Welcome to American Issues, Take One. I'm Tim Apachele, your host. And for today's title, it's Next Move USA, EU to Counter Putin's Threats. October is the 60th anniversary of the Cuban Missile Crisis. The world came very close to an all out war between the United States and USSR, the Soviet Union, potentially was gonna involve the use of nuclear weapons. That didn't happen, thank God. But fast forward to 60 years later and we have the president of Russia, who not only is stable rattling, but he seems to be raising the stakes and implying that limited tactical nuclear weapons may be used in order to preserve Russia's sovereignty. His misperceived sovereignty, specifically for the four regions in Ukraine that he annexed unlawfully, Donetsk, Luhansk, Kyrgyzstan and Zaporizhia. Those four territories were formally adopted by the Russian government to say they now belong to Russia and they are Russian territory. And should any moves be to dislodge Russia from those areas may be met with severe limited tactical nukes. So that's where we are today. Vladimir Putin seems to be putting himself in a corner that he can't extract himself out of and he seems to be doing it on purpose. So with that, I'd like to introduce my guests. I'd like to introduce our special guests, Chuck Crumpton. Thank you Chuck for appearing. And of course, my co-host, Jay Fidel. Good morning gentlemen. Good morning. Yeah. Chuck, to you on this first question. As I just mentioned in the intro, Vladimir Putin seems to be raising the stakes and putting himself more and more into a corner. At what point does the United States and the European Union stop referring to it as saber-rattling and start to realize that maybe he is serious about using limited tactical nuclear weapons in Ukraine? It's a great question, Tim. I think one of the things is because there's so much in the way of political dimensions to this and political powers in there, you can't just treat the EU as one entity. You've got Hungary, Turkey, now Italy, even England with some questions about its choices and directions that didn't used to be there. So first thing I think the EU and the US have to concentrate on three things. One, stay united. Number two, stay committed for the long term. Number three, be consistent. Internally and externally. If they can do that, the message to Putin at least is he knows his enemy is a conglomerate, not divisible. Well, don't you think that Putin, don't you think Putin has already realized that? Certainly I don't think he expected the EU to coalesce around with the United States as fast as they did. And certainly to the degree of commitment that they put forth and the money. Wasn't that a miscalculation on his part to begin with? Sure, but miscalculations don't necessarily come with corrections based on factual information as we've seen in our former president continuing on now to today. He's as delusional as he always was. There's good cause to believe that Putin is no less delusional or narcissistic than our former president. So whether he sees that unified response, whether he's really going to respond to it in a way that acknowledges it as a reality that requires adjustment on his part, those are two completely different questions. Well, I guess my second part B of the question is, what is the best approach now that Putin has basically, he's annexed, again, wrongly annexed these four regions. What's now the best approach to counter Putin's threats? Is it to ignore it and to say it's Saber-Raddling or do we now get more aggressive and come in with more tactics that maybe polarize the two nations? Well, I'll defer to you folks the two things that are essential. One is have defensive strategies in place and at the ready for even the worst case plan B analysis. And number two, continue to with the EU provide extensive committed support for Ukraine's military actions, which are achieving a level of success that not only Putin, but I think most of the rest of the world did not anticipate. All right, yeah, thanks Chuck. JTU, basically the same question is, the beginning of part of this war and it continues that the United States is not giving Ukraine aggressive offensive military weapons such as jets and other offensive weapons. We're still trying to supply them with defensive apparatus. So how does the United States and the EU best now respond to Putin's annexation of the four regions in Ukraine? But more importantly, his more definitive threats of tactical weapon, tactical nuclear weapons, possibly for use. Yeah, I don't think it's a good time to give Ukraine jets that would further escalate the risk. Steady as she goes, just as Chuck says. Steady as she goes, let's not get too excited. This is international terrorism is what it is. It's like the fellow walking in with a vest full of bombs and telling you what he wants and you're supposed to react to it. And he may or may not pull the plug and blow himself up. I think part of this is Putin. I think he's losing it. And he's losing the war. He's losing his own rationality. Part of it is this whole echo chamber thing where who is he really talking to? He's not talking to you or me because I wouldn't change my approach on from what he says. I don't believe him. I think he's just stamping his feet like some seven year old with a tantrum. But he is appealing to countries and autocrats that support him anyway, or maybe that are going in that direction as you mentioned in your opening. And as Chuck mentioned, you have countries that are softer on him these days. And maybe he's playing to them. Maybe he's trying to move the needle with them so that they can speak up in his favor somehow or talk to their populations, their electorates, assuming they still have electorates and try to move right in their countries. Move toward Putin. Is he talking to the world? Is he talking to all of us? It's really interesting. Who's he talking to? I love the reference to John F. Kennedy and the Cuban Missile Crisis because he didn't back down. And he won, not backing down against the Russians. So backing down doesn't seem to be a good option because it's like, we don't pay a random amount of ransom money. It's a matter of policy. This is ransom. If we do, then it'll happen again. And I guess he had some effect the first time he mentioned nuclear weapons because now he's trying it again. And if we give him credence on this, I mean, I don't know which part of the echo chamber, if some part of the echo chamber gives him credence on this, he'll do it again. And that'll be his foreign policy. I threaten, you bend over, I threaten some more. Yeah. Let me interject something. Let me interject this. I mean, we already know that Vladimir Putin has lost face, severe face with the retreat of his armies and this disaster he calls a Ukraine invasion, where he doesn't call that, but that's what it is. Has he now set the stage for him for further embarrassment and loss of face by declaring an annexation of the four regions in Ukraine and it'll be summarily ignored by the weapons that the EU and the USA and everyone gives Ukraine to continue their advances in those four regions.  I think you have to watch the, as Chuck suggested, the playbook for Donald Trump and compare it against the playbook for Putin. And I think it has something to do with doubling down here. It has something to do with, and this is the big word, distraction, changing the subject. You know, I mean, I keep telling you, I grew up in Queens and I know the bullies from the schools and one of the issues aside from insulting everybody was you change the subject. And in fact, there are a lot of lawyers in New York that practice that way. You know, when you're down and out, when you're losing the case, change the subject in every which way. And I think it's clear that he's losing the war in Donbass and that's why he had the referendum, and the world was maybe distracted by the referendum. And now the referendum has been called out as a sham. So he wants to change the subject yet again. So let's bring back the nuclear card. They make, they should make a board game you know, like Monopoly, with all these things that keep repeating themselves, and the distraction card, the nuclear card, you know, the phony referendum card, it'll be a very popular board game. It won't sell in Russia, I'm telling you now. In any event, I think that's what he's doing. And I don't think he's looking to consequences that we would look to because before you get to those consequences, there'll be more distraction. There'll be more doubling down. There'll be more lying. Russians are leaving the country by hundreds of thousands. He's got to change the subject, or he'll be so stark how he is losing. He's really desperate. Look at every direction. Well, and that's the point. I mean, he is desperate, and doesn't that ought to give us pause and concern that a desperate despot has the ability to deploy tactical nuclear weapons in Ukraine? Well, there are two things that have got to be on his mission list. You know, one is to expand the USSR, or back to the USSR. That's not working, but that's what he wants to do. And the question is whether any of this helps him do that. I doubt it does. The other is the personal agenda, you know, to save his job, to save his reputation. What have you? And blowing up nuclear weapons is not gonna do that. That'd be the answer. Okay. That's not gonna help him at all. In fact, it's gonna, you know, at the end, you said, Chuck, that we should be ready with our own counter-offensive. We are. I guarantee you that. You know, I could not be more affirmative in guaranteeing you that. So that if he does this, we're gonna be escalating. The U.S. is gonna be escalating. Maybe some of the stronger countries in NATO will be escalating. And Putin can't win that. He's a super pariah, even with the Chinese and the Indians and some of the countries in sub-Saharan Africa and Latin America. All the despots are gonna leave his side. They can't possibly support him on that. So he destroys himself. He knows this.  