Transcripts For CSPAN2 Ali Khan The Next Pandemic 20240713 :

Response at the centers for Disease Control and dr. Kahn has been in the fight to contain the worlds deadliest diseases. Hes not the first to have done so they draft history he hasut been fighting diseases and doing deadly wars against deadly contagion spread of factors never been a time when humans were not affected by microbes that fought against them. Our speakers speaker has had his own brushes with viruses and Infectious Diseases and contagion. For example in 1995 he worked among red cross workers in the apollo crisis and after 9 11 he was called to washington to the Senate Office building and in 2003 he was called to hong kong to quarantine victims. These are just some of the stories that dr. Kahn chronicles. As an epidemic intelligence officer, disease hunter d welll his mission for for two decades was to prepare the public for disease outbreaks and health emergencies. He has seen it all. While dr. Kahn tells us microbes will always be a problem he also writes not all epidemics and pandemics are inevitable. In fact most outbreaks can be mitigated if not prevented. The question is how and do we have enough resources . To help us separate the hype from the facts what diseases pose the greatest risk in and what they need to do to prevent the next pandemic pleasedd when my and a Public Health journey to the four corners of the earth by welcoming dr. Kahn 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 is that my career in thesi preparedness business d that usually means you are ready in advance. Over time itim became getting ready just in time and at this point in my career i went into the realtime speaking process which means i may get up as i go along. Now one of the things ive been told to do with audiences is to put the movies but theres something about mike career that starts with levity. I promise, lots of pretty will be mosquito but decides that it will be lots of fun. Im really delighted to have this opportunity is shareable bunch of stories with a broader audience and what it is as the disease detected pretty share about patients who make the papers of the popular press etc. But someone from may perspective of someone whos doing it every day. Also tonight if you read the paper this morning reading about zika or at the lower the yellow fever going on in the dash you think its easy to start a discussion about burgeoning infections. Why is the size of the paper and why are we always hearing about these types of diseases . Are classical diseases think about smallpox and measles, those all started pretty much with the egg or cultural revolution when people came together. You need to have a lot of people to spread disease from person to person. Thats where i start my story of disease. For me thats when the world starts when rodents that were carrying smallpox moved into somebodys home and that virus made the jump and started to spread to people the same thing with measles and classic diseases. But my fastforward to the Industrial Revolution the germ theory. We realize r infections diseases word that my asthma but spread from persontoperson and a lot of enthusiasm that occurred around the beginning of the 20th century with the sanitation revolution vaccines and antibiotics and people going okay we are done with this whole Infectious Disease problem. All we have to do is put a shot in somebodys arm and give them a couple of pills and theyll be all better. If that were true we wouldnt be having this conversation right now. H what is happening is even though we have taken care a lot of these classical viruses we havent dealt with emerging Infectious Disease and their a lot of factors that drive the merging of those diseases. Some of the key factors are microbes. Collectively someone who thinks they are smart collectively and they evolve. Theypl have multiple generations within a single date. A generation in 35 years or somethingg before we can swap or genetic material. Microbes no problem at all. They swap genetic material of the time and they get smarter of the time and thats why you read about these drugresistant microbes because thats what they do. They move around and find a set of genes in a goal of code these will protect me from these sets of antibiotics and you have the superbugs. The microbes evolve and humans change their behaviors. 100 years ago nobody had a kidney transplant. We changed our wrist infection changes. The other thing that happens is we change our environment. Its a big driver and why we have emerging diseases. Should not be surprising when i talk about zika and i talk about ebola somehow very quickly the animal connection comes into play. Zika is with mosquitoes and ebola expats. It infects someone in thats how you spread the chain of transmission in humans. 75 of the diseases you hear about these emerging diseases if an has an animal connection. Ife you move people out into the environment into the jungle they get infected and that disease has the potential then to cause a persontoperson transmission as we see with ebola and with murders which we believe is from bats and camels and with contact with camels thats how you get the disease brings not a surprise when you think about these emerging diseases they come from Southeast Asia where you have a lot of connection with animals. The birdd flu is another good example where you have people in china and other parts of southeast Southeast Asia who live close to their in very close to their birds and their chickens and its a great opportunity for these viruses to swap genes and eventually infect humans and the tecumseh global pandemic. Those are the sets of Global Conditions that lead to these pandemics and why we keep hearing about them pretty special callout to Climate Change is one of those environmental factors that lead to emerging infections. Nffirst i want to say often Climate Change is framed as an economic issue orders and energy, somehow in energy issued over the last year or two we been doing a better time reframing this is a Public Health issue of whats happening with the climate currently. April was the hottest record on year, the hottest year on record since 1880 people a asked me how do you know what was going on in 1880 and believe it or not if you are a farmer its really important to you what the temperature is. There are excellent records about what temperature look like atke least for the past 100 or 0 years and the same thing with murdering temperatures. As the captain you are doing your daily log what are the things you are logging is what does the water temperature look right . We t have excellent and as you pass through that historical document record and all sorts of aother of her mission that loos at temperature thousands and millions of years ago. April was the hottest record, the hottest year on record in the 12 hottest year in a row. This isnt a coincidence whats happening with temperature and whats happening with climate and if you look at Carbon Dioxide we should be about 200 parts of a million, 230 parts of a millionll so preindustrial level. The thought that by 2100 we are only going to cap increases to 1. 