[inaudible conversations] >> good afternoon. welcome to csi as time the senior vice president and we

are thrilled to be here today we have a terrific lineup of speakers i will introduce momentarily the ceo of the vaccine alliance. first thank you to our colleagues who put this program together very carefully over many weeks and my partner catherine who we will hear from on the panel. this is a big year of replenishment you hear about that it is the second replenishment in the tenure of ceo data back to 2013 and in that. reflecting on what has happened during his tenure it

is remarkable. the amount of leadership and achievement and change we have seen over the course of this. a continuous process of reworking and improving the transition policy, we have seen movement of the institution to a concentrated discussion in advancing health security and promoting stockpiles to advance hpv vaccine and looking immunization across the entire lifespan. the institution has been graded at various points with very high marks in terms of gender equity and accountability to shape markets to bring prices to within affordable levels and to expand the pool of

producers which has more than tripled in the course of the last ten years the relationship with the united states remains very strong. congratulations last week the administration on the tenth announced a plan of one one.6 billion that comes out 290 million per year that is significant over the earlier years and a side of the high regard across a political landscape and the work that it does it is a very strong partner and a much stronger partner moving on to a campus in geneva we see a strong alignment with the global fund

with polio eradication initiative these are the high marks and we are delighted seth has chosen to take his time out of a frenetic schedule to be with us this afternoon so please join me to welcome him. [applause] >> thank you steve for that introduction and all of you for coming to hear this presentatio presentation. we were together at the munich security conference where we had a chance to discuss some of the things we are talking about today which is even more relevant given the news we have in front of us. so you have heard, turning 20

years old the top is the original panel and different leaders and the multilateral institutions. the question when it started is will this succeed? are has been a children's vaccine initiative that failed miserably before this it was an experiment we have to agree it was very successful. since it began we have immunized more than 760 additional million children but what people don't know is close to 1 billion additional children have been reached by campaign supporting between 50 and 60 percent with 13 million death and economic benefits we expanded the vaccines now to cover a whole range of diseases so i think we can see

that public-private partnership is working. more importantly the numbers and development to use child mortality as an indicator and we can see during this period of 2017 a 50 percent reduction of child mortality is extraordinary if you asked the question which components you can see a 70 percent reduction of mortality. not only to get the vaccines out but this works. >> over a timeline you can see the improvements that have occurred you see the cohort growing slowly because they talk about a more global number like africa with a 40 percent increase and the

number immunized we have 22 percentage points in the reason we use that as an indicator to have to know that the health system is working look at the other immunized to see the numbers going down but this is children that have not had any contact with routine immunization system is a much more important indicator going forward and i will come back to that. so why was it set up originally as an equity agenda knew a powerful vaccines made available but not reaching the people that needed them the most you can see hepatitis b not only a virus that the mean cause of liver cancer so you can see high income countries

where we are today more developing countries have access than developed countries this is a dramatic change of equity in one of the challenges one of the poorest countries have access but those that do not that we as the alliance discuss what role we could play to improve that. where have we been before we got those formal programs about sustainability. china was specific around hepatitis b to have 365,000 deaths per year from but today less than 1 percent are infected and those deaths are going away. starting with 77 then went down with a former loan - - formal policy of transition

and where the cohort comes from, 15 countries transition. i will show how that works. and for those that were left behind. the only time they ever included a country that was not included for economic reasons but because of the situation there and tragically two years after it was included it was it eligible for the economic disaster so 57 countries plus serbia if the eligibility policy and the way it works is a peer economic policy. if you are above $1630 you're not eligible if you are below that you are we don't choose

countries based upon politics but purely based on economics and start off with countries paying just a little bit as they move into the preparatory transition to increase expenditure 15 percent per year until they crossed the threshold that they have five years to take on the full cost of their vaccine the pharmaceutical partners have made sure there is no shock after this to allow countries to keep prices five or ten years after now we're at the process of graduate school looking at how we make sure there is a smooth landing and then to expect ten more to transition during this period. this means they are putting more and more of their finances on those tough

interventions you could see the financing going up over time with the dramatic increase of 36 percent of the financing is but we need to figure out to make sure we have vaccines available but we do that with the private sector. here some of everything from better vaccines and ecological solar powered change and digital health workers. this is a process process to

deliver them better for - . and this is better for the next phase of leave no one behind. we already heard from steve we are doing more on outbreaks this has been and evolution more than one.3 billion have been protected but we know over 50 years there is a global resurgence there are those of the vaccine residency we also see problems in the west and south with fragile countries that the one --dash more people have died in drc

