The francis prize for outstanding books on American History 1997. He is current New York Times bestseller is the great influenza. Hes here to talk about that with us today. Hes currently a consultant with the World Health Organization on the subject of influenza. When hes done speaking, if you would like to ask questions, there will be two microphones in the back of the room. You can go and get a microphons are your questions can be heard. Please join me in welcoming john barry. [applause] thank you very much. Its kind of funny to be sitting here in a Community Room of the Louisiana Legislature talking about this subject largely because although you might not think it, politics is very involved in the story of the pandemic i cant think of a better place to talk about politics in the legislature. When you read about the 1918 pandemic in the newspapers these days you say the death toll was over 20 million. That estimate comes from the first of the disease thats fairly accurate for the western world but wildly inaccurate for the rest of the world. In a Nobel Prize Winner that spent most of his life studying influenza concluded that the death toll was a minimum of 50 Million People and possibly as many as 100 million. All this was in a world with the population 28 the size of today. So, if you adjust the population, the death toll on 1918 was between 175 to 350 Million People in todays world. But even without adjusting for population, the death toll back then influenza killed more people than 24 weeks then aids killed in 24 years. And sometimes sometimes could be gruesome. He would be familiar if youve got it today. It wasnt a tiny minority. If its something entirely different. The symptoms could include both from the cares and the eyes. Its known as a breakthrough in a fever or cholera. Its not only a lethal virus but violent virus. And of course one of the questions that i always get is could it happen again. The National Academy of science into another pandemic is not only inevitable but overdue. And this disease put a tremendous strain on the society so much so that even if the university of the medical school, a very sober scientist by no means an alarmist said in the middle of the pandemic if this disease considers continues its present course for a few more of the common civilization could disappear from the face of the earth. Now the story itself is a war story. Its not so much man versus nature is nature versus man. There are two interrelated contests that were involved in the story. One involved a Larger Society and the other involved a scientist. The battlefield is important to understand the battlefield in this situation. We were already at four in the latter days of world war i. The whole nation, the whole world is a tinderbox. For example in the United States there was an influx and there was no housing. As a result, for example in philadelphia there was a single shipyard. People would be inclined bed, go to work and come back and sleep in the same so it was a Public Health tinderbox waiting to happen. Even more important than that, ultimately what happened in the epidemic was the political context. As i said, we were already at war and i want to read you a quote from a law that was passed by the wilson administration. They would write, print or publish any abusive language about the government of the United States. They could send you to prison for 20 years for criticizing the United States government even if what you said was the truth. And they sent a congressman to jail for more than ten years. In addition, the press very much fell in line in terms of patriotism. There wasnt any outright censorship but it was sort of an understood censorship. The Cleveland State of the nation demands is a treason whether its quite unmatched to be stamped out. It was above the title of the newspaper every single day. They should be treated i into te Illinois Bar Association declared lawyers they were unpatriotic and unprofessional and of course the german language in many places nobody taught it anymore. This kind of thing ultimately became very important in what happened later in the course of the disease so thats what was going on in the Larger Society not to mention 40 of all the doctors and nurses are in the military said the civilian healtso the civilian healthcarey disappeared. Now when i started out, i said this was also a contest between science, not just the Larger Society that scientists and the virus. If you think they were backward, you need to rethink that. Half a dozen or so extraordinary man and one woman and they give you a sense of how good these people were. One of them in 1966 won the nobel prize for what they did in 1911. Another of them who is the first hit of the Rockefeller Institute is an interesting guy, a juvenile delinquent. The program scared straight these days where they take kids and walk them through trails his father actually did this to him when he was a teenager. A plumber if used to take them on as an apprentice because he was such a troublemaker but he got the job as a pharmacist. The pharmacist had a microscope and he told this guy dont go near the microscope. That wasnt the right way to handle it. In the new england journal of medicine, bacterial meningitis and Massachusetts General Hospital has a 25 mortality rate it had a mortality rate of 18 . The. Its not only proved pouliot was a viral disease in 1907, the 19th 08 divisive vaccine that was 100 effective at protecting monkeys from polio in 1908 and 1909 so that took almost 50 years to move that command. Another major character probably the most important person in the history of American Science he created the entire medical infrastructure in the United States and had the power to change their life with a flick of a wrist. One other guy you may have heard of who was the army Surgeon General. The Surgeon