He may be illusional. What did you call it, Chuck?  Yeah. That's a fact.  Chuck, you know, through all the sanctions, they've had limited success against Russia. But it seems to me that the call-up of 300,000 potential new recruits has struck more of a discord of disharmony, if you will, with the Russian people than ever any of the sanctions have as far as creating a concern of the Russian people. What new tactics should the United States deploy other than the same old sanctions of individuals or their banking accounts or their ability to conduct a swift account transfer? What more effective devastating sanctions can the United States and the EU come up with that will really put Vladimir Putin back on his heels? Well, when you look at Putin's so-called mobilization, at least up to this point in time, it appears that more people have left Russia to avoid it than who have been recruited into it. And you see photography of those who are recruited into it. And there are bowling leagues with people in much better shape than that. So, and they know that they're being sacrificed. So this is high risk, but you have to remember there are three strategies involved here. The initial strategy, the Blitzkrieg, which wasn't a Blitzkrieg and wasn't effective. It was slow plotting and unsuccessful. And in the end, essentially reversed. Now strategy number two, which is, I've got four areas that we're going to take. He gained probably a lot of confidence with the successful annexation of Crimea years ago and thought he could pull that again, maybe on Ukraine as a country. Clearly that's not the case. Can he do it with all or any of these four areas? Strategically, everybody knows ultimately there's going to be a bargaining. Putin's digging in for the four areas to the extent he can or as much of that as he can get. President Zelensky is digging in saying, you don't get any of it. So we've got the lines drawn. And that's getting a lot more attention and a lot more infusion of effort from both sides than the verbal references to possible all weapons. Okay, we'll thread it nuclear. Let me go in a different direction on this. We have countries still supporting Russia through purchases of either energy products or other products. They're basically propping up the ruble and they're helping Russia skirt around a lot of these sanctions. China comes to mind, India comes to mind. South African nations come to mind. Should the United States or the EU start exerting a lot more pressure on those nations than we previously have? Chuck? Probably not unless and until we need to. Because I'm sure that the US intelligence which is one of our stronger concerted efforts and forces has determined the impact on the Russian economy. In addition to that, when you impose a threatened mobilization of people who are clearly unqualified and unwilling for military service at the same time, you've got a double whammy effect going on there. So he may be losing support both economically as well as politically and in terms of popularity and in the population of Russia. So if you look at China, India, even the EU, there are some continuing purchases of Russian fuel products and energy products, but the support for Russia militarily and politically have not come. You don't hear China or India. And certainly not any of the EU nations saying he's doing the right thing, we support him, we will be there to back him up.  Okay. So look at what's missing from the places where he needs that support. Okay, thank you. Jay, I'm gonna kind of stick with the same question with you and that is, should the United States and EU countries start tamping down the screws on those countries, whether they broadcast it or not, that are still assisting Russia, either less than the sanctions or completely get around the sanctions? Should we start looking at them and start saying, you're part of the problem? The sanctions are not working as intended because you still and are continuing to support Russia's and their economy through purchases. What should the United States do about ratcheting up sanctions with those countries? Or should they? I think all the factors point to the larger phenomenon here and that is that he's falling on his own sword. And that if we wait a little longer with the combination of the sanctions we have now and his pariah status in the world, that word is gonna get out on the war crimes. It is getting out, you hear more and more about that. And we at Think Tech, we hear more and more about that. It's everywhere, the talk of the war crimes. This is not good for him. And people in Russia, leaving Russia, all these things are resulting in the loss of status influence and so forth in the world community. However, the question is, what else can we do? Because the sanctions are, they're not immediate, they're intermediate and they may not have the effect that we hoped for, we in Europe hoped for at the inception of this thing. So if we wanted to turn up the jets for one thing, we would find ways to deliver energy even in the winter, especially in the winter. To countries where the people are screaming for energy, they're gonna get cold and soon, a matter of weeks, a crunch there. And so, the problem with liquid natural gas is that we have it, we have gobs of it, they don't have receiving infrastructure, say in Germany and the countries around Germany. If we could somehow accelerate that, that would help because you wouldn't have him undermining, national resolve in some of these countries. But the other thing is, and I really take your point about trying to put some influence on the countries that are soft on him.  You can have somebody from our State Department talk to somebody from their State Department say, you know, this is gonna be over not too long and the US is gonna be in the cat bird on this and Putin's gonna be in the doghouse and who do you wanna invest with?  How about a little kukua here? And I think in some countries that would work swell. In other countries, you have to move maybe more aggressively. In some countries, you know, make a deal, make a deal for energy, make a deal for food, make it transactional. And you could ply them away from Russia. I think India is a good example of that. India is not wedded to Russia. And, you know, India has a soft spot for the United States, it always did, despite Modi's attitudes, which I don't favor. And so, you know, I think there are various solutions with various countries and a nuanced approach by the State Department could put the heat on not all at the same time, not all in the same way, but they could turn the jets tighter, harder, hotter for Putin that way. And I think in the long term, if they're not doing that already, that's exactly what they should do. So is this a wait-and-see game? Cause you, like someone said, I think it was you, Jay, he's already falling on his own sword. So is this a wait-and-see game or no, we don't have time to wait anymore? Putin's ratcheting up the demands and the threats. So now's the time to get these nations like India or China or whatever. Now is the time to use that ratchet effect rather than later. This whole thing is asymmetric. It's asymmetric on his part. You know, like for example, where he does hacking in a given country is softening them up, you know? He's working on every level he can. He's working on trying to get the, you know, the government here in the United States to go soft on him. And we can talk about that tomorrow. But, you know, bottom line is it's asymmetric on his part and it should certainly be asymmetric on our part. That's the nature of war today. So yes, I think he's falling on his own sword. Yes, you know, the combination of things including his own mistakes are hurting him, you know, in very profound ways. But that doesn't mean we should sit and wait. It means we should try other things in a soft, modulated way, perhaps in a smart power, soft power approach, country by country, a political official by political official. We should always keep on moving and we should make it just as asymmetric as he is. Okay, there you go. You missed your opportunity to work for the State Department, by the way. I like your tactics. Chuck, winter is coming in. It's October, when winter is coming soon to Eastern Europe. Do things slow down? And all winter campaigns kind of basically come to a trickling halt. With that halt, we probably won't have any more Ukraine announcements of achievements and captured territory that Russia once held. So lack of really great news, because winter's here and everyone's hunkering down. How does the resolve go? How does the resolve from the United States and the EU during the winter months stay the same, only increase with more funding or does that wane? It's a great question. I would not underestimate President Zelensky and Ukraine, their momentum and their initiative and their dedication. And think of the Green Bay Packers and the frozen tundra. If they get on that turf at the end of the pro football season, they're really hard to beat. They're gonna press that advantage. So you don't think winter, at all, blunts, Ukrainians advanced? Sorry? You don't think necessarily winter, the winter weather will blunt, Ukrainians advance into these four regions that Russia now says is theirs. The weather certainly has the impact to make a difference, but whether it shifts the momentum away from Ukraine toward Russia or toward a stalemate, I wouldn't assume that. The other thing to remember is that Putin's delusions and miscalculations and poor strategies have probably done more for Joe Biden and the Democrats than they possibly could have or anyone possibly could have. His foreign policy is essentially so sacrosanct that he's gotten everything he's asked for the Ukrainian military support in the billions and billions of dollars. And that appears to continue to be the case. So I wouldn't underestimate that either. Will that make a difference in a month? It may or may not. I am not sure why the Democrats are not pressing that foreign policy, foreign strategy advantage that they clearly have, but it's there. I mean, it seems like it seems on an overall basis the nation still and does support the support of Ukraine. And that's a good question you bring to the tables. Why hasn't the Biden administration kind of taken advantage of that popularity? Okay, we're all almost out of time, but I have to ask this question, Jay, to you. What are your predictions for the Ukraine conflict? This war that was created by Vladimir Putin for no reason, but other than his own ego and illusions of grandeur. What's your prediction in the next six months? 