites from the human reservoir, then you actually do need a tool to measure that. And so you absolutely need a true negative laboratory test, where you can go out, take specimens, and demonstrate that a population in general is negative and that transmission hasn't occurred for a number of years. And serology is an excellent measure of that if you start looking at age-specific co-parts. So with that, my last slide here. Oops, we're cycling through. I don't know what happened. Give me a second. Just a few take-home points. There's really no silver bullet. Hopefully one of my slides indicated that there are many use scenarios and probably no one tool is going to fit all the needs in the way that RDTs have been really instrumental in a one-size-fits-all for control recently. New tools can create temporal and cost efficiencies for malaria, that should say malaria elimination programs. Unfortunately, the market forces are insufficient to drive innovation. And we've seen this with RDTs. We've in fact seen the opposite, where the market forces have been a force against innovation. And unfortunately, it may be the case that the scale of the markets or the economies of scale that we're used to seeing with RDTs may not apply in an elimination context, depending on how many countries are adopting the same tactics and therefore the same tools. So it's something I think we want to do some market shaping to make sure that we can try to achieve the same economies of scale. User-friendliness, you can't underestimate that. And I think going with platforms that are familiar can get you an operational sensitivity much better than platforms that are difficult to use. And then finally, there's a lot of innovation piled up. Right now, a lot of that has to do with unknowns. We still don't know everything about the heterogeneity of malaria and the differences between how tactics and tools may be used and successful in one area and not another. And so I think we still have to do some basic research and also move that up to the level of new policy and consensus at that level in order to drive innovation. Great. Thank you. Now, do we have a microphone? Great. If you could hand it to Dr. Steve Hoffman up here. He's in the middle right in front of me. And the question for you, Steve, is, first of all, in terms of acceptability, you are working with a novel classic approach which requires IV formulation. I'd love to hear what kind of response you've had from people in country where you're doing studies about the acceptability of that kind of a strategy, which is very different from any other vaccine. And then could you comment on what engaging with research community in Africa and Asia, wherever you're doing your studies has been like, because you're taking a very different approach to working in product development. Well, how long do you want me to talk for? You get a minute. So let me just go back about to 2009 when there was a meeting convened by the WHO in Senegal about whole parasite malaria vaccines. And there were a number of individuals from institutions that you may have been associated with before and others who stood up and said, it is impossible. We will never accept a vaccine that is IV, for example. Right. What we call now direct venous inoculation. And the next morning, seven African scientists from seven different countries stood up and said, you give us a vaccine that works. We're going to figure out how to administer it. As you well know, we've been studying our vaccine, which is given through a 25 gauge needle of 0.5 ml in Mali, in Tanzania, in Equatorial Guinea.  In Mali, they've given 500 consecutive injections in less than 10 seconds without a miss. 60% of the injectees don't even know that they've been injected. So I think the answer is, and I would like to extend that. You mentioned about the target product profile and so on. The target product profile has to start with being sensitive enough. A vaccine has to start with being effective in us. And the idea that in the 21st century, we have a job of getting a highly effective malaria vaccine or a non-PCR, highly sensitive diagnostic or a drug that works in a single dose for all parasites. And my view, and as you well know it, and its scenario has been, let's get that first. The idea that we can't figure out how to engineer getting that to people, I think is just to try to start with practical and then move towards effective when you don't have effective is not the way that we've chosen to go. So the answer is that our colleagues in Africa who are clamoring for this have never once said we can't do it. They just said, let's see if it works and if it works, we'll figure out how to do it. Great. Thank you now. Lift your hand. No, no, no, lift your hand. Michael, could you take the microphone please?  Sorry, the back of my head is kind of ruined. It's okay. All right. And because we couldn't keep on inviting more people, we can't hit absolutely everything happen. It's a very rich field right now. But there's a very important area that's not on the table, which is vector control. And I didn't want to talk about insecticides because hopefully there's insecticides being worked on to replace or offer alternatives for insecticide resistance. But if you could address a little bit of the novel paradigms like spatial repellents, et cetera, just let the group know the richness of what's coming along. Okay. Thank you, Virginia. I have to apologize. In the last session, it was a shameless attempt to get the names of the mosquitoes on the record here. And fortunately, we do have Fred and Martin. We'll be talking in the next session about entomology. I think it's often forgotten that there is a lot of innovation going on in the vector control field. So right now I'm doing some work with the Innovative Vector Control Consortium. There is work with insecticides, as you said. Just to make one point, though. Although vector control is more than 60% of GMAP of our investment in malaria, when you look at the global insecticide industry, the pesticide industry for agriculture is about 