禽流感和明天的流行病 (Avian Flu and Tomorrow's Pandemics)

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Meyers I'm president of the National Press Foundation.
We are an independent, nonprofit organization devoted on Lee to professional development programs for journalists and awards for accomplishment.
We're not affiliated with any other organization.
We're delighted this morning to be co sponsoring this event with WGBH in conjunction with the important public television presentation on November 1st 2nd and third of Rx for survival.
A Global Health Challenge.
Public health is the health across populations, and it may be for journalists, one of the most important topics imaginable in our modern world.
Events take place around the globe, um, and they can't affect us immediately.
Here at home.
Some of these events are unpredictable, such as an earthquake or hurricane, others air chronic, like malaria or waterborne diseases.
All of them can be anticipated, responded to and described by journalists.
We plan and critically important role in informing individuals, governments and societies of what is happening elsewhere.
What can be done to prepare and how the response is going or not going or should be going.
Let me take this opportunity to welcome my colleague non dirty tree and offer her the opportunity to greet you as well.
Good morning, and welcome.
I'm not a jittery.
I'm here on behalf of our ex for survival.
Ah, Global Health Challenge.
This ambitious multimedia project is being co produced by the WGBH Nova Science Unit and Vulcan Productions, with major funding provided by the Bill and Melinda Gates Foundation and The More Company Foundation.
The narrative heart of this project is a six part PBS series that will air November 1st through third that combines up to the minute documentary stories with brief historical dramatic recreations toe help viewers understand the critical issues and breakthrough moments in global public health, and you will be seeing some of the highlights from the Siri's later on this morning.
Arcs for survival is also a major awareness initiative, with many partners ranging from media, health and humanitarian organizations to civic and educational groups.
We are very grateful today to Bob Myers and the National Press Foundation, and especially to all of you for participating in this conference.
In today's global society, the health of every human being can affect each of us.
An outbreak of infectious diseases is no more than a plane right away, and even those sitting in first class or at risk But before many of the natural disasters of this year, global health was a subject that did not appear very often on the media landscape.
Yet a 2000 and four national survey that we commissioned found that 53% of Americans had some concept of global health.
And perhaps most importantly, our research showed that by nearly 2 to 1, Americans reject the idea that the world's health problems are too big to solve.
So knowing this, we as journalists, filmmakers, educators and Web producers asked ourselves, How can we not cover this story with the death as well as the immediacy that it deserves?
But we wanted to do much more than have a PBS series on global health.
First, we wanted to be able to provide ah, high end form for a select group of journalists to discuss the opportunities and obstacles of global health reporting.
An earthquake in Asia takes 50,000 lives.
That's news.
While the everyday deaths of 30,000 Children is not news, it's quote the wallpaper unquote, as New York Times columnist Nicholas Kristof recently said.
But disasters or even potential pandemics like avian flu can put the spotlight on the need for global public health preparedness and signal the need for change.
Second, we also found that the producers had amassed thousands of facts and hundreds of personal stories.
And rather than let all of this knowledge sit in shelves and file of cabinets and buried in e mails and hard drives, we decided to commission a newsroom guide on Global Health to share with you our colleagues and journalism.
We're very pleased to offer you the first of these guides that are just delivered from the printer, and I think most of you picked him up outside.
Only an informed public can be expected to act responsibly, and we believe that by taking a more proactive journalistic stance, understanding that fresh and compelling stories are there if we make the commitment to find them, I hope today is the beginning of an even broader effort to improve global health coverage in the United States.
Thank you again for all participating in this conference.
Thank you, Nana.
We're going to have three panels today and we'll be hearing from some of the world's leading experts on our subjects.
Um, the first panel will look at avian flu and other potential pandemics.
The second will look a global health crises and child survival.
We'll have the brief preview of our experts survival that non dimension.
Then we will hear from a panel of journalists who have reported on global health crises around the world.
And here at home, National Press Foundation programs are always on the record and include plenty of time for questions and answers.
So people sitting there gonna work Justus hard as the people sitting here.
Um, there is in your packet and evaluation form in this attractive yellow format.
Please fill it out.
It is very important for us to know how this format and this kind of program worked for the purpose of educating journalists.
There's coffee in the back.
Lunch is going to be available.
Um, our first, uh, mentioned the evaluation form.
Our first panel is on avian flu in tomorrow's pendant pandemics.
Doctor Market.
Michael Osterholm is director of the Center for Infectious Disease Research and Policy, associate director of the Department of Homeland Security's National Center for Food Protection and Defense and professor in the School of Public Health at the University of Minnesota.
He is also a member of the Institute of Medicine of the National Academy of Sciences.
Dr.
Rex Archer is director of health for the city of Kansas City, Missouri, and president of the National Association of County and City Health Officials.