5 degrees is highly unlikely. Let me tell the story from a way. Rent i got into the Climate Change business 20 years ago almost. This is a mosquitoborne disease in africa so if you are in africa you dont have a 401 k . You have your cows and you have your goats and thats your 401 k . If a virus if a mosquitoborne virus comes around in your animals die that is bad news. Its a biblical disease and what we have recognized over the last couple of decades as we study this besides the fact moving of Subsaharan Africa into Northern Africa and to the middle east is that it depends on climate on whether these viruses and when this mosquito emerges in these sort of have to have this great heavy dry period followed by what period the causes this to happen. To protect your animals this virus causes that diseases in humans and it causes hemorrhagic fever and brain inflammation in humans. The farmers t dont have the moy so if you have some sort of tool to say this is that the bad year and get vaccinated this year that would really benefit them. People spent a lot of time trying to understand what happened with the climate so you can protect these farmers and protect animals. Thats how i got into Climate Changege issues understanding wt the dynamics were and what became clear right now only talk about Climate Change everybodys like was going to happen in 2100 . Its really whats happening today self we look at the biggest disease in the United States caused by ticks and mosquitoes is actually lied disease. Everybody in thisun audience kns very well about it if you live in thehe northeast. Looking at where the vectors are spreading over last 20 to 30 years of continued to spread across united a states but almot in half of the counties. We are seeing that already today. Theres a fungus a tropical fungus in vancouver causing infections to humans and animals. It doesnt belong in vancouver. It belongs and the tropics. We are getting infect that oysters from the northwest. We all know any oyster here like me . You dont Pay Attention to all the good Public Health messages about oysters. Im an oyster. If you eat oysters and cold months and the reasons you eat oysters in months with r in them if youre getting your oysters up from the northwestern United States or from the alaska area its nice cold waters but we are starting to see outbreaks reported from those oysters and cold water because the water is not cold anymore. Contemporaryen examples today where we are seeing it because of Climate Change. The maze shifting from the us to hear. If you go s to sweden they havea tape or disease encephalitis. We take whatever you tell us and we give it back to is a w medicl term and you think we are all smart. My head hurts and they say you have encephalitis and you say what you are so smart. Its called tick one brain inflammation what we see in sweden is that this disease has been spreading over the last couple of decades are there a lot of factors. Respiratory virus for any of you who work with kids or have kids or grandchildren little kids get infected with rsv which causes a severe respiratory elmezayen usually they are okay but not always we are seeing those respiratory seasons in europe are becoming shorter and shorter during the cold months of the seasons are becoming shorter. Again contemporary examples that are ours going to get worse for me think about heatwaves and whats happening in india right now 120 degrees or Something Like that. And lots of people have died but unfortunately more will die from when we think about the air pollution and obviously all the Infectious Diseases. Anything that has to do with mosquitoes and ticks and where things are climate plays a big role in those illnesses. There are waterborne. Veteran issue is to get flooding. And Mental Health illnesses but i want to give a quick shout out to Climate Change in one of the factors to keep in mind the need think about infections. The biggest factor in what has happened to microbes and whats happening to us and whats happening in the environment is a more political social factor. If you look at these outbreaks these diseases will continue to emerge as id hoped to do in the last five to 10 mins. The key think we keep a play role in keeping them from becoming pandemics. For example an outbreak of ebola in west africa. We have known about ebola since 1976 and we have known about the science of ebola since 1976 and i had the opportunity to help support that science in the mid1900s in the mid1990s when we had in the Ebola Outbreak in zaire. What happens quick to get infected with ebola usually by a bat and if you are out in the bush you died and 5 of people died. Unfortunately maybee a Family Member or two will die with you but if you are out in the bush you are done. Lets say you change that dynamic and you decide to get health care in a hospital. Unfortunately that hospital doesnt have infection control. When you are infected with theou bali become a virus factory. If your immune system doesnt kick in when you have the most possible viruses in your body when you die. You go to the hospital because you are sick and you dont have were then when you die. I can give you attend with lots of big numbers around and hundreds of millions and billions. Here you are sick and dying in the hospital and someone has to wash their hands as they go from patient to patient. Whats going to happen quick to spread ebola from patient to patient. Hospitals have always served and we have known this for many years as a reservoir for how these diseases spread. Somebody sick at home and you are the Family Member taking care than you are at risk. They died unfortunately and then you decide to wash the body and kissed the body hug the body and invite the loved ones and one of the practices we saw during his Ebola Outbreak that they would wash the body needs out water to allow people to wash their hands is one of the attributes of the sainted gerson who had just died. This is not a good idea, okay . Lets admit that. We know the science but the sciences and the issue. When its outbreak occurred a think this was the 24th or 25th or Something Like that in 1976. Many people thought this is going to be like what we are seeing in africa. To shut them down within a couple of days and have a system in place. Teens russian and they dont need International Teams anymore but the locals know exactly what to do. They rush in and test everybody and they follow everybody who is potentially sick and they get rid of the outbreaks rather quickly. This outbreak no one had seen before it spread to urban areas in large metropolitan areas. The thinking was oh rush in and take care ofk everything in this Ebola Outbreak will go away. What happened . Thats not what happened at 11,000 deaths and every one was a needless death i would say and an inadequate response, Global Response. Politics in our Public Health system played the biggest role in whether or not this goes with a handful of cases or small outbreaks and whether or not but we had was essentially an aepidemic across west africa wh cases across the world including us. Ne we know what happened here in United States but are the reasons we have that in United States is the social political factor that plays into Infectious Diseases that we didnt have an 1800s. How many people i want to ask. Ive read around the world in 80 days. How quaint, 80 days to get around the world. For 22 years i were Public Health y uniform and on my publc health uniform was an anchor and i would be