Galien Forum USA 2020 / The Next 50 Years of Innovation (CEOs panel)

Everyone, I'm Sue Desmond-Hellmann and I am the chair of the Galien Awards Committee. I'm happy to remind you that this year we're celebrating the 50th anniversary, and I'm particularly excited about this CEO panel: The Next 50 Years of Innovation. Now, along with the members of the committee, I'll be hosting this evening's award nominees, a record number of 67 products from 54 companies and covering 13 diverse therapeutic areas, ranging from cancer, cardiology, and neurosciences to infectious diseases and very rare diseases. I want to just note that this year we decided to expand the Galien to a full week of innovation, giving all the nominees for Best Pharmaceutical, Best Biotech, and Best Med Tech more visibility in describing their journeys of medical discovery. It's our way of showing how ideas flow from many directions, and the combination of all of that leads to better health for all. So that hard work of science comes together this evening, and it's also the focus of this CEO panel: a view from the very top of the trenches, to be sure, but one that looks forward. Which, as a former CEO myself, does carry some risk. Once you put it out there, people are going to ask you about it. But I expect each of our panelists will be brave, and we're all friends here, so we'll give a lot of forgiveness if people want to be bold. So I'll encourage that. I'm now really happy to turn this meeting over to my co-moderator and fellow award committee member, Dr. Mike Rosenblatt, Senior Medical Officer of Flagship Pioneering, to recognize and introduce our three distinguished panelists. Mike, take it away.

Thanks so much, Sue. And I'm honored to join you in both co-chairing the Galien Forum and co-chairing this specific session on the next 50 years in innovation. I'm also very honored to be sharing the stage here with such distinguished CEOs, and I'll introduce them in a minute. But first, let me say a few words of introduction. I am the Chief Medical Officer at Flagship Pioneering, and that's a company that creates new venture firms in Cambridge, Mass. I've spent my career in academia, in the pharmaceutical industry, and now in venture biotech, so I've had a chance to see up close and be involved in the ways in which innovation can really transform health. And there are multiple ways to innovate. At our firm, we actually think there's a methodology, and you can stimulate it and learn it; it's not just by serendipity. And along those lines, it's been interesting to hear how our national political leaders view the process of drug invention, and it reveals really how little our process is understood both by policymakers and the public. For instance, President Trump, when he received medicines for his infection for having COVID-19, he said it was a miracle. Well, a miracle is something that's unexpected, unexplained, and something that sort of drops out of the heavens by surprise. But I think all the panelists and probably the whole audience knows that that's not the way we get medicines. There's a team effort that's highly coordinated, and it needs oxygen; it needs an investment of money to succeed. Similarly, Vice President Biden has characterized the process as a moonshot, but it's actually much harder than a moonshot. We also know that if you take a team of really terrific engineers and give them the resources they need, they can do the calculations to send a rocket to the moon. But developing a drug actually has a much lower probability of success because human biology is so complex and the human systems are so integrated. So just before I introduce the panelists, I want to say that we are going to be having a poll, and I'd ask you all to answer that poll. It'll come up on your screen; you'll have 10 minutes to answer this, and then we'll give you the results at the end. So the CEOs that I am going to introduce are all leaders in their sector, whether it be the pharmaceutical industry, academia, or biotech, and I think they all share the same mission as the Galien Foundation, which is to use innovation to improve human health. I'm going to introduce all three of them in order, and then we will turn to each of them to speak for a few minutes. They'll go one after the other without interruption, and then at the end of that, we'll have some questions for them, either coming from Sue or me or the panelists to each other. And then in the final part of this session, we'll open it up to you, the audience, to send us questions and answers. So my great pleasure to introduce Ken Frazier, who's the Chairman and the CEO of Merck. He joined Merck in 1992, held a number of leadership positions within the corporation, including General Counsel and President of Global Human Health. He has invested and really doubled down on research at Merck, and he's shown evidence that he's clearly committed to the mission of the company, honoring its 125-year heritage. And during this time, he's really enhanced the focus on patients and on philanthropy. Betsy Nabel is the President of Brigham Health, which is a flagship hospital, a key hospital, and a couple of affiliates. She's the president there and a cardiologist who has done some distinguished research and has led the National Heart, Lung, and Blood Institute of the NIH. She's also a professor of medicine at Harvard Medical School. And Michel Vounatsos, who's the CEO of Biogen. He's had a 20-year career at Merck, led their efforts in primary care and in customer centricity strategies, and since joined Biogen in 2016 as the Vice President and Chief Commercial Officer, and now since January of 2017 has been the CEO. So I think you'll agree we've got the A-team here. And as you said, we're celebrating our 50th anniversary, so we have a question for them, which is to tell us their view of how innovation will transform lives and improve the human condition for the next 50 years, and then from a business and societal perspective, what do we need to do to get there? Now, we don't expect you to literally think about 50 years, but we want you to go as far as you can see, and we accept unreasonable answers. So Ken, why don't you start, please?

