Transcripts For CSPAN2 Pandemic Biosecurity Policy Summit - Part 2 20240714

There are going to go ahead and resume. Once introduced quickly our panel of speakers. This represents more of an institutional leadership and Innovation Panel where pariente have Anne Schuchat from the center for Disease Control and dr. Daniel salmon director of the institute for vaccination safety at Johns Hopkins university. We are very hard to have that there Maurizio Barbeschi health and security interface from the World Health Organization join us and hes gone above and beyond the call of duty as he came to los angeles and took the red eye to be here this afternoon so he has gone above and beyond the call of duty. Our final panelists is that your irene koek the administrator for Global Health United States agency for international development. We are going to have a similar format for a last panel and i would also encourage the panelists if they feel the urge to ask one of their copanelists a question just interrupt me and do it and if i asked the wrong question as david said on the last panel just restate the question you would rather answering go for it. I think we are way behind so we can probably go to audience q a. There a lot of things we have talked about and i know they would like to Say Something so we want to make sure we give you an opportunity to ask questions of this esteemed panel. Dr. Schuchat and Everybody Knows you are our nations Public Health authority so we are pretty much familiar with the agency. If you want to we thank commission and the approach and talk about the great things that the cdc and colleagues are doing and many friends of mine thats great but maybe one way to do that is maybe you can tell us what we learned from past outbreaks and even a pandemic that i know you were in the middle of the 2009 and other outbreaks that we can apply as lessons observed for Lessons Learned for future outbreaks. Its a real pleasure to be here and appreciate folks who have stuck with us the whole afternoon. Its just been 10 years since the h1n1 influenza pandemic struck and we are, we have learned a lot from that and in some ways are a lot better off than in some ways theres a lot more to do. I think a key lesson there was the value of everyday systems. I think sometimes we want to have a the Fire Department for fires in a whole different Fire Department for bio terrorist events but i think the work that we do year in and year out the seasonal flu helped us with the h. One and went pandemic and their efforts has been to strengthen to prepare for seasonal flu. Whether the Laboratory Work the communication work the partnership the trusted relationships with public and private sector u. S. And global relationships exercising every day instead of waiting for the big one, i think thats a critical theme. In terms of learning from the west africa ebola epidemic as you heard its not enough to come in when theres an emergency. The countries that were affected in and the global Health Security agenda was really about taking sure every country could prevent epidemics and the world could search when needed. However that is we dont want to just come when they are in the middle of an ebola problem but we want to be working sidebyside with them to strengthen their systems. We are focused on the Public Health system and as with much of the primary care system. We use the Emergency Operation system to address trying to eliminate motherless child transmission of hiv are yellow fever or other conditions. We tried these Laboratory Networks and the workforce compassion for the problem of the day. I think we have activities and 57 countries right now. Very much focused on critical government priorities like pepfar or the Malaria Initiative but very much about the global Health Security and strengthening everybodys capacity to deal with the priorities they have. Thank you anne and actually id like to have dr. Koek from usaid jump in. I know the person who is sitting in your seat at usaid recently traveled maybe over a month now with dr. Read feld improperly came back for some interesting observations that have impact for both usaid cdc and other government agencies. Can you share some of the experiences and observations that you are think about both usaid and how that integrates and dr. Schuchat me jump back and let the great work you are doing in collaboration. Thanks. I would echo annes appreciation for being on this panel and being with you all here today. We are the Development Agency for the u. S. Government so please do work and health is one of the air areas working but certainly work in a number of other areas critical to building the capacity. To build countrys capacity to do all of the things whether it be and health or overnights etc. And help you work acrosstheboard closely with her our colleagues at cdc in a number of areas. We do have a number of programs and the congo. On the last panel for the big issues with this outbreak is it is in the middle of a war. War has been underway for a long time so it becomes extraordinarily difficult to do the kind of ongoing programs that you would be doing in that situation. Dr. Golden who was my predecessor in march with dr. Redfield and just last week tim ziemer who is the acting administrator for the assistance work we do was also there working with the current ambassador on communities affected. Whats really clear is the complex emergency that is underway in eastern congo is absolutely getting in the way of the kinds of interventions that we want to do that ultimately worked in west africa and worked very much in the last outbreak on the western side of the country. What is also coming clear and there is a lot of consensus about the need to do a much more holistic approach. Not just medical interventions of people coming in but what are the needs of the community and what does the Community Need and what do they want in order to bring the interventions we need around the ebola response. We talked about it in last panel its not just ebola is the issues being faced there. People are dying of malaria and dying of tuberculosis. Women are dying in childbirth. There a lot of issues on the ground and lots of fear with everyone coming and so trying to engage very actively with local communities and local ngos that faithbased, church and other annotations to try to reach the community on a much broader scale than simply around inspection prevention control and as well as the vaccine really does make you feel much more holistic and thats certainly the impression might colleagues have come away with. Dr. Maurizio barbeschi id like to turn to you if i could. You are heading up the interface at the World Health Organization i suspect many in this room may be or not familiar with the health and security interface so first if you could gives us an overview of the Health Security interface and impact how that supports pandemic Public Health Emergency Preparedness and your work with cdc and usaid. Thank you and thank you all. Its the result of the failure of the International System to have the definition on Health Security. Global Health Security for the u. S. May not be the same definition or understanding of the security treatment for health in another part of the world. Most of your Intelligence Surveillance interview investigator may mean certain things from Law Enforcement and civilians may not the sensitive. Health was central where this understanding was put on the front page. For instance in thailand that contributed to the investigations here and it killed 1500 people in the 1920s. That wouldnt apply to political possibilities with the u. N. Making the case and which kind of patients to sample. A similar thing when the world uses chemical weapons. Not only the concept and epidemiology at how to get people the proper care but how to preserve, how to maintain this year the event. Also the colic asked the question in nigeria without involving the day when i landed in nigeria but david we asked for help from the police but otherwise we would have never gone out. Its basically impossible to move and have one contact trained that they without a police escort. The now of course you have to ask which neighborhood to go with the police in which neighborhood not to go with the police. We elucidated in essence we are facilitating across all the systems. To exploit all those opportunities for w. H. O. Into the security sector. If you have a normal response for the pandemic you cannot do Public Health without the roadblocks, people bringing the food to the quarantine. Really its a multifactorial and we should start recognizing that we are just a really complicated pandemic when you cross the border in three countries like in 2013. Read it on line with is three different Health Systems, the same tribe. The same tribe which wasnt very friendly with each government so going back to the dialogue what w. H. O. Contributes us to have those messages across many countries. If there is an event which is deliberate or suspected which country are going to be listened to . And reflection point that could offer the answer. He dr. Salmon i want to inject a new but very related topic into the conversation and would like to ask you how you see the role of vaccines with very specifically Vaccine Hesitancy and how that may impact preparedness or response when a vaccine will be absolutely essential. Thank you for the opportunity to speak to everyone today. Its been an interesting day. Its a great question because my experience with h1n1, and speaking as an academic. The time i was responsible for overseeing and coordinating the vaccine Safety Monitoring Program at the International Vaccine office. The point about the value of 14 influenza control efforts are really important because what we had to work with was what we had at the time and i remind you what the secretary of defense Donald Rumsfeld said about when you go to war you use the army you have a army you you want and thats the reality on the ground. When you look at things like vaccine safety for example. Vexing to use routinely are very safe and thats very fortunate. Flu vaccines are very safe. Theres always the possibility of something you dont expect as was the case in 1976 with the swine flu. You have to always look for that and if youre talking about a vaccine where you have experience the potential for real safety problem to occur may be greater but you also they have the problem which is if you vaccinate everyone