0:00:01.722,0:00:03.874 My son was born in January 2020, 0:00:03.898,0:00:06.145 shortly before the lockdown in Paris. 0:00:06.169,0:00:08.212 He was never scared[br]of people wearing masks, 0:00:08.236,0:00:09.752 because that's all he knows. 0:00:10.306,0:00:14.458 My three-year-old daughter knows[br]how to say "gel hydro-alcoolique." 0:00:14.482,0:00:17.507 That's the French word[br]for hydroalcoholic gel. 0:00:17.531,0:00:19.841 She actually pronounces it[br]better than I do. 0:00:20.763,0:00:22.927 But no one wants to be wearing a mask 0:00:22.951,0:00:26.605 or wash their hands[br]with hand sanitizer every 20 seconds. 0:00:26.629,0:00:31.567 We're all desperately looking at R and D[br]to find us a solution: a vaccine. 0:00:32.157,0:00:34.167 It's interesting that in our minds, 0:00:34.191,0:00:37.760 we keep thinking of the vaccine discovery[br]like it's the Holy Grail. 0:00:38.825,0:00:42.253 But there are a couple of shortcuts here[br]that I'd like to unpack. 0:00:42.277,0:00:44.950 I'm not a doctor, I'm just a consultant. 0:00:44.974,0:00:46.672 My clients focus on health care -- 0:00:46.696,0:00:50.997 biopharma companies, providers,[br]global health institutions -- 0:00:51.021,0:00:52.746 and they've educated me. 0:00:53.769,0:00:56.465 We need to find the tools to fight COVID, 0:00:56.489,0:00:59.050 and we need to make them[br]accessible to all. 0:00:59.796,0:01:03.584 First, one single vaccine[br]will not get us out of this. 0:01:03.988,0:01:06.253 What we need is an arsenal of tools. 0:01:06.277,0:01:10.070 We need vaccines, we need therapeutics,[br]we need diagnostics 0:01:10.094,0:01:14.788 to make sure that we can prevent,[br]identify and treat COVID cases 0:01:14.812,0:01:16.932 in a variety of populations. 0:01:16.956,0:01:20.826 Second, it's not just[br]about finding a tool. 0:01:21.798,0:01:24.819 What do you think will happen[br]when one of those clinical trials 0:01:24.843,0:01:27.154 demonstrates that the tool is effective? 0:01:27.178,0:01:29.747 Do you think we can all[br]run to the pharmacy next door, 0:01:29.771,0:01:31.766 we get the product,[br]we take off our masks 0:01:31.790,0:01:33.706 and we go back to French kissing? 0:01:34.520,0:01:35.731 No. 0:01:36.557,0:01:40.177 Finding an effective tool[br]is just one step in this big fight, 0:01:40.201,0:01:43.276 because there is a difference[br]between the existence of a product 0:01:43.300,0:01:45.201 and access to that product. 0:01:46.058,0:01:47.303 And now you're thinking, 0:01:47.327,0:01:50.328 "Oh -- she means other countries[br]will have to wait." 0:01:50.741,0:01:52.544 Well, no, that's not my point. 0:01:52.568,0:01:54.647 Not only others may have to wait, 0:01:54.671,0:01:56.587 but any of us may have to. 0:01:57.240,0:01:58.894 The humbling thing about COVID 0:01:58.918,0:02:01.820 is that because of its speed[br]and magnitude, 0:02:01.844,0:02:04.463 it's exposing all of us[br]to the same challenges 0:02:04.487,0:02:07.561 and giving us a flavor[br]of challenges we're not used to. 0:02:08.064,0:02:10.634 Remember when China got into lockdown? 0:02:10.658,0:02:13.278 Did you imagine that you[br]would be in the same situation 0:02:13.302,0:02:14.507 a few weeks after? 0:02:15.016,0:02:16.612 I certainly didn't. 0:02:17.057,0:02:20.617 Let's go to the theoretical moment[br]when we have a vaccine. 0:02:21.240,0:02:23.406 In this case, the next access challenge 0:02:23.430,0:02:24.846 will be supply. 0:02:25.355,0:02:27.486 The current estimate[br]of the global community 0:02:27.510,0:02:29.743 is that by the end of 2021 -- 0:02:29.767,0:02:32.843 so that's over a year after[br]the discovery of the vaccine -- 0:02:32.867,0:02:35.821 we would have enough doses[br]to cover one to two billion 0:02:35.845,0:02:38.139 of the eight billion of us on the planet. 0:02:38.798,0:02:40.450 So who will have to wait? 0:02:41.157,0:02:43.941 How do you think about access[br]when supply is short? 