12 months? You know, a few days ago, can't remember the channel, might have been BBC, but they had Mrs. Zelensky on for an interview. That was actually 60 minutes. Yeah, thank you. And my goodness, if you saw that, it would make your heart run fast. She was not only an extraordinary, classy, classy woman. She was so smart, so focused, so with her husband. I mean, if you gauge a man's success in the world by how well his wife supports him, this was an example of a wife who supports her husband. If somehow it was easier to understand Zelensky seeing this interview and seeing her comment on things. She was unrestrained. She was completely informed. She was brilliant and she was a great communicator. I think she was part of his TV team. What he was doing and she was, yes. I think she was the writer. Okay, talking about a fantastic woman. Okay, then fast forward to all of these battlefield commanders. And it's not just one person. It's not just one PR trained spokesman for the Ukrainian army. It's one after the other over and over different people. An assortment, an unending random supply of battlefield commanders talking about their state of mind and what they see happening and how they deal with their own success or maybe their own aspirations. And you say, gee, where do they get these guys? These are really classy guys. They're intelligent, they're informed, they're thoughtful, they're reasonable. And then you talk to the people who, we talked to on Think Deck. You talk to the people, for example, with Project Expedite Justice in Kiev just a few days ago, a fellow named Dmitry Kovale. This guy was brilliant. He was an academician. I don't know the subject of his academic studies, but he was a PhD or a PhD candidate. And he decided he was gonna help the Ukrainian people. So he joined an organization that was helping them. And he consults, he said, with the Ukrainian government. Very classy, very classy. And it's one after the other like that. I mean, we are finding the smartest, most reasonable, thoughtful, careful, tactical people. And it was not just, he was just not just waving a flag. He was telling, he was answering our questions in the most thoughtful way. And I said to myself, gee, you get a whole sample of these Ukrainians looking into the future, trying to figure out where they are, what they need to do, comparing their own abilities against the Russian abilities, comparing their own governmental solidarity with the Russian lack of solidarity. And you say that in the end, Ukraine really has some talent and they have some integrity, even as regards the battlefield, the madness of battlefield operation. So when I come to this, you have to judge the future on how strong these people are. They are very strong. And assuming for a moment, and I'll go along with for this discussion with Chuck's optimism that the United States will continue to support them. And we can discuss that more tomorrow, but assuming the United States keep supporting them at the same level, nothing fancy, no fighter jets, just these good missiles. I think that in the end, the people in Russia will not support him. They will leave the country. They will take the risk of going to jail. There are hundreds of thousands or even over a million people in jail now and he's arrested. He's breaking his own political back. He's a pariah not only in the global sense, but in his own country. This is not a good thing for him. And I think that he's not gonna use nuclear weapons. That's just me. Me and John F. Kennedy, the two of us, somebody comes out of the wings now and says, J, whatever you are, you're no JFK. But I happen to agree with JFK. So I think the Ukrainians really are going to have the edge because it's a moral, ultimately a moral question. And ultimately it's a question of whether autocrats can prevail. And if we find in the world today that autocrats can prevail, if that's where the world's growing well, the Ukrainians have a hard time. But assuming that they're either stable, not moving further to the right in any great degree, I think the Ukrainians will prevail and they will have their country. All right. I don't know anyone would say that eight months ago, but your prediction is a good one and I hope it comes true. Chuck, same question to you. Your prediction is what we may see in the next six months, 12 months in the Ukraine war. Well, clearly Putin has not learned the Vietnam lesson, which is if you take on people to try and displace them from their homeland, they will outlive you, they will outlast you.  They are in for the interminably long haul. Putin cannot afford to be, he's already reaching into unqualified and resistant people in his own country to be able to feed them into that conflict. Those days have to be numbered. I agree with Jay. All right. Thank you for your predictions. We've run out of time. I'd like to thank my special extraordinary guests, Chuck Crumpton, and of course my extra special, extraordinary co-host, Jay Fidel. Won't you join us next week for American Issues Take One? I'm Tim Appichelle, your host. And don't forget to tune in tomorrow for American Issues Take Two with Jay Fidel. And until then, much aloha to all of you. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter, and LinkedIn, and donate to us at thinktechhawaii.com. Mahalo.


Welcome to JSA TV, the newsroom for tech and telecom professionals. I'm Jamie Scott-Okitaya of JSA here at the Channel Partners Evolution Conference in the Chorus Communications Lounge. Joining me today, John Young, he's the EVP of Net Fortress. John, welcome to JSA TV. Thank you. Pleasure to be here. It's an honor to have you and for our viewers who might not already know, tell us a little bit about Net Fortress. Net Fortress is a communications company. In the end, we start with voice, data, network, security, and we can serve all customers. So we provide customers the ability to scale their business, to run their business efficiently, and to know that they have a provider that stands behind them. Wonderful. And so specifically, what services are you known for that makes you sort of the provider of choice, especially for partners? We're known for voice and data primarily. Our UCAS product is a proprietary product that we have. Our network, our nationwide network that we have is a private network. We're also known for our security, our Wi-Fi analytics, but also our broadband aggregation. We have a lot of customers that span across all of those products. And I've been hearing a lot about your security products. Definitely a buzz here on the floor at Channel Partners. So what customer verticals would really be interested in your offerings? You know, it's an interesting thing about our products and services. We don't have to specialize in a specific vertical. We can serve all customers of all industries based on the pain points and the needs. And that's one of the things that makes us unique is we don't have to specialize in a specific vertical to serve the customers. And that gives us a really wide offering to most everyone. If you have a phone system, if you have data needs, we can serve you. And I imagine that that's pretty appealing for Channel Partners here on the floor who are looking for a program that would fit for them. Any other key differentiators between your Channel Partner program and others? Our deployment styles. There's nothing that closes the door for our partners and customers. I like to say that we're an open door company because if a customer has a contract with a specific product, we can offer them another one. And if they're in a contract for that, we can go to the next product. Whether it's voice, they're in a contract for voice. We can go to their data. If they're in a contract for data, we can look at backups. We can look at managed Wi-Fi, managed security. So really we give the customer and the partner no more excuses. They have to basically push us out because we can provide many different things and we do it very well. Love that, love that. So John, looking into your crystal ball, what do you see in store for Net Fortress in 2019? I see us growing the channel tremendously. We're already making a big investment in growing our channel organization, our channel program, our channel resources. Our company's focused on building partnerships. We're also focused on building our product sets. We have a lot of engineering and product going on right now that will allow us to scale our product and to grow in 2019. We're looking forward to it, very excited. We're looking forward to all your news and growth ahead and we're definitely going to be watching the Net Fortress train as it speeds on along. Thank you so much, John, for joining us and thank you viewers for tuning in to JSA TV. Happy networking.


