The Afghan Government can stand up and be the ones that take care of things in afghanistan. I just want to add something to love this. When i saw the book, mrs. Bush, i am honored as always to be around you and im thankful to the u. S. Afghan womens councils. They have done an incredible job. When i saw the book, it reminded me, took me back 14 years ago. I want to read something to you. The honorable mrs. Bush, i would like to thank you on behalf of afghan men and women for all the work you have supported and the care you have given the afghan women and children. You even went to pyongyang. I went to those days. I gave my first speech in chicago in 2004. 400 americans is as men and women have had to convince many leaders with my speech to believe in afghan women capacity and to fund for the project. After a long speech, i ended with the following sentence with a lot of hope. This is what the afghan woman says. Still after her pain she says i feel like the thunder, the dark days and the storm has left. The sun is up now. I just started blooming like a rose. The rose needs tender loving care to fully bloom. I do not want to die again. Mrs. Bush, through your leadership, you played a major role in water in d. C. By building capacity and today you have recognized a few of the blooming flowers in your book because 14 years ago it was not possible. [applause] eggs, everybody. On behalf of all of us here today on behalf of the u. S. Is to to to peace sent want to thank mrs. Laura bush, ms. Mina sherzoy and of course mr. Steve hadley, our chair. Thank you for my death after 37 years of war it will take a long time to fully emerge in the conflict but that there are extraordinary sense of progress and much of. Thank you for your collective passion and inspiration this afternoon as we look at the pathway forward. Mrs. Bush, special thanks for what youve done for afghan women and women around the world and thank you for bringing this beautiful powerful stories to all of us with your wonderful new book, voices of hope. Its been an honor to host everybody today. I want to ask everybody to please stay seated by the panel departs stage. Please join me in one more round of thanks and applause for her wonderful panel. [applause] [inaudible conversations] [inaudible conversations] [inaudible conversations] welcome, everyone. Im rebecca doing him from the university of virginia and im absolutely delighted to be moderating this panel today. Two journalists and authors who are both currently living in alta more i know of come down to share yours or his wife asked. We are going to be on a tight schedule which i am responsible for keeping. We will look forward to about 15 or 20 minutes presentation from each author and an ample time for questions. I would like to request that everyone silent their cell phones. I would also like to comment initially think im so excited about the panel and the other events, like to remind everyone that the virginia festival of the book is very pleased to keep most events very and if youd like to help with that, please consider a donation. The request is to please evaluate the session. The festival is always working to improve its offering. Finally, we will have books for sale here and in local bookstores throughout the festival and we hope youll be interested. Without further ado, i would like to introduce sonia shah to my far left. Sonia shah has written the book under discussion today, pandemic as well as other books. She is a prizewinning author and science journalist. Her work has appeared in the new york times, the wall street journal, Foreign Affairs and she has announced and made ted talk on eliminating malaria if you want to take a look at that also. She focuses on the intersection of science, politics and human rights and will be discussing her new books with us today. We also have stabbed to, who is a former political reporter for the Washington Bureau of the Houston Chronicle and she actually left newspapers to pursue an interest close to my heart and the hearts of many in this room, microbiology. And she won in 2005 the u. S. Center for Disease Control and she has a masters in journalism from the university of maryland and also a masters in science writing from hopkins where she is now a teacher of science journalism. She lives in baltimore with her husband and twin daughters who have believed just joined us. We are delighted to have you here. Again, welcome. Please are member to keep the cell phones quiet. I know we are going to have a fascinating discussion i would like to turn the microphone over to sonya. Hi, is this on . So what i wanted to do with this latest book, this is my fourth book and i wanted to look at how it is that microbes, which are these little microscopic things that have no independent locomotion cause these highly as deadly events that we call pandemics. Over the past 50 years weve had about 300 infectious pathogens that if either newly emerged or reemerged into new places theyve never been seen before. Ebola in west africa never seen before. We have zeke a virus now, has never been seen here before. Novel kinds of Avian Influenza, mosquito borne illnesses, tick. , highly antibiotic resistant pathogens. What i tried to distract the origins of the same from what i found is a lot of them coming out of the environment. About 60 of the pathogens come out of the bodies of animals. Over 70 come from wildlife. What is happening is that their populations expand from industrial activities expand, we are disrupting and they demanded destroying a lot of wildlife habitat. This means we lose a lot of other species. The ones that remain come into closer contact with us and with this novel intimate contact allows the microbes that live in their bodies to spill over into our bodies. So from bats they got ebola and marburg and nico virus. For Brandon Smith got monkey pod , bone disease. For monkeys and chimps for monkeys in chance they got hiv, malaria, probably zika virus. Influenza, et cetera. These pathogens are moving into human populations and allowing the great opportunities to amplify in our cities. The process of urbanization that first started in the night in century is really reaching its peak now. By 2030, the majority of the human population will be urban and we are going to be living in giant adidas. They wont be cities echo of a charlottesville. Cities like when rovira and free sound. A lot of ad hoc development. A lot of slums. Poor