This theory does not only dishonor individual creates unnecessary suffering. How is it possible to set whether they are winning the fight against covid. We just held an event last week. If no mortality data was being recorded in the Public Domain according to who mentality fatality report. Will be talking about one strategy. From the measurement record in realtime. When they cannot generate him causes of death. An where were death in the community are left out. We will look att examples. From much better debt. Dot registration. Has still struggled to prove produce accurate and timely data. Will be focusing on the big picture. What can we do to develop modern systems. Wh what other Innovative Strategies are being tested and how can we move this issue up the agenda as it deserves. We are really lucky to be joined today by the experts in the field. They advised that brazilian government on this issue. The assistant director general. A delivery for impact at the World Health Organization. Ct they have just watched their own initiative. And Aaron Nichols who the registrations of the u. S. Centers for disease control. Lets get started. Thank you so much to all of you. If you will just give me one moment to share my screen input as into a slide mode here. Presentation mode. Presentation mode. Good morning and good afternoon even good evening. And thank you for joining us here. This is an important topicth and it really goes to the heart of the adage of know if note your response. It is a phraseope that was coind over a decade ago. How do we know that covid pandemic. We believe everybody should know that. The shape that data given driven response. It doesnt represent death and concerned cases due to covid. We need to1 in terms of understanding. Particularly the members of death. In the middle and countries. This is in ati focus on one measure excess mortality that we feel captures the full scale of the toll of the pandemic. Now it should be no news. Since the early days there has been shortages and concerns over testing. N over the scope and the scale. Not to mention some high income can. Testing has been argued its actually a next dental service. As it cannot. A cabinet. I will have argued recently and absent of the vaccine. Widespread testing is crucial to halting transmission and into something which we can all concerned confirmed. It is highly variable actually often inadequate and have been inadequate to the relationship and the need. Given the scarcity that it has tended to be focused on symptomatic cases. To identify cases in clinical settings. The question here is that what are the implications for that scale for that detection of the total burden of the pandemic. And as we have seen from this guardian. Com. This undercount cases the Community Meaning that the who want that it could be the tip of the iceberg in terms of the actual number of cases sedetected. The key picture that im trying to paint for you today is what a murky picture we have because we do not have the count and the data enhanced. In many places. That dashboard tallied over 960,000 in front case. Again, we need to unpack a little bit the numbers that are coming from countries that lack. In the Civil Registration programs. And the cause of death gave us systems that were rooted in the Health Sector that are not yet capable of delivering and providing timely data on the time of death. In those kind of context those are two issues that arise in particular. Pertains to the deck numbers themselves. Were just trying to get them how to get them. That is going to depend on the adaptation and adoption of important guidance issued by the World Health Organization in terms of how to correctly certified in code a death. This guidance which i have looked at can get a little complicated when it concerns that morbidity for example. Where there is presence. The upshot is. The all of guided the estimates. Hi the suspected mortality. The second issue howeverrt that i want to call attention to deals with what is left out of the frame completely with an exclusive focus on covid death in mortality. Namely, there are death that occur in locations far away from hospitals. Alluded to that reality in her opening remarks. We leave out those that arise fromve overextended Health Systems. In deaths that occur because people avoid where delay seeking hospital care for fear of infection where they fear they might be infected. It also excludes emergency room death for those that are brought in deaths hospitals that are not counted. All of these forces are acting in many placesalal where the majority of death as a man that pointed out even before the pandemic were occurring. This really contributes to a murky picture. We only have hypothesis at the moment about the indication that we have that there may be comparatively you are or unexpectedly located at the moment o of covid in the deaths occurring during the pandemic i should say across much of the continent. S is this really a factor of limited Testing Programs so that we dont have a window into the pandemic. Make the virus have come early already. We might have missed the arrival of the virus. Rr it may just had a later arrival. For the competing causes of death. And they have a mitigating effect of the age structure. In terms of person out mortality by cause. We think it is a simple and fairly comprehensive way of capturing in a timely manner the full human cost cost of the pandemic. I want to explain this mortality interest to parks. The first part of measuring it. Is to focus on the enumeration of all deaths that are occurring now regardless of cause by age, and location. To get that on the weekly basis. Tracking the current level of my mortality. The second piece. Of measuring expert mortality is to establish a baseline of expected death or historically observed death for the same week. With todays mortality. This mortality can be attributed. Also to the causes of death that are a results of that the sorts of factors i outlined a moment ago. Major outlets. They are using the mortality. Such as these. Thats all well and good. But work to bring us back to our main concern here. What about places on the globe that are notha any of the support of the bloomberg