Speakers include doctor anthony tolkien, director of the National Institute of allergy and Infectious Diseases and hamburg , former fda commissioner. This is about an hour. Why are we even hear. I will give one example. In 2009 there was a pandemic flu. Make a swine flu, i dont know why. Its beside the point. Doing you want enough to go back and out of blake instructed more than 2 billion people. As far as i can tell and theres a lot of reporting on this, the who acted incredibly admirably and rapidly in getting vaccine out. And the only reason that it wasnt one of the most devastating epidemics in the history of humanity is because that person particular flu decided not to be berlin. We dont get a vote but the Gates Foundation else modelers who are pretty good and they estimated that had been anything like the 1918 flu, 33, 37 Million People would have died and then we wouldnt be having this conversation or at least some of us wouldnt becausewe began. And what happens when these sort of things occur is if they dont kill a lot of people we just move on, especially when it comes to influenza which people seem to think itsjust a word that means i dont feel well. It doesnt, and i think for the first question i like to ask tony, maybe you can explain a little bit about what, why would we want universal vaccines, how does this work mark is a pandemic than what we get every year and where are we. Okay. Thanks mike. Just very briefly because i know we certainly have a lot to talk about , but the situation with influenza i think that many people in the audience know is that unlike a virus like the measles which if you have the measles virus and you get vaccinated against measles you get infected with measles, then you are protected essentially for life for the simple reason that measles doesnt change from year to year or from decade to get that they whereas influenza is very unique in that it is a virus, a group of viruses. There are differentkinds of influenza , lets just focus on influenza a tend to we use the terminology direct from season to season and that there are mutations that change it and not so that you really need to get vaccinated each year. Then you try to anticipate the right match between a vaccine and the virus that will be circulating. And then every once in a while as michael alluded to you have a very dramatic change either by mutations or by evolutions from animal influences that jump species, recombine or what have youand you have something called a ship or a real big change thats really unique. A viral infections that we deal with, polio, smallpox, measles,etc. Dont do that. Dealing with a continual moving target season to season and the threat of a pandemic. So the title of the session is the quest for universal flu vaccine so when we talk aboutuniversal flu vaccine it really right now is an aspirational goal. In that the quest being to make a vaccine that induces a response in the body so that part of the influenza doesnt change from season to season from decade to decade or even that much when you get a pandemic. And scientists now throughout the country and the world have been able to identify opponents of the influenza that really do not change much at all and the critical issue is getting a vaccine to induce a response against that part area of universal flu vaccine is not going to be, today we dont have it, then we flip a switch and the next month or next year we have it. Its going to be an iterative process because if you look at the display of in the blends of their in two major groups and there are 18 different ages so theres a lot of wiggle room from there that youre goingto have to cover. So the quest on the road to a universal flu vaccine would be to take one of the influences in group 1. Lets say h1 and we know that changes bit from season to season to make a vaccine that would cover all of the iterations of h1. And then the next step would be maybe all the iterations of whats ever in group 1 and then theres room to has aged three and it and the next go would be to make a vaccine covers all of the iterations of age 3 and on and on so it will be a stepwise process with the ultimate aspirational goal of having a vaccine you can give relatively and frequently compared to now, which you needed every year. That would be every five years, 10 years or what have you that over a broader array of the influences that we would be experiencing the basket in a nutshell. One of the things ive done as a journalist is constantly write stories telling people get flu vaccines. But they really kind of suck. And people always say to me why should i get a flu vaccine and i always say 23 percent is better than zero percent and as far as my macros that is true. But im wondering when i wrote something for a report that many of you have access to, the vaccine report on influenza we put out last year and i talked to literally dozens of people in this field and not one person. I asked them at least one question. Is this as good as we can do . Not one group said yes, not one person said we were close to doing it as well as we can do. And im just sort of curious, why are we so bad at protecting ourselves from what many people consider the sort of most likely virus to cause the most damage to humanity . And im going to let anyone who wants to answer this do so. Thanks michael and i wish the narrative would have come up on the video coming through because whats called out in that there is a sense of urgency to address those problems. Theres still 650,000 people around the world from seasonal influenza scenario bill gates is 40 disease modeling thatsays we had another upgrade break like a pandemic virus today , and that sixmonth time. We would have 33 Million People dead and not only that, that virus has been seated all around the globe. Two months after that best technologies to make vaccines would start releasing vaccines. So were still behind gone on to make vaccines. We have some reasonable vaccine foundations and we can make them better by adding adjectives or what whether those vaccines are fully utilized and a lot of parts around the world dont have access to the vaccines at all so i think that the sense of urgency needs to be there michael but also the fact that we need to