And more life conversation weeknights at 8 p. M. Eastern for washington journal prime time. Good morning, everyone. Im joanne myers and only half of the Carnegie Council id like to thank you all for beginning the morning with us. Were delighted to welcome ali khan and cspan booktv to this breakfast program. Ali will be discussing his book United States. As a former director of the centers for Disease Control p ad prevention, he has been on the front lines in the fight to contain the worlds deadliest diseases. But hes not the first to have done so. Throughout history human seven fightingng diseases, waging deay and never ending wars against rampant and violent contingents. In fact, there is never been a time when were not affected with microbes and fought against them. During his time as selfdescribed disease, our speakers had his own brushes with viruses, Infectious Diseases and contagion. S for example, in 1995 he worked among red cross workers in your for the first ebola crisis. After 9 11 he was called washington to prevent the spread of anthrax here in 2003 he was called to hong kong to courting victims of the sars. But these are just some of the stories dr. Khan chronicles in the next pandemic. As an epidemic intelligence officer, a disease hunter if you will, his mission for over two daggett was to lead the u. S. Governments efforts to prepare the public for disease outbreak and health emergencies. He has seen it all. Dr. Khan tells us rogue microbes was the problem come also writes not all epidemics and pandemics are inevitable. In fact, most outbreaks can be mitigated, if not prevented. But the question is how, and to have enough resources . To opus separate hype from the facts, what diseases pose the greatest risk and what we need to do to prevent the next pandemic, please join the in a Public Health journey to the four corners of europe by welcoming dr. Khan to the Carnegie Council this morning. Thank you so much for coming. [applause] thank you very much. Good morning, everybody. Lets put this over here. So as you heard i have spent a career in the preparedness business and usually youre ready in advance the overtime it became sort of hidden ready just in time. And at this point of my career i went to the realtime speaking process which are pretty much make it up as i go along. Now one of the things ive been told when you speak to an audience is start with a joke but as you can tell, theres nothing about my career that, it starts with levity. But i do promise sex, lots of sex. It will be miskito sacks. [laughing] but besideses that, there will e lots of sex. Im really delighted to have this opportunity to share wholes bunch of stories with a broad audience of whate it means to be a disease detective and hunting down these diseases. You hear about patients, read the papers, all popular press, the movies, et cetera but what is a from the perspective of someone whos been doing it every day with lots of other interesting Public Health practitioners . And also tonight to give a talk if you read the paper this morning, if youve if you beeng about zika or ebola or yellow fever going on in angola, so its topical. Lets just start there. The idea of why is this always in the papers and why im always hearing about these types of diseases . Our classical diseases, think about smallpox, think about measles,d those all started pretty much around the agricultural revolution when people sort of came together because you need to have enough people to spread disease from persontoperson. And so thats when i start my story. Everyone has their own storybook for me thats when the world starts whento some rodents that were carrying some version smallpox moved into somebodys home and that fibers made this gel and started to cause smallpoxox in people. Same things for measles, classic diseases. Let me fastforward to the industrial revolution, germ theory. We realize Infectious Disease were notti due to miasma but due to infectious agents that spread from persontoperson. A lot of enthusiasm that occurred around the beginning of the 20th century with sanitation revolution, vaccines and antibiotics and people thought okay, were done with assault Infectious Disease problem. All we have to do is publish autosomes arm, give them a couple pills and that we all better. If thatn was true we wouldnt e having this conversation today right now. Whats happening is that even though we have taken care of a lot of these classical virtues we have his continued in bridging Infectious Disease and a lot of factors that drive this emerging come of those diseases. Some of the key factors are just around microbes, collectively on somebodyly who thinks they are smart collectively and that if all. They have multiple generations with a single day. Humans before lucky, a generationon in what 35 years or something. Before we can swap out our genetic materials. All. Bes can no problem at they swap geneticia material all the time. They get scored all the time. Thats what you read about these drugresistant microbes because thats what to do. They sort of move around, find a good set of genes and they go this will protect me from the set of n of alex and boom, you get your superbugs. Microbes evolve. Humans change a behavior so when it hears ago i could tell you know but had a kidney transplant. Nobody had a kidney transplant. The other thing is we change our environment. This is a big driver in why we had emerging Infectious Diseases. It should not be surprising what i talk about zika, ebola, somehow very quickly the animal connection comes into play but zika its with mosquitoes with ebola its bats which are the original cause of where this fiber sort of lives, infect somebody at that second spread