asked about the anchor on the Public Health uniform. Its very much like a navy uniform and the results like like navy uniform we started 200 years ago providing care to merchant marines. One of the chores of the public hhealth service was what we stl have the working flag when a ship came into port. If its going to take you 80 days to go from point a 2. B by the time you show up in the port of new york city we knew if you had smallpox and we knew he had yellow fever because the division. The time it takes to get infected to manifest in the system was only shorter than the time it takes from going from point a 2. B. You can go to your mothers funeral in liberia and you fly to liberia and go to your mothers funeral engage unusual act that you went around the funeral. Your mothers died in your kissing her and hugging her and the next day you get on the plane to amsterdam to new york city. That is 18 to 24 hours and maybe 40 hours incubation period of five to seven days. Its three days after you show up in new york where you go you know what, ive got a headache andng i have fever and im not feeling well right now. You show up at a hospital thats a good hospital and the number one diagnosis will be malaria. One, two and. If its not malaria and they missed it its easy to see how you could hospitalize forr something and it spreads in the community. We saw this in texas and is same scenario. Someone showed up and infected to local nurses. Our Health Care System is not better than what you see in toronto when they had the sars outbreak in singapore when they had their sars outbreak or hong kong. I do spend some time in sowell and soul might have an outbreak of murders and again excellent Health Care System. Excellent Health Care Systems but they are not ready for patients to commence a travel is played a big role in how these diseases emerge currently. I think im giving you a sense of why you hear about this but what we can do to make things bettersp round social political aspects of protecting people. I did want to spend a couple of minutes to talk about you at the Carnegie Council that ethics matter. An observation which i get recognized my whole life so the thing about hiv is often a marginalized population but as i started to write the book it dawned on me how when ill most every chapter you pull out the marginalized population for merging infection could think about coronavirus rates of disease passed through roaches in the southwestern Disease Control<\/a> and dr. Kahn has been in the fight to contain the worlds deadliest diseases. Hes not the first to have done so they draft history he hasut been fighting diseases and doing deadly wars against deadly contagion spread of factors never been a time when humans were not affected by microbes that fought against them. Our speakers speaker has had his own brushes with viruses and Infectious Diseases<\/a> and contagion. For example in 1995 he worked among red cross workers in the apollo crisis and after 9 11 he was called to washington to the Senate Office<\/a> building and in 2003 he was called to hong kong to quarantine victims. These are just some of the stories that dr. Kahn chronicles. As an epidemic intelligence officer, disease hunter d welll his mission for for two decades was to prepare the public for disease outbreaks and health emergencies. He has seen it all. While dr. Kahn tells us microbes will always be a problem he also writes not all epidemics and pandemics are inevitable. In fact most outbreaks can be mitigated if not prevented. The question is how and do we have enough resources . To help us separate the hype from the facts what diseases pose the greatest risk in and what they need to do to prevent the next pandemic pleasedd when my and a Public Health<\/a> journey to the four corners of the earth by welcoming dr. Kahn to the Carnegie Council<\/a> 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 is that my career in thesi preparedness business d that usually means you are ready in advance. Over time itim became getting ready just in time and at this point in my career i went into the realtime speaking process which means i may get up as i go along. Now one of the things ive been told to do with audiences is to put the movies but theres something about mike career that starts with levity. I promise, lots of pretty will be mosquito but decides that it will be lots of fun. Im really delighted to have this opportunity is shareable bunch of stories with a broader audience and what it is as the disease detected pretty share about patients who make the papers of the popular press etc. But someone from may perspective of someone whos doing it every day. Also tonight if you read the paper this morning reading about zika or at the lower the yellow fever going on in the dash you think its easy to start a discussion about burgeoning infections. Why is the size of the paper and why are we always hearing about these types of diseases . Are classical diseases think about smallpox and measles, those all started pretty much with the egg or cultural revolution when people came together. You need to have a lot of people to spread disease from person to person. Thats where i start my story of disease. For me thats when the world starts when rodents that were carrying smallpox moved into somebodys home and that virus made the jump and started to spread to people the same thing with measles and classic diseases. But my fastforward to the Industrial Revolution<\/a> the germ theory. We realize r infections diseases word that my asthma but spread from persontoperson and a lot of enthusiasm that occurred around the beginning of the 20th century with the sanitation revolution vaccines and antibiotics and people going okay we are done with this whole Infectious Disease<\/a> problem. All we have to do is put a shot in somebodys arm and give them a couple of pills and theyll be all better. If that were true we wouldnt be having this conversation right now. H what is happening is even though we have taken care a lot of these classical viruses we havent dealt with emerging Infectious Disease<\/a> and their a lot of factors that drive the merging of those diseases. Some of the key factors are microbes. Collectively someone who thinks they are smart collectively and they evolve. Theypl have multiple generations within a single date. A generation in 35 years or somethingg before we can swap or genetic material. Microbes no problem at all. They swap genetic material of the time and they get smarter of the time and thats why you read about these drugresistant microbes because thats what they do. They move around and find a set of genes in a goal of code these will protect me from these sets of antibiotics and you have the superbugs. The microbes evolve and humans change their behaviors. 100 years ago nobody had a kidney transplant. We changed our wrist infection changes. The other thing that happens is we change our environment. Its a big driver and why we have emerging diseases. Should not be surprising when i talk about zika and i talk about ebola somehow very quickly the animal connection comes into play. Zika is with mosquitoes and ebola expats. It infects someone in thats how you spread the chain of transmission in humans. 