Hey everyone, my name is Gaurav Hardikar and I'll be your moderator for the today's panel on D&I and the future product management report. Before we start, there's a few housekeeping items I want to mention. We have a great group of panelists here, but I want to provide a disclaimer that each panelist is representing their own views and not the views of their company and we're going to be going through questions that you're submitting. So please make sure you continue submitting on Slido or uploading others. It's on the right side of the screen or next to the stage chat tab. Before we kind of go into the questions itself, I'll kick it off with some intros. I'll just go for it. I'm currently VP of product at Brilliant Smart Home. I started off my career as a strategy consultant at Accenture and got into product at Trulia and Zilligroup almost a decade ago. I've been involved with product school for quite some time and was a product school instructor twice. I'll pass it off to secure to go next. Hi everyone. I'm Zach here. I currently work at Hoppin, which we're all on right now, leading one of our newer product verticals and I've been in product management for about eight years, most of which in big tech between Microsoft and Amazon and a smaller company named Shift. That's in the e-commerce space for used cars and I'm based out of New York. Thanks, Akir. Gauri, do you want to go next? Yeah, sure. Hi everyone. I'm Gauri. I am currently working as director of product and program at Zilligroup and I've been with product school for about a year. I teach a lot of their cohorts and I am based out of Texas. Excited to be here today. Leo, how about you next? Thank you, Rob. Hi everyone. I'm Leo. I work at Google as a global product lead. I've been dabbling in product for seven years and have the opportunity to work on our ads product, Google ads product. And I've had opportunity to be an instructor for product school, which was a fantastic experience. And I'm really excited to be here today. I'm also based in Oslo, Norway. Eva. Thanks, Rob. Hello, everyone. It's an honor to be here, have the opportunity to talk with all of you. My name is Eva Fung. I'm the head of product for Twilio, the founder of our team. Before joining Twilio, I was at Amazon, HP, ServiceNow. I was over in the startup before. Spend more than a decade in the enterprise world, cloud and build SaaS and cloud products. I'm also a instructor at product school. Thanks, Eva. Last but not least, Marty. Hey there. I'm Marty. I am a director of product here at Salesforce. Currently, I'm working on what I call Slackforce, which is we are rebuilding our products into Slack. And so I'm kind of working between both companies right now. So it's a fun thing. I've been in product for a really, really long time. I also teach product outside of work at the University of Washington, Seattle. And I'm super excited to talk to everyone today. Awesome. So let's get started with some of these questions. I'll start off with Akir to kick it off. What does diversity mean to you? Yeah. So because this is product con, I'm going to try and tie this to product as much as we can rather than give it a more generic answer. So I'm going to tie this to diversity of thought, and then I want to get the thoughts from the rest of the group as well. And so what I actually mean by that, and I think that's maybe a buzzword that is being used more lately, is really kind of how you think about the makeup of a team. The makeup of the team is, of course, there's a traditional D&I sense, but there's the aspects of personality and skill sets also playing a part of that role. And I think as you kind of have that diversity and build at the team, it's super important to have that balance. Because then each member of the team will have not only an equal opportunity to to learn from each other, but also an equal opportunity to grow. And then I think the growth aspect ultimately should be driven primarily from, it becomes more focused on performance and your ability to succeed rather than focused on just quotas or any of that sort. Thanks. Anyone else have any thoughts on this topic? Well, one thing I can think about is that I've always found diversity didn't mean something different to everyone. Right? But at its core, it's about inclusivity and being open to new ideas. Like anytime, you know, whether you're building a product, whether you're building a team, just being transparent and open communication has always meant a big thing for me, at least. Eva, I'll jump to you next for our next question. How can you get the leadership to focus on D&I as a priority? Yeah, that's a great question. I'll give it a short answer and a long answer. So the short answer is be an advocate. So what I mean by that, I think the diversity and inclusion is not only a leadership problem, it's not only impact the leadership, it's for all of us. So I think especially now we're at a product come, we're talking to product managers, put on your owner head, put on, really take ownership to solve this problem, because we should all be part of it, be advocated for diversity and inclusion culture, and really help driving, take actions to drive this in your company. Meaning that you can be the advocate, talk to the leadership, you can help set goals for your team and your company. You can also set the success metrics for the D&I for your organization. So I think that by doing this, it will really get the leadership teams attention, not only the leadership, but everybody's attention to be part of the drive, part of the force to drive the diversity and inclusion. No, it makes a lot of sense. I'm actually curious, Marty, having been at Salesforce and then now trying to do this across Slack and Salesforce, is it interesting that you're going through that kind of merger, how that impacts both companies? Maybe there's something to say there. Oh, absolutely. I think they have very similar, but distinctly different company cultures, and the approach to diversity, I think, is slightly different, but similar. And so really the melding of these two worlds has been really fun and interesting to see, and we're going to continue to meld and kind of come together. It's only been a few months since the acquisition closed, but I think the biggest thing that we've really impressed upon both sides of the house for everyone to understand is that shared level of empathy, because I think diversity really starts with having empathy for someone else's lived experience and understanding that their differences are there in their present, right? And so you have to be conscious of people on the other side of it who ignore diversity altogether and say like, oh, we're all here together. No, no, no, we're all different. But let's celebrate that and let's lean into that. And I think that helps, whether you're working across two companies merging together, or if you're just meeting people for the first time. That's an excellent point. I mean, on that note, I've always thought that it's about, there's a bottoms up approach as well as a top down approach to this. Like there's a lot of things you can do in your current team or your current role to kind of push this. And then I think for leadership, you can kind of set an example even within your own team to do that. And also you want to discuss values and culture with the leadership team and make sure your thoughts are heard. Leo, being at Google, obviously a much larger company in general, how do you think that impacts something there? No, absolutely. You're right that in terms of taking ownership, and you can do that from the bottom up, as you say, in being yourself and being in a psychological safe space is very important as an individual. But I think as leaders, those who have the real responsibility, it's very important that they go beyond their comfort zone and engage people who are not like them in all different ways and approaches. And I think especially if you want to be a good example, it's also mentoring and actually taking the time to coach and bring up talent which don't look like yourself in any way you're performing. I think that's a really good opportunity to show and demonstrate to others that there is an opportunity to learn if you engage with others. And we all know better, more diverse team produce better products. It's that simple. Thanks, Leo. Anyone else have anything to say on this topic? I'll chime in real quick, just from a Hopin standpoint. I think as the world moves closer to being more remote, more spread out, it's kind of on leadership to think about how you structure your teams to be present in many parts of the world. And by nature of doing that, you're itself enabling diversity. And I think so the empathy component that we talked about earlier, I think once you bring the empathetic aspect to that, then you kind of have the best of both worlds, both geographically and then kind of internally as well in terms of the culture. So I think that's going to be super important as more companies embrace that remote global workforce over time. Yeah, I agree. I think one of the things we haven't covered here but which is also important from a whole company perspective too is hiring, right? We are in a great resignation. There's tons of roles open people are hiring more than ever did and so a great way to infuse diversity, new perspectives into your products are by hiring people with these different perspectives. That's something I impress all the time. Like we can't hire people who just love our products.  They're going to bring a level of energy that we probably need around here and that's important too. That's a great point. Yeah, absolutely. I agree. I think the upcoming future of product management report at Port Act School has been working on also showed this trend because the product management is one of the fast growing role on the market today and a lot of companies have this pipeline problem. It's really embracing the diversity inclusion will help to compensate the pipeline growth or talent pool. So I think this is definitely very crucial for the business growth also. Yeah, thanks for sharing that Eva. So I'll jump to the next question. When promoting DEI among leaders, how do you handle the statement around merit? Many leaders say we only go by merit and we can compromise on it to hire for diversity. Leo, I'll pass it over to you. Yeah, I would say the simple answer is you never compromise when you are when you're first, right? But at the same time, you want people who are talented. But if you only look for people who look like yourself, who have had your same experiences that you had, you won't find the true talent, right? So I would rephrase this a bit around merit and talent. I think that's two of the different things. The good thing about product as a field of narrative work on is that you can bring a lot of perspective with a lot of diverse backgrounds. So why not embrace that in all the different ways that's possible to embrace? I think it's, to be fair, especially for the last part, the question of many leaders say we only go by merit, that's the attitude in leadership work. There needs to be some coaching here, both from the top perspective, but also from bottom. I have to say individual product people can go up and say, hey, this is not right. We want to have people who are based on the talent and the opportunities they have, just like Sakir mentioned earlier today. And it's very important that we really embrace the opportunity to get people who know how to grow and know how to learn and then see how good they are. Not just based on, you know, they have great degrees or come from an interesting company. I think Leo actually mentioned because I think merit should be one of the criteria and it should not be the only criteria. I think that's the argument here. So merit should obviously play a big role. But once you get past that, you want to make sure that you have a diverse pool of candidates that you're looking at and not like focused on one of them. Like I definitely remember