philanthropies. They are levered existing sources of data. To create excess. In part they are reliant on the technical package that we had produced in partnershipe with the World Health Organization. Regional partners in africa and asia. This technical package is existing countries along a spectrum of system readiness if you well. I will show the graph from brazil. The point i like to make here. You will hear much more about brazil shortly. Is that rapid mortality surveillance was actually a kind of innovative use of existence in public data. They have to make fairly minor innovations. What we had found. In these settings systems do lack high coverage. They make the incident that more. In much africa and south asia. They have a need to measure the mortality both from the community because theres such a big community. And Health Systems. In order to form a complete picture. In such circumstances they have shown the communitybased surveillance piece of the Technical Work that needs to de accomplished is a bit more challenging than getting that silly base help. The vital strategies have been working out with a few countries. And routine Health Information system and based reporting that to a weekly basis. This is mostly to people that are familiar with Health Information systems. The communitybased surveillance. They are actively detected and reported on. Iv we are supporting the government of colombia and that government of england dash to undertake this work. In colombia the intention is to reach remote and harder to access parts of the population in the country. And in bangladesh we are leveraging an expanding model of active vital event notification to be able to identify that on a more rapid basis. Under the Civil Registration system there. As we are beginning to support countries to produce the data the question arise. In addition to advocacy and serving as the corrective for misinformation access mortality data can be viewed in conjunction used in conjunction with other core indicators to assess geographic disparities for example. Or perhaps even to chart the lagging because mortality is a leading indicator the Impact Public Health and social measures that may have an impact on both the number of cases in the number of deaths that are served. If there is available cause of death data. It may be possible to understand the excess mortality more in terms of the specific causes of death in private. Certainly that majority will be there. The quotient that is left over in the additional excess due to other causes may be due to some importante system breakdowns and Health System. And knowing the specific causes can help to pinpoint action. He this is before the survey for addressing the situation. And lastly, this is more significant everything. We may have the opportunity to discuss this further. We can shore up the registration during the pandemic that is rapid mortality. In fact, we are working with at least one country intending to undertake rapid mortality surveillance coming up i just want twopoint out that we know that knowledge is key to the response. A focus on solely covid cases and that insufficient to is insufficient to understand the true magnitude of the pandemic. In measuring excess mortality is one very familiar and at leastrt relatively straightforward thing to do to fill the faith of knowing the epidemic in terms of crucial statistics. I would argue that it also adds to the urgency of pre these are i believe, the longterm solutions for ssm that can indeed meet the needs of future Public Health emergency. And the director of civil reservation service. Sums it up nicely at that. These are the words i will leave you with. She said we had realized the need for a resilience. In the emergency such as covid. To meet the needs of the population but at vulnerable and marginalized populations in the country. Ze with that i would like to conclude thank you. And hand back. I would like to turn over to it over to vital strategies doing work in brazil looking at the excess mortality settlement. We hope that you will tell if the findings from brazil. And how you use seen it used in policy would be great. Amanda. Morning. Good afternoon. Good evening to everyone. This is helping me with the presentation. This is the. With the help involvement. The data force. You combine to data source. We have that from the Minnesota Health team. We have to history. They go to the cause of events. We are looking at the data. Because of the places where we see the resistance. We compare it today. We have the gap. And an age group. And we apply the collection. You can see on the right it is for one seat. And you can see the gap between the blue line and the red light. The blue light at scr. It is an example of how we did this we did for 2019 and also we head in 2020. The assignments. Where there is a reference. And always to make small areas beautiful. There is a mixed method. The next flight please with the excess mortality. We have left of those. Two age groups it is a clear path and so much is. My stage were region. Next please be an example. We have to go there. Have exactly race. Definition also using the data. We did every distribution of data. We work with those. And the translate to brown. In the mix of population. So here it is. In brazil. The consortium. Of the Health Department is that the mortality rate. This that model. They have just started collecting data we are using the data that we had corrected. But for the obvious reasons of the country. Some parts. You can see is from of march. The end of may and beginning of june. Starts to decline. It is moving into country territory. Even the end of the time. And going so effective. You are discussing about the registration. The next flight please. As an example in a different phase. And the last one we call that a pandemic. In the Central Region has bolivia. And you see that it starts to peek there. In the peak of excess mortality is the end of july. It is still going on the state. In the right. We just head release date. Then it starts. In the region. Next, please. So here is the map. The last numbers in the right percentage, so numbers but we have, the most popular states in the country with higher numbers. And in