75 of the diseases you hear about these emerging diseases if an has an animal connection. Ife you move people out into the environment into the jungle they get infected and that disease has the potential then to cause a persontoperson transmission as we see with ebola and with murders which we believe is from bats and camels and with contact with camels thats how you get the disease brings not a surprise when you think about these emerging diseases they come from Southeast Asia<\/a> where you have a lot of connection with animals. The birdd flu is another good example where you have people in china and other parts of southeast Southeast Asia<\/a> who live close to their in very close to their birds and their chickens and its a great opportunity for these viruses to swap genes and eventually infect humans and the tecumseh global pandemic. Those are the sets of Global Conditions<\/a> that lead to these pandemics and why we keep hearing about them pretty special callout to Climate Change<\/a> is one of those environmental factors that lead to emerging infections. Nffirst i want to say often Climate Change<\/a> is framed as an economic issue orders and energy, somehow in energy issued over the last year or two we been doing a better time reframing this is a Public Health<\/a> issue of whats happening with the climate currently. April was the hottest record on year, the hottest year on record since 1880 people a asked me how do you know what was going on in 1880 and believe it or not if you are a farmer its really important to you what the temperature is. There are excellent records about what temperature look like atke least for the past 100 or 0 years and the same thing with murdering temperatures. As the captain you are doing your daily log what are the things you are logging is what does the water temperature look right . We t have excellent and as you pass through that historical document record and all sorts of aother of her mission that loos at temperature thousands and millions of years ago. April was the hottest record, the hottest year on record in the 12 hottest year in a row. This isnt a coincidence whats happening with temperature and whats happening with climate and if you look at Carbon Dioxide<\/a> we should be about 200 parts of a million, 230 parts of a millionll so preindustrial level. The thought that by 2100 we are only going to cap increases to 1. 5 degrees is highly unlikely. Let me tell the story from a way. Rent i got into the Climate Change<\/a> business 20 years ago almost. This is a mosquitoborne disease in africa so if you are in africa you dont have a 401 k . You have your cows and you have your goats and thats your 401 k . If a virus if a mosquitoborne virus comes around in your animals die that is bad news. Its a biblical disease and what we have recognized over the last couple of decades as we study this besides the fact moving of Subsaharan Africa<\/a> into Northern Africa<\/a> and to the middle east is that it depends on climate on whether these viruses and when this mosquito emerges in these sort of have to have this great heavy dry period followed by what period the causes this to happen. To protect your animals this virus causes that diseases in humans and it causes hemorrhagic fever and brain inflammation in humans. The farmers t dont have the moy so if you have some sort of tool to say this is that the bad year and get vaccinated this year that would really benefit them. People spent a lot of time trying to understand what happened with the climate so you can protect these farmers and protect animals. Thats how i got into Climate Change<\/a>ge issues understanding wt the dynamics were and what became clear right now only talk about Climate Change<\/a> everybodys like was going to happen in 2100 . Its really whats happening today self we look at the biggest disease in the United States<\/a> caused by ticks and mosquitoes is actually lied disease. Everybody in thisun audience kns very well about it if you live in thehe northeast. Looking at where the vectors are spreading over last 20 to 30 years of continued to spread across united a states but almot in half of the counties. We are seeing that already today. Theres a fungus a tropical fungus in vancouver causing infections to humans and animals. It doesnt belong in vancouver. It belongs and the tropics. We are getting infect that oysters from the northwest. We all know any oyster here like me . You dont Pay Attention<\/a> to all the good Public Health<\/a> messages about oysters. Im an oyster. If you eat oysters and cold months and the reasons you eat oysters in months with r in them if youre getting your oysters up from the northwestern United States<\/a> or from the alaska area its nice cold waters but we are starting to see outbreaks reported from those oysters and cold water because the water is not cold anymore. Contemporaryen examples today where we are seeing it because of Climate Change<\/a>. The maze shifting from the us to hear. If you go s to sweden they havea tape or disease encephalitis. We take whatever you tell us and we give it back to is a w medicl term and you think we are all smart. My head hurts and they say you have encephalitis and you say what you are so smart. Its called tick one brain inflammation what we see in sweden is that this disease has been spreading over the last couple of decades are there a lot of factors. Respiratory virus for any of you who work with kids or have kids or grandchildren little kids get infected with rsv which causes a severe respiratory elmezayen usually they are okay but not always we are seeing those respiratory seasons in europe are becoming shorter and shorter during the cold months of the seasons are becoming shorter. Again contemporary examples that are ours going to get worse for me think about heatwaves and whats happening in india right now 120 degrees or Something Like<\/a> that. And lots of people have died but unfortunately more will die from when we think about the air pollution and obviously all the Infectious Diseases<\/a>. Anything that has to do with mosquitoes and ticks and where things are climate plays a big role in those illnesses. There are waterborne. Veteran issue is to get flooding. And Mental Health<\/a> illnesses but i want to give a quick shout out to Climate Change<\/a> in one of the factors to keep in mind the need think about infections. The biggest factor in what has happened to microbes and whats happening to us and whats happening in the environment is a more political social factor. If you look at these outbreaks these diseases will continue to emerge as id hoped to do in the last five to 10 mins. The key think we keep a play role in keeping them from becoming pandemics. For example an outbreak of ebola in west africa. We have known about ebola since 1976 and we have known about the science of ebola since 1976 and i had the opportunity to help support that science in the mid1900s in the mid1990s when we had in the Ebola Outbreak<\/a> in zaire. What happens quick to get infected with ebola usually by a bat and if you are out in the bush you died and 5 of people died. Unfortunately maybee a Family Member<\/a> or two will die with you but if you are out in the bush you are done. Lets say you change that dynamic and you decide to get health care in a hospital. Unfortunately that hospital doesnt have infection control. When you are infected with theou bali become a virus