We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to episode 117 of The Therapy Show behind closed doors with the wonderful Mr Bob Cook and myself Jackie Jones and in this one Bob what we're going to be looking at is really interesting topic I can't wait for this one falling in love with your clients in the therapy process. Well you know Jackie I think we've been doing these two years or however long we've been doing these titles but I always love it when you say the when the introduction goes and wonderful Bob Cook and you know when we talk about love the English language or the English yeah the English language is very very limiting. Yes. So if you go to Greek culture for example there's about seven words for various type of love same in Italy and many other countries but in England or the United Kingdom love covers many different aspects yeah wonderful Bob Cook is a very loving caring thing to say we could say but we haven't got the different types of love so in Greek you've got a gape have a new you've got eros I can't remember all the nine various forms of love but we haven't got that it's very processed in our language is very definitive. So when I'm talking about you know falling in love with clients my colleague beat me to what I was going to say anyway because I said to my colleague friend um I was going to do this this podcast and he said what I was thinking about but he said it before so I didn't say it so he took ownership of this but I actually had thought this and that is my report. I was laughing when I thought of it but my response is um well I'd be worried if I didn't fall in love with my client. Interesting. It's what your perception of it is isn't it? So if love equals taking account of taking care of yeah thinking about them. The last podcast I think we did all another part which is about tissues and you know tea it's in this ballpark yeah taking care thinking about them uh promoting loving actions spending time worrying about them being concerned about them they're all the ballpark of love yeah it depends what we mean by love yeah you know um if we're going to about romantic love which part of this podcast will be about yeah and we're into perhaps another whole story which a lot of this podcast has been about but love on a more general sense I mean we haven't got the the word in the English language taking time to take our client to supervision if we're stuck yeah thinking about them maybe offering a cup of tea passing a psychotissue box um spending time pondering clinical processes being moved from the heart they're all in the ballpark of love yeah absolutely yeah yeah there's an energetic love stream so from that perspective I'd be worried if I wasn't thinking fondly loving counting all things I've just said per se yeah and I bet my bottom draw is the same for you yeah yeah I think when I read that title there was you know that instant thing oh you know is he gonna ask me if I've ever fallen in love with one of my clients and then you think about the intimacy and the relationship side of loving everything but I also know that you know every one of my clients have a special place in my heart for whatever reason yeah lots of different reasons you know if they're I feel moved by the story to me is an you know show of affection or caring about them does that equate to love it like you said there's there's lots of different ways that we can show it absolutely so when you say how are you today I was thinking about you last week yeah what actually happened for you when you left the therapy session yeah isn't that a loving action that you would be thinking about your client that you'd be pondering about them that you'd remember what you worked in the last session yeah now the clients may never have had that type of love if you like and many of my clients didn't yeah yeah so that type of fertile ground that type of attitude can be very repetitive in its own sense anyway yeah and there's something I don't actually know what they all are and it's very American or whatever but the love languages and how we need to be shown love whether that's by you know different acts like people making us a cup of tea you know going on to that podcast that we recently did about tissues and tea whether it's you know by touch or you know acts of kindness you know we all receive love in lots of different ways for me it's been seen and heard that makes me feel important and cared for by the other person if I'm literally seen and heard and for many many many of my clients over all the years a lot of the therapy has been about this type of attitude and the client being able to take the loving types of actions and thoughts which they often had never you know had in their lives yeah or in fact would think it was a trick yes yeah technique or some sort of language like that and we found it so hard to take yeah and I think you know when sometimes when we have given love in you know a way that connects with the client it can change the dynamic somehow oh you know I've had it where some clients have literally withdrawn because it's been it's felt too too intense or being seen and heard in a therapy session can be too much for them yeah and that's really really important for the therapist to think about yeah and to notice if it happens and then bring it back to the therapy room and discuss you know how did it feel for you when I said that or did that yeah because if people haven't been brought up on a full meal yeah say they've been brought up on crumbs rather than the full meal and if they have a full meal they'll be sick yeah absolutely that's a really good metaphor Bob and I think that's how it feels it's overwhelming yeah overwhelming yeah and then they'll close down yeah um so it's important that the therapist is going to think this way relationally they consider all this in terms of a developmental perspective with their clients in transaction analysis it would be the world script yeah they spend some time thinking about the client's script within the therapeutic relationship yeah yeah because giving and receiving love often can be seen as you know it's that place of vulnerability you know if it's going to be received and and you know reciprocated or whatever it is so it can be quite triggering for clients oh oh in fact extraordinarily yeah extraordinarily triggering because you know um often for many many clients who've never had that love or that's what they've dreamt about or that's what they've desired or that's what they've fundamentally needed but have never had um it's such a challenging process yeah to be able to open their heart up or be vulnerable with someone in a completely different place in their history comes so challenging and you know Jackie's often the therapy in the end yeah and I think it it it shines a light on what they haven't had in their upbringing and in their past when it is given to them freely you know without any I don't know you know bartering or you know something attached to it if love is just given for the sake of it you know that can often shine a light on that that's not how it was when they were growing up you know there was always in a something attached to it they had to there was a payback or a clause to love they had to do something yeah yeah yeah or the people that've been so neglected so neglected they don't even know what loving actions are yeah so any loving actions go through a psychological filter for them so by the time it they have to receive it they've got they've got a a coat of armor called denial that they don't even recognize it yeah and it feels sad to I'm thinking of lots of my clients I feel sad talking this way but you know it's so true and a therapist needs to really I believe understand these things we're talking about and understand the defences that clients have often had to put up for survival work and reasons and it's very important that their stop these loving actions but they may have to dilute them yeah yeah absolutely because it can be overwhelming when you've not had it before and you mistrust you know what I mean you don't believe it there's there's like you said the the hurdles that the therapist will have to jump over sometimes to prove that what they're doing doesn't have ulterior motives it needs to be a slow process extraordinarily slow yeah and in the type of therapy I've practiced for years and years which is developmental integrative relational psychotherapy then what I'm talking about here is really really important to understand for the therapist more than anything else because it's like then they will understand the filtering system of the client the defences of the client they'll understand how to pace the psychotherapy process they won't take withdrawal rejection denial as a personal attack on them or various other things and they will understand or all what we're talking about here Jackie in a therapeutic lens yeah yeah and I think that's an important point you know whether the therapist takes it personally the client's reaction to certain things do you know what I mean and I know we've spoke about it in the past getting it wrong in therapy you know and how we come back from making a mistake and maybe doing too much too soon and all those sort of things yeah I think what we're here is really important now Richard Erskine one of my mentors and the developer the developer if you like of integrative developmental relational psychotherapy and the founder of the international integrative psychotherapy association talked about the the person's relational need for expressing love yeah you know to you know we could call that kindness if you like but it's a relational need within all of us to you know or a desire if you like to express love and so for him I think what we're talking about here is how he would see therapy yeah now let's jump back then from that to what I think you've hinted on and what I would just like to talk about for a few minutes which is in the therapeutic lens of erotic transference yeah and that's when we might want to term what would the other end of cloudy what I've just been talking about in some ways romantic love you know so if the therapist finds themselves you know coming from a place of romantic love or sexual love or however we want to term this it's very very important that they go to their supervisor yeah that's the first thing they need to go to yeah as soon as they become aware of these feelings now when a soup when somebody comes to me say talk about what we're just talking about here my first question probably would be whose love do you think this is romantic love do you think this is do you think this is a projection on you from the client and you picked it up my projected identification and it doesn't actually come from you it comes from yeah or do you think it is an actual physical attraction in the here and now from both of you yeah even from you so okay you know there's an explore exploration which we could call