Putting science into practice | Nobel Week Dialogue 2025 | Health For All

0:00 little bit about Médecins Sans Frontières.

0:02 So, just for for the audience a little bit in numbers.

0:05 So, you employ 67,000 people worldwide, and most of those people are locally

0:12 local people employed for Médecins Sans Frontières.

0:17 You have 7 million donors worldwide,

0:20 and 98% of your money comes from private donations.

0:26 So, so me, this is this is what a common humanity looks like.

0:29 I think this is incredible.

0:31 So, you became president then this this year, just in September.

0:36 So, but as Adam indicated, you know,

0:41 in 2024, you were medical team leader in Gaza.

0:48 So, let's start off talking about this.

0:53 So, so your experience there.

0:56 So, what is a medical team leader?

0:59 What is what is your role in in that in that position?

1:01 Yes, a medical team Firstly, thank you for having me.

1:04 It's a real pleasure to be here, and it's been fascinating all day.

1:08 A medical team leader is a little bit what it says on the on the tin.

1:11 So, at project level down, you know, by the patients,

1:14 you're the team lead for all the medical operations.

1:17 And what's not medical is the logistics, the administration,

1:20 finance, and HR, and of course the operations.

1:23 And the operations really looks at security and representation.

1:26 So, you're the team leader,

1:28 and depending on what the project is, you'll have the medical managers,

1:32 and and and and be bringing them

1:34 together to deliver the objectives of the project.

1:36 So, for example, in Gaza, [snorts] I was over three projects.

1:40 One was a trauma, so orthopedic trauma and burns unit

1:45 inside the Ministry of Health hospital called Nasser in Khan Yunis.

1:49 But also, we had two primary health care centers, and also water distribution.

1:55 So, in that sense, I had a water water manager,

2:00 surgeons, medics, nurses, physiotherapists,

2:03 occupational therapists, mental health activity managers,

2:08 and and I would be their team lead just to make

2:10 sure that we can do what we need to do.

2:12 And but in this doing what you need to do in such an extreme environment,

2:21 I mean, particularly the medical community were under attack.

2:26 How how how did you manage to work?

2:29 How did you cope in this?

2:30 Yes, I mean, you know, Gaza we characterize Gaza as a genocide, right?

2:35 And it's it's contextualized within the wider occupied occupy occupation,

2:39 sorry, of Palestine.

2:42 One feature of that genocide for us is is

2:45 the systematic dismantling of the health care system there.

2:48 And and that [snorts] was characterized in several different ways.

2:51 And and what we saw were not only

2:53 the direct attacks on hospitals and even medical convoys,

2:58 but also closures of hospitals.

3:00 So, when there is a a displacement order,

3:04 an order to leave an area, the hospital has to close.

3:07 The whole population goes.

3:08 So, so just in the in in the time in the 2 years that we've been there,

3:13 there have been 24 medical facilities that we've had to leave.

3:17 So, that's sort of the the the infrastructure closure.

3:20 But then, what's a feature that I hadn't seen previously quite so

3:23 much is this sort of very intentional attack on health care workers.

3:28 So, there have been over 1,700 health care workers

3:31 killed in Gaza since the beginning, since October 7th.

3:35 And we've had 15 colleagues, MSF colleagues, some killed at work,

3:40 and others killed just because of the sheer level of violence.

3:45 But [snorts] the feature here that's that's quite so

3:47 worrying is the sort of the very deliberate targeting,

3:52 and even torturing of health care workers simply for doing what they do.

3:56 So, my colleagues said at checkpoints,

3:59 whenever they were moved from the north to the south,

4:02 if there was any sign that you were a medic,

4:04 they'd been pulled out and then detained, questioned, some for many months.

4:09 Many many were beaten.

4:11 The orthopedic surgeon that I was working with still had a limp

4:14 from his detention when he had been detained at Shifa Hospital.

4:17 And so, how is Médecins Sans Frontières dealing with this, you know,

4:22 as an organization, this unimaginable situation?