factory. If your immune system doesnt kick in when you have the most possible viruses in your body when you die. You go to the hospital because you are sick and you dont have were then when you die. I can give you attend with lots of big numbers around and hundreds of millions and billions. Here you are sick and dying in the hospital and someone has to wash their hands as they go from patient to patient. Whats going to happen quick to spread ebola from patient to patient. Hospitals have always served and we have known this for many years as a reservoir for how these diseases spread. Somebody sick at home and you are the Family Member<\/a> taking care than you are at risk. They died unfortunately and then you decide to wash the body and kissed the body hug the body and invite the loved ones and one of the practices we saw during his Ebola Outbreak<\/a> that they would wash the body needs out water to allow people to wash their hands is one of the attributes of the sainted gerson who had just died. This is not a good idea, okay . Lets admit that. We know the science but the sciences and the issue. When its outbreak occurred a think this was the 24th or 25th or Something Like<\/a> that in 1976. Many people thought this is going to be like what we are seeing in africa. To shut them down within a couple of days and have a system in place. Teens russian and they dont need International Teams<\/a> anymore but the locals know exactly what to do. They rush in and test everybody and they follow everybody who is potentially sick and they get rid of the outbreaks rather quickly. This outbreak no one had seen before it spread to urban areas in large metropolitan areas. The thinking was oh rush in and take care ofk everything in this Ebola Outbreak<\/a> will go away. What happened . Thats not what happened at 11,000 deaths and every one was a needless death i would say and an inadequate response, Global Response<\/a>. Politics in our Public Health<\/a> system played the biggest role in whether or not this goes with a handful of cases or small outbreaks and whether or not but we had was essentially an aepidemic across west africa wh cases across the world including us. Ne we know what happened here in United States<\/a> but are the reasons we have that in United States<\/a> is the social political factor that plays into Infectious Diseases<\/a> that we didnt have an 1800s. How many people i want to ask. Ive read around the world in 80 days. How quaint, 80 days to get around the world. For 22 years i were Public Health<\/a> y uniform and on my publc health uniform was an anchor and i would be asked about the anchor on the Public Health<\/a> uniform. Its very much like a navy uniform and the results like like navy uniform we started 200 years ago providing care to merchant marines. One of the chores of the public hhealth service was what we stl have the working flag when a ship came into port. If its going to take you 80 days to go from point a 2. B by the time you show up in the port of new york city we knew if you had smallpox and we knew he had yellow fever because the division. The time it takes to get infected to manifest in the system was only shorter than the time it takes from going from point a 2. B. You can go to your mothers funeral in liberia and you fly to liberia and go to your mothers funeral engage unusual act that you went around the funeral. Your mothers died in your kissing her and hugging her and the next day you get on the plane to amsterdam to new york city. That is 18 to 24 hours and maybe 40 hours incubation period of five to seven days. Its three days after you show up in new york where you go you know what, ive got a headache andng i have fever and im not feeling well right now. You show up at a hospital thats a good hospital and the number one diagnosis will be malaria. One, two and. If its not malaria and they missed it its easy to see how you could hospitalize forr something and it spreads in the community. We saw this in texas and is same scenario. Someone showed up and infected to local nurses. Our Health Care System<\/a> is not better than what you see in toronto when they had the sars outbreak in singapore when they had their sars outbreak or hong kong. I do spend some time in sowell and soul might have an outbreak of murders and again excellent Health Care System<\/a>. Excellent Health Care System<\/a>s but they are not ready for patients to commence a travel is played a big role in how these diseases emerge currently. I think im giving you a sense of why you hear about this but what we can do to make things bettersp round social political aspects of protecting people. I did want to spend a couple of minutes to talk about you at the Carnegie Council<\/a> that ethics matter. An observation which i get recognized my whole life so the thing about hiv is often a marginalized population but as i started to write the book it dawned on me how when ill most every chapter you pull out the marginalized population for merging infection could think about coronavirus rates of disease passed through roaches in the southwestern United States<\/a>. Some of you will remember when the coronavirus outbreak occurred in 1990s there were group of young navajo kids who had come to d. C. For capitol to l her and they were denied. Oh you came from the southwest and you could be infected with coronavirus so there is nothing we knew that said these kids were posing a threat but it affects marginalized populations i have talked about hiv and a little bit about ebola and the marginalized populations in west africa and in todays day and age we are talking about zika or the marginalized population of pregnant women in brazil. Brazil has about 1. 1 million cases and i think they are calculating now the zika virus and over 1500 women who have been infected and their babies have gotten congenital zika syndrome where they get small brains and other Developmental Disabilities<\/a> including hearing loss and vision problems. Have learned now is because essentially a laserguided missile to neurons. It looks for the neuron cells and it goes to the neuron cells. Its not just true in babies. Iewhen zika was first describede were told about 20 of people will get sick and if they get sick they will get a fever and a headache. They will get red eyes and a few days theyll get better. Quickly became clear that this was a problem for pregnant women. Now we know even for adults because of this laser like focus on neuronal cells we have this disease and this is under a logic illness that causes weakness and we also know even in a healthy person zika virus can cause brain inflammation and inflammation of the coverings around your brain. And what are otherwise healthy adults that are not i pregnant this virus is a problem. This fire shouldnt be a problem. Thes viruses spread by a certain kind of mosquito. Its the exact same mosquito that spreads yellow fever that causes 30,000 deaths a year and the exact same mosquito that spread dengue and if we were having this conversation five years ago we talked about this large thingy outbreak thats occurring in south america. Dinghy causes 30,000 deaths a year something around that. This is the same exact mosquito that causes virus the big thing in the news two or three is ago. It didnt cause any deaths but because of the failure since the 