CARTER: Well, good morning, everyone. It’s really a pleasure to be here with you. Welcome to Session Two for the Symposium on Global Health Security and Diplomacy in the Twenty-First Century. My name is Hillary Carter, and I will serve as the moderate for this session, which is focused on “The Power of Partnerships in Collaboration to Advance Global Health Security.”

I’m joined by an incredible group of panelists who represent diverse organizations that are critical to advancing global health security. And it’s my pleasure to briefly introduce our panelists. First, on the screen, we have Dr. Jarbas Barbosa, who is the director of the Pan American Health Organization. Welcome. We have Dr. Joy St. John, who is the executive director of the Caribbean Public Health Agency. We have Dr. Ayoade Alakija, who is the World Health Organization’s special envoy for Access to COVID-19 Tools Accelerator. Welcome. And then joining us here in the room we have Ms. Rachel King, who is the president of the Biotechnology Innovation Organization. And we have Dr. Jean Kaseya, who is the director-general of the African Centers for Disease Control and Prevention.

So I’ll start with a little bit of framing, but want to reserve the bulk of our time for hearing from our excellent panelists. We know that partnerships are powerful. When we come together, we can achieve things we can’t do alone. The COVID-19 pandemic taught us that partnerships are essential to saving lives and restoring livelihoods. Sometimes these partnerships are predictable and other times these partnerships are more unconventional, but equally as important. We heard this morning from Secretary Blinken that the only way to advance global health security is together. We heard from DG Tedros about coordinated and collective action.

And I wanted to kick off the panel with a few questions, and then let’s get started. So, first, how do you harness the power of partnerships from your unique vantage point? Where do you see opportunities for furthering partnerships of all kinds? And, generally, what impacts have partnerships had on your organizations? And we are going to turn first to Dr. Barbosa to get us started, on the screen. Dr. Barbosa, over to you.

BARBOSA: Thank you. Thank you. Good afternoon, or good morning for you. First of all, I want to thank the Global Health Security office for inviting me to participate. You know, the Pan American Health Organization is, I think, a concrete example of collaboration and partnership. Our organization was created more than 120 years ago when the countries in the region came together to the be able to build the Panama Canal. That was a very important enterprise at that moment. Since then, the Pan American Health Organization has built many partnerships and collaborations with different entities, organizations, foundations, public and private, the companies, they have worked together.

And this partnership and collaborations were crucial to provide the main achievement for the region of the American. We were the fifth region of the world to eliminate the polio, to eliminate the measles. So I think that these are very concrete examples that together, and working not only with our member states, all the countries and territories in the Americas, but also with different organizations and foundations, we have delivered many important advances in the health of the region. The Americas, you see, are a very variable region, with many challenges ahead. But, for sure, that the—with these partnerships and collaborations, we were able—we were able to achieve many, many advances in the region. And we were also able to respond better to the COVID-19 pandemic. Thank you.

CARTER: Thank you very much, Dr. Barbosa, for sharing that perspective. Let’s now come in the room here. DG Kaseya.

KASEYA: Thank you. Thank you, the Office of Global Health Security, for inviting me. We bring the voice of Africa, because we value partnership. Our head of state, they have to learn from COVID. And they decided to put in place what we call the new public health order. And one of the pillars of the new public order is the

respectful partnership, because we believe that if we have a respect that will help us to advance this agenda of health security. And saying that, they decided to support this respectful partnership. They wanted to have a strong Africa CDC, at the highest political level. And they decided to have a director-general politically appointed by head of state, who can talk to them directly, who can push the agenda, who can convene them, we can put all countries together.

Let me inform you, colleagues, thanks to that now I’m leading an agenda, how Africa can come strongly to advocate for the reauthorization of PEPFAR. I’m meeting a number of head of state. You will see what we’ll do in the coming days to show that Africa is pushing this agenda under the leadership of Africa CDC. This respectful partnership is also to help us to build a strong PPPR agenda because, as Tedros said, the question is not if, the question is when. And for us to win, we need to accelerate. And we need this partnership to come to support, like, the local manufacturing.

Africa CDC is leading this agenda. I’m so happy to see my brother Amadou here. We are leading this agenda, not only for vaccines but also for diagnostics and for therapeutics. And this local manufacturing is what I called, as I was discussing with president—one of our head of state. I said, this is the second independence of Africa, having Africa manufacturing their own product. It’s not just for health security. It’s building our economies. It’s creating jobs. And, you know, we have many angles to take this strategic partnership and respectful partnership.

