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My son was born in January 2020,

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shortly before the lockdown in Paris.

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He was never scared
of people wearing masks,

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because that's all he knows.

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My three-year-old daughter knows
how to say "gel hydro-alcoolique."

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That's the French word
for hydroalcoholic gel.

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She actually pronounces it
better than I do.

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But no one wants to be wearing a mask

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or wash their hands
with hand sanitizer every 20 seconds.

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We're all desperately looking at R and D
to find us a solution: a vaccine.

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It's interesting that in our minds,

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we keep thinking of the vaccine discovery
like it's the Holy Grail.

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But there are a couple of shortcuts here
that I'd like to unpack.

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I'm not a doctor, I'm just a consultant.

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My clients focus on health care --

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biopharma companies, providers,
global health institutions --

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and they've educated me.

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We need to find the tools to fight COVID,

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and we need to make them
accessible to all.

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First, one single vaccine
will not get us out of this.

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What we need is an arsenal of tools.

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We need vaccines, we need therapeutics,
we need diagnostics

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to make sure that we can prevent,
identify and treat COVID cases

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in a variety of populations.

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Second, it's not just
about finding a tool.

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What do you think will happen
when one of those clinical trials

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demonstrates that the tool is effective?

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Do you think we can all
run to the pharmacy next door,

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we get the product,
we take off our masks

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and we go back to French kissing?

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No.

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Finding an effective tool
is just one step in this big fight,

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because there is a difference
between the existence of a product

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and access to that product.

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And now you're thinking,

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"Oh -- she means other countries
will have to wait."

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Well, no, that's not my point.

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Not only others may have to wait,

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but any of us may have to.

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The humbling thing about COVID

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is that because of its speed
and magnitude,

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it's exposing all of us
to the same challenges

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and giving us a flavor
of challenges we're not used to.

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Remember when China got into lockdown?

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Did you imagine that you
would be in the same situation

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a few weeks after?

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I certainly didn't.

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Let's go to the theoretical moment
when we have a vaccine.

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In this case, the next access challenge

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will be supply.

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The current estimate
of the global community

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is that by the end of 2021 --

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so that's over a year after
the discovery of the vaccine --

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we would have enough doses
to cover one to two billion

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of the eight billion of us on the planet.

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So who will have to wait?

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How do you think about access
when supply is short?

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Scenario number one:

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we let the market forces play,

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and those who can pay the highest price
or be the fastest to negotiate deals

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will get access to the product first.

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It's not equitable at all,

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but it's a very likely scenario.

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Scenario number two:

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we could all agree,
based on public health rationale,

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who gets the product first.

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Let's say we agree that
health care workers would get it first,

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and then the elderly

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and then the general population.

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Now let me be a bit more provocative.

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Scenario number three:

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countries who have demonstrated
that they can manage the pandemic well

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would get access to the product first.

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It's a little bit extrapolated,

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but it's not complete science fiction.

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Years ago, when the supply of high-quality
second-line tuberculosis drug was scarce,

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a special committee was established

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to determine which countries
had health systems that were strong enough

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to ensure that the products
would be distributed properly

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and that patients would follow
their treatment plans properly.

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Those select countries got access first.

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Or, scenario number four:

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we could decide on a random rule,

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for instance, that people get
to be vaccinated on their birthday.

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Now let me ask you this:

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How does it feel to think of a future
where the vaccine exists,

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but you would still have to wear a mask
and keep your kids home from school,

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and you would not be able
to go to work the way you want

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because you wouldn't
have access to that product?

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Every day that passed
would feel unacceptable, right?

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But guess what?

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There are many diseases for which
we have treatments and even cures,

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and yet people keep being infected
and die every year.

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Let's take tuberculosis:

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10 million people infected every year,

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1.5 million people dying,

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although we've had a cure for years.

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And that's just because
we haven't completely figured out

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some of the key access issues.

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Equitable access is the right thing to do,

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but beyond this humanitarian argument

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that I hope we are more sensitive to

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now that we've
experienced it in our flesh,

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there is a health and an economic argument

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to equitable access.

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The health argument is that
as long as the virus is active somewhere,

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we're all at risk of reimported cases.

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The economic argument is that
because of the interdependencies

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in our economies,

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no domestic economy can fully restart
if others are not picking up as well.