0:02:44.759,0:02:46.140 Scenario number one: 0:02:46.164,0:02:48.122 we let the market forces play, 0:02:48.146,0:02:51.865 and those who can pay the highest price[br]or be the fastest to negotiate deals 0:02:51.889,0:02:53.807 will get access to the product first. 0:02:54.339,0:02:55.793 It's not equitable at all, 0:02:55.817,0:02:57.619 but it's a very likely scenario. 0:02:58.444,0:02:59.785 Scenario number two: 0:02:59.809,0:03:02.433 we could all agree,[br]based on public health rationale, 0:03:02.457,0:03:04.139 who gets the product first. 0:03:04.163,0:03:07.183 Let's say we agree that[br]health care workers would get it first, 0:03:07.207,0:03:08.683 and then the elderly 0:03:08.707,0:03:10.663 and then the general population. 0:03:10.687,0:03:12.737 Now let me be a bit more provocative. 0:03:12.761,0:03:14.317 Scenario number three: 0:03:15.619,0:03:19.118 countries who have demonstrated[br]that they can manage the pandemic well 0:03:19.142,0:03:21.368 would get access to the product first. 0:03:22.055,0:03:23.937 It's a little bit extrapolated, 0:03:23.961,0:03:26.209 but it's not complete science fiction. 0:03:26.233,0:03:30.968 Years ago, when the supply of high-quality[br]second-line tuberculosis drug was scarce, 0:03:30.992,0:03:32.692 a special committee was established 0:03:32.716,0:03:36.133 to determine which countries[br]had health systems that were strong enough 0:03:36.157,0:03:39.247 to ensure that the products[br]would be distributed properly 0:03:39.271,0:03:42.600 and that patients would follow[br]their treatment plans properly. 0:03:42.624,0:03:44.996 Those select countries got access first. 0:03:46.782,0:03:48.225 Or, scenario number four: 0:03:48.249,0:03:50.042 we could decide on a random rule, 0:03:50.066,0:03:53.434 for instance, that people get[br]to be vaccinated on their birthday. 0:03:54.108,0:03:55.542 Now let me ask you this: 0:03:56.201,0:04:00.613 How does it feel to think of a future[br]where the vaccine exists, 0:04:00.637,0:04:05.021 but you would still have to wear a mask[br]and keep your kids home from school, 0:04:05.045,0:04:07.684 and you would not be able[br]to go to work the way you want 0:04:07.708,0:04:10.331 because you wouldn't[br]have access to that product? 0:04:11.593,0:04:14.763 Every day that passed[br]would feel unacceptable, right? 0:04:15.309,0:04:16.600 But guess what? 0:04:17.067,0:04:21.219 There are many diseases for which[br]we have treatments and even cures, 0:04:21.243,0:04:25.409 and yet people keep being infected[br]and die every year. 0:04:26.310,0:04:27.907 Let's take tuberculosis: 0:04:28.479,0:04:30.963 10 million people infected every year, 0:04:30.987,0:04:33.073 1.5 million people dying, 0:04:33.969,0:04:36.072 although we've had a cure for years. 0:04:36.096,0:04:38.924 And that's just because[br]we haven't completely figured out 0:04:38.948,0:04:40.757 some of the key access issues. 0:04:42.495,0:04:45.126 Equitable access is the right thing to do, 0:04:45.801,0:04:48.393 but beyond this humanitarian argument 0:04:48.417,0:04:50.159 that I hope we are more sensitive to 0:04:50.183,0:04:52.566 now that we've[br]experienced it in our flesh, 0:04:52.590,0:04:54.877 there is a health and an economic argument 0:04:54.901,0:04:56.398 to equitable access. 0:04:57.104,0:05:00.688 The health argument is that[br]as long as the virus is active somewhere, 0:05:00.712,0:05:03.219 we're all at risk of reimported cases. 0:05:03.909,0:05:07.588 The economic argument is that[br]because of the interdependencies 0:05:07.612,0:05:08.915 in our economies, 0:05:08.939,0:05:14.207 no domestic economy can fully restart[br]if others are not picking up as well. 0:05:14.977,0:05:17.386 Think of the sectors[br]that rely on global mobility, 0:05:17.410,0:05:20.102 like aerospace or travel and tourism. 