eSigning Pet Adoption Contract Made Easy

Esigning pet adoption contract

do we've reached a human crisis unlike any that we've experienced in the last 75 years any one side has too much the other side will oppose it we've done a lot of things to create the imbalances that we have today covert 19 has laid bare the systemic social inequities addressing these larger problems must become our priority we have to make sure that the economy actually works for the people it's not just about growth for growth's sake but how we share that prosperity it is not sustainability or profit it is profit through sustainability we have to reskill our people to be successful and if they're more prosperous the companies can be more prosperous the most important tools are education and technology technology creates opportunities so that people are able to move to greener industries it's not about not knowing that we are in a climate emergency it's about choosing to take action for that you need to act decisively in the support of renewable energy the science is very clear today that the sustainable path is more attractive we can focus on the short-term benefit or we can look further to solve bigger issues we need unprecedented collaboration to create systemic change it means redesigning the instruments we currently have on a completely different trajectory and that doesn't leave anybody behind we are one community and we have to remember that hello and welcome um i am john michaelthwaite um the editor-in-chief of bloomberg but also i should just disclose for this session at least the author of a book on the challenge that covert has posed to the west called the wake up call as you know we are getting close to 100 million cases of covid nearly two million deaths and this panel is here to look at solutions in a way to look at the future of what lies ahead both for governments and businesses and what we can do to improve the collaboration and the efforts both to deal with this particular disease and to deal with other potential ones and it fits into a pattern where there are other panels coming at the where for many different parts of this and we will look forward at issues like when exactly how exactly vaccines will work what changes what we need to do with multilateral organizations um as i said this is a very forward-looking panel but i think it's worth recording that we have an exception a panel which already proved itself in what has happened to the extent that covid has been a war um all four of our panelists have had a very good war um we begin with kiriakis mitsutakis who's the prime minister of greece i think it's worth reminding people just how well greece has done in this um if the west has generally been rather lousy at dealing with covid greece has sadly lost 5 600 people but that out of a population of 10.4 million means a death rate per million of just over 500. by contrast germany which not that long ago used to rather look down on the greeks has a death rate over 651 the u.s is up around 1300 deaths per million and the uk from where i am at the moment is 1500. so the prime minister has done well dr anthony fauci the director of the national institute of allergy and infectious diseases probably needs no introduction at all america's numbers may be lousy as i've just said but in the chaos of the trump administration he has been a voice of science and reason i think it's fair to say that he's reacted to the arrival the new present a little bit like a hostage being released but throughout this um i think it's worth noting the enthusiasm with which the biden administration has turned to him nancy brown is the chief executive officer of the american heart association and she has also been a voice of reason in this particular drama particularly on the idea of the cost of help of covid to the wider healthcare system and what that matters to the wider world heart disease like cancer has kept on going whilst these other resources have been detected have been concentrated on one thing franz van hooten the chief executive office officer of royal phillips is credited with having transformed philips as we used to know it into a company which did used to do many many things but is now focused on healthcare technology it has reacted extremely quickly to corona for instance quadrupling the supply of ventilators and delivering a lot of ppe changing supply chains and things like this so all of you um have done well in this but our focus is on the future and so may i begin with you prime minister you know what have you learned that is relevant to the rest of the world well first of all john thank you for your kind words although when we talk about that's you know any any statistic involving that's uh is problematic in its own uh in its own right but what what i learned uh personally uh in my mind is very obviously we need to trust the experts when you trust a scientist that's what we did from the very beginning we let them do the talking um we took decisions early we recognized that there is never such a thing as a perfect data set that there will always be some degrees of uncertainty when dealing with such an epidemic that is why i think we were successful overall we've managed this this crisis well we've had a second wave that hit us hard in november we went into a hard lockdown suffered the economic pain but we fully understood that you cannot return to any sort of economic normality unless you bring the epidemic under control so what what we learned is to trust the scientists but also trust the people uh if you communicate clearly with the people and you know greeks have this reputation for not being particularly disciplined once we told them exactly what was happening and asked for their support most of them if not all of them complied we have very few anti-vaxxers very few anti-massacres even though even now nasa are mandatory but everybody wears them and we understand that if we are to return to any um sort of degree of normality before we vaccinate more than 50 of the population we need to stick to the basic measures we know work and the scientists have told us that they do work so no rocket scientists no rocket science really involved here just go with what the experts tell us and make sure if you have to take a bold decision especially if it is a painful one economically make sure you take it early and use the time uh to build your healthcare system we inherited the healthcare system that was very very problematic with doubled our icu bets but even