Transcripts For CSPAN Tom Frieden On Public Health And Safety 20140726

He spoke of the National Press club for about one hour. Good afternoon. Welcome. Im an adjunct professor at George Washington university and 107th president of the National Press club. The National Press club is the worlds leading professional organization journalists committed to our professions future through our programming with events such as this while fostering a free press worldwide. For more information about the National Press club please visit our website press. Org. On behalf of our members worldwide i would like to welcome our speaker and those of you attending todays event. Our head table includes guests of our speaker as well as working journalists who are club members so if you hear applause in our audience i note that members of the general public are attending so its not necessarily evidence of a lack of journalistic objectivity. I would also like to welcome our cspan and public radio audiences. Can you follow the action on twitter using the m pclunch. After our lunch speak concludes well have a question and answer period. Now its time to introduce our head table guests and ask each of you to stand briefly as your name is announced. From the usedenses right, thomas snyderman. Barun. Jmal iliani. Ruth katz, director of the Health Medicine and Society Program of the Aspen Institute and member of the Cdc Foundation board. Anna miller associate editor at psychology magazine. John lewis cofounder and executive director of the Peggy Lillis Memorial Foundation and guest of dr. Frieden. Donna lagier reporter for u. S. Today, vice chair of National Press Club Speakers Committee and former president. Doris mar fwmpb olis president of Editorial Associates and National Press Club Speakers Committee member who organized todays luncheon. Faith mitchell, president and ceo of grant makers in health and guest of dr. Friedens. Susan heavy correspondent for reuters. Carolyn block publisher and editor federal telemedicine news. Hirito. This time last week dr. Tom frieden was busy cramming for his july 16th appearance before the House Committee on energy and commerce. The director of the centers for Disease Control dr. Frieden had been summoned to washington to answer questions about the startling and potentially Dangerous Lab errors at the cdc and while that topic is likely to come up again here today, dr. Frieden joins us to explore a much bigger and broader issue, looming Worldwide Health threats including the pathogens that put modern medicine at risk. Hell explain the mr. Mers coronavirus a disease that has no known cure and has recently immigrated to our country. It haunts the Arabian Peninsula and is showing up in travellers through other destinations far away. The virus has reached an arrival in the United States, sent hundreds of cdc staff into emergency mode. And some now refer to this illness as public enemy number one. Other issues that dr. Frieden will tackle this afternoon includes the dramatic increase in the number of measles cases in america and the growing threat that draws new pathogens pose. They can hitchhike rides and crisscross the globe detain. Hell update us about the new program the cdc launched three weeks ago combat drug resistant pathogens. Some of these killers microbes jump from an mols to humans and a growing number of them are resistant to currentry known drug treatments. Dr. Frieden has been director of the cdc since june 2009. A physician with training in internal medicine, Infectious Diseases, Public Health, hes known for his expertise in tuberculosis control. From 1990 to 2002, dr. Frieden worked for the cdc starting as an epidemic Nuclear Weapons Service Officer at the new York City Health department. Fluent in span injuries hes a graduate of 0 Berlin College and received both his medical degree and masters of Public Health degree from colombia university. He completed his training at yale university. Dr. Frieden has won many awards and honors and has published more than 200 scientific articles. His talk today is titled mers public enemy number one . Dr. Frieden last appeared last september. Ladies and gentlemen, please join me in welcoming back to the National Press club, dr. Tom frieden, director of the centers for Disease Control and prevention. [ applause ] thank you very much. Its great to be here. And thank you so much to the National Press club, to the president and Doris Margolis for the invitation and thanks for your interest in health and what i would like to do is talk to you about some of the biggest threats facing us today. Some of you may have heard about problems at the cdc laboratory where weve had two safety lapses in recent months. These lapses should never have happened. The cdc laboratories are some of the best scientifically in the world and now were taking rapid and Decisive Action to make sure that they are also some of the safest laboratories anywhere in the world. Ill be ethiopia talk about that later but right now i want to talk a little bit more about some of the challenges that we face. Sometimes at cdc problems like the one that has come to light recently, occur because people are so used to working with danger. Were currently mounting a substantial response in west africa where three countries in that region are battling eboli. Theres more than 1,000 cases and 600 deaths from eboli. I had been in