General of the army cut the death rate from the low fever 20 in havana and about the panama canal if he created this infrastructure in the army and he had a nightmare. It was during this war with 4 million soldiers close quarters combat an epidemic was going to break out. And even before the influenza pandemic and created and expected pneumonia to be the killer. Before world war i in American History more soldiers died of disease van died in battle and even the spanishamerican war six american soldiers died of disease. They lost ten soldiers before world war i the army was 15 15 soldiers diffuse or ten or 15 to every one who died in battle. The. That is the sort of situation of the Larger Society wilson is it a spirit of ruthless brutality had to infuse every aspect of american life. And in the Scientific Community you had great scientists organized into trying to prepare for some disease they expected to direct. Now you have the enemy that is of course the virus. Now, all influenza viruses are bird viruses. All of them. Periodically coming in through history its happened thre it ho five years in this country. Periodically in influenza virus will jump species from birds to people and its one of the fastest mutating of any virus in existence. In fact a few others were referred to as a mutant swarm because even with a viral subtype of a particular type of influenza, there is no single virus. In about six hours to single celled ends up emitting it explodes between 100,000 a million. One person still between a thousand to 10,000 are able to effect a new so that the mutation rate allows it to jump species. In 191 1918 it wasnt by any sth the only lethal pandemic in history, but they are not all people. For example we went for pandemics in 1957 and 1968 while they killed considerably more people they normally died of dif influenza incidentally the normal pull for influenza according to the cdc is 36,000 a year. A its about three or four times the normal numbers of people that die of influenza. When the virus jumps from birds to people, and nobody knows exactly where that will happen. Most pandemics have become in asia. However, there were some overworked epidemiological evidence i managed to trip over that strongly suggests that this virus actually jumped species in kansas and moved from google kansas, which is in the Far Southwest corner of the state moved from rural kansas to what is now fort riley and fort riley and 56,000 troops to. As it turned out there with him are far more effective at killing than anyone could imagine. This was a war waged in hit with full force. It took about six months for the virus once it jumped species it wasnt immediately efficient. It have to adapt to its new environment and thaenvironment a while before it became athome it became efficient. But about six months after it jumped it became very lethal and all over the world simultaneously exploded. One of the first places hit a was during the spring there were outbreaks of outside of boston. I read a letter from a physician to another physician describing what was going on. It appears to be in the ordinary attack and we broke the very rapidly developed and most vicious type of pneumonia that has ever been seen. Two hours after, they had mahogany spots of the cheekbones and you can imagine to see cyanosis which is when you start turning blue actually because of the lack of oxygen. You see the cyanosis extending and spreading over their face. Its hard to distinguish the color from the white. It spread rumors of black death. They were turning so dark you couldnt distinguish black from white. Its only a matter of a few hours until death. Its horrible. One could see one, two or 20 men died up to see them dropping like flies, w we had been averaginhave beenaveraging abour day. Weve lost an outrageous number of nurses and doctors. It takes special trains to carry away the dead. For several days the bodies were piled up something fierce. God be with you until we meet again. As the virus spread across the world, and throughout the United States, i if extreme pressures n the political system and in fact its a very good case study its quite relevant to the fears about bioterrorism, not to mention the possibility of another influenza outbreak. It demonstrated that the political system was unfair to handle it. Politicians had the wrong priority is. They were so focused on the war. And they unfortunate irony is this hit when we were literally only for the five weeks away from the end of the war. Virtually every enemy country we were fighting except germany itself had already stopped. Germany already sent out feelers for peace but wilson and the entire administration was so focused they wouldnt do anything for Public Health that might in any way jeopardize the 100 for effort called ruthless brutality that he wanted to infuse the american spirit with. As a result, not only to federal officials, but Public Health officials and mayors and governors ove all over the unitd states essentially lied. First, they told people this was only ordinary influenza. Then they said they fear kills more people than disease. In philadelphia where they were planning a huge rally, hundreds of thousands are about to be in the streets early in the outbreak so the general public was not aware that there was a problem. Privately, one doctor was warning the Public Health commissioner that this rally would create a readymade flammable mask and he was trying to get every newspaper to print warnings but they all refused to pay any attention. There were many others saying the same thing. They hel held up his alley and hundreds of thousands of people. In 72 hours later in philadelphia, influenza absolutely exploded to the plight not only did they run out of coffins which happened in almost every city in the United States, but they also used steam shovels to dig