that is not enough unless you proactively manage the athletic dr fatchi the um prime minister correctly said we should listen to the scientists i wonder if i could ask you about america as i said you know the deaths per million people is up around 1300 which compares say with china which can claims a number of free and even if we don't believe that entirely there are plenty of asian countries we have around 50. um these are enormous differences 20 america's done 20 30 times worse than some countries in asia is this you know in your judgment all to do with the leadership with donald trump or is there something more fundamental wrong with american health care that you would like to fix well john there are a few things that are really complicated and overlapping that explain almost the unimaginable that a very very rich country which before the outbreak was judged by a number of evaluating organizations to be the best prepared for a pandemic actually got hit the worst and i think what it reflects is i hope things that we could learn lessons for the future uh first of all uh something that the prime minister mentioned uh uh we had the opposite we had a situation where instead of concentrating from the top on the science and realizing that we must make decisions based on data and based on evidence there was a considerable amount of mixed messaging about what needed to be done from the top down and that really cost us dearly the other thing that may involve things that are going on in other countries but certainly intensively going on in the united states it makes it extremely problematic to adequately address a public health crisis when you're in the middle of a profound degree of divisiveness in the country when public health issues become politically charged like wearing a mask or not becomes a political statement it is you cannot imagine how destructive that is to any unified public health message the other thing that we learned is that some of the things about the united states specifically that under different circumstances work well namely the federalist approach where you have 50 states and territories each of which are given a degree of flexibility of doing things their own way uh the federal government doesn't want to tell the states what to do so we had a situation where the states were sort of left on their own so we had a disparate inconsistent response from one state to the other which is antithetical to the fact that the virus is the same it doesn't know the difference between new york and pennsylvania between louisiana and mississippi it's all the same yet there was such a very very strong differences the way different states handle it so the lesson we learned there was we needed to have a good cooperation between the federal government and the individual locals which we did not have can i ask can i ask you one very quick thing which leads into the other one says do you think that in the end the biggest weakness of america is a healthcare system that is designed to look after the old and especially the rich that any pandemic was bound to expose something given the the the fact that america does not have a public health system on the same level as the other countries represented here you know john a pandemic as you alluding to i think in hinting sheds a very bright light on a lot of the weaknesses in a society for us it did one of the things that you are alluding to the deficiencies of our health care system which really needs to be strengthened at multiple different levels for the reasons that you're hinting at the other thing that it shed a bright embarrassing light on is the extraordinary disparities we have in health we're in our country similar to other disease a vastly disproportionate amount of suffering among our brown and black people our minority population in which the incidence of their getting infected is much higher their degree of hospitalizations intensive care and death is significantly higher than the general population related to the social determinants of health that have been ingrained in our society essentially from the very beginning nancy brown you know you have you you you at the american heart association you've been very outspoken about the need to focus on the wider well-being of society which dr virtue just sort of hinted at especially looking forward do you think that there is need for a broader healthcare rethink in in the american healthcare system absolutely there's no question that we need to rethink how healthcare is delivered in america and i would just re-emphasize the points that dr fauci made you know the epidemic absolutely shed a light on the vulnerabilities related to not just the health care system but the public health infrastructure and the supply chain of health care in america but i do want to say something positive and i want to give a call up to the incredible health care workers in america and the people who lead our healthcare institutions who have worked tirelessly um sometimes with their hands behind their back to try to serve the people in their communities but as dr fauci said we are seeing this incredible disparity not only of treatment for covid but you have to back it up you know prior to the covid pandemic you know these same populations were having much higher levels of high blood pressure elevated cholesterol obesity type 2 diabetes we have found through studies in our own covid registry that we have at the american heart association you know of hundreds of hospitals in this country that those individuals are suffering more greatly and we also are seeing delays and care um that goes back to the word trust which we have alluded to but we haven't called out directly yet and i think trust in what people are hearing trust in the health care system all of that matters if we're going to get on the other side of this trans-van houston you know you have you have sat there you've listened to you've you've certainly seen this at firsthand the government's struggling to deal with these things from the prior private sector's point of view you know if i gave you power over europe or indeed of the netherlands what would you do to change the way john to uh to to evaluate the lessons we do have to briefly look back right so i i've noted five points for myself and that is first of all there wasn't enough capacity to deal with the spike of the pandemic and then of course there were shortage of beds and so on so both providers as well as industry we all had to scramble to expand capacity