Collectively have map of the system necessary to record peoples deaths in a way that protect livelihood. List is not only dishonor sacrifices but to creates unnecessary suffering how is it possible to assess with a large share of dust in the noncovered year go unreported . If mortality data of any kind is being reported in the Public Domain according to the 2019 mortality report. And to on death in real time and then to generate the reliable cause of death we look at examples of countries have started off for those a struggle to produce accurate and timely data what can we do and what other Innovative Strategies are being tested what can we see on the Global Community and this work and how to remove this further up the agenda . And with those vital strategies the assistant director general for Data Analytics of the who Just Launched their own initiative and Aaron Nichols with Vital Statistics at the us center for Disease Control so lets get started now i will turn it over. Thank you so much. Just give me one moment to share my screen. And now i put into presentation mode. Thank you for joining us. This is an important topic this is know your epidemic andat response claimed over a decade ago but during the covid pandemic we believe every country should know the scope and scale to the greatest extent possible to shape the datadriven response here we have the who global dashboard. Itoa does represent death and unconfirmed cases do to cope 19. We need to be careful to interpret these numbers particularly the measures of death and immortality in the data coming from middle Income Countries. As amanda indicated this will focus to access mortality we feel captures the full scope and scale of the goal of the pandemic. It should be known the early days in the pandemic there have been shortages and concerns over testing with the scopert and scal scale. There have been worries of over Testing Capacity not to mention high Income Countries like the united states. Looking at the implications when it comes to interpreting big numbers. One plant i would like to make is testing as has been argued is an essential service and in the absence of the vaccine are highly effective treatment , this is something that which we could all concur and the reality on the ground is it is highlygh variable and often inadequate. Gifted in the scarcity it is on symptomatic cases and to identify cases so the question here is what are the implications for that scope and scale of the total burden of the pandemic . And as can be seen the center counts cases in the Community Meaning who warned it could be the tip of the iceberg in terms of the actual number of cases detected. What about death . The key picture im trying to paint today is a murky picture because we do not have data in hand in many places. The who dashboard tallied those covid deaths as of the past wednesday but again, we need to unpack those numbers coming from countries that are robust statisticsl and civil legislation programs and those systems that are in the Health Sector not yet capable of delivering and providing timely data on the cause of death so there are two issues pricing in particular the first pertains to getting the death numbers might themselves so that depends on the adoption of important guidance issued by the who and how to code a covid19 death suspected or confirmed this can get a little complicated those comorbidities for example but the upshot is both sides need to be disseminated and manifested in the practices of those to have a very robust measure of suspected mortality. The second issue to call attention to is what is left out of the frame completely i focus on covid death and mortality. Namely those they cannot be certified with the stark reality in her opening remarks. We weed out those that arise from descriptions due to overextended Health Systems and those that people avoid or delay seeking hospital care for your action or they might be infected or separated from family and taken away. Also excluding emergency room death those who are not counted all of these and many places for the majority of deaths even before the pandemic were occurring at home and in many african context this contributes to a murky picture we only have a hypothesis at the moment of the indications comparatively few were for unexpectedly low cases at the moment of death occurring during the pandemic. Is this really a factor of limited Testing Program and because of Surveillance Systems were not in place we might of missed the arrival of the virus and with those that are older ages in particular and with that age structure and residential patterns of the population. So when we need to think in terms of parsing out mortality but then this brings us to the idea of access mortality. A fairlyay comprehensive way the full cost of the pandemic all those regardless of cause age and sex and location to get that on a weekly basis so we are tracking today the current levels of mortality the second piece of measuring access mortality is to establish a baseline of those historically observed death for the same epidemiological weight and location sometime in the past and to be expected. And with those causes of death are a result of the factors i outlined a moment sor ago and those visualizations are more common we have the graph from switzerland published by the economist they are increasingly using visualization to represent the pandemic. Thats well and good but paying us back to her main concern that they are not able to particularly from the community . At the moment at least 13 countries and more every day with the support of bloomberg the word philanthropy leverage to measure access mortality in part the package we have produced in partnership with the who and with those partners in africa and asia. The technical packages assisting countries on the spectrum of system readiness if you well. s showing a graph from brazil the countries produce seen rapid mortality rapid mortality surveillance was the innovative use of public data brazil and other countries such as colombia and peru have the availability of data to make fairly minor innovations compared to where we haverd been working to establish