C. Mcadoo morning of there i am joanne myers is like to thank you all for beginning your morning with us. We are delighted to welcome dr. Ali khan and sesnon will tv to this program. Dr. Khan will be discussing his look the next pandemic. The former director of the office of Public Health and response at the centers for Disease Control prevention dr. Khan has been on the frontlines in the fight to contain the worlds deadliest diseases. Hes not the first to have done so. Throughout history humans have been fighting diseases waging wars against rampant violent contagion. In fact theres never been a time when humans were not a good by microbes. During his time as a selfdescribed disease detective our speakers had his own brushes with viruses Infectious Diseases and s contagion. For example in 1995 he worked among red cross workers in zaire during the first of ebolala cris but after 9 11 he was called to washington to prevent the spread event that anthrax in the Senate Office building in 2000 throughs call to hong kong to quarantine victims of sars. These are some of the stories that his book chronicles in the next pandemic prison epidemic officer disease hunter fewell his mission for two decades was to prepare the public for isdisease outbreak and health emergency. He has seen at all. While dr. Khan tells us world microbes always be a problem he writes not all of epidemics and pandemics are inevitable. In fact most outbreaks can be in mitigated if not prevented. The question is how end do we have enough resources . To help uss separate the hype from the facts, would diseases pose the greatest risk and what you need to do to prevent the next pandemic please join me on a Public Health journey to the four corners of the earth 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. There we go. As you heard i have spent a career in the preparedness business and usually it means talks over weeks or the overtime it he came getting ready just in time and at this point in my career im in the realtime speaking process which means i pretty much make it up as i go along. One of the things ive been told this my career starts with levity. It will be mosquito facts but besides that therell be lots of facts. Im really delighted to have this opportunity to share a whole bunch of stories with a broaderr audience and that what it means is a disease detective in hunting down these diseases. You hear about in the papers or the popular press about it but what is respective of someone whos been doing it every day in Public Health as a practitioner prince lies nice to give a talk and if you read the paper this morning about zika or yellow fever or a bowl its topical to start a talk with purging infections. Wires as the paper and why are we hearing about these types of diseases . Are classical diseases, think about smallpox, think about measles. This all started pretty much during the revolution when people came together. We didnt have enough people to spread disease from person to person and so thats when i start. Everyone has their own story when the world starts but for me thats on the world starts when rodents they were carrying a version of smallpox moved into somebodys home had that virus made the jump and started to cause problems in people like these classic diseases. Let me fastforward to the Industrial Revolution germ theory. We realized Infectious Diseases were not do the miasma but Infectious Diseasest that spread from person to person a lot of enthusiasm occurred around the beginning of the 20th century with the sanitation revolution, vaccines and antibiotics and people thought okay we are done with this hole in Infectious Disease problem. All we have to do is put do is push out of somebodys arms and give themm a couple of pills and they will be all better. If that was true we wouldnt be having this conversation right now. What is happening is evene thouh we have taken care of a lot of these classical problems we have these emerging Infectious Diseases and there are a lot of factors that drive those diseases. Some of the key factors are just around microbes or collectively im someone who thinks they are smart collectively and they evolve. If ultrabook generations within a single day. 35 years before he swapped our genetic material. Microbes,em nope, no. They swap genetic betrayal of the time they get smarter all the time. We read about these drugresistant microbes becausey thats what they do. They move around and find a good set of genes and nay oh this will protect me from the set of antibiotics and boom you get your superbug or the microbes evolve in humans change their behaviors. 100 years ago i could tell you nobody had a kidney transplant. We change and our risks to infections change. The other thing that happens is we change our environment. This is the big driver in why we have emerging Infectious Diseases. It should not be surprising when i talk about zika and ebola quickly the animal connection comes in to play but zika was with mosquitoes and ebola was through bats for 75 of diseases you hear about the new diseases emerging diseases have an animal connection. As we move people out into the environment into the jungle they get infected and that disease has the potential done to cause persontoperson transmission such as we see with ebola or with murders which we believe is from bats and camels. Having a connection with camels thats how you can get diseases so thats a price and we think about these emerging infections they tend to come from africa or south america were 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 s the country with close to their gigsnd let close to their birds so