Dr.
Ola say G A Day is coordinator of public health programs at the World Bank, an adjunct professor at the Johns Hopkins Bloomberg School of Public Health.
Each of them will speak for five or 10 minutes on, then we'll go to Q and A.
I've offered the speaker is the opportunity to either speak here from the podium or from their seats as they choose?
Um, and we look forward to their remarks.
Dr.
Esther home.
Good morning.
Thank you, Bob.
I will speak from here, so I don't ignore this part of the audience over here that we can't see from the table.
First of all, I'd like to congratulate and really acknowledge the incredible effort that's been put forward to make this all happen.
Having had the good fortune of being involved with some of the planning around this which was almost believe 18 months ago, there has been a tremendous concerted effort to really lay out the issue of global health is unlike I've ever seen it done before in this type of format, and I think it will serve as a primer for all public health, government officials and the media as we go forward in terms of some of the issues before us now.
Today I have the dubious distinction or terrible challenge of trying to lay the context for global health as we sit here potentially on the cliff of a pandemic of avian influenza or that term avian influenza, which has now been going in the popular press.
This is a significant challenge because quite honestly, in my 30 years of public health, having been involved with many different issues, emerging from such things as toxic shock syndrome, HIV AIDS, emerging infections worldwide, antibiotic resistance, terrorism, et cetera, I was often asked in my career how did I sleep a night and to my embarrassment, had to say, Well, I'm sorry, but I do infect My family would suggest I have fallen asleep in the middle of giving directions.
I lay awake at night thinking about pandemic influenza.
It scares the hell out of me and so I don't want it to overshadow all the issues today, because there are many very important global health issues that are not related to pandemic influenza.
But you cannot ignore the gigantic dinosaur in our kitchen today.
It is there, and it truly is an overwhelming thought.
We make just a couple of points about pandemic influenza.
First of all, it is a lesson in public policy.
In 18 61 if Congress had marched down from the hill up here and gunned out of the White House, said the President Lincoln, you know, the Civil War stuff is just not something we really want to take part in.
Rather, we would really like to take the entire federal budget and get to the moon.
By the end of the 18 sixties, they could have done that.
They would never got into the moon.
The technology was not there to do it.
Rather, in 1961 when then newly elected president decided we're gonna get to the moon by the end of the decade.
But it's going to take an incredible effort.
It was done because the technology was there.
Today, we have within our miss the technology to handle many of the issues we're gonna talk about here today, but we've never made the commitment.
As a world.
We've never understood how to put that in the context of global health.
And so today, one of the challenges we have is not just talking about the problem, but talking about what we're gonna do to solve it and talking about missed opportunities.
I will tell you right now, for some of us who have been on the pandemic influenza bandwagon for decades, not weeks or months, we would have had the opportunity following our scare in 1976 to have put together the technology to have put together the commitment to not be we're at today.
We could have a global vaccine supply that would be available with new modern vaccines, unlike the slide ruler type vaccine and for the two or three in the room old enough to remember using slide rules in the 19 fifties.
Remember, with one slight exception.
That's the same vaccine technology we're using today to make influenza vaccine.
We also understand commitment as Andy Granite Telly, the famous STP race car driver First commercial used to say, You can pay me now or you'll pay me later.
And for many of these problems, We understand what it's like to pay later.
Look no further than New Orleans.
So today we're also here to talk about that if in fact we had committed 20 years ago or 30 years ago to the sinful wins this situation.
As I said, we wouldn't be here today.
The other issue I would raise with you is why his global health important if in fact we could.
And we can't and I'll just say it in a moment of re comment about that.
If we could find a vaccine that could be readily available to US citizens shortly after or coincident with the onset of the new influence of pandemic and we could protect all of us, the collateral damage to this country would be unimaginable anyway, because we live in a global just in time economy.
Today.
That depends on both the developed enveloping worlds.
Do you know where most your pharmaceutical products that are not related to influenza come from today?
Do you know how thin those supply chains are?
Do you know that we would lose many of the pharmaceutical products in this country?
Because in fact, those supply chains would collapse.
You know where your food supply comes from today.
Do you realize when global transportation shuts down, we would lose much of our food supply both domestically as it's growing here and moved or as it is brought in from foreign countries?
I could go through a long list of essential products, and service is that will collapse with the collapse of the global economy associate with a pandemic because of what I believe will be an inevitable closing the borders.
And that's even if we were fully protected.
So the idea of a global health today is not just a term.
It's not just all tourism.
It's not just the fact that we want it to be good citizens.
It's about being smart.
It's about being strategic, and I fear that we don't still get it.
Let me just say a couple words about pandemic influenza clothes, first of all, contrary to what you read in the media and right now that I fear we have a media on steroids, you have to go from crisis to crisis.
