Avril Benoit: ... for joining us for our 2022 discussion series and moving forward, this is a four part series running throughout the year and exploring how aid workers and humanitarians are tackling some of the world's biggest and most complex challenges today while preparing for future emergencies. I'm Avril Benoit, I'm the executive director of Doctors Without Borders based here in New York City. Some of you might know Doctors Without Borders from our international name, which is French [foreign language 00:00:34]. From that, we get the acronym MSF that you'll likely hear a lot today with my colleagues. Avril Benoit: Here we are going to be discussing the future of this COVID 19 pandemic. What does it mean to learn to live with COVID? What does it mean to prepare for the future? How much does that answer depend on where you live or what kind of access you might have to vaccines or tests or treatments? While many political leaders here in the United States are talking about moving on from the emergency phase of the pandemic, COVID 19 is still a global crisis. We see the impact on communities every day in the places that we work. Avril Benoit: We have so great experts here with us today who can answer your questions and reflect on what we've learned from our COVID response over the last couple of years and where things are going in the future. A couple of housekeeping notes though, before we continue, in order to make the most of your participation in this live webinar, we're going to speak and continue this for about 45 minutes. Wherever you're joining from today, you can submit your questions to our panelists, and then I will ask them. If you're watching here on Zoom, you could submit your questions and comments in the Q&A feature. If you're watching the live stream on YouTube live or Twitch, you can send your questions in the comments or the chat section, and our teams will send them on to me. We are going to prioritize questions that directly relate to today's discussion, which is the pandemic. We also have live captions for this event, and you can view them in Zoom by turning on the live transcription, which is there at the bottom of your screen or on YouTube or Twitch. Avril Benoit: Joining me today are Dr. Elena Nicco, an infectious disease doctor and medical coordinator of MSF's COVID 19 task force based in Brussels. Welcome to you, Elena. Good to have you with us. We also have Mihir Mankad, MSF USA senior advisor for global health advocacy and policy. Hello, Mihir. Good to have you. Last but not least, we have Dr. Northan Hurtado, the head of MSFs medical unit based in New York as well. Welcome to you all. Avril Benoit: We're going to start with something that we know we've already been receiving questions about, and this is it's inevitable that we would start here, I suppose, as an emergency responder in conflict zones, and this is Ukraine. As the conflict in Ukraine escalates, our teams are preparing to step up our emergency response in the region. This is a massive humanitarian crisis, both inside Ukraine and in those neighboring countries. We are seeing the impact on civilians. This conflict has already pushed a million people to flee Ukraine into bordering countries, and more than a million others are displaced within the country itself. We have humanitarian teams here and there trying to work on their assessments, pulling together the needs, bringing in supplies and staffing up. Avril Benoit: MSF is committed to providing medical humanitarian assistance to people affected by conflict, no matter where they are or who they are. During the registration for this event, about the future of the pandemic, we did receive a few questions from our audience members, including Doreen, Paula, Margaret, thank you for those. We'll just touch on Ukraine just to get things started and then we'll move on to the pandemic. Northan, I know you've been following this closely. Can you tell us about the medical needs that are evolving in Ukraine? What are we seeing and what concerns us? Dr. Northan Hurtado: Hi, Avril, hi everyone. Thanks for having me here. Yes. Before the conflict started last week, MSF was already working in Ukraine. We were providing care for people living with what we say, TB, tuberculosis, the acronym and HIV as well for older people living in isolated that areas near the front lines. These projects now have been halted due to the conflict and that is normal, that we are switching this moment from regular projects or stable activities to emergency missions. Dr. Northan Hurtado: What does that mean exactly, passing to that step, is that we're going to do assessment in areas where we are doing all of those, in several other countries and in Ukraine as well, trying to identify the needs that are going to be... can for sure estimate there are going to be massive needs. There's around two million people on the move of Ukraine today, inside and outside the country. Just to give you a perspective, the biggest refugee crisis in the planet is Syria with six million, Venezuela follows close with six million, and then you have South Sudan and Afghanistan with two million. In just one week, Ukraine is the equivalent of South