uganda, which is as you imagine a cave with a very large python, about 15 feet large and about 10,000 bats and those bats turns out our researchers have identified have a 5 infection with the mabird virus. Its similarly fatal and there were two infection, one fatal one not a few years back and our staff went in there to try to figure out and understand how the bats were moving around the region and what might be able to be done to control mabird there. I asked werent you scared to go into this cave that had 10,000 bats, lots of them with mabird often fatal virus and this notorious python and they said the python didnt worry us and the bats didnt worry us because we were wearing those moon suits and the mabird didnt worry us because we have the protective equipment on. The cobras worried us. [ laughter ] and underneath their moon suits they had to wear leather chance so if they had a cobra strike they wouldnt be killed by it. So we have to always remember above aldo no harm needs be more than a motto. It needs an organizing principle for all of our work. Now, like other Health Care Workers i have my personal experiences with risk, sometime back i was working in rural latin america on Public Health programs in communities and im sorry to say this over lunch i wont go into details communities that didnt have great sanitation and i became extremely ill. It was in the brief period between medical school and starting internship and residency and i had learned in medical school what a rigor was but if you ever had a rigor you under its not a shaking chill, its a violent shaking chill so violent the bed shakes. Its a reflection of having grand negative bacteria in your blood and i became quite ill. I returned to the u. S. Feeling a little bit better to start my internship and i was tested and found to have an organism from poor sanitation, it was in my bloodstream, i was very ill with it. Highly infectious. Ten xx organisms can infect another person and just give you a sense of scale you can fit about a million organisms on the head of a pin. So when i went in for testing the doctor said you not shagilla and resistant to every antibiotic known. I said i have to start my internship. [ laughter ] and the Infectious Disease attending said you need to go home. But we always want to be part of the solution. In health that can be part of the problem. So now a little footnote to that story. That episode of illness i did eventually get better not as quickly as i would like and recovered completely. About a year later, a new drug came on the market and two players later i wrote an article published in jama on the inappropriate use of medicine. So i have a quiz for you. What are the six organisms all have in common besides the fact that they are all Infectious Disease. Thats too easy. Mers. Eboli. Measles. Tuberculosis. And cre. Any guesses for what these three, what these six diseases all have in common these six Infectious Diseases. Yes. They are preventable. Yes. They are all preventable. Thats one thing they have in common. How about how they spread . Is there something in common. You have eboli from bats, mers maybe from camels. Some are airborne, some are not. Three quarters of the new infections we face are zornonic. No. They are all very importantly spread in hospitals. We can be part of the problem if were not careful. All of them and ill talk a little bit more about that. Now when i went to medical school they taught me to use some fancy words. I know reporters never use fancy words but, you know, we dont say we gave to it them in a hospital. We dont say the doctor made him sick. We use fan sip 50 cent words to avoid the uncomfortable truth. My most favorite of all we know exactly the cause of his illness, its i diopathic. It means we dont know what causes it. Another definition is patient is sick and the doctor is an idiot. Now mers is very concerning because like sars which occurred a decade ago it has a high case fatality rate. Maybe as high as 30 . Mers also could cause significant not only illness but economic dislocation. Sars cost the world more than 30 billion in just three or four months. Were learning more about mers and that quiz i gave earlier was actually the key lesson we learned as we work close wli the saudis and were now work very closely with them on a variety of investigations and control measures, we found that the overwhelming majority of mers cases in recent months or in the past six to 12 months have been associated with hospitals. Theyve been spread in hospitals, patients, staff, visitors, others associated with hospitals. Thats bad news and good news. Bad news because it shouldnt have happened and should be able to prevent it. Good news because we know how to turn off that tap. We know how to protect Health Care Workers and other through Infection Control measures and i received an email last week from the saudi minister of health to our staff who reported that in the past ten weeks they not had a single case of mers in a Health Care Worker now they they implemented stringent control measures. When you know how something is spreading you can stop it. Theres still more we dont know. We dont have a prevention. We dont have a cure or a vaccine. We dont know how it jumped from animals to people. It does seem that camels have perhaps been infected by bats and perhaps have Something Like mers whether its direct contact with