infrastructure. Weve are to see new pathogens take advantage of this. Ebola is a great example where it had Ebola Outbreak since the 1970s but they were always rather small and selflimited. One of the reasons why it is those viruses never infected a place more than a few hundred thousand inhabitants. What happened at the end of 2013 is ebola virus emerged in kidney and within a few weeks was able to reach three Capital Cities with the combined population of nearly 3 million that is an important reason why it became such a huge conflict where we lost 11,000 or more people. More people died in the outbreak and all the previous Ebola Outbreaks combined. Similarly, zeke a virus since at least 1940s, possibly before that. It was in africa and asia, carried by a mosquito that mostly good animals. So we didnt have a lot of infections in humans. What has happened recently is zika virus has arrived in the americas for it is a fixed and in urban populations in tropical areas and that means we have massively asked any territories of this mosquito that thrives in cities. Philistine human garbage, can breathe and a drop of water. All of our plastic garbage, little rain gets in them and this mosquito is a very efficient carrier of diseases because it only bites people. We are not only crowding our cities together. They are also crowding animals together. Its not just about people. Its also about livestock. Now we have more animals under domestication than the last 10,000 years of domestication until 1960 combined. This is because our populations are getting more wealthy, getting bigger and as we do that we demand more protein than me and our diets. A lot of animals are living in the equivalent of slums. So we have 2 billion People Living in slums by the year 2030 but we are to have value for millions of animals living in slums and those are direct arms where we have a million or more animals crowded really close together exposed to each others fluids and excreta appearing this is one reason why we have one increasing the of Avian Influenza. These Avian Influenza viruses are moved to. They dont make google sick at all. They are fall captive chickens and birds. They can replicate really quickly. They can spread faster and often become more virulent. This is why weve seen increasing frequency of these Avian Influenza emerges world the wild flowers live. Besides her dancing way too fast. Is there something we can do about this . We are about five slides ahead. Thank you. This last one last year we had avian and walesa in the giant Poultry Farms reached north america for the first time, cause the biggest outbreak of animal disease in u. S. History. We are also getting this is what happens. Thank you. Technical my goodness. There we go. We still have a sanitary crisis of human waste and our planet right now. With 2. 6 billion people around the world with no access to modern sanitation. They are still living in the equivalent of 19th century slums. But we also have now is a new kind of sanitary crisis about livestock excreta. I livestock are now having 7 billion tons of waste every year. This is far more than croplands could possibly absorb. Farmers are collecting them and things like this, essentially giant of mind. If untreated animal waste. So when it rains or winter storms, and this is one reason why we have an increase in problem with fear that forms of equality. There is history and producing a call live with one half of all cattle are infected with this. Doesnt really make the cows sick but because cattle manure contaminates so much food and water, we have about 70,000 americans coming down with his derelict form of e. Coli every year. So we are driving these pathogens inter populations and then of course would carry them around at the most efficient way possible which is through our flight network. We dont have just a few airports in a futile thing they have hundreds of airports in small towns and cities and hundreds of thousands of connections between them, which means that a pathogen breaks out in one part of the world that can rapidly spread to the rest of the world as a simulation of a flu pandemic on a graphic map. You can see how quickly it disperses. If you plot the same pandemic on a map like this, which is all the cities connected by direct flight, you can see when it comes up that it will resolve into a series of ways that you can actually predict where and when a city will get infected by looking at the number of direct flights in effect been infected cities. Besides theyre going fast. So one of the things i did in my book is not on the reporting to look at where emerging pathogens are coming from and i went to haiti and south china and new delhi and elsewhere, but i also looked at the history of our most powerful pandemics. The one i focused on la scala road because its one of our most successful pathogens that cause seven global pandemics and the first emerged in the 19th century. We think of cholera as a disease of poverty and it is that today. When it first emerged, this s a map of epidemic in 1832 of cholera in 1832. Dozens of people died in this happened again and again over the course of the 19th century. It wasnt just new york city. London, paris, new orleans, and Member Service are played by the 19th century. What i wanted to look at how it was responded and how that could shed light on the challenges we face today as we face our road era of new pandemics. Back in the 1832 we can show that. Doctors collected this data. It shows a pretty clear picture. Coming down the hudson river, an area canal heading straight for new york city. However, nobody in the city of new york want to quarantine the rivers. This is the engine of economic growth. This is the time of the robber barons huge amounts of commerce coming down waterways. They refuse to quarantine the rivers. Just make it stay there. I dont know how to do it. My powerpoint wants to give you the taco bias tells. Its very annoying. They didnt want to quarantine any of the waterways. And they didnt. Doctors went along with this. Looks like they come down the waterways, but in fact its not. Cholera is caused by stinky errors by decomposing matter and organic material. This is based in a 2000 old hippocratic theory. They said its not the waterways. You know whos to blame . Its the poor, the immigrant, the drunks. Koller came down the came down waterways and affected new york city again and again over the course of most of the night and