Hi everyone Joe for jazby's case breaks calm coming at you with 21 22 panini elite basketball Six box half case pick your team number 15 all-card chip and Number 15 and 16 are from the same case Right here and break 16 is already up Grab your teams. We can run this back tonight jazby's case breaks calm All right, so big thanks to everybody here on Thursday 24th for getting into it Andrew with the Milwaukee Bucks last bot mojo. Thanks to him And everyone else for getting into this break. We did this straight up no fillers straight no fillers And I was originally saying after break 16. We don't have any more cases, but Nick jazby was some sort of warlock and Conjured up another case of elite basketball So we do have one more case after this case. All right, so we've got six Block of six on the left side and another six boxes on the right side. We're gonna select a die We're gonna select that one right the the Bellagio B on there 123 for the left side four five six for the right side and it's five one two three four five six We're gonna do the right side here And this side we're gonna save for break For picker team 16, which again is currently on the website right now to ask these case breaks calm Save those for next time here is what we're doing this time. All right. Thanks everybody We got we got MBA back in action after their all-star break. We've got I think Celtics at Nets I think the Celtics went to the all-star break They were a little a little a little down this season, but they finished they went to the all-star break strong They're looking to keep that momentum going is Ben Simmons playing today For the Nets, I actually have only been sort of half-hanging attention to this game but it's good to have The MBA back No, Simmons is not in Steve Burke is saying. Let's see what's happening in the world of basketball today I know the TNT game is Celtics at Nets Celtics up 1510 in the middle of the first quarter with a About 543 left in the first half Cavs up 48 41 on the pistons. Let's see what's happening here Evan Mobley just only a couple points for him on Free throws rebound Jared Allen already has six rebounds Rondo with five assists Cade Cunningham eight points already First half a couple rebounds and an assist could be a nice 20-point 20-point game for him See how it all ends up Good luck everybody pick your team 15 box one. We got Jeff Malone impact impressions autograph is our first Auto out of the gate that'll be for Corey and the Washington Wizards Formerly the Bullets and we'll do an autograph recap at the end of the At the end of the break as well So if you're replaying the video and if you don't want to watch the whole thing you can Fast forward all the way to towards the end and there's Scotty Lewis Charlotte Hornets 369 out of 999. That's for Danny and Charlotte There's a power form in this Nicola Jokic 17 out of 99. That'll be for Denver. That's gonna go to Leo Nasri 46 out of 49 and Redemption anyone all want to make a guess on the redemption for bragging rights And all a card ship of course I Got Devon the cell 60 out of 99 and 714 out of 999 Jason Preston for the Clippers rookie card for Evan Hollywood guessing Barclay. Let's check the checklist for which edition of Barclay if that's the case is your redemption Steve Bertz saying earlier that he finally got a Barclay auto All right The redemption is Scotty Barnes, there you go Matt Jen. Please finally a Scotty Barnes pen pal He was saying just a moment ago. You spoke it into existence That's for Matt Jen Toronto Raptors. All right, so there you go Matt Jen next box. You're welcome, man Finally happened. What other games are on tonight after this? I think the late TNT game is gonna be Warriors yeah warriors at trailblazers Half of other games going on today Hawks at Bulls and about should be tipping off soon Grizzlies Timberwolves tipping off soon sons at Thunder tipping off soon And then Warriors Blazers are the late TNT game and then another late game Not on national television nuggets at kinks a little piece of the An elite card when they're cutting there There's Jericho Sims 471 at a 999 for the New York Knicks That's gonna be for Shang in the Knicks Yes speak into existence Joe P That's what Matt Jen just did This might be one of those magical days There's Isaiah Stewart die cut To 72 for the pistons. That's gonna be for Danny and we've got a Mario Chalmers. Remember him That's kind of hard to see the number right there, but 24 out of 35 Printed the silver number against the silver background That's for Jonathan and the heat We had a Quentin Grimes 41 out of 94 Die cut rookie die cut for Shang and the Knicks 20 out of 99 Deandre Aiden Joe P and his sons and the rookie yearbook autograph Joshua Primo for the San Antonio spurs That'll be for Corey and San Antonio and Markel folds right there All right next box wrong spur. I'll take it. Yeah a hit better than no hits Oh, no, yeah, I didn't I missed your comment before I'll take a Duncan or Parker auto and not greedy or picky, but Another spur you spoke of spurs auto into existence Yeah, I think it's been a minute or two. Are they are those two even on the checklist? Cobra Cora you should check actually I think I have the checklist up no Tim Duncan autographs And but there is a Tony Parker autograph That's a possibility. He's got a turn of the century signature And we got a trade Murphy the third 842 out of 999 rookie card for the Palikins all rookie cards are numbered You're not gonna find a non numbered rookie card. I think that's how they designed the checklist That's 69 out of 99 Chuma O'Keeke Orlando magic Jason Price and we got a Sean Kemp autograph impact impressions auto. It'll be for Dusty And we got a Charles Basie bassie Basie 163 out of 999 wasn't that the name of the the last name of the Woman who sung a lot of the Bond James Bond theme song Shirley Basie made Well the bond themes in the couple of few bond themes in the early days, and we got Shay Gildes Alexander 77 out of 98 die cut for Okay, see dusty and behind Lamello is Greg Brown the third For the trailblazers that's gonna be for Corey and Portland. All right. We are halfway through this half-case break Next box Do I know who the first on-screen bond is I'm assuming you're asking me because it's the answer. It's not Sean Connery George so George Lazenby was the silhouette in the gun barrel sequence at the beginning and like dr. No or whatever Right. Yeah, he was he was a he was a one-and-done Right George Lazenby He was in on her majesty's secret service Or is that sort was he in something else? all right Next box and the autograph popping early Trey man Okay, see That's gonna be for Dusty in the Thunder got Rudy go bare 59 out of 73 Die cut for the jazz Jonathan Hollywood with that one. I feel like have we spelled this out? I feel like we've seen a few of those spellbound card for Chris Paul and we've got a rookie card Keon Johnson 762 out of 999 For Evan Jones and the clip show and we've got a Charles Oakley autograph bulls edition five out of 49 That's Leo with the Chicago Bulls And we got a Jericho Sims for the Knicks That's 140 out of 210 That's for shang in the New York Knicks Yeah, Charles Oakley in a bulls uniform kind of threw me a little bit. He should be a Nick, right? There's Luca Donchich to 49 It'll go to Dallas that'll be for Jeffrey and Two more boxes to go Have Charles Oakley and the Knicks have they made up? I know he wasn't like a couple years ago or something like that There is like Disagreements with with the owner don't know. I'm good. Are you out? All right. See you Chris. Have a good one Thank you. See you next week Boston's up 38 24 Cavs up 55 52 at the half Hawks at Bulls just started bulls up 11 for early And then Grizzlies at Timberwolves just started there up 11 7 early Sons at Thunder, they're up 12 8 6 minutes into the quarter Cory's still trying to speak some more auto into existence. Let's see Good luck. Good luck everybody. That's out of 10. I like the The gold in the lettering there looks really cool. That goes to Joe P in the Suns out of 10 You know, all you have to do is find the out of 10 P a and L You've got the set And we've got Jeremiah Robinson Earl 24 out of 25 pen pals autograph For Dusty and the Oklahoma City Thunder, there's JT Thor 124 out of 999 Danny with Charlotte and a 2 out of 10 at Jeremiah Robinson Earl Nice little number. You can see that see the gold background instead of the usual orange. That looks pretty sharp It's for Dusty spellbound LeBron It kind of does look like a super factor. I for a second I thought I was gonna see a one-of-one there, but No, I did not see the one-of-one script. They were just the two out of ten numbers Almost got me There is turn of the century autograph Hito Turglou That is 44 out of 149 for the Sacramento Kings that goes to Arthur King and the Kings 23 out of 35 Cameron Payne Hip rates all that nice And the filler too. All right final box coming up both nice Good good good. So that's coming up soon All right final box pick your team 15. Good luck. 16 is already in the store Jasper's case breaks comm is a good chance that we might be able to run that back To a night. All right, and here is a nice Davion Mitchell 163 out of 210 for Arthur King and the Kings like that top-loader There you go Arthur King and the Kings. I've got old Mark Eaton impact impressions For the Utah Jazz Jonathan with the Jazz All right, he mark eating right didn't we talk about this the other day? Thank you It was a a cycling accident Accident, I don't know or maybe it wasn't an accident And either way RIP We got another Jericho Sims to 99 and we've got a James Harden dimensions short printed card 3d card or lenticular or whatever you want to call it and We've got a rookie yearbook autograph Moses moody That's going to be for Leo and the Golden State Warriors last little bit here to what else we have here We've got Theo Maladon 70 out of 99. I Know I feel like we can almost build a Jericho Sims rainbow. It's a lot of his numbered cards Bama to bio carousel avert and that my friends is that pick your team 15 in the books Thanks for watching. Thanks for breaking with us quick little autograph recap and short print recap That out of town. Yeah, it doesn't kind of super factory, but it's just out of ten still nice We've got the Some nice pen pals autographs and rookie yearbooks autos All right, that's cool. Sean camp autograph. We've got that Scotty Barnes Redemption That's Jeff Malone right there. Thanks everybody. I'm Joe for jasmies case breaks calm I'll see you next time for the next elite break. Bye. Bye