erotic transference you know it's an exploration of the erotic transference but if it's a physical attraction here and now and the client is sorry the therapist is certain about that yeah and it's not got any transference history for example yeah biological or chemical or whatever we want to because then the therapist then asked the thing well this is this going to hinder any therapeutic process am I going to act out on this is this going to be counter counterproductive and what do I do about this so there's lots of options you know but I think they need strongly to think about referring on yeah I've got further than that they need to refer like I think it's a really valid point though when you're saying about is this transference is this the feeling or is this something that's being projected on them because in therapy sessions it can it can be you know a den of emotional stuff that's in there I know for me you know sometimes I'm I'm quite good at picking up somebody else's stuff whether it's usually anxiety I'm really good at picking up anxiety from other people and then realizing that I'm starting to feel anxious but I know it's not my anxiety it's somebody else's but you know as a new psychotherapist I wasn't even aware that that was what was happening a lot of the time I thought I was feeling anxious you know literally my heart you know would race and I couldn't work out what was going on for a while so it's a very important another important question as as the supervisor explores the transference with the therapist is to ask the question in this transferential matrix or projective identification process is who is the client for you yeah and ask the therapist just to reflect on that doesn't have to be actually be a person in my part of yourself the younger part of yourself could be even you know to do qualities and it might be a real person yeah yeah mother could be assistant it could be somebody you've never had it could be but we're starting then to explore transferential implications and psychological processes yeah and I think those that whole way of talking clinically about what's happening in the therapy room is why supervision is so important yeah absolutely and in that situation you would still refer on and and say you need to work through this in your own therapy well I'd want to explore all completely what you just said there I want to explore for a transferential point of view yeah I'd want the person to explore therapeutically yeah and if it's a physical attraction in the here and now then without any transferential without any you know historical aspects and if they think they aren't able to do the therapy therapy process because they're always in inverted commas lusting after the client or or whatever language we want here they have to refer on yeah because I think we need to mention that it's not ethical to be in a relationship with a client a hundred percent that's that's not the world where anybody should be going I mean I have a colleague I'm thinking of my head who said well there is another I'm hearing it in my head now as I speak oh there's another option Bob and the other option is or he would say anyway as a supervisor one another option is you could talk to your client about this yeah you could say well you know before going any further I just wanted to say that I have an attraction for me to take this supervision and look at it in therapy and see what the other person says yeah that's an interesting one that Bob just thinking of somebody who's purely relational yeah you know but yes of course we can't have to work with somebody who you know once we've explored all these things and you need to do it straight away not just because you know the danger of all this is that we therapy proper therapy won't happen if you always yeah thinking during your listening and and of course you could end up acting out something yes so it's really important we refer on and you know I think it's vitally important we don't like a month to see our supervisor either yeah we wing up and have an emergency session yeah or we have an emergency session with our therapist before we next see the client yeah we don't oh well I've got supervision in a month or I've got therapist in two you know two months time or something like that because you know we're sort of coming from an ethical position yeah absolutely otherwise yeah and it's a really interesting concept and you know the title of this you know falling in love with your clients in the therapy process and I'm sure we've discussed this in other ones but there's also the completely opposite side to this where we don't like our clients for similar reasons whether that's you know transferring so whatever it is either way it's not ethical to not take that to supervision or to do something about that we couldn't carry on seeing those clients with those strong feelings at either end of the spectrum if we are I've got obsessive romantic love we have to refer on what I'm saying though is before you see the client next as soon as you know where that have an emerging supervision session have an emergency therapy session just to give yourself a chance to talk about these things yeah but see them again until you've resolved it in other words if if you can't resolve this or you don't understand what it's about or XXX then you have to refer yeah yeah because you can't do effective therapy if you don't feel you know quite often though by the way I do want to give a plea of you know when therapists have come to me saying the same sort of thing I've had an emergency session we talk about it and what I've just the frame I've just talked about transferentially and they've seen their therapist also two days time sometimes they've had such a big quantum shift and understanding it's not their sexual feelings has actually come from somewhere else yeah and it's a project of identification they have been able to work with the client yeah but it is it is that taking it and talking about it with somebody who's unbiased who can think outside of the relationship as in the therapeutic relationship because it is difficult when you're in that situation and that relationship with somebody to look at it objectively yeah it's also difficult again I'm hearing this person when I say don't you can always go back to the client and talk about it so you go back to the client and you say that the client is an option I've been I just want to say that I've been having sexual feelings around you so I've taken this this decision and I was wondering if if you if these feelings have come from you or now it's an important discussion the problem with that is and I'm not I'm not saying don't do it by the way because anything's better than continuing in a situation yeah and it's not resolved or not looked at or whatever way you want to talk about it um is shame because you know the client can get ashamed very easily in all this but at the end of the day it has to be addressed yeah and if it can't be resolved you need to refer that person on yeah I know the good topic Bob there's a lot written on this by the way I did a youtube years ago 10 years ago if you're into my web my youtube channel what cool can put in erotic transfers in did at least 10 years ago uh with willy leo because he's a friend of mine it's one of the what most watched videos I've ever done um um I'm 10 years it's 10 years ago of the way wow long time ago so um but but I was talking specifically about erotic transfers I do want to give a plea of though of what we started off talking about at the beginning which is what constitutes loving actions yeah a character pondering thinking about your client asking your clients you know I was thinking about you last week how are you today yeah all loving actions aren't they yeah yeah that whole discussion for me is really important as is what we have just talked about because I think often this is is in the role of transfer and sound can be resolved and there might be a quantum shift and you you can discuss it with your client but you know it's really important that if you can't resolve it you don't work with that client you need to explain it yeah yeah I was saying just sort of don't turn up or something or you say well I can't work and make something up you need to be transparent and honest but in my experience clients really respect that and my commands say well I've been sexually attracted to you and then you go I just go it's a really difficult situation to be in in that respect because I would imagine I don't know whether it's just me it could just be me but you know my fostering background and everything there was always a big thing about allegations being a foster carer you know to me that I would the things that we were doing could be misconstrued by the kids or whatever so if you're going to come out to a client and say you know I'm having some sexualised feelings about you does that open us up as therapists you know to our allegations against I think the worst position is if you continue therapy yeah and do not only say that I think you know in terms of transparency and referring someone on yeah because we're human aren't we absolutely yeah problem is if in terms of allegations of things you're talking about is if you don't do that yeah but I would imagine there is a big fear you know we with therapists around allegations and where that might lead well if you said to you've seen that and you say look I've uh taken this description discuss that and I start to have sexual feelings with you and I feel that I can't do the therapy now I have to be transparent with you what what's your thinking about litigation there I I don't know that it's just not ethical to have those sorts of feelings for a client and how it can be you know misinterpreted by the client that's true what you've just said misinterpretation yeah yeah when you might want to record it then yeah it was it was just a thought that you know what I mean it is a very delicate subject and you know the the guilt and the shame whether that's on the therapist part or the client's part yeah I agree Jackie but I think it's far worse if you make something up and say well I just want to refer you because I don't get on with you yeah well I just want to refer you because I think you owe me the clients a level of transparency in all this yeah and it's good if you have taken it to your supervisor because then there will be a note that you've obviously spoken to your supervisor about it and everything so again it just I'm just thinking for anybody listening you know if they were going through this sort of a situation how they might be feeling if that makes sense well talk to your supervisor yeah he might say we only need to record the session yeah say xx and x but it's very important you don't continue with somebody if or how are you on in this process yeah without track being transparent yeah yeah I agree and then another level what you said earlier on