century. Theres actually companies that were making money selling can terminate in water to new yorkers yorkers in the 19th century. The epicenter, the epidemics of cholera in europe at the time is pictured here and this is a slum that if anyone has a number of film gangs of new york, that was about fivepoint. Very crowded, about 77,000 people per square climate or an six times more crowded than tokyo is today. Islam had been built on what was once a pond. The pond had been filled up with garbage and then built on top of that. There was a new sewer system and make century new york. Theyre one of the girls who had full text the human waste is allowed to spill over into the alleys, into peoples strike in water, and down into the groundwater. Of course in this area the groundwater underneath in particular would be extremely contaminated because the ground underneath the slow line, filled with garbage. It wasnt bedrock like the rest of manhattan. The company that the state of new york chartered to deliver Drinking Water to the people of new york rather than cap onstream sources of water which they knew at that time would be cleaner, fresher and taste better, the cap do well in the middle of islam. They delivered back to one or that the residents of new york city and they did it over the course of centuries through repeated epidemics of cholera. The company that did this because they want to save money. The reason they wanted to save money is because they wanted to start a bank and the company the bank was called the bank of the manhattan come to me. Does anyone here know what the bank of the Manhattan Company is called today . Jpmorgan chase. Yes, thank you. So all in the story just by telling you how cholera vanish in new york city because its as sharp as. Eventually new yorkers moved from there to have their in the river. But they didnt do it because they wanted to upload the Public Health. They didnt do because people were screaming for better water, which they knew would make them more healthy. They did it because the local brewers want a better tasting water for their beers. They felt like they are putting them at a disadvantage to the brewers in philadelphia. Finally they moved the water intake and vanished in new york city after that. I century pandemics and it can spread throughout the country and throughout europe as well. The question i have this of course we can do a lot better today in our era of emerging pathogen. This story to me says its not as if theyre really a matter of type allergy. Its about whether we have the political will to do it. Thank you so much for listening. [applause] now we are going to welcome karen masterson, author of the malaria project. Im going to switch with you so i could manage the pc. [inaudible conversations] i came to Global Health issues by accident. I was actually a political reporter. Both environmental reporter for that for the philadelphia inquirer. I was looking for Something Different and stumbled upon records that talked about how researchers during world war ii and affected hospital patients with malaria so they could test new drugs on them. This was shocking to me and i couldnt find a whole lot of historical treatment of this. As i kept pulling thread and searching through boxes in the archives, i realized i was in uncharted territory and had to tell a story. I didnt know much about world war ii, malaria, bioethics, but i got up to speed because this is a fascinating story wanted to tell. I wanted these sites to be deleted because i is 65 tear for 15 minutes. The boxes look like this. The records were stamped top secret because its a secret project. The World Without war and nobody had a good malaria drug before normandy, if you had a weapon you have a leg up on all the battles. Our government, the Roosevelt Administration to open the spigot for this project by 50 universities, most of the American Drug companies to come together and find a bomb the wartime science project including the men had project. Their reports were that can be published so they were red dyed the lead investigators in the end to John Hopkins University and there they meant every month so they could compare notes. I figured out how to not be totally judgmental of the scientists who did this work. I was taught that by this man, bill collins and i got to go down and sit next to this band and listen to his story. He had been around long enough to infect State Hospital patients with malaria so you could study the disease and test drugs on their infections. The problem that was you couldnt go malaria in a petri dish. It was the mic back. You have to have live infections and as malaria dried up in Northern Europe and the northern states of the united states, it was hard to come by. If youre infected people you could study it and he called those the good old days. I said you know youre talking to a reporter, right . The u. S. Is here. Those are the good old days. Now he had to infect monkeys and they were difficult and live and they try to bite him the monkey malaria can extrapolate all that well and they had to run all the new vaccine studies off on this monkeys first. So he had a roomful of archives that no one had ever seen before from world war ii and the years immediately following world war ii and he used the Data Collected from this and occupation to inform todays vaccine researchers, the data they had remained valuable to this day. He had one of his colleagues. He got me thinking like a malaria allergist here they came to the store with a little bit more objectivity and not as much judgment. This is a side taken from an american soldier during world war ii. This is the blood stage of malaria. The parasite interested in mosquito bite and call them shape shifters. This is a shape shifting parasite. It immediately gets into your liver and incubated them near mint system until its ready to launch an attack on your red cells. When it does that, your red cells and up looking like this. When you have trillions of these you get thicker than youve ever been. It is a terrible, weeklong infection. At some point when you are feeling the most, some of these parasites mature and they become distinct, migrate to the surface of the chemical that attracts mosquitoes. The mosquitoes drink them in and the mosquitoes a week or two later depending on temperature first into these microbes they get into the saliva and then they infect again. He was called economy to support in the 