foul and chickens and its a great opportunity for these viruses to swap genes and infect humans ended becomes a global pandemic. Those are the anbar mental conditions that lead to these infections when we keep hearing about them. I want to give a special callout to Climate Change is one of those environmental factors that lead to emerging infections. First i want to say often Climate Change is framed as an economic issue or an energy issue. Over the last year or two we been doing a better job reframing this is a Public Health issue of whats happening currently. The hottest record on year the rep heard wasn 1880. How do you know was going on in 1880 and believe it or not if youre a farmer is really important to you what the temperature is. There are excellent records about what the temperature look like for the last 100 or 150 years for the same thing with marine temperatures. Its a cat january doing your daily log and one of the things youre locking is what does water temperature look like. We have excellent records and as we passed through that historical documented records and look at all sorts of other information such as temperature thousands and millions of years ago. April was the hottest year on record and the 12 hottest year in a row. This isnt a coincidence whats happening with climate and if you look at Carbon Dioxide we should be about 200 parts per million, 1038 parts per million and not foreignow to parts per million for the thought that by 2100 we are only going to have decreases of 1. 5 degrees is highly unlikely. Let me tell the story in a different way. I got into climate. Change 20 years ago almost. It has to do with fever. This is a mosquitoborne disease in africa. If youre in africa you dont have a 401 k . Have your cows and you have your codes and thats your 401 k . If a mosquitoborne virus comes around and an animal dies that is bad news. Its a biblical disease and what we recognize over the last couple ofan decades besides the fact that moving out of Subsaharan Africa into Northern Africa is that it depends on climate on when the mosquito emerges and you have to have these dry periods followed by what periods to cause this to happen. To protect your animals that causes hemorrhagic fever and inflammation blindness in humans the farmers dont have the money so if you say this is the bad year. Vaccinate this year that would benefit that some people have spent a lot of time trying to understand what happens and how climate protects these farmers in particular animals and obviously the community. Thats how i got into Climate Change g issues understanding wt the dynamics were and what became very clear right now we talk about Climate Change everybodys like was going to happen in 2100 . Its really whats happening today. T. 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, ali it does not belong been there, blondes in the tropics. When getting infected oysters from the northwest. We all know, which are ears here anybody like me, you do. An intention to that. Do you eat oysters and one of the reasons you eat oysters, is to try to protect yourself from infected oysters especially gulf oysters printed they should not be a problem if you getting your oysters up front from the northwesternte United States frm alaska area. It is supposed to be nice coldwater so we have are now starting to see outbreaks reported from this oysters and coldwater. Cito contemporary examples of today warmer already seeing Climate Change. The mischief you up over from u. S. To europe. If you go to sweden, they have two quarantines of lightness. We doctors, when we name stuff. What we do is we take every whatever you tell tell us what you back to you as medical professional you think we are all smart. [laughter]. It makes my head hurt. Oh my gosh were so smart. Lol exactly, so is called information. In sweden, this disease has been spreading over the last couple of decades. There is a lot of factors now the climate is one of those. Respiratory viruses cup for any of you have have kids urgent grandchildren, little kids gettl infected which the severe little respiratory illness. Usually there okay printed but not always what we are saying is is respiratory viruses in the season, in europe are becoming shorter and shorter because of the less cold months. So the seasons arean becoming shorter. So again, contemporary examples like that, their only going to get worse when i think of heatwave. What is happening in the right operated one to 8 degrees. Something like that. And yes, thats people will die from the cold but more will die from eight. When you think about heart and lung disease a role of the air pollution then obviously all of this Infectious Diseases. Anything that has to do with mosquitoes and ticks more things are, climate plays a big role in the house and also those foodborne illnesses. Theres also waterborne it illness is there an issue as well. Flooding, storms, and Mental Health illnesses. An unwanted of a quick shout to Climate Change. One of the factors to keep in mind as we think about emerging infections. The biggest factor is whats happening with the microbes and to us in something in the environment. Its actually more political social factors. If you look at these outbreaks, these diseases will continue to emerge. I think we play a role in keeping them from beginning becoming epidemics and pandemics pretty good example, would be the recent outbreak of ebola in west africa. As an open up a note from titan 1976. Not about the size people up front 1976 at the opportunity to help support that science the mid 1990s when it in nevada outbreak study. What happens, yet infected with