Sudan and Afghanistan with people moving in and outside the country. Dr. Northan Hurtado: It is a massive emergency going on really quickly. We are going to evaluate what are the possible scenarios for intervention that can range from mental health support to all the many other activities, but it will depend on the assessment and identifying those needs. Then for sure, what is more worrying for us is we know [inaudible 00:06:25] are the typical breeding site for epidemics. We have to keep that in mind as well in light of the COVID pandemic today. Avril Benoit: Elena, you have a lot of experience working in conflict zones. Can you talk about some of the particular challenges of providing COVID 19 care in a conflict setting? Dr. Elena Nicco: Yes. Thank you, Avril. Hi everyone. I think we can, for example, take a practical example, like a country such as Yemen, which is in the situation of a chronic conflict. Maybe it's important to start framework of COVID care, covers multiple domains, but in Yemen we assessed particular needs, especially linked to hospital healthcare and critical care support. Which means basically providing complex care such as invasive ventilation. Dr. Elena Nicco: What MSF did, we supported several hospital facilities and particularly during the second wave in Yemen, we also fully managed a 13 bed intensive care unit, that over three months admitted over 100 patients. I think we can only imagine what are the challenges of giving such complex care in this context. First of all, from the highly volatile situation where the teams are, it's very difficult to work with communities, which is something that normally we do. We establish a link, a connection with communities which try to inform, and this there was not possible because of security constraints, because of the chronic conflict. There was very few skilled human resources that are essential to provide this complex care. We also add a scarcity of international experience of human resources, because they were mostly busy at the time in their home countries, also responding to COVID. We had to implement this high level of care in a very short time, because we also know that the COVID wave is going very fast, so it all needed to be in place rapidly. Dr. Elena Nicco: We had there, for example, a lot of supply challenges that were linked to the pandemic. We all know that all flights were stopped, et cetera, the borders were closed. These were adding up to chronic conflict challenges. There was a huge limitation in capacity of imported drugs, biomedical equipment. We moved of course to local [inaudible 00:09:31], but these also open issues as to the quality of the material of the drug. It was complex. Dr. Elena Nicco: Another point is related to the need of oxygen. When we provide critical care, we need to have a high capacity of oxygen, which means we manipulate [inaudible 00:09:58] oxygen, which is stored under very high pressure. You can imagine in Yemen, the teams were handling around 100 oxygen cylinders a day. You can imagine, what does it mean in terms of risk of incident for the team. To this, we can add all the local challenges. Dr. Elena Nicco: MSF basically was the only structure that was providing this level of care. People had to travel up to six hours to reach our centers. Because of what we said, it was impossible to in the community, there was a lot of misinformation in the community. People were really thinking about the isolation center, like they were scared that there was history about a little injection that were provided there. There was a lot of stigma around it. When a person was coming back from the hospital, it was difficult for them. Dr. Elena Nicco: I had in my position, a lot of debriefing from staff coming back, reporting very difficult situations with significant pressure, because despite all the effort that we did to implement these services, the capacity was still limited, compared to doing it. Often the staff was put in front of very difficult, sometimes impossible choices. A lot of pressure. It was very complex. We tried to support our staff and the patients through mental health and psychosocial support in Yemen, but this has been done massively over the two years for all the staffing needs all over the countries. We try whenever we can to really engage with communities and patients to explain what we do, why we do and to somehow try to increase uptake. Avril Benoit: It does give us an idea of how complex this is going to be in Ukraine, where just before this conflict, we had read reports that the vaccination rate for the COVID vaccine was around 40%, that they were in a peak. You can imagine that right now, many of the medical professionals are also hiding from the risks that are in the places where they are, with all the conflict around them. Then the supply issue as well. Avril Benoit: Now, Mihir, this is an area where you've been following always very closely with the pandemic, the logistical challenges, the supply challenges. Can you talk a little bit about this and we will shift now and really, really focus on where the pandemic is going. Tell us about those logistical... Avril Benoit: ... pandemic is going. Tell us about