And now without further ado, I'm going to hand it over to a very close friend and mentor, Elias Serhouni, who's going to lead a discussion with the current director of the NIH, Francis Collins and former FDA commissioner, Peggy Hamburg. And before I hand it over to Elias, I'll introduce you. Elias is one of the most multi-dimensional leaders that exists in our industry, having assumed top leadership positions in academia, government and industry. Elias was the executive vice dean at Johns Hopkins. I said that correctly. Elias, you have funny stories about that pronunciation I know. Elias was the director of the NIH under George Bush and Elias was an R&D head at Sanofi Pharmaceuticals for almost a decade. And Elias, if you read through all of your, the Wikipedia sites and all of the online sites, your CV, there's one thing that doesn't show up and that's the mentorship and the teaching that you provided to so many of us. And I was the great beneficiary of your mentorship for several years. And I say that for two reasons. One is to thank you for everything that you did for me and for the many individuals for whom you mentored. And secondly, I'll harken back to the first fireside chat that we have between Albert Borla and Stelius Papadopoulos, in which Albert acknowledged Stelius as one of his mentors and mentioned that Stelius cooks dinner for him all the time. So I'll leave that up in the air, what I'm getting at. Without further ado, Elias, I'll hand it over to you. Well, thank you, Andy, for your kind introduction. Actually, I'm getting better and better at cooking since I have more. And my wife doesn't want to cook anymore as much as she did before. So next time I'll treat you all with my own cooking. But let me first thank Peggy and Francis for agreeing to share your experience and views here at the US India Chamber of Commerce Forum. The session will essentially be about lessons you learn during this pandemic, the challenges remaining ahead and the recommendations for the future that you would espouse to be better prepared and avoid the high tribute will all pay to COVID-19 both from the US point of view as well as the international point of view and more recently the India point of view. And so I would like to start with Peggy, if you allow me. Peggy, you've been a public health leader. You've been, as you know, as I remember leading public health in New York, in Washington and also you've been the commissioner of the FDA. I know you've been involved to a great extent during the response. But my question is this, is that the regulatory systems of the world have been challenged by this pandemic, not just for vaccines, but for diagnostics, for therapeutics. And as you observe the approach of the FDA and other regulatory agencies, what did you learn? What struck you as either very different, uniquely creative or things that need improvement during the pandemic response? Peggy. Well, thank you, Elias. And let me add my thanks to you for your leadership and mentorship over many years as well. You've been an extraordinary role model for so many. I think that there were lessons learned and also understandings that were very solidly confirmed as we dealt with the unfolding COVID pandemic and as we continue to struggle to find our way through this. Certainly one of the crucial lessons learned is the importance of partnership and transcending boundaries, whether it's boundaries of discipline or sectors or of countries. And the fact that we have to work together to really think through from start to finish, how best to frame R&D efforts and regulatory oversight in an urgent and pressing crisis of this kind. I think obviously the vaccine development issues have become a much remarked upon scientific accomplishment and it really does reflect the fact that we, at the very beginning, had the players at the table, both the companies, government scientists and funders and regulators thinking about what were the critical questions that had to be asked and answered and how could we be more flexible in our approach to doing studies and developing the necessary data to maintain regulatory decision-making that was rigorous and scientifically based but was as streamlined as possible. And the way that the studies, the clinical trials and the preclinical work were kind of telescoped to really create maximal efficiency and also, of course, the way financial risks were taken in terms of beginning to invest in manufacturing in a very significant way and scale up before we knew for sure which vaccines were gonna actually make it over the finish line. Of course, we continue to face the grand challenge of how do we actually make remarkably safe and effective vaccines available to all who need it around the world and India is such an important partner in all of these efforts. But I think that clearly, we learned important lessons that we could be more nimble, we could be more responsive to critical unmet public health and medical care needs and that we could work together in important ways. For me, it reaffirms the lesson that we live in a globalized world. Some may like it, some may not, but it is simply the truth and that we need to think about and implement stronger governance models. And certainly in the regulatory area, it's something that Elias and I actually worked on together at an earlier time, trying to think about how to bring regulatory authorities together in new ways to really align and harmonize regulatory oversight, both the standards and approaches, but also the regulatory activities including things like inspections that don't need to be done by multiple different regulatory agencies with slightly different standards and approaches. So I was delighted to see that a new governance model that I had worked on as a commissioner, ICMRA, was actually put into practice during COVID in ways that I think did make a real difference. So happy to talk about all of this more, but I will stop now. Can you comment on the global supply chain for vaccines and its regulation? Because I understand that this is actually a difficult issue in terms of national policies, exports, controls, quality. Is there anything there that we as a world, India for example, is a great producer of vaccines, but vaccine nationalism in terms of global supply, command and control, what would be your advice on that? Well, the complexity of global supply chains for routine medical products is challenging. And then you get into a crisis like this one and it gets even more complex. The fact that components or the products themselves of drugs and vaccines and diagnostics and other medical products that are used in one country are coming from different countries around the world and are moving through a complex supply chain that involves many different players and partners and is subject to different rules and regulations in different countries. So we need very much to streamline that for routine needs, but in a crisis it becomes more complicated because countries do implement certain kinds of emergency laws that limit export of certain items to other countries and may also sometimes limit imports from other countries. And that can be so disruptive. And again, to the supplies and components that are needed for medical countermeasures in a crisis, but also can have impacts on routinely needed important medical products. So we've seen this really as a huge barrier to some aspects of our international collaborations to try to make vaccines more available where certain countries, including my own, the United States have been making sure, understandably that we have enough things like even the glass vials and rubber stoppers needed for packaging vaccines to address our own national needs, but that does create gaps and shortages in other places and it includes assays and reagents and other important components of vaccines and their manufacture. And so I think we do need to step back as a global community, a scientific enterprise and a regulatory community, look across the needs of industry and the role of government and really try to learn from this experience so that we can be better prepared for the next time. Thank you, Peggy. There will be actually follow-on questions from some of our panelists. Let me go to Francis. Francis, science has delivered this year and a major reason for it than your role and the role of NIH under your strong leadership, which has been central to the public-private approaches that have been taken. Could you share with us all your experience over this year and the most important lessons you drew from that experience and obviously, from your point of view, we were doing better thanks to vaccines, but we're not out of the tunnel yet. We have multiple issues that are in front of us, not beast of which is what Peggy was talking about, manufacturing vaccines. So what do you see as lessons and major challenges ahead of us nationally and internationally? Francis? Well, thanks, Elias. It's nice to be part of this and let me add my thanks to you for mentoring me when I stepped into the role that you once had as NIH director and you shared a lot of good points that kept me from making more mistakes than I otherwise would have. I didn't expect, however, that almost 12 years later, I would still be holding this particular position, but it's a great privilege to be able to do so. It's certainly been an incredibly intense year and a half since COVID-19 appeared on the scene and devastated our planet with all of the consequences that this coronavirus has created. Actually, for the first time in a year and a half, taking a little bit of a break, I'm at a beach house in North Carolina with my daughter and three grandkids who are hopefully not going to disrupt the proceedings here. We'll see whether that happens or not, but it's nice to have a chance to converse a little bit about the lessons we've learned and there are a lot of them. One lesson that I think we shouldn't lose track of is that the investments that have been made over the course of decades in basic science were really critical to get us to the point where we could in the space of just a day or two after the sequence of SARS-CoV-2 was posted on the internet, design an mRNA-based vaccine, which turned out to be remarkably successful. Building also on the hard work that had been done prior to that about how one might optimize the pre-fusion form of the spike protein so that it would be maximally immunogenic work that was done at our vaccine research center by Barney Graham and Kizmiki Acorbit and others over the course of several years. Because I think some people thought, oh, well, you just suddenly thought up this idea of mRNA and then that changed everything. And of course, instead, that's based upon decades of work done all over the place to make that possible. So that's a lesson we must not forget that as we see the necessity for quickly approaching an outbreak, we also have to have a foundation of really solid science upon which we can build. I guess for me, what I was able to see early on as we began to try to figure out how to respond with vaccines and therapeutics and diagnostics is that there was ever a time to get all of the talent around the same table, public and private and regulatory agencies and everything else, this was it. And out of that came the formation of something called ACTIV, which stands for Accelerating COVID-19 Therapeutic Interventions and Vaccines. An effort that now involves 20 pharmaceutical companies, multiple NIH institutes, the FDA in a very important fundamental way to be sure that we are understanding each other exactly. CDC, the Veterans Administration, the European Medicines Agency, and all of this managed very effectively by the foundation for NIH, which brought to the table the kind of program management that was necessary for this very complicated organization to be able to go forward. And people dropped everything. It was amazing to see about a hundred people engaged in the four different components of ACTIV, pretty much 24-7 doing everything we could to identify ways to move forward, defining master protocols for vaccines and therapeutics so that we would all have the same understanding about what power was needed, what kind of end points were gonna be followed, how do you prioritize therapeutics to get into clinical trials?  