so in a way if sars would have taught us a lesson then we could have planned ahead and created more capacity and have the scenarios available about what is needed in terms of capacity the second point is that i think and dr fauci you'll refer to it but you need coordinated care right between primary care and emergency response and your tetrary centers and in many countries that coordination of care was absent or very difficult and for example in the netherlands we built at philips a national covid data cloud to enable the transfers of patients from one hospital to the next that infrastructure just didn't exist right so that's my second point you've got to think about um the how do you organize care among states among countries between hospitals between primary care and secondary care etc so that your your response is orchestrated and efficient and effective that would be my second point the third point then is that as you build capacity you've got to have a supply chain that works now we all know that we were in lockdown but there was also a lot of nationalism countries including in the us in germany where countries said you know what you produce is for us only you're not allowed to export it but in a way that stops everything because you know every product that we make have components from all over the world right and to to put it together in pennsylvania to make a ventilator i need stuff from the philippines and china so that's the third insight is that when a crisis hits we should not have the pavlov reaction to say well me first you know we need to collaborate in order to to scale the response and then i have a fourth point and if an answer you refer to the incredible heroism of the caregivers right but there are ways to deliver care that is more productive but also better for staff and patient if you use technology for example remote patient monitoring reduces the exposure to individual patients remote patient monitoring also can support chronic patients while at home we saw and we were quickly able to scale teleradiology telepathology so that pathologists and radiologists at home could still contribute you know to the whole care process so i i think we are going to see looking forward a much better usage of data of data infrastructure of cloud technologies that enable teleworking between healthcare professionals but also the doctor-patient relationship we will have to overcome privacy concerns in many countries in the world privacy was a show stopper for all that infrastructure that you need and i you need data when fighting a pandemic and to make care available to everybody that that needs it so i think there's about these five lessons that i wanted to to bring to the table now that doesn't mean it's solved right because we have then just identified what needs to be done i would plead for a much better coordinated effort between private and public and a standing kind of uh forum where we we look at how are you prepared because there there will be other variants of of virus and we need to be prepared for the next wave let me let me let me jump on that we will come back to talk about telehealth but just just to just to jump at the immediate question which i think is dominating many countries a moment i'm going to come to dr fauci on this because it is basically a scientific one is we now have these new variants um we have one the british parent which were responsible we also have the south african one um and that moment there seems to be a race between people developing vira vaccines which is a good thing and then this issue about these new variants dr patchy how seriously from a scientific point of view from the point of view of the next few months should we take these new variants how do you look at them yeah we take them very seriously john for a number of reasons uh one the situation for example of the variant that is dominant in the uk right now clearly has an increased capability of transmitting and recent data from the uk indicates that although at first it was felt to not really have an increase in virulence which means it is more likely to make you seriously ill or kill you we're finding that that's not the case that it is that it does have the inherent capability of making you more sick the thing that we pay a lot of attention to is what is the impact of the variant which is now in more than 22 states in the united states as well as in other places throughout the world on the efficacy of both the vaccines that are now being distributed throughout the world as well as monoclonal antibodies the uk that's done the uk i don't want to say the uk variant for the or the i'll allow you guys the reason is because we really got to get away from it because there tends to be some stigma associated with that it's not the uk's fault it just happens to be prevalent there same way with the republic of south africa but the issue is it does not appear to have a substantial effect at all on the efficacy of the vaccine so we're pretty good there but you've got to pay attention to it because it's evolving the second one really quick question on that some people say that this people have been delaying the second dose of the vaccine does that worry you at all you're one of the people who's yeah it does it does i mean i can understand the reason why that is being done but i would be concerned about that because you don't get full efficacy until you get that second dose and if you allow sub-optimal efficacy you can actually immunologically select more for mutations when you do that so that's the reason why you know it may not be the case but it gets risky and that's the reason why we prefer to keep it on the time that the clinical trials said for the two that are in the that we deal with in the united states mordana and pfizer the second dose from odanna is 28 days for pfizer it's 21 days but let me get back to the variant that's now dominant in the republic of south africa that's a bit more problematic john because when we've looked at it in a number of papers are coming out on the pre-print journals that are showing that when it comes to the monoclonal antibodies several of them are completely um negated in their efficacy by the mutation and there seems to be a considerable more threat to vaccine efficacy even though the cushion of efficacy is sound enough that the vaccines that we're using now will be good against both the mutant in south africa as well as in the uk having said that this is an evolving situation so what we need to do and