those logistical challenges to vaccination, treatment efforts, the problems that you are seeing on the supply side at a global level. What's the global picture right now in terms of COVID-19 vaccines, treatments, diagnostic tests, and the rest? Mihir Mankad: Sure. Thanks, Avril. Maybe before getting just to that question about supply, just a reflection that it's really miraculous that we were able to see the scientific advancements we needed to have vaccines for this illness generated in less than a year after the pandemic was declared. And we went from that happening to getting shots in arms in December, essentially. And that's amazing and a credit to all the scientists who worked on developing these tools. But what we have failed at doing, and we continue to fail at doing, is to ensure that these tools are equitably available across the world. So what we're seeing in terms of suppliers, still massive challenges and inequities in relation to vaccines, and now increasingly treatments and diagnostics. I think currently there's only about 13 or 14% of people in low income countries have received even just one dose of the COVID-19 vaccine. Mihir Mankad: And that's in comparison to nearly 70% in high income countries. And obviously, that's a completely unacceptable level of inequity. I mean, almost any level would be unacceptable. This is so glaring as to be shocking. And as I said, this is unfortunately a kind of inequity that we're seeing now being replicated in newly available treatments. Pfizer just received emergency use authorization from the FDA for a treatment called Paxlovid, which is an oral antiviral drug, which has proven to be extremely effective at preventing hospitalization for people who are at high risk of COVID. And this is something that we could use in our programs. However, as far as we know, as far as a forecast is concerned, this drug will be completely unavailable to low and middle income countries, probably until the end of the year. Mihir Mankad: And even now, I think, basically until September the United States and the United Kingdom have purchased 20 to 30 million doses, which is about over half the existing supply. And the same is true for diagnostics, rapid tests are not easily available in many places. And it's difficult to even determine whether you have COVID or not. So forget about getting treated if you don't know if you have COVID, it's very difficult to treat yourself, or be treated in general. Unfortunately, what we saw unfolding over the last year has changed very minimally. So it's still very, very urgent that we increase supply in many different ways, which I can discuss later on. Avril Benoit: Well, we have started to receive questions from those who are taking part in this live webinar now. And thank you for those. Of course, just go into the Q&A function if you have a question for our panelists. This one is from Margaret, how can MSF overcome this question that you raised, Elena, of disinformation and increase vaccination rates in the countries where we're working? Elena, do you want to take that on? Dr. Elena Nicco: Yes. Thanks a lot for this question. In fact, it's really a key element today. Because we saw the, as we hear just say the huge importance of vaccines and the enormous impact that they can have. Particularly for people at very high risk, such as elderly, immunocompromised, affected by chronic diseases, but also pregnant women. So we saw enormous importance. We see that the availability, unfortunately, is not still equitable. Although the main real issues remains to, one is the country rollout capacity. And in this MSF can play, of course, a big role to help countries. We have a lot of expertise there. Dr. Elena Nicco: And the second part is really into this hesitancy. And really to hold the misinformation that has been going over this hole here, along with the vaccines. So what we try to do is really to try... And it's a very complex issue, and it's very difficult to generalize, because the reasons are really context specific. What we try to do is really to understand in every setting, what are the reasons why people are scared, why healthcare workers are scared, what are the determinants? And then to really try to modulate the messages that we provide, to talk with the people, with the health providers, with authorities to show what is the evidence. Yeah, to really try to adapt the program based on real information that we get for specific settings. Avril Benoit: It's easy to imagine though, that if you're in a conflict setting or a place where there's another disease that seems to be killing people, that people would come to the conclusion that COVID is just not the biggest threat and that they have other worries. And it really is a complex problem when you add in the disinformation. Quite apart from, I have other priorities, like just surviving. And then you add in disinformation in terms of the potential of vaccination, it's just shattering to think that people would die or require hospitalization for COVID in a situation when there are so many complex issues around them. Avril Benoit: We have a question here from Michael, how can we make meaningful progress in a fight