Okay, so I want to thank you, Mike, as well as Sue and Bruno, for including me on this panel to celebrate the pre-Galien Golden Jubilee. I'm particularly delighted to participate along with my distinguished co-panelists, Dr. Betsy Nabel and my good friend and former colleague, Michel Vounatsos. Some say the best predictor of the future is the past. Yet in 1970, I believe it would have been very difficult to predict the remarkable progress we're observing today. As we celebrate the last 50 years of biopharmaceutical achievements, it's important to think back to the 1970s and reflect on our progress and our priorities. In his 1969 congressional testimony, the U.S. Surgeon General William Stewart claimed, quote, 'The time has come to close the book on infectious diseases,' close quote, and that antibiotics and vaccines would win the war on this class of disease. He obviously did not perceive the threatening pathogens that began to emerge even in the 1970s, including Lyme disease, Lassa fever, Legionnaires' disease, and antibiotic-resistant bacteria. Then in later years, HIV, SARS, Ebola virus, Zika, etc., leading to our current SARS-CoV-2 pandemic. 50 years later, clearly the era of infectious diseases is far from over. What Surgeon General Stewart did recognize was that we needed to focus more attention on chronic diseases, including cancer, heart disease, and diabetes. This led to President Nixon's announcement of the War on Cancer in 1970. The focus on cancer therapeutics and the $500 million investment in the National Cancer Institute catalyzed a series of basic discoveries about oncogenesis in the 1970s that were translated into new treatment approaches like cyclosporine, more powerful radiation therapy, combination treatments, and autologous bone marrow transplantation. This era also ushered in the era of biotechnology with the advent of recombinant DNA technology, monoclonal antibodies, and the launch of the first biotechnology company, Genentech, in 1976, a company that I think Sue Desmond-Hellmann knows a little bit about. The discovery of reverse transcriptase and the link between cancer and viruses created new insights which proved to be critical a decade later when the HIV pandemic emerged. And of course, we're still building on that foundational work today as we create vaccines to combat SARS-CoV-2. Though we haven't yet won that war on cancer or infectious diseases, the steady achievements of biopharmaceutical innovations over the past 50 years have accelerated our progress and saved countless lives around the world. These progressive achievements are the source of the optimism I feel about our ability to contain the current pandemic and are certainly cause for celebration. Unfortunately, there is one challenge where progress over the past 50 years has been far too slow: we still struggle to achieve equitable access to our innovations at a national or global level. Unless we take collective action to not only ensure our vaccines and treatments reach all the people who need them, but also champion the longer-term policy and societal changes necessary to redress systemic inequalities and particularly health disparities, we won't be able to claim success.