about if you extremely hate your client or dislike you need to talk about that and transfer in terms of the supervisory process and see where that all comes from yeah because we we do have feelings and emotions in the therapy room that belong to us you know to me because we're co-created a relationship so we're in there all of our stuff as well as the client is you know I think that's one of the reasons why I like the relational psychotherapy and transactional analysis because I do take the whole of myself in the room with me I don't leave parts of my personality outside the door if that makes sense so we are going to come across difficult situations with the client in the therapy room and I think using supervision using your therapist transparency and ethical integrity is the way forward yeah me too so another good podcast of what we're going to be talking about could have been in the in the air an ethical dilemma but I do think that it's important to discuss yeah I think I think a lot of the topics that we talk about are really important and I think that's one of the reasons you know the the therapy show behind closed doors because I don't think a lot of this stuff is openly spoken about no between the the therapist and the supervisors hopefully but openly with students or you know people that are interested in therapy I don't think these things are spoken about no and I'll give a sort of adverse for the United Kingdom Council psychotherapy here which is the the basic I think regulating model not model authority for therapists regulating body play that way and they demand that people try to be therapists have 160 hours of therapy over four years and they have a very strong ethical code and it's so important yeah because if there's not this accountable body for example we live in the what we can look we could live in the world of the wild west yeah easily yeah without any regulation or accountability yeah the ACP another important regulating body without these bodies without these forms of accountability without these frameworks of supervision therapy and everything else goes with it we can live in the world of the world west easily and a deregulated unappountable process without framework or structure and that was set psychotherapy back to the dark ages yeah yeah yeah so I started to be trained when I first trained 1985 when I first went into training to be a psychotherapist UK CP didn't exist BACP didn't exist there was no regulating bodies at all I was in the world of transaction analysis which did have a european regulation regulating body which I really liked because it gave structure gave ethical framework at least gave me some sort of you know process could hold on to but many of the regulating bodies in the arty kingdom didn't exist even so it was it was in this very young infancy of the disciplines of psychotherapy and counselling so the regulating body at least gave me some sort of protection structure and of course clients protection structure and accountability yeah definitely so Bob thank you thank you thank you very much given me the chance to talk about the different types of love as well and in the next podcast we'll be looking at codependency in the therapy process which kind of leads on I think from this yeah sometimes in transaction analysis world codependence codependency is called symbiosis yeah and again in the transaction analysis world you've got first order symbiosis second order symbiosis but we'll talk about it I think in the world of codependency which is really an American word but for the people who are listening to it you can call it symbiosis we call it codependency but it's a fascinating subject for what can happen often transferentially in the psychotherapy room and the two people that may not even be aware of it yeah I think codependency is more easily understandable like you said it's American but it kind of says what it is on the tin I agree with you I look forward to discussing that absolutely until next time Bob thank you so much thank you speak to you soon speak to you soon bye bye you've been listening to the therapy show behind closed doors podcast we hope you enjoyed the show don't forget to subscribe and leave us a review we'll be back next week with another episode


Ian Fathom-Nickel, this morning we were talking about how you have two primary projects that are over what, approximately 110,000 hectares in Saskatchewan, is that correct? That's correct, yes. One of them is north of 90,000 hectares and the other is a little bit more than 22,000 hectares. I would argue what sets you apart for many companies out there is you have experience taking companies from exploration to production. Obviously, you put an amazing management team together already. You just finished and put out some drilling results. Where do you want to start in this interview? Well, maybe just, you know, as you said, we did put some news out last week indicating that we had completed our drill program at the Gochager Lake project. We didn't have any assays in that news release, but we did release some photographs of the mineralization that we are encountering. I guess the takeaway from that news release is we've encountered mineralization 100 meters below the boundaries of the historic deposit. We are recognizing magnetic nickel sulfide textures, which are common in other nickel-magnetic operations around the world, so that is very, very encouraging. The borehole electromagnetic tool that we've been utilizing, so this is a geophysical instrument that goes in the borehole upon completion of the drillhole and it's been termed the giant metal detector. What it does is it looks for zones of conductivity away from the drillhole, and we know now that these zones of conductivity do have nickel mineralization associated with them. So the stronger the conductivity, the stronger the nickel mineralization. So we've successfully followed up on some of these borehole EM targets, and we have multiple more based on this most recent round of drilling. There is conductivity building up below where we've stopped several of our drillholes. So this is all very, very encouraging and we plan to continue to test all these things in the new year. I did hear one of your audience members in the most recent investor talk was asking when we should anticipate the next round of drilling results. Yes, so this program that we just wrapped up, we have been telling people that we'll have assays in hand by the end of October and be looking to release the results once we digest everything and get it out to the public, hopefully very early in November. So you finished up with Gochage, Gochage for a project here for the fall. Is that correct for the drilling? That's correct, yeah. So there'll be no additional expiration at either one of the projects through the remainder of 2023. Fathom Nickel is a member of the Critical Minerals Institute, and of course, in addition to the Copper and Nickel, in both of the projects, you have PGMs. Can you talk to us a little bit more about your Platinum Group of metals and any surprising updates you can share with our audience? Well, yeah, thank you Tracey. I'm glad you brought that up because, you know, Platinum Group elements, they tend to be a bit forgotten perhaps, and they are indeed critical and absolutely fantastic what you can do with Platinum Group elements. And so I think, you know, hydrogen fuel cells, that's something that's going to be revisited. And, you know, we're not getting rid of oil for a period of time yet, so you need the catalytic converter. So there's a tremendous market for Platinum Group elements. And both projects, if I can start with the Gochager Lake project, our drill hole that we, well, both drills that we drilled in February, encountered Platinum Platinum Plus Gold mineralization that I was not expecting. We had one intercept in our drill hole GL 23003 where we had 28 grams, 28 grams Platinum Platinum Plus Gold over an intersection of 0.7 meters. And that is very high grade, obviously, but what I think is very, very important about that, if you're concentrating Platinum Group elements at that magnitude, you are drawing from a very, very large magmatic source. So that, what has me excited there is, you know, hopefully with this second round of drilling, we were drilling again in that area, we'll have a few more intercepts of these PGEs, which will allow us to start putting it together and try and figure out what it's doing there. But nonetheless, it is telling me that this is a big system.  But again, just to concentrate it in that magnitude, it's a very, very big source. The Albert Lake project historically 9.63 grams per ton Platinum Platinum Plus Gold came out of the ground in a small operation 1965 through 1969. And again, just the 9.63 grams speaks to the volume speaks to what I like to think is a sort of a regional outlook to both projects. So to get PGEs at that level, again, big magmatic systems, big potential nickel caps at both projects, nickel plus PGEs. Just want to ask you one more question. Can you talk to me about your proximity to large majors and or infrastructure? I mean, I think a lot of, for instance, American audience members are increasingly understanding how valuable Saskatchewan is and projects in Saskatchewan. Would you like to add any comments on that matter? Yeah, first of all, with respect to the promise of Saskatchewan, consistently ranked in the top five jurisdictions in the world by the Fraser Institute for exploration. And we have very, very good rapport with First Nations in Northern Saskatchewan. We meet quarterly with the Lack LaRange Indian Band constantly in communications with stakeholders. So that's a very positive. Saskatchewan, with respect to infrastructure, it goes without saying the Athabasca Basin and the amount of very, very high grade uranium that comes out of the Athabasca Basin. So Saskatchewan knows how to mine. And Saskatchewan is very pro development. So that that is very, very positive. But at the same time, you need to do it respectfully. And you need to do it safely, which we feel that we check both of those boxes. Infrastructure, both our projects at the moment, they both have history. So there are historic trails that you can still see from the air as we are flying into both projects. Go Chagger Lake is 20 kilometers from Highway 102, which goes up to the Athabasca Basin. And the Albert Lake project, we're within 60 kilometers of this main thoroughfare. But again, there are numerous exploration trails that we can get closer to the closer to the project. But currently, both projects are flying. But we are looking at ways where we can decrease our dependency on helicopter, which ultimately will have a positive impact on our all in cost per meter of drilling. Batham Nicholl, for more information, please go to their website. And Ian, thank you so much for joining us today. Thank you very much, Tracy. Look forward to the next time.