against the virus when vaccines aren't blunting transmission now as much as they used to, and there's widespread opposition still to masking in some communities? Would any of you like to answer this question? [crosstalk 00:19:55] Northan? Dr. Northan Hurtado: I can give a try. Yeah. I can give a try on that one. It's true that the subject of this webinar, in certain ways, what is the future? We can't see the future. I think the first one that we have to internalize is the fact that COVID will be with us for a long, long, long time. Eradication, even for another body like the WHO, the World Health Organization, it's like, government policymaker on the health side for the planet. And eradication seems quite unlikely. So we have to continue the fight for COVID for the future, continue on that one. Could be best case scenarios, could be worst case scenario. Best case scenarios that countries have a higher vaccination rate. We're learning still a lot from vaccination. Dr. Northan Hurtado: We know that today vaccine has less effect in the transmission on the virus, but gives a lot of protection for the people passing from moderate or light disease to severe disease. And that is very important, because one of the fact that we saw in COVID for sure was the patients are COVID in several of the place that we work. But in all the places, like was the African, Sub-Saharan African region, and all the places in the planet we saw as well the [inaudible 00:21:22] like the overloading of the health system as well, that is not coping with that one. Or closing the health system, because they were scared of having COVID patients, and then the people not having access to that one and dying at home, as we saw in several mortality studies that we did. Dr. Northan Hurtado: I think the future is not the dream future. That all of us, I think we dream about it to have world free of COVID. So we have to continue the fight, we have to continue having high vaccination rate, we have to continue adapting. I think the key word is adapting ourself. As Elena was saying, situation is very evolving. Today, for example, I'm talking from here from New York, number of cases are going down, masks are more relaxed. In four or five months I cannot bet that it will be the case anymore. And probably we have to mask up again to receive an extra dose. I think, for me, that is the future, is to adapt ourselves to follow the good public health message, as Elena was suggesting. And how to adapt these health messages to the population. Avril Benoit: Yeah. And we do, of course, get a lot of information through the political leadership. And maybe you could address this one, Mihir. The President of the United States, and Biden administration, generally announced today that the US will share US government devised coronavirus technologies with the World Health Organization. What impact will this have, really? Mihir Mankad: Well, it's certainly a promising development. And, I think we welcome it, but obviously there's many details that still need to be clarified. What we do know is that this is not with respect to any technologies that are currently on the market. In that sense, these are things that are still in the research and development pipeline. And it's important that in advance of those things reaching the market, that how they will be made accessible is clarified, and sharing them with the WHO is a critical step in that process. But again, the main thing we need to find out right now from the administration is, with respect to these technologies, which they will be sharing in fact. And, how critical will they be in the future to helping us fight COVID? Yeah, again, there's just lots of details that we still need to learn. But in general, it's a positive development, for sure. Especially since there's been very little traction that we've seen on existing technologies, and sharing those technologies. Avril Benoit: Yeah. I mean, there's that part of it. And then there's also the regulatory, the mandate oriented policies that governments are bringing in. And Mihir, I have another question here from Michael. What effect did the booster mandates in wealthy countries have on the global distribution? Mihir Mankad: Sure. Avril Benoit: Because Michael's mentioning that he recalls reading that the day the FDA, the Food and Drug Administration, in the US did not recommend a booster for low risk populations because of the concern about shortages. Can you address this? Mihir Mankad: Sure, I can. I think this is an important question, but I think it's more important to ask why global supply has been constrained in the way that it has. And that's primarily due to the interest of the few pharmaceutical companies, for example, that control production of these vaccines. Now, if they were willing to share their technology with other vaccine manufacturers in other countries, we wouldn't have this question about artificially constrained supply. We would've been able to be producing these vaccines in other parts of the world and rapidly deploying them into the environments in which they were needed. And along with that comes this concern about why they can do it, which is because they have the right