Nisha Pillai:

Hello and welcome to Insight, a webcast from the Asian Development Bank, focusing on development issues around the Asia Pacific region. I'm Nisha Pillai. COVID-19, a once in a century event, has appended all our lives. We all want to go back to normal, but that can't happen until there's a vaccine. One that is safe, effective, and widely distributed. Scores of vaccines are in development around the world but lots of questions remain: how soon until we see the first vaccines. How do we distribute them? Who should get them first? will developing countries be left behind? And how to overcome anti-vaccine sentiment. Later, we'll have a panel discussion with experts from development, the private sector and academia. But first to our interview. Jane Halton is one of the most renowned figures in global health. She previously served on the board of the WHO, and was also president of the World Health Assembly. Today she's chair of CEPI, the Coalition for Epidemic Preparedness Innovations. Jane Halton, thank you so very much for joining us on Insight. Now, CEPI was formed – it’s a very young organization - in 2017 with the motto “new vaccines for a safer world.” Now, did you think at the time in your wildest imagination that just three years later, we'd be in the grip of this raging pandemic?

Jane Halton:

No. I mean, certainly when we established CEPI, we understood that there was a threat. In fact, that's the whole reason we set CEPI up, but I don't think anybody anticipated that so soon after the establishment of, as you say, a very young organization, we would literally be where we are today.

Nisha Pillai:

So right now, one of the main things that CEPI is involved in is the huge COVAX program to distribute vaccines round the world. Tell us more about it.

Jane Halton:

Well, one of the things that I think a number of us were very concerned about was the experience we had during H1N1, which I think people would remember and the problem with that was the wealthy countries and people with access to money and resources, and therefore to vaccine what access to that vaccine much earlier than the rest of the world. And so for those of us who are looking at global health security and thinking, how do we bring something like this pandemic to an end and particularly to reduce deaths that we needed to find a new way to ensure that people got equitable access to vaccine. And we know that if the people around the world who have most need get access first we will actually reduce deaths quite considerably by 66%. Whereas if the vaccine only goes to wealthy countries for broad-based distribution in those countries, we will reduce deaths by a third. So there's really seriously material difference in the outcome.

Nisha Pillai:

So where are we then in terms of the fundraising efforts, you've still got quite a long way to go in terms of meeting your own ambitious targets.

Jane Halton:

Well, we do. And I mean, I think we need to understand that to, to use the phrase Rome wasn't built in a day, and in this particular case, we have done unbelievably well, and we've got over 190 countries now who have said that they will participate. We have raised a significant amount of funding, but yes, there's always greater need. And certainly when it comes to not just procurement of vaccine, particularly for low to middle income countries, but also underwriting the cost of delivery for those vaccines, we do have some way to go. However I think everyone knows that we're not going to have a vaccine particularly at scale in the very near future. So we've got time and we're obviously working with all of these countries to firstly encourage participation. But most importantly, I think to ask them to help ensure that we vaccinate the vulnerable around the world.

Jane Halton:

Isn't it a bit of an own goal for richer countries to put the interest of their own citizens first, because I'm sure, this is a global pandemic. None of us are safe unless all of us are safe.

Jane Halton:

Well, that's exactly right. I think I use the term vaccine nationalism in an interview I gave in US to US public radio in February. And the reason I've started raising it then is exactly as you say, and I've already told you about the different impacts in terms of deaths. If you vaccinate just the citizens of one country versus if you actually target all of the vulnerable around the world, but let's think about it this way. We want to be able to travel. We want to be able to conduct our business to trade, to go and see family. And of course, where ever this disease is raging in other parts of the world, it limits our ability to get on with our lives. So it is shortsighted because just protecting your own citizens is not going to enable your citizens to go about their business in the way that they would like. And indeed it doesn't enable your economy to function much as you would like. So it is an on goal. And it's one of the reasons we're encouraging people to think beyond their own borders and to think about the collective interests because exactly, as you say, if one country still has this, we all still have it.

Nisha Pillai:

So tell us a bit more about timing then, when can the waiting world expect to receive those first precious doses of vaccines?