I think we saw that there was really a need for that. In the early days of COVID-19, I think this is true across the world, but it certainly was true in the U.S. There was a lot of scrambling around and setting up clinical trials that were actually not that well-designed. They were underpowered. Perhaps they weren't particularly thoughtful in terms of the end points. We would not have been able to get many answers if that was all we had going. We had to regularize this and make sure that we were putting together trials that were sufficiently large in scale to be able to get answers. All of that had to come together. And I can't say enough about the remarkable way that all of the sectors just decided that this was okay and let's not worry about who's gonna get the credit. Let's just do it. And ACTIV continues to this day to have about 30 working group meetings a week with this ongoing effort, because we're not done. So that was a really important lesson that how we can pull this together. I think it helped that we had had other public-private partnerships building up to this and particularly think of the accelerating medicines partnership in the U.S. where the people involved at high levels in the government science agencies and in the companies, we already knew each other. We knew each other well enough to call each other up and say, hey, we gotta do this and to have the trust that it was gonna work and that people would live up to their commitments and that milestones could be set and they would be absolutely rigorously adhered to. So that was a pretty important lesson. In terms of where we got to, obviously to have two vaccines in the U.S. approved for emergency use in 11 months, the Pfizer and the Moderna vaccines was pretty amazing record compared to what had ever been done before. And again, a testimony to the remarkable efforts that were made to make that. So particularly important part of that and a lesson we must not lose is how important it was that the recruitment of participants in those trials was diverse that if you're going to have a vaccine that you want people to take advantage of, you wanna be able to say, yeah, in the trial, people like you were included. And for us, that took an additional push forward to be able to do that kind of outreach, setting up community engagement efforts to be able to enlist lots of other participants from the African-American, Latino and Native American communities, which ultimately was pretty successful, although it was a bit of a heavy lift right at the beginning. We must not forget how we did that and we need to apply that in other trial situations as well. In terms of where we are now and what we need to do next, I mean, Elias, you and I've talked a little bit about this. We certainly need to learn the lessons from this with mRNA vaccines having turned out to be as safe and effective as has been the case. We are in a position, I think, to basically look at the list of the 20 most likely pathogens for the next outbreaks and go ahead and get started on designing those vaccines, maybe carry them all the way to a phase one trial to see if you can get a decent antibody response and then have those in the freezer and ready to go if that next pandemic does appear. So 11 months was great, but maybe we could do it even faster if we planned ahead. And the other thing, which we really have to work hard on and which the US government has just announced about a week ago, a $3.2 billion investment is antivirals. We tried really hard to find things that could be repurposed for COVID-19, an awful lot of the clinical trials that were run over the course of the last year, took things that maybe we're gonna have some promise and almost all of them failed. Well, we did get a hit from remdesivir, although it was modest in its contribution and certainly dexamethasone coming out of the recovery trial in the UK turned out to be a really important advance for the sickest patients. But we don't yet have an oral agent that could be quickly administered to somebody who just got a positive test. And that's what we really need and that's what now, again, with a lot of effort in a pharmaceutical effort that Andy could talk about, called Intrepid and with the US now making this commitment to put another $3 billion into this to have hopefully in the course of the next year or two, not just one, but more than one, a safe and effective oral antivirals that targets one of the vulnerabilities of a coronavirus and there are plenty of them particularly the proteases that deserve that. And that's a hard problem and it's the sort of thing we couldn't get done in that first year but we should not give up now. We still have lots and lots of needs for those kinds of therapeutics and we will be pushing forward. I didn't mean to skip over the monoclonal antibodies because that's also been a big step forward and to have monoclonals very quickly developed and tested which do show benefit for outpatients has been really valuable. Although I think we were disappointed to discover that monoclonals at least for the most part have not been helpful for hospitalized patients. That by the time you get that far along in the illness they don't seem to add much to therapeutics. You've got to give them early and of course that's a little challenging logistically because that's an infusion to somebody who's infected with a contagious agent that you need to do as an outpatient and that has challenged our medical care system to figure out how to do that. And ultimately we'd like to have something much simpler like that oral pill that we're all now working on. I could go on and on about all of this but I think I'll stop, Elias, and see what questions people have for us. Terrific. Could you comment on the emergence of the variants and the Delta variant in particular and what you're thinking about or how to address this challenge? Yeah. Well, obviously we're all watching this with great interest and some anxiety in terms of what these variants mean for the effectiveness of the vaccines which are incredibly effective, 94, 95% efficacy against the original virus. And with the variants that have appeared so far, Alpha, Beta, Gamma, Delta, we're looking pretty good and Delta is probably the one of the greatest concern now as it has absolutely decimated the country of India and now has rapidly spread through the UK or it is now by far the majority of the isolates. And in the US this has gotten up to 10% rather quickly and is predicted to become the dominant viral strain by August. I mean, it is interesting if you look at the shape of those curves, previously we thought that B117 which we now call Alpha was a very rapid spreader. Well, this Delta is spreading even more quickly in the space of a few weeks. And of course it is alarming because it is more contagious, estimated about 60% more contagious and also potentially more dangerous, at least a Scottish study suggesting twice the risk of hospitalization if you get infected with Delta and that includes young people. The good news is that the mRNA vaccines are still effective after two doses, about 88% efficacy. By the way, one dose, not so much, only about 33%. People really gotta get that second dose in there. I don't know the data about the J&J vaccine for the Delta variant, I think that's still in the works. But I guess what I'm worried about is what's the next one? And I think we all have to be really watching this closely. The one called Lambda coming out of South America, C37, which I don't know the data yet, but it's also spreading quite rapidly. It must be one of those pretty contagious items. It's got a seven amino acid deletion in the spike protein, which really makes me worry about what it looks like to the immune system. So we just have to watch these closely and we have to be prepared, if necessary, to deliver boosters that are designed against something that the current vaccines don't cover effectively enough and that's already been put into a trial basis by developing boosters against B1351, South African variant. And it does look as if that's something you can do fairly quickly and safely with the mRNA platform. I kind of hope we don't have to, because that's a big deal and it's gonna be a huge challenge once again to do the manufacturing and the distribution, but we gotta be ready for it. And considering that this virus is still spreading so rapidly across the world, there's lots and lots of opportunities for additional mutations. If you want a textbook on viral genome evolution, it's happening right in front of us every day in a way that's actually kind of alarming, but we gotta stay ahead of it. Elias, can I just jump in for one second to build on what Francis was saying and just quickly underscore three critical lessons from the variant experience, things we need to be acting on now and building better for the future as well. One is genomic surveillance. We need to integrate that into how we think about biosurveillance so that we can really understand from the get-go trends in variants that are to be expected, but have real impact on disease control and on our lives. Secondly, we have to really recommit to the international vaccine delivery issues. Every country remains vulnerable when, as Francis noted, we're allowing transmission to be running rampant in other places in the world that can really foster the development and spread of new variants. And then thirdly, it really speaks to the fact that we have to think about these new opportunities in science that we have with the mRNA vaccines, but other emerging technologies as well. We can develop and sort of pre-study and pre-approve certain kinds of platforms that then can be quickly used in a sort of a plug-in play way as new variants emerge and as we see the need to rapidly develop new vaccines or other modalities to address emerging new variants and new threats. Thank you. Thank you. I would like to point out to everyone that indeed you probably are the longest serving director of the NIH. I think Jim Shannon may have been 12, 13 years, but no matter what, this year counts for three years. Because... Oh, so you are the longest serving. The other thing I'd like to tell the audience is you are a genius at acronyms. And I learned that from you. You were a mentor to me. So when I heard the acronym ACTIV and what it meant, it said that absolute signature of Francis Collins. And you're always... But acronyms, one time we were doing this proposed study called AGES, American Gene and Environment Study. And I thought it was a struggle genius to put AGES in the study, or the book of life, which you have used. So I think you're willing to communicate to the general public in ways that really connect both the momentum and the substance of something is unique that all of us are learning from. Anyway... And his ability to sometimes do it in song. We can't forget that. And write poems about it.  