What it takes to crush a pandemic
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0:02 - 0:04My son was born in January 2020,
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0:04 - 0:06shortly before the lockdown in Paris.
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0:06 - 0:08He was never scared
of people wearing masks, -
0:08 - 0:10because that's all he knows.
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0:10 - 0:14My three-year-old daughter knows
how to say "gel hydro-alcoolique." -
0:14 - 0:18That's the French word
for hydroalcoholic gel. -
0:18 - 0:20She actually pronounces it
better than I do. -
0:21 - 0:23But no one wants to be wearing a mask
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0:23 - 0:27or wash their hands
with hand sanitizer every 20 seconds. -
0:27 - 0:32We're all desperately looking at R and D
to find us a solution: a vaccine. -
0:32 - 0:34It's interesting that in our minds,
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0:34 - 0:38we keep thinking of the vaccine discovery
like it's the Holy Grail. -
0:39 - 0:42But there are a couple of shortcuts here
that I'd like to unpack. -
0:42 - 0:45I'm not a doctor, I'm just a consultant.
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0:45 - 0:47My clients focus on health care --
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0:47 - 0:51biopharma companies, providers,
global health institutions -- -
0:51 - 0:53and they've educated me.
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0:54 - 0:56We need to find the tools to fight COVID,
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0:56 - 0:59and we need to make them
accessible to all. -
1:00 - 1:04First, one single vaccine
will not get us out of this. -
1:04 - 1:06What we need is an arsenal of tools.
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1:06 - 1:10We need vaccines, we need therapeutics,
we need diagnostics -
1:10 - 1:15to make sure that we can prevent,
identify and treat COVID cases -
1:15 - 1:17in a variety of populations.
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1:17 - 1:21Second, it's not just
about finding a tool. -
1:22 - 1:25What do you think will happen
when one of those clinical trials -
1:25 - 1:27demonstrates that the tool is effective?
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1:27 - 1:30Do you think we can all
run to the pharmacy next door, -
1:30 - 1:32we get the product,
we take off our masks -
1:32 - 1:34and we go back to French kissing?
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1:35 - 1:36No.
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1:37 - 1:40Finding an effective tool
is just one step in this big fight, -
1:40 - 1:43because there is a difference
between the existence of a product -
1:43 - 1:45and access to that product.
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1:46 - 1:47And now you're thinking,
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1:47 - 1:50"Oh -- she means other countries
will have to wait." -
1:51 - 1:53Well, no, that's not my point.
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1:53 - 1:55Not only others may have to wait,
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1:55 - 1:57but any of us may have to.
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1:57 - 1:59The humbling thing about COVID
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1:59 - 2:02is that because of its speed
and magnitude, -
2:02 - 2:04it's exposing all of us
to the same challenges -
2:04 - 2:08and giving us a flavor
of challenges we're not used to. -
2:08 - 2:11Remember when China got into lockdown?
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2:11 - 2:13Did you imagine that you
would be in the same situation -
2:13 - 2:15a few weeks after?
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2:15 - 2:17I certainly didn't.
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2:17 - 2:21Let's go to the theoretical moment
when we have a vaccine. -
2:21 - 2:23In this case, the next access challenge
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2:23 - 2:25will be supply.
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2:25 - 2:27The current estimate
of the global community -
2:28 - 2:30is that by the end of 2021 --
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2:30 - 2:33so that's over a year after
the discovery of the vaccine -- -
2:33 - 2:36we would have enough doses
to cover one to two billion -
2:36 - 2:38of the eight billion of us on the planet.
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2:39 - 2:40So who will have to wait?
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2:41 - 2:44How do you think about access
when supply is short? -
2:45 - 2:46Scenario number one:
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2:46 - 2:48we let the market forces play,
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2:48 - 2:52and those who can pay the highest price
or be the fastest to negotiate deals -
2:52 - 2:54will get access to the product first.
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2:54 - 2:56It's not equitable at all,
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2:56 - 2:58but it's a very likely scenario.
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2:58 - 3:00Scenario number two:
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3:00 - 3:02we could all agree,
based on public health rationale, -
3:02 - 3:04who gets the product first.
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3:04 - 3:07Let's say we agree that
health care workers would get it first, -
3:07 - 3:09and then the elderly
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3:09 - 3:11and then the general population.
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3:11 - 3:13Now let me be a bit more provocative.
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3:13 - 3:14Scenario number three:
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3:16 - 3:19countries who have demonstrated
that they can manage the pandemic well -
3:19 - 3:21would get access to the product first.
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3:22 - 3:24It's a little bit extrapolated,
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3:24 - 3:26but it's not complete science fiction.
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3:26 - 3:31Years ago, when the supply of high-quality
second-line tuberculosis drug was scarce, -
3:31 - 3:33a special committee was established
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3:33 - 3:36to determine which countries
had health systems that were strong enough -
3:36 - 3:39to ensure that the products
would be distributed properly -
3:39 - 3:43and that patients would follow
their treatment plans properly. -
3:43 - 3:45Those select countries got access first.