are doing are already looking at making upgraded versions of the vaccine that could address both the south african mutant as well as the one in the uk so even though right now the vaccines seem to be able to work against them we need to be prepared to upgrade and maybe even as a boost later on or as a bivalent vaccine that goes against both the wild type and the evolving mutants that's incredibly clear prime minister mr turkis i mean from greece's point of view i think you're one of these countries which has been talking about life returning to normal spring do you now feel as if that level's being put put back when can we expect when you expect kind of normal activity to come well a lot will depend on the patient vaccination all european countries have built their infrastructure we could deliver many more vaccines we just don't have access to them having said that and in spite of the delays um in terms of approving that level i still think that the european corporation in terms of purchasing vaccines um has been overall a success story of course we will push companies to honor the contracts and deliver vaccines faster but we i'm a little bit skeptical about this daily counts of you know how many we have vaccinated we have taken the conscious decision of making sure that we will always stockpile the second dose so that there is going to be no delay whatsoever because we know that these vaccines have been approved based on very specific clinical trials we don't want to take the risk to run out of doses and not administer the second dose on time according to the protocols that these vaccines have been approved so if we if if we assume that q2 we will have a big breakthrough in terms of the number of available vaccines i do expect a real mass vaccination um to um to start you know at some point in march april may um if we also assume that there is a degree of seasonality which we saw uh last year one could you know envision a return to normal by late spring early summer certainly very important for us given that we want people to travel uh and that we want people to come to greece but we want people to come to greece safely that is why we also launched this initiative at the european level regarding some sort of vaccine certification obviously now you vaccinated you know close to two percent of the population it's not a relevant discussion but it will become relevant at some point sooner rather than later so the conditions um making it easier for people to travel assuming they have been vaccinated that is going to be an important topic um for for europe as a whole until then it's going to be stop and go again as i've told you we've opened up our retail activity a few a few days ago we're very very carefully monitoring cases but all this is taking a big economic hit we've supported jobs through aggressive furlough schemes but we know we cannot do that forever so a lot is really dependent a on the vaccination um availability and b on people complying with the basic rules uh that we know actually do work you know i'm i'm cautiously optimistic on both fronts just very quickly this leads that we'll ask you first and i'll come on to nancy brown on this on this issue about redesigning public health systems i would imagine at the moment that your entire focus is just purely on trying to keep as many people alive as possible and trying to restart the economy but have you gotten have you got a thought about how you would try to redesign health care after this i think kobe has been an accelerator this is a tremendous opportunity to take a hard look at a public health care system which has worked reasonably well but we can significantly improve it and what is that what is the one thing you would really try to change what is what is the our focus is on prevention uh and public health you know the the points that nancy made you know all the underlying diseases that make people sicker and you know once you have a pandemic they end up in hospital with greater frequency we've launched a very successful anti-smoking campaign we managed to convince greeks that they should not smoke in cafes and restaurants and you know john how difficult that was but yeah we implemented a smoking ban it does work you can't do that and in my my focus is on primary care and technology that is where i think you know the real breakthrough is going is going to come from uh and that's where i think you know the the new frontier for a public health system really uh is that's where most of my focus at least is going to be you know postponed nancy can i come to you on that i was going to read you a quote you had with you with together with global and local collaborative collaborators we will equitably increase worldwide healthy life expectancy from 64 to at least 67 by 2030 like i don't know when you say that but do you think we're still hasn't covered mess with that and all your message of prevention and all the things that kirakos is just talking about the these are now much more difficult to achieve or what how do you look at that well i would say they're much more difficult to achieve but they're i think the light has been shined on watch why they're much more critical to achieve and i might just say that for us to help people live longer healthier lives in a pandemic or not it starts with every person having access to high quality affordable accessible health care and in the united states that is not the reality and this is why this is the main uh priority of our advocacy function in the us is every person must have access to health care and until that happens you know we can redesign systems all we want but we have to be sure people can access them you would be you would be firmly on the level that you need a universal healthcare system in the same way as not necessarily european one but canada singapore germany most of the countries which have better health levels in america i'm not talking about how the program would be designed i.e a universal system versus other systems i'm talking about people being able to access care when they need it no matter what system is in place and in the united states you know we have a system that has been built for people who have health insurance and there's a lot of people who don't have health insurance i'm not speaking about the model of payment i'm speaking about the ability of people to access a system through things like the affordable care act and enhancements to that program which we strongly strongly support but i do want to say that