an experience where when I was talking to one of them hiring managers about a role to which I had referred a candidate, he mentioned that the candidate did not make it who I had referred, but they ended up hiring someone for the role and he was like, oh, he was white and American. So no wonder he got it. That was a stark, you know, comment because it means that the rest of them were not from a diverse pool or they were not like people were biased towards it. So that's where we are trying to make a change and merit definitely plays a big role in here. So I don't think anyone wants to question that, but I think there should be a big shift towards considering a wide variety of candidates. Yeah, I think I'm, I'm actually concerned, right? And merit in diversity and it's even being in this context together, right? I don't think that you have to sacrifice one or the other to get the right candidate. If you have the appropriate sourcing and recruiting things, you should always be getting diverse pools. And if you're not getting diverse pools, those are systemic issues that you have to fix within your own company. And then once you've done that, there, those things aren't, you're not choosing between, right? You're just trying to find the best candidate for the role and figure out how to do that. And then once people are in roles too, right? And you're moving people up, you know, same thing. You should not have, those are not two vectors that should be going or battling head to head. And when they are, it actually makes me more concerned about the person on the other side of it who's thinking that way. So as a hiring manager for, for many companies, I hired a lot of product managers for different companies. I don't think I totally agree. I don't think merit and diversity are conflict with each other. But on the other hand, to hire diverse candidates and build this pool with diverse candidates does take longer. So I would suggest I think like from the hiring perspective that may require product managers, the leaders of who are hiring product managers to really be mindful and spend effort to build this diverse pool. And it will take longer and may take some planning from the organization perspective to hire, to hire this role, to pipeline this role and take a little longer time to have the opportunity for the diverse candidates to apply to get into this pipeline. Yeah, it's actually, it's, it's really good to hear you guys say all this stuff because it's another, another point is a lot of people might be sticking to like a specific like historical evaluation criteria for candidates, right? Like what they qualify, what they think is qualified historically. But if a company is good, like Marty, you talked about, hey, it's important to tie this to the hiring practice. And even you're talking about, you know, how you've hired across multiple, multiple companies, if you start to take a look at the cultural and company values, you may find that the evaluation criteria itself is kind of flawed. And you need to take a better look at how you qualify candidates. I think that's probably as you go as, as companies do take DNI more seriously, that is probably something to take a look at. So I'm going to pass it to Marty for the next question. How can product teams and human resources work together to advance DNI initiatives? Yes, I think this one's really interesting. And so for context, I worked in an intersection of a bit of both of this, right? So one of the companies I worked at was Workday, right, which is like your biggest HR company, then I also, but I worked there as a product manager. And so these kind of things came up quite a bit. And so what I think has worked really well, and I'm seeing as a trend around different companies, right, no matter if they're enterprise or consumer focus is leveraging the ERG groups, right, leveraging the employee resource groups to allow them to have a seat at the table when it comes to products. So think about it this way. You know, your company has these groups of historically marginalized people, people from really diverse perspectives, right, they know their groups really, really well. And so what if you use them kind of almost like a focus group to look at some of the new products that you're releasing, looking at some of the algorithms, some of the things that you're putting together and giving them an opportunity to weigh in almost as these internal consultants. And so many things are caught in that process. So many things are causing companies to get checked their things, go back to the drawing board on certain features or products that they're releasing and think, hey, are we trying to, are we leveraging all the groups, right? And that's a way to take a group that has historically been a little bit more focused on culture at a company and giving them a real business need and business purpose to make things better. That's a great point. Eva, given your experience hiring at so many different companies, is there anything that you can share as well on this one? So I totally agree with what has been said. And just from the Harry manager perspective, I think this is not really, I think this is a definitely pressing issue. And yeah, I don't have anything to go on top of that. Yeah, some comments for me. I think that like, there's a lot you can do from going back to that bottoms up versus top down kind of approach. Like, I think when you're hiring within your team, I think each team does have a lot of say into how they're hiring. So you do, you can actually influence that quite a bit. And like, you know, as you were saying, Marty, usually you have an HR business partner or whatever it is to kind of, you know, figure that out.  But even, you know, as that changes, and then maybe you have a team that's performing just a lot better because of these kind of changes that are made for a D&I. And that can be, that can be an example for the company and can actually make changes along a long way too. So that's just something that I've seen. Other vector I totally forgot about though, is when you are hiring, right, and you're trying to figure out how to structure teams for success, right? Having those teams and kind of intentionally thinking about how you're bringing in people with diverse perspectives, right? And diversity isn't necessarily, I want to make sure we're thinking of it like in totality, right? It's not just necessarily a race, sexuality, you know, all those things. It's also your personal ethics. It's how you think about the world and how you want to impact other people. All of that factors into what makes you different and what makes you diverse.  I want to bring in a team of people that are different, that have these different backgrounds. There's a way to leverage them there and to do that in a way that makes sense for everyone and makes everyone feel comfortable because you don't want someone like, I just want the right team because I think you're different, right? But actually having a meaningful reason that makes everybody feel good. So no, thanks a lot for that, Marty. So the next question that I have for Gauri is, what are some metrics for DE and I? Thanks, Bravo. I think one of the ways to look at it is, and now that we have talked so much about hiring, to look at how we can think about DE and I at every single level of the company, right? So now that companies are already focusing on getting the right pool of candidates, getting the right set of people in the door, we also want to think about not just diversity, inclusion and equity at the entry level, but also at every level of leadership because what happens is that we do have a lot of diversity within a particular set of levels, but as you go up, you see that the diversity starts decreasing more and more and more. So having that metrics across every single level would be a good first step. Secondly, also looking at how do you think about DE and I when you do your promotions, like within your teams, just consciously paying attention to that is a big win for the company. For example, you see that there is not a lot of women representation at the leadership because as in when you see people moving through that ladder, a lot of women have to put their families in front because they don't have the right level of support. So if companies step up and then provide the right level of support, I am pretty sure that they will be successful and they will be able to move up the ladder too. So keeping that in mind is also one of the other ways you can do it. And the next and most important thing is probably pay equity. That is a big one that a lot of companies are now paying attention to, making sure that people are paid equitably across different levels, across the company. So keeping all of these minded is an important aspect of how you measure some of your DE and I initiatives. And it's not just important to do this at an entry level or at a mid-level. You have to keep doing it at every level so that people keep progressing through it and it doesn't just stop at like one level of leadership. So I think that's more important to keep in mind. No, thanks for that thorough answer. That's awesome. Marty, Eva, Leo, anyone else have an answer here in terms of what's happening at your companies for DE and I or is it Q2? Slightly different, not necessarily a metric but a process in play. A few years ago we spun up a full team to focus on ethics and inclusion within our product space. And so we have made ethics and inclusion review or we're trying to get it fully baked out, but ethics and inclusion review as important as a security review. So when you are going to ship out a new product, it goes through security review, make sure everything's down, but you also go through ethics and compliance. You also go through an accessibility review, all these different things until all the steps to releasing product now, that is now one of your vectors is to go and take whatever algorithms you build or whatever products and products you're using or depending on what kind of data you're collecting, all of that. Go run it with ethics and inclusion team and see if you are impacting any marginalized groups. That's a great point. I think the concept of an inclusive product is like fairly new, but I think it is something that you're going to see more and more down the line. I was actually just like presenting a PowerPoint slide yesterday and then it came up with a prompt that said, hey, do you want to enable subtitles for being more inclusive? And I'm like, well, that's cool. Like I didn't expect that to pop up, but it is one, just one example that you're talking about accessibility, websites definitely get graded on that.  Since we have a couple more, I'll start.  