those measures ofre access mortality that surveillance can produce. So now with discussion of low Income Countries we find that in the settings systems due to lack coverage and Company Lists on completeness and coming up with ways to measure incident death more complex and resource intensive with the notable exception of south africa this is generally thehege case of africa and Southeast Asia were government has a need to measure mortality from the community because her such a big burden that exist regardless and to form a complete picture. Our early experience has shown the Community Based surveillance piece of the Technical Work that needs to be accomplished is a bit more challenging than the facility based up and running but in that regard Growth Strategy has been working including bangladesh and senegal so with those routine Health Information system memphis reporting to a weekly basis those that leverage and functionality and the district Health Information. And Community Based rapidh surveillance that is reported o on, we are supporting the government g of columbia and bangladesh to undertake this work. The intention is to reach remote and harder to access parts of the population and in bangladesh we have us expanding model be able to identify that on a more rapid basis than previously was the case under the Civil Registration system there. Supporting countries to produce this data in addition to advocacy or misinformatio misinformation, access mortality data is in with other indicators with the geographicic disparities. Death registration during the pandemic that is rampant mortality can shore up the death registration during the pandemic and in fact, we are working with one country we know knowledge is key to the response and a focus on solely covid19 deaths we have to unpack it whether its insufficient to understand the magnitude it was the relative thing to do to fill the space of knowing the epidemic and the crucial statistics. I would argue that it also adds to the urgency. The longterm solution for a resilient system they summed it up nicely i thought and these are the words i will leave you with. She said weve als we also reale need for the resilience emergency systems such as covid19 to meet the needs not only of the population but of theio vulnerable and marginalizd populations in the country. Great overview to get us kicked off and now i would like to turn over with vital strategies for work in brazil looking at the mortality measurement. Good morning, good afternoon, good evening. With a consortium for the department and states and also to [inaudible] and 2020. Natural cause and data because we compare it today and we can y the views and you can see it is one state and you can see the gap between the blu blue line ad the red line. This is in 2020 and the red line we apply the correction when needed as an example. Also used as a reference. [inaudible] and to get it by state or region. Next, please. We fused the definition and the data but we work to continue it [inaudible] with a consortium of the Health State Department and using the Historical Data using the data the resistant and the country with more distant parties. But you can see here it is increasing and areas at the end of may and beginning of june start to decline. So we dont believe that its going down so fast as we are discussing with the administration. Next, please. [inaudible] and you see that its started to peak in june at the peak of mortality and this is still going on in the region. In the radio dj genaro state it was early. Now we see in this period its starting to increase again. We are following this space closely and other spaces as well. In the last few numbers we had the most popular states in the country with higher numbers and in the percentage we see that 74 in the amazon space, so it was early, the beginning of marchaz and it collaborated in e most [inaudible] and also with argentina its a small increase in infant mortality because it is still ongoing in this area so to the current country sides now it is moving to the south. Next, please. We have mortality, but who was dying . Much more male dying compared to women, the average compared to women, 18 . But we have 50 in the north region so its a huge difference among men and women and also in the age group, 60 or moreyearsold so the impact was in the average 28 but in some regions itn was higher. And also more balance so we have this cooperation we hav weve sn the next slide please [inaudible] it is an ongoing work for the vulnerable pollution and the Inadequate Health to focus. Its the most popular in the states in the country with 60 of the population white, but you see the excess mortality among the black and brown compared to 11 among the white population. In other states yo the other ste it, tomac. More black and brown people dying than white in this excess mortality. And when we move it to the right, we can see we had 42 excess mortality among black and brown in this age group compared to 24 within the white populations in the group. The other states have more balanced distribution. We are discussing this more vulnerable population and how we can use the excess mortality to paint a picture of the impact. Next, please. , so the excess mortality [inaudible] its been used for decisionmakers, Civil Societies and others to discuss with us how to [inaudible] the national new space is showing they havent been following every week so its fallen. Next please. So, also it is a source of data and agencies using the excess mortality data, so for instance 100,000 deaths and massive 100,000 deaths [inaudible] they would die anyway so they started to use the excess mortality to show people are dying excess mortality. We estimate that its very close, around 80 . [inaudible] to the next one. Here is the dashboard recognizing mortality and then the new dashboard in comparing the resistance by states using [inaudible] [inaudible] its higher compared to hear, but here its a lower population. We realize we need to correct because when the pandemic moves, they are delaying it we are discussing about it with the groups how to do this correction but right now we should be focused on