He can not only just play music, but he can write poems. So anyway, enough kudos. Questions from the panelists who have really signed up to ask you questions. And the first is going to be by Professor Sinhar Sanjeev. Sanjeev is a professor of medicine at the All India Institute of Medical Sciences. Sanjeev, can we have Sanjeev please? Thank you very much, Professor Ilyas, for giving this opportunity. Very nice discussion by Professor Colin and Peggy. Thank you very much. My question is the COVID pandemic has demonstrated that WHO's lack of authority regarding enforcing pandemic control measures internationally. Should the WHO be invested with more executive powers in the interest of ensuring global health? And number two, would the empowerment of the WHO go act more decisively in the interest of global health influence upon the sovereignty of the countries for the COVID pandemic? Thank you. Thank you for that question. Yeah, that's a very important question. What is WHO's role and what has it been? What should it be? For Francis, you've been, I know that WHO is funded by NIH in many ways and help by NIH. Could you comment? I mean, there's been defunded WHO. WHO really has not been given a lot of credit for managing this. What is your thought, Peggy, from your point of view, what should WHO do differently? Yeah, well, I'll start. Yeah, it's been a difficult period, of course, in terms of our relationship with WHO, with the previous administration, basically wanting to withdraw from that organization. I will tell you that we continued scientifically to interact almost daily with WHO in the course of COVID-19 because of all the shared interests. And we have people in Geneva who continued to be a part of that partnership. WHO now, I'm glad to say, we are back very much in the connected state and it's wonderful having Sumia Swaminathan there as the chief scientist, somebody that I've known for quite a long time. WHO has a tough job to do, of course, because they have so many masters that they have to try to satisfy and makes it very difficult to move things along in any kind of rapid fashion at a time of a pandemic where you really want to try to be as rapid as possible. But they do provide a connectivity for all of the international efforts that are happening at a time like this, which is greatly valuable. I just think it's very difficult for them to be the driver of big changes in policy because they have too many people who don't quite agree about how that should be done. So that while their hands in some ways end up being tied, they're absolutely critical and we depend on them a lot for that kind of interaction. And just to follow up on Francis's comments, I mean, I think it is absolutely the case that WHO is a critical point of information and coordination for countries around the world. It surely is not perfect and we can all identify areas where we wish they had been stronger, swifter or more focused during the response to COVID. But I think that they are uniquely important, uniquely situated and we need to support them and we need to help them strengthen and extend their work. They are the only unifying health agency of its kind in the world. They provide really critical normative standards and guidance and information for countries rich and poor including also a mechanism to help countries that have much less well-established systems for drug review, medical product review, et cetera, get information and ultimately access to critical products. And they really in times between a crisis can and should play a critical role in defining critical competencies that countries need for pandemic threat preparedness and response and helping to ensure that that set of capabilities is actually built up and sustained over time. But they do answer to many different masters, as Francis said. They also are dramatic in terms of, are dramatically underfunded and the way that historically they've received funding, I think has exacerbated some of the problems because they get funding for very specific areas of work sometimes which may not actually reflect what is their core mission, what are their critical and unique functions. And I think that as a community of nations, we really should help to make sure that the core functions of WHO are identified and supported so they can play that role and then add on extra programs that are sort of a special interest to different countries or different groups. But we really do need to recognize that WHO warts and all plays a critical role and it's our job to help WHO do a better job going forward. But Peggy, on a very specific point, that I heard from many different countries, especially low income countries, is that many of the governments really expected and waited for WHO approval to acquire the vaccines. But the WHO approvals have been delayed and not very swift, if you will. So people who wanted to buy Chinese vaccines said, no, there's gonna kill us for Russian vaccines and FDA did not approve the AstraZeneca, I mean, EMA bit, which is a subject near and dear to you and I, the harmonization issue. Yes. Well, it's what you would recommend for the future to make sure that countries are a level playing field in terms of approval of vaccines. Yes, I think that this is gonna take some time and some thoughtful work. WHO is not a regulatory agency, yet it can convene regulatory authorities to work together in important ways. Now that we have a new global governance framework through ICMRA, the International Coalition of Medicine Regulatory Authorities, I think we need to strengthen that activity and then we have to get those two entities to really seamlessly work together because I don't think that WHO should pretend to be a regulatory agency, should take that on, they don't have the depth and breadth of experience with respect to the science and R&D and they don't have the kind of legal authorities that they would need to be able to serve the world in that way, but working closely with regulatory authorities around the world and an international governance mechanism for regulatory authorities. I think we could really make systems much clearer, make information more accessible and really help countries to better use information coming through that network for their own regulatory decision-making without having to create additional new mechanisms to satisfy the needs and concerns of their own country. So I think it's a really important area of work. I hope that you and I, LAS and others will have a chance to continue to work on this issue as we come out of COVID and look towards the future. Thank you. The next question is from Stan Ella, who is Chairman and Managing Director of Barrelt Biotech. Questions related to vaccines? Krishna. Thank you. Thank you, Professor Deroni. It's really honored to video connect to Francis Collins and Margaret Amber. Thank you, honored. And I think I'm also a distinguished panelist. My question is very simple. Would establishing a manufacturing facility dedicated for pandemic, is that a right decision for many countries? Well, I'll jump in first on this one. I think that what we really need to think about is how to make manufacturing and scale up more efficient, how to make it work on a routine basis in a more distributed way where we have more capacity in different parts of the world. And we need to think about what are the elements that make it possible to scale up even further in a crisis. I think the idea of dedicated manufacturing for pandemics can have an appeal but can be dangerous because if you're not using a manufacturing facility and keeping it warm so to speak on a day-to-day basis, I think you're gonna find major problems when you go to use it in a crisis. And the truth is that we still have vaccine needs for a lot of unmet public health and medical care needs. And we really can and should ensure more vaccine availability through manufacturing and distribution to address a range of preventable diseases of childhood as well as an increasing set of adult immunizations as well. So I think that if we scale up capacity, we'll use those vaccines, we'll be able to keep the manufacturing facilities in good use with trained people and quality manufacturing capabilities, but also be able to gear up. And I think we need to be thinking not just about how to introduce advanced manufacturing approaches to some of our vaccine manufacturing and really modernizing these processes, but also with new vaccines, some of the manufacturing requirements are gonna be, I think, easier to stand up to maintain and will be less cumbersome in terms of what it requires. So at least that's my hope that we can apply new technologies and new systems as well as making broadened commitments to making manufacturing capabilities available in places around the world. Yeah, I totally agree with Peggy's perspective here. The idea that you're going to set up manufacturing and just sort of have it on hold waiting for pandemic needs probably isn't gonna be a successful approach. You've gotta have a facility that has actively trained individuals that has all the materials in place to be able to make this happen quickly. But there's plenty of need for that kind of manufacturing capacity and it is really a problem that right now it is not distributed across the world the way you would ideally wanna see. I've been engaged in multiple conversations about how we might do something about enhancing vaccine manufacturing capacity in Africa and there are places that I think are potentially ready to try to take that on like Senegal and South Africa, for