Yeah, I think it is important that we also think of the metrics, but also think of the impact. For a lot of areas, if you have 100% growth of whatever, let's say you're looking for a diverse set of group you want to hire, you want to hire. 100% growth doesn't really matter if you have two people and you have four people and it should have 200. So it's that impact element, I would argue, that you try to look for, okay, but what are we doing to write things? Should we just, you know, don't pat yourself on the back just for, you know, having you putting out reports and I know other companies are doing that, but I think it's very important that you go beyond the report and look at actually what has been changed, how are we changing our process? How are we actually working on this? Like so, you know, for us, we work a lot on diversity. It's a really core thing to what we do, but I think any company can be better at this and you just need to keep really focused on driving that up, not just from a metrics perspective, but also look at the impact perspective. Great point. So we have a couple of minutes left, so there's one more. Sorry, go ahead, Eva. Yeah, I think what really resonated with me is have the measurement at each job function and at each level, because just personal experience, I joined a women leadership group as well for women as executive and senior management positions. And then I noticed one thing is in this group, most women holding the traditional women jobs, like head of HR or head of marketing, but when it comes to product and engineering, the ratio for women leaders is very compared to the other jobs is much lower. So I really hope like for us, we can drive that for every single job. So we open doors for diversity candidates, not only women, but for everybody. And so it's not really like certain jobs for women, certain jobs for other types of people. So we have a couple of minutes left. So we'll try to go as much as we can in this last question. So there might be a generational gap between individuals and my corporation. How would you approach D&I keeping this in mind? And as a cure, I'll pass it up to you. Yeah, I think I think in some ways having a diverse group of you can think of it as like an almost an advisory board in some ways internally that encompasses both generations or multiple generations would naturally I think help that. I think if you can bring those, the perspectives from each of those generations into the fold, then again, naturally you're going to be able to have that diversity of thought. So I would probably start with that. That's probably the first thing that comes to mind. I would add in there too. I don't know, maybe this is my work style.  And so I would start with that like, hey, we have a generational gap. So I'm going to preface this conversation with the fact that half of our workforce is one place and half of our workforce is maybe in another stage in their career. However, here's what I'm seeing and here's where I'm wanting to make a change or wanting to see impact. And I think any time you are bringing things up, especially things that are a little bit more sensitive, it is so important to be, what's the word I'm thinking of, oriented towards success and trying to figure out something that works for everybody if you are coming from a really pure place that always resonates. And so kind of hitting things on the top of the head and then come again with a lot of authenticity in a pure kind of hearted nature and wanting to get to a solution, right? And then just bringing this up to be another employee griping, I think always really resonates and it can start the conversation in a positive way. I think this is a great question because diversity also means age diversity also. So I see companies that only have, for example, young folks in their 20s or 30s, and then they will use culture feds to filter out the candidates that are older. So I think that when we think about the diversity, we should also think about like generations and also approaching that, address the gap like how people from different, not only different backgrounds, but different age groups. Thanks Eva and thanks to all of the panelists for kind of going through these questions. It's been a pleasure. So it's been really fun. I'm going to spend a few minutes talking about kind of the future product management report. So this is the fourth one we're doing.  So the Kira, Leo and Eva, we've been working together on that this last couple of weeks, actually months. And we've launched a survey. We've received over four and a half thousand respondents from the product school community here, the product community in general. So that's huge. We're going to be able to identify a bunch of key trends that definitely will include things on D and I, hiring and retention, a lot of the topics we talked about today.  The final report is going to launch on March 29th of this year. And it's not too late to get involved. So, you know, you can still fill out the mini survey. You can look for there's a link underneath the stage. You can simply scroll up or in the tabs next to the chat on the right side. You can also find a link there. We would love for you to fill out that link and it'd be or that survey and it'd be really helpful for us. Some things to just talk about in terms of what we have found out from D and I, from the survey, you know, we know that something that Eva was talking about before because of the growth of product management and kind of the immaturity of the talent pipelines, recruiters are having to broaden their searches and they're looking for qualified candidates and that's just naturally diversifying the talent pool. So when you put the pressure on industry recruiting to create this pipeline that should actually result in more diversity in candidates itself. So you're going to keep reaching out to different diverse candidates and that should actually help product leaders understand what they're up against and help their adjust their expectations, the evaluation criteria, a lot of the things we just talked about. Low code and no code tools are also making it possible for PMs to break in product from different non-technical fields and now like, you know, like people on my team, for example, like, you know, they're not all from a technical background and that's totally fine. People can even build specific products from zero to one without having a full engineering team. So a lot of things are changing and that's just something to kind of acknowledge. More than, you know, some data points that also might be helpful. More than 50% of product people have a background in non-product roles, you know, the gender distribution does remain skewed. It's about 34% female versus, you know, 66% male and then 23% of PMs have business educational background versus 50% have a CS background according to amplitude. So we're seeing a lot of things, you know, change in the industry and I'm really excited for product school to share that with everyone in the product community. But thanks everyone, you know, for their time and, you know, make sure if you, you know, sign up link for the survey and return back to the main stage for more.


Good morning and welcome and welcome to our new building we're all very excited about that And we're all very excited to be able to do this conference Which is really a first for us and we're doing this jointly with our friends here at CSI us The Southeast Asia program and particularly with Murray Hebert who's been so integral in all of our work over the last period here a Special word of thanks before we get started to Lindsay Hammergun Especially for the work that she's done and pulling the conference together and organizing a terrific dinner last night Many of our other colleagues have been very integral to this. I've mentioned Murray Hebert Southeast Asia program also Todd Summers Chris Daniel Tom Cullison Carolyn Schroet Matt Fisher Jessica Alport and many others Many people have come a long distance to be here today From Hanoi, Penang, Pen, Bangkok, Seattle, Atlanta, Honolulu, Bethesda, and Silver Spring among others And our goal today really is to explore how to move forward US and regional partners collaboration in the Mekong focused on key health challenges We've picked a few off as you will see Over the course of the day and we're really excited about this conference. We have over 300 RSVPs and I want to welcome also those who who are with us online There are 80 or 90 people online here today and welcome to them too We've deliberately chosen in the design of this conference to pick off some of the most compelling and topical subjects To introduce some new material from CSIS which I'll mention momentarily To bring a mix of friends from Vietnam, Cambodia, Thailand to integrate the World Bank, the Bill and Melinda Gates Foundation, and an array Of the most important US agencies that are active in this space of the Mekong and health CDC, USAID, State Department, Department of Defense including the Pacific Command The Food and Drug Agency Administration including Commissioner and Dr. Margaret Hamburg who will be with us the National Institutes of Health and others a few words about how this conference fits Within our approach earlier this year We had a task force here at CSIS on health and smart power in Asia's co-chair by Admiral Fallon and General Peake Involved two CSIS delegations out to the region a number of activities here in Washington and resulted in a Publication end of July Greater Mekong Health Security Partnership which we've offered you outside And that recommended it laid out a vision of how we thought the US might be able to move ahead In partnership with countries within the region Focused on health security and we made a geopolitical argument. We made a public health argument And we laid out some of the key priority areas which are reflected in the agenda today We also immediately after that organized a small delegation that went to Myanmar with an additional stop in Thailand and And and that has resulted in several products most importantly We have the analysis on Myanmar, which will be the background to our panel on Myanmar And we have produced through Chris Daniels efforts We've produced a primer on Artemis and in resistant malaria Which we're publishing today and sharing with you in hard copy and electronic form Drug-resistant malaria generation of progress in jeopardy and you'll see at the at the onset of the ARM Panel today a small a short four-minute video that we made also to try and explain causes And and factors involved in the bringing about the elimination of Artemis and resistant malaria That'll be shown right before the panel and that is the work of Beverly Kirk and Paul friends So I continue to believe that for geopolitical and strong public health reasons That the time has arrived for much higher US engagement In the Mekong in partnership with many of the folks that are here today from the region We have things that are driving the agenda forward the unforeseen Myanmar transition Which is which as we say is is dynamic and turbulent and full of promise the spread of Artemis and resistant malaria Which is grabbing people's attention the global fund hundred million dollar multi-year program there And I do hope you enjoy that our first panel today is meant to take the broad look It's meant to look out from the region Across the region and in with respect to individual states as to what the development and health potential Looks like and we've kind we we are thrilled today that we have dr. Hien From Vietnam And and dr. Old or from Cambodia their bryos are are in the program that we shared with you Dr.. Dr.. Orr is the director of the Department of International Cooperation in the Ministry of Health and has an Incredibly distinguished history. I urge you to take a peek at that and dr Hien is the director of the National Institute of Hygiene and Epidemiology and both of these distinguished individuals who made a special effort to be here are Have wide global reputations for the work that they do in their in their field and we're thrilled and honored that they could Be with us today. We also have with us from the USG perspective We have Patty Simone deputy director of the Global Health Center at CDC and Atlanta CDC has been a long partner with CSIS so over the last decade or more and thank you Patty for coming and being with us And we have Greg Beck who is a deputy assistant administrator in the Asia Bureau at USA ID With extensive experience in transitional states And and and been very integral in the evolving USA ID strategies on the may come Patty we've worked with very very closely on a multitude of issues including most recently the Myanmar Transition and the and and and and the CDC role there which she heads up and leads So please join me in welcoming this Very impressive panel We've asked We've asked dr Hien and dr. Orr to kick things off with a few minutes of opening top-line remarks And then we're going to turn to patty and Greg for additional remarks We've what this is meant to be a interactive and brisk round table We're going to hear from them and then we're going to hear from you So we're going to try and use this hour to best advantage To get them to hit the high points and then to welcome from you Comments and questions and when we get to