mass graves where they simply rolled bodies in and sheets and priests literally drove horsedrawn carriages on the streets calling upon people to bring out a. Of very reminiscent of the black death. The same thing is happening all over the country. Rapidly the society began to disintegrate. The reason is people very soon n were getting a disconnect. They could see their spouse was dying in 24 hours into the body was lying there. Down the street somebody else is dying in a few hours or a few days. The emergency hospitals are being created all over the place and at the same time the Public Health authorities and the mayor the only thing you read in the newspaper is fear kills more than disease. Dont worry, you can keep yourself safe. So, this ridiculous reassurance they were getting was so conflicted with what they were seeing about them and destroyed their trust. Ultimately the society is on trust. And without it as i said it began to disintegrate. A fear is everywhere. Was everywhere. I will give you one example for some reason in phoenix, im not sure why, there was a rumor spread that carried influenza. Those of you that have kept understand the attachment and if they had too much love for their pets to kill the bugs themselves they were handing them over to the police and the local newspapers said phoenix with county chocolates. But they read a couple of comments from people who lived through this. In North Carolina one man said we were actually almost afraid to breathe. The theaters were closed. Everything was closed, schools were closed, theaters, every place. So you didnt get into any crowds. You felt like youre walking on eggshells and afraid even to go out. The fear was so great people were actually afraid to leave their homes and afraid to talk to one another. You never knew was going to be next on the death list. His father had a store and farmers stopped farming and merchants selling merchandise and the country north or west just shut down. Another man in washington, d. C. Took away all of the community. People were afraid to eat with one another and have anything that made contact because that is how you got the flu. In kentucky one red cross chapter chairman was begging for help because there were hundreds of cases in announcing tha and t they couldnt reach into people were starving to death. They were to stick to prepare food for themselves and they were starving and they could have survived otherwise there was so much fear nobody would help them. And part of the world where you have such close family conscio conscious. Posted at five are so sick they couldnt care for themselves. Then there was almost 2 Million People. There was one running in emergency at the tim time only a medical student. He whiffed 12 miles from where the hospital was in the middle of the city. He started counting the cars passed on the street on his way home and i in the city of 2 miln people over the distance of 12 miles, one night he noted he didnt pass a single other car. And i got in the illustrations of the book theres one from manhattan and theres a couple sanitation workers but you see all these cars parked on the street the society was on the verge. This was the first collision between modern science and epidemic disease. One of the things the book gets into that im very interested in is how you approach a problem. One of the things that is crazy to us a therapy that lasted for 2300 years and to us makes no sense at all. This observation and logic and based on that observatio the obt the logical conclusions you draw from the observation it made great sense. I dont have time to get into it here but that changed in science much later than others with the idea that you cant simply have a reason. You have to test and create a hypothesis and they started to do this by then and obviously i talk about how successful some of these people were. That and epidemic that grew over the period of we in the United States alone is not the best place to do this. And yet even so there is a hard society around them that is collapsing. There is a hard kernel of a dozen or so with a little bit more than scientists whom im focusing on making almost unbelievable progress. They didnt know this was a virus in fact they were not even sure what the virus was at this point and one of the things that came out of the research on influenza was the definition of the virus but that wasnt for a couple ocouple of years later as again one of the characters i write about they were not sure if it was just a small bacteria as opposed to an entirely different organism. But if you ever get a flu shot this year you get the pneumonia vaccine and that is a direct descendent of the vaccine was developed back then. Straightline defendant and significantly improved. Anyway, i want to leave time for questions. Science is on the verge of conquering disease. In fact it was way too pessimistic about the outcome. I dont know if youve ever heard the arrow in the error theory of basic science but what is if you shoot an arrow and wherever it lands that is where you draw the target. [laughter] and probably my favorite character in the book, this took me seven years to write and when i started and believed that it would be a quick look at least for me, i was confident, almost certain i could do it in two years, certainly two and a half but i was mistaken. Anyway, one of my favorite characters in the film i identified with was oswald avery who was clearly one of the greatest medical scientists of the 20th century and arguably even the greatest. Avery started studying pneumococcus. Nobody knew about yesterday seemed an obvious place to begin. And he stuck with it after the pandemic ended. He came to say he wasnt making much progress. He was presented with a very interesting problem and question. He said failure is my daily bread, i thrive on it. Year after