Booktv to this breakfast program. Ali khan will discuss his book the next pandemic on the front lines against humankinds gravest dangers. A former director of the office of Public Health, preparedness and response at the centers for Disease Control and prevention, ali khan has been on the frontline in the attempt to contain the world after these diseases. He is not the first, throughout history humans have been fighting diseases, waging deadly and neverending wars against rampant and violent contagions. Humans are not affected by microbes, during ali khans time as a detective our speaker has had his own russians with viruses, infections and contagion. For example in 1995 he worked among red cross workers in the year for the first ebola crisis. After 9 11 he was called washington to defend the spread of anthrax in the Senate Office building. In 2003 he was called to hong kong to quarantine victims of sars. These are just some of the stories ali khan chronicles in the next pandemic on the front lines against humankinds gravest dangers. As an epidemic intelligence officer, disease hunter, if you will has mission for two decades was to be the Us Government efforts to prepare the public for the disease outbreak and health emergency. He has seen it all. Ali khan tells us rogue microbes will always be a problem he also writes that not all epidemics and pandemics are inevitable. He writes most outbreaks can be mitigated if not prevented. Do we have enough resources. To help a separate the hype from the facts, what diseases pose the greatest risk and what we have to do to prevent the next pandemic, please join me in a Public Health journey to the four corners clear if by welcoming ali khan to the Carnegie Council this morning. Thank you for coming. [applause] thank you very much. Good morning, everybody. Lets look this over here. There we go. I have spent a career in the preparedness business and usually that meant for talks in advance. Over time it became getting ready just in time. At this point we are into realtime speaking process which i pretty much make it up as i go along. One of the things i have been told when i speak to an audience, theres nothing about my career but starts with some levity. I do promise sex, lots of sex. It will be mosquito sex. I had an opportunity to share a bunch of stories, the broader audience what it means to be interviewed. And what is the perspective of somebodys ability. And talking about sica or ebola or yellow favor. And emerging infections. Why is this always in the paper and why we always hearing about these types of diseases. Our classical diseases, think about smallpox or measles, and people came together. It disease spread from persontoperson and that is when i thought my stories Infectious Diseases starts. For me, when rodents that were carrying some version of smallpox into somebodys home in some virus made this something for measles and classic diseases. Let me fast forward to the industrial revolution. Infectious diseases were not due to my asthma miasma, agents that spread persontoperson. And what occurred around the twentieth century, the sanitation revolution with vaccines, antibiotics, we are done with this small Infectious Disease. Given a couple pills and they will be all better. If that were true we would not be having this conversation today and what is happening is even though we have taken care of a lot of them, we have these continued emerging Infectious Diseases and there are a lot of factors that drive those diseases. Some of the key factors, they are smart, collectively. Multiple generations in a single day, humans if we are lucky our generation in 35 years or so, microbes, no problem at all, they swapped in attic material all the time, they get smarter all the time, read about drugresistant microbes, they move around, this will protect me from the set of antibiotics, and and so we change, the risk to infections change. We change our environment. It should not be surprising when i talk about the cover ebola, the animal mentioned comes into play. Zikait was mosquitoes and with ebola it was bats. That is how you spread the chain of transmission humans. 75 of diseases that you hear about, emerging diseases are sora not act meaning an apple connection. If you move people into the environment into the jungle they get infected, there is a potential to cause persontoperson transmission as you see with ebola, bats and camels, to connect contact with camels, it is not a surprise when using of these emerging infections they tend to come from africa, south america or southeast asia, bird flu is another good example when you have people in china, pretty close to their pigs. And a great opportunity for these viruses to infect them. These are the environmental set of environmental conditions and why we keep hearing about them. A special call out to Climate Change as one of those environmental factors leading to emerging infections. I want to say Climate Change is often framed as an economic issue or as an energy issue. Over the last year we have been doing a better time reframing this as Public Health issue of what is happening with climate currently. The hottest record, hardest year on record, 1880. How do you know what is going on in 1880 and if you have a farmer it is really important to you, there are excellent records. The same thing with marine temperatures if youre out as a captain doing daily life, one of things he would be logging, what does water temperature look like. We have excellent records. If you pass through that historical, other information, temperature, thousands of millions of years ago. April has the hottest record, hottest year on record and the 12 hottest year in a row. This isnt a coincidence with what is happening with climate, we should be about 200 parts per million, preindustrial