we have to make sure we pay attention to the routine systems. for a surface of these countries don't have measles. >> going back to the global health but the meningitis or cholera or the ebola vaccine we have had a pretty good track record more than 140 million people protected within 170 million doses since we started the program and we have become much more systematic working with unicef as the supply division and procurement. we work to make sure there is adequate supply of vaccines in case of emergencies. >> the ebola situation is

operating at its best when the outbreak occurred people realized everybody was piling in with new technology when we thought it was a global out break but who will pay for this as companies scale up and sustain at the board made a decision because of innovative financing mechanisms we could do this and we announced we would put up the $390 million available to create a marketplace for ebola vaccines and distribute those we did the advance purchase commitment merck stepped forward we announced that at davos and part of that agreement is to make sure the regulatory systems moving forward that merck would submit an application at who but also with regulatory approval but as important to keep 300,000 doses available just in case there was another

outbreak in the interim. and thank goodness for that because there have been three outbreaks as you know two of which were rapidly controlled and then where the vaccine has been remarkable more than 280,000 people and has kept it at bay from spinning out of control of course the challenges in governance means the epidemic has continued today we have a licensed product not only in the west but now for african countries have licensed it working with merck to create a global stockpile so hopefully this will not be a problem again in the future. talk about the importance of polio, we have been working with the polio group for a long time but where we really stepped up when they introduce the activated polio vaccine

that is the most rapid scale up ever done in history. we tried to do it more than 70 countries over a year and a half. that has now occurred. it was independently financed in the past but the last two years and assuming that we have a punishment. >> also to look at the coverage but also the vaccine those are expected to be ready and if it's to move forward toward better product.

>> this looks at pricing which is the important issue because we purchased vaccines for 60 percent of the world's population but that means we can negotiate a better price and that is very important to shift the mindset to high volume lower cost. this is just true for industrial country manufacturers but we have brought a lot of new manufacturers going from five to 17 during this period and what that means is we have a healthy vaccine market and you can see today not exactly apple to apple comparison we don't use the exact same but it is around $1100 for the vaccines the who recommends this gives you the idea of market shaping that's critical if they will pay for the vaccines themselves. that's a little introduction now where we are pivoting cracks this is the new

strategy goals and you can see on the top leaving no one behind this is the big change that's occurring. you will see but at one point when started more than half of the kids were getting vaccines but today we are up to 90 percent receiving at least one dose. how do we have it to a different program cracks a lot of things are affecting us with population growth , urbanization with an increase of two.3 billion people 70 percent of the global population is in urban settings the largest place of displaced people that are in developing countries and dramatic effects from climate change with the ecological disaster and movements of people that affect the way they are these are more act

one - - macro would affect the strategies for looking at where we were and now to the united states we have reduced it by half you can see the 15 million but who has not had any contact with routine immunization that has gone from 18.nine down to ten. 4 million that so-called zero dose children are a critical priority pivoting towards in the next. wire we focused on them cracks from the equity point of vie view, two thirds of those children are below the poverty line this is critical not just in the isolated or rural area but in the urban slums and refugee camps and people

moving because of climate change that's why we have to change our strategies. >> think of this as global health security that corona violent virus occurred in china with a good public health system and you could make critiques if you want but china was able to jump on it quickly they had the tools and could work on it that wasn't true in 2018 it occurred on the border for three months we were unable to know it was ebola and wyatt spread we have

to have no communities left out. not just as a development or equity issue bad a global health security issue. if you get sick in a community without a health intervention you will have side effects or die or spread it among you. where are they crack 75 percent 13 large and fragile countries we will get very granular and come up with the metric to reach zero dose children but also a metric on how those zero dose children are incorporated into a health system and that's really the critical metric because we like to build a resilient health system for everybody. >> what do we have to do to do this cracks we have to be more

differentiated and targeted to go subnational there is a reason why communities are reached how do we reach them cracks we have to have tailored responses and pay attention to gender issues because many have that gender component and focus on demand not just supply but deal with those hesitancy issues and think about this not just in the traditional alliance of who and unicef and the fate - - gates foundation but the humanitarian players traditionally have not been involved. how do we take advantage of polio quick. >> lastly we changed. it used to be just about kids but lincoln said public health is like a sinking ship. women and children and everybody else comes last.

