Council i would like to think you offered joining with us. We would like to welcome ali khan and cspan book to be to this breakfast program. He will be discussing his book, the next pandemic, as a former director of the office of Public Health preparedness and response at the centers for Disease Control and t prevention, he isn the front line in the front to contain the worlds deadliest diseases. He is not the first to have done so. Throughout history, humans have beento fighting diseases, waging deadly and neverending word against contagious. In fact, there has never been at time when humans were not affected with microbes and fought against him. During his time as a selfdescribed disease detective, our speaker has had hise own viruses, Infectious Diseases and contagion. For example, 1995 he worked among red cross workers in that year for the first double crisis, after 9 11 he was called to washington to prevent the spreadntnt of anthrax in the see office building. In 2003 he was called to hong kong to quarantines victims apart. But these are just some of the stories doctor chronicles in the next pandemic. A disease hunter if you will, his mission for two decades was to read the u. S. Government efforts to prepare the public for disease outbreaks and health emergency. He has seen it all. While he tells us that microbes will always be a problem, he also writes that not epidemics and pandemics are inevitable, and fact most outbreaks can be mitigated if not prevented. But the question is how, do we have enough resources. To help a separate the myths from the facts, what disease posa greatest risks and what we need to do wto prewritte prevent pandemic. Please join me on the Public Health journey to the four corners of the earth by welcoming dr. Khan this morning. [applause] thank you very much. Good morning, everybody. Lets put this over here. As you heard i spent a career in the preparedness business, usually that meant for talks and in advance, over time it became getting ready just in time and at this point my career were into the realtime speaking process which i pretty much make it up as they go along. Now one of the things iak have been told when you speak to p an audience, as you can tell there is nothing about my career that starts within levity. But i i do promise sex, lots of sex, it will be mosquito sex but there will be lots of sex. So im really delighted to have this opportunity to share a whole bunch of stories with the broader audience of what it means to be a disease detective and hunting down the diseases. You hear about patients and you read the papers and all the popular press and the movies and et cetera, but what is it from a perspective of somebody doing every day with lots of another Public Health practitioners. Also its nice to give a talk when you read the paper this morning you are either reading about zeke or ebola or yellow fever, it is topical, so to think its easy to start a discussion of emerging infections. That shouldns start their, the idea of why this is always in the paper and why are we always hearing about these diseases. A classical disease to think about, smallpox, measles, those all started pretty much around the agricultural revolution when people came together, you needed to have enough people to spread the disease from persontoperson. So thats when i start the Infectious Disease, everybody has their own story of when the world starts, thats when the world starts when rodents were carrying smallpox and they moved into somebodys home and the virus made the jump and started to cause smallpox. Let me fast for to the Industrial Revolution theory, we realize Infectious Diseases is from asthma but it spread from person to person and a lot of enthusiasm that occurred around the beginning of the 20th century with sanitation revolution, vaccines, antibiotics and people thought we are done with this whole Infectious Disease problem, all we have to do is pop a shot in somebodys arm and give them a couple of pills and the all be better, if that was true we would not have this conversation today right now. What is happening, even though weve taken care of a lot ofha t these, we have these continued emerging Infectious Diseases, theres a lot of factors that drive this emerging diseases. So some of the key factors are just around microbes, theres collectively somebody who thinks that theyre smart collectively and they evolve, they multiple generations with a single day, humans if we are lucky, generation and 35 years or something before we can swap out our genetic materials. Microbes, no problem at all, they swap genetic material all the time, they get smarter all the time, thats why you read about the drug microbes because thats what they do, they move around find a good setet of gens and think thisll protect me from the antibiotics. So the microbes evolve, human change their behavior so 100 years ago i tell you nobody had a kidney transplant so we changed in our risks to infections changed, the other thing that happened is that we change our environment, this is the big driver and why we have it emerging. When i talk about zeke a and ebola, somehow the animal connection comes into play was eco the and the mosquitoes and ebola itre is bad which is the original cost of where the virus lives in effect somebody and thats we spread out the chain of transmission and humans. 75 of the diseases that you hear about, the new the new diss emerging, if an animal connection, if you move people out into the environment, into the jungle, they will get infected. That disease has the potential to cause persontoperson transmission as we see with ebola or mers which we believe from bats and camels, if you have a contact with camel, thats how you get the disease. It is not a surprise when we think about the emerging infections that 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 good example where as if you have people in china and other parts of Southeast Asia who live very close to their pigs and very close to their birds, chickens and its a a great opportunity r the virus to swap genes and infect humans and that becomes a global pandemic. E. 