Have you ever left Time Capsule of some sort, like a note in a renovation, like last remodeled by Stephanie in 2012 or anything like that? I haven't, but now I need to do something. You know, the other night I had a dream that I could make this like really cool plaque that I could put on the houses that was like built by She Builds in the day so that like you couldn't take the plaque off, but. I did a Time Capsule on our last project and it was, I put coins in there, I put like a couple bucks, I put the newspaper, I put like Trump was president, I put the price of gas. It's always an afterthought, but it is fun. I want to do that now. Leave your mark.


Non-alcoholic fatty liver disease, NAFLD, is a growing health concern due to its association with liver cancer. Risk factors include age, gender, obesity, diabetes, and certain genetics. Early detection of liver cancer is important as it allows for more effective treatments. However, NAFLD patients face unique challenges when it comes to surveillance, such as difficulty identifying those at risk and low surveillance rates in clinical practice. Additionally, existing screening methods have limited accuracy and sensitivity. Surgery remains the only curative treatment option for some patients, but immunotherapy has shown promise in some cases. This article was authored by Doreen Dahar, Kareem Sif El-Dahan, and Ahmed G. Singhal.


Rich forever main, ah, then we in the game, see We won't ever change, age, here we go again, ah Rich forever main, ah, then we in the game, see We won't ever change, age, here we go again Rich gang, rich gang, here we go again Stock market is climbing, dancing like Rick James Here to give you the big picks, everything on the wish list No L's over here, just big, big, big checks Baby, we're in up 10%, time now to take a risk Xenobis is on the rise, make sure it's on your watch list Nurran, wireless, Ignite International Tech Central Inc, it's on point, never irrational Halo Labs, that's a plus, can they trust?


So thank you all. This is really meant to be a conversation among these three experts around some of the questions and issues that Dr. Fauci touched on towards the end of his presentation, which is, how do we think in a strategic and long-term way about guaranteeing that there is a robust engagement by the private sector over the long term in bringing forward new discoveries in developing new vaccines and also being present in the production and distribution side of things. And these are complicated and difficult issues. And we'll hear about many of the competing tensions around guaranteeing that there are finances at the front and back and guaranteeing that there's sufficient incentives, guaranteeing that there's enough of a mix between the profit considerations and the considerations around equity, high volume, low cost access. We know that partnerships is the broad frame in which these relationships over the long term are sorted out. And we know there are many other issues that surface with respect to defining what your goals are, looking to the future with some specificity as to what the products should look like, preserving public investment at the early phase in the back phase, talking about quality and the like. We want to bring this discussion back to the question of US leadership and policy because ultimately we're trying today to think about the role in the policy environment here in Washington in trying to guarantee the stability and the robustness and vitality of private sector engagement in this area as we look forward. Margie, I'd like to ask you to kick things off with a few minutes. You go, Margie, Julie, and Gina with opening remarks and then we'll carry forward a conversation and we'll ask you to join us. So welcome and thank you. Great, thanks Steve. A great introduction. I think you covered everything I was going to say. So maybe I'll turn to Julie. Just kidding. You know, when I thought about what perspective do I answer the question that Steve posed? How do we assure a robust market for vaccines and really have the incentives that the private sector needs to participate in that market? I thought, you know, what perspective do I come at this from given my history? And I thought of the Joni Mitchell song I've looked at life from both sides now spending 26 years with a pharmaceutical company and running global vaccine business and now being the CEO of a product development partnership focused on coming up with an HIV vaccines. But fortunately I come to the same answer looking through both of those lenses. The only way, as Tony clearly stated in the Q&A session to address this is public-private partnerships and each sector has an absolutely critical role and I'll focus more on what the private sector needs but clearly the public sector provides the funding. Provides the funding upfront research and development to remove that risk which is so critically important when you're talking about diseases for the developing world because to ask a private company to invest R&D dollars especially with a tough economic times and financial situation that most participants in the industry have found themselves in to ask them to take on that risk especially before you have proof of concept is a very difficult value proposition. So the public funding that's available to support that research, the NIH funding the funding that comes to organizations like IAVI and other product development partnerships addressing these diseases of the developing world were able to channel that to various researchers including pharma vaccine biotech companies to help support that early research and remove that risk. Also critically important then is a market being available because to make the subsequent investment decisions private industry needs to know when they get to the back end should they get to the back end of that development cycle and introduce a vaccine that somebody's actually going to fund it and certainly there's no guarantees there'll be competition and that's all expected the industry knows how to deal with that but to not know that when you get to the end of a development cycle where you may have invested hundreds of millions or well over a billion dollars that funding will be available for that vaccine it's just not something that's going to cut it. And so knowing through organizations like GAVI knowing through the funding that comes from governments like the US as well as foundations like Gates Foundation knowing that funding is available overcomes the second critical hurdle. Clearly then private industry is absolutely essential as Tony said, I love the analogy to his daughter. I don't know why I didn't say his wife I know he's happily married, but anyway. That was a great answer and I was pleased to hear it. And when you think about why is that true? There really is no broad based vaccine that's come from anywhere other than an industry source and in many cases a public private partnership. When you think about all the tools needed to get through that R&D process whether you're talking about some of the game changing technologies like sequencing, high throughput screening whether you're talking about the bioprocess development to actually come up with a way to make that vaccine and then to be able to scale it up to produce hundreds of millions of doses a year clearly you need industry to do that. Also to introduce vaccines to be able to figure out what is the right product profile and working through partners organizations like GAVI, WHO, SAGE, what's the right presentation of that product? Do we need a multi-dose vial or will this not be utilized in a campaign such that you could end up with a lot of wastage with multi-dose vials? So all of that clarity is needed up front but there are a couple additional things that are needed. One is accurate demand forecasting. How big a plant or multiple plants do you need? Will this be widely adopted? Will this have a universal recommendation for everyone at a certain age? Or will this be targeted to more high risk populations? And from a funding perspective, will the funding be there for all countries or more endemic high risk regions? You need clarity on that in order to be able to move forward with that investment decision. You also need to know that IP protection will be there and we know there's a few examples around the world where that's been an issue. You need to know that if you're developing this vaccine and expect there to be a high and middle income market but you're going to have tiered pricing and be able to provide a very affordable price in the world's poorest markets, you need to know that that IP protection will be there to justify your investment. You also need to know that from a regulatory perspective, there's going to be support for efficient trials. You're going to be able to have low cost manufacturing and perhaps tech transfer to organizations that may be able to take advantage of a lower cost labor base, particularly in the south. So there are a lot of characteristics that are needed but fortunately we have a lot of very positive examples of things that have happened and that's why we have many vaccines in development even for the big three, AIDS, TB and malaria