that's not true now were trying to build a but you can see here some of the advantages across looking the platform where you can work with and then to have those integrated approaches. >> this is a particularly good place to do it because we have more than half a billion contact points each year so again going to scale this is a great way to look at it. talk about the replenishment and resource needs so in berlin we asked for seven.5 million and agreed the replenishment would be less than that but we also ended up

absorbing the big ask on polio so we squeezed our health system funding more than we liked the board said we have means we're looking at lease for seven.$4 billion we see that as a minimum to do this. we have more finance we can use that for the equities and zero dose to the hss agenda. what is interesting about the finances you see the china non- - - the changes that have occurred 71 percent owner financed now 54 percent. here is what that looks like it will be full 31 percent if

you add in the cost of paying for the health systems which is another 6 billion of those poor developing countries are developing close to $10 billion in their systems the most cost-effective intervention you can have. i've already talked about the price reductions the core vaccines and you can see a 50 percent reduction over this time. one of the important things to say is there will be a point we cannot lower the price anymore because we have to make sure companies are able to make adequate profit but but then of course where there

are changes for countries. they say you saved us we could not have done that ourselves if we purchase bilaterally but even more important and then to afford the vaccines going forward. >> this is what we are trying to do to shift out coverage. obviously that is difficult to do and when to prioritize. we did the launch for replenishment in japan because traditionally japan has been the g7 country that is the

least largest supporter. we wanted to get them to do more and you can see the prime minister and the foreign minister with six african heads of state to speak extemporaneous how good it was. the replenishment this time is in the uk june 3rd and 4th we were quiet for a while. and with his celebration with the meeting talking about pledging confidence in london. this is actually the one one.16,000,000,004 year

commitment so this is proud the us that only 16 percent but they came out early and made this statement but it is a particularly strong statement the rest of the budget so it does show value that they place on this alliance going forward. and by the end of the. to be immunized one.1 million children preventing more than 22 million deaths. this really talks about scale at its best and how we can make a difference globally to help countries protect themselves but as important to

make the world safe from infectious diseases back i hope i have given you a view of what we are doing. from the past and into the future. thank you.

>> thank you so much for that presentation getting back to those issues that we touched on in the course of conversation to have robin and catherine in quick sequence and then we will come to the audience as soon as we can. we heard the story of the successes and progress made and asked the three figures there are plenty of tough challenges sending a signal but first we will introduce the three speakers as the acting assistant administrators.

>> she was very integral with the bureau for global health on the security agenda as the acting administrator. with a large spectrum of issues. so thank you for joining us. and as the principal advisor in chief of headquarters. we are thrilled to have you with us today. and earlier over 35 years is

extremely generous. we don't miss an opportunity and this author list i would encourage you all to read and then around those us national interests but then to explain what catherine put together so

to talk about the health security strengthening so now we will talk about some of those to be at the very center of issues of how to protect that infrastructure programs. it with those interruptions. and for all of that work was versatile. and to venezuela and then you can collect your thoughts and

then me will start the conversation. >> thank you it's a great pleasure to be here. >> and with the government's commitment in those things talking about in that presentation that requires 1 billion kids and saving them with the privates sector and others.

>> but also very excited so the partnership was part of those alliances since the very beginning. and those underage kids with the priorities that they have. >> and then try to engage on that equity issue. and those in the sustainable

way. would with that global health security and then addressing the coronavirus. >> and the approach to that not only from the health sector across the board but those that we work on it with those opportunities to move forward and with that broader alliance but it is key to

other civil society for those that come together that have that tremendous impact over the first 20 years. >> thank you for having me. >> and happy 20th birthday it is now the mature alliance and i hope i can speak as well

when i say this. so i will keep my remarks very short and with four specific points we were working but then there are a number of

they are alliance partners are here. so to talk about the challenges that we face that we can no longer rely on to the national. and we need to broaden that partnership. second what the alliance is done and with accountability. and then to be holding each other accountable we can agree

to disagree. and with the common goal. and that was extremely critical of their children and their mothers so what i would like to say in terms of innovation. and those that the involvement but i didn't want to that innovation is a mindset. said talk about achieving

equity with that location. but then you look for the one-size-fits-all. but this is the most powerful thing that we have. and then to engage with heads of state and advocating for children and that is a huge potential so one of those last points is the immunization and

then to be sure with the intervention and whatever the case may be. so we are the alliance committed to working is on telly one - - horizontally. >> thank you very much. >> i would like to say a few words about the report and with the global health security. and then to look at this relationship and with the

uptake of that scene is it is very much connected to the us global health and then to strengthen us engagement and the second time and on the country's path and then to put that emphasis. and that is very much consistent with that.

with those diplomatic objectives. and with that alliance with the integration and also the private sector to credit the alliance from the beginning and these other areas and with that diplomacy and a larger diplomatic outreach to showcase that entrepreneurship. i was very interested to hear traveling in london.

