Innovation panel. Weber honored to have dr. Anne schuchat, the center for Disease Control and prevention, and our second panelist is dr. Daniel salmon, Bloomberg School of public school. We are very honored to have the help and security interface from the World Health Organization joint joined us and he is going above and beyond the call of duty as he is alone in from australia through los angeles and took the redeye to be here this afternoon. He has come really above and beyond the call of duty. And then a final panelist is doctor irene koek, acting assistant administered for Global HealthUnited States agency for international development. We will have a similar format of our last panel, and i would also maybe encourage the panelists if they feel the urge to ask one of their copanelist a question that just interrupt me and do it. Ask a wrong question, they just restate the question you would rather answer and go for it. What we are way behind so well probably go to audience q a much quicker because a lot of things to talk about, i know they would like to say, something safari been said so be want to make sure we give you an opportunity to ask some questions of this esteemed panel. I want to start first with dr. Schuchat, and anybody knows the public cdc, and you are our nations Public Health authorities. We are pretty much familiar with the cdc. If you want to restate some of the mission and approach and talk about the great things the cdc, colleagues are doing and many friends of mine, thats great but maybe one way to do that is maybe you can tell us what did we learn from past outbreaks and even a pandemic that i know you in the middle of that in 2009, and other outbreaks we can apply as lessons observed through Lessons Learned for future outbreaks. Sure, thanks. Its a real pleasure to be here and appreciate folks who stuck with the whole afternoon. It is just ten years since the h1n1 influenza pandemic struck, and we have learned a lot from that into some ways are a lot better off, and in some ways theres a lot more to do. I key lesson there was the value of everyday systems. I think sometimes want to have a Fire Department for fires and then whole different Fire Department for bioterrorist events perhaps. But i think the work that we do here in year out with seasonal flu helped us with the h1n1 pandemic, and our efforts since then to strengthen pandemic preparedness will help us with seasonal flu. Whether its the survey lids were, the laboratory work, the communication work the partnerships, the trusted relationships with public and private sector, u. S. And global relationships, exercising every day instead of waiting for the big one, i think thats a critical theme. In terms of learning from the west africa ebola epidemic, as you heard, its not enough to come in when theres an emergency. The three countries that were affected, weakens Public Health systems, and Global Health security agenda was really about making sure every country could find stuff and prevent epidemics, and that the world could surge when needed. What we learned from that is we dont just want to come to drc when theyre in the middle of an ebola problem but we want to be working sidebyside with them to strengthen your system. We are focused on a Public Health system. Just mention the primary care system, but we use the Emergency Operation systems to address trying to eliminate mother to child transmission of hiv. We use them for yellow fever or other conditions. We try to use the Laboratory Networks and the workforce capacity for the problems of the day. I think at cdc we got activities in 57 countries now, very much focused on critical government priorities like pepfar president s malaria initiative, but very much about Global Health security and strengthening everybodys capacity to do with the priorities that have. Thank you. Actually i would like to ask doctor coke from usaid actually, i know the person who is sitting in your seat at usaid recently traveled maybe a month now to the dnc drc and polly came back with some interesting observations that have impeccable usaid, cdc usaid, cdc and other government agencies. Can you share some of the experiences and observations your thinking that at usaid and perhaps have that integrates with an doctor shook it may jump back in with the great work youre doing and collaboration to five necessary support. Was great. Thanks. Would echo her appreciation for the chance to be on this panel and be with you all here today. Usaid roll is with the Development Agency for the u. S. Government. We do work and health is when the ice we work in but sort of work in a number of other areas critical to go in country. As are administered talks our goal is to work ourselves out of a job and that is to build countries capacity to do all of the things whether health, Economic Growth and governance, et cetera. In health we do work across the board. We were close with our colleagues at cdc in a number of areas and you have a lot of programs in dr congo. On the last panel when the big issues with this outbreak is that it is in the middle of a war, a war thats been underway for a long time. It becomes extraordinary difficult to do the kind of ongoing programs that you would be doing in that situation. My predecessor in the current job im in now was there in march i think with doctor redfield and just last week ten seamer who is acting assistant administrator for the human chan assistance work that we do was also there working with the current ambassador and visited the communities affected. Whats really clear is the kind of complex emergency thats underway in Eastern Congress is absolutely getting in the way of the kinds of interventions that we want to do that work in west africa, worked very much in the last