the right percentages so we see 74 of the increase in the amazon states pixel amazon states was early beginning of march why it is so. In the most remote areas we have the same status as in the south. Starts ins the north and in the southeast. And also youhe can see the south the last states, boarding with uruguay andnd argentina, still small increasing death mortality. Still ongoing in this area. From the north, south east to the current countryside and now its moving to the south. Southo brazil. Shows very well. Next, please. Who is dying . We can see much more, men dying compared to women, compared to women 18 . But some states we have 67 increase in the north region. Its a huge difference among men and women and also in the age group in the right, under 60 years old and in the orange it 60 or more years old. So the impact in the group that we expect too much mortality was in the average 28 , but in some areas we are higher and also more balances with the elderly and people under 60. So also we have this the entire population. We will see in the next slide, please, so who is dying . Black people, black and brown. Its ongoing work. Vulnerable populations and this kind of analysis would help more, both populations. Black and brown people had High Percentage of mortality then white. Also the average ongoing work, so the first state here is sao paulo. Sao paulo is most richest state in the country with 60 of population white, but you see the excess mortality in the black and brown was 32 compared to 11 among the white population. And in the other states you can see similar. More black and brown people dying than whites dying with excess mortality. When we moved to the right, 3059 years old we can see that in sao paulo, the state, we had 42 excess mortality among black and Brown Age Group compared to 24 , the whites population also in this age group. The other states have more balanced distribution also high in this age group of course, 3059, but were discussing with states, how can we use the excess mortality to give better picture of impacts of the pandemic. Next,po please. So the excess mortality dashboard that deals with states, it has been used for decisionmakers, citizen society, researchers and others, discussing how to use this. National newspapers showing, have been following the debates that we cant excess mortality and has been using this information as well. Nextew please. So also the dashboard is a source of data. Also agencies fake yields have been using the excess mortality data. For instance, 100,000 deaths by covert, there was massive numbers saying 100,000 deaths in fact, wasnt caused by covert. What was the cause . People just die anyway, so this kind of agency, they started to use the excess mortality channel show no, look at the excess mortality. People are dying not just because they are dying of the disease that they could die, but they are dying, there is an excess mortality, that is, it is exactly hyper sometimes its the same number of causes of death. So excess mortality around 80 now. But we are still working on this estimate because of [inaudible] media has been asking for more analysis. Please, the next one. Here it is, the dashboard with conass that i showed for some of you. Anthony dashboard now were using Vital Statistics and comparing Vital Statistics and civil resistance by states using estimated excess mortality as well. This is a new one. We Just Launched with the ministry, and here its not so updated. Because there is a rate higher compared to hear but theres a lower completeness so thats why we need this data. We realize we needed to correct for the delayed registration. Because when the pandemic moves through [inaudible] its bigger compared to overnight. Now its importantnt to correct for this, and were discussing about it. By now it should be very discussed the correction. Thats what i have to show you. I would like to thank you for this opportunity to show the excess mortality rate. Thank you so much, dr. Marinho potentially interesting and particularly completely obvious the implications of this data for help system response come for geographical focus, for reaching foldable groups, implications are very clear so that consummate for the presentation. Lets now turn to erin nichols. You obviously been working with us on the global perspective bue you also said India Centers for disease control. Whats your view on sort of the state of the system at this stage and what else do we need to do better on . Good day, everyone. My name is erin nichols. I lead a small team focus on global registration of Vital Statistics his improvements situated at cdc. Since 2015 we have partnered with vital strategies and w. H. O. To the bloomberg data for Health Initiative to support one of the growing number of initiatives that in the last ten to 15 years have focus on approving Civil Registration of Vital Statistics, or crvs in low and middle income countries. Laid out the forces behind the challenges that were trying to tackle through that initiative. So now parallel to this ongoing moment for crvs improvement theres this critical demand on the mortality data. Surveillance collects throughout cdc a look at what data is available across a multitude of existing surveillance platforms and thinking about how these platforms can be leveraged to compile mortality information. A a unique open is to System Integration and convergence as Data Collection efforts among the community may lead us to lasting change in the crvs space. If i could be a bit academic for a minute, Civil Registration is the continuance, prominent, compulsory and universal recording of the occurrence and characteristics of vital events. So in this case with focus on death or mortality. Civil registration is theme idel source of mortality information because of these inherit characteristics of the system, unlike a service which they are oneoff or intermittent and dont include a sample of the population Civil Registration is continuous permanent and universal. Because its compulsory by law it provides a solid basis for everyone to participate in the system. The Health Sector is always recognize the value ofre mortaly data and, therefore, is has ben one of its most regular