Transcripts For CSPAN2 The Next Pandemic 20171113 : vimarsan

And vote on this bill after things getting and popularity to combine their version with house version and hopes to get it to President Trump for christmas. Next up will take you alive to a forum on preparations for the next health pandemic, scientists and doctors are reviewing current influence the dangers and future challenges. Hosted by the Johns Hopkins school of Public Health it live coverage around hes been to. It is a combination of protection in their age group that has seen the related strain of [inaudible] but [inaudible] also now look at historical tenements from 1890 to 1918 to 1,962,009 and theyre all different. They share pictures and come at odd times and come in the summer and the effect more of the younger population but they are quite different and that means for the future we need to have systems to have Technology Information and what it looks like. David, in 1918 there were no pharmaceutical interventions available to help expand the pandemic. We now both antivirals and vaccines, though as tony mentioned, their efficacy is not as high as we like them to be. Could you talk about the influence of vaccine history and where i see the field going in the near future to try to improve the tools we had to deal with the pandemic. I think back in 1918 as jeff pointed out they were already working on vaccines. Mistakenly working on a vaccine for a bacteria and it wasnt until 1931 that it was dependably shown that influenza was caused by a virus, 1933 they were able to grow it in the laboratory in may 1945 there was the first license vaccine in the United States. There have been some improvements since 1945. There have been improvements in the manufacturing process. The 1945 vaccine was a [inaudible] vaccine for one influenza type a component and a type b component and we are now moving to for vaccines and in 1935 we used embryonated eggs to grow the virus and now we still use those to grow the virus for most of our vaccine but as the doctor pointed out some companies are moving to subculture to move the virus and some are largely bypassing the growth of the virus in the sense that theyre using technology to express the proteins from the surface of the virus to make the vaccine. We have improved vaccines for older adults by virtue of higher doses or by using [inaudible] and importantly were using the vaccines more since 2010 theres been a recommendation for universal use of the vaccine for all of us from six months of age and older to get each year but still, as the doctor pointed out our current vaccine needs some work and theres more we can do. They are different from other vaccines. First of all, the disease were trying to prevent is very prevalent, up to 20 of us will have an influenza infection during the course of the year. Secondly, the viruses keep changing. That is why we need a new vaccine each year. Also, the efficacy is lower than for other vaccines. On the doctor slide and show the different efficacy estimates for 2014 and 2015 and the efficacy was 19 but cdc tells us that year that vaccine presented 1. 6 million cases of influenza despite relatively low use of the vaccine and a low apathy. Increased use particularly in pregnant women we heard from john about pregnant women being in a particular susceptible group for disease and this all helps. Looking forward i think there is two ways we are moving to improve things. The doctor covered the idea of universal influenza vaccine and if we are successful they are then we have a vaccine for any influenza virus. Past, president or future, human, alien drives, we are set. This is a vaccine that who is looking for. Most influenza deaths occur in developing countries and very few vaccinations occur there. The second approach is to advance these Rapid Response platforms. Gs k has few such platforms and one of them, for example was used to make a vaccine for aged seven and nine virus. That took eight days to make that vaccine from the time the chinese posted the sequence information for the virus until it was injected into cell culture and into mice and talking to the scientist that did that work they tell me they could have done it in four days because they were too snail mail steps in the process. Once we have these platforms that are working it then becomes quality control, release a product, regulatory steps that are on the critical path. We need the time and resources to make it happen. I encourage anyone in the audience to ask questions and if you have a question raise a hand and try to get my attention. He will try to acknowledge it and get you involved in the discussion. While we are waiting for that a couple of followup questions and will start to start with jeff. Do you think influenza is most likely virus or are there other microorganisms out there that pose an equal or greater threat to the human population . Well, i think the future is always a good strong vet and their other viruses you think about other respiratory viruses an animals for one that led to stars and something concerning but the but can be concerned about and there are viruses that the insect borne virus like [inaudible] that are concerning but influenza is the way to bet something that is most concerning. You have enormous diversity of influenza virus in an incredible in birds and mammals and domestic birds and mammals and these viruses mutate like mad and can adapt and move between species. That is what i think gets us the greatest fear is that despite 100 years of studying the virus we really have no way to accurately predict what strains will emerge and how they will adapt from one animal to another and how serious they will be. That is a huge challenge. To be added to that the national vectors are such a different disease. It doesnt cause that much illness and these animals can be affected for long periods of time and go on migration patterns that take them hundreds if not