leverage the tools we have and at the same time envision what that universal flu vaccine is in a very rapid, urgent pace to get there. As part of my life i teach at stanford and people use this word in Silicon Valley which i mostly hate but im going to use it now. Disruption read why dont we blow the system up . Obviously we cant just turn off the spigot on the system we have and say everyone in the world should get this flu vaccine we havent given to anyone yet but there must be some way that we grow vaccines mostly in eggs the way we did in 1947. We live in a world where i can download whatever song i want onto my phone at command and we grow vaccines the way we did 70 years ago. What is going on with that . I think i can talk on my own. Never knew that about you. It really is the case that we are behind where we have to be in terms of the urgency of this threat and how were harnessing advances in science and technology and how were mobilizing as a society to recognize the magnitude andscale of the problem before us. Clearly disruption comes with uncertainty and it comes with uncertainty on many levels, uncertainty within the Scientific Community on how we do science, regulatory uncertainty which i know something about and also uncertainty about adoption and access and all of that. I think one of the things is, and i think hopefully one of the metrics we can have on this panel is its time to stop talking. Its time and we talked about these issues for a long time and that has taken the place of action sometimes i think but in terms of why were still growing its mainly in eggs, i think a part of it is that its just the way weve always done it. Its the way we know we will get some kind of vaccine out into the marketplace and theres always that in the meantime other work will be going on and it will have a breakthrough and the homily when we had a vaccine. Clearly that is not going to happen. I think its also that we havent had this sense of urgency. Do we have not got lots of people die for that sense of urgency . The incredible thing is a lot of people do die every year and yet we are mobilizing. I would have to say to be more positive that i cant really answer the question of why is it taking us so long because i think it shouldnt have. And you know, there really is not a good excuse. The science has had to move forward. Gaps in the science still persist including our understandings about immune protection in addition to understanding the nature of this particular virus which has its complexities area certainly part of the problem have been that its much safer for a company to keep doing what its doing and to try to do something new but its also i think, we havent funded all the work that needs to be done on an optimistic note, theres a lot going on now and tony is leading efforts and there are other efforts, the Gates Foundation, the European UnionResearch Horizon 20 20. Many other entities as well but were also not good at collaboration and i think that needs to be addressed area we need to start sharing knowledge, we need a roadmap for research that really we follow, we identify what do we know where the gaps, how can we fill those gaps. We need to identify what are the ruts that were stuck in that we have to get out of and how are we going to use all the capabilities in science and Technology Today and the energy of our society and the Scientific Community to get the job done. This collaboration issue seems particularly interesting and urgent to me because this is a vast amount of data out there and what happens is a lot of it just falls by the wayside. If you do a study and it doesnt get published it goes away and yet there maybe good data. I think casey has something to say about that about openness and collaboration. Cannot talk about that, can you hear me mark good day, its my pleasure to be here. I think isolation is our enemy and there are opportunities to expand transparency and expand a culture of transparency and open data sharing but i think could unlock victories and create new insights to accelerate our progress and with the sole philanthropy on the group and we really build into our dna a bravery about asking really hard questions for example, weve been asking what is the role of publication bias they play in limiting our progress going forward. What are the opportunities for funders in this space to really meaningfully elaborate to build funding opportunities and dont strategies together. What are the ways by which grantees can behave as cohorts in a collaborative fashion unless its as individual contributors and one of the programs i think michael is alluding to is we just established a new collaboration with the center for open science in the Public Library of science to really create new incentives for researchers to publish negative findings. I think publication bias really does limit our options and if we can shed more light on data thats not published, can we create new incentives to bring that, bring those analysis to the front and shed more light on them but in mark i think it would be really wonderful. Is no program that we started , we are asking researchers to open their file drawers, route floppy disks, whatever they have to and we will pay them to reduce that opportunity cost and to drop draft those manuscripts and work and help them get those published because we think there are a number of opportunities ahead of us if we shed morelight on that information. Im curious to what degree any of you can maybe address this. Its a pr issue in some ways because people talk about the flu. I had the flu. I feel bluish. About 80 percent of the time im making that number up but its a lot of the time. You dont have really have it be so last night i had a bug area i do what i do for a living so i wont call it the stomach flu because im sure it isnt most people would call it that read is that part of the problem that we dont have appropriate nomenclature . I think theres complacency on that side as well. He mentioned the institutionalarchitecture that keeps innovation from happening. I think those two things are connected. That the people throughout the disease is so bad i had the flu. I got over it. The vaccine is so bright. Good enough, ill take it theres a piece of