Jane Halton:

It's a $64 billion question, isn't it? And nobody really knows when we will actually get to the start line. We have a couple of vaccine we have in fact, more than a couple of candidates who are currently in phase three trials, a number of which are in the CEPI portfolio now, all being well. For example, with the Oxford vaccine, if that vaccine, which will be manufactured by AstraZeneca and a number of others on contract around the world, if that vaccine passes a regulatory approval hurdle, which we would all want it to that vaccine would be available probably from early next year. And our objective is to actually deliver by the end of next year to 2021 to deliver 2 billion doses. So that's the target we've set ourselves. And that would then enable us to really go and focus on those highly vulnerable populations right around the world. But that wouldn't start, we don't believe until probably the first quarter of next year.

Nisha Pillai:

So Jane Halton, there's a real concern amongst developing countries that big places like the US, EU, Japan have pre-ordered so many vaccines, they're really worried that there'll be very little left to the developing world. What reassurance can you give them?

Jane Halton:

Well, I mean, what I'd say is this to start with, I mean, people have put down bids for vaccines, none have yet of these are approved. Secondly, there are real constraints around production. So the world can't produce a billion doses of vaccine very, very quickly. We are, we are really trying very hard to get to multiple billions by the end of next year. So every country is going to face that kind of challenge. And yes, we would all like to be vaccinated by an effective vaccine in the first quarter of next year. I don't think anybody would deny that that is their interest, but I think the speed at which we moving and the pace that would be then followed on in terms of delivery, I think it will give all of the world that kind of access. So, yes, it's true. If an American, for example, vaccine succeeds, and they can produce enough for the 300 or something, a billion, a million people in the United States will certainly they will be vaccinated, I would imagine in around the same timeframes. So we would all wish that everyone could get access at the same time, but there are these very real constraints around production, but we're doing everything we can to get the, to that target by the end of 2021.

Nisha Pillai:

Okay. So could you put a bit more detail on this for me, please? If I were a health ministry official sitting in Delhi, and in the Maldives and Indonesia, when should I be preparing to expect vaccines and how much should I expect to get?

Jane Halton:

Well again, because of the constraint here is we don't know when something will succeed and when it will be approved you can't say to yourself, I will have vaccine delivered to me in March, but what you can do now. And in fact, what I would be encouraging every health ministry and I was still running the Australian health ministry. I would be doing this right now. I'd be saying to myself, hmm, WHO have issued some guidance about who priority populations might be, but that's sort of global level. What is my strategy in my country, given my geography, given the vulnerability of parts of my population given issues around density of living in various places who should I be vaccinating first? And then how is it? I might do that now in some countries, there are long established partnerships with GABI for example, and I would be working with all of my regular partners with the health professionals. And we've obviously state delivered the health services to actually get those arrangements in place that may include cold chain. It may include actually thinking about perhaps novel mechanisms of delivery, because you don't necessarily always immunize the elderly every health care worker and people, particularly people who've got co-morbidities, they may not be as easy to find as finding kids who we would be normally vaccinating. So if I was in any of those countries in, but if I was in every country, that is what I would be thinking about now.

Nisha Pillai:

So if we look around the Asia Pacific region, Jane Halton, there's great diversity. There are some countries like Vietnam, where the COVID situation is more or less under control, but others where cases are growing very rapidly, the case numbers are huge. So what do you think COVAX should do?

Jane Halton:

So what we've said very clearly, and this is subject to the technical guidance from the World Health Organization is that every country has got vulnerable populations. And hence the allocation that is proposed to 20% of a country's population for then targeting by that country based on local public health advice to actually target the vulnerable. And yes, it is the case, but outbreaks are varying points in varying countries. You've talked about Vietnam and my good friends in public health and Vietnam have done an outstanding job, but the truth is their population is still very vulnerable. So what we need to do is protect, and this is my point about the death numbers and the evidence. I think it's from Northwestern University, who's done this modeling that if we do vaccinate the vulnerable in all of these populations around the world, before we go to the well and people who are less at risk, we will actually improve the reduction in lives lost by a 50% margin. So it's very, very, very significant. And that's why we’re targeting these countries. Now we know some countries will not be as ready to deliver, and they will have to be some logistical consideration around those matters, but we should target all of them first before we target other populations.