it was very interesting to hear and and it's important to maintain that bilateral engagement of your own but that this should be part of a larger commitment. not only usaid but center for disease control and then it with the priority countries and all those eligible countries but there are differences but with those relationships and then moving toward a transition and also

those in the past historical relationship trying to understand over the long ter term. >> thank you very much. i have the pleasure recently from the security conference and at that time there was great interest of the coronavirus outbreak. we will get to that with the course of our discussion. with the norwegian prime minister. and across all of these activities what is the degree in which operating and

preparedness innovations. and with the gates foundation. it was very impressive that those relationships have become and how central they are with the response to this new challenge. and intellectually contributes to this debate the quality of the contributions made had all of those different points in time and to shift to those challenges one that we have given focus to is disorder and

insecurity. and the spread of disorder and with the low income countries that demand to be very high with the outbreaks that are often times situated to be a big focus in the last two years and other outbreaks. and the discussions that we have had with what kind of capacities would be required without militarizing the response you cannot fall back.

we cannot sit on the sidelines to have personnel there safely and effectively. and meeting the demand and investing in partners in those areas. to have that expeditionary mindset. and then to move forward and think differently. and then to move forward and think differently. what you think is needed further right now and what you look for what those partners that you operate with. >> one of the greatest challenges if you look at

fragile countries at the least it is ten or 20 percent less so the first thing we have to do to think it is a norm for your systems and so if you come in at this specific approach to say i am here from the polio program i will keep immunizing until we eradicate polio eventually you will see pushback so we need a norm about doing this for everybody. and you have the most cost-effective intervention then you get a 54-dollar return even for a poor country this is where you should be putting your money so where we

all agree mrs. really ought to be financing then how do you work in these places. so then working in yemen. and then to immunize their kids. we have been able to do that in many places. so those are those other activities. and then to have the ebola outbreak but one of the things that set it off may had to stop the election. but the reason they brought you bullet here was the

opposition this is why getting the norms are so critical. and to work with the previous administration and it's really exciting because i just met with the president two days ago. but the president has taken leadership they sign that immunization declaration to going add local level to get better coverage. this is a maybe we'll get there. and then to be normalized. and then going back to make this a norm and then it's critical to success.

>> and that communications of weaponize social media and the information that is so pervasiv pervasive. >> how do you combat that clicks and entrusted to a science disoriented or anxious. >> that is a different solution in the industrialized world but we are complacent that child will live and be healthy that is what you expect and as a result the

idea to maintain and make them cry our sense of the possibility for rumors. so we would walk a huge distance so you saw these diseases now that is changing a little bit because we are successful with immunization. but what is interesting is now they come together. if you are in northern nigeria and you have questions about vaccines you go on to the internet and then you see the same information. what the alliance has tried to do was look at demand as a continuum those that will not even eyes under any circumstances. and those that will go at any length to have immunization.

so focusing on demand with local leaders to do that. so to reach out to social media companies because obviously telling people it shouldn't be there but that's not enough. if a mother is looking for information then frankly they don't want to go to the cdc website and those that are using vaccines as information

and the last thing that we say about this mostly about local trust so what is the highest confidence? it is rwanda. very interesting. but it was more than they trust governments so how do they make sure they are prepared with the right information. >> so tell us what you are doin doing. >> and with that demand to get that information out.

it really is a critical piece. >> it's really important from to the community. and to those communities and the way that trump did it. and so using that technique and that is something they are working on. then to partner with that effort. and that is the reality between countries of crisis

and what they do under that normal development side but then they look at it differently. >> and with that issue it is complex so to describe what it

takes to get a kid vaccinated. and with that policy you get the vaccine and bring it to the house and then get your kids out of school. and then get vaccinated. so the bottom line and those that are updated by the

community. and with that strategy is completely different. and that other aspect and it to be in a marginalized community as a minority. you can get treated really badly. but health workers begin if you read it on the internet you would not believe it and then the issues.

[inaudible] >> thank you very much. and then to mention the middle income countries can become problematic. and then graduating into middle income status that is very tenuous to be supportive with approaches to this but there are risks for that population and country. it comes down to motivating the leadership. so what can you do in this

context to lower the risk because it's too difficult they are not quirks would you do to lower the risk but have success in the transition process. >> there are a few one way is to identify way for countries to access lower prices through a longer period of time. and those at so another is to the point so that with those transitions way in advance.

and so many years earlier. >> so what can you do to motivate your leaders? former washington dc mayor

moderated the discussion. [background noises] >> i am sharon, i will ask the camera crew that we are blessed tonight not only to have our regular camera crew but also to have c-span with us. we are also live streaming this on