today every bad thing that happens tomorrow happens within a day of vaccination and thats the problem domestically but especially a problem in parts of the world where more bad things happen every day. People naturally assume the temporal relationship is a coppola relationship and you will say look at all these people that got the vaccine and then something happened. We need science to separate the coincidental from the true adverse reactions. Science takes time but the more of the structure you have the better and the faster you can respond with good science. That infrastructure needs to largely exist before theres an emergency because they dont have time to go oh now we can put this thing together. One aspect thats really important which is in the report has been shared his trust and trust specifically in Public Health authorities. This is very complicated. What makes people trust Public Health and is probably a whole bunch of things from transparency and equity and a lot of different pieces that have trust. We understand it and we dont measure very well. We need to do that. For health is important you measured in the improve it and we need Peoples Trust and their confidence. We need their confidence in our Public Health measures that the benefits upgrade the risks and we are doing the right thing. The end of the day we need their compliance. He you brought up the relationship with seeing a vaccine and something bad happens even though there is not a causeandeffect and the trust issue. We seem to be in a state right now where the public distrust of public figures. How do we rebuild that . We need to address legitimate concerns. We all his appearance have legitimate concerns. How do we rebuild that trust and develop effective education and Communication System . Those are Great Questions and we are at a point where trusting government is well. We are in a world of alternative facts were somehow something can be said within a short amount of time have the population questions the birthplace of our president. So i think the problems are complex and the solutions are also going to be complex. I think we need to make sure we have the rigorous effective science. Think it needs to be rapid. The tape the autism example it took longer than it should have for us to have it. We had really good data. We had 15 wellconducted studies the founder of the world showing vaccines are not associated with autism but in a time for when that paper was published when science became available you have a very charismatic wellcredentialed person traveling the world creating fiction. I think we need a spokesperson who is really really trustful and we need to address it that way. Even if in the United States certain countries or certain areas you possibly listen to tom brady more than local health there are countries where if you start they will go directly in the other direction. The issue which has been researched but not that well because by the time the Research Gets done social media really changes the opinion and becomes much more of the phenomenon. Its an iteration of the complication. I have a lot of thoughts. [laughter] i need to calm myself. One thing i want to say we are at a record right now with more ebola cases this year than we have had in 25 years and larger and longer outbreaks in a couple of areas of the country which are really quite difficult to control to. Think its really important for people to know that here in the United States most parents make sure their kids get vaccinated against all the things that are recommended and in fact if you look at 2yearolds its 1. 1 of them to have gotten no at all. We are not in crisis mode across the country everywhere with everybody opting out of the system but i think we are really delicate period in terms of trust which i think building up panel is really local parties to be the people trusted their family physician. They often trusted their mom or the grandmother right now a lot of parents and grandparents have different opinions that we are in a New Territory with that. I think there are many other influences and some of them are pacifists and some of them are active. The current outbreaks appear having some of the influencer at this targeting vulnerable candidates with very targeted misinformation. Thats quite challenging but its not as problem. You look worldwide there are a lot of different factors including confidence of vaccination confidence in the Health System and this is where we cant put all of our eggs in one basket of the perfect spokesperson are the perfect role. You need to look locally at the Public Health systems. We need to make sure we get the best information so partners would be more trusted than we are. It is really about who is the most trusted voice in a given setting and getting that good quality scientific information in a way that is understandable and observable to the people you are trying to reach. Complicated studies for. Understanding the lancet is not something necessarily my sisterinlaws going to just dandy want to get that information in a way thats understandable but really understanding who are these folks in a given area. There is a lot of evidence from the behavior change colleagues who have really looked at this. How do he get that information out in a way thats going to change that behavior and can be understood and trusted and look back at some of those approaches as a way to try to get on top of these kinds of misinformation and misunderstandings. I think we need to be careful not to respond. There are two places that im worried about in particular. One is there is a push to eliminate nonmedical exemptions and i understand the desire. My concern is that it doesnt get at the larger issues. The impact on california which did so in response to a Measles Outbreak in 2015 is that the impact was really small. It reduces the economy and disproportionally for lowincome people that might not be able to afford their shop doctors. My concern is that of trust in the herens feel like we are being more draconian they are maybe a backlash and also the question of social media. That the letter itself is misinformation is coming from government leaders. I think working with social media is great, and much rather see it done between individuals. In the Companies Taking social responsibility. I think we have to be careful not to over respond and feed into the missed trust problem. We met of our over response is probably thriving and dividing the date that we have on both sides of this right now. We need to avoid that. Unlike politics, we need 95 percent compliance genius sleep across the population indefinitely. We dont want this to be a divided issue. We need to bring people together. We need to sustain that success. We need to keep it that way. We need talk about innovation and technology. We do share a little bit about cdc and how theyve advanced innovation and technologies and responses and part of the culture of cdc . So my bill brought it a little bit in contrast where we are right now. There was an enormous effort to get Laboratory Confirmation of ebola cases in 2014 and 15. Because of the diagnosis. It meant you needed be separated from everybody. Inflammation on all of your contacts in the Public Health response. Is this very fever due to malaria or ebola. Funny 7000 were shipped by helicopter to a lab that cdc is set up for the kind of hot lab testing. Well today, with decentralized labs, you need to be able to know how to use it and have a safe way, screening to see what they have. Just that diagnostic in a few years is really transformative. In 2014 and 15, partners did trials experimental vaccines that i cant believe we did these trials. The trust issue was humongous league complex. People thought we were told in ebola vaccine to the community its a vaccine that gives you ebola. Many of individuals got vaccinated under study protocols showing that the product was safe and again showing that it was effective. Crc today, 110,000 people have gotten vaccinated without which we wouldve had so many more cases. As the Previous Panel said, these technological advances are not silver bulldozed bullets. You cant deliver them without trials. You cant get the staff to feel comfortable providing vaccine or giving care, if they are being targeted. The response has been the target of many other agendas. Innovation where there is technological tech or manage Main Management or it doesnt take away the requirement of Community Trust and engagement and mobilization. Most people think of usaid as fully involved in international development. Providing aid, and i for one have seen firsthand that you guys have made, technology and the approach to the problems. Could you expand on that . Much like talking about the innovation, usually important part of a lot of what we do. Is not the only thing. Across the work we do in health and every single component, there is a certain portion of the effort given to pushing the envelope on innovations. Weatherby development, were doctors, and eight h does. New diagnostics for tb or the better Drug Resistance tb or trying to help with the fence working with gabi getting the ebola vaccine into the field. All of the kinds of things we are trying to do. It is not a Silver Bullet but it can really make a difference. Revolution in Data Technology can really make a huge difference so how do you build that into the system. A lot of the work we are trying to do is to take this Fabulous Technology in all of the help information can be on your pho phone. We need it into the health and primary care physician. Then its really useful and useful to the people using that data. A lot of the effort is trying to refine the technology that is out there. Really make it the most useful for getting to the end of what we need, the outcomes. Healthy population. Healthcare workers that have the information or the tools that they need to make the difference at the end of the road. Who . The same type of companies that have a lack there of. When we speak of innovation, we should also speak of the capacity of the different parts, intellectual thoughts and think about all of the research is possible. There is a debate on the research. Who could or could not be using it. Its not to be linked with any of the conversation we have here. We have to try rather than running after the next experiment, we should select which kind of technologies are going to help us in the next ten years. Then before or the merge of