Been living through an unprecedented health, economic and social crisis. A global catastrophe many have predicted and index of which are living around the world, a vaccine which has been hailed threat as the only solution to this crisis to the covid pandemic, and there has been investment in the site and manufacturing a developing such a vaccine rolling about in record time and getting it ideally to everybody around the world. A few of us get together a few months ago building upon in may this year to try to understand this journey to characterize the vaccine for polio, scaling up of such a product. And to reflect on what this means for policymakers and for society all over the world. What are the chances of getting a successful vaccine the next 12 months on how long will it take to manufacture it to scale, how good a job have government, collisions of government, donors and supranational organizations done in designing their vaccine portfolios why does any of this matter . National peers and taxpayers need to know this information. We are aware of cores that it is, national governments, other Major Players have own internal models and analysis. But the stakes are just too high and information shared so far has been so little and how to verify and allow such an independent objective effort with that in the endowment bias, honest and acknowledging uncertainty is really badly needed. Not only to try plan and approve portfolios but also to help build strike him strength among the general public that which a vaccine will never work however successful. That said, vaccine and we will discuss but its something we did not include a modeling axis i support it is. Today were sharing a find with you including the code for a model and our approach and our conclusions. More will become in the next few weeks including usually friendly webbased tool to get lunch deluxe another event dedicated to manufacturing. Hoping to hold in early november. We hope this web tool will be launching next month will allow for either one to come up with their own forecast. Ultimately this is what we talking about come forecast, excellence, informed predictions. We dont have the answers to my colleague anthony will discover our results in a minute but a key take away from is that there is no surprise here for specification is hugely important. My portfolio diversification we are referring to making sure the vaccine candidates however promising they may look now are not all likely to fail for the same reason. And that is hugely important today. To diversify we need an attractive marketplace and the way it is finest in the ways vaccines a place determined to some extent the level of diversification and is that creating marketplace benefits base. We suggest we will probably not get a vaccine or more but it will take time and at least to start with the vaccines will not solve covid force. We must continue to live with the virus in the meantime including maintaining social distancing and other measures while working ever so hard, hard or even on better treatments. In doing so we must not overlook the Collateral Damage in terms of human life and livelihoods in reaching poor countries that are global focus in dealing with covid is causing and which is affecting the poorest amongst us the hardest. We need to keep continue measuring and publicize a giving a voice to those suffering in silence. This work is a collaborative effort. Medics, site discomfort supply chain, engineers, high energy it turns out finding successful covid19 vaccine share a common methodology all come together to think things through and today we will tell you what we found. Thats hardly a conclusion. This is work in progress. We want to hear from you. What do we need input to do that and ensure it remains relevant. Let be set up for you the structure of todays event and introduce the speakers. We have an lineup of speakers and panelists. We have josh joshua schottensto get us started as her opening quito. Hes a former Principal Deputy commissioner of the u. S. Food and drug administration. Following josh, Anthony Mcdonnell has been instrumental in driving this work forward will present our results and Gabriel Jaramillo, covid19 vaccine advisor in columbia, together with former minister of columbia doctor Ivan Gonzales will respond ensure reflections. Then we will go to the Panel Structure which will comprise four of the four people are feeling the analysis of the past few months and ill introduce them to you when we get to that stage but i will just mention we will have anthony, United States, Rebecca Weintraub and Prashant Yadav and i will introduce them to you further when we get to that point. They will make short comments in this of these opportunity for you to ask questions which help with a 45 minutes to do that. So we had this conversation i think critically important to have. So without further ado i will fastforward over to josh who will have ten minutes to share with us his situation with Vaccine Development. Very grateful to have you with us, josh. Over to you. I think you might be muted, josh. Apologists. I was saying thank you, thank you for having me here. Venture for organizing this terrific session and for the work that has been done which is very important. I really appreciate the opportunity to share a few thoughts. I think when this all started the idea that this horrible pandemic, the idea that would be a vaccine to save this was a lifeline. It was a dream that people could have now were getting to the point where we have an opportunity to understand what that really means. It is not a magic solution, its not a magic wand that comes to save as and wake up from this horrible nightmare, although we all wish it were. Thats not the situation. But it is something that can make an enormous amount of difference. It can save so many lives, and the idea of using estate and effects effective vaccine and a set of vaccine in the middle of this pandemic is a very, very important focus for the work that all of us need to do. What i would like to do is talk about how we can get from here to there at a very high level with the most important tasks are this stage, how do we get from where we are now two of vaccine really making an enormous difference and saving many lives around the world. The first thing is we need to complete effectively the Scientific Research in order to know whether its vaccines are safe and effective. We have to know not only what works and what is safe but for whom it works and what populations it works and how well. Those things will only come when the science is a bear. They cant see asserted or a legislated. This will require some patience, expertise to look at the studies and a willingness to recognize when things are not working. And perhaps above all this stage requires integrity, integrity in the studies, integrity in the regulatory reviews, and a strong commitment to science. Obviously there are some worrisome