Thank you very much. Thank you very much, Ken, for those wonderful comments. I'm thinking back to my early days in medical school; I don't think immunology was an established field then, so what you just highlighted shows the tremendous progress we've made and the challenges ahead. Thank you also, Sue and Mike, for the introduction. And it's a real pleasure to join you today. I'm going to speak from the perspective of academic medical centers, which are deeply devoted to scientific discovery and research and are firmly committed to translating these discoveries into advances which will benefit patients. The COVID-19 pandemic has undoubtedly accelerated the pace of change in just about all aspects of our lives, but especially in scientific innovation and the practice of clinical medicine. At our academic medical centers, we have quickly learned to manage a new disease in creative ways that we absolutely didn't know about one year ago. We have shifted our research focus to innovate in new technologies to address COVID-19, and these technologies have been rapidly translated to the care of our patients. And this includes very simple techniques in terms of how do you maneuver a ventilator, how do you position a patient to ensure adequate oxygenation—very simple things that have made huge differences in the lives of our patients. And we've also partnered with biotech and pharma to test new vaccines and therapeutics. We've learned to be more focused, disciplined, and efficient, and this disruptive change on how we do our business is our new normal. And perhaps we can come back to that during the discussion period. While much has changed, there are several constants that have not. The first is the fundamental strength of our life sciences ecosystem, and by that I mean the partnership between academic medicine, venture capital, biotech, and pharma. The pipeline whereby scientific discoveries often made at academic medical centers and funded through NIH research are spun out, developed, and marketed through industry partnerships remains intact, but we must nurture it and grow it. A second and equally important variable that hasn't changed is the brilliant talent of our young physicians and scientists in training who want to commit their life's work to scientific discovery and therapeutic advances to benefit our patients in a variety of ways and in a variety of sectors. So our challenges going forward are multiple: how do we continue to fund basic and clinical research? How do we harness the remarkable talent of our young people in their training? How do we ensure that we are inclusive to the broader group of individuals who will make scientific contributions but may have been left out because of educational opportunities not available to them due to systemic racism? How do we not allow government policy to overregulate, denounce, and get in the way of scientific innovation? And how do we allow market forces to build the capital necessary to expand our innovation pipeline? So finally, what am I most excited about and think will build value over the next 50 years? I'm going to put something out on the table for us to discuss, and I'm going to say I believe firmly that gene and cell-based therapies are going to be one of the major, if not the major, innovative platform over the next 50 years. And by gene and cell-based therapies, I mean DNA and RNA-based therapeutics, cell-based treatments including T-cell therapies, nucleic acid aptamers, and other approaches to regenerative medicine. We've only begun to realize the potential of these new therapeutic platforms. For example, I'm sure you've discussed earlier in this forum the speed of RNA vaccines from genomic sequence identification to vaccine candidate development to clinical testing has really defied all scientific norms. We have yet to unleash the full potential of our genomic therapeutics for rare and common diseases, and several that I'm particularly excited about are the approaches to the genetic hemoglobinopathies such as sickle cell and thalassemia. So I'll end there, but I simply want to thank you for inviting me to join you this afternoon.

So we've had a couple of questions from the audience. Maybe I'll ask the one that came in just a couple minutes ago. Given some of the proven value that digital innovations have shown during this pandemic, what types of new collaborations, partnerships, or alliances will be forged to fast track the acceleration for R&D? So how do you all see digital innovation as being part of this next 50 years?

I was just going to say, Betsy, one of the things I've read is that as soon as the pandemic kind of decreased in intensity, people went back to seeing their clinicians. What's been your observation on telemedicine and the impact of the pandemic on your staff?

Telemedicine has had a huge impact on our practice of medicine across academic and community hospitals. During the height of COVID here in New England, which was March, April, May, we rapidly converted all of our ambulatory visits to being telemedicine. That was in part because our governor required us to shut down our ambulatory and elective care procedures, but we rapidly ramped up to converting all ambulatory visits to telemedicine. Fortunately, we had the electronic medical record and digital applications in place so that we could do that very quickly. I would say that since the spring, over the course of the summer, as we've opened up our facilities, we have reverted back to some clinical care programs obviously we need to for a variety of urgent care and procedures, but our patients are still using digital technology to access their primary care physicians, their nurse practitioners, as the first entree into the health system, both for prevention as well as screening, routine care, medication prescription refills, et cetera. So right now, I would say at the peak we were 70% virtual, 30% in person. We're now about 50-50, and we think the virtual is absolutely going to continue. The partnership for us is really we can't innovate all of the digital applications or all of the AI usage in-house, and so even though we've got really incredible bright millennials and Gen Xers, we can't do it all ourselves. So we really do need to partner, and we're doing that primarily through a number of startup digital companies that'll come in and build on our technology platforms to really build out our patient care access.

Right, Ken, are you all working from home at Merck? What's the future look like on digital for Merck?