the two, we try to see what it is that we need to enter and manage. You mentioned vaccine safety research. But that takes a long time. I suspect there are some innovative opportunities there. More rapid in realtime, evaluation of vaccine safety and efficacy, i know actually a big champion of Operational Research as we were deploying things. Would you mind speaking to that and your ideas on that question. I am happy to. Huge opportunities. One is large databases in one medical record and under doctor lawyers leadership, we were able to create a prism, it is now part of fda, is the largest active Surveillance System for vaccine safety. With these large databases, you can do bigger studies. The infrastructure is really helpful. I think the other place where there is tremendous opportunity through science is in genomics. Adverse no makes, most people respond well to vaccines. They get a sufficient immune response that protects them. They dont have a serious rate adverse reaction. Some people are not protected and some people overprotected and have mary rarely have an adverse reaction. Thats the role of genomics. Thats really an opportunity to not just push the science further, but to bring in the skeptical parents. When you hear from parents are frequently, i have a Family History of automotive immune disease or another syndrome. Even though most of people, the vaccine is good my child is not. When they are saying is that they think their child hamza genetic factor. If we can do science and addresses concerns, and the science is hard, its difficult and it takes time and it takes money but its an opportunity for us to go to personalized vaccinations like personalized medicines to hear the concerns of parents and responds with science. Many avoid the very rare adverse reactions. Im going to come back a little bit to the work. What i like to do now is open up for the audience opportunity to ask questions of the panelists. If there are anybody in the audience would like to ask a question, take a microphone and state your name. We are funded to work in the drc by cc and tbs with usaid. I wanted to ask a couple of questions regarding security strategy. We were really pleased to see that file released. The content included. One of the things we were really pleased about is around inclusive and i understand that for the strategy, there is an internal group led by the screw. When you think that might practically to your. So many complexities here. What is that actually look like for you guys to work on that together question work in the global strategy if you look back at the team required response, one of them was future financing. I know thats a little complicated only because omb doesnt want to put itself on the record. I want to ask, can you give us an idea of what the cost of this programming might look like Going Forward for each of your agencies. The drc and other countries, et cetera. I can give you specifics on that. I around global Health Security, they been working really closely together from the beginning. They talk to each other probably everyday. Certainly on the ground, the plans that we were talked about earlier are doing jointly in response to the joint evaluations. The work that the Us Government is going to do in any given country. As planned out between the two agencies. Sorting out who is going to be doing what and his taking the lead. That there is no duplication or what the government can do. Its really important to put this together and build on this kind of work that weve been doing jointly together. In terms of future financing, this global Health Security is a priority for the administration and has been for the Us Government. Certainly in the 2020 request, there is increased funding for usa and for cc as well. And also though on the financing, and the cost today and it varies from country to country. We really do need to look at the country investments. You cant beat just all Us Government to pay all of the costs are the kind of commitment that we seen in global Health Security, as countries theres really stepping up. How very important this is. And what they need to do in putting in their own investments. Let me expand a little bit. Its very fundamental to the culture and building again off of the earlier panels. If we cant measure, we dont know how we are doing. If we want accountability, we need to know how we are doing as well. I think also building on the earlier panel, to really get ownership of global Health Security sustainably, we need not to be just Us Government is doing the whole thing are paying for the whole thing. This has to be country owned and partnered with multiple countries. On maltase laterals as well. In some eyes you can look at this and say wow, its incredibly packed full and successful. In some ways its fairly simple. One single disease that you are trying to a really difficult disease but with great tools right now, one single disease that can have very measured tracking and we can really be investing in whats effective and costeffective in making sure that we are accountable. Security is going to be addressing improvements in the ged is absolutely fundamental in ways to measure. We are really in the early stages of how to monitor and evaluate and take the best up the metrics from some of the other global initiatives but built into a really Health System strengthening effort. The meaningful way to track. We have had a fiveyear emergency simple mental dollars that have gotten a lot of improvements. A lot of countries as well as global partnerships and crosscutting threats. We are not done and this is not something that is going to be, you are done. This is not a forever kind of thing, it doesnt mean the Us Government is going to be paying for it at a certain level forever. There is question in the back. Hello im kathy with a Vaccine Institute and i am working on influenza vaccine particular lady animation. In this workweek spoken to stakeholders from a lot of sectors to all kinds of said that the government and Academic Research Development Architectures really arent bit built for accelerated innovation and risktaking. My question to all of the panelist, is natalie d risk the environment to foster the multisector collaborations and encourage the open source and open data collaboration necessary to make these challenges and problems accessible to different thinke thinkers, nontraditional experts in genomics and engineering and big data. How do we foster that collaboration and encourage those types of different thinkers to join the cause for different solutions. Is really hard. [laughter] [inaudible conversation] i am more optimistic about that than i was a few years ago because i do think that people recognize for influenza. We are not where we should be given how much we have been investing for decades. With substantial scientific investment and innovative approaches to it, we could be in a lot better shape. We spend a lot of money every year vaccinating everybody with the best tools we have right now. But you need to be giving them every year and they dont work as well in some people and some others. There is some incentives for industry to not innovate right now in terms of having a good market. Its not as lucrative as some of the newer vaccines. Whether it is a rule or nihs rule or the governments role, academics role, i think there is a shared expense that we need to do things differently. It doesnt mean i have a solution but having an agreement that is a problem is a start. I think there is policymaker agreements problem. Just to add on that, i think there is also and i very much agree that there has been a shift. To try and moving a much more open and innovative approach. I think there been a couple of tools out there recently, things like the grand challenges which put out here is a problem and we need to better do this. A better way to monitor the vitals from the patients sitting in the bully unit. It did bring in all kinds of really Innovative Solutions from different sources and not the usual sources that we typically look for. There are some really exciting ways to bring in those new ideas from people who arent usually at the table. On data, i think theres also a data revolution. Pushing the envelope and i am opening, openly sharing that data is not quite where we are at. It puts us closer to that place where we can have a much better way to have that data shared. We are not quite there yet. But we are making progress. My colleagues back in the back of the room, they certainly try to be in the front wave of the new programs and my question is what advice do you have to make sure they bring the vaccine safety issues and other innovative programs question mark. I am careful in this regard because a lot of Vaccine Research and development along with the work is trial work. I guess one thing that i think to realize was you have the infrastructure, for example, i was contacted by a Vaccine Company was developing ebola vaccines and asked me the question will how can we monitor the safety it is rolled out in an african country. The challenge was there was no infrastructure. I think that historically at least, that in terms of Vaccine Development that is just outside my expertise to try and give advice on that. Just a comment, in general, the Research Suggests that people dont like new vaccines. We like new iphones but not really vaccines. Theres some comfort that other people of god and that and we are not going to get surprised. In the midst of an emergency where everybody wants something, so one of the challenges is they are been doing a ring vaccination and scout some of the concerns and some of the communities are asking what about the rest of us question mark yet, you know very little about the other vaccine that is proposed to be used in that context. We have a problem that when the Public Acceptance is the highest for something new and potentially untested, we dont have anything. And we have incredibly well studied products like influenza vaccines, people start to kind of wonder about his safety. I didnt mean to also mention that one of the impacts of the 2009 pandemic was a real change in acceptability of vaccination in pregnancy. We went from having 50 percent of women to about 50 percent which might not sound like a lot but that is a lot for obstetricians and Family Physicians and women to decide that this is a good thing, not a risky thing to do. I do think when people see bad events on natural diseases and