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Fauci was positive about the Sanaria vaccine efficacy study. Bill talked about the limitations for use in low income settings of the Sanaria irradiated sporozoite vaccine, and by contrast the value of this approach to learn about protective immunity and how it might be induced by a vaccine that is more practical for low income settings. Fauci suggested that the mechanism is likely to be predominantly CD8 T cell mediated immunity in the liver. He indicated that the NIH will do durability and heterologous protection studies at the NIH and Steve Hoffman has funding to do an initial POC study in Africa. Bill reiterated that the deliverability of the current Sanaria vaccine is a big barrier given the need for liquid nitrogen storage, putting aside the ability to manufacture at scale and affordable cost. Bill then talked about issues of RTS,S deployment given the limited efficacy of the current vaccine and that we do not see wide deployment of RTS,S given its relatively limited efficacy. He noted our commitment to a second generation vaccine with either better efficacy for the individual or with sexual stage-gametocyte component that would block onward transmission. The discussion turned to drug therapy, the importance of drugs that can clear gametocytes, and the potential with highly effective test and treat that included a drug that cleared gametocytes to drive elimination. Cancer: Varmus discussed infection-related cancers in the developing world, in particular talking about HPV and HepB related cancers. He focused on the potential to scale HPV vaccination with fewer than 3 doses potentially providing meaningful benefit, referencing a GAVI study in Costa Rica which indicated that 2 rather than 3 doses could be equally effective when focusing on 9-11 year old adolescents.. Bill talked about Serum Institute of India HPV vaccine candidate that could come in at <$1/dose. Varmus also referenced a nonavalent vaccine by Merck which would cover 90 percent of cervical cancer. The group discussed some of the myth and controversy around HPV administration in India leading to deaths. Varmus turned to Epstein-Barr virus (jaw-related disease) related malignancies, the geographical association between high malaria incidence and greater risk for Burkitt's lymphoma. Varmus also talked about Medimmune EBV vaccine candidate abandoned for uncertain reasons around the time they were acquired by Astra Zeneca; the vaccine was not aimed at preventing infection but appeared to have an ~80% reduction in Infectious Mononucleosis; it is unclear whether it would have a similar impact on Burkitt's lymphoma. The topic of RNA vaccines came up as a possible approach to rapidly test antigenic constructs, including the Novartis approach and one from CureVac. Diagnostic tools to detect these and other infections were discussed. Bill talked about nucleic acid based diagnostics -- the promise of a low cost, platform has not yet been met (e.g., the GenXpert for TB) but might get there in the next 10 years. The discussion turned to which countries are most nimble and efficient to develop and test practical and scalable diagnostics and intervention testing, and the potential value of emerging economies (Brazil, Mexico, China) rather than the lowest income countries to this end. Cookstoves/Indoor air pollution: Collins acknowledged the challenges of getting something that would be properly taken up and used and the weakness of the data showing benefit. Bill noted that we need data -- what do we need to remove to have a health benefit and can this best be achieved with a new stove or an