it as well. I want to go back to the Sabin Vaccine Institute is here in washington knowledge and innovation is one of our colors and we turn aspen to pull together a group and the idea was a Diverse Group of thinkers, people from science, people from philanthropy, from journalism to take on issues in vaccine and vaccination and not surprisingly hundred anniversary of the 1918 flu pandemic, that was the issue and thats where the peace of the video came from. But thats where the urgency came from and the recognition is we need to do some things differently. There was a discussion there about the sort of cascade from unification to coordination to collaboration to convergence and we need to sort of work our way down the pipeline to make sure we are actually getting all the way to the end to bring in as much as possible to take on this problem. The complacency really is real. Reflecting back on when i was in government not from the last administration but a few administrations back and iwas starting to develop Public Health preparedness programs. I went to fema to talk to them about doing an exercise with us and preparing us for a biological threat and we were going to do a flu pandemic and arial and they said we dont do infectious disease, we do hurricanes. We do floods. Earthquakes, all kinds of disasters. But disease outbreaks . And i persuaded them to participate. And it was a remarkable thing to watch them as events unfolded. Realizing just how much this kind of an outbreak would undermine all of the sort of essentials of civic life. How it would undermine their own ability to mobilize and respond to needs. And also, the recognition of the Economic Costs in addition to the medical concerns and ultimately the loss of space of people in government and leadership. Because of the failure to be able toprovide vaccines in a timely way and other things. So people just still dont think enough about what this means in our daily life and what the impacts are. Even though every year, were suffering a lot of preventable deaths, illness and disability. Thats one asked the dark and unpleasant question does something really bad have to happen and it seems to me one of the curses of the Public Health world is if you guys do your job well, everyone goes along. But if you dont or if you do your job well and people get sick anyway, then somehow you just failed. And im not sure how you get around that. Id like to take a half step back and maybe tony is the person to address this or rick. Where are we . Can you give us a better sense of how far we come on our approach to a universal vaccine in the last decade . Because we used to be not just michael, we didnt have a real confidence in the scientific basis that we could actually induce a response or even what components of the virus if you did have immune response against would actually be able to broadly cover. When we had the evolution of structure based vaccine design, when we used claims to look at the molecular configuration of the stem , one of the targets of a universal flu vaccine certainly not the only target but one of the targets if you look at the hemoagglutinin molecule which if you kind of metaphorically construct it, its kind of like a head which is a mushroom with a store or a broccoli with a stork, is that the part that the body makes an immune response against is the head. Its what you call him you dominant. When the body sees influenza its much prefers to make a response against the head. When that gets it right, thats good news because youre going to get protected. The sobering news is thats the part that does the mutations that i mentioned a little bit ago. The part thats the stock or the stem doesnt really change much at all. Thats potentially good news. A challenging news is that the body doesnt want to make an immune response against that because its not immuno dominant andit really hasnt been studied very well. Now that we know that if in fact you make a response against the part of the virus that doesnt change, that when you look at the response the body makes and test it against an array of viruses, you get a much broader coverage than against just a particular head of the human hemoagglutinin which like to change from season to season whereas the stem stays the same relatively speaking. Thats not something we need 40 years ago. Thats something that just now beginning to appreciate so what investigators are doing and is not the only target, to take that stem and get rid of the distracting head and stabilize that stem and put it in a way not with an egg, getting back to what you were saying. Not growing the virus at all but getting sequences, getting the appropriate protein and sticking it on a self assembling nanoparticles that is much more immunogenic. Not only is it much more immunogenic but you dont have to grow it. You can make a lot of it and if you do it right and partner with industry, thats the kind of thing that doesnt have the vicissitudes of growing and egg. This issomething that is 10 years in the making , not the 40, 50, 60 years you said we were doing the same thing. A critical challenge and it relates to one of the things that peggy said is that in order to make the transition from getting out of the tried and true egg growing which we know gives us results that can be beneficial. Weve done well with that because something that has to be much better. You have to prove that this works and then you got to go through all of the critical trials, phase i, phase ii, phase 3 and show that this particular product is going to be good over a period of years. That alone it works perfectly is going to take a decade. Im not a representative of industry but ill pretend im one. I need flu vaccine every year and it sells and we tax people to the degree that it does. Why the hell would i go spend 400 million to do this thing which may be great and then its really great you get it once or twice but. And thats where the federal government comes in. [laughter] seriously, what happens is you bring up an excellent point. Our responsibility to the Public Health and not for profit line has to be able to push the process to the point where industry will find it to be a benefit to do that. I think if youre going to sit back and wait for