users, engagement with other sectors including registration officials that are typically is required to achieve a comprehensive mortality Surveillance Program that is linked to Civil Registration. This engagement often requires more time, tension and coordination than vertical disease Surveillance Systems have traditionally been able too give. Ave a parallel interest of the improvement in mortality surveillance. Culture a little bit more background about the work of our team. And how we have pivoted with the arrival of the covid19. And what we are thinking about as we look ahead in that phase. As a partner of the data for Health Initiatives. Our teams have been supporting the mortality surveillance data. It is development and implementation. We are hoping to coordinate multiple partners to support a comprehensive program with rapid mortality surveillance components. About uganda and bambi upgraded its coordinating a community of practice focus on me medical Death Investigation. Is been used for sharing covid19 debts certification guidelines among the global forum of medical examiners. To help identify probable cause when theres no physician to verify that printer team also works with who, and the Reference Group and for covid1e compile the guidance on the use of proxy in the context of the covid19 and were now coordinating an av and evaluation to assess within the new questions can identify a probable covid19 debts. And frankly supporting you as cdc covid19 response our team is working to integrate mortality surveillance. In response to the increased demand for information on mortality. So i have two slides to show hero quick. There we go. We developed the slide to show the various potential forces of mortality information across platforms. The cdc supported activities among these include the mortality prevention surveillance and initiative or champ. With a funded by the foundation. In mortality surveillance works through the u. S. Government support. With the any possible information, there are any opportunities. Bringing these together and useful manner requires coronation and support for team to working to provide. The next slide please. The second slide we see a stark contrast among countries on it complete lack of information on positive. The countries slide have no data available. Its makes the information paradox. And what we need the information the most, is just not available. Then as we are showing on the first light, we do have any potential forces we do have an opportunity now to bring them together for optimal use. So looking forward, working on implementation package for comprehensive Surveillance Programs. One that for example she posted by National Public institute. Together with our colleagues across cdc, or sporting efforts to coordinate and integrate Health Information systems such as this one. To clarify roles and responsibilities across the agencies. And to facilitate and secure data sharing across all stakeholders the nieces mortality information. And these efforts, our regional partners including tomato, the cdc Surveillance Programs, the un economic commissions through africa and you and economic Institutions Commission for asia and pacific. They play critical and complementary role in advocating at the highest level of government. In providing important coronation among the relevant government agencies. So in short on this pandemic is underscore the need for harmonizing mortality Surveillance Systems are heated and we build a home for rapid mortality efforts within a cover has a program that is backed by a continuous pulse rate and universal structure. It is in the registration of Vital Statistics and ultimately supports human rights. That is all for me. Im glad to be part of this farm and looking forward to discussion. Thank you aaron. And thank you also for sharing the slides that show there is a lot that has been done and as you can see is directed to a specific population or centers for diseases and together we have to have this optimized. Back to you to reflect on how easy that is or not. What kinds of things that you think might make it easier. And at the World Health Organization, the doctor here to reflect a little on this issue from her perspective and some new ideas in terms of building rapid mortality surveillance moving forward. Goahead doctor. Thank you amanda. Can you hear me. Great. So everyone. Hello to all of the analysts and colleagues. And all of the listeners. Thank you for having me for who to have a discussion on this very important and timely topic. Matters. Finding reliable actionable data is very important. I will make a few points here. Twelve of these 17 svgs and 67 out of 234 indicators rely on good wellfunctioning registration. It is the bedrock. Today we are reporting 973,000 deaths. Due to covid19. We know this is the number that is recorded and we also had a discussion that this may be an under report because the death reporting is also lagging. There are also other reasons for underreporting. What am told is 73 percent registered. And only 50 percent of deaths are registered. Only half of the 194 Member States report on only 80 percent of deaths of the seniors and older. In only one third of the countries accurately report the debts. Civil we have seen today, in the midst of the pandemic, is a reflection of the longstanding problem. And thats with the solutions that the partners the cdc and any experts around the world have come together and established a mechanism of rapid mortality surveillance. In their area sounded countries report certified deaths. Were getting reports from countries through the surveillance mechanisms. And as philip mentioned, there are debts that are at of the facilities in the communities. And that is where the problem is. We have the tools. The building is going to take time for the capacity. But also i think that from the Partner Organizations need to commitments. Care of all of the un entities, and the countries in these different ministries of Health Ministries of justice, ministries of interior. There is often the responsibility of death certification and causes of death ice with different ministries. So that is also an inherent problem that we are facing. I think