signs that there are some countries jumping ahead hoping, leading hope jump ahead of their understanding of vaccines. The most important thing here is really for the science to become clear. The second stage and obviously work on visa stages may happen all at the same time but this is how i think about the key challenges each stage is an ability to distribute, make available the vaccine and vaccine acceptance. This sounds like to some people a pretty easy step. You got a vaccine, you just give it up people and field of Global Health know how many steps that are, how much implementation and management, how people have to roll up their sleeves and do all kinds of very, very specific, difficult work to be able to take the potential of a vaccine into the reality of vaccination, which actually isnt the thing that saves lives. At this point i think its very important for people to have the resources necessary to do that work, the work of implementing with the chain of custody for vaccines that may need to be kept very cold, the work of reaching different communities as well as the work of engagement, listening to peoples concerns, answering their questions, having trusted messengers talking about vaccination and building trust. You skip over that step and you have a potential of a vaccine but not really the reality of what it can do to save lives. A third critical stage is Global Cooperation. We know for many reasons that Global Cooperation is extraordinarily important. Vaccines that some countries are developing may be very good for certain populations but not others. By pooling the intellectual resources of the planet we will be in the best position to share knowledge across the world and have as many people possible benefit from the correct vaccination. And heres the challenge is to set aside the parochial fears, concerns, competition and get people to work together. We are essentially facing a common enemy for humanity and its a very, very important at every stage from the studies to the review to the distribution and acceptance, that we think of this as a global enterprise. Because no country is safe if there are parts of the world where theres enormous pandemic. I last want to talk about the important, importance of maintaining our strong precautions gets Coronavirus Spread during this whole process. This is very important aspect of the model. I understand you would be presenting but we cant let our guard down while these of the stage is happening, while we were waiting for the research to come in, while we are building at these distribution networks. Because we could have a tremendous problem and loss of life in the interim. For this i think this is a little bit beyond politics because what we are all dealing with, is tremendous fatigue from what we are doing and it was going to take potentially quite a long time, at least in our current mindset where we want a vaccine next week. Quite a long time for us to really get their, but we can save a lot of lives in the interim and we need to be able to maintain that persistence. For that i would like to quote who pointed out that there is the virus doesnt care how tired we are. In that case it was a bacteria, but the virus doesnt care how tired we are, doesnt care how sick we are, having to amass, not going to be groups and concerts and things like that. What he wrote was what natural is the micro. All the rest, health, integrity, purity if you like is a product of the human will, of vigilance that must never falter. Our challenge is to maintain that vigilant as best we can so we can have the minimum loss of life, the ability to do things that are important, economic, education while were putting in place the strong protections through a vaccine. I think our strength here is science. Its understanding, its empathy, and i think this important discussion is very, is going to help illuminate key aspects of the past between here and a vaccine that really helped the world move through this very difficult and unfortunate stage. Thank you very much for a chance to share some of those thoughts. I really look forward to reading about all the Important Research thats going on, and i think everybody who is participating today has a role to play in making sure that we are really using the best of humanity to fight this virus. Thank you, josh. These are inspiring words in a difficult time. I do appreciate you taking the time to share your thoughts with us. So i would like to ask anything now to take us through the actual results. We have released our reports, annexes. Weve also released our code and we will be releasing a userfriendly web tool as i mentioned earlier next month so we people can input their own assumptions. In the meantime please do read the report if you have the time and interest. Please do get in touch with us for questions, suggestions. And right now over the next hour or so we will be collecting audience questions through youtube, twitter and email. So please get those questions through. So anthony, i would like to ask you to take us through the results of this work before you move on to a response and a panel discussion. Over to you, anthony. Thank you very much, kalipso. Let me put up my slides. You should all be able to see these now. So the first thing to say is as kalipso has mentioned, this was a very diverse team that brought us together, and i am we really could have done this without a massive collaborative effort, including Robert Van Exan was a vaccine expert, steve lloyd uses infinite knowledge of to help us build this model, laura, julie and rebecca are partners. Kalipso youve already seen. Prashant yadav, Gabriel Jaramillo, david reeder, von thomas. Thank you to all of them and its been a pleasure to work with everyone. What did we do . First of all we built a model using a range of estimates to try to estimate how long it will take to get a covid19 vaccine relisted. We put the vaccines into eight categories come protein, an active virus, attenuated virus, dna, replicating and replicated vaccine and other vaccines. There were 20 vaccines in the portfolio where we couldnt determine their platform so we deleted. We put the vaccines also into five mutual exclusive funding categories. More than 400 million in grants per 100 million some extra funding and then vaccines that are taken by large site from pseudocompanies or by academic institutions. We looked at that stage of development whether phase one, phase two, come face really put all this information can elect this in the mall and come up with this form for how likely each individual vaccine is likely to succeed. Success is approval by its regulator, or vaccine good enough to be approved if it is not being taken forward in a country that a regular his dream stringent by the World Health Organization. Approval for emergency use but which it seems might happen before we get full licensure. We took all of these inputs and put them into simulation. A monte carlo