Deadliest diseases. Throughout history, humans have been fighting diseases winning deadly neverending wars against rampant contagions. In fact, theres never been a time when humans were not affected with microbes and against them. During the time as a disease detective our speaker has had his ow own brush and own brushi, Infectious Diseases and contagions. For example, in 1995, working with red cross workers for the first ebola crisis and after 9 11, he was called to washington to prevent the spread of anthrax to the Senate Office building. And in 2003 he was called to hong kong. But these are just some of the stories doctor khan chronicles in the next pandemic carried as an epidemic intelligence officer, a disease hunter if you go, his missions for two decades were to read the efforts to prepare the public for disease outbreaks in the Health Emergencies. He has seen it all. While he tells us that it will always be a problem, he also writes as all epidemics and pandemics are inevitable. In fact, most can be mitigated if not prevented. The question is how an did we he enough resources. To help us separate the hype from the fact that diseases pose the greatest risk and what they need to do to prevent the next pandemic, please join me to the four corners of the earth by welcoming doctor khan to the Carnegie Council this morning. Thank you for coming. [applause] thank you very much good morning everybody. As you heard, i spent a career in the preparedness business and usually thats meant for talks. Over time it became getting ready just in time and at this point we are at the realtime speaking. One of the things ive been told is to start with a joke as you can told us nothing about my career but i do promise sex, it will be mosquito sex but there will be lots of it. So im really delighted to have this opportunity to share a bunch of stories within the broader audience of what it means to be a disease due to defend hunting down the diseases. You hear about agent zero and if you read the papers to the movies etc. But what is that from the first of somebody thats been doing it every day with lots of other amazing Public Health practitioners and also tonight if you read the paper this morning whether it is ebola or yellow fever going on in angola it is topical so it makes it easier to start a discussion off of emerging infections, so lets just start there and the idea of why is this always in the paper and why are we always hearing about these type of diseases. Our classical diseases think about smallpox and measles, those all started pretty much around the cultural revolution when people saw this come together because it spreads from person to person. Everybody has their own story of when it starts. And the virus made this jump and same for measles and classic diseases. Moving forward to the Industrial Revolution we realize Infectious Diseases were not due to my asthma was that agents that spread from persontoperson and a lot of enthusiasm that occurred around the beginning of the 20th century with sanitation revolution vaccines, antibiotics people thought okay we are done with this whole Infectious Disease problem all we have to do is put a shot in someones arm, give them a pill and it will be better. If that were true we wouldnt be having this conversation today right now. What is happening is even though we have taken care a lot of these classical we have these continued emerging Infectious Diseases and there are a lot of factors that drive the diseases. Some of the key factors are just about microbes collectively somebody that thinks that they are smart collectively and they evolve. If multiple generations over a single day. A gesture to beat generation and 35 years before we can swap out our genetic material. Microbes, no problem at all, they get smarter over time and e and thats what they do. This will protect me. 100 years ago we changed the risks and the other thing that happens is we change our environment. This is a big driver why we have emerging Infectious Disease. It shouldnt be surprising when i talk about ebola somehow very quickly the animal connection comes into play but with the original cause. The diseases you heard about. But the disease has the potential to cause persontoperson transmission as we see or mers which is what bats and camels, so if you have contact that is how you could get the disease. So it isnt a surprise they tend to come from africa or south america or parts of Southeast Asia where you have a lot of connections with animals. Bird flu is another example where you have people in china and Southeast Asia that live very close to pigs and birds, foul, chickens and its a great opportunity for the viruses this up and eventually infect humans and become global pandemics so those are the environmental conditions that lead to these infections and why we keep hearing about them. I want to d wanted to a specialo Climate Change as one of those environmental factors that lead to emerging infections. First i want to say it is framed as either an economic issue or energy and i think over the last year or two we have been doing better reframing this as a Public Health issue of whats happening with climate currently. April was the hottest record, hottest year on record since 1880 and people ask me how did you know what was going on in 1880 and believe it or not if you are a farmer its important to you with the temperature is so there are excellent records about the temperatures looked like at least for the last 150 years and the same thing with marine temperatures because if youre a captain one of the things you are logging is what the temperature looks like so we have excellent records and to an as they pass through the historical documented record with all sorts of other information that looks at temperatures thousands of millions of years ago but april was the hottest record, hottest year on record and the 12 hottest year in a row. This is not a coincidence that is happening with temperature or climate and if you look at Carbon Dioxide we should be about 240 million, 258 dot 400 parts per million. So the thought that only 100 would like to only cap increases to 1. 