And in fact, everyone's wondered where this flu issue come from.
Why is it suddenly a major issue when in fact, yes, post.
Katrina led us to understand that we're not nearly as prepared as we thought we were.
Yes, there's some new publications that came out that gave us even more reason to believe that in 1918 like scenario could be replayed.
And yes, the president, after hearing in a number of briefings from his people with department health News Service, is This is a serious issue.
They all came together.
But folks is none of this is new.
None of this is anything that wasn't already there.
And as I said yesterday in a commentary that was written in ST Petersburg times, I worried desperately that if a pandemic of influenza doesn't occur in 6 to 8 weeks, maybe as long as a couple of months, which guys, I hope it doesn't happen that soon there will be tremendous blowback because they'll say You scared us needlessly.
Why did you say this?
Does knowing full well that there will be a pandemic of influenza?
I wrote a book that was published a 9 11 of 2000 1 year to the day before 9 11 called Living Tears.
In that book, I talked about the Al Qaeda in the World Trade Center towers and the whole risk of terrorism.
If you had asked me in that intervening year between 9 11 of 2009 11 2001 what's the chances the World Trade Center would have an attack like that?
I would have probably told you one in 10,000.
I don't know, but enough that you really have to take it seriously.
I will tell you today unequivocally the risk of another pandemic.
Influenza one.
It's a one.
There have been 10 pandemics in the last 300 years.
Influenza virus, which involves out of wild birds, ultimately goes for genetic changes periodically and then gets into the human population and causes a variety of different types of pandemics.
Those a severe is 1918 18 30 going a 15 30.
And those are milder, like the 1957 and 68 pandemics they occur unless someone today can stand here at this podium and say we now have a means to stop tsunamis, earthquakes and hurricanes.
They cannot say we won't have another pandemic.
The question is win.
Will it occur?
Where will it start in?
How bad will it be?
And many of us today are convinced that the culmination of events in Asia with age five in one and what's happening there is everything about the next pandemic.
And then the question answered, We can cover that.
And so today we have a number of critical issues before us.
You'll hear about any number of global health problems.
If I've left you with nothing else today, know that it's not always about the fact that we couldn't solve them.
It's that we don't sell them.
Second of all, global health is really critical to every little coffee shop, every gas station, every church, every school, every business, every hospital in this country.
It's not just a function of something on the other side of the border, and finally, we're in for some tough times ahead.
We will, I believe, rewrite our American history with pandemic influenza.
Those are strong words to say, and I wouldn't say him if I didn't honestly believe.
And today this format hopefully allows us to get a sense for just what that means and to understand what your role is.
The media will be in response for reporting.
I'll conclude with my motto has been and continues to be, and I hope that it is something that the media can embrace.
It's our job to scare people into their wits, not out of their wits.
And today I hope that we're able to accomplish Thank you very much.
Not Archer.
Good morning.
Tough act to follow.
But it is a sobering act.
If I was to start off by asking you a question, how many of you believe that we have the best illness care system in the world?
There might be a few hands that would go up, but then, if I asked you how many of you believe that we have the longest longevity of any nation in the world?
I would hope no hands would go up because we don't.
We're not in the top five.
We're not in the top 10.
We're not in the top 15.
We're not.
The top 20 will bounce around from year to year on the estimates down around 25th in the world.
Part of that is because our belief in the cure gets in the way of improving the quality of our life and living longer.
And so much of the focus and misdirection and expectations that have been going on.
I have to do with the concept.
We can cure anything and that we don't need to bother to prevent it anymore.
So I want to focus a little bit about the why I believe we're here today talking about this issue as doctor also homes Ulster, Holmes said.
After Katrina, it made us aware again, or I think we have an opportunity to relearn something that we've known, which is the pre deployment is critical, that you don't save lives in a disaster by waiting until the disaster is there and then try to respond.
So what is pre deployment in regards to a communicable disease outbreak?
Something like pandemic influenza?
Well, one of the important things obviously has to do with isolation and quarantine.
You don't do a very good job in this country with infection control in our hospitals.
Excellent article.
Few years back Chicago Tribune kind of pointed this out to everybody that we're losing more people every month that go into hospital, get an infectious disease they didn't have when they went into the hospital and die from that, then died in the Trade Center on 9 11 So if we don't tighten up those kinds of things in this country.
We're not going to be doing very well If you look at the challenge of SARS.
SARS was not very communicable.
It basically took poor infection control and hospitals for it to spread.
Pandemic influenza is likely to be many times more communicable.
Let's talk a little bit about quarantine because that's been raised recently.