coordination amongst all partners, led by bloomberg philanthropies and. And five Partner Organizations including the bho is an impressive effort. Has to be skilled at speed. They recognize that we as a Global Community to invest in countries that have doubled up. As well as other countries that are facing the problems. And this is apparent. Counting the dead which is a fact we are having problems. Also not to forget every death that is being reported, there is a person behind. Often we forget that. So i just thought we should take a moment to recognize the lives that we are using. And more importantly being able to account for for those. And improve our response in a way that would have an impact because as you said amanda, flying with her eyes closed and being blinded or shooting in the dark. Solutions in the work that is underway is already mentioned by erin and others. What we have done rapidly is introduced directly to with the members to report on certified deaths. On a weekly of highly biweekly basis by age, and by broader causes. And the doctor, who also infrequently says, we cannot make progress. If we cannot measure progress. So this has been established and we are working with countries to support the countries to report in a rapid matters we we can gather the certified deaths. His work in progress. Weve got a very positive response from a number of countries where hoping in the next month or so we should have a majority countries reporting. The second point is the who hosts a global database. Its a unique database approved by Member States and it dates back to the 1950s. As reported by age. And also bisects for his unique database. What we have done is scaled it up and launching the revised database for the public in a couple of months. Third, given the challenges that you have heard, who has also prioritized this is a Flagship Initiative within the division of data and delivery for impact. The full data picture to drive and make who a Data Driven Organization the flagship of the doctors Transformation Initiative of who. The wto has not been transformed sentence and inception and out has gone to a massive reengineering so that we are responsive in embracing partnerships and being able to support countries in a coordinated way bringing the partnership and Technical Assistance together. So in this regard, a month ago who along with partners, launched a technical passage for data. And we were greeted 92 in interventions. In each of the letters stands for serving surveillance population. Civil registration optimizing information systems. Reporting data in a transparent way in calling for investments into the data systems. And finally, actionable data enabling uses of data to drive policies and programs and improve those. And ultimately have a measurable impact in the lives of the people that we are serving. So this is a package that has been launched. And going forward, each of the countries have done their own assessment of where they stand for each of these elements. This will be launched in november and then we know where each of the countries are so that we can make targeted interventions and support in every aspect of the countries requesting the support. Coming back to covid19 again. We have also established the secretary between who and the un division of statistics. To start quantifying the direct and indirect impacts of covid19. The network is going to be challenged we do not have all of the deaths quantified. And that is where the rapid mortality surveillance comes into play. And its an important area of work. How we make it happen. We can say it is only one country here to countries there are five countries here. We do not have time. Nine and a half years since and to 2030. So any are relying on root causes of death. And death information. So the question here is, are we going to repair and fill the gaps, fix the problems and save another nine years. Or, we rapidly with a sense of urgency, given that we have tools now. We have partners, and we can make this happen. We know what we can do. So i think that is the question prayed and that is the message i would like us to take away. In who along with any partners that have been mentioned with the un agencies and bilateral as well as national governments, planning to have and maintain in march at the Un Commission to again make a renewal call to action with some concrete actions so that we can address once and for all these data gaps. By the end of 2021. Its very ambitious. But we must be able to come back next year and say, x number of countries with good causes of death for the root causes of death have been reported but also that there sustained capacity that is in our countries. Centers of excellence that have been established in the countries. It is possible. We speak of the providences in bangladesh. We need to see this rapidly and quickly. We discovered separated and as soon as possible. So that, i think we are open and who to work with everyone. I look forward to coming together and leap forward so that we address this problem and find a solution which we already have. It is a matter of getting to work and taking a measurable difference. Thank you. Amanda thank you. This is one of the areas where we do kind of know what to do. Of course week should test the relative prospect of the various things. But we are faced with an opportunity. And i hope to see her can we invest as much in this court data to get out of covid19 plus plus plus. As we do in other areas. We have something to offer. Not just money but no, and the experiences. Let me ask you a followup question on the issue of context of these continuous permanent universal systems that erin spoke with us about. We have an analytical approach of this mortality is a way of using existed in existing data to see what is happening. We have problems of classification of deaths from this novel disease. Because of general weaknesses in the system and Health Facilities in the classified debts. Can you maybe, we will start with philip and will go back to the group. If you could reflect on what kind of innovations that you seen. Of course the standard person in the private sector looks at us in the field and says, why are we just reporting a