4:29 I mean, for us, you know,

4:30 we we concentrate on bringing about care in in in in the best way that you can.

4:37 Right now, coming into winter with the ceasefire that's very fragile,

4:41 with ongoing violence, our main concern is that we haven't seen a huge

4:45 amount of increase in aid that we were expecting.

4:49 So, food, water, shelter is still a big need.

4:52 And you know, my colleagues are living through this.

4:55 I have the enormous privilege of going

4:56 in for 2 months and knowing that I would leave.

5:00 But but but my colleagues are still there.

5:02 They're living through this, and of course

5:04 the the threats of violence and disease is all around.

5:06 So, in that sense, I think what I always

5:09 do and with my teams is just really focus, you know, what can we do more?

5:13 What can we do better?

5:15 Think about those little moments of care

5:17 that you bring and healing to each patient, and try and facilitate it for them.

5:22 But that can be hard in a situation of a supply

5:24 blockade where you're reaching for your second or third line drug,

5:29 or you didn't have crutches or wheelchairs, and you've got so many amputees.

5:33 Or [snorts] it's it's impossible.

5:35 And it is impossible.

5:37 It It's It's even hard to imagine.

5:39 Yet, after Gaza, up until February this year year, you were in Sudan,

5:45 and which the UN says is the biggest humanitarian crisis on the on the planet.

5:50 It's bigger than Gaza.

5:51 There's more deaths than Gaza, twice as many,

5:54 I think, 150,000 people killed, many million displaced.

5:59 And what what is how is again, what is this experience like,

6:04 and how is Médecins Sans Frontières coping with dealing with this?

6:08 Sudan presents really profound difficulties, not not only in the sheer scale.

6:15 So, it really it is the biggest humanitarian

6:19 disaster in in terms of numbers of displaced,

6:21 numbers of killed, numbers at risk of of people.

6:24 You're in the tens of millions here.

6:26 What what happened in Sudan, and I'm half Sudanese,

6:29 is was it was a total implosion of the state overnight,

6:32 and and and and and and general warfare.

6:36 One characteristic of this war is is attacks on civilians,

6:39 attacks on civilian infrastructure, attacks on health care.

6:42 And it and [snorts] it's very difficult to work on both sides of the lines.

6:46 You've got two warring parties controlling their own territories,

6:51 and and they see and they they create blockades and make

6:55 it very hard for us to move supplies, to move staff.

6:58 You need a permit for everything.

7:00 And in that way, it creates a control, a a control that shouldn't be there.

7:05 Humanitarian aid, whether it's Gaza or Sudan,

7:08 shouldn't be conditioned on anything.

7:10 It's something that needs to get to the population.

7:12 It's independent.

7:13 It's neutral.

7:14 It mustn't be treated as a as a bargaining chip.

7:17 And you're doing this in the context of huge amounts of funding

7:22 being pulled at the US and other countries reducing aid funding,

7:29 development funding.

7:30 The Lancet There was a Lancet report a few few weeks ago, a few months ago now,

7:35 estimating about 14 million people by 2030 could be

7:40 could die because of this pull pull back from funding.

7:44 Many uncertainties in those numbers.

7:45 It's But you know, how how how

7:48 is Médecins Sans Frontières coping with that then?

7:51 Are you You can't We can't fill the gaps.

7:55 We can't fill the gaps.

7:56 We're not directly impacted by that.

7:58 So, we're independent, as you mentioned earlier,

8:00 with all our donors in terms of our funding.

8:02 But when you work in a healthy ecosystem,

8:05 and and actors around you are are falling away, then it has a profound impact.

8:10 So, on one side, it's costing us more to do the same,

8:13 and on the other side, we have to do more.

8:15 And an example there I can give is while I was in Sudan,

8:18 the cuts that had been announced meant

8:20 that And I was working in Omdurman in Khartoum,

8:22 and we were doing trauma inside an emergency room,

8:25 but also pediatrics and and cholera and vaccination.