In a sense, what I'd like for you to think about is that justice when somebody is selected for jury duty or if somebody has to go overseas with the commitment because they're in the reserves or military theirjob is protected while they're doing that service for the country or for the local community.
We need protection for people that are put into quarantine.
We need protection for people who don't have sick leave and are living paycheck to paycheck.
We have problems right now in this country without brakes, particularly food born related issues with food workers, where we don't get reported to us as quickly or as often as we should.
Because people are scared, they're scared that they might lose their job.
There's not protection there right now.
Daycare outbreaks or another good example.
If there's a child that second a day care and they have an infectious disease and we keep them out of that day, care for a period of time until they're well to come back, what is the parent do that has to stay home with them but doesn't have sick leave?
Sometimes they take him to another day care, so we need to look at this realistically second issue that was already mentioned is vaccine production capabilities.
It's a little late to be building the plants after it's here.
It takes a significant amount of time.
One of the things that we believe as a national organization, our National Association of Counting City Health Officials, is that if we set the goal for annual universal influenza vaccination for the entire population in this country and start doing everything we have to do to get there just as it was mentioned in getting to the moon, if we lay out all the things that need to be done to get the entire population to get a flu shot every year or as close as we believe, we can get to that if we try to set goals say 90%.
A lot of benefits from that one will be It will help to stabilize the demand for vaccine.
Uh, two.
You know, if if I was to stand here and say we're gonna be on the moon in a few years again and we had never been there before, we had never put an astronaut into space at all.
I might get question a little differently than if we had already done it.
This is the same issue here.
If we can't vaccinate 90% of our population in a few weeks each year, how are we going to do 99% when they want it?
Particularly if they may end up needing more than one shot even because it's a new enough organism that they need a booster in the last issue that I want to focus on has to do with trust and relationships in communities and how people go about their business, how they take the information they get from the media and then what they get from their social groups within their communities and how that all sorts out and leads them in the right way, with wrong way under various kinds.
of challenges or or panic situations.
If we look at the tale of two cities and some of you may have heard about this before, when there was a smallpox outbreak in New York City in 1949 I want to compare that to a smallpox outbreak that occurred in Milwaukee in 18 94 in Milwaukee.
When that outbreak occurred.
The authorities were very draconian.
They really came in hard gangbusters.
They did not have the relationships with their local communities.
They didn't understand the diversity.
They were not trusted, and they had riots over that situation.
The outbreak went on needlessly long.
Several 100 people died in New York City in 1949.
If you can imagine, people lined up for miles and didn't cut in line to get their shot.
You can see pictures of this people out in the streets, in the lines.
And that was accomplished because the public health department was strong, had great relationships with its community, went through a process of making sure that at the grassroots level at the same time that the media were reporting issues that they were reinforcing the messages.
Technology can go a long ways towards solving problems, but it doesn't do it without also people that have relationships and our trusted.
If you're on a community and you have an 18 year old National Guardsmen that's never had a course in biology or infectious diseases standing down the corner with a gun are you going to trust that person Maur, than a public health nurse that you've seen working in your community day in, day out on other health related issues?
And when they give you advice, we cannot be like having a military and just deciding to have planes or aircraft carriers.
But not having anybody thio run them.
That's the state of affairs.
We're in this country right now.
Thank you, Dr Olusoji A day.
Thanks.
Good morning, everyone.
And thanks for having me.
It's a tough act to follow Dr Foster home on Dr Artur.
So I would like to take off from where they left off on DDE to talk about just three items.
The first is what makes this global.
A second is is this uniquely bad?
And is there any benefit to be had from it on dhe thirties?
So what can be done?
We're making global is that in this day and age, there is no such thing as a protection off a vast ocean anymore.
Dr.
Austen.
Hamas told us that the risk of a pandemic off avian influenza is one.
So it's a question off when not, it's not a matter of if, in that scenario, even leave one country were able to hunker down even if one country were able to immunize all its residents effectively.
What about the knock on effect of a glow of the potential global economic meltdown?
Well, you keep me and not have imports from China off all those fancy Halloween costumes they wanna wear on dhe.
There are many other things that may not happen.
That is how it becomes.
Look alive.
Schools may close down.
Health workers in hospitals may be among the first to be affected on is a complete shutdown.
Now those who have a night for history may recall when Winston Churchill was defeated after the world war and he wasn't very happy.
I don't know many people who like losing elections, and, I recalled Due was had to grumble that this is really bad on, Mrs Churchill said.
Well, you know, this may be a blessing in disguise, at which point Winston, ever quick on his feet, said, If it's a blessing that is very well disguised indeed.
So maybe this is a blessing that is, these guys, and they're very, very, very, very terrible mask.
What does it all mean?