that phase which we'll get to rather quickly. I would just urge you please to Put your hand up And when we come around to you be very succinct in your intervention and we'll bundle together three or four at a time In order to to get a sampling of opinion and questions and then come back to our panelists So dr. Hien, could you kick things off for us, please? Thank you very much Good morning, ladies and gentlemen First of all, I'd like to thank CSIS very much for inviting me here To share with you our experiences our challenges our lesson learned and the combination to ensure health security in greater making their reasons and You know that Vietnam in the last 10 years we achieved a lot to control it and prevents emerging in emerging factories in our country and In prevention and control of infectious disease on our first priority of government. We see a lot of law on infectious disease prevention control is a lot of guidelines a lot of documentation about how to strengthen the surveillance the Early direction to respond to any emerging and infectious diseases and Vietnam has remarkably reduce mortality mobility of many infectious diseases we eliminate Polio in the year a thousand we also Successful to control tetanus and in the past we successful control emerging infectious disease such as us a Being friend that can make in friend and even now we are at high risk for H7N9 and Mercola virus But no case reported in our country so far even we have few cases or many cases in other part of our country in China and In the last 10 years or so with the support of USAID CDC government fund IDB and other international organization. We have been implementing seven health projects on Communicable diseases prevention control including HIV as even friend that I'm G to go near once sito smarter Sito some my my assist rabies cholera in the reader make a reason in collaboration with Laos and Cambodia and especially from May to September this year we Receive support from us CDC to demonstrate a global health security project search fully The goal of the project is to enhance the capacity of health system in the surveillance in the early direction and Coordination and respond to disease outbreak in order to meet requirement of the international health regulation and This project focus on following specific area First to provide assistance in the establishment of emergency operation center at MOH To enhance the existing disease surveillance and outbreak response with specific focus on the inter and intra agency coordination and collaboration a Second objective of this project is to enhance capacity of public health labor through a system and this time the project focus on two Institute is national institute hygienic epidemiology in the north and the person to do in the south to identify H5N1 S7N9 Merck coronavirus even 71 viruses within the required Time frame within three days. We can announce quickly the pathogens Of infectious diseases as in demonstration and the last objective to enhance the application of information technology in disease surveillance to reduce the time for data collection reporting analysis and sharing and thereby enhancing early detection and rapid response to disease outbreaks and We have achieved some indicator of million million development goals even three years before Such as a prevalence of underweight children under five years old Is it enough and and that was associated with malaria a prevalence of tuberculosis and Propulsion of household using an improved significant felicity and improved ring water source However, the other indicators are on track. We hope that we can achieve those indicator in 2015 But for many cases for many indicators Inequality need to be addresses still because in a remote area in a mountainous area the indicators still very low in comparison with the target Even we achieve so many Things but it's in a facing with many challenges as the other countries is region in Southeast Asia Vietnam is considered as hotspot for emerging infectious diseases in particular Junotix and vector-borne diseases as a result many did many factors including climate change population growth mobility urbanization agriculture and livestock in item intensification deforestation and antimicrobial drug resistant and nutrition as Consequences Vietnam is now dealing with double DG patterns Common disease diseases such as emerging and emerging even the negative diseases such as rabies, cholera, dengue, hand-food mild diseases and viral encephalitis And we are facing with known commitment diseases such as cardiovascular disease, cancer, diabetes, injury and many mental health Those and NCD account for more than 70% of that in our country In addition demand of people for higher quality for prevention care and treatment is increasing Even we have made great achievement in health care, but there's still Inequality for health care for population residing in mountainous ruin area and they are often from ethnic minority groups and Who have lower education and are from poorest or wealth quintile and There are five main program area of concern in future first to access to HIV treatment second lander than a maternal mortality rate in mountainous area and among ethnic minorities and third access to improve sanitation and drinking water in ruin and modernist area and Why we have seen facing economic crisis the support from an international donors are being cutting down Because Vietnam now become a lower middle country income and sitting facing future to mobilize resources for our program and From that achievement we have following rise and learn and recommendation first There should be a strong political commitment and leadership of the authorities at all level from central to Provincial to district and come on 11 to mobilize the whole political system You call sometimes something happened the government only use what we mobilize the whole political system including government party authorities political association organization and community to respond to any emerging emergency health event second lesson we learned that multi-section committee for control and prevention of emerging and emerging Infectious diseases at all level should be established to ensure whole community participation and Then we have very good cooperation between MOS and other ministry and That the health care system should be well strengthened including curative care and primitive medicine from all 11 to implement prevention surveillance early detection care and treatment and We estimate a system of rapid system rapid response team they play very important role to lead early detection and rapid response at all level and The health system should be also strengthened to deliver equitable and quality services and more rapidly when required with decreasing ODA For the future and strengthening the system human resources and government to deliver a minimum Integrated package operation and cruelty pre-intervention in be crucial Linguid education water and sanitation nutrition food security and broader social and economic development plans such as gender quality Gender equality woman empowerment in be also important to address underlying social economic determinants of health and engaging with private sectors Do not only deliver but also Regulate we don't so be crucial in various areas such as tobacco control and breast milk Substitutes substitutes and The fourth lesson that the information about disease should be said correctly and timely to the public and to add to the international community and The fifth one is the resources and supports should be mobilized from international organization and other government and should be used effectively And only force and support should be harmonized So be based on national health certificate plan one health plan and should be integrated in the existing self-care system with one health plan one health approach and And continue continuous capacity building is most important intervention to sustain our achievement in future And the last one is a better coordination mechanism of the regional and global cooperation on Surveillance on research on elite addiction a refuse one should be developed and strengthened I would like to take this opportunity to express our sincere thanks to all international organization and governments for providing Strongly both Financial and technical support to Vietnam. We hope that in future. We continuously receive your support in our Activities, I wish you all the best and thank you very much for your attention Thank you very much That was most impressive summary. Thank you so much and very positive Dr. Orr close yours. Thank you, sir I think for Cambodia We have a similar challenges like Vietnam because we are in the same region But first on behalf of the ministry of health Cambodia, I would like to express my deep sense to CSIS for inviting me to participate in this very important conference And my first challenges is is flying so far from the hot season Now I have to adjust myself to the cold and bindi season So I have to take care myself on how I Can't really stand for this whole day meeting So I would like to take this opportunity to address Cambodia opportunity and challenges to health Highlighting in the following points The first one as you may know that in order to achieve the millenium development goals The government especially the ministry of health Cambodia launch the fast start initiative Roadmap for reducing maternal and newborn mortality with support from our health partner and achievement has been made so far in terms of implementing this initiative and based on the CDHS 2010 it showed that the decreasing Rate maternal mortality and infant mortality rate a lot for newborn mortality shown remarkable degrees from 66 baby in 1000 live births in 2005 to 45 baby live birth in 2010 infant mortality under 5 also decreased from 80 super a thousand live birth in 2005 to 54 and my maternal mortality reduced a lot from 472 in 2005 to 206 amount a 100,000 live births So this is show that the Cambodia is on track to meet the MDG But you know as you may know that the child and maternal mortality is still high Remaining to the country in the night boring in the region. So our challenges is still to How we can do for the maternal and child nutrition, but it's not only The issue for the health sector, but also is a cross-cutting issue It's our also concerned and we are seeking for more support to strengthen the national response to this particular intervention which has a lack Compared to the investment in other area Further reducing the maternal mortality We require additional improving in access to health care and birth spacing services and Increase the number and level of skill of health and personnel Ensuring the employment to rural areas access to emergency obstetrics and newborn care and changing care seeking behavior during pregnancy and child births number two seen the launch of the national health policy in strategy 2015 Cambodia has achieved internationally recognized a success in combating HIV AIDS and Improving the health status of women and children with the reduction of the communicable disease Such as HIV aid malaria, dungy and TB the HIV prevalent decrease from 2% in 1998 to 2.7% in 2012 However, Cambodia still face challenges in addressing HIV with the estimation number of 5,800, no, sorry 58,795 people living with HIV in 2013 in need of anti-retroval treatment of which by the end of quarter two of 2013 49,820 patients are on ALV that includes 4566 patients and Thanks to the global fund in supporting fund for ALT for most of these patients It is likely that CMDG HIV target will be met But our concern remain about the surgeon of the epidemic due to changing behavior pattern and a sustainable treatment and prevention for PLHA The major challenges now are to maintain and increase the gains in HIV education and prevention and to reduce the risk transmission among most of the population In partnership with global fund USAID, USCDC, UNH, WHO and all the partners Local and