8:29 But overnight, three different organizations came to me saying,

8:33 "Can you help?" And one of them was an emergency room giving food,

8:37 an emergency response room, the ERR's of Sudan.

8:40 Was actually giving food in the hospital.

8:41 They'd lost their funding.

8:43 Another was a Sudanese network that had had funding

8:46 from a US agency to do community sexual reproductive health.

8:50 So, a community network of midwives just fell away.

8:54 And in the context where there is sexual violence

8:56 as a as a as a weapon of war, that's an issue.

9:00 And so, there's a there really is a maternal

9:02 and child health sort of emergency in Sudan.

9:05 So, when sexual reproductive health fell away

9:07 overnight in the city, that was a problem.

9:09 And we, you know, we can flex, but we you know,

9:12 to fundamentally change our program overnight was not something I could do.

9:16 So, I could support as much as possible.

9:18 But other examples are that, for example, with malnutrition, you know,

9:21 even now this year in Yemen and Niger, for example,

9:27 we've had to put in unplanned provision for malnutrition,

9:33 something that hadn't been provisioned or or planned

9:35 in the beginning of the year, but we pivoted and do that.

9:38 So, then we're doing more than we expected.

9:41 That's okay.

9:41 We always keep buffers of funding in our unplanned pot.

9:45 You never know when an emergency is going to start.

9:47 But there's we have to be clear.

9:49 There's no way that one organization, MSF,

9:52 can fill the gap left behind

9:54 by so many countries abandoning their international donations

9:59 and and and their sort of commitments

10:01 for global health and and humanitarian action.

10:04 Now, now we're going to invite some more panelists and then

10:09 and and discuss this this this this idea of bench

10:14 to bedside because with MSF as as sort of the the extreme

10:20 in some ways extreme environments for providing health care.

10:24 So I'd like to invite on stage Jan

10:26 Nielsen and Maya Fiennes start and Sally Davis.

10:34 [applause] Next to chair.

10:41 Oh right, so I should stay on this one then.

10:43 Oh there we go.

10:45 [laughter]

10:45 There's an order.

10:46 Musical chairs.

10:47 There we go.

10:48 Good.

10:48 Get there in the end.

10:50 All right, so it's a gender division.

10:54 [laughter] Interesting.

10:53 Well, there is a And color also, yes.

10:57 Um so just but maybe just

10:59 to to to to bridge this as well then this conversation.

11:03 So on that bedside on treatment Yavid you you do a lot of innovation within MSF.

11:11 You have like mechanisms internally to sort of create new innovations

11:16 and speed up that process between you know research and and and treatment.

11:23 Absolutely, yes.

11:24 I mean we have internally what's called the access fund and and that's precisely

11:28 actually based on some of the things we've been talking about in earlier panels.

11:32 So so looking at drug development, drug pricing,

11:35 access to medicines was the fuller name and it's to assure that lower income

11:40 countries and neglected populations can have access

11:42 to medicines that the the richer nations do.

11:46 And actually interestingly our peace prize fund from in 1999.

11:52 I mean that's the reason MSF is here.

11:54 We're sort of Nobel laureates in that sense.

11:56 We we gave committed some of that money to starting an organization

12:01 called the drugs for neglected diseases

12:03 initiative DNDI and it does exactly that.

12:07 It develops for in a non-profit model

12:10 medicines for neglected diseases and I remember

12:13 visiting in in the DRC in Congo a clinical research trial that was literally

12:18 a you know a short flight over the jungle a half a half

12:23 a day's drive to the town and then you take a motorcycle at 5:00 a.m.

12:28 couple of hours through the jungle again and then

12:31 onto a canoe and that was about 3 hours down

12:34 to the community and there you're doing lumbar punctures to to check

12:37 on these people to see if they have sleeping sickness.

12:39 And if they did, you have to bring them all the way back to the hospital

12:44 and that's not for a 3-week inpatient treatment

12:46 that killed one in five and it was arsenic based.