Let me take you outside his room because while a pandemic off avian influenza will be a uniquely bad or could be a uniquely bad event in world history, that's actually a lot of bad stuff going on out there as we speak.
It just happens that those who live in well their societies are removed from the day to day realities off millions for hundreds of millions of people in four countries with a middle income countries with a low income countries on.
As a result, that's a certain degree off insularity that has developed.
If we look at some of the data we have from the World Health Organization, and I'm not even into your secret here it's Holland is all in the public.
Every year, countries lose millions of Children too readily preventable, readily treatable diseases.
Respiratory infections are still their technology is still there.
Some of these made some very strange of those of us who lived in the comfort of very rich societies, where their realities daily realities for a number of people are underworld.
It's kill.
Some close to three million people in 2000 and three on malaria kills on one million Children in Africa every year.
These are daily realities for many people out there.
So what is the unifying factor in all of this?
There are some things that the market will not take care off.
There are some things that individual responsibility will not take care off.
There are profound markets videos, and there are profound policy failures on would delude ourselves if we think that because some societies are able to take care of these scotches that are referred to that, then we're protected.
We're not there.
Continue to be failures in public policy all over the world, and they're continually Market futures are all over the walls so that people cannot get access to basic vaccines.
For example, they cannot get access to basic medicines.
For example, what are some of these functions off the state setting policies for those things that individuals can reasonably be expected to take care of ensuring the epidemiologic surveillance gets done, that there are trained workers that they have the equipment required to do their work.
On that there are roads.
The communication facilities actually work so that it can be reported because without an effective surveillance system in public health, it's like an army fighting without any command and control facilities whatsoever.
This also relates to the never ending debate about the effect, even as our ineffectiveness or 48 well, it actually does work.
It depends on the context.
Depends on where.
For those of us who are members of the off the press, I recommend to you the publication and statue of millions Saved.
Published by the Centre for Global Development.
It contains a number off success stories like skill successes, international health success is actually possible.
It is not a story of doom and gloom.
So what does this mean for the future veins they need for transformational leadership, a compelling vision?
A vision is not enough.
I remember from my days in clinical practice that given psychiatric patients had visions, so vision alone is not enough.
So a compelling vision on a commitment for the long haul.
This is going to be a marathon.
Improving global health on the infrastructure for public health is a marathon.
It does not take the mindset of a sprinter.
It means putting off the money on this Austin busy so that these problems can be taken care off so that infrastructure for maintaining successes can be taken care off.
I continue to remember these very articulate, very eloquent person I meant in this was in Mozambique about a year ago on over a cup of coffee, he said.
You know, I'm really frustrated at the weigh in number of people agonized that success will not be sustainable when in fact they're only too happy by default to sustain a pattern of underperformance on the pattern of failures.
Thank you all of our programs of time for Q and A So I, uh, we have a microphone in the audience.
So please raise your hand and Phil Donahue will come and you'll be able to answer questions.
Hello.
I think this would be primarily for Dr Auster home, but perhaps others wouldn't know A swell um, you've been speaking about There's really two related questions.
You've been speaking about.
The fact that there's been 10 flu pandemics over time.
Um, number one.
What do we know about the relative risk that this will be a severe epidemic if and when it occurs versus the nuts of severe academic epidemic?
Like, you know, the 1968 or 1957 flu is certainly the last to have been not so severe.
And what's the basis for the rather precise sounding estimate that's floating everywhere that the next time there's an avian flu, 1/2 1,000,000 Americans will die in?
Two million will be hospitalized?
How can we be so precise about that?
And what What's the basis for that?
Thank you for that question because I think it's a good framework question to begin that whole discussion on even influenza.
First of all, let me just make it really, really clear that I know less about influenza today than I did 10 years ago.
I knew much more about it because, in a sense, there has been a lot of dogma that's arisen around many of these infectious diseases.
I was recently asked to do a review of the New England Journal of Medicine on are prepared to strip endemic in four winds of last spring and I went back to a the primary textbook of infectious diseases where there was a very wonderful chapter on and friends and I called the author and I said Now where did you come with this number of how many pandemics there have been over a certain period of time, he said.
Well, the previous author wrote chapter had that a nurse.
I just kept it.
So I called the previous author.
He says, Well, you know, I think I got it from this guy.
So I called this kinds I don't know.
I just kind of remember that number, and I kept tracing it back.
No one knew.
So John Berry, the historian who wrote the very wonderfully descriptive and painful to read book on the 1918 Pandemic, which I would urge you all to read, and I have been looking at this, and that's what I came for the number.
In fact, if you look back, there is a lot of wives tales you might say in this whole business of influenza.
So in fact, that's where the number came up is I literally went back to using historic records and other textbooks to come up with the number, which is different, by the way.
That's what the textbook and what I've come to realize is that we didn't know a lot about influenza.