CARTER: Great. Thank you so much, DG Kaseya.
Let’s go back to the screen and Dr. St. John. Can we hear from you, please, on the power of partnerships?

ST. JOHN: So CARPHA is a close partner of the member states in the regional—sub-regional CARICOM space for all things public health. We know their needs, and we know how they function best to achieve these needs. And because our strategic planning process is informed by the CARICOM strategic plan, the Caribbean Cooperation in Health, in its fourth iteration, the PAHO plan, and the SDGs, we ensure through our annual process that our member states say clearly what their priorities are. So CARPHA has both the thirty-foot regional perspective, as well as understanding of the national needs which are best suited to partner interventions. We also understand partner perspectives, because we’ve been trained and facilitated training for our member states.

So CARPHA hosts many networks for the chief medical officers, in laboratories, vector control, communications, medicines regulation, research ethics, noncommunicable diseases, nutrition, and mental health focal points, which allow CARPHA to get granular with subject matter focal points. The networks further enhance the interface between a subject intervention and a partner. So for future partnerships, I see climate change, environmental sustainability, and environmental health, noncommunicable diseases, mental health, violence and injuries prevention as my top picks for the topics for further partnerships.

And our partners have been good to CARPHA and the region and have so far stayed with us, because we deliver. So, the partners have allowed us a process of modernizing our corporate processes. So we’re results based, about to run through ERP, and after a risk management exercise CARPHA won the risk management company of the year. The pandemic period also allowed us to support health security, strengthening of our member states through an explosion of partners from the usual to the new. and allowed us some unusual achievements through unusual collaborations.

CARTER: Fantastic. Thank you, Dr. St. John.

Let’s come back into the room here. Rachel, I wonder if you can tell us about partnerships from the private sector perspective.

KING: Yeah, thank you. Thank you. And as Hilary indicated, I’m the CEO of the Biotechnology Innovation Organization, which is the industry organization that has about 1,000 members, primarily small and mid-sized biotechnology companies. So these are the innovators developing new drugs, new therapies, vaccines. And as much as the COVID experience was a tragedy around the world, and terrible—you know, a huge challenge for humanity, one of the reflections that I think we would share as we look back on it was the amazing accomplishments that we were able to achieve together, because of partnerships.

Really the unprecedented speed with which the vaccines were developed and the way that the pandemic was cut short, as much as, again, there was a lot of suffering in the world during the pandemic. But the fact that that the world was able to come together as we did to address it is really remarkable. It’s a success that I think we all share, as a result of partnerships. Looking at research, manufacturing, clinical development, supply chain, all across the whole spectrum of development the reason we were able to succeed was because of the partnerships. So as we look ahead to some of the learnings from that, and we think about kind of an inter-pandemic period and potentially a pandemic period, there are a number of areas where I think we would look to continued partnerships.

One is enhancing investment in these platform technologies, both from governments and the private sector. And we don’t know where the solutions are going to come from. I think that’s an important—an important thing to emphasize. So we need to invest broadly in platform technologies in order to ensure that we have a robust capacity in the event that another pandemic occurs. So that’s one area. Another is strengthening regulatory regimes and ensuring harmonization. Again, another area where we’ll require intense partnership and collaboration. Strengthening supply chains. And, as you’ve indicated also, expanding the diverse manufacturing—diverse regional manufacturing capabilities, I would say, is another important aspect of preparation.

During a pandemic itself, we want to ensure that there’s unfettered access to pathogens, so that we can partner together with academic, regional, and industry collaborators, all to ensure that we get as quickly as possible to the vaccines and therapeutics that we need. We want to ensure good background of surveillance and good health systems are in place so that we can effectively distribute the vaccines and therapies that are developed. And that we fully fund procurement mechanisms. All of this, in our view, also requires a strong IP regime, so that we can ensure that the intellectual property is present in order to incentivize the investment that’s going to be required.

So across all of these different aspects of the development and the implementation of the vaccines and therapeutics, we need, critically, to partner. We learned that in COVID. We’ve learned that through the normal development process that we go through as industry. And so we very much look forward to working together through conversations like this going forward, as well as ongoing collaborations, to ensure that, together, we participate in a way that prepares us as well as possible for whatever next pandemic may come.

