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  • OK.

  • That was amazing, an incredible tour de force.

  • And really, as I said, nobody thinking

  • about how to protect our country and keep

  • it safe over the last 30 years than Tony Fauci--

  • so amazing way to begin.

  • What we're going to do next is I'm going

  • to bring the first panel up.

  • And we have a little video.

  • So let me line up the video while I ask

  • our first panelists to come up.

  • So if we could have Mike, Dennis, Hillary, and Mosoka

  • come on up, and join us.

  • And the first video--

  • so we had asked Larry Summers to come, and offer some remarks.

  • Larry is traveling.

  • For those of you who don't know, he's

  • the Eliot University Professor, a former president of Harvard,

  • former Treasury Secretary.

  • So then the question is, why Larry Summers?

  • He has been very deeply engaged in this,

  • and thinking about this, and cares a lot about this.

  • I was going say, I realize you guys

  • may not be able to see the video from sitting up there.

  • So it's up to you if you want to--

  • either way.

  • And so Larry was kind enough to record a video for us.

  • And it's about six minutes.

  • We're going to watch it.

  • And then I will introduce our panelists,

  • and we'll get started on our first panel.

  • [VIDEO PLAYBACK]

  • - I welcome the Harvard Global Health Initiative's review

  • of what happened a century ago with the flu pandemic

  • and its effort to look forward to mitigating the risks

  • and the consequences of future pandemics.

  • I am convinced that pandemic flu is the least focused on

  • of major global challenges.

  • Vast efforts and concern surround nuclear proliferation.

  • Vast efforts, appropriately, are directed to issues

  • around global climate change.

  • Taking the risks over time of pandemic,

  • I believe that the consequences are similar,

  • in terms of total economic impact,

  • in terms of lives lost, to the risks associated

  • with climate change and the risks associated

  • with nuclear proliferation.

  • And yet, pandemic risk is a obsession for specialists,

  • a preoccupation of those concerned with insurance

  • and reinsurance, but a much less-mainstream issue

  • than nuclear proliferation or global climate change.

  • And so, I believe that this initiative that reminds us

  • that more people died in the flu epidemic after World War I than

  • died as a consequence of World War I,

  • that reminds us of how profoundly society was changed

  • by a disease that took the strongest rather

  • than the weakest among us, those who

  • were young or of middle age, is something

  • that is very, very important.

  • We certainly have made immense progress

  • in the biomedical sciences over the last century.

  • And that is a positive development

  • with respect to pandemic risks.

  • On the other hand, we live in a much, much smaller and much,

  • much more interconnected world, which

  • means that disease vectors will be transmitted

  • that much more rapidly.

  • Full quarantines will be that much more difficult.

  • We live in a world that faces too much

  • superstition, propaganda--

  • dare I say it-- fake news, and confusion with respect

  • to vaccination, which has to be at the center of any effort

  • to control epidemics and pandemics.

  • And we live in a world where, too often, the preoccupation

  • is with the urgent rather than with the profoundly important.

  • And that diverts us, too, from preparing

  • for the next pandemic.

  • I believe that this is a central challenge

  • that deserves far more global attention than it is now

  • receiving.

  • And I am glad to see Harvard's Global Health Initiative do

  • its part to arouse concern, prompt study and reflection,

  • and drive preparation for the epidemics and pandemics that

  • are all too likely to come, albeit unpredictably,

  • at some point in the future.

  • [END PLAYBACK]

  • Great.

  • So as I said, most people in this room

  • have been thinking about and working on these issues.

  • But Larry Summers, who has thought broadly, has worked,

  • obviously, across a variety of sectors and is one

  • of the leading economists-- and I think, public intellectuals--

  • has glommed onto something that is really

  • a key issue, which is that this is not a specialized issue.

  • This is not a health care issue.

  • This is not an issue that specialists need to obsess on.

  • And the point he makes, that if you

  • think about the things that can cause catastrophic harm

  • to human society--

  • global climate change is more slow moving.

  • But if you think about things like a nuclear weapon going off

  • in a major city, terrorist threats,

  • we spend enormous amount of resources-- and rightly so--

  • on understanding those risks and mitigating those risks.

  • And then when we switch to something like pandemics,

  • it drops way down.

  • And we start thinking about, well,

  • do we really have the money to afford it?

  • Can we really make the investments?

  • So that's part of the challenge that we're dealing with.

  • And so our first panel for today is an extraordinary panel.

  • And I'm going to very quickly turn it over to them.

  • I'm going to do very quick introductions.

  • This is about understanding and mitigating risks.

  • And so the first panel--

  • for those of you who've been with us,

  • you've seen Mike Osterholm join us.

  • So thank you, again, for coming back, Mike.

  • He's the director of CIDRAP at the University of Minnesota.

  • And as I described him a couple of days

  • ago, when the country faces challenges

  • he's one on the shortlist of experts

  • we turn to, as he was after 2001.

  • Dennis Carroll, next to him, is the director of the USAID

  • Global Health Security and Development Unit

  • and has been deeply involved in these issues.

