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tv   Book Discussion on The Next Pandemic  CSPAN  August 6, 2016 7:03am-8:01am EDT

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habitats, addressing intensification of agriculture and livestock waste and all these things we know our drivers, we don't know which pathogen will cause the next pandemic but we can predict where it is most likely to happen and emerging to these experts came up with maps of hotspots where pathogens are most likely to emerge. we can't track every single micro but in those places we can do active surveillance to see where are the microbes changing, where they getting new opportunities, let's analyze them and try to detect these things before they start to cause disease. that is a technological approach but by doing that we will learn so much more about the underlying conditions that lead to these that then we get this huge opportunity to address
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those. thank you all. [applause] >> i would like to thank all of you for your attention, fill out your evaluations and enjoy the rest of the festival, sonia shah and karen masterson will sign books. >> 48 hours of nonfiction book and doctors every weekend. here are some featured programs this weekend. wall street journal political columnist kimberly's trostle argues the left is utilizing tactics to usurp the political process in her book the intimidation game. >> government abuse is unsighted. there are a couple reasons for that. i care about free-speech and the first amendment. i libertarian when it comes to this. i have no allegiance to one
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party or the other. i have written about the abuses on the left in my column on the wall street journal but i assumed i would find stuff on the right too. i didn't. >> on sunday, in depth with jeffrey toobin, will take your calls, text and email questions at 3:00 pm eastern, mister toobin will discuss his latest book, the wild saga of the kidnapping, crimes and trial of patty hearst. mister toobin is also author of the oath, the obama white house and the supreme course, inside the secret world of the supreme court. too close to call, the 36 day battle to decide the 2000 election was a vast conspiracy, the real story of the sex scandal that nearly brought down a president. the run of his life, the people versus o.j. simpson and opening arguments, a young lawyer's first case, united states versus oliver north.
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joining the conversation with your phone calls and tweets beginning at noon eastern on c-span2. then at 7:00 eastern the impact of a hillary clinton presidency on america in his book hillary's america, the secret history of the democratic party. go to for the complete we can schedule. >> i am joann myers and on behalf of the carnegie council i think you for beginning your morning with us. we are delighted to welcome doctor ali khan to this program. ali khan will discuss his book "the next pandemic: on the front lines against humankind's gravest dangers". is former director of public health preparedness and response at the centers for disease control and prevention ali khan has been on the frontlines in the fight to contain the world's deadliest diseases but he is not the first to have done so. throughout history humans have been fighting diseases, waiting
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to be a never-ending wars against violence contagions. there has never been a time when humans were not affected with microbes that plot against them. during ali khan's time as a self-described disease protector our speaker has worked with viruses and infectious diseases and contagion. in 1995 he worked with red cross workers in zaire for the first ebola crisis. after 9/11 he was in washington to prevent the spread of anthrax and in 2003 he was called to hong kong to quarantine victims of sars but these are just some of the stories chronicles in "the next pandemic: on the front lines against humankind's gravest dangers". as a disease under his mission for two decades was to read the us government's efforts to prepare the public for disease outbreaks and health emergencies, he has seen it all. ali khan tells us rogue microbes will always be a problem but
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also writes that not all epidemics and pandemics are inevitable. most outbreaks can be mitigated if not prevented but the question is how and do we have enough resources. to help separate the hype from the facts, what diseases pose the greatest risk and how to prevent the next pandemic please join me on a public health journey to the four corners of the earth by welcoming ali khan to the carnegie council this morning, thank you for coming. [applause] >> thank you very much. good morning, everybody. put this over here. there we go. as you heard, i spent a career in the preparedness business and
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usually that meant for talks. over time it became getting ready just in time and at this point in my career in the real-time speaking process i make it up as i go along. one of the things i have been told when you speak to an audience -- there's nothing about my career that starts -- i promise sex, lots of sex. it will be mosquito sex but besides that lots of sex. i am delighted to share a bunch of stories with a broader audience, hunting down these diseases. you hear about this, all the popular press, from the perspective of someone who has been doing it every day with other public health practitioners and nice to give a
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talk, reading about zika or ebola or yellow fever going on in angola, it is interesting to start a discussion about emerging infections so let's start there, the idea of why is it always in the paper and we are always hearing about these types of diseases. our classical diseases, think about smallpox, measles, those all started around the agricultural revolution when people sort of came together because you needed enough people to spread disease from person-to-person and that is when i start my story of infectious diseases. for me that is when the world starts, some rodents carrying some version of smallpox were in somebody's home and that virus made the jump and started to cause smallpox in people, same for classic diseases. let me fast-forward you to the industrial revolution, germ