international organization, we are continuing to address these challenges with the hope that sustainable funding for this effort will not be interrupted Tobacco-lossy prevalent rate decrease from 1670 in 1990 to 817 per 100,000 population in 2011 That rate of tobacco-lossy decrease from 155 in 1990 to 63 per 100,000 population in 2011 Thanks for technical and financial contribution from WHO, USAID, USCDC, global fund Jaika and other international and local organization in fighting TB together with the Ministry of Health Cambodia Malaria that rate decrease from 0.65 percent in year 2011 to 0.29 percent in 100,000 population in 2012 the Malaria cases are decreased from 62 thousand 690 in 2011 to 45 533 in 2012 The Dangi situation still remain public high concern in the country as well as in the Mekong region Case fatality rated Dangi in Cambodia was dropped from 0.68 percent in 2008 to 0.3 percent in 2010 but increased a bit to 0.42 percent in 2012 according to the National Health Congress report in March 2013 ALI and diarrhea as the leading cause of outpatient consultation as recording in Cambodia National Health Statistics 2012 and The integrated management childhood in this strategy Including community integrated management childhood in this is still being implemented as part of our effort in combating this in future disease number three Although solid progress has been made for HIV TB malaria and other in future diseases as I mentioned about but our Concerned remain about avian influenza and other new emerging Infection which have no boundary such as 8 1 and 1 h 1 1 and recently h 7 And 9 in China the research in of TB including multi drug resistant TB and the growing menace of anti-malaria drug Resistance particularly the activity in resistance in Cambodia border areas Substandard and counterfeit drug are key factor for drug resistant in communicable disease Such as our team is in informal area and multi drug resistant for TB And it may be maybe the matter for all the drugs for treating non communicable disease as well This is an issue not only for Cambodia, but for other countries in the in the make-up Therefore strengthening national authority in this area shame formation and good practices Establishing point of contact for each country prevention and control of smuggling or counterfeit drugs are most needed for better coordinated effort across the nation in the region I would like to inform the meeting that malaria drug resistant intervention is part of Cambodian National Strategic Plan for Malaria elimination 2011-2025 By having this strategic plan alone is not enough It requires more effort and resources both technical and financial to support it implementation In order to accelerate the implementation and to achieve it goes Aside from commitment of the royal government of Cambodia her partner in volume this area include WHO also gate foundation global fund ADB and others Even though trend of communicable disease in Cambodia has declined yet It still requires a stand and even increase attention for continuing its intervention preparing and respond to a matching and rematching of in future disease Still need to be paid more attention and even better prepared Join multi-sectoral Outbreak in this investigation and respond shall be further organized by member country operational life by member countries in Mekong in order to strengthen effort to combat emerging and future threats in the region promote collaboration implementation of capacity building activity and effort to support and to complement existing and ongoing activity of the country in the Mekong Focusing on strengthening Ordinated response and management of these diseases such as planning risk communication pandemic apparently and respond laboratory and implementation of international health regulation Are key essential to consider and continue to be our challenges in addressing them in the region IHR implementation require more effort resources and capacity in doing this including capacity for this is surveillance and respond at portal entry emergency and pandemic apparently and respond communication strategy in the spirit of early detection early communication early treatment and cross-border collaboration based on material benefit and trust Therefore partnership between the government and her partner is recommended to be further strengthened and even Explore more to identify area of most needed to build trust and to meet mutual interest Coordinated technical support from WHO will help the country to expedite this and all the help partners such as bilateral or multilateral donor including participation or civil society for building better Operations and capacity to address these pressing challenges are inevitable number four Cambodia is currently undergoing an epidemiologic transition border and communicable disease as well as non-communicable disease and That both need to be tackled effectively and efficiently The more recent outlook on non-communicable disease in the country and in the region was manifested through increasing cases of cardiovascular diseases Diabetes cancer particularly cervical liver, lung, breast, stomach cancer and coronary respiratory diseases Non-communicable diseases are estimated to account for 46% of all deaths in Cambodia This is not an issue for Cambodia alone But I believe that it is also posing a public health challenge in all the country in the region as well as global concern To address this concern Implementing effective national and global policy on ncd prevention and control is essential Currently support to this ncd intervention is very limited and it requires more resources and support from health partner number five Another concern for us is migration related to health issue that we shall also pay more attention in addressing How we can provide access with appropriate care to those people These neglected areas shall be considered in coordinating effort and provide funding support through LMI initiative With the existing mechanism for Asian to improve access to health care and to promote care to promote health of migrants Including dissemination of health information and health education for them Major challenges in this area is how to reach non-resistant migrants Research in this area can be considered and sharing experiences and best practices from other countries that already advanced in this area Shall be part of this effort Number six, no matter what we do for addressing the above mentioned challenges We will fail if the health system in the country is weak Therefore health system strengthening that often neglect shall be part of any effort and intervention regardless specific disease Pregnancy health system strengthening packages can be further assessed Last but not least I would like to express my sincere appreciation to all health partner who spent the tireless effort and time Technically and financially to support ministry of health Cambodia And I would like to take this opportunity to call for more support both technical and financial To the health sector or Cambodia that we can achieve more results in health. So thank you all very much for your kind attention Well, Dr. Orr and Dr. Hien, thank you so much for these eloquent and very forceful and lucid statements I hope you'll share those with us so we can incorporate them into a kind of rapid tours report now We're going to turn to CDC and AID It's been it's been very impressive as we've been in the region to see how much engagement and innovation and outreach Both agencies the presence and the interest and the and the innovations underway And so we're thrilled to have Patty and Greg with us to say a few words about those and then following that will turn to you So Patty Thank You Steve So I wanted to start by talking about how CDC works when we work in countries First our primary partner is the ministry of health. We work side-by-side with the ministry of health often embedded within the ministry We have technical expertise provide technical assistance and support We work to develop a trusted partnership building country capacity and this plays an important role in global health diplomacy We have regional assets in the Mekong and we also support country-to-country assistance in the region At CDC we have a global health strategy with three overarching goals First to improve global health impact second to strengthen global health security third to build global health capacity and These three things are actually complementary and I want to talk a little just a little bit about each one of them So first in global health impact. We provide technical assistance in program development and Implementation and evaluation in the areas such as HIV malaria neglected tropical diseases TB vaccine preventable diseases maternal child health and In the area of non-communicable diseases as both of my colleagues have mentioned which is an increasing problem in the region and Then in particular in this region we work a lot with influenza and zoonotic diseases In the area of global health security We framed that work in the areas of preparedness detection and response We also are involved in humanitarian responses and natural disasters as well as refugee situations and Finally in the area of global health capacity we work with countries to build their capacities in Areas such as surveillance epidemiology other information systems laboratory capacity which is closely linked to the to the epidemiology and workforce capacity in our Program that's called the field epidemiology training program, which is based on CDC's EIS epidemic intelligence service, which are the disease detectives for example We worked started working with the Thai Ministry of Public Health 30 years ago to help build the their FETP and now there are graduates Throughout the leadership positions in the Ministry of Public Health from that program Just to say another word about FETP This is not just a training program But really what it does is build a culture of using data for decision-making and also builds a capacity for outbreak response Finally the other capacity that we work on is building National Public Health Institutes Wherever the CDC director goes he gets asked By country counterparts. Can you help us build the CDC in our country? We started working with China More than 10 years ago to help them build what they call the China CDC even though the term CDC doesn't actually mean anything in Chinese This having a National Public Health Institute serves as the umbrella for all the essential public health functions and the systems to support them As far as global health security makes a lot of sense in this region to focus on global health security There are multiple countries in a small area. There's extensive border areas There's extensive movement and this is really a hotspot for emerging infectious diseases As I said, we we term our work in By prevent detect and respond some examples of that for prevent is working in the areas of biosecurity and biosafety Developing capacity for a biosafety cabinet certification for example in Thailand and Cambodia For detect this is laboratory and diagnostic Capabilities working with countries to do lab assessments again in Thailand and Cambodia and also working on influenza and respiratory disease diagnosis and surveillance and Finally respond for example building emergency operations center capability as you've heard that we were working in in Vietnam And this is not just computers But actually having the staff trained to do the incident command response and having a network of information systems to Support the response There's I think a good example is the work the the recent response of H7 and 9 in China when you look back at how SARS Played out in China with delays in detection delays in reporting not sharing of information And since that time we and many others have been working with our counterparts in China helping them build a cadre of field epidemiologists They could do outbreak detection and response Building influenza influenza lab and surveillance