that there are tools to help them, that acceptance is changing. I think this is acutely a problem. Historically, we develop vaccines for developed countries first, and then after a decades of experience, including a lot of safety in science, they would make it to a low biddle income country which is obviously a problem because those countries often need to vaccines most arent getting them right away. We see mischief were now vaccines are being developed and rolled out first along lowincome countries. But the challenge is the infrastructure safety and surveillance. The capacity is out there as it is in high income countries. Thats really about Infrastructure Investment to have capacity. Im always fascinated by the introduction of the vaccine. Thats only one moment. You dont know who to vaccinate if you dont go there. You cannot vaccinate if you dont have community permission. Back to the logistics, these vaccines need to be kept at any given moment in time. Think of the complications. The other deflection down there, appears to be. [inaudible conversation] certain areas appeal to the young scientists. Together and the concentration in other parts of the plant planets. , iqs and phds, these have been studied when i was there. Another deflection how to facilitate this movement will probably follow what else do we need to d give to the scientists. Is there one more audience question question mark. Earlier docket was mentioned. I was thinking about the diagnostic and local diagnostic industry issue. Tropical Public Health research and the partnership with both of you people in the field is trying to do it in a Sustainable Way when there is no one other than this one person in nigeria who happens to be certified to certify who its for instance in these kinds of issues. It kinda sounds like you two need Capital Funds where you with some support from may be part a and nih and others, can actually do spinoffs focused on local Market Development for biomedical science and Health Security. Im sorry that this guy is still not here, he spent years there. He is very excited about the innovation and de risking and the kinds of problems that karen and i are dealing with all of the time. What do you think that the usual approaches are challenging. We did that congressional support for Infectious Disease Rapid Response fund. We saw so many challenges with the long leg between emergency that we clearly have exceeded that fund me capacity for and that the resources for h1 and one so we have a small panel start. A very different issue. Its an innovation kind of investment. The prices on responses supposed to be one fifth of the expense of a warhead. Not just the technology, the knowledge in the capacity, if this goes well,. The other thing i would add just very briefly is that i think this is also been a lot of interest in bringing in the private sector investments needed in the space. I think theres a whole number we can do without. I have one more question then we can keep a brief and we talked about it before early in the day but i would like you all perspective on this. The question is, and will start with you, how you doing today in the Ebola Outbreak compared to 2014 and 2016 . Are there different ways you feel about that question but one of the differences today versus 2014 and 2016. Nine organization but we as a community. Anthropology and the outbreak is in 2013, is that we always found that phenomenal that we are local. Same family crossing moving in a space of three countries. We treated the problem geographically. Because we followed it and thats the only thing we have. Quite possibly we should use marketing and design the outbreak. In nigeria, 20 percent los without vaccines. Than the current one. We entered myself and others entered into the ward to talk to the patient to speak with him and joke with him. People are dying of desperation because they are upset and they are sick and they are abandoned in his own words. There is only thinking about today in the vaccines. This should be much easier. Its one of the most potentially wealth in terms of resources and everybody is having a piece of it. So they are fighting for it. There are five levels of differences. From the political to the community and from the mind to the and so on. We didnt have it. So it is one of the companies things. Last but not least. If we were to lose a patient for lack of effort, we wouldnt be here speaking of the differences. It would be history. I think that the last panel sums up a lot of things. The big fundamental difference between this outbreak and where we were in 2014 as quite frankly, the public emergency setting which makes it extraordinarily different. Its a kind of things that weve been talking about. The similarities and the need to understand that one of the issues in the Community Level and what can we possibly reach people given that setting. That becomes a very difficult thing. The other pieces talked about is that we do have the vaccine. It has been said that it is made a phenomenal difference at this time and it is a tool, there is no Silver Bullet. It is an incredibly powerful tool that we have. Reaching people and trying to overcome some of those fundamental issues of distrust. And concern. A whole lot of other issues in addition that people are most affected. We have to figure this out. I would say there are some really disturbing conference to make. Despite the country, the Global Community responding very rapidly. They identified the virus themselves. Despite that, it is getting worse, not better. Despite hundred and 10000 some people having been vaccinated in products being tested and so forth, it is getting worse not better. Our ability to change that trajectory has very limited as from outsiders in the context of where it is occurring. Beyond the vaccine, that is helping kind of keep even though it is getting much worse, the vaccine is keeping that at at a slower pace. Theres also this enormous investment going on the border screening. Theres one tribe, people crossing borders into uganda, vaccinations uganda rwanda, it is really, we cannot stop intensive response and we have to become creative about how to support the community. This could get so much worse. It could be in many other communities. Its already in 2122 health cells. There are active cases. Dan is an International Health professor. I dont have anything to add to this discussion. Tmac i want to thank our pane panels, its been fascinating and i really appreciate you taking the time joining us this afternoon. [applause] if we can ask our final panel to come up. I buried deep introduced professor. [inaudible conversation] we will moderate this panel and i will turn it over to andrew to introduce our panel discussions. Andrew. We are at the final panel today. We have to people who can manage politics. Ron claim was the chief of staff due to american Vice President to al gore, in the Clinton Administration and he was chief of staff to joe biden, when he was Vice President under president obama. He is i think the Senior Executive in the capital fund the most important thing however, he was the star at the bullet outbreak. He is a toppers in the white house which is why we have invited him here today. Jim greenwood, is the president of anzio a biotechnology innovation technology, and a member of the Blue Ribbon Study Panel on bio defense. His former house representatives member. In pennsylvania, and in the state senate so he is a career politician. I see that as a complement. I was a career politician myself. Some people still think i am a politician. I think actually what we are dealing with is political management. These emergencies because we are dealing with issues that are really not health issues. They are lack of trust in government. Not just here but around the world and the social media now, is misuse of that is a political issue. It is not a health issue per se. It is affecting health. In any case, want to read something before we start the discussion. This is from john perrys great book, the great influenza. Its probably one of the best histories of the epidemic in 1918. One paragraph. Victor on was the dean of the university of michigan medical school, one of the two leading Health Scientists in the United States and best friends with William Welch who for 30 years or 40 years was the dean of the Johns Hopkins Public Health. Victor bond, sitting in the office of the Surgeon General of the United States army, and head of the armies division of communicable diseases, watch the virus the influenza, in 1918. Move across the earth. Hereof this in his own hand. If the epidemic continues, it is mathematical right of acceleration, civilization could disappear from the face of the earth within a matter of a few more weeks. Now this is not some crazy person, one of the two top medical scientists in 1918, in the United States. He wrote that in his own handwriting. Thats the panic that existed. We are going to face the same sense of panic. We havent yet. We have had two or three people got sick with the bullet in the United States. You saw what happened. There were headlines. Imagine six hundred thousand people died. What we are going to deal with a whole series of political issues which i think we are not prepared to deal with. We have been warned now because of these viruses and the diseases that have spread now. Fungus that have spread in the hospitals, very dangerous. And so we want to talk about leadership in vaccine and epidemics which is a political issue. If i could start with you jim, given your leadership role now but also your previous career in politics. Could i ask you to begin by looking at the question of the complexity of the enterprise with the Public Sector and the government, the nonprofit sector, and corporations in developing the bio defense capabilities of the us to meet one of these crises in the future . Thats easy. Where i come from, my recent perspective in the last 20 years or so is to lead the trade association for Biotechnology Companies as membership of about a thousand of them. A number of those are companies are in the vaccine business. I guess the first thing i need to say is that inventing and innovating a drug of any kind, is extraordinarily difficult. We fail 90 percent of the time. If you look at alzheimers, we failed, basically 100 percent the time. Scientists say is really complicated and one of the reasons drugs are expensive is because of the high failure rate. Now imagine your