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3:47 - 3:48Or, scenario number four:
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3:48 - 3:50we could decide on a random rule,
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3:50 - 3:53for instance, that people get
to be vaccinated on their birthday. -
3:54 - 3:56Now let me ask you this:
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3:56 - 4:01How does it feel to think of a future
where the vaccine exists, -
4:01 - 4:05but you would still have to wear a mask
and keep your kids home from school, -
4:05 - 4:08and you would not be able
to go to work the way you want -
4:08 - 4:10because you wouldn't
have access to that product? -
4:12 - 4:15Every day that passed
would feel unacceptable, right? -
4:15 - 4:17But guess what?
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4:17 - 4:21There are many diseases for which
we have treatments and even cures, -
4:21 - 4:25and yet people keep being infected
and die every year. -
4:26 - 4:28Let's take tuberculosis:
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4:28 - 4:3110 million people infected every year,
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4:31 - 4:331.5 million people dying,
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4:34 - 4:36although we've had a cure for years.
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4:36 - 4:39And that's just because
we haven't completely figured out -
4:39 - 4:41some of the key access issues.
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4:42 - 4:45Equitable access is the right thing to do,
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4:46 - 4:48but beyond this humanitarian argument
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4:48 - 4:50that I hope we are more sensitive to
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4:50 - 4:53now that we've
experienced it in our flesh, -
4:53 - 4:55there is a health and an economic argument
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4:55 - 4:56to equitable access.
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4:57 - 5:01The health argument is that
as long as the virus is active somewhere, -
5:01 - 5:03we're all at risk of reimported cases.
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5:04 - 5:08The economic argument is that
because of the interdependencies -
5:08 - 5:09in our economies,
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5:09 - 5:14no domestic economy can fully restart
if others are not picking up as well. -
5:15 - 5:17Think of the sectors
that rely on global mobility, -
5:17 - 5:20like aerospace or travel and tourism.
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5:20 - 5:23Think of the supply chains
that cut across the globe, -
5:23 - 5:25like textiles or automotive.
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5:25 - 5:28Think of the share of the economic growth
that is coming from emerging markets. -
5:29 - 5:34The reality is that we need all countries
to be able to crush the pandemic in sync. -
5:35 - 5:38So not only is equitable access
the right thing to do, -
5:38 - 5:40it is also the smart thing to do.
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5:41 - 5:43But how do we do that?
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5:44 - 5:47Let's make sure we're on the same page
in terms of what "access" means. -
5:47 - 5:50It would actually mean
that the product exists; -
5:50 - 5:53that it's working sufficiently well;
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5:53 - 5:55that it's been approved
by the local authorities; -
5:55 - 5:57that it is affordable;
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5:57 - 6:00but also that there is evidence
that it works in all the populations -
6:01 - 6:02that need it,
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6:02 - 6:06and that can include pregnant women
or immunodepressed people, or children; -
6:06 - 6:09that it can be distributed
in a variety of settings, -
6:09 - 6:14like hospitals or rural clinics,
or hot climate or cold climate; -
6:14 - 6:17and that we can produce it
at the right scale. -
6:17 - 6:19It's a very long checklist, I know,
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6:19 - 6:21and in a non-crisis situation,
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6:21 - 6:26we would likely address these issues
one after the other in a sequential way, -
6:26 - 6:27which takes a lot of time.
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6:28 - 6:30So what do we do?
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6:31 - 6:33Access is far from being a new challenge,
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6:33 - 6:35and in the case of COVID,
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6:35 - 6:38I have to say, we're seeing
extraordinary collaboration -
6:38 - 6:42of international organizations,
civil society, industry and others -
6:42 - 6:43to accelerate access:
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6:43 - 6:45working things in parallel,
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6:45 - 6:47speeding up regulatory processes,
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6:47 - 6:49engineering supply mechanisms,
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6:49 - 6:52securing procurement,
mobilizing resources, etc. -
6:53 - 6:57Yet we are likely to face a situation
where, for instance, -
6:57 - 7:00the vaccine would need to be
constantly stored at, let's say, -
7:00 - 7:02minus 80 Celsius degrees;
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7:02 - 7:05or where the treatment
would need to be administered -
7:05 - 7:07by a highly specialized
health care worker; -
7:07 - 7:10or where the diagnostic
would need to be analyzed -
7:10 - 7:11by a sophisticated lab.
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7:12 - 7:14So what more can we do?
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7:15 - 7:18Pushing further the logic
that the global health community -
7:18 - 7:20has advocated for for years,
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7:20 - 7:23there is one additional thing
I can think of that might help. -
7:24 - 7:27There is a concept
in product development and manufacturing -
7:27 - 7:29that's called "design to cost."