54 billion per year. With vector control, it's less than a billion. So we have the same issues with MMV, MVI. It's the public-private partnerships to develop these new products. So there is a lot of work going on with new formulations, new insecticides, et cetera. But for innovative products, there is work going on. And a lot of this was started, again, from the AFPMB, the Armed Forces Past Management Board, in their deployed warfighter protection program. But looking at treated materials, repellents, spatial repellents. And we have a number of projects now with IVCC looking at push-pull strategies where you have a spatial repellent combined with a trap to push the mosquito into a trap. There's other work going on with attractive toxic sugar baits, trying to get the mosquito, interrupting the mosquito's life when she is looking for a carbohydrate meal. Some other things with swarming, et cetera. So there are a number of little niche issues going on. But I think what's important to stress is that we will never have a magic bullet, as Paul put up here. We will never have a magic bullet like we had with DDT, like we had with pyrethroids. Everything now, I think, moving forward will be much more niche products. Things that you can use, not globally, but in certain situations, spatial repellents save for funerals in Africa. Topical repellents or treated clothing for rubber taffers in Burma. So much more niche products. And this requires people. And I'm glad that the very first session with Alan and Bernard mentioned the issues of systems and capacity building. Because without the environmental health technician, environmental health officer, the public health entomologist, we don't have the capacity to adapt these new tools that are coming to a specific situation. So we often joke about the gray hairs and the no hairs in our business. And fortunately, I think there are a lot of good young entomologists coming up for the next generation of public health entomologists that can really develop these innovative vector control tools, thinking that we will not have something at the magic bullet that we had for our generation and previous generations. Thank you very much. So to bring it back to the panel, clearly there are a series of innovations and probably more than we can swallow. There's a pipeline so that we can optimize and choose the best of what will work well and what will be acceptable and what will be usable. Has industry remained engaged? And let me just ask you to opine that, because we've gone from a control scenario to an elimination scenario. And there's unknowns about what the scale of manufacturing is required and who's going to pay for it because you're not dealing with treatment of acute illness for which people are willing to pay. These are different public health strategies. Has industry remained enthusiastic and engaged? And let me start. We'll start with diagnostics. Sure. Thanks, Gina. Has industry remained engaged? Or are they? Are they engaged? Well, I think that's actually two different questions. So the first question, as I said, there's been disincentives to innovation driving down the price of RDTs, rapid diagnostic tests over the years have certainly provided a disincentive. And I think so that's where some of these in-between players like PATH with Gates Foundation funding can create that incentive through product development partnerships to recreate that. So in fact, getting them back engaged is part of our product development plan. And in fact, although I can't disclose who we're working with right now, we certainly are working with some of the same players who have the broad distribution reach and a history of high quality and have the R&D capabilities to move forward with new tools. Ashley. You know, our TSS will, whatever will happen will happen. What about the pipeline following? Are those academic constructs or is industry engaged? Yeah, I think when we think of industry I really group it into two because I think they're so different. I think pharma and biotech, you know, are very different industrial partners that we work with. So I think our experience with pharma, obviously with GSK has been there's been a commitment to malaria vaccine development all the way up through the senior management, which I think is critical. We haven't seen that with other large pharma. So we've tried to engage with biotech artists and Concernofi and you get tremendous enthusiasm with the scientists and you'll get so far but when push comes to shove there isn't the commitment there to put the resources onto these projects. So I think you need the commitment all the way up to the top if you're working with large pharma. With biotech it's very different. I think there's a lot of enthusiasm in biotech in sort of proving their technology and because we have these fantastic challenge models and exciting space for them to work in in terms of proving that their technology can do something in such, you know, preventing infection in challenge models and what have you. However, working with biotech, you know, you've got groups with new technologies don't always have the most experience in manufacturing their product and that can lead to some delays and challenges. So we see industry as critical particularly for platforms but it's a very different space. He's extremely enthusiastic. Pharma is concerned about success because success comes with a huge obligation and they understand that and they have to manage it. So I think they're very different but for us clearly, you know, these commercial partners are critical to what we do and of course then we also rely on the academics to bring through novel target antigens key assays and model systems and things to support that. And I think that's where the PDP model works so well that we bring all of that together. You've got to bring together a GSK doing assays at Hopkins with some new antigens coming through somewhere else and bring all that together and that won't happen. I don't think that'll happen organically without somebody driving it and that's really what