Nisha Pillai:

What's your advice to development, finance organizations, to donors like the ADB, how can they best support countries, the region to make sure that they're really ready for the vaccine supplies as they begin to trickle through?

Jane Halton:

Well, as you've already indicated, we still have a level of financing and fundraising to do, even in relation to the purchase of vaccine. But you've also raised one of the crucial points here, which is having the infrastructure. And of course, this also includes the staff who are trained and ready when the vaccine becomes available to actually do that work, to record the information as to who's been vaccinated, and then to make sure that this vaccine can be delivered speedily and effectively to those vulnerable populations now big institutions like the ADB and other relevant donors. I know already looking to see how they might assist that effort in various countries.

Nisha Pillai:

Finally, I wanted to ask you about this huge resurgence in anti-vaccine sentiment that we're seeing, what can be done about it. Should there be greater curbs on social media, for instance, for a more moderate debate?

Jane Halton:

Well, I do think the laws of the land should apply including in cyberspace and to the social media companies. We know that people thoroughly disapprove of, and there is regulation to prevent, for example, the use of images of children and other exploitative arrangements. I actually think the misinformation, the misstatement, and in fact, the downlight lies about the science and the facts that underpin issues in respect to vaccination, I actually think that they are very dangerous as well. Now I would hope that the quality of information and this approach to managing this misinformation would be done voluntarily by companies. It's in their interest to be good corporate citizens and global citizens. But I do think for many countries, it is coming to the point where a difficult discussion should be had about their social license to operate. And in fact, what else could we do done be that regulation or other things to encourage them to actually do the right thing here.

Nisha Pillai:

Jane Halton. Thank you so very much for joining us today. Fascinating insights there. Let's broaden this out now into a panel discussion. We're joined from the ADB by Patrick Osewe from the Pharmaceutical Giant Takeda, by Rajeev Venkayya, from UNICEF, by Michelle Dynes and from the University of Chicago by Professor Anup Malani. Welcome to you all. So Patrick Osewe, if I could start with you, you're responsible for health policy at the ADB. We heard Jane Halton talking about the importance of making sure the developing countries don't get left behind when it comes to vaccine distribution. Is that something that your member countries are actually worried about?

Patrick Osewe:

Of course, many member countries are worried about this because in our region we have 52% of the global population. The rich countries will be able to the vaccines directly. The poor countries have to pull together and try and get vaccines through COVAX. COVAX, we'll start by providing only 3% of vaccines to healthcare workers on people with pre-existing conditions and so on in 2021.

Nisha Pillai:

So can I ask you then what it is that the ADB is doing to support your member countries?

Patrick Osewe:

So since the beginning of this pandemic, ADB moved very quickly to provide significant resources, initially a hundred million dollars to support all our member countries to purchase emergency supplies, and so on. As we were planning a $20 billion package, for vaccines we have been engaged with almost all of them through direct contact with our field officers and also through webinars, and we've discussed on what is the best way by which we can support countries months before the vaccines are available.

Nisha Pillai:

So it begs the question, why is vaccine production going to be so constrained next year? I'm going to ask Rajeev Venkayya. That question, Rajeev, you run Takeda's global vaccine unit. Takeda has decided to focus on manufacturing and distributing COVID-19 vaccines under license. Why will production be so constrained?

Rajeev Venkayya:

Well, the reality is that there is a tremendous amount of potential capacity to manufacture vaccines around the world, but that capacity has to be designed or modified in order to accommodate any vaccine that you're going to be making at scale. That's issue number one - you have to get the equipment ready and the facilities need to be made available. They need to stop doing whatever they were doing before so that they can work on this vaccine. The other problem is that we don't yet know which vaccines are going to work. We have over 170 vaccines in development. A number of them are actually now in phase three developments, so that's very close to knowing whether we, they work or not, but until we actually have that proof, it's hard to massively scale up manufacturing because you could be unnecessarily utilizing capacity that could be redirected for a vaccine that actually works. And the third issue, perhaps the most important issue, is that we've never manufactured this much vaccine, this fast, ever in the history of mankind. And so this is a, an extraordinary undertaking and it's hard to get it right. It's really difficult to make sure you can manufacture at scale with reproducible quality products vaccine doses that can go to hundreds of millions or billions of people. So for all those reasons, it's, it just takes time to do it right.