through intellectual property rules to do so. And that's why we've been pushing consistently for the Biden administration and other countries to adopt what's been called a TRIPS Waiver. Which is an agreement at the World Trade Organization that would relax these rules for the period of the pandemic and allow other manufacturers in other countries to produce all of the medical tools that we need to address- Mihir Mankad: ... in other countries to produce all of the medical tools that we need to address the pandemic. It's hard to quantify how much of a trade off there is in existing supply, but I think the question is not about that necessarily, but how we can expand the overall pool and increase supply overall and get it to the places that we need to Avril Benoit: Thank you for that. Our speakers today are Dr. Northan Hurtado, he's the head of our Doctors Without Borders medical unit in New York. Mihir Mankad, MSF USAs senior advisor for global health and advocacy policy. We also have Dr. Elena Nicco, an infectious disease doctor and medical coordinator, and one of the key people in our efforts, in our task force for COVID 19 to make sure that we're trying to support all our teams to be able to do the right thing and to know what's the latest when it comes addressing this pandemic, which is still ongoing. Avril Benoit: We have some more questions coming in, and if you have questions for our panelists, please take the opportunity. We still have some more minutes to go. A good 15 minutes, so just put your question in the chat or the Q&A function. Let's talk to Elena now about Hong Kong, because this is the place where we've seen now quite an increase. Could you describe what's going on there with this increase in cases in Hong Kong? This was one of the first places that our organization, Doctors Without Borders [foreign language 00:27:39] MSF was responding to COVID 19 back in the very beginning in 2020. What's the situation there now, Elena? Dr. Elena Nicco: Yeah. Thank you. The situation is quite worrying because we observe a number of cases, positive cases are increasing really fast. This is the fifth wave actually in Hong Kong, but there is no precedent in terms of impact because in a few weeks they reached... They are now at 50,000 cases per day. The mortality is also very, very high. They had today almost 150 people dying. Those are mostly elderly and vaccinated. Despite the vaccination correlation in Hong Kong, there it is quite high compared to many other countries in the world, the elderly are a group that has been poorly, poorly reached by vaccination for many specific reasons. There is a real concern of the impact of this wave, mostly due to [inaudible 00:29:16] have on them. We'll see all over the news that the health system is completely overstretched with people waiting, long queue outside of the hospital, people in need of oxygen, in need of care. Dr. Elena Nicco: As MSF, we are monitoring the situation and our ambition of course will be to support the public information. We hope to be able to work with the most vulnerable, so particularly in this case, that would be elderly people. What seems the most immediate action and most relevant would be to engage in vaccination for such groups. We are really trying hard to have a proper network with local private and public care practitioners, and to see what best can we do for the population. Avril Benoit: Yeah. Whenever we do these interventions also, we learn, we adapt, we learn from others, we try things. These lesson are instructive for every time we have to go back to a place or reengage. Northan, you've been following a number of different COVID interventions, but particularly in Peru where MSF responded to COVID 19. Maybe you can describe a little bit what we have done there, what we're doing now, what were some of the lessons learned of that? Dr. Northan Hurtado: Yeah, thanks for that. Yes Peru was... You can hear my accents, I'm from Latino origin, so it stays closer to my heart as well for sure, you know, of all the places in the planet. It was quite interesting when you see the absolute numbers of Peru as a country during COVID. It's not in the top five, because you have big players like the United States as well with Brazil. When you see more in details, Peru has one of the highest death rate due to COVID in the planet. Dr. Northan Hurtado: The first time we went to Peru, it was an alarm sent by the people mostly, at the beginning, from the Amazon regions. I remember that letter from my staff, from MSF saying, the lung of the planet, the Amazon is giving out without oxygen. We sent teams to Brazil and to Peru, for sure. In Peru, we started to work in the Amazon regions in some isolated areas with isolated communities to donate. For example, oxygen, as Elena mentioned, is one of the key corners on the treatment of and the management of the COVID cases. Dr. Northan Hurtado: Then as well we act in bigger cities, particularly Lima and Cusco as well. We provide oxygen as well. We saw that a lot of people were, and the government as well, were focusing on the management of severe patients, but we were trying to avoid that the people with moderate disease became