describing the direction. Thats what i have to show you and i would like to thank you for the opportunity to show the excess mortality rate. Ou thank you so much. That was really interesting and in particular completely obvious the implications of this data for the system response and geographical focus and reaching vulnerable groups and the implications arege very clear, o thank you for that presentation. Lets now turn to Aaron Nichols. Youve been working on this from a global perspective but also sitting at the u. S. Centers for Disease Control. Whats your view on the sort of state of the systems at this stage, and what else do we need to do better on . Good day, everyone. I lead a small team focused on global registration and Vital Statistics improvements situated at the cdc and the National Center for health statistics. Since15 2015 weve partnered wih vital strategies and who through the bloomberg data initiative. To support one of the growing number of initiatives that in the last ten to 15 years focused on improving Civil Registration and Vital Statistics or low and middle Income Countries so its all laid out the forces behind the challenges we are trying to tackle through that initiative. So now in parallel to this ongoing momentum for fear of the improvement, there is a critical demand for a timely mortality data. Surveillance callings throughout the cdc are looking at what data is available across a multitude of existing surveillance platforms and thinking about how these platformsms can be leverad to compile mortality information. A unique openness and convergence of the Data Collection efforts among the cert communities they lead us to lasting change. If i could be a bit academic for a minute, Civil Registration is the continuous permanent universal recording of the occurrence and characteristics of the vital events. So in this case, we focus on death or mortality. Civil registration is the ideal source of mortality information because of these characteristics in the system. Unlike surveys which are more oneoff or intermittent, Civil Registration is continuous, permanent and universal. Because it is compulsory by law it provides the basis for everyone to participate in f the system. Weve always recognized the value of the data and one of the most regular users engaged in that with other sectors including registration officials that are typically in the home affairs required to achieve a comprehensive Mortality Program that is linked with Civil Registration. This engagement requires more time, attention and coordination than the vertical disease Surveillance System has traditionally been able to give and so we hope to leverage the interest and mortality surveillance. I will share a little more background about the team and how weve pivoted with the arrival of covid19 and what we are thinking about as we move ahead in this space. As the partner for the initiative, our team has been supported in the guidance just described in its development and implementation wereon helping to coordinate multiple partners to support a comprehensive mortality Surveillance Program with components in both uganda and zambia. We coordinate a Community Focused on the Death Investigation which is f to shae covid19 death certification guidelines among a global forum of medical examiners. To help identify a probable cause of death when theres no position to certify it, the team also works with who and the Reference Group and for covid19, we have compiled guidance on the use of the verbal and context of covid19 and we are now coordinating an evaluation to assess whether the new t questions can identify probable covid19 deaths. And finally, supporting the u. S. Cdc International Covid response, the team iss working for the existing surveillance platforms in response to the demand for information on mortality. So, to slides to show here. Can you help show those, please. There we go. We developed this slide to show the various potential sources of information across the platforms. Cdcs purported activities include the Child Health MortalityPrevention Initiative which is funded by the bill and Melinda Gates foundation, and mortality surveillance work through u. S. U government suppo. With the many possible sources of information theres opportunities at bringing these together in a useful manner requires extensive coordination and support that our team is working to provide the next slide, please. So, in the second slide we see a contrast among the countries on the complete lack of information on the cause of death that is officially compiled. The countries in gray on the slide have no data available. To take the information paradox where in the places we need information the most as supporting partners is available. But as was shown in the first slide, we do have many potential sources and an opportunity now to bring them together for optimal use. So, looking forward, we are working l on an implementation package for comprehensive Surveillance Programs, one thata for example may be hosted by the Public Health institute and together with our colleagues across the cdc we are supporting efforts to coordinate and integrate the Health Information systems to clarify the roles and responsibilities across the agencys and to facilitate efficient secure data sharing across all stakeholders that need information. And for these efforts, the regional partners including who, the Mortality Program, the Un Economic Commission for africa and the economic and Statistical Commission for asia and the pacific play a critical and complementary role advocating at the highest levels of government and providing important coordination among the relevant government agencies. So, in short, the pandemic has underscored the need for the harmonized and timely system and we need to build a home forr the rapid efforts within a comprehensive program thator is backed by the continuous compulsory universal structure inherent to the Civil Registration of the statistics that supports the human rights. Thats all for me. Im pleased to be part of the forum and im looking forward to theki discussion. Thank you. And thank you also for sharing the slide that shows, you