1950s. Before the war he was a malay expert. You start out as a graduate student as part of a Large Network of americans come american researchers trying to get a handle on the u. S. Pandemic mueller. The infection rates were 80 . He worked in places to look like this with a cypress trees were being ripped up to keep up with development in the northern states and southerners were left with these holes of lara producing swamps that filled the skies with mosquitoes that carry malaria. Throughout the course of 1920s and 30s he worked, this is some the darling, the brains behind the effort to build the panama canal. Samuel dorling was responsible for leaking malaria which, the american attempt to build the panama canal come and next is paul russell, you know him, one of malaria is most favorite sons. Through the new deal, antipoverty programs, building dams in a way that eliminated mosquito larvae instead of reducing mosquito larvae, wringing electricity to the south. Fans and air conditioning and attracted industry which brought jobs and people could get into homes with screens come essentially by 1940 most of americas malaria had completely dried up. While were working on malaria, this man won the nobel prize because he figured out how to give malaria to nurse athletics and cure them of insanity. In 1927 he won a nobel prize because syphilis was rampant. The late stage of syphilis is an infection in the brain and causes erratic behavior and the same insane behavior. He figured out he gets is about 30 if he gave been malaria. Malaria fevers, he can control them with quinine, would increase the bodys immune system to a point where it could fight off that difficult stage of syphilis which gets into the brain. Because you cant grow parasites in a petri dish he kept those trains going by taking blood from his infected patients and getting them to patients. This became the new way of treatment. State hospitals all over the world picked up this come if they could afford it, but if you are lucky you could take malaria the end you could potentially be cured of the. This was a major breakthrough. He is only one of two psychiatrist to win the nobel prize in medicine in history. The germans were clever. Mccandless were going to come up with a synthetic drug for malaria very clever they said we dont need to go into our studies in africa and in places where malaria is endemic. We get to study the disease, test our drugs. Behr came up with two potential drugs. The die attach it to the parasite. Bit at a site change that is leading to the parasite, carries the drug to the target and wiped out the infection to the old problem they were pretty toxic drugs so they never broke into the market. Quinine was the only drug made from the bark of a tree that grew on plantations that the dutch have a monopoly on. The world just kept using quinine. This is one of the leading malaria colleges in germany to read some of these studies for behr and he said why stop there . Why not run these studies on prisoners . We have t defined a drug so he wrote a proposal to do studies on parishioners. Lets give the drug and test the drug consider it out is a great idea and gave him a concentration camp were infected a thousand oppressors. Most of them were russians. The parishioners got an extra ration of food and a slept on clean sheets, and they were given the feverishly to test their drugs and theories. And then given quinine and then sent back to the barracks where they died. This is him trying to explain to american lawyers who liberated the camp it is just doing malaria therapy, that is a Standard Company wasnt doing anything wrong and you understand malaria therapy and he hanged. Meanwhile, back before the war now, and he knows other leading malariologist in germany any knows theyre working with behr and testing their drugs on State Hospital patients and making some progress in building drugs. He comes up, he masterminds a plan for the americans to do the same thing. He temporarily is sidetracked to africa because an air route we had created to supply the british in egypt and the russians with guns and planes was completely shut down because of malaria in west africa. So that supplies started, were flown out of miami down to brazil, across africa and then better stop because the airfields, the workers were all completely infected with malaria. The u. S. Air command asks if he would go over there and cleaned up the he got there and he found this. He found airfields building carved out of the jungles and creating massive mosquito production, massive mosquito breeding. This was the reason why the pilots and the mechanics and construction people are all getting malaria or he had quinine but he realized under these conditions it didnt work. He had the german drug. It didnt work. He tried to screens. You guys will roll down your pants, roll down your cities, you where netting over your helmets and to those of you building you will wear a spray. He had sessions every day. He made education the most important part of what he did. He told them if you go to the sex villages he have to go during the day, not at night because the malaria carrying mosquito bites at night. And in the course of six months, the infection rates in liberia were about 100 about 50 , they were brought down to 1 . He was completely successful. The quinine was used as a backup just to save them from this african form of malaria which come into cerebral malaria which can do in a day. Had brought that back to the u. S. Military and said, to the War Department, and said its not the drugs you need. Unitas multipronged approach. And they said we dont have time for you, we are training our troops in these pristine camps down in the south. We will talk to you later. And then came bataan. Macarthur strips were forced out of manila and down the peninsula and within a month whether quinine ran out, they started falling with malaria. 