the system does need to be redesigned and friends and i work a lot off to the side on models of redesigning primary care using technology you know when you look at the numbers of people that have not accessed routine medical care during the pandemic and how quickly things like telemedicine became a standard of care in the united states we have we see real promise in that providing um an opportunity for care to be delivered more quickly of higher quality but we have to really you know close that last mile and help that become a reality uh in the u.s and around the world we don't need to put band-aids on old systems we need to build new systems does that mean a fundamental rethink about what exactly a doctor is because you know as well as anybody that there is a degree of restrictive practice in this is if i just want to go to telemedicine some doctors want to see you in person it means probably giving more power to kind of nurses and people like that to be able to make basic decisions is that the kind of thing you're hinting at what i'm hinting at is that our physician community in the us and around the world play a valuable role in designing and directing care for individual patients and by the way when we speak about the word trust in the u.s 81 of people who might not trust anything they hear on tv trust their doctor right so we're not speaking about replacing physicians we're talking about making care more accessible to people where care is not as easily accessible and allowing all health care providers to operate at the top of their license and that's really the goal that we have in places like in rural america you know you don't often hear about healthcare in rural america where hospitals are shutting down and it's hard to access care you know people have to be flown to get you know if they're having a heart attack or a stroke to get care in the nearest city we have to find new models in new ways and when those models are built effectively your care does not suffer we've seen that as an example during the pandemic with stroke care in the united states at the american heart association we've spent 20 years building stroke systems of care you know how to be building primary stroke centers comprehensive centers where appropriate care can be delivered thrombectomies and tpa administration changing laws and communities so people can be transferred to the right hospital and during the pandemic in papers that we will soon publish you will see that the stroke system of care was there to support people who had a stroke during the pandemic all of these things matter when we get back to the individual patient mr houston you look at phillips you mentioned telemedicine you know do you think governments understand the full just focus on television because we haven't we haven't got a huge amount of time but i'm telling medicine do you think that the promise is there what what should governments do to enable that um well rather than a wholesale change of system john that you refer to between us and uk i don't think that that's necessary but we got to put in place the incentives that the system can change so i agree with the prime minister we need to enable the first line care primary care to to be involved in that community backed up by the specialists of the hospitals this is exactly where telehealth can be effective between care professionals we are working for example with the department of defense on algorithms to much earlier detect infection and this can aid a first-line health worker in their diagnosis and we got to make traditional health care more cost effective because if you want to bring more money to new technologies and to enable the first line then productivity in the in the in the category centers needs to improve the remote patient engagement and wearables will help very much to avoid that people need to come to the hospital so that a teleconsult can also be effective i'm an optimist i believe that covet is an accelerator in this and that the acceptance of these new care models is going to accelerate what we need from governments is the courage to to shift policies and to enable primary care physicians to do what they need to do and also to to encourage the collaboration which may need uh changes in incentive systems and reimbursement so that it actually becomes uh a requirement and then we move to the world of value-based care that nancy and i are very much involved with so the technology is available we just need to accelerate the adoption can we can we look at the multilateral approach you've talked all talked a lot about things that happen within countries but as we i think dr factor said at the beginning this this is a disease that does not respect borders um two things kind of unfortunately maybe i'll come to you first on this that two things are multilateralism one firstly it's a broad one you know how great a gain is that do we do we need to set up some kind of multinational organization that deals with with with disease preparedness in a in a specifically on that subject oh absolutely yes john um you know we had a situation which was very unfortunate where the united states withdrew out of the who and as you might recall just a few days ago president biden asked me to address the world health organization executive board and announced that we are going back into the who as well as with our support i think this is absolutely critical uh org the world needs an organization like the who i believe that with the reforms that we hope the who will enact that it will serve as that multilateral organization that is absolutely critical we need global health security you might recall there's a global health security agenda we need transparency communication coordination collaboration and the solidarity that we all talk about if we don't have that it becomes maybe not impossible but extremely problematic to address an emerging outbreak not only the initial aspects of it when you start to see that there is something going on in some country somewhere that is alarming but is even when we're at the stage where we are right now when we have the emergence of mutants in countries as far away as the republic of south africa and california just came out with their own uh variant which is different from all of the above so if we don't have health people who are in california communicating with the people in the uk who are communicating with the people in the republic of south africa and not letting people see about the origin of the virus