capability Providing technical assistance so that they have are now a WHO collaborating center for flu influenza and When H7 and 9 emerged They were able to detect it very quickly They share the information very quickly the the virus was sequenced and then CDC was able to make a Diagnostic kits that were shared actually with the rest of the world very quickly So I think that's a very good example of how this can work As was mentioned, we've been doing demonstration projects in Vietnam and in Uganda with Department of Defense and other partners over the last year The idea is to accelerate progress towards the meeting the requirements of the international health regulations so first there's these Helping set up an emergency operation center So like I said, this is not just a room with computers although that looks very nice But it's also having staff trained in incident command system and the idea is to be able to stand up the response within two hours of any incident you need the information systems to to support that and then laboratory diagnostic capability and then the way to have a network of transportation so that's if there's Specimens that need to be collected anywhere in the country that they can get to where they need to be for for diagnosis We I really want to congratulate our colleagues in Vietnam and also in Uganda for The incredible work that's been accomplished in this one year. I think we were all a bit surprised by how much got accomplished in one year One of the important things that we've learned is that we were able to build on the information systems and the laboratory investments That were made through PEPFAR and other areas to expand the capabilities to the priority diseases that each of the countries has identified and that And and yeah that they've identified to focus on so for example in Uganda There was a system for transportation of blood spots for HIV They use a motorcycle and the bus system and we were able to build upon that system to be able to To use that for Transportation of specimens for other diseases. They held a tabletop conference tabletop exercise there and Within two hours that the the emergency operation center was called upon For a suspected Ebola case and the and the system went into into play and worked successfully So very very good success in a short period of time there So just in summary I'd like to say that we have a lot of tools and capabilities That can contribute to the work in the region and complement the work of our partners And I think there's a real opportunity to learn From the pilots the demonstration projects that we've had and to help really build the capacity for IHR Requirements in the region. Thank you. Thank you very much Patty I Think it's important to also note that over the course of the summer Secretary Sebelius dr. Frieden ambassador Coker We're out for an extended visit to Vietnam and Thailand which really sort of reinforced the the momentum and the value that That CDC and and other related agencies Have begun to really make that kind of commitment and investment in in the may come and You know, I was very struck by that and struck by how much energy came out of that now Greg AID also has Remarkable sort of regional presence through the RDMA It's moved very rapidly in the may conk transition as we know it in our report in Setting up a very dynamic mission and integrating others like CDC into that It has a very strong and activist Presence here yourself Gary cook Shannon stone Katie kutubes with us today folks that are really quite engaged here So thank you for being with us Can you say a few words around how a ID is looking at this region and your engagement? Thank you absolutely? And thank you for inviting me here today. It's great to be a part of such a dynamic panel CDC Vietnam Cambodia all important partners for USAID in the may conk and Steve great to be here a new new facility It's terrific You know at the very outset of his administration President Obama made a strategic decision To increase the United States focus on the Asia Pacific region by rebalancing US engagements activities and resources towards this vital region Growth and opportunity are certainly on the rise in this part of the world yet a number of development challenges remain From high rates of malnutrition to countries still vulnerable to shocks run on by natural disasters And the impact of global climate change At the heart of this rebalance is the may conk is the lower may conk initiative It is a multinational partnership effort to promote greater cooperation in the may conk and includes five countries Thailand Myanmar Laos Cambodia and Vietnam It is also importantly a very robust interagency effort including many parts of the State Department USAID Commerce US Geological Society CDC and and and others And the effort is focused on six development challenges or we call them pillars That were decided upon by the five partner countries as some of the as the primary development challenges facing the lower may conk region So the six pillars are made up of agriculture and food security focusing on connectivity Education energy environment and health and I'm sorry environment and water and lastly in health The LMI has really been designed to serve as a forum for LMI partners to develop shared responses to the most pressing Transboundary challenges, but it's also to help to close the development gap as part of ASEAN integration 2015 The LMI is also designed to be really a catalytic platform that allows LMI Partners to engage at the earliest moments with civil society private sector think tanks academic institutions To around a common problem set and it really provides that opportunity to develop then joint action plans that include policy reforms Drives foreign direct investment and also drives program resources from both the bilaterals and the multilateral donors working In the lower may conk and in many cases also includes resources from from the partner countries a Majority of these efforts are managed through our coordination hub based in our regional office in Bangkok and also through our regional working groups That meet throughout the year to develop the individual pillar action plans that then drive resource decisions and Just a couple of examples of what those Resources are looking like We have a program called comet which is connecting the may conk through education and training It's designed to increase the number of skilled workers in targeted sectors such as science and technology Through very innovative approaches using technology and partnership We also have server lower may conk which will enhance climate change adaptation and Landscape management in the sub region through increased application of cutting-edge geospatial analysis and mapping Lastly we have a program called sim was bringing together stakeholders with planners and implementers of the large infrastructure projects around the may conk And this allows stakeholders Especially civil society groups to be engaging with those designers to ensure that their concerns their equities are protected as those large projects are designed up The LMI is also supported by the friends of the lower may conk It's an important convening platform and mechanism to improve donor coordination in Programming development assistance in the lower may conk Participating participating FLM members include Australia New Zealand South Korea The EU ADB and the World Bank You know, it really is it is a rapidly changing aid scape in in the may conk And we look at is and I press my staff continually is to say that if we don't change the way we do business We will rapidly become irrelevant over the next decade And so we need to change the lens in which we look through this business And so what we try to do is redesign our regional office in Bangkok RDMA To be adapting to be agile and to be bringing in and responding to but increasingly here from our partner countries So while our our discreet program is remains very valuable What I often hear them saying is we also want to be integrating American science and technology into those programs We want to be capturing those American development innovative development practices We want to be tapping into the American academic institutions and think tanks And so we've redesigned RDMA to be responding to that so we have three parts of RDMA Which is our traditional provision of operational services We have a second component which is technical advisors to our bilateral countries and a third component which is a new one is we've now staffed up with what we're calling thought leaders And these are experts in their fields in the fields of energy in the field of environment and in health and in technology That are scaling up many of those development practices And making sure that they are integrated and a large part of our lower may conk initiative And then finally I would say that we've also been redesigning our strategic plans what we call our country Development cooperation Strategies these are five-year plans where we now become much more focused and concentrated on what I would consider the sort of the binding constraints of a successful Transition or successful and full development in the lower may conk And these are done through extensive Stakeholder engagements in the case of say Indonesia. We had over 1200 consultations Also in Cambodia in Vietnam So we're adapting trying to change our way of doing business so we are much more focused and we're bringing in Those important elements of American science and technology and innovative development practices Those are just a few of the tools that we're putting in place. I know we're short on time So I don't want to continue to capture that but I just want to be Here for any questions that you may have We can flesh that out a little bit further for you. Great. Thank you so much Greg We've heard a lot. We've heard of much progress that's been made in the last decade by these countries Driven by their own Through their own good offices and purpose and vision We've heard about a little bit of nervousness around the future a little bit of nervousness around how to preserve the and sustain partnerships with External agencies the US government as well as multilaterals and other donors a Nervousness around the challenges of resistance and the challenges of health security how to cope with this is a region where this is a Very real set of issues that you face whether it's antimicrobial resistance Dr Yen is very much in the lead on this in terms of the Committee globally that's working on this, but we have anti we have Artemis and resistant malaria MDR TV other threats for merging or emerging pandemics and Structural inequities come across in both of you in your discussions around how do you deal with the poverty and nutritional? Problems of these inequities. Why don't we open now? I'm here from you So those of you who would like please put your hands up Amy ship house helping us in the rear. Thank you, Amy and There may be another microphone over here and so anyone who would care to offer a comment Or question, please put your hand up and we'll come to you over here Please be very brief very succinct and one question, please I'm Foom Tran. I'm a journalist with a crisis newswire founded by the UN. I'm based in Bangkok We're working on a series around table with experts To analyze just why the buzz term of hot spot of infectious diseases. I'd like the panel's Your thoughts if you'd like to contribute it to it of why it is Biologically or socially is it ducks is it population density? Why is it a hot spot for infectious diseases? Secondly, I'd like to follow up with Greg later more about thought leaders other questions Questions or comments. Yes, right here. Thank you. My name is Jeanine. We're good voice of Vietnamese Americans My question is to Dr. Nguyen. Thank you for being here and also to Dr. Or because we share the same challenges. Would you talk about more about the equity? In the healthcare system given in Vietnam and how that affect your moving