80 of malaria at the time of surrender. Commanders said we had rifles, bullets, tony of ammunition but nobody could lift their heads. Everyone was sick with malaria. We had no quinine. That woke up the War Department, and to open the spigot for this big plan. A lot of other scientists came together to argue for. While 10,000 marines landed on guadalcanal, the first meetings of his malaria project took place. They were recruiting top scientist in the field from many of these men had never learnt about malaria but they were needed for this project. This was the number one political priority of the War Department. And they started working on drugs as the marines on guadalcanal without the landscape or the waters pooled, the mosquito spread. They cant turn into mud holes. At one point a medical corpsman said to a battle commander, we have got to do something about all the mosquitoes that are breeding in this landscape because we will have terrible malaria. The commander said we are hill to we are here to kill jobs and to hell with mosquito. That was sent back to headquarters. Everybody in malaria knows but it was sent back to headquarters. That week the first cases of malaria landed in a field hospitals. By january of 1943 the infection rate on guadalcanal and on new guinea and on so many of the islands was 3000 infections from 1000 in per animal. So there were going to get three times in a year. So Zawahiri Barba said we dont have a drug it. The malaria project, the scientists are doing their best, screening drugs using burglar which to extrapolate the human malaria. They are doing toxicity tests on dogs which didnt translate very well for human toxicity test. They were fighting with each other. The War Department said stoppages make this drug atabrine work. So they did. And the American Drug companies started making it. They did not do it very well. We ended up overdosing our troops on the pacific and atlantic site. They were soiling the pants in the middle of battles because of uncontrolled diarrhea. They were vomiting. Some of them had psychological episodes because this is a neurotrophic drug and did affect certain people that we. So the men refused to take. So the War Department turn on its Propaganda Machine which happened to theodor geisel, dr. Seuss. Dr. Seuss drew cartoons. He made posters. A guys, the troops, these posters were so ubiquitous that the troops started calling the mosquito transit. They started to listen. They were the mosquito repellent and to protect themselves from these mosquitoes, that they wouldnt get this disease malaria. The War Department was encouraging to me to take atabrine. They have lowered the dose and to learn they could use it as a prophylactic. It wasnt great. It still make you sick. Clearly they thought sex would help get the message out. [laughter] they trained about 10,000 men in new orleans to form malariae units attached to comprehend. Comprehend. Instead of learning how to use rifles to learn how to use dipsticks so they could catch the larvae in water and study it. Once they were attached to the combat units they hired thousands of local men to clear the waterways. Running water kills larvae. Stagnant water produces mosquitoes. They sprayed tire tracks and dumps with kerosene to kill the larvae. They studied the problem in their tents. They had on the location. They would take blood from local people and figure out how they were and how large malaria problem theyre going to have. The doctors had to go to malaria schoolchildren the difference between the kind julie is used in his malaria therapy, the when you can control quite easily with quinine, and its not Deadly Forces the kind you get in africa which is quite deadly. They had to know the difference between dengue and malaria. They had to know the difference with a relapse. Macarthur even had to go to school. Everyone up the chain was educated about malaria was and how it worked. The army air command had to spray the flooded areas in italy after the germans retreated and destroyed all the pumps so that they could flood the landscape to produce skewed larva and slow the this army down with malaria. It was about this time in italy looked like this that the malaria project that dont have a major breakthrough. Again they have made almost 7000 compounds. Nothing had been produced that was worth anything. They were fighting, and they ended up with a report on the desk that been captured in tunisia. It was report that showed some results from studies that were done in the adobe villages of tunisia using this drug from behr. Behr was the most advanced and coming up with these potential synthetic quinines. The studies showed not only work as a prophylactic by the insecure and it was nearly 100 . So the malaria project finally have something to work with, but they just all other State Hospital patients because there were not than many State Hospital patients so they didnt have clinical material. Many of them just refer to the patients as clinical material, including James Shannon who would become the head of the nih. So they decided that they should go into prisons. That they could have plenty of men to do the research on in the prisons. So in goldwater Memorial Hospital would have been running malaria studies, this is what was walter island, Teddy Roosevelt island, a group of parasites the were captured and then coming home from the war, they drew them in goldwater memorial and manhattan State Hospital in boston psychopathic hospital, in milledgeville State Hospital in georgia, in the South Carolina State Hospital. The blood from them, of these different kinds of parasites that we need to build off were sent to this man. He ran the most successful project in figure out how to use this drug in statesville prison. He said i dont need to go into the State Hospital. I dont need to use those people at all. I have plenty of prisoners who volunteered to be part of a project. He grew his malaria in prisoners and detested his drugs on the prisoners at the infected with his malaria and even gives prisoners as technicians, among the most famous was nathan leopold. Leopold and loeb murder case, the crime of the century. In the foreground is clarence darrow. He saved the boat and loeb from hanging. These two boys were brilliant. They were from wealthy families and they picked up a neighbor of other mansions line the streets and killed just to see if they could get away with it because they thought they were so smart that they could come and they didnt. Globe was killed in a shower stall but leopold went on to be a ringleader in the prison and he was brilliant and he worked in the lab and helped turn this drug into after the work was used like aspirin in the tropics. Before the war, the approach to eliminating malaria was multipronged, longterm, hard. It costs money. It meant creating jobs, it meant putting screens announced after the war because with this drug and ddt which is another product that came out of the were, suddenly the policymakers