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Goal 4: Discussion Questions and Answers

Biodefense Summit Transcript

Panel Moderator: Panel Moderator: Mr. Lance Brooks, Chief of the Biological Threat Reduction Department, Defense Threat Reduction, Department of Defense

​>> LANCE BROOKS: Thank you, John and thank you --

>> CHRISTOPHER KRATOCHVIL: Is this we spread apart to look like a bigger group? 

>> LANCE BROOKS: Yeah, spread out a little bit. But thanks, John and Chris for your initial perspective. So just as we get ready for some comments and questions from the floor and from the webcast, I'll remind you that this is a strategy but also the big part of the strategy is for an implementation plan. And so part of this summit here is to start -- as you can see the questions are not only what are the gaps but identify some actions and some new initiatives, which Chris did nicely there, that can lead into meaningful implementation for the strategy. That's the difference between the strategy and past. It really has a component that says, there must be an implementation plan.

So welcome any comments or questions from the floor as you think about early response and some initiatives and actions. You can't tell me this whole crowd is only in the preparedness room. We don't have any folks here that think about anything in early response that can mitigate a vile incident. Let's start to the right. Please give your name and affiliation, please.

>> FRED LICHEM: Fred Lichem [phonetic], Washington Institute in Lawrence Livermore National Lab. I think what's most striking is I've been involved in this since the '90s. So I've seen a lot of these questions asserted and all that is great. But I don't get any sense that you guys are taking into account any damage or disruption occurring to your peacetime mode of operation or as it would transition in some kind of an emergency situation.

Same thing would apply as I was listening to the presentation -- the prior presentation. You assume that medical records, electronic records, and telecommunications are going to be intact. What makes you think that? I mean, part of what can be involved in an actual realistic, plausible attack on the United States is one in which the infrastructure and particularly the public health infrastructure and the food supply, et cetera, is the main target. And ceding chaos and disruption not only just by disrupting cyberattacks and telecommunications interruption but also active measures like we saw versions of in the elections and in other phenomena, the Russians and the Chinese are all very adept at doing that.

So I just wonder, a lot of hard work and initiatives that both of you put on the table. And I can especially see the importance of being able to have some assumptions about damage if you're co-located in the reasonable vicinity of the strategic command. But you know, I just point this out and I worry that that's an aspect of the problem we need to discuss.

>> LANCE BROOKS: I think John has an answer for you. He's ready to address your question.

>> JOHN BENITEZ: In the limited time I didn't talk about some of those issues but in a lot of our planning we do go into disruption of infrastructure, just using a general term. For example, and this is one coming up, in June of this year, there's a Federal as well as regional as well as at our level state and then all of our locals -- and I'm trying to remember my acronyms here but CUSEC the Central U.S. Earthquake Consortium I think is the proper name for the New Madrid earthquake. Now this is not necessarily biodefense but again put into context the infrastructure loss where, you know, a good chunk of the country in our particular case part of the state is out of communications. There's no roads. There may be no cell phone, Internet, et cetera. Medical records may be -- may be available locally but they are not available outside. How do we still regenerate that communications capability? How do we do situational assessment? This is a multi-day drill. Now, taking little time slots into account because of the limited time to exercise. But we're looking at what happens Day 1. We're looking at what happens at Day 6. And we're looking at what happens Day 60. So we can look at the different elements over time.

>> FRED LICHEM: Do you have thoughts about specific initiatives that you would want to implement in light of what you already know?

>> JOHN BENITEZ: Well, I'm not sure I can address everything, nor do I have time to address everything. But we're looking at communications. We're looking at situational awareness. How do we know, find out, what's going on, especially if -- I'm going to pick on Memphis. But if Memphis becomes an island, how do they communicate back to us? How do we establish that link?

Because basically they are going to be on a survival mode. Whatever it is that they have after the earthquake, that's all that can happen. But at point we're going to be trying to reach out to each other. So we do have elements in place for training both equipment-wise through radio communications. Again, it assumes that they can have so many days supply of energy. Whether it be fuel stores if it's for generator use. Solar power so that you can, again, do some basic communication. It won't be the best glorified cell phone direct talk to each other right now like we do. But it's almost like an email you send out, eventually gets there. I can respond to eventually get some situational awareness to know we can respond and dispatch a team to X location to try to reach in with whatever the needed supplies are. So that's just a brief example of some things that we're doing.