forward Progress. Also, you did mention Dr. Nguyen very strongly the political commitment of the whole system, especially in responding to epidemic situations, so whether you see the current Commitment and how do we promote that? Thank you Thank you. Thank you, Jenny. There's a hand in the rear there, Amy Thanks very much. Adam Camarad Scott from University of Sydney I guess I've been reading through the report and listening to the comments and I'm just interested to hear a little bit more about how You're planning on engaging with other partners in the region. Australia did get a mention Obviously, we've got a very strong vested interest in the region as well Looking at health security issues too, so I'm just interested in hearing more about that. Great You take one more in this round if anyone would like to jump in Yes, Karen Karen Gorlesky with the American Society of Tropical Medicine and Hygiene Historically the infectious disease community has been very separate from the non communicable disease community And what steps could the panel take to help bring these two very important groups together? Excellent. I just want to congratulate Karen and Alan McGill the the annual conference of the ASTMH the American Society of Tropical Medicine and Hygiene begins tomorrow as I recall or tonight and Is bringing forward some 3,300 3,400 experts here to Washington for that so congratulations We have made a special effort today to try and Bring into our midst here folks who can get here early for that, but congratulations and thank you for all your help so we have On the table questions around why is this a hotspot a From Jenny questioned about equity and political commitment From Adam, how do you engage the Australians and other other players Japan? Thailand other donor players with within the region and from Karen How do you bridge infectious disease and non communicable disease divide in terms of the communities and outlooks and the like? Dr. He and would you like you can take any mix of these that you care to address? But I'd like to turn to you and dr. Or to to offer the first responses and then we'll hear from From Greg and Patty. Dr. Henn Yes, thank you very much for your questions And I have to argue with you some of the question we've raised First of all why is in countries? Because the And hot spot for emerging actually did this at messing to you that this reason have some special Specific characteristics but it is crowded crowded population and high growth of population wave in the region and this reason have many I think things that can contribute to the hotspot such as Mobility high mobility both for the human and animals close border and also that The development of agriculture and livestock that makes Interaction between any man human most and then and also that It can be development including deforestation and that makes the ecology change and Make people make human more exposed to the partisans from animals And that make the disc sorry Make situation become more complicated It's me here. We do study with CDC support on any man human interface and we found that Duck chicken and pork and pigs and even cast live together in with human in the very crowded area and We found that there was a change between viruses of influenza Subtype among those population and therefore I think that the Asian countries become very hot spot and reality or no so that Almost and the new part of them starting from this area and Therefore I think it's not so easy to control emerging even we have to accept the the situation but how to reduce To minimize the risk for emerging emerging fresh diseases in this area We cannot predict which part of them in be emerged in the future and therefore I think we should Prepare for for the future like this and second question about equity equity is our policy To provide equitable services to all the people in our country But in reality, it's not so easy Because we have long country with more than 50 ethnic ethnic minorities and in some other areas the living condition and also the control factors Make the the equitable services become more difficult talking voice-offened about EPI program immunization We have very high coverage of vaccination in the country in more than 90% even more than 95% in urban area, but in some district the remote area difficult to reach even The the coverage not still low lower than 90% or you provide Martin and and China services to ensure that we eliminate Neonathan tetanus, but still some areas in hospital for the tetanus This you know, we are working closely with me in the set to develop a good mechanism. Good acting action plan how to Provide services to the remote area, but it's a big challenge for us Even have a good policy, but actually in reality it's been a lot of difficult difficulty to to ensure that equity in in healthcare in future and The third about the political commitment Vietnam may be the only country in the world not so many countries do and have very strong political system From central level to that now to village level. We have a party. We have a government authorities at all level and And even yet because in the past with the war with many different Things and when country when the ramen Mobilize the whole political system. We achieve something Even in very deep different area the different time doing the war with France and even in China Chinese US for many others, but when we government mobilized come home community Whole whole society you can mobilize whole resources the same for Infectious diseases for each one for the sauce for even for and that and when the government Mobile at home political system everybody everyone every organization involved in this process and it's been that we mobilize the whole politically for all Community participation and we are cheap our Objectives and Vietnam is most the first country to want to announce that we control successfully sauce and Now in that event friends are and our other epidemics and sometimes someone told me that It seemed that we now have some polygon button if the the policy maker Press a button and some whole system in be mobilized and you learn from the past and then now If something happened the prime minister always issue Announcement that we Mobilize the whole political system to against cholera to against thank you to against a handful of money It is and that that will lesson you learn that political system And commitment play very important role even now Russell level in common level. We have the in every comments They have so-called committee There are see a committee to prevent Infectious diseases or to prevent emerging emerging infectious disease or see committee for primary health care that committee including different sectors In close sectional sectors in that committee and when something happen They have meeting and they discuss how to solve this issue. This is the whole committee Mobile eyes for action. I think that lesson we learned that very important You cannot do our own from technical point of view, but we have to To ask people to you to our way that that there is tea that they work that they need they should of themselves and about the CDNN and CD communication disease and unknown conditions as you said is separately Vietnam so far now the fight very funny. I think it's system As you know it's intact by not only primitive medicine system, but by guilty care system by hospitans and therefore in last 10 years we receive support from the bridge over others and That taking care by guilty care system and the focus mainly on treatment of MCD of Adioscope as vascular cancer and diabetes but very little to be to be bad on How to do intervention or prevention at computer level how to reduce the risk of NCD is more important and even our and she do National and she do hygiene AP demology We have that both duty duty to control CD and control and CD But we have very limited very limited I think capacity on this area because in Japan we focus mainly our effort to CD But now actually emerging and increasing we start to increase our capacity to deal with entity by starting to do some committee-based surveillance program doing to matter the mortality mobility of NCD at community to measure the risk for NCD and to do some small intervention to reduce the risk for NCD and Very important that how to work together to this to this system system And they think that we have to make use our system for completing reason for infectious diseases and now for NCD together. We use the same staff see approach of a surveillance system and we have to ask them just to provide some some capacity to NCD surveillance and to increase capacity to do a risk assessment and to do intervention to reduce the risk and as I said to you that we should Use our existing system. You cannot create other system But the same system same staff but to just provide technical support and supervision and capacity to do their work better Thank you. We're getting close to the end Dr. Orr, I'd like you to offer your responses on these and then I'm afraid we're going to have to close In order to move to our next panel. I apologize to Greg and Patty for prayer for Truncating things, but Dr. Orr, could you offer your thoughts on those issues that we put on the table? Thank you very much You hear me. I Think because time is Now so I just want to compliment what I would collect from Vietnam or they respond to some of your questions One of the questions come up about how to engage our development partner in the health security. I think this is a Difficult area that we are dealing especially As I'm the director of international cooperation of them this year. Well, it's a lot of headache every day I have to say that and I actually may know that we've been the Cambodian government we have the system on how we engage with our Development partner in order to assist the country as you may recall that after liberation in 1979 from the genocide regime which one of the survival from that regime We try at that time to call for the support to rebuild our country and at that time whatever support that our Partner can provide it. We just accept it but since the evolution of the country especially the development of the country with the free economic open so We have to think on how we are putting especially the Engage with our partner to abide by our Priority rather than doing whatever they do. I have to say that. Yeah, so that's why we have at the government level we have the government development partner forum which lead by our prime minister and below that we have the 19 Technic overking group in each line ministry and in the health sector we have the technical working group for health which is the forum is the platform for the Discussing the Priority as well as the health issue in the country including monitor the progress of the agree work plan at the country level in that it come to the engagement day-to-day inform of Looking at what are together what are the Priority that we need to tackle in the health sector and of course When we start the country When the people just most of the survival from the genocide regime Most of them it's exposed to the Disease easily, so that's why at that time we try to really help them in order to cure and prevent the transmission of disease but later on when the economic growth and Changing lifestyle including the change the eating habit of the people especially for the young generation now The non-communicable disease now become apparent. So that's why I come to one of the question why Idea and CD it's quite different. It's not coming together But now we have to think how can we put this package together? So that's why they are in the process of looking at how we can integrate the ncd Care and prevention into the healthcare services But it's before we have only in the health system like at the health center at the referral hospital or the national hospital pretty much oriented on the HIV TB malaria and other in future disease like diarrhea and a Or something like that But now we have to think about how can we do for this? And I hope that in the future with the effort and support technically from WHO and financially from our partner we have the a lot of her partner working in Cambodia now and I hope yes ID and CDC also will Continue to support then we see how can we do for this? Thank you. Thank you very much. Please join me in thanking our panelists