simulation is a simulation where you take input and in each simulation model define success based on randomly in line with the probability that we put in. You could have a model that checks how likely you are to roll two dice and that thats x and it would randomly choose two that was between one and six each time and if both the numbers were six, it would be a monte carlo simulation. It will give you the likelihood that will happen. We build on a simulation that looks at the whole vaccine model in this forward month by month and vaccines randomly succeed or fail in each of the models. Each individual front doesnt tell you an awful lot about vaccine portfolio but if you combine all of the runs together you should be able to get an overall picture of the probability of success. The model is dynamic. What that means is if one vaccine succeeds or fails, the model could use another presume other vaccines would be less likely to succeed. If a leading vaccine shows very good against covid19, we presume in the real world this would increase probability for the expectation that other vaccines will also work well against covid19. And for the model, can also slow down vaccine at pretrial because we told this might happen in the real world and also create limits the number of trials that can happen in the world. Then we have a second model that looks at the steel of time for manufacturing and processing site in other in the time it to adapt or build factories so that they can produce the vaccine that are i model produce a final a Global Manufacturing model and this looks at the global capacity to produce various vaccines. One of the things that really struck me in this project was how little we actually know about Global Manufacturing capacity. But theres been a wonderful job of trying to shed light by come in this area through a survey and were kind enough to share that the information with us which is invaluable. We will create this model and with treat this model and kalipso has told us will make this publicly available so people can put any input they like in the model and it will get different results based on the input. We also interviewed 16 expert ourselves to get the input for this model, and these are people from industry, four people from government, people and agencies that are funding vaccines and people in academia. Through the people are leading vaccine candidates at all of them we are deeply grateful for the time. So what did these experts tell us . They told us they would expect about a 66 chance that a vaccine in would proceed to phase one. It has been a 70 chance of reaching phase two and the vaccine and face two has about mac has about 16 chance of reaching phase three. For phase three we collected input that are different for each one of the vaccine platforms. A platform that are experts like most was protein the one they like least was dna vaccine or actually its not in the scarf but vaccines that these seven criteria were given a 5 chance of of getting to a phase three trial. What we found in general is that they think theres a higher chance of these vaccines going to Preclinical Phase one and phase two then traditional the case because theyre so much president did a vaccine quickly. But doing this more quickly doesnt fundamentally change whether not the vaccine succeeds or fails and so we would expect a higher failure rate in phase three than you would normally expect there are experts also anticipated and roughly three in four chance that if it is submitted for approval having achieved phase three trial would be approved. So what does this mean for the vaccines . We used all of this information as well as the funding criteria and the the state of the builde into workout up probability of success for every vaccine in the portfolio. We collected information which used to collect to provide a timeline to approval for a vaccine for all of you will find is even the most successful vaccines, theres only about 35 chance the vaccines that are model likes most will succeed. Theres only two vaccines with over 30 chance. The average time to succeed even the quickest vaccines are probably six months away from success. But fear not, there are 230 vaccines in the portfolio. While our i model is not huge optimistic about any one vaccine can when you put all of the vaccines to get the model becomes incredibly optimistic that some of the vaccines will succeed. This is a timeline for when we might see the first vaccine approved according to our model. Theres a very small chance the model thinks a a vaccine will e approved in december and then from january the chance starts to rise very quickly. April becomes the month where its more likely than not by the individual we will have vaccine approved. Theres a 79 chance of vaccine is approved by year today, and 85 chance by the end of 2021, and the model thinks the within the next three years theres over 99 chance one of the vaccines will succeed. This is based on the input from experts. We also looked at what happens if we run the most optimistic and pessimistic inputs are experts gave us. To do this we moved all of the inputs up or down by a standard deviation of a multiplied or divided the timeline by 1. 5. In optimistic scenario and surprisingly every run that we did of the model, all of the vaccines were approved. The average number of vaccine approval in total in the next three years goes from 5. 7 up to 18 and the median time to approve his january 2021 with 90 of simulation seeing a vaccine approved by march and 99 seeing one approved by december 21. So if you are very optimistic, the you very optimistic results. However, if you put in more pessimistic input, the results are unsurprisingly more pessimistic. We see 81 chance one of the vaccines in the portfolio will be approved in the next three years. About just under 50 with Everton Liverpool being 1. 7, the median time to approval is not until april 2022. So the point of this and the point of model in general is that it hopefully allows people in the have to see how long a pretrial will take an different platforms exceeded get, translate the fuse and you get different results. We will be making this available in just over one month so that everyone can see what their perceptions leak occurred within the this onto the manufacturing model. The manufacturing model, we took four targets, three of them based on the World Health Organization, target was having enough vaccine to treat all of the paramedical professionals in the world. Number two is all of the people over 65 in the world. Target three is all adults with comorbidities and target four as a whole world population. The reason we need 18 billion for the whole worlds population because the World Health Organization research presumes we will need two doses of the vaccine to inoculate somebody and that will leave 50 of vaccine doses. And so what you find here is the meeting time for approval is late 2021, early 2022. We start to see enough vaccine to reach target one, target to and target three follow on fairly quickly. The reason for this is the model thinks theres a lot of manufacturing capacity for vaccines in the world. Once we start churning out vaccines we can get to target two and three quite quickly but target four will take quite a bit longer because to reach 18 billion doses even with quite a large amount of vaccines, it will probably take well over a year. Finally we look at the verification here we looked fif all at come on our right when look at our ideal scenario. We put into the model, we asked and what are the best candidates we could get to ensure that one drug is successful. Or one vaccine for successful. We came up with 85. 