Speaker1: [00:00:00] Hello, I'm Suhail Mirza and welcome to this episode of Voices of Care.

Speaker2: [00:00:04] Voices of Care. The healthcare podcast.

Speaker1: [00:00:08] And my guest today is absolutely someone who looks at global healthcare. He's the executive director at The Medicines Patent Pool, Charles Gore, and this year was nominated and recognised as one of the most influential leaders in healthcare by no less than Time Magazine. Charles, welcome to Voices of Care. Thank you for flying in on your travels to join us. 

Speaker3: [00:00:29] Thank you Suhail. I'm delighted to be here.

Speaker1: [00:00:31] Well, it's a pleasure to have you here. I'd like to start, if I may, just to get a picture of what Medicines Patent Pool does, your vision, and mission. It's very much looking at the broad global healthcare and access to the best medicines.

Speaker3: [00:00:46] Yes. Essentially what we're trying to do is to get affordable medicines into low and middle-income countries. And we were set up to do this for HIV in 2010 because that was a very pressing problem. But we've moved on into a great many more areas since then.

Speaker1: [00:01:07] And that included, of course, going into Hep C and Tuberculosis, and just paint the picture because people have heard of these diseases, they're around for a long time, but there are millions of people, 3 million deaths annually, I think, attributed to these three diseases. So this is very much a live issue in lower and middle-income countries access to that medicine.

Speaker3: [00:01:29] It is, it's a huge issue. And a lot of it, a lot of those deaths could be prevented if people had access to good, in fact, the latest ideally medicines.

Speaker1: [00:01:45] And you collaborate with pharmaceutical companies and governments to make sure that these medicines are available and have been over the past few years. 

Speaker3: [00:01:54] Yes. Our model, the concept, if you like, is that we approach the pharmaceutical industry who have the latest medicines, which are always patented. And we asked for a license. And with that license, we then go to generic manufacturers and ask them to produce affordable versions for typically about 100 or so countries where it's not very economically interesting for pharma to go, and certainly not at the prices that they would like to charge. And typically generic companies, because it's their expertise, are extremely good at coming up with processes that allow them to produce much cheaper versions, but still the same high quality. 

Speaker1: [00:02:41] Now, you took over as executive director in 2018. Medicines Patent Pool has been around since 2010. Can you just give us a picture of the impact that it's had around the globe from a human perspective? Because I think it's had, I forget the numbers now it's billions of doses. I've just been interested. Looking at your 23 annual report.

Speaker3: [00:03:04] Yes. 43.5 billion doses of medicines. So that is a huge number. It's 41 different products. And we reckon that the reduction in price that generic versions have allowed us has saved close to $2 billion to the global health community.

Speaker1: [00:03:29] And that tens of thousands of lives have been saved. Now, in terms of the savings that you talked about and financial savings, I think this is a subject that comes naturally to you having started your life in the banking and finance industry. I'm reminded of Twelfth Night, Shakespeare's Twelfth Night, and I think they talk about some are born great, some achieve greatness, and some have greatness thrust upon them. Now, I'm not saying it's greatness or not, but I think it's about nearly 30 years ago. Destiny thrust you onto a very different path, I think, with a diagnosis that you had to face.

Speaker3: [00:04:07] That's absolutely true. I was diagnosed with Hep C in 97, and it was a time where Hep C had only just recently been identified as a disease. They knew there was something going on, and they called it Non-A, Non-B hepatitis because there was Hepatitis A and Hepatitis B. And my doctor just said to me, well, you know, just live with it, and try not to drink too much. Too much obviously being quite an elastic term, her. And then, a few years later, I got diagnosed with cirrhosis as a result of the Hep C, and that then led me to meet up with other people with Hep C because I found it very difficult in the UK to find any support or information I could really trust, and with another three people that I met and got to know as friends, we decided we ought to do something about this. And at the time there were more than 500 HIV charities in the UK. Nothing to support people with Hepatitis C, so we set up something called the Hepatitis C Trust in 2000, which is still going very strong. 

Speaker1: [00:05:31] And 18 years of that journey that you had, that odyssey, leadership, etc.. brand new area, non-governmental. Hepatitis C remains a very important priority today. I think it's over a million people still die from that, I think globally. I was going to ask you, it went on to a global stage as well. World Hepatitis Day, I think we celebrate or commemorate on the 28th of July every year. And I think you played a part in that being established.