and we can use these projects. Weve got these magic bullets. The World Health Organization use them in this global effort to eradicate malaria. In 1957 resistance developed against this, and the malaria parasites so it stopped working. By 1978 it had spread throughout africa. You can change the dates and replace the drug, and the same route would hold true. Every drug thats been made to fight mother has suffered the same fate. The last remaining drug that we have, in fact the only drug that we use that wasnt created during, or at least a parabolic it wasnt created during this wartime project, that is also going down the same route, resistance is developed in asia, and its spreading. The reason why i find this story so important and why i wanted to tell it is because it is constructive. I think we have these Global Health programs that focus on drugs. We need drugs. We need vaccines but we need to do the hard work. Thank you. I think ive gone over my time. [applause] thank you both so much for fantastic presentation. Ill just ask one question and then well open up for questions. So be ready with your questions. Your fine words that are, and that pink and green map of the shows the development of resistance almost as soon as the magic bullet is developed, and sonia, in your book you talk about the developer of resistance to multiple different kinds of pathogens. That is, the patterns these pathogens evolve with us and around us. Im wondering, its a political year, what would you recommend in terms of the paradigm shift necessary to move between the dominant paradigm of searching for a magic bullet in the context of the germ theory, to wading into the complex intersections of commerce and politics and war and the environment that actually lead to the emergence of these pathogens to their spread and to their success . How should we be thinking about that . I think thats a great question and i think theres a big sort of taliban in the room that we never get to the we talk about this problem, which is that if we aim our Public Health goals towards furthering biomedical interventions, that really does fails with economic interest. Theres powerful private interests that benefit from the of tales Drug Companies and others. Over talk about interventions that about social and political changes, they often are going to be in conflict with the same private interests. Weve already seen, and this is something ive been writing about, is how a lot of our Public Health agencies have become rlly beholden to some of these private interests and its partially because the event underfinanced for so long and where thi the sole method to publicprivate partnerships, which i think is generally a good idea. When we have companies telling the cdc how they should, too, earmarking money for the cdc as he looked into this and look into that and this is how we will sell more of our products so we will do for money away from things that will industry with her economic interest. And this is been happening. Cdc, w. H. O. Now gets twothirds or more of its budget from private donors. These are agencies that are getting their money from people who can buy control at our premiere Public Health institutions. So i think we really need to address that before we can even, of course we will always do the more industry friendly Public Health intervention so long as private interests are such a huge influence on our Public Health factors. I think we need to as a public reclaim debt. If you look at the 19th century, Sanitary Movement which they didnt know, they did have a clean water would make especially they had these ideas and none of it was true. Territories were all wrong but i thought for clean water and better housing and sanitation, you know, in the face of a lot of scientific uncertainty and they said this is what we need. We need to reform Public Health to protect yourself it doesnt matter if it disrupts commerce. We as the public are going to demand that. Does a social movement that did that. I feel like thats a big missing factor as the public we are very cynical and to send well, new disease, okay, lets do so many of the Drug Companies and get some scientist to come up with a magic bill or drug that will fix the problem. What we find it is its not going to be enough. I think its a matter of perception. We have a certain perception about how to handle anything that has to do with the disease, right . Im a swimmer and a half a shoulder thing going on, and its bugging me so went to the doctor. And the doctor said, you have bursitis and tendinitis and you should go get a cortisone shot. And i said, this is my first time to notice you, this is my first problem and you want to give me a cortisone shot. Then i went to see my acupuncturist and he said i just need to loosen your muscle and ago just to get some needles in your arm or a couple of weeks and you will not have to get that cortisone shot. But it was that medicalized, immediate solution to a problem that yes, you are going to take longer to get me back in the pool swimming, but its going to be longer, more permanent and i will not have any side effects. I feel like this is what we as consumers are fed in our personal lives. So when we take our perception to Global Health and to these matters of pandemics like ebola, we think the only thing that we can do is come up with a drug or a vaccine. When what we really need to do is think about poverty, we need to think about surveillance and we need to think about health systems. They all need to be in countries where they are nonexistent. They need to be built if theyre going to be protected from things across our borders we need to care about how well the Surveillance Systems are in these other countries. If we dont a percentage of the money that we spend on Global Health, much of it comes back to western labs and to scientists salaries. And instead, decide we should spend this on different ways of creating a better surveillance system. The products that are produced in those labs will last longer and they will work better. So our perception is off. The solution is always a medicalized one, and its exactly, the germ theory that is there. The germ theory, we came to understand germs as the devices that caused illness, and our First Response was to come up with ways to prevent those illnesses using first vaccines and then step out of chemistry labs. But its more than that. We need to take a broader view. Thank you very much. Id