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