7 chance of success, based on mostly wellfunded pharmaceutical with three protein subunits, one enacted, one in ornate and his towers with that you are model likes the first portfolios. We ask the model how likely fastly vaccine could approved. They have five candids they like and 67 operation warp speed which is u. S. Government is 79 . So very close to our ideal portfolio. We also look at the chance one of the vaccines gets approved and a run from each of the various platforms. The protein subunit of both like with 87 . Theres something on the order 90 subunits would not make sense to get 87 . Inactivated is 65. Replicating 18. These have very similar inputs. Dna, just under 10 of the time and length of the live attenuated viruses succeed in any of the 3000 runs the model used. Also because theres only four of them and and they get very low funding. So thats kind of the overview of joseph find support for the first of all, are experts were not wildly optimistic about the efficacy of these vaccines. They will be safe but we might not get a vaccine application enough to in this crisis. It will allows to get more vaccines, more likely to vaccine and also when it reaches a different population groups that josh assessed in the second thing to say on this is that in manufacturing capacity in the world is somewhat broken down by different types of vaccine. Andy slavitt at the first portfolios vaccines, will allow us to vaccines more quickly. We are seeing theres not enough inactivated viral vaccine in the portfolio. Theres only one outside of asia being pushed forward. Theres a lot of capacity to make those types of vaccines. The final thing to say is that we did not look at take and acceptance in rolling and the vexing. Is a huge challenges that we really think the world ought to be looking at now. They are highly unstable and without run large vaccination campaigns for adults and most of the world for a very long time. So if you want to know more about this please read our paper and id like to thank our coauthors as well as the labs whose our partner in brian woods who let all of the manufacturing work and she did an amazing job of proofreading, collecting and putting the spirit together and we are deeply grateful to all the expert interviewed and for sharing the data with us. Theres far more organizations fit into this but of have time to name the names but really appreciate it and look forward to hearing your thoughts on a research. Thank you very much. Thank you, anthony. That was great. Anthony has been the mastermind, key driver behind all this work bringing us all together and driving the research from the beginning, so very well done. I will pass over now the Gabriel Jaramillo who chairs the private sector of covid19 Vaccine Advisory Council of columbia and he has written former minister of health of columbia. We are grateful and honored to have him with us so theyll spend a few minutes sharing their thoughts and response to what was just presented and then will move into our panel here over to you. Thank you. Gabrielle, are you going first or is ive been going first . [inaudible] minister, over to you. Thank you, kalipso. Thanks to everyone on the panel. That was very, very interesting what we just heard, and congratulations for that effort to all of you. And thanks also to gabrielle were going to split this presentation into two parts. Im going to start sharing the slides of what has been colombia has performance during the last months, and not an approach of judgment but just trying to show what numbers are showing to us and what we understand from those numbers. This is our Current Situation today. We have around 85,000 cases, most of them recovered, still have around 56,000 active cases and weve reached pretty much 26,000, thats in the last month. Comparing this to other countries in terms of cases or deaths per million, we are in the first ten places in terms of cases and deaths, between ten and 20 in the ranking in terms of testing per Million People in our country. This is how it looks. Im not going to get deep in this but this is how it looks. Weve been having a lot of challenges between july and september, and we have different moments in different parts of the country where we have been giving a lot of cases. It has not been like just one peak for all our country, but different small peaks in different parts in the region of our country. In terms of testing we have been increasing our pcr molecular tests since march, and some parts in average the government decide how to change we were giving the incentives for testing, and pcr start to drop down while we authorized the new test of antigens, and though it has not as much as good results in terms of specificity and sensibility, well, for some places and regions, its very hard to have pcr is. So this event another way of increasing the testing but we are still lacking the capability of testing more. In terms of response, you are like a couple ideas of how colombia strategy a response. We started early in january looking for to the pandemic and we had a theological or frontier and followup. We also had the opportunity to prepare our health system. We were able to double the numbers in icu beds, for example. I think theres been like likek of focus on primary health care in a country were primary health care is very important. There have been a lot of struggles between the Central Government and the local government, and the strategy included, early since march, prolonged generalize lessons. It ran from march to september, almost 180 days of lockdown, profound impacts and social and economic aspects. In order for more people to use the mask and keep safe at their homes. It was this integration around this, trying to make an effort to be better and tracing but it was not successful so i think we lost capability of tracing. As i said before, it was good in the beginning but it never reached those levels since august. I think we have been effective in the efforts containing, especially in among elderly people. Social and Financial Aid for organizations and theres been a lot of work in terms of adopt organizations in order to keep moving the economy. I will leave the next part of the presentation. Thank