CARTER: Fantastic. Thank you, Rachel.
And then let’s go, last but not least, to Dr. Alakija, to share how partnerships have shaped your work.

ALAKIJA: Thank you so much. It’s a real pleasure to be with you today. I’m speaking to you from Indonesia, where I’ve just literally come in from what is a physical manifestation of partnerships. I’ve just been in the remote islands of the—of Indonesia, all over the place, looking at people working at the very lowest levels of community—community health workers, health workers. Incredible women, mostly. You know, so as we talk of partnerships here today, I want to also raise partnerships and women leading partnerships. And looking at what they can do, because health security—which is our topic today—cannot be health security unless you have local security, unless we have country, community-level security. Unless my home is secure, my country, my community, cannot be secure.

But we saw traditional partnerships falter in the past few years during the pandemic. We’ve seen traditional partnerships falter even recently, in more recent months. And yet our collective health security has never been more urgent. In my work, and you sort of say in my work and that’s sort of a difficult question to answer. And as Rachel spoke just now, she talked about, you know, vaccines, and therapeutics, and partnerships. But I also chair FIND, which is the foundation for diagnostics and sort of the diagnostics alliance of the world. And just in the last few days, I’ve had incredible meetings speaking to what dear Jean Kaseya just said about local production, meeting with incredible people here in Indonesia who are producing diagnostics, who are working in local production. It was in labs. It was in in local perkesamas (ph) and buskesamas (ph) and little community clinics, where we were able to see rapid tests for HIV, for syphilis, for TB that would be produced by people in this country. That is the core of partnerships.

And we have come here—so I represent partnerships not just on a multilateral level—which I’ve been introduced as a special envoy to my dear brother Dr. Tedros—for the Access to COVID Tools Accelerator, but my proudest partnership is with the Africa Vaccine Delivery Alliance, which was started under the leadership of dear John, Dr. John—Ambassador, sorry—His Excellency Ambassador John Nkengasong in his previous iteration as the head of Africa CDC under the incredible work that he did there. And we saw regional partnerships. So I can speak to so many partnerships—regional partnerships with investment institutions, with the Afreximbank, for instance, who started Africa’s procurement mechanism for COVID vaccines and for—not just vaccine, but for diagnostics, for PPE, for therapeutics. Partnerships are critical.

And my sister Anyaga (ph), my namesake, Joy just referred to the SDGs. Partnerships are core to SDG 17. And yet, in my work I’m seeing a world where—you spoke earlier, Hillary, about the need, potentially—one of the speakers spoke about the need for unconventional partnerships. And I think as this world is faltering more and more, we need to start looking at unconventional partnerships. We need to start looking at that work together. I heard Rachel just stay together. My brother Tedros earlier said together. The world needs to come together in such a way that it is respectful, just like Jean Kaseya just said. But respect is not just between continents; respect is also within continents. We have to show respect to one another before we expect the world to show respect to us.

Partnerships is about respect. It is about—it is about understanding that you are not OK—I am not OK if you are not OK. It’s about working together as a global community to ensure that the health of this world—not just our health security, but the health total of this world—is together in one place.

So for me, partnerships have been incredible in the last few years. I have seen them—I have seen the power of partnerships, and I have also seen how partnerships can dissolve when we try to restrain them too strongly within traditional limits or when we don’t have the right leadership for certain partnerships and we try to force those partnerships into place that they don’t fit.

I’ll leave it there for now. But for those who are in the room, I know that Ambassador Nkengasong, I hope, is there, but my message is for Dr. Fauci. I hope he’s still around. And somebody put it on record if he’s there that his incredible work during COVID-19 led so many partnerships in this world, and we want—I really want to thank and salute him for his service. And if I were there today, I would want to give him the biggest hug ever. (Laughter.)

CARTER: Well, thank you so much. I think there’s many of us who would want to replicate that hug for the work that he did.

Let’s—what we’re hearing is a lot of support for partnerships and how they’re critical for the work that each of you do day in and day out. I’m wondering if we can get more specific, and if you can share with us a specific partnership and the impact that it has had on the work that you do, and maybe one of the most impactful partnerships, if you could share with us. So let’s go back to Dr. Barbosa. If you could share the experience from PAHO.