camels orca medal products. Were under taking studies to find that out the prevent it. When we under something the better we the prevent it. The next pandemic is not likely mers unless it mutates the capacity to develop easily from person to person. It may not be an influenza like the one that emerged in china and thats a wonderful story of how we have global collaboration. But maybe the thing that we are most at risk for is not the thing that we dont know but something thats hiding in plain sight. Something that could kill any of us. Something that could undermine our ability to practice modern medicine. Something that could devastate our economy and something that could sicken or kill millions. Now, someone here in this room, Christian Lillis knows about this problem. Christians mother peggy was a beloved kindergarten teacher. She went in for a routine root canal procedure. Within a week she had sepsis. And tragically at the age of 56 she died. Christian and others have carried the standard to make clear what is the human face behind the tragedies that we read about because in Public Health were at our best as bill fagy said when we see and help others see the face s and lives behind the numbers. I think of a 15yearold who loved music had a congenital, a mall formation, not major and went in for a routine check up. Two days later had a resistant bacterial pneumonia and died easter weekend. I think of josh nahem, a young man from colorado, 27 years old, loved skydiving. Had an injury from skydiving. Got infected, began to recover then developed a highly resistant organism and also died at the age of 27. Joshs mother victoria has Christian Elisabeth hasselbeck been be a activist, an advocate information proving the way we address infections in this country. Antibiotic resistance could affect any of us. In fact, 2 million americans get resistant infections each year. 23,000 americans die from infections each year, resistant infections each year and another 14,000 americans have deaths like christians mother from or contributed by. Im an Infectious Disease physician. I treated patients for many infections. And i treated patients with no antibiotics left. I felt like a time traveller going before the time of antibiotics. We talk about the preantibiotic era and antibiotic era. Soon we can be in the postantibiotic era. Antimicrobial resistance is getting worse. It creates two problems that are worthying of a little separately. One of them are the thing that we usually think of as infections. Urinary Tract Infections, wound infections. Were seeing more and more resistance from those organisms. But theres a second problem that we may not think of notally and that is how important in control of infections is to the practice of modern medicine. 600,000 americans a year get cancer chemotherapy. When we give cancer chemotherapy we drive down the bodys defenses so we can wipe out the harmful cancer cells and patients get if he verse and serious infections and we can keep them in check until the bodys resistance comes back. So cancer chemotherapy may be at risk. We have more than 400,000 americans who are in dialysis. Infections commonly complicate dialysis if we throes ability to treat those infections it will make dialysis much more difficult to do. Modern treatments for everything from arthritis to asthma suppress the immune system. Our ability to give these cuttingedge treatments is at risk because of the spread of Drug Resistance. Every day we delay means that it will be harder and more expensive to fix this problem tomorrow. Bacteria are evolving very quickly. We need to move quickly to get ahead, to catch up and to control it. Its possible to keep resistant bacteria from spreading. Its possible for some pathogens to actually reverse the level of Drug Resistance but only if we act now and act decisively. What weve seen is that organisms can start in hospitals. Our most resistant organisms start in the hospital. Now we see it go out in the community so now the most common pathogen recovered from patients with cuts and wound infections in the emergency room are mrsa. Its not too late. We know in cre we still largely are dealing with a hospital infection. We can keep it in the hospital. We can shrink the numbers and crow it. If we dont then common infections like urinary Tract Infections could be untreatable. To stop Drug Resistance we need fundamentally to do four things. First, we need better detection, second better control. Third, better prevention. And fourth, more innovation. On detection, we need realtime systems to find out whats happening around the country. In fact, this week cdc will be launching for the first time a system that will allow any hospital in the country to track electronically automatically with no extra work after the initial uploading work all of the antibiotics dispensed in that hospital and all the antibiotic resistant patterns of patient whose have infections. That will allow doctors to be empowered with the right information at the right time to make the right decision so that they can give a patient antibiotics that are needed neither too broad nor too narrow. So better detection is the first step in controlling drug resistant organisms, to allow us improve prescribing practices, to identify outbreaks, to figure out our outbreak control measures are working. The second key step has to do with control. As with