you. This helps ground the conversation, why its so important so that is very helpful. Thank you. A few more minutes. This whole process is not as sophisticated as yours for developing vaccines, it became obvious it would be very difficult to do that for a middle income spectrum in the country. Being able to run, we made the recommendation to enter for reasons we all know. The best resource and recommendation. Next slide, please. The challenges i have, we all know about but the thing that really concerns me is how we get the ministries to be able to respond to the most sophisticated challenges of covid19. Lots of stress, fatigue after months of dealing with the politics and realities of writing the virus. How did you look forward and plan for major challenges i think this is the solution for a diversified portfolio what is progress and questions are still to be cleared and that is a stage for those who want to do individual transactions to go after them. Columbia house vaccination but it has never really bought any vaccines, all order from a system all the way up to unicef. We have this major challenge in front of us not being able to be prepared to respond. Vaccine acceptance has this already and the communication with the population is very difficult to do also from rigid structures. It is really complicated for them to be able to use all the channels of communications. To monitor every day how confident or lack of confidence is shifting. What is worrying people and what is able to be responded to. The authorities, the Legal Framework makes life very difficult but at the same time, dealing with covid19 without investing resources deal with covid19 over an extended period of time to deal with these solutions and vaccines. You can already see how we will have a couple of them coming up for approval, one to three vaccines, but at the same time, it would be difficult to do that. I believe preparation for those solutions, those are sort of left on the side. Testing and contact tracing, as they emphasize one thing, we saw a drop in testing we experienced over the last few months. My reflection of this whole thing is there is a business perspective to manage for your vaccines and im not ready to deal with that because if you dont experience that, clearly we dont have the experiences to do with that. Buying a vaccine is monica phone call, its an opportunity, an individual opportunity. As the idea but some of the individuals have that portfolio, supposed to have a strategy in the building of that dynamic portfolio, things improve and get better, your portfolio in one direction and things start to show some failures and thin things. Two by these vaccines when it places this Public Service in a difficult situation because if things go wrong, a couple of years from now, people get the emergency and they will deal with difficult circumstances. All and all, i think having a solution is clearly the best solution. It totally set up, these are not questions to go to the public market. Right. Thank you. Its great to see columbia, mexico, did, too. Buying a vaccine, getting to that is only the beginning of a long journey as you describe the logistics and is not an end solution, it is a big, complex problem. We will move into a panel discussion, we got about 45 minutes. I will introduce four panelists and ask each one one question and to get us going. In the meantime, please do send them, email. I will be getting those from the team and sifting through them. Our panelists are anthony, you heard him present our results. Robert, a translation expert. Rebecca, director for the Global Health delivery project and senior fellow is also here for the supply chains and professor. Ill start with robert whos been in the science development, grateful for him volunteering his time and helping us get where we got right now. My question is, how are the research and Development Timelines different from other vaccines how do they differ in other obvious benefits, what are what you are seeing . Thank you. Could i have the first slide, please . While that is coming up, ill just comment on the fact that okay, so this is a picture of normal involvement of a vaccine. Ignore the detail. There are two points. The average time is 15 years, the range is between ten 24 years and the other thing to note is all the little fragments of Vaccine Development close to done and to end. You dont start the next step until you finish this step in that really is because a lot of money is involved and nobody wants to go on to step three and find out step two failed. If i could go to the next slide, you can see how much we have condensed the process in the case of the covid19 pandemic to be able to come up with a vaccine within two to three years which is what our model is predicting. Theres one overwhelming factor enabling us to do this. It is the incredible cooperation and collaboration between government, industry, biotech companies, academic institutions and regulators. This is unprecedented. I think the last time weve seen that kind of collaboration his efforts to eradicate smallpox and efforts to eradicate polio. Having said that, the key factors here are some of the elements have been either eliminated or overlapped so they are happening at the same time rather than and to end. For example, the Technology Assessment and Preclinical Development has been skipped because we already had some experience with sars and a morris which we were able to used to rapidly move to a Vaccine Development. Second, pretty much all of the 235 candidates for covid19 vaccine were already being developed for a vaccine, whether cancer vaccine or another infectious disease, they were all are in the Early Department stage. They switched what they were doing and jumped into focusing on covid19. The Clinical Trials will overl overlap, as i said, eliminating cutting the time to at least the third despite overlapping process. The fact that the pandemic is raging so intently, its allowed to shorten each phase by engaging with rapid enrollment and high incidence is allowing us to determine efficacy much quicker than we would if there was no raging incidents or disease. The last factor that allowed us to scale up, it was being done because it was being done on other platforms and finally, manufacturing was sped up mainly due to the Financial Support from governments to encourage manufacturers to manufacture product at risk. These are the main factors limiting in terms of the outcome, we sped it up but we havent necessarily increased the risk. All nine of the major vaccine manufacturers in the world have recently signed a pledge they will commit to adhering to the Regulatory Approval practices in existence before this process of condensing time frames darted and they will not submit data that does not adequately approve safety and efficacy of the vaccine so what i take from this is because of the collaboration, weve been able to shorten or left out