Speaker3: [00:06:03] Yes. I got involved in, in 2004, setting up something on a European level, actually it was a bit broader than just Hepatitis C for liver patients. And then, they asked me to be president of that. So I did that for a couple of years. And when I stopped that, I realised that I still had failed in many respects to do what I wanted to do, which was to raise the profile and the priority of viral hepatitis. So I by that time knew a lot of patient groups around the world. And I got them together at a meeting and I said, do you want to do something about this? And they said, absolutely. And within 20 minutes, we'd agreed we were going to have a community-based World Hepatitis Day. And we actually picked May because it was during the World Health Assembly each year. And we thought this will raise the profile with countries, ministers of health, whatever. But after the first one, which we held in 2008, all these patient groups came back to me and said, we can't get our governments to buy into this. And their excuse is it's not an official day. So I said, fine, we'll make it an official day. How hard can that be? And there's a lot to be said for naivety. You take on things... 

Speaker1: [00:07:31] You didn't know. 

Speaker3: [00:07:32] Exactly, exactly. Anyway, what I did was that I wrote to every minister of health in the world, and I said, there is nowhere in global public health where the disparity between the burden of the disease and the level of awareness is so great. And Brazil, China, Oman, and Afghanistan took this up and went, okay, we're with you on this. And they put a resolution down at the World Health Assembly, which is the gathering of all the countries at the World Health Organisation once a year. And they adopted World Hepatitis Day. And that meant that W.H.O., which had really not done anything for hepatitis, had to set up a unit to start doing something. And so essentially, we had to slightly drag W.H.O. into making this a priority area. And then they took it on with a lot of gusto. And then we work more with them to come up with a plan for the elimination of viral hepatitis. And then and then actually we worked also in the UK to get the UK or the four different nations to sign up to this idea of elimination. And England have been fantastic in taking that forward.

Speaker1: [00:08:54] Wonderful. That's a fabulous legacy. Now that all that experience of writing to governments, dragging people to the table, I guess was a perfect preparation for taking the role at Medicines Patent Pool because it sounds deceptively straightforward the way you put it. You take patented medicine, which is very expensive to produce, and then make sure generic manufacturers can produce it cheaply and send it to lower-middle-income countries. There's a lot behind that, and I just want to interrogate that a little, because patents are property rights, which are incentives for pharmaceutical companies to spend hundreds of millions and billions of dollars and pounds. How does this all work? Because it sounds fiendishly difficult and a lot of diplomacy. 

Speaker3: [00:09:41] Yes, I will do my best to explain this in pretty simple terms. So, as you said, essentially a patent gives you exclusive rights in the pharmaceutical industry for 20 years generally. And that then incentivises the investment needed to find new medicines. Because it's very risky. You start developing something, and then you suddenly find it's very toxic. And you may find that after you've spent tens or even hundreds of millions of pounds. So that's how it works. And because of that, essentially that means that nobody else can produce it. So what we do is go to the pharmaceutical company and say, can you give us a licence on this patent? 

Speaker1: [00:10:33] And it's on a voluntary basis.

Speaker3: [00:10:34] On a voluntary basis, and we negotiate the terms of that licence to make sure that everyone benefits. And actually the entire principle behind the medicines patent pool is that it should be win win-win-win. So it's always a bit of a compromise because there are people with different views. The generic companies want one thing, the pharma companies want another. What's right for public health is a bit different. Making all that work means generally it's not perfect for everyone, but it's very good for everyone. If you see what I mean.

Speaker1: [00:11:12] So the win-win-win, it means the pharmaceutical company who may be selling drugs, antiretroviral drugs, for example, the HIV at a certain price in developed economies will now have access to markets which they perhaps otherwise wouldn't. People then benefit from cheaper drugs, obviously, and the generic manufacturers can compete. And a patent pool. Just very briefly, if you can explain that, that's when we have a number of actors that come together to allow a new technology, whether it's medicines, typically been used for technology. So it's quite a novel to apply it to medicines, isn't it?