BARBOSA: Thank you. I will have not to tell you what’s the most impactful, because maybe I will not be fair with many hundreds of good partnership, but to give two examples, very concrete.

One was the, in March 2022, we—working with many partners including U.S. government, we establish our COVID-19 Genomic Surveillance Regional Network, COVIGEN. Now we have thirty-three laboratories from thirty countries and territories that are participating in this network, and over six hundred thousand— (inaudible)—specimens from Latin America and the Caribbean have been shared through this—through the global database. So I think that this is a very concrete example that, working together, we can, in only three years, change the way that we are performing genomic surveillance in the region.

And the second is that the—a partnership trying to reduce the vulnerability of Latin America and the Caribbean. Following the recommendations from our member states, we established a regional platform that is bringing together public and private companies to strengthen their capacity in Latin America and the Caribbean to produce vaccines, medicines, laboratory (kits, and others ?). That is one outcome important of this process. Now we have two projects—one in Argentina, one in Brazil—to develop the mRNA vaccines that will benefit not only Brazil and Argentina, but the whole region through PAHO’s Revolving Fund.

So these are two very concrete examples that I have, probably the most recent ones. Thank you. CARTER: Thank you, Dr. Barbosa.

Rachel, can we come to you? We heard Dr. Barbosa talk about public-private partnerships and would love to hear your perspective.

KING: Sure. I would say—I would name three types of partnerships. There are many that the industry benefited from that I could name, but I’ll name three as such that were—that were particularly important.

One is a background of both public and private investment. And I want to name that first because that is the foundation, from a—from a basic technology perspective, that we need to have in place in order to ensure that when the pandemic hits we have technologies available. So that was both government investment and venture capital investment as a partnership with industry that forms a basis of innovation.

Another I would name is the advance purchase agreements, which were a public-private partnership, again, that made it possible for industry to invest in manufacturing, which was the third thing that I would mention as a critical partnership. Scaling up the manufacturing of the vaccines—in particular of the vaccines—was an incredible challenge in terms of the supply chains, in terms of the capacity. And it could not have been accomplished without a tremendous amount of partnerships.

So I would highlight those three among many. One is the background of investment, second is the advance purchase agreements, and the third is the incredible collaborations that took place around manufacturing and supply chain.

CARTER: Fantastic.
Joy, can we come to you to share your most impactful or one of your most impactful partnerships?

ST. JOHN: So, for me the most impactful partnership I have experienced is the partnership with the members of the CARICOM Security Cluster—CARICOM-MPACS; CDEMA; RSS; and my own organization, CARPHA. We are responsible for maintaining and enhancing regional security from many perspectives—traditional security with armed forces, health security, disaster preparedness and response, and security surveillance.

So, among ourselves with the support of a wide range of sectoral partners, we have—including PAHO and WHO—we have also tried to ring-fence the CARICOM region. So this partnership was a literal lifesaver during the pandemic. And right now, we are working together to build a secure foundation of extreme solidity with pillars of capacity building, surveillance, border security, and response to support the staging of the Men’s T20 Cricket World Cup in the region and the U.S. in the midst of warmup matches in May and June, the actual matches next year. We are marshaling out national focal points, much as we did during the pandemic, to ensure that they fully understand their critical roles to protect national security while making this event a true pleasure for the players, officials, spectators, and visitors. We are also sensitizing our sectoral partners about the key areas of need which their unique contributions can fulfill capacity building, of course providing linkages to other regions which have staged mass-gathering events for guidance and avoidance of pitfalls, and resource mobilization.

So these—this describes my most impactful partnership. CARTER: Wonderful.
DG Kaseya, can we hear from you?

KASEYA: (Laughs.) As my friend Jarbas said, when you are leading a continental organization and we have to talk about one partnership specifically, you know, it’s like you are forgetting others and you are creating a number of issues. But I will just talk about one regarding the PPP—public-private partnership—as Rachel said.

Why I’m talking about it? Because when I was special advisor and minister in my country, at that moment talking about PPP was like a scene. But today it becomes that we are really doing, what we are pushing.

Africa CDC, we have a partnership with Mastercard Foundation. And that one is the gamechanger in Africa, not only for Africa CDC but I’ll say in Africa, because this funding that we got from Mastercard Foundation, it was for COVID. Now I think a number of you will CPHIA. This is the second-biggest public-health event in the world. That will take place in Zambia. We are expecting twenty thousand people. During this CPHIA, we launched the second phase of our partnership with Mastercard Foundation. What this partnership is doing? We are changing the face of Africa.