12:49 So that's not that's not a viable treatment for a disease

12:52 and DNDI MSF did this clinical research and have been able

12:55 to bring forward an oral treatment for sleeping sickness and it's

12:59 just revolutionized that and it's affordable and and and easy to store,

13:04 easy to deliver and so that's an example that it can be done.

13:07 Mhm.

13:08 Good and then maybe and then this is good to bring you in Jan because

13:12 you know are we doing enough to do

13:14 that translational work in least developed economies,

13:20 at least developed countries.

13:21 I mean so much of the work is happening

13:24 in the developed world and emerging economies could be losing out.

13:30 Yes, no we're not doing that at all.

13:33 It really struck me last year we had Nobel Symposium cardiovascular disease

13:39 in South Africa and we had the leading scientists there and we were discussing

13:44 the latest diagnostics and molecular diagnostics and new treatments based on RNA

13:50 and then we had one day you have focused on cardiovascular disease in Africa.

13:55 And it was only with African scientists that they said it

13:59 was all very interesting but it doesn't really help us anything.

14:03 You know, we have public health problem in Soweto 50% of the women are obese.

14:09 They all are developing hypertension

14:12 and they're suffering from diabetes and stroke.

14:15 And if we try to convince about public health, they don't listen to us.

14:22 They listen to the to the village witch doctor.

14:27 And our governments are so busy with corruption,

14:31 war and so that they're not really paying attention to the public issues.

14:35 So we would like you and our sector

14:38 we really say we have to solve these problems.

14:41 It's not something that you would do but it's something completely

14:44 different from what we're doing in science in the developed countries.

14:49 Mhm.

14:50 And Sally, do you have a thought on this as well

14:53 on this translational to emerging economies and developed developing countries?

14:59 So I think it is very difficult to take

15:01 high-tech and dump it in a low a low-income country.

15:07 Can they afford it?

15:08 Can they run it?

15:09 Do they want it?

15:10 Was it a priority?

15:12 I set up in 2020 an NGO called the Trinity

15:16 Challenge and we've gone about it by mission driven.

15:20 Here's a problem.

15:22 Bid in if you want the prize for how you would solve it using local tech.

15:29 85% of the solutions have AI and machine learning

15:32 but it's locally that they've worked out what to do, how to do it better.

15:37 The winner the first time was a tie winner who's turned farmers.

15:42 This one was about AMR.

15:43 If if I'm involved that's often there.

15:47 But it turned farmers into disease detectives using their mobile phones

15:52 and a central vet and it's really helped their local economies.

15:57 So doing things locally and letting them solve

16:02 their own problems which I think is part of yours.

16:04 But you can extend that into the high-income countries.

16:08 So what I used to be famous for was

16:12 that I persuaded our government in 2006 to let

16:16 me launch the National Institute of Health Research NIHR

16:21 which was there to fund clinical applied and policy research.

16:26 And the whole concept behind it was that no one was funding that properly.

16:31 We had to keep the basic and experimental but we needed this.

16:36 And that if people got their hands dirty and joined in the clinical studies then

16:41 once they got the results they were much more likely to put them into practice.

16:45 So it was a way of getting more research done but it was also a way

16:50 of improving the standards of care so that they

16:54 were modern in our NHS hospitals and primary care.

16:57 And it's huge success.

16:58 We would say over 1.2 billion funding each each year now.

17:03 And can you give some examples of the the kind of things

17:07 that have have come from it that wouldn't have come without?

17:12 A study that showed that you only needed as a woman

17:16 with a certain time of breast cancer

17:18 three visits for radiotherapy instead of 12.

17:22 In COVID all the recovery trials, one of the parts of NIHR that I set up was I

17:30 I took away all the research funding that was in the NHS,

17:33 put it together and instead of having clinical

17:37 trials networks that were based on just friends meeting,

17:40 we developed managed clinical trials networks where the nurses,

17:45 the data collectors, everyone was trained in what their role was, how to do it.

17:51 We would only put into our managed clinical network

17:54 that was in 99% of hospitals trials and studies that had

17:59 gone through ethics committee and were properly powered and properly

18:03 constructed and then we could run them really effectively.

