Good afternoon, everyone. I am the director of the museum and staff director of the museum of Natural History. It is my pleasure to welcome you to the next pandemic. Hopefully its not the next pandemic right here. You might think that the Natural History museum is not 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 frontiers in preserving 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 years 300 years preserved at acceptable by research scientists. Last year over 400 species were described by scientists working the building. At the same time we welcome 6 million visitors. Most of those visitors are tourists which means the next years a different 6 million, the world plus largest collection, visit by the Worlds Largest is the audience, and we live in Interesting Times with human population growing. There are so many things happening on the planet where humans interface in the Natural World and where it seems like pandemics can emerge. Just a couple of examples. If we were to go to the other side the building into the sixth floor, 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 because we had birds collected in 1918. We have those birds, and we sampled 25 of 26 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 the classic example is the hanta 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. It is an interesting time to be in a museum. 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 all related. We call it 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 genomics 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 specialists and the world and it will do the same thing for emerging Infectious Disease outbreaks. One of the speakers leader one of the speakers today is dr. 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 fate 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 influenza the story of the deadliest pandemic in 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. He was on the team that developed nonpharmaceutical interventions to the pandemic. He has 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] barry 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 start at 35 million go to 100 million. Adjusted for population, that would be approximately 150 million to 400 million today. Most of the dead were adults aged 20 to 50. Probably between 30 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 virgin 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, where case mortality was the lowest, the 1918 pandemic killed as many children aged 1 to 4 as today die of all causes over a 20 year period. It killed as many children aged 5 to 14. 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 million and 100 million americans, 2 billion people worldwide. That would overwhelm the medical system, use up 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 and research, particularly universal in 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. Particularly 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 effectiveness of handwashing. That data has not been touched. There is excellent data on quarantine by a brilliant pioneer epidemiologist, strongly not just suggesting i think proving that quarantines is pretty useless with influenza. Thats untouched. Maybe most important i think the data from 1889 pandemic and from 1918 and 1920 about the first person in a household to become sick with the disease. I think that would 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 implies 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 it ordinary influenza by another name. The surgeon Surgeon General of the United States that 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, 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 led to a loss of trust. It was alienating, isolating, and as a result, society began to disintegrate. As one person said, the disease kept people apart. You had no school life, no church life. It completely destroyed all family and community life. People were afraid to kiss one another. They were afraid to eat with one another. It destroyed this context and destroyed the intimacy that exists amongst people. In philadelphia, there was a doctor who lived 12 miles from his hospital. There were so few cars on the road, 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, another doctor stepped outside of his hospital and said i stood in the middle of Wellington City at 2 00 on a weekday afternoon and 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 not food, but because people were afraid to deliver food to them. The dean of the Michigan Medical School had seen a serious person not given to overstatement said that the present rate continuing for a few more weeks, civilization 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 an 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 wear 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 behaved 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. Sustained compliance will be much more difficult. In mexico city in 2009, for example, masks were recommended on public transit. Free ones were distributed. Usage peaked at 65 in four days later it was down to 27 . So if we expect compliance withe totally accessible, they need to stay ahead of internet rumors. Message is not from 1918, it is 2009. Planning does not equal preparation. There was a lot of planning done between 2004 and 2009. ,hen i very mild pandemic hit it was at this none of that it was as if none of that made any difference. Similar responses in china, egypt, france, and some to a lesser extent in the United States planning does not equal preparation. The biggest challenge to the Public Health community is to get political leaders to make rational decisions in crisis situations. And is where leadership the Public Health community really matters. Thank you. [applause] good afternoon. I am michael caruso, i am the editor in chief of the magazine all on your chairs. ,f you like what is in there we did the three stories in this issue about influenza. If you like what is in there, it is due to the efforts of our Deputy Editor and our senior editor. If you do not like what is in there, it is my fault. [laughter] ive one of those impossible roles introducing a man who needs no introduction. Im going to plow on anyway. To thinking about epidemics, everybody wants to talk to tony fauci. Manhas been americas point on Infectious Disease for 30 years now. He has led us through every crisis from aids, to ebola, tuesday got. Ika. Wo z he has received the president ial medal of freedom and his citation reads that it is for his commitment to enabling men, women, and children to live longer, healthier lives. With his broad appreciation of the public good and is l, hertisan nerves of stee oversees a 4. 