Speaker3: [00:11:50] Yes. Viruses typically require more than one medicine. Attacking the virus in different places. And it's far from certain that these different medicines are going to be made by the same company. So you might have one medicine that in combination with another one made by another company, is really the perfect or is near perfect as you can get combination you want. So if they both give us licenses, we can give a license for them both to a generic company that can then put them together and sell them in a single pill. So the current World Health Organisation recommended first-line treatment is exactly that. It's a combination for HIV. It's a combination of three drugs. Two developed by one company, one developed by another company.

Speaker1: [00:12:45] And you brought that together? 

Speaker3: [00:12:47] Yes.

Speaker1: [00:12:47] And to bring this alive in an example, perhaps, the work that you've done with ViiV healthcare would be really interesting, because that brings it into a case study showing the impact that you can actually have doing this.

Speaker3: [00:12:59] Yes. So, ViiV Healthcare, which is majority owned by GSK, the UK company gave us a license for Dolutegravir, which is a really good HIV drug. However, W.H.O. recommended that it should be taken with a couple of other drugs, lamivudine and tenofovir. Lamivudine was a GSK drug that had in fact gone off patent by then. But tenofovir was a Gilead drug that was still on patent that we had a license for. So we could combine this for, or at least our generics could combine it and sell it in a single tablet. And so these three different drugs co-formulated into one tablet a day is down to a price of $45 per person per year. It is extraordinary what we've been able to do, and it's mostly governments buying it, because HIV tends to be a government program in most countries, or it's the Global Fund buying it to distribute to governments. And so that kind of difference in price suddenly makes things possible that weren't possible before.

Speaker1: [00:14:31] Millions of people have access.

Speaker3: [00:14:32] I mean, 20 plus million taking this every day. So, and to give you another example featuring ViiV, there were four upper-middle-income countries. So not the richest countries, but certainly not the poorest either. And all their HIV patients were on a combination based on a drug called efavirenz, which is not actually particularly nice. Got nasty side effects. But the country said we cannot afford to transition our population onto a dolutegravir-based treatment. And so we negotiated between ViiV and the countries as to what would be an affordable price that would be an acceptable return also for ViiV. And as a result, we came out with a license for those four countries. That has meant that is now very, very affordable. In fact, the price has come down significantly even from what they said was their top price. And so it's absolutely perfect, ViiV is getting money that it wasn't getting anyway. And for them it's enough to compensate them for the risk of development and so on. The countries can afford to transition all their population. And of course there's a population, but the people living with HIV are getting the best. And that's really what we try and do. There's obviously a lot of discussion around the IP system. It's particularly happening.

Speaker1: [00:16:18] Intellectual property.

Speaker3: [00:16:19] Intellectual property. And people feel it's a barrier to access. And what we're trying to show is that it needn't be.

Speaker1: [00:16:30] And don't be afraid. Don't be afraid of voluntary licensing.

Speaker3: [00:16:33] Exactly. And when patents were sort of set up, they were really for two reasons. One was to create the incentives for innovation, but also equally important, they should be for the public good. And what we try and do is make sure that happens through a voluntary system. 

Speaker1: [00:16:56] Fabulous. And we've talked about obviously the mandate for Medicines Patent Pool, HIV, tuberculosis, hep C, that was broadened I think when you arrived. Obviously we had Covid. And it's been broadened further. I just wanted to touch base about the work you did in Covid, but more on some later initiatives, because you're now seeking to empower low and middle-income countries in terms of health security and the technology and R&D capability.

Speaker3: [00:17:29] Yes, you're absolutely right, Suhail. When I joined well, actually, in fact, when they offered me the job, the board had just decided that based on the success in these other areas, it should be expanded across diseases. We try and concentrate on things that are prioritised by W.H.O.

Speaker1: [00:17:51] The essential.

Speaker3: [00:17:52] Essential medicines, exactly. And so during Covid, we expanded also to Covid drugs clearly. And we got given licenses for the three small molecule antivirals. So the least complicated drugs because obviously it's much quicker to make generic versions of them, which was great. But it still took too long to do that. And we have ways now that we think we can speed up the process tremendously. But at the same time, during Covid, it became apparent quite early that there was not enough production of vaccines, but more importantly, that there was almost no production of vaccines in low and middle-income countries. And so this nationalism that came about meant that the high-income countries are sort of hogging all the vaccines and Africa in particular was left really behind. And so the World Health Organisation asked us to partner with them to set up vaccine manufacturing in low and middle-income countries where there was either non-existent manufacturing or it wasn't sufficient.