thousands of miles away to introduce them to new reservoirs. The diversity out there and how those viruses move around the world is mindboggling. Cecile, you have been doing a lot of work in understanding and modeling how pathogens spread in human populations. This has been particularly fascinating to me as my center of working towards understanding seasonal influential more carefully. Could you speak to how modeling efforts can perhaps inform our Public Health responses to the next pandemic and help us come up with interventions or ways to at least minimize the spread of viruses. It is useful to look at scenarios and in the context of the closing schools when should you close schools and for how long and [inaudible] there was also a lot of questions about in the context of a pandemic and all of the models agree that it is no use to [inaudible] there is more and more effort to end the cdc context that has been done in 2009 since the evil outbreak and there has been modeling around typecasting and decades ahead of the web and putting effort into that. One i think the progress is quite exciting. David, you mentioned briefly in your answer to the first question, they started initiatives aimed at shortening the time to generate new vaccines to emerging pathogens including one for a Global Pandemic potential and its a relatively new facility opening up nearby here in rockville, maryland, devoted to those efforts and can you tell us about approaching this idea of making vaccines to pandemics or potential pandemic. Gs k has been working with the Us Government specifically the Biomedical Advanced Research and Development Authority since the inception in 2006 to develop and to produce preparedness products. In our case age five and one vaccine we had month so close antibodies for anthrax, for treatment for influenza and also a microbial resistance would be a great topic for another option symposium. Barta is working with other companies and they have 21 products in the Strategic National stock ready for use in this is great but its not really sustainable. We need more and more products and the products we have reached the end of their shelf life and need to be replaced. Dsk and others are interested to move more to the Rapid Response platforms. Dsk is partially motivated by the 2014 epidemic of ebola in west africa. We responded to that outbreak with our primary scientific partners at nih and went from the start of a phase i Clinical Trial to the start of the phase three Clinical Trial in five months rather than the usual five years or longer. But it was too late. We need to be able to act faster. Again, many other groups are working for these platforms. In the ideal we would have continued to have or improve our surveillance and we identify pandemic threats and it would be sequenced posted to the cloud, Research Laboratories would be downloaded and create a vaccine handling a computer identify the gene segments that are needed for that and loaded back up to the cloud and it would come down to different manufacturing facilities that are using a platform and using it every day for standard vaccines, say influenza in many parts of the world. Then when the pandemic threatens they interrupt their routine manufacturer and they start making pandemic vaccines within weeks and months or billions of doses and that is the ideal. I glossed considerably there but i think those are the sort of things we can hope to look forward to. Thats an excellent to make. Some of the work we have been doing using seasonal influence is the model system for setting up those realtime diagnostic efforts and identify the past and spread the word around and see what new variants are coming through. What you would want to do eventually in a pandemic its a great way to model social as ever to talk about it on the par away. At least organisms where we understand it well like influenza and we know what the target should be as the head of the [inaudible] trent. [inaudible] i repeat the question. John asked that we been talking about vaccines but what about progress on antivirals and their role in terms of the tool in countering pandemics. Well, there are antivirals against influenza that really only in two classes and the problem is that influenza viruses can very often develop mutations to make them resistant to these drugs and clearly more classes, newer classes of drugs need to be made in clearly there has been a lot of research governmentfunded research as well as industry to develop anti value and as far as i know i dont know how close those are two Life Insurance but we are still faced that for many strains the antivirals that are available for position to describe are often inadequate because viruses are already resistant. Nothing to add except the Silver Lining to the 2009 pandemic in the 2008 viruses were becoming resistant but the new h1 and one is susceptible. I think there is an added realization that developing one antiviral is great but having two or three as a administered as a cocktail is the ideal situation. Those are seen with hiv and hepatitis c virus when you have a group or a cocktail of antivirals the likelihood of resistance coming up really is decreased exponentially and i think that is something to keep an eye on in the future as terms of these moments. [inaudible] yes, i know there are few drugs in the pipeline and i know there has been one new antiviral license to japan but certainly i dont think there is as many antivirals in the pipeline of development that could be or should be. [inaudible] what about the immune response mechanism for protection against the influenza virus you mentioned the antibodies in gluten however i went to a session in the Political Center where it showed a better correlation where antibodies then in gluten with protection and a human study and i found that really interesting finding is fairly recent, years ago and wondering whether that has been pursued or what i was once