the quiz earlier, much of this is a problem and we have to take seriously above aldo no harm. Too many infections are being spread in our hospitals. Too many patients are coming in with one condition and leaving with an infection that they didnt come in with. But prevention requires work across many facilities, even the best of hospitals cant do it alone. They need to intersect with the Nursing Homes wthe outpatient providers, with other facilities in their communities and that can best to be done with Public Health departments serving a convening, collaborating and facilitating role. State Health Departments will be key to reversing drug resistant and reversing hospital spread of infections. Third is prevention. The fact is that the quality of treatment for many conditions is nowhere near what we would like it to be. My father was a cardiologist. He used to say that when you see how other doctors Practice Medicine you realize how resilient the human body is. [ laughter ] improving prescribing practices in all sectors is crucially important. We recommend that cdc that every single hospital in the country has an antibiotic stewardship program. This means that antibiotics are looked at carefully, the data from their hospital both resistance patterns, prescribing patterns are tracked regularly. And if things are not right they are improved. We have done a study that a third of all antibiotics used in this hospital are either unnecessary or inappropriate. There are enormous difference between one region of the country and another and those dont reflect undertreatment in areas of lower rates of utilization. Teambased care, checklists, reporting, feedback, accountability, these are simple management tools that need to be applied systematically to prevent Drug Resistance and many antibiotics being used are not necessary. With every medication, whether its for Infectious Disease or other we need to think of the risk benefit ratio and always think about that ratio. Theres no medicine without risks. And we have to balance that risk benefit ratio. That risk may include Drug Resistance. It may even include in the case of antibiotics contributing to the obesity epidemic a current hypothesis which theres some data. Theres some data about a lot of hypothesis of whats contributing to the obesity epidemic. Another area where weve seen a risk benefit calculation with medications get off kilter. Another area is opiates. So we have to keep track of that risk benefit ratio. Ironically we underutilize a lot of medications that have a favorable risk benefit ratio. Aspirin is only used half the time. Blood pressure son lie controlled half the time. Even among those at highest risk, statins which are very effective only used half the time. We have to get that risk benefit ratio to make sure that were above all doing no harm and on balance doing as much good as possible. The fourth is innovation. We need to couple with new tools and while we need new drugs and new antibiotics theres at least five or ten years away that may or may not be available, may or may not work for our resistant organisms and today we can stop, slow or even reverse that drug resistant trend and theres also innovation needed in tracking resistance, understanding it better, figuring out what works to reverse it. In the president s budget for 2015 theres an initiative that would allow us to build five Regional Centers of excellence all around the country so we can help doctors understand whether patients have resistance faster and in realtime whether there are outbreaks and how can we stop them. It would help us develop a bank of resistant organisms that pharmaceutical companies and others could use to come up with more rapid diagnostics. We project that if funded we could save money but more importantly save lives. We project based on real data that with this initiative over five years we would be able to cut our two deadliest threats in half. Both cre, the nightmare bacteria thats spreading in many of our intensify care units and cdif. We know that because places that have done that right have had that result. We can make this succeed across the country but only with investment. In fact, over five years we project we can reduce by 600,000 the number of resistant infections by 27,000 the number of deaths from resistant infections and by 7. 7 billion dollars to Health Care Cost from it. Public health is a best buy. But we have to act now. Antimicrobial resistance thats ability to kill anybody in the country, to undermine modern medicine and devastate our economy and make our Health Care System less stable. Confronting this can protect americans from the moment they are born and throughout their lives but every day we delay it gets harder and more expensive to reverse it. Its too late for peggy, for nile, for josh and for 23,000 people who died this year from infections that might have been able to be prevented. And although the problem is big and although its getting worse its not too late to reverse it by taking Decisive Action now we can reverse it and we can protect these antibiotics. The concept of stewardship is an important concept. Were protecting them not only for ourselves were protecting them for our families, for our children and for our childrens children. Thank you very much. [ applause ] thank you, dr. Frieden. According to a recent report by the fda, 80 of all antibiotics