The next pandemic. Hopefully its not the next pandemic right here. You might think that the Natural History museum is not the best place to have a meeting like this. I would suggest that the Natural History museum is the best placed at the meeting like this. This museum is the largest Natural Museum and has 145 million objects. I say that objects whatever but the reality is collecting the Natural World for the last 300 years and preserving those objects in museums and this is the place where we have what we know about planet earth so the records have collect and over the expansion of humans. In any given year, 400 phd is working behind the scenes. Last year, over 400 new species were described. At the same time, we welcome 6 million visitors. Most of those visitors are tourists which means the next year is a different 6 million so in a decade you might get as many as 50 Million People in this building. We live in Interesting Times with human population is growing. There are so many things happening on the planet where humans interface with the Natural World and where things like pandemics can emerge. Just a couple of examples. Examples. If we were to go to the other side the building into the sixth or you would walk into a collection that is 640,000 birds skins collected over the last years all around the world. The other side of the building 590,000 examples of mammals so huge collection of organisms that carry the genetic code of their species but also carry other features of the environment as they became biological data collectors. Recently several thousand of these birds were sampled for evidence of the 1918 influenza pandemic week as we had words in 1918. We have those birds and we sample 25 of the six tested positive for the influenza. We have in our collections fossil examples of diseases. When diseases break out there are times when those outbreaks the vectors are not known and its an example of the junta virus discovered so we have come to realize our collections arent just historical artifacts with Research Tools and affect Scientific Infrastructure that allow us to investigate emerging scientific issues in areas of diseases and Food Security and Invasive Species etc. So i welcome you here today. We are going to be opening an exhibit next spring called outbreak, epidemics and the connected world and this really will map the Museum Perspective and the fact that human health and Environmental Health and Animal Health is related to one health and the exhibit will discuss a lot of emerging effects of diseases and present them to the huge public. Couple of years ago we did an exhibit called genome about the human genome discovery. Most scientists have a good understanding of whats happening in human shouldnomics but the general public has almost no clue what it is. You take the tools of museum and interpret Something Like genomics for the public it provides a bridge between specialist in the world and it will do the same thing for merging Infectious Disease outbreaks. One of the speakers leader status dr. Sabrina schultz who is the curator on staff here who is the lead curator for the exhibit. So all that said id like to introduce our first speaker who is someone who i just met a moment ago but i enjoyed his work over the years. John barry is an author and historian currently a distinguished scholar at Tulane University where he is focused very much on the state of the gulf coast. I came to know him from his book rising tide the great mississippi flood of 1927 and how it changed america. He has also written a book entitled the great influences the story of the deadliest pandemic and history published in 2004 preview is ranked by the academy of sciences that year as the the outstanding book of science and medicine. Hes the only nonscientist on the federal Infectious Disease board of experts. Was on the team that developed nonpharmaceutical interventions to the pandemic. He is also advice for bush and obama white house, so that i would like to have you help me welcome john barry to the podium. [applause] thank you and thanks for coming and thanks for putting together this conference. I want to give you a very quick summary of what happened in 1918 and what we might learn from it. The estimates of the death toll started 35 million go to 100 million. Adjusted for population approximately 150 million to 400 million today. Most of the debt the deaths were adults aged 20 to 50. Probably between three day of the entire population of people in those age groups died. Certain subgroups, it was worse than that. There were numerous studies of pregnant women that had case mortality rates from 23 to 71 . In populations it was not unusual for 20 to 30 of the entire population to die and although the focus has often been on young adults who died they are not the only people who died. Look at children even in the west were case mortality was the lowest the 1918 pandemic killed as many children aged one to four s. Today die of all causes over a 20 year period. He killed as many children aged five to 14 s. Died from all causes over to attend a 15 year period and remember that well over half the deaths occurred in a period of weeks about 10 weeks in the fall of 1918 so just think of the impact that would have. Today even in nonlethal pandemic could sicken between 60 and 100 million americans, 2 billion people worldwide. That would overwhelm the medical system use of antibiotic stocks from secondary infections, destroy the timing of inventories, devastate the economies so we need to extract every lesson we can from 1918 and the first lesson is we need to put a lot more resources into Vaccine Research particularly universal vaccines but in the interim improving technologies on vaccine