told and all about ctls and theres always people that believe in ctls and i dont have a feeling for what how much is known at this point about what kind of immune response would confer better then, lets say, the maximum 60 which would not pass these days for approval of any vaccine. Thank you. Im sure i cannot completely answer that question. I dont know that much more than what you stated in your question. There remain a number of unknowns about that in the best way to prevent it. It is completed with having a series of infection that complicates so the history is important in terms of you as an individual respond to a vaccine and there are parts of the viruses that can be targeted through cellular responses and antibodies can protect and if there is enough for them but the current standard for better hemagglutinin antibodies which is acknowledged as perhaps meaningful by regulatory authorities would you like to add . I can speak to the fact that i spent the morning at the campus where universal flu vaccines are being discussed in the first thing that came up was set up studies to better understand immune responses, infection and vaccination outside of the typical anti back and get a stronger sense of what the natural course of it induces as protecting into my responses into no longer fit into the [inaudible] looking at the protein standard. Its a much broader thinking now that we need to go back and think about any antibodies and t cell responses and immune response in total to seasonal influenza and use that as a way to help us inform universal vaccine study going forward. It cant speak clear that because we had some success with seasonal flu vaccine that we were okay and there wasnt a lot of going back to the basics it its almost a little embarrassing that we have hemagglutination and that is what we use as the protection. We had not pursued normal [inaudible] and we havent pursued t cells as much is the shed and so forget to get to the universal vaccine that i was trying to we are almost in some respects going to have to go back to the basics and ask fundamental questions of what the true immunity in the scope of the its very interesting that in 2017 we really dont know as much as we probably should. That is the conclusion of that workshop you are at. Absolutely. With that im going to close this panel i want to thank my panelists for their wonderful discussion we had in thank you very much for your attention. [applause] good afternoon everyone. Im ball, director of the center for military health at Johns Hopkins Bloomberg School of Public Health. Were going to talk about. For the worst and is the world ready to respond. Im hoping he will get beyond the vaccine to other areas clearly there will not be a universal vaccine anytime soon and there will be a lot of people that are sick and how will the Healthcare System in Different Countries respond. We have two speakers and im going to introduce the first one, doctor daniel, Deputy Director and chief medical officer of the Public Health preparedness and response or php are at the center for Disease Control and prevention. In this role he is the lead science advisor it provides scientific representation for preparedness on behalf of php are in cdc. He served in the external partners for cdc and the sears strategy and Program Coordination for php are in the medical and Public Health preparedness response. Daniel, welcome. Thank you, paul. Its an honor to be here had to represent the cdc scientists and staff who are more than 60 years have worked to address this threat of influenza and ways the Public Health response to health crises. You have heard how the 1918 influenza pandemic was an unprecedented Public Health crisis and nearly 100 years later the world has made major advances in the science of influenza prevention and control. Influenza virus, however, continue to pose one of the worlds greatest Infectious Disease challenges and risk of pandemic influenza remains. Our vulnerability in a pandemic relate to the virus its susceptibility of our population and the environmental factors that favor the spread of disease. By definition a pandemic virus is one for which the population lacks immunity and is capable of transmission from person to person and to cause severe disease. In addition to our naive immune systems in a pandemic significant numbers of people today are more susceptible to Infectious Diseases because of disease is a have or therapies they take that compromise their immune system. The exponential growth of our populations around the world expanded International Travel and increase proximity to humans to animal reservoirs increase the risk that a pandemic influenza will emerge with extreme effects. In the absence of a vaccine that can illuminate influenza pandemics time will be of the essence and early recognition of persontoperson transmission of a pandemic virus can make all the difference to effective response. This is why ongoing Surveillance Networks around the world are so important. Many pathogens can cause similar symptoms to influenza so diagnostic tests that are rapid, accurate and feasible for widespread use are critical to rapid understanding of the pandemic conditions and for specific treatment plans. Nonpharmaceutical interventions such as personal protective equipment, respiratory etiquette, hand hygiene and social distancing can prevent disease transmission even with a specific medical intervention is not available. Vaccines will be an aborted part of response even today. Medical treatments for influenza in secondary infections can save lives available in the right hands at the right time. An effective pandemic also requires effective with the public. And with our help responders so that there is confidence in our recommendations and motivation to follow them. In 1918 we were sorely lacking in these capabilities. There was no National System of surveillance, much less a global surveillance effort. Viru