recording of paper. It buys and sells low. Why cant we do it in real time. You think it would be easy enough to do. To collected directly from the populace. Some cases, the Health System is reporting deaths. In other cases, the offices are responsible. If i understood your perspective of it. Other fixes other thieves seen work that are promising. Sure. I think there are systemic and Technological Innovations is an easy way of having these things to begin with. For the sake of our brief discussion here. Lets think about technological information. In precisely the ones you identified. Moving towards systems and positive death that leverage the why or why the use of the systems. But automate data entry. And generate the automated cause of death to the application, theres an automated cause of death assignment virus. And then introduces much more system consistency. And so forth into the coding a positive death. So automation drug cause of death attribution system. So in terms of systems connections targeted and limiting my remarks just to the registration and cause of death. In terms of death registration in terms of death registration making sure the Health Sector, Civil Registration link is functional, the systems are interoperable and events that occur within the Health Sector are notified to the Civil Registration authorities for later followup for registration. In the context of covid, and i will wrap up here, im sure there are otherer innovations my colleagues will identify but one that jumps outut to meet is the innovation i of taking a surveillance viewpoint and a surveillance model that you have in Something Like programs of integrated disease surveillance and response which are very widespread surveillance platform in r africa. Adding in their own way of detecting all incident deaths creates an onramp to the crvs system for detecting Community Deaths in a way that we badly need to get a handle on the Community Burden t of mortality because as youve been saying, so many deaths have occurred there. S i will throw those few thoughts out. Thank you so much. Thanks. Fatima. The proposal facility is exactly what we pursue. Surveillance. [inaudible]. They have their own data. So the cause of death and also working with unilateral. They dont have any research. [inaudible]. Thats exactly why. They dont have anything. They dont have life insurance. Even in the mortalities. They have to pay a fee to have essentials. So how to work with the situation or how to make it much more kind of the civil rights. The family should know the reason of the death. When is the cause of the death. People want to know. They want to know why. Why my beloved died. What is the cause. So if you could work with the community. The common interest, it will come. They will do this work. The reporting the deaths. So when you start this type of surveillance, everyone knows what it is. [inaudible]. They can help in these kinds of surveillance. And i agree that it is possible. And you can do it, if you cannot do it. [inaudible]. Technology available and we have experience as well. International interest in the countries. So it is possible to move this quickly. We believe its possible. And then we could move this quickly. A group effort. Amanda thank you and also for reminding us, what is the incentive that any individual has to report that is actually occurred that youre not working and health facility. Thats a really important piece of the puzzle. And their simple things that can be done to involve the people. And to make that information relative to them in their lives. It so thank you for those comments. Erin, did you want to reflect a little bit of this question of the systemic and Technological Innovations that phyllis talked about. Erin i think of philip and fatima very much agree with. I think that covid19 is really forced us to see and test the limits of what we can do with support via the virtual platforms. I think weve really seen the benefits that those can bring when we are trying to bring this new technical product and Technical Area and supporting the workforce. And in participating in it. I mentioned earlier that a community of practice, that fatima supported. So those are medical examiners that are responsible for doing autopsies and Death Investigation often there by country but also taking place out of the Health Facilities. Maybe suspicious debts but often there is only one small handful in the country working very much in isolation. It in this very much a field that is benefited by being collaborative in nature. To be using virtual platforms to give these folks a chance generate and review difficult cases. Rather than the mainstream news and the challenges that we have in the certified covid19 debts. This really been a great contribution to improving this cause of death information around the world. In general and in relation to the covid19 specifically. Another example that philip mentioned was the iris coding information. And you can do it in provisional ways in surveillance purposes in complaint and full practice and for officials but it can be quite complicated and often have to be reviewed manually then give back to needing special expertise and experience. So we been able to facilitate by monthly remote online sessions for coders in india. As a focusing on advanced cases. Soon we can link up with experts that have extensive experience and they can continue to develop their knowledge on this. So think the scenario that we thought would be very helpful. Speech of thank you. We have talked about mobile phone service is another, lots of researchers are in the business of the mobile phone surveys. How useful are they for mortality incidents. You are unmute. On mute. Its always the zoom event when one of us is on mute. Can you adjust that . Can you hear me now . Perfect. Thank you. I will make three points. People, technology, partnership here with regard to people, i think there is no replacement with any technology. We have to invest in building the capacity come providing incentives. There is an attraction to this topic that is left behind. The field of crvs. The training and good medical causes of death, certification in then medical schools, short courses, et