any steps of the process. Thank you. My next question goes to rebecca, beyond covid19 vaccine production, what steps should government be taking now to prepare for vaccine . Thank you so much to the te team, particularly anthony. As thinking in the time of shelter important team, in this partnership. We view this model as an essential toolkit because of the complexities of upgrading their vaccine delivery versus. The diversity of the covid19 vaccine portfolio reminds us we are doing two things, reduce covid19 related illness and mortality and indirect effects of vaccine, restore the Global Economy and reduce transmission. Looking for evidence based Community Getting knowledge and uncertainty, not only vaccine safety and efficacy but ongoing updates regarding transmission and existing populations unity. To ensure vaccines to vaccination, we believe they need to upgrade their system. There are four interconnected services, distribution, allocation, verification and demand for the vaccine promoting vaccine. All of these require investment and data analysis. Distribution, uncertainty of diversity of vaccine for polio means you have to think about multiple vaccines, dosage and administration. Allocation, limited supplies, its a necessity. Committing to global allocation is vital and ideal to get the commitment allocated for limited supply. In the u. S. Today, and a few minutes, the National Academy for science or medicine will finalize space regarding vaccines. Will require updates to estima estimate. Third, verification. Interruption will require verifying Vaccine Coverage of population not only to reduce waste but also monitor for vaccine value. Identity services into immunization registries. Investing Global Standards and modular, secure, it will become essential. We are looking at a diverse set of portfolios regarding vaccines, we need to upgrade the system. It reminds us, vaccination is a health and social intervention. Government needs to update and through the interview process, many of our experts remind us of three experts we can to promote confidence. As i mentioned earlier, stakeholders must be held accountable for vaccine safety. Number two, invest in safety Monitoring Systems and number three, we have to understand Vaccine Hesitancy. Only then can we tailor the strategies. Should be not only efficacy and faith the timeline. The covid19 vaccine requires an urgent unprecedented investment in the delivery strategy model enables them to plan their vaccine delivery. It reminds us leaders must detect problems early, target average systems, find reliable ways to measure success, new ways of working together and enable this in the system. Either upstream to prepare the portfolio of vaccine delivery. Thank you. Thanks very much. Let me move on now, what you see as the greatest challenge with the covid19 vaccine in manufacturing capacity thank y you. Before i respond to that, i want to take a few seconds to reflect on the fact is, in a way, a preview of how evidence generation in the future will occur the nature of multidisciplinary games coming together so we help businesses researchers, and vaccine manufacturing, the ability to bring all of them together is our only way and trying to find answers to questions which have uncertainty in them something i would commend anthony for pulling us all together taking this perspective and integrating it into a meaningful manner. We see a lot of things that have happened for the first time in how we think about manufacturi manufacturing, rob mentioned some of it. They done both for these agreements, incentivizing investments and manufacturing and relieving, whether its searches or other things but one thing we continue to struggle with his we are solving manufacturing capacity problem, one at a time. What we need is a portfolio approach. The thing were full diversification, i think we need to take think about the portfolio and say what would happen if a candidate fails . What would enable us to create facility which does not succeed its shown what we were seeking. It requires information that are unclear where its in the global structures, globally and medical experts they see. All these are with reflecting, how do we address the covid19 vaccine portfolio . There is opportunity that has other groups working on it. For the future, we should think about Something Like the registry for manufacturing capacity but also for that. Having a registry should ensure next time we want to think about the capacity, can do that in a true allocation of the candidates, and changing so that is one part. The second part is that this is highlighting a few years ago, many of us with manufacturing aspects, the fact that we have these vaccines, they will give us Rapid Response development and manufacturing but it will show in order that, he manufacturing capacity needed for the rollout dont exist. These are the challenges of distributing and other things so i think we need a more coordinated way to think about how in the world would we have enough manufacturing capacity for upcoming Promising Technology weve seen coming up the first time this time, why we continue to have enough manufacturing capacity . The mismanagement hasnt occurred possibly enough i see all eternity for us to use the project and ongoing conversations along with other National Efforts to make that happen both in shortterm and mediumterm. Thank you for sharing. That is very thoughtful. Generally, if you have questio questions, to send them through so weekend relay them. What is your main take away from research . You get us results what if there is one thing, what is that . What struck me is there is a lot of uncertainty within this space. A lot of the experts we see fundamentally struggle with this probably in the space through trials or how long the child might take. Research and development is about the unknown. If we knew what works, we would have to put people in labs, testing things and run large trials. Given this uncertainty in manufacturing and things we have not put together at scale befo before, uncertainty about distribution and Vaccine Hesitancy and how many scenes you should put in your portfolio but we are trying to get clarity and direction on this. We just dont know how long vaccine will take with have exact information on what the answer looks like. Weve done our best to try and clarify these things but ultimately, using what we can do with uncertain knowledge that exists so i think we should continue to invest widely many different types of vaccines we can in increase in treatment and diagnostics look at ways we can use technology we had to open things up in society so we can test and trace people very rapidly and have a degree of normality with the knowledge that it might be a while before it goes away because we dont know the answers yet so we want as many as possible back thank you. A good to go. Weve got some reflections from colleagues online. Her comments on something