Well, I think Mike was going to make a point before. No, no, please. So we are not completely working from home. Our office-space people are working from home, and there's been a quick adaptation to that. I think the great thing is the company is frankly in some ways more productive than it has been with respect to drug supply. But you know, as you know, production workers, people in our laboratories, they have to be on site; that's wet work, it can't be done from your home office. And I think that's really important. But coming back to the broader question about artificial intelligence and information technology, I'm really optimistic, not just because of what we've seen recently. But if we take a step back and think about the business model of these companies over time, R&D productivities continue to decline and the cost of developing a new drug has gone up. At Merck, we spend essentially 21 cents on every dollar of revenue that gets plowed back into R&D for future drugs. And so it's imperative to find new ways to enable and streamline drug development so we can develop affordable medicines in a timely fashion and deliver them to the people who need them, and I mean people all over the world, not just people in advanced economies like the United States. And that's where I think advances in data capture and digital technologies, artificial intelligence, may help develop new and improved and hopefully minimally invasive methods to provide physiological and biochemical activities within the body, and the ability to capture large amounts of data hopefully will allow us to interrogate them to find correlations and therapeutic insights that will have the potential to transform how we conduct clinical trials, again with the goal of evaluating these medicines with fewer individuals, particularly earlier in the discovery and development continuum.

If I could, I'm going to raise a challenge to my co-panelists because I think this is an opportunity for us to partner together. We've spoken earlier about the dire need to recognize health inequities and to build access to all of our patients, even in a well-developed society like ours and globally around the world. But we know that not all of our patients have access to digital technology. And while the technology is rapidly advancing and we're using it as the foray into our healthcare system, we do need to think about how we can partner together to improve access for all patients and how we can work collaboratively in order to educate our patients about therapeutic advances. I think we're all very concerned that as we have our COVID vaccines become available, many of our patients won't understand, will be frightened, will be fearful, and will not be interested in being vaccinated. So I think that's an opportunity and it challenges us to work across the academic, biotech, pharma partnership.

I agree, Betsy. And I would also add that in addition to those things that you talk about in terms of patient education, etc., I'm going to take a step back and talk about how this digital divide is going to affect our country going forward. You know, I stood on Governor Murphy's, the New Jersey governor's, panel for reopening this state, and the number one challenge we have is how this digital divide is going to affect the next generation of students coming through our system. It is not easy for people to be educated in a remote context. And I think those people who have been left out in the past, underprivileged people, minorities, are likely to suffer even more in a world where this digital divide is actually going to be significant in terms of the ability to educate people. And I think education will be the fundamental thing that will help us over time address the systemic inequalities, including health disparities.

Maybe I could change the topic for a moment to the pandemic that we're currently going through. I think most scientists predict that this probably isn't the last one, and there are some important lessons to be learned. One of which was how strikingly unprepared we were in many ways. And so if you look at the next 50 years and you look at the suffering and the economic devastation that's come from this, we hope we can be better prepared. But if you look at our health system the way it's constructed now and all the sectors that participate in it, for instance, Betsy, you're running a hospital system. We've had now three decades of trying to make health care as efficient as possible, to the point that not a hospital has an extra doctor or nurse in a hospital in America. This is the opposite of how you have to prepare for a pandemic, right? You need extra equipment in the storerooms, you need things stockpiled. If we had reservists the way the army does, reservist doctors, reservist nurses, that would have been a big help. You have to pay for things that you probably won't use, like take a gamble on whether we need an antiviral or we need a vaccine and that particular pathogen may never get to us and never be used. So you basically have two different business models, I think: one for day-to-day health care for the whole country, and a different one to be prepared to handle a pandemic. And the second one just hasn't been developed. What are your thoughts about what we need to do in either our business model or government intervention, or what do we really need to do with the kinds of expertise and resources the three of you represent to be prepared over the next decade or so?

Well, my own view, Mike, is that we haven't developed a global pandemic preparedness effort. And I know Sue, you've been engaged in some of the international efforts, and I'm sure my panelists would say we've had false starts, we've put our foot in the water, but we've never come together as a collective global community to do this. And I'm far from being the expert in this to know what's the best way to proceed, but I often wonder if we shouldn't just let the private sector begin to organize this and come together. When you think about the toll on our businesses across this country and internationally, my guess is it would require a relatively small sum of money for the private sector to come together and contribute into a global pandemic preparedness program. I think even though we're a non-for-profit, I think it's something that our healthcare system would rapidly invest in. But again, I'm not expert, I don't know the best way to go about that, but I simply put that out that private sector organization may be the route to go. Maybe it's a public-private partnership.