Nisha Pillai:

Clearly it's a massive challenge. Tell us about your own plans at Takeda. How big is your own production capacity? When are you going to be supplying vaccines at the earliest? Will there be anything left over for the whole of Asia once you've supplied the Japanese market?

Rajeev Venkayya:

I certainly hope that we'll have vaccine four available for people who needed outside of Japan. If that is in fact a need, we have made a decision not to start our own COVID vaccine program, because there were so many other companies that were doing exactly that, but we prepared early on with discussions with other vaccine manufacturers to put in place partnerships, to be able to transfer the technology into Japan, to be able to manufacture vaccine for Japan. And then hopefully for other parts of the world, we expect to be manufacturing at scale in the second half of next year, our partnership, our primary partnership is with a company called NOVAVAX, a US-based biotechnology company. Now the important caveat is we don't know whether that vaccine is going to work, and we're not going to know that probably until early next year, but we're not waiting. And in fact, that's a critical element of the plan to make vaccines available quickly is to do things in parallel and to take risks, including risks in scaling up manufacturing before, you know, whether the vaccine actually works and that's what we're doing.

Nisha Pillai:

Okay. So we've just been hearing from Rajeev Venkayya that the world has never seen a vaccine program on such a scale before. Let's get a view now from UNICEF, which is the biggest distributor of vaccines around the world to poor and middle-income countries. Michelle Dynes, please can you explain to us what are the challenges going to be in switching the focus of vaccine delivery programs from children - which is what most of them focus on - to the elderly and people with co-morbidities.

Michelle Dynes:

What we normally do is use communication messages to reach the community level, focusing on caregivers of children under five. Now, of course, COVID vaccine is going to be initially given to priority groups, such as you said, the elderly or people with co-morbidities. So now we need to determine what are the right communication messages for those populations. And what are the right ways of communicating is that through social media through traditional ads or TV radio. So those communication messages, I think, are going to be really important for reaching the priority groups and for understanding how we can physically reach them or how they can physically reach the place that we'll be vaccinating. So those are some of the challenges that we are already starting to plan for and working with country offices in the region to develop those strategies that are going to be more effective for the new population.

Nisha Pillai:

Michelle, you're a trained epidemiologist based in Bangkok, but working across the Asia Pacific region, what do we need to do to make sure that health workers on the ground are COVID ready?

Michelle Dynes:

So as you know, healthcare workers are one of the highest priority groups to be vaccinated. So as both recipients of the vaccine, and also as vaccinators themselves, this key population is critical for giving the right education and training so that they feel comfortable with administering that the vaccine, but also that when they receive the vaccine themselves, that they have a positive experience because they are going to be a proponents of it, to the community. What we know from research is that community members at look to healthcare workers for their recommendation on vaccination or not. So the perspective of healthcare workers is going to be really critical and what we're doing now at the global level and at the regional level is to develop key messages for healthcare workers training materials for what they need to know both for the skill of vaccinating, but also for increasing their confidence in the vaccine so that they can also communicate appropriately to community members in simple language that will make community members understand the safety profile of the vaccine and the importance of getting it, if they're in one of those priority groups.

Nisha Pillai:

So we heard from Jane Halton that it's really important that countries do that own hard work, their own thinking on who their key priority populations are before the vaccines arrive and I'm going to ask a new Anup Malani from the University of Chicago to shed some light on that. Professor Malani, you and your team have been conducting large COVID seropositivity trials in India and Mumbai and in Karnataka, what are your thoughts on who should be getting the vaccines first?