manufacturer. Second, to inform policy choices choices. We need to continue to study events therein, the virus itself. We continue to learn more about it. One of your speakers in epidemiology is certainly an expert there and another speaker and we also need to look at it from an interdisciplinary perspective. I believe there is plenty to learn from 1918 still. I will give you three examples of untouched data. I know of studies of several hundred thousand people and institutions that relates to wreck way to the effectiveness of handwashing. That data has not been touched. There is excellent data on quarantine by a brilliant pioneer epidemiologists, strongly, not just suggesting i think proving that quarantines is pretty useless with influenza. Thats untouched. Maybe most important i think the data from 1989 pandemic and from 1918 and 1920 about the first person in a household to become sick with the disease. I think that was certainly deepen and challenge some of our understanding of how disease spreads. But to me the main lessons involve what today we call Risk Communication which happens to be a phrase i despise because of it colludes managing the truth and i dont think you manage the truth, i think you tell the truth. In 1918 chiefly because of the war but not entirely for that reason they did not tell the truth or close to it. The disease was known as the spanish flu. National Public Health leaders called that quote ordinary influenza by another name. The surgeon Surgeon General of the United States that quote you have nothing to fear if ordinary precautions are taken. And what was true nationally was also true locally. The false reassurances were almost everywhere. In arkansas a doctor reported his hospital closed, overwhelmed overwhelmed, doctors and nurses dead, thousands of soldiers sick and dying in barracks and miles of double rows of cots. He says everywhere there is only death and destruction. Seven miles away in little rock the newspaper reported the same old fever and chills. I think society is built on trust and these false reassurances, these efforts to keep morale up quickly lead to a loss of trust. It was alienating, eraza and dating, isolating and as a result society began to disintegrate. As one person said the disease can people apart. You had no school life, no church life. Completely destroyed all family and community life. People were afraid to kiss one another. They were afraid to eat with one another. It destroyed the intimacy that exists amongst people. In philadelphia there was a doctor who lived 12 miles from his hospital or there were so few cars on the road as if he went home every day he started counting them. One day on the drive of 12 miles there was not a single other car on the road. He said the life of the city has almost stopped. On the other side of the world in new zealand and other doctor stepped outside of his hospital and said i stood in the middle of Wellington City at 2 00 on a weekday afternoon. There was not a soul to be seen. It was a city of the dead. There were people starving to death, not because there was an food but because people were afraid to deliver food to them. Victor von who would then the dean at the Michigan Medical School had seen a serious person not given to overstatement said that the present rate continuing for a few more weeks it was safe and could disappear from the face of the earth. Thats what happens when People Lose Trust in each other and in authority. And to test my hypothesis or the hypothesis that the truth does make a difference there was one city that did tell the truth in entirely different experience. In San Francisco the mayor of the labor leaders Business Leaders put their name on a full page ad huge print that said where a mask and save your life through the mask didnt do a bit of good but that is a very different message than ordinary influenza by another name. In San Francisco the city was extremely well organized and certainly nobody starved to death. Blocks were well organized. Teachers when schools close they volunteered as orderlies telephone operators delivering things. The San Francisco paper said one of the most thrilling episodes in the citys history was how this gallantly the city the hate during the epidemic. Thats what happens when you do tell the truth. So i think the lesson is clear. Public compliance with recommendations will be difficult under any circumstances, sustain compliance will be much more difficult. In mexico city in 2009 for example masks were recommended on public transit. Three wins were distributed. Usage peaked at 65 in four days later it was down to 27 . So for expect compliance with recommendations authorities beat to get out front and stay out runs. We need to be totally accessible. They need to stay ahead of internet rumors and the final lesson is not from 1819, term 2009. Planning does not equal preparation. There was a lot of planning done between 2004 and 2009 but when that very mild pandemic hit it was as if at least by Authority Figures none of that made any difference. If you look at rational responses in china, egypt India Britain france, even some to a lesser extent the United States and began planning does not equal preparation which means the biggest challenge is the Public Health community is to get political leaders to make rational decisions in crisis situations and that is where leadership and the Public Health community really matter. Thank you. At afternoon. Im Michael Caruso the editorinchief of smithsonian magazine, the magazine that is not coincidentally seen on your chairs. If you like whats in there we did three stories in this issue all about influence. If you like within their of the efforts of terry the executive editor and jenny griz a Senior