Okay, my name is Remi Brouard, I'm an M.D., a nephrologist working for Santa Fe now for 21 years. I'm currently in charge of external innovation for Santa Fe R&D and I'm based in San Fransisco and I'm covering the scouting activity of the west coast of Santa Fe. So my background, as I mentioned, I, I, I was initially an MD working in a hospital in [INAUDIBLE] in [INAUDIBLE]. I did a post doc in clinical pharmacology at UCSF with Tom Toser and, and the team of Lou Schiner. Quite a long time ago. And then I moved progressively to the pharma industry because I was interested in doing more research and especially more clinical pharmacology. So I've been in charge in Santa Fe of what we call the clinical exploratory unit. And then I was I moved to internal medicine. I was in charge of the internal medicine, clinical development and after that, after a couple of years of basically I did something like 15 years of clinical development and clinical pharmacology. And then I became in charge of house economics and epidemiology. for the group and so had ex not of experience with what we call payer here or, or [INAUDIBLE] in the UK. And more recently five years ago, I moved to the west coast for this position, to open the first office of Santa Fe centre here in the West Coast. So that's, that's my background. Okay. So now, I can move and start and, [LAUGH]. Okay. So, the topic of today is about academic industrial relationship, partnership. Well, it is kind of. I don't really like the title of model, because model means to me something that you have to replicate, something that you have to follow. Well, there are a lot of various models, you know, I'm not going to tell you today what we have to do because. I know by experience that the success of a model, the success of a relationship, of a partnership with someone, in pharma, will be judged 15 years era, when the drug is on the market. And if it's helped people to survive, or be cured. Okay. So it's difficult to say that. This is why I put. Model with an s and [INAUDIBLE] because things are moving, things are completely change, continuously changing. And in fact, what I would like to, today for you is to explain to why things are changing, and what is the context. Why do we need this partnership with the, between pharma and, and industry and also biotech? And, and, and so, so you understand better what is needed, and, and how you and yourself, by the time you will do this kind of partnership, you'll probably do something different. And you'll still be judged 15 years later, anyway. And you will not be responsible for it sometimes because somebody will take it, take it over and change it. Okay, but I think it's a wonderful thing to do, and I think, I will say, a natural, obvious thing to do, to, to have pharma and academia working together, in particular, because they have the same background. You know, it was in the company that I'm representing today, there's a lot of people that were academic people, and, and so they speak to their friends. They speak to other people and they have the same background to start. Then the change, but basically the relationship remains the same, okay. So let's move to the first slide, okay. So this is a summary of what we're going to look at today. So first I'll speak about the health care systems changing next landscape, housings are moving and why do we need this partnering? Then I'll speak about the new model. What is coming up now. What's going on now. There are new models that are being developed. And then and then I'll go through the, the classical model, what does it mean and some recommendation of what you should do if you were doing this. Okay? Okay, so this is the, the historical model as people know. You know, if you speak with someone that has been in the academy for many years, they will say, yes I'm doing the science and that's it. Okay? And, and that the private sector will, will, will manage my discovery and do the preclinical and do clinical testing, regulatory, manufacturing and product distribution and it will be a success. Okay? So, that's our model. What's coming up now is that it's evident that we need partnership, it's evident that you need to validate things, you need to have a vision of translability of what you find. You need to make sure that at the end, even if it's a wonderful idea, there will be some potential market for that and that will have to cure [UNKNOWN], the people, the patient. So, and of things that have been pushing to move to what we'll call new model. So there's clearly an increase in scientific knowledge. It's much more than before. [UNKNOWN] discovery are growing so fast that you need in fact to combine the effort to have people working together. We may go through the Public Health concerns and the economic challenge in the next few slides. Let's go to the next slide. This is one of the things that are used in impacting [INAUDIBLE] health system but also it's impacting governments and allocation of resource for health and even the allocation of resource for UCSD. So, what what you see, I put a picture of the two representatives of the next market, clearly the next customer for pharma is aging woman, because women are surviving more than men as you know, much cleverer