70s to keepor up with these effortss to decrease mosquitoes and not paying attention to the people dying from yellow fever and people dying from dinghy now all of a sudden we are all up in arms. Oh we of the disease to be a jedi that seems to be infecting pregnant women so if this lack of action over the last 20 to 50 years against a known threat that has put us in this current position. If you happen to be in south america these days i heard yesterday that zika is not just mood throughout america but its no essentially knocking on the door of africa. Im next, you are next. Think about whats going to happen if this virus sweeps through africa and to pregnant women they are in africa. Barbara chen who is the head of w. H. O. , brilliant woman who has done some amazing work and did time in hong kong has an major policycy failure over the last 0 years in addressing the mosquito. Although she brought it to talk about major policy failures as we think about protecting women. Its a big issue in brazil and other places where they dont have the same sort of contraceptive device that you take for granted in the United States<\/a>. Why did it take all this time people dying of dinghy and people dying of yellow fever who all of a sudden say we need to Pay Attention<\/a> because now we may get cases in europe and in north america of women who may have this disease. We will see zika in the United States<\/a>. Hopefully we will not see a lot of cases but we will likely see it. Let me, thank you. You gave me a lovely comment the other day. The ethics of r a delayed response. I think this goes back to some of what you talked about here amongst your audience. If you think about a marginalized populations why do we see these delayed responses . We are seeing it today. The story for the last couple of days is a conversation thats probably a conversation between lets protect the United States<\/a> against zika and nobody can decide whether they want to do it and how much they want to pay for it. I often get asked should it be 500 million the Congress Wants<\/a> to givegr our 1. 9 that the president asked for or the 1. 1 from the senate. I dont care what it is prepaid in number but why are we having this conversation six months later . We know whats going to have been pretty also know mosquitoes control deniedve state is not a federal function and snotty but a state function princes city county and district function and you need to get the money out of these people so they can do what they should be doing which is eliminating mosquitoes and making sure they identify cases. Hopefully would be a vaccine strategy to protect women and are we funding vaccine development. Why are we still having this conversation six months later. Why are we not doing that and why are we robbing . Peter to pay paul . We are responsible for keeping americans safe from all Public Health<\/a> threats no matter what the nature weathers a pandemic Natural Disaster<\/a> biological chemical terrorism and its my passion is for the Public Health<\/a> Preparedness Program<\/a> which puts money out to help pay for the zika response. We essentially pull back some of that money to help support some of the goodies and other places including puerto rico where they party had 11 cases. Why are we taking my analogy taking the bricks of the foundation to build a second story of the building. Why are we taking money out of that for Something Like<\/a> zika. We should be putting money into the preparedness infrastructure and what i will leave you with is the number because im all about determinable measures. 27. In last three years the foundation has been doing great work looking at how prepared the United States<\/a> is for Public Health<\/a> emergencies. Every here it gets a little bitt that are and thats 6. 7 out of 10. Thats just not good enough for us here. We really want to make sure americans are protected against the Public Health<\/a> threat as far as im concerned the responsibility of the government is to protect us against threats and that includes Public Health<\/a> and Health Threats<\/a> and hack and we make sure. Im old enough not to realize its not always about the science but maybe sometimes we need to be the politics and thinking about the health needs of our population. Thank you. [applause] that. Was fascinating to do seems so calm. What keeps you up at night . [laughter] i think im calm because i decided 20 years ago that fear is not a Public Health<\/a> strategy. I know it makes for great press that the sky is falling but really its about education and good science. What keeps me up at night is what the next pandemic is likely going to be. The zika is a pandemic that say but its not causing hundreds of thousands of deaths. What is likely to cause hundreds of thousands of deaths, we are to know that from 1918. Wero did a repeat of 1918 so thy get the flu every year and im good to tight right now my Public Health<\/a> message of the day is to get vaccinated. We get the flu every interchange is a little bit which is why we need to do a vaccine every year but unpredictably the flu takes up its overcoat and all of a sudden you have no protection against it at all. If we repeat the same thing we saw in 1918 today 7. 5 million americans would die. 2. 5 think about the body bags and how would disrupt our society. So the fluet keeps me up at nig. Mers and diseases like mers keep you up at night. Ive seen these health system. Our Health Systems<\/a> are Getting Better<\/a> and our ability to respond is Getting Better<\/a> and part of my job in nebraska was helping hospitals get that are but we know we have infections in nine states so i worry about mers and a third example and i will stop at the third example is the next aids. Hiv aids and nowadays you think of it in terms of sexual behaviors or i. V. Drug abuse and that gives you hiv aids but lets remember hiv aids is another one of those diseases they that came from nonhuman nhimates probably multiple times and at one time is the right one that made its way to humans and it spread from humantohuman. I worry about another viruslike that spreads through sexual transmission there are some other mode and has a long incubation period before you get sickened by the time discovered it spread widely. Those are some the things that keep you up at night about what the next pandemic could be that would have been morbidity and mortality. Thank you. We will have a discussion when i call on you please introduce yourself. See mixes in. I was too fascinating especially in the morning but we have to be concerned about what can be done and here you are the most experienced so the question isst first of all what is the cdc doing to educate people and control the disease is and as soon as theres an indication that they might be serious and on the other hand you are now in nebraska. What is the difference between control measures in an agricultural relatively small population and washington or new york, the large urban areas . How cano the u. S. Do more in the cdc do more to prevent these outbreaks . Thank you very much susan. Thats an excellent question. How we can do more starts at multiple levels and it helps so lets start with something very simple. Health care acquired infections and drugresistant microbes. The paper came out last week that suggested one third of