>> CHRISTOPHER KRATOCHVIL: And one final thing to move on, let me just quickly add, so for one of the trainings that we do with NDMS, for example, is for austere environments. So we actually do training with them in how they set up their base of operations. How they set up those mobile units. So you're right, it needs to be austere and recert source.

>> LANCE BROOKS: I'm going to give somebody else --

>> FRED LICHEM: Real quickly and then I'll shut up.

>> LANCE BROOKS: You can take it offline and give somebody else an opportunity to ask a question.

>> CHRISTOPHER KRATOCHVIL: I'm going to talk afterwards.

>> JOHN BENITEZ: We can talk later.

>> LANCE BROOKS: So next question here.

>> FEMALE SPEAKER: Thank you. My ears perked up when I heard forensics and attention as part of this response discussion. Because my institute is the National Institute of Microbial Forensics & Food & Ag Biosecurity. And I wanted to tell you about an initiative that was started by the FBI. It's FBI and DHS and us. We're doing a plant and animal health criminal epidemiology initiative where we go state to state training law enforcement on what it would look like if there were an intentional event in an agricultural setting. And it's kind of an interesting group because you put biologists and state departments of agriculture together with law enforcement in the same room.

And for law enforcement to get a sense of what they would have to do if we expected that -- or thought that something had been intentionally done, what would it look like. You can't put crime tape around a 30-acre field. So it's an interesting opportunity.

And my second point, and I guess it's a question, too, we know that initial response authority is always local.  The first people to assist -- certainly in agriculture it's the Department of Agriculture has the authority, the statutory authority. And when that response is local and I know it can go big and there can be incident commands and all of that stuff. But the response still is local. And law enforcement is often called on to be the ones to help respond because they are having to close roads, they are having to do all kinds of things.

So I just wanted to kind of put it in our minds that we do have an interface with law enforcement. And perhaps we need to make sure that that somehow features in our response plan.

>> LANCE BROOKS: Thank you. Did you want to --

>> JOHN BENITEZ: Just a really quick -- I didn't have time to mention that in my brief intro. But yeah, I do think multi disciplinary is very important. It's not just health as in human health but animal and plant health as in the Department of Agriculture. There's probably other departments I'll skip over so I'm not going to mention. But there's others. I was including law enforcement. Because one of the people that are first responders traditionally, especially at the local level whether it be fire or police or even EMS, health is always kind of out of the picture as like a stepchild at best. But I think that talking together is starting to happen. But I think it needs a lot more motivation.


>> CHRSTIOPHER KRATOCHVIL: Yeah, and the first responders across the board are very actively involved all of our exercises, our trainings, our statewide SOPs. Because you're right, they are critically important to be involved. 

>> FEMALE SPEAKER: Thank you.

>> LANCE BROOKS: Great. Thank you. We'll move over here to the right.

>> FEMALE SPEAKER: So that was -- I was going to talk about one of the FBI programs with joint criminal epidemiological investigations. And my colleague here talked about their animal plant course they hold jointly with USDA but I've also been lucky enough to participate in the human health focused criminal epi course that the FBI holds jointly with the CDC, as my colleague mentioned, they go around to areas all over the country. They do this internationally, as well. And get public health officials, local public health and law enforcement together and put them through case studies so you get a suspicious patient in or law enforcement hears a tip. How do you share information between both sectors? I think early information sharing across sectors is really important to limiting any sort of an impact of a bio incident. So I would second what my colleague recommended and look into those joint criminal epidemiological investigative courses that can be held again both regional and internationally, as well. Thank you.

>> LANCE BROOKS: Great, thank you. Here, please.

>> PHYLLIS ARTHUR: Phyllis Arthur, BIO. Great discussion. I wanted to actually go back to the point you made about academia or rather about the research of new cano measures when you're in the middle of an outbreak. And I think I would add two points to what is a really important point during response. It's not yet clear how we do this when we have products with an EUA sitting in a stockpile or we're about to use them for real. I think there's a lot to be learned from the two ebola outbreaks where one and now soon two to be companies are putting a not yet approved ebola vaccine into what is an outbreak setting through an IND and in a clinical setting. And they have already learned a lot. I think it's worth it to talk to Merck. They have already learned a lot to talk about the complexity of the scattershot of having a bunch of people researching in quotes a vaccine during outbreak setting.