where across those three we have four million deaths per year, most of which occur in the developing world. So we now have pipelines of seven candidates in the pipeline for TB, over 20 for malaria plus as you heard Tony talk, very promising results have come out over the past year and for HIV. He talked about the RV-144 results while modest, we can build upon that and we have some clues as to why that may have worked. And then very importantly, over 25 other candidates in the clinic, some taking advantage of the technology that Tony talked about, broadly neutralizing antibodies. So I'll just end with what Tony said, this can only happen through effective public-private partnerships. Thank you, Julie. So thank you for allowing me to be on the panel and I agree with everything that Margie said. In fact, she taught me most of what I know so I'm very happy to support and agree with what she said. However, I also just came from Zambia and so this video is really remarkable to me. I came from Zambia where Zambia announced that it's the first African country to make a commitment, a national commitment to reducing cervical cancer among women and girls in that country. And many of you know that cervical cancer is essentially an opportunistic infection associated with HIV infection. So in our world where cervical cancer, fortunately it's rare because we have screening and we have tools to detect and treat it. In the developing world, cervical cancer is common. About 25% of the women in Zambia with HIV infection have cervical disease and it is a killer. It's the number one killer of girls and women in those age groups. So it's a remarkable experience for the president and the first lady of a country that just had a peaceful change of government to stand up and make a commitment to this disease program in their nation. So why did that happen in Zambia? But it happened first and foremost because of the national leadership. The first lady is an OBGYN doctor so that certainly was a big help. But it also happened because of the leadership of the health ministry that you met, the leadership of the ambassador who was also on this video, the leadership of the missions from other countries who are there supporting this effort. It happened because of the leadership of the CDC in the country. Our CDC leader, Larry, has been out experimenting with inexpensive ways to diagnose and treat cervical cancer in the HIV clinics there. It happens because of the USAID investment in logistics and supplies. Happens because of the medical leadership of the teaching hospital there, the Zambians who are out. But it will happen, most importantly, because of a woman named Mildred.  She's examining them. She's applying vinegar to their cervix and then taking a picture of it with a camera that has a magnifying lens. And when she sees lesions that are white, that's a sign that they're probably cervical disease in early stages of cancer. She, if she has a doubt about that, she flashes that picture by email to the doctor in the teaching hospital who's on call to run to the computer, check out the lesion, and if he agrees that it looks suspicious, she immediately takes a canister of carbon dioxide, frees off the lesion on the cervix, the woman goes home and does not have to worry about cervical cancer in her near future. Mildred is teaching women all over Zambia to be able to do this. So we're now in a situation where we have an inexpensive screen, we have an inexpensive treatment, we have trained personnel, and we have a vaccine that can essentially eliminate the hazard for a whole generation of women in Zambia. Now that happened because of leadership. It happened because of ingenuity. It happened because there's a CDC that knows that there is a problem with cervical disease in the nation and can track the epidemiology and the unmet health need. But it also happens because there is a vaccine. And when we sit in the United States and think about cervical cancer prevention with the vaccines that we have, they're expensive, they're not easy to have distributed properly in our society because we don't have school-based programs, but we have the capacity here to protect our girls and women very easily from a disease that really should go away. But in the rest of the world, that vaccine is a lifesaver. And we wouldn't be able to think about a cancer free world for women if we didn't have those vaccines. And the challenge is how do we make it cheap enough so that we can afford to use it in those nations? And one of the things that I've learned is that when Margie was talking about the market commitment, there's no better way to get the cost down than to increase the volume. Because once you've covered all that R&D cost, all the costs of the things that you tried that fail, all the costs of building the plan, all the costs of the regulatory environment, all of the money that you have to put into it, at the end of the day, once you have covered those costs, any additional dose of vaccine you make, you can make essentially for the raw material price that pulls it together. And that's how we get the cost down so that we can afford to bring vaccines into the areas of the world where people need them the most. But in order to do this, we have to know that there's procurement. So we need Gavi. We need the United States government committing to Gavi. We need UNICEF. We need the mechanisms that many of the developed world nations are contributing to assure that we can purchase the vaccines and that there's a future commitment to do that, not just this year, but five years from now or 10 years from now. We also need one other thing that was really remarkable in Zambia. And that was the mobilization of the partnerships. The Susan G. Coman for the Cure is now working globally to mobilize women, build advocacy, and start at the grassroots to engage people in the awareness that cervical cancer is a preventable disease and that women need that protection in order to thrive and to be able to raise healthy children who are benefiting from all the other vaccines that get distributed in the world. So you've got leadership, got the vaccine, you've got these incredible partnerships, and now we have social mobilization so that awareness and demand for these life-saving interventions can come through. I believe if we can do this in Zambia, we can do it anywhere. Thank you, Julie. Gina. Thank you. I guess I'm hearing from the perspective of non-governmental organization, I guess we were called the Bill and Melinda Gates Foundation. And our focus really is on the global health aspects and the global health impact of vaccines. Tony showed a very long list of potential candidates for the life course and out of those, we don't focus on all of them. Not only because of budgets, but because we have to set priorities to be able to deal not only with the R&D, but our commitments to Gavi and on the implementation side. And those priorities are set according to disease impact, the potential for preventing disability life years lost. And so there are a group of diseases that we do prioritize and of course it includes HIV, TB, malaria, but a number of others, including pneumococcus and motorbars. The challenge is in terms of answering your first question, which is how do we ensure engagement of the private sector? And I will define that very broadly, not only pharma, but biotech and the developing country manufacturers. So include private sector outside of the United States is that we have sort of a triple challenge for many diseases, not all of them. We're talking about first and man vaccines that don't exist yet. So we're engaged with US and European innovators because really this requires innovation and we've made some of those investments, but largely that depends on the number one funder in the world, which is really NIH. The second is that when we do have a vaccine, we need it at really large scale. It's either the world's birth cohort or catch-up campaigns that go beyond one birth cohort. And you take any competent, mature company that's used to dealing with markets in the US and Europe, and you're really talking about a much larger commitment in terms of the facility that's required and therefore you have the potential for efficiencies of scale, but boy, do you have to make investments to get those potentials and efficiencies of scale. And I think the third challenge is that realistically the problem in terms of cost effectiveness analysis is not one in which you would limit that analysis to R&D costs, but you have to look at what the potential cost effectiveness would be of vaccines at the end. And those vaccines have to compete not only with each other for attention on the global stage, but with the other potential mechanisms for ensuring impact, you know, in malaria, it's bed nets. Do you buy a vaccine? Do you buy a bed net? Do you spray personal protection, prophylaxis, and how do you pull together the story of how you would maximize impact. So we give industry a very large challenge indeed and I think larger than if they remain focused on Northern higher profit markets. Now, under the framework of the decadent vaccines and Tony alluded to it, which is really a collaboration