-
7:29 - 7:32The basic idea is that
the cost management conversation -
7:32 - 7:34happens at the same time
as the product being designed, -
7:34 - 7:37as opposed to the product
being designed first -
7:37 - 7:39and then reworked to bring the cost down.
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7:40 - 7:42It's a simple method that helps ensure
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7:42 - 7:47that when cost has been identified
as a priority criteria for a product, -
7:47 - 7:49it's made a target from day one.
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7:49 - 7:53Now, in the context of health and access,
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7:53 - 7:55I think there is untapped potential
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7:55 - 7:56in R and D to access,
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7:56 - 7:59the same way that
manufacturers design to cost. -
8:00 - 8:04This would mean that,
instead of developing a product -
8:04 - 8:08and then working to adapt it
to ensure equitable access later, -
8:08 - 8:11all of the items
on the checklist I mentioned -
8:11 - 8:14would be built into the R and D process
from the beginning, -
8:14 - 8:16and this would actually benefit us all.
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8:16 - 8:18Let's take an example.
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8:18 - 8:22If we develop a product
with equitable access in mind, -
8:22 - 8:25we might be able to optimize
for scale-up faster. -
8:26 - 8:30In my experience, drug developers
often focus on finding a dose that works, -
8:30 - 8:34and only after do they optimize
the dosage or make adjustments. -
8:35 - 8:37Now imagine that we're talking
of a candidate product -
8:37 - 8:40for which the active ingredient
is a scarce resource. -
8:40 - 8:44What if instead we focused
on developing a treatment -
8:44 - 8:47that uses the lowest possible amount
of that active ingredient? -
8:48 - 8:50It could help us produce more doses.
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8:51 - 8:53Let's take another example.
-
8:53 - 8:56If we develop a product
with equitable access in mind, -
8:56 - 8:59we might be able to optimize
for mass distribution faster. -
9:00 - 9:01In high-income countries,
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9:01 - 9:03we have strong health systems capacity.
-
9:03 - 9:06We can always distribute
products the way we want. -
9:06 - 9:09So we often take for granted
that products can be stored -
9:09 - 9:11in temperature-controlled environments
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9:11 - 9:15or requires a highly skilled
health care worker for administration. -
9:16 - 9:17Of course,
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9:17 - 9:20temperature-controlled environments
and highly skilled health care workers -
9:20 - 9:22are not available everywhere.
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9:22 - 9:24If we were to approach R and D
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9:24 - 9:27with the constraints
of weaker health systems in mind, -
9:27 - 9:29we might get creative
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9:29 - 9:32and develop sooner, for instance,
temperature-agnostic products -
9:33 - 9:35or products that can be taken
as easily as a vitamin -
9:35 - 9:39or long-lasting formulations
instead of repeat doses. -
9:40 - 9:45If we were able to produce and develop
such simplified tools, -
9:45 - 9:47it would have the added benefit
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9:47 - 9:50of putting less strains
on hospitals and health systems -
9:50 - 9:53for both high- and low-income countries.
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9:54 - 9:55Given the speed of the virus
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9:55 - 9:58and the magnitude
of the consequences we're facing, -
9:58 - 10:00I think we have to continue
challenging ourselves -
10:01 - 10:04to find the fastest way
to make products to fight COVID -
10:04 - 10:06and future pandemics accessible to all.
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10:07 - 10:08In my perspective,
-
10:08 - 10:10unless the virus disappears,
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10:10 - 10:12there are two ways this story ends.
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10:12 - 10:14Either the scales tip one way --
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10:14 - 10:16only some of us get access to the product
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10:16 - 10:19and COVID remains a threat to all of us --
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10:19 - 10:21or we balance the scales,
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10:21 - 10:23we all get access to the right weapons,
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10:23 - 10:25and we all move on together.
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10:27 - 10:29Innovative R and D can't beat COVID alone,
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10:29 - 10:32but innovative management
of R and D might help. -
10:32 - 10:34Thank you.
- Title:
- What it takes to crush a pandemic
- Speaker:
- Johanna Benesty
- Description:
-
An effective COVID-19 vaccine is just the first step in ending the pandemic, says global health strategist Johanna Benesty. In this illuminating talk, she explores the various barriers to “equitable access” -- making sure COVID-19 therapeutics are available to all -- and shares a creative approach to research and development that could ensure vaccines are rolled out fairly, efficiently and at a global scale.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 10:46
Erin Gregory commented on English subtitles for What it takes to crush a pandemic | ||
Erin Gregory edited English subtitles for What it takes to crush a pandemic | ||
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Erin Gregory edited English subtitles for What it takes to crush a pandemic | ||
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Camille Martínez edited English subtitles for What it takes to crush a pandemic | ||
Camille Martínez edited English subtitles for What it takes to crush a pandemic |
Erin Gregory
12/02/2020:
Title changed to "What it takes to crush a pandemic"