know, theres a lot thats been done that as we can see is directed to specific populations or specificsp diseases and togethei think i like your word optimize. I might come back to you to reflect on how easy that is or not and what kind of things you think might make it easier. But now lets go to doctor zamir organizationhealth to reflect a little on this issue from her perspective and some new ideas in terms of veilding rapid mortality surveillance. Thank you, amanda. Can you hear me . Yes, perfectly. Hello to the panelists and colleagues and all of the listeners. Thank you for having me as well asav who to have a discussion on this very important and timely topic. Data matters, timely, reliable, actionable data is very important. I will make a few points here. Twelve of the 17, and 67 out of 234 indicators rely on good or wellfunctioning Civil Registration and vitalst statistics. It is the bedrock of Public Health. Today we are reporting 973,000 deaths due to covid. We know this is the number that isis reported and we also had earlierls discussions that this may be an underreported because the deaths are often lagging but there are also other reasons of underreporting. What im told is 73 of registered and only 50 of deaths are registered. And only half of the 194 Member States report on only 80 of deaths for 15 years and older and only one third of the country report accurately on the causes of death. So what we are seeing today in the midst ofay the pandemic is a reflection of a longstanding problem and this is what many experts around the world have come together and established a mechanism of the rapid mortality surveillance. The other area is how do countries report 35 deaths. Ou we are getting the reports from the countries to the surveillance mechanism from the facilities and as mentioned, they are occurring out of facilities, in the communities and that is where the problem is. That lies with the different ministries. That is also an inherent proble problem. And the coordination with the Initiative Led by the bloomberg pletters and those organizations including who and the oppressive efforte. That has to be scaled at speed. And it recognizes of the community we ought to invest in countries and those that are facing the problems. And that we are having problems. Also not to forget every death reported a person is left behind and often we forget that. And more importantly and then to for response and as you rightly said amanda and then with their eyes closed to be blinded or shooting in the dark. And solutions and the work underway so what we have done rapidlyap and then to work with the Member States to report on certified debt. And on a biweekly basis by age, and pride causes those who often frequently says we cannot make progress if we cannot measure progress. It is a simple concept. So youre working with countries to support the countries in a rapid manner to get the certified debt. So then this process will continue and so with that mortality the database approved by Member States and the debt debt dates back to the 19 fifties it is a unique database. And then launching the inherent database and a couple of months. So third, given the challenges that you have heard who has tiprioritized the flagship gsinitiative within the Data Analytics. Local Data Architecture to drive delivery to make who a more datadriven organization as ati flagship and with that initiative who has not been transformed since its inception and that we are responsive and embracing partnerships and being able to support in a coordinated way so a month ago we launched the score for Health Technical package for data. And each stands for the surveillance of population. And then to call for investment into the data systems. Finally, actionable data to have the user data to drive policies and programs and ultimately have a measurable impact in the lives of the people we are serving. And Going Forward they have done the selfassessment of where they stand for each of these elements. To be launched in november so that we can make targeted interventions and support in areas that they are requesting the support. Now coming back to covid with the direct and indirect impact of covid19. And to have all that debt quantified and that is with the rapid mortality surveillance comes into play with an important area of work. One country there or two there were five here. We dont have time nine and a half years. So many of the indicators rely on the good causes of debt and debt information. So the question here is, will we fill the gap and fix the problem and take another nine years . To find those partners that are influential to make it happen. We know that it will cost. And thats the message i would like us to take away and who with the bilateral National Governments are planning to have a meeting in march with the commission to make a renewed call to action but in 2021 it is very ambitious but we must be able to say x number of countries that has been reported but also a sustained capacity and the centers of excellence that have been established we and also talking about bangladesh to score properly and quickly as soon as possible. So with that and i look forward to coming together to take a leap forward to address this problem and find a solution which we already. Have. And to make a measurable difference. Thank you for joining us. This is one of the areas where we do know what to do. Can we invest as much in the core data and then that experience so let me ask you a followup question on the issue of innovation of these continuous universal systems and with the powers of classification and with general weaknesses and then to reflect on the innovations with the standard percent in the private sector why is it so slow i can we do that in real time it would be easy enough to collect this information and in some cases the Health System and if i understood your presentation further fixes out there you have seen that are promising . I think there are Technological Innovations i am sure you kurds segment further but for our brief discussion with talk about Technological Innovations and what we moved forward as a cause of death like the dhi hris to system to