Anup Malani:

So I think there's two parts to this. The first thing that we ought to be thinking about is what are the benefits to vaccinating the person who actually receives the vaccination? If you think of it from that perspective, we want to go after the individuals that are at the highest risk of being infected, going forward, and those that are at the highest risk of mortality, if they were to get infected, then there's a second component of it, which is the indirect benefit of getting vaccinated, which is you're probably either infecting other people or your ability to help other people avoid getting infection. It is on the second dimension that we really want to prioritize healthcare workers because healthcare workers are going to be critical. For example, if they're part of the vaccination drive, they're going to be critical for actually vaccinating other people and reducing infection that way. But even healthcare workers that are at healthcare facilities are preventing individuals who are infected from having severe health consequences. So there is where you'd prioritize those individuals. However, it's also important to remember that there are some areas where the infection is spreading quickly or more quickly than other areas. So it's going to be critical that each country do their own, or they find datasets that are maybe elsewhere, but representative their populations. The good thing is it's not that expensive, actually to do the sorts of serological studies that you need in order to do a localized plan. It's also possible to begin to analyze the data that many countries have gathered on who is dying from COVID to understand what the best predictors of death are, whether it's age, gender, location, et cetera.

Nisha Pillai:

And Patrick, your response to that.

Patrick Osewe:

I think this is a very context specific issue at the beginning, when many countries were under lockdown. The health workers are at the highest risk. And now that the economies are opening up and to that, going back to school, we are seeing that some schools like in Chile for instance, 16% of the teachers were infected. So I think this is something that country has to look at, who is it, who is at the highest risk in their own, in their own context.

Nisha Pillai:

Rajeev, if you'd like to come in on this as well.

Rajeev Venkayya:

The principles that have been discussed are exactly the right ones. I would also bring in the equity dimension. You know, in the case of healthcare workers, Michelle makes a very good point that they are on the front lines, they're part of what we would call critical infrastructure. They're necessary for communities to continue operating, but a lot of groups fit in that category. The difference about healthcare workers is that they're putting themselves in harm’s way and they are often doing it without having adequate personal protective equipment, and they're doing it out of their desire to serve. And so I think that's another dimension that we need to consider. In the US we have a parallel situation with frontline workers that are working in warehouses or driving buses that are, they're doing things where working in factories, they can't stay home from work. They can't work on their computer at home like many of us are able to, they have to show up in the office. And so there's also an ethical dimension to ensuring that those that don't have choices, which often are disproportionately bearing the burden of this pandemic get early access to vaccine.

Nisha Pillai:

So I'd like to move on to another key issue now. Once the vaccines arrive in countries, will the distribution systems be up to scratch? Patrick Osewe, your thoughts.

Patrick Osewe:

The cost of distribution of the vaccine sometimes is twice as much as the cost of vaccine itself. It’s a big challenge that countries are going to face. What kind of communication system do you need to have in place to get people to take the vaccine? What kind of IT training should we have in place for the frontline workers, who've never delivered this vaccine before? What kind of system do you need in place? Because people will be getting the first vaccine and you need to check them to get the second vaccine. And then I just want to also add that it's not just about the vaccines. The vaccine has to be put in glass vials. So despite the fact that this shortage of vaccines, the manufacturers are also saying that the glass vials, the needles, the syringes, there's also shortage of these. So it requires a concerted effort using for example our Private Sector Operations (PSOD) to stimulate private sector companies in Asia Pacific to ensure that at least there's some readiness when vaccines that are available in the early part of 2021.

Nisha Pillai:

And Michelle, what kind of evidence are we seeing that this kind of preparation on the ground is actually going on?

Michelle Dynes:

Yes, there's a lot of planning for cold chain, maintaining cold chain, maintaining electrical access as needed for that cold chain and for storage. That's something UNICEF has done a lot of work in and continues to support in the region for other vaccines. In addition you know, we should also think about the community members and how even if that cold chain is in place and the storage is in place and the healthcare workers are trained, how can our community members access those health facilities to get back safely? If we consider a usual caregiver between the ages of 20 and 40, and normally they're taking their, you know, their three-year-old to vaccination. Now they have to think about taking their elderly parent. And how are they going to travel to do that? How are they going to pay for transportation? How are they going to pass through roads during the rainy season?