cetera, it has been done but not at scale, a global scale. So investing people is extremely important, and i think that we dont need to travel. Take flights and be in a hotel room and do the workshop. This can be training anytime anywhere. With mentorship, with mentorship from people who have done it and incentives to the mentors as well. So a Virtual Community that is really prioritized and investing and infusing. Second is we have seen out as a result this year as a result of covid, a lot of innovations, a lot of ads, a lot of tools, a lot of private partner sector partners who have come up with good solutions. So we have the tools and the technology. Crvs was mentioned. Wheree the digital icd 11 that e launched the update just a few days ago here. Mobile phone surveys is a very important cost efficient way of gathering information. We are launching the world health Data Collection the platform, multimode, both the topic, multiplatform Data Collection with Technical Support in consultation with all the partners. Mobile phones i think is a very easy and affordable, efficient way to gather t information. Geospatial technology is another very important resource, especially Health Facilities, et cetera. Analytics, artificial intelligence. When we have data in one place. That is aboard. Those things can be automated, how to analyze and how to forecast, et cetera. We have the technology and the tools at our disposal. I just sometimes wonder, why cant there be an amber alert when there is a death that takes place in the community . There are lessons already from Community Health workers in other areas. We should innovate and use those experiences for this purpose. And finally we cant do it alone. We cant be fragmented. Partnership, publicprivate partnership, private partnerships at all levels here here but i think again with a common approach, standards and be extremely important so that we dont keep reinventing the wheel and going in different areas or not making the impact that this area demands. My last point is the combination of people, innovation, Technology Tools and partnerships. Hopefully we can solve the puzzle. Great. Let me just ask, the audience is also welcome to write in questions on twitter with the hashtag i think those of the way she went want to submit questions. We can address them. I have question to you about all this of course makes sense and, of course, the crvs community has asked for this before from the community of funders. Theres a lot of these ongoing activities, a lot of earmarked money for specific diseases that is hard to deploy for systems uses. Can you reflect a little bit on the obstacles that you should be getting to better coordination and what we might be able to do about it . We all want it to work out but we alle know also in the real world its hard to get everyone to move in the same direction. Do you have any reflections on that . Maybe starting with philip. Yeah. Well, off the top of my head i would tend to stand back and view these things from a pretty distance perspective. What i see is a couple of things. One, i do see progress. I do see a sea change in the kind of support for crvs strengthening now compared to ten years ago or more when we First Published the call for addressing the scandal of invisibility as we named at the time. There certainly is progress. What we find is we are able to make progress on the back though of or hitched to another wagon. Even the global Financing Facility really falls under the roof of maternal and child health. There are precious few such as the bloomberg philanthropies that are strata for crvs and data strengthening. And for using those data to a impact more importantly or at least as importantly. I would say then there are two or three strategic alliances that we in the crvs bt Community Need to make your point is to the enormous enterprise of Identity Management systems that are beginning to proliferate throughout the world. The relationship of establishing legal identity to Identity Management and crvs has been the subject of the u. N. Of Highlevel Panel at the United Nations and they havean pointed out, the fact the crvs is the foundational system for the establishment of legal identityo that is a feed in to the id system, a death of an individual was in that system needs to retire record. So there should be a symbiotic relationship with the id community. The of the driver is governance. One of the drivers of crvs improvement i think has been the idea that we can avoid the break, gross expense of creating Voter Registration rolls if their proper Civil Registration and Identity Management systems in place rather than recreating these once every election cycle. I have seen certain investment come from that space. Between that id systems, governance community, also very much womens rights, gender issue. So allies in that space i think are a natural source of alliance forat a partnership i think as samira very nicely pointed out. I will stop there. Thank you. And for measures of the quality in general,su right . I think thats a how important it is for Vulnerable Community and equality. Do you have any thoughts on brazil has made an enormous progress on this. What were the ingredients . Where did the leadership come from . What would you say has worked well and less well . We take the country in perspective, how we started, prioritized. Usually people prioritize surveillance, many demands, whats more important. Crvs has been [inaudible] the National Community as well. So how to include them, the data in our country. So how to move this data, not just the Public Policy but trying to move all the interest from the communities. As i said, maybe its not so important to the deaths but its important to them to know the cause of death. They want to know. Certainly they want to know. It is in their interest. They were healthy, the Public Policy, so they would be much more interested in working with and communicating, also no official cemeteries. So create a life was difficult. [inaudible] but if you dont move with the own people, you are creating to the most remote areas that will not improve. Its okay, but if we can move it but we have to create an alliance with not just people, with