  • USAID-- when we talk about the importance of global health

  • security, we often talk about CDC,

  • and NIH, and the Global Health Security Agenda.

  • USAID has been a very central part of this.

  • And it's really been from Dennis' leadership.

  • Hillary Carter, next to him, is the director

  • for counterbiological threats at the National Security Council--

  • has been working on global issues--

  • not just global health issues, but global issues--

  • for quite a long time--

  • is a PhD from Georgetown.

  • And then next to her is Mosoka Fallah, whose official title

  • is deputy director of general and technical services

  • at the National Public Health Institute in Liberia.

  • What he really is--

  • he's been a close friend of the Institute for many years--

  • is one of the people who was central to turning around

  • the Ebola outbreak in Liberia.

  • And he did it through a combination

  • of both incredible intellect, but also personal integrity,

  • and trust, and working with the community quite directly

  • and has been a colleague, friend, and a hero of mine.

  • So I was thrilled to have Mosoka join us.

  • So why don't I turn it over to Mike.

  • I think everybody is just going to make some reflections--

  • up to you.

  • Do you want to come up here?

  • You tell me.

  • Why don't you come up?

  • I think people can see a little bit better if you're up there.

  • I'll sit.

  • And then we'll have a discussion.

  • Good morning, and thank you again for the invitation

  • to be here this week.

  • It has been really, truly a remarkable experience

  • over the course of the last four days.

  • And I just want to thank the organizers

  • for the vision to put this kind of a meeting on.

  • Let me begin by saying that I, as usual,

  • want to kind of send this meeting into a topsy-turvy

  • moment.

  • I would like to challenge the notion

  • of what we talk about when we talk

  • about pandemics and epidemics.

  • And there's a very real reason why.

  • It's not a semantic issue.

  • It's a actual response issue in a key way.

  • We often throw around the term pandemics and epidemics.

  • And we intermix them.

  • And I think that's at our own peril.

  • To my mind-- and I tried to discuss this in some length,

  • the justification and the background for it, in my book,

  • Deadliest Enemy, Our War Against Killer Germs, last year--

  • I believe that there really are only

  • two disease categories that rank in the category of pandemic.

  • Remember, a pandemic is a worldwide epidemic,

  • meaning every country, every region,

  • every continent has the chance to have the same problem happen

  • as does any other one.

  • Obviously, first and foremost is influenza.

  • Just to remind people-- and Tony showed a nice slide up here--

  • but our group went back and looked at this carefully.

  • And by the time that the first isolate of H1N1

  • was identified in California in April of 2009--

  • we now recognize that that virus was

  • in at least 27 countries for certain and maybe

  • as many as 43 countries.

  • It had moved that quickly around the world.

  • That's a pandemic.

  • The second category, I would say,

  • is an unusual one, in that it's not a disease in and of itself.

  • We are facing truly a pandemic of antimicrobial resistance,

  • which is a pan pandemic in the sense

  • that, on a worldwide basis, it's happening every day everywhere.

  • Some organisms may be more prominent in some areas

  • of the world.

  • But it's just a matter of time.

  • Beyond that, all these diseases we're talking about

  • are really what I call diseases of

  • critical regional importance.

  • Ebola is absolutely critical to Sub-Saharan Africa.

  • But will Ebola become a major disease problem

  • in the Americas?

  • No, not likely.

  • Now could we have cases--

  • as we talked about and I mentioned

  • in my previous presentation the other day--

  • that what kills us, versus what hurts us,

  • versus what concerns us, versus what scares

  • us can all be very different.

  • And we saw that with Ebola in the United States.

  • But from an impact statement that's very, very important

  • to distinguish.

  • Let me give you an example.

  • We live today in a global economy

  • that we are so dependent on others

  • out there to supply to us what we need every day.

  • As of this morning, pre-hospital drug shortages in this country,

  • meaning what's on the emergency room cart, what's

  • on the ambulance cart right now--

  • we have 189 drugs that are either absolutely not available

  • or in critical short supply.

  • Many of them are absolutely lifesaving drugs.

  • Why is that?

  • In part, because almost all of them are generic.

  • Almost all are made in China.

  • And the business model has been set up to cover the mode,

  • cover the mean.

  • Don't try to cover shortages, et cetera.

  • It's too much money to have that much [? pan ?] capacity.

  • If you wanted, today, to go to war with China--

  • and for anyone who's in the room from China,

  • I hope that never happens.

  • They wouldn't need to fire one bullet

  • to put their drug supply hands around our neck

  • and strangle us.

  • Our military is totally dependent on these same drug

  • shortage drugs that we, as the public, are dependent on.

  • When the situation happened with the poor Hurricane Maria

  • in Puerto Rico, everybody seemed so surprised

  • that we had this big shortage of IV bags all of the sudden.

  • I gave a talk four years ago in which I predicted the next F4

  • or F5 hurricane to hit Puerto Rico was going to take down

  • our ability to supply IV bags because 80% of the world's

  • capacity to make them were all on that island.

  • Should we have been surprised?

  • The reason I bring this up is because,

  • from a pandemic standpoint, those diseases which impact

  • those kinds of