severe and overload the already overloaded health system. We were providing oxygen. We call it like an oxygen bar, where the patients can go during the day and receive oxygen therapy. Dr. Northan Hurtado: One other thing that Peru activities will show is that we were not working in Peru for so many years, MSF, and then we restarted our activities there. We started to notice the crisis there is related to their Venezuela migrants. Mostly migration in the region, but mostly Venezuela migrants coming to the country. Up to today, there is around 1200 to 1600 people crossing the border still today, going from Venezuela, most of them by foot. Dr. Northan Hurtado: Then today we have two projects. One is in Lima, where there is the highest concentration of Venezuela migrants, as well as Haitian. It's not only Venezuela, but a large majority of Venezuela, for sure. The other one is in the border between Ecuador and Peru, where we provide as well healthcare and some other activities I would call nonmedical items that is like related to wash, hygiene kit as well as food, but as well as referrals to health systems, if needed. Dr. Northan Hurtado: We were still exploring the possibility of doing more activities in the country today, but just COVID as well shows not only in Peru as well, but Peru is a good example, how the inequalities in the health system, in the planet, how that can affect... That COVID will show even more the difference between that. Dr. Northan Hurtado: Just coming back to the Mihir response. One of the things as well that we saw is that the work created this mechanism to supply vaccines to the country. That is as excellent idea why not, but then, some of the country didn't have the capacity to distribute and to [inaudible 00:34:40] vaccines in the population. What is called the program for immunization are heavily underfunded for the last few years. They don't have the cold chain, they don't have the capacity to do that one. You send doses, but you sending the doses is not enough, you have to send as well support on the structure. Avril Benoit: Yeah. Well, you mentioned just in passing there, the cold chain and some of the technical needs of a vaccination campaign. We actually have a question that came in from Twitch, that Elena, perhaps you could take this one. What logistical support do medical people need to carry out a vaccination campaign for COVID 19? Dr. Elena Nicco: It's enormous. It's not only for COVID-19, it's starting from having vaccines where they need to be, that can be a capital city, and then to store them properly in safe conditions with good temperature. That means that we need electricity, we need tools to monitor temperature. Then we need a whole system to transfer the vaccines from that central sites to more [inaudible 00:36:01] sites. This can be very... If we imagine African countries, like, I don't know, Congo or many others, where you have plenty of roads that are not working, and you have the rainy season. There is the huge importance of the logistics that needs to be behind. That needs to really work in a coordinated way with the [inaudible 00:36:32] to have a proper plan where we need to go. It all needs to be very, very well scheduled. It's not that we wake up in the morning and we decide. There is a full plan to do with doses that needs to be allocated every day in every single place. Yeah, it's an enormous and very important part of the vaccination, but of all the activities actually that MSF is doing. Avril Benoit: Yeah. Yeah, so the work of people like you, Mihir, to try to secure the vaccines and special arrangements and calling in favors and calling the authorities to account for the needs of a population. We certainly did that for Peru, for the work that we were doing there to make sure that they had those vaccines. Avril Benoit: Mihir, can you reflect a little bit then on, just coming back to the lessons learned. So far in the pandemic, in terms of your work, the work you mentioned before around this trips waiver, we have a question here from Anita on YouTube, just wondering a little more about why this is so important and how it could make a difference. Maybe reflect on some of the things that we've tried that we've learned from? Mihir Mankad: Sure. Just before that, Avril, it would be great if I had favors that I could call in from the US government. Unfortunately I don't. Avril Benoit: That's not how it works? Mihir Mankad: Maybe in some cases, but not for me. Yeah, just in terms of reflections over the last period, I think my reflections are more about kind of at the global level, what we have learned as compared to MSF specifically, though obviously this is applicable to us to some extent. I think the biggest lesson that we learned is that we were unprepared as a global community, especially when it comes to access to medical tools, to ensure that it would happen in an equitable way as rapidly as possible. That is both in terms of supply, but also the logistical questions and implementation and things of that nature. I'd like to say that what we've learned is that in the current architect... Mihir Mankad: Like to say that what we've learned is that in the current architecture, equity