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 year on record since 1880. And people ask me how did you know whatbe was going on in 188, and believe it or not, if you are a farmer it is important to you the temperature is, so there tre excellent records about what it looks like th for the last 10 to 150 years. You are doing your daily log. Wwhat is water temperature look like. So we have excellent records and then asked you pass through that historical sort of documented record and look at all sortst of other information that looks at temperature thousands of millions of years ago but april was the hottest record, hottest year on record and its the 12th of this year in a row. This isnt a coincidence that is happening with temperature or climate and if you look at Carbon Dioxide we should be above 200 parts per million. So the 2100 year going to only catch increases to 1. 5 degrees. This is a mosquito Borne Disease in africa. So you have your cows and goats and that is your 401 k . It is a biblical disease and what we have recognized the past few decades despite the fact its moving out of Subsaharan Africa depends on climate and when this emerges. To protect your animals this also provides feature and brain inflammation. But they dont have the money to vaccinateni every year so if the is a sort of tool every five to ten, 15 years to say get vaccinated this year, that would benefit so they could understand what happens so they could help protect the community so that is how i got into Climate Change issues understanding what the dynamics were. Whats going to happen in 2100, know what is happening today. So if we look at the diseases caused by arthropods which are tanktanks andthink since mosquis effectually wined disneys. Its continued to spread about half of the county so we are seeing that already today. There is a fungus up in vancouver called the infections of humans and animals. It doesnt belong there. It belongs in the tropics. We are getting infected oysters from the i northwest. Are there any oyster eaters here like the . You dont Pay Attention to the good publichealth messages. Okay. One of the reasons is to try to protect yourself but that shouldnt be a problem if you were getting theyouregetting td states or the alaska area with an ice cold waters. But weve started to see outbreaks reported from those because the waters are not as cold anymore. So, contemporary examples where we are seeing because of Climate Change. Lets shift from the u. S. To europe they have this disease. We take whatever you tell us and give it back. We know what it says in latin. Into where we are nothing but the climate is one of those. Respiratory virus o for any of u that work here, have kids, grandchildren. Kids get infected and it causes this respiratory illness usually they are okay but not always. Contemporary examples are going to get worse when we talk about these ways. And t then obviously the Infectious Diseases and anything that has to do with mosquitoes and ticks and where things are. All of these are important and what is happening to the microbes and whats happening to us and in the environment is actually more political and social factors. If you look at these outbreaks of diseases will continue to emerge as i convinced you the last five to ten minutes but i hope that we play a role in keeping them from becoming epidemics and pandemics. A good example would be the outbreak of ebola in west africa. Weve known about it since 76 and the science since 1976, and i had the opportunity to support a into 1990s when i did this. You get infected anyouve got iy with a bat. If you are out in the bush and w you die 85 to 95 of people by unfortunately maybe a Family Member or two urls in the middle of the bush, you are done. Whalets say you changed the dynamic and seek healthcare in a hospital. Unfortunately they do not have Infection Control so when you are infected you essentially virus factory. You can infected and if your system doesnt kick in your increasing the amount you are producing every minute until you die so you go to the hospital because you are sick and you dont have more than when you die you. Hundreds of millions of billions of them to be in a milliliter of your blood. So here you are dying in the hospital and someone doesnt wash their hands whats going to happen. Theyve always served and weve known this for many years as a reservoir of a spread in the community. Somebody sick at home and you have a Family Member taking care of them, you are at risk. They die, unfortunately, didnt you decide to wash the body, case the body, invite all the loved ones. One of the fact is as we saw during the outbreak as they would wash and use the water to allow them to wash their hands to take on the attributes of the person that just died. This isnt a good idea. Lets admit that. 24th, 25th since 1976 many people thought this isht going o be like what we have seen happening in east africa. They shut them down within a couple of days and have a system in place to identify the case. They dont even need to teams anymore they wont know what to do. They test everybody and extinguish these outbreaks very quickly. Its never occurred before and in urban areas their thinking was one in the same. So each and every one was a needless death i would say and adequate response. Politics in the publichealth system goes from the outbreaks and what we had essentially was an epidemic across west africa with the cases across the world including what happened in the United States and one of the pasons is another factor of social political factor that plays into Infectious Diseases that we didnt have in the 18 hundreds. 