5 degrees is highly unlikelunlikely thatunlikely bus story from a different way. I got into Climate Change years ago and this is a mosquito Borne Disease in africa. You have your cows and goats and that is your 401 k. If a mosquito borne virus comes around. And that is bad news. And what we have recognized her for the last couple of decades and beside the fact moving out of Subsaharan Africa into Northern Africa and into the middle east is that it actually depends on climate. There were these great heavy dry. That caused this to happen and it also causes bad disease and fever and brain inflammation and blindness in humans but they dont have the money to vaccinate every year so if you have some sort of tool every five, ten, 15 years that were really benefit them, so people spend a lot of time trying to understand what happens. They protect their animals and the community. To understand what the dynamics were whats going to happen in 2100. If we look at diseases the biggest disease in the United States was caused by arthropod coming up mosquitoes effectually lined disease. Everybody knows if you live here in the northeast we look at the spreading and over the last 20 to 30 years theyve continued to spread across the United States and they are almost about half the u. S. Counties, so we see that already today. There is a fungus up in vancouver causing infections in humans and animals. It belongs in the tropics. They are getting infected oysters from the northwest so we all know. Are there any here like me . A good Public Health messages. Its to try to protect yourself especially from both oysters but that shouldnt be a problem getting them up from the northwestern United States to the alaska area because there should be nice cold water watert they have now started to see outbreaks reported since the waters are not as cold anymore. We think we are all smart so you say but we have seen is the disease has been spreading the last couple of decades and that is in addition to where we are living with climate is one of those and respiratory virus for any who work here to have kids, little kids get infected which causes this illness and what we are seeing are becoming shorter and shorter. Again, contemporary examples are going to get worse when we think about it. Its happening right now, 128 degrees or Something Like that and yes less people will die from cold unfortunately more will die from heat when we think about heart and lung disease from all the air pollution and Infectious Diseases. There is waterborne illnesses at issue with this. I want to make a shout out to Climate Change and one of the factors to keep in mind when you think about emerging infections, the biggest factor in all of these are important with this happening to microbes and in the environment its actually more political social factors and if you look at these outbreaks, these diseases will continue to emerge as i spoke over the last five to ten minutes, but i think that we play a role keeping them from becoming epidemics and pandemics. A good example, for example, would be the recent outbreak of ebola in west africa. So, it wasnt new. Weve known about the science ebola and in the mid1990s. We get infected and usually probably with a bat and if you are out and i 85 to 90 of people die, unfortunately maybe a Family Member or two lets say you changed the dynamic and decide on a hospital. Unfortunately at the hospital to doesnt have infection control. Its producing every minute until you die. You dont have more than when you die and i can give you ten with lots of big numbers around of hundreds of millions of billions in the milliliter of the blood. If somebody doesnt wash their hands as they go from patient to patient, its going to happen you spread from patient to patient so hospitals have always served and weve known this for many years there was a reservo reservoir. Somebody sick at home and you are the Family Member taking care of them, you are at risk. They die then you decide one of the practices we saw during this outbreak is to wash the body and use the water to a file others to take on the attributes of this person who had just died. The science isnt the issue. Its wha what we have seen happg in east africa. To identify the case and a day dont need International Teams anymore. They know what to do for the outbreak to occur which never occurred before and in urban areas and the thinking was more the same. 11,000 each and every one was a needless death i would say. But inadequate Global Response and so politics and the public over systems. What we had essentially was an epidemic across africa with the seeding of cases out of the world including what happened here. To the Infectious Diseases that we didnt have in the 18 hundreds, so how many people, i wont ask because the answer would be yes and ive heard around the world. How great, 80 days to get around the world. So, for 24 years i wore a publichealth uniform and on my publichealth uniform was an anchor looking very much beginning of uniform. It was the service that we still have right now with the quarantine flag and somebody with yellow fever or smallpox. It will take 80 days to go from point a to point b. The incubation took a time it takes to get infecte infected to manifest the system is always shorter than the time it is going to take to get from point a to point b. We turned that upside down now. So now you could