I think it is a public-private partnership. I think if you compare the amount of money, for example in the U.S., that we spend on national security, on defending ourselves from the threats of foreign powers who may seek to use weapons against us, traditional weapons, we spend a lot of money hoping that we'll never have to use it. We don't want to have to use those bombs or those bombers or those jet fighters or those missiles, but we think it's imperative that we have them to defend ourselves. And yet with respect to ensuring health security, we do the opposite. We don't ensure that we can secure, as Mike was saying, our health care systems. We want to run our hospitals as lean and as efficiently as we possibly can. We want to actually spend money on the things that are challenges today and not spend money on the threats of emerging infectious diseases. And I don't mean just potentially pandemic influenza and other viruses, but what about drug-resistant bacteria? You know, here we continue to invest a lot of money in AMR issues. The reality of the world is there is no good business model for those things. You want to develop new products that will be useful against drug-resistant bacteria, but you know, it actually defeats the general model that we have in this industry of wanting to have rapid and high uptake of new drugs. So that we can make money on the volume of it. Here you want to actually, if you can, reserve these new life-saving medicines for those people who need them. And the toll that these sort of superbug infections right now are taking on hospitalized patients is really great. And I've seen data that says that more people in 2050 will die from resistant forms of bacteria than from cancer. And yet we're not investing in that at all. So I'm very much worried that while we focus a lot on spending money on weapons for quote national security, and even a significant amount on domestic security, we don't really recognize health security in the same way.

Much of the comments that the three of you have made are emphasizing equity, emphasizing health rather than sickness, emphasizing inclusion. If you again go to that sort of long-term period, how do you think about public health and how to push on some of those forces that push companies or academic medical centers away from public health and towards sickness care? Do you have ideas about how from a policy and public sentiment that could change? Many of the questions we're getting from the audience have to do with that inequality, diversity, and clinical trials. And I would put a lot of what's been said under the rubric of public health, and yet public health, especially when we're not in a pandemic, doesn't get a lot of publicity or attention.

You know, it's interesting, Sue. We think a lot about value-based healthcare. And I'd be really curious to see what Ken and Michelle think about it from your vantage point. The way that we think about it is that we need to lower the cost of care to consumers. We call it lowering total medical expense, but it's really lowering the cost of care. And how do we do that? It's by engaging in more preventive work, more community-based work, delivering care at the appropriate setting, reducing the amount of care that's delivered in high-cost academic medical centers. And it's really developing an entirely new workforce that is home-based, office-based, telemedicine-based, community-based. And with that, we found during COVID, you might find this curious, but I bought five RVs and we equipped them with testing and educational materials, and we took them out into various communities in Boston because our city simply didn't have the resources or the talent to do community-based testing, contact tracing, and education, multilingual education. And so we did that as a strategy to educate and test early to prevent subsequent infections and hospitalizations. So I think of public health not as a separate discipline, but I think of it as a continuum of care. And it's the care we have to deliver in the community very early on to educate folks, help them learn to take care of themselves, their families, their loved ones, deal with whatever insecurities they have, food insecurities, housing insecurities. And to me, that is one of the ways in which we at the end of the day are going to lower the cost of care to all of us in this country.

So I agree wholeheartedly with what Betsy just said. I think we treat these societal challenges in silos when they're obviously integrated and interdependent. The simple fact of the matter is we will not be able to address health disparities unless we address the disparities that run through our system. And I'll just be really blunt for a minute. I struggle sometimes with our unwillingness as a country to deal with the historical issues that have led to systemic racism in this country. Most of us have never really grappled with our history in this country. We never grappled with the fundamental question of why in a free society we could ever justify slavery in the first place. And so we know that in the 1860s with the 13th Amendment we abolished involuntary servitude, but we don't ask ourselves what were the beliefs that allowed that to happen in our society. And those beliefs fundamentally are the issues that we don't talk about because it's impolite. We don't talk about the concept that certain people are viewed as not being equal, or not equally deserving, or not warranting the same kind of focus in our society. So if we're not going to educate children in the very beginning, and it's got to start actually at preschool, if we look at what's happening to children in our society, we're going to continue to have these challenges. And not just health disparities, we're going to have educational disparities, we're going to have employment disparities, we're going to have law enforcement disparities. And all these things come together in my view to create a challenge for us when we say we want to be a more equitable society. I do think we have to look at how these things are integrated and not treat them as siloed issues going forward. I mean, the simple fact of the matter is we spent a lot of energy and effort to sequence the genetic code, and it's still the fact that your zip code is much more determinative of your health than your genetic code. And I think as a society we've started to have these conversations. I'm hopeful because particularly after the George Floyd situation this year, these are issues that we're talking about at kitchen tables, we're talking about in boardrooms, we're talking about in the public health arena. But I just want to go back to Betsy's point: if people don't have good housing, if they don't eat good food, and they're in inner cities often are food deserts, you don't have the choice to eat good nutritious food, that's going to lead to the chronic conditions that we see in terms of cardiovascular issues, diabetes. We're going to see greater levels of homicide, greater levels of suicide, greater levels of drug abuse. Until we decide that we're going to take on the challenges that are left from the vestiges of our history, I think we're not going to make progress. And forgive me for going on so long and being so preachy.