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Think of the sectors
that rely on global mobility,

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like aerospace or travel and tourism.

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Think of the supply chains
that cut across the globe,

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like textiles or automotive.

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Think of the share of the economic growth
that is coming from emerging markets.

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The reality is that we need all countries
to be able to crush the pandemic in sync.

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So not only is equitable access
the right thing to do,

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it is also the smart thing to do.

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But how do we do that?

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Let's make sure we're on the same page
in terms of what "access" means.

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It would actually mean
that the product exists;

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that it's working sufficiently well;

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that it's been approved
by the local authorities;

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that it is affordable;

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but also that there is evidence
that it works in all the populations

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that need it,

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and that can include pregnant women
or immunodepressed people, or children;

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that it can be distributed
in a variety of settings,

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like hospitals or rural clinics,
or hot climate or cold climate;

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and that we can produce it
at the right scale.

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It's a very long checklist, I know,

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and in a non-crisis situation,

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we would likely address these issues
one after the other in a sequential way,

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which takes a lot of time.

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So what do we do?

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Access is far from being a new challenge,

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and in the case of COVID,

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I have to say, we're seeing
extraordinary collaboration

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of international organizations,
civil society, industry and others

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to accelerate access:

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working things in parallel,

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speeding up regulatory processes,

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engineering supply mechanisms,

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securing procurement,
mobilizing resources, etc.

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Yet we are likely to face a situation
where, for instance,

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the vaccine would need to be
constantly stored at, let's say,

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minus 80 Celsius degrees;

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or where the treatment
would need to be administered

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by a highly specialized
health care worker;

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or where the diagnostic
would need to be analyzed

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by a sophisticated lab.

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So what more can we do?

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Pushing further the logic
that the global health community

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has advocated for for years,

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there is one additional thing
I can think of that might help.

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There is a concept
in product development and manufacturing

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that's called "design to cost."

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The basic idea is that
the cost management conversation

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happens at the same time
as the product being designed,

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as opposed to the product
being designed first

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and then reworked to bring the cost down.

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It's a simple method that helps ensure

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that when cost has been identified
as a priority criteria for a product,

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it's made a target from day one.

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Now, in the context of health and access,

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I think there is untapped potential

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in R and D to access,

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the same way that
manufacturers design to cost.

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This would mean that,
instead of developing a product

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and then working to adapt it
to ensure equitable access later,

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all of the items
on the checklist I mentioned

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would be built into the R and D process
from the beginning,

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and this would actually benefit us all.

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Let's take an example.

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If we develop a product
with equitable access in mind,

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we might be able to optimize
for scale-up faster.

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In my experience, drug developers
often focus on finding a dose that works,

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and only after do they optimize
the dosage or make adjustments.

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Now imagine that we're talking
of a candidate product

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for which the active ingredient
is a scarce resource.

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What if instead we focused
on developing a treatment

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that uses the lowest possible amount
of that active ingredient?

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It could help us produce more doses.

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Let's take another example.

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If we develop a product
with equitable access in mind,

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we might be able to optimize
for mass distribution faster.

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In high-income countries,

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we have strong health systems capacity.

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We can always distribute
products the way we want.

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So we often take for granted
that products can be stored

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in temperature-controlled environments

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or requires a highly skilled
health care worker for administration.

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Of course,

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temperature-controlled environments
and highly skilled health care workers

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are not available everywhere.

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If we were to approach R and D

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with the constraints
of weaker health systems in mind,

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we might get creative

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and develop sooner, for instance,
temperature-agnostic products

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or products that can be taken
as easily as a vitamin

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or long-lasting formulations
instead of repeat doses.

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If we were able to produce and develop
such simplified tools,

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it would have the added benefit

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of putting less strains
on hospitals and health systems

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for both high- and low-income countries.

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Given the speed of the virus

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and the magnitude
of the consequences we're facing,

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I think we have to continue
challenging ourselves

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to find the fastest way
to make products to fight COVID

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and future pandemics accessible to all.

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In my perspective,

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unless the virus disappears,

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there are two ways this story ends.

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Either the scales tip one way --

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only some of us get access to the product

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and COVID remains a threat to all of us --

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or we balance the scales,

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we all get access to the right weapons,

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and we all move on together.

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Innovative R and D can't beat COVID alone,

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but innovative management
of R and D might help.

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Thank you.