0:05:20.126,0:05:22.635 Think of the supply chains[br]that cut across the globe, 0:05:22.659,0:05:24.515 like textiles or automotive. 0:05:24.539,0:05:28.409 Think of the share of the economic growth[br]that is coming from emerging markets. 0:05:28.719,0:05:34.211 The reality is that we need all countries[br]to be able to crush the pandemic in sync. 0:05:35.155,0:05:38.140 So not only is equitable access[br]the right thing to do, 0:05:38.164,0:05:40.168 it is also the smart thing to do. 0:05:41.263,0:05:42.693 But how do we do that? 0:05:44.058,0:05:47.443 Let's make sure we're on the same page[br]in terms of what "access" means. 0:05:47.467,0:05:49.931 It would actually mean[br]that the product exists; 0:05:49.955,0:05:52.544 that it's working sufficiently well; 0:05:52.568,0:05:55.422 that it's been approved[br]by the local authorities; 0:05:55.446,0:05:57.231 that it is affordable; 0:05:57.255,0:06:00.488 but also that there is evidence[br]that it works in all the populations 0:06:00.512,0:06:01.695 that need it, 0:06:01.719,0:06:06.229 and that can include pregnant women[br]or immunodepressed people, or children; 0:06:06.253,0:06:08.788 that it can be distributed[br]in a variety of settings, 0:06:08.812,0:06:14.344 like hospitals or rural clinics,[br]or hot climate or cold climate; 0:06:14.368,0:06:16.647 and that we can produce it[br]at the right scale. 0:06:17.266,0:06:19.321 It's a very long checklist, I know, 0:06:19.345,0:06:21.280 and in a non-crisis situation, 0:06:21.304,0:06:25.634 we would likely address these issues[br]one after the other in a sequential way, 0:06:25.658,0:06:27.241 which takes a lot of time. 0:06:28.423,0:06:29.844 So what do we do? 0:06:30.609,0:06:33.124 Access is far from being a new challenge, 0:06:33.148,0:06:34.659 and in the case of COVID, 0:06:34.683,0:06:37.986 I have to say, we're seeing[br]extraordinary collaboration 0:06:38.010,0:06:41.727 of international organizations,[br]civil society, industry and others 0:06:41.751,0:06:43.356 to accelerate access: 0:06:43.380,0:06:45.208 working things in parallel, 0:06:45.232,0:06:47.302 speeding up regulatory processes, 0:06:47.326,0:06:49.045 engineering supply mechanisms, 0:06:49.069,0:06:52.149 securing procurement,[br]mobilizing resources, etc. 0:06:52.632,0:06:57.072 Yet we are likely to face a situation[br]where, for instance, 0:06:57.096,0:07:00.053 the vaccine would need to be[br]constantly stored at, let's say, 0:07:00.077,0:07:02.245 minus 80 Celsius degrees; 0:07:02.269,0:07:04.788 or where the treatment[br]would need to be administered 0:07:04.812,0:07:07.228 by a highly specialized[br]health care worker; 0:07:07.252,0:07:09.561 or where the diagnostic[br]would need to be analyzed 0:07:09.585,0:07:11.003 by a sophisticated lab. 0:07:11.873,0:07:13.685 So what more can we do? 0:07:15.265,0:07:18.018 Pushing further the logic[br]that the global health community 0:07:18.042,0:07:19.695 has advocated for for years, 0:07:19.719,0:07:22.977 there is one additional thing[br]I can think of that might help. 0:07:23.855,0:07:26.688 There is a concept[br]in product development and manufacturing 0:07:26.712,0:07:28.561 that's called "design to cost." 0:07:28.585,0:07:31.588 The basic idea is that[br]the cost management conversation 0:07:31.612,0:07:34.476 happens at the same time[br]as the product being designed, 0:07:34.500,0:07:36.942 as opposed to the product[br]being designed first 0:07:36.966,0:07:39.457 and then reworked to bring the cost down. 0:07:39.854,0:07:41.678 It's a simple method that helps ensure 0:07:41.702,0:07:46.655 that when cost has been identified[br]as a priority criteria for a product, 0:07:46.679,0:07:48.663 it's made a target from day one. 0:07:49.386,0:07:52.519 Now, in the context of health and access, 0:07:52.543,0:07:54.775 I think there is untapped potential 0:07:54.799,0:07:56.296 in R and D to access, 0:07:56.320,0:07:59.477 the same way that[br]manufacturers design to cost. 0:08:00.012,0:08:03.995 This would mean that,[br]instead of developing a product 0:08:04.019,0:08:08.382 and then working to adapt it[br]to ensure equitable access later, 0:08:08.406,0:08:10.559 all of the items[br]on the checklist I mentioned 0:08:10.583,0:08:13.898 would be built into the R and D process[br]from the beginning, 0:08:13.922,0:08:16.453 and this would actually benefit us all. 0:08:16.477,0:08:18.098 Let's take an example. 