level, we are not 400 parts per million. And and it had to do with other fevers. This is a mosquito Borne Disease in africa. We have cows and goats, that is your 401 k . If a virus, if a mosquito borne virus comes around, that is bad news. It is a biblical disease. What we recognized the past couple decades of studying this besides the fact that it is moving in Subsaharan Africa into Northern Africa and the middle east, it depends on climate, on when these viruses, when the mosquito emerges and great heavy periods. To protect your animals, bad diseases, it causes hemorrhagic fever, brain inflammation. They dont have the money to vaccinate the animal every year. If you have a sort of tool, every 5 or 10 years to say this is a bad year, that would really benefit. People spend a lot of time to understand what happens, to protect these farmers and their animals, Climate Change issues, understanding what the dynamics were but what is clear right now when you talk about Climate Change, what happens in 2100, what is happening today, if we look at diseases, disease in the United States caused octopi which are ticks and mosquitoes which everybody in this audience knows very well. If you look at where live disease vectors are spreading. We see that already, theres a tropical fungus in vancouver causing infections of humans and animals. It doesnt believe belong in vancouver, belongs in the tropics. We are getting infected oysters from the northwest. We all know any oyster eaters here . All the good Public Health messages about oysters. Gulf coast in cold months, one of the reasons you eat oysters in months with an are in the ms. Try to protect yourself from infected oysters especially gulf oysters. That shouldnt be a problem getting oysters from the northwest United States from the alaska area. We are not seeing outbreaks, and contemporary examples, let mission from the us to europe. It is encephalitis. What we do is we give it back to you and you think we are all smart. My head hurts, you have several asia, youre so smart. You know what it says in latin. It is called tick one brain inflammation and what we see in sweden, the disease is spreading and there are a lot of factors, climate is one of those. For any of you who work here or have kids or grandchildren, little kids get infected with a severe respiratory illness. And those viruses in europe. They are becoming shorter and shorter. And and and proportionally more will die from heat when we think about heart and lung disease from all your pollution and all the Infectious Disease. Anything that has to do with mosquitoes and ticks and where things are, climate, this waterborne illness as we get flooding, severe storms and Mental Health illnesses. As we think about emerging infections. All of these are important what happens to microbes and all of us in the environment. And and the good example would be a recent outbreak of ebola in west africa. Since 1976 we have known about the science of ebola since 1976 and i had a chance to support that clients in the 1990s when i did and Ebola Outbreak in zaire. What happens . You get infected with ebola and if you are out in the bush you die 85 percent95 of people die. A Family Member or two guy with you. You are in the middle of the bush, you are done. Lets say you change the dynamic and go seek healthcare in a hospital. Unfortunately a hospital that doesnt have infection control. When you are infected with ebola you essentially become a virus vector. You get infected and if your immune system doesnt kick in, you will increase the amount of virus your producing. When do you have the most hostile virus in your body . When you die. As you go to the hospital because you are sick and you dont have more than when you die. I can give you a 10 with lots of big numbers around it, hundreds of millions, billions in a milliliter of your blood. Here you are, sick, dying in the hospital and somebody doesnt wash their hands as they go from patient to patient. You spread ebola from patient to patient. Hospitals always served as a reservoir for how these spread within their communities. Somebody sick at home and you as a Family Member taking care of them, you are at risk. They die, unfortunately, then you decide to wash the body, kissed the body, hug the body, invite the loved ones. One of the practices we saw during this Ebola Outbreak is they would wash the body and then use that water, to wash their hands and take on the attributes of the same dead person who had just died. This is not a good idea, okay, lets admit that. That is the science. We know the science. When this outbreak occurred 24th, 25th outbreak since 1976 many people thought this will be like east africa, uganda, sees outbreak the time, they shut them down in a couple days, they have a system in place to identify the case. They dont even need International Teams anymore, the locals know what to do, they test everybody, they follow everybody was potentially sick and take care of these are brakes quickly. For december to start in west africa where it never occurred before, it very quickly spreads to urban areas, large metropolitan areas, urban areas with slums and the thinking was more of the same. Russian, take care of everything in this Ebola Outbreak will go away. What happens . That is not what happened. 11,000 deaths, every one was a needless death. Inadequate response, Global Response to a local response but inadequate Global Response. As though politics in our Public Health system, the biggest role in whether this goes from a handful of cases or small outbreaks to whether or not what we had was essentially an epidemic across west africa and cases across the world, you know what happened in the United States and one of the reasons we had that was another factor, social or political factor that plays into Infectious Diseases that we didnt have any 1800s. How many people . I wont ask. Have read around the world in 80 days. How quaint. 