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theory, we realized they are due to infectious agent spreading from person-to-person. and a lot of enthusiasm around the beginning of the 20th century with the sanitation revolution, vaccines, antibiotics, we are done with this, all we have to do is pump shots into somebody's arm, give them a couple pills and they will be all better. if that were true we would not be having this conversation today right now. what is happening is even though we have taken care of a lot of classical problems we have continued emerging infectious diseases and there are a lot of factors that drive those diseases. some of the key factors are around microbes, collectively i think they are smart collectively and they evil, they have multiple generations a single day, humans, if we are lucky, a generation in 35 years
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before we can swap out our genetic material, microbes no problem at all, they swap genetic material all the time, smarter all the time which is why you read about drug-resistant microbes because that is what they do. they move around, find a good set of genes and go this will protect me from this set of antibiotics and you get your superbugs, microbes evolved, humans change their behaviors, until 100 years ago nobody had a kidney transplant, so we change and our risks to infections change. the other thing that happens is we change our environment, this is a big driver of emerging infectious disease. it should not be surprising when i talk about zika and ebola that very quickly the animal connection comes into play. with ebola it is bats which are
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the original cause, where the fire slips, it infects somebody and you spread the chain of transmission in humans, 75% of the diseases you hear about, new diseases, emerging diseases, if an animal connection, if you move people out into the environment, into the jungle they get infected and that disease has the potential to cause person-to-person transmission, as we see with bats and candles, that is how you get the disease so it is not a surprise when we think of emerging infections they come from africa or south america or part of southeast asia where you have a lot of connection with animals, bird flu is another example where you have people in china and parts of southeast asia, close to their birds and chickens, great opportunity for these viruses to swap their
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genes and that becomes a global pandemic so those are the environmental conditions that lead to these infections and why we keep hearing about them. a special call out to climate change as one of those environmental factors that lead to emerging infections. first, climate change is often changed as an economic issue or energy issue and over the last year we have done a better job reframing this as a public health issue of what is happening with climate currently. april was the hottest record on year, hottest year on record, 1880. people ask how do you know what was going on in 1880? believe it or not, if you are a farmer it is important to you what the temperature is, so there are excellent records about what temperature looks
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like at least for the last 150 years, the same with marine temperatures. you are doing your daily log, you would log water temperature. we have excellent records. as you pass through that historical documented record and look at other information that looks at temperature thousands, millions of years ago, april was the hottest year on record, the 12th hottest year in a row. it isn't a coincidence what is happening with climate. if you look at carbon dioxide, we should be 200 ppm, 238 ppm, since the industrial level we are at 400 ppm. the thought that by 2100 we will only increases to 1.5 ° is
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highly unlikely but let me tell this a different way. i was in business 20 years ago almost. this is a mosquito borne disease in africa, and that is your 401(k). if a mosquito borne virus comes around and your animals die, that is bad news so that is a biblical disease, moving out of sub-saharan africa to northern africa, it depends on climate and when the mosquito emerges and you have great, heavy periods followed by wet periods to cause this to happen.
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to protect your animal, this causes bad diseases, causes hemorrhagic favor, and the farmers don't have the money -- if you have some sort of tool every 5 to 10 to 15 years that this is a bad year, that would really benefit, people spend a lot of time trying to understand what happens and protect their animals. when we get into climate change issues understanding what the dynamics where. what became clear when we talk about climate change what is going to happen in 2100, what is happening today, if we look at diseases, the biggest disease in the united states caused by
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arthropods, is actually lyme disease, everyone in this audience in the northeast knows when live disease vectors are spreading, continuing to spread across the united states, we are seeing that today. there is a tropical fungus in vancouver causing infections of humans and animals in vancouver, it belongs in the tropics. we are getting infected oysters from the northwest. you don't pay attention to the good public -- i am an oyster on the gulf coast. one of the reasons what is in them, you try to protect yourself from infected oysters. that should not be a problem
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from the northwestern united states, should be nice cold water but outbreaks recorded from cold waters. contemporary examples of today with climate change, let me shift you from the us, and encephalitis, you take what you get us, your head hurts, it is called tickborne brain information. what we see in sweden this disease has been spreading over the last -- climate is one of
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those. little kids get infected, severe respiratory illness, and what we are seeing is those respiratory viruses in europe are becoming shorter and shoulder but. the seasons are becoming shorter. contemporary examples will get worse with heat waves, 128 °, and less people will die from cold but more will die from heat. from all the air pollution and the infectious disease, anything that has to do with mosquitoes and where things are climate plays a big role in those, waterborne illnesses are an issue with that as we get
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flooding, mental health illnesses, i want to give a shout out to climate change, one of the factors to think about emerging infections, the biggest factor, all of these are important, and more political, social factors. these diseases continue to emerge over the last 5 to 10 minutes. we play a role in keeping them from becoming epidemics. a good example would be the recent outbreak of ebola in west africa. we have known about ebola since 1976, we have known about the science of ebola since 1976. what happens?