positions in the government, but also people with interest in the committee level, the family. They want to move this. They want to do it. If you create this, we can move it. Dont be afraid off the people. Never be afraid of them. Create this kind of fusion, how can we get our ideas of what we think about. What is important for that from a government perspective, important for the own community to know. Its a process that we can create but it will work and create the foundation, for sustainable progress. Thats a really vital and important point and r especially true, many countries are federl countries where, and this is the classic vocal function, right, to register in death. Where else are you going to do it . So making that all work together, creating networks of people engaged in similar activities and helping with communities. How can we really be more effective . We blame the people because you dont resistant so we blame them. Yeah, so they dont, how can we move together . We cannot have a solution isolated. Absolutely. And its not just a technical solution, i think both of you have pointed out. Erin, do you have any thoughts on this as you i love your slide. Im going to come back to it again and again. Thats a lot of different initiatives. What do you do . Yes, interoperability but if you have passion for not going as to this. I will ask someone else. If we had in the next our new administration in u. S. Government, what should we hope for in terms of support to these kinds of functions across the Global Health portfolio to answer that, erin. We will come to you, phillip and fatima. But what you think might work, erin . Is basically a need for a lot of innovative technological, more advanced contributions but im going to Say Something that is equally as simple as it is challenging, and that is maintain the Attention Span on this space for a minute. Figuratively speaking. Its keeping with the urgency of Public Health data and the needs that come withh that when theres a crisis. Crvs offers thecr sustainability for the investments, for those investments. But given all the challenges everybody has laid out today, the need for coordination, the ministerial nature, the different needs people have when youre looking at mortality data, somebody has to keep the focus on that bigger system change, and providing the Situational Awareness of where advancements are being made, where a funding is available for this or that aspect, you know, making sure efforts are complementary. But even if its a matter of, you get on the phone and people have a lot of great ideas and then people get busy, and we all have a gazillion meetings right now and theres no followup. Just keeping the conversation going, taking notes to remember what everybody committed to and Holding People accountable to the great ideas that we can talk about on a phone call, but then get lost in just keeping that moment from going. Really valuable what philip mentioned with having the dataav for Health Initiative where we have this luxury to fully focus on Civil Registration of Vital Statistics component of it. I will note when cdc first became engaged with bloomberg philanthropies onen it, it was y former supervisor who hired me to do this work at cms and hes been around for over 40 years. He saw the improvements in the space before service came around, and they called an up and said hey,e were interesten investing in this. What do you think . Most people would be thrilled talking about this area of investment and his First Response was, how much time do you have . Its not something happens immediately. Just working to keep the kitchen, to keep showing the benefit and demonstrating the value is an area thats helpful for committing to. Samira, any reflections on that and then i will come back to philip on the u. S. Government question. No. I cant hear you. Sorry. Can you hear me now . Yes. Sorry about the technical glitch. Concrete actions now is important. Commitment, commitment at the highest levels of the international u. N. Agencies now, and also the highest levels in the countries, the state ministers of health, ministries of justice and ministries of interior, a real collaboration and a commitment by x time we will have x percent of deaths and causes of death recorded and reported. This is a matter of as everyone said, human rights and many other areas. Commitment, the focus should be in the countries of all the multilateral organizations. We need champions, champions as communities, champions as people, champions as countries. We need to have cash that can also use startup funding in the countries so that our people who can be recruited and trained and made into champions. We have budgeted hundred Million Dollars for improving crvs in most of the countries that lack the information that is needed. With all the money going into the i countries, with standard tools that we already discussed that should be available comps i think an investment by multilateral and development partners, 100 100 billion ove course of next two years should close the gap. Coming back, commitment continues, concrete action is monitored with accountability. We will t have countries that he better crvs information, and we have champions. So we have a pipeline, a cadre of leaders who will carry this forward and hopefully the technology will catch up in countries where we are making progress and not yet of there but there are some very supershort examples that we can take from from and replicate ap up so bottom line, hundred Million Dollars if we can get we can fix. Which is to be clear, do you have 100 million in the in the bank for this purpose right now . No. We had a proposal andnd we are working with the partners to bring in coherence and leverage partnerships and bring in the various Partner Organizations now at this stage. Given the covered response and recovery, because we cannot build back matter if we leave this gaping gap in this area. The Civil Registration and statistics. Just that the responsibility of one. It is again, coming together. So that is that is the proposal were working towards and we hope we will come together. This is in response to the needs some countries have. Being bold and hoping if not now, wn