Okay, I couldn't agree with you more. And I have to say that this is one of the issues that has really pained me the most during the past nine months of our COVID crisis, just seeing the inequities in our care. As much as we try, it is the one thing that gives me hope is that it's our young people. I have to say, it's our young, our students, our residents, our fellows, our junior faculty now are demanding the conversation, and we're having the conversation day in and day out within the walls of the hospital, outside of the hospital, in the community. And I see this as hopeful and good news. But at the same time, you know, it's trendy to say we've got to address social determinants of health. Well, as you know, it's complicated, and we've got to work on this together. But I think it's become painfully clear to us in our communities that this isn't something for somebody else to solve; it's something that we all take the responsibility for, and we have to solve. So just thank you for your comments.

You know, all of you have spoken very eloquently about health disparities and inequalities and injustice. And I hope like all of you that this is a moment where the trajectory of changing that is really going to take a sharp upturn and things will really be different. We're also in real time in the movie now of global health because there will be vaccines and antivirals, I'm confident, in the next several months to a year. And it's not clear to me that they will be made available across the globe in the way that's needed. Many countries are battling to get their first lots of vaccine or antiviral and aren't necessarily spending much time thinking about whether anyone else will get them. Do you think that this is the same potential kind of moment as it is domestically, globally, that we could actually change the way that we think and the industry or public-private partnerships could start to address global health needs?

So let me say that I want to say yes, but I don't believe it. Our experience is that there's an ultra nationalism that's taking over. I think it's exemplified in some ways, and I don't want to be political, by what's happening in the U.S. with the sort of America First ethos. We're seeing that countries in Europe are trying to say let's make sure that our populations get them first. I recognize that there are a lot of forces for goodwill. You know, Sue just recently was at the Gates Foundation; they've done an awful lot in this area. There are a lot of organizations in the world, CEPI and others, who are trying to make sure that we get these vaccines to the people who need them. But let's take a step back and realize that there's seven and a half billion people on the planet. I don't think we've ever had to contend with something that was truly a global pandemic. If you think about vaccines in terms of volume, I think the biggest vaccines in terms of volume have to be influenza seasonal influenza vaccines, and we make less than two billion of them. And we have seven and a half billion people in the world to deal with. And we have to think about the difficulty of distributing these innovations, these life-saving innovations, to the people, including the last mile, in places that have been neglected up until now. I think this is a big challenge. And I think there's a certain amount of, it goes, there's an enormous rhetorical appeal to saying that we care about everyone in the world and we care about everyone equally, but it is just rhetoric at this point. As you know, Mike, because you were here at Merck when we did the Mectizan program, you know, we're going to be giving the award to Bill Fagan tonight, and so Bill has been a hero. But just think about how challenging it was to deal with river blindness in sub-Saharan Africa, and we're talking about one pill per person per year. Compare and contrast that with distributing vaccines that have to be kept in a cold chain to people all over the world. So I just think this is one of those things that if the rich countries in the world don't really, really come together and provide help along with great organizations like the Gates Foundation, we won't be getting these medicines to the people in the parts of the world who need them anytime soon.

I think Mike, you're being very provocative. And I actually agree with you, Ken, that I think nationalism, bad behavior, will become evident as soon as several vaccines have been approved, at least in the United States. But I think we all realize that this pandemic, it's a global pandemic, and with pandemics to come, it's just not one country that's going to be safe until we're all safe. And so I don't know how we're going to do it, but we've got to rise above the nationalism.

Agreed. I think that is really the big challenge that we face right now. Globalism has a bad name around the world. These populist political leaders have grown up with people feeling insecure. You mentioned climate change, where climate change has led to mass migrations of people, and those mass migrations have threatened countries when new people are at their shores. It's created this feeling that we have to be protective of our old concept of nationalism that is actually tribalism, if you actually want to use the right phrase. And tribalism is growing in the world right now. You might actually say that the fact that we're more connected to technology and through global travel, you would have thought that that would have made us able to understand each other as people more. I think it's actually having the opposite effect in some ways right now, as people are threatened by new and different people at their borders overwhelming them. We can see it with the southern border in the United States, of course you see it in Europe. It has become a potent political message for so-called populist nationalist leaders.