company, in particular a small company, which want to do is make Counter Measures against endemic and bioterror attack. You know that essentially you are only purchaser the only entity thats going to buy your goods as the government. So now you are at this highly risky enterprise trying to meet a need that is not been made perfectly clear by the government. Youre not sure that its going to be approved and then very uncertain about whether it is actually going to be acquired. And whether its going to be acquired consistently insistently and whether the funds will be there. So now imagine trying to attract investors into this enterprise saying so i like to invest mine in my company. Were going to try to make some important measurements. We probably will fail. If we do succeed, we may or may not get it approved and if we do get an approved we may or may not ever have it purchased by the federal government. Its a risky proposition. But nonetheless, companies are busy doing that. In an effort to participate in this effort, this Blue Ribbon Panel by former senator and governor and Health Secretary tom ridge, several people. We have been setting this reef for five years. Great contribution. The biggest problem is that number of problems, this is one of those things where the last big epidemic which was a hundred years ago, congress is not good at longrange thinking. Even though the expert saying there is inevitable seat to the horrific pandemic. There is inevitability to terroristic attacks. The thousands and thousands of items on the agenda of the congress are such that this doesnt come to the fore. When we wrote our first report, at my suggestion we began with a simulated hearing. A congressional hearing after the fact of and thousands and thousands of people have died. Members of congress holding the hearing were calling saying the federal government shouldve seen this coming and they were asking why . We did that is a message to congress saying let us not wait until the horses have left the barn to prepare. So that is what we are desperately trying to do and were trying not to be just another report this is on the shelf somewhere. One of the things this goes to the leadership question, we zeroed in on the responsibility for these issues is scattered throughout the government. There is no unified budget. No unified chain of command and so therefore, its high load and contradictions. The left hand doesnt know what the right hand is doing throughout the federal government. We thought that would what was important was to have a centralized individual who had ultimate responsibility to give that responsibility to the Vice President of the United States. That is not happened. We have not succeeded on that. Right now the leadership is with the secretary of health and human services. Used to be on my board. The problem that he has as good as he may be, he is a conflict with the department of defense for homeland security. He doesnt have the clout of just one of the secretaries. He doesnt have the clout to say you will do x and y. So thats what we filled it should be and needed to be in the white house and in the hands of the Vice President in order to provide leadership that we think this issue desperately needs. Ron, you are the closest thing to the Vice President being chosen because your chief of staff and president obama appointed you as the czar for this. In some ways you had the authority of the vice presidency. I left the office a couple of years before. But you came back. But he came back but i didnt report to the Vice President , he wasnt involved. Look, i think a couple of things just to kick this off. One, i want to really command the institute and texas in the white paper. I think its a very exceptional document that collects really powerful recommendations from across space and puts them together. Its really great work. They read it and followed it. We are here at the hundredth anniversary of the 1918 spanish and flu epidemic. I think its been said starting to think that its an event that americans know about. And yet, 100 hundreds of americans in world war i and world war ii thought that you can barely hear a word about. A collective and forgotten memory in our country. Thats one reason they dont really react to it. Obviously in a hundred years, a lot of technology and innovation make its safer than we were 100 years ago. It actually makes us los safe. Globalization the Rapid Transit people, Something Like this happens again, it will go around the world a lot faster than in 1918. A lot more complicated factors. I think first, in the report, spot on and essential. Second, i think there is no replacement in tackling this global problem for us leadership. Not to say that this is in a multilateral. It is a global problem. No question about it its very important. But for better or worse we are indispensable nation and addressing this global challenge. Whether its our Technical Expertise or resources Healthcare Systems are experienced. There is no replacement in the us being at the forefront of this. I think we are at a place right now in our country where there is a lot of question whether we are going to be at the forefront of this and i think weve got to get past those questions. We need to make sure we are leading. The third thing i want to say about it is, this should not be a partisan issue. Im a partisan and unapologetically, democrat in front of it. I have lots of issues and i am quite outspoken on that. I think on this question, you should not be a democrat or republican issue. The viruses dont look at the political affiliations before they infect people. This is not something that we should divide ds and ours, it is something people should work across the party finds on. We talk about some of the bipartisan leadership on that. During the response we have a certain amount of politics, democrats or republicans came together and funded 6 milliondollar response. Theres been some here in the world have helped turned around the Ebola Outbreak in 2014. I hope that we can keep it that way. Keep it bipartisan. Having said its not a bipartisan issue, it is a political issue. When we talk about Public Health, we are talking about engaging the public. We engage them in our country through politics. Whether that means some of the issues in the panel before us was discussing about responding to anti vaccines sentiment, responding to isolationism, responding to antiimmigrant segment. All of these things, that complicate our response from Infectious Diseases. I think that politics and people in the Public Health community have to be unafraid and willing to step into the political arena and provide the kind of force for the kind of actions of this report and others recommend. Last. On this white house thing. I absolutely believe we need leadership at the white house and i do not think it should be the Vice President. He is a fulltime job and ready for and responding to other things that is also a fulltime job. What he does in his spare time, doesnt seem like a good idea to me. President obama after he brought me into bring bring the ablest response, when i left, we gotten into the curb and bent down. He appointed a Senior Member of the sec staff to be in charge of the epidemic response. President trump continued the that at his first year presidency. That position has been terminated. I hope that the president ial trump changes his mind and brings them back in that position. Whoever he or she is. We need someone leading this at the white house for some of the reasons jim said. I think it should be a fulltime position. Not the Vice President. If i could just come in and on that. That is a debatable. I think the fact that we have it decided on that indicated an indicative of that. The thinking that we used here was that of course the Vice President is going to be doing the things that Vice President s do in the present was never anticipated focused on this the whole time. Rather the vice present would appoint someone who is capable and qualified to take to do that leadership. I would then be able to when necessary and simply turn to the Vice President and say, i need some juice. I need you to knock some heads together. And rethink the Vice President has the political clout to do that. Influence also on the budgetary process in the white house. Most Scientists Say that the biggest threat we face and scares people most is still influenza for its various reasons. Last year was the worst year in 20 years for influenza or the flu. 88000 people died. I bet most people dont even know that. Thats from cdc, 88000. In 2009, cdc reports that 1. 9 billion not million but billion people in the world got the, endemic but had an extremely low death rate. 1. 9 billion people got the disease in six months. Thats how fast it spread. I think you were the one that said we created, our eighth air force by the way is the best thing that ever happened to pandemic. They will spread the disease overnight before they know whats going on because of the greatest transportation in the world. Two questions for both of you. Both related to influenza or the flu. One is the National Strategic stockpile was established 20 years ago before 911 and before the anthrax attacks. Its evolved and is it really a model that we should be using to protect ourselves particularly lead against the flu that is one question. In the second question is, what could we do to create the incentives for industry to perhaps invest more money, research on this, for universal flu vaccine. Which of course comedies are working on right now. Is there anything we need to do to change as the senator said this morning, the architecture of the system and the census within the system so that we can get some kind of vaccine before it happens, before the next pandemic place. Those are obviously very closely related. I dont think that the problem is so much with the architecture although, all yield to the senator on that. As much as it is with the funding. The liability of the funding. I think unfortunately a few have 535 members of Congress Sitting here, and they asked them what the likelihood of a 1918, era pandemic, i would guess that the vast majority of them would not think thats possible. They would think that we have had so many medical advances in the last hundred years that of course that could never happen again. Of course the flu is as regular as anything can be. So they see the flu, they see people get get sick and they know some