80 days to get around the world. On my publichealth uniform was an anchor and i get asked about it. The publichealth uniform was very much a navy uniform and we started about 200 years ago providing care to the merchant marines and one of the chores was to be so hot right now essentially to fly the flags and there was somebody with yellow fever or smallpox. We knew if you had smallpox or no fever because the incubation. Coincubation. Co. And the time it takes to get the systems was shorter than the time to go from point a to point b. We turned that upsideps down now so now you can go to your proter mothers funeral in liberia, fly to liberia, go to your mothers funeral, engage in the usual act that the word if you are kissing her and hugging her and the next day you get on a plane up to to amsterdam to kneejerk city. New york city we give me 48 hours, incubation period of five to seven days. Its three days aftethree days k up in new york and say ive got a headache and a fever and im not feeling quite well right now. Ive spent time in places across theno world. They are not ready for these patients coming in with these viruses so travel has played a big role. What can we do to make things better around social political aspects. I guess they recognized if we think about this and who gets infected as i started to write the book is sort of dawned on me how most every chapter you could swap a marginalized population that was the increased risk. So this is due to rodents and often occurs in the southwestern United States and the most likely people to get infected and when thehe outbreak occurred was among the native americans into some of you will remember that when this occurred in the 1990s there was a group of kids that had come to dc and they were denied to her you could potentially infected. And todays day and age we are talking about zika and others including that what weve learned now is zika is a laserguided missile it kills your cells and its not just truee in babies so when it was yfirst described you were told about 20 of people get sick and get a fever if they missed to be a cook at a little headache and some red eyes and they will get better and it quickly became clear that this was a problem for pregnant women but now we know even for adult in this laser like focus we have this disease that is a neurological illness that causes weakness and we also know that even in a healthy person that can cause brain inflammation. So what we should think of as normal healthy adults that are not present it as a problem. The virus shouldnt be am, problem. Its spread by a certain type of mosquito. It isnt new to us. Its the same that spreads yellow fever. It causes 30,000 around that. And not paying attention to the people dying of yellow fever now all of a sudden we are up in arms that we have the disease due to these that seem to be infecting pregnant women. So it is a lack of action over the last 40 to 50 years against the known threa threats that hat us in this current position. Its essentially knocking on the door of africa whats going to happen is it then sweeps through africa and the rest on pregnant women. The head of who whos done amazing work in her time in hong kong has admitted in addressing this mosquito, although to talk about the major policy failure as we think about protecting women and contraceptive rights is a big issue in brazil and other places to all of a sudden say we need to Pay Attention because now we may get some cases in north america women who may have this disease. We will see zika in the United States, hopefully we will not see a lot of cases that we will likelbut we willlikely see it. What they you gave me a lovely comment the other day. You think about these m populations. In this conversation is probably better terms between lets protect the United States against zika and no one can decide if they want to do it or how much they want to pay for it and should it be 500 Million Congress wantses to give, some version and they are like i dont care what it is, pick a number of way ar that way are wg this conversation six months later. We know what is going to happen and we also know us keep those controlled in the United States is not even a state function. It is a state and city and county function and we need to get the money out to these people so they can be doing what they should be doing which is eliminating mosquitoes making sure the identify the cases. Why are we still having this conversation six months later. Why are we sort of robbing peter to pay paul. So we were responsible for keeping americans safe from all publichealth threats no matter what their nature if it was biological chemical terrorism. The program puts money out into state and local Health Departments. To pay for this week essentially pulled back some of that money eto help support some of the activities and other places including britne theyve alreadd 1100 cases believe it orup not. This is the preparedness infrastructure why are we taking money outut a of that when we sd be putting money into the preparedness infrastructure and what i will leave you with is a member because i am all about these measures. 6. 7. In the last three years the foundation has been doing great work looking at how prepared the United States emergencies we started at 6. 3 or 6. 7 out of ten. That just is not good enough for us if we want to make sure americans are protected and as far as i am concerned, the responsibility is to protect us against threats and that includes publichealthhr and threats and how