arguably that was not discussed in great detail because we didnt actually have the supply and chain distribution steps for manufacturing. All of these complex requirements may push down the associated vaccine. What are your thoughts and ill move on to the next question. This is a distribution and supply effort model, which we have yet to do and supply issues, do we have enough money, more agencies have come, question remains, how does it attribute globally and within the country . When we ask how will i get distributed . Some of it depends on what are the supplies, the attributes of the product you are talking about . I think the probabilities say if we are to build a Global Distribution model, what portfolio also allow us to think about where people, such as how often do distribute from the National Storage points from every vaccine clinic in the country . Requires that, you probably can only have the capacity of this nature of what we would have to do almost daily, multiple times a week distribution which weve never done before with vaccine. If it can work with the coaching, we can rely on distributed with less frequency, the week or month but then we still need to ramp up the capacity who comes in and its one thing we can say to set up a new manufacturing site reactors outside of london or where ever it is located but its another thing to say will come from around the world, many of which are operated in an increased capacity, that is oftentimes much more research intensive and everything we may imagine. Their resources in terms of people, technicians and of that sort, we know how they have been on building for these vaccines to those states. How long, how complex we only have a few months to start that so we should take the portfolio from this and we need to put. Absolutely. We are looking at a large part of the puzzle and we hope this will have different parts and then bring it all together. Anthony, how much is the probability of success and how did you bring together, combined estimates in the model . We have a lot of disagreements around estimates, the quantitative results for success. I think those are areas where we have struggled with. Theres a lot of similarity between the actual, to request for an example, there to not replicating and then theres replicating. Clumsy replicating would be less likely to succeed because of safety issues. Others say its more likely because their applications, replicated. Im fully convinced both are true but we have to do a lot of work to bring those questions, to think through the Different Things people are getting people focus on different parts of the problem. We could use these. The second part of your question, we put the average response to our model is our main result but then we also optimistic scenarios to share in our presentation to show where we built on one standard deviation up and one down and then we want to make our model available to the public because some people might have different responses to our experts. The experts are what drive the model and we want to give them the opportunity to see what the world would look like using theres. Thank you. Weve got one more question with what builds on what you have been talking about, how long will it take to ensure access for all, previous vaccine processes in particularities of the situation we are in . It depends on what access for all really means. Perhaps you can collect on this. No he answers to this so i just say our model, what is the likelihood having enough manufacturing capacity . That timeline goes into 2023 for that capacity. Depending upon which candidate, its manufacturing for more vaccines for which we have larger capacity and what we can figure but what happens after that, if it has to be distributed, still oftentimes a very big part unless we can invest in building that now. How soon capacity would we have vaccines distributed and in the vaccination clinic depends upon described as many of the things in this process, can we put together a similar effort to do all the things that routinely take us a couple of years and do it in a few months . If that is the case, i think we would have vaccine doses ready and would also have that but that requires all the planning to be done now but it needs to happen now and thats what i think we are still focused in the global effort in figuring out, how to purchase the vaccines and get the money to buy it but we need access for howie distributed and then how the public will be, the ability stop the vaccine administrators, synchronizing so many activities and bring them together in an orchestrated manner, its oftentimes very challenging endeavor. Absolutely. This is not a question we have model but its the strategy for vaccination. Targeting the most vulnerable or increased Community Across the population and reduce risk of people catching the buyers, something looking forward to what they will come up with but over to you,. This is a good question. A voice said, what you ought to do with the vaccine depends on what vaccine you select. What i mean by that is, highly efficacious vaccine can be used to hopefully limit the spread of the disease, or even stop it. In that kind of vaccine could be used to control a pandemic, open up economy and do a lot of things. A vaccine 60 effective is not going to do that so you have to use it in a way, and perhaps is a different target group to use it most effectively. A vaccine like that might be useful in reducing the spread but it is not going to stop it so how us could we use it . One thing to provide as much protection as it offers to our most vulnerable population and frontline local people and approach it that way. I had a really highly efficacious vaccine, you might think about using it more broadly in working age groups to stop the spread and get the economy open, search the economy itself is going to take lives as much as the disease is and we often need to think about how that plays out. It is not just the disease, its what the disease does to our entire society so it is a complex issue but i think again, it is a matter of looking at what the vaccines has to offer and some forethought about how we would use the vaccines, weve got a wonderful window right now while waiting for the first ones to come out to start thinking about these things and that is what we should be doing right now. Fantastic. Thank you. A question in my mind as well as what he was showing, the great graphics how the whole process has been compressed. The question is, we are doing currently, can offer lessons for how we do Vaccine Development in the future you think this will have lasting lessons that will result in more timely ways of producing, getting things to people who need them in the future . Thank you. The quick answer is absolutely, i think theres tremendous work being done across the world to document what we could have done but even in this moment, we think about the speed at which we communicated