if youre out of the much coming die. 8595 for some people die. But unfortunately maybe the Family Member to indict. But the drops in the middle of bush, you are done. Lets take you change the dynamic you decide seek eahealthcare in hospital. Hospital does not have infection control. So when youre infected with ebola, you essentially become fires factory. And you get infected, and if your immune system does not kick in, your increasing the amount of virus every minute die die. So when you have most possible virus anybody. When you die. You go to the hospital because youre sick he did not have more than many die. Okay. I can you be ten thoughts of big numbers about it. Hundreds of millions of billy is a bacteria in your blood. Here you are sick and dying in hospitals and he doess not wash their hands is a go patient patients. It will happen. You are spreading information to patients hospitals have always served and weve known it for many years, it gets amplified. Somebody is to get home and use a Family Member taking care of them, you are at risk. The dog. , unfortunately and then you decide to watch the body, gets a modicum of the body, one of the practices that we saw was that they would watch the body would use the water for little kids and people wash theires hands to take one of the attributes of this person who just died. This is not a good idea. [laughter]. Lets admit that. Thats a science. We knowce it. It is not the issue. Simmons outbreak occurred, some 24th and 25th of ebola since we have seen since 1976. Many people i thought well this is been what we are seeing a nest africa. Uganda sees outbreaks all the time, they shut them down and ahab a system in place when they shut down everything in teensns russian. The duty Many International team ryymore printed the locals know what they do, they brush in a new testament betting they follow everybody was potential sick and extinguish these fabrics very quickly. Westcc africa. No one seen this disease before. They quickly spread to urban large metropolitan areas. In the thinking was, were the same, russian take care of everything this ebola a break will go away. It is not what r happened 11000 deaths, needless deaths i would say. Inadequate response, Global Response and obviously local response easily. So politics in our Public Health system, play the biggest role in whether or not discussed from a handful of cases are a small outbreak whether or not we had was essentially an epidemic across west africa with cases across the world including you would happen here obviously in the United States. In one of the reasons we have the case, and the United States is not a factor of social political back in the place into Infectious Diseases that we did not have innate and hundreds. How many people of read the book around the world in 80 days. Have point, 80 days. To get around the world. Right. So far 22 years, our Public Health uniform. No Public Health uniform, was an anchor, i would get an estimate anchor on the Public Health uniform printed three mexican navy uniform. The reason it was like a navy uniform is because we started about 200 using of providing care for merchant marines. One of the chores of the Public Health service was to we still have right now is essentially the flag 14 flag when the ship came in. The takes you 80 days to go from pointing to toy be. By the time he shored up at to the port of new york city, we knew if you had it because the incubation period was always sort of firstorder than the time it took to get from point a to toy point b. Glowing turnips i dont know. So you can now go to your mothers funeral in liberia, you fly to library it, your mothers funeral, engage in the usual acts that you want around the funeral, your mothers side youre distraught youre kissing her and youre hugging and in the next day you get on the plane to amsterdam to new york city. Okay, so we have 18 24 hours maybe 48 hours. Incubation period of five seven days. It is three days after you show backup in new york. I got a fever im not feeling quite well right now. You show up in a hospital, which is good hospital, number one diagnosis with malaria, 12 and three, one two three. A fitness malaria business and is very easy to see how get hospitalized with something you can spread the disease within the community. Beside in texas printed the exact same scenario, somebody showed up and came home and infected to local nurses. Imi spent a lot of time to juno that our Healthcare System is not better than what you see in toronto and what you saw in singapore or hong kong or in seoul. They had an outbreak of verse. Its all relative. Excellent Healthcare Systems like ours. They arehe not ready for patiens coming in with all of this. So travel has played a big role in how these cases emerge. So im sort of giving you a sense of why you always hear about this but whatr we can try to did make things better around social political aspects of protecting people. I did want to spend a couple of minutes to talk about you as ethic planners. An observation, i guess i recognized my whole life. When you recognize hiv and hookahs infected. Its also for a lot of people market is a certain population. As a sort of domine is a most every chapter he could pull out marginalized population would increase risk for emerging infections. Southwestern United States and most likely people to get infected with the original outbreaks occur, was amongst native americans. Several people and remember when this hunter virus occurred in the early 1990s, there is these group of young navajo kids and come to dc for a capital tour and they were denied. Tour the capitol good beca