First, we are targeting all flagships that are important—local manufacturing, and workforce, and lab, everything. But more important, we are using that to leverage more domestic resources because we are giving an example. I have to say to my head of state: We cannot rely on external resources. Even if we wanted, let me tell you, my budget for next year is around $1 billion. I’m still expecting that Office of Global Health Security, they will help me to move from 1 million from the U.S. to maybe a hundred million. (Laughter.) And what is important is to see how African countries can start now to invest in their health system, and what we are sharing with them is the model from Mastercard Foundation.

Now this model is transforming the way we are perceiving health in Africa, and we are using that also to advocate. As you know, Africa CDC appointed President Ramaphosa as the champion for PPP. Reeta, I will talk with you. Now you would see President Ramaphosa and myself coming strongly to support how we can advocate for more funding for Pandemic Fund. And as you know, Africa CDC is—plan to become an implementing entity because we want to leverage resources from Africa to support also Pandemic Fund by being implementing entity.

I think there are a number of lessons we are learning from this partnership with Mastercard Foundation. CARTER: Great. And it’s an example of a catalytic partnership—
KASEYA: Yes.

CARTER: —a partnership that leads to additional partnerships. Fantastic. So let’s go back to our screen. Ayoade, please go ahead.

ALAKIJA: Thank you. Well, you talked about catalytic partnerships, so let me talk about a partnership that I have been involved in that really has sparked off much of what we’re talking today.

In the middle of COVID or at the very beginning of COVID, the Bureau of the Heads of State—African Bureau of Heads of State established a three-pronged pillar of the continental response. One was the CONCVACT, which was looking after tests and trials. One was the AVAT, which was supporting procurement mechanisms for Africa, which was led by Strive Masiyiwa and John Nkengasong in his then-iteration and many others, and Afreximbank very importantly. And the third was the Africa Vaccine Delivery Alliance, which has now become the Africa Countermeasures and Readiness Alliance, that I co-chaired with then-Dr. John Nkengasong, now Ambassador Nkengasong. It is that partnership that was catalytic in really—you know, you have Amadou, my brother, there in the room today—in starting local production in Africa, in starting local production not just in Senegal but in Rwanda, but in South Africa with people like Afrigen, with whom I was—I was together in Berlin or wherever that was last week. It wasn’t Berlin. Where was last week? Last week was the Netherlands. (Laughter.) Last week was the Netherlands. Go figure. You know?

And so I love the fact that you’re talking about catalytic partnerships because partnerships, you know, they’re— it’s not a—it’s not a static construct; it’s a dynamic construct. You know, partnerships evolve and they change over time. That particular partnership led with what—was at the front—very forefront. And it was not just, you know, African governments; it was private sector, it was CSOs, it was logistics companies. It was actually the way the world should be, is, you know, when I talk to my brothers now within ACT-A—which is another partnership that I lead at the moment and co-lead together with the former prime minister of Sweden, Carl Bildt—you know, when I talk to them, when I say, what does the future of PPPR look like—which, you know, Jean Kaseya just mentioned—that looks like that partnership. It looks like what AFTA (ph) did. It looks like what ACARA (ph) is now—is now turning into, which is a sort of—not just multilateral, but it includes, you know, people from communities who understand. I say all the time, and I speak in my language a lot which is Yoruba, that (speaks Yoruba.) It is a person who wears the shoe who understands where it is hurting. So we need people at that level to be able to be within our partnerships so that they can help us.

You know, like Rachel was saying earlier, how do we deliver to the last mile? The people that I met with today, I went to some of the clinics and literally seven hours, eight hours away from Jakarta, by some very bumpy boat rides, I might add. You know, so I’ve sort of, you know, been taking a little bit of my motion sickness pills and got back here just in time. You know, but they will tell you that the big freezer that they have, which has been supplied by GAVI or by whoever, it doesn’t work. The electricity in their community doesn’t work. So they still rely on the cold chain. Some of the diagnostic tools that we looked at—oh, my goodness, does any one of you girls remember those colposcopy tables where you have to sit on it and, like, splay your legs and have a, you know, visual, and instead of the proper—I mean, OMG. That’s what we were dealing with today.