outbreak in the western side of the country. Whats also, clear, and theres lot of consensus about the need to do a much more holistic approach, not just the medical interventions with people coming in but doing what are the needs of the community, what does the Community Need and what do they want in order to really bring some of the interventions we need around the Ebola Response, but recognizing as talked about in the last panel its not just ebola that is the issue that is being faced there. People are dying of malaria, tuberculosis. Women are dying in childbirth. Theres lots of fear and distrust of everyone coming in, so trying to engage very, very actively with local committee groups, local ngos, faithbased, the church and other organizations that are active to try to reach the community on a much, much broader scale than simply around Infection Prevention control and going to the etu is host of things. It does need to be holistic and thats impressions by colleagues have come away from visiting there. Dr. Barbeschi, i would like to know, you are heading up the health and security interface at the World Health Organization. I suspect many in this room may be on the phone with the health and security interface may be the first is if you could give us an overview of the health and security interface and how that supports and makes Public HealthEmergency Preparedness and your work with cdc and usaid . Thank you all for being with us this afternoon. Health security interface is a result of a failure of the International System to have a definition of Health Security. What for the lack of, or we heard this morning or during the day, for a reflection for this type of platform. Thank you. Dr. Salmon, i want to inject a new but very related topic into this conversation and would like to ask you how you see the role of vaccine safety but very specifically Vaccine Hesitancy and how that may impact epidemic preparedness or response when vaccine will be absolutely essential. Thank you. Thank you for the opportunity to speak youre going today. Its interesting day. The bar is high for us. Its a great question because my experience with h1n1, and im speaking as an africanamerican academic effort at the time i was speaking for overseeing according the vaccine Safety Monitoring Program at the National Vaccine rogan office, and i think the point about the value of routine influenza, control efforts are very important because what we had to work with with what we had at the time. I reminded of what secretary of defense Donald Rumsfeld said that when you go to war, you just with the army you want, with the army you have, not the army you want. Thats just the realities on the ground. When you look at things like vaccine safety, for example, vaccines we use routinely are very, very, very safe and thats very fortunate, and flu vaccines are very, very, very safe. Theres always the possibility of something you dont expect as was the case in 1976 with the swine flu affair. You have to always look for that. If you have vaccine we are blessed experience, the potential for a real safety problem to occur may be greater but you also have a problem which is that he could vaccinate everyone today, every bad thing that happens tomorrow happened within a day of vaccination. And thats a problem domestically but its especially a problem in part of the world where more bad things happen every day. People will naturally assume that this temporal relationship is a causal relationship. They will see look at all these people that got the vaccine and then something happened. We need signs to separate the coincidental from the true, adverse reaction. Science takes time, but the more infrastructure you have, the better, the faster you can respond with good science. And that infrastructure needs to largely exist before theres an emergency because we dont have time to go now we need to put this together. One aspect of this is really important, which is in the report thats been shared is that of trust, and trust specifically in Public Health authorities. This is very complicated, what makes people trust Public Health . Its probably a whole bunch of things from transparency and equity, and a lot of different pieces make up trust, the we dont understand it well. We dont even know how to measure it very well. We need to do that. Thats a cornerstone of Public Health. Its important to measure it, to improve it. We need peoples trust. We need their confidence. We need their confidence in our Public Health measures that the benefits outweigh the risks, that were doing the right thing. Because at the end of the day we need their compliance. You brought up the temporal relationship with receiving the vaccine and something that happened even though theres not a cause and effect relationship. Are we hope theres not. We seem to be in a state right now where the public has some distrust of public figures and Public Health. How do we rebuild that . How do we go about making, we need to address legitimate concerns. We all as ptab legitimate concerns, but how do we rebuild that trust and develop effective education, fumigation system and who is the messenger . Those are great questions. Were at a point where trust in government is at an alltime low. Were in a world of alternative facts where somehow something can be said and within a short amount of time half of the population questions the birthplace of our president , and so i think the problems are complex and the solutions are also going to be complex. I think we need to make sure we have rigorous objective science. I think it needs to be rapid. If you take the autism example, it took longer than it should have for us to have good data. We have really good data. We have 16 well conducted studies done throughout the