18:07 And during COVID that's why we were able

18:09 to prove very quickly that high-dose steroids had

18:12 an impact that many of the things

18:15 that Trump thought up caused harm and didn't work.

18:19 And then to try out the actual drugs.

18:21 We've got a vaccine part of it that did

18:23 a lot of the challenge studies and everything.

18:26 So we've got lots of good examples.

18:29 Good and then so on COVID then Maya I'm going to turn to you.

18:33 I mean you you were Secretary of State

18:36 for Health during the COVID crisis here in Sweden.

18:40 Had to remind me about that, did you?

18:43 [laughter] And you've written a book about it at the center of the crisis

18:47 and it was an absolute unique moment and it it changed a lot of things.

18:54 When we talk about from bench to bedside,

18:57 all along the chain it revolutionized many

19:00 many things and and accelerated many things.

19:03 But can you talk through that that period of decision making and stress that it

19:10 must have been to to change a whole system to respond to this this pandemic?

19:17 Don't bring it back.

19:18 But I think when we're speaking about from from bench to bedside,

19:22 I would say that that COVID was really a a triumph

19:26 of the professions really because it did go quickly from bench to bedside.

19:30 I mean we did implement new protocols for treatment.

19:34 I mean of course the vaccines is one

19:36 part of it but but treatments were changed quickly.

19:39 We phased out chloroquine and quickly when we realized

19:41 that that was not a a good way of treating patients.

19:45 And and when I speak to to professions that that worked during COVID,

19:48 they often feel that that they were allowed to to make decisions that you know,

19:52 should be the the of the professions during this time.

19:56 But on the other hand,

19:57 they often described that nobody listened to their experiences afterwards.

20:02 And and that's something we also work at on at Karolinska

20:06 Institute to actually I mean we put so much resources into COVID.

20:10 We could put resources into collecting lessons learned, right?

20:13 And and so many people working in health care did incredible things

20:17 during during very chaotic circumstances and we need to collect their lessons.

20:22 But I think on your other question on on sort of [snorts]

20:25 the the science to policy during COVID,

20:27 I think that was something I struggled with.

20:28 And and some people asked me, "Well, oh, you have a PhD,

20:31 it must have been much easier for you." Well,

20:32 my PhD is not in, you know, infection medicine, so that didn't help so much.

20:37 I think the only thing that that helped was that to have

20:39 a PhD made me a little bit less respectful towards researchers.

20:43 I mean, I don't hesitate to call a researcher if

20:45 I need an answer or something and that's sometimes great.

20:47 Sometimes you end up with the wrong researcher

20:49 and then you have to ask someone else.

20:51 But but I think that's been something I've

20:53 been reflecting a lot about after the pandemic.

20:55 How can we actually put in place that a good system

20:58 for for science to policy or evidence-based

21:00 policy because I did struggle with that.

21:03 And and and maybe say a little bit more on the struggling because it's you know,

21:07 it's making decisions under extreme uncertainty and that you know,

21:12 constantly changing and having to make some judgments about how

21:16 the public are going to respond to those decisions etc.

21:19 So how how did how did how did that go when Sweden

21:23 took a very different route in some ways than than other countries?

21:30 Can can you say a little on that?

21:32 Well, we did.

21:32 We there was I would describe it as a political

21:35 decision but also as a natural consequence of our you know,

21:39 public administration and and about our contagious matter

21:43 law that we wanted to to listen very

21:45 closely to the Public Health Agency and to listen

21:48 to the experts and that made us difficult.

21:51 I mean, there were other countries where the politicians made one decision

21:54 and the Public Health Agency did one

21:55 but we didn't really have that opportunity luckily,

21:59 I think personally because I think it was important to stay close to the agency.

22:03 But there's of course a discussion that I think is

22:05 interesting if if politicians use experts to sort of delegate responsibility.

22:11 I mean, the democratic responsibility must always be with the politicians.