Yeah, no, I really want to just reinforce what you're saying, Ken. Because I thought post-Ebola we would be in the world, you know, that a health crisis anywhere is a health crisis everywhere, and that would be more unifying than what we've observed. And yet, as we think about the future, thinking about how we drive, and I go back to what Betsy said about young people. Young people think globally. Many, many young people in this country, I know, think about the world in ways that are not populist. And so grabbing onto that energy and seeing, I hope there'll be many active vaccines and we'll have a chance to look at something global. But seven and a half billion with the cold chain is daunting. I really agree that that's a lot of money, a lot of infrastructure. I think it's daunting in the U.S., much less global. So we have work to do.

Yeah, let me ask the group something parochial about our industry. You know, we've made over the certainly the 50 years of Galien great contributions to health. And we make them, and then there's public amnesia about what was done, and the reputation goes back to the same unfortunate for us low point. We've had the polio vaccine, we've had statins, we've transformed AIDS, Ebola. And I think we're about to make comparable inventions to alter the course of the coronavirus. And do you think it's going to be the same thing now, that we'll do something great and then people will forget about it and go back to the reputation that they're most comfortable with, or do you think this is a moment where it'll change? And are we doing the right things to change it?

So may I just take a shot at that? I hope it is the moment of change, but I think my industry has to be willing to engage in self-examination. It wasn't that long ago when this industry was referred to, not tongue-in-cheek, as the ethical pharmaceutical industry, and a company like Merck could be most admired for seven or eight years in a row in the Fortune survey. But a lot of things happened. And you know, we've talked about climate change a couple of times, and I'd like to make an analogy. You know, if you're in the oil and gas business, you know that the world needs more hydrocarbons as people come into the middle class in order for them to have lifestyles that they need and want to have. We're going to need even more hydrocarbons. But from a shared value perspective, we also see that the environment is being destroyed. So at the same time that there's more of a demand for those hydrocarbons, there's a concern about greenhouse gases. And I think in that same shared value analogy, with all the great achievements of our industry that have expanded human life in a great way, you know, what we're seeing with cancer, what we saw with HIV, what we're seeing with infectious disease, what Michelle is going to do with Alzheimer's disease very soon, those are all wonderful things. But in a shared value framework, the question of affordability is a real issue for our industry, just as the issue of the environment is for the people in the oil and gas industry. And I think sometimes we haven't focused on that. We haven't focused on the fact that access and affordability are the issues that cause people to really frown upon our industry, notwithstanding all the contributions we've made. So I'm sort of tempted to say something that I would say to my kids when they were growing up, which is we don't want you to have a good reputation, we want you to have a good character. Because if you have a good character, your reputation will flow from it. And I do think that this industry has to think about that shared value issue of how we get our life-saving medicines and vaccines to all the people who need it.

If I could pick up on the character theme, one of the major observations over the past nine months is that our patients continue to deeply, deeply respect and admire the health care they receive in this country. And I, on a personal level, I've seen it over and over again across our patients from all sectors of society. Probably what we don't do a good job of is connecting the dots and understanding how deeply we care about our health and our well-being, and how we connect the dots, as you said, Ken, to access and availability. And I think that that's where the reputation piece comes in. I think fundamentally that the character is there. I'd like to believe in our care providers, and I think in your industry as well. But I think we've got to do a better job of connecting the dots, and I think that's something we've got to do together.

So Mike, as my co-chair here, I will, on behalf of both of us, thank these three folks, Ken and Betsy and Michelle, for a really interesting and engaging discussion. And thank you. It's always challenging to do this remotely, and I think you did it really well. Mike, you want to talk about the next panel?

Sure. This panel, first of all, let me just say what a privilege it's been to be with all of you and to hear your thoughts. It's really terrific. This panel is going to flow very nicely into Panel Four, which is the Future of Therapeutics, and then we're going to have some closing remarks for the Galien Forum at 3:30 from Sue. So I hope you can join us for all of that. And the results of the poll are also being posted right now. Thanks everybody. Thank you, thank you, thank you very much. Bye bye.