Up until a year ago, I would have this debate with one of the premier influence ologists of the world, whose opinion is often been taken, his gold, where he adamantly said that every influenza pandemic occurs when a phenomenon owners reassortment occurs.
Reassortment is the process where influenza virus coming from wild birds and that is the reservoir for influenza viruses.
The term even into wins is really a bad term because they're many avian influenza is.
I mean, they're they're ones we deal with in the poultry distribute a h seven h nine other h is that air not age five in one, so the veterinary world gets real confused.
We call this the avian influenza because they have many.
But in terms of looking at this issue, what is happening?
The passes this virus comes out of that wild bird or world in.
Typically, we thought it went through domestic animals.
Pigs pigs actually have the unique ability to be infected by both the bird strains and human strains.
Human strains ultimately occur when that wild birds stream either changes enough genetically.
So now that it has a lock and key to get into the human lung cell with wild bird virus just does not infect humans well at all.
And it was used to think we used.
We thought that resort was only to do that.
Reassortment occurs when a wild bird virus and a human virus get into the same lung cell we thought in pigs.
And because it's viruses so promiscuous, it's so indiscreet, and it's so sloppy that it will exchange this genetic material readily with other influenza viruses.
And while Lou, 1/3 virus, comes out, which is the 57 68 experience that we know for a fact prior to that we didn't have virology well, he was insistent that that's only way of pandemic could begin.
And yet the 1918 data didn't support that is, you know, two weeks ago, some very important papers were published in science and Nature, in which the 1918 virus has now been reconstructed totally de novo, from just identifying the eight genes of the influenza virus from samples from dead people not growing the virus but literally reading the genetic material off of that and then turning around and recreating the virus.
So we now have a 1918 virus, and with that we're able to do additional studies, and it's been confirmed beyond a shadow of a doubt.
Now that the 1918 virus actually emerged directly from birds to humans, it didn't have this reassortment.
That's what we call re combination accumulative mutations that occurred.
And that's a very important point because, in fact, that's what's happening right now.
If they drive in one, we have no evidence of reassortment in the years that's been circulating.
But what's happened is we live in a world today where there are so many animals.
Asia Asia will remain the genetic roulette table for influenza virus.
I have no doubt about it.
So even though there are these invasions in Europe, Eurasian General, the primary focus is Asia.
Look at China.
In 1969 the last year we had a pandemic in China, there was about five million chickens.
Today there are 13 billion chickens in China because of the changes social, cultural, political and ownership issues, and those chickens are harvested every 18 weeks.
So in essence, is really three cycles a year.
I'II almost 45 billion birds or turn over every year in China.
That's the kind of place in Asia in general was going to see this, the question asked is, Well, what will this be like?
Well, the 57 in the 68 outbreaks were clearly re assortments where a bird virus, a human virus, got together.
And I think that we now recognise and I don't have I can't support this and say It's absolutely true and I'll make clear today when as those were re assortment and I think it dumb down the virus.
So those were milder pandemics.
The 1918 virus has all the makings today of being reproduced in the H five, n one in 1918.
And for those of you who want to get the right numbers because they're many numbers floating in the media right now, there was a very well done study by a group of historians several years ago published in the Journal of the Building A Medical History.
And it's the first reference in my New England Journal paper actually went that country by country by country and looked at immortality to the 1918 19 pandemic, and their estimate is at least 50 million died in more likely 100 million.
That, I think, is today.
The best estimate we have for 1918 and all the numbers you're getting here that you ask about are really just an extrapolation of either of the 57 68 outbreaks of the 1918.
The CDC model, which you recited earlier, basically eyes in terms of the numbers of deaths in the United States is a 68 pandemic, which was a very mild one today.
We think up to a 1,000,000 people a year die from flu anyway.
Regular flu.
So when W.
H.
O says it could be as bad as two million, I hate to say, you know, two million lives were still two million lives, but that's almost a yawner when you think of what it's doing already.
I mean, I don't know if any of you even write a story about it.
On the other hand, if you extrapolated the 1918 experience to today, that's 182 360 million deaths worldwide, based on the 1918 population, which was 1.75 billion today at 6.5 billion.
And you say well, but we have modern medical science.
We can spend time going that we don't have any better way to handle the kind of illness that this virus causes the site a kind storm phenomena where it's your own immune system that does you in.
In a three month period in Boston in 1918 which was duplicated many locations around the world, 5.7% of all the people between 20 to 40 years of age died.
That's a remarkable situation which we believe could occur today.
So to give you the numbers in this country.
And I believe I will foreshadow the HHS fairness plan, which we coming out soon, says that we have to pair up to 1.9 million deaths in this country for a 12 to 24 month period Associated flute, and I think that is a very fair upper bound of what we might see with the pandemic of influenza.