80 days to get around the world. For 22 years, i wore a Public Health uniform and on my Public Health uniform was an anchor. The Public Health uniform looks much like a navy uniform and the reason it look like a navy uniform, we started 200 years ago, one of the chores of the Public Health service which we still have right now with the quarantine flag when the ship came to port, somebody with yellow fever and smallpox. If it is going to take you 80 days govern. 80 point be by the time you show up in the court of new york city, we knew if you had smallpox a yellow fever because the incubation period, the time it takes to get infected, manifest your symptoms was always shorter than the time to go from point a 2 point be. We turned that upside down. You could now go to your mothers funeral in liberia, you fly to liberia, go to your mothers funeral, engage in the usual acts you around a funeral, your distraught, your mother died, youre kissing her, youre hugging her in the next day you get on a plane to amsterdam to new york city. And incubation period, and in new york, all of a sudden you find out, i am not feeling quite well. Number one diagnosis would be malaria. If it is not malaria, in the community, they happen in texas, the same scenario, infected two local nurses, in places across the world letting you know our Healthcare System is not better than you see in toronto when you had the sars outbreak, i spent some time in seoul, and Excellent Health care system like ours, they are not ready for nations coming in, travel played a big role in how these diseases emerge, why you will always hear about this but what we can try to do to make things better. The ethics matter, an observation, i recognized it, often marginalized populations. I started to write the book and it dawned on me every chapter you could pull out, the marginalized population for emerging infections. This is a disease due to rodents. The most likely people to get infected, was among native americans. Some of you will remember when the junta virus occurred in the 1990s a group of young navajo kids who had come to the sea for a capital tour and were denied, you happen to come from the southwest. There was nothing anything we knew that said these kids were at risk. They didnt pose any risk to us but often these diseases affect marginalized populations and increases the prejudice against marginalized populations. We talk about hiv and ebola and the marginalized populations in west africa and in todays day and age we are talking about zika. Brazil has 1. 1 million cases, what they are calculating now of zika virus and 1500 women have been infected and their babies have died of congenital zika syndrome, they get small brains, other Development Disabilities including hearing loss, vision problems. What we have learned is zika is a laserguided self or neurons. It looks for neuron cells and kill your neuron cells. It is not just true in babies. When zika was first described, we were told 20 of people will get sick, if they get sick they get a fever and a little headache, some itching, some redeye, they will get better. Very quickly it became clear this was a problem for pregnant women. Now we know even for adults, this laserlike focus on the ronil cells we have this disease, a neurologic illness causes weakness. Even in a healthy person zika virus can cause brain inflammation of coverings around your brain. Even in normal healthy adults who are not pregnant this virus is a problem. This virus shouldnt be a problem. The virus is spread in certain type of mosquito, this is not news to us. This is the same mosquito that spreads yellow fever, that causes 30,000 tests a year, the same mosquito that spreads dengue and if we were having this conversation five years ago when we talk about this large dengue outbreak that is occurring in south america, this causes 30,000 of the year. Its the same exact mosquito that causes chikungunya virus. That was the big thing in the news 2 or 3 years ago. That doesnt seem to cause any deaths but because of the failure since the 70s to keep up with these efforts to decrease mosquitoes and kill mosquitoes and not paying attention to the people dieing from yellow fever and dieing two people died from yellow fever and people dying from dengue now the sudden were all up in arms that we have disease due to aedes aegypti the soontobe infecting pregnant women. This lack of action overn the last 40, 50 years against a known threat that is put us in this current position. At least ifme you happen to be n south america these days and i heardte yesterday zika now is nt just move throughout the americass but is not a verdict. At the center did not get on the to say hi, im next. Your next think about what could happen if that virus goes to africa and the risk to pregnant women there in africa. The head of w. H. O. Brilliant woman has done some amazing work, did some amazing work anytime in hong kong has admitted a major policy failure over the last 40 years and addressing this mosquito. Also she brought it to talk about major policy failures as we think about protecting women and contraceptive rights for women because theres and big issue in brazil and other places where you dont have the same contraceptive rights as you take for granted here in the United States and other parts of the western world. Why did it take all this time people die of dengue, people dying of yellow fever with just a vaccine to all of a sudden say we need to Pay Attention . Because now we may get some cases in europe and north america, women who may have this disease. We will see zika in the United States. Ill preempt that c question, hopefully we will not see a lot of