So one of the things to do in the preparedness aspect is take what we learned from ebola, which was a massive outbreak use of an experimental vaccine. And learn how -- what we should be doing right. Protocols, as you said. INDs, IRBs, these things.

But also really setting the standards on collection of data. In the end all of this is supposed to go into a filing. The Merck folks spent an extra year just trying to get the data in some way that they could file it with the FDA. Most people don't know how to do that. Big companies do.

So I think it's really important to connect with the private sector that's used to working with the regulatory agencies, not just in the U.S. but abroad. And capture the ebola learnings. They are about to do this with lassa and many other things. And I think we're getting a little better at tightening it up. It would be great to share that with some of the academics that are doing the same way.

>> CHRISTOPHER KRATOCHVIL: Yeah, I completely agree. It's an incredibly important point. And those learnings are continuing on with the outbreak. So NIAID is funding the four arm study in the DRC. So they have done a lot of work in developing that infrastructure there. And we're learning a lot in the U.S. about how we can operationalize that here and quickly activate it so we can systematically collect data. And then BARDA is funding ongoing a data collection with ZMap through an open access opportunity. So there continue to be a couple of avenues to systematically collect data which is incredibly important.

>> PHYLLIS ARTHUR: No. And this is terrific. I really want to make sure that I reinforce my cornerstone point -- reinforce my cornerstone point. Industry knows how to do this.


>> PHYLLIS ARTHUR: All the way to the end and the time Merck has spent taking what would have been an easy clinical trial's worth of data and trying to turn it into something they could file, I think that's probably the biggest lesson they learned was that. So I do want to make sure some of that learning is applied to whatever we do across Government and the private sector. I know you know that. But I have to say it again. Thank you.

>> CHRISTOPHER KRATOCHVIL: No that's a great point and that's where BARDA is a great liaison between liaison and the outbreak.

>> MALE SPEAKER: Yes, BARDA is involved in this. Phyllis, so when we were at NewLink, we got into a great big fight with Marie Pulcini [phonetic] over exactly that point. Because she wanted to take that vaccine, remember, because there was the early IND lot and jab it straight into the NSF people without trying because they were not willing to go back into the country. And my heart goes out to Merck. But it's not like we didn't warn them.


>> MALE SPEAKER: And WHO, I can tell you directly, kind of doesn't get it. We'll just leave it at that.

For you guys, I'm -- I used to have this client, Deloitte, with their highly active modeling center. And I know that that got modelled in its operation in BARDA. I'm preserving that the BARDA modeling group is really intimately engaged in your kind of assessing the feasibility and risks associated with some of these things. Is that true? Or no? Oh, I gently suggest that you might want to talk to Rick about getting linked in to the modeling group. Because they can really help you to work through the implications of some of these transport internal processes, availability of supply, communication breakdown, all of that kind of stuff is readily worked out. This is what Deloitte does for a living. Not that I'm pushing -- they are not my client anymore. But this is known how to work through this stuff at an industrial level.

The other thing I wanted to mention, the ADMs, not to be a Nattering Naybob, offer a real cautionary note of sustainability for these large programmatic initiatives. Because having helped build some of those bids early on and then watching it play out, a lot of folks were pretty skeptical about some might say the Government can be an arbitrary and capricious customer. And the ADM experience suggests that there might be some merit to that.

That the sustainability of these programs is critical. If we build this infrastructure and then, you know, the wind shifts and populism arises or whatever, suddenly the money is gone. And you just burn people out.

So as you think about this, I suggest that the ADM experience may have some lessons learned that one could learn from. I'll leave it at that. Thanks.

>> LANCE BROOKS: Okay. Thank you.

Any other questions from the floor? Any from the web I can make up some, but I would rather --


>> LANCE BROOKS: I've got plenty of questions.

>> FEMALE SPEAKER: There was --


>> FEMALE SPEAKER: Okay. One question from the web comes from Kelly Perry who asks about the incorporation of social media into biodefense preparedness efforts.

>> LANCE BROOKS: I would expand that to bio response, as well, early response.