we see as one of our roles. Chris, I know you don't work for MMV but you're aware of their portfolio specifically for the CERCAP single dose radical cure type drugs is industry engaged? Well, I think, yeah, broadly for drugs, industry is engaged but you asked two questions, are they engaged and are they enthusiastic? And so, you know, industry is engaged to some extent and there is some enthusiasm in my experience sometimes that's a personal thing where the family member of a CEO spent time in Africa and got interested in malaria that's how Pfizer kind of got into looking at quark and azithromycin where you see the enthusiasm tempered though I think there's a much lower risk tolerance for risk and it's not going to be a big blockbuster for cholesterol lowering or electrical dysfunction or whatever when it's something like malaria so anything that can be done to mitigate risk whether it's liability for vaccines or whether it's kind of looking at markets up front for vaccines or drugs is going to help because I think the level of enthusiasm is just marginal for these products and it doesn't take very much for the pharma companies to pull back so like the Gates Foundation has done for and others for vaccines and even I'm sure this is true for diagnostics the more we can kind of get out ahead of anticipating who's going to pay for it what are going to be the risks to the manufacturer and how can we kind of increase their comfort will be important to do So the question then becomes because at some point I mean pharma generates innovation and innovative ideas product development partnerships creates a group of people who can do different components and have historically done so but eventually some kind of company needs to manufacture product fix and so that it is usable and the question is in 2014 basically almost 2015 what should we be thinking about doing to make this whole enterprise more successful let me just open it up to you first and then we'll see what other ideas people in the room have let me remove money from it yes we need more money let's just take that as a given we used to speak of pilot lot manufacturing for vaccines being a huge barrier I think there's lots of providers of that kind of capacity in fact they're competing with each other we used to have problems with protein manufacturing and the appropriate folding that's not a problem we used to have problems with quality control or the diagnostics and more systematic approach was taken to make sure that the ones that were out there are good quality we didn't have a pipeline for drugs now there definitely is one you didn't show the picture but there's definitely one what would make I'll take a first I'll take a first step at this I think we need to think of it not as just research and development moving to development moving to commercialization with perhaps a tech transfer from an academic to somebody who has market share I think we have to think of the overall architecture of the vision of what's needed and engage all of the parties including the policy makers and the regulators early on in the conversation engage them as members of that if not advisors to members of that product development partnership because I think what can very often happen is that you get to the point where the technology is there you've validated it to your specifications and then you find out that's the stopping point that there isn't this receptive energetic population market ready to receive it so I think especially in the case of of new tools aimed at tactics that are influx and still being developed and validated I think we need to engage everyone and make sure that they move forward and lock step together so it sounds like the kind of what you're saying is we need to think harder and be smarter about what we're asking for and mean it because if we keep asking for a variety of things and then end up not using them we won't have too many times at bat that industry will say no we don't really believe you and that's where we used to be 15 years ago so I kind of worry about because I see all this wealth of innovation different kinds of constructs from a field operational view that's a little overwhelming I would think are there any people here that are worried about how you're going to take on all this innovation who's going to pay for it train for it and is it worth it how you make that decision or are you all fine with it someone yes Steve so I'm actually not clear on what you're saying so if we start with diagnostics and say we just heard we need a highly sensitive easily executed diagnostic we don't have it okay I mean so we're not asking for a symptomatics it means highly you know you have to recognize parasitemia at a level below you know the most sensitive thick blood smear for two or four parasites for microliter but practically 50 parasites per microliter so you need to have that we have test PCR that we can do that with right now but it's not practical so the question then becomes are you know we heard about a program are we engaging all the people that we could in such a program do we have all the technical experts working on it that they could be and then you raise the question is how do we do it all right so what's the incentive well the incentive really is only going to be that you know UNICEF the Gates Foundation the world community is going to buy this stuff because there's nobody out there going to pay for it otherwise so you have two types of clarity of what the strategy is and I think that's what these documents GMAP and GTS where if we're clear that the strategy is elimination and that's what we're moving to that there's missing that will solve problems that people aren't grappling with yet that's a huge transition we need to make that we haven't made yet and that's kind of the point I was trying to get to okay I mean so I think that that's important you know and it's the same thing whether it's for vaccines or drugs what you needed for you know we need a drug vaccine that's 100% protective for life in one dose okay that you give under your