Nisha Pillai:

Are there lessons to be learned you think from the mad scramble we saw for PPE at the beginning of the pandemic?

Michelle Dynes:

Absolutely. and I think this really goes back to the comment about essential workers that are not healthcare workers, so essential workers who are transporting the vaccine, who are enabling those vaccines to get to where they need to be. I think that really puts a lot of focus on the need to vaccinate them so that they can maintain those services. We're talking about truck drivers and workers in factories who are helping to prepare vaccines and other components that are needed for vaccination.

Nisha Pillai:

If you'd like to add a comment?

Rajeev Venkayya:

I don’t think we can overstate the complexity of this challenge and, and Patrick and Michelle have explained some of those challenges. I would add to this that we've never pushed this much vaccine through a supply chain in countries. We we've never introduced this many potential vaccines at the same tim. And Michelle talked about healthcare worker training where we have countries with more than one vaccine available? Well, many of these vaccines require two doses. Then you need to make sure the individual who gets the first dose of one vaccine gets the same vaccine the next time. And that may seem like a simple issue, but it actually becomes quite complicated when you're trying to vaccinate so many people in a country. So for those who are watching this, that are in governments, that have the ability to influence the priority list of the health ministry, and those who are handling logistics, working with UNICEF and other partners that have a lot of experience at this, acting now is critically important. It may feel like vaccine is going to arrive a long time from now, but the complexity means you have to begin working on it now.

Nisha Pillai:

So I'd like to broaden out the discussion now to bring in some other questions, Professor Malani, we have some really massive countries in Asia with huge regional diversity. So what should governments do? How can they prioritize which regions to put first?

Anup Malani:

Yeah, I think there are a number of interesting and challenging trade-offs, beyond the ones that we've talked about, before needing to incentivize healthcare workers and other essential workers to actually deliver vaccination. One of the key ones I think I want to point out is that the vaccine is not the only way to limit the spread of the infection. It's the ultimate way we'd like to limit the spread of the infection, but we also have suppression policies in place. And the reason these two things interact is that it's difficult to do both at the same time. Let me explain what I mean. Let's suppose you've got two regions and you have enough vaccination for one of the regions, but not the other region. If you decide that you're going to, for equity reasons, spread the vaccine half and half across the two regions, you're going to face a problem. The individuals who are vaccinated will want to get back to work, will want to engage in economic activity. But the people that are not vaccinated you'd want to suppress, it's very difficult to identify those people that are vaccinated versus those that are not. So you're not going to be able to fully open up by the economy. It's going to be a complicated administrative problem. It may make sense to prioritize one area for vaccination and use suppression in the other areas. It may also be good if you have limited number of healthcare workers or limited supply chain capacity to go from area to area. But of course that raises equity questions.

Nisha Pillai:

So Rajeev, let's just pull you into the discussion. Now you wrote to the US strategy and vaccines, and we're a White House advisor at one stage. What are the kinds of difficult trade-offs governments are going to have to make between being seen to be fair and actually saving the most lives?

Rajeev Venkayya:

You know, there has been an open discussion so far at the global level and in some countries, including the US, about a priority setting. Now this is before any vaccine is available. So we don't know if people are going to behave the same way or say the same things or sign up to things once scarce vaccines becomes available, but at least when things are relatively calm, people seem to be supportive of the principles that have been put forth so far, healthcare workers being a priority, key, vulnerable populations. And so I think this idea of being very transparent and consultative and defining what the priority groups should be is very, very important because we're in an environment now where there isn't a lot of trust everywhere. And so the more we can do to engage communities in this priority setting, the better that we'll the better off we'll be once we actually get to the point when vaccine is available.

Nisha Pillai:

So we heard earlier from Jane Halton, how worried she is about the rise of vaccine skepticism, but is this really a in the Asia Pacific region, Michelle.