to bring together all of the parties that are working on the various aspects of vaccine R&D on one side to delivery and financing on the other side. As I thought about the various work streams and we're funders of the secretariat on this, the concept came out of a speech that Bill Gates gave at Davos in 2010 saying there is so much potential for impact with ROTA and Numo HPV being introduced this decade, but for the R&D base to really generate the next generation of vaccines, it really has to be the decade of vaccines. And so it's both, it's both about delivery and maximizing impact, but it's also about the R&D base. As I think back to the challenges we faced when we had Jim Grant, the last time that vaccines were really beginning to be scaled up is that the challenge in the global stage has changed. It's not a single entity that drives or owns the entire agenda. Countries have to make decisions. There's Gavian as a financing vehicle, but then for vaccines, every single district has to meet certain performance characteristics and make decisions about where they put their resources. So the decade of vaccines is really about bringing leadership to bear across the value chain. And I think an example of that is the work that has been done on the malaria vaccine. You asked me to address one vaccine. So let's talk a little bit about malaria because it's easier than HIV, right? We have some things, we've had years of research, HIV has a lot more money, but we have a human challenge model. The most advanced vaccine was just recognized by Time Magazine as the number two invention or medical breakthrough of the year, which was rather cool, you know? But let's look at where that vaccine came from. The collaboration included pharma. So it actually was born out of a collaboration with Walter Reed in the Department of Defense Laboratories, which is something we haven't talked about. There really has been so much support for R&D particularly in the elected and emerging diseases coming out of those laboratories and their engagement with GlaxoSmithKline. And if I were to show you what is now a 30-year picture of that vaccine in its first iteration, it's the second iteration, and it's third, the trial in Gambia, there's a whole lot of work that got done and then here, the Gates Foundation got involved. Really, from the trial that had been done in the Gambian adults, then to supporting to prove that it worked or didn't work and it was actually quite risky that it wouldn't. I actually thought that was the likelihood when we made that decision was to prove that it would work or not work in children. Has a couple of things going for it. The partnership structure, the challenge model which demonstrated the concept that it worked in humans, which is, think about the enormous investment that industry had to make an HPV vaccine, not knowing till the very end, they were gonna have something, not only was immunogenic, but it actually worked. That's pretty scary. And then what it has had is the ability to do, it has an adjuvant, and I wanna focus on the adjuvant because adjuvants per se are very expensive products to develop, have to be developed with a vaccine. And the reason this worked for GSK, I think, I'm not speaking for them, this is my assessment, is that because of the human challenge model, they were able to test adjuvants and optimize. Malaria occurs so frequently, you can do a trial in 2,000 toddlers and figure out if it works or not. And you don't need to spend five or 10 years and do it in 90,000 people. So really they were able to optimize the vaccine and then take it down into infants for the results that just got announced in the New England Journal, just out of the first year of the study. So the industry is important, having a good scientific base with the human challenge model, having the product components like an adjuvant program to enhance the immunogenicity, which is challenging for a parasitic disease. I think those are all critical elements that allow a company to engage in something which really will not be a product for the North, but really be limited to a product for the South. So maybe I should just stop there. Great, thank you very much. This has been very rich. I'm very pleased to hear the reference to the DoD Overseas Medical Research Labs, which are terribly important and under recognized in the contributions that they've made historically and continue to make. And also congratulations on the pink ribbon, red ribbon initiative, which is really quite innovative and exciting. And when it was first rolled out in early September, mid September here in Washington, it was amazing to see the excitement and the presence of Secretary Clinton along with President Bush and Mrs. Bush and the many other partners from the corporate side that had come forward like yourselves to join into this effort and to make use very systematically of those 250 PEPFAR clinics that are now becoming the access point. I wanna bring it back to questions around US policy. You made a strong case for strong upfront public sector investment as part of setting the incentives for the discovery and development. We're in a tough budgetary situation right now. We're in a very austere and uncertain climate. You could make a case that we're in an exceptional austere and uncertain sort of climate. So the question I guess for all of you is how do you make, how you best make the case? Because this is a long run investment. These are not necessarily well understood and brought among a broad public, but they're so fundamental to guaranteeing that those partnerships take place, that the development and discovery of new products proceeds along a course and that you can build towards that. That's one big question I was hoping you could speak to and related to that is, do we need in this time that we are in, do we need a renewed focus on some of the innovative financing alternatives to both build into that thinking about how we get through this difficult period because this difficult period could stretch for a while. And what you're saying is you need the very long range thinking. That's what the decade of vaccines is about. That's what the private sector is looking for. So maybe if you could jump in, is Margie doing it? Sure. In terms of how do you make the case, especially with these tough economic times, I think you have to focus on three aspects, especially if you're within the US thinking about the leadership role that we play in global health. Look first at the human aspect. Clearly that's what drives our global health agenda is doing something to help those more vulnerable, less fortunate. And so with all of these diseases, unless you've got the vaccines that can prevent the illness, you can only get so far. We should absolutely make the best use of all prevention treatment technologies that we have available today. As Tony said, we'll bend the trajectory, but the holy grail getting to the end will require a vaccine. So you can model that many different ways. Sure, you can model it that if we could really control human behavior, you could get to zero and I wish we could, but we all know we can't control human behavior, so we'll get to something less than zero. So let's let the experts who understand what you can achieve with human behavior and many groups have put forward projections. I know Bill and Melinda Gates Foundation had a project where they put forward projections, but you clearly can't get to the end game without the vaccines and how does that impact human beings, how many millions of lives will still be lost? Second is the economic impact. And when you think about, I'll take HIV since I know the figure's much better there, if we're spending globally $15, $16 billion a year right now to get, I think it's between six and a half and seven million people on treatment over the next couple of years, and the projections have been, if we go out to 2030, that will be over $30 billion a year to continue that treatment. I can't tell you exactly what a vaccine would cost when you get through that ketchup cohort and get to immunizing a full cohort, but it's in the single digit, low single digit billions, if you look at any other model that's out there. And so thinking about it from the cost effectiveness, the total impact on budgets globally, that's a clear argument. And the third aspect to look at is just the leadership role of the United States, the United States government, the United States research institutions. We have been the leader in innovations like this, and just imagine the pride we will have as a government and as a company if we reach that holy grail and we bring out the ultimate solution to these devastating illnesses. So from a 40,000 foot level, for the United States government and the policymakers here, I would say it's really, it's about the three Ds. It's about development, it's about defense. When you think about the threat that infectious diseases bring, it's not just for those people over here, as we learn over and over again, we're one traveler away from an infectious disease problem in the United States. So we have every reason to be thinking about diplomacy, development, and defense in the realm of vaccination, development