the front runners and the media. That in and of itself. The way in which we frame this conversation, a portfolio vaccine candidate, we will wait to understand the safety and efficacy, which vaccine is right for you considering your risk factors, i think it can be pivoted as academic researchers to remind the public we are here to ensure thirdparty, a vaccine is delivered to you. I think that expectation is part of our responsibly to establish trust and we can do that with leadership with folks like josh dollars you have been saying clear and accurate questions about these timelines, Clinical Trials, Development Data that will unfold and become public in the near future. They asked your comment about the workforce because in many ways, we look at the allocation principles both from the World Health Organization and National Academy is important to protect the Healthcare Workforce and weve seen this in the pandemic as well. To protect the workforce not only the risk but the risk of transmitting. The understand who is at the frontline and what it means to be part of the workforce and protecting the workforce i think be a vital lesson. Indeed. Absolutely. Coming to the end of our session and i wonder whether colleagues have any final thoughts before i try to wrap up a great session. I will start with you, anthony, any final words . My final thought would be first piece we introduced in this space the first time we tried to model this, you can never capture all the complexities of the world in a model and some of the questions we asked were fundamentally unknown, how likely the vaccines will get through a phase three trial. People have different responses and ideas and there will be different ways to model going forward, we want to use this research and continue to use the model as we learn more about these vaccines and we might want to think about things like Distribution Site so if this is something youre interested in if you have ideas, if you have inputs you want to use, please do get in touch and we are happy to expand on this work. Thank you. Id like to bring in gabrielle ivan as well for this discussi discussion. I think the value of this, in the business world, of great significance for businesses to plan ahead with the perspective of a longer term, this idea it will be sold by the end of the year with a vaccine. I congratulate you are doing it in for the courage of doing in the middle of so much uncertainty. Thank you very much. Congratulations all, i think its been a wonderful moment and a very important study. I think it is going to be a hard landing for anxiety and a lot of optimistics but that is what the world needs. We have to stop dreaming, process intervention and we have to work on these interventions and continue to prepare countries so this information is very useful for governments in order to plan work ahead. Congratulations all. Thank you. Rebecca. Thank you again for including this, we do think about these sciences and i think this model and collaborating is a phenomenal example of what is also looking forward to getting together as data becomes more available in the model better and we can serve governments more closely. Thank you. Thank you. It has been an honor to work with everybody involved in this and i think for me, if we did Something Else, and i think we did a lot more but if we did Something Else and speak the truth about how long this is going to take and what it looks like, weve done a good thing because now it is the time strengthen the things we are already doing as Public Health interventions like thing, masks and Everything Else we are doing and strengthen and keep going with that but secondly, now is the time to be working on treatments and other things we can be doing to reduce morbidity and mortality rather than sitting around waiting for vaccine. Id be focusing attention on t the. Having said that, the interim. While waiting for this vaccine, a wonderful opportunity for us to get it right now is the time to think about getting it right when it comes to Distribution Getting the vaccine interview this on, 40 years in the vaccine field, one thing ive learned is vaccines are useless unless they go into somebodys arm. Thank you. Two things come to mind, model is a start, will look for everybodys input. The people who work on the model, people come in and change the data, look at something useful and that thing may not just space bar covid19 vaccines, it could be a model we use in looking at new Health Technology and interventions. The second thing, while work is focused on vaccines, the portfolio expands including new candidates, antibody cocktails, needs to be similar and it can be done differently so there are countries thinking about something similar to look at this i think that is another so we can think part of the. Thank you, everybody. Id like to wrap up the session now. Two . Josh put it, the vaccine is not a magic wand like i hope we can build strengths, one of our parts, who wrote the counterintuitive message is that many great manufacturers, estimating portfolios its more important than adding another winner. This is an estimate for correlations, managing them to manage those correlations. We have no answers but hopefully we are in a better position in terms of spending using certainty to get those. It is not easy, this undermines individual stress in the process and the interjections of the vaccines, the vaccine is useless unless it gets into somebodys arm. In undermines the notion and enclosures secrecy and undermines stress. Global corporatization, it is encouraging to see columbia joining. As opposed to certainty for some of our leaders radiant and this is not the way to go. I will quote john fund, no man is an island. Thank you very much session. Thank you for your time and effort. Take care, goodbye. You are watching cspan2, the unfiltered view of government created by americas capable Television Company and brought to you today by your television provider. Tonight, communicators, freedom founder, darren and free press coceo, Jessica Gonzales on tech issues that may play a role in campaign 2020. The administration is trying to do is narrow the production of content moderation so websites would no longer be protected if they try to remove content they thought was false racist. I am no fan tech platforms and how they have abused their workers and abused the privacy right up there users but frankly, going after section 230 is not the right approach to the very real problems we are seeing with online platforms. Tonight at 8 00 p. M. Eastern on the communicators on cspan2. The competition is on. Be part of this years video competition. 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As a reminder as a counter to election day, we are facing record levels of mailin voting, concerns about United States postal service, confusion about drop boxes, polling places in lid
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