of the chain of transmission in humans. Emerging diseases are anl connection. If you move people out into the environment into the jungle, you know, they get infected and that disease has a potential then to cause person to person transmission, as we see with ebola or lets say with mers from bats and camels. They tend to come from africa or south america or parts of Southeast Asia where you have a lot of connection with animals, bird flu is another good example where you have people in china and other parts of Southeast Asia who live very close to pigs, live close to birds or chickens and great opportunity for viruses to swamp genes and infect humans and become global pandemics. These are the environmental, some set of environmental conditions that lead to infections and why we keep hearing about them. I want to do a special callout to Climate Change as one of those environmental factors that lead to emerging infections. First i want to say often Climate Change is framed as either an economic issue or has an energy somehow issues and i think over the last year or two we have been doing a better time reframing this actually as Public Health issue of whats happening with climate currently. So april was the hottest record on year hottest year on record since 1880. And people ask me, how do you know what was going on in 1880, believe it or not, if youre a farmer its really important to you what the temperature is. So there are excellent records about what temperature looked like at least for the last 100, 150 years, the same thing with marine temperatures because if youre out there as a captain your doing your daily log, one of the things that you will log is what does water temperature look like so we have excellent records and if you pass through the historical sort of documented records and look at 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 its the 12th hottest year in a row, okay. This isnt a coincidence whats happening with temperature whats happening with climate and if you look at carbon dioxide, we should be about 200 parts of million, 238 parts million preindustrial level. We are now 400 parts per million. But let me tell you the story in a different way. I got in the climate business almost 20 years ago and had to do with fever, mosquitoborne disease in africa. If you are in africa, you dont have 401 k , you have cows and goats, thats your 401 k . If a mosquitoborne virus comes and youre animals are dying, that is bad news and so thats fever and its a biblical disease, besides the fact that its moving out of Subsaharan Africa into Northern Africa and into the middle east is that its actually depends on climate on when the viruses sort of when this mosquito emerges and you sort of have to have the great heavy dry periods followed by wet periods to cause this to happen and to protect your animals and this virus, fever also causes bad disease in humans, abortions in humans, fever and causes brain inflammation and blindness in humans, but the farmers, they dont have the money to vaccinate the animal every year so if you catch some sort of tool every 5 to 10, 15 years, you know what, this is the bat year, that would benefit them. People spend a lot of time trying to understand what happens weather and climate to help protect farmers and protect their animals and then obviously the community. So thats how i got into Climate Change issues, understanding what the dynamics were and what became very clear right now is when we talk about Climate Change everybody is like, whats going to happen in 2100, well, what is happening today . If we look at diseases, the biggest decide diseases in the United States which are ticks, its lyme disease. If you look at where lyme disease sectors are spreading, they are actually over the last 20 to 30 years have continued to spread across the United States. Theyre almost in about half of u. S. County, fungus in vancouver, doesnt belong in vancouver, it belongs in forest. Im an oyster eater. Thats to try to protect yourself from infected oysters especially gulf oysters. That shouldnt be a problem if youre getting oysters up from the North WesternUnited States, up from the alaska area because those should be nice, cold waters but we have not seen outbreaks because the waters arent as cold anymore. If you go to sweden they have the tickborne disease. We doctors, when we name stuff, we take whatever you tell us, you think we are all smart, oh, my head hurts, you have we know what it says in latin. What we have seen in sweden that the disease has been spreading over the couple of decades. Theres a lot of factors but climate is one of those. Respiratory virus for those who have kids, grandkids, little kids get infected with rsd, usually they are okay but not always and what we are seeing the respiratory seasons in europe are becoming shorter are becoming shorter and shorter because theres less cold months and the seasons are becoming shorter. Contemporary examples that are only going to get worse when we think about heat waves. Whats happening in india right now, 128degrees or Something Like that. Heat waves and, yes, less people will die from cold but proportionately will die from heat when we think about heart and lung disease from all the air pollution and obviously all of the all the Infectious Diseases. Anything that has to do with the mosquitoes and ticks and where things are, climate plays a big role, waterborne illnesses that are an issue if we get flooding, so i want to make a quick shoutout to Climate Change as one of the factors to keep in mind as you think about emerging infections. The biggest factor of all of these and all of these are important, what is happening to microbes, what is happening to us, what