seemingly is a secondary concern and it shouldn't be. We saw countries hoarding vaccines, we're seeing the same with treatment and it's fine and fair obviously for countries to secure enough supply for their citizens to be covered adequately but well we weren't seeing just that. We were seeing countries buying up way more than they needed to, and then doing a very poor job of redistributing those things. And that's why we've been asking governments to redistribute their excess doses to lower and middle income countries in particular, because it's mostly been high income countries that have been hoarding these particular medical tools. And what we've also seen and this is again related is that we needed to be more agile and for me that means that we need a more globally distributed system of production of these various medical tools. And we don't have that right now. Mihir Mankad: The producers are [inaudible 00:40:07] in a few places, mostly in high income countries. Although also including India though, but we can't see that rapid deployment that we need. We can't see the kind of supply that we need to be produced in a really quick way. And then maybe the last thing to say is, unfortunately, something that we have learned repeatedly that we have not addressed is that we continue to put the interest of private companies over the wellbeing and health of the world's most marginalized communities. And this is kind of where the TRIPS waiver question comes into play. So the TRIPS waiver is important because in many instances, companies that have created COVID 19 medical tools, new ones have intellectual property rights over those tools and those rights, which are dictated at the national level but as part of a World Trade Organization agreement allow companies to prevent other companies, these originator companies from producing these goods, basically wherever they are. Mihir Mankad: And they do that because of course they want to make a profit on the products that they've produced and obviously in a situation like we have been in over the last two years, that's completely unacceptable to put those profits over the lives of billions of people, literally around the world. And if the TRIPS waiver is adopted at the World Trade Organization, this would prevent much of that because it would relax those rules and suspend those rules for the period of time of the pandemic. What we're asking for is for vaccines, for diagnostics, for treatments. We learned that we needed to be able to scale up supply really rapidly and this was a major obstacle to doing that. Avril Benoit: I'd like to have the last question, be the one that we received from Eric, who is watching, and I'll start with you, Mihir. And then we'll go around for a last question to everybody. And Eric is asking about COVID becoming endemic, is that the state we're in now? And what does this look like for the future around the world? How's this going to go? Mihir? Mihir Mankad: I'll leave it to the doctors to make an assessment about whether COVID is going to be endemic or not. I think that's well above my pay grade, but what I can say is- Avril Benoit: But from a policy perspective? Mihir Mankad: From a policy perspective, what I can say is that it just even more critical that we ensure equitable access to these tools. If we're going to see COVID and circulation across all these societies to a great extent, especially when it comes to vaccinations and treatments, of course well also diagnostics I suppose, it's that much more important that we make sure that everyone has access to these essential COVID-19 medical tools when they need them. Avril Benoit: All right, hear, hear. Northan, would you like to go next? Dr. Northan Hurtado: Let's do- Avril Benoit: With respect to it being endemic. And what does this look like in the future, this pandemic? Dr. Northan Hurtado: Yeah. I'll invite people for them to take a look on the dictionary what is pandemic, what is endemic because I think we've been using the words a little bit too lightly in the planet today on this pandemic-endemic. Pandemic, for sure, that means the entire global, the earth completely, and all the regions are touched by, that is the case today. Endemic means it's a regular transmission of the disease. Endemic doesn't mean that it's good. Endemic doesn't mean very harmless. We have endemic diseases in certain areas of the planet, like measles and measles still kills a lot of people every year, drug losses, these are endemic diseases. Endemic doesn't mean for us as well, probably will become endemic because it looks like the reach of the COVID 19 is quite big and it will stay with us for a long time. Dr. Northan Hurtado: So yes, it looks like will become endemic to the planet. Like it's the flu today, just a reminder it is the same word that we use for the flu, but that doesn't mean that we have to drop our arms in certain ways, we have to continue fighting, decrease transmission, decrease mortality and mobility, decrease the consequences of the disease in the population and to protect most importantly the vulnerable operation. That is something that MSF, we want to leave no one behind in a certain way. It's just a