Like how the huss drop loop down. They didn't used to do that if you all are done trading we need to save the world I'm just joking.  Oh Whoops. Yay Thank you for the brick Brickaroonie sub testicle brick. Oh and pony sub. I am just dropping the ball The name of that channel was Vincent Vega Let me get the spelling on it. That was a long time ago, too. I'm just like what? There is Vincent Vega. I got it. I Gotta give you the sub man. I'm sorry. I am dropping the ball twitch.tv Slice Vincent Vega He's live Twist now only alerts you when you're active when a streamer goes live. No more duplicate alerts. Well, thanks, tWitch All right, get the subscription. Give to a viewer. Hey, I'm pony Oh, hey, I'm pony There's only one a on pony twitch.  Oh man, I almost did that again I just be like almost running over everybody's stuff y'all over here having the trade convention Take care of a great stream by chat. Have a good time. All right, man. See you later.  Yeah, I'm taking notes I'm taking notes. I'm watching Hey, I'm pony. I am now full of health love Hey, my last batch of freshly baked bits. Oh, they taste so fresh and bitty Thank you so much. Hey, I'm pony for the freshly baked bits Everybody's showing the love of chat before I get over this back you the hug It's a weird streamer and twitchy smacks people with hugs Thanks for the best man. Appreciate it. Yeah, the cameras. All right. I like it. Oh Oh, okay, no to self do not use the hammer jump close to a cliff Oh, I almost just jumped right off People usually use those floors under these stairs like that. I'm putting the smack down right now Floors on the stairs like what we mean what under here they use the use the floor launcher. Oh Okay, it's good idea to keep bumping their heads Think I'm tired of trading now Yeah, they just did they are They are really It's really helping me though because Those herbs are Priceless So why are they getting rid of them? That confuses me. They just don't use them. I guess they don't use trap I guess they won bolts for bullets Yeah Because they have they have their gun level without thinking about it Why won't they implement the trade system already like just give us a trade window? So people can stop scamming There's so much scamming going on. I'll trade you this for this. Yeah, they drop theirs first They pick it up and then leave the game.  I'm sorry my internet's cutting out I'll try to connect again. I think it's your invite. I think it's your invite. I think it's your invite And I think it's your invite And they just Sit back and giggle as they get away with a scam Yeah, that used to happen all the time at Diablo 2. You're right. Why he just picked that bear up and Suplex them. All right, these guys just sitting back Trading during the fight. I'm gonna go over here and smell the roses Sit on top of my my my wonderful wife's beautiful base. I'm just gonna watch Since y'all want to trade during the fight This is not annoying me at all chat. Not annoying me at all. Oh Geo, what's going on with the wild thing are people not able to get in? Is it I mean aren't they usually hit don't they have usually have good launches I thought wow had perfect launches Like absolutely like They never have a problem ever with anything Especially with new thing Are they like the beacon of shining hope for MMOs Like every emotion really just just shut down right now Give you a hard time. I am repairing this beautiful base. It's so loverly Hamilton Perfection this guy just plugged the stream by the way Zip zips about bop adieu foot by the spray What's in the box 77 gold 100 tickets I should have enough for me. I'm mini llama now No, 420 out of 500 Not a mini long my road trip. I might mean What is wrong with them? Oh my goodness in Spanish Yes, ma'am All right, so the last leg meant the last leg meant the last segment of The Plankerton quest that I'm on is called sound off Help recruits learn advanced storm atlas techniques by completing fight the storm mission in a 34 plus zone and Complete a category 2 fight the storm mission in a 34 zone So I'll do a normal fight the zone fight the storm and in a category 2 separately apparently Because I think I was thinking I could just do a category 2 and it'll cover both But it probably won't it probably won't Discourage it's not going fast enough I hate to play more. I don't have time. I Just don't have time. I have no time Spent my entire day off doing work I'll have enough time to get it. I'm kind of happy with making progress though Like didn't I want to get out of Plankerton like fast I'm like barely halfway through it. I don't know if y'all know y'all this this this takes a long time Like this is this is quite a bit of gameplay people's like saying There's not a lot. This takes a while This this all this takes a long time and that's just Plankerton I've gotten to the other places the other two zones and then there's a horde mode, which is ridiculous That's a whole the whole nother grind You're grinding for tickets and you know Gold and all these events. Yeah, exactly all these all these distractions That pop up they they there's just no shortage of content So all these people wondering if they neglected this part of the game.  There's another there's another something that needs our help. He just keeps bugging you about that nonsense There it is nearby camp nearby celibate. These are Just keep saying that man. Oh Every time he come a commander This is it's very lot if don't buy a fallout for for base building. No If you're gonna buy it for something don't buy for that because that's that's a very light part of it Fallout 76 looks like they're gonna try to build upon that pun intended But right now fallout 4 is not that There's some mods to make it better though I know there's some mods to increase the limits what you can place and the sizes and stuff Yeah, I don't remember a base building Like at all on there.  It wasn't bad Another settlement needs your help.  All right, let's go I'm trying not to stop trying to push on I'm getting discouraged What am I doing? We're doing I'll fight the storm in a 34 plus zone fight the storm is which one That one, okay. It's the one with one of us on there. I got it 234 oh that 34 didn't have a thing on it. There's a half. Can it go higher? Yeah, it says minimum 34 I can go higher. Yeah, I Mean I think that's all I have though. I don't have Anything higher than 34 for a fight the storm. I got a couple of yellows out here 40s, but none of them are fighting or up there. That's why I just look There's a couple here, but they're not fight the storm they're delivered the bomb and ride the lightning There's another bomb over there. So I mean we could do these. There's a There's a couple over here It wasn't there a V bucks that you just passed I seen that bottom right-hand side, I Don't know like what There was like a V bucks For fight the storm when I said you just passed it. I think Down below go down a little bit and the same area at the same area there Build a shelter. Was it real to shelter one? prepare a shelter Didn't have V bucks There's one to the right. Oh, this one is 30 bucks. Okay. Okay, so it is repair the shelter. Okay We did a that was think first Okay, roses are red snails eat kelp another settlement. He's your help So you took that from a mean? didn't yeah didn't yeah This guy's got wukong That guy's got the mythic guy from last week I've got a little inky-dinky Outlander, okay? Okay, I've never seen one those that was that wasn't lovable. You must be feeling me I'm struggling. I'm like It's like farming for something. It's just you get like one little thing. I can't hear you. Oh Yeah, yeah, I feel you I feel you plus I want to play monster on her That's pretty sad That's why I'm feeling I'm free. I'm itching like it's like my legs are twitching right now It's pretty awful It's just I don't have time to do all this I got time like it's like I have no time This is time. I could be spent playing monster hunter. That's the thing. I want to play both. I won't play warframe, too. I Want to tomorrow, but I want to play battlefield, but I have no time.  I think most of these are already having my collection books. I'm just gonna nuke them Well, you can't put those in your collection book. Oh, they're already crafted her. You need to get rid of those some of those old stuff Oh guns Yeah, oh, why do I why do I have these that pick these up?  I got a llama. You need it. Oh Once we find this I went around the entire man. Oh, it's inside the house Yeah Leave me alone Then we're gonna rush this one. I don't need any farm. Let's just get it done. I do want this cake though Oh, no, I dropped the loot llama instead of what I wanted to really drop. Why I Didn't vote. I didn't see it pop up. I never see it pop up I just don't notice it bye Hey way to use a house Don't owe me with a toe down the whole house and then rebuilt everything Can Like I brought about it. I prefer this method. Okay, so on that side So you think stuff was stairs all around this house Like you're doing No, I'll just chill Elon Musk similar. Thanks for the follows by the way guys Elon Musk similar. What do you do? It's like a business simulator or something Is it Huh Okay, do you Not put on deodorant and become musky and become Elon Musk Musk, do you have a faint musk smell? In the game and you spread it to the joyous humans are across the world and You do something Elon Musk related you build a rocket. Is it Kerbal space program? But with a giant Elon Musk head today He didn't bother to change the assets. I don't know what I'm talking about. I'm just rambling Can we vote again or can we go out the way? Or show this guy where it's at Create your colony on Mars What because he launched a car to Mars? Somebody's got an obsession. Oh Elon Musk you are my hero.  I am upgrading your wood. This is a song of learning Yay You now have a standard pyramidal thing J Them Chicks Where they at? Oh Never mind Found them black Zabba-dabba Yeah, we did the same thing not for long Jump right over them again. Yeah, swing dodge Perry carry cherry Bye Put those cookies down No, I see you. He's going for the base I'll get him and him And him and him Leave it alone Leave that alone That's not yours Well, this is a happy guy. I'm not gonna touch him But then again, this might be a bad idea. Oh, I didn't blow up good. Oh, I wasted that I Didn't know I know oh sheep trap. I didn't mean to put that fire trap down.  It's a lot of AFK lately right during the fight, too Sometimes I see that just want to leave them like I'll start the Atlas and just want to leave Yeah, sometimes I usually just let them fail it. That's mean, but man, they shouldn't be AFK. It's so stupid So I mean it's just you don't want to carry it exactly when they're not putting up for that There's no boat kick There was there before What you can report people stop throwing stuff at people didn't mama Tina not throw in the house one minute He was a bear you are not a bear By the way, this hammer I have is in the event shop so you can buy it If you want it's like 1600 gold, which is not that much. Oh, this is open You do stairs. I was just gonna wait it out since it was over Kaboom kaboom Yeah Thanks, sweetie for the help. I appreciate it. Your sleepiness is dripping on me. I will shrug it off really Take a nap for both of us. Are you gonna play a monster on her now? Yes, I Can't play this game without you I'm hopeless Okay, although you make it a lot easier Exactly that's what you're here for I'm just joking Open the mission alert of wars. What is it doing? I gotta go save the earth They've been happy It must be like just laggy that like I said the service been laggy healthy. What did you do before streaming bono?