tongue right but it's not going to happen you know in my lifetime exactly the person with the red tie behind you please say hi yourself I'm Roman Makaya the ambassador of Costa Rica I find this a topic fascinating you've been talking about level of enthusiasm for developing this type of technology and if the enthusiasm isn't there then you need a proxy for enthusiasm how can you achieve that there's been discussion on for example patent extensions that in other words if you developed a drug or a patent a vaccine that fits certain criteria you would get sort of a coupon to extend a patent of your choice so it wouldn't necessarily be you wouldn't necessarily be making your money on the malaria vaccine you'd be making your money on extending your patent on a very lucrative drug and you know however this is paid for there has to be a transfer of investment or wealth from the rich to the poor because the base of patients is not going to be able to pay for this so getting the incentive right is critical we've seen it with orphan drugs where drugs weren't developed for rare diseases malaria isn't a rare disease but in the orphan drugs situation giving a monopoly a temporary monopoly on the treatment of the disease created the incentive so what is the incentive for malaria I mean there has to be something that attracts investment into this field and I'd like to hear you know what other ideas have been discussed and which ones do you think most likely to succeed in creating that incentive others? I'm Bob Guads recently retired from the NIH and I suppose my fact of the appointment is the Collegium Medicum of the Agalonian University and I'll give a nickel to anybody who knows where that is it's 40 years from essentially from the publication of the concept of transmission blocking immunity and now we have a pipeline just to show you how long these things take but that's not my interest I'm an entomologist we don't know anything about the vectors in the Mekong Mike mentioned dires 20 years ago, 10 years ago you would have said dires is the vector all over the place in most of Cambodia it's almost impossible to find dires now it's a forest mosquito the forests are gone there are 26 potential vectors in Cambodia and minimus may be the most important but who knows what we don't have amongst all these entomologists you talk about are biologists every entomologist now gets up and says well here is the molecular structure of such and such but if that mosquito landed on their hand they wouldn't know what it was we need to appropriately train people we have a question down here my name is Wilson Magaya from Zimbabwe I heard something about materials that can be treated and such small interventions and I'm wondering why we do not have those on the ground I came across a blanket that was tested by in Africa University and we tried to sell it as a private sector drive and we're told we needed who approval we needed to get certain paperwork but the chemical that was being used is already approved it's EPA approved here in the US and the university actually made a blanket infusing that chemical now to interest the big funders here we couldn't get any interest in it the question then is the discussion here seems to be happening here we have researchers in Africa who are trying these small things is it possible to take maybe 5% or 1% of all R&D funds and put them into these small things that can actually be done now and people try them out and say they work or not thank you and I think there are some limited funds for that kind of concept testing sort of the grand challenges exploration Canada or grand challenges exploration when there's a malaria topic there's a lot of innovation to test concepts but clearly just as innovation comes from academia in the US and Europe we also need to look for innovation coming from academia in Africa and Asia so I think that's a really good point yes Michael you want to respond to that Michael just respond to that by the way you need the microphone because otherwise people really can't hear and it's a very isolated blanket and not to say that we're completely useless but it has gone to the vector control advisory group for WHO so it is under consideration by WHO now and again coming back to the issue of niche we're thinking of this not for general populations so much but for South Sudan for CAR for displaced populations outside the house so again coming back to what I said earlier we may not have this one magic bullet but the niche products that I think will in total when you add them up will make the difference having just two minutes left I want to highlight this chair how different the discussion is today than it was 14 years ago when I first became involved in this field there's a pipeline there's a pretty robust pipeline and concepts there are pools of money for development not of all of them but for those that meet certain criteria there's probably innovation money for testing of smaller concepts and I think compared to where we were in 2000 when none of the tools that are being used today were being used we weren't using long lasting bed nets we weren't using insecticide treated bed nets we weren't using RDTs the companies would call us that we have them no one will buy them we weren't using ACTs remember this is before that painful article came out in the Lancet saying WHO is killing babies because there's no recommendation for this these are innovations that now are old but they weren't being used at that time it doesn't take a lot of vision to look at the pipelines that have been described in this very humble small session and realize that it is quite likely that the tools that we will be using 10 years from now will be quite different and will perform differently than those that we're using today and so the challenge is really one for all of us because managing that kind of innovation influx is going to test every single part of the system but hopefully it could make it much more effective and ultimately much more efficient and I think that's the promise for the future thank you very much