reminder, that is the aim that we have thus following in COVID-19. Avril Benoit: Absolutely. All right, Elena, where is this headed? What does it look like in the future? Dr. Elena Nicco: Yeah, but from my perspective, so yes, it is not over. So, but maybe from an operational perspective as a [inaudible 00:45:14], we invest less on vertical projects targeting the general population, but it'll still remain very, very important to maintain surveillance, to maintain capacity, to monitor in the countries, what is happening, to work on preparedness, this is really key. To monitor the capacity of the health system where they are and their capacity response. Are the human resources still trained? Because there is a lot of quick change in human resources, so do human resources that are there today and our experience with COVID will be there in six months, in one year. We need to maintain the capacity. In some countries, we are really working also on more long term planning, for example, for oxygen capacity in Lesotho, we are implementing oxygen plant because we saw the huge importance of preparedness. Dr. Elena Nicco: We will probably go through more and more integration of the COVID disease in other health programs. So COVID might be another disease to be considered when we design our health program, when we write our IPC protocols, when we deal with our patients. And I would say for sure, vaccination will still remain essential, particularly for vulnerable groups in countries where the vaccination coverage remains still unacceptably low. Working as we said on all these hesitancy, all these mechanisms that prevent to the population to access. We will have to work a lot on the collateral damage of the pandemic. And I would like to maybe just close with a positive one. So our teams have been able to incredibly well adapt to the pandemic and to maintain the service delivery. Often they have been even able to speed up some innovation, something that we wanted to implement since very long time. Let's think about for example, HIV treatment, that have been available in the community, long term refiller of air, antiviral drugs, tuberculosis, simplification of all the processes. So I think this is a way I hope we'll use this and we'll make it work. Avril Benoit: Thank you all so much for answering that question. We did also, I should note receive several questions about how people can help, how they can contribute beyond donating. And of course, supporting our work through donations is what allows us to respond, to adapt, to pivot and to be there where the humanitarian medical assistance is needed most. You can go to our website doctorswithoutborders.org for that, but for those who want to know what can we do beyond donating or supporting and making a financial contribution? I would just summarize with one thing and that is listen to the science. We're going to have to adapt. There might be new variants. There might be new protocols. We might learn new things about vaccines or masking or the treatments and whatnot. And just to be confident that there are reputable, legitimate medical researchers, scientific organizations who do come together, who analyze all of this. Avril Benoit: And we just have to accept that sometimes what we were told in the past has changed, and we all have to do our part to respect that there are probably things that we can do individually, whether it's masking or vaccination or whatever it is to help bring down the levels of transmission just through our individual actions and our choices. So thank you all for those great questions. So again, thank you to our panel today, Dr. Elena Nicco, Medical Coordinator of MSF's COVID-19 taskforce, Mihir Mankad MSF USA Senior Advisor and global health advocacy and policy expert, and Dr. Northan Hurtado, Head of MSF USA's medical unit for this great conversation. Avril Benoit: Our next webinar in this series is going to be Thursday, June 16th, when we're going to take a look at global migration and the major challenges that lie ahead. You can also join us for something special, an upcoming storytelling event. It's called Stories from the Pandemic with MSF Aid Workers. So again, MSF, meaning Médecins Sans Frontière, the international name of Doctors Without Borders. That's on Friday, March 11th, it's coming up. MSF will be partnering with The Nocturnists, a medical storytelling community to bring you an evening of live storytelling and reflection by healthcare workers from across the America, sharing their personal experiences of responding to COVID-19 over the last couple of years. Avril Benoit: So we will post the registration link in the chat. So please sign up for that. There it is. Sign up for that next week and I hope to see you there. Apologies if we didn't get to your question, but you have anything else that you want to relay to us, please stay in touch. The email address for the team is event.rsvp@newyork.msf.org. And again, just go to our website doctorswithoutborders.org for lots of information about what we're doing. Our international site is msf.org so we're all over the place, Facebook, Twitter, Instagram, and beyond. I'm Avril Benoît, thanks for joining us. Bye for now.