Michelle Dynes:

Vaccine hesitancy is a major concern for the COVID vaccine. What we've seen in the past with vaccinations is that if there is a concern about safety, for example, if there's a perception that the process of creating the vaccine has not gone through the usual safety mechanisms that we would usually do, then hesitancy in that vaccine will increase. What we've seen in this region is most recently in Indonesia when people were presented with the idea of getting the vaccine at a 95% effectiveness rate, more than 90% of people said, yes, I would take that vaccine. But when they were presented with the possibility of getting a vaccine that was only 50% effective, then that number went down to about 65% of people who said they would be okay to get the vaccine. So our communication messages about the COVID vaccine are going to be really critical in terms of communicating the effectiveness level, the safety profile, so that the community members can feel safe to go ahead and get vaccination. And all of that communication is go, is going to go through healthcare workers. So training and education of healthcare workers on all of these indices about the vaccine as they become available is going to be critical.

Nisha Pillai:

Rajeev, your thoughts on the way vaccine skepticism is on the rise.

Rajeev Venkayya:

I am deeply concerned about what we're facing with vaccine confidence around COVID vaccines. And actually it's understandable why so many people have questions because we've never developed vaccines this fast. They normally take 10 or 15 years, and we're doing it in about a year and a half. And people reasonably are wondering, what did you give up? What corners might you be cutting? The reality is we're not cutting a lot of corners. However, there are going to be some things that we won't know such as the incidence of rare side effects at the time that the vaccines are launched and we need to be very open to inspire confidence.

Nisha Pillai:

So drawing together our conversation, it's clear that there are a number of different challenges that have to be overcome in the next six to nine months. So I'm going to ask our panelists one last question, and please answer it briefly, preferably in just one sentence, maximum two, if you were sitting in a health ministry right now, what would be your key priority? And I'd like to put that first to Professor Malani.

Anup Malani:

Well, you can find me the one thing that's very hard to do for a professor. The first one is supply chain. I think what Rajeev you've said, and what Michelle said is critical. You need to have the healthcare workers and you need the infrastructure in place. If you get a bunch of doses and you don't have that, you're wasting your vaccination regardless of what your priorities are. But if you'll permit me a second, one is getting your priorities are clear upfront so that there's no confusion along the way and no political conflict that slows down your campaign.

Nisha Pillai:

Okay - so the professor snuck in two priorities! Patrick, your thoughts.

Patrick Osewe:

This is too big for the ministry of health to do alone. This requires a multisectoral collaboration involving the transport sector that will be responsible for transporting the vaccines and all the associated supplies that the energy sector has to play a role in terms of ensuring that the culture for the culture and we talked about the communication sector for training of health workers and all. So this is just too big. The ministry of health has to collaborate with other ministries, identify the role for each sector to be able to ensure that this delivery is successful.

Nisha Pillai:

Michelle Dynes.

Michelle Dynes:

Well, I'm going to come back to healthcare workers. I think the preparation and training of healthcare workers is going to be so vital because they are going to be some of the earliest recipients of the vaccine and their experience in receiving the vaccine is going to be critical for their ability to be proponents of it. So developing training materials and communication messages to increase their confidence in the vaccine and increase their confidence in their interpersonal skills to translate those messages to the community.

Nisha Pillai:

Rajeev Venkayya looks like you have the last word. What should be top of the priority list?

Rajeev Venkayya:

Well, when you have brilliant panelists, they list three things that, that you don't have to list. So I can focus on something different. I I'd agree with everything that has been said. I think preparing the population for what is to come and the uncertainty that we will be facing around the science surrounding vaccines, not that the science around safety, I think we'll have a very good sense for that, but they're going to hear different things from different sources of information about, about vaccines and treatments that are coming along. And so building the trust with the population through transparency, explaining exactly what governments know, what they don't know and committing to updating the population as more information becomes available is very, very important. And when it comes specifically to vaccines, I do think every government needs to be thinking about monitoring for safety in all populations, once vaccines are launched so that they can tell the population, look, we think these are safe and we believe that they're safe, but we're going to continue monitoring and letting you know if unexpectedly something comes up, you'll be one of the first to know

Nisha Pillai:

Very good point. Thank you very much to our guests for such a rich and productive discussion. Thank you to all of you for joining us on Insight. I'm Nisha Pillai - goodbye for now.