Other questions and comments, so do you refer.
So he referred to the success stories in 1,000,000 save, which is very happy making reading compared to what we're hearing now about a possible pandemic.
But most of those stories, I think so Ji would agree, are about long slogs to get to success about taking quite a few years, getting polio almost eradicated, eradicating smallpox, bringing a guinea worm under control.
None of these successes happened against something that could overwhelm the world in the space of a few weeks for months.
And I think that the comparison just reinforces what Dr ESTA Home was saying about if you need a long slog to be ready.
And he just started probably 10 years or more before the storm actually hits.
We've done this in some ways with knowing what might happen.
We don't seem to have done it with actually preparing for when it happens and hurricanes, to which he referred to a nice example.
We can now track hurricanes extremely well.
That doesn't mean that people get out of the way in time, and it certainly doesn't mean that we're protected against them all the damage they can do.
Is there any way that the three of you can think of to speed up that process, or are we condemned to a long slog.
It will start after the next wreckage.
Certainly the ability to shape public opinion and get the word out that something can be done can help that process.
I would argue that the 30 36 40 again, you can get different estimates each year on how many people are dying in this country from our annual influenza experience that we could put many things in place that would say many lives there that would also prepare us better for a pandemic situation.
As I said, if we look at our vaccine production capabilities and look at our distribution systems in this country that needs significant work, we could make a significant strides.
We need Thio reeducate our population on hand washing.
It's amazing how few people still wash their hands and even half of the appropriate situations or settings that they need to be doing that in.
And we need get back to some of those basics.
The in a sense, from a prepared the standpoint, I would say that we are at the best level of preparedness in a few areas, but there are many areas where I think we're actually losing some ground and overall over the last five years.
I think that we've been making some progress, but not at the rate that the risk is going up.
It's a little bit like if you're in the airport and you've got to get to your next connection and you start moving to the next connection and it's really tied up and you see an empty walkway, it's empty because it's turned off.
But you think, Well, I could go down that walkway so you're moving down that walkway rapidly and then the walkway starts up.
But it's moving towards you and you're half into now work even harder to try to make progress on.
If you're not moving faster than the walkways moving towards you, you're not gonna make progress and you may not get to your gate.
I think that the risk of when you look at all the news zoonotic diseases that air hitting when you look at the population rates, the animals, the risk of zoonotic diseases were not beefing up our for lack of a better way of saying at our interstate highway defense system, but calling it an interstate infectious disease defense system, which is what we really need to be doing.
When Eisenhower came back after World War Two, said, We need to build an interstate highway system.
We need to be able to move troops around in case wherever attacked.
There are a lot of other benefits that have been created from that highway system.
But if we waited until our soil was attacked, then decide to build the interstate highway system, we wouldn't get it done in time.
So it's that kind of initiative.
I think we need to look at.
Where can we get double winds?
Where can we be saving lives for things that we need to put in place that will also help us for pandemic?
Let me just ask a follow up question that you said that we're making progress in some areas and falling behind and others.
Can you briefly give us a couple of specifics in each category?
Yes, I think on areas where I think we're the best we've ever been is we've significantly improved our communication capabilities.
You know our ability to communicate with centers of disease control the blackberries that were almost slaves to in some place now, but their ability to communicate rapidly you know, I can have a situation where I could get noticed that I need to send something out to 1500 physicians in my community into all the emergency rooms.
And that could be over the weekend.
And I can call a staff member and they can send that out from home and we can get it into every emergency room with a warning flashing at a computer.
There we can get it to the physician's offices.
So many of our communications systems have improved dramatically and are the best they've ever been.
I also believe that we have connected in ways with various other resource is in our communities and our emergency operations centers much more effectively than we've ever done before.
Our lab capabilities are much stronger than they've been before.
We still have some places we can improve those, but we've made leaps and strives in our lab capabilities.
And probably though the most important thing that's improved is our public awareness that we are where we need to be.
And I think that is an opportunity that people are realizing that we still need thio make some improvements on the negative side in many areas because of local and state tight budgets.
I believe we have less disease.
Detectives, less epidemiologist, less people that could do contact tracing on dhe fall upon outbreaks now than we had a few years ago.
It's a little bit like the airport walkway scenario that we may have gotten some additional federal dollars for some of those positions, but we've been losing ground because of tight budgets at the local level.
So the actual capacity to manage and do contact tracing in some of our communities is not going where it should be going.
Certainly our vaccine production capabilities going the wrong direction.
And we really need to go back where we were decades ago, where you've probably heard the term of community policing that police departments have found that in many cases they need to be out in the community and identified in the community to have trust and to be able to make a difference on issues.