used in the United States are fed to farm animals. This means that only 20 of antibiotics which were originally developed frwere mea to protect humans. We want to see rational antibiotic use wherever antibiotics are used. And i think that means, for example, in farm animals or feed animals that if animals are ill they should be treated. Using antibiotics that are of importance to humans for growth promotion is clearly something that we, the fda, the usda and the Food Industry is concerned about. I think thats something that well see progress on in the coming months and years. Its more of an fda, usda issue than a cdc issue but we could recognize as cdc that some of the most resistant organisms were seeing like cre which is a nightmare bacteria, resistant to virtually all antibiotics and covers multiple different organisms that have a fatality rate as high as 50 in the hospital. Some of our most serious resistant organisms are in the Health Care System particularly in hospitals. We want to see rational prescribing every where antibiotics are prescribed. Antibiotic development is not as profitable for Drug Companies as drugs such as statins and viagra. How do we encourage pharmaceutical companies to develop new antibiotics to treat these emerging antibiotic resistant infections. We do really have a problem with the incentives. One of the, from a strictly business standpoint, a terrible thing about antibiotics is that they cure people. And then you can stop taking them. Thats not a model for a highly lucrative pharmaceutical product. You want a product thats going to be taken for a long, long time. And thats not what we want with antibiotics. So we have to figure out a way for government and industry to Work Together so that the incentives for antibiotic production, antibiotic Development Match the need and there have been important steps taken by congress in the past few years, bipartisan, new laws in place that improve those incentives but its going to require creativity, going to require innovation, going to require a dialogue between government and industry, thinking about ways to reduce the risk for developers to improve the benefit and to ensure that theres reasonable profit without excessive profit that might result in a backlash. These are tough issues but they are important to address. We do want new antibiotics. They are important. But we also have to recognize that we may or may not succeed. We dont know why the antibiotic pipeline has thinned out in recent years but it has. Is that because of less investment . Maybe. It is because the lowhanging fruit has all been plugged and harder to make antibiotics in the future. Maybe. We dont know. We cant assume that were going to develop new drugs to get ourselves out of this mess. We have to assume we have to make rapid progress with the tools we have and preserve the antibiotics we have while at the same time we promote development of new antibiotics as well. Is cdc looking into natural cures in addition to prescriptions . Theres some really interesting developments in a variety of ways to reduce infection. We know that lots of things will reduce your sues septemberibility. Theres some intriguing new data coming out on the microbes. We got trillions of microbes in us and they are important for our health and were just beginning to understand that. Some of the new tools, some of which congress funded cdc to expand the use of called advance mode less can you lar detection which allow us to sequence the genomes of microbes in realtime. Its teaching us new things about the microbes that are helpful as well has harmful. For cdif new treatment pros avoiding microbes that fight against cdif as a way of battling microbes. After all, if you go back to the first drug developed against tuberculosis, Sheldon Waxman and his graduate stunt figured out that there had to be things in nature that fought tuberculosis. Otherwise you would have tuberculosis every where. They went into the soil of Staten Island and figured out there were bacteria there that produced chemicals that killed the tuberculosis bacteria. So there are ways we can use fire to fight fire, if you will. Can the cdc or the hhs take any regulatory steps to enforce responsible use of antibiotics in hospitals . We have to work in collaboration with the Health Care System. One of the Biggest Challenges for Public Health in the coming years is that integration of Public Health and clinical medicine. At cdc weve been delighted to have a very positive Constructive Partnership with the center for medicare and medicaid service. As an example we for many years have run something called nhsm. We had many hospitals involved and then cms said by the way if you dont get 100 of your reimbursements you must participate suddenly we have 14,000 facilities participating. They benefit from that. They are given information that they can act on to improve their care. Just yesterday the person who is leading much of our work here met with eight different Health Care Systems to figure out how can we sustainablely achieve the hospital stewardship programs. Its not so much a question of mandating and enforce as figure out together whats need and making sure we have a level Playing Field so that gets done and tools like the National Heart care Safety Network provide tools to hospitals to improve the quality of their care. In september 2013, cdc put out a report