0:08:18.122,0:08:21.633 If we develop a product[br]with equitable access in mind, 0:08:21.657,0:08:24.908 we might be able to optimize[br]for scale-up faster. 0:08:25.616,0:08:30.272 In my experience, drug developers[br]often focus on finding a dose that works, 0:08:30.296,0:08:33.888 and only after do they optimize[br]the dosage or make adjustments. 0:08:34.555,0:08:37.101 Now imagine that we're talking[br]of a candidate product 0:08:37.125,0:08:39.620 for which the active ingredient[br]is a scarce resource. 0:08:40.044,0:08:43.635 What if instead we focused[br]on developing a treatment 0:08:43.659,0:08:47.371 that uses the lowest possible amount[br]of that active ingredient? 0:08:47.802,0:08:50.065 It could help us produce more doses. 0:08:50.834,0:08:52.768 Let's take another example. 0:08:52.792,0:08:55.655 If we develop a product[br]with equitable access in mind, 0:08:55.679,0:08:58.838 we might be able to optimize[br]for mass distribution faster. 0:08:59.788,0:09:01.251 In high-income countries, 0:09:01.275,0:09:03.412 we have strong health systems capacity. 0:09:03.436,0:09:06.015 We can always distribute[br]products the way we want. 0:09:06.039,0:09:08.750 So we often take for granted[br]that products can be stored 0:09:08.774,0:09:10.739 in temperature-controlled environments 0:09:10.763,0:09:15.084 or requires a highly skilled[br]health care worker for administration. 0:09:15.698,0:09:16.875 Of course, 0:09:16.899,0:09:20.407 temperature-controlled environments[br]and highly skilled health care workers 0:09:20.431,0:09:21.877 are not available everywhere. 0:09:21.901,0:09:23.888 If we were to approach R and D 0:09:23.912,0:09:27.004 with the constraints[br]of weaker health systems in mind, 0:09:27.028,0:09:28.542 we might get creative 0:09:28.566,0:09:32.486 and develop sooner, for instance,[br]temperature-agnostic products 0:09:32.510,0:09:35.354 or products that can be taken[br]as easily as a vitamin 0:09:35.378,0:09:38.777 or long-lasting formulations[br]instead of repeat doses. 0:09:39.832,0:09:45.136 If we were able to produce and develop[br]such simplified tools, 0:09:45.160,0:09:46.782 it would have the added benefit 0:09:46.806,0:09:50.034 of putting less strains[br]on hospitals and health systems 0:09:50.058,0:09:52.974 for both high- and low-income countries. 0:09:53.894,0:09:55.310 Given the speed of the virus 0:09:55.334,0:09:58.085 and the magnitude[br]of the consequences we're facing, 0:09:58.109,0:10:00.480 I think we have to continue[br]challenging ourselves 0:10:00.504,0:10:03.705 to find the fastest way[br]to make products to fight COVID 0:10:03.729,0:10:06.049 and future pandemics accessible to all. 0:10:06.501,0:10:07.852 In my perspective, 0:10:07.876,0:10:09.738 unless the virus disappears, 0:10:09.762,0:10:11.655 there are two ways this story ends. 0:10:12.288,0:10:14.148 Either the scales tip one way -- 0:10:14.172,0:10:16.371 only some of us get access to the product 0:10:16.395,0:10:18.918 and COVID remains a threat to all of us -- 0:10:18.942,0:10:20.696 or we balance the scales, 0:10:20.720,0:10:23.085 we all get access to the right weapons, 0:10:23.109,0:10:25.104 and we all move on together. 0:10:26.501,0:10:29.183 Innovative R and D can't beat COVID alone, 0:10:29.207,0:10:31.905 but innovative management[br]of R and D might help. 0:10:32.341,0:10:33.540 Thank you.