generate automated cause of death assignment to the application there is the automated cause of death assignment and also into the coding and then to make sure the whole sector and those that are notified to the registration authorities for later followups. And in the context of covid but to take the surveillance viewpoint with the programs of integrated disease and response that are widespread surveillance platform in africa and then to have an on ramp to the system for detecting Community Deaths in a way that they badly need to get a handle on the Community Burden of mortality. I will throw those thoughts out. Thank you so much. And the cause of death and also people dont resist that they dont have any reason. And the dont have Life Insurance and then to make it muchuc more so if you can work with communities that they will come and do this and then is just because it is not official. And i agree that we are talking politics the technology and experience and to agree with that plan. And thank you for reminding us of the point what is that incentive any individual has to report the injustice occurred if not working in the Health Facility . And those to make that information relevant to them in their lives. You want to reflect on the question of innovation . But to add to that it has forced us to test the limits of what we can do with this new Technical Area and cadre of the workforce. And as a community of practice and those medical examiners not only one but a small handful working very h much in isolation so to use those virtual platforms to give them a c chance to reiterate and review and the mainstream news and that is a great contribution to improving and then in complete info practice in the has to be reviewed manually and to facilitate bimonthly that of those coders inn india so we can link them with experts with have experience and continue to develop their knowledge. Talking about mobilephone service and researchers are in the business about and for that mortality measurement and extending a reallife Sample Survey you would just expect to unmute three. Of people and technology in partnership. We have to invest to build the capacity to provide the incentive where is the attraction that is left behind and those medical causes of death in that certification in the medical schools but at a global scale. And those that are extremely important and now we dont need to travel and be in the workshop this could be training anytime anywhere with mentorship from people who have done it and incentives to the mentors. So that community is prioritized. Second because that we have seen and as a result because of covid a lot of innovation and those that have come up with Good Solutions virus was mentioned and to launch the updates with a very cost efficien par affordabley in the community and community is in other areas we should use those experiences for this purpose. Finally cannot be fragmented Publicprivate Partnership at all levels here but with this approach standard will be extremely important so we dont keep reinventing the wheel and go in different areas not making the impact this area demands. So the combination of people and information and technology and tools in partnershipnd. So let me just as the audiences will come to write in questions on twitter to submit questions. I have a question of course the see brs Community Asked for this before but a lot of these ongoing activities and earmarked money for specific diseases it is hard to deploy for system uses can you reflect on the obstacles you see two Getting Better coordination what we can do about it . We all wanted to work out and then its hard to get everyone to move in the same direction what are your thoughts on that quick. Off the top of my head, he would stand back to view these things from a distant perspective. I doee see progress and see djs in that kind of support now compared to ten years ago or more when we first was the call or addressing the scandal of invisibility that we named it at the time. Certainly thereil is progress of what we find we can make progress on the back hitched to another wagon even the global Financing Facility was under maternal and child health. Or pratchett on precious views that are for see brs data strengthening and for using those data to have impact more importantly. There are two or three strategic alliances that we need to make one is the identityty Management System to proliferate throughout the world and the relationship to establish legal identity see brs is the subject of the High Level Panel at the United Nations and it has been pointed out to see brs is a foundational system for legal identity and that is to the system the death of the individual that needs to retire a record so there should be a symbiotic relationship with the community. The driverss government. One of the drivers of improvement from the eu is the idea we can avoid the expense of having Voter Registration role with proper identity Management Systems in place rather than recreating once every election cycle. I have seen investment come from thattm space. So between that the Governance Community also very much womens rights and gender issue and allies in that space are a Natural Alliance for partnership as was nicely pointed out i will stop there. For measures of quality in general i think the presentation really shows for the Vulnerable Community and the quality do you have any thoughts on the amount of progress made on this where do the leadership come from and what has worked well quick. And thinking how we prioritize because with the surveillance any demand from others from the community and National Community for health and in the country when we had nono commitment so what is that Public Policy . Writing with all the interest from the community . It is not so important to sit at the desk but it is important to them they want to know. It is their interest because they will help the Public Policy they are much more interested to work with and to communicate into the community with more official cemeteries. But with your own people and in the most remote areas will not improve. But if we can move it to create alliance is not just the people