like to open up does someone have a microphone for questions . Okay. And im going to repeat the question in case anyone doesnt hear it. Hi. Thank you for the presentation. I have a question. I have noticed that every time there is an outbreak, whether its ebola or zika virus, this seems to be a fringe group with this conspiracy theorists. As somebody who is not seeking out those, i was amazed by the number that just popped up on my social media be. People say zika virus is caught by gmo mosquitoes or gmo crops, something else. So we have a public who is one, not even taking the threat seriously and claiming its a big conspiracy and saying, you know, any vaccine that might be prevented is out of the question for them, and even any preventative measures. So my question is what our Public Health organizations, ngos and governments doing to try to combat that . Even though this is a very fringe group with the power of the internet and things like that, these theories are spreading quite, well, almost like a virus. I think you are right. This is something i go into in a chapter of the book is why is it there so little trust of our Public Health authorities that when we even have good evidence that zika is being carried by mosquitoes, it originate in this place, its a virus. Have good evidence for all these things. Why is it then that are groups of people who very fervently believe otherwise and come up with these alternative theories . At i think our traditional response to say they are ignorant, not littered scientifically complex than the specific the same thing we do with people dont want to take vaccines. It down, backward, selfish, whatever. I think thats a realistic. What i look at in the book is what if we trace that back . Wedges that mistrust come from . It has come from something real, that people are distrustful of the corporate influence on medicine. They are distrustful of transgressions and western medical science. Its happened all over the world. Carriages talked about a great example. They are distrustful of chemical contaminants. Those all in my opinion real concerns. They need to be addressed in an honest way. So we cant just say dismissed these theories, these alternate theories as conspiracies coming from modeled minds. I think they come from somewhere real and i think they need to be addressed in a real way. I dont think we have done that yet. I agree. I think its the other side of the coin where probably a majority of people would assume that a medical response to a Health Problem is the most appropriate when perhaps its not. Theres a pushback on that because the pharmaceutical industries have so much influence on how we perceive things, theres pushback youre why should i trust you when your commercial interests are not in my in line with a personal interest was is exactly what she said. Out under iq as the extremes that are coming from a public that is too trusting i even as the extremes you were talking about basically i guess between the public and private interests, getting all mixed in. Im wondering if you find that, i know ag gag clause are usually based on what animals are treated but do you find that those same laws are hindering getting Accurate Information about how much waste is on these farms and how big, i think you call them lagoons, the manure lagoons are. Just look at the sight of thing from anil writes perspective ive never put it together with perhaps learning where these passages are coming from. Im not that familiar with the laws around disclosures about these things. These are estimates that other people put together that i am synthesizing in the book and in my research. And all of these areas theres a great deal of proprietary secrecy. Like my Research Methods is all but looking into the gray literature and digging around in unlikely places to find some of this data, then putting it together into a larger story. I think you had a question. [inaudible] often say that doctors are casually overprescribing, and im sure theres also the case, ive lived in the middle east for a long time and you can buy antibiotics. You can go to a drugstore and buy them come in many places. Of the gulf official in oman told me he said the problem problem sometimes is not what the doctor the doctor may do the right prescription. The patient, maybe he was come 800 miles to get there, gets a prescription, goes home and after three days feels better so throws away the rest come even though its a 10 day regimen. Or does it feel better afterwards them away, they dont work. So no matter what happens, it advances the bacterial resistance. I guess ill take that one as the physician up here. I think its a good observation. I think that questions about monitoring a prescription practices for human beings, and i think actually more important for animals, the tons and tons of antibiotics of actual use in animals i think are an even greater threat potentially to us. And we seem strong david in some European Countries which abandoned the prescription of an of alex as a growth enhancer for animals. I think access to and opprobrious of antibiotics is incredibly important in order to try to preserve those that we do have that still function against our most dangerous pathogens. First off, thank you for coming and its a very interesting topic. Kind of get to that original, that last question. Interesting, that specific issue of patient compliance or adherence is directly informed our approach to tuberculosis, for example, directly observed therapy is a world standard regarding a specific disease combating drug resistance. What i would ask you something i found interesting in the mosquitoborne illness. This new use of chemically modified mosquitoes or bacterial he infected mosquitoes, or to something i had not heard of it until just recently that if you talk about that as a new Disease Control approach. Spent we both really want to answer that question. Speed we were just talking before we came on because of the talk enough to entomologist. They come up with the Wonderful Technology and its Exciting Technology on how you can genetically modified the mosquito, a male mosquito, to prevent pregnancy in female mosquitoes. But they stopped there and then and what else extrapolates and starts talking about using these genetically modified mosquitoes to displace natural mosquitoes, excuse me, natural habitat the entomologist all races ahead and say, we didnt say you could do that. Thats