a substantial uh negative impact on us and it began a long time ago john when it was clear among the scientists who are my colleagues who i know who i speak to were saying this is really different it's not a virus that just jumps from an animal reservoir to a human and is very ineffective in going from human to human it goes very effectively from human to human and the critical issue that we didn't realize first that if there had been transparency it would have profoundly influenced policies and that is that at least half of the infections are transmitted by somebody who has no symptoms at all right right now their doctor patches that is there a you know what is the cost of china not not not opening the books on this well i think it's very important because there are still things that we don't know right now about the origin understanding the origin would really be important and and we don't know it now it's a big black box which is which is awful we're we're over a year into it and we still don't appreciate it prime minister you this is obviously somewhat more political issue for you what do you think that the rest of the world has a has a responsibility to put pressure on china about this i absolutely agree with what dr fauci said first of all on china's responsibility to be transparent on this issue on the role of the who that's what it was designed to do and it is clear that it has a very important role to play and of course at the european level because we're also a supra national organization that is looking uh to serve the well-being of european citizens i think there is more we can do to coordinate uh policies a big debate regarding our dependence on uh supply chains and not being dependent on you do you think the european union is now i mean to begin with it was not the european union's finest hour certainly wasn't the american administration's finest hour but it was not the european union's either do you think now the european union has got its act together well i think at the beginning it was you know you know a race uh you know a very national race it was a wild west when we were trying to procure you know ppe during april and may but i would still argue john that in spite of the delays the fact that the european union decided to purchase vaccines centrally and allocate them per capita without making any distinction between rich and poor countries within the european union was a moment of european solidarity i certainly feel better that the european union is negotiating on our behalf and having to negotiate as a medium-sized country on my own with with big pharma on this issue could could we have done it better and faster certainly but let's not forget that we all have access to vaccines hopefully you know the pace is going to be accelerated because we managed to purchase them at the european level and of course we also need approval uh at the european level uh you know that we've approved two vaccines there's a question of approving the astra zenica vaccine hopefully if the european authorities decide to approve it we will also have access to that but i think uh the crisis has taught us a lot about how we can better cooperate at the european level transplantation can i come to you particularly on that point what would you like to see that the european union do differently look in a crisis you need a general right and and unity of command and uh i would like very much the the solidarity and the clarity of policy i've had phone calls to about every politician in the world to keep the supply chains open in this multilateral arrangement we need to make that as a standard and not debatable right and so that we don't regress to old behavior but these things can all be discussed and put into policy and then i think we are better prepared for the future same to some of the other points that i mentioned like having data transparency exchanging data on a regular basis will all help for a better healthcare system and i hope that those will be the lessons learned once the dust settled that will be put into policy nancy brown you you've seen this especially on the multilateral level this element of beyond america which i know you you look at a lot now what is the one thing you'd like to see between governments between nations at the moment you know i think the coordination that we've heard about is really critical and um dr fauci mentioned the word solidarity there's a really good model in science and research there's a international consortium of researchers working together across countries on covet therapeutics in a solidarity trial being conducted in more than a dozen countries this can be done supported by governments um and i we think it's very important and i will say you know that i also in addition to the who the west has a very important role to play because here the west is convening leaders of governments leaders of industry leaders of non-government organizations and back to this important word trust people around the world really trust when they see that level of cooperation and collaboration coming together and so all of these pieces together can give us promise for a different future than what we've been experiencing this past year would you like to see a particular thing targeted at this issue of dealing with infectious diseases on a kind of global level that you see some people calling for a need for people to do a the equivalent of sort of manhattan project of looking at this in a much bigger bigger way well as has been said by my colleagues you know these uh viruses show no boundaries so we need things like global registries global data sharing um commitments and agreements for transparent immediate communication you can't solve a problem when you're guessing at what the problem is uh you can solve it eventually but when you have to take time to guess what the problem is that doesn't put anyone in an advantage and we clearly would call for that level of global support and collaboration especially in data and science always first that seems a very appropriate place in which to and end our discussion i would or particularly the issue of science um i will thank all of you we are we are ending on time and thank dr fauci franz van hooten nancy brown and prime minister mitsukis thank you very much for a very interesting discussion which has varied across everything and thank you all very much to the questions of which we have tried to answer some indirectly thank you very much thank you thank you thank you very much you