>> JOHN BENITEZ: I'm not sure what to say other than we do incorporate that into some of our response in outbreaks and trying to message the right people through the right media. Sometimes social media, sometimes it's other. I'm not exactly what is not a social media. But reaching out to the right targets. Right now we have for example a nationwide hepatitis A outbreak. We're trying to reach the right population. Some through social media. And other NGOs or other governmental channels to reach out to the right populations for what needs to be done, what are the risks, and where to get vaccinated in this case.

>> LANCE BROOKS: All right. Dave.

>> SAN JUSHA: Great presentations throughout the day. Lance, you know me. But I still have to initially introduce myself.

I am San Jusha [phonetic] from the National Homeland Security Center of the U.S. Environmental Protection Agency. And you know that to get a Federal job, I have to be a U.S. citizen.

So I'm not speaking on behalf of EPA. But I'm speaking as a private citizen. But with knowledge of working in the Government for the last 20 plus years.

The main reason of getting up is that we have some time. Second reason is that Lance in his remarks talked about not much discussion about environmental contamination and response and all. And then there were questions about infrastructure disruption and all.

So based on my experience, I have three or four things very quickly to state. That whenever there is an environmental contamination in contrast to clinical cases, we do not have national-level infrastructure of SAD agents to handle hundreds of thousands of samples to be analyzed in a very rapid way. Only then you will be able to restore your infrastructure. So we need to look into that matter.

The other thing is that when 9/11 happened and immediately after that, a meta-thrax anthrax bioterrorism incidence happened. And a lot of activities went on. And there were conclusions, many of those conclusions led to lack of interagency collaboration, coordination, lack of communication and all. And there were great efforts put in since then to establish interagency collaboration, cooperation and all. And one of the coordination and collaboration efforts was if you have massive number of samples to be analyzed, whether they are full samples, clinical samples, environmental samples, different agencies and departments have responsibility to analyze those samples. And there are people sitting in this room, they work very hard including, Lance Brooks, he was he also involved in leading both efforts. Now we have high interagency laboratory collaboration and coordination. And the name was Integrated Consortium of Laboratory Networks. ICLN.

I use the word was because I don't know what is its future. It is on hold for some time.

So there is some mention in the NBS about this kind of interagency collaboration. And preparedness in terms of laboratory sample analysis. So please capture this that we do need ICLN kind of efforts to continue. Only then we will be able to analyze a lot of samples.

And there is a lot of emphasis on clinical samples. And I know that CDC is very capable of handling the clinical samples. But at the same time CDC LRN is the largest laboratory infrastructure. And even EPA and other departments and agencies depend on CDC LRN to help out. So we do need some more efforts on establishing laboratory capacities and mentoring ICLN kind of programs.

The last thing is that there is another deficiency when it comes to environmental contamination. And many of you know this. But I want the NBS to capture, again as a private citizen, not as an EPA employee. Lance, you and a couple other people also mentioned decontamination. We know if there's a wide area contamination insitu, we do not have enough resources to even carry out effective decontamination. If you want to use chlorine dioxide, methyl bromide, or any other agent decontaminant, we don't have that full capacity to handle wide area incident.

So these are burning issues when you talk of environmental contamination. And if we don't take care of the environmental contamination in a proper way, yeah, you will handle, you take care of the clinical samples and take care of the people who got infected. But there are many people who will go to the contaminated side and get infected and we will just prolong the response.

So I know that these panel members may not have all of the answers. But Lance knows these are burning questions. And these are questions to all of the panelists and also National Academy of Science who is holding this particular event. And when you talk of NBS summit, I don't want the environmental side to be forgotten. Thank you.

>> LANCE BROOKS: Thank you. That was quite a bit. And you're right, there's a lot of issues. It comes back to even in the medical community talking about surge capacity. And it's something when you start thinking about all scales of type of biological events that we could possibly face and imagining what we could face based on some of the risk analysis that, yeah, it's certainly one of the gaps we still -- the coordination is better. But there's still some limitations there.

Now, going back to the web question about using social media. As we think about large scale events, are we thinking like at the state level, university level, about how much engagement and involvement we can do with the public by looking at actions they can take, premessaging, being prepared in that way, so that when we do early response to take -- to empower the public to take actions to mitigate their exposure or mitigate, depending on what the bioevent is, that type of event? From your experience/perspective, do you have such initiatives or know of any type of initiatives?