in the government but also people in the interest in the community. They want to t move it. They want to do it. Dont be afraid of the people. Never be afraid so how can we get those ideas of what to think is the cause of death and what is important from that government perspective for the whole community to know. But then to create that foundation that is sustainable. That is a vital and important point especially federalntries are countries that this is the classic local function to register the death making it all Work Together to make sure people are engaged. Is because they dont resist. And lee are not isolated. Absolutely not just a technical solution. Thats a lot of different initiatives. You have interoperability. With the new administration and the Us Government a Global Health portfolio dont answer that we will go to philip instead what you think might work . But there is a space for innovative contributions but i will Say Something that is equally as simple as a challenging Attention Span on the space. But with the urgency of Public Health data when there is a crisis to have that sustainability as it is mentioned for the investment. Given all the challenges everybody lead out today on laid out today that ministerialff nature those needs that people have somebody has to keep the focus on that bigger focus of change to provide the Situational Awareness where funding is available for this or that aspect and to make sure efforts are complementary but you get on the phone and people have a lot of great g ideas and then we have a lot of meetings and then there is no followup just keeping the conversation going andve taking notes to find out what everybody committed to and hold them accountable for those great ideas on a phone call but then get lost but keep that momentum going. It is veryso valuable with the data for Health Initiative to have that luxury to focus on that component so when cdc first became engaged with philanthropy my former supervisor hired me hes been around over 40 years and saw the improvements in the space they called him and said we are investing in this what do you think . Most people would beld thrilled in her responses how much time do you have . It doesnt happen immediately so just working to show the benefit and to demonstrate the value is an area helpful to committing. Any reflections on that . No. I cannot hear you. Sorry. Can you hear me now . Sorry about the Technical Glitch action now is important. Commitment at the highest level of the highest level of un agencies and also the highest level in the country the ministries of health and ministries of justice and ministries of interior a collaboration and commitment to have x percent of causes of death this is a matter to human rights and many other areas. Commitment the focus should be of all multilateral organizations we need champions as communities and people in this country we also need cash for the startup funding in the countries support can be recruited and trained and made into champions. We a budgeted 100 million for improving crv has sent most of the countries that lack the information needed. With all the money going into the country with those tools that we already discussed so i think investment by multilateralnk partners 100 million over the course of the next two years should close the gap commitment continues and concrete action to have better crv s information and champions so we have a pipeline for those to carry this forward and the technology will catch up in countries but there are some superstar examples to take home and replicate so the bottom line 100 million if we can get that we can fix it. Just to be clear if you have 100 million in the bank for this purpose right now . No. We have a proposal we are trying to bring and leverage with partnerships in the various Partner Organizations now at the stage given the covert response and recovery because we cannot buildha that if we leave this gaping gap in this area we already said that at the start and then to rely on that registration is just not the responsibility of the Health Sector alone it is again coming together so that is the proposal we are working towards and hoping that we come together in response to the needs to be bol bold. If not now, when . Speaking of funding if we think about the nextdoor new administration in the Us Government, when word you hope to see the level of effort and organizational changes . And that is appropriate but this is the bedrock and also so with the magic wand what would you hope to do . Thats what iph would start. I do believe Civil Registration and Vital Statistics are the bedrock of the health security. I would like to see more on the Us Government side, one government approach that is characterized responses to malaria and hivaids and with that far were talking about those coming with a rights perspective with those through traffickingm and underage marriage and Child Exploitation and those who are interested on the health side but also those social services that countries are starting to connect to the registration of vital events in the legal identities and legally establisheded persons there with availability to the social Services Like education and mentioning theca election commission. All of these Us Government entities concerned with those aspects of International Affairs and those of Global Development have a definite stake in the strengthening of the cprs systems the next to speak to the total social fact and it does hit on the most fundamental of human rights to the most r important of i statistics used to understand and plan and track important healthmp programs and have that acknowledgment reflected that may ultimately be a knows one an easierr lift than using the Health Sector as the sharp end of theth stick and those that have been working on these systems for a long time social services to be more efficient and gender equality but is great now looking at the perspective of more mortality statistics. I hope we can continue to shine a light on this area and to seize the moment. Thank you for precious if they in that conversation. Stay tuned and thank you to all of you for joining the session. Thank you