9 billion annual budget. This event itself grew out of an gave to us dr. Fauci that was posed at another event of ours. We asked him what concerned you most . Pandemicr was simple, influenza. Ladies and gentlemen, dr. Anthony fauci. [applause] thank you very that kind introduction. Finding that encourage following that encouraging story from john, im going to tell you a little bit about the the step that i think it john was very clearly referring to about what we need to do regarding preparation. That is what im going to talk about. Preparing for the future and pandemic influenza. The first thing i want to do is to make the point that when you look at influenza, preparation for seasonal influenza essentially should be the preparation for pandemic influenza in a Perfect World. The Perfect World that i hope we get to we are certainly trying hard is the development of what john alluded to, the vaccine. I am 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 seasonal influenza vaccines are not consistently affected. That is a fact we have to face consistently effective. If you look at 2004 until the last year, when you have a bad year with a mismatch, you have a 10 efficacy at best. Efficacy at best. Compare that to other infections 98. 5 sles vaccine is effective, yellow fever, pouliot is more than 90 effective. There are a lot of reasons for that. We all know about the fact that the response against the hemoagglutinin drips from yeartoyear and sometimes shifts. Y of howa stark realit we address seasonal influenza. Pandemics do occur. Since then. Ree 1950 7, 1968, and 2009. The response after the fact is not effective. Alluded to the 2009 pandemic were we had a bit of warning. I want to show you what the response of us that were going as quickly as we could. It was the swine flu. That the nexting pandemic would come out of china or the far east. It did not. It came right in our western hemisphere somewhere around california and mexico. You recall and i am sure people in this audience do recall that 2009he end of the 2008 season, as things work cal down in march, all of a sudden we started to see a new kind of influenza. We felt, lets make a vaccine for that influenza. This is march. This is what happened in april so it was not a 1976, shoot from the hip, by vaccinating everybody. We knew we were going to get a pandemic. A picture of ais good friend of mine and i testifying before a committee saying that it is april it takes about six months to get a vaccine going. Now, ifart working to we have the vaccine by october, we will be prepared for the inevitable pandemic. However, what happened . The children came back to school and instead of having an epidemic that peaks in january and february, it peaked in september. What is wrong with the slide . The blue line is where the redline should be and the red line is where the blue line should the. Peakedcent of illnesses before he had the vaccine available. It would have been wonderful and peak in january. Even then with our current capabilities, it did not work well. On tom andexpression explainingsses about the vaccine that we were supposed to have we did not. The third thing, chasing after potential pandemic outbreaks. I refer to them as prepandemics. It is costly and ineffective. ,n1 thecall the h5 virus that started in hong kong. We took this very seriously and what happened . It was during the george w. Bush administration and he asked for billions of dollars and weise about 5nd we spent billion to switch from egg s. It ine a vaccine, we put the stockpile at, and nothing happened. We put a pandemic influenza Preparedness Plan we approved the vaccine, but we did not use it. Several years later, we had the h7,n9. It started in 2013. We were quick. We made a vaccine in 2013, we stockpiled it. Ande at the mini outbreak then what happened in 2017 and mutated a little. It was not protected by the vaccine that we developed for 2017. We had to go back again and start all over. What is this telling us . This is telling us my conclusion. We need to get a universal influenza vaccine. From a scientific standpoint, we will get there. We will if i get this. For about 30ef seconds, there are a number of ways to get a response that is universal against all viruses. One,f them, not the only when you look at the hemagglutinin it is very , can we go back one . Ok. There you go. Im sure people in the audience are very well aware of that that the part that is protected in the current vaccine is the head of the hemagglutinin that is the good news. The sobering news is that is the part that mutates or dress from season or drifts from season to season. It is one of the ways we to get aing to try vaccine response that is against the virtually all strains. I want to close on this slide. We had just written this for scientific american. Goal to spur us on to the that we need to do. Lethal 1918ter the flu that john just described, we are still vulnerable. Infrastructureth has improved greatly but without a universal vaccine, a single virus would result in a world catastrophe. Thank you. [applause] thanks very much to john and tony for those presentations. Our first Discussion Panel will focus on what scientists have learned about the 1918 influenza pandemic. From theew Microbiology Department from john hopkins. I would like to introduce our panelists. Jeffreymediate left is taubenberger. Laboratory sequenced the 1918 influenza virus. Recently, he has been focusing on development of universal influenza vaccines. In the center of our panel is cecile viboud. Theresearch focuses on transmission dynamics of influenza and