actually pretty art and were pretty sure you cant go had this Technology Technology and we are still working with it. And i think its interesting that theres been so much press into these gmo mosquitoes are special with zika coming now. And yet its actually a very delicate thing to do, to disrupt transmission of these mosquito borne disease. You look at malaria or zika. You are looking at only female infected mosquitoes who are the problem. Thats a subset of the population. On top of which the mosquito have to bite one person can get infected, wait five to seven days before they are infected to another person. We really talk about the grandmother mosquitoes. Those of the what you need to kill. Geriatric mosquitoes spirit the old ladies, thats all you need to get. The whole way we are pushing Mosquito Control is a very blunt tool for a very delicate task. We dont need to kill all the mosquitoes. And, in fact, we dont even know how many come how much Mosquito Control you have to do, like we have to get down to 99 control in order to actually reduce transmission . Who knows, maybe those female grandmother mosquitoes are really resilient. We dont know their habits. Because were not spending it in an ecological way at all. I think theres a big push to use the latest technology, a really huge questions as to whether it will work. All the Mosquito Control that they been doing for dengue for years has not worked to diminish dengue. Strip mosquitoes are adaptable. In zambia, there was an effort to make sure that a set number of villages were using bed nets properly. So the a lot of Public Health, a lot of american Public Health experts living in these villages, working with the villagers. It was an intense effort to make sure these villages all used to bed thats probably. If you are a thing about, if youre not used properly, in many parts of africa and all kinds about outcomes have developed because of that. Especially jeffrey wrote and editorial and in your times about bed thats a joy to look at the. What they found was that window is almost 100 bed net coverage, the mosquitoes change their buying habits and a bit earlier. They find a way. They are adaptable. They are small and they can change their habits pretty quickly. So africas main malaria carrier is a rural mosquito, and as africa organizes, the our projections that suggests malaria will not be as large a problem because its a rural mosquito. Indias malaria terry is an urban mosquito. These mosquitoes will adapt. As africa organizes theres no reason to believe that it will not adapt and become an urban mosquito. The frustrating part of reading the news is seeing a simplistic representation of how these insects operate in nature. I know just enough to be dangerous, but i know that this is a lot harder said than done, as if it were easy, we would have done it, right with the our other plenty of other diseases they can do for zika that screamed for mosquito elimination. Its not really doable. What we can do is work on the conditions the People Living so that they are not exposed to mosquitoes. We know that works but thats too politically difficult so we dont do it would try to eliminate mosquitoes as a species. Last question. In addition to mosquito transmission, how many of the emerging viruses are sexually transmitted . The question was, how many of these emerging viruses are sexuallytransmitted in addition to transmission through vectors spirit i think zika is an interesting example but as far as i know its the only mosquitoborne virus that is also transmitted sexually. So that allowed it to spread beyond where the mosquitoes are automatically present. So i think thats going to be really interesting, Interesting Development and how that disease poster at first i know this feeling has been able to do that, that we know of. With reference to mosquito borne, of course you know people of also and theres an interesting project going on in south africa right now looking at the bible population of the prostate actually, and so ill be very interested to see because its a clever place for a virus to hide. So we may learn more. I think spent i had a question. Thank you. Essentially been fast and. Really, really fascinating, thank you. My question is we keep on running from running to one part of the world to another ebola, everybody works to work on people. Zika, everybody is in brazil. When you look at the world and you look at just we think we are going next, with our next run to the barn after the barn door is left open, what do you think is coming up . Well, thats what the book is about. [laughter] maybe i should just end it there. I think you are right, thats the milliondollar question. Like, can we track this back to the we can look at the drivers avoid these pathogens are coming rather than waiting until they erupt, waiting until we have exponentially growing outbreaks of untreatable disease and then scurrying to come up with drugs and vaccines to try to throw at it. I think thats been our model come and maybe that would work okay if we didnt have so many new pathogens emerging. But the way we live today, we do. I think were going to have to go backwards and we will have to look at access to health care in poor communities, restoring wildlife habitat, addressing the intensification of agriculture and livestock waste and all these things we know are drivers. So we dont know which pathogen will cause the next pandemic but we didnt know how it happens which the weekend predict where. Experts have come up with maps of hotspots of the pathogens are most likely to emerge. In those places, so we cant track every single microbe but in those places at least we can do active surveillance is he were other microbes changing, what are they getting the opportunities . Lets look, analyze and try to detect these things before they start to cause disease. I think that is a technological approach, but by doing that we will learn so much more about the underlying conditions that lead to these, but then we get this huge opportunity to address those. Thank you so much. Thank you all. [applause] id like to thank all of you for your attention. Please remember to fill out evaluations. I hope you enjoy the rest of the festival. Sonia and karen will be until 3 30 p. M. To answer additional questions and design books. Thank you. [inaudible conversations] hrsa look at some books that are being published this week
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