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you get infected with ebola and if you are in the bush and you die, 95% of people die, maybe a family member or two will die but in the bush you are done. let's say you change the dynamic and go to a hospital, in a hospital that doesn't have infectious control, you essentially become a virus and the immune system doesn't kick in you are increasing the amount of virus every minute. when you have the most possible viruses when you die, you go to the hospital because you are sick and don't have more than when you die and give you 10 with lots of big numbers, billions that happen to be in the middle of your blood.
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somebody doesn't wash their hands, they are spreading ebola. hospitals have always served and we have known this for many years as a reservoir of how to spre within their community. someone sick at home, family member taking care of them. they die, and kiss the body and invite loved ones, one of the practices we saw is they would wash the body and use that water to allow little kids and other people to wash their hands to take on the attributes, this is not a good idea. that is the science. we know the science but the science isn't the issue.
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when this outbreak occurred, the outbreak of ebola, since 1976, many people have thought this is like what we see happening in east africa, they shut them down in a couple days to identify the case, they don't even need international teams anymore, the locals know what to do. they test everybody and follow everybody and these and -- this outbreak occurred in west africa which never occurred before, and it quickly spreads to urban areas, large metropolitan urban areas. more of the same, russians take care of everything and the outbreak will go away. that is not what happened. 11,000 deaths, everyone was a needless death, inadequate response, inadequate local
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response, but inadequate global response. politics and the public health system, a biggest role in whether there were a handful of cases, and essentially an academic across west africa, cases across the world. and one reason for that case was another factor, social political factor that played into infectious diseases that we didn't have in the 1800s. how many people i won't ask, have read around the world in 80 days and -- how quaint, 80 days to get around the world. for 22 years i wore a public health uniform. on my public health uniform was an anchor. i would get asked about the
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anchor, very much like a navy uniform. we started about 200 years ago providing care and one of the chores of the public health service we still have right now, essentially to fly quarantine flags when a ship came into port and someone with yellow fever or smallpox and if it takes 80 days to go from .8 rebecca did -- point b and you show up in new york city you would knew if you had smallpox a yellow fever because the incubation period, the time to get infected, to manifest your systems with shorter than the time it takes to go from point a 2 point b. you can to your mother's funeral, you fly to liberia, go to your mother's funeral, engage in the usual acts that you would around the funeral, you are kissing her and hugging her and the next day you get on a plane
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to new amsterdam, to new york city. you have 18, 24 hours, 48 hours incubation period, 5 to 7 days, three days after you show up in new york, i have a headache and a fever and not feeling well. show up at a hospital. if it is a hospital -- the number one diagnosis of malaria, and if it is not malaria and they miss this it is easy to see you get hospitalized for something, we saw this happen in texas, the same scenario, and a lot of time in places across the world, our healthcare system is not better than you see in toronto.