Speaker3: [00:19:10] So we first of all looked at what we should start with, and it became clear that the mRNA platform, the one that was used in the drugs that Moderna and Pfizer produce the vaccines, which were the most used ones, was the place to start. And so W.H.O. put out calls for proposals to identify someone to develop the platform. And then other companies in low and middle-income countries to ask to receive it. And the reason they wanted to partner with us is because of our licensing experience and expertise. And so we had not been doing vaccines before, so I immediately hired a new tech transfer team of vaccine and biologic experts. And we started doing this with developing the platform in South Africa. And this is really about empowering South Africa to do this. This is not about us giving them money and saying, you do this, you must do it this way. It's allowing them to work it out for themselves.

Speaker1: [00:20:39] The sovereignty to make that decision. 

Speaker3: [00:20:41] And that's really important. And then, of course, since then, with all the discussions about a pandemic treaty to try and deal with how we approach the next pandemic. This has been very apparent that low and middle-income countries are now saying it's imperative that you give us the technology in order to allow us to have the health security that we need to make sure that we'll have vaccines next time or medicines. 

Speaker1: [00:21:13] That we can move in an agile way to manufacture.

Speaker3: [00:21:16] Yeah, but also industrial development. This feeling that everything is done in the high-income countries, and then it's sort of parcelled out as an afterthought to low and middle-income countries. And so it's about really trying to change the balance here and empower them. And this is you see, economically, it had always been decided, oh, what we need to do is to concentrate production into the smallest number as possible, where we have the biggest volumes. 

Speaker1: [00:21:51] Economies of scale.

Speaker3: [00:21:52] Exactly. But then you realise that's a problem because it leads to no sovereignty for all these other countries. So it may lead to some higher costs, at least initially, because you won't have the vast volumes, but it will give you the security that, that countries now need.

Speaker1: [00:22:15] And the technology transfer program you've talked about, I think Afrigen is the hub in South Africa. I think 14 or 15 other programs that have come from that. So you must be very proud of at least this initial step that's been taken with gusto. 

Speaker3: [00:22:30] Yes. And I think it's a very different approach. So Afrigen with support, we've been very lucky. We had a lot of the foremost experts in the world supporting Afrigen. They have developed a vaccine, and what they did is a proof of concept, was develop a Covid vaccine so that they could compare it to the existing ones, which they've done. And we're now just about to start the technology transfer to the first of these 14 other, there's one in South Africa, so I won't count them because that's already happened. 14 other countries who will then have this technology. And then the next thing we're doing is supporting them to get together and decide what they do want to make with this. What sort of vaccines against what sort of diseases currently are a big problem. And it's often different in different regions. So, we're actually holding regional meetings that allow them to talk through, you know, should we be concentrating now on producing a vaccine for dengue, for example, which is one of the projects going forward.

Speaker1: [00:23:40] Fabulous. Really interesting. I'm just going to turn the dial slightly. Part of that mandate. You've become sort of agnostic in terms of the diseases that you support. Non-communicable diseases, I want to talk about that these are infectious diseases. Very important. I was flabbergasted to read that something like 40 million plus people a year die from non-communicable diseases. Whether it's diabetes, whether it's cardiovascular. Can you touch upon that? Because that's an area that Medicines Patent Pool is doing a lot of work in.

Speaker3: [00:24:13] I mean, historically, infectious diseases have been the area where most concentration has been. And it's only relatively recently that people have understood how big problem non-communicable diseases are, and particularly in low and middle-income countries. And when our mandate expanded, we thought, yes, I mean, absolutely, we should tackle this as well. But, in communicable diseases, because there's quite a lot of funds there because there's been so much concentration. It's been relatively simple for us to get the licences, the generics, produce the, the medicines, and then they get distributed. In non-communicable diseases, that's much less easy because access is not about oh, or at least not only about having affordable medicines. You can have affordable medicines sitting in a warehouse, but if nobody's diagnosed, they're not going to get used. Or you don't have doctors who understand how to treat people, or you don't have anywhere that people can go for treatment, or you don't have adjuvants, adjuvant treatments that you need to have. So, in cancer what we did is we talked to UIC, which is the Union for International Cancer Control, which is a sort of umbrella patient organisation, a global one with, I think, more than 1200 member organisations, about setting up a consortium, which is called the Access to Oncology Medicines Consortium, where we would address these different elements of access. So, we would try and get licenses for the drugs, so they'd be available at affordable prices. Somebody else would take on doing the diagnostics, teaching the doctors, interfacing with governments to make sure that they actually would buy the drugs.