>> JOHN BENITEZ: We do some public messaging. For example, I hate to label that emergencies only happen in one -- you know National Preparedness Month and that's all we message. But there's a conflicting balance of trying to message and then it becomes too much so that they don't listen to the subsequent messages over time. Versus just doing it you know when there's something really bad going on, in which case they might listen at that point in time. So it does get to that fine tuning balance. I am not a Public Information Officer and we have a section that pretty much deals with that and helps us with that. But we do try to do some general learning, putting up some web pages, for example, and things you can do to help start to prepare.

I think we heard some earlier speakers talk about some of the just educational materials that are out there that can be used for those kinds of purposes. When I go out and public speak across the state for whatever I do bring up, what do you have right now today with you that could be used for preparedness if we get stuck here? What could you start with? And start thinking from very local, meaning yourself right now to eventually your family, your home, your business, wherever you may be.

​>> CHRISTOPHER KRATOCHVIL: Then if you go all the way to the other end of the biocontainment level care, when we opened our unit almost 15 years ago there was a very active public education initiative that was started then. The community was very on board and that engagement continued throughout the last decade and a half. And even when the ebola patients were flown to Nebraska because it's pretty clear that your highest risk of getting ebola in Nebraska is someone that we bring into the unit, right? 


>> CHRISTOPHER KRATOCHVIL: So we had an Apple iTunes university for clinicians that we pushed out but we also had one for the community that we pushed out. So we were actively engaged in the community, giving talks in the media. But also putting resources out there, very transparent what was happening. And I think that's why we were able to get the community to really support the vision and the initiative that we move forward.


>> JOHN BENITEZ: And I think that's important is getting those different stakeholders involved at all levels for whatever that particular problem or issue or preparedness standpoint that you get buy-in from the physician community, the healthcare community, it could be the business community and it could be just your general public, your patient population, if you will.

>> LANCE BROOKS: Yeah, I think it's an area that maybe could be explored further. My thought was that if you do -- if you go through scenarios and you start working on pre- -- I don't want to say precanned that just makes it sound a little flippant. But think about the type of response you may need. Because we know we have a manpower shortage when it comes to doing if it's an environmental event cleanup and decontamination and things are some of the things that were passed around in the past. But also if we look at ebola that came to the United States, very few cases. But if you remember in the media, there was a wide varied response among the various states and governors. And I say that people forget. Public health officers do forget the ability to quarantine. Most laws on the books allow them to do it without question if you really get down to it.

But they felt there was some conflicting messaging coming from the Federal Government. And it elicited a wide array of response across the country. That's kind of my point going forward. Is think a little bit more proactively going forward with these type of things.

>> JOHN BENITEZ: And I think from my comments that I've made, everything starts local and one of the things that we take opportunity of in helping is from a planning standpoint at the state we're trying to do a lot of drills and exercises across different communities in our state but at the local level, the local health departments have their medical reserve corps and the other reserve corps volunteers for doing things. And those are the things that come in primarily from the general public or sometimes public health and they participate in these drills and they get to see and become educated to some degree on how and why we're doing these things. Why it's important to educate. They are almost our goodwill ambassadors that can spread this back to our communities.

>> LANCE BROOKS:  So what's really interesting is in the previous three goals we had no shortage of questions and comments. Now we get into actually taking preparedness and putting it into action for early response to mitigate a bio incident, I hardly have any web questions and I don't have any people standing at the mic phone. So I would say if you want to look at the NBS and the implementation plan, this is probably a shortfall in gap to see so many people in the audience, certainly so many working on this issue. You can't tell me everyone is working on prevention and preparedness. Yes, if we're 100% successful, we never have to get to this stage but we know that's unrealistic.

So in my mind this is already -- should be informing ASPR and the interagency that this is probably a gap area that probably needs explored a little bit further, you know, looking at how do we get to these actions.

Certainly this talks about information sharing for biothreats and bioincidents. So I take it from the lack of response that we've solved the problem of sharing information from the Federal level all the way down to the state local level. Because I haven't heard any concerns about that.

You guys are getting all of the information from the Federal level. And vis-a-vis at the Federal level we're getting all of the information from the state and local level. That's what I'm hearing. We don't have any issue there with the communication of sharing any information some that may be FOUO classified that may come to light during on a certain incident. Depending on how it originates, it could have some classification issues.