Antimicrobial Resistance in which the agency identified new dreg development. Congress is currently considering legislation to facilitate Drug Development by creating a new approval pathway for drugs to treat serious and life threatening infections for which there are few or no treatments. From cdcs perspective which are the infections for which we most need new drugs. Well we have one success story. A new drug thats useful for multidrugresistant tuberculosis and the fda was able to approve that rapidly. There was some controversy about that. But the data was strong and cdc recommended it and cdc is in support of that decision. We need to look at the organisms for which we have the greatest risk. That includes the whole spectrum. Includes the grand rods, things like eboli in our intensify care units but also the grand positive organisms like staph where we have mrsa. Theres a range of organisms for which we need better treatment and we also need to understand them better and the tools that were now using of advanced detection are fascinating. Were learning many of our assumptions were real simplifications. If you have an infection it may not include one organism bath broad range. And how we measure that in the laboratory may be different from whats actually happening and causing illness in people. So theres a lot we need to learn about the patterns of disease not only within the population but within individual people so we can innovate and target our innovations most effectively. Perhaps the battle against microbial resistance to drugs will have to be fought genetically. I mentioned cre a couple of times. Let me give you more detail. This illustrates the answer to this question. Cre is something we really have not seen before. It is a jumping gene, a plasmid, a part of genome, a part of the dn sequence that can move not only between one organism and another but between one species and another and not only can it move between species but it can encode for resistance to an entire class of antibiotics, all the penicillin and penicillinlike antibiotics, first, second, third generation, our big guns what we have got from text people np organism can spread its resistance to multiple species and multiple antibiotics and weve seen a couple different ways it can be spread. Theres a dominant one in this country and a secondary one. If thats what the jumping gene is doing, if thats whats causing, was driving the resistance to our biggest gun antibiotics what can we do to counter act that across multiple species for multiple antibiotics. Have you stein latest mers study saying it may be airborne and your thoughts, please . Were working very closely with the saudis and with other countries in the region to better understand and control mers. We have teams on the ground but weve done study, we did one in jordan a couple of years ago that was fascinating. It showed if there were lapses in infectioncontrol you had a lot of spread in the health care facility. But if you had good infectioncontrol just standard infectioncontrol even if you had several infectious patients and lots of exposure you had no spread as confirmed by check being serology workers. Were understanding how mers spread how it jumped the species barrier. From everything weve seen largely been spread in recent years in the past two years in hospitals and largely controllable by rigorous infectioncontrol. Thats good news. Done mean it wont change in the future but thats where we are now with it. You have called the bird flu safety breaches the most distressing to you of all the breaches. Why is that breach most troubling to you . We had two laboratory breaches at cdc. One was anthrax where there was potential, probably not but potential expossible sure of workers to anthrax. They thought they killed the anthrax. But they hadnt. Weve done subsequent studies which suggest its not impossible some of the anthrax may have exposed other people at cdc but extremely unlikely. Still that was a reflection of Center Policy and lapses that should never have occurred. The h5n1 situation of different. Through means were not sure of through our laboratory a nonpathogenic or nonharmful bird flu was mixed up with a harmful bird flu and stoints Department Agriculture laboratory. All of this work was done and sometimes called enhanced bsl blah towers. Very highly contained. People wearing what are called fancy respiratoriors. We were dealing with a deadly virus that had a big impact on agriculture and that there was a six week delay between people at cdc being notified about this and it being notified up the chain at cdc made me very concerned that we need to do a better job of encouraging a culture of safety, of encouraging information report problems or potential problems if they have the slightest concern that there may be a problem and whatever the reason, were still investigating that second incident, whatever the reason, the facts that first off it happened in our flu lab and without exaggerating i can say our flu slabs good as any in the world. Phenomenal laboratory. That made me really stunned that if this could happen at the cdc flu lab where else could Something Like this happen and second i was deeply disappointed that it took so long to notify and still understanding the reasons for that. What weve done since then is take Decisive Action. We stopped shipment of biological materials from