22:14 You can never say that oh, but the agency said that I mean that that has

22:18 to be a a decision taken within a democratic

22:21 system because the responsibility must also be be possible

22:25 to to demand within the political or democratic system.

22:29 Mhm.

22:29 And uh I I wanted to come in because I was

22:34 when I was setting up the National Institute for Health Research,

22:37 I was the chief scientific advisor at the Department of Health.

22:40 Then I became the chief medical officer

22:43 and I stopped talking about evidence-based policy.

22:46 What I aimed for was evidence-informed policy because I recognized

22:51 the democratic right of the ministers to take a decision.

22:55 My job was to try and make sure they knew all the bits.

22:58 I would often if asked tell them what I would do if I was them

23:02 but I wasn't them and they brought other

23:04 things to the table to make those decisions.

23:07 Mhm.

23:07 [clears throat] And and Jan, I mean,

23:10 you you you you think there were some amazing innovations you know,

23:14 from bench to bedside in during COVID but we

23:18 we're at risk of ignoring them or forgetting about them.

23:22 I I think it was an interesting experience because as Myra said,

23:27 the decision-making went down to the professionals.

23:30 And it turned out to be effective

23:34 and the working environment was much more stimulating.

23:38 So people really liked working even though it was tough work,

23:40 they really liked it.

23:41 And the interesting thing that's the way it used to be.

23:44 If you go back to the 70s and 80s, the professionals were running the thing.

23:48 Unfortunately, they didn't care about the budget that much.

23:51 So something had to be done and then came I'm

23:55 sure you heard of new public management all of you.

23:57 So there were managers taking care of health care

24:00 and these focused more or less entirely on health care.

24:04 Of course and the universities increasing competitiveness,

24:08 you wanted to go for the big funds which was more on the molecular side.

24:12 So the clinical research just disappeared.

24:16 And that's so dangerous because if the if the really

24:21 new discoveries is going to come to benefit of the patients,

24:25 we need a translation of course and that's clinical research

24:29 and we have to find a way back again where we can

24:31 work together health care and university and I think you did

24:34 a fantastic initiative in forming the National Institute of Health Research.

24:39 And we have to find similar ways.

24:42 We can't do the same way because you know,

24:44 we have counties taking care of health care and and government taking care.

24:48 But I think you the way you did it is a great inspirer to others.

24:52 Thank you.

24:53 And Javed, with MSF, how how was COVID dealt with in those sort of humanitarian

25:01 crises in that sort of area and sort of retraining,

25:04 rethinking and just managing the sort of bedside

25:07 treatment in the in in that kind of environment?

25:10 What were the learnings?

25:11 It was a it was a profound shock obviously to everyone.

25:14 I mean, I was working in the UK health

25:16 service through through COVID because I was stuck, right?

25:19 There were no flights out and and we have teams that turn over.

25:22 We have supply lines that not quite just in time but you know,

25:27 they they are quarterly and so when

25:31 you have a two-year blockage of supply lines,

25:33 that creates a a real problem and and so for us

25:37 the issues were were really structural in in just carrying on.

25:41 We took the outlook very early that this is bigger than us.

25:46 We're not going to be able to respond

25:49 to a pandemic in every region and in every country.

25:53 So our outlook was preserve the life-saving

25:57 we're doing already which is critical

25:59 in many of the places that we work and that was very hard.

26:03 So we had staff who if they were on six-month rotations,

26:07 the international staff that come in and go out

26:10 stayed in projects for a very very long time.

26:13 Um supplies and of course then there were there were issues around yes,

26:19 then in places where we were expecting a high burden of disease,

26:23 what operational response can we and should we make?

26:26 And we did do that and actually it ended up being

26:28 in Europe in in in in sort of vulnerable or marginalized populations.

26:33 So we ended up doing COVID care for homeless people

26:37 in the UK or for the elderly in in Belgium in care homes

26:41 in France and that was also new for us because we're quite

26:45 used to the field being over there and it being in Europe.