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and soul had an outbreak relative -- excellent healthcare system. not ready for this patients coming in. travel has played a big role in how these diseases emerge currently. and what we can try to do to make things better in the social political aspect, i did want to spend a couple minutes to talk about ethics matters. and who gets infected with hiv is often marginalized. as i started to write the book it dawned on me, every chapter
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you could pull out, emerging infection. this diseases due to rodents, in the southwestern united states, where the outbreak occurred was among native american this and some of you remember the outbreak occurred in the 1990s, a group of young navajo kids, a tour of the capital because you happen to come to the southwest and could be infected, and these kids were at risk and pose any risk to us but these affect marginalized populations and increase this, i talked about hiv and ebola, and marginalized populations in west africa. in today's day and age we are
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talking zika. the marginalized population are pregnant women in brazil, 1.1 million cases. and over 1500 women infected and their babies got congenital diseases, and they get small brains, other developmental disabilities including hearing loss. what we learn now is the cut is a laser guided missile for neurons. and it kills neuron cells and it is not just true in babies. when zika was first described we were told 20% of people get sick and get a fever and a headache, some red eyes and get better. very quickly it became clear
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this was a problem for pregnant women. even for adults a laserlike focus on neuron cells and neurologic elements, and even in the healthy person zika virus can cause brain inflammation covering, and this virus is a problem. this virus shouldn't be a problem. the virus is spread by a certain type of mosquito. the same mosquito spread yellow fever that causes 50,000 deaths a year, the same mosquito that spreads dengue. if we had this conversation 5
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years ago, and it is occurring in south america. think about 30,000, something like that, the same mosquito that causes another virus that was in the news three years ago, that doesn't seem to cause any deaths but because of the failure since the 70s to keep up with these efforts to kill mosquitoes, not paying attention to people dying from yellow fever or dengue all of a sudden we are up in arms that we have a disease to to a mosquito that is infecting pregnant women. this lack of action over the last 40 or 50 years against a known threat that put us in this current condition if you have been in south america, i heard yesterday that zika has not just move through the americas but it
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is knocking on the door of africa. think about the risk to pregnant women in africa. the head who who has done amazing work, has admitted a major policy failure over the last 40 years addressing this mosquito and broadened it to talk about major policy failure, protecting women, a big issue in brazil and other places where they don't have the same contraceptive rights you take for granted in the united states. why did it take all this time, people dying of dengue and yellow fever, all of the sudden we need to pay attention because we may in some cases in europe
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and north america of women who may have this disease. we will see zika in the united states was i will preempt that question, hopefully not a whole lot of cases. you gave me a lovely comment the other day. the ethics of a delayed response goes back to what you talk about here among your audience. think about marginalized populations why do we see these delayed responses? we are seeing it today. the last couple days this conversation, better terms than a conversation, let's protect the united states against zika. no one can decide whether they want to do it but how much they pay for it. the 1.9 or 1.1 the senate wants to give, some version, take a
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number but why are we having this conversation? we know what is going to happen, we also know that mosquito control in the united states is not a federal function or a state function but a city, county and district function, you need to get money to these people so they are doing what they should be doing which is illuminating mosquitoes and identifying cases. if you have the money to think about a long-term strategy to protect pregnant women do you have thoughts about funding vaccine development for long-term vaccine strategy and why we having this conversation 6 months later? why are we not already doing that? we are robbing peter to pay paul. my own program at cdc was responsible for keeping americans safe from health problems, pandemics or terrorism and as part of that program my passion was public health
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preparedness program which puts money into state and local health departments. we essentially pulled back the money to support activities and other cases. we had 1100 cases but why are we taking, my analogy is taking the bricks out of a foundation to build the second story of the building. if this is our preparedness infrastructure, why are we taking money out of that for something like the cut which we put money into the preparedness infrastructure, what i leave you with is a number. 6.7. in the last three years, the robert johnson foundation has done great work looking at how prepared the united states is for public health emergencies and every year gets better, 6.7 out of 10, that is just not good
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enough for us. as far as i am concerned the responsibility of government is to protect us against threats including public health and health threats and how we make sure, take politics out of policy decisions, not always about the science but need to be stripping more politics and what other health needs. [applause] >> you seem so calm, what keeps you up at night? >> i am calm because i decided 20 years ago that fear is not a public health strategy. it makes for great press, the sky is falling, but it is about education and good science. what keeps me up at night is what the next pandemic is likely
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to be. zika is a pandemic needless to say but not causing hundreds of thousands of deaths. what is likely to cause hundreds of thousands of deaths, we know from 1918, if we did a repeat of 1918, we get flu every year. my public health message is get vaccinated, we get flu every year and it changes a little bit, but unpredictably, the flu takes off its overcoat and you have no protection at all and repeat the same thing we saw in 1918, 7.5 million americans would die. think about body bags and how this would disrupt our society if we kill 7.5 million americans. flu keeps me up at night.
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and these health systems, one of my job in nebraska, the training center helps hospitals get better but we know the risk of healthcare in the united states so i worry about murders as another example. the third example is the next hiv-aids. nowadays you think of it in terms of sexual behaviors or iv drug abuse. it is one of those diseases that came from nonhuman primates probably multiple times and one time it was the right version that made its way into humans so i worry about another virus like that that spreads through sexual transmission or some other mode, a long incubation period before you get sick and when you discovered it has spread widely.