Speaker1: [00:26:26] So it's a system change. Behavioural change. Much more complicated.

Speaker3: [00:26:30] Much more complicated. And we got our first license for a leukaemia drug.

Speaker1: [00:26:36] Was that Novartis? 

Speaker3: [00:26:37] Yes. Novartis gave it to us for Nilotinib, is the name of the drug. I feel that the opportunity of this is being massively underutilised. There are a lot of very good drugs for NCDs out there and we are not being given licenses. And so that means there is no access to these drugs. And this is, in my view, really problematic. And it's one of the reasons that there is so much of a cry for access at the moment, particularly at the negotiations around a pandemic treaty, because there isn't enough being done. And to me, that's so sad because we're sitting here ready to make this happen. And I slightly feel that what's happening is pharma companies have the life belt. The river is going past with people drowning in it. And instead of throwing the life belts into the river in the form of us empowering us to help those people through licenses, they're kind of just standing on the bank and waving a bit. There are notable exceptions who have given us licenses, but as an industry, there's too little, and I think it's something that industry need to address. Equitable access. We're not the only way of doing it, but I still don't think there's nearly enough of it. 

Speaker1: [00:28:23] Well, I think we'll see your advocacy and work in this area. I'm sure if as the lifeboat, to use the metaphor, if I may, I wanted to end the discussion today. It's incredibly fascinating. Could have stayed on any of these topics. And that's to look a bit more broader. The goal, of course, is universal health coverage. To have any meaning, you need access, which of course, you've talked about. And even on the non-communicable diseases, the predicate for that happening is collaboration at industry level, at government level. And in your end-of-year message in 2023, you referred to a I think you used the phrase troubling geopolitical environment, which has not become any less troubling in the subsequent months. Can you paint the picture of the threats that are facing the headwinds for your work and more broadly, to achieve this very laudable aim?

Speaker3: [00:29:21] I can try. They're various things. As we become more divided as a world and often within countries where people seem to be living in their own reality, that doesn't intersect necessarily with other people's reality. It's very difficult to get proper collaboration and to be honest, viruses and bacteria and disease doesn't care what your politics are unfortunately. And, in particular, one of the things that has happened has been an anti-science movement.

Speaker1: [00:30:05] Misinformation.

Speaker3: [00:30:06] Misinformation. Exactly, and that has persuaded people not to take, for example, vaccines or to believe that Big Pharma are some huge conspiracy to do them harm rather than to actually do good. And this is a major troubling factor for us, because if people don't actually want to take all these life-saving products, then, you know, we're kind of wasting our time.

Speaker1: [00:30:37] Absolutely. And part of that's going to be looking here at the UK, a new government that in its manifesto has expressly said that one of its missions is to have a reconnected Britain and, through genuine respect, rebuild relationships with the global South. This is a very broad topic. I don't know if there's any particular message you have, from our point of view in the UK to inform this debate, because polarisation is here. But the government have made a very clear statement. I think Anneliese Dodds is now the new Minister for Development. This development is going to require people to break some of those barriers and boundaries.

Speaker3: [00:31:18] Yes, the UK government have always supported the Medicines Patent Pool. They were one of the key funders of Unitaid who set us up and continue to be very good funders of ours. So, they've always been involved in this. And as you say, their commitment to doing more with the global South. But I have some quite strong opinions about this, which are that this needs to be real partnerships with the global South, and it needs to be the global South agenda. I talked about empowerment before, and that's very much the kind of idea. It's all very easy to sit in London or New York or Geneva and go, oh, this is what they should do. And whereas it's actually about what do they need? What do they want? And empowering that. But it is also when I talk about a partnership, there's a lot that low and middle-income countries also need to do their side of the bargain. First thing is, by and large, they don't spend enough of their GDP on health. They need to increase that. That's one thing. Secondly, and this is a problem for us is if we produce through our generics, affordable medicines and they then don't buy them. The pharma companies turn to us and say, well, we're not going to give you any licenses because it doesn't have any impact.

Speaker1: [00:32:59] It's a two-way street.