all the antibiotics we are using are not necessary, one third. All the antibiotics we have been using it that are necessary but as a patient when he talked of patient and talk to your doctor you are powerful to say do i really need this antibiotic and is there something we can work out for couple of days and it doesnt get better should take an antibiotic that you have that power. You have that power when you walk into a Health Care Facility<\/a> and a doctor or a nurse or respiratory technician walks in the room and says he remember to wash your hands . You are powerful. Do not forget that. You have the power within your committee when you think about personal preparedness issues. Lets say a pandemic friends to your community or a Natural Disaster<\/a> runs throughhr your community, are you prepared personally for that . Not just in termsn of having the kids in your home and being ready but are your vaccines uptodate . How many people in todays cell phone age noted your physical member. If somebody asked for her phone number what do i do . My cell phone dies its not so good. In terms of numbers. In my part of her Response Team<\/a> within the community . Have i taken a cpr course of something bad happens i dont need too call 911. I can take care of something small myself to help somebody out pretty in my blood donor . There also do things they can personally do and that things we should expect from our government. If tomorrow morning in new york city we decided youed know what lets lay off half the police force. My guess is you think Public Safety<\/a> is so important but the same thing is happening to your Public Health<\/a> safety workforce here in the United States<\/a>. Nobody is tarring and feathering anybody when you can score 6. 7 and how prepared your community is or your status. Demand is the same thing from your local representatives and frthe national representatives. You want a little less politics and what is happening. Why are there still 30 million uninsured americans in the United States<\/a> right now given the fact that we passed the Affordable Care<\/a> act. There are 19 states so i think you are powerful and you need to expect more and ask for more of every level including your own level. When i was at the cdci did a tongueincheek thing about the Zombie Apocalypse<\/a> to get people prepared for a Natural Disaster<\/a>. Somehow they werent paying attention to the realm Natural Disaster<\/a> but you mentioned zombies everybody wants in know what to do with zombies. Dont ask me but we took a popular meme and converted it. One of the things i did do the one thing you cant do is outrun them so please make sure you stay personally healthy so you can outrun those o zombies. Its something you can personally do. Whether i happen to be in nebraska and an agricultural state or a happen to be in washington d. C. With greater isk of importation of diseases from international travel. We need local Public Health<\/a> entity needs to take the appropriate things into account including for Climate Change<\/a>. We are not coastal but if you are close to what is that implication going to be for flooded Water Supplies<\/a> and things like that . Thank you. Island university. New scientist reader and i remember in article, opinion piece years ago to the effect that only silent springs publication had been delayed for about 3 years and if ddt use had continued for another 2 or 3 years we wouldnt have malaria and, y ali we would not have malaria if it wouldve continued for a few more years. You stressed mosquito control. I was wondering what your take w that thesis is. Ali so we need to use every tool available to us when i think about mosquito control. We are fortunate here in the United States<\/a> to actually the cdc, is one of the only federal agencies outside of washington. Lewis took me a while to figure out why that is the reason is because ofal malaria. Used to be in the southwestern unUnited States<\/a>. There was a program that and what was happening as we were send our troops down to be trained and they were being affected with malaria. There were getting ready for war and getting infected with malaria. So the program was set up and became cdc. In the malaria was quickly eradicated. In 1945 or 1946 priscillas look at it right now. So there in the texas border, and due to the mosquitoes. We dont see them in the United States<\/a> only in mexico. Says through the screens and air conditionings actually. So when we think about what does it take to protect us, we need to use every tool available for us pretty over the mosquitoes, its about killing the but baby mosquitoes. And killing the adult mosquitoes and then its about reduction which means no find the sources of waters out there and then get rid of it. We need to think about every tool that is available to us. And people are thinking what is the right tool for the right area. Where the mosquitoes resistant to and what are they not resistant to. Thank you. Doctor, as you know the number of societies have had in a resistance tote certain n certan Animal Protein<\/a>s. You make the connection that theres a lotee of connection between these viruses that come from animals. Henneman studies to show that societies have the presumption of Animal Protein<\/a> is limited or not it all. The ability to resist these illnesses. To be able to take an antibiotic and have an effective. If theres awe connection betwen our presumption and the likelihood of our continued ability to cope with the consequences of these viruses. I was wondering if you could comment on that. Qali it is naturally very excellent andnt extremely complex questio. I will break it down into two quick thesis. We do know the people have predominantly vegetarian diet do do better. Their wellestablished at this point. The other issue is around the infections in the really has to do more with the contact that we have to do with animals. When you think about it, and i say this all the time. I get challenged about this. If you just heat it to the right temperature, there is no risk. You shouldnt be eating burgers that are rare anymore. So the risk, not from the conception because all you have to do it is just heat it to the right temperature. He comes from the daily you have with these animals and touching them in the routine set of interactions. Even if youre not eating them coming milking them and keeping them in your process. That risk is there. In the same with a foul pretty well cooked chicken, or filethif chicken will not kill you but handling these chickens that have in the chicken poop, could eventually and will eventually kill you. Guest Marilyn Matson<\/a> from cornell medical college. I appreciate the clarity of i appreciate the clarity of your presentation. One of the things that came to mind was the delay in the identification and response to ebola. So my question really is what does the cdc do to try to increase collaboration with countries and the Health Departments<\/a> around the world. And to begin to do something about early identification and response and then something maybe about the World Health Organization<\/a> in terms of whethes it plays a part in this area. Ali is a great question which leads back to the earlier question about what can you do. So the u. S. Government has embraced something called Global Health<\/a> security