26:50 Um again was a little bit sort of oh, we haven't you know,

26:53 we haven't done this before this sort of medical operations.

26:56 So yeah, in in many different ways it provided us with um yeah,

27:02 difficulties and challenges that we hadn't met before not least

27:05 that three our three main we do all our logistics in house.

27:09 Everything that we move goods, supplies is is done we do it by ourselves

27:15 but our three main logistics centers were in Europe.

27:18 Uh and so when Europe was shut down, that created its own issue.

27:22 So even on that basic level,

27:24 a learning has been to diversify our supply chains and lines and even look

27:29 for local procurement in ways that we would

27:32 not because of you've mentioned earlier today Sally, the assurance of drugs.

27:36 I mean, if you're buying antibiotics locally, you don't know where that's from.

27:40 We had very strict rules to not do

27:42 that but in a situation where we couldn't move supplies out,

27:46 we had to make trade-offs.

27:48 Yeah.

27:49 Okay, so well, looking forward Sally, what what do you think are the sort

27:54 of cultural and structural changes needed, you know,

27:58 learnings from from the the institute in the UK and beyond to to really embed

28:05 to sort of accelerate this this gap

28:08 or this from from from the research to to treatment?

28:16 Well, I think what doctors at least in Britain and I

28:19 think generally are very bad at is taking things from outside.

28:25 A supermarket, you do something that way, it works.

28:29 You scale it.

28:30 So I think we need to start much younger with our medical staff

28:34 and our nursing staff and pharmacists saying

28:37 join in research so that you understand it,

28:40 you get a feel for it and you want to put it into practice.

28:43 But then look at what's going on elsewhere and pull it in.

28:49 You know, be absorptive.

28:52 We don't all have to do the research.

28:54 Let's change to a behavior that's absorptive

28:58 and ever improving and as frugal as possible.

29:01 And what do you mean by absorptive is it Well,

29:03 um it's it's a business term, isn't it?

29:06 That you you don't just go on doing what you always did.

29:10 You see that someone else is doing

29:12 it differently and you evaluate or think about

29:16 anyway is it better and then you start doing it if you think it is.

29:21 Right.

29:21 [laughter] And innovation absorbing from elsewhere their learnings

29:24 so that you you really keep up to date.

29:28 And you really need a culture of innovation organization to be able to do that.

29:31 much better way of saying it.

29:33 Thank you.

29:33 [laughter] But it's like how do you create

29:35 that kind of culture of innovation I suppose.

29:38 Um And you have to make it fun and you have

29:40 to give people enough money and you have to trust them.

29:44 Mhm.

29:44 And I think Jan and I probably agree

29:47 that the present health systems don't really trust the doctors enough.

29:52 So how my any thoughts how do we how how can we create these governance

29:57 systems for for innovation do you think

30:00 in the medical systems all the way through?

30:03 That's tricky question.

30:05 I'm I'm also reflecting actually on on I

30:08 mean the implementation side that we're all discussing here.

30:10 I think that sometimes suffers actually from a a bit of paternalism and I mean

30:16 we were discussing this earlier during the day

30:18 that why do people go to McDonald's?

30:20 We told them that it's not healthy.

30:21 They keep doing it.

30:23 And why do people not take vaccines?

30:26 We told them it's good for them and I think that there's

30:29 actually there's a amount of danger actually to to to have this attitude

30:33 from both you know political side and the medical side because sometimes we

30:38 we don't realize that you know it's

30:40 not a conflict between enlightenment and stupidity.

30:43 It's it's a social conflict.

30:44 It's the the reason that people don't take vaccines is that they don't trust

30:48 government and sometimes it's actually rational not

30:50 to trust government if we look at history.

30:53 So so I think that we need a little bit of be a little

30:56 bit humble also when we approach the implementation

30:59 of both medical inventions and other inventions.

31:02 Well I think that is a a good a good moment to end on.

31:06 So humbleness of the the research community in this.

31:09 So I'd just like to thank our panelists so much for joining us today.

31:14 A big round of applause.

31:17 [applause]