instance, but we should not actually underestimate the complexities in doing so. And certainly for a quick turnaround to try to produce more vaccines for COVID-19, I don't think it's realistic that you're gonna go from a standing start to be able to do that in less than a couple of years, but we should be doing it anyway for the next pandemic and for all the other vaccine needs that are gonna be ongoing for childhood illnesses and other things. But it's not just about the technology, it's not just about buildings, a lot of it's gonna be about training and that's gonna, I think, call upon the existing manufacturing capacity to not only expand its capability which they're being asked to do but also being willing to do that kind of outreach, to do the training for new facilities as they begin to step up. But yeah, that's gotta be a big lesson from this experience that vaccine manufacturing has been way too limited geographically and if we really care about the health of the world, we gotta fix that. Thank you, very helpful. The next question is actually from Robert K. Leif. Rob is the head of clinical policy and strategy at Verily and Google Health. As you know, he was a former commissioner of the FDA but I think his claim to fame is to have created the best clinical research institute in the world at Duke and changed the old trials from academia to industry to government. So Rob, your question. Thanks, Alice. This is a rare opportunity. I wish we had five hours to ask questions but I know we're short of time so I'm gonna fire out a two-sided question that is in the jurisdiction between FDA and NIH and that I think all countries need to be thinking about with regard to vaccines and other issues. The first is diagnostic testing and I think I certainly learned a lot at FDA about the issues in diagnostic testing that are not going so well. It is the foundation of precision medicine but of course you need to be able to make a diagnosis to treat during a pandemic. And then the second is the global suspicion about vaccines, which is a huge issue in the US right now and I'd particularly be interested in Francis' view on this because somewhat unexpectedly to a lot of people the residual vaccine hesitancy people turn out to be conservative white men and from areas like where I'm from. And I'm sure every culture has its own groups of people who are hesitant. So those are two big issues that sort of reside between NIH and FDA. I wonder what your thoughts are about them. Well, I'll start and try not to take too much time because I wanna hear what Peggy will say too. With diagnostics, I agree that this was perhaps underappreciated as a critical part of dealing with a pandemic. I think we've come a long way in the last year and a half on that after a very rough start. One of the things that NIH got engaged in in a way that we never really had before was to become kind of a venture capital organization to try to create platform opportunities for new diagnostic technologies to detect the presence of virus in a nasal swab or a saliva sample. And with that encouragement from the Congress we basically have now funded the development of no less than 32 new platforms for doing this kind of technology including many that are point of care and quite a few that are now home-based testing which of course if we'd had at the beginning of the outbreak that would have been really helpful. It's coming along a little later than you would like for this. And I think that is something going forward that we can build on because we learned a lot about ways to do this either using nucleic acid or viral antigen assays that we hadn't really invested in in quite the same way before. And we ought to be prepared to utilize those lessons also going forward. As far as the global suspicion it is incredibly frustrating that we have now vaccines that are safe and effective and yet there are about 90 million people in the United States who have yet to roll up their sleeves to get the first dose. Many of them skeptical suspicious and much of that driven not by scientific information but by misinformation, by political posturing, by things that you would not have thought such an advanced technological society would be so tripped up by in which many of us, bless him, Tony Fauci especially have been out there trying to counteract and basically getting demonized as a result. It is a sad tale, I'm sorry to say that kind of reflects the way in which at the present time there's so much polarization in our country and not uniquely in our country. And here it is in this instance, not just causing headaches but causing loss of life. I mean, people are dying because of misinformation about COVID-19 that otherwise could have saved them. And that's a terribly sad thing to be able to say. And despite efforts for lots of people and lots of different venues, we not apparently made very many inroads into the most resistant part of the community that simply is not interested in something that they've decided is not for them. So yeah, Rob, I'm really frustrated about this and it's also this terribly ironic situation where the rest of the world is desperate to get access to vaccines. And now here we in the US have done all this manufacturing, we've got all these copies and people don't want them. So what's wrong with this picture? We have really turned everything upside down. Peggy. Okay, well, I'll try to be quick because I know we're up against time. First on the diagnostics question, this has been an area of great focus and concern in the pandemic preparedness area and biological threats, literally for decades. Back in 2003, actually, I co-chaired a National Academy of Sciences study and report with the late great Dr. Joshua Letterberg called microbial threats to health in the 21st century. And we did in that report call out the need for new better diagnostics as one of the most critical elements of preparedness for a full range of biological threats both naturally occurring and deliberately caused. And we expected action to happen very swiftly to really organize activities. And sadly, there were cycles of crisis and complacency, little progress was made in the pandemic preparedness domain with respect to diagnostics. From the perspective of working at FDA diagnostics have been a challenge in terms of the legal regulatory framework and how to really harness what are opportunities in science and technology today to develop a whole range of new diagnostic technologies. Many of those are going forward, but have been caught in the crosshairs, I think, of the legal regulatory framework and the willingness to invest, but also reimbursement. It was sad not too long ago when we had very dramatic advances in precision medicine that could make huge difference in disease, but the diagnostics to enable the alignment of the new therapeutics with the underlying disease weren't being reimbursed. And so this precision medicine wasn't being adequately utilized. We're making progress in those domains, but it's a question of really, again, recommitting to work in this area. And with COVID-19, we saw in those early days, the floundering around getting diagnostics and not just any old diagnostic, but multiple diagnostics for different purposes. What you need for public health surveillance is different than what you need for medical diagnosis. So I think it's an area where we have to do better as we come out of this in terms of creating strategies for diagnostic development and their application in medical practice, whether for routine use or in a crisis. Vaccine hesitancy, it's a problem around the world. It's multi-determined. The anti-vaxxers had a huge impact pre-COVID and then were able to reinforce their misinformation and negative messaging, praying on vulnerable people. Of course, that then got overlaid with concerns about the adequacy of the science and was the vaccine being developed with political interference and pressure and was it really safe and effective because of that? And then of course, the fact that there are social and cultural issues that affect people's willingness to trust vaccines and their youth and political ideologies that are now undermining uptake in many countries, including the United States. So we have to make sure we have the right messages about vaccines, why they matter for individuals, families, communities, and our overall national and international security. But we also have to have the right messengers and for different communities and target populations, those messengers are different. We have to be very mindful of that as we proceed with our vaccine programs. It's interesting sometimes I was just put an anecdote up in the vials of vaccines that are distributed around the world. Sometimes the world's sterile is written on the vial and that has been misinterpreted as sterilization of women and you have this rumor going around that the vaccine is to prevent actually, I mean, it's a contraceptive essentially or actually no, but pretending to stop, you know. You know, I think we are out of time. This was a fascinating panel. I want to thank you both. I want to apologize to Dr. Ship-Sarin, who had the last question. And I think, fortunately, because of fine limits, I won't be able to let him ask his question. You can see the amount of interest that these issues have raised. You've absolutely led the world in terms of your leadership, your differences in terms of active responses and the acronym that you use, which really activates everybody. And Peggy, your experience in policy and global common regulatory responses needed in the future. So with that, I'd like to thank all of you and all the participants for this great panel. Thank you very much. Thank you. Thank you. Thanks a lot, everybody. Thank you very much. Thank you, Peggy. Thank you, Peggy. Thank you, Thomas Collin. Thank you, Dr. Krishna. Thank you, Karan. Thank you, Karan. Thank you so much. And can you put the poll slide, please, quickly? That's an exciting question for this panel. What is the most crucial step to building resilience against the next pandemic? The poll starts now. We have 60 seconds. Please cast your poll. Welcome back, everybody, and thank you very much to Elias, Peggy, and Fran for a really terrific fireside. Three incredible leaders who have all served or continue to serve as civil servants and their role in helping to drive science and policy on a global scale is greatly appreciated by all of us. So we can now bring up the results of the most recent poll. And the question was, what is the most crucial step to building resilience against the next pandemic? And you can see the results here. And we have a favorite, an overwhelming favorite, where over 50% of you believe that the answer is B, establish infrastructure for more efficient research, collaboration, and data sharing. So thank you very much.