Well, that's where public health waas years ago and we need to reinvest in our public health system.
So some of you have heard me say this before that I think we need double centers of disease control, budget and we need to double the dollar's going down to local health departments for every program because not only can that improve whatever that program is targeted at, but we could be cross training and making sure that we've got the people on the street in the communities to improve our health so that we're not 25th fromthe world in life expectancy.
Thank you.
If I could respond, I think to your thoughtful question, you one of the things that we have a problem with today, as we live in a world of 24 hour news cycles and we live in a world in this country, it leaves two very different politics.
It's much more than politics of blood letting off, and then it is the politics of compromise, and that is an unfortunate reality we live in.
So anything we try to do is based on that issue.
Let me just give you an example.
Following the post Katrina events.
Obviously, Washington and the country as a whole was aghast at what happened, and they needed somebody to blame, and I'm not suggesting that it wasn't deserved, or that there was anything other than a miserable failure with the response to Katrina.
But Mike Brown became the focus of a sense of who's qualified to do this work over my and just by the way of by way of background, I served two Republican governors to Democratic governors, one independent wrestler when I was in Minnesota, and I have served in every Azad advisor, every administration since 1988 in our federal government and my own family can't tell you my partisan politics.
And so I want to make it clear of any comments I make cannot be perceived as partisan.
I came after 2001 to assist Secretary Thompson at his request, never having met the man before on the issue around terrorism, and I only requirement I had is that I would speak my mind the day that I couldn't I would leave, and I stayed with him in that group for two and 1/2 years, one of the most competent, one of the most amazing manners I've ever worked with.
One of the people that tried harder to get us ready for pandemic flu than anybody I've known.
A Stewart Simonson, assistant secretary, public health, prepared us.
He has problems.
He has to be a lawyer, and he has to be in a senior position.
And so this city has painted.
This man is incapable and confident because of the fact.
Like Mike Brown, he was a lawyer.
Well, if you use those criteria, thank God we didn't have President Lincoln around because he, too, was a lawyer.
And what I find really unfortunate in this town, we don't often really evaluate issues on the truth.
We evaluate issues on perception, and so men, and in this case, they're out there now calling for his resignation.
Yet it was Stewart Simonson, the right after 9 11 made HHS keep its eye on the ball on pandemic flu is a man who brought in in a numeral number of experts.
Bipartisan brought him in there there and has run one of the best shops anywhere in this town.
And because people don't get it in there out attacking him, and some of that you all in the media just as recently as yesterday.
We're doing that without knowing what you were talking about.
That's what I worry is the backdrop for our response to infectious diseases is we don't often get to talk about the real issues we have to talk about.
What is the perception or what is the political point of view at the time?
You know, I had the unfortunate and yet, I guess, interesting experience.
I was on Nightline a couple of weeks ago, right after the Senate had just passed this bill to for 3.9 more $1,000,000,000 for influenza.
And Senator Frist and Senator Reed came on and I was on there with him and they were self congratulatory about.
They're really gonna do this.
One of them even made the comment about, you know, this will help us get the, you know, bug to drug situation there and why I thought it was wonderful that they acknowledge this was an important issue.
We needed it.
I had to, you know, in my mid western understanding of the situation.
Say, But please, senators understand that amount of money is like trying to fill experience a garden hose relative to the size of this problem.
And somehow there was this perception that night that this three point 1,000,000,000 was gonna do it.
And so part of it is we need to have a much more honest discussion.
We need to have a much more intellectual discussion.
And I find that very hard to do in this town in a 24 hour news cycle.
And so I think that's one of the final piece I would just say here in response to your question is, you know, let's just be honest.
Also, about one thing everyone in this room is gonna die.
We're all gonna die unless you plan on your religious beliefs.
Very few people have gotten out of this world life, given that there always will be a tapped in causes of death.
If you eliminate the top, can there'll be 10 new ones?
I'm not so sure they're better than the first him.
So what our goal really needs to be is to figure out not just how we want to die, but how you want to live.
And to me, I would assume the long life relatively free of infirmity, of poverty, of mental distress would be an ideal way to go.
And obviously we're on a collision course, their destiny with world population, and that's got to be an issue we've got to confront.
But I can say with some certainty of all the diseases that we could eliminate that would affect early death would affect death of an untimely time of life, that our diseases of poverty, it's infectious diseases.
And I interesting enough.
They are the ones that in many cases we have the best tools.
If we committed to doing that, to postpone those.
And so I think from a global health standpoint, if you understand infectious diseases, you understand the life of many of the developing countries of this world.
So I want to make it clear that every group a cancer group, you know, ah cart disease group heart disease People in town this week could all have their own same meetings about how we're gonna eliminate all these diseases. 00:55:38.960