also. >> [LAUGH] And, China and probably Africa as you can see here, you don't see the curve. You see that the Africa and clearly Asia. The aging population is impacting and it's growing. Okay, so what does it mean? It mean that we discover a new disease. It's been that, I mean I'm sure that you know that elderly people consume much more drugs than the others. Okay, so this has a tremendous impact in term of health care costs, okay. Which means that since our governments have a fixed amount of money that they can give every year. They need to make a choice, okay. And, and of course country like UK say, well fine so now we have to make a decision. Do we need a compound that going to be a very new idea lovely for 2000 people or do we need to still vaccinate the elderly population against flu? And we have to make a choice. Okay? So keep that in mind and this clearly why when new ideas are coming, you also need to have this vision. Okay? Next slide. The healthcare cost is also, it's interesting to look at the healthcare cost related to domestic product. What, what you call the GDP [COUGH]. You see that USA, for example is farther Okay? They, they are now reaching something like 17% of the GDP. Okay, it has been all like that for the last ten years. So what does it mean. Does that mean that people are better cured? Fine does that mean that you spend too much money on a pharmaceutical product and that the pharma is pushing too hard the price? Well, I'll show you the next slide, that is another case. But anyway, the payer and the academic are impacted by that for sure. Okay, so let's go to the next slide and we'll see why. So here is what I just said. In the U.S the contribution of U.S house spending is clearly related to ambulatory care and administration cost. You can see that here there is a lot of [UNKNOWN] U.S care systems. And what is good about people that was job but clearly that's impact mostly the U.S healthcare system. Okay, and you can see that the pharmaceutical and medical goods are not that high as compared to the rest and almost close to what Germany is spending. Okay, so that's not really, the price of the product is more the intermediate structure. And it's great, I mean maybe it's the way people are curious, better done than in another country. But in total, what is the metrics for that? Are people surviving longer? While you saw that. Next slide, maybe you have that next slide? that's too bad you can't see it, but this is the, this is the matrix. How many, what's the life expectancy in a virus country relative to the amount of money that you have put. And you see the amount of money that US has put. And you see that, it does not impact in total the quality of the life or in fact at least the morbidity. Okay? And you, and you see here, male expectancy, female expectancy. As I mentioned to you, you have better female expectancy in terms of life, okay? And you see here that you have United States here. And European Union, just one year ago. So today, I think it's 79 years life expectancy in, in, in Europe. And I think it's 78 in the US, okay? So the amount of money that is put in the health care system has no impact. Under life duration at this time. Okay? So this is how the government are looking at health. Now you can see also it's better to live in Monaco if you want to live longer rather than Angola, okay? So that's something of use, and we know that. Okay? Now, what I'll, speaking of that, I put that, I put in addition this slide the, the main reason to develop product in, in for virus disease. So you see here, I don't know if you can see it. But this is the world leading cause of death. So, world, every country together, all of them. You see that, IschemiC heart disease, stroke, cardio and respiratory condition is the first reason for death in the world, at this time. Including every country. Then if you move to a low income country, then you see that the impact of tuberculosis is still very high, of course. Ischemic causes is still leading. Okay why? Probably because of tobacco consumption. That's probably one of the reasons [COUGH]. And then you have the infectious disease which include diarrhea and, and of course the maternal and neonatal infection is all, all the woman has i, is clearly there. Okay, cause that's a now when you're company, and when you are someone from an academy, you need to think about what you really want to do. Okay, so if you're going to cardiovascular disease, it's Okay for every country. If you're going for Pulmonology, it's fine. But infections, still one of the leading causes of death. And it's impacting a lot, even outside economics. In the low income countries. Okay. So that's the thing that we are also looking at it. Now you should know also that the market for pharma is growing. In low income country. Okay, so pharma is not always telling you, I don't care about malaria. This is wrong, in Santa Fe we have a lot of malaria projects and tuberculosis because it's important and it because this is probably the future if you go back two slides, the future population to cure. Go back two slides, tick tock. Which is what I told you here. Well China is developed anyway but Africa is probably not that much. So that. Just to show you the big picture.