our high containment laboratories until i personally review and approve the Procedures Laboratory by laboratory. We appoint ad single Senior Scientist to review those protocols with then of a working group and strengthen them. We have also ensured well take a look at every aspect of our safety to improve the culture there and improve, again, as i said in the beginning we have not only some of the scientifically most advanced laboratories in the world but also some of the safest laboratories in the world. This touches on your previous comments but let me ask. In a recent hearing you told congress you recognize the pattern of weaknesses within the culture of safety. How were those weaknesses allowed to develop . When we look back at the last few years we see that there have been isolated incidents and i believe in each of those isolated incidents the staff at cdc and i took responsible behavior to address the concern that was raised. And what i missed and what i think our staff missed was that these isolated incidents did reflect a pattern and it was a pattern of insufficient attention to safety in our laboratories. You can hypothesize the story i told at the outset about python cave and ebol spampbt of it. If you work with dangerous or beganisms day after day, month after month, year after year theres a tendency to get lapse. What we have to ensure even though human error is inevitable, human harm shouldnt. We will do everything in our power to ensure there are redundant practices in place so if there is human error there will not be human harm. I think the broader lesson is that its possible to minimize the risk of many things but maybe not possible to achieve zero risk and that has a lot of us thinking hard about what makes sense to do in that risk benefit ratio. If were balancing a minimal but nonzero risk against a potential benefit we better be very sure both that we make that risk as low as possible, and that we have a reasonable expectation that there will be a benefit. Can you describe the sweeping changes in quotes that you initiate at the cdc and i realize you touched on some of them. You might want to expand. We have done a series of things. We have ive issued a moratorium on transfer of all biological materials out of high containment laboratories. We closed the two laboratories where these incidents occurred and not reopen them until were sure they can reopen safely. Appointed a single point of accountability to overhe is Laboratory Safety throughout cdc and his group dr. Michael bell are reviewing first and foremost those applications to lift the moratorium lab by lab. They will work not just as an individual group but throughout every part of cdc to promote that culture of safety which has to be every lab worker, every supervisor and team lead. Well also take disciplinary action as appropriate. We have convened and ive invited an external Advisory Group of worked for cdc before come in and give us a fresh look. Tell us what we can do different or better to improve safety. Were investigating the incident with flu thats not completed yet. Were looking at our function as a regulatory agency. We have something called the division of select agents and toxi toxins. We regulate over 300 entities that work with dangerous organisms. What are the lessons from our experience to make sure that we do that regulation effectively. Do i hear that are you advocating for harsh punishment against those who brief safety in labs and what can congress do to improve lab safety . Its really important to balance two competing divisions of how you deal with an insid eptd li ent like this. In another vision you fix the culture and policy and procedures. I dont think either of those on its own is the right way to move forward. On the one hand, you have to ensure that you have policies and procedures and a culture that promotes safety continuously that recognizes that risks are serious and nonminimal and does everything to analyze what are ways to reduce that risk. At the same time, you look at individual incidents and if there is negligence, if there is a failure to report, then you have to take proemt actiappropr. I think those are either or. Thats a combined areport. In terms of congressional action, there are observers who said perhaps there should be a different entity to look at the dangerous path ojens. Its complicated to inspect these laboratories to make sure they do a good job. We do as good of as job on that as we can but we will look at that and see if there are ways we can do that better. Several years ago because of it looking like a conflict of interest, i asked them to inspect cdcs lab. Were open to all ideas to how to improve safety in these laboratories and more broadly, i think we have to look at do we have the right number of laboratories . Do we have the right risk benefit ratio calculations for some of the research thats going on . You faced tough questions during last weeks house hearing. I noticed. What was your take away from what you heard from the Committee Members . I think the committee very appropriately had concerns that if Something Like this can happen at cdc first off how did it happen . Are you going to fix it . Whats happening elsewhere . So i think the questions were tough but fair. The approach that im taking with my staff and that i encourage congress to take is very much a trust but verify approach. Were