Speaker3: [00:33:00] It is a two-way street. And it is absolutely up to donor governments like the UK to be clear about this. And I think sometimes they are not firm enough around this. And I know that in Africa for example, Africa CDC totally understand this. But you know, there's politics and it's, it's still not easy to make it happen. 

Speaker1: [00:33:26] No. Well, let's see. As you say, if it's predicated on genuine respect, that requires some truth and candour in the conversation. One final point I want to end, if I may, a little bit looking in the future There's a couple of areas we haven't touched. And just very briefly. One is the work that you're doing at the beginning of life, children, maternal health. I just want to talk about that. I have a slight personal prejudice or preference from that. As someone born in the global South, in a village with and a home in a village with no water, running water or electricity. Premature in a low-resource environment. So, the support you give for maternal health is really important. But I think it's something that's very close to your heart in terms of the access to children's health.

Speaker3: [00:34:13] It is, there's a W.H.O. partnership called GAP-f, which is a global accelerator for paediatric formulations, because, you know, at the preamble to the Sustainable Development Goals, it talked about leaving nobody behind. And I'm sure when most people think about that, they think about, I don't know, Indigenous Populations or people who are in extreme poverty or whoever it might happen to be. I bet they don't think much about children. Children always get left behind because drugs, for example, tend to be designed for adults. Children are not little adults, and you can't give them something that's so bitter to swallow. They're going to throw up, or the pill is just too big to swallow or whatever. And so, we are very involved with GAP-f. We're sort of vice chair of the organisation to really make sure that there are appropriate formulations for children. And we also have a sort of conditional license for a very important drug because it's heat stable, meaning you can have it at room temperature effectively rather than as part of some cold chain for postpartum haemorrhage, which is a massive problem in lots of low and middle-income countries where after a woman gives birth, there's bleeding and this can be fatal. And we're very keen to stop that. And unfortunately, that there is a drug on the market that's not heat-stable. It's not patented. And there's been so much competition that the price has come down, the quality has suffered. And so, because one of the things that we ensure is high quality, we require that all of our licensees put their medicine through a very good regulatory authority to make sure it's of the highest standard. 

Speaker1: [00:36:26] Absolutely. And one very final point. At the risk of sounding like Captain Kirk from Star Trek, you've called long-acting therapeutics the next frontier of healthcare management. Can you just explain what that potential is? It sounds really exciting, and what they are. 

Speaker3: [00:36:43] Often you need to take a medicine once a day, or sometimes more often than once a day. Imagine that you could take it once every six months for some chronic disease. And so that's what we're looking at the moment. Unitaid have been funding a number of programmes in this area. And as an example, they've funded one for a long-acting hepatitis C cure. And the idea is you would have one injection. Now where you have people with hep C who might be difficult to engage with. It might be people who are using drugs, for example, who are very susceptible to hepatitis C because it's a blood-borne virus. You could literally find someone, test them, and immediately then give them, it would be an injection and that would be it. And then within a few weeks they'd be cured. So, I think that's very important. Also in HIV, we have a drug from ViiV, actually, a license for it, which is a long-acting, it's a treatment, but we're particularly excited about it being used for prevention. And also, another company, Gilead, also have an even more long-acting prevention drug for HIV. So, in Africa with HIV, young girls and young women are particularly susceptible. Sex is not always consensual and for them to be protected could be really game-changing.

Speaker1: [00:38:29] Absolutely.

Speaker3: [00:38:30] So we're hoping that Gilead will give us a license for their long-acting as well. So, there are lots of ways that long-acting is going to be able to be used. And this idea of doing it once or just very, very infrequently, particularly for chronic diseases, is going to be amazing.

Speaker1: [00:38:49] Well, we look forward to hearing more about that. Hopefully, we can persuade you to come back and give us an update but thank you for sharing the voice for those sometimes whose voice isn't heard on Voices of Care. Charles Gore, thank you for your time. 

Speaker3: [00:39:03] My pleasure. Thank you for asking me.

Speaker1: [00:39:04] My pleasure. If you've enjoyed this episode of Voices of Care, please like, follow, or subscribe wherever you receive your podcasts. And if you want to learn more about how we're turning the dial on the health and social care debate, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza. Thank you very much for joining us and look forward to seeing you on the next episode.

Speaker2: [00:39:26] Voices of Care, the healthcare podcast.