And we have to have people like this at the table. That is what partnerships are about. So partnerships also have to be about investment. And that’s my third point. The first was the Africa Vaccine Delivery Alliance, started under the leadership of Dr. Nkengasong and also President Ramaphosa, in his then lead as chair of the African Union. But the third one is investment partnerships, which we saw within Africa with the Afreximbank. You know, Professor Benedict Oramah and Afreximbank came to the table. I have recently been appointed co-chair of the G-7—thank you, USA, because you were all there as well—of the G-7 Impact Investment Initiative for Global Health. That is another partnership, looking at the fact that the world needs more money in this space, but we need to get creative. And let me go back to your—almost your first words, Hillary. We need unconventional partnerships. And we need, as Dr. Tedros said, to do them together. Over.

CARTER: Thank you. Really great. Thank you for helping us understand the dynamic partnerships and the types of investments that we need for those partnerships.

So we are right on time to open it up to the audience. At this time, I would like to invite members and guests in Washington and on Zoom to join our conversations with their questions. A reminder that this meeting is on the record. And we will take our first question here in Washington in the room. Don’t be shy. Yes.

Q: Thank you, again, so much for your time. Captain Grant Hall (sp).

I’m very curious to hear what your opinions on what the biggest barriers are to these new partnerships. And, particularly, the unconventional partnerships that you talked about, if we’re going to start building them.

CARTER: Thank you. I think all of our panelists could respond to this question. So maybe let’s do a lightning round. And we’ll start first maybe with Rachel.

KING: So that’s a good—that’s a good question. And I think, to some degree, the barrier depends on the partnership that we’re talking about. I mean, one of the concerns that—what I think from the industry perspective, from the perspective of the small-to-medium sized companies that are driving a lot of innovation in the biotechnology industry, one of the critical barriers to being able to partner is being able to finance and being able to have investable assets to partner. And that really requires a strong ecosystem for investment, part of which is intellectual property. And I know that may be a controversial topic within this—within this group, but I think to enable the small-and-middle sized companies to be able to really raise the financing and to partner, we need to have—we need to ensure that we have strong intellectual property regimes around the world that enable them to incentivize investments. So I think that’s a critical potential barrier to investment for small and medium companies.

CARTER: Great. DG Kaseya.

KASEYA: I will answer this question by quoting President Ruto when he attended the meeting in Paris. He said—(inaudible)—with President Macron. And he said, one of the key barriers is lack of respect. Sometimes I’m talking like—I’m talking health leader, African leader. Sometimes people, they can think that they know what they can do for us. They can come to Africa to impose even the model to implement the program. We don’t want it anymore. And this is what my head of state they are saying. This is what I’m seeing as DG Africa CDC. In health sector, I’m leading the agenda of health.

You think that you can invest in health sector in Africa, please come in. We can talk with you. We are open. We know our needs and priorities. We know where we need to invest, what we need to do. You think that you can support the local manufacturing, come to Africa CDC. We’ll talk and we’ll guide you, and we’ll convene. In September we had a meeting with ten ministers, regulatory authorities, GAVI. And let me say I respect Gavi, because Gavi, they know how to respect partnership. We managed to talk with Gavi. We secured one billion for African manufacturers. I think Amadou attended this meeting. This is what we are doing. And we will do that for diagnostics, for therapeutics. I think, for us in Africa, as my head of state are saying, it’s mostly lack of respect. And thinking that others, they know more than ourselves we know for our health system.

CARTER: Thank you.
Would the virtual panelists like to respond? Joy, would you like to respond?

ST. JOHN: I think the biggest barrier is not understanding the rules of engagement. And if you don’t make it clear what the boundaries are, and where the unusual collaborations can be, you’re either hampering or giving too much license to a partner. And so it’s very important to understand the issues of partnering, and the conflicts of interest, and so on. The next biggest barrier, from my experience, is understanding precisely what the

recipients of the partnering process will gain. And I’m here thinking of, for example, my member states. And they, therefore, have to put some skin in the game and say what their needs are, so it’s easier for partners to really come in and support rather than to come in and dictate.

CARTER: Great. Ayoade, can we turn to you?