Editor and if you dont like whats in there its my fault. I am one of those impossible roles introducing a man who needs no introduction especially to the people in his room but im going to plow on anyway so bear with me. When it comes to thinking about epidemics and everybody wants to talk tony fauci. Hes americas point man on disease for 33 years now. Lead our nation through every Infectious Disease crisis through various years from aids to ebola to seek a. Dr. Connie leyva is a member of the National Academy of alliances. He has 42 honorary doctoral degrees has received the president ial medal of freedom and his citation reads that it is his commitment and enabling men women and children to live longer and healthier lives. With his broad appreciation for the public good and is nonpartisan if they failed dr. Or fauci perceive the budget. The story and the event itself came out of an answer that doctors fauci gave us that was onstage at another friend of ours a couple of years ago. We asked him what concerns you the most, what keeps you up at night and his answer was simple, two words pandemic influenza. Okay we thought lets hear more about that. Ladies and gentlemen dr. Anthony fauci. [applause] thank you very much for that kind introduction. Following that encouraging story from john im going to tell you a little bit about the next step that i think john was very clearly referring to about what we need to do regarding preparation. And thats what im going to talk about in my 10 minutes, preparing for the future and endemic influenza. The first thing i want to do is to make the point that when you look at influenza that preparation for seasonal influenza essentially should be the preparation for pandemic influenza in a Perfect World. In a Perfect World that i hope we get to in the next period of years. We certainly are trying hard for that. Its the development of what john alluded to a universal influenza vaccine and let me tell you why is someone who is an Infectious Disease person that im concerned about our capabilities today against any kind of influenza. I want to break it up into three quick parts. First of all the current influenza vaccines are not consistently effective and that is a fact that we just have to face. If you look at rum 2004 until the last year when you have a bad year with a mismatch as we saw in 2004 and 2005 you have a 10 efficacy at us, as we had in 2010 and 11. You have the 60 efficacy to compare that to other infections that we have vaccines for the measles vaccine is 98. 5 effective. Yellow fever is 99 effective. Polio is more than 90 effective. There are a lot of reasons for that. We all know about the mutations. We all know about the fact that the response brings hemoagglutinin although it can be effective from yeartoyear sometime shipped but this is a stark reality of how we address seasonal influenza. Now pandemics do occur. You just heard from john about the mother of all pandemics but we have had three since then in 1957, 1968 and most recently in 2009. However the response afterthefact is not effective. John alluded to the h1n1 pandemic in which we actually had a bit of a warning. I want to show you what the response was of those of us who were going as quickly as we possibly could. It was the swine flu. The first thing is that we were expecting as we always have that the next pandemic would come out of china or the far east. When in fact it did not. He came right in our western hemisphere somewhere around california and mexico. Now you were called and i have shown im i am sure people in his audience to recall that the end of the 2008 9 season as things were calming down in march the way they usually do and peaks in january, all of a sudden in march and april we started to see a new kind of influenza. So we felt lets make a vaccine for that influenza and this is march. This is what happened in april so wasnt in 1976 shoot from the hip and get in trouble as we did then by the vaccinating everybody. We knew we were going to get a pandemic so in april this is a picture of my good friend ann and i testifying before the Appropriations Committee enables saying and you can go back and see what we said, it takes about six months to get a vaccine going soap we start working now may, June July August september october if we have the vaccine buyout sober then we will be prepared for the inevitable pandemic. However what happened . The children came back to school and instead of having an epidemic or pandemic that peaks in january and february it peaked in september as graphically shown on the slide. Whats wrong with this slight . The blue line is where the red line should be in the red line is where the blue line should be be. In other words the illnesses peaked before we had the vaccine available which became available and it would have been wonderful as peaked in january but it didnt come it peaked in september so even though we had some warning about a pandemic, even then with our current capability it does not work well well. Notice the expression on tom friedman and Jesse Goodman explaining to the House Oversight committee about the vaccine that we were supposed to have in time. We didnt and then theres a third thing and that is chasing after a potential pandemic outbreaks. I refer and others refer to them is as prepandemics. Its costly and it is an effective and let me just give you a couple of examples. You were called the h5n2 one pound the chicken virus that started in hong kong. It had a high degree of brutality but didnt develop the capability of efficiently going from humantohuman. We took this very seriously and what happened during the george w. Bush administration he asked for 7 billion we spent 45 billion to switch from eggs to cells