in particular. It's not just health, which is what motivates me to get up in the morning, but it's about development from a global standpoint of economic security for the countries where people will have lower birth rates because they have more confidence that their children can grow to become adults. It's about development of the systems to deliver and produce vaccines and what an incredible force of economic growth this could really be and has been in nations that have taken this on. It's about development of capacity and infrastructure and rising into the global economy. Vaccines are a very important tip of the spear in those areas, but they are also very important diplomatically. When we launched the pink ribbon, red ribbon campaign in the country, and I was just there last week, the outpouring of human emotion, their love for the United States, their appreciation for what we do as a generous nation is really emotionally overwhelming. It is such a powerful statement that our country that has so much is willing to do this for the people who have so little. It's an absolutely epitome of the United States government at its best and it makes me personally very proud to be a part of it but I think many people in our country don't realize that their tax dollars are doing such good in the world and it's really important that we step up as policy leaders to continue to make those investments. Now those investments need to go to the NIH. There's no question that that's the powerhouse of basic research that fuels that kind of research all over the world. But those investments also need to go to CDC because if we don't have a CDC we not only don't understand where the disease threats are but we don't have the laboratory and the programmatic support to get immunizations with the technical capability where they need to be and we must continue to fund those DOD labs.  If we didn't have the DOD labs we would not have the surveillance capability that we have for understanding which flu strains are emerging and which parts of the world and what do we need in our vaccine in the United States. So it isn't just about a platform to put money into the global fund or to put money into the GAVI fund. It's about supporting those agencies in the US government that are globally relevant and really provide a front line of defense of diplomacy and development for all of us. Gina, would you care? So in the best of all worlds I believe that global health, compassion and understanding the impact on diplomacy would be drivers for US investment. I think there are drivers for our investment. This is why we engage. This is what we see when we go out to countries. But I think what resonates when we're talking to decision makers here who are trying to make the difficult trade-offs and financing and investments in NIH, et cetera, are numbers. So the person who asked the question about, and vaccines do very well on that, prevention, highly cost-effective, really when you think about what you could invest in and you can make projections. It's called modeling. There are people who are spending their careers doing this. What you could invest in that would have the biggest impact US and globally and you test vaccines against other health interventions. They come out number one. We have to be rigorous about bringing those numbers together about utilizing them. I love Tony's figures and I don't know what the sources of those data are but he's rigorous too, so I'm sure he's looked. In terms of not only impact on lives but impact on dollars. We have to make the case. And having made the case and we need to bring the funders, the donors around those kinds of investments. I think the numbers have to speak for us and we have to be rigorous about developing those numbers and driving their use. Thank you. I'd like to open the floor for some comments and questions and just stand up or raise your hand and we'll bring a microphone to you and please identify yourself and offer a quick comment or question and we'll bring together two or three at a time and then come back to our panelists. There's a hand right here and I think there's someone in the back row. So why don't we start with you, ma'am, please? Hi, good morning. My name is Ashley Weatherford. I'm from the Best Shot Foundation, a global child health nonprofit. And first of all, I'd like to thank the panelists for coming out today and taking the time to speak to us all. And my question is, given the recent trends in economic and budgetary constraints, what is your overall sense of the future of public health programs in the next five, 10, 15 years, including vaccine R&D and other health interventions? Thank you. There's a gentleman right here. Please. Sorry. Matt Lawler from HHS. I just wanted to ask about prioritization. So Dr. Fauci showed some slides with probably 75 worthwhile targets, but giving diminishing resources and given what seems to be a broadening number of NGO private sector and government partners interested in this space, is there a value in bringing people together and focusing on two or three or five or some limited subset and really galvanizing more support around a limited list of threats? Thank you. We have a hand here, please. Thank you. Anne Thompson, I'm with World Vision and the core group polio project, which is funded by USAID and the Gates Foundation to play a part in eradicating polio. I just was wondering if you all could comment on the drive to eradicate polio in relation to resources and priorities, those types of issues. There's a question right here, hand up. And we'll come back to, we'll take the fourth. Yes, sir. David Curry, Center for Vaccine Ethics and Policy at University of Pennsylvania. I'm interested perhaps for Julie, the Decade of Vaccines collaboration has been mentioned a few times and obviously that longitude has interesting implications for industry. I was wondering how industry is participating or will participate in the refinement of that strategy. Thank you. Julie, do you wanna lead off?  Then we have a question around polio, around prioritization. How do we, how might we prioritize? And then Ashley's very broad question around what is the future for the next five to 15 years look like given the austerity. Julie. So I'll start. First of all, with respect to the future, I'm very bullish about vaccines in the future. I think that we're slowly but surely making progress on the big three, as you said. But we're also, I think, really beginning to build the social mobilization, the political mobilization and the private sector mobilization necessary to really pull forward and continue to use this very cost-effective intervention for protecting health. With respect to polio, I, you know, the world's expert in polio eradication is sitting here, was sitting here in the room, Steve Cacci. And we just have to do it. There's no question about it. It needs to get done. We can do it. Look at India right now. I think this is the longest India's gone without a case. This disease can go away and we have a responsibility to make sure it does. And yes, the last cases are very expensive on a relative scale. But once it's done, it's done. That's it, bing-bang boom. And it's just hard to have any other talk about it. It just needs to happen. The question about prioritization is really the toughest question. And one of the challenges that I think we are maturing into now is an appreciation that ultimately the decider about what the priority should be is first and foremost, the person who's receiving the vaccines, mom or woman or child. But more importantly, the country. And it is tempting to sit in the United States and think we know best. But in actual fact, a country's agenda to understand and make values about their own health priorities is really the most important aspect of making decisions about prioritization. Many countries welcome the support and the input from technical experts in health economic data from outside of the country, but ultimately we need to be in a position where our vaccine agendas are first and foremost addressing the needs of the people in the countries who are making and paying for them. Having said that, I also think that prioritization is changing. We're seeing now multinational companies put enormous emphasis and investments in vaccines that will not be marketed in the United States. Merck is doing that, Glaxo is doing that. Companies are stepping up and saying that we have a responsibility here. This isn't just about the developed world. This is also about using our excellent science and our capabilities to solve problems in new markets. And we're doing that through partnerships. We're doing that through creative funding mechanisms. Merck has a wonderful partnership with the Welcome Trust called the Hillam and Laboratory. It's a nonprofit vaccine developer in India that is taking products that right now are not suited for the developing world use because of cold chain requirements or various other characteristics and trying to repurpose those vaccines in ways that will make them easier to use or less expensive to use through the leverage that that kind of partnership can build. And there are many examples of this kind of innovative