year as he kept trying to take a different angle like chipping away at the rock, looking at ways to get into this thing. I think this is a good point to end the story all influenza viruses come from birds. They know the virus will job a species another pandemic is inevitable thats why we said in the introduction now i am the unofficial advisor. Last week was a meeting with several vaccine manufacturers. If this is a case study have to take it very seriously and prepare for a pandemic will be like 1918 it could be mild but at best, cdc has a study out that predicts if we do have a vaccine it would still be probably 150,000 deaths in the United States. If we do not, it is off the scale. The real determinant is the virus in asia with that jump species is is a frightening situation we need to prepare for it. Aside from taking this seriously is that government needs to tell the truth. And as was demonstrated during the sars outbreak they had gotten a head start of several months there would be millions of not tens of millions of deaths right now with the asian bird flu thailand a couple of other countries didnt fully tell the truth either but in chinas case it is political they believe in keeping morale up was exactly the same reason why the United States lied in 1918 but in Southeast Asia it was economic because poultry is a huge part of their economy to damage that the truth would hurt their economy. And we need to find a way to compensate those countries so they will not be penalized economically for telling the truth to protect the worlds population. Will know we are short for time and i want to leave more time but we have five minutes and there is a microphone over there. What happens in the 1918 virus did it mutate into something . Two things happened. Number one normally they are not that lethal when you start as the outlier chances are the mutation will bring you back toward the average. Mutated back to the average influenza virus. But more important the reason it was so lethal initially nobody had any immunity because it was a new virus of they had not seen it before. Was it made the cycle of the world a few times peoples immune systems could react. One thing i didnt say the largest number group of people who died in 1918 were young adults between 20 and 35 years old and ironically because the immune systems were stronger but they were being killed by the immune systems instead using very specific weapons so they unleashed everything they had and the battlefield was the lungs and that was where they attacked the virus. The only thing analogous to this is the yellow fever epidemic that hit new orleans are we any better prepared . By 19 oh five we knew how to fight yellow fever. And we are fairly effective at it. When they did not have the same idea they did not have the same lies being told. There were some of them. People in new orleans were trying to convince the rest of the country. [laughter] but they would say that because it was of mosquitoes. What would cause you to choose this particular subject . It is very timely. I planned that seven years ago. [laughter] i almost became a scientist my best friends tend to be scientist. Plus i was very interested world war i 1919 and eventually expected to write a book one of the two or three most interesting so doing research in the same time. But again seven years. Or the mutating virus then the vaccine how effective will they be next fall . They redesigned the vaccine every year it mutate so rapidly that it wont work very well the next year because it whisks away from where i was in a try to anticipate when they make it each year. And they are usually pretty good at that. That vaccine works pretty well at the 85 percent effective rate even if they dont hit the target like last year it was still pretty effective. Web pandemic is a different problem thats an entirely new virus. You have to isolate, make the vaccine, tested for safety produce hundreds of millions of not billions of dose doses, distribute and administer them all in a period of months. Now as i said earlier last week i was at a conference which included Vaccine Companies around the world from the who, hhs and the ceo of a major Vaccine Company given todays circumstances and capabilities that if a new pandemic virus appeared six months after isolation we would only have 100 million doses worldwide. And that was unanimous in any country to nationalize that they would use it for their own people first. Other people were more optimistic of that capacity but it is a real problem we need to address the vaccine infrastructure just for regular vaccines. Much less a major pandemic crisis frankly i think its a National Security issue. People need to take influenza seriously. Last year during the sars outbreak it dominated the news but there was another virus that threatened to job threatening 89 people only killed a single person. They slaughtered 30 million poultry now they slaughtered 100 million to contain the virus now one death out of 89 may not sound horrific but it infects so many people that if that virus at the United States, it would cause a minimum of half a Million Deaths in a single season and easily 1 million death with one out of every 89. Get your priorities straight. Nobody knows the exact figure of what we spend on west nile virus. In the last five years in total has kid one killed 650 and five years. Although there is no exact figure spending over 300 million per year. Influenza we spent about 275 million per year and it kills 36000 per year. But west nile gets the News Headlines and influenza does not. You tell me. Do i have time for one more question . Is it true they are outsourced very few are in the United States . Some are in some are not some antiviral drugs could be effective. But we need to stockpile them and thats another step we have to take. [applause] thank you