agenda. So should week. That is a way for us to work with countries internationally to make sure they have the right tools and systems in place with an early diagnosis. There is number of countries that have bought into this including who remember, is the Technical Agency<\/a> that does this work. In the cdc has people all of the world to help with this. But who is a global mandate to do this. They are the World Health Agency<\/a> and they have been very introspective and have recognize the failures of ebola and what happened. Especially, not just the failure of Early Detection<\/a> but six nine months that causes International Public<\/a> event. To say oh my goodness this is a problem, in the spring of 2014, they misread the data that they thought that everything was better. But it was a little before things got worse. There a complete reform process to be able to respond to these emergent infections including for the first time, putting some things to actually go into new country assessments. And the world bank is setting up a new brand nail Pandemic Response<\/a> fund. Ive a story in my book from a really good friend of mine who was asked to come to respond to the Ebola Outbreak<\/a>. Any of the resources to do so. He had just a handful of cards and some dollars. In the really good sense of resources. So we cannot afford for now break to get out of control the somebody cant get their hands on a couple hundred thousand dollars. They have to go put some systems in place and some hospitals did. Guest one of my clients has city sent out mosquito inspections. In the put up traps pretty new york cityew is actually looking for mosquitoes. You mentioned the political aspect of the health situation. We have two candidates that are i think diametrically opposed a number of health issues. More interest care for many people and also on the issue of womens reprinted active rights pretty my opinion, all peoples rights. Everything that happens to family happens everybody in the family. Could you comment little bit of this issue in a way that this affects the political outcome. He ali you know im a Health Personnel<\/a> politics person rights. [laughter]. I opened the door. I will look for the expertise in this audience for the answer. New york is my home. I grew up in brooklyn. I went to college. And i realized i could leave. Actually have a hard but i never going to the city. Everything what is in brooklyn. [laughter]. Signed a little bit about the city from having grown up here. But mosquitoes, you are very fortunate in having some of the public best Public Health<\/a> practitioners here. In 1999, it wouldnt start, the nile started right here pretty soon a lot about it. West nile is another good example. It belongs in the west nile pretty does not belong in new york okay. Another example of a disease from somewhere else. They decided america was home. We need to help individuals as we make choices about who we elected support in the office. And for people who say health is an important factor. You are much more eloquent about this than matt i could ever be. His and everybodys right. Its not just pregnant women and we to make sure the women have the rights. And were talking about brazil, and the united t states. A lot of things are going on across the United States<\/a>. So we need to make sure that women do have a full set of rights. Guest i want to ask a question about the developing global problem and also potential developing response to that problem. In the problem of course is refugees. And i will just leave it at that. As far as the Global Response<\/a> is concerned, i think one of the things that have been overlooked is the role of pharma. And the lack of incentives in the pharmaceutical business. For responding to these kinds of emergencies and to make a really wild suggestion that perhaps this time pharmaceuticals to be considered pretty much as a public utility. But the military, like the water system. I also like all the other things that we got. We take item for granted. And then are not incentivized. Ali thank you. I assume the refugees was an issue to Infectious Disease<\/a>. So my comments and that always is, ias know people in terms of what risk do i have in terms of refugees. I like to read from that into a week protect the refugees. I will make sure, i dont get the measles. As a horrific disease. So what are we doing to make sure that the refugees are protecting themselves pretty we dont want people to have it so how do we make sure that they are protected. And in screening and processes to make sure that these people are protected. So actually, people recognized this problem for a very long time. So i will bring it to you, so the stories about anthrax. There is zero incentive for anybody to build a medical anthrax. Nt gets oregon smallpox. Something else that worked on pretty u. S. Government actuallye established a biological advanced research and Development Agency<\/a> that specific persons in the department of health and to make sure that somebody understood how to work with the big pharma and make sure that we have these excellent product that now are available to us against things like anthrax. We haveen a note small fox disee estimate decides to reengineer and make it in the lab. Some are available to us but youre right, its a challenge. How to make sure that you continue damage drugs available for these bugs that just gets smarter and smarter all the time. Thank you. Guest he addressed the biological threat issue just now. I was going to ask you about that. Im just like to thank you for an exciting journey took us on this morning. [applause]. The book is available free you. Traffic thank you. [applause]. [background sounds]. [background sounds]. Youre watching a special addition about to be. Airing during the week while members of congress are in the district due to the coronavirus pandemic. Tonight, the presidency, first u. S. World reports can. Looks at how different president s have handled prices. And former second lady, lynn cheney and former president ial reflect in the george w. Bush administration. And later, eight Vice President<\/a> who became president to do the deaths of their predecessors pretty good book tv, now and over the weekend on cspan2 read this weekend on book tv, saturday at 6 00 p. M. Eastern, richard former director of the Consumer Financial<\/a> Protection Bureau<\/a> read. Is about consumers the process they face and how the finances change and its about the new Consumer Financial<\/a> Protection Bureau<\/a> and the role of the person work that does to protect people across america. Former trumpet ministration National Security<\/a> advisor. The United States<\/a> free and open societies emma we will do everything we can to protect ourselves against the efforts of the china for free market economics. In our democratic form of governance. At 6 20 p. M. , ruth author and City University<\/a> of new york professor on mass incarceration in the u. S. The fact that most people leave prisons, do a little bit of analysis to see that we could be closing prisons already and joels already if we just got bite two weeks in three weeks and four weeks much less years, the kinds of sentences that people are starving. Watch book to be this weekend on cspan2. 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