world showing vaccines are not associate with autism, but in the time from when the paper was published when science became available, you had a very charismatic, well credentialed person traveling the world creating fiction. So i think rapid is important, objective, rigorous. We need a spokesperson who was really, really trusted, and we need to address it that way. Even if in the United States, certain country or certain areas, to possibly listen to tom brady more than the local ministers health. In the planet that are countries where the issues dealt with giving the politician the states. It will go directly in the other direction. So the message or issue which been researched but not that well yet, because by the time the Research Gets the data, social media can really change the opinion of the public is much faster. Even at the international level, and iteration of the compensation is already matched. Thoughts . I have a lot of thoughts. I need to calm myself. One thing i do want to say, we are at a record right now with more measles cases this year that weve had for 25 years, and larger, longer outbreaks and accomplishments in the country that are quite difficult to control. I think its really important for people to know that here in the United States, most parents make sure their kids get vaccinated against all the things that are recommended. In fact, if you look at twoyearolds, its 1. 1 of them had gotten no vaccines at all. Were not in crisis mode across the country everywhere with everybody opting out of the system but we are at a delicate time of trust which i think building up the last panel is truly local. It used to be people trusted their pediatrician or the family physician. They often trusted their mom or the grandmom. Right now a lot of parents and grandparents havent seen measles and so in sort of a New Territory with that and a lot of pediatricians having either. I think that there are many other influences and some of them are passive and some are active. In the current outbreaks were having, some of the influencers are active with really targeting vulnerable communities with very targeted misinformation. Thats quite challenging but its not a generalizable problem. If we look worldwide theres a lot of different factors influencing confidence in vaccination to confidence in the Public Health system or the government system. This is where we can put all our eggs in one basket of the perfect spokesperson or the perfect role for a spokesperson. You need to look locally and then as a Public Health system we need to make sure we get the best information to all of those partners who might be more trusted than we are. Just to build on her point, because it is really about whos the most trusted voice in any given setting, and getting that goodquality scientific information in a way thats understandable and absorbable to the people youre trying to reach, the complicated studies that you can understand, the lancet is that something by sisterinlaw is necessarily going to understand or similarly in the community. You want to get that information in a way thats understandable but understanding who are the trusted spokespeople in a given area. Theres a lot of evidence from our behavior change colleagues who really look at this, how do you get the information out in way that changes the behavior and can be understood and trusted, and we can look back to some of that, some of those approaches and evidence as a way to get on top of these kinds of misinformation and the misunderstandings thats out there. We need to be careful not to over respond. Theres two places i worry about that in particular. One is theres been a push to eliminate nonmedical exemptions. I understand the desire. My concern is that it doesnt get at the larger issues. The impact based on what weve e in california, which did so in response to a Measles Outbreak in 2015 is that the impact is really small and it reduces parental autonomy and disproportionate for low income people that may not be able to afford the homeschool or shop doctors. My concern is that of trust, and parents feel like were being more draconian, it may have backlash. Also the push on social media. Theres a lot of problems with social media but i recently read a letter written a congressman to that of facebook and twitter, and he said there is no evidence that vaccines cause serious harm or death. Vaccines are incredibly safe but thats not a true statement. The argument is to curtail misinformation but the letter itself is misinformation and its coming from a government leader. I think we can with social b is great. I would much rather see it done between individuals and the Companies Taking social responsibility. I just think we have to be careful not to over respond and feet into the mistrust problems. A lot of our over response is actually probably driving division, device of this we have on both sides of this argument now. We need to avoid it. Id like politics. Need 95 compliance homogeneously across the population indefinitely. We dont want this to be a defining issue. We need to bring people together and we need to sustain that success. Most parents waxing their kids and we need to keep it that way. Let me change gears again. We need to talk about innovation and technology. Doctor shook it, could you share all of it other thoughts about how cdc has advanced innovation and technologies and preferred his outbreak response and how its part of the culture of cdc . Sure. Maybe ill just write a little bit and kind contrast will be our right in 201415 with ebola. There were enormous efforts to get Laboratory Confirmation of ebola cases in 201415 because a diagnosis making it to be separated from everybody, applications on all your contacts, quite a bit of a lift for the