is happening in the environment is more political social factors and if you look at the outbreaks, these diseases will continue to emerge as i hope ive convinced you over the last 5 to 10 minutes. I think we play a role in thinking of them becoming epidemics and pandemics. A good example the recent outbreak of ebola in west africa, so it wasnt new, right, we have known about ebola since 1976. Weve known about the science of ebola since 1976 and i had the opportunity to help support that science in 19 mid1990s when i did Ebola Outbreak in zair. What happens, you get infected probably with a bat. If youre out way in the bush you die 85 to 95 of people die. Unfortunately maybe a Family Member or two would die with you but youre out in the middle of the bush, youre done. Lets say you change the dynamic and you decide to go seek health care in a hospital. Unfortunately on hospital that doesnt have infection control. So when youre infected with ebola you essentially become a virus factory and you get infected and if your immune system doesnt kick in youre kicking the virus and when do you have the most possible virus in your body . When you die, as you go to the hospital because youre sick and you dont have more than when you die, okay, i can give you a 10 with lots of big numbers around it meaning hundreds of millions of billions that happened to be in the middle of your blood. So here you are sick, dying in a hospital and somebody doesnt wash their hands as they go from patient to patient, whats going to happen . Youre spreading ebola from patient to patient and so hospitals have always served and weve known this for many years as a reservoir for thousand the diseases get amplified and spread within their community. Somebody sick at home and youre Family Member taking care of them, youre at risk, we know that. They die unfortunately and then you decide to wash the body, kiss the body, hug the body, invite all the loved ones, one of the practices we saw during Ebola Outbreak, they would wash body and use that water to allow little kids and other people to wash their hands to take on the attributes of the sainted person who had just died. This is not a good idea, okay. Lets admit that. [laughter] thats the science. We know the science, right . But the science isnt the issue, so when this outbreak occurred and i think this was some 24, 25th Something Like that outbreak of ebola we have seen since 1976, many people thought this is like what we have been seeing in east africa, uganda sees outbreaks all of the time, they have a system in place to identify the case, teams rush in. They dont need international teams. They rush in and test everybody, they follow everybody who is potentially sick and extinguish the outbreaks very quickly and the outbreak occurred in west africa where its never occurred before. Nobody had seen the disease before and it very quickly spread to urban areas, large metropolitan urban areas and the thinking was, oh, more of the same, you know, rush in, take care of this everything and the Ebola Outbreak will go away, what happened . Thats not what happened, right . So 11,000 deaths each and every was a needless death i would say and inadequate response, Global Response. Inadequate local response obviously but inadequate Global Response and so politics and our Public Health systems, play the biggest role in whether this goes to handful of cases to what we had was essentially a epidemic across west africa with cases across the world. We know what happened here in the United States. And one to have reasons we had the case in the United States is another factor, social political factor that plays into Infectious Diseases that we didnt have in the 1800s. How many people, i wont ask, have read around the world in 180 days . 80 to get around the world. For 22 years i worked Public Health uniform and on my Publishing Health uniform there was an anchor and i would get asked about the anchor in Public Health uniform. The public uniform looks like a navy uniform and the reason it looks like a navy uniform we started providing care to merchant marines and one of the shores of the Public Health service is we still have right now is essential through flag quarantine flag when ship came to port and somebody with yellow fever or smallpox on it. If its going to take you 80 days from point a to point b, by the time you show up in port of new york city we knew if you had smallpox or yellow fever because the incubation fever, shorter than the time from point a to point b. Well, we turned that upside down now. You could go to your mothers funeral in liberia, right, so you fly to line line liberia, engage in usual acts, your mother has died, kissing her, the next day you get on a plane to amsterdam to new york city. You have 48 hours incubation of 5 to 7 days. 3 days before you show up back to new york. Ive got a headache and fever and im not feeling quite well right now. You show up to a hospital, the number one diagnosis would be malaria, 1, 2 and 3 and if its not malaria and they miss this its easy to see how you get hospitalized for something and spread disease within the community. We saw this happened in texas. Exact same scenario, somebody showed up, came home and infected two local nurses. And i have spent a lot of times in places across the world to let you know the Healthcare System is not what they see in toronto when they had their sars outbreak or hong kong or i just spent time in seoul due to mers, Excellent Health care system. Like ours, Excellent Health care systems but they are not ready for patients to come in with highhazard viruses. Travel has played a big role in how the diseases emerge currently. So let me now so now i think i gave you now