ALAKIJA: Thank you. I would agree with what Joy just said—lack of understanding rules of engagement. And I would add to that also the lack of understanding of the political economy in which one operates. I think too often, there is a helicoptering into various sort of situations. I mean, only speak from the sort of, you know, the Global South perspective. As I said, I’m in Indonesia today, so I’m sort of not wearing just an Africa hat but I’m wearing sort of a wider Global South hat. And I’ve done a lot of work in India this year working with the Indian government and through that whole G-20 process.

And, you know, what is clear to those of us who work in these settings is that people do not fully understand the political economy of the environments in which they work. Recently, last week, I was at the local—I just remembered where I was now—it was at the Local Production Summit, World Local Production Summit in the Netherlands. And, you know, a lot of conversations around local production. And I sort of chaired the leaders panel at that meeting, where I challenged them to say that everybody’s talking about local production but, you know, if every single country in every region of the world started producing vaccines, who’s going to—who’s going to buy them? If we don’t understand the local—you know, these are the elephants in the room. I also brought up my country.

Of course, you know, working very closely with my own minister of health at the moment, and my dear brother, Professor Muhammad Pate. You know, if Nigeria wakes up—the sleeping giant finally wakes up one day and starts producing vaccines, therapeutics, diagnostics, it’s over for everybody else because that is the biggest market in Africa. So if you don’t engage with Nigeria, you can’t engage with Africa. If you don’t engage with—you know, you have to understand. I don’t say that just as—you don’t engage with Ethiopia, you don’t engage with South Africa. You know, so it’s a lack of understanding.

And then I think the third thing I would say is the lack of—there is no—there’s very limited risk appetite at the moment in the world. You know, everybody is very happy within their little sort of boxes and their little—their little sort of, you know, global health fraternities, as I call them, because that’s—let’s face it, that’s what they are. They’re little fraternities. Girls, we need to form a sorority. (Laughs.) You know? But they’re really happy with that. So there’s not—that there is very limited risk to go out.

And the question specifically said, how do we get into these unconventional partnerships? That was what the gentleman said. And to get into unconventional partnerships, you have to take risks. You have to take risks. And those risks must then be de-risked, if you like, you know, because the risks are largely financial. You know, you could invite me to a meeting. That’s a risk. You know, if Ambassador Nkengasong invites Ayoade to a meeting, oh, my God, what is she going to say? You know, BBC invites Ayoade to an interview, oh, my God, what is she going to say? That’s not a risk. But the risk is where you put your money where your mouth is. And so we need financial institutions—so Priya’s there today in the World Bank, and others to—you know, IFC and many others, to help de-risk the environments that we live in. That is where we can get into unconventional partnerships.

Let me end with AVDA. I mean, I led—I’m continuing to lead AVDA now as a sort of independent thing, you know, once we—once the previous director left. And we’re all volunteers. Were unpaid. We started the very first delivery partnership for vaccines, therapeutics, and diagnostics in the world. CoVDP, the one that came out of ACT-A, which I also co-chair, copied our model. Yet the world was comfortable with funding CoVDP, because it was—it was not an unconventional partnership. But they would not fund through Africa the work that we did, which was the model for that. That is—those are the key barriers. Over. Thank you.

CARTER: Thank you.
And let’s go last to Dr. Barbosa on the challenges to partnerships.

BARBOSA: Thank you. Owe you all for commenting on this topic, my dear friend Ayoade and also Jean. Of course, that we have—one important barrier is when you have some conflict of interest, you don’t have a really a common objective is to deal with. But I think that the main talk in our days is how we can translate some complex issues into partnership that can work. And I will comment on this topic of the local regional production.

In Latin America and the Caribbean, I think that the experience that the countries had, the lack of access for PPE, for medicine, for ventilators, and for vaccines was so traumatic that everybody would like to produce everything. And we know this is not feasible. So this is, I think, a very concrete example of a complex issue. That is, how we can translate this legitimate political will to reduce the vulnerability into partnerships, bringing together public and private sector, working together to establish a reasonable production that can reduce the vulnerability, that it can leverage the current capacity that we already have in Latin America and the Caribbean, and can let us be better—much better prepare in a new pandemic. So I think that this is the kind of problem is that is complex, that with different—many different interests. But that that we can convene them together to work in a collaborative way.

CARTER: Thank you. We have to set the table for partnerships to overcome those complexities and to take risk. You have to know the rules of engagement. I think we have—OK, I’m getting the signal that it is time to conclude our session. Thank you all so much. This was a really rich and diverse conversation, thank you. (Applause.)

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