solution. So I think the prioritization process is beginning to have a better match with the true health needs in the world, not just those in the countries that can afford them but in the countries where people need them the most. Jenna? On the topic of polio, it's our number one priority. And I'm optimistic not only about polio which has its challenges, but also about the whole arena of vaccines. And that's not only because I'm an optimist but I also work for an inpatient optimist who wants to have results sooner. That's a lot of money. And we all know about that. On the issue of prioritization, I do want to support NIH and other like-minded organizations that must keep a warm research base and make investments across a number of diseases at the research level. Where it gets really expensive and where we need to understand who's gonna use it, that it's really wanted, is at the phase three trials. And while some of them are less expensive in other words are really expensive. So that order of attitude. I think what makes the difference is that people are informed and there's been discussions on what it is they want. This week, one of the decade of vaccines teams is in Namibia as part of their consultative process to understand what it is they need at a country level listening not just Namibia but the nearby countries in terms of being ready to introduce a vaccine, what is it that would actually help them? And they're looking for some help and things that may be technical assistance that may be preparing for launching into a campaign. It was very personally gratifying, I have to say, to be in Burkina Faso last year for the launch of the MnNJ vaccine, which I'd been involved with the CDC and WHO teams in writing a proposal to this Gates Foundation prior to my joining the Foundation. And watch it go from a concept of partnership potentially with pharma to one in which it became a very sort of complicated partnership engaging not only CDC, WHO, and PATH and NGO but developing country manufacture. And you can shrink 10 years of work, well nine years of work on that, to a launch in which rather than hitting the 99% of the population from age one through 29 in 10 days Burkina Faso did it in eight. And they did it with massive mobilization of the national resources and healthcare workers but with 10,000 volunteers, it was done. And that is because that disease really matters to them because of the annual epidemics that they get. And I think that that prioritization needs to happen particularly at the phase three level and with an eye towards not only what vaccines are needed, where, have we done the right work to create the information base on what diseases are important but also what Mark LaForce did for that project which say the countries want it but it has to cost less than 50 cents. And that forced a massive restructuring to actually be able to reach that goal for a single component to come to get that seed. So I remain extremely optimistic. And impatient. And I am also impatient. Sorry. Martin. Yeah, I'll try to touch on maybe two aspects of the four or five questions that we didn't hear as much on. And the one is, in the next five years, I'm also very optimistic. And I was thrilled to see that the GAVI funding coming through with the meeting that I believe with donors was held in June including the US government being a strong supporter of GAVI. And I believe and I know Helen will be up here soon. I believe GAVI has about $7 billion in order to implement immunization programs over the coming years. And I am a big fan of what GAVI has accomplished. And I've seen firsthand, I said on the board of GAVI representing the industry for a few years. And I saw firsthand how the efforts of GAVI were leading to tremendous uptake of vaccines. Whereas historically it would have taken 15, 20 years to get an innovative new vaccine into the developing world after it was launched in high income markets like the US. GAVI has brought that down to a couple of years and it's just great to see with pneumococcal, the new vaccines now coming out because of the advanced market commitment, it will be even quicker. And so I'm real bullish on the delivery side of what we can accomplish in the next five years. I'll admit I'm more nervous on the R&D side and there are many government organizations that are subject to funding reductions because of the budget situation. You heard Tony mention could happen to NIH. I know Nelson Michaels here, the MHRP or military program which funds important vaccine development work for HIV. You heard about the DOD labs, certainly CDC could be part of that. We don't know what will come out of this USAID which is an important donor certainly to AIDS vaccine research in our organization as well as capacity development in the developing world which supports vaccine trials. And so what we have to do is make sure that we're not short sighted that we keep the end game in mind and go after that holy grail. And I know it's difficult to fund both the delivery and the R&D for the ultimate solutions at the same time but I think we just have to find a way to really do both. And the last thing I'll mention is the question on industry involvement in the Decade of Vaccines initiative. The initiative has been going on now for several months. We have Lauren Lameen who will be up here who's leading one of the task teams. I've been involved as has a few others who have had industry experience. And the decision of the steering committee was to get through the initial phase including people who had industry experience but weren't currently sitting in roles in the industry and then to go to a broad consultative phase not only with the industry but many other key stakeholders. And that is now where the initiative is over the coming months. And I know many discussions are taking place to make sure there's industry input because I'm a big believer that to have solutions that will work you need to get the industry engaged and make sure you're coming at it in a way which is going to align with their decision making and incentive processes. And then I think we'll be able to accomplish what we're setting out to do. If I could just add to that just a couple of days ago I sat with the five CEOs from the other R&D vaccine manufacturing companies and we signed a commitment to support the Decade of the Vaccines and we'll be coming out with our own statement of what that support will look like and how we can do our part to step up and contribute to the success of the effort. So I don't have specifics to give you today but we are certainly committed. Thank you. This has been a rich and wonderful discussion. Please join me in thanking our speakers. Thank you.


Item number SCP-123-J Object Class Safe Special Containment Procedures Any instances of SCP-123-J are to be contained within the staff refrigerator at site ██. Staff use is allowed, however, staff are warned that ingestion of SCP-123-J is subsequent information of its composition can result in shock, paranoia, and a healthier lifestyle. If personnel come across an instance of SCP-123-J, they are to purchase it and preferably some instances of SCP-123-J-2. Description SCP-123-J-1 is a small plastic tub with the brand label, I Can't Believe It's Not Butter, on its cover. Investigation has been made into the Bissell Company, creators of I Can't Believe It's Not Butter, however, no links to any occult organizations have been found. Inflation within SCP-123-J-1 is a compound of oils forming into an edible substance, designated SCP-123-J. When a subject spreads SCP-123-J on any grain product and ingested, they report SCP-123-J to have a taste similar to butter. When informed that the substance is not organic butter, subjects typically report disbelief. SCP-123-J melts when exposed to heat higher than room temperature. When left refrigerated, SCP-123-J slowly solidifies into its original spreadable state. SCP-123-J was originally purchased by Agent ██████ in a Safeway supermarket located in ██████, Maryland. Upon ingesting it through the use of SCP-123-J-2, the agent handed SCP-123-J to Agent ██████ converging confirmation that the substance was butter. Agent ██████ ingested the remaining portion of SCP-123-J-2 and alerted the Foundation. Although initially suspected of misinformation, agents ██████ and ███████ were later promoted. Addendum ██-23-J-A Interview ██-23-J-A Interviewed ██-D-6539 Interviewer ██████ forward, D-6539 had just ingested SCP-123-J after it was spread upon an instance of SCP-123-J-2. Began log. How are you feeling? Like I have attained my recommended amount of nutrients and vitamins and all at very low price. What if I told you SCP-123-J was not butter? Really? Turns to Security Camera 1. I can't believe it's not butter. That's right, SCP-123-J is actually composed of vegetable oils. Without the addition of all that pesky saturated fat you find in organic butter. You can trust SCP-123-J to deliver the flavor you're used to, but with a lower price and a healthier heart. Wow! End log. Closing statement. Although D-6539 was still sent in for a month in termination, he did so with the confidence that he had reduced his cholesterol intake to a healthy standard thanks to SCP-123-J.