take your mothers funeral in liberia and engage in the usual packed yet he was. They get to new york city so we have got the tea team to the 24 hours, maybe 48 hours. Ive got a headache and fever and im not feeling quite well. If its not malaria and its easy to see how that hospitalized and we saw this happen in texas. The same scenario somebody showed up, came home and infected local nurses and i spent a lot of time in places across the world to let you know over Health Care System isnt better than what we have seen in toronto which is what we saw in singapore when they had this outbreak or hong kong and in excellent Health Care System. But they are not ready for these patients coming in with these viruses comes wit to travel has played a big role in how these diseases emerge currently. So now to give you the sense of why you always hear about this but what we can do to make things better around social and political aspects. I did want to spend a couple of minutes to talk about the Carnegie Council. I guess they recognized if we think about hiv and who gets infected with hiv is often a marginalized population but as i started to write the book almost every chapter you could pull out in a marginalized population that would increase the risk for emerging second about the disease that often occurs in the southwestern United States and most likely infected with the original outbreak were native americans into some of you will remember when it occurred in the early 1990s there was a group of young navajo kids who had come to dc and they were denied a tour of the capital because you happened t happen to come fe southwest. Anything that said they were at risk but they were not. But the the effect of the they d population of increase the purchase against the marginalized populations. I already talked about hiv and i talked a little bit about ebola and other marginalized populations in west africa into todays day and age the marginalized population. I think it is what they are calculating now and over 1500 women that have been infected and their babies have got unconscionable symptoms were to get other Developmental Disabilities including hearing loss and vision problems. Problems. What we have learned now is it is essentially a laserguided missile. When it was first described we were told about 20 of people would get sick and get a fever and a little headache, some itching, red eyes and they will get better and there he quickly became clear that this was a problem but now they know even for adults. It causes weakness and they also know it can cause brain inflammation. So even when they think of a small healthy adults that are not present, the virus is a problem. This virus shouldnt be a problem. Its spread by a certain type of mosquito that is not new to us. Its the sam same mosquito that spreads and if we were having this conversation five years ago we would be talking about this large outbreak occurring in south america and it causes about 30,000 a year. The same one that was the big thing in the news two were three years ago that doesnt seem to cause any death. But the failure to keep up with these and not paying attention to people dying from yellow fever we have a diseas the diseo this that are not afraid affecting pregnant women over the last 40 to 50 years against a known threat that has put us in this current position. I heard yesterday that it has now not just moved throughout the Americas Summit essentially knocking on the door of africa to say whats next so its great to have the next is to risk going to pregnant women in africa. The head of who, brilliant woman has done amazing work. Its a major policy failure over the last 40 years in addressing this mosquito and also to talk about major policy failure as we talk about protecting women and comprehensive rights. Some cases in europe and north america remains c. Zika, hopefully im not al not all oft we will see it. You gave me a lovely comments the other day. The ethics of the delayed response and some of what you talk about here. If you think about these marginalized populations and why do we see these delayed responses, and we are seeing it today. The story of the last couple of days this conversation is probably better terms for the conversation between you know what lets protect the United States against zika and deciding whether they want to do that and whether they want to pay for it so should it be 500 Million Congress wants to give or 1. 9 or the 1. 1 to give a version and i dont care what it is, pick a number but why are we having this conversation six months later backs we know whats going to happen and they also know Mosquito Control is not a federal function it is a city and county and district function we need to get the money out of these people so they ca can betn whabedoing what they should be g which is making sure they are identifying cases and have the money to think about hopefully a longterm strategy, vaccine strategy to protect pregnant women with lots of funding and Vaccine Development for the longterm. My analogy is the second story of a building. This is the preparedness infrastructure why are we taking money out of that . And then into the preparedness infrastructure because im all about measures. In the last three years of how prepared for Health Emergencies and it gets a bit better if we want to make sure that they are a threat. And then government is to protect us against threats and that includes Public Health and how do we make sure im old enough to understand you cant completely strip politics from politics decisions but maybe sometimes about what are the health needs of the populations. That is fascinating but you seem so calm. [laughter] but fear is not a Public Health strategy. I know it makes for great press but really it