>> JOHN BENITEZ:  Well, I mean, just a comment from my perspective at least. I'm getting information that I know that's out there that's available but I don't know what's not available so I can't really say what I'm not getting. I think we're getting a lot of good information, situational awareness, again what's going on in the country in general and across the world. But even at the local level, for example, we have in Tennessee and other states have these, too, fusion centers where the different state and Federal and local law enforcement as well as other first responders and in some cases health departments also department in. And we had a fairly good partnership. But we were not always invited. It's gotten to the point right now where we talk to each other on the phone but we don't really meet in person. And there's something to say for that knowing each other at least once in a while in person that makes it much easier to communicate when things really go bad that I'm trying to push for right now that we still need to go back to that model where we meet at least every now and then in person. If they meet altogether in secret that's fine but at least invite us once in a while from the health standpoint.

>> LANCE BROOKS:  Yeah. So it's one of the issues we faced in my tenure in DHS working with the UASES [phonetic] is PERCI [phonetic] managers, you guys have to do all hazards, bioincidence is just one of them. And usually a lot of the response we got back is the majority of the expertise resides in the Federal Government. But the people we see and hear from the least are in the Federal Government.

So you know, we got a lot of questions back to how do we tap into that? And I don't know whether we have solved that problem or it's something to be looked at when you talk about this information sharing. Because some of what you need will be very technical in nature. Obviously some universities have great wealth of experience. And we know who they are and can tap into. But when it comes to some of the early response and some of the characterization of what's going on, especially if it's intentional will be most likely at the Federal level coming down. So I think that's an area it sounds like we need to -- unless some people know some initiatives out there more than I do -- work a little harder onto hit this objective within the strategy. Yes.

>> MALE SPEAKER: So to your point, whether the flow of information is sufficient, again, I love case studies. So zika was a super one. Maybe even better than ebola in some ways. Because it didn't get quite so much attention and there was a lot of confusion.

I know personally a lot of docs ended up clicking into an intelligence network that a colleague of mine that had come out of the IC had set up. And we're actually paying subscription services to get information, particularly folks that were in the southwest along the border regions, down in Texas and areas that were -- Rio Grande Valley that were potentially at risk along the gulf. So those, I know from personal experience, that frontline physicians were going outside of Federal communication channels to obtain and pay for information that they thought was more targeted and accurate on that threat and how to manage it and how to diagnose it.

So in response to your query, is there adequate communication, I think it's -- you know the answer. Otherwise you wouldn't have said it.

But there's a case study and an example that's hard that where physicians and some businesses that were potentially impacted thought that the threat was significant enough, they were willing to put up some treasure to get what they believed to be a more accurate real-time threat assessment and advice on management. 

>> CHRISTOPHER KRATOCHVIL: Well, and I guess say our ASPR regional disaster pilot grant that we're working on right now, really when they stepped up and looked at what were the initial resources we need to develop communications was it. And I think we saw very clearly with the flooding that's been going on with Nebraska over the last month and unfortunately continues, it really identified what some of those gaps were. So because we had that project already in place and starting to move forward, we could really identify in real-time where those gaps were. But it continues to be a major issue. And I think that's a small microcosm obviously of the entire country.

>> MALE SPEAKER: I can also say there's plenty of Nattering Naybobs in every community, sometimes I'm one of them, the CDC is not always perceived as a neutral arbiter of information. And there's some communities that prefer to go to the Canadian resources or other resources of information. And I think that's trouble personally. And something that ought to be kind of thought about. 

>> LANCE BROOKS:  All right. It looks like we're coming to a conclusion of this lively goal session here, panel. I would say that if you're looking -- I got one minute left. If you can do it in 30 seconds, I'll give you a comment.


>> MARY ANNE NAHENCART: No, I just was going to point out -- I'm Mary Anne Nahencart [phonetic], formerly at NSF and a lot of interagency biotech stuff. And I just wanted to point out that there are no representatives here from the law enforcement community. And I think if there's a problem of communication, I think we heard an example with the Agriculture Department having really good connections with the microbial forensics. There has been a microbial forensics component at the FBI Academy. And I think that it would have been interesting to have somebody from there or nearby at this meeting to help with the communication.

>> LANCE BROOKS:  Thank you. So with that we're going to conclude this panel. Let's give a round of applause for our panelists and for their great work. Thank you, gentlemen.