going to do things to improve safety but dont take us at our word. We will review and share the results of that and ensure that what we do, we do transparently, openly, clearly. We always find that its much better to be clear and open about a problem then otherwise. I think we have been about these problems from the moment we learned about them. That will be our way Going Forward as well to say here is what weve done, here is whats achieved and not achieved. I would be disappointed but not surprised if we identified other incidents in the past or other things happened in the future and that may well be a reflection that were improving that culture of safety and that willingness to report problems rather than failing to correct what is an important issue to address. I think the questions were tough but fair. We will continue to provide information because we have such important work to do. This work is not done out of idol curiosity. This work is done because anthrax continues to kill people around the world because it has been used as a bio lomglogical weapon. Because these dangerous organisms are spreading in nature and could be used in a bio terrorist event. We have some media related questions. What is your reaction to the Media Coverage of recent incidents involving Laboratory Safety at cdc . I generally think the media has been responsible in their coverage. I sometimes wish it would be a little different but i dont think thats something that anyone wouldnt say at some point or another. I think the small pox discovery on the nih campus somehow gotten conflated in some of the reported. What happens there was a researcher probably in the 1960s before there was small box reraddication put aside her p h small boxes. It was kept undisturbed and touched. The moment it was touched the fdia appropriately informed us to make sure that along with Law Enforcement we were able to go in safely and securely, secure the materials. Transport them securely back to cdc and in a controlled environment in the only laborato laboratory that was allowed to have small boxes in a laboratory who was the most experienced in the world safely opened it, analyzed it, tested it and determined that if fact it was viable small pox. What we will do with that as we said from the very first moment it became apparent is we will fully analyze the genome and once that genome is sequenced and analyzed, we will invite the World Health Organizations observers in and we will destroy the strains and all of the biologically viable materials associated with the strains. Thats one part of the study that the story sometimes gets confused with the other parts going on. It really shows cdc staff working 24 7 to protect people and make sure we could understand and control what turned out to be not a risk but that required a very active response. We got that response. Media related question on behalf of some judournalists. Despite the fact that in previous times there were no such restraints . As far as im aware the cdc is not prohibited from talking to reporters. We do like to have hemedia staf present so we can followup on questions and make sure youre talking to the right people. We try to facilitate that but we really do like to be quite open and the more information there is out there about what cdc does in this country and around the world 24 7 to protect people from threats, the challenges that we have as well as the programs that were implementing the better. Were almost out of time. Before asking the last question, we have a couple of House Keeping matters to take care of. First of all id like to remind you about our Upcoming Events and speakers. On august 1 his excellency, president of the republic of congo will discuss peace and stability and Oil Investments in his country. Next, id like to present our guests with a traditional National Press club mug you can add this to your collection. The traditional last question how is it your experience appearing before the National Press club compare to your experiences last week before congress . The food was much better here. Its a pleasure to be with you. Its a pleasure to share with you what cdc does because despite the recent incidents the fact is that the cdc has more than 15,000 staff. We work in over 50 countries in every state in the u. S. We provide 2 3 of our resources to state and local entities. Were there 24 7 to infect people from threats whether they are infectious threats, intentionally created, or nationally occurring in it country or anywhere else in the world. We do see a press as a vital partner in providing information and shedding light on the Important Health challenges that we face. Thank you all so much. [ applause ] thank you all for coming today. Id also like to thank you National Press club staff including the Journalism Institute and the Broadcast Center for helping to organize todays event. Here is a reminder that you can mind more information about the National Press club on our website. If youd like to get a copy of todays program please check out our website at press. Org. Thank you. We are adjourned. [ applause ] ont, k. T. Mcfarland president obamas foreignpolicy. Then a discussion on congressional oversight. K. T. Mcfarland says president obamas Foreign Policy is an unmitigated disaster. She discussed recent events in the mideast, iran, and iraq. She also touched on immigration. Were 25 minutes