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and the next pandemic could have significant mortalities. >> i would like to open the floor to discussion. >> that was fascinating especially in the morning but we have to be concerned, you are the most experienced person, what is the cdc doing to educate people and control the diseases, on the other hand, you are in nebraska. what is the difference between control measures and agricultural state with relatively small population, washington or new york and urban areas, how can the us do more to
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prevent these outbreaks? >> thank you, excellent question. how we can do more start on multiple levels, you always tell people are more powerful than they think they are. let's start with something simple, a paper came out suggesting one third of all the antibiotics we are using, less than one third of antibiotics are unnecessary so has a patient's when you talk to your patient and talk to your doctor you are powerful to say do i need this antibiotic to work out for a couple days and if it doesn't get better i should take an antibiotic, you have that power, you walk into a healthcare facility and a doctor or nurse or respiratory
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technician says did you remember to wash your hands? you are powerful not to get that, you have the power in your community to think about personal preparedness, if a pandemic runs through your community, are you prepared personally for that, not just in terms of having a kid in your home and being ready but are your vaccines up to date? how many people at this stage have a physical phone number? the only number i memorize is my wife's number. if someone asks for a phone number i pull out the cell phone and if my cell phone dies, not so good in terms of numbers. am i part of a response team in the community? have i taken cpr course so if something bad happens i don't have to call 911, i can take care of something small myself or help somebody else. mi a blood donor? and things we should expect from our government is where we are powerful. tomorrow morning in new york
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city we decided to lay off. my guess, public safety is so important, the same thing is happening to your public health safety workforce in the united states which is not fully funded. no one is tarring and feathering anybody, how prepared your community is or your state. to demand the same from local representatives and national representatives but want a little less politics in what is happening in our health. why are there 30 million uninsured americans in the united states given the fact we passed the affordable care act? 19 states have not passed medicaid expansion. you are powerful and need to expect more and ask for more at every level including your own
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level. when i was at cdc i did a tongue-in-cheek thing about the zombie apocalypse to get people prepared for a natural disaster. they were not paying attention to the real natural disasters but mention zombies and everyone wants to know what to do. don't ask me. we took a popular meme and converted it but one thing i used it for, the one thing you can do with zombies is out run them so make sure you stay personally healthy so you cannot run those zombies. that changes whether i happen to be in nebraska, and agricultural state, or washington dc with greater risk of disease from international travel. and climate change, we are not coastal, if your coastal what is the implication going to be for
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flooded water supplies? thank you. >> long time new scientist reader. an opinion piece, only silent springs, ddt use continued another two or three years we wouldn't have malaria. you stressed mosquito control. i wonder what your take on that thesis is? >> we need to use every tool available to us. we were fortunate in the united states, cdc, one of the only federal agencies, always took me a while to figure out why that
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is, and there was a -- sending troops to be trained in the south. and men and women ready to be more. and they were eradicated in 1945-46. and on the texas border, in mexico, and it was due to screens and air-conditioning, and need to use every tool available, and it is about killing the adult mosquitoes. it is about source reduction which means sources of water out there, get rid of it.
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we need to be thinking about every tool that is available to us including ddt and others, the right tool for the right area, what are they not resistant to. >> thank you for this presentation. i wonder, the number of societies with prohibition against consumption of certain animals, the faith i grew up in fleas were forbidden. you made the connection that there is a lot of connection between these viruses that come from animals, i wonder if any studies have been done to show the consumption of animal protein is limited or not at all or the ability to resist these illnesses, ability to take antibiotics and have an effective if there is a
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connection between consumption and likelihood of continued ability to cook with the consequences of these illnesses. >> that is an excellent and extremely complex question. let me break it down into these two quick pieces. we know people with predominantly vegetarian diet do better. that is well-established at this point. let me get to beef and animal consumption. it has to do more with the close contact, think about it i say this all the time, and if you heat it to the right temperature there is no risk, you shouldn't eat burgers that are rare, the
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risk comes not from the consumption, you heat it to the right temperature but from daily interaction with these animals, the routine interaction even if you're not eating them you are milking them and if you're keeping them in your houses, the same thing with well cooked chicken burger or sliced chicken is not going to kill you but handling chickens that have chicken flu. >> thank you. >> wild cornell medical college, appreciate the clarity of your presentation and impressive work you are doing which one thing that came to mind is the delay and identification and response to ebola so my question is what does the cdc do to increase collaboration with countries, health departments, countries
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around the world to do something about early identification and then something may be about the world health organization in terms of whether it plays a part in this area. >> great question that goes back to the earlier question of what can you do, the us government has embraced the global health security agenda and so should we. that is a way to work internationally to make sure they have the right tools and systems in place for early diagnosis. a number of countries
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