people die but they usually think they are probably old people who are going to die anyway. But they dont recognize that having a popsicle of the pop apocalyptic scenario is would really happen. Again, in congress, this is not the top of the issue, for the public so there is no public pressure to do this. The one thing that i could say it if the structure were wellfunded in the industry can rely on that, the investors could rely on that the money will be there, in the procurement will happen and is worth the risk. When the ebola first round occurred, comedies lost money. They did a patriotic thing, it was humane thing to do. They turned away from other projects. They are still behind in some projects because they brought attention to this. The epidemic was over and there they were. No one to procure the products. They do this at great risk. I think of the funding were there, the sense of urgency were there, the industry would respond. On the partisan issue, youre absolutely right, there is nothing partisan about this issue. But there is a way in which partisan ship present. It is this. What is desperately needed is oversight. The oversight subcommittees of all of the committees in the house and the senate, any dire responsibility to look into these prop programs that they are funding. The oversight function is the kind of function that doesnt have to be an emergency in order to occur. Its the kind of function that congress is supposed to do on a regular basis to look into all of these programs that are important and received them. As long as both parties, and lets not get into the politics of this, but both parties continue to monopolize the oversight function on political matters, then there is not enough time for the things that are important. There is no need to go into what the what has been justified in what is not been justified in the last many years in congress. In many instances, the public will be Better Services that there was time for the oversight committees to do that kind of important work. I just had a couple of things. I wasnt involved directly in the response but i lived through it as white house staffer in a way that i would say about it is bunch of talented people and we did Everything Possible wrong. 60 million americans died in that period of time. Its just purely of fortuity. It had nothing to do with us doing anything right. Just luck. So if anyone thinks that this cant happen again, although back to 1918, they just have to go back to 2009 or 2010, you can just do the math on that. Mask out casualties. When that telus, it told us that the vaccine will arrive late, told us that its not prepared in advance, we dont have the answer before, we are not going to get the answer in time. Told us that our systems were deciding how to distribute and administer a vaccine in a time of crisis. Its going to be badly tested. It also told us whatever thing. We lack mobile policy mechanism for dealing with these untested vaccines in an emergency situation. No we saw this a little bit in 2014, just as from the tail end of the outbreak, from these new experimental vaccines handsome phase i testing. Anaphase two. We wanted to get them into the field in west africa and had immediately had issues who would be liable if they made anybody sick. If there were different claims and who would only intellectual property from the resulting testing of the vaccine. We kind of found a way to bandaid through that instance. Its pretty clear that we have the prep act. There is no global prep act. There is no global structure. A lot of companies were very worried about their exposure in that circumstance. You can imagine the scenario, we kinda face a little bit of this in 2010. H1 and one. It didnt arrive for us in time. He got in time to europe. Then there was a big controversy in europe. Theres been a life or death situation policy wouldve killed people. Or the absence of policy would of killed people. One thing we can give dave now is try to get together and try to figure out a solution on this liability issue. It works worldwide such as the us. And deal with this. One thing we know for sure is that if we have to deal with it in the moment, it is going to be very bad. On the Global Nature of this, as fully prepared as we are, i dont think there is a country in the world that is better prepared. Thats not good news. What is really writing about it is should you have an outbreak summer, that could readily arrive here, and we have countermeasures that could be responsive. How do we tell our fellow earthlings in other continents that im sorry but we have to hoard arson case to protect our own people. That is a very difficult and humanitarian decision to make because i think we would make and its really does require a lot more global coordination and lot of work by the nations as well. I would. I would say the development is not the owners of the United States. Theres no way were going to prevent this from getting into the United States. In other words, the infectious nature of whatever the virus is, like measles, hamza very high infection rate. The bullet actually is a very low rate. Following is a hamza high rate. It is going to get into the United States. The first line of defense is in the developing world, not here. For me at least, we need to respond immediately to try to stamp thing out before he gets outside the country that is arson. Thats a hard sell in the United States because people say why do we worry about ourselves . The reality is we cant. If we want to worry about ourselves, we need to extend the help to the rest of the world. Spak this is my opening comment. The isolation is intimate in our country right now is one of the most dangerous dynamics we have. We cant have Public Health safety in the United States out of the context of global Health Security. As eddie said, in the event of any kind of pandemic or whatever, we had millions of cases of age one and one before we knew it was here. And, that can be true for whatever comes down the road. The only way to keep our people safe is to engage globally in making other people safe. Thats why us leadership is so important. This is an area where the Public Health Community Needs to speak out. Ill just be very honest about it we saw what we had as he got, in 2015 and in 2016, very slow action in the congress. In funding the response that president obama said to the congress. Ten months away. I spoke a lot about this a lot of reaction was easy god is an immigrants disease. When we just keep the immigrants out which in all just keep the immigrants out. And, that mindset really impacted our response. I fear that mindset a little bit colors our reaction out to different Global Health challenges and how we engage in the world. I think that we gotta get past that and rally people in both parties, rally people of goodwill across the globe perspective to understand. We understand this with terrorists. With terrorism, the only way is to engage on people around the world by the time the threat gets your comment is too late. Is the same mindset. In terms of building global Health Security around the world is the best way to keep people safe here. Even if the sediment is the europeans and the engines have to pull their weight and make their contributions, financially and so forth, thats assuming that that that is the case, you dont get there by retrenching, you could thereby leadership and by having these conversations around the world. Contributing but also encouraging participation on the rest of our members. Can i get both of you to comment on something. Three years ago, released this conference the first one. Which is the fact that who, did not perform well in west africa. I think is performed much better since then but is not quite there yet. What needs to be done to finish the process of reforming and strengthening these because they need to play a central role in this in terms of International Court nation in the event of an emergency. Can both of you comment on that. Not very well. [laughter] me start that. So who did a very bad job on bullet in 2014. I think they are doing a support job right now in response to vrc. They were doing everything now that they did not do in 2014. Theyve been fast and transparent and candid, quite responsive. Leadership is exceptional exceptional. I think that what this outbreak is showing, is the limitations of who. It is not a responsible organization. The biggest problems we have right now in the drc, is security and stability is the tax on healthcare workers the tax on responders and that Community Resistance and the community is getting violent and dangerous. Who has no capacity to respond that. That is not their mandate. And they are never going to have that. There is a big debate on how much bigger checks more countries right to who but that certainly will help in the drc but not solve the core problem. Since 2015, ive been a public advocate of having some kind of white helmet and security battalion. Something that could provide Security Assistance in the event of an epidemic response. 2014 and 2015, president obama did something that he had never done before. He ordered us troops into the field to help with an epidemic response. 3000 troops in the first airborne in kentucky kentucky and liberia. It work marvelously in library where american troops were welcome. They were welcomed as friends. A blessing to have. That solution is not going to work in congo. Its not going to work and a lot of the places in the world that you have to literally fight your way in. As a bad way to do it for an academic response. This not some sort of local Security Forces needed. What we are seeing in congo, is new but likely to be the new normal. The combination of Infectious Diseases outbreak and regional conflict fighting over resources, fighting over control, thats like more likely to be the scenario in the future. We have to have the tools as a planet to deal with that because if we dont solve this thing in congo, it is going to spread. Its going to spread to some places that are much more populous and much more connected to the outside world and were going to regret the lack the tools the to deal with that right now where it is. Let me just add something. Almost everything thats happening in the congo, has happened before but not in the context of epidemic disease. Its happened with emmons and civil wars in south sudan and somalia and yemen and its been going on for 30 years. Their eyes huge literature on this but none of it deals with publications of the Infectious Disease. This was new and whats not happening is a you and not using the Emergency Response function of the rest of the human system to help debbie ho deal with these instability issues which weve been dealing with for a long time now. We happened in place some things you are correct, the biggest factor in my view is the lack of a powerful and the mechanism for putting together is very dysfunctional. I would never use that. It does not work. It involved in it for 30 years and we need a different model. I think your idea of having the eu is a very good idea because they would be as full stores that philosophically admitted in many respects. I would say i am largely critical of the organization for a couple of reasons. I think they are very political in ways result in lack of a good science surveilling. I think its a very political and that they for instance, seem to be the enemy and it intellectual property which is easy to do under certain ways of thinking that with that intellectual property there wont be any innovation to the meet the health needs of the world. I think that the World Health Organization needs a lot of work. I was unsparing in 2014, i think that what doctor has done with who has been dramatic change. Im not saying theres not room for improvement. Theres always room for improvement. What theyre doing right now in congo, is amazing and heroic. Again i think we have to tell it up. Where we are falling short. The us is not doing his part right now. I think that means in both of resources and helping to put together the Diplomatic Solutions that might help address some of the Security Issues but i do think that we need to recognize the dramatic improvement after bho in the past five years and a lot of credit needs to go to doctor ted rose. Spak may raise another issue which is the role of social media. Its called locating all of this. It is clear that social media is being used for very good things in the world where it openness, accountability, however it is also being used for rumors anti scientific excess such as this. Its not just this field but a bunch of other fields. There is a lot of stuff in the internet that is complete nonsense. So the question is what we do about it. I might add that there is a new study out by and in one of the peer review article done by a Computer Engineering scientist looking at tweets to see where a lot of the anti messaging is coming from. Its not coming from random people. There is a legitimate and what i say legitimate, people are genuinely concerned about it. I dont think the right, theyre wrong but we need to understand the domestic sources of it. However, it is now become a function of great power politics. With the study shows is that tweeting is now being used toussaint and type vaccine messages, 90 percent are anti back messages and 10 percent were pro. It causes more conflict around the world and its not just, it is directed against the United States and it is from russia. Not the Civil Society the opposite. It appears that it is a public source. This study you can rate and the Public Health journal just came out a couple of months ago and is based on a comprehensive study with algorithms that were used to look at mass numbers of tweets to see what the source of the information was. Huge disparity between the tweets in the west and the tweets coming from russia. On the Measles Outbreak. The question is what you do about it. If this is being used a tool of use of strategic competition of all diseases. You know the reason we got rid of smallpox is because soviet scientists and american scientists made a deal in the 1960s to wipe out the disease. One thing we cooperated on that worked heroically. The fact that now this is happening in the opposite way for strategic purposes is very disturbing i think. So can you comment on social media and how do we deal with this issue of social media being used for very destructive purposes for strategic purposes that are destabilizing in terms of a pandemic disease. Ill make a few comments. I think probably most of us at the earliest stages of the internet, were filled with hope. What a fabulous tool this will be to educate the world and to unify the world, to bring knowledge to all. Now we find ourselves in this strange moment in history where virtually everyone in the world has a device in the pocket that enables them to handle it well to find the truth and real science and real facts and viable information but at the same time, were getting dumbed down by it at an alarming pace. It is one thing to think about how destructive it is in this world of anti back sitters and anti gmo and all of this kind of take science that is out there but the real terror is what happens in the midst of a pandemic or bioterrorism. When people are desperately looking for what we do, and where do i go and imagine the flow of this information and that information and mall information that could occur. People would almost be better off throwing the devices in the river. How do we do with that. I think lord only knows. You can talk about teaching Critical Thinking and teaching people how to find their way through the miasma of disinformation. We have been talking about that for decades now. Were getting nowhere. By the end of his education as far as im concerned how we get a handle on his how we educate people to go beyond the first suite or the first facebook posting that they see. Two real facts. Is challenging. The frontline they are courageous in their willingness to change but there were a lot of from other countries. That included not just the United States. West african spreading this information. What are the solutions . I think it was discussed on the last panel about voices of authority and with Authority Comes from a crisis. I would like to think it comes from up high, i would love to think the president , oval office and Surgeon General and human services, but west africa in the middle of this was it came from local clergy, local healers and traditional healers and private leaders and so forth. In social media is like its own kind of community. It is really a very erratically in a world of Global Social media, local social Media Authority take to persuade people the right information and locally prominent religious leaders and the people know and trust off the platform and people who they know outside of the twitter world that they will listen to and have confidence in. We have to build a network of those local leaders who can use social media to drive these messages effectively. This unquestionably in the face of an effort to disrupt a response, this is going to be a big challenge, we will have to have people to know and trust to push back. That is local or national. We have the president of the United States same fake news is news and issuers health does not help. The republican on the panel so that. Can i open it to questions . Please identify yourself. I am doctor from the organization. But to, what is been said [inaudible] there is room for improvement in the transformation in place now as we speak, we learned our lesson and it shows. It is far from working it is this time of the contribution to all of the members. So if each of the member could bash on the head of her child, its like having a child i hope i can be edited. [laughter] the second reflection is in a different year, this is where you kick the door open, take the children back in todays world you dont vaccinate anybody without a lawyer in a legal agreement. Again it may be more costly than having an approach and moralistic but to close with your comment was very insightf insightful. Other questions . My name is the winter mike and the help the permit in houston, texas and i just would from houston and i missed almost the entire day. Anything i should fit completely off i apologize. I wanted to say that outfront. Have a question for you, im associate with and also Association City Health Officials which represent 3000 local Health Department across u. S. Part we are interested in a Global Learning that impacts domestic Global Health practice in the u. S. And as were going to the process we are learning a lot of organizations are very interested in Global Health space but not in Domestic Health or doing Domestic Health work and not interested in the Global Health aspect. As we talk about pandemics it seems that this is a gulf between the three of you have been speaking about which is real Global Health, domestic help and how they come together. You have ideas of how to bridge that gap in terms of model proctors and practice at the local or local level not a national or federal where we can share across the system which are help were pandemics and beyond . Let me tell you something, they started in the early 1980s and still going on, if the school runs by the office of foreign disaster, the First Responders in latin america, they train the trainer program. This is been going on for almost 40 years. It is drought a reduce the need for the United States for Emergency Response and not the market. There are couple of exceptions. Most platinum working countries dont need the help and repaid it is a most unknown to run from the center. It is all done at the local level. People at the National Health ministry and police and all that. It is mostly at the Community Level in a fortyyear effort to do it. I dont know why we cant do the same thing in africa and set up the school in africa, and you fund it over long period of time and you do the train the trainer approach. They do it for natural disasters like earthquakes and storms and all that. But theres no reason it can be expanded. I went down and stopped 30 years ago at the office under bush 41. They are all models. Can i tell you there is nothing like being in charge of response involved in the u. S. Healthcare system. [laughter] and when we had one case of ebola in texas where we had under the texas system most of the key decisions were made based state court judge in a commissioner that oversaw the county with governor peary as a governor and the county Public Health director and barry ansari in washington. And so one thing i took out of that was one great way for locay the pluralism in our Healthcare System has a great strength integrate weakness. Its great weakness if the command control that is really left to have in a crisis. Every week i did when mckenna part in the uk. Every week we benchmarked who was sending more healthcare workers to west African Response and i would report on the 52 Healthcare Systems baking them to some people and he would tell me all the national Health System they were sending 60 more people and they would be there in five minutes and then i got very envious of unitary Healthcare System. Until our christmas time one of the nurses came home with a bullet in the union voted to send no one else. So their strengths and weaknesses to the effort system in america. But i think one thing away from ebola in response was people on the local level organized exercises where you put everyone in the room at the local Public Health people in the local providers in the private providers in the First Responders, the community leaders, the political leaders, the state political leaders and you saw what would happen in the event of some kind of instance and then community. Nothing will make more Global Health than doing the exercise, understanding that by the time it gets to houston it is too late. And the problems you will have, will say we have to go to washington and get engaged in Global Health. I think its one of those thin things, think locally and act globally. If you see how hard this is in the u. S. County by county, toby tom you realize how we need to take the different players and pulled them in to Global Health awareness. The concept that we use is called one health and by that we talk about the relay of health and the Domestic Animals and domestic crops in the Global Health community because of the world shrinks and increasingly interconnected to travel across all the boundaries is greater than ever. I think all Health Planners and ministers have to think that way, its a lot of thinking to do and hard for the local responsibly. A number of us have to be thinking that way about all of that and all those conditions. Another question here . I have the privilege of working with doctor for nine years. I will ask you to envision a world where we have relationships and Effective Communication in Healthcare System that works for us and i want to focus on the medical component piece and that we need to save lives. And asked the question if we can view the suppliers of asset of a critical element of Industrial Base, the way you think about the industrialbased and other components of the aircraft carriers, it does not make review that way, its a series of transactions, we have a threatened requirement in a transaction but we dont have industrialbased policy or assessment, we dont look at the fragile nature of some of these companies and some high teens. So with that in your perspective on the lens on the countermeasure enterprise and also exercising. Can you imagine exercising and making a vaccine. Actually having a system where that Industrial Base in the biopharmaceutical sector is tested and evaluated on a vaguely basis so if we found the capability and it does not emerge into the next major outbreak or pandemic that we tested and evaluated the capability. By the way, we did the stimulation in our conference of october of last year based phd students across texas a m and they wrote the paper up in addition as a white paper frankly its as good as white paper. Its very well done with the students who went to the stimulation and reported after they did more research on what the conclusions were. I think stimulation are very valuable, i wanted the simulation, this is about ten years ago and north korea and there was a retired admiral and i said how many of these have you been through . And he said 22. And i said how are they all in . And he said everyone aided in nuclear war. And he said do you know why were in south korea . Because of the simulations. They are so scary that the policymakers who see the results of the simulation prevent the two countries from going back to work again because it will mean to escalate. So i had to say, one thing we could do that is not politically impossible to do a dod does all the time is to do simulation award training exercises i think they both have rolls in this and do it on a regular basis in the community in the developing world and a system on a regular annualized basis with the regular budget and get the reporting out to policymakers is what comes out of the simulations. Let me respond. As i said early on, the federal government as well as the State Government are silent and not interconnected and not cornered. The private sector and members of my organization, the grand job but what is needed is a level of coronation to create more platforms, to have the capacity to surge and have the capacity to share manufacturing facilities and turnaround in realtime and very quickly to have a more unified system of diagnoses and capabilities around the country and around the world. , we have systems that were developed right after 9 11 where we have sensors all over the place that can pick up when events are occurring in complete shambles virtually used with how many tomb used to modernize and update the systems. The only thing i will add to that, i agree. We need to think more strategically, i agree with the idea of medical accounting as a goal sector. I also think what we can be doing governmentally to increase capacity and responsiveness. Barnetts poster kind have this role in some respect but i think they need more funding and strategic leadership and power. I think there should be someone at the white house whose job is everyday, 70s week, ten hours a day to get up in the morning and think about how to build a plant and how to make it happen. I had a lot of Great Teachers when i took over this but i think tom always emphasized that youre going to respond to these crises by your existing system. And you will be ready and hope youll build magical capacity in the emergency moment, you have a strong Healthcare System with a lot of capacity and trade and shout and dizzy with the daytoday looks like. And things that are strong on a daytoday basis and things that are less strong. But capacities are a go issue. Someone says to me, why dont we have hundreds were we can put people have Infectious Diseases. Can you imagine the lien hundreds of beds and keeping them empty indefinitely, can you imagine having the capacity and not using it so its sitting there. We have so many healthcare needs that we could Spare Capacity and its a hard thing to imagine and consider. And if thats true with our country just think how true with other countries. I think it is really about vestments in the core system making up the ability in the event of a crisis. Would like to thank the staff of the Veterinary School and the leadership and her staff, their efforts and texas a m students who are here. [applause] it is 5 00 oclock and this is been an outstanding day, we have learned a lot, unfortunately some of these issues are not new issues like i said in my opening remarks and we simple have to find a way that we can turn these longstanding lessons observed into Lessons Learned. Our nation in International Community deserves it. I want to think our last panel for getting in to the particular issues. [applause] and everybody who is made this possible and of course our time at the office here in washington, d. C. This concludes the third annual and bio security. We will keep in touch and continue this dialogue. Thank you very much. November 11 through the 12th please join us at the Conference Center at the Government Service at texas a m university for the pandemic and bio Security Summit and again, will be at the townhouse type rules and began our posting process once again. Thank you very much. [applause] in the late 1850s americas generally trusted condos woman and they did not trust congress as an institution more than congress trust each other. By 1860 many were routinely armed not because they were eager to kill their opponents but as their opponents might kill them. Professor and author will be our guest on indepth sunday from noon to 2 00 p. M. Eastern. Ms. Freemans latest book is the field of blood. Her other titles include the essential hamilton, hamilton writing and the fears of honor. During a live conversation with your phone calls, tweets and facebook questions. Then at 9 00 p. M. Eastern on after words in the latest book the majority. He examines whether evangelical with political power of christian values. I think the lesser evil argument is dangerous. It contributes to keeping a system in place that takes accountability out of the system. I think it also is an easy way to bringing Something Like evangelicalism and then use them as a way to get both which seems the worst possible way. Watchful tv every weekend on cspan2. The u. S. Senate comes back into session on monday septembet issues on their agenda. Passing federal spending bills and antigun violent legislation. But before senators are at washington behind look at the senate, the senate conflict and compromise. Here is a preview. The government in which we live to compromise. Con Thomas Jefferson question the need. Lets follow the constituti constitution. Lets protect people from the ruler and the check on the house. This country and maybe even the world lies in the hands of congress of the United States. Conflict and compromise, cspans archives and unique access to the senate chamber, we will look at the history, traditions and roles of the u. S. Senate. Please raise your right hand. Sunday at 9 00 p. M. Eastern and pacific on cspan. Sunday night on q a. University of Pennsylvania Law School professor andy on Free Expression on college campuses. In the conflicts surrounding the coauthor in the philadelphia inquirer. I think its what ruffled a lot of people and not all cultures are light with this code of behavior of being one that was functional to our current technological democratic Capitalistic Society and compared to other cultures which arent as functional and we gave some examples and that immediately caused the firestorm. Sunday night at 8 00 p. M. Eastern on cspan q a. Now President Trump with the freedom Boston Celtic star, mr. Cousy played for the celtics from 1950 to 19631 to Coach Boston College